Closure Technique Research Articles

Photo-crosslinking modified gelatin-silk fibroin hydrogel for accelerating wound repair of open abdomen

Open abdomen (OA), a major advance in modern trauma surgery, enables the treatment of severe abdominal trauma, infections, and hypertension by temporarily closing the abdominal cavity without suturing. Although OA can reduce mortality rates, it also presents challenges such as disruption of the abdominal environment, intestinal exposure, and impaired wound healing. Current temporary abdominal closure (TAC) techniques using polypropylene (PP) mesh are susceptible to abrasion and rupture of the intestine, leading to adhesions and serious complications such as intestinal fistulas and chronic wounds. These complications seriously impact outcomes due to mesh rigidity and its incompatibility with surrounding tissues. In this study, we designed a multifunctional hydrogel composed of GelMA (Gelatin Methacryloyl) and SilMA (Silk Fibroin Methacryloyl) as a promising solution for open abdominal wound repair. In vitro experiments confirmed the biocompatibility, self-healing properties, pro-angiogenic effects, and promotion of macrophage polarization. In vivo studies revealed that the GelMA-SilMA hydrogel could enhance abdominal wall tissue thickness and integrity via isolating the peritoneal cavity, protecting the intestinal tract, polarizing macrophages, promoting collagen formation, inducing neovascularization, inhibiting oxidative stress, and suppressing inflammation. Furthermore, immunofluorescence, immunohistochemistry, and RNA sequencing were employed to evaluate the wound healing mechanisms of GelMA-SilMA hydrogels. The results demonstrated that the hydrogels can promote angiogenesis, inhibit inflammation and immune responses, and enhance wound healing by activating the HIF-a-VEGF signaling pathway, RAP1 signaling pathway, and PI3K-AKT signaling pathway. Hence, the multifunctional GelMA-SilMA hydrogel has tremendous potential for clinical use in open abdominal wound repair.

Comparative Outcomes of Immediate and Delayed Wound Closure Techniques in Appendectomies for Gangrenous Appendicitis

Background: Post-operative medical complications are very common in patients with gangrenous nonperforated appendicitis, especially surgical site infections (SSIs). Currently no conclusive answers on the relative benefits of immediate vs delayed wound clear therefore a comparison is essential. Objectives: In order to compare the results of immediate versus delayed wound closure in patients with gangrenous appendicitis who underwent appendectomy, SSIs, wound healing, and general postoperative recovery will be assessed. Methodology: The present study is a retrospective cohort study, using data from 185 patients, operated for gangrenous appendicitis during the period between from January 2023 to February, 2024. Total patients were categorized into two groups based on the wound closure technique employed, immediate wound closure (IWC, n=105) and delayed wound closure (DWC, n=80). Specific dependent variables were the overall SSI rate, days to wound healing and days of hospitalization. Secondary endpoints included a return of symptoms and overall postoperative morbidity. Results: The study also revealed that the incidence of SSIs was relatively low in the DWC group at 8. 0% compared to the (22.0± 0.01) % in the IWC group, which was statistically significant (p<0. 001). The overall IWC time was significantly shorter in the IWC group (11 days) as compared to the DWC group (15 days) (P value = 0. 02). In our study, the DWC group was found to have a lower median LOS of 6 days as compared to IWC group that had a LOS of 8 days. When compared the two groups regarding readmission rates, the difference was not statistically significant (p-value = 0. 05). Conclusion: These delayed wound closure strategies in appendectomy for gangrenous appendicitis are a safe means of decreasing SSIs and hospital stay without a predisposing effect on wound healing and readmission. Based on these findings, it is recommended that DWC is the better approach in the management of such high-risk surgical patients.

The dragonfly technique for trachea closure in temporary tracheostomies. Surgical steps and clinical results.

To assess the effectiveness of a new suturing technique called Dragonfly for the closure of temporary tracheotomies. This technique involves placing two sutures during the tracheotomy procedure and leaving them loose and unknotted until the day of skin closure. Retrospective case control study. Monocentric study at a department of Otolaryngology and head and neck surgery at a tertiary centre in Italy. A total of 50 patients who underwent temporary tracheotomy between January 2017 and December 2021. Patients were divided into two groups based on the trachea closure method: traditional closure with sutures placed during the skin closure procedure (Group A) and the Dragonfly technique (Group B). The incidence of tracheal stenosis by Computed Tomography (CT), granulation tissue formation, bleeding, procedure duration, patient discomfort were evaluated. The incidence of tracheal complications and tracheal stenosis was reduced in Group B (6%) compared to Group A (24%). Procedure times (3min vs. 6min) durations was significantly shorter. No patients had symptoms of tracheal stenosis at the end of the procedures. The Dragonfly suturing technique is effective and safe for tracheotomy closure, reducing the incidence of tracheal stenosis and shortening hospitalization duration compared to the traditional method.

Skin and Muscle Closure Techniques Following Large-Scale Osteosarcoma Removal: A Comparative Analysis.

Osteosarcoma (OS), the most prevalent form of bone cancer, typically arises in osteoblast cells responsible for generating new bone. The bone produced by these cancer cells is weaker compared to healthy bone. OS is an aggressive bone cancer that often requires extensive resection, leaving behind substantial soft tissue defects. Successful closure after tumor excision is critical for wound healing and postoperative recovery. However, the optimal approach varies depending on factors like defect size and location. After extensive resection of OS, restoring the integrity of the affected area demands careful closure of both the skin and underlying muscle. The appropriate closure technique depends on the size and location of the soft tissue defect. The main objective of this systematic review is to evaluate and compare different surgical techniques for closing skin and muscle layers following large-scale OS removal. Through a systematic review methodology, we conducted an extensive analysis of the existing body of literature on this topic, drawing from relevant research papers published over the past two decades. This allowed us to collectively evaluate and synthesize available data on the subject. This review found that negative pressure wound therapy (NPWT) and flap reconstruction are the main surgical approaches used to close skin and muscle following extensive OS resection, which commonly results in large soft tissue defects due to the nature of tumor removal. Furthermore, NPWT was the most widely used method for closing soft tissue defects after major OS removal, while flap reconstruction was also common when NPWT was not appropriate or the defect was too large. An integrated approach combining vacuum therapy, skin stretching, and occasional flaps seeks to primarily close large defects after OS resection through optimized healing and tension reduction to achieve the best postoperative results.

Perventricular device closure of the ventricular septal defects in children-first experience in the United Arab Emirates

BackgroundVentricular septal defect (VSD) is the most common congenital cardiac malformation, accounting for approximately 30% of congenital heart defects. Conventional surgical repair using cardiopulmonary bypass is invasive and associated with morbidities and prolonged hospital stay. With the advent of interventional approaches and availability of different occluding devices, the technique of perventricular device closure is evolving and being implemented successfully in larger groups of patients. We present herein, our initial experience of perventricular device closure for the ventricular septal defects in children to assess risks and benefits.MethodsFrom March, 2023 to February, 2024, we have performed perventricular closure of ventricular septal defects in 13 children, under guidance of transesophageal echocardiography without cardiopulmonary bypass support. The median age at operation was 2 year (range 1.3–10 years) with the median body weight 11 kg (range 8.7–16.6 kg). Sixty-nine percent were males. The ventricular septal defect sizes ranged from 2.7 to 6 mm (mean 4.7 mm). Seven defects were perimembranous, four sub-aortic and two were muscular. One patient also underwent pulmonary artery de-banding with pulmonary artery balloon angioplasty and other one patent ductus arteriosus ligation, concomitantly. For defect closure, we used ventricular septal defect occlusion device (MemoPart™, Lepu Medical Technology Company, China) through a 3-cm skin incision in the lower- third of the sternum. The device sizes ranged from 5 to 8 mm (mean 6.9+-1.8 mm) and all patients except for two required symmetrical devices.ResultsAll patients underwent device closure successfully. The procedural duration ranged between 32 and 52 min. None of the patients required cardiopulmonary bypass. The mean ventilation time and intensive care unit stay was 3 and 24 h, respectively. None of the patients required inotropic support or blood transfusions. Moreover, no patients developed any arrhythmias including heart block. The average length of hospital stay was 4.4 days. At the latest follow up, there were no residual shunts, conduction disturbances, device dislodgement or major aortic or tricuspid valve complications seen in any patients. There was no mortality.ConclusionsPerventricular device closure of ventricular septal defects is a less invasive, extremely safe and effective method in children. It is associated with very fast recovery, shorter hospitalization time and better cosmetic incision. Moreover, it avoids cardiopulmonary bypass. The modifications and refinements in the design, material and implantation techniques will help in expanding the indications and prevent complications in the long-term.

A novel technique for the single-port laparoscopic percutaneous extraperitoneal closure (SLPEC) of paediatric isolated giant inguinal hernias using double-modified hernia needles

The objective was to explore the efficacy of single-port laparoscopic percutaneous extraperitoneal closure using double-modified hernia needles with hydrodissection (SLPEC group) and two-port laparoscopic percutaneous extraperitoneal closure (TLPEC group) for the treatment of giant indirect inguinal hernias in children. We performed a retrospective review of all children with giant indirect inguinal hernias (inner ring orifice diameter ≥ 1.5 cm) who underwent laparoscopic high ligation of the hernia sac at FuJian Children’s Hospital from January 2019 to December 2021. We collected data from the medical records of all the children and analysed their clinical characteristics and operation-related and follow-up information. Overall, this study included a cohort of 219 patients with isolated giant inguinal hernias who had complete clinical data and who had undergone laparoscopic high ligation of the hernia sac at our centre. All procedures were successfully performed for the 106 patients who underwent SLPEC and for the 113 patients who underwent TLPEC at our centre. There were no statistically significant differences in patient age, sex, body weight, follow-up time or the side of inguinal hernia between the SLPEC group and the TLPEC group (P = 0.123, 0.613, 0.121, 0.076 and 0.081, respectively). However, there were significant differences in the bleeding volume, visual analogue scale (VAS) score, and postoperative activity time between the two groups (P ≤ 0.001). The operation times in the TLPEC group were significantly longer than those in the SLPEC group (P = 0.048), but there were no significant differences in hospital length of stay or hospitalization costs between the two groups (P = 0.244 and 0.073, respectively). Incision scars were found in 2 patients in the SLPEC group and 9 patients in the TLPEC group, and there was a significant difference between the two groups (P = 0.04). However, the incidence of ipsilateral hernia recurrence, surgical site infection, suture-knot reactions and chronic inguinodynia did not significantly differ between the two groups (P = 0.332, 0.301, 0.332 and 0.599, respectively). Postoperative hydrocele occurred in only 1 male child in the SLPEC group and in no male children in the TLPEC group, and there was no difference between the two groups (P = 0.310). In this study, there were no cases of testicular atrophy or iatrogenic ascent of the testis. Compared with the TLPEC group, the SLPEC group had the advantages of a concealed incision, light scarring, minimal invasiveness, a reduced operation time, minimal bleeding, mild pain and rapid recovery. In conclusion, SLPEC using double-modified hernia needles with hydrodissection and high ligation of the hernia sac is a safe, effective and minimally invasive surgery. The cosmetic results are impressive, and the follow-up results are promising.

Endoscopic techniques for management of large colorectal polyps, strictures and leaks

The implementation of screening colonoscopy with polyp removal has significantly decreased mortality rates associated with colorectal cancer (CRC), although it remains a major cause of cancer-related deaths globally. CRC typically originates from adenomatous polyps, and increased removal of these growths has led to reduced CRC incidence and mortality. Endoscopic polypectomy techniques, including hot and cold snare polypectomy, play a pivotal role in this process. While both methods are effective for small polyps (<10 mm), recent evidence favors cold snare polypectomy due to its superior safety profile and comparable complete resection rates. Large polyps (>10 mm), particularly those with advanced features, pose increased cancer risks and often require meticulous assessment and advanced endoscopic techniques, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), for resection.This chapter also provides a practical overview of endoscopic techniques for managing colonic obstructions and pericolonic fluid collections, detailing their indications, advantages, disadvantages, and complications. The goal is to improve understanding and application in clinical practice. Additionally, we provide a summary of endoscopic closure techniques that have revolutionized the management of perforations and fistulas, offering safe and effective alternatives to surgery.

Use of a new vertical traction device for early traction-assisted staged closure of congenital abdominal wall defects: a prospective series of 16 patients

PurposeAbdominal wall closure in patients with giant omphalocele (GOC) and complicated gastroschisis (GS) remains to be a surgical challenge. To facilitate an early complete abdominal wall closure, we investigated the combination of a staged closure technique with continuous traction to the abdominal wall using a newly designed vertical traction device for newborns.MethodsFour tertiary pediatric surgery departments participated in the study between 04/2022 and 11/2023. In case primary organ reduction and abdominal wall closure were not amenable, patients underwent a traction-assisted abdominal wall closure applying fasciotens®Pediatric. Outcome parameters were time to closure, surgical complications, infections, and hernia formation.ResultsTen patients with GOC and 6 patients with GS were included. Complete fascial closure was achieved after a median time of 7 days (range 4–22) in GOC and 5 days (range 4–11) in GS. There were two cases of tear-outs of traction sutures and one skin suture line dehiscence after fascial closure. No surgical site infection or signs of abdominal compartment syndrome were seen. No ventral or umbilical hernia occurred after a median follow-up of 12 months (range 4–22).ConclusionTraction-assisted staged closure using fasciotens®Pediatric enabled an early tension-less fascial closure in GOC and GS in the newborn period.

Investigation of risk factors for vaginal dehiscence and development of small bowel evisceration after robot-assisted radical cystectomy for female bladder cancer and an improved vaginal reconstruction technique to prevent its onset.

Transvaginal organ prolapse, such as small bowel evisceration, is a rare complication after radical cystectomy (RC) in female patients with invasive bladder cancer, However, it often requires emergency surgical repair. Here, we describe our experience with such a case and a review of similar previously reported cases, along with evaluation of the risk factors. We also propose a vaginal reconstruction technique to prevent this complication during robot-assisted laparoscopic radical cystectomy (RARC). A total of 178 patients who underwent laparoscopic radical cystectomy (LRC) or RARC were enrolled, 34 of whom (19%) were female. One of the 34 female patients had transvaginal small bowel evisceration after RARC. We evaluated our case and six such previously reported cases, to determine vaginal reconstruction techniques during RARC to prevent this complication postoperatively. Median age of these cases was 73 (51-80) years, and all patients were postmenopausal. The median time to small bowel evisceration was 14 (6-120) weeks postoperatively. In addition, we changed the methods of the vaginal reconstruction technique during RARC from the conventional side-to-side closure technique to the improved caudal-to-cephalad closure technique. Since implementing this change, we have not experienced any cases of vaginal vault dehiscence or organ prolapse. Transvaginal small bowel evisceration after RC can easily become severe. Therefore, all possible preventive measures should be taken during RARC. We believe that our vaginal reconstruction techniques might reduce the risk of developing this complication.

Optimizing cutaneous excisions on extremities: a comparative review of elliptical closure and S-plasty techniques

This review elucidates the comparative applications of elliptical closures and S-plasty or “lazy s” in the excision of cutaneous neoplasms on the extremities. The article completes an analysis of closure techniques by discussing their merits, limitations, and optimal applications based on their orientation and tension dynamics. It also provides a detailed guide on suture placement and specific intraoperative maneuvers associated with the S-plasty to enhance surgical outcomes. The S-plasty, preferred for its diminished suture line tension and adaptability to convex areas, is analyzed against traditional relaxed skin tension lines and the emerging biodynamic excisional skin tension (BEST) lines. The review underscores the BEST lines’ role in minimizing perpendicular traction and their impact on improved surgical outcomes on the extremities. It also addresses the challenges of excessive traction along wound margins and the consequential suboptimal healing outcomes, emphasizing the importance of appropriate tension management. This review also compares the stability, efficiency, and esthetic outcomes of the S-plasty with elliptical excisions, highlighting the S-plasty’s superior ability to distribute tensile forces evenly, thus reducing the risk of scar-related complications. It also discusses the benefits of using BEST lines for tension vector dispersion coupled with the design of an S-plasty, even when relaxed skin tension line favors a horizontal orientation. Furthermore, the review elaborates on the procedural execution of the S-plasty, emphasizing the importance of precise suture placement and selecting suitable suture materials and techniques to ensure optimal wound edge perfusion. The overarching theme is the prioritization of technique based on specific anatomic considerations and the surgeon’s expertise to ensure the most effective and beneficial cutaneous excisions on the extremities.

Rives-Stoppa Repair Versus Bilateral Inguinal Hernioplasty: A Comprehensive Review of Surgical Techniques and Patient Outcomes.

Hernia repair surgery is a common procedure to address the protrusion of organs or tissues through weakened muscles or connective tissue. This review compares two prominent surgical techniques for hernia repair: the Rives-Stoppa repair and bilateral inguinal hernioplasty. The Rives-Stoppa repair involves a posterior approach with extensive mesh placement suitable for complex and recurrent hernias. In contrast, bilateral inguinal hernioplasty focuses on simultaneously repairing bilateral hernias, potentially reducing operative time and enhancing recovery. This review examines each approach's technical aspects, including incision methods, mesh placement, and closure techniques. Patient outcomes, such as postoperative pain, recovery time, recurrence rates, and quality of life, are critically analyzed based on current research and clinical data. Economic considerations are also evaluated, encompassing each technique's cost-effectiveness and economic impact. By synthesizing these findings, this review aims to provide valuable insights for surgeons, healthcare providers, and policymakers in optimizing hernia repair strategies. The evolving landscape of surgical techniques and materials underscores the importance of ongoing research to refine practices and improve outcomes for patients undergoing hernia repair surgery.

1269 Comparing Patient Outcomes for Drain vs Drain-Less Technique in Abdominal Donor-Site Closure Following Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

1269 Comparing Patient Outcomes for Drain vs Drain-Less Technique in Abdominal Donor-Site Closure Following Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

Pattern of velopharyngeal valve closure in patients with cleft palate after primary cleft palate repair: A cross-sectional nasoendoscopic analysis

ABSTRACT Background: The velopharyngeal valve (VPV) consists of the velum, lateral pharyngeal walls, and posterior pharyngeal walls. Velopharyngeal (VP) closure is required during attempted phonation, deglutition, and sucking, and serves to prevent nasal regurgitation of fluids or solids that are normally delivered to the oropharynx. Objectives: This study aimed to identify the patterns of VPV closure in children with cleft palate (CP) who had palatal repair done and to determine the relationship between surgical technique and pattern of closure. Patients and Methods: This study was conducted in the nasoendoscopy room of the Orofacial Cleft Clinic, Lagos University Teaching Hospital. All patients with nonsyndromic cleft lip and palate or isolated CP who had palatal repair done at age 12 months and above with either von Langenbeck, Bardach, or Furlow’s techniques were included in this review. All patients were examined using a flexible fiber-optic nasoendoscope. Results: There were 35 patients who had nasoendoscopy done and met the inclusion criteria. The most common pattern of closure of the VP mechanism in patients examined by nasoendoscopy was circular (48.6%), followed by coronal (37.1%). von Langenbeck’s technique had the highest frequency in all patterns of closure though this was not statistically significant (P = 0.47). Both von Langenbeck and Bardach techniques had both coronal and circular as their most common closure patterns, while Furlow’s had the circular as the most common pattern of closure. Conclusion: The most common pattern of closure of the VP mechanism in patients who had CP repair in this study was circular and there was no apparent relationship between the surgical technique of repair and pattern of closure.

Anesthetic Choice for Percutaneous Transcatheter Closure of the Left Atrial Appendage: A National Anesthesia Clinical Outcomes Registry Analysis.

Left atrial appendage closure (LAAC) was developed as a novel stroke prevention alternative for patients with atrial fibrillation, particularly for those not suitable for long-term oral anticoagulant therapy. Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography. Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice. Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry. Retrospective data analysis from 2017-2021. Independent-sample t tests or Mann-Whitney U tests were used for continuous variables and Chi-square tests or Fisher's exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics. A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017-2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03-0.80, P = 0.0261). While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017-2021. Anesthetic management for LAAC varies with geographic location.

Novel rubber band assisting closure technique as a new approach for the closure of large mucosal defect after colorectal endoscopic submucosal dissection

Novel rubber band assisting closure technique as a new approach for the closure of large mucosal defect after colorectal endoscopic submucosal dissection

1133 Assessment of Medical Students’ Competence in Wound Closure Techniques

1133 Assessment of Medical Students’ Competence in Wound Closure Techniques

Meningiomas in the Central Skull Base:From the Perspective of Endoscopic Transnasal Surgery

Recent advancements in endoscopic transnasal surgery(ETS)have expanded the application of this technique to meningiomas in the central skull base area, offering a less invasive alternative with a potentially lower physical burden on patients than conventional microscopic skull base surgery. Notably, while ETS allows surgeons to reach tumors without traversing the brain and nerves, thus theoretically reducing the risk of cranial nerve damage, it requires a high level of proficiency to avoid inadequate resection and tumor recurrence. In this article, we discuss the various surgical considerations, including preoperative imaging, surgical setting, nasal cavity expansion, skull base opening, tumor removal, and skull base reconstruction, as general procedures for specific meningiomas. We further describe the concept and details of our multi-layer fascial closure technique for dural repair in ETS, underlining the importance of skilled dural reconstruction in preventing postoperative complications. In conclusion, while ETS for skull base meningiomas presents a promising and less invasive treatment option, its success relies heavily on the surgeon's experience and understanding of the skull base anatomy, stressing the need for careful approach selection.

Ply curving termination for enhancing tensile strength of composite ply drop-off: static evaluation and failure mechanism

Composite structures are optimized in shape by terminating specific plies gradually. However, stress concentration at the ply drop-off can cause interlaminar delamination from the ply edge. In this study, Ply Curving Termination (PCT), which is introduced by locally curving fibers at 0° ply edges, is used to enhance tensile strength of the ply drop-off. To clarify the dependence of the PCT strength on the curved fiber angle (PCT angle), static tensile tests using ply drop-off specimens are conducted, followed by detailed damage observations using X-ray CT. The results indicates that the strength significantly increases with PCT but the fracture behavior differs depending on the PCT angle. Interestingly, specimens with large PCT angles fail from the position where the fibers curve, away from the ply edge. This PCT-specific failure mechanism is then elucidated using finite element analysis and the virtual crack closure technique, indicating that shear lag caused by the stiffness change due to fiber curving is important. Finally, using the revealed PCT failure mechanism, PCT angles that are the most effective in enhancing tensile strength is discussed.

MODELING INFLATION DYNAMICS USING THE LOGISTIC MODEL: INSIGHTS AND FINDINGS

This paper examines applying the logistic model, frequently used in biology, to analyze inflation patterns in dynamic economic systems. The primary objective is to simulate and analyze the complex dynamics of inflation, thus providing new insights into the stability of financial institutions. Numerical methods such as Euler's Method, Runge-Kutta Method (RK4), and Adams-Bashforth-Moulton's method were used to simulate inflation patterns by discretizing the logistic equation. The data utilized in this research were obtained from INSTAT, BoA, MoF, and Eurostat, with quarterly results from 1995 to 2023. The simulation results indicated that the RK4 and Adams-Bashforth-Moulton methods yielded more precise and reliable inflation forecasts than Euler's. The logistic model represented the non-linear aspects of inflation dynamics well, emphasizing the necessity of using suitable numerical approaches. The study's findings highlight the effectiveness of the logistic model in economic analysis, specifically in forecasting inflation trends. Enhanced closure approaches have proven their effectiveness in analyzing intricate economic data, providing crucial insights into the stability of inflation, and informing policy formulation. This study utilizes the logistic model to analyze inflation dynamics, offering a unique methodology for comprehending and forecasting inflation in economic systems. An analysis of several closure techniques reveals a novel aspect of financial modeling tools. The findings indicate that incorporating advanced numerical methods can significantly improve the precision of economic models. These findings significantly impact economic research and policy formulation, especially in devising measures to manage inflation and ensure financial stability.

CLosure of Abdominal MidlineS Survey (CLAMSS): A national survey investigating current practice in the closure of abdominal midline incisions in UK surgical practice.

Incisional herniation (IH) is a frequent complication following midline abdominal closure with significant associated morbidity. Randomized controlled trials have demonstrated that the small bites technique (SBT) and prophylactic mesh augmentation (PMA) may reduce IH compared to mass closure techniques, but data are lacking on their implementation in contemporary surgical practice. This survey aimed to evaluate the use of the SBT and PMA and to identify factors associated with their adoption. Between 22 January 2023 and 16 March 2023, consultant surgeons across the UK were asked to complete a 25-question survey on closure of an elective primary midline incision. Responses were received from 267 of 675 eligible surgeons (39.6%) in 38 NHS Trusts. Respondents were evenly split between tertiary centres (47.6%) and district general hospitals (49.4%). SBT and PMA were used by 19.9% and 3.0% of respondents, respectively. Compared to other techniques, surgeons using the SBT were more likely to close the anterior aponeurotic layer only, use single suture filaments, 2-0 gauge sutures and sharp needle points and routinely dissect abdominal layers to aid closure (all p < 0.001). Attendance at lectures/conferences on SBT (p = 0.043) and basing practice on available evidence (p < 0.001) were independently associated with use of the SBT. The commonest barriers to adopting SBT were a perceived lack of evidence (23.8%) and belief that personal IH rates were low (16.8%). A minority of UK consultant surgeons have adopted the SBT or PMA. Practice change should be driven by more widespread dissemination of current evidence and procedural information.