Use of a Novel Adhesive Suture Retention Device in Lower Leg Excisional Wound Closure

A Retrospective Review

Windy Cole, DPM, CWSP; Whitney Fancher, MD; Allison Stoecker, DO; Stephanie Howerter, DO; William Lear, MD

Disclosures

Wounds. 2021;33(9):222-225. 

In This Article

Abstract and Introduction

Abstract

Introduction: Lower extremity excisional wound closures are associated with complications, including infection, delayed wound healing, skin tearing after suture placement, and dehiscence. Use of a novel adhesive suture retention device (ASRD) has previously been shown to support fragile skin under high tension and improve linear closure.

Objective: A retrospective analysis of lower extremity excisional wounds was performed to investigate the effect of adopting ASRD on rate of wound closure and adverse events.

Materials and Methods: A retrospective chart review from 2 Mohs surgical practices was conducted. The chart review assessed the differences before and after adopting ASRD in linear closure rates, wound healing, and dehiscence rates for lower extremity post-surgical full-thickness wounds of at least 1.0 cm diameter in patients aged 18 years or older. In all cases, the authors shared the same surgical techniques, including limited undermining and use of buried dermal polyglactin sutures. In all ASRD cases, the device was used with 2–0 nylon retention sutures.

Results: Adoption of ASRD was associated with a significantly faster time to healing (P < .001). Dehiscence was significantly more commonly seen in the pre-ASRD cohort (24% vs 3%, P = .03). Infection was also more common in the pre-ASRD cohort; however, the difference was not statistically significant (18% vs 3%, P = .09).

Conclusions: Utilization of ASRD decreased the incidence of lower extremity wound dehiscence and resulted in faster healing times after Mohs surgery.

Introduction

Management of lower extremity excisional wounds can be complicated by the inability of the skin to withstand suturing, thus leading to surgical wound dehiscence (SWD). Surgical wound dehiscence can be a result of suture breakage, poor incisional or flap design, and/or closure under tension.[1] Decreases in dermal collagen integrity occur with age and can result in friable skin that can easily separate with sutures alone.[1] Despite this known complication, primary closure of lower extremity excisional wounds has been shown to have significantly fewer complications than split-thickness skin grafting.[2] Secondary intention healing has been shown to have better functional and aesthetic outcomes compared with split-thickness skin grafts (STSG) but at the expense of significantly longer healing times.[2] Secondary healing may take up to 3 months in healthy patients and longer in patients with increased risk factors for poor healing (eg, peripheral edema, venous insufficiency, diabetes).[2,3]

Health care spending has increased substantially, with the Centers for Medicare & Medicaid Services projecting health spending to continue to rise to 20.1% of gross domestic product by 2025.[4] Health care systems are initiating proactive approaches to help mitigate the cost of surgical complications. New and innovative devices that can help curb costs, decrease adverse events, and increase the value of care are a sought-after commodity. Recently launched, the adhesive suture retention device (ASRD) can potentially improve surgical outcomes over the use of glue-based or tape-based products to bolster skin wounds under high tension and allow for uncomplicated linear closure.[5] This device allows for increased peak suture tension prior to ripping human skin and, in some cases, can be used to close wounds in which the skin had been torn by traditional sutures.[5]

This study examined the period of transition from standard of care linear excisional wound closure to ASRD-assisted skin closure in 2 Mohs surgical practices. A retrospective analysis of lower extremity excisional wounds was performed to investigate the effect of adopting the ASRD on rate of wound closure and adverse events such as SWD and infections.

processing....