Sutures are better than staples in third or high-order cesarean sections wound closures

Wound closure with suture is associated with 56% lower odds of wound complications as compared to using staple in third or high-order cesarean sections reports the results retrospective cohort study published ahead of print in February issue of Journal Obstetrics and Gynecology.

The researchers looked at wound closure techniques of all tertiary or higher-order cesarean deliveries over a period of 12 years at a large academic medical center. All the cases were performed by surgeons belonging to a single group practice.

Patients with three or more cesarean deliveries with pfannensteil incision were included in the study.

A total of 551 patients had third or higher order cesarean deliveries, in 192 patients staples were used while 359 received suture closure.

The patients were not randomized to receive either type of wound closure, but the group doctors used staples for most of the cases for the first 6 years and in the later 6 years subcuticular suture closure was preferred. If the subcutaneous fat was 2 cm or deeper, the space was obliterated in all the patients.

Prophylactic antibiotics were routinely used in all patients. The researchers looked at data on wound infection requiring antibiotics, resuturing or wound gaping that required packing 6 weeks post-operatively.

A total of 551 patients had third or higher order cesarean deliveries, in 192 patients staples were used while 359 received suture closure.

Wound complications were observed in about 5% of patients with suture closure as opposed to nearly 12% of patients with staple closure (P=.003).

Even after accounting for number of previous cesareans and operator surgical skills, suture closure has 56% lower odds of wound complications as opposed to staple closure (adjusted odds ratio 0.44, 95% CI 0.23–0.86).

Abstract

Media courtesy: Headley Family Medicine

New surgical glue that works well in wet environment on the horizon.

Staples and surgical sutures will soon be a thing of past. Researchers at Purdue University have developed a nontoxic, biocompatible glue from adhesive proteins produced by mussels and other creatures.

The paper was published in April in Journal Biomaterials.

The material is unique because it is able to work while immersed in a water environment, and have shown to be far better than other current commercially available products.

The material is currently named ELY16, is constructed from an elastin-like polypeptide (ELP) that can be produced in high quantity from Escherichia coli and can coacervate in response to environmental factors such as temperature, pH, and salinity.  

ELY16 is rich in tyrosine and after reaction with tyrosine kinase it is changed into mELY16, converting the tyrosine residue into 3,4-dihydroxyphenylalanine (DOPA).

Both these compounds (ELY16 and mELY16) are cytocompatible and exhibit significant dry strength. Addition of DOPA makes them adherent in humid environment.

Julie Liu, an associate professor of chemical engineering and biomedical engineering at Purdue University said, “Sutures and staples have several disadvantages relative to adhesives, including patient discomfort, higher risk of infection and the inherent damage to surrounding healthy tissue.”

It is estimated that 230 million major surgeries are performed worldwide every year and 12 million trauma patients are treated in USA each year. About 60% of these wounds are closed by surgical suture or staples.

“Current biomedical adhesive technologies do not meet these needs,” she said. “We designed a bioinspired protein system that shows promise to achieve biocompatible underwater adhesion coupled with environmentally responsive behavior that is ‘smart,’ meaning it can be tuned to suit a specific application.”

The initial tests were done aluminum substrates, but the researchers will soon start testing with soft body tissue like substrates to make it suitable for biomedical purposes.

“To our knowledge, mELY16 provides the strongest bonds of any engineered protein when used completely underwater, and its high yields make it more viable for commercial application compared to natural adhesive proteins,” she said. “So it shows great potential to be a new smart underwater adhesive.”

Here is the YouTube video ‘Non-toxic underwater adhesive could bring new surgical glue’

  

Source: Purdue University News letter.