The Study of The Safety And Efficacy of Knot-free Barbed Sutures for Wound Healing in Obese Patients Undergoing Posterior Cervical Surgery

The Study of The Safety And Efficacy of Knot-free Barbed Sutures for Wound Healing in Obese Patients Undergoing Posterior Cervical Surgery | 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 Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Study of The Safety And Efficacy of Knot-free Barbed Sutures for Wound Healing in Obese Patients Undergoing Posterior Cervical Surgery Wei Qi, Wei Lei, Yang Zhang, Tiancheng Ma, Yufei Ji, Dawei Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3935839/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 Objective This retrospective, single-center clinical study aims to evaluate the safety and efficacy of barbed sutures for incision closure in posterior cervical surgery among obese patients, providing evidence for their potential broader application in this surgical context. Methods A total of 92 obese patients (Body Mass Index (BMI) ≥ 28kg/m 2 ) who required posterior cervical decompression, fusion, and internal fixation surgery between January 2021 and December 2022 at the First Affiliated Hospital of the PLA Air Force Military Medical University were enrolled. The patients were divided into two groups according to admission time: a control group (n = 53, admitted in 2021) where common Mersilk sutures were used and a test group (n = 39, admitted in 2022) where knot-free barbed sutures were used for suturing the deep fascia layer, superficial fascia layer, and skin. Various factors were compared between the groups at 3 months after surgery, including JOA, NDI, and VAS scores, incision length, subcutaneous fat thickness, incision suture time and speed, incision healing rate, and complication incidence, including specific comparisons of incision infection and dehiscence rates with cerebrospinal fluid leakage. Results The data showed no significant difference between the two groups in terms of incision length, subcutaneous fat thickness, as well as NDI, and VAS scores at 3 months after surgery (p > 0.05). However, the test group had significantly shorter incision suture time (p < 0.01), faster suture speed (p < 0.01), and higher incision healing rate (p < 0.05) as compared to the control group. Furthermore, this group also demonstrated a significantly lower incidence of complications, including lower incision dehiscence rate when cerebrospinal fluid leakage occurred (p 0.05). Conclusion Compared with the conventional silk suture, the utilization of the knot-free barbed suture in posterior cervical incisions among obese patients is efficacious and of high significance, as it promotes optimal incision healing and minimizes the likelihood of postoperative complications. Wound closure with barbed suture Posterior cervical surgery Surgical Site Infections (SSI) Incidence of incision complications Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Posterior cervical decompression, fusion and internal fixation is a widely recognized surgical technique in clinical practice 1 . It is commonly used to treat diseases such as ossification of the posterior longitudinal ligament, cervical spondylotic myelopathy, and cervical fractures that cause degeneration or injury to the cervical spine.With the advancement of medical technology, the affluence of the material life of the people, and the increasing societal concerns about aesthetics and success rates of surgical site incision healing, the quality of suturing in incisions in the posterior cervical surgery has gained importance, especially in the context of increasing obesity rates that pose challenges to surgical procedures and increase the risk of reoperations and complications 2-5 . Historically, Mersilk sutures were commonly used in clinical settings. However, this traditional suture material presented several issues, including poor histocompatibility that is susceptible to allergic reactions, insufficient strength and toughness that are prone to breakage after being soaked in tissue fluids, non-absorbability that may led to body rejection, and longer suturing time that may indirectly prolong the surgery. Advancements in material science have brought forth synthetic absorbable sutures, including knot-free barbed sutures, from traditional silk 6 . These have seen increasing use in various fields such as orthopedic surgery 7-9 , gynecology 10, 11 , gastrointestinal surgery 12, 13 , hepatobiliary surgery 14, 15 thanks to their impressive benefits. However, there is limited coverage on the use of knot-free barbed sutures in posterior cervical spine surgeries, particularly in obese patients.In 2022, our department introduced and implemented knot-free barbed sutures as a novel suture material in clinical practice. This study, therefore, seeks to comprehensively investigate the safety and efficacy of knot-free barbed sutures in suturing incisions in the posterior cervical surgery in obese patients through a rigorous clinical controlled trial that the traditional silk suture is the control. Upon thorough analysis on perioperative and follow-up data, the study aims to establish a foundation for broader clinical use of knot-free barbed sutures in posterior cervical spine surgery in such niche population. Materials and Methods 1.1.1 Case Collection This study selected a total of 92 obese patients who underwent posterior cervical spine surgery at the Department of Orthopedics, the First Affiliated Hospital of Air Force Medical University, Chinese People's Liberation Army, from January 2021 to January 2022. Both the test and control groups had similar surgical indications. Patients admitted in 2021 (n = 53) were assigned to the control group, and those admitted in 2022 (n = 39) formed the test group. All patients in both groups had normal results in pre-operative blood routine, erythrocyte sedimentation rate, and high-sensitivity C-reactive protein examinations. The control group comprised 38 males and 15 females, with a mean age (Mean ± SD) of 57.3 ± 10.8 years, while the test group had 26 males and 13 females, with a mean age (Mean ± SD) of 58 ± 9.8 years. The study received ethical approval from the Ethics Committee of the First Affiliated Hospital of the People's Liberation Army Air Force Medical University (Approval number: KY-20232136-F-1,the date of approval: 20/04/2023). And the study registrated in Clinical Trials in 25/05/2023 and the registration number was NCT05895968. 1.1.2 Inclusion Criteria ( 1 ) Patients aged between 45–65 years old, with diagnosis of C3-7 multilevel cervical spondylotic myelopathy or cervical canal stenosis, determined through systematic clinical and imaging examinations, requiring posterior cervical spine surgery; ( 2 ) There was no contraindication to surgery found in the preoperative routine laboratory tests and examinations; ( 3 ) BMI ≥ 28kg/m 216 − 18 ; ( 4 ) Able to provide informed consent. 1.1.3 Exclusion Criteria ( 1 ) History of consumptive diseases, such as malignant tumor, radiotherapy, and chemotherapy, that could potentially affect wound healing; ( 2 ) Previous skin conditions that could interfere with the study; ( 3 ) History of immune system disorders; ( 4 ) History of hematological diseases; ( 5 ) Presence of skin injury or defect in the back of the neck; ( 6 ) Severe allergic predisposition; ( 7 ) Recent cold, fever, trauma, or other infection within one week prior to surgery; ( 8 ) Existing infectious diseases; ( 9 ) Mental illness that would prevent cooperation with follow-up; ( 10 ) Patients or their family members who do not agree to provide informed consent; ( 11 ) Any other circumstances that would preclude participation in the study. 1.2 Methods 1.2.1 Grouping 1.2.2 Perioperative Management All surgical and incision suturing procedures were performed by the same team of senior spine surgeons. The open decompression range of the surgery was executed from C3 to C7. Cefazolin sodium was administered intravenously half an hour before surgery to prevent infection, and was repeated twice postoperatively. Antibiotics were discontinued within 24 hours after surgery. During the procedure, incision suturing was meticulously performed, adhering strictly to the instructions for using knot-free absorbable surgical sutures (see Fig. 2 ). The negative pressure drainage was performed post-procedurally for 48h; The drainage tube was only removed when the drainage volume was less than 50ml, and in case of cerebrospinal fluid leakage, only when the drainage fluid became clear. Dressing changes were done every 2–3 days post-surgery. In the control group, skin sutures were removed 2 weeks post-procedurally depending on the healing progress of the incision. 1.3 Observation Measures 1.3.1 Intraoperative incision suturing speed and quality: The incision suturing time, suturing speed, incision length, and subcutaneous fat thickness were compared between the two groups. Suturing time was calculated from the first to the last stitch; suturing speed was determined as the incision length divided by the suturing time 19 . Subcutaneous fat thickness was measured using preoperative MRI sagittal images to determine the maximum thickness of the subcutaneous fat 20 . A leakage test was utilized to verify suturing quality: After the deep fascia layer was sutured, the surgeon would roll a sterile gauze on it. If bloody exudation occurred during this process, the leakage test was Positive, indicating poor quality of the deep fascia suture and thus requiring a repair. If no bloody exudation was seen as the wound was rolled and squeezed, the leakage test was Negative, indicating good quality of the deep fascia suture (Fig. 3 ). 1.3.2 Incision healing rate: The healing of surgical site incision was evaluated based on the relevant standards specified in the ninth edition of Surgery 21 . 1.3.3 Surgical site incision complications: According to the Diagnostic Criteria for Nosocomial Infections 22 , the Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection 23 and A guideline on the management of incisions for the enhanced recovery after orthopedic surgery in China 24 , surgical site incision complications, including infection, wound dehiscence, rejection reaction to suture, and fat liquefaction, were visually inspected and recorded at 2 weeks, 4 weeks, and 3 months post-surgery. 1.3.4 Perioperative functional assessment: All patients were assessed at follow-up visits in the outpatient clinic at 2 weeks, 4 weeks, and 3 months post-surgery. The JOA score was used to evaluate cervical spinal cord function, and the VAS score was used to assess the incision pain symptoms. 1.4 Statistical Methods SPSS Statistics 26.0 was used for data analysis. Quantitative data were expressed as mean ± standard deviation (), and t test was used to compare the differences between groups. Qualitative data were expressed using rate and constituent ratio indicator, with \({\chi }^{2}\) test for comparison between groups. For non-normally distributed continuous data, we expressed them as median and interquartile range (Median (IQR), analyzed using the Mann-Whitney U test). Categorical variables were presented as frequencies and percentages and analyzed with the chi-square test or Fisher's exact test. All hypothesis tests were two-sided, and a p-value of less than 0.05 was considered statistically significant. Results 2.1 Comparison of Baseline Data Table 1 presents the baseline demographic data of the two groups. There was no significant difference between the groups in terms of gender, age, BMI, history of diabetes, hypertension, smoking, disease classification, or surgical segment (p > 0.05). This indicates that the baseline characteristics were consistent and comparable across both groups. Table 1 Comparison of baseline demographic data of the patients Control group (n = 53) Test group (n = 39) t/χ 2 /Z p-value Gender, n(%) 0.269 0.604 Male 38 (71.7) 26 (66.7) Female 15 (28.3) 13 (33.3) Age, years 57.3 ± 10.8 58 ± 9.8 -0.310 0.758 BMI, kg/m 2 29.5 ± 1.6 29.6 ± 2.0 -0.316 0.753 Diabetes, n(%) 29 (54.7) 22 (56.4) 0.026 0.872 Hypertension, n(%) 32 (60.4) 19 (48.7) 1.236 0.266 Smoking, n(%) 32 (60.4) 19 (48.7) 1.236 0.266 2.2 Test Design (see Fig. 4 ) 2.3 Comparison of Incision Suturing Time, Suturing Speed and Incision Length Between the Two Groups The study found no significant difference in incision length and subcutaneous fat thickness between the two groups (p > 0.05). However, the test group had significantly lower surgical time, suturing time, subcutaneous skin suturing time, deep fascia suturing time, and less intraoperative blood loss compared to the control group (p < 0.05). In addition, the deep fascia suturing speed in the test group was significantly higher than that in the control group (p < 0.001). See Table 2 . Table 2 Comparison of incision suturing time, suturing speed, and incision length Control group (n = 53) Test group (n = 39) t/χ 2 /Z P-value Subcutaneous fat thickness 2.9 ± 0.4 2.7 ± 0.3 1.610 0.201 Incision length 11.1 ± 1.3 10.9 ± 1.2 1.180 0.241 Surgery time 205.6 ± 21.5 190.3 ± 21.6 3.368 0.001 Suturing time 32.3 ± 2.5 25.0 ± 2.2 14.503 < 0.001 Subcutaneous skin suturing time 14.9 ± 1.1 11.4 ± 1.2 14.663 < 0.001 Deep fascia suturing time 17.9 ± 1.4 13.6 ± 1.2 15.534 < 0.001 Deep fascia suturing speed 0.63 ± 0.08 0.81 ± 0.09 -9.873 < 0.001 Intraoperative blood loss 250 (200, 300) 200 (200, 250) 2.872 0.004 2.4 Comparison of Incision Healing Rate Between the Two Groups The incision healing rate of the test group was higher than that of the control group (p < 0.05), as shown in Table 3 . Table 3 Comparison of incision healing rate (case, %) Group Number of cases, n Good healing, n(%) Poor healing, n(%) Healing rate Control group 53 42(79.2) 11(20.8) 79.2% Test group 39 38(97.4) 1(2.6) 97.4% χ 2 / / / 6.234 P / / / < 0.05 2.5 Comparison of Efficacy and Complications Between the Two Groups The comparison of efficacy and complications between the test group and the control group is shown in Table 4 . The median in differences of JOA scores before and after surgery in the test group was higher than that in the control group (p < 0.001), while there was no significant difference in NDI score (p = 0.516) and VAS score improvement (p = 0.183) between the two groups. Moreover, the test group had a lower incidence of wound infection (p = 0.013) and dehiscence (p < 0.001) compared to the control group. There was no significant difference in the incidence of rejection reaction to suture (p = 0.232) and fat liquefaction (p = 0.466) between the two groups. 2.6 Comparison of the Incidence of Wound Infection and Dehiscence in Patients with Cerebrospinal Fluid Leakage Between the Two Groups The study noted 25 cases of cerebrospinal fluid leakage, with 18 in the control group and 7 in the test group. The incidences of postoperative wound infection and dehiscence in these patients were compared in Table 5 . There was no significant difference in the rate of wound infection between the control and test groups (p = 0.156). However, the rate of wound dehiscence was lower in the test group compared to the control group (p = 0.032). (Fig. 5 ). Table 5 Comparison of the incidence of wound infection and dehiscence in patients with cerebrospinal fluid leakage Control group (n = 18) Test group (n = 7) χ 2 p-value Wound infection 14 (77.8%) 3 (42.9%) - 0.156 * Wound dehiscence 16 (88.9%) 3 (42.9%) - 0.032 * * , Fisher's exact test. Discussion Posterior cervical spine surgery, commonly used to treat cervical spinal stenosis in clinical practice, is significantly influenced by the quality of the closure of surgical site incision due to the unique surgical site and local anatomy. Especially in recent years, with the improvements of people's living standards, the number of obese people has been rising. Under this context, many patients undergoing this procedure often have a history of comorbidities like diabetes mellitus, hypertension, or are smokers. This elevates the complexity of suturing the posterior cervical incision and increases the risk of complications at the incision site. All of this, the key contributing factors of postoperative wound infections, are not only a concern for patients but also for healthcare professionals 20 . Historically, due to technological and material limitations, the silk suture was widely used for surgical site incisions. However, as it is made of non-absorbable material, such suture has suboptimal biocompatibility that is prone to poor skin alignment and may lead to local inflammatory reactions, and requires removal which is likely to form a “centipede-like scar” that could negatively impact the patient psychology due to the aesthetics concern 25 . Additionally, traditional suture materials like silk have potential complications such as foreign body reactions, local tissue ischemia, persistent pain, and prolonged surgical time. These risks can seriously compromise the success of posterior cervical surgeries. The knot-free barbed suture is a unique type of absorbable suture with fishbone-like protrusions on the surface. These barbs help to keep the incision tissues closer and prevent the suture from breaking, especially in high-tension areas like the deep fascia layer 26 . Compared to the conventional suture of the same size with continuous or interrupted technique, this kind of barbed suture also provides superior tissue-holding strength; even when the sutures were broken at one point, the tissue holding remains safe and sound 27 . Additionally, it is so excellent in watertight suturing that helps prevent joint fluid, blood, tissue fluid, and other substances from penetrating into the subcutaneous tissue through the deep fascia, thereby reducing the risk of wound infection 28 . All these benefits allow the knot-free barbed suture for widespread use in surgical tissue suturing 12, 29, 30 . It offers numerous advantages over traditional silk sutures, including quicker suturing, less tissue irritation, absence of knot-related complications, finer scars, uniform tension distribution, effective fixation, improved wound closure, and enhanced safety, all of which have been recognized by both patients and doctors in clinical practice. However, there is a lack of research on the use of barbed sutures for suturing posterior cervical incisions in obese patients, both domestically and internationally, making it a crucial focus of this study. Effective incision closure is a key to the success of posterior cervical surgeries, as the risk of complications is almost double compared to anterior approaches 31, 32 . Various incision complications such as SSI, wound dehiscence, rejection reaction to suture, and fat liquefaction are associated with wound closure techniques. Therefore, it is critical to understand the potential differences in complication rates and outcomes between closure techniques to reduce postoperative complications and improve patient outcomes 33 . Previous studies have indicated that longer durations of general anesthesia during surgery are associated with increased surgical risks and postoperative complications, particularly in relation to recovery of respiratory, digestive, physiological response, and autonomic functions. This can impact the quality and duration of postoperative rehabilitation to a large extent, particularly for patients with underlying conditions or advanced age, who face significantly greater risks. Additionally, prolonged surgical time may also increase the risk of wound contamination and infection due to prolonged exposure of the surgical site incision to air 34–36 . Our study found that when the surgical site incision and subcutaneous fat thickness were nearly the same (p > 0.05), the employment of knot-free barbed sutures for incision closure significantly curtailed the duration of surgery, intraoperative blood loss, and suturing time in comparison to the control group (p < 0.05). This outcome is an echo to the barbed sutures that eliminate the need for knotting and offer a robust tissue holding strength. More importantly, since the obese patients have relatively thick subcutaneous fat behind their necks, their surgical site incisions would be deeper, which undoubtedly makes the suturing more complex and duration of surgery longer, thus increasing the incidence of surgical complications. Accordingly, this also places high requirements for the surgeon's suturing technique. The use of barbed suture for suturing the posterior cervical incision in obese patients simplifies the suturing process and technical requirements to a great extent, making the learning curve of less experienced surgeons shorter. The results of the study showed that the wound healing rate and patient satisfaction of the test group were significantly higher than those of the test group (p < 0.05). This indicates that the application of barbed suture in obese patients with posterior cervical incision yields better outcomes. Compared to traditional silk sutures, the knot-free barbed sutures have been shown to decrease tissue irritation, which in turn effectively reduces inflammation. Symmetric employs a unique fumigation process to incorporate triclosan's antibacterial properties into the suture material, achieving a deeper and more concentrated effect than typical absorbable antibacterial braided sutures. This leads to an extended period of antibacterial action, inhibiting bacterial growth for as long as 11–23 days. The study found that the knot-free barbed sutures can substantially lower the rate of infections in surgical site incisions (p < 0.05). In addition, as Symmetric is comprised of poly(p-dioxanone) (PPDO), it sustains 55% of its initial tension into the sixth week, a pivotal stage in wound healing, promoting enhanced healing in surgical site incision tissue. Furthermore, knot-free barbed sutures were found to effectively prevent wound dehiscence (p < 0.01), an important consideration in obese patients with high tension in their posterior neck incisions. The barbed suture's fishbone-like design provides enduring and reliable wound support, especially for the musculofascial layer under high tension 27 . However, our study found no significant variance in the incision rejection reaction to suture and fat liquefaction between the knot-free barbed sutures and traditional silk sutures (p > 0.05), possibly due to the increased subcutaneous fat and tension in incisions in obese patients. In the realm of spinal surgery, cerebrospinal fluid leakage is a common complication and timely management is crucial in preventing incisional problems. It is reported that the occurrence of cerebrospinal fluid leakage is around 1% during cervical spine surgeries and about 14% in lumbar spine procedures 37 . Full-thickness incision dehiscence is a condition where all layers of the soft tissue, including the spinal muscles and the deep fascia, separate, leading to a lack of incision union and exposure of the internal fixation, thereby elevating the risk of infection. As per Feng et al. 38 , the primary cause of this condition is the accumulation of cerebrospinal fluid in the subcutaneous soft tissue due to poorly sutured fascia. How to address the difficulty in wound healing caused by cerebrospinal fluid leakage is a huge challenge to both patients and healthcare providers. Previous studies suggest that the use of knot-free barbed sutures for continuous suturing of surgical site incisions in posterior cervical spine surgeries decreases the incidence of postoperative wound complications and SSI when compared to the interrupted suturing with the traditional silk sutures 39 . Our study confirms this finding. In fact, the continuous suturing technique with the fishbone barbed suture provides better water tightness than that of the interrupted suturing with traditional sutures 29 since it will improve the consistency of tissue alignment, reduce gaps in suturing, and prevent fluid exudation; in case of any cerebrospinal fluid leakage during posterior cervical surgeries, this technique combination will offer sound water tightness, thereby minimizing the occurrence of incision dehiscence and infection caused by suture degradation, relaxation or fracture as a consequence of that the sutures are immersed in exudate accumulations for a long period of time. Meanwhile, the application of the knot-free barbed suture in surgical site incisions can help circumvent the burden and pressure of secondary debridement and suture surgery caused by wound dehiscence or infection (Fig. 5 ). All the participating surgeons in this study were well-trained senior spinal surgeons, but there were instances where the knot-free barbed suture broke during the suturing process, which could potentially be due to improper suturing operations. Given that barbed sutures have a barbed structure, any entanglement can cause the barbed portion to sever the suture. Barbed sutures, as observed, establish a strong tissue holding strength, ensuring that they will not be easily dislodged; however, exactly because of this, the likelihood of suture breakage is high. Nevertheless, it's imperative for surgeons to pay attention to their suturing technique and the force they apply to avoid suture breakage. For suturing of deep fascia in the posterior neck incision of obese patients, it is advisable to suture as extensively as possible while posing no unnecessary financial burden to them. This approach increases the integrity of the deep fascia layer, thereby reducing the risk of incision dehiscence. This study provides robust evidence backing the safety and efficacy of knot-free barbed sutures in the closure of posterior cervical incisions in obese patients. Nonetheless, it's essential to recognize that the study's methodology–a single-center, retrospective trial with a short duration and relatively small sample size–inherently imposed certain limitations, which may affect the results' generalizability. Despite these constraints, it is our aspiration that this study will lay the groundwork for clinical application of barbed sutures in posterior cervical spine surgeries in obese patients and serves as a valuable reference for future related research by others. In conclusion, the knot-free barbed sutures demonstrate enhanced safety and efficacy in posterior cervical spine surgeries in obese patients. This particular suture technique markedly minimizes the incidence of incision-related complications (e.g., infection, dehiscence, and exudation, etc.), while enhancing suturing speed and reducing suturing time consumption, thereby diminishing the surgical risks associated with prolonged surgical time. Declarations Conflicts of Interest :None of the authors has a financial interest in any of the products or devices mentioned in this article. Sources of Funding : Key Research and Development Projects of Shaanxi Province was received for this study. Author Contributions : All authors were involved in either drafting or revising the submitted manuscript, approval of the final submission, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Wei Qi, Yang Zhang, and Wei Lei were responsible for designing the project and interpreting the data. Zixiang Wu and Yabo Yan were responsible for the acquisition of data. Xiong Zhao and Tiancheng Ma were responsible for the analysis. Yufei Ji was responsible for the acquisition and interpretation of data for the submitted work. Ethical Approval : The study received ethical approval from the Ethics Committee of the First Affiliated Hospital of the People's Liberation Army Air Force Medical University (Approval number: KY-20232136-F-1,the date of approval: 20/04/2023). And the study registrated in Clinical Trials in 25/05/2023 and the registration number was NCT05895968. Informed Consent : Informed consent for publication was obtained by all participants in this study “Availability of Data and Materials” statements: The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Informed consent to participate statements: Informed consent to participate in the study was obtained from all subjects. References Nori S, Nagoshi N, Daimon K, et al. Comparison of surgical outcomes of posterior surgeries between cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. Spinal Cord 2022;60:928-33. Collins N. Obesity and wound healing. Advances in Skin & Wound Care 2003;16:45-7. Wilson JA, Clark JJ. Obesity: impediment to postsurgical wound healing. Advances in Skin & Wound Care 2004;17:426-35. Guo S, Dipietro LA. Factors affecting wound healing. Journal of Dental Research 2010;89:219-29. Pierpont YN, Dinh TP, Salas RE, et al. Obesity and surgical wound healing: a current review. Isrn Obes 2014;2014:638936. Dragovic M, Pejovic M, Stepic J, et al. Comparison of four different suture materials in respect to oral wound healing, microbial colonization, tissue reaction and clinical features-randomized clinical study. Clinical Oral Investigations 2020;24:1527-41. Han Y, Yang W, Pan J, et al. The efficacy and safety of knotless barbed sutures in total joint arthroplasty: a meta-analysis of randomized-controlled trials. Archives of Orthopaedic and Trauma Surgery 2018;138:1335-45. Li R, Ni M, Zhao J, et al. A modified strategy using barbed sutures for wound closure in total joint arthroplasty: a prospective, randomized, double-blind, self-controlled clinical trial. Medical Science Monitor 2018;24:8401-7. Sah AP. A prospective, randomized evaluation of the quality of wound closure with barbed versus standard suture after total joint arthroplasty. Orthopedics 2021;44:216-22. Greenberg JA. The use of barbed sutures in obstetrics and gynecology. Rev Obstet Gynecol 2010;3:82-91. Greenberg JA, Goldman RH. Barbed suture: a review of the technology and clinical uses in obstetrics and gynecology. Rev Obstet Gynecol 2013;6:107-15. Velotti N, Manigrasso M, Di Lauro K, et al. Barbed suture in gastro-intestinal surgery: a review with a meta-analysis. Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 2022;20:115-22. Wiggins T, Majid MS, Markar SR, et al. Benefits of barbed suture utilisation in gastrointestinal anastomosis: a systematic review and meta-analysis. Annals of the Royal College of Surgeons of England 2020;102:153-9. Talwar P, Velayudam L, Hemapriya L, et al. Barbed suture in total laparoscopic hysterectomy: a comparative study of the safety in vaginal cuff closure with that of polyglactin 910 suture. Gynecology and Minimally Invasive Therapy-Gmit 2021;10:154-8. Lopez CC, Rios J, Gonzalez Y, et al. Barbed suture versus conventional suture for vaginal cuff closure in total laparoscopic hysterectomy: randomized controlled clinical trial. Journal of Minimally Invasive Gynecology 2019;26:1104-9. UK CFPH, UK NCCF. Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children . London: National Institute for Health and Clinical Excellence (UK); 2006. China OWG. Guidelines for the prevention and control of overweight and obesity in chinese adults. Journal of Nutrition 2004;1:1-4. Physical status: the use and interpretation of anthropometry. Report of a who expert committee. World Health Organ Tech Rep Ser 1995;854:1-452. Muellner M, Chiapparelli E, Moser M, et al. The effect of age on psoas and paraspinal muscle morphology in patients undergoing posterior lumbar fusion surgery. European Spine Journal 2022;31:2619-28. Mehta AI, Babu R, Sharma R, et al. Thickness of subcutaneous fat as a risk factor for infection in cervical spine fusion surgery. Journal of Bone and Joint Surgery-American Volume 2013;95:323-8. Chen X. Surgery : People's Publishing House; 2018. Infections, diagnostic criteria for nosocomial. Journal of Modern Practical Medicine 2003:460-5. Berrios-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. Jama Surgery 2017;152:784-91. Kang Y, Zhou ZK, Yang HL. A guideline on the management of incisions for the enhanced recovery after orthopedic surgery in china. Chinese Journal of Bone and Joint Surgery 2018;1:3-10. Kolimi P, Narala S, Nyavanandi D, et al. Innovative treatment strategies to accelerate wound healing: trajectory and recent advancements. Cells 2022;11. Reynolds Z, Hibbert N, Stevenson P, et al. The effect of iron deficiency on quality of life outcomes after surgery for obstructive sleep apnoea. Journal of Paediatrics and Child Health 2022;58:1816-23. Nawrocki JG, Nonnenmann H, Mooney M, et al. A high-strength, absorbable, antibacterial knotless tissue control device for fascial closure. Current Obstetrics and Gynecology Reports 2017;6:175-81. Nett M, Avelar R, Sheehan M, et al. Water-tight knee arthrotomy closure: comparison of a novel single bidirectional barbed self-retaining running suture versus conventional interrupted sutures. Journal of Knee Surgery 2011;24:55-9. Chan V, Chan PK, Chiu KY, et al. Does barbed suture lower cost and improve outcome in total knee arthroplasty? A randomized controlled trial. Journal of Arthroplasty 2017;32:1474-7. Cervone A. Robotic hernia repair using a barbed suture. Surgical Technology International-International Developments in Surgery and Surgical Research 2022;41. Yoshii T, Egawa S, Chikuda H, et al. Comparison of anterior decompression with fusion and posterior decompression with fusion for cervical spondylotic myelopathy-a systematic review and meta-analysis. Journal of Orthopaedic Science 2020;25:938-45. Papavero L, Lepori P, Schmeiser G. Revision surgery in cervical spine. European Spine Journal 2020;29:47-56. Cheung JP, Luk KD. Complications of anterior and posterior cervical spine surgery. Asian Spine Journal 2016;10:385-400. Deng H, Chan AK, Ammanuel S, et al. Risk factors for deep surgical site infection following thoracolumbar spinal surgery. Journal of Neurosurgery-Spine 2019;32:292-301. Zhang X, Liu P, You J. Risk factors for surgical site infection following spinal surgery: a meta-analysis. Medicine 2022;101:e28836. Seidelman JL, Mantyh CR, Anderson DJ. Surgical site infection prevention: a review. Jama-Journal of the American Medical Association 2023;329:244-52. Hannallah D, Lee J, Khan M, et al. Cerebrospinal fluid leaks following cervical spine surgery. Journal of Bone and Joint Surgery-American Volume 2008;90:1101-5. Feng C, Qianqian S, Jianhua H, et al. Treatment experience for full-thickness wound dehiscence with cerebrospinal fluid leakage following posterior primary spine surgery: three case reports. Medicine 2019;98:e15126. Tang AR, Steinle AM, Chanbour H, et al. Barbed suture versus interrupted suture in posterior cervical spine surgery: are they equivalent? Spine Surgery and Related Research 2022;6:645-53. Additional Declarations No competing interests reported. Supplementary Files file.xlsx 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies 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-3935839","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":271942476,"identity":"95b70c97-7448-4b90-a869-83ca4453804e","order_by":0,"name":"Wei Qi","email":"","orcid":"","institution":"Xijing Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Qi","suffix":""},{"id":271942477,"identity":"8ba52613-0288-4585-8fc4-add887fd1897","order_by":1,"name":"Wei Lei","email":"","orcid":"","institution":"Xijing Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Lei","suffix":""},{"id":271942478,"identity":"9ea62e60-0d6e-4ff0-bde3-916ab303c3cd","order_by":2,"name":"Yang Zhang","email":"","orcid":"","institution":"Xijing Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Zhang","suffix":""},{"id":271942479,"identity":"0ac3c877-8536-4b85-b73d-a67788b84a1a","order_by":3,"name":"Tiancheng Ma","email":"","orcid":"","institution":"Xijing Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tiancheng","middleName":"","lastName":"Ma","suffix":""},{"id":271942480,"identity":"d8ce42e9-ccfc-4998-9f66-aa16264801f5","order_by":4,"name":"Yufei Ji","email":"","orcid":"","institution":"Xijing Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yufei","middleName":"","lastName":"Ji","suffix":""},{"id":271942481,"identity":"5d5d50e6-b5e8-497f-9465-0c06545e1b1e","order_by":5,"name":"Dawei Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIie3PsWrDMBCA4RMHyqLYq/0WB4HSwdivoiDQlCEP0EEl0Kl0zmP0EZQcyZQHMCSQQMCzwRAylFJ7KN1sdytU/6BDcN9wAKHQX8wDYDeL89X7mrJ8PAFv55v10prfkMWMVb0VbkhEpcZm+XTKn50nzsgjTHj33kfSUsNsva/MSjjNCzpFoKwt+wgdNRgl2UgE35IKIVEPg4TVJ7dMOH4kFm4EEavpC+eJQmAYQ9LzBXH6xpoSCZtXskYO3RIdPDbqxgUlcVPfP7I8nvC+lwDEdffO3fdf9q//VIxdDIVCoX/YFx6jUHcoeX1pAAAAAElFTkSuQmCC","orcid":"","institution":"Xijing Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Dawei","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-02-07 05:14:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3935839/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3935839/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51018396,"identity":"c03dc881-8e35-4a4b-a1f2-b48af1f55f48","added_by":"auto","created_at":"2024-02-12 19:21:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":44297,"visible":true,"origin":"","legend":"\u003cp\u003eKnot-free absorbable barbed surgical sutures\u003c/p\u003e\n\u003cp\u003eSTRATAFIX™ Symmetric PDS™ Plus 1-0/2-0 Pressed Barbed Suture\u003c/p\u003e\n\u003cp\u003eSTRATAFIX™ Spiral PGA-PCL 3-0 Barbed Suture\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3935839/v1/ebcc3ede5748b0d5c241df64.png"},{"id":51018399,"identity":"0804f6b4-f453-4512-93d1-53d638f72911","added_by":"auto","created_at":"2024-02-12 19:21:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":418316,"visible":true,"origin":"","legend":"\u003cp\u003eDemonstration diagram and practical application image of Symmetric in suturing the fascia layer. (A, B, C demonstration diagrams are quoted from Symmetric's Instructions for Use [IFU]; D, E are images taken during the surgery.)\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-3935839/v1/a53fc88fa727c1606d15d62d.png"},{"id":51018406,"identity":"cc62edb4-25de-47fa-ab0c-1bdefaa11dcf","added_by":"auto","created_at":"2024-02-12 19:21:42","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":493871,"visible":true,"origin":"","legend":"\u003cp\u003eLeakage test\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-3935839/v1/1bb0d42555321833e5e2d6e2.png"},{"id":51018398,"identity":"cbf21d9f-46b8-4493-a4ac-0d855a034d82","added_by":"auto","created_at":"2024-02-12 19:21:38","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":298559,"visible":true,"origin":"","legend":"\u003cp\u003eTest flow chart\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-3935839/v1/906fd265ea849da0ccbf6597.png"},{"id":51018401,"identity":"51d05125-5b93-49a8-8cae-6d68ea40da1c","added_by":"auto","created_at":"2024-02-12 19:21:40","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":2288207,"visible":true,"origin":"","legend":"\u003cp\u003eA 48-year-old female patient, with BMI=32.3kg/m\u003csup\u003e2\u003c/sup\u003e and over 10 years of diabetes mellitus history and another male patient who was 53-year-old with BMI=28.1kg/m\u003csup\u003e2\u003c/sup\u003e and over 20 years of diabetes mellitus history. They underwent C3-C7 posterior open-door laminoplasty due to \"incomplete paralysis from cervical spinal stenosis\". Intra-procedurally, the fascia layer and skin were interrupted sutured using the Mersilk sutures in the female patient and the fascia layer and skin were interrupted sutured using the knot-free barbed suture. A: Two weeks post-surgery, the female patient suffered from poor wound healing accompanied with cerebrospinal fluid leakage, requiring ongoing changes to the wound dressing. B: A month post-surgery, the patient experienced a full-thickness dehiscence of surgical site incision, leading to the formation of a 6 x 5cm cavity in the wound. Extensive debridement was therefore performed, and the deep fascia layer was sutured using a 1-0 fishbone suture, while a 4\u003csup\u003e#\u003c/sup\u003e Mersilk suture was used for the skin. C: Three months after the surgery, the wound had healed effectively, but a large \"centipede-like scar\" was left on the skin over the wound. D:One weeks post-surgery, the male patient’s wound healed well. E: Three weeks post-surgery, the male patient's wound has healed completely without any infection or scarring.\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-3935839/v1/fab9f07d072a4381a1d9e257.png"},{"id":51019812,"identity":"ab691663-033e-4b70-88f7-6c4e5dc33a6c","added_by":"auto","created_at":"2024-02-12 19:37:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4297481,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3935839/v1/44fd4377-8b72-4603-b8a4-ac02fbe86cfc.pdf"},{"id":51018404,"identity":"59934af7-e535-487b-b60f-86e1dbc43ff5","added_by":"auto","created_at":"2024-02-12 19:21:41","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":41435162,"visible":true,"origin":"","legend":"","description":"","filename":"file.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-3935839/v1/6a1788fd448463fabf4ad118.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Study of The Safety And Efficacy of Knot-free Barbed Sutures for Wound Healing in Obese Patients Undergoing Posterior Cervical Surgery","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePosterior cervical decompression, fusion and internal fixation is a widely recognized surgical technique in clinical practice\u003csup\u003e1\u003c/sup\u003e. It is commonly used to treat diseases such as ossification of the posterior longitudinal ligament, cervical spondylotic myelopathy, and cervical fractures that cause degeneration or injury to the cervical spine.With the advancement of medical technology, the affluence of the material life of the people, and the increasing societal concerns about aesthetics and success rates of surgical site incision healing, the quality of suturing in\u0026nbsp;incisions\u0026nbsp;in the posterior cervical surgery has gained importance, especially in the context of increasing obesity rates that pose challenges to surgical procedures and increase the risk of reoperations and complications\u003csup\u003e2-5\u003c/sup\u003e. Historically, Mersilk sutures were commonly used in clinical settings. However, this traditional suture material presented several issues, including poor histocompatibility that is susceptible to allergic reactions, insufficient strength and toughness that are prone to breakage after being soaked in tissue fluids, non-absorbability that may led to body rejection, and longer suturing time that may indirectly prolong the surgery. Advancements in material science have brought forth synthetic absorbable sutures, including knot-free barbed sutures, from traditional silk\u003csup\u003e6\u003c/sup\u003e. These have seen increasing use in various fields such as orthopedic surgery\u003csup\u003e7-9\u003c/sup\u003e, gynecology\u003csup\u003e10, 11\u003c/sup\u003e, gastrointestinal surgery\u003csup\u003e12, 13\u003c/sup\u003e, hepatobiliary surgery\u003csup\u003e14, 15\u003c/sup\u003e thanks to their impressive benefits. However, there is limited coverage on the use of knot-free barbed sutures in posterior cervical spine surgeries, particularly in obese patients.In 2022, our department introduced and implemented knot-free barbed sutures as a novel suture material in clinical practice. This study, therefore, seeks to comprehensively investigate the safety and efficacy of knot-free barbed sutures in suturing incisions in the posterior cervical surgery in obese patients through a rigorous clinical controlled trial that the traditional silk suture is the control. Upon thorough analysis on perioperative and follow-up data, the study aims to establish a foundation for broader clinical use of knot-free barbed sutures in posterior cervical spine surgery in such niche population.\u003c/p\u003e\n"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec2\"\u003e\n \u003ch2\u003e1.1.1 Case Collection\u003c/h2\u003e\n \u003cp\u003eThis study selected a total of 92 obese patients who underwent posterior cervical spine surgery at the Department of Orthopedics, the First Affiliated Hospital of Air Force Medical University, Chinese People\u0026apos;s Liberation Army, from January 2021 to January 2022. Both the test and control groups had similar surgical indications. Patients admitted in 2021 (n\u0026thinsp;=\u0026thinsp;53) were assigned to the control group, and those admitted in 2022 (n\u0026thinsp;=\u0026thinsp;39) formed the test group. All patients in both groups had normal results in pre-operative blood routine, erythrocyte sedimentation rate, and high-sensitivity C-reactive protein examinations. The control group comprised 38 males and 15 females, with a mean age (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) of 57.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8 years, while the test group had 26 males and 13 females, with a mean age (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) of 58\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8 years. The study received ethical approval from the Ethics Committee of the First Affiliated Hospital of the People\u0026apos;s Liberation Army Air Force Medical University (Approval number: KY-20232136-F-1,the date of approval: 20/04/2023). And the study registrated in Clinical Trials in 25/05/2023 and the registration number was NCT05895968.\u003c/p\u003e\n \u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003e1.1.2 Inclusion Criteria\u003c/h2\u003e\n \u003cp\u003e(\u003cspan\u003e1\u003c/span\u003e) Patients aged between 45\u0026ndash;65 years old, with diagnosis of C3-7 multilevel cervical spondylotic myelopathy or cervical canal stenosis, determined through systematic clinical and imaging examinations, requiring posterior cervical spine surgery; (\u003cspan\u003e2\u003c/span\u003e) There was no contraindication to surgery found in the preoperative routine laboratory tests and examinations; (\u003cspan\u003e3\u003c/span\u003e) BMI\u0026thinsp;\u0026ge;\u0026thinsp;28kg/m\u003csup\u003e216\u0026thinsp;\u0026minus;\u0026thinsp;18\u003c/sup\u003e; (\u003cspan\u003e4\u003c/span\u003e) Able to provide informed consent.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec4\"\u003e\n \u003ch2\u003e1.1.3 Exclusion Criteria\u003c/h2\u003e\n \u003cp\u003e(\u003cspan\u003e1\u003c/span\u003e) History of consumptive diseases, such as malignant tumor, radiotherapy, and chemotherapy, that could potentially affect wound healing; (\u003cspan\u003e2\u003c/span\u003e) Previous skin conditions that could interfere with the study; (\u003cspan\u003e3\u003c/span\u003e) History of immune system disorders; (\u003cspan\u003e4\u003c/span\u003e) History of hematological diseases; (\u003cspan\u003e5\u003c/span\u003e) Presence of skin injury or defect in the back of the neck; (\u003cspan\u003e6\u003c/span\u003e) Severe allergic predisposition; (\u003cspan\u003e7\u003c/span\u003e) Recent cold, fever, trauma, or other infection within one week prior to surgery; (\u003cspan\u003e8\u003c/span\u003e) Existing infectious diseases; (\u003cspan\u003e9\u003c/span\u003e) Mental illness that would prevent cooperation with follow-up; (\u003cspan\u003e10\u003c/span\u003e) Patients or their family members who do not agree to provide informed consent; (\u003cspan\u003e11\u003c/span\u003e) Any other circumstances that would preclude participation in the study.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\"\u003e\n \u003ch2\u003e1.2 Methods\u003c/h2\u003e\n \u003cdiv id=\"Sec6\"\u003e\n \u003ch2\u003e1.2.1 Grouping\u003c/h2\u003e\n \u003cdiv\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec7\"\u003e\n \u003ch2\u003e1.2.2 Perioperative Management\u003c/h2\u003e\n \u003cp\u003eAll surgical and incision suturing procedures were performed by the same team of senior spine surgeons. The open decompression range of the surgery was executed from C3 to C7. Cefazolin sodium was administered intravenously half an hour before surgery to prevent infection, and was repeated twice postoperatively. Antibiotics were discontinued within 24 hours after surgery. During the procedure, incision suturing was meticulously performed, adhering strictly to the instructions for using knot-free absorbable surgical sutures (see Fig.\u0026nbsp;\u003cspan\u003e2\u003c/span\u003e). The negative pressure drainage was performed post-procedurally for 48h; The drainage tube was only removed when the drainage volume was less than 50ml, and in case of cerebrospinal fluid leakage, only when the drainage fluid became clear. Dressing changes were done every 2\u0026ndash;3 days post-surgery. In the control group, skin sutures were removed 2 weeks post-procedurally depending on the healing progress of the incision.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\"\u003e\n \u003ch2\u003e1.3 Observation Measures\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003e1.3.1\u003c/strong\u003e Intraoperative incision suturing speed and quality: The incision suturing time, suturing speed, incision length, and subcutaneous fat thickness were compared between the two groups. Suturing time was calculated from the first to the last stitch; suturing speed was determined as the incision length divided by the suturing time\u003csup\u003e19\u003c/sup\u003e. Subcutaneous fat thickness was measured using preoperative MRI sagittal images to determine the maximum thickness of the subcutaneous fat\u003csup\u003e20\u003c/sup\u003e. A leakage test was utilized to verify suturing quality: After the deep fascia layer was sutured, the surgeon would roll a sterile gauze on it. If bloody exudation occurred during this process, the leakage test was Positive, indicating poor quality of the deep fascia suture and thus requiring a repair. If no bloody exudation was seen as the wound was rolled and squeezed, the leakage test was Negative, indicating good quality of the deep fascia suture (Fig.\u0026nbsp;\u003cspan\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003e\u003cstrong\u003e1.3.2\u003c/strong\u003e Incision healing rate: The healing of surgical site incision was evaluated based on the relevant standards specified in \u003cem\u003ethe ninth edition of Surgery\u003c/em\u003e\u003csup\u003e21\u003c/sup\u003e.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e\u003cstrong\u003e1.3.3\u003c/strong\u003e Surgical site incision complications: According to the \u003cem\u003eDiagnostic Criteria for Nosocomial Infections\u003c/em\u003e\u003csup\u003e22\u003c/sup\u003e, the \u003cem\u003eCenters for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection\u003c/em\u003e\u003csup\u003e23\u003c/sup\u003e and \u003cem\u003eA guideline on the management of incisions for the enhanced recovery after orthopedic surgery in China\u003c/em\u003e\u003csup\u003e24\u003c/sup\u003e, surgical site incision complications, including infection, wound dehiscence, rejection reaction to suture, and fat liquefaction, were visually inspected and recorded at 2 weeks, 4 weeks, and 3 months post-surgery.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e\u003cstrong\u003e1.3.4\u003c/strong\u003e Perioperative functional assessment: All patients were assessed at follow-up visits in the outpatient clinic at 2 weeks, 4 weeks, and 3 months post-surgery. The JOA score was used to evaluate cervical spinal cord function, and the VAS score was used to assess the incision pain symptoms.\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\"\u003e\n \u003ch2\u003e1.4 Statistical Methods\u003c/h2\u003e\n \u003cp\u003eSPSS Statistics 26.0 was used for data analysis. Quantitative data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (), and t test was used to compare the differences between groups. Qualitative data were expressed using rate and constituent ratio indicator, with \u003cspan\u003e\u003cspan\u003e\\({\\chi }^{2}\\)\u003c/span\u003e\u003c/span\u003e test for comparison between groups. For non-normally distributed continuous data, we expressed them as median and interquartile range (Median (IQR), analyzed using the Mann-Whitney U test). Categorical variables were presented as frequencies and percentages and analyzed with the chi-square test or Fisher\u0026apos;s exact test. All hypothesis tests were two-sided, and a p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 Comparison of Baseline Data\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the baseline demographic data of the two groups. There was no significant difference between the groups in terms of gender, age, BMI, history of diabetes, hypertension, smoking, disease classification, or surgical segment (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This indicates that the baseline characteristics were consistent and comparable across both groups.\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of baseline demographic data of the patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTest group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et/\u0026chi;\u003csup\u003e2\u003c/sup\u003e/Z\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.604\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38 (71.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15 (28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e58\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.758\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29 (54.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22 (56.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.872\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32 (60.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19 (48.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.266\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSmoking, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32 (60.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19 (48.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.266\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003e\u003cstrong\u003e2.2 Test Design\u003c/strong\u003e (see Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/h2\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3 Comparison of Incision Suturing Time, Suturing Speed and Incision Length Between the Two Groups\u003c/h2\u003e\n \u003cp\u003eThe study found no significant difference in incision length and subcutaneous fat thickness between the two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, the test group had significantly lower surgical time, suturing time, subcutaneous skin suturing time, deep fascia suturing time, and less intraoperative blood loss compared to the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In addition, the deep fascia suturing speed in the test group was significantly higher than that in the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). See Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of incision suturing time, suturing speed, and incision length\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTest group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et/\u0026chi;\u003csup\u003e2\u003c/sup\u003e/Z\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSubcutaneous fat thickness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncision length\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgery time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e205.6\u0026thinsp;\u0026plusmn;\u0026thinsp;21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e190.3\u0026thinsp;\u0026plusmn;\u0026thinsp;21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSuturing time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.503\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSubcutaneous skin suturing time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.663\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDeep fascia suturing time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDeep fascia suturing speed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-9.873\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntraoperative blood loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e250 (200, 300)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e200 (200, 250)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.872\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e2.4 Comparison of Incision Healing Rate Between the Two Groups\u003c/h2\u003e\n \u003cp\u003eThe incision healing rate of the test group was higher than that of the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of incision healing rate (case, %)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of cases, n\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGood healing, n(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePoor healing, n(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHealing rate\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42(79.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTest group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38(97.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.234\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e2.5 Comparison of Efficacy and Complications Between the Two Groups\u003c/h2\u003e\n \u003cp\u003eThe comparison of efficacy and complications between the test group and the control group is shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e. The median in differences of JOA scores before and after surgery in the test group was higher than that in the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while there was no significant difference in NDI score (p\u0026thinsp;=\u0026thinsp;0.516) and VAS score improvement (p\u0026thinsp;=\u0026thinsp;0.183) between the two groups. Moreover, the test group had a lower incidence of wound infection (p\u0026thinsp;=\u0026thinsp;0.013) and dehiscence (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to the control group. There was no significant difference in the incidence of rejection reaction to suture (p\u0026thinsp;=\u0026thinsp;0.232) and fat liquefaction (p\u0026thinsp;=\u0026thinsp;0.466) between the two groups.\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1707719513.png\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003e2.6 Comparison of the Incidence of Wound Infection and Dehiscence in Patients with Cerebrospinal Fluid Leakage Between the Two Groups\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe study noted 25 cases of cerebrospinal fluid leakage, with 18 in the control group and 7 in the test group. The incidences of postoperative wound infection and dehiscence in these patients were compared in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e. There was no significant difference in the rate of wound infection between the control and test groups (p\u0026thinsp;=\u0026thinsp;0.156). However, the rate of wound dehiscence was lower in the test group compared to the control group (p\u0026thinsp;=\u0026thinsp;0.032). (Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of the incidence of wound infection and dehiscence in patients with cerebrospinal fluid leakage\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTest group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWound infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (77.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.156\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWound dehiscence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (88.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.032\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e, Fisher\u0026apos;s exact test.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePosterior cervical spine surgery, commonly used to treat cervical spinal stenosis in clinical practice, is significantly influenced by the quality of the closure of surgical site incision due to the unique surgical site and local anatomy. Especially in recent years, with the improvements of people's living standards, the number of obese people has been rising. Under this context, many patients undergoing this procedure often have a history of comorbidities like diabetes mellitus, hypertension, or are smokers. This elevates the complexity of suturing the posterior cervical incision and increases the risk of complications at the incision site. All of this, the key contributing factors of postoperative wound infections, are not only a concern for patients but also for healthcare professionals\u003csup\u003e20\u003c/sup\u003e. Historically, due to technological and material limitations, the silk suture was widely used for surgical site incisions. However, as it is made of non-absorbable material, such suture has suboptimal biocompatibility that is prone to poor skin alignment and may lead to local inflammatory reactions, and requires removal which is likely to form a \u0026ldquo;centipede-like scar\u0026rdquo; that could negatively impact the patient psychology due to the aesthetics concern\u003csup\u003e25\u003c/sup\u003e. Additionally, traditional suture materials like silk have potential complications such as foreign body reactions, local tissue ischemia, persistent pain, and prolonged surgical time. These risks can seriously compromise the success of posterior cervical surgeries.\u003c/p\u003e \u003cp\u003eThe knot-free barbed suture is a unique type of absorbable suture with fishbone-like protrusions on the surface. These barbs help to keep the incision tissues closer and prevent the suture from breaking, especially in high-tension areas like the deep fascia layer\u003csup\u003e26\u003c/sup\u003e. Compared to the conventional suture of the same size with continuous or interrupted technique, this kind of barbed suture also provides superior tissue-holding strength; even when the sutures were broken at one point, the tissue holding remains safe and sound\u003csup\u003e27\u003c/sup\u003e. Additionally, it is so excellent in watertight suturing that helps prevent joint fluid, blood, tissue fluid, and other substances from penetrating into the subcutaneous tissue through the deep fascia, thereby reducing the risk of wound infection\u003csup\u003e28\u003c/sup\u003e. All these benefits allow the knot-free barbed suture for widespread use in surgical tissue suturing\u003csup\u003e12, 29, 30\u003c/sup\u003e. It offers numerous advantages over traditional silk sutures, including quicker suturing, less tissue irritation, absence of knot-related complications, finer scars, uniform tension distribution, effective fixation, improved wound closure, and enhanced safety, all of which have been recognized by both patients and doctors in clinical practice. However, there is a lack of research on the use of barbed sutures for suturing posterior cervical incisions in obese patients, both domestically and internationally, making it a crucial focus of this study.\u003c/p\u003e \u003cp\u003eEffective incision closure is a key to the success of posterior cervical surgeries, as the risk of complications is almost double compared to anterior approaches\u003csup\u003e31, 32\u003c/sup\u003e. Various incision complications such as SSI, wound dehiscence, rejection reaction to suture, and fat liquefaction are associated with wound closure techniques. Therefore, it is critical to understand the potential differences in complication rates and outcomes between closure techniques to reduce postoperative complications and improve patient outcomes\u003csup\u003e33\u003c/sup\u003e. Previous studies have indicated that longer durations of general anesthesia during surgery are associated with increased surgical risks and postoperative complications, particularly in relation to recovery of respiratory, digestive, physiological response, and autonomic functions. This can impact the quality and duration of postoperative rehabilitation to a large extent, particularly for patients with underlying conditions or advanced age, who face significantly greater risks. Additionally, prolonged surgical time may also increase the risk of wound contamination and infection due to prolonged exposure of the surgical site incision to air\u003csup\u003e34\u0026ndash;36\u003c/sup\u003e. Our study found that when the surgical site incision and subcutaneous fat thickness were nearly the same (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), the employment of knot-free barbed sutures for incision closure significantly curtailed the duration of surgery, intraoperative blood loss, and suturing time in comparison to the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This outcome is an echo to the barbed sutures that eliminate the need for knotting and offer a robust tissue holding strength. More importantly, since the obese patients have relatively thick subcutaneous fat behind their necks, their surgical site incisions would be deeper, which undoubtedly makes the suturing more complex and duration of surgery longer, thus increasing the incidence of surgical complications. Accordingly, this also places high requirements for the surgeon's suturing technique. The use of barbed suture for suturing the posterior cervical incision in obese patients simplifies the suturing process and technical requirements to a great extent, making the learning curve of less experienced surgeons shorter. The results of the study showed that the wound healing rate and patient satisfaction of the test group were significantly higher than those of the test group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This indicates that the application of barbed suture in obese patients with posterior cervical incision yields better outcomes.\u003c/p\u003e \u003cp\u003eCompared to traditional silk sutures, the knot-free barbed sutures have been shown to decrease tissue irritation, which in turn effectively reduces inflammation. Symmetric employs a unique fumigation process to incorporate triclosan's antibacterial properties into the suture material, achieving a deeper and more concentrated effect than typical absorbable antibacterial braided sutures. This leads to an extended period of antibacterial action, inhibiting bacterial growth for as long as 11\u0026ndash;23 days. The study found that the knot-free barbed sutures can substantially lower the rate of infections in surgical site incisions (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In addition, as Symmetric is comprised of poly(p-dioxanone) (PPDO), it sustains 55% of its initial tension into the sixth week, a pivotal stage in wound healing, promoting enhanced healing in surgical site incision tissue. Furthermore, knot-free barbed sutures were found to effectively prevent wound dehiscence (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), an important consideration in obese patients with high tension in their posterior neck incisions. The barbed suture's fishbone-like design provides enduring and reliable wound support, especially for the musculofascial layer under high tension\u003csup\u003e27\u003c/sup\u003e. However, our study found no significant variance in the incision rejection reaction to suture and fat liquefaction between the knot-free barbed sutures and traditional silk sutures (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), possibly due to the increased subcutaneous fat and tension in incisions in obese patients.\u003c/p\u003e \u003cp\u003eIn the realm of spinal surgery, cerebrospinal fluid leakage is a common complication and timely management is crucial in preventing incisional problems. It is reported that the occurrence of cerebrospinal fluid leakage is around 1% during cervical spine surgeries and about 14% in lumbar spine procedures\u003csup\u003e37\u003c/sup\u003e. Full-thickness incision dehiscence is a condition where all layers of the soft tissue, including the spinal muscles and the deep fascia, separate, leading to a lack of incision union and exposure of the internal fixation, thereby elevating the risk of infection. As per Feng et al.\u003csup\u003e38\u003c/sup\u003e, the primary cause of this condition is the accumulation of cerebrospinal fluid in the subcutaneous soft tissue due to poorly sutured fascia. How to address the difficulty in wound healing caused by cerebrospinal fluid leakage is a huge challenge to both patients and healthcare providers. Previous studies suggest that the use of knot-free barbed sutures for continuous suturing of surgical site incisions in posterior cervical spine surgeries decreases the incidence of postoperative wound complications and SSI when compared to the interrupted suturing with the traditional silk sutures\u003csup\u003e39\u003c/sup\u003e. Our study confirms this finding. In fact, the continuous suturing technique with the fishbone barbed suture provides better water tightness than that of the interrupted suturing with traditional sutures\u003csup\u003e29\u003c/sup\u003e since it will improve the consistency of tissue alignment, reduce gaps in suturing, and prevent fluid exudation; in case of any cerebrospinal fluid leakage during posterior cervical surgeries, this technique combination will offer sound water tightness, thereby minimizing the occurrence of incision dehiscence and infection caused by suture degradation, relaxation or fracture as a consequence of that the sutures are immersed in exudate accumulations for a long period of time. Meanwhile, the application of the knot-free barbed suture in surgical site incisions can help circumvent the burden and pressure of secondary debridement and suture surgery caused by wound dehiscence or infection (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAll the participating surgeons in this study were well-trained senior spinal surgeons, but there were instances where the knot-free barbed suture broke during the suturing process, which could potentially be due to improper suturing operations. Given that barbed sutures have a barbed structure, any entanglement can cause the barbed portion to sever the suture. Barbed sutures, as observed, establish a strong tissue holding strength, ensuring that they will not be easily dislodged; however, exactly because of this, the likelihood of suture breakage is high. Nevertheless, it's imperative for surgeons to pay attention to their suturing technique and the force they apply to avoid suture breakage. For suturing of deep fascia in the posterior neck incision of obese patients, it is advisable to suture as extensively as possible while posing no unnecessary financial burden to them. This approach increases the integrity of the deep fascia layer, thereby reducing the risk of incision dehiscence.\u003c/p\u003e \u003cp\u003eThis study provides robust evidence backing the safety and efficacy of knot-free barbed sutures in the closure of posterior cervical incisions in obese patients. Nonetheless, it's essential to recognize that the study's methodology\u0026ndash;a single-center, retrospective trial with a short duration and relatively small sample size\u0026ndash;inherently imposed certain limitations, which may affect the results' generalizability. Despite these constraints, it is our aspiration that this study will lay the groundwork for clinical application of barbed sutures in posterior cervical spine surgeries in obese patients and serves as a valuable reference for future related research by others.\u003c/p\u003e \u003cp\u003eIn conclusion, the knot-free barbed sutures demonstrate enhanced safety and efficacy in posterior cervical spine surgeries in obese patients. This particular suture technique markedly minimizes the incidence of incision-related complications (e.g., infection, dehiscence, and exudation, etc.), while enhancing suturing speed and reducing suturing time consumption, thereby diminishing the surgical risks associated with prolonged surgical time.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e:None of the authors has a financial interest in any of the products or devices mentioned in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSources of Funding\u003c/strong\u003e: Key Research and Development Projects of Shaanxi Province was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e: All authors were involved in either drafting or revising the submitted manuscript, approval of the final submission, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u0026nbsp;Wei Qi,\u0026nbsp;Yang Zhang, and\u0026nbsp;Wei Lei\u0026nbsp;were responsible for designing the project and interpreting the data.\u0026nbsp;Zixiang Wu\u0026nbsp;and\u0026nbsp;Yabo Yan\u0026nbsp;were responsible for the acquisition of data.\u0026nbsp;Xiong Zhao\u0026nbsp;and\u0026nbsp;Tiancheng Ma\u0026nbsp;were responsible for the analysis.\u0026nbsp;Yufei Ji\u0026nbsp;was responsible for the acquisition and interpretation of data for the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e:\u0026nbsp;The study received ethical approval from the Ethics Committee of the First Affiliated Hospital of the People\u0026apos;s Liberation Army Air Force Medical University (Approval number: KY-20232136-F-1,the date of approval: 20/04/2023). And the study\u0026nbsp;registrated in\u0026nbsp;Clinical\u0026nbsp;Trials\u0026nbsp;in 25/05/2023\u0026nbsp;and the\u0026nbsp;registration number\u0026nbsp;was\u0026nbsp;NCT05895968.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e: Informed consent for publication was obtained by all participants in this study\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u0026ldquo;Availability of Data and Materials\u0026rdquo; statements:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eInformed consent to participate statements:\u003c/strong\u003e Informed consent to participate in the study was obtained from all subjects.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNori S, Nagoshi N, Daimon K, et al. Comparison of surgical outcomes of posterior surgeries between cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. \u003cem\u003eSpinal Cord\u003c/em\u003e 2022;60:928-33.\u003c/li\u003e\n\u003cli\u003eCollins N. Obesity and wound healing. \u003cem\u003eAdvances in Skin \u0026amp; Wound Care\u003c/em\u003e 2003;16:45-7.\u003c/li\u003e\n\u003cli\u003eWilson JA, Clark JJ. Obesity: impediment to postsurgical wound healing. \u003cem\u003eAdvances in Skin \u0026amp; Wound Care\u003c/em\u003e 2004;17:426-35.\u003c/li\u003e\n\u003cli\u003eGuo S, Dipietro LA. Factors affecting wound healing. \u003cem\u003eJournal of Dental Research\u003c/em\u003e 2010;89:219-29.\u003c/li\u003e\n\u003cli\u003ePierpont YN, Dinh TP, Salas RE, et al. Obesity and surgical wound healing: a current review. \u003cem\u003eIsrn Obes\u003c/em\u003e 2014;2014:638936.\u003c/li\u003e\n\u003cli\u003eDragovic M, Pejovic M, Stepic J, et al. Comparison of four different suture materials in respect to oral wound healing, microbial colonization, tissue reaction and clinical features-randomized clinical study. \u003cem\u003eClinical Oral Investigations\u003c/em\u003e 2020;24:1527-41.\u003c/li\u003e\n\u003cli\u003eHan Y, Yang W, Pan J, et al. The efficacy and safety of knotless barbed sutures in total joint arthroplasty: a meta-analysis of randomized-controlled trials. \u003cem\u003eArchives of Orthopaedic and Trauma Surgery\u003c/em\u003e 2018;138:1335-45.\u003c/li\u003e\n\u003cli\u003eLi R, Ni M, Zhao J, et al. A modified strategy using barbed sutures for wound closure in total joint arthroplasty: a prospective, randomized, double-blind, self-controlled clinical trial. \u003cem\u003eMedical Science Monitor\u003c/em\u003e 2018;24:8401-7.\u003c/li\u003e\n\u003cli\u003eSah AP. A prospective, randomized evaluation of the quality of wound closure with barbed versus standard suture after total joint arthroplasty. \u003cem\u003eOrthopedics\u003c/em\u003e 2021;44:216-22.\u003c/li\u003e\n\u003cli\u003eGreenberg JA. The use of barbed sutures in obstetrics and gynecology. \u003cem\u003eRev Obstet Gynecol\u003c/em\u003e 2010;3:82-91.\u003c/li\u003e\n\u003cli\u003eGreenberg JA, Goldman RH. Barbed suture: a review of the technology and clinical uses in obstetrics and gynecology. \u003cem\u003eRev Obstet Gynecol\u003c/em\u003e 2013;6:107-15.\u003c/li\u003e\n\u003cli\u003eVelotti N, Manigrasso M, Di Lauro K, et al. Barbed suture in gastro-intestinal surgery: a review with a meta-analysis. \u003cem\u003eSurgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland\u003c/em\u003e 2022;20:115-22.\u003c/li\u003e\n\u003cli\u003eWiggins T, Majid MS, Markar SR, et al. Benefits of barbed suture utilisation in gastrointestinal anastomosis: a systematic review and meta-analysis. \u003cem\u003eAnnals of the Royal College of Surgeons of England\u003c/em\u003e 2020;102:153-9.\u003c/li\u003e\n\u003cli\u003eTalwar P, Velayudam L, Hemapriya L, et al. Barbed suture in total laparoscopic hysterectomy: a comparative study of the safety in vaginal cuff closure with that of polyglactin 910 suture. \u003cem\u003eGynecology and Minimally Invasive Therapy-Gmit\u003c/em\u003e 2021;10:154-8.\u003c/li\u003e\n\u003cli\u003eLopez CC, Rios J, Gonzalez Y, et al. Barbed suture versus conventional suture for vaginal cuff closure in total laparoscopic hysterectomy: randomized controlled clinical trial. \u003cem\u003eJournal of Minimally Invasive Gynecology\u003c/em\u003e 2019;26:1104-9.\u003c/li\u003e\n\u003cli\u003eUK CFPH, UK NCCF. \u003cem\u003eObesity: the prevention, identification, assessment and management of overweight and obesity in adults and children\u003c/em\u003e. London: National Institute for Health and Clinical Excellence (UK); 2006.\u003c/li\u003e\n\u003cli\u003eChina OWG. Guidelines for the prevention and control of overweight and obesity in chinese adults. \u003cem\u003eJournal of Nutrition\u003c/em\u003e 2004;1:1-4.\u003c/li\u003e\n\u003cli\u003ePhysical status: the use and interpretation of anthropometry. Report of a who expert committee. \u003cem\u003eWorld Health Organ Tech Rep Ser\u003c/em\u003e 1995;854:1-452.\u003c/li\u003e\n\u003cli\u003eMuellner M, Chiapparelli E, Moser M, et al. The effect of age on psoas and paraspinal muscle morphology in patients undergoing posterior lumbar fusion surgery. \u003cem\u003eEuropean Spine Journal\u003c/em\u003e 2022;31:2619-28.\u003c/li\u003e\n\u003cli\u003eMehta AI, Babu R, Sharma R, et al. Thickness of subcutaneous fat as a risk factor for infection in cervical spine fusion surgery. \u003cem\u003eJournal of Bone and Joint Surgery-American Volume\u003c/em\u003e 2013;95:323-8.\u003c/li\u003e\n\u003cli\u003eChen X. \u003cem\u003eSurgery\u003c/em\u003e: People\u0026apos;s Publishing House; 2018.\u003c/li\u003e\n\u003cli\u003eInfections, diagnostic criteria for nosocomial. \u003cem\u003eJournal of Modern Practical Medicine\u003c/em\u003e 2003:460-5.\u003c/li\u003e\n\u003cli\u003eBerrios-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. \u003cem\u003eJama Surgery\u003c/em\u003e 2017;152:784-91.\u003c/li\u003e\n\u003cli\u003eKang Y, Zhou ZK, Yang HL. A guideline on the management of incisions for the enhanced recovery after orthopedic surgery in china. \u003cem\u003eChinese Journal of Bone and Joint Surgery\u003c/em\u003e 2018;1:3-10.\u003c/li\u003e\n\u003cli\u003eKolimi P, Narala S, Nyavanandi D, et al. Innovative treatment strategies to accelerate wound healing: trajectory and recent advancements. \u003cem\u003eCells\u003c/em\u003e 2022;11.\u003c/li\u003e\n\u003cli\u003eReynolds Z, Hibbert N, Stevenson P, et al. The effect of iron deficiency on quality of life outcomes after surgery for obstructive sleep apnoea. \u003cem\u003eJournal of Paediatrics and Child Health\u003c/em\u003e 2022;58:1816-23.\u003c/li\u003e\n\u003cli\u003eNawrocki JG, Nonnenmann H, Mooney M, et al. A high-strength, absorbable, antibacterial knotless tissue control device for fascial closure. \u003cem\u003eCurrent Obstetrics and Gynecology Reports\u003c/em\u003e 2017;6:175-81.\u003c/li\u003e\n\u003cli\u003eNett M, Avelar R, Sheehan M, et al. Water-tight knee arthrotomy closure: comparison of a novel single bidirectional barbed self-retaining running suture versus conventional interrupted sutures. \u003cem\u003eJournal of Knee Surgery\u003c/em\u003e 2011;24:55-9.\u003c/li\u003e\n\u003cli\u003eChan V, Chan PK, Chiu KY, et al. Does barbed suture lower cost and improve outcome in total knee arthroplasty? A randomized controlled trial. \u003cem\u003eJournal of Arthroplasty\u003c/em\u003e 2017;32:1474-7.\u003c/li\u003e\n\u003cli\u003eCervone A. Robotic hernia repair using a barbed suture. \u003cem\u003eSurgical Technology International-International Developments in Surgery and Surgical Research\u003c/em\u003e 2022;41.\u003c/li\u003e\n\u003cli\u003eYoshii T, Egawa S, Chikuda H, et al. Comparison of anterior decompression with fusion and posterior decompression with fusion for cervical spondylotic myelopathy-a systematic review and meta-analysis. \u003cem\u003eJournal of Orthopaedic Science\u003c/em\u003e 2020;25:938-45.\u003c/li\u003e\n\u003cli\u003ePapavero L, Lepori P, Schmeiser G. Revision surgery in cervical spine. \u003cem\u003eEuropean Spine Journal\u003c/em\u003e 2020;29:47-56.\u003c/li\u003e\n\u003cli\u003eCheung JP, Luk KD. Complications of anterior and posterior cervical spine surgery. \u003cem\u003eAsian Spine Journal\u003c/em\u003e 2016;10:385-400.\u003c/li\u003e\n\u003cli\u003eDeng H, Chan AK, Ammanuel S, et al. Risk factors for deep surgical site infection following thoracolumbar spinal surgery. \u003cem\u003eJournal of Neurosurgery-Spine\u003c/em\u003e 2019;32:292-301.\u003c/li\u003e\n\u003cli\u003eZhang X, Liu P, You J. Risk factors for surgical site infection following spinal surgery: a meta-analysis. \u003cem\u003eMedicine\u003c/em\u003e 2022;101:e28836.\u003c/li\u003e\n\u003cli\u003eSeidelman JL, Mantyh CR, Anderson DJ. Surgical site infection prevention: a review. \u003cem\u003eJama-Journal of the American Medical Association\u003c/em\u003e 2023;329:244-52.\u003c/li\u003e\n\u003cli\u003eHannallah D, Lee J, Khan M, et al. Cerebrospinal fluid leaks following cervical spine surgery. \u003cem\u003eJournal of Bone and Joint Surgery-American Volume\u003c/em\u003e 2008;90:1101-5.\u003c/li\u003e\n\u003cli\u003eFeng C, Qianqian S, Jianhua H, et al. Treatment experience for full-thickness wound dehiscence with cerebrospinal fluid leakage following posterior primary spine surgery: three case reports. \u003cem\u003eMedicine\u003c/em\u003e 2019;98:e15126.\u003c/li\u003e\n\u003cli\u003eTang AR, Steinle AM, Chanbour H, et al. Barbed suture versus interrupted suture in posterior cervical spine surgery: are they equivalent? \u003cem\u003eSpine Surgery and Related Research\u003c/em\u003e 2022;6:645-53.\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":"Wound closure with barbed suture, Posterior cervical surgery, Surgical Site Infections (SSI), Incidence of incision complications","lastPublishedDoi":"10.21203/rs.3.rs-3935839/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3935839/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis retrospective, single-center clinical study aims to evaluate the safety and efficacy of barbed sutures for incision closure in posterior cervical surgery among obese patients, providing evidence for their potential broader application in this surgical context.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 92 obese patients (Body Mass Index (BMI)\u0026thinsp;\u0026ge;\u0026thinsp;28kg/m\u003csup\u003e2\u003c/sup\u003e) who required posterior cervical decompression, fusion, and internal fixation surgery between January 2021 and December 2022 at the First Affiliated Hospital of the PLA Air Force Military Medical University were enrolled. The patients were divided into two groups according to admission time: a control group (n\u0026thinsp;=\u0026thinsp;53, admitted in 2021) where common Mersilk sutures were used and a test group (n\u0026thinsp;=\u0026thinsp;39, admitted in 2022) where knot-free barbed sutures were used for suturing the deep fascia layer, superficial fascia layer, and skin. Various factors were compared between the groups at 3 months after surgery, including JOA, NDI, and VAS scores, incision length, subcutaneous fat thickness, incision suture time and speed, incision healing rate, and complication incidence, including specific comparisons of incision infection and dehiscence rates with cerebrospinal fluid leakage.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe data showed no significant difference between the two groups in terms of incision length, subcutaneous fat thickness, as well as NDI, and VAS scores at 3 months after surgery (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, the test group had significantly shorter incision suture time (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), faster suture speed (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and higher incision healing rate (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) as compared to the control group. Furthermore, this group also demonstrated a significantly lower incidence of complications, including lower incision dehiscence rate when cerebrospinal fluid leakage occurred (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Nonetheless, there was no statistical difference in incision infection rate between both groups when cerebrospinal fluid leakage occurred (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCompared with the conventional silk suture, the utilization of the knot-free barbed suture in posterior cervical incisions among obese patients is efficacious and of high significance, as it promotes optimal incision healing and minimizes the likelihood of postoperative complications.\u003c/p\u003e","manuscriptTitle":"The Study of The Safety And Efficacy of Knot-free Barbed Sutures for Wound Healing in Obese Patients Undergoing Posterior Cervical Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-12 19:21:29","doi":"10.21203/rs.3.rs-3935839/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":"6dd676c5-3ff8-4858-bb67-c65cd1c94622","owner":[],"postedDate":"February 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-12T19:21:34+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-12 19:21:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3935839","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3935839","identity":"rs-3935839","version":["v1"]},"buildId":"zQwnuV7TCBrMSSSToR1PI","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}