Incision Closure Technique Research Articles

Клинико-морфологическая оценка рубцов на матке после кесарева сечения у пациенток с гинекологическими и экстрагенитальными заболеваниями

Introduction. The article studies excised scars on the uterus after Gusakov’s and Stark’s cesarean sections, with an assessment of the impact of gynecological and extragenital diseases on the viability of the scar. Cesarean scar pregnancy is known to be a frequent indication for surgical delivery. However, if the uterine scar is stable, it is advisable to deliver the baby through the natural birth canal. At present, natural delivery of pregnant women with a scar on the uterus through natural childbirth is an important task in modern obstetrics. Thus, the aim of our study was to perform a multifaceted clinical and morphological evaluation of uterine scars after cesarean section in patients with gynecological and extragenital diseases. Materials and methods. We analyzed samples of scar tissue on the uterus after cesarean section performed in 68 patients. A pathomorphological study was carried out with Mallory staining with hematoxylin and eosin. Immunohistochemical study was performed with antibodies to collagen IV, vimentin, desmin, and von Willebrand factor. Results. In 56 out of 68 puerperas (82.3%), the scars on the uterus were stable with complete replacement of the defect with muscle (63.2%) or connective tissue (19.1%), regardless of the operation duration and the suturing technique. This was confirmed by additional diagnostic methods (Mallory stain and IHC with an antibody panel). We found that connective tissue dysplasia, which is indirectly indicated by the presence of myopia in 5 patients with wealthy fibrous scars, can affect excessive connective tissue in the scar. Twelve out of 68 puerperas (17.6%) had the scars (according to pathomorphological criteria) with severe edema, hemorrhages, tissue with different fibers, and uneven thinning. These patients had extragenital diseases, such as type 2 diabetes mellitus (36.4%) and anemia (18.2%). We did not reveal any influence of existing gynecological diseases on the scar stability. Conclusion. The healing of the postoperative uterine wound was mostly influenced by extragenital diseases (type 2 diabetes mellitus, anemia, connective tissue dysplasia) associated with metabolic disorders and having systemic effects on the body. The Gusakov’s or Stark’s incision closure techniques did not affect the quality of the scar. However, the scars after cesarean section using the Stark incision technique had significantly more connective than muscular tissue. Keywords: cesarean section, incompetent uterine scar, type 2 diabetes mellitus, anemia, connective tissue dysplasia, pathological examination, immunohistochemical study

The Impact of Uterine Incision Closure Technique on the Post Cesarean Residual Myometrial Thickness and Scar Defects. A Novel Technique at a Tertiary Care Hospital

The Impact of Uterine Incision Closure Technique on the Post Cesarean Residual Myometrial Thickness and Scar Defects. A Novel Technique at a Tertiary Care Hospital

The Impact of Uterine Incision Closure Techniques on Post-cesarean Delivery Niche Formation and Size: Sonohysterographic Examination of Nonpregnant Women.

To compare the prevalence and size of residual niche in the nongravid uterus following Cesarean delivery (CD) with different hysterotomy closure techniques (HCTs). Saline infusion sonohysterogram (SIS) was performed in women after one prior CD, documenting the presence or absence of a postoperative niche and measuring its depth, width, length, and residual myometrial thickness. Women were grouped by HCT: Technique A (endometrium-free) and Technique B (routine non-endometrium-free). The primary outcome was the prevalence of a clinically significant niche, defined as a depth of >2 mm. HCT groups were compared using χ2 , T-test (ANOVA), and analyzed using logistic regression and two-sided test (P < .05). Forty-five women had SIS performed, 25 and 20 via Technique A and B, respectively. Technique groups varied by average interval time from CD to SIS (13.6 versus 74.5 months, P=0.006) but were otherwise similar. Twenty niches were diagnosed, 85% of which were clinically significant, including five following Technique A, nine following Technique B with double-layer closure, and three following Technique B with single-layer (P=.018). The average niche depth was 2.4 mm and 4.9 mm among the two-layer subgroups following Techniques A and B, respectively (P=.005). A clinically significant niche development was six times higher with Technique B when compared to Technique A (OR 6.0, 95% CI 1.6-22.6, P=.008); this significance persisted after controlling for SIS interval on multivariate analysis (OR 4.4, 95% CI 1.1-18.3, P=.04). The average niche depth was 5.7 ± 2.9 mm following Technique B with single-layer. Hysterotomy closure techniques determine the prevalence of post-Cesarean delivery niche formation and size. Exclusion of the endometrium at uterine closure reduces the development of significant scar defects.

A new technique for uterine incision closure at the time of cesarean section: does it make a difference?

The purpose of this study was to compare the short-term operative outcomes of three different surgical techniques for uterine incision closure during caesarean section (CS). This trial enrolled 120 patients scheduled for primary caesarean delivery. Patients were randomised into either classical double-layer uterine closure, purse-string double-layer uterine closure (Turan), or our new approach of uterine closure (double layer step up-step down technique). For short-term comparison, transvaginal ultrasonography was planned for all patients 6 weeks after surgery. Compared to group II and Group III, residual myometrial thickness was significantly thinner in group I (p < .001). The number of patients with uterine niche was 10 (50% of all scar defects) in group I whereas it was 4 (20%) in group II and 6 (30%) in group III. Operative time was significantly longer in group II (p < .001). This led to our conclusion that Turan technique and our new approach are associated with thicker myometrial thickness and less frequency of uterine scar defect than classical double-layer uterine incision closure; however, our approach takes less operative time. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT04681378 Impact statement What is already known on this subject? Many variations in CS technique have been studied. For example, single-layer uterine incision closure has been compared to double-layer uterine incision closure. Purse string double layer (Turan) has been also compared to the traditional double-layer technique. Double layer unlocked closure has been shown to result in a thicker residual myometrium and as a consequence can possibly lead to the decrease of niche development after a CS compared to single-layer closure with lower frequency of uterine scar defect with Turan technique. What do the results of this study add? Here we introduce a new uterine closure technique, which we have named double-layer step up–step down technique, as an alternative method. With this technique, the uterine incision contract more than with the traditional double layer technique and has similar results to the Turan technique; however, our approach takes less operative time. What are the implications of these findings for clinical practice and/or further research? These alternative techniques of uterine incision closure decrease the frequency of uterine niche that may be associated with many clinical problems such as ectopic pregnancy at the CS scar, placenta accreta, rupture of the uterus during a subsequent pregnancy. Future studies are needed to investigate the frequency of uterine rupture in a subsequent pregnancy following different uterine incision closure techniques.

A Comparative Study between Conventional Sutures, Staples and Adhesive Glue for Clean Elective Surgical Skin Closure

Background: A surgeon's signature is 'scar' [1]. On a regular basis, surgeons face various kinds of wounds which must be healed. The healing process and cosmetic result can be influenced by wound and incision closure techniques.&#x0D; The Goal of this Research is to Compare 3 Skin Closure Techniques: conventional skin sutures, adhesive glue, surgical stapler. These methods will be used to determine which of them is superior in terms of wound healing and cosmetic outcome in clean elective surgeries.&#x0D; Objectives:&#x0D; &#x0D; To compare duration between closure by 3 methods.&#x0D; To compare prices amongst the 3 methods.&#x0D; A comparison of the cosmetic appearances of the skin after closure.&#x0D; A comparison of post-operative pain between the 3 methods.&#x0D; To assess surgical site infections after closure with these 3 methods&#x0D; &#x0D; Methodology: 90 patients, undergoing clean elective surgeries, will be included in this study. 30 patients will be included in every group. Hospitalised under Department of General Surgery in Datta Meghe Institute Of Medical Sciences, Wardha. The study will be conducted between October 2020 to October 2022.&#x0D; Results: The result would be undertaken in SPSS software.&#x0D; Conclusion: Conclusion will be based on findings of study protocol.

A New Method for Surgical Abdominal Mass Closure After Abdominal Fascial Dehiscence Using Nasogastric Tube and Hemovac Perforator: A Case-Series Study

As the challenge for finding the best abdominal incision closure technique continues, surgeons are aiming to minimize postoperative wound complications such as wound dehiscence and hernia as an acute or late manifestation. In order to achieve this goal, several abdominal opening and closure techniques have been tried. In this article, we describe a method in which we used a nasogastric tube (NGT) in mass closure for patients with fascial dehiscence. In this case-series study, a total number of 25 patients participated. All of the patients had abdominal dehiscence after a surgery and had to undergo for another. An NGT was used for abdominal closure. The patients were followed for a month and were examined for any signs and symptoms of fever, infection, pain, material expenses, closing time, and laboratory data. The data were analyzed using SPSS software V.22. Mean ± SD and frequencies were used for describing the variables. The mean NGT mass closure material expenses for each patient were 8400.00 ± 0.00 IRR (around 0.25 US dollars). The mean closure time after the operation was 13.08 ± 3.09min. There was no evidence of infection among the patients as well as no other complications after the surgery in the 1-month study period. Abdominal mass closure with NG tube suturing technique is associated with reduced time required for closure of the incision, incidence of wound dehiscence, and the incidence of incisional hernia as well as infection, with a considerable low cost.

Subcutaneous Closed-Suction Drainage Does Not Affect Surgical Site Infection Rate Following Elective Abdominal Operations: A Prospective Randomized Clinical Trial

Purpose: To evaluate whether subcutaneous closed-suction drainage (SCSD) would decrease the SSI rate in elective abdominal operations.Methods: Participants were randomly assigned to have subcutaneous drains or not following elective abdominal surgery. The fascia and incision closure technique and antimicrobial prophylaxis were standardised. In the drain cohort, SCSD was applied after fascia closure. The drain was removed on postoperative day three. Patient characteristics, body mass index (BMI) and the depth of subcutaneous fatty tissue (SCFT) were noted. The incisional SSI rates were analysed. Results: There were 210 patients in the drain group and 192 in the no-drain group. There was no significant difference between groups in terms of demographics, BMI or SCFTs. The overall SSI rate was 7.7% and was 5.7% in the drain group and 9.9% in the no-drain group (p = 0.116). Neither BMI nor subcutaneous skin depth affected the SSI rate. However, subgroup analysis revealed that the SSI rate was lower in patients with drains who had undergone resection of colorectal malignancies or had lower abdominal incisions ( p< 0.03).Conclusions: The overall incisional SSI rate was comparable between the drain and no-drain groups. However, subcutaneous closed-suction drainage was not found effective in preventing SSI in our study except in a subgroup of patients with colorectal malignancies and lower abdominal incisions.

Wound Integrity of Clear Corneal Incisions Closed with Fibrin and N-Butyl-2-Cyanoacrylate Adhesives

Purpose: To compare the integrity of clear corneal incisions closed with fibrin (Tisseel®) and n-butyl-2-cyanoacrylate (Histoacryl®) tissue adhesives to those closed with conventional sutures. Methods: Four replicate experiments were performed on porcine eyes with each of the following conditions: three limbal clear corneal incision sizes (3.0 mm, 4.5 mm, and 6.0 mm), three incision closure techniques (fibrin adhesive, n-butyl-2-cyanoacrylate adhesive, and 10-0 interrupted nylon sutures)—1, 2, and 3 sutures at the 3.0-mm, 4.5-mm, and 6.0-mm incision sizes, respectively. Wound integrity was then measured by elevating the intraocular pressure of the eye to the point where wound leakage (IOPL) occurred. Two-way repeated measures analysis of variance (ANOVA) was used to analyze the IOPL data. Results: Incision closure technique and incision size showed significant interaction in the ANOVA model (p = 0.0008). Fibrin adhesive demonstrated higher IOPL compared to suture closure at the 3.0-mm incision size (p < 0.0001). There was no significant difference in IOPL when comparing wound closure with fibrin adhesive and sutures at the 4.5-mm and 6.0-mm incision sizes (p = 0.52 and p = 0.56, respectively). There was no significant difference between the three closure techniques for the 6.0-mm incisions (p > 0.15). When comparing the wound closure techniques for all incision sizes, the mean IOPL significantly increased in the following order: suture(s), fibrin adhesive, n-butyl-2-cyanoacrylate glue. Conclusions: Fibrin or n-butyl-2-cyanoacrylate tissue adhesive may be used as a more stable alternative to conventional sutures in the closure of clear corneal incisions.

Value of Subcutaneous Drainage System in Obese Females Undergoing Cesarean Section Using Pfannenstiel Incision

Objective: To determine whether closed subcutaneous drainage systems were efficacious in reducing the rate of wound breakdown of Pfannenstiel incision after cesarean section (CS) in obese females. Design: Prospective controlled clinical trial. Participants: 118 obese pregnant females with a body mass index >32 undergoing CS were divided into two groups: group I (n = 78) with closed subcutaneous drainage system and group II (n = 40) without drainage system. Incision closure technique was standardized. Prophylactic antibiotics were given routinely to both groups. Outcome Measures: Primary outcomes were the incidence of wound breakdown in both groups together with rate of hematoma formation and occurrence of fever. Secondary outcomes were amount of fluid drained, need for redressing. Results: Wound breakdown occurred in 9 cases in group I (11.5%), while it happened in 5 cases in group II (12.5%) (p > 0.05). Relative risk was 0.92 (95% CI 0.26–3.75). Hematoma formation was observed in only 1 case in the nondrainage group (group II). Fever was observed in 18 cases in group I (23.1%) in the first 24 h postoperative while in group II, 13 cases developed fever (32.5%) (p > 0.05). The need for redressing within the first 24 h was only in 2.5% of cases in group I while it was 17.9% in group II (p < 0.05). Conclusion: We found no significant benefit in using a subcutaneous drain as a prophylactic measure against wound breakdown in obese pregnant females undergoing CS as long as they received a prophylactic antibiotic.

Use of a subcutaneous closed drainage system and antibiotics in obese gynecologic patients

OBJECTIVE: The purpose of this study was to evaluate the effect of subcutaneous closed drainage systems and prophylactic antibiotics on the wound breakdown rate in obese patients undergoing gynecologic surgery. STUDY DESIGN: A prospective study was performed on 197 obese patients who were randomly selected to have a subcutaneous drain. Incision closure technique was standardized. Antibiotic usage was not randomized. Demographic data, perioperative data, and postoperative complications were noted and analyzed by χ 2 test and 2 × 2 contingency tables. RESULTS: The overall complication rate was 25%, with 20% (22/109) among the group receiving a drain versus 31% (27/88) without a drain. Seventeen patients (8.6%) had wound breakdowns: 7 of 109 (6.4%) with drains and 10 of 88 (11.4%) without drains. Prophylactic antibiotics were given to 46% (50/109) in the drain group and 51% (45/88) without a drain. Fewer patients (2%) with a drain receiving antibiotics had wound breakdowns. The group with the most breakdowns had neither a drain nor antibiotics (14%). CONCLUSION: We suggest the use of subcutaneous drains plus prophylactic antibiotics may decrease morbidity when operating on obese gynecologic patients. (Am J Obstet Gynecol 1996;175:358-62.)

The Terry surgical keratometer: a 12-month follow-up report

Postoperative astigmatism was studied in two groups of patients. All patients had undergone phacoemulsification with implantation of a posterior chamber intraocular lens. The incision closure techniques in both groups were identical, with one exception: One group was closed using the Terry keratometer intraoperatively, the second group was closed without the use of this instrument. Two observations are made from the twelve-month data. First, astigmatic error in the Terry group remained constant from the postoperative keratometer readings at six weeks to the twelve-month keratometer readings. Second, while there was a considerable difference in astigmatism at six weeks between the Terry group and the control group (less astigmatism in the Terry group), the differences were no longer apparent at twelve months. Sutures were removed as necessary to improve astigmatism in the control group. No sutures were cut in the Terry group during this twelve-month period.