A Novel Skin Closure Device for Total Knee Arthroplasty: Randomized Controlled Trial versus Staples

Abstract

Twenty-five patients undergoing simultaneous, bilateral total knee arthroplasty (TKA) were randomized to receive skin closure with Zip device on one knee and staples on the other. Patients' pain and scar appearance were rated from 0 (best) to 10 (worst). Knee arc of motion was measured by a physical therapist. At 2 weeks postoperatively, pain scores were significantly better with the Zip device during device wear (p = 0.03) and during device removal (p = 0.003); arc of motion was significantly better with the Zip device (p = 0.002). At 8 weeks of follow-up, scar appearance was significantly better in the Zip device knee as rated by the patients (1.3 vs. 2.6, p = 0.04), the surgeon (1.9 vs. 3.3, p = 0.0006), and three independent plastic surgeons (3.7 vs. 4.8, p < 0.001). Results of this randomized controlled trial show that skin closure with the Zip device resulted in less pain and better scar appearance and knee arc of motion than with staples.

A novel zipper device versus sutures for wound closure after surgery: a systematic review and meta‐analysis

“…The zipper device provides precise, adjustable, and tension‐free adaptation of the incision edges for a sufficient time and minimal trauma to the skin and underlying tissues, without resulting in an ischemic condition that could impact healing and scarring, thus make it beneficial to a good cosmetic result 16,26 . Several studies reported similar results that a better cosmesis was observed in the zipper group compared with stapler group 6,8,26 . Furthermore, a distinctive feature of the zipper was that no need of removing sutures and bandages thus cause less painful, which further improved the patient satisfactions.…”

“…16,26 Several studies reported similar results that a better cosmesis was observed in the zipper group compared with stapler group. 6,8,26 Furthermore, a distinctive feature of the zipper was that no need of removing sutures and bandages thus cause less painful, which further improved the patient satisfactions.…”

“…7 Recently, a novel atraumatic, noninvasive zipper surgical wound closure device has become popular in orthopaedic and cardiothoracic surgical procedures. 6,[8][9][10] It is sterile, adjustable, hydrocolloid adhesive-based, and designed to replace staples and sutures for closure of the superficial skin layer, which can be applied directly to intact skin on either side of the incision and provides uniform force along the wound edge. 8 The similar incidence of SSI between the zipper and sutures was reported.…”

“…6,[8][9][10] It is sterile, adjustable, hydrocolloid adhesive-based, and designed to replace staples and sutures for closure of the superficial skin layer, which can be applied directly to intact skin on either side of the incision and provides uniform force along the wound edge. 8 The similar incidence of SSI between the zipper and sutures was reported. 5,11 Two previous meta-analyses of randomised controlled trials (RCTs) on this topic have been published in 2016 and 2020, respectively.…”

Clinical outcome of different skin closure in total-knee arthroplasty: running subcuticular closure vs intermittent closure

“…[ 3 , 4 ] In addition to running subcuticular or intermittent closure using staples or barbed sutures, [ 5 – 7 ] a novel “zip” device and skin adhesives have also been explored for post-TKA skin closure. [ 8 , 9 ] Although intermittent closure with silk suture is routinely used for different surgical wounds, subcuticular closure with absorbable sutures are increasingly being considered owing to their convenience and better cosmetic appearance. In this retrospective study, we compared the 6-month clinical outcome of running subcuticular closure and intermittent closure post-TKA.…”