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360 degree approach to ‘stitchless-drainless’ surgeries

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Dr Swapnil Zambre, HOD-Orthopaedics, Fortis Hospital Kalyan, talks about how stitchless-drainless procedures are the future of orthopaedic surgeries

A majority of joint replacements are currently being done using older techniques, requiring skin sutures and plastic tube (drain) in the knee after surgery, to drain the blood that accumulates after surgery. This has been shown to significantly slow down the patient’s recovery and affects joint motion in the long term.

The stitchless-drainless procedure is beneficial to patients which allows them rapid mobilisation of their operated joints immediately after surgery. There are no drains that need to be pulled out after 24 hours, neither are there any stitches to come out later, thus avoiding pain and apprehension associated with these procedures. Patients are therefore able to walk on day one and climb stairs between day three and five, post-surgery. Apart from the avoided pain from removal of stitches, patients have reported better cosmetic scars and joint motion. The technique has been combined with Cruciate Retaining Knee Implants in TKR (Total Knee Replacement) thereby allowing a large number of patients to start sitting cross-legged at six weeks post-surgery, which is considered unachievable not so long ago. Patients who have had this procedure done are now happy and guiding others to get this procedure for comfort and safety.

The stitchless procedure not only serves as a cosmetic purpose but adds strength and protection to the incision. The technique increases the strength of closure by more than 1.5 times that of a simple suture or clips. It adds a watertight seal to the incision immediately post-surgery thus creating an antimicrobial barrier preventing Surgical Site Infection (SSIs) of all types. This is important, since the advent of advanced aseptic techniques and laminar flow theatres vast majority of joint infections are due to bacteria that are native to the patient’s skin. So stitch-less procedures are a step further in direction of eradicating infection from arthroplasties.

The technique uses plasticizers and initiators. Plasticizers increase flexibility and three dimensional strength for secure wound closure and patient comfort while initiator enables consistent setting time across various skin types and conditions. It also inhibits Gram Positive Bacteria (MRSA & MRSE) and Gram Negative Bacteria (E. Coli).

The technique is now used for total knee arthroplasty, minimally invasive TKR, total hip arthoplasty, partial knee replacements and total and partial shoulder replacements. There are plans to rollout the procedure to a vast majority, if not all of elective orthopaedic procedures. This will allow patients to also shower while bathing within few days of post-surgery and there is no need to take sutures or clips out.

The team of in-house physiotherapists at Fortis Hospital, Kalyan, have also noticed significant differences in recovery. Earlier, bending the operated knee, sitting at the edge of bed/ chair, standing and walking were all very painful and terrifying for recovering patients at physiotherapy. The staples used for closing skin, caused pulling sensation on the incision, restricted joint mobility and generated tremendous pain. Sometimes there were chances of drains coming out, making patients more apprehensive and reluctant to undergo physiotherapy sessions which are vital after knee replacement surgery. Patients typically need a walker for a month or more and are unable to return to normal activities for a significant period of time.

The very first question the patients ask on post-op day one is “When will I be able to walk?” Nowadays, the answer is today. Patients are more cooperative due to less pain. Their confidence level is boosted when they find themselves bending knees, maximally walking and climbing staircase with almost no pain within few days after surgery.

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