Water-tight knee arthrotomy closure: comparison of a novel single bidirectional barbed self-retaining running suture versus conventional interrupted sutures

Standard medial parapatellar arthrotomies of 10 cadaveric knees were closed with either conventional interrupted absorbable sutures (control group, mean of 19.4 sutures) or a single running knotless bidirectional barbed absorbable suture (experimental group). Water-tightness of the arthrotomy closure was compared by simulating a tense hemarthrosis and measuring arthrotomy leakage over 3 minutes. Mean total leakage was 356 mL and 89 mL in the control and experimental groups, respectively (p = 0.027). Using 8 of the 10 knees (4 closed with control sutures, 4 closed with an experimental suture), a tense hemarthrosis was again created, and iatrogenic suture rupture was performed: a proximal suture was cut at 1 minute; a distal suture was cut at 2 minutes. The impact of suture rupture was compared by measuring total arthrotomy leakage over 3 minutes. Mean total leakage was 601 mL and 174 mL in the control and experimental groups, respectively (p = 0.3). In summary, using a cadaveric model, arthrotomies closed with a single bidirectional barbed running suture were statistically significantly more water-tight than those closed using a standard interrupted technique. The sample size was insufficient to determine whether the two closure techniques differed in leakage volume after suture rupture.     

腹壁缝合关闭方式的临床随机对照研究

目的 探讨不同腹壁切口缝合方式的切口愈合效果.方法 将2009年1月至2010年12月间收治的腹部正中切口及旁正中切口病人168例,随机分为两组:观察组85例,采用全层缝合方式缝合腹壁;对照组83例,采用传统的分层缝合方式缝合腹壁.结果 观察组切口一期愈合率96.5%,对照组为77.1%;观察组切口脂肪液化率为2.4%...     

Evaluating the use of a barbed suture for skin closure during autologous breast reconstruction

This study compared the use of barbed suture to a traditional skin closure method for incision closure in free flap breast reconstruction. A retrospective study compared the two closure methods in consecutive series of patients undergoing autologous breast reconstruction between January 2007 and January 2009. Outcomes included total duration of operation and wound complications. We also performed a cost analysis. Use of the barbed suture significantly decreased operative time for unilateral cases by an average of 45 minutes (405 versus 360 minutes, P = 0.02). For bilateral cases, the mean operative time was decreased by an average of 10 minutes (510 versus 500 minutes, P = 0.44). There were more episodes of delayed wound healing in the bilateral barbed suture group (33/46 [72%] versus 15/31 [48%], P = 0.04). No statistical difference was noted between the two groups with regard to dehiscence, infection, or suture extrusion. Use of the barbed suture was, however, more cost-effective. The use of a barbed suture in the closure of abdominal and breast incisions in free flap breast reconstruction may expedite wound closure and reduce the cost of the procedure but may increase wound complications.     

Continuous versus interrupted suturing of traumatic lacerations: a time, cost, and complication rate comparison

BACKGROUND: The most frequently used techniques in the repair of traumatic lacerations are interrupted and continuous suturing. METHODS: We performed a prospective study of interrupted and continuous suturing techniques evaluating suturing rates, suture economy, and complication rates in the repair of 101 traumatic lacerations. RESULTS: Continuous closure was accomplished at a statistically faster rate (mean, 0.276 cm/min) than interrupted closure (mean, 0.175 cm/min; p = 0.004). Less suture material was used in the continuous closures (0.321 suture packets/cm) than in interrupted closures (0.508 suture packets/cm; p = 0.03). No statistically significant difference existed in the complication rate between the two closure methods (continuous, 1 of 44; interrupted, 1 of 57; p = 0.59). CONCLUSION: Although suturing technique should be selected primarily on the basis of wound characteristics and surgeon preference, continuous suturing warrants consideration for the closure of traumatic lacerations because of its time/material economy and the lack increased complication rates.     

“立体缝合”法在腹腔镜造口旁疝Sugarbaker修补术中的应用

背景与目的 造口旁疝是肠造口术后的常见并发症，腹腔镜Sugarbaker修补术是目前主流的手术方式，而如何缝合关闭筋膜缺损是手术最大的难点。常规的缝合关闭技术存在闭合或缩小缺损困难、术后血清肿发生率高、腹壁塑形效果差等不足。笔者中心在前期应用“立体缝合”技术缝合关闭缺损，可以较好地解决上述问题。本研究通过对比造口旁疝腹腔镜Sugarbaker修补术中应用“立体缝合”技术和常规缝合技术的两组患者的临床疗效，探讨“立体缝合”技术在造口旁疝修补术中的临床价值。方法 回顾性分析2018年1月—2021年12月中山大学附属第六医院疝和腹壁外科行腹腔镜Sugarbaker修补术的造口旁疝患者资料，其中44例采用“立体缝合”关闭缺损（研究组），29例采用传统缝合方法关闭缺损（对照组），比较两组患者的相关临床指标。结果 研究组均实现了筋膜缺损的完全关闭，对照组无法完全关闭缺损9例（31.0%）；研究组平均关闭筋膜缺损缝合时间（47.45±10.44）min，平均手术时间（132.14±13.72）min，对照组平均关闭筋膜缺损缝合时间为（33.72±8.64）min，平均手术时间（113.97±18.30）min，两组以上指标差异均有统计学意义（均P<0.001）。研究组术后血清肿发生率明显低于对照组（6.8% vs. 27.6%，P=0.036），两组术后补片感染发生率差异无统计学意义（2.3% vs. 3.4%，P=0.640）。研究组术后复发率明显低于对照组（2.3% vs. 20.7%，P=0.027）。研究组术后住院时间6（5~7）d，住院费用为（72 998.79±15 352.46）元，对照组术后住院时间6（5~7）d，住院费用为（72 998.79±11 542.77）元，两组间该两项指标差异均无统计学意义（P=0.447，P=0.708）。结论 立体缝合技术应用于造口旁疝修补术中，可有效关闭筋膜缺损，减少术后血清肿和复发的发生率。     

Bimodal assessment of laparoscopic suturing skills: Construct and concurrent validity

Background The assessment of technical skills should provide objective feedback and judge suitability of progress during training. The aim of this study was to validate two objective assessment techniques for laparoscopic suturing and demonstrate a correlation between them. Methods Six experts, seven surgeons skilled in laparoscopic suturing, and 13 with no laparoscopic suturing skills were asked to place two or three intracorporeal sutures on a synthetic suture pad. The latter group was given video-based instructions prior to the execution of the sutures. Ergonomic conditions were standardized for all subjects. The procedures were recorded on videotape and two blinded observers rated the first suture of each subject on a 29-point checklist. A motion analysis system, Imperial College Surgical Assessment Device, was used to assess psychomotor skills. Results There was a significant difference in the time taken (p=0.000) and total path length (p=0.000) per suture across the groups. There were also a significant difference in the total checklist score (p=0.000) and its individual categories. The was a strong correlation between the total path length and the total checklist score (coefficient, 0.78;p<0.001). Conclusions A combination of the motion analysis system and the checklist would make the process of formative feedback during the learning of intracorporeal suturing objective and comprehensive. Online publication: 13 October 2004     

单向倒刺线在腹腔镜胆总管探查一期连续缝合中的应用

【摘 要】 目的 探讨单向倒刺线连续缝合在腹腔镜胆总管探查一期缝合术中闭合胆总管的安全性和有效性。方法 对2016年6月至2017年12月西安交通大学第一附属医院进行腹腔镜胆总管探查一期缝合术治疗的81例胆总管结石患者进行前瞻性研究。按照随机数字表法,患者分为单向倒刺线连续缝合组（41例）和普通可吸收线连续缝合组（40例）。比较两组患者胆总管闭合缝合时间,术后并发症情况,术后住院时间及随访情况。结果 两组患者均手术成功,术中结石取净,无术中并发症。倒刺线组胆总管缝合时间明显少于普通线组[（11.4±2.0）min vs （15.6±3.5）min,t=-6.67,P < 0.05];两组胆漏发生率（2.4% vs 5.0%）,急性胆管炎发生率（4.9% vs 5.0%）,术后平均住院时间[（4.4±1.2）d vs（4.4±1.6）d]差异均无统计学意义（P > 0.05）。所有患者均获得随访,随访半年以上者倒刺线组18例,普通线组15例,尚未见结石残余、结石复发或胆管狭窄情况。结论 单向倒刺缝线连续缝合用于腹腔镜胆总管探查一期缝合术安全可行,可以降低腹腔镜下缝合难度,缩短缝合时间,并且不增加并发症风险.     

Sternal wound infections in patients undergoing open heart surgery: randomized study comparing intracutaneous and transcutaneous suture techniques.

BACKGROUND: Intracutaneous suture technique has been our standard method for closing sternal wounds in cardiac surgery, mainly for cosmetic reasons. However, an increased rate of postoperative infections has been reported in cosmetic surgery with this method compared with the percutanous or transcutaneous closure technique. A comparison of these two techniques in cardiac surgery is presented. METHODS: In a randomized study, 300 patients were selected to intracutaneous suture (n = 150) or percutanous suture (n = 150). The endpoints were superficial and deep sternal wound infections within 6 weeks postoperatively. RESULTS: The total infection rate was lower in the percutanous group compared with the intracutaneous group (3% versus 8%) (p = 0.007). The superficial infection rate was lower in the percutaneous group (2.3% versus 6.7%) (p = 0.01), whereas there was no statistically significant difference in the deep infection rate between the groups. CONCLUSIONS: The percutaneous suture technique reduces the incidence of superficial wound infections, but not the deep infection rate in open heart surgery. There was no difference in the cosmetic results on a visual scale, assessed by the patients.     

Suture reaction following skin closure with subcuticular polydioxanone in total knee arthroplasty

A retrospective study revealed a 20% incidence of suture reaction following closure of wounds with subcuticular polydioxanone after total knee arthroplasty. In a control group whose wounds were closed with subcuticular polyglycolic acid (Dexon, Davis & Geck, Wayne, NJ), no suture reactions occurred (P = .0012, Fisher's exact test). It is concluded that subcuticular polydioxanone should not be used for skin closure after total knee arthroplasty.     

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.     

Comparison of interrupted versus continuous closure in abdominal wound repair: a meta-analysis of 23 trials

OBJECTIVE: There is a lack of consensus among surgeons over interrupted versus continuous methods of abdominal wound closure. The objective of this study was to perform a meta-analysis to estimate the pooled odds ratio (OR) for dehiscence and incisional hernia in the interrupted technique of laparotomy wound closure as compared to the continuous technique. METHODS: All randomized, controlled trials comparing continuous and interrupted methods of laparotomy wound closure, with burst abdomen and/or incisional hernia as the outcomes, were included in the meta-analysis. MEDLINE, Clinical Evidence and the Cochrane Library were searched. Burst abdomen and incisional hernia were the two primary outcomes. RESULTS: Twenty-three studies were identified, with a total of 10,900 patients. The interrupted method of closure was associated with significantly less dehiscence as compared with the continuous method (OR, 0.576; p = 0.014; relative risk reduction, 39.8%; number needed to treat, 143). The interrupted technique was also found to be better in the nonabsorbable suture, vertical incision and mass closure subgroups. However, no difference in the hernia risk was found between the two methods. CONCLUSION: Interrupted laparotomy wound closure reduces the odds of dehiscence by half compared with continuous wound closure.     

Skull base cerebrospinal fluid leakage control with a fibrin-based composite tissue adhesive

Cerebrospinal fluid (CSF) leaks can be responsible for significant patient morbidity and mortality. While the majority of leaks induced after head trauma will seal without intervention, spontaneous or surgically-induced leaks often require operative repair. Many modifications on standard surgical technique are available for repair of CSF fistulae, but none assures adequate closure. We have studied the efficacy of a novel fibrin-based composite tissue adhesive (CTA) for closure of experimentally-induced CSF leaks in rats. Fistulae were created in two groups of animals. Two weeks after creation of the leaks, the animals were sacrificed and analyzed for persistence of leak. A 58% leakage rate was noted in the control group (n = 12), and no leaks were noted in the experimental group closed after application of CTA to the surgical defect followed by skin closure (n = 11). Comparing the control group to the experimental group, results were statistically significant (p = 0.015). These data suggest that CTA may be effective as an adjunct for the closure of CSF fistulae.     

Skull Base Cerebrospinal Fluid Leakage Control with a Fibrin-Based Composite Tissue Adhesive

Cerebrospinal fluid (CSF) leaks can be responsible for significant patient morbidity and mortality. While the majority of leaks induced after head trauma will seal without intervention, spontaneous or surgically-induced leaks often require operative repair. Many modifications on standard surgical technique are available for repair of CSF fistulae, but none assures adequate closure. We have studied the efficacy of a novel fibrin-based composite tissue adhesive (CTA) for closure of experimentally-induced CSF leaks in rats. Fistulae were created in two groups of animals. Two weeks after creation of the leaks, the animals were sacrificed and analyzed for persistence of leak. A 58% leakage rate was noted in the control group (n = 12), and no leaks were noted in the experimental group closed after application of CTA to the surgical defect followed by skin closure (n = 11). Comparing the control group to the experimental group, results were statistically significant (p = 0.015). These data suggest that CTA may be effective as an adjunct for the closure of CSF fistulae.     

Suture length to wound length ratio and the integrity of midline and lateral paramedian incisions

A total of 349 patients were randomized to undergo laparotomy through a lateral paramedian incision with layered closure (n = 137), a midline incision with mass closure (n = 104) or a midline incision using layered closure (n = 108), endeavouring to close the latter two incisions with a measured suture length to wound length ratio of greater than 4:1. After 18 months follow-up, no patient in the lateral paramedian group had developed an incisional hernia whereas 7 of 104 patients undergoing a midline incision with mass closure and 7 of 108 patients undergoing a midline incision with layered closure had incisional hernias (P less than 0.01). The mean suture length to wound length ratios for the three groups were 2.6 (range 1.3-6.2), 5.0 (range 3.0-8.7) and 3.7 (range 2.0-6.3) respectively (P less than 0.0001). The lateral paramedian incision remains superior to the midline incision closed with the mass technique and its integrity is independent of the suture length to wound length ratio.     

A prospective randomized trial of closing laparoscopic trocar wounds by transcutaneous versus subcuticular suture or adhesive papertape

BACKGROUND: Several methods for closure of trocar wounds are known in laparoscopic surgery. The choice of technique (mostly transcutaneous or subcuticular suture or adhesive papertape) is often based on the surgeon's personal experience. Thus, the objective of this trial was to assess the impact of these closure methods on potential complications of wound healing, cosmetic outcome, and patient satisfaction. METHODS: Sixty patients undergoing operative laparoscopic surgery for gynecologic indications were enrolled in this prospective randomized trial. Five-millimeter port-site incisions were closed either with subcuticular or transcutaneous absorbable sutures (4-0 polyglactin 910) or with adhesive papertape. Postoperative complications, pain, and patient satisfaction with scars were evaluated at 3-month follow-up after operation using a questionnaire. RESULTS: Data from 52 patients who returned the questionnaire were analyzed. Dissatisfying cosmetic results were reported significantly more frequently after subcuticular sutures (p < 0.05). Assessment of patient satisfaction with cosmetic outcome on a visual-analogue scale revealed significantly better results after transcutaneous skin closure than with other approaches (p < 0.05). Adverse wound healing (e.g., infections and dehiscence) was observed most frequently in the subcuticular suture group. Also, the rate of painful scars was highest with this technique. CONCLUSIONS: Transcutaneous closure with absorbable suture material seems to be the most suitable technique for closure of laparoscopic port-site incisions.     

不缝合皮下脂肪层的切口缝合方式在腹部外科的应用

目的比较不缝合皮下脂肪层的关腹方式与传统关腹方式的切口愈合效果。方法选取2010年9月至2012年9月期间笔者所在医院科室收治的患者400例,随机分为2组：观察组199例,采用不缝合皮下脂肪层的缝合方式;对照组201例,采用传统的分层缝合方式。比较2组患者的切口愈合效果。结果观察组发生脂肪液化1例（0．5％）、切口红肿3例（1．5％）、切口硬结1例（0．5％）、切口裂开0例及皮下血肿2例（1．0％）,对照组上述并发症的发生数量分别为18例（9．0％）、16例（8．0％）、15例（7．5％）、9例（4．5％）及0例,除皮下血肿发生率的差异无统计学意义（P〉0．05）外,观察组其余切口并发症的发生率均低于对照组（P〈0．01）。观察组切口全部一期愈合（100％）,对照组愈合186例（92．5％）,观察组的-期愈合率较高泸〈0．01）。观察组的关腹时间和术后住院时间分别为（13．0±1．6）min和（7．7±1．3）d,均短于对照组[（18．0±2．2）min,（9．6±1．9）d,P〈0．01]。结论不缝合皮下脂肪层的切口缝合方式的切口愈合效果明显优于传统的分层缝合方式,值得推广。     

Peritoneal closure reduces port site metastases

BACKGROUND: The arm of this study was to assess the role of peritoneal closure in the prevention of port site metastasis after carbon dioxide (CO2) CO2 pneumoperitoneum. METHODS: We developed a xenograft ovarian cancer model by intraperitoneal injection of 27 106 IGR-OV1 line cells in nude rats Seven days after the inoculation, the animals underwent a CO2 pneumoperitoneum. At the end of the procedure, port sites were randomly closed either with suture of peritoneum (n = 14, group A) or without suture of peritoneum (n = 12, group B). The rats were killed 7 days after surgery and their port site scars were resected. Tumor implantation was assessed by a pathologist who was blinded to the type of wound closure. RESULTS: The animals in group B were significantly more likely to have at least one port site metastasis frequent (seven of 12, or 58.3%) than those in group A (two of 14, or (14.3%) (p = 0.037). Port sites with metastases were seen more frequently in group B (eight of 24, or (33.3%) than in group A (three of 28, or 10.7%) (p = 0.046). CONCLUSIONS: Our results shows that peritoneum closure decreases the risk of port site metastasis.     

DISTAL PANCREATECTOMY: IS STAPLE CLOSURE BENEFICIAL?

Background: Appropriate closure of the pancreatic remnant after distal pancreatectomy remains controversial. Data on distal pancreatectomy were reviewed to evaluate the effectiveness of staple closure compared with suture closure. Methods: Thirty‐three patients underwent distal pancreatectomy between January 1994 and December 2001. They were subdivided according to the method of closure of the distal pancreatic stump: the staple group comprised 10 patients and the suture group comprised 23 patients. Charts were reviewed for the method of closure of the distal stump as well as for the serum and urinary amylase level, mortality and morbidity. Results: In the staple group, no patient developed a pancreatic fistula, whereas in the suture group, eight patients (33.3%) developed a pancreatic fistula (P = 0.0353). The serum amylase level (mean ± SD) on the first postoperative day was 185 ± 71 IU/L in the staple group and 499 ± 461 IU/L in the suture group (P = 0.0413). Conclusion: Staple closure by means of a Powered Multifire Endo GIA 60 is a simple, quick and safe alternative to the standard suture closure technique, as it reduces the incidence of pancreatic fistula.     

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??Application of straight needle three-tail non-kontting suture in peritoneal closure in transabdominal preperitoneal inguinal hernia repair ZHOU Tai-cheng, YU Hong-yan, JIANG Zhi-peng, et al. Department of Gastroenterological Surgery and Hernia Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou 510655??China
Corresponding author??CHEN Shuang??E-mail??sysusc@126.com
Abstract Objective To investigate efficiency of straight needle three-tail non-kontting suture in peritoneal closure in transabdominal preperitoneal inguinal hernia repair (TAPP). Methods A total of 238 patients with inguinal hernia performed TAPP in the Sixth Affiliated Hospital of Sun Yat-sen University between December, 2013 and December, 2015 were enrolled into the study, including 120 patients in control group with traditional suture and 118 patients in experiment group with straight needle three-tail non-kontting suture. All the patients received TAPP operation under general anaesthesia. The difference between tow groups were compared in age, gender, BMI, hernia type, defective area, hernia sac handling, operative time, peritoneal closure time, hospitalization cost, postoperative complications, VAS score and recurrence rate. Results The mean operative time was ??44.8±2.7??min for experimental group and??50.3±3.1??min for control group??t =7.243??P=0.025??. The mean peritoneal closure time was ??4.2±0.7??min for experimental group and??9.8±1.1??min for control group??t =9.833??P=0.010??. The mean cost was ??8927.4±135.2??yuan for experimental group and??9232.5±159.8??yuan for control group??t =4.782??P=0.041??. There was no difference in mesh infection??P=0.759??, recurrence ??P=0.759??, seroma??P=0.899??and VAS score??P=0.375?? between two groups. Conclusion Compared with traditional method, straight needle three-tail non-kontting suture could reduce operative cost as well as shorten operative and peritoneal closure time, without increasing postoperative complications, pain and recurrence.     

Continuous-suture technique in aortic valve replacement

From April 2000 to April 2003 total 103 patients underwent aortic valve replacement and some concomitant cardiac procedures including mitral valve replacement in our hospital. According to the suture technique used in aortic valve replacement, the patients were divided into two groups: group A, 42 patients, the continuous suture technique with some modifications was used; group B, 61 patients, the conventional interrupted suture technique was used. There were no statistical differences between the two groups in age, sex, bodyweight, valve lesion, concomitant cardiac procedure and early mortality. But there were significant differences ([<0.001 approximately 0.012) in aortic cross-clamp time (AOCT) and cardiopulmonary bypass time (CPBT) between the two groups with less time for the group A patients. During a follow-up from 1 to 35 months, in group B, one patient developed perivalvular leak. The incidence of perivalvular leak was 1.7% (1/59). Three patients developed prosthetic bacterial endocarditis, the incidence of which was 5.0% (3/59). All the patients in group A recovered satisfactorily without suture technique or prosthesis associated complications. The modified technique was introduced and illustrated with diagrams, and the reasons for the advantages of the technique over the conventional interrupted suture technique were discussed.