Surgical Wound Closure Research Articles

Absorbable versus conventional methods for wound closures in surgeries for benign breast diseases: a randomized case control study

Background: Surgeons and patients prefer absorbable sutures for surgical wound closure in breast surgeries which are usually continuous subcuticular sutures so that patients can skip a hospital visit for suture removal. But in case of breast biopsies authors usually put circumareolar incisions. Here authors find it difficult to put continuous subcuticular sutures. In this contest authors thought of interrupted subcuticular sutures where authors can tackle the above-mentioned limitations; while actually reducing the financial burden of the patients.Methods: In this randomized case controlled study authors included elective general surgical procedures for benign breast diseases that was being carried out in the department of General Surgery Govt. Medical College, Kottayam for a period of 6 months starting from January 2017. Total number of cases taken are 20; 10 each in each group.Results: The mean rank for interrupted method was 14.20 and conventional method was 6.80. Mann-Whitney U statistic was 13.000 and p value was 0.03. Since p value was less than 0.05, authors had clear evidence to reject the null hypothesis. Therefore, authors concluded that both the methods were dissimilar and based on mean rank interrupted method seemed to be better method.Conclusions: Authors recommended interrupted absorbable subcuticular suturing technique in general surgical procedures for benign breast diseases, especially where authors used circumareolar incisions, which saved time of the surgeon and the patient. This can lead to considerable cost savings for the government without compromising clinical effectiveness or safety.

Injectable Click Chemistry-Based Bioadhesives for Accelerated Wound Closure

Tissue adhesives play a vital role in surgical process as a substitution of sutures for wound closure. However, most currently existing tissue adhesives suffer cell toxicity, weak adhesive strength to tissue, and costly. Herein, by taking advantage of the fast and specific inverse-demand Diels-Alder cycloaddition reaction, a series of bioadhesive were produced by employing copper-free click chemistry pair trans-cyclooctene (TCO) /tetrazine (Tz) in the chitosan. The gelation time of the bioadhesives can be optimized to be less than 2 minutes, which meets the need for surgical wound closure in practice. With the adding of 4-arm polyethylene glycol propionaldehyde (PEG-PALD) as a co-crosslinker, the adhesive strength of the bioadhesives is optimized to be 2.7 times higher than that of the conventional fibrin glue. Moreover, by adjusting the amount of the co-crosslinker, the swelling ratio and pore size of the chitosan bioadhesives can be tuned to fit the need of drug encapsulation and cell seeding. The chitosan bioadhesives possess excellent in vitro cytocompatibility. Through a mice skin incision wound model, we proved that the chitosan bioadhesives was able to close the wound faster and promote wound healing process faster than the fibrin glue. In conclusion, our results support that the innovative click-chemistry based bioadhesives have been developed with improved physical and biological properties for surgical wound closures.

Surgical skin adhesive bond is safe and feasible wound closure method to reduce surgical site infection following minimally invasive colorectal cancer surgery.

PurposeMinimally invasive colorectal surgery had reduced the rate of surgical site infection. The use of surgical skin adhesive bond (2-octyl cyanoacrylate) for wound closure reduces postoperative pain and provides better cosmetic effect compared to conventional sutures or staples. But role of surgical skin adhesive bond for reducing surgical site infection is unclear. Our objective in this study was to evaluate the role of surgical skin adhesive bond in reducing surgical site infection following minimally invasive colorectal surgery.MethodsWe performed a retrospective analysis of 492 patients treated using minimally invasive surgery for colorectal cancer at Seoul St. Mary's Hospital, the Catholic University of Korea. Of these, surgical skin adhesive bond was used for wound closure in 284 cases and skin stapling in 208. The rate of surgical site infection including deep or organ/space level infections was compared between the 2 groups.ResultsThe rate of superficial surgical site infection was significantly lower in the group using skin adhesive (P = 0.024), and total costs for wound care were significantly lower in the skin adhesive group (P < 0.001).ConclusionThis study showed that surgical skin adhesive bond reduced surgical site infection and total cost for wound care following minimally invasive colorectal cancer surgery compared to conventional skin stapler technique. Surgical skin adhesive bond is a safe and feasible alternative surgical wound closure technique following minimally invasive colorectal cancer surgery.

Use of 3D Printing in Model Manufacturing for Minor Surgery Training of General Practitioners in Primary Care

In order to increase the efficiency of the Spanish health system, minor surgery programs are currently carried out in primary care centers. This organizational change has led to the need to train many general practitioners (GPs) in this discipline on a practical level. Due to the cost of the existing minor surgery training models in the market, pig’s feet or chicken thighs are used to practice the removal of figured lesions and the suture of wounds. In the present work, the use of 3D printing is proposed, to manufacture models that reproduce in a realistic way the most common lesions in minor surgery practice, and that allow doctors to be trained in an adequate way. Four models with the most common dermal lesions have been designed and manufactured, and then evaluated by a panel of experts. Face validity was demonstrated with four items on a five-point Likert scale that was completed anonymously. The models have obtained the following results: aesthetic recreation, 4.6 ± 0.5; realism during anesthesia infiltration, 4.8 ± 0.4; realism during lesion removal, 2.8 ± 0.4; realism during surgical wound closure, 1.2 ± 0.4. The score in this last section could be improved if a more elastic skin-colored filament were found on the market.

Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015-2017.

Describe common pathogens and antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred during 2015-2017 and were reported to the Centers for Disease Control and Prevention's (CDC's) National Healthcare Safety Network (NHSN). Data from central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), and surgical site infections (SSIs) were reported from acute-care hospitals, long-term acute-care hospitals, and inpatient rehabilitation facilities. This analysis included device-associated HAIs reported from adult location types, and SSIs among patients ≥18 years old. Percentages of pathogens with nonsusceptibility (%NS) to selected antimicrobials were calculated for each HAI type, location type, surgical category, and surgical wound closure technique. Overall, 5,626 facilities performed adult HAI surveillance during this period, most of which were general acute-care hospitals with <200 beds. Escherichia coli (18%), Staphylococcus aureus (12%), and Klebsiella spp (9%) were the 3 most frequently reported pathogens. Pathogens varied by HAI and location type, with oncology units having a distinct pathogen distribution compared to other settings. The %NS for most pathogens was significantly higher among device-associated HAIs than SSIs. In addition, pathogens from long-term acute-care hospitals had a significantly higher %NS than those from general hospital wards. This report provides an updated national summary of pathogen distributions and antimicrobial resistance among select HAIs and pathogens, stratified by several factors. These data underscore the importance of tracking antimicrobial resistance, particularly in vulnerable populations such as long-term acute-care hospitals and intensive care units.

TL - 18148 - Partial plantar fasciotomy for the treatment of plantar fibromatosis

Introduction: Ledderhose's disease (plantar fibromatosis) is an uncommon condition that usually affecting men older than 40 years of age and causes major discomfort and disability. The low response to conservative treatment and the progression of surgical techniques have motivated some professionals to resume considering surgical resolution for this disease. Our study describes the outcomes of a series of cases treated with resection of the affected band. Methods: This is a retrospective study with 14 patients (17 feet) diagnosed with plantar fibromatosis of the medial fascia that was refractory to conservative treatment and was treated surgically from December 2016 to November 2018. All patients were evaluated for improvement in symptoms, for major and minor complications and for relapse during the study period. Results: Our sample consisted of 9 men and 5 women with a mean age of 40.6 years (15-63 years). All patients showed medial fibromatosis and underwent subtotal fasciotomy of the medial fascial band with margins of at least 2 cm. Of the 17 feet, 5 showed relapse (29%) and only 2 required reintervention. Three patients (17%) developed surgical wound dehiscence, although all patients progressed to surgical wound closure with no need for surgical intervention. Two feet showed signs of medial plantar nerve injury, although the branch of the nerve was wrapped in fibromatosis and was also resected in those cases. Conclusion: Partial plantar fasciotomy is an alternative for the treatment of Ledderhose's disease. Our series showed outcomes in line with those reported in the literature in terms of relapse and postoperative complications. The moderate relapse and reoperation rates should be considered when this procedure is indicated.

1245. Does Complexity of Infection Prevention Bundles Matter in Colorectal Surgery? A Systematic Review and Meta-Analysis

BackgroundSurgical site infection (SSI) prevention bundles in colorectal surgery are common. The optimal bundle composition and impact of increasingly complex and resource-intensive bundled interventions on SSI remain unclear.Methods(1) A systematic review and meta-analysis of randomized and observational trials with pre-post implementation data for colorectal SSI prevention bundles to study their effect on superficial, deep, and organ-space SSI. (2) A meta-regression to determine whether the bundle size (number of different bundle elements) affects SSI. (3) A correlation analysis to identify individual bundle elements with greatest SSI reduction. We used the METAN, METAEFF, and METAREG packages in STATA SE 15 for analysis.ResultsWe included 38 studies in the systematic review, and 29 studies (49,589 patients) in the meta-analysis. Bundle composition was highly variable, ranging from 3 – 13 guideline-recommended elements per bundle. Meta-analyses showed bundles to be associated with relative risk reductions of 43% for any SSI (RR 0.57 [95% CI 0.48–0.67]; 44% for superficial SSI (RR 0.56 [95% CI 0.42–0.75]; 33% for deep SSI (RR 0.67 [95% CI 0.45–0.98], and 37% for organ/space SSI (RR 0.63 [95% CI 0.49 – 0.81]). On meta-regression, bundle size, especially ≥10 elements, was significantly associated with SSI reduction for any SSI (P = 0.04) and for superficial SSI (P = 0.005). Individual bundle elements correlated with strongest SSI reductions were mechanical bowel prep combined with oral antibiotics (R = −0.68, P = 0.0028) and pre-operative chlorhexidine showers (R = −0.49, P = 0.04) for organ/space SSI. Protocols including separate instrument trays and glove ± gown change prior to surgical wound closure (R = −0.55, P = 0.009), and standardized postoperative wound dressing change at 48 hours (R = −30.59, P = 0.005) correlated with highest superficial SSI reductions.ConclusionComplex colorectal bundles with ≥10 clinical guideline-recommended prevention elements are associated with higher reductions in any SSI and in superficial SSI. Further research should evaluate how complex SSI prevention colorectal bundles can be implemented and sustained with high fidelity in the clinical setting in a cost-effective manner.Disclosures All authors: No reported disclosures.

Early laser intervention to reduce scar formation in wound healing by primary intention: A systematic review

Hypertrophic scars frequently follow primary closure of surgical wounds. Laser application at or shortly after suture may be associated with a reduction in scar formation, although the respective study results vary. The objective was to evaluate the efficacy of early laser applied within the first six months after surgery to reduce scar formation compared to no treatment. We searched the databases MEDLINE and CENTRAL on 14 January 2019 and included randomized controlled trials (RCTs). Primary outcome was the Vancouver Scar Scale (VSS). Measure of treatment effect was the mean difference from baseline. Seventeen relevant RCTs randomized 430 scars (413 assessed) and compared laser versus no treatment. Fourteen studies applied a split-scar and three applied a simple parallel design. Three studies with a split-scar design favored the laser group on VSS, and one study had indifferent findings. Considerable heterogeneity I2 = 86% did not justify a meta-analysis. The remaining 13 studies did not report appropriate data. On the basis of the currently available evidence, we are uncertain whether early laser can reduce scar formation, and more high-quality research is needed for a definitive conclusion.

A study of comparison between skin sutures and skin staplers

Wound closure is as important as any other action performed by the surgeon. Apart from the need for producing a healthy and strong scar, it is the surgeon’s responsibility to ensure its aesthetically pleasing physical appearance. Skin staples are an alternative to regular sutures in offering this advantage. The present study has helped to highlight the comparison between skin sutures and skin staplers. The skin stapling devices have revolutionized surgery for the purpose of rapid closure of abdominal wounds. However, staples have their own drawbacks. In view of this, this prospective study has been undertaken to highlight the outcomes of closure by staples and sutures with respect to speed of closure, cost effectiveness and post operative wound dehiscence, acceptance of scar and post operative pain. This is a prospective hospital based study conducted in our hospital from January 2017 to December 2018 at S.V.S Medical College. 200 patients who underwent various surgical procedures. Results were analyzed and compared with previous studies. It has been found that the use of staples in abdominal surgical wound closure gives faster speed of closure, less postoperative pain, and better cosmetic results. Staples, however, are costlier, and when used in emergency cases, associated with higher rates of wound dehiscence and a less acceptable scar.

Use of Cyanoacrylate N-Butyl Versus Subcuticular Suture in the Dermal Closure Following Cesarean Delivery: A Randomized Controlled Trial

Background: Currently the use of tissue adhesives for surgical wound closure has multiplied; however, its use in cesarean sections is still not well determined. The objective of this study was to compare the surgical wound healing following cesarean sections between N-butyl cyanoacrylate (Tisuacryl) and suture (Monocryl 2-0). Methods: A randomized, non-blinded controlled clinical trial was conducted from October 2017 to March 2018 at the Instituto Nacional de Perinatologia. Forty women undergoing cesarean delivery were randomly assigned to skin closure group using a random number table: 20 with N-butyl cyanoacrylate (Tisuacryl) (cases group) and 20 with Monocryl (control group). Scars were evaluated at 24 h, 1 week, 1 month and 3 months. Primary objective was to evaluate the esthetics of the scar with the scar cosmesis assessment and rating (SCAR) scale. Secondary objectives were skin closing time, the satisfaction of the patient and the satisfaction of the surgeon. Results: Demographic characteristics, including average age, body mass index and number of pregnancies, were similar in both groups. The skin closing time showed a significant decrease with a P value of 0.000 between Tisuacryl and Monocryl (54.95 ± 10.353 s in the first group vs. 407.5 ± 72.61 s) . The esthetic evolution of surgery using the SCAR scale showed a better evolution in the first visits (weekly and monthly) in the Monocryl group (2.05 ± 0.60 and 1.68 ± 0.477) vs. Tisuacryl (2.77 ± 0.685 and 2.55 ± 0.74) with a P value of 0.001 in SCAR 1 (first visit) and 0.000 in SCAR 2 (second visit). However, no significant differences were observed in the last result at 3 months (SCAR 3). Similarly, no significant differences were observed regarding the satisfaction of the surgeon or the patient. Conclusions: The results of skin healing with Tisuacryl vs. Monocryl were similar in terms of the esthetics and satisfaction of the patient or the surgeon. Therefore, the use of each one depends on surgeon/patient preferences and the availability of materials. J Clin Gynecol Obstet. 2019;8(3):85-90 doi: https://doi.org/10.14740/jcgo560

Dilute Betadine Lavage Reduces the Risk of Acute Postoperative Periprosthetic Joint Infection in Aseptic Revision Total Knee and Hip Arthroplasty: A Randomized Controlled Trial

BackgroundThe purpose of this randomized, controlled trial is to determine whether dilute betadine lavage compared to normal saline lavage reduces the rate of acute postoperative periprosthetic joint infection (PJI) in aseptic revision total knee (TKA) and hip arthroplasty (THA). MethodsA total of 478 patients undergoing aseptic revision TKA and THA were randomized to receive a 3-minute dilute betadine lavage (0.35%) or normal saline lavage before surgical wound closure. Fifteen patients were excluded following randomization (3.1%) and six were lost to follow-up (1.3%), leaving 457 patients available for study. Of them, 234 patients (153 knees, 81 hips) received normal saline lavage and 223 (144 knees, 79 hips) received dilute betadine lavage. The primary outcome was PJI within 90 days of surgery with a secondary assessment of 90-day wound complications. A priori power analysis determined that 285 patients per group were needed to detect a reduction in the rate of PJI from 5% to 1% with 80% power and alpha of 0.05. ResultsThere were eight infections in the saline group and 1 in the betadine group (3.4% vs 0.4%, P = .038). There was no difference in wound complications between groups (1.3% vs 0%, P = .248). There were no differences in any baseline demographics or type of revision procedure between groups, suggesting appropriate randomization. ConclusionDilute betadine lavage before surgical wound closure in aseptic revision TKA and THA appears to be a simple, safe, and effective measure to reduce the risk of acute postoperative PJI. Level of EvidenceLevel I.

Comparison between noninvasive and conventional skin closure methods in off-pump coronary artery bypass grafting using bilateral internal thoracic artery.

Sternal wound complications could increase the hospital cost while decreasing the satisfaction of surgery. Furthermore, it can potentially also lead to life-threatening mediastinitis especially after coronary artery bypass grafting using bilateral internal thoracic artery (BITA). Skill levels of suture technique vary among surgeons and may contribute to an increased wound complication rate. Thus, standardization of surgical wound closure could potentially decrease the surgeon factor. The aim of the study is to compare the wound complication rate between non-invasive surgical skin closure devices (zip surgical skin closure device, Zipline Medical, Campbell, CA, USA) and conventional suture closure. Three hundred seventy-nine patients who underwent off-pump coronary artery bypass grafting (OPCAB) using BITAs at our institution between 2016 and 2018 were included in this study. Patients were divided into two groups; the Zipline group (zip-group, N=100), and conventional group (con-group, N=279). Following propensity score matching, 95 con-group patients were matched to 169 zip-group patients. The average age and history of cancer were significantly higher in the zip-group (P=0.021 and P=0.023, respectively). However, after propensity score matching, no differences were observed in the demographic data between the groups. In total patients (unmatched), although there was no significant difference in the incidence of deep sternal wound infection (DSWI) between the two groups (zip vs. con, 0% vs. 1.1%, P=0.569), the incidence of post-operative superficial sternal wound infection (SSWI) or dehiscence was significantly higher in the con-group than in the zip-group (1.0% vs. 7.9%, P=0.013). The results were consistent in the matched patients. (DSWI: 0% vs. 0.6%, P>0.999; SSWI or dehiscence: 1.1% vs. 7.1%, P=0.036). Multivariable analysis revealed use of the zip surgical skin closure device showed a preventive effect against wound complications [odds ratio (OR): 0.128, 95% confidence interval (CI): 0.017-0.976, P=0.029]. Zip surgical skin closure devices could decrease superficial wound complication rates compared to conventional suture techniques in OPCAB using BITAs.

Optimal wound closure techniques for thyroid and parathyroid surgery: A systematic review of cosmetic outcomes.

Cosmesis after surgical wound closure is an important outcome. This is relevant after thyroid and parathyroid surgery as anterior neck scars are visible and often of concern to patients. We aimed to investigate whether wound closure method influences cosmetic outcome in thyroid and parathyroid surgery, in particular using sutures, staples, steri-strips and glue. We performed a systematic review of MEDLINE, PubMed, EMBASE, CINAHL and Cochrane focusing on wound cosmesis following thyroid and parathyroid surgery. Searches were conducted using combinations of the search terms: thyroid/parathyroid surgery, wound/skin closure and suture, staples, clips, glue and steri-strips, using appropriate MESH terms and Boolean operators. Primary outcome was wound cosmesis. Secondary measures were also extracted. Initial search found 304 papers and after systematic review, a total of 10 studies compared different closure methods and cosmetic outcomes. There were nine randomised controlled trials and one cohort study, with a total of 712 patients. Three studies compared staples vs glue; three compared sutures vs clips; two compared suture vs steri-strips and two studies for suture vs glue. In general, short-term cosmesis was better with subcuticular sutures compared to glue or clips, long-term cosmetic outcomes were not influenced by closure method. We found closure with subcuticular suture or steri-strips produced superior short-term cosmetic outcomes. Although long-term cosmetic outcome is not influenced by closure method, given the superior cosmetic outcome and advantage of not needing removal, we recommend subcuticular sutures should be performed for wound closure in thyroid and parathyroid surgery.

Unedited microneurosurgery of a falcotentorial meningioma

Background:Falcotentorial meningiomas are pineal region meningiomas that arise from the dura of the tentorium cerebelli and posterior part of the falx. These tumors are commonly supplied by branches of the internal carotid artery such as the meningohypophyseal trunk, inferolateral trunk, and anterior choroidal artery. Less frequently, branches of the ophthalmic artery, vertebral artery, or external carotid artery are also involved. Based on neuroimaging studies, falcotentorial meningiomas may be classified as anterior, superior, inferior, and posterior types. Here, we present an unedited microsurgical resection of a superior falcotentorial meningioma.Case Description:The patient with a meningioma of the posterior inferior falx and a minimal extension to the tentorium underwent sitting praying position and a right occipital interhemispheric approach. Strong retraction of the dura followed a superior sagittal sinus based opening. Careful microsurgical access between the medial surface of the occipital lobe and the falx toward the splenium of corpus callosum allowed us to recognize the lesion. Thus, a cottonoid placed over the cerebral surface avoiding direct contact with the bipolar forceps, and the constant separation of the falx cerebri with the aspiration tube along the access developed a proper surgical route preventing any cortical lesion. Along the approach, cerebrospinal fluid was continuously released from the pericallosal cistern as well. Once well recognized the meningioma, we proceeded with the internal decompression of the lesion using a thumb regulated suction tube and bipolar forceps. Tissue samples from the tumor were taken for the histological diagnosis, and under conventional microsurgical technique, the meningioma was completely removed by piecemeal technique. A small lateral tear on the falx required hemostatic reparation with Tachosil. Water dissection provided us a clear cleavage plane for the microsurgical dissection of the tumor and maintained a clean operative field along the procedure. Occipital arteries running over the lateral surface of the meningioma were carefully dissected and isolated from the lesion, while the deep venous system did not achieve any contact with the tumor. After the ipsilateral component of the meningioma was resected, we intent are dissecting the contralateral segments of the tumor with a curved dissector. At the last stage of the surgery, small incision at a tumor-free segment of the falx allowed us to remove the falcotentorial attachment of the lesion. Under high microscopic magnification, the remaining minimal portion of meningioma extending under the tentorium was coagulated. After complete microsurgical removal of the meningioma, careful homeostasis based on electrocoagulation surgical and Tachosil was achieved. Finally, we performed a surgical wound closure under standard technique.Conclusion:This unedited video offers all detailed aspects for an efficient and safe falcotentorial meningioma microneurosurgery.Videolink:http://surgicalneurologyint.com/videogallery/pineal-meningioma.

Comparative study between silk suture and metallic Staplers in skin wound closure in Rabbits

This research aimed to compared between natural non-absorbable suture (silk) and metallic clips in skin wound closure, the result appeared that the use natural non-absorbable suture (silk) get the best result when closed the wound compared with staples. In view of this prospective study has been undertaken to highlight the outcomes of closure by clips and sutures with respect to speed of closure, cost effectiveness and postoperative wound dehiscence, acceptance of scar. It has been found that the use of silk in surgical wound closure gives faster speed of closure and better results.

Novel Technique to Reduce the Incidence of SSI after Colorectal Surgery

SSI is a leading cause of morbidity and increases health-care cost after colorectal operations. It is a key hospital-level patient safety indicator. Previous literature has identified perioperative risk factors associated with SSI and interventions to decrease rate of infection. The purpose of this study was to evaluate the impact of blowhole closure on the rate of superficial and deep SSI. The ACS-NSQIP database was queried for patients undergoing colectomy at the University of Kentucky from 2013 to 2016. Retrospective chart review was performed to gather demographic data and perioperative variables. Wounds left open and packed were excluded. Rates of postoperative SSI were measured between the groups. One thousand eighty-three patients undergoing elective and emergent colectomy were reviewed. Nine hundred and forty-five had closed incision and 138 had blowhole closure. Patient characteristics between the groups were well matched. Patients with a blowhole closure were more likely to have an open procedure (P = 0.037) and a higher wound class (P < 0.001). The rate of superficial and deep SSI was 9.1 per cent in patients with a closed incision and 5.1 per cent in patients with blowhole closure (P = 0.142). With adjustment for approach and wound class, blowhole closure decreased the incidence of SSI (P = 0.04). There was no significant difference in morbidity or mortality. Patients undergoing elective and emergent colectomy had decreased incidence of SSI when blowhole closure was used. Given that it does not increase resource usage and its technical ease, blowhole closure should become the standard method of surgical wound closure.

Development of a Novel Polymer-Based mRNA Coating for Surgical Suture to Enhance Wound Healing

A therapeutic strategy to improve wound healing has become an increasingly important medical task due to the rising incidence of adiposity and type II diabetes as well as the proceeding population aging. In order to cope with the resulting burdens, new strategies to achieve rapid and complete wound healing must now be developed. Accordingly, the development of a bioactive wound dressing in the form of a messengerRNA (mRNA)-bearing poly(lactide-co-glycolide acid) (PLGA) coating on surgical suture is being pushed further with this study. Furthermore, the evaluation of the polymer-based transfection reagent Viromer RED has shown that it can be used for the transfection of eukaryotic cells: The mRNA gets properly complexed and translated into a functional protein. In addition, the mRNA-PLGA coating triggered the expression of the keratinocyte growth factor (KGF) in HaCat cells although KGF is not expressed under physiological conditions. Moreover, transfection via surgical sutures coated with mRNA does not affect the cell viability and a proinflammatory reaction in the transfected cells is not induced. These properties make the mRNA-PLGA coating very attractive for the in vivo application. For the future, this could mean that through the use of mRNA-coated sutures in surgical wound closure, cells in the wound area can be transfected directly, thus accelerating and improving wound healing.

Cold Atmospheric Plasma as an Additional Tool for Successful Therapy of Left Ventricular Assist Device Related Infections

Purpose Despite all innovations in continuous flow left ventricular assist devices (cfLVAD) wound infections are still leading factors for morbidity and mortality in VAD patients. Over the last years, cold atmospheric plasma (CAP) has been safely and effectively used to treat superficial infections. Thus, in this study we used CAP the first time intraoperativly and postoperativly in patients with ascending driveline infections (DI) and device related infections (DRI). Methods We describe a two center experience with nine patients (HVAD n=8; HeartMate III n=1), who were implanted between 08/2013 and 03/2018 and developed a DI or DRI in the follow up. Five patients had an ascending DI, one patient with recurrent ascending DI, one patient had a substernal abscess, one patient had first a sternal abscess and after the follow up an ascending DI and another patient first an ascending DI and after the follow up a subxiphoidal abscess. All wounds were treated with CAP (kinPen MED) starting intraoperatively (n=11), after surgical wound debridement and after wound closure postoperatively during wound dressing. Five wounds were additional treated with vacuum therapy till secondary surgical wound closure. Bacteria specific antibiotic therapy was given for all patients. Results Median time from implantation to device related infections was 18.5 (3 to 60) months. CAP applications was done on average 20 times per wound (6 to 50), median time of CAP therapy was 38.6 (6 to 150) days. In the follow-up after 3 months the healing of 10 wounds was normal. Wound infection recurrence happened in one wound after primarily closure (n=6), and in one wound of a patient with vacuum therapy (n=5). There were no adverse side effects of CAP therapy observed and there were no abnormalities of cfLVAD during CAP treatment. Conclusion In our study we demonstrate that CAP therapy could be effectively and safely applied in cfLVAD patients with device related wound infections. Future studies have to show if early CAP therapy of superficial cfLVAD wound infections has the potential to prevent progression of infection to avoid surgical debridement.

Does plastic incise drape prevent recolonization of endogenous skin flora during lumbar spine procedures?

Background:The aim of this study was to compare the PID with bare skin (without PID) regarding bacterial recolonization and bacterial regrowth of the adjacent skin of surgical incision in lumbar spine surgery patients.Methods:This quasi-experimental study was conducted from February to May 2018 on 88 patients who were candidate for lumbar spine surgery. Patients were assigned to one of two groups, treatment (with PID) and control (without PID). Skin sampling (adjacent of surgical incision) for bacterial culture was done in two steps, immediately after surgical skin prep (IASSP) and immediately after surgical wound closure (IASWC) by researcher. Finally, samples were sent to the laboratory.Results:The mean total bacterial count of patient's skin in stage IASSP was not significantly different between treatment and control groups (0.34 vs 0.27, P = 0.68). However, mean total bacterial count in stage IASWC in treatment group was significantly higher than control group (2.2 vs 0.93, P = 0.03). The frequency distribution of S. aureus (P = 0.04) and S. epidermidis (P = 0.02) was significantly higher in treatment group compared with control group in stage IASWC.Conclusions:The results showed that using PID is unable to reduce recolonization and regrowth of bacteria on patients’ skin adjacent to surgical wound in clean lumbar spine surgeries. However, making a definite decision about using or not using of PID requires further studies.

Inverse 'D' incision technique in treatment of pilonidal sinus disease; excision with minimal tissue loss, closure without tension and lateral location of the suture line.

PurposeSurgical excision is the preferred treatment modality for sacrococcygeal pilonidal sinus (PS). Notably, the desirable features of an ideal surgical intervention are excision with minimal tissue loss, closure without tension, and a lateral suture line. The present study aimed to investigate early outcomes of surgical excision through the inverse D (ᗡ) incision based on tissue loss, wound tension, and suture line location.MethodsThis prospective study was comprised of 80 patients with PS in whom excision of PS was performed through the ‘ᗡ’ incision to minimize tissue loss with a tensionless primary surgical wound closure. The suture line was located laterally in all patients. Early and late postoperative complications, duration of hospital stay, return to work, and recurrence rates were investigated. The mean duration of the follow-up period was 36 months.ResultsSixty-three patients (78.8%) were male. PS in all patients was surgically removed by subcutaneous excision through a ‘ᗡ’ incision. Laterally placed surgical wounds were closed primarily with interrupted vertical mattress sutures. No general complications were encountered. Five patients (6.3%) experienced early postoperative surgical site complications. On average, the duration of hospital stay and return to work were 2.4 days and 3.8 days, respectively. Recurrence was seen in 1 case (1.3%) during the follow-up period. Satisfaction score was high in 83.8% of patients.ConclusionThe method of sinus excision using the ‘ᗡ’ incision with a primary suture facilitates excision with minimal tissue loss and closure without tension with an off-midline suture. It is both a simple and effective surgical technique for the treatment of sacrococcygeal PS.