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冯 骏, 侯 建, 王 岩, 杨 云. [Application of Allgöwer-Donati suture in internal fixation of Schatzker type Ⅴand Ⅵ tibial plateau closed fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:723-727. [PMID: 38918194 PMCID: PMC11190689 DOI: 10.7507/1002-1892.202401059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/11/2024] [Accepted: 05/16/2024] [Indexed: 06/27/2024]
Abstract
Objective To investigate the effectiveness of Allgöwer-Donati suture in open reduction and internal fixation of Schatzker type Ⅴ and Ⅵ tibial plateau closed fractures. Methods A clinical data of 60 patients with Schatzker type type Ⅴ and Ⅵ tibial plateau closed fractures, who met the selection criteria and admitted between May 2022 and May 2023, was retrospectively analyzed. After open reduction and internal fixation via double incisions, the incisions were closed with conventional mattress suture in 30 cases (control group) and Allgöwer-Donati suture in 30 cases (observation group). There was no significant difference in gender, age, fracture side and type, time from injury to operation, body mass index, and other baseline data between the two groups ( P>0.05). The incidence of incision-related complications after operation, visual analogue scale (VAS) score of incision at 3 days and 1 and 2 weeks after operation, and the short-form 36 health survey scale (SF-36) [physical functioning (PF), role physical (RP), bodily pain (BP), and general health (GH)] at 12 weeks after operation were compared between the two groups. Results All operations of the two groups successfully completed. All patients were followed up 6-14 months (mean, 12 months). Incision fluid leakage occurred in 1 case of observation group and 7 cases of control group within 1 week after operation, and the incisions healed after symptomatic treatment. The incisions of other patients healed by first intention. The incidence of early incision complications in observation group was significantly lower than that in control group ( P<0.05). No late incision complications was found in the two groups. There was no significant difference in VAS scores at each time point between the two groups ( P>0.05). The VAS score significantly decreased with the increase of time in the two groups, showing significant differences between the different time points ( P<0.05). There was no significant difference in SF-36 scores (PF, RP, BP, and GH) between the two groups at 12 weeks after operation ( P>0.05). Conclusion Compared with conventional mattress suture, Allgöwer-Donati suture is effective in open reduction and internal fixation via double incisions for Schatzker type Ⅴand Ⅵ tibial plateau closed fractures, which can reduce the incidence of early incision complications.
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Affiliation(s)
- 骏 冯
- 南通大学附属南通第三医院/南通第三人民医院骨科(江苏南通 226006)Department of Orthopedics, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong Jiangsu, 226006, P. R. China
| | - 建伟 侯
- 南通大学附属南通第三医院/南通第三人民医院骨科(江苏南通 226006)Department of Orthopedics, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong Jiangsu, 226006, P. R. China
| | - 岩松 王
- 南通大学附属南通第三医院/南通第三人民医院骨科(江苏南通 226006)Department of Orthopedics, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong Jiangsu, 226006, P. R. China
| | - 云峰 杨
- 南通大学附属南通第三医院/南通第三人民医院骨科(江苏南通 226006)Department of Orthopedics, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong Jiangsu, 226006, P. R. China
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Sunjic Roguljic V, Roguljic L, Jukic I, Kovacic V. The Influence of Wound Closure Techniques after Surgical Decompression in Patients with Carpal Tunnel Syndrome on Sleep Disturbance and Life Quality: A Prospective Comparison of Surgical Techniques. Clin Pract 2024; 14:546-555. [PMID: 38666800 PMCID: PMC11049585 DOI: 10.3390/clinpract14020042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The compression of the median nerve within the carpal tunnel is the cause of carpal tunnel syndrome (CTS). Surgical decompression is successful in improving sleep and quality of life, but the effect of tissue adhesives as a material for wound closure has not been investigated. The objective of the study was to evaluate sleep disorders and health-related life quality by comparing two methods for wound closure after carpal surgery in participants who were randomized to receive tissue adhesives or transcutaneous sutures. METHODS The subjects, aged 61.56 ± 12.03 years, were randomized to receive either tissue adhesives (n = 50) or suture-based wound closure (n = 50) using the Glubran Tiss 2® skin adhesive after subcutaneous running sutures. The outcomes were assessed during the 12-month postoperative follow-up. The Pittsburgh Sleep Quality Index (PQSI) and Insomnia Severity Scale (ISI) were used for the sleep disturbance assessment, and for the health-related quality of life assessment, the total SF-36 (36-Item Short Form Survey) was used. RESULTS The PQSI, ISI, and SF-36 were not statistically different between groups during the follow-up, except in the ISI score two weeks after surgery (9.40 ± 1.18 in the tissue adhesive group vs. 9.96 ± 1.09 in the suture-based group, p = 0.008). The PQSI, ISI, and SF-36 scores for all the subjects and groups were persistently improved at all the follow-up intervals after surgery. The total SF-36 score increased 12 months after surgery (49.84 ± 5.85 vs. 82.46 ± 5.68, p < 0.001). CONCLUSIONS Cyanoacrylate-based adhesion material can be used for wound closure after open CTS decompression as a standard transcutaneous suture, and both techniques equally lead to improved sleep and life quality. The possible advantages of tissue adhesives include a faster reduction in the ISI.
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Affiliation(s)
- Veridijana Sunjic Roguljic
- Plastic, Reconstructive and Aesthetic Surgery with Burn Care Division, Surgery Department, University Hospital of Split, 21000 Split, Croatia;
| | - Luka Roguljic
- Orthopaedics and Traumatology Division, Surgery Department, University Hospital of Split, 21000 Split, Croatia
| | - Ivana Jukic
- Gastroenterology Division, Internal Medicine Department, University Hospital of Split, 21000 Split, Croatia
- University Department of Health Studies, University of Split, 21000 Split, Croatia
| | - Vedran Kovacic
- Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, Internal Medicine Department, University Hospital of Split, 21000 Split, Croatia
- School of Medicine, University of Split, 21000 Split, Croatia
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Sunjic Roguljic V, Roguljic L, Kovacic V, Bilic I, Jukic I. The Influence of the Tissue Adhesive Material as a Surgical Wound-Closure Technique Following Carpal Tunnel Decompression on Neurological and Functional Outcomes: A Single-Center Randomized Controlled Trial. Cureus 2024; 16:e53312. [PMID: 38435874 PMCID: PMC10906781 DOI: 10.7759/cureus.53312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Background Carpal tunnel syndrome (CTS) is caused by compression of the median nerve in the carpal tunnel. The effect of tissue adhesives as a material for wound closure following CTS decompression has been insufficiently investigated. This study aimed to evaluate outcomes by comparing two modalities of wound closure following carpal surgery in patients randomly assigned to either tissue adhesives or sutures. Methodology This randomized, prospective study was conducted in April 2022 at the University Hospital of Split in Croatia. Patients aged 61.56 ± 12.03 years were randomized to either tissue adhesive Glubran Tiss 2®-based (n = 50) or suture-based (n = 50) wound-closure techniques. The following outcomes were assessed before surgery and six months postoperatively: hand strength, electroneurographic characteristics of the median nerve, and the Boston Carpal Tunnel Questionnaire. Results Significant differences between glue-based and suture-based wound-closure techniques were found in the six-month postoperative hand grip strength (25.06 ± 6.69 vs. 21.41 ± 5.62 kg; p = 0.002), postoperative sensory amplitude (10.08 ± 5.50 vs. 7.54 ± 5.41 mV; p = 0.012), and postoperative sensory velocity (42.22 ± 11.04 vs. 35.23 ± 16.40 m/s; p = 0.008). In the glue-based group, significantly more patients achieved a postoperative sensory velocity greater than 45 m/s (47.9% vs. 22.0%; p= 0.006), postoperative distal sensory latency less than 3.5 ms (89.6% vs. 84.0%; p = 0.304), and postoperative motor latency of less than 4.2 ms (60.42% vs. 38.00%; p = 0.022). Conclusions This trial demonstrated that cyanoacrylate-based adhesion material for wound closure after open CTS decompression compared with sutures showed a significant six-month postoperative increment in hand grip strength and median nerve sensory conduction.
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Affiliation(s)
- Veridijana Sunjic Roguljic
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery With Burn Care, University Hospital of Split, Split, HRV
| | - Luka Roguljic
- Department of Surgery, Division of Orthopaedics and Traumatology, University Hospital of Split, Split, HRV
| | - Vedran Kovacic
- Department of Internal Medicine, Division of Emergency and Intensive Medicine With Clinical Pharmacology and Toxicology, University Hospital of Split, Split, HRV
| | - Ivica Bilic
- Department of Neurology, Division of Clinical Neurology, University Hospital of Split, Split, HRV
| | - Ivana Jukic
- Department of Internal Medicine, University Hospital of Split, Split, HRV
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Hammert WC, Chung KC, Miller LE. Best-Evidence Systematic Review and Meta-Analysis of Mini-Open Carpal Tunnel Release. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:35-42. [PMID: 38313621 PMCID: PMC10837294 DOI: 10.1016/j.jhsg.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose This study aimed to evaluate the safety and effectiveness of mini-open carpal tunnel release (mOCTR) using best-evidence synthesis methods. Methods We systematically searched for prospective studies published from January 2013 to July 2023 that reported outcomes from a minimum of 50 mOCTR cases. The outcomes included Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire, Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), pain visual analog scale (VAS), complication rate, and reoperation rate. Data analysis was performed using a random-effects meta-analysis, with metaregression to identify the associations between patient- and study-level factors with surgical outcomes. Results The meta-analysis included 23 studies with 2,303 patients followed for median durations ranging from 6 to 12 months depending on the outcome. Mini-open carpal tunnel release resulted in statistically significant and clinically important improvements in Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (mean difference = -25.5; 95% confidence interval [CI]: -36.4 to -14.5; P < .001), BCTQ-SSS (mean difference = -2.2; 95% CI: -2.5 to -1.9; P < .001), BCTQ-FSS (mean difference = -2.1; 95% CI: -2.4 to -1.7; P < .001), and pain VAS (mean difference = -5.1; 95% CI: -6.2 to -4.1; P < .001). The sole predictor of improvement in BCTQ-SSS, BCTQ-FSS, and pain VAS was a higher preoperative score for the respective variable (all P < .001). The risk of complications (mainly short-term pillar pain or scar complications) was 8.9% (95% CI: 4.0%-13.8%) and increased with longer incision lengths (P = .008). Revision carpal tunnel release was performed in 0.6% (95% CI: 0.1%-1.0%) of the cases during follow-up. No cases of median nerve transection were reported. Conclusions Based on a best-evidence meta-analysis of contemporary studies, mOCTR significantly improved function and pain, with a relatively low risk of mainly temporary complications. Patient outcomes after mOCTR were influenced by patient symptomatology and surgical incision length. Clinical relevance Mini-open carpal tunnel release is an effective surgical option that significantly improves symptoms and function, especially for patients with more severe baseline dysfunction. Surgeons should use the shortest incision that allows adequate visualization to safely divide the transverse carpal ligament.
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Affiliation(s)
- Warren C. Hammert
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University Medical Center, Durham, NC
| | - Kevin C. Chung
- University of Michigan Comprehensive Hand Center, Michigan Medicine, Ann Arbor, MI
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Bueno A, Nevado-Sanchez E, Pardo-Hernández R, de la Fuente-Anuncibay R, González-Bernal JJ. Treatment and Improvement of Healing after Surgical Intervention. Healthcare (Basel) 2023; 11:2213. [PMID: 37570454 PMCID: PMC10418496 DOI: 10.3390/healthcare11152213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
The development of abnormal scars has a great impact on people's well-being, and improving scarring outcomes after surgery is a field that currently lacks consensus. This review aims to identify newly researched approaches to improving the quality of surgical scars. A systematic search of PubMed, Scopus, Web of Science, and ScienceDirect was conducted between 13 May 2023 and 17 May 2023, in accordance with the recommendations of the PRISMA Statement. Study selection and analysis of methodological quality were performed in parts, independently and blindly, based on eligibility criteria. The 21 prospective, comparative, and randomized studies reviewed included 1057 subjects and studied approaches such as topical applications of creams with herbal extracts and silicone gels, growth factors, negative pressure dressings, oligonucleotides, intralesional injection of compounds such as botulinum toxin, skin closure techniques such as suturing and tissue adhesive, and laser treatments. There are recent research techniques that generate good results and are really promising to improve the results of surgical scars; however, the available evidence is extremely limited in some cases, and it is necessary to deepen its analysis to obtain reliable action protocols in each type of surgery.
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Affiliation(s)
- Andrea Bueno
- Health Center of Las Huelgas, 09001 Burgos, Spain;
| | - Endika Nevado-Sanchez
- Reconstructive and Aesthetic Plastic Surgery Service, University Hospital of Burgos, 09006 Burgos, Spain
- Propios Nevado Clinic, 09004 Burgos, Spain
| | - Rocío Pardo-Hernández
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (R.d.l.F.-A.); (J.J.G.-B.)
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Sunjic Roguljic V, Roguljic L, Kovacic V, Jukic I. A Comparison of Tissue Adhesive Material and Suture as Wound-Closure Techniques following Carpal Tunnel Decompression: A Single-Center Randomized Control Trial. J Clin Med 2023; 12:jcm12082864. [PMID: 37109201 PMCID: PMC10145928 DOI: 10.3390/jcm12082864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy caused by compression of the median nerve in the carpal tunnel. The presented study aimed to evaluate clinical outcomes by comparing two techniques of wound closure following carpal tunnel surgery in subjects randomized to the application of tissue adhesive or sutures. METHODS From April 2022 to December 2022, a single-center randomized prospective trial was conducted at the University Hospital of Split in Croatia. The study participants consisted of 100 patients (70 females) aged 61.56 ± 12.03 years, randomly assigned to suture-based wound closure (n = 50) or tissue adhesive-based wound closure (n = 50) with two-component skin adhesive Glubran Tiss 2®. The outcomes were assessed postoperatively during the follow-up period at intervals of 2, 6, and 12 weeks. A scar assessment was performed using the POSAS (Patient and Observer Scar Assessment Scale) and cosmetic VAS (Visual Analog Scale). The VNRS (Verbal Number Rating Scale) was used to assess pain. RESULTS There were significant differences between glue-based wound closure and suture-based wound closure at 2-week and 6-week intervals after the surgery on the POSAS and cosmetic-VAS scales (better aesthetic effect with glue-based wound closure technique where noticed), with less postoperative pain at the same intervals. With the 12-week interval, differences in outcomes were insignificant. CONCLUSIONS This trial demonstrated that cyanoacrylate-based adhesion mixtures might be possibly superior in the short term in terms of cosmetic appearance and discomfort compared to conventional skin suturing techniques for the closing of surgical wounds following open CTS decompression, but there was no difference between both procedures in the long term.
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Affiliation(s)
- Veridijana Sunjic Roguljic
- Surgery Department, Plastic, Reconstructive and Aesthetic Surgery with Burn Care Division, University Hospital of Split, 21000 Split, Croatia
| | - Luka Roguljic
- Surgery Department, Orthopaedics and Traumatology Division, University Hospital of Split, 21000 Split, Croatia
| | - Vedran Kovacic
- Internal Medicine Department, Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, University Hospital of Split, 21000 Split, Croatia
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Ivana Jukic
- Internal Medicine Department, Gastroenterology Division, University Hospital of Split, 21000 Split, Croatia
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