Comparison of polydioxanone and polyglactin 910 in intradermal repair

Comparison of laparoscopic port site skin closure techniques (CLOSA): transcutaneous suturing versus subcuticular sutures versus adhesive strips: a prospective single-blinded randomized control trial

BACKGROUND

Cosmesis is an essential aspect of laparoscopic surgery. Various methods of skin closure techniques have been described. We conducted a study to evaluate the cosmesis and patient satisfaction with the scars three months after laparoscopic surgery using transcutaneous suture (TS) vs. adhesive strips (AS) and subcuticular suturing (SS).

METHODS

A randomized, controlled, prospective study was conducted at AIIMS, Bhubaneswar. The included patients were randomly assigned among the three arms. The time for skin closure was measured. Wounds were assessed till discharge, at 14 days, one month, and three months. Cosmesis was measured by the Hollander Wound evaluation scale (HWES) for each incision separately, and patient satisfaction by a 10- point Visual analog scale (VAS).

RESULTS

One hundred six patients were assessed for eligibility, and 90 patients were randomized. Three-month follow-up data was obtained from 83 patients (92.22%). Baseline characteristics were similar among the groups. Cosmetic outcome was assessed in 312 incisions across 83 patients, and 206 (66.03%) incisions had an HWE Score of 0, but there was no significant difference (p = 0.86). Patient satisfaction was highest in the TS group (TS = 1.29, SS = 1.79, AS = 2.04, p = 0.03). Time for skin closure was the least in the AS arm (41.4 secs, p = 0.00). Skin dehiscence was significantly more in the AS arm. Four (4.44%) patients had port site infections.

CONCLUSION

This study demonstrates that skin closure by transcutaneous, subcuticular, or adhesive strip methods had comparable cosmetic outcomes at three months. However, the transcutaneous closure method showed better patient satisfaction and minimal post-operative complications.

Dermatological surgery: an update on suture materials and techniques. Part 2

This is the second part of a two-part series summarizing the latest evidence related to suture materials and wound closure techniques in dermatological surgery. We critically appraised evidence focusing on the following consequences of suture choice: scar/cosmesis, pain, patient satisfaction, cost, infection and wound complications. We searched the databases MEDLINE, PubMed and Embase using the keywords 'skin surgery', 'dermatological surgery', 'sutures', 'braided sutures', 'monofilament sutures' and 'antibacterial sutures' to identify relevant English-language articles. This part of the review assesses the evidence for different types of buried sutures, including braided vs. monofilament sutures, longer-absorbing sutures and antibacterial sutures. The majority of trials were noted to be of poor quality, single-centre (thus lacking external validity) and underpowered, which presents challenges in comparing suture techniques in skin surgery. Future large-scale, multicentre, randomized trials are needed, with both surgeon and patient-assessed validated outcomes.

Comparison of Two Tube-Modification Techniques in Baerveldt Glaucoma Implantation in Refractory Glaucoma

Importance

To compare treatment outcomes among a stent group, ligature group and combined group in eyes with refractory glaucoma.

Background

Various techniques have been used intra-operatively to restrict the aqueous flow in Baerveldt glaucoma implantation.

Design

Retrospective chart review.

Participants

All glaucoma patients aged over 18-years old who had Baerveldt implantation in Ramathibodi Hospital, Bangkok, Thailand, between October 2011 and February 2018 were included for analysis.

Methods

Retrospective interventional research was conducted. All glaucoma patients who underwent drainage device implantations were retrospectively reviewed from medical records and divided into three groups: stent group, ligature group, and combined group. The primary outcome was post-operative intraocular pressure (IOP) changes and BCVA (logMAR) change. The secondary outcome is treatment failure. Repeated measurements with mixed models and multi-level parametric survival model stratified by propensity score and eye side were used to compare the primary and secondary outcomes between stent group and ligature group.

Main Outcome Measures

Treatment failure between two groups.

Results

A total of 163 patients with a mean age of 57.11 ± 19.04 years, implanted with Baerveldt tube, were eligible. There were no significant differences between stent and ligature groups in terms of post-operative IOP changes [mean difference with 95% confidence interval = 0.53 (−0.49, +1.55) vs −0.02 (−0.84, +0.81); P = 0.411] and post-operative BCVA (logMAR) change (0.02 (−0.13, +0.18) vs –0.05 (−0.18, +0.07); P = 0.465). The hazard ratio and 95% confidence interval of treatment failure in ligature group were 2.57 (0.72–9.19) compared with the stent group.

Conclusion

This study suggests a trend toward a better result in the stent group compared with the ligature group. Further research with a larger sample size and randomized control trial is warranted.

Prospective Randomized Trial Comparing Absorbable and Non-Absorbable Sutures in Open Carpal Tunnel Release

A prospective randomized trial was undertaken to compare the influence of absorbable and non-absorbable sutures on pillar pain, scar tenderness, extent of wound inflammation and overall outcome of the surgery following open carpal tunnel release. Forty hands in 33 patients (mean age, 51 years; range, 31–74 years) were randomized into group A (absorbable sutures) or group B (non-absorbable sutures). Clinical assessment was done at 2, 6 and 12 weeks follow-up. The outcome of surgery in terms of improvement of severity of symptoms and functional status of patients was assessed using a self-administered Boston Questionnaire. There was no significant difference between the two groups for any of our outcome measures at the final follow-up.

Comparison of poliglecaprone-25 and polyglactin-910 in cutaneous surgery

BACKGROUND

Few clinical studies have compared deep absorbable sutures. Poliglecaprone-25 and polyglactin-910 are two of the most commonly used absorbable sutures in cutaneous surgery.

OBJECTIVES

To compare the rate of suture extrusion, degree of lumpiness, and appearance of scars from wounds closed with poliglecaprone-25 and polyglactin-910.

METHODS

Poliglecaprone-25 or polyglactin-910 was used for closure of the deep part of Mohs defects. The number of extruded sutures and the number of lumps were recorded at each follow-up visit. Photographs of 1-week and 3-month postoperative scars were rated on a visual analogue scale.

RESULTS

One hundred forty patients completed the study. There was a statistically significant difference in the percentage of extruded sutures between poliglecaprone-25 (3.1%) and polyglactin-910 (11.4%) (p < .01). There was not a statistically significant difference in the percentage of lumps (both 22%) or overall appearance of scars at 1 week or 3 months.

CONCLUSION

Poliglecaprone-25 resulted in significantly less extruded sutures than did polyglactin-910, although both resulted in the same degree of lumpiness and similar-appearing scars at 1 week and 3 months.

Tissue reaction and surface morphology of absorbable sutures after in vivo exposure

Tissue reaction to suture materials depends mainly on how the polymer they are composed of interacts with the tissues. There are few in vivo studies evaluating the suture material modifications resulting from its interaction with tissues. This paper aimed to study rat subcutaneous tissue reaction to irradiated polyglactin 910, polydioxanone, poliglecaprone 25 and chromic gut and its correlation with the ultra-structural alterations the materials undergo. The histological alterations were studied on the 1st, 2nd, 3rd, 7th and 14th day after suture implantations. In these periods, the materials were removed from the tissues and their surfaces were analyzed by scanning electron microscopy. Irradiated polyglactin 910 stimulated the formation of multinucleated giant cells and its filaments underwent cleavage and dissolution. In potydioxanone, a few inflammatory cells and scar fibrosis was observed, and triangular cracks appeared on its surface. Around the poliglecaprone 25, a diffused infiltration of a few mononuclear cells and fibrosis was recorded and formation of craters was observed on its surface. Chromic gut induced necrosis and granulation tissue and underwent dissolution in the tissues during the studied periods. In this study, it was observed that suture materials induced differentiated tissue reactions and morphologic surface changes, suggesting that indications should be individualized.

Tools of the trade

An unhurried, deft, economical technique allied to efficient use of available resources, surgical instruments and support staff is the hallmark of a 'good' surgeon. To achieve this sense of fluency, surgeons need to be familiar with the tools of their profession so that these can be employed appropriately for the task at hand. The range of instruments available in obstetrics and gynaecology is no less wide or complex than in any other branch of surgery, but formal teaching in the full range of surgical hardware is frequently lacking and an individual's exposure is generally limited to the instruments used in his or her own training hospital. This chapter sets out to describe key technical areas with which surgeons need to be familiar.

Comparison of two absorbable monofilament polydioxanone threads in intradermal buried sutures

BACKGROUND AND OBJECTIVES

Two absorbable polydioxanone threads are compared regarding intraoperative handling qualities, scar dehiscence, and possible side effects.

METHODS

In 30 excisions, half of each suture was performed with PDS II (Ethicon GmbH, Norderstedt, Germany), whereas the other half was closed with Serasynth (Serag-Wiessner, Naila, Germany). Clinical evaluation for scar spreading, spitting of the sutures, hypertrophic scarring, or suture granuloma was performed 3 and 6 months after surgery.

RESULTS

No significant difference in scar spreading, hypertrophic scarring, or the incidence of suture granuloma was noted. A significantly lower frequency of spitting was seen with Serasynth than with PDS. The handling and suturing properties of SerasynthM were estimated to be slightly superior compared with those of PDS.

CONCLUSION

Our study shows that PDS and Serasynth provide equal cosmetic results when applied in an appropriate suturing technique. Possibly owing to its better pliability, the frequency of spitting was lower with Serasynth.

Comparação entre o uso de fio inabsorvível (polipropileno) e fio absorvível (poliglactina 910) na fixação de prótese de polipropileno em correção de defeitos músculo-aponeurótico da parede abdominal: estudo experimental em ratos

OBJETIVO: Comparar a fixação da tela de prolipropileno na correção de defeitos músculo-aponeuróticos da parede abdominal com fio absorvível (poliglactina 910) e fio inabsorvível (polipropileno). MÉTODOS: Oitenta e um ratos machos da linhagem Wistar foram submetidos a ressecção longitudinal de um segmento músculo-aponeurótico e peritoneal (3x2 cm) da parede abdominal, seguida por reforço com tela de polipropileno, em forma de ponte sobre a aponeurose. Foram distribuídos em dois grupos de acordo com o fio usado para fixação da tela: grupo poliglactina 910 - fixada com 8 pontos separados e eqüidistantes em forma de "U" com fio 4-0; e grupo polipropileno - fixada com fio 4-0. A pele foi suturada com fio de nylon 4-0. Após 90 dias, os animais foram submetidos à eutanásia e avaliados macroscopicamente, quanto à presença de hérnia e avaliação histológica da reação inflamatória crônica, absorção do fio e percentagem de fibrose pela técnica vídeo-morfométrica assistida por computador. Utilizaram-se as técnicas de coloração de hematoxilina-eosina e picrossírius. RESULTADOS: Não houve diferença estatisticamente significante entre os grupos, quanto à presença de hérnia incisional (p=0,194). Houve maior fibrose no grupo polipropileno pela avaliação histológica de reação inflamatória crônica, o que não foi verificado quando avaliado pela técnica vídeo-morfométrica (p=0,0005). Não houve diferença entre os grupos quando avaliados os gigantócitos, linfócitos e neutrófilos. Houve maior número de macrófagos no grupo polipropileno (p=0,02). Não houve absorção do fio poliglactina 910 após 90 dias. CONCLUSÃO: A fixação de tela de polipropileno pode ser feita com êxito com fios absorvíveis como a poliglactina 910.

Double butterfly suture for high tension: a broadly anchored, horizontal, buried interrupted suture

BACKGROUND

The excision of skin lesions such as tumors, nevi, and scars frequently results in tension on surgical wound margins. This tension is commonly counteracted surgically with buried, intracutaneous, interrupted sutures of absorbable material which are anchored vertically in the corium.

METHOD

The horizontal, buried, intracutaneous butterfly suture has been described elsewhere. It is firmly anchored in the corium, everts wound margins, and adapts them nearly as broadly as two vertical sutures. It can also be laid as a double butterfly suture, as described here, and then has the shape of an "8." This double butterfly suture is equivalent to three vertical sutures because of its broad base in the corium. Moreover, it can cope with much greater tension because of its "pulley" effect. A single double butterfly suture usually suffices for small defects, particularly when the wound edges are cut obliquely with a longer rim of epidermis.

MATERIALS

We have laid the traditional butterfly suture in more than 35,000 skin lesion excisions since 1985 and the double butterfly suture alone or as a supplement in more than 10,000 sutures since 1992. We use 2-0 to 6-0 polydioxanone for these procedures, since it has proven in trials to be the best-absorbed suture material.

RESULTS

In most cases, the resulting scars were narrow and smooth in spite of high tension. Results were unsatisfactory in only 6.2% of procedures.

CONCLUSION

The double butterfly suture described here 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.