Sutures For Wound Closure Research Articles

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.

Knotless suture in revision total joint arthroplasty: a prospective randomized controlled trial.

The use of barbed sutures for wound closure in primary total joint arthroplasty (TJA) has been shown to be effective and safe. However, their effectiveness and safety in revision TJA procedures has not been thoroughly studied. This study aims to evaluate the efficacy and safety of using barbed suture closure in revision TJA setting. A total of 80 patients undergoing revision TJA between September 2020 and November 2022 were included in this randomized controlled trial study. Following informed consent, patients were computer-randomized to the treatment arm (barbed suture wound closure) or to the control arm (conventional wound closure). Closure duration, closure rate, number of sutures used and wound related outcomes including complication rates and Patient and Observer Scar Assessment Scale (POSAS) score were compared between groups. The use of barbed sutures decreased closure time by 6min (30.1 vs. 36.1min, P = 0.008) with a higher wound closure rate (6.5 vs. 5.5mm/minute, P = 0.013). Additionally, the number of sutures used for wound closure in the barbed group was significantly lower than in the control group (6.2 vs. 10.1, respectively, P < 0.001). There were no significant differences in the rate of postoperative wound complications (P = 0.556) or patient and observer POSAS scores (P = 0.211, P = 297, respectively) between the two groups at 3-month follow-up. Closure of revision TJA surgical wound utilizing barbed sutures reduced closure time and the number of needles handled by operative staff, with no significant increase in intra- or post-operative complications rate when compared to traditional closure technique. I.

Preliminary results of Polish national multicenter LILEO study on ileostomy reversal.

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; Ileostomy reversal is a common surgical procedure and currently standardized perioperative and surgical protocols are lacking.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; LILEO study was designed to perform a multicenter analysis on numerous perioperative parameters and estimation of the incidence of postoperative complications.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Materials and methods:&lt;/b&gt; The study is an open multicenter prospective cohort study. Preliminary results of the LILEO study after 3 months were available from 18 Polish surgical centers comprising full data of 59 patients who underwent ileostomy reversal.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; Parameters such as preoperative care, surgical technique, postoperative course and complications were analyzed. Preoperative fasting was used in 49.1% of patients. Fifty nine percent of anastomosis were handsewn and in 72.9% of patients had primary single suture wound closure. Mean length of hospital stay was 7.9 days (min 2 days, max 26 days). Complications occurred overall in 20 patients (33.9%). In 11.9% of patient's complications had grade III A/B in Clavien-Dindo classification.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Discussion:&lt;/b&gt; The perioperative care in the group of patients undergoing ileostomy reversal still lacks standardized and optimized treatment.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; Ileostomy removal is a procedure with high risk of postoperative complications. Standardization of perioperative care based on further multicenter national study could result in a decrease of complications rate.&lt;/br&gt.

Is the risk of wound complications after total hip arthroplasty with suture closing the skin lower than closing the skin with staples?

AbstractThis is a study assessing the effectiveness of staples versus sutures for closing incisions after total hip arthroplasty (THA). We searched all relevant literature up to July 2023, and after reading through the full text, we finally included 5 for analysis, with a total of 1084 cases who underwent total hip arthroplasty, of which 548 were closed with staples and 536 with sutures, and evaluated the risk of bias with the Cochrane Risk of Bias Assessment Tool, using the ratio of ratios (OR) and 95% confidence intervals (CI) to compare the effectiveness of staples and sutures in wound closure in total hip arthroplasty. The study found that the suture group was superior to the staple group in terms of superficial infection and incisional exudate; superficial infection (OR = 3.04, 95% CI: 1.14–8.07; p = 0.03, I2 = 0%), incisional exudate (OR = 3.22, 95% CI: 1.84–5.65; p &lt; 0.001, I2 = 0%) and suture staples were superior to suture group in terms of closure time (WMD = −231.8 95% CI: −429.55 to −34.05; p = 0.02, I2 = 100%). There was no remarkable distinction between the two groups in terms of deep infection, postoperative hospital, HWES score and patient's satisfaction, deep infection (OR = 1.24, 95% CI: 0.35–4.35; p = 0.74, I2 = 0%), postoperative hospital (WMD = 2.50 95% CI: −2.25 to 7.25; p = 0.30, I2 = 100%), HWES score (WMD = −0.38 95% CI: −0.52 to −0.24; p &lt; 0.01, I2 = 72%) and patient's satisfaction (WMD = −0.23 95% CI: −1.43 to 0.96; p = 0.70, I2 = 94%); however, due to the small sample sizes of several studies included in this study, caution must be exercised when addressing their value.

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

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

A Comparison Between the Effectiveness of Isoamyl 2-Cyanoacrylate Tissue Adhesive and Silk Sutures in Wound Closure Following Minor Oral Surgical Procedures: A Prospective Clinical Study.

Background In order to maintain the surgery site's shape, functionality, and aesthetics, closure of the wound is essential for intra-oral and general surgical procedures. Wound closure speeds up healing by reducing the buildup of inflammatory cells. For a wound to heal well, the incision must be precise, the tissue must be handled delicately, the wound must be precisely repositioned, and the closure material must have optimum functional properties and be sterile. Aim This study aims to conduct a clinical comparison of the effectiveness of silk suture versus isoamyl 2-cyanoacrylate (IAC) for intra-oral mucosal incisions. Methodology Fifty patients who needed a minor oral surgical operation under local anesthesia from the Department of Oral and Maxillofacial Surgery were recruited for this prospective clinical trial.Ethical clearance and informed consent were obtained for this study. Two groups were created from the sample of 50 patients in this investigation. An intra-oral mucosal incision was closed in one group using a 3-0 silk suture and in the second using two drops of IAC. An accurate approximation of the incised edges was used to avoid leaving any gaps between them. Parameters such as the time taken for closure, pain, bleeding, swelling, mouth opening, wound dehiscence, wound infection, and local ulceration were evaluated in this study. A visual analogscale (0-10) was used to assess the pain score. Facial swelling was evaluated by the tape method given by Gabka and Matsumura. The measurement was done from tragus to pogonion, tragus to oral commissure, and outer canthus to gonion. The sum of these measurements was calculated. By measuring the distance between the incisal edges of the upper and lower central incisors, the trismus was evaluated using a graduated metal scale. Assessment of bleeding (0-4) was done by asking the patient. Assessment of wound dehiscence and local ulceration was done based on visual inspection and palpation on the first, second, and seventh days postoperatively. All the recorded parameters were tabulated. The statistical analysis was done using SPSS version 25.0 (IBM Corp., Armonk, NY). The Chi-square test was used to compare the categorical variables between the study groups. The independent t-test was used to compare the means between the study groups. The statistical significance was kept at a p-value less than 0.05. Results The results showed that there was no statistically significant difference between suture and IAC in terms of incidence of pain and wound dehiscence. Butthe time taken for wound closure was less with IAC, and the pain score on the seventh day was higher with IAC and statistically significant. Conclusion We observed that IAC was as effective as the gold standard silk suture. The advantages of IAC are its hemostatic and bacteriostatic qualities, and IAC also took less time to complete the procedure.

Evolution of Suture Material - A Systemic Review

Reviewing the development and history of sutures used in surgery is the goal of the study. Based on a review of the literature, we identified pertinent papers and surgical textbooks regarding suture for wound closure using computerised and manual database searches. The essay explores those earliest known applications of suture by Edwin Smith surgical papyrus and after that the name suture comes from Latin term was first used by Hippocrates in 400 BC. He used linen as suture material. The development of sutures made of natural materials is traced chronologically up to the present, when synthetic sutures are used in an increasing number of daily surgeries. In this millennium, long history of sutures, the early work of Edwin smith, Hippocrates, Sushruta, Galen, Albucasis, Avicenna Celsus, Paré, and Lister is recognised. Because the science and history of sutures are not well-known to the majority of surgeons. Suture needs a holistic review to understand current research and progress on this widely used product.

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

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

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

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

Barbed Suture versus Interrupted Suture in Posterior Cervical Spine Surgery: Are They Equivalent?

Posterior cervical spine approaches have been associated with increased rates of wound complications compared to anterior approaches. While barbed suture wound closure for lumbar spine surgery has been shown to be safe and efficacious, there is no literature regarding its use in posterior cervical spine surgery. In a cohort of patients undergoing elective posterior cervical spine surgery, we sought to compare postoperative complication rates between barbed and traditional interrupted suture closure. A retrospective review of demographics, past medical history, and operative and postoperative variables collected from a prospective registry between July 1, 2016, and June 30, 2020 was undertaken. All patients 18 years old and above undergoing elective posterior cervical fusion were included. The primary outcome of interest was wound complications, including surgical site infection (SSI), dehiscence, or hematoma. In addition, numerical rating scale (NRS) neck pain (NP), NRS arm pain (AP), Neck Disability Index (NDI), and operative time were collected. A variety of statistical tests were used to compare the two suture groups. Of 117 patients undergoing posterior cervical fusion, 89 (76%) were closed with interrupted suture and 28 (24%) with barbed suture. The interrupted cohort were more likely to have >1 comorbidity (p<0.001), diabetes mellitus (p=0.013), and coronary artery disease (p=0.002). No difference in postoperative wound complications between interrupted/barbed sutures was observed after univariate (OR 1.07, 95% CI: 0.27-4.25, p=0.927) and multivariable logistic regression analysis (OR 0.77, 95% CI: 0.15-4.00, p=0.756). Univariate logistic regression revealed no differences in achieving minimal clinically important difference (MCID) NRS-NP (OR 0.73, 95% CI: 0.28-1.88, p=0.508) or NRS-AP (OR 0.68, 95% CI: 0.25-1.90, p=0.464) at 3 months between suture groups. The interrupted suture group was less likely to achieve MCID NDI at 3 months (OR 0.29, 95% CI: 0.11-0.80, p=0.016). Barbed suture closure in posterior cervical spine surgery does not lead to higher rates of postoperative wound complications/SSI compared to traditional interrupted fascial closure.

Tissue Adhesive or Suture for Wound Closure Following Surgical Removal of an Impacted Mandibular Third Molar: A Randomized Comparative Study

Tissue Adhesive or Suture for Wound Closure Following Surgical Removal of an Impacted Mandibular Third Molar: A Randomized Comparative Study

Outcomes in Sutured Versus Sutureless Wound Closure in Pediatric Cataract Surgery.

To analyze the postoperative course, specifically postoperative complications, of pediatric patients who underwent cataract surgery by a single surgeon. The type of wound closure was compared to provide an evidence-based approach to surgical technique in pediatric cataract surgery. This retrospective study analyzed pediatric patients who underwent cataract extraction by a single surgeon from 2014 to 2020. Excluded from the study were patients with postoperative follow-up of less than 1 month. The primary outcome compared postoperative complications between patients with sutured and sutureless wound closure. Other outcomes analyzed included intraocular pressure, mean corrected distance visual acuity, and incidence of procedure needed to remove posterior capsule opacification. The study comprised 116 eyes with sufficient follow-up; 86 had sutureless wound closure and 30 had sutured wound closure. An intraocular lens was placed in 52% of eyes in the sutureless group and in 80% of eyes in the sutured group. There was no statistically significant difference between preoperative and postoperative intraocular pressure between groups. The best corrected distance visual acuity was better in the sutured group at 6 months but not at the most recent follow-up visit. No cases of endophthalmitis were found in either group. There was no statistically significant difference between the incidence of retinal detachments and iris prolapse. The incidence of endophthalmitis, retinal detachment, and iris prolapse was similar between pediatric patients who underwent cataract removal with sutureless versus sutured wound closure. Therefore, it may be reasonable to avoid the suture after pediatric cataract surgery. [J Pediatr Ophthalmol Strabismus. 2023;60(2):147-151.].

Prevention of Orthopedic Prosthetic Infections Using Evidence-Based Surgical Site Infection Care Bundles: A Narrative Review

Background: The number of primary/revision total joint replacements (TJR) are expected to increase substantially with an aging population and increasing prevalence of comorbid conditions. The 30-day re-admission rate, in all orthopedic specialties, is 5.4% (range, 4.8%-6.0%). A recent publication has documented that the surgical site infection (SSI) infection rate associated with revision total knee (rTKR, 15.6%) and revision total hip (rTHR, 8.6%) arthroplasties are four to seven times the rate of the primary procedures (2.1%-2.2%). These orthopedic infections prolong hospital stays, double re-admissions, and increase healthcare costs by a factor of 300%. Methods: A search of PubMed/MEDLINE, EMBASE and the Cochrane Library publications, which reported the infection risk after TKR and THR, was undertaken (January 1, 1995 to December 31, 2021). The search also included documentation of evidence-based practices that lead to improved post-operative outcomes. Results: The evidence-based approach to reducing the risk of SSI was grouped into pre-operative, peri-operative, and post-operative periods. Surgical care bundles have existed within other surgical disciplines for more than 20 years, although their use is relatively new in peri-operative orthopedic surgical care. Pre-admission chlorhexidine gluconate (CHG) showers/cleansing, staphylococcal decolonization, maintenance of normothermia, wound irrigation, antimicrobial suture wound closure, and post-operative wound care has been shown to improve clinical outcome in randomized controlled studies and meta-analyses. Conclusions: Evidence-based infection prevention care bundles have improved clinical outcomes in all surgical disciplines. The significant post-operative morbidity, mortality, and healthcare cost, associated with SSIs after TJR can be reduced by introduction of evidence-based pre-operative, intra-operative, and post-operative interventions.

Medical Adhesives and Their Role in Laparoscopic Surgery-A Review of Literature.

Laparoscopic surgery is undergoing rapid development. Replacing the traditional method of joining cut tissues with sutures or staples could greatly simplify and speed up laparoscopic procedures. This alternative could undoubtedly be adhesives. For decades, scientists have been working on a material to bond tissues together to create the best possible conditions for tissue regeneration. The results of research on tissue adhesives achieved over the past years show comparable treatment effects to traditional methods. Tissue adhesives are a good alternative to surgical sutures in wound closure. This article is a review of the most important groups of tissue adhesives including their properties and possible applications. Recent reports on the development of biological adhesives are also discussed.

The use of novel knotless barbed sutures in posterior long-segment lumbar surgery: a randomized controlled trial

BackgroundThe study carries the aim to compare the clinical efficacy and economic outcomes of using barbed suture closure versus conventional closure for wounds after posterior long-segment lumbar surgery.MethodsOne hundred and eighty-one patients undertaking posterior long-segment lumbar surgery participated in the prospective randomized controlled trial study to receive either barbed suture wound closure (n = 91) or conventional suture closure (n = 90). Outcome measures included operating room time (ORT), wound closure time, length of incision, length of hospital stay (LOS), 90-day readmission rates, wound complications of dehiscence and infection, and costs.ResultsBarbed suture group was related with significantly lower ORT (P = 0.036), wound closure time (P < 0.001) and average wound closure time (P < 0.001), and significantly lower wound complication rates (dehiscence and infection) (P = 0.031). No significant differences were found when compared with conventional suture group in terms of length of incision (P = 0.086), length of hospital stay (P = 0.174), readmission rates up to 90 days after the surgical procedure (P = 0.232) and costs (P = 0.205).ConclusionThe study suggested the knotless barbed suture technique outperformed the conventional suture in shortening operating room time, wound closure time and average wound closure time, and reducing wound complication rates.

Comparison of 2-octyl cyanoacrylate skin adhesive and interrupted polypropylene sutures for wound closure in total ankle arthroplasty

BackgroundAdhesive skin materials have increasingly been used in orthopedic surgery. We aimed to compare the efficacy and safety of skin adhesive (2-octyl cyanoacrylate and polymer mesh, Dermabond Prineo) and interrupted polypropylene sutures for wound closure in patients undergoing total ankle arthroplasty (TAA).MethodsWe prospectively enrolled 107 consecutive patients (108 ankles) undergoing TAA and divided them into two groups: skin adhesive group (36 ankles) and suture group (72 ankles). The primary outcome assessment included wound complications and patient satisfaction for wound cosmesis. The secondary outcome assessment included duration of surgery, length of hospital stay, and the Ankle Osteoarthritis Scale (AOS) pain and disability score.ResultsThere was one case of allergic contact dermatitis, three cases of wound dehiscence, and one case of superficial surgical site infection in the skin adhesive group. Among them, one case each with allergic contact dermatitis and wound dehiscence finally progressed to deep surgical site infection. Three cases of wound dehiscence were also reported in the suture group; however, there was no case of surgical site infection. Patient satisfaction for wound cosmesis was significantly higher in the skin adhesive group than in the suture group (p = 0.001). There was no statistically significant difference between the groups in terms of secondary outcomes (p > 0.05).ConclusionsAlthough the use of Dermabond Prineo showed better patient satisfaction for wound cosmesis, it showed significantly high wound complication rates and no other clinical benefits compared to interrupted polypropylene suture in TAA. Our results suggest that awareness of the possibility of wound complications is necessary when Dermabond Prineo is used in TAA.

Subcuticular Barbed Suture and Skin Glue Wound Closure Decreases Reoperation and Length of Stay in Geriatric Hip Fractures When Compared With Staples.

Introduction:Patients with geriatric hip fracture are notoriously frail and at risk for complications. Persistent postoperative wound drainage can lead to prolonged hospital stay, increased risk for infection, and need for revision surgery. The purpose of this study was to determine the effect of wound closure technique, barbed monofilament subcuticular suture and skin glue versus staples on rates of intervention for wound drainage and length of hospital stay after geriatric hip fracture fixation.Methods:A retrospective review of isolated hip fractures in patients older than 60 years at a single institution over a 3-year period was done. Hip fractures included femoral neck, intertrochanteric, and subtrochanteric femur fractures treated with internal fixation or arthroplasty. Skin closure technique, at the discretion of the operating surgeon, included either barbed subcuticular monofilament suture and skin glue or staples. Charts and radiographs were reviewed to determine patient characteristics, Charlson Comorbidity Index, type of wound closure, length of stay, and interventions for persistent wound drainage.Results:There were 175 patients in the barbed suture and skin glue group and 211 patients in the staples group. The barbed suture group had an average postsurgical length of stay of 5.0 days which was significantly lower than the staples group (7.0 days, P < 0.00001). In the staples group, 17 patients (8%) required incisional negative pressure wound therapy due to wound drainage with five patients (2.4%) returning to the operating room secondary to persistent wound drainage. No patients were observed in the barbed suture group that required intervention for wound drainage.Discussion:Barbed suture and skin glue closure is associated with markedly shorter hospital stay and fewer interventions for wound drainage when compared with staples after surgical treatment of geriatric hip fractures.

Dermatological surgery: an update on suture materials and techniques. Part 2.

This is the second part of a two-part series summarizing the latest evidence related to suture materials and wound closure techniques in dermatological surgery. We critically appraised evidence focusing on the following consequences of suture choice: scar/cosmesis, pain, patient satisfaction, cost, infection and wound complications. We searched the databases MEDLINE, PubMed and Embase using the keywords 'skin surgery', 'dermatological surgery', 'sutures', 'braided sutures', 'monofilament sutures' and 'antibacterial sutures' to identify relevant English-language articles. This part of the review assesses the evidence for different types of buried sutures, including braided vs. monofilament sutures, longer-absorbing sutures and antibacterial sutures. The majority of trials were noted to be of poor quality, single-centre (thus lacking external validity) and underpowered, which presents challenges in comparing suture techniques in skin surgery. Future large-scale, multicentre, randomized trials are needed, with both surgeon and patient-assessed validated outcomes.

A Prospective, Randomized Evaluation of the Quality of Wound Closure With Barbed Versus Standard Suture After Total Joint Arthroplasty

Complications such as joint infection or delayed wound healing can lead to morbidity and elevated health care costs after total joint arthroplasty. The purpose of this study was to compare the quality of running knotless barbed suture vs standard monofilament suture wound closure with respect to wound drainage and healing complications after total joint arthroplasty. For this study, 1000 joint arthroplasty patients were prospectively randomized to have fascial, soft tissue, and skin closure with knotless barbed suture vs standard suture during the period 2016 to 2018. An absorptive dressing was used for 1 week postoperatively. Each dressing was weighed and the saturated surface area of the dressing measured. A total of 939 dressings were available for evaluation. Incisions were evaluated for wound healing at each postoperative visit. Of the 1000 joint arthroplasties performed, suture breakage or needle disengagement occurred similarly with the standard monofilament suture and the running barbed suture (13 times vs 6 times; P=.17). Dressings were weighed, and when standard monofilament sutures were used, an average of 1.2 g more postoperative bandage weight was recorded (P<.002). Postoperative wound complications including stitch abscess or wound irritation occurred more often with standard monofilament sutures than with running barbed sutures (16 times vs 5 times; P<.025). Optimal wound closure after joint replacement is critical to enhance soft tissue healing and minimize infection risk, which can be caused by excessive wound drainage. The positive results shown for the running barbed suture of this prospective study indicate the difference in quality of closure between the standard monofilament suture and the running barbed suture in hip and knee arthroplasty surgical sites. [Orthopedics. 2021;44(4):216-222.].

Polyrotaxane Crosslinked Self‐Healing Hydrogels for Switchable Bioadhesion

AbstractAs an effective alternative to suture in wound closure, tissue adhesives often need to have excellent biocompatibility and suitable bioadhesion. To achieve long‐term adhesion on moist tissue, polyrotaxane (PR) crosslinked self‐healing hydrogels have been prepared by the introduction of dynamic borate bonds between PR bearing phenylboronic acid moieties (PR‐PBA) and dopamine grafted poly(vinyl alcohol) (PVA‐DOP). Synthesis of these precursor polymers PR‐PBA and PVA‐DOP is quite simple and the hydrogels combine dynamic borate bonds with the sliding motion of the phenylboronic acid moieties on PR. The sliding nature of the crosslinking points along the axle in the PR is thought to enhance the mechanical properties and adhesion ability of the resultant hydrogels. Meanwhile, catechol groups on dopamine units have been protected by borate bonds under alkaline conditions to avoid oxidation, and they then are released to react with various functional groups on tissue surface to ensure the switchable tissue adhesion. The self‐healing test and adhesion of hydrogels on pigskin demonstrate the ability to restore the original performance after repeated strain cycles and maintain strong tissue adhesion. The components of these hydrogels have satisfying biocompatibility. These results indicate that these self‐healing hydrogels have great potentials in tissue adhesion.