Journal of orthopaedic trauma · 2023
The Routine Use of Running Subcuticular Closures in Orthopaedic Trauma Patients Does Not Increase Wound Complications.
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Aravindan Shreyaas, Kim Ye Joon, Tucker Nicholas J, Heare Austin, Parry Joshua A
Аннотация
OBJECTIVE: To investigate whether the routine use of running subcuticular closures (RSC) in orthopaedic trauma patients increases the rate of wound complications and reoperations.
DESIGN: Retrospective comparative study.
SETTING: Urban Level 1 trauma center.
PATIENTS/PARTICIPANTS: Two hundred sixty-six patients undergoing orthopaedic trauma procedures between June 2020 and March 2022.
INTERVENTION: Adoption of an RSC protocol where any incision/wound that could be approximated with interrupted subcuticular 2-0 monofilament sutures was closed with a running subcuticular 3-0 monofilament suture.
MAIN OUTCOME MEASUREMENTS: Wound complications and subsequent reoperations.
RESULTS: With adoption of the RSC protocol, 91.0% of all orthopaedic trauma procedures were closed with RSC compared with 7.5% of the historical control group. There were no observed differences in the rate of wound complications (proportional difference (PD) 6.0%, confidence interval (CI) -2.3% to 14.1%; P = 0.15) or reoperations (PD 5.2%, CI -1.9% to 12.2%; P = 0.14) between the RSC and the control group. Wound complications were not associated with RSC on univariate analysis (PD 7.2%, CI -10.0% to 24.0%; P = 0.41). On multivariate analysis, an ASA>2 (odds ratio (OR) 2.4, CI 1.0 to 5.7; P = 0.03), lower extremity injuries (OR 4.9, CI 1.3 to 17.8; P = 0.01), and open reduction internal fixation procedures (OR 2.8, CI 1.1 to 7.2; P = 0.02) were found to be independently associated with wound complications.
CONCLUSION: RSC for orthopaedic trauma procedures was not associated with increased wound complications when compared a historical cohort.
LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Retrospective comparative study.
SETTING: Urban Level 1 trauma center.
PATIENTS/PARTICIPANTS: Two hundred sixty-six patients undergoing orthopaedic trauma procedures between June 2020 and March 2022.
INTERVENTION: Adoption of an RSC protocol where any incision/wound that could be approximated with interrupted subcuticular 2-0 monofilament sutures was closed with a running subcuticular 3-0 monofilament suture.
MAIN OUTCOME MEASUREMENTS: Wound complications and subsequent reoperations.
RESULTS: With adoption of the RSC protocol, 91.0% of all orthopaedic trauma procedures were closed with RSC compared with 7.5% of the historical control group. There were no observed differences in the rate of wound complications (proportional difference (PD) 6.0%, confidence interval (CI) -2.3% to 14.1%; P = 0.15) or reoperations (PD 5.2%, CI -1.9% to 12.2%; P = 0.14) between the RSC and the control group. Wound complications were not associated with RSC on univariate analysis (PD 7.2%, CI -10.0% to 24.0%; P = 0.41). On multivariate analysis, an ASA>2 (odds ratio (OR) 2.4, CI 1.0 to 5.7; P = 0.03), lower extremity injuries (OR 4.9, CI 1.3 to 17.8; P = 0.01), and open reduction internal fixation procedures (OR 2.8, CI 1.1 to 7.2; P = 0.02) were found to be independently associated with wound complications.
CONCLUSION: RSC for orthopaedic trauma procedures was not associated with increased wound complications when compared a historical cohort.
LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.