From a surgeon’s perspective, there are many reasons surgical sites should be small and correctly closed: infection risk, healing time, tissue damage and more. They understand patients link a surgeon’s capabilities, in great measure, to the appearance of the scar. Today’s social media focused, selfie-crazed society puts added pressure on appearance, making it even more important to patients for their scars to be unnoticeable.  

With this in mind, surgeons turn to skin adhesives, staples, zip-like designs and sutures offering cosmetically pleasing results. But, despite patient demands, facilities continue buying into methods offering more tangible benefits, such as increased efficiency or lower infection risks.

Technical Trends

For instance, Eric Storne, vice president of marketing at ZipLine Medical, said complications, such as surgical site infections, are a top concern as different federal reimbursement policies have been implemented.  “We are seeing a movement away from the more invasive means of wound closure, particularly at the skin layer (that)… can create pathways for bacteria to be distributed within and colonize tissue,” he explained. The method his company recently launched does not puncture the skin, and it brings the two side of the incision together with even pressure.

Topical skin also adhesives feed into this trend, because they typically offer low maintenance. Polymers, such as octyl and butyl cyanoacrylates, offer innate characteristics, such as flexibility or strength, that seal the incision. “Different products have their own spin or formula resulting in slightly different outcomes,” Ryan Mancini, closure technology product manager at Aesculap, Inc., said.

Tweaks are still being made to this concept, but experts predict innovations will focus on sealing tissue internally. Adhesives have already been cleared to seal vessels together, and surgeons are able to use the product off-label other than the labeled hemostasis indication.

Non-invasive solutions, like glues and zip-like designs might be quicker, but surgeons still demand innovations in staples and sutures.

For example, Dr. K. Anthony Shibley, FACOG, prefers using absorbable subcuticular staples for their efficiency. He says the subcuticular nature of these staples eliminates piercing of the skin, and the absorbable feature means patients do not need a follow up appointment to have staples removed, which is a benefit to both parties. His patients find the wounds low maintenance, comfortable and aesthetically pleasing.

“The bottom line is that improved cosmesis can only occur with improved healing,” says John Shannon, of Incisive Surgical. He says dermis-to-dermis wound closure does not strangulate the tissue and creates an everted skin edge. All scars will tend to retract over time, so eversion of the skin incision will result in less prominent scarring, he explained.

These innovations are based off established approaches, and none of the experts expect radical departures anytime soon. They do, however, anticipate challenges.

• Inertia and the Status Quo: Traditional wound closure methods are still taught during training, with slow adoption of new technologies. “There does not seem to be a lot of cross-training amongst different surgical specialities,” Storne said. “Wound care protocols implemented in each hospital have inertia, since change requires not only new products, but large re-training and monitoring efforts.”
• Increased Barriers to Entry: Surgeons are not able to adopt new technology as quickly before, because purchasing committees are being established. While facilities can benefit from making more informed purchasing decisions, it also means surgeons do not have the opportunity to try new products right after they become available, or they could be met with resistance.  
• Shift to Healthcare Marketplace: Facilities are shifting from a fee for service mindset to one centered on overall cost. Efficiency, cosmetic appearance and maintenance are all becoming more important.
• Patient Trends: “I think the challenges are not so much coming from technology but from the patient population and their comorbid conditions, whether it’s an underlying health condition or physical condition,” Liza Ovington, PhD, CWS, FACCWS, FAPWCA, wound healing and closure expert of Medical Affairs at Ethicon, said. For instance, incisions might take longer to close on obese patients, and challenges, such as impaired tissue perfusion and limited blood supply can impact the healing and subsequent cosmetic results. Sometimes the quality of patient tissue has already been compromised from previous procedures or radiation treatment, which might also impact cosmetic results.

This article was featured in the November/ December 2015 issue of Surgical Products. To see the complete issue, click HERE.