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      A Prospective, Randomized and Controlled Study on Tissue Adhesive for Skin Incision in Total Knee Arthroplasty

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          Abstract

          Background

          The study focusing on the tissue adhesive in total knee arthroplasty (TKA) was rare. This study aimed to evaluate the clinical outcomes and economic costs of tissue adhesive when acting as the adjunct to standard incision closure in TKA.

          Patients and Methods

          From September 2019 to November 2019, we prospectively enrolled the consecutive patients who underwent simultaneous bilateral TKA in our institute. The allocation using the tissue adhesive was done after the subcuticular suture in right knee first and another method was applied in the left knee automatically. The patients’ demographics, length of stay (LOS), times of dressing changes and incision-related cost, range of motion (ROM), incision-related complications and incision evaluation scores were recorded.

          Results

          Thirty-two patients were enrolled in this study and followed at two months after surgery. In the knees of tissue adhesive, the times of dressing change and patient scar assessment scores (PSAS) were significantly less than those standard skin closure (p=0.000; p=0.003). Although there were no significant differences of the delayed discharge, incision-related cost, ROM, incision-related complications and Vancouver scar score (VSS) between two groups, 65.6% (21/32) patients preferred the tissue adhesive and only 15.6% (5/32) patients preferred the standard incision closure.

          Conclusion

          Tissue adhesive could effectively reduce postoperative wound drainage and improve patients’ satisfaction rate with no difference in medical costs and ROM in TKA. The application of tissue adhesive and subcuticular sutures might be one safe and convenient method of skin closure in TKA.

          Chinese Clinical Trial Registry

          ChiCTR1900025730; Registered 6 September 2019.

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          Most cited references 22

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          The Vancouver Scar Scale: an administration tool and its interrater reliability.

           M J Baryza,  G Baryza (2015)
          The Burn Scar Index, often called the Vancouver Scar Scale, is widely used in clinical practice and research to document change in scar appearance. Several sections of the Index require equipment to accurately score the items. Additionally, the numeric scores are difficult to remember. We recently devised a pocket-sized tool to aid in scoring the scar and to increase staff compliance in use of the Index. With this tool interrater reliability is good, which makes the Burn Scar Index a viable measure for research.
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            A comparison of wound closure techniques for total knee arthroplasty.

            Four wound closure techniques for total knee arthroplasty were compared in a prospective, randomized, controlled, institutional review board-approved study with 75 subjects. The study compared tissue adhesives, stapling, and suturing with respect to procedure time and cost, together with functional and clinical outcome. Total knee arthroplasty closure time (capsule to cutaneous) favored staples at 26 s/cm, followed by adhesives (45 and 37 s/cm for 2-octyl and n-butyl-2, respectively) and, finally, subcuticular suturing at 54 s/cm (P < .0007). Reduced procedure time translated into intraoperative cost reduction where closure cost per centimeter was $70, $62, $57, and $75 for 2-octyl, n-butyl-2, staples, and sutures, respectively. No significant differences in infection, dehiscence, cosmesis, general health (SF-12v2 (QualityMetric Inc., Lincoln, RI)), and functional and clinical assessments (range of motion, Knee Society knee score, and pain) were observed.
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              A prospective, randomized, controlled clinical trial of tissue adhesive (2-octylcyanoacrylate) versus standard wound closure in breast surgery.

              Recent studies suggest that the use of tissue adhesive for closure of both traumatic lacerations and incisional surgical wounds leads to cosmetic outcome comparable to conventional sutures. To date, no studies have investigated tissue adhesive in breast surgery and costs. Our aim was to compare the tissue adhesive 2-octylcyanoacrylate (OCA) with standard suture in breast surgery. A prospective randomized study was conducted in which 151 patients were assessed for eligibility, and 133 were randomly allocated to skin closure with OCA adhesive or monofilament suture. Cosmetic outcome with blinded assessment, wound management by the patients, complication rates, and economic outcome were recorded. There was no difference in cosmetic score in the 2 groups, nor in complications at the early, 6-month, and 1-year follow-up. Patient satisfaction with the wound closed with OCA was rated significantly higher when compared with standard suture (P <.0001). The application of the tissue adhesive was significantly faster than that for standard suture (P <.001). In economic terms total costs were less in the tissue adhesive group, mainly due to lower postoperative costs of physician and assistant services (P <.001). OCA is effective and reliable in skin closure for breast surgery, yielding similar cosmetic results to standard suture. OCA is faster than standard wound closure and offers several practical advantages over suture repair for patients. Cost analysis has found that OCA adhesive can significantly decrease health care costs.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                tcrm
                tcriskman
                Therapeutics and Clinical Risk Management
                Dove
                1176-6336
                1178-203X
                24 August 2020
                2020
                : 16
                : 795-802
                Affiliations
                [1 ]Department of Orthopaedics, Chinese PLA General Hospital , Beijing, People’s Republic of China
                [2 ]Nankai University , Tianjin, People’s Republic of China
                Author notes
                Correspondence: Wei Chai; Yan Wang Email chaiweiguanjie@sina.com; wangyanguanjie@sina.com
                Article
                260007
                10.2147/TCRM.S260007
                7457845
                © 2020 Kong et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 4, Tables: 8, References: 29, Pages: 8
                Categories
                Clinical Trial Report

                Medicine

                dressing change, total knee arthroplasty, incision closure, tissue adhesive

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