Use of cyanoacrylate in the coaptation of edges of surgical wounds

Cyanoacrylate has been used in several fields of different surgical specialties as an adhesive for closure of gingival flaps and in mucous and cutaneous lacerations. One of its advantages is that it has an excellent immunological response. In view of aesthetic needs, cyanoacrylate has been applied with satisfactory results, when compared with sutures. It presents better coaptation of edges of cutaneous and mucosal lesions, smaller residual scars, and biocompatibility. However, it is limited to areas of little tissue tension. This work attempts to provide a literature review with the aim of revealing the advantages of using tissue adhesives, especially cyanoacrylates, in wound coaptation in comparison with conventional methods.     

Reliability and reproducibility of the method of assessment of midpalatal suture maturation: A tomographic study

Objectives:To assess reliability and reproducibility of the individual assessment of midpalatal suture maturation in computed tomography among orthodontists and radiologists for potential diagnosis application.Materials and Methods:Sixty axial slices from cone-beam computed tomography and multi-slice CT scans of patients aged between 11 and 21 years old (33 females and 27 males) were selected. For the investigation of reliability and reproducibility of the method, two groups of examiners were established. The first group consisted of 11 orthodontists and the second consisted of 10 radiologists. Each group examined the images and performed individual assessment of the midpalatal suture maturation method twice within an interval of 21 days. During the first and second analyses, the sequence of images was randomized to reduce potential bias. Weighted Cohen''s kappa was performed to assess inter- and intra-examiners'' agreement. The percentage of perfect agreement and the number of stages apart for each disagreement were calculated. The significance level was P < .05.Results:The overall inter-examiner agreement was satisfactory in the first (kappa_w: 0.37) and the second (kappa_w: 0.34) analyses. Intra-examiner agreement outcomes were similar between orthodontists (kappa_w: 0.44) and radiologists (kappa_w: 0.41). The percentage of perfect agreement was 43.2%.Conclusions:The method for individual assessment of midpalatal suture maturation revealed potential reliability and reproducibility. However, the agreement rate observed in the present study was not high enough for a method designed for routine clinical applications.     

Galeal Tack-Up Sutures to Prevent Subgaleal Cerebrospinal Fluid Collection

Objective

Postoperative subgaleal cerebrospinal fluid (CSF) collection is considered as one of the common minor surgical complication which can lead to prolonged hospitalization. We introduce "galeal tack-up suture" to prevent postoperative subgaleal CSF collection.

Methods

Galeal tack-up suture consists of various surgical techniques which aim to fix galea to cranium in order to prevent CSF pooling in subgaleal space. A total of 87 patients who underwent craniotomy were divided into two groups while closing the wound : group A with galeal tack-up suture and group B with routine wound closure without galeal tack-up suture. The patients were observed for postoperative subgaleal CSF collection.

Results

Among 87 cranitomy cases, galeal tack-up suture was performed in 32 cases and routine wound closure was done in 55 cases. Postoperative subgaleal CSF collection occurred in 13 cases (15%) in which 12 cases occurred in group B patients and 1 case occurred in group A patients (p=0.026).

Conclusion

Galeal tack-up suture is an easy and effective technique in wound closure to prevent postoperative CSF collection.     

The constrictor knot is the best ligature

Introduction

An ideal ligature should tighten readily and remain tight. Ligature failure can be a critical complication of invasive procedures in human and veterinary surgical practice. Previous studies have tested various knots but not the constrictor knot.

Methods

A new test bench was employed to compare six ligatures using four suture materials. As tension in a ligature is not readily measured, the study employed a surrogate measurement: the force required to slide a ligature along a rod. Benchmark values tested each suture material wrapped around the rod to establish the ratio between this force and the ligature tension for each material. Each ligature was tested first during tightening and then again afterwards. The benchmark ratios were employed to calculate the tensions to evaluate which ligature and which suture material retained tension best.

Results

The model provided consistent linear relationships between the tension in the suture and the force required to pull the ligature along the rod. The constrictor knot retained tension in the ligature best (55–107% better than the next best ligature). Among the suture materials, polydioxanone had the greatest ability to retain the tension in a ligature and polyglactin the least.

Conclusions

The constrictor knot showed superior characteristics for use as a ligature, and should be introduced into teaching and clinical practice for human and veterinary surgery. The new test bench is recommended for future testing of ligatures as well as objective comparison of suture materials.     

简易子宫压迫缝合术在防治剖宫产术中宫缩乏力性出血中的临床应用

目的 探讨一种简易子宫压迫缝合术在剖宫产术中防治宫缩乏力性子宫出血的临床作用与疗效.方法 选择2012年2月至2013年8月兰州军区乌鲁木齐总医院收治的80例剖宫产术中发生宫缩乏力性子宫出血的患者为研究对象,按入院顺序号随机分为两组,简易子宫压迫缝合术组（n=50）及改良B-Lynch组（n=30）,观察比较其止血效果.两组患者年龄等一般临床资料比较,差异无统计学意义（P〉0.05）（本研究遵循的程序符合兰州军区乌鲁木齐总医院人体试验委员会制定的伦理学标准,分组得到该委员会批准,征得受试对象知情同意,并与之签署临床研究知情同意书）.结果 应用该简易子宫压迫缝合术,50例剖宫产术中宫缩乏力性子宫出血患者均有效止血,患者的产后出血量显著少于接受改良B-Lynch组患者,且差异有统计学意义（t＇=4.309 1,P〈0.05）;止血时间亦显著短于改良B-Lynch组,且差异有统计学意义（t＇=7.947 9,P〈0.05）.简易子宫压迫缝合术组中仅1例患者需输血治疗.两组患者中无一例再次发生产后出血,亦无一例因产后出血导致子宫切除.结论 该子宫压迫缝合术操作技术简单、便于掌握,止血安全、有效、迅速,能保留患者子宫和生育能力,容易被患者接受,是一种防治剖宫产术中宫缩乏力性出血的有效止血方法.     

Economic comparison of methods of wound closure: wound closure strips vs. sutures and wound adhesives

Our objective was to review and assess the treatment of low-tension wounds and evaluate the cost-effectiveness of wound closure methods. We used a health economic model to estimate cost/closure of adhesive wound closure strips, tissue adhesives and sutures. The model incorporated cost-driving variables: application time, costs and the likelihood and costs of dehiscence and infection. The model was populated with variable estimates derived from the literature. Cost estimates and cosmetic results were compared. Parameter values were estimated using national healthcare and labour statistics. Sensitivity analyses were used to verify the results. Our analysis suggests that adhesive wound closure strips had the lowest average cost per laceration ($7.54), the lowest cost per infected laceration ($53.40) and the lowest cost per laceration with dehiscence ($25.40). The costs for sutures were $24.11, $69.91 and $41.91, respectively; the costs for tissue adhesives were $28.77, $74.68 and $46.68, respectively. The cosmetic outcome for all three treatments was equivalent. We conclude adhesive wound closure strips were both a cost-saving and a cost-effective alternative to sutures and tissue adhesives in the closure of low-tension lacerations.     

A re-evaluation of the premaxillary bone in humans

The discovery of the premaxillary bone (os incisivum, os intermaxillare or premaxilla) in humans has been attributed to Goethe, and it has also been named os Goethei. However, Broussonet (1779) and Vicq dAzyr (1780) came to the same result with different methods. The first anatomists described this medial part of the upper jaw as a separate bone in the vertebrate skull, and, as we know, Coiter (1573) was the first to present an illustration of the sutura incisiva in the human. This fact, and furthermore its development from three parts:—(1) the alveolar part with the facial process, (2) the palatine process, and (3) the processus Stenonianus—can no longer be found in modern textbooks of developmental biology. At the end of the nineteenth and in the early twentieth century a vehement discussion focused on the number and position of its ossification centers and its sutures. Therefore, it is hard to believe that the elaborate work of the old embryologists is ignored and that the existence of a premaxillary bone in humans is even denied by many authors. Therefore this re-evaluation was done to demonstrate the early development of the premaxillary bone using the reconstructions of Felber (1919), Jarmer (1922) and data from our own observations on SEM micrographs and serial sections from 16 mm embryo to 68 mm fetus. Ossification of a separate premaxilla was first observed in a 16 mm embryo. We agree with Jarmer (1922), Peter (1924), and Shepherd and McCarthy (1955) that it develops from three anlagen, which are, however, not fully separated. The predominant sutura incisiva (rudimentarily seen on the facial side in a prematurely born child) and a shorter sutura intraincisiva argue in this sense. The later growth of this bone and its processes establish an important structure in the middle of the facial skull. Its architecture fits well with the functional test of others. We also focused on the relation of the developing premaxilla to the forming nasal septum moving from ventral to dorsal and the intercalation of the vomer. Thus the premaxilla acts as a stabilizing element within the facial skeleton comparable with the keystone of a Roman arch. Furthermore, the significance of the premaxillary anlage for the closure of the palatine was documented by a synopsis made from a stage 16, 10.2 mm GL embryo to a 49 mm GL fetus. Finally the growth of the premaxilla is closely related to the development of the human face. Abnormal growth may be correlated to characteristic malformations such as protrusion, closed bite and prognathism. Concerning the relation of the premaxillary bone to cleft lip and palate we agree with others that the position of the clefts is not always identical with the incisive suture. This is proved by the double anlagen of an upper–outer incisor in a 55 mm fetus and an adult.     

Effect of suture material on tensile strength and complication rate in abdominal fascial defects repaired with acellular dermal matrix

Background

Repair of ventral hernias represents a challenging problem for surgeons. AlloDerm^® (LifeCell, Branchburg, NJ, USA), an acellular dermal matrix (ADM) product derived from cadaveric human skin, has gained in popularity in the management of abdominal hernias because of its ability to support neovascularization and therefore resist infection. Surgeons have traditionally used nonabsorbable suture when using ADM in this setting, perhaps because of concerns regarding wound strength. This study was undertaken to examine the influence of suture material on wound breaking strength and complication rates in abdominal wall defects closed with ADM.

Methods

Full-thickness abdominal defects were created in athymic rats and immediately repaired with an ADM interposition graft using either interrupted Prolene^® or Maxon^® suture. Complications were recorded over time and the animals were sacrificed at 1 month intervals. The abdominal repair complex was harvested and wound strength was measured using a tensiometer.

Results

There were no hernias in any of the groups. There were also no cases of major adhesions to the AlloDerm^®. Two rats in the Prolene^® group developed a stitch extrusion through the ventral skin. Wound breaking strength increased significantly from the second to third month after surgery in both suture groups (p = 0.0000, LSD test). The breaking strength of the abdominal fascia-ADM complex increased over the course of the experiment in both test groups, but no significant difference was found between the groups at any time point (p = 0.3157). At 3 months, the breaking strength of the Prolene^® group and Maxon^® group was nearly identical (27.1 N ± SD 7.4 and 29.7 N ± SD 9.6, respectively).

Conclusions

We were unable to identify a significant difference in breaking strength at the interface between ADM and normal, native fascia when using permanent versus resorbable sutures.