Abstract
BackgroundWhether using tissue adhesive alone after subcutaneous suture can close the skin incision with safety as well as cosmetic appearance after total hip arthroplasty was not clear.MethodsA prospective study was conducted. The same surgical methods were consistent throughout the entire study. After implanting prosthesis, the joint capsule was reconstructed. Fascial and subcutaneous layer were respectively closed by continuous running barbed suture. Patients were randomized allocated to group A with octyl-2-cyanoacrylate tissue adhesive alone, to group B with tissue adhesive after continuous subcuticular suture, or to group C with skin staples. Time of closure, drainage, pain, wound complications, and cosmesis were compared. All data were analyzed statistically.ResultsThere was no significant difference in drainage, Visual Analog Scale score or early wound complications between the three groups. However, there was significant difference in time of closure (P = 0.013). In pairwise comparison, time of closure in groups A and B was significantly longer than those in group C (P = 0.001 and P = 0.023, respectively); time of closure in group A was significantly shorter than those in group B (P = 0.003). Patient and Observer Scar Assessment Scale total scores were not significantly different at 6 weeks and 3 months postoperatively (P = 0.078 and P = 0.284, respectively).ConclusionTissue adhesive without subcuticular suture was similar with a combination of subcuticular suture and tissue adhesive as well skin staples in terms of safety and cosmetic appearance after total hip arthroplasty.
Highlights
A safe technique of wound closure permits rapid incision healing without complication; it is very important for rapid rehabilitation and quicker discharge of patients from hospital following total hip arthroplasty (THA) [1]
Several studies have compared the efficacy of tissue adhesive, subcuticular suture and skin staples, the results indicated that skin staples had a higher rate of discharge on post-operative days 1 and 3 as well as shorter time of closure, but little difference in the occurrence of complications, scar outcome, or patient satisfaction between the three techniques [11,12,13]
There was no significant difference in drainage, Visual Analog Scale (VAS) score at third day postoperatively or wound complications between the three groups
Summary
A safe technique of wound closure permits rapid incision healing without complication; it is very important for rapid rehabilitation and quicker discharge of patients from hospital following total hip arthroplasty (THA) [1]. Tissue adhesive had some potential advantages such as ease of use, painless application, rapid closure, cosmesis, and avoidance of needlestick injuries and removal of the suture or staples [8] It was applied in a high volume arthroplasty unit for skin closure and did not increase the risk of surgical site infection in THA [9]. This technique provided an immediate water tight seal in a sterile operative environment and a barrier to microorganisms; it had good tensile strength, esthetic value, and patient satisfaction [10]. Whether using tissue adhesive alone after subcutaneous suture can close the skin incision with safety as well as cosmetic appearance after total hip arthroplasty was not clear
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