Low serum zinc level as a predictive factor of delayed wound healing in total hip replacement.

Delayed wound healing after total arthroplasty puts the patient at risk for superficial and deep infection, with substantial economic and social consequences. The objective of this study was to assess serum zinc levels as a tool for predicting such a delay in patients with primary osteoarthritis or osteoarthritis secondary to avascular necrosis. We conducted a prospective study of 80 total hip arthroplasties, analyzing possible correlations between delayed healing and serum zinc, nutritional parameters, and other demographic and epidemiological variables. The predictive value of preoperative serum zinc levels and lymphocyte counts was confirmed; thus, an arthroplasty procedure could be timed to minimize risk.

Shoelace technique for gradual closure of fasciotomy wounds.

BACKGROUND: After emergency fasciotomy in acute compartment syndrome, skin graft techniques are usually necessary to cover the wound. METHODS: The shoelace technique for gradual skin closure was retrospectively analyzed after having been applied in 20 patients with acute compartment syndrome. RESULTS: With the application of this technique, none of the cases required new surgical interventions to close the wound. Closure was reached in an average time of 8.8 days, with an average hospital stay of 10 days and a low rate of complications. CONCLUSIONS: Gradual skin closure using the shoelace technique avoids the use of free skin grafts to close the dermotomy-fasciotomy wounds, reducing the need for anesthesia, nursing care, and hospital stays of patients, resulting in lower healthcare costs.

Serum zinc as a prognostic tool for wound healing in hip hemiarthroplasty.

Malnutrition in patients who had surgery leads to the risk of postoperative complications, especially impaired wound healing. Preoperative serum zinc levels and other nutritional parameters were analyzed to establish criteria that would enable delayed healing to be predicted. A prospective study of 97 patients who had hemiarthroplasty for hip fracture is reported. Univariate analysis established the relationship between serum zinc, nutritional parameters, and other demographic variables with delayed healing. Significant variables were included in a multivariate analysis. Univariate and multivariate analyses identified a significant correlation between impaired wound healing and serum zinc levels. The logistic regression equation for probability of delay was: P = 1/[1 + e]. Serum zinc levels less than 95 microg/dL increased risk of delayed healing 11.76 times. Serum zinc levels were shown to have predictive value for delayed wound healing in patients who had hemiarthroplasty for hip fracture.

Preoperative nutritional evaluation as a prognostic tool for wound healing.

In 170 patients given primary hip or knee joint prosthesis surgery, we determined the relation between variables connected with the preoperative nutritional state and delayed healing of the surgical wound. 46 patients had a lymphocyte count of less than 1500 cells/mm3 (normal 1500-3300 cell/mm3), 18 an albumin level of less than 3.5 g/dL (normal 3.5-5 gr/dL), and 35 patients had a transferrin level of less than 200 mg/dL (normal 200-400 mg/dL). We found an association between the preoperative lymphocyte count and delay in wound healing, whereas preoperative seru albumin and transferrin levels had no significant predictive value. In addition, a preoperative lymphocyte count of less than 1500 cells/mm3 was associated with a 3 times higher frequency of healing complications.

Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery: analysis of predictive factors.

BACKGROUND: Several studies have established a relationship between the preoperative hemoglobin level and the need for postoperative blood transfusion. We analyzed the relationship between preoperative hemoglobin levels, as well as other factors such as age, gender, weight, height, type and duration of the total joint replacement surgery, and the need for postoperative blood transfusion. METHODS: A retrospective study of 296 patients treated with 370 procedures (209 total hip arthroplasties [56.5%] and 161 total knee arthroplasties [43.5%]) from 1994 to 1998 was carried out. A univariate analysis was performed to establish the relationship between all independent variables and the need for postoperative transfusion. Variables that were determined to have a significant relationship were included in a multivariate analysis. RESULTS: The univariate analysis revealed a significant relationship between the need for postoperative blood transfusion and preoperative hemoglobin levels (p = 0.0001), duration of surgery (p = 0.0001), weight (p = 0.002), height (p = 0.019), and gender (p = 0.0056). However, the multivariate analysis identified a significant relationship only between the need for transfusion and the preoperative hemoglobin level (p = 0.0001) and weight (p = 0.011); height (p = 0.776) and gender (p = 0.122) were discounted as significant factors. Patients with a preoperative hemoglobin level of <130 g/L had a four times greater risk of having a transfusion than did those with a hemoglobin level between 130 and 150 g/L and a 15.3 times greater risk than did those with a hemoglobin level of >150 g/L. CONCLUSIONS: The preoperative hemoglobin level (p = 0.0001) and weight of the patient (p = 0.011) were shown to predict the need for blood transfusion after hip and knee replacement.