Comparative Study Regarding the use of Cyanoacrylate Glue and Subcuticular Sutures in Thyroidectomy Wound Closure

Akshay, P R (2019) Comparative Study Regarding the use of Cyanoacrylate Glue and Subcuticular Sutures in Thyroidectomy Wound Closure. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Surgeon is known by the scar he gives”; this is a quote, we are quite familiar with. With times changing, one thing has not changed is the desire to look better. Since time immemorial, surgeons have struggled to produce invisible scars. Over the time wound closure techniques have evolved from the earliest suturing materials to synthetic absorbable sutures, staples, tapes, and adhesive compounds. The ideal method of incision closure has to be simple, safe, rapid, inexpensive, painless, bactericidal, and result in optimal cosmetic appearance of the scar. Thyroid surgeries are one of the most commonly performed by a general surgeon. Surgery in this region also arises significant aesthetic problems because this is the region most exposed to others and therefore very important. These surgeries classically require anterior neck incisions that are at the risk of undesirable aesthetic results when scars do not form as expected. Moreover these surgeries are practiced in young women and the incidence of thyroid disease is three times more in women than men. Also incidences peaks in third and fourth decades of life. For all these reasons the cosmetic outcomes of this kind of surgery is very important. AIM OF THE STUDY: To study the efficacy of Cyanoacrylate glue in comparison to routinely used subcuticular sutures in thyroidectomy wound closure in GRH, Madurai. OBJECTIVES: A comparison regarding cyanoacrylate glue and subcuticular suture in thyroidectomy wound closure in view of the following parameters: Time taken in the closure of wound intraoperative. Wound Infection and Dehiscence postoperatively. Scar Cosmesis. MATERIALS AND METHODS : Design of Study: Prospective study. Period of Study: 2 Years. Selection of Study Subjects: Age between 17 and 70 years in both sexes, patients undergoing thyroidectomy surgery in GRH, Madurai. Data Collection: Data regarding History, surgery done and outcome. Methods: Observation study. Participants: Any case of thyroidectomy irrespective of sex and occupation were included in the study, (excluding the patients who have co-morbidities like Diabetes Mellitus, Systemic Hypertension, HIV, immunosuppressed status etc.). ELIGIBILITY CRITERIA: Inclusion Criteria: Age group from 17 to 70 years. All patients undergoing thyroidectomy surgeries (including total and hemi-thyroidectomy surgeries). All patients willing for follow-up up to 6 months. Exclusion Criteria: Patients with diabetes mellitus, HIV, Immunocompromised status. Patient not consented for inclusion in the study. Patients with history of allergic disorders. Patients with history of previous thyroid surgeries. Incisions which require to be closed under tension. Patients undergoing thyroidectomy for malignancy with neck dissection or recurrence. Patients with known personal history of scar hypertrophy or keloid formation. DISCUSSION Thyroidectomy is a surgery commonly performed across the country, in both large volume centers and small hospitals. The incision used for thyroid surgery has become shorter overtime, from the classical 10 cm long Kocher incision to the shortest 15 mm access achieved with minimally invasive video assisted thyroidectomy. This is mainly to achieve a good cosmetic outcome along with less postoperative morbidity. As this surgery is well described and standardized, we based our study on this surgery to reduce inter-operative variations. OCA have a number of advantages over conventional sutures like their fast and painless application, rapid setting, which reduces the total operating time and their antibacterial properties. OCA itself acts as a waterproof dressing and helps in reduction in the number of follow up visits. As they do not require any needles, accidental needle stick injuries are prevented. However, there are certain disadvantages of OCA like their less tensile strength and chances of adhesive seepage, if edges are not properly approximated. CONCLUSION: OCA is one of the novel techniques and efficient techniques available for wound closure especially where cosmesis is required. OCA has a better outcome than the sutures in the initial post op days but shows an equivalent cosmetic outcome in comparison to the routinely used sub cuticular prolene sutures in the long term 6 month follow up. The cost of OCA being equivalent to prolene, OCA will not change the cost effectiveness of the procedure. Also OCA having antibacterial property and water sealing property decreases the chances of surgical site infections. In a developing country like India, where cost and resources play a major role, it is better to use OCA than the routinely used sub cuticular prolene sutures. Suture removal is not required and reduces the frequency of visits by the patients to the hospital. Also sub cuticular suturing being a skilled procedure needs expertise in comparison to OCA. As the study undertaken contains a sample size of 50, high chances of sampling error are present. And surgical techniques, accuracy and duration of a procedure varies from surgeon to surgeon. So further studies in a large scale, from different institutions and a longer follow up are recommended.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cyanoacrylate Glue, Subcuticular Sutures, Thyroidectomy Wound Closure.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 04 Sep 2019 00:17
Last Modified: 06 Sep 2019 03:45

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