Bio-Occlusive Gauze with Tegaderm: A Dressing for Surgical Wounds in Primary THA and TKA
Bio-Occlusive Gauze with Tegaderm: A Dressing for Surgical Wounds in Primary THA and TKA
ReconstructiveReview.org • JISRF.org • Joint Implant Surgery & Research Foundation
Postoperative; Dressing; Bio-Occlusive; THA; TKA; TJA; Gauze; Tegaderm; Primary; Arthroplasty; SSI; PJI Level of Evidence; AAOS Therapeutic Level IV Educational Value & Significance; JISRF Level A
Background: We introduce a simple, cost-effective bio
occlusive dressing to be used for primary total hip
arthroplasty (THA) and primary total knee arthroplasty (TKA).
Methods: The gauze-Tegaderm™ (GT) dressing consists
of a 5cm wide 8-layered gauze covered by 3 to 5
mediumsized Tegaderm transparent films. We prospectively
evaluated 100 consecutive primary THA’s and 107 consecutive
primary TKA’s utilizing this dressing with a minimum of
Results: In the primary THA group, there was one
surgical site infection (SSI) requiring oral antibiotic treatment.
There were no cases of periprosthetic joint infection (PJI).
In the primary TKA group, there were two surgical site
infections requiring oral antibiotic treatment and one case of
chronic PJI requiring a two-stage exchange protocol.
Discussion: Our SSI and PJI rates are comparable to
published rates in the literature. The GT dressing is a
simple, inexpensive dressing that can compete against the many
proprietary bio-occlusive dressings that are more
expensive and are not readily available worldwide. Our favorable
review has merited a large volume randomized controlled
study comparing the GT dressing to another proprietary
As the world population continues to rise, so does the
prevalence of degenerative joint disease. Currently, it is
estimated that more than 2 million total hip arthroplasty (THA)
and total knee arthroplasty (TKA) procedures are
performed worldwide [1,2]. Although these total joint
arthroplasty (TJA) procedures are very successful, periprosthetic
joint infection (PJI) is a major complication that occurs at a
steady rate worldwide. The combined PJI rate for primary
THA and TKA procedures is estimated to be between 1-6%
[3,4]. This is a major challenge to all healthcare institutions
and personnel, as the cure requires an inordinate amount of
time and consumes a significant portion of one’s healthcare
budget. As a result, in the last decade, PJI prevention has
been emphasized by governmental and healthcare
organizations. Methods to reduce PJI include preoperative
optimization of the patient’s health, pre-admission skin cleansing,
and adherence to strict intra-operative measures to reduce
joint implant microbial colonization. Additionally,
post-operative wound care measures have been highlighted to
reduce the rate of local surgical site infections (SSI) that can
progress into a PJI. Consequently, the healthcare market has
seen a proliferation of various wound dressings as a means
to reduce SSI.
The aim of any post-operative wound dressing is to
absorb wound blood and exudate while reducing local
bacterial load to the surgical site. Furthermore, the dressing should
keep the environment around the wound moist enough to
prevent desiccation and accelerate natural wound healing
. Many companies have developed
bactericidal/bacteriostatic dressing coverings to mitigate SSI. All advertised
dressings report effective reduction of SSI to some degree,
but the costs of such dressings are relatively expensive.
With the costs of healthcare rising throughout the developed
world, all healthcare personnel are cognizant of providing
effective treatment at lower costs. This applies to all aspects
of perioperative total joint arthroplasty (TJA) care,
including perioperative dressings.
In this review, we introduce a simplified surgical dressing
that we believe provides effective treatment of
perioperative TJA wounds. The design consists of an 8-layered simple
gauze dressing covered with an occlusive polyurethane film
(Tegaderm™, 3M, St. Paul, MN). It is simple, readily
available, and economical. The gauze dressing over the wound
acts as a highly absorbent pad to absorb any excess
exudate as well as keeping the immediate surroundings moist.
The occlusive polyurethane film (Tegaderm), applied over
the gauze, provides a waterproof seal to the wound. It still
allows for the exchange of water vapor while inhibiting the
entry of bacteria. This keeps the wound moist as well as free
from any external contaminate . It serves as a
significantly cheaper alternative to its counterpart dressings currently
available on the market. To date, to the best of our
knowledge, no study has shown the effectiveness of this
particular dressing combination in terms of prevention of SSI and
PJI, nor the calculated reduction in the cost for the
healthcare system. The objective of this study was to evaluate the
effect of using this dressing combination on the occurrence
of PJI and SSI. We compare our results to the reported rates
in the literature. In addition, we assess the financial impact
of utilizing this simple perioperative dressing. We
hypothesize that the Gauze-Tegaderm dressing combination will be
as effective as other “modern” dressings discussed in the
literature while providing a significant cost savings.
Between January 2015 and December 2016, 796 TJA
procedures were performed at our single TJA quaternary
referral institution by the senior author (ejm). The TJA
procedures included total shoulder arthroplasty (TSA), total
hip arthroplasty (THA), and total knee arthroplasty (TKA).
During this time period there were 395 revision TJA
procedures, 115 resection TJA procedures, 52 reimplant TJA
procedures, and 234 primary TJA procedures. We selected
our primary THA and primary TKA procedures as the basis
for this study. Beginning January 2015, we started the
prospective study in which we covered all consecutive primary
THA and TKA procedures with a gauze-tegaderm dressing
combination. We selected a minimum follow-up period of
one year for this report.
The constituents of the gauze-Tegaderm (GT) surgical
dressing are sterile 4x4 inch gauze dressing pads (Medline,
Mundelein, IL) and 4x4.75 inch Tegaderm™ Film covers.
The technique of assembling and applying the GT dressing
was the same for THA and TKA procedures; this technique
remained constant over the entirety of the study period. The
dressing assembly required unfolding 4 sterile gauze
dressings and laying them on top of one another. Next, the 4
layers were folded in half to a width of 2 inches (5.08cm). The
now 8-layered gauze was applied over the surgical site and
any excess at the ends was cut off. The gauze was then
covered with the Tegaderm films. The films were overlapped
approximately 1cm to provide an impervious seal of the
surgical incision. They were applied in a fashion to have at
least 2cm of skin contact circumferentially around the gauze
dressing. For THA procedures, the GT dressing was applied
at the termination of the surgical procedure with the patient
in the lateral decubitus position. Prior to the application of
the dressing, the skin was cleaned with sterile saline
solution via a laparotomy sponge (Medline, Mundelein, IL) and
completely dried with a dry laparotomy sponge. The
Tegaderm was applied over the gauze and gently pushed onto
the skin. We were strict not to stretch the Tegaderm during
application in the interest of preventing skin blistering. For
TKA procedures, the GT dressing was applied at the
termination of the surgical procedure with the knee flexed at 90°.
The skin was cleaned and dried in a similar fashion to the
THA application. Again, the Tegaderm was gently pushed
digitally onto the skin avoiding any stretching of the cover.
For all primary TKA procedures we used a joint drain that
was exited over the lateral mid-thigh. The drain was secured
with a smaller 4x3cm GT dressing. The GT dressing
applications are illustrated in Figures 1a-1c.
Dressing changes were performed on the surgical floor
when blood or serous fluid extended to the edge of the
gauze. If the surgical dressing required a change, a similar
dressing was reapplied after cleaning the surgical site with
alcohol pads and/or sterile dry gauze. If the surgical dressing
remained dry and intact, the patient was discharged with
instructions to remove the dressing on post-operative day 7 or
8. Patients were allowed to shower with the waterproof GT
dressing. Similarly, if the dressing was changed, the patient
was discharged with the last GT dressing and instructed to
remove the dressing on post-operative day 7 or 8.
All THA procedures were performed using a less
invasive posterolateral incision . The patient was positioned
and secured in the lateral decubitus position utilizing the Hip
Grip System (SunMedica, Redding, USA). The entire limb,
hip, and pelvis were first cleansed and wiped with 70%
isopropyl alcohol wipes (McKesson, Santa Fe Springs, USA)
and allowed to dry. The entire limb, hip, and pelvis were
treated with DuraPrep™ (3M, St. Paul, USA) and draped
sterilely with disposable paper drapes. Exposed skin
surfaces were covered with an Ioban™ dressing cover (3M, St.
Paul, USA) that was removed at the termination of skin
closure. A first generation cephalosporin (Ancef, Baxter
International, Deerfield, USA) was administered intravenously
30 minutes prior to incision and continued for 24 hours. If
a patient stated an allergy to penicillin, a test dose of Ancef
was administered and, if after 15 minutes there was no
observable reaction, IV Ancef was continued. If the patient had
a known or documented allergy to Ancef, IV 1 gram
Vancomycin was administered prior to incision and was continued
for 24 hours. Throughout the procedure, the tissues were
injected with a periarticular joint cocktail for pain
management. The pain block cocktail is listed in Table 1. The tissues
were strategically injected with a multi-stab technique with
a 23 gauge needle .
The hip incision was made long enough to allow for
comfortable access and exposure to the hip. A cementless
acetabular cup was used in all cases. A titanium, porous plasma
spray hemisphere cup was inserted (Magnum or Ranawat
Burstein, Biomet, Warsaw, USA) with a press-fit technique
of a 1mm underream. Just prior to implant insertion, the
acetabular bone was hand lavaged with 100 to 150cc of sterile
saline solution containing 1 gram of Bacitracin (APP
Pharmaceuticals, Schaumburg, USA) mixed in one liter of
sterile saline solution. For the femoral stem, a cementless stem
was used in all cases (TaperLoc, Biomet, Warsaw, USA).
This was a titanium alloy, proximal, porous plasma spray
tapered stem. The femoral canal was prepared by serial broach
technique utilizing a 0.75mm undersized press-fit at stem
insertion. Prior to stem implant insertion, the femoral
canal was lavaged with 100 to 150cc of sterile saline solution
containing Bacitracin. The acetabular and femoral stem
implants were inserted using a “no touch” technique as much
as possible. Prior to closure the entire wound was hand
lavaged using a 25cc Asepto syringe (McKesson, San
Francisco, CA) with 200 to 250cc of sterile saline solution
containing Bacitracin. The top surgical gloves were changed at the
beginning of closure (double glove technique was employed
for all surgical personnel). A multilayered closure was
performed using all absorbable sutures. Number One Vicryl
and 2-0 Vicryl (Ethicon, Somerville, NJ) sutures without
antibiotic coating were used for all layers. The skin was closed
with a subcuticular technique using 3-0 Monocryl (Ethicon,
Somerville, USA). The skin was reinforced with ½ inch
steristrips (3M, St. Paul, USA) cut to a width of 2.5cm so
that they would be covered by the GT dressing. The
steristrips were applied with a thin application of Benzoin (3M,
St. Paul, USA) applied only to a width of 2.5 cm of the skin.
All TKA procedures were performed using a less
invasive paramedial incision with a medial parapatellar
]. The knee and limb were secured utilizing the
Knee Grip System (SunMedica, Redding, USA). The entire
limb was initially cleansed with alcohol wipes and allowed
to dry. A pneumatic tourniquet was applied into the most
proximal thigh. The tourniquet pressure was 275mm/Hg in
all cases. The tourniquet was inflated prior to skin incision
and deflated after cementing of the implants. The entire limb
was treated with Duraprep and draped sterilely with
disposable paper drapes. Exposed skin surfaces were covered with
an ioban dressing cover. The ioban was removed at the
termination of skin closure. Intravenous antibiotics were
administered using the same protocol as the THA procedures.
Additionally, the same periarticular pain block cocktail was
injected into the knee tissues. For all TKA procedures, an
adductor block using 20cc of 0.5% Ropivacaine was
administered prior to the surgical procedure.
The knee incision was made long enough to allow for
comfortable access and exposure to the knee. The Vanguard
Total Knee System™ (Biomet, Warsaw, USA) was used in
all cases. An anterior stabilized Vitamin E reinforced
polyethylene bearing was used in all cases except when a
constrained knee system was required for severe deformities. All
patellae were resurfaced with a polyethylene 3-peg dome.
All implants were cemented with Palacos Cement
(Biomet, Warsaw, USA) without antibiotics added to the PMMA
powder. Prior to cementing of the implants, all boney
surfaces of the knee were pulse mechanical lavaged with
sterile saline solution containing Bacitracin. Top gloves were
changed for insertion of implants and also changed at the
time of closure of the knee. Just prior to closure, the knee
was lavaged with 1 liter pulsed mechanical lavage using
sterile saline solution containing Bacitracin. All layers of
the knee incision were closed at 90° of flexion, including
the subcuticular layer. A 10 French Blake wicking silicone
drain (Ethicon, Somerville, USA) was placed into the lateral
gutter of the knee and brought out of the skin at the
anterolateral mid-thigh. The drain was removed on the first
postoperative day. A multilayer closure was performed using all
absorbable sutures without antibiotic coating. The
arthrotomy was closed with number 1 and 2-0 Vicryl sutures. The
subcutaneous layers were closed with 2-0 and 3-0 Vicryl
sutures and the subcuticular layer was closed with a
subcuticular technique using 3-0 Monocryl sutures. The skin was
reinforced with 1/2" steristrips cut to a width of 2.5cm and
applied with a thin coat of Benzoin. The skin was cleaned
and dried prior to application of the steristrips, after which
the GT dressing was applied.
All THA and TKA procedures were performed with body
exhaust suits (Flyte, Stryker, Kalamazoo, USA) in
non-laminar flow dedicated total joint rooms. Anesthesia consisted
of a general anesthetic combined with a spinal anesthetic.
Intrathecal morphine sulfate was not used in any cases.
Patients were started in physical therapy within 6 hours of the
procedure with standing and walking. For thromboembolic
prophylaxis, a graduated risk assessment protocol was
utilized by the medical team. The default, low risk, patients
were treated with mechanical foot pumps and enteric
coated aspirin (325mg) daily. Higher risk patients were treated
with other antiplatelet inhibitors or oral warfarin with a
target INR of 2.8 to 3.0. On rare occasion, the very high-risk
patients were treated with a pre-operative removable
inferior vena cava filter, which was removed 3-4 months after the
joint replacement procedure.
Preoperatively, all patients were scored for
periprosthetic joint infection risk using the Musculoskeletal Infection
Society (MSIS) risk scoring system, calculating both a
systemic host grade (A, B, or C) and a local extremity grade
(1, 2, or 3) [
]. All patients were followed routinely at
6 weeks, 12 weeks, and yearly thereafter. Additional
treatment was provided as needed. All complications or
additional surgeries were documented. All clinical follow-up
was with the operating surgeon. TKA procedures were
evaluated with radiographs, Knee Society Scoring and Oxford
Scoring at regularly defined intervals. THA procedures were
evaluated with radiographs, Hip Society Scoring, and
Oxford scoring at regularly defined intervals. When there was
any suspicion of a PJI, the patient was assessed with serum
blood testing. This included Complete Blood Count (CBC),
quantitative c-reactive protein levels, and an erythrocyte
sedimentation rate (ESR). When indicated, all joint
aspirations were performed by the operating surgeon. All cultures
were sent for a 14-day bacterial growth protocol. Fungal and
mycobacterial plates were reviewed for a 6-week duration.
A PJI was defined using the major and minor criteria as set
forth by the International Consensus on Periprosthetic Joint
In this study there were 100 primary THA procedures
in 91 patients and 107 primary TKA procedures in 100
patients. For the THA group, there were 48 females and 52
males. The average age was 72 (range 51-98). Average body
mass index (BMI) was 27 (range 14-46). The main
diagnosis for needing the THA procedure was primary
osteoarthritis in 48 patients, developmental dysplasia (DDH) in
32 patients, acute femoral neck fracture with joint
arthritis in 9 patients, rheumatoid arthritis in 5 patients,
avascular necrosis in 3 patients, and acetabular fracture in 3
patients. The MSIS scores for the study group consisted of 51
A Hosts, 42 B Hosts, and 7 C hosts. Ninety-one patients had
a Type 1 limb score (local extremity score), while 9 patients
had a Type 2 limb score. Operative blood loss was measured
and averaged 255cc (range 50-500). Four patients required
a post-operative blood transfusion. The average incision
length was 11.8 cm (range 9 to 15). The average number
of Tegaderm films used was 3.4 (range 3-5). The GT
dressing was changed 44% (N=44) of the time prior to discharge.
Table 2 displays the calculated total costs of the THA
dressing application and compares this to an estimated cost of
a silver-impregnated occlusive wound dressing (10-inch
Aquacel™, ConvaTec, Deeside, UK) that is available at our
institution. At latest follow-up, an average of 18.1 months
(range 12.9 to 24), there were no cases of PJI. No patients
required additional surgery for an SSI or wound drainage.
Two patients were prescribed oral antibiotics at their 6-week
post-op evaluation for redness surrounding a localized
suture reaction (i.e., “split sutures”). There were 3
reoperations performed. One patient dislocated at 3 weeks
post-operatively, requiring an open reduction and revision of the
acetabular cup. One patient underwent a removal of
heterotopic bone at 10 months for symptomatic pain with hip
flexion limited to 80°. One patient required revision at one week
due to peri-prosthetic fracture of the femur. Other
compli*At our institution the acquisition cost is $0.08 (USD) for one 4”x4” gauze
sponge pack (10 sponges) and $0.59 (USD) for one Tegaderm film cover. A
comparable Aquacel 3.5”x10” dressing cover costs $37.03 (USD).
cations were encountered that did not necessitate
reoperation. One patient suffered from bilateral DVT at 12 weeks
post-operatively. Another patient had a partial femoral nerve
palsy with post-operative quadriceps power as 3/5. This
fully recovered. Lastly, one patient had a non-displaced
greater trochanteric fracture intra-operatively that did not require
any further intervention.
For the TKA group, there were 66 females and 41 males.
The average age was 71 years (range 33 to 89). Average
body mass index (BMI) was 26 (range 16-47). The main
diagnosis for needing the TKA procedure was
osteoarthritis in 90 patients, rheumatoid arthritis in 12 patients, and
post-traumatic in 5 patients. For MSIS scoring, there were
54 A Hosts, 48 B Hosts, and 5 C Hosts. Eighty-seven
patients had a Type 1 limb score (local extremity score), while
20 patients had a Type 2 limb score. The average measured
intraoperative blood loss was 95cc (range 35-400). Only 1
patient required 1 unit of fresh frozen plasma
preoperatively for known coagulopathy and cirrhosis. The average
incision length was 12.4 cm (range 10-16). The average number
of Tegaderm films used was 5.3 (range 5-7). The GT
dressing was changed 45% (N=48) of the time prior to discharge.
Table 2 displays the calculated total costs of the TKA
dressing application and compares this to an estimated cost of
the comparable Aquacel dressing. At latest follow-up, an
average of 17.2 months (range 12.1 to 24), there was 1 case
of PJI. This patient was successfully treated with a 2-stage
revision arthroplasty. No other patients required additional
surgery for SSI or wound drainage. Two patients were
prescribed oral antibiotics at their 6-week postoperative
evaluation for redness surrounding a localized suture reaction (i.e.,
split sutures). One patient also suffered from a loose
tibial component 8 months postoperatively, requiring revision
arthroplasty. Among complications not requiring
reoperation, 4 patients developed joint arthrofibrosis requiring
subsequent manipulation of the replaced knee joint, 1 patient
suffered from a foot drop and fully recovered at 4 months,
1 patient had a DVT at 8 weeks, and 1 patient
suffered from a superficial wound dehiscence requiring
a wound vac. This was a patient with rheumatoid
arthritis who went onto complete healing.
Reduction of perioperative infection after total
joint arthroplasty (TJA) is of paramount importance
as infection is one of the most potentially disastrous
complications that can occur. Superficial surgical site
infection (SSI) can progress and result in deep
periprosthetic joint infection (PJI). A PJI has enormous
consequences, not only to the patient, but also to the
healthcare community at large. Typically, a PJI requires
reoperation to clear the infection and, if the acute PJI is not
resolved, the implants require removal in either a single-stage
or two-stage protocol. The costs of treating a chronic PJI
could well pay for a further 10-30 primary TJA procedures.
Primary TJA wounds are classified as “clean,” acute
wounds with only moderate exudation [
]. The wound
exudate is rich in IL-1, PDGF, EGF, and TGF-beta, all of
which modulate connective tissue formation and epidermal
]. Winter’s research has demonstrated that a
moist microenvironment enhances the wound healing
]. However, in some instances, some wounds can
be highly exudative with persistent leakage. Ironically, this
excess fluid could act as the breeding ground for
microorganisms and cause infection. Thus, the ideal wound
dressing should be able to absorb any excess exudate, but provide
a moist microenvironment for optimal wound repair [
A unique challenge for the THA/TKA wound dressing
is its direct application over a moving joint. The dressing
must allow for functional range of motion, often over
fragile elderly skin, without causing significant skin friction,
shearing, and/or blistering. In addition, primary TJA is
often associated with postoperative soft tissue edema,
whereby there can be a substantial increase in skin circumference.
Thus, a dressing must accommodate daily fluctuating skin
circumference changes without causing significant skin
friction and/or shearing. Any dressing that increases skin shear
forces, increases the risk for blister formation. Blistering
leads to breaks in the skin protective barrier and increases
the risk of SSI . Therefore, an ideal dressing should be
flexible with range of motion and must accommodate cyclic
fluctuations in periarticular joint circumference. Lastly,
Odland’s research demonstrated that blisters heal faster if left
]. Hence, a dressing with mechanical
properties that limit blister formation and rupture would be ideal.
Cost conscious comprehensive medical care has become
the normative process, competing against advancing
medical technology and parabolic escalations in healthcare costs
]. All aspects of orthopaedic surgical care are now
carefully scrutinized with the advent of comprehensive
medial informatics. Informatics programs allow comparisons
of treatments between surgeons, OR teams, hospitals, and
healthcare systems; providing effective safe treatment at
reduced costs is the goal. The treating surgeon, going forward,
will have to adapt to these changes and must take a
leadership role in determining strategic changes in healthcare
delivery that considers cost and benefit to both the individual
patient and healthcare society in general.
Putting all criteria together, the characteristics of an ideal
wound dressing for primary THA/TKA should include: 1)
protection against bacterial delivery at the surgical site, 2)
maintaining an ideal microenvironment for wound healing
while wicking excess exudate from the incision site, 3)
visually transparent to determine the need for dressing change,
4) ability to adhere to the skin of a moving joint without
causing significant skin blistering, and 5) inexpensive and
readily available supplies for worldwide use.
At our center we selected the GT dressing as a means to
address head-on the competitive field of occlusive
postoperative dressings. Our basis for selecting this dressing
specifically was multiple. First, Tegaderm is “easy” on the skin. It
is thin and mechanically flexible, which is advantageous for
application over a moving joint. Our previous experience
using Tegaderm over ruptured skin blisters and skin tears
showed that it caused minimal marginal dermatitis and
blistering. Secondly, the GT dressing construct is a
vapor-permeable occlusive film. An important characteristic of
Tegaderm is its pore size; the pores are large enough to allow for
the exchange of water vapor, but small enough to prevent
bacteria from entering into the wound site. The GT dressing
keeps the local wound environment moist, preventing
excessive drying. Thirdly, the gauze dressing is a highly absorbent
material that works on the mechanism of capillary action of
its fine threads, effectively wicking fluid from the surgical
wound. Furthermore, the white gauze beneath a
transparent Tegaderm film allows for the treating physician to easily
identify the color and volume of discharge from the wound
below. This ease of identification also reduces unnecessary
dressing changes. Frequent dressing changes cause
episodic cooling of the wound, resulting in a longer time for
resuming cellular mitotic activity and, in turn, wound healing
]. Additionally, each dressing change poses a potential
risk of exposing the wound to external nosocomial
pathogens. Fourth, the GT dressing provides an essentially
waterproof seal. This allows the patient to take a shower the next
day postoperatively, if needed. With the skin cleaned and
dried in the operating room, we have found that the
Tegaderm can stay secure for an extended period of time. We
have had patients with an intact GT dressing on the hip and
knee for up to 14 days. Fifth, the GT dressing creates a
hypoxic environment which has been shown to accelerate
]. Both moisture and hypoxia are beneficial
for wound healing. Lastly, the GT dressing is inexpensive
and its supplies are readily available worldwide. At our
institution, the cost of a typical GT dressing consisting of 4x4
gauze sponges and 5 medium-sized Tegaderm films is $3.00
USD. A comparable length Aquacel dressing at our
institution costs $37.03 USD.
This review reports a favorable outcome of the
majority of primary THA and TKA performed within this study
group. We attribute our low overall infection rate to a
disciplined comprehensive TJA protocol focusing on minimizing
SSI and PJI. Our selection of the GT dressing for
postoperative application did not appear to adversely affect our rates
of SSI and PJI when compared to other published series
]. Our low PJI rate is encouraging in light of our series
having 49% B and C grade systemic hosts. The
weaknesses of this study are several. First, this was not a
randomized trial. Secondly, the total number of subjects studied was
relatively small. Per design, we chose first to study the GT
dressing construct to see if it was an acceptable dressing for
continued use as a perioperative joint dressing for primary
THA and TKA. After review of our results, we feel
comfortable in stating that the GT dressing meets our criteria as
a cost-effective dressing. Going forward, a more rigorous
study is needed, At present, we have received IRB approval
for a prospective randomized control trial comparing the GT
dressing to a proprietary bio-occlusive dressing in
primary THA and TKA. The enrollment will exceed 650 primary
TJA procedures with a minimum follow-up of 1 year. This
RCT will help determine via a rigorous comparison,
whether the GT dressing will be equally effective in maintaining a
low SSI and PJI rate in primary THA and TKA.
In summary, we introduce the concept of the
gauzeTegaderm dressing for use in postoperative primary THA
and TKA wounds. This dressing construct meets a
majority of criteria to promote wound healing and protect against
SSI. The GT dressing has many salutary attributes and our
study results show a low rate of SSI and PJI. The GT
dressing, thus far, seems to be a reasonable cost-effective
dressing that can be utilized worldwide. Our favorable early
findings in this review merit a more rigorous investigation of
this dressing. An upcoming large volume RCT will
delineate the effectiveness of the GT dressing in minimizing
postoperative SSI in TJA.
© 2017 Chowdhry, Dipane, McPherson. All rights reserved.
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Submitted December 10, 2017 Reviewed December 15 , 2017 Revised December 20 , 2017 Accepted December 21, 2017 Published December 31 , 2017 1 Madhav Chowdhry , Matthew Dipane, Edward J . McPherson LA Orthopedic Institute 201 S. Alvarado Street Suite 501 , Los Angeles, CA 90057