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Higher rate of infection seen with increased tourniquet time for TAR

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Dan H. Boack

KEYSTONE, Colo. — The tourniquet time has a direct bearing on the wound complication rate in total ankle replacement, according to a presentation at the 2011 Annual Meeting of the American Orthopaedic Foot and Ankle Society.

“The tourniquet time has an influence on the evaluated wound complication rate in [total ankle replacement] TAR,” Dan H. Boack, MD, who presented the study, said. “Therefore, it is recommended to minimize the tourniquet time, especially less than 30 minutes.”

Boack studied the impact of the tourniquet on wound healing in a clinical, prospective study. He assessed 414 patients with ankle arthritis who underwent TAR between 2003 and 2009. The patients were allocated into one of the following groups based on tourniquet time:

• group A with 0 minutes;
• group B with 1 minute to 29 minutes; and
• group C with 30 minutes or longer of tourniquet time.

Patients were clinically evaluated perioperatively and postoperatively at up to 12 weeks. The follow-up rate was 100%.

The cumulative rate of wound edge necrosis was 2.9%. Boack treated five patients with two flaps, one patient had a mesh graft and two underwent local revisions.

“Seven patients were treated conservatively with longer immobilization and local wound treatment,” Boack said.

There were no differences among the groups regarding the frequency of risk factors, according to Boack. Risk factors included smoking status, global operating time, age, body mass index, additional procedures and concomitant medical conditions.

There was no significant difference between the patients in groups A and B regarding complications. However, Boack discovered that patients in Group C — who had 30 minutes or more of tourniquet time — had 5.1% increased rate of complications.

Reference:

• Boack DH. Does the tourniquet time influence the complication rate of TAR? Paper #90. Presented at the 2011 Annual Meeting of the American Orthopaedic Foot and Ankle Society. July 13-16. Keystone, Colo. Dan H. Boack, MD, can be reached at Foot and Ankle Center Berlin, Kieler Strasse 1, Berlin D-12163, Germany.
• Disclosure: Boack has no disclosures.

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