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Randomized Trial of 3 Techniques of Perineal Skin Closure During Second-Degree Perineal Laceration Repair.

ABSTRACT: INTRODUCTION:Perineal lacerations during childbirth are common, and suturing the perineal skin during repair has been associated with increased postpartum pain. This study sought to test the hypothesis that no difference in postpartum perineal pain exists between 3 methods of skin closure for second-degree repair: suture, no suture, and surgical glue. METHODS:A single-blind randomized controlled trial of women after vaginal birth who had a second-degree perineal laceration was conducted at a tertiary care teaching hospital from August 2014 to April 2017. Women were randomized to perineal skin closure with suture, no suture, or surgical glue using a 1:1:1 allocation. Pain was assessed using the short-form McGill Pain Questionnaire, a 100-mm visual analog scale (VAS), and Present Pain Index (PPI) at one day, 2 weeks, 6 weeks, and 3 months postpartum. Wound healing was assessed at 6 weeks using the Redness, Edema, Ecchymosis, Drainage, Approximation (REEDA) scale. Pain scores were compared across groups using a chi-square test, Mann-Whitney U test, or analysis of variance where appropriate. RESULTS:A total of 35 women were randomized: 14 received suture, 11 had no suture, and 10 received surgical glue for perineal skin repair. Demographic characteristics were similar between groups. At 2 weeks postpartum, women with suture had higher median pain scores on the short-form McGill Pain Questionnaire (15.0 suture vs 2.0 glue vs 2.0 no suture, P = .03) and VAS (50.0 suture vs 3.0 glue vs 7.0 no suture, P = .02). Significant differences in pain were not seen on the PPI. At 3 months, women in the suture group had higher median pain scores on the short-form McGill Pain Questionnaire compared with surgical glue (1.0 vs 0, P = .04). Wound healing was similar across groups (REEDA score: 0 suture vs 1.0 no suture, vs 0 surgical glue, P = .24). DISCUSSION:Compared with no suture and surgical glue, suturing the perineal skin was associated with the highest postpartum pain scores.

SUBMITTER: Swenson CW

PROVIDER: S-EPMC7747225 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Randomized Trial of 3 Techniques of Perineal Skin Closure During Second-Degree Perineal Laceration Repair.

Swenson Carolyn W CW Low Lisa Kane LK Kowalk Katherine M KM Fenner Dee E DE

Journal of midwifery & women's health 20190821 5

<h4>Introduction</h4>Perineal lacerations during childbirth are common, and suturing the perineal skin during repair has been associated with increased postpartum pain. This study sought to test the hypothesis that no difference in postpartum perineal pain exists between 3 methods of skin closure for second-degree repair: suture, no suture, and surgical glue.<h4>Methods</h4>A single-blind randomized controlled trial of women after vaginal birth who had a second-degree perineal laceration was con ...[more]

PMID: 31433108

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Project description:ObjectiveFacial lacerations, which are common in the emergency department, have usually been repaired by non-facial trauma specialists, such as emergency physicians. Given the ongoing discussion regarding quality assurance or the optimal training model on facial laceration repair for nonspecialists, we sought to determine the impact of a 1-year wound closure training provided to emergency physicians. We hypothesized a decrease in early complications following facial wound closure after the training.MethodsA retrospective observational study was conducted between 2013 and 2015 at an academic center. We included patients with isolated facial lacerations that were repaired by emergency physicians and reviewed by board-certified plastic surgeons during a follow-up visit. Patients whose wounds were not reviewed within 3 days were excluded. The 1-year training curriculum, which consisted of several sessions of lecture, hands-on practice, and case review, had been developed by a multidisciplinary team and provided to emergency physicians. Patient data were divided between nonparticipant and participant groups, and a propensity score was developed to estimate the probability of being assigned to the participant group. The incidence of early complications, defined as the need for additional suturing or resuturing due to wound dehiscence, was compared among the groups after propensity score matching.ResultsAlthough 132 patients satisfied all the inclusion criteria, 11 were excluded due to delayed initial wound review. Among the 70 patients who were eventually included in the participant group, 40 were matched with those in the nonparticipant group. The incidence of early complications was significantly lower in the participant group than in the nonparticipant group (5.0% vs. 20.0%, odds ratio = 0.21, 95% confidence interval = 0.07-0.61, p = 0.04).ConclusionsThe 1-year training provided to emergency physicians reduced the incidence of early complications following facial laceration repair. Accordingly, future wound closure training models should consider the 1-year training curriculum presented herein.

Project description:Incisional hernias are common complications of midline closure following abdominal surgery and cause significant morbidity, impaired quality of life and increased health care costs. The 'Hughes Repair' combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. This theoretically distributes the load along the incision length as well as across it. There is evidence to suggest that this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared the Hughes Repair with standard mass closure for the prevention of incisional hernia formation following a midline incision.This is a 1:1 randomised controlled trial comparing two suture techniques for the closure of the midline abdominal wound following surgery for colorectal cancer. Full ethical approval has been gained (Wales REC 3, MREC 12/WA/0374). Eight hundred patients will be randomised from approximately 20 general surgical units within the United Kingdom. Patients undergoing open or laparoscopic (more than a 5-cm midline incision) surgery for colorectal cancer, elective or emergency, are eligible. Patients under the age of 18 years, those having mesh inserted or undergoing musculofascial flap closure of the perineal defect in abdominoperineal wound closure, and those unable to give informed consent will be excluded. Patients will be randomised intraoperatively to either the Hughes Repair or standard mass closure. The primary outcome measure is the incidence of incisional hernias at 1 year as assessed by standardised clinical examination. The secondary outcomes include quality of life patient-reported outcome measures, cost-utility analysis, incidence of complete abdominal wound dehiscence and C-POSSUM scores. The incidence of incisional hernia at 1 year, assessed by computerised tomography, will form a tertiary outcome.A feasibility phase has been completed. The results of the study will be used to inform current and future practice and potentially reduce the risk of incisional hernia formation following midline incisions.ISRCTN 25616490 . Registered on 1 January 2012.

Project description:BackgroundSome children feel pain during wound closures using tissue adhesives. We sought to determine whether a topically applied analgesic solution of lidocaine-epinephrine-tetracaine would decrease pain during tissue adhesive repair.MethodsWe conducted a randomized, placebo-controlled, blinded trial involving 221 children between the ages of 3 months and 17 years. Patients were enrolled between March 2011 and January 2012 when presenting to a tertiary-care pediatric emergency department with lacerations requiring closure with tissue adhesive. Patients received either lidocaine-epinephrine-tetracaine or placebo before undergoing wound closure. Our primary outcome was the pain rating of adhesive application according to the colour Visual Analogue Scale and the Faces Pain Scale--Revised. Our secondary outcomes were physician ratings of difficulty of wound closure and wound hemostasis, in addition to their prediction as to which treatment the patient had received.ResultsChildren who received the analgesic before wound closure reported less pain (median 0.5, interquartile range [IQR] 0.25-1.50) than those who received placebo (median 1.00, IQR 0.38-2.50) as rated using the colour Visual Analogue Scale (p=0.01) and Faces Pain Scale--Revised (median 0.00, IQR 0.00-2.00, for analgesic v. median 2.00, IQR 0.00-4.00, for placebo, p<0.01). Patients who received the analgesic were significantly more likely to report having or to appear to have a pain-free procedure (relative risk [RR] of pain 0.54, 95% confidence interval [CI] 0.37-0.80). Complete hemostasis of the wound was also more common among patients who received lidocaine-epinephrine-tetracaine than among those who received placebo (78.2% v. 59.3%, p=0.008).InterpretationTreating minor lacerations with lidocaine-epinephrine-tetracaine before wound closure with tissue adhesive reduced ratings of pain and increased the proportion of pain-free repairs among children aged 3 months to 17 years. This low-risk intervention may benefit children with lacerations requiring tissue adhesives instead of sutures.Trial registrationClinicalTrials.gov, no. PR 6138378804.

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Randomized Trial of 3 Techniques of Perineal Skin Closure During Second-Degree Perineal Laceration Repair.

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Randomized Trial of 3 Techniques of Perineal Skin Closure During Second-Degree Perineal Laceration Repair.

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