Subcuticular Absorbable Suture Research Articles

Closure of skin with simple interrupted Prolene suturing versus subcuticular continuous Monocryl suturing after ORIF of distal radius fractures

Objectives: The aim of the study was to assess the effects of subcuticular absorbable versus interrupted nonabsorbable sutures for skin closure after distal radius fracture (DRF) fixation surgery in adults on post-operative pain, hand function, scar satisfaction, wound inflammation, and adverse events. Methods: A retrospective study was conducted with 65 patients undergoing DRF surgical treatment between March 2022 and December 2022. Patients were divided into two groups: Traditional interrupted suture with Prolene® (n = 27) and subcuticular continuous suture with Monocryl® (n = 38). Pain intensity, complications, and cosmetics were evaluated. Results: Subcuticular continuous suture with Monocryl® was superior to traditional interrupted suture with Prolene® in terms of the number of complications and esthetic and functional outcomes. Conclusion: This study concluded that the subcuticular suturing with absorbable monofilament Monocryl® proved advantageous compared to simple interrupted suturing with Prolene® because it presented better results regarding pain intensity and esthetic results, with fewer complications.

An approach for cutting interrupted buried dermal sutures

Reconstructing surgical defects often requires various suturing techniques. Buried dermal sutures are commonly utilized for wound closures, achieving superior aesthetic outcomes and a low risk of wound infection.1Zhang W. Xie J. Zeng A. The origin and development of interrupted subcuticular suture: an important technique for achieving optimum wound closure.Dermatol Surg. 2022; 48: 619-624Crossref PubMed Scopus (1) Google Scholar,2Hideki B. Hideyuki S. Kentarou M. Uchida Eiji Tokunaga A. Prevention of incisional surgical site infection using a subcuticular absorbable suture in elective surgery for gastrointestinal cancer.Int Surg. 2015; 100: 999-1003Crossref PubMed Scopus (5) Google Scholar Suture tail length, the length of the suture beyond the knot, is an important factor in ensuring satisfactory wound healing. Excessively long suture tails can protrude through the skin and predispose to wound infections. If cut too short, the knot could be cut or unravel, decreasing surgical efficiency and efficacy. Furthermore, using tissue scissors to cut sutures results in dulling and decreased life of tissue scissors. In this video tutorial (Video 1, available at www.jaad.org), we demonstrate a proper technique for cutting interrupted buried dermal sutures, reliably achieving the appropriate tail length. This technique is geared toward right-handed surgeons, but can be used for left-handed surgeons by reversing the direction in which the suture cutting scissors (SCSs) are rotated.1.Place index finger on the fulcrum of the SCS to optimize control of the scissor tips.2.Once the suture knot has been tied, the suture tails are pulled taut in an upward manner, with the most distal aspect of the SCS tips placed directly on top of the knot.3.Rotate the SCS clockwise 90° along the axis of the incision so that the thin edge of the SCS falls slightly into the wound (Fig 1).4.Cut the suture at this angle, using the most distal aspect of the scissor tips, leaving the knot intact with minimal suture tail. This reproducible method achieves consistent secure subcutaneous suture tail lengths, providing knot security, good cosmetic results, and may reduce infection risk. None disclosed. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI0NmQ4YWM2MjEwNmFmZDYzOTc5NjU5MzM1OWIwNDQyNiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjcwOTQ0ODIxfQ.lW8EG2N8vMv3VJM3XD-yjpZRmHiIh5Ao84f4yAj7q2GajNUvykA0BXsTaASYwyROR2rR9YlB-QGIdAJmQ33-phuRsVAPt5-FV3xqcrZqJSeJcYcIDsYZOS2WNrFakYcytZ0miAi83x3KxJRlFuTczyXmjPwqdHKa-sg6xCgmtQEDAhIeiA2bZGrHdQHEiHJs_G94OnloiV5JCMWnnsfqYaanFq5nrL-_yX5K4Yorw2Xec0qkgxqu7y0Aelhjzid-4nNfp1RzdG_TKAv4LIMVm2TF-fPfwclUsmeNyufL896FZiLzBM5VLzYwLAcvJCE-RS7nADtrsZjxZ9COy6wnNg Download .mp4 (6.1 MB) Help with .mp4 files Video 1

Suture Compared With Staples for Skin Closure After Cesarean Delivery: A Systematic Review and Meta-analysis.

Absorbable suture is the preferred method of cesarean skin closure compared with metal staples, because it decreases wound complications. Two recently published trials in patients with obesity contradict this evidence. The goal of this meta-analysis was to assess whether suture remains the recommended method of cesarean skin closure, regardless of obesity status. MEDLINE through OVID, PubMed, Cochrane Database, and ClinicalTrials.gov were searched from inception until September 24, 2021. Published randomized controlled trials (RCTs) comparing subcuticular absorbable suture with nonabsorbable metal staples for cesarean skin closure were included. Non-RCTs, RCTs that did not compare staples with suture, and ongoing trials were excluded. Fourteen studies met inclusion criteria. Data were individually abstracted and entered into RevMan. Fixed and random effects models were used. The Cochrane risk-of-bias tool was used to assess each study. The primary outcome, a sensitivity analysis of wound complications (excluding studies at high risk of bias), showed a significant decrease in wound complications when the cesarean skin incision was closed with suture compared with staples (10 studies; 71/1,497 vs 194/1,465; risk ratio [RR] 0.47, 95% CI 0.25-0.87). When all studies were analyzed, there remained a significant decrease in wound complications when the skin was closed with suture (14 studies; 121/1,780 vs 242/1,750; RR 0.59, 95% CI 0.36-0.97). Of the individual wound complications, wound separation was significantly decreased with suture closure compared with staples (11 studies; 55/1,319 vs 129/1,273; RR 0.43, 95% CI 0.32-0.58). In patients with obesity, there remained a significant decrease in wound complications with suture closure of the skin incision compared with staples (five studies; 34/507 vs 67/522; RR 0.51, 95% CI 0.34-0.75). Closure of the cesarean skin incision with suture decreased composite wound complications by 50% as compared with closure with staples; a significant decrease persisted regardless of obesity status. PROSPERO, CRD42021270378.

Does method of closure effect cesarean wound healing? Stapler versus absorbable sub-cuticular closure done in a tertiary hospital, Nepal

Introduction: Postoperative wound complications for women undergoing cesarean delivery constitute a major cause of morbidity. Data on wound healing based on the type of cesarean wound closure is limited. In this study, we assess the outcome of stapler versus absorbable sub-cuticular suture for skin closure of the cesarean wound. Method: Prospective observational study. All cesarean section patients during the period of six months (Dec 2019 to May 2020) at Patan Hospital, Nepal, whose skin closure was done by sub-cuticular suture or stapler technique were recruited in the study. Ethical approval was obtained. These patients were followed up postoperatively on the 10th day for wound outcome (redness, edema, hematoma, seroma, discharge, gaping). Number and proportion were calculated, chi-square test, and Fisher’s exact test at 95% confidence interval were used to see the association and p<0.05 was considered significant. Result: Out of 379 patients, 26(6.9%) were lost to follow-up. Among 353 patients, an unhealthy wound was seen in 7(1.98%) during follow-up. Of these unhealthy wounds, closure with stapler technique was 5(71.4%) and by sub-cuticular technique, 2(28.6%), statistically significant with a p-value of 0.014. Conclusion: Cesarean wound closure by sub-cuticular technique had a better wound outcome compared to closure by staplers.

Current technical surgical practice of emergency appendicectomy: a cross-sectional survey of surgical registrars in the UK.

Appendicectomy remains one of the most commonly performed procedures in general surgery. The aim of this study was to explore variation in operative techniques of an appendicectomy among surgical registrars in England. An anonymised survey was sent out to surgical registrars in the UK via email and social media. Subgroup analyses were performed comparing respondents based on their level of seniority and subspecialty background. A total of 168 respondents completed the survey, of whom 77.4% (130/168) were specialty trainees years 3-8 and 44.6% (75/168) were colorectal trainees. The majority (98.8%) preferred a laparoscopic approach to appendicectomy. Overall, 73.2% opted to use diathermy to divide an uninflamed mesoappendix. Half of the respondents (50%) preferentially used diathermy to control the appendicular artery, followed by 44% preferring use of metal or polymeric clips. The appendicular stump was most often secured with Endoloops (85.7%) when removing a macroscopically uninflamed appendix but less readily used in the visibly inflamed appendix (75.6%, p = 0.01). Colorectal and upper gastrointestinal registrars were more likely to use diathermy on the mucosa of the appendix stump compared with other subspecialties (p = 0.03). The majority (82.1%) of respondents extracted the appendix via a retrieval bag. Regarding skin closure, most respondents (69%) adopted absorbable subcuticular sutures. Preferential duration of postoperative antibiotic use following appendicectomy for complicated appendicitis varied among the respondents. There are similarities and differences across surgical registrars in terms of technical practice in appendicectomy, partially attributed to prior experience and training.

Effect of Wound Closure Technique in Proximal Femoral Fractures: A Prospective Cohort Study.

To compare the effect of different wound closure techniques on wound drainage, postoperative length of stay, and complications in patients with proximal femoral fractures, including femoral neck fractures (31A fractures) and peritrochanteric fractures (31B fractures). Prospective cohort study. Footscray Hospital, Western Health, Victoria, Australia; an acute teaching hospital. All inpatients receiving surgery for proximal femoral fractures at our facility between May 2016 and August 2017. A total of 486 consecutive patients who presented during the study period were included in the study. Three cohorts of consecutive patients were assigned to use either skin staples, monofilament absorbable subcuticular sutures (Monocryl), or, sutures with the addition of 2-octylcyanoacrylate (OCA) (Monocryl and Dermabond), respectively, for skin closure according to when the patients entered the study. The primary outcome of interest was prolonged wound drainage measured using a standardized technique after postoperative day 3. Secondary outcomes included inpatient length of stay and overall complications. We found a statistically significant increase in prolonged wound drainage in the staples cohort compared with the subcuticular sutures cohort and the sutures and OCA cohort (21.1% vs. 8.5% vs. 4.4%, P < 0.001). Inpatient length of stay was also significantly increased in the staples cohort (5.83 days vs. 4.78 days vs. 5.5 days, P = 0.005). There were no statistically significant differences between the 3 cohorts when comparing incidence of any medical complications, withholding of thromboprophylactic agents, or usage of topical negative pressure dressings. In patients with proximal femoral fractures, closure with staples has the highest rate of prolonged wound drainage and length of stay. Subcuticular sutures in combination with OCA result in the lowest incidence of prolonged wound drainage. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Skin-Adhesive Tape versus Interrupted Suture in Episiotomy Skin Repair: Randomized Control Trial

Introduction: The ideal method for perineal repair should be quick, easy to perform and preferably, with minimal pain. Aim: To compare skin adhesive tape and interrupted absorbable subcuticular suture for episiotomy repair after birth as regard postoperative pain, skin closure time and wound infection. Design: Prospective double-blinded randomized controlled trial. Methods: Three-hundred qualified patients were equally distributed between two groups. Group 1 underwent skin repair with skin adhesive tape, while group 2 underwent the currently traditional method for perineal repair by interrupted suture. Pain was evaluated at 2, 4, 6 and 12 hours after birth then daily until one week using Wong-Baker faces pain rating scale with verbal expression for pain intensity as primary outcome. Skin closure time and wound infection were also evaluated as secondary outcomes. Results: Statistically significant difference in pain was found at 4 and 6 hours, and 3, 4, 5 and 7 days after perineal repair in favor of the adhesive tape group (p = 0.04 and 0.02 respectively) (p = 0.002, 0.002, 0.003 and 0.001 respectively). No statistically significant difference was found in skin closure time between both groups, and no cases of wound infection occurred in both groups (p = 0.3). Conclusion: Skin adhesive tape may be superior to skin suturing in decreasing pain resulting from perineal repair after birth; however, further studies are needed to assess long-term effects, calculate costs and accurately measure patients’ satisfaction, which were not addressed in this study.

Skin closure after ileostomy reversal: comparative study between conventional linear versus purse-string suturing

Background: Wound infection and scarring are relatively common complication after stoma reversal. Immediate skin closing by conventional linear closure technique is associated with varying percentage of wound infection ranging from 2 to 41%. Delayed skin closure is associated with prolonged healing time and poor scar cosmesis. In order to overcome these problems, an alternative method of skin closure during stoma reversal has been suggested. It involves taking purse-string subcuticular absorbable sutures to close the skin during Ileostomy reversal. Our study is a comparative study between conventional linear skin closure and this alternative form skin closure in stoma closure procedures for the assessment of surgical site infection and scar cosmesis.Methods: 40 patients were enrolled for the study, divided in two groups, one undergoing purse-string skin closing (n=20) and the other undergoing linear skin closure (n=20) during stoma reversal. All the data was analysed using IBM SPSS version 21.0 taking p value less than 0.05 was taken as level of significance.Results: Surgical site infections were seen in 3 out of 20 patients in whom purse-string skin closure was done, while it was 9 out of 20 patients in primary linear closure during stoma reversal group. Post-operative pain was found significantly lesser in purse-string group compared to linear closure group on same and first post-operative day. Scar cosmesis was assessed using patient and observer scar assessment scale and was observed better in purse-string group of patients.Conclusions: Purse-string skin closure is a better alternative surgical option to consider during stoma reversal surgeries as compared to conventional linear closure.

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Modified round block technique for peripherally located early cancer breast, a technique that fits for all quadrants.

Round block technique (RBT) is an oncoplastic technique used in periareolar lesions, particularly in breasts with moderate ptosis or hypertrophy. However, it has some drawbacks including the possibility of late-onset scar widening, change in areolar shape, and asymmetry of the breasts. Moreover, it is hard to be performed with tumors located in periphery of breast. Modified round block technique (MRBT) is a new technique described to overcome these problems. A circumferential periareolar incision was made around the areola followed by subcutaneous dissection to the entire breast. Wide local excision (WLE) could then easily be performed with a good field of view, the breast tumor was excised with an acceptable macroscopic safety margin, and specimens were marked with orienting sutures for intraoperative frozen section. Remodeling of the breast was done, a close suction drain was placed, and the wound was narrowed with a nonabsorbable purse-string suture and attached to the NAC with continuous subcuticular absorbable suture. This study was conducted on 144 female patients diagnosed with breast cancer. The median size of the tumor was 2cm, the majority of the patients (66.7%) had moderate breast size (cup B) and the median distance of the tumor from NAC was 7cm. Patients' satisfaction was assessed according to Harvard scale and good to excellent results were found in 88.8% of the patients. There were no postoperative changes in areolar shape or position. Complications in the form of hematoma, wound dehiscence, and infection were encountered in 25% of the patients. Modified round block technique is an oncoplastic technique that permits excision of peripherally located breast cancer without excision of periareolar skin and it is suitable for all quadrant tumors. It also avoids the scar which occurs after ordinary breast-conserving surgery.

Mini-incision Hemithyroidectomy—Incision Closure with Subcuticular Suture Versus No Suture of Subcutaneous Tissue and Skin

Minimally invasive thyroid surgery techniques (MIT) have the advantage of reduction of tissue trauma, early hospital discharge, and better neck wound cosmetic appearance, while maintaining the same surgical outcome as traditional thyroidectomy. In addition to MIT, methods of skin closure contribute to the overall aesthetic outcome and patient’s satisfaction. Methods of skin closure depends largely on the surgeon’s choice based upon the need for a rapid, economic, and reproducible technique. The aim of the study is to compare the quality of resulting scar at 6 weeks after mini-incision hemithyroidectomy with subcuticular absorbable sutures or no subcuticular or skin sutures for the closure of the incision. Methods. There are 102 patients undergoing mini-incision hemithyroidectomy. Fifty two patients were randomly assigned to closure with approximation of subcutaneous tissue and skin by bringing the wound edges together by pressing with forceps and the other 50 with subcuticular absorbable suture. Post-operatively patients were assessed for pain and it was observed that pain was less in group treated without skin or subcutaneous sutures. At 6 weeks, the scar was evaluated by the patient after viewing in the mirror and graded as 1-5. Results. Pain during the postoperative period was significantly less in patients without subcutaneous or skin sutures. Assessment of scar appearance by the patients showed a statistically significant difference in favor of no skin or subcutaneous suture (n=48) as compared to subcuticular suture (n=40). Conclusion. Incision closure of mini –incision hemithyroidectomy without subcuticular or skin sutures and only by approximation had less pain postoperatively as compared to subcuticular suture. Scar assessment by patients revealed better satisfaction by this method.

Absorbable subcuticular staples versus suture for caesarean section closure: a randomised clinical trial.

To compare outcomes of efficiency, safety, patient, and surgeon satisfaction between absorbable subcuticular staples and subcuticular suture for caesarean section skin closure. A prospective, randomised, non-blinded, parallel-group trial. Mayo Clinic Family Birth Center in Rochester, MN, USA. At least 18 years old and 24 weeks' gestation, undergoing caesarean section. Exclusion criteria were body mass index >50, chorioamnionitis, intrauterine fetal death, and multifetal gestation. Patients were stratified by prior caesarean section, body mass index, and surgeon level and randomised to absorbable subcuticular staples or subcuticular suture. Electronic medical records and surveys were used. Primary outcomes were total operating time, from incision start to close. Secondary outcomes included subcuticular skin closure time, patient and surgeon satisfaction, percutaneous injuries, pain (analgesic use), cosmesis, and wound complications. Of 220 randomised patients, 206 were included in the final analysis (103 per group). Baseline characteristics were similar. The primary outcome of total operative time was not significantly different between groups [54.0 (44.9-63.6) versus 58.0 (50.4-68.2) minutes, P = 0.053]. The subcuticular staple group had shorter subcuticular skin closure time [median 2.6 (1.8-4.0) versus 8.5 (6.2-10.5) minutes, P < 0.001]. There were no differences in analgesic use, wound complications, cosmesis or patient satisfaction. One needlestick injury occurred with suture. Surgeons were more likely to recommend (97% versus 85%, P = 0.004) and use (98% versus 82%, P < 0.001) absorbable subcuticular staples. For caesarean section skin closure, absorbable subcuticular staples did not result in significantly different total operative times compared with sutures. Analgesic use, wound complications, and cosmesis were comparable. Patient and surgeon satisfaction were high with both methods. Absorbable subcuticular staples associated with a similar total operative time compared with suture.

Patient satisfaction and cosmetic outcome in a randomized study of cesarean skin closure

Objective: To evaluate patient satisfaction and patient and physician assessment of scar appearance after cesarean skin closure with suture versus staples.Methods: Women undergoing cesarean delivery (CD) at ≥23 weeks’ gestation via low-transverse skin incisions at three hospitals in the CROSS Consortium were randomized to receive skin closure using subcuticular absorbable suture or nonabsorbable metal staples. The primary outcome of this substudy, patient satisfaction, was assessed by surveys at the postpartum visit using a 10-point Likert scale. Scar outcomes according to patients and trained observers were assessed at the primary research site using the Patient and Observer Scar Assessment Scale (POSAS). The POSAS is comprised of a patient-completed assessment including subjective data such as pain and itchiness, and an observer-completed assessment about cosmetic criteria.Results: Between June 2010 and August 2012, 746 women were randomized; 370 received suture and 376 received staples. Satisfaction data were available for 606 (81%). Complete patient scar assessment data were available for 577 (77%) and complete observer scar assessment data were available for 275 (57% of the 480 planned for evaluation at the primary research site). Demographic data for women in the two groups were similar. Satisfaction with the closure method was higher (superior) among women who received suture closure: median 10 (interquartile range 9, 10) versus 9 (interquartile ranges (IQR) 6, 10); p < .01. The suture group also had higher satisfaction with the scar’s appearance at the postpartum visit: median nine (IQR 7, 10) versus 8 (IQR 6, 10); p = .02. Receiving one’s preferred closure method was associated with higher patient satisfaction, and wound complications were associated with lower satisfaction. POSAS scores were superior (lower) in the suture group. Patient Scar Assessment Scale scores were median 15 (IQR 10, 25) for sutures versus 20 (IQR 11, 28) for staples; p < .01. Observer Scar Assessment Scale scores were median 12 (IQR 9, 15) for sutures versus 13 (IQR 9, 16) for staples; p = .01.Conclusions: Satisfaction with the closure method, satisfaction with the scar’s appearance, and patient and physician assessments of scar cosmesis were all superior in those closed with suture. These results further support the use of sutures for cesarean skin closure.Trial registration: ClinicalTrials.gov identifier: NCT01211600.

Randomized Controlled Trial of Octyl Cyanoacrylate Skin Adhesive versus Subcuticular Suture for Skin Closure after Implantable Venous Port Placement

PurposeTo compare early outcomes of skin closure with octyl cyanoacrylate skin adhesive versus subcuticular suture closure. Materials and MethodsOver a 7-month period, 109 subjects (28 men and 81 women; mean age, 58.6 y) scheduled to undergo single-lumen implantable venous port insertion for chemotherapy were randomly assigned to skin closure with either octyl cyanoacrylate skin adhesive or absorbable subcuticular suture after suturing the deep dermal layer. Subjects were followed for episodes of infection or dehiscence within 3 months of port implantation. At 3 months, photographs of the healed incision were obtained and reviewed by a plastic surgeon in a blinded fashion who rated cosmetic scar appearance based on a validated 10-point cosmesis score. ResultsOf subjects, 54 were randomly assigned to skin adhesive, and 55 were randomly assigned to subcuticular suture. No subjects had incision dehiscence. Infection rates at 3 months were similar between groups (2.1% vs 4.0%; P = 1.0). The mean cosmesis scores were 4.40 for skin adhesive and 4.46 for subcuticular suture (P = .898). The superficial skin closure time was 8.6 minutes for suture versus 1.4 minutes for skin adhesive (P < .001). ConclusionsScar cosmesis and patient outcomes did not significantly vary between skin adhesive versus subcuticular suture, although skin closure time was significantly less with skin adhesive.

Prevention of Incisional Surgical Site Infection Using a Subcuticular Absorbable Suture in Elective Surgery for Gastrointestinal Cancer.

This study examined whether subcuticular absorbable sutures actually reduce incisional SSI in patients undergoing surgery for gastrointestinal (GI) cancer. Surgical site infection (SSI) is still a source of major complications in digestive tract surgery. Reportedly, incisional SSI can be reduced using subcuticular suturing. We performed subcuticular suturing using a 4-0 absorbable monofilament in patients undergoing elective surgery for GI cancer beginning in 2008. Using an interrupted technique, sutures were placed 1.5-2.0cm from the edge of the wound, with everted subcuticular sutures created at intervals of 1.5-2.0cm. The control group consisted of cases in which the common subcutaneous suture method using clip. One hundred cases were examined in the subcuticular group. The incidence of SSI was 0% in the subcuticular suture group, compared with 13.9% in the control group; this difference was significant. Incisional SSI can be prevented using the devised subcuticular absorbable sutures in patients undergoing elective surgery for GI cancer.

Suture versus staples for skin closure after cesarean: a metaanalysis

We sought to perform a metaanalysis to synthesize randomized clinical trials of cesarean skin closure by subcuticular absorbable suture vs metal staples for the outcomes of wound complications, pain perception, patient satisfaction, cosmesis, and operating time. A systematic search was performed using MEDLINE, Cochrane Databases, and ClinicalTrials.gov registries. We included randomized trials comparing absorbable suture vs metal staples for cesarean skin closure. Data were abstracted regarding wound complications, patient pain perception, patient satisfaction, cosmesis as assessed by the physician and patient, and operating time. Twelve randomized trials with data for the primary outcome on 3112 women were identified. Women whose incisions were closed with suture were significantly less likely to have wound complications than those closed with staples (risk ratio, 0.49; 95% confidence interval [CI], 0.28-0.87). This difference remained significant even when wound complications were stratified by obesity. The decrease in wound complications was largely due to the lower incidence of wound separations in those closed with suture (risk ratio, 0.29; 95% CI, 0.20-0.43), as there were no significant differences in infection, hematoma, seroma, or readmission. There were also no significant differences in pain perception, patient satisfaction, and cosmetic assessments between the groups. Operating time was approximately 7 minutes longer in those closed with suture (95% CI, 3.10-11.31). For patients undergoing cesarean, closure of the transverse skin incision with suture significantly decreases wound morbidity, specifically wound separation, without significant differences in pain, patient satisfaction, or cosmesis. Suture placement does take 7 minutes longer than staples.

Comparison of 2 Methods of Incision Closure in Patients With Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion Surgery

A prospective, randomized, and controlled clinical trial. To compare surgical zipper with subcuticular Monocryl sutures in terms of incision closure time, cosmetic results, and the complication rate in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) surgery. In previous literatures, the application of surgical zipper to incision closure has been reported to be associated with a favorable outcome. However, in the PSF surgery of patients with AIS, the use of surgical zipper has not been described. Ninety female patients with AIS undergoing PSF were assigned randomly to 2 incision closure groups either using surgical zipper or using the 4-0 absorbable subcuticular suture. The incision outcome was evaluated with the Hollander Incision Evaluation Score at 7 days, 2 weeks, 6 months, and 1 year after surgery, respectively. Besides, a visual analogue scale was allocated to each patient to rate the cosmetic result of the incision. The 2 groups were compared to determine the differences in terms of incision closure time, the complication rate, and cosmetic results. The incision closure using surgical zipper consumed significantly less time than that using subcuticular suture (45.3 vs. 540.5 s, P < 0.001). As for the cosmetic results, no significant differences of Hollander Incision Evaluation Score scores between the 2 suturing groups were found. Besides, patients' satisfaction with cosmetic outcome on a linear visual analogue scale also revealed similar results between the 2 groups. As for postoperative complications, we found 1 case of mild blister due to allergy to the tape of the dressings and 2 cases of incisional pain in the Monocryl suture group. The application of surgical zipper in PSF surgery is a safe and effective method. The ease and the speed of application make surgical zipper an attractive option for incision closure in patients with AIS undergoing PSF. 4.

Continuous versus interrupted skin sutures for non-obstetric surgery.

Most surgical procedures involve a cut in the skin, allowing the surgeon to gain access to the surgical site. Most surgical wounds are closed fully at the end of the procedure; this review focuses on these closed wounds. There are many ways to close the surgical incision, for example, using sutures (stitches), staples, tissue adhesives or tapes. Skin sutures can be continuous or interrupted. In general, continuous sutures are usually subcuticular and can be absorbable or non-absorbable, while interrupted sutures are usually non-absorbable and involve the full thickness of the skin - although some surgeons do use absorbable interrupted sutures. To compare the benefits and harms of continuous compared with interrupted skin closure techniques in participants undergoing non-obstetric surgery. In August 2013 we searched the following databases: Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase; and EBSCO CINAHL. We included only randomised controlled trials (RCTs) that compared skin closure using continuous sutures with skin closure using interrupted sutures, irrespective of whether there were differences in the nature of the suture materials used in the two groups. We included all relevant RCTs in the analysis, irrespective of language of publication, publication status, publication year or sample size. Two review authors independently identified the trials and extracted data. We calculated the risk ratio (RR) with 95% confidence intervals (CI) for comparing binary outcomes between the groups, and calculated the mean difference (MD) with 95% CI for comparing continuous outcomes. We performed meta-analysis using a fixed-effect model and a random-effects model. We performed intention-to-treat analysis whenever possible. We included five RCTs with a total of 827 participants. Outcomes were available for 730 participants (384 participants randomised to continuous sutures and 346 participants to interrupted sutures). All the trials were of unclear or high risk of bias. The participants underwent abdominal or groin operations. The only outcomes reported in the trials were superficial surgical site infection, superficial wound dehiscence (breakdown) and length of hospital stay. Other important outcomes such as quality of life, long-term patient outcomes and use of healthcare resources were not reported in these trials.Overall, 6.5% (39/602 participants, four trials) developed superficial surgical site infections. There was no significant difference between the groups in the proportion of participants who developed superficial surgical site infections (RR 0.73; 95% CI 0.40 to 1.33). A total of 23 participants (23/625 (3.7%), four trials) developed superficial wound dehiscence. Twenty-two of the 23 participants belonged to the interrupted suture group.The proportion of participants who developed superficial wound dehiscence was statistically significantly lower in the continuous suture group compared to the interrupted suture group (RR 0.08; 95% CI 0.02 to 0.35). Most of these wound dehiscences were reported in two recent trials in which the continuous skin suture groups received absorbable subcuticular sutures while the interrupted skin suture groups received non-absorbable transcutaneous sutures. The non-absorbable sutures were removed seven to nine days after surgery in the interrupted sutures groups whilst sutures in the comparator groups were not removed, being absorbable. The continuous suture technique with absorbable suture does not require suture removal and provides support for the wound for a longer period of time. This may have contributed to the difference between the two groups in the proportion of participants who developed superficial wound dehiscence. There was no significant difference in the length of the hospital stay between the two groups (MD -1.40 days; 95% CI -7.14 to 4.34). Superficial wound dehiscence may be reduced by using continuous subcuticular sutures. However, there is uncertainty about this because of the quality of the evidence. Besides, the nature of the suture material used may have led to this observation, as the continuous suturing technique used suture material that did not need to be removed, whereas the comparator used interrupted (non-absorbable) sutures that did need to be removed. Differences in the methods of skin closure have the potential to affect patient outcomes and use of healthcare resources. Further well-designed trials at low risk of bias are necessary to determine which type of suturing is better.

Quality of Scar after Total Thyroidectomy: A Single Blinded Randomized Trial Comparing Octyl-Cyanoacrylate and Subcuticular Absorbable Suture

Objective. To compare the quality of resulting scar at 6 weeks after total thyroidectomy with the use of the tissue adhesive octyl-cyanoacrylate or subcuticular absorbable suture for the closure of cervicotomy. Material and Methods. There are 50 patients undergoing a cervicotomy for total thyroidectomy. Twenty-five patients were randomly assigned to closure with tissue adhesive and 25 with subcuticular absorbable suture. At week 6 the scar was evaluated by blinded assessors with the Italian version of POSAS questionnaire, a validated wound scale composed of an observer's and a patient's subscale. Results. Assessment of scar appearance showed a statistically significant difference (p = 0. 038) in favor of subcuticular suture with respect to tissue adhesive on observer's assessment. The difference on patients' self-assessment was not significant. A multivariate analysis of six qualitative features of scars showed a significant influence on assessment for hyperpigmentation and relief of scar. The Italian version of POSAS proved to be reliable. Conclusion. Though tissue adhesive represents a valid method of skin closure, subcuticular absorbable suture provides a better aesthetic outcome in small cervical incisions in the early phase after thyroid surgery.

Randomized controlled trial comparing subcuticular absorbable suture with conventional interrupted suture for wound closure at elective operation of colon cancer

Subcuticular closure provides a superior cosmetic result in clean wounds. The aim of this work was to investigate the safety in terms of postoperative infection and cosmetic effectiveness of subcuticular wound closure after elective colon cancer surgery in clean-contaminated wounds. Patients who underwent elective resection of colon cancer were randomized to interrupted subcuticular and interrupted transdermal suture groups. The large bowel was prepared by mechanical washout with polyethylene glycol. All patients received metronidazole and kanamycin orally and flomoxef sodium once parenterally for antimicrobial prophylaxis. The primary end point was the incidence of incisional surgical-site infections within 30 days after operation. We assessed noninferiority of subcuticular suture within a margin of 10%. Analysis was by intent-to-treat. Secondary objectives include comparison of wound closure time, comfort, and cosmesis of the scar and satisfaction of patients. This study was registered with UMIN-CTR, UMIN000003005. A total of 293 patients were randomized to the two groups. Incisional surgical-site infection rates were 11.0% (90% confidence interval 7.0-16.3%) for both groups. The relative risk of subcuticular suture was 1.00 (0.58-1.73, one-tail P = .57). Interrupted subcuticular suture was noninferior to interrupted transdermal suture (P = .0088). Throughout 6 months after operation, patients expressed a significant preference for the subcuticular suture technique, noting rapid relief from pain, decreased vascularity, and smaller width, although the procedure took twice as long. Subcuticular suture did not increase the incidence of wound complications in elective colon cancer operation. Patients preferred a technique of interrupted subcuticular closure, citing better cosmetic results, and less pain.