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J Knee Surg 2021; 34(11): 1237-1242
DOI: 10.1055/s-0040-1702186
Original Article

Surgical Wound Complications after Knee Cruciate Ligament Reconstruction in Patients with Atopic Dermatitis

Takuji Yokoe
1   Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
,
Takuya Tajima
1   Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
,
Nami Yamaguchi
1   Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
,
Yudai Morita
1   Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
,
Etsuo Chosa
1   Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
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Abstract

Atopic dermatitis (AD), sometimes referred to as eczema, is a common skin disease, and skin barrier dysfunction and immunological disorders are well recognized. However, surgical wound complications after orthopaedic surgery in patients with AD have not been described. This study aimed to report four patients with AD who developed foreign body reactions to FiberWire sutures with or without surgical wound infection (SSI) after knee cruciate ligament reconstruction (CLR). The mean age was 19.8 (range, 16–25) years, and patients 1 and 3 underwent reconstructions of the posterior and anterior cruciate ligament, respectively. At a mean of 7.5 (range, 4–10) weeks postoperatively, discharge from the surgical wound at the tibial side of the fixed graft was identified. All patients were treated with continuous saline lavage and antibiotics; however, their wounds did not heal. Second-look arthroscopy and hardware removal were performed at a mean 12.2 (range, 9–15) months postoperatively. Proliferated granulation tissue surrounding the FiberWire was identified. Intraoperative wound cultures were negative in three of the four patients. Histological examination of the tissues adjacent to the FiberWire revealed a foreign body reaction. All wounds healed immediately after the second surgery. In addition to SSI, foreign body reactions are more likely to occur in patients with AD than in those without AD. Preoperative management of AD by dermatologists and consideration of appropriate suture materials are mandatory to reduce surgical wound complications after knee CLR in patients with AD.

Keywords

knee cruciate ligament reconstruction - atopic dermatitis - foreign body reaction - surgical site infection

Ethical Approval

All procedures in this study involving human participants were in accordance with the ethical standards of our institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Written informed consent was obtained from all patients.




Publikationsverlauf

Eingereicht: 01. Oktober 2019

Angenommen: 07. Januar 2020

Artikel online veröffentlicht:
19. Februar 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Williams H, Robertson C, Stewart A. et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol 1999; 103 (1, Pt 1): 125-138
    CrossrefPubMedGoogle Scholar
  • 2 Bieber T. Atopic dermatitis. Ann Dermatol 2010; 22 (02) 125-137
    CrossrefPubMedGoogle Scholar
  • 3 Maintz L, Novak N. Modifications of the innate immune system in atopic dermatitis. J Innate Immun 2011; 3 (02) 131-141
    CrossrefPubMedGoogle Scholar
  • 4 Williams HC. Clinical practice. Atopic dermatitis. N Engl J Med 2005; 352 (22) 2314-2324
    CrossrefPubMedGoogle Scholar
  • 5 Kawata M, Sasabuchi Y, Taketomi S. et al. Atopic dermatitis is a novel demographic risk factor for surgical site infection after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26 (12) 3699-3705
    CrossrefPubMedGoogle Scholar
  • 6 Flohr C, Johansson SG, Wahlgren CF, Williams H. How atopic is atopic dermatitis?. J Allergy Clin Immunol 2004; 114 (01) 150-158
    CrossrefPubMedGoogle Scholar
  • 7 Lee JH, Bae DK, Song SJ, Cho SM, Yoon KH. Comparison of clinical results and second-look arthroscopy findings after arthroscopic anterior cruciate ligament reconstruction using 3 different types of grafts. Arthroscopy 2010; 26 (01) 41-49
    CrossrefPubMedGoogle Scholar
  • 8 Kawasaki H, Kubo A, Sasaki T, Amagai M. Loss-of-function mutations within the filaggrin gene and atopic dermatitis. Curr Probl Dermatol 2011; 41: 35-46
    CrossrefPubMedGoogle Scholar
  • 9 Miajlovic H, Fallon PG, Irvine AD, Foster TJ. Effect of filaggrin breakdown products on growth of and protein expression by Staphylococcus aureus . J Allergy Clin Immunol 2010; 126 (06) 1184-90.e3
    CrossrefPubMedGoogle Scholar
  • 10 Leyden JJ, Marples RR, Kligman AM. Staphylococcus aureus in the lesions of atopic dermatitis. Br J Dermatol 1974; 90 (05) 525-530
    CrossrefPubMedGoogle Scholar
  • 11 Williams RE, Gibson AG, Aitchison TC, Lever R, Mackie RM. Assessment of a contact-plate sampling technique and subsequent quantitative bacterial studies in atopic dermatitis. Br J Dermatol 1990; 123 (04) 493-501
    CrossrefPubMedGoogle Scholar
  • 12 Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics 2009; 123 (05) e808-e814
    CrossrefPubMedGoogle Scholar
  • 13 Gong JQ, Lin L, Lin T. et al. Skin colonization by Staphylococcus aureus in patients with eczema and atopic dermatitis and relevant combined topical therapy: a double-blind multicentre randomized controlled trial. Br J Dermatol 2006; 155 (04) 680-687
    CrossrefPubMedGoogle Scholar
  • 14 Eichenfield LF, Bieber T, Beck LA. et al. Infections in dupilumab clinical trials in atopic dermatitis: a comprehensive pooled analysis. Am J Clin Dermatol 2019; 20 (03) 443-456
    CrossrefPubMedGoogle Scholar
  • 15 Bernstein DT, Sochacki KR, Jafarnia KK. Sterile abscess with subsequent iatrogenic draining sinus tract formation 3 years after FiberWire and ENDOBUTTON distal biceps brachii tendon repair: a case report. JBJS Case Connect 2017; 7 (02) e32-e35
    CrossrefPubMedGoogle Scholar
  • 16 Mack AW, Freedman BA, Shawen SB, Gajewski DA, Kalasinsky VF, Lewin-Smith MR. Wound complications following the use of FiberWire in lower-extremity traumatic amputations. A case series. J Bone Joint Surg Am 2009; 91 (03) 680-685
    CrossrefPubMedGoogle Scholar
  • 17 Ollivere BJ, Bosman HA, Bearcroft PW, Robinson AH. Foreign body granulomatous reaction associated with polyethelene ‘Fiberwire’ suture material used in Achilles tendon repair. Foot Ankle Surg 2014; 20 (02) e27-e29
    CrossrefPubMedGoogle Scholar
  • 18 Willmott HJ, Singh B, David LA. Outcome and complications of treatment of ankle diastasis with tightrope fixation. Injury 2009; 40 (11) 1204-1206
    CrossrefPubMedGoogle Scholar
  • 19 Elias PM, Schmuth M. Abnormal skin barrier in the etiopathogenesis of atopic dermatitis. Curr Opin Allergy Clin Immunol 2009; 9 (05) 437-446
    CrossrefPubMedGoogle Scholar
  • 20 Kondo H, Ichikawa Y, Imokawa G. Percutaneous sensitization with allergens through barrier-disrupted skin elicits a Th2-dominant cytokine response. Eur J Immunol 1998; 28 (03) 769-779
    CrossrefPubMedGoogle Scholar
  • 21 DeFife KM, Jenney CR, McNally AK, Colton E, Anderson JM. Interleukin-13 induces human monocyte/macrophage fusion and macrophage mannose receptor expression. J Immunol 1997; 158 (07) 3385-3390
    CrossrefPubMedGoogle Scholar
  • 22 Klopfleisch R, Jung F. The pathology of the foreign body reaction against biomaterials. J Biomed Mater Res A 2017; 105 (03) 927-940
    CrossrefPubMedGoogle Scholar
  • 23 Hirai T, Yoshikawa T, Nabeshi H. et al. Amorphous silica nanoparticles size-dependently aggravate atopic dermatitis-like skin lesions following an intradermal injection. Part Fibre Toxicol 2012; 9: 3
    CrossrefPubMedGoogle Scholar
  • 24 Smith RJ, Atkinson RE, Jupiter JB. Silicone synovitis of the wrist. J Hand Surg Am 1985; 10 (01) 47-60
    CrossrefPubMedGoogle Scholar
  • 25 Esenyel CZ, Demirhan M, Kiliçoğlu O. et al. [Evaluation of soft tissue reactions to three nonabsorbable suture materials in a rabbit model] (in Turkish). Acta Orthop Traumatol Turc 2009; 43 (04) 366-372
    CrossrefPubMedGoogle Scholar