Conventional Wound Closure Research Articles

FixAtion of skiN flaps after mastectomy using ruNning or Interrupted suturEs for combatting seroma: a protocol for a randomised controlled trial (ANNIE).

Flap fixation significantly reduces the incidence of seroma formation after mastectomy. Previous studies have compared running sutures, interrupted sutures and tissue glue application with conventional wound closure. A recent systematic review with network meta-analysis showed running sutures to be the most optimal technique; however direct comparisons and high adequate scientific evidence are lacking. This prospective trial aims to directly compare running sutures with interrupted sutures to determine which technique of flap fixation using sutures is superior Methods: This trial will combine a retrospective cohort of patients undergoing flap fixation using interrupted sutures from a previous trial, with a randomised prospective cohort with patients undergoing flap fixation using running sutures or flap fixation using interrupted sutures. This study design was chosen to acquire a sample size with sufficient power and the ability to conduct this study in an acceptable time frame. The primary endpoint is the incidence of complications requiring interventions, including clinically significant seroma, infections and haemorrhagic complications. Secondarily, the length of the procedure and cosmetic results will be compared. This is the first trial comparing two suturing techniques for flap fixation after mastectomy. Results will be used to optimise flap fixation techniques for these patients to prevent seroma formation.

A bioabsorbable mechanoelectric fiber as electrical stimulation suture.

In surgical medicine, suturing is the standard treatment for large incisions, yet traditional sutures are limited in functionality. Electrical stimulation is a non-pharmacological therapy that promotes wound healing. In this context, we designed a passive and biodegradable mechanoelectric suture. The suture consists of multi-layer coaxial structure composed of (poly(lactic-co-glycolic acid), polycaprolactone) and magnesium to allow safe degradation. In addition to the excellent mechanical properties, the mechanoelectrical nature of the suture grants the generation of electric fields in response to movement and stretching. This is shown to speed up wound healing by 50% and reduce the risk of infection. This work presents an evolution of the conventional wound closure procedures, using a safe and degradable device ready to be translated into clinical practice.

Rapid-Response Water-Shrink Films with High Output Work Density Based on Polyethylene Oxide and α-Cyclodextrin for Autonomous Wound Closure.

Conventional wound closure methods, including sutures and tissue adhesives, present significant challenges for self-care treatment, particularly in the context of bleeding wounds. Existing stimuli-responsive contractile materials designed for autonomous wound closure frequently lack sufficient output work density to generate the force needed to bring the wound edges into proximity or necessitate stimuli that are not compatible with the human body. Here, semi-transparent, flexible, and water-responsive shrinkable films, composed of poly(ethylene oxide) and α-cyclodextrin, are reported. These films exhibit remarkable stability under ambient conditions and demonstrate significant contraction (≈50%) within 6 s upon exposure to water, generating substantial contractile stress (up to 6MPa) and output work density (≈1028kJ m-3), which is 100 times larger than that of conventional hydrogel and 25 times larger than that of skeletal muscles. Remarkably, upon hydration, these films are capable of lifting objects 10000 times their own weight. Leveraging this technology, water-shrink tapes, which, upon contact with water, effectively constrict human skin and autonomously close bleeding wounds in animal models within 10 seconds, are developed further. This work offers a novel approach to skin wound management, showing significant potential for emergency and self-care scenarios.

Knotless suture in revision total joint arthroplasty: a prospective randomized controlled trial.

The use of barbed sutures for wound closure in primary total joint arthroplasty (TJA) has been shown to be effective and safe. However, their effectiveness and safety in revision TJA procedures has not been thoroughly studied. This study aims to evaluate the efficacy and safety of using barbed suture closure in revision TJA setting. A total of 80 patients undergoing revision TJA between September 2020 and November 2022 were included in this randomized controlled trial study. Following informed consent, patients were computer-randomized to the treatment arm (barbed suture wound closure) or to the control arm (conventional wound closure). Closure duration, closure rate, number of sutures used and wound related outcomes including complication rates and Patient and Observer Scar Assessment Scale (POSAS) score were compared between groups. The use of barbed sutures decreased closure time by 6min (30.1 vs. 36.1min, P = 0.008) with a higher wound closure rate (6.5 vs. 5.5mm/minute, P = 0.013). Additionally, the number of sutures used for wound closure in the barbed group was significantly lower than in the control group (6.2 vs. 10.1, respectively, P < 0.001). There were no significant differences in the rate of postoperative wound complications (P = 0.556) or patient and observer POSAS scores (P = 0.211, P = 297, respectively) between the two groups at 3-month follow-up. Closure of revision TJA surgical wound utilizing barbed sutures reduced closure time and the number of needles handled by operative staff, with no significant increase in intra- or post-operative complications rate when compared to traditional closure technique. I.

The Outcome of Purse-string Versus Conventional Wound Closure Techniques in Patients Undergoing Stoma Reversal: A Randomized Controlled Trial

BackgroundPatients undergoing stoma reversal may experience surgical site infections and poor scarring. A purse-string closure approach may lower the incidence of surgical site infections due to its inherent ability to drain wound exudates. This study compared the frequency of surgical site infections and the cosmetic outlook of the scar among patients undergoing stoma reversal with linear and purse-string skin closure techniques. Setting and durationDepartment of Pediatric Surgery, University of Child Health Sciences Lahore with a duration of one year (June 2021 to June 2022). MethodsThis randomized controlled trial (TCTR20210417001) was conducted with IRB approval. A total of 124 patients undergoing stoma reversal were randomly assigned to two groups (62 in each): Group A received conventional linear skin closure, while Group B received purse-string wound closure. The study evaluated surgical site infection, cosmetic outcome, and length of stay. ResultsBoth groups had similar age, gender ratio, indication for surgery, and length of stay. The purse-string group had a significantly lower incidence of SSI (38.7 % vs. 14.5 %; p = 0.002) and better scar quality (Manchester scar scale showed 'good' scar quality in 63 % of patients vs. 22.6 % in the linear closure group, p-value <0.0001). ConclusionThe purse-string technique for skin closure resulted in fewer surgical site infections and improved scar appearance.

Surgical and Clinical Outcomes Associated With the Use of Barbed Sutures and Self-Adhering Mesh System and Polymeric Glue for Wound Closure in Multilevel or Revision Spinal Surgery: A Matched Cohort Comparative Study With Conventional Wound Closure Procedure.

Multilevel or revisional posterior spinal surgery is prone to infection and delayed wound healing, related with the wound closure time and suture strength. Knotless barbed suture is an innovative self-locking, multianchor suture. This study aims to evaluate the safety and efficacy of the knotless barbed suture and self-adhering mesh with polymeric glue in multilevel or revisional posterior spinal surgery. This is a single-center retrospective matched cohort study. Patients were divided into 2 groups based on the wound closure method: barbed suture group with novel wound closure, and conventional suture group with conventional wound closure, 1:1 matched by the level of surgery and sex, resulting in 120 subjects each. Total operation time and wound closure time were measured intraoperatively, and perioperative clinical outcome parameters including postoperative wound complication were investigated for the first 3 months postoperatively. The distribution of continuous variables was assessed for normality by Shapiro-Wilk test, then parametric or nonparametric tests were applied accordingly (paired t-test or Wilcoxon signed-rank test). Wound closure time was significantly shorter with the novel barbed suture than with conventional suture in all subgroups divided by the level of spinal surgery: 3-5, 6-9, ≥ 10 levels (p < 0.001). The 2 groups showed no significant differences in surgical complications (p = 1.000). Specially, total operation time and wound-closing time were significantly shorter in revisional subgroup. Absorbable knotless barbed suture and self-adhering mesh with polymeric glue can shorten spinal wound closure time with noninferiority in complications for multilevel or revisional spinal surgery.

The QUILT study: quilting sutures in patients undergoing breast cancer surgery: a stepped wedge cluster randomized trial study

BackgroundSeroma is the most common complication following breast cancer surgery, with reported incidence up to 90%. Seroma causes patient discomfort, is associated with surgical site infections (SSI), often requires treatment and increases healthcare consumption. The quilting suture technique, in which the skin flaps are sutured to the pectoralis muscle, leads to a significant reduction of seroma with a decrease in the number of aspirations and surgical site infections. However, implementation is lagging due to unknown side effects, increase in operation time and cost effectiveness. Main objective of this study is to assess the impact of large scale implementation of the quilting suture technique in patients undergoing mastectomy and/or axillary lymph node dissection (ALND).MethodsThe QUILT study is a stepped wedge design study performed among nine teaching hospitals in the Netherlands. The study consists of nine steps, with each step one hospital will implement the quilting suture technique. Allocation of the order of implementation will be randomization-based. Primary outcome is ‘textbook outcome’, i.e.no wound complications, no re-admission, re-operation or unscheduled visit to the outpatient clinic and no increased use of postoperative analgesics. A total of 113 patients is required based on a sample size calculation. Secondary outcomes are shoulder function, cosmetic outcome, satisfaction with thoracic wall and health care consumption. Follow-up lasts for 6 months.DiscussionThis will be one of the first multicentre prospective studies in which quilting without postoperative wound drain is compared with conventional wound closure. We hypothesize that quilting is a simple technique to increase textbook outcome, enhance patient comfort and reduce health care consumption.

Evaluation of Vacuum Assisted Wound Closure and Conventional Wound Closure In Contaminated Major Surgical Wound

Background: Surgical Site Infections (SSI) increase costs, hospital stay, morbidity, and mortality. Vacuum-Assisted Closures (VAC) system has been gaining popularity recently in managing wounds to reduce SSI. But the current guidelines do not recommend its routine use for surgical wounds. This study aimed to compare the effectiveness and safety of VAC with conventional wound closure techniques for preventing SSIs in the major contaminated surgical wound. Methods and materials: Sixty patients with a contaminated surgical wound from the Department of Surgery and Department of Casualty of Chittagong Medical College Hospital were randomized in a 1:1 ratio to receive either VAC (Using Romovac device) or conventional wound closure. The primary endpoint was the rate of uncomplicated wound healing, defined as a Southampton wound score of &lt;2 at 30 days postoperatively. Secondary outcomes include duration of hospital stay and other complications (Defined by the Clavien-Dindo Classification). The primary analysis was an intention-to-treat analysis performed with a Chi-square test. Results: There were no significant differences in mean age, sex, body mass index, smoking history, wound class, indication for surgery and duration of surgery between the two groups. At 30 days postoperatively, 29 (96.3%) of 30 patients undergoing VAC had uncomplicated wound healing compared to 13 (43.6%) in the conventional closure group (p&lt;0.001). Most patients (26/30, 86.6 %) in the VAC group experienced Clavien-Dindo grade I or II complications. In contrast, in the conventional closure group, 28 (93.3%) patients developed Clavien-Dindo Grade III or IV complications (p&lt;0.001). The mean length of hospital stay was significantly shorter in the VAC group than in the conventional closure group (12.2±3.59 versus 29.07±10.36 days, p&lt;0.001). Conclusion: VAC resulted in favourable wound healing with less complication and shorter hospital stay than the conventional technique for the closure of the contaminated surgical wound. IAHS Medical Journal Vol 5(2), Dec 2022; 6-10

Polyphenolic Gelatin-Based Bioadhesives

ConspectusBioadhesives are important for the future of medicine in their roles in wound closure and as measures to enhance wound healing. These adhesives are more effective and less invasive than conventional wound closure methods, such as surgical sutures or staples. Adhesive substances based on naturally occurring biological materials from living organisms harness phenolic compounds for their attachment to wet surfaces. For example, plants, such as Boston ivy, or animals, such as mussels, have evolved tissues that create optimal adhesion under a variety of challenging conditions, including in aqueous and saline environments. Current research aims at using biomimetic strategies to create a new generation of bioadhesives that will be better suited for medical use. Biomaterials design has evolved around integration of phenols with protein backbones among which gelatin has received particular attention due to its excellent bioactivity, biocompatibility, biodegradability, low cost, facile chemical tunability, and tissue-mimetic properties. Bioadhesion performance in these biomaterials is a strong function of polyphenolic functionality and the processing approach for their integration into hydrogel networks. A number of studies have used phenolic small molecules to modify biomacromolecules chemically for bioadhesion. One of the major hurdles in these studies is insufficient phenolic uptake due to low-yield modification chemistries and inherently limited functionalization capacity of proteins. Polyphenols are an attractive toolbox for bioadhesive design, as they not only enable stronger interactions with various substrates but also act as cross-linking points, strengthening polymer network cohesion. In addition, the cross-linking mechanism used for gelation of bioadhesives should be compatible with polyphenolic moieties, as, for instance, free-radical polymerization in the presence of phenolic compounds is compromised by their free-radical scavenging effects. Polyphenolic compounds derived synthetically from phenolic small molecules as well as those occurring naturally, such as tannins, have added a large library of additional functionality, such as antimicrobial and photothermal responsiveness, calling for further developments for applications in wound management.In this Account, we review several recent breakthroughs in polyphenol-integrated gelatin that have been analyzed in the context of their use as bioadhesives. Polyphenols play important roles in covalent and noncovalent interactions with functional groups in biological substrates, including keratins, connective tissue, or soft internal tissues. We consider different polyphenol-carrying compounds for modification including catecholamines, phenolic amino acids, tannins, and lignins. We then discuss how these polyphenolic materials can be fabricated to mimic naturally derived bioadhesives through infusion, physical mixing, and copolymerization. We discuss the implications of using these bioadhesives, questioning their viability and prospects. Finally, we highlight current challenges and future opportunities for taking polyphenolic bioadhesives closer to clinical translation.

Long-Term Degradation Assessment of a Polyurethane-Based Surgical Adhesive—Assessment and Critical Consideration of Preclinical In Vitro and In Vivo Testing

Tissue adhesives constitute a great possibility to improve conventional wound closure. In contrast to sutures, they enable nearly immediate hemostasis and can prevent fluid or air leaks. In the present study, a poly(ester)urethane-based adhesive was investigated which already proved to be suitable for different indications, such as reinforcing vascular anastomosis and sealing liver tissue. Using in vitro and in vivo setups, the degradation of the adhesives was monitored over a period of up to 2 years, to evaluate long-term biocompatibility and determine degradation kinetics. For the first time, the complete degradation of the adhesive was documented. In subcutaneous locations, tissue residues were found after 12 months and in intramuscular locations, tissue degradation was complete after about 6 months. A detailed histological evaluation of the local tissue reaction revealed good biocompatibility throughout the different degradation stages. After full degradation, complete remodeling to physiological tissue was observed at the implant locations. In addition, this study critically discusses common issues related to the assessment of biomaterial degradation kinetics in the context of medical device certification. This work highlighted the importance and encouraged the implementation of biologically relevant in vitro degradation models to replace animal studies or at least reduce the number of animals in preclinical testing prior to clinical studies. Moreover, the suitability of frequently used implantation studies based on ISO 10993-6 at standard locations was critically discussed, especially in light of the associated lack of reliable predictions for degradation kinetics at the clinically relevant site of implantation.

Efficacy and aesthetic outcomes for quilting sutures in the prevention of seroma after mastectomy

Worldwide, mastectomy for breast cancer is one of the most frequently performed surgical procedures. As one of the main complications of mastectomy, seroma is associated with pain, infections and a prolonged hospital stay. We performed a prospective multicenter randomized trial to assess the efficacy and esthetic outcomes associated with quilting the skin flap. Eighty-seven patients were included. The proportion of patients with seroma on postoperative day 15 was significantly lower in the quilting group (12 out of 39 (30.8%)) than in a control group with conventional wound closure (21 out of 40 (52.5%); P = 0.05). The mean breast seroma volume was significantly lower in the quilting group (130.2 mL) than in the control group (236.8 mL; P = 0.02). There were no differences in the esthetic outcomes. The pain level on day 1 was similar in the quilting and control groups (mean visual analog scale score: 2.5 vs. 2.1, respectively; P = 0.3). Quilting the skin flap was associated with a lower prevalence of seroma and a lower seroma volume, and did not worsen the esthetic outcomes or pain levels. This technique is technically straightforward and should be offered to all patients scheduled for mastectomy.

Using Drain-Free Flap Fixation Techniques Versus Traditional Wound Closure With Drain Placement to Prevent Seroma Formation and Its Complications in Breast Cancer Patients Undergoing Mastectomy: A Systematic Review and Meta-analysis.

During the past decade, there has been some controversy related to using flap fixation techniques instead of conventional wound closure methods and drain placement during mastectomy procedures. The purpose of our study was to address this controversy using a systematic review and meta-analysis of current published literature. Nineteen studies met our inclusion criteria. Our sample population consisted of 2,956 participants divided into two groups. The study group (SG) consisted of 1,418 individuals and the control group (CG) consisted of 1,538 participants. We found there was a significant reduction in the incidence of seroma formation (odds ratio [OR] = 0.35; 95% confidence interval, CI [0.3, 0.42]; p < .000) and surgical site infection (OR = 0.65; 95% CI [0.48, 0.88]; p = .006) in the SG compared with the CG. The length of hospital stay was also significantly reduced in the SG (0.59 days; 95% CI [0.73, 0.46]; χ 2 [6, N = 502] = 52.88; p < .000) compared with the CG. The results of our study show that using a flap fixation technique after mastectomy can decrease the patient's risk for seroma formation and surgical site infection while reducing their length of hospital stay. Further studies with longer follow-up periods are warranted to evaluate long-term complications associated with using a flap fixation technique compared with using conventional wound closure techniques and drain placement.

1028 Systematic Review of Outcomes of Applications of Prineo-Dermabond

Abstract Aim The aims of this study are to assess published data regarding infection rates, delayed wound healing, cosmetic appearance and application time compared to conventional wound closure techniques across multiple surgical procedures. Method A literature search was conducted according to PRISMA guideline using PubMed, SCOPUS and Science Direct. The primary outcome was the incidence of wound infection after Prineo Dermabond compared to controls. Secondary outcome measures included allergic reactions and time for application. Literature search identified 52 studies, of which 19 were eligible for qualitative synthesis and 12 for meta-analysis. Results Studies included reflected a broad range of applications of Dermeo-Prineo to wound closure in Abdominoplasty, Mammoplasty and Arthroplasty. Overall, all studies reporting on time of application found a positive indicator of Prineo Dermabond reducing time for wound closure. Meta-analysis identified a statistically significant reduction in rates of the 6 studies that described wound infection (Prineo 1.51%, Control N=2.13%, OR 0.65 (0.46–0.91); P=0.01) and in the 5 studies reporting delayed wound healing (Prineo 0.99%, Control N=1.79%, OR 0.42 (0.18–0.98); P=0.05) in the use of Prineo Dermabond versus controls. Three studies reported outcomes of scar cosmesis or long-term maturation. All attested to better cosmetic results in comparison to sutures. Two studies discussed cost-effectiveness of Dermabond with a hypothetical model concluded that Skin Closure System of Prineo Dermabond could achieve savings of $50–76 per patient, whilst a retrospective model found no statistically significant difference in Total Hospital costs or Operating room time. Conclusions Prineo Dermabond provides an alternative method of wound closure in reported studies.

Role of Pie Crusting Technique on Soft Tissues in Preventing Soft Tissue Complications Compared to Conventional Closure of Wound in Fractures of Distal Tibia (PILON) and Fibula

Objective: To demonstrate the effect of performing pie crusting on skin bridging two incisions used for open reduction and fixation to reduce wound complications compared to conventional wound closure.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Orthopedics and Trauma, Combined Military Hospital Rawalpindi from Jan to Nov 2020.&#x0D; Methodology: Forty-seven patients, managed primarily with open reduction and internal fixation for type-43 fractures per AO/OTA classification, were studied. Group-1 comprised patients in whom the pie crusting technique was used during the closure of the wound. Group-2 included patients in whom conventional closure of the wound was performed. Evaluation of complications in the presence or absence of superficial and deep infection and necrosis was done. The time from injury to surgery was 6 hours to 72 hours. Patients were followed for an average of 12 weeks. &#x0D; Results: In group-1 (pie-crust technique), there were 23 patients, whereas group-2 (classic wound closure) comprised 24 patients. In group-1, only 1 (4%) patient had a superficial infection, and no deep infection was reported. Whereas in group-2, six patients (25%) had superficial infection, and two patients (8%) had the deep infection.&#x0D; Conclusion: Results indicated that pie-crust technique significantly reduces the risk of superficial and deep wound complications compared to classic wound closure because it reduces skin tension and allows the drainage of subcutaneous fluids.

Supramolecular Thermo-Contracting Adhesive Hydrogel with Self-Removability Simultaneously Enhancing Noninvasive Wound Closure and MRSA-Infected Wound Healing.

Conventional wound closure and dressing are two crucial, time-consuming but isolated principles in wound care. Even though tissue adhesive opens a new era for wound closure, the method and biomaterial that can simultaneously achieve noninvasive wound closure and promote wound healing are highly appreciated. Herein, a novel supramolecular poly(N-isopropylacrylamide) hybrid hydrogel dressing composed of quaternized chitosan-graft-β-cyclodextrin, adenine, and polypyrrole nanotubes via host-guest interaction and hydrogen bonds is developed. The hydrogel demonstrates thermal contraction of 47% remaining area after 2 h at 37℃ and tissue adhesion of 5.74kPa, which are essential for noninvasive wound closure, and multiple mechanical and biological properties including suitable mechanical properties, self-healing, on-demand removal, antioxidant, hemostasis, and photothermal/intrinsic antibacterial activity (higher 99% killing ratio within 5 min after irradiation). In both full-thickness skin incision and excision wound models, the hydrogel reveals significant wound closure after 24 h post-surgery. In acute and methicillin-resistant Staphylococcus aureus-infected wound and photothermal/intrinsic antibacterial activity assays, wounds treated with the hydrogel demonstrate enhanced wound healing with rapid wound closure rate, mild inflammatory response, advanced angiogenesis, and well-arranged collagen fibers. Altogether, the results indicate the hydrogel is promising in synchronously noninvasive wound closure and enhanced wound healing.

Dual composite bioadhesives for wound closure applications: An in vitro and in vivo study

AbstractOver the years, new biomaterials have been introduced as an alternative to conventional wound closure methods. Compared with traditional methods including sutures and staples, bioadhesives are more convenient to use and less time‐consuming. Nevertheless, the application of topical skin adhesives such as Cyanoacrylates (CA) is limited, due to cytotoxicity. Hence, developing skin adhesives with strong adhesion to soft tissue in wet environment, controlled physical and mechanical properties, and excellent biocompatibility has been a significant challenge. In the current study, we developed a new bioadhesive based on the highly biocompatible natural polymers gelatin and alginate. In order to enhance the mechanical‐ physical properties and functionality, two types of fillers were loaded: hemostatic agent (kaolin or montmorillonite) and cellulose fibers. Our in‐vitro results show that the addition of the functional fillers increased the tensile strength and modulus of the bulk material, leading to higher sealing ability and higher bonding strength. In addition, the gelation time and swelling degree were significantly decreased and the viscosity increased with the incorporation of the filler, which enables better functioning. The in‐vivo model focused on using a porcine skin incision, demonstrated superior efficacy of these new bioadhesives compared to the control group. I.e., they resulted in rapid healing, less inflammation, and a higher degree of wound closure. In conclusion, our dual‐composite bioadhesives demonstrated promising potential for use in wound closure applications and may serve as a suitable alternative for conventional sutures. Their unique properties make them beneficial, especially for first medical care applications such as rescuing casualties.

Comparison of Flap Fixation to Its Bed and Conventional Wound Closure with Drainage in Preventing Seroma Formation Following Mastectomy for Breast Cancer: Systematic Review and Meta-analysis.

Seroma formation is a common complication following mastectomy. The objective of this systematic review and meta-analysis is to evaluate the impact of flap fixation techniques that omit drainage versus conventional closed drainage on seroma formation and related complications after mastectomy. Clinical studies of flap fixation techniques versus the conventional closure technique in patients undergoing mastectomy with or without axillary clearance were retrieved from the PubMed, Embase and Cochrane databases. Papers were eligible for inclusion if the outcome was described in terms of seroma formation. Studies older than 20years, animal studies and studies involving patients undergoing direct breast reconstruction were excluded. Four randomized controlled trials (RCTs) and four cohort studies were included in our examination. Compared with the conventional drainage group, the flap fixation group had a similar incidence of seroma formation (OR 0.76, 95% CI 0.30-1.93, p = 0.57). Based on current evidence, mechanical flap fixation can replace conventional drainage without increasing seroma formation after mastectomy. Further well-designed RCTs are warranted to evaluate the effects of flap fixation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Quilting following mastectomy reduces seroma, associated complications and health care consumption without impairing patient comfort.

Background: An important complication following mastectomy is seroma formation, associated with repeated aspirations, pain and discomfort. Quilting, in which skin flaps are sutured to the underlying muscle, is reported to reduce seroma incidence, but might induce pain and impair shoulder function. Main objective is to compare quilting with conventional wound closure, regarding seroma incidence, healthcare consumption and patient discomfort.

Quilting following mastectomy reduces seroma, associated complications and health care consumption without impairing patient comfort.

BackgroundAn important complication following mastectomy is seroma formation. Quilting, in which skin flaps are sutured to the underlying muscle, is reported to reduce seroma incidence, but might induce pain and impair shoulder function. Main objective is to compare quilting with conventional wound closure, regarding seroma incidence, health care consumption, and patient discomfort.MethodsIn a combined prospective and retrospective study, 254 patients undergoing mastectomy and/or axillary lymph node dissection (ALND) were included. Patients received quilting sutures or conventional closure. Primary outcome was clinical significant seroma (CSS). In prospectively included patients shoulder function and analgesic use was observed.ResultsCSS incidence was 12.9% in the quilted versus 62.3% in the nonquilted cohort (p < 0.001). Surgical site infections were reported significantly less in the quilted cohort. Duration of hospital stay was shorter and outpatient clinic visits were less in the quilted cohort. Surgical procedure required 10 additional minutes for quilting. No significant differences were observed in postoperative shoulder function and analgesic use.ConclusionQuilting following mastectomy reduces CSS incidence. Quilting requires 10 additional minutes during surgery. It facilitates day treatment and results in less additional outpatient clinic visits culminating in reduced health care consumption. Shoulder function and pain are not affected by quilting.

Rational engineering and applications of functional bioadhesives in biomedical engineering.

For the past decades, several bioadhesives have been developed to replace conventional wound closure medical tools such as sutures, staples, and clips. The bioadhesives are easy to use and can minimize tissue damage. They are designed to provide strong adhesion with stable mechanical support on tissue surfaces. However, this monofunctionality of the bioadhesives hinders their practical applications. In particular, a bioadhesive can lose its intended function under harsh tissue environments or delay tissue regeneration during wound healing. Based on several natural and synthetic biomaterials, functional bioadhesives have been developed to overcome the aforementioned limitations. The functional bioadhesives are designed to have specific characteristics such as antimicrobial, cell infiltrative, stimuli-responsive, electrically conductive, and self-healing to ensure stability under harsh tissue conditions, facilitate tissue regeneration, and effectively monitor biosignals. Herein, we thoroughly review the functional bioadhesives from their fundamental background to recent progress with their practical applications for the enhancement of tissue healing and effective biosignal sensing. Furthermore, the future perspectives on the applications of functional bioadhesives and current challenges in their commercialization are also discussed.