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Advanced Rhinoplasty
Published in Suleyman Tas, Rhinoplasty in Practice, 2022
In thick-skinned patients, wing excision is often required to readjust the skin envelope, which often results in scarring. However, if suturing is done on the alar sulcus with subcutaneous sutures, skin sutures are properly removed, the area is protected with sunscreen for at least one year and silicone gel treatment is used for three months, scarring will be minimal (Figure 7.30). It is best to inform the patient that hypertrophic and keloid scarring usually do not occur in the mid-face, but protective measures should still be followed (Figure 7.31).
Principles of wound care
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
If a person with a traumatic wound has delayed seeking attention, then prolonged bacterial invasion will have occurred. Usually, the wound will be cleansed with the aim of free drainage and/or detection of infection, followed by delayed primary closure by suturing at 4–6 days. Secondary closure should be used when a wound is heavily contaminated; although this leaves a broader scar than after primary (early or delayed) closure, it is still cosmetically preferable to that achieved through the healing of an open granulating wound.
Predictors of Uterine Rupture and Recurrence after Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Furthermore, correct suturing technique is paramount to achieve good wound healing. Excessive tension sutures or incomplete approximation of edge-to-edge seromuscular planes can be a risk factor for tissue necrosis, increased scarring, and collagen deposition which can contribute to a weak myometrium exposed to the risk of rupture during pregnancy and labor. Figure-of-eight sutures or separated single sutures are preferred in the deep myometrial layers, whereas continuous sutures can be used in the superficial layers. The literature reports that, depending on the depth of fibroid into the myometrium, single- or double-layer sutures can be used [19]. Intramural fibroid enucleation often requires a double-layer suture, especially when more than 50% of the myometrial thickness is involved [4, 10, 18]. The potential value of multiple-layer stitching was reflected by the multicenter, case-control study by Bujold et al., who suggested that a single-layer closure of the lower uterine segment is associated with a twofold risk of UR during labor when compared with a double-layer closure [23]. Parker et al. reported on 19 UR cases following LM, the mean diameter of myoma was 4.5 cm (range of 1 to 11 cm), and only three cases were sutured in multiple-layer; moreover, in all but two cases, electrosurgery was used for hemostasis [9]. However, others have found no association between single-layer closure and UR [2, 24, 25].
Comparison of closure versus non-closure of the intraoral buccal mucosa graft site in urethroplasties. A systematic review and meta-analysis
Published in Arab Journal of Urology, 2023
Closure or non-closure of the buccal mucosa defect area in the oral cavity has been debated for a long time [16]. The advantages of primary suturing include bleeding control and more rapid healing of the wound. Contrary to this, leaving the wound open, or secondary healing, is proposed to be more advantageous for oral pain and difficult mouth opening. For this reason, the topic of whether to perform primary suturing of the defect in the oral cavity or leave it for secondary healing to reduce these perioperative and postoperative complications and to increase patient quality of life and satisfaction with surgery is still controversial. In this meta-analysis, we assessed whether or not closure or non-closure of the donor field in urethroplasty patients with buccal graft replacement for male urethral stricture induced a difference in postoperative oral morbidity.
Surgical success of ‘W’ shaped incision versus Tear Trough incision in External Dacryocystorhinostomy
Published in Orbit, 2022
Isha Acharya, Jolly Rohatgi, Pramod Kumar Sahu
Nevertheless, there were certain limitations of W incision encountered in our study as well. Surgical time was prolonged possibly due to time taken for fashioning, passing traction sutures, and suturing of the skin incision. Mild darkening of apices of the flaps was noticed at the end of surgery in 67.7% of patients. This complication was also mentioned by Ekinci et al. who postulated that it was due to vascular compromise to the tips of the triangular skin flaps.14 However, the darkening of skin flaps was temporary and had disappeared on the first postoperative day in all our cases. Superficial bleeding was more common in cases of ‘W’ incision as compared to tear trough incision, though the difference between our two groups was insignificant (p = 0.06). This could be due to the location of the W incision corresponding with the anatomical location of the angular vein and its branches.
A Standardized Workshop for Peer-Teaching Simple Interrupted Sutures to Medical Students: Analysis of the Student Factors That Affect Outcomes
Published in Journal of Investigative Surgery, 2022
Philip P. Manolopoulos, Stefanos Chatzidakis, Andriana Vasilakou, Marianna Balta, Dimitrios Ntourakis
The intervention was a multimedia modular task training workshop created by EUC faculty members and EUC Surgery Club’s student peer-teachers with the aim of teaching suturing skills to medical students. The workshop included an electronic booklet, video demonstrations, a PowerPoint presentation and one hour and fifteen minutes of hands-on practice session. The teaching methodology followed Peyton’s 4-Steps-Approach with steps 1 (demonstration) and 2 (deconstruction) delivered by an electronic booklet and video recordings made available online prior to the workshop. The skill of suturing was broken down to basic elements: instrument handling, needle arming and handling without touching the needle, passing of the needle through the skin at a right angle with wrist rotation, and knot tying with needle holder. Steps 3 (comprehension) and 4 (execution) were delivered through hands-on practice performed on a synthetic skin model with the use of a standardized suturing kit. After consecutive training of these elements during the workshop, the students were asked to perform simple interrupted sutures on simulated lacerations.