Fast Absorbing Gut Suture versus Cyanoacrylate Tissue Adhesive in the Epidermal Closure of Linear Repairs Following Mohs Micrographic Surgery

Background: Cyanoacrylate topical adhesives and fast absorbing gut sutures are increasingly utilized by dermatologic surgeons as they provide satisfactory surgical outcomes while eliminating an additional patient visit for suture removal. To date, no head-to-head studies have compared the wound healing characteristics of these epidermal closure techniques in the repair of facial wounds after Mohs micrographic surgery. Objective: To compare the cosmetic outcome of epidermal closure by cyanoacrylate topical adhesive with fast absorbing gut suture in linear repairs of the face following Mohs micrographic surgery. Methods: Fourteen patients with wound length greater than 3cm who underwent Mohs micrographic surgery for nonmelanoma skin cancer of the face were enrolled in this randomized right-left comparative study. Following placement of dermal sutures, half of the wound was randomly selected for closure with cyanoacrylate and the contralateral side with fast absorbing gut suture. Using photographs from the three-month postoperative visit, six blinded individuals rated the overall cosmetic outcome. Results: The present study shows no significant difference in cosmetic outcomes between cyanoacrylate and fast absorbing gut suture for closure of linear facial wounds resulting from Mohs micrographic surgery. Cyanoacrylate tissue adhesive may not be as effective in achieving optimal cosmesis for wounds on the forehead or of longer repair lengths. The majority of patients did not have a preference for wound closure techniques, but when a preference was given, cyanoacrylate was significantly favored over sutures. Conclusion: Cyanoacrylate tissue adhesive and fast absorbing gut suture both result in comparable aesthetic outcomes for epidermal closure of linear facial wounds following Mohs micrographic surgery. Consideration should be given to factors such as need for eversion, hemostasis, and wound tension when selecting an epidermal wound closure method. (ClinicalTrials.gov, Identifier: {"type":"clinical-trial","attrs":{"text":"NCT01298167","term_id":"NCT01298167"}}NCT01298167, http://clinicaltrials.gov/show/{"type":"clinical-trial","attrs":{"text":"NCT01298167","term_id":"NCT01298167"}}NCT01298167).Tissue adhesives have been used in surgical procedures for more than 50 years since cyanoacrylate was first discovered in 1949.1 These adhesives work by self-polymerizing in a spontaneous exothermic reaction. The first widely used variety, N-butyl-2-cyanoacrylate, has been used with good cosmetic outcomes for a number of surgical procedures (blepharoplasty, lacerations, incisions).2-5 However, this adhesive did not gain widespread use because of its low tensile strength and brittleness.6 In 1998, the United States Food and Drug Administration (FDA) approved 2-octyl cyanoacrylate for superficial skin lacerations. This cyanoacrylate polymer was designed to be stronger and more flexible and has been used successfully in many studies.7,8Fast absorbing gut is a plain gut suture that has been heat treated to enable rapid absorption. It is primarily used for epidermal suturing, where sutures are only required for five to seven days.9Both cyanoacrylate and fast absorbing gut suture eliminate the need for an office visit for suture removal, which can represent a significant cost savings in patient and staff time as well as related healthcare resources. Both cyanoacrylate and fast absorbing gut suture are currently routinely used for epidermal closure following Mohs micrographic surgery (MMS). Physician preference currently dictates which epidermal closure method is chosen for a given surgery and depends on weighing advantages and disadvantages of each technique.Recently, one study reported that for defects on the trunk and extremities, tissue adhesive may not be as effective in achieving optimal cosmesis as fast absorbing gut.10 The purpose of this study was to compare the cosmetic outcome and patient satisfaction of cyanoacrylate tissue adhesive versus fast absorbing gut suture for the closure of surgical defects on the face following MMS.     

Is open acute Achilles tendon rupture repair still justified? A single center experience and critical appraisal of the literature

IntroductionAcute Achilles tendon ruptures are injuries with multiple treatment strategies with possibly far reaching consequences. Open repair is associated with a high complication rate, whereas percutaneous techniques are associated with higher re-rupture rates. The goal of this study was to evaluate the clinical outcome and economic burden of open surgical repair and define a medically and economically sound treatment protocol for acute Achilles tendon ruptures.MethodsBetween June 2012 and December 2016 one hundred and five patients with an acute Achilles tendon rupture, treated in an open surgical manner, were studied retrospectively. All demographic, clinical and hospital-related costs were retrieved from the electronic patient database. ATRS questionnaires were sent to assess the functional outcome. A response rate of 70.5% was achieved.ResultsWe recorded a complication rate of 40%, respectively sural nerve hypoesthesia (14.3%), delayed wound healing (28.6%), infection (20.9%) and re-rupture (4.8%). Surgical resident, as primary operating surgeon was associated with a higher complication rate (p = 0.042). Overall, a median functional ATRS score of 17 (IQR 6.5–39.5) was recorded. Infection was associated with significantly higher total healthcare costs per patient as compared to re-rupture (€17,435 vs. €4,537, p = 0.013). The total cost for surgical debridement (n = 6) was approximately 5-times higher than for re-rupture (n = 5), €108,382 vs. €22,272. The median ATRS score for surgical debridement after infection and re-rupture did not differ significantly from the overall ATRS score, respectively 32 (IQR 21–63) and 28 (IQR 15–28). Nevertheless, a difference of 10 points is considered clinically relevant.ConclusionThe overall functional outcome of open repair of Achilles tendon ruptures is rather good, however associated with a high complication rate, mainly due to wound problems and infection. Although several risk factors were identified, only the operating surgeon is modifiable. Considering the high total costs for surgical debridement in the context of infection compared to re-rupture surgery, despite equal functional outcome,we decided to change clinical practice to reduce the complication rate and healthcare costs. The outcome and precise costs for percutaneous repair will be addressed.     

A prospective randomized trial comparing 2-octyl cyanoacrylate to conventional suturing in closure of laparoscopic cholecystectomy incisions

OBJECTIVE: To compare 2-octyl cyanoacrylate (Dermabond) with conventional suturing for closure of laparoscopic cholecystectomy (LC) wounds in a prospective randomized controlled trial. SUBJECTS: Twenty-five consecutive patients underwent LC at a teaching hospital in the United Kingdom. Patients were randomly allocated to have skin closed with 2-octyl cyanoacrylate or absorbable suture. METHODS: Fifty-one wounds underwent skin closure with absorbable subcuticular suture (3/0 polydiaxanone) and 48 wounds were closed with tissue adhesive. The time to close the wounds, including the placement of dressings, was recorded. At 6 to 8 weeks, the incisions were evaluated with the Hollander wound evaluation scale (HWES). Using a visual analogue scale (VAS), the wounds were also rated by a plastic surgeon who was blinded to the method of closure. RESULTS: The wounds were closed significantly faster in the Dermabond group (mean 165 seconds versus 356 seconds, P = 0.03). There were no differences in the percentage of wounds achieving optimal scores on the HWES (suture 64.7% versus tissue adhesive 60.4%, P = 0.42) nor on the mean VAS (suture 62 mm versus tissue adhesive 59 mm, P = 0.45). CONCLUSION: The tissue adhesive 2-octyl cyanoacrylate is a safe and fast method for closure of LC wounds, with cosmetic results comparable to suturing.     

Patient-Reported Outcomes of Achilles Tendon Repair Using the Modified Gift-Box Technique With Nonabsorbable Suture Loop: A Consecutive Case Series

We sought to determine the early range of motion, complication rates, and 1-year patient-reported outcomes following Achilles tendon repair, using a modified gift-box suture loop technique. Sixty consecutive patients (49 males, mean age 36.2 ± 9.9 years) who underwent Achilles tendon repair with a modified gift-box suture loop technique performed by a single surgeon were prospectively enrolled. The range of motion at the final follow-up visit (mean 6 months) and the Achilles tendon rupture score (ATRS) and the complication rates at 1 year were obtained with 83% follow-up. The predictors of complications and ATRS were assessed. The mean operative time was 63.1 ± 10.8 minutes, which decreased throughout the case series (r = 0.46, p < .001). The mean plantarflexion at the final office evaluation was 31.7° ± 6.2°, dorsiflexion was 11.7° ± 6.3°, and total ankle arc of motion was 43.6° ± 9.7°; longer length of follow-up was associated with greater dorsiflexion (p = .008) and the total arc of motion (p = .008) but not with plantarflexion (p = .16). The overall rerupture rate was 1.7% (1 patient), wound complication rate was 1.7% (1 patient), and the overall complication rate was 6.7% (4 patients). No predictors of complications were identified. Complication rates did not differ between the first 30 (6.7%) cases and second 30 (6.7%) cases. The mean ATRS at 1 year was 81.8 ± 16.8 points. The rerupture and overall complication rates by 1 year were low. The range of motion, particularly dorsiflexion, improved through at least 6 months. Diabetic patients had lower 1-year ATRS than nondiabetic patients using this technique.     

Tensile strength of wound closure with cyanoacrylate glue.

2-Octyl cyanoacrylate tissue adhesive is increasingly being used for closure of traumatic lacerations. Data regarding the strength of incisions closed with 2-octyl cyanoacrylate are limited. We compared the strength of disruption of closure with glue with that of more conventional methods of wound closure. Segments of fresh porcine skin measuring 3.5 x 10 cm were approximated by one of four methods: 1) 2-octyl cyanoacrylate glue, 2) surgical staples, 3) 0.5 inch Steri-Strips, and 4) interrupted 4-0 poliglecaprone 25 sutures in a subcuticular fashion. Fifteen specimens were used to test each type of closure. The strength of closure was tested on an Instron 4502 tensionometer. The peak force required for disruption of the closure was recorded and the strength of the closure was compared. Staples provided the strongest closure. Skin glue proved superior to Steri-Strips but inferior to stapled closure. The difference between skin glue and suture closure was not statistically significant (P = 0.12). Patterns of failure differed between the groups. Skin glue failed because of disruption of the skin-glue interface. 2-Octyl cyanoacrylate glue provides a wound closure that is similar to closure with an interrupted subcuticular absorbable suture. This study validates the clinical use of skin glue for closure of surgical incisions. The technique should be used with caution in areas of the body that are subject to tension.     

Meta-analysis of skin adhesives versus sutures in closure of laparoscopic port-site wounds

Objective  To analyze the effectiveness of skin adhesives and sutures in the closure of laparoscopic port-site wounds. Methods  Electronic databases were searched to find relevant randomized controlled trials and their data was analyzed to generate a summative outcome. Results  Seven trials on port-site wound closure after laparoscopic procedures encompassing 902 patients were retrieved from the electronic databases. Four randomized controlled trials on 404 patients qualified for the review according to inclusion criteria. In both fixed- and random-effects models, there was no difference between the two port-site wound closure techniques in terms of wound infection, wound dehiscence and, patient satisfaction. However, statistically tissue adhesives were quicker in port-site wound closure as compared with sutures. Conclusions  Based on this review, there is insufficient evidence that port-site wound closure technique by tissue adhesives is superior to traditional suture closure technique in terms of wound infection, wound dehiscence, and patient satisfaction. However, tissue adhesives are quicker in port-site wound closure. A multicentre randomized controlled trial is required in order to obtain stronger evidence.     

Foreign body reaction after usage of tissue adhesives for skin closure: a case report and review of the literature

Introduction  The usage of tissue adhesives such as 2-octyl cyanoacrylate is a standard tool for closure of superficial wounds of the body. The benefits using 2-octyl cyanoacrylate are well known and appreciated by surgeons world wide. Especially in superficial or small wounds in children where no surgical procedure is wanted this technique is commonly used. However, so far the risks and possible complications after using 2-octyl cyanoacrylate are not sufficiently published and discussed. Case report  We report a case of foreign body reaction after 3 weeks in a 39-year-old female patient after usage of 2-octyl cyanoacrylate treating a superficial wound of the right wrist. Conclusion  The use of 2-octyl cyanoacrylate for the closure of superficial and small wounds or lacerations is a simple, quick and comfortable method. However, there is clinical evidence that in some cases the use of this type of tissue adhesive may lead to foreign body reaction. We suggest that each patient who is treated by this type of wound closure technique should be mandatory informed on the potential risk of a foreign body reaction.     

Evaluation of a Modified Spoon-Shaped Medial Incision in the Surgical Repair of a Chronic Achilles Tendon Rupture

This study aims to investigate the clinical significance of preventing incision skin necrosis and the improved function offered in patients with a chronic Achilles tendon rupture treated surgically with a modified spoon-shaped medial incision. From January 2013 to January 2017, 50 patients (N = 50) who were admitted to our department with a clinically and radiologically confirmed chronic Achilles tendon rupture met inclusion criteria and were divided retrospectively into two groups. In group A (n = 26), a modified spoon-shaped medial incision in the surgical repair of Achilles tendon rupture was performed. In group B (n = 24), a traditional posterior medial incision was used. All skin healing was observed. Functional evaluation was performed using American Orthopedic Ankle & Foot Society scale(AOFAS) hindfoot score and Achilles tendon total rupture score(ATRS). Return-to-work time and major complications were also measured. The patients were followed for 12 to 48 months. All incisions exhibited primary healing in group A, while four incisions healed delay for skin necrosis which includes superficial, deeper necrosis, and skin defection caused by the necrosis in group B. Both groups had similar results regarding return-to-work time. There were no infections in either group. There was no rerupture of the Achilles tendon in either group. Patients in group A had better AOFAS hindfoot score (p = .020) and ATRS (p = .010), and the difference was significant (p ≤ .05).Using the modified spoon-shaped medial incision in the surgical repair of a chronic Achilles tendon rupture seems to be a safe and effective method that may reduce risk of incision skin necrosis and offers better function in patients with a chronic Achilles tendon rupture.     

Comparison of clips versus sutures in orthopaedic wound closure

A prospective randomised trial was conducted to compare the use of skin clips versus interrupted nylon sutures in uncomplicated orthopaedic wound closure. Non-blinded wound assessment for complications and outcome (cosmesis) was performed on day 13 when the clips/sutures were removed. Average time for removal of each clip/suture was calculated for each wound. Also, an assessment of patient pain during removal was made using a patient-completed visual analogue scoring system (VAS). No statistically significant difference was found in wound healing and cosmesis between the clip and suture group at follow-up. Clip removal with the special clip remover was found to be quicker and less painful (p=0.001). There was good patient satisfaction with the use of skin clips over nylon sutures. We recommend the use of skin clips, using an assistant to evert the wound edges, as an efficient form of wound closure in most uncomplicated orthopaedic procedures.     

带髂胫束的股前外侧皮瓣游离移植一期修复跟后区组织缺损

目的评定带髂胫束的股前外侧皮瓣游离移植一期修复跟后区组织缺损的疗效。方法2000年1月~2005年1月,收治跟腱合并跟后区皮肤缺损11例。其中男7例,女4例,年龄6~45岁。6例为跟腱合并跟后区皮肤缺损,5例为跟腱、跟后区皮肤合并跟骨骨折或部分跟骨缺损。皮肤缺损范围6cm×5cm~14cm×8cm,跟腱缺损长度5~11cm。皮瓣切取范围11cm×6cm~17cm×11cm。髂胫束的切取长度7~13cm,宽度3~5cm。将髂胫束内外侧缘内翻缝合成腱状形成双层髂胫束重建跟腱。供区创面直接缝合5例,余6例行游离全厚皮片植皮。结果术后所有皮瓣均成活,伤口期愈合。获随访6个月~4年。根据尹庆水疗效评价标准优6例,良4例,可1例。Thompson试验和提踵试验均为阴性。无跟腱再断裂、跟区皮肤破溃等并发症发生,足跟部两点辨别觉6~8mm。结论带髂胫束的股前外侧皮瓣游离移植是一种有效且能一期修复跟腱合并跟后区皮肤缺损的手术方法。     

Treatment outcome at 1 year did not differ between use of cast or walker in the first 3 weeks after an acute Achilles tendon rupture. A registry study of 1304 patients from the Danish Achilles tendon database

BackgroundThe best choice of orthosis in the treatment of acute Achilles tendon rupture is still under debate.ObjectiveTo investigate if choice of orthosis in the first 3 weeks of treatment affected patient reported outcome (Achilles tendon Total Rupture Score (ATRS)), tendon elongation (Achilles Tendon Resting Angle (ATRA) and Heel Rise Height (HRH)) and re-rupture.MethodsRegistry study in the Danish Achilles tendon Database. Patients treated with cast and patients treated with walker in the first 3 weeks of treatment were compared using a linear mixed-effects model adjusted for potential confounders.Results1304 patients were included in the study. No clinically relevant difference was found: Adjusted mean difference (using walker the whole period as reference)(95% CI) ATRS after 1 year = 0.1(?3.0; 4.1), ATRS after 6 months = 2.0(?4.5; 5.8), ATRS after 2 years = 3.0(?0.7; 7.0), HRH difference = 0.6(?6.6; 8.2), ATRA difference = 0.03°(?1.5; 1.6), re-rupture(odds ratio) = 0.812(0.4; 1.61).ConclusionPatients treated with cast the first 3 weeks after acute Achilles tendon rupture did not have better treatment outcome than patients treated with walker.     

Outcomes of open “crown” type v. percutaneous Bunnell type repair of acute Achilles tendon ruptures. Randomized control study

BackgroundThe optimal treatment of acute Achilles tendon ruptures (AATR) is still under debate. The purpose of this study was to evaluate outcomes of open repair comparing with percutaneous procedure for AATR.Methods100 patients with AATR were randomized in two groups: open “crown” type (group A) and percutaneous Bunnell type repair (group B). 87 patients were available for the mean follow up of 27 monthsResultsNo statistically significant difference was observed between groups in ATRS score, leg circumference, single heel rise, Achilles resting angle, time back to work and sports and overall patient satisfaction. Percutaneous technique was much faster. Overall 13 complications occurred in both groups (5 and 8 respectively). No deep infection occurred, no revisions were needed.ConclusionsBoth techniques showed to be effective and safe when using absorbable suture material with a high patient satisfaction and a low complication rate, but percutaneous repair was significantly faster.     

Use of absorbable cyanoacrylate glue to repair an open cystotomy

PURPOSE: A biodegradable cyanoacrylate glue was tested for its ability to close bladder injuries in an established porcine model. Inflammation and encrustation associated with this glue were examined in a rabbit model. MATERIALS AND METHODS: Four domestic pigs underwent transverse cystotomy, which was closed with absorbable cyanoacrylate glue. Four weeks later the bladder was distended with normal saline to evaluate the repair. A total of 45 rabbits underwent cystotomy, which was closed with polyglactin suture, absorbable cyanoacrylate glue or nonabsorbable 2-octyl cyanoacrylate glue. The bladder was harvested at 4 or 12 weeks to evaluate inflammation, microcalcification and encrustation. RESULTS: All 4 pig bladders tolerated a pressure of 200 mm. Hg 4 weeks after closure. In the rabbit bladders there was no difference in inflammation in the groups at 4 and 12 weeks. The absorbable glue and suture groups had less microcalcification than the 2-octyl cyanoacrylate glue group at 4 and 12 weeks (p = 0.01 and 0.02, respectively). Encrustation was less in the suture and absorbable glue groups than in the 2-octyl cyanoacrylate glue group at 4 and 12 weeks (p = 0.004 and 0.02, respectively). CONCLUSIONS: An experimental absorbable cyanoacrylate glue has the strength to seal a large cystotomy. The inflammatory response to absorbable glue is similar to that to suture at 12 weeks. Absorbable glue does not promote calcification. These properties may make it a suitable material for replacing or augmenting suture in the urinary tract.     

Prospective, Randomized, Blinded Study of a New Wound Closure Film Versus Cutaneous Suture for Surgical Wound Closure

BACKGROUND Wound closure devices include sutures, tissue adhesives, adhesive strips, and staples. Recent studies suggest no differences between various tissue adhesives and sutures for dehiscence, infection, and satisfaction when assessed by patients or surgeons. To date, no studies have investigated ClozeX (Clozex Medical LLC, Wellesley, MA, USA), a novel adhesive strip, for closure of surgical incisions.
OBJECTIVE To compare surgical wounds repaired with ClozeX versus suture.
METHODS A prospective, randomized study was conducted, in which 15 patients with surgical incisions were allocated to closure with ClozeX on half of the wound and monofilament suture on the other half. Physician satisfaction with blinded assessment, patient satisfaction, complication rates, and closure times were recorded.
RESULTS Application with ClozeX was faster than with suture ( p =.007). There were no complications in either group. Sixty-nine percent of the patients gave ClozeX a higher satisfaction score ( p =.02). More physicians were satisfied with the ClozeX half than with the suture half ( p =.007).
CONCLUSIONS This pilot study demonstrates ClozeX to be a safe and effective closure device. The cosmetic outcome seems to be at least as good as simple running suture. Physicians and patients were generally more satisfied with ClozeX. No difference was found in the rate of dehiscence or infection between the groups.     

Rates of complications in Achilles tendon rupture repair using absorbable and nonabsorbable suture material; A systematic review

BackgroundThe impact of suture type on tensile strength, re-rupture rates and infection risk in Achilles tendon rupture repair is not been well established. The aim of this review is to evaluate existing literature on the associated risk of postoperative infection with absorbable and non-absorbable suture materials in Achilles tendon rupture repair.MethodsA systematic review of search databases PubMed; Google Scholar; and OVID Medline was made to identify studies related to complications associated with Achilles tendon rupture repair. PRISMA guidelines were utilised for this review. Meta-analysis was used to compare rupture rates and infections following rupture repair.Results12 studies with a total of 460 patients, 230 in both nonabsorbable and absorbable suture groups were included for analysis. Risk of wound complications was significantly higher in patients with non-absorbable sutures (p < 0.001).ConclusionNonabsorbable braided sutures is associated with the highest risk of postoperative wound complications following Achilles tendon rupture repair.     

Chronic sinus formation using non absorbable braided suture following open repair of Achilles tendon

This study reports a case of a 34 year old man who sustained an Achilles tendon rupture which was surgically repaired using a non-absorbable suture that was complicated by a deep sinus and chronic infection. Despite antibiotics, surgical debridement and skin grafting, his condition did not resolve. Further imaging revealed a sinus leading to the core suture knot that was eccentrically placed but not buried within the healed tendon repair, and the offending suture was subsequently removed.This case highlights the importance of meticulous surgical technique when performing Achilles tendon repair and a high index of suspicion for early imaging when patients present with chronic wound infection post-operatively.The authors urge surgeons to use routinely use an absorbable non-braided suture, which remains buried within the core when performing Achilles tendon repair.     

A Randomized Controlled Trial of High-Viscosity 2-Octyl Cyanoacrylate Tissue Adhesive versus Sutures in Repairing Facial Wounds Following Mohs Micrographic Surgery

BACKGROUND: High-viscosity 2-octyl cyanoacrylate (HVOCA) is a rapidly polymerizing liquid topical adhesive indicated for epidermal approximation of superficial lacerations and surgical wounds. Use of HVOCA in repair of facial wounds after Mohs micrographic surgery (MMS) has not been reported. OBJECTIVE: To compare aesthetic outcome of HVOCA versus sutured epidermal closure of linearly repaired facial wounds following MMS. METHODS: Patients undergoing MMS for facial tumors with postoperative wounds >3 cm appropriate for linear closure were recruited. After placement of dermal sutures, half the wound was randomly selected for closure with HVOCA and the other half was closed with 5-0 polypropylene suture. RESULTS: Fourteen patients (13 men and 1 woman; mean age, 72+/-8.8 years; range, 52-81 years) with basal cell or squamous cell carcinoma of the face (n=12) or neck (n=2) were enrolled. The mean wound length was 4.9+/-1.9 cm (range, 3.1-10 cm). No postoperative complications, including bleeding, infection, or dehiscence, occurred. Using photographs obtained 3 months postoperatively, five dermatologists (including two Mohs surgeons) blinded to the intervention rated cosmesis using a visual analog scale from 1 (worst) to 10 (best). The mean ratings for HVOCA half (6.64+/-1.55) versus sutured half (6.77+/-1.88) were not significantly different (p=.35). Paired comparisons of rater preferences similarly showed no cosmetic differences. All 14 patients preferred OCA for ease of postoperative care. CONCLUSION: HVOCA tissue adhesive is cosmetically equivalent to epidermal sutures in the linear repair of facial wounds following MMS. This technique represents an additional option for Mohs surgeons.     

TwinFix带线锚钉辅助改良Kessler法修补陈旧性跟腱断裂

目的 探讨TwinFix带线锚钉辅助改良Kessler法修补陈旧性跟腱断裂的临床疗效.方法 采用TwinFix带线锚钉辅助改良Kessler法修补陈旧性跟腱断裂患者11例,术中用改良Kessler法对位缝合跟腱断端,再用2枚TwinFix带线锚钉辅助固定断裂跟腱.术后予患侧下肢屈膝90°、踝跖屈30°位长腿石膏托固定,3周后改踝跖屈石膏托固定.结果 11例均获随访,时间3～18个月.患者均未发生切口延期愈合、感染、皮肤坏死和跟腱再断裂等并发症.采用Arner-Lindholm评分标准评价疗效:优7例,良3例,差1例.结论 TwinFix带线锚钉辅助改良Kessler法手术操作简便,是修补陈旧性跟腱断裂的有效方法.     

A randomised clinical trial to compare octyl cyanoacrylate with absorbable monofilament sutures for the closure of laparoscopic cholecystectomy port incisions

Tissue adhesives have gained increasing use as a possible method of wound closure. We compared the use of 2‐octyl cyanoacrylate (OCA) or subcuticular suture in incisions sutures for the closure of laparoscopic cholecystectomy port incisions. A prospective randomised controlled trial was performed. Patients were randomised to have closure of laparoscopic port sites using either OCA or sutures. Patients were reviewed at 24 hours and returned for follow‐up 1 week and 1 month after postoperatively. At these times, different wound characteristics were documented: Two tools were used to measure the cosmetic result using Hollander wound evaluation scale (HWES) and the patient and observer scar assessment scale (POSAS). A total of 70 patients, 35 in each group were enrolled. The wounds were closed significantly faster in the OCA group (mean 229.16 [±43.7] seconds versus 258.82 [±51.7] seconds, P = .01). Statistically significant difference in favour of using OCA was found for dehiscence (17.1% versus none in the suture group, P = .025) after 1 week. However, no difference was found for wound dehiscence after 1 month. OCA and suture groups did not differ significantly on patient satisfaction. There were no differences in the percentage of wounds achieving optimal scores on the HWES (suture 85.7% versus OCA 74.2%, P = .169). Nerveless, wound evolution was judged to be significantly better in the OCA group using POSAS. Patients' median POSAS was 9.45 (6–11) and 11.43 (10–13) in the OCA and suture groups, respectively (P = .005), and surgeon's median POSAS was 9.42 (6–11) and 11.48 (10–13) in the OCA and suture groups, respectively (P = .006). N‐butyl‐cyanoacrylate tissue adhesive is an acceptable technique for the closure of laparoscopic wounds with less operative time, and cosmetic results are comparable to suturing.     

Effect of muscle atrophy and fatty infiltration on mid-term clinical,and functional outcomes after Achilles tendon repair

ObjectivesMuscle atrophy is one of the most common problems after Achilles tendon repair. The aim of this study was to evaluate the effect of gastrosoleus muscle atrophy and fatty infiltration on clinical, and functional outcomes after Achilles tendon repair.Material and methodsA total of 46 patients (mean age = 39.3 ± 7.4 years) who underwent open Achilles tendon repair were included in the study. During the clinical evaluation of muscle atrophy, ipsilateral and contralateral calf circumference (CC), maximum heel rise (HR), and ankle range of motion measurements were recorded. Functional outcomes were assessed via The Achilles tendon Total Rupture Score (ATRS), the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the Leppilahti score. Muscle volume (MV), cross-sectional area (CSA), and percent of fatty infiltration (FI) were measured via magnetic image resonance.ResultsThe functional outcome scores were excellent: ATRS = 98.1 ± 2.2; AOFAS = 97.3 ± 4.1; Leppilahti score = 95.8 ± 5.1. There were significant differences detected between injured and non-injured legs regarding CC, HR, MV, CSA, and FI. Additionally, there were significant negative correlations between CSA and MV loss with all functional outcome scores. FI was correlated with only the AOFAS ankle-hindfoot score.ConclusionsSignificant muscle atrophy was measured after a mean follow-up period of 7.4 (range 2.0–12.6) years post-surgery and negatively correlated with clinical outcomes. CC is an easy and cost-effective measurement method to predict MV during the follow-up of Achilles tendon repairs.