The Chitranjan Ranawat Award: Running Subcuticular Closure Enables the Most Robust Perfusion After TKA: A Randomized Clinical Trial

Abstract

Background Maintaining robust perfusion is an important physiologic parameter in wound healing. The effect of different closure techniques on wound perfusion after total knee arthroplasty (TKA) has not been established previously and may have implications for wound healing. Questions/purposes We asked whether a running subcuticular, vertical mattress, or skin staple closure technique enables the most robust wound perfusion after TKA as measured by laser-assisted indocyanine green angiography (LA-ICGA) in patients without specific risk factors for wound healing complications. Methods Forty-five patients undergoing primary TKA without comorbidities known to impact wound healing and perfusion were prospectively randomized to receive superficial skin closure with one of the following techniques: (1) running subcuticular (3-0 monofilament); (2) vertical mattress (2-0 nylon); or (3) skin staples. Twenty procedures were performed by RTT, 15 by RJS, and 10 by FHS. All surgeons used an anterior skin incision over the medial third of the patella in combination with a median parapatellar arthrotomy. Perfusion was assessed with a LA-ICGA device and software system immediately after closure to quantify fluorescence. Twenty-seven points were assessed immediately after closure in the operating room in each patient (nine along the incision and nine pairs medial and lateral to the incision). Mean incision perfusion was determined from the nine points along the incision with One of the authors (RJS) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: Lifecell Corporation (Branchburg, NJ, USA) in an amount of less than USD 10,000 and Biomet Inc (Warsaw, IN, USA) in an amount of USD 10,000 to USD 100,000. One of the authors (MJT) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: DJO Global (Vista, CA, USA) in an amount of less than USD 10,000. One of the authors (RTT) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: DePuy Orthopaedics, Inc (Warsaw, IN, USA) in an amount of USD 10,000 to USD 100,000. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. higher values indicating greater blood flow. Mean perfusion impairment was determined by calculating the difference between the nine pairs of surrounding skin and the nine points along the incision with smaller values ind...

A Cadaveric Study of Cutaneous Vascular Anatomy about the Elbow Using Computed Tomography Angiography

“…Unfortunately, this literature fails to describe the subdermal vascular network in these areas, which is the anatomic layer of importance in wound healing. As has been previously reported in the general and orthopedic surgery literature, subdermal perfusion linearly correlates with tissue oxygen tension, collagen deposition, and subsequent healing (Schreml et al, ; Jonsson et al, ; Ries, ; Wyles et al, ). Consequently, it is important to characterize the subdermal perfusion of elbow integuments in order to understand its correlative importance to wound healing.…”

Bidirectional knotless barbed sutures during primary total knee arthroplasty: effective solution or new problem?

“…После выполнения операции капсулу сустава и подкожную жировую клетчатку ушивали плетеной нитью непрерывно, а ушивание кожной раны производили тремя различными способами. Анализ полученных данных показал, что наименее негативно на перфузию мягких тканей послеоперационной раны влияет внутрикожный шов с использованием монофиламентной нити [3]. Безусловно, есть статьи, авторы которых, исследуя применение нитей с насечками в различных отраслях хирургии, увидели в них потенциально проблемный шовный материал.…”

“…зорбции шовного материала, завязывание узла требует времени, и именно хирургический узел является наиболее слабым звеном в механической системе, которой является комплекс «ушиваемая ткань/хирургическая нить» [1,2]. В настоящее время не прекращается поиск новых эффективных и безопасных решений для ушивания операционных ран, при этом уделяется внимание не только тому материалу который используется для изготовления нити (металлы, продукты животного происхождения, полимеры), но и технологии ее использования in vivo, то есть методологии укрытия раны [2][3][4]. Так, при выполнении шва мягких тканей создается неравномерное распределение натяжения нити с его концентрацией в области узлов, и при затягивании узлов перед хирургом стоят противоположные задачи: максимально сблизить сшиваемые ткани, жестко зафиксировав их хирургическим узлом, при этом не вызывая ишемию тканей.…”

What’s New in Musculoskeletal Infection: Update on Biofilms

“…Primary wound closure for appropriate patients is being favored over leaving wounds open and planning for delayed wound closure. Two Level-I studies showed that the technique of wound closure can improve incisional perfusion, which was seen in the setting of ankle fracture with the Allgöwer-Donati suture technique 91 and in elective total knee arthroplasty with a running subcuticular closure 92 . A prospective study showed decreased nonunion and deep infection for grade-IIIA or lower open fractures with a wound deemed to be clean at the initial surgery 93 .…”