Randomized clinical trial comparing skin closure with tissue adhesives vs subcuticular suture after robotic urogynecologic procedures

BACKGROUND Skin closure techniques during minimally-invasive gynecologic surgery is largely based on surgeon preference.The optimum technique would theoretically be safe,rapid,inexpensive,and result in good cosmetic appearance.Cyanoacrylate tissue adhesive(Dermabond)may be a comparable and safe option for port site closure as compared with subcuticular suture.In this randomized clinical trial,we hypothesized that operative time for skin closure would be less than subcuticular suture during robotic urogynecologic procedures.AIM To compare skin closure during robotic urogynecologic surgeries for tissue adhesives and subcuticular suture.METHODS Fifty female subjects>18 years of age undergoing robotic urogynecologic procedures were randomized to have port site closure with either cyanoacrylate tissue adhesive(n=25)or subcuticular suture(n=25).All procedures and postoperative evaluations were performed by the same board certified Female Pelvic Medicine and Reconstructive Surgeon.Incisional closure time was recorded.Each subject was followed for 12-wk postoperatively.Incision cosmesis was evaluated using the Stony Brook Scar Evaluation Scale.RESULTS A total of 47 subjects(cyanoacrylate group,n=23;suture group,n=24)completed the 12-wk postoperative evaluation.Closure time was significantly less(P<0.0005)using cyanoacrylate tissue adhesive(5.4±2.0 min)than subcuticular suture(24.9±5.6 min).Cosmesis scores were significantly higher in the cyanoacrylate tissue adhesive group than subcuticular suture(P=0.025).No differences were found between bleeding,infection,or dehiscence(P=1.00,P=0.609,P=0.234,respectively).No statistical demographical differences existed between the two study arms.CONCLUSION Our study supported our original hypothesis that cyanoacrylate tissue adhesive for port site closure during robotic urogynecolgic procedures uses less time than with subcuticular suture.Our study also supports that tissue adhesive is comparable to cosmetic outcome while not jeopardizing rates of bleeding,infection,or dehiscence.

The effect of surgical skin tension reduction combined with early electronic line irradiation on keloid treatment after median sternotomy

Background Median sternotomy remains the preferred technique in open heart surgery. The middle part of the chest is a predilection site for keloids. Keloids are often accompanied by itching and pain, and seriously affect the beauty and quality of life. The main treatments of keloids include surgical resection, local injection of drugs, laser, cryotherapy, compression therapy, and topical application of silica gel. Unfortunately, there is no way to achieve superior results. Therefore, there is a need to find an effective way to treat keloid after median sternoto- my. Our study was designed to investigate the effect of reducing the tension of the skin and the early electronic line irradiation on the treatment of keloid after median sternotomy. Methods A retrospective analysis was per- formed in 54 patients with keloid after median sternotomy treated by reducing the tension of the skin and remov- ing the keloid, followed with electron beam irradiation treatment 24 hours after the operation. For each patient, 5 Gy electron beam irradiation was used every day after the operation for 4 days with the total dose of 20 Gy. The patients were followed up at 6 months and 12 months after surgery. Results Fifty-four cases of patients were followed up for at least 6 months. In 6 months follow-up, there were significant effects in 34 cases with a total effective rate of 98.1%. In 12 months follow-up, 33 cases were cured with the total effective rate was 96.3%. Conclusion The treatment of keloid after median sternotomy can be achieved by the combination of tension re- duction surgery and early electronic line irradiation.