Closure Strips Research Articles

An inexpensive wound closure strip

COSTLY CHALLENGE The use of adhesive suture strips after placement of buried and subcuticular sutures is commonly accepted as a means to further reduce wound tension, approximate the wound edges, and protect wounds from external environmental factors such as microbiological contamination. However, such devices are not always readily available and have a relatively high cost depending on wound length (even more so when placed over skin glues) and their use can be time consuming.

Identification of new risk factors for wound separation in gynecologic malignancy surgery.

The purpose of this study was to compare prophylactic subcutaneous drainage plus subcuticular sutures versus staples for the risk of wound separation after skin closure following gynecologic malignancy surgery, and to investigate the risk factors of this procedure. Patients were divided into two groups: 120 patients who were treated with subcutaneous drainage plus subcuticular sutures (Suture group) and 201 patients with staples plus subcutaneous sutures (Staples group). In the Suture group, subcuticular tissue was approximated with interrupted 4-0 polydioxanone sutures, and adhesive closure strips were used on the skin surface. A 3.3-mm closed drainage was implicated in subcutaneous tissue. In the Staples group, subcutaneous tissue was approximated with interrupted polyglactin (Vicryl, Ethicon) sutures. Baseline characteristics were not significantly different between the two groups. Mean operation times were compatible (201 vs 196 min, P = 0.16). The incidence of wound separation was less in the Suture group than in the Staples group (3/120 vs 17/201, P = 0.033). Multiple logistic regression analysis revealed that the Staples group was an independent risk factor for wound separation (odds ratio 7.34, 95% confidence interval: 1.59-33.91, P = 0.011), independent of obesity, International Federation of Gynecology and Obstetrics stages, and operation time. None of the 14 obese patients in the Suture group showed surgical wound separation. The combination of a prophylactic subcutaneous drain and subcuticular sutures reduced wound separation after skin closure following gynecologic malignancy surgery. With the information regarding risk factors established in this study, the above method provides the best results to minimize the risk, particularly in obese patients.

Sutures versus Sterile Strips for Closure of Ankle Arthroscopy Portals: Prospective Crossover Trial

Either a nylon single suture or adhesive tape in the form of Steri strip are commonly used for the closure of portals in ankle arthroscopy. The purpose of this study was to compare the two methods with regards to their safety, complications and cosmetic result. This was a prospective cross over study of 100 patients who underwent ankle arthroscopy. Materials used for wound closure were either a 3-0 nylon suture or a single Steri strip. Portals were reviewed according to a validated wound scoring system. Parameters such as the age and gender of the patients, the duration of tourniquet use and the use of an intraarticular corticosteroid injection at wound closure were also studied. Ninety-five patients were included in the statistical analysis. No technique was found to be superior in terms of the wound description (p = 0.164), infection grade (p = 0.232), infection treatment (p = 0.557) and the cosmetic appearance (p = 0.371). Seventy-two percent of patients had a good to excellent cosmetic result. There were two cases of infection requiring administration of antibiotics, one from each method of closure. Of the independent parameters, the use of cortisone was related to a lower infection treatment score (p = 0.013). Patients with signs of infection had a shorter total tourniquet time compared to the patients with no infection (p = 0.002). The use of either a single suture or Steri strip in the closure of ankle arthoscopy portals has equivalent results. Both methods were safe with equivalent cosmesis and low infection rates.

Investigation of closure-strip details for connecting prefabricated deck systems

This article describes how the Bridge Office of the Ministry of Transportation of Ontario initiated a research project to investigate the use of precast bridge technology as an innovative approach to bridge construction and rehabilitation in 2001. Two potential precast systems were investigated: precast composite slab-on-girder beam elements connected with cast-in-place concrete closure strips, and full-depth precast concrete deck slab panels laid across new or existing girders and connected with cast-in-place concrete closure segments. One of the main issues inherent in these precast systems is the presence of cold joints created by the closure pours and their potential effect on the overall deck system behavior. In addition, there is a need to develop effective connection details between the precast elements to provide continuity of reinforcement in the closure strips so that load sharing between girders is not compromised. This article presents the findings of a series of laboratory tests that were performed on 2/3-scale model of the closure strip system to study the serviceability and ultimate state behavior of the joint detail. Several types of reinforcement lapping systems were considered for the steel reinforcement in the closure strips: U-shaped bars, L-shaped bars, welded straight bars, and straight bars with full lap splice length as well as splices with reduced lap length but confined by steel spirals or stirrups. Scale models of the closure-strip connections were subjected to extensive cyclic loading and then tested to failure. Overall, the test results demonstrated the excellent performance of U-shaped, L-shaped, and welded straight reinforcing bars as connection details in the closure strips. The use of high-early-strength concrete in the closure pour was shown to have little effect on long-term performance, while a shortened lap length confined in a steel spiral was shown to be as effective as the conventional full-lap-length splice detail.

Letters

Ms. Shirland raises a valid concern regarding safe securement of the neonatal PICC catheter and its role in preventing catheter fracture and catheter embolism. Ms. Paulson and Ms. Miller’s response is appreciated [see the author’s response in Neonatal Network, November/December 2008, p. 427]. In Dislodgement Rates and Impact of Securement Methods for Peripherally Inserted Central Catheters (PICCs) in Children, Frey and Schears report methods of PICC securement include transparent dressings, skin closure strips, sutures, and catheter-specific securement devices.1 However, a specific procedure for the appropriate placement of the skin closure strips is not delineated. In PICC Complications in Neonates and Children, Frey describes catheter fracture, where the damage was caused by a “sterile-tape thread” in a skin closure strip.2 Given the extended dwell time expected with PICC catheters, placement of skin closure strips including sterile tape fibers directly overlying the catheter would, in combination with infant mobility, support the possibility of external forces (fibers, adhesive agent, activity) causing severance of the catheter over time, which cannot be discounted. In cases of catheter embolism, catheter fragments required cardiac catheterization for retrieval.2

Investigation of prefabricated bridge systems using reduced-scale models

In 2001, the Bridge Office of the Ministry of Transportation of Ontario, Canada, initiated a research project to investigate the use of prefabricated bridge technology as an innovative approach to bridge construction and rehabilitation. Two potential prefabricated systems were investigated: prefabricated composite slab-on-girder beam elements connected with cast-in-place concrete closure strips and full-depth prefabricated concrete deck-slab panels laid across new or existing girders and connected with cast-in-place concrete closure segments. The proposed systems are applicable to bridges that use steel or concrete girders and trusses as longitudinal loadcarrying members. This paper presents the findings of a series of laboratory tests that were performed on scale models to study the overall structural behavior of the bridge systems under service loads, the long-term load effect on the longitudinal cold joints, and the ultimate punching-load capacity of the concrete deck slab. The test specimens were subjected to a minimum of 7 million load cycles, after which ultimate-strength tests were conducted on the deck slabs. Overall, the test results demonstrated the excellent performance and integrity of the prefabricated bridge systems under the applied test loads.

Letters

I am writing concerning an article titled “Neonatal Peripherally Inserted Central Catheters: Recommendations for Prevention of Insertion and Postinsertion Complications,” published in Vol. 27, No. 4 (July/August 2008), pages 245– 257. Of concern are Figures 3 and 4 on page 253 titled securing the catheter with adhesive skin closure strips and looping the catheter. The instructions and pictures demonstrate how to secure the catheter using skin closure strips and show the strips placed over the catheter. This is of great concern. The manufacturer’s recommendations on BD L-Cath System state the following on page 8 line 26, “Secure the catheter and dress the site with a sterile dressing. Tapes and securing devices should never be applied directly to the non-protected catheter.” This caution is echoed in the article titled “Tiny Patients, Tiny Dressings: A Guide to Neonatal PICC Dressing Change,” published in Advances in Neonatal Care, Vol. 8, No. 3, pages 141–162. The author states the following, “Some hospitals use skin closure strips. If these are utilized, manufacturer’s recommendations should be followed, and they should never be placed directly overlying the catheter to avoid catheter breakage and embolism.” The author supports this statement with the following reference, Frey AM. PICC complications in neonates and children. Journal of Vascular Access Devices. 1999: 17–26. It is clear that skin closure strips used to secure the peripherally inserted central catheter pose great risk and must never be applied directly over the catheter. Thank you for sharing this important information with your readers.

Intraoperative Handling and Wound Healing of Arthroscopic Portal Wounds: A Clinical Study Comparing Nylon Suture with Wound Closure Strips

This prospective, single-centre study compared wound closure methods in patients undergoing arthroscopy. Closure of arthroscopic portal wounds with sterile adhesive strips is effective and convenient for wound management. The method was associated with a reduced potential for infection, faster renewal of tensile strength, greater cost effectiveness, and better cosmetic effects comparing with suture closure. This method of wound closure may also reduce the incidence of needle stick injury in the theatre environment. Thereby the incidence of percutaneous exposure following a surgical procedure may not facilitate transmission of blood borne pathogens such as human immunodeficiency virus (HIV), hepatitis C virus and hepatitis B virus. As a result it may reduce litigation in today's changing healthcare climate.

Flange-to-Flange Moment Connections for Precast Concrete Deck Bulb-Tee Bridge Girders

This paper reports findings on new flange-to-flange moment connections for precast concrete deck bulb-tee (DBT) bridge girders. In bridge systems made of precast concrete DBT girders, the concrete deck slab is cast with the prestressed, precast concrete girders at the production facility and then shipped to the bridge site. To make the deck continuous and allow for live load distribution, a concrete closure strip is placed between the precast concrete DBT girders. The objectives of this study are to develop a moment connection for DBT bridge girders and provide experimental data on the ultimate strength of the connection system. Study parameters include identifying crack formation and propagation patterns, failure modes, and ultimate load-carrying capacities. Four moment connections were designed and six full-sized bridge panels were fabricated and loaded to failure to test the developed connections. Effects of steel reinforcement, joint width, and location of the simulated wheel load on the connection designs are discussed. A joint design is considered successful if, prior to failure, the experimental wheel load satisfies North American bridge code requirements. Data show that most of the connection designs satisfy the wheel load specifications. Results indicate that the location of the wheel load on the deck slab affects the ultimate load-carrying capacity of the developed connections. Connections typically failed due to flexure.

Traumatic and surgical wounds

Management of traumatic and surgical wounds has had a chequered history. For example, in 1346 at the Battle of Crecy, France, foot soldiers were issued with cobwebs to staunch haemorrhage...

Economic comparison of methods of wound closure: wound closure strips vs. sutures and wound adhesives

Our objective was to review and assess the treatment of low-tension wounds and evaluate the cost-effectiveness of wound closure methods. We used a health economic model to estimate cost/closure of adhesive wound closure strips, tissue adhesives and sutures. The model incorporated cost-driving variables: application time, costs and the likelihood and costs of dehiscence and infection. The model was populated with variable estimates derived from the literature. Cost estimates and cosmetic results were compared. Parameter values were estimated using national healthcare and labour statistics. Sensitivity analyses were used to verify the results. Our analysis suggests that adhesive wound closure strips had the lowest average cost per laceration ($7.54), the lowest cost per infected laceration ($53.40) and the lowest cost per laceration with dehiscence ($25.40). The costs for sutures were $24.11, $69.91 and $41.91, respectively; the costs for tissue adhesives were $28.77, $74.68 and $46.68, respectively. The cosmetic outcome for all three treatments was equivalent. We conclude adhesive wound closure strips were both a cost-saving and a cost-effective alternative to sutures and tissue adhesives in the closure of low-tension lacerations.

Economic comparison of methods of wound closure: wound closure strips versus sutures and wound adhesives

Economic comparison of methods of wound closure: wound closure strips versus sutures and wound adhesives

Avoiding stitch abscesses in subcuticular skin closures: the L-stitch: R.C. Mahabir, B. Christensen, G.K. Blair, et al. Can J Surg 46:223–224, (June), 2003

A potential problem with the standard method of skin closure in pediatric surgery is the development of a skin abscess. To avoid this problem, we introduce a new stitch--the L-stitch. The technique involves passing the suture subcuticularly at the end of the incision and redirecting the needle at a 90 degree angle from the previous suture, before bringing it out to the skin surface. This stitch can be used in place of the initial and finishing knot of a running suture. It takes less time to perform than a square or a surgeon's knot and is less bulky. This technique is straightforward and, when used in conjunction with adhesive skin closure strips, provides strong, reliable skin closure, yielding excellent cosmetic results.

Tissue adhesive and adhesive strips for wound closure

Tissue adhesive and adhesive strips for wound closure

Prevention of Damage to Cuffed Catheters

Cuffed catheters, although not ideal for long-term use, are now used more frequently due to an increase in the aging population, in whom the vessels are not suitable for either arteriovenous fistulas or polytetrafluoroethylene (PTFE) grafts. Infections and thrombosis remain the major causes for removal or change of catheters. We recently identified eight catheter defects that required replacement of catheters. Of these, two were due to patient negligence: one catheter was accidentally severed while the patient was shaving; the other was snipped during a haircut. One was believed to have a manufacturing defect. One catheter sustained needle-prick damage near the hub while irrigating the catheter. Two catheters were lost due to needle pricks during skin closure, and one catheter sustained similar damage while fixing the suture wing to the skin. The other two were damaged by suture material slicing through the lumen of the catheter as it expanded due to increased blood flow during repeated dialyses. Importantly, several of these injuries to the catheters were not immediately obvious and were detected only after repeated use of the catheters. Delayed bleeding of cuffed catheters necessitating change or removal has not been reported. Such bleeding may be due to manufacturing defects, patient carelessness, or iatrogenic causes. Avoiding the use of sutures can minimize the latter. Skin closure strips and a double transparent dressing may serve the same purposes, such as securing the catheter and aiding wound healing. In addition, these dressings have the added advantage of being waterproof, bacteria-proof, and cost effective.

Skin closure at laparoscopy

To discern the best method of wound closure after laparoscopy based on patient acceptability of pain, complications, and cosmetic result. Randomized, prospective study. A university-affiliated hospital. Fifty-four women. Interventions. The women received interrupted 3-0 nylon sutures, subcuticular 3-0 polyglactin 910 sutures, or adhesive strips for skin closure. At the umbilical port site the rectus sheath was closed with a single 0 polyglactin suture and then one of the three materials for skin closure. The lateral ports were closed with a combination of these materials, allowing each patient to act as her own control. Pain was significantly less in wounds closed by subcuticular technique than in those closed by either transcutaneous suture or adhesive strips. This was seen for the 5-mm, 10-mm, and umbilical port sites. There was no statistically significant difference in the rate of reported complications or patient satisfaction between subcuticular and transcutaneous wound sites. We believe these results support subcuticular methods of wound closure after laparoscopic procedures.

Closure strip for atraumatic wounds

Closure strip for atraumatic wounds

The use of adhesive surgical tape in plastic surgery

Summary The use of adhesive sterile wound closure strips (Steri-strips) in relation to plastic surgery is outlined briefly. The strips appear to be of more universal use in conjunction with conventional suture materials than by their use alone. It is suggested that their use represents an important step forward in the search for the technique that will produce the invisible scar.