Silk Fibroin Wound Dressing Significantly Decreases Hypersensitivity Compared to 2-Octyl Cyanoacrylate Mesh Dressing

Mesh dressings sealed with 2-octyl cyanoacrylate have been associated with hypersensitivity following total joint arthroplasty. Silk fibroin is a biopolymer available as a novel adhesive woven dressing that does not require skin glue and allows permeability. The purpose of this study was to compare hypersensitivity, delayed wound healing, wound edge separation, reoperations within 90 days, dressing application time, and cost differences between silk dressings and 2-octyl cyanoacrylate mesh dressings.

We reviewed 261 consecutive patients who received either silk or mesh dressings for the incidence of hypersensitivity, delayed wound healing, wound edge separation, reoperations, dressing application time, and cost after total joint arthroplasty. Silk fibroin dressings were used in 58 patients, while 2-octyl cyanoacrylate mesh dressings were used in 203 patients. Statistical analyses were performed using independent t-tests, Chi-square tests, two-sided Fisher's exact tests, and multivariate logistic regressions.

The silk group had a lower rate of hypersensitivity (0 versus 9.9%, P = 0.009). We observed delayed wound healing associated with hypersensitivity in 1% of mesh patients. There were no cases of wound edge separation in knee cases in either group. There were no differences in reoperations. With silk dressings, the total average cost savings were $465.91 per case. There was $327.34 in dressing cost savings and $138.57 in operating room cost savings, with an average of 3.7 minutes of operating room time saved.

Silk fibroin dressing was associated with less hypersensitivity and shorter application time as compared to the 2-octyl cyanoacrylate mesh dressings, with no cases of wound edge separation on removing the silk dressing, even with early knee motion protocols. Although direct costs will vary with institutional pricing, we found substantial savings with the silk dressing. Eliminating the glue drying time saved 3.7 minutes, which can be impactful in health systems that do not have parallel-processing efficiencies.