Technology and product reviews Page Points 1. The study was carried out at Alingsas


Hospital between February and April 2010 and initially involved 146 patients.


2. Orthopaedic patients, especially those undergoing hip and knee arthroplasty,


commonly experience problems with skin blistering.


3. The aim of this study was to assess the effectiveness of Mepilex Border in preventing


post-operative skin blisters following hip and knee arthroplasty.


dressing adherence. Dressing choice, therefore, is an important consideration. Dressings that lack elasticity, or those that are applied too tightly, in some cases to provide compression, create greater tension at the skin/dressing interface. This can be exacerbated by post- operative wound oedema and/or physical movement[6,7]


.


HIP AND KNEE ARTHROPLASTY Orthopaedic patients, especially those undergoing hip and knee arthroplasty, commonly experience problems with skin blistering. These surgical procedures involve incision sites that are located over joints with continual skin movement, and are associated with much of the intra-operative positioning and joint manipulation that can result in soft tissue oedema. In addition, wound dressings are required to remain in place over long time periods. All these factors can contribute to the development of post-operative skin blisters. Rates of incidence of skin blistering following hip and knee arthroplasty have been reported


in the literature as being between 2.4 –41%[2,4- 5,8-13]


. The number of joint replacements that References


1.Cuzzell J. Clues: bruised, torn skin. Am J Nurs 1990; 90(3): 16–18.


2 Hahn, GJ, Grant D, Bartke C, McCarting J, Carn RM. Wound complications after


hip surgery using a tapeless compressive support. Orthopaedic Nurs 1999; 18(3): 43–49.


3 Adderley U. Wound exudate: what it is and how to manage it. Wounds Essentials 2008; 3: 8–13.


4 Gupta SK, Lee S, Moseley LG.


Postoperative wound blistering: is there a link with dressing usage? J Wound Care 2002; 11(7): 271–73.


5 Abuzakuk TM, Coward P, Shenava Y,


Kumar VS, Skinner JA. The management of wounds following primary lower limb arthroplasty: a prospective, randomised study comparing Hydrofibre and central pad dressings. Int Wound J 2006; 3(2): 133–37.


6 Blaylock B, Murray M, O’Connell K, Rex J. Tape injury in the patient with total


hip replacement. Orthopaedic Nurs 1995; 14(3): 25–28.


are performed annually is steadily increasing. For example, in Sweden 35,699 patients underwent hip and knee prosthesis surgery in 2009, compared with 20,224 patients in 1999[14]


. Due to the rise in joint replacements,


the number of surgical complications and their related health care costs will concomitantly increase. Until 2001, post-operative wound care


following hip and knee arthroplasty at Alingsas Hospital saw the traditional absorbent dressing, Cosmopor E being routinely used. Unfortunately, hip and knee arthroplasty wounds can be highly exuding[15] a consequence of their size[3]


, simply as , and persistent


dressing leakage was identified as an issue. Dressing changes were, therefore, carried out more frequently, which increased the risk of post-operative wound infection. Furthermore, periwound skin blistering was a concern. In an attempt to overcome these problems,


an Aquacel/Tegaderm dressing combination was introduced, which provided sufficient absorption but failed to prevent the development of wound blisters. This continued development of skin blisters correlates with results in the published literature of wound blistering following treatment with Aquacel alone (13%) [5]


, in combination with Tegaderm 30 Wounds International Vol 3 | Issue 2 | ©Wounds International 2012 (2.4%)[12] or with Tegaderm plus pad (16%)[11] following hip and knee surgery.


ABSORBENT FOAM DRESSING In 2007, Mepilex Border was introduced into the post-operative wound care regimen with the ultimate aim of preventing these periwound skin blisters. Mepilex Border is an all-in-one island


dressing that incorporates a perforated wound contact layer that uses Safetac (soft silicone) technology, an absorbent pad, and an outer vapour-permeable waterproof film. Mepilex Border is designed to absorb exudate but still maintain a moist wound-healing environment and minimise the risk of maceration. The Safetac technology allows the dressing


to adhere to the surface of intact dry skin yet it remains in situ on the surface of a moist wound or damaged periwound skin without adhering to the fragile tissue. Soft silicone adhesives are described as micro-adherent — many contact points are established over the uneven surface of the skin. Consequently, it could be reasonably assumed that the increased contact between the skin and dressing may help to reduce the risk of friction resulting from physical movement, alleviating blister formation. In addition, the seal that forms between the intact skin and dressing prevents the lateral movement of wound exudate onto the surrounding skin, which helps prevent the maceration of the periwound area[16] The aim of this study was to assess the


.


effectiveness of Mepilex Border in preventing post-operative skin blisters following hip and knee arthroplasty.


METHODS This prospective study was carried out at Alingsas Hospital between February and April 2010. It initially involved 146 patients, all of whom received the test dressing (Mepilex Border) to use as the post-operative dressing. Ethics committee approval was not required because the dressing was used in accordance with its intended use and in line with routine clinical practice. After relevant training, the study nurses documented the post-operative wound status for each patient during the treatment period using case report forms designed for the study [Fig 1 - see end of article]. All the nurses were educated about wound blisters and their appearance.


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