A Retrospective Review of Soft-Tissue Complications in Total Talus Replacement and Total Ankle Replacement Using the Orthoplastic Anteromedial Approach

The anterior approach to the ankle addresses many pathologies. The orthoplastic anteromedial incisional approach to the ankle courses between the anterior tibial and posterior tibial angiosomes. There are various modalities that can be used in evaluating the integrity of these angiosomes before surgical intervention. A retrospective review of 23 patients using the anteromedial ankle approach in either total talus replacement or total ankle replacement was performed from January 1, 2016, through August 31, 2021. Surgical intervention occurred from January 29, 2016, through January 10, 2019, and follow-up was through August 2021. Patients were evaluated based on medical history, postoperative week of suture or staple removal, incision complications, and time at which full weightbearing began. Smoking history was also documented. Eighteen patients healed uneventfully, and some of these patients had a smoking history, a history of type 2 diabetes mellitus, or both. A preoperative evaluation of vascular supply is necessary to determine the healing potential of this approach. Atraumatic handling of the soft-tissue envelope is imperative to aid in wound healing and optimize the postoperative course. The orthoplastic anteromedial ankle incisional approach is a possible alternative option for an anterior ankle incision if adequate vascular status is determined to be present before surgical intervention.