title: Reduction in Wound Complications After Total Ankle Arthroplasty Using a Compression Wrap Protocol.
abstract: BACKGROUND
  The purpose of this study was to evaluate the clinical differences in wound complications after total ankle arthroplasty (TAA) between a cohort of patients that received a compression wrap protocol and a historical control group treated with cast immobilization.
  
  
  METHODS
  Patient charts and postoperative wound pictures were reviewed for 42 patients who underwent a compression wrap protocol and 50 patients who underwent circumferential casting after primary TAA from 2008 to 2013. A blinded reviewer graded each wound using a novel postoperative wound classification system, and recorded whether the wound was completely healed by or after 3 months. A second blinded review was performed to determine intraobserver reliability. Mean patient age was 55 years (range, 24-80) and all patients had at least 6-month follow-up.
  
  
  RESULTS
  There were significantly more total wound complications (P = .02) and mild wound complications (P = .02) in the casted group compared to the compression wrap group. There were no significant differences in the number of moderate and severe complications between each group. A significantly higher proportion of TAA incisions took longer than 3 months to heal in the casted group (P = .02).
  
  
  CONCLUSIONS
  Based on our clinical experience with postoperative wound care after TAA, use of a compression wrap protocol was safe and effective at reducing wound-related complications, and well tolerated by patients. Further prospective, randomized clinical trials are warranted to evaluate the utility and cost-effectiveness of a compression wrap protocol after TAA.
authors.affiliation: Department of Orthopedic Surgery and Rehabilitation, University of Chicago Medical Center, Chicago, IL, USA o.schipper@gmail.com.
authors.forename: Oliver N
authors.initials: ON
authors.lastname: Schipper
authors.affiliation: OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Hsu
authors.affiliation: Illinois Bone and Joint Institute, LLC, Glenview, IL, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Haddad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058737:Arthroplasty, Replacement, Ankle; D002370:Casts, Surgical; D058128:Compression Bandages; D003646:Debridement / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D065386:Historically Controlled Study; D006801:Humans; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications; D013524:Surgical Flaps / Q000706:statistics & numerical data; D007507:Therapeutic Irrigation / Q000706:statistics & numerical data; D014945:Wound Healing; D055815:Young Adult
keywords: ankle replacement; anterior incision; cellulitis; compression dressings; necrosis; wound dehiscence