How to Incorporate Dressings that Optimize the Surgical Wound

    Attending orthopaedic surgeons often delegate wound closure and wound management to their fellows and residents, with little thought to how those crucial steps in the surgical procedure affect wound healing and patient outcomes.

    Ghassan Boghosian, DO, from STAR Orthopaedics in LaQuinta, California, says it is time to recognize the importance of optimizing the surgical wound to prevent blistering, excessive wound drainage, and surgical site infections (SSI) after total joint arthroplasty – all of which are not as rare as many surgeons believe.

    Dr. Boghosian wound dressing options at ICJR’s Modern Trends in Joint Replacement course. He noted that to optimize the wound, surgeons should use dressings that are:

    • Permeable, to balance moisture in the wound and promote healing
    • Capable of providing a barrier to microbial ingress
    • Occlusive to create a hypoxic environment that accelerates angiogenesis
    • Waterproof to allow patients to shower
    • Painless to apply and remove
    • Cost effective

    Dr. Boghosian shared his postoperative wound dressing protocol for a total knee arthroplasty patient, which includes the use of advanced wound dressings.

    Day of Surgery

    • Layered closure: arthrotomy,  #2 Quill Suture; subcutaneous, #0 Quill Suture; subcuticular – #3 Monoderm Quill Suture
    • Dermabond topic skin adhesive
    • Steri-strips
    • Xeroform
    • 4×8 gauze
    • ACE wrap from thigh to foot

    Postoperative Day 1

    • ACE wrap removed
    • 4x8s debulked, with the 4 or 5 bottom layers left in place; wound not exposed as this is a debulking only, not wound inspection
    • Covered with a Tegaderm dressing

    Day of Discharge

    • Typically post-operative day 2
    • Dressing removed
    • Steri-strips left untouched
    • Acquacel AG Surgical Dressing placed over the wound
      • “Remove Date” written on the dressing, generally 8 days after discharge
      • Patient allowed to shower at home
      • Patient instructed not to remove the dressing and not to allow the home health nurse to remove it