Comparison of gross and histologic tissue responses of skin incisions closed by use of absorbable subcuticular staples, cutaneous metal staples, and polyglactin 910 suture in pigs

An Experimental Design to Compare the Compatibility of Absorbable and Nonabsorbable Suture Materials in the Lateral Canthus Area

Polyglactin 910 (Vicryl) and polypropylene (Prolene) are common suture materials used in ophthalmic surgical procedures. However, there are limited studies assessing tissue reactions to different sutures in eyelid areas. In this study, these suture materials were used subcutaneously in 10 lateral canthi of 5 pigs. Clinical reactive score (CRS) was assessed 14 days and 60 days after surgery. On histology, subcutaneous tissue reactions were assessed by the presence of different inflammatory cells, and the aggregate tissue irritation score was calculated. CRS and the histology score did not differ between these sutures. None of the suture materials used were superior for use in the lateral canthi of pig eyes. Therefore, we recommend both of these sutures for use in the subcutaneous tissue of the eyelid area in animal experiments or clinical practice.

Zinc-based subcuticular absorbable staples: An in vivo and in vitro study

A zinc-nutrient element alloy (Zn-1.0Cu-0.5Ca) was developed into subcuticular absorbable staples (SAS) as a robust alternative to the commercially available poly(l-lactide-co-glycolide) (PLGA) SAS for the first time. The fixation properties of the Zn SAS were measured via pull-out tests and in-situ lap-shear pull-out test comparatively against the PLGA SAS. The Zn SAS exhibited fixation force of 18.9±0.2 N, which was over three times higher than that of PLGA SAS (5.5±0.1 N). The Zn SAS was used to close incision wounds in a SD rat model for biodegradability and biocompatibility characterisation at 1, 4 and 12 weeks. The Zn SAS showed uniform degradation behaviour after in vivo implantation at the average rate of 198±54, 112±28, and 70±24 μm/y after 1, 4, and 12 weeks, which reduced the fixation force to 16.8±1.1 N, 15.4±0.9 N, 12.7±0.7 N, respectively. These findings showed the potential of the Zn SAS for the closure of heavy loading and slowing healing tissues. The Zn SAS enabled successful closure and healing of the incision wound, similar to the PLGA staples. However, the slow long-term degradation rate of the Zn SAS may lead to unnecessary implant retention. In addition, the alloy SAS resulted in higher local foreign body responses due to their stiffness. Reducing the implant cross-section profile and applying low stiffness and a corrosion-accelerating coating are suggested as possible approaches to reduce post-service implant retention and improve the biocompatibility of the Zn SAS. STATEMENT OF SIGNIFICANCE: This work reports the fabrication of the first metallic subcuticular absorbable staples (SAS) made from Zn-Cu-Ca alloy for skin wound closure applications. The Zn-based SAS were characterised in vitro and in vivo (SD rat model) for biodegradability, fixation properties, biocompatibility and inflammatory responses, which were compared against the commercially available PLGA-based SAS. The Zn-based SAS provided a secure attachment of the full-thickness wounds on SD rats and allowed successful healing during the 12-week service period. In addition, the in vitro results showed that the Zn-based SAS provided more than three times higher fixation strength than the commercial PLGA, indicating the potential of the Zn-based SAS for load-bearing wound closure application.

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.

Contact Dermatitis in the Surgical Patient: A Focus on Wound Closure Materials

ABSTRACT

Irritant and allergic contact dermatitis from wound closure materials can occur in patients after surgical procedures. The resulting inflammation from contact dermatitis can compromise wound healing, mimic surgical site infections, and result in wound dehiscence. Components of wound closure material, such as antibiotic coatings, dyes, sterilizing compounds, or the material itself, have been implicated as contact allergens. This article provides the latest overview of the components of 3 major forms of wound closure materials-sutures, staples, and tissue adhesives-associated with contact dermatitis, discusses their cross-reactivity, and provides diagnostic and treatment guidelines.

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.

Skin closure with surgical staples in ankle fractures: a safe and reliable method

PURPOSE

The purpose of this study is to examine the rates of surgical site complications of staple closure versus suture closure following open reduction and internal fixation of closed unstable ankle fractures.

METHODS

Between 2014 and 2016, a total of 545 patients with closed ankle fractures were treated at our level-1 trauma centre by means of open reduction and internal fixation. A total of 360 patients matched the inclusion criteria and were included in the final analysis of this study. This included 119 patients undergoing wound closure using sutures and 241 patients using surgical staples. The demographics, clinical data, and injury characteristics were recorded. The primary outcome measure was the adverse event of any type of surgical site complication.

RESULTS

The overall rate of patients with a surgical site complication was 15.6%. There was a trend towards a higher risk of surgical site complication in patients undergoing wound closure with sutures as compared with staples (20.2% versus 13.3%); however, this difference was not statistically significant (P = 0.0897). The rate of superficial surgical site infection also trended higher in patients undergoing wound closure with sutures versus staples without demonstrating statistical significance (10.1% versus 5%, P = 0.0678). The rate of deep surgical site infection was similar in both groups.

CONCLUSION

The use of metal staples remains controversial in the setting of orthopedic surgery, particularly involving the foot and ankle. The current study supports that metal staples are a safe and reliable option in the closure of traumatic ankle fractures.

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.

Clinical and histologic tissue responses of skin incisions closed with glycomer 631 and lactomer 9-1 using a subcuticular technique in pigs

BACKGROUND

Glycomer 631 and lactomer 9-1 are absorbable suture materials indicated for soft tissue approximation in non-infected wounds. Pigs are often used as surgical models in translational research; however, reports of tissue reactions to both suture materials in pigs are limited. The aim of this study was to assess clinical and histologic responses of skin incisions closed with a subcuticular technique using glycomer 631 and lactomer 9-1 in pigs.

RESULTS

Skin incisions on 17 pigs were closed with glycomer 631 and lactomer 9-1, and a clinical reactive score (CRS) including erythema, swelling, discharge and dehiscence was calculated on postoperative days 7 and 14. Subcuticular tissue reaction was assessed histologically on postoperative day 14 (the presence of extravascular neutrophils, macrophages, multinucleated giant cells, lymphocytes, fibroblasts, bacterial colonies and the overall severity of the inflammatory response to the suture material), and the cumulative score of the variables was calculated as an aggregate tissue irritation score (ATIS). Tissue samples were examined for suture extrusion and evaluated microbiologically. The clinical reactive score did not differ between the suture materials. Only one ATIS variable, namely the overall severity of the inflammatory response, was lower (p = 0.029) when glycomer 631 was used. Suture extrusion was found in 10/17 of the incisions closed by glycomer 631 and in 7/13 of the incisions closed by lactomer 9-1. Trueperella pyogenes was isolated from the skin and from the area of tissue reaction in six pigs.

CONCLUSIONS

No difference in CRS between the suture materials was observed, and thus both materials may be used for the subcuticular technique in pigs. Glycomer 631 induced less tissue reaction only in terms of the overall severity of the inflammatory response. Suture extrusion was observed in more than 50% of incisions regardless of the suture material, possibly due to a large amount of suture material in the wound. Trueperella pyogenes was the only pathogen isolated from the tissue surrounding the suture material.

Comparative evaluation of metallic skin staples or polypropylene sutures for primary closure of teat wounds in sheep

AIMS

To compare stainless steel staples and polypropylene suture material for primary closure of wounds after teat amputation in ewes and to assess progress of healing in the presence or absence of intramammary infection (IMI).

METHODS

Chios-cross ewes, aged 3-5 years were randomly allocated to be infected in one teat with 1,200-1,500 cfu of Mannheimia haemolytica 5 days after parturition (groups A and B; n = 8 in each group) or remain uninfected (groups C and D; n = 4 in each group). On the following 4 days one teat from each ewe was amputated 2.5 cm from the teat end and the wound was closed using skin staples (groups A and C) or polypropylene sutures (groups B and D). Clinical evaluation of wound healing was performed between 1-21 days after surgery. On day 21 tissue sections were collected for tensiometric and histological evaluation.

RESULTS

The mean interval from the start to finish of wound closure was shorter when staples were used than when sutures were used (p < 0.001). Healing scores were lower (improved) for ewes in group A than B between days 1-7 after surgery (p = 0.005), but were similar between days 10-21 (p = 0.43). Healing scores were similar in groups C and D (p = 0.98). The tensile strain at maximum load was higher in tissue from group A than B (p = 0.001) and D (p = 0.004), but all other tensiometric measures were similar between groups. Histologically, collagen density was higher in sections from group A than B (p = 0.05) and D (p = 0.01), and angiogenesis was lower in sections from group A than B (p = 0.03) and D (p = 0.01).

CONCLUSIONS AND CLINICAL RELEVANCE

Skin staples and polypropylene sutures can be used effectively for primary closure of teat wounds, even in the presence of IMI. Skin staples had the advantage of a reduction in surgical time.

ABBREVIATION

IMI: intramammary infection.

Natural fiber reinforced biodegradable staples: Novel approach for efficient wound closure

Every year millions of lacerations and incisions taken place and require an effective methodology to manage the wound for a better life. The primary causes include mechanical trauma and surgical procedures. The rapid healing of the wound is critical to prevent further infection and reduction pain etc. Current options comprise of sutures, staplers, surgical strips and glues, again the intervention depends on the type of wound and the surgeon preference. The current wound closure techniques pose various potent limitations and confronting the problems to create a desired wound closure technique is necessary for faster and effective wound healing management. The surgical staplers are fast and easy to use wound closure devices, which approximates the edges of the wounds together by staples. The staples are mostly made up of metals like titanium and stainless steel. By modifying the existing stapling method using biodegradable staples that are expected to have good mechanical properties, not require removal procedure, minimized scarring and an overall acceleration in wound healing with minimal complications. Present, the paper focuses on the novel hypothesis on natural fiber reinforced biodegradable polymer staples as wound enclosures with high strength and degradability.

Staple versus suture closure for ankle fracture fixation: Retrospective chart review for safety and outcomes

INTRODUCTION/AIM

Recent comparisons of suture versus metal staple skin closure on the rates of wound complications in orthopaedic surgeries have yielded conflicting results. Several studies have since started to approach this question based on anatomic location, comparing suture versus staple closure in total hip and knee arthroplasty and acetabulum fracture surgery. Ankle fractures are one of the most commonly treated fractures by orthopaedic surgeons with unique challenges to skin closure due to the lack of subcutaneous support. However, to date there are no studies comparing superficial skin closure methods specifically in ankle surgery. The objective of this study was to evaluate the safety of staple versus suture closure for open fixation of acute traumatic ankle fractures.

METHODS

The medical records of patients treated at one institution by a single surgeon with open surgical fixation of an acute traumatic ankle fracture between 2011 and 2017 were retrospectively reviewed. Patients with less than 6 months of follow-up, polytrauma patients, diabetic patients, and patients with more than 3 medical comorbidities were excluded. Skin closure technique was determined by the presence or absence of metallic staples on postoperative imaging. Demographic variables, surgical characteristics, and postoperative outcomes up to one year were compared between patients who received superficial skin closure using staple versus suture techniques. Statistical analysis was performed using chi-squared tests and Fisher's exact tests, with p=0.05 used to denote statistical significance.

RESULTS

This study included 94 patients aged 18 to 75: two groups of 47 patients (Staple group and Suture group) that were demographically similar at baseline. Overweight and obese patients constituted the majority of the sample, 34% and 46% of patients, respectively. Current tobacco use was reported by 45% of patients. Fractures tended to be right-sided (63%), low energy (64%), and closed (98%), and the most common fracture types were bimalleolar (30%), lateral malleolar (24%), and pilon (19%) fractures. Ten patients (10.6%) developed local wound related complications within 4 months postoperatively, including five incidences of wound dehiscence, four superficial wound infections, and one deep infection. Eight patients (8.5%) required revision surgery due to wound related complications. There was no difference in the incidence of surgical site infections (p=0.361), local wound related complications (p=0.316), or revision surgeries (p=0.267) between wound closure techniques. Suture group patients required more staff in the operating room compared with staple group patients (p=0.001).

CONCLUSION

These results suggest that staples are a safe alternative to sutures for superficial skin closure in healthy, non-diabetic patients following open surgical fixation of acute traumatic ankle fractures. However, this retrospective, single-institution study was limited by the low number of available patients relative to the rare outcomes of interest. Larger, prospective studies are needed to validate the accuracy and generalizability of these results.

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.

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.

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.

Ultrafiltration of equine digital lamellar tissue

There are no experimentally validated pharmacological means of preventing laminitis; however, locally acting pharmaceutical agents with the potential to prevent laminitis have been identified. Demonstrating therapeutic drug concentrations in lamellar tissue is essential for evaluating the efficacy of these agents. The aim of this study was to develop an experimental technique for repeatedly sampling lamellar interstitial fluid. A technique for placing ultrafiltration probes was developed in vitro using 15 cadaver limbs. Subsequently, lamellar ultrafiltration probes were placed in one forelimb in six living horses. Interstitial fluid was collected continuously from the probes as ultrafiltrate for 4 (n = 4) or 14 days (n = 2). The rate of ultrafiltrate collection was calculated every 12 h. Biochemical analyses were performed on ultrafiltrate collected on night 1 (12-24 h post-implantation) and night 4 (84-96 h post-implantation). Sections surrounding the probe and control tissue from the contralateral limb were harvested, stained with H&E and Masson's trichrome and scored based on the tissue response to the probe. Ultrafiltration probes were placed in the lamellar tissue in all six horses. Ultrafiltrate was collected from these probes at 55 (30-63) μL/h (median [interquartile range]). Fluid production decreased significantly with time from night 3 onwards (P < 0.05). There was no significant change in the constituents of the ultrafiltrate between nights 1 and 4 (P > 0.05). The technique was well tolerated. This study demonstrates that ultrafiltration can be used to sample equine digital lamellar interstitial fluid, and has potential for measuring lamellar drug levels.

A novel foil flip-over system as the final layer in wound closure: excellent cosmetic results and patient comfort

BACKGROUND

Wound closure after excision is commonly done with sutures or staples. A new sutureless innovative wound closure system is available for sutureless skin closure.

OBJECTIVE

To evaluate wound healing, patient comfort, and cosmetic results of a foil flip-over system for excision of small skin lesion.

MATERIALS AND METHODS

Patients presenting to the department of Dermatology of Erasmus University Medical Center, Rotterdam, The Netherlands for skin surgery during a 1.5-year period were prospectively studied. Key outcome measures were wound healing, patient comfort, and cosmetic results. Three independent physicians scored photographs of the scars. Evaluation tools used were comfort and body image questionnaires and visual analogue scales.

RESULTS

Ninety-six patients with 103 lesions were included in our study. The surgeon scored wound healing as excellent or good in 96%. No wound infections occurred. Ninety-two percent of patients scored removal of the system as comfortable. Median patient grade of scar after 1 month was 8 out of 10 points (interquartile range [IQR] 7-9). Median independent physician grade of photographs of the scars was 7.7 (IQR 7.1-8.0).

CONCLUSION

Sutureless foil flip-over is promising, with excellent patient comfort characteristics and good to excellent cosmetic results.

Skin closure with subcuticular absorbable staples after cesarean section is associated with decreased analgesic use

PURPOSE

To determine if skin closure with subcuticular absorbable staples at the time of cesarean section is associated with decreased in-hospital analgesic use compared to skin closure with surgical steel staples.

METHODS

A retrospective cohort study was performed between 1 January 2005 and 31 December 2008 comparing in-hospital analgesic use after cesarean section between patients ,who underwent skin closure with surgical steel staples and subcuticular absorbable polyglycolic acid staples.

RESULTS

Eighty-nine subjects were included in the absorbable staple cohort and 95 were included in the steel staple group. There was a 1.5-fold decrease in ketorolac use (p < 0.0001) and a trend toward decreased ibuprofen use in the absorbable staple cohort (p = 0.06). There was no difference in hydrocodone/acetaminophen use between groups (p = 0.89).

CONCLUSIONS

Our results suggest that the use of subcuticular absorbable staples for skin closure at the time of cesarean section may lead to less in-hospital analgesic use, and thereby positively impact a patient's post-operative course. In addition, while reduced analgesic use may represent a small cost savings for each individual patient, there is the potential for significant savings when one considers the large number of cesarean sections performed in the US annually. Prospective studies will be required to assess the full impact of the use of this new skin closure technology.

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.

Effects of avotermin (transforming growth factor β3) in a clinically relevant pig model of long, full-thickness incisional wounds

BACKGROUND

The pig is an accepted species for evaluating the safety of molecules in dermal wound healing indications; however, the sizes of wounds assessed have not always been comparable to large incisions encountered clinically.

OBJECTIVE

To develop a clinically relevant model of incisional wounding in the Göttingen minipig for assessing the safety and tolerance of compounds in development to improve scarring.

METHODS

Intradermal avotermin (recombinant transforming growth factor β3 [TGFβ3]) up to 6,000 ng/100μL was administered twice to 20 cm full-thickness incisions.

RESULTS

Incisions were well tolerated in the minipig. Avotermin treatment was not associated with adverse changes in a range of clinical parameters, including wound healing and strength. Plasma TGFβ3 levels were transient with ≈0.1% bioavailability.

CONCLUSION

A clinically relevant model of long, full-thickness, sutured surgical incisions in the minipig is achievable. Avotermin is well tolerated in this model and does not adversely affect normal wound healing at levels that significantly exceed those doses to be used clinically in humans.

A randomized, prospective study of total hip wound closure with resorbable subcuticular staples

Resorbable subcuticular staples are a new way to close surgical wounds and have not been reported in the orthopedic literature. This randomized, controlled study compared a resorbable subcuticular staple system with stainless steel wound stapling in patients undergoing unilateral primary total hip arthroplasty (THA). Institutional Review Board approval and patient consent was obtained for all patients. Sixty patients (30 each group) were randomized to receive either resorbable subcuticular staples or stainless steel staples after primary THA. Incision length, number of staples used, and any staple insertion problems were recorded. Subjective reports of pain levels or incision complaints were solicited, and wound photographs were obtained on days 1 and 14 and 6 weeks postoperatively. The presence of wound drainage, erythema, wound separation, or echymosis was recorded at each visit, as well as all postoperative complications. The average incision length in the resorbable group was 13.2 cm and required 16 staples for closure, compared to 15 cm and 20 staples for the metal staple group. No infections occurred in either group, although the incidence of erythema and wound drainage at 2 weeks was higher for patients in the stainless steel group. One patient with metal staples had a postoperative hematoma requiring secondary irrigation and debridement. Patient satisfaction was higher with the resorbable staples. A resorbable subcuticular staple system can provide comparable wound closure to stainless steel staples following THA and may do so with less local discomfort, wound drainage, or erythematous reaction.

Risk factors for surgical site infection-inflammation in dogs undergoing surgery for rupture of the cranial cruciate ligament: 902 cases (2005-2006)

OBJECTIVE

To evaluate the incidence of and potential risk factors associated with development of postoperative infection-inflammation in a large number of dogs with rupture of the cranial cruciate ligament (CCL) that were treated via elective surgery.

DESIGN

Retrospective case series.

ANIMALS

808 dogs that underwent surgery (902 procedures) for rupture of the CCL.

PROCEDURES

Medical records of dogs that underwent extracapsular lateral suture (ECLS) stabilization or tibial plateau leveling osteotomy (TPLO) between January 1, 2005, and December 31, 2006, were reviewed. Data regarding development of postoperative infection-inflammation were obtained. Potential risk factors were identified and recorded.

RESULTS

496 ECLS surgeries were performed, and 406 TPLO surgeries were performed. Infection-inflammation developed in 55 of 902 (6.1%) surgeries within 6 months after surgery. There was a significant difference in infection-inflammation rate after the ECLS surgeries (21/496 [4.2%]), compared with rate after the TPLO surgeries (34/406 [8.4%]). Factors associated with a significantly lower rate of infection-inflammation included the use of suture material other than stainless-steel staples for skin closure and postoperative oral administration of antimicrobials.

CONCLUSIONS AND CLINICAL RELEVANCE

TPLO was associated with a significantly higher rate of infection-inflammation than the infection-inflammation rate after ECLS stabilization. The use of suture material other than staples for skin closure and postoperative oral administration of antimicrobials may be protective in minimizing infection-inflammation in dogs with rupture of the CCL that are treated via ECLS or TPLO.

Laser-assisted end-to-end BioWeld anastomosis in an ovine model

The BioWeld tube, an albumin-based exovascular stent, has been used for microsurgical anastomoses and compared to conventional sutures. The study presented investigated the potential of the BioWeld tube for vascular anastomosis in larger vessels. Laser-assisted BioWeld anastomoses were compared to conventional-sutured anatomoses of the carotid artery of Merino-x ewes. The BioWeld procedure resulted in 100% survival and 100% patency at 1 and 6 week post-operative periods, with no noticeable foreign body response. Sutured animals showed 100% survival and patency. The ischemic time for BioWeld anastomosis averaged 15 minutes compared with 10 minutes for sutures. This study indicates that the BioWeld tube is an easy to use anastomotic technique with equivalent success rates and comparable anastomotic times.

Surgical Stapling Devices in Veterinary Medicine: A Review

OBJECTIVES

To review indications, benefits, and complications of surgical stapling in animals.

STUDY DESIGN

Literature review.

RESULTS

Benefits and complications of surgical stapling depend on the procedure performed. Use of surgical staplers does not improve wound strength but may decrease surgical time.

CLINICAL RELEVANCE

In patients at significant risk for intraoperative contamination or morbidity from prolonged anesthesia time, use of stapling devices should be considered.