Patient Satisfaction and Cosmetic Outcome in a Randomized, Prospective Study of Total Knee Arthroplasty Skin Closure Comparing Zip Surgical Skin Closure with Staples

Abstract

BackgroundEvaluation of the Zip surgical skin closure device (Zip) versus metal staples regarding patient satisfaction and cosmesis after total knee arthroplasty (TKA). MethodsPatients undergoing TKA at Einstein Medical Center Montgomery were randomized to receive skin closure using Zip or staples. Patient satisfaction was assessed by surveys at discharge, three weeks and six weeks post-operatively. Cosmesis according to patients and observers was assessed using the Patient and Observer Scar Assessment Scale (POSAS). ResultsRandomization resulted in 21 Zip and 20 staple patients. Two subjects were lost to follow-up and one patient suffered cardiac arrest. Surgeon satisfaction favored Zip over staples on day of surgery and patient discharge. At three weeks, Zip was favored over staples for patient-reported movement and device removal pain. Patient satisfaction results favored Zip for comfort, ease of wound care, and hospital selection based on wound closure. POSAS favored Zip for appearance, pain, itching, color, stiffness, thickness, irregularity, vascularity, pigmentation, relief, pliability, surface area, and observer opinion. Subject opinion resulted in no difference between groups. At six weeks, no differences were found for patient-rated movement pain or ease of wound care. POSAS favored Zip for color, stiffness, thickness, vascularity, pigmentation, thickness, relief, pliability, surface area and observer opinion. ConclusionSatisfaction with the closure method and patient and physician assessments of cosmesis were superior with Zip. Orthopedic surgeons strive to optimize TKA patient satisfaction. Skin closure can influence patient satisfaction as the memory of their recovery fades and the scar remains the most visible reminder of their experience.

A novel zipper device versus sutures for wound closure after surgery: a systematic review and meta‐analysis

“…16,26 Several studies reported similar results that a better cosmesis was observed in the zipper group compared with stapler group. 6,8,26 Furthermore, a distinctive feature of the zipper was that no need of removing sutures and bandages thus cause less painful, which further improved the patient satisfactions.…”

“…The zipper device provides precise, adjustable, and tension‐free adaptation of the incision edges for a sufficient time and minimal trauma to the skin and underlying tissues, without resulting in an ischemic condition that could impact healing and scarring, thus make it beneficial to a good cosmetic result 16,26 . Several studies reported similar results that a better cosmesis was observed in the zipper group compared with stapler group 6,8,26 . Furthermore, a distinctive feature of the zipper was that no need of removing sutures and bandages thus cause less painful, which further improved the patient satisfactions.…”

“…In a study by Levi et al 25 indicated zipper device provides greater shielding of the wound from perturbation caused by distraction forces than sutures. The zipper device provides precise, adjustable, and tension‐free adaptation of the incision edges for a sufficient time and minimal trauma to the skin and underlying tissues, without resulting in an ischemic condition that could impact healing and scarring, thus make it beneficial to a good cosmetic result 16,26 . Several studies reported similar results that a better cosmesis was observed in the zipper group compared with stapler group 6,8,26 .…”

A Prospective, Randomized, Controlled Comparison of Adhesive Wound Closure Devices in an Orthopaedic Patient

“…Overall, potential benefits of surgical skin closure devices include improved operating efficiency, reduced risk of needle stick injuries (approximately 50% of which occur with suturing needles), and improved cosmesis. 12,13,[21][22][23][25][26][27][28] Potential drawbacks include minor skin reaction to the adhesive used in these devices and increased cost compared with suture, which may even be offset considering increased operating efficiency and potential needle stick costs. 12,21 There are several weaknesses to this study.…”

“… 21 Zip has also been studied previously in an orthopaedic patient population undergoing total knee arthroplasty; however, these studies compared Zip with surgical staples rather than suture for final layer closure. 13 , 16 , 22 , 23 In one such study, Zip was found to be favored over staples for patient-reported comfort, ease of wound care, and pain with device removal as well as superior patient and physician assessments of cosmetic outcomes. 22 Another study also found Zip to be associated with fewer wound complications compared with staples in patients undergoing total knee arthroplasty.…”