Suture Group Research Articles

Glued suture-less peritoneum closure in laparoscopic inguinal hernia repair reduces acute postoperative pain

Inguinal hernia repair is performed more than 20 million times per annum, representing a significant health and economic burden. Over the last three decades, significant technical advances have started to reduce the invasiveness of these surgeries, which translated to better recovery and reduced costs. Here we bring forward an innovative surgical technique using a biodegradable cyanoacrylate glue instead of a traumatic suture to close the peritoneum, which is a highly innervated tissue layer, at the end of endoscopy hernia surgery. To test how this affects the invasiveness of hernia surgery, we conducted a cohort study. A total of 183 patients that underwent minimally invasive hernia repair, and the peritoneum was closed with either a conventional traumatic suture (n = 126, 68.9%) or our innovative approach using glue (n = 57, 31.1%). The proportion of patients experiencing acute pain after surgery was significantly reduced (36.8 vs. 54.0%, p = 0.032) by using glue instead of a suture. In accordance, the mean pain level was higher in the suture group (VAS = 1.5 vs. 1.3, p = 0.029) and more patients were still using painkillers (77.9 vs. 52.4%, p = 0.023). Furthermore, the rate of complications was not increased in the glue group. Using multivariate regressions, we identified that using a traumatic suture was an independent predictor of acute postoperative pain (OR 2.0, 95% CI 1.1–3.9, p = 0.042). In conclusion, suture-less glue closure of the peritoneum is innovative, safe, less painful, and possibly leads to enhanced recovery and decreased health costs.

Effect of Alaska pollock-gelatin sheet on repair strength and regeneration of nerve.

The aim of the study was to investigate the repair strength and the biocompatibility of Alaska pollock-derived gelatin (ApGltn) sheet for nerve repair. Cadaveric digital nerves were repaired with double suture, single suture + ApGltn sheet, single suture + fibrin glue, single suture, ApGltn sheet and fibrin. Maximum failure loads were measured (20 nerves each). Rat sciatic nerves were repaired with double suture, single suture + ApGltn sheet, single suture, ApGltn sheet, fibrin glue and resection (10 nerves each). Macroscopic appearance, muscle weight and histopathological findings were examined 8 weeks postoperatively. The mean failure load of ApGltn sheet (0.39 N) was significantly higher than that of a fibrin (0.05 N), and that of single suture + ApGltn sheet (1.32 N) was significantly higher than that of a single suture alone (0.97 N). Functional and histological assessments showed similar nerve recovery among the suture, ApGltn and fibrin groups. ApGltn sheet has potential for clinical application as an alternative to fibrin.

Outcomes of Septal Surgery with Nasal Packing Versus Quilting Sutures

Background: Septoplasty is a common surgical procedure used to correct a deviated nasal septum, which can cause nasal obstruction and impact respiratory function. Postoperative management traditionally includes nasal packing to prevent complications such as bleeding and hematoma, although it can be associated with discomfort and other complications. Quilting sutures have been proposed as an alternative technique to reduce these issues. Objective: To compare the postoperative outcomes of nasal packing versus quilting sutures in patients undergoing septoplasty. Methods: This prospective comparative cross-sectional study was conducted at the ENT unit of Combined Military Hospital Rawalpindi, Pakistan, after obtaining ethical approval. The sample size comprised 384 patients, with 192 in the nasal packing group and 192 in the quilting sutures group. Inclusion criteria included patients aged 18 to 70 years undergoing elective nasal septoplasty. Exclusion criteria were patients with nasal polyps, allergic rhinitis, diabetes, coagulation disorders, septal flap tears, those unfit for surgery, and those undergoing combined septoplasty and turbinate intervention. Patients were randomly assigned to either nasal packing or quilting sutures groups. Baseline characteristics, including age, gender, and BMI, were documented. Postoperative assessments were conducted at 48 hours, 1 week, and 3 months, evaluating pain using a visual analogue scale (VAS), bleeding, epiphora, dyspnea, hematoma, and adhesions. Data analysis was performed using SPSS version 26.0, with quantitative data represented as mean ± standard deviation and qualitative data as percentages and frequencies. Statistical significance was determined using chi-square and unpaired two-tailed Student’s t-tests, with p < 0.05 considered significant. Results: The mean age of participants was 34.37 ± 6.95 years. Gender distribution included 256 males (66.7%) and 128 females (33.3%). At 48 hours postoperatively, the nasal packing group had a higher mean pain score (5.96 ± 1.39) compared to the quilting sutures group (2.03 ± 1.05) (p < 0.001). Bleeding was more significant in the quilting sutures group (1.82 ± 0.60) than in the nasal packing group (1.27 ± 0.45) (p < 0.001). Epiphora and dyspnea were more common in the nasal packing group, with 48 patients (25%) and 81 patients (42.2%), respectively, compared to 8 patients (4.2%) and 6 patients (3.1%) in the quilting sutures group (p < 0.001). Hematoma occurrence was low and not significantly different between the groups. After 1 week, pain scores remained higher in the nasal packing group (1.45 ± 1.12) compared to the quilting sutures group (0.58 ± 0.79) (p < 0.001). At 3 months, pain scores were still higher in the nasal packing group (1.45 ± 1.12) compared to the quilting sutures group (0.58 ± 0.80) (p < 0.001), with no significant difference in adhesion formation. Conclusion: Quilting sutures resulted in lower postoperative pain and fewer complications compared to nasal packing in patients undergoing septoplasty, despite a slightly higher risk of bleeding. These findings suggest that quilting sutures may be a preferable alternative to nasal packing for postoperative management in septoplasty.

The Use of Fast-Acting Insulin Topical Solution on Skin to Promote Surgical Wound Healing in Cats.

Wound healing is a complex biological process involving a coordinated sequence of events aimed at restoring tissue integrity and function. Recent advancements in wound care have introduced novel therapies, with topical insulin application emerging as a promising strategy for promoting tissue healing. This study, involving 60 female cats (n = 60) undergoing elective spaying, aimed to evaluate the effects of topical fast-acting insulin on the healing process of surgical wounds. Each surgical suture was divided into two regions: the control zone (Zcr) without insulin application and the study zone (Zst), where insulin was applied topically for 10 min every 24 h over eight consecutive days. Assessment of suture healing was conducted using an adapted scale at two time points post-surgery: T1 (day 2) and T2 (day 8). Statistically significant differences were registered in the final healing scale scores between Zcr and Zst (p < 0.022), as well as for the parameter of regional fluid (p-value = 0.017). Additionally, at T2, all Zst regions exhibited wound closure, whereas Zcr did not, although not in a statistically significant manner. The observed discrepancy at T2 between the Zcr and Zst regions may suggest a potential benefit of utilizing insulin. No side effects resulting from the insulin topical application performed by the tutors were recorded in the Zst suture group. This study represents the first exploration of the benefits of topical insulin application for surgical wound healing in cats.

Reproductive outcome after laparoscopic ovarian cystectomy using barbed sutures versus conventional smooth sutures: Aretrospective cohort study.

To investigate the effects of barbed and conventional sutures on reproductive outcomes and ovarian reserve after laparoscopic treatment for benign non-endometrioma ovarian cysts. This retrospective study was conducted at an affiliated women's hospital between May 2017 and December 2019. Patients with benign non-endometriotic ovarian cysts undergoing laparoscopic cystectomy were included. Patients received barbed sutures (221 patients) or conventional smooth sutures (203 patients) intraoperatively. The two groups had comparable baseline characteristics. The surgical duration and ovarian suturing time were significantly shorter in the barbed suture group than in the conventional smooth suture group (P < 0.001 and P = 0.002, respectively). The rate of postoperative hemoglobin decline and serum anti-Müllerian hormone decline were similar between the two groups (P > 0.05). A total of 316 (74.53%) patients experienced at least one pregnancy postoperatively: 170 (76.92%) and 146 (71.92%) patients in the barbed suture and conventional smooth suture groups, respectively (χ2 = 1.395, P = 0.238). Multivariate Poisson regression demonstrated that barbed sutures had no significant effect on the overall postoperative pregnancy rate (adjusted incidence rate ratio, 1.10; 95% confidence interval, 0.93-1.36; P = 0.382). In patients with benign non-endometriotic ovarian cysts undergoing laparoscopic ovarian cystectomy, barbed sutures had a reproductive outcome similar to that of conventional smooth sutures while providing higher surgical efficiency without adverse effects on the postoperative ovarian reserve. Barbed sutures are probably a viable option to conventional smooth sutures.

Comparison of the Efficacies of Vicryl Rapide and Prolene Sutures in Transcolumellar Incision.

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; Septorhinoplasty aims to enhance nasal function and appearance. This common but complex procedure has demonstrated advancements with both open and endonasal approaches. The selection of sutures can impact patient comfort and scar outcomes, presenting both advantages and disadvantages.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; This study was conducted to compare the cosmetic outcomes of the use of absorbable polyglactin 910 (PG) (Vicryl Rapide 5/0; Ethicon Inc.) and nonabsorbable polypropylene (PP) (Prolene 5/0; Ethicon Inc.) in open septorhinoplasty in terms of surgical scarring.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Methods:&lt;/b&gt; The sample of this prospective, randomized, single-blind study consisted of 42 patients who underwent open septorhinoplasty. The patients were randomized into the vicryl rapide (n = 16) and prolene (n = 26) suture groups. The groups were comparatively evaluated by two surgeons in terms of surgical scarring, pigmentation, level difference, indentation, and general appearance based on patient photographs taken in the 2nd week, 6th weeks and 12th week post-op.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; The mean age of the vicryl rapide and prolene groups was 26.9 5.7 years and 24.6 3.9 years, respectively. There was no significant difference between the groups in any of the parameters investigated within the scope of the study in postoperative week 2, 6, and 12 (P &gt; 0.05). On the other hand, intragroup analyses revealed that suture scar significantly decreased in the vicryl rapide group in the 6th and 12th weeks compared to the 2nd week (P &lt; 0.05), while no significant difference was observed in the prolene group in the suture scars in week 6 and 12 compared to week 2 (P &gt; 0.05).&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; Inverted V trans-columellar incisions sutured with rapidly absorbable suture material resulted in significantly less suture discomfort and did not significantly increase the risk of postoperative infection compared to nonabsorbable suture material. However, there was no significant difference between the two suture materials in terms of scar appearance.&lt;/br&gt.

Simulation training of laparoscopic biliary-enteric anastomosis with a three-dimensional-printed model leads to better skill transfer: a randomized controlled trial.

A new simulation model and training curriculum for laparoscopic bilioenteric anastomosis has been developed. Currently, this concept lacks evidence for the transfer of skills from simulation to clinical settings. This study was conducted to determine whether training with a three-dimensional (3D) bilioenteric anastomosis model result in greater transfer of skills than traditional training methods involving video observation and a general suture model. Fifteen general surgeons with no prior experience in laparoscopic biliary-enteric anastomosis were included in this study and randomised into three training groups: video observation only, practice using a general suture model, and practice using a 3D-printed biliary-enteric anastomosis model. Following five training sessions, each surgeon was asked to perform a laparoscopic biliary-enteric anastomosis procedure on an isolated swine organ model. The operative time and performance scores of the procedure were recorded and compared among the three training groups. The operation time in the 3D-printed model group was significantly shorter than the suture and video observation groups ( P =0.040). Furthermore, the performance score of the 3D-printed model group was significantly higher than those of the suture and video observation groups ( P =0.001). Finally, the goal score for laparoscopic biliary-enteric anastomosis in the isolated swine organ model was significantly higher in the 3D model group than in the suture and video observation groups ( P =0.004). The utilisation of a novel 3D-printed model for simulation training in laparoscopic biliary-enteric anastomosis facilitates improved skill acquisition and transferability to an animal setting compared with traditional training techniques.

Gal - T Knockout Porcine Nerve Xenografts Support Axonal Regeneration in a Rodent Sciatic Nerve Model.

Nerve xenografts harvested from transgenic α1,3-galactosyltransferase knockout (GalT-KO) pigs lack the epitope responsible for hyperacute rejection in pig-to-primate transplants. It is unknown whether these cold preserved nerve grafts support axonal regeneration in another species during and after immunosuppression. In this study, we compare outcomes between autografts and cold preserved xenografts in a rat sciatic model of nerve gap repair. Fifty male Lewis rats had a 1 cm sciatic nerve defect repaired using either: autograft and suture (n=10); 1-week or 4-week cold preserved xenograft and suture (n=10 per group); 1-week or 4-week cold preserved xenograft and photochemical tissue bonding using a human amnion wrap (PTB/HAM) (n=10 per group). Rats with xenografts were given tacrolimus until 4 months post-operatively. At 4 and 7 months, rats were euthanized and nerve sections harvested. Monthly sciatic functional index (SFI) scores were calculated. All groups showed increases in SFI scores by 4 and 7 months. The autograft suture group had the highest axon density at 4 and 7 months. The largest decrease in axon density from 4 to 7 months was in the 1-week cold preserved PTB/HAM group. The only significant difference between group SFI scores occurred at 5 months, when both 1-week cold preserved groups had significantly lower scores than the 4-week cold preserved suture group. Our results in the rat sciatic model suggest that GalT-KO nerve xenografts may be viable alternatives to autografts and demonstrate the need for further studies of long-gap repair and comparison with acellular nerve allografts. This proof-of-concept study in the rat sciatic model demonstrates that cold preserved GalT-KO porcine xenografts support axonal regeneration, as well as axonal viability following immunosuppression withdrawal. These results further suggest a role for both cold preservation and photochemical tissue bonding in modulating the immunological response at the nerve repair site.

Evaluation of two liver biopsy and rectal sealing techniques in dog cadavers undergoing Natural Orifices Transluminal Endoscopic Surgery (NOTES) by transrectal access

The aim of this study was to evaluate two liver biopsy techniques by transrectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) and compare tensiometric parameters of rectal sealing using 2-octyl cyanoacrylate glue or conventional rectal sutures in a dog cadaver model. In sixteen dog cadavers two liver biopsy techniques were performed via transrectal NOTES using either polypectomy diathermy forceps or endoscopic oval biopsy forceps. The cadavers were divided into two groups: Glue Group (GG) where rectal sealing was performed with 2-octyl cyanoacrylate glue and Suture Group (SG) with the rectal defect sealed with simple continuous extracorporeal 3-0 polydioxanone sutures. The rupture pressure of the seals was measured on a rectal burst test. The diathermy polypectomy endoscopic forceps biopsy technique was significantly faster (p&lt;0.001) and provided larger diameter samples. Rectal sealing was significantly faster (p&lt;0.001) in the GG. There was no difference between the two groups with regard to rupture pressure (258.5 mmHg) with air insufflation. Using endoscopic oval biopsy forceps, biopsy samples can only be collected from the surface of the liver, whereas polypectomy forceps with a diathermy loop can be used to collect samples from the tip of the hepatic lobe. There was no difference in rectal rupture pressure in the burst test between the cadavers where sealing was performed with rectal sutures and those where cyanoacrylate adhesive was used.

Compari̇son of PTFE sutures with polypropylene sutures in suprapopliteal femoropopliteal bypass with PTFE grafts

Aim: Infrainguinal bypass surgery stands as the predominant open surgical procedure for lower limb revascularization and is reserved for cases of intermittent claudication (IC) that have proven unresponsive to maximal medical management. Polypropylene monofilament sutures have been widely used for peripheral vascular surgery operations. Aim of this study is comparing this new type of suture with propylene sutures. Material and Methods: Between January 2022 and December 2022, two cohorts who underwent suprapopliteal femoropopliteal bypass surgery, each comprising 15 patients were included in the study. In Group I (polytetrafluoroethylene (PTFE) Group), PTFE served as the suture material, whereas in Group 2 (Non PTFE Group), polypropylene sutures were employed. All preoperative demographics, perioperative and postoperative data were collected carefully. Results: All patients underwent surgical interventions due to either rest pain or ischemic ulcers. Among the 30 patients, 11 fell into Fontaine class 4, while 19 were categorized as Fontaine class 3. Out of the 30 patients, 18 received cilostazol treatment. The mean age of the patient cohort was 66.97±7.4 years, with a mean body mass index of 29.03±6.2. When we compared the two groups, no statistically significant difference was found between groups according to demographic data. In the evaluation of intraoperative data, the mean operation time was 88.7±9.37 minutes, and the mean hemostasis time was 5.8±2.8 minutes. Group I (PTFE group) exhibited significantly lower hemostasis time and drainage levels on the first and second postoperative days (p&lt;0.0001, p=0.03, and p=0.017, respectively). The use of absorbable hemostats were significantly less in PTFE suture group. Conclusion: The selection of sutures significantly influences the achievement of soft tissue approximation, reduced inflammation, suture hole leakage and capsule formation.

Long-Term Mesh Exposure 5 Years Following Minimally Invasive Total Hysterectomy and Sacrocolpopexy

Introduction and HypothesisThe objective was to assess long-term mesh complications following total hysterectomy and sacrocolpopexy.MethodsIn this second extension study, women from a multicenter randomized trial were followed for more than 36 months after surgery. Owing to COVID-19, participants were assessed through either in-person visits or telephone questionnaires. The primary outcome was the incidence of permanent suture or mesh exposure. Secondary outcomes included surgical success and late adverse outcomes.ResultsOut of the 200 initially enrolled participants, 82 women took part in this second extension study. Among them, 46 were in the permanent suture group, and 36 in the delayed absorbable group. The mean follow-up duration was 5.3 years, with the cumulative mesh or suture exposure of 9.9%, involving 18 cases, of which 4 were incident cases. Surgical success after more than 5 years stood at 95%, with few experiencing bothersome bulge symptoms or requiring retreatment. No serious adverse events occurred, including mesh erosion into the bladder or bowel. The most common adverse events were vaginal pain, bleeding, dyspareunia, and stress urinary incontinence, with no significant differences between suture types.ConclusionThe study found that mesh exposure risk gradually increased over time, reaching nearly 10% after more than 5 years post-surgery, regardless of suture type. However, surgical success remained high, and no delayed serious adverse events were reported.

In vivo comparison of mesh fixation solutions in open and laparoscopic procedures for inguinal hernia repair: A meta-analysis

BackgroundAbdominal hernia repair surgeries involve the fixation of a surgical mesh to the abdominal wall with different means such as suture, tacks, and glues. Currently, the most effective mesh fixation system is still debated. This review compares outcomes of mesh fixation in different surgical procedures, aiding surgeons in identifying the optimal technique. MethodsA meta-analysis was conducted according to PRISMA guidelines. Articles published between January 2003 and January 2023 were searched in electronic databases. Randomized controlled trials (RCTs) comparing mesh fixation with cyanoacrylate-based or fibrin glues with classical fixation techniques (sutures, tacks) in open and laparoscopic procedures were included. Results17 RCTs were identified; the cumulative study population included 3919 patients and a total of 3976 inguinal hernias. Cyanoacrylate-based and fibrin glues were used in 1639 different defects, suture and tacks in 1912 defects, self-gripping mesh in 404 cases, and no mesh fixation in 21 defects. Glue fixation resulted in lower early postoperative pain, and chronic pain occurred less frequently. The incidence of hematoma was lower with glue fixation than with mechanical fixation. Recurrence rate, seroma formation, operative and hospitalization time showed no significant differences; but significantly, a higher number of people in the glue group returned to work by 15- and 30-days after surgery when compared to the tacker and suture groups in the same time frame. ConclusionCyanoacrylate and fibrin glue may be effective in reducing early and chronic pain and hematoma incidence without increasing the recurrence rate, the seroma formation, or the operative and hospitalization time.

Peripheral arterial catheter securement and catheter survival in the pediatric intensive care unit.

Peripheral arterial catheters (PACs), and their associated complications, are common in the pediatric intensive care unit (PICU). Accidental catheter displacement and non-functional PACs are the most common complications, and this may be related to inadequate catheter securement. There is mixed guidance on the best way to secure PACs to prevent complications. The authors hypothesized that sutures would not be associated with a decreased risk of malfunction or accidental removal. This was a single center retrospective cohort study at a quaternary-care PICU. PICU patients with a peripheral arterial catheter placed in the PICU from 7/2020 to 1/2023 were included. The primary outcome was unplanned PAC removal. A univariate and multivariate Cox proportional hazards regression analysis was performed, using patient weight, sedation, paralytic, and role of the proceduralist as covariates. The secondary outcome was survival probability. A log-rank test was used to compare survival curves. Of 761 PACs that met inclusion criteria in 437 unique patients, 599 were sutured (78.7%) and 162 were un-sutured (21.3%). In 257 cases (33.8%), the PAC had an unplanned removal. Among all PACs, the median duration of PAC placement was 5.3 days (IQR 2.1-10.5 days). There was an unplanned removal rate of 42.2% (68) in the un-sutured group and 31.4% (188) in the sutured group (p < 0.001). In multivariable analysis, sutured PACs were also associated with a lower rate of unplanned removal (hazard ratio, 0.59; 95% CI, 0.44-0.78). Use of continuous sedation was also associated with an increased risk of unplanned removal of PACs (hazard ratio, 1.54; 95% CI, 1.10-2.16). There was a 50% survival probability at 13.3 days for un-sutured PACs and 23.7 days for sutured PACs. Suturing is associated with fewer unplanned removals and longer catheter survival, compared to un-sutured PACs in pediatric patients.

Buttressing Sutures at the Center of the Mesh May Reduce the Probability of Recurrence in Onlay Incisional Hernia Repair: A Single-Center Study.

An incisional hernia is a common complication after abdominal surgery. Mesh fixation and fascial closure are crucial aspects of repairing incisional hernias. The aim of this study is to investigate the effect of adding a buttressing suture in the center of the mesh in onlay incisional hernia repair on recurrence. This retrospective study analyzed 157 patients who underwent elective repair of incisional hernia at Tokat State Hospital between January 2013 and January 2020. The study examined age, gender, comorbidity, smoking, hernia type, defect size, operative time, follow-up time, recurrence, and chronic pain. The patients were divided into two groups based on the type of buttressing suture used: normal and buttressing suture. Recurrence was defined as the reappearance of a hernia at the site of a previous surgery. The study included 126 patients, with 61 (48.4%) in the control group and 55 (51.6%) in the buttressing suture group. Ten patients reported recurrence, with eight (13.1%) in the control group and two (3.1%) in the buttressing suture group. The difference in recurrence between the groups was statistically significant (p=0.038). The control group had an operative time of 58.79±13.23 minutes, while the buttressing suture group had an operative time of 62.12±13.51 minutes. The statistical analysis did not reveal any significant difference between the two groups (p=0.091). Out of the patients with chronic pain, two (33%) were in the control group and four (66%) were in the buttressing suture group. The incidence of chronic pain did not differ significantly between the two groups (p=0.52). In incisional hernia repair, the use of buttressing sutures with mesh in incisional hernia repair resulted in decreased recurrence rates without increasing chronic pain or affecting operative time.

Effect of anti-reflux suture on gastroesophageal reflux symptoms after one anastomosis gastric bypass: a randomized controlled trial.

Gastroesophageal reflux disease (GERD) is an issue after one anastomosis gastric bypass (OAGB) and modification of OAGB with adding an anti-reflux system may decrease the incidence of postoperative GERD. This study aimed to compare the efficacy of the anti-reflux mechanism to treat preoperative GERD and prevent de novo GERD. A prospective randomized clinical trial study was conducted on patients with a body mass index of 40 and more from August 2020 to February 2022. Patients undergoing one anastomosis gastric bypass with and without anti-reflux sutures (groups A and B, respectively). These patients had follow-ups for one year after the surgery. GERD symptoms were assessed in all the patients using the GERD symptom questionnaire. The mean age was 39.5 ± 9.8 years and 40.7 ± 10.2 years in groups A and B respectively. GERD symptoms remission occurred in 76.5% and 68.4% of patients in groups A and B, respectively. The incidence of de novo GERD symptoms was lower in group A, compared to group B (6.2% and 16.1% in groups A and B respectively), without any statistically significant difference (p-value: 0.239). GERD symptoms and de novo GERD after OAGB seems to be under-reported after OAGB. This study suggests that applying an anti-reflux suture can decrease de novo GERD symptoms.

In vitro and in vivo investigation of Argiope bruennichi spider silk-based novel biomaterial for medical use.

As a natural and biocompatible material with high strength and flexibility, spider silk is frequently used in biomedical studies. In this study, the availability of Argiope bruennichi spider silk as a surgical suture material was investigated. The effects of spider silk-based and commercial sutures, with and without Aloe vera coating, on wound healing were evaluated by a rat dorsal skin flap model, postoperatively (7th and 14th days). Biochemical, hematological, histological, immunohistochemical, small angle x-ray scattering (SAXS) analyses and mechanical tests were performed. A. bruennichi silk did not show any cytotoxic effect on the L929 cell line according to MTT and LDH assays, in vitro. The silk materials did not cause any allergic reaction, infection, or systemic effect in rats according to hematological and biochemical analyses. A. bruennichi spider silk group showed a similar healing response to commercial sutures. SAXS analysis showed that the 14th-day applications of A. bruennichi spider silk and A. vera coated commercial suture groups have comparable structural results with control group. In conclusion, A. bruennichi spider silk is biocompatible in line with the parameters examined and shows a healing response similar to the commercial sutures commonly used in the skin.

Long-term outcomes of glued (sutureless) amniotic membrane transplantation in acute Stevens-Johnson syndrome/toxic epidermal necrolysis: a comparative study

PurposeTo compare the effectiveness and efficiency of a glued (sutureless) technique for amniotic membrane transplantation (AMT) with a traditional sutured one in the setting of acute Stevens-Johnson syndrome/toxic epidermal necrolysis...

Comparison of 2-octyl cyanoacrylate with polyester mesh with standard suture and staples in total knee and hip arthroplasty.

The use of 2-octyl cyanoacrylate with polyester mesh (OCA-M) has become common in total hip and knee arthroplasty (THA, TKA). We aimed to compare the safety and cosmetic outcomes between OCA-M and standard suture techniques and staples, and determine whether OCA-M can safely be used for TKA. Inclusion criteria were patients who underwent THA or TKA from January 2010 to October 2011 (Suture group), November 2011 to August 2013 (Staple group), March 2017 to September 2018 (OCA-M group). Exclusion criteria was loss of imaging data. Complications during hospitalisation (early complication) and after discharge (late complication) were compared in groups. Plastic and orthopaedic surgeons performed cosmetic evaluations with the modified Vancouver Scar Scale (VSS) and Likert scale at three and six months postoperatively and compared in groups. A total of 249 arthroplasties (suture group=88 patients; staple group=94 patients; OCA-M group=67 patients) were included in the study. The OCA-M group had a significantly lower early complication rate than the suture group (p=0.015). For THA, the OCA-M group had a significantly lower total complication rate than the suture group (p=0.048). For TKA, there was no significant difference among the three groups. The complication rate in the OCA-M group showed no significant difference between THA/TKA. With regards to the VSS, the OCA-M group was significantly better for cosmetic qualities than the suture group (p=<0.001, p=0.021 at three and six months, respectively). For the Likert scale, the OCA-M group was also significantly better for cosmetic qualities than the suture group and staple group (suture-OCA-M, p=0.003 (three months), p=<0.001 (six months); staple-OCA-M, p=0.027 (three months)). In this study, the OCA-M complication rate was low compared to suturing and similar to stapling. Moreover, better cosmetic outcomes were achieved compared to suturing and stapling.

Effects of endometrial versus non-endometrial suturing on isthmocele development; a randomized controlled trial.

ObjectiveIncomplete healing after cesarean section (CS) can result in isthmocele formation. When suturing the uterus, fully folding the wound lips may embed the endometrial layer into the myometrium, leading to isthmocele development. Hence, this study aimed to compare the effects of endometrial and non-endometrial suturing on isthmocele development. Material and methodsThis randomized controlled trial included 274 patients. Women who underwent primary CS were randomly allocated to one of the two study groups: endometrial suturing and non-endometrial suturing. The primary outcome was isthmocele rate at postpartum 6 months. Secondary outcomes were the volume of the isthmocele, thickness of the residual myometrium, menstrual irregularities (intermenstrual spotting), and the relationship between the isthmocele and uterine position. ResultsA total of 159 patients (81 in the endometrial suturing group and 78 in the non-endometrial suturing group) were analyzed. The incidence of isthmocele was significantly lower in the non-endometrial suturing group than in the endometrial suturing group (12 [15.4%] vs. 24 [29.6%] patients; p = 0.032). Menstrual irregularities, such as intermenstrual spotting, were significantly higher in the endometrial suturing group than in the non-endometrial group (p = 0.019). ConclusionUterine closure with non-endometrial suturing was associated with significantly lower isthmocele development and less intermenstrual spotting compared to that with endometrial suturing.

Neurocognitive outcomes and associated clinical factors 5 years after surgery in children with craniosynostosis.

Craniosynostosis involves early closure of one or more sutures, which is known to limit normal cranium growth and interfere with normal brain development. Various surgical methods are used, ranging from minimally invasive strip craniectomy to more extensive whole-vault cranioplasty. This study aimed to evaluate neurocognitive outcomes 5 years after surgical treatment in children with craniosynostosis and to evaluate relevant clinical factors. After exclusion of genetically confirmed syndromic craniosynostosis patients, a retrospective review was conducted on 112 nonsyndromic craniosynostosis patients who underwent surgical treatment and follow-up neurocognitive assessment. Ninety-seven patients underwent strip craniectomy with postoperative orthotic helmet therapy, and 15 received other surgical treatment: 4 with distraction osteotomy and 11 with craniofacial reconstruction. Neurocognitive assessment using the Korean Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (K-WPPSI-IV), was performed 5 years postoperatively. Clinical factors were assessed regarding neurocognitive outcomes. The mean age at surgery was significantly younger in the strip craniectomy group (strip craniectomy 4.6 months vs other surgical treatment 18.6 months, p < 0.01). Patients with 2 or more sutures involved were more likely to receive more extensive surgical treatment (16.5% in the strip craniectomy group vs 53.8% in the other group, p < 0.01). Four (3.5%) patients who showed evidence of increased intracranial pressure (ICP) also underwent more extensive surgical treatment. Multivariable linear regression revealed a significant correlation of age at neurocognitive testing (-3.18, 95% CI -5.95 to -0.40, p = 0.02), increased ICP (-34.73, 95% CI -51.04 to -18.41, p < 0.01), and the level of maternal education (6.11, 95% CI 1.01-11.20, p = 0.02) with the Full-Scale Intelligence Quotient (FSIQ). Age at surgery, involvement of 2 or more sutures, and type of operation demonstrated no correlation with FSIQ. Among the 97 patients who underwent strip craniectomy, the FSIQ ranged from mean ± SD 100.2 ± 10.2 (bicoronal) to 110.1 ± 12.7 (lambdoid), and there was no significant difference between the suture groups (p = 0.41). The 5 index scores were all within average ranges based on their age norms. Age at neurocognitive assessment, increased ICP, and maternal education level showed significant correlations with the neurocognitive function of craniosynostosis patients. Although children with craniosynostosis exhibited favorable 5-year postoperative neurocognitive outcomes across various synostosis sutures, longer follow-up is needed to reveal the incidence of neurocognitive dysfunction in these patients.