Delayed wound healing after forefoot surgery in patients with rheumatoid arthritis

Abstract

Objective. To elucidate the systemic and local risk factors and the effect of surgical procedures for delayed wound healing after forefoot surgery in patients with rheumatoid arthritis (RA).

Methods. Fifty forefoot surgeries were performed in 39 patients using resection arthroplasty or a joint-preserving procedure (25 feet for each procedure). The associations between the occurrence of delayed wound healing and clinical variables, radiological assessment, or surgical procedures were analyzed.

Results. Delayed wound healing was recorded in nine feet of eight patients. The duration of RA was significantly longer in the delayed healing group than that in the healed group. Age, sex, smoking history, concomitant diabetes, and RA medication did not differ between the groups. Radiological evaluation showed significant differences between groups in metatarsophalangeal dorsal flexion angle. The shortened length of the fourth and the fifth metatarsal bones affected the occurrence of the complication. The joint-preserving procedure had significantly less delayed wound healing compared with resection arthroplasty.

Conclusions. Preoperative dorsoplantar deformity and perioperative tissue damage can cause delayed wound healing after forefoot surgery in RA patients.

Keywords:

• Delayed wound healing
• Forefoot surgery
• Operative complication
• Rheumatoid arthritis

Acknowledgments

We thank Dr Hiroyuki Yoshitomi, the Center for Innovation in Immunoregulative Technology and Therapeutics, Kyoto University Graduate School of Medicine, for his valuable help. We also thank Professor Emeritus Takashi Nakamura, Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, for his tremendous support for this manuscript.

Conflict of interest

M.F. and M.I. are affiliated with a department that is supported financially by four pharmaceutical companies (Mitsubishi Tanabe Pharma Co., Bristol-Myers K.K., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd.). H.I. has received grant and research support from Takeda Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Chugai Pharmaceutical Co., Ltd., Pfizer Japan Inc., Astellas Pharma Inc., and Daiichi Sankyo Co., Ltd. M.F. has received grant and research support from Mitsubishi Tanabe Pharma Co., Astellas Pharma Inc., and Pfizer Japan Inc. S. M. has received grant and research support from Kyocera Medical Co., Ltd., Ishihara Sangyo Kaisha. Ltd., Asahi Kasei Parma Co. Ltd., Taisho Toyama Pharmaceutical Co. Ltd., Hisamitsu Pharmaceutical Co. Inc., Kaken Pharmaceutical Co. Ltd., Astellas Pharma Inc., MSD K.K., Eisai Co., Ltd., Pfizer Japan Inc., Teijin Pharma Ltd., Smith & Nephew Orthopaedics KK, Eli Lilly Japan K.K., Daiichi Sankyo Co., Ltd., and Zimmer Inc.; The sponsors were not involved in the study design; in the collection, analysis, interpretation of data; in the writing of this manuscript; or in the decision to submit the article for publication. The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.