Incidence and Risk Factors for Flap Coverage After Total Ankle Arthroplasty

Foot Ankle Int. 2021 Jun;42(6):744-749. doi: 10.1177/1071100720982901. Epub 2021 Feb 1.


Background: Wound complications following total ankle arthroplasty (TAA) can have a significant impact on patient morbidity, particularly when they require flap coverage. We sought to determine the risk factors associated with the need for flap coverage after TAA and hypothesized that medical and operative risk factors such as diabetes and additional procedures would be associated with the need for flap coverage after TAA.

Methods: We performed a single-center retrospective review of TAAs from April 2007 to February 2019. Patient demographics and medical comorbidities were collected, in addition to other procedures performed at the time of TAA. Patients were stratified by the need for flap coverage, and unadjusted inferential statistics were performed to evaluate the risk factors associated with subsequent need for flap coverage.

Results: Among 2065 patients undergoing TAA, 28 (1.4%) patients required flap coverage after the index arthroplasty. Patients requiring flap coverage were older (P = .045), had higher Charlson comorbidity indices (P = .017), and had higher rates of diabetes and pulmonary disease (P = .038). Patients requiring flap coverage also had higher rates of additional procedures (P = .043, P = .007). The most common flap was a radial forearm free flap, which was performed in 14 (50%) patients. Twenty-one patients (75%) requiring flap coverage had a stable, plantigrade foot at median 1.5-year follow-up.

Conclusion: Patient and operative risk factors, including advanced age, increased comorbidity burden, diabetes, pulmonary disease, and increased number of simultaneous procedures, were significantly associated with need for subsequent flap coverage. This should be considered as the indications for TAA expand.

Level of evidence: Level III, retrospective, prognostic cohort study.

Keywords: flap; total ankle arthroplasty; wound breakdown.

MeSH terms

  • Ankle* / surgery
  • Arthroplasty, Replacement, Ankle* / adverse effects
  • Cohort Studies
  • Humans
  • Incidence
  • Retrospective Studies
  • Risk Factors