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Utility of Fresh Frozen Section Analysis in Foot and Ankle Surgery: A Pilot Study
Spencer J Monaco1, Jeffery M Manway2, Patrick R Burns3
1Second-Year Resident Physician, Podiatric Residency Program, University of Pittsburgh Medical Center, Pittsburgh, PA.
Abstract:
The use of intraoperative fresh frozen section (FFS) analysis to determine the presence of infection has been well reported in orthopedic studies. Specifically, the number of polymorphonuclear leukocytes per high-power field has been used to diagnose total joint arthroplasty-related infection. Less commonly, reconstructive surgeons have extended the use of FFS analysis for intraoperative evaluation when suspicion of deep infection with or without hardware is high. The purpose of the present study was to retrospectively review the data from 11 patients undergoing foot and ankle reconstruction in the setting of possible deep infection and determine the usefulness of FFS analysis. A retrospective review of the medical records of patients who had undergone reconstructive foot and ankle revision surgery with intraoperative FFS analysis and tissue/swab cultures available was performed. A positive FFS was defined as >5 polymorphonuclear leukocytes per high-power field. A positive frozen section was associated with a positive tissue culture 4 of 7 times (57%). The sensitivity and specificity of FFS analysis for infection was 80% and 50%, respectively. The positive and negative predictive value of the FFS result was 57.1% and 75%, respectively. In conclusion, FFS analysis and intraoperative cultures correlated only 57% of the time in the present series. This test had moderate sensitivity for detecting infection at 80%, but the specificity was poor (50%). More research is needed to further evaluate the role of FFS analysis in foot and ankle surgery.
Insights
Fresh frozen section (FFS) analysis for diagnosing deep infection in foot and ankle reconstruction shows moderate sensitivity (80%) but poor specificity (50%). Intraoperative cultures and FFS only correlated 57% of the time, indicating a need for further research.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Diagnosis
Background:
- Intraoperative fresh frozen section (FFS) analysis is utilized in orthopedic surgery to detect infection.
- FFS, specifically polymorphonuclear leukocyte count, aids in diagnosing total joint arthroplasty infections.
- Surgeons sometimes extend FFS use for intraoperative deep infection evaluation in reconstructive cases.
Purpose of the Study:
- To retrospectively assess the utility of FFS analysis in foot and ankle reconstruction patients with suspected deep infection.
Main Methods:
- Retrospective review of 11 patients undergoing foot and ankle revision surgery.
- Intraoperative FFS analysis and tissue/swab cultures were performed.
- A positive FFS was defined as >5 polymorphonuclear leukocytes per high-power field.
Main Results:
- FFS and intraoperative cultures correlated in 57% of cases.
- FFS demonstrated 80% sensitivity and 50% specificity for infection.
- Positive and negative predictive values for FFS were 57.1% and 75%, respectively.
Conclusions:
- FFS analysis shows moderate sensitivity but poor specificity for detecting deep infection in foot and ankle reconstruction.
- The correlation between FFS and intraoperative cultures was limited.
- Further research is required to establish the role of FFS in foot and ankle surgery.
