Comparison of various methods and materials for treatment of skin laceration by a 3-dimensional measuring technique in a pig experiment

BACKGROUND: The ability to obtain an objective comparison of scar formations by reproducible and quantitatively measurable results have posed a longstanding problem. This was especially troublesome when conclusions were to be drawn about the materials and methods applied. Two-dimensional methods (photography) gave no plastic impression about the spatial coherences in an examined scar. However, a quantifiable and reproducible recording of volumes and a 3-dimesional visualization of scars should provide the basis of any evaluation of methods and materials. METHODS: The OPTOCAT 3-dimensional scanning technique that was used was provided by the Breuckmann GmbH Company (Meersburg, Germany), and it permits a 3-dimensional, contact-free recording of data. The experiment animal was the Goettinger minipig. A total of 10 animals were used to examine the process of wound healing and scar development in full skin incisions. Every animal was incised 20 times with a 10-cm long and 20 times with a 2-cm long wound. In our investigation, comparable suture materials (skin adhesive, absorbing and nonabsorbing suture materials) of the companies Braun (Histaocryl, Monosyn, Safil, Premilene) and Ethicon (Dermabond, Monocryl, Vicryl, Prolene) as well as various suture techniques were used (continuous, mattress suture, and over-and-over/interrupted suture; each once with and once without an intracutaneous suture). In the course of the trial, numerous images of all wounds-a total 1200-were taken. Thanks to the 3-dimensional software, the resulting scar volumes of lacerations, which received different wound management, were quantifiably recorded, compared, and evaluated. RESULTS: In total, dehiscence occurred in 2.5% of all treated wounds. The greatest share (15%) fell to wounds treated with Histoacryl skin adhesive. In the end, skin adhesive, mattress, and interrupted suture all delivered similar results. An additional intracutaneous suture had, with an increasing wound length, a positive effect on the intention/wound healing, especially in connection with the application of skin adhesive. Except the combination of continuous absorbable suture and intracutaneous suture, the scar volume dwindled over time and adapted to the surrounding skin level. Continuous sutures were, by comparison, more inclined to an increased scarring (absorbable suture > nonabsorbable suture). It did not escape our notice that in case of small wounds, all various suturing materials and methods led to almost identical results. With respect to scarring, no significant difference regarding the suturing material was proven. CONCLUSIONS: If possible, the wound closure, treated with common suturing techniques and especially with skin adhesive, should be enhanced by an intracutaneous suture with an increasing length of the wound. Under certain circumstances, skin adhesive is an adequate substitute for common suturing materials and methods. The final decision about the method and material is as much closely related to the length and localization of the wound as to time exposure, efficiency, and the comfort of the patient. SUMMARY: For objective comparison of intention and scarring, a scanning technique was used that permits a quantifiable, contact-free, single-session recording of volume differences. For this purpose, various suture materials and methods were used. Altogether, it could be shown that, if possible, wound closure treated with common suturing techniques, and especially with skin adhesive, should be enhanced by an intracutaneous suture with an increase in wound length. At the same time and under certain circumstances, skin adhesive poses an adequate substitute for the common suturing materials and methods. In the end, however, the final decision about the choice of method and material should be made depending on the localization and expanse of the wound as well as on the comfort of the patient (eg, absorbable suture/nonabsorbable suture), the time of exposure (eg, skin adhesive vs suture), and the economic efficiency (eg, producer of suture material).     

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.     

Results of a prospective randomised study comparing a non-invasive surgical zipper versus intracutaneous sutures for wound closure

A prospective randomised study was undertaken to investigate the advantages and disadvantages of a non-invasive surgical zipper (Medizip) vs intracutaneous sutures skin closure in orthopaedic surgery. The study group consisted of 120 consecutive patients, 45 men and 75 women with a mean age of 47 years. The Medizip was used in 20 surgical knee wounds, 20 hip wounds and 20 orthopaedic spine wounds. The same number of patients received intracutaneous sutures. Handling, wound healing and scar formation on day 1, at 2 weeks and 6 weeks were evaluated. The average time for wound closure with the zipper was 2 min and 9.4 min when the wound was closed with intracutaneous sutures (p = 0 .01). Patients were positive in their assessment of the wound healing progress and results; they found the skin closure device agreeable to wear. The scar result was rated very good in 82% (n = 4 9) of the zipper group, and 85% (n = 5 1) in the intracutaneous group (p = 0 .67). Based on the results obtained, the non-invasive skin closure system Medizip represents a safe option in the spectrum of surgical wound treatment.     

A comparison between different suture techniques in lumbar spine surgery

As a result of solicited muscles, strong friction, and tensile force on cutaneous tissue, the difference in closure procedure and management strategies and complications of surgical incision healing is a real challenge in lumbar spine surgery. We performed a retrospective study to compare different types of wound closure in lumbar spine surgery. 4383 patients were included in this study. Wound dehiscence was more common in the intracutaneous suture group than in the far- near-near-far suture group. Delayed wound healing occurred more in the far-near near-far suture group than intracutaneous suture group. Also, the far-near near-far interrupted point suture group showed a higher ratio of delayed wound healing compared with crossover suture. The superficial wound infection rate was roughly the same in all types of sutures with an average value of 0.79% with 0.81% SD. This is a preliminary study to compare different types of operative wounds showing the pros and cons related to each option.     

Leg Wound Closure after Saphenous Vein Harvesting in Patients Undergoing Coronary Artery Bypass Grafting: A Prospective Randomized Study Comparing Intracutaneous,Transcutaneous and Zipper Techniques

Objective : Two prospective randomized studies were undertaken to compare different suture closure techniques with respect to postoperative wound infection rates and cosmetic results after saphenous vein harvesting in patients undergoing coronary artery bypass surgery. Design : A total of 166 patients were included in the first study, in which 85 had their leg wounds closed with transcutaneous and 81 with intracutaneous suture. In the second study, 168 patients were selected to a non-invasive surgical zipper ( n = 78) or intracutaneous suture ( n = 90). Results : In the first study the overall infection rate was 20.5%, 17.6% in the transcutaneous group compared with 23.5% in the intracutaneous group ( p = 0.35). In the second study the infection rate was 19.3%, 15.3% in the zipper group vs 23.3% in the intracutaneous group ( p = 0.20). On a cosmetic scale from 1 to 10, an average score of 8.0 was obtained in the percutaneous (p.c.) group vs 8.3 in the intracutaneous (i.c.) group ( p = 0.35), and 9.0 in the zipper group vs 8.4 in the i.c. group ( p = 0.003). Conclusion : The incidence of leg wound infection after saphenous vein harvesting in coronary artery bypass graft surgery is high. The zipper closing method may give a lower infection rate and a better cosmetic result compared with the intracutaneous suture.     

Leg wound closure after saphenous vein harvesting in patients undergoing coronary artery bypass grafting: a prospective randomized study comparing intracutaneous,transcutaneous and zipper techniques

OBJECTIVE: Two prospective randomized studies were undertaken to compare different suture closure techniques with respect to postoperative wound infection rates and cosmetic results after saphenous vein harvesting in patients undergoing coronary artery bypass surgery. DESIGN: A total of 166 patients were included in the first study, in which 85 had their leg wounds closed with transcutaneous and 81 with intracutaneous suture. In the second study, 168 patients were selected to a non-invasive surgical zipper (n = 78) or intracutaneous suture (n = 90). RESULTS: In the first study the overall infection rate was 20.5%, 17.6% in the transcutaneous group compared with 23.5% in the intracutaneous group (p = 0.35). In the second study the infection rate was 19.3%, 15.3% in the zipper group vs 23.3% in the intracutaneous group (p = 0.20). On a cosmetic scale from 1 to 10, an average score of 8.0 was obtained in the percutaneous (p.c.) group vs 8.3 in the intracutaneous (i.c.) group (p = 0.35), and 9.0 in the zipper group vs 8.4 in the i.c. group (p = 0.003). CONCLUSION: The incidence of leg wound infection after saphenous vein harvesting in coronary artery bypass graft surgery is high. The zipper closing method may give a lower infection rate and a better cosmetic result compared with the intracutaneous suture.     

生物粘合剂对胆肠吻合口瘢痕形成的影响

为了克服丝线缝合组织加重瘢痕形成之不足，作者用生物粘合剂（ＦＧ）替代缝线，结合内支撑导管建立了各种胆肠吻合口瘢痕动物实验模型，并定期对吻合口瘢痕组织进行病理形态学观察和计算机图像处理（ＥＣＶＤ），从瘢痕形成的角度观察胆肠吻合口愈合过程。结果表明，ＦＧ可促进伤口愈合、减少瘢痕形成、加速瘢痕成熟软化；内支撑保留６个月瘢痕成熟。作者认为，ＦＧ克服了丝线缝合加重瘢痕形成的不足，是预防术后胆道狭窄的一种有效措施。     

Effect of nutrition, diet and suture material on long term wound healing.

Although it is known that malnutrition hinders early wound healing, it has not been determined whether this occurs because of formation of a poor scar or a slow rate of normal healing; the ultimate fate of the malnourished wound is unknown. Malnutrition was produced in rats by short gut syndrome. Elemental diet was compared to rat chow and silk was compared with polyglycolic acid suture. Nutritional deficiency was seen in short gut rats for two weeks postoperatively. Thereafter adaptation allowed partial recovery, but relative deficiency persisted. Morbidity and mortality of short gut rats doubled that of controls and all wound complications were limited to this group, occurring within the first two weeks. Malnourished animals surviving for 60 days had wound strength equal to the control rats as determined by gut anastomosis bursting strength, skin wound breaking strength and wound hydroxyproline content. Neither diet nor suture material altered ultimate wound strength. Improved nutrition allowed more animals and wound to survive, but ultimate healing survivors was indistinguishable from that of normal controls. Thus early weakness probably results from slow healing rather than formation of poor scar. Nutrition plays an important role in early strength and survival, but not in ultimate wound healing.     

Dermatotraction: an effective technique for the closure of fasciotomy wounds: a preliminary report of fifteen patients

Dermatotraction was evaluated as an alternative technique for the closure of dermatofasciotomy wounds, with a review of literature and of our clinical experience. The dermatotraction technique provides closure of fasciotomy wounds and avoids the use of skin grafting. Patients treated with dermatofasciotomy for an acute compartment syndrome of the limbs, without obvious tissue necrosis and without shock or urgent life saving surgery, had their fasciotomy wound closed with dermatotraction with vessel loops, the skin approximation system, or the prepositioned intracutaneous suture. In our experience, the mean time to wound closure was nine days. Dermatotraction techniques that cause local skin compression should be avoided because skin necrosis might occur (skin approximation system). Dermatotraction with vessel loops or the prepositioned intracutaneous suture provides good skin apposition without the necessity for skin grafting.     

Comparative study of skin wound closure with polybutester (Novafil) and polypropylene

A prospective study of skin wound closure using polybutester (Novafil) and polypropylene was carried out in 100 elective procedures in 77 patients over a 1-year period at the Plastic Surgery Unit of Mubarak Al Kabeer Hospital, Kuwait. In this comparative study based on clinical evaluation, particular note was made of the handling characteristics of the suture material, wound infection, healing and eventual scar in each case. The tensile strength of both sutures was comparable and the wound infection rate and wound healing characteristics in the two groups were more or less the same. Our study has shown Novafil to be a superior suture for skin wound closure because of its handling qualities, easier removal from the healed wound and because of a cosmetically better scar in a significant number of patients.     

Sternal wound closure in patients undergoing open-heart surgery: a prospective randomized study comparing intracutaneous and zipper techniques.

OBJECTIVE: A prospective, randomized study was undertaken to compare a non-invasive surgical zipper to intracutaneous suture closure in open-heart surgery with respect to postoperative wound infection rate and cosmetic results. METHODS: A total number of 300 patients were included in the study, of which 150 had their skin wound closed with zipper and 150 with intracutaneous suture. The end-points were superficial and deep sternal wound infections within 6 weeks postoperatively. RESULTS: The incidence of total infection after 6 weeks was equal in the two groups (6.7 vs. 6.7%) (P=0.94). The superficial infection rate was 5.3% in the zipper group vs. 6.0% in the intracutaneous, and the deep infection rate was 1.4% in the zipper group and 0.7% in the intracutaneous. There was no statistically significant difference between the groups. Only the cosmetic result differed. On a visual scale from 1 (poorest) to 10 (best), an average score of 8.2 was obtained in the intracutaneous group versus 8.9 in the zipper group (P<0.01). CONCLUSION: The wound infection rate was equal for the intracutaneous group compared with the zipper group; however, the cosmetic result was judged better by the patients in the zipper group.     

皮肤减张闭合器缝合与传统缝合对剖宫产术后切口美观度及瘢痕形成情况比较分析

目的:对比皮肤减张闭合器缝合与传统缝合对剖宫产产妇切口美观度以及瘢痕形成的影响。方法:纳入笔者医院2018年1月-2019年1月112例剖宫产产妇,采用随机数字表法分为观察组、对照组各56例,对照组产妇采用常规缝合方式,观察组产妇应用皮肤减张闭合器缝合。比较两组产妇术后1周、术后1个月切口疼痛程度[视觉模拟评分法(Visual analogy score,VAS)]评分,切口愈合情况(创面闭合时间,术后2周甲级愈合率),术后3个月瘢痕遗留情况(瘢痕增生发生率、瘢痕厚度、瘢痕宽度)以及切口美观程度评价。结果:观察组术后1周、术后1个月VAS评分均低于对照组,差异有统计学意义(P<0.05);观察组创面闭合时间小于对照组,术后2周切口甲级愈合率高于对照组,差异均有统计学意义(P<0.05);术后3个月,观察组瘢痕增生发生率低于对照组,瘢痕厚度、瘢痕宽度均小于对照组,观察组切口美观度高于对照组,差异有统计学意义(P<0.05)。结论:对比传统缝合,皮肤减张闭合器缝合可有效改善术后切口疼痛,利于切口愈合,减少瘢痕形成,美观度更高。     

Adhesive bonds or percutaneous absorbable suture for closure of surgical wounds in children. Results of a prospective randomized trial

Background

Surgeons have become increasingly interested in replacing conventional sutures by means of adhesive bonds for the closure of skin wounds. There are several advantages to the use of adhesive bonds compared with the conventional sutures.

Methods

Between January and August 2001, all the wounds in children after groin surgery were closed with an adhesive, N-butylcyanoacrylate (Indermil, Locite Corp, ’s-Hertogenbosch, The Netherlands), or with a suture, polyglactin 5-0 (Vicryl), intracutaneously. Fifty Inguinal wounds were treated with Indermil and 50 with Vicryl. Wounds were evaluated for hematoma, infection, dehiscence, or formation of granuloma. A scale from 1 to 10 expressed the cosmesis by patient and surgeon.

Results

The most remarkable difference in wound healing was dehiscence of the wound in 26% of cases in the adhesive group and no dehiscence in the suture group. The cosmesis of the wounds was marked with an 8.6 in the suture group and in the adhesive group with a 6.8.

Conclusions

Wound dehiscence was seen significantly more frequent in the patients in whom the wound was closed with N-butylcyanoacrylate. The cosmesis of wounds closed with tissue glue was significantly lower then the cosmesis after suturing. Therefore, the authors advise, on the basis of this prospective randomized trial, that surgical wounds in children should be closed with a intracutaneous absorbable suture.     

Intracutaneous butterfly suture – a horizontal buried interrupted suture for high tension

Background: Tension on surgical wound margins frequently results following the excision of skin lesions such as tumors, naevi or scars. This tension is commonly counteracted with buried, intracutaneous, interrupted sutures of absorbable or non-absorbable material anchored vertically in the corium. Method: A horizontal, buried, intracutaneous suture has now been developed which can be more firmly anchored in the corium. It adapts and everts wound margins nearly as broadly as two vertical sutures, particularly, when the wound edges are cut obliquely with a longer rim of epidermis. When finished, the suture has a butterfly shape, whence its name. It can also be laid as a double suture (double butterfly suture). In creating this sutures, the surgeon changes the customary direction of the needle holder from horizontal to vertical. Materials: Since 1985, this suture has been made with polydioxanon in more than 30000 skin lesion excisions with very good results. In most cases the resulting narrow and smoth scars were narrow and flat in the most cases. During the study, the following suture materials were tested prospectively in 1325 patients: polyglactin 910 (Vicryl^®) (n=390), polytrimethylcarbonate (Maxon^®) (n=95), poliglecaprone 25 (Monocryl^®) (n=175), and (PDS^®) (n=665). Results: The results were unsatisfactory in only 8% of procedures. Polyglactin 910 was accompanied by somewhat more inflammation and scar dehiscence, poliglecaprone 25 by a high rate of scar dehiscence. Polytrimethylcarbonate caused skin reactions in 23% and was discontinued. Suture perforation occurred in 9%. Polydioxanon yielded the best results (p-value of the difference <0.05). Conclusions: The butterfly suture has the advantages of withstanding tension better while everting wound margins and requiring fewer stitches for wound closure. However, it is important that the suture knot be deeply anchored beneath the corium.     

Loose fascial closure and fascial defects: effects on laparotomy healing in rats

Summary Every suture technique in surgery aims at connecting tissue structures until stable scar formation has developed. Although the negative effects of high suture tension on the mechanical properties of the developing scar are well known, the applied suture tension has not been standardized and depends on the surgeon's experience. In this study the effects of low suture tension on laparotomy closure were studied in rats and an incisional hernia model was developed. Median laparotomies were closed by running suture using Foley-catheters with a diameter of 2.4, 4.8 and 7.2 mm as distance holders. In another group, an abdominal wall defect of 2 cm diameter was created and covered internally by larger omentum. After 28 days laparotomies closed using a distance holder with diameter of 2.4 and 4.8 mm had healed without developing fascial dehiscence or incisional hernia. With 7.2 mm catheters all animals developed a ruptured abdomen. All animals with abdominal wall defects developed incisional hernias with stable hernial sacs without significant inflammatory reaction. Laparotomy closure intentionally performed with a surplus of suture material of up to 21% per stitch in a 4 cm incision does not result in a disturbance of wound healing or hernia formation. Creating an abdominal wall defect with an internal covering of great omentum in rats reliably results in incisional hernia formation closely resembling that found in humans. These results underline the necessity to further determine values for tissue-specific suture tension experimentally.     

美容缝合技术在面部外伤患者中的应用效果

目的 探讨美容缝合技术在面部外伤患者中的应用效果。方法 选取2021年1月-2022年6月我科 收治的80例面部外伤患者为研究对象,采用随机数字表法分为常规组和美容组,各40例。常规组行常规缝 合,美容组行美容缝合,比较两组缝合时间、缝合费用、术后伤口愈合情况、瘢痕主客观评价结果。结果 美容组缝合时间、缝合费用均高于常规组（P＜0.05）;美容组甲级愈合率为97.50%,高于常规组的87.50% （P＜0.05）;美容组满意度评分高于常规组,瘢痕面积、瘢痕长度小于常规组（P＜0.05）。结论 美容缝 合技术在面部外伤患者中的应用效果确切,相比于常规缝合方式,美容缝合技术虽然缝合时间稍长、费用 稍高,但伤口愈合情况更为理想,且术后瘢痕不明显,患者满意度较高,值得临床应用。     

Clinico-morphological characteristics of the methods of connection of the postoperative wound edges

The decision for the method of connection of the skin wound edges should be based on specific reconstruction of the injured tissues depending on the suture material and kind of the skin suture. An alternative of the classical suturing of the postoperative wound is a sutureless fixation of the skin edges--a method of using adhesive plaster. The work includes a clinico-morphological comparison of the course of the process of regeneration when using the intracutaneous suture and the adhesive plaster. The macroscopic and pathologic-histological estimation of the healing of the postoperative wound of the skin has shown that a smoother course of the postoperative period is noted in the groups where the adhesive plaster was used.     

心形减张美容缝合术对剖宫产患者切口愈合的效果

目的 分析剖宫产患者应用心形减张美容缝合术对切口愈合的影响。方法 选取2021年5月-2023年 5月永靖县妇幼保健院收治的60例剖宫产患者为研究对象,随机分成对照组和研究组,每组30例。对照组采用常 规缝合方法,研究组采用心形减张美容缝合术,比较两组切口愈合时间、切口缝合时间、疼痛情况、并发症发生 情况、瘢痕美观程度。结果 研究组切口缝合以及愈合时间均短于对照组（P ＜0.05）;研究组切口愈合程 度及瘢痕美观度均优于对照组（P ＜0.05）;研究组术后7、14 d疼痛评分低于对照组（P＜0.05）;研究组 并发症发生率为3.33%,低于对照组的20.00%（P＜0.05）。结论 心形减张美容缝合术可促进剖宫产手术患 者术后伤口愈合,抑制瘢痕形成,提高皮肤美观程度,降低术后疼痛感,且并发症发生率较低。     

Comparison of wound closure techniques in median sternotomy scars in children: subcuticular suture versus Steri-Strip™ S

Objectives: The aim of this retrospective study was to compare subcuticular sutures and Steri-Strip? S in closing median sternotomy incisions in children with regard to wound healing and scar formation.

Methods: Fifty-three children and adolescents were enrolled in this study who all underwent a median sternotomy at age 0–18?years and had their presternal cutaneous wounds closed with either a running subcuticular suture (Group 1) or Steri-Strip? S (Group 2). Their scars were assessed using the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcome measures were the scar measurements and the incidence of wound problems post-surgery.

Results: A significant difference was found between both groups in median POSAS observer scale scores for the items thickness (p?=?.027), pliability (p?=?.045), surface area (p?=?.045) and the total score (p?=?.048). All in favor of the subcuticular suture group. There were no significant differences concerning the POSAS patient scale scores. Middle parts of scars of patients in Group 2 were significantly broader (p?=?.001) than scars of patients in Group 1. No significant differences concerning wound problems were found.

Conclusions: There are, according to our results, no significant differences in wound healing of median sternotomy incisions in children closed with either a subcuticular suture or Steri-Strip? S. Significant differences do exist regarding scar formation and final cosmetic results of the scars, in favor of subcuticular closure.     

优质护理在剖宫产后行皮下美容缝合患者中的应用效果

分析优质护理在剖宫产后行皮下美容缝合患者中的应用效果。方法 选择2022年1月-2023年 6月南京医科大学附属妇产医院/南京市妇幼保健院产科收治的50例剖宫产后行皮下美容缝合患者为研究对 象,采用随机数字表法分为对照组与观察组,每组25例。对照组实施常规护理,观察组实施优质护理,比 较两组切口愈合时间、心理状态、术后3个月切口瘢痕宽度、厚度。结果 观察组切口愈合时间短于对照 组,SAS、SDS评分低于对照组（P ＜0.05）;观察组切口瘢痕宽度及厚度均小于对照组（P ＜0.05）。结论 对剖宫产后行皮下美容缝合患者行优质护理有助于缩短切口缝合及愈合时间,减少术后瘢痕的宽度及厚 度,提高切口愈合质量。