Background: Adjustable sutures increase the success rate of strabismus surgery. However, the optimal timing of postoperative suture adjustment remains controversial. This trial was aimed at comparing the surgical outcomes and pain scores of early or 2 –,4 h and delayed or 24 h postoperative suture adjustment in adult patients undergoing strabismus surgery. Methods: An open-label, prospective, randomized, comparative interventional study was performed in consecutive adult patients scheduled for eye muscle surgery. Patients were randomized into two groups: the early group, with suture adjustment 2 –,4 h postoperatively, and the delayed group, with suture adjustment 24 h postoperatively. Subjective pain scores during the adjustment were also analyzed. The angles of misalignment at 1 and 3 months and the success rate at 3 months postoperatively were compared. Results: Forty-five (90%) patients completed the follow-up, including 23 (92%) in the early adjustment group and 22 (88%) in the delayed adjustment group, with a mean (standard deviation) age of 25. 6 (9. 5) years and a male-to-female ratio of 46. 7: 53. 3. Thirty patients (66. 7%) had exotropia, and 15 (33. 3%) patients had esotropia. Both groups had comparable baseline characteristics (all P > 0. 05). The mean pain scores during adjustment did not differ significantly between groups (P > 0. 05). The postoperative angles of alignment were comparable between the groups before suture adjustment and at the 1-and 3-month follow-ups (all P > 0. 05). The success rate in the early adjustment group was slightly higher (87. 0% versus 63. 6%), but the difference was not statistically significant (P > 0. 05). The success rate was comparable between the groups in patients with esotropia or exotropia (both P > 0. 05). Conclusions: Although the early adjustment group had a slightly higher success rate, the difference was not significant. Both groups had comparable subjective pain scores during adjustment, final motor alignment, or success rate. Future clinical trials should be performed different time intervals for postoperative suture adjustment, and subjective and objective outcomes, such as diplopia and stereopsis, should be compared between patients with a first strabismus surgery and those who underwent reoperation. This could better resolve the persistent controversy related to the optimal time for suture adjustment.

Introduction & Objective: It is often advised to have repair of subcutaneous soft tissue using absorbable suture at the end of surgery before skin closure. We decided to compare the complication of subcutaneous suturing with those without subcutaneous suturing in the clean orthopedic wounds.Materials & Methods: We conducted a single blind randomized clinical trial on all admitted orthopedic patients who were candidate for primary wound clousure, during 1382-88 in Sina hospital. After categorizing patients based on upper/lower limb and fascia repair, the patients were divided into two groups with or without subcutaneous repair, by using computerized random numbers chart. The patients were assessed for probable complications (wound dehiscence, infection, fluid collection, inflammation, and skin necrosis) for 3 months postoperatively. Exclusion criteria were; the patients who need any kind of skin or muscle flaps, those who needed subcutaneous drainage, those who need secondary repair and those with loss to follow up.Results: After applying exclusion criteria, 14953 patients (1662 female, 13291 male, mean age 40.6±4.9 years) were enrolled into our study. Of these, 4153 were allocated to upper limb and the others to lower limb group. These groups were further divided based on fascia and subcutaneous repair. Totally, 6120 (41% of patients) had subcutaneous repair. The observed complications were more in patients without subcutaneous suture in comparison to those having with subcutaneous suture. Other parameters (upper or lower extremity and fascia repair) were not statistically significant regarding wound inflammation, infection, fluid collection, necrosis and dehiscence.Conclusions: It seems that omitting subcutaneous soft tissue repair will not lead to major complications in several cases of orthopedic surgery. It shortens the time of surgery and it may also reduce the costs, because of avoiding the use of suture materials.

Background:  Despite the prevalence of palmar injuries and surgeries, no consensus exists regarding the type of wound closure. The present study compares simple sutures and vertical mattresses sutures in carpal tunnel release (CTR), trigger finger release (TFR), and trigger thumb release (TTR). Methods: A total of 89 surgeries were randomized to either simple or vertical mattress sutures. Outcomes including pain, infection, Patient and Observer Scar Assessment Scale (POSAS), satisfaction level, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) were evaluated on postoperative day 3, week 3, and month 3. Month 3 assessments were mostly performed remotely due to coronavirus disease 2019 (COVID-19). Results: The mean pain was higher in the vertical mattress sutures group compared with simple sutures, though the pain difference was statistically significant only on day 3. No significant mean difference was found between the two groups regarding POSAS items. Some patients underwent bilateral CTR with simple sutures on the one hand and vertical mattresses sutures on the other. The results of their investigation were consistent with the other findings. Conclusion: Vertical mattress suture in palmar surgeries is associated with greater short-term pain. Other variables did not differ between the two groups at different times. Hence, conclusively, regardless of the short-term pain associated with simple suture, both types of sutures can be used in hand surgeries with similar long-term results.

Introduction: Thyroidectomy is a common surgery in the neck area, in which the application of platysma muscle suture after thyroidectomy is still being discussed. This study was conducted to compare the application (currently common) or non-application of suture for platysma muscle. Methods: In this retrospective cross-sectional study, 117 patients underwent thyroidectomy, among which 63 cases without suturing platysma (control group) and 54 subjects with suturing platysma (Intervention group ) were examined in terms of postoperative pain based on visual analogue scale score measured 24 h post-operation. The samples were also investigated regarding hematoma and seroma, wound infection, length of hospitalization, scarring (1 year after surgery), duration of surgery, and the number of cases using opioids during the hospitalization. Patients with diabetes, previous neck surgery, coagulopathy, and radiation history were excluded from the study. The gathered data were analyzed statistically in SPSS software (version 18) using the Chi-square test and the Mann– Whitney U test. A p-value of less than 0. 05 was considered significant. Results: Based on the findings, the mean age of the patients in the Intervention group was calculated at 51 years, of which 41 and 13 cases were females and males, respectively. In the Intervention group, 34 patients underwent complete thyroidectomy and 20 patients had hemithyroidectomy. The mean age score of subjects in control group was calculated at 50 years, of which 44 and 19 patients were respectively female and male. No significant difference was revealed considering wound infection, length of hospitalization, created scarring, the amount of opioid use (opioids), and postoperative pain. However, only the length of surgery was different between the groups (P-value<0. 05) Conclusions: There was no difference between wound and surgical complications and cosmetic results between both groups; nevertheless, due to the duration of the surgery and other benefits, such as consuming less thread, not suturing the platysma is recommended.

Background and Objective: Cesarean section is one of the most common surgical procedures worldwide. However, it carries significant risks, including hemorrhage, adhesion formation, infection, scar tissue development, uterine rupture in subsequent pregnancies, niche formation, and more. Therefore, the technique used for uterine closure plays a crucial role in determining postoperative outcomes. This study aims to introduce a novel uterine suturing method during cesarean section, specifically designed to preserve the anatomical structure and enhance the repair and healing of the uterus following surgery. Methods: The Sarem suture technique begins at the corner of the uterine incision using a size 0 Vicryl suture. After an initial knot at the uterine angle, the myometrium is closed with a continuous non-locking suture to the opposite end of the incision. A second layer is then initiated again from the uterine angle. In this layer, to better restore the natural uterine anatomy, a portion of the myometrium and the fascia over the outer (serosal) surface of the uterus—known as the uterovesical fascia—are approximated with another continuous non-locking suture using size 0 Vicryl. Finally, to reinforce the myometrium and minimize adhesion formation, a separate continuous non-locking suture with 2-0 Vicryl is used to close the visceral peritoneum over the uterus. Conclusion: This method allows each uterine layer to heal independently, reducing postoperative inflammation and pain. The findings suggest that the new Sarem suture technique offers significant improvements in patient recovery. Its advantages over conventional and even some newer techniques include reduced postoperative pain, enhanced hemostasis, faster uterine healing, decreased risk of uterine rupture in future pregnancies, and a lower chance of niche formation.