Skin closure with 2-octyl cyanoacrylate and polyester mesh after primary total knee arthroplasty offers superior cosmetic outcomes and patient satisfaction compared to staples: a prospective trial

Sundaram, Kavin; Piuzzi, Nicolás S.; Patterson, Brendan M.; Stearns, Kim L.; Krebs, Viktor E.; Mont, Michael A.

doi:10.1007/s00590-019-02591-4

Cited by 21 publications

(14 citation statements)

References 17 publications

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“…If the incision-related costs after discharge were took into consideration, perhaps the additional material cost of the tissue adhesive would be offset or even exceed. The use of tissue adhesive could increase the patients' satisfaction and confidence in surgery, which was also found in other studies [10,27].…”

Section: Resultssupporting

confidence: 76%

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

Kong

Yang

Guo

et al. 2020

Preprint

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BackgroundThe study focusing on the tissue adhesive in total knee arthroplasty (TKA) was rare. This study aimed to evaluate the clinical outcomes and economic costs of tissue adhesive when acting as the adjunct to standard incision closure in TKA.Methods From September 2019 to November 2019, we prospectively enrolled the consecutive patients who underwent simultaneous bilateral TKA in our institute. The allocation whether using the tissue adhesive was done after the subcuticular suture in right knee first and another method was applied in the left knee automatically. The patients’ demographics, length of stay (LOS), times of dressing changes and incision-related cost, range of motion (ROM), incision-related complications and incision evaluation scores were recorded.Results Thirty-two patients were enrolled in this study and followed at two months after surgery. In the knees of tissue adhesive, the times of dressing change and patient scar assessment scores (PSAS) were significantly less than those in the control group (p=0.000; p=0.003). Although there were no significant differences of the delayed discharge, incision-related cost, ROM, incision-related complications and Vancouver scar score (VSS) between two groups, 65.6% (21/32) patients preferred the tissue adhesive and only 15.6% (5/32) patients preferred the standard incision closure.Conclusions Tissue adhesive could effectively reduce postoperative wound drainage and improve patients’ satisfaction rate with no difference in medical costs and ROM in TKA. The application of tissue adhesive and subcuticular sutures might be a relatively ideal method of skin closure in TKA.

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Section: Resultssupporting

confidence: 76%

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

Kong

Yang

Guo

et al. 2020

Preprint

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“…All studies (n = 22) had either low or unclear risk of bias for random sequence generation and allocation concealment ( Supplement Table 1 ). Thirteen RCTs had high risk of bias for both lack of blinding participants and personnel or outcome assessors [ [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] ], and the other 9 had low or unclear risk of bias [ [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ]. Two studies had high risk of bias from incomplete outcome data [ 26 , 28 ], and 7 studies had high risk of bias from other sources [ [19] , [20] , [21] , 23 , 24 , 28 , 29 ].…”

Section: Resultsmentioning

confidence: 99%

“…Two studies had high risk of bias from incomplete outcome data [ 26 , 28 ], and 7 studies had high risk of bias from other sources [ [19] , [20] , [21] , 23 , 24 , 28 , 29 ]. Overall, 3 studies had low risk, [ 34 , 38 , 40 ] 6 studies had unclear risk, [ 32 , 33 , [35] , [36] , [37] , 39 ] and 13 studies had high risk of bias [ [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] ] The risk of bias for the 14 included comparative observational studies was assessed using the NOS scale [ 14 ]. Overall, 13 of the 14 studies were of moderate to high quality (6-7 or 8-9 stars, respectively) [ [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] ], and 2 received 5 stars [ 53 , 54 ] ( Supplement Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue Layer

et al. 2021

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Background Wound closure is a key, and often underrecognized, component of hip and knee arthroplasty. Methods for wound closure are an important consideration to better avoid wound-related adverse events; however, there is a lack of consensus on optimal methods. The objective of the following review was twofold: to characterize the wound closure methods used by layer in the total knee arthroplasty and total hip arthroplasty literature and summarize optimal wound-healing strategies to address the risk of adverse events. Methods A systematic literature review was performed to identify total knee arthroplasty and total hip arthroplasty randomized controlled trials and nonrandomized studies reporting wound closure methods by layer and wound-healing adverse events (including superficial, deep, or periprosthetic joint infections, wound dehiscence, or prolonged wound drainage). Studies on revision procedures were excluded. Wound closure methods and adverse events were summarized qualitatively as meta-analyses were not possible because of study heterogeneity. Results Forty studies met the inclusion criteria: 22 randomized controlled trials and 18 observational studies. Across studies, 6 categories and 22 unique techniques for closure were identified. Conventional closure methods exhibited large ranges of adverse event rates. Studies of multilayer barbed sutures with topical skin adhesives and polyester mesh or multilayer antimicrobial sutures reported narrow ranges of adverse events rates. Conclusions Considerable variability exists for wound closure methods, with a wide range reported in adverse events. Recent technologies and methods for standardized watertight, multilayer closure show promise for avoiding adverse events and unnecessary health-care costs; however, higher quality, comparative studies are required to enable future meta-analyses. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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“…In a systematic review that included five studies directly comparing barbed to interrupted sutures, Khlopas et al 42 determined that barbed suture was associated with significantly shorter closing times (p < 0.05). Sundaram et al 43 conducted a prospective RCT of 60 patients who underwent a primary TKA and compared the duration of arthrotomy closure, the number of sutures utilized, and the 90-day outcomes when using barbed versus standard-of-care sutures. Arthrotomy closure time was significantly shorter in the barbed group compared with the standard-of-care group (13 AE 5 minutes, p < 0.001).…”

Section: Deep Fascia Layermentioning

confidence: 99%

“…76 Combining the skin closure and dressing has become an attractive option for TKA wound management while occlusive dressings have demonstrated encouraging results regarding infection prevention. 43,68 These options both necessitate minimal to no dressing changes, which is an attractive option safely minimizing follow-up and allowing normalized self-care. However, further value-based studies will be needed in the future to weigh the frequently constricting costs in the current health care landscape to the improved outcomes.…”

Section: Subcuticular Tissue/skin Layermentioning

confidence: 99%

Wound Management following Total Knee Arthroplasty: An Updated Review

et al. 2021

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Optimal wound closure techniques following total knee arthroplasty (TKA) have focused on enhancing healing potential, preventing infection, yielding satisfactory cosmesis, and allowing early ambulation and functionality. An appropriate layered closure and management of the TKA typically involves addressing the (1) deep fascial layer; (2) subdermal layer; (3) intradermal layer, including the subcuticular region; and (4) final application of a specific aseptic dressing, each of which are covered here in detail. This focused critical review of the literature discusses traditional techniques used in all layers of wound closure following TKA while introducing several emerging popular techniques. For example, absorbable barbed skin sutures and occlusive dressings have the potential to reduce operative time, limit the need for early postoperative visits, obviate the need for suture or staple removal, and safely promote patient communication via telemedicine. As novel wound closure techniques continue to emerge and traditional approaches are improved upon, future comparative studies will assist in elucidating the key advantages of various options. In an extremely important field that has tremendous variability, these efforts may enable the reaching of a classically elusive standard of care for these techniques.

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Skin closure with 2-octyl cyanoacrylate and polyester mesh after primary total knee arthroplasty offers superior cosmetic outcomes and patient satisfaction compared to staples: a prospective trial

Cited by 21 publications

References 17 publications

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

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

Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue Layer

Wound Management following Total Knee Arthroplasty: An Updated Review

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