SLR - April 2012 - Brian Freeman
Reference: Highlander, P., & Greenhagen, R. M. (2011). Wound complications with posterior midline and posterior medial leg incisions: A systematic review. Foot & Ankle Specialist, 4(6), 361-369.
Scientific Literature Review
Reviewed by: Brian Freeman, DPM
Residency Program: Kaiser Permanente/Cleveland Clinic Foundation
Podiatric Relevance:
The optimal incisional approach to the posterior leg by which to avoid wound healing complications has long been debated. The purpose of this systematic review was to report and compare complication rates associated with a posterior midline incision versus a posterior medial incision.
Methods:
A total of 8724 studies were analyzed, with 38 meeting the inclusion criteria: peer-reviewed and a linear longitudinal incisional approach to the posterior leg. Once inclusion criteria were met, each article was placed in one of two groups based on incision placement: posterior midline or posterior medial. Study format, patient demographics, surgical indication, wound complications, and other details were recorded. The data obtained was reviewed for trends between the two groups.
Results:
Of the articles reviewed, 7 used the midline approach, whereas 31 articles used the posterior medial incision. The 38 articles included 1287 patients (25.6% were female) with an average age of 43.9 years. Midline approach included 142 patients and posterior medial approach had 1145 patients. The wound complication rate among reports was determined to be 8.2 percent overall, with 7.0 percent (midline) and 8.3 percent (posterior medial) between the two groups (not statistically significant).
Conclusions:
Although there were interesting conclusions drawn from this study, it had limitations in terms of the heterogeneity of articles included. Most were retrospective (30 of 38), and the surgical indications for the approach were very different between the two groups. The study concluded that there is not a significant difference in the number of complications between the two incisional approaches and that other factors such as age, delay in surgical intervention, gender, comorbid conditions, prior surgery, and postoperative protocols played a more significant role in the development of complications. One point not discussed by the article was the number of superficial versus deep wound infections as a percentage of the total number of complication, with 20 percent (superficial) and 40 percent (deep) for the midline group and 46.3 percent and 8.4 percent, respectively, for the posterior medial group.