Suture Group Research Articles

The Outcome and Safety in Laparoscopic Common Bile Duct Exploration with Primary Suture versus T-Tube Drainage: A Meta-Analysis.

Sometimes, after choledochotomy, the common bile duct is closed with T-tube drainage for several weeks to prevent postoperative complications such as biliary fistula and stricture. But there has been controversy over the advantages of primary suture versus T-tube drainage. The purpose of our meta-analysis in laparoscopic common bile duct exploration is to appraise the efficacy and safety of T-tube drainage and primary suture. The literatures were searched by Web of Science, PubMed, Cochrane Library, OVID, and EMBASE between the year January 1, 2001 and February 28, 2021. Meta-analysis was performed by Stata 12. Fourteen studies with 1,549 patients (827 vs. 722) were included in our study. The primary suture group had significant lesser operative time (P ≤ 0.001), postoperative hospital stay (P ≤ 0.001), hospital expenses (P ≤ 0.001), intraoperative bleeding (P=0.001), and postoperative complications (P=0.006) than the T-tube drainage group. In postoperative bleeding (P=0.289), bile leakage (P=0.326), and bile duct stricture (P=0.750), there was no statistical difference. In the primary suture group, using single-arm synthesis, the bile leakage rate and the bile duct stricture rate were 0.07 vs. 0.04 and 0.00 vs. 0.00 in interrupted suture and continuous suture groups. The bile duct stricture rate was same in both groups, and the bile leakage rate was lower in the interrupted suture group. But the difference was not significant. The primary suture group had several advantages, including lesser operative time, postoperative complications, intraoperative bleeding, postoperative hospital stay, and hospital expenses. In bile leakage and bile duct stricture, the difference between the two groups was not significant. In the primary suture group, interrupted suture and continuous suture groups had similar bile leakage rate and bile duct stricture rate.

Staples versus sutures wound closure in hip and knee arthroplasty: a prospective cohort study

This study aimed to compare two methods of wound skin closure-staples versus vertical mattress nylon sutures-in patients undergoing primary total hip (THR) and total knee replacements (TKR). The comparison was for wound complications as a primary outcome, and satisfaction of patient and nurse as secondary outcomes. A prospective cohort study was conducted at an academic teaching hospital. All the patients who were admitted for either primary THR or TKR from September 2018 to September 2019 were included. Revision surgeries, patients >85 years of age, and those who were on steroid therapy were excluded. Patients were divided into two groups (staples and sutures) to compare the two methods of wound closure. Patients in each group were assessed for characteristics such as age, sex, weight, height, comorbidities, smoking status, postoperative wound complications, reoperation and patient/nurse satisfaction. A total of 100 patients met the inclusion criteria. In the staples group (n=50), 26 patients underwent THR while 24 patients underwent TKR. In the sutures group (n=50), 23 patients underwent THR and 27 patients underwent TKR. Overall, there was no significant difference between the two groups (staples versus sutures) in terms of wound complications (p=0.401), patient satisfaction (p=0.357) and nurse satisfaction (p=0.513). Further analysis compared THR and TKR subgroups (THR staples versus THR sutures and TKR staples versus TKR sutures). The results showed no significant difference between the staples and sutures subgroups of THR and TKR in terms of wound complications, patient satisfaction and nurse satisfaction. In THR and TKR, there was no significant difference between either vertical mattress nylon sutures or staples primary skin closure in terms of wound complications and patient satisfaction in this study. The decision on wound closure method should be based on the availability of resources in the institution/country.

SKIN GLUE AS A EMERGING ALTERNATIVE IN SKIN CLOSURE-A COMPARATIVE STUDY

Introduction:Traditional wound closure techniques include skin sutures and metal clips. The ideal incision closure should be simple, effective, safe, rapid, inexpensive, painless, cosmetic, and bactericidal. Cyanoacrylate glue has good neovascularization, epithelialization,and fasterApplication.Soit can be considered an alternative for skin closures. Methods:A study was conducted on 50 individuals undergoing elective surgery in the department of general surgery. They were randomized into 2 groups. In group A skin closure was done with skin glue and in group B skin closure was done with sutures. Post-op pain was assessed with VAS and cosmesis was assessed with a modified Hollander cosmesis scale. The time taken for closure was assessed using a stopwatch. Results:Skin closure with skin glue was quicker than traditional closure. The average time for skin closure with glue was 1 minute and 14 seconds while it was 3 minutes and 47 seconds in the suture group. The postoperative pain was comparatively less in people who had closure with glue. Cosmesis was better in patients who had closure with glue compared to sutures.The overall satisfaction level was better in people who had closure with glue compared to those who had closure with sutures. Conclusion:According to this study, using skin glue for skin closure in clean surgery reduces thewound closure time with a superior cosmetic effect. The usage of skin glue can greatly save healthcare expenses and is favored by patients due to the simplicity of postoperative wound care. The study established the efficacy and advantages of this unique technique.The broad adoption of this innovative approach may drastically reduce the need for sutures in clean surgery.

Autologous fibrin glue versus sutures for conjunctival autograft in primary pterygium: a randomized clinical trial.

To describe and compare the autologous fibrin glue and traditional sutures for conjunctival graft attachment in patients undergoing primary pterygium excision surgery. A randomized clinical trial included patients who underwent pterygium surgery with conjunctival autologous graft (CAG). Using randomization, a single-trained surgeon performed graft fixation with autologous glue or sutures. The glue was prepared immediately before the surgery, using the patient's blood components. After centrifugation, the plasma was collected and enhanced with calcium gluconate. Postoperative assessments were performed on Days 1, 7, 21, 30 and 180. The study evaluated postoperative edema and pain and complications. The mean surgical time was compared. Recurrence of the pterygium was assessed 6months postoperatively. The study evaluated 61 eyes. Thirty-three eyes underwent pterygium surgery using the glue technique, and 28 underwent the traditional suture technique. Fifty-one patients (83.60%) had successful graft adhered to at the end of follow-up. Ten patients (10/33) lost their graft in the glue group, and only 69.70% maintained graft presence in the fourth week versus 100% of the patients in the suture group (p = 0.001). Pain scores were lower in the glue group, and clinical edema was significantly higher. There was no significant difference in graft retraction or the presence of granuloma, necrosis or postoperative infection. Autologous fibrin glue is an affordable option for CAG fixation in particular contexts where commercial fibrin glue is unavailable, and it could offer advantages compared to sutures. A higher graft loss rate was observed and might be related to topical anesthesia, and improvements to the technique are needed. gov Identifier: NCT04151017. https://clinicaltrials.gov/ct2/show/NCT04151017?term=20170467&draw=1&rank=1 .

A comparative study of transscleral sutured intraocular lens fixation and sutureless flanged intraocular lens fixation

BackgroundTo compare the intraocular lens (IOL) tilt and decentration and visual outcomes of transscleral sutured IOL fixation and sutureless flanged IOL fixation. To investigate the influence of IOL tilt and decentration on internal higher-order aberrations (HOAs) in these two techniques.MethodsPatients who received transscleral sutured or sutureless flanged IOL fixation procedures were included in this prospective, non-randomized, comparative study. Corrected distance visual acuity (CDVA) was measured at baseline and at every postoperative visit for 12 months. IOL tilt and decentration were measured using a second-generation anterior segment optical coherence tomography (Casia2) and internal HOAs were measured using iTrace Visual Function Analyzer at 3 months postoperatively.ResultsThe study included 27 eyes from the transscleral sutured IOL fixation group and 26 eyes from the sutureless flanged IOL fixation group. There was no significant difference in CDVA between the two groups at all time points. The two groups did not differ in refractive difference from the predicted value, corneal endothelial cell loss, IOL tilt, IOL decentration, internal astigmatism or internal HOAs. Vertical IOL decentration significantly correlated with total internal optical aberration (r = 0.288, P = 0.036), total internal HOA (r = 0.440, P = 0.001), internal coma (r = 0.348, P = 0.001), vertical internal coma (r = 0.388, P = 0.004), average height of modulation transfer function (r = − 0.364, P = 0.007) and Strehl ratio (r = − 0.297, P = 0.031). Horizontal IOL decentration significantly correlated with horizontal internal coma (r = 0.312, P = 0.023).ConclusionsTransscleral sutured IOL fixation and sutureless flanged IOL fixation had similar IOL positions and visual outcomes. IOL decentrations correlated with internal HOAs and thus should be avoided.

Subcuticular suture and incisional surgical-site infection in elective hepatobiliary and pancreatic surgery: an open-label, pragmatic randomized clinical trial (CLOSKIN trial)

BackgroundSubcuticular suture has proven to reduce superficial incisional SSI (si-SSI) in clean surgery. However, question remains regarding clean-contaminated procedures. The aim of this study is to assess if subcuticular suture is superior to staples in reducing si-SSI incidence in elective HBP surgery.MethodsSingle-centre, open-label, parallel, pragmatic randomized clinical trial conducted at a referral tertiary Hospital between January 2020 and April 2022. Patients eligible for elective HBP surgery were randomly assigned (1:1) to subcuticular suture or surgical staples wound closure using a minimisation method based on previously confirmed risk factors. The primary endpoint was the incidence of si-SSI. Considered secondary endpoints were major postoperative morbidity in both groups, additional wound complications, median hospital length of stay and need for re-hospitalisation.ResultsOf the 379 patients, 346 patients were randomly assigned to receive skin closure with staples (n = 173) or subcuticular suture (n = 173). After further exclusion of 11 participants, 167 and 168 patients, respectively in the control and the experimental group received their allocated intervention. For the primary endpoint, no significant differences in si-SSI rate were found: 17 (9.82%) staples group vs. 8 (4.62%) in subcuticular suture group (p = 0.062). Subset analysis confirmed absence of significant differences. As for secondary endpoints, overall wound complications did not differ significantly between two procedures: 19 (10.98%) vs. 10 (6.35%) (p = 0.127). There were no treatment related adverse events. However, occurrence of si-SSI contributed to major postoperative morbidity in both groups (p < 0.001 and p = 0.018) and to a substantially prolonged postoperative hospitalization (p = 0.015).ConclusionsSubcuticular suture might offer a relative benefit for skin closure reducing incidence of si-SSI after elective HBP surgery, although this was found not to be clinically relevant. Yet, this should not be interpreted as equivalence among both treatments. Therefore, wound closure strategy should not be based only on these grounds.Trial registration number: ISRCTN Registry number ISRCTN37315612 (registration date: 14/01/2020).

Transanal full-thickness excision for rectal neoplasm: is it advisable to leave the defect open?

PurposeAfter a full-thickness total wall excision of a rectal tumor, suturing the defect is generally recommended. Recently, due to various contradictory studies, there is a trend to leave the defects open. Therefore, this study aimed to determine whether leaving the defect open is an adequate management strategy compared with suturing it closed based on postoperative outcomes and recurrences.MethodsA retrospective review of our prospectively maintained database was conducted. Adult patients who underwent transanal surgery for rectal neoplasm in our institution from 1997 to 2019 were analyzed. Patients were divided into two groups: sutured (group A) or unsutured (group B) rectal defect. The primary outcomes were morbidity (early and late) and recurrence.ResultsIn total, 404 (239 men) patients were analyzed, 143 (35.4%) from group A and 261 (64.6%) from group B. No differences were observed in tumor size, distance from the anal verge or operation time. The overall incidence of complications was significantly higher in patients from group B, which nearly double the rate of group A. With a mean follow-up of 58 (range, 12–96) months, seven patients presented with a rectal stricture, all of them from group B.ConclusionsWe acknowledge the occasional impossibility of closing the defect in patients who undergo local excision; however, when it is possible, the present data suggest that there may be advantages to suturing the defect closed.

Bionic artificial penile Tunica albuginea

Bionic artificial penile Tunica albuginea

Is Popularity of Fibrin Glue a Misrepresentation? A Comparative Study with Fibrin Glue and Suture Anastomosis in Rat Sciatic Nerve Injury Analysing Functional, Histological, Electrophysiological Parameters.

Fibrin glue as an adjunct in peripheral nerve injuries has gained recent popularity. Whether fibrosis and inflammatory processes which are the major hindrances in repair reduce with fibrin glue has more of theoretical support than experimental. A prospective nerve repair study was conducted between two different species of rats as donor and recipient. Four comparison groups with 40 rats were outlined with or without fibrin glue in immediate post-injury period with fresh or cold preserved grafts were examined based on histological, macroscopic, functional, and electrophysiological criteria. There was suture site granuloma along with neuroma formation and inflammatory reaction and severe epineural inflammation in allografts with immediate suturing (Group A), whereas suture site inflammation and epineural inflammation were negligible in cold preserved allografts with immediate suturing (Group B). Allografts with minimal suturing and glue (Group C) had less severe epineural inflammation with less severe suture site granuloma and neuroma formation as compared to first two groups. Continuity of nerve was partial in later group as compared to other two. In fibrin glue only group (Group D), suture site granuloma and neuroma were absent, with negligible epineural inflammation, but continuity nerve was partial to absent in most of the rats with some showing partial continuity. Functionally, microsuturing with or without glue demonstrated significant difference with better SLR and toe spread (p = 0.042) as compared with only glue. Electrophysiologically, NCV was maximum in Group A and least in Group D at 12 weeks. We report significant difference in CMAP and NCV between microsuturing group vs. only glue group (p < 0.05) and also between microsuturing with glue group vs. only glue group (p < 0.05). There may be more data required with proper standardization for adept usage of fibrin glue. Though our results have shown partial success, it nonetheless highlights the lack of sufficient data for widespread glue usage.

Clinical Equivalence of Monoglyde® and Monocryl® Absorbable Poliglecaprone-25 Sutures: A Single-Blind, Randomized Study

Objectives: Poliglecaprone-25 is a synthetic monofilament suture, commonly used for post-cesarean subcuticular skin closure. The present study was designed to assess the effect of subcuticular skin closure using Monoglyde® vs. Monocryl® poliglecaprone-25 absorbable sutures, on the risk of wound composite outcomes in the first 30 days postpartum [surgical site infection (SSI), wound dehiscence, hematoma or seroma]. Study Design: This is a prospective, single-blind, randomized (1:1), multicentric, two-arm, study performed between September 2020 and December 2021 at two different centres across India. Women (18-40 years) with a singleton pregnancy, requiring cesarean delivery were randomized to Monoglyde® (n=62) or Monocryl® (n=62) suture groups. The primary endpoint is incidence of wound composite outcomes in the first 30 days postpartum (SSI, wound dehiscence, seroma, or hematoma). In addition, the secondary outcomes, incidence of wound composite outcome at all visits (till 4 months), suture extrusion and loosening, suture removal and evaluation of microbial deposits on sutures (in case not absorbed or infection), operative time, intraoperative suture handling, postoperative pain, return to normal day-to-day activities, modified Hollander cosmesis score, subject satisfaction score, and adverse events were noted. Results: Non-significant difference between the groups regarding demographic characteristics and primary endpoint, incidence of wound composite outcome was observed. Moreover, no significant difference in suture extrusion and loosening, suture removal and evaluation of microbial deposits on sutures, operative time, intraoperative suture handling, pain, return to normal day-to-day activities, modified Hollander cosmesis, and subject satisfaction score were registered between the groups. Conclusions: This study establishes the clinical equivalence of Monoglyde® and Monocryl® poliglecaprone-25 sutures and both sutures can be used for subcuticular skin closure following cesarean delivery with minimal risk for wound complications.

The Early Effects of Longus Colli Muscle and Anterior Longitudinal Ligament Reconstructions on Swallowing Function after Anterior Cervical Surgery: A Six-Month Follow-Up Study.

Anterior cervical discectomy and fusion (ACDF) is the gold standard surgery used to treat cervical degenerative disease. Dysphagia and hoarseness are the two most common complications that occur after anterior cervical surgery (ACS). In this study, we aim to evaluate the early effects of longus colli muscle (LCM) and anterior longitudinal ligament (ALL) reconstructions on swallowing function after ACS. We recruited 91 patients (35 males and 56 females; mean age: 49.41 ± 8.60 years [range: 26-72 years]) who have undergone either ACDF or anterior cervical corpectomy and fusion (ACCF) between August 2019 and October 2021. Patients were divided into LCM and ALL suture group (Group A), and LCM and ALL non-suture group (Group B). Assessments of the incidence of dysphagia and the swallowing quality of life (SWAL-QOL) were completed in 2 days, 1 week, 1 month, 3 months and 6 months after surgery. Average prevertebral soft tissue thickness (APSTT) were measured on lateral cervical spine radiographs taken with X-rays 2 days, 1 month, 3 months and 6 months after surgery. In the 2-day, 1-week and 1-month postoperative follow-up, the incidence of dysphagia in group A was significantly lower than that in group B (p < 0.05), and the SWAL-QOL scores of group A were significantly higher than those of group B (p < 0.05). In the 3-month and 6-month postoperative follow-up, no significant differences were found between groups A and B in terms of the incidence of dysphagia (p > 0.05). In the 6-month postoperative follow-up, no significant differences were found between the groups in terms of SWAL-QOL scores (p > 0.05). There were no significant differences in APSTT between groups during postoperative follow-up (p > 0.05). The reconstructions of LCM and ALL in ACS can effectively improve short-term postoperative swallowing function.

Attached Oral Mucosal Wound Closure using Blue Glue - A Prospective Clinical Study.

Traditionally, sutures have been widely used to close intraoral wounds. Various alternatives have been developed amongst which newer tissue adhesives such as N-butyl-2-cyanoacrylate having accepted clinical properties are gaining popularity. The primary purpose of the present study is to evaluate the efficacy of N-butyl-2-cyanoacrylate for intraoral attached mucosal wound closure following alveoloplasty. In this prospective split-mouth study, 25 patients requiring alveoloplasty in either maxillary or mandibular arch bilaterally with a total of 50 sites were divided into two equal groups, namely silk suture (Group 1) and cyanoacrylate (Group 2). Each patient was evaluated on the first, third, seventh, 14th and 21st post-operative days. Parameters evaluated were time taken to close incision and to achieve haemostasis, pain, oedema, post-operative wound healing, patient discomfort and possible complications. Time taken to close incision, time taken to achieve haemostasis, post-operative pain and oedema were found to be less in Group 2. Wound healing too was found to be better in Group 2. There was one case of adhesive peel off on the first post-operative day which was managed by reapplying the tissue adhesive. The incidence of wound dehiscence and wound infection was observed more in Group 1 on the third post-operative day. Suture breakage (16%) and adhesive dislodgement (8%) were reported on the seventh post-operative day. The use of cyanoacrylates' inherent benefits, such as improved wound seal off in attached mucosa, quick polymerisation and bacteriostatic characteristics can be beneficial when performing minor oral surgical procedures on elderly, young and mentally challenged patients.

Efficacy of Bilateral Uterine Artery Ligation versus B-lynch Suture in Primary Postpartum Haemorrhage due to Uterine Atony in Lower Segment Caesarean Section: An Interventional Study

Introduction: Postpartum Haemorrhage (PPH) is the leading cause of maternal mortality in both developing and developed countries. PPH is a severe obstetric emergency that often occurs unexpectedly, leaving birth attendants unprepared to handle it on a regular basis. Aim: To evaluate the efficacy and complications of the Bilateral Uterine Artery Ligation (BUAL) technique and B-lynch sutures in Lower Segment Caesarean Section (LSCS) for primary PPH caused by uterine atony. Materials and Methods: A hospital-based prospective, interventional study was conducted at a secondary care centre in the inpatient Department of Obstetrics and Gynaecology at District Hospital, Tumkur, Karnataka, India. The duration of the study was one year from August 1, 2019, to August 1, 2020. A total of 100 patients with atonic PPH were randomly assigned to receive either BUAL (group BUAL-50 patients) or B-lynch sutures (group B-lynch-50 patients). Age, parity, gravidity, socioeconomic status, and risk factors were compared. The mean drop in Haemoglobin (Hb) percentage, the need for blood transfusion, and complications were studied and analysed. The success of the method was defined as avoiding obstetric hysterectomy and major complications. The z-test was used to calculate the difference between the means of the two groups. Results: The mean age of the patients was 25.22±4.33 years in the BUAL group and 26.02±4.32 years in the B-lynch group. During the one-year study period, the total number of deliveries in the Institution was 4,658, with 1,864 vaginal deliveries and 2,794 LSCS performed. Among the 2,794 LSCS cases, 268 women (9.58%) developed primary PPH. Out of these 268 women, 134 (50%) were managed with primary medical treatment for atonic PPH. For those who did not respond to primary medical management and met the inclusion and exclusion criteria, 50 women underwent BUAL and were assigned to the BUAL group. Another 50 cases were treated with B-lynch sutures and assigned to the B-lynch group. The patients in both groups were matched in terms of age, socio-economic status, booking status, gestational age at delivery, induction of labour, and high-risk factors for PPH. Maternal outcomes were analysed. The mean preoperative Hb level was 9.65±1.16 g/dL, which significantly decreased to 8.54±1.27 g/dL post-procedure in the BUAL group (p-value &lt;0.001). In the B-lynch group, the mean preoperative Hb level was 9.68±0.85 g/dL, which significantly decreased to 8.52±0.95 g/dL post-procedure (p-value &lt;0.001). The mean blood loss among patients was 1312.14±227.65 mL in the BUAL group and 1359.22±259.07 mL in the B-lynch group, but the difference was not statistically significant (p-value = 0.33). In the present study, 17 patients (34%) in the BUAL group and 21 patients (42%) in the B-lynch group did not require blood transfusion. The Intensive Care Unit (ICU) care was necessary for 6 (12%) patients in the BUAL group and 8 (16%) in the B-lynch group. Postoperative fever was a common complication in both groups. The success rate of BUAL was 94%, while the B-lynch procedure was successful in 96% of cases. Conclusion: The PPH a significant concern for obstetricians, and effective and meticulous management is crucial in reducing maternal mortality. Both BUAL and B-lynch sutures are simple, safe, and effective methods for controlling PPH during caesarean section by uterine devascularisation.

Influence of staple line reinforcement on the occurrence of bleeding complications following laparoscopic sleeve gastrectomy: a retrospective analysis.

Laparoscopic sleeve gastrectomy (LSG) has gained prominence as a therapeutic option for obesity and metabolic diseases. The choice of staple line reinforcement technique in LSG remains a subject of debate, particularly concerning postoperative bleeding complications. The aim of this retrospective analysis is to assess the influence of different staple line reinforcement techniques on the occurrence of bleeding complications LSG. We conducted a retrospective analysis of patients undergoing LSG between September 2021 and April 2023 at our institution. Patients were stratified into two groups based on the staple line reinforcement method: continuous suturing (n = 53) and clipping (n = 28). Surgical outcomes, including operative time, length of hospital stay, and bleeding complications, were assessed. Complications were classified using the Clavien-Dindo classification. Continuous suturing was associated with a significantly longer operative time (88.15 min vs. 74.64 min, p < 0.05) but a similar length of hospital stay. Notably, no bleeding complications occurred in the continuous suturing group, while the clipping group experienced postoperative bleeding in 7.14% of cases (p < 0.05). Continuous suturing exhibited a slightly higher incidence of minor complications classified as Class I in the Clavien-Dindo classification (7.55% vs. 0%). This retrospective analysis suggests that continuous suturing may provide enhanced hemostasis along the staple line, reducing the risk of postoperative bleeding compared to clipping. Despite the longer operative time and a slightly higher rate of minor complications, the clinical significance of these findings should be considered within the context of individual patient risk profiles.

Simple Separate Sutures Versus Continuous Sutures on Hepatic Artery Anastomosis in Liver Transplant: A Prospective Study.

Liver transplant is the definitive treatment for liver failure of various causes. There are various operation methods, of which the conventional approach is most frequently performed. In the conventional technique, 4 anastomoses are required, and different subtleties in these techniques are known to cause different rates of complications. We assessed the outcome of a simple separate (ie, interrupted) suture technique compared with a the continuous suture technique in 194 patients. There were 194 patients included in this single-center, controlled study. The exclusion criteria were patients who died during the surgical procedure and patients with incomplete medical records. The data recorded were age, sex, past medical history of liver disease, tobacco use, comorbidities, and whetherthe livertransplant was for the first time or retransplant. All patients included in this study were recipients of liver transplants from deceased donors. The patients were categorized as those who received either simple sutures (n = 16) or continuous sutures (n = 178). The continuous suture operations were performed first, and the simple suture operations were performed at a later time (ie, the 2 groups were temporally separated). The results included the duration of surgery, hepatic artery thrombosis rate, hepatic artery stenosis rate, 2-year survival, and further complications. No evidence of hepatic artery thrombosis or hepatic artery stenosis was observed in the study groups. The duration of surgery was equal in both groups. The 2-year mortality rate was significantly higher in the simple suture group. The continuous suture method seems to be accompanied by a similar duration of operation and rate of complications compared with the simple suture process.

EFFICACY AND SAFETY OF KNOTLESS BARBED SUTURES IN CAPSULAR CLOSURE FOLLOWING DISTAL FEMUR FRACTURE FIXATION.

Good wound closure is an important step in management of distal femur fracture to prevent infection and faster rehabilitation. Knotless barbed sutures can save time and distribute wound tension evenly. However, its role in terms of functional outcome, closure time, and postoperative complications has not been studied in a distal femur fracture. A total of 47 patients aged more than 18 years of distal femur fracture treated with distal femur locking plate were randomized either into either barbed or traditional suture groups. in the barbed group, capsular wound closure was carried out with 2-0 bidirectional barbed knotless sutures (Quill SRS® PDO, Angiotech, Vancouver, BC, Canada). In patients assigned to group B, capsular closure was done with 1-0 Vicryl® (Ethicon inc. Somerville, NJ) and 5-0 Ethibond® alternatively. The mean flexion at the knee joint was 105.7±15.6 degrees in the study group while it was 110.4±13.7 in the control group (p= 0.2133). Mean estimated closure time was significantly shorter in the study group as compared to the control group (p<0.05). Cases of needle prick injury were higher in traditional suture group. Patients developed stitch abscess and superficial infection in both groups. However, the difference in incidence between the two was not statistically significant. Barbed suture is an efficient method of wound closure. It reduces wound closure time with similar complication rate as with use of conventional sutures. Evidence Level II; Randomized Clinical Trial.

A modified triangular flap suture method used for inferior third molar extraction: A three-arm randomized clinical trial for the assessment of quality of life.

The purpose of this study is to explore whether decreasing the number of sutures can improve the quality of life after inferior third molar extraction. This study used a three-arm randomized design that included 90 individuals. Patients were randomized and divided into three groups-the airtight suture group (traditional), the buccal drainage group, and the no-suture group. Postoperative measurements, including treatment time, visual analog scale, questionnaire on postoperative patient quality of life, and details about trismus, swelling, dry socket, and other postoperative complications were obtained twice and the mean values were recorded. To verify the normal distribution of the data, the Shapiro-Wilk test was performed. The statistical differences were evaluated using the one-way ANOVA and the Kruskal-Wallis test with Bonferroni post-hoc correction. The buccal drainage group showed a significant decrease in postoperative pain and better speech ability than the no-suture group on the 3st day, with a mean of 1.3 and 0.7 (P < 0.05). The airtight suture group also showed similar eating and speech ability, which was better than the no-suture group, with a mean of 0.6 and 0.7 (P < 0.05). However, no significant improvements were noted on the 1st and 7th days. The surgical treatment time, postoperative social isolation, sleep impairment, physical appearance, trismus, and swelling showed no statistical difference between the three groups at all measured times (P > 0.05). Based on the above findings, the triangular flap without a buccal suture may be superior to the traditional group and no-suture group in less pain, and better postoperative patient satisfaction in the first 3 days and may be a simple and viable option in clinical practice.

Barbed Sutures: A Comprehensive Review of their Application in Medical

Objective: This study aims to analyze the use of barbed sutures in minimally invasive procedures, considering safety, efficiency, and reduction of surgical time. Methods: The analysis involved 43 articles selected from the PubMed electronic database, using the descriptors “Barbed sutures,” “Suture suspension,” and “Absorbable Knotless Barbed Suture.”. Results: Selected articles indicate that while the cost of barbed sutures slightly increases, the reduction in operating time potentially compensates for this, resulting in improved outcomes due to shorter anesthesia time. Barbed sutures reduced closure time by 32.8% compared to standard sutures. Unidirectional barbed sutures distribute soft tissues more effectively, preventing tissue slippage, leading to safer and more stable healing environments and less inflamed, thinner scars. Barbed sutures are valuable in rectus abdominis plication, particularly in abdominal wall fascia reinforcement post-TRAM flap removal for breast reconstruction or in conjunction with abdominoplasty. While not an official outcome, suture extrusion was 10% in the barbed suture group versus 20% in conventional sutures. Average complication rates were 9.7%, and surgical times averaged 108 minutes for breast augmentations and 156 minutes for abdominoplasties. Conclusion: The review found similar safety between barbed and conventional sutures. Barbed sutures offer enhanced tissue distribution, support, and aesthetic outcomes with lower inflammation risks. Data suggest improved complication rates, surgical time, and patient safety in breast reduction and panniculectomy. Barbed sutures are suitable for rectus abdominis plication, skin closure, and body contouring but not for arm regions due to prolonged foreign body response.

The Use of Different Suture Methods in Tilapia (Oreochromis niloticus) Fish

In this study, it is aimed to compare the suture methods in wounds created for different purposes in the field of aquaculture. For this purpose, Tilapia fish, which took the second place after carp in the inland waters fish breeding of hot countries, were used. In the study, Control group (n = 3), simple suture (n = 3), U suture (n = 3) and X (Sultan) suture (n = 3) applications were performed. The fish were subjected to 7 days of adaptation before starting the study. During the study, feeding was done once a day with Tetra Discus food. For the formation of cut wounds, scales were removed in Tilapia fish under anesthesia, and 2 cm long incision were performed. As a result of the study, it was observed that the cut wounds were closed on the 6th day in the U suture group, at the end of the 7th day in the control group and simple suture groups, and the 9th day in the X suture group. It was observed that the absorbable suture materials were absorbed in all fish in which they were applied, but in the X suture group, 1 fish was absorbed at the end of the 9th day. It is concluded that it is healthier to prefer simple suture and U suture primarily in areas such as marking, remote sensing, monitoring and management of fish methods, and fish health.

Total diz artroplastisi sonrası yara kapamada stapler ile prolen sütürün karşılaştırılması: Retrospektif kohort çalışması

Aim: The wound closure method applied after total knee replacement, plays a critical role in the success of the surgery. Various skin closure methods have been described in the literature in order to reduce infection rates, shorten the surgical time, and increase patient satisfaction. However, there is no standardized guideline on which type of suture should be used. The aim of this study was to compare the efficiency and safety of staples with prolene sutures in wound closure after total knee arthroplasty.&#x0D; Materials and Methods: Eighty-five patients that underwent total knee arthroplasty between January 2021 and October 2021 were retrospectively assessed. Patients were divided into two groups according to the wound closure method. The two groups were compared in terms of wound complication rate, operative time, postoperative hospitalization duration, and Likert scale level of patient satisfaction.&#x0D; Results: The majority (87.1%) of the patients were women . The mean age of the patients was 64.6±7.2 (range, 45-79). The prolene suture group had no wound complications while the staples group had five (11.9%) (p