CHAPTER 41 Wound Closure and Postoperative Orthosis
The final steps in revision arthroplasty are wound closure and placement of the postoperative orthosis. Wound closure after revision arthroplasty is performed similar to that for other arthroplasty cases. Revision shoulder arthroplasty often involves larger skin incisions, which can make wound closure an arduous task. The type of revision arthroplasty performed dictates the type of postoperative orthosis used and the duration of its use.
TECHNIQUE FOR WOUND CLOSURE
After reduction of the implant and closure of the subscapularis, if present, the wound is irrigated with 800 mL of antibiotic-impregnated sterile saline (50,000 units bacitracin per liter sterile normal saline) via a bulb syringe. The wound is checked to ensure that adequate hemostasis has been achieved. The electrocautery is used as necessary to minimize any residual hemorrhage. A medium-size closed suction drain is placed to help prevent postoperative hematoma formation in all cases in which a reverse prosthesis has been used, as described in Chapter 31.
Wound closure is initiated by reapproximation of the deep fascial layer with no. 0 braided absorbable suture in an interrupted figure-of-eight technique. As in cases of primary shoulder arthroplasty, we do not close the deltopectoral interval. The subcutaneous fascia is reapproximated with 2-0 braided absorbable suture in an interrupted figure-of-eight technique. The skin is reapproximated with skin staples (Fig. 41-1). We use skin staples in most revision cases because closure with subcuticular suture can be difficult in the presence of dermal scarring from a previous incision. Additionally, the incision for revision shoulder arthroplasty can be large, especially if an extended approach is required. Use of skin staples facilitates closure of these large incisions (Fig. 41-2).
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