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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Wound Closure for TKR

 - Discussion: 
       - Should Subcuticular Sutures be Avoided in TKR?
              - references:
                      - Modality of wound closure after total knee replacement: are staples as safe as sutures? A retrospective study of 181 patients.
                      - Wound complications in joint arthroplasty: comparing traditional and modern methods of skin closure
                      - Staple vs. subcuticular vicryl skin closure in knee replacement surgery: a spectrophotographic assessment of wound characteristics.


       - Running Verticle Matress Suture (0-PDS-plus)
               - this suture technique takes care of the subcutaneous and skin layers;
               - it allows for a rapid closure, with optimally everted skin edges, free of asymmetric wound tension;
               - 45 deg angled sutures:
                        - angling the sutures at a 45 deg, may allow better perfusion (from random proximal to distal perfusion);
               - patients can be allowed to max out on the CPM without concerns of skin necrosis or breakdown;
               - references:
                        - Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis.
                        - Skin closure using staples and Nylon sutures: a comparison of results
                        - Wound closure in flexion versus extension following total knee arthroplasty: a systematic review.
                        - Wound Complications in Joint Arthroplasty: Comparing Traditional and Modern Methods of Skin Closure

                           


    -
wound dressing

    - tourniquet:
           - some surgeons release tourniquet and achieve good hemostasis before wound closure where as others apply the compression dressing before closure 
           - references:
                 - Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion.
                 - The effects of early tourniquet release during total knee arthroplasty: a prospective randomized double-blind study.
                 - Closed suction drainage following knee arthroplasty. Effectiveness and risks.
                 - The use of postoperative suction drainage in total knee arthroplasty.
                 - Closed Suction Drainage for Hip and Knee Arthroplasty. A Meta-Analysis.
                 - Effect of the Timing of Tourniquet Release on Perioperative Blood Loss Associated With Cementless Total Knee Arthroplasty: A Prospective Randomized Study.
                 - Emboli observed with use of transesophageal echocardiography immediately after tourniquet release during total knee arthroplasty with cement
                 - Timing of Tournique Release in Knee Arthroplasty. Meta-Analysis of Randomized, Controlled Trials. 

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Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, August 14, 2013 9:19 am