Can Preoperative Skin Perfusion Predict Wound Healing Complications in High-Risk Peri-Articular Tibial Fracture Fixation
Abstract
Tibial plateau and plafond fractures are associated with a significant risk of postoperative wound healing complications following open surgical fixation. This increased risk is believed to be related to the initial trauma and a subsequent perfusion deficit in the surrounding soft tissue envelope. In order to reduce post-operative wound healing complications, patients frequently receive a two-surgery staged fixation protocol to allow soft tissue recovery from the time of injury to their final operative fixation. Ideally, only patients with the highest risk of wound complications would receive the staged fixation protocol; however, the absence of a reliable assessment of the soft tissue injury has led to the vast majority of these injuries being definitively treated in a delayed fashion. This additional soft tissue healing time is at the expense of a second surgery, a more challenging open reduction, a prolonged hospitalization, and delayed rehabilitation. Laser-assisted Indocyanine Green Angiography (LA-ICGA) is a novel method to reliably measure tissue perfusion. This method involves an intravenous injection of a Food and Drug Administration (FDA)-approved dye followed by real-time visualization of skin perfusion. A pilot study conducted at our center demonstrated that it is feasible to perform pre-operative LA-ICGA in orthopaedic trauma patients, and tibial plafond fractures are associated with a measurable a skin perfusion deficit. We propose a prospective observational study that will enroll 160 patients with closed peri-articular tibial fractures requiring surgical fixation to assess whether preoperative skin perfusion predicts subsequent postoperative wound complications. The overarching objective is to determine whether LA-ICGA can be used to guide the optimal timing for operative management of these high-energy, complex injuries, thus reducing the risk of wound healing complications and the need for multiple surgeries. Ultimately, this study takes essential steps toward the development of LA-ICGA as a prognostic tool that surgeons can use to objectively guide their surgical decision making, specifically relating to the use of delayed fixation and optimal timing of definitive open fixation. The overarching goal is to minimize infection while safely expediting patient recovery and rehabilitation. This aligns with the Fiscal Year 2019 Clinical Translational Research Award Focus Area: Retention on Duty Strategies.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010652
Entities
People
- Raymond Pensy
Organizations
- United States Army
- University of Maryland, Baltimore