Comparison of 2-octyl cyanoacrylate with polyester mesh with standard suture and staples in total knee and hip arthroplasty

OBJECTIVE

The use of 2-octyl cyanoacrylate with polyester mesh (OCA-M) has become common in total hip and knee arthroplasty (THA, TKA). We aimed to compare the safety and cosmetic outcomes between OCA-M and standard suture techniques and staples, and determine whether OCA-M can safely be used for TKA.

METHOD

Inclusion criteria were patients who underwent THA or TKA from January 2010 to October 2011 (Suture group), November 2011 to August 2013 (Staple group), March 2017 to September 2018 (OCA-M group). Exclusion criteria was loss of imaging data. Complications during hospitalisation (early complication) and after discharge (late complication) were compared in groups. Plastic and orthopaedic surgeons performed cosmetic evaluations with the modified Vancouver Scar Scale (VSS) and Likert scale at three and six months postoperatively and compared in groups.

RESULTS

A total of 249 arthroplasties (suture group=88 patients; staple group=94 patients; OCA-M group=67 patients) were included in the study. The OCA-M group had a significantly lower early complication rate than the suture group (p=0.015). For THA, the OCA-M group had a significantly lower total complication rate than the suture group (p=0.048). For TKA, there was no significant difference among the three groups. The complication rate in the OCA-M group showed no significant difference between THA/TKA. With regards to the VSS, the OCA-M group was significantly better for cosmetic qualities than the suture group (p=<0.001, p=0.021 at three and six months, respectively). For the Likert scale, the OCA-M group was also significantly better for cosmetic qualities than the suture group and staple group (suture-OCA-M, p=0.003 (three months), p=<0.001 (six months); staple-OCA-M, p=0.027 (three months)).

CONCLUSION

In this study, the OCA-M complication rate was low compared to suturing and similar to stapling. Moreover, better cosmetic outcomes were achieved compared to suturing and stapling.

Comparison of Different Suturing Techniques in Post-Extraction Socket Healing

Background

The process of post-extraction socket healing is critical for ensuring proper tissue repair and minimizing complications in dental practice. Suturing techniques play a pivotal role in this process, influencing wound closure, hemostasis, and overall healing.

Materials and Methods

This prospective clinical trial involved 80 participants who required single-tooth extractions. Patients were randomly assigned to four groups, each receiving a distinct suturing technique: simple interrupted sutures, horizontal mattress sutures, vertical mattress sutures, and continuous sutures. Standardized assessments, including clinical examination and cone-beam computed tomography (CBCT) scans, were performed at baseline, 1 week, and 4 weeks post-extraction. Wound dehiscence, soft tissue healing, and bone preservation were evaluated.

Results

At 1-week post-extraction, the continuous suture group exhibited the lowest rate of wound dehiscence (5%) compared to other groups (simple interrupted, 15%; horizontal mattress, 10%; vertical mattress, 12%). Soft tissue healing scores at 4 weeks were significantly higher in the continuous suture group (8.7 ± 0.5) than in the other groups (simple interrupted, 7.2 ± 0.8; horizontal mattress, 7.8 ± 0.7; vertical mattress, 7.5 ± 0.6). CBCT analysis revealed superior bone preservation in the continuous suture group (98% remaining bone volume) compared to the other groups (simple interrupted, 92%; horizontal mattress, 95%; vertical mattress, 94%).

Conclusion

This study demonstrates that the continuous suturing technique offers advantages in post-extraction socket healing, including reduced wound dehiscence, improved soft tissue healing, and better bone preservation.

Comparison of Polymeric Cyanoacrylate Adhesives with Suturing in Free Gingival Graft Stability: A Split Mouth Trial

The aim is to compare the use of Cyanoacrylate adhesives (CAA) to the conventional suturing technique in terms of free gingival grafts (FGG) stability and healing in lower anterior and premolar regions. A split mouth design was initiated on 22 participants. Each side (from 2nd premolar to central incisor) was randomized to either the control or test groups. In the control group, sutures were used to stabilize the FGG, while, in the test group, the FGG was stabilized with butyl-cyanoacrylate. Full-periodontal clinical parameters were employed to assess the periodontal health. FGG-related parameters assessed included the keratinized tissue width (KTW), gingival tissue thickness (GTT), FGG shrinkage% and pain using the VAS score. No significant differences in the mean values of the KTW nor FGG shrinkage% across six time points (p < 0.05) were observed, whereas highly significant differences in the mean values of GTT across six time points (F = 3.32; p = 0.008) were observed. The use of CAA in FGG stability and healing is comparable to conventional suturing for soft tissue grafts in terms of success outcomes. With its cost effectiveness, lesser time consumption, post-operative pain and comparable graft stability and dimensions, the use of CAA may be a promising alternative for conventional and microsurgical techniques for the stabilization of FGG in the oral cavity.

The Evaluation of Further Complications after the Extraction of the Third Molar Germ: A Pilot Study in Paediatric Dentistry

Some authors suggest germectomy to prevent the impaction of mandibular third molars, which can cause anterior crowding. The aim of the study, conducted with 2 years of follow-up, was to clarify when the extraction of the germ of the third molar is optimal, together with possible post-operative complications. A new surgical approach was performed through the application of a combined suture, which can provide better wound healing. The study was performed on 25 patients with a mean age of 15.44 ± 2.06. Based on orthodontic and surgical indications, 46 germectomies were performed. Follow-ups were conducted after 1 week, 2 weeks, 4 weeks, 1 year and 2 years. All procedures were carried out by the same operator and were standardized. Data analysis was conducted using R-Software. Statistical evaluation used the chi-squared test and the Monte Carlo test. The level of significance was set as 0.05. Results showed that out of 46 germectomies, the prevalence of complications was 4.2% for two patients (8%). Both complications were observed in male patients. In the first case, the patient (at Nolla stage 7) showed delayed onset infections after four weeks; in the second case, the patient (at Nolla stage 6) showed bleeding immediately after surgery and suture. With reference to delayed onset infections, no statistically significant association was found among gender (χ² = 0.719; p = 0.396), germ development stage (χ² = 2.595; p = 0.658) or Winter's classifications (χ² = 0.046; p = 0.829); similarly, no significant associations were found among bleeding, gender (χ² = 0.719; p = 0.396), germ development stage (χ² = 2.595; p = 0.658) or Winter's classification (χ² = 0.046; p = 0.829). From our results, it is also possible to state that post-operative complications following germectomy of the mandibular third molar germ in adolescence occur in a significantly reduced percentage of patients, so this oral surgery treatment becomes a reliable surgical technique in adolescence.

How to facilitate laparoscopic extraperitoneal suture?

To show a simplified technique of extraperitoneal laparoscopic suture. Step-by-step explanation of the technique using an educative video and pictures. This technique of extraperitoneal laparoscopic suture is highlighted through two laparoscopic procedures: a sacrocolpopexy (mesh fixation) for a pelvic organ prolapse and an ovariopexy after hysterectomy without adnexectomy (fibromatous uterus). This method avoids the need for repetitive use of the knot-pusher in performing extraperitoneal knots. Time saved in the operating room and limited gestures can theoretically contribute to decrease cost and improve safety. Although our intimate conviction goes in this direction, further studies are needed to better evaluate this procedure. Rehabilitating a process historically used during laparotomic procedures, this technique avoids iterative intra-abdominal gestures and expedites the knot-tying steps.

Experimental Evaluation of the Optimal Suture Pattern With a Flexible Endoscopic Suturing System

BACKGROUND

The ability to perform reliable, secure endoluminal closure of the gastrointestinal tract wall, is a prerequisite to support the progress of the emerging field of endoluminal surgery. Along with advanced clipping systems, flexible endoscopic suturing devices are commercially available. Current systems can replicate traditional surgical suturing patterns in the endoluminal environment. The aim of this study was to evaluate the optimal endoluminal suturing technique using a flexible endoscopic suturing device.

MATERIALS AND METHODS

Procedures were performed on bench-top simulators containing 20 explanted porcine stomachs. A standardized 3-cm full-thickness incision was created on the anterior wall of each stomach using monopolar cautery. The gastrotomy was closed endoscopically using an over-the-scope suturing device (OverStitch, Apollo Endosurgery; Austin, TX). Three different techniques were used: single stitches, figure-of-8 pattern, and running suture. Material consumption and operation time were recorded and bursting pressure measurement of the closure was performed.

RESULTS

No statistically significant differences were identified in suturing time. Suturing time (minutes) was slightly shorter with the figure-of-8 technique (41.14 ± 4.6) versus interrupted (45.75 ± 1.1) versus continuous (51.44 ± 10.0), but the difference was not statistically significant. The number of sutures required was greater in the interrupted group. No significant difference was found in the burst pressure (mm Hg): figure-of-8 (45.85 ± 26.2) versus interrupted (30.5 ± 22.89) versus continuous (32.0 ± 26.5). In the figure-of-8 group, 85.5% of cases were leakproof above 30 mm Hg, while in the other groups only 50% of cases were so.

CONCLUSION

A figure-of-8 suturing pattern seems to be the preferable suturing technique with the endoscopic suturing device.

How to suture a wound

Rationale and key points This article explores how to suture a wound using several common techniques. The use of different suture techniques depends on various factors, including the type of wound, its location, skin thickness, wound tension and cosmetic considerations. » Nurses should have a comprehensive understanding of the relevant anatomy and underlying structures, and the expertise to determine that suturing, rather than other methods of wound closure, is appropriate in each case. » Nurses should work within their scope of practice and to agreed departmental protocols. » Nurses should audit and reflect on their practice to ensure that their suturing skills are maintained and improved. » Nurses should be aware of local procedures in the event of needle-stick injury. Reflective activity 'How to' articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. What factors would affect your decision to use sutures to close a wound rather than another method. 2. How you think this article will change your practice.

Horizontal running mattress suture modified with intermittent simple loops

Using the combination of a horizontal running mattress suture with intermittent loops achieves both good eversion with the horizontal running mattress plus the ease of removal of the simple loops. This combination technique also avoids the characteristic railroad track marks that result from prolonged non-absorbable suture retention. The unique feature of our technique is the incorporation of one simple running suture after every two runs of the horizontal running mattress suture. To demonstrate its utility, we used the suturing technique on several patients and analyzed the cosmetic outcome with post-operative photographs in comparison to other suturing techniques. In summary, the combination of running horizontal mattress suture with simple intermittent loops demonstrates functional and cosmetic benefits that can be readily taught, comprehended, and employed, leading to desirable aesthetic results and wound edge eversion.

Scissor-knot-pusher: an instrument for simplified laparoscopic extracorporeal knotting

This paper describes the "scissor-knot-pusher," an instrument that greatly facilitates the execution of knot tying during laparoscopic operations. The instrument acts in essence as an extension of the surgeon's hand and, given its rigid structure, allows the surgeon full control of the process of knot tying. Additionally, after the knot has been tightened, it is possible to cut the suture without using a different instrument. As a result, this technical device simplifies knot tying and may help to reduce the frustration and the time often associated with intracorporeal suturing during laparoscopic surgery.

Intracorporeal knot-tying and suturing techniques in laparoscopic surgery: technical details

BACKGROUND

Intracorporeal suturing and knot-tying in laparoscopic surgery require great manual dexterity; these techniques must absolutely be mastered by every surgeon who is interested in pursuing the minimally invasive approach.

METHOD

The initial and final knot of a laparoscopic continuous suture can be accomplished in several ways and with easy technical solutions that are fully illustrated in the present study.

CONCLUSION

We think it is better to perform a continuous suture than an interrupted one. It is advisable, moreover, to use traditional suture materials (not specially created for laparoscopy) that cost less than the more sophisticated ones.