Wound Closure Techniques Research Articles

A Novel Closure Technique for Complex Abdominal Wounds.

Abdominal wound closure is a challenge in patients undergoing colorectal surgery with a complex history of multiple abdominopelvic operations. Loss of domain of the abdominal fascia because of prior laparotomies precludes the use of simple, everyday abdominal wound closure techniques. Furthermore, ongoing intra-abdominal sepsis, with or without a concurrent entero- or colocutaneous fistula, increases the risk of postoperative morbidity and mortality in this patient population. We propose an abdominal wound closure technique for patients with multiple previous complex operations and subsequent ongoing abdominopelvic sepsis. Following completion of the intra-abdominal component of the operation, the abdominal wall fascial edges are identified and mobilized to allow for a smooth skin closure. The skin is brought together with a small amount of subcutaneous tissue in the abdominal wound line and sutured with a 1.0 Prolene stitch by using the vertical mattress technique. For both wound edges, a dental roll is inserted between the entry and exit points of the suture, with the suture material placed above and over the dental roll, and thus the dental roll is incorporated within the stitch when it is tied down. These stitches and dental rolls are placed along the length of the wound. No mesh is utilized, and the technique achieves skin closure with development of a subsequent ventral hernia. Good postoperative short-term and long-term overall outcomes were achieved in 14 patients who underwent complex abdominal wound closure. Two patients required further late operative intervention because of the incarceration of the known ventral hernia (at 34 and 120 months postoperatively). Complex abdominal wound closure in this setting is safe and feasible to achieve a healthy abdominal wall closure and enable healing by primary intention after colorectal surgery.

Wound closure expectations after fasciotomy for paediatric compartment syndrome.

PurposeAcute compartment syndrome often requires additional surgery to achieve wound closure. Little information exists regarding the expected number of surgeries, techniques and complications after closure in paediatric patients.MethodsA retrospective chart review identified patients treated for acute compartment syndrome at four hospitals over a ten-year period. The cause of injury, type of dressing, number of surgeries, type of closure and complications were recorded.ResultsIn all, 32 patients (mean 10.9 years, 1 to 17) who underwent 18 lower and 14 upper extremity fasciotomies met inclusion criteria. Definitive wound closure technique was delayed primary in 72%, split thickness skin graft in 25%, and primary in 3% of patients. Closure required a mean 2.4 surgeries (0 to 4) over a mean 7.7 days (0 to 34). Days to closure and number of surgeries required were not significantly affected by mechanism of injury, fasciotomy location or type of dressing used. A total of 23.1% of patients with upper extremity and 0% with lower extremity fasciotomies had concerns about the scar appearance. Other complications included neurapraxia (6.7%), stiffness (6.7%), swelling (3.3%), scar pain (3.3%) and weakness (3.3%).ConclusionsThe most common complication after paediatric compartment syndrome is an unpleasant scar. Wound closure after upper or lower extremity fasciotomies in paediatric patients requires a split thickness skin graft in approximately one in four patients. However, avoiding a skin graft does not guarantee the absence of cosmetic concerns, which are more likely following upper extremity fasciotomies.Level of EvidenceIV

Patient and Physician Assessment of Surgical Scars: A Systematic Review.

Surgical scarring affects patients by distracting the gaze of onlookers, disrupting social interactions, and impairing psychosocial health. Patient and physician agreement regarding ideal scar characteristics is important in developing congruent expectations after surgery. To summarize published studies assessing patient and physician ratings of surgical scars, rates of patient and physician agreement in scar assessment, and elements of cutaneous scar assessment that differ between patients and physicians. A literature search of Ovid/Medline, PubMed, and EMBASE was conducted from January 1, 1972, to August 1, 2015. Prospective studies comparing scars from different surgical techniques using at least 1 physician-reported and patient-reported scar measure were included. Strength of studies was graded according to the Oxford Centre for Evidence-Based Medicine guidelines. The review identified 29 studies comprising 4485 patients. Of the 29 included studies, 20 (69%) were randomized clinical trials (RCTs), 5 (17%) were prospective, nonrandomized studies, and 4 (14%) were descriptive studies. Disagreement between patients and physician evaluation of scars occurred in 28% (8 of 29) studies, with only patients rating scar difference in 75% (6 of 8) of these cases. Patients were more likely to value scar depth while physicians were more likely to value scar pigmentation and relief. Methodologically rigorous studies that include clinician- and patient-reported scar outcomes are uncommon. Studies that incorporate subjective and objective scar grading reveal disagreement between patients and clinicians. Of the incision and wound closure techniques assessed, few affected patient- and clinician-reported outcomes, but the evidence remains weak and future studies are recommended.

An Observational Study of Midline Abdominal Wound Closure Using Small Tissue Bites versus Large Tissue Bites with Reference to Surgical Site Infections and Wound Dehiscence

Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbidity. The techniques of wound closure after midline laparotomy differ among operating surgeons and institutions. Faulty techniques and suture materials used play a crucial role in post-operative wound complications like stich abscess, surgical site infections, wound burst and incisional hernia. Aims: The aim of this study is to assess the outcome of midline abdominal wound closure using small tissue bites versus large tissue bites with reference to surgical site infection and wound dehiscence. Materials and methods: The study is the prospective observational study conducted in the department of general surgery Government Medical College Srinagar. A total of 100 cases were enrolled and studied who underwent midline laparotomy in the elective as well as emergency settings from 2015 to 2018. In 50 patients midline incisions were closed with large tissue bites placed at least 10 mm from the wound edge and 10 mm apart and in another 50 patients small tissue bites were used placed 5 - 7 mm from the wound edge and 5 - 7 mm apart and included only the aponeurosis in the stitches without peritoneum. Results: In all, 100 patients, 50 patients were subjected to large tissue bites and another 50 patients to small tissue bites. 15 patients out of 50 patients (30%) in large tissue bites group and 10 patients (20%) in small tissue bites developed surgical site infection. 8 patients out of 50 patients (16%) in large tissue bites group and 4 patients (8%) in small tissue bites developed wound dehiscence. Conclusion: A total of 100 patients who underwent abdominal surgery through midline incision were divided into two groups. In 50 patients midline wound was closed using large tissue bites and in other 50 patients; small tissue bites was used to close midline incision including only aponeurosis. The research findings show that the small stitch length between 5 to 7 mm depending on the wound site is the ideal stitch length to close a midline incision. However, there was no statistical deference seen in both groups with reference to surgical site infection and wound dehiscence.

Current Surgical Patches and Novel Wound Closure Techniques

The alarming incidence of bacterial resistance even in regions with improved healthcare systems has accelerated the need to search for alternative antibacterial therapies. Considering this, hexane, ethanol, aqueous, methanol and chloroform leaf extract of Daturainoxiawerescreened for their antibacterial activity against the clinical strains of Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli isolated from blood, urine and pus. Agar well diffusion assay was employed to detect inhibitory activity of the plant. Ethanolic extract was found most effective among all the tested extracts. The extract showed greater inhibitory activity against the strains of Staphylococcus aureus. Ethanolicextract was further subjected for fractionation through column chromatography. Different isolated fractions were again screened for their antibacterial activity against the strains of Staphylococcus aureus. All the fractions showed inhibitory activity, of which fraction 4 was found effective against all the tested strains. Present study also revealed that, both gram negative and gram positive bacterial isolates from urine samples were more inhibited by the ethanolic extract than the isolates from pus and blood samples. Further studies are needed to explore theantibacterial activity of this ethanolic extract in various urinary tract infections, which presently require long term treatment with synthetic antibiotics.

The utility of the subcuticular suture in hepatic resection.

Aim of the studyDespite recent technical progress and advances in the perioperative management of liver surgery, postoperative surgical site infection (SSI) is still one of the most common complications that extends hospital stays and increases medical expenses following hepatic surgery.Material and methodsFrom 2001 to 2017 a total of 1180 patients who underwent hepatic resection for liver tumours were retrospectively analysed with respect to the predictive factor of superficial incisional SSI, using a propensity score matching by procedure (subcuticular or mattress suture).ResultsThe incidence of superficial and deep incisional SSIs was found to be 7.1% (84/1180). By propensity score matching (PSM), 121 of the 577 subcuticular suture group patients could be matched with 121 of the 603 mattress suture group patients. Multivariate analysis demonstrated wound closure technique as the only independent risk factor that correlated significantly with the occurrence of superficial incisional SSIs (p = 0.038). C-reactive protein (CRP) levels on postoperative day 4 were significantly higher in patients with incisional SSIs than in those without (p < 0.001).ConclusionsWound closure technique with subcuticular continuous spiral suture using absorbable suture should be considered to minimise the incidence of incisional SSIs. Moreover, wounds should be carefully checked when CRP levels are high on postoperative day 4.

Principles in Reconstruction after Resection of Extremity and Truncal Sarcomas

Reconstruction of sarcoma defects of the trunk or extremity requires detailed understanding of a variety of techniques for wound closure. Advances in reconstruction and oncologic treatment have led to higher rates of limb salvage in patients who would have previously undergone amputation. Such defects often require consideration of the reconstructive ladder, moving from the most simplistic closure to free flaps. As previous surgeries or radiation therapy can create a challenging wound environment with scar and fibrosed tissues, at times the more complex up-front option will be a better long-term solution for a patient following sarcoma resection. A multidisciplinary approach to the initial management, resection, and reconstruction is certainly warranted to attain the best overall outcome for the patient from the oncologic and aesthetic standpoint. This review provides an overview of the reconstructive techniques employed in addressing defects of the trunk and extremities following sarcoma resection. This review contains 20 Figures and 30 References. Key words: abdominal wall reconstruction, chest wall reconstruction, free flap, lower extremity reconstruction, pedicled flap, propeller flap, reconstructive elevator, reconstructive ladder, upper extremity reconstruction

Principles in Reconstruction after Resection of Extremity and Truncal Sarcomas

Reconstruction of sarcoma defects of the trunk or extremity requires detailed understanding of a variety of techniques for wound closure. Advances in reconstruction and oncologic treatment have led to higher rates of limb salvage in patients who would have previously undergone amputation. Such defects often require consideration of the reconstructive ladder, moving from the most simplistic closure to free flaps. As previous surgeries or radiation therapy can create a challenging wound environment with scar and fibrosed tissues, at times the more complex up-front option will be a better long-term solution for a patient following sarcoma resection. A multidisciplinary approach to the initial management, resection, and reconstruction is certainly warranted to attain the best overall outcome for the patient from the oncologic and aesthetic standpoint. This review provides an overview of the reconstructive techniques employed in addressing defects of the trunk and extremities following sarcoma resection. This review contains 20 Figures and 30 References. Key words: abdominal wall reconstruction, chest wall reconstruction, free flap, lower extremity reconstruction, pedicled flap, propeller flap, reconstructive elevator, reconstructive ladder, upper extremity reconstruction

Dermotaxis v/s loop suture technique for closure of fasciotomy wounds: a study of 50 cases

Fasciotomy incisions lead to large, unsightly, chronic wounds after surgical intervention. Classic management was to use split-thickness skin grafts, but this leads to insensate skin with reports that as many as 23% of patients are dissatisfied by the appearance of the wound. Since no skin loss has occurred with the fasciotomy incision, utilizing the dermal properties of creep, stress relaxation and load cycling, closure can be achieved in a better way. We describe using dermotaxis for skin edge approximation that is done using inexpensive equipment available readily in any standard operating room. Twenty-five patients had fasciotomy wounds closed either by dermotaxis or a loop suture technique with the inclusion criteria being closed fractures, no concomitant skin loss, fracture-related compartment syndrome and fasciotomy performed within 36 h. The fasciotomy incision was closed in a single stage by loop suture technique or gradually by dermotaxis once the oedema had settled between 3 and 5 days. Results were graded as excellent if approximation could be achieved, good if sutures had to be applied for protective care and poor if wounds needed to be skin-grafted. In the dermotaxis group, results were excellent in 15, good in 8 and poor in 2 cases. In the loop suture technique group, results were excellent in 20, good in 4 and poor in 1 case. Dermal apposition using inexpensive, readily available equipment is an alternative method for closure of fasciotomy wounds. If limb oedema has settled sufficiently, closure using a loop suture can be done in a single stage. If the limb remains oedematous, gradual closure can be done using dermotaxis.

Interventions for managing medication-related osteonecrosis of the jaw.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: (A) To assess the effects of interventions versus no treatment, placebo or an active control for prophylaxis of MRONJ in patients exposed to antiresorptive or antiangiogenic drugs. (B) To assess the effects of nonsurgical or surgical interventions (either single or in combination) versus no treatment, placebo or an active control for treatment of patients with manifest MRONJ.

Double tips needle (Lasheen needle) for wound repair

Aim: There are an increasing number of wound closure materials and techniques types in skin surgery. Still now, there is much controversies about optimal procedure of wound closure. This study tries to achieve this goal.

English

INTRODUCTION : Surgical site infection (SSI) is an immense burden on healthcare resources even in the modern era of immaculate sterilization approaches and highly effective antibiotics. An estimated 234 million various surgical procedures, involving skin incisions requiring various types of wound closure techniques, are performed in the world, with the majority resulting in a wound healing by primary intention. The most widely recognized definition of infection, which is used throughout the United States and Europe, is that devised and adopted by the Centre for Disease Control and Prevention. An SSI is defined as an infection occurring within 30 days of surgery that meets the following criteria: the diagnosis consists of the infection of an anatomic plane by one of the following manifestations: collection, inflammatory signs (pain, edema, tenderness, redness), dehiscence, or positive culture; and classification according to the anatomic plane as follows: superficial incisional SSI, infection of the skin and subcutaneous tissue; deep incisional SSI, infection of the deep soft tissue (fascia and muscles); and organ/space SSI, infection of the organ/space. In this study, SSIs were categorized by the above classifications. A system of classification for surgical wounds that is based on the degree of microbial contamination was developed by the US National Research Council group in 1964. Four wound classes with an increasing risk of SSI were described: clean, clean-contaminated, contaminated, and dirty. In this study, SSIs were researched based on each of the wound classes. AIM OF THE STUDY : To assess abdominal closure with antibacterial coated suture materials and its relation to the incidence of post-operative superficial surgical site infection rates. OBJECTIVES OF THE STUDY : 1. To compare the incidence of superficial SSI in laparotomy incisions closed with coated polyglactin910 suture with triclosan versus incisions closed with coated polyglactin910 suture without triclosan. 2. To study the time frame between surgery and development of SSI. 3. To determine which bacteria is commonly associated with SSI after laparotomy closure. MATERIALS AND METHODS : Source of Data: 1. The data will be collected from hospital records of surgery performed, post-operative daily progress notes and outpatient folders and telephonic conversations with patients after discharge. 2. Type of subject: all patients undergoing emergency laparotomy procedure for any cause. 3. Choosing subjects: number to be studied: 70-divided as 35 in each group. This number was chosen keeping in mind the time restrictions of the study, the feasibility and ease of calculations. Inclusion criteria : 1. All patients above the age of 18 yrs requiring a laparotomy. 2. All superficial SSI (skin and subcutaneous layer only) developing within a 30 day period post-surgery, as per the traditional definition. Exclusion criteria : 1. Patients<18 yrs. of age. 2. Deep SSI or Organ space SSI. 3. Wound infections occurring beyond the 30 day time period post-surgery. CONCLUSION : In conclusion since there was a definite advantage inferred to the patients by using triclosan coated polyglactin 910, it is the opinion of the researcher that triclosan coated sutures has a role to play in reducing SSI in clean-contaminated, contaminated and dirty wounds and its use should be confined to areas where its application has proven benefits. However more studies should be done to clearly define its role and indications in surgery. Microbialogical culture and sensitivity should be done, for all the patients who developed SSI so as to elucidate local causative agents and the most effective drugs. Microbiological testing for local patterns of resistance to triclosan should also be done. Prudent use of antimicrobial so as to reduce the development of drug resistance.

Vacuum-assisted wound closure and mesh-mediated fascial traction for open abdomen therapy - a systematic review.

The aim of this paper was to review the literature on vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) in open abdomen therapy. It was designed as systematic review of observational studies. A Pub Med, EMBASE and Cochrane search from 2007/01-2016/07 was performed combining the Medical Subject Headings "vacuum", "mesh-mediated fascial traction", "temporary abdominal closure", "delayed abdominal closure", "open abdomen", "abdominal compartment syndrome", "negative pressure wound therapy" or "vacuum assisted wound closure". Eleven original studies were found including patients numbering from 7 to 111. Six studies were prospective and five were retrospective. Nine studies were on mixed surgical (n = 9), vascular (n = 6) and trauma (n = 6) patients, while two were exclusively on vascular patients. The primary fascial closure rate per protocol varied from 80-100%. The time to closure of the open abdomen varied between 9-32 days. The entero-atmospheric fistula rate varied from 0-10.0%. The in-hospital survival rate varied from 57-100%. In the largest prospective study, the incisional hernia rate among survivors at 63 months of median follow-up was 54% (27/50), and 16 (33%) repairs out of 48 incisional hernias were performed throughout the study period. The study patients reported lower short form health survey (SF-36) scores than the mean reference population, mainly dependent on the prevalence of major co-morbidities. There was no difference in SF-36 scores or a modified ventral hernia pain questionnaire (VHPQ) at 5 years of follow up between those with versus those without incisional hernias. A high primary fascial closure rate can be achieved with the vacuum-assisted wound closure and meshmediated fascial traction technique in elderly, mainly non-trauma patients, in need of prolonged open abdomen therapy.

Comparison of surgical incision complete closure versus leaving skin open in wound class IV in emergent colon surgery

IntroductionOur aim was to compare the effect of techniques of wound closure in the emergent colon surgery with wound class IV. MethodsUsing 2014 the colectomy targeted ACS-NSQIP dataset; we identified patients undergoing emergent colectomy with wound class IV. Comparison of surgical incision complete closure versus leaving the skin open and multivariate logistic regression analyses was performed. ResultsOf 1792 patients undergoing emergent colectomy with wound class IV, the complete closure cohort had 1376 patients and the incision skin open cohort had 416 patients. The incidence of deep SSI was 2.3% in the complete closure cohort vs. 1.2% in the incision skin open, p = 0.15, and intra-abdominal abscess rate was 11.8% in the complete closure cohort vs. 12.3% in the incision skin open, p = 0.78. The dehiscence rate, readmission rate, and reoperation rates were not statistically significant between two cohorts. A multivariate model for dehiscence did not yield significant association between the complete closure cohort and incision skin open cohort. ConclusionsSurgical incision complete wound closure in the emergent colon surgery with wound class III/IV is safe and effective.

A clinical study of continuous and interrupted fascial closure in emergency midline laparotomy at a tertiary care centre

Background: Commonest approach in emergency open abdominal surgeries remains to be midline laparotomy because it is simple, saves time and causes minimal blood loss. Optimal technique for laparotomy wound closure has been a topic of debate since long. Risk factors for development of incisional hernia and burst abdomen are wound infection, systemic illnesses of patient and closure technique. Factors related to patients like age, gender, body mass index (BMI), systemic illnesses are not modifiable when an emergency laparotomy is the only option. Hence closure technique is one factor where surgeon has total control, which can bring down the incidence of burst abdomen and incisional hernias.Methods: Prospective study conducted in 150 patients who underwent emergency midline laparotomy from December 2014 to February 2016 in Krishna Rajendra Hospital attached to Mysore Medical College and Research Institute, Mysore, Karnataka, India with 6 months’ follow-up after surgery.Results: Most of patients in the study belonged to 30-40-year group and were males (78%). Gastrointestinal perforation peritonitis (52%) was the single most common indication for emergency midline laparotomy. In the continuous and interrupted groups, post-operative wound infection was found in 54.6% and 34.6%, wound dehiscence was found in 16% and 6.6% and incisional hernia in 14.4% and 4% respectively.Conclusions: Interrupted suturing is superior to continuous technique in emergency midline laparotomy wound closure in terms of complications and post-operative morbidity.

Barbed suture material technique for wound closure and concomitant tube placement in uniportal VATS for pneumothorax

Uniportal video-assisted thoracoscopic surgery (VATS) is an alternative modality for treatment of primary spontaneous pneumothorax (PSP) with its less invasiveness and acceptable surgical outcomes. However, a few reports have been introduced for wound management to achieve better cosmetic wound healing and for placement of the chest tube in uniportal VATS. Thus, we aimed to evaluate the feasibility of our novel method for wound closure and concomitant tube placement using continuous barbed suture material in uniportal VATS for PSP. Between July 2012 and December 2015, consecutive 31 patients (22 males) underwent uniportal VATS to treat PSP. Bilateral approaches were performed in four patients, thus total 35 cases were enrolled. We divided them into two groups with one group of 17 (48.5%) cases (group A), using barbed absorbable wound closure device for knotless continuous wound closure and subsequent chest tube anchoring, and the other group of 18 (51.4%) cases (group B), using conventional suture anchoring after skin closure using absorbable suture device. Postoperative surgical outcomes were compared to assess the feasibility of this technique. Demographic data demonstrate no significant difference in both groups. There was no significant difference in length of hospital stay (3.7±1.2 vs. 4.1±1.2 days, P=0.267) and in median chest tube indwelling time (2.4±0.9 vs. 3.1±1.2 days, P=0.066), respectively. Operation time in group A was shorter than in group B but there was no significant difference (41.7±11.8 vs. 45.6±16.0 minutes, P=0.415). There was neither conversion to two or three port VATS in all cases. In group A, all chest tubes were removed with concomitant sealing the tube removal site by pulling the thread. Residual knots do not exist that stitch out procedure is not required. There was no wound complication in both groups during the median follow-up period of 18 months. Knotless, barbed suture material technique for continuous wound closure with concomitant chest tube placement achieved equivocal outcomes in comparison to the conventional suture anchoring method. We suggest this simple technique for wound closure and easy tube removal with cosmetic wound healing in uniportal VATS for PSP.

S-shaped Wound Closure Technique for Dumbbell-shaped Keloids.

Summary:Dog-ear collection, Z-plasty, and W-plasty are often performed for excision of dumbbell-shaped keloids; however, these procedures require additional incisions or excision of normal skin. Thus, an S-shaped wound closure technique was performed. The keloid lesions were extralesionally excised above the deep fascia, and the wound edges were shifted in opposite directions along the major axis to form an S-shape. The incision was closed by applying deep fascial sutures, subcutaneous sutures, and superficial sutures. Postoperative external beam radiation therapy was started within 6 hours after surgery at a dose of 20 Gy applied in 4 fractions. All wounds were covered with silicone-gel sheeting and fixed with tape after suture removal. No intralesional corticosteroid injection or oral tranilast was administered. Corticosteroid tape was applied in cases with suspected postoperative recurrence. Scoring was performed using the Manchester Scar Scale. A total of 8 lesions were treated. Temporary erythema and scar elevation were observed in 2 chest lesions; however, both were flattened and turned white using corticosteroid tape. Other than these 2 lesions, there was no recurrence or complication. The mean score improved from 15.8 to 7.2. The S-shaped wound closure technique has 3 advantages. First, no additional incision or excision is required, and additional scarring and keloid recurrence can be avoided. Second, aesthetic results are good, and noticeably long and zigzag-shaped scars can be avoided. Third, dispersion of tension on the scar can be expected. Although the S-shaped wound closure technique has limited application, it is a useful option for keloid treatment.

Flap Fixation Using Tissue Glue or Sutures Appears to Reduce Seroma Aspiration After Mastectomy for Breast Cancer

BackgroundUp to 90% of patients undergoing breast cancer surgery suffer from seroma formation, which can cause discomfort and various complications after mastectomy. This retrospective observational cohort study aimed to elucidate whether flap fixation with fibrin sealant (ARTISS) tissue glue reduces seroma formation and seroma aspiration after mastectomy when compared with flap fixation using Vicryl sutures and when compared with a conventional wound closure technique. MethodsAll patients undergoing mastectomy due to invasive breast cancer or ductal carcinoma in situ were eligible for inclusion. From May 2012 to March 2013, all patients undergoing mastectomy in 2 large breast cancer centers were treated using flap fixation with Vicryl sutures. From September 2013 to March 2014, all patients undergoing mastectomy were treated with flap fixation using ARTISS tissue glue. The data were retrospectively analyzed and compared with a “drain-only” group that was not treated with flap fixation (May 2011-March 2012). ResultsA total of 230 women who underwent mastectomy were retrospectively analyzed in this trial; 88 patients were included in the drain-only group (DO), 92 patients were included in the flap fixation group using Vicryl sutures (FF-1), and 50 patients were included in the flap fixation group using ARTISS tissue glue (FF-2). There was significantly less seroma formation in the group after flap fixation using sutures (P = .006). There were significantly fewer patients who required seroma aspiration in the FF-1 group (P = .001) and the FF-2 group (P = .001) after undergoing mastectomy and sentinel node biopsy or modified radical mastectomy. ConclusionThis study suggests that flap fixation after mastectomy using ARTISS tissue glue or sutures reduces postoperative seroma aspiration. As a result, flap fixation might lead to less patient discomfort. A randomized, prospective trial should be performed to verify these results.

Allgöwer-Donati Versus Vertical Mattress Suture Technique Impact on Perfusion in Ankle Fracture Surgery: A Randomized Clinical Trial Using Intraoperative Angiography.

The purpose of this study was to evaluate which primary wound closure technique for ankle fractures affords the most robust perfusion as measured by laser-assisted indocyanine green angiography: Allgöwer-Donati or vertical mattress. Prospective, randomized. Level 1 Academic Trauma Center. Thirty patients undergoing open reduction internal fixation for ankle fractures were prospectively randomized to Allgöwer-Donati (n = 15) or vertical mattress (n = 15) closure. Demographics were similar for both cohorts with respect to age, sex, body mass index, surgical timing, and OTA/AO fracture classification. Skin perfusion (mean incision perfusion and mean perfusion impairment) was quantified in fluorescence units with laser-assisted indocyanine green angiography along the lateral incision as well as anterior and posterior to the incision at 30 separate locations. Minimum follow-up was 3 months with a mean follow-up 4.7 months. Allgöwer-Donati enabled superior perfusion compared with the vertical mattress suture technique. Mean incision perfusion for Allgöwer-Donati was 51 (SD = 13) and for vertical mattress was 28 (SD = 10, P < 0.0001). Mean perfusion impairment was less in the Allgöwer-Donati cohort (12.8, SD = 9) compared with that in the vertical mattress cohort (23.4, SD = 14; P = 0.03). One patient in each cohort experienced a wound complication. The Allgöwer-Donati suture technique offers improved incision perfusion compared with vertical mattress closure after open reduction internal fixation of ankle fractures. Theoretically, this may enhance soft tissue healing and decrease the risk of wound complications. Surgeons may take this into consideration when deciding closure techniques for ankle fractures. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Comparison of glues, sutures, and other commercially available methods of skin closure: A review of literature

Objectives: Octyl-2-cyanoacrylate (Dermabond) is a soft tissue adhesive that has been approved for topical use to close traumatic lacerations and surgical incisions. We review paediatric and adult human studies that compared octyl-2-cyanoacrylate with conventional closure techniques in a variety of wounds.Methods: Medline were searched using a combination of ‘tissue adhesives’, ‘cyanoacrylates’, ‘sutures’, ‘surgical staplers’ and ‘surgical tape’ for paediatric and adult studies comparing skin adhesives with other methods of wound closure. A review was performed using search results screened using predetermined inclusion and exclusion criteria.Results: We found and summarized 17 studies comparing octyl-2-cyanoacrylate skin glue to conventional methods of skin closure.Conclusions: Octyl-2-cyanoacrylate skin adhesive produces similar cosmetic results to sutures and other current wound closure techniques while being cost effective, quick and easy to use. Studies suggest that it may be a preferable alternative to sutures.