Suture Closure Research Articles

Aesthetic outcome of running subcuticular suture versus running horizontal mattress suture in closure of linear wounds of the trunk and extremities: A randomized evaluator-blinded split-wound comparative effectiveness trial

Both running horizontal mattress (HM) and running subcuticular (SQ) suturing techniques have been suggested to be superior to other running cuticular suturing techniques. These 2 techniques have not been directly compared. To compare cosmetic outcomes between a running HM and a running SQ technique in a split scar model following linear closure of trunk and extremity defects. Fifty patients were enrolled in a randomized, evaluator-blinded, split-scar study. One side of the surgical wound was randomized to receive one intervention (HM vs SQ) with the other side receiving the alternate intervention. The primary outcome was the Patient and Observer Scar Assessment Scale (POSAS) score at a minimum of 3months postoperatively. Observer POSAS sum of components was 19.49 and 17.76 for HM and SQ, respectively (P=.14). The mean score for patient overall opinion was 4.71 for HM and 3.50 for the SQ technique (P=.02). Overall opinion scores of evaluators were 3.87 and 3.29 for HM and SQ, respectively (P=.03). Single-center study of a relatively homogenous population. Although there was no significant difference in the sum of POSAS components between HM and SQ (P=.14), both patients and evaluators had a superior overall opinion of the SQ-treated side (patient P=.02, evaluator P=.03).

Emergency rescue of a patient with hemorrhagic shock caused by superior mesenteric artery rupture: A case report

BACKGROUND Superior mesenteric artery (SMA) injuries rarely occur during blunt abdominal injuries, with an incidence of < 1%. The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation, which progress rapidly and are easily misdiagnosed. Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases. This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture. CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture. On admission, he showed extremely unstable vital signs and was unconscious with a laceration on his head, heart rate of 143 beats/min, shallow and fast breathing (frequency > 35 beats/min), and blood pressure as low as 20/10 mmHg (1 mmHg = 0.133 kPa). Computed tomography revealed abdominal and pelvic hematocele effusion, suggesting active bleeding. The patient was suspected of partial rupture of the distal SMA branch. The patient underwent emergency mesenteric artery ligation, scalp suture, and liver laceration closure. In view of conditions with acute onset, rapid progression, and high bleeding volume, key points of nursing were conducted, including activating emergency protocol, opening of the green channel, and arranging relevant examinations with various medical staff for quick diagnosis. The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time. Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability. Strict measures were taken to avoid intraoperative hypothermia and infection. CONCLUSION After 3.5 h of emergency rescue and medical care, bleeding was successfully controlled, and the patient’s condition was stabilized. Subsequently, the patient was transferred to the intensive care unit for continuous monitoring and treatment. On the sixth day, the patient was weaned off the ventilator, extubated, and relocated to a specialized ward. Through diligent medical intervention and attentive nursing, the patient made a full recovery and was discharged on day 22. The follow-up visit confirmed the patient’s successful recovery.

Absorbable versus Nonabsorbable Sutures for Facial Skin Closure: A Systematic Review and Meta-analysis of Clinical and Aesthetic Outcomes.

When repairing facial wounds, it is crucial to possess a thorough understanding of suitable suture materials and their evidence base. The absence of high-quality and comprehensive systematic reviews poses challenges in making informed decisions. In this study, we conducted a review of the existing literature and assessed the quality of the current evidence pertaining to the clinical, aesthetic, and patient-reported outcomes associated with absorbable and nonabsorbable sutures for facial skin closure. The study was registered on Prospective Register of Systematic Reviews. We conducted searches on Embase, Ovid, and PubMed/MEDLINE databases. Only randomized controlled trials (RCTs) were eligible for inclusion in this study. Additionally, the risk of bias in the randomized studies was assessed using Cochrane's Risk of Bias Tool. The study included a total of nine RCTs involving 804 participants with facial injuries. Among these injuries, absorbable sutures were utilized in 50.2% (403 injuries), while nonabsorbable sutures were employed in 49.8% (401 injuries). The analysis of cosmesis scales revealed no statistically significant difference between absorbable and nonabsorbable sutures regarding infections ( p = 0.72), visual analog scale ( p = 0.69), wound dehiscence ( p = 0.08), and scarring ( p = 0.46). The quality of the included studies was determined to have a low risk of bias. Absorbable sutures can be considered a suitable alternative to nonabsorbable sutures, as they demonstrate comparable aesthetic and clinical outcomes. Future high-quality studies with a level I evidence design and cost-effectiveness analysis are necessary to enhance clinician-patient shared decision-making and optimize the selection of suture materials. Level of evidence is I, risk/prognostic study.

Apert Syndrome with Combination of Synostosis: A Case Report

Apert syndrome is a rare condition affecting the skull, face, hands and feet due to premature closure of cranial sutures. This case report describes a 6-month-old boy with Apert syndrome presenting with an abnormal head shape. A CT scan revealed craniosynostosis (fused sutures) of both the coronal and lambdoid sutures. Surgery involved removing a 1-2 cm section of the fused sutures along the coronal suture and across the lambdoid suture. After 4 months, the boy showed improvement in both clinical appearance and imaging scans. While Apert syndrome is typically classified based on the suture involved, the specific timing of surgery depends on various factors. This case demonstrates that minimally invasive surgery can be effective with minimal complications. Even though unilateral coronal and lambdoid suture fusion in Apert syndrome is uncommon, it can still be successfully treated with surgery.

A prospective single-arm clinical trial to assess the safety and efficacy of monofilament polydioxanone barbed suture, MONOFIX®, on abdominal fascial closure.

For abdominal fascial closure, the choice of optimal suture material and appropriate suture technique are of paramount importance to prevent the incidence of incisional hernia. Although barbed sutures are widely used in various surgical fields, their safety and feasibility on abdominal fascial closure which requires the most tensile strength for security have not been established yet. We conducted a prospective, single-arm, interventional clinical trial to present the postoperative outcomes of using barbed sutures in abdominal fascial closure between April 2021 and August 2021. Patients with colorectal cancer who underwent minimally invasive surgery in elective setting were included. For all participants, monofilament polydioxanone barbed suture, MONOFIX®, was used to secure the abdominal fasica. The primary outcome was the 1-year incidence of incisional hernia assessed by computed tomography. A total of 30 patients were included. The median fascial incision length and suture length were 6.5cm (range, 6-7.5cm) and 31cm (range, 27.5-39.0cm), respectively. The median procedure time of abdominal fascial closure was 4min (range, 3-9min). There was no incidence of unexpected event related to suturing including suture cutting, stopper separation from threads, and suture loosening. One case of superficial surgical site infection occurred during postoperative hospital stays. There was no fascial dehiscence, incisional hernia, and adhesive ileus during a median follow-up period of 17.5months. Monofilament polydioxanone barbed suture, MONOFIX®, may be used safely and effectively on abdominal fascial closure. NCT05872334.

A Comparison between 2-Octyl Cyanoacrylate and Conventional Suturing for the Closure of Epiblepharon Incision Wounds in Children: A Retrospective Case-Control Study.

Background: Tissue adhesive has been widely used in ophthalmic surgery for various procedures, proving both effective and safe. However, no studies have compared the surgical efficacy of the tissue adhesive 2-octyl cyanoacrylate (SurgiSeal®) to that of traditional suture closure in Asian children undergoing surgery for lower lid epiblepharon. Methods: This is a single-center retrospective case-control study. Surgical correction for epiblepharon was performed on 22 patients from November 2019 to May 2023. A total of 20 patients who were followed up for at least 1 month were included for analysis. After standardized epiblepharon surgery, group A underwent wound closure with a subcuticular suture and 2-octyl cyanoacrylate, and group B underwent closure with a 6-O fast-absorbing surgical gut suture. Patients were followed up at 1, 4, and 12 weeks post-surgery. Results: A total of 10 patients (20 eyes) underwent skin closure with tissue adhesives (group A), and 10 patients (18 eyes) underwent wound closure using conventional suture material (group B). No significant differences in the sex ratio, mean age at operation, pre- and postoperative best-corrected visual acuity (BCVA), or average surgical time were observed between groups. Both groups exhibited improved postoperative BCVA, with symptom relief and a significant decrease in the severity of keratopathy after surgery. Neither recurrence nor complications were reported during follow-up. The aesthetic results were similar between groups, while caregivers of children in the tissue adhesive group expressed high satisfaction regarding the ease of postoperative care. Conclusions: Successful closure of lower lid epiblepharon surgery wounds in children can be performed using 2-octyl cyanoacrylate (SurgiSeal®). This method is simple, safe, and effective when compared to conventional sutures.

Incision Closure for Direct Anterior Total Hip Arthroplasty: Is There a Difference in the Rate of Superficial Wound Complications With Suture Versus Staples?

Background Direct anterior total hip arthroplasty (DA-THA) has increased in popularity over recent decades. However, DA-THA has been reported to have a higher incidence of superficial wound complications, including infection and incisional dehiscence, compared to other surgical approaches to hip arthroplasty. While this indicates a need for optimal wound closure, little research exists on the preferred method of skin closure following DA-THA. This study aimed to determine if there was any difference in rates of superficial infection, wound dehiscence, or overall wound complications with skin closure using a running subcuticular 3-0 Monocryl® suture compared to surgical staples following DA-THA. Methods Records of patients who underwent DA-THA at our institution between July 2017 to July 2022 were retrospectively reviewed. Data were abstracted on patient demographics, comorbidities, skin closure method, and wound complications from the electronic medical record. Superficial infection and wound dehiscence were classified based on explicit diagnosis in post-operative records and incision photographs taken during follow-up visits. Overall wound complications were classified in patients who experienced either superficial infection, incisional dehiscence, or both complications following surgery. Descriptive statistics and chi-squared measures were obtained from post-operative patient data, and significance was set at p[Formula: see text] 0.05. Results A total of 365 DA-THAs were completed in 349 patients. A running subcuticular 3-0 Monocryl® suture closed 207 surgeries (56.7%), while surgical staples closed 158 surgeries (43.3%). There was no significant difference in independent rates of superficial infection (p = 0.076) or wound dehiscence (p = 0.118) between suture and staple cohorts; however, suture closure (10, 2.7%) was associated with a significantly higher rate of overall wound complications compared to staple closure (1, 0.3%) (p = 0.020). Conclusion DA-THA carries the risk of overall wound complications, including superficial infection and wound dehiscence. Our findings suggest superficial skin closure with staples may be preferred over sutures due to lower rates of overall wound complications. Further studies are needed to determine the optimal method of skin closure following DA-THA.

Laparoscopic management of delayed traumatic left diaphragmatic hernia with intrathoracic kidney: A rare case report and technical aspects

Abstract Occult traumatic diaphragmatic hernias (DHs) are relatively rare and may present years after the trauma. Clinical presentations range from asymptomatic incidental findings on imaging to life-threatening incarceration of abdominal organs. Traumatic migration of the kidney into the thorax is a very uncommon event. We herein report a rare case of a 34-year-old male patient with a symptomatic DH secondary to a motor vehicle accident and a history of laparotomy for liver laceration 10 years back who underwent laparoscopic reduction and intraabdominal reposition of left kidney from thorax, suture repair of the defect with mesh reinforcement. Thoracoscopic visualization was performed to assess the efficiency and completeness of the repair and to rule out any iatrogenic pericardial injury after mesh fixation. The operative technique, difficulties encountered, and tips to overcome these challenges were discussed. With adequate expertise, reduction, and repositioning of migrated kidney, suture closure of the defect with mesh reinforcement is safe and feasible by laparoscopic approach.

Adenoidectomy in a child with Crouzon syndrome complicated with severe obstructive sleep apnea: Case report and review of literature.

Crouzon syndrome is an extremely rare craniofacial dysplasia, which is mainly caused by the early ossification and closure of the coronal suture of the skull. Craniofacial deformities can cause stenosis of the nasal cavity and posterior nasal meatus, resulting in sleep apnea. A 9-year-old boy with sleep snoring for 6 years, progressive aggravation in the past 1 month and accompanied by apnea during sleep. This case was diagnosed with Crouzon syndrome complicated with severe obstructive sleep apnea and severe hypoxemia. After adenoidectomy, he was admitted to the pediatric intensive care unit with ventilator-assisted respiration. During this period, the blood oxygen saturation fluctuated greatly. After trying to extubate, the blood oxygen was difficult to maintain and had to be intubated again. After active treatment, extubation was successful. The wound of nasopharynx recovered well and the sleep state was significantly improved 3 months postoperation. It is suggested that the time of ventilator-assisted breathing should be prolonged and the perioperative airway management should be strengthened in order to reduce the risk of postoperative complications.

Loss of ninein interferes with osteoclast formation and causes premature ossification.

Ninein is a centrosome protein that has been implicated in microtubule anchorage and centrosome cohesion. Mutations in the human NINEIN gene have been linked to Seckel syndrome and to a rare form of skeletal dysplasia. However, the role of ninein in skeletal development remains unknown. Here, we describe a ninein knockout mouse with advanced endochondral ossification during embryonic development. Although the long bones maintain a regular size, the absence of ninein delays the formation of the bone marrow cavity in the prenatal tibia. Likewise, intramembranous ossification in the skull is more developed, leading to a premature closure of the interfrontal suture. We demonstrate that ninein is strongly expressed in osteoclasts of control mice, and that its absence reduces the fusion of precursor cells into syncytial osteoclasts, whereas the number of osteoblasts remains unaffected. As a consequence, ninein-deficient osteoclasts have a reduced capacity to resorb bone. At the cellular level, the absence of ninein interferes with centrosomal microtubule organization, reduces centrosome cohesion, and provokes the loss of centrosome clustering in multinucleated mature osteoclasts. We propose that centrosomal ninein is important for osteoclast fusion, to enable a functional balance between bone-forming osteoblasts and bone-resorbing osteoclasts during skeletal development.

Risk Factors for Development of Incisional Hernia after Aortic Aneurysm Repair: Secondary Analysis of the OVER Randomized Controlled Trial

Since the risk of mortality from rupture is elevated, elective repair of abdominal aortic aneurysms (AAAs) is often recommended. Currently, over 80% of elective repairs are carried out using an endovascular approach. While open repair has similar late survival and fewer reintervention outcomes when compared to endovascular repair, incisional hernia is a frequent complication with morbidity and cost implications. The Open versus Endovascular Repair (OVER) trial was the largest randomized trial of endovascular versus open repair of AAA in the United States. The purpose of this study was to determine risk factors associated with incisional hernia development following AAA repair via secondary analysis of the OVER data. This was a multisite trial conducted within the Veterans Affairs health-care system. Study participants (N=881) were enrolled from 2002 to 2008 and followed until 2011 with additional administrative data collection until 2016. Eligible patients had AAA for which elective repair was planned and randomized 1:1 to either open or endovascular repair. Incisional hernia was a prespecified end point in the OVER protocol, specifically assessed at each protocol follow-up visit. Technical details were extracted from each operative report, repair case report form(s), and adverse event form(s). Patient demographics, comorbid conditions, reported preoperative activity level, and operative details including initial approach, blood loss, and closure methods were analyzed using Bayesian hierarchical Weibull survival regression modeling. Incisional hernias were recorded among 46 participants (5.2%). The average time to hernia diagnosis was 3.5years. Of the 437 participants randomized to open treatment, 427 received an open repair including crossovers from endovascular treatment assignment. Transperitoneal repair was performed in 81%, running suture in 96%, and absorbable suture in 71% of cases. Randomization to endovascular repair was associated with reduced risk of hernia (hazard ratio [HR] 0.70, 95% credible interval [CI] 0.49-0.94). Higher activity level was associated with increased hernia risk (HR 1.39, 95% CI 1.06-1.84). Approach, suture closure techniques, body mass index, diabetes, and smoking status were not associated with increased risk of hernia development. Incisional hernia is a frequent complication associated with open repair of abdominal aortic aneurysm and commonly required reintervention. Endovascular repair was associated with reduced risk of hernia. Patients with increased activity experienced a higher incidence of hernia. However, no other modifiable patient, operative, or technical factors were found to be associated with hernia development.

A SYSTEMATIC REVIEW AND META-REGRESSION OF FACTORS AFFECTING INCISIONAL HERNIA RATES IN MIDLINE INCISIONS OVER A 10-YEAR PERIOD

Abstract Aims The Incisional hernia (IH) rate after midline incisions was reported to be 12.8% in a systematic review of literature published in 2015. With updated guidance on abdominal wall closure techniques, the landscape of abdominal wall closure has changed. We aimed to update this literature to assess any change in the rates and any new identifiable risk factors for IH in midline incisions. Methods We undertook a systematic review of literature according to PRISMA guidelines and registered on PROSPERO. All papers reporting IH rates in midline incisions with primary suture closure between April 2013 — October 2022 were included. Papers with two or more arms suitable for inclusion were extracted independently. Results Sixty three papers (21 RCTs, 36 cohort studies and 6 case-control studies), comprising 18,126 patients were included. The mean IH rate was 16.8% at a weighted mean follow up of 31.3 months. Meta-regression identified two study level variables that correlated with an increase in IH rates (Use of radiology for diagnosis of IH and inclusion of patients undergoing a contaminated procedure) and one operative variable that corresponded with a decrease in rates (Small bites closure technique). Conclusions The Incisional hernia rate in midline incisions reported in the literature have increased over the last decade. A change in detection method and an increase in patient complexity may account for the majority of risk, suggesting standardisation of trial technique is essential in IH prevention trials. Small bites technique is associated with a significant reduction in IH rates, and future work should focus on strengthening the evidence base around this technique.

Divergent patterns of cranial suture fusion in marsupial and placental mammals

Abstract Cranial sutures, both open and closed, support a myriad of skull functions, including redistributing strain, accommodating brain expansion, supporting cranial bone growth, and protecting the brain. Thus, variation in the degree, timing, and pattern of suture fusion has functional implications. Using a comparative ontogenetic framework across Mammalia, we quantified degree and pattern of suture fusion through ontogeny for 22 mammalian species (N = 165). Suture closure was scored on a discrete scale for 31 cranial sutures and used to calculate closure scores for individual sutures and specimens. Ancestral state estimations found the degree of ancestral marsupial fusion to be more derived, differing from both the ancestral placental and ancestral therian. The average placental pattern followed the Krogman pattern of suture fusion (cranial vault, cranial base, circum-meatal, palatal, facial, and cranio-facial), whereas marsupials showed a distinct pattern. We propose a new pattern of suture fusion for marsupials: vault, cranio-facial, facial, circum-meatal, palate, cranial base. Delayed fusion of the marsupial cranial base is hypothesized here to support prolonged postnatal growth of the marsupial brain. Collectively, our study has identified a clear marsupial-placental dichotomy in the degree, timing, and pattern of suture fusion, with implications for understanding skull function and ontogeny.

Do Absorbable Sutures Work for Rectus Diastasis Repair in Abdominoplasty Patients?

The standard treatment for rectus diastasis is rectus sheath plication during abdominoplasty. Lasting correction of diastasis is essential, but there is currently a debate as to whether absorbable or nonabsorbable rectus plication achieves a lower rate of recurrence. The goal of this study is to assess long-term patient outcomes and the recurrence of rectus diastasis after plication with long-lasting absorbable sutures. A retrospective study of abdominoplasties performed by the senior author between 2018 and 2022 was performed. Only female patients with >6 months of follow-up were included. Plication of the rectus muscles was performed with a combination of interrupted, buried, figure of eight #0 polydioxanone suture and running #0 Maxon (Covidien, Mansfield, MA). Outcomes were assessed by physical examination at postoperative visits. A retrospective chart review was used to obtain demographic and perioperative information. Seventy-one patients underwent abdominoplasty with an average follow-up of 21.1 months. The average age was 43 years, and the average BMI was 27 kg/m2. Correction of rectus diastasis was performed using absorbable sutures in all patients with no recurrence of diastasis in any patient (0% diastasis recurrence rate). Complications included delayed wound healing (11%), seroma (8.5%), hematoma (2.8%), and deep vein thrombosis/pulmonary embolism (2.8%). No patients needed reoperation. Abdominal wall plication using a double-layered, long-lasting absorbable suture closure is a safe, reliable, and effective method to address rectus diastasis during abdominoplasty. Our technique achieved no recurrence of diastasis in any patient and a low complication profile.

Biomechanical comparison of bone staple fixation methods with suture material for median sternotomy closure using 3D-printed bone models

ABSTRACT Aim To compare the biomechanical properties of three different sternal closure techniques in a 3D-printed bone model of a sternum from a 30-kg dog. Methods Median sternotomy was performed on a total of 90 three-dimensional (3D) copies of a polycarbonate (PC) model of a sternum, generated from the CT images of the sternum of a 30-kg German Shepherd dog. Three different methods were used to repair the sternotomies: polydioxanone suture (group PDS, n = 30), stainless steel bone staples (group SS, n = 30), and nitinol bone staples (group NS, n = 30). Each repair method was tested by applying tensile force in one of three ways (longitudinally, laterally, or torsionally) resulting in a sample size of n = 10 for each repair method-loading combination. In all experiments, the loads at 1-mm and 2-mm gap formation, failure, and the displacement at the failure point were measured. Results In lateral distraction and longitudinal shear tests, NS and SS staple repairs required application of significantly greater force than PDS across all displacement criteria (1 and 2 mm). NS exhibited significantly greater failure load than PDS. In torsion tests, NS required significantly greater application of force compared to SS or PDS at all displacement criteria (1 and 2 mm) and exhibited a greater failure load than PDS. In terms of displacement at failure point, PDS suture showed more displacement than SS or NS across all experiments (laterally, longitudinally, torsionally). Conclusions In this study, bone staples were mechanically superior to PDS suture in median sternotomy closure using 3D-printed bone model in terms of 1-mm, 2-mm displacement loads, and displacement at failure. NS had a higher failure load than PDS under lateral, longitudinal, and torsional distraction. Clinical relevance These study results imply that bone staples can be considered as an alternative surgical method for median sternotomy closure in dogs.

Accelerating Fleur-de-lis Panniculectomy with the Absorbable Dermal Stapler-A Study of Efficiency, Aesthetics, and Quality-of-life.

Fleur-de-lis panniculectomy (FDL), a contouring technique involving vertical and horizontal tissue resections, often involves longer operative times and potential complications. This study assessed operative time, postoperative outcomes, and patient-reported quality of life (PRO) with Insorb® Absorbable Subcuticular Skin Stapler versus traditional sutures during FDL. A retrospective review from 2015 to 2022 of FDL patients excluded those with complex concomitant procedures. Demographics, operative details, and surgical outcomes were compared between patients using the dermal stapler and those with suture-only closures. Forty subjects were identified, with 25 (62.5%) in the dermal stapler cohort. The dermal stapler significantly reduced total procedure time (66.76 vs. 125.33 min, p < 0.05). There were no significant differences in surgical site occurrences, aesthetic outcomes, readmissions, or reoperations. Multivariate regression analysis further highlighted the choice of closure technique as an independent predictor of operative time, with traditional sutures indicating a significantly increased operative time compared to using the dermal stapler (AOR 76.53, CI 38.11-114.95, p < 0.001). Regarding PROs, both groups saw improvements across multiple BODY-Q domains, but the dermal stapler group reported greater enhancements (six out of nine domains vs. three for sutures). The absorbable dermal stapler significantly reduces FDL operative time without increasing wound healing or aesthetic dissatisfaction incidents and maintains comparable quality-of-life improvements to standard suture closure. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://link.springer.com/journal/00266 .

Superiority trial for the development of an ideal method for the closure of midline abdominal wall incisions to reduce the incidence of wound complications after elective gastroenterological surgery: study protocol for a randomized controlled trial

BackgroundThe recent guidelines from the European and American Hernia Societies recommend a continuous small-bite suturing technique with slowly absorbable sutures for fascial closure of midline abdominal wall incisions to reduce the incidence of wound complications, especially for incisional hernia. However, this is based on low-certainty evidence. We could not find any recommendations for skin closure. The wound closure technique is an important determinant of the risk of wound complications, and a comprehensive approach to prevent wound complications should be developed.MethodsWe propose a single-institute, prospective, randomized, blinded-endpoint trial to assess the superiority of the combination of continuous suturing of the fascia without peritoneal closure and continuous suturing of the subcuticular tissue (study group) over that of interrupted suturing of the fascia together with the peritoneum and interrupted suturing of the subcuticular tissue (control group) for reducing the incidence of midline abdominal wall incision wound complications after elective gastroenterological surgery with a clean-contaminated wound. Permuted-block randomization with an allocation ratio of 1:1 and blocking will be used. We hypothesize that the study group will show a 50% reduction in the incidence of wound complications. The target number of cases is set at 284. The primary outcome is the incidence of wound complications, including incisional surgical site infection, hemorrhage, seroma, wound dehiscence within 30 days after surgery, and incisional hernia at approximately 1 year after surgery.DiscussionThis trial will provide initial evidence on the ideal combination of fascial and skin closure for midline abdominal wall incision to reduce the incidence of overall postoperative wound complications after gastroenterological surgery with a clean-contaminated wound. This trial is expected to generate high-quality evidence that supports the current guidelines for the closure of abdominal wall incisions from the European and American Hernia Societies and to contribute to their next updates.Trial registrationUMIN-CTR UMIN000048442. Registered on 1 August 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055205

The Model Study of Phase-Transitional Magnetic-Driven Micromotors for Sealing Gastric Perforation via Mg-Based Micropower Traction.

Gastric perforation refers to the complete rupture of the gastric wall, leading to the extravasation of gastric contents into the thoracic cavity or peritoneum. Without timely intervention, the expulsion of gastric contents may culminate in profound discomfort, exacerbating the inflammatory process and potentially triggering perilous sepsis. In clinical practice, surgical suturing or endoscopic closure procedures are commonly employed. Magnetic-driven microswarms have also been employed for sealing gastrointestinal perforation. However, surgical intervention entails significant risk of bleeding, while endoscopic closure poses risks of inadequate closure and the need for subsequent removal of closure clips. Moreover, the efficacy of microswarms is limited as they merely adhere to the perforated area, and their sealing effect diminishes upon removal of the magnetic field. Herein, we present a Fe&Mg@Lard-Paraffin micromotor (LPM) constructed from a mixture of lard and paraffin coated with magnesium (Mg) microspheres and iron (Fe) nanospheres for sutureless sealing gastric perforations. Under the control of a rotating magnetic field, this micromotor demonstrates precise control over its movement on gastric mucosal folds and accurately targets the gastric perforation area. The phase transition induced by the high-frequency magnetothermal effect causes the micromotor composed of a mixed oil phase of lard and paraffin to change from a solid to a liquid phase. The coated Mg microspheres are subsequently exposed to the acidic gastric acid environment to produce a magnesium protonation reaction, which in turn generates hydrogen (H2) bubble recoil. Through a Mg-based micropower traction, part of the oil phase could be pushed into the gastric perforation, and it would then solidify to seal the gastric perforation area. Experimental results show that this can achieve long-term (>2 h) gastric perforation sealing. This innovative approach holds potential for improving outcomes in gastric perforation management.

SUTURE CHOICE IN CARPAL TUNNEL SURGERY: A RANDOMIZED CONTROLLED TRIAL

ObjectiveCarpal tunnel release surgery is a commonly performed procedure for alleviating symptoms of median nerve compression and restoring hand function. With pressure on theatre time these procedures are now commonly performed in a step-down out-patient facility under local anaesthetic. The choice of suture for skin closure in this procedure can impact the quality of wound healing, patient outcomes and the follow-up required however the question of the best type of suture remains unanswered. The purpose of this study was to compare the outcomes of absorbable and non-absorbable sutures using a randomised control trial design.MethodsEighty patients diagnosed with bilateral carpal tunnel syndrome were enrolled and underwent outpatient carpal tunnel release surgery under local anaesthetic in a staged fashion. Random number generation was used to assign each hand to receive interrupted nylon or Vicryl Rapide sutures. Pre-operative data collection included patient demographics, ASA, inflammatory conditions, smoking status as well as a Boston Carpal Tunnel Questionnaire (BCTQ) for each hand. Patients were followed up at 2 and 6 weeks after each operation and the BCTQ was repeated along with the Patient and Observer Scar Assessment Scale and the VAS score for wound discomfort. This study has approval from the DHB ethics committee, Local Iwi, HDC and ANZ Clinical Trials:ACTRN12623000100695.ResultsStatistical analysis assessed patient preference and the scores between the groups. Multi-variate analysis was performed to assess the factors that may be contributing to patient choice.ConclusionInsights into patient preference and clinical outcomes associated with absorbable sutures and non-absorbable sutures in the setting of out-patient surgery are discussed.

Octyl-2-cyanoacrylate Tissue Adhesive Closure Versus Subcuticular Suture for Post-Auricular Incisions.

Skin closure techniques in otolaryngology vary based on surgeon preference and wound site. Octyl-2-Cyanoacrylate may be a safe, rapid, and cost-effective option for post-site closure. This randomized controlled trial study aimed to compare Octyl-2-Cyanoacrylate and conventional subcuticular sutures in ear surgeries, assessing wound closure results in both case and control groups. This prospective, randomized, controlled, single-blind study was conducted at Ohud Hospital from May 2021 to May 2022. Ear surgery and cochlear implantation in patients were examined, and each group was randomly assigned to receive Dermabond TM and deep layer subcuticular sutures closure. Incisions were assessed at various time points, including 3 weeks, 6 weeks, 6 months, and 1 year post-surgery. The patient and observer Scar Assessment Scale was used, and two independent ear surgeons used the Stony Brook Scar Evaluation Scale for initial scar assessment. This study involved 126 ear surgery and cochlear implantation patients randomized to use cyanoacrylate tissue adhesive or subcuticular suture for port site closure. The study found that tissue adhesive (OCA) was faster and more efficient than standard sutures, saving an average of 12 min per incision in each ear. Incision cosmesis showed immediate results and significant differences, and patient satisfaction with OCA wound closure was higher than standard sutures. The findings confirmed that cyanoacrylate tissue adhesive significantly reduced the time needed for skin closure during ear surgery and showed immediate cosmetic improvements without any documented instances of bleeding, hematoma, infection, or wound separation. This is a randomized controlled trial, it follows Level 2 of evidence. Randomized trial or observational study with dramatic effects Laryngoscope, 134:4036-4041, 2024.