Anterior Incision Offloading for Primary and Revision Total Ankle Replacement: A Comparative Analysis of Two Techniques

Andrew D. Elliott, Thomas S. Roukis*
Gundersen Health System, Orthopaedic Center, La Crosse, WI, USA

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© 2017 Elliott and Roukis.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Gundersen Health System, Orthopaedic Center, 1900 South Avenue, La Crosse, WI, 54601-5467, USA; Tel: (608) 775-9673; Fax: (608) 775-6707; E-mail:



There exists a high risk of post-operative complications with primary and revision total ankle replacement surgery. Delayed wound healing of the anterior incision is common. The reason for this is multi-factorial and, to date, most of the research has focused on predisposing factors involving the patients themselves. Only recently have researchers begun to look at the post-operative dressing as a possible consideration when trying to prevent incision wound healing complications. Currently, no standard post-operative dressing for primary or revision total ankle replacement exists. However, the principles of post-operative edema reduction to improve healing, as advocated by Sir Robert Jones and demonstrated in his compressive dressing, have been known for decades. We have been using a modified Sir Robert Jones compressive dressing for both primary and revision total ankle replacements. Recently, we have added an aperture pad made of cotton cast padding over the anterior incision in order to protect the area from pressure necrosis.


This is a comparison study of the post-operative wound complications involving 35 patients that received the original dressing and 33 patients that received the addition of the aperture pad.


With no significant difference in the patient populations, the results demonstrate a 3-fold decrease in the number of anterior incision wound healing complications with the use of the aperture pad.


This dressing represents a simple, reproducible, easy to apply and inexpensive way to prevent post-operative edema and anterior incision wound healing complications.

Keywords: Anterior Incision Site, Delayed Wound Healing, Offloading, Post-Operative Complication, Sir Robert Jones Compression Dressing, Total Ankle Arthroplasty.