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    "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&#44; allowing correct management thereafter&#46; However&#44; achieving the best functional and cosmetic result is a secondary objective that is acquiring ever greater importance&#44; and that has even been extended to the excision of benign lesions&#44; many of which are not included in the range of services offered by numerous hospitals&#46;<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&#46; 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&#46; That technique was modified and improved by Serrano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> in 2015&#44; hiding the entry and exit orifices of the suture by performing the subcutaneous vector-running suture along the length of the wound&#44; completely burying the suture&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Based on the concept proposed by Serrano&#44;<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&#44; thus&#44; of the scar&#46;<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&#44; demonstrated previously in the surgical videos section of <span class="elsevierStyleItalic">Actas Dermo-Sifiliogr&#225;ficas</span>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This adaptable and simple technique enables us to control tension forces until the wound has healed&#46; It is not necessary to remove the suture material&#46; To avoid the formation of foreign body granulomas that can develop with nonabsorbable sutures&#44; we use a mid-term absorbable suture&#58; Novosyn 3&#47;0&#44; a mid-term absorbable multifilament synthetic suture of braided and coated poly&#40;glycolide-co-L-lactid 90&#47;10&#41;&#46; 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&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Between January and December&#44; 2015&#44; 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&#46; The study was approved by the ethics committee of our hospital&#46; All patients were over 18 years of age&#46; The variables gathered were sex&#44; age&#44; clinical diagnosis&#44; length and breadth of the incision&#44; and width of dehiscence at 3 and 6 months&#46; All the lesions excised were on the trunk or root of the thighs&#46;</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&#46; Variables were compared using the Student t test or Welch test for normal variables and the Mann Whitney U test for non-normal variables&#46; The &#967;<span class="elsevierStyleSup">2</span> test was used to study associations between qualitative variables&#46; Sixty-five patients were included in the study&#46; Wound closure was performed with the continuous suture by tissue planes in 37 patients and with the conventional Weber technique in 28 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; No statistically significant differences were found between the 2 groups in the variables age&#44; sex&#44; and length and breadth of the incision&#46; Wounds closed using the continuous suture by tissue planes presented a mean dehiscence of 4&#46;88<span class="elsevierStyleHsp" style=""></span>mm&#44; whereas mean dehiscence in the conventional suture group was 7&#46;25<span class="elsevierStyleHsp" style=""></span>mm&#59; this difference was statistically significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46;</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&#46;<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&#46; It should also be noted that this suture technique is designed for use in areas of high tension&#44; such as the trunk and limbs&#44; though initially all body regions were included&#46; Results in the late postoperative period are not yet available&#46; However&#44; it is clear that dehiscence with our technique is less marked that with conventional surgery&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This is a novel line of research&#44;<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&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> All the lesions were on the trunk and limbs&#44; and although there were no statistically significant differences in the cosmetic result&#44; dermal suture appears to be necessary to approximate the epidermal borders of the wound when using such a device&#46; The device can be removed by the patient&#44; and the time required to perform the suture is clearly lower&#44; but further studies&#44; such as ours&#44; are needed to evaluate the improvement in risk of dehiscence&#46;</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&#46;</p></span></span>"
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        "texto" => "<p id="par0055" class="elsevierStylePara elsevierViewall">We would like to thank Dr&#46; Gonzalo Blasco Morente and Dr&#46; Cristina Garrido Colmenero for their help in performing this study&#46;</p>"
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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
Autor para correspondencia
ismenios@hotmail.com

Corresponding author.
Unidad de Dermatología Médico-Quirúrgica y Venereología, Complejo Hospitalario de Granada, Granada, Spain
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    "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&#44; allowing correct management thereafter&#46; However&#44; achieving the best functional and cosmetic result is a secondary objective that is acquiring ever greater importance&#44; and that has even been extended to the excision of benign lesions&#44; many of which are not included in the range of services offered by numerous hospitals&#46;<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&#46; 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&#46; That technique was modified and improved by Serrano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> in 2015&#44; hiding the entry and exit orifices of the suture by performing the subcutaneous vector-running suture along the length of the wound&#44; completely burying the suture&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Based on the concept proposed by Serrano&#44;<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&#44; thus&#44; of the scar&#46;<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&#44; demonstrated previously in the surgical videos section of <span class="elsevierStyleItalic">Actas Dermo-Sifiliogr&#225;ficas</span>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This adaptable and simple technique enables us to control tension forces until the wound has healed&#46; It is not necessary to remove the suture material&#46; To avoid the formation of foreign body granulomas that can develop with nonabsorbable sutures&#44; we use a mid-term absorbable suture&#58; Novosyn 3&#47;0&#44; a mid-term absorbable multifilament synthetic suture of braided and coated poly&#40;glycolide-co-L-lactid 90&#47;10&#41;&#46; 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&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Between January and December&#44; 2015&#44; 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&#46; The study was approved by the ethics committee of our hospital&#46; All patients were over 18 years of age&#46; The variables gathered were sex&#44; age&#44; clinical diagnosis&#44; length and breadth of the incision&#44; and width of dehiscence at 3 and 6 months&#46; All the lesions excised were on the trunk or root of the thighs&#46;</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&#46; Variables were compared using the Student t test or Welch test for normal variables and the Mann Whitney U test for non-normal variables&#46; The &#967;<span class="elsevierStyleSup">2</span> test was used to study associations between qualitative variables&#46; Sixty-five patients were included in the study&#46; Wound closure was performed with the continuous suture by tissue planes in 37 patients and with the conventional Weber technique in 28 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; No statistically significant differences were found between the 2 groups in the variables age&#44; sex&#44; and length and breadth of the incision&#46; Wounds closed using the continuous suture by tissue planes presented a mean dehiscence of 4&#46;88<span class="elsevierStyleHsp" style=""></span>mm&#44; whereas mean dehiscence in the conventional suture group was 7&#46;25<span class="elsevierStyleHsp" style=""></span>mm&#59; this difference was statistically significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46;</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&#46;<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&#46; It should also be noted that this suture technique is designed for use in areas of high tension&#44; such as the trunk and limbs&#44; though initially all body regions were included&#46; Results in the late postoperative period are not yet available&#46; However&#44; it is clear that dehiscence with our technique is less marked that with conventional surgery&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This is a novel line of research&#44;<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&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> All the lesions were on the trunk and limbs&#44; and although there were no statistically significant differences in the cosmetic result&#44; dermal suture appears to be necessary to approximate the epidermal borders of the wound when using such a device&#46; The device can be removed by the patient&#44; and the time required to perform the suture is clearly lower&#44; but further studies&#44; such as ours&#44; are needed to evaluate the improvement in risk of dehiscence&#46;</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&#46;</p></span></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;01<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;203&nbsp;\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&#44; cm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;251&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "texto" => "<p id="par0055" class="elsevierStylePara elsevierViewall">We would like to thank Dr&#46; Gonzalo Blasco Morente and Dr&#46; Cristina Garrido Colmenero for their help in performing this study&#46;</p>"
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Información del artículo
ISSN: 15782190
Idioma original: Inglés
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