title: Delayed Wound Dehiscence of Anterior Knee Incisions in Patients Aged 20 Years and Younger: A Comparison of Subcutaneous Skin Closure.
abstract: BACKGROUND
  Delayed wound dehiscence (DWD) typically occurs 2 to 7 weeks postoperatively and is characterized by wound gapping and drainage at a surgical site which has initial normal wound healing. This wound problem clinically mimics deep surgical site infection and, after eventual skin healing, leaves a cosmetically unattractive widened, atrophic surgical scar.
  
  
  METHODS
  A single-center, retrospective analysis was completed of 252 knees, over a 13-year period, in 194 patients (average age, 14.9 y) undergoing patellar realignment surgery. All knees in this study were treated through an anterior midline knee incision from mid-patella to the tibial tubercle. At wound closure either a 2-0 polyglactin 910 (Vicryl) group (V) or polydioxane (PDS) group (P) suture was used for subcutaneous reapproximation and then the skin was closed with a 4-0 subcuticular Poliglecaprone 25 and IRGACARE (Monocryl) suture. Wound complications were recorded and analyzed by subcutaneous suture type, severity, size of involvement, duration, and treatment type.
  
  
  RESULTS
  Of the 252 knees, there were 132 knees in the V group and 120 in the P group. A total of 195 surgeries were primary surgeries and 57 knees were through previous surgical scars. Eleven patients had surgeries in which 1 knee was in each study group. Overall there were 6.1% (8/132) of the V group and 1.7% (2/120) of the P group with DWD (P=0.11); hence there was a trend toward more DWD with Vicryl than PDS, but this did not meet statistical significance. Mean time to resolution of wound dehiscence was 26 days for V group and 46 days for the P group. The length of incision was demonstrated to be a statistically significant independent risk factor for the development of DWD, irrespective of suture type.
  
  
  CONCLUSIONS
  The frequency of DWD in anterior knee incisions in our study population was 6.1% in the polyglactin 910 (Vicryl) group and 1.7% in the polydioxane (PDS) group. Although this analysis did not achieve statistical significance, a 3.5 times decrease in DWD when PDS was used is considered by the authors to be clinically significant. The authors have definitively switched from Vicryl to PDS for the subcutaneous skin closure at the knee in patients aged 20 years and younger in the push to make wound complications a nonevent.
  
  
  METHODS
  Level IV.
authors.affiliation: *Department of Orthopaedic Surgery, Washington University School of Medicine †St Louis Shriners Hospital ‡St Louis Children's Hospital, St Louis, MO.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Salib
authors.forename: June C
authors.initials: JC
authors.lastname: Smith
authors.forename: Nicholas
authors.initials: N
authors.lastname: Siow
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Luhmann
mesh_terms: D000328:Adult; D000368:Aged; D004146:Dioxanes / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011091:Polyesters / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D013537:Sutures
chemical_list: D004146:Dioxanes; D011091:Polyesters; C095495:glycolide E-caprolactone copolymer