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6 4 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 2 0 time is of the essence." Wound closure technology also eliminates the need for patients to schedule post-op appointments to have staples or sutures removed. Safely reducing or limiting provider-patient visits until the pandemic is under control is in everyone's best interests. "Staplers and suture require a post-op visit for removal," points out Dr. Freed. "That's a time-con- suming, non-reimbursable event that requires an interaction with the patient." Of course, absorbable stitches are an option, but they can lead to abscesses — drainage, pus or red- ness around the wound — that essentially negate any of the benefits of the patient not having to return to have the stitches removed. "Approximately one out of every 20 patients will end up with redness or drainage from an abscess and wind up having to come in for follow-up treat- ment," says Dr. Ho. COVID-19 dangers aside, non-invasive wound closure options are the safer option. Suture use car- ries the constant risk of needlestick injuries for sur- geons and surgical team members. Staples, mean- while, can harm patients. "If you punch 50 staples into the skin, there's a risk, albeit a small one, of infection," says Dr. Freed. Plus, he points out, non- invasive wound closure options don't traumatize tis- sue like staples do, and less tissue trauma leads to better outcomes. 4. Patient satisfaction Even patients who claim they don't care about post-op cosmesis would prefer their skin showed little evidence of surgery. Dr. Ho performs a lot of ACL repairs and focuses primarily on returning the knee to its former function. Still, there's no doubt the aesthetic component of the procedure plays a major role in his patients' overall satisfaction with their experience. To close incisions, Dr. Ho relies on a wound-closure technology that employs tiny hooks or micro- anchors that dig into the dermis — deep enough to secure the skin but not deep enough for patients to feel it — and apply an even tension to stretch out skin around the incision and compress the wound to bring the skin together. This approach generally results in faster healing and less scarring. "Even patients who claim to not care about scarring love how their skin looks after healing," says Dr. Ho. There's also a convenience component for patients who don't have to worry about caring for sutures or staples when they're home recovering. Many of the alternative-closure devices are water- proof, so patients can shower without having to cover up their incisions. The device Dr. Ho uses is waterproof and see-through, which allows patients to monitor the incision as it heals. If they have con- cerns about the way it looks, they simply snap a pic and send it to him for evaluation. A benefit of alternative wound closure devices that all too often flies under the radar is the "wow" factor, something that greatly bolsters word-of- mouth marketing for facilities. "When you tell patients about a new device you'll use to close their incision and explain how it works, they get excit- ed," says Dr. Ho. "These are the people who will talk to their friends and family and spread positive reviews about your facility." OSM SCAR WARS Incisions made during a knee arthroscopy are barely visible nearly two weeks after surgery thanks to a device that employs micro-anchors to close wounds. Sherwin S.W. Ho, MD