Layered Closure and Adjunctive Adhesive Retention Suture Device Use

In this video, Dr. Stefanski expands on the details of her research for the article, Outcomes of Layered Closure and Adjunctive Adhesive Retention Suture Device Use Following Ankle Fracture Open Reduction and Internal Fixation: A Single Center, Retrospective Cohort Study. Additional authors of the article include Arun Karwal, DPM and Erik Haniuk, DPM. Read the full article here.
 

Transcript:

I am Emily Stefanski. I am located out of Warwick, Rhode Island, out of Kent Hospital and we also work out of Landmark Hospital, which is where most of the study was completed.

Our paper titled is “Outcomes of Layered Closure and Adjunctive Adhesive Retention Suture Device Use Following Ankle Fracture, Open Reduction, and Internal Fixation.” It was a single center retrospective cohort study. We did look at 20 patients that had the assistive retention suture device used for their closure following the ankle RAF versus 20 patients without it. We did see approximately 80% reduction in postoperative dehiscences and 90% reduction in the need for reoperation. Unfortunately, in our area, we do have very high comorbidity risk and when we have these excessive traumas that do need emergent intervention, we saw incredible benefits using these devices.

As noted, we do have very poor patient compliance, unfortunately, in our area. Most commonly, our patients love to walk on ankle fractures the day after, for whatever reason. We have very high dehiscence rates just typically in surgery. Despite everything that we've done and we've educated our patients with, we also have very high rates of diabetics in our practice and in our area. We've also seen very poor vascularity, which we try to offset by working very closely with our vascular teams, but unfortunately in emergent situations we need to take care of these patients. So we wanted to create the study to try to find ways to reduce risk for dehiscence, and we found, as you can see in the study, approximately 80% improvement just using these simple devices.

We did expect improvement using the adhesive retention suture devices. However, I don't think we expected to see the outcomes that we did with the 80% decrease in dehiscences. Now it's something that we do implement on every case that we use in order to help with any postoperative edema. It allows retention relief to the incision, and it's something that we can keep on for a little bit longer than we do typical sutures. It offers us just basically a seatbelt to the area in order to improve outcomes.

I think specific to our paper, a multicenter randomized control study would be especially encouraging. We have an N of 39 in total, and I think more patients always leads to better information, long term. I think also though, we can start looking at other types of foot surgery, so specifically we did look at ankle surgery with incisions on the medial lateral aspect. However, it's very common for us to do Lisfranc injuries with multiple incisions on top of the foot. And with the reduced surface area and the postoperative edema that we typically see in those types of injuries, it could be a very interesting future study.