1
|
Tajmiri G, Sh ME. Effect of the absorption rate of suture material on oral mucosal scar formation: A triple-blind randomized controlled trial. Heliyon 2024; 10:e23054. [PMID: 38223718 PMCID: PMC10784138 DOI: 10.1016/j.heliyon.2023.e23054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/28/2023] [Accepted: 11/24/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Extensive oral mucosal scar formation following LeFort-I osteotomy can pose patients with several scar-related complications in case of function as well as cosmesis. The present study aimed to evaluate the effect of the absorption rate of Vicryl Rapide and Vicryl on oral mucosal scar formation. Material and methods In a triple-blind randomized controlled trial study, Vicryl and Vicryl Rapide were used randomly for wound closure on the left and right sides of the LeFort-I incision line. Three maxillofacial surgeons evaluated mucosal scars on each side two and four months post-surgically using Mucosal Scarring Index (MSI). Results The differences in the total scores of MSI between the Vicryl and Vicryl Rapide groups were not significant, neither in the anterior nor in the posterior areas (Paired t-test, df = 25, CI = 95 %, P-value >0.05). Conclusion The results of the present study demonstrated that Vicryl Rapide is comparable to Vicryl suture material regarding the mucosal scar formation following LeFort-I osteotomy surgery; therefore, it could be considered for such oral surgical procedures.
Collapse
Affiliation(s)
- Golnaz Tajmiri
- Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Milad Etemadi Sh
- Department of Oral and Maxillofacial Surgery, Dental Implants, Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
2
|
Khanuja K, Burd J, Ozcan P, Peleg D, Saccone G, Berghella V. Suture type for hysterotomy closure: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol MFM 2022; 4:100726. [PMID: 35995367 DOI: 10.1016/j.ajogmf.2022.100726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/20/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Recent randomized controlled trials have demonstrated an association between uterine closure technique at the time of cesarean delivery and short- and long-term operative outcomes with varied results. This systematic review and meta-analysis aimed to examine types of suture material used for cesarean delivery. DATA SOURCES Scopus, PubMed, Cochrane Central Register of Controlled Trials, Ovid, and ClinicalTrials.gov were searched from inception of each database to October 2021. STUDY ELIGIBILITY CRITERIA All randomized controlled trials that compared types of suture materials used for hysterotomy closure during low-transverse cesarean delivery at ≥24 weeks' gestation and examined maternal outcomes were included for this review. The primary outcome was estimated blood loss. Secondary outcomes included additional surgical complications. METHODS Results were summarized as mean difference or risk ratio with associated 95% confidence intervals. The quality of studies was evaluated with the Cochrane Handbook for Systematic Reviews of Interventions for judging risk of bias. Heterogeneity was measured using I-squared (Higgins I2). RESULTS This review included 7 randomized controlled trials, of which 3 compared multifilament with barbed suture (136 vs 136 participants), 3 compared multifilament with conventional monofilament suture (245 vs 244 participants), and 1 trial compared multifilament with chromic suture (4590 vs 4595 participants). Primary analysis showed no difference in estimated blood loss between the multifilament and the barbed suture group (mean difference, 46.2 mL; 95% confidence interval, -13.6 to 105.9), nor in change in hemoglobin concentration between the multifilament and the conventional monofilament group (mean difference, -0.1%; 95% confidence interval, -0.5 to 0.3). Secondary outcomes showed a reduction in operative time with barbed vs multifilament suture (mean difference, 1.9 minutes; 95% confidence interval, 0.03-3.8). Analysis also demonstrated an increased uterine scar thickness with use of conventional monofilament vs multifilament suture (mean difference, -1.05 mm; 95% confidence interval, -1.9 to -0.2). CONCLUSION This meta-analysis does not support a specific type of suture material for uterine closure at cesarean delivery because of insufficient data. Although barbed suture was associated with an overall decrease in operative time, and use of conventional monofilament suture was associated with an increase in uterine scar thickness, the clinical utility of these differences is not clear. Further adequate randomized controlled trials are warranted for evaluation of different suture materials for hysterotomy closure.
Collapse
Affiliation(s)
- Kavisha Khanuja
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA (Drs Khanuja and Burd)
| | - Julia Burd
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA (Drs Khanuja and Burd)
| | - Pinar Ozcan
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey (Dr Ozcan)
| | - David Peleg
- Department of Gynecology and Obstetrics, Ziv Medical Center, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel (Dr Peleg)
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Dr Saccone)
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA (Dr Berghella).
| |
Collapse
|
3
|
Saccone G, De Angelis MC, Zizolfi B, Gragnano E, Musone M, Zullo F, Bifulco G, Di Spiezio Sardo A. Monofilament vs multifilament suture for uterine closure at the time of cesarean delivery: a randomized clinical trial. Am J Obstet Gynecol MFM 2022; 4:100592. [PMID: 35131497 DOI: 10.1016/j.ajogmf.2022.100592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Different factors may influence the closure of the uterine wall, including suture material. Suture materials may indeed influence tissue healing and therefore the development of scar defects. OBJECTIVE To test whether uterine closure using synthetic absorbable monofilament sutures at the time of cesarean delivery would reduce the rate of cesarean scar defects compared with uterine closure using synthetic absorbable multifilament sutures. STUDY DESIGN Parallel-group, nonblinded, randomized clinical trial of women with singleton pregnancies undergoing cesarean delivery at term in a single center in Italy. The inclusion criteria were singleton pregnancy, first or second cesarean delivery, scheduled and emergent or urgent cesarean deliveries, and gestational age between 37 0/7 and 42 0/7 weeks. Eligible participants were randomly allocated in a 1:1 ratio to either the monofilament group (polyglytone 6211 [Caprosyn]; Covidien, Dublin, Ireland) or the multifilament suture group (coated polyglactin 910 suture with Triclosan [Vicryl Plus]; Ethicon, Inc, Raritan, NJ). The primary outcome was the incidence of cesarean scar defect at ultrasound at the 6-month follow-up visit. The secondary outcomes were residual myometrial thickness and symptoms. RESULTS Overall, 300 women were included in the trial. Of the randomized women, 151 were randomized to the monofilament group and 149 to the multifilament group. However, 27 women were lost to follow-up: 15 in the monofilament group and 12 in the multifilament group. Of note, 6 months after delivery, the incidence rates of cesarean scar defect were 18.4% (25 of 136 patients) in the monofilament group and 23.4% (32 of 137 patients) in the multifilament group (relative risk, 0.79; 95% confidence interval, 0.41-1.25; P=.31). The mean residual myometrial thicknesses were 7.6 mm in the monofilament group and 7.2 mm in the multifilament group (mean difference, +0.40 mm; 95% confidence interval, -0.23 to 1.03). There was no between-group substantial difference found in the incidence of symptoms, including pelvic pain, painful periods, and dyspareunia. CONCLUSION In singleton pregnancies undergoing primary or second cesarean delivery, the use of synthetic absorbable monofilament sutures at the time of uterine wall closure was not associated with a reduction in the rate of cesarean scar defect 6 months after delivery compared with the use of synthetic absorbable multifilament sutures.
Collapse
Affiliation(s)
- Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Saccone and Zizolfi, Ms Gragnano, and Drs Musone, Zullo, and Bifulco).
| | - Maria Chiara De Angelis
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Angelis and Di Spiezio Sardo)
| | - Brunella Zizolfi
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Saccone and Zizolfi, Ms Gragnano, and Drs Musone, Zullo, and Bifulco)
| | - Elisabetta Gragnano
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Saccone and Zizolfi, Ms Gragnano, and Drs Musone, Zullo, and Bifulco)
| | - Mariateresa Musone
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Saccone and Zizolfi, Ms Gragnano, and Drs Musone, Zullo, and Bifulco)
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Saccone and Zizolfi, Ms Gragnano, and Drs Musone, Zullo, and Bifulco)
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Saccone and Zizolfi, Ms Gragnano, and Drs Musone, Zullo, and Bifulco)
| | - Attilio Di Spiezio Sardo
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Angelis and Di Spiezio Sardo)
| |
Collapse
|
4
|
Dukaew N, Sakuludomkan W, Na Takuathung M, Pruksakorn D, Punyodom W, Koonrungsesomboon N. Analysis of Study Designs and Primary Outcome Measures in Clinical Trials of Investigational Suture Materials. Expert Rev Med Devices 2022; 19:247-258. [PMID: 35289244 DOI: 10.1080/17434440.2022.2054333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Clinical trials are a prerequisite for any investigational suture materials before a market approval application. The appropriate study designs and primary outcome measures are key to the validity and reliability of clinical trial results. This study aimed to characterize the study designs and primary outcome measures being applied in clinical trials of investigational suture materials. METHODS The systematic searches on PubMed, EMBASE, Web of Sciences, Scopus, and Cochrane databases were conducted to gather relevant studies published between January-2019 and May-2021. Data on general characteristics, suture intervention, study design, and primary outcome measures were extracted and analyzed. RESULTS Of 46 included studies, the majority of them were conducted with a randomized-controlled (93.5%), single-blind (50.0%), two-arm (84.8%), and parallel (76.1%) design with a 1:1 allocation ratio (95.7%). Through correlation network and heatmap analysis, the moderate-to-very strong correlations between some types of investigational suture materials and primary outcome measures were found including barbed vs non-barbed suture and suturing time, antibacterial-coated vs non-coated suture and wound infection, mono- vs multi-filament suture and wound healing index/markers, and different sizes of suture materials and scar assessment. CONCLUSIONS Our analysis provides guidance, with several key considerations, for designing a clinical trial evaluating investigational suture materials.
Collapse
Affiliation(s)
- Nahathai Dukaew
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wannachai Sakuludomkan
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Mingkwan Na Takuathung
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Dumnoensun Pruksakorn
- Musculoskeletal Science and Translational Research Center (MSTR), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Biomedical Engineering Institute, Chiang Mai University, Chiang Mai, Thailand
| | - Winita Punyodom
- Polymer Research Laboratory, Department of Chemistry, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.,Center of Excellence in Materials Science and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Nut Koonrungsesomboon
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Musculoskeletal Science and Translational Research Center (MSTR), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|