title: Wound complications with posterior midline and posterior medial leg incisions: a systematic review.
abstract: There is no consensus on the optimal incisional approach at the posterior leg to avoid wound healing complications. The purpose of this systematic review is to report and compare complication rates associated with two common incisions used to approach the Achilles tendon in order to provide additional recommendations for optimal incision placement.
  
  
  METHODS
  Four electronic databases were searched using keywords for procedures using posterior leg incisions. A total of 8724 studies were analyzed and subjected to inclusion and exclusion criteria. Once inclusion criteria were met, each article was placed in 1 of 2 groups based on incision placement: midline (group 1) or posterior medial (group 2). Study format, patient demographics, surgical indication and other details, and wound complications were recorded. The data obtained was reviewed for trends between the two groups.
  
  
  RESULTS
  38 articles met the inclusion criteria. Seven articles used the midline approach (group 1) whereas 31 articles used the posterior medial incision (group 2). The 38 articles included 1287 patients, of whom 25.6% were female with an average age of 43.9 years. Group 1 included 142 patients and group 2 had 1145 patients. The total wound complication rate among all reports was determined to be 8.2%, with 7.0% and 8.3% between groups 1 and 2, respectively.
  
  
  CONCLUSIONS
  Although incision placement may influence wound healing complications, it appears that additional factors such as advanced age, delay in surgical intervention, gender, comorbid conditions, prior surgery, and postoperative protocols also play a role. This report suggests that a midline approach is no less precarious in avoidance of wound complications regardless of patient demographics or other surgical details in comparison with a posterior medial incision.
  
  
  METHODS
  Therapeutic, Level IV.
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Highlander
authors.forename: Robert M
authors.initials: RM
authors.lastname: Greenhagen
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000367:Age Factors; D015897:Comorbidity; D006801:Humans; D007866:Leg / Q000601:surgery*; D011182:Postoperative Care; D012737:Sex Factors; D013530:Surgical Wound Infection / Q000209:etiology*; D014945:Wound Healing