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Campagnoli M, Dell'Era V, Rosa MS, Negri F, Malgrati E, Garzaro M, Valletti PA. Patient's Scar Satisfaction after Conventional Thyroidectomy for Differentiated Thyroid Cancer. J Pers Med 2023; 13:1066. [PMID: 37511679 PMCID: PMC10381783 DOI: 10.3390/jpm13071066] [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: 05/27/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Differentiated thyroid carcinoma (DTC) is the most frequent endocrine neoplasm. Its treatment is based on surgery with consequent impact on patients' quality of life (QoL) and aesthetic implication. The aim of the present study is to assess scar satisfaction in patients affected by DTC who underwent total or partial thyroidectomy. A comparison was also made between scar satisfaction with different subcuticular suture. Validated questionnaires have been employed during a 3-month follow-up: Patient and Observer Scar Assessment Scale (POSAS) and the Patient Scar Assessment Questionnaire (PSAQ). Eventually, the impact of thyroid cancer on QoL of patients was performed in the studied population employing the Thyroid-related patient-reported outcome questionnaire (ThyPRO) and European Organisation for Research Additionally, Treatment of Cancer-Quality of Life questionnaire-C30 (EORTC QLQ-C30). It was conducted in a single center observational study considering 74 patients respecting inclusion criteria. Overall scar satisfaction was found to improve during follow-up, reaching the best scores at 3 months from surgery. Subcuticular suture does not seem to influence the scar satisfaction. In our study male patients seem to be more satisfied, on the other hand age does not seem to influence satisfaction. Overall, the ThyPRO questionnaire and EORTC QLQ-C30 scores did not statistically differ between preoperative and postoperative suggesting a small impact of DTC in QoL.
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Affiliation(s)
| | - Valeria Dell'Era
- ENT Department Maggiore della Carità Hospital, 28100 Novara, Italy
| | | | - Fabiola Negri
- ENT Department Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Eric Malgrati
- ENT Department Maggiore della Carità Hospital, 28100 Novara, Italy
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Evaluation of Incisional Wound Healing in Dogs after Closure with Staples or Tissue Glue and Comparison to Intradermal Suture Pattern. Animals (Basel) 2023; 13:ani13030426. [PMID: 36766316 PMCID: PMC9913468 DOI: 10.3390/ani13030426] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
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.
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Davey MG, Browne F, Davey MS, Walsh SR, Kerin MJ, Lowery AJ. Optimal primary wound closure methods after thyroid and parathyroid surgery: network meta-analysis of randomized clinical trials. BJS Open 2023; 7:7055521. [PMID: 36821724 PMCID: PMC9949711 DOI: 10.1093/bjsopen/zrac170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/17/2022] [Accepted: 12/06/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND At present, there is no consensus on optimal neck wound closure methods after thyroid and parathyroid surgery. The aim of this study was to perform a systematic review and network meta-analysis of RCTs evaluating the optimal neck closure method after thyroid and parathyroid surgery. METHODS A frequentist random-effects network meta-analysis was performed for RCTs comparing at least two closure methods according to PRISMA-network meta-analysis guidelines. Analysis was performed using R packages and Shiny. RESULTS Eighteen RCTs evaluating six closure methods (that is adhesive (28.5 per cent, 404 patients), absorbable subcuticular suture (18.1 per cent, 257 patients), non-absorbable subcuticular suture (16.8 per cent, 238 patients), staples (26.3 per cent, 372 patients), steristrips (8.1 per cent, 115 patients), and conventional suture (2.1 per cent, 30 patients)) in 1416 patients were included. At network meta-analysis, there was no difference in complication, infection, dehiscence, or haematoma rates irrespective of closure method used. Staples reduced closure duration versus absorbable subcuticular suture (mean difference (MD) 8.50, 95 per cent c.i. 6.90 to 10.10) and non-absorbable subcuticular suture (MD 0.30, 95 per cent c.i. 0.23 to 0.37), whereas adhesives (MD -1.05, 95 per cent c.i. -1.31 to -0.79) reduced closure time relative to staples. Cosmesis was improved after non-absorbable subcuticular suture (odds ratio (OR) 3.41, 95 per cent c.i. 1.66 to 7.00) relative to staples. Staples reduced patient satisfaction (OR 0.04, 95 per cent c.i. 0.00 to 0.33) and ability to shower (OR 0.04, 95 per cent c.i. 0.00 to 0.33) relative to adhesives. CONCLUSION Despite staples decreasing closure times, this advantage is offset by reduced patient satisfaction, ability to shower, and cosmesis compared with patients with wounds closed using adhesives, absorbable subcuticular suture, and non-absorbable subcuticular suture. Therefore, these closure methods are favourable for closing neck wounds due to more acceptable patient-reported outcomes, without compromising the safety of the procedure.
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Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Ferdia Browne
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Martin S Davey
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Stewart R Walsh
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Michael J Kerin
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
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Muacevic A, Adler JR, Nagtode T, Rewale V. A Comparative Study Between Conventional Sutures, Staples, and Adhesive Glue for Clean Elective Surgical Skin Closure. Cureus 2022; 14:e31196. [PMID: 36505125 PMCID: PMC9728503 DOI: 10.7759/cureus.31196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
As long as medicine has subsisted, wound closure has existed. When assessing a surgical wound, physicians are more than ever confronted with various sutures and other closure materials. The surgeon must choose the most appropriate material for that specific closure because not one substance is perfect in all circumstances. The history of suturing wounds is intertwined with the history of surgery. Wound suturing is a critical component of wound therapy, including suturing materials and techniques. Suturing has been practiced for thousands of years. Although suture materials and techniques have changed, the goals like closing dead space, supporting and strengthening wounds until healing increases their tensile strength, approximating skin edges for an aesthetically pleasing and functional result, and reducing the risk of bleeding and infection remain the same. Traditional skin closure with sutures requires time and effort, creates an unsightly scar, and requires infection removal. In this modern era, patients find it appealing when the operated location has a decent cosmetic appearance. The quicker, more comfortable, and most aesthetically pleasing method of skin closure is what surgeons are searching for. Assessing whether newer methods are superior to sutures and staples is necessary. Better cosmesis, flexibility, water resistance, painless sealed skin closure, and ease of application are all advantages of 2-octyl cyanoacrylate. This article aims to provide an overview of the critical characteristics of traditional sutures, common suture materials, sticky glue, and staples, as well as additional closure materials.
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Parikh UM, Mentz J, Collier I, Davis MJ, Abu-Ghname A, Colchado D, Short WD, King A, Buchanan EP, Balaji S. Strategies to Minimize Surgical Scarring: Translation of Lessons Learned from Bedside to Bench and Back. Adv Wound Care (New Rochelle) 2022; 11:311-329. [PMID: 34416825 DOI: 10.1089/wound.2021.0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Significance: An understanding of the physiology of wound healing and scarring is necessary to minimize surgical scar formation. By reducing tension across the healing wound, eliminating excess inflammation and infection, and encouraging perfusion to healing areas, surgeons can support healing and minimize scarring. Recent Advances: Preoperatively, newer techniques focused on incision placement to minimize tension, skin sterilization to minimize infection and inflammation, and control of comorbid factors to promote a healing process with minimal scarring are constantly evolving. Intraoperatively, measures like layered closure, undermining, and tissue expansion can be taken to relieve tension across the healing wound. Appropriate suture technique and selection should be considered, and finally, there are new surgical technologies available to reduce tension across the closure. Postoperatively, the healing process can be supported as proliferation and remodeling take place within the wound. A balance of moisture control, tension reduction, and infection prevention can be achieved with dressings, ointments, and silicone. Vitamins and corticosteroids can also affect the scarring process by modulating the cellular factors involved in healing. Critical Issues: Healing with no or minimal scarring is the ultimate goal of wound healing research. Understanding how mechanical tension, inflammation and infection, and perfusion and hypoxia impact profibrotic pathways allows for the development of therapies that can modulate cytokine response and the wound extracellular microenvironment to reduce fibrosis and scarring. Future Directions: New tension-off loading topical treatments, laser, and dermabrasion devices are under development, and small molecule therapeutics have demonstrated scarless wound healing in animal models, providing a promising new direction for future research aimed to minimize surgical scarring.
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Affiliation(s)
- Umang M. Parikh
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - James Mentz
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Ian Collier
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Matthew J. Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Daniel Colchado
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Walker D. Short
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Alice King
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Edward P. Buchanan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Swathi Balaji
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
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Comparison of wound closure techniques after thyroid and parathyroid surgery: an updated systematic review and network meta-analysis. Updates Surg 2022; 74:1225-1237. [DOI: 10.1007/s13304-022-01296-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/01/2022] [Indexed: 10/18/2022]
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Bal-Ozturk A, Cecen B, Avci-Adali M, Topkaya SN, Alarcin E, Yasayan G, Ethan YC, Bulkurcuoglu B, Akpek A, Avci H, Shi K, Shin SR, Hassan S. Tissue Adhesives: From Research to Clinical Translation. NANO TODAY 2021; 36:101049. [PMID: 33425002 PMCID: PMC7793024 DOI: 10.1016/j.nantod.2020.101049] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Sutures, staples, clips and skin closure strips are used as the gold standard to close wounds after an injury. In spite of being the present standard of care, the utilization of these conventional methods is precarious amid complicated and sensitive surgeries such as vascular anastomosis, ocular surgeries, nerve repair, or due to the high-risk components included. Tissue adhesives function as an interface to connect the surfaces of wound edges and prevent them from separation. They are fluid or semi-fluid mixtures that can be easily used to seal any wound of any morphology - uniform or irregular. As such, they provide alternatives to new and novel platforms for wound closure methods. In this review, we offer a background on the improvement of distinctive tissue adhesives focusing on the chemistry of some of these products that have been a commercial success from the clinical application perspective. This review is aimed to provide a guide toward innovation of tissue bioadhesive materials and their associated biomedical applications.
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Affiliation(s)
- Ayça Bal-Ozturk
- Department of Analytical Chemistry, Faculty of Pharmacy, Istinye University, 34010, Zeytinburnu, Istanbul, Turkey
- Department of Stem Cell and Tissue Engineering, Institute of Health Sciences, Istinye University, 34010 Istanbul, Turkey
| | - Berivan Cecen
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Cambridge, MA 02139, USA
| | - Meltem Avci-Adali
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Calwerstraße 7/1, 72076 Tuebingen, Germany
| | - Seda Nur Topkaya
- Department of Analytical Chemistry, Faculty of Pharmacy, Izmir Katip Celebi University, Izmir, Turkey
| | - Emine Alarcin
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Marmara University, 34668, Haydarpasa, Istanbul, Turkey
| | - Gokcen Yasayan
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Marmara University, 34668, Haydarpasa, Istanbul, Turkey
| | - Yi-Chen Ethan
- Department of Chemical Engineering, Feng Chia University, Taichung, Taiwan
| | | | - Ali Akpek
- Institute of Biotechnology, Gebze Technical University, 41400, Gebze Kocaeli-Turkey
- Department of Bioengineering, Gebze Technical University, 41400, Gebze Kocaeli-Turkey
- Sabanci University Nanotechnology Research & Application Center, 34956, Tuzla Istanbul-Turkey
| | - Huseyin Avci
- Department of Metallurgical and Materials Engineering, Faculty of Engineering and Architecture Eskisehir Osmangazi University Eskisehir Turkey
| | - Kun Shi
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Cambridge, MA 02139, USA
| | - Su Ryon Shin
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Cambridge, MA 02139, USA
| | - Shabir Hassan
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Cambridge, MA 02139, USA
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Lee K, Ward N, Oremule B, Mani N. Optimal wound closure techniques for thyroid and parathyroid surgery: A systematic review of cosmetic outcomes. Clin Otolaryngol 2019; 44:905-913. [PMID: 31145548 DOI: 10.1111/coa.13382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/14/2019] [Accepted: 05/28/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Cosmesis after surgical wound closure is an important outcome. This is relevant after thyroid and parathyroid surgery as anterior neck scars are visible and often of concern to patients. We aimed to investigate whether wound closure method influences cosmetic outcome in thyroid and parathyroid surgery, in particular using sutures, staples, steri-strips and glue. DESIGN We performed a systematic review of MEDLINE, PubMed, EMBASE, CINAHL and Cochrane focusing on wound cosmesis following thyroid and parathyroid surgery. Searches were conducted using combinations of the search terms: thyroid/parathyroid surgery, wound/skin closure and suture, staples, clips, glue and steri-strips, using appropriate MESH terms and Boolean operators. MAIN OUTCOME MEASURES Primary outcome was wound cosmesis. Secondary measures were also extracted. RESULTS Initial search found 304 papers and after systematic review, a total of 10 studies compared different closure methods and cosmetic outcomes. There were nine randomised controlled trials and one cohort study, with a total of 712 patients. Three studies compared staples vs glue; three compared sutures vs clips; two compared suture vs steri-strips and two studies for suture vs glue. In general, short-term cosmesis was better with subcuticular sutures compared to glue or clips, long-term cosmetic outcomes were not influenced by closure method. CONCLUSIONS We found closure with subcuticular suture or steri-strips produced superior short-term cosmetic outcomes. Although long-term cosmetic outcome is not influenced by closure method, given the superior cosmetic outcome and advantage of not needing removal, we recommend subcuticular sutures should be performed for wound closure in thyroid and parathyroid surgery.
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Affiliation(s)
- Kristina Lee
- Department of Otolaryngology and Head and Neck Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Nicholas Ward
- Department of Otolaryngology, Royal Bolton Hospital, Manchester, UK
| | - Babatunde Oremule
- Department of Otolaryngology, Fairfield General Hospital, Manchester, UK
| | - Navin Mani
- Department of Otolaryngology and Head and Neck Surgery, Manchester Royal Infirmary, Manchester, UK
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10
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Huang YH, Chen C, Lee CH, Loh EW, Tam KW. Wound Closure after Thyroid and Parathyroid Surgery: A Meta-Analysis of Randomized Controlled Trials. Scand J Surg 2018; 108:101-108. [PMID: 30187825 DOI: 10.1177/1457496918798203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Wound closure after thyroidectomy and parathyroidectomy is associated with patients' satisfaction, perception of cosmetic appearance, and experience of postoperative pain. Subcutaneous sutures, clips, and tissue adhesive are the three major methods of wound closure. In this study, we conducted a meta-analysis of randomized controlled trials to evaluate the outcomes of these methods. METHODS Relevant studies published before December 2017 were identified from PubMed, Embase, Cochrane Library, Scopus, and the ClinicalTrials.gov registry. Individual effect sizes were standardized, and a meta-analysis was conducted to calculate the pooled effect size by using random-effect models. The primary outcome was the cosmetic appearance, which was evaluated 4 weeks, 6 weeks, and 6 months after surgery. The secondary outcomes were patient satisfaction, postoperative pain, and complications. RESULTS A total of nine trials with 612 patients were reviewed. No significant difference was observed in patient satisfaction, postoperative pain, and complications among the wound closure methods. However, according to surgeon assessment, the subcutaneous suture method resulted in a significantly more favorable cosmetic appearance than the clip method (mean difference: -1.47, 95% confidence interval: -2.72 to -0.23). CONCLUSION In the current study, no differences were found in patient satisfaction and postoperative pain among the subcutaneous suture, clip, and tissue adhesive wound closure methods. However, surgeons provided a more favorable appraisal for the subcutaneous suture method because of the improved cosmetic appearance. The choice of the closure method should be based on surgeon's preference and cost.
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Affiliation(s)
- Y-H Huang
- 1 School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - C Chen
- 1 School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - C-H Lee
- 2 School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,3 Comprehensive Cancer Center, Taipei Medical University, Taipei, Taiwan.,4 Department of Laboratory Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - E-W Loh
- 5 Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,6 Shared Decision Making Resource Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - K-W Tam
- 5 Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,6 Shared Decision Making Resource Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,7 Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,8 Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,9 Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
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Pencle FJ, Seale JA, Benny A, Salomon S, Simela A, Chin KR. Option for transverse midline incision and other factors that determine patient's decision to have cervical spine surgery. J Orthop 2018; 15:615-619. [PMID: 29881206 PMCID: PMC5990331 DOI: 10.1016/j.jor.2018.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Authors aim to determine patients' preference for surgical incision and factors affecting the decision for surgery to the anterior neck. METHODS A questionnaire was presented prior to evaluation and if preceded to surgery followup given. RESULTS 243 patients completed questionnaire, with 60% female population and younger than 50 years. 151 patients preferred a transverse midline incision with a statistically significant increase in outcomes and cosmesis importance and a decrease in the importance of board certification. CONCLUSION Findings of questionnaire demonstrate that patients' prefer a transverse midline anterior neck incision, with surgical outcomes being the overall factor affecting decision making.
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Affiliation(s)
- Fabio J.R. Pencle
- Less Exposure Surgery Specialists Institute (LESS Institute), United States
- Less Exposure Surgery (LES) Society, United States
| | - Jason A. Seale
- Less Exposure Surgery Specialists Institute (LESS Institute), United States
- Less Exposure Surgery (LES) Society, United States
| | - Amala Benny
- Less Exposure Surgery (LES) Society, United States
| | | | - Ashley Simela
- Less Exposure Surgery (LES) Society, United States
- Bronx Lebanon Hospital Center, United States
| | - Kingsley R. Chin
- Less Exposure Surgery Specialists Institute (LESS Institute), United States
- Herbert Wertheim College of Medicine, Florida International University, United States
- Charles E. Schmidt College of Medicine, Florida Atlantic University, United States
- University of Technology, Jamaica
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A paired comparison analysis of third-party rater thyroidectomy scar preference. The Journal of Laryngology & Otology 2016; 131:13-18. [PMID: 27917727 DOI: 10.1017/s002221511600952x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the length and position of a thyroidectomy scar that is cosmetically most appealing to naïve raters. METHODS Images of thyroidectomy scars were reproduced on male and female necks using digital imaging software. Surgical variables studied were scar position and length. Fifteen raters were presented with 56 scar pairings and asked to identify which was preferred cosmetically. Twenty duplicate pairings were included to assess rater reliability. Analysis of variance was used to determine preference. RESULTS Raters preferred low, short scars, followed by high, short scars, with long scars in either position being less desirable (p < 0.05). Twelve of 15 raters had acceptable intra-rater and inter-rater reliability. CONCLUSION Naïve raters preferred low, short scars over the alternatives. High, short scars were the next most favourably rated. If other factors influencing incision choice are considered equal, surgeons should consider these preferences in scar position and length when planning their thyroidectomy approach.
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Lloris-Carsí JM, Ballester-Álvaro J, Barrios C, Zaragozá-Fernández C, Gómez-De la Cruz C, González-Cuartero C, Prieto-Moure B, Cejalvo-Lapeña D. Randomized clinical trial of a new cyanoacrylate flexible tissue adhesive (Adhflex) for repairing surgical wounds. Wound Repair Regen 2016; 24:568-80. [DOI: 10.1111/wrr.12424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 02/16/2016] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Carlos Barrios
- Division of Experimental Surgery; Valencia Catholic University; Spain
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Comparison of Skin Staples and Standard Sutures for Closing Incisions After Head and Neck Cancer Surgery: A Double-Blind, Randomized and Prospective Study. J Maxillofac Oral Surg 2015; 15:243-50. [PMID: 27298549 DOI: 10.1007/s12663-015-0809-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To investigate the merits and demerits of stapled skin closure when compared to conventional sutures in head and neck cancer surgery. MATERIALS AND METHODS A total of 80 patients (40 patients each in control and study group) were enrolled. The patients underwent closure of incision wounds following head and neck cancer surgical procedures. Skin incisions were closed with sutures using 3-0 silk in control group and with stainless steel staples in study group. Both the groups were compared for speed of closure, cost effectiveness, pain on removal, patient comfort, aesthetic outcome on day of removal, 15 and 30 days after day of removal and complications. RESULTS The mean incision length in control group was 54 ± 16.3 cm while in study group was 53.7 ± 15.4 cm which was statistically not significant (P = 0.95). The mean time of closure in control group was 34.2 ± 12 min while in study group was 3.3 ± 1.2 min which was statistically highly significant (P < 0.001). The mean cost of material for skin closure in control group was Rs. 270.0 ± 46.4 and in study group was Rs. 517.5 ± 135.7 which was also statistically highly significant (P < 0.001). CONCLUSION It was concluded that skin staples are better alternatives to conventional sutures in head and neck cancer surgery as they offer ten times faster wound closure, cost effectiveness, and similar results to sutures in terms of patient comfort, aesthetic outcome and complication rate.
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Dai L, Gao M, Gu C, Zhang F, Yu Y. Perivenous application of cyanoacrylate tissue sealants reduces intimal and medial thickening of the vein graft and inflammatory responses in a rabbit model of carotid artery bypass grafting. Eur J Cardiothorac Surg 2015; 49:675-81. [PMID: 25838460 DOI: 10.1093/ejcts/ezv111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/17/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Effective therapies to prevent vein graft failure after coronary artery bypass grafting (CABG) are still lacking. α-Cyanoacrylate (α-CA, 99% n-octyl-α-cyanoacrylate + n-butyl-α-cyanoacrylate) has been increasingly used as a tissue sealant for wound closure because of its bacteriostatic, biodegradable and haemostatic properties. As a strong tissue adhesive, α-CA might prevent an arterial circulation-induced mechanical stretch on vein graft to attenuate intimal hyperplasia. Here, we investigated the effects of perivenous application of α-CA on the vein graft in a rabbit model of carotid artery bypass grafting. METHODS Healthy New Zealand white rabbits were randomized into no graft, graft or graft + α-CA group (n = 10 per group). Rabbit carotid artery was bypassed with the jugular vein. α-CA sealants were sprayed on the entire jugular graft including both anastomotic sites after completion of anastomoses. Blood flow parameters and histological characteristics of the vein grafts including vessel wall thickness, number of medial elastic lamina and proliferation index were evaluated 4 weeks after the surgery. The mRNA or protein levels of proinflammatory factors, chemokine (C-C motif) ligand-2 (CCL-2) and tumour necrosis factor-α (TNF-α) were measured 4 weeks after the operation by quantitative reverse transcription polymerase chain reaction or enzyme-linked immunosorbent assay. RESULTS Compared with the untreated vein grafts at Week 4 after the operation, the α-CA spray significantly improved graft flow (39.4 ± 1.5 vs 27.8 ± 2.9 ml/min, P < 0.01), attenuated intimal and medial thickening (116.3 ± 1.0 vs 159.7 ± 0.9 μm, P < 0.01), reduced anti-proliferating cell nuclear antigen proliferation index of the vein grafts (15.0 ± 0.4 vs 23.6 ± 0.4%, P < 0.01), decreased the mRNA levels of plasminogen activator inhibitor-1 and CCL-2, and reduced the serum levels of TNF-α (92.9 ± 1.7 vs 102.7 ± 1.8 pg/ml, P < 0.01). CONCLUSION Perivenous application of α-CA sealants exerts short-term beneficial effects on the vein graft and reduces inflammatory responses in a rabbit model of carotid artery bypass grafting. Long-term effects of α-CA on vein graft remodelling and the clinical significance of α-CA in CABG remain to be determined in future studies.
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Affiliation(s)
- Longsheng Dai
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Mingxin Gao
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Fan Zhang
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Yang Yu
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
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Ghosh A, Nanjappa M, Nagaraj V, Rajkumar GC. Comparison between stainless steel staples and silk sutures for primary closure of skin in patients undergoing neck dissection: A comparative clinical study. Contemp Clin Dent 2015; 6:S51-5. [PMID: 25821376 PMCID: PMC4374320 DOI: 10.4103/0976-237x.152938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: Comparison between stainless steel staples and silk sutures for primary closure of skin in patients undergoing neck dissection, in context of rapid application, approximation of the skin edges, economy and aesthetics of the resultant scar. Aim: (1) To compare surgical stainless steel staples and silk sutures for primary wound closure, with respect to presence/absence of wound infection and dehiscence (2) To compare the resultant scar following the two different methods of the closure at 3rd month postoperatively with the help of visual analog scale and analyze the result statistically Design: This study was designed to compare skin closure using staples and silk sutures in patients undergoing neck dissection, using both methods in one-half of the same wound; thus each wound affording its own control. Materials and Methods: The study was conducted on patients requiring collar line incision (high submandibular incision) with or without a cephalad extension of midline lower lip split incision for surgical access, who presented to the Department of Oral and Maxillo-Facial Surgery. (1) Sample size: 10 (2) Study design: Prospective Comparative study (3) Study duration: One and half years (4) Surgical stainless steel staples: Proximate Plus MD 35 W, Ethicon Endo Surgery (5) Sutures: 3–0 Ethiprime NW 5003, Non-Absorbable Surgical Suture, Mersilk-90 cm, Ethicon, (16 mm 3/8 circle cutting needle). Conclusion: It was concluded that there is no significant difference between the scars observed in the regions of incision which underwent primary closure by two different methods, that is surgical stainless steel staples and 3–0 Mersilk Sutures.
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Affiliation(s)
- Abhishek Ghosh
- Department of Oral and Maxillofacial Surgery, V. S. Dental College and Hospital, Bengaluru, Karnataka, India
| | - Madan Nanjappa
- Department of Oral and Maxillofacial Surgery, V. S. Dental College and Hospital, Bengaluru, Karnataka, India
| | - Vaibhav Nagaraj
- Department of Oral and Maxillofacial Surgery, V. S. Dental College and Hospital, Bengaluru, Karnataka, India
| | - G C Rajkumar
- Department of Oral and Maxillofacial Surgery, V. S. Dental College and Hospital, Bengaluru, Karnataka, India
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Dumville JC, Coulthard P, Worthington HV, Riley P, Patel N, Darcey J, Esposito M, van der Elst M, van Waes OJF. Tissue adhesives for closure of surgical incisions. Cochrane Database Syst Rev 2014; 2014:CD004287. [PMID: 25431843 PMCID: PMC10074547 DOI: 10.1002/14651858.cd004287.pub4] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sutures (stitches), staples and adhesive tapes have been used for many years as methods of wound closure, but tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables the closure to be meticulous, but the sutures may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of an absence of risk of needlestick injury and no requirement to remove sutures later. Initially, tissue adhesives were used primarily in emergency room settings, but this review looks at the use of tissue adhesives in the operating room/theatre where surgeons are using them increasingly for the closure of surgical skin incisions. OBJECTIVES To determine the effects of various tissue adhesives compared with conventional skin closure techniques for the closure of surgical wounds. SEARCH METHODS In March 2014 for this second update we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We did not restrict the search and study selection with respect to language, date of publication or study setting. SELECTION CRITERIA Only randomised controlled trials were eligible for inclusion. DATA COLLECTION AND ANALYSIS We conducted screening of eligible studies, data extraction and risk of bias assessment independently and in duplicate. We expressed results as random-effects models using mean difference for continuous outcomes and risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes. We investigated heterogeneity, including both clinical and methodological factors. MAIN RESULTS This second update of the review identified 19 additional eligible trials resulting in a total of 33 studies (2793 participants) that met the inclusion criteria. There was low quality evidence that sutures were significantly better than tissue adhesives for reducing the risk of wound breakdown (dehiscence; RR 3.35; 95% CI 1.53 to 7.33; 10 trials, 736 participants that contributed data to the meta-analysis). The number needed to treat for an additional harmful outcome was calculated as 43. For all other outcomes - infection, patient and operator satisfaction and cost - there was no evidence of a difference for either sutures or tissue adhesives. No evidence of differences was found between tissue adhesives and tapes for minimising dehiscence, infection, patients' assessment of cosmetic appearance, patient satisfaction or surgeon satisfaction. However there was evidence in favour of using tape for surgeons' assessment of cosmetic appearance (mean difference (VAS 0 to 100) 9.56 (95% CI 4.74 to 14.37; 2 trials, 139 participants). One trial compared tissue adhesives with a variety of methods of wound closure and found both patients and clinicians were significantly more satisfied with the alternative closure methods than the adhesives. There appeared to be little difference in outcome for different types of tissue adhesives. One study that compared high viscosity with low viscosity adhesives found that high viscosity adhesives were less time-consuming to use than low viscosity tissue adhesives, but the time difference was small. AUTHORS' CONCLUSIONS Sutures are significantly better than tissue adhesives for minimising dehiscence. In some cases tissue adhesives may be quicker to apply than sutures. Although surgeons may consider the use of tissue adhesives as an alternative to other methods of surgical site closure in the operating theatre, they need to be aware that sutures minimise dehiscence. There is a need for more well designed randomised controlled trials comparing tissue adhesives with alternative methods of closure. These trials should include people whose health may interfere with wound healing and surgical sites of high tension.
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Affiliation(s)
- Jo C Dumville
- University of ManchesterSchool of Nursing, Midwifery and Social WorkManchesterUKM13 9PL
| | - Paul Coulthard
- School of Dentistry, The University of ManchesterDepartment of Oral and Maxillofacial SurgeryCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Helen V Worthington
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Philip Riley
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Neil Patel
- University Dental Hospital of ManchesterOral SurgeryHigher Cambridge StreetManchesterGreater ManchesterUKM15 6FH
| | - James Darcey
- School of Dentistry, The University of ManchesterDepartment of Oral and Maxillofacial SurgeryCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Marco Esposito
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Maarten van der Elst
- Reinier de Graaf GroepDepartment of SurgeryReinier de Graafweg 3‐11DelftNetherlands2625 AD
| | - Oscar J F van Waes
- Reinier de Graaf GroepDepartment of SurgeryReinier de Graafweg 3‐11DelftNetherlands2625 AD
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Abstract
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.
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Affiliation(s)
- Luluah Al-Mubarak
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Al-Haddab
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Quality of scar after total thyroidectomy: a single blinded randomized trial comparing octyl-cyanoacrylate and subcuticular absorbable suture. ISRN SURGERY 2013; 2013:270953. [PMID: 24324898 PMCID: PMC3845629 DOI: 10.1155/2013/270953] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/26/2013] [Indexed: 12/14/2022]
Abstract
Objective. To compare the quality of resulting scar at 6 weeks after total thyroidectomy with the use of the tissue adhesive octyl-cyanoacrylate or subcuticular absorbable suture for the closure of cervicotomy. Material and Methods. There are 50 patients undergoing a cervicotomy for total thyroidectomy. Twenty-five patients were randomly assigned to closure with tissue adhesive and 25 with subcuticular absorbable suture. At week 6 the scar was evaluated by blinded assessors with the Italian version of POSAS questionnaire, a validated wound scale composed of an observer's and a patient's subscale. Results. Assessment of scar appearance showed a statistically significant difference (p = 0. 038) in favor of subcuticular suture with respect to tissue adhesive on observer's assessment. The difference on patients' self-assessment was not significant. A multivariate analysis of six qualitative features of scars showed a significant influence on assessment for hyperpigmentation and relief of scar. The Italian version of POSAS proved to be reliable. Conclusion. Though tissue adhesive represents a valid method of skin closure, subcuticular absorbable suture provides a better aesthetic outcome in small cervical incisions in the early phase after thyroid surgery.
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Personal Factors that Affect the Satisfaction of Female Patients Undergoing Esthetic Suture after Typical Thyroidectomy. Arch Plast Surg 2013; 40:414-24. [PMID: 23898441 PMCID: PMC3724005 DOI: 10.5999/aps.2013.40.4.414] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/28/2013] [Accepted: 06/04/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In esthetic surgery, understanding the factors that influence patient satisfaction is important for successful practice. We hypothesize that the factors that influence patient satisfaction include not only aesthetic and functional outcomes, but also personal factors such as the level of familiarity with factors affecting wound healing and expectations regarding aesthetic outcome. METHODS One hundred patients who underwent esthetic closure after thyroidectomy were included in this study. In order to evaluate the individual characteristics of the patients, a preoperative survey was administered to the patients. We estimated the patient satisfaction six months postoperatively and assessed the aesthetic and functional outcomes using the Patient and Observer Scar Assessment Scale. RESULTS According to the results of correlation analysis, level of familiarity with wound healing factors had a positive correlation with satisfaction. High expectations, pain, itching, and high observer scale score had negative correlations with satisfaction. The factors that were correlated with satisfaction were included in the multiple regression analysis. Level of familiarity with wound healing factors was found to have a positive relationship with satisfaction, while itching and observer scale were found to have a negative relationship with satisfaction. After excluding 10 patients who had hypertrophic scars, only level of familiarity with wound healing factors and expectations affected satisfaction. CONCLUSIONS The level of familiarity with factors affecting wound healing and expectations were found to independently affect satisfaction. Improving patients' level of familiarity with wound healing factors and reducing their expectations by providing suitable preoperative education has the potential to improve patient satisfaction.
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21
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O'Leary DP, Clover A, Galbraith JG, Mushtaq M, Shafiq A, Redmond H. Adhesive strip wound closure after thyroidectomy/parathyroidectomy: A prospective, randomized controlled trial. Surgery 2013; 153:408-12. [DOI: 10.1016/j.surg.2012.08.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 08/30/2012] [Indexed: 11/28/2022]
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Juergens S, Maune C, Kezze F, Mohr T, Scheuer K, Mallmann P. A randomized, controlled study comparing the cosmetic outcome of a new wound closure device with Prolene suture closing caesarean wounds. Int Wound J 2011; 8:329-35. [PMID: 21615866 DOI: 10.1111/j.1742-481x.2011.00789.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A prospective, randomised study was conducted to compare the wound closure performance and cosmetic outcome of caesarean section wounds closed with traditional Prolene suture or a new wound closure device (Leukosan(®) SkinLink). Sixty-one patients referred to primary section were allocated to wound closure with either Leukosan(®) SkinLink or Prolene suture. Cosmetic outcome as the primary measure was evaluated by the patient, the surgeon as well as by independent examiners blinded to the method of wound closure. Evaluations were recorded at 3, 6 and 12 months following wound closure. Both methods of wound closure scored equally high on the visual analogue scale for cosmetic evaluation at the 3-, 6- and 12-month follow-ups as assessed by the patient, surgeon and the blinded observers. The study has shown that innovative methods for wound closure compared with traditional methods such as suture providing excellent cosmetic results represent a valid alternative to physician and patient for surgical incisions.
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Affiliation(s)
- Sven Juergens
- Department of Gynaecology and Obstetrics, University of Cologne, 50924 Cologne, Germany.
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23
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Murrmann SG, Markowitz JS, Gutterman EM, Magee G. Postoperative outcomes associated with topical skin adhesives among women having hysterectomies. Surg Infect (Larchmt) 2010; 11:441-7. [PMID: 20673145 DOI: 10.1089/sur.2009.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Multiple options are available for closure of hysterectomy incisions. This study compared postoperative clinical and economic outcomes using topical skin adhesive (2-octyl cyanoacrylate; OCA) vs. conventional skin closure in women undergoing total abdominal hysterectomy. METHODS A multi-hospital administrative database was used to identify women discharged in 2005 who had undergone total abdominal hysterectomy. Patients, classified by skin closure as suture (n = 21,201), staples (n = 23,441), OCA (n = 880), or staples + OCA (n = 489), were compared on length of inpatient stay (LOS), total inpatient cost, and non-prophylactic antibiotic treatment after day four. RESULTS The unadjusted mean LOS was 3.9, 4.5, 3.7, and 5.2 days for suture, staples, OCA, and staples + OCA, respectively; and the percentages of patients having antibiotic treatment were 12.93, 17.51, 11.14, and 23.72. There were overall differences in adjusted mean LOS, mean total cost, and antibiotic treatment (p < 0.0001). Pairwise comparisons indicated no difference between sutures and OCA, whereas the outcomes for each of the non-staple groups were more favorable than those for the staple group (p < 0.01). Results were similar in adjusted comparisons, with pairwise comparisons between OCA and staples at or near the threshold for significance. CONCLUSIONS 2-octyl cyanoacrylate appears to be a safe and cost-effective alternative to topical sutures for patients having total abdominal hysterectomy. There were less favorable outcomes in groups receiving staples.
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Affiliation(s)
- Susan G Murrmann
- Department of Obstetrics & Gynecology, University of Tennessee , Memphis, TN, USA
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Closure of cutaneous incision after thyroid surgery: a comparison between metal clips and cutaneous octyl-2-cyanoacrylate adhesive. A prospective randomized clinical trial. EUROPEAN JOURNAL OF PLASTIC SURGERY 2010. [DOI: 10.1007/s00238-010-0477-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chow A, Marshall H, Zacharakis E, Paraskeva P, Purkayastha S. Use of Tissue Glue for Surgical Incision Closure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Coll Surg 2010; 211:114-25. [DOI: 10.1016/j.jamcollsurg.2010.03.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 02/03/2010] [Accepted: 03/04/2010] [Indexed: 10/19/2022]
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Coulthard P, Esposito M, Worthington HV, van der Elst M, van Waes OJF, Darcey J. Tissue adhesives for closure of surgical incisions. Cochrane Database Syst Rev 2010:CD004287. [PMID: 20464728 DOI: 10.1002/14651858.cd004287.pub3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sutures, staples and adhesive tapes are the traditional methods of wound closure, whilst tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables meticulous closure, but they may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of no risk of needlestick injury and no requirement to remove sutures later. Tissue adhesives have been used primarily in emergency rooms but this review looks at the use of tissue adhesives in the operating room where surgeons are increasingly using these for the closure of surgical skin incisions. OBJECTIVES To determine the relative effects of various tissue adhesives and conventional skin closure techniques on the healing of surgical wounds. SEARCH STRATEGY For this update we searched the Cochrane Wounds Group Specialised Register (Searched 17/11/09); The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library Issue 4 2009; Ovid MEDLINE - 1950 to November Week 1 2009; Ovid EMBASE - 1980 to 2009 Week 46; EBSCO CINAHL - 1982 to 17 November 20098. No date or language restrictions were applied. SELECTION CRITERIA Only randomised controlled clinical trials were eligible for inclusion. DATA COLLECTION AND ANALYSIS Screening of eligible studies and data extraction were conducted independently and in triplicate whilst assessment of the methodological quality of the trials was conducted independently and in duplicate. Results were expressed as random effects models using mean difference for continuous outcomes and relative risks with 95% confidence intervals for dichotomous outcomes. Heterogeneity was investigated including both clinical and methodological factors. MAIN RESULTS This update identified an additional six trials resulting in a total of fourteen RCTs (1152 patients) which met the inclusion criteria. Sutures were significantly better than tissue adhesives for minimising dehiscence (10 trials). Sutures were also found to be significantly faster to use. For all other analyses of infection, patient and operator satisfaction and cost there was no significant difference between sutures and tissue adhesives. No differences were found between tissue adhesives and tapes (2 trials) for minimising dehiscence, infection, patients assessment of cosmetic appearance, patient satisfaction or surgeon satisfaction. However a statistically significant difference in favour of using tape was found for surgeons' assessment of cosmetic appearance (mean difference 13, 95% CI 5 to 21). Tapes were also demonstrated to be significantly faster to use than tissue adhesives as were staples (1 trial). No other outcome measures were analysed in this group. One trial compared tissue adhesives with a variety of methods of wound closure and found both patients and clinicians were significantly more satisfied with the alternative closure methods than the adhesives. In this same trial tissue adhesives were significantly less time consuming to use. For the remaining outcomes of dehiscence and infection no difference was observed between groups. This trial also compared high viscosity with low viscosity adhesives and found that high viscosity adhesives were less time consuming to use than low viscosity tissue adhesives. For all other outcomes of dehiscence, infection, patient satisfaction and operator satisfaction there was no statistically significant difference between high and low viscosity adhesives. AUTHORS' CONCLUSIONS Sutures were significantly better than tissue adhesives for minimising dehiscence and were found to be significantly faster to use. Although surgeons may consider the use of tissue adhesives as an alternative to other methods of surgical site closure in the operating theatre they must be aware that adhesives may take more time to apply and that if higher tension is needed upon an incision, sutures may minimise dehiscence. There is a need for more well designed randomised controlled trials comparing tissue adhesives and alternative methods of closure. These trials should include people whose health may interfere with wound healing and surgical sites of high tension.
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Affiliation(s)
- Paul Coulthard
- Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH
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2-Octyl-cyanoacrylate for wound closure in cervical and lumbar spinal surgery. Neurosurg Rev 2010; 33:483-9. [PMID: 20440558 PMCID: PMC2936674 DOI: 10.1007/s10143-010-0258-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 03/07/2010] [Accepted: 03/08/2010] [Indexed: 12/19/2022]
Abstract
It is claimed that wound closure with 2-octyl-cyanoacrylate has the advantages that band-aids are not needed in the postoperative period, that the wound can get in contact with water and that removal of stitches is not required. This would substantially enhance patient comfort, especially in times of reduced in-hospital stays. Postoperative wound infection is a well-known complication in spinal surgery. The reported infection rates range between 0% and 12.7%. The question arises if the advantages of wound closure with 2-octyl-cyanoacrylate in spinal surgery are not surpassed by an increase in infection rate. This study has been conducted to identify the infection rate of spinal surgery if wound closure was done with 2-octyl-cyanoacrylate. A total of 235 patients with one- or two-level surgery at the cervical or lumbar spine were included in this prospective study. Their pre- and postoperative course was evaluated. Analysis included age, sex, body mass index, duration and level of operation, blood examinations, 6-week follow-up and analysis of preoperative risk factors. The data were compared to infection rates of similar surgeries found in a literature research and to a historical group of 503 patients who underwent wound closure with standard skin sutures after spine surgery. With the use of 2-octyl-cyanoacrylate, only one patient suffered from postoperative wound infection which accounts for a total infection rate of 0.43%. In the literature addressing infection rate after spine surgery, an average rate of 3.2% is reported. Infection rate was 2.2% in the historical control group. No risk factor could be identified which limited the usage of 2-octyl-cyanoacrylate. 2-Octyl-cyanoacrylate provides sufficient wound closure in spinal surgery and is associated with a low risk of postoperative wound infection.
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Abstract
BACKGROUND Cyanoacrylate glue is commonly used for approximation of skin after various surgical procedures. METHOD We have written this illustrated article to educate junior doctors without any practical experience in using tissue glue. DISCUSSION The advantages of gluing the skin are that it is quick, saves theatre time, cheap, no stitches to remove and is waterproof. The disadvantage being it can be messy if not applied correctly.
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Affiliation(s)
- Rajaraman Durai
- Department of Surgery, University Hospital Lewisham, London, UK.
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