Tape blisters following hip surgery. A prospective, randomized study of two types of tape.

BACKGROUND: Tape blisters after hip surgery can be a source of postoperative morbidity and can increase patient discomfort. The purpose of this prospective study was to compare two different types of tape to determine whether the type of tape influences the rate of blister formation. METHODS: Ninety-nine patients (100 hips) were enrolled in the study. Patients were randomized into one of two treatment groups: one treated with a nonstretchable silk tape and one treated with a perforated, stretchable cloth tape. After surgery, the assigned tape was applied over the postoperative dressing with care not to produce skin tension. At the first dressing change, the presence or absence of blisters was recorded as were the number, size, location, and type of any blisters. The presence or absence of tape blisters was recorded at the time of each subsequent dressing change. RESULTS: A tape blister developed on twenty-five hips in twenty-five patients. The risk of a blister developing was 41% (twenty of forty-nine patients) when the nonstretchable silk tape was used and 10% (five of fifty patients) when the perforated cloth tape was used (relative risk = 4.08, 95% confidence interval = 1.53 to 10.87, p = 0.005). We found no association between formation of tape blisters and the age or gender of the patient, number of medical comorbidities, smoking history, results of nutritional assessment, or type of surgery. CONCLUSIONS: The prevalence of tape blisters was significantly lower when perforated cloth tape was used than it was when nonstretchable silk tape was used.

Suture materials and other factors associated with tissue reactivity, infection, and wound dehiscence among plastic surgery outpatients.

The most common complications in plastic surgery are tissue reactivity, infections, and wound dehiscence. In the literature, there are only a few studies with sample sizes large enough and methods of statistical analysis appropriate for evaluating the role of suture materials in inducing such complications. In the 1000 plastic surgery outpatients in this study, the association of different suture materials, individual patient characteristics, surgeon skill, and wound site and length with postoperative wound complications (i.e., tissue reactivity, infection rate, and wound dehiscence) were investigated. No substantial differences were found between the different suture materials and suturing techniques. A moderate increase in the risk of tissue reactivity for silk and polyglactin 910 and a protective effect of thinner internal sutures were observed. In multivariate analysis, such differences were not statistically significant. Male sex [odds ratio (OR), 1.7; 95 percent confidence interval (CI), 1.06 to 2.72] and older age (OR, 2.34; 95 percent CI, 1.36 to 4.05) were found to be the most important risk factors for tissue reactivity and infection rate (male sex: OR, 5.1; 95 percent CI, 1.7 to 15.9; older age: OR, 5.6; 95 percent CI, 1.9 to 16), whereas younger age was associated with an increased risk of dehiscence (OR, 3.06; 95 percent CI, 1.41 to 6.65). Wounds on the lower limbs showed a lower risk of tissue reactivity and wounds on the back a higher risk of dehiscence. Wound length was associated with the risk of tissue reactivity in one-layer sutures (OR, 2.92; 95 percent CI, 1.51 to 5.65). An increased risk of both tissue reactivity (OR, 1.53; 95 percent CI, 1.03 to 2.27) and dehiscence (OR, 2.44; 95 percent CI, 1.1 to 5.43) was observed for operations performed by less-experienced surgeons. Rather than factors related to suture materials and different surgical techniques, and with the exception of surgeon experience, general characteristics of the patients (i.e., sex and age) and of the wounds (i.e., length and site) seemed to be primarily responsible for local wound complications.

The relationship between five kinds of laparoscopic knots and five types of suture materials and histological findings in tissues: an experimental study on rabbits.

The aim of the current study was to examine the slipping and the tightening of laparoscopic knots with various kinds of sutures, as well as the histologic alterations in tissues. Fifty rabbits and five kinds of sutures were used-silk, polyglactine-910 (Vicryl), Polydioxanone (PDS), Polyglycol (Dexon), and cat-gut chromic-and five laparoscopic knots were used-Tayside, Roeder, Melzer, Cross, and Blood. The knots were performed extracorporeally and were used to ligate a part of the omentum. Sliding and tightening of the knots were evaluated. The omentum, the suture, and the knots were checked 10 days and 1 month after operation. Histologic examination was performed 1 month after surgery. Polyglactine-910 (Vicryl) and silk were the most qualitative sutures used in Tayside, Roeder, and Blood knots and the least harmful for the tissues. Catgut chromic and Polydioxanone (PDS) were the most defective sutures. The most efficient laparoscopic slipknots are Tayside, Roeder, and Blood, especially when constructed with silk and polyglactine-910 (Vicryl).

Oral tissue reactions to suture materials.

Tissue reactions to natural and synthetic braided and monofilament suture materials in gingiva and oral mucosa were studied. A total of 138 sutures made of four commonly used materials were placed in the edentulous ridges and vestibular mucosa of eight beagle dogs. Biopsy specimens including the suture loop and surrounding tissues were obtained after 3, 7, and 14 days and processed for histologic analysis. The inflammatory reaction was more rapid and intense than the reaction that has been reported after suture placement in skin. Bacterial invasion of the suture track was a common sequela regardless of the material used, but it was particularly prominent for silk. The formation of a perisutural epithelial sleeve was well under way at 3 days and in some instances included the entire suture track within 7 days. Connective tissue reactions consisted of several well-defined, concentric perisutural zones. At 14 days, these zones were partly replaced by granulation tissue surrounded by a fibrous capsule. The synthetic monofilament suture elicited a mild inflammatory tissue response. The results showed that sutures placed in gingiva and oral mucosa produce a prolonged tissue response that is most likely a result of the continual influx of microbial contamination along the suture channel, which may be a lesser problem when sutures are placed in other surgical compartments. The results indicate that chromic gut sutures are rapidly and unpredictably absorbed when used in an environment characterized by moisture and infectious potential.

The action of Amblyomma cajennense tick saliva in compounds of the hemostatic system and cytotoxicity in tumor cell lines.

Ticks are blood-feeding arthropods that secrete anticoagulant molecules to maintain the fluidity of the blood during its feeding. Tick saliva has many compounds with biological activities that interact directly with host systems, such as blood clotting, platelet aggregation, cell death, among others. Some reports show that there are proteins with anticancer properties in tick saliva. This paper reports some of the biological roles of the Amblyomma cajennense tick saliva, including Factor Xa and thrombin inhibition, action on platelet aggregation, and also preliminary cytotoxic effects on tumor cell lines. The crude saliva was tested in the coagulation, fibrinolysis and platelet aggregation systems. The protein profile of the crude saliva was examined through anion exchange chromatography performed in a FPLC system. The chromatography separated seven protein fractions (Pools I to VII), which biological activities were evaluated. Moreover, the cytotoxic effects of the crude saliva were evaluated on SK-MEL-28 (melanoma cells) and MIA PaCa-2 (pancreas adenocarcinoma cells) using the MTT assay, flow cytometry and fluorescence microscopy. The crude saliva was able to induce cell death on both cancer cells lines, and, interestingly, the cytotoxic effects were not observed on human fibroblasts, which were used as control. The present work opens perspectives for the characterization and development of new molecules involved in the hemostatic system and in cancer control.

Suture materials and local recurrence in colorectal cancer: an experimental study.

OBJECTIVE: To investigate the carcinogenic role of suture materials in an experimental model in rats. DESIGN: Laboratory, experimental study. SETTING: University hospital, Spain. SUBJECTS: 125 Sprague-Dawley rats in 5 groups of 25 each. INTERVENTIONS: 3 Different suture materials (silk, polydioxanone, and titanium staples) were implanted in a region of the colon in 75 rats divided into three groups of 25. Another 25 animals were injured by puncture only in the same region, and a further 25 rats were not operated on (controls). Injections of 1-2,dimethylhydrazine were then given for 26 weeks. MAIN OUTCOME MEASURES: Number of rats in each group who had tumours in the region of interest, and level of infiltration of the tumours in each group. RESULTS: There were no differences between the injured and control rats in the number of tumours in the study zone. All groups in which suture material had been inserted had tumours in this zone. Titanium was more carcinogenic than either silk or polydioxanone. The tumours associated with titanium were the most infiltrating. CONCLUSIONS: We recommend the use of absorbable sutures, with a careful follow-up of patients in whom titanium staples have been used.