Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Vascular & Interventional Radiology, Singapore General Hospital, Singapore; Division of Radiological Sciences, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore.
Clin Radiol. 2022 Aug;77(8):628-635. doi: 10.1016/j.crad.2022.04.014. Epub 2022 Jun 1.
To compare peri-operative outcomes of skin closure with octyl cyanoacrylate (OCA) skin adhesive (Dermabond) with or without subcuticular sutures after deep dermal suturing for implantable venous port placement closure.
Seven hundred and ninety-two single-lumen implantable venous port insertions for chemotherapy were reviewed from September 2019 to March 2021 in a retrospective single-centre study. Propensity-score matching by a 1:1 nearest neighbour algorithm was conducted to control for confounding baseline differences. Distances were determined by logistic regression. Propensity-score matching was performed based on the following variables: age at procedure, gender, race, operator's seniority, use of anchoring polypropylene suture (PROLENE), port model, and volume of intra-operative local analgesia. The primary outcome was wound dehiscence at the first follow-up (∼1 week).
The 792 port insertions were conducted in 302 males (38.1%), median age 63 years (IQR: 54-69). Of the 656 wounds closed with subcuticular sutures and skin adhesive, 136 were matched in a 1:1 fashion against procedures closed without a subcuticular suture. No significant differences were demonstrated in pain scores, bleeding, swelling, bruising, fever, wound dehiscence, and discharge at postoperative day 1 (POD1) and at first follow-up between the groups (all p>0.05). Of note, no significant differences in wound dehiscence at first follow-up was found in both unmatched (p=0.133) and matched cohorts (McNemar-Bowker's χ = 1.167, p=0.761).
These findings suggest that the omission of subcuticular sutures during implantable venous port closure may not compromise peri-operative outcomes when OCA skin adhesives were used.
比较在真皮缝合后使用辛基氰基丙烯酸酯(OCA)皮肤粘合剂(Dermabond)进行皮肤闭合,以及是否联合皮内缝线在植入式静脉港放置关闭中的围手术期结果。
在一项回顾性单中心研究中,回顾了 2019 年 9 月至 2021 年 3 月期间 792 例用于化疗的单腔植入式静脉港插入术。采用 1:1 最近邻算法进行倾向评分匹配,以控制混杂的基线差异。距离通过逻辑回归确定。倾向评分匹配基于以下变量进行:手术时的年龄、性别、种族、术者的资历、使用锚固聚丙烯缝线(Prolene)、港型号和术中局部镇痛的体积。主要结局是第一次随访(约 1 周)时的伤口裂开。
792 个港插入术在 302 名男性(38.1%)中进行,中位年龄为 63 岁(IQR:54-69)。在 656 例使用皮内缝线和皮肤粘合剂闭合的伤口中,有 136 例以 1:1 的比例与未使用皮内缝线闭合的手术相匹配。在术后第 1 天(POD1)和第一次随访时,两组之间的疼痛评分、出血、肿胀、瘀伤、发热、伤口裂开和引流均无显著差异(均 p>0.05)。值得注意的是,在未匹配和匹配队列中,第一次随访时的伤口裂开差异均无统计学意义(p=0.133)和匹配队列(McNemar-Bowker χ2=1.167,p=0.761)。
这些发现表明,在使用 OCA 皮肤粘合剂时,在植入式静脉港关闭时省略皮内缝线可能不会影响围手术期结果。