What to Remember in Wound Closure

The differences can be difficult to distinguish with a variety of wound closure methods available on the market. To help isolate why different methods are effective and how they work, Surgical Products connected with industry leaders to answer one question:

What are two key factors surgeons should remember when selecting an epidermal closure method?

Experts at Cardinal Health reported:

Key factors surgeons should consider in selecting an epidermal closure method are the ability to:

• Achieve effective closure strength and provide microbial barrier protection, and 
• Close the incision in a quick and timely manner that optimizes O.R. room and clinician time.

By selecting a closure method that has demonstrated good wound burst strength, tensile and lap shear strength, dehiscence can be avoided.  Topical skin adhesives provide the closure strength required while also creating an effective microbial barrier that still provides visibility to the incision. The ability to close in a quick, timely manner is a crucial factor in today’s economic environment where operating room time can be expensive.  Topical Skin Adhesives offer dry times within several minutes, an advantage over alternative methods.

Experts at Ethicon reported:

Historically, surgeons have chosen wound closure methods based on habit and training background. But innovative tools that improve operating room efficiency and patient outcomes can help them more effectively treat evolving patient populations, and manage quality and costs. Choosing the right wound closure device can improve efficacy depending on tissue type and patient. STRATAFIX™ Knotless Tissue Control Devices transform wound closure by providing a combination of more consistency, more security and more efficiency compared to traditional sutures.^{1 2 3 4} The unique anchor design provides multiple points of fixation along the suture line, enabling surgeons to easily manage tension and control approximation with each pass. With greater strength and security, STRATAFIX™ Devices can close wounds substantially faster than using an interrupted suturing technique with traditional sutures.^{1 2 3 4 5 6 7 8} The addition of Plus antibacterial coating has been shown in vitro to inhibit bacterial colonization of the suture by pathogens that are commonly associated with surgical site infections.^{9 10 11 12}

For complete indications, contraindications, warnings, precautions, and adverse reactions, please reference full package insert.

Experts at Incisive Surgical reported:

The two most important decisions that surgeons must make are:

• To properly prepare the wound by relieving tension in layers, and
• To select the skin closure modality that delivers secure approximation with minimal trauma (“approximation, not strangulation”) and wound eversion.  “Because scars tend to retract over time, eversion of the wound edges at the time of closure promotes less prominent scarring.” – (T Zuber, MD, American Family Physician)  In some areas of the body, a subcuticular, interrupted closure modality (vs. a subcuticular continuous running modality) may allow for natural physiologic drainage resulting in improved healing and a reduction in wound complications including hematomas, seromas and surgical site infections.  

References 

1. Moran ME, Marsh C, Perrotti M. Bidirectional-barbed sutured knotless running anastomosis v classic Van Velthoven suturing in a model system. J Endourol. 2007;21(10):1175-1178.
2. M. Rodeheaver GT, Pineros-Fernandez A, Salopek LS, et al. Barbed sutures for wound closure: in vivo wound security, tissue compatibility and cosmesis measurements. In: Transactions from the 30th Annual Meeting of the Society for Biomaterials; Mount Laurel, NJ; 2005. p. 232.
3. Vakil JJ, O’Reilly MP, Sutter EG, Mears SC, Belkoff SM, Khanuja HS. Knee arthrotomy repair with a continuous barbed suture: a biomechanical study. J Arthroplasty. 2011;26(5):710-713.
4. Data on file, Ethicon (IC 028 SFX-308-12 STRATAFIX).
5. Eickmann T, Quane E. Total knee arthroplasty closure with barbed sutures. J Knee Surg. 2010;23(3):163-167.
6. Einarsson JI, Chavan NR, Suzuki Y, Jonsdottir G, Vellinga TT, Greenberg JA. Use of bidirectional barbed suture in laparoscopic myomectomy: evaluation of perioperative outcomes, safety, and efficacy. J Minim Invasive Gynecol. 2011;18(1):92-95.
7. Levine BR, Ting N, Della Valle CJ. Use of a barbed suture in the closure of hip and knee arthroplasty wounds. Orthopedics. 2011;34(9):e473-e475.
8. Warner JP, Gutowski KA. Abdominoplasty with progressive tension closure using a barbed suture technique. Aesthet Surg J. 2009;29(3):221-225.
9. Wang ZX, Jiang CP, Cao Y, Ding YT. Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg. 2013;100(4):465-473.
10. Ming X, Rothenburger S, Nichols MM. In vivo and invitro antibacterial efficacy of PDS Plus (polidioxanone with triclosan) suture. Surg Infect. 2008;9(4):451-457.
11. Ming X, Rothenburger S, Yang D. In vitro antibacterial efficacy of Monocryl Plus Antibacterial Suture (poligelcaprone 25 with triclosan). Surg Infect. 2007;8(2):201-207.
12. Rothenburger S, Spangler D, Bhende S, Burkley D. In vitro antimicrobial evaluation of coated Vicryl Plus Antibacterial Suture (coated polyglactin 910 with triclosan) using zone of inhibition assays. Surg Infect. 2002;3(suppl):79-87.