Evaluation of the effect of the accordion suturing technique on wound lengths in breast cancer surgery: a randomised clinical trial.

BACKGROUND: Cosmetic outcomes and scar lengths remain important considerations in breast cancer surgery. Suturing techniques should decrease scar tissue formation and provide good cosmetic results. The use of an accordion suturing technique may result in decreased surgical wound lengths and better cosmetic outcomes. We compared the outcomes of the accordion suturing technique with the standard suturing technique in breast cancer surgeries. MATERIALS AND METHODS: Female patients undergoing wide local excision of breast cancers were randomised to undergo closure of their surgical wound by either the accordion or the non-accordion (standard) suturing techniques between the months of May and October 2015. Pre-closure and post-closure wound lengths were measured intra-operatively. The primary outcome was a reduction of the surgical wound length at 6 weeks. The secondary outcome was a composite of the absence of hypertrophic scar tissue formation and optimal cosmesis. RESULTS: Thirty eligible women for wide local excision of breast tumours were randomly assigned to the accordion and non-accordion groups (15 accordion and 15 non-accordion). Seven women were excluded from the study because they underwent re-excision of margins for their breast tumours before the end of 6 weeks, and one woman was lost to follow-up. We therefore compared the outcomes of 12 women who underwent closure of their surgical wound by way of the accordion suturing technique to the outcomes of 10 women who underwent closure with the non-accordion (standard) suturing technique. The percentage reduction of wound length at 6 weeks was significantly greater in the accordion group than in the non-accordion group (M = 24.4, SD = 10.2 vs. M = 8.6, SD = 11.5, p = 0.0026). There was no significant difference in the cosmetic outcome between both groups using the James Quinn's wound evaluation score. CONCLUSION: The accordion suturing technique was associated with a significant reduction in surgical wound lengths in breast conserving surgery at 6 weeks without compromising the cosmetic result.

Optimal feature selection applied to multispectral fluorescence imaging.

Recent rapid developments in multi-modal optical imaging have created a significant clinical demand for its in vivo--in situ application. This offers the potential for real-time tissue characterization, functional assessment, and intra-operative guidance. One of the key requirements for in vivo consideration is to minimise the acquisition window to avoid tissue motion and deformation, whilst making the best use of the available photons to account for correlation or redundancy between different dimensions. The purpose of this paper is to propose a feature selection framework to identify the best combination of features for discriminating between different tissue classes such that redundant or irrelevant information can be avoided during data acquisition. The method is based on a Bayesian framework for feature selection by using the receiver operating characteristic curves to determine the most pertinent data to capture. This represents a general technique that can be applied to different multi-modal imaging modalities and initial results derived from phantom and ex vivo tissue experiments demonstrate the potential clinical value of the technique.