Foot & Ankle International - 2017 FAI Supplement - 12S

Effects of Cryopreserved Amniotic
Membrane Allograft on Total Ankle
Arthroplasty Wound Healing
Thomas Bemenderfer, MD, MBA, Robert
Anderson, MD, Susan Odum, PhD, W. Hodges
Davis, MD
Category: Ankle, Ankle Arthritis, Basic Sciences/Biologics
Keywords: Total ankle arthroplasty, orthobiologics, regenerative adjuncts, ankle arthritis, wound complications
Introduction/Purpose: Despite improvements in newer-generation total ankle arthroplasty (TAA) implants, relatively high
wound-healing complication rates continue to be reported with
the anterior ankle incision. Only 66% heal without woundhealing complications, 25% have minor complications requiring local care and/or oral antibiotics, and 9% experience major
complications requiring reoperation (Raikin et al., 2010).
Recently, multiple regenerative adjuncts have been investigated to reduce postoperative complications by enhancing
local healing factors and reducing risk of infection. The relatively novel use of adjunctive therapy utilizing cryopreserved
amniotic membrane modulate wound healing by down-regulating inflammation and scar formation (Hanselman et al.,
2015). The purpose of our study is to determine whether the
local application of cryopreserved amniotic membrane wound
allograft may enhance soft tissue wound healing of the TAA
anterior ankle incision.
Methods: Patients with symptomatic ankle arthritis who
failed conservative management underwent TAA by two
senior foot and ankle surgeons at single tertiary hospital.
Both senior surgeons were present and involved in all surgeries, and all patients underwent the same procedure as
indicated by their pathology, postoperative regimen, and
rehabilitation protocol. At skin closure, patients were either
allocated to the treatment or control group strictly by the
designated primary attending. The skin closure of the treatment group was performed in standard fashion with local
application of cryopreserved amniotic membrane to the
extensor retinacular layer and no allograft was used for the
control group. Demographics, sagittal and coronal correction, and patient comorbidity information was collected.
The primary outcome was time to skin healing as determined by suture removal and surgical site skin apposition
without evidence of granulation tissue or eschar. Secondary
outcomes were skin dehiscence, local wound care, and use
of antibiotics.
Results: Local application of amniotic membrane allograft
significantly decreased overall time to skin healing (40 days
to 28.5 days, p=0.0377). There were no reoperations for
wound complications in either group. However, there was a
12S

trend in decreased dehiscence (13% to 6%, p=0.29) and antibiotic prescription (23% to 9%, p=0.09). There was no significant difference in treatment versus control group with
respect to body mass index, sagittal or coronal correction,
sex, history of smoking, prior arthrodesis, or primary or revision. There was a significantly higher percentage of patients
with history of diabetes who received amniotic membrane
than those who did not receive the adjunct therapy (20% versus 2%, p=0.01).
Conclusion: Regenerative technology using local application of cryopreserved amniotic membrane allograft may
enhance TAA outcomes by decreasing time to healing.
Although there was a trend in decreased dehiscence and antibiotic usage, larger randomized controlled trials are necessary to determine whether local application of cryopreserved
amniotic membrane allograft may enhance soft tissue wound
healing and ultimately reduce the incidence of devastating
soft tissue complications.
Foot & Ankle International, 38(S1)
DOI: 10.1177/1071100717S00008
©The Author(s) 2017

2017 IFFAS Award for Excellence
Winner:
Two-year PROMs in Total Ankle
Replacement for Osteoarthritis
Following Pilon Fracture: Are
They Comparable to Those for
Other Indications for Total Ankle
Replacement?
Adam Bennett, BSc (Hons), MBBCh,
MRCS, Malik Siddique, DO, Jayasree Ramas
Ramaskandhan, MD
Category: Ankle Arthritis
Keywords: Total ankle replacement, osteoarthritis, pilon
fracture
Introduction/Purpose: Pilon fractures of the distal tibia are
high energy injuries often occurring in a young patient cohort.
Despite optimal acute fracture management, post traumatic
osteoarthritis of the tibiotalar joint is a common corollary.
Standard treatment is by way of tibiotalar arthrodesis, however the lack of motion at the ankle afforded by this treatment
is often poorly tolerated by patients and can lead to arthrosis
of adjacent joints. Total ankle replacement (TAR) offers an
attractive pain relieving and motion preserving option for this
Foot & Ankle International 38(1S)



Table of Contents for the Digital Edition of Foot & Ankle International - 2017 FAI Supplement

TOC 1
TOC 2
TOC 3
TOC Page 4 + Verso
Editorial Board
President's Introduction
AOFAS Annual Meeting Abstracts 2017
AOFAS Annual Meeting Abstracts 2017
Foot & Ankle International - 2017 FAI Supplement - CT1
Foot & Ankle International - 2017 FAI Supplement - CT2
Foot & Ankle International - 2017 FAI Supplement - Cover1
Foot & Ankle International - 2017 FAI Supplement - Cover2
Foot & Ankle International - 2017 FAI Supplement - i
Foot & Ankle International - 2017 FAI Supplement - TOC 1
Foot & Ankle International - 2017 FAI Supplement - iii
Foot & Ankle International - 2017 FAI Supplement - TOC 2
Foot & Ankle International - 2017 FAI Supplement - 1A
Foot & Ankle International - 2017 FAI Supplement - 1B
Foot & Ankle International - 2017 FAI Supplement - v
Foot & Ankle International - 2017 FAI Supplement - TOC 3
Foot & Ankle International - 2017 FAI Supplement - vii
Foot & Ankle International - 2017 FAI Supplement - TOC Page 4 + Verso
Foot & Ankle International - 2017 FAI Supplement - Editorial Board
Foot & Ankle International - 2017 FAI Supplement - x
Foot & Ankle International - 2017 FAI Supplement - President's Introduction
Foot & Ankle International - 2017 FAI Supplement - AOFAS Annual Meeting Abstracts 2017
Foot & Ankle International - 2017 FAI Supplement - 3S
Foot & Ankle International - 2017 FAI Supplement - 4S
Foot & Ankle International - 2017 FAI Supplement - 5S
Foot & Ankle International - 2017 FAI Supplement - 6S
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Foot & Ankle International - 2017 FAI Supplement - 45S
Foot & Ankle International - 2017 FAI Supplement - 46S
Foot & Ankle International - 2017 FAI Supplement - AOFAS Annual Meeting Abstracts 2017
Foot & Ankle International - 2017 FAI Supplement - 48S
Foot & Ankle International - 2017 FAI Supplement - 49S
Foot & Ankle International - 2017 FAI Supplement - 50S
Foot & Ankle International - 2017 FAI Supplement - 51S
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Foot & Ankle International - 2017 FAI Supplement - Cover3
Foot & Ankle International - 2017 FAI Supplement - Cover4
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