Loose knots and surgical site infections in abdominal surgeries (clean-contaminated and contaminated wounds)

Background: Surgical site infections (SSIs) are associated with high healthcare costs and worsen the post-operative course of a considerable proportion of general abdominal surgical patients. SSIs raise the risk of post-operative morbidity and mortality, necessitating hospitalization, intravenous antibiotics, and potentially surgical reintervention. The aim of the study was to compare the outcome of intermittent loose knots and the conventional vertical mattress suturing in patients undergoing abdominal surgeries.Methods: This prospective comparative study was done in patients undergoing emergency abdominal surgeries for any cause. Patients were divided into 2 groups- (a) group 1 (45 patients): intermittent loose knots between conventional vertical mattress sutures; (b) group 2 (45 patients): conventional vertical mattress suturing.Results: In this study, 31% of patients were in the 41-50 years age group, 53.3% of patients were male. Among various abdominal surgery opted, laparotomy was the most commonly performed procedure (47%). In this study, group 1 patients shown a decrease in wound gap, secondary wound closure and delayed wound approximation than group 2 patients.Conclusions: Loose knots in between conventional vertical mattress sutures are better than conventional vertical mattress suturing in terms of wound gap, secondary wound closure and delayed wound approximation.

Complications associated with closure of the linea alba using a combination of interrupted vertical mattress and simple interrupted sutures in equine laparotomies

Objectives(1) Evaluate the occurrence and variables associated with incisional morbidities (IMs) after ventral median laparotomy when using interrupted vertical mattress sutures (IVMS) and (2) determine the occurrence of abdominal bandage-associated complications in horses.MethodsOccurrence of IM and bandage-associated complications were determined after single laparotomies (SL group; n=546 horses) and repeat laparotomies (RL group: multiple laparotomies within four weeks; n=30 horses) in horses that survived ≥7 days postoperatively. Univariate analysis and multivariate logistic regression were performed to evaluate variables associated with IM.ResultsThe IM rate was 9.52 per cent in the SL group and 33.33 per cent in the RL group. The actual infection rate was 5.31 per cent in the SL group and 26.67 per cent in the RL group. Overall, long-term clinically relevant wound complications was 1.68 per cent. After multivariate analysis, increased anaesthesia duration was associated with IM and performing an enterotomy and postoperative intravenous lidocaine administration were associated with incisional infection in the SL group; no parameter remained significant in the RL group. Bandage-related complications were recorded in 2.95 per cent of the cases.ConclusionsThese results suggest that the use of IVMS for closure of the linea alba is another viable option for closure and that an abdominal bandage does not appear to cause significant complications.

Analysis of the effectiveness of wound closure techniques among surgeons and emergency physicians in Mecca Hospitals: Retrospective Cohort Study.

Objective: Wound suturing is a procedure performed at many medical specialties. This study aims to analyze the effectiveness of wound closure techniques by recognizing the common suturing techniques and materials used in different types of wounds among surgeons and emergency physicians in Mecca hospitals and assessing their awareness about the factors contributing to scars formation and improper wound healing.Result: Choosing the simple interrupted technique exceeded 50% among all other types of studied wounds. The other most common techniques among participants were the subcuticular and vertical mattress, respectively, also using stapler was limited to some wound types. This study showed a high level of awareness among participants with significant p-values (P<0.05) of Strongly agree and Agree regarding the essential factors affecting wound healing and scars formation. The result gives an insight into the most common suture techniques and materials used in wound closure. There are wide variations in selecting these techniques and materials among the participants. Also, it showed that there is good awareness among participants about factors that lead to scar formation.

Analysis of the effectiveness of wound closure techniques among surgeons and emergency physicians in Mecca Hospitals: Retrospective Cohort Study

Objective: Wound suturing is a procedure performed at many medical specialties. This study aims to analyze the effectiveness of wound closure techniques by recognizing the common suturing techniques and materials that used in different type of wounds among surgeons and emergency physicians and to assess the rate of scars formation among their patients in-Mecca City Hospitals, Saudi Arabia.Results:Every participant selects and prefers some methods in wound closure over other methods. Choosing the simple interrupted technique exceeded 50% for all types of studied wounds. The other most common techniques among participants were subcuticular and vertical mattress respectively, also using stabler was limited to some wound types with less percentage than other suture techniques. Regarding suturing material, there are many materials alternatives were selected for the studied wounds such as 23% of participants used Monocryl for eyelid wounds, and 6% for breast wounds, also 9% of participants were using Polypropylene for scalp wounds and 8% for eyelids wounds. This study showed a high level of awareness among participants with a significant p-values regarding the important factors affecting wound healing and scare formation.

Sutures versus staplers for skin closure in laparotomy patients: a prospective study

Background: Every surgeon wants cosmetically acceptable scars along with optimal healing. Good tissue union and cosmetically acceptable scars are vital for ideal surgical practice. A basic need for skin closure is a good approximation. Apart from cosmetically good scars, it is also necessary that the skin closure technique should be technically easy, speedy, economical and acceptable.Methods: The study was conducted on 100 patients on whom elective abdominal surgeries were performed. Patients were divided into two groups with 50 patients in each group after matching the parameters like age, co morbid conditions, using simple random sampling technique. All operations were performed by one consultant. In group A, Skin was approximated with vertical mattress sutures while in group B, staplers were used to close the wound.Results: The age of the patients varied from 16 to 85 years. The average time taken for skin closure for suture group (A) was found to be 300sec (±20.78) and for stapler group was found to be 120sec (±16.50) respectively. Wound infection was found in 10 patients (20%). In stapler group 4 (8%) and in suture group 6 Patients (12%) had post-operative wound infection.Conclusions: Cosmesis is essential and necessary in modern surgical practice. It also reflects surgical expertise.

Differences in effectiveness of membrane fixation using periosteal vertical mattress and simple sling suture techniques in infrabony pocket treatment

Guide tissue regeneration (GTR) is the treatment of infrabony pockets for soft and hard tissue regeneration. Membrane is used as a barrier and prevents apical migration of the cells in epithelial tissues. Membrane fixation is one of the procedures in GTR treatment because resorbed membrane is less stable. Simple sling suture technique for membrane fixation has 1 anchorage, located in coronal flap, while periosteal vertical mattress suture technique has 2 anchorages in periosteum, making it more stable. This study aimed to study the differences in the effectiveness of membrane fixation using periosteal vertical mattress suture and simple sling suture techniques in terms of probing depth, relative attachment loss, and alveolar bone height in the treatment of infrabony pockets. The samples were divided into 2 groups. The first group was open flap debridement (OFD) with demineralized freeze dried bone allograft (DFDBA) application and membrane fixation with simple sling suture, while the second group was OFD with DFDBA application and membrane fixation with periosteal vertical mattress suture, observed on day 0, 30th day, and 90th day. The results of the study showed significant differences in the probing depth and relative attachment loss (except from the 30th day to the 90th day), and there were no significant differences in the alveolar bone height from the baseline to the 90th day, between the group of membrane fixation using simple sling suture and that of periosteal vertical mattress suture techniques on flap surgery. This study concluded that membrane fixation in the treatment of infrabony pocket with periosteal vertical mattress suture technique is more effective in reducing the probing depth and relative attachment loss, but there is no difference in increasing the alveolar bone height when compared to simple sling suture technique.

Biomechanical Comparison of Three Novel Repair Techniques for Radial Tears of the Medial Meniscus

Objectives: Historically, radial meniscal tears were treated with partial or near- total meniscectomy which usually resulted in with poor outcomes. Radial meniscal tears function similar to a total meniscectomy and are challenging to treat. Repair of radial meniscal tears should be performed to prevent joint deterioration and the need for salvage procedures in the future. The purpose of this study was to compare three novel repair techniques for radial tears of the medial meniscus; the two-tunnel, the hybrid, and the hybrid tunnel techniques. We hypothesized that there would be no difference between the three groups in regards to gapping and ultimate failure strength. Methods: Thirty human male cadaver knees (ten matched pairs (n=20) and ten unpaired (n=10)) were used to compare the two-tunnel, hybrid, and hybrid tunnel repairs. A complete radial tear was made at the midbody of the medial meniscus. Repairs were performed according to the described techniques. Specimens were potted and mounted on a universal Instron testing machine where each specimen was cyclically loaded for 1000 cycles before experiencing a pull-to-failure. Gap distances at the tear site, ultimate failure load, and failure location were measured and recorded. Results: After 1000 cycles of cyclic loading, there was no significant difference in displacement between the two-tunnel repair (3.0 mm ± 1.7 mm), hybrid repair (3.0 mm ± 0.9 mm) or hybrid tunnel repair (2.3 mm ± 1.0 mm) (p=0.4042). On pull-to-failure testing there was also no significant difference in ultimate failure strength when comparing the two-tunnel (259 N ± 103 N), hybrid (349 N ± 149 N), or hybrid tunnel (365 N ± 146 N) repairs (p=0.26). However, the addition of vertical mattress sutures to act as a “rip stop” did significantly reduce the likelihood of the sutures pulling through the meniscus during pull-to-failure testing for the hybrid and hybrid tunnel repairs (4/16=25%) when compared to the two-tunnel repair (7/9=78%) (p=0.017). Conclusion: This study biomechanically evaluated two previously described techniques- the two-tunnel and hybrid repair- as well as one novel repair technique- the hybrid tunnel repair. The results showed equivalent biomechanical testing in regard to gap distance and pull to failure strength among each repair. The addition of the vertical mattress sutures to act as a rip stop suture was effective in preventing meniscal cut out through the meniscus. [Table: see text][Table: see text]

Biomechanical Comparison of Vertical Mattress and Cross-stitch Suture Techniques and Single- and Double-Row Configurations for the Treatment of Bucket-Handle Medial Meniscal Tears

Background: Given the variety of suturing techniques for bucket-handle meniscal repair, it is important to assess which suturing technique best restores native biomechanics. Purpose/Hypothesis: To biomechanically compare vertical mattress and cross-stitch suture techniques, in single- and double-row configurations, in their ability to restore native knee kinematics in a bucket-handle medial meniscal tear model. The hypothesis was that there would be no difference between the vertical mattress and cross-stitch double-row suture techniques but that the double-row technique would provide significantly improved biomechanical parameters versus the single-row technique. Study Design: Controlled laboratory study. Methods: Ten matched pairs of human cadaver knees were randomly assigned to the vertical mattress (n = 10) or cross-stitch (n = 10) repair group. Each knee underwent 4 consecutive testing conditions: (1) intact, (2) displaced bucket-handle tear, (3) single-row suture configuration on the femoral meniscus surface, and (4) double-row suture configuration (repair of femoral and tibial meniscus surfaces). Knees were loaded with a 1000-N axial compressive force at 0°, 30°, 60°, 90°, and 120° of flexion for each condition. Resultant medial compartment contact area, average contact pressure, and peak contact pressure data were recorded. Results: Intact state contact area was not restored at 0° ( P = .027) for the vertical double-row configuration and at 0° ( P = .032), 60° ( P < .001), and 90° ( P = .007) of flexion for the cross-stitch double-row configuration. No significant differences were found in the average contact pressure and peak contact pressure between the intact state and the vertical mattress and cross-stitch repairs with single- and double-row configurations at any flexion angles. When the vertical and cross-stich repairs were compared across all flexion angles, no significant differences were observed in single-row configurations, but in double-row configurations, cross-stitch repair resulted in a significantly decreased contact area, average contact pressure, and peak contact pressure (all P < .001). Conclusion: Single- and double-row configurations of the vertical mattress and cross-stitch inside-out meniscal repair techniques restored native tibiofemoral pressure after a medial meniscal bucket-handle tear at all assessed knee flexion angles. Despite decreased contact area with a double-row configuration, mainly related to the cross-stitch repair, in comparison with the intact state, the cross-stitch double-row repair led to decreased pressure as compared with the vertical double-row repair. These findings are applicable only at the time of the surgery, as the biological effects of healing were not considered. Clinical Relevance: Medial meniscal bucket-handle tears may be repaired with the single- or double-row configuration of vertical mattress or cross-stitch sutures.

Biomechanical Comparison of 3 Novel Repair Techniques for Radial Tears of the Medial Meniscus: The 2-Tunnel Transtibial Technique, a “Hybrid” Horizontal and Vertical Mattress Suture Configuration, and a Combined “Hybrid Tunnel” Technique

Background: Historically, radial meniscal tears were treated with partial or near-total meniscectomy, which usually resulted in poor outcomes. Radial meniscal tears function similar to a total meniscectomy and are challenging to treat. Repair of radial meniscal tears should be performed to prevent joint deterioration and the need for salvage procedures in the future. Purpose/Hypothesis: The purpose was to compare 3 repair techniques for radial tears of the medial meniscus: the 2-tunnel, hybrid, and hybrid tunnel techniques. It was hypothesized that there would be no differences among the 3 groups in regard to gapping and ultimate failure strength. Study Design: Controlled laboratory study. Methods: Thirty human male cadaver knees (10 matched pairs, n = 20; 10 unpaired, n = 10) were used to compare the 2-tunnel, hybrid, and hybrid tunnel repairs. A complete radial tear was made at the midbody of the medial meniscus. Repairs were performed according to the described techniques. Specimens were potted and mounted on a universal material testing machine where each specimen was cyclically loaded for 1000 cycles before experiencing a pull to failure. Gap distances at the tear site, ultimate failure load, and failure location were measured and recorded. Results: After 1000 cycles of cyclic loading, there were no significant differences in displacement among the 2-tunnel repair (3.0 ± 1.7 mm), hybrid repair (3.0 ± 0.9 mm), and hybrid tunnel repair (2.3 ± 1.0 mm; P = .4042). On pull-to-failure testing, there were also no significant differences in ultimate failure strength among the 2-tunnel repair (259 ± 103 N), hybrid repair (349 ± 149 N), and hybrid tunnel repair (365 ± 146 N; P = .26). However, the addition of vertical mattress sutures to act as a “rip stop” significantly reduced the likelihood of the sutures pulling through the meniscus during pull-to-failure testing for the hybrid and hybrid tunnel repairs (4 of 16, 25%) as compared with the 2-tunnel repair (7 of 9, 78%; P = .017). Conclusion: The results showed equivalent biomechanical testing with regard to gap distance and pull-to-failure strength among the 3 repairs. The addition of the vertical mattress sutures to act as a rip stop was effective in preventing meniscal cutout through the meniscus. Clinical Relevance: Effective healing of radial meniscal tears after repair is paramount to prevent joint deterioration and symptom development. Each tested repair showed a biomechanically equivalent and stable construct to use to repair radial meniscal tears. The authors recommend that rip stop vertical mattress sutures be used, especially in poor-quality meniscal tissue, to prevent suture cutout.