Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan.
J Knee Surg. 2021 Sep;34(11):1237-1242. doi: 10.1055/s-0040-1702186. Epub 2020 Feb 19.
Atopic dermatitis (AD), sometimes referred to as eczema, is a common skin disease, and skin barrier dysfunction and immunological disorders are well recognized. However, surgical wound complications after orthopaedic surgery in patients with AD have not been described. This study aimed to report four patients with AD who developed foreign body reactions to FiberWire sutures with or without surgical wound infection (SSI) after knee cruciate ligament reconstruction (CLR). The mean age was 19.8 (range, 16-25) years, and patients 1 and 3 underwent reconstructions of the posterior and anterior cruciate ligament, respectively. At a mean of 7.5 (range, 4-10) weeks postoperatively, discharge from the surgical wound at the tibial side of the fixed graft was identified. All patients were treated with continuous saline lavage and antibiotics; however, their wounds did not heal. Second-look arthroscopy and hardware removal were performed at a mean 12.2 (range, 9-15) months postoperatively. Proliferated granulation tissue surrounding the FiberWire was identified. Intraoperative wound cultures were negative in three of the four patients. Histological examination of the tissues adjacent to the FiberWire revealed a foreign body reaction. All wounds healed immediately after the second surgery. In addition to SSI, foreign body reactions are more likely to occur in patients with AD than in those without AD. Preoperative management of AD by dermatologists and consideration of appropriate suture materials are mandatory to reduce surgical wound complications after knee CLR in patients with AD.
特应性皮炎（AD），有时也称为湿疹，是一种常见的皮肤病，其皮肤屏障功能障碍和免疫紊乱已得到广泛认可。然而，AD 患者骨科手术后的手术部位并发症尚未被描述。本研究旨在报告 4 例 AD 患者在接受膝关节前交叉韧带（ACL）重建后出现异物反应，伴或不伴手术部位感染（SSI），异物为 FiberWire 缝线。患者平均年龄为 19.8 岁（范围，16-25 岁），其中 1 例和 3 例患者分别接受了后交叉韧带和前交叉韧带重建。术后平均 7.5 周（范围，4-10 周）时，在固定移植物胫骨侧的手术切口处发现有渗液。所有患者均接受了持续盐水冲洗和抗生素治疗，但伤口未愈合。术后平均 12.2 个月（范围，9-15 个月）行二次关节镜检查和取出内固定物。发现 FiberWire 周围有增生的肉芽组织。术中对 4 例患者中的 3 例进行了伤口培养，结果均为阴性。FiberWire 周围组织的组织学检查显示异物反应。第二次手术后所有伤口立即愈合。除 SSI 外，AD 患者比非 AD 患者更易发生异物反应。AD 患者术前应由皮肤科医生进行管理，并考虑使用合适的缝线材料，以减少 ACL 重建后膝关节手术部位并发症。
