Posterior crural fasciotomy is more effective at reducing post-operative surgical site infection rates than inserted vacuum suction drainage in open Achilles tendon repair surgery, according to a new study.
Reducing Infection Risk for Achilles Open Repair
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Secondary#achillesopenrepair#posteriorcruralfasciotomy
The study, “The Efficacy of Posterior Fasciotomy Versus Inserted Vacuum Drainage in Reducing Post-operative Surgical Site Infection in Open Achilles Tendon Repair: A Prospective Cohort Study with Inverse Probability Treatment Weight Propensity Score Analysis,” was published online on June 30, 2022 in The Journal of Foot & Ankle Surgery.
Traditional open surgical repair offers excellent functional outcomes, and when performed with proper technique and layered closure, the risk of infection is small.
This new study compares post-operative surgical site-infection rates for patients who’ve been treated with a posterior crural fasciotomy, but without vacuum suction drainage and patients who’ve had the same treatment, but with vacuum suction drainage.
The prospective, single-centered study was designed and conducted at a tertiary referral hospital between January 2017 and January 2020. The surgeries themselves were performed by one of two surgeons.
The research team set the primary outcome to be measured as surgical site-infection rate. They also, as secondary outcomes, collected Achilles Tendon Total Rupture Score, Functional Foot Index, and Visual Analogue Scale.
The research team enrolled 60 patients who were split between the two groups. Of the 60 patients, 2 in the posterior crural fasciotomy group and 5 in the vacuum suction drainage group experienced post-operative surgical site-infection (crude RR: 0.40 (95% CI 0.08, 1.90); p = 0.228).
Using an Inverse-Probability-Treatment-Weighted Propensity Score Analysis, the researchers found that the posterior crural fasciotomy group had a lower surgical site-infection rate than the vacuum suction drainage group (adjusted RR 0.30(95% CI 0.01, 0.91); p = 0.033).
The team also found that the Inverse-Probability-Treatment-Weighted Propensity Score Analysis of Achilles Tendon Total Rupture Score along with crude analysis of total Functional Foot Index and Visual Analogue Scale were also significantly better in the posterior crural fasciotomy group than the inserted vacuum drainage group (p < 0.05).
In conclusion, the researchers found evidence that Achilles repair was associated with a significant reduction in post-operative surgical-site-infection rate compared to vacuum suction drainage group, according to all the data.
Study authors included Pissanu Reingrittha, M.D., Krianokamol Beniawongsathien, M.D., and Surawit Visuthisakchai, M.D., all of Buddhachinaraj Hospital in Phitsanulok, Thailand.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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