A Modified Technique for Applying Closed Incision Negative Pressure Therapy Dressing Following Total Joint Arthroplasty.

Shane Dowling,Timothy B Alton

doi:10.7759/cureus.20539

Abstract

Postoperative incisional management subsequent to total joint replacement arthroplasty is of importance to the orthopedic surgical team. The application of closed incision negative pressure therapy (ciNPT) to surgical incisions following replacement arthroplasty has demonstrated positive outcomes in orthopedics. This paper describes a technique involving the postoperative application of ciNPT over closed incisions originating from joint arthroplasty to facilitate a reduction in the incidence of surgical site complications (SSCs). To address any potential challenges that may be associated with ciNPT application and removal, the ciNPT dressing was applied to the knee incision with approximately 15 degrees of ﬂexion utilizing the total knee bump to allow the knee to rest with ﬂexion at that angle. For posterior hip replacements or revisions, the readily adjustable ciNPT dressing was enlisted for use to cover curvilinear incisions. The adhesive drape over the foam ciNPT dressing would be blocked to ensure that drain placement, if used, would not be incorporated with the hydrocolloid portion of the dressing. In order to properly apply the dressing, it was imperative that the hydrocolloid portion was not subject to any buckling. The dressing was walked over the foam ciNPT dressing to ensure that there was an absence of tension on the dressing. The manufacturer’s instructions support dressing use for a maximum of seven days with continuous subatmospheric pressure (-125 mmHg) applied to the closed incision. Applying the adhesive ciNPT drape over the ciNPT foam dressing with a minimal amount of tension is integral to attaining positive outcomes using ciNPT. Employing ciNPT may reduce the risk of delayed incisional healing and SSCs, which may alleviate providers from extra postoperative global visits.

Highlights

Total arthroplasty procedures involving either the knee or hip are common orthopedic interventions that generally yield positive outcomes
To address any potential challenges that may be associated with closed incision negative pressure therapy (ciNPT) application and removal, the ciNPT dressing was applied to the knee incision with approximately 15 degrees of flexion utilizing the total knee bump to allow the knee to rest with flexion at that angle
The incision remained closed at the 30-day follow-up. This pilot study included one female (20.0%) patient and four male (80.0%) patients, who were at an elevated risk for developing surgical site complications (SSCs) and received ciNPT intraoperatively following total joint arthroplasty (Table 1)

Summary

Introduction

Total arthroplasty procedures involving either the knee or hip are common orthopedic interventions that generally yield positive outcomes. The rise in these procedures is due in part to the elevated incidence of osteoarthritis and the growing aging population [1]. Despite the effectiveness of these orthopedic interventions, diverse postoperative complications are common occurrences following primary knee and hip arthroplasty [3]. Postoperative swelling or edema is a common SSC associated with increased nociception, reduced range of motion, gait alteration, decreased strength of the quadriceps, and delayed recovery [3,4,5]. Postoperative lower extremity edema may result in decreased functional performance and can have an adverse impact on inpatient length of stay (LOS) and influence the patient’s perception of the surgical outcome [1,5]

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Conclusion