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Delgado-López PD, Martín-Alonso J, Herrero-Gutiérrez AI, Martín-Velasco V, Castilla-Díez JM, Montalvo-Afonso A, Diana-Martín R, Pérez-Cabo EM. Barbed versus conventional suture in elective posterior spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2261-2268. [PMID: 38649486 DOI: 10.1007/s00586-024-08224-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Barbed sutures are tissue control devices that can reduce operating room time and costs. We analyzed the utility of barbed sutures in posterior spinal surgery in order to prove non-inferiority to conventional methods for wound closure. METHODS A cohort of patients undergoing elective posterior spinal surgery in which barbed (prospective) versus conventional sutures (retrospective) were used was analyzed. The primary endpoint was the occurrence of wound healing complications or the need for surgical revision. Secondary endpoints included postoperative stay, readmission rate, and duration and cost of wound closure. RESULT A total of 483 patients participated in the study, 183 in the Barbed group and 300 in the Conventional group. Wound dehiscence or seroma occurred in 3.8% and 2.7% of the Barbed and Conventional groups, respectively (p = 0.6588). Both superficial (1.6% versus 4.0%, P = 0.2378) and deep infections (2.7% versus 4.7%, p = 0.4124) occurred similarly in both groups. Overall, the rate of re-intervention due to wound healing problems was also similar (4.9% versus 5.3%, p = 0.9906), as well as, total median hospital stay, postoperative stay and 30-day re-admission rates. The average duration of wound closure (1.66 versus 4.16 min per level operated, p < 0.0001) strongly favored the Barbed group. The mean cost of wound closure per patient was higher in the Barbed group (43.23 € versus 22.67 €, p < 0.0001). CONCLUSIONS In elective posterior spinal procedures, the use of barbed sutures significantly reduced the duration of wound closure. The wound healing process was not hindered and the added cost related to the suture material was small.
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Affiliation(s)
- Pedro David Delgado-López
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain.
| | - Javier Martín-Alonso
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
| | | | - Vicente Martín-Velasco
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
| | - José Manuel Castilla-Díez
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
| | - Antonio Montalvo-Afonso
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
| | - Rubén Diana-Martín
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
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Additional Relaxing Suturing Using Absorbable Symmetric Barbed Sutures to Help Close Scalp Defects. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2658. [PMID: 32537329 PMCID: PMC7253276 DOI: 10.1097/gox.0000000000002658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/02/2020] [Indexed: 11/29/2022]
Abstract
Closing a scalp wound with skin defects is challenging because the scalp skin lacks extensibility and closing it tends to result in a remarkable, widespread, hairless scar. Absorbable symmetric barbed suture device (Stratafix Symmetric; Ethicon, USA) allows wound closure using a pulling motion alone and provides a strong and secure closure for the high-tension area. We used this device to close wide scalp defects easily without tension and with minimized sequential scalp alopecia. The aim of this study was to show our experiences with using this technique. From January 2017 to March 2019, our relaxing suture technique was performed in 7 pediatric patients with scalp alopecia due to various lesions that ranged 23.0 ± 6.5 mm. After resecting the lesions, the galea was sutured using the 3-0 absorbable symmetric barbed suture via a running subcutaneous suture technique. The widespread wound edges were approximated by pulling the suture device. Wound closure was completed with galeal suturing and a superficial suture. We evaluated the width of the postoperative hairless scar at the final follow-up. In all 7 patients, we could approximate the widespread wound edges by pulling alone. Subsequently, the wounds could be closed without tension or difficulty. The mean width of the postoperative hairless scar was 3.3 ± 0.8 mm (range: 1.9–4.3 mm), and no complication was detected during the follow-up period. Our new relaxing suture technique using an absorbable barbed suture with symmetric anchors is a supportive and additional way to help close scalp defects.
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Eichberg DG, Shah AH, Luther EM, Menendez I, Jimenez A, Perez-Dickens M, O'Phelan KH, Ivan ME, Komotar RJ, Levi AD. Letter: Academic Neurosurgery Department Response to COVID-19 Pandemic: The University of Miami/Jackson Memorial Hospital Model. Neurosurgery 2020; 87:E63-E65. [PMID: 32277754 PMCID: PMC7184381 DOI: 10.1093/neuros/nyaa118] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Ashish H Shah
- Department of Neurosurgery University of Miami Miami, Florida
| | - Evan M Luther
- Department of Neurosurgery University of Miami Miami, Florida
| | - Ingrid Menendez
- Department of Neurosurgery University of Miami Miami, Florida
| | - Andrea Jimenez
- Department of Neurosurgery University of Miami Miami, Florida
| | | | | | - Michael E Ivan
- Department of Neurosurgery University of Miami Miami, Florida.,Sylvestor Comprehensive Cancer Center Miami, Florida
| | - Ricardo J Komotar
- Department of Neurosurgery University of Miami Miami, Florida.,Sylvestor Comprehensive Cancer Center Miami, Florida
| | - Allan D Levi
- Department of Neurosurgery University of Miami Miami, Florida
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Hair-sparing technique using absorbable intradermal barbed suture versus traditional closure methods in supratentorial craniotomies for tumor. Acta Neurochir (Wien) 2020; 162:719-727. [PMID: 32002670 DOI: 10.1007/s00701-020-04239-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/19/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hair-sparing techniques in cranial neurosurgery have gained traction in recent years and previous studies have shown no difference in infection rates, yet limited data exists evaluating the specific closure techniques utilized during hair-sparing craniotomies. Therefore, it was the intention of this study to evaluate the rate of surgical site infections (SSIs) and perioperative complications associated with using an absorbable intradermal barbed suture for skin closure in hair-sparing supratentorial craniotomies for tumor in order to prove non-inferiority to traditional methods. METHODS A retrospective review of supratentorial craniotomies for tumor by a single surgeon from 2011 to 2017 was performed. All perioperative adverse events and wound complications, defined as a postoperative infection, wound dehiscence, or CSF leak, were compared between three different groups: (1) hair shaving craniotomies + transdermal polypropylene suture/staples for scalp closure, (2) hair-sparing craniotomies + transdermal polypropylene suture/staples for scalp closure, and (3) hair-sparing craniotomies + absorbable intradermal barbed suture for scalp closure. RESULTS Two hundred sixty-three patients underwent hair shaving + transdermal polypropylene suture/staples, 83 underwent hair sparing + transdermal polypropylene suture/staples, and 100 underwent hair sparing + absorbable intradermal barbed suture. Overall, 2.9% of patients experienced a perioperative complication and 4.3% developed a wound complication. In multivariable analysis, the use of a barbed suture for scalp closure and hair-sparing techniques was not predictive of any complication or 30-day readmission. Furthermore, the absorbable intradermal barbed suture cohort had the lowest overall rate of wound complications (4%). CONCLUSIONS Hair-sparing techniques using absorbable intradermal barbed suture for scalp closure are safe and do not result in higher rates of infection, readmission, or reoperation when compared with traditional methods.
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Figueroa J, Morell A, Bowory V, Shah AH, Eichberg D, Buttrick SS, Richardson A, Sarkiss C, Ivan ME, Komotar RJ. Minimally invasive keyhole temporal lobectomy approach for supramaximal glioma resection: A safety and feasibility study. J Clin Neurosci 2020; 72:57-62. [PMID: 31948883 DOI: 10.1016/j.jocn.2020.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/05/2020] [Indexed: 10/25/2022]
Abstract
With a recent trend towards supra-maximal resection for gliomas and minimally invasive techniques, keyhole temporal lobectomies may serve an important role in neurosurgical oncology. Due to their location and proximity to eloquent brain, temporal lobe gliomas offer unique challenges that may limit the extent of resection. Here we describe a modified technique using mini-craniotomies through a keyhole approach for temporal lobectomies in glioma patients. We retrospectively reviewed data from consecutive patients who underwent temporal lobectomies for resection of gliomas from 2012 to 2018. Demographic data, extent of tumor resection, pre and post-op KPS, short term and long term complications, as well as other relevant data were collected. We identified 57 patients who underwent keyhole-mini craniotomy for temporal lobectomies for glioma. Surgical procedures were performed in 12 patients for low-grade glioma (LGG) and 45 patients for high-grade glioma (HGG). Awake craniotomies were performed in 15 of the cases, and 13 cases were for tumor recurrence. Supra-maximal resection (SMR) was achieved in 15 patients, while gross total resection (GTR) and near total resection (NTR) achieved in 32 patients and 10 patients, respectively. Average pre- and post-op KPS were equivalent, and post-operative complications requiring surgical intervention were experienced in 4 patients. Here we show that our modified keyhole craniotomy is both safe and effective in achieving SMR or GTR in glioma patients, with minimal morbidity. This minimally-invasive temporal lobectomy may be an instrumental tool for neurosurgical oncologists transitioning to less invasive techniques.
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Affiliation(s)
- Javier Figueroa
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States.
| | - Alexis Morell
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Veronica Bowory
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Daniel Eichberg
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Simon S Buttrick
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Angela Richardson
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Christopher Sarkiss
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
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