Silk Fibroin Mesh Significantly Reduces, but Does Not Completely Eliminate, Skin Reactions Compared to Cyanoacrylate Adhesives in Total Joint Arthroplasty.

Abstract

Medical adhesive-related skin injuries (MARSI) are common complications associated with traditional cyanoacrylate-based adhesives, leading to a range of adverse patient outcomes. Silk fibroin mesh has emerged as a biocompatible alternative, designed to minimize these reactions while maintaining effective wound support; however, comparative data assessing its effectiveness in reducing wound complications remains limited. This study compared the incidence of MARSI, particularly allergic contact dermatitis (ACD), between cyanoacrylate mesh (CM) and silk fibroin mesh (SFM) wound closure systems in total joint arthroplasty (TJA). All primary total hip and knee arthroplasty cases at our institution that utilized CM or SFM wound closure were retrospectively reviewed. Revision arthroplasty, hemiarthroplasty, unicompartmental knee arthroplasty, and fracture fixation were excluded. The final cohort included 797 patients and 874 arthroplasty procedures, of which 626 utilized CM and 248 utilized SFM. Demographic characteristics, MARSI incidence, treatment patterns, and wound outcomes were collected and analyzed. The incidence of MARSI was significantly higher with CM than SFM (4.7 versus 1.2%, P = 0.03). When stratified by procedure, MARSI occurred more frequently following total knee arthroplasty (TKA) than total hip arthroplasty (THA) for both dressing types (TKA: 13.4 CM versus 2.3% SFM, P = 0.01; THA: 2.5 CM versus 0.63% SFM, P = 0.21). On multivariable logistic regression, CM use (OR [odds ratio] 4.41 [1.45 to 19.2], P = 0.020), TKA procedure (OR 4.11 [1.81 to 9.34], P < 0.001), and obesity (OR 2.67 [1.17 to 6.52], P = 0.023) were independently associated with MARSI. There were no differences observed in MARSI management or wound-related complications between groups. Silk fibroin mesh is a promising wound dressing alternative to traditional cyanoacrylate mesh, offering a lower risk of medical adhesive-related skin injury.