Skin Adhesive Tapes are an effective wound closure method for Percutaneous Vertebral Body Stenting, A Retrospective Cohort Study 

Skin Adhesive Tapes are an effective wound closure method for Percutaneous Vertebral Body Stenting, A Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Skin Adhesive Tapes are an effective wound closure method for Percutaneous Vertebral Body Stenting, A Retrospective Cohort Study Cassie Yang, Theophilus Qiu, Chee Cheong Reuben Soh, Youheng Ou Yang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3132524/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Percutaneous Vertebral Body Stenting (VBS) is performed via a balloon-expandable metallic stent introduced through a stab incision to reduce and maintain the reduction of vertebral body fractures and minimise bone cement extravasation. The delivery of the balloon and stent involves a larger skin incision, soft tissue trauma and pedicle bore tract compared to traditional vertebroplasty (PVP) systems (4.7mm vs 2.59mm diameter), thus increasing the risk of bleeding and wound complications. Skin Adhesive Tapes (SATs) are a common method of wound closure for PVP. This study aims to evaluate the use of SATs in closure of larger VBS wounds. Methods: A retrospective cohort of patients who underwent percutaneous VBS (DePuy Synthes, USA) was obtained from electronic medical records at a tertiary hospital from May 2019 to March 2021. Data was collected for wound closure method (conventional non-absorbable suture, SAT), number of operative levels, postoperative skin-related complications, wound dehiscence, wound infection, bleeding, symptomatic haematomas and return to operating theatre. At follow-up post-discharge, the wounds were reviewed for complete healing and unsightly scarring requiring wound revision. SAT closure was performed by applying 3 strips of SATs to loosely oppose the wound edges. Results: 36 patients were identified with 45 levels of VBS performed. 3 (8.3%) patients received conventional suture closure, 33 (91.6%) received SAT closure. Conventional suture closure was performed due to ongoing bleeding at the wound site for 2 patients who had coagulopathy. The remaining patient received a planned suture closure in view of surgical expediency as part of a staged procedure. Vertebral Body Stent Wound Healing Skin Adhesive Tapes Primary Suture Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Vertebral compression fractures (VCF) arise due to various aetiologies including osteoporosis, osteolytic metastasis and multiple myeloma. These VCFs may be treated with infiltration of cancellous bone with polymethyl methacrylate (PMMA) bone cement to stabilise the fracture site and provide pain relief. The first generation of percutaneous vertebroplasty (PVP) was developed in 1987 [ 1 ], with the injection of bone cement into the vertebral body via a percutaneously inserted cannula under pressure. The pressure on the bone cement would cause interdigitation of porous channels between the cancellous trabeculae to provide pain relief and prevent further collapse. Limitations inherent to PVP are cement leaks caused by cement pressurisation [ 2 , 3 ] and the presence of large open vascular channels [ 4 ]. PVP is also unable to actively reduce vertebral body kyphosis, leading to an increased risk of adjacent segment fractures due to altered spinal biomechanics and alignment [ 5 ]. Balloon kyphoplasty (BKP) introduced 1998, addressed the deficiencies of PVP. This utilised a percutaneously placed inflatable balloon to both reduce the fracture site, restore spinal alignment, and create a low pressure void to allow for a more viscous bone cement mixture to flow under much lower pressure [ 6 ]. This succeeded in improving spinal alignment and reducing bone cement leakage [ 7 ]. Vertebral Body Stenting (Synthes, Oberdorf, Switzerland) (VBS), introduced in 2010 [ 8 ] refined BKP by adding a metallic stent to be expanded and deployed by an inflatable balloon within the fractured vertebral body. After the balloon was deflated and retrieved, the stent would effectively maintain fracture reduction and reduce the loss of vertebral body height after the momentary absence of support prior to cementation [ 9 ] (Fig. 1 ). The evolution of vertebral body cementing techniques from PVP to VBS Stentoplasty is of improved fracture reduction, maintenance of vertebral height and reduced cement leakage rates at the tradeoff of requiring increased hardware being introduced to the fracture site. As a highly minimally invasive procedure with small incisions, PVP wounds can be closed with Skin Adhesive Tapes (SATs) alone. Compared to PVP cannulas, the VBS access kit requires a working sleeve of 4.7mm in diameter as opposed to 2.59mm. This 330% increase in surface area is necessary to accommodate both the metallic stent and inflatable balloon for deployment. In addition, the implantation of metal stents demands precise placement of the access kit compared to the larger and more forgiving target area for cement portal placement in PVP. VBS stentoplasty thus requires larger skin incisions, causes greater soft tissue trauma and generates a bigger pedicle bore tract with exposed cancellous bone. These factors increase the risk of bleeding and wound complications. SATs are a common modality of wound closure, having the capacity to provide mechanical and strangulation-free support for wounds. It opposes the superficial wound edges with minimal tension, providing similar tensile strength as skin sutures while maintaining epidermal integrity [ 10 ]. They are typically used in conjunction with subdermal or subcuticular sutures in larger wounds but have shown reasonable reliability when used in isolation on lacerations or smaller surgical incisions. Compared to conventional suture closure, SATs have been found to deliver comparable [ 11 ] or better cosmetic results, and require less time for closure [ 12 ]. Complications associated with SATs are rare but include contact dermatitis, tension blisters, tape dislodgement, wound dehiscence and wound infection [ 13 ]. This study aims to evaluate the effectiveness, safety and cosmesis of skin adhesive tapes in the closure of VBS Stentoplasty wounds. Methods Surgical Technique for Transpedicular VBS Stentoplasty and subsequent closure Patients are sedated and positioned prone on a radiopaque surgical table. After surgical cleansing and draping, radiopaque markers are placed approximately 3–4 cm paramedian to the affected surgical level to localise the target pedicles by intraoperative radiography. Marcaine and adrenaline is infiltrated along the planned cannula tracts and to the periosteum surrounding the pedicle entry site. Stab incisions of approximately 1.5–2 cm are made. A guidewire is inserted through the skin incisions, across the pedicles and into the vertebral body guided by sequential radiographs. Adjustments to the final positions of the guidewires can be made by stretching the surrounding soft tissue envelope at the expense of tissue trauma. A working sleeve is advanced over the guidewire and the guidewire removed. A drill is passed into the working sleeve to create an access channel which is tamped down with a blunt plunger. The VBS stent size is templated according to markings on the blunt plunger. The bilateral VBS stents and inflation balloons are inserted into the vertebral body through the working sleeve. They are subsequently inflated with contrast-saline via a hand held pump with an integrated pressure gauge. Balloon inflation with stent expansion is performed in a bilateral and symmetrical fashion until there is adequate fracture reduction, or if a pressure of 30 atmospheres and/or the maximum height of the metal stent (Small: 15mm - Large: 17mm) is reached. Both balloons are then deflated and retrieved, leaving the expanded VBS stents to maintain the reduction. An injection needle is placed into the working sleeve and PMMA bone cement is subsequently injected to produce a stent-reinforced cement implant within the treated vertebral body (Fig. 2 ). The wound is irrigated with normal saline. If remnant bleeding is noted from the wound, manual pressure is applied for approximately 30 seconds before closure with SATs. If bleeding fails to stop after manual compression, the wound is closed with simple interrupted prolene sutures and dressed with non adherent waterproof dressings. For suitable wounds, 3 SATs are applied to each incision in an overlapping fashion (Fig. 3 ). Non-adherent waterproof dressings are applied above the SATs (Fig. 4 ). The majority of the SATs are removed at the first dressing change, 3 days after surgery. Dry dressings are then continued until sufficient epithelization for the wound to be exposed. This typically occurs within 7 days. In the rare event that wounds continue to gape, SATs are reapplied until wound healing has progressed further. Data collection: A retrospective cohort of patients was obtained from electronic medical records. Collection of data was obtained under Institutional Review Board waiver. Data was anonymised and keyed into an electronic spreadsheet (Microsoft, Inc., USA). The inclusion criteria included all patients who underwent VBS Stentoplasty (DePuy Synthes, USA) at a tertiary hospital from May 2019 to March 2021. Only patients operated on by either of two surgeons who practised the surgical technique described were included. Data was collected for patient biodata, number of operative levels, wound closure method, and postoperative skin-related wound complications: contact dermatitis, tape dislodgement, tension blisters, wound dehiscence, wound infection, postoperative bleeding, and return to operating theatre. Risk factors for poor postoperative outcomes including wound site dehiscence and infection were recorded according to the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) At clinic follow-up post-discharge, the wounds were also reviewed for complete healing and unsightly scarring requiring wound revision. Results 36 patients were identified with a total of 45 levels of VBS stentoplasty performed. 3 (8.3%) patients received primary closure with non-absorbable sutures while 33 (91.6%) received SAT closure. Within the patients who received SAT closure, 27 (81.8%) had at least 1 risk factor for wound dehiscence including steroid use for chronic conditions (n = 4, 12.1%), disseminated cancer (n = 5, 15.1%), diabetes mellitus (n = 7, 21.1%), hypertension requiring medication (n = 18, 54.6%) and dialysis (n = 1, 3.03%) Among patients whose wounds required conventional primary sutures, 2 of these patients had ongoing bleeding at the wound site at the end of the procedure. This was attributed to underlying coagulopathy, as one patient had perioperative aspirin use while the other had severe thrombocytopenia due to underlying bone marrow disease. The remaining 1 patient had VBS stentoplasty performed as part of a staged procedure. The primary suture closure was performed to accommodate an intra-theatre positional change from prone to supine on traction table for a femoral intramedullary nail insertion. 32 (97.0%) patients received SAT closure without any early complications of contact dermatitis, tension blisters, tape dislodgement, wound dehiscence, wound infection and return to theatre. 1 (3.0%) patient developed blood soaked dressings that required early removal and reapplication of the SATs at the ward a day later with uneventful recovery thereafter. (Fig. 5 ) All patients with SAT closure had complete wound healing at outpatient follow up with adequate cosmetic outcome, without the need for wound revision. (Fig. 6 ) Table 1 Demographics and biodata of patients Gender N % Male 10 28 Female 26 72 Age ≤ 50 3 8 51 to 60 7 19 61 to 70 5 14 71 to 80 12 33 81 to 90 8 22 ≥ 90 1 3 Ethnicity Chinese 30 83 Malay 4 11 Indian 1 3 Others 1 3 BMI < 18.5 5 14 18.5 to 24.9 19 53 25 to 29.9 6 17 ≥ 30 6 16 ASA I 0 0 II 20 56 III 16 44 IV 0 0 Table 2 Risk factors for wound dehiscence Whole sample n = 36 SAT n = 33 Primary closure n = 3 N % N % N % Steroid use for chronic conditions 4 11.11 4 12.12 - - Ascites < 30 days before surgery - - - - - - Systemic sepsis < 48hours prior to surgery - - - - - - Ventilator dependent - - - - - - Disseminated cancer 6 16.67 5 15.15 1 33.33 Diabetes 7 19.44 7 21.21 - - Hypertension requiring medication 18 50.00 18 54.55 - - CHF < 30 days prior to surgery - - - - - - Dyspnoea - - - - - - Current smoker < 1 year prior to surgery - - - - - - History of severe COPD - - - - - - Dialysis 1 2.78 1 3.03 - - Acute renal failure - - - - - - Discussion Compared to skin sutures and staples, SATS are an easy to apply and non-invasive method of skin closure. SATs eliminate the risk of introducing skin infections via the suture needle or suture material, avoids scarring associated with suture/staple entry and exit sites and wound strangulation. SATS are faster to apply than conventional skin sutures and can save 1.5 to 3.5 minutes of operating time per patient compared to skin sutures [ 14 ]. Due to its ease of application, it may also be applied in the ward setting, as shown in the one patient in this study with a soaked dressing. It also does not require a removal of stitches or staples, which reduces outpatient time and cost [ 15 ]. Limitations to SAT closure include long, deep or gaping wounds as well as wounds located at areas of high movement, such as those overlying joints. This is due to the relatively lower amounts of tissue and skin support provided by SATs. In addition, bleeding or oozy wounds introduce moisture at the site of tape adhesion which can lead to easy dislodgement. For wounds which exhibit mild bleeding, sutures still provide an additional hemostatic advantage for the avoidance of haematoma formation. VBS wounds are short but deep, and located over the thoracolumbar spine that is an area under tension and subject to friction. They have a potential to continue bleeding from exposed cancellous bone surfaces and traumatised muscle. Compared to PVP, the VBS skin incision has an increase in length of 50–100% (1.5–2 cm vs 1 cm). Nonetheless, a low rate of conversion to primary sutures was observed 5.7% (n = 2). In this study, these patients had risk factors for coagulopathy which could account for the lack of wound site hemostasis after gentle pressure. One patient had blood soaked wounds on postoperative day 1, and while initially concerning, the removal of soaked SATs and re-application of new SATs in the ward under mild manual pressure appeared sufficient in controlling the bleeding and providing wound closure. A return to the operating theatre or conversion to primary sutures for wound closure and haemostasis was avoided. This study demonstrates that SATs are effective, safe and produce acceptable cosmetic results in the primary wound closure for VBS wounds. This has been demonstrated in a cohort where the majority of patients (81.2%) had at least 1 risk factor for wound dehiscence. Despite the overall positive results, the authors advise caution on the use of SATs in patients with bleeding diathesis, such as a background of malignancy, anticoagulant use or liver disease. The superficial means of skin apposition may not be suitable to provide adequate pressure for haemostasis, especially at deeper layers. Conclusion SATs are a simple, safe and effective means of wound closure for the majority of percutaneous VBS procedures. Conversion to primary suture closure due to continued wound site bleeding is rarely required. Declarations The authors declare that this is an independent original study. Funding – Not applicable. There are no financial disclosures. The authors declare that they have no conflicts of interest. Ethical waiver was granted concordance with regulations established by our institution’s Centralised Institutional Review Board (CIRB). Consent for publication of images were obtained from relevant patients prior to publication. OYYH and SCCR conceived the idea and edited the manuscript. YC took the lead in writing the manuscript. QT collected the data. All authors read and approved the final manuscript. References Deramond H, Depriester C, Galibert P, Le Gars D. Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am. 1998 May;36(3):533-46. doi: 10.1016/s0033-8389(05)70042-7. PMID: 9597071. Muijs SP, Nieuwenhuijse MJ, Van Erkel AR, Dijkstra PD. Percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures: evaluation after 36 months. J Bone Joint Surg Br. 2009 Mar;91(3):379-84. doi: 10.1302/0301-620X.91B3.20970. PMID: 19258616. Sun H, Yang Z, Xu Y, Liu X, Zhang Y, Chen Y, Xu D, Yang Y, Li D, Xia J. Safety of percutaneous vertebroplasty for the treatment of metastatic spinal tumors in patients with posterior wall defects. Eur Spine J. 2015 Aug;24(8):1768-77. doi: 10.1007/s00586-015-3810-8. Epub 2015 Feb 19. PMID: 25694161. Wang L, Zhang C, Liang H, Huang T, Zhong W, Zhao Z, Luo X. Cement leakage in percutaneous vertebroplasty for spinal metastases: a retrospective study of risk factors and clinical outcomes. World J Surg Oncol. 2022 Apr 7;20(1):112. doi: 10.1186/s12957-022-02583-5. PMID: 35387653; PMCID: PMC8988338. Huang MH, Barrett-Connor E, Greendale GA, Kado DM. Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo study. J Bone Miner Res. 2006 Mar;21(3):419-23. doi: 10.1359/JBMR.051201. Epub 2005 Dec 5. PMID: 16491290; PMCID: PMC4964958. Masala S, Cesaroni A, Sergiacomi G, Fiori R, Massari F, Manenti G, Nardi P, Simonetti G. Percutaneous kyphoplasty: new treatment for painful vertebral body fractures. In Vivo. 2004 Mar-Apr;18(2):149-53. PMID: 15113041. Phillips FM, Ho E, Campbell-Hupp M, McNally T, Todd Wetzel F, Gupta P. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976). 2003 Oct 1;28(19):2260-5; discussion 2265-7. doi: 10.1097/01.BRS.0000085092.84097.7B. PMID: 14520041. Rotter R, Martin H, Fuerderer S, Gabl M, Roeder C, Heini P, Mittlmeier T. Vertebral body stenting: a new method for vertebral augmentation versus kyphoplasty. Eur Spine J. 2010 Jun;19(6):916-23. doi: 10.1007/s00586-010-1341-x. Epub 2010 Mar 1. PMID: 20191393; PMCID: PMC2899980. Heini PF, Teuscher R. Vertebral body stenting / stentoplasty. Swiss Med Wkly. 2012 Aug 6;142:w13658. doi: 10.4414/smw.2012.13658. PMID: 22869449. Aulia I, Bangun K. Comparison of tensile strength and histopathological evaluation of wound healing process using adhesive skin tapes on laceration wounds of porcine skin. Journal of Physics: Conference Series. 2018 Dec; 1073(3):1-7. doi:10.1088/1742-6596/1073/3/032038 Ladipo-Ajayi OA, Lawal TA, Ogundoyin OO, Michael AI. Steri-strip TM versus subcuticular skin closure of paediatric groin wounds: A randomised study. Afr J Paediatr Surg. 2022 Jul-Sep;19(3):137-143. doi: 10.4103/ajps.AJPS_184_20. PMID: 35775513; PMCID: PMC9290360. Phakdeedindan W, Kamma C. Cosmetic Outcome of Wound Closure between Steri-Strips (3M™ Steri-Strip) and Simple Interrupted Nylon 6-0 Sutures in Out-Patient Cervical Lymph Node Excision: A Randomized Controlled Trial. J Med Assoc Thai. 2021;104:1088-94. doi: doi.org/10.35755/jmedassocthai.2021.07.12306 Maene, B. Hidden costs of medical tape-induced skin injuries. Wounds UK. 2018;9(1):46-50. Aitchison LP, Chen AZL, Toms C, Sandroussi C, Yeo DA, Steffens D. To stitch or not to stitch: the skin closure of laparoscopic port sites, a meta-analysis. Surg Endosc. 2022 Oct;36(10):7140-7159. doi: 10.1007/s00464-022-09269-9. Epub 2022 May 24. PMID: 35610480; PMCID: PMC9485090. Takayama S, Yamamoto T, Tsuchiya C, Noguchi H, Sato J, Ishii Y. Comparing Steri-Strip and surgical staple wound closures after primary total knee arthroplasties. Eur J Orthop Surg Traumatol. 2017 Jan;27(1):113-118. doi: 10.1007/s00590-016-1848-x. Epub 2016 Sep 6. PMID: 27600333. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3132524","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":215123375,"identity":"467374fa-a886-46be-b30e-5f6642521270","order_by":0,"name":"Cassie Yang","email":"","orcid":"","institution":"Singapore General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Cassie","middleName":"","lastName":"Yang","suffix":""},{"id":215123376,"identity":"1fe0152d-355e-4882-905a-db03027efeab","order_by":1,"name":"Theophilus Qiu","email":"","orcid":"","institution":"National University 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2","display":"","copyAsset":false,"role":"figure","size":441802,"visible":true,"origin":"","legend":"\u003cp\u003ea) Anterior-Posterior View, b) Lateral View of Intraoperative VBS Insertion prior to cement implantation\u003c/p\u003e","description":"","filename":"Fig2aandb.png","url":"https://assets-eu.researchsquare.com/files/rs-3132524/v1/76f32d67d4a90af20cd5b15a.png"},{"id":39695638,"identity":"cfb9fb19-6016-447b-8836-0cdeee1b2960","added_by":"auto","created_at":"2023-07-07 13:34:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":236977,"visible":true,"origin":"","legend":"\u003cp\u003eSAT closure of VBS wounds in stellate pattern\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-3132524/v1/447f368784dd9bca6401939b.png"},{"id":39695636,"identity":"dcac7dff-afd2-492d-ad8f-f6bdc6a653e9","added_by":"auto","created_at":"2023-07-07 13:33:59","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":213643,"visible":true,"origin":"","legend":"\u003cp\u003eNon-adherent dressing applied over SATs\u003c/p\u003e","description":"","filename":"Fig4.png","url":"https://assets-eu.researchsquare.com/files/rs-3132524/v1/a4ac320a9b1c33814b27fabc.png"},{"id":39695635,"identity":"13bfabc0-322a-44e7-b9ed-8d6d3f49f2ef","added_by":"auto","created_at":"2023-07-07 13:33:59","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":82674,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of interventions\u003c/p\u003e","description":"","filename":"Fig5.png","url":"https://assets-eu.researchsquare.com/files/rs-3132524/v1/211381adcf2d39483e4071b2.png"},{"id":39695639,"identity":"d70ef756-b5e9-4a72-92f8-28b2b55f407f","added_by":"auto","created_at":"2023-07-07 13:34:00","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":562060,"visible":true,"origin":"","legend":"\u003cp\u003eTypical appearance of post-VBS wound closed by SAT at 6 weeks\u003c/p\u003e","description":"","filename":"Fig6.png","url":"https://assets-eu.researchsquare.com/files/rs-3132524/v1/8121e5012bf19e6df6676dc3.png"},{"id":41611993,"identity":"07f672b0-2d3d-4c09-a1a1-4d3586a24111","added_by":"auto","created_at":"2023-08-16 05:52:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3883370,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3132524/v1/565ad9f4-7bc3-4062-abc2-2d7ff5739d3f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Skin Adhesive Tapes are an effective wound closure method for Percutaneous Vertebral Body Stenting, A Retrospective Cohort Study ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eVertebral compression fractures (VCF) arise due to various aetiologies including osteoporosis, osteolytic metastasis and multiple myeloma. These VCFs may be treated with infiltration of cancellous bone with polymethyl methacrylate (PMMA) bone cement to stabilise the fracture site and provide pain relief. The first generation of percutaneous vertebroplasty (PVP) was developed in 1987 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], with the injection of bone cement into the vertebral body via a percutaneously inserted cannula under pressure. The pressure on the bone cement would cause interdigitation of porous channels between the cancellous trabeculae to provide pain relief and prevent further collapse. Limitations inherent to PVP are cement leaks caused by cement pressurisation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and the presence of large open vascular channels [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. PVP is also unable to actively reduce vertebral body kyphosis, leading to an increased risk of adjacent segment fractures due to altered spinal biomechanics and alignment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBalloon kyphoplasty (BKP) introduced 1998, addressed the deficiencies of PVP. This utilised a percutaneously placed inflatable balloon to both reduce the fracture site, restore spinal alignment, and create a low pressure void to allow for a more viscous bone cement mixture to flow under much lower pressure [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This succeeded in improving spinal alignment and reducing bone cement leakage [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVertebral Body Stenting (Synthes, Oberdorf, Switzerland) (VBS), introduced in 2010 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] refined BKP by adding a metallic stent to be expanded and deployed by an inflatable balloon within the fractured vertebral body. After the balloon was deflated and retrieved, the stent would effectively maintain fracture reduction and reduce the loss of vertebral body height after the momentary absence of support prior to cementation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe evolution of vertebral body cementing techniques from PVP to VBS Stentoplasty is of improved fracture reduction, maintenance of vertebral height and reduced cement leakage rates at the tradeoff of requiring increased hardware being introduced to the fracture site. As a highly minimally invasive procedure with small incisions, PVP wounds can be closed with Skin Adhesive Tapes (SATs) alone. Compared to PVP cannulas, the VBS access kit requires a working sleeve of 4.7mm in diameter as opposed to 2.59mm. This 330% increase in surface area is necessary to accommodate both the metallic stent and inflatable balloon for deployment. In addition, the implantation of metal stents demands precise placement of the access kit compared to the larger and more forgiving target area for cement portal placement in PVP. VBS stentoplasty thus requires larger skin incisions, causes greater soft tissue trauma and generates a bigger pedicle bore tract with exposed cancellous bone. These factors increase the risk of bleeding and wound complications.\u003c/p\u003e \u003cp\u003eSATs are a common modality of wound closure, having the capacity to provide mechanical and strangulation-free support for wounds. It opposes the superficial wound edges with minimal tension, providing similar tensile strength as skin sutures while maintaining epidermal integrity [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. They are typically used in conjunction with subdermal or subcuticular sutures in larger wounds but have shown reasonable reliability when used in isolation on lacerations or smaller surgical incisions. Compared to conventional suture closure, SATs have been found to deliver comparable [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] or better cosmetic results, and require less time for closure [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Complications associated with SATs are rare but include contact dermatitis, tension blisters, tape dislodgement, wound dehiscence and wound infection [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This study aims to evaluate the effectiveness, safety and cosmesis of skin adhesive tapes in the closure of VBS Stentoplasty wounds.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurgical Technique for Transpedicular VBS Stentoplasty and subsequent closure\u003c/h2\u003e \u003cp\u003ePatients are sedated and positioned prone on a radiopaque surgical table. After surgical cleansing and draping, radiopaque markers are placed approximately 3\u0026ndash;4 cm paramedian to the affected surgical level to localise the target pedicles by intraoperative radiography. Marcaine and adrenaline is infiltrated along the planned cannula tracts and to the periosteum surrounding the pedicle entry site. Stab incisions of approximately 1.5\u0026ndash;2 cm are made. A guidewire is inserted through the skin incisions, across the pedicles and into the vertebral body guided by sequential radiographs. Adjustments to the final positions of the guidewires can be made by stretching the surrounding soft tissue envelope at the expense of tissue trauma.\u003c/p\u003e \u003cp\u003eA working sleeve is advanced over the guidewire and the guidewire removed. A drill is passed into the working sleeve to create an access channel which is tamped down with a blunt plunger. The VBS stent size is templated according to markings on the blunt plunger.\u003c/p\u003e \u003cp\u003eThe bilateral VBS stents and inflation balloons are inserted into the vertebral body through the working sleeve. They are subsequently inflated with contrast-saline via a hand held pump with an integrated pressure gauge. Balloon inflation with stent expansion is performed in a bilateral and symmetrical fashion until there is adequate fracture reduction, or if a pressure of 30 atmospheres and/or the maximum height of the metal stent (Small: 15mm - Large: 17mm) is reached. Both balloons are then deflated and retrieved, leaving the expanded VBS stents to maintain the reduction. An injection needle is placed into the working sleeve and PMMA bone cement is subsequently injected to produce a stent-reinforced cement implant within the treated vertebral body (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The wound is irrigated with normal saline. If remnant bleeding is noted from the wound, manual pressure is applied for approximately 30 seconds before closure with SATs. If bleeding fails to stop after manual compression, the wound is closed with simple interrupted prolene sutures and dressed with non adherent waterproof dressings.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor suitable wounds, 3 SATs are applied to each incision in an overlapping fashion (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Non-adherent waterproof dressings are applied above the SATs (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The majority of the SATs are removed at the first dressing change, 3 days after surgery. Dry dressings are then continued until sufficient epithelization for the wound to be exposed. This typically occurs within 7 days. In the rare event that wounds continue to gape, SATs are reapplied until wound healing has progressed further.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData collection:\u003c/h2\u003e \u003cp\u003eA retrospective cohort of patients was obtained from electronic medical records. Collection of data was obtained under Institutional Review Board waiver. Data was anonymised and keyed into an electronic spreadsheet (Microsoft, Inc., USA). The inclusion criteria included all patients who underwent VBS Stentoplasty (DePuy Synthes, USA) at a tertiary hospital from May 2019 to March 2021. Only patients operated on by either of two surgeons who practised the surgical technique described were included.\u003c/p\u003e \u003cp\u003eData was collected for patient biodata, number of operative levels, wound closure method, and postoperative skin-related wound complications: contact dermatitis, tape dislodgement, tension blisters, wound dehiscence, wound infection, postoperative bleeding, and return to operating theatre. Risk factors for poor postoperative outcomes including wound site dehiscence and infection were recorded according to the \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAmerican College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP\u0026reg;)\u003c/span\u003e\u003c/p\u003e \u003cp\u003eAt clinic follow-up post-discharge, the wounds were also reviewed for complete healing and unsightly scarring requiring wound revision.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e36 patients were identified with a total of 45 levels of VBS stentoplasty performed. 3 (8.3%) patients received primary closure with non-absorbable sutures while 33 (91.6%) received SAT closure. Within the patients who received SAT closure, 27 (81.8%) had at least 1 risk factor for wound dehiscence including steroid use for chronic conditions (n\u0026thinsp;=\u0026thinsp;4, 12.1%), disseminated cancer (n\u0026thinsp;=\u0026thinsp;5, 15.1%), diabetes mellitus (n\u0026thinsp;=\u0026thinsp;7, 21.1%), hypertension requiring medication (n\u0026thinsp;=\u0026thinsp;18, 54.6%) and dialysis (n\u0026thinsp;=\u0026thinsp;1, 3.03%)\u003c/p\u003e \u003cp\u003eAmong patients whose wounds required conventional primary sutures, 2 of these patients had ongoing bleeding at the wound site at the end of the procedure. This was attributed to underlying coagulopathy, as one patient had perioperative aspirin use while the other had severe thrombocytopenia due to underlying bone marrow disease. The remaining 1 patient had VBS stentoplasty performed as part of a staged procedure. The primary suture closure was performed to accommodate an intra-theatre positional change from prone to supine on traction table for a femoral intramedullary nail insertion.\u003c/p\u003e \u003cp\u003e32 (97.0%) patients received SAT closure without any early complications of contact dermatitis, tension blisters, tape dislodgement, wound dehiscence, wound infection and return to theatre. 1 (3.0%) patient developed blood soaked dressings that required early removal and reapplication of the SATs at the ward a day later with uneventful recovery thereafter. (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) All patients with SAT closure had complete wound healing at outpatient follow up with adequate cosmetic outcome, without the need for wound revision. (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics and biodata of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51 to 60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61 to 70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e71 to 80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e81 to 90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChinese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18.5 to 24.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25 to 29.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eASA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRisk factors for wound dehiscence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eWhole sample \u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;36\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSAT\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;33\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ePrimary closure\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSteroid use for chronic conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAscites\u0026thinsp;\u0026lt;\u0026thinsp;30 days before surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystemic sepsis\u0026thinsp;\u0026lt;\u0026thinsp;48hours prior to surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVentilator dependent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisseminated cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension requiring medication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHF\u0026thinsp;\u0026lt;\u0026thinsp;30 days prior to surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnoea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent smoker\u0026thinsp;\u0026lt;\u0026thinsp;1 year prior to surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of severe COPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute renal failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCompared to skin sutures and staples, SATS are an easy to apply and non-invasive method of skin closure. SATs eliminate the risk of introducing skin infections via the suture needle or suture material, avoids scarring associated with suture/staple entry and exit sites and wound strangulation. SATS are faster to apply than conventional skin sutures and can save 1.5 to 3.5 minutes of operating time per patient compared to skin sutures [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Due to its ease of application, it may also be applied in the ward setting, as shown in the one patient in this study with a soaked dressing. It also does not require a removal of stitches or staples, which reduces outpatient time and cost [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLimitations to SAT closure include long, deep or gaping wounds as well as wounds located at areas of high movement, such as those overlying joints. This is due to the relatively lower amounts of tissue and skin support provided by SATs. In addition, bleeding or oozy wounds introduce moisture at the site of tape adhesion which can lead to easy dislodgement. For wounds which exhibit mild bleeding, sutures still provide an additional hemostatic advantage for the avoidance of haematoma formation.\u003c/p\u003e \u003cp\u003eVBS wounds are short but deep, and located over the thoracolumbar spine that is an area under tension and subject to friction. They have a potential to continue bleeding from exposed cancellous bone surfaces and traumatised muscle. Compared to PVP, the VBS skin incision has an increase in length of 50\u0026ndash;100% (1.5\u0026ndash;2 cm vs 1 cm). Nonetheless, a low rate of conversion to primary sutures was observed 5.7% (n\u0026thinsp;=\u0026thinsp;2). In this study, these patients had risk factors for coagulopathy which could account for the lack of wound site hemostasis after gentle pressure. One patient had blood soaked wounds on postoperative day 1, and while initially concerning, the removal of soaked SATs and re-application of new SATs in the ward under mild manual pressure appeared sufficient in controlling the bleeding and providing wound closure. A return to the operating theatre or conversion to primary sutures for wound closure and haemostasis was avoided. This study demonstrates that SATs are effective, safe and produce acceptable cosmetic results in the primary wound closure for VBS wounds. This has been demonstrated in a cohort where the majority of patients (81.2%) had at least 1 risk factor for wound dehiscence.\u003c/p\u003e \u003cp\u003eDespite the overall positive results, the authors advise caution on the use of SATs in patients with bleeding diathesis, such as a background of malignancy, anticoagulant use or liver disease. The superficial means of skin apposition may not be suitable to provide adequate pressure for haemostasis, especially at deeper layers.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSATs are a simple, safe and effective means of wound closure for the majority of percutaneous VBS procedures. Conversion to primary suture closure due to continued wound site bleeding is rarely required.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors declare that this is an independent original study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding \u0026ndash; Not applicable. There are no financial disclosures.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical waiver was granted concordance with regulations established by our institution\u0026rsquo;s Centralised Institutional Review Board (CIRB).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication of images were obtained from relevant patients prior to publication.\u003c/p\u003e\n\u003cp\u003eOYYH and SCCR conceived the idea and edited the manuscript. YC took the lead in writing the manuscript. QT collected the data. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDeramond H, Depriester C, Galibert P, Le Gars D. Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am. 1998 May;36(3):533-46. doi: 10.1016/s0033-8389(05)70042-7. PMID: 9597071. \u003c/li\u003e\n\u003cli\u003eMuijs SP, Nieuwenhuijse MJ, Van Erkel AR, Dijkstra PD. Percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures: evaluation after 36 months. J Bone Joint Surg Br. 2009 Mar;91(3):379-84. doi: 10.1302/0301-620X.91B3.20970. PMID: 19258616. \u003c/li\u003e\n\u003cli\u003eSun H, Yang Z, Xu Y, Liu X, Zhang Y, Chen Y, Xu D, Yang Y, Li D, Xia J. Safety of percutaneous vertebroplasty for the treatment of metastatic spinal tumors in patients with posterior wall defects. Eur Spine J. 2015 Aug;24(8):1768-77. doi: 10.1007/s00586-015-3810-8. Epub 2015 Feb 19. PMID: 25694161.\u003c/li\u003e\n\u003cli\u003eWang L, Zhang C, Liang H, Huang T, Zhong W, Zhao Z, Luo X. Cement leakage in percutaneous vertebroplasty for spinal metastases: a retrospective study of risk factors and clinical outcomes. World J Surg Oncol. 2022 Apr 7;20(1):112. doi: 10.1186/s12957-022-02583-5. PMID: 35387653; PMCID: PMC8988338. \u003c/li\u003e\n\u003cli\u003eHuang MH, Barrett-Connor E, Greendale GA, Kado DM. Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo study. J Bone Miner Res. 2006 Mar;21(3):419-23. doi: 10.1359/JBMR.051201. Epub 2005 Dec 5. PMID: 16491290; PMCID: PMC4964958. \u003c/li\u003e\n\u003cli\u003eMasala S, Cesaroni A, Sergiacomi G, Fiori R, Massari F, Manenti G, Nardi P, Simonetti G. Percutaneous kyphoplasty: new treatment for painful vertebral body fractures. In Vivo. 2004 Mar-Apr;18(2):149-53. PMID: 15113041. \u003c/li\u003e\n\u003cli\u003ePhillips FM, Ho E, Campbell-Hupp M, McNally T, Todd Wetzel F, Gupta P. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976). 2003 Oct 1;28(19):2260-5; discussion 2265-7. doi: 10.1097/01.BRS.0000085092.84097.7B. PMID: 14520041. \u003c/li\u003e\n\u003cli\u003eRotter R, Martin H, Fuerderer S, Gabl M, Roeder C, Heini P, Mittlmeier T. Vertebral body stenting: a new method for vertebral augmentation versus kyphoplasty. Eur Spine J. 2010 Jun;19(6):916-23. doi: 10.1007/s00586-010-1341-x. Epub 2010 Mar 1. PMID: 20191393; PMCID: PMC2899980.\u003c/li\u003e\n\u003cli\u003eHeini PF, Teuscher R. Vertebral body stenting / stentoplasty. Swiss Med Wkly. 2012 Aug 6;142:w13658. doi: 10.4414/smw.2012.13658. PMID: 22869449.\u003c/li\u003e\n\u003cli\u003eAulia I, Bangun K. Comparison of tensile strength and histopathological evaluation of wound healing process using adhesive skin tapes on laceration wounds of porcine skin. Journal of Physics: Conference Series. 2018 Dec; 1073(3):1-7. doi:10.1088/1742-6596/1073/3/032038\u003c/li\u003e\n\u003cli\u003eLadipo-Ajayi OA, Lawal TA, Ogundoyin OO, Michael AI. Steri-strip\u003csup\u003eTM\u003c/sup\u003e versus subcuticular skin closure of paediatric groin wounds: A randomised study. Afr J Paediatr Surg. 2022 Jul-Sep;19(3):137-143. doi: 10.4103/ajps.AJPS_184_20. PMID: 35775513; PMCID: PMC9290360. \u003c/li\u003e\n\u003cli\u003ePhakdeedindan W, Kamma C. Cosmetic Outcome of Wound Closure between Steri-Strips (3M\u0026trade; Steri-Strip) and Simple Interrupted Nylon 6-0 Sutures in Out-Patient Cervical Lymph Node Excision: A Randomized Controlled Trial. J Med Assoc Thai. 2021;104:1088-94. doi: doi.org/10.35755/jmedassocthai.2021.07.12306\u003c/li\u003e\n\u003cli\u003eMaene, B. Hidden costs of medical tape-induced skin injuries. Wounds UK. 2018;9(1):46-50.\u003c/li\u003e\n\u003cli\u003eAitchison LP, Chen AZL, Toms C, Sandroussi C, Yeo DA, Steffens D. To stitch or not to stitch: the skin closure of laparoscopic port sites, a meta-analysis. Surg Endosc. 2022 Oct;36(10):7140-7159. doi: 10.1007/s00464-022-09269-9. Epub 2022 May 24. 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PMID: 27600333.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Vertebral Body Stent, Wound Healing, Skin Adhesive Tapes, Primary Suture","lastPublishedDoi":"10.21203/rs.3.rs-3132524/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3132524/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003ePercutaneous Vertebral Body Stenting (VBS) is performed via a balloon-expandable metallic stent introduced through a stab incision to reduce and maintain the reduction of vertebral body fractures and minimise bone cement extravasation. The delivery of the balloon and stent involves a larger skin incision, soft tissue trauma and pedicle bore tract compared to traditional vertebroplasty (PVP) systems (4.7mm vs 2.59mm diameter), thus increasing the risk of bleeding and wound complications. Skin Adhesive Tapes (SATs) are a common method of wound closure for PVP. This study aims to evaluate the use of SATs in closure of larger VBS wounds.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA retrospective cohort of patients who underwent percutaneous VBS (DePuy Synthes, USA) was obtained from electronic medical records at a tertiary hospital from May 2019 to March 2021. Data was collected for wound closure method (conventional non-absorbable suture, SAT), number of operative levels, postoperative skin-related complications, wound dehiscence, wound infection, bleeding, symptomatic haematomas and return to operating theatre. At follow-up post-discharge, the wounds were reviewed for complete healing and unsightly scarring requiring wound revision. SAT closure was performed by applying 3 strips of SATs to loosely oppose the wound edges.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003e36 patients were identified with 45 levels of VBS performed. 3 (8.3%) patients received conventional suture closure, 33 (91.6%) received SAT closure. Conventional suture closure was performed due to ongoing bleeding at the wound site for 2 patients who had coagulopathy. The remaining patient received a planned suture closure in view of surgical expediency as part of a staged procedure.\u003c/p\u003e","manuscriptTitle":"Skin Adhesive Tapes are an effective wound closure method for Percutaneous Vertebral Body Stenting, A Retrospective Cohort Study ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-07-07 13:33:54","doi":"10.21203/rs.3.rs-3132524/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"13083ad5-b3b8-4e9b-80e0-709fe1a82a80","owner":[],"postedDate":"July 7th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-08-16T05:44:22+00:00","versionOfRecord":[],"versionCreatedAt":"2023-07-07 13:33:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3132524","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3132524","identity":"rs-3132524","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}