A multicenter randomized controlled trial comparing absorbable barbed sutures versus conventional absorbable sutures for dermal closure in open surgical procedures.

BACKGROUND: Barbed sutures were developed to reduce operative time and improve security of wound closure. OBJECTIVE: The authors compare absorbable barbed sutures (V-Loc, Covidien, Mansfield, Massachusetts) with conventional (smooth) absorbable sutures for soft tissue approximation. METHOD: A prospective multicenter randomized study comparing barbed sutures with smooth sutures was undertaken between August 13, 2009, and January 31, 2010, in 241 patients undergoing abdominoplasty, mastopexy, and reduction mammaplasty. Each patient received barbed sutures on 1 side of the body, with deep dermal sutures eliminated or reduced. Smooth sutures with deep dermal and subcuticular closure were used on the other side as a control. The primary endpoint was dermal closure time. Safety was assessed through adverse event reporting through a 12-week follow-up. RESULTS: A total of 229 patients were ultimately treated (115 with slow-absorbing polymer and 114 with rapid-absorbing polymer). Mean dermal closure time was significantly quicker with the barbed suture compared with the smooth suture (12.0 vs 19.2 minutes; P<.001), primarily due to the need for fewer deep dermal sutures. The rapid-absorbing barbed suture showed a complication profile equivalent to the smooth suture, while the slow-absorbing barbed suture had a higher incidence of minor suture extrusion. CONCLUSIONS: Barbed sutures enabled faster dermal closure quicker than smooth sutures, with a comparable complication profile. LEVEL OF EVIDENCE: 1.

Outpatient lipoabdominoplasty: review of the literature and practical considerations for safe practice.

BACKGROUND: Lipoabdominoplasty, popularized by Saldanha et al in 2001, is a powerful technique to contour the abdomen and flanks. It has not gained widespread use as concerns exist about increased complications related to wound healing and thromboembolism. OBJECTIVES: The authors review the existing literature on lipoabdominoplasty and discuss their experiences with the technique in a retrospective case series. METHODS: A literature search of PubMed/MEDLINE using the search terms lipoabdominoplasty and abdominoplasty was performed by 2 independent investigators. The charts of 85 consecutive patients who underwent lipoabdominoplasty between February 2007 and July 2012 were reviewed. RESULTS: A combined 1316 lipoabdominoplasty patients had results reported in the literature. Of these patients, 21 of 1316 (1.6%) developed seroma, 5 of 1032 (0.5%) experienced hematoma, 6 of 1032 (0.6%) experienced venous thromboembolism, and 3 of 1032 (0.3%) developed pulmonary embolism. In our case series, all patients were women with an average age of 48 years (range, 27-70 years), average body mass index of 25.2 (17.7-35.5), average follow-up of 8 months (range, 1-54 months), average lipoaspirate of 1605 mL (range, 150-5350 mL), and average weight of resected tissue of 1039 g (range, 128-4838 g). The average operative time was 225 minutes (range, 88-435 minutes), and average time in recovery prior to discharge was 124 minutes (range, 33-270 minutes). Seroma occurred in 20 of 85 patients, 1 patient developed deep venous thrombosis (DVT), 1 patient developed cellulitis, and 1 patient developed an abscess. CONCLUSION: Lipoabdominoplasty is a safe and effective procedure in appropriately selected patients. Performing the procedure in an outpatient setting requires attention to multiple factors in the perioperative period to ensure safe patient outcomes. Larger prospective studies should be performed to evaluate best practices regarding rare complications such as DVT or pulmonary embolism.

Preferences of healthy inner city women and the surgical treatment of early stage breast cancer.

Numerous studies have shown that women of a lower education level and socioeconomic status use less breast-conserving surgery than women of a higher education level and socioeconomic status. Surveys of healthy women and the surgical treatment of early stage breast cancer have been performed. However, no survey has focused exclusively on inner city women. The objective of this study was to determine the awareness, preferences, and concerns of inner-city, multiethnic women and the surgical treatment of stage I and II breast cancer, and to identify if a distinct treatment preference for mastectomy or lumpectomy exists in such a population. The study consisted of a prospective survey of volunteers, age 18 years and older, in the nononcologic clinics of St. Barnabas Hospital in the Bronx, New York. We consecutively surveyed 200 women between the ages of 18 and 75 using a 12-item form from January 2004 to May 2004. Of 200 surveys, 21 were excluded as incomplete and two women surveyed who gave a prior history of breast cancer were excluded from study, leaving 177 total surveys for analysis. Women were presented with a hypothetical diagnosis of early stage breast cancer curable by mastectomy or lumpectomy and radiation therapy. Women were asked about their surgery preferences, who they would seek advice from, if they would let their physician decide treatment, and their concerns if faced with a diagnosis of breast cancer. One hundred seventy-seven completed surveys were obtained; 124 (70%) women chose lumpectomy and radiation, 48 (27%) chose mastectomy, and 5 (3%) chose no treatment. Women who were educated below the collegiate level were more likely to prefer breast conservation therapy compared with those with a college education and above (adjusted OR 1.8, 95% CI 1.0, 3.6). Overall, most women surveyed (62%) were concerned with cancer recurrence followed by the side effects of radiation therapy (19%). Most women surveyed (63%) would make their physician principal advisor, whereas some (23%) would make their significant other the principal advisor. More women who chose mastectomy would make their physician their principal advisor (80%) versus those who chose lumpectomy (65%). More than 80 per cent of the women surveyed would have their physician decide their treatment. The women in the present study exhibited a distinct preference for breast conservation therapy over mastectomy.