Skip to main content
main-content

01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Surgery 1/2015

Influence of skin incision position on physiological and biochemical changes in tissue after primary total knee replacement – A prospective randomised controlled trial

Zeitschrift:
BMC Surgery > Ausgabe 1/2015
Autoren:
David Q Donaldson, Matthew Torkington, Iain C Anthony, Eugene F Wheelwright, Mark JG Blyth, Bryn G Jones
Wichtige Hinweise
David Q Donaldson, Matthew Torkington, Iain C Anthony, Eugene F Wheelwright and Bryn G Jones contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

BGJ Initial concept, study design, data collection and drafting of manuscript. MJGB Initial concept, study design, data collection and drafting of manuscript. ICA Study design, data analysis and drafting of manuscript. EFW Data collection and drafting of manuscript. MT Data collection and study co-ordination. DQD Data collection, study co-ordination, drafting of manuscript. All authors read and approved the final manuscript.

Abstract

Background

Influence of skin incision position on physiological and biochemical changes in tissue after primary total knee replacement. A prospective randomised controlled trial.
The blood supply to the skin covering the anterior knee has been shown to arise predominantly from blood vessels on the medial side of the knee. Skin incisions for primary Total Knee Replacement (TKR) positioned medially therefore risk creating a large lateral skin flap that may be poorly perfused. Poorly perfused skin is likely to result in hypoxia at the wound edges and consequently may lead to delayed wound healing and complications.

Methods

We have carried out a randomised controlled trial (n = 20) to compare blood flow on both the medial and lateral sides of two commonly used skin incisions in TKR (midline and paramedian). We have also assessed interstitial biochemistry (glucose, pyruvate and lactate levels) in the presumed at risk lateral skin flap of both incision types.

Results

In both incision types tissue hyper-perfusion occurs post-operatively and is maintained for at least 3 days. We found no significant difference between blood flow between the two incision types on the medial side of the incision at either day 1 (p = 0.885) or day 3 post-op (p = 0.269), or, on the lateral side of the incision (p = 0.885 at day 1, p = 0.532 at day 3). Glucose levels are maintained post-operatively in the at risk lateral flap with only minimal changes. Lactate levels rise post-operatively and remain elevated for at least 24 hours. However, the levels did not reach levels suggestive of critical ischaemia in either incision group and no significant difference was observed between incision types.

Conclusion

We conclude that the use of a paramedian incision results in only minimal biochemical changes, which are unlikely to alter wound healing.

Trial registrations

Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2015

BMC Surgery 1/2015 Zur Ausgabe

Neu im Fachgebiet Chirurgie

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Chirurgie und bleiben Sie gut informiert – ganz bequem per eMail.

Bildnachweise