Impact of surgical procedures on soft tissue microcirculation in calcaneal fractures: A prospective longitudinal cohort study

Injury. 2019 Dec;50(12):2332-2338. doi: 10.1016/j.injury.2019.10.004. Epub 2019 Oct 4.

Abstract

Purpose: Wound healing complications are a major concern after open reduction and internal fixation (ORIF) in patients with calcaneal fractures. Microcirculation is known to play a key role in bone and soft tissue healing. The present study aimed to characterize and contrast the dynamics of changes in microcirculation comparing two different surgical procedures: A) ORIF and B) a minimally invasive approach (MIA).

Methods: Blood flow (BF[AU]), oxygen saturation (sO2[%]) and relative amount of haemoglobin (rHb[AU]) were measured at two depths (2 mm and 8 mm) non-invasively by spectrophotometry (Micro-Lightguide O2C®, LEA Medizintechnik, Giessen, Germany) before surgery and every 24 h after surgery for a duration of six days. A linear mixed model (LMM) was used to analyse longitudinal data and repeated measurements.

Results: Nineteen patients (44 years, range 21.9-71.0 years) were enrolled in the study. Surgical treatment consisted of ORIF (n = =15) and MIA (n = =9). The postoperative BF and sO2 at the 2 mm and 8 mm depths were higher in the ORIF group (BF: p < 0.001, p = =0.003; sO2: p = =0.001, p = =0.011). The BF at the 2 mm and 8 mm depths increased after surgery (2 mm: p = =0.003, 8 mm: p = =0.001) in both groups. This increase did not correlate with the surgical technique. sO2 and rHb values at the 8 mm depth decreased after surgery (sO2: p = =0.008, rHb: p < 0.001) in both groups, whereas sO2 at the 2 mm depth increased after surgery (p = =0.003). Furthermore, the surgical technique correlated with the postsurgical course of sO2 values at the 2 mm depth (p = =0.042).

Conclusions: The spectrophotometry results were in line with the generally accepted phases of soft tissue wound healing. Postsurgical changes in microcirculation are predominantly independent of surgical techniques and may be primarily determined by wound and fracture healing. Future studies should focus on the potential of spectrophotometry to monitor wound healing after surgery. Moreover, studies with longer observation periods are needed in order to examine the changes in microcirculation during all wound-healing phases.

Keywords: Calcaneal fracture; Doppler/white light spectroscopy; Extended lateral approach; Microcirculation; Minimalinvasive treatment; O2C®.

MeSH terms

  • Adult
  • Calcaneus* / diagnostic imaging
  • Calcaneus* / injuries
  • Calcaneus* / surgery
  • Female
  • Foot* / blood supply
  • Foot* / surgery
  • Fracture Fixation, Internal* / adverse effects
  • Fracture Fixation, Internal* / methods
  • Fractures, Bone* / diagnosis
  • Fractures, Bone* / surgery
  • Humans
  • Male
  • Microcirculation*
  • Open Fracture Reduction* / adverse effects
  • Open Fracture Reduction* / methods
  • Outcome Assessment, Health Care
  • Oxygen Consumption
  • Perioperative Care / methods
  • Regional Blood Flow
  • Spectrophotometry / methods*
  • Wound Healing / physiology*