Skin Avulsion Injuries with Use of Adhesive Surgical Drapes

Abstract

Iodophor-impregnated adhesive drapes are commonly used to reduce the incidence of surgical site infections (SSI).While proper and discretionary use of drapes can provide significant benefit, there are potential risks. We present two cases of degloving injuries sustained from use of these drapes during total knee arthroplasty. The patients, deemed high risk for potential skin avulsion injuries, received standard wound care and close follow-up which resulted in healing of the lesions at 6-week follow-up.

Perioperative Skin Preparation and Draping in Modern Total Joint Arthroplasty: Current Evidence

“…Liu et al presented two cases of degloving injuries sustained from the use of drapes during TKR. According to them, patients who suffer skin avulsion injuries should receive standard surgical site care and close follow-up until the healing of the lesions [33].…”

Prevention of medical adhesive-related skin injury during patient care: A scoping review

“… Information pamphlet The four basic steps for the prevention of MARSI are: selection of the appropriate adhesive; proper skin preparation; and correctly applying and removing the adhesive. McNichol, Liu et al., 2013 To determine a consensus on the assessment, prevention, and treatment of medical adhesive–related skin injury. Specialist consensus To prevent MARSI, it is necessary to adapt the choice of adhesive to the patient's conditions and needs; evaluate the skin daily; investigate allergy history; obtain additional information from manufacturers; identify patients at risk for MARSI; use soft adhesives, barriers and adhesive removers; maintain skin care, good nutrition and hydration; consider Langer Lines when applying adhesives; avoid the use of adhesion agents or binders; properly apply and remove adhesives; and store products properly.…”

“…Intrinsic risk factors are: age extremes, comorbidities (for example atopic dermatitis, epidermolysis bullosa, ectodermal dysplasia, psoriasis, diabetes, vascular diseases, infection, kidney failure, immunosuppression, rheumatoid arthritis, venous hypertension, peristomal varicose veins), dehydration, nutritional deficit, edema, exposure to free radicals, mental disorders (for example stress and anxiety), less pigmentation skin, reduced mobility, and female sex. Extrinsic risk factors are: extremes of humidity, prolonged use of medications (for example corticosteroids, chemotherapy, anti-inflammatories, anticoagulants), radiotherapy, exposure to ultraviolet radiation, repeated removal of adhesives, inappropriate use of adhesives, creams and devices, obesity, cachexia, smoking, excessive cold or heat, friction and pressure on the skin, use of products that increase the adhesion of adhesives, excessive bathing, use of inappropriate cleaning products, and history of injury ( Bryant, 1988 ; Cutting, 2008 ; Fumarola et al., 2020 ; Hill and Moureau, 2019 ; Hunt, 2016 ; Jones, 2017 ; LeBlanc and Baranoski, 2011 ; ( Liu et al., 2013 ); McNichol et al., 2013 ; McNichol and Bianchi, 2016 ; Morgan, 1981 ; Roberts, 2007 ).…”

Skin avulsion injuries caused by the application of adhesive drapes during total knee arthroplasty

“…[ 14 ] Common plastic adhesive drapes have been reported to be associated with a risk of skin avulsion injuries. [ 15 ] Iodophor is a stimulant chemical agent; when combined with stimulation, impregnation, friction, and pressure, it can make the skin more prone to burns and superficial ulcers. [ 16 , 17 ] Therefore, iodophor-impregnated adhesive drapes are more likely to cause degloving injuries.…”