Factors affecting wound ooze in total knee replacement

Butt, Umer; Ahmad, Riaz; Aspros, Dimitrios; Bannister, G.C.

doi:10.1308/003588410x12771863937124

Cited by 40 publications

(34 citation statements)

References 10 publications

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“…Butt et al (2010) also reported a significant relationship between the increase in tourniquet time and wound discharge after total knee arthroplasty (29), which is consistent with the results of this study. Several studies have approved that prolonged wound discharge increases the risk of infection (13)(14)(15)(16)(17).…”

Section: Discussionsupporting

confidence: 92%

“…This occlusion is not resolved in the early revascularization and, therefore, re-oxygenation of the tissue is prohibited, leading to the increased possibility of damaged tissues around the wound (28). Butt et al (2011) believed that the migration of macrophages and fibroblasts to the wound is secondary Mod Care J. 2016; 13(3):e10489.…”

Section: Discussionmentioning

confidence: 99%

“…This means that if the wound edges are hypoxic, angiogenesis and the migration of macrophages and fibroblasts, and consequently cell response to restoration are inhibited. Accordingly, lesser tourniquet times are more beneficial for oxygenation of the tissues and wound healing (29). Therefore, the use of tourniquet can increase wound hypoxia after surgery, particularly at higher pressures, and this can affect wound healing and may increase wound infection.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Tourniquet Release Time on Wound Healing in Patients Undergoing Tibia Fracture Plating Surgery

2016

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Background: The use of tourniquet is very common in orthopedic surgeries. By obstructing blood flow in the limb, tourniquet may result in muscle ischemia and skin flap hypoxia. This study aimed at determining and comparing the effects of tourniquet release time on wound healing in patients undergoing tibia fracture plating surgery. Methods: This study was a randomized clinical trial, wherein 40 patients with acute extra-articular tibia fractures were randomly assigned to 2 groups of A (releasing the tourniquet after fracture fixation and before wound closure) and B (releasing the tourniquet after wound closure and application of compression dressing). Duration of surgery in each group was recorded and independent t test was utilized to compare the 2 groups. The wound healing rate was investigated in the patients 24 hours and 14 days after surgery using the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale. In this tool, 0 represents "lack of the variable" and 3 indicates "maximum variable score". The scores in this scale range from 0 to 15. The Mann-Whitney test was used in order to compare the wound healing rates between the 2 groups. Results: There was no significant difference between the 2 groups concerning the average duration of surgery. Wound redness, edema, ecchymosis, discharge, approximation, and the general condition of wound healing showed no significant difference in the 2 groups 24 hours after surgery, while there was a significant difference 14 days after surgery with the aforementioned parameters being greater in group B than group A. Conclusions:The results showed that releasing the tourniquet before wound closure in group A led to improved wound healing. Wounds need oxygen for restoration and prevention from infections. As the use of tourniquet occludes blood flow to the limb for a while, it can result in increased wound hypoxia after surgery and delayed healing process; hence, less tourniquet time is more desirable for oxygenation of tissues and wound dryness.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Impact of Tourniquet Release Time on Wound Healing in Patients Undergoing Tibia Fracture Plating Surgery

2016

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“…Advantages of tourniquet use include improved visualization, reduced intraoperative blood loss, and enhancement of cement fixation [11,14,17,21,22,27,45,54]. Reported adverse effects of tourniquet use include reduced early knee flexion [11,14,60,62,65], increased perioperative pain [11,14,27,56], postoperative limb swelling [11,21,47], wound complications [9,12,40,41], and creation of cardiac and cerebral microemboli [16,20,[42][43][44]55]. Additionally, some have reported an increased incidence of deep venous thrombosis [8,57,65], arterial thrombosis in subjects with preoperative vascular disease [26,48,49], and peripheral nerve injury [28,39].…”

Section: Discussionmentioning

confidence: 99%

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Dennis

Kittelson

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

160

148

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Background Tourniquet use during total knee arthroplasty (TKA) improves visibility and reduces intraoperative blood loss. However, tourniquet use may also have a negative impact on early recovery of muscle strength and lower extremity function after TKA. Questions/purposes The purpose of this study was (1) to determine whether tourniquet use affects recovery of quadriceps strength (primary outcome) during the first 3 postoperative months; and (2) to examine the effects of tourniquet application on secondary outcomes: voluntary quadriceps activation, hamstring strength, unilateral limb balance as well as the effect on operative time and blood loss.Methods Twenty-eight patients (mean age 62 ± 6 years; 16 men) undergoing same-day bilateral TKA (56 lower extremities) were enrolled in a prospective, randomized study. Subjects were randomized to receive a tourniquetassisted knee arthroplasty on one lower extremity while the contralateral limb underwent knee arthroplasty without extended tourniquet use. In the former group, the tourniquet was inflated just before the incision was made and released after cementation; in the latter group, a tourniquet was not used (10 of 28 [36%]) or inflated only during component cementation (18 of 28 [64%]). The choice of no tourniquet or use just during cementation was based on surgeon choice, because some surgeons felt a tourniquet during cementation was necessary to achieve a dry surgical field to maximize cement fixation. A median parapatellar approach and the One or more of the authors (DAD, CCY, TMM, RHK) has received funding from Porter Adventist Hospital, during the study period, in the amount of USD 10,000 to USD 100,000. One of the authors (DAD) has or may receive payments or benefits from DePuy (Warsaw, IN, USA) in the amount of USD more than USD 1,000,001 not related to this work. One of the authors certifies that he (RHK) has or may receive payments or benefits from Stryker (Kalamazoo, MI, USA) and Innomed (Savannah, GA, USA) in the amount of USD 100,001 to USD 1,000,001 not related to this work. One of the authors (TMM) has or may receive payments or benefits from Zimmer (Warsaw, IN, USA) in the amount of less than USD 10,000 not related to this work. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. 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.The surgeries for this study were performed at Porter Adventist Hospital, Denver, CO, USA, and the postoperative patient te...

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“…35 Wound oozing cessation was found to be significantly reduced with shorter tourniquet time, periarticular local anaesthesia and the subvastus approach, which, in turn, reduced hospital stay and enhanced recovery. 36 There is a growing interest in the use of modern wound dressings (eg Aquacel ® Surgical; ConvaTec, Uxbridge, UK) in the context of enhanced recovery. However, a prospective audit comparing two types of wound dressings (traditional vs modern) as part of an enhanced recovery non-operative intervention in a district hospital failed to find any significant difference in LOS between these groups, with a significantly shorter wear time and more dressing changes in the traditional form (Mepore ® ; Mölnlycke, Dunstable, UK) as well as significantly less blistering in the modern type (Aquacel ® Surgical).…”

Section: Wound Carementioning

confidence: 99%

An evidence-based review of enhanced recovery interventions in knee replacement surgery

Ibrahim

Alazzawi

Nizam

et al. 2013

annals

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Introduction Total knee replacement (TKR) is a very common surgical procedure. Improved pain management techniques, surgical practices and the introduction of novel interventions have enhanced the patient’s postoperative experience after TKR. Safe, efficient pathways are needed to address the increasing need for knee arthroplasty in the UK. Enhanced recovery programmes can help to reduce hospital stays following knee replacements while maintaining patient safety and satisfaction. This review outlines common evidence-based pre, intra and postoperative interventions in use in enhanced recovery protocols following TKR. Methods A thorough literature search of the electronic healthcare databases (MEDLINE®, Embase™ and the Cochrane Library) was conducted to identify articles and studies concerned with enhanced recovery and fast track pathways for TKR. Results A literature review revealed several non-operative and operative interventions that are effective in enhanced recovery following TKR including preoperative patient education, pre-emptive and local infiltration analgesia, preoperative nutrition, neuromuscular electrical stimulation, pulsed electromagnetic fields, perioperative rehabilitation, modern wound dressings, different standard surgical techniques, minimally invasive surgery and computer assisted surgery. Conclusions Enhanced recovery programmes require a multidisciplinary team of dedicated professionals, principally involving preoperative education, multimodal pain control and accelerated rehabilitation; this will be boosted if combined with minimally invasive surgery. The current economic climate and restricted healthcare budget further necessitate brief hospitalisation while minimising costs. These non-operative interventions are the way forward to achieve such requirements.

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Factors affecting wound ooze in total knee replacement

Abstract: Peri-articular local anaesthesia, the subvastus approach and shorter tourniquet time were all associated with less wound oozing after total knee arthroplasty.

Cited by 40 publications

References 10 publications

The Impact of Tourniquet Release Time on Wound Healing in Patients Undergoing Tibia Fracture Plating Surgery

The Impact of Tourniquet Release Time on Wound Healing in Patients Undergoing Tibia Fracture Plating Surgery

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

An evidence-based review of enhanced recovery interventions in knee replacement surgery

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