Subcuticular Suture Research Articles

Comparative Efficacy of Knotless (Polyglyconate) Over Conventional (Poliglecaprone 25) Suture as a Wound Closure Material in Mandibular Impacted third Molar Surgery (MI3M)

Background: The third molar surgery is the most commonly practised minor oral surgery in dental clinic. Post-operatively the patient suffers from pain, swelling and trismus due to tissue injury during surgical procedure. After extraction of third molar, conventional sutures are used for primary closure of the wound. During the procedure the clinician get difficulties intra-orally related to knot placement, limitation of instrument accessibility and knot slippage. Barbed sutures are the knotless suture which help in adhering the tissue while suturing.
 Objectives: The primary focus of the study is to evaluate the efficacy of knotless suture as a wound closure agent in terms of post-operative pain, swelling, trismus, degree of wound healing and quality of life over the conventional one.
 Methodology: Two groups (study & control) with 20 individuals as subjects are considered for the study model. Systemically healthy individual with presence of at least one mesioangular or horizontal or vertically oriented mandibular impacted third molar(MI3M) with similar difficulty index, depth of, and relationship with ramus will be included in the study sample. Wound closure would be achieved by using 3-0 knotless suture using continuous sub-cuticular suturing technique for the study group and 3-0 conventional suture using simple interrupted suturing technique for control group respectively. Post-operatively measurement of pain, swelling, trismus, degree of wound healing and quality of life will be done.
 Expected Results: Knotless suture for closure of wound after MI3M surgery will be effective in reducing post-operative pain, edema and trismus and also helpful in better wound healing and improve quality of life.
 Conclusion: Use of knotless barbed suture after surgical removal of lower impacted third molar to simplify intra-oral suturing technique and to reduce post-operative pain, swelling, trimus and knot related complications would be a familiar and effective way which could be executed by a dental practitioner himself.

"A banana a day keeps wound failure away": comparing the utility of fruit, pig, and synthetic skins for suturing practice.

To investigate how suturing orange and banana peels, pig skin, and synthetic skin compares with the experience of suturing human skin. Interventional study of simple interrupted, vertical mattress, and subcuticular suturing on the four test materials. Fifteen consultants and six trainees in surgical and emergency medicine specialties at a New South Wales regional teaching hospital. The primary outcome was completion of simple interrupted, vertical mattress, and subcutaneous sutures. Secondary outcomes (assessed in a questionnaire) were similarity of suturing each material to suturing human skin, suitability of each material for practising each suture type, and similarity of each material to human anatomic skin types. All 21 participants completed simple interrupted sutures in bananas and pig and synthetic skins, and 15 in orange skin (P=0.002). All 21 participants completed vertical mattress sutures in pig and synthetic skins, 18 in bananas, and six in oranges (P<0.001). The numbers of completed subcuticular sutures were lower for the two fruits (orange, zero; banana, two) than for pig and synthetic skins (each, 21; P<0.001). Banana peel was rated as somewhat similar to human skin and recommended for practising simple interrupted and vertical mattress suturing. Bananas are not only useful as healthy snacks between theatre cases, but also for practising and improving simple and vertical mattress suturing skills. However, less portable and nourishing materials are required for subcuticular suturing practice, such as pig skin or synthetic skin.

Adhesive Taping Shows Better Cosmetic Outcomes Than Tissue Adhesives for Sutured Upper Extremity Incisions: A Single-Blind Prospective Randomized Controlled Trial.

Adhesive taping is commonly used to reinforce wound closure and approximate minor lacerations. Recently, tissue adhesives such as 2-octylcyanoacrylate have gained popularity because of their high tensile strength, bacteriostatic properties, and spontaneous peeling. We sought to evaluate the cosmetic result of upper extremity incisions closed primarily by subcuticular suture, randomizing the application of tissue adhesive vs adhesive taping to different halves of the same surgical incision. Subjects were recruited from patients undergoing common procedures at the senior surgeon's hand surgery clinic. After primary closure, we applied either quarter-inch adhesive tape or tissue adhesive to the proximal and distal aspects of the wounds, based on a preoperative randomization protocol. We assessed the scars at approximately 3 months (range, 2-5 months). Subjects completed a validated scar assessment questionnaire, and a blinded photograph was obtained to allow 2 independent surgeons to assess the scar. Mean age was 63 years (SD, 11.8 years; range, 21-88 years); 56% of patients were women, and 44% were men. Most of the incisions were open carpal tunnel release and thumb carpometacarpal arthroplasty (14 each). Adhesive taping showed a better overall mean score based on evaluation by the hand surgeons, a finding that was statistically significant. The greatest differences were observed between color and size, but no subcategories were significantly different. Patients reported nonstatistical, but slightly better overall cosmetic outcomes with adhesive taping rather than tissue adhesive. Adhesive strips provide a modest but significant improvement in cosmetic outcomes vs more expensive tissue adhesive. Future evaluation of closure methods that evaluate cost, speed of application, suture technique, and dressing will optimize scar appearance. [Orthopedics. 2022;45(1):e42-e46.].

Virtual medical student dermatologic surgery workshop increases confidence in suturing and skin biopsy skills in the era of COVID-19

Background: During the COVID-19 pandemic, many pre-clinical medical school courses were conducted virtually. In order to increase exposure to basic procedures in the remote learning setting, our group developed a virtual dermatologic surgery workshop.&#x0D; Objective: To evaluate whether a virtual dermatologic surgery workshop increases medical student confidence in their ability to perform suturing and skin biopsies.&#x0D; Methods: All 147 second-year medical students at the University of Pittsburgh watched 70 minutes of pre-recorded lectures that introduced suturing, skin biopsies, and other dermatologic procedures. Each student was provided with a suturing kit to remotely practice the following skills: simple interrupted suture, simple running suture, horizontal mattress suture, vertical mattress suture, running subcuticular suture, shave biopsy, and punch biopsy. Pre- and post-workshop surveys were distributed to the students and paired using a randomized de-identified number.&#x0D; Results: 117 (80%) students completed the pre-survey and 71 (48%) completed the post-survey. 61 (41%) responses were paired. The average baseline level of confidence ranged from 1.0 on a 10-point scale for subcuticular running suture to 2.4 for simple interrupted suture. The average level of confidence increased after the workshop for each skill, ranging from 3.7 for subcuticular running suture to 8.0 for instrument tie. In the paired responses, the average level of confidence increased significantly for each skill by an average of 5.5 points (SD=1.1, p&lt;.001).&#x0D; Conclusions: A virtual, asynchronous dermatologic surgery workshop significantly increases medical student confidence in their ability to perform suturing and skin biopsies.

Subcuticular Barbed Suture and Skin Glue Wound Closure Decreases Reoperation and Length of Stay in Geriatric Hip Fractures When Compared With Staples.

Introduction:Patients with geriatric hip fracture are notoriously frail and at risk for complications. Persistent postoperative wound drainage can lead to prolonged hospital stay, increased risk for infection, and need for revision surgery. The purpose of this study was to determine the effect of wound closure technique, barbed monofilament subcuticular suture and skin glue versus staples on rates of intervention for wound drainage and length of hospital stay after geriatric hip fracture fixation.Methods:A retrospective review of isolated hip fractures in patients older than 60 years at a single institution over a 3-year period was done. Hip fractures included femoral neck, intertrochanteric, and subtrochanteric femur fractures treated with internal fixation or arthroplasty. Skin closure technique, at the discretion of the operating surgeon, included either barbed subcuticular monofilament suture and skin glue or staples. Charts and radiographs were reviewed to determine patient characteristics, Charlson Comorbidity Index, type of wound closure, length of stay, and interventions for persistent wound drainage.Results:There were 175 patients in the barbed suture and skin glue group and 211 patients in the staples group. The barbed suture group had an average postsurgical length of stay of 5.0 days which was significantly lower than the staples group (7.0 days, P < 0.00001). In the staples group, 17 patients (8%) required incisional negative pressure wound therapy due to wound drainage with five patients (2.4%) returning to the operating room secondary to persistent wound drainage. No patients were observed in the barbed suture group that required intervention for wound drainage.Discussion:Barbed suture and skin glue closure is associated with markedly shorter hospital stay and fewer interventions for wound drainage when compared with staples after surgical treatment of geriatric hip fractures.

Comparing the running subcuticular technique versus the Donati technique in open carpal tunnel release: a randomized controlled trial

BackgroundThere are various skin suture techniques for wound closure following carpal tunnel release, and well-performed suturing will result in low post-operative scar tenderness. The aim of this study was to compare the Donati suture technique and running subcuticular technique in terms of surgical scar, post-operative pain and functional outcome in open carpal tunnel release.MethodsOne-hundred forty-two patients were randomized using a computer-generated random number table into two groups receiving either running subcuticular suturing or Donati suturing after surgical intervention. We evaluated postoperative scarring using the Patient and Observer Scar Assessment Scale (POSAS), pain intensity using a verbal numerical rating scale, and functional outcomes using the Thai version of the Boston Carpal Tunnel Questionnaire after surgical decompression for carpal tunnel syndrome at 2, 6, and 12 weeks. Continuous data are reported as mean ± SD while normally distributed or as median (interquartile range) when the distribution was skewed.ResultsLower scores at 2 weeks were given by the patients receiving the running subcuticular suture technique than the Donati suture technique (15.3 ± 4.8 vs 17 ± 4.6, respectively, P < 0.05) while the observer scores were not significantly different (15.6 ± 5.8 vs 16.7 ± 5.2, respectively, P = 0.15). At both 6 and 12 weeks post-surgical decompression both patient and observer scores were not significantly different. There were no differences between the groups in terms of VNRS pain scores and functional Boston Carpal Tunnel Scores at all time points.ConclusionsThis randomized controlled trial found that although scarring assessments were slightly better in the earliest period following wound closure after surgical decompression in carpal tunnel syndrome using the running subcuticular suture, the final results at 3 months postoperative were not significantly different.Trial registrationThe study was registered at https://www.thaiclinicaltrials.org/ (TCTR20191204002).

COMPARATIVE EVALUATION OF SUBCUTICULAR SKIN CLOSURE USING MONOCRYL (POLIGLECAPRONE 25) VERSUS ETHILON (MONOFILAMENT POLYAMIDE BLACK)

Skin suturing is most important aspect of surgery in this era of minimal surgery with patient wanting minimal scar of incised wound for cosmesis. Skin not only acts as protection but also as homeostasis therefore its proper closure is important to maintain its function. Various methods of skin closure are available like subcuticular suture, adhesive tapes, staplers, etc. Subcuticular suturing is one of the skin closuring technique involving stich placement in subcuticular tissue using various suture with minimal scarring. To compare outcome of MONOCRYL (poliglecaprone 25) versus Ethilon (Monofilament Polyamide Black) suture in Subcuticular technique of skin closure. This study was conducted at Dhiraj Hospital, Smt. B.K. Shah Medical Institute and Research Centre, Suman deep Vidyapeeth Deemed to Be University (An Institution), Pipariya, Vadodara. And included total of 50 patients who were randomly divided in two groups A &amp; B. Results were tabulated and analyzed statically to arrive at conclusion. Most of the patient belonged to 21-40 years. Female predominance was found in our study with 29 Female and 21 males. Wound Dehiscence occurred in 1 patient in Group A. 7 patients complained of Itching in Group A. Ethilon (Monofilament Polyamide Black) suture gives better result compared to MONOCRYL (poliglecaprone 25) in subcuticular wound closure.

Evaluation of three methods of suture for skin closure in total knee arthroplasty: a randomized trial

BackgroundThere are several studies comparing techniques and different materials, yet the results are not unanimous. We compared three methods of skin closure in total knee arthroplasty (TKA), including suture with single stitches and unabsorbable MonoNylon®, as well as continuous subcuticular suture with Monocryl® or barbed Stratafix® absorbable suture.MethodsA prospective, randomized study was conducted with 63 patients undergoing TKA between March 2016 and December 2016. Patients were divided into three groups: traditional suture MonoNylon® (n 22), subcuticular continuous suture with Monocryl® (n 20), and another barbed with Stratafix® (n 21). The closure time, length of wire used, pain intensity, possible complications, and cosmeses were evaluated.ResultsSubcuticular continuous suture using Monocryl® was superior to traditional suture using MonoNylon® as less thread was used (p 0.01) and a better cosmetic effect was achieved (p < 0.01), which was equal to Stratafix® aspects analyzed (p > 0.05). Complications were observed mostly in patients who used Stratafix®.ConclusionsThis study concluded that the subcuticular suture with absorbable monofilament Monocryl® proved to be advantageous compared to the others because it presented results equal to the barbed Stratafix®, however with fewer complications. Furthermore, Monocryl® was shown to be equal or superior to traditional MonoNylon® suture regarding in relation pain intensity, aesthetic result, and effective cost.Trial registrationWHO ICTRP identifier RBR78dh5d. Retrospectively registered: 07/29/2020.

Dermatological surgery: an update on suture materials and techniques. Part 1.

Significant variation exists in the surgical suture materials and techniques used for dermatological surgery. Many wound-closure techniques are now practised, including use of sutures, staples and topical adhesives. The focus of our review article is to summarize the latest evidence relating to suture materials and wound-closure techniques, considering the following areas: scar/cosmesis, pain, patient satisfaction, cost, infection and wound complications. We searched the databases Medline, PubMed and Embase using the keywords 'skin surgery', 'dermatologic surgery', 'sutures', 'suture techniques', 'suturing techniques' and 'surgical techniques' to identify relevant English-language articles. Absorbable superficial sutures may be a preferred alternative to nonabsorbable sutures by both patients and surgeons. Subcuticular sutures may be preferable to simple interrupted sutures for superficial wound closure, and there may also be a role for skin staples in dermatological surgery, particularly on the scalp. However, there remains limited evidence specific to dermatological surgery supporting the use of particular suture materials and suturing techniques. Further high-quality research is required, including multicentre randomized trials with larger cohorts.

Sutures versus clips for skin closure following caesarean section: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials.

To evaluate comparative outcomes of skin closure with clips and sutures after caesarean section (CS). We conducted a systematic search of electronic information sources and bibliographic reference lists. Wound infection, wound separation, haematoma, seroma, re-admission, closure time, length of hospital stay, patient scar assessment scale (PSAS) and the observer scar assessment scale (OSAS) were the evaluated outcome parameters. We identified 16 randomised controlled trials reporting a total of 4926 patients who had skin closure with sutures (n = 2724) or clips (n = 2202) following CS. Use of clips was associated with a significantly higher rate of wound separation (risk ratio (RR): 2.33, P = 0.004) and longer length of hospital stay (mean difference (MD): 1.21, P = 0.03) but shorter closure time (MD: 5.35, P = 0.00001) when compared to sutures group. There was no significant difference between the two groups in the risk of wound infection (RR: 1.12, P = 0.75), haematoma formation (RR: 2.46, P = 0.23), seroma (RR: 1.17, P = 0.73), re-admission rate (RR: 1.28, P = 0.73), PSAS (MD: 0.44, P = 0.73) and OSAS (MD: 0.32, P = 0.55). Trial sequential analysis showed the meta-analysis was conclusive for wound infection, wound separation and closure time; however, it was inconclusive for length of hospital stay, PSAS and OSAS due to risk of type 2 error. This meta-analysis of best available evidence (level 1) demonstrated that although skin closure with subcuticular sutures is more time-consuming than clips, it is associated with a significantly lower risk of wound separation and shorter length of hospital stay.

STAPLES VS SUBCUTICULAR SUTURES FOR SKIN CLOSURE IN INGUINAL HERNIA REPAIR: A COMPARATIVE STUDY

Inguinal hernia repair can be achieved by many techniques but skin closure still limited to only two methods; sutures and staples. In spite of that both have the same role in healing by approximation of skin edges; they differ in terms of cost, pain, cosmoses, wound complications,and time of wound closure.Two groups, each contain 50 patients were studied regarding inguinal hernia repair by using subcuticular suturing or staples for skin closure. The time of closure, cost, infection rate, pain at removal and scar acceptance were assessed and compared in the two groups.The mean time was shorter in staples group (8.77 min. Vs 2.35 min.) with a p-value <0.05.Stapler cost was significantly higher than sutures (12 USD VS 2 USD) and p<0.05. Infection rate was more with sutures than staples (8% VS 4%) however it was with no significant difference (p>0.05). Pain difference was significant at time of removal assessed by visual analog scale score which is mild with staples and moderate with sutures (p<0.05). No much difference in scare acceptance between the two groups with more than 90% good scar in both(p>0.05).In conclusion, staples are good alternatives to subcuticular sutures in closure of skin incision in inguinal hernia repair. They are associated with good cosmetic results, less pain at removal, less wound infection and shorter time of wound closure but there is a need to reduce their cost.Key words: Staples, Sutures, Skin closure, Wound complications

Subcuticular Sutures versus Staples in Reducing Surgical Site Infections after Open Abdominal Digestive Surgery: A System Review and Meta-Analysis of Randomized Controlled Trials.

Background: Wound complications, primarily surgical site infections (SSIs), impose heavy a heavy burden on public health. This study aimed to compare the difference in the abilities of subcuticular sutures and staples to prevent SSIs after open abdominal surgery on the digestive system. Methods: A comprehensive search in Ovid-MEDLINE, Embase, Web of Science, and Cochrane Library (Central Register of Controlled Trials) was performed in January 2021. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PICOS (population, intervention, control, outcome, study type) model was applied to guide study selection and data extraction. Results: Six studies including 3,863 participants were included. According to analysis of SSI incidence, there was no obvious difference between the incidence of SSI when subcuticular sutures and staples were used (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.61-1.08; p = 0.15). In the subsequent subgroup analysis of different operation procedures, the pooled results also failed to show significance for upper gastrointestinal surgery (OR, 1.09; 95% CI, 0.63-1.9; p = 0.75), lower gastrointestinal surgery (OR, 0.77; 95% CI, 0.56-1.05; p = 0.1), or hepatobiliary-pancreatic surgery (pooled OR, 0.72; 95% CI, 0.34-1.54; p = 0.4). Conclusions: Subcuticular sutures and staples did not show differences in their ability to prevent SSI incidence after open abdominal operation. These results require further verification by large-scale, high-quality randomized controlled trials.

Does the suturing technique (continuous versus interrupted) have an impact on the outcome of tubularized incised plate in hypospadias repair with adequate urethral plate? A prospective randomized study

Hypospadias is one of the most common anomalies of male external genitalia. The aim of hypospadias repair is to achieve a normal phallus with a satisfactory functional and cosmetic result and to develop a single and consistent urinary stream while in standing position. The introduction of tubularized incised plate (TIP) urethroplasty by Snodgrass in 1994 resulted in revolutionizing management of different types of hypospadias. While there is consensus on the use of absorbable sutures in hypospadias repair, there are no specific guidelines for the suturing technique and the technique itself remains debatable. To compare the outcome of interrupted- and continuous-suture in hypospadias repair using TIP technique. This was a prospective randomized study. It comprised 260 uncircumcised hypospadiac boys with adequate urethral plate who underwent TIP repair. Boys with glanular, recurrent, proximal hypospadias and inadequate urethral plate were excluded from the study. The boys were randomized into two groups: Group A consisted of 130 boys who underwent TIP repair using continuous subcuticular suture urethroplasty and Group B of 130 boys who underwent TIP repair using interrupted subcuticular suture urethroplasty. The operative time was of lower statistical significance in group A (P=0.006) while the rate of complications were of higher statistical significance in group A (P=0.027). Urethrocutaneous fistulae occurred in 20 patients (14 in Group A and six in Group B), which is a statistically significant difference (P=0.048). On the other hand, superficial wound infection, partial glans dehiscence, meatal stenosis, urethral stricture, and aesthetic appearance were statistically insignificant. The effect of suturing techniques in bowel anastomosis has been studied and it has been found that the use of an interrupted-suturing technique results in a decreased complication rate compared to continuous suturing. This agrees with our study where the running sutures groups was associated with a higher complication rate compared to interrupted sutures.

Subcuticular sutures versus staples for skin closure in patients undergoing abdominal surgery: A meta-analysis of randomized controlled trials

BackgroundSurgical site infections (SSIs) are common postoperative complications. Whether the use of staples or sutures makes a difference in abdominal surgery’s infection rate remains elusive.MethodsA systematic review was performed to identify randomized clinical trials comparing staples and sutures after abdominal surgeries. Eligibility criteria involved the SSI occurrence as the primary outcome and the incidence of wound dehiscence, closure time, cosmesis, and patient satisfaction as the secondary outcomes.ResultsOf the 278 studies identified, seven randomized controlled trials representing 3705 patients were included in this review. There was no significant difference in SSI rates between sutures and staples in general (OR = 0.98, 95% CI = 0.79–1.22, I2 = 44%, P = 0.1) or in a subgroup of gastrointestinal surgery, where subcuticular suturing was found with a comparable SSI risk with skin stapling (OR = 0.85, 95% CI = 0.66–1.09). Staple closure was associated with a shorter surgery duration, whereas sutures appeared to provide better cosmesis and patient satisfaction. Sutures and staples achieved a comparable incidence of dehiscence. There was no significant between-study publication bias.ConclusionOur study demonstrated similar outcomes in SSI rate between subcuticular sutures and staples for skin closure in patients undergoing abdominal surgery.

187 Improving Awareness of Managing Post-Operative Haemorrhage in Patients Undergoing Thyroid and Parathyroid Surgery: The SCOOP Protocol

Abstract Introduction Post-operative haemorrhage is a rare but potentially life-threatening complication of thyroid surgery and occurs in 1 in 100 patients. Our aim was to assess current levels of awareness of post-operative haemorrhage in the surgical department and to improve confidence in managing this. Method Questionnaires with a combination of clinical questions were distributed amongst nurses, foundation doctors, senior house officers and registrars in the surgical department. Results There was a clear gap in awareness in all grades. The British Association of Endocrine and Thyroid surgeons (BAETS) have guidance on the management of these patients and in particular the acronym SCOOP (Steristrips removed, Cut subcuticular sutures, Open skin wound, Open strap muscles, Pack wound). 18/24 of participants had not heard of the SCOOP protocol. Most nurses (6/12) all junior doctors (8/8) showed lack of confidence in managing patients with suspected bleeding. Conclusions An informative poster was created for relevant clinical areas as per the BAETS recommendation. These posters outlined the steps in the SCOOP acronymas well as the main clinical signs of haemorrhage. BAETS recommend that all first responders, including nursing staff, junior doctors and the crash team should be aware of the SCOOP protocol. Simulation training sessions are in progress for these members of staff.

2-Octyl Cyanoacrylate Topical Adhesive as an Alternative to Subcuticular Suture for Skin Closure After Total Knee Arthroplasty: A Randomized Controlled Trial in the Same Patient

BackgroundThe 2-octyl cyanoacrylate topical adhesive with flexible self-adhesive polyester mesh (Dermabond Prineo) is becoming widely used in many surgical fields. However, no prior studies have tested the efficacy and safety of this topical adhesive compared with subcuticular suture in the same patient. The purpose of this study was to compare the efficacy and safety between Dermabond Prineo and subcuticular suture for skin closure in patients undergoing same-day bilateral total knee arthroplasties (TKAs). Materials and MethodsA prospective, double-blind randomized controlled trial was performed in 51 patients scheduled to undergo same-day bilateral TKAs. One knee was randomly assigned to the Dermabond Prineo and the other knee was allocated to the subcuticular suture. As primary outcomes, Vancouver scar scale was evaluated at 6 months and Patient and Observer Scar Assessment Scale was evaluated at 2 weeks, 6 weeks, 3 months, and 6 months. Secondary outcomes included cosmesis efficacy (Hollander wound evaluation scale [HWES] and cosmesis visual analog scale [VAS]), time and pain efficiency (skin suture time, stitch out time, and stitch out pain VAS), and safety (wound complications during the 6-month follow-up period). The primary and secondary outcome measures were compared between groups. ResultsThere were no significant differences in Vancouver scar scale and Patient and Observer Scar Assessment Scale at 6 months. Although there were no significant differences in HWES at 2 weeks, the Dermabond Prineo group showed better step-off border item of HWES. There was also no difference in cosmesis VAS at 6 months. The Dermabond Prineo group showed superior results in terms of time (suture time: Dermabond Prineo = 191 second (sec) ± 60.1 sec, subcuticular suture = 356.8 sec ± 92.3 sec; stitch out time: Dermabond Prineo = 4 sec ± 1.3 sec, subcuticular suture = 26.6 sec ± 4.2 sec, all P < .001) without significant differences in pain scale (P = .823) or wound complications (all P > .05). ConclusionComparing cosmetic efficacy, time efficiency, and safety, Dermabond Prineo provided quicker wound closure, shorter stitch out time, and better wound margin coaptation in the early postoperative period but similar cosmetic efficacy compared with subcuticular suture. Based on our study, Dermabond Prineo is a useful alternative to subcuticular suture in patients undergoing TKA. Level of EvidenceTherapeutic level 1.

Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery

Groin incision surgical site infections (SSIs) following arterial surgery are common and are a source of considerable morbidity. This review evaluates interventions and adjuncts delivered immediately before, during, or after skin closure, to prevent SSIs in patients undergoing arterial interventions involving a groin incision. MEDLINE, EMBASE, and CENTRAL databases were searched. This review was undertaken according to established international reporting guidelines and was registered prospectively with the International prospective register of systematic reviews (CRD42020185170). The MEDLINE, EMBASE, and CENTRAL databases were searched using pre-defined search terms without date restriction. Randomised controlled trials (RCTs) and observational studies recruiting patients with non-infected groin incisions for arterial exposure were included; SSI rates and other outcomes were captured. Interventions reported in two or more studies were subjected to meta-analysis. The search identified 1 532 articles. Seventeen RCTs and seven observational studies, reporting on 3 747 patients undergoing 4 130 groin incisions were included. A total of seven interventions and nine outcomes were reported upon. Prophylactic closed incision negative pressure wound therapy (ciNPWT) reduced groin SSIs compared with standard dressings (odds ratio [OR] 0.34, 95% CI 0.23 – 0.51; p < .001, GRADE strength of evidence: moderate). Local antibiotics did not reduce groin SSIs (OR 0.60 95% CI 0.30 – 1.21 p = .15, GRADE strength: low). Subcuticular sutures (vs. transdermal sutures or clips) reduced groin SSI rates (OR 0.33, 95% CI 0.17 – 0.65, p = .001, GRADE strength: low). Wound drains, platelet rich plasma, fibrin glue, and silver alginate dressings did not show any significant effect on SSI rates. There is evidence that ciNPWT and subcuticular sutures reduce groin SSI in patients undergoing arterial vascular interventions involving a groin incision. Local antibiotics did not reduce groin wound SSI, although the strength of this evidence is lower. No other interventions demonstrated a significant effect.

A Novel Suture Training System for Open Surgery Replicating Procedures Performed by Experts Using Augmented Reality

The surgical education environment has been changing significantly due to restricted work hours, limited resources, and increasing public concern for safety and quality, leading to the evolution of simulation-based training in surgery. Of the various simulators, low-fidelity simulators are widely used to practice surgical skills such as sutures because they are portable, inexpensive, and easy to use without requiring complicated settings. However, since low-fidelity simulators do not offer any teaching information, trainees do self-practice with them, referring to textbooks or videos, which are insufficient to learn open surgical procedures. This study aimed to develop a new suture training system for open surgery that provides trainees with the three-dimensional information of exemplary procedures performed by experts and allows them to observe and imitate the procedures during self-practice. The proposed system consists of a motion capture system of surgical instruments and a three-dimensional replication system of captured procedures on the surgical field. Motion capture of surgical instruments was achieved inexpensively by using cylindrical augmented reality (AR) markers, and replication of captured procedures was realized by visualizing them three-dimensionally at the same position and orientation as captured, using an AR device. For subcuticular interrupted suture, it was confirmed that the proposed system enabled users to observe experts’ procedures from any angle and imitate them by manipulating the actual surgical instruments during self-practice. We expect that this training system will contribute to developing a novel surgical training method that enables trainees to learn surgical skills by themselves in the absence of experts.

Subcuticular sutures versus staples for skin closure after primary hip arthroplasty

High-quality and cost-effective health care are highly recommended especially in joint replacement surgeries, particularly in total hip arthroplasty. Therefore, it is indispensable for orthopaedic surgeons to spot the potential areas of quality improvement. Evaluating the efficacy of the different ways of skin closure is an unacknowledged topic. We performed this study following both the Preferred Reporting Items for Systematic Reviews and Meta- analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Articles were from any country, written in any language. We included all randomised control trials and retrospective cohort studies undergoing primary total hip arthroplasty who either received staples or subcuticular sutures for skin closure. The primary outcome was the incidence of wound infection. Secondary outcomes included length of stay (LOS), time to skin closure, total cost, and patient's satisfaction. We included five studies in our cumulative meta- analysis. We conducted them using Review Manager V.5.0. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used Random-effect models. Primary skin closure with subcuticular sutures had insignificant marginal advantages for wound infections, LOS, and wound oozing. On the contrary, staples were more cost- effective and had less time for closure with higher patient's satisfaction. Except for closure time and patient satisfaction , no significant difference between the two groups. The use of staples after THA may have several slight clinical advantages over the subcuticular sutures. However, owing to the complexities associated with wound closure, future clinical and laboratory studies assessing their complication outlines must be examined before an optimum technique can be determined.

ADHESIVE GLUE Vs SUBCUTICULAR SUTURING IN THYROIDECTOMY

BACKGROUND: Suturing has been the commonest method of surgical wound closure that is being practiced because of good results of skin closure. With adhesive glue being an alternative for skin closure which is less time consuming, comfortable, without the risk of needle prick injury and leaves behind a cosmetically acceptable scar. OBJECTIVES: The aim of this study is to compare subcuticular suturing versus adhesive glue for skin closure in thyroidectomy with respect to clinical outcome which included postoperative pain, wound complications, wound dehiscence and cosmesis. MATERIALAND METHODS: This prospective study of 100 cases of skin closure using subcuticular suturing versus adhesive in thyroidectomy was carried out at BGS Global institute of medical science and Hospital, Bangalore with the aim of comparing suturing versus adhesive glue, with respect to clinical outcome which included postoperative pain, wound complications, wound dehiscence and cosmesis. RESULT: 100 patients divided into 2 groups, randomly underwent subcuticular suturing and adhesive glue skin closure. Post- operative pain was less in glue group (p value &lt;0.001) and wound complications were comparable in both groups. CONCLUSION: Octylcyanoacrylate provides an effective and reliable means of skin closure and yields similar cosmetic results as with subcuticular skin sutures. The incidences of wound complications are comparable in both the groups. However the severity of postoperative pain is lesser in the adhesive group.