Barbed suture and glue in skin closure during lower limb arthroplasty: reduced delayed discharge due to wound exudate

Abstract

Objective: The number of hip and knee replacement performed is rising, causing increased pressure for the timely management of these patients. A dry incision is considered a prerequisite for discharge. This is a retrospective cohort study comparing two treatments for skin closure during elective hip and knee arthroplasty. Methods: A barbed monofilament absorbable 3.0 subcuticular suture (Quill), with the additional surface application of n-butyl-2-cyanoacrylate glue, was used for the study group and metal clips or a smooth monofilament absorbable 3.0 subcuticular suture (Monocryl) for the control group. Each group comprised 46 hip and 27 knee replacement patients and data on predisposing risk factors for prolonged wound exudate were collected. We have calculated the proportion of patients who have exceeded their expected length of stay due to a wound exudate, the additional days required for the wound to dry and the derived cost. Results: No significant differences were identified with regards to risk factors. The study group demonstrated a significantly lower incidence of exudating wounds of excessive duration (1% versus 14%, p=0.005, relative risk: 10; 95% confidence interval: 1.31–76.13). The combined additional stay was 22 days more for the control group, producing an average financial benefit of £80 per patient for the study group. There were seven knee replacement and two hip replacement patients treated with a nozzled glue applicator who presented with delayed (> 2 weeks) wound healing issues. Conclusion: Barbed subcuticular suture with surface glue application is a viable option for skin closure after elective lower limb joint arthroplasty and can reduce the incidence of prolonged wound discharge. A brushed glue applicator should be preferred over the nozzled one.

<p>A Prospective, Randomized and Controlled Study on Tissue Adhesive for Skin Incision in Total Knee Arthroplasty</p>

“…10,[20][21][22] Roumeliotis and Graham reported that tissue adhesive with subcuticular suture application was a viable option for skin closure after lower limb arthroplasty and can reduce the incidence of prolonged wound discharge. 23 However, their study had several obvious limitations. Firstly, the study was retrospective and two groups of patients came from different time periods.…”

Subcuticular Barbed Suture and Skin Glue Wound Closure Decreases Reoperation and Length of Stay in Geriatric Hip Fractures When Compared With Staples

“…A British National Health System study on skin closure in hip and knee arthroplasty found a notable reduction in prolonged wound drainage and inpatient stay for wound exudate with the use of barbed suture and glue compared with staples or monofilament suture. 27 They also conducted a cost-benefit analysis which demonstrated overall cost savings with the use of barbed suture, despite the more expensive cost of the suture compared with staples. The extra cost in using barbed suture was outweighed by its benefit in reducing the cost of prolonged inpatient hospitalization for wound observation.…”

“…Although we cannot state that the increased LOS is attributable solely to the type of wound closure, the approximate 2-day difference is consistent with previous literature demonstrating a similar delay until postoperative wounds are dry after staple closure. 17 , 27 …”

Wound Management following Total Knee Arthroplasty: An Updated Review

“…Additionally, there were no differences in KSS, ROM, or cosmesis. Likewise, Roumeliotis et al 13 retrospectively evaluated a TJA cohort treated with either a barbed suture versus a conventional method demonstrating a significantly lower incidence of sustained wound drainage (1 vs. 14%, p ¼ 0.05, RR: 10; 95% confidence interval [CI]: 1.31-76.13). Several further studies have supported the proposed advantages of barbed suture regarding closure efficiency and decreased drainage.…”