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Scribante A, Ghizzoni M, Pellegrini M, Poli PP, Maiorana C, Spadari F. Microbiological and Clinical Assessments of Suture Materials and Cyanoacrylate Application in Impacted Third Molar Surgeries: A Scoping Review. J Funct Biomater 2023; 14:529. [PMID: 37888194 PMCID: PMC10607494 DOI: 10.3390/jfb14100529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
The extraction of impacted third molars is a common but potentially complication-prone oral surgical procedure. Wound healing plays a vital role in preventing complications. This scoping review aimed to assess the clinical and microbiological aspects of various suture materials and cyanoacrylates. Unlike existing studies, we included more articles and comprehensively compared suture materials. Articles published in languages other than English; duplicate studies; studies deemed irrelevant for the specific research questions, including those analyzing different supplementary treatments or not corresponding to the abstract's content; ex vivo or experimental animal studies; studies lacking approval from an ethics committee; and narrative reviews, systematic reviews, or systematic and meta-analysis reviews were excluded. Thus, only 17 studies, published between 2000 and 2023, were included in the search. Suture techniques varied among surgeons, with debates on primary and secondary closure methods. A comparison of different suture materials and their effects on wound healing, infection rates, and other factors was described. Cyanoacrylate has also been used as an alternative to traditional sutures. Microbiological analysis showed varying bacterial adhesion based on the suture material, with silk sutures retaining more microbes than PTFE sutures. Clinical assessments have revealed differing inflammatory responses that affect wound healing and complications. Cyanoacrylate has emerged as a promising alternative to traditional sutures, owing to its rapid polymerization and early healing. However, the choice of suture material in impacted third molar surgery remains controversial, considering microbiological factors and clinical outcomes. More extensive randomized clinical trials are required to better understand the effect of suture materials on surgical outcomes and potential improvements. This study could enhance the safety and effectiveness of this common oral surgical procedure.
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Affiliation(s)
- Andrea Scribante
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Martina Ghizzoni
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Matteo Pellegrini
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.P.P.); (C.M.); (F.S.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Pier Paolo Poli
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.P.P.); (C.M.); (F.S.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Carlo Maiorana
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.P.P.); (C.M.); (F.S.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Francesco Spadari
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.P.P.); (C.M.); (F.S.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
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Özcan Y, Gamsizkan M. Dermatoscopic and Dermatopathologic Features of a 3-Year-Old Buried Polypropylene Suture. Adv Skin Wound Care 2023; 36:1-4. [PMID: 37079795 DOI: 10.1097/01.asw.0000923092.57459.7a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
ABSTRACT Cutaneous foreign bodies are a well-known cause of delayed wound healing and complications such as abscesses, fistula formation, and secondary infections. Polypropylene sutures are widely utilized in cutaneous surgery because they easily travel through tissues while eliciting minimal tissue reactions. Despite these advantages, retained polypropylene sutures can cause complications. The authors report a case of a retained polypropylene suture that remained buried after a total excision 3 years prior. It started to cause cutaneous symptoms when the patient began exercising 1 week prior to presentation. The authors also examine the dermatoscopic and dermatopathologic features and other complications related to retained polypropylene sutures that have been reported in the literature.
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Affiliation(s)
- Yunus Özcan
- Yunus Özcan, MD, is Dermatologist, Department of Dermatology, Duzce Ataturk State Hospital, Turkey. Mehmet Gamsizkan, MD, is Professor, Department of Pathology, School of Medicine, Duzce University
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Ziaian B, Shahriarirad R, Fouladi D, Amirian A, Ranjbar K, Karoobi M, Ketabchi F, Mardani P, Fallahi MJ. The effect of suture techniques on the outcome of tracheal reconstruction: An observational study and review of literature. Surgeon 2023; 21:e89-e96. [PMID: 35504817 DOI: 10.1016/j.surge.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Tracheal resection and anastomosis surgery is a safe operation and is used to treat various benign and malignant diseases of the trachea. However, tracheal stenosis is among the main anastomotic complications following this procedure. Surgeons use both the continuous and the interrupted suture techniques for tracheal anastomosis, but contradicting results in each technique's complications have been reported in various studies. In this study, we aimed to compare the outcome of these two different suture techniques and a relevant literature review. METHODS Surgical records during a period of 15 years (2005-2019) were screened for tracheal reconstruction surgery in affiliated hospitals of Shiraz University of Medical Sciences, Shiraz, Iran. A total of 82 patients were evaluated based on surgical and suture features, along with their follow-up bronchoscopy for anastomotic complications. RESULTS Post-operational subclinical restenosis occurred in 8 (15.3%) out of 52 and 10 (33.3%) of 30 patients who underwent continuous and interrupted suturing techniques, respectively. Also, 6 (20%) patients in the interrupted group developed symptomatic restenosis, while in the continuous group, only one patient was clinically symptomatic. The patients with continuous suture technique had a shorter surgery time than patients whose interrupted technique was used (P < 0.001). CONCLUSIONS Based on our results, we conclude that restenosis is significantly reduced when the continuous technique is applied for tracheal anastomosis; However, the results are contradicting in relevant literature and due to the retrospective nature of our study, further human studies and clinical trials are warranted.
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Affiliation(s)
- Bizhan Ziaian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran; Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Damoun Fouladi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Armin Amirian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran; Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keivan Ranjbar
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Karoobi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Ketabchi
- Department of Physiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parviz Mardani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Javad Fallahi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran; Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Abboud J, Zezyk C, Boehmer AA, Bork F, Kaess BM, Ehrlich JR. Prospective randomized trial of skin closure for pacemaker implantation: absorbable vs. non-absorbable suture : PRO-PACE. Herzschrittmacherther Elektrophysiol 2022; 33:203-208. [PMID: 35230504 DOI: 10.1007/s00399-022-00847-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Pacemaker implantations have been performed for > 50 years, reaching 1.25 million implants worldwide per year. Despite this, only few randomized studies exist regarding technical aspects of the implantation procedure-in particular, wound closure. Accordingly, the authors compared absorbable vs. non-absorbable suture regarding wound healing. METHODS Consecutive patients scheduled for de novo pacemaker implantation without defibrillation therapy were prospectively randomized into two groups: non-absorbable (Prolene®, Ethicon Inc.) or absorbable suture (Monocryl®, Ethicon Inc.). The wound was systematically assessed for cosmetic outcome at 1 day, 6 weeks, and 1 year post implantation using the patient and observer scar assessment scale (POSAS). Adverse events noted included bleeding, pocket hematoma, infection, suture insufficiency, and revision surgery. RESULTS A total of 114 patients (mean age: 79 ± 10 years, n = 60 male) were randomized into the two groups. Of these, 105 completed follow-up (lost to follow-up: 7.9%). Groups were comparable for clinical characteristics or use of oral anticoagulants. There was no difference in cosmetic outcome and incidence of adverse events at any follow-up visit. POSAS scores were: 1 day: 1.4 ± 0.4 vs. 1.3 ± 0.4, P = 0.44, 6 weeks: 1.4 ± 0.6 vs. 1.4 ± 0.7, P = 0.57; 1 year: 1.4 ± 1.4 vs. 2.1 ± 3, P = 0.60. No pocket hematoma or infection occurred in either group. No additional surgery was necessary for local findings. Retrospectively, scar development was straight in the Prolene® group and slightly wavy with Monocryl®. CONCLUSION Suture material does not influence wound healing as represented by the cosmetic result and the occurrence of adverse events. The choice of suture material used should be left to the physician's discretion.
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Affiliation(s)
- Jaber Abboud
- St. Josefs-Hospital, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Celine Zezyk
- St. Josefs-Hospital, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | | | - Fabian Bork
- St. Josefs-Hospital, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Bernhard M Kaess
- St. Josefs-Hospital, Beethovenstr. 20, 65189, Wiesbaden, Germany
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Adekunle AA, James O, Onuoha EO, Adeyemo WL. Wound Healing Following Palatoplasty Using Either Honey or Warm Saline Mouth Bath for Postoperative Wound Care: A Randomized-Controlled Study. Cleft Palate Craniofac J 2022:10556656221086192. [PMID: 35261292 DOI: 10.1177/10556656221086192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate and compare the effect of honey or saline mouth bath for wound care on the rate of re-epithelisation of the lateral palatal defects and occurrence of early postoperative complications following palatoplasty. METHODOLOGY This was a prospective randomized study on participants with non-syndromic cleft palate conducted at a tertiary health institution in Lagos, Nigeria. The test group received oral honey drops for post-operative care for an initial period of two weeks post-surgery, while the control group had regular oral toileting using a warm saline solution. The primary outcome was epithelisation of lateral palatal defect at 2- and 4-weeks post repair. Descriptive and comparative statistics were computed, and the p-value was set at <0.05. RESULTS Fifty participants were recruited into the study, 24 in the Test group and 26 in the Control group. The frequency of occurrence of oronasal fistula in the Test group was 4.0% while in the Control group was 10.0%, however, this was not statistically significant. Complete epithelisation of the lateral palatal defect was clinically observed in 66.7% of the participants in the Test group at 2 weeks post-operation, while only 38.5% of participants in the Control group had clinically observed complete epithelisation at the same time point (β = 1.70, p = .035, 95% CI 1.122-26.533). At four weeks, all wounds had epithelised irrespective of the study group. CONCLUSION The application of honey appears to aid earlier epithelization of palatal surgical wounds following cleft palate repair and reduced the incidence of palatal fistula.
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Affiliation(s)
- Adegbayi Adeola Adekunle
- Fellow, Department of Oral and Maxillofacial Surgery, 291389Lagos University Teaching Hospital, Idi - Araba, Lagos
| | - Olutayo James
- Associate Professor, Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos/ Lagos University Teaching Hospital, Idi, Araba, Lagos
| | - Emmanuel Onyebuchi Onuoha
- Senior Resident, Department of Oral and Maxillofacial Surgery, 291389Lagos University Teaching Hospital, Idi, Araba, Lagos
| | - Wasiu Lanre Adeyemo
- Professor, Department of Oral and Maxillofacial Surgery, College of Medicine, 98002University of Lagos/Lagos University Teaching Hospital, Idi, Araba, Lagos
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Dermatologic Complications Following Cosmetic and Reconstructive Plastic Surgery: A Systematic Review of the Literature. Aesthetic Plast Surg 2021; 45:3005-3018. [PMID: 34231016 DOI: 10.1007/s00266-021-02362-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Plastic surgery procedures, including minimally invasive cosmetic procedures, continue to grow in popularity. Although dermatologic complications following plastic surgery procedures are rare, the authors have encountered several of these complications in their practice, including herpes simplex virus (HSV-1) and varicella zoster virus (VZV) infections, pyoderma gangrenosum (PG), contact dermatitis, and suture hypersensitivity. These cases prompted a systematic literature review of dermatologic complications following plastic surgery procedures. METHODS The authors conducted a systematic review of PubMed, MEDLINE, EMBASE, Scopus, Web of Science, and the Cochrane Library to identify relevant articles published from 1975 to 2021. Articles were independently reviewed by the authors to determine whether studies met inclusion criteria. RESULTS The majority of articles that met inclusion criteria represented level V evidence. The most robust evidence in the literature was for PG, for which there were 63 total studies. Pyoderma gangrenosum was most frequently reported following breast surgery (85.1%), while HSV-1 infections were frequently seen following minimally invasive procedures (84.6%). VZV reactivation was reported after a range of interventions, including pedicled flap surgeries and laser treatments. Other complications, such as suture hypersensitivity, were less frequently reported in the literature, usually as isolated case reports. CONCLUSIONS Dermatologic complications represent a rare but serious concern following plastic surgery procedures. While most dermatologic complications resolve with appropriate treatment, sequelae of these conditions can be devastating to the patient's overall outcome. Plastic surgeons performing procedures at a high risk of these complications should recognize the diagnostic criteria to facilitate appropriate treatment. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Time to removal of sutures from the palmar surface of the hand in dark-skinned patients: Results in a prospective cohort of 146 hands. HAND SURGERY & REHABILITATION 2021; 41:142-148. [PMID: 34600132 DOI: 10.1016/j.hansur.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/25/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022]
Abstract
The objective of this study was to estimate the time to removal of a suture from the palmar surface of a dark-skinned adult hand. A descriptive and analytical study included a cohort of 146 patients, 57% male, with a mean age of 37 ± 14 years, covering a period of 10 years. The mean time to removal of sutures on the palmar surface of the dark-skinned adult hands was 21 ± 2 days. Complete epithelialization of the suture path was the clinical indication for the ideal day for removal. After removal, closure was total in 90% of cases (132 hands) and partial in 9% (14 hands). The day of suture removal was significantly (p = 0.006) related to wound healing (complete closure). Eighty-five percent of patients without complete wound closure at suture removal had history of use of skin-lightening products. Tobacco use significantly lengthened time to suture removal (p < 0.001). There was a correlation between patient age and time to suture removal. On multivariate analysis, three factors were predictive of suture removal later than day 21: being a manual worker (44% of patients) (p 0.006), suture location in a palmar fold area (<0.001) and the age of patient, the 41-50 years (p = 0.001) and >50 years (p < 0.001).
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de la Harpe KM, Kondiah PPD, Marimuthu T, Choonara YE. Advances in carbohydrate-based polymers for the design of suture materials: A review. Carbohydr Polym 2021; 261:117860. [PMID: 33766349 DOI: 10.1016/j.carbpol.2021.117860] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 12/25/2022]
Abstract
Suture materials constitute one of the largest biomedical material groups with a huge global market of $ 1.3 billion annually and employment in over 12 million procedures per year. Suture materials have radically evolved over the years, from basic strips of linen to more advanced synthetic polymer sutures. Yet, the journey to the ideal suture material is far from over and we now stand on the brink of a new era of improved suture materials with greater safety and efficacy. This next step in the evolutionary timeline of suture materials, involves the use of natural, carbohydrate polymers that have, until recent years, never before been considered for suture material applications. This review exposes the latest and most important advancements in suture material development while digging deep into how natural, carbohydrate polymers can serve to advance this field.
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Affiliation(s)
- Kara M de la Harpe
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown, 2193, South Africa
| | - Pierre P D Kondiah
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown, 2193, South Africa
| | - Thashree Marimuthu
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown, 2193, South Africa
| | - Yahya E Choonara
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown, 2193, South Africa.
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James O, Adekunle AA, Adeyemo WL. How Does Octyl-2-Cyanoacrylate Tissue Adhesive Compare With Prolene Sutures in Cleft Lip Repair? J Oral Maxillofac Surg 2021; 79:1540-1548. [PMID: 33621479 DOI: 10.1016/j.joms.2021.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Comparative evidence of the usefulness of octyl-2-cyanoacrylate tissue adhesive in cleft lip epidermal skin closure especially in Africans is still lacking. This study aimed to compare the outcome of wound healing after the use of Dermabond tissue adhesive and 5/0 Prolene sutures in cleft lip repair. METHODS This was a prospective randomized controlled clinical study. The sampled population was patients undergoing cleft lip repair at a tertiary health facility in Lagos, Nigeria. Study patients were randomly allocated to either group A (Dermabond) or group B (suture). The predictor variable was the type of material used in skin closure; the primary outcome variable was the esthetics of the resulting scar, and secondary outcome variables were wound healing complications. Assessment of the 3-month postoperative wound scar was performed using the cosmetic visual analog scale (CVAS) and the Hollander Wound Evaluation scale (HWES). Calculated sample size was 14 participants per group. Descriptive and comparative statistics were computed, and the P value was set at <0.05. RESULTS Analysis of result included 38 participants. Median age was 4 months and 52.6% were women. Two cases (5.3%) of wound healing complications were recorded (1 in each group). Blinded evaluation of the 3-month postoperative photographs yielded a mean CVAS score of 86.0 (±11.2) and HWES score of 5.0 (±0.9) for group A and a mean CVAS score of 76.5 (±14.5) and HWES score of 4.5 (±1.1) for group B. There was no statistically significant difference between these 2 groups based on the CVAS (P = .052) and HWES (P = .152). CONCLUSIONS The results of this study suggest Dermabond offers a comparable cosmetic outcome as 5/0 Prolene suture in epidermal closure of cleft lip. There was no statistically significant difference in wound complications and wound cosmetic scores between the 2 groups.
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Affiliation(s)
- Olutayo James
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi - Araba, Lagos, Nigeria
| | - Adegbayi Adeola Adekunle
- Senior Resident, Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi - Araba, Lagos, Nigeria.
| | - Wasiu Lanre Adeyemo
- Professor, Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi - Araba, Lagos, Nigeria
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Delpachitra M, Heal C, Banks J, Charles D, Sriharan S, Buttner P. Risk Factors for Surgical Site Infection after Minor Dermatologic Surgery. Adv Skin Wound Care 2021; 34:43-48. [PMID: 33323802 DOI: 10.1097/01.asw.0000722760.27083.3c] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Surgical site infection (SSI) after dermatologic surgery is associated with poor outcomes including increased recovery time, poor cosmesis, and repeat visits to doctors. Prophylactic antibiotics are prescribed to reduce these adverse outcomes. Identifying risk factors for SSI will facilitate judicious antibiotic prophylaxis. OBJECTIVE To identify risk factors for SSI after minor dermatologic surgery. METHODS Individual patient data from four large randomized controlled trials were combined to increase statistical power. A total of 3,819 adult patients requiring minor skin procedures at a single facility were recruited over a 10-year period. The main outcome measure was SSI. MAIN RESULTS A total of 298 infections occurred, resulting in an overall incidence of 7.8% (95% confidence interval [CI], 5.8-9.6), although the incidence varied across the four studies (P = .042). Significant risk factors identified were age (relative risk [RR], 1.01; 95% CI, 1.001-1.020; P = .008), excisions from the upper limbs (RR, 3.03; 95% CI, 1.76-5.22; P = .007) or lower limbs (RR, 3.99; 95% CI, 1.93-8.23; P = .009), and flap/two-layer procedures (RR, 3.23; 95% CI, 1.79-5.85; P = .008). Histology of the excised lesion was not a significant independent risk factor for infection. CONCLUSIONS This study demonstrated that patients who were older, underwent complex excisions, or had excisions on an extremity were at higher risk of developing an SSI. An awareness of such risk factors will guide evidence-based and targeted antibiotic prophylaxis.
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Affiliation(s)
- Meth Delpachitra
- Meth Delpachitra, MBBS, is Registrar, Royal Brisbane and Women's Hospital, Queensland, Australia. Clare Heal, PhD, MBChB, is Promotional Chair, Discipline of General Practice and Rural Medicine, and Jennifer Banks, PhD, MBS, is Senior Research Officer, James Cook University, Mackay. Daniel Charles, MBBS, is Registrar, Cairns Hospital. Shampavi Sriharan, MBBS, is Associate Lecturer, University of Queensland, Brisbane. Petra Buttner, PhD, is Adjunct Professor, Epidemiology & Biostatistics, Centre for Chronic Disease Prevention, James Cook University, Townsville. The authors have disclosed no financial relationships related to this article. Submitted December 19, 2019; accepted in revised form February 14, 2020
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Kim SM. Importance of various skin sutures in cheiloplasty of cleft lip. J Korean Assoc Oral Maxillofac Surg 2020; 45:374-376. [PMID: 31966984 PMCID: PMC6955424 DOI: 10.5125/jkaoms.2019.45.6.374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 09/21/2018] [Indexed: 11/24/2022] Open
Abstract
Last week, after our receiving online journal regarding Journal of the Korean Association of Oral and Maxillofacial Surgeons, we found a recently published original article by Alawode et al., entitled “A comparative study of immediate wound healing complications following cleft lip repair using either absorbable or non-absorbable skin sutures”. Although this clinical article was well written and provided a great deal of information regarding the suture materials in the cleft lip repair, I would like to add a few additional comments based on the importance of skin suture during cheiloplasties in the primary cleft lip or secondary revision patients with representative figures.
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Affiliation(s)
- Soung Min Kim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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BMI and specimen weight: impact on personalized risk profiling for optimized informed consent in breast reduction surgery? Sci Rep 2019; 9:12690. [PMID: 31481711 PMCID: PMC6722094 DOI: 10.1038/s41598-019-49169-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/15/2019] [Indexed: 11/16/2022] Open
Abstract
We aimed to evaluate the interaction between individual risk factors and institutional complication rates after reduction mammaplasties to develop a chart for a personalized written patient informed consent. We retrospectively reviewed charts of 804 patients who underwent bilateral breast reduction between 2005 and 2015. The Clavien-Dindo classification was used to classify postoperative complications. Relevant predictors were found by applying a stepwise variable selection procedure. Multilevel predictors were assessed through chi-square tests on the respective deviance reductions. 486 patients were included. The most common complications were wound healing problems (n = 270/56%), foreign body reactions (n = 58/12%), wound infections (n = 45/9, 3%) and fat tissue necrosis (n = 41/8%). The risk factors for the personalized patient chart for the most common complications influencing the preoperative informed consent were: smoking, operative technique, resection weight for wound healing problems; body mass index and allergies for wound infections; and patients’ age, resection weight for fat tissue necrosis. The resultant chart of institutionally encountered most common complications based on individual risk factors is a graphical template for obtaining patient informed consent in the future. Whether this approach influences patient information retainment, incidence of filed lawsuits or behavioral change needs to be prospectively tested in future studies.
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Pourang A, Crispin MK, Clark AK, Armstrong AW, Sivamani RK, Eisen DB. Use of 5-0 Fast Absorbing Gut versus 6-0 Fast Absorbing Gut during cutaneous wound closure on the head and neck: A randomized evaluator-blinded split-wound comparative effectiveness trial. J Am Acad Dermatol 2019; 81:213-218. [DOI: 10.1016/j.jaad.2019.02.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/23/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
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Risk Factors for Surgical Site Infection in Minor Dermatological Surgery: A Systematic Review. Adv Skin Wound Care 2019; 32:217-226. [DOI: 10.1097/01.asw.0000546118.25057.1a] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pivot D, Hoch G, Astruc K, Lepelletier D, Lefebvre A, Lucet JC, Beaussier M, Philippe HJ, Vons C, Triboulet JP, Grandbastien B, Aho Glélé L. A systematic review of surgical site infections following day surgery: a frequentist and a Bayesian meta-analysis of prevalence. J Hosp Infect 2019; 101:196-209. [DOI: 10.1016/j.jhin.2018.07.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/24/2018] [Indexed: 01/19/2023]
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Alawode AO, Adeyemi MO, James O, Ogunlewe MO, Butali A, Adeyemo WL. A comparative study of immediate wound healing complications following cleft lip repair using either absorbable or non-absorbable skin sutures. J Korean Assoc Oral Maxillofac Surg 2018; 44:159-166. [PMID: 30181982 PMCID: PMC6117469 DOI: 10.5125/jkaoms.2018.44.4.159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/13/2017] [Accepted: 09/20/2017] [Indexed: 11/07/2022] Open
Abstract
Objectives The aim of the study was to compare wound healing complications following the use of either absorbable or non-absorbable sutures for skin closure in cleft lip repair. Materials and Methods This was a randomized controlled trial conducted at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria. Sixty subjects who required either primary or secondary cleft lip repair and satisfied all the inclusion criteria were recruited and randomized into two groups (Vicryl group or Nylon group). The surgical wounds in all subjects were examined on 3rd, 7th, and 14th postoperative days (POD) for presence or absence of tissue reactivity, wound dehiscence, and local wound infection. Results Hemorrhage, tissue reactivity, wound dehiscence, and local wound infection were identified as wound healing complications following cleft lip repair. The incidence of postoperative wound healing complications on POD3 was 33.3%. Tissue reactivity was more common throughout the evaluation period with the use of an absorbable (Vicryl) suture compared to a non-absorbable (Nylon) suture, although the difference was statistically significant only on POD7 (P=0.002). There were no significant differences in the incidences of wound dehiscence and infection between the two groups throughout the observation period. Conclusion There were no statistically significant differences in the incidences of wound dehiscence and surgical site wound infection following the use of either Vicryl or Nylon for skin closure during cleft lip repair. However, more cases of tissue reactivity were recorded in the Vicryl group than in the Nylon group on POD7. Particular attention must be paid to detect the occurrence of wound healing complications, most especially tissue reactivity, whenever a Vicryl suture is used for skin closure in cleft lip repair.
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Affiliation(s)
- Akeem O Alawode
- Department of Oral and Maxillofacial Surgery Unit, Gbagada General Hospital, Lagos, Nigeria
| | - Michael O Adeyemi
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olutayo James
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Mobolanle O Ogunlewe
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Azeez Butali
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Wasiu L Adeyemo
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
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The effect of postoperative closed incision negative pressure therapy on the incidence of donor site wound dehiscence in breast reconstruction patients: DEhiscence PREvention Study (DEPRES), pilot randomized controlled trial. J Tissue Viability 2018; 27:262-266. [PMID: 30126630 DOI: 10.1016/j.jtv.2018.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 12/14/2022]
Abstract
AIM Wound dehiscence is a serious postoperative complication associated both with high morbidity and mortality. It has a significant rate of occurrence in breast reconstruction surgeries with a deep internal epigastric perforator (DIEP) and with a profunda artery perforator (PAP) flap. Risk factors for wound dehiscence include smoking, diabetes mellitus, chronic obstructive pulmonary disease, and obesity. The aim of this pilot study was to assess whether postoperative treatment with closed incision negative pressure therapy (ciNPT) decreases the incidence of donor site wound dehiscence in breast reconstruction patients. METHOD Women undergoing a breast reconstruction with a DIEP or PAP flap were enrolled in a pilot randomized controlled trial and assigned treatment with either ciNPT or adhesive strips. The primary outcome was wound dehiscence upon follow-up after four weeks. Secondary outcomes that were evaluated included wound infection, pain, and allergy. There was no loss to follow-up. RESULTS This pilot study included 51 women (n = 25 ciNPT, n = 26 adhesive strips). The two groups did not differ significantly in patients demographics or comorbidities. Wound dehiscence occurred in 11 patients (n = 2 ciNPT, n = 9 adhesive strips). This difference was statistically significant: p = 0.038. There were no statistically significant differences in secondary outcomes between the two groups. CONCLUSION In this pilot study, postoperative treatment with ciNPT decreased the incidence of donor site wound dehiscence in breast reconstruction patients. Further research is ongoing by the same hospital. This trial was registered in the Netherlands Trial Register (NTR) under ID no. NTR5808.
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Chanda A, Ruchti T, Unnikrishnan V. Computational Modeling of Wound Suture: A Review. IEEE Rev Biomed Eng 2018; 11:165-176. [DOI: 10.1109/rbme.2018.2804219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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The effects of different suture materials in the nasal cavity. The Journal of Laryngology & Otology 2016; 130:352-6. [PMID: 26857847 DOI: 10.1017/s002221511600027x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate the effects of different suture materials in the nasal cavity on encrustation and micro-organism colonisation. METHODS Four different suture materials were used to suture the nasal septum. The effects of suture materials on intranasal encrustation were evaluated with anterior rhinoscopy. The sutures were removed and evaluated in terms of micro-organism colonisation on the 7th and 21st post-operative days. RESULTS Monofilament sutures were found to cause less encrustation and micro-organism colonisation. There was increased late-stage encrustation if an absorbable monofilament suture remained in place for a long time. The removal of a non-absorbable monofilament suture in the early or late post-operative period made no difference in terms of micro-organism growth on the suture. CONCLUSION The material and physical characteristics of sutures placed inside the nose may indirectly affect the healing process. It may be more appropriate to use different materials depending on the length of time the suture is to remain in place.
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Bekele T, Bhokre AP, Tesfaye A. Tissue reactivity and suture handling characteristics of "jimat" against silk and chromic gut in cat thigh muscle: A comparative study. Vet World 2015; 8:958-69. [PMID: 27047183 PMCID: PMC4774762 DOI: 10.14202/vetworld.2015.958-969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/03/2015] [Accepted: 07/12/2015] [Indexed: 11/16/2022] Open
Abstract
AIM This study was conducted to evaluate and compare the tissue reactivity and suture handling characteristics of chromic gut, silk, and 'jimat' suture materials in cat thigh muscle. MATERIALS AND METHODS This experimental study was conducted from November, 2013 to April, 2014 in Kombolcha Animal Diseases Survey, Research and Diagnostic Laboratory, Kombolcha, Ethiopia. A total of 36 local breed male cats were randomly assigned into chromic gut, silk, and "jimat" groups of 12 cats each as A, B, and C, respectively. The hind leg muscle biceps femoris was incised and sutured with suture materials according to their groups. The muscle samples with its suture were collected at six different days interval i.e. 1, 3, 7, 14, 21, and 28 and processed histopathologically to assess the degree of leukocytic infiltration and fibrous and granulation tissue formation (GTF). In addition, all suture materials were evaluated intraoperatively about their handling characteristics, by rating the precision of knot tying, square knot positioning, and resistance to knot slippage. The statistical analysis was done with two-way ANOVA, Kruskal-Wallis, and Chi-square tests. RESULTS The histopathology showed that "jimat" thread (2.4±1.2) had produced least leukocytic infiltration than chromic gut (4.5±1.9) and silk (4.3±1.5) sutures during the study period. Higher GTF was seen at day 3 (6 [100%]), 7 (6 [100%]) and day 14 (4 [66.7%]) in all sutures, whereas "jimat" showed significantly (p<0.05) higher fibrous tissue formation (10 [83.3%]) than others. Moreover, "jimat" suture had equal suture handling characteristics (p>0.05) with both chromic gut and silk. CONCLUSION The result indicated that a single strand "jimat" thread appears to be the most satisfactory suture material as regards to both tissue reaction and suture handling characteristics for skeletal muscle approximation in cats and provided that studies on its carcinogenic effects should be done.
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Affiliation(s)
- Tilahun Bekele
- School of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Jimma University, P. O. Box 307, Jimma, Ethiopia
| | - A. P. Bhokre
- Department of Veterinary Medicine, College of Veterinary Medicine, Mekelle University, P. O. Box 231, Mekelle, Ethiopia
| | - Abreha Tesfaye
- Department of Veterinary Medicine, College of Veterinary Medicine, Mekelle University, P. O. Box 231, Mekelle, Ethiopia
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Bertucci Zoccali M, Biondi A, Krane M, Kueberuwa E, Rizzo G, Persiani R, Coco C, Hurst RD, D'Ugo D, Fichera A. Risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy. Int J Colorectal Dis 2015; 30:87-95. [PMID: 25376336 DOI: 10.1007/s00384-014-2062-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Perineal wounds after complete proctectomy are at risk for failure, with dramatic consequences on patients' health and quality of life. This study is aimed at identifying risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy. METHODS Data from 284 patients undergoing total proctectomy from 2002 to 2012 either at the University of Chicago Medical Center or the Catholic University of Rome Hospital were collected and analyzed. RESULTS Overall, the perineal wound complication rate was 21.8%. Successful conservative management was accomplished in 45.2% of cases. Complications occurred significantly more often in patients with a higher Charlson score index, with the diagnosis of rectal cancer, who had received preoperative radiation and who had a surgical drain placed at the time of initial surgery. Neoadjuvant radiation was the only significant risk factor at multivariate analysis (OR 4.40). In the rectal cancer subgroup, younger age, female gender, and preoperative radiation were predictors of wound complications. Based on that, a 3-point score (radiation, age, and gender (RAG)) was developed. Patients with a score of 3 had a 50% risk of developing a perineal wound complication. CONCLUSIONS Perineal wound complications are a common and burdensome problem after total proctectomy. Preoperative radiation is the single most significant and controllable risk factor predicting perineal wound failure. In the presence of multiple, non-modifiable risk factors, alternative approaches to primary closure should be considered in managing complex perineal defects.
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Affiliation(s)
- Marco Bertucci Zoccali
- Department of Surgery, Catholic University School of Medicine, Largo A. Gemelli 8, 00168, Rome, Italy
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Smith SC, Heal CF, Buttner PG. Prevention of surgical site infection in lower limb skin lesion excisions with single dose oral antibiotic prophylaxis: a prospective randomised placebo-controlled double-blind trial. BMJ Open 2014; 4:e005270. [PMID: 25079934 PMCID: PMC4120377 DOI: 10.1136/bmjopen-2014-005270] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine the effectiveness of a single perioperative prophylactic 2 g dose of cephalexin in preventing surgical site infection (SSI) following excision of skin lesions from the lower limb. DESIGN Prospective double-blinded placebo-controlled trial testing for difference in infection rates. SETTING Primary care in regional North Queensland, Australia. PARTICIPANTS 52 patients undergoing lower limb skin lesion excision. INTERVENTIONS 2 g dose of cephalexin 30-60 min before excision. MAIN OUTCOME MEASURES Incidence of SSI. RESULTS Incidence of SSI was 12.5% (95% CI 2.7% to 32.4%) in the cephalexin group compared with 35.7% (95% CI 18.6% to 55.9%) in the placebo group (p=0.064). This represented an absolute reduction of 23.21% (95% CI -0.39% to 46.82%), relative reduction of 65.00% (95% CI -12.70% to 89.13%) and number-needed-to-treat of 4.3. CONCLUSIONS Administration of a single 2 g dose of cephalexin 30-60 min before skin lesion excision from the lower limb may produce a reduction in the incidence of infection; however, this study was underpowered to statistically determine this. TRIAL REGISTRATION NUMBER ACTRN12611000595910.
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Affiliation(s)
- Samuel C Smith
- The Townsville Hospital, Townsville, Queensland, Australia
| | - Clare F Heal
- School of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
| | - Petra G Buttner
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia
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Aslan M, Büyükkurt MC, Yildirim Ü. Comparison of different absorbable suture materials in skin closure: An experimental study in rats. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/1568569053421717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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The use of biodegradable sutures for the fixation of tibial eminence fractures in children: a comparison using PDS II, Vicryl and FiberWire. J Pediatr Orthop 2013; 33:409-14. [PMID: 23653031 DOI: 10.1097/bpo.0b013e31827d0c67] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Arthroscopic suture fixation of tibial eminence fractures using FiberWire is a favorable therapeutic option. The application of biodegradable material may be of advantage especially during childhood. The aim of this study was to evaluate the biomechanical properties using the biodegradable suture materials PDS II and Vicryl compared with FiberWire. METHODS Bone mineral density was evaluated by pqCT in 18 human knee specimens and 3 similar groups were formed. A standardized anterior tibial eminence fracture was created and suture fixation was performed using each suture material (PDS II, Vicryl, FiberWire) in 6 specimens. Cyclic testing and destructive loading to failure was conducted. RESULTS Both testing modalities showed PDS II to be inferior to the other evaluated suture materials. Although significantly higher failure loads were seen with FiberWire sutures, Vicryl yielded comparable stiffness in load-to-failure testing. No significant differences between Vicryl and FiberWire could be observed under nondestructive cyclic conditions. CONCLUSIONS Even though FiberWire yields a superior ultimate failure load, Vicryl presented comparable results under cyclic conditions. CLINICAL RELEVANCE For tibial eminence fractures in children, Vicryl should be considered as an alternative biodegradable suture material. The use of PDS II cannot be advocated.
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Nasal tip abscess due to adverse skin reaction to Prolene: an unusual long term complication of rhinoplasty. The Journal of Laryngology & Otology 2012; 127:76-9. [PMID: 23171664 DOI: 10.1017/s0022215112002575] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Allergic reactions to Prolene are rare. This paper reports a nasal tip abscess which developed in a patient with an adverse skin reaction to Prolene after rhinoplasty. METHODS AND RESULTS A 26-year-old woman presented with painful, progressive nasal tip swelling and redness. She had undergone septo-rhinoplasty two years previously. She was initially treated with endonasal drainage of the abscess and antibiotics, but a revision rhinoplasty three months later became necessary because of recurrent abscess formation. Intra-operative findings included granulation tissue with pockets of pus and knotted Prolene sutures at the tip-defining points of the lower lateral cartilages. She was patch-tested with Prolene and a cutaneous Prolene suture was placed on her back; an adverse skin reaction was seen for the latter. CONCLUSION Use of non-absorbable sutures, such as Prolene, in the subcutaneous layer may be a potential, rare risk factor for adverse skin reactions.
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Ibrahimi OA, Sharon V, Eisen DB. Surgical-site infections and routes of bacterial transfer: which ones are most plausible? Dermatol Surg 2011; 37:1709-20. [PMID: 22092583 DOI: 10.1111/j.1524-4725.2011.02183.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Surgical-site infections (SSIs) are an unfortunate consequence of cutaneous surgery. Their incidence can be a significant problem for patients and surgeons. Most SSIs are presumed to originate from the patient and operating room staff. OBJECTIVES To review the potential routes of iatrogenic bacterial transfer during cutaneous surgery. METHODS A review of the medical literature. CONCLUSIONS Potential routes of bacterial transfer during surgery include respiratory droplets and nuclei, skin scales carried on air currents, direct contact with the surgical team's skin, and contaminated fomites. The route with the most significant potential for iatrogenic bacterial transfer is direct physical contact. Strategies that minimize contact with infected fomites and with the surgical team would probably have the best chances of reducing the incidence of SSIs.
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Affiliation(s)
- Omar A Ibrahimi
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA
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Kim JS, Shin SI, Herr Y, Park JB, Kwon YH, Chung JH. Tissue reactions to suture materials in the oral mucosa of beagle dogs. J Periodontal Implant Sci 2011; 41:185-91. [PMID: 21954423 PMCID: PMC3175498 DOI: 10.5051/jpis.2011.41.4.185] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 06/30/2011] [Indexed: 11/24/2022] Open
Abstract
Purpose The objective of this study was to compare and evaluate the inflammatory responses of three widely used suture materials in the keratinized gingiva and buccal mucosa of beagle dogs. Methods Silk, polyglycolic acid, and nylon sutures were placed within the mandibular keratinized gingiva and maxillary buccal mucosa of four male beagle dogs. Biopsies were taken 3, 7, and 14 days after suturing. Specimens were prepared with hematoxylin-eosin stain for evaluation under a light microscope. Results The suture materials placed in the oral mucosa elicited more inflammatory reactions than did those placed in the keratinized gingiva. The multifilament suture materials caused more inflammatory tissue reactions than did the monofilament suture materials in the oral mucosa. Conclusions If oral hygiene is well maintained and suture materials are placed in the keratinized gingiva, silk, nylon, and polyglycolic acid are considered to be proper suture materials for oral surgery. However, it is advisable to use monofilament suture materials if the suture site is within the oral mucosa.
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Abstract
More than ever, dermatologic surgeons are faced with a multitude of suture and other closure materials when evaluating a surgical wound. Given there is no single material that is ideal for all situations, the physician must decide which material is best suited for that particular closure. This review seeks to summarize the major properties of common suture materials as well as other closure materials including adhesive tapes, glues and staples.
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Affiliation(s)
- Ani L Tajirian
- Dermatology, New Jersey Medical School, Newark, NJ, USA.
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Rosenzweig LB, Abdelmalek M, Ho J, Hruza GJ. Equal cosmetic outcomes with 5-0 poliglecaprone-25 versus 6-0 polypropylene for superficial closures. Dermatol Surg 2010; 36:1126-9. [PMID: 20653727 DOI: 10.1111/j.1524-4725.2010.01594.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cutaneous sutures should provide an aesthetically pleasing result. After placing subcutaneous sutures, enough absorbable suture often remains for the superficial closure. Mohs surgeons often use a nonabsorbable suture to close the superficial layer to obtain cosmetically elegant results, but using this additional suture is less cost effective than using the remaining absorbable suture. OBJECTIVES To compare the cosmetic results of simple running sutures using an absorbable suture material (5-0 poliglecaprone-25) with those of a nonabsorbable suture (6-0 polypropylene) in primary closures of suitable facial Mohs defects. MATERIALS AND METHODS Fifty-two patients with 57 facial Mohs surgery defects appropriate for multilayer primary repair had the defects prospectively randomized into a side-by-side comparison. After closure of the deep layers with 5-0 poliglecaprone-25 sutures, half of the wound was closed with a 5-0 poliglecaprone-25 simple running suture, and the other half of the wound was closed with a 6-0 polypropylene simple running suture. The investigators blindly determined the cosmetically superior side of the closure at 1 week and 4 months after suture removal. RESULTS Forty-four patients (48 total defects) completed the study. At the 4-month follow-up, 85% (41/48) did not show any difference between poliglecaprone-25 and polypropylene, 4% (2/48) had better outcomes with poliglecaprone-25, and 10% (5/48) had better outcomes with polypropylene. There was no statistically significant cosmetic difference between the two closure types. Wound complications such as infection, hematoma, and dehiscence did not occur in any of the patients. CONCLUSION In primary closures of facial defects, using 5-0 poliglecaprone-25 or 6-0 polypropylene for the superficial closure did not affect the cosmetic result. Therefore, 5-0 poliglecaprone-25 provides a comparable and cost-effective alternative to nonabsorbable sutures for epidermal approximation in layered closures.
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Affiliation(s)
- Laura B Rosenzweig
- Laser and Dermatologic Surgery Center, Chesterfield, Missouri 63017, USA.
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Wound Healing and Suturing Techniques in Dental Implant Surgery. IMPLANT DENT 2010. [DOI: 10.1016/b978-0-323-05566-6.00009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
If pharmaceutic modulation of scar formation does not improve the quality of the healing process over conventional healing, the surgeon must rely on personal skill and experience. Therefore a profound knowledge of wound healing based on experimental and clinical studies supplemented by postsurgical means of scar management and basic techniques of planning incisions, careful tissue handling, and thorough knowledge of suturing remain the most important ways to avoid abnormal scarring. This review summarizes the current experimental and clinical bases of surgical scar management.
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Affiliation(s)
- P M Vogt
- Klinik und Poliklinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 3, 30625 Hannover, Deutschland.
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Abstract
Optimal cosmetic surgical results are dependent, in part, on the chosen suture material. Given the importance of sutures in wound healing, it is imperative for the esthetic physician to choose the correct suture material. There are a wide variety of suture materials available and each material presents advantages and disadvantages. An ideal suture material has great strength and knot security while remaining elastic with minimal tissue reactivity. Given that there is no single suture material that is ideal for all situations, the cosmetic physician must decide which material is best suited for the particular closure. This review will address the major properties of common suture materials and describe their advantages and disadvantages.
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Bedder MD, Bedder HF. Spinal Cord Stimulation Surgical Technique for the Nonsurgically Trained. Neuromodulation 2009; 12 Suppl 1:1-19. [DOI: 10.1111/j.1525-1403.2009.00194.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Martens AA, Portale G, Werten MWT, de Vries RJ, Eggink G, Cohen Stuart MA, de Wolf FA. Triblock Protein Copolymers Forming Supramolecular Nanotapes and pH-Responsive Gels. Macromolecules 2009. [DOI: 10.1021/ma801955q] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Aernout A. Martens
- Biobased Products, Agrotechnology & Food Sciences Group, Wageningen UR, Bornsesteeg 59, 6708 PD Wageningen, The Netherlands, Laboratory of Physical Chemistry and Colloid Science, Agrotechnology & Food Sciences Group, Wageningen UR, Dreijenplein 6, 6703 HB Wageningen, The Netherlands, Dutch Polymer Institute (DPI), John F. Kennedylaan 2; 5612 AB, Eindhoven, The Netherlands, and European Synchrotron Radiation Facility, 6 Rue Jules Horowitz, BP 220, 38043 Grenoble, Cedex 9, France
| | - Giuseppe Portale
- Biobased Products, Agrotechnology & Food Sciences Group, Wageningen UR, Bornsesteeg 59, 6708 PD Wageningen, The Netherlands, Laboratory of Physical Chemistry and Colloid Science, Agrotechnology & Food Sciences Group, Wageningen UR, Dreijenplein 6, 6703 HB Wageningen, The Netherlands, Dutch Polymer Institute (DPI), John F. Kennedylaan 2; 5612 AB, Eindhoven, The Netherlands, and European Synchrotron Radiation Facility, 6 Rue Jules Horowitz, BP 220, 38043 Grenoble, Cedex 9, France
| | - Marc W. T. Werten
- Biobased Products, Agrotechnology & Food Sciences Group, Wageningen UR, Bornsesteeg 59, 6708 PD Wageningen, The Netherlands, Laboratory of Physical Chemistry and Colloid Science, Agrotechnology & Food Sciences Group, Wageningen UR, Dreijenplein 6, 6703 HB Wageningen, The Netherlands, Dutch Polymer Institute (DPI), John F. Kennedylaan 2; 5612 AB, Eindhoven, The Netherlands, and European Synchrotron Radiation Facility, 6 Rue Jules Horowitz, BP 220, 38043 Grenoble, Cedex 9, France
| | - Renko J. de Vries
- Biobased Products, Agrotechnology & Food Sciences Group, Wageningen UR, Bornsesteeg 59, 6708 PD Wageningen, The Netherlands, Laboratory of Physical Chemistry and Colloid Science, Agrotechnology & Food Sciences Group, Wageningen UR, Dreijenplein 6, 6703 HB Wageningen, The Netherlands, Dutch Polymer Institute (DPI), John F. Kennedylaan 2; 5612 AB, Eindhoven, The Netherlands, and European Synchrotron Radiation Facility, 6 Rue Jules Horowitz, BP 220, 38043 Grenoble, Cedex 9, France
| | - Gerrit Eggink
- Biobased Products, Agrotechnology & Food Sciences Group, Wageningen UR, Bornsesteeg 59, 6708 PD Wageningen, The Netherlands, Laboratory of Physical Chemistry and Colloid Science, Agrotechnology & Food Sciences Group, Wageningen UR, Dreijenplein 6, 6703 HB Wageningen, The Netherlands, Dutch Polymer Institute (DPI), John F. Kennedylaan 2; 5612 AB, Eindhoven, The Netherlands, and European Synchrotron Radiation Facility, 6 Rue Jules Horowitz, BP 220, 38043 Grenoble, Cedex 9, France
| | - Martien A. Cohen Stuart
- Biobased Products, Agrotechnology & Food Sciences Group, Wageningen UR, Bornsesteeg 59, 6708 PD Wageningen, The Netherlands, Laboratory of Physical Chemistry and Colloid Science, Agrotechnology & Food Sciences Group, Wageningen UR, Dreijenplein 6, 6703 HB Wageningen, The Netherlands, Dutch Polymer Institute (DPI), John F. Kennedylaan 2; 5612 AB, Eindhoven, The Netherlands, and European Synchrotron Radiation Facility, 6 Rue Jules Horowitz, BP 220, 38043 Grenoble, Cedex 9, France
| | - Frits A. de Wolf
- Biobased Products, Agrotechnology & Food Sciences Group, Wageningen UR, Bornsesteeg 59, 6708 PD Wageningen, The Netherlands, Laboratory of Physical Chemistry and Colloid Science, Agrotechnology & Food Sciences Group, Wageningen UR, Dreijenplein 6, 6703 HB Wageningen, The Netherlands, Dutch Polymer Institute (DPI), John F. Kennedylaan 2; 5612 AB, Eindhoven, The Netherlands, and European Synchrotron Radiation Facility, 6 Rue Jules Horowitz, BP 220, 38043 Grenoble, Cedex 9, France
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Chou LB, Lee DC. Current concept review: perioperative soft tissue management for foot and ankle fractures. Foot Ankle Int 2009; 30:84-90. [PMID: 19176194 DOI: 10.3113/fai.2009.0084] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Loretta B Chou
- Stanford University Medical Center, Department of Orthopaedic Surgery, 300 Pasteur Drive, Room R111, MC 5343, Stanford, CA 94305-5343, USA.
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Marquess JS, Burke CT, Beecham AH, Dixon RG, Stavas JM, Sag AA, Koch GG, Mauro MA. Factors Associated with Failed Retrieval of the Günther Tulip Inferior Vena Cava Filter. J Vasc Interv Radiol 2008; 19:1321-7. [DOI: 10.1016/j.jvir.2008.06.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 05/30/2008] [Accepted: 06/03/2008] [Indexed: 11/28/2022] Open
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Use of 2-Octyl-Cyanoacrylate Skin Adhesive (Dermabond) for Wound Closure following Reduction Mammaplasty: A Prospective, Randomized Intervention Study. Plast Reconstr Surg 2008; 122:10-18. [DOI: 10.1097/prs.0b013e318171524b] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Balighi K, Robati RM, Moslehi H, Robati AM. Subcision in acne scar with and without subdermal implant: a clinical trial. J Eur Acad Dermatol Venereol 2008; 22:707-11. [DOI: 10.1111/j.1468-3083.2008.02583.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
OBJECTIVES We sought to compare the long-term cosmetic outcomes of absorbable versus nonabsorbable sutures for facial lacerations in children and to compare the complication rates and parental satisfaction in the 2 groups. DESIGN/METHODS Healthy patients presenting to a pediatric emergency department with facial lacerations were randomized to repair using fast-absorbing catgut or nylon suture. Patients were followed up at 5 to 7 days and at 3 months. Three blinded observers, using a previously validated 100-mm cosmesis visual analogue scale (VAS) as the primary instrument, rated photographs of the wound taken at 3 months. For this noninferiority study, a VAS score of 15 mm or greater was considered to be the minimal clinically important difference. Parents also rated the wound using the VAS and completed a satisfaction survey. RESULTS Of the 88 patients initially enrolled, 47 patients completed the study: 23 in the catgut group and 24 in the nylon group. There were no significant differences in age, race, sex, wound length, number of sutures, and layered repair rates in the 2 groups. The observers' mean VAS for the catgut group was 92.3 (95% confidence interval [CI], 89.1-95.4) and that for the nylon group was 93.7 (95% CI, 91.4-96.0), with a difference of the means of 1.4 (95% CI, -5.31 to 8.15), which was less than the minimal clinically important difference of 15 mm (power, >90%). The mean parental VAS score for the catgut group was 86.3 (95% CI, 78.4-94.1) and that for the nylon group was 91.2 (95% CI, 86.9-95.4), with a difference of the means of 4.9 (95% CI, 2.41-7.41), also less than 15 mm. There were no significant differences in the rates of infection, wound dehiscence, keloid formation, and parental satisfaction. CONCLUSIONS The use of fast-absorbing catgut suture is a viable alternative to nonabsorbable suture in the repair of facial lacerations in children.
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Affiliation(s)
- Jim Bush
- Renovo plc, The Incubator Building, Manchester
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Calkins CM, St Peter SD, Balcom A, Murphy PJ. Late abscess formation following indirect hernia repair utilizing silk suture. Pediatr Surg Int 2007; 23:349-52. [PMID: 17333211 DOI: 10.1007/s00383-007-1894-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2007] [Indexed: 02/07/2023]
Abstract
Inguinal hernia repair is the most common operation performed by pediatric surgeons. The critical portion of the operation is high ligation of the hernia sac, which is classically performed with silk suture. This foreign body has the potential to serve as a nidus for latent infection/rejection that may result in an abscess long after the operation. This complication has rarely been described in the literature. We have cared for six children who have presented with latent inguinal or pelvic abscesses following high ligation of the inguinal hernia sac with silk suture. The purpose of this report is to examine the varied presentations by which latent complications following herniorraphy may manifest. The pediatric surgeon should recognize that not every inguinal mass following a previous inguinal herniorraphy represents a recurrent hernia! A retrospective review of the charts of six patients with late abscess formation following antecedent inguinal hernia repair was undertaken. The details of the initial and operative endeavors were recorded with specific attention to the details of the initial operative hernia repair as well as the suture material utilized. Inguinal hernia repair continues to be the most common operation performed by pediatric surgeons. Utilization of braided, non-absorbable silk suture may result in latent abscess formation and the need for operative drainage of inguinal or pelvic abscess. Today, as other types of suture material are likely equally efficacious in the ability to effectively close the patent processus vaginalis, pediatric surgeons should consider utilizing non-braided, or absorbable suture material for high ligation of the indirect hernia sac to potentially prevent this complication.
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Affiliation(s)
- Casey M Calkins
- Department of Pediatric Surgery, Children's Hospital of Wisconsin, Milwaukee, WI 53045, USA.
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Kouba E, Smith AM, Derksen JE, Gunn K, Wallen E, Pruthi RS. Efficacy and Safety of En Bloc Ligation of Renal Hilum During Laparoscopic Nephrectomy. Urology 2007; 69:226-9. [PMID: 17275073 DOI: 10.1016/j.urology.2006.09.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 07/15/2006] [Accepted: 09/21/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the feasibility, efficacy, and safety of en bloc ligation of the renal hilum with titanium vascular staplers during laparoscopic nephrectomy. En bloc ligation of the renal hilum has historically been associated with the very rare complication of arteriovenous fistula (AVF) formation, primarily in inflammatory renal pathologic features. Currently, no evidence exists of AVF development in human nephrectomies after ligating the hilum en bloc with titanium staplers. METHODS A total of 161 consecutive patients underwent planned laparoscopic radical nephrectomy or nephroureterectomy. A retrospective review was performed to evaluate the operative variables, including the method of hilar ligation, estimated blood loss, and final pathologic findings. The additional postoperative outcomes of diastolic blood pressure, heart rate, and other cardiovascular sequelae were evaluated. RESULTS Of the 161 patients, 90 underwent en bloc hilar ligation and 71 underwent individual hilar vessel ligation with the stapler. The blood loss and open conversion rate trended lower in the en bloc group. Postoperatively, no differences were found in blood pressure or heart rate between the two groups, and no instances of bruits or other clinical evidence of AVF were found after mean follow-up of 34 months. CONCLUSIONS This series found no evidence of AVF or other adverse clinical events in patients undergoing en bloc ligation of the renal hilum and laparoscopic nephrectomy. En bloc ligation may provide for more secure, expeditious control of the hilum without an increased operative time or the added potential of vascular injury that can be associated with the individual dissection of the vessels.
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Affiliation(s)
- Erik Kouba
- Division of Urologic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
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Abstract
Despite major advances in surgical management and approaches, including aseptic techniques, prophylactic antibiotics, and laparoscopic surgery, surgical wound infection and wound failure remain common complications of surgery. In a review of the literature, the authors found that a growing body of literature supports the concept that patient factors are a major determinant of wound outcome after surgery. In particular, wounds are exquisitely sensitive to hypoxia, which is both common and preventable. Perioperative management can be adapted to promote postoperative wound healing and resistance to infection. The most important factors are fluid management, temperature management, pain control, increased arterial oxygen tension, and, as has been long recognized, appropriate sterile techniques and administration of prophylactic antibiotics. This article reviews how knowledge of and attention to physiology can improve quality of care in both acute and chronic wounds.
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Affiliation(s)
- Christiane Ueno
- University of California, San Francisco, Wound Healing Laboratory, Departments of Anesthesia and Perioperative Care and Surgery, San Francisco, Calif 94143-0648, USA
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Tahir A, Titley OG. Reducing infections in cutaneous oncology defects reconstructed using skin grafts. EUROPEAN JOURNAL OF PLASTIC SURGERY 2005. [DOI: 10.1007/s00238-004-0706-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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