From Sutures to Staples to….Zippers?

The Zip Surgical Skin Closure device from ZipLine Medical (Campbell, CA) is an intriguing recent evolution in surgical wound closure. If the experiences of two orthopaedic surgeons from OrthoIndy in Indianapolis are any indication, this innovative method could be poised for clinical take-off.

Jack Farr, MD and David A. Fisher, MD, (both authors of JBJS-published papers) have observed improved patient satisfaction with Zip, as compared with sutures or staples. In an article they contributed to Orthopedics This Week (subscription required), Drs. Farr and Fisher also tout the theoretical reduction in infection risk, seeing as Zip closes wounds without perforating the skin.

The Zip attaches to the skin adjacent to the incision with a hydrocolloid adhesive. The individual straps for wound tensioning carry the potential to distribute closing forces more evenly than sutures or staples, and “in our experience, applying the Zip took about the same amount of time as applying staples,” Farr and Fisher wrote. The incision remains exposed in the center of the device so absorptive dressings placed on top can collect wound exudates.

Another significant advantage is the increased range of motion that Zip allows due to the device’s “programmed separation” feature, which permits it to lengthen upon joint flexion without stressing the incision. Four days after partial knee replacement surgery closed with Zip, Dr. Farr himself was using a stationary bike. Farr and Fisher also report reduced patient apprehension about removal. Zip is simply peeled off, easing the trepidation that’s often associated with staple removal.

Although the OrthoIndy experience with Zip has been uniformly positive, it has been anecdotal. To bolster the evidence base, Drs. Farr and Fisher (neither of whom reportedly has any financial stake in ZipLine Medical) are planning a prospective randomized, controlled study on “bilateral partial or total knee patients to measure the differences between the Zip and staples.”