Bio-Occlusive Gauze with Tegaderm: A Dressing for Surgical Wounds in Primary THA and TKA
Background: We introduce a simple, cost-effective bio-occlusive dressing to be used for primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA).
Methods: The gauze-Tegaderm™ (GT) dressing consists of a 5cm wide 8-layered gauze covered by 3 to 5 medium-sized Tegaderm transparent films. We prospectively evaluated 100 consecutive primary THA’s and 107 consecutive primary TKA’s utilizing this dressing with a minimum of one-year follow-up.
Results: In the primary THA group, there was one surgical site infection (SSI) requiring oral antibiotic treatment. There were no cases of periprosthetic joint infection (PJI). In the primary TKA group, there were two surgical site infections requiring oral antibiotic treatment and one case of chronic PJI requiring a two-stage exchange protocol.
Discussion: Our SSI and PJI rates are comparable to published rates in the literature. The GT dressing is a simple, inexpensive dressing that can compete against the many proprietary bio-occlusive dressings that are more expensive and are not readily available worldwide. Our favorable review has merited a large volume randomized controlled study comparing the GT dressing to another proprietary bio-occlusive dressing.
Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, et al. Prevalence of Total Hip and Knee Replacement in the United States. J Bone Joint Surg Am. 2015;97(17):1386-97.
Kurtz SM, Ong KL, Lau E, Widmer M, Maravic M, Gomez-Barrena E, et al. International survey of primary and revision total knee replacement. Int Orthop. 2011;35(12):1783-9.
Renaud A, Lavigne M, Vendittoli PA. Periprosthetic joint infections at a teaching hospital in 1990-2007. Can J Surg. 2012;55(6):394-400.
Greene LR. Guide to the elimination of orthopedic surgery surgical site infections: an executive summary of the Association for Professionals in Infection Control and Epidemiology elimination guide. Am J Infect Control. 2012;40(4):384-6.
Arroyo AA, Casanova PL, Soriano JV, Torra IBJE. Open-label clinical trial comparing the clinical and economic effectiveness of using a polyurethane film surgical dressing with gauze surgical dressings in the care of post-operative surgical wounds. Int Wound J. 2015;12(3):285-92.
Chowdhry M, Chen AF. Wound dressings for primary and revision total joint arthroplasty. Ann Transl Med. 2015;3(18):268.
Hoppenfeld S, de Boer P, Buckley R. Surgical Exposures in Orthopaedics: The Anatomic Approach: Lippincott Williams & Wilkins; 2016.
Ross JA, Greenwood AC, Sasser P, 3rd, Jiranek WA. Periarticular Injections in Knee and Hip Arthroplasty: Where and What to Inject. J Arthroplasty. 2017;32(9S):S77-S80.
McPherson EJ DM, Sherif SM. he Fate of the PCL in Cruciate Retaining TKA: A Critical Review of Surgical Technique. Reconstructive Review. . 2013:3(4): 11-7.
McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M. Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res. 2002(403):8-15.
McPherson EJ PC. Musculoskeletal Infection, In: Flynn JM ed. Orthopaedic Knowledge Update 10. Rosemont, IL: American Academy of Orthopaedic Surgeons. 2011:239-58. .
Parvizi J, Gehrke T, Chen AF. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J. 2013;95-B(11):1450-2.
Siddique K, Mirza S, Housden P. Effectiveness of hydrocolloid dressing in postoperative hip and knee surgery: literature review and our experience. J Perioper Pract. 2011;21(8):275-8.
Falanga V. Occlusive wound dressings. Why, when, which? Arch Dermatol. 1988;124(6):872-7.
Ravenscroft MJ, Harker J, Buch KA. A prospective, randomised, controlled trial comparing wound dressings used in hip and knee surgery: Aquacel and Tegaderm versus Cutiplast. Ann R Coll Surg Engl. 2006;88(1):18-22.
Sharma G, Lee SW, Atanacio O, Parvizi J, Kim TK. In search of the optimal wound dressing material following total hip and knee arthroplasty: a systematic review and meta-analysis. Int Orthop. 2017;41(7):1295-305.
Odland GF. The fine structure of the interrelationship of cells in the human epidermis. J Biophys Biochem Cytol. 1958;4(5):529-38.
Kaplan RS, Porter ME. How to solve the cost crisis in health care. Harv Bus Rev. 2011;89(9):46-52, 4, 6-61 passim.
Collins A. Does the postoperative dressing regime affect wound healing after hip or knee arthroplasty? J Wound Care. 2011;20(1):11-6.
Springer BD, Cahue S, Etkin CD, Lewallen DG, McGrory BJ. Infection burden in total hip and knee arthroplasties: an international registry-based perspective. Arthroplast Today. 2017;3(2):137-40.
Copyright (c) 2018 Madhav Chowdhry, Matthew Dipane, Edward J. McPherson
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.