A randomized clinical trial comparing two methods of fascia closure following midline laparotomy.

Three hundred forty women undergoing midline laparotomy were randomized into an interrupted suture (polyglactin 910, size 1) or a continuous suture (polyglyconate, size 0) closure group. The two groups were well balanced with respect to various risk factors for postoperative wound complications. Early evaluation revealed no differences between the continuous and interrupted suture groups with respect to wound infection (3% vs 1%), superficial wound dehiscence (2% vs 4%), and deep wound dehiscence (0.6% vs 0%). Late evaluation showed no differences between the two groups either. Continuous polyglyconate and interrupted polyglactin 910 sutures had a similar incidence of suture fistula (0% vs 2%), wound pain (1% vs 2%), and incisional hernia (3% vs 4%). Continuous closure was done faster and resulted in less foreign-body suture material. Despite its smaller diameter, the polyglyconate suture also retains a higher tensile strength after surgery than does the quicker-degrading polyglactin 910 suture. Results of this study lead to the conclusion that a running polyglyconate suture is the better choice for closure of the abdominal-wall fascia following midline laparotomy.     

Study of Two Techniques for Midline Laparotomy Fascial Wound Closure

To study the results of two techniques, simple interrupted closure and continuous with intermittent Aberdeen knot technique for midline laparotomy fascial wound closure. A random selection of 200 midline laparotomy cases was done. In one group (group A) of 100 cases, midline fascial wound closure was done with continuous sutures with intermittent Aberdeen knot technique using Prolene No. 1 suture material. In the other group (group B) of 100 cases, closure was done with the technique of simple interrupted sutures with Prolene No.1 suture material. Comparison of both the techniques regarding preoperative status and postoperative complication such as incisional hernia, wound dehiscence, suture sinus formation, stitch granuloma, and chronic wound pain was done according to clinical examination and recorded in the pro forma prepared. In group A, postoperative complications were incisional hernia 3 %, wound dehiscence 4 %, and suture sinus formation 1 %. In group B, postoperative complication were incisional hernia 5 %, wound dehiscence 4 %, and suture sinus formation 1 %. All these complications were statistically insignificant, in both group comparisons. While the complication such as stitch granuloma 3 %, chronic wound pain 3 %, and wound infection 4 % in group A was significantly less than in group B where the complication of stitch granuloma was 12 %, chronic wound pain 13 %, and wound infection 13 % (P value 0.03, P value 0.018, and P value 0.048, respectively). Both the techniques, simple interrupted suture closure and continuous with intermittent Aberdeen knot closure for midline laparotomy fascial wounds, show a similar rate of postoperative complication such as incisional hernia, wound dehiscence, and suture sinus formation. But the continuous suturing with intermittent Aberdeen knot technique is a better option to prevent complications such as stitch granuloma, chronic wound pain, and wound infection, which are higher in the simple interrupted fascial wound closure technique.     

可吸收缝线连续缝合间断打结在关闭腹部正中切口中的应用

目的：观察可吸收缝线连续缝合间断打结在腹部正中切口缝合中的应用效果。方法回顾性分析2012年9∽12月,郑州大学附属肿瘤医院接受腹部手术的患者70例。随机分成二组,观察组采用可吸收缝线全层连续缝合间断打结,对照组采用普通缝线间断全层缝合。比较二组患者切口感染、线结反应、脂肪液化、切口裂开的发生情况。结果术后二组均有患者出现切口红肿和渗出,观察组脂肪液化3例,感染1例,线结反应0例,切口裂开0例,经换药和充分引流、抗感染后,愈合良好;对照组脂肪液化5例,切口感染6例,线结反应15例,切口裂开0例,经换药和充分引流、抗感染后,有部分需要拆除缝线。观察组切口感染、线结反应的发生率明显低于对照组,二组比较差异有统计学意义（χ2＝3．968、20．741,P＝0．026、0．000）;脂肪液化二组比较差异无统计学意义（χ2＝0．565, P＝0．452）。结论可吸收缝线全层连续缝合间断打结方法与普通缝线全层间断缝合方法相比具有预防切口裂开的特点,同时具备减少切口脂肪液化、感染、线结反应等发生的优点,值得推广。     

腹壁正中切口关闭缝合的荟萃分析

目的 以相关的文献资料,对腹壁正中切口缝合关闭技术的安全性和疗效进行荟萃分析.方法 查询MedLine和Embase数据库中1981至2009年有关腹壁正中切口关闭缝合的文献,要求为具有1年以上随访、采用不同缝合技术和(或)不同缝线材料进行腹壁正中切口关腹的随机对照研究.分析指标包括切口疝、伤口裂开、伤口感染、缝线窦道形成等.结果 共纳入文献13篇,共计6263例患者.与连续缝合相比,间断缝合切口疝发生率明显增加(OR=0.80,95%CI:0.66～1.00;P=0.05),两种缝合方式在切口裂开、切口感染和窦道形成方面无显著差异.与连续不吸收缝线缝合相比,采用连续快吸收缝线的切口疝发生率显著增加(8.3%比15.8%,P＜0.05);而连续不吸收缝线缝合的窦道形成发生率更高(5.6%比1.0%,P＜0.05).与连续慢吸收缝线缝合相比,连续快吸收缝线缝合切口疝发生率更高(10.0%比15.8%,P＜0.05);与间断快吸收缝线缝合相比,使用间断不吸收缝线缝合窦道形成发生率更高(0比8.8%,P＜0.05);连续慢吸收缝线缝合与连续不吸收缝线缝合相比,两者切口疝、切口感染、切口裂开发生率等差异无统计学意义,而连续不吸收缝线缝合窦道形成发生率会明显增加(OR=0.47,95%CI:0.24～0.92;P＜0.05).连续缝合时,缝线长度与切口长度比值(SL/WL)＜4∶1与≥4∶1相比,切口裂开、切口感染差异无统计学意义;但SL/WL＜4:l时切口疝发生率会明显增加(P＜0.05).结论 腹壁正中切口缝合关闭以连续全层(SL/WL为≥4∶1)慢吸收缝线关腹为宜,适宜的关腹技术和材料,可以明显减少切口裂开、切口感染和切口疝的发生.     

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.     

Absorbable polydioxanone suture for venous anastomoses: experimental studies using venography and transluminal angioscopy

Because of their increased tendency to stenosis and spasm and thrombosis, results after venous anastomoses are often unsatisfactory. Nonabsorbable sutures and a continuous suture technique have been suggested to have a negative effect on the compliance of vascular anastomoses. Eighty venous anastomoses were performed with either an interrupted or continuous suture technique, using polypropylene or polydioxanone (PDS) sutures, according to a randomised experimental model. The anastomoses were divided in four groups: (1) Nonabsorbable suture material, continuous suture technique; (2) Nonabsorbable suture material, interrupted suture technique; (3) Absorbable suture material, continuous suture technique; and (4) Absorbable suture material, interrupted suture technique. The morphology of the anastomoses was controlled by venography directly after closure of the wound and at weekly intervals for 2 months and monthly intervals thereafter until 2 years had passed. In 10 cases venography was followed by transluminal angioscopy in the early postoperative period and after 1, 2, 4, 8 and 12 weeks. In the first 2 months moderate and high degree stenoses were found in all 4 groups by venography. After 8 weeks there was a significant decrease in the incidence of stenosis in all groups with the exception of the group, in which continuous nonabsorbable suture had been used. Using angioscopy a marked swelling of the intima at the site of the anastomoses could be detected in the early postoperative period in all experimental groups. After 2 months no significant narrowing could be identified in groups 2, 3 and 4.(ABSTRACT TRUNCATED AT 250 WORDS)     

Wound Healing after Open Appendectomies in Adult Patients: A Prospective, Randomised Trial Comparing Two Methods of?Wound Closure

Background

The skin is closed in open appendectomy traditionally with few interrupted nonabsorbable sutures. The use of this old method is based on a suggestion that this technique decreases wound infections. In pediatric surgery, skin closure with running intradermal absorbable sutures has been found to be as safe as nonabsorbable sutures, even in complicated cases. Our purpose was to compare the safety of classic interrupted nonabsorbable skin closure to continuous intradermal absorbable sutures in appendectomy wounds in adult patients.

Methods

A total of 206 adult patients with clinically suspected appendicitis were allocated to the study and prospectively randomized into two groups of wound closure: the interrupted nonabsorbable (NA) suture and the intradermal continuous absorbable (A) suture group. Primary wound healing was controlled on the first postoperative day, at 1?week clinically and after 2?weeks by means of a telephone interview. Follow-up data were obtained from 185 patients (90 in group NA and 95 in group A).

Results

Continuous absorbable intradermal suturing was as safe as nonabsorbable sutures in regard to wound infections.

Conclusion

Continuous, absorbable sutures can be used safely even in complicated appendicectomies without increasing the risk of wound infection. Considering the benefits of absorbable suturing, we recommend this method in all open appendectomies.     

Influence of the distance between interrupted sutures and the tension of sutures on the healing of experimental colonic anastomoses.

Certain technical factors determine the success of the creation of intestinal anastomoses. The influence of the distance between interrupted sutures and the suture tension on wound healing was investigated in an experimental study using a specially designed suture model. The combination of a long suture distance (group A, 2.5 mm) and a short suture distance (group B, 1.5 mm) with three different suture tensions, i.e., (1) no tension; (2) moderate tension; and (3) high tension, resulted in six different techniques. Tension was created by means of a spring balance. The anastomoses were examined macroscopically, histologically by microangiography, and by bursting pressure. Apposition of the bowel wall between the interrupted sutures was inappropriate due to prolapse of the mucosa in 7.9% of the patients in group A but did not occur in groups B2 and B3. The leakage rate was 4.6% in group A and 1.3% in group B. Early healing of the mucosa was noted in group B2. Bursting pressure was significantly higher on day 2 and 4 in groups B2 and B3. The results demonstrate the influence of suture technique on the wound healing of intestinal anastomoses. The best healing pattern was achieved by a small distance between the sutures and a moderate suture tension.     

Novafil. A dynamic suture for wound closure.

Abdominal wound dehiscence was quantitatively studied in a rat model. Polybutester suture is a new monofilament nonabsorbable suture that has unique stress-strain properties that are potentially beneficial for abdominal wound closure. The abdominal volume at the moment of wound dehiscence was correlated with the extensibility of the suture material used for closure. Interrupted sutures of polybutester cut through the tissues at a mean abdominal volume of 212 +/- 3 ml. This volume was significantly (p less than or equal to 0.005) greater than the mean volumes reached with nylon (197 +/- 3 ml) or polyglycolic acid (187 +/- 4 ml). Closure of abdomens with continuous polybutester suture resulted in a mean rupture volume of 218 +/- 3 ml, which was significantly (p less than or equal to 0.005) greater than that achieved with the same suture employed as simple interrupted sutures (212 +/- 4 ml). The influence of width of tissue bite, suture size, and needle configuration was also evaluated.     

面部清创术中两种皮肤缝合法的疗效对比观察

目的:探寻面部清创术后两种不同的皮肤缝合方法,对面部美观影响的临床疗效。方法:将2010年1月至2011年12月的181例面部伤后需清创缝合的伤员,按就诊的顺序随机分为观察组和对照组。观察组的伤员伤口清创后采取皮下间断缝合后,皮肤层用三角针、1号丝线皮内缝合,对照组的伤员伤口清创后皮肤采取5-0的美容线间断外翻缝合法。对比观察两组伤员伤口甲级愈合后面部瘢痕对面部美观的影响程度,来判断两种缝合法的临床疗效。结果:观察组:不影响美观90例,影响美观1例。对照组:不影响美观82例,影响美观8例。经χ2检验,P<0.025,两组相比较差异有统计学意义。结论:观察组的缝合法在美容效果上优于对照组,值得在面部清创缝合术中推广应用。     

Use of synthetic absorbable sutures for abdominal and chest wound closure. Experience with 650 consecutive cases.

The advent of synthetic collagen suture (polyglycolic acid and polyglacin 910) has provided a new dimension in surgical suturing. However, surgeons in general have not yet taken full advantage of the potential that this new material offers. Associated evisceration and wound dehiscence rates as well as the incidence rate of wound infection were assessed since these represent standards by which the suture material can be evaluated. In an entire series of 650 cases, there has been one case of wound dehiscence with evisceration. The incidence of infection has been less than 1%, which is comparable to previous experience with interrupted, nonabsorbable sutures. The time required for closure using the new material has been approximately one third of that associated with the use of conventional interrupted closure sutures. This implies a substantial cost reduction for the patient. As a result of this experience, the synthetic absorbable sutures seem to represent the material of choice for routine abdominal or chest wound closure.     

Wound closure and suturing patterns: a vector analysis of suture tension.

When the vectors of force required to close the ideal surgical wound are analysed, it is apparent that suture tension varies with the pattern of suture. For a given closing force, perpendicular interrupted sutures have the least tension. Symmetrical continuous sutures require greater suture tension, and this increases the more the suture is aligned with the direction of the wound. Asymmetrical (perpendicular/diagonal) continuous suturing requires more tension than interrupted sutures but this never exceeds 200%. Symmetrical suturing has slightly less tension than asymmetrical suturing when the spacing is about equal to the width of the suture. However, as the spacing ratio increases to greater than 2, the tension in the symmetrical suture rises very sharply. At a length:width ratio of 4, the symmetrical suture tension is about 70% greater than the same asymmetrical suturing.     

WOUND CLOSURE AND SUTURING PATTERNS: A VECTOR ANALYSIS OF SUTURE TENSION

When the vectors of force required to close the ideal surgical wound arc analysed, it is apparent that suture tension varies with the pattern of suture. For a given closing force, perpendicular interrupted sutures have the least tension. Symmetrical continuous sutures require greater suture tension, and this increases the more the suture is aligned with the direction of the wound. Asymmetrical (perpendicular/diagonal) continuous suturing requires more tension than interrupted sutures but this never exceeds 200%. Symmetrical suturing has slightly less tension than asymmetrical suturing when the spacing is about equal to the width of the suture. However, as the spacing ratio increases to greater than 2, the tension in the symmetrical suture rises very sharply. At a length: width ratio of 4. the symmetrical suture tension is about 70% greater than the same asymmetrical suturing.     

A histologic comparison of continuous and interrupted microarteriorrhaphy

Interrupted and continuous microsuturing techniques were compared 3 weeks after microarteriorrhaphy in the rat femoral artery using light microscopy, and internal luminal diameter determinations were measured with a Bio Quant II Digitizer. The histologic appearance of the arteries of both groups was similar, with intimal hyperplasia, intimal incorporation of suture projections into the lumen, minimal inflammatory response to suture material, and restoration of the media. No significant difference was demonstrated between internal diameters at the anastomosis site for the continuous (N = 11, mean diameter 804 +/- 60 microns) and interrupted (N = 11, mean diameter 901 +/- 45 microns) groups. However, the experimental arteries in both continuous and interrupted groups were significantly dilated when compared to their controls (513 +/- 41 microns and 621 +/- 44 microns, respectively). This study indicated that interrupted and continuous suture techniques in laboratory microarteriorrhaphy result in similar histologic and morphologic characteristics, and that the repaired vessels were dilated compared to intact vessels.     

The Impact of Running,Monofilament Barbed Suture for Subcutaneous Tissue Closure on Infection Rates in Total Hip Arthroplasty: A Retrospective Cohort Analysis

BackgroundRecently, running, monofilament barbed suture has become more popular as an efficient and economical alternative to traditional braided interrupted suture for wound closure following total joint arthroplasty. Its overall association with wound complications following surgery remains unknown at this time. Several studies have investigated its use in total knee arthroplasty (TKA), but there is limited literature surrounding use in total hip arthroplasty (THA). In this retrospective cohort study, our primary objective was to determine whether the use of monofilament barbed suture in THA was associated with reduced rates of postoperative infection when compared to traditional braided suture.MethodsPatients who underwent primary unilateral THA between November 2011 and December 2017 by a single senior surgeon with closure using either monofilament barbed suture (162 patients) or braided interrupted suture (429 patients) were retrospectively reviewed for postoperative wound complications during the first 90 days after surgery. Demographics, comorbidities, and perioperative data were also included to assess for risk factors for infection.ResultsThere was no difference between braided and barbed suture in overall rates of major complication, including periprosthetic joint infection (PJI) (0.47% vs 0.62%, P = .82) or revisions (1.86% vs 1.23%, P = .60). The overall rate of minor, superficial wound complications was also similar between both groups (6.1% vs 3.1%, P = .15). However, when superficial complications were categorized by type (dehiscence vs infection), the use of barbed suture was associated with a decreased rate of superficial wound infection (0% vs 5.4%, P = .003) and an increased rate of wound dehiscence (3.1% vs 0.7%, P = .04).ConclusionThe use of monofilament barbed suture for superficial skin closure in THA leads to similar overall rates of both major and minor wound complications when compared to traditional interrupted braided suture. However, while barbed suture was associated with fewer superficial infections, there was an increased incidence of wound dehiscence. Overall, barbed suture demonstrated a cumulatively equivalent rate of superficial wound complications compared to braided suture. Based on this investigation, barbed suture appears safe to use in THA and may represent an efficient and effective alternative to braided suture for wound closure.Level of EvidenceLevel IV; retrospective cohort study.     

Posterior-wall-first continuous suturing combined with conventional interrupted suturing for microvascular anastomosis

Vascular anastomosis with conventional interrupted suturing is often difficult to perform when the vascular clamp is not reversed, because of a narrow operative field or a short vascular pedicle. A posterior-wall-first continuous suture technique combined with the standard interrupted suture technique is one method of solving this problem. The authors conducted a comparative study of posterior-wall-first continuous suturing combined with standard interrupted suturing and conventional interrupted suturing in rat vessels. There was no statistically significant difference in patency rates or suturing times. Electron microscopy demonstrated no significant difference in recoverability of the intima. The posterior-wall-first continuous suture technique combined with the standard interrupted suture technique is a useful alternative to the conventional interrupted suture technique.     

Oblique intradermal suture as a faster choice for intradermal closure: a randomized equivalence trial

Performing interrupted intradermal suture during bi-layered skin closure is time consuming. The oblique intradermal suture is hypothesized to be a faster choice for intradermal closure while yielding similar wound cosmetic outcomes. This study aims to demonstrate the equivalence of wound outcomes between the interrupted oblique intradermal suture (OIS) and conventional interrupted intradermal suture (IS) methods. This prospective, multicenter, double-blind randomized equivalence trial included patients scheduled to undergo elective surgery with a linear incision wound. A split-wound model was used. One half of the wound was sutured using IS method and the other using OIS method. Wounds were evaluated at 1 week and 2 months after surgery. Of the 120 patients, OIS was found to be equivalent to IS for all clinical outcome parameters. OIS was associated with 50% reduction in suture time and the number of stitches required, and a 40% reduction in suture material used (p?Trial registration: ClinicalTrials.gov identifier: NCT03001856.

Meeting presentation: 7th Bozner Symposium of Plastic Surgery, Bozen, Italy, January 2017.     

Combined microvascular anastomosis: experimental and clinical experience

A short operative time and a high successful rate of microvascular anastomosis are the goals of many plastic surgeons. The authors present their experimental and clinical experience in microvascular anastomoses with the use of a combination of continuous suture and interrupted tie. Twenty rats were divided into two groups. The aorta and inferior vena cava were used for microvascular anastomoses. The vessels of 10 rats were repaired with conventional interrupted suture, and the vessels of the other 10 rats were repaired with combined anastomoses. A total of 150 clinical microvascular surgeries during the past 2 years are also presented, all of which were performed using the combined method. Microvascular anastomoses with the combined method were completed faster than when using the conventional interrupted method in experimental studies. Clinically, no direct microvascular anastomosis failed with the use of combined method. Microvascular anastomosis with the use of the combined continuous suture and interrupted tie resulted in satisfactory outcomes. This technique has the advantages of both interrupted and continuous methods, but not their shortcomings.     

Suture technique and wound-bursting strength

Despite advances in wound healing, fascial dehiscence continues to be a problem in celiotomy wounds. Experimental and clinical studies on suture material and on patient-related factors in wound disruption are abundant, but little attention has been given to mechanical factors in wound closure, although they may be of greater importance. A midline abdominal wound was made in 120 Harlan Sprague-Dawley rats, and the fascia was closed with Dacron in one of six ways: simple interrupted, interrupted figure-of-eight, and running, each tied loosely in one half of each group and tightly in the other half. One week later, the rats were reanesthetized and wound-bursting strength was measured. In general, the running suture technique resulted in the greatest wound-bursting pressures. A loosely tied figure-of-eight technique was nearly as good as a loosely tied running stitch, but tying figure-of-eight sutures tightly caused a significant decrease in wound-bursting pressure. The simple interrupted technique was unaffected by suture tension but was generally inferior to the running stitch in terms of wound-bursting strength. Histologic studies were performed, but most of the disparity in wound strength among the suture techniques apparently was due solely to mechanical factors. Closing midline abdominal fascial wounds with a running suture may be a superior method of closure in clean, incised wounds.     

The influence of suture technique on early wound healing.

The burst strength, swelling, and microcirculatory dynamics were compared in model skin wounds closed by interrupted or continuous suturing techniques. Incised skin wounds of the midline abdomen and anteromedial and anterolateral knee of the pig were used. Microcirculatory kinetics were assessed by means of skin fluorescence following intravenous fluorescein at intervals of up to 12 days. The burst strength of wounds was measured at 12 days using an Instron Tensiometer. In wounds closed with an interrupted suture technique a 30 to 50% greater tensile strength, less edema and induration, and less impaired microcirculation at the wound margin was demonstrated in comparison to that observed in wounds closed with a continuous suture technique. The results support the use of interrupted rather than continuous suture technique for skin wound closure in instances where impaired healing can be anticipated due to disease or age, or where early stress on the healing wound is planned as in incisions about a moveable joint.