Aims. Tissue adhesives (TAs) are a commonly used adjunct to traditional surgical
The purpose of this modified Delphi study was to obtain consensus on
Introduction and Aims: Primary
Introduction. Primary
Several disadvantages can be attributed to suture knots in
Aim. Wound leakage has been shown to increase the risk of prostetic joint infections (PJIs) in primary total hip (THA) and knee arthroplasty (unicondylar and total knee arthroplasty; KA). The aim of this study is to determine whether the addition of a continuous subcuticular bonding stitch to a conventional 3-layer closure method reduces the incidence of prolonged wound leakage and PJIs after THA and KA. Method. This retrospective cohort study included all patients receiving a THA or KA. Patients in the control group with a 3-layer closure method had surgery between November 1. st. 2015 and 2016, and were compared to the study group with a 4-layer closure method that had surgery between January 1. st. 2017 and 2018. The primary outcome was incidence of prolonged wound leakage longer than 72 hours. Differences were evaluated using logistic regression. Incidence of PJIs was the secondary outcome. Results. A total of 439 THA and 339 KA in the control group and 460 THA and 350 KA in the study group were included. In the control group 11.7% of the patients had a prolonged leaking wound compared to 1.9% in the study group (p<0.001). The modified
We compared the postoperative wound discharge rates and 3 months clinical results of three types of
A suitable
Background. Surgical
Aims. The aims of this study were to determine if vacuum assisted closure (VAC) therapy affords quicker
Introduction and Aims: The use of ‘superglue’ (2-Octylcyanoacrylate) in
Aims: To compare
Introduction. Skin closure methods are various in total knee arthroplasty (TKA). Subcuticular skin closure techniques, which do not require postoperative stitch removal, are considered to be useful for excellent cosmesis and patients' satisfaction. Basically, subcuticular skin closure provides the tightness and water-tight seal, which leads to loss of postoperative normal physiologic drainage. As a routine
Introduction: Wound Hemearthrosis remains a major concern following TKA. This prospective study evaluates the use of a knotless interlocking suture system and its relationship to wound appearance and OR efficiency. Methods: Two groups of patients undergoing TKA in our institution were evaluated using two different
Purpose: Resection of pelvic sarcoma with limb preservation (internal hemipelvectomy) is a major undertaking. Resection requires large areas of soft-tissue to be removed. Because of wound complications, we manage these defects with immediate tissue transfer (ITT) at the time of resection when a large defect is anticipated. This study compares the outcomes of ITT with primary
Obtaining primary wound healing in Total Joint Arthroplasty (TJA) is essential to a good result. Wound healing problems can occur and the consequences can be devastating to the patient and to the surgeon. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as Type A: no healing compromises and Type B: systemic or local healing compromises factors present. Local factors include traumatic arthritis with multiple previous incisions, extensive scarring, lymphedema, poor vascular perfusion, and excessive local adipose deposition. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immune compromise, steroids, smoking, and poor nutrition. In high risk situations the surgeon should encourage positive patient choices such as smoking cessation and nutritional supplementation to elevate the total lymphocyte count and total albumin. Careful planning of incisions, particularly in patients with scarring or multiple previous operations, is productive. Around the knee the vascular viability is better in the medial flap. Thus, use the most lateral previous incision, do minimal undermining, and handle tissue meticulously. We do all potentially complicated TKAs without tourniquet to enhance blood flow and tissue viability. The use of perioperative anticoagulation will increase wound problems. If wound drainage or healing problems do occur immediate action is required. Deep sepsis can be ruled out with a joint aspiration and cell count, and negative culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be managed by debridement to obtain a live wound. Options available for coverage of complex wound problems include myocutaneous flaps, pedicled skin flaps, and skin grafts. Wet, occlusive dressings and wound VACs encourage epithelisation of chronic wounds.
Our audit examined the rates of complication in the surgical wounds of patients having surgery for fractured neck of femur, comparing the use of skin clips and an absorbable subcuticular suture. The initial part of the audit compared the commonly used methods of skin closure at our institution, as outlined above. One hundred consecutive patients with fractured necks of femur (NOF) were studied. The closure of the wounds was randomly allocated between skin clips and subcuticular suture. The wounds were monitored for signs of complications, including infection, for the duration of hospital stay. It was found that the use of skin clips carried with it a significantly higher rate of complication (11.1% ) when compared with use of subcuticular absorbable suture (0% ). At this stage, we concluded that the latter method be adopted as departmental policy. A further study was performed one year later to reevaluate the efficacy of the new practice. A further fifty consecutive patients with NOF were studied using the same parameters as before. Our results demonstrated that the rate of complication was clinically and statistically significant. We closed the loop of the audit cycle and concluded that the use of an absorbable subcuticular suture should be the preferred method of closure of hip wounds in NOF surgery.
Orthopaedic surgical site infections (SSI's) prolong total hospital stays by a median of 2 weeks per patient, approximately double re-hospitalization rates, and increase healthcare costs by more than 300%. Patients with orthopaedic SSI's have significant reductions in their health-related quality of life. We performed a systematic review and meta-analysis to compare differences in outcomes between use of sutures and non-absorbable staples for closure of orthopaedic surgical wounds in adults. The primary outcomes were rates of superficial and deep SSI. Secondary outcomes included wound dehiscence, length of hospital stay, patient satisfaction and pain during removal of closure material. Data sources including PubMed, EMBASE, Scopus, Web of Science, Cochrane Library,
Open tibia fractures are common injuries in our paediatric population and are often associated with high-energy trauma such as pedestrian-vehicle accidents. At our institution, these injuries are routinely treated with debridement and mono-lateral external fixation. The purpose of this study was to determine the outcome of open tibia fractures treated according to this protocol, as well as the complication rate and factors contributing to the development of complications. We performed a retrospective folder review of all patients with open tibia fractures that were treated according to our protocol from 2015–2019. Patients treated by other means, who received primary treatment elsewhere, and with insufficient data, were excluded. Data was collected on presenting demographics, injury characteristics, management, and clinical course. Complications were defined as pin tract infections, delayed- or non-union, malunion, growth arrest, and neurovascular injury. Appropriate statistical analysis was performed. One-hundred-and-fifteen fractures in 114 children (82 males) with a median age of 7 years (IQR 6–9) were included in the analysis. Pedestrian vehicle accidents (PVA's) accounted for 101 (88%) of fractures, and the tibial diaphysis was affected in 74 cases (64%). Fracture severity was equally distributed among the Gustillo-Anderson grades. The median Abbreviated Injury Score was 4 (IQR 4;5). Ninety-five fractures (83%) progressed to uneventful union within 7 weeks. Twenty patients (17%) developed complications, with delayed union and fracture site infections being the most common complications. Gustillo-Anderson Grade 3 fractures, an increased Abbreviated Injury Score, and the need for advanced