Deo Jaspreet Kaur, Mehra Pravesh, Sharma Rakesh, Rehan Harmeet Singh
Lady Hardinge Medical College, New Delhi, Delhi India.
J Maxillofac Oral Surg. 2024 Feb;23(1):81-87. doi: 10.1007/s12663-023-02000-8. Epub 2023 Oct 10.
The choice of wound closure material may influence the clinical outcomes of intra-oral incision closure. Studies evaluating the application of barbed suture in the oral cavity are scarce. Hence, the present study was carried out with the aim to monitor and compare the efficacy and ease of handling of monofilament polyglycolide caprolactone (PGCL) unidirectional barbed and non-barbed sutures used for intra-oral incision closure in patients undergoing transalveolar extraction of impacted mandibular third molar and mandible fracture open reduction internal fixation.
A prospective randomized open label study was carried out among subjects requiring intra-oral incision closure following mandibular third molar extraction and isolated mandible fracture fixation. The difficulty index of the impacted third molars was evaluated pre-operatively. Subjects were randomized to receive either 3-0 monofilament PGCL unidirectional barbed or non-barbed sutures. Incision closure time and ease of suture handling were recorded intra-operatively. Post-operatively, patients were monitored for incision healing using the Hollander wound evaluation scale (HWES) and intensity of pain using visual analog scale (VAS) on post-operative days 1, 3 and 7. Data analysis involved descriptive statistics, Chi-square, unpaired t test and multivariate analysis using the IBM SPSS-PC software (v.25.0).
A total of 60 subjects completed the study protocol, who were randomized into two groups (1 = 2 = 30), comparable in terms of age, gender and treatment (TAE = 51; ORIF = 9) received. The incision healing outcomes were significantly better ( = 0.016) with barbed suture using HWES on day 7. The mean closure time using barbed suture (142.50 ± 34.803 secs) was significantly ( = 0.001) shorter than that with non-barbed suture (204.56 ± 52.94 secs). The mean VAS for the barbed suture (0.97 ± 1.89) was less ( = 0.015, 95% CI) than the non-barbed suture (2.50 ± 2.91) on day 3. The suture handling ease was comparable between the two groups.
Monofilament unidirectional PGCL barbed suture has merits over the non-barbed suture with regards to superior post-operative incision healing, reduced incision closure time (43%), lower post-operative pain and comparable ease of suture handling. Hence, knotless PGCL suture is a promising alternative for intra-oral surgical incision closure in oral and maxillofacial surgery.
伤口闭合材料的选择可能会影响口腔内切口闭合的临床效果。评估倒刺缝线在口腔中应用的研究较少。因此，本研究旨在监测和比较单丝聚乙醇酸己内酯（PGCL）单向倒刺缝线和非倒刺缝线在接受经牙槽拔除下颌阻生第三磨牙及下颌骨骨折切开复位内固定术患者的口腔内切口闭合中的疗效和操作便利性。
对需要在拔除下颌第三磨牙及单纯下颌骨骨折固定后进行口腔内切口闭合的受试者进行一项前瞻性随机开放标签研究。术前评估阻生第三磨牙的难度指数。受试者被随机分为接受3-0单丝PGCL单向倒刺缝线或非倒刺缝线。术中记录切口闭合时间和缝线操作的便利性。术后，在术后第1、3和7天使用霍兰德伤口评估量表（HWES）监测患者切口愈合情况，并使用视觉模拟量表（VAS）评估疼痛强度。数据分析采用描述性统计、卡方检验、独立样本t检验以及使用IBM SPSS-PC软件（v.25.0）进行多变量分析。
共有60名受试者完成了研究方案，他们被随机分为两组（每组30人），在年龄、性别和接受的治疗方面（经牙槽拔除术=51例；切开复位内固定术=9例）具有可比性。使用HWES评估，在第7天时，倒刺缝线的切口愈合结果明显更好（P=0.016）。使用倒刺缝线的平均闭合时间（142.50±34.803秒）明显（P=0.001）短于非倒刺缝线（204.56±52.94秒）。在术后第3天，倒刺缝线的平均VAS评分（0.97±1.89）低于非倒刺缝线（2.50±2.91）（P=0.015，95%置信区间）。两组之间的缝线操作便利性相当。
单丝单向PGCL倒刺缝线在术后切口愈合更好、切口闭合时间缩短（43%）、术后疼痛减轻以及缝线操作便利性相当方面优于非倒刺缝线。因此，无结PGCL缝线是口腔颌面外科口腔内手术切口闭合的一种有前景的替代方法。
