A Comparison of Wound Closure Techniques for Total Knee Arthroplasty

Eggers, M.; Fang, Li; Lionberger, David R.

doi:10.1016/j.arth.2011.02.029

Cited by 82 publications

(84 citation statements)

References 20 publications

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“…Many studies have previously compared wound closure techniques in TKA [2,3,6,[15][16][17][18]. Results have been highly variable and currently there is no consensus on a superior closure method.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have compared different closure techniques in TKA [2,3,6,[15][16][17][18]. From the perspective of wound complications, one recent meta-analysis by Smith et al showed that staple closure resulted in increased rates of infection after both hip and knee arthroplasty in comparison to running subcuticular [17].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have compared different closure techniques in TKA [2,3,6,[15][16][17][18]. The majority of these studies have involved running subcuticular closure versus staple closure and focused on factors such as cost, performance time, patient satisfaction, and wound complications.…”

Section: Introductionmentioning

confidence: 99%

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The Chitranjan Ranawat Award: Running Subcuticular Closure Enables the Most Robust Perfusion After TKA: A Randomized Clinical Trial

Wyles

Jacobson

Houdek

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Maintaining robust perfusion is an important physiologic parameter in wound healing. The effect of different closure techniques on wound perfusion after total knee arthroplasty (TKA) has not been established previously and may have implications for wound healing. Questions/purposes We asked whether a running subcuticular, vertical mattress, or skin staple closure technique enables the most robust wound perfusion after TKA as measured by laser-assisted indocyanine green angiography (LA-ICGA) in patients without specific risk factors for wound healing complications. Methods Forty-five patients undergoing primary TKA without comorbidities known to impact wound healing and perfusion were prospectively randomized to receive superficial skin closure with one of the following techniques: (1) running subcuticular (3-0 monofilament); (2) vertical mattress (2-0 nylon); or (3) skin staples. Twenty procedures were performed by RTT, 15 by RJS, and 10 by FHS. All surgeons used an anterior skin incision over the medial third of the patella in combination with a median parapatellar arthrotomy. Perfusion was assessed with a LA-ICGA device and software system immediately after closure to quantify fluorescence. Twenty-seven points were assessed immediately after closure in the operating room in each patient (nine along the incision and nine pairs medial and lateral to the incision). Mean incision perfusion was determined from the nine points along the incision with One of the authors (RJS) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: Lifecell Corporation (Branchburg, NJ, USA) in an amount of less than USD 10,000 and Biomet Inc (Warsaw, IN, USA) in an amount of USD 10,000 to USD 100,000. One of the authors (MJT) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: DJO Global (Vista, CA, USA) in an amount of less than USD 10,000. One of the authors (RTT) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: DePuy Orthopaedics, Inc (Warsaw, IN, USA) in an amount of USD 10,000 to USD 100,000. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. higher values indicating greater blood flow. Mean perfusion impairment was determined by calculating the difference between the nine pairs of surrounding skin and the nine points along the incision with smaller values ind...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Chitranjan Ranawat Award: Running Subcuticular Closure Enables the Most Robust Perfusion After TKA: A Randomized Clinical Trial

Wyles

Jacobson

Houdek

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…It may also be used in conjunction with, but not in place of, deep dermal sutures. Dermabond® had demonstrated superiority over subcuticular sutures (Krishnamoorthy et al, 2009) and staples (Miller and Swank, 2010) with regard to closure time, cosmetic appearance and patient satisfaction, without an increase in wound dehiscence (Eggers et al, 2011), and with a reduction in infection rates (Dohmen et al, 2009). The antimicrobial property is particularly relevant to orthopaedic surgery where surgical site infections can have such a devastating consequence.…”

Section: Discussionmentioning

confidence: 99%

The antibacterial effect of 2-octyl cyanoacrylate (Dermabond®) skin adhesive

Rushbrook

White

Kidger

et al. 2014

Journal of Infection Prevention

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Dermabond® is a tissue adhesive commonly used for wound or surgical incision closure. Its use has previously been associated with a reduction in wound infection, and it has been thought to act as a physical barrier to bacteria accessing the wound. This study aimed to establish whether the Dermabond® adhesive demonstrated any intrinsic antimicrobial properties. Solidified pellets of Dermabond® were placed on standardised Agar plates cultured with a variety of pathogens. Inhibition of growth was demonstrated against Gram-positive bacteria. Culture swabs taken from the inhibition rings demonstrated no growth, suggesting that Dermabond has a bactericidal mechanism of action. Based on the design of this study, the results suggest that Dermabond® demonstrates bactericidal properties against Gram-positive bacteria. Its use for wound closure following surgical intervention may reduce postoperative wound infection by Gram-positive organisms.

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“…Tissue adhesives such as (2-octyl or n-butyl-2 or OCA) have also been added to wounds closed with sutures. One trial including 90 patients with TKA found that patients with staple had longer hospital stay in comparison with sutures alone or sutures combined with OCA (Eggers et al 2011 ). Another RCT in patients with TKA and THA found that although wound drainage was less in patients with OCT compared with staples or sutures alone, the use of OCT was associated with prolonged wound drainage in the TKA subgroup .…”

Section: Optimal Closurementioning

confidence: 99%

Perioperative Medical Management for Total Joint Arthroplasty

Baldini¹,

Caldora²

2015

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A Comparison of Wound Closure Techniques for Total Knee Arthroplasty

Cited by 82 publications

References 20 publications

The Chitranjan Ranawat Award: Running Subcuticular Closure Enables the Most Robust Perfusion After TKA: A Randomized Clinical Trial

The Chitranjan Ranawat Award: Running Subcuticular Closure Enables the Most Robust Perfusion After TKA: A Randomized Clinical Trial

The antibacterial effect of 2-octyl cyanoacrylate (Dermabond®) skin adhesive

Perioperative Medical Management for Total Joint Arthroplasty

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