1
|
Sofii I, Dipoyono W, Prima H, Sari YM, Fauzi AR, Gunadi. The effect of different suturing materials for abdominal fascia wound closure on the collagen I/III expression ratio in rats. Ann Med Surg (Lond) 2020; 60:106-109. [PMID: 33145017 PMCID: PMC7593262 DOI: 10.1016/j.amsu.2020.10.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/18/2020] [Accepted: 10/18/2020] [Indexed: 11/30/2022] Open
Abstract
Background Incisional hernia is a frequent complication of abdominal wall incision and has a high rate of recurrence. Most of the studies stated that non-absorbable sutures decreased incisional hernia incidences, but some stated otherwise. We aimed to compare the collagen type I/III ratio between monofilament non-absorbable sutures and multifilament absorbable sutures for abdominal fascia closure in Wistar albino rats. Methods Forty rats were divided into four groups. Groups 1 and 3 were sutured with monofilament non-absorbable (polyvinylidene fluoride). Groups 2 and 4 were sutured with multifilament absorbable (polyglycolide). Then, groups 1 and 2 were euthanized on day 4 (POD 4), while groups 3 and 4 were euthanized on day 7 (POD 7). Samples of fascia (1 × 0.5 cm) were taken for analysis. Collagen I/III ratios were measured using immunohistochemistry staining methods. Results While the expression of collagen I was not significantly different between monofilament non-absorbable and multifilament absorbable at POD 4 and 7 (p = 0.45 and 0.81, respectively), the expression of collagen III reached a significant level with p-values of 0.0003 and 0.0004 for POD 4 and 7, respectively. Moreover, the collagen I/III ratio was also significantly different between the two groups either at POD 4 (0.88 ± 0.23 vs. 0.53 ± 0.08; p = 0.0003) and 7 (1.77 ± 0.65 vs. 1.03 ± 0.28; p = 0.004). Conclusions Monofilament non-absorbable sutures show a significantly higher collagen I/III ratio than multifilament absorbable sutures for abdominal fascia closure in rats. Our findings imply that the usage of monofilament non-absorbable sutures might have a beneficial effect on decreasing the incisional hernia occurrence. One of the most important factors that influences the occurrence of incisional hernia is suturing material. Collagen is a major component of the extracellular matrix and plays an important role in maintaining tissue elasticity and tensility. The usage of monofilament non-absorbable sutures might have a beneficial effect on decreasing the incisional hernia occurrence.
Collapse
Affiliation(s)
- Imam Sofii
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Wisnu Dipoyono
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Heryu Prima
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Yessy Martha Sari
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Aditya Rifqi Fauzi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Gunadi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| |
Collapse
|
2
|
Trottier ED, Doré-Bergeron MJ, Chauvin-Kimoff L, Baerg K, Ali S. Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures. Paediatr Child Health 2019; 24:509-535. [PMID: 31844394 DOI: 10.1093/pch/pxz026] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/21/2019] [Indexed: 12/17/2022] Open
Abstract
Common medical procedures to assess and treat patients can cause significant pain and distress. Clinicians should have a basic approach for minimizing pain and distress in children, particularly for frequently used diagnostic and therapeutic procedures. This statement focuses on infants (excluding care provided in the NICU), children, and youth who are undergoing common, minor but painful medical procedures. Simple, evidence-based strategies for managing pain and distress are reviewed, with guidance for integrating them into clinical practice as an essential part of health care. Health professionals are encouraged to use minimally invasive approaches and, when painful procedures are unavoidable, to combine simple pain and distress-minimizing strategies to improve the patient, parent, and health care provider experience. Health administrators are encouraged to create institutional policies, improve education and access to guidelines, create child- and youth-friendly environments, ensure availability of appropriate staff, equipment and pharmacological agents, and perform quality audits to ensure pain management is optimal.
Collapse
Affiliation(s)
- Evelyne D Trottier
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Marie-Joëlle Doré-Bergeron
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Laurel Chauvin-Kimoff
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Krista Baerg
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Samina Ali
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Navanandan N, Renna-Rodriguez M, DiStefano MC. Pearls in Pediatric Wound Management. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017. [DOI: 10.1016/j.cpem.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
5
|
Macdonald P, Primiani N, Lund A. Are patients willing to remove, and capable of removing, their own nonabsorbable sutures? CAN J EMERG MED 2015. [DOI: 10.2310/8000.2012.120451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACTObjectives:Providing patients with instructions and equipment regarding self-removal of nonabsorbable sutures could represent a new efficiency in emergency department (ED) practice. The primary outcome was to compare the proportion of patients successfully removing their own sutures when provided with suture removal instructions and equipment versus the standard advice and follow-up care. Secondary outcomes included complication rates, number of physician visits, and patient comfort level.Methods:This prospective, controlled, single-blinded, pseudorandomized trial enrolled consecutive ED patients who met the eligibility criteria (age > 19 years, simple lacerations, nonabsorbable sutures, immunocompetent). The study group was provided with wound care instructions, a suture removal kit, and instructions regarding suture self-removal. The control group received wound care instructions alone. Outcomes were assessed by telephone contact at least 14 days after suturing using a standardized questionnaire.Results:Overall, 183 patients were enrolled (93 in the intervention group; 90 in the control group). Significantly more patients performed suture self-removal in the intervention group (91.5%; 95% CI 85.4–97.5) compared to the control group (62.8%; 95% CI 52.1–73.6) (p< 0.001). Patients visited their physician less often in the intervention group (9.8%; 95% CI 3.3–16.2) compared to the control group (34.6%; 95% CI 24.1–45.2%) (p< 0.001). Complication rates were similar in both groups.Conclusion:Most patients are willing to remove, and capable of removing, their own sutures. Providing appropriate suture removal instructions and equipment to patients with simple lacerations in the ED appears to be both safe and acceptable.
Collapse
|
6
|
|
7
|
Abstract
Introduction: On a daily basis, dermasurgeons are faced with different kinds of wounds that have to be closed. With a plethora of skin closure materials currently available, choosing a solution that combines excellent and rapid cosmetic results with practicality and cost-effectiveness can be difficult, if not tricky. Objectives: We aimed to review the available skin closure materials over the past 20 years and the scientific claims behind their effectiveness in repairing various kinds of wounds. Materials and Methods: The two authors independently searched and scrutinised the literature. The search was performed electronically using Pub Med, the Cochrane Database, Google Scholar and Ovid as search engines to find articles concerning skin closure materials written since 1990. Conclusion: Many factors are involved in the choice of skin closure material, including the type and place of the wound, available materials, physician expertise and preferences, and patient age and health. Evidence-based main uses of different skin closure materials are provided to help surgeons choose the appropriate material for different wounds.
Collapse
Affiliation(s)
- Luluah Al-Mubarak
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Al-Haddab
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
8
|
Hernandez KA, Hooper RC, Boyko T, Golas AR, van Harten M, Wu D, Weinstein A, Chu C, Spector JA. Reduction of suture associated inflammation after 28 days using novel biocompatible pseudoprotein poly(ester amide) biomaterials. J Biomed Mater Res B Appl Biomater 2014; 103:457-63. [DOI: 10.1002/jbm.b.33211] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 03/31/2014] [Accepted: 05/17/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Karina A. Hernandez
- Division of Plastic and Reconstructive Surgery; Weill Cornell Medical College; New York
| | | | - Tatiana Boyko
- Division of Plastic and Reconstructive Surgery; Weill Cornell Medical College; New York
| | - Alyssa R. Golas
- Division of Plastic and Reconstructive Surgery; Weill Cornell Medical College; New York
| | - Michel van Harten
- Division of Plastic and Reconstructive Surgery; Weill Cornell Medical College; New York
| | - D.Q. Wu
- Department of Fiber Science and Apparel Design; and Biomedical Engineering Program; Cornell University; Ithaca New York
| | - Andrew Weinstein
- Division of Plastic and Reconstructive Surgery; Weill Cornell Medical College; New York
| | - C.C. Chu
- Department of Fiber Science and Apparel Design; and Biomedical Engineering Program; Cornell University; Ithaca New York
| | - Jason A. Spector
- Division of Plastic and Reconstructive Surgery; Weill Cornell Medical College; New York
| |
Collapse
|
9
|
Tejani C, Sivitz AB, Rosen MD, Nakanishi AK, Flood RG, Clott MA, Saccone PG, Luck RP. A comparison of cosmetic outcomes of lacerations on the extremities and trunk using absorbable versus nonabsorbable sutures. Acad Emerg Med 2014; 21:637-43. [PMID: 25039547 DOI: 10.1111/acem.12387] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/24/2013] [Accepted: 01/11/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The primary objective was to compare the cosmetic outcomes of traumatic trunk and extremity lacerations repaired using absorbable versus nonabsorbable sutures. The secondary objective was to compare complication rates between the two groups. METHODS This was a randomized controlled trial comparing wounds repaired with Vicryl Rapide and Prolene sutures. Pediatric and adult patients with lacerations were enrolled in the study. At a 10-day follow-up, the wounds were evaluated for infection and dehiscence. After 3 months, patients returned to have the wounds photographed. Two plastic surgeons blinded to the method of closure rated the cosmetic outcome of each wound using a 100-mm visual analog scale (VAS). Using a noninferiority design, a VAS score of 13 mm or greater was considered to be a clinically significant difference. We used a Student's t-test to compare differences between mean VAS scores and odds ratios (ORs) to compare differences in complication rates between the two groups. RESULTS Of the 115 patients enrolled, 73 completed the study including 35 in the Vicryl Rapide group and 38 in the Prolene group. The mean (±SD) age of patients who completed the study was 22.1 (±15.5) years, and 39 were male. We found no significant differences in the age, race, sex, length of wound, number of sutures, or layers of repair in the two groups. The observer's mean VAS for the Vicryl Rapide group was 54.1 mm (95% confidence interval [CI] = 44.5 to 67.0 mm) and for the Prolene group was 54.5 mm (95% CI = 45.7 to 66.3 mm). The resulting mean difference was 0.5 mm (95% CI = -12.1 to 17.2 mm; p = 0.9); thus noninferiority was established. Statistical testing showed no differences in the rates of complications between the two groups, but a higher percentage of the Vicryl Rapide wounds developed complications. CONCLUSIONS The use of absorbable sutures for the repair of simple lacerations on the trunk and extremities should be considered as an alternative to nonabsorbable suture repair.
Collapse
Affiliation(s)
- Cena Tejani
- The Department of Emergency Medicine; Newark Beth Israel Medical Center; Newark NJ
| | - Adam B. Sivitz
- The Department of Emergency Medicine; Newark Beth Israel Medical Center; Newark NJ
| | - Micheal D. Rosen
- The Department of Emergency Medicine; Newark Beth Israel Medical Center; Newark NJ
| | - Albert K. Nakanishi
- The Department of Emergency Medicine; Cardinal Glennon Children's Medical Center; St. Louis MO
| | - Robert G. Flood
- The Department of Emergency Medicine; Cardinal Glennon Children's Medical Center; St. Louis MO
| | - Mathew A. Clott
- The Department of Surgery; Newark Beth Israel Medical Center; Newark NJ
| | - Paul G. Saccone
- The Department of Surgery; Newark Beth Israel Medical Center; Newark NJ
| | - Raemma P. Luck
- The Department of Emergency Medicine; Cardinal Glennon Children's Medical Center; St. Louis MO
| |
Collapse
|
10
|
Abstract
Traumatic wounds are a common reason for patients to attend emergency departments. There are many ways of managing these wounds from glue to suturing. The authors conducted a patient survey to identify the outcome measures most important to patients after closure of traumatic wounds. The results showed that having the least chance of infection was the most important outcome, followed by being looked after by caring staff and a quick recovery. These finding were consistent regardless of the anatomical location of the wound or age of the patient. This information is being used to guide the authors in the most appropriate outcome measures for further research.
Collapse
Affiliation(s)
- Helen Keeton
- Department of Emergency, University Hospital Southampton, Southampton, UK
| | - Robert Crouch
- Department of Emergency, University Hospital Southampton, Southampton, UK
| | - Kate Lowe
- Department of Emergency, University Hospital Southampton, Southampton, UK
| |
Collapse
|
11
|
Abstract
This article presents an overview of facial wound management, beginning with a brief review of basic anatomy of the head and face as it relates to wound care. Basic wound management is discussed, and techniques for repairing specific cosmetically high-risk areas of the face, particularly the eyes, lips, and ears, are reviewed. Also described are the proper techniques for the management of an auricular hematoma.
Collapse
Affiliation(s)
- Frank Sabatino
- Department of Emergency Medicine, North Shore University Hospital, Hofstra North Shore-LIJ School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA.
| | | |
Collapse
|
12
|
Comparison of cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations. Pediatr Emerg Care 2013; 29:691-5. [PMID: 23714755 DOI: 10.1097/pec.0b013e3182948f26] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to compare cosmetic outcomes, complication rates, and patient/caregiver satisfaction of absorbable versus nonabsorbable sutures in children. METHODS Healthy patients, 1 to 18 years old, with facial lacerations 1 to 5 cm, were randomized to repair with fast-absorbing catgut (FAC) or nylon (NYL) sutures. Patients returned in 4 to 7 days and in 3 to 4 months, at which time photographs and caregiver surveys were completed. Unlike part I, all FAC sutures were permitted to absorb rather than be removed. Using a 100-mm visual analog scale (VAS), a noninferiority (NI) design was applied, with a difference of less than 15 mm considered clinically equivalent. Caregivers and 3 blinded physicians independently rated the scars via photographs. RESULTS Ninety-eight patients were enrolled, 76 caregiver surveys were completed, and 61 (29 FAC, 32 NYL) had photographs scored by physicians. The mean physician VAS scores for FAC and NYL were 57.6 and 67.6, respectively (difference, -10.0; 95% confidence interval, -19.1 to -0.4); thus, NI could not be established. The mean caregiver VAS scores for the FAC and NYL groups were 93.8 and 86.6, respectively (difference, 7.2; 95% confidence interval, -4.9 to 13.9); thus, NI of FAC was established. There were no significant differences in rates of infection, wound dehiscence, or keloid formation. In terms of future preference, caregivers favored FAC (33/33) over NYL (26/36) (P < 0.01). CONCLUSIONS Caregiver VAS scores showed NI of FAC, which were also preferred by the caregivers. However, NI for FAC could not be demonstrated by blinded physicians with respect to cosmetic outcomes.
Collapse
|
13
|
O'Leary DP, Clover A, Galbraith JG, Mushtaq M, Shafiq A, Redmond H. Adhesive strip wound closure after thyroidectomy/parathyroidectomy: A prospective, randomized controlled trial. Surgery 2013; 153:408-12. [DOI: 10.1016/j.surg.2012.08.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 08/30/2012] [Indexed: 11/28/2022]
|
14
|
Manson WC, Ryan JG, Ladner H, Gupta S. Comparison of Metallic Foreign-Body Removal between Dynamic Ultrasound and Static Radiography in a Pigs' Feet Model. West J Emerg Med 2012; 12:467-71. [PMID: 22224139 PMCID: PMC3236155 DOI: 10.5811/westjem.2010.6.1885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Revised: 06/03/2010] [Accepted: 07/06/2010] [Indexed: 11/25/2022] Open
Abstract
Introduction We compared the immediate cosmetic outcome of metallic foreign-body removal by emergency medicine (EM) residents with ultrasound guidance and conventional radiography. Methods This single-blinded, randomized, crossover study evaluated the ability of EM residents to remove metallic pins embedded in pigs' feet. Before the experiment, we embedded 1.5-cm metallic pins into numbered pigs' feet. We randomly assigned 14 EM residents to use either ultrasound or radiography to help remove the foreign body. Residents had minimal ultrasound experience. After a brief lecture, we provided residents with a scalpel, laceration kit, a bedside portable ultrasound machine, nipple markers, paper clips, a dedicated radiograph technician, and radiograph machine 20 feet away. After removal, 3 board-certified emergency physicians, who were blinded to the study group, evaluated the soft-tissue model by using a standardized form. They recorded incision length and cosmetic appearance on the Visual Analog Scale. Results In total, 28 foreign bodies were removed. No significant difference in the time of removal (P = 0.12), cosmetic appearance (P = 0.96), or incision length (P = 0.76) was found. Conclusion This study showed no difference between bedside ultrasound and radiography in assisting EM residents with metallic foreign-body removal from soft tissue. No significant difference was found in removal time or cosmetic outcome when comparing ultrasound with radiography.
Collapse
Affiliation(s)
- William C Manson
- Emory University, Department of Emergency Medicine, Atlanta, Georgia
| | | | | | | |
Collapse
|
15
|
Cadeddu M, Farrokhyar F, Levis C, Cornacchi S, Haines T, Thoma A. Users' Guide to the Surgical Literature. Understanding confidence intervals. Can J Surg 2012; 55:207-11. [PMID: 22630064 DOI: 10.1503/cjs.010211] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
16
|
Affiliation(s)
- Maria E Moreira
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO 80204, USA.
| | | |
Collapse
|
17
|
The Effects of Demineralization Process on Diameter, Tensile Properties and Biodegradation of Chitosan Fiber. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.proche.2012.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
18
|
Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics. J Am Acad Dermatol 2012; 66:13-24; quiz 25-6. [DOI: 10.1016/j.jaad.2011.08.035] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 08/13/2011] [Accepted: 08/17/2011] [Indexed: 02/08/2023]
|
19
|
Regalado S, Funaki B. Novel devices for wound closure in interventional radiology. Semin Intervent Radiol 2008; 25:58-64. [PMID: 21326494 DOI: 10.1055/s-2008-1052307] [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: 10/22/2022]
Abstract
Wound closure issues are not as common in the field of interventional radiology when compared with other surgical fields, such as plastic surgery or dermatology. A common exception to this rule involves the placement and removal of chest wall vascular ports. This article reviews newer wound closure devices such as skin adhesives and closure film.
Collapse
Affiliation(s)
- Sidney Regalado
- Section of Vascular and Interventional Radiology, University of Chicago Medical Center, Chicago, Illinois
| | | |
Collapse
|
20
|
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.
Collapse
|
21
|
Abstract
There are many techniques available for the closure of traumatic wounds in emergency departments. Each method has its own unique benefits and limitations that must be considered in each case individually. The best technique provides durability, simplicity, excellent cosmetic outcome, and overall patient satisfaction. Unfortunately, at this time no single method is superior for all situations. Emergency physicians must be familiar with multiple techniques to provide the best outcomes for their patients.
Collapse
Affiliation(s)
- Jeremy D Lloyd
- Department of Emergency Medicine, Wilford Hall Medical Center, 959 MSGS/MCED, 2200 Bergquist Drive, Suite 1, Lackland Air Force Base, TX 78236, USA.
| | | | | |
Collapse
|
22
|
Al-Abdullah T, Plint AC, Fergusson D. Absorbable versus nonabsorbable sutures in the management of traumatic lacerations and surgical wounds: a meta-analysis. Pediatr Emerg Care 2007; 23:339-44. [PMID: 17505281 DOI: 10.1097/01.pec.0000270167.70615.5a] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To complete a systematic review of randomized controlled trials (RCTs) that compare the cosmetic outcomes and complications of traumatic lacerations and surgical incisions closed with absorbable sutures versus nonabsorbable sutures. DESIGN/METHODS We searched MEDLINE, EMBASE, and Cochrane Central to identify all RCTs comparing absorbable versus nonabsorbable sutures that assessed cosmetic outcomes or complications. Reference lists of all identified trials were also searched. Two independent reviewers screened abstracts for eligibility, extracted study data, and assessed trial quality. Disagreements were resolved by consensus or a third party. RESULTS Three hundred thirty-eight citations were retrieved, of which 7 met inclusion criteria. Studies were heterogeneous with respect to specific interventions and outcome measures; sample sizes ranged from 44 to 166. There was no statistically significant difference between absorbable and nonabsorbable sutures in short- or long-term cosmetic score, scar hypertrophy, infection rate, wound dehiscence, and wound redness/swelling. CONCLUSIONS Our meta-analysis suggests a lack of large, methodologically sound RCTs evaluating the effectiveness of absorbable versus nonabsorbable sutures. Although our analysis demonstrates that nonabsorbable sutures seem to be no better than absorbable sutures in the management of wound repair, a large methodologically sound RCT is needed to adequately answer this question.
Collapse
Affiliation(s)
- Tawfik Al-Abdullah
- Emergency Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | | |
Collapse
|
23
|
DeBoard RH, Rondeau DF, Kang CS, Sabbaj A, McManus JG. Principles of Basic Wound Evaluation and Management in the Emergency Department. Emerg Med Clin North Am 2007; 25:23-39. [PMID: 17400071 DOI: 10.1016/j.emc.2006.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The primary objectives of basic wound management center around promoting optimal wound healing and cosmesis. These objectives may be achieved through the systematic assessment, preparation, and repair of the laceration supplemented with appropriate patient care instructions. The meticulous and methodical management of traumatic wounds described in this article will assist the emergency physician in decreasing overall complication rates and help improve patient satisfaction.
Collapse
Affiliation(s)
- Ryan H DeBoard
- Department of Emergency Medicine, Madigan Army Medical Center, Bldg. 9040, Fitzsimmons Drive, Tacoma, WA 98431, USA
| | | | | | | | | |
Collapse
|
24
|
Abstract
Optimal management of full-thickness wounds requires a thorough knowledge of wound-healing principles and practices. In the absence of underlying disease, almost every full-thickness wound will heal with minimal intervention; however, the process can be enhanced by judicious wound management. The first clinical decision to be made is whether to repair the wound or to allow it to heal by second intention. This decision is guided by a host of objective and subjective factors. Reconstruction options include primary closure, flaps, and grafts. Materials to aid reconstruction, including the introduction of tissue adhesives, continue to evolve. Both primary and secondary intention wounds are aided by occlusive dressings and adjutants. A plethora of wound-healing adjuncts have been developed to aid wound healing in diseased states, and a working knowledge of their use is beneficial in managing all full-thickness wounds.
Collapse
Affiliation(s)
- Albert E Rivera
- Department of Dermatology, Mt Sinai School of Medicine, New York, NY, USA
| | | |
Collapse
|
25
|
Kuo F, Lee D, Rogers GS. Prospective, randomized, blinded study of a new wound closure film versus cutaneous suture for surgical wound closure. Dermatol Surg 2006; 32:676-81. [PMID: 16706763 DOI: 10.1111/j.1524-4725.2006.32140.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Wound closure devices include sutures, tissue adhesives, adhesive strips, and staples. Recent studies suggest no differences between various tissue adhesives and sutures for dehiscence, infection, and satisfaction when assessed by patients or surgeons. To date, no studies have investigated ClozeX, a novel adhesive strip, for closure of surgical incisions. OBJECTIVE To compare surgical wounds repaired with ClozeX versus suture. METHODS A prospective, randomized study was conducted, in which 15 patients with surgical incisions were allocated to closure with ClozeX on half of the wound and monofilament suture on the other half. Physician satisfaction with blinded assessment, patient satisfaction, complication rates, and closure times were recorded. RESULTS Application with ClozeX was faster than with suture (p=.007). There were no complications in either group. Sixty-nine percent of the patients gave ClozeX a higher satisfaction score (p=.02). More physicians were satisfied with the ClozeX half than with the suture half (p=.007). CONCLUSIONS This pilot study demonstrates ClozeX to be a safe and effective closure device. The cosmetic outcome seems to be at least as good as simple running suture. Physicians and patients were generally more satisfied with ClozeX. No difference was found in the rate of dehiscence or infection between the groups.
Collapse
Affiliation(s)
- Felix Kuo
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts 02111, USA
| | | | | |
Collapse
|
26
|
Prospective, Randomized, Blinded Study of a New Wound Closure Film Versus Cutaneous Suture for Surgical Wound Closure. Dermatol Surg 2006. [DOI: 10.1097/00042728-200605000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Abstract
A short cut review was carried out to establish whether absorbable sutures offered any benefits over non-absorbable sutures in the treatment of childhood facial lacerations. A total of 31 papers were found, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of this best paper are tabulated. We conclude that absorbable sutures appear to be as good as, and show a trend towards benefit in the treatment of paediatric lacerations.
Collapse
|