Issue: July 2021
Source: Chen HH, et al. Arch Surg. 2001;doi:10.1001/archsurg.136.7.801.
Disclosures: Cole reports he is a medical consultant for BandGrip. Farr reports he is a medical consultant for BandGrip.
July 15, 2021
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Skin closure device aids wound care in a variety of knee procedures

Issue: July 2021
Source: Chen HH, et al. Arch Surg. 2001;doi:10.1001/archsurg.136.7.801.
Disclosures: Cole reports he is a medical consultant for BandGrip. Farr reports he is a medical consultant for BandGrip.
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On a daily basis, surgeons are faced with different options for wound closure. Traditionally, surgical incision closure involved sutures or metal staples.

The goals of surgical wound closure include enabling the wound to heal rapidly without infection or complication and returning the incisional region to the best level of function and appearance. How effectively health care professionals use their time in the surgical suite and postoperatively can be a determining factor in the selection of a closure modality.

Skin anchors on a patch

The micro-anchor skin closure device (BandGrip) is a sterile, polycarbonate, class 1, non-significant risk device. It uses a novel method that precisely approximates skin edges of the incision utilizing several rows of small skin anchors on a clear bandage-type patch. The clear anchors, which are 0.029 inches high, are designed to penetrate only the epidermal layer of the skin.

We performed a retrospective review of our patients who underwent a variety of knee procedures that ranged from arthroplasty and patellofemoral realignment to osteotomies and cartilage restoration, also including cases that involved scar revision, and were treated with the micro-anchor skin closure device.

Patients were generally observed at 2 weeks, 6 weeks and 12 weeks postoperatively. Patients who returned to the clinic at the 2-week interval had the micro-anchor device removed easily, after which porous surgical tape strips were applied. If patients were seen via a telehealth visit, they removed the device following verbal guidance and applied the surgical tape strips themselves, and then covered the healing incision with dry gauze until healing was complete.

Closes incision, allows drainage

Previously, our standard wound closure technique involved nonabsorbable monofilament suture, staples and/or tape. The deep tissues were first closed using simple interrupted 2-0 to 4-0 Monocryl suture (Ethicon). The skin edges were then manually approximated and the skin closure devices were horizontally placed about 1-cm apart along the incision line (Figure 1) (Video). This method closed the incision and allowed for drainage. The incisions were then covered with gauze, abdominal pads and a compressive wrap. Patients were admitted overnight for observation. The dressings were then taken down within 24 hours, and the incisions were monitored for any draining or signs of infection. Abdominal pads and a compressive wrap were then reapplied. Patients were instructed to change the abdominal pad every 2 to 3 days, as needed, and to follow up in 2 weeks (Figure 2).

preprocedural hypertrophic scar
1. Intraoperative images show the preprocedural hypertrophic scar (a) and post-procedural application of a micro-anchor skin closure device (b).

Source: Jack Farr, MD
improvement in hypertrophic scar
2. Images show improvement in hypertrophic scar postoperatively at 2 weeks (a), 12 weeks (b) and 12 months (c).

Improved early scar appearance

The micro-anchor closure device provided equivalent efficacy compared with standard closure methods. Typically, closures were closely approximated with good eversion. Visible peri-incisional erythema and other signs of inflammation were not observed in our patients. We found the device was easy to apply, allowed for home removal by patients during telehealth visits and demonstrated improvement in early scar appearance. Patients reported pain-free removal vs. the reported discomfort associated with suture or staple removal for earlier methods of wound closure.

Overall, our patients have been highly satisfied with results with the micro-anchor device, particularly those who previously had surgery that involved a different means of skin closure.

Discussion

The goals of surgical wound closure include enabling the wound to heal rapidly without infection or complication and returning the incisional region to the best level of function and appearance. Effective time utilization of health care professionals in the surgical suite and postoperatively can be a determining factor in selection of a closure modality. A number of surgical incision closure techniques are available, including a variety of suture materials, metal skin staples, skin glue and adhesive dressings that involve a mechanical apposition method.

We used this new technique for a variety of knee surgical procedures and scar revisions. Although it differed from traditional closure with metal staples, suture material and adhesive devices that provide mechanical apposition of wound edges, the novel device was readily adopted by the surgical team. Its design allowed for visualization of the incision, any egress of blood and easy, painless removal.

We have treated more than 100 patients with the closure device and have observed no infections, hematomas or seromas to date. The device demonstrated superior efficacy compared with traditional surgical incision closure techniques. It was easily and quickly applied in the OR by a physician assistant and did not catch on cover dressings as did some other closure devices. The micro-anchor closure was cost-effective and it eliminated the cost, patient discomfort and inconvenience associated with postoperative removal of metal skin staples. Patients reported positive outcomes in terms of comfort upon removal and wound cosmesis.

Conclusion

The medical community has long understood that optimal incisional closure techniques result in minimal wound edge tension with reliable approximation. In addition, surgical efficiency during wound closure is important for patient safety and to achieve inherent economies due to shortened OR time. Satisfaction was excellent and no complications or wound revisions were required during the postoperative observation period among our patients.

Furthermore, the skin closure device we used resulted in uniform and symmetric skin closure without linear or crosshatch scarring, which commonly occurs in closures done with metal staples and other mechanical adhesive closure systems. Our clinical results indicate the incisional closure achieved with the device resulted in easy postoperative wound care and less patient discomfort. Additionally, the inconvenience and costs associated with postoperative removal of metal skin staples or sutures were avoided.

Our initial experience suggests use of a clear bandage-type patch with skin anchors for skin closure results in patient satisfaction, improved scar appearance and is a reasonable alternative to metal skin staples, sutures and other adhesive wound closure systems.