‘Superglue’ works, but possibly inappropriate for THR, TKR incisions

Dermabond seals incisions more thoroughly, but staples close wounds faster.

Closing total hip or knee replacement incisions using a surgical “superglue” seals wounds significantly better than sutures or staples. However, staples provide faster, more stable closures, Australian researchers show.

In a prospective study, David Wood, FRACS(Orth), and colleagues at the Perth Orthopaedic Institute and at Sir Charles Gairdner Hospital, Western Australia, found that 2-octylcyanoacrylate (OCA) reduced early wound discharge, measured as the presence and amount of blood on the wound dressing (strike-through) the first postoperative day. “However, in the more mobile wounds around the knee, OCA was associated with increased discharge thereafter. This suggests that the initial bond between the glue and the skin edges was not able to withstand the early rehabilitation utilized and thus failed,” the authors said in the study.

The study included 102 THR patients and 85 TKR patients randomly assigned to receive one of three different wound closure techniques — either OCA (Dermabond, Johnson & Johnson), continuous 3.0 subarticular absorbable poliglecaprone suture (Monocryl, Johnson & Johnson) or skin staples.

All groups had similar ages, gender distributions, body mass indices and incision lengths. In all cases, surgeons used continuous 1-vicryl sutures for the deep fascia and 2.0-vicryl sutures for the deep dermal layers. For OCA, surgeons applied the adhesive in two layers, waiting 15 seconds between applications to allow polymerization.

All patients also received a standard, identical absorbent dressing, which was changed on the second day postop by a nurse who instructed patients to not look at their incision until before hospital discharge, according to the study.

For THR patients, the researchers found no significant differences in early or late complication rates between the three wound closure methods. TKR patients also had no significant differences in late complication rates between closure methods. However, TKR patients did have significantly more early complications (18.8%) compared to THR patients (5.9%, P=.02), according to the study.

Regarding the extent each method sealed incisions, the researchers found that significantly fewer OCA patients had blood strike-through, which indicated significantly more completely sealed wounds (THR, P=.0004; TKR, P=.002). OCA patients also had significantly smaller median areas of strike-through at 24 hours follow-up (THR, P=.001; TKR, P=.008), according to the study.

No significant differences in the extent of strike-through was seen between either sutures or staples, the authors noted.

However, stapled wounds closed significantly faster than OCA-treated wounds (P<.0001) . But OCA-treated wounds closed significantly faster than those that received sutures (P<.0007), according to the study.

“The increased strike-through noted with skin staples and suture at 24 hours was not associated with an increase in prolonged wound discharge or in higher rates of infection, suggesting that early ooze may not be clinically significant,” the study authors said. But, “We echo the concern that has been raised about the use of OCA on mobile wounds,” they added.

“The increased tensile forces associated with total knee replacement makes OCA inappropriate. We now use staples routinely for routinely for the wounds following arthroplasty of the hip and knee,” they said.

For more information:

Khan RJK, Fick D, Yao F, et al. A comparison of three methods of wound closure following arthroplasty. J Bone Joint Surg Br. 2006;88-B:238-242.