Delayed wound healing after forefoot surgery in patients with rheumatoid arthritis.
OBJECTIVE
To elucidate the systemic and local risk factors and the effect of surgical procedures for delayed wound healing after forefoot surgery in patients with rheumatoid arthritis (RA).


METHODS
Fifty forefoot surgeries were performed in 39 patients using resection arthroplasty or a joint-preserving procedure (25 feet for each procedure). The associations between the occurrence of delayed wound healing and clinical variables, radiological assessment, or surgical procedures were analyzed.


RESULTS
Delayed wound healing was recorded in nine feet of eight patients. The duration of RA was significantly longer in the delayed healing group than that in the healed group. Age, sex, smoking history, concomitant diabetes, and RA medication did not differ between the groups. Radiological evaluation showed significant differences between groups in metatarsophalangeal dorsal flexion angle. The shortened length of the fourth and the fifth metatarsal bones affected the occurrence of the complication. The joint-preserving procedure had significantly less delayed wound healing compared with resection arthroplasty.


CONCLUSIONS
Preoperative dorsoplantar deformity and perioperative tissue damage can cause delayed wound healing after forefoot surgery in RA patients.
Department of Orthopadeic Surgery, Kyoto University Graduate School of Medicine , Sakyo, Kyoto , Japan.
Shinichiro
S
Ishie
Hiromu
H
Ito
Masayuki
M
Azukizawa
Moritoshi
M
Furu
Masahiro
M
Ishikawa
Hiroko
H
Ogino
Yosuke
Y
Hamamoto
Shuichi
S
Matsuda
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000503:physiopathology* / Q000601:surgery; D001174:Arthrodesis; D001178:Arthroplasty; D005260:Female; D005530:Foot Deformities / Q000503:physiopathology / Q000601:surgery*; D005545:Forefoot, Human / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*
Delayed wound healing; Forefoot surgery; Operative complication; Rheumatoid arthritis