Electronic Letters to:

Hip: C. Livesey, V. Wylde, S. Descamps, C. M. Estela, G. C. Bannister, I. D. Learmonth, and A. W. Blom Skin closure after total hip replacement: A RANDOMISED CONTROLLED TRIAL OF SKIN ADHESIVE VERSUS SURGICAL STAPLES J Bone Joint Surg Br 2009; 91-B: 725-729 [Abstract] [Full text] [PDF]

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Authors' reply:

Christine Livesey, Ashley W Blom   (2 July 2009)

Glue: skin closure method or dressing?

Chris A Peach   (18 June 2009)

Authors' reply: 2 July 2009
Christine Livesey, Research Assistant University of Bristol, Ashley W Blom Send letter to journal: Re: Authors' reply: c.livesey{at}bristol.ac.uk Christine Livesey, et al.	Sir, We thank Mr Peach for his interest in our study. We agree that wound infection rates would be interesting to look at, however, these are very low following total hip and total knee replacements,1,2 Therefore a randomised controlled trial looking into this would require extremely large numbers. However, due to changing patient demographics, with younger patients having total hip replacements, cosmetic appearance of the scars is likely to become more important to patients. In response to Mr Peach's question, the surgical adhesive has two components: one is for the initial wound closure and therefore directly comparable with other skin closure methods, and the other is a liquid bandage. C.Livesey, Research Assistant, A.W.Blom, University of Bristol, Bristol, UK. 1. Blom AW, Taylor AH, Pattison G, Whitehouse S, Bannister GC. Infection after total hip arthroplasty: the Avon experience. J Bone Joint Surg [Br] 2003;85-B:956-9. 2. Blom AW, Brown J, Taylor AH, et al. Infection after total knee arthroplasty. J Bone Joint Surg [Br] 2004;86-B:688-91.
Glue: skin closure method or dressing? 18 June 2009
Chris A Peach, Specialist Registrar, Trauma and Orthopaedics Royal Blackburn Hospital Send letter to journal: Re: Glue: skin closure method or dressing? c.peach{at}doctors.org.uk Chris A Peach	Sir, I read this paper with interest, however, I am unsure whether the outcome measure of a cosmetically appealing scar is really that important for patients. It is the effect of tissue glue on wound infection rates that would really be interesting to look at, albeit needing much larger numbers. Closing the wound with glue in the cleanest room in the hospital, the operating theatre, should have a positive effect on wound infections picked up in the early post-operative period during dressing changes. So, for this reason, should tissue glue be regarded more as an impermeable dressing rather than an invisible suture line? C.A. Peach, Specialist Registrar, Trauma and Orthopaedics, Royal Blackburn Hospital, Blackburn, UK.