Closure Method Research Articles

A guide to removing sutures.

This article provides an overview of the wound healing process, outlining the four distinct phases of the healing cascade: haemostasis, inflammation, proliferation, and maturation. The different types of closure method are described and, specifically, the various types of surgical suture that can be used for wound closure, as well as the strengths and limitations of each. The article explains aspects of patient care that need to be considered such as obtaining informed consent, and the importance of nurses maintaining appropriate clinical skills. It concludes with a step-by-step outline of best practice on how to remove sutures.

A study to compare abdominal wall closure with interrupted vs. continuous sutures using polydioxanone in patients undergoing emergency exploratory laparotomy

Background: Wound closure in emergency surgeries can be done either by interrupted or by continuous sutures with each having its own advantages and disadvantages. In this paper we shall try to compare the advantages and adverse effects of both these methods of wound closure. Methods: A prospective comparative study involving 50 patients undergoing emergency laparotomies was conducted in Department of General Surgery, MMIMSR, Mullana from October 2022 to April 2024 (18 months). We compared two abdominal wall closure techniques using polydioxanone (PDS), patients, aged 18-75 years, were alternatively assigned to one of two groups: Group I received interrupted PDS sutures, while Group II received continuous PDS sutures. Postoperatively, pain and complications like infections were observed and analysed statistically. Results: In our study, we compared abdominal wall closure techniques in emergency exploratory laparotomy patients. The mean age was similar in the two groups, 43.68 years vs 43.08 years respectively in group I and II. Wound infection occurred in 44% of patients in the interrupted suture group and 60% in the continuous suture group, with a significant difference favouring the interrupted method. The mean wound closure time (33.24 vs 18.32 minutes) and post operative pain were more in the interrupted suture group as compared to the continuous suture group. Conclusions: The interrupted suturing method proved to be more effective in preventing complications, it did require more time to perform. However, after thoroughly reviewing the available data, no definitive evidence was found to support the superiority of either techniques.

COMPARISON OF SURGICAL SITE INFECTION IN PATIENTS UNDERGOING SKIN CLOSURE WITH STAPLES VS. SUTURES IN CLEAN ELECTIVE SURGERIES

Thyroidectomy is a common surgical procedure with various techniques for wound closure, including dermal staples and intradermal suturing. Each method has potential advantages and disadvantages, particularly in terms of wound complications, cosmetic outcomes, and postoperative pain. Understanding which technique offers better outcomes in these areas can guide surgeons in selecting the most appropriate method for skin closure after thyroidectomy. Objective: To compare wound complications, cosmetic outcomes, and pain scores between skin closure with dermal staples and intradermal sutures in patients undergoing thyroidectomy. Methods: A prospective study was conducted in the Surgical Department of Sheikh Zayed Hospital, Lahore, from August 2023 to August 2024. The study included 100 adult patients undergoing thyroidectomy for thyroid disease. The patients were randomly divided into two groups: Group A (n=50) received wound closure with dermal staples, and Group B (n=50) received intradermal suturing. Postoperative assessments were conducted at 1, 4, 12, and 24 weeks to evaluate wound complications, cosmetic outcomes, and pain scores. Cosmetic outcomes were measured using the Stony Brook Scar Evaluation Scale and Manchester Scar Scale. Pain was assessed using the Visual Analog Scale (VAS). Results: No surgical site infections were reported in either group. At the 24-week follow-up, cosmetic outcomes measured by the Stony Brook Scar Evaluation Scale were significantly better in Group A (4.12 ± 1.0) compared to Group B (3.32 ± 1.17) (p=0.027). Similarly, the Manchester Scar Scale score was higher in Group A (7.83 ± 1.34) than in Group B (9.20 ± 2.26) (p=0.033), indicating better cosmesis with staples. However, pain scores were significantly higher in Group A than in Group B both immediately after surgery and at the 4- and 12-week follow-ups. Conclusion: The use of dermal staples in thyroidectomy demonstrated better cosmetic outcomes and wound healing compared to intradermal suturing. However, patients who received staples experienced significantly more postoperative pain. While dermal stapling is a safe and effective alternative for skin closure, further studies with larger populations are necessary to corroborate these findings and guide clinical practice.

Effect of Ethyl-Cyanoacrylate and Platelet-Rich Fibrin on Fresh Sockets of Rabbits Subjected to Anticoagulant Therapy

Objectives: There are no studies related to the use of PRF associated with cyanoacrylates in fresh post-extraction sockets. Thus, the aim of this study was to assess the effect of ethyl-cyanoacrylate combined with PRF in fresh sockets of rabbits subjected to anticoagulant therapy. Methods: Twelve adults rabbits were selected and premedicated with heparin 1 week before surgery to induce and simulate anticoagulant therapy. Upper and lower first premolars on the right side were extracted and then were divided into four groups of three animals each, with the groups distributed according to the type of intervention in the sockets (n = 6): (1) clot and suture (control); (2) PRF and suture; (3) clot and ethyl-cyanoacrylate; (4) PRF and ethyl-cyanoacrylate. At 12 weeks, the animals were sacrificed and the sockets were analyzed histologically and quantitatively. Total bone area, inflammation infiltrate, and adhesive remnants were assessed. Results: No remnants of adhesive were found in the samples. Groups 1 and 2 showed the highest bone area (G1 = 37.87% ± 17.86; G2 = 30.31 ± 9.36) with significant differences to those treated with ethyl-cyanoacrylate adhesive (G3 = 26.6% ± 11.82; G4 = 24.29% ± 6.25). Conclusions: The groups that used ethyl-cyanoacrylate as a closure method in sockets exhibited less bone area than the groups that used sutures. Both groups that used PRF as therapy did not show a significant improvement in bone healing at 12 weeks compared with the clot groups.

A versatile natural gelatin-based hydrogel for emergency wound treatment through hemostasis, antibacterial, and anti-inflammation.

Emergency wounds are often accompanied by bacterial infection, oxidative stress, and excessive inflammation due to the inability to quickly close and stop bleeding, resulting in chronic wounds that are difficult to heal. Clinically, surgical suturing is the fastest method for wound closure, but it is only suitable for wounds with small bleeding volumes and causes unsightly scar formation. Consequently, there is a critical need for hemostatic dressings versatile enough to address a spectrum of diverse and intricate wounds, especially in emergency scenarios. In this study, we constructed a unique versatile natural gelatin-based hydrogel with hemostasis, antibacterial, and anti-inflammation properties. The hydrogel was composed of 4-(4-(hydroxymethyl)-2-methoxy-5-nitrophenoxy) butyrylethylenediamine-modified methacrylated gelatin (GelMA-NB) and epigallocatechin gallate-grafted polylysine (EPL-EGCG), which imparts adhesion, antibacterial and antioxidant properties to the hydrogel. Simultaneously, the hydrogel was loaded with GelMA microspheres encapsulating natural resveratrol (RES@GM). This combination not only exhibited outstanding hemostatic capabilities but also preserved the anti-inflammatory potential of RES. In different animal models, the hydrogel exhibited outstanding hemostatic and wound healing effects, down-regulated the expression of IL-1β to promote inflammatory regulation and potential for angiogenesis and anti-scar. In conclusion, unique versatile natural gelatin-based hydrogel suitable for various complex wounds provides a promising strategy for emergency wound dressing applications.

Preoperative, Intraoperative & Postoperative Concepts to Prevent Infection for Unicompartmental Knee Arthroplasty

Periprosthetic joint infection (PJI) is a complication that occurs in less than 1% of patients after unicompartmental knee arthroplasty (UKA). Though infrequent, it may potentially lead to revision while placing a significant financial burden on the healthcare system. Pre-operative, intra-operative, and postoperative strategies should be implemented to minimize the risk of PJI. Patient optimization prior to surgery can help to identify patients at risk for PJI and also maximize the health of the patient prior to surgery. Intraoperative and postoperative strategies can also mitigate the risk of postoperative infection. This article will summarize the evidence for preoperative, intra-operative, and postoperative strategies to prevent PJI in UKA. This will include topics on malnutrition and obesity, staphylococcus aureus, smoking, human immunodeficiency virus, rheumatoid arthritis, as well as skin preparation, laminar air flow, preoperative antibiotic administration anti-microbial incision drapes, pulsatile lavage, vancomycin powder, wound closure method, thromboprophylactic agents, and closed incisional negative pressure wound therapy dressings.

Stump Appendicitis: An Update on Current Management: A Narrative Review Article

Stump appendicitis is a rare complication that occurs after an appendectomy and the diagnosis of this condition is usually delayed. The diagnosis is confirmed by either an ultrasound or computerized tomography. The management of stump appendicitis is by performing a completion appendectomy, which can be done as an open or laparoscopic procedure. The delay in diagnosis can often lead to complications like perforation and abscess formation. We have conducted this review article to look at the diagnosis and management of stump appendicitis. The method of stump closure is also discussed by looking at the various methods that are employed.

Effect of Thermal Load Caused by Tread Braking on Crack Propagation in Railway Wheels on Long Downhill Ramps

To investigate the propagation behavior of thermal cracks on the wheel tread under the conditions of long downhill ramps, a three-dimensional finite element model of a 1/16 wheel, including an initial thermal crack, was developed using the finite element software ANSYS 17.0. The loading scenarios considered include mechanical wheel–rail loads, both with and without the superposition of thermal wheel–brake shoe friction loads. The virtual crack closure method (VCCM) is employed to analyze the variations in stress intensity factors (SIFs) for Modes I, II, and III (KI, KII, and KIII) at the 0°, mid, and 90° positions along the crack tip. The simulation results show that temperature is a critical factor for the propagation of thermal cracks. Among the SIFs, KII (Mode II) is larger than KI (Mode I) and KIII (Mode III). Specifically, the thermal load on the wheel tread during braking contributes up to 23.83% to KII when the wheel tread reaches the martensitic phase transition temperature due to brake failure. These results are consistent with the observed radial propagation of thermal cracks in wheel treads under operational conditions.

Enhanced wound closure in rabbit oral vestibule: a comparative analysis of suturing and laser tissue soldering

This study investigates the comparative effectiveness of laser soldering technique and conventional suturing methods for wound closure in rabbits. Over a 60-day post-operative period, scar formation and healing were monitored, with a particular focus on scar characteristics such as width, height, and overall appearance. Results indicate that the laser group exhibited improved scar characteristics, especially in the early stages (first and third days) of healing. By the seventh day, both groups demonstrated similar scar conditions, though the laser group showed a slightly faster recovery trajectory, with marginally lower scar height observed on the 21st and 60th days. While the laser technique showed some advantages in minimizing short-term complications, the long-term outcomes between the two methods were largely comparable. These findings suggest that the laser soldering method may offer some benefits over traditional suturing, particularly in the early stages of healing, but further research is needed to fully assess its clinical potential.

The Effect of Main Bronchus Stump Closure Method on the Incidence of Stump Failure during Pneumonectomy for Tuberculosis

The objective: to evaluate the effectiveness of various methods for the main bronchus stump closure when performing pneumonectomy for destructive pulmonary tuberculosis.Subjects and Methods. Treatment results of 1211 tuberculosis patients from 1958 to 2022 were studied. The patients were treated in three clinical phthisiopulmonary centers. All of them underwent pneumonectomy with closure of the main bronchus stump by different methods.Results. We studied results of using different methods for suturing the main bronchus during pneumonectomy. For this purpose, the incidence of early fistulae of the bronchial stump and mortality from bronchopleural complications were assessed. The worst result was observed when using a mechanical suture (21.7% and 8.3%, respectively), the combination of polyspast-circular ligature with mechanical suture improved the effectiveness (2.3% and 4.6%, respectively), and the best result was demonstrated by the stump-free method of bronchus closure offered by D.B. Giller et al. (0.3% and 0.1%, respectively).

Comparison of continuous versus modified continuous SMEAD jones “far-near-near-far” suturing technique for abdominal wall closure in emergency midline laparotomy wound in terms of wound dehiscence.

Objective: To compares the frequency of wound dehiscence in emergency midline laparotomy wound closure using the modified continuous Smead-Jones technique to the continuous method. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: December 20, 2022, to June 20, 2023. Methods: Every one of the one hundred patients having an emergency exploratory laparotomy gave written informed consent. They were split into two groups at random: Group A received continuous closure using prolene #01 suture bites placed 1 cm from the margin and 1 cm apart, and Group B received a modified Smead-Jones technique where suture bites were taken 1.5 cm from the wound margin and 0.5 cm linea alba on either side with prolene # 01 with suture placed 2cm apart. Wound dehiscence was checked following operational definitions. Results: The study's mean age was determined to be 40.18+13.53 years for Group A and 41.18+13.33 years for Group B. Males made up 58.0% (n = 29) of Group A and 72.0% (n = 36) of Group B, while females made up 42.0% (n = 21) of Group A and 28% (n = 14) of Group B. The mean wound dehiscence was 28% in Group B and 10% in Group 2. The p-value for this study was 0.022. Conclusion: When compared to the traditional continuous abdominal wound closure technique, the wound dehiscence rate was significantly lower with the modified continuous smead-jones abdominal wound closure method.

Bridge modal identification method based on adaptive VMD-HT algorithm

ABSTRACT Bridge engineering structures play a crucial role in transportation. Traditional methods of road and bridge closures for inspection and evaluation, while effective, increase bridge inspection costs and disrupt normal traffic flow. Therefore, a rapid detection and evaluation method for bridge structural modal parameters in the operational state is more suitable for practical engineering applications. However, under real operating conditions, bridge vibration signals typically contain a large amount of noise and interference, and modal identification must overcome issues of non-stationarity and non-linearity in the vibration signals caused by vehicle loads and environmental changes to ensure the accuracy of the identification. This study replaces the traditional Empirical Mode Decomposition algorithm in the Hilbert-Huang Transform with the Variational Mode Decomposition algorithm. It proposes a new method that combines the VMD algorithm with the Hilbert Transform, referred to as the Variational Mode Decomposition-Hilbert Transform method. Compared to the EMD algorithm, it offers significant improvements in suppressing mode mixing and endpoint effects. A vehicle-bridge coupling model was constructed, and the bridge’s natural modal information was successfully extracted from the vibration response signals. The research results indicate that the improved algorithm offers higher accuracy and faster computational speed compared to traditional identification algorithms.

Prospective Observational Study Of Surgical Site Infections In Obstetrics And Gynaecological Operations In Teaching Hospital

Background: Surgical site infections (SSI) are defined as infections occurring upto 30 days after surgery or (upto one year in patients receiving implants) and affecting either the incision or deep tissue at the operative site. SSIs are potential complications associated with any type of surgical procedure. Even though SSIs are among the most preventable hospital acquired infections, they still symbolize a significant burden in terms of patient’s morbidity and mortality leading to prolonged hospital stay and increase the patient susceptibility to other nosocomial infections affecting the financial condition of patients. Risk factors for SSIs are grouped as patient related, preoperative or pre pregnancy, intraoperative or intrapartum, and postoperative. SSI causes a substantial risk to patients and financial loses for health system because the multi-factorial causes achieving a measurable and sustained reduction in SSIs. In this context it becomes important to determine the prevalence of SSI, assess the magnitude of problem and provide a rationale to set priorities in infection control in the hospitals. Materials and Methods: The present prospective observational study was conducted on 200 patients in the Department of Obstetrics and gynaecology, at Dr B R Ambedkar Medical College and Hospital for a period of 12 months. Prior to the initiation of the study, Ethical and Research Committee clearance was obtained from Institutional Ethical Committee. Results: There was a significant statistical difference in the incidence of SSIs basing on the body mass index of subjects (pvalue:<0.001). SSI incidence was high in morbidly obese subjects. There was a highly significant statistical difference in the incidence of SSIs basing on the history of previous surgeries of subjects (p-value: <0.0001). SSI incidence was low in subjects with no history of previous surgeries. There was a highly significant statistical difference in the incidence of SSIs basing on the type of surgery (p-value: 0.48). SSI incidence was high in caesarean and low in tubectomy surgeries. There was a significant no statistical difference in the incidence of SSIs basing on the type of incision (p-value: 0.70). There was a highly significant statistical difference in the incidence of SSIs basing on the methods of skin closure (p-value: 0.002). SSI incidence was high in mattress method of skin closure and low in subcuticular method of skin closure. There was a highly significant statistical difference in the incidence of SSIs basing on the class of wound (p-value: 0.00001). SSI incidence was high in dirty wounds and low in clean wounds of skin closure. Conclusion: Although several preoperative risk factors (e.g., age, morbid obesity, ability to pursue a minimally invasive approach, type of gynaecologic surgery, type of incision, methods of skin closure, class of wound) may not be within the surgeon’s control, several evidence based interventions can limit the incidence of SSIs.

An in Vitro Evaluation of the 14-Day Microbial Barrier Property of Exofin High Viscosity Topical Skin Adhesive.

Background: Wound closure is a critical aspect of medical care, and the choice of closure methods plays a pivotal role in preventing infections. Traditional sutures and staples can introduce foreign material into the wound, increasing the risk of infection. Adhesives offer a potential alternative by providing a physical barrier against microorganisms. Objective: To assess the microbial barrier properties of Exofin High Viscosity Topical Skin Adhesive (HVTSA), a novel adhesive system, against a range of challenge organisms. Methods: This study, conducted by the independent research organization NAMSA (North American Science Associates, LLC), aimed to evaluate the effectiveness of Exofin HVTSA as a microbial barrier. This study was carried out by an independent research organization NAMSA. Challenge organisms, including Staphylococcus aureus, Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Escherichia coli, Candida albicans, and Aspergillus brasiliensis, were used to evaluate the adhesive's effectiveness. Inocula of each organism were placed on cured Exofin HVTSA test articles and observed for 14 days. Positive and negative control plates were included to validate the effectiveness of the challenge organisms and assess the absence of contamination. Results: Exofin HVTSA demonstrated effective microbial barrier properties against all challenge organisms, except Pseudomonas aeruginosa. No growth or color change was observed for Staphylococcus aureus, Staphylococcus epidermidis, MRSA, Escherichia coli, Candida albicans, and Aspergillus brasiliensis over the 14-day observation period. Pseudomonas aeruginosa exhibited no growth, but showed a color change in two out of five replicates on day 14. Conclusion: Exofin HVTSA demonstrated effective microbial barrier properties for 14 days against a range of common wound pathogens, suggesting its potential as a safe and effective alternative to traditional wound closure methods. Further research is warranted to investigate its efficacy in clinical settings.

Clinical Outcomes of the Arthroscopic Capsular Suture-Lifting Technique in the Treatment of Femoroacetabular Impingement in Patients With Borderline Developmental Dysplasia of the Hip.

Patients with femoroacetabular impingement (FAI) are likely to present with borderline developmental dysplasia of the hip (BDDH). Considering the prolonged risk of negative prognosis in these patients, the need for surgical management of the capsule has been emphasized. Although previous studies have advocated different techniques of capsular closure during surgery, no consensus has been achieved. Therefore, the aim of this study was to evaluate the clinical outcomes of a new arthroscopic capsular suture-lifting technique for the treatment of FAI combined with BDDH. The arthroscopic capsular suture-lifting technique would achieve better anterior stability and show better clinical outcomes compared with routine capsular closure. Cohort study; Level of evidence, 3. Consecutive patients diagnosed with FAI and BDDH and who underwent hip arthroscopy in our hospital between September 1, 2017, and April 30, 2021, were evaluated. Data were collected prospectively and analyzed retrospectively. Patients were divided into 2 groups according to the capsule closure methods used: capsular suture-lifting technique (lifting group) and routine capsular closure (control group). Anteroposterior hip radiography, Dunn view radiography, and computed tomography imaging were carried out for all patients preoperatively and postoperatively. Patient-reported outcomes, including the modified Harris Hip Score (mHHS) and visual analog scale (VAS) for pain, were collected preoperatively and at least 1 year after surgery and compared between the 2 groups. The Wilcoxon signed-rank test was used to evaluate changes in preoperative to postoperative mHHS scores and VAS. Mann-Whitney U test was used to evaluate significant differences in postoperative mHHS and VAS scores in the 2 groups. In all, 144 patients were included in this study, of whom 77 (53.5%) underwent the arthroscopic capsular suture-lifting technique and 67 (46.5%) underwent routine arthroscopic surgery. The patients in both groups had significant improvement in postoperative mHHS and VAS compared with the preoperative assessment (P < .05). The postoperative VAS score of patients in the suture-lifting group was significantly lower (2.6 vs 3.8; P < .05) and the mHHS score was significantly higher (75.2 vs 68.5; P < .05) than those of patients in the control group. Of the 77 patients in the suture-lifting group, 68 (88.3%) surpassed the minimal clinically important difference (MCID) and 49 (63.6%) achieved the Patient Acceptable Symptom State (PASS). Of the 67 patients in the control group, 26 (38.8%) surpassed MCID and 32 (47.8%) achieved PASS. The percentage of patients achieving MCID and PASS in the suture-lifting group was significantly greater than that in the control group (P = .007 for MCID; P = .03 for PASS). The study demonstrated that the arthroscopic capsular suture-lifting technique provided good clinical outcomes in the treatment of patients with FAI combined with BDDH. This technique showed better improvement of postoperative clinical outcomes than routine capsular closure.

Artificial deformity creation in treatment of soft tissue wounds and lower leg bones defect: a case report

Background. The problem of treating wounded patients with defects of soft tissues and bones of the extremities continues to be relevant. One of the ways to close soft tissue defects, especially in case of bone tissue loss, after open fractures of the extremities is acute shortening and creation of artificial angular deformity of the segment. The aim of the study — to demonstrate the possibilities of acute shortening and angulation of the segment as a technique to replace soft tissue and bone defects in treatment of a patient with a gunshot wound to the lower leg. Case description. A 30-year-old wounded man was admitted to the clinic with an extensive defect in soft tissues and bones of the lower leg in the middle third. To reduce the wound size, acute shortening and angulation of the lower leg was performed. The intentional angular deformation was 24º, shortening — up to 8 cm. The residual soft tissue wound defect was closed with local tissues and split skin autograft. The tibia was fixed by the Ilizarov hinge-distraction apparatus with following gradual correction of the angular deformity. After that, one performed osteotomy of the tibia in order to eliminate shortening with the Ilizarov method (the distraction rate of 1 mm per day). After restoring the length of the lower leg, in order to replace the defect along the anterior surface of the tibia, a marginal “flake” was formed from a displaced fragment. At a follow-up examination, in 18 months after the injury the patient walks with full weight bearing on the injured limb without any additional means of support, continues to perform military service duties in accordance with his position. Conclusions. The presented clinical case demonstrates that acute shortening of a limb segment with creation of artificial angular deformity is an effective method for temporary closure of a gunshot defect of soft tissues. The technique allowed closing critical soft tissue defect of the lower leg and restoring the anatomy (length) of the segment. Consequently, one was able to achieve satisfactory treatment results and restore the functions of an injured limb. Besides, acute temporary shortening technique eliminated the need to perform technically sophisticated and lengthy microsurgical reconstructions, which are associated with a flap replacement for closure of soft tissue defects in a shotgun fracture area.

TROCAR SITE CLOSURE WITH OMENTAL PLUG INSERTION IN LAPAROSCOPIC BARIATRIC OPERATIONS: EFFICACY, SAFETY, AND OUTCOMES

Introduction:Trocar site herniation (TSH) remains a significant complication following laparoscopic bariatric surgery. Conventional closure techniques often prove challenging and may lead to inadequate closure, increasing the risk of TSH. This study aimed to evaluate the effectiveness and safety of a novel omental plug technique for closing trocar sites in laparoscopic bariatric surgery. Methodology:A retrospective study included 256 patients who underwent laparoscopic bariatric surgery (LSG, OAGB, or RYGB) between 2019 and 2023 at Armed Forces Hospital, Taif, Saudi Arabia. We used an innovative omental plug technique to close trocar sites ≥10mm. The primary outcome was the incidence of TSH within 12 months postoperatively, assessed clinically and with an ultrasonography examination. Secondary outcomes included wound infections, seroma formation, and reoperation for trocar site complications. Results:We observed no cases of TSH, indicating significant efficacy in preventing this complication. Other postoperative complications were minimal, with only one case (0.4%) of a superficial wound infection. Conclusion:In laparoscopic bariatric surgery, the omental plug technique demonstrated promising results in preventing TSH and reducing postoperative complications. Its ease of use, safety profile, and potential biological advantages suggest it may be a valuable alternative to traditional fascial closure methods. We warrant future larger, multicentric studies with longer follow-up to confirm these findings.

Snare-assisted clipping method for closure of mucosal incision of gastric peroral endoscopic myotomy.

Snare-assisted clipping method for closure of mucosal incision of gastric peroral endoscopic myotomy.

Clip-to-clip hand-in-hand closure method for a large mucosal defect after colorectal endoscopic submucosal dissection.

Clip-to-clip hand-in-hand closure method for a large mucosal defect after colorectal endoscopic submucosal dissection.

Simulating Mixed‐Phase Open Cellular Clouds Observed During COMBLE: Evaluation of Parameterized Turbulence Closure

AbstractMarine cold‐air outbreaks, or CAOs, are airmass transformations whereby relatively cold boundary layer (BL) air is transported over relatively warm water. To more deeply understand BL and mixed‐phase cloud properties during CAO conditions, the Cold‐Air Outbreaks in the Marine Boundary Layer Experiment (COMBLE) took place from late 2019 into early 2020. During COMBLE, the U.S. Department of Energy's first Atmospheric Radiation Measurement Mobile Facility (AMF1) was deployed to Andenes, Norway, far downstream (∼1,000 km) from the Arctic pack ice. This study examines the two most intense CAOs sampled at the AMF1 site. The observed BL structures are open cellular with high (∼3–5 km) and cold (−30 to −50 C) cloud tops, and they often have pockets of high liquid water paths (LWPs; up to ∼1,000 g ) associated with strong updrafts and enhanced turbulence. We use a high‐resolution mesoscale model to explore how well four turbulence closure methods represent open cellular clouds. After applying a radar simulator to model outputs for direct evaluation, cloud top properties agree well with AMF1 observations (within ∼10%), but radar reflectivity and LWP agreement is more variable. Results suggest that the turbulent Prandtl number may play an important role for the simulated BL and cloud properties. All simulations produce enhanced precipitation rates that are well‐correlated with a cloud transition. Finally, the eddy‐diffusivity/mass‐flux approach produces the deepest cloud layer and therefore the largest and most coherent cellular structures. We recommend the use of a non‐local turbulence closure approach to better capture turbulent processes in intense CAOs.