Closure Events Research Articles

A Systematic Review and Meta-Analysis of the Association between Residual Shunts after Patent Foramen Ovale Closure and Long-Term Cerebrovascular Events

Background: The association between a patent foramen ovale (PFO) and cryptogenic stroke (CS) is well established, and the benefits of PFO closure are clearly recognized. This study aimed to investigate the presence of a residual shunt in patients who have experienced cryptogenic cerebrovascular events following a PFO closure. Methods: Two researchers systematically searched the PubMed and Embase online database for pertinent clinical studies published between January 2000 and July 2021 concerning the recurrence of cerebrovascular events after PFO closures. Results: Upon screening an initial list of 2,342 articles, six studies were identified, involving 2,083 patients. Overall, the analysis indicated a marked difference in the recurrence of cerebrovascular events in 8.89% of residual shunt (RS) cases compared to only 2.90% of non-RS cases. The summary odds ratio was 3.484 (95% confidence interval, 2.169–5.596), which suggested that RS may be a risk factor for recurrent cerebrovascular events in patients that experienced PFO-related cerebrovascular events within 6 months after PFO closure surgery. Conclusions: The presence of RS significantly increases the risk of recurrent cerebrovascular events in patients with clinical PFO closure.

Wound Complications Are Affected by Different Skin Closure Methods in Primary Hip and Knee Arthroplasty

BackgroundThere is a lack of consensus on optimal skin closure and dressing strategies to reduce early wound complication rates after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). MethodsAll 13,271 patients at low risk for wound complications undergoing primary, unilateral THA (7,816), and TKA (5,455) for idiopathic osteoarthritis at our institution between August 2016 and July 2021 were identified. Skin closure, dressing type, and postoperative events related to wound complications were recorded during the first 30 postoperative days. ResultsThe need for unscheduled office visits to address wound complications was more frequent after TKA than THA (2.74 versus 1.78%, P < .001), and after direct anterior versus posterior approach THA (2.94 versus 1.39%, P < .001). Patients who developed a wound complication, had a mean of 2.9 additional office visits. Compared to the use of topical adhesives, skin closure with staples had the highest risk of wound complications (odds ratio 1.8 [1.07-3.11], P = .028). Topical adhesives with polyester mesh had higher rates of allergic contact dermatitis than topical adhesives without mesh (1.4 versus 0.5%, P < .0001). ConclusionWound complications after primary THA and TKA were often self-limited but increased burden on the patient, surgeon, and care team. These data, which suggest different rates of certain complications with different skin closure strategies, can inform a surgeon on optimal closure methods in their practice. Adoption of the skin closure technique with the lowest risk of complications in our hospital would conservatively result in a reduction of 95 unscheduled office visits and save a projected $585,678 annually.

Non-muscle MYH10/myosin IIB recruits ESCRT-III to participate in autophagosome closure to maintain neuronal homeostasis

ABSTRACT Dysfunction of the endosomal sorting complex required for transport (ESCRT) has been linked to frontotemporal dementia (FTD) due in part to the accumulation of unsealed autophagosomes. However, the mechanisms of ESCRT-mediated membrane closure events on phagophores remain largely unknown. In this study, we found that partial knockdown of non-muscle MYH10/myosin IIB/zip rescues neurodegeneration in both Drosophila and human iPSC-derived cortical neurons expressing FTD-associated mutant CHMP2B, a subunit of ESCRT-III. We also found that MYH10 binds and recruits several autophagy receptor proteins during autophagosome formation induced by mutant CHMP2B or nutrient starvation. Moreover, MYH10 interacted with ESCRT-III to regulate phagophore closure by recruiting ESCRT-III to damaged mitochondria during PRKN/parkin-mediated mitophagy. Evidently, MYH10 is involved in the initiation of induced but not basal autophagy and also links ESCRT-III to mitophagosome sealing, revealing novel roles of MYH10 in the autophagy pathway and in ESCRT-related FTD pathogenesis. Abbreviations: ALS: amyotrophic lateral sclerosis; AP: autophagosome; Atg: autophagy-related; ESCRT: endosomal sorting complex required for transport; FTD: frontotemporal dementia

Magmatic records of subduction and closure of the Meso-Tethys Ocean in the northern-central Tibetan Plateau

The evolution of the Tethys Ocean has received much research attention; however, the timing and subduction mechanisms involved in the closure of the Bangong-Nujiang Meso-Tethys Ocean remain poorly constrained. In this study, we present geological, geochronological, geochemical, and zircon isotopic data from Cretaceous magmatic rocks and combine these with previously published data within the central Bangong-Nujiang suture zone in the north-central Tibetan Plateau. The integrated data update the regional tectonic framework and enable a comprehensive geodynamic model to be developed for the subduction and ocean closure events. In detail, temporal and spatial variations in the Jurassic−Cretaceous magmatism reflect the influence of the northward subduction of the Dongqiao-Amdo oceanic basin and the bidirectional subduction of the Bangong-Nujiang Meso-Tethys oceanic crust. The evolution of the Bangong-Nujiang Meso-Tethys Ocean further involved initial intra-ocean subduction, slab rollback, and flat subduction, as evidenced by two phases of north-south migration of magmatism at ca. 190−160 and 160−130 Ma and a magmatic hiatus at 160−140 Ma. The ocean closed during a two-stage process, including the closure of the Dongqiao-Amdo oceanic basin to the north and the Bangong-Nujiang Meso-Tethys Ocean to the south. The Dongqiao-Amdo oceanic basin closed soon after ca. 180 Ma, accompanied by continent-continent collision between the Amdo microcontinent and the South Qiangtang terrane. The Bangong-Nujiang Meso-Tethys Ocean closed at 130−120 Ma, corresponding to a period of waning magmatism. This closure represented complete oceanic closure and caused an arc-continent collisional event involving the Baingoin magmatic arc, the Amdo microcontinent, and the Lhasa terrane. The Lower Cretaceous terrestrial strata and their basal unconformity mark the final closure of the ocean, and the Early Cretaceous ocean islands might have formed before ca. 130 Ma.

The Impact of Equity Funding Dynamics on Venture Success: An Empirical Analysis Based on Crunchbase Data

Equity funding is a widespread financing form that often accompanies the life cycle of innovative ventures from initial stages until maturity. From the perspective of investors, the event defining the success of an equity financing operation is the exit, which represents the moment when they leave the venture with the purpose of selling their shares. The potential high return of equity funding has motivated an empirical literature aimed at developing predictive models in support of investors’ decisions. However, no study so far has investigated how equity funding dynamics impact on a venture’s chance of successful exit. In this article, we develop a multinomial logistic regression model based on the Crunchbase 2013 Snapshot that relates the events of exit and closure to the amount of equity funds raised at different rounds, while controlling for geographical location, economic sector, age, network ties and several proxies of effectiveness. Our study contributes to the existing literature by providing a quantitative assessment of the impact of equity funding dynamics on a venture’s chance of successful exit and risk of closure that is not limited to the startup stage, but also covers advanced stages of development. In this way, we provide a comprehensive view of the different scenarios that may be envisioned in a venture’s life cycle, which is of core importance to achieve an effective support of investors’ decisions.

A New Technique for Estimating Stress from Fracture Injection Tests Using Continuous Wavelet Transform

The diagnostic fracture injection test (DFIT) is widely used to obtain the fracture closure pressure, reservoir permeability, and reservoir pressure. Conventional methods for analyzing DFIT are based on the assumption that a vertical well is drilled in ultra-low permeability reservoirs with potential multiple closures but fails to consider horizontal wells. There is still significant debate about the rigorousness and validity of these techniques due to the complexity of the hydraulic fracture opening and closure process and assumptions of conventional fracture detection methods. The paper introduces a new method for detecting fracture closure pressure using the continuous wavelet transform (CWT). The new method aims to decompose the pressure fall-off signal into multiple levels with different frequencies using the CWT. This “short wavy” function is stretched or compressed and placed at many positions along the signal to be analyzed. The wavelet then convoluted the signal yielding a wavelet coefficient value. The signal energy is observed during the fracture closure process (pressure fall-off) and the fracture closure event is identified when the signal energy stabilizes to a minimum level. A predefined simple commercial fracture simulation case with known fracture closure, flow regime modeling, and actual field cases was used to validate the new methodology.

Fixation with lower limb immobilization in primary and secondary exstrophy closure: A saving grace

A pivotal factor in the success of bladder closure in patients with classic bladder exstrophy (CBE) is the postoperative immobilization of the pelvis and lower extremities after pelvic osteotomy. This study investigates the outcomes of closure among patients with lower limb immobilization using many techniques. The authors hypothesize that the addition of external fixation (pelvic immobilization) in patients with any form of limb immobilization will be associated with improved outcomes. A prospectively maintained institutional exstrophy-epispadias complex database of 1415 patients was reviewed for patients with CBE who had undergone closure with available immobilization and osteotomy data. Association between closure outcomes and immobilization techniques were determined. Univariate analysis was performed using Chi-Square or Fischer-Exact test as appropriate for categorical variables. Multivariate analysis via binomial logistic regression was used to identify factors leading to successful closure. A total of 747 closure events matching the inclusion criteria were identified. Patients included 508 males and 239 females. There were 597 primary closures (79.9%) with 150 reclosure events (20.1%). Limb immobilization was used in 627 (83.9%) of closure events. Successful closures were associated with osteotomy use (p<0.0001) and limb immobilization (p<0.0001); specifically, the combined anterior innominate with posterior vertical iliac osteotomy and modified Buck's traction with external fixation (p<0.0001, p<0.0001). Among the group of 33 patients who received external fixation alone and no other type of immobilization, the failure rate was 33.3%, comparatively, patients with any form of combined immobilization (external fixation with lower limb immobilization) had a failure rate of 7.1% ( Table 1). Among patients immobilized with mummy wrap, spica casting, or knee immobilizers, external fixation was associated with 3.76 increased odds of successful closure (p=0.0005, 95% CI 1.79-7.90). In a unique group of 67 patients without pelvic osteotomy or any form of pelvic or limb immobilization, the failure rate was 74.6%. This study confirms, in a larger series, previous findings of improved outcomes when patients are immobilized with modified Buck's traction and external fixation. The authors apply this technique in most all closures and recommend this technique be utilized whenever feasible. However, regardless of the manner of lower limb immobilization, external fixation is a critical factor to optimize closures and ensure success. The results of this study clearly suggest the use of external fixation can be protective against bladder closure failure. The use of pelvic immobilization, in addition to post-operative lower limb immobilization should be strongly considered.

Acute Vessel Closure or Major Adverse Cardiac Events of Drug-Coated Balloons and Stents: A Systematic Review and Meta-Analysis

While the use of drug-eluting stents (DES) has become the first-line strategy for treating coronary artery disease, there are still drawbacks with their use. As our understanding of coronary artery anatomy and physiology evolves, growing evidence supports the use of drug-coated balloons (DCB) not only in the treatment of in-stent restenosis but also in de novo lesions. The aim of this systematic review and meta-analysis is to determine if there is a difference in outcomes when DCBs are used versus when stents are used. PubMed, Cochrane and Web of Science databases were systematically searched. The primary outcome of the meta-analysis was acute vessel closure and the secondary outcomes were stent complications including major adverse cardiovascular events (MACE) and all-cause mortality. Eleven studies with a total of 2349 patients were included. No significant difference was found in terms of acute vessel closure between DCBs and all stents (2.6% vs. 1.0%, OR: 2.13 (0.74–6.44), I2: 4%, p = 0.16). Furthermore, there was no difference in MACE (6.8% vs. 10.1%, OR: 0.53 (0.27–1.04), I2: 48%, p = 0.06), all-cause mortality and target lesion revascularisation. This meta-analysis suggests that the use of DCBs is a safe alternative to stents when treating coronary artery disease.

Early Steps in C-Type Inactivation of the hERG Potassium Channel.

Fast C-type inactivation confers distinctive functional properties to the hERG potassium channel, and its association to inherited and acquired cardiac arrythmias makes the study of the inactivation mechanism of hERG at the atomic detail of paramount importance. At present, two models have been proposed to describe C-type inactivation in K+-channels. Experimental data and computational work on the bacterial KcsA channel support the hypothesis that C-type inactivation results from a closure of the selectivity filter that sterically impedes ion conduction. Alternatively, recent experimental structures of a mutated Shaker channel revealed a widening of the extracellular portion of the selectivity filter, which might diminish conductance by interfering with the mechanism of ion permeation. Here, we performed molecular dynamics simulations of the wild-type hERG, a non-inactivating mutant (hERG-N629D), and a mutant that inactivates faster than the wild-type channel (hERG-F627Y) to find out which and if any of the two reported C-type inactivation mechanisms applies to hERG. Closure events of the selectivity filter were not observed in any of the simulated trajectories but instead, the extracellular section of the selectivity filter deviated from the canonical conductive structure of potassium channels. The degree of widening of the potassium binding sites at the extracellular entrance of the channel was directly related to the degree of inactivation with hERG-F627Y > wild-type hERG > hERG-N629D. These findings support the hypothesis that C-type inactivation in hERG entails a widening of the extracellular entrance of the channel rather than a closure of the selectivity filter.

The chance of spontaneous patent ductus arteriosus closure in preterm infants born before 32 weeks of gestation is high and continues to increase until 5 years of follow-up.

The primary aim was to estimate premature infants' spontaneous patent ductus arteriosus closure rate. Secondly, to identify criteria associated with the chance of spontaneous closure. We performed a retrospective cohort study of 167 infants born before 32 weeks of gestation and diagnosed with a patent ductus arteriosus between 1 January 2008 and 31 December 2017. The spontaneous patent ductus arteriosus closure event rate was evaluated using the Kaplan-Meier estimator. The spontaneous closure rate within the first year of life was 66% (95% CI 58%-73%), increasing to 80% (95% CI 72%-86%) five years after birth. When including both spontaneous closure and closure following treatment, 96% (95% CI 86%-100%) closed within 5 years after birth. The chance of spontaneous closure was reduced in the case of a large patent ductus arteriosus: OR 0.16 (95% CI 0.05-0.52), left atrial enlargement: OR 0.16 (95% CI 0.05-0.51), and pulmonary hypertension: OR 0.23 (95% CI 0.07-0.74). The chance of spontaneous closure in premature infants born between 23 and 32 weeks of gestation was high, and the incidence continued increasing until 5 years of follow-up.

코로나 시대, 어린이집의 가정 육아 지원에 대한 부모 경험에 관한 연구

Objectives The purposes of this study were to specify variables related to find the direction in which home childcare support should proceed in the event of prolonged closure or non-face-to-face childcare process due to infectious diseases that may occur continuously through the story of parents who have experienced home childcare support from daycare centers in the COVID-19 situation.&#x0D; Methods To this end, individual in-depth interviews with 12 parents were conducted 22 times in consultation with 7 daycare centers in Busan Metropolitan City for parents who experienced closure due to COVID-19, and the contents were classified through the process of transcription, coding, nomination, and subject generation.&#x0D; Results The purposes of this study were to specify variables related to In the COVID-19 situation, parents' experiences and demands for support through home childcare support at daycare centers are as follows. First, the home childcare support provided by the daycare center alleviated the frustration of childcare, and it was difficult to use the supported data, and event-like support experienced a lack of help for childcare. Second, parents' demand for home childcare support due to COVID-19 is mind care to quench their thirst for meetings, and a systematic and continuous support program. They wanted to receive support from daycare centers for parental education due to the lack of parenting knowledge. In addition, the demand for support from the state demanded the expansion of the criteria for payment of family childcare allowances, emotional support to alleviate parenting stress, and the need for flexible customized institution operation.&#x0D; Conclusions The purposes of this study were to specify variables related to suggested the introduction of a customized home care system that reflects parent's needs, systematic support from the state that supports home care centered on daycare centers, and parent's needs in the event of re-proliferation of infectious diseases such as OVID-19.

Molecular characteristics of the edge cells responsible for expansion of the chick embryo on the vitelline membrane.

During early avian development, only a narrow band of cells (the edge cells, also called 'margin of overgrowth') at the rim of the embryo is responsible for blastoderm expansion by crawling over the vitelline membrane (VM) to cover the whole egg yolk in just 4 days (a process called epiboly). Surprisingly, this has not yet been studied in detail. Here we explore the edge cells of the chick embryo using in situ hybridization, immunohistochemistry and live imaging. Morphological and molecular properties reveal that the edge has a distinctive structure, being subdivided into sub-regions, including at least four distinct zones (which we name as leading, trailing, deep and stalk zones). This allows us to study reorganization of the edge region that accompanies reattachment of an explanted blastoderm to the VM. Immunohistochemistry uncovers distinct polarized cellular features resembling the process of collective cell migration described in other systems. Live imaging reveals dynamic lamellipodial and filopodial activity at the leading edge of the outermost cells. Our data provide evidence that edge cells are a distinct tissue. We propose that edge cells may be a useful model system for the study of wound healing and other closure events in epithelial cell sheets.

Multi-factor tracking of tidal processes in an intermittently open estuarine lake

A multi-factor approach to the assessment of the dynamics of the entrance of small, intermittently open and closed estuarine lakes and lagoons, utilising publicly available data, has been developed. Both conventional and novel methodologies have been employed to provide a more robust evaluation and to expand the range of timescales that can be resolved from these databases. This has been applied to an example on the south coast of NSW, Australia (Durras Lake) to illustrate the methodology. A 20 year water level record was available, including 10 closure and breaching events and with ample time for long period patterns to be identified and studied. The study has shown that these intermittent estuaries have a sequence of regime states, with progression from one regime to another, driven by external forcing. Forcing processes are primarily catchment inflow, ocean waves and ocean tide. The study develops and demonstrates a novel sequence of qualitative and quantitative methods to provide an understanding of varying processes in an intermittently open estuarine lake system. From these analyses, a more comprehensive classification and sequence of different entrance regime states is developed. The analyses and the regimen identified may be applied to any similar estuarine system, facilitating the making of more complete and more robust predictions of entrance conditions. Links to the software are given.

Paleoceanographic Conditions of Neo-Tethys Deposits in Northeast Iraq (Shiranish Formation) by Geochemical Proxies

Geochemical proxies provide detailed information on depositional environment and diagenetic processes. The main objectives of the present study are the evaluation of the paleoenvironment and diagenetic conditions of selected three sections of the Shiranish Formation (Late Campanian-Maastrichtian) in Dokan-Sulaymaniyah, Kurdistan Region, northeast of Iraq. The major and some trace elements were analysed by X-Ray Fluoresces. These geochemical results showed a positive correlation of SiO2, Al2O3, Fe2O3, MgO and TiO2 between each other due to the influence of detrital influx from the active oceanic margins and thrust belts of the northeast Arabian Plate. The terrigenous supply of silicates (K-feldspar) and clay minerals (Illite) caused a positive correlation between K2O values and Al2O3. In general, there is a low abundance of SiO2 and Al2O3 contents, referring to the deepening of the Neo-Tythus ocean basin in the formation's lower part. The Mn* factor of the lower and middle part of the formation exhibited anoxic conditions while oxic- suboxic conditions at the upper part. The Mn/Sr ratios were less than one, which means that Shiranish marly limestone was well preserved out of diagenetic processes. The paleoredox proxies {Th/U, V/Cr &amp;V/(V+Ni)} confirmed that the lower part of the Formation was deposited in a relatively anoxic deep-outer shelf environment with a rising in paleoproductivity. In contrast, the upper part was characterised by dyoxic-oxic redox. Due to the inner shelf environment, this redox fluctuation reflects a regression phase of sea level, which is compatible with the closure events of the Neo-Tethys in the Eocene epoch.

Benefits and Challenges of a Stakeholder-Driven Shellfish Toxicity Forecast in Coastal Maine

Paralytic shellfish poison (PSP) is a human health concern for shellfish aquaculture and wild harvest. This paper discusses lessons learned from a forecasting program for PSP in coastal Maine, USA, designed based on stakeholder input, and run in an operational mode for the 2021 season. The forecast uses a deep learning algorithm to make site-specific, probabilistic forecasts at a weekly forecast range for toxin levels measured in shellfish tissue. Forecasts had high accuracy in the 2021 season, correctly predicting closure events and locations despite a highly unusual season. Stakeholders reported a positive view of the forecast system, and stakeholder input continues to be of key importance as further modifications are made to the system. There are benefits and challenges to the stakeholder-based design of the system.

Unruly Tramscapes

This article reappraises tramway closures in 1930s London by reading enthusiast memoirs of the events surrounding them. Literary representations in forms such as the novel and poetry of urban public transport experience often overlook experiences in peripheral urban zones and on modes such as the tramway which had a chiefly working-class ridership. Building a perspective around London’s tramscapes, and by practicing Deep Locational Criticism as part of a characteristically “humanities” mode, temporally focused, in mobility studies, the article reveals contestations including acts of disorder surrounding the closure events, deploying those in a rereading of mid-twentieth-century British history more broadly. The 1930s North London suburbs emerge through a reading of George Atkins’s account of 1938 closure events as sites of carnivalesque disorder and other bottom-up transport-focused activity, including the formation of enthusiast groups. This group of practices opposed the extremely top-down transport planning of the post-1933 London Passenger Transport Board’s management.

Safety Verification for Urban Air Mobility Scheduling

In Urban Air Mobility (UAM) networks, takeoff and landing sites, called vertiports, are likely to experience intermittent closures due to, e.g., adverse weather. For safety, it will be required that all in-transit Urban Air Vehicles (UAVs) in a UAM network have alternative landing sites in the event of a vertiport closure. In this paper, we propose analytical conditions for developing an efficient algorithm that, given a proposed UAM schedule, verifies whether all UAVs are able to safely reach a back-up landing site in the event of a vertiport closure without violating the limited landing capacity of each vertiport in the network. If safety verification is not possible, the algorithm returns a counterexample demonstrating the violation. Our solution allows for uncertain travel time between UAM vertiports and scales quadratically with the number of scheduled UAVs. We demonstrate our algorithm on a UAM network with up to 1,000 UAVs.

Force measurements of Myosin II waves at the yolk surface during Drosophila dorsal closure

The mechanical properties and the forces involved during tissue morphogenesis have been the focus of much research in the last years. Absolute values of forces during tissue closure events have not yet been measured. This is also true for a common force-producing mechanism involving Myosin II waves that results in pulsed cell surface contractions. Our patented magnetic tweezer, CAARMA, integrated into a spinning disk confocal microscope, provides a powerful explorative tool for quantitatively measuring forces during tissue morphogenesis. Here, we used this tool to quantify the in vivo force production of Myosin II waves that we observed at the dorsal surface of the yolk cell in stage 13 Drosophila melanogaster embryos. In addition to providing for the first time to our knowledge quantitative values on an active Myosin-driven force, we elucidated the dynamics of the Myosin II waves by measuring their periodicity in both absence and presence of external perturbations, and we characterized the mechanical properties of the dorsal yolk cell surface.

Permian to Cretaceous tectonic evolution of the Jiamusi and Songliao blocks in NE China: Transition from the closure of the Paleo-Asian Ocean to the subduction of the Paleo-Pacific Ocean

Zhangguangcailing Orogen constitutes a significant part of the Eastern Asian Continental margin. Its evolution was constrained by the oceanic consumption processes between the Jiamusi and Songliao blocks during late Paleozoic and Mesozoic time, resulted from the closure of the Paleo-Asian Ocean and subsequent Paleo-Pacific Ocean subduction. Considerable and continuing controversy has surrounded when, where, and how the ocean was subducted and the two blocks were eventually amalgamated, which plays a crucial role in understanding the tectonic transition from the closure of the Paleo-Asian ocean to the subduction of the Paleo-Pacific Plate, especially the initial formation of the Mesozoic foreland basin of the Songliao Basin. This review synthesizes the most recent data and geologic evidence that place critical constraints on the evolution of this oceanic domain.Available data and geological evidence indicate that there exists a stable micro-continent consisting of several microblocks of NE China and adjacent area within the Paleo-Asian Ocean regime during the Late Paleozoic. In the early Permian, voluminous magmatism occurred in an extensional setting induced by the subduction of the Paleo-Asian Ocean to the south and the Mongol-Okhotsk Ocean to the northwest. As the crustal extension continued, a continental rifting was initiated and further developed into an oceanic domain (the Heilongjiang Ocean or the Mudanjiang Ocean) separating the Jiamusi and Songliao blocks during Permian and Early Triassic time. Later, an active continental margin was situated along the Zhangguangcailing Orogen due to the subduction of the Heilongjiang oceanic plate in the Late Triassic, followed by a change in the regional stress regime controlled by Paleo-Pacific plate subduction. The high-pressure metamorphism occurred synchronously with the subduction/collision between the Jiamusi and Songliao blocks, forming the Heilongjiang Complex. The oceanic closure and collision events were sequentially followed by the A-type granitic magmatism, which commenced in the earliest Cretaceous.

Use of a Novel Adhesive Suture Retention Device in Lower Leg Excisional Wound Closure: A Retrospective Review

Introduction. Lower extremity excisional wound closures are associated with complications, including infection, delayed wound healing, skin tearing after suture placement, and dehiscence. Use of a novel adhesive suture retention device (ASRD) has previously been shown to support fragile skin under high tension and improve linear closure. Objective. A retrospective analysis of lower extremity excisional wounds was performed to investigate the effect of adopting ASRD on rate of wound closure and adverse events. Materials and Methods. A retrospective chart review from 2 Mohs surgical practices was conducted. The chart review assessed the differences before and after adopting ASRD in linear closure rates, wound healing, and dehiscence rates for lower extremity post-surgical full-thickness wounds of at least 1.0 cm diameter in patients aged 18 years or older. In all cases, the authors shared the same surgical techniques, including limited undermining and use of buried dermal polyglactin sutures. In all ASRD cases, the device was used with 2-0 nylon retention sutures. Results. Adoption of ASRD was associated with a significantly faster time to healing (P &lt; .001). Dehiscence was significantly more commonly seen in the pre-ASRD cohort (24% vs 3%, P = .03). Infection was also more common in the pre-ASRD cohort; however, the difference was not statistically significant (18% vs 3%, P = .09). Conclusions. Utilization of ASRD decreased the incidence of lower extremity wound dehiscence and resulted in faster healing times after Mohs surgery.