Silk Fibroin Closure Eliminates the Incidence of Allergic Contact Dermatitis Compared to Cyanoacrylate Mesh in Total Joint Arthroplasty

Background: Allergic contact dermatitis (ACD) from adhesive wound closure systems has garnered particular attention for its potential role in increasing wound complications in total joint arthroplasty (TJA). This study, performed at a high-volume orthopaedic specialty hospital, investigates the inci...

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Main Authors: Justin P. Moo Young, MD, Viraj A. Deshpande, BS, Susanne Porter, FNP-BC, Edward J. Quilligan, BS, Travis Scudday, MD, Steven Barnett, MD, Robert Gorab, MD
Format: Article
Language:English
Published: Elsevier 2025-06-01
Series:Arthroplasty Today
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Online Access:http://www.sciencedirect.com/science/article/pii/S235234412500055X
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Summary:Background: Allergic contact dermatitis (ACD) from adhesive wound closure systems has garnered particular attention for its potential role in increasing wound complications in total joint arthroplasty (TJA). This study, performed at a high-volume orthopaedic specialty hospital, investigates the incidence of wound complications among 2 adhesive systems: a cyanoacrylate mesh (CM) adhesive and a silk fibroin (SF) adhesive. Methods: All TJAs from January 2019 to April 2024 with at least 6 wks postoperative follow-up were retrospectively reviewed. Demographics and surgical outcomes were collected and analyzed. Statistical analyses were performed using Fisher’s exact tests and t-tests. Results: A sample size of 170 CM and 85 SF subjects was calculated to achieve a power of 80%. Of the 257 patients identified (172 CM and 85 SF), 46.7% were females and 53.3% were males, with a mean age of 65.3 ± 9.0 years and a mean body mass index of 28.0 ± 4.6. Bivariate analyses revealed no significant differences in demographics or comorbidities between the CM and SF cohorts, except for frequency of American Society of Anesthesiologists 1 classification (3.9% vs 1.7%; P = .011). The CM cohort exhibited a significantly higher incidence of ACD (6.4% vs 0%; P = .018), while differences in all other clinical outcomes were nonsignificant. Conclusions: There is a very low incidence of wound complications in TJA when using the SF adhesive for wound closure. There was a statistically significant increase in ACD when using the CM adhesive. SF adhesives appear to be a superior wound closure option to consider in patients undergoing TJA.
ISSN:2352-3441