Prospective randomized trial of skin adhesive versus sutures for closure of 217 laparoscopic port-site incisions

BACKGROUND

The purpose of this study is to determine whether closure of laparoscopic port-site incisions using octylcyanoacrylate (OCA) is feasible, whether it is faster than traditional subcuticular suturing, whether the number and length of incisions impact on closure time, and to determine wound morbidity and patient satisfaction outcomes.

STUDY DESIGN

A prospective randomized trial was performed on adult patients scheduled for elective laparoscopic surgery in three surgical specialties at a tertiary referral center. Patients were randomized to have closure of laparoscopic port sites using either OCA or sutures. Patients were followed up 2 to 3 weeks postoperatively. At 2 months patients were mailed a questionnaire regarding their satisfaction with the method of closure and the appearance of their scars.

RESULTS

A total of 175 incisions in 50 patients were closed with OCA, and 142 incisions in 42 patients were closed with subcuticular sutures. Time to close was significantly faster for OCA (median 2.5 minutes versus 6 minutes, p < 0.001). OCA was faster than traditional subcuticular suturing for cases involving three or more port sites (median 2.5 minutes versus 6 minutes, p < 0.001), and for cases with total length of incisions >4 cm (median 2.6 minutes versus 7 minutes, p < 0.001). OCA and subcuticular suturing groups did not differ significantly on patient acceptance or assessment of scars.

CONCLUSIONS

Closure of laparoscopic port-site incisions is feasible with OCA. Closure with OCA requires significantly less operative time than subcuticular suturing, particularly in cases when three or more port sites are used or when total incision length is greater than 4 cm. OCA appears to have equivalent adverse wound outcomes and patient acceptance rates as subcuticular suturing.

A practical guide to adhesive bonding

Choosing the best adhesive method can be an exacting design task. This is especially true when joining dissimilar materials and when bonding certain plastics. All too often the adhesive is not fully considered at the design stage, which leads to problems during production. This guide discusses the key elements of the bonding process and provides advice when things do not go right.

Evaluation of tissue adhesives in closure of scleral tunnel incisions

Using a biomechanical wound strength model, we compared the efficacy of cyanoacrylate and fibrin glues used to close scleral tunnel incisions. Scleral tunnel incisions were made in four groups of rabbits: (1) traditional self-sealing incision, (2) modified non-self-sealing incision, (3) method 2, closed with cyanoacrylate glue, or (4) method 2, closed with fibrin glue. Overall, Groups 1 and 4 showed the least clinical reaction, the slightest decrease in intraocular pressure (which recovered to baseline by day 7), and the most significant recovery of postoperative astigmatism. Initially, the bursting pressure in Groups 1 and 3 was statistically the highest (P < .005). By day 3, wound strengths in Groups 1 and 4 were comparable. Bursting pressure decreased in Groups 2 and 3 by day 7. Our results indicate that clinical responses, intraocular pressure, induced astigmatism, and ultimately wound strength were comparable in fibrin-glue-closed scleral pocket and sutureless self-sealing cataract incisions. Although cyanoacrylate glue cures immediately and initially demonstrates a strong adhesive quality, it causes a severe inflammatory response that inhibits subsequent collagen remodeling. Fibrin tissue adhesives may have an application as adjunctive means of closing scleral tunnel incisions.

Adhesives in orthopaedic surgery. A review of the literature and in vitro bonding strengths of bone-bonding agents

Adhesives may offer a number of advantages over conventional metal osteosynthesis in the treatment of fractures: ease and speed of fixation are improved, they have the anatomy to anatomically coapt small fragments, and hardware removal is not necessary. A review of the literature was performed to evaluate experiments with collagen and other biologic adhesives, epoxy resins, polyurethane foam, cyanoacrylates, zinc polycarboxylate, polymethylmethacrylates, and fibrin adhesives pertaining to osteosynthesis. Cyanoacrylates, polymethylmethacrylates, and fibrin adhesives are currently being investigated. These agents are tested to evaluate their bone-bonding strength. Cyanoacrylates of biologically tolerated chain length did not develop useful bonding in cancellous bone; they bond well to cortical bone only with meticulous surface preparation. Fibrin adhesives developed only minimally useful bonding. Polymethylmethacrylate developed surgically useful bonding in osteosynthesis where conventional fixation is impossible.

[Adhesive sealing of fissures and pits for the prevention of caries. Review]

Conformably to the order received, the present contribution aims, as desired by the editor, at meeting the information requirements of the practitioner as completely as possible. For that reason, the cruical points are stressed. This complex of questions is also analysed from the aspect of the author's opinion. This analysis is intended for aiding the reader in processing source material and in forming his own opinion. Starting from the epidemiological foundation of the necessity of caries prevention, the author integrates the method of adhesive sealing and describes the necessary materials and the various steps of the procedure. The article centers in a critical interpretation of its preventive efficiency in clinic and experiment and ends in an outlook.

Effects of cement type and thickness on retention of serrated pins

The retentive capacity of cemented pins was determined. Zinc phosphate, polycarboxylate, and cyanoacrylate were used to cement threaded pins (0.024 inch) into precise channels of 0.025, 0.026, and 0.027 inch. Highest retentive values were realized when zinc phosphate and polycarboxylate cements were used with the smallest pin-channel mismatch. Ethyl cyanoacrylate was least retentive and demonstrated no mismatch dependency.

Initial leakage under pit and fissure sealants assessed by neutron activation

An improved neutron activation method and a model system were used to study microleakage associated with three pit and fissure sealants. Both the sealant and the etching procedure were evaluated on enamel surfaces as well as in prepared model pits. Leakage was reduced to 3 to 4 μg for all three materials, and the etching process was relatively ineffective in forming an initial seal.