Comparison of continuous intradermal with simple interrupted suture pattern: an experimental study in dogs

Skin repair and infection control in diabetic, obese mice using bioactive laser-activated sealants

Conventional wound approximation devices, including sutures, staples, and glues, are widely used but risk of wound dehiscence, local infection, and scarring can be exacerbated in these approaches, including in diabetic and obese individuals. This study reports the efficacy and quality of tissue repair upon photothermal sealing of full-thickness incisional skin wounds using silk fibroin-based laser-activated sealants (LASEs) containing copper chloride salt (Cu-LASE) or silver nanoprisms (AgNPr-LASE), which absorb and convert near-infrared (NIR) laser energy to heat. LASE application results in rapid and effective skin sealing in healthy, immunodeficient, as well as diabetic and obese mice. Although lower recovery of epidermal structure and function was seen with AgNPr-LASE sealing, likely because of the hyperthermia induced by laser and presence of this material in the wound space, this approach resulted in higher enhancement in recovery of skin biomechanical strength compared to sutures and Cu-LASEs in diabetic, obese mice. Histological and immunohistochemical analyses revealed that AgNPr-LASEs resulted in significantly lower neutrophil migration to the wound compared to Cu-LASEs and sutures, indicating a more muted inflammatory response. Cu-LASEs resulted in local tissue toxicity likely because of effects of copper ions as manifested in the form of a significant epidermal gap and a 'depletion zone', which was a region devoid of viable cells proximal to the wound. Compared to sutures, LASE-mediated sealing, in later stages of healing, resulted in increased angiogenesis and diminished myofibroblast activation, which can be indicative of lower scarring. AgNPr-LASE loaded with vancomycin, an antibiotic drug, significantly lowered methicillin-resistant Staphylococcus aureus (MRSA) load in a pathogen challenge model in diabetic and obese mice and also reduced post-infection inflammation of tissue compared to antibacterial sutures. Taken together, these attributes indicate that AgNPr-LASE demonstrated a more balanced quality of tissue sealing and repair in diabetic and obese mice and can be used for combating local infections, that can result in poor healing in these individuals.

First-Intention Incisional Wound Healing in Dogs and Cats: A Controlled Trial of Dermapliq and Manuka Honey

This study aimed to compare incisional wound healing in cats and dogs after the topical application of Μanuka honey and a new medical device, Dermapliq. Comparisons were made between each treatment and control, between the two treatments, and between dogs and cats. Twelve cats and twelve dogs were included in this study, and the impact of the two substances was examined through cosmetic, clinical, ultrasonographical, and histological evaluation. The use of Dermapliq in first-intention wound healing achieved a significantly better cosmetic evaluation score and better total clinical score at days 20-41, compared to the control, in both dogs and cats. The ultrasonographically estimated wound area was smaller with Dermapliq compared to the control. Wounds treated with Dermapliq showed histologically less inflammation compared to the control. The use of Manuka honey did not show a significantly better cosmetic score compared to the control. Skin thickening was significantly higher after using Manuka honey compared to the control and so was the total clinical score. However, the median wound area, as was evaluated ultrasonographically, was significantly smaller when wounds were treated with Manuka honey, the difference being more apparent in dogs. Dermapliq was proven to be a better choice in achieving favorable wound healing than Manuka honey in dogs and cats in first-intention healing. In our study, cats had a statistically better cosmetic score and less skin thickening and scar width compared to dogs. Histologically, cats showed significantly less edema, higher inflammation and angiogenesis scores, and lower fibroblast and epidermis thickening scores when compared to dogs.

Comparison of Absorbable and Nonabsorbable Sutures for Intradermal Skin Closure in Dogs

The study aimed to compare incisional wound healing with intradermal suture patterns performed with (a) absorbable suture with burying of the knots and (b) nonabsorbable suture anchored with clips. Ten dogs were included in the study. Surgically created skin incisions were apposed with continuous intradermal suture pattern with 4/0 poliglecaprone 25 with burying of the knots and continuous intradermal pattern with 4/0 polypropylene with clips. Cosmetic, clinical, ultrasonographic and histological scores were evaluated. The intradermal pattern with clips was easier to perform and required significantly less time to complete than the intradermal suture with burying of the knots. Cosmetic, clinical, ultrasonographic and histological evaluation scores did not differ significantly between the techniques. Irrespective of the technique used, the cosmetic, ultrasonographic, clinical and histological appearances of the incisions improved over time. In conclusion, polypropylene was found to be a safe and effective suture material for use with intradermal suture pattern with clips in dogs and to have an easy and quick application. However, in our sample, its earlier removal from wounds than poliglecaprone 25 was not found to be associated with a supposedly beneficial effect on wound healing and scar appearance. Both suture materials can be useful in intradermal suture techniques in dogs.

Evaluation of Incisional Wound Healing in Dogs after Closure with Staples or Tissue Glue and Comparison to Intradermal Suture Pattern

The study aimed to monitor the healing process in the canine skin following surgical incision and closure using staples or tissue glue and to compare them with the intradermal suture pattern. Surgically created skin incisions in 10 dogs were apposed with staples, tissue glue (n-butyl cyanoacrylate) and continuous intradermal pattern. The cosmetic appearance of the wounds was blindly evaluated on days 7, 14 and 28 and once a month until the end of the experiment, i.e., one year after the incision. Ultrasonographic and clinical evaluation was performed on days 0-10, 12, 14, 16, 18, 21, 24 and 28, once a week until the end of the 3rd month and once a month until the end of the experiment. Histopathological evaluation was performed on days 7, 14, 28, 180 and 365. The median time required for the performance of each technique differed significantly between techniques; stapling lasted 21 s, glue 2 min 16 s and intradermal 15 min 37 s. Cosmetic appearance with glue was statistically worse than staples and intradermal. The clinical appearance of intradermal was significantly better than glue and staples. No significant differences were found at histological evaluation; however, glue had the worst score throughout the experiment. The overall evaluation of the techniques showed that glue had the worst score compared to intradermal and staples, with the difference being statistically significant in the first postoperative week. Intradermal suture pattern is much better than glue application for skin closure in dogs, whilst is not significantly better than staples. Staples should be preferred when time is an important factor.

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 Controlled Trial of Polyglytone 6211 versus Poliglecaprone 25 for Use in Intradermal Suturing in Dogs

Simple Summary

The choice of suture material for skin closure can affect the final cosmetic outcome, the risk of wound infection, and other complications in companion animals. We assessed two commercially available suture materials, namely Caprosyn and Monocryl, for use in suturing the skin of dogs, by using cosmetic, clinical, and histological evaluation. The results indicate only minimal differences between the two products, although better scores were achieved after using Monocryl. Both were found sufficient for use in intradermal suturing in dogs. The earlier absorption of Caprosyn, compared to Monocryl, did not have any additional beneficial effect on wound healing and scar appearance in dogs.

Abstract

The objective of this work was the comparative evaluation of the healing process after employing 4/0 poliglecaprone 25 and 4/0 polyglytone 6211 in a continuous intradermal suture pattern. Ten Beagle dogs were used, in which skin incisions were created surgically and subsequently were sutured by means of continuous intradermal pattern using polyglytone 6211 or poliglecaprone 25 suture. Cosmetic, clinical, and histologic scores were evaluated. The cosmetic appearance of the wounds was blindly evaluated on days 7, 14, 28, 180, 360, 730, and 1095. On the same days, tissue biopsy was performed for histological evaluation. Clinical evaluation was performed initially daily, then weekly, monthly, and finally yearly, till day 1095. The clinical appearance of the intradermal pattern with both sutures was initially very good, deteriorated in the second post-operative month and thereafter improved. The cosmetic, clinical, and histological differences between the two suture materials were minimal and statistically insignificant. Polyglytone 6211 is sufficient for use in intradermal suturing in dogs. However, its earlier absorption compared to poliglecaprone 25 did not have any beneficial effect on cutaneous wound healing and scar appearance in the experimental animals.