The Routine Use of Running Subcuticular Closures in Orthopaedic Trauma Patients Does Not Increase Wound Complications. Issue 4 (April 2023)

• Record Type: Journal Article
• Authors: Aravindan, Shreyaas; Kim, Ye Joon; Tucker, Nicholas J.; Heare, Austin; Parry, Joshua A.
• Is Part Of: Journal of orthopaedic trauma. Volume 37:Issue 4(2023)
• Page Start: e153
• Page End: e158
• Publication Date: 2023-04
• Subjects: wound closure -- wound complications -- running subcuticular -- monofilament -- staples -- infection; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000002534
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : 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.