Wound Closure after Thyroid and Parathyroid Surgery: A Meta-Analysis of Randomized Controlled Trials

Huang, Yu‐Chen; Chen, C.; Lee, C.-H.; Loh, El Wui; Tam, Ka‐Wai

doi:10.1177/1457496918798203

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…Huang et al . 23 performed a meta-analysis of nine RCTs, which included 612 patients, and illustrated the cosmetic advantage associated with using subcutaneous sutures to improve cosmesis versus staples. While these analyses provide some clarity with respect to cosmetic outcomes after thyroid and parathyroid neck closures, the present study reports the combined surgical and patient-reported outcomes of 18 RCTs through the adoption of NMA methodology of six different primary closure methods after neck surgery.…”

Section: Discussionmentioning

confidence: 99%

“…While there have been previous systematic reviews and meta-analyses performed for determining the optimal wound closure 22 , 23 , there are several shortcomings to such studies: failure to include all available RCT data to inform outcomes; 22 and failure to implement a network meta-analysis (NMA) methodology to ensure robust evaluation of all potential closure methods. The advantage of an NMA is the simultaneous comparison of more than two treatments with a control or standard-of-care option 24 , 25 .…”

Section: Introductionmentioning

confidence: 99%

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Optimal primary wound closure methods after thyroid and parathyroid surgery: network meta-analysis of randomized clinical trials

et al. 2023

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Background At present, there is no consensus on optimal neck wound closure methods after thyroid and parathyroid surgery. The aim of this study was to perform a systematic review and network meta-analysis of RCTs evaluating the optimal neck closure method after thyroid and parathyroid surgery. Methods A frequentist random-effects network meta-analysis was performed for RCTs comparing at least two closure methods according to PRISMA-network meta-analysis guidelines. Analysis was performed using R packages and Shiny. Results Eighteen RCTs evaluating six closure methods (that is adhesive (28.5 per cent, 404 patients), absorbable subcuticular suture (18.1 per cent, 257 patients), non-absorbable subcuticular suture (16.8 per cent, 238 patients), staples (26.3 per cent, 372 patients), steristrips (8.1 per cent, 115 patients), and conventional suture (2.1 per cent, 30 patients)) in 1416 patients were included. At network meta-analysis, there was no difference in complication, infection, dehiscence, or haematoma rates irrespective of closure method used. Staples reduced closure duration versus absorbable subcuticular suture (mean difference (MD) 8.50, 95 per cent c.i. 6.90 to 10.10) and non-absorbable subcuticular suture (MD 0.30, 95 per cent c.i. 0.23 to 0.37), whereas adhesives (MD −1.05, 95 per cent c.i. −1.31 to −0.79) reduced closure time relative to staples. Cosmesis was improved after non-absorbable subcuticular suture (odds ratio (OR) 3.41, 95 per cent c.i. 1.66 to 7.00) relative to staples. Staples reduced patient satisfaction (OR 0.04, 95 per cent c.i. 0.00 to 0.33) and ability to shower (OR 0.04, 95 per cent c.i. 0.00 to 0.33) relative to adhesives. Conclusion Despite staples decreasing closure times, this advantage is offset by reduced patient satisfaction, ability to shower, and cosmesis compared with patients with wounds closed using adhesives, absorbable subcuticular suture, and non-absorbable subcuticular suture. Therefore, these closure methods are favourable for closing neck wounds due to more acceptable patient-reported outcomes, without compromising the safety of the procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimal primary wound closure methods after thyroid and parathyroid surgery: network meta-analysis of randomized clinical trials

et al. 2023

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“…The degree of scar hyperplasia after cleft lip surgery was positively correlated with anxiety [ 1 ]. The prevention and treatment of scar hyperplasia have been of great interest in cleft lip operations, and have been addressed by various means ranging from surgical suture materials to postoperative laser treatment [ 2 – 4 ]. However, current therapeutic measures were inadequate to resolve skin wound scar hyperplasia.…”

Section: Introductionmentioning

confidence: 99%

Inhibition of p38 mitogen-activated protein kinases may attenuate scar proliferation after cleft lip surgery in rabbits via Smads signaling pathway

Ding,

Yue,

Xue

et al. 2022

Eur J Med Res

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Background Cleft lip repair surgery always results in visible scarring. It has been proved that scar formation can be reduced by inhibiting the p38 mitogen-activated protein kinases (p38MAPKs) signaling pathway. However, the interaction between p38MAPK and Smads in scar formation is still controversial. Methods This study was designed to investigate whether inhibition of p38MAPK reduces postoperative scar formation of cleft lips on rabbits via the Smads signaling pathway. Scar models in rabbits after cleft lip surgery were created and their fibroblasts were extracted. Then the expression of p38MAPK was disturbed by adenovirus in vitro and Vivo. The scar thickness was measured and scar tissues were excised for Sirius red staining and immunohistochemistry to detect the expression of type I collagen (col I), type III collagen (col III), and α-smooth muscle actin (α-SMA). The underlying mechanisms of p38MAPK knockdown on the extracellular matrix and Smad signaling pathway were invested in vitro using the EdU assay, Western blot, RT PCR, and immunofluorescence. Results p38MAPK knockdown suppresses the expression of p-smad3 and p-smad2 in fibroblasts, modulating the expression of its target genes, such as α-SMA, col I, and col III. When Ad-P38MAPK-1 was injected into lip scar, it reduced the expression of scar-related genes and scar thickness when compared to the negative control groups. Conclusions In rabbits, inhibiting p38MAPK expression prevents scar proliferation through inhibiting the Smad signaling pathway after cleft lip surgery.

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“…1 Such concerns may cause self-consciousness in individuals undergoing cervicotomy (e.g., anterior neck surgery) for either thyroid or parathyroid disease. 2 Recent studies on reducing scar post-cervicotomy have utilized different techniques for surgical closure such as the use of synthetic glue, subcuticular and intradermal absorbable sutures, or adhesive strips. 3 , 4 However, a modest to no significant effect on reducing SF were reported; thus, aesthetic outcomes are still suboptimal and an alternative option might be able to address this gap.…”

Section: Introductionmentioning

confidence: 99%

Continuous Diffusion of Oxygen Adjunct Therapy to Improve Scar Reduction After Cervicotomy – A Proof of Concept Randomized Controlled Trial

Zulbaran-Rojas

Mishra

Pham

et al. 2021

Journal of Surgical Research

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Background: Dressing materials are known to influence post-operative surgical wound healing and scar formation (SF). A particular dressing that could promote wound hydration is essential to ensure quick epithelialization and reduce SF. This study examined the effectiveness of a novel Continuous Diffusion of Oxygen (CDO) dressing to reduce scar length post cervicotomy.Methods: A randomized controlled trial was performed in patients undergoing cervicotomy, either for thyroid or parathyroid disease. Patients were randomized to either control (CG) or intervention (IG) groups. The IG received a portable CDO system (TransCu O2, EO2 Concepts Inc., TX, USA), whereas the CG received a standard dressing for a 4-week period. The primary outcome was > 10% of scar length reduction and %change in scar length.Results: 21 patients were recruited (Age: 53 ± 16 years; 90% female; CG = 9, IG = 12). 5 patients were lost to follow-up. At 4 weeks, 88.8% of the IG significantly achieved > 10% of scar reduction (versus CG = 28.5%, d = 0.48, P = 0.049), showing a 40.4% smaller scar (15.7% versus 11.2%, d = 0.13, P = 0.72) compared to the CG. However, the difference was not significant. A sub-sample of patients undergoing thyroidectomy showed a significant scar reduction using CDO (IG = 11.6% versus CG = 5.1%, d = 2.96, P = 0.009).Conclusions: This is the first study to assess scar reduction using CDO adjunct therapy after cervicotomy. Advanced CDO dressings may assist wound healing showing improved out-

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Wound Closure after Thyroid and Parathyroid Surgery: A Meta-Analysis of Randomized Controlled Trials

Cited by 6 publications

References 19 publications

Optimal primary wound closure methods after thyroid and parathyroid surgery: network meta-analysis of randomized clinical trials

Optimal primary wound closure methods after thyroid and parathyroid surgery: network meta-analysis of randomized clinical trials

Inhibition of p38 mitogen-activated protein kinases may attenuate scar proliferation after cleft lip surgery in rabbits via Smads signaling pathway

Continuous Diffusion of Oxygen Adjunct Therapy to Improve Scar Reduction After Cervicotomy – A Proof of Concept Randomized Controlled Trial

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