Wound Closure Techniques in Orthopaedic Surgery

Wound closure in orthopaedic surgery is fundamental to patient recovery, influencing infection risk, mechanical integrity and scar appearance. Traditional methods include metallic staples and non-absorbable interrupted sutures, valued for speed and tensile strength but sometimes associated with increased pain on removal and visible track marks. Continuous and subcuticular absorbable sutures offer superior cosmetic results and reduced external scarring at the expense of longer operating times. Tissue adhesives such as 2-octyl cyanoacrylate have been adopted as adjuncts or alternatives to sutures, providing a bacterial barrier and water-resistant seal without needle punctures. More recently, zip-type skin closure devices and adhesive tapes have entered clinical practice, applying uniform tension across the incision to support healing while enhancing patient comfort. Selection of technique depends on factors such as anatomical site, soft-tissue quality, biomechanical loading, infection risk profiles and cost considerations. Contemporary research in enhanced-recovery pathways emphasises closure approaches that balance mechanical stability with minimised tissue trauma, optimised patient experience and accelerated mobilisation.

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Wound Closure Techniques in Orthopaedic Surgery publication trend

The graph below shows the total number of articles in wound closure techniques in orthopaedic surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Interrupted suture: Individual stitches placed separately along a wound, permitting precise tension control at each stitch.

Continuous suture: A single thread applied in a running fashion along the wound edge, allowing rapid closure but requiring uniform tension.

Subcuticular suture: An absorbable stitch laid within the dermal layer beneath the skin surface, reducing external puncture marks and improving cosmesis.

Tissue adhesive: Medical-grade cyanoacrylate formulations used to bond skin edges without the need for traditional sutures or staples.

Zip-type device: A non-invasive, tape-based closure system that applies adjustable, even tension across an incision via interlocking straps.

Surgical site infection (SSI): Infection occurring at or near a surgical incision within 30 days postoperatively, potentially leading to delayed healing and increased morbidity.

Dehiscence: The partial or complete separation of wound edges after closure, posing risks for infection and prolonged recovery.

References

1. Surgical site infection after wound closure with staples versus sutures in elective knee and hip arthroplasty: a systematic review and meta-analysis. Arthroplasty (2022).
2. Patient Satisfaction and Cosmetic Outcome in a Randomized, Prospective Study of Total Knee Arthroplasty Skin Closure Comparing Zip Surgical Skin Closure with Staples. Cureus (2020).
3. Tissue adhesive for wound closure in enhanced-recovery total hip arthroplasty: a prospective, randomized and controlled study. BMC Musculoskeletal Disorders (2020).
4. Clinical outcome of different skin closure in total-knee arthroplasty: running subcuticular closure vs intermittent closure. Medicine (2020).