Murtha Amy P, Kaplan Andrew L, Paglia Michael J, Mills Benjie B, Feldstein Michael L, Ruff Gregory L
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA.
Plast Reconstr Surg. 2006 May;117(6):1769-80. doi: 10.1097/01.prs.0000209971.08264.b0.
Suture knots present several disadvantages in wound closure, because they are tedious to tie and place ischemic demands on tissue. Bulky knots may be a nidus for infection, and they may extrude through skin weeks after surgery. Needle manipulations during knot-tying predispose the surgeon to glove perforation. A barbed suture was developed that is self-anchoring, requiring no knots or slack management for wound closure. The elimination of knot tying may have advantages over conventional wound closure methods.
This prospective, randomized, controlled trial was designed to show that the use of barbed suture in dermal closure of the Pfannenstiel incision during nonemergent cesarean delivery surgery produces scar cosmesis at 5 weeks that is no worse than that observed with conventional closure using 3-0 polydioxanone suture. Cosmesis was assessed by review of postoperative photographs by a blinded, independent plastic surgeon using the modified Hollander cosmesis score. Secondary endpoints included infection, dehiscence, pain, closure time, and other adverse events.
The study enrolled 195 patients, of whom 188 were eligible for analysis. Cosmesis scores did not significantly differ between the barbed suture group and the control group. Rates of infection, dehiscence, and other adverse events did not significantly differ between the two groups. Closure time and pain scores were comparable between the groups.
The barbed suture represents an innovative option for wound closure. With a cosmesis and safety profile that is similar to that of conventional suture technique, it avoids the drawbacks inherent to suture knots.
缝线结在伤口缝合中存在诸多缺点，因为打结操作繁琐，且会对组织造成缺血性影响。粗大的结可能成为感染病灶，术后数周还可能从皮肤穿出。打结过程中的持针操作易导致外科医生手套穿孔。一种倒刺缝线被研发出来，它可自行固定，伤口缝合时无需打结或处理缝线松弛问题。与传统伤口缝合方法相比，省去打结操作可能具有优势。
本前瞻性、随机、对照试验旨在表明，在非急诊剖宫产手术中，使用倒刺缝线对Pfannenstiel切口进行真皮层缝合，术后5周产生的瘢痕美观程度不劣于使用3-0聚二氧杂环己酮缝线进行传统缝合的情况。由一名不知情的独立整形外科医生通过查看术后照片，使用改良的霍兰德美观评分法对美观程度进行评估。次要终点包括感染、裂开、疼痛、缝合时间及其他不良事件。
该研究共纳入195例患者，其中188例符合分析条件。倒刺缝线组与对照组的美观评分无显著差异。两组的感染率、裂开率及其他不良事件发生率无显著差异。两组的缝合时间和疼痛评分相当。
倒刺缝线是一种创新的伤口缝合选择。其美观度和安全性与传统缝合技术相似，避免了缝线结固有的缺点。
