Therapeutic downregulation of neuronal PAS domain 2 (Npas2) promotes surgical skin wound healing

Attempts to minimize scarring remain among the most difficult challenges facing surgeons, despite the use of optimal wound closure techniques. Previously, we reported improved healing of dermal excisional wounds in circadian clock neuronal PAS domain 2 (Npas2)-null mice. In this study, we performed high-throughput drug screening to identify a compound that downregulates Npas2 activity. The hit compound (Dwn1) suppressed circadian Npas2 expression, increased murine dermal fibroblast cell migration, and decreased collagen synthesis in vitro. Based on the in vitro results, Dwn1 was topically applied to iatrogenic full-thickness dorsal cutaneous wounds in a murine model. The Dwn1-treated dermal wounds healed faster with favorable mechanical strength and developed less granulation tissue than the controls. The expression of type I collagen, Tgfb1, and a-smooth muscle actin was significantly decreased in Dwn1-treated wounds, suggesting that hypertrophic scarring and myofibroblast differentiation are attenuated by Dwn1 treatment. NPAS2 may represent an important target for therapeutic approaches to optimal surgical wound management.

Wound Closure Skills: Teaching Suturing in Athletic Training Education

Context The examination, diagnosis, and intervention curricular content listed in the 2020 Commission on Accreditation of Athletic Training Education Standards for Accreditation of Professional Athletic Training Programs states that learners must be able to evaluate and manage wounds, including care and closure. Although many wound closure techniques exist in clinical practice, suturing may be a necessary skill for athletic trainers (ATs) and one for which they need proper training. Objective To describe the instructional format and step-by-step process for wound closure using the “simple interrupted” method of suturing. Background Athletic training has continued to evolve in terms of the skills that are permitted within the scope of an AT's practice. The skill of wound closure via suturing has been omitted in athletic training programs due to the invasive nature of the technique. As state practice acts continue to adapt, many athletic training programs are adding suturing to their curricular content, and subsequently, a need exists to educate the credentialed AT. Description A multimodal approach to teaching suturing is recommended. This educational technique focuses on the cognitive introduction module that should occur before the skills lab. Step-by-step instructions are available to ensure that educators are able to properly train others in the task and for learners to gain a baseline understanding of the technique. Clinical Advantage(s) Described herein are multiple strategies related to supplies and techniques to be mindful of the resources available for other athletic training programs. In addition, ATs who are trained and permitted to suture can provide improved patient outcomes through comprehensive interventions at the point of care. Conclusion(s) Learners should be taught the skills of suturing including wound cleaning and anesthetizing and given opportunities to practice the skills over time. By providing budget-conscious options and alternative methods of instruction, this skill can be delivered for most programs.

Wound Management following Total Knee Arthroplasty: An Updated Review

Optimal wound closure techniques following total knee arthroplasty (TKA) have focused on enhancing healing potential, preventing infection, yielding satisfactory cosmesis, and allowing early ambulation and functionality. An appropriate layered closure and management of the TKA typically involves addressing the (1) deep fascial layer; (2) subdermal layer; (3) intradermal layer, including the subcuticular region; and (4) final application of a specific aseptic dressing, each of which are covered here in detail. This focused critical review of the literature discusses traditional techniques used in all layers of wound closure following TKA while introducing several emerging popular techniques. For example, absorbable barbed skin sutures and occlusive dressings have the potential to reduce operative time, limit the need for early postoperative visits, obviate the need for suture or staple removal, and safely promote patient communication via telemedicine. As novel wound closure techniques continue to emerge and traditional approaches are improved upon, future comparative studies will assist in elucidating the key advantages of various options. In an extremely important field that has tremendous variability, these efforts may enable the reaching of a classically elusive standard of care for these techniques.

934 Remote one-to-one virtual surgical skills training: Evolving the delivery of operative skills training in the UK

Introduction COVID-19 has had an unprecedented effect on surgical training, including prerequisite entry-level courses to speciality training. We describe the implementation of a virtual, one-to-one training programme aimed at the acquisition and retention of operative skills. Methods Enrolment commenced 8th May 2020 for wound closure techniques or an extended programme including tendon repairs, delivered by Specialist Registrars in Plastic Surgery using Zoom® (v. 5.0.5) via mobile device. Participant feedback was collected retrospectively using a 5-point scale following course completion. Results 5 participants completed the wound closure programme, and 3 the extended programme, over an average of 5 weeks, with 2 sessions per week. 5 participants were male, 3 female and were of the following grades: 2 CT2, 4 FY2, 1 FY1 and 1 medical student. A total of 103.5 hours of training was recorded to 7 September 2020. Participants reported that all virtual skills taught were readily transferable to the theatre environment. Following the course, all participants felt confident to complete the skills learnt independently, rating the course as excellent. Conclusions The COVID-19 crisis has placed insurmountable obstacles in the face of surgical training. With further validation, we aim to develop surgical skills training with virtual, easily reproducible, cost-effective, trainee centred programmes.

Practice of wound closure techniques among emergency physicians and surgeons in Makkah City Hospitals in Saudi Arabia

Background: Wound suturing is a procedure performed by medical and surgical specialists. While there are many different suturing techniques and materials used to treat patients, the choice of which to employ depends on different variables that affect the outcome of the procedure.Design and Methods: This is a cross-sectional study conducted to provide descriptive data regarding the practice of wound closure techniques, and to develop an awareness of scar formation factors. A total of 172 general surgery (GS) surgeons and emergency (EM) physicians in Makkah city hospitals in Saudi Arabia participated in the study.Results: More than 50% of the practitioners favored the simple interrupted technique for the treatment of all types of studied wounds. The other most common techniques among participants were the subcuticular and vertical mattress methods, respectively, while the use of a stapler was limited to certain wound types. Regarding suturing material, polyglycolic acid was the most frequent material used by 50.1% of participants, whereas only 22% of the participants selected nylon material for wound suturing. However, this study showed a good level of awareness among participants, with significant p-values (p<0.05) of strongly agree and agree regarding the essential factors affecting wound healing and scar formation.Conclusions: The result provides insight into the most common suture techniques and materials used in wound closure. There are wide variations in selecting these techniques and materials among the participants. Also, we found that there is good awareness among participants about factors that lead to scar formation.

Analysis of the effectiveness of wound closure techniques among surgeons and emergency physicians in Mecca Hospitals: Retrospective Cohort Study.

The authors have requested that this preprint be withdrawn due to erroneous posting.

Analysis of the effectiveness of wound closure techniques among surgeons and emergency physicians in Mecca Hospitals: Retrospective Cohort Study.

Objective: Wound suturing is a procedure performed at many medical specialties. This study aims to analyze the effectiveness of wound closure techniques by recognizing the common suturing techniques and materials used in different types of wounds among surgeons and emergency physicians in Mecca hospitals and assessing their awareness about the factors contributing to scars formation and improper wound healing.Result: Choosing the simple interrupted technique exceeded 50% among all other types of studied wounds. The other most common techniques among participants were the subcuticular and vertical mattress, respectively, also using stapler was limited to some wound types. This study showed a high level of awareness among participants with significant p-values (P<0.05) of Strongly agree and Agree regarding the essential factors affecting wound healing and scars formation. The result gives an insight into the most common suture techniques and materials used in wound closure. There are wide variations in selecting these techniques and materials among the participants. Also, it showed that there is good awareness among participants about factors that lead to scar formation.

Analysis of the effectiveness of wound closure techniques among surgeons and emergency physicians in Mecca Hospitals: Retrospective Cohort Study

Objective: Wound suturing is a procedure performed at many medical specialties. This study aims to analyze the effectiveness of wound closure techniques by recognizing the common suturing techniques and materials that used in different type of wounds among surgeons and emergency physicians and to assess the rate of scars formation among their patients in-Mecca City Hospitals, Saudi Arabia.Results:Every participant selects and prefers some methods in wound closure over other methods. Choosing the simple interrupted technique exceeded 50% for all types of studied wounds. The other most common techniques among participants were subcuticular and vertical mattress respectively, also using stabler was limited to some wound types with less percentage than other suture techniques. Regarding suturing material, there are many materials alternatives were selected for the studied wounds such as 23% of participants used Monocryl for eyelid wounds, and 6% for breast wounds, also 9% of participants were using Polypropylene for scalp wounds and 8% for eyelids wounds. This study showed a high level of awareness among participants with a significant p-values regarding the important factors affecting wound healing and scare formation.

Barbed Sutures in Total Knee Arthroplasty: A Meta-analysis of Randomized-Controlled Trials

Newer methods of wound closure such as barbed sutures hold the potential to reduce closure time and equivalent wound complications in various surgeries. However, few studies have compared barbed suture and conventional wound closure techniques in total knee arthroplasty (TKA). The purpose of this review was to appraise the efficacy and safety of the barbed suture in closure of TKA. We conducted a meta-analysis to identify relevant randomized-controlled trials involving barbed sutures and conventional sutures in TKA in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, Wanfang database, up to August 2019. Finally, we identified 1,472 TKAs (1,270 patients) assessed in 13 randomized-controlled trials. Compared with conventional wound closure techniques, barbed sutures resulted in shorter total wound closure time (p < 0.001), fewer needle puncture injuries to members of the surgical team (p = 0.02). There were no significant differences in terms of blister formation (p = 1.0), superficial infection (p = 0.82), range of motion (p = 0.94), incisional exudate (p = 0.75), suture abscess (p = 0.26), or suture breakage (p = 0.11), wound-related complications (p = 0.10), ecchymosis (p = 0.08) between barbed and conventional wound closure. Based on the available level I evidence, we thus conclude that a knotless barbed suture is a safe and effective approach for wound closure in TKA. Given the relevant possible biases in our meta-analysis, more adequately powered and better-designed randomized-controlled trials studies with long-term follow-up are required to recommend barbed sutures for routine administration in TKA.