The Absorbable Dermal Staple Device: A Faster, More Cost-Effective Method for Incisional Closure:

Accelerating Fleur-de-lis Panniculectomy with the Absorbable Dermal Stapler-A Study of Efficiency, Aesthetics, and Quality-of-life

BACKGROUND

Fleur-de-lis panniculectomy (FDL), a contouring technique involving vertical and horizontal tissue resections, often involves longer operative times and potential complications. This study assessed operative time, postoperative outcomes, and patient-reported quality of life (PRO) with Insorb® Absorbable Subcuticular Skin Stapler versus traditional sutures during FDL.

METHODS

A retrospective review from 2015 to 2022 of FDL patients excluded those with complex concomitant procedures. Demographics, operative details, and surgical outcomes were compared between patients using the dermal stapler and those with suture-only closures.

RESULTS

Forty subjects were identified, with 25 (62.5%) in the dermal stapler cohort. The dermal stapler significantly reduced total procedure time (66.76 vs. 125.33 min, p < 0.05). There were no significant differences in surgical site occurrences, aesthetic outcomes, readmissions, or reoperations. Multivariate regression analysis further highlighted the choice of closure technique as an independent predictor of operative time, with traditional sutures indicating a significantly increased operative time compared to using the dermal stapler (AOR 76.53, CI 38.11-114.95, p < 0.001). Regarding PROs, both groups saw improvements across multiple BODY-Q domains, but the dermal stapler group reported greater enhancements (six out of nine domains vs. three for sutures).

CONCLUSION

The absorbable dermal stapler significantly reduces FDL operative time without increasing wound healing or aesthetic dissatisfaction incidents and maintains comparable quality-of-life improvements to standard suture closure.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://link.springer.com/journal/00266 .

Use of Absorbable Dermal Staples in Bilateral Breast Reduction Surgery: Effects on Operative Times, Surgical Outcomes, and Procedure Charges

BACKGROUND

Use of the absorbable deep dermal stapler in wound closure has become more common in plastic surgery because of its possible reduction in operative times and subsequent decrease in operative room costs. In this study, we examine the effects of this stapler on operative times and postoperative complications in bilateral reduction mammaplasties.

METHODS

A retrospective, observational cohort study was conducted via electronic chart review on patients who underwent bilateral reduction mammaplasties. Patients were stratified by wound closure method. One group was closed with sutures only, and in the other group, deep dermal staples were used during closure of the inframammary fold incision. Incidences of patient comorbidities and postoperative complications were compared. In addition, a financial cost analysis was performed.

RESULTS

The final patient cohort included 62 patients. Operative time was reduced by an average of 21.8 minutes when using deep dermal staples during closure, compared with when closing solely with sutures (P = 0.032). When controlling for mass of breast tissue removed and type of pedicle, deep dermal staple closure still predicted a reduction of 26.5 (SE, 9.9) minutes in operative time (P = 0.010). Postoperative complications were not affected by wound closure method (odds ratio, 4.36; 95% confidence interval, 0.91-31.7, P = 0.087). Though not statistically significant, financial charge was decreased with usage of deep dermal staples (P = 0.34).

CONCLUSIONS

Use of absorbable deep dermal staples produces a significant decrease in operative time for reduction mammaplasties with no increase in postoperative complication rates.

Retroperitoneoscopic adrenalectomy may be superior to laparoscopic transperitoneal adrenalectomy in terms of costs and profit: a retrospective pair-matched cohort analysis

BACKGROUND

A direct comparison of the cost-benefit analysis of retroperitoneoscopic adrenalectomy (RPA) versus the minimally invasive transperitoneal access (LTA) approach is currently lacking. We hypothesized that RPA is more cost effective than LTA; promising significant savings for the healthcare system in an era of ever more limited resources.

METHODS

We performed a monocentric retrospective observational cohort study based on data from our Endocrine Surgery Registry. Patients who were operated upon between 2019 and 2022 were included. After pair-matching, both cohorts (RPA vs. LTA) were compared for perioperative variables and treatment costs (process cost calculation), revenue and profit.

RESULTS

Two homogenous cohorts of 43 patients each (RPA vs. LTA) were identified following matching. Patient characteristics between the cohorts were comparable. In terms of both treatment-associated costs and profit, the RPA procedure was superior to LTA (costs: US$5789.99 for RPA vs. US$6617.75 for LTA, P = 0.043; profit: US$1235.59 for RPA vs. US$653.33 for LTA, P = 0.027). The duration of inpatient treatment and comorbidities significantly influenced the cost of treatment and the overall profit.

CONCLUSIONS

RPA appears not only to offer benefits over LTA in terms of perioperative morbidity and length of hospital stay, but also has a superior financial cost/benefit profile.

The use of absorbable skin stapler in mastectomy does not increase the rate of surgical site infection

Purpose

The use of absorbable skin staplers (ASS) for skin closure has been increasing due to their convenience and time-saving effect. In this study, we evaluated the effectiveness of ASS in reducing skin closure time and its safety regarding surgical site infection (SSI), comparing it to conventional hand sewing (HS) in patients who underwent mastectomy.

Methods

A single-center, retrospective study was conducted. The electronic medical records of patients who underwent mastectomy between July 2015 and June 2020 in Samsung Medical Center were reviewed. The data included previously known risk factors for SSI. We compared the time expended on skin closure and the occurrence rate of SSI between the ASS group and the HS group.

Results

We included 4,311 patients in the analysis. Among them, 520 patients were treated with ASS and 3,791 patients with HS. The average time for skin closure was 16.2 ± 10.1 minutes in the ASS group and 36.5 ± 29.0 minutes in the HS group (P < 0.001). The SSI rate was 0.38% (2 of 520) in the ASS group and 0.36% (14 of 3,791) in the HS group (P > 0.999).

Conclusion

The use of ASS in mastectomy reduced the time for skin closure significantly but did not increase the SSI. Therefore, it can be an effective and safe choice to use ASS instead of HS for skin closure in mastectomy.

The Learning Curve of an Absorbable Subcuticular Stapling Device in Plastic and Reconstructive Surgery

Background

Learning curves can reflect a surgical trainee's rate of progress and competence in acquiring new skills. The INSORB subdermal staple device has been well established to facilitate decreased closure time across various surgical procedures, with similar cosmesis, healing, and consistency as those of standard subdermal sutures. This study is unique, as it demonstrated an observable learning curve with this device when used by a junior surgeon.

Methods

Sixty-six patients underwent a cosmetic procedure during the second half of 2019 under the care of a single plastic surgeon in Melbourne, Australia. This corresponded to 254 unique linear incisions. Subdermal closure was done either with interrupted 3-0 Monocryl sutures or with the INSORB device. The consultant closed the incisions on one side, with the contralateral incision closed by the assistant using the same closure method. Data were then compared retrospectively, and closure times were compared over the ensuing 6 months.

Results

Overall, consultant closure speed is 25% faster than assistant speed. When using 3-0 Monocryl, the difference is 33%, whereas the difference is reduced to 21% when using the INSORB. Furthermore, a mild learning curve could be appreciated with the assistant's use of the INSORB over the comparatively short 6-month study period.

Conclusions

In addition to improved speed, cost, outcome, and ergonomics, subdermal absorbable staples may also garner a faster learning curve than standard closure with 3-0 Monocryl. This study supported the learning curve of a surgical device as another innovative benefit and an important aspect of developing surgical technology.

The process of estimating the cost of surgery: Providing a practical framework for surgeons

Over the last decades, health care costs have been increasing at an alarming, exponential rate which is considered unsustainable. Surgical care utilizes one-third of health care costs. Estimating, evaluating, and understanding the cost of surgery is a vital step towards cost management and reduction. Current cost estimation studies and cost-effectiveness studies have vast disparities in their methodology, with published costs of Operating Room varying from as low as $7 and as high as $113 per minute. Costs in surgery are distinguished as direct and indirect. Allocation of direct costs involves identification, measurement, and valuation processes. Allocation of indirect costs involves the allocation of capital and overhead costs and of indirect department costs. Annualised capital costs and overhead hospital costs are then allocated to surgery by either the cost-centre allocation or the activity-based allocation frameworks. Indirect department costs are allocated to a specific surgery by weighted service allocation or hourly rate allocation or inpatient day allocation, or marginal markup allocation. The growing societal, financial and political pressure for cost reduction has brought cost analysis to the forefront of healthcare discussions. Thus, we believe that almost every single surgeon will eventually enter the field of healthcare economics by necessity. This review aims to provide surgeons with a practical framework for engaging in cost estimation studies.

Use of Absorbable Dermal Stapler in Reduction Mammoplasty: Assessing Technical, Quality-of-Life, and Aesthetics Outcomes

Introduction:

Reduction mammaplasty is a mainstay in the treatment of symptomatic macromastia, with a well-described positive impact on patient quality-of-life (QoL). Absorbable dermal staplers have the potential to improve the efficiency of skin closure in reduction mammoplasties, but a more comprehensive assessment of its impact on key outcomes has not been fully elucidated.

Methods:

A retrospective review of patients undergoing reduction mammoplasty between November 2018 and December 2020 was conducted. Patients were included if they had undergone a wise-pattern reduction with a superomedial pedicle and completed 3 months of follow-up. Patient demographics, operative information, clinical and aesthetic outcomes, and QoL were compared between patients that had INSORB stapler-assisted and suture-only closures.

Results:

Seventy-five patients met the inclusion criteria, with 34 patients (45%) in the stapler cohort. Total procedure time was significantly reduced with the use of the dermal stapler (stapler: 154 vs. suture: 170 minutes; p = 0.003). The incidence of major complications was similar between cohorts (stapler: 8.8% vs. suture: 12%; p = 0.64), as was the incidence of minor complications (stapler: 44% vs. suture: 41%; p = 0.82). Regardless of closure technique, patients demonstrated significant increases in all QoL domains (p <0.001). Lastly, 10 independent raters found no difference in the cosmetic appearance of breasts from either cohort, when judging overall breast appearance, shape, scars, volume and the nipple-areolar complex (all p > 0.05).

Conclusions:

The dermal stapler improves efficiency of closure during reduction mammoplasty without increasing the incidence of wound healing complications. Additionally, cosmetic outcomes are not affected, and patients demonstrate similar post-operative satisfaction with the result regardless of closure technique.

Aesthetic Comparison of Abdominal Donor Site Scar Between Absorbable Dermal Staple and Subcutaneous Suture after Autologous Breast Reconstruction: A Prospective Randomized Controlled, Double-Blinded Study

BACKGROUND

Abdominal tissue transfer has become the most commonly used tool for breast reconstruction. However, a secondary operator is often responsible for donor closure, which leaves dissatisfaction to patients due to inconsistent donor scars. Now, an absorbable dermal stapler is popularized worldwide and currently used for wound closure in many surgical fields. In this study, we aim to evaluate the abdominal donor site scar in using an absorbable dermal staple compared to a conventional suture.

METHODS

This is a prospective, randomized controlled and double-blinded study. Between January 2018 and April 2019, a total of 30 patients who underwent breast reconstruction using abdominal flap were included. Donor sites were divided into equal halves, and the each dermal layer was sutured with either dermal staples or traditional suturing, respectively. At 1, 3 and 6 months after operation, the scar was evaluated by two blinded plastic surgeons by using the modified Manchester scar scale (MSS).

RESULTS

An averaged sum of modified MSS was lower for the side sutured with a dermal stapler at the first month (11.76 ± 2.12 vs. 12.28 ± 2.03, p = 0.097), third month (12.17 ± 1.86 vs. 12.62 ± 2.31, p = 0.301) and sixth month (11.28 ± 2.63 vs. 12.14 ± 2.76, p = 0.051). Also, the dermal stapler side scored significantly higher for patient satisfaction than did the suture side (4.03 ± 0.98 vs 3.66 ± 0.97, p < 0.05).

CONCLUSION

The objective outcome of the scar closed by an absorbable dermal stapler was not statistically superior to conventional suturing. (p > 0.05) In the subjective outcome, however, it showed a significantly higher patients' satisfaction (p < 0.05).

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Novel Absorbable Stapler Provides Patient-Reported Outcomes and Cost-Effectiveness Noninferior to Subcuticular Skin Closure: A Prospective, Single-Blind, Randomized Clinical Trial

BACKGROUND

Deep dermal suturing is critical for scar quality outcomes. The authors evaluated a new, fast medical device for dermal suturing, with the hypothesis of noninferiority with regard to clinical scar and cost-effectiveness.

METHODS

A prospective, patient-blind, randomized, multicenter noninferiority study in 26 French hospitals was conducted. Patients were randomized 1:1 to suturing with conventional thread or a semiautomatic stapler. The Patient Scar Assessment Scale was rated at 3 months for primary endpoint effectiveness. Secondary endpoints were cost-effectiveness of the two suturing methods, prevalence of complications, suturing/operating time, Observer Scar Assessment Scale and Patient Scar Assessment Scale score, scar aesthetic quality 18 months after surgery, and occupational exposure to blood during surgery.

RESULTS

Six hundred sixty-four patients were enrolled, 660 were randomized, and 649 constituted the full analysis (stapler arm, n = 324; needle arm, n = 325). Primary endpoint Patient Scar Assessment Scale score in the stapler arm was not inferior to that in the needle arm at 3 months or after 18 months. The mean operating time was 180 minutes in the stapler arm and 179 minutes in the needle arm (p = not significant). The mean suturing time was significantly lower in the stapler arm (p < 0.001). There were seven occupational exposures to blood in the needle arm and one in the stapler arm. The two arms did not differ significantly in terms of complications (p = 0.41). The additional cost of using the device was &OV0556;51.57 for the complete-case population.

CONCLUSION

Wound healing outcome was no worse than with conventional suturing using a semiautomatic stapler and associated with less occupational exposure to blood.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, I.

A Prospective Randomized Control Study Comparing the Effects of Dermal Staples and Intradermal Sutures on Postoperative Scarring After Thyroidectomy

BACKGROUND

We compared cosmetic outcomes, pain intensity, and costs between dermal stapling and intradermal suturing in patients who underwent thyroidectomy through cervical incision.

PATIENTS AND METHODS

In total, 40 patients were randomly assigned to undergo thyroidectomy through a low cervical incision and dermal closure using either absorbable staples (n = 20, staple group) or interrupted intradermal sutures (n = 20, suture group). Wound complications, cosmetic outcomes (modified Stony Brook Scar Evaluation Scale [SBSES] and Manchester Scar Scale [MSS]), and pain intensity (visual analog scale) were assessed at 1, 4, 12, and 24 weeks postoperatively. The difference in total "wound-closure cost" between the two groups was also analyzed.

RESULTS

There were no wound-related complications and no significant differences in SBSES or MSS scores between the two groups (P = 0.609 and P = 0.141, respectively). However, the staple group had significantly higher SBSES scores, compared to the suture group, at 24 wk postoperatively (4.06 ± 0.94 versus 3.26 ± 1.24; P = 0.030, respectively); MSS scores were significantly lower in the staple group than in the suture group at 24 wk postoperatively (6.72 ± 1.27 versus 8.16 ± 2.17, respectively; P = 0.028). Visual analog scale scores were significantly lower in the suture group than in the staple group (P = 0.038). The total wound-closure cost was significantly higher in the staple group than in the suture group (137.10 ± 8.39 versus 81.79 ± 19.95 USD; P < 0.001).

CONCLUSIONS

When dermal staples were used, wound complications were absent and long-term cosmetic outcomes were superior; however, pain intensity was higher and the cost was greater, although healing was significantly more rapid, compared to intradermal sutures. Closure using absorbable dermal staples may be safe and effective for cervical incisions during thyroid surgery. Further studies with larger number of participants are needed to confirm our findings.

Surgical wound closure by staples or sutures?: Systematic review

AIM

To compare the effects of sutures and staples for skin closure of surgical wounds.

MATERIAL AND METHODS

We included published and unpublished randomized controlled trials (RCTs) and cluster-randomized trials comparing staples with sutures. Patients were adults (aged 18 years or over) who had undergone any type of surgery. The primary outcomes were risk of overall and severe wound infection. Secondary outcomes included length of hospital stay, readmission rate, adverse events, patient satisfaction with cosmetic results, postoperative pain.

RESULTS

Forty-two very low to low quality RCTs with a total of 11,067 patients were included. Sutures resulted in slightly fewer overall wound infections (4.90%) compared to staples (6.75%) but it is uncertain whether there is a difference between the groups (risk ratio [RR] 1.20, 95% confidence intervals [CI] 0.80-1.79; patients = 9864; studies = 34; I = 70%). The evidence was also insufficient to state a difference in terms of severe wound infection (staples 1.4% vs sutures 1.3%; RR 1.08, 95% CI 0.61-1.89; patients = 3036; studies = 17; I = 0%), grade of satisfaction (RR 0.99, 95% CI 0.91-1.07; patients = 3243; studies = 14; I = 67%) and hospital stay. Staples may increase the risk of adverse events (7.3% for staples vs 3.5% for sutures; RR 2.00, 95% CI 1.44-2.79; patients = 6246; studies = 21; I = 33%), readmission rate (RR 1.28, 95% CI 0.18-9.05; patients = 2466; studies = 5; I = 66%) and postoperative pain (standardized mean difference [SMD] 0.41,95%CI -0.35 to 1.16; I = 88%, patients = 390 patients, studies = 5).

CONCLUSIONS

Due to the lack of high quality evidence, we could not state if sutures are better than staples in terms of wound infection, readmission rate, adverse events, and postoperative pain. With a low quality of evidence, sutures reduce postoperative pain and improve grade of satisfaction with the cosmetic outcome.

The use of absorbable staples for skin closure after tibial plateau leveling osteotomy

OBJECTIVE

To compare the use of stainless steel staples with absorbable staples for closure of skin incisions in dogs undergoing tibial plateau leveling osteotomy (TPLO).

STUDY DESIGN

Prospective study.

SAMPLE POPULATION

Client-owned dogs (n = 80).

METHODS

With client consent, dogs were randomly assigned a staple type (stainless steel or absorbable) immediately prior to closure of a TPLO skin incision. Incisions were compared for length, staple type and number, and an inflammation-infection score 2 weeks after surgery.

RESULTS

Overall, 18.8% of incisions were diagnosed with inflammation or infection. No difference was found between inflammation-infection scores, incision length, number of staples used, or general anesthetic time between the 2 staple groups. However, wound closure was faster with stainless steel staples (22.50 seconds; range, 11-180) by approximately 30 seconds compared with absorbable staples (56.50 seconds; range, 18-190; P < .001). Time taken to close the incision correlated negatively with the number of occasions that absorbable staples were used (P = .01).

CONCLUSION

Absorbable skin staples were successfully used to close skin incisions after TPLO and were not associated with an increased level of inflammation or infection in our clinical setting.

CLINICAL SIGNIFICANCE

Absorbable staples may be considered to close surgical wounds when subsequent suture removal would be impractical, without specific concerns over inflammation or infection of the wound.

Wound Closure Techniques for Total Knee Arthroplasty: An Evidence-Based Review of the Literature

BACKGROUND

This literature review is aimed at identifying the different methods for superficial and deep wound closure in total knee arthroplasty and evaluating their outcomes. We evaluated (1) closure time, (2) infection and other complication rates, and (3) local wound-related outcomes.

METHODS

A thorough search of the literature was performed using 3 electronic databases. Inclusion criteria included manuscripts that were written in English and available in full-text format. Reports were stratified into those that describe deep closure (7) and those that describe superficial closure (11).

RESULTS

In superficial closure, staples may provide the fastest closure, adhesives, lower incidence of superficial complications, and subcuticular suture closures, greatest blood flow. In deep closure, barbed sutures may allow for faster closure time while providing similar postoperative complication rates and outcomes when compared to traditional sutures. The use of barbed sutures has been shown to utilize fewer resources and may potentially lead to a slight reduction in costs.

CONCLUSION

Ultimately, no optimal closure technique has been developed, and current studies do not provide a clear evidence-based answer. This field needs much more evidence-based studies before one can draw conclusions. Even though some of these studies are prospective and randomized, they may not be generalizable. Also, many of the studies have small numbers and are subject to type II errors and fragility. Certainly, more studies are needed to truly understand the advantages and disadvantages of these new methods. Nevertheless, this review allows orthopedists to evaluate the differences between closure methods.

Laceration Management

BACKGROUND

Traumatic lacerations to the skin represent a fairly common reason for seeking emergency department care. Although the incidence of lacerations has decreased over the past decades, traumatic cutaneous lacerations remain a common reason for patients to seek emergency department care.

OBJECTIVE

Innovations in laceration management have the potential to improve patient experience with this common presentation.

DISCUSSION

Studies have confirmed that delays in wound closure rarely confer increased rates of infection, although comorbidities such as diabetes, chronic renal failure, obesity, human immunodeficiency virus, smoking, and cancer should be considered. Antibiotics should be reserved for high-risk wounds, such as those with comorbidities, gross contamination, involvement of deeper structures, stellate wounds, and selected bite wounds. Topical anesthetics, which are painless to apply, have a role in select populations. In most studies, absorbable sutures perform similarly to nonabsorbable sutures and do not require revisit for removal. Novel atraumatic closure devices and expanded use of tissue adhesives for wounds under tension further erode the primacy of regular sutures in wound closure. Maintaining a moist wound environment with occlusive dressings is more important than previously thought. Most topical wound agents are of limited benefit.

CONCLUSIONS

Recent innovations in wound closure are allowing emergency physicians to shift toward painless, atraumatic, and rapid closure of lacerations.

Placement of Absorbable Dermal Staples in Mammaplasty and Abdominoplasty: A 12-Month Prospective Study of 60 Patients

BACKGROUND

The duration to close an incision is an important consideration in plastic surgery. The placement of Insorb absorbable subcuticular staples (Insorb, Incisive Surgical, Plymouth, MN) may allow for a decreased closure time compared with other modalities.

OBJECTIVES

The authors evaluated the utility of Insorb staples for the closure of mammaplasty and abdominoplasty incisions.

METHODS

Sixty patients who underwent anterior abdominal dermatolipectomy, total circular abdominal dermatolipectomy, bilateral breast reduction, or bilateral mastopexy were evaluated in a prospective study. Dermal closure was achieved on 1 side of each patient with Insorb absorbable staples and on the other with absorbable monofilament sutures. Scar quality, pruritus, and pain were scored according to a modified Vancouver Scar Scale (mVSS) at 1, 6, and 12 months postoperatively.

RESULTS

Closure with absorbable staples was approximately 7-fold faster than closure with absorbable sutures for all surgical procedures. No significant differences in mVSS scores were noted between incisions closed with staples vs sutures.

CONCLUSIONS

Absorbable staples enable faster closure of a surgical incision without compromising scar quality or patient comfort.

LEVEL OF EVIDENCE

3 Therapeutic.

Donor-site closure using absorbable dermal staple for deep inferior epigastric artery perforator flaps: its efficacy and cosmetic outcomes

BACKGROUND

Surgeons tend to pay less attention to the donor site during breast reconstruction using deep inferior epigastric artery perforator flaps because attention is focused on microanastomosis and breast shaping. Therefore, donor site closure is typically performed by a secondary operator. We present consistently reduced operative times and improved scar quality using an absorbable dermal staple.

METHODS

Retrospective review was performed on 25 patients who were either standard suture controls (group I, n = 15) or received absorbable staples (group II, n = 10). Mean age, flap size, whole operative time, and length of hospital stay were collected. The donor site scar was evaluated by three plastic surgeons in a blinded manner using the modified Vancouver scar scale 6 months after surgery. Data were analyzed with the independent t test, and a p value ≤0.05 was considered significant.

RESULTS

No differences were detected between the groups for age, harvested flap size, or length of hospitalization. However, operative time was significantly longer in group I (1.07 ± 0.24 min/cm(2)) than that in group II (0.86 ± 0.16 min/cm(2), p = 0.015). The total scar assessment score was significantly lower in group II (3.8 3 ± 1.30) than that in group I (5.27 ± 1.83, p = 0.043).

CONCLUSIONS

Absorbable dermal stapling reduced operative time, compared to that of traditional suturing. In addition, scar quality from absorbable dermal staples was superior to that resulting from traditional sutures.

LEVEL OF EVIDENCE

II.

A randomized 'N-of-1' single blinded clinical trial of barbed dermal sutures vs. smooth sutures in elective plastic surgery shows differences in scar appearance two-years post-operatively

BACKGROUND

Barbed sutures have unidirectional circumferential shallow barbs, which distribute tension throughout the wound and close wound securely without the need to tie knots.

OBJECTIVES

We compare two different methods of wound closure in elective plastic surgical cases: barbed 3/0 V-Loc™180 suture and smooth 3/0 Maxon™ sutures, both polyglyconate monofilament synthetic absorbable sutures. We assessed the aesthetic long-term results with a minimum two year follow up.

METHODS

This is a prospective, randomized controlled study with internal control. A single surgeon performed all cases. Patients who underwent elective operations that involved long wound closure were enrolled in the study. Each patient acted as their own internal control with half their wound being sutured with 3/0 V-Loc™180 barbed suture and the other half with smooth 3/0 Maxon™ deep dermal sutures and then a subcuticular skin closure. In both groups, the superficial fascial system was closed with 1 Vicryl interrupted sutures on both sides. Long-term cosmesis was evaluated using the modified Hollander cosmesis score by review of standardized postoperative photographs by 9 blinded plastic surgeons and specialist registrars.

RESULTS

The study reports on 33 female patients. The time taken for wound closure was significantly reduced using the barbed suture (p < 0.001). There was no difference in the complication ratio in either group. Two-year aesthetic outcome was significantly superior when using the barbed suture (p = 0.0075).

CONCLUSION

Barbed sutures closure of long wounds is faster and produces a better long-term aesthetic outcome than smooth sutures.

Biomechanical evaluation of a novel subcuticular skin stapling device for use in equine abdominal surgeries

OBJECTIVE

To compare the in vitro biomechanical properties of a novel subcuticular stapling device to current methods of abdominal skin closure for equine abdominal surgery.

STUDY DESIGN

In vitro randomized, matched design.

SAMPLE POPULATION

Equine ventral median abdominal skin specimens (n = 24 horses).

METHODS

Subcuticular absorbable staples (SAS), metallic staples (MS), polyglyconate suture (PG), and nylon monofilament (NYL) were applied to longitudinally transected portions of equine ventral midline skin. Loads that resulted in an initial failure point and the ultimate failure load and mechanism were recorded.

RESULTS

Mean ± SD loads at initial failure for PG (86 N ± 64 N), NYL (81 N ± 142 N), and SAS (70 N ± 20 N) were not significantly different from each other. PG and SAS were significantly higher than MS (43 N ± 17 N; P < .05). Ultimate failure load for PG (563 N ± 157 N) and NYL (558 N ± 162 N) were significantly higher than either MS (175 N ± 44 N) or SAS (96 N ± 20N; P < .001). For the suture groups, nearly all failures occurred because of skin pull through whereas all SAS staples failed because of staple fracture. Failure patterns were mixed for MS.

CONCLUSIONS

SAS had the lowest ultimate failure load; however, other measured variables identified characteristics of SAS that may be clinically beneficial.

Cutaneous wound closure materials: an overview and update

Introduction:

On a daily basis, dermasurgeons are faced with different kinds of wounds that have to be closed. With a plethora of skin closure materials currently available, choosing a solution that combines excellent and rapid cosmetic results with practicality and cost-effectiveness can be difficult, if not tricky.

Objectives:

We aimed to review the available skin closure materials over the past 20 years and the scientific claims behind their effectiveness in repairing various kinds of wounds.

Materials and Methods:

The two authors independently searched and scrutinised the literature. The search was performed electronically using Pub Med, the Cochrane Database, Google Scholar and Ovid as search engines to find articles concerning skin closure materials written since 1990.

Conclusion:

Many factors are involved in the choice of skin closure material, including the type and place of the wound, available materials, physician expertise and preferences, and patient age and health. Evidence-based main uses of different skin closure materials are provided to help surgeons choose the appropriate material for different wounds.

A randomized trial comparing metallic and absorbable staples for closure of a Pfannenstiel incision for cesarean delivery

OBJECTIVE

The purpose of the study is to compare postoperative pain, cost, speed of closure, and patient satisfaction of Pfannenstiel skin incisions closed with traditional metallic staples vs absorbable staples after cesarean delivery. It is hypothesized that incisions closed with absorbable staples will cause less postoperative pain than traditional metallic staples.

STUDY DESIGN

A randomized, controlled trial was conducted from July 2010 through May 2011. Patients undergoing a scheduled cesarean delivery via a Pfannenstiel skin incision were recruited. Patients were randomized into the control group (metallic staples) or the experimental group (absorbable staples). The postpartum nurse and patient were blinded to the type of staples. Postoperative pain was assessed using a visual analog scale on both postoperative day 1 and day of discharge, and the total dose of oral narcotics taken during the postoperative period was assessed.

RESULTS

In all, 100 patients enrolled in the study: 50 in each group. Based on visual analog scale scores, there were no significant differences between the 2 groups on postoperative day 1 or day of discharge. There were no significant differences in the total dose of oral narcotics taken or in wound complication rates. The time for skin closure was significantly different: 3.5 ± 1.7 for absorbable and 1.39 ± 0.7 minutes for metallic staples (P < .0001). The calculated cost of each device, including placement and removal, was $285.60 for the absorbable and $150.79 for the metallic staples.

CONCLUSION

Postoperative pain is comparable for both devices. The absorbable staple skin closure time, and therefore cost, is significantly greater than for metallic staples.

Absorbable fixation in forefoot surgery: a viable alternative to metallic hardware

After 4 to 8 weeks of normal primary bone healing, rigid internal fixation is no longer required. Newer generation absorbable implants have become reliable and cost-effective alternatives to metallic hardware. Modern implants are formulated to have increased strength and smoother resorption over the course of 18 to 24 months, which decreases the possibility of local inflammation. Historically, bioresorbable screws can be time consuming to insert, but newer devices are being developed that help ease their insertion. A case of a bunionectomy is presented with double osteotomy on a 40-year-old nurse fixated with polyglycolic acid and poly-l-lactic acid copolymer screws.

Sharps injuries: the risks and relevance to plastic surgeons

Surgeons are at risk for injury in the operating room daily. Because of the ubiquity of occupational hazards, injuries remain prevalent and expensive. Although occupational hazards can include musculoskeletal conditions, psychosocial stress, radiation exposure, and the risk of communicable diseases, sharps injuries remain the most common among surgeons in practice and the most frequent route of transmission of blood-borne pathogens. Therefore, increased attention to the health, economic, personal, and social implications of these injuries is essential for appropriate management and future prevention.

A review of sutures and other skin closure materials

More than ever, dermatologic surgeons are faced with a multitude of suture and other closure materials when evaluating a surgical wound. Given there is no single material that is ideal for all situations, the physician must decide which material is best suited for that particular closure. This review seeks to summarize the major properties of common suture materials as well as other closure materials including adhesive tapes, glues and staples.