Abstract
BackgroundInfluence of skin incision position on physiological and biochemical changes in tissue after primary total knee replacement. A prospective randomised controlled trial.The blood supply to the skin covering the anterior knee has been shown to arise predominantly from blood vessels on the medial side of the knee. Skin incisions for primary Total Knee Replacement (TKR) positioned medially therefore risk creating a large lateral skin flap that may be poorly perfused. Poorly perfused skin is likely to result in hypoxia at the wound edges and consequently may lead to delayed wound healing and complications.MethodsWe have carried out a randomised controlled trial (n = 20) to compare blood flow on both the medial and lateral sides of two commonly used skin incisions in TKR (midline and paramedian). We have also assessed interstitial biochemistry (glucose, pyruvate and lactate levels) in the presumed at risk lateral skin flap of both incision types.ResultsIn both incision types tissue hyper-perfusion occurs post-operatively and is maintained for at least 3 days. We found no significant difference between blood flow between the two incision types on the medial side of the incision at either day 1 (p = 0.885) or day 3 post-op (p = 0.269), or, on the lateral side of the incision (p = 0.885 at day 1, p = 0.532 at day 3). Glucose levels are maintained post-operatively in the at risk lateral flap with only minimal changes. Lactate levels rise post-operatively and remain elevated for at least 24 hours. However, the levels did not reach levels suggestive of critical ischaemia in either incision group and no significant difference was observed between incision types.ConclusionWe conclude that the use of a paramedian incision results in only minimal biochemical changes, which are unlikely to alter wound healing.Trial registrationsISRCTN06592799.
Highlights
Influence of skin incision position on physiological and biochemical changes in tissue after primary total knee replacement
Wound healing complications are one of the most common problems encountered after Total Knee Replacement (TKR) and utilises significant additional healthcare resources including additional Health Care Worker visits for wound care, additional General Practitioner (GP) visits and occasionally re-admission to hospital
We found no significant difference between blood flow between the two incision types on the medial side of the incision at either day 1 p = 0.885 or day 3 post-op p = 0.269 (Table 2), or, on the lateral side of the incision p = 0.885 at day 1 and p = 0.532 at day 3 post-op (Table 3)
Summary
Influence of skin incision position on physiological and biochemical changes in tissue after primary total knee replacement. Skin incisions for primary Total Knee Replacement (TKR) positioned medially risk creating a large lateral skin flap that may be poorly perfused. Wound healing complications are one of the most common problems encountered after Total Knee Replacement (TKR) and utilises significant additional healthcare resources including additional Health Care Worker visits for wound care, additional General Practitioner (GP) visits and occasionally re-admission to hospital. A number of risk factors are associated with development of wound complications following TKR. Donaldson et al BMC Surgery (2015) 15:44 alter the risk of post-operative wound complications; including venous thromboembolic (VTE) prophylaxis, use of surgical drains and historically type of incision utilised.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
