Abstract
Introduction
Superficial wound complications can occur in up to 10% of total knee arthroplasty (TKA) patients and have been associated with deep infection. The ideal material for TKA closure should fulfill the following requirements: 1) fast intraoperative application, 2) minimal wound complications and discomfort, and 3) can be removed by patients without a home care visit. We present our experience with a novel, non-invasive, removable skin closure system compared to conventional staple closure.
Methods
We prospectively evaluated 105 consecutive patients who underwent unilateral or bilateral primary TKA and received skin closure consisting of the Zip 16 Surgical Skin Closure System (Zipline) for skin. All procedures were performed a by single surgeon (SBH) using a mini-midvastus approach. All patients were mobilized on the day of surgery and received 2 weeks of Rivaroxaban thromboprophylaxis. Patient demographics, medical comorbidities, in-hospital complications and wound healing and complications during the first 6-week post-operatively were recorded. Data was compared to a previous TKA cohort of 1,001 patients from the same surgeon who received staples for closure and warfarin for thromboprophylaxis.
Results
Zip and staple patient groups had similar age, gender and BMI. There was a higher percentage of diabetic patients in the Zip closure group (12% vs. 10%). All 105 patients with Zip closure removed dressings themselves and had healed wounds with no noted drainage or blistering at six-weeks. Two patients had protruding subcutaneous vicryl stitches that were removed. In the staple group there were six knees (0.6%) that had wound drainage with 2 (0.2%) requiring reoperation for debridement and reclosure.
Discussion
In our experience, the Zip 16 Surgical Skin Closure System is easy to apply, avoids the need for home care or office visit and had fewer wound complications compared to staples. Results have been positive despite the study cohort having a higher number of diabetic patients and using an anticoagulant which may be associated with higher risk of wound problems.
