Abstract
The aim of this study was to compare the effectiveness of barbed versus smooth sutures for soft tissue closure of exposed jawbone sites in medication-related osteonecrosis of the jaw (MRONJ) patients. Exposed necrotic jawbone sites surgically managed by intraoral soft tissue closure were evaluated. Either barbed sutures (Stratafix™ or V-Loc™) together with Prolene® or Vicryl® sutures were used. We estimated the effect of barbed sutures (BS) with Prolene® compared to smooth sutures (Vicryl®) on the hazard rate of intraoral soft tissue dehiscence using a multivariate Cox regression model within a target trial framework, adjusting for relevant confounders. In total, 306 operations were performed in 188 sites. In the primary analysis 182 sites without prior surgery were included. Of these, 113 sites developed a dehiscence during follow-up. 84 sites were operated using BS and Prolene®. A total of 222 sites were operated with Vicryl® (control group). In the BS group, the median time to event (i.e., dehiscence) was 148 days (interquartile range (IQR), 42–449 days) compared to 15 days (IQR, 12–52 days) in the control group. The hazard rate of developing intraoral dehiscence was 0.03 times (95%-confidence interval (CI): 0.01; 0.14, p < 0.001) lower for BS patients compared to the control group. Within the limits of a retrospective study, BS showed a high success rate and are therefore recommended for soft tissue closure of exposed jawbone sites in MRONJ patients. Additional studies are warranted to further evaluate this novel application of BS.
Highlights
From December 2006 to December 2019, a total of 306 operations were performed in 188 sites in 150 medication-related osteonecrosis of the jaw (MRONJ) patients
In 41 patients 124 sites were excluded from the primary analysis, as they did not conform with the target trial protocol due to prior surgery, but were included in the secondary analysis
We reported considerable progress and significant advance for intraoral soft tissue closure in MRONJ patients achieved by use of barbed sutures (BS) and Prolene® instead of conventional smooth suture material (Vicryl® )
Summary
Medication-related osteonecrosis of the jaw (MRONJ) is a typical side effect of antiresorptive drugs, which are for example used in osteoporosis or tumor patients with osseous metastases. Areas of exposed necrotic jaw bone, pain, infection, and a high rate of recurring dehiscences following surgical soft tissue closure dominate the clinical picture [1]. The first report of MRONJ was published in 2003 and, at the time, was referred to as BRONJ (bisphosphonate-related osteonecrosis of the jaw) because it was first seen as a side effect in patients receiving bisphosphonate therapy for osteoporosis or bone metastases [3,4]. Antiangiogenetic drugs and tyrosine kinase inhibitors have been reported to cause this type of jaw osteonecrosis [6]
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