Herndon Carl L, Coury Josephine R, Sarpong Nana O, Geller Jeffrey A, Shah Roshan P, Cooper H John
Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Arthroplast Today. 2020 Apr 23;6(2):158-162. doi: 10.1016/j.artd.2020.01.013. eCollection 2020 Jun.
New dressings purport to reduce surgical wound complications after total hip arthroplasty (THA). This study compared delayed wound healing rates and reoperations between 2 increasingly popular dressings: a silver-impregnated occlusive (standard) dressing and a 2-octyl cyanoacrylate adhesive with polyester mesh.
This retrospective cohort study reviewed 431 consecutive THAs performed by 2 surgeons between January 2017 and May 2019. One hundred and eight were excluded for not using standard or mesh dressings. A final 323 cases were separated into 2 cohorts: mesh (n = 186) and standard dressings (n = 137). Standard dressings were removed at 1 week. Mesh persisted until nonadherent, approximately 3-4 weeks. The surgeon assessed delayed wound healing at the 2-week postoperative visit. Secondary outcomes include deep infection and return to the operating room for a wound-related diagnosis. Differences were determined using the chi-square test.
There were no demographic, comorbidity, or surgical differences between groups. There were 22 total cases of delayed wound healing with 7 (3.8%) in the mesh group and 15 (10.9%) in the standard dressing group ( = .01). There were no significant differences in reoperations (2 [1.1%] vs 2 [1.5%], = .76) or deep infections (2 [1.1%] vs 1 [0.7%], = .75).
Mesh dressings are a safe and reliable dressing type for THA and were associated with a decrease in early wound healing complications when compared with standard, silver-impregnated occlusive dressings in this retrospective series. The mesh tension sharing properties and longer duration of occlusive protection may explain this difference.
Level III.
新型敷料旨在降低全髋关节置换术（THA）后手术伤口并发症的发生率。本研究比较了两种越来越受欢迎的敷料的伤口愈合延迟率和再次手术情况：含银封闭（标准）敷料和含聚酯网的2-辛基氰基丙烯酸酯粘合剂。
这项回顾性队列研究回顾了2017年1月至2019年5月期间两位外科医生连续进行的431例THA手术。108例因未使用标准或网状敷料而被排除。最终323例病例分为两组：网状敷料组（n = 186）和标准敷料组（n = 137）。标准敷料在1周时拆除。网状敷料持续到不粘连，大约3 - 4周。外科医生在术后2周的随访中评估伤口愈合延迟情况。次要结局包括深部感染和因伤口相关诊断返回手术室。使用卡方检验确定差异。
两组之间在人口统计学、合并症或手术方面无差异。共有22例伤口愈合延迟病例，网状敷料组7例（3.8%），标准敷料组15例（10.9%）（P = 0.01）。再次手术（2例[1.1%]对2例[1.5%]，P = 0.76）或深部感染（2例[1.1%]对1例[0.7%]，P = 0.75）无显著差异。
在本回顾性系列研究中，网状敷料是THA一种安全可靠的敷料类型，与标准的含银封闭敷料相比，其早期伤口愈合并发症减少。网状敷料的张力分担特性和更长时间的封闭保护可能解释了这种差异。
三级。
