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Kulkarni S, Goodbun M, Chowdhury M, Stather PW. Dermabond Prineo: a systematic review and meta-analysis. J Wound Care 2025; 34:220-226. [PMID: 40047817 DOI: 10.12968/jowc.2023.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2025]
Abstract
OBJECTIVE Dermabond Prineo (Ethicon Inc., US) is a combination of a skin adhesive applied over a polyester mesh to reinforce and share tension equally over the surgical wound with the aim of reducing closure time and improving wound healing. The aims of this systematic review were to assess published data on Dermabond Prineo regarding infection rates, delayed wound healing, cosmetic appearance and application time compared to conventional wound closure techniques across multiple surgical procedures. METHOD A literature search was conducted according to PRISMA guidelines. The primary outcome was the incidence of wound infection after Dermabond Prineo compared to controls, namely traditional methods of wound closure such as staples, sutures and adhesives. Secondary outcome measures included allergic reactions and time taken for application. RESULTS A literature search using PubMed, SCOPUS and Science Direct identified 52 studies, of which 19 were eligible for qualitative synthesis and 12 for meta-analysis. The studies included reflected a broad range of applications of Dermabond Prineo for wound closure in abdominoplasty, mammoplasty and arthroplasty. Overall, all studies reporting on time taken for application found that Dermabond Prineo reduced time for wound closure. Meta-analysis identified a statistically significant reduction in wound infection rates (Dermabond Prineo 1.51%, control 2.13%; OR: 0.65 (0.46, 0.91); p=0.01) and a reduction in delayed wound healing (Dermabond Prineo 0.99%, control 1.79%; OR: 0.42 (0.18, 0.98); p=0.05). All three studies reporting on outcomes of scar cosmesis or long-term maturation attested to improved cosmetic results compared with sutures. The cost-effectiveness of Dermabond Prineo with a hypothetical model was discussed in two studies which concluded that it could achieve savings of $50-76 USD per patient, while a retrospective model found no statistically significant difference in total hospital costs or operating room time. CONCLUSION In this review, Dermabond Prineo showed lower wound infection rates and a reduction in delayed wound healing. Further studies are required to assess cost-effectiveness in a real-world setting.
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Affiliation(s)
- Shreya Kulkarni
- Department of Vascular Surgery, Norfolk & Norwich University Hospital, Norwich, UK
- Department of Plastic Surgery, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - Matthew Goodbun
- Department of Vascular Surgery, Norfolk & Norwich University Hospital, Norwich, UK
- Department of Orthopaedics, James Paget University Hospital, Great Yarmouth, UK
| | - Mohammed Chowdhury
- Department of Vascular Surgery, Norfolk & Norwich University Hospital, Norwich, UK
- Department of Vascular Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Philip W Stather
- Department of Vascular Surgery, Norfolk & Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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Flener JL, Chen BPH, Ernst FR, Libolt A, Gunja NJ, Barrett WP. Advanced Multi-Layer Watertight Closure versus Conventional Closure in Total Hip and Knee Replacement Surgery. Pragmat Obs Res 2024; 15:93-102. [PMID: 39049871 PMCID: PMC11268763 DOI: 10.2147/por.s450183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Background In total joint replacement procedures, surgeons have increasingly adopted advanced multi-layer, watertight closure. The objective of the study was to compare the clinical and economic outcomes for advanced multi-layer, watertight closure patients to those with conventional closure with sutures and skin staples. Methods Patients aged ≥18 years were included in the study if they underwent total joint arthroplasty of the hip or knee as an elective, primary, inpatient procedure between January 2014 and March 2019. Cohorts having advanced multi-layer, watertight closure or conventional closure were compared using multivariable regression analysis of surgical site infections, length of stay, operating room time, procedure time, discharge status, readmissions, reoperations, and hospital emergency department visits. Results A total of 1828 patients received at least one total hip or knee replacement, of which 434 (23.7%) had advanced multi-layer, watertight closure and 1394 (76.3%) had conventional closure. Unadjusted time to readmission, when occurring, was considerably longer following advanced multi-layer, watertight closure (89.9 vs 51.1 days, p < 0.0001), and a lower proportion of the advanced multi-layer, watertight closure cohort required reoperation within 90 days (0.0% vs 2.6%, p < 0.0001). Adjusted mean hospital length of stay was approximately half of a day shorter for advanced multi-layer, watertight closure patients (1.10 vs 1.65 days; p < 0.001), and they were also more likely to be discharged to home (Odds Ratio: 4.61; p = 0.002). Conclusion Among patients undergoing total hip and knee arthroplasty in a highly optimized real-world clinical practice, advanced multi-layer, watertight closure was associated with significantly shorter inpatient length of stay and increased likelihood of being discharged to home compared with conventional closure. These findings suggest that advanced multi-layer, watertight closure is a valuable component of an optimal workflow for total hip or knee replacement, and may be especially valuable for high-risk patients.
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Affiliation(s)
| | | | - Frank R Ernst
- Real World Evidence and Late Phase, CTI Clinical Trial and Consulting Services, Covington, KY, USA
| | - Aaron Libolt
- Proliance Orthopedic Associates, Renton, WA, USA
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Koyama S, Tensho K, Takashimizu I, Aoki T, Shimodaira H, Iwaasa T, Horiuchi H, Saito N, Yuzuriha S, Takahashi J. Comparison of 2-octyl cyanoacrylate with polyester mesh with standard suture and staples in total knee and hip arthroplasty. J Wound Care 2024; 33:lxi-lxviii. [PMID: 38457269 DOI: 10.12968/jowc.2024.33.sup3a.lxi] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
OBJECTIVE The use of 2-octyl cyanoacrylate with polyester mesh (OCA-M) has become common in total hip and knee arthroplasty (THA, TKA). We aimed to compare the safety and cosmetic outcomes between OCA-M and standard suture techniques and staples, and determine whether OCA-M can safely be used for TKA. METHOD Inclusion criteria were patients who underwent THA or TKA from January 2010 to October 2011 (Suture group), November 2011 to August 2013 (Staple group), March 2017 to September 2018 (OCA-M group). Exclusion criteria was loss of imaging data. Complications during hospitalisation (early complication) and after discharge (late complication) were compared in groups. Plastic and orthopaedic surgeons performed cosmetic evaluations with the modified Vancouver Scar Scale (VSS) and Likert scale at three and six months postoperatively and compared in groups. RESULTS A total of 249 arthroplasties (suture group=88 patients; staple group=94 patients; OCA-M group=67 patients) were included in the study. The OCA-M group had a significantly lower early complication rate than the suture group (p=0.015). For THA, the OCA-M group had a significantly lower total complication rate than the suture group (p=0.048). For TKA, there was no significant difference among the three groups. The complication rate in the OCA-M group showed no significant difference between THA/TKA. With regards to the VSS, the OCA-M group was significantly better for cosmetic qualities than the suture group (p=<0.001, p=0.021 at three and six months, respectively). For the Likert scale, the OCA-M group was also significantly better for cosmetic qualities than the suture group and staple group (suture-OCA-M, p=0.003 (three months), p=<0.001 (six months); staple-OCA-M, p=0.027 (three months)). CONCLUSION In this study, the OCA-M complication rate was low compared to suturing and similar to stapling. Moreover, better cosmetic outcomes were achieved compared to suturing and stapling.
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Affiliation(s)
- Suguru Koyama
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Keiji Tensho
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Ikkei Takashimizu
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Tetsuhiro Aoki
- Suwa Red Cross Hospital, 5-11-50, Kogandoori, Suwa, Nagano 392-8510, Japan
| | - Hiroki Shimodaira
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Tomoya Iwaasa
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Hiroshi Horiuchi
- Department of Rehabilitation, Shinshu University Hospital, 3-26-1, Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Naoto Saito
- Institute for Biomedical Sciences, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano 390-8621, Japan
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Gunga Z, Marchese MV, Pfister R, Dulgorov F, Nowacka A, Rancati V, Ltaief Z, Niclaus L, Pretre R, Kirsch M. Topical skin adhesive PRINEO as the ideal wound closure system in cardiac surgery to limit surgical site infection. J Wound Care 2023; 32:S24-S30. [PMID: 37591665 DOI: 10.12968/jowc.2023.32.sup8a.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Surgical site infections (SSIs) are a major source of morbidity after cardiac surgery, involving prolonged hospitalisation. Among the numerous techniques of skin closure and dressings available, the optimal method remains undetermined. The DERMABOND-PRINEO (PRINEO) (PRINEO, Ethicon, J&J) is the only skin closure system which combines a topical skin adhesive with a mesh. Other surgical disciplines have highlighted remarkable results with PRINEO. The aim of this study was to evaluate the effects of PRINEO, used as the final layer in sternotomy closure, in the incidence of postoperative SSIs. METHOD This was a retrospective single-centre cohort study including adult patients who underwent cardiac surgery between January 2015 and December 2018. Patients who had undergone heart transplantation or ventricular assist surgery were excluded. Included patients were divided into two groups depending on the type of post-operative wound care technique used. Group 1 consisted of patients who had their sternotomy closed with a standard dressing and group 2 consisted of patients who were treated with PRINEO. The primary endpoint of our study was the occurrence of SSIs and secondary outcomes were the length of hospitalisation and mortality. RESULTS A total of 1603 patients were reviewed with the occurrence of 44 SSIs. Both groups were homogeneous in terms of risk factors. The incidence of SSIs was significantly lower in group 2 (PRINEO) than in group 1 (standard dressing) (n=29, 3.8% vs n=15, 1.8%, respectively; p=0.042). However, there was no significant difference in the duration of hospitalisation and mortality. CONCLUSION In our practice, PRINEO has proven to be a safe wound closure system after sternotomy, with a reduced SSI rate compared to conventional wound care techniques.
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Affiliation(s)
- Ziyad Gunga
- Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Mario Verdugo Marchese
- Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Raymond Pfister
- Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Filip Dulgorov
- Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Anna Nowacka
- Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Valentina Rancati
- Department of Anesthesiology, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Zied Ltaief
- Department of Anesthesiology, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Lars Niclaus
- Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Rene Pretre
- Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
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Naylor BH, Tarazi JM, Salem HS, Harwin SF, Mont MA. Wound Management following Total Knee Arthroplasty: An Updated Review. J Knee Surg 2023; 36:274-283. [PMID: 34261158 DOI: 10.1055/s-0041-1731740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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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Affiliation(s)
- Brandon H Naylor
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York City, New York
| | - John M Tarazi
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York City, New York
| | - Hytham S Salem
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York City, New York
| | - Steven F Harwin
- Department of Orthopaedic Surgery, Mount Sinai West Hospital, New York City, New York
| | - Michael A Mont
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York City, New York
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Stricker S, Eberhard N, Licci M, Greuter L, Zweifel C, Guzman R, Soleman J. Wound closure with a mesh and liquid tissue adhesive (Dermabond Prineo) system in pediatric spine surgery: a prospective single-center cohort study incorporating parent-reported outcome measures. J Neurosurg Pediatr 2022; 30:624-632. [PMID: 36459394 DOI: 10.3171/2022.8.peds22270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Wound healing can be challenging in children undergoing spine surgery for neurological conditions due to a high risk of cerebrospinal fluid (CSF) leakage and wound infection. In adults, use of the Dermabond Prineo (DP) skin closure system, which consists of both tissue adhesive glue and a self-adhesive mesh, for wound closure of medium-length surgical incisions has been reported. The aim of this study was to investigate the efficiency and cosmetic outcome of DP for wound closure in extra- and intradural pediatric neurological spine surgery. METHODS In this prospective cohort study, 47 children underwent 50 spine procedures using DP for wound closure between 2018 and 2022 at a single institution. Patient demographic and surgical data were collected. The primary outcome was revision surgery for wound healing disorders, while secondary outcomes were infections, minor wound healing disorders, and both physician and parental satisfaction (parent-reported outcome measures [PROMs]) at last follow-up. RESULTS Among 50 spinal (45 intra- and 5 extradural) interventions, 1 patient (2%) underwent revision surgery for a cutaneous CSF fistula and pseudomeningocele. Minor wound healing disorders occurred after 16 surgeries, which did not require surgical wound revision and resolved completely. No allergic reactions to DP or surgical site infections within 30 days were observed. The parents and the medical team described wound care as significantly facilitated since wound dressing changes were not needed. Three families (6.4%) encountered difficulties in wound care, and 46 (97.9%) were satisfied with DP. The cosmetic outcome based on PROMs was excellent, with a mean score of 8 (IQR 2) on a scale from 1 to 10. At long-term follow-up, a mean of 11.3 ± 10.7 months after surgery, physicians rated the cosmetic outcome on the visual analog scale (median score 9, IQR 1) and Hollander scale (median score 6, IQR 1). The outcomes were similar among the different pathologies and age groups and did not differ in patients with and without syndromic malformations. CONCLUSIONS The application of DP is simple, enables good patient comfort, facilitates both professional and parental wound care, and leads to excellent cosmetic results. DP possibly aids in the reduction of postoperative CSF leakage and infections after pediatric neurological spine surgery.
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Affiliation(s)
- Sarah Stricker
- 1Department of Pediatric Neurosurgery, Children's University Hospital of Basel
- 2Department of Neurosurgery, University Hospital of Basel
| | - Noëmi Eberhard
- 1Department of Pediatric Neurosurgery, Children's University Hospital of Basel
- 2Department of Neurosurgery, University Hospital of Basel
| | - Maria Licci
- 1Department of Pediatric Neurosurgery, Children's University Hospital of Basel
- 2Department of Neurosurgery, University Hospital of Basel
| | - Ladina Greuter
- 1Department of Pediatric Neurosurgery, Children's University Hospital of Basel
- 2Department of Neurosurgery, University Hospital of Basel
| | - Christian Zweifel
- 2Department of Neurosurgery, University Hospital of Basel
- 3Faculty of Medicine, University of Basel
- 4Division of Neurosurgery, Department of Surgery, Kantonsspital Graubünden, Chur; and
| | - Raphael Guzman
- 1Department of Pediatric Neurosurgery, Children's University Hospital of Basel
- 2Department of Neurosurgery, University Hospital of Basel
- 3Faculty of Medicine, University of Basel
| | - Jehuda Soleman
- 1Department of Pediatric Neurosurgery, Children's University Hospital of Basel
- 2Department of Neurosurgery, University Hospital of Basel
- 3Faculty of Medicine, University of Basel
- 5Clinical Trial Unit, University Hospital of Basel, Switzerland
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Chen Z, Bains SS, Sax OC, Sodhi N, Mont MA. Dressing Management during Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Knee Surg 2022; 35:1524-1532. [PMID: 36538940 DOI: 10.1055/s-0042-1758674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Dressings for total knee arthroplasty (TKA) typically focus on promoting optimal healing, while preventing infection, allowing for functionality and immediate ambulation, while providing for excellent cosmesis. We have previously described four aspects of closure after TKA involving the: (1) deep fascial layer; (2) subdermal layer; (3) intradermal layer, including the subcuticular region; and (4) a specific aseptic dressing. In this meta-analysis and systematic review of the literature, we will focus on the dressing. Specifically, we assessed: (1) infection risk of different techniques; (2) re-operation or readmission risk; and (3) length of time until dressing change needed. There were 16 reports on infection risk, re-operation risk, and length of time until change needed. A meta-analysis focused on the qualifying wound complication risk reports was also performed. The meta-analysis including four studies (732 patients) demonstrated overall lower wound complication risk with the use of adhesives and mesh dressings (odds ratio 0.67) versus traditional closures. Additionally, studies demonstrated fewer re-operations and readmissions with the use of adhesives and mesh dressings. Furthermore, one report demonstrated mesh dressings persist longer than silver dressings. Therefore, multiple recent reports suggest superior outcomes when using adhesive and mesh dressings for TKAs.
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Affiliation(s)
- Zhongming Chen
- Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Sandeep S Bains
- Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Oliver C Sax
- Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, North Shore University Hospital Northwell Health, New York, New York
| | - Michael A Mont
- Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Eichinger JK, Oldenburg KS, Lin J, Wilkie E, Mock L, Tavana ML, Friedman RJ. Comparing Dermabond PRINEO versus Dermabond or staples for wound closure: a randomized control trial following total shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:2066-2075. [PMID: 35568261 DOI: 10.1016/j.jse.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The method of surgical incision closure after total shoulder arthroplasty is an important factor to consider, as it affects operating room time, procedure cost, cosmetic outcomes, and patient satisfaction. The optimal method of wound management is unknown, but should be cost-effective, reproducible, and provide a reliable clinical result. This study aimed to compare the following wound closure methods after total shoulder arthroplasty: staples, Dermabond, and Dermabond PRINEO. We hypothesized that wound closure time for Dermabond PRINEO would be faster than Dermabond and comparable to that of staples, and Dermabond PRINEO would be more cost-effective than Dermabond and staples, and provide equal or superior closure outcomes to Dermabond and staples. METHODS A randomized, prospective clinical trial comparing wound closure time and cost for 2 surgeons' traditional technique with that of Dermabond PRINEO was conducted. This study included at least 18 subjects in each group. Surgeon 1's patients were randomized to traditional Dermabond or Dermabond PRINEO, whereas surgeon 2's patients were randomized to staples or Dermabond PRINEO. Cosmetic outcomes and satisfaction scores were collected at 6 weeks and 3 months, postoperatively. Incisions were photographed, at both the 6-week and 3-month visits, and subsequently evaluated by a plastic surgeon blinded to the treatment method. RESULTS The wound closure time for surgeon 1 was significantly faster for Dermabond PRINEO vs. Dermabond, and surgeon 2 closed significantly faster with staples vs. Dermabond PRINEO. The mean cost of closure was significantly less with Dermabond PRINEO compared with Dermabond, whereas the mean cost of staples was significantly less than Dermabond PRINEO. For both surgeons 1 and 2, there were no significant differences in patient satisfaction at 6 weeks or 3 months. In addition, the wound closure methods did not produce differing cosmetic outcomes. CONCLUSIONS Although significant, the closing time for each method did not differ by a clinically relevant amount. Staples were the most cost-effective closing method, followed by Dermabond PRINEO. As neither method was superior over the other in terms of patient satisfaction, adverse events, and cosmetic outcomes, cost-effectiveness may be the greatest differentiator between the 3 methods.
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Affiliation(s)
- Josef K Eichinger
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA.
| | - Kirsi S Oldenburg
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Jackie Lin
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Erin Wilkie
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Lisa Mock
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - M Lance Tavana
- Department of Plastic and Reconstructive Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Richard J Friedman
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
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9
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Kiaii B, Johnston SS, Jang SR, Elangovanraaj N, Tewari P, Chen BPH. Clinical and economic outcomes after sternotomy for cardiac surgery with skin closure through 2-octyl cyanoacrylate plus polymer mesh tape versus absorbable sutures plus waterproof wound dressings: a retrospective cohort study. J Cardiothorac Surg 2022; 17:212. [PMID: 36031599 PMCID: PMC9420285 DOI: 10.1186/s13019-022-01956-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To compare clinical and economic outcomes after sternotomy for cardiac surgery with skin closure through 2-octyl cyanoacrylate plus polymer mesh tape (2OPMT) versus conventional absorbable sutures plus waterproof wound dressings (CSWWD).
Methods
Retrospective study using the Premier Healthcare Database. Patients undergoing a cardiac surgery requiring sternotomy with 2OPMT or CSWWD were included. Primary outcome was 60-day cumulative incidence of diagnosis for wound complications (infection, dehiscence). Secondary outcomes were index admission hospital length of stay (LOS), total hospital-borne costs, discharge status, and 60-day cumulative incidences of inpatient readmission and reoperation. After propensity score matching, outcomes were compared between the 2OPMT and CSWWD groups using bivariate multilevel mixed-effects generalized linear models.
Results
Overall, 7,901 2OPMT patients and 10,775 CSWWD patients were eligible for study. After propensity score matching on 68 variables, each group comprised 5,338 patients (total study N = 10,676). The 2OPMT and CSWWD groups did not differ significantly in terms of the 60-day cumulative incidences of wound complication (3.47% vs 3.47%, p = 0.996), inpatient readmission (12.6% vs. 13.6%, p = 0.354), and reoperation (10.3% vs 10.1%, p = 0.808), as well as discharge to home versus non-home setting (77.2% vs. 75.1%), p = 0.254. However, the 2OPMT group had significantly lower LOS (9.2 days vs 10.6 days, p < 0.001) and total hospital-borne costs ($50,174 vs $60,526, p < 0.001).
Conclusions
This large observational study provides evidence that sternotomy skin closure with 2OPMT is associated with nearly identical 60-day cumulative incidence of wound complication as compared with CSWWD, while exhibiting a significant association with lower LOS and total hospital-borne costs.
Trial registration Not applicable.
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10
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Chobpenthai T, Poosiripinyo T, Tuntarattanapong P, Thanindratarn P, Trathitephun W. Outcomes of 2-octyl cyanoacrylate skin adhesives following musculoskeletal oncology surgery: A STROBE-compliant observational study. Medicine (Baltimore) 2021; 100:e28326. [PMID: 34918713 PMCID: PMC8678018 DOI: 10.1097/md.0000000000028326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/16/2021] [Accepted: 11/28/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT 2-octyl cyanoacrylate (2OCA) is a high-viscosity medical-grade tissue adhesive that is routinely used. However, no studies have evaluated its use in musculoskeletal surgery.We enrolled 99 patients who underwent musculoskeletal surgery. 2OCA was chosen for wound closure and was performed by a specific surgeon for all patients. The drying times for the adhesive were recorded, and photographs were obtained intra-operatively. Posttreatment follow-up consisted of queries regarding pain level and recording incisional dehiscence, wound infection, hematoma, and incisional bleeding. Data collection was performed postoperatively at 48 hours, 5 to 10 days, 14 days, and 30 days. Other adverse events were documented.2OCA was applied to 110 incisions in 99 patients, comprising 62 female and 37 male patients. The mean age of patients was 50.41 (±16.83) years; mean incision length was 10.24 (±5.7) cm, and the mean pain score using a visual analogue scale was 2.37 on a postoperative day 7. The mean drying time was 1.81 (±0.59) minutes; 91 (91%) patients reported excellent and superior satisfaction, and the remaining patients reported "good" (6%) and "fair" (2%) satisfaction. The percentages of dehiscence, hematoma and keloid formation were considerably low.In this study, 2OCA was safe for musculoskeletal oncology surgical incisions. The incidence of postoperative adverse events was low. However, some patients develop hematomas. Postoperative pain was low, and patient satisfaction was high. 2OCA can be a practical alternative to traditional suture closure for skin incisions after musculoskeletal surgery.
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Affiliation(s)
- Thanapon Chobpenthai
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
- Department of Orthopaedic Surgery, Chulabhorn Hospital, Bangkok, Thailand
| | | | - Pakjai Tuntarattanapong
- Department of Orthopaedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Lee GW, Kwak WK, Lee KB. Comparison of 2-octyl cyanoacrylate skin adhesive and interrupted polypropylene sutures for wound closure in total ankle arthroplasty. J Orthop Surg Res 2021; 16:636. [PMID: 34689815 PMCID: PMC8543931 DOI: 10.1186/s13018-021-02791-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adhesive skin materials have increasingly been used in orthopedic surgery. We aimed to compare the efficacy and safety of skin adhesive (2-octyl cyanoacrylate and polymer mesh, Dermabond Prineo) and interrupted polypropylene sutures for wound closure in patients undergoing total ankle arthroplasty (TAA). METHODS We prospectively enrolled 107 consecutive patients (108 ankles) undergoing TAA and divided them into two groups: skin adhesive group (36 ankles) and suture group (72 ankles). The primary outcome assessment included wound complications and patient satisfaction for wound cosmesis. The secondary outcome assessment included duration of surgery, length of hospital stay, and the Ankle Osteoarthritis Scale (AOS) pain and disability score. RESULTS There was one case of allergic contact dermatitis, three cases of wound dehiscence, and one case of superficial surgical site infection in the skin adhesive group. Among them, one case each with allergic contact dermatitis and wound dehiscence finally progressed to deep surgical site infection. Three cases of wound dehiscence were also reported in the suture group; however, there was no case of surgical site infection. Patient satisfaction for wound cosmesis was significantly higher in the skin adhesive group than in the suture group (p = 0.001). There was no statistically significant difference between the groups in terms of secondary outcomes (p > 0.05). CONCLUSIONS Although the use of Dermabond Prineo showed better patient satisfaction for wound cosmesis, it showed significantly high wound complication rates and no other clinical benefits compared to interrupted polypropylene suture in TAA. Our results suggest that awareness of the possibility of wound complications is necessary when Dermabond Prineo is used in TAA.
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Affiliation(s)
- Gun-Woo Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 42 Jebongro, Donggu, Gwangju, 61469, Republic of Korea
| | - Woo Kyoung Kwak
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 42 Jebongro, Donggu, Gwangju, 61469, Republic of Korea
| | - Keun-Bae Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 42 Jebongro, Donggu, Gwangju, 61469, Republic of Korea.
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Hasan O, Jiwani A, Mazhar L, Begum D, Lakdawala R, Noordin S. Comparison of Surgical Site Infection After Skin Closure by Prolene or Staples in Bilateral Simultaneous Knee Arthroplasty Patients: A Parallel Design Randomized Controlled Trial Protocol. Int J Surg Protoc 2021; 25:154-159. [PMID: 34430763 PMCID: PMC8344962 DOI: 10.29337/ijsp.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Knee arthroplasty also known as the total knee replacement is an orthopedic surgical procedure done to resurface the knee that has been severely damaged by arthritis. After the completion of the surgical procedure, the skin closure is done. The optimal goal of skin closure after the procedure is to promote rapid healing and an acceptable cosmetic result while minimizing the risk of infection. Skin closure after knee arthroplasty is done by using either of the two widely used sutures i.e., polypropylene (Prolene) sutures or the skin staple sutures. There are no standard guidelines as which type of the suture should be used. The present study aims to compare the incidence of surgical site infections (superficial and deep) for Prolene vs staple sutures in the bilateral knee arthroplasty patients within 6 weeks for superficial and within 90 days for deep infection. Methods: This study will be conducted as an open blinded, parallel design, equivalence randomized controlled trial. The patients would be selected and randomized in 1:1 ratio to receive either of the two interventions i.e., Prolene or Staples. Patients undergoing unilateral or staged total knee replacement (TKR) were excluded. Analysis: The normality assessment will be done using Shapiro Wilk test. Cox proportional hazard regression will be used to check the univariate and multi-variable associations of independent variables with the outcome. Both intention to treat analysis and per protocol analysis would be performed. Ethics and Dissemination: All the required approvals will be taken from the ethical review committee. Informed consent will be taken form the patient to enroll him/her in the study. Results of the study will be disseminated to the study participants, public health and clinical professionals and would also be published in a reputable international journal. The trial is registered at clinicaltrials.gov and UIN of the registry is NCT04492852. Highlights
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Affiliation(s)
- Obada Hasan
- Orthopaedic Oncology, University of Iowa, US
| | | | - Laraib Mazhar
- Department of Medicine, Aga Khan University Karachi, PK
| | - Dilshad Begum
- Clinical Trials Unit, Aga Khan University Karachi, PK
| | - Riaz Lakdawala
- Department of Surgery, Medical College, Aga Khan University Karachi, PK
| | - Shahryar Noordin
- Department of Surgery, Medical College, Aga Khan University Karachi, PK
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13
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Comparison between Zip-Type Skin Closure Device and Staple for Total Knee Arthroplasty: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6670064. [PMID: 34055997 PMCID: PMC8137286 DOI: 10.1155/2021/6670064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/03/2021] [Accepted: 04/29/2021] [Indexed: 01/26/2023]
Abstract
Purpose To compare the efficacy and safety of zip-type skin closure device (SCD) and staple in total knee arthroplasty (TKA). Methods Potential academic articles were identified from PubMed, Springer, ScienceDirect, and Cochrane Library from the inception of electronic databases to July 2020. The statistical analyses were performed with RevMan 5.1. Results One randomized controlled trial (RCT) and 5 non-RCTs met the inclusion criteria. Present meta-analysis reveals that SCD is associated with lower wound pain score, scar score, and readmission compared with a staple. No significant differences are identified in terms of wound total complications, dehiscence, blisters, and infection. Conclusions Comparing with a staple, zip-type SCD is a less painful skin closure method with fewer medical cost undergoing TKA.
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Johnston SS, Fortin SP, Pracyk JB, Tommaselli GA, Elangovanraaj N, Chen BP. Economic and clinical outcomes of spinal fusion surgeries with skin closure through skin staples plus waterproof wound dressings versus 2-octyl cyanoacrylate plus polymer mesh tape. Spine J 2021; 21:45-54. [PMID: 32890785 DOI: 10.1016/j.spinee.2020.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal fusion surgeries are one of the most common types of operations performed during inpatient stays in the United States. Successful wound closure, including watertight closure at the skin layer, plays in important role in patient outcomes. PURPOSE To compare the economic and clinical outcomes of spinal fusion surgeries using one of two sutureless skin closure techniques: skin staples plus waterproof wound dressings (SSWWD) or 2-octyl cyanoacrylate plus polymer mesh tape (2OPMT). STUDY DESIGN/SETTING Retrospective study using a multi-hospital database. PATIENT SAMPLE Patients undergoing inpatient spinal fusion surgery for a spine disorder between October 1, 2015 and March 31, 2019. OUTCOME MEASURES Total costs from the hospital perspective, operating room time (ORT), hospital length of stay (LOS), non-home discharge, infection/wound complications during the 90-day global period (index surgery through 90 days post-discharge), and 30/60/90-day all-cause readmissions. METHODS Outcomes were compared between study groups using nearest neighbor propensity score matching with exact matching on 45 primary procedure/diagnosis code groupings and generalized estimating equations to account for hospital-level clustering. This study was sponsored by Ethicon, Inc., a Johnson & Johnson company; the authors are employees or consultants of Johnson & Johnson. RESULTS A total of 11,991 patients met the study criteria (2OPMT=5,961; SSWWD=6,030), of which 3,602 were included in each post-match study comparison group (total=7,204). As compared with the SSWWD group, the 2OPMT group had statistically significant lower median ORT (240 vs. 270 minutes; p=0.002), mean LOS (3.35 [SD=2.6] vs. 3.86 [SD=2.8] days, p=0.031), risks of non-home discharge status (17.63% vs. 23.10%, p=0.035), overall infections/wound complications (1.37% vs. 2.48%, p=0.015), and surgical site infection (1.11% vs. 2.07%, p=0.023). Differences between the study groups in total hospital costs, all-cause readmissions, and other sub-components of the infection/wound complication composite outcome were statistically insignificant (p>0.05). CONCLUSIONS In this retrospective observational study of patients undergoing elective inpatient spinal fusion surgery, the use of 2OPMT for skin closure was associated with significantly lower ORT, LOS, non-home discharge, and 90-day rates of infections/wound complications as compared with SSWWD.
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Affiliation(s)
- Stephen S Johnston
- Epidemiology, Medical Devices; Johnson & Johnson; 410 George Street, New Brunswick, NJ, USA.
| | - Stephen P Fortin
- Epidemiology, Medical Devices; Johnson & Johnson; 410 George Street, New Brunswick, NJ, USA.
| | - John B Pracyk
- Pre-Clinical & Clinical Research, Medical Affairs; DePuy Synthes Spine; 325 Paramount Drive, Raynham, MA, USA.
| | - Giovanni A Tommaselli
- Pre-Clinical & Clinical Research, Medical Affairs; Ethicon, Inc.; Ethicon Srv Rd, Bridgewater Township, NJ, USA.
| | - Nivesh Elangovanraaj
- Mu Sigma; 7th - 14th Aviator Building Whitefield Road Ascendas, ITPL SEZ, EPIP Zone, Bengaluru, Karnataka 560066, India.
| | - Brian P Chen
- Franchise Health Economics and Market Access, Ethicon, Inc.; Ethicon Srv Rd, Bridgewater Township, NJ, USA.
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15
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Kong X, Yang M, Guo R, Chen J, Chai W, Wang Y. A Prospective, Randomized and Controlled Study on Tissue Adhesive for Skin Incision in Total Knee Arthroplasty. Ther Clin Risk Manag 2020; 16:795-802. [PMID: 32922017 PMCID: PMC7457845 DOI: 10.2147/tcrm.s260007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/04/2020] [Indexed: 12/23/2022] Open
Abstract
Background The 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. Patients and Methods From September 2019 to November 2019, we prospectively enrolled the consecutive patients who underwent simultaneous bilateral TKA in our institute. The allocation 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 standard skin closure (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. Conclusion 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 one safe and convenient method of skin closure in TKA. Chinese Clinical Trial Registry ChiCTR1900025730; Registered 6 September 2019.
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Affiliation(s)
- Xiangpeng Kong
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Minzhi Yang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, People's Republic of China.,Nankai University, Tianjin, People's Republic of China
| | - Renwen Guo
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jiying Chen
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wei Chai
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yan Wang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, People's Republic of China
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16
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Anderson FL, Herndon CL, Lakra A, Geller JA, Cooper HJ, Shah RP. Polyester Mesh Dressings Reduce Delayed Wound Healing and Reoperations Compared with Silver-Impregnated Occlusive Dressings after Knee Arthroplasty. Arthroplast Today 2020; 6:350-353. [PMID: 32566715 PMCID: PMC7298533 DOI: 10.1016/j.artd.2020.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/08/2020] [Accepted: 05/02/2020] [Indexed: 01/05/2023] Open
Abstract
Background New dressings aimed at reducing surgical wound complications after knee arthroplasty continue to evolve. We compared wound complications and reoperations between 2 dressings: 2-octyl cyanoacrylate adhesive and polyester mesh (Dermabond® Prineo®, “mesh”) and silver-impregnated occlusive dressings and n-butyl-2-cyancacrylate adhesive (AQUACEL® Ag SURGICAL cover dressing with SwiftSet™, “standard"). Methods This retrospective cohort study reviewed 353 consecutive partial and total knee arthroplasties performed by a single surgeon; 6 were excluded for not using either dressing type. Thus, 347 cases were separated into 2 cohorts: mesh (n = 176) and standard dressing (n = 171). Demographics and risk factors were similar, except for age. Surgical and closure techniques were consistent in all patients. Delayed wound healing was assessed by the surgeon at the 2-week office visit for drainage, suture abscess, or wound edge separation. Secondary outcome measures include infection, office-based closure, and return to the operating room for reclosure. Results There were 2 instances of delayed wound healing in the mesh group and 16 in the standard dressing group (1.14% vs 9.36%, P ≤ .0001). There were significantly fewer reoperations in the mesh group than in the standard group (0 vs 2.33%, P = .04). There were no infections or office-based closures. Conclusion Mesh dressings were associated with fewer episodes of delayed wound healing and reoperations than the standard dressing. A possible mechanism may be that this brand of mesh distributes wound tension more evenly. In addition, because it remains in place longer during the immediate postoperative period, it may work via prolonged wound edge support.
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Affiliation(s)
- Forrest L Anderson
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Carl L Herndon
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Akshay Lakra
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey A Geller
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - H John Cooper
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Roshan P Shah
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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17
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Polyester mesh dressings reduce delayed wound healing rates after total hip arthroplasty compared with silver-impregnated occlusive dressings. Arthroplast Today 2020; 6:158-162. [PMID: 32368604 PMCID: PMC7184099 DOI: 10.1016/j.artd.2020.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 12/23/2022] Open
Abstract
Background New dressings purport to reduce surgical wound complications after total hip arthroplasty (THA). This study compared delayed wound healing rates and reoperations between 2 increasingly popular dressings: a silver-impregnated occlusive (standard) dressing and a 2-octyl cyanoacrylate adhesive with polyester mesh. Methods This retrospective cohort study reviewed 431 consecutive THAs performed by 2 surgeons between January 2017 and May 2019. One hundred and eight were excluded for not using standard or mesh dressings. A final 323 cases were separated into 2 cohorts: mesh (n = 186) and standard dressings (n = 137). Standard dressings were removed at 1 week. Mesh persisted until nonadherent, approximately 3-4 weeks. The surgeon assessed delayed wound healing at the 2-week postoperative visit. Secondary outcomes include deep infection and return to the operating room for a wound-related diagnosis. Differences were determined using the chi-square test. Results There were no demographic, comorbidity, or surgical differences between groups. There were 22 total cases of delayed wound healing with 7 (3.8%) in the mesh group and 15 (10.9%) in the standard dressing group (P = .01). There were no significant differences in reoperations (2 [1.1%] vs 2 [1.5%], P = .76) or deep infections (2 [1.1%] vs 1 [0.7%], P = .75). Conclusions Mesh dressings are a safe and reliable dressing type for THA and were associated with a decrease in early wound healing complications when compared with standard, silver-impregnated occlusive dressings in this retrospective series. The mesh tension sharing properties and longer duration of occlusive protection may explain this difference. Level of Evidence Level III.
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18
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Snyder MA, Sympson AN, Wurzelbacher SJ. Integrated clinical pathways with watertight, multi-layer closure to improve patient outcomes in total hip and knee joint arthroplasty. J Orthop 2020; 18:191-196. [PMID: 32042225 PMCID: PMC7000436 DOI: 10.1016/j.jor.2019.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/11/2019] [Indexed: 01/26/2023] Open
Abstract
The number of primary total hip and knee replacement surgeries is increasing primarily due to an aging population. There is also a concomitant increase in the number of complications which could be attributed to high variation in arthroplasty techniques, peri-operative methods and the absence of integrated clinical pathways (ICP) to mitigate risks such as surgical site infections (SSIs). The implementation of ICPs incorporating watertight, multi-layer closure could increase the preventative effectiveness against joint prosthetic adverse events. The objective of this review is to describe the ICPs implemented by one US facility to help address ten adverse events synergistically.
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Affiliation(s)
| | - Alexandra N. Sympson
- Corresponding author. Academic Research Coordinator of Orthopaedics, TriHealth Hatton Research Institute, Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH, 45220, USA.
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19
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Skin Closure Tape and Surgical Staples in Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4827617. [PMID: 32420346 PMCID: PMC7199617 DOI: 10.1155/2020/4827617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/15/2019] [Accepted: 11/22/2019] [Indexed: 01/17/2023]
Abstract
Background Staples closure technology has been widely used in total knee arthroplasty (TKA) and achieved good results. In recent years, a new type of material called skin closure tape (SCT) has been applied to TKA which also showed good treatment results. However, since it is still not clear yet which one is better, this paper collects literatures for statistical analysis so as to provide evidence for the use of SCT in TKA. Methods The comparative study on effects between SCT and staples is reviewed after the primary release of TKA in PubMed, the Cochrane library, and the EMBASE database up to March 2019. The two researchers independently screened the literature and evaluated the quality of the literature using bias risk tools. Results A total of four studies (3330 knees) have been included in our meta-analysis. For the main point, the results show that the SCT can reduce readmission rates compared to staples (RR 0.68, 95% CI 0.49–0.95, P=0.03), with no significant difference in complications (RR 0.85, 95% CI 0.27–2.64, P=0.77). Secondly, the results suggest that although there is no significant difference in removal time between the two groups, the SCT can reduce pains, save time and costs, and have a better cosmetic effect. Conclusions Our study indicates SCT as a closure method with fewer complications and faster speed compared with staples. Nevertheless, the cost and pain need to be further confirmed because of the small sample size included in this study.
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20
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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. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:447-453. [DOI: 10.1007/s00590-019-02591-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/02/2019] [Indexed: 02/06/2023]
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Vendittoli PA, Pellei K, Desmeules F, Massé V, Loubert C, Lavigne M, Fafard J, Fortier LP. Enhanced recovery short-stay hip and knee joint replacement program improves patients outcomes while reducing hospital costs. Orthop Traumatol Surg Res 2019; 105:1237-1243. [PMID: 31588036 DOI: 10.1016/j.otsr.2019.08.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/29/2019] [Accepted: 08/27/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION An attractive option to reduce hospital length of stay (LOS) after hip or knee joint replacement (THA, TKA) is to follow the Enhanced Recovery After Surgery principles (ERAS) to improve patient experience to a level where they will feel confident to leave for home earlier. The objective of this study was to evaluate the implementation of short-stay protocol following the ERAS principles. HYPOTHESIS We hypothesized that our ERAS THA and TKA short-stay protocol would result in a lower complication rate, shorter hospital LOS and reduced direct health care costs compared to our standard procedure. MATERIAL AND METHODS We compared the complications rated according to Clavien-Dindo scale, hospital LOS and costs of the episode of care between a prospective cohort of 120 ERAS short-stay THA or TKA and a matched historical control group of 150 THA or TKA. RESULTS Significantly lower rate of Grade 1 and 2 complications in the ERAS short-stay group compared with the standard group (mean 0.8 vs 3.0, p<0.001). No difference was found between the 2 groups for Grade 3, 4, or 5 complications. The mean hospital LOS for the ERAS short-stay group decreased by 2.8 days for the THAs (0.1 vs 2.9 days, p<0.001) and 3.9 days for the TKAs (1.0 vs 4.9 days, p<0.001). The mean estimated direct health care costs reduction with the ERAS short-stay protocol was 1489 CAD per THA and 4158 CAD per TKA. DISCUSSION In many short-stay protocols, focus has shifted from ERAS goals of a reduction in complications and improved recuperation to use length of stay as the main factor of success. Implementation of an ERAS short-stay protocol for patients undergoing THA or TKA at our institution resulted not only in reduced hospital LOS, but also in improved patient care and reduced direct health care costs. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Pascal-André Vendittoli
- Surgery Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada.
| | - Karina Pellei
- Surgery Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
| | - François Desmeules
- Surgery Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
| | - Vincent Massé
- Surgery Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
| | - Christian Loubert
- Anesthesia Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
| | - Martin Lavigne
- Surgery Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
| | - Josée Fafard
- Internal Medicine Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
| | - Louis-Philippe Fortier
- Anesthesia Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
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