Surgical Wound Closure in Orthopaedic Surgery
Surgical wound complications are a significant problem in orthopaedic surgery with wound infection, dehiscence, and poor cosmesis contributing significantly to patient morbidity. Surgical techniques and adjunctive modalities continue to be introduced with the goals of avoiding these issues, and an increasing number of research studies have been undertaken to characterize clinical outcomes. A thorough understanding of surgical wound closure strategies and the efficacy of available techniques and treatment options should help decrease complication rates and improve patient outcomes.
Surgical wound complications such as infection, dehiscence, and poor cosmesis are the source of significant morbidity in patients undergoing orthopaedic surgery. Although the overall wound complication rate has not been directly quantified, surgical site infections occur in 1.9% of all operations performed in the United States. For orthopaedic procedures, the Center for Disease Control National Nosocomial Infections Surveillance reports infection rates ranging from 0.79–1.04%. High risk groups, such as those with open fractures and diabetic neuropathy, are over seven and 15 times as likely to develop wound complications when undergoing lower extremity surgery, respectively. Orthopaedic patients who do develop wound infections are hospitalized for an additional 2 wk on average, are twice as likely to require readmission, and sustain a 300% increase in the cost of their care. As such, a multitude of techniques and adjunctive modalities have been introduced with the goal of preventing these complications from occurring. An increasing number of research studies have been undertaken to evaluate the efficacy of these measures, but this diverse and growing body of literature has yet to be summarized. A detailed understanding of wound healing, wound closure techniques, and adjunctive treatment modalities is important in minimizing complication rates after orthopaedic surgery.
Abstract and Introduction
Abstract
Surgical wound complications are a significant problem in orthopaedic surgery with wound infection, dehiscence, and poor cosmesis contributing significantly to patient morbidity. Surgical techniques and adjunctive modalities continue to be introduced with the goals of avoiding these issues, and an increasing number of research studies have been undertaken to characterize clinical outcomes. A thorough understanding of surgical wound closure strategies and the efficacy of available techniques and treatment options should help decrease complication rates and improve patient outcomes.
Introduction
Surgical wound complications such as infection, dehiscence, and poor cosmesis are the source of significant morbidity in patients undergoing orthopaedic surgery. Although the overall wound complication rate has not been directly quantified, surgical site infections occur in 1.9% of all operations performed in the United States. For orthopaedic procedures, the Center for Disease Control National Nosocomial Infections Surveillance reports infection rates ranging from 0.79–1.04%. High risk groups, such as those with open fractures and diabetic neuropathy, are over seven and 15 times as likely to develop wound complications when undergoing lower extremity surgery, respectively. Orthopaedic patients who do develop wound infections are hospitalized for an additional 2 wk on average, are twice as likely to require readmission, and sustain a 300% increase in the cost of their care. As such, a multitude of techniques and adjunctive modalities have been introduced with the goal of preventing these complications from occurring. An increasing number of research studies have been undertaken to evaluate the efficacy of these measures, but this diverse and growing body of literature has yet to be summarized. A detailed understanding of wound healing, wound closure techniques, and adjunctive treatment modalities is important in minimizing complication rates after orthopaedic surgery.
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