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

Abstract

An intermittent closure with silk suture is routinely used for closing different surgical wounds. However, subcuticular closure with absorbable sutures has gained considerable attention due to convenience and better cosmetic appearance. To compare the clinical outcomes and risk of surgical-site infection of subcuticular and intermittent closure after total-knee arthroplasty (TKA), 106 patients that underwent TKA between January 2017 to June 2019 at the Department of Orthopedics in Xiangya Hospital of Centre South University were retrospectively assessed. Forty-three had received running subcuticular closure (group A) and 58 underwent intermittent closure (group B). The Knee Society score was measured before and 6 months after operation. Inflammation markers including the serum levels of procalcitonin, interleukin-6, and C-reactive protein, and the erythrocyte sedimentation rate were evaluated before operation, 1 day after and 1 month after operation. Patient satisfaction with the closure was evaluated using the Likert scale at the last follow-up. No significant difference was seen in the 6-month postoperative Knee Society score, or in the 1-day and 6-month postoperative inflammation marker levels between both groups ( P > .05). Likert scores were higher in group A compared to group B (4.0 ± 1.0 vs 3.6 ± 1.2, P < .05). Running subcuticular closure after TKA results in a better appearance compared to intermittent closure, although neither method has an advantage in terms of efficacy and risk of infection.

The Routine Use of Running Subcuticular Closures in Orthopaedic Trauma Patients Does Not Increase Wound Complications

“…26 Although RSC has been shown to have superior wound perfusion and cosmesis across multiple surgical subspecialties, its effect on postoperative wound complications in orthopaedic surgery is scarce and conflicting. [13][14][15][16][17][18][19][20][21] A meta-analysis of 6 studies by Smith et al 4 found that the risk of postoperative wound complications was 3.8 times greater for patients who received staples compared with those who received sutures. A subsequent systematic review and meta-analysis of 12 studies by Krishnan et al 5 found no differences in the rate of wound complications between these groups.…”

“…4–14 More recently, studies in multiple surgical subspecialities have demonstrated that running subcuticular closures (RSC) result in improved wound perfusion and cosmesis when compared with staples or cutaneous mattress suture closures (CMC). 15–21 However, the use of RSC in orthopaedic trauma remains poorly studied and rarely used because of concern for increased risk of wound complications. 1,9,11,13,22…”

“…[4][5][6][7][8][9][10][11][12][13][14] More recently, studies in multiple surgical subspecialities have demonstrated that running subcuticular closures (RSC) result in improved wound perfusion and cosmesis when compared with staples or cutaneous mattress suture closures (CMC). [15][16][17][18][19][20][21] However, the use of RSC in orthopaedic trauma remains poorly studied and rarely used because of concern for increased risk of wound complications. 1,9,11,13,22 The purpose of this study was to compare the rate of postoperative wound complications and wound-related reoperations before and after the implementation of an RSC protocol for orthopaedic trauma procedures.…”

Epidermoid cyst beneath the scar after total knee arthroplasty: a case report

“…In this case, the articular capsule, subcutaneous and skin layers were sequentially closed with one absorbable line (PDP359 and VCP359), a 2-0 VCP317 suture and a 3-0 VCP316 suture, respectively. Compared with intermittent closure, running subcuticular closure after TKA results in a better appearance [ 9 ]. All kinds of surgical and invasive procedures can induce epidermal inclusion cysts.…”

Erythrocyte sedimentation rate, C-reactive protein, and interleukin-6 as inflammatory biomarkers in dogs naturally infected with Ehrlichia canis

“…Erythrocyte sedimentation rate (ESR) test is an inexpensive evaluation performed by measuring the distance that red blood cells (RBC) descend in a test tube (Westergren tube) within 1 h. A high ESR is found in inflammatory conditions due to a large increase in fibrinogen levels; it is usually used as a generic index of illness and for tracking inflammation in humans. ESR can be used to identify various diseases and conditions, such as acute tissue injury, infection, malignancy, rheumatoid arthritis, lymphoma, coronary disease, stroke, and heart failure, as well as for Available at www.veterinaryworld.org/Vol.14/September-2021/5.pdf postoperative monitoring [13][14][15][16][17]. ESR has rarely been analyzed in dogs, but it has been found to be useful in cases of canine rheumatoid arthritis, osteoarthritis, and babesiosis [18][19][20].…”