Continuous Wound Closure Research Articles

A meta-analysis on continuous versus interrupted skin closure following appendicectomy.

The aim of this review was to analyse RCTs comparing wound-related outcomes between continuous subcuticular and interrupted transdermal wound closures for open appendicectomies in all age groups. A systematic literature search was conducted in April 2020 (MEDLINE, Embase, CENTRAL, Web of Science, PROSPERO, Google Scholar, WHO International Clinical Trials Registry Platform). RCTs without restrictions on study language, year, status of publication, and patient age were included. The risk of bias was assessed using the risk-of-bias tool for RCTs. Pooled risk ratios (RRs) and mean differences (MDs) for binary and continuous variables were calculated using random-effects models. A summary-of-findings table was generated to assess the level of evidence. Eleven trials were included (1781 patients analysed, 891 in continuous and 890 in interrupted groups). The overall rate of wound infection was 7.1 per cent. There was no significant difference in the risk of wound infection (11 trials, 1781 patients; RR 1.13, 95 per cent c.i. 0.77 to 1.66; P = 0.530) or wound exploration (7 trials, 1129 patients; RR 0.74, 0.41 to 1.34, P = 0.320) between the two groups. Continuous wound closure had a significantly reduced risk of wound dehiscence (6 trials, 865 patients; RR 0.16, 0.05 to 0.50; P = 0.002) and smaller wound scar (3 trials, 417 patients; MD -2.11 (95 per cent c.i. -2.57 to -1.66) mm; P < 0.001). The absolute risk reduction and number needed to treat for wound dehiscence were 6.1 per cent and 16 respectively. There was no significant statistical heterogeneity for all outcomes (I2 0-15 per cent, χ2 P > 0.100). Most RCTs had a high risk of bias. Continuous subcuticular open appendicectomy wound closure is not associated with an increased risk of wound infection and exploration. This method of closure has a reduced risk of wound dehiscence and better cosmetic outcomes.

Continuous suturing as a wound closure technique for circumcisions

Male circumcision is an extremely common urological procedure worldwide, with many variations in technique. Despite the large volume there is a low incidence of complications associated with circumcisions, with the majority being Clavien-Dindo I or II. In this study, we analyse the outcomes and complication rates associated with a continuous wound closure following a male circumcision. Methods: In a urology department from a single institution, 201 male circumcisions with a continuous wound closure were performed in a 4-year period. Outcomes were analysed retrospectively looking at postoperative complications and readmissions to hospital via our clinical portal. Results: No patients had complications that required admission or re-operation at our institution. Conclusion: No major post-operative complications were observed from our cohort. There were also no documented admissions back to our institution with wound healing complications. However, a limitation is that Clavien-Dindo I and II complications and treatment at general practitioner surgeries were not captured and may not accurately represent our complication rates quoted. Nevertheless, we can conclude from these data that closure for a circumcision using a continuous suture technique gives favourable outcomes with acceptable complication rates. Level of evidence: Not applicable for this multicentre audit.

Antimicrobial and anti-inflammatory drug-delivery systems at endodontic reparative material: Synthesis and characterization

ObjectiveThe aim of this study was to synthesize and characterize an experimental endodontic paste. MethodsAn experimental endodontic paste (EX) was characterized by its particle size, zeta potential, drug content and morphology. The powder of EX is composed of amoxicillin microspheres, calcium tungstate and α-tricalcium phosphate, mixed with an indomethacin nanocapsules suspension. Ultracal® (Ultradent), an iodoform-based paste (GP) and the EX were evaluated by its physical properties (flow, film thickness and radiopacity). The cytocompatibility was performed by MTT and SRB-colorimetric assays; the cell-migration was tested with scratch assay and cell-ability to remineralization with ALP and Alizarin Red S, with fibroblastic cell line. The antibacterial activity was assessed by the formation of inhibition zones and against planktonic bacteria. ResultsThe EX and UL flow achieved ISO6876 standard, and GP was lower than 17mm. All pastes achieved the film thickness required. Radiopacity was equivalent to 1.81±0.25mmAl for EX, which did not differ from GP group 1.39±0.33mmAl (p>0.05). The UL presented 3.04±0.33mmAl. The values for SRB showed better citocompatibility in comparison with MTT for all materials. The ALP activity and formation of mineralized nodules demonstrated the remineralization potential for UL and EX. Cell migration showed continuous wound closure until complete cell healing, however, the EX accelerated the process (p<0.05). The EX showed the greatest inhibition zone (p<0.05) and was the only group with antibacterial activity against planktonic bacteria. SignificanceThe synthesized endodontic paste demonstrated reliable physical and biological properties and could be a promising material for periapical tissue repair.

Barbed suture material technique for wound closure and concomitant tube placement in uniportal VATS for pneumothorax

Uniportal video-assisted thoracoscopic surgery (VATS) is an alternative modality for treatment of primary spontaneous pneumothorax (PSP) with its less invasiveness and acceptable surgical outcomes. However, a few reports have been introduced for wound management to achieve better cosmetic wound healing and for placement of the chest tube in uniportal VATS. Thus, we aimed to evaluate the feasibility of our novel method for wound closure and concomitant tube placement using continuous barbed suture material in uniportal VATS for PSP. Between July 2012 and December 2015, consecutive 31 patients (22 males) underwent uniportal VATS to treat PSP. Bilateral approaches were performed in four patients, thus total 35 cases were enrolled. We divided them into two groups with one group of 17 (48.5%) cases (group A), using barbed absorbable wound closure device for knotless continuous wound closure and subsequent chest tube anchoring, and the other group of 18 (51.4%) cases (group B), using conventional suture anchoring after skin closure using absorbable suture device. Postoperative surgical outcomes were compared to assess the feasibility of this technique. Demographic data demonstrate no significant difference in both groups. There was no significant difference in length of hospital stay (3.7±1.2 vs. 4.1±1.2 days, P=0.267) and in median chest tube indwelling time (2.4±0.9 vs. 3.1±1.2 days, P=0.066), respectively. Operation time in group A was shorter than in group B but there was no significant difference (41.7±11.8 vs. 45.6±16.0 minutes, P=0.415). There was neither conversion to two or three port VATS in all cases. In group A, all chest tubes were removed with concomitant sealing the tube removal site by pulling the thread. Residual knots do not exist that stitch out procedure is not required. There was no wound complication in both groups during the median follow-up period of 18 months. Knotless, barbed suture material technique for continuous wound closure with concomitant chest tube placement achieved equivocal outcomes in comparison to the conventional suture anchoring method. We suggest this simple technique for wound closure and easy tube removal with cosmetic wound healing in uniportal VATS for PSP.

Procedure of continuous wound closure and chest tube anchoring using barbed suture material

Procedure of continuous wound closure and chest tube anchoring using barbed suture material

Surgical Knot Strength in Continuous Wound Closures

Background: Forces applied to knots used for interrupted vs. continuous closures are very different. We studied the knot strength and knot security of three knots when simulating a continuous wound closure: the square, the sliding, and a hybrid constructed using a surgeon’s square knot followed by a sliding knot. Mate-rials and Methods: Knot holding capacity (KHC) of single-strand 1-0 polypropylene was determined by slow distraction on a horizontal testing sled of the strand that would be used to complete a continuous (“running”) closure following placement of an anchoring knot with six throws. Distraction continued until failure of the knot defined as breakage or slippage of the knot. Results: The mean and standard deviation of KHC meas-ured in pounds was determined (n = 30 for each knot): standard square 8.94 +/– 1.04; sliding 10.72 +/– 1.35; and hybrid 10.95 +/– 1.10. For each knot the relative knot security [(KHC of the knot/Tensile strength of untied strand) x 100] was calculated: standard square 69.5%; sliding 83.4%; hybrid 85.2%. Significant dif-ferences (p < 0.0001) in KHC exist between square and sliding knots (favoring sliding knots) and between square and hybrid knots (favoring hybrid knots). Hybrid and sliding knots were not statistically different. Conclusion: Sliding knots and hybrid knots are superior to square knots as anchoring knots for single-strand continuous wound closure.

Comparison of Interrupted Versus Continuous Closure in Abdominal Wound Repair: A Meta-analysis of 23 Trials

Objective There is a lack of consensus among surgeons over interrupted versus continuous methods of abdominal wound closure. The objective of this study was to perform a meta-analysis to estimate the pooled odds ratio (OR) for dehiscence and incisional hernia in the interrupted technique of laparotomy wound closure as compared to the continuous technique. Methods All randomized, controlled trials comparing continuous and interrupted methods of laparotomy wound closure, with burst abdomen and/or incisional hernia as the outcomes, were included in the meta-analysis. MEDLINE, Clinical Evidence and the Cochrane Library were searched. Burst abdomen and incisional hernia were the two primary outcomes. Results Twenty-three studies were identified, with a total of 10,900 patients. The interrupted method of closure was associated with significantly less dehiscence as compared with the continuous method (OR, 0.576; p =0.014; relative risk reduction, 39.8%; number needed to treat, 143). The interrupted technique was also found to be better in the nonabsorbable suture, vertical incision and mass closure subgroups. However, no difference in the hernia risk was found between the two methods. Conclusion Interrupted laparotomy wound closure reduces the odds of dehiscence by half compared with continuous wound closure.

Integration and Persistence of an Investigational Human Living Skin Equivalent (ICX-SKN) in Human Surgical Wounds

To present the first human clinical data on an investigational living skin graft replacement that is being designed for application where tissue has been lost through surgery, disease or trauma. The ICX-SKN skin graft replacement is composed of an autosynthesized human collagen-based extracellular matrix and human dermal fibroblasts. In a first study to examine integration and persistence, full-thickness excisional wounds were made in six healthy human female volunteers and the ICX-SKN skin graft replacement applied and dressed. The surgical wounds were examined for up to 28 days post-application and the graft excised from each volunteer. Pre-excision gross examination revealed that the ICX-SKN skin graft replacement had integrated well in each of the six wounds and that re-epithelialization had occurred in each case. Histological analysis revealed that the ICX-SKN skin graft replacement remained in place and had become vascularized and provided a continuous wound closure. No serious adverse events were reported and no gross scarring or wound contracture was evident in the healed wounds. This is the first report of preliminary evidence indicating the persistence of an autosynthesized, tissue-engineered, living human skin substitute in healed acute wounds in humans.

Assessment of knot security in continuous intradermal wound closures

The traditionally used square knot used for commencement and termination of continuous wound closures is bulky, requiring a minimum of four to six throws to form a secure knot with most suture materials and sizes. This study evaluates the security of self-locking knots, which are significantly smaller in volume than the traditionally applied square knot, for the intradermal closure of standardized wounds in porcine skin. Porcine skin samples with standardized wounds were closed in one of five patterns with 3/0 PDS suture. Wounds were harvested and tested to failure on a materials testing machine. Load at failure, ultimate elongation, wound stiffness, and mode of failure was determined for each sample. Wound closures incorporating the chain stitch knot performed as well as closures incorporating the conventional square knot for load to failure, elongation, and stiffness. Partial slippage or complete knot failure of 4/40 (10%) of the square knots used in closures was observed. 0/20 (0%) of the chain stitch knots displayed slippage. The half-blood knot performed similarly to the square and chain stitch knot in load to failure, elongation, and stiffness, however, 16/20 (80%) of these knots displayed slippage or complete knot failure. The chain stitch knot is as secure as the traditionally used square knot when used for termination of a continuous intradermal wound closure. This knot displays characteristics such as smaller knot volume and ease of applications that may make it a superior knot to the square knot in many clinical situations.

The burst abdominal wound: a mechanical approach.

The burst abdominal wound has a mechanical cause. It is the results of suture breaking, knot slipping, the intact suture cutting out of the tissues or protrusion of gut or omentum between stitches. Measurements of abdominal girth and the xiphoid-pubis distance before and during abdominal distension show that a wound may lengthen by 30 per cent if distension occurs. An adequate reserve of suture length in the wound is necessary to allow this lengthening to occur and to ensure a minimal resulting rise in tension between the sutures and the tissues. Three variables present in every continuous wound closure--the suture length inserted, the wound fasical length and the number of stitches--determine the stitch interval and the size of the tissue bite, which are the two vital factors in wound strength under the surgeon's control. These variables may be expressed by the ratio of the length of suture (SL) inserted to the wound length (WL), the ratio SL:WL. Analytical and clinical evidence is presented to show that: 1. Deep wound disruption (evisceration and ventral hernia) is associated with the use of an SL: WL ratio of 2: 1 or less-the lower the ratio, the greater is the risk of a burst wound. 2. Wound disruption because of cutting out of sutures can be prevented by the use of non-absorbable continuous sutures at 1-cm intervals and an SL:WL ratio of 4:1 or more.

Immunosuppression and Temporary Skin Transplantation in the Treatment of Massive Third Degree Burns

A method of burn treatment (immunosuppression and temporary skin transplantation) for patients suffering from massive third degree burns is evaluated. The method is based on the prompt excision of all dead tissue (burn eschar) and immediate closure of the wound by skin grafts. Total wound closure is achieved before bacterial infection or organ failure takes place by carrying out all initial excision and grafting procedures within the first ten days post burn and supplementing the limited amount of autograft with allograft. Continuous wound closure is maintained for up to 50 days through immunosuppression. Both azathioprine and ATG have been used but ATG is preferred. During the period of immunosuppression, allograft is stepwise excised and replaced with autograft donor sites regenerate for recropping. Bacterial complications are minimized by housing the patient in the protected environment of the Bacteria Controlled Nursing Unit. Intensive protein and calorie alimentation are provided, and 0.5% aqueous AgNO3 dressings are used. A swinging febrile illness has been associated with large areas of allograft rejection. Eleven children have been treated and seven have been returned to normal, productive schooling.