Allgower-Donati Versus Vertical Mattress Suture Technique Impact on Perfusion in Ankle Fracture Surgery: A Randomized Clinical Trial Using Intraoperative Angiography

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: Allgower-Donati or vertical mattress. Design: Prospective, randomized. Setting: Level 1 Academic Trauma Center. Patients/Participants: Thirty patients undergoing open reduction internal fixation for ankle fractures were prospectively randomized to Allgower-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. Main Outcome Measurements: 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: Allgower-Donati enabled superior perfusion compared with the vertical mattress suture technique. Mean incision perfusion for Allgower- Donati was 51 (SD = 13) and for vertical mattress was 28 (SD = 10, P, < 0.0001). Mean perfusion impairment was less in the Allgower-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 Allgower-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.