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Malhotra K, Bondje S, Sklavounos A, Mortada H, Khajuria A. Absorbable versus Nonabsorbable Sutures for Facial Skin Closure: A Systematic Review and Meta-analysis of Clinical and Aesthetic Outcomes. Arch Plast Surg 2024; 51:386-396. [PMID: 39034976 PMCID: PMC11257736 DOI: 10.1055/a-2318-1287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 04/15/2024] [Indexed: 07/23/2024] Open
Abstract
When repairing facial wounds, it is crucial to possess a thorough understanding of suitable suture materials and their evidence base. The absence of high-quality and comprehensive systematic reviews poses challenges in making informed decisions. In this study, we conducted a review of the existing literature and assessed the quality of the current evidence pertaining to the clinical, aesthetic, and patient-reported outcomes associated with absorbable and nonabsorbable sutures for facial skin closure. The study was registered on Prospective Register of Systematic Reviews. We conducted searches on Embase, Ovid, and PubMed/MEDLINE databases. Only randomized controlled trials (RCTs) were eligible for inclusion in this study. Additionally, the risk of bias in the randomized studies was assessed using Cochrane's Risk of Bias Tool. The study included a total of nine RCTs involving 804 participants with facial injuries. Among these injuries, absorbable sutures were utilized in 50.2% (403 injuries), while nonabsorbable sutures were employed in 49.8% (401 injuries). The analysis of cosmesis scales revealed no statistically significant difference between absorbable and nonabsorbable sutures regarding infections ( p = 0.72), visual analog scale ( p = 0.69), wound dehiscence ( p = 0.08), and scarring ( p = 0.46). The quality of the included studies was determined to have a low risk of bias. Absorbable sutures can be considered a suitable alternative to nonabsorbable sutures, as they demonstrate comparable aesthetic and clinical outcomes. Future high-quality studies with a level I evidence design and cost-effectiveness analysis are necessary to enhance clinician-patient shared decision-making and optimize the selection of suture materials. Level of evidence is I, risk/prognostic study.
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Affiliation(s)
- Kashish Malhotra
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Sophie Bondje
- Department of ENT Surgery & Cancer Services, Torbay Hospital, Torquay, United Kingdom
| | - Alexandros Sklavounos
- Urology Division, Department of Surgery, Addenbrooke's Hospital, University of Cambridge, United Kingdom
| | - Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Plastic Surgery and Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ankur Khajuria
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
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Tatalović V, Marinković M, Perić R, Belopavlović R. Absorbable vs. non-absorbable suture: which one gives better results? Ir J Med Sci 2024:10.1007/s11845-024-03710-9. [PMID: 38771464 DOI: 10.1007/s11845-024-03710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND There is no ideal suture material or ideal sewing technique. The type of suture material affects the quality of the scars. Patient and surgeon satisfaction with the quality and comfort of the scar is one of the main goals of modern surgery. AIMS This study aims to compare the quality of scars and patient satisfaction after using two different types of sutures. METHODS This research was conducted as a prospective study that included 64 patients whose surgical wounds were closed with intradermal suture using different suturing materials according to which the patients were divided into two groups: absorbable - Monocryle (32) and non-absorbable - DemeLENE suture (32). POSAS scale and an ultrasound machine were used to assess the scars. The doctor and the patient evaluated seven parameters on two occasions, after 2 and 6 weeks after the surgery. RESULTS The statistically significant advantage was found after 2 weeks in scars sewn with non-resorptive suture in terms of elasticity, doctor's general impression, pain, itching, color, stiffness, thickness, irregularity, and patient's general impression. After 6 weeks, statistically significantly better results were shown on scars sewn with non-resorptive thread for the parameters doctor's general impression, itching, irregularity, and patient's general impression. CONCLUSIONS Non-resorptive sutures show statistically significantly better results, especially after 2 weeks from the patient's point of view so we consider them more comfortable and convenient to use.
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Affiliation(s)
- Vanja Tatalović
- Clinic for Plastic and Reconstructive Surgery, University Clinical Center of Vojvodina, Novi Sad, Serbia.
- Medical Faculty Novi Sad, University of Novi Sad, Novi Sad, Serbia.
| | - Marija Marinković
- Clinic for Plastic and Reconstructive Surgery, University Clinical Center of Vojvodina, Novi Sad, Serbia
- Medical Faculty Novi Sad, University of Novi Sad, Novi Sad, Serbia
| | - Radmila Perić
- Medical Faculty Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Clinic for Radiology, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Radomir Belopavlović
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Novi Sad, Serbia
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Tajmiri G, Sh ME. Effect of the absorption rate of suture material on oral mucosal scar formation: A triple-blind randomized controlled trial. Heliyon 2024; 10:e23054. [PMID: 38223718 PMCID: PMC10784138 DOI: 10.1016/j.heliyon.2023.e23054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/28/2023] [Accepted: 11/24/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Extensive oral mucosal scar formation following LeFort-I osteotomy can pose patients with several scar-related complications in case of function as well as cosmesis. The present study aimed to evaluate the effect of the absorption rate of Vicryl Rapide and Vicryl on oral mucosal scar formation. Material and methods In a triple-blind randomized controlled trial study, Vicryl and Vicryl Rapide were used randomly for wound closure on the left and right sides of the LeFort-I incision line. Three maxillofacial surgeons evaluated mucosal scars on each side two and four months post-surgically using Mucosal Scarring Index (MSI). Results The differences in the total scores of MSI between the Vicryl and Vicryl Rapide groups were not significant, neither in the anterior nor in the posterior areas (Paired t-test, df = 25, CI = 95 %, P-value >0.05). Conclusion The results of the present study demonstrated that Vicryl Rapide is comparable to Vicryl suture material regarding the mucosal scar formation following LeFort-I osteotomy surgery; therefore, it could be considered for such oral surgical procedures.
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Affiliation(s)
- Golnaz Tajmiri
- Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Milad Etemadi Sh
- Department of Oral and Maxillofacial Surgery, Dental Implants, Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Guan X, Yan H, Zhang J, Li Y, Zhou Y. Risk factors of infection of totally implantable venous access port: A retrospective study. J Vasc Access 2023; 24:1340-1348. [PMID: 35389296 DOI: 10.1177/11297298221085230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Infection is the most frequent complication associated with the use of totally implantable venous access port (TIVAP). This retrospective study was conducted to determine the risk factors affecting TIVAP-related infection. METHODS A total of 1406 patients implanted with TIVAP at our center were included in this retrospective study. Incidence of perioperative infection, patient characteristics and bacteriologic data were retrieved and analyzed. Univariable analyses and multiple logistic regression analyses were used to determine the risk factors. RESULTS Overall, 72 (5.1%) patients had perioperative infection, and TIVAP was finally removed from 12 (0.85%) patients. There was significantly more hematologic malignancy in the infection group, compared to the non-infection group. Patients with chemotherapy and infection within 30 days before operation also had more infections. There were more inpatients in the infection group than in the non-infection group. The rate of hematoma was higher in the infected patients. Multivariate logistic analysis revealed that hematoma (OR 5.695, p < 0.001), preoperative hospital stay (⩾14d) (OR 2.945, p < 0.001), history of chemotherapy (OR 2.628, p = 0.002), history of infection (within 30 days) (OR 4.325, p < 0.001) were independent risk factor for infection. CONCLUSIONS This study demonstrated that hematoma, preoperative hospital stay (⩾14d), history of chemotherapy and history of infection (within 30 days) are independent risk factor for all patients.
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Affiliation(s)
- Xiaonan Guan
- Center of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - He Yan
- Center of Intervention Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jianjun Zhang
- Center of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yanbing Li
- Center of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yiming Zhou
- Center of Intervention Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Gallop J, Andrasik W, Lucas J. Successful Use of Percutaneous Dissolvable Sutures During COVID-19 Pandemic: A Retrospective Review. J Cutan Med Surg 2023; 27:34-38. [PMID: 36471621 DOI: 10.1177/12034754221143083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had dramatic effects on all fields of medicine, including an effort to limit in-person visits. Within dermatologic surgery, one strategy is to close surgical incisions using percutaneous absorbable sutures. To the authors' knowledge, there are no large studies comparing changes in suture preferences and subsequent outcomes during the pandemic. OBJECTIVE To assess changes in suture preference and frequency of post-operative complications for percutaneous absorbable and non-absorbable sutures during the pandemic. METHODS A retrospective review of 1358 Mohs surgeries completed at the Cleveland Clinic during a 2-month period prior to COVID-19 and a matched 2-month period during the pandemic. RESULTS Sutures were used to close 1103 cases. Significantly more closures were performed with percutaneous absorbable sutures during COVID-19 (87.6%, 39.6%; P < .0001). There was no significant difference in the frequency of post-operative complications between suture materials (P = .48). The use of absorbable sutures were associated with a significantly higher frequency of suture hypersensitivity reaction (P = .020) but significantly lower frequency of infection (P = .021) and wound dehiscence (P < .0001). CONCLUSIONS Suture preference shifted towards absorbable sutures during the COVID-19 pandemic. Percutaneous absorbable sutures offered a formidable alternative to non-absorbable sutures and could reduce in-person follow-up visits without increasing post-operative complications.
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Affiliation(s)
- Joshua Gallop
- 2569 Cleveland Clinic Lerner College of Medicine, OH, USA
| | - Wyatt Andrasik
- 2569 Dermatology and Plastic Surgery Institute, Cleveland Clinic, OH, USA
| | - Jennifer Lucas
- 2569 Dermatology and Plastic Surgery Institute, Cleveland Clinic, OH, USA
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Kenny H, Jonas RH, Oyer S. Columellar Scar Following Open Rhinoplasty Using Absorbable Suture Versus Nonabsorbable Suture: A Meta-Analysis. Facial Plast Surg Aesthet Med 2023; 25:54-60. [PMID: 34516890 DOI: 10.1089/fpsam.2021.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objective: This meta-analysis seeks to determine whether a difference in long-term scar outcomes exists between absorbable and nonabsorbable sutures for closure of the columellar incision after open rhinoplasty. Review Methods: PubMed, OVID Medline, Conference Papers Index, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched using terms including "suture," "sutures," "absorbable," "columella," "columellar," "transcolumellar," "trans-columellar," "rhinoplasty," "septorhinoplasty," "scar," "scars," and "scarring," as well as associated MeSH terms. Results: Six studies with 435 patients were included for systematic review and meta-analysis, with five studies included in meta-analysis for patient-reported outcomes, and six studies included for physician-reported outcomes. There was no significant difference in scar appearance between the absorbable suture group and nonabsorbable group among both patient-reported and physician-reported outcomes. Conclusion: This meta-analysis of six studies meeting inclusion criteria does not demonstrate a significant difference in long-term scar appearance based on suture type after open rhinoplasty.
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Affiliation(s)
- Hannah Kenny
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Rachel H Jonas
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Samuel Oyer
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
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Alkandari AF, Soliman DM, Madhyastha S, Alawadhi AA, Alawadhi FA, Almotairi NM, Alozairi O. Using Absorbable Sutures for Traumatic Wound Closure to Avoid Additional Hospital Visits for Suture Removal During the COVID-19 Pandemic: A Randomized Controlled Trial. Cureus 2022; 14:e30012. [DOI: 10.7759/cureus.30012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
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Ceylan ME, Balıkçı HH. Comparison of scar outcomes of alar flare region using absorbable and non-absorbable sutures: a single-blind study. Braz J Otorhinolaryngol 2022; 88 Suppl 5:S133-S139. [PMID: 35729041 PMCID: PMC9801037 DOI: 10.1016/j.bjorl.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/27/2022] [Accepted: 06/05/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Formation of scar on the face after septorhinoplasty may disturb the patient due to cosmetic concerns. One of the main factors affecting scar outcomes is probably the suture material used. The aim of this study was to examine the effect of different suture materials on scar outcomes of alar base in patients undergoing septorhinoplasty. METHODS Thirty-one patients who underwent alar base intervention during primary septorhinoplasty were divided into two groups according to the suture material used as the Polypropylene group (n = 16), (Polypropylene, Prolene 6/0; Ethicon Inc., Somerville, NJ, USA) and the Polyglactin group (n = 15), (Irradiated polyglactin 911, Vicryl Rapid™ 6/0; Ethicon Inc., Somerville, NJ, USA). The scar outcomes of alar base were compared between the Polypropylene and Polyglactin groups. The modified Stony Brook Scar Evaluation Scale was used to measure wound healing results at one and 12-months postoperatively for objective evaluation. Patient satisfaction questionnaire was used for subjective evaluation. RESULTS There were no statistically significant differences in the Stony Brook Scar Evaluation Scale and patient questionnaire scores between Polypropylene and Polyglactin groups. Irradiated Vicryl Rapid had poor cosmetic outcomes in the alar base when compared to polypropylene, indicating no statistically significant difference. CONCLUSION Both sutures can be used for closure of alar base considering their advantages and disadvantages, in patients undergoing septorhinoplasty. LEVEL OF EVIDENCE Treatment Benefits; Level 2 (Randomized Trial).
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Affiliation(s)
- Mehmet Emrah Ceylan
- Isparta Davraz Yasam Hospital, Department of Otolaryngology, Isparta, Turkey.
| | - Hasan Hüseyin Balıkçı
- Isparta Davraz Yasam Hospital, Department of Otolaryngology, Isparta, Turkey; Private Otolaryngology Clinic, Antalya, Turkey
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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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Abboud J, Zezyk C, Boehmer AA, Bork F, Kaess BM, Ehrlich JR. Prospective randomized trial of skin closure for pacemaker implantation: absorbable vs. non-absorbable suture : PRO-PACE. Herzschrittmacherther Elektrophysiol 2022; 33:203-208. [PMID: 35230504 DOI: 10.1007/s00399-022-00847-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Pacemaker implantations have been performed for > 50 years, reaching 1.25 million implants worldwide per year. Despite this, only few randomized studies exist regarding technical aspects of the implantation procedure-in particular, wound closure. Accordingly, the authors compared absorbable vs. non-absorbable suture regarding wound healing. METHODS Consecutive patients scheduled for de novo pacemaker implantation without defibrillation therapy were prospectively randomized into two groups: non-absorbable (Prolene®, Ethicon Inc.) or absorbable suture (Monocryl®, Ethicon Inc.). The wound was systematically assessed for cosmetic outcome at 1 day, 6 weeks, and 1 year post implantation using the patient and observer scar assessment scale (POSAS). Adverse events noted included bleeding, pocket hematoma, infection, suture insufficiency, and revision surgery. RESULTS A total of 114 patients (mean age: 79 ± 10 years, n = 60 male) were randomized into the two groups. Of these, 105 completed follow-up (lost to follow-up: 7.9%). Groups were comparable for clinical characteristics or use of oral anticoagulants. There was no difference in cosmetic outcome and incidence of adverse events at any follow-up visit. POSAS scores were: 1 day: 1.4 ± 0.4 vs. 1.3 ± 0.4, P = 0.44, 6 weeks: 1.4 ± 0.6 vs. 1.4 ± 0.7, P = 0.57; 1 year: 1.4 ± 1.4 vs. 2.1 ± 3, P = 0.60. No pocket hematoma or infection occurred in either group. No additional surgery was necessary for local findings. Retrospectively, scar development was straight in the Prolene® group and slightly wavy with Monocryl®. CONCLUSION Suture material does not influence wound healing as represented by the cosmetic result and the occurrence of adverse events. The choice of suture material used should be left to the physician's discretion.
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Affiliation(s)
- Jaber Abboud
- St. Josefs-Hospital, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Celine Zezyk
- St. Josefs-Hospital, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | | | - Fabian Bork
- St. Josefs-Hospital, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Bernhard M Kaess
- St. Josefs-Hospital, Beethovenstr. 20, 65189, Wiesbaden, Germany
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Aldhabaan SA, Hudise JY, Aldosari BF. Comparison Between Using Monocryl Suture and Polypropylene Suture in Closure of Alar Base Excision in Rhinoplasty. Plast Surg (Oakv) 2022; 30:59-62. [PMID: 35096694 PMCID: PMC8793751 DOI: 10.1177/2292550320969651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Rhinoplasty is one of the most common procedures that act as a challenge for consistent outstanding results. Alar base reduction is a technique of rhinoplasty that is prescribed in many conditions. Wound closure requires using of sutures and there are several types of sutures for this purpose; however, good scar results are necessary for patients'satisfaction. AIM To evaluate alar base resection scar results after surgical resection using different types of suturing material. METHODS This is a retrospective cohort study that was conducted at King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia. The study was performed by reviewing patient's records and performing post-operative photography for patient who underwent alar base resection. The patients were divided into 2 groups, the first group of patients had the alar base wound closed with interrupted Polypropylene 6/0 and the other group wound was closed with monocryl 6/0 sutures. Visual analog scale was used to investigate basal views. RESULTS The study included 80 patients divided into 2 groups, each group included 40 patients, in the first group (Polypropylene group) there were 25% males and 75% females, whereas in the second group (monocryl) there were 15% and 85% males and females, respectively. There were 85% and 82.5% unnoticeable scar reported by the first and second group, respectively; however there was no significant difference between the 2 groups (P = .75). CONCLUSION Both Polypropylene and monocryl sutures result in the same result for closing alar base wound post surgically.
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Affiliation(s)
- Saud A. Aldhabaan
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, Riyadh, Saudi Arabia,Saud A. Aldhabaan, Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia; King Fisal Medical City of Southern Region, Abha, Saudi Arabia.
| | - Jibril Y. Hudise
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Badi F. Aldosari
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
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Wound Closure with Transcutaneous Absorbable Polyglactin Sutures after Hidradenitis Suppurativa Excision. Adv Skin Wound Care 2022; 35:1-4. [PMID: 35050922 DOI: 10.1097/01.asw.0000805360.14633.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Wide surgical excision is the standard treatment for severe hidradenitis suppurativa (HS). Because of the nature of HS, these wounds are often nonsterile, located in moist intertriginous regions, and closed under tension, increasing the risk for surgical site complications. Although uncommon, absorbable sutures may confer benefits over nonabsorbable material for skin closure. Accordingly, the authors evaluated the use of absorbable, braided, transcutaneous polyglactin sutures after wide surgical excision of HS. METHODS The authors performed a retrospective chart review for all consecutive patients who underwent wide surgical excision of HS at a tertiary university hospital between January 2009 and March 2020. RESULTS Sixty consecutive patients with 174 operative sites were included in the study. The surgical site complication rate was 17.8%. Postoperative complications included wound dehiscence (n = 18), surgical site infection (n = 2), and scar contracture (n = 1). Sutures were removed from 12 (6.9%) operative sites. Factors influencing complications were Hurley grade and area of excision. Complications did not differ significantly among disease locations (P = .6417). CONCLUSIONS The results support the growing evidence that absorbable sutures are an appropriate option after wide surgical excision of HS.
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Lanzano G, Lanzano G, Faenza M, Izzo S, Ferraro G, Nicoletti G. Absorbable vs. non-absorbable sutures in plastic and dermatologic surgery procedures during the COVID-19 pandemic: Which would you prefer? J Cutan Aesthet Surg 2022; 15:202-203. [PMID: 35965900 PMCID: PMC9364445 DOI: 10.4103/jcas.jcas_130_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vaid R, Yildirim E, Pasquinelli MA, King MW. Hydrolytic Degradation of Polylactic Acid Fibers as a Function of pH and Exposure Time. Molecules 2021; 26:molecules26247554. [PMID: 34946629 PMCID: PMC8706057 DOI: 10.3390/molecules26247554] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
Polylactic acid (PLA) is a widely used bioresorbable polymer in medical devices owing to its biocompatibility, bioresorbability, and biodegradability. It is also considered a sustainable solution for a wide variety of other applications, including packaging. Because of its widespread use, there have been many studies evaluating this polymer. However, gaps still exist in our understanding of the hydrolytic degradation in extreme pH environments and its impact on physical and mechanical properties, especially in fibrous materials. The goal of this work is to explore the hydrolytic degradation of PLA fibers as a function of a wide range of pH values and exposure times. To complement the experimental measurements, molecular-level details were obtained using both molecular dynamics (MD) simulations with ReaxFF and density functional theory (DFT) calculations. The hydrolytic degradation of PLA fibers from both experiments and simulations was observed to have a faster rate of degradation in alkaline conditions, with 40% of strength loss of the fibers in just 25 days together with an increase in the percent crystallinity of the degraded samples. Additionally, surface erosion was observed in these PLA fibers, especially in extreme alkaline environments, in contrast to bulk erosion observed in molded PLA grafts and other materials, which is attributed to the increased crystallinity induced during the fiber spinning process. These results indicate that spun PLA fibers function in a predictable manner as a bioresorbable medical device when totally degraded at end-of-life in more alkaline conditions.
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Affiliation(s)
- Radhika Vaid
- Fiber and Polymer Science Program, Wilson College of Textiles, NC State University, Raleigh, NC 27606, USA; (R.V.); (M.A.P.)
| | - Erol Yildirim
- Department of Chemistry, Middle East Technical University, 06800 Ankara, Turkey;
| | - Melissa A. Pasquinelli
- Fiber and Polymer Science Program, Wilson College of Textiles, NC State University, Raleigh, NC 27606, USA; (R.V.); (M.A.P.)
- Department of Forest Biomaterials, College of Natural Resources, NC State University, Raleigh, NC 27606, USA
| | - Martin W. King
- Fiber and Polymer Science Program, Wilson College of Textiles, NC State University, Raleigh, NC 27606, USA; (R.V.); (M.A.P.)
- College of Textiles, Donghua University, Shanghai 201620, China
- Correspondence: ; Tel.: +1-919-291-2563
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15
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Rezaei E, Farhadi H, Khaniki SH, Zarei H, Hojjati YS. Surgical wounds in reduction mammoplasty: a comparison of Monocryl and Prolene sutures on scars. J Wound Care 2021; 30:626-630. [PMID: 34382853 DOI: 10.12968/jowc.2021.30.8.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The type of suture material affects the quality of scars. The aim of this study was to find the superior suture material for reduction mammoplasty between Prolene and Monocryl based on the comparison of scars. METHOD A prospective observational study was conducted at a university-based hospital in Mashhad, Iran between October 2015 and September 2017. Monocryl and Prolene suture materials, used for closing the outermost layer in mammoplasty, were compared. Patients' incision scars were assessed objectively according to the Patient and Observer Scar Assessment (POSAS) criteria. The relevant CONSORT guideline was used for reporting this study. RESULTS Seventy-eight women with a mean age of 36.8±9.5 years were entered into the study. The frequency of wound healing in both groups was 97.4% 1 month after surgery and by the third visit, 3 months after surgery, only one patient had a stretched scar. Moreover, wound inflammation in the first two visits was less frequent in the Prolene group that healed completely 3 months after surgery (after excluding the one patient with wide scar inflammation). The frequency of itching of the wound in the Monocryl group was 24.4%, 11.5% and 12.8% in the three follow-up visits, respectively, and the values for the Prolene group were 24.4%, 9.0% and 6.4%, respectively. No significant difference was seen between the two groups in terms of wound healing, inflammation and itching (p>0.05). Overall, 94.8% of patients were satisfied with the surgery. CONCLUSIONS Our study revealed that there was no significant difference between Monocryl and Prolene. Hence, either of the two suture materials can be used for wound closure in reduction mammoplasty.
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Affiliation(s)
- Ezzatollah Rezaei
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Farhadi
- Department of Plastic Surgery, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeedeh Hajebi Khaniki
- Student Research Committee, Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamzeh Zarei
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yavar Shams Hojjati
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Niederstätter IM, Schiefer JL, Fuchs PC. Surgical Strategies to Promote Cutaneous Healing. Med Sci (Basel) 2021; 9:medsci9020045. [PMID: 34208722 PMCID: PMC8293365 DOI: 10.3390/medsci9020045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 12/27/2022] Open
Abstract
Usually, cutaneous wound healing does not get impeded and processes uneventfully, reaching wound closure easily. The goal of this repair process is to restore the integrity of the body surface by creating a resilient and stable scar. Surgical practice and strategies have an impact on the course of wound healing and the later appearance of the scar. By considering elementary surgical principles, such as the appropriate suture material, suture technique, and timing, optimal conditions for wound healing can be created. Wounds can be differentiated into clean wounds, clean–contaminated wounds, contaminated, and infected/dirty wounds, based on the degree of colonization or infection. Furthermore, a distinction is made between acute and chronic wounds. The latter are wounds that persist for longer than 4–6 weeks. Care should be taken to avoid surgical site infections in the management of wounds by maintaining sterile working conditions, using antimicrobial working techniques, and implementing the principles of preoperative antibiotics. Successful wound closure is influenced by wound debridement. Wound debridement removes necrotic tissue, senescent and non-migratory cells, bacteria, and foreign bodies that impede wound healing. Additionally, the reconstructive ladder is a viable and partially overlapping treatment algorithm in plastic surgery to achieve successful wound closure.
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Erol O, Buyuklu F, Koycu A, Jafarov S, Gultekin G, Erbek SS. Comparison of Rapid Absorbable Sutures with Nonabsorbable Sutures in Closing Transcolumellar Incision in Septorhinoplasty: Short-term Outcomes. Aesthetic Plast Surg 2020; 44:1759-1765. [PMID: 32700009 DOI: 10.1007/s00266-020-01864-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Following open rhinoplasty, a postoperative scar at the columellar incision line is a common morbidity. The aim of this study is to compare absorbable and nonabsorbable suture materials which had been used for closing the transcolumellar incision, in the aspect of risk of postoperative infection, wound healing, postoperative columellar scar and patient satisfaction. METHOD A prospective, randomized, single-blind study was conducted between May 2017 and February 2018. Sixty-four rhinoplasty patients were randomly assigned to absorbable (n = 32) or nonabsorbable (n = 32) groups. The columellar incision was closed with 7 full-thickness skin sutures. Either nonabsorbable 6/0 polypropylene (Group 1) or absorbable 6/0 polyglytone 6211 (Group 2) sutures were placed at the columellar incisions. Polypropylene sutures were removed at the 7th postoperative day. A Mann-Whitney U test and Monte Carlo were used for statistical comparison. Photographs of the patients at the postoperative third month (Fig. 2) were evaluated and scored in terms of scarring, pigmentation, notching, level differences in the incision area by two different otorhinolaryngologists who did not know the randomization. Suture removing discomfort was assessed with visual analogue scale scores. A satisfaction survey was filled out by all the patients completing their third month after the operation. RESULTS According to the results of both otorhinolaryngologists, there was no significant difference between the two groups in terms of pigmentation, level difference, notching, overall appearance and total score (p = 0.920, p = 0.498, respectively). The mean score on the Wong-Baker scale was 3.19 ± 1.67 in group 1. In the Satisfaction Survey, the average score of the group 1 was 6.90 ± 3.24, while the mean score of the group 2 was 7.062 ± 2.77. There was no statistically significant difference between the two groups (p = 0.715). CONCLUSIONS Suturing inverted V transcolumellar incisions with rapid resorbable sutures caused significantly less discomfort but no difference in scarring compared to nonresorbable sutures as evaluated by patients and observers. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ozan Erol
- Department of Otorhinolaryngology, Elmadag Hulusi Alatas State Hospital, Ankara, Turkey.
| | - Fuat Buyuklu
- Department of Otorhinolaryngology, Baskent University Hospital, Ankara, Turkey
| | - Alper Koycu
- Department of Otorhinolaryngology, Baskent University Hospital, Ankara, Turkey
| | - Sabuhi Jafarov
- Department of Otorhinolaryngology, Baskent University Hospital, Ankara, Turkey
| | - Goknil Gultekin
- Department of Otorhinolaryngology, Baskent University Hospital, Ankara, Turkey
| | - Selim S Erbek
- Department of Otorhinolaryngology, Baskent University Hospital, Ankara, Turkey
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18
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Zhu W, Nie X, Tao Q, Yao H, Wang DA. Interactions at engineered graft-tissue interfaces: A review. APL Bioeng 2020; 4:031502. [PMID: 32844138 PMCID: PMC7443169 DOI: 10.1063/5.0014519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
The interactions at the graft-tissue interfaces are critical for the results of engraftments post-implantation. To improve the success rate of the implantations, as well as the quality of the patients' life, understanding the possible reactions between artificial materials and the host tissues is helpful in designing new generations of material-based grafts aiming at inducing specific responses from surrounding tissues for their own reparation and regeneration. To help researchers understand the complicated interactions that occur after implantations and to promote the development of better-designed grafts with improved biocompatibility and patient responses, in this review, the topics will be discussed from the basic reactions that occur chronologically at the graft-tissue interfaces after implantations to the existing and potential applications of the mechanisms of such reactions in designing of grafts. It offers a chance to bring up-to-date advances in the field and new strategies of controlling the graft-tissue interfaces.
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Affiliation(s)
- Wenzhen Zhu
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 70 Nanyang Drive, Singapore 637457
| | - Xiaolei Nie
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 70 Nanyang Drive, Singapore 637457
| | - Qi Tao
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225009, Jiangsu, People's Republic of China
| | - Hang Yao
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225009, Jiangsu, People's Republic of China
| | - Dong-An Wang
- Authors to whom correspondence should be addressed: and
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19
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Moran B, Humphrey S, Seal A, Berkowitz J, Zloty D. Photographic assessment of postsurgical facial scars epidermally sutured with rapidly absorbable polyglactin 910 or nylon: A randomized clinical trial. J Am Acad Dermatol 2020; 83:1395-1399. [PMID: 32534080 DOI: 10.1016/j.jaad.2020.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/24/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Surgeons use absorbable and nonabsorbable sutures for epidermal wound closure. No large, randomized studies have compared the effect of these suture types on facial scar appearance. OBJECTIVE To assess postsurgical facial scar appearance using either rapidly absorbable polyglactin 910 or nylon for epidermal closure. METHODS Randomized, blinded, split-scar clinical trial. A total of 105 patients with facial wounds resulting from Mohs micrographic surgery excisions were randomly assigned for epidermal closure with rapidly absorbable 5-0 polyglactin 910 (Vicryl Rapide) on one half of the repair and 5-0 nylon (Ethilon) on the other half. Two physicians (1 dermatologist and 1 plastic surgeon), unaware of the original suture location, examined photographs of each healed wound at 6 months after surgery and graded the appearance of each half of the scar using the visual analog scale, wound evaluation scale, and Stony Brook Scar Evaluation Scale. RESULTS At 6 months, there was no significant difference in the combined mean (standard deviation) visual analog scale scores (83.1 [14.2] and 83.0 [13.7]), Stony Brook Scar Evaluation Scale scores (4.3 [0.9] and 4.4 [0.9]), or wound evaluation scale scores (5.3 [1.1] and 5.2 [1.1]) for rapidly absorbable polyglactin 910 versus nylon (P = .72, .57, and .21, respectively). LIMITATIONS Single institution. CONCLUSIONS Both rapidly absorbable polyglactin 910 and nylon sutures placed through the epidermis resulted in an equivalent photographic appearance of facial scars at 6 months after surgery.
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Affiliation(s)
- Benvon Moran
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada; Division of Dermatology, Queen's University, Kingston, Ontario, Canada.
| | - Shannon Humphrey
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Alexander Seal
- Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, Canada
| | - Jonathan Berkowitz
- Sauder School of Business, University of British Columbia, Vancouver, Canada
| | - David Zloty
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
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20
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Eisen DB, Zhuang AR, Hasan A, Sharon VR, Bang H, Crispin MK. 5-0 Polypropylene versus 5-0 fast absorbing plain gut for cutaneous wound closure: a randomized evaluator blind trial. Arch Dermatol Res 2020; 312:179-185. [PMID: 31724097 PMCID: PMC7192227 DOI: 10.1007/s00403-019-02009-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/05/2019] [Indexed: 11/28/2022]
Abstract
Mixed opinions exist regarding cosmetic outcomes of 5-0 fast absorbing plain (FG) gut relative to nonabsorbable suture material, such as 5-0 polypropylene (PP). High quality randomized trials comparing these two suture materials are lacking. To determine whether the use of PP during layered repair of linear cutaneous surgery wounds improves scar cosmesis compared to wound closure with FG. A randomized, split wound, comparative effectiveness trial was undertaken. Patients were evaluated 3 months after the intervention by two blinded physicians using the validated patient observer scar assessment scale (POSAS). Patient assessments were also captured using the same instrument as well as scar width and complications. The mean sum of the six components of the POSAS was 10.26 vs 12.74 for PP and FG, respectively, significantly (p < 0.001) in favor of PP. Mean observer overall opinion similarly showed better outcomes for PP than for FG [1.88 vs 2.52, respectively (p < 0.006)]. The mean sum of the patient assessed components of the POSAS for PP and FG was 12.3 vs 14.34, respectively (p = 0.11). Patient overall opinion significantly favored PP (2.41 vs 3.14, p = 0.043). PP resulted in small but statistically significant better cosmetic outcomes than FG. Pain experienced during suture removal was minimal for most patients.
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Affiliation(s)
- Daniel Brian Eisen
- Department of Dermatology, University of California Davis Medical Center, 3301 C St., Suite 1400, Sacramento, CA, 95816, USA.
| | - Anne Rang Zhuang
- Laser and Skin Surgery Center of Northern California, 3835 J St, Sacramento, CA, 95816, USA
- Union Square Dermatology, 450 Sutter St. #830, San Francisco, CA, 94108, USA
| | - Aliza Hasan
- Department of Dermatology, University of California Davis Medical Center, 3301 C St., Suite 1400, Sacramento, CA, 95816, USA
| | - Victoria Rose Sharon
- Department of Dermatology, Zucker School of Medicine At Hofstra/Northwell, 1991 Marcus Ave, Suite 300, New Hyde Park, NY, 11040, USA
| | - Heejung Bang
- Division of Biostatistics, University of California, Davis, CA, USA
| | - Milene Kennedy Crispin
- California Skin Institute, 9781 Blue Larkspur Ln, Monterey, CA, 93940, USA
- Salinas Valley Imaging Center, 559 Abbott Street, Salinas, CA, 93901, USA
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21
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Koroglu N, Temel Yuksel I, Aslan Cetin B, Aytufan Z, Deniz N, Akca A, Yetkin Yildirim G, Yuksel A. Skin closure at cesarean section, polypropylene versus polyglactin 910: a randomized controlled study. J Matern Fetal Neonatal Med 2020; 35:1088-1092. [PMID: 32228099 DOI: 10.1080/14767058.2020.1743654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: To compare the rates of surgical wound infection in women who have undergone cesarean delivery with subcuticular skin closure with polyglactin 910 or polypropylene.Methods: Between April 2018 and October 2018, patients who had undergone a cesarean delivery for any reason were randomized with polyglactin 910 or polypropylene for subcuticular skin closure. Participants were evaluated for wound complications on day 7 and 30 postoperatively. The primary outcome was surgical site infection within the first 30 days following delivery. In addition, factors affecting surgical site infections were analyzed by binary regression.Results: A total of 220 women who had undergone cesarean delivery were randomized and 213 were included in the final analysis. The groups were similar in terms of demographic characteristics and perioperative features. No statistically significant difference was observed between the groups in terms of wound complications or superficial site infections (8.3% in the polypropylene group versus 10.6% in the polyglactin 910 group, p = .642). Similarly, no difference was observed between the groups in terms of other wound complications. A binary logistic regression analysis indicated that superficial wound site infection was not affected by gravidity, BMI, duration of operation, repeated or unplanned cesarean delivery.Conclusion: It was observed that surgical site infections and other wound complications in skin closures with polyglactin 910 were similar to those with polypropylene.
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Affiliation(s)
- Nadiye Koroglu
- Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital, Istanbul, Turkey
| | - Ilkbal Temel Yuksel
- Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital, Istanbul, Turkey
| | - Berna Aslan Cetin
- Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital, Istanbul, Turkey
| | - Zubeyde Aytufan
- Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital, Istanbul, Turkey
| | - Necip Deniz
- Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital, Istanbul, Turkey
| | - Aysu Akca
- Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital, Istanbul, Turkey
| | - Gonca Yetkin Yildirim
- Department of Obstetrics and Gynecology, Istanbul Medipol University Faculty of Medicine, Fatih, Turkey
| | - Aytac Yuksel
- Department of Obstetrics and Gynecology, Beykent University, Istanbul, Turkey.,Maternal-Fetal Medicine Unit, Acıbadem University Atakent Hospital, Istanbul, Turkey
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22
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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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23
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Haley RM, Qian VR, Learn GD, von Recum HA. Use of affinity allows anti-inflammatory and anti-microbial dual release that matches suture wound resolution. J Biomed Mater Res A 2019; 107:1434-1442. [PMID: 30771234 DOI: 10.1002/jbm.a.36658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/01/2019] [Accepted: 02/09/2019] [Indexed: 11/08/2022]
Abstract
Surgical sutures are vulnerable to bacterial infections and biofilm formation. At the suture site, pain and undesirable, excess inflammation are additionally detrimental to wound healing. The development of a polymerized cyclodextrin (pCD) coated surgical suture introduces the capability to locally deliver both anti-inflammatory and anti-microbial drugs throughout the phases of acute and chronic healing. Local delivery allows for the improvement of wound healing while reducing related systemic side effects and drug resistance. Through testing, it has been shown that the fabrication of our pCD coating minimally affects the suture's mechanical properties. In vitro studies show measurable and consistent drug delivery for nearly 5 weeks. The therapeutic level of this delivery is sufficient to show inhibition of bacterial growth for 4 weeks, and free-radical scavenging (an in vitro anti-inflammatory activity approximation) for 2 weeks. With this pCD coating technique, we maintain clinical performance standards while also introducing a long-term dual delivery system relevant to the wound healing timeframe. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2019.
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Affiliation(s)
- Rebecca M Haley
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106
| | - Victoria R Qian
- Department of Bioengineering, University of California, Berkeley, California 94720
| | - Greg D Learn
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106
| | - Horst A von Recum
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106
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24
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Liu S, Wang Y, Kotian RN, Li H, Mi Y, Zhang Y, He X. Comparison of Nonabsorbable and Absorbable Suture in Total Knee Arthroplasty. Med Sci Monit 2018; 24:7563-7569. [PMID: 30350827 PMCID: PMC6354634 DOI: 10.12659/msm.910785] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Wound closure of KA is important for postoperative rehabilitation. At present there is still no consensus on the best wound closure technique for KA. We performed the present study to determine whether absorbable suture is better than nonabsorbable suture in total knee arthroplasty (TKA). Material/Methods A total of 180 patients who underwent TKA were divided into 3 groups: 80 cases of nonabsorbable suture, 50 cases of 2-0 absorbable suture, and 50 cases of 4-0 absorbable suture. The time required for closure, frequency of gauze change, length of stay in hospital, adverse events, range of motion (ROM) after 3 months postoperatively, and VAS score of wounds were calculated. Comparison was made to explore any significant differences between different groups. Results There were significant differences between the nonabsorbable group and the absorbable group with regards to closure time, frequency of gauze change, and hospital length of stay (LOS). Closure time was longer in the absorbable group than in the nonabsorbable group. Frequency of gauze change, hospital LOS, and adverse events were lower, and VAS was higher in the absorbable group. Closure time was longer in the 4-0 absorbable group than in the 2-0 group. There was no significant difference between the 4-0 group and 2-0 group in other variables. There was no significant difference in long-term ROM among all groups. Conclusions Absorbable suture in TKA reduces the incidence of fatty liquefaction, frequency of gauze change, and postoperative LOS. It improves the cosmetic appearance and overall reduces the economic cost. There was no significant effect on early and long-term functional ROM. In conclusion, absorbable suture can be used in TKA when appropriately indicated.
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Affiliation(s)
- Shuguang Liu
- Department of Orthopedics, Second Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland).,Department of Joint Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
| | - Yunmei Wang
- Department of Medical Oncology, Shaanxi Provincial Cancer Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
| | - Ronak N Kotian
- Department of Orthopedics, Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Hui Li
- Department of Joint Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
| | - Yufei Mi
- Department of Joint Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland).,Department of Orthopedics, Orthopedic Hospital of Henan Province, Luoyang, Henan, China (mainland)
| | - Yumin Zhang
- Department of Joint Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
| | - Xijing He
- Department of Orthopedics, Second Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China (mainland)
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25
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Aboul-Fettouh N, Marzolf S, Smith JM, Srivastava D, Nijhawan RI. Patient satisfaction and preference for absorbable versus nonabsorbable sutures for linear repairs. J Am Acad Dermatol 2018; 79:561-562. [DOI: 10.1016/j.jaad.2018.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 01/24/2018] [Accepted: 02/03/2018] [Indexed: 10/18/2022]
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Comparison of Subcuticular and Interrupted Suturing Methods for Skin Closure After Appendectomy: A Randomized Controlled Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2018. [DOI: 10.5812/ircmj.14469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
BACKGROUND Traumatic lacerations to the skin represent a fairly common reason for seeking emergency department care. Although the incidence of lacerations has decreased over the past decades, traumatic cutaneous lacerations remain a common reason for patients to seek emergency department care. OBJECTIVE Innovations in laceration management have the potential to improve patient experience with this common presentation. DISCUSSION Studies have confirmed that delays in wound closure rarely confer increased rates of infection, although comorbidities such as diabetes, chronic renal failure, obesity, human immunodeficiency virus, smoking, and cancer should be considered. Antibiotics should be reserved for high-risk wounds, such as those with comorbidities, gross contamination, involvement of deeper structures, stellate wounds, and selected bite wounds. Topical anesthetics, which are painless to apply, have a role in select populations. In most studies, absorbable sutures perform similarly to nonabsorbable sutures and do not require revisit for removal. Novel atraumatic closure devices and expanded use of tissue adhesives for wounds under tension further erode the primacy of regular sutures in wound closure. Maintaining a moist wound environment with occlusive dressings is more important than previously thought. Most topical wound agents are of limited benefit. CONCLUSIONS Recent innovations in wound closure are allowing emergency physicians to shift toward painless, atraumatic, and rapid closure of lacerations.
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Ploegmakers IBM, Olde Damink SWM, Breukink SO. Alternatives to antibiotics for prevention of surgical infection. Br J Surg 2017; 104:e24-e33. [PMID: 28121034 DOI: 10.1002/bjs.10426] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/29/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Surgical-site infection (SSI) is still the second most common healthcare-associated infection, after respiratory tract infection. SSIs are associated with higher morbidity and mortality rates, and result in enormous healthcare costs. In the past decade, several guidelines have been developed that aim to reduce the incidence of SSI. Unfortunately, there is no consensus amongst the guidelines, and some are already outdated. This review discusses the recent literature regarding alternatives to antibiotics for prevention of SSI. METHODS A literature search of PubMed/MEDLINE was performed to retrieve data on the prevention of SSI. The focus was on literature published in the past decade. RESULTS Prevention of SSI can be divided into preoperative, perioperative and postoperative measures. Preoperative measures consist of showering, surgical scrubbing and cleansing of the operation area with antiseptics. Perioperative factors can be subdivided as: environmental factors, such as surgical attire; patient-related factors, such as plasma glucose control; and surgical factors, such as the duration and invasiveness of surgery. Postoperative measures consist mainly of wound care. CONCLUSION There is a general lack of evidence on the preventive effectiveness of perioperative measures to reduce the incidence of SSI. Most measures are based on common practice and perceived effectiveness. The lack of clinical evidence, together with the stability of the high incidence of SSI (10 per cent for colorectal procedures) in recent decades, highlights the need for future research.
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Affiliation(s)
- I B M Ploegmakers
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - S W M Olde Damink
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, University College London, London, UK
| | - S O Breukink
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
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