Subcuticular Group Research Articles

“SUBCUTICULAR (POLYGLECAPRONE 3-0) VERSUS THREE MATTRESS (POLYPROPYLENE 3-0) SUTURE TECHNIQUE FOR SKIN CLOSURE OF LOW TRANSVERSE INCISION IN OBG SURGERIES”

“SUBCUTICULAR (POLYGLECAPRONE 3-0) VERSUS THREE MATTRESS (POLYPROPYLENE 3-0) SUTURE TECHNIQUE FOR SKIN CLOSURE OF LOW TRANSVERSE INCISION IN OBG SURGERIES”

Advantages of skin closure with subcuticular suture for liver resection on postoperative and cosmetic outcomes: a propensity matched analysis.

The effects of subcuticular sutures on postoperative and cosmetic outcomes in patients who underwent liver resection have not been well studied. Here, we investigated the advantages of subcuticular suture compared to skin stapler regarding open liver resection. We assessed 342 patients who underwent liver resection at Nara Medical University between 2008 and 2015. They were divided into two groups: subcuticular suture and staple groups. Baseline characteristics and perioperative outcomes were retrospectively compared using one-to-one propensity score matching analysis. In this period, 179 patients underwent skin closure with subcuticular sutures and 163 patients underwent skin closure with staples. After propensity matching, 85 pairs of cases were matched. The incidence of wound infection was similar in the two groups (3.5% in the subcuticular suture group and 9.4% in the staple group; p = 0.119). The length of hospital stay was significantly shorter in the subcuticular suture group than in the staple group (10days vs 15days; p < 0.001). In addition, the rate of patients who were discharged within 7days after surgery was statistically higher in the subcuticular group (21.1% vs 3.5%, p = 0.001). Hypertrophic scar 6months after surgery was significantly less frequent in the subcuticular group (9.4% vs 25.9%, p = 0.010). Subcuticular sutures might be advantageous for liver surgery reducing length of hospital stay and proportion of hypertrophic scar.

Comparison of Wound Infection in Uncomplicated Acute Appendicitis by Subcuticular Suture and Interrupted Suture.

Postoperative complications such as wound infection and scarring are some of the major concerns regarding suturing techniques. This study is designed to evaluate postoperative outcomes of adhering subcuticular sutures in comparison to the interrupted suturing method in patients who underwent appendectomy for uncomplicated acute appendicitis. 240 patients were randomly assigned into two groups; 120 with interrupted and 120 subcuticular sutures after an appendectomy, at Shohada Ashayer hospital, Khorramabad, Iran. The prevalence of wound infection, three days after the surgery in the hospital and a week after discharge was determined and evaluated statistically. No wound infection was seen within three days of hospitalization in the subcuticular group whereas, 1 patient reported infection in the interrupted group, however, the difference was not statistically significant. A week after discharge, a patient was reported to have wound infection in the subcuticular group and 2 in the interrupted group. No significant difference was seen in this regard either. 55 females and 66 males received subcuticular sutures whereas, 74 males and 46 females were given interrupted sutures for wound closing. One male in interrupted and 1 male and female in the subcuticular group were referred for wound infection, after discharge, respectively. Among these groups, no significant differences were seen. In catarrhal appendicitis, the infection was reported in the interrupted group only which was not statistically significant. Subcuticular sutures provide better cosmetic outcomes without any additional complications in comparison to interrupted sutures.

Skin closure with Pfannenstiel incision in lower segment caesarean section; comparison of wound outcome with interrupted vs. subcuticular techniques

Introduction: Caesarean section is the most common surgical procedure performed in the world. A vast majority of the procedures are carried out with Pfannenstiel incision. Different techniques and materials are used to approximate the skin in caesarean section. Each method has its own advantages and disadvantages. The objective of the study was to compare surgical wound outcome and satisfaction of women who underwent Pfannenstiel incision closure with interrupted vs. subcuticular suturing in caesarean sections. Methods: A prospective comparison was carried out in 400 age and body mass index matched women who underwent lower segment caesarean section for the first time. Standard lower segment caesarean section was performed with assigning interrupted and subcuticular wound closure for 200 women in each group, following matching for BMI and age. Two arms were compared for wound complications, postoperative pain and overall satisfaction of the outcome. Results: There was no statistically significant difference between groups for baseline characteristics (age, BMI and category of caesarean sections). According to visual analogue scale 91% of women reported to have moderate to severe pain in interrupted group compared to 80% in subcuticular group (p Conclusions: Women who had subcuticular suturing method had less post-operative pain, better wound outcome and more satisfaction compared to interrupted suturing.

Comparison of skin closure technique with stapler and subcuticular suture in patients with inguinal hernia undergoing lichtenstein tension-free mesh repair – An open-label randomized controlled trial

Background: Both subcuticular suturing and stapler closure are used for skin closure. However, the superiority of one over the other is yet to be established clearly. Aims: This study compares the efficacy of skin closure technique by stapler and subcuticular suture in patients undergoing Lichtenstein repair for inguinal hernia. Methods: Elective inguinal hernia repair patients were randomized to undergo skin closure using either subcuticular sutures or staplers. Skin closure time in minutes, postoperative wound site pain using the Visual Analog Scale, wound cosmesis and scar outcome using the Patient and Observer Scar Assessment Scale, and patient satisfaction using the Likert scale were assessed. Results: A total of 38 patients with inguinal hernia were included: 20 in subcuticular suture group and 18 in stapler group. The scar outcomes assessed by patients (3.05 ± 1.83 vs. 4.94 ± 2.54; P = 0.0013) and observers (2.83 ± 0.98 vs. 4.44 ± 1.67; P = 0.0105) were significantly better in the subcuticular group. The time taken for skin closure was significantly longer in the suture group (P

Subcuticular interrupted versus continuous skin suturing in elective cesarean section in obese women: a randomized controlled trial

Objective: To compare the interrupted subcuticular skin closure with continuous one in obese women undergoing cesarean delivery. Materials and methods: A randomized controlled study conducted on 169 obese women with term uncomplicated singleton pregnancy who underwent elective cesarean delivery. They were randomized to either skin closure through continuous subcuticular sutures using vicryl 3/0 or interrupted subcuticular suturing using vicryl 3/0. The primary outcome parameter was occurrence of wound infection. Secondary outcomes included other skin complications, postoperative pain, operative duration and hospital stay Results: There was a statistically higher number of cases with wound hematoma (20 vs. 10, p = .04), infection (30 vs. 15, p = .008) and those who needed reclosure of wound (8 vs. 0, p = .004) in the continuous when compared to women in the interrupted subcuticular group, respectively. Healing with secondary intension was significantly higher in women in the continuous subcuticular group (52 vs. 26, respectively, p < .001). The number of cases with wound seroma and keloid formation was not statistically different between the two groups (25 vs. 19, p = .272 and 12 vs. 5, p = .069 in the continuous vs. interrupted groups, respectively). The duration of CS was longer in those who underwent interrupted closure when compared to continuous ones. However, that was statistically insignificant (40.95 + 6.376 vs. 37.05 + 6.455, p = 0.14). Conclusions: Most surgical wound complications were reduced if skin closure with continuous subcuticular sutures is replaced with interrupted one.

Evaluation of intradermal absorbable and mattress sutures to close pilonidal sinus wounds with Limberg flap: a prospective randomized comparative study.

PurposeWe aimed to compare skin closure techniques, standard (intermittent mattress) and continuous subcuticular sutures, following Limberg flap procedure.MethodsFrom July 2013 to July 2015, 92 patients with sacrococcygeal pilonidal disease were prospectively randomized into 2 groups consisting of 46 patients for both. Patients underwent sinus excision and closure with Limberg flap; continuous subcuticular suture was used in subcuticular group (SG) and intermittent mattress sutures were used in mattress group (MG) for skin closure. Characteristics of patients, features of pilonidal disease, macerations, infections, wound dehiscence, flap necrosis, operation time, time of drain removal, wound complications, early recurrences, and time till return to work were compared between the 2 groups.ResultsThere was no statistical difference between groups per sex, age, body mass index, smoking, number of sinuses, depth of intergluteal sulcus, distance of incision to anus, volume of extracted tissue, number of hair follicles per cm2, recurrence, operation, and mean follow-up time. Two patients showed signs of wound complications (4.4%) in SG, whereas 8 cases (17.4%) showed signs in MG (P < 0.05). One patient in SG had surgical site infection and required antibiotics (2.2%), where as there were 6 cases treated in MG (13.0%) (P < 0.05). Removal of drain tube, and time till return to work rates are lower for SG than MG (P < 0.05).ConclusionIn conclusion, surgical procedures which include Limberg flap method and subcuticular closure may reduce infection and maceration rates. Future studies are needed to achieve greater detailed evaluation.

Wound complications after chemo-port placement in children: Does closure technique matter?

PurposeWound dehiscence after chemo-port placement is a rare but potentially significant complication. We hypothesize that by using a simple running skin closure technique during chemo-port placement the rate of wound dehiscence and overall wound complications can be significantly decreased. MethodsIRB approval was obtained and patients <18years that received a tunneled central line with port from June 2012 to April 2016 were analyzed. Data collected on patients included patient demographics, skin closure type, and wound complications within 30days. Chi-square was performed to examine the univariate association with skin closure technique and wound dehiscence. Logistic regression was performed to examine the multivariable association between skin closure type and wound dehiscence and to compute odds ratios. ResultsThere were 259 ports placed in this cohort: 125 used simple running skin closure technique, and 134 used the subcuticular skin closure. Patients were found to not have any difference in rate of dehiscence or overall wound complications based on gender, age, location of port, or use of steroids or chemotherapy within 1week of port placement. When compared, only 1 case (0.80%) in the simple running group vs 10 cases (7.46%) in the subcuticular group experienced a wound dehiscence [unadjusted OR=14.07 (1.69, 116.99) p=0.0144]. When comparing overall wound complications the simple running group had 3 (2.4%) versus 12 (8.96%) in the subcuticular group [unadjusted OR=4.78 (1.27, 17.94) p=0.0203]. When adjusting for port-number both dehiscence and overall wound complications remained statistically significant. ConclusionWe conclude that the simple running skin closure for chemo-port placement in children has superior outcomes in regards to prevention of dehiscence and overall wound related complications when compared to the subcuticular technique.

A Comparative Study of Stapled Vs Subcuticular Vs Simple Interrupted Closure of Inguinal Hernia Incision

Introduction:Hernia repair is one of the most common surgical procedure performed by general surgeons. With increasing knowledge about accelerated rehabilitation, the surgeons are under pressure to reduce the duration of hospital stay, due to which the method of skin closure has gained importance. The two main techniques of skin closure used by surgeons, are removable skin staples and skin sutures. We decided to study the various skin closure techniques in hernia surgery. Material and Method:The present study was a comparative study carried out at a tertiary care hospital over a period of two years. Total 90 patients of hernia were included in the present study. Patients were divided into 3 groups based on the method of skin closure applied. Main parameters investigated were postoperative pain, postoperative wound infection rates, cosmetic acceptability of scar and time required for skin closure. Statistical analysis was used wherever applicable. Results:The incidence of hernia is common in the younger age group, the mean age being in the 41years. The majority of cases were unilateral (right side); right sided indirect inguinal hernia was the most frequent type observed in this study. At 48 hrs both stapled and subcuticular group have comparable but not significant pain i.e. they experienced only mild, nagging pain. At discharge Subcuticular closure group has significantly less pain. At 48 hrs, highest wound infection rate was in subcuticular group (60%). 73.3%of patients having skin closure using stapler didn’t had any wound infection at 48 hrs. At time of suture removal, highest number of wound complication occur in subcuticular group. Conclusion:Subcuticular closure of inguinal skin incision gives best cosmetic scar to patients. Subcuticular skin closure technique is painless. Skin Stapler is most rapid method of skin closure. Least wound complications are with use of skin stapler.

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.

Absorbable Subcuticular Staples Compared With Suture for Cesarean Closure

INTRODUCTION: Cesarean skin closure data are limited, although recent studies indicate subcuticular suture is superior to external metal staples. The INSORB subcuticular staple is designed to combine the speed of a stapler with the superior wound approximation of suture, but data on INSORB are limited. This study compared INSORB staples with subcuticular suture for cesarean skin closure. METHODS: In this prospective, randomized, nonblinded, parallel-group trial, patients were stratified by prior cesarean delivery, body mass index (BMI, calculated as weight (kg)/ [height (m)]2), and surgeon skill level. Eligible women were at least age 18 and 24 weeks of gestation.Exclusion criteria were BMI greater than 50, chorioamnionitis, intrauterine fetal death, and multifetal gestation. The primary outcome was operative time. Secondary outcomes included patient and surgeon satisfaction, needlestick injury, pain, wound complications, and cost. RESULTS: Of 220 randomized patients, 206 were included in the final intention-to-treat analysis (103 per group). Baseline characteristics were similar. The subcuticular staple group had significantly shorter skin closure time (2.6 versus 8.5 minutes, P<=.001) and trended toward shorter operative time (54.0 versus 58.0 minutes, P=.053). The cost reduction with subcuticular staples was $172 – $829 per case. There were no differences in analgesic use, wound complications, or patient satisfaction. One needlestick injury occurred with suture. Surgeons were more likely to recommend (97% versus 85%, P=.004) and use (98% versus 82%, P<=.001) subcuticular staples in the future. CONCLUSION: For cesarean delivery, the INSORB staple is faster and more cost-effective than subcuticular suture and has equivalent analgesic use, wound complications, and patient satisfaction. (C) 2015 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Evaluation of Healing Intervals of Incisional Skin Wounds of Goats Closed with Three Suture Patterns

The aim of this study was to compare the healing intervals among simple interrupted (SI), ford interlocking (FI) and subcuticular (SC) suture patterns in goats. We hypothesized that these common suture patterns used for closure of incisional skin wounds may have effect on the healing interval. To test this hypothesis, two parameters (subjective healing interval and histologic objective healing interval) were used to investigate the healing interval of the three suture patterns. Our findings showed that, there was significant differences (P<0.05) in subjective healing interval between subcuticular (SC) withford interlocking (FI), but there was no significant difference between subcuticular with simple interrupted patterns. There were also no significant differences between ford-interlocking and simple interrupted. Histologic findings at seventh day post surgery revealed low polymorphonuclear leukocytes (PMNL) infiltrations and early fibroblast, collagen fibers and epidermal keratinization in the subcuticular group in comparison with the two other groups. At fourteen day post-surgery, there was marked reduction of inflammatory infiltrates in the subcuticular group when compare with the two other groups, while the collagen fiber density and epidermal keratinization increased in the subcuticular group. At twenty first-day post - surgery , there were no inflammatory cells in subcuticular group, while collagen density was higher, and the orientation of the collagen fibers were horizontal, suggestive of faster healing in comparison with the simple interrupted and ford interlocking groups. It was concluded as measured by subjective healing interval and histologic objective healing interval that surgical skin-wound closed by subcuticular suture pattern alone healed faster than simple interrupted and ford interlocking suture patterns reinforced after subcuticular closure, on the other hand simple interrupted pattern healed faster than ford interlocking. Keywords: Incisional wound healing, histology, goat, suture patterns, healing interval

Risk Factors for Wound Complications After Surgery for Gynecologic Malignancies

Factors in wound complications such as surgical duration and suture methods are surgeon-side problems. The purpose of the present study was to retrospectively evaluate the incidence of wound complications in patients who underwent wound closure with stainless steel staples or subcuticular sutures in surgery for gynecologic malignancies and to retrospectively determine the risk factors for wound complications. From April 2007 through March 2012, a cohort of 317 consecutive patients undergoing surgery for gynecologic malignancies was evaluated in the retrospective study. The skin was closed with stainless steel staples before March 2010 (staples group). From April 2010, the skin was closed by subcuticular suturing (subcuticular group). We compared the incidence of wound complications between 2 groups and evaluated independent multivariate associations with the effect of clinical parameters on occurrence of wound complications. The incidence of wound disruption was 7.3% (23/317): 12.1% (17/140) in the staples group and 3.4% (6/177) in the subcuticular group (P = 0.0029). The incidence of wound infection was 2.5% (8/317): 5.0% (7/140) in the staples group and 0.6% (1/177) in the subcuticular group (P = 0.0124). Multivariate analyses performed with wound disruption as the end point revealed long-term steroid treatment, subcutaneous thickness, and skin staples as independent predictors. Subcutaneous thickness and skin staples were independent factors significantly associated with the possibility of wound infection. The findings of the present study indicated that risk factors for wound complications after surgeries for gynecologic malignancies include, as a surgeon-side problem, the use of staples for skin closure, and as a patient-side problem, a subcutaneous thickness of more than 30 mm.

Retrospective Review of Wound Complications Following Skin Closure by Either Percutaneous Metal Staples or Absorbable Subcuticular Staples in Patients Undergoing Cesarean Delivery

Objective: To determine the wound complication rate of patients undergoing cesarean delivery skin closure by either percutaneous metal staples or absorbable subcuticular staples in a large teaching hospital. Methods: This was a retrospective chart review of six hundred sixty patients who underwent cesarean delivery skin closure with either metal staples or absorbable staples. The primary outcome examined was the development of any wound complications. Results: Two hundred forty eight patients were eligible for analysis in the metal staple group compared to sixty-five patients in the absorbable staple group. A 7.7% wound complication rate was observed in the absorbable staple group compared to a 21.3% wound complication rate in the metal staple group. A statistical difference (p=0.01) was noted between the two groups. Body mass index between both groups were also statically different yielding 37 kg/m2 in the metal staple arm group versus 32 kg/m2 (p ≤ 0.001) in the absorbable staple group. Conclusion: Percutaneous metal staples were associated with more wound complications compared to absorbable subcuticular staples. Body mass index was greater in the percutaneous metal staple group as compared to the absorbable subcuticular staple group.

Comparison of three suture techniques in closure of caprine skin incision: cosmetic and cost considerations

The cosmetic and economic evaluations of three suture techniques were evaluated in closure of caprine skin incision. Fifteen apparently healthy male and female intact goats, free of any dermatological lesions were used for the investigation. They were randomly grouped into three; A (Subcuticular); B (Ford interlocking) and C (Simple interrupted). Cosmetic appearance of the surgical site was assessed on day 7, 14 and 21 post surgery using standard procedure as described by Sakka et al , 1995. There was statistical significant difference (P 0.05) at day 21 post surgery; in the entire scoring interval, subcuticular group had the best score. There was also statistical significant difference (P<0.05) in the three cost of suture materials used with the subcuticular suture pattern being the most economic. It was concluded that subcuticular suture patter gave the best cosmetic outlook and most economic in closure of caprine skin incision.

Outcome of colostomy closure with different skin closure techniques in a developing country

Colostomy site, which is a potentially contaminated wound, is traditionally closed with interrupted skin stitches and placement of intraperitoneal or parietal or both drains; often with poor cosmetic outcome in our country. This study aims at prospective evaluation of colostomy closure wounds by different techniques. This study was carried out in all infants and children with colostomy (for different pathologies) admitted for colostomy closure in our institute from August 1, 2006 to February 29, 2008. Patients were divided into two groups: Group A with colostomy closure without any drain and subcuticular skin closure and Group B with colostomy closure with both intraperitoneal and parietal drain and interrupted skin closure. Patient's details, including age, sex, body weight, diagnosis, preoperative bowel preparation, peroperative antibiotics, postoperative wound infection, anastomotic leaks, duration of hospitalisation and postoperative follow-up for wound assessment, were recorded. By the end of February 2008, 151 cases of colostomy closure were recorded, 70 in Group A and 81 in Group B. Statistical analysis of the data showed no statistically significant difference in wound infection and anastomotic leak between the two groups. On postoperative follow-up, wound assessment showed significantly better cosmesis in the no drain subcuticular group. This study shows that closing colostomies without any drain and subcuticular skin closure does not result in any increased incidence of wound infection and has better cosmetic results.