Wound Suture Research Articles

Formation chirurgicale en ophtalmologie en Île-de-France : résultats d’une enquête sur 89 internes

This study aims to evaluate surgical training in ophthalmology through feedback from residents. An anonymous questionnaire was created, including 20 items which assessed the number of complete or partial surgical procedures performed during a semester, self-assessment of surgical skills, use of surgical simulators, an overall rating of the surgical training received and some suggestions to improve surgical training. It was sent by email to all residents in training in Île-de-France (DES Île-de-France and Inter-CHU), France. From October 23 to November 7, 2021, 89/137 residents responded to the questionnaire (65%). Since the beginning of their residency, ninety percent of the residents received training using simulators. Over 90% performed all of the technical steps of a "standard" cataract surgery at least once during the semester, and 60% 10 times or more. The least performed technical steps or procedures also received the lowest self-assessment: management of expulsive hemorrhage, open-globe or lacrimal laceration wound suturing, capsular tension ring injection, and intraocular lens explantation. Residents gave an overall average rating of 6.6/10 to their training and suggested some feedback on videos of resident surgeries (67%) and theoretical courses dealing with surgical techniques (61%). The increasing use of simulators should improve surgical training. Residents express the need for training regarding surgical complications and emergencies as well as improvement of their technical skills via improved feedback. Surgical teaching appears suitable for learning cataract surgery but seems less effective for the management of emergencies and intraoperative complications.

A non‐randomised pragmatic trial for the early detection and prevention of surgical wound complications using an advanced hydropolymer wound dressing and smartphone technology: The EDISON trial protocol

Total hip or knee arthroplasty is a highly effective intervention for treating the symptoms of degenerative joint disease or osteoarthritis (OA), often an unwelcome consequence of obesity. A safe and common surgical procedure, hip and knee arthroplasty procedures are not immune to the occurrence of postoperative complications such as surgical site infection (SSI) or surgical wound dehiscence (SWD). While published rates of SSI following hip or knee arthroplasty are low, 1% to 2% in some cases, it is the resulting wound complication and its clinical management and the impact on patient well-being and return to daily life for the 1% to 2% that is of concern. Postoperative complications such as SSI are a major cost driver to the health care system following arthroplasty and often result in extended lengths of stay, readmission for further surgery, primary and community nursing visits, and are a costly burden to health care settings. Early identification of a wound complication through post-discharge surveillance using a fully transparent dressing and smartphone technology and patient education may ameliorate contributing factors or reduce the likelihood of a complication occurring in the first instance. This clinical trial is a non-randomised pragmatic convenience sample carried out in 200 participants of both sexes receiving either a TKA or THA. There will be equal allocation to two groups (100 hips and 100 knees), with 50 in each allocation receiving the interventional dressing and 50 as control. The dressing will be applied prior to discharge and participants will be provided with education on postoperative wound care, when to contact home care nursing for a potential wound problem, and use of their smartphone to capture and send images of their incision site to the study nurses. Participants will also be followed up by home care nursing services at day 14 for suture removal and wound assessment. Participants will complete a patient-reported outcomes survey on day 14 and followed up on day 30 after surgery for wound assessment. The results of this trial may provide a novel pathway using a fully transparent dressing and digital technologies for the prevention of acute readmissions because of wound complications through early detection and intervention.

The role of miR-135b-5p in inhibiting mice acute lung injury (ALI) induced by sepsis and its mechanism

Objective: To investigate the expression status of miR-135b-5p in the sepsis induced acute lung injury (ALI) mice and its effects on inflammatory responses and cell pyroptosis in mice pulmonary tissues. Methods: The cecal ligation puncture (CLP) method was employed to construct sepsis-induced ALI mice models. The C57BL/6 mice were randomly divided into 6 groups with 8 mice in each group. The sepsis mouse models were constructed by performing CLP surgery: mice were anesthetized by intraperitoneal injection of 0.1 mg/kg barbital, the abdomen was cut longitudinally to expose the cecum, the cecum was ligated and perforated with syringe needle, the wound was sutured after extruding part of the intestinal contents. The sham operation group (Sham group) did not undergo any treatment and suture wounds after laparotomy, and no CLP operation was performed. The treatment groups were divided into CLP+NC mimic group, CLP+ miR-135b-5p mimic group, CLP+NC mimic+ Empty vector group, CLP+GSDMD group, and CLP+ miR-135b-5p mimic+GSDMD group. One week before CLP surgery, mice in the treatment group were injected subcutaneously with 200 μ L NC mimic (200 nmol/L), miR-135b-5p mimic (200 nmol/L), Empty vector (100 nmol/L), GSDMD Vector (100 nmol/L), and miR-135b-5p mimic (200 nmol/L), once a day for a week. The euthanasia was performed 24 h after operation by carbon dioxide asphyxiation. The qRT-PCR was utilized to determine miR-135b-5p and GSDMD expressions;HE staing assay was performed to observe the pathological changes of pulmonary tissues. The mice right lung tissues were flushed with 5 ml saline for 3 times, and each flush lasted for 3~5 min to collect the BALF, and the levels of GSDMD, IL-1β and IL-18 in BALF were determined by ELISA. The protein levels of NLRP3, caspase 1 and cleaved GSDMD in mice lung tissues were examined by immunoblotting analysis; Dual-luciferase reporter gene system assay was employed to validate the targeting relationship of miR-135b-5p and GSDMD. Results: Compared with the control group mice, there were a large number of inflammatory cell infiltration, alveolar damage, interstitial edema and alveolar collapse in the lung tissues of the CLP group mice (P<0.01), and the expression levels of the pyroptosis-associated proteins (NLRP3, caspase-1 and GSDMD) were all increased, while miR-135b-5p was down-regulated in the CLP group (P<0.01). Further experiments confirmed that overexpression of miR-135b-5p significantly reduced CLP-induced pyroptotic cell death in mice lung tissues (P<0.01), and dual-luciferase reporter gene system assay confirmed that miR-135b-5p targeted GSDMD for its degradation. Moreover, the rescuing experiments validated that up-regulation of GSDMD abrogated the inhibition effects of miR-135b-5p overexpression on cell pyroptosis in CLP mice lung tissues (P<0.01). Consistently, we verified that miR-135b-5p also suppressed the expression levels of IL-1β and IL-18 in mice BALF via degrading GSDMD (P<0.05). Conclusion: Overexpression of miR-135b-5p attenuated sepsis-induced ALI by inhibiting GSDMD-mediated pyroptotic cell death, and this study provided potential therapeutic target and theoretical foundation for sepsis-induced ALI treatment.

Measuring harm-free care in childbirth: a pilot application of the maternity safety thermometer in Brazil

Introduction: In Brazil, interventions during labor and childbirth are harmful and, for the most part, unnecessary. In addition, there is a high prevalence of abuse and disrespect for women and babies during this period. Objective: To describe the prevalence of maternal and neonatal harm and harm-free care in a Brazilian maternity setting. Methods: Pilot application of the Portuguese version of Maternal Safety Thermometer (MST) by a cross-sectional study in a public setting. Data collection was made at two timepoints. Results: 140 women were included. Over 84% of women had a postpartum sutured wound, resulting from a caesarean section, an episiotomy, or a perineal trauma. Puerperal infection, especially on a caesarean wound, was the most frequent physical harm. Women’s perception of safety, including being left alone in labour, and feeling their safety concerns were not taken seriously, decreased from 80.6% to 43.3% in the second timepoint. Using the MST helped to improve the quality of medical records since critical information about a patient’s health status was not properly recorded, or even absent. Conclusion: MST is a concise tool and includes indicators related to harm-free care in a short time range. However, this study suggests that the MST can underestimate harm if it is used alone to assess harm-free care in maternities with excessive levels of intervention, and poor reporting of harms (i.e., blood loss), as in most Brazilian settings.

The choice of suture material and techniques of the laparotomic wound suture

Surgical technique and suture material applied in laparotomic wound suturing are important factors determining the risk of incisional hernias and other wound complications. Optimization of laparotomic wound closure will undoubtedly reduce the frequency of postoperative complications, including incisional hernias and subsequent secondary surgeries in patients. Thus it will improve their quality of life and, in economic terms, significantly reducing the cost of health care resources. Despite the great work carried out in this area by many groups of medical specialists and scientists around the world, today there is no single, generally accepted and proven advantage of the technique for closing a laparotomic wound.

Single blind, randomized study comparing clinical equivalence of Trusilk® and Mersilk® silk sutures for mucosal closure following surgical removal of mesioangular impacted mandibular third molar

Background: Mesioangular impacted mandibular third molar is a common dental anomaly, for which surgical extraction is required. Post-surgery closure of mucosa reduces the prevalence of pain and other surgery-associated complications. We compared tissue reaction/inflammation after 3 and 7 days of mucosal closure with Trusilk ® and Mersilk ® silk sutures, following impacted mandibular third molar removal. Methods: This multicenter, prospective, two-arm, parallel-group, randomized (1:1), single-blind study (July 2020-November 2021) included subjects (Trusilk ®, n=65 and Mersilk ®, n=64), requiring mucosal suturing following impacted mandibular third molar removal. The primary endpoint, incidence of pain, swelling and trismus at the extraction area on post-surgery day 3 and 7 was evaluated. The secondary endpoints, incidence of tissue reaction, wound infection, suture loosening, other complications, operative time, amount of anesthesia, intraoperative suture handling, time needed for complete wound healing and suture removal, and adverse events were also recorded. Results: Socio-demographic and intra-oral characteristics were comparable between the groups. In Trusilk ® and Mersilk ® groups, a gradually decreasing pain score, starting from day 0 post-surgery (42.17±22.38 vs. 45.97±22.20) to day 7 (8.40±11.93 vs. 8.28±12.13) to day 30 (1.98±0.89 vs. 1.75±0.76) was witnessed. After the surgery, 21.54% and 17.19% subjects in Trusilk ® and Mersilk ® groups, respectively, had no post-operative swelling, while at the last two visits none of the subjects had swelling. Non-significant difference in wound infection, suture loosening, wound healing, bleeding, taste changes, operative time, amount of anesthesia, intraoperative suture handling, and time needed for complete wound healing and suture removal was noted among the groups. No suture-related adverse events were recorded. Conclusions: The results indicated that the Trusilk ® and Mersilk ® silk sutures are clinically equivalent and can be used for mucosal closure after removal of an impacted mandibular third molar with a minimal rate of pain, swelling and trismus. Clinical Trial Registry of India Registration: CTRI/2020/03/024100 (20/03/2020).

Comparing running vs interrupted sutures for skin closure: A systematic review and meta-analysis.

Continuous sutures and interrupted sutures have been widely applied to skin closure after non-obstetric surgery or traumatic wounds. Usually, continuous sutures were divided into transdermal or subcuticular sutures according to whether the stitches were placed through or below the epidermal layer. Interrupted sutures, on the other hand, involved penetration of the loose connective tissue beneath the skin layers, with stitches placed through the external skin layer. Complications including infection, dehiscence, and poor cosmetic appearance were not rare after suturing. Whether a suture method is a suitable option for rapid wound healing and long-term cosmetic appearance remains controversial. To examine the potential benefits and harms of continuous skin sutures vs interrupted skin sutures in non-obstetric surgery or traumatic wounds. Searching websites such as PubMed, the Cochrane Central Library, Web of Science and Embase, and ClinicalTrials.gov were systematically searched up to 5 January 2022 and were assessed and guided by Preferred Reporting Items for Systematic Reviews and Meta-analysis rules as well as guidelines. All relevant randomised controlled studies comparing continuous sutures with interrupted sutures of skin closure were analysed. The suture techniques and material used in each trial were recorded. The transdermal and subcuticular continuous sutures were separately compared with interrupted sutures in the subgroup analysis of dehiscence and cosmetic appearance because the visual appearance of these two continuous suturing techniques was significantly different. Ten studies including 1181 participants were analysed. Subcuticular continuous sutures had comparatively higher visual analogue scale (VAS) scores among patients and doctors than interrupted sutures (OR=0.27, 95% Confidence Intervals [CI]=0. 07-0.47, P < .01). Similarly, priority was found regarding transdermal continuous sutures and interrupted sutures (OR=0.40, 95% CI=0.21-0.60, P < .01). Five randomised controlled trials (RCTs) demonstrated relevant data about dehiscence events. The incidence of continuous suture was significantly lesser than that of interrupted suture (OR=0.16, 95% CI=0.07-0.37, P < .01). There was no significant difference between the infection events rates of two suture methods (OR=0.69, 95% CI=0.40-1.21, P=.62, I2 =0%). This systematic review indicated the superiority of both transdermal and subcutaneous continuous sutures over interrupted sutures in skin closure in terms of wound healing and cosmetic appearance.

A tactics for treating large skin wounds on the head

An open wound on the head is an injury (skin tear) of all scalp external layers including dermis, subcutaneous fatty tissue, aponeurosis, muscles, vessels and nerves with intact skull bones and intact neurological reactions [1].Extensive wounds of the external head layers, in addition to a standard threat to the human health, bear an additional risk due to their close localization to the brain. Because of the abundant blood supply to scalp soft tissues, high rate of volumetric blood flow (50–60 milliliters per 100 g of brain tissue), numerous extra-, intracranial arterial and venous anastomoses, there is a real danger of spreading the infection inside the skull and developing meningitis or encephalitis.Problems of care of patients with extensive head wounds, risk of complications that can cause severe consequences determine the relevance of the issue presented in this work.Objective. To analyze treatment results of patients admitted to the emergency department of Mariinskaya State City Hospital in St. Petersburg within three months in 2021 and to develop an optimal tactics for treating patients with extensive wounds of the scalp.Material and research methods. 2245 patients with various types of head injury were admitted to the hospital; 610 (27.2 %) of them had damage of the external scalp layers. Each patient had standard clinical and laboratory examination and multislice computed tomography (MSCT) examination of the head at 64-slice Definition AS (Siemens, Germany) CT scanner. In the emergency department, all patients who were injured by high-energy traumatic objects had the primary surgical debridement; all patients who were injured by low-energy traumatic objects had wound toilet and wound suturing. Three most representative cases with extensive wounds of the external scalp (over 10 cm) with illustrations are presented in the article as clinical examples.Results. All patients had good outcomes. There were no any signs of wound infection either.Conclusion. A thorough primary surgical debridement of scalp wounds with their drainage followed by observation and treatment in the hospital is a necessary condition for successful healing of large scalp wounds.

Results of Evaluation of the Physical and Mechanical Properties of a New Suture Material with Miramistin Coating

Background: The imperfection of surgical sutures, from the point of view of insufficient prevention of microbial contamination in the area of suturing, is one of the urgent problems in modern practical healthcare. In this connection, one of the promising areas at the present time is the study of suture material under conditions of its coating with various antiseptics. This study aimed to evaluate the physical and mechanical properties of the suture material impregnated with miramistin for further application in experimental studies on animals. Methods and Results: By applying a two-layer polymer coating on absorbable polyglycolide threads, the threads were given antimicrobial properties. In the amount of 10% or 20% by weight of the polymer, miramistin was introduced into both coatings. The breaking load and elongation data in the surgical suture knot were evaluated by immersing the samples in a phosphate buffer solution (pH=7.4), maintaining a constant temperature of 37°C by a thermostat. Threads from the solution were extracted on Days 1, 3, 7, 14, and 21 of the experiment. Further, the studied samples of the suture material were subjected to stretching to rupture on a universal tensile testing machine of the domestic company Metrotest. Physical and mechanical properties were evaluated by the dynamics of the breaking load and elongation at a break in the node after being in a phosphate buffer solution. Coating of polyglycolide thread, which is a suture material, with miramistin at a concentration of 10% and 20% does not lead to loss of strength even in the long term of the experimental study, which, in turn, meets the standards for suture material. Conclusion: The results obtained allow us to recommend a suture material impregnated with miramistin for further research, the ultimate goal of which will be the possibility of active use of this material in practical medicine, in particular in surgery to prevent microbial contamination in the area of suturing and infection of wounds.

Post Caesarean Section Wound Healing among Postpartum Women who Consumed Boiled Eggs

In Indonesia, there is an increase in the number of cesarean sections accompanied by the incidence of post-sectional caesarean section(CS) wound infections, where data obtained about 90% of post-C-section morbidity is caused by surgical wound infections. Post CS suture wound healing is influenced by several factors, one of which is the consumption of high protein nutrition such as eggs. This study aimed to determine post-SC wound healing among postpartum women who consumed boiled eggs at the RSIA Pasutri, Bogor in 2021. This research method was a Quasy Experiment Design with a post-test approach with Control Group. The total population was 30 postpartum women post CS, with a sample of 15 experimental groups and 15 control groups taken by purposive sampling, while data analysis used parametric test is Independent T-Test. The results of the study found that post CS postpartum women who consumed boiled eggs all respondents experienced post CS ound healing with good wounds which was 15 respondents (100%) compared to those who did not consume boiled eggs which was only 8 respondents (53.3%) experienced good wound healing. while the others experienced poor wound healing which was 7 respondents (46.7%). Based on the Independent T-Test statistical test in the experimental and control groups, the results of p value = 0.002 &lt;0.05, thus there was a difference in post-SC wound healing between experiment and control group. The results of this study can be used as input in accelerating wound healing.

Role of intravascular methylprednisolone in surgical impaction

Introduction: Mandibular impacted third molar surgical extraction may cause pain, trismus and swelling. Hence in this study we aim to evaluate the effect of methylprednisolone injection into the muscles on pain edema and trismus post third molar impaction. Material and Methods: We injected methylprednisolone acetate into the masseter muscle via the intrabuccal approach, one hour before the surgery and immediately after suturing of the surgical wound, among the 100 subjects divided to two groups as case and controls, we evaluated postoperative pain, trismus and swelling. The numeric pain scale (NPS) was used for pain assessment. Results: we observed that superior results in preoperative group for mouth opening, pain and all the facial swelling parameters, they were also statistically significant differences than when the postoperatively administered methylprednisolone acetate. Conclusions: Preoperative administration of the methylprednisolone is more effective in reducing pain, trismus and swelling, when compared to that administered postoperatively.

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.

Implantation of an Impedance Sensor for Early Detection of Gastrointestinal Anastomotic Leaks

IntroductionAccurate early diagnosis of a gastrointestinal anastomotic leak remains a challenge. When an anastomotic leak develops, the electrical properties of the tissue undergoing inflammatory processes change, resulting from the extravasation of inflammatory fluid and cellular infiltration. The method described here intends to provide a novel early anastomotic leak warning system based upon measurable changes in tissue impedance nearby an acute inflammatory process. MethodsA biodegradable Mg-alloy was compared with a nonabsorbable stainless steel (STS) electrode connected to a wireless recording system for impedance measurement. In vitro measurements were made in physiological solutions and small animal (eight mice) and large animal (eight pigs) models with an anastomotic leak simulated by an open colotomy. Measurements were made at 10 mm intervals from the open colon at baseline and up to 120 min comparing these with a sutured colonic wound and normal tissue. ResultsIn-vitro biodegradable magnesium electrode impedance evaluation showed good sensitivity to different media due to its environmental corrosion properties. The impedance of an acidic environment (1.06 ± 0.02 kΩ for citric acid) was twice that of phosphate-buffered saline (PBS) (0.64 ± 0.008 kΩ) with a distinction between Normal Saline (0.42 ± 0.013 kΩ) and PBS (0.64 ± 0.008 kΩ). This was in contrast to the performance characteristics of the control STS electrodes, where impedance in an acidic environment was lower than saline or PBS (citric acid:0.76 ± 0.01 kΩ versus PBS: 1.32 ± 0.014 kΩ). In a mouse model simulating an anastomotic leak, there was a significant increase in impedance after 120 min when compared with controls (99.7% increase versus 9.6% increase, respectively; P < 0.02). This effect was confirmed in a pig model when relative impedance measurements of the leak and control groups were compared (1.86 ± 0.46 versus 1.07 ± 0.02, respectively; P < 0.027). ConclusionsElectrophysiological measurement shows diagnostic sensitivity for a gastrointestinal leak with potential clinical utility in the postoperative detection of early intra-abdominal sepsis. Further investigation of biodegradable tissue sensors capable of monitoring an early anastomotic leak is required.

The clinical pattern of intentional injuries at a primary Saudi Arabian trauma center.

The term "intentional injuries" refers to a spectrum of injuries resulting from self-inflicted injuries, interpersonal violence, and group acts of violence. Intentional injuries are underreported in Saudi Arabia. This study aimed to analyze and evaluate the characteristics of intentional injuries in patients who presented to the emergency department of a primary trauma center in Medina, Saudi Arabia in 2013. A prospective cohort database analysis of the clinical patterns and treatment outcomes of 252 patients who had intentional injuries between January and December 2013 was done. The proportion of trauma patients with intentional injuries was 1.3%. The mean age was 34.2±9.4 years, 141 patients (56.0%) were male, and 111 (44.1%) were female (male to female ratio, 1.27:1). The majority (n=159, 63.1%) of injuries occurred at night. Most occurred outside the home (n=180, 71.0%). Financial problems (n=62, 24.6%) and social disputes (n=61, 24.2%) were the most common reasons. Sharp objects (n=93, 36.9%) were the most common weapons used. The head and neck were the most commonly injured areas (n=63, 54.4%). Superficial cuts (n=87, 34.5%), were the most common type of injury. Suturing of wounds (n=54, 21.4%) and surgical debridement (n=47, 18.7%) were the most commonly performed modalities of management. We conclude that intentional injuries in Saudi Arabia are a health care hazard that is, unfortunately, underreported. The clinical pattern is similar in most aspects to international reports but differs in certain features due to the specific religious and conservative characteristics of the community. Nationwide clinical studies are strongly recommended.

EVALUATION OF EFFICACY OF BARBED SUTURES IN INTRAORAL WOUND CLOSURE

Background and Objective: Surgical knots though provides an anchoring function on suture line, but also present a potential source of infection. Knotless barbed sutures were designed to prevent knot-related complications. The aim of this study was to determine the safety, effectivity and longevity of unidirectional barbed sutures in intraoral wound closure. Materials and method: A non-randomised study involving 13 patients who required intraoral incisions for open reduction and internal fixation of mandibular fractures and alveoloplasty. Following the surgical procedures, wound closure was done by unidirectional barbed sutures. Outcome parameters that were measured were type of healing, erythema, wound discharge, wound dehiscence, necrosis and pus on 3rd and 7th post-operative day and 2nd and 4th post-operative week. Results: Statistically significant change in healing and erythema status was observed in the group (P value &lt; 0.001) across the timeline. No statistical significance was found for other parameters. Dehiscence of sutured wound was observed on the same day of the procedure in one patient. Suture extrusion was also noticed in one patient after 1st postoperative week. Conclusion: Knotless barbed sutures can be used without harm in wound approximation of intraoral incisions with no potentially harmful major or minor complications.

Sutureless circumcision using monopolar diathermy and 2-octyl cyanoacrylate is safe and effective in a cohort of 634 post-neonatal prepubescent boys

Circumcision is the most commonly performed surgical procedure in the world, with one-third of males circumcised globally. Post-neonatal, prepubescent sutured circumcision demonstrates complication rates ranging from 1.7% to 9.1%. We have previously reported that 2-octyl cyanoacrylate (2-OCA, Dermabond, Ethicon) primary circumcision (PC) and circumcision revision (CR) in prepubescent children demonstrated superior cosmesis, shorter operating room (OR) times and cost savings. The aim of our study is to evaluate complication and reoperation rates with a scalpel-free and suture-less technique for primary circumcision (PC) and circumcision revision (CR) using 2-OCA. Following IRB approval, we conducted a retrospective review of all boys at our institution who underwent PC or CR using 2-OCA and monopolar diathermy between January 2014 and January 2021. All procedures were performed by a single surgeon. The technique is outlined in the figure below. No aligning sutures or instruments were used in this process. Patients that required sutures or compressive dressings based on age or associated anomalies were excluded from analysis. We obtained all returns to our system within 30 days of the procedure and returns to the OR during the study period using the REDCap database. Of 1107 procedures performed during the study period, 634 procedures (479PC and 155 CR) met inclusion criteria. Median age was 12 months (range 3 months-10.4 years) with minimum follow up of 1 year. There were 3 patients (0.47%) that returned to system within 30 days for surgical site bleeding, and one patient (0.15%) required surgical intervention within 30 days. Nine patients required reoperation after 30 days, five (0.8%) for iatrogenic phimosis, 3 (0.5%) for redundant prepuce and 1 for keloid formation. We observed an overall complication rate of 1.3% (6/634) and reoperation rate of 1.6% (10/634). Since FDA approval in 1998, 2-OCA has been widely adopted as a replacement for sutures in tension-free wounds. However, it has yet to gain widespread use for circumcision given concerns for wound dehiscence and surgical site bleeding. This study demonstrates that a scalpel-free and suture-less technique demonstrates complication and reoperation rates are lower than reported circumcision using scalpel and sutures. Limitations include retrospective design, single surgeon experience, and REDCAP database only identifying patients with complications that required a return to system. Our technique for suture-less circumcision using 2-OCA offers superior cosmesis, shorter OR times, cost savings, and a lower complication rate (1.3%) compared to sutured circumcision (>1.7%) reported in post-neonatal prepubescent boys.

Comparison Between Ultrasound-Guided Suprainguinal Fascia Iliaca Block and Anterior Quadratus Lumborum Block for Total Hip Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Trial.

Nerve block is a key technique in postoperative analgesia for total hip arthroplasty (THA). This study aimed to compare ultrasound-guided suprainguinal fascia iliaca block (SFIB) and anterior quadratus lumborum block (AQLB) in patients undergoing primary THA. In this prospective, double-blind, randomized controlled trial, 100 patients undergoing primary THA under general anesthesia were randomly allocated to receive an ultrasound-guided SFIB+ sham AQLB (SFIB group), or an ultrasound-guided AQLB+ sham SFIB (AQLB group). Before wound suture, all patients received periarticular infiltration analgesia which the local anesthetic was injected into joint capsule, exposed gluteal and abductor muscles, peritrochanteric zone, and subcutaneous tissue under the incision as multiple sites. The primary outcome was postoperative morphine consumption within 24hours after surgery. Secondary outcomes were the time to first rescue analgesia, postoperative pain assessed on the visual analog scale, postoperative quadriceps strength, the time to hospital discharge, and the incidence of postoperative complications. There were no significant differences between the 2 groups concerning morphine consumption within 24hours after surgery (P= .774), the time to first rescue analgesia (P= .890), the time to hospital discharge (P= .532), and the incidence of postoperative complications (P > .05). The visual analog scale pain scores at rest and during motion also were similar at all time points (P > .05). Significantly more patients in the SFIB group experienced quadriceps muscle weakness at 2hours (P= .008) and 6hours (P= .009) after surgery. Under the circumstances of this study, when combined with periarticular infiltration analgesia, the SFIB provided similar pain relief compared with AQLB in patients undergoing THA, but was associated with muscle weakness within 6hours after surgery.

Ancient surgeons: A characterization of Mesopotamian surgical practices

BackgroundThe Ancient Mesopotamian civilization, the earliest known, emerged in the fourth millennium BCE.1 While the advent of medicine is established, there is little understanding of surgery's origins. We sought to describe the characteristics and medical acumen of the surgeons of the first civilization. MethodsSource documents and commentary on Mesopotamian medicine were systematically analyzed for evidence of surgery and physician descriptions. ResultsEarly tablets reveal evidence of the incisional drainage of a scalp abscess and empyema, advanced wound care, fracture alignment, and possible caesarians without evidence of wound suturing, emergency procedures, trephination, or circumcision.2 While the asû and āšipu understood disease processes, strong evidence of an inextricable connection between spiritual and diagnostic/curative roles exists. ConclusionsMesopotamian physicians were diagnosticians and healers, approaching surgery as part of their holistic practice rather than a separate entity. Surgery was utilized as an endpoint to a careful process aided by objective evaluation and spiritual incantation.

Trans-umbilical Single-Site Plus One Robotic Assisted Surgery for Choledochal Cyst in Children, a Comparing to Laparoscope-Assisted Procedure.

ObjectiveWe introduce the trans-umbilical single-site plus one robotic-assisted surgery for the treatment of pediatric choledochal cyst. Compare the intraoperative and postoperative outcomes between the new method and traditional laparoscopy-assisted procedure.MethodWe retrospectively analyzed the clinical data of 51 children diagnosed with choledochal cysts and received surgery from June 2019 to December 2020 at our department. About 24 patients who underwent the robot-assisted procedure were selected as the R group, and 27 patients who underwent the laparoscope-assisted procedure were selected as the L group. We compare the intraoperative and postoperative outcomes between the two groups.ResultNo significant differences were found in demographic information between the two groups (P > 0.05). The median total operative time, median port/trocar installation time, and median wound suture time of the R group were a little longer than the L group (217.63 ± 5.90 vs. 199.37 ± 5.13 min; 30.71 ± 3.18 vs. 6.11 ± 1.15 min; 30.79 ± 1.82 vs. 20.40 ± 3.12 min, respectively; P < 0.001). However, the R group had shorter choledochal cyst excision time and mean hepaticojejunostomy anastomosis time than the L group (52.04 ± 2.74 vs. 59.26 ± 3.23 min; 52.42 ± 2.72 vs. 60.63 ± 3.30 min, respectively, P < 0.001). The mean extracorporeal Roux-y jejunojejunostomy time of two groups has no remarkable difference (P > 0.05). The R group also had less mean volume of blood loss (7.04 ± 1.16 vs. 29.04 ± 18.21 mL; P < 0.001). The R group had a shorter indwelling time of gastric tube, anal exhaust time, water feeding time, solids feeding time, and hospital stay time than the L group (P < 0.05). The R group had a lower early complication rate than the L group (4.2 vs. 29.63%; P = 0.026). No statistical differences were identified between the two groups in late or any single complication (0.00 vs. 11.11%; P > 0.05).ConclusionsA resection of the choledochal cyst and a Roux-en-Y hepaticojejunostomy can be performed much more precisely by single-site plus one robotic-assisted surgery. Patients can achieve rapid recovery, and the umbilical incision is more concealed and beautiful. Combing the experience of single-site surgery with robot-assisted surgery, the operators can implement the technique in children safely and feasibly.

Effect of Modified Allgöwer-Donati Suture Technique on Wound Cosmetics in Spinal Surgery.

ObjectiveTo analyze the efficacy of modified Allgöwer–Donati suture (MADS) technique on cosmetic outcomes compared with vertical mattress suture (VMS) technique in spinal surgery wounds.MethodsThis randomized controlled trial was conducted at the First Hospital of Lanzhou University (Gansu, China) from September 2019 to August 2020. The patients were randomly divided into two groups, a VMS group and a MADS group, by staff not involved in the treatment using a computer‐based random number table program (no restrictions on age or sex). Both procedures were performed by the same group of physicians as well as assistants. All suture wounds were completed by the same person. The primary endpoint was the scar area, and the postoperative scar area was scored by the Patient and Observer Scar Scale Assessment (POSAS). The scar area was calculated by ImageJ software. The second outcome measure was wound complications, including poor wound healing, wound edge necrosis, and infection. The trial was recorded in the Chinese Clinical Trial Register on 18 August 2019 (ChiCTR1900024548).ResultsA total of 143 patients were included: 72 in the VMS group and 71 in the MADS group. There was no significant difference in their demographics in terms of age (49.71 ± 8.91 vs 50.15 ± 6.79 years, P = 0.737), sex (M/F, 30/41 vs 31/41, P = 0.923), suture time (3.39 ± 0.22 vs 3.47 ± 0.25 s/mm, P = 0.057), or body mass index (BMI, 23.88 ± 3.50 vs 24.05 ± 3.50, P = 0.765) for MADS to VMS. The postoperative scar area was compared between the two groups transversely on day 12, the MADS wound scars decreased by 58.95% (75,133.24/127,452.58). In the POSAS evaluation, after MADS treatment, surface area score decreased from 5 (4, 5) to 2 (2, 3) (P < 0.0001), observer's overall opinion from 5 (4, 5) to 3 (2, 3) (P < 0.0001), itching from 3 (3, 4) to 3 (2, 3) (P = 0.001), color from 4 (4, 5) to 3 (2–4) (P < 0.0001), stiffness 4 (3–4.75) to 3 (3, 4) (P < 0.0001), or thickness from 4 (3–5) to 4 (3, 4) (P = 0.004). In terms of overall opinion evaluation, the MADS showed a significant difference in observer's overall opinion to the VMS (5 (4, 5) vs 3 (2, 3), P < 0.0001) and in patient's overall opinion 5 (5, 6) to 3 (3, 4), (P < 0.0001). There was no significant statistical difference in poor wound healing (3 vs 0, P = 0.245), wound edge necrosis (3 vs 0, P = 0.245), and infection (1 vs 0, P = 1.000) with the MADS to the VMS.ConclusionThe results of this study show that the MADS effectively reduced the surgical scar area to 58.95% with no additional adverse events compared with that of the VMS in spine surgery.