Double-layer Closure Technique Research Articles

Single Versus Double Layer Uterine Closure Technique According to Development of Uterine Niche: A Literature Review

Prevalence of cesarean deliveries increases globally. The prevalence of cesarean births increased from 5% in 1970 to 31.9% in 2016. There are short term and long-term complications of cesarean delivery including uterine niche. After a cesarean, the uterus is closed using a variety of methods, such as single- and double-layer closures with/without locking. This study compared single-layer and double-layer uterine closure with regard to the outcomes and complications. This review was synthesized and obtained from various online databases. Scientific articles were selected based on the inclusion criteria. The result showed that cesarean deliveries is a hysterotomy and an open abdominal incision (laparotomy) to deliver the fetus. An iatrogenic pouch-like defect known as a uterine niche result from improper tissue repair at the site of a prior cesarean scar. Up to 70% of women who have had a prior cesarean section experience uterine niche, of which 30% have symptoms. Compared to a single full-thickness closure, a single-layer, decidua sparing closure approach is more likely to result in an incomplete closure. No differences were discovered between the single- and double-layer closure techniques with locked first layers, but double-layer closures without locking resulted in thicker residual myometrium thickness when compared with locked single-layer closures. It is also possible that the locked suture can strangulate the scar tissue leading to poorer healing. Current evidence shows that no significant difference between single-layer and double-layer uterine closure techniques following in terms of uterine niche development.

A preliminary exploration into the efficacy of personalized surgical schemes in the repair of maxillary sinus perforation and maxillary sinus fistula

To explore the efficacy and value of personalized surgical schemes in the repair of maxillary sinus perforation and maxillary sinus fistula based on the size of the maxillary sinus perforation and maxillary sinus fistula. A total of 28 patients with maxillary sinus perforation and maxillary sinus fistula who were admitted to the Department of Oral and Maxillofacial Surgery, Stomatology Hospital of Kunming Medical University from July 2017 to May 2020 were included to conduct a prospective case clinical study. After the inflammation in the maxillary sinus was controlled, a proper surgical repair method was selected according to the size of the perforation and fistula based on the double-layer closure technique. The diameter of the perforation and fistula was measured with the assistance of cone-beam CT. After that, the platelet rich fibrin (PRF) repair was performed on the perforation and fistula with 3 mm≤diameter<7 mm in size in 14 patients. The PRF repair and buccal flap repair were performed on the perforation and fistula with 7 mm ≤diameter<15 mm in size in 7 patients. The adjacent buccal pad repair, palatine flap repair, and buccal flap repair were performed on the perforation and fistula with 15 mm≤ diameter<25 mm in size in 4 patients. The nasolabial axial flap repair and nasolabial free flap repair were performed on the perforation and fistula with a diameter ≥25 mm in size in 3 patients. The medical follow-up was conducted in all patients in the 1st, 2nd, and 4th week after surgery, with an overall success rate reaching 96.4% (27/28) after the initial intervention. The relapse of disease occurred in one patient (4.6%) with diabetes and a smoking history in the 2nd week after surgery. Identifying a proper surgical repair method according to the size of the oral and maxillary sinus perforation and maxillary sinus fistula based on the double-layer closure technique can improve the one-time cure rate in these patients under the premise that the inflammation in the maxillary sinus can be controlled.

The efficacy of mylohyoid muscle flap use in surgical treatment of ‘krokodil’ drug-related osteonecrosis of the mandible

The aim of this study is to show the effectiveness of the use of mylohyoid muscle flap in surgical treatment of stage 1 and 2 Krokodil drug-related ON of mandible.Retrospective study of patients with stage 2 Krokodil drug-related ON of distal mandible was performed. Regarding to the used surgical technique the patients were divided into two groups (groups 1 and 2). In group 1(control group) the wound was closed only by the local mucoperiosteal flaps, while in group 2 (experimental group) the wound was closed by combining mylohyoid muscle flap and local mucoperiosteal flaps.24 patients were included in this study (15 patients in the group 1 and 9 patients in the group 2). In all patients of experimental group the postoperative period was uneventful and no recurrence occurred. In group 1 recurrence was found in 7 patients, which is significantly higher than in group 2 (χ2=5.9, p=0.015). Disease recurrence occurred as wound dehiscence during 4-10 postoperative days.Within the limitations of the study it seems that the adoption of the mylohyoid muscle flap as double-layer closure technique is an effective and predictable method for the treatment of such patients and, therefore, should be chosen whenever deemed appropriate.

Single- or double-layer uterine closure techniques following cesarean: A randomized trial.

Cesarean deliveries are commonly performed throughout the world. Although the uterine closure technique following this procedure may influence how the uterine scar heals, there is insufficient evidence for choosing the appropriate technique and so preventing long-term negative consequences. This prospective, randomized study examined the effects of single- and double-layer uterine closure techniques on uterine scar healing following cesarean delivery. This study assessed a total of 282 women aged 18-45years who were in gestational weeks 24-41 of singleton pregnancies. None had previously undergone uterine surgeries. These participants completed their first cesarean deliveries at the time of study and were randomized into the following two treatment groups: single-layer closure with locking and double-layer closure with locking in the first layer, but not in the second layer (NCT03629028). However, the decidua was not included for treatment in either group. Participants were evaluated at 6-9months after cesarean section by saline infusion sonohysterography to assess cesarean delivery scar defects. These procedures were conducted by experienced sonographers who were not aware of the uterine closure technique. Of the 225 final participants, 109 received the single-layer closure technique, whereas 116 received the double-layer technique. The niche rates were 37% (n=40) for the single-layer group and 45.7% (n=53) for the double-layer group (P=.22, relative risk 1.4, 95% CI=0.8-4.4). The single- and double-layer closure techniques did not produce different impacts on uterine scar niche development.

Endoscopic myringoplasty: comparison of double layer cartilage-perichondrium graft and single fascia grafting

ObjectiveTo compare surgical results of endoscopic myringoplasty using double layer cartilage-perichondrium grafts versus single fascia grafts.Study designProspective, randomized, controlled.SettingUniversity-affiliated teaching hospital.Subjects and methodsIn total,134 patients who underwent endoscopic myringoplasty were included in this study. Patients in group A received a double layer tragal cartilage-perichondrium graft and those in group B received a temporal muscle fascia graft. The groups were compared with respect to the pre- and postoperative air-bone gap (ABG) and the graft success rate.ResultsThe graft success rate was 98.5% (66/67) in the Group A and 94.0% (63/67) in the Group B at 6 months, the difference wasn’t statistically significant (p = 0.362). However, the graft success rate was 97.0% (65/67) in the Group A and 85.1% (57/67) in the Group B at 12 months, the difference was statistically significant (p = 0.034).In addition, only one patient (1.49%) had small keratin pearls in the Group A, no patients developed cholesteatoma of middle ear in either group.ConclusionsThe endoscopic double layer perichondrium-cartilage graft technique is feasible for repairing medium or larger perforations, it has a better long-term graft success rate and less operative time compared with the single layer fascia graft technique. However, long-term hearing outcomes were the same for the single and double layer closure techniques.

Robson’s class and caesarean scar defects

Caesarean scar defect (CSD) may lead to the occurrence of gynecologic symptoms such as abnormal uterine bleeding secondary to intermittent passage of retained menstrual blood within the CSD pelvic pain, and infertility. This prospective cohort study was conducted at the Department of Obstetrics at Maria Vittoria Hospital in Turin (Italy), from January 2013 to December 2013 to analyze the effects of two different suturing techniques (single layer and double layer closure of the hysterotomy) and Robson's class impact on the incidence of CSD. All procedures were performed using a modified Stark technique by the same single senior surgeon. The way of closure of the uterine incision was alternated every three months, in order to have two groups of partecipants: one with a single layer and the other with a double layer closure technique. Single layer was carried out as one continuous locking stitch; double layer was performed with a first closure identical to the single layer and an additional suture with a continuous unlocked stitch used to imbricate the first layer. Both ways of closure of the uterine incision were performed using monofilament synthetic absorbable polydioxanone suture. Twelve months after their caesarean section, the women had an ultrasound examination of the uterine scar performed by a single experienced operator blinded to suture technique and the Robson class. The trial recruited 85 cases. 21 patients (24.8%) belonged to Robson's class 1, 5(6%) to class 2, 1(1.3%) to class 4, 35(41%) to class 5, 13(15.4%) to class 6, 6(7%) to class 7, 4(4.5%) to class 8. During the ultrasound follow up we found 10 CSD (11,8%): 8/10 CSD (80%) were found in Robson's class 5, 1 in class 1 and 1 in class 6 (p 0.008), with no correlation with single- or double-layer suture (p 0.141). To our knowledge, no previous studies evaluated the correlation with Robson classification and CSD.

Single- versus double-layer closure of the caesarean (uterine) scar in the prevention of gynaecological symptoms in relation to niche development \u2013 the 2Close study: a multicentre randomised controlled trial

BackgroundDouble-layer compared to single-layer closure of the uterus after a caesarean section (CS) leads to a thicker myometrial layer at the site of the CS scar, also called residual myometrium thickness (RMT). It possibly decreases the development of a niche, which is an interruption of the myometrium at the site of the uterine scar. Thin RMT and a niche are associated with gynaecological symptoms, obstetric complications in a subsequent pregnancy and delivery and possibly with subfertility.MethodsWomen undergoing a first CS regardless of the gestational age will be asked to participate in this multicentre, double blinded randomised controlled trial (RCT). They will be randomised to single-layer closure or double-layer closure of the uterine incision. Single-layer closure (control group) is performed with a continuous running, unlocked suture, with or without endometrial saving technique. Double-layer closure (intervention group) is performed with the first layer in a continuous unlocked suture including the endometrial layer and the second layer is also continuous unlocked and imbricates the first. The primary outcome is the reported number of days with postmenstrual spotting during one menstrual cycle nine months after CS. Secondary outcomes include surgical data, ultrasound evaluation at three months, menstrual pattern, dysmenorrhea, quality of life, and sexual function at nine months. Structured transvaginal ultrasound (TVUS) evaluation is performed to assess the uterine scar and if necessary saline infusion sonohysterography (SIS) or gel instillation sonohysterography (GIS) will be added to the examination. Women and ultrasound examiners will be blinded for allocation. Reproductive outcomes at three years follow-up including fertility, mode of delivery and complications in subsequent deliveries will be studied as well. Analyses will be performed by intention to treat. 2290 women have to be randomised to show a reduction of 15% in the mean number of spotting days. Additionally, a cost-effectiveness analysis will be performed from a societal perspective.DiscussionThis RCT will provide insight in the outcomes of single- compared to double-layer closure technique after CS, including postmenstrual spotting and subfertility in relation to niche development measured by ultrasound.Trial registrationDutch Trial Register (NTR5480). Registered 29 October 2015.

Evaluation of leak pressure and closure time for double-layer esophagotomy closure with an interrupted or a continuous suture pattern.

OBJECTIVE To compare the leak pressure and amount of time required to perform closure for 2 double-layer esophagotomy closure techniques. SAMPLE 28 intrathoracic esophageal segments harvested from 38 porcine cadavers. PROCEDURES Longitudinal 3-cm esophagotomy incisions made in porcine cadaveric esophagi were closed with 2 double-layer closure techniques. Fifteen incisions were closed with a simple interrupted pattern, and 13 incisions were closed with a simple continuous pattern. Leak pressure, bursting wall tension, and closure time were compared between suture patterns by use of a t test or Mann-Whitney rank sum test. RESULTS Median leak pressures differed significantly between segments closed with the simple interrupted pattern (16.0 mm Hg; range, 5.4 to 54.9 mm Hg) and the simple continuous pattern (38.7 mm Hg; range, 11.3 to 81.9 mm Hg). Median bursting wall tension differed significantly between the simple interrupted pattern (0.63 × 105 dynes/cm; range, 0.16 × 105 dynes/cm to 2.89 × 105 dynes/cm) and the simple continuous pattern (1.79 × 105 dynes/cm; range, 0.44 × 105 dynes/cm to 4.70 × 105 dynes/cm). Mean ± SD closure time differed significantly between the simple interrupted pattern (19.2 ± 2.0 minutes) and the simple continuous pattern (14.7 ± 1.5 minutes). CONCLUSIONS AND CLINICAL RELEVANCE In the study reported here, double-layer simple continuous closure resulted in a higher median postoperative leak pressure and higher median postoperative bursting wall tension and could be performed more rapidly than the double-layer simple interrupted closure on these porcine cadaveric specimens.

Double-layer closure techniques after bone surgery of medication-related osteonecrosis of the jaw – A single center cohort study

IntroductionMucosal wound closure plays a key role after surgery of manifested medication-related osteonecrosis of the jaw (MRONJ). Additional soft tissue layers promise better vascularization and mechanical stability. The objectives of this study were to examine success rates of double-layer closure techniques in MRONJ patients, namely the mylohyoideus muscle flap (MMF) for the lower jaw and the pedicled buccal fat flap (BFF) for the upper jaw. Materials and methodsWe designed and implemented a restrospective cohort study and enrolled a sample of patients diagnosed with MRONJ that were treated between 2015 and 2017 with either the MMF or the BFF after removal of the necrotic bone areal. Success was assessed as the maintenance of full mucosal coverage without signs of residual infection at (T0) four weeks (T1), four months (T2), and eight months (T3) after operation. The occurrence of side effects was evaluated. ResultsA total of 87 (MMF n = 57; BFF n = 30) patients with 104 MRONJ (MMF 68 = ; BFF n = 36) lesions were included. At the time of the last follow-up, 88.0% (44 of 50) of patients in the MMF group and 93.1% (27 of 29) of patients in the BFF group showed mucosal integrity. No serious side effects were reported. Overall treatment of earlier lesions (stage I and II) showed a better outcome than more severe necrosis (stage III). ConclusionDouble-layer closure techniques after surgery in MRONJ patients provide a mechanically stable, well-vascularized covering of the bone defect and should be considered as an option in the standard protocol for all degrees of severity of the disease.

Postauricular Cutaneous Mastoid Fistula Repair

Objective: 1) To review traditional techniques for the closure of postauricular cutaneous mastoid fistulas. 2). To describe a novel double layer closure technique in the management of postauricular cutaneous mastoid fistulas. Method: Retrospective review of patients diagnosed with postauricular cutaneous mastoid fistulas in an academic medical center over a 10-year period. Results: Four patients identified from January 2000 to August 2010 were treated for postauricular cutaneous mastoid fistulas. Follow-up varied from 8 to 48 months. The etiologies of development of postauricular fistulas were all post-mastoidectomies. All patients were treated using a similar surgical technique involving double layer closure of the fistula tract utilizing 2 rotational flaps of 1) temporalis muscle and fascia and 2) conchal cartilage. All patients had successful fistula closure with lasting results. Conclusion: Cutaneous mastoid fistulas are often the result of repeated postauricular approaches for surgical treatment of mastoid infections, and can be difficult to surgically manage. These postauricular fistulas can be managed with long-term success using a novel double layer closure technique using temporalis muscle and fascia and conchal cartilage with skin.

Intradermal Double-Layer Closure with Suture Knot Contained Within Incision: Easy, Fast, and Safe

We read with great interest the recent article by Thomas C. Wiener [1]. About 12 years ago Maia introduced the intradermal double-layer closure technique with the suture knot contained within the incision. Since that time he has used it as his standard suture technique in more than 3000 cases that include different aesthetic surgery procedures. The technique consists of an intradermal double-layer closure with a deep and a superficial dermal running component that are in continuity (Figs. 1 and 2), with no intradermal orientation stitches (except in very large incisions, i.e., [40 cm). The final knot is placed deep within one end of the incision (Fig. 2). In our experience this technique is safe and fast and puts less artificial material inside the wound compared with conventional techniques that have internal knots and running suture. We reported very few cases of knot extrusion, which were probably caused by a superficial position of the knot, and there were no major consequences. Because of the results we have with our technique we do not see any significant advantage of the remote-knot technique, which has the disadvantage of a second scar, even if it is a small scar.

SUBCUTANEOUS MASTECTOMY IN THE LARGE PTOTIC BREAST

A procedure is described for doing a subcutaneous mastectomy on large ptotic breasts. The method employs a reduction of the skin brassiere, free transplantation of the areola-nipple, and a double layer closure technique.