Standard Closure Research Articles

Two alternative dural sealing techniques in posterior fossa surgery: (Polylactide-co-glycolide) self-adhesive resorbable membrane versus polyethylene glycol hydrogel.

Background:Post-operative cerebrospinal fluid (CSF) leak in posterior fossa surgery remains a significant source of morbidity. TissuePatchDural (TPD), a novel impermeable adhesive membrane, was used to reinforce dural closure. A comparison with one of the most commonly used dural sealing devices, DuraSeal, has been made.Methods:A retrospective, single-center study was conducted on 161 patients who underwent elective posterior fossa surgery. On surgeon's opinion, when a primary watertight closure was not possible, they received TPD or DuraSeal to reinforce dural closure.Results:Out of 161 patients analyzed, 115 were treated with TPD and 46 with DuraSeal. The post-operative leaks related purely to TPD or DuraSeal failure were recognized in 3 (2.6%) and 5 (10.86%) cases, respectively (P = 0.015). The presence of pre- and post-operative risk factors was associated with an increased incidence of CSF leak in both groups. TPD showed a better control in patients without these risk factors (P = 0.08). The incidence of CSF leak in patients who underwent posterior fossa surgery by craniectomy was statistically lower in TPD group compared to DuraSeal group (3.22% vs 17.8%, respectively; P = 0.008)Conclusions:TPD seems to be a safe tool for use as an adjunct to standard dural closure in posterior fossa surgery, particularly in patients without pre- or post-oper ative risk factors, in those who did not develop hydrocephalus, and who underwent craniectomy. The CSF leak rate in TPD group was found to be lower or within the range of the more advanced alternative dural closure strategies, including polyethylene glycol (PEG)-based sealant.

Postpartum Infection in Morbidly Obese Women After C-Section: Does Early Prophylactic Oral Antibiotic Use Make a Difference?

The rising prevalence of morbid obesity particularly in women coupled with a higher likelihood of having a caesarean section (C-section) birth and an increased risk of Surgical Site Infection (SSI) places wound assessment among priority areas in maternity care. There is a level of ambiguity about the efficacy of routine preventative care pathways particularly in morbid obese women with regards to SSI after caesarean section. A pilot study was therefore undertaken to explore the number of women with a C-section infection in a cohort of morbidly obese women during six weeks postpartum against a background of standard care early antibiotic prophylaxis and skin closure practice. A short questionnaire was sent to 59 women with an early pregnancy BMI ≥ 40 who gave birth via C-section in a large maternity unit in Sheffield, UK. Of 39 participants who responded, 20 (51%) developed a post-operative wound infection within 6 weeks postpartum. Infections were higher in the women who had emergency C-section births (14/24, 60%). There was no significant difference in wound infection risk with respect to wound closure material (Chi-square = 0.298, p-value = 0.86) or the use of oral prophylactic antibiotic after birth (Chi-square = 0.2053, p-value = 0.650). Although all the women received routine IV antibiotics before C-section, only 26/39 received the 5 day oral antibiotic prophylaxis after birth. Six of 13 women who did not receive postpartum oral antibiotics (46%) developed a SSI. In summary, over half of morbidly obese women who delivered by C-section developed a wound infection, despite receiving prophylactic antibiotics. We acknowledge the limitations of these results from a small sample retrospective observational study. However this may indicate that SSI imposes a greater risk because of a lack of antibiotic prophylaxis efficacy and requires further investigation.

Is the Photosuturing Agent, Rose Bengal, a Mutagen?

Rose Bengal (RB) is a potential photosuturing agent that may improve standard dermatologic surgical closure techniques. However, RB produces reactive oxygen species with photoactivation and its photomutagenic potential must be considered in clinical application. We investigated cytotoxicity, mutagenicity, and singlet oxygen (SO) production of RB on epithelial Chinese hamster ovary cell line. Cells were exposed to RB concentrations: 0.1%, 0.01%, 0.001%, 0.0001%, 0.00001%; irradiated for 400 s using a high-intensity visible wavelength lamp or maintained in the dark. Cell viability was assessed by XTT assay, mutagenicity by HPRT gene mutation assay, and SO production by Sensor Green reagent. RB > 0.001% was significantly cytotoxic. Viabilities were uninfluenced by ≤0.0001% RB controls, or 30-min incubation. 49% of irradiated cells died after 24-h in 0.0001% RB. At ≥0.001% RB, >90% of cells died. Irradiating 0.00001% - 0.001% RB increased SO; levels dropped significantly between 0.01% - 0.1%. Controls exhibited negligible SO production. HPRT suggested that RB was not mutagenic (0.0001%, 0.00001%); SO induction increased between 0.00001% - 0.001%, with reduced production at higher concentrations. Pilot studies suggested irradiated 0.0001% RB is mutagenic in vitro; current data suggest RB is not photomutagenic. The contribution of RB’s cytotoxicity on observed clinical improvement of scars and mutagenic potential remains unclear, necessitating further study.

PolysorbR (an absorbable lactomer) staples, a safe closure technique for distal pancreatic resection.

To investigate twenty-year experience evaluated the use of the Polysorb(R) (an absorbable lactomer) staples for distal pancreatic resection. The data on 150 patients [92 men, 58 women, mean age 52 (24-72) years] who underwent distal pancreatectomy (DP) in the last 20 years were collected prospectively from an electronic database. The diagnosis was confirmed by endoscopic retrograde cholangiopancreatography, sonography, computed tomography and/or magnetic resonance imaging. The indications for DP were focal pancreatic necrosis, spontaneous pancreatic fistulas, abscesses, pseudocysts, segmental chronic obstructive pancreatitis in the tail, traumatic disruption, and benign (cystadenomas, insulinomas, or glucagonomas) or malignant tumours. The distal resections were performed without splenectomy in 29 of the 150 patients (19%). In the event of splenectomy, the splenic artery and vein were individually ligated, the TA-55 Auto Suture stapler, loaded with Premium Polysorb(R) 55 staples (5.5 mm), was placed across the gland, and the trigger was pulled, the action of which produced two staggered absorbable suture lines. The gland distal to the stapler was then amputated with a scalpel on the TA-55 stapler and the two rows of staples were left in the proximal pancreatic stump. After the distal resection, a drainage tube was inserted into the pancreatic bed. The average duration of the operation was 150 min (range: 90-210 min) and no transfusion was indicated during the operation. After DP in one patient a type B fistula was diagnosed, which was treated successfully by conservative treatment comprising of 12-d octreotide medication (3 × 0.1 mg/d) and jejunal feeding. The incidence of postoperative pancreatic fistula was therefore 0.6%. Another 2 patients suffered postoperative pancreatitis, which was also conservatively treated. Reoperations were performed in 2 patients on the first or second postoperative day, necessitated by bleeding from the retroperitoneal region. The morbidity was 3.3% (5 patients), but no mortality occurred in the postoperative period. Overall, the postoperative period was uneventful without any complications (pancreatic fistula, abscess, bleeding or wound infection) in 145 patients. The length of the postoperative stay ranged between 8 and 16 d. For the 145 patients who had no any postoperative complications, the hospital stay was 8 or 9 d. No mortality occurred in the follow-up period (6 or 12 mo postoperatively); but 6 mo after surgery one patient suffered a pseudocyst following recurrent pancreatitis and was treated with cystojejunostomy. Our clinical results demonstrated that the application of absorbable lactomer staples for distal pancreatic resection is a safe alternative to the standard closure technique.

A prospective randomized comparison of two skin closure techniques in acetabular fracture surgery

BackgroundRecent publications have shown an infection rate of 5–7 % for acetabular fractures treated with the Kocher-Langenbeck (K-L) approach. Using metallic staples to close hip skin incisions has been considered the gold standard. The purpose of this study was to answer the following: (1) will closure of a K-L incision after acetabular fracture surgery with a running subcuticular monocryl suture, then sealing the wound with 2-octyl cyanoacrylate (OCA), result in a lower infection rate compared to metallic staple closure? (2) Do incisions closed with subcuticular monocryl and OCA exhibit decreased drainage? (3) Is there a cost difference between these two methods?Materials and methodsIn a prospective clinical study, 103 patients with acetabular fractures treated using the K-L approach were randomized into two groups: skin closure with metallic staples (n = 52) versus subcuticular running monocryl suture sealed with OCA (n = 51).ResultsTwo postoperative deep infections (4 %) in the staples group required multiple debridements; no infections developed in the OCA group. However, there was no statistical difference between the groups, (p = 0.495). There was a statistically significant difference (p = 0.032) comparing days from surgery to a dry incision favoring OCA (4.2 versus 5.85 days). The patient charge was approximately $900 greater on average in the OCA group due to the increased time in the operating room required for the subcuticular closure.ConclusionsClosure with OCA and subcuticular monocryl showed no clinical disadvantages and appears to have a clinical advantage when compared to standard metallic staple skin closure in acetabular fracture surgery. However, additional patient costs may be incurred.Level of evidenceII.

Surgical Technique: Medial Ulnar Collateral Ligament Reconstruction Using Hamstring Allograft.

In the overhead throwing athlete, medial ulnar collateral ligament reconstruction utilizing a hamstring allograft as an alternative to an autograft provides similar results without the donor site morbidity or potential complications of autograft harvest. Obtain an MRI or MRA to determine the location and importance of the tear in the ligament. Position the elbow to allow access to the medial side, and expose the medial ulnar collateral ligament via a flexor-pronator split approach. Prepare the non-irradiated hamstring allograft by placing lead Krackow stitches into each end, and if necessary suture it in the middle to help with passage through the bone tunnels. Use a single-hole technique, inserting a Beath pin into the sublime tubercle to allow a single screw to fix the graft into the ulna, OR use a double-hole technique, making connecting drill holes under the sublime tubercle and passing the graft through the tunnels. Place a single drill hole into the center of the origin of the medial ulnar collateral ligament at the distal end of the medial epicondyle; place two connecting tunnels and shuttle the graft ends through these tunnels. Tension the graft while the elbow is placed though a full arc of motion, suture the two limbs of the graft together, and suture the medial ulnar collateral ligament to the graft. Irrigate the wound, repair the flexor-pronator fascia with absorbable suture, and perform a standard subcutaneous and skin closure. Medial ulnar collateral ligament reconstruction utilizing a hamstring allograft instead of an autograft has so far produced excellent results.IndicationsContraindicationsPitfalls & Challenges.

A Surface Temperature Initiated Closure (STIC) for surface energy balance fluxes

The use of Penman–Monteith (PM) equation in thermal remote sensing based surface energy balance modeling is not prevalent due to the unavailability of any direct method to integrate thermal data into the PM equation and due to the lack of physical models expressing the surface (or stomatal) and boundary layer conductances (gS and gB) as a function of surface temperature. Here we demonstrate a new method that physically integrates the radiometric surface temperature (TS) into the PM equation for estimating the terrestrial surface energy balance fluxes (sensible heat, H and latent heat, λE). The method combines satellite TS data with standard energy balance closure models in order to derive a hybrid closure that does not require the specification of surface to atmosphere conductance terms. We call this the Surface Temperature Initiated Closure (STIC), which is formed by the simultaneous solution of four state equations. Taking advantage of the psychrometric relationship between temperature and vapor pressure, the present method also estimates the near surface moisture availability (M) from TS, air temperature (TA) and relative humidity (RH), thereby being capable of decomposing λE into evaporation (λEE) and transpiration (λET). STIC is driven with TS, TA, RH, net radiation (RN), and ground heat flux (G). TS measurements from both MODIS Terra (MOD11A2) and Aqua (MYD11A2) were used in conjunction with FLUXNET RN, G, TA, RH, λE and H measurements corresponding to the MODIS equatorial crossing time. The performance of STIC has been evaluated in comparison to the eddy covariance measurements of λE and H at 30 sites that cover a broad range of biomes and climates. We found a RMSE of 37.79 (11%) (with MODIS Terra TS) and 44.27Wm−2 (15%) (with MODIS Aqua TS) in λE estimates, while the RMSE was 37.74 (9%) (with Terra) and 44.72Wm−2 (8%) (with Aqua) in H. STIC could efficiently capture the λE dynamics during the dry down period in the semi-arid landscapes where λE is strongly governed by the subsurface soil moisture and where the majority of other λE models generally show poor results. Sensitivity analysis revealed a high sensitivity of both the fluxes to the uncertainties in TS. A realistic response and modest relationship was also found when partitioned λE components (λEE and λET) were compared to the observed soil moisture and rainfall. This is the first study to report the physical integration of TS into the PM equation and finding analytical solution of the physical (gB) and physiological conductances (gS). The performance of STIC over diverse biomes and climates points to its potential to benefit future NASA and NOAA missions having thermal sensors, such as HyspIRI, GeoSTAR and GOES-R for mapping multi-scale λE and drought.

Numerical Simulation of Free Surface in the Case of Plane Turbulent Wall Jets in Shallow Tailwater

Wall-jet flow is an important flow field in hydraulic engineering, and its applications include flow from the bottom outlet of dams and sluice gates. In this paper, the plane turbulent wall jet in shallow tailwater is simulated by solving the Reynolds Averaged Navier-Stokes equations using the standard turbulence closure model. This study aims to explore the ability of a time splitting method on a non-staggered grid in curvilinear coordinates for simulation of two-dimensional (2D) plane turbulent wall jets with finite tailwater depth. In the developed model, the kinematic free-surface boundary condition is solved simultaneously with the momentum and continuity equations, so that the water surface elevation can be obtained along with the velocity and pressure fields as part of the solution. 2D simulations are carried out for plane turbulent wall jets free surface in shallow tailwater. The comparison undertaken between numerical results and experimental measurements show that the numerical model can capture the velocity field and the drop in the water surface elevation at the gate with reasonable accuracy.

Titanium Plates for Median Sternotomy Closure: A Case Presentation

Sternal dehiscence following cardiovascular surgery occurs approximately 0.5 to 5% of the time (Grevious, 2009) with standard practice closure using stainless steel wires in a median sternotomy. Patients at greatest risk of dehiscence are those with obesity, diabetes, osteopenia, and chronic steroid use and impaired wound healing. Dehiscence leads to sternal instability, pain, infection and increased length of stay and mortality.

Epistemic paradox and the logic of acceptance

Paradoxes have played an important role both in philosophy and in mathematics and paradox resolution is an important topic in both fields. Paradox resolution is deeply important because if such resolution cannot be achieved, we are threatened with the charge of debilitating irrationality. This is supposed to be the case for the following reason. Paradoxes consist of jointly contradictory sets of statements that are individually plausible or believable. These facts about paradoxes then give rise to a deeply troubling epistemic problem. Specifically, if one believes all of the constitutive propositions that make up a paradox, then one is apparently committed to belief in every proposition. This is the result of the principle of classical logical known as ex contradictione (sequitur) quodlibet – that anything and everything follows from a contradiction, and the plausible idea that belief is closed under logical or material implication (i.e. the epistemic closure principle). But, it is manifestly and profoundly irrational to believe every proposition and so the presence of even one contradiction in one's doxa appears to result in what seems to be total irrationality. This problem is the problem of paradox-induced explosion. In this paper it will be argued that in many cases this problem can plausibly be avoided in a purely epistemic manner, without having either to resort to non-classical logics for belief (e.g. paraconsistent logics) or to the denial of the standard closure principle for beliefs. The manner in which this result can be achieved depends on drawing an important distinction between the propositional attitude of belief and the weaker attitude of acceptance such that paradox constituting propositions are accepted but not believed. Paradox-induced explosion is then avoided by noting that while belief may well be closed under material implication or even under logical implication, these sorts of weaker commitments are not subject to closure principles of those sorts. So, this possibility provides us with a less radical way to deal with the existence of paradoxes and it preserves the idea that intelligent agents can actually entertain paradoxes.

Repair of Acute Inferior Wall Myocardial Infarction-Related Basal Ventricular Septal Defect: Transatrial versus Transventricular Approach

We describe our contemporary experience for the management of patients with an acute postinfarction basal ventricle septal defect (VSD) using the transatrial (TA) and transventricular (TV) approaches. Retrospective review of all patients diagnosed with an ischemic basal VSD since January 2000. There were 20 patients with a median age of 68 years (39 to 85); 13 (65%) were males. Median time from diagnosis of the ischemic basal VSD to operation was 22 hours (6 to 144). All patients received standard patch closure of the septal defect with exposure of the VSD through the TA approach in eight patients (40%) and the TV approach in 12 (60%). All TA group patients received tricuspid valve replacement, while in the TV group, two had tricuspid valve replacement and two repair. Five patients (25%) had clinically insignificant (<0.5 mm) residual septal defects; three additional patients (15%) experienced patch dehiscence and two (10%) underwent re-exploration. There were five mortalities (25%): one in the TA group (right ventricular heart failure) and four in the TV group (one right ventricular heart failure, three ventriculotomy site hemorrhage or patch dehiscence). Preoperative right atrial pressure (p=0.0003) and right ventricular dysfunction (p=0.04) were predictors of hospital mortality. Follow-up of the hospital survivors was 4.3 years (40 days to 11.5 years) with one death at seven years. Operative mortality associated with repair of postinfarction basal ventricular septal defect is high and is related to right ventricular failure and bleeding from the ventriculotomy. The TA approach avoids ventriculotomy-associated bleeding and provides excellent exposure but is associated with an increased incidence of tricuspid valve replacement.

Reduction of intraoperative air leaks with Progel in pulmonary resection: a comprehensive review

Intraoperative alveolar air leaks (IOALs) occur in 75% of patients during pulmonary resection. Despite routine use of sutures and stapling devices, they remain a significant problem in the daily practice of thoracic surgery. Air leaks that persist beyond postoperative day 5 often result in increased costs and complications. Several large meta-analyses have determined that sealants as a class reduce postoperative air leak duration and time to chest drain removal, but these results did not necessarily correlate with a reduction in length of postoperative hospital stay. These analyses grouped surgical sealants together of necessity, but differences in efficacy may exist due to the differing product characteristics, study protocols, surgical procedures, and study endpoints. Progel, currently the only pleural surgical sealant FDA-approved for use in lung resection, has demonstrated efficacy and safety in two controlled clinical studies and superiority over standard air leak closure methods in reducing IOALs and length of hospital stay. This paper will review these findings and report on real-world experience with this recently approved pleural sealant.

Technik der Leberentnahme bei postmortaler Spende

The procurement of the liver is a standardized surgical procedure in the hands of qualified transplantation and organ procurement surgeons which is defined in the German guidelines. Literature review and discussion of critical aspects concerning the procurement of liver allografts. The procurement of livers should be performed by qualified transplantation and organ procurement surgeons (certification). The technique is standardized in German guidelines. A thoracotomy can help to optimize exposition which is essential to avoid technical complications and injuries to the graft especially in a training situation. Dissection in the cold is recommended. Knowledge of the anatomic variations of the hepatic artery is essential in procuring liver allografts. Documentation of errors and anatomic variations, packing of organs and a standardized closure of the thorax and abdomen are obligations of the responsible leading organ procurement surgeon.

A new level 1 oncoplastic technique for breast conserving surgery: Rotation glandular flap

BackgroundWhen performing conservative surgery for breast cancer, breast reshaping can be a challenging procedure. Level 1 oncoplastic surgery (OPS) techniques, i.e. advancement or rotation of glandular flaps, should be performed when less than 20 per cent breast volume is excised. ObjectiveA new Level 1 OPS technique is described. A wide centro-lateral glandular flap is created after extensive undermining of the skin and nipple-areolar complex, and rotated into the cavity. DiscussionThis rotation glandular flap is a new technique for use following a wide excision, in glandular, not fatty, breasts, and when standard closure of the cavity would not leave a satisfactory cosmetic result.

Comparative Effectiveness of Pressurized Irrigation or Subcutaneous Antibiotics Versus Standard Wound Closure on Surgical Site Infections Following Colorectal Surgery

Surgical site infections (SSI) following colorectal surgery are common postoperative complications leading to prolonged length of stay, increased hospital costs and postoperative mortality. Prior studies suggest that pressurized lavage irrigation and/or subcutaneous antibiotics might reduce SSI by removing non-viable tissue from the wound, decreasing the burden of bacteria and increasing tissue concentration of antibiotics. This study was designed to determine whether the use of pressurized irrigation or topical antibiotics decreased the rate of SSI compared to standard wound closure following colorectal operations.

A modulated gradient model for scalar transport in large-eddy simulation of the atmospheric boundary layer

As a simple alternative to the standard eddy-diffusivity closure, a nonlinear subgrid-scale (SGS) flux model is introduced and implemented in simulations of a neutral atmospheric boundary layer and a stable atmospheric boundary layer. The new model computes the structure of the SGS flux (relative magnitude of the vector components) based on the normalized gradient vector, which is derived from the Taylor expansion of the exact SGS flux. The SGS magnitude is computed as the product of a SGS velocity scale and a SGS scalar concentration scale, which are estimated based on the local-equilibrium hypothesis. To resolve the instability issue of the original gradient model and ensure numerical stability, we adopt a clipping procedure to avoid local negative SGS dissipation rate of the scalar variance. The model formulation, using constant coefficients, is assessed through a systematic comparison with well-established theoretical predictions and reference results of various flow statistics. Simulation results obtained with the use of this new model show good agreement with the reference results and an evident improvement over results obtained using traditional eddy-diffusivity models. For instance, the new model can deliver the expected surface-layer similarity scalar profile and power-law scaling of the power spectrum of scalar fluctuation.

New-Fangled Slowly-Absorbable versus Non-Absorbable Sutures for Abdominal Fascial Closure. Have the Goals towards an Advantageous Suture Been Met?

Background-Aim: The technique of abdominal closure along with the material to be used is constantly evolving. The aim of the present study is to evaluate differences in midline laparotomy closure with a standard closure technique and new-fangled slow-absorbable versus non-absorbable sutures. Material and Methods: A prospective, comparative study of patients undergoing laparotomy closure with either STARDIOX (Polydioxanone) or STARLENE (Polypropylene) sutures during a 9 month period was performed. Patients were evaluated and compared in terms of surgical site infection, incisional hernia, burst abdomen, and suture sinus formation. Results: A total of 284 patients were included [141 in the STARDIOX (Polydioxanone) group and 143 in the STARLENE (Polypropylene) group]. Sinus formation was not noticed and no palpable knots were reported in both groups. Moreover burst abdomen was never encountered. Incisional hernia rates were similar for both suture materials: n = 6 (4.3%) for the STARDIOX (Polydioxanone) group and n = 5 (3.5%) for the STARLENE (Polypropylene) group. There was not statistically significant relationship between the type of suture that was used and wound infection: n = 5 (3.5%) in the STARDIOX (Polydioxanone) group and n = 6 (4.2%) in the STARLENE (Polypropylene) group. Complications did not occur in 96.1% of all patients. Conclusions: Our study suggests that there are no significant differences between these two new-fangled sutures. It seems that progress of suture materials has led to a step towards the goals of a beneficial suture and from then on complications of surgical wound closure should be merely a matter of operative technique.

Perturbed, entropy-based closure for radiative transfer

We derive a hierarchy of closures based on perturbations of well-known entropy-based closures;we therefore refer to them as perturbed entropy-based models. Our derivation reveals finalequations containing an additional convective and diffusive term which are added to theflux term of the standard closure. We present numerical simulations for the simplest member of the hierarchy, theperturbed $M_1$ or $PM_1$ model, in one spatial dimension. Simulations are performed using a Runge-Kuttadiscontinuous Galerkin method with special limiters thatguarantee the realizability of the moment variables and the positivity of the materialtemperature. Improvements to thestandard $M_1$ model are observed in cases where unphysical shocks develop in the $M_1$ model.

Prevention of seroma formation with TissuGlu® surgical adhesive in a canine abdominoplasty model: Long term clinical and histologic studies

Seroma formation is a common postoperative complication following many surgical procedures including abdominoplasty. Recently, a lysine-derived urethane (LDU) surgical adhesive was shown to prevent seroma formation in short term studies in a canine model of abdominoplasty. This current study evaluates efficacy of the adhesive (TissuGlu®, Cohera Medical, Inc.) in the same model at longer time points, and examines the histological tissue response to extended exposure to the adhesive. Bilateral subcutaneous pockets were created in the ventrolateral abdominal wall and additional tissue damage was inflicted using electrocautery. On one side, the tissue layers were treated with the adhesive prior to closure, whereas the control side received no treatment prior to standard closure of the incision. Seroma fluid accumulation was measured and histologic analysis was performed at 3 and 12 weeks. Seroma formation (mean±SD, 690±870 ml; median volume of 348.5 ml) was observed on the control side, whereas the treated side had adherence between the tissue layers, and minimal if any fluid accumulation (mean±SD, 44±53 ml; median volume of 15 ml) (p<0.01) (n=8) at 3 week necropsy. In animals survived to 12 weeks, two of the four control sides required aspiration of serous fluid, and dead space persisted for the entirety of the study in one animal. For the adhesive treated sites, none of the four animals showed signs of seroma at euthanasia, although serial aspiration was performed in one treatment site within the first month and resulted in resolution of the process. The adhesive was detected in the surgical site at 3 and 12 weeks, and independent histological analysis found it to be a non-irritant compared to control (no treatment). Long term evaluation of TissuGlu® Surgical Adhesive showed that it is capable of preventing the formation of seroma in this canine abdominoplasty model, indicating that it may be of clinical benefit in the prevention of seroma formation in patients undergoing abdominoplasty.

The Use of Dermabond® as an Adjunct to Wound Closure After Total Knee Arthroplasty: Examining Immediate Post-Operative Wound Drainage

Wound drainage after total knee arthroplasty (TKA) can be detrimental to surgical outcome. This IRB-approved randomized, prospective, blinded study examined the use of Dermabond® as an adjunct to wound closure after TKA. We proposed that Dermabond® supplementation to wound closure would result in a significant decrease in wound drainage after TKA. After standardized closure, patients were randomized into experimental or control groups with the experimental group receiving Dermabond® supplementation. Standardized dressings were evaluated postoperatively and drainage units were compared using a Mann–Whitney U Test. The median drainage for the Dermabond group (153) was lower than the drainage for the control group (657) at a statistically significant level (P<0.001).