Lebanon, N.H. From the Section of Plastic Surgery and the Dartmouth-Hitchcock Leadership Preventive Medicine Residency Program, Dartmouth Hitchcock Medical Center.
Plast Reconstr Surg. 2010 Jan;125(1):186-194. doi: 10.1097/PRS.0b013e3181c2a492.
Technological innovations are often adopted before scientific comparison to an accepted standard. The authors' study compared suture with a new coaptive film device, 3M Steri-Strip S Surgical Skin Closure, on linear incisions.
Patients undergoing Wise-pattern breast reduction or abdominal procedures had paired incisions randomly assigned to Steri-Strip S or suture closure. Key outcome measures were closure time, patient comfort, and scar quality at 6 months by patients and surgeons using a new scar evaluation tool, visual assessment of linear scars. Statistical differences between the two closure techniques were assessed by Wilcoxon signed rank test.
Of 59 patients, eight were excluded from randomization (a surgeon judged Steri-Strip S to be a nonviable closure technique for mismatched wound edges). Fifty-one patients (breast, n = 24; abdomen, n = 27) were randomized. Operative time with Steri-Strip S for breast was 2.0 minutes (SD = 1.1) versus suture closure at 4.6 minutes (SD = 1.5; p < 0.001). Similarly, Steri-Strip S versus suture for the abdomen was faster (p < 0.001; 4.9 minutes, SD = 2.3 versus 10.1 minutes, SD = 3.4). Comfort scores did not differ between closures [5.8 (SD = 2.7) versus 6.9 (SD = 2.0), respectively, on breast (p = 0.142) and 7.7 (SD = 1.8) versus 7.7 (SD = 2.3) on abdomen (p = 0.903)]. Complication rates did not differ between closure types. Patients' visual assessment of linear scars rating of breasts was 3.8 (SD = 2.9) for Steri-Strip S and better at 2.6 (SD = 2.9) for suture (p = 0.008). One surgeon rated breast Steri-Strip S scars worse than suture scars (4.3 versus 3.7; p = 0.014). For abdominal scars, there was no difference in the patient or surgeon ratings.
Steri-Strip S permits faster wound closure than suture. On the basis of patient reports of comfort and scar quality, surgeons increase efficiency and maintain quality with the use of Steri-Strip S on abdominal wounds but not on breast wounds.
技术创新通常在与公认标准进行科学比较之前就被采用。作者的研究比较了缝线与一种新的贴合膜装置(3M Steri-Strip S 外科皮肤闭合器)在直线切口上的应用。
接受 Wise 模式乳房缩小术或腹部手术的患者,其切口采用随机分组,分别接受 Steri-Strip S 或缝线闭合。主要结局指标是由患者和外科医生使用新的疤痕评估工具(线性疤痕视觉评估)在 6 个月时评估的闭合时间、患者舒适度和疤痕质量。通过 Wilcoxon 符号秩检验评估两种闭合技术之间的统计学差异。
59 例患者中,8 例因(外科医生认为 Steri-Strip S 对不匹配的伤口边缘不是可行的闭合技术)被排除在随机分组之外。51 例患者(乳房,n = 24;腹部,n = 27)被随机分组。乳房使用 Steri-Strip S 的手术时间为 2.0 分钟(SD = 1.1),而缝线闭合时间为 4.6 分钟(SD = 1.5;p < 0.001)。同样,Steri-Strip S 与腹部缝线相比更快(p < 0.001;4.9 分钟,SD = 2.3 与 10.1 分钟,SD = 3.4)。在乳房(分别为 5.8(SD = 2.7)和 6.9(SD = 2.0),p = 0.142)和腹部(分别为 7.7(SD = 1.8)和 7.7(SD = 2.3),p = 0.903),舒适度评分在两种闭合之间没有差异。两种闭合类型的并发症发生率没有差异。患者对线性疤痕的视觉评估,乳房 Steri-Strip S 的评分是 3.8(SD = 2.9),缝线的评分是 2.6(SD = 2.9)(p = 0.008)。一位外科医生对乳房 Steri-Strip S 疤痕的评分低于缝线疤痕(4.3 比 3.7;p = 0.014)。对于腹部疤痕,患者和外科医生的评分没有差异。
Steri-Strip S 比缝线更能快速闭合伤口。基于患者对舒适度和疤痕质量的报告,外科医生使用 Steri-Strip S 闭合腹部伤口可以提高效率并保持质量,但在乳房伤口上则不然。