Running versus interrupted allgower suture technique in ankle fracture surgery: a randomised controlled trial assessing peri-incisional perfusion using intra-operative angiography in 26 ankle fracture patients

INTRODUCTION: The Allgower‐Donati suture technique has been widely recommended for wound closure for at‐risk wounds. This technique maintains peri‐incisional microcirculation, thereby decreasing soft tissue morbidity, but is a time consuming suture to apply. The purpose of this study is to compare the peri‐incisional perfusion and perfusion impairment between the conventional Interrupted Allgower‐Donati (IAD) technique and a modified Running Allgower‐Donati(RAD) technique in ankle fracture surgery. MATERIAL AND METHODS: This study is an IRB approved, prospective, randomized controlled clinical trial. Between 2017‐2018, 26 healthy patients with ankle fractures (AO/OTA 44‐A, B or C), were prospective randomized into two groups; (1) 13 patients in RAD group and (2) 13 patients in IAD group. Skin perfusion was assessed immediately after wound closure with laserassisted indocyanine green angiography (ICG‐A). Mean incision perfusion and mean perfusion impairment were measured and compared with analysis of variance (ANOVA). All patients were followed for a minimum of 3 months after surgery to assess for wound complications. RESULTS: The RAD technique demonstrated a statistically significantly shorter closure time compared to IAD technique (375±76second vs 440±84second, p<0.05). No difference was found regarding postoperative wound complications, and intraoperative mean incision perfusion and mean perfusion impairment (p>0.05). CONCLUSION: With the exception of significant shorter wound closure time for the RAD suture, both techniques showed comparable results in healthy patients. Increased power analysis and use in non‐healthy patients, may show additional differences between techniques. Further investigation is warranted.