Epub Sep Sleeve gastrectomy operations have become popular among restrictive obesity surgeons, due to its effectiveness for losing weight and acceptable complication rates. However, leakage is a significant problem in these operations. In this ex vivo study, we tried to understand mechanisms of leakage and to examine the effects of two different types of frequently referred reinforcement techniques using sutures. The resected gastric specimens that were removed during sleeve gastrectomy operations were used in this ex vivo study.
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Search Menu The subcuticular suture is one of the most commonly employed techniques for closure of wounds. It is particularly important in the realm of plastic surgery, as the results are usually aesthetically acceptable. There are three primary types of wound closure: suturing, skin clips, and tissue adhesives. Each technique has its own advantages and disadvantages. For example, tissue adhesives have the advantage of being quick and easy to apply, but they are relatively expensive compared to other methods of wound closure.
In intradermal wound closure, suture threads are embedded intradermally within the wound. This potentially avoids the crosshatching associated with interrupted suture technique, hence making intradermal wound closure cosmetically appealing.
Intradermal sutures can be knotless, knotted, or placed with barbed wire suture. Knots can be placed either externally or internally. The advantage of tying knots is that the intradermal suture is secured firmly, and the chance of wound dehiscence is minimal.
The disadvantage, however, is that these knots can be potential breeding grounds for bacteria, which may then predispose the wound to an increased risk of infection and stitch abscesses. Knots may also cause localized irritation and granulation, which may impair wound healing.
Paul, Minnesota to anchor the ends of the thread. Knotless sutures are generally more advantageous than knotted ones, as they have a decreased risk of infection, irritation, granuloma, and stitch abscess. From a literature search, we determined that there are three primary techniques for knotless intradermal sutures, described respectively by Giddins, 6 Singh and Oni, 7 and Ranaboldo.
Although truly knotless, the creation of extra wound sites from needle puncture and the necessity of blind suturing albeit intradermally may increase the risk of injury to other structures. Again, although it is indeed a knotless technique, extra wound sites result from this method. This technique is also comparatively more complicated than the others. To create the loops, the needle has to be passed through the distal end of the suture held with toothed forceps, making it much more challenging and time-consuming.
The holding technique is not reliable since only two zigzags are created; these alone may not be stable in areas of high tension such as the back. Here, we describe a knotless intradermal suture that is self-securing and does not require any extra adhesives for suture anchorage. It relies on a series of anchoring sutures placed within the wound itself. The suture is begun at one-third of the wound length, working toward the closest end of the wound.
The initial intradermal bites are deeply and widely placed until the suture reaches the end of the wound, at which point the pattern turns degrees and continues in the reverse direction. The rest of the wound closure proceeds with a standard intradermal suturing technique, until the suture reaches the opposite end of the wound.
From this point the suture takes another degree turn and proceeds in the reverse direction, similar to the way it was applied on the opposite pole. Once again, the intradermal bites are applied deeply and widely until the suture reaches the opposite one-third of the wound. At this stage, both ends of the suture are cut flush to the skin and buried in the deeper part of the wound. The beginning and the end of the deeper sutures serve as a knotless anchoring point in the deep dermis.
The multidirectional positioning of the threads, along with the extra length of suture embedded in the deeper part of the wound, prevents slippage Figure 1. This novel method of intradermal suturing incorporates the benefits of a knotless suture, while at the same time keeping the suture confined to the wound itself, in contrast to previously described methods in which the suture is started outside the confinement of the wound, which carries added morbidity.
We have performed this technique on approximately varied types of elective postsurgical wounds over the past two years. Complications in this series have included three cases of hypertrophic scarring, one case of scar stretching, and three cases of minor cellulitis that responded well to antibiotics.
Again, there has been no wound dehiscence, no patients have required reoperation, and there has been a high patient and surgeon satisfaction. The only contraindications to this method of skin closure are the presence of a potentially contaminated wound, areas of high tension, acute posttraumatic wounds, and wounds with a length of less than 1.
Figure 1. Diagram demonstrating the anchor sutures red and the regular intradermal sutures black. Disclosures The authors declared no potential conflicts of interest with respect to the authorship and publication of this article.
Knotless Suture for Wound Closure in Intraoral Surgery-A Report of 2 Cases.