Feasibility and Safety of a New Chest Drain Wound Closure Method with Knotless Sutures

Abstract

BackgroundA method of wound closure using knotless suture material in the chest tube site has been introduced at our center, and is now widely used as the primary method of closing chest tube wounds in video- assisted thoracic surgery (VATS) because it provides cosmetic benefits and causes less pain.MethodsWe included 109 patients who underwent VATS pulmonary resection at Samsung Medical Center from October 1 to October 31, 2016. Eighty-five patients underwent VATS pulmonary resection with chest drain wound closure utilizing knotless suture material, and 24 patients underwent VATS pulmonary resection with chest drain wound closure by the conventional method. Complications related to the chest drain wound were compared between the 2 groups.ResultsThere were 2 cases of pneumothorax after chest tube removal in both groups (8.3% in the conventional group, 2.3% in the knotless suture group; p=0.172) and there was 1 case of wound discharge due to wound dehiscence in the knotless suture group (0% in the conventional group, 1.2% in the knotless suture group; p=0.453). There was no reported case of chest tube dislodgement in either group. The complication rates were non-significantly different between the 2 groups.ConclusionThe results for the complication rates of this new chest drain wound closure method suggest that this method is not inferior to the conventional method. Chest drain wound closure using knotless suture material is feasible based on the short-term results of the complication rate.

Effect of lidocaine cream analgesia for chest drain tube removal after video-assisted thoracoscopic surgery for lung cancer: a randomized clinical trial

“…Moreover, a dressing is required for the chest tube removal site, and remaining suture material must be removed at a subsequent outpatient visit. Some methods of wound closure using knotless suture material,7 21 a two-layer method with triclosan-coated sutures,22 or the “Roman sandal” modified method using an alpha shape made up of cross-wires23 at the chest tube site have also been reported for general thoracic surgery. Advantages of these new suturing methods include quicker performance during both instillation and removal of the drain, no need for stitch removal at follow-up, good wound healing, and excellent cosmetic results without infection.…”

“…The conventional method usually utilizes an anchoring suture, a purse-string suture, and skin stapler for wound closure after the chest tube is removed. Although this method is reliable, clipping with a stapler or suturing can be painful and may require good anesthesia technique to reduce pain 6 7…”

Knotless suture and hydrocolloid method improves chest drain wound complication

“…1,2 A method for closing this type of wound using a knotless suture, that is, a continuous intradermal suture of barbed absorbent suture material, at the chest drain insertion site has recently been reported. 3,4 As this closure method tightens the wound by pulling the suture when removing the drain, it should close the wound as effectively as the conventional ligature technique, and it has the advantage of not requiring suture removal. However, as this closure method is recently introduced, few studies have compared the efficacy of the drain wound closure method between knotless suture and conventional ligation closure, and it is not certain regarding the frequency of additional treatment due to wound closure failure at the time of drain removal.…”

“…However, as this closure method is recently introduced, few studies have compared the efficacy of the drain wound closure method between knotless suture and conventional ligation closure, and it is not certain regarding the frequency of additional treatment due to wound closure failure at the time of drain removal. 4 In addition, it is unclear whether factors such as the size of the chest drain and drainage duration affect wound closure or wound complication. Therefore, in this study, we aimed to evaluate a chest drain wound closure method using a knotless suture and compare it with closure by ligation.…”

Novel Chest Tube Anchoring and Closure Technique with an Aesthetic Scar

“…This method often gives undesirable result as the linear wound is converted into a circular one that leaves an unsightly scar or keloid formation [1,2]. Two methods have been proposed to improve the chest tube scar by using barbed knotless suture and no suturing technique [4][5][6]. Improvement in scar cosmesis is seen but they both reported low incidence of pneumothorax and serous discharge after drain removal that required intervention [5,6].…”