title: Wound complications in joint arthroplasty: comparing traditional and modern methods of skin closure.
abstract: Various methods of skin closure exist in joint replacement surgery. Although subcuticular skin closure techniques offer an aesthetic advantage over conventional skin stapling, no measurable differences have been reported. Furthermore, newer barbed sutures, such as the V-Loc absorbable suture (Covidien, Mansfield, Massachusetts), theoretically distribute tension evenly through the wound and help decrease knot-related complications. The purpose of this study was to evaluate whether wound complication rates were (1) lower in V-Loc closure cases as theoretically suggested, (2) lower for subcuticular closure vs staples, and (3) significantly different for knee and hip joint reconstruction.A retrospective chart review was conducted of 278 consecutive cases of primary joint reconstruction performed by a single surgeon (L.P.). The study group comprised 106 men and 161 women. Average patient age at surgery was 63 years (range, 18-92 years), and average body mass index of the cohort was 33.7 kg/m(2) (range, 25-51 kg/m(2)). Skin was closed via staple gun or subcuticular stitch (3-0 Biosyn [Covidien] vs V-Loc). Seven (3.9%) wound complications occurred in 181 cases closed with staples. Four (7.8%) wound complications occurred in 51 cases closed via subcuticular Biosyn suture. Six (13.0%) wound complications occurred in 46 cases closed with V-Loc suture. The staple group had a lower rate of complications when compared with the suture group as a whole (P=.033) and when compared specifically with the V-Loc suture group (P=.017).
authors.affiliation: Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA. r-patel7@md.northwestern.edu
authors.forename: Ronak M
authors.initials: RM
authors.lastname: Patel
authors.forename: Max
authors.initials: M
authors.lastname: Cayo
authors.forename: Arpan
authors.initials: A
authors.lastname: Patel
authors.forename: Marie
authors.initials: M
authors.lastname: Albarillo
authors.forename: Lalit
authors.initials: L
authors.lastname: Puri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000379:methods*; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects*; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013537:Sutures / Q000009:adverse effects*; D014945:Wound Healing; D055815:Young Adult