Suture Closure Research Articles

Is Botox or Dermabond Superior in the Appearance of the Lip Scar After Primary Cleft Lip Repair and Revision? A Systematic Review and Meta-Analysis

Background: Cleft lip scar formation is an inevitable consequence of cleft lip repair (CLR) and is exacerbated by the dynamic movement of the middle face. Various methods to correct or prevent these deformities have been described including silicone sheeting, surgical revisions, laser therapy, and more recently, Botulinum toxin-A (Botox) and Dermabond. This study aims to analyze and compare the impact of Botox versus Dermabond on scar appearance after CLR. Methods: Following PRISMA guidelines, a systematic review was performed on Medline, Embase, Cochrane, and CINAHL using the following keywords: “Dermabond,” “botulinum toxin,” and “cleft lip.” Outcomes of interest were the rates of scar hypertrophy, scar width, Vancouver scar scale (VSS), visual analog scale (VAS), Hollander wound evaluation scale (HWES), and complications. Results: Nine studies were included of which 4 articles analyzed Botox and 5 analyzed Dermabond. Forest plots for scar width at the first and second time point supported the use of Botox to achieve a smaller scar width with P < .0001 (95% CI: −1.09 [−1.56 to −0.63] and 95% CI: −0.94 [−1.37 to −0.50], respectively). A significant increase in VAS was observed with Botox (95% CI: 1.66 [1.27-2.05], P value < .0001) and VSS was insignificant. Of the articles that analyzed Dermabond, scar appearance was comparable to the traditional suture closure group. There were no feeding complications for either intervention. Pooled forest plots for VAS comparing Botox and Dermabond supported the use of Botox with improved VAS (95% CI: 1.66 [1.27-2.05], P < .0001) compared to Dermabond (95% CI: 0.07 [ −0.48 to 0.61], P = .80). Conclusions: The current literature supports the use of Botox for scar improvement following CLR or revision. However, there is limited data to support Dermabond’s utility in improving scars in CLR, which highlights the need for further studies.

Wound healing and hernia after abdominal aortic aneurysm repair: Onlay self-gripping polyester mesh reinforcement compared with small bite sutured closure.

Prophylactic mesh implantation following open surgical repair of abdominal aortic aneurysm is a debatable subject. To assess the efficacy of a self-gripping polyester mesh used in on-lay technique to prevent incisional hernia after open abdominal aortic aneurysm repair. We retrospectively reviewed the records of 495 patients who underwent aortic surgery between May 2017 and May 2021. Patients included in the study underwent open surgical repair for infrarenal abdominal aortic aneurysm (AAA) with closure of the abdominal wall with either small bite suture technique or prophylactic mesh reinforcement. Primary endpoint of the study was the occurrence of incisional hernia during a two-year follow-up period. Secondary endpoints were mesh-related complications. Mesh implantation with the on-lay technique was successful in all cases. No patient in the mesh group developed an incisional hernia during the 24-month follow-up period. Two patients in the non-mesh group developed a symptomatic incisional hernia during the follow-up period at 6 months. Three cases of post-operative access site complications were observed in the mesh group. Application of a self-gripping polyester mesh using the on-lay technique demonstrates acceptable early-durability after open surgical repair of abdominal aortic aneurysms. However, it appears to be associated with a number of post-operative access site complications.

No difference in prevalence of postoperative iliopsoas tendinitis in patients undergoing arthroscopic hip surgery when using absorbable versus non-absorbable suture for capsular closure.

The volume of arthroscopic hip surgery has increased dramatically in recent years with iliopsoas tendinitis (IPT) being one of the most common complications of this procedure. The purpose of this study is to investigate the prevalence of post-operative IPT in patients who undergo arthroscopic hip surgery with capsular closure using absorbable versus non-absorbable suture. This is a single center, single surgeon, retrospective analysis performed between August 2007 and May 2023 comparing two cohorts who underwent hip arthroscopy. Patients were divided into those who underwent surgery with capsular closure using absorbable (Vicryl®, Johnson and Johnson, New Brunswick, NJ) suture and those who underwent capsular closure with non-absorbable suture (Suturetape, Arthrex, Naples FL). All patients who underwent primary or revision hip arthroscopy and were at least 2 months post-operation were initially included in the study. Between August 2007 and May 2023 a total of 1513 hip arthroscopy surgeries were performed. Within this cohort, 1421 hips underwent hip arthroscopy with non-absorbable suture and 64 hips underwent surgery with absorbable suture. There was no significant difference between the proportion of IPT in the non-absorbable cohort (2.3%) versus the absorbable cohort (1.6%) (P = 0.669). Capsular closure with Absorbable sutures was non-inferior to capsular closure with non-absorbable sutures with respect to the proportion of post-operative IPT following hip arthroscopy for FAI. Additionally, the proportion of post-operative IPT was found to be significantly higher in patients undergoing revision versus primary hip arthroscopy, regardless of capsular closure suture type. IV.

Comparison of Wound Outcomes for Absorbable versus Non-absorbable Suture after Carpal Tunnel Release

Background and Hypothesis:Carpal tunnel release (CTR) is a common hand surgery procedure. Despite the large volume of CTRs performed worldwide (400,000-600,000 cases/year), there is no consensus as to the optimal suture material for incision closure. In this study, we sought to compare outcomes of absorbable and non-absorbable suture for skin closure after CTR. Our hypothesis was that that there is no statistically or clinically significant difference in wound-related outcomes between the cohorts.
 Project Methods:All patients who underwent primary open carpal tunnel release (CTR) at a large, public county hospital in Indianapolis, IN were identified by CPT code (64721). All patients were treated by one of two fellowship-trained hand surgeons. The most recent 50 patients treated between September 2022 and May 2023 by each surgeon were identified. Surgeon “A” uses 4-0 vicryl rapide for closures (absorbable). Surgeon “B” uses 4-0 nylon for closures (non-absorbable). Adverse events (AE) were defined as infection, dehiscence, or suture granuloma observed at any follow-up appointment. This study was approved by the Institutional Review Board.
 Results:100 patients were identified - 4 patients were lost to follow-up and were excluded from the study. Of the remaining 96 patients, 46 received absorbable suture and 50 non-absorbable suture. Of the 46 patients who received absorbable suture, 8 experienced AE (17.4%). None of the 50 patients who received non-absorbable suture experienced an AE. There was a statistically significant difference in AE between the absorbable and non-absorbable suture cohorts (p=0.002). Patients with absorbable suture averaged 1.61 follow-up appointments, whereas those with non-absorbable suture averaged 2.32 (p=.0008).
 Conclusion and Potential Impact:In this study, absorbable suture resulted in more wound-related complications after CTR. However, patients with non-absorbable suture had more post-operative follow-up appointments. These findings should be considered when selecting suture material for skin closure after CTR.

Duramesh registry study: short-term outcomes using mesh suture for abdominal wall closure.

Sutures are flexible linear elements that join tissue and maintain their hold with a surgeon-created knot. Tension at the suture/tissue interface can cut the very tissues that sutures are designed to hold, leading to dehiscence and incisional hernia formation. A new suture design (Duramesh, Mesh Suture Inc., Chicago, IL) was approved for marketing by the United States Food and Drug Administration in September 2022. The multiple filaments of the mesh suture are designed to diffuse tension at the suture/tissue interface thereby limiting pull-through. The macroporosity and hollow core of the mesh suture encourage fibrovascular incorporation for a durable repair. We created the first registry and clinical report of patients undergoing mesh suture implantation to assess its real-world effectiveness. A patient registry was created based on institutional implant logs from January to August 2023 at an integrated health-care system. Operative reports were reviewed by the study team to verify use of "Duramesh" by dictation. Retrospective chart review was conducted to evaluate patient and surgical characteristics, follow-up, and short-term outcomes of interest. Results were analyzed using descriptive statistics and Chi-squared analysis with Microsoft Excel and GraphPad Prism. Three hundred seventy-nine separate implantations by 56 surgeons across 12 (sub) specialties at a university hospital and two community hospitals were performed. Mesh suture was used for treatment of the abdominal wall in 314 cases. Follow-up averaged 80.8 ± 52.4 days. The most common abdominal wall indications were ventral hernia repair (N = 97), fascial closure (N = 93), abdominal donor site closure from autologous breast reconstruction (N = 51), and umbilical hernia repair (N = 41). Mesh suture was used in all Centers for Disease Control (CDC) wound classifications, including 92 CDC class 2 or 3 abdominal operations. There were 19 surgical site infections (6.1%) and 37 surgical site events (11.8%). Short-term registry data demonstrates the wide diversity of surgical disciplines and scenarios in which mesh suture has been used to date. The early adoption of mesh suture into practice highlights that consequences of suture pull-through influence operative decision making. As this is the first interim report of the Duramesh mesh suture registry, follow-up is too short for characterization of long-term durability of abdominal wall closures.

Increase in Intraoperative Intraocular Pressure in the Prone Position.

This study aimed to measure the intraocular pressure (IOP) of patients undergoing open surgery in the supine position (control group) and spine surgery in the prone position (spine group) to clarify IOP range and change by posture, determine the risk factors for increased IOP in the prone position, and reduce visual complications after surgery in the prone position. A prospective cohort study was conducted in healthy adults (34-83 years of age) with an American Society of Anesthesiologists classification I/II. The spine group was examined for IOP, anterior chamber angle (ACA), and fundus findings the day prior to surgery. On the day of surgery, IOP measurements were taken at fixed time points: immediately after intubation; at 0.5, 1, and 2 h after intubation; at suture closure; and at the end of surgery in the control group. In the spine group, they were taken immediately after intubation; at 0.5, 1, and 2 h after prone position; at suture closure; and immediately and 5 min after returning to the supine position. The risk factors for increased IOP in the prone position were examined. The control group showed no significant changes in IOP within the normal range (<20 mmHg) during surgery. In the spine group, IOP was higher at each time point than immediately after intubation. IOP increased sharply above the normal range within 1 h after changing from the supine to the prone position and continued to gradually increase until suture closure. IOP decreased 5 min after the patient returned to the supine position. ACA, body mass index, blood loss, time in the prone position, and operative time were not risk factors for increased IOP in the prone position. Patients were constantly exposed to above-normal IOP during prone spinal surgery. However, neither group reported visual impairment. No risk factors were identified for increased IOP in the prone position.

An autopsy-based study on Cranial vault Suture fusion for estimation of Age in Ajmer region at J.L.N Medical College, Ajmer

Introduction: Cranial suture closure is one trait that has been used since the 16th century for age estimation after the 2nd decade of life. To determine the pattern of cranial vault suture closure in relation to age among dead bodies of subjects (3rd to 5th decades of life) and identify any relationship between progression of the union of cranial suture and age. Materials and Methods: We conducted a cross-sectional observational study from January 2023 to June 2024 involving 150 cadavers. Cadavers were studied for ecto cranial and endo cranial closure pattern for sagittal-coronal and lambdoid sutures. Spearman coefficient was utilized to assess the correlation between the age of the subject and the stage of fusion of cranial sutures. Results: We noted that the process of endo-cranial fusion of cranial suture was more regular than ecto-cranial. The coronal suture was the first to fuse. Conclusion: No definite correlation was found to exist between age and suture closures.

The pros and cons of suturing the ventral hernia defect using the intraperitoneal onlay mesh technique

Background/Aim. Laparoscopic ventral hernia surgery, including intraperitoneal onlay mesh (IPOM), is as effective and safe as open surgery, with a lower recurrence rate. Some surgeons advocate laparoscopic primary fascial closure (PFC) with intraperitoneal mesh placement to reduce recurrence rates. The aim of this study was to compare the treatment outcome between two laparoscopic techniques: the PFC technique and mesh placement without suture closure (IPOM technique) for defects under 4 cm in patients with ventral hernias. Methods. The study sample was comprised of 50 patients who underwent laparoscopic ventral hernia surgery from January 1, 2018, until December 31, 2020. Half of the patients underwent only the IPOM technique (group of patients without the suture), while in others, this was preceded by the closure of the hernial ring (group of patients with the suture). All hernias were midline and all defects were under 4 cm. The studied groups were homogeneous according to gender and age. Comorbidities, complications, and postoperative comfort were monitored. Results. The most common (76%) hernias were primary, and the most common comorbidity was arterial hypertension (28%). One (2%) patient had intraoperative bleeding, and the most common postoperative complication was pain in 7 (14%) patients. After a threeyear follow-up, there were 10 (20%) patients with complications - one hernia recurred, while 9 (18%) patients died. There was no difference in the types of occurrence of hernias, comorbidities, and intraoperative complications. The distribution of postoperative complications differed significantly (p = 0.007) between the groups. Pain was statistically significantly more prevalent in patients with sutures. During the first three months postoperatively, significantly more patients with sutures had chronic pain (?2 = 8.140; p = 0.004). Conclusion. We recommend the application of the PFC technique in selected ventral hernia repair cases, although it can lead to more frequent postoperative pain (which, fortunately, is easily treated).

Tracheostomy in infants: Indications and outcomes

Background/Aim. Laparoscopic ventral hernia surgery, including intraperitoneal onlay mesh (IPOM), is as effective and safe as open surgery, with a lower recurrence rate. Some surgeons advocate laparoscopic primary fascial closure (PFC) with intraperitoneal mesh placement to reduce recurrence rates. The aim of this study was to compare the treatment outcome between two laparoscopic techniques: the PFC technique and mesh placement without suture closure (IPOM technique) for defects under 4 cm in patients with ventral hernias. Methods. The study sample was comprised of 50 patients who underwent laparoscopic ventral hernia surgery from January 1, 2018, until December 31, 2020. Half of the patients underwent only the IPOM technique (group of patients without the suture), while in others, this was preceded by the closure of the hernial ring (group of patients with the suture). All hernias were midline and all defects were under 4 cm. The studied groups were homogeneous according to gender and age. Comorbidities, complications, and postoperative comfort were monitored. Results. The most common (76%) hernias were primary, and the most common comorbidity was arterial hypertension (28%). One (2%) patient had intraoperative bleeding, and the most common postoperative complication was pain in 7 (14%) patients. After a three-year follow-up, there were 10 (20%) patients with com-plications ? one hernia recurred, while 9 (18%) patients died. There was no difference in the types of occurrence of hernias, comorbidities, and intraoperative complications. The distribution of postoperative complications differed significantly (p = 0.007) between the groups. Pain was statistically significantly more prevalent in patients with sutures. During the first three months post-operatively, significantly more patients with sutures had chronic pain (?2 = 8.140; p = 0.004). Conclusion. We recommend the application of the PFC technique in selected ventral hernia repair cases, although it can lead to more frequent postoperative pain (which, fortunately, is easily treated).

Age Estimation from closure of some cranial sutures (coronal, sagittal, and lambdoid) in a sample of Egyptian population using computed tomography: retrospective study

Age Estimation from closure of some cranial sutures (coronal, sagittal, and lambdoid) in a sample of Egyptian population using computed tomography: retrospective study

Research progress and perspective of metallic implant biomaterials for craniomaxillofacial surgeries.

Craniomaxillofacial bone serves a variety of functions. However, the increasing number of cases of craniomaxillofacial bone injury and the use of selective rare implants make the treatment difficult, and the cure rate is low. If such a bone injury is not properly treated, it can lead to a slew of complications that can seriously disrupt a patient's daily life. For example, premature closure of cranial sutures or skull fractures can lead to increased intracranial pressure, which can lead to headaches, vomiting, and even brain hernia. At present, implant placement is one of the most common approaches to repair craniomaxillofacial bone injury or abnormal closure, especially with biomedical metallic implants. This review analyzes the research progress in the design and development of degradable and non-degradable metallic implants in craniomaxillofacial surgery. The mechanical properties, corrosion behaviours, as well as in vitro and in vivo performances of these materials are summarized. The challenges and future research directions of metallic biomaterials used in craniomaxillofacial surgery are also identified.

A importância da antropometria e semiologia craniana para o diagnóstico precoce da trigonocefalia: relato de caso

Trigonocephaly is a type of craniosynostosis in which there is premature closure of the metopic suture, in order to determine an abnormal growth of the skull. In a minority of cases, trigonocephaly can cause increased intracranial pressure and the onset of neurological disorders. When present, these complications can be prevented or mitigated if the diagnosis and treatment occur between 6 and 12 months of life. The objective of the study is to report a case of craniosynostosis in an infant and reaffirm the importance of anthropometry and cranial semiology. On physical examination, a 4-month-old infant had a head circumference: 41 cm, metopic suture mounted, biparietal diameter: 23 cm, fronto-occipital diameter: 28 cm. Cranial computed tomography with 3D reconstruction confirmed the diagnosis of trigonocephaly, and he was referred to pediatric surgery. The study was submitted to the Human Research Ethics Committee approved under CAAE number 53607821.7.0000.5237. The diagnosis of trigonocephaly is made through the analysis of anthropometric measurements of the skull, represented by the head circumference, anteroposterior distance and binaural distance, and confirmed through computed tomography with 3D reconstruction. In pediatric practice, it is common to only measure the head circumference, which is often normal, with changes only in the anteroposterior and binaural distances. Consequently, there is a delay in the diagnosis of craniosynostosis. Thus, the importance of routinely measuring the three anthropometric measurements of the skull is emphasized for the early diagnosis of craniosynostosis and for the prevention and reduction of its complications, even though they are rare.

Descemet stripping automated endothelial keratoplasty via a frown incision.

To assess the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) via a sclerocorneal frown incision. Retrospective comparative study. The outcomes of Descement stripping endothelial keratoplasty (DSAEK) were retrospectively compared between 36 patients (36 eyes) who underwent surgery via a 3.8-mm frown incision (frown incision group) and 20 patients (20 eyes) who underwent surgery via a 4.6-mm straight incision (straight incision group). In all patients, an NS Endo-Inserter was used as the graft inserter and the incision for a frown incision was via the superior sclerocorneal site and for the straight incision via the temporal cornea. DSAEK was performed by the standard technique, except for the incision. At 1 year after surgery, the two groups were compared with respect to the visual acuity, decrease of corneal endothelial cell density, the severity of corneal astigmatism (diopters), the number of sutures for wound closure, and intraoperative/postoperative complications. There was no significant difference between the two groups in terms of postoperative visual acuity, corneal astigmatism, and intraoperative/postoperative complications one year after surgery. On the other hand, the number of sutures required for wound closure was 1.13±0.42 in the frown incision group, whereas in the straight incision group, it was 3.20±0.40, showing a significant difference (P<0.001). In addition, there was no decreased corneal endothelial cell density associated with the reduction in incision width. A sclerocorneal frown incision is useful for performing DSAEK with an NS Endo-Inserter as it does not affect endothelial cell loss despite its short incision width.

Application of sutureless corneal incision for patients with congenital ectopia lentis - Is it feasible, effective and safe?

Purpose: To compare the clinical outcomes, feasibility, and safety between groups with sutured and sutureless wound closure in congenital ectopia lentis (CEL) patients. Methods: Patients with CEL who received phacoemulsification combined with intrascleral fixation of capsular hook (CH) and implantation of capsular tension ring (CTR) and in-the-bag intraocular lens (IOL) were included in this study. Results: A total of 68 eyes of 34 patients aged 18 years or younger were enrolled in this study. Incisions of 21 patients (34 eyes) did not require sutures while sutures were applied in 21 patients (34 eyes). Postoperative uncorrected distance visual acuity, best corrected distance visual acuity and intraocular pressure measurements were comparable on follow-up visits (P > 0.05). The magnitude of surgically induced astigmatism was significantly greater (P = 0.001) in the suture group (Median: 0.47; IQ: 1.63, 2.97) than in the sutureless group (Median: 0.88; IQ: 0.63, 1.35). No cases of endophthalmitis and retinal detachment were found postoperatively in either group, while suture-related complications were observed in the sutured group, including loose suture with discomfort in 5 (14.71%) eyes, loose suture with mucus infiltration in 3 (8.82%) eyes. In total, 22 sutures (64.71%) of 34 eyes required removal. Conclusions: Sutureless clear corneal incision in CEL patients can achieve satisfactory clinical results comparable to sutured wound closure in terms of the efficacy and safety. Advantages of this approach are the reduced risk of suture-related complications, no need for additional surgery under general anesthesia for suture removal, and less cost.

832 Trial of labor outcomes after knotless-barbed vs. conventional suture for closure of cesarean uterine incision

832 Trial of labor outcomes after knotless-barbed vs. conventional suture for closure of cesarean uterine incision

Surgical Time for Laparoscopic Ovariectomy in Adult and Prepubertal Dogs

Two-portal laparoscopic ovariectomy (LOVE) was performed in adult (n=23) and prepubertal dogs (n=23) to compare surgical time and to evaluate the effect of age, body weight (BW), body condition score (BCS), ovarian pedicle fat score (OPFS) and intraoperative surgical complications on surgical time. Three classes of BCS were considered: BCS 1-2=lean; BCS 3=ideal; BCS 4-5=overweight. The same surgeon performed all surgeries. OPF was scored and was considered negative or positive. Intraoperative complications were recorded. Total surgical time was recorded from the first skin incision to the last portal closure suture placement. The surgical procedure was divided into seven stages, and each stage’s time was recorded. Data are reported as mean±SEM. Differences in the duration of defined surgical stages between groups were evaluated by age, BW, OPFS and intraoperative complications. One-way analysis of variance was used to assess the effect of BCS. No major complications were observed. Five and four minor complications were observed in adult and prepubertal dogs, respectively. Total surgical time was not different (p&gt;0.05) between adult (20.63±0.60 min) and prepubertal (21.48±1.75 min) dogs. BCS, BW, and OPF did not affect total surgical time (p&gt;0.05). Intraoperative complications have prolonged surgical procedure times (25.20±2.33 min vs 20.04±0.93 min). The time from the first skin incision to the insertion of the first trocar was shorter (p

Subcuticular skin closure at cesarean delivery with poliglecaprone-25 vs polyglactin-910: a randomized controlled trial

Cesarean delivery is a commonly performed surgical procedure worldwide. There is limited good-quality evidence regarding subcuticular skin closure with absorbable sutures in transverse incisions after cesarean delivery. This study aimed to compare poliglecaprone-25 (3-0) and polyglactin-910 (4-0) sutures for subcuticular skin closure in Pfannenstiel incisions among women undergoing cesarean delivery. In this double-blind, single-center, randomized controlled trial among women undergoing cesarean delivery (elective and emergency), 200 women were randomized (Group 1-subcuticular skin closure with poliglecaprone-25 [3-0] vs Group 2-subcuticular skin closure with polyglactin-910 [4-0]). All women received similar preoperative and postoperative care. A sample size of 200 women was selected with the aim of reducing the composite wound complication rate from 15.8% to 3.6% with a power of 0.80 and a 2-tailed α of 0.05. Thus, 90 women were required in each group, but 100 were selected to account for attrition. Composite wound complications (including surgical site infection, hematoma, seroma, need for resuturing or readmission for wound complications) were similar in the 2 groups (Group 1 vs 2: 16 vs 10; P=.293; relative risk, 1.28; 95% confidence interval, 0.91-1.79). Surgical site infection (8 vs 7; P=1.000; relative risk, 1.08; 95% confidence interval, 0.64-1.83), hematoma (1 vs 2; P=.561; relative risk, 0.66; 95% confidence interval, 0.13-3.31), seroma (8 vs 2; P=.052; relative risk, 1.65; 95% confidence interval, 1.17-2.33), need for resuturing (4 vs 3; P=.700; relative risk, 1.15; 95% confidence interval, 0.60-2.22), and need for readmission (4 vs 4; P=1.000) were similar in the 2 groups. Pain score on the visual analog scale at 3 days (3.2±1.0 vs 3.6±1.2) and 6 weeks after operation (1.6±0.8 vs 1.7±0.9;) was significantly lower in Group 1 (P=.023 and P=.033, respectively). There was no difference between observer and patient scar assessment scores measured at 6 weeks after operation (P=.069 and P=.431, respectively). Poliglecaprone-25 (3-0) and polyglactin-910 (4-0) subcuticular sutures were comparable regarding composite wound complications (surgical site infection, hematoma, seroma, wound separation or re-suturing, need for readmission) and cosmetic appearance (patient scar assessment score & observer scar assessment score) related to skin closure among women undergoing cesarean delivery through a Pfannenstiel incision in nonobese women (average body mass index, 25).

Esthetic Outcomes of Primary Cleft Lip Repair Utilizing 2-Octyl Cyanoacrylate Liquid and a Self-adhesive Polyester Mesh Tape

Background: The method of epidermal closure during cleft lip repair is important to consider, as it may affect complication rates, cosmetic outcomes, and patient comfort levels. Historically, this has most commonly been performed with permanent suture that requires subsequent removal, which is not well tolerated in infants. The purpose of this study is to compare the outcomes between 2-octyl cyanoacrylate liquid with a self-adhesive polyester mesh tape (2-OPMT) and typical suture closure techniques, which to our knowledge has never previously been investigated. Methods: In nine consecutive cleft lip repairs, the epidermal closure was performed with permanent suture, and in the subsequent nine consecutive cleft lip repairs, the epidermal closure was performed with 2-OPMT. Complication rates were compared between the groups. Esthetic scar outcomes were investigated via post-operative photograph analysis utilizing the Manchester Scar Scale. Statistical significance was determined with Fischer Exact Tests and Wilcoxon Rank-Sum tests. Subsequently, scar scores for 30 cleft lip repairs performed with 2-OPMT in our practice were compared to previously reported scores in the literature for 30 cleft lip repairs performed with typical suture technique. Results: Three patients in the permanent suture group had documented scar-related complications and one patient in the 2-OPMT group had documented scar-related complications. No statistically significant difference was found in complication rates between the two groups. No statistically significant difference was found in esthetic scar scores between the two different closure techniques either within our practice or in comparison to reports in the literature. Conclusions: Overall, the use of 2-OPMT offers comparable esthetic outcomes and complication rates to the use of permanent suture in epidermal closure of cleft lip repairs.

Effects of cyanoacrylate on leakage pressures of cooled canine cadaveric jejunal enterotomies.

To compare the intraluminal initial and maximal pressures of enterotomies closed using three different techniques (single-layer appositional continuous closure; closure with cyanoacrylate; a single-layer appositional closure augmented with cyanoacrylate) in a cooled canine cadaveric jejunal model and to report the initial leak location in all samples. Experimental, ex-vivo study. Grossly normal chilled small intestine segments from three canine cadavers. A total of 45 chilled jejunal segments (n = 15 segments/group) were assigned to a handsewn group (HSE), a cyanoacrylate only group (CE) and a handsewn and cyanoacrylate group (HS + CE). A 2 cm antimesenteric enterotomy was performed and closure with one of the above techniques. Initial leakage pressures (ILP), maximal intraluminal pressures (MIP) and initial leakage location were recorded by a single observer. Handsewn enterotomies leaked at higher ILP when augmented with cyanoacrylate (83.3 ± 4.6 mmHg, p < .001) compared to both the HSE group (43.8 ± 5.3 mmHg) and the CE group (18.6 ± 3.5 mmHg). Those sealed with cyanoacrylate only leaked at a lower MIP compared with the other groups (p < .001). Maximal intraluminal pressures did not differ between handsewn enterotomies, whether augmented or not (p = .19). Reinforcement of a sutured enterotomy closure with cyanoacrylate was easy to perform and resulted in significantly increased initial leak pressures in cadaveric jejunum. The increased leakage pressures achieved by reinforcing enterotomies with cyanoacrylate could consequently reduce the incidence of postoperative intestinal leakage following an enterotomy and may result in reduced patient morbidity or mortality.

A Comparison of a Small-Stitch Closure With a Standard Closure in Midline Laparotomy Incisions: A Prospective Comparative Study.

Introduction Midline incision provides a rapid and thorough approach to the abdominal cavity and, therefore, is widely employed in both emergency and elective procedures. However, midline laparotomy is associated with many post-operative complications likewound dehiscence, incisional hernia, fistula formation, and surgical site infection (SSI). The purpose of the study is to comparethe complications that occurred post-operativelyin associationwith thelong and smallbite suture techniques for midline laparotomy incisions. Methodology A prospective comparative study was carried out among 90 cases of midline laparotomies for 18 months (January 2021 to June 2022). The participants were categorizedinto two groups: (1) Group A, which included 45 patients, underwent small-suture abdominal fascia closure, and (2) Group B, which consisted of the remaining45 patients, underwent large-suture abdominal midline wound closure. Patients were followed up in the hospital till the day of discharge and in the outpatient department (visit 1, within one month of surgery) for pain, wound dehiscence, and surgical site infection. Patients were called for visit 2 (six months post-surgery) and incisional hernia rates were assessed. Results On the numerical pain rating scale, the mean score was higher in Group B, that is, 4.1 than in Group A, which was 3.5. Wound dehiscence and incisional hernia rates were higher among Group B cases. The majority of SSIs were noted in Group B with statistically significant results. Conclusion Despite the lack of randomization,the results demonstrated in this study support the use of small bite sutures in comparison to long bite sutures for laparotomy closure.