scholarly journals Comparison of Topical Skin Adhesive and Simple Interrupted Nylon Sutures for Wound Closure in Forefoot Surgery: A Prospective Randomised Trial

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0039
Author(s):  
Robbie Ray ◽  
Thomas A. Goff ◽  
Paul M. Dearden ◽  
Peter W. Robinson ◽  
Peter Lam ◽  
...  
Keyword(s):  
Wound Healing ◽  
Wound Closure ◽  
Wound Care ◽  
Randomised Trial ◽  
Data Set ◽  
Prospective Randomised Trial ◽  
Forefoot Surgery ◽  
High Satisfaction ◽  
Patient Reported

Category: Bunion Introduction/Purpose: There are many options for wound closure in forefoot surgery. The purpose of this study was to compare topical skin adhesive (2-Octyl-cyanoacrylate) to standard simple interrupted nylon sutures with attention to the quality of wound healing and the acceptability to the patient. Methods: Patients undergoing elective 1st ray forefoot surgery utilising a medial incision, either Hallux Valgus correction or 1st Metotarsophalangeal joint arthrodesis, were recruited to this study. Patients were randomly allocated during surgery to final layer wound closure with either the intervention topical skin adhesive (TSA) or the control interrupted nylon sutures (INS). Practicality was assessed by time taken for wound closure and subsequent time to perform wound care at 2 weeks postoperatively, wound care pain (VAS) and quality of wound healing was assessed at this point with a dedicated scoring tool, patient satisfaction and acceptability was assessed at 6 weeks postoperative. Results: 70 patients (18 bilateral) were recruited, resulting 42 feet in each study group (after 4 exclusions for incomplete data set). Mean age 61 (29-83). There were no statistical differences in the demographics or surgery performed between groups. Wound closure time was significantly slower for TSA (272 secs (SD 72.2) vs 229 secs (SD 58.8), p=0.0038). At 2 weeks postoperative wound care time was significantly faster for TSA (71 secs (SD 50.8) vs 120 Secs (SD 47.8), p<0.0001), and patient reported pain was significantly less with TSA (VAS 0 vs 2, p=0.025). Significantly more inflammation and wound edge separation was recorded with TSA (17 vs 5 cases, p=0.006) and (12 vs 3 cases, p=0.02) respectively. High satisfaction was reported in both groups with no signifcant difference. Conclusion: Topical skin adhesive and interrupted nylon sutures are both acceptable closure methods for forefoot surgery with high satisfaction rates, low pain scores and low complications. However, the observation of significantly more inflammation and areas of wound separation at the early post-operative period with topical skin adhesive is sufficient to recommend routine use of sutures.

Wound Healing after Open Appendectomies in Adult Patients: A Prospective, Randomised Trial Comparing Two Methods of Wound Closure

2012 ◽  
Vol 36 (10) ◽  
pp. 2305-2310 ◽  
Author(s):  
S. Kotaluoto ◽  
S.-L. Pauniaho ◽  
M. Helminen ◽  
H. Kuokkanen ◽  
T. Rantanen
Keyword(s):  
Wound Healing ◽  
Wound Closure ◽  
Randomised Trial ◽  
Adult Patients ◽  
Prospective Randomised Trial

A prospective randomised trial of absorbable versus non-absorbable sutures for wound closure after fasciectomy for Dupuytren’s contracture

2009 ◽  
Vol 34 (5) ◽  
pp. 618-620 ◽  
Author(s):  
K. HOWARD ◽  
A. J. M. SIMISON ◽  
A. MORRIS ◽  
V. BHALAIK
Keyword(s):  
Wound Closure ◽  
Wound Care ◽  
Randomised Trial ◽  
Dupuytren’S Contracture ◽  
Polyglactin 910 ◽  
Randomised Study ◽  
Dupuytren's Contracture ◽  
Prospective Randomised Trial ◽  
Absorbable Sutures ◽  
Significant Difference

After fasciectomy for Dupuytren’s contracture the wound has traditionally been closed with non-absorbable sutures. A prospective randomised study of 59 patients was undertaken to compare wound closure after fasciectomy with irradiated polyglactin 910 absorbable sutures and non-absorbable sutures. The outcomes studied were: time spent attending to the wound at the first postoperative visit; the patient’s pain score at that visit; and any complications. Wound care required significantly more time when non-absorbable sutures were used. There was no significant difference in pain scores or in complications between the two groups. We recommend the use of irradiated polyglactin 910 absorbable sutures for wound closure after fasciectomy as it saves time and resources without compromising wound healing.

Randomized Controlled Trial of Topical Skin Adhesive vs Nylon Sutures for Incision Closure in Forefoot Surgery

2021 ◽  
pp. 107110072110025
Author(s):  
Thomas L. Lewis ◽  
Thomas A. J. Goff ◽  
Robbie Ray ◽  
C. Ruth Varrall ◽  
Peter W. Robinson ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Patient Satisfaction ◽  
Wound Closure ◽  
Wound Care ◽  
Controlled Trial ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Forefoot Surgery ◽  
Significant Difference ◽  
Patient Reported

Background: There are many options for incision closure in forefoot surgery. The aim of this study was to compare topical skin adhesive (2-octyl-cyanoacrylate) to simple interrupted nylon sutures. Methods: A prospective randomized controlled trial comparing topical skin adhesive (TSA) and nylon sutures (NSs) for elective open forefoot surgery. Primary outcome was Hollander Wound Evaluation Scale (HWES) assessed 2 weeks following surgery. Secondary objectives included time taken for wound closure, wound assessment, patient satisfaction with wound cosmesis, incision pain, and infection rate. Results: Between January and December 2018, 84 feet (70 patients) underwent hallux valgus scarf/Akin osteotomy or first metatarsophalangeal arthrodesis and were randomized to receive either intervention (topical skin adhesive) or control (3/0 nylon sutures). We found worse HWES scores when using TSA compared to NSs (1.07 vs 0.60). Incision closure time was slower for TSA (mean, 272 vs 229 seconds). At 2 weeks postoperatively, wound care was faster for TSA (mean 71 secs) vs NSs (mean 120), and patient-reported pain was less with TSA (visual analog scale: TSA 1.2 vs NSs 2.1). A high degree of overall patient satisfaction was reported in both groups, without significant difference. Conclusion: Closure of elective forefoot surgery incisions with topical skin adhesive or interrupted nylon sutures offers high satisfaction rates, low pain scores, and low complications. However, topical skin adhesive was associated with more inflammation and areas of wound separation compared to nylon sutures. We recommend the use of sutures for wound closure in forefoot surgery. Level of Evidence: Level I, randomized controlled trial.

Management of Acute Wounds

2019 ◽  
Author(s):  
Lee D. Faucher ◽  
Angela L. Gibson
Keyword(s):  
Wound Healing ◽  
Wound Repair ◽  
Wound Closure ◽  
Wound Care ◽  
Connective Tissue Diseases ◽  
Skin Grafting ◽  
Adjunctive Treatment ◽  
Local Trauma ◽  
Life Threatening ◽  
Acute Wound

Acute wounds are the result of local trauma and may be associated with severe life-threatening injuries. All patients with acute wounds should be assessed for comorbidities such as malnutrition, diabetes, peripheral vascular disease, neuropathy, obesity, immune deficiency, autoimmune disorders, connective tissue diseases, coagulopathy, hepatic dysfunction, malignancy, smoking practices, medication use that could interfere with healing, and allergies. The authors address the key considerations in management of the acute wound, including anesthesia, location of wound repair (e.g. operating room or emergency department), hemostasis, irrigation, débridement, closure materials, timing and methods of closure, adjunctive treatment (e.g. tetanus and rabies prophylaxis, antibiotics, and nutritional supplementation), appropriate closure methods for specific wound types, dressings, postoperative wound care, and potential disturbances of wound healing.  This review contains 11 figures, 31 tables, and 92 references. Keywords: wound, wound infection, burns, suture, staple, wound closure, wound healing, dehiscence, skin grafting

scholarly journals DOP24 Patient-reported health-related quality-of-life outcomes with vedolizumab vs. adalimumab treatment of ulcerative colitis: Results of the VARSITY trial

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S063-S063
Author(s):  
E V Loftus ◽  
S W Schreiber ◽  
S Danese ◽  
L Peyrin-Biroulet ◽  
J F Colombel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ulcerative Colitis ◽  
Randomised Trial ◽  
Double Blind ◽  
Specific Domain ◽  
Faecal Calprotectin ◽  
Meaningful Improvement ◽  
Treatment Difference ◽  
Patient Reported

Abstract Background Patients with ulcerative colitis (UC) experience substantial impairment in quality of life (QOL). Patient QOL endpoints are important measures of treatment outcome. We evaluated the effects of intravenous vedolizumab vs. adalimumab on QOL in VARSITY, the first head-to-head trial comparing the efficacy and safety of biologics in patients with moderately to severely active UC. Methods VARSITY was a phase 3b, double-blind, double-dummy, randomised trial (NCT02497469; EudraCT 2015-000939-33). QOL was assessed using the inflammatory bowel disease questionnaire (IBDQ) at baseline, Week (Week) 30, and Week 52. Endpoints included clinically meaningful IBDQ improvement (defined as an increase in total score of ≥16 points from baseline to Week 52), IBDQ remission (defined as a total score of &gt;170 points at Week 52) and change from baseline in IBDQ-specific domain scores (bowel symptoms, systemic symptoms, emotional function, and social function) at Week 30 and Week 52. Serum C-reactive protein (CRP) and faecal calprotectin (FCP) were also assessed as indicators of disease activity. Results Among randomised patients, 383 (vedolizumab) and 386 (adalimumab) patients received ≥1 dose of study drug (N=769). At Week 52, clinically meaningful IBDQ improvement was observed in 52.0% (vedolizumab) vs. 42.2% (adalimumab) of patients (treatment difference 9.7%; 95% confidence interval [CI], 2.7% to 16.7%), while IBDQ remission was achieved by 50.1% (vedolizumab) vs. 40.4% (adalimumab) of patients (treatment difference 9.6%; 95% CI, 2.8% to 16.5%). Mean (standard deviation [SD]) changes in IBDQ total score from baseline for observed cases favoured vedolizumab over adalimumab (Week 30: 61.3 [39.8] vs. 52.6 [42.8]; Week 52: 66.1 [41.8] vs. 60.4 [42.2]; Figure 1). IBDQ subscores showed similar favourable trends for vedolizumab (Figure 2). At Week 52, mean (SD) changes from baseline in CRP for patients treated with vedolizumab vs. adalimumab were –50.9 (174.8) nmol/l vs. –37.2 (169.2) nmol/l and for FCP were –2187.3 (7440.4) µg/g vs. –1846.6 (4560.6) µg/g (Figure 3). Among patients with FCP &gt;250 µg/g at baseline, the proportion of patients achieving FCP ≤250 µg/g was 33.9% vs. 24.5% at Week 30 and 35.2% vs. 28.9% at Week 52 for patients treated with vedolizumab vs. adalimumab, respectively. Conclusion Based on IBDQ total score and subscores, more patients with UC treated with vedolizumab than with adalimumab achieved clinically meaningful improvement and clinical remission. Reduced inflammation, as indicated by improvements in CRP and FCP, was consistent with improvements in QOL.

scholarly journals Ca-Zn-Ag Alginate Aerogels for Wound Healing Applications: Swelling Behavior in Simulated Human Body Fluids and Effect on Macrophages

Polymers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 2741
Author(s):  
Claudia Keil ◽  
Christopher Hübner ◽  
Constanze Richter ◽  
Sandy Lier ◽  
Lars Barthel ◽  
...  
Keyword(s):  
Wound Healing ◽  
Wound Care ◽  
Developed Countries ◽  
Swelling Behavior ◽  
Wound Dressings ◽  
Regulatory Function ◽  
Wound Fluid ◽  
Healing Wounds ◽  
Injury Models

Chronic non-healing wounds represent a substantial economic burden to healthcare systems and cause a considerable reduction in quality of life for those affected. Approximately 0.5–2% of the population in developed countries are projected to experience a chronic wound in their lifetime, necessitating further developments in the area of wound care materials. The use of aerogels for wound healing applications has increased due to their high exudate absorbency and ability to incorporate therapeutic substances, amongst them trace metals, to promote wound-healing. This study evaluates the swelling behavior of Ca-Zn-Ag-loaded alginate aerogels and their metal release upon incubation in human sweat or wound fluid substitutes. All aerogels show excellent liquid uptake from any of the formulas and high liquid holding capacities. Calcium is only marginally released into the swelling solvents, thus remaining as alginate bridging component aiding the absorption and fast transfer of liquids into the aerogel network. The zinc transfer quota is similar to those observed for common wound dressings in human and animal injury models. With respect to the immune regulatory function of zinc, cell culture studies show a high availability and anti-inflammatory activity of aerogel released Zn-species in RAW 264.7 macrophages. For silver, the balance between antibacterial effectiveness versus cytotoxicity remains a significant challenge for which the alginate aerogels need to be improved in the future. An increased knowledge of the transformations that alginate aerogels undergo in the course of the fabrication as well as during wound fluid exposure is necessary when aiming to create advanced, tissue-compatible aerogel products.

A Randomised Controlled Trial of the Effect of Esmarch Tourniquet Use on Blood Loss, Bruising and Quality of Life in Elective Varicose Vein Surgery

2002 ◽  
Vol 17 (1) ◽  
pp. 10-12
Author(s):  
A. Fowler ◽  
M. Stechman ◽  
D. Mitchell
Keyword(s):  
Quality Of Life ◽  
Blood Loss ◽  
Varicose Vein ◽  
Controlled Trial ◽  
Randomised Trial ◽  
Varicose Vein Surgery ◽  
Clinical Value ◽  
Prospective Randomised Trial ◽  
Randomised Controlled

Objective: To assess the effect of tourniquet use on bleeding, bruising and quality of life in varicose vein surgery. Method: A prospective randomised trial of 49 patients undergoing varicose vein surgery was carried out. All patients were having single leg surgery as a day case. Blood loss was assessed by weighing swabs. Bruising was measured at 10 days, and quality of life assessed with SF36 questionaires. Synthesis: In the tourniquet group blood loss was significantly reduced but not the area of bruising. The SF36 scores showed deterioration in the non-tourniquet group at 10 days but this was not present at 6 weeks. We saw no complications of tourniquet use but the study was limited by disappointing recruitment reducing the power. Conclusion: Tourniquet use may be of clinical value. A larger study is required to assess the significance.

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