A HYDROCOLLOID FILM “KARAYAHESIVE” AS AN ALTERANATE FOR EPIDERMAL SUTURE IN TOTAL KNEE ARTHROPLASTY

Abstract

“Karayahesive” is a viscoelastic film made of Karaya gum. The Karaya gum includes some polysaccarides and is exted from Karaya gum tree (Sterculia urens). It applies “Moist Wound Healing Mechanism” which has been proposed by plastic surgeons. According to this mechanism, the spontaneous wound cure can be promoted by preventing wound becoming dry, keeping a wet environment around wound, and reducing the inhibitors against wound healing. It was originally developed as a wound dressing material to use after the ordinal skin closure. We remarked its strong adhesiveness, as a modification, we use it as an alternate for epidermal suture. Since June 2006, we have been using it for 183 knees. Among them, in this study, we evaluated 158 knees in 183 (18 male, 165 female) patients with minimum of two months follow-up. The diagnosis at the surgery was osteoarthritis for 137 knees, rheumatoid arthritis for 20 knees, and aseptic necrosis of the femoral condyle for one knee. The average age at the surgery was 70.8 (40 to 84). The average of follow-up was 8.5 (two to 21) months. In all knees we used a parapatellar medial approach. Without any epidermal suture, the wound was closed by attaching Karayahesive. Before attaching Karayahesive, we made the ordinal subcutaneous suture just like as the conventional skin closure. We wipe off the blood to dry the skin. Without any epidermal suture, we attached Karayahesive to reduce the wound tension. After attaching it, we made the ordinal gauze dressing and compression bandage. No dressing change was necessary until the removal. Karayahesive was removed two weeks after the surgery, together with clot and overlaying dressings. After the removal, most patients require no additional dressing and could go into bathtub on the same day. The excellent primary wound healing was obtained in 152 knees. In six knees, the wound disrupted. However, re-attach of “Karayahesive” provided early healing of the disrupted wound successfully. Comparing the ordinal epidermal suture, the patients complained less pain at the removal and irritation after the surgery, and Karayahesive provided better wound healing. It saved time and labor as no epidermal suture and no dressing change were necessary. It saved cost of the medical waste. On the other hand, it was difficult to observe the wound; as it was concealed by clot. We had to be very careful not to miss early symptom of the infection. In conclusion, for the knee arthroplasty Karayahesive was not only very useful wound closure material but also the excellent alternate for the epidermal suture.