Postoperative Wound Complications after Foot and Ankle Surgery with and without Topical Vancomycin: A Retrospective Cohort Study

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: Wound complications, whether superficial or deep, can be challenging to manage after orthopaedic foot and ankle surgery. Intra-operative application of topical vancomycin powder within surgical wounds has shown promise in reducing surgical site infections (SSI) among patients with diabetes, lower extremity trauma, and following spine surgery. However, there are few studies with large patient populations that examine its use in orthopaedic foot and ankle surgery. The purpose of this study is to retrospectively evaluate and compare postoperative wound complications following foot and ankle surgery with and without intra-operative application of topical vancomycin powder within the surgical wound(s). We hypothesize that patients who received topical vancomycin within their surgical wound(s) will have lower rates of wound complications than those without. Methods: 367 patients that received foot and ankle surgery were retrospectively included in this study, with 93 and 274 patients with and without the use of topical vancomycin within surgical wounds during surgery, respectively. All surgeries were performed by a single fellowship-trained orthopaedic foot/ankle surgeon from February 2019 - October 2023. Exclusion criteria were patients that were minors, with wounds too small for usage of topical vancomycin, or receiving surgery for treatment of an infectious condition. Retrospective chart review was performed to identify patient demographics, comorbidities, and post-operative outcomes including the incidence and nature of superficial and deep wound complications. Chi-squared and independent samples t-tests were performed to determine statistically significant differences in patient characteristics and post-operative wound problems between these two groups. Results: There were no statistically significant differences in patient demographics between both study groups. The only statistically significant difference in medical comorbidities between both study groups was that more patients that did not receive intra-operative topical vancomycin were nicotine users (P=0.013). 13 of 93 (14%) and 27 of 274 (10%) patients that did and did not receive intra-operative topical vancomycin at their wound(s) respectively developed post-surgical superficial wound complications without SSI (P=0.270). 5 of 93 (5%) and 8 of 274 (3%) patients that did and did not receive intra-operative topical vancomycin at their wound(s) respectively developed post-surgical deep wound complications with SSI (P=0.268). There was no statistically significant difference in hospital readmission rates between the two study groups. Conclusion: This study demonstrates that the intra-operative use of topical vancomycin powder at surgical wounds does not significantly decrease the incidence of superficial or deep wound complications in foot and ankle surgery. Despite its reported value in preventing wound complications and/or surgical site infection in prior literature, this study showed no such benefit in the patient populations examined. Studies that are prospective with a larger patient population may be needed to further confirm this reported lack of difference when using topical vancomycin intra-operatively to minimize post-surgical wound complications.