TISSUE OXYGEN PERFUSION AROUND THE ANKLE JOINT IN SMOKERS AND NON-SMOKERS

Abstract

A high incidence of complications with wound healing in calcaneum fractures treated with open reduction and internal fixation (25 – 33% of cases) has been reported. In one study 80% of those who had wound complications required surgical treatment of these. Two recent studies have shown that the risk factors for wound complications in this injury are single layered closure, high BMI, extended time between injury and surgery, diabetes, open fractures and smoking. In our unit, out of a small sample of 56 patients undergoing calcaneal fracture fixation, all those who developed wound complications were smokers.

Transcutaneous oximetry is a technique that has been used routinely to assess oxygen perfusion in neonates and also sometimes in peripheral vascular disease (PVD). It has seen greater use as a research tool in PVD and orthopaedic surgery, being used to look at oxygenation around wounds to assess different surgical approaches. This study was performed to assess whether a difference in the oxygen perfusion around the ankle joint could be measured in smokers and non-smokers. A transcutaneous oximetry probe was used to assess the tissue oxygen perfusion at the ankle (posterior to lateral malleolus where the incision line would be) and on the chest (just to the side of the sternum). A standardised technique was used for each patient.

Patients were chosen who had no lower limb orthopaedic problem or known PVD. The groups were matched in terms of sex and average age. The data was analysed after logarithmic transformation using a two-tailed Students t-test. The average pO2 chest/foot ratio was higher in the non-smokers than smokers but this was not significant (p=0.704). The average ankle pO2 was higher in the non-smokers and this was shown to be significant (p=0.026).

Although a small sample, these data suggest that tissue oxygenation around the ankle may be significantly lower in smokers. This would help to explain why they are at increased risk of wound healing complications. This work also demonstrates that transcutaneous oximetry can be a useful tool in orthopaedic research. Tissue oxygenation around other joints could also be assessed in relation to position to discover the optimum position for wound healing.