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Hu XY, Yang Q, Guan XY, Li JY, Wang LL, Li K, Zhang XT. Efficacy of surgical resection and ultra-reduced tension suture combined with superficial radiation in keloid treatment. World J Clin Cases 2023; 11:8310-8319. [PMID: 38130623 PMCID: PMC10731203 DOI: 10.12998/wjcc.v11.i35.8310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND There are many available treatment options for keloid; however, single treatments are usually less effective. Therefore, more scientifically rational and effective combined treatment methods should be sought to solve the pain associated with keloids. AIM To explore the efficacy and safety of surgical resection and ultra-reduced tension suture combined with superficial radiation as keloid treatment. METHODS Fifteen keloid patients admitted to Qingdao Eighth People's Hospital from June 2020 to January 2022 were enrolled in this retrospective analysis. All patients underwent a comprehensive treatment approach comprising surgical resection, ultra-reduced tension suture incision, and superficial radiation therapy within 24 h postoperatively. The modified Vancouver Scar Scale (mVSS) and Patient and Observer Scar Assessment Scale (POSAS) were used to evaluate the treatment effect, whereas the efficacy, adverse effects, and recurrence rate were observed according to the 12-mo follow-up after treatment. RESULTS The mVSS and POSAS scores at 1 and 6 mo after combination treatment decreased compared to before treatment (P < 0.001), and the overall response rate was 93.3%. Only one case recurred, yielding a 6.7% recurrence rate. The incidence of local chromour sedimentation rate in 1-3 mo after radiotherapy was 33.3% (5 patients), all subsiding after 6-9 mo, without complications, such as delayed wound healing or dermatitis. CONCLUSION Surgical resection, super subtraction sutures, and superficial radiotherapy are treatment methods with short courses, low recurrence rates, and good safety profiles.
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Affiliation(s)
- Xiao-Ying Hu
- Department of Cosmetic Medicine, Qingdao Eighth People’s Hospital, Qingdao 266100, Shandong Province, China
| | - Qiao Yang
- Department of Cosmetic Medicine, Qingdao Eighth People’s Hospital, Qingdao 266100, Shandong Province, China
| | - Xiao-Yu Guan
- Department of Cosmetic Medicine, Qingdao Eighth People’s Hospital, Qingdao 266100, Shandong Province, China
| | - Jin-Ying Li
- Department of Radiation Oncology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao 266042, Shandong Province, China
| | - Ling-Ling Wang
- Department of Cosmetic Medicine, Qingdao Eighth People’s Hospital, Qingdao 266100, Shandong Province, China
| | - Kun Li
- Department of Cosmetic Medicine, Qingdao Eighth People’s Hospital, Qingdao 266100, Shandong Province, China
| | - Xiao-Tao Zhang
- Department of Radiation Oncology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao 266042, Shandong Province, China
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The Origin and Development of Interrupted Subcuticular Suture: An Important Technique for Achieving Optimum Wound Closure. Dermatol Surg 2022; 48:619-624. [PMID: 35315801 PMCID: PMC9154294 DOI: 10.1097/dss.0000000000003437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Subcuticular suture is an important technique for achieving optimum wound closure, and there has been no comprehensive summary of subcuticular sutures to date. OBJECTIVE To summarize the origin and development of interrupted subcuticular suture to help clinicians improve their wound closure skills. MATERIALS AND METHODS A comprehensive review of subcuticular suture techniques was conducted in PubMed to summarize the advantages and disadvantages of various methods and clinical indications. RESULTS Buried suture is the oldest subcuticular suture technique, followed by buried vertical mattress suture, intracutaneous butterfly suture, modified/variant buried vertical mattress suture, intradermal buried vertical mattress suture, buried horizontal mattress suture, wedge-section and modified buried vertical mattress suture, set-back suture, and modified buried horizontal mattress suture, which have gradually been applied in clinical practice. Buried vertical mattress suture is currently the most widely used subcuticular suture technique. CONCLUSION Patients can certainly benefit from the appropriate application of subcuticular suture. There is also no single ideal method for achieving optimal results in all cases. Fully understanding the history of subcuticular suture can help doctors improve their wound closure technique.
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A Controlled Trial of Polyglytone 6211 versus Poliglecaprone 25 for Use in Intradermal Suturing in Dogs. Animals (Basel) 2021; 11:ani11113094. [PMID: 34827826 PMCID: PMC8614295 DOI: 10.3390/ani11113094] [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: 09/29/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/20/2022] Open
Abstract
Simple Summary The choice of suture material for skin closure can affect the final cosmetic outcome, the risk of wound infection, and other complications in companion animals. We assessed two commercially available suture materials, namely Caprosyn and Monocryl, for use in suturing the skin of dogs, by using cosmetic, clinical, and histological evaluation. The results indicate only minimal differences between the two products, although better scores were achieved after using Monocryl. Both were found sufficient for use in intradermal suturing in dogs. The earlier absorption of Caprosyn, compared to Monocryl, did not have any additional beneficial effect on wound healing and scar appearance in dogs. Abstract The objective of this work was the comparative evaluation of the healing process after employing 4/0 poliglecaprone 25 and 4/0 polyglytone 6211 in a continuous intradermal suture pattern. Ten Beagle dogs were used, in which skin incisions were created surgically and subsequently were sutured by means of continuous intradermal pattern using polyglytone 6211 or poliglecaprone 25 suture. Cosmetic, clinical, and histologic scores were evaluated. The cosmetic appearance of the wounds was blindly evaluated on days 7, 14, 28, 180, 360, 730, and 1095. On the same days, tissue biopsy was performed for histological evaluation. Clinical evaluation was performed initially daily, then weekly, monthly, and finally yearly, till day 1095. The clinical appearance of the intradermal pattern with both sutures was initially very good, deteriorated in the second post-operative month and thereafter improved. The cosmetic, clinical, and histological differences between the two suture materials were minimal and statistically insignificant. Polyglytone 6211 is sufficient for use in intradermal suturing in dogs. However, its earlier absorption compared to poliglecaprone 25 did not have any beneficial effect on cutaneous wound healing and scar appearance in the experimental animals.
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Chen X, Lv B, Liu Y, Huang M, Guan J, Zhou X. An improved cosmetic suture method without stitch removal for facial skin. J Plast Reconstr Aesthet Surg 2021; 74:1931-1971. [PMID: 34011472 DOI: 10.1016/j.bjps.2021.03.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/03/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Xing Chen
- Department of Cosmetology and Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Bo Lv
- Department of Cosmetology and Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Ya Liu
- Department of Cosmetology and Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Mengya Huang
- Department of Cosmetology and Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Jingling Guan
- Department of Cosmetology and Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Xun Zhou
- Department of Cosmetology and Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China.
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Gouletsou PG, Prassinos NN, Papazoglou LG, Kostoulas P, Galatos AD. Comparison of continuous intradermal with simple interrupted suture pattern: an experimental study in dogs. Top Companion Anim Med 2020; 41:100454. [PMID: 32823154 DOI: 10.1016/j.tcam.2020.100454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 04/20/2020] [Accepted: 05/31/2020] [Indexed: 11/28/2022]
Abstract
The aim of the study was to compare incisional wound healing in intradermal and simple interrupted suture patterns. Ten dogs were included. Surgically created skin incisions were apposed with (a) continuous intradermal pattern, (b) simple interrupted pattern, [both with 3/0 poliglecaprone 25], and (c) continuous intradermal pattern with 4/0 poliglecaprone 25. Cosmetic, clinical and histologic scores were evaluated. Simple interrupted sutures required significantly less time than intradermal sutures to complete. Cosmetic evaluation scoring was not statistically significant among the techniques. Irrespectively of the technique, the cosmetic, clinical and histologic appearance of the incisions improved over time. The cosmetic and histologic differences between the techniques were large during the first month, but decreased latter, whereas clinical differences persisted. The clinical appearance of the intradermal pattern was initially very good, worsened during the second postoperative month, and improved afterwards. Intradermal pattern with 4/0 poliglecaprone 25 was superior in terms of cosmetic, clinical and histologic appearance compared to simple interrupted pattern and to intradermal pattern with 3/0 poliglecaprone 25 for skin closure in dogs.
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Affiliation(s)
- Pagona G Gouletsou
- Clinic of Obstetrics and Reproduction, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, Karditsa, Greece.
| | - Nikitas N Prassinos
- Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lysimachos G Papazoglou
- Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Polychronis Kostoulas
- Laboratory of Epidemiology, Biostatistics and Animal Health Economics, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, Karditsa, Greece
| | - Apostolos D Galatos
- Clinic of Surgery, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, Karditsa, Greece
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Nayak G B, Saha PK, Bagga R, Joshi B, Rohilla M, Gainder S, Sikka P. Wound complication among different skin closure techniques in the emergency cesarean section: a randomized control trial. Obstet Gynecol Sci 2020; 63:27-34. [PMID: 31970125 PMCID: PMC6962586 DOI: 10.5468/ogs.2020.63.1.27] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/02/2019] [Accepted: 07/15/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cesarean section is the most commonly performed obstetrical surgical procedure; however, there are no standard guidelines on appropriate skin closure techniques and materials. Only few comparative studies have been conducted on different skin closure techniques, and they have shown conflicting results. Therefore, we compared different skin closure techniques during emergency cesarean section to identify the best technique with minimal wound complication rates. METHODS Patients were randomized into 3 groups (group A, n=100; group B, n=102; and group C, n=98). In group A, the skin was closed using staples; in group B, via the subcuticular technique using monocryl 3-0; and in group C, using mattress suture nylon (2-0). The primary outcome was a composite of wound complications, including infection, seroma, gaping, and need for resuturing and antibiotic administration. The secondary outcome included closure time, pain perception, patient satisfaction, and cost. Analyses were performed in accordance with the intention-to-treat principle. RESULTS The composite wound complication rate in the entire cohort was 16.6% (n=50); the complication rate was significantly higher in group A than in the other groups. Infection was the most common wound complication observed in the entire study group (86%) and was significantly higher in group A than in groups B and C (P≤0.001). CONCLUSION The use of staples for cesarean section skin closure is associated with an increased risk of wound complications and prolonged hospital stay postoperative visits.
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Affiliation(s)
- Bhimeswar Nayak G
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pradip Kumar Saha
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rashmi Bagga
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bharti Joshi
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalini Gainder
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Li JN, Nijhawan RI, Srivastava D. Cutaneous Surgery in Patients Who Are Pregnant or Breastfeeding. Dermatol Clin 2019; 37:307-317. [PMID: 31084725 DOI: 10.1016/j.det.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Dermatologic surgery in pregnant/postpartum patients requires deliberate consideration. Although surgery can be safely performed during any trimester, the second trimester and immediate postpartum period is optimal. Surgery should not be delayed for melanoma/high-risk skin cancers. Perioperative positioning, analgesic, antiseptic, and antibiotic selection should be deliberate to avoid risk to the patient/fetus/infant. The left lateral tilt position reduces aortocaval compression syndrome. Lidocaine and epinephrine can be used safely. Alcohol and chlorhexidine are considered safe. Antibiotics commonly used in skin surgery are safe in pregnancy and lactation. Acetaminophen is first line for pain management. Nonsteroidal antiinflammatory drugs should be avoided.
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Affiliation(s)
- Jeffrey N Li
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Boulevard, Professional Office Building 2, Suite 400, Dallas, TX 75390, USA
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Boulevard, Professional Office Building 2, Suite 400, Dallas, TX 75390, USA.
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