CHAPTER 15 Wound Closure and Postoperative Orthosis
The final steps of the operative procedure are wound closure and placement of the postoperative orthosis. These steps are relatively elementary but no less important than other aspects of the procedure.
TECHNIQUE FOR WOUND CLOSURE
After closure of the subscapularis and rotator interval, the wound is irrigated with 800 mL of antibiotic-impregnated sterile saline (50,000 units bacitracin per liter sterile normal saline) via a bulb syringe. The wound is checked to ensure that adequate hemostasis has been achieved. The electrocautery is used as necessary to minimize any residual hemorrhage. No drain is used because it has been shown to be unnecessary during unconstrained shoulder arthroplasty.1 We do not close the deltopectoral interval but initiate our closure with the overlying fascial layer. This layer is reapproximated with no. 0 braided absorbable suture via an interrupted figure-of-eight technique (Fig. 15-1). The subcutaneous fascia is reapproximated with 2-0 braided absorbable suture via an interrupted figure-of-eight technique (Fig. 15-2). The skin is reapproximated with 3-0 undyed absorbable monofilament suture in a subcuticular running closure (Fig. 15-3).
