The Routine Use of Running Subcuticular Closures in Orthopaedic Trauma Patients Does Not Increase Wound Complications.
Journal
Journal of orthopaedic trauma
ISSN: 1531-2291
Titre abrégé: J Orthop Trauma
Pays: United States
ID NLM: 8807705
Informations de publication
Date de publication:
01 04 2023
01 04 2023
Historique:
accepted:
15
11
2022
pubmed:
3
2
2023
medline:
21
3
2023
entrez:
2
2
2023
Statut:
ppublish
Résumé
To investigate whether the routine use of running subcuticular closures (RSC) in orthopaedic trauma patients increases the rate of wound complications and reoperations. Retrospective comparative study. Urban Level 1 trauma center. Two hundred sixty-six patients undergoing orthopaedic trauma procedures between June 2020 and March 2022. Adoption of an RSC protocol where any incision/wound that could be approximated with interrupted subcuticular 2-0 monofilament sutures was closed with a running subcuticular 3-0 monofilament suture. Wound complications and subsequent reoperations. With adoption of the RSC protocol, 91.0% of all orthopaedic trauma procedures were closed with RSC compared with 7.5% of the historical control group. There were no observed differences in the rate of wound complications (proportional difference (PD) 6.0%, confidence interval (CI) -2.3% to 14.1%; P = 0.15) or reoperations (PD 5.2%, CI -1.9% to 12.2%; P = 0.14) between the RSC and the control group. Wound complications were not associated with RSC on univariate analysis (PD 7.2%, CI -10.0% to 24.0%; P = 0.41). On multivariate analysis, an ASA>2 (odds ratio (OR) 2.4, CI 1.0 to 5.7; P = 0.03), lower extremity injuries (OR 4.9, CI 1.3 to 17.8; P = 0.01), and open reduction internal fixation procedures (OR 2.8, CI 1.1 to 7.2; P = 0.02) were found to be independently associated with wound complications. RSC for orthopaedic trauma procedures was not associated with increased wound complications when compared a historical cohort. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 36729908
doi: 10.1097/BOT.0000000000002534
pii: 00005131-202304000-00011
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e153-e158Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflict of interest.
Références
Shetty AA, Kumar VS, Morgan-Hough C, et al. Comparing wound complication rates following closure of hip wounds with metallic skin staples or subcuticular vicryl suture: a prospective randomised trial. J Orthop Surg (Hong Kong). 2004;12:191–193.
Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infectionHospital infection control practices advisory committee. Infect Control Hosp Epidemiol. 1999;20:250–278. quiz 279–80.
Livesey C, Wylde V, Descamps S, et al. Skin closure after total hip replacement: a randomised controlled trial of skin adhesive versus surgical staples. J Bone Joint Surg Br. 2009;91:725–729.
Smith TO, Sexton D, Mann C, et al. Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis. BMJ. 2010;340:c1199.
Krishnan R, MacNeil SD, Malvankar-Mehta MS. Comparing sutures versus staples for skin closure after orthopaedic surgery: systematic review and meta-analysis. BMJ Open. 2016;6:e009257.
Clayer M, Southwood RT. Comparative study of skin closure in hip surgery. Aust N Z J Surg. 1991;61:363–365.
Liew SM, Haw CS. The use of taped skin closure in orthopaedic wounds. Aust N Z J Surg. 1993;63:131–133.
Murphy M, Prendergast P, Rice J. Comparison of clips versus sutures in orthopaedic wound closure. Eur J Orthop Surg Traumatol. 2004;14:16–18.
Singh B, Mowbray MAS, Nunn G, et al. Closure of hip wound, clips or subcuticular sutures: does it make a difference?. Eur J Orthop Surg Traumatol. 2006;16:124–129.
Eggers MD, Fang L, Lionberger DR. A comparison of wound closure techniques for total knee arthroplasty. J Arthroplasty. 2011;26:1251–1258.e1–4.
Slade Shantz JA, Vernon J, Morshed S, et al. Sutures versus staples for wound closure in orthopaedic surgery: a pilot randomized controlled trial. Patient Saf Surg. 2013;7:6.
Mudd CD, Boudreau JA, Moed BR. A prospective randomized comparison of two skin closure techniques in acetabular fracture surgery. J Orthop Traumatol. 2014;15:189–194.
Lehtonen E, Patel H, Phillips S, et al. Staple versus suture closure for ankle fracture fixation: retrospective chart review for safety and outcomes. Foot (Edinb). 2018;37:71–76.
Badres IA, Suen K, Tran P. Effect of wound closure technique in proximal femoral fractures: a prospective cohort study. J Orthop Trauma. 2020;34:553–558.
Wyles CC, Jacobson SR, Houdek MT, et al. The chitranjan ranawat award: running subcuticular closure enables the most robust perfusion after TKA: a randomized clinical trial. Clin Orthop Relat Res. 2016;474:47–56.
Shorten P, Haimes M, Nesbit R, et al. Impact of skin suture pattern on incision perfusion using intraoperative laser angiography: a randomized clinical trial of patients with ankle fractures. J Orthop Trauma. 2020;34:547–552.
Shin TM, Bordeaux JS. How suture technique affects the cosmetic outcome of cutaneous repairs. J Drugs Dermatol. 2014;13:967–969.
Gurusamy KS, Toon CD, Allen VB, et al. Continuous versus interrupted skin sutures for non-obstetric surgery. Cochrane Database Syst Rev. 2014:CD010365.
Perivoliotis K, Christodoulou P, Liapis S, et al. Comparison of wound closure techniques after thyroid and parathyroid surgery: an updated systematic review and network meta-analysis. Updates Surg. 2022;74:1225–1237.
Ashraf I, Butt E, Veitch D, et al. Dermatological surgery: an update on suture materials and techniques. Part 1. Clin Exp Dermatol. 2021;46:1400–1410.
Chen L, Yang J, Xie J, et al. Clinical outcome of different skin closure in total-knee arthroplasty: running subcuticular closure vs intermittent closure: a retrospective study. Med Baltim. 2020;99:e21947.
Bosch LC, Beger SB, Duncan ST, et al. Intraoperative practice variability in total knee arthroplasty. J Arthroplasty. 2020;35:725–731.
Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453–458.
Govaert GAM, Kuehl R, Atkins BL, et al. Fracture-related infection (FRI) consensus group. Diagnosing fracture-related infection: current concepts and recommendations. J Orthop Trauma. 2020;34:8–17.
Jonsson K, Jensen JA, Goodson WH 3rd, et al. Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients. Ann Surg. 1991;214:605–613.
Balabanova A, Chu X, Chambers L, et al. Incidence of surgical site infections and acute kidney injuries after topical antibiotic powder application in orthopaedic trauma surgery. J Orthop Trauma. 2021;35:e377–e380.
Adam G, Miller MLS. Dermabond Efficacy in total joint arthroplasty wounds. Am J Orthop. 2010;39:476–478.