Transcutaneous compression suture with iodine gauze for wound closure in revision surgery for therapy-resistant periprosthetic shoulder infections

Florian Grubhofer; Evan O'Donnell; Lukas Ernstbrunner; Ilker Uçkay; Karl Wieser

doi:10.1016/j.jseint.2023.08.007

Transcutaneous compression suture with iodine gauze for wound closure in revision surgery for therapy-resistant periprosthetic shoulder infections

JSES Int. 2023 Sep 9;7(6):2517-2522. doi: 10.1016/j.jseint.2023.08.007. eCollection 2023 Nov.

Authors

Florian Grubhofer¹, Evan O'Donnell², Lukas Ernstbrunner^{3

4}, Ilker Uçkay¹, Karl Wieser¹

Affiliations

¹ Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
² Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
³ Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia.
⁴ Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia.

Abstract

Background: To successfully treat a periprosthetic infection, successful bacteria eradication and successful wound closure are mandatory. Despite adequate surgical débridement in the deep, persistence of wound drainage and subsequent persistence of periprosthetic infection may occur, especially in patients with compromised soft tissue conditions. This study presents a transcutaneous compression suture technique with iodine gauze that was used in patients with persistent wound secretion in therapy-resistant periprosthetic shoulder infections in order to achieve successful infection control and wound healing.

Methods: All patients with persistent periprosthetic or implant-associated shoulder joint infections despite correct previous surgical and antibiotic therapy attempts were included in the study. In all patients, in addition to repeat deep surgical débridement, a transcutaneous "iodine-gauze-compression-suture" was performed with postoperative antibiotic therapy. The primary endpoint was infection control; the secondary endpoint was wound healing rate; and the third endpoint was complication rate after index surgery.

Results: Ten consecutive patients with a mean age of 74 (±7.6) years and a mean follow-up of 14 (±2) months were included. All ten patients showed infection control and successful wound healing, with no need for further revision surgery. In 8 out of 10 patients, the wound healing was fast and completely uncomplicated. Two out of 10 patients showed delayed wound healing with fibrin coatings for 3 and 4 weeks, respectively. No additional intervention was necessary in both patients.

Conclusions: Transcutaneous iodine gauze compression sutures were used to achieve successful infection control without additional revision surgery in 10 out of 10 patients who previously underwent surgery with failed infection control. This wound closure technique is a reliable adjunctive therapy method in the treatment of implant-associated infections of the shoulder in patients with fragile wound conditions.

Keywords: Fragile wound conditions; Iodine gauze compression suture; Periprosthetic shoulder infection; Persistent drainage; Revision shoulder surgery; Transcutaneous compression suture.