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Mori S, Odaka M, Suyama Y, Tsukamoto Y, Oh M, Shigemori R, Toya N, Ohtsuka T. Reduction in drain-related adverse events using the barbed suture method for chest tube wound closure. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-023-02002-w. [PMID: 38214884 DOI: 10.1007/s11748-023-02002-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/07/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE A chest tube is usually placed in patients undergoing general thoracic surgery. Although the barbed suture method has been introduced for chest tube wound closure, its superiority to the conventional suture methods for drain management remains unclear. The study aimed to determine whether the barbed suture method could reduce drain-related adverse events compared to the conventional method. METHODS We retrospectively reviewed the medical records of patients who underwent general thoracic surgery between January 2021 and December 2022, 1 year before and after the introduction of the barbed suture method at our institution. Patients who underwent the barbed suture or conventional method were included. Univariate and multivariate analyses of drain-related adverse events were performed. RESULTS Of the 250 participants, 110 and 140 underwent the barbed suture method and conventional suture method, respectively. The univariate analysis showed that a higher body mass index, preoperative malignant diagnosis, lobectomy, longer operative time, larger tube size, longer chest drainage duration, surgical complications, and conventional method were risk factors for drain-related adverse events. The multivariate analysis showed that the barbed suture method was a protective factor against drain-related adverse events (odds ratio 0.267; 95% confidence interval 0.103-0.691; P = 0.007). CONCLUSIONS The barbed suture method could reduce drain-related adverse events compared to the conventional method. Therefore, it might be a potential standard method for chest tube wound closure in patients undergoing general thoracic surgery.
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Affiliation(s)
- Shohei Mori
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwashi, Chiba, 277-8567, Japan.
| | - Makoto Odaka
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwashi, Chiba, 277-8567, Japan
| | - Yu Suyama
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwashi, Chiba, 277-8567, Japan
| | - Yo Tsukamoto
- Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minatoku, Tokyo, 105-0003, Japan
| | - Maki Oh
- Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minatoku, Tokyo, 105-0003, Japan
| | - Rintaro Shigemori
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwashi, Chiba, 277-8567, Japan
| | - Naoki Toya
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwashi, Chiba, 277-8567, Japan
| | - Takashi Ohtsuka
- Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minatoku, Tokyo, 105-0003, Japan
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Chou PR, Kao CN, Lo YT, Chuang CY, Liu YW. Ameliorated chest drain wound closure in patients undergoing uniportal thoracoscopic pulmonary resection. Front Surg 2023; 10:1323937. [PMID: 38192490 PMCID: PMC10773875 DOI: 10.3389/fsurg.2023.1323937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/20/2023] [Indexed: 01/10/2024] Open
Abstract
Background Although uniportal video-assisted thoracoscopic surgery (VATS) has been performed for a wide array of thoracic diseases, unsightliness and poor wound healing often occur, particularly when a chest drain is placed postoperatively. Different chest drain wound closure (CWC) methods have been introduced with the benefits of cosmesis and patient satisfaction. We aimed to describe our improved CWC technique in this setting and assess its efficacy. Methods A total of consecutive 334 patients undergoing uniportal VATS pulmonary resection with single chest drain placement were investigated from 2016 to 2021. The techniques for CWC were classified into the conventional method (35 patients, group A), continuous suture with removal-free stitches (122 patients, group B), and continuous suture with removal-free barbed suture plus topical skin adhesives (177 patients, group C). Perioperative data and complications related to CWC were analyzed. Results Group C had a significantly shorter operative time, postoperative hospital stay, and chest tube days than groups A and B (all p < 0.01). In terms of chest tube-related complications, there were no statistically significant differences in post-removal pneumothorax, subcutaneous emphysema, incisional effusion leakage, wound dehiscence, or infection. Overall, significant differences in scar scale scores were observed between the groups, where the ameliorated group C was superior to the conventional group A (p < 0.01). Conclusion The improved CWC technique using continuous sutures with removal-free barbed sutures and topical skin adhesives is simple, safe, and effective. This may be a favorable CWC strategy when performing uniportal VATS, with enhanced patient satisfaction.
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Affiliation(s)
- Ping-Ruey Chou
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chieh-Ni Kao
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ting Lo
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Che-Yu Chuang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Wei Liu
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Xu L, Wang Y, Wang Z, Mai S, Xu L, Xu Z, Yang W. Evaluation of the efficacy of a modified method of treating the incisions of the single-port video-assisted thoracoscopic surgery using V-Loc™ barbed sutures. Int Wound J 2023; 20:3131-3139. [PMID: 37143445 PMCID: PMC10502285 DOI: 10.1111/iwj.14189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
This paper describes a modified method of applying unidirectional barbed sutures to treat the incisions of the single-port video-assisted thoracoscopic surgery (VATS) and discusses its safety and feasibility. This was a retrospective analysis of 108 patients who underwent single-port VATS admitted to the Department of Thoracic Surgery, the China-Japan Union Hospital of Jilin University, from April 2019 to April 2020. The experimental group (65 patients) was given unidirectional barbed sutures (V-Loc™ sutures) to treat the incision, and the control group (43 patients) had a skin stapler to treat the incision. The complications related to the incisions of the two groups were compared. There was no statistically significant difference between the experimental and control groups regarding incisional infection, incisional splitting, fat liquefaction, and incisional resewing. The pleural fluid outflow from the drainage orifice after removal of the chest tube (0 cases in the experimental group and 7 cases in the control group, P = 0.001) was significantly lower in the experimental group than in the control group. The scores of the scars showed that the experimental group was significantly better than the control group. The modified method of treating the incisions of the single-port VATS with V-Loc™ sutures has good efficacy and safety. It reduces the incidence of pleural fluid outflow from the drainage orifice after removal of the chest tube compared with the traditional stapler suture method, and it has superior cosmetic outcomes.
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Affiliation(s)
- Li Xu
- Department of Thoracic SurgeryChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Yue Wang
- Department of Thoracic SurgeryChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Zhen‐xing Wang
- Department of Thoracic SurgeryChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Shi‐xiong Mai
- Department of Thoracic SurgeryChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Lei Xu
- Department of Thoracic SurgeryChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Zhe‐nan Xu
- Department of Thoracic SurgeryChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Wei Yang
- Department of Thoracic SurgeryAffiliated Hospital of Jilin Medical UniversityJilinChina
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Zhao L, Wang L, Wang J, Zhao S, Wang J, Gu C. Feasibility of an improved knotless method of chest drain wound closure:a prospective cohort clinical trial. J Wound Care 2023; 32:cxlvi-cl. [PMID: 37561704 DOI: 10.12968/jowc.2023.32.sup8.cxlvi] [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] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Chest tube management plays a key role in minimising erioperative period. We have improved the knotless method to chest tube wounds. In this article, we demonstrate the clinical bility and safety of this method. METHOD From 13 October 2018-3 January 2019, patients were ecutively included in our study at the First Affiliated Hospital of n Medical University, Dalian, China. They were separated into approximately equally sized groups-the knotless group and the entional group. Our improved knotless method was performed ose the chest tube wounds of patients in the knotless group, and onventional method using the pre-existing U-shaped string to the chest tube wounds of patients in the conventional group. Patient clinical information, tube-related complications, retreatment s and cosmetic scores were compared between the groups. RESULTS The cohort comprised 102 patients; 47 in the knotless group and 55 in the conventional group. There were no statistically significant differences in patient clinical information or tube-related complications between the two groups (p>0.05; both comparisons). In the knotless group, retreatment times were shorter (p<0.001) and cosmetic scores were higher (p<0.001). CONCLUSION This study showed that our new knotless method is safe and has wide clinical feasibility. The new method also improved patient cosmetic scores. Furthermore, it decreased the patients' economic burdens.
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Affiliation(s)
- Lei Zhao
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Longfei Wang
- The Affiliated Hospital of Ningbo University, Ningbo, China
| | - Jin Wang
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shilei Zhao
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jinna Wang
- The Dalian Municipal dship Hospital, Dalian, China
| | - Chundong Gu
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Shi W, Hu Y, Wang C, Chang G, Zheng H, Yang Z, Yang Y, Zhao X, Li X. Experience of a modified chest tube suture-fixation technique in uniportal thoracoscopic pulmonary resection. BMC Surg 2023; 23:73. [PMID: 36991429 DOI: 10.1186/s12893-023-01952-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/28/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE This study aimed to explore the feasibility and advantages of a modified chest tube suture-fixation technique in uniportal video-assisted thoracic surgery for pulmonary resection. METHODS A retrospective analysis was conducted on 116 patients who underwent uniportal video-assisted thoracic surgery (U-VATS) for lung diseases in Zhengzhou People's Hospital between October 2019 and October 2021. Patients were stratified into two groups based on the applied suture-fixation methods, i.e., 72 patients in the active group and 44 patients in the control group. The two groups were subsequently compared in the terms of gender, age, operation method, indwelling time of chest tube, postoperative pain score, chest tube removal time, wound healing grade, length of hospital stay, incision healing grade, and patient satisfaction. RESULTS There was no significant difference between the two groups in terms of gender, age, operation method, indwelling time of chest tube, postoperative pain score, and length of hospital stay (P = 0.167, 0.185, 0.085, 0.051, 0.927, and 0.362, respectively). However, the chest tube removal time, incision healing grade, and incision scar satisfaction in the active group were significantly better compared with those of the control group (P = < 0.001, 0.033, and < 0.001, respectively). CONCLUSION In summary, the new suture-fixation approach can minimize the number of stitches, and time necessary for chest tube removal process, and avoid the pain experienced when removing the drainage tube. This method is more feasible, has better incision conditions, and provides a convenient tube removal, making it more suitable to patients.
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Affiliation(s)
- Wensong Shi
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, The fifth Clinical Medical College of Henan of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450052, China
| | - Yuzhui Hu
- Department of Geratology, Ninth People's Hospital of Zhengzhou, Zhengzhou, 450053, China
| | - Cuimei Wang
- Department of Plastic Surgery, The fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450052, China
| | - Guotao Chang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, The fifth Clinical Medical College of Henan of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450052, China
| | - Huiyu Zheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, The fifth Clinical Medical College of Henan of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450052, China
| | - Zhiqiang Yang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, The fifth Clinical Medical College of Henan of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450052, China
| | - Yulun Yang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, The fifth Clinical Medical College of Henan of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450052, China
| | - Xiaogang Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, 200433, China
| | - Xiangnan Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, The fifth Clinical Medical College of Henan of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450052, China.
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Imamura Y, Watanabe H, Hiramatsu Y, Okasaka T. Knotless suture and hydrocolloid method improves chest drain wound complication. Asian Cardiovasc Thorac Ann 2022; 30:807-812. [DOI: 10.1177/02184923221106770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Ligation is a widely used wound closure method after chest drain removal in thoracic surgery. Knotless suture, which does not require ligation or suture removal, has been developed and is currently used in our institution. This study compared the efficacy of the drain wound closure method between knotless suture and our previous mattress suture. Methods We examined the clinical performance of knotless suture for chest drain wound closure in 117 patients who underwent surgery following this method in our department from October 2020 to April 2021. We compared outcomes with those of mattress suture using 2-0 nylon in 115 patients who underwent thoracic surgery at our institution between October 2018 and April 2019. Hydrocolloid dressing is applied to the drain wound after chest drain removal in a knotless suture. We conducted an analysis of both groups based on the condition of wound closure and drain wound complication. Results Appropriate wound closure was obtained and no patient required a prolonged hospital stay because of incomplete wound closure in both methods. The rate of chest drain wound infection for knotless suture (0.0%, 0/117 patient) was significantly lower than that of mattress suture (5.2%, 6/115 patients) at the outpatient follow-up ( p = 0.01). The rate of delayed drain wound healing was also significantly lower than that of mattress suture (0.9% vs. 7.0%; p = 0.02). Conclusions The results of knotless closure were better than those of conventional mattress suture regarding wound complications. Moreover, knotless suturing requires no suture removal, indicating its usefulness.
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Affiliation(s)
- Yoshito Imamura
- Department of Thoracic Surgery, Toyota Kosei Hospital, Aichi, Japan
| | - Hiroki Watanabe
- Department of Thoracic Surgery, Toyota Kosei Hospital, Aichi, Japan
| | | | - Toshiki Okasaka
- Department of Thoracic Surgery, Toyota Kosei Hospital, Aichi, Japan
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Watanabe SN, Imai K, Kimura T, Saito Y, Takashima S, Matsuzaki I, Kurihara N, Atari M, Matsuo T, Iwai H, Sato Y, Motoyama S, Nomura K, Nishikawa T, Minamiya Y. Effect of lidocaine cream analgesia for chest drain tube removal after video-assisted thoracoscopic surgery for lung cancer: a randomized clinical trial. Reg Anesth Pain Med 2019; 45:rapm-2019-100760. [PMID: 31748424 DOI: 10.1136/rapm-2019-100760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/30/2019] [Accepted: 11/06/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Pain management makes an important contribution to good respiratory care and early recovery after thoracic surgery. Although the development of video-assisted thoracoscopic surgery (VATS) has led to improved patient outcomes, chest tube removal could be distressful experience for many patients. The aim of this trial was to test whether the addition of lidocaine cream would have a significant impact on the pain treatment during chest tube removal from patients who had undergone VATS for lung cancer. METHODS This clinical trial was a double-blind randomized study. Forty patients with histologically confirmed lung cancer amenable to lobectomy/segmentectomy were enrolled. All patients had standard perioperative care. Patients were randomly assigned to receive either epidural anesthesia plus placebo cream (placebo, Group P) or epidural anesthesia plus 7% lidocaine cream cutaneously around the chest tube insertion site and on the skin over the tube's course 20 min (Group L) before chest drain removal. RESULTS Visual analog scale (VAS) scores were higher in Group P (median 5, IQR, 3.25-8) than in Group L (median 2, IQR, 1-3). Pain intensities measured using a PainVision system were also higher in Group P (median 296.7, IQR, 216.9-563.5) than Group L (median 41.2, IQR, 11.8-97.0). VAS scores and the pain intensity associated with chest drain removal were significantly lower in Group L than Group P (p=0.0002 vs p<0.0001). CONCLUSION Analgesia using lidocaine cream is a very simple way to reduce the pain of chest tube removal after VATS. TRIAL REGISTRATION NUMBER UMIN000013824.
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Affiliation(s)
- Shin-Nosuke Watanabe
- Thoracic Surgery, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
| | - Kazuhiro Imai
- Thoracic Surgery, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
| | - Tetsu Kimura
- Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
| | - Yoshitaro Saito
- Thoracic Surgery, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
| | - Shinogu Takashima
- Thoracic Surgery, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
| | - Ikuo Matsuzaki
- Thoracic Surgery, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
| | - Nobuyasu Kurihara
- Thoracic Surgery, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
| | - Maiko Atari
- Thoracic Surgery, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
| | - Tsubasa Matsuo
- Thoracic Surgery, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
| | - Hidenobu Iwai
- Thoracic Surgery, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
| | - Yusuke Sato
- Thoracic Surgery, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
| | - Satoru Motoyama
- Thoracic Surgery, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
| | - Kyoko Nomura
- Public Health, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
| | - Toshiaki Nishikawa
- Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
| | - Yoshihiro Minamiya
- Thoracic Surgery, Akita University Graduate School of Medicine School of Medicine, Akita, Japan
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