Hlas Arman C, Marinier Michael C, Ogunsola Ayobami S, Elkins Jacob M
Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, USA.
Cureus. 2024 Jun 11;16(6):e62145. doi: 10.7759/cureus.62145. eCollection 2024 Jun.
Background Direct anterior total hip arthroplasty (DA-THA) has increased in popularity over recent decades. However, DA-THA has been reported to have a higher incidence of superficial wound complications, including infection and incisional dehiscence, compared to other surgical approaches to hip arthroplasty. While this indicates a need for optimal wound closure, little research exists on the preferred method of skin closure following DA-THA. This study aimed to determine if there was any difference in rates of superficial infection, wound dehiscence, or overall wound complications with skin closure using a running subcuticular 3-0 Monocryl® suture compared to surgical staples following DA-THA. Methods Records of patients who underwent DA-THA at our institution between July 2017 to July 2022 were retrospectively reviewed. Data were abstracted on patient demographics, comorbidities, skin closure method, and wound complications from the electronic medical record. Superficial infection and wound dehiscence were classified based on explicit diagnosis in post-operative records and incision photographs taken during follow-up visits. Overall wound complications were classified in patients who experienced either superficial infection, incisional dehiscence, or both complications following surgery. Descriptive statistics and chi-squared measures were obtained from post-operative patient data, and significance was set at p [Formula: see text] 0.05. Results A total of 365 DA-THAs were completed in 349 patients. A running subcuticular 3-0 Monocryl® suture closed 207 surgeries (56.7%), while surgical staples closed 158 surgeries (43.3%). There was no significant difference in independent rates of superficial infection (p = 0.076) or wound dehiscence (p = 0.118) between suture and staple cohorts; however, suture closure (10, 2.7%) was associated with a significantly higher rate of overall wound complications compared to staple closure (1, 0.3%) (p = 0.020). Conclusion DA-THA carries the risk of overall wound complications, including superficial infection and wound dehiscence. Our findings suggest superficial skin closure with staples may be preferred over sutures due to lower rates of overall wound complications. Further studies are needed to determine the optimal method of skin closure following DA-THA.
背景 近几十年来，直接前路全髋关节置换术（DA-THA）越来越受欢迎。然而，与髋关节置换术的其他手术入路相比，据报道DA-THA的浅表伤口并发症发生率更高，包括感染和切口裂开。虽然这表明需要优化伤口闭合，但关于DA-THA术后皮肤闭合的首选方法的研究很少。本研究旨在确定与DA-THA术后使用连续皮下3-0单丝可吸收缝线（Monocryl®）缝合皮肤相比，使用外科缝合钉进行皮肤闭合时，浅表感染、伤口裂开或总体伤口并发症的发生率是否存在差异。方法 回顾性分析2017年7月至2022年7月在我院接受DA-THA手术的患者记录。从电子病历中提取患者人口统计学、合并症、皮肤闭合方法和伤口并发症的数据。浅表感染和伤口裂开根据术后记录中的明确诊断以及随访期间拍摄的切口照片进行分类。总体伤口并发症在术后发生浅表感染、切口裂开或两者兼有的患者中进行分类。从术后患者数据中获得描述性统计数据和卡方测量值，显著性设定为p[公式：见正文]<0.05。结果 349例患者共完成365例DA-THA手术。连续皮下3-0单丝可吸收缝线（Monocryl®）缝合207例手术（56.7%），而外科缝合钉缝合158例手术（43.3%）。缝线组和缝合钉组之间浅表感染（p = 0.076）或伤口裂开（p = 0.118）的独立发生率无显著差异；然而，与缝合钉闭合（1例，0.3%）相比，缝线闭合（10例，2.7%）的总体伤口并发症发生率显著更高（p = 0.020）。结论 DA-THA存在总体伤口并发症的风险，包括浅表感染和伤口裂开。我们的研究结果表明，由于总体伤口并发症发生率较低，使用缝合钉进行浅表皮肤闭合可能优于缝线。需要进一步研究以确定DA-THA术后皮肤闭合的最佳方法。
