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.