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Comparison of Absorbable and Nonabsorbable Sutures for Intradermal Skin Closure in Dogs

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The choice of suture material for skin closure can affect the final cosmetic outcome, the risk of wound infection and other complications in companion animals. We assessed two commercially available suture materials, namely, Monocryl and Securex, for use in suturing the skin of dogs, using cosmetic, clinical, ultrasonographic and histological evaluations. The results indicated only minimal differences between the two products, although better scores were achieved using Monocryl. Both were found to be sufficient for use in intradermal suturing in dogs. The earlier removal of Securex compared to Monocryl did not have any additional beneficial effect on wound healing and scar appearance in dogs.

Abstract

The study aimed to compare incisional wound healing with intradermal suture patterns performed with (a) absorbable suture with burying of the knots and (b) nonabsorbable suture anchored with clips. Ten dogs were included in the study. Surgically created skin incisions were apposed with continuous intradermal suture pattern with 4/0 poliglecaprone 25 with burying of the knots and continuous intradermal pattern with 4/0 polypropylene with clips. Cosmetic, clinical, ultrasonographic and histological scores were evaluated. The intradermal pattern with clips was easier to perform and required significantly less time to complete than the intradermal suture with burying of the knots. Cosmetic, clinical, ultrasonographic and histological evaluation scores did not differ significantly between the techniques. Irrespective of the technique used, the cosmetic, ultrasonographic, clinical and histological appearances of the incisions improved over time. In conclusion, polypropylene was found to be a safe and effective suture material for use with intradermal suture pattern with clips in dogs and to have an easy and quick application. However, in our sample, its earlier removal from wounds than poliglecaprone 25 was not found to be associated with a supposedly beneficial effect on wound healing and scar appearance. Both suture materials can be useful in intradermal suture techniques in dogs.

SUBMITTER: Balomenos D

PROVIDER: S-EPMC9960444 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Project description:ObjectiveTo compare the clinical outcomes of staples versus sutures in wound closure after orthopaedic surgery.DesignMeta-analysis.Data sourcesMedline, CINAHL, AMED, Embase, Scopus, and the Cochrane Library databases were searched, in addition to the grey literature, in all languages from 1950 to September 2009. Additional studies were identified from cited references. Selection criteria Two authors independently assessed papers for eligibility. Included studies were randomised and non-randomised controlled trials that compared the use of staples with suture material for wound closure after orthopaedic surgery procedures. All studies were included, and publications were not excluded because of poor methodological quality. Review methods Two authors independently reviewed studies for methodological quality and extracted data from each paper. Final data for analysis were collated through consensus. The primary outcome measure was the assessment of superficial wound infection after wound closure with staples compared with sutures. Relative risk and mean difference with 95% confidence intervals were calculated and pooled with a random effects model. Heterogeneity was assessed with I(2) and chi(2) statistical test.ResultsSix papers, which included 683 wounds, were identified; 332 patients underwent suture closure and 351 staple closure. The risk of developing a superficial wound infection after orthopaedic procedures was over three times greater after staple closure than suture closure (relative risk 3.83, 95% confidence interval 1.38 to 10.68; P=0.01). On subgroup analysis of hip surgery alone, the risk of developing a wound infection was four times greater after staple closure than suture closure (4.79, 1.24 to 18.47; P=0.02). There was no significant difference between sutures and staples in the development of inflammation, discharge, dehiscence, necrosis, and allergic reaction. The included studies had several major methodological limitations, including the recruitment of small, underpowered cohorts, poorly randomising patients, and not blinding assessors to the allocated methods of wound closure. Only one study had acceptable methodological quality.ConclusionsAfter orthopaedic surgery, there is a significantly higher risk of developing a wound infection when the wound is closed with staples rather than sutures. This risk is specifically greater in patients who undergo hip surgery. The use of staples for closing hip or knee surgery wounds after orthopaedic procedures cannot be recommended, though the evidence comes from studies with substantial methodological limitations. Though we advise orthopaedic surgeons to reconsider their use of staples for wound closure, definitive randomised trials are still needed to assess this research question.

Project description:Continuous sutures and interrupted sutures have been widely applied to skin closure after non-obstetric surgery or traumatic wounds. Usually, continuous sutures were divided into transdermal or subcuticular sutures according to whether the stitches were placed through or below the epidermal layer. Interrupted sutures, on the other hand, involved penetration of the loose connective tissue beneath the skin layers, with stitches placed through the external skin layer. Complications including infection, dehiscence, and poor cosmetic appearance were not rare after suturing. Whether a suture method is a suitable option for rapid wound healing and long-term cosmetic appearance remains controversial. To examine the potential benefits and harms of continuous skin sutures vs interrupted skin sutures in non-obstetric surgery or traumatic wounds. Searching websites such as PubMed, the Cochrane Central Library, Web of Science and Embase, and ClinicalTrials.gov were systematically searched up to 5 January 2022 and were assessed and guided by Preferred Reporting Items for Systematic Reviews and Meta-analysis rules as well as guidelines. All relevant randomised controlled studies comparing continuous sutures with interrupted sutures of skin closure were analysed. The suture techniques and material used in each trial were recorded. The transdermal and subcuticular continuous sutures were separately compared with interrupted sutures in the subgroup analysis of dehiscence and cosmetic appearance because the visual appearance of these two continuous suturing techniques was significantly different. Ten studies including 1181 participants were analysed. Subcuticular continuous sutures had comparatively higher visual analogue scale (VAS) scores among patients and doctors than interrupted sutures (OR = 0.27, 95% Confidence Intervals [CI] = 0. 07-0.47, P < .01). Similarly, priority was found regarding transdermal continuous sutures and interrupted sutures (OR = 0.40, 95% CI = 0.21-0.60, P < .01). Five randomised controlled trials (RCTs) demonstrated relevant data about dehiscence events. The incidence of continuous suture was significantly lesser than that of interrupted suture (OR = 0.16, 95% CI = 0.07-0.37, P < .01). There was no significant difference between the infection events rates of two suture methods (OR = 0.69, 95% CI = 0.40-1.21, P = .62, I2 = 0%). This systematic review indicated the superiority of both transdermal and subcutaneous continuous sutures over interrupted sutures in skin closure in terms of wound healing and cosmetic appearance.

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Comparison of Absorbable and Nonabsorbable Sutures for Intradermal Skin Closure in Dogs

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