4 | Discussion
Reconstruction of the oral cavity and oropharynx after transoral cancer ablation is a key step to restore swallowing, speech, and respiration abilities and prevent wound complication.10However, oral cavity interrupt knot tying suturing takes time and effort because it is difficult to visualize and access deep and narrow spaces. In our study, we presented a time sparing method without additional complication in comparison with conventional interrupted knot tying suturing. Furthermore, time saving with barbed knotless continuous suture was effective for narrow and deep spaces, such as retromolar and base of the tongue areas, where surgeons have difficulty manipulating instruments.
Our study demonstrated successful outcomes with the barbed suture by measuring suture time and analysis of complication, which were not reported previously. Suture time was markedly decreased by the barbed suture, while complication was comparable between the two groups. Notably, some patients of the barbed suture group reported prickling sensation during follow up because of the stiff and barbed nature of the material, which was resolved after removal of protruding suture material. Among three patients in the barbed suture group who experienced dehiscence, two suffered partial necrosis of a flap, and one showed dehiscence due to suture site necrosis and inflammation. In the interrupt suture group, wound dehiscence was observed in one patient due to suture site necrosis and inflammation. We assumed that both suturing methods provided similar watertight closure. The barbed sutures have multiple regular anchoring points, which could offer a consistent tension along the suture line and appropriate tension to prevent saliva infiltration.
We experienced convenience and safety of closure of oral/oropharyngeal defects using the barbed knotless continuous suture. Based on this, we applied the barbed suture in almost every subsequent case of oral/oropharyngeal suture, even in hard palate and nasal sinus defects. The barbed suture has been shown to be effective in cases of hard palate and maxillary defects, which were reconstructed with free flaps and had weight-bearing.
This study was performed by a single experienced surgeon and involved patient enrollment over a short time period. The data could be supplemented by further large-scale studies using transoral robotic surgery.