title: Allgöwer-Donati Versus Vertical Mattress Suture Technique Impact on Perfusion in Ankle Fracture Surgery: A Randomized Clinical Trial Using Intraoperative Angiography.
abstract: OBJECTIVE
  The purpose of this study was to evaluate which primary wound closure technique for ankle fractures affords the most robust perfusion as measured by laser-assisted indocyanine green angiography: Allgöwer-Donati or vertical mattress.
  
  
  METHODS
  Prospective, randomized.
  
  
  METHODS
  Level 1 Academic Trauma Center.
  
  
  METHODS
  Thirty patients undergoing open reduction internal fixation for ankle fractures were prospectively randomized to Allgöwer-Donati (n = 15) or vertical mattress (n = 15) closure. Demographics were similar for both cohorts with respect to age, sex, body mass index, surgical timing, and OTA/AO fracture classification.
  
  
  METHODS
  Skin perfusion (mean incision perfusion and mean perfusion impairment) was quantified in fluorescence units with laser-assisted indocyanine green angiography along the lateral incision as well as anterior and posterior to the incision at 30 separate locations. Minimum follow-up was 3 months with a mean follow-up 4.7 months.
  
  
  RESULTS
  Allgöwer-Donati enabled superior perfusion compared with the vertical mattress suture technique. Mean incision perfusion for Allgöwer-Donati was 51 (SD = 13) and for vertical mattress was 28 (SD = 10, P < 0.0001). Mean perfusion impairment was less in the Allgöwer-Donati cohort (12.8, SD = 9) compared with that in the vertical mattress cohort (23.4, SD = 14; P = 0.03). One patient in each cohort experienced a wound complication.
  
  
  CONCLUSIONS
  The Allgöwer-Donati suture technique offers improved incision perfusion compared with vertical mattress closure after open reduction internal fixation of ankle fractures. Theoretically, this may enhance soft tissue healing and decrease the risk of wound complications. Surgeons may take this into consideration when deciding closure techniques for ankle fractures.
  
  
  METHODS
  Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Shannon
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Houdek
authors.forename: Cody C
authors.initials: CC
authors.lastname: Wyles
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Yuan
authors.forename: William W
authors.initials: WW
authors.lastname: Cross
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Cass
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Sems
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D064386:Ankle Fractures / Q000503:physiopathology* / Q000601:surgery*; D000843:Ankle Joint / Q000098:blood supply / Q000000981:diagnostic imaging; D001783:Blood Flow Velocity; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000098:blood supply / Q000503:physiopathology*; D025321:Surgery, Computer-Assisted / Q000379:methods; D013536:Suture Techniques; D058106:Wound Closure Techniques; D055815:Young Adult