Commentary & Perspective

Commentary & Perspective on
"Tape Blisters Following Hip Surgery: A Prospective, Randomized Study of Two Types of Tape"
by Kenneth J. Koval, MD, et al.

Commentary & Perspective by
Michael D. Ries, MD*,
Department of Orthopaedic Surgery, UCSF Medical Center, San Francisco, California

Tape blisters around the incision after a total hip arthroplasty can be a source of pain and frustration for patients. Koval et al. identified blisters in 41% of patients when non-stretchable silk tape was used to secure the postoperative dressing. Although superficial, blisters can occasionally lead to infection or leave scars. Blisters may form because of the use of constricting tape or because of swelling and/or skin sensitivity. Patients who have experienced the development of skin blisters after previous surgery may request that paper tape be used after subsequent surgical procedures, but paper tape is often poorly adherent to the skin.

In a well-designed, prospective randomized study, the authors have identified a lower prevalence of tape blisters with use of a more compliant or stretchable tape, suggesting that the shear stress or the pulling of the skin that occurs with the use of a more rigid tape is associated with the development of blisters.

Use of a compressive spica Ace wrap dressing has also been associated with a lower prevalence of skin blisters¹. This type of dressing does not restrict skin movement as much as a more rigid, non-stretchable tape dressing, but the application of the compressive spica Ace wrap dressing is difficult and dressing changes are not easily performed, particularly in obese patients.

The authors report that postoperative swelling may also contribute to the formation of skin blisters. Skin blisters are not uncommon at fracture sites where a closed reduction has been performed and there is associated post-reduction swelling. In addition, nutritional deficiencies, obesity, or other medical comorbidities that oftentimes cannot be improved before surgery may contribute to the risk of the formation of skin blisters.

Koval et al. have identified a method that is clearly under the control of the surgeon and that may lower the prevalence of skin blisters without compromising any other aspects of patient care. When skin blisters do develop, treatment with protective dressings and observation for signs of infection are appropriate. However, the time until healing may vary. Koval et al. found that blood-filled blisters may be more likely to heal with permanent scarring.

Skin blisters would not be expected to compromise the results of arthroplasty with regard to long-term function and may not represent a serious concern for the surgeon. However, they can be a very disconcerting problem for the patient, who often requires reassurance from the surgeon that the blisters will heal. The authors should be complimented for identifying a method of reducing the prevalence of a problem that represents a frequent cause of postoperative morbidity and patient anxiety.

*The author did not receive grants or outside funding in support of his research or preparation of this manuscript. He did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author is affiliated or associated.

References

1. Hahn GJ, Grant D, Bartke C, McCartin J, Carn RM. Wound complications after hip surgery using a tapeless compressive support. Orthop Nurs. 1999;18:43-9.