HYDROCOLLOID-GEL SHEET FOR HIP ARTHROPLATY: AN ALTERNATIVE TO EPIDERMAL SUTURE

Abstract

We apply a hydrocolloid-gel sheet (C-12, Karayaheive, Alcare, Tokyo, Japan) for the hip arthroplasty. The sheet is a kind of wound dressing film made of the Hevea sap. The Hevea sap has been widely applied for the stoma or cosmetics (e.g. facial mask, UV protection moisturizer, hair lotion). We use it since October 2004. It applies the moist wound healing mechanism without preventing the self-wound-healing. The surgical exudate is kept under the sheet to apply the moist wound healing mechanism. The sheet had been improved originally as a wound dressing material. Because of its very strong adhesiveness, we use it also as an alternative to the epidermal suture. In our method, we do not use any epidermal suture or staples. We use an anterolateral approach making an arcate incision. After the subcutaneous tissue was sutured just like as in the case of using the epidermal sutures or staples, the sheet was attached to the skin. Both the sheet and the overlaying gauze were not changed until the removals on the tenth day after surgery.

We have applied this wound closure method for 814 primary surgeries. Among them, we evaluated 56 hips in 49 patients (three males and 46 females) (including seven patients of the simultaneous bilateral surgery) with minimum of two years follow-up. The average age at the surgery was 61 (40 to 77). The diagnosis at the surgery was dysplastic osteoarthritis for 50 hips in 45 patients, primary osteoarthritis for five patients in three hips, and rheumatoid arthritis for one hip. The uncemented implants were used for all patients. In all patients, a good wound healing was obtained. The wound dehiscence occurred in two patients, however the wound healed later by attaching the hydrocolloid-gel sheet again. The hyperplastic scar was observed in one hip.

Though Orientals have less ability of wound healing than Caucasian, a satisfactory wound healing was achieved without any epidermal suture. Comparing the conventional skin closure methods, the hydrocolloid gel sheet brought about less pain; as no removal of staples was necessary, less time and labor, less medical waste, and better wound healing. As the disadvantage, some sensitive patients might mind the smell of the exudate under the gel sheet. The wound closure method using the hydrocolloid-gel sheet was very useful for the hip arthroplasty.