Adhesive strips as the sole method for skin closure is effective in total knee arthroplasty

Abstract

Objective: Adhesive strips are used as the sole method for skin closure in many operations except total knee arthroplasty. The claims are decreased wound closure time, less tissue reaction, and lack of stitch marks. The purpose of this study was to compare the efficacy of closure using adhesive strips versus running subcuticular stitches. Methods: This study was a retrospective case-matched study. Running subcuticular stitches or adhesive strips were used for skin closure in 151 and 137 patients, respectively. All of the patients had an operation by a single surgeon and had the same patient care protocol. All of the patients were evaluated postoperatively for wound complication at 2 weeks, 6 weeks, and 3 months follow-up. Results: The wounds of most patients in both groups had healed. The incidence of superficial infection was not different between the groups (1.32% in the running subcuticular suture group and 1.46% in the adhesive strip group) ( p = 0.92). One case (0.66%) in the running subcuticular suture group had deep infection, which required reoperation ( p = 0.34). The patients in the running subcuticular suture group had higher unabsorbable sutures, which required further removal compared to the adhesive strip group ( p < 0.001). Conclusion: The use of adhesive strips is an effective skin closure method with a low rate of infection and skin complications. This technique is easy and there is no need for suture removal. Furthermore, there are no stitch marks and the cost of suturing is lower.

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

“…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 ).…”

“…[ 30 , 67 ] 2019 USA RCT Knee 54 TSA + polyester mesh vs staples Superficial SSIs were defined according to literature (Healy 2013 and Deirmengian 2014) Yuenyongviwat et al. [ 51 ] 2019 Thailand Observational (case matched) Knee 288 Traditional sutures vs adhesive strips Definition not reported. Akdogan and Atilla [ 54 ] 2020 Turkey Observational Knee 274 Aquacel Ag vs conventional gauze Definition not reported.…”

“… b All but one study received a star for ascertainment of exposure using surgical records and the study that did not included no description of the ascertainment of exposure [ 10.1016/j.jss.2020.11.087 ]. c Twelve of the studies received one star for comparability of the cohorts on the basis of design or analysis [ [41] , [42] , [43] , [44] , [45] , [46] , [47] , [49] , [50] , [51] , [52] , [54] ] since they did not perform adjusted analyses, regression, or matching for the outcomes of interest. The cohorts from most studies were balanced in terms of patient age and other baseline characteristics apart from those of two studies [ 48 , 53 ].…”

“… e Only two studies did not follow patients for at least one month following surgery [ 53 , 54 ] and did not receive a star for follow-up duration long enough for outcomes to occur. f Five studies reported either no loss to follow-up or follow-up of >80% of patients [ [41] , [42] , [43] , [44] , 46 ] and received a star, the other nine studies did not provide information of loss to follow-up [ 45 , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] ]. …”

Clinical outcome of different skin closure in total-knee arthroplasty: running subcuticular closure vs intermittent closure

“…[ 3 , 4 ] In addition to running subcuticular or intermittent closure using staples or barbed sutures, [ 5 – 7 ] a novel “zip” device and skin adhesives have also been explored for post-TKA skin closure. [ 8 , 9 ] Although intermittent closure with silk suture is routinely used for different surgical wounds, subcuticular closure with absorbable sutures are increasingly being considered owing to their convenience and better cosmetic appearance. In this retrospective study, we compared the 6-month clinical outcome of running subcuticular closure and intermittent closure post-TKA.…”