Barbed Suture Research Articles

V-038 ENDOSCOPIC SPIEGEL'S HERNIA REPAIR BY TOTALLY EXTRAPERITONEAL EXTENDED ETEP APPROACH

Abstract Background Spiegel's hernia is a rare form of spontaneous abdominal anterolateral hernia (0.12–2% of abdominal hernias) seen in people between 40 and 70 years old. It is often found at the weak point located at the intersection between the semilunar line and the lateral end of the arched line. Traditionally, it was repaired with an open approach, currently we have multiple minimally invasive techniques (enhanced-view total extraperitoneal eTEP, transabdominal preperitoneal, intraperitoneal onlay mesh repair…) that offer less pain, faster recovery and shorter hospital stay as well as less complications risk and better cosmetic outcomes. None of these has proven superior to others but the eTEP approach requires an extensive learning curve. Aim To show a video of an eTEP approach to Spiegel's hernia. Methods We report the case of a 51 year old woman, without previous abdominal surgery, who consulted for a lump, manually reducible, in the right iliac fossa which appeared 2 years ago, and became progressively painful. She was diagnosed pre-surgically with abdominal tomography and was scheduled electively for an eTEP repair. Results After hernia sac reduction and tension-free closure of the defect with barbed suture 0, 15×15cm polypropylene mesh is placed. Conclusion Spiegel's hernia is an infrequent type of abdominal wall defect and several techniques have been developed. Adequate selection of patients is important to identify the most suitable approach for each one. The eTEP approach allows working in a large extraperitoneal space and has been demonstrated to be safe and effective although a demanding procedure.

V-021 MIDLINE RESTORATION VIA EMILOS TECHNIQUE

Abstract Aim In recent years, numerous minimally invasive techniques have been developed for the repair of midline hernias associated with diastasis recti. The eMILOS technique (Endoscopic mini/less open sublay technique) allows midline repair with mesh placement in the retromuscular space through a small trans-hernial incision without entering the abdominal cavity. Material & Methods We present a case of a 45 year-old male who complained of umbilical bulge and pain. On physical exam, an umbilical hernia measuring 2cm was observed, associated with 5cm diastasis recti. Midline restoration via eMILOS approach was decided. In this technique, a transhernial endoscopic approach is performed with two 5mm ports on both flanks, allowing a complete dissection of the retromuscular space. First, a sublay approach of the umbilical hernia is performed. The hernial content is reduced and the posterior sheath is closed. Then, we place a homemade device (consisting of a wound protector, a surgical glove and a port) to perform the endoscopic approach. When the retromuscular space is completely dissected, both anterior and posterior sheaths are closed with barbed sutures. A large heavy polypropylene mesh is placed and fixed with absorvable tackers and glue. Afterwards, the endoscopic step is over and the ports are taked out, the umbilical fascia is closed with a running suture and the umbilicus scar is fixed. Results The patient presented a favorable evolution, with no recurrence a year postoperatively. Conclusions The eMILOS technique is a safe and effective alternative for the treatment of diastasis recti associated with midline defects.

V-005 Robot assisted parastomal hernia repair of an ileal conduit stoma

Abstract Aim The optimal surgical treatment of a parastomal hernia after ileal conduit urinary division has yet to be determined. Data is scarce and reported recurrence rates after different approaches in parastomal hernia repair remain high. Material & Methods A 65-year-old male patient, who had a history of a radical cystectomy with an ileal conduit urinary diversion, presented with a recurrent symptomatic parastomal hernia. He had a previous repair of his parastomal hernia via an open retromuscular approach with a unilateral posterior component separation (transversus abdominis release). Results A robot assisted repair of the recurrent parastomal hernia was performed using a partial intraperitoneal onlay mesh technique (PIPOM). Intraoperatively, intraluminal Indocyanine green (ICG) was used to identify the ileal conduit loop. A closure of the defect was performed with a barbed suture whereafter the repair was reinforced with a PVDF IPST ‘Chimney’ parastomal mesh. The latter being partially covered by peritoneum. The postoperative course was uneventful, and the patient went home on postoperative day one. The patient had no complications and a well-functioning ileal conduit stoma 6 weeks after surgery. Conclusions The repair of a recurrent parastomal hernia after ileal conduit urinary division represents a surgical challenge. After a previous retromuscular approach, a robotic assisted approach using a partial intraperitoneal onlay mesh technique (PIPOM) represents a feasible technique with promising results.

OC-056 CLOSURE STRENGTH OF SUTURE TECHNIQUES AND SUTURE MATERIALS

Abstract Aim Small bites closure is being implemented as standard of care (SOC) for laparotomy closure, but no consensus on which suture material to use is reached. The aim of our study was to compare biomechanical properties of four different closure techniques to SOC. Materials & Methods Fifty porcine abdominal walls were divided into five groups: 1. SOC (2/0 polydioxanone); 2. interlocking 2/0 polydioxanone; 3. size 0 barbed polydioxanone; 4. size 0 barbed glycolic acid and trimethylenecarbonate (GATC); 5. size 0 suturable polypropylene mesh. The small bites technique was used for closure of the linea alba in all groups. The abdominal walls were divided into a supra- and infra-umbilical half, which resulted in 20 specimens per group that were pulled apart in a tensile testing machine. Maximum tensile strength and types of suture failure were registered. Results The highest tensile strength was measured in the barbed polydioxanone arm (334.8 N ± 157.0) but did not reach statistical significance compared to the other groups. Infra-umbilical abdominal walls endured a significantly higher maximum tensile force compared to supra-umbilical (397 N vs 271 N, p<0.001). Resorbable GATC barbed suture failed significantly more often (25% vs 0%, p = 0.008). Conclusion When using small bites for fascial closure, the highest tensile strength was found using size 0 barbed polydioxanone suture, but results were similar among all groups. Tensile strength in infra-umbilical abdominal walls was significantly higher compared to supra-umbilical. Use of GATC barbed suture should be discouraged, as this suture fails significantly more often.

V-041 ROBOTIC MONOLATERAL TAR FOR LATERAL INCISIONAL HERNIA IN PREVIOUS COLOSTOMY SITE

Abstract Background Novitsky described the Transversus Abdominis Muscle release (TAR) extending the retromuscolar plane (RMP) improving the midline restoration (MR) with high morbidity. The robotic approach seems to have the same effectiveness reducing wound complications. Video's comment A 58-year-old male submitted to Hartmann procedure for acute diverticulitis, developed an incisional hernia (IH) (3cm width) on colostomy site, L2-W1 according to IH-EHS classification and an umbilical IH of 2cm width (EHS classification: M3-W1), after Hartmann reversal. We planned the abdominal wall repair with R-TAR by drawing on the skin the dimension of the mesh with an overlap of 7cm from the defect, helping us to orient the dissection using transfascial needles. After the pneumoperitoneum created and the lateral-right sided-docking of Da Vinci Xi, we incised the lateral edge of right posterior rectus sheet (PRS) and dissected the RMP. The incision of the medial edge of the PRS and the identification of the linea alba allows the crossing-over to the contralateral RMP. We reduced the umbilical IH and dissected completely the left RMP to the flank defect and the Neurovascular Boundles. We started the division of TA fibers and we dissected the preperitoneal plane beyond the IH sac and to the arcuate line. We closed the defects with a 0-vloc and the peritoneum with a 3/0-vloc both barbed. We implanted a 15×30 Progrip selfigripping mesh and we closed the peritoneal-flap with a 2/0-vloc barbed suture. The patient was discharged in 2 days and any complication were recorded after 30 days.

V-002 Robotic suprapubic eTEP retrorectus repair for incisional hernia

Abstract Aim A retrorectus mesh position is often considered the most suitable for the repair of a midline incisional hernia. The minimal invasive extraperitoneal approach is gaining popularity. Material & Methods A 56-year-old female patient, who had a laparoscopic deroofing of a bile cyst in her history, presented with an incisional midline hernia (EHS M2-M3, width 6.6 cm). Preoperative optimization via dietary instructions reduced her BMI from 40 kg/m2 to a BMI of 35 kg/m2. Results A robotic extraperitoneal approach via suprapubic docking was performed. The patient is positioned supine and flexed for 15° at the level of the spina iliaca. An intraperitoneal trocar is placed to explore the abdomen for adhesions. Three trocars are placed in the suprapubic position in the extraperitoneal plane whereafter the robot is docked. A dissection in the cranial direction is performed in the retrorectus plane by incising both posterior rectus fascia in a symmetric way. A preperitoneal plane behind the linea alba is created. At the level of the hernia defect the hernia sac is opened, and adhesions are freed. Once the retrorectus space is dissected up to the xyphoid, the linea alba is reconstructed with a barbed suture size 0. A self-fixating mesh is placed in the retrorectus position. The posterior layer of the peritoneum is closed. The postoperative course was uneventful. Conclusions We present an extraperitoneal minimal invasive approach to the retrorectus plane allowing for an adequate retrorectus dissection and mesh placement like in a classical Rives-Stoppa repair.

P-077 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL HERNIA REPAIR (TAPP): OUR EXPERIENCE IN 200 PATIENTS

Abstract Aim To review and report our experience in the laparoscopic hernia treatment. Material & Methods It's a retrospective observational study including all patients who underwent a laparoscopic transabdominal preperitoneal hernia repair (TAPP) in our hospital between January 2016 to April 2022. Results From a total of 190 patients, 92% were male with a median age of 55,7 years old. Most of the cases were a primary hernia repair (81%) and 51,6% had bilateral presentation. Regarding the type of mesh employed, 89,1% were Adhesix®, 7,5% were Progrip® and 3,2% were flat polypropylen meshes. Tackers were used to fix the mesh only in a 11,2% of the patients. To close the peritoneum flap an absorbable barbed suture was used in a 94% of the cases, while tackers in a 5,9%. No intra-operative complications were described and 91,5% of surgeries were performed on an outpatioent basis. Concerning complications on the first fllow-up month: 7 patients suffered pain (3,4%) and 7 hematoma/seroma. Long-term complications were: chronic pain in 4 patients (2 with Adhesix®, 1 Progrip®, the forth one unknown; in none of them tackers were used); recurrence happened in 14 patients (7,6%) (11 Adhesix®, 2 Progrip®, 1 flat polypropylen mesh; tackers were used in three of these patients to fix the mesh). Conclusions Adhesix® mesh was the most employed (89,1%) and the one with the lowest recurrence rate (6,6%). According to our experience, tackers aren't necessary when an auto-adhesive mesh is used. Although they weren't related with postoperative pain, they didn't seem to prevent recurrence eiher.

V-033 MINIMAL INCISION REPAIR OF RECTUS ABDOMINIS MUSCLE DIASTASIS (MIRRAD) AS DAY CASE SURGERY: A PILOT STUDY

Abstract Rectus abdominis muscle diastasis (RAD) is a common condition where the rectus muscles are separated by an abnormal distance causing widening of the linea-alba. This condition usually occurs due to increased abdominal cavity pressure. The most common causes are pregnancy and truncal obesity. There is also an increased risk of hernia in the linea-alba. Some of the patients with RAD can increase the stability with the abdominal wall muscle-training program, while others do not benefit from this type of exercise. There is no consensus yet regarding the preferred surgical treatment. The need for a minimal invasive surgical procedure as a day case surgery in RAD in selected cases is obvious. The aim of this study is to evaluate the safety and effectiveness of MIRRAD as a day case surgery. All patients are planned as elective day case surgery. Through a small skin incision on one side of the umbilicus, the subcutaneous fat is undermined and dissected from the external aponeurosis 7–9 cm above and 5 cm below the umbilicus to expose the diastasis. The umbilicus is de-attached from the external fascia. The abdominal rectus muscle diastasis is then plicated with double layer barbed suture. The umbilicus re-attached and skin sutured. Results 20 patients are repaired with this method, all as a day case surgery, without any immediate complication. Conclusion This new, relative simple, method is cost effective and may minimize the postoperative morbidity. The method may preferably appropriate for patients without excessive skin.

The effect on incisional hernia of absorbable barbed suture for midline fascial closure in minimally invasive surgery for colorectal and gastric cancers: study protocol for a randomized controlled trial

BackgroundIncisional hernia following abdominal surgery is a frequent complication of midline laparotomy. This complication is strongly associated with the technique and material used for suture. While a monofilament absorbable suture is recommended to prevent incisional hernia, it can lead to suture loosening or surgical-knot breakage. Although barbed sutures can be an alternative suture material in abdominal fascial closure, evidence for its safety and effectiveness is lacking. Therefore, we designed a prospective randomized trial to evaluate the safety and efficacy of absorbable barbed sutures for midline fascia closure in minimally invasive surgery for colorectal and gastric cancers in comparison with conventional absorbable monofilament sutures.MethodsA total of 312 patients who underwent minimally invasive surgery for colorectal and gastric cancers will be randomly allocated to either the absorbable barbed or monofilament suture group for abdominal fascia closure in a 1:1 ratio. The primary outcome is incisional hernia rate within 3 years after surgery, as verified by physical examination and computed tomography. Postoperative complications, including surgical site infection, postoperative pain, and quality of life, will be compared between two groups as secondary outcomes. The investigator will examine the patients until discharge and at 6, 12, 18, 24, and 36 months postoperatively.DiscussionThis is the first randomized controlled trial to compare absorbable barbed sutures with monofilament sutures for midline fascia closure in minimally invasive surgery. If absorbable barbed sutures demonstrate superior results to those of monofilament sutures, this type of suture material may be recommended as an alternative option for abdominal fascia closure.Trial registrationKCT0007069. Registered on January 30, 2023

Close orthopedic surgery skin incision with combination of barbed sutures and running subcuticular suturing technique for less dermal tension concentration: a finite element analysis

BackgroundMechanical forces have an important role in the initiation and progression of orthopedic surgical incisions complications. To avoid incision complications with the reduction of dermal tension, surgeons may choose a buried continuous suture technique other than the traditional interrupted vertical mattress suture. Absorbable barbed sutures are widely used in orthopedics due to their convenience and reducing wound tension. The aim of this research is to compare and explain the advantages of running subcuticular suturing technique with absorbable barbed sutures for orthopedic surgical incisions closure.MethodsFinite element models of layered skin and two different suture techniques, running subcuticular suture and intradermal buried vertical mattress suture, ware constructed. The mechanical property difference between standard sutures and barbed sutures was modelled using different contact friction coefficient. Pulling the skin wound was simulated, and the sutures’ pressure on the skin tissue was determined.ResultsCompared with traditional smooth sutures, the barbed sutures effectively increased the contact force for subepidermal layers, which led the less force variation between different layers. The results also suggested that subcuticular suture caused less stress concentration compared with intradermal buried vertical mattress suture.ConclusionsIn conclusion, our study indicated that running subcuticular suturing technique with absorbable barbed sutures for orthopedic surgical incisions closure results in more uniform stress distribution in the dermis. We recommend this combination as the preferred method of skin closure in orthopedic surgery unless contraindicated.

Laparoscopic-assisted robotic distal gastrectomy for gastric cancer by Billroth II reconstruction.

There are several reconstructions in distal gastrectomy for gastric cancer, and there is no clear definition regarding the method selection. The optimal reconstruction is likely to vary according to the surgical setting, and the optimal reconstruction for robotic distal gastrectomy is urgently needed. In addition, as robotic gastrectomy is getting popular, cost and operative time are pressing issues of robotic gastrectomy. Gastrojejunostomy was planned with Billroth II reconstruction using a linear stapler arranged specifically for a robotic approach. After firing the stapler, the common insertion orifice of the stapler was closed using a 30 cm long non-absorbable barbed suture, and continuously, the afferent loop of the jejunum was lifted to the stomach with the same barbed suture. In addition, we introduced laparoscopic-assisted robotic gastrectomy, using extracorporeally inserted laparoscopic devices from the assistant port. Scissors, clips, and linear staplers were all laparoscopic tools inserted extracorporeally. Twenty-one gastric cancer patients underwent laparoscopic-assisted robotic distal gastrectomy by Billroth II reconstruction with our modifications. There were no anastomosis-related complications such as leakage, stenosis, or bleeding. There were 2 cases of aspiration pneumonia (Clavien-Dindo grade 2), 1 case of pancreatic juice leakage (grade 3a), and 1 case of delayed gastric emptying (grade 1). We successfully arranged Billroth II reconstruction for robotic distal gastrectomy with fewer operative and postoperative complications. Laparoscopic-assisted robotic gastrectomy using extracorporeally inserted devices, and continuous suturing using a barbed suture will reduce the time and cost of robotic gastrectomy.

Evaluation of the efficacy of a modified method of treating the incisions of the single-port video-assisted thoracoscopic surgery using V-Loc™ barbed sutures.

This paper describes a modified method of applying unidirectional barbed sutures to treat the incisions of the single-port video-assisted thoracoscopic surgery (VATS) and discusses its safety and feasibility. This was a retrospective analysis of 108 patients who underwent single-port VATS admitted to the Department of Thoracic Surgery, the China-Japan Union Hospital of Jilin University, from April 2019 to April 2020. The experimental group (65 patients) was given unidirectional barbed sutures (V-Loc™ sutures) to treat the incision, and the control group (43 patients) had a skin stapler to treat the incision. The complications related to the incisions of the two groups were compared. There was no statistically significant difference between the experimental and control groups regarding incisional infection, incisional splitting, fat liquefaction, and incisional resewing. The pleural fluid outflow from the drainage orifice after removal of the chest tube (0 cases in the experimental group and 7 cases in the control group, P = 0.001) was significantly lower in the experimental group than in the control group. The scores of the scars showed that the experimental group was significantly better than the control group. The modified method of treating the incisions of the single-port VATS with V-Loc™ sutures has good efficacy and safety. It reduces the incidence of pleural fluid outflow from the drainage orifice after removal of the chest tube compared with the traditional stapler suture method, and it has superior cosmetic outcomes.

Feasibility of Robotic Mitral Valve Repair Using Barbed Nonabsorbable Sutures: A Preliminary Single-Center Experience.

Barbed nonabsorbable sutures have been widely adopted for tissue closure in noncardiac robotic surgery to improve intraoperative efficiency. Here, we examine the profile in robotic mitral valve repair (rMVR), which utilized barbed nonabsorbable sutures. To our knowledge, this is the first report to describe clinical outcomes for rMVR with barbed nonabsorbable sutures. A retrospective review identified 90 patients who underwent rMVR using barbed nonabsorbable sutures at our center between 2019 and 2021. The primary outcome measure was dehiscence, while other relevant outcomes included 30-day readmission and 30-day mortality. In addition to fixation of the mitral annuloplasty band, barbed nonabsorbable sutures were employed commonly in concomitant pericardiectomy closure (100.0%, 90 of 90), atriotomy closure (100.0%, 90 of 90), and left atrial appendage closure (if eligible; 98.8%, 83 of 84). One patient who underwent mitral valve annuloplasty using only barbed nonabsorbable suture required reoperation for annuloplasty ring dehiscence. Immediate postoperative ring dehiscence was not observed in any patients after the routine reinforcement of barbed nonabsorbable sutures with everting pledgeted polyester sutures, and no additional patients required reoperation for suture-related complications. Clinical signs of dehiscence were not observed after pericardiectomy, atriotomy, or left atrial appendage closure with barbed nonabsorbable sutures. The 30-day readmission rate was 3.3% (3 of 90), and 30-day mortality was 0% (0 of 90). These data suggest the initial feasibility of barbed nonabsorbable sutures in robotic cardiac surgery, specifically within rMVR. Further research is necessary to explore the long-term safety and efficacy profile of such approach.

Use of Barbed Suture During Minimally Invasive Resection of the Choledochal Cyst

Introduction: Choledochal cysts are rare congenital anomalies of the bile ducts, characterized by dilations of the intrahepatic and extrahepatic biliary ducts. Approximately 80% are diagnosed in childhood, with a higher incidence in Asian countries.1 Imaging studies are essential for the diagnosis, including magnetic resonance cholangiopancreatography as the method of choice.2 Patients with types I, II, or IV cysts usually undergo surgical resection of the cysts because of the significant risk of malignancy. The treatment of choice of type I bile duct cysts in adults is total cystectomy and hepaticojejunostomy in a Roux-en-Y manner.2 The advantages of this procedure include a reduced incidence of anastomotic strictures, stone formation, cholangitis, and intracystic malignancy.2 This video shows the surgical steps, tips, and tricks of minimally invasive resection of the choledochal cyst and continuity with a bilioenteric anastomosis. Materials and Methods: A 48-year-old woman with previous laparoscopic cholecystectomy presented with a history of right subcostal pain and jaundice. After magnetic resonance cholangiopancreatography, a type I Todani choledochal cyst was diagnosed with a width of the proximal bile duct of 12 mm. She underwent minimally invasive resection of the bile duct and a terminolateral hepaticojejunostomy in a Roux-en-Y manner. Operatively, an 11 mm trocar was placed at the umbilicus. Three 5 mm trocars were placed in the epigastrium, right hypochondrium, and right flank. An 11 mm trocar was placed in the left flank. A type I choledochal cyst was confirmed with cystic duct dilation. The right hepatic artery, proximal bile duct, and portal vein were identified. The main bile duct was completely dissected, and two clips were placed in the intrapancreatic portion. The distal part of the bile duct was sectioned above the clips. The proximal bile duct was divided 1 cm from the hilar plate and the specimen was completely removed. The jejunal loop was identified and a terminolateral hepaticojejunal anastomosis was performed using barbed suture (V-locTM 4/0, Covidien). Then, a laterolateral jejunojejunal anastomosis was performed using a stapler. The common loop between the two anastomosis was sectioned with another stapler that completed the Roux-en-Y. Finally, a subhepatic suction drain was left. Results: The drain was removed 72 hours after the procedure and the patient was discharged on postoperative day 6 without complications. The pathology report confirmed a choledochal cyst without malignancy. A follow-up was done at 1 and 6 months. The patient was asymptomatic and blood workup and cholangiography were normal. Conclusions: Different publications with high level of evidence document that minimally invasive surgical treatment on Todani I choledochal cysts reduces hospital stay and postoperative pain compared with an open approach.3 It is a demanding technique with a long learning curve that decreases with the use of barbed sutures without increasing complications. No competing financial interests exist. Runtime of video: 10 mins 0 secs

A technique for esophagojejunostomy following robot-assisted gastrectomy: a liner stapler and barbed suture device-based technique: a case series.

For esophagojejunostomy after total gastrectomy or proximal gastrectomy with double-tract reconstruction, we choose the "overlap method," in which entry holes were made at the left of the esophageal stump and at 5cm of the anal side in antimesentric area of the jejunum, followed by anastomosis on the left of the esophagus using SureForm (blue 45mm) and hand-sewing closure of the common entry hole with V-Loc. We analyzed the short-term surgical outcomes of all patients. 23 patients underwent this reconstruction technique. None of the patients required any further open surgeries. The mean time to perform anastomosis was 24.7±2.8min. The postoperative course was uneventful in 22 patients; a single patient developed minor anastomotic leakage (Clavien-Dindo grade 3), which was treated with conservative therapy employing a drainage tube. Our esophagojejunostomy method following robot-assisted gastrectomy is simple and feasible, with acceptable short-term outcomes, and could represent the procedure of choice for esophagojejunostomy.

Endoscopic treatment of diastasis recti: Training method and literature review

Endoscopic treatment of diastasis rectus abdominis offers the possibility of correcting the condition without complete abdominoplasty. The purpose of this study was to develop a training method on fresh cadavers models based on a literature review on this surgery. The endoscopic procedure considered involved the insertion of a 10mm suprapubic trocar and of 5mm trocars in each iliac fossae. The muscle suture is done using running barbed suture. The surgery was performed on eight fresh cadavers to estimate the learning curve for this intervention, which was estimated with the CUSUM method. A systematic literature review in the PubMed database was performed, and 20 articles that met the inclusion criteria were analyzed. The learning curve threshold was reached after 6 operations and can be separated into two phases. The most common complication of this surgery is seroma, it is encountered in 3 to 27% of cases according to the studies. Diastasis recurrence is rare, occurring in less than 2% of cases. In comparison, open surgical treatment of diastasis recti is associated with a higher risk of hematoma, skin necrosis and longer operating times. Recurrence rates are similarly low after open and endoscopic repair. Mesh reinforcement is indicated in cases of diastasis wider than 5cm, diastasis recurrence, severe musculoaponeurotic laxity, or hernia larger than 1cm. The data in the literature indicate that laparoscopic surgery is an efficient and safe approach to correct diastasis of the rectus muscles and can be offered by plastic surgeons to selected patients.

Optimal Method of Skin Wound Management for Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Skin closure for total knee arthroplasty (TKA) typically focuses on promoting optimal healing, while preventing wound complications and infection, allowing for functionality and immediate ambulation, and providing for excellent cosmesis. In this systematic review and meta-analysis of the literature, we will focus on closure of the skin. Specifically, we assessed: (1) wound complication risk of different techniques and (2) closing time of different sutures/techniques. There were 20 reports on infection risk and closing time. Meta-analyses focused on the qualifying studies for closing time and wound complication risk reports were also performed. These studies (378 patients) demonstrated overall lower wound complication risks with the use of barbed compared with traditional sutures (3% vs. 6%, p < 0.05). The subsequent meta-analysis included 749 patients demonstrating overall significant closing time reductions of a mean of 7 minutes with the use of barbed sutures (p < 0.05). Therefore, multiple recent reports suggest superior outcomes and faster results when using barbed sutures for TKA skin closure.

Primary Total Knee Replacement: A Recipe for Dry Dressing.

To evaluate surgical outcomes using sets of techniques to achieve single dry dressing for two weeks post total knee replacement (TKR) at Dr. Sulaiman Al-Habib Hospital, Riyadh, Saudi Arabia. A prospective study comprised of 110 consecutive unilateral total knee replacements was conducted at the orthopedic department of Dr. Sulaiman Al-Habib Hospital, Suwaidi, Riyadh, KSA. Patients of both genders underwent knee replacement surgery due to primary knee osteoarthritis, Kellgren-Lawrence grades 3 and 4. Routine investigations and fitness evaluations of patients were carried out preoperatively. Preoperative minimal use of a tourniquet and release prior to arthrotomy closure; intravenous tranexamic acid, no drains; capsule infiltration with local anesthetics without adrenaline; tight closure with barbed sutures up to the skin in three layers; skin glue; Aquacel dressing; adductor canal block; and continuation of oral anticoagulant for four weeks. A total of 110 cases were included, of which 81 (73.6%) were females and 29 (26.4%) were males. The mean age of the study population was 60.5+10.3 years (48 to 88 years). The mean BMI in our patients was 30.57+10.5 kg/m2. Most patients were morbidly obese 13 (30.95%). The mean preoperative Hb% was 13.07+1.6 g/dl, while the mean postoperative Hb% was 12.58+1.9 mg/dl with a p-value of 0.28, which was non-significant statistically. Only two patients needed a change of Aquacel wound dressing for ooze. None of our patients developed deep venous thrombosis (DVT) or an infection. A sequential use of sets of techniques is observed to be associated with improved outcomes in terms of blood loss, wound infection, mobility, and patient satisfaction, leading to the ultimate end point of dry Aquacel wound dressing.

Effectiveness of fascial tissue flaps and skin flaps with layered sutures for repair of wounds after excision of sacrococcygeal pilonidal sinus

To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus. Between March 2019 and August 2022, 9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females with an average age of 29.4 years (range, 17-53 years). The disease duration ranged from 1 to 36 months, with a median of 6 months. There were 7 cases with obesity and dense hair, 3 cases with infection, and 2 cases with positive bacterial culture of sinus secretion. The wound area after excision ranged from 3 cm×3 cm to 8 cm×4 cm, with a depth of 3-5 cm, reaching the perianal or caudal bone; there were 2 cases with perianal abscess formation and 1 case with caudal bone inflammatory edema. Enlarged resection was performed during operation, and the fascial tissue flap and skin flap were designed and excised at both left and right sides of the buttock, ranging from 3.0 cm×1.5 cm to 8.0 cm×2.0 cm. A cross drainage tube was placed at the bottom of the wound, and the fascial tissue flap and skin flap were advanced and sutured in three layers, namely, 8-string sutures in the fascial layer, barbed wire reduction sutures in the dermis, and interrupted skin sutures. All 9 patients were followed up 3-36 months, with an average of 12 months. All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred. There was no recurrence of sinus tracts, the shape of gluteal sulcus was satisfactory, both sides of buttocks were symmetrical, local incision scar was concealed, and the shape disruption was minimal. Fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus can effectively fill the cavity and reduce the incidence of poor incision healing, with the advantages of small trauma and simple operation.

Knotless Tendon Repair with a Resorbable Barbed Suture: An In-vivo Comparison in the Turkey Foot.

Background: Un-knotted barbed suture constructs are postulated to decrease repair bulk and improve tension loading along the entire repair site resulting in beneficial biomechanical repair properties. Applying this repair technique to tendons has shown good results in ex-vivo experiments previously but thus far no in-vivo study could confirm these. Therefore, this current study was conducted to assess the value of un-knotted barbed suture repairs in the primary repair of flexor tendons in an in-vivo setting. Methods: Two groups of 10 turkeys (Meleagris gallapovos) were used. All turkeys underwent surgical zone II flexor tendon laceration repairs. In group one, tendons were repaired using a traditional four-strand cross-locked cruciate (Adelaide) repair, while in group two, a four-strand knotless barbed suture 3D repair was used. Postoperatively repaired digits were casted in functional position, and animals were left free to mobilise and full weight bear, resembling a high-tension post-op rehabilitation protocol. Surgeries and rehabilitations went uneventful and no major complications were noted. The turkeys were monitored for 6 weeks before the repairs were re-examined and assessed against several outcomes, such as failure rate, repair bulk, range of motion, adhesion formation and biomechanical stability. Results: In this high-tension in-vivo tendon repair experiment, traditionally repaired tendons performed significantly better when comparing absolute failure rates and repair stability after 6 weeks. Nevertheless, the knotless barbed suture repairs that remained intact demonstrated benefits in all other outcome measures, including repair bulk, range of motion, adhesion formation and operating time. Conclusions: Previously demonstrated ex-vivo benefits of flexor tendon repairs with resorbable barbed sutures may not be applicable in an in-vivo setting due to significant difference in repair stability and failure rates. Level of Evidence: Level IV (Therapeutic).