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

Abstract

Background: A method of wound closure using knotless suture material in the chest tube site has been introduced at our center, and is now widely used as the primary method of closing chest tube wounds in video- assisted thoracic surgery (VATS) because it provides cosmetic benefits and causes less pain.

Methods: We included 109 patients who underwent VATS pulmonary resection at Samsung Medical Center from October 1 to October 31, 2016. Eighty-five patients underwent VATS pulmonary resection with chest drain wound closure utilizing knotless suture material, and 24 patients underwent VATS pulmonary resection with chest drain wound closure by the conventional method. Complications related to the chest drain wound were compared between the 2 groups.

Results: There were 2 cases of pneumothorax after chest tube removal in both groups (8.3% in the conventional group, 2.3% in the knotless suture group; p=0.172) and there was 1 case of wound discharge due to wound dehiscence in the knotless suture group (0% in the conventional group, 1.2% in the knotless suture group; p=0.453). There was no reported case of chest tube dislodgement in either group. The complication rates were non-significantly different between the 2 groups.

Conclusion: The results for the complication rates of this new chest drain wound closure method suggest that this method is not inferior to the conventional method. Chest drain wound closure using knotless suture material is feasible based on the short-term results of the complication rate.

Keywords: Chest tubes; Complication; Lung; Sutures; Video-assisted thoracic surgery.

Fig. 1

Technique of chest drain wound closure and chest tube removal. From Kim et al. Ann Thorac Surg 2017;103:e93–5 [2]. (A) After suturing the muscle layer, closure of wound using knotless sutures begins at the one end of an incision. Instead of tying the knot, the tip of the needle enters through the fixation loop and is tightened. (B) The needle is placed horizontally through the subcutaneous tissue by passing through the opposite sides of the wound exactly same as in the continuous subcutaneous suture technique. (C) The suture continues around the chest tube until the needle reaches the other end of the incision. (D) At the other end of the incision, the tip of the needle passes under the skin and comes out through the skin about 1 cm away from the edge of the incision. (E) After the chest tube is removed, the secured thread is pulled forward to tighten the suture. Then the wound is sealed as with a zipper. (F) Leftover thread is cut off and nothing is left over at the scar of the chest tube site.