Optimal Closure Research Articles

Scalp defect associated with extensive fibrosis of artificial dura requiring modified closure

Background A variety of methods are available for scalp defect closure and necessitate extensive planning. Superficial temporal artery (STA) based local flaps are widely used in the field of scalp and face reconstruction because of their flexibility and rich vascularity. Rotation and transposition techniques are commonly used in the area, however at times result in excessive tension. V-Y advancement allows tension-free closure with reduced post-operative complications. Case presentation A case of scalp defect post multiple craniectomies for a traumatic head injury complicated with subgaleal collection and poor wound healing in a 29-year-old male, is reported. Due to the nature of defect, with underlying fibrosis and previous artificial duraplasty, along with location in the frontotemporal region, a local STA based flap closed in a rotation, transposition and unilateral V-Y advancement pattern was used. Conclusion The challenges encountered in wound closure of complicated post-traumatic and multiple craniectomy cases can be overcome with a modified combined approach which achieves optimal wound closure. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1227-1232

Generalized field inversion strategies for data-driven turbulence closure modeling

Most data-driven turbulence closures are based on the general structure of nonlinear eddy viscosity models. Although this structure can be embedded into the machine learning algorithm and the Reynolds stress tensor itself can be fit as a function of scalar- and tensor-valued inputs, there exists an alternative two-step approach. First, the spatial distributions of the optimal closure coefficients are computed by solving an inverse problem. Subsequently, these are expressed as functions of solely scalar-valued invariants of the flow field by virtue of an arbitrary regression algorithm. In this paper, we present two general inversion strategies that overcome the limitation of being applicable only when all closure tensors are linearly independent. We propose to either cast the inversion into a constrained and regularized optimization problem or project the anisotropy tensor onto a set of previously orthogonalized closure tensors. Using the two-step approach together with either of these strategies then enables us to quantify the model-form error associated with the closure structure independent of a particular regression algorithm. Eventually, this allows for the selection of the a priori optimal set of closure tensors for a given, arbitrary complex test case.

Research on Vault Settlement during Three-Step Tunnel Construction Process Based on Sandstone Rheological Experiment.

Tunnel stability is influenced by the rheological properties of the surrounding rock. This study, based on the Ganshen high-speed railway tunnel project, examines the rheological characteristics of siltstone and sandstone through laboratory tests and theoretical analysis. Rheological curves and parameters are derived, revealing the time-dependent deformation mechanisms of the surrounding rocks. A numerical simulation model is created using these parameters to analyze deformation and stress characteristics based on different rock levels and inverted arch closure distances. Results indicate that sandstone follows the Cvisc model, with the Maxwell elastic modulus increasing under higher loads while the viscous coefficient decreases. The vault displacement is mainly affected by the surrounding rock strength; lower strength leads to greater displacement, which also increases with the closure distance of the inverted arch. These findings are crucial for determining the optimal closure distance of inverted arches in sandstone conditions.

Letter to the editor: Prospective analysis of STRATAFIX™ symmetric PDS plus suture for fascial closure in spinal surgery: a pilot study.

Spine surgery is essential for restoring alignment, stability, and function in patients with cervical spine injuries, especially when instability, pain, deformity, or progressive nerve damage is present. Effective wound closure is vital in these procedures, aiming to promote rapid healing, reduce infection risks, enable early mobilization, and ensure satisfactory cosmetic results. However, there is limited evidence on the optimal wound closure technique for posterior spine surgery, highlighting the need for innovative approaches. A study by Glener et al. evaluated the effectiveness of STRATAFIX™ Symmetric barbed sutures compared to traditional braided absorbable sutures in spinal surgery. In a randomized trial involving 20 patients, the STRATAFIX™ group demonstrated a shorter mean closure time and significantly fewer sutures used, though without a statistically significant reduction in closure time. No significant differences were observed in postoperative complications between the groups during a six-month follow-up. While the findings suggest potential cost savings and efficiency improvements with STRATAFIX™, the study's small sample size and short follow-up period limit its generalizability. Furthermore, AI-based models, such as the Xception deep learning model, show promise in improving suture training accuracy for medical students, which could enhance surgical outcomes and reduce complications. Despite the promising results, further research with larger sample sizes, extended follow-up periods, and multi-center trials is necessary to validate the effectiveness of barbed sutures like STRATAFIX™ in neurosurgery. The integration of AI in surgical training and continued exploration of innovative techniques are essential to advancing the field and optimizing patient care in spinal surgery.

Adjoint-based enforcement of state constraints in PDE optimization problems

This study demonstrates how the adjoint-based framework traditionally used to compute gradients in PDE optimization problems can be extended to handle general constraints on the state variables. This is accomplished by constructing a projection of the gradient of the objective functional onto a subspace tangent to the manifold defined by the constraint. This projection is realized by solving an adjoint problem defined in terms of the same adjoint operator as used in the system employed to determine the gradient, but with a different forcing. We focus on the “optimize-then-discretize” paradigm in the infinite-dimensional setting where the required regularity of both the gradient and of the projection is ensured. The proposed approach is illustrated with two examples: a simple test problem describing optimization of heat transfer in one direction and a more involved problem where an optimal closure is found for a turbulent flow described by the Navier-Stokes system in two dimensions, both considered subject to different state constraints. The accuracy of the gradients and projections computed by solving suitable adjoint systems is carefully verified and the presented computational results show that the solutions of the optimization problems obtained with the proposed approach satisfy the state constraints with a good accuracy, although not exactly.

Research on a Multi-Objective Optimization Method for Transient Flow Oscillation in Multi-Stage Pressurized Pump Stations

The long-distance multi-stage pressurized pump station water delivery system involves numerous valve closure parameters, complicating the rapid identification of an optimal valve closure scheme that satisfies multiple transient flow oscillation protection requirements. A hydraulic transient model was established based on transient flow calculation theory to address this challenge. Decision biases were identified using the Analytic Hierarchy Process and the Entropy Weight Method. A multi-objective optimization model, incorporating Support Vector Regression (SVR) and the Beluga Whale Optimization (BWO) algorithm, iteratively searches for optimal schemes under different biases. The results indicate that Support Vector Regression exhibits optimal performance, while Beluga Whale Optimization demonstrates excellent performance. The optimal schemes obtained from the multi-objective optimization model meet the transient flow protection requirements of the water delivery system. The study demonstrates that this model effectively solves the multi-objective optimization problem for water hammer protection in multi-stage pressurized pump station water delivery systems.

Incision Closure for Direct Anterior Total Hip Arthroplasty: Is There a Difference in the Rate of Superficial Wound Complications With Suture Versus Staples?

Background Direct anterior total hip arthroplasty (DA-THA) has increased in popularity over recent decades. However, DA-THA has been reported to have a higher incidence of superficial wound complications, including infection and incisional dehiscence, compared to other surgical approaches to hip arthroplasty. While this indicates a need for optimal wound closure, little research exists on the preferred method of skin closure following DA-THA. This study aimed to determine if there was any difference in rates of superficial infection, wound dehiscence, or overall wound complications with skin closure using a running subcuticular 3-0 Monocryl® suture compared to surgical staples following DA-THA. Methods Records of patients who underwent DA-THA at our institution between July 2017 to July 2022 were retrospectively reviewed. Data were abstracted on patient demographics, comorbidities, skin closure method, and wound complications from the electronic medical record. Superficial infection and wound dehiscence were classified based on explicit diagnosis in post-operative records and incision photographs taken during follow-up visits. Overall wound complications were classified in patients who experienced either superficial infection, incisional dehiscence, or both complications following surgery. Descriptive statistics and chi-squared measures were obtained from post-operative patient data, and significance was set at p[Formula: see text] 0.05. Results A total of 365 DA-THAs were completed in 349 patients. A running subcuticular 3-0 Monocryl® suture closed 207 surgeries (56.7%), while surgical staples closed 158 surgeries (43.3%). There was no significant difference in independent rates of superficial infection (p = 0.076) or wound dehiscence (p = 0.118) between suture and staple cohorts; however, suture closure (10, 2.7%) was associated with a significantly higher rate of overall wound complications compared to staple closure (1, 0.3%) (p = 0.020). Conclusion DA-THA carries the risk of overall wound complications, including superficial infection and wound dehiscence. Our findings suggest superficial skin closure with staples may be preferred over sutures due to lower rates of overall wound complications. Further studies are needed to determine the optimal method of skin closure following DA-THA.

Numerical modeling and simulation of water hammer phenomena using the MacCormack method

ABSTRACT Water hammer refers to pressure fluctuations caused by changes in fluid speed in hydraulic systems. This research proposes a model using the MacCormack method to study and control water hammer, specifically focusing on managing valve closure to reduce shock wave pressure during transient flow. Numerical simulations compare linear and quadratic closure laws for both rapid and gradual valve closure, with the goal of identifying the optimal laws. The findings show that with faster closure times, the overpressure at the valve section decreases linearly in the second quarter of the return period (t4). The application of the quadratic law results in reduced pressures at the valve compared to the linear law, with a maximum pressure difference of 0.05 bar between the highest and lowest values. When searching for the optimal valve closure law to mitigate overpressure, it is found that the exponent ‘m’ falls within the range of 1.117–1.599. As the slow closing time increases gradually, the range of variation for ‘m’ decreases. Furthermore, in the case of underpressure prevention, the exponent ‘m’ ranges from 0.95 to 1.419, and the range of ‘m’ remains relatively constant with the increase in closing time.

Hughes Abdomen Closure Technique Versus Continuous Closure in Emergency Midline Laparotomy: A Randomized Controlled Study.

Background Abdominal wound dehiscence, a serious postoperative issue, remains a significant concern for surgeons due to its potential to increase patient mortality and morbidity. Disruption can occur at any point after surgery, sparking debate over the optimal closure method for midline vertical abdominal wounds. Therefore, it's crucial to determine the safest approach. Our randomized clinical trialis plannedtocompare the risk of a burst abdomen associated with the Hughes abdominal closure technique to that of continuous abdominal closure. Methods All patients >18 years scheduled for emergency midline laparotomy were randomly assigned into two groups using computer-generated random numbers: Group A underwent Hughes repair (12 patients) and Group B underwent continuous closure(17 patients). Preoperative data, including patient demographics, and postoperative outcomes, such as time for rectus closure, wound dehiscence, surgical site infection (SSI), and length of hospital stay, were documented for analysis. Results The study found that the average patient age was 37.89 years, with more males than females. Both groups had an equal distribution of co-morbidities (p = 0.468), but none of these factors were statistically significant. Burst abdomen occurred in 25% of group A and 41.1% of group B (p = 0.367, not significant). Incisional hernia was absent in both groups. Surgical site infection (p = 0.119) and respiratory complications (p = 0.16) were not statistically significant between groups. However, in group A, theregressive analysis showed significant associations between burst abdomen, surgical site infection (p = 0.018), and respiratory complications (p = 0.007), whilein group B, these associations were not significant (p = 0.252 for SSI and p = 0.906 for respiratory complications). Conclusion The occurrence of burst abdomen and closure time differences between continuous and Hughes techniques were not significant. The Hughes technique was quicker to learn (32 vs. 22 minutes). Burst abdomen was more common in continuous closure (group A: 25% vs. group B: 41%), favoring the Hughes technique. Factors like age, gender, and others didn't significantly impact the burst abdomen in either group.

Construction alignment and closure control of CFST truss arch bridges based on temperature effect

To reveal the temperature deformation laws and achieve the accurate alignment prediction during the installation process of long-span concrete-filled steel tubular arch bridge ribs in complex environments, this paper establishes a three-dimensional refined heat transfer model for temperature field and effect calculation of truss arch ribs. The model uses the Ray Tracing Technology to recognize the member-caused-shading area on arch ribs. And by comparing with the actual measurement results and shadow effects to achieve the accurate calculation of temperature field. Finally, the variation of ribs deformation during construction and the optimal closure time are detailed analyzed. Results show that the computational method used in this paper can achieve accurate recognition of shadows and precise calculation of the complex three-dimensional temperature field of truss arch ribs. After considering the shadows, the maximum temperature difference between the upper chord sunshine area and lower chord shadow areas can reach 25 °C, which is significantly greater than 8 ℃ in the "Specifications for design of highway concrete-filled steel tubular arch bridge" (JTG/T D65–06-2015). Due to the solar incidence variation along the longitudinal direction of the arch ribs, extreme temperature fluctuation of the chord tubes occurs, with a maximum temperature difference of 21 °C. When arch ribs reach the maximum cantilever, the daily vertical displacement variation can reach approximately 87 mm, and the maximum displacement difference between arch ribs of two canyon sides can reach 15.6 mm at the same time. The solar-caused maximum compressive stress is 34 MPa, which can exceed 100 MPa after superimposing the gravity and cable effects. Based on the analysis of the displacement of both sides of the closure joint under the influence of sunlight, this paper identifies the window period for the closure control of the long-span steel truss arch ribs, laying the foundation for the accurate control of the rib construction alignment and the closure internal force state.

AWLC: Adaptive Weighted Loop Closure for SLAM with Multi-Modal Sensor Fusion

The present prevailing loop closure detection algorithm is mainly applicable for simultaneous localization and mapping (SLAM). Its effectiveness is contingent upon environmental conditions, which can fluctuate due to variations in lighting or the surrounding scenario. Vision-based algorithms, while adept during daylight hours, may falter in nocturnal settings. Conversely, lidar methods hinge on the sparsity of the given scenario. This paper proposes an algorithm that comprehensively utilizes lidar and image features to assign weighted factors for loop closure detection based on multi-modal sensor fusion. First, we use [Formula: see text]-means clustering to produce a point cloud spatial global bag of words. Second, an improved deep learning method is used to train feature descriptors of images while scan context is also used to detect candidate point cloud features. After that, different feature-weighted factors are assigned for homologous feature descriptors. Finally, the detection result related to the maximum weight factor is designated to the optimal loop closure. The adaptive weighted loop closure (AWLC) algorithm we proposed inherits the advantages of different loop closure detection algorithms and hence it is accurate and robust. The AWLC method is compared with popular loop detection algorithms in different datasets. Experiments show that the AWLC can maintain the effectiveness and robustness of detection even at night or in highly dynamic complex environment.

Preoperative Velopharyngeal Closure Predicts Hypernasality Outcomes of Secondary Furlow Double-Opposing Z-Plasty.

To determine if preoperative velopharyngeal closure percentage (VCP) is predictive of successful Furlow double opposing Z-plasty (DOZP) and subsequently determine the optimal velopharyngeal closure cutoff for successful DOZP. Retrospective study. Tertiary academic center. 110 patients with repaired cleft lip and palate having hypernasality treated with DOZP. Speech videofluoroscopy images were used to obtain the preoperative VCP and other measurements. Changes in hypernasality scores using the Cleft Audit Protocol for Speech-Augmented-Americleft Modification (CAPS-A-AM) rating system were used as the primary outcome measure. A successful DOZP was defined as a postoperative hypernasality score of ≤ 1 or an improvement of 2 or more scores from baseline. A receiver operating characteristic (ROC) curve was calculated to determine preoperative VCP cutoff. There were 110 patients who underwent DOZP for treatment of velopharyngeal insufficiency. Of these patients, 94 (85%) had successful surgery as determined by their postoperative CAPS-A-AM hypernasality score. Preoperative VCP was a statistically significant predictor of successful DOZP (P < .0001). The ROC curve with Youden index (J) determined a cutoff (c*) of 55% preoperative VCP or greater to optimize surgical success rate. Grouping by preoperative VCP showed that surgical success increases directly with preoperative VCP, and patients with low VCP had above a 50% success rate in reducing hypernasality scores. Preoperative VCP was significantly associated with improved hypernasality ratings postoperatively. A preoperative VCP of ≥55% may be used to help predict success of Furlow palatoplasty treatment. Patients with lower VCP can still benefit from secondary DOZP.

Quality of stapled mesenteric defect closure influences the chance of reopening after laparoscopic Roux-en-Y gastric bypass surgery

Internal herniation (IH) is a common problem after laparoscopic Roux-en-Y gastric bypass surgery (RYGB). Routine closure of the mesenteric defects (MDs) reduces the risk of IH. Only very few articles report on risk factors for IH or describe detailed closing techniques. There is no consensus yet on the best closing method. The objective of this study is to determine the optimal stapling method for closure of MDs after RYGB. All performed RYGB procedures in our high-volume bariatric institute were included. Quality of the closure was scored in the categories poor, sub-optimal, and optimal, to see if the quality of the closure would predict the chance of reopening of the MDs and, therefore, the chance of IH. During any type of laparoscopy in the follow-up of the patient, the conditions of the MDs were stated, for example during diagnostic laparoscopy in symptomatic patients suspicious for IH or during laparoscopic cholecystectomy. Technically well-executed closure of Petersen’s space (PS) with two rows of staples had a greater chance of still being closed upon re-inspection compared to closure with one row (odds ratio = 8.1; 95% confidence interval [1.2–53.2], p = 0.029). Optimal closure of the MD at the jejuno-jejunostomy (JJ-space, JJS) resulted in more closed JJSs upon re-inspection compared to sub-optimal closure (odds ratio = 3.6 [CI 95% 0.8–16.1], p = 0.099). Non-optimally closed MDs had higher reopening rates and, therefore, pose an additional risk for IH. Our classification provides a quality assessment of MD closure during RYGB and gives insight into how to optimize surgical technique.

International Delphi Study on Wound Closure and Incision Management in Joint Arthroplasty Part 2: Total Hip Arthroplasty

BackgroundThis modified Delphi study aimed to develop a consensus on optimal wound closure and incision management strategies for total hip arthroplasty (THA). Given the critical nature of wound care and incision management in influencing patient outcomes, this study sought to synthesize evidence-based best practices for wound care in THA procedures. MethodsAn international panel of 20 orthopedic surgeons from Europe, Canada, and the United States evaluated a targeted literature review of 18 statements (14 specific to THA and 4 related to both THA and total knee arthroplasty). There were 3 rounds of anonymous voting per topic using a modified 5-point Likert scale with a predetermined consensus threshold of ≥ 75% agreement necessary for a statement to be accepted. ResultsAfter 3 rounds of voting, consensus was achieved for all 18 statements. Notable recommendations for THA wound management included (1) the use of barbed sutures over non-barbed sutures (shorter closing times and overall cost savings); (2) the use of subcuticular sutures over skin staples (lower risk of superficial infections and higher patient preferences, but longer closing times); (3) the use of mesh-adhesives over silver-impregnated dressings (lower rate of wound complications); (4) for at-risk patients, the use of negative pressure wound therapy over other dressings (lower wound complications and reoperations, as well as fewer dressing changes); and (5) the use of triclosan-coated sutures (lower risk of surgical site infection) over standard sutures. ConclusionsThrough a structured modified Delphi approach, a panel of 20 orthopedic surgeons reached consensus on all 18 statements pertaining to wound closure and incision management in THA. This study provides a foundational framework for establishing evidence-based best practices, aiming to reduce variability in patient outcomes and to enhance the overall quality of care in THA procedures.

Concurrent Design Optimization of Tether-Net System and Actions for Reliable Space-Debris Capture

Tether-nets deployed from a chaser spacecraft are a promising solution to capturing space debris. The success of the one-shot capture process depends on the net’s structural dynamic properties, attributed to its physical design, and on the ability to perform an optimal launch and closure subject to sensing and actuation uncertainties. Hence, this paper presents a reliability-based optimization framework to simultaneously optimize the net design and its launch and closing actions to minimize the system mass (case 1) or closing time (case 2) while preserving a specified probability of capture success. Success is assessed in terms of a capture quality index and the number of locked node pairs. Gaussian noise is used to model the uncertainties in the dynamics, state estimation, and actuation of the tether-net, which is propagated via Monte Carlo sampling. To account for uncertainties and ensure computational efficiency, given the cost of simulating the tether-net dynamics, Bayesian optimization is used to solve this problem. Optimization results show that the mission success rate in the presence of uncertainties has increased from 75% to over 98%, while the capture completion time has almost halved.

HPB P50 A comparison of layered vs mass closure in development of incisional hernia following Kocher’s incision for open cholecystectomy, a retrospective analysis

Abstract Background Incisional hernias are a common complication of abdominal surgery. Open cholecystectomy procedures predispose to development of incisional hernias. Studies have shown rates of incisional hernias in visceral abdominal surgery to be 12.6% at one year and 22.4% at 3 years [1]. Several techniques have been developed to reduce rates of incisional hernia, namely abdominal wall closure in layers rather than mass closure. The purpose of our study is to evaluate whether layered closure is superior in preventing incisional hernias compared to mass closure. Methods The study reviewed retrospective data on 694 cholecystectomies at Southport or Ormskirk NHS Trust between 2018-23. Of these cases, 104 underwent open procedures. Operation notes and follow up were accessed electronically and analysed. Patients were also contacted by telephone to further establish whether they have developed incisional hernias and discuss other complications following surgery. The primary objective was to compare hernia rates between mass and layered closure. Secondary objectives were to establish hernia incidence in relation to gender, age, BMI, and elective vs emergency surgery. Results Of the data analysed, there was an equal proportion of male and female patients. Median age of patients was 62. Median BMI of all patients was 29 and median BMI of those developing hernias was 37. 80.8% of open cholecystectomies were elective procedures and 19.2% were emergency procedures. Infection rate was found to be 3.8%, and 30-day mortality was 1.9%. The mean rate of incisional hernia was 7.7% with mean rates of mass and layered closure at 2.7% and 11.1%, respectively. Fisher’s exact test showed that there was no statistical significance in closure method on hernia development. Conclusions We found no statistical significance in incisional hernia development between mass and layered closure in open cholecystectomies. No statistical significance was seen in hernia development with relation to age, gender and elective vs emergency surgery, however greater BMI was found to be statistically significant in increasing risk of hernia development. Larger, prospective multi-centre data are needed to further evaluate these results and aid surgeons in choosing an optimal closure technique in the future.

Expert Consensus on Best Practices for Optimal Wound Closure in Total Knee Arthroplasty: A STRIDE Initiative for Orthopedic Surgeons of India.

Wound closure in joint replacement surgeries is crucial for postoperative rehabilitation. Despite substantial advances in total knee arthroplasty (TKA), no guidelines/recommendation or consensus practice statement available internationally or nationally around the optimal method of wound closure. The study aimed to develop evidence-based consensus on current practices, and proposed adoption of advanced wound closure initiatives. From Nov 2020 to Jan 2021, a group of 12 leading orthopedic surgeons from India met virtually under the Success in Total joint replacement through Recommendation In wounD closure (STRIDE) initiative. Expert committee used Delphi method to evaluate definitional statements that were identified through a comprehensive review of the published literature. Over three rounds of iterative voting, revision, and exclusion, the expert panel provided recommendations based on their clinical expertise and scientific evidence. Statements that reached ≥ 80% agreement was considered as "consensus". A survey poll was conducted following each round to add or suggest changes to the statements. General recommendations include marking the arthrotomy before incision, placing the knee in flexion (less than 90°) for re-approximation during arthrotomy closure. The barbed suture can be a good alternative to traditional sutures for providing water-tight capsule closure and topical skin adhesives (TSAs) to staples for minimizing hospital visits and improving patient satisfaction. This consensus provides interim guidance and practical references to orthopedic surgeons of India enabling easy access to evidence-based healthcare solutions for TKA wound closure. These recommendations need to be periodically reviewed in light of emerging evidence.

Cellulose-based bioabsorbable and antibiotic coated surgical staple with bioinspired design for efficient wound closure

The quest to design a flawless wound closure system began long ago and is still underway. Introducing surgical staples is one of the most significant breakthroughs in this effort. In this work, we developed a biodegradable surgical staple to meet the optimal wound closure system criteria and other clinical requirements, such as radiography compatibility and secondary infection prevention. To meet these requirements, a naturally derived cellulose acetate (CA) fiber-reinforced poly-(l-lactic acid) (PLLA) composite was synthesized, and its physicochemical properties were determined using several characterizations such as Fourier-transform infrared spectroscopy (FTIR), Differential scanning calorimetry (DSC) and Universal testing machine (UTM), etc. Taking cues from the Mantis's foreleg, a novel staple design was implemented and verified using Finite Element Analysis (FEA). The CA + PLLA staples were fabricated using melt-casted/3D-printing processes. The staples exhibited excellent biodegradation in both wound and physiological microenvironments with sufficient puncturing strength and later closed the wound's edges mechanically. In addition, the CA + PLLA staples also exhibit metal-like ductility properties to withstand horizontal skin tensions during the healing process. Further, the staples are coated with an antibiotic to combat infections effectively to provide better healing.

Comparison of outcomes with stapler versus hand-sewn closure of the pancreatic stump following minimally invasive distal pancreatectomy: a retrospective cohort study

Background: Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication. The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy (MDP) remains unclear. Methods: Data of consecutive patients who underwent MDP in our institution between July 2018 and June 2021 were collected. The outcomes of MDP with stapler and hand-sewn closure were compared. The primary outcome was clinically relevant postoperative pancreatic fistula (CR-POPF) per the International Study Group of Pancreatic Surgery definition. Results: Of the 384 patients (stapler closure, 339; hand-sewn closure, 45) enrolled, 249 developed CR-POPF (grades B and C: 242 and 7 patients, respectively). The rates of grade B and grade C POPF in the stapler group were similar to the corresponding rates in the hand-sewn group (64.6% and 1.5% vs 51.1% and 4.4%, P = .078 and P = .223, respectively). No differences between the stapler and hand-sewn groups were observed regarding the median operation time (207 vs 222 minutes, P = .139), incidence of major complications (16.5% vs 20.0%, P = .559), and mortality (0.2% vs 0%, P = 1.000). The independent risk factors of CR-POPF were abdominal abscess, prolonged operation time, and transection site (P = .004, .006, and .001, respectively). Conclusion: The incidence and severity of CR-POPF by stapler closure of the pancreatic stump were comparable to those associated with hand-sewn closure in MDP in this retrospective cohort. Randomized controlled trials are needed to verify this finding.

Trigger Finger Release: Are Sutures Requiring Removal Necessary?

There is no consensus regarding optimal closure for trigger finger release (TFR) surgery. The purpose of this study was to compare the number of postoperative visits and complications following TFR closure with nonabsorbable sutures versus those following TFR closure with absorbable sutures and skin glue. The hypothesis was that wound closure with absorbable sutures and glue will result in fewer postoperative visits, while having similar complication rates as that with nonabsorbable sutures. A retrospective review identified all patients undergoing open TFR over a 3-year period performed by two hand surgery fellowship-trained hand surgeons who adhered to an identical surgical protocol except for incisional closure. Patients were divided into two groups: a control group with nonabsorbable 4-0 monofilament sutures requiring removal ("suture" group) and a study group with buried absorbable 4-0 monofilament sutures not requiring removal as well as skin glue ("glue" group). The data collected included age, sex, number of postoperative visits, wound complications, infections, antibiotic use, prescribed hand therapy, hospital admission, and reoperation. A total of 305 open TFR surgeries in 278 patients were included in the study, with 155 digits in the "suture" group and 150 in the "glue" group. Both groups were similar in age and sex. The "suture" group had significantly more total postoperative visits (185 vs 42, respectively, P < .001) and postoperative visits within the first 2 weeks (155 vs 10, respectively, P < .001) than the "glue" group. Additional postoperative visits beyond 2 weeks of surgery were similar between the two groups. Three (1.9%) patients in the "suture" group and two (1.3%) patients in the "glue" group developed a superficial surgical site infection within 30 days after surgery. Neither had deep infections requiring hospitalization or reoperation. Both groups required similar rates of postoperative hand therapy. Absorbable sutures afford fewer postoperative visits while having a similar complication rate as nonabsorbable sutures requiring removal. Therapeutic IV.