Case and Research Letter
Pilot Study to Evaluate Postsurgical Dehiscence After Continuous Suture by Tissue Planes
Estudio piloto de valoración de dehiscencias posquirúrgicas tras sutura continua por planos
J. Tercedor-Sánchez, A. Martinez-Lopez, I. Pérez-López, R. Ruiz-Villaverde
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Unidad de Dermatología Médico-Quirúrgica y Venereología, Complejo Hospitalario de Granada, Granada, Spain
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Tercedor-Sánchez, A. Martinez-Lopez, I. Pérez-López, R. Ruiz-Villaverde" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Tercedor-Sánchez" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Martinez-Lopez" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Pérez-López" ] 3 => array:4 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" "email" => array:1 [ 0 => "ismenios@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Dermatología Médico-Quirúrgica y Venereología, Complejo Hospitalario de Granada, Granada, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio piloto de valoración de dehiscencias posquirúrgicas tras sutura continua por planos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The main objective of dermatologic oncologic surgery is the surgical excision of a tumor with sufficient safety margins, allowing correct management thereafter. However, achieving the best functional and cosmetic result is a secondary objective that is acquiring ever greater importance, and that has even been extended to the excision of benign lesions, many of which are not included in the range of services offered by numerous hospitals.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Several different surgical techniques have been developed to avoid wound dehiscence in the immediate and late postoperative periods. The conventional technique for which the best results have been reported is the one described by Weber and Wulc<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> in 1992. That technique was modified and improved by Serrano et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> in 2015, hiding the entry and exit orifices of the suture by performing the subcutaneous vector-running suture along the length of the wound, completely burying the suture.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Based on the concept proposed by Serrano,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> we perform a continuous suture by tissue planes to prevent dehiscence of the wound and, thus, of the scar.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> Our wound closure consists of a continuous subcutaneous suture followed by an intradermal suture, demonstrated previously in the surgical videos section of <span class="elsevierStyleItalic">Actas Dermo-Sifiliográficas</span>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">This adaptable and simple technique enables us to control tension forces until the wound has healed. It is not necessary to remove the suture material. To avoid the formation of foreign body granulomas that can develop with nonabsorbable sutures, we use a mid-term absorbable suture: Novosyn 3/0, a mid-term absorbable multifilament synthetic suture of braided and coated poly(glycolide-co-L-lactid 90/10). Two additional advantages of this technique are that it is rapid to perform and that no assistant is needed to cut the suture material after each stitch.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Between January and December, 2015, we performed a prospective nonrandomized pilot study in our unit to determine dehiscence in the immediate postoperative period and in the mid-term using the technique described above and the one employed in conventional surgery. The study was approved by the ethics committee of our hospital. All patients were over 18 years of age. The variables gathered were sex, age, clinical diagnosis, length and breadth of the incision, and width of dehiscence at 3 and 6 months. All the lesions excised were on the trunk or root of the thighs.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A descriptive analysis was performed of the overall population and by groups after testing for normality of the continuous quantitative variables using the Kolmogorov-Smirnov test. Variables were compared using the Student t test or Welch test for normal variables and the Mann Whitney U test for non-normal variables. The χ<span class="elsevierStyleSup">2</span> test was used to study associations between qualitative variables. Sixty-five patients were included in the study. Wound closure was performed with the continuous suture by tissue planes in 37 patients and with the conventional Weber technique in 28 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). No statistically significant differences were found between the 2 groups in the variables age, sex, and length and breadth of the incision. Wounds closed using the continuous suture by tissue planes presented a mean dehiscence of 4.88<span class="elsevierStyleHsp" style=""></span>mm, whereas mean dehiscence in the conventional suture group was 7.25<span class="elsevierStyleHsp" style=""></span>mm; this difference was statistically significant (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.002).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">No infectious complications were observed in the immediate or late postoperative periods with either of the 2 techniques after strict adherence to the pre- and postsurgical verification protocols applied in our hospital.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The main limitation of our pilot study is that comparison of the 2 surgical techniques was not performed in patients with paired sites and randomization to the treatment groups. It should also be noted that this suture technique is designed for use in areas of high tension, such as the trunk and limbs, though initially all body regions were included. Results in the late postoperative period are not yet available. However, it is clear that dehiscence with our technique is less marked that with conventional surgery.</p><p id="par0045" class="elsevierStylePara elsevierViewall">This is a novel line of research,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> and a recent publication has reported on new systems of nontraumatic wound closure that have been tested in a prospective randomized controlled clinical study.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> All the lesions were on the trunk and limbs, and although there were no statistically significant differences in the cosmetic result, dermal suture appears to be necessary to approximate the epidermal borders of the wound when using such a device. The device can be removed by the patient, and the time required to perform the suture is clearly lower, but further studies, such as ours, are needed to evaluate the improvement in risk of dehiscence.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:2 [ "identificador" => "xack280252" "titulo" => "Acknowledgments" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Tercedor-Sánchez J. Estudio piloto de valoración de dehiscencias posquirúrgicas tras sutura continua por planos. Actas Dermosifiliogr. 2017;108:371–372.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Continuous Suture by Tissue Planes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Conventional Suture \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> Value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age, y</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54.66<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>19.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.67<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.381 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sex</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.880 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Dehiscence, cm</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.49<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.73<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Incision length, cm</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.48<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.01<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.203 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Incision width, cm</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.19<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.54<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.251 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1406722.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison of the 2-Suture Techniques Performed in the Study Patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Process of care for patients with benign cysts and tumors: Consensus document of the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. 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Khorasani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2015.08.004" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2016" "volumen" => "74" "paginaInicial" => "173" "paginaFinal" => "174" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26702797" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack280252" "titulo" => "Acknowledgments" "texto" => "<p id="par0055" class="elsevierStylePara elsevierViewall">We would like to thank Dr. Gonzalo Blasco Morente and Dr. Cristina Garrido Colmenero for their help in performing this study.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010800000004/v1_201704280927/S1578219017300677/v1_201704280927/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010800000004/v1_201704280927/S1578219017300677/v1_201704280927/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017300677?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 7 | 17 |
| 2024 October | 65 | 43 | 108 |
| 2024 September | 80 | 27 | 107 |
| 2024 August | 96 | 50 | 146 |
| 2024 July | 72 | 28 | 100 |
| 2024 June | 90 | 38 | 128 |
| 2024 May | 70 | 33 | 103 |
| 2024 April | 75 | 25 | 100 |
| 2024 March | 59 | 25 | 84 |
| 2024 February | 63 | 26 | 89 |
| 2024 January | 51 | 24 | 75 |
| 2023 December | 50 | 15 | 65 |
| 2023 November | 68 | 24 | 92 |
| 2023 October | 45 | 10 | 55 |
| 2023 September | 48 | 26 | 74 |
| 2023 August | 30 | 12 | 42 |
| 2023 July | 33 | 30 | 63 |
| 2023 June | 47 | 25 | 72 |
| 2023 May | 34 | 21 | 55 |
| 2023 April | 31 | 21 | 52 |
| 2023 March | 35 | 19 | 54 |
| 2023 February | 35 | 15 | 50 |
| 2023 January | 32 | 37 | 69 |
| 2022 December | 42 | 41 | 83 |
| 2022 November | 38 | 31 | 69 |
| 2022 October | 24 | 15 | 39 |
| 2022 September | 26 | 31 | 57 |
| 2022 August | 18 | 27 | 45 |
| 2022 July | 24 | 32 | 56 |
| 2022 June | 16 | 19 | 35 |
| 2022 May | 32 | 26 | 58 |
| 2022 April | 24 | 34 | 58 |
| 2022 March | 46 | 43 | 89 |
| 2022 February | 22 | 26 | 48 |
| 2022 January | 30 | 34 | 64 |
| 2021 December | 28 | 41 | 69 |
| 2021 November | 24 | 49 | 73 |
| 2021 October | 36 | 51 | 87 |
| 2021 September | 21 | 38 | 59 |
| 2021 August | 20 | 32 | 52 |
| 2021 July | 25 | 20 | 45 |
| 2021 June | 18 | 25 | 43 |
| 2021 May | 46 | 37 | 83 |
| 2021 April | 55 | 44 | 99 |
| 2021 March | 49 | 26 | 75 |
| 2021 February | 57 | 26 | 83 |
| 2021 January | 28 | 13 | 41 |
| 2020 December | 38 | 18 | 56 |
| 2020 November | 37 | 21 | 58 |
| 2020 October | 28 | 11 | 39 |
| 2020 September | 44 | 12 | 56 |
| 2020 August | 26 | 25 | 51 |
| 2020 July | 30 | 12 | 42 |
| 2020 June | 28 | 31 | 59 |
| 2020 May | 18 | 13 | 31 |
| 2020 April | 31 | 18 | 49 |
| 2020 March | 28 | 9 | 37 |
| 2020 February | 5 | 0 | 5 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 4 | 0 | 4 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 5 | 0 | 5 |
| 2019 August | 2 | 0 | 2 |
| 2019 July | 7 | 0 | 7 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 7 | 1 | 8 |
| 2019 April | 2 | 2 | 4 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 8 | 0 | 8 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 4 | 0 | 4 |
| 2018 February | 20 | 3 | 23 |
| 2018 January | 22 | 9 | 31 |
| 2017 December | 24 | 9 | 33 |
| 2017 November | 23 | 9 | 32 |
| 2017 October | 20 | 9 | 29 |
| 2017 September | 23 | 12 | 35 |
| 2017 August | 24 | 6 | 30 |
| 2017 July | 17 | 4 | 21 |
| 2017 June | 44 | 9 | 53 |
| 2017 May | 57 | 31 | 88 |
| 2017 April | 18 | 24 | 42 |
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