Suture Closure Research Articles

A pedicled anterolateral thigh flap decreased the risk of empty pelvis syndrome following total pelvic exenteration.

Total pelvic exenteration (TPE) can be complicated by empty pelvis syndrome (EPS), and none of the currently available procedures completely mitigate this problem. The aim of this study was to evaluate the feasibility and effectiveness of a pedicled anterolateral thigh (p-ALT) flap for preventing EPS. All cases of TPE at the National Cancer Center Hospital in Tokyo between 2008 and 2022 were retrospectively reviewed. The main indication for TPE was colorectal cancer, with some other malignancies. Background factors, surgical outcomes and postoperative complications were compared between patients who underwent primary suture closure (the PC group) and those who underwent p-ALT flap reconstruction (the flap group). A total of 114 patients underwent TPE during the study period. Twenty patients in whom a different procedure was performed or a different flap was used for reconstruction were excluded, leaving 94 for analysis (PC group, n = 54; flap group, n = 40). There was no significant between-group difference in patient characteristics. Severe pelvic abscess developed in 12 patients (22.2%) in the PC group and 2 (5%) in the flap group. Multivariable analysis identified a significantly lower risk of severe pelvic abscess in the p-ALT flap reconstruction (OR 0.07, 95% CI 0.01-0.58, p = 0.01). EPS-related readmissions were more common in the PC group [37.0% (20/54) vs. 25% (10/40)]. The risk of severe pelvic abscesses and readmission for EPS was significantly lower after perineal reconstruction with a p-ALT flap. Perineal reconstruction with this flap is a feasible and effective method in TPE.

HPB SO12 - Comparison of outcomes between stapled closure and sutured closure of pancreatic stump following robotic distal pancreatectomy

Abstract Background Postoperative pancreatic fistulas (POPFs) are associated with high patient mortality and morbidity. There are multiple approaches in managing pancreatic stumps following distal pancreatectomy. We compared the outcomes between sutured closure and stapled closure following robotic distal pancreatectomy and splenectomy, and the associated cost difference between the two techniques. Method We retrospectively analysed consecutive robotic distal pancreatectomy and splenectomy cases between October 2022 and January 2024 in a single United Kingdom tertiary hospital. Stapled closure was the initial standard approach. Sutured closure utilising 3/0 Prolene was regularly performed from July 2023. The study cohort was divided into these two groups and outcomes were compared. Primary outcome was POPF rates and secondary outcomes included postoperative length of stay (LOS), 30-day readmission rates and postoperative complications graded by Clavien-Dindo classification (CDC). Equipment costs for the respective procedures were obtained from hospital procurement team. Results 36 patients were reviewed; 14 (38.9%) were stapled and 22 (61.1%) were sutured. Patient characteristics including mean age, gender and ASA grade were similar in both groups. 23/36 (63.9%) patients had confirmed malignancy on postoperative histopathology – similar distribution in both groups. 6/14 (42.9%) in the stapled group vs 4/22 (18.2%) in the sutured group developed POPF Grade B (p=0.14). LOS, 30-day readmission and CDC complication rates were similar in both groups. Median costs were £2236.40 and £1541.86 in the stapled and sutured groups respectively. Conclusion Sutured closure of pancreatic stump yielded similar outcomes to stapled closure following robotic distal pancreatectomy, associated with a significant cost saving in favour of sutured closure.

BN SO05 - Risk Factors associated with Complications Post-Laparoscopic Common Bile Duct Exploration: A Comprehensive Literature Review

Abstract Background Gallstone-related diseases, particularly common bile duct (CBD) stones, present a significant global health issue. The adoption of laparoscopic common bile duct exploration (LCBDE) has revolutionized the management of these conditions by providing a minimally invasive alternative to open surgery. This literature review aims to identify and analyze the risk factors associated with complications in LCBDE, thereby offering insights to improve patient care and outcomes. Method comprehensive search for primary research studies, systematic reviews, and meta-analyses pertaining to risk factors for complications following LCBDE. The search was conducted on PubMed, focusing on English-language articles published within the last 20 years and encompassing all age groups. Peer-reviewed journal articles were prioritized. All relevant studies reporting complications after LCBDE were eligible for inclusion if available as full texts, structured abstracts, or conference reports. The initial search yielded 826 articles. Exclusion criteria : open surgery, non-English articles, lacking full-text. A total of 29 records were identified by the literature search. Results Laparoscopic common bile duct exploration (LCBDE) is generally safe and effective, with complication rates influenced by patient and procedural factors. Older age, comorbidities, previous abdominal surgeries, high BMI, narrow common bile ducts, and difficult stones increase risks. Experienced surgeons and shorter operative times reduce complications. The transcystic approach and primary suture closure have fewer complications compared to the transductal route and T-tube drainage, respectively. Intraoperative imaging significantly reduces risks by ensuring complete stone clearance and identifying anatomical variations. Tailoring surgical approaches to patient-specific factors and leveraging surgical expertise are crucial for minimizing complications in LCBDE. Conclusion LCBDE emerges as a safe and effective therapeutic modality for addressing conditions impacting the bile ducts (31). The success and utility of LCBDE can be significantly enhanced through the meticulous optimization of patient-related, surgeon-related, and procedure-related factors. By addressing and fine-tuning these key elements, the occurrence of complications associated with LCBDE can be mitigated, thereby reinforcing its potential as a primary choice for managing various bile duct conditions. This strategic approach not only underscores the clinical efficacy of LCBDE but also advocates for its expanded utilization as a frontline intervention in the comprehensive management of bile duct disorders.

Do Antibacterial Skin Sutures Reduce Surgical Site Infections After Elective Open Abdominal Surgery?—A Prospective, Randomized Controlled Single-Center Trial

Background/Objectives: The general use of triclosan-coated suture material (TCSM) for wound closure to prevent surgical site infections (SSIs) remains controversial. There is no conclusive evidence in the literature to support this and recommendations by professional organizations are contradictory. Therefore, the main objective of the study was to evaluate the 30-day rate of surgical site infections (SSIs) after elective open abdominal surgery using triclosan-coated versus uncoated running sutures (NCSM) for skin closure. Methods: This prospective, randomized, double-blinded study enrolled patients scheduled for open elective abdominal surgery, intraoperatively assigned to either the use of triclosan-coated or non-coated sutures for skin closure. The follow up was 30 days after surgery to detect SSIs. Secondary endpoints were wound dehiscence and reoperation rate due to wound dehiscence within 30 days, all-cause 30-day mortality and length of hospital stay. Potential risk factors for poor wound healing were evaluated in multivariate analysis. Data were analyzed in an intention to treat analysis. Results: In total, 364 patients (171 males [47%]) were randomized, 182 in either group. Six underwent urgent reoperation prior to first visit and were excluded from analysis. In the full analysis set (FAS), 358 were analyzed. SSI within 30 days occurred in 22 [12.2%] patients in the control group compared to 32 [18%] in the study group. The risk difference was not statistically significant (5.8%; 95% confidence interval (CI) −1.6–13.2%; p = 0.128). The wound dehiscence rate within 30 days was 14 of 179 [7.8%] in the NCSM group vs. 19 of 178 [10.7%] in the TCSM group. The difference in re-operation rates due to wound dehiscence was 0 of 179 [2.8%] vs. 5 of 178 [2.8%] in either group and not statistically significant (p = 0.0706). Among all patients recruited, 8 died within 30 days after surgery. Three of them died before the first assessment of the primary endpoint on day 3 and were therefore excluded from the FAS. The 30-day mortality rate was 2 of 180 [1.1%] in the NCSM group vs. 3 of 178 [1.7%] in the TCSM group. The majority of SSIs occurred in the superficial layer of the wound in both study groups (8.9% vs. 9.6%). The median [inter quartile range (IQR)] length of hospital stay was 13 [9.0, 19.2] days in the NCSM group vs. 11 [9.0, 16.8] days in the TCSM group There was a tendency towards shorter hospitalization in the study group (0.72 days [6%]). Conclusions: Our prospective randomized controlled trial could not confirm the superiority of TCSM for skin closure after elective open abdominal surgery in terms of SSI rates in a 30-day follow up period. Therefore, based on our results, a general recommendation for its use in all surgical fields cannot be justified.

Changes in donor site after two variants of patellar tendon graft harvest

Background. The patellar tendon is often used as ACL graft. Identifying of factors that improve donor site healing may improve the outcomes.Aim. Study changes in the patellar tendon after two variants of graft harvest techniques and determine what features contribute to better donor site healing.Methods. The morphology of the patellar tendon was studied after two variants of graft harvest techniques with early rehab protocol. The retrospective group included 30 patients with no patellar tendon and bone defects closure. The prospective group included 30 patients with full-layer patellar tendon suture and bone defects closure. The Insall-Salvati ratio after surgery was measured on an X-ray in both groups. MRI study before surgery and 12 months after and CT 1 day and 6 months after surgery was performed in prospective group. The sizes of patellar tendon and conditions of bone defects were studied. Results. Patella position was physiological and did not differ between the groups (1.11 ± 0.13 - in group 1 and 1.12 ± 0.15 - in group 2, p = 0.955). In the prospective group after 12 months the patellar tendon length was shorter by 3.1% (-1.4 ± 2.4 mm, p = 0.003); the ligament width in the upper and middle thirds slightly increased (0.3±2.4 mm, p=0.502 and 0.5±2.1, p=0.205), and in the lower third it was 2.7% greater (0.7±1.7 mm, p=0.034); the ligament thickness increased by 55% (2.4±1.6 mm, p=0.001). All patients in group 1 had persistent bone and tendon defects. In group 2 the bone defects healed 6 months after, the ligament restored its shape and size, approaching the preoperative values 12 months after the surgery.Conclusions. Full-layer suture of the patellar tendon, autoplasty of bone defects and early mobilization ensure healing of bone defects and restoration of the integrity, shape and size of the ligament.

Wound complication rates after anterior total hip arthroplasty: A case series comparison of interrupted vs. continuous sutures for skin closure

BackgroundThe anterior approach for total hip arthroplasty (THA) carries a higher risk of wound complications, which can significantly affect patient outcomes and increase healthcare costs. There is limited research comparing infection rates based on closure techniques in patients who undergo THA. Therefore, this study aims to compare wound complications based on interrupted or continuous sutures for skin closure after anterior approach THA. MethodsThis single-surgeon retrospective study extracted data from 388 patients who had undergone a primary THA using the anterior approach. Patient demographics, comorbidities, perioperative factors, and infection-related complications were recorded. All variables associated with a given infection complication were controlled for in a binary logistic regression model. ResultsAfter controlling for confounding variables, wound closure type was not associated with any infectious complications. BMI was a strongly associated factor in PJI (p = 0.028; 95 % CI = 1.02–1.34), prolonged drainage (p < 0.001; 95 % CI = 1.08–1.28), readmission (p = 0.023; 95 % CI = 1.01–1.20), and I&D and revision surgery (p = 0.021; 95 % CI = 1.02–1.31). ConclusionBody mass index was the sole factor associated with a higher risk of wound complications postoperatively. These findings suggest a non-inferiority between continuous and interrupted suture closure techniques regarding wound-related infectious complications in anterior total hip arthroplasty.

Analysis of 398 cases of intradural spinal tumor resection with primary dural closure: surgical outcomes based on the suture material.

Cerebrospinal fluid (CSF) leak after resection of intradural spinal tumors (IST) represents a significant postoperative challenge. Although various dura suture techniques and materials have been explored experimentally, direct clinical comparative studies are lacking. This study evaluated the effectiveness of specific suture materials in primary dural closure post-IST resection and identified associated risk factors for CSF leak. A retrospective review was conducted of patients who underwent IST resection surgery at a single institution from January 2012 to February 2021. Patients were categorized on the basis of the dura suture materials used. Eligibility for the study required a posterior midline surgical approach, primary dural closure after durotomy, and absence of closed-suction drainage. Of 398 patients who met the inclusion criteria, the overall CSF leak-related surgical complication rate was 4.27% (17/398). The sutures used were 6-0 Prolene for 163 patients and 5-0 silk for 235 patients. Significant differences were observed between the suture groups in the CSF leak rate (Prolene 1.8% vs silk 6.0%, p = 0.046), lumbar drainage insertion rate (Prolene 0.6% vs silk 4.3%, p = 0.031), and length of postoperative bed rest (Prolene 1.07 days vs silk 3.25 days, p < 0.001). Logistic regression analysis indicated a significant association of CSF leak with the use of 5-0 silk (OR 4.11, p = 0.006) and revision surgical procedures (OR 6.73, p = 0.001). Surgical complications related to CSF leaks were significantly lower with the use of 6-0 Prolene sutures compared to 5-0 silk sutures in primary dural closure after IST resection.

Allometry of human calvaria bones during development from birth to 8 years of age shows a nonlinear growth pattern

Pediatric skulls change rapidly in size and shape during development, especially for children up to 8 years of age. This project was developed to address the gap in understanding of the three-dimensional growth parameters of the human skull during this period and the impact these growth patterns have on fontanelle closure and suture formation. This study offers novel data on the dynamic changes in the anatomy of the skull with the intention of providing better guidance for pediatric surgical care. Craniometric landmarks defined on three-dimensional computed tomography reconstructions were used to map skull development in children aged 0 to 8 years old. A total of 364 datasets were analyzed and statistically representative 3D skulls with anatomical craniometric features such as head shape, bone size, suture and fontanelle closure time were generated for 17 age groups spanning birth to 8 years of age to provide a comprehensive neuroanatomical understanding of how the pediatric skull changes over time. This study indicates that the cranial bones follow a non-linear growth pattern, with the occipital and frontal bones driving the directionality of fontanelle closure and delivers a 3D visualization of the developmental characteristics of the skull providing a landmark resource for understanding the growth dynamics of the human skull. While clinical measurements remain valid approaches for the planning of surgical interventions, these 3D models may provide a more accurate planning paradigm.

Exploring Risk Factors for Post-operative Complications in Laparoscopic Common Bile Duct Exploration: A Literature Review.

Gallstone-related diseases, particularly common bile duct (CBD) stones, pose a significant global health challenge. The emergence of laparoscopic common bile duct exploration (LCBDE) has transformed the management of these conditions by offering a less invasive alternative to traditional open surgery. This literature review aims to analyze published literature to identify and understand the risk factors associated with LCBDE. The study aims to offer valuable insights that could potentially enhance patient care and outcomes in managing CBD stones. A comprehensive search of English-language studies from the past 20 years was conducted using PubMed, focusing on peer-reviewed primary research, systematic reviews, and meta-analyses. From 830 initial articles, 25 were selected based on relevance and availability. The review identified several key risk factors influencing LCBDE outcomes, including patient-related factors such as advanced age, high comorbidity scores, narrow bile ducts, and complex stones, which increase the likelihood of complications. Surgeon experience also plays a crucial role, with lower complication rates observed among surgeons who have performed at least 70 LCBDE procedures over a 10-year period. Additionally, procedure-related factors such as the transcystic (TC) approach, primary suture (PS) closure, and intraoperative imaging were found to reduce complication rates. LCBDE remains a promising approach for managing bile duct stones, particularly when patient, surgeon, and procedural factors are optimized.

Papilla Access Tunnel Combined With the Laterally Closed Tunnel: A Technique for Treatment of Deep Gingival Recession in the Anterior Mandible.

Treatment of gingival recession in the anterior mandible is more complex due to unique anatomic features including excessive tension due to frenal and muscle attachments, thin tissue, shallow vestibule, and narrow interdental space. These features are particularly limiting in the presence of deep recession and negatively impact the success most routine soft tissue grafting procedures. The recently proposed laterally closed tunnel combined the benefit of tension management from tunneling rather than incising papillae with lateral closure of deep recession to minimize the need for coronal advancement. This is an effective, although technically demanding procedure. This report presents a method of facilitating tunnel preparation by utilizing superficial papillary access incisions bilaterally in the papilla between the lateral incisor and canine. This papilla has the least tension and most robust interdental volume and blood supply. This incision creates a mini flap that facilitates tunnel dissection and graft placement. Because the mini flap is used for graft insertion, the suturing for lateral closure can be performed before graft insertion. The result is reduced technical difficulty.

Advancements in Vascular Closure Devices for Effective Hemostasis in Femoral Artery Interventions.

With medical technology development, endovascular intervention has been widely used in clinical practice, and the establishment of surgical access through the femoral artery, where most vascular interventions are performed, is a common method. Postoperative hemostasis at the femoral artery puncture site is a key part of interventional procedures and is particularly important to ensure the safety and effectiveness of hemostasis. Some patients undergoing interventional therapy also use anticoagulant and antiplatelet drugs preoperatively and undergo systemic heparin session intraoperatively, which leads to abnormal coagulation, thus increasing the difficulty of hemostasis at the puncture point postoperatively. Certain patients with specific conditions, such as combined vascular calcification, obesity, diabetes mellitus, and renal impairment, present more challenging cases for postoperative puncture point hemostasis. Femoral artery puncture site hemostasis methods include manual compression, arterial compression devices, and vascular closure devices, which are a kind of equipment that helps interventional doctors stop bleeding quickly at the femoral artery puncture site. From the 1990s to the present, vascular occluders with many different concepts and mechanisms have emerged. Based on different hemostatic principles and materials, the mechanisms and principles of action are varied and include sealant occlusion, collagen patch embolization, polyester suture closure, absorbable polyethanol embolic agents, nickel-titanium alloy clips, polydiethanol sealant embolization, and suture bioabsorbable patches. Many studies have compared the hemostatic effect of vascular closure devices with those of manual compression. In this article, we review the hemostatic effects of the 2 modalities and the advances in the use of vascular closure devices in vascular intervention.

A Comparative Study of Tackers Versus Sutures in Transabdominal Preperitoneal Hernia Repair: Tackers Versus Sutures in Mesh Fixation and Peritoneal Closure in Tapp

Background: This study evaluates the surgical outcomes of using tackers versus sutures for mesh fixation and peritoneal closure in transabdominal preperitoneal (TAPP) mesh repair of inguinal hernia, focusing on postoperative pain, quality of life, and other key metrics. Although there are many studies in studying various outcomes of Transabdominal preperitoneal mesh repair (TAPP), there exists only few trials that compare peritoneal closure techniques in TAPP Methods: A prospective comparative study was conducted at Mahatma Gandhi Medical College and Research Institute. Sixty patients undergoing TAPP were divided into two groups: one using non-absorbable sutures and the other using non-absorbable titanium tackers for mesh fixation and peritoneal closure. Intraoperative and postoperative outcomes were assessed, including time taken for procedures, postoperative pain (measured using the Visual Analog Scale), incidence of seroma formation, and short-term quality of life assessed using the Carolinas Comfort Scale. Results: The suture group demonstrated significantly less postoperative pain on postoperative day (POD) 1 and at 3 months compared to the tacker group (p=0.001 and p=0.004, respectively). The time taken for mesh fixation and peritoneal closure was shorter in the tacker group, but the overall operative time was significantly longer in the suture group (p=0.001). The cost of using sutures was substantially lower than tackers. Quality of life scores at 3 months indicated better outcomes in the suture group (p=0.001). Conclusions: Sutures for mesh fixation and peritoneal closure in TAPP repair provide better postoperative outcomes in terms of pain, quality of life, and cost compared to tackers, despite a longer operative time. These findings suggest that sutures may be a preferable option for TAPP inguinal hernia repair.

Isthmocele‑an iatrogenic pathology: A prospective study in a tertiary unit.

Isthmocele, also known as uterine niche, refers to a myometrial defect of the anterior wall of the uterine isthmus, specifically at the site of the previous C-section scar. The prevalence of isthmocele has increased in tandem with the rise in deliveries by caesarean section. Risk factors include aspects related to the surgical procedure. The present study aimed to assess the relationship between various suture types and the development of a niche. The analysis of the present study is based on data collected from the evaluation of 52 patients, 6 weeks post C-section performed in 'Saint Pantelimon' Hospital in Bucharest, Romania. The parameters examined included patient age, the number of previous births by C-section, the type of suture used and uterine anatomy. Out of all the 52 patients, 42.3% developed an isthmocele. The results confirm a significant association between the presence of the niche and the type of suture of the first layer, proving that when non-locking continuous suture was used, the absence of niche was observed in most cases, while using the locking continuous suture was associated with more niches. Using the continuous locking suture for the first layer was associated with severe niches, while no severe niches were observed in patients with the other two types of sutures. There is a statistically significant association between the use of continuous locking sutures for uterine closure in the first layer and the development of a uterine niche. Furthermore, all instances of severe niches were linked to this type of suture, compared with continuous non-locking suture or interrupted suture. Given the escalating rate of C-sections, further research is crucial to identify the suture type that minimizes the risk of isthmocele formation. The present study's limitations revolve around its exclusive focus on a single institution and the relatively small sample size.

Comparing Closure Techniques for Pharyngeal Mucosa After Total Laryngectomy: Manual Suture, Linear Stapler, and Thyroid Gland Flap-A Retrospective Analysis.

Objective: This study aimed to compare the clinical effectiveness of manual suture (group A), linear stapler (group B), and thyroid gland flap (group C) for pharyngeal mucosal closure after total laryngectomy (TL) in laryngeal cancer patients. Methods: The data of laryngeal cancer patients who underwent TL between January 1, 2017, and December 1, 2021, were analyzed. Patients were categorized into group A, group B, and group C based on the closure technique. Various parameters, including general data, hospitalization days, total cost, pharyngeal closure time, pharyngeal fistula, pre- and post-surgical calcium levels, and thyroid function indexes, were compared. Results: The study included 81 patients (mean age: 64.09 ± 9.20 years), the general data of the 3 groups of patients were comparable. Tumor stage and primary tumor location varied significantly among the groups (P = .002 and P < .001, respectively). Group A was more commonly used for advanced-stage tumors with widespread invasion. Group B was primarily used for early-stage tumors localized to the larynx. Group C was preferred for cases with mucosal defects or extensive hypopharyngeal invasion. Group B presented a significantly shorter operation time and slightly lower total cost (P = .006). Pharyngeal fistula incidence was 17.28% (14/81), with comparable rates among the groups [12.35% (10/50) in group A, 12.5% (2/16) in group B, and 13.3% (2/15) in group C]. No dysphagia complications were observed during the 2-to-5-year follow-up. Blood calcium levels and thyroid function indicators showed no significant differences before and after surgery among the 3 groups (P > .05). Conclusion: Thyroid gland flap is a safe option that can be used to repair mucosal defects and close the pharyngeal cavity after TL surgery, but in the absence of mucosal defects and widespread tumor invasion, linear staplers are the most time-efficient method.

Efficacy and safety of the over-the-scope endoscopic suturing device for closure of defects after endoscopic submucosal dissection: a systematic review and meta-analysis

Background and AimsEndoscopic submucosal dissection (ESD) is used for closure of gastrointestinal (GI) lesions following endoscopic resection techniques such as endoscopic mucosal resection. Generally, a large defect is left that can increase the risk of postprocedural bleeding or perforation, and has been managed by techniques such as endoscopic placement of clips to reapproximate the defect edges. An over the scope suturing system (OSS), Overstitch created by Apollo endosurgery, has been designed for similar utility in ESD closure. Its design intent aimed for full thickness closure and exchange of suture without endoscopic removal. This paper aims to evaluate the technical success and efficacy of use of OSS in the closure of ESD. MethodsA comprehensive literature review across multiple databases was performed. Studies including Overstitch and ESD information were evaluated, with 7 articles meeting predetermined eligibility of quality for inclusion. Statistical analysis was completed using CMV v 3.0 software. The primary evaluated endpoint was technical success and efficacy of instrument use in patients undergoing ESD closure with OSS. The secondary evaluated endpoint was the overall rate of adverse events related to the use of OSS. ResultsOverall, the pooled rates for instrumental efficacy and technical success were 95.8% (95% CI: 80.6%, 99.2%; P=0.04) and 99.2% (95% CI: 79.8%, 100.0%; P=1.00), respectively. The pooled rate of adverse events was 0.9% (95% CI: 0.0%, 24.8%; P=0.99) with pain reported as the most common adverse event. ConclusionsThe OSS system appears to be an effective and safe tool in the closure of defects after ESD. However, its design also makes it quite large and difficult to maneuver. While it allows for replacement of the suture kit without endoscopic removal, there have been multiple reported episodes of device failure. Further randomized controlled trials warranted as OSS becomes more widely used.

Biomimetic poly(thioctic acid)-based bioadhesive hydrogels for wet adhesion, expeditious hemostasis and enhanced wound healing

The bioadhesive hydrogels have been viewed as promising substitutes for surgical sutures in wound closure. However, current bioadhesives face challenges such as weak wet adhesion and hemostatic performance, which hinder their wider clinical application. In this study, a novel poly(thioctic acid)Li+/caffeic acid-grafted sericin (CAS) (PTALi-CAS) supramolecular hydrogel was prepared using facile one-pot method. Among the PTALi-CAS hydrogels with varying CAS content, the PTALi-7%CAS hydrogels exhibited the highest adhesion strength (32.02 ± 2.28 kPa) and could adhere on surfaces of various organs in moist environments. It is noteworthy that the microstructure of the PTALi-7%CAS hydrogels after stretching closely resemble those of mussel byssal adhesion proteins. Additionally, the PTALi-7%CAS hydrogels exhibited rapid hemostatic properties in rat hemorrhage models and significantly accelerated the wound healing in rat skin incision experiments. Therefore, this study proposes a promising approach for developing a versatile hydrogel to aid in healing traumatic wounds.

S1587 Endoscopic Clipping vs Suturing for Mucosotomy Closure in E-POEM and G-POEM: A Systematic Review and Meta-Analysis

S1587 Endoscopic Clipping vs Suturing for Mucosotomy Closure in E-POEM and G-POEM: A Systematic Review and Meta-Analysis

Endoscopic suturing for mucosal defect closure following endoscopic submucosal dissection: Systematic review and meta-analysis.

Background and study aims: Endoscopic submucosal dissection (ESD) is a minimally invasive and effective treatment for gastrointestinal lesions. It carries potential risks such as bleeding and perforation. This meta-analysis was conducted to assess the safety, effectiveness, and feasibility of endoscopic suturing, a promising technique for closing mucosal defects post-ESD. Methods: We reviewed several databases, including MEDLINE/PubMed, Cochrane Library, Web of Science, and Embase up to May 1,2023. We aimed at identifying original studies that provided insightful data on the use of endoscopic suturing in reducing complications post-ESD. Results: In our study, we evaluated 426 publications and included 10 studies involving a total of 284 patients. The pooled technical success rate of endoscopic suturing was 92.6% (95% confidence interval [CI] 0.88-0.96). The pooled rate for sustained closure of mucosal defects post-endoscopic submucosal dissection (ESD) was estimated to be 80.7% (95% CI 0.71-0.88). The pooled mean time required to perform the endoscopic suturing procedure was calculated to be 31.11 minutes (95% CI 16.01-46.21). Among the studies reviewed for the incidence of delayed perforation post-ESD, a singular event of perforation was documented, suggesting a minimal occurrence. The overall rate of delayed bleeding was 5.3% (95% CI 0.30-0.10). Within the subset of patients using antithrombotic drugs, our subgroup analysis identified a delayed bleeding event rate of 6.7% (95% CI 0.02-0.25). Conclusions: Our results underscore the potential of endoscopic suturing as a viable and efficient technique in managing mucosal defects following ESD, highlighting the need for further large, prospective research to corroborate these findings and concentrate on establishing standard methodologies.

Total Ankle Arthroplasty Incision Management: What Matters? A Systematic Review

Modern advancements in total ankle arthroplasty techniques and implants have increased the popularity of this treatment for ankle osteoarthritis. The preeminent approach for ankle replacement involves an anterior incision, however, wound complications with this approach provide a persistent challenge to surgeons. The present study was conducted to synthesize current data on ankle replacement wound complications via an anterior approach. A systematic review was completed including studies published from 1993 to present that employed an anterior approach and had precise criteria for wound healing and revisions. Twenty-nine studies, with level 3 to 4 evidence and moderate to serious bias, were included for a total of 6,986 ankle arthroplasties. The rate of wound healing without any complication was 90.38%. Minor dehiscence occurred in 6.00% of cases, while major wounds or infections occurred in 3.62%. Across 2,966 implants, the rate of major wounds or infections decreased from 7.03% before 2013 to 4.75% after 2013 (p = 0.034). Limited comparisons involving simple suture closure to various adjunct wound management techniques including negative pressure wound therapy, 2-octyl cyanoacrylate, platelet-rich plasma, dehydrated human amniotic membrane allograft, non-invasive skin expansion strips, compression wound dressings, tranexamic acid, surgical helmets, tourniquets, ankle arthrodesis, and lateral approach ankle arthroplasty, yielded non-significant differences (p > 0.18). Therefore, contemporary techniques, patient selection, and current implants may be leading to better soft tissue healing. As ankle replacement continues to surge in popularity, further research is needed to evaluate causative factors in successful anterior incision healing. Level of Clinical Evidence3

Impact of Needle Design and Suture Gauge on Tissue Tearing During Skin Suturing: A Comparative Analysis.

Surgeons face numerous choices in selecting sutures for skin closure, with potential adverse effects such as tissue tearing. To investigate the influence of needle design and suture gauge on tissue tearing during suturing procedures. The authors tested the tear-through force in Newtons for 3 needle types and 3 suture gauges using an artificial skin model and a professional-grade tensiometer. Suture material was secured into the skin model, and force was applied to the suture at a constant rate, resulting in tearing. Force-displacement and force-time curves were generated. Evaluation included conventional cutting (PC-3), reverse cutting (PS-3), and taper point (BB) needles with a 5-0 polypropylene suture. In addition, nylon sutures with a reverse cutting needle (PS-2) were tested at 3 suture gauges (5-0, 4-0, 3-0). The mean tear-through forces for PC-3, PS-3, and BB were 3.26 N, 3.75 N, and 4.07 N, respectively. For the 5-0, 4-0, and 3-0 nylon sutures, the mean tear-through forces were 3.44 N, 3.81 N, and 4.04 N, respectively. Statistical analysis revealed a significant impact of suture gauge size (p < .001) and needle geometry (p < .001) on tear-through force. Larger suture diameter and taper needles minimize tissue tearing.