***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To examine early results in patients with incision lines closed only along the skin and subcutaneous tissue after removal of the great saphenous vein during coronary artery bypass surgery .  Material s and Methods : We enrolled 82 patients who underwent elective operations in our clinic between December 2008 and April 2009 . The patients had similar demographic characteristics , and the method of incision closure was chosen r and omly . Three patients were excluded due to in-hospital mortality . The saphenous incision lines were closed using continuous skin sutures in 41 patients ( Group 1 ) or using continuous subcutaneous sutures followed by continuous skin sutures in 38 patients ( Group 2 ) . Patients were followed every day that they were in the hospital , in the first week after being discharged , and at the end of the second month after discharge . The incision lines were evaluated for hematomas , infection , edema , pain and numbness . Results : During the follow-up performed in-hospital and in the first week after discharge , infection , edema and numbness were observed significantly more often in Group 2 than in Group 1 . Hematoma was observed more often in Group 1 , and pain was observed more often in Group 2 , but neither of these findings reached statistical significance . During the follow-up at the end of the second month after discharge , infection , edema , and numbness were observed significantly more frequently in Group 2 . Conclusion : In patients undergoing saphenous removal using st and ard procedures , it is sufficient to close the incision line using only skin sutures OBJECTIVE This study was undertaken to determine the most appropriate management of the subcutaneous tissue of midline vertical incisions with 3 cm or more of subcutaneous fat . STUDY DESIGN Patients undergoing surgery within the Division of Gynecologic Oncology at University of South Florida and East Tennessee State University with 3 cm or more of subcutaneous fat were r and omly assigned to 1 of 3 groups : suture approximation of Camper 's fascia , closed suction drainage of the subcutaneous space , or no intervention as a control group . Participants were evaluated daily during postoperative hospitalization and at 2 and 6 weeks postoperatively as an outpatient . Demographic information , perioperative data , and wound complications were recorded and then analyzed with chi2 , t test , analysis of variance , and logistic regression where appropriate . RESULTS Two hundred twenty-five patients were enrolled with 222 eligible for evaluation .  Wound complications were observed in 34 ( 15.3 % ) patients , and 25 of these women also had wound disruption . Overall wound complication and wound disruption rates were not significantly different between groups : suture ( 12.8 % , 7.7 % ) , drain ( 17.9 % , 14.9 % ) , control ( 15.6 % , 11.7 % ) ; P = .70 and P = .39 , respectively . CONCLUSION Suture approximation or drainage of the subcutaneous tissues of women with 3 cm or more subcutaneous fat measured in midline vertical incisions result ed in no significant change in the incidence of overall wound complications or superficial wound disruption OBJECTIVE The aim of this study was to determine the effect of the depth of subcutaneous tissue at the operative site and the closure of subcutaneous tissue on  abdominal wound disruption after cesarean delivery . METHODS 164 women divided into two groups : 70 with subcutaneous tissue thickness of at least 2 cm and 94 with subcutaneous tissue thickness more than 2 cm . These groups were r and omized to closure of the subcutaneous fat tissue or no closure with cesarean delivery . RESULTS In the 68 women with subcutaneous tissue thickness of at least 2 cm who completed the study , there was no difference between closure and no closure subgroups in terms of incidence of wound disruption . In 91 women with subcutaneous tissue thickness more than 2 cm who completed the study , the incidence of wound disruption was significantly higher in the no closure subgroup . In the no closure subgroup of 91 women with subcutaneous fat thickness more than 2 cm , the incidence of wound disruption was significantly higher than that of the 68 women with subcutaneous tissue thickness at least 2 cm . CONCLUSIONS Subcutaneous tissue approximation with absorbable suture at closure of the abdominal incision during cesarean delivery appears to reduce the rate of postoperative wound disruption in patients with more than 2 cm of subcutaneous tissue Background : The objective of this study was to compare the cosmetic outcome of facial lacerations closed with a single or double layer of sutures . Methods : Patients aged 1 year or older presenting to a university-based emergency department with nongaping ( width , < 10 mm ) , simple , nonbite , facial lacerations were r and omized to closure with a single layer of simple interrupted 6 - 0 polypropylene sutures or a double layer of simple interrupted 6 - 0 polypropylene plus inverted deep dermal 5 - 0 polyglactin sutures . At 90 days , the scar width and cosmetic appearance were determined using a vali date d 100-mm visual analogue scale ranging from 0 ( worst ) to 100 ( best ) and a vali date d wound evaluation score ranging from 0 ( worst ) to 6 ( best ) . Results : Sixty-five patients were r and omized to single-layer ( n = 32 ) or double-layer ( n = 33 ) closure . Mean age ( SD ) was 18.5 years ( 20.0 ) , and 14 percent were female . Groups were similar in baseline patient and wound characteristics . Length of single-layer closure  was 7 minutes shorter ( 95 percent CI , 2 to 11 minutes ) than double-layer closure . There were no infections or dehiscences in either group . There were no between-group differences in patient ( mean difference , 0.5 mm ; 95 percent CI , –5.7 to 6.6 mm ) or practitioner ( mean difference , 1.0 mm ; 95 percent CI , –4.8 to 6.7 mm ) visual analogue scale scores . All but one patient had an optimal wound evaluation score of 6 ( p = not significant ) . Scar width was similar at 90 days ( mean difference , 0.2 mm ; 95 percent CI , –0.05 to 0.5 ) . Conclusions : Single-layer closure of nongaping , minor ( <3 cm ) facial lacerations is faster than double-layer closure . Cosmetic outcome and scar width are similar in sutured wounds whether or not deep dermal sutures are used Purpose : The aim of this prospect i ve r and omized study was to investigate the necessity of suturing subcutaneous fat tissue in elective abdominal surgery . Methods : 415 patients undergoing elective abdominal surgery were admitted to the trial . The patients were divided into two basic groups according to wound contamination : clean operations ( n = 201 ) and clean-contaminated operation ( n = 214 ) . Subcutaneous suturing of the subcutaneous fat tissue was performed in half of the patients in each group , determined using the envelope method ( ‘ Suture Yes ’ or ‘ Suture No ’ ) . Wounds were checked on postoperative days 3 , 7 , 14 , and 30 . Infectious and non-infectious wound complications were charted in the records . Data were statistically analyzed . The percentages of complications in groups with and without subcutaneous suturing were statistically compared using Yates ’ corrected χ2 two-tailed test . Results : There were no statistically significant group differences in infectious and non-infectious wound complications . Conclusion : These results suggest that omission of subcutaneous fat tissue suturing does not increase the occurrence of infectious or non-infectious wound complications Purpose Surgical site infections ( SSI ) cause excess morbidity and mortality in modern surgery . Several different approaches to reduce the incidence of SSI have been investigated with variable results . Method This is to our knowledge the first systematic r and omized evaluation in patients undergoing laparotomy in visceral surgery  to clarify whether widely used subcutaneous drains ( Redon ) affect wound infection as the primary outcome measure . Results In 200 patients , we were unable to show a statistically significant impact on the postoperative healing process in patients with the full variety of abdominal surgical interventions . Overall , we observed surgical site infection in 9.5 % of all patients ( n = 19 ) , of these n = 9 ( 47.4 % ) were in the control group without a drain , and 10 ( 52.6 % ) were in the experimental group with a Redon drain ( not significant ) . Conclusion As this study could not demonstrate a reduction of SSI by the use of Redon drains , there is no indication for prophylactic subcutaneous suction drains after laparotomy AIMS To evaluate the role of subcutaneous tissue closure in relation to wound disruption after abdominal hysterectomy in obese patients . MATERIAL AND METHODS In a prospect i ve study at a tertiary referral centre in Mumbai , India , 60 obese patients with subcutaneous fat more than 2.5 cms were included in the study . In 30 patients , subcutaneous tissue was closed using synthetic suture ( dexon ) while in 30 control patients subcutaneous tissue was not closed .  Average weight in the study and control groups were 69 -/+ 9.2 kg and 63.3 -/+ 11.2 kg respectively . RESULTS The wound disruption occurred in 5 patients in non-closure group as compared to only one in the closure group . Incidence of seroma , haematoma formation and other wound complications were higher in the non-closure group . CONCLUSIONS Closure of the subcutaneous tissue after abdominal hysterectomy of women with at least 2.5 cms of subcutaneous tissue lowers the overall rate of complications leading to disruption of the incision Methods for combining data from several studies exist and appear to be quite useful . None satisfactorily addresses the question of what studies should be combined . This issue is the most serious method ological limitation . Even studies with statistically significant interaction might still be combined if the effect were in the same direction . Thus , substantial scientific input is required as to what criteria must be met by each potential study . Much can be learned from combining or pooling data but it must be done cautiously . Pooling exercises do not replace well design ed prospect i ve clinical trials . Efforts for establishing basic design criteria to allow for multicentre and multicountry trials to be more easily combined might be useful . BACKGROUND Wound infection and dehiscence are both major contributors to postoperative morbidity . One potential cause or co-factor is the use of suture material . A recently introduced subcutaneous suture is coated with triclosan ( TC ) , an antiseptic drug . It is suggested to reduce wound complications . METHODS To investigate the effect of TC on wound healing a double blind prospect i ve pilot study in women undergoing a breast reduction was performed . Each patient was her own control . After r and omisation the TC-coated sutures were used either on the left or right side . The contralateral side was used as the control . The incidence of dehiscence was studied . RESULTS Twenty-six patients were included . In the TC breasts there was a wound dehiscence in 16 cases , whereas in the control breasts in seven cases a dehiscence was observed ( P=0.023 ) . CONCLUSION These results suggest that TC-coated sutures should be used with caution . These sutures have already been introduced on to the market without good clinical studies and might have potential adverse effects as shown by these data Wound haematoma is an undesirable complication of surgery . We report a prospect i ve trial to establish whether a subcutaneous fat stitch affects haematoma formation in hip surgery . A series of 50 patients undergoing hip surgery were r and omised to have either a fat stitch or no fat stitch during wound closure . The wounds were assessed clinical ly with a minimum follow-up of 5 weeks . Subcutaneous haematomas were seen more easily with the patient st and ing . As clinical assessment for haematoma formation may be unreliable , each patient also had an ultrasound scan . Although the incidence of subcutaneous haematoma was slightly higher in the no fat stitch group ( 36 % compared with 24 % in the fat stitch group ) this difference was not statistically significant ( chi 2 test , P < 0.5 ) . There were no significant differences in the incidence of wound infection and healing rate . From our study we also showed that ultrasound examination was twice as sensitive as clinical examination in diagnosing subcutaneous haematomas and that subcutaneous haematomas are common after hip surgery We report a prospect i ve trial to establish whether a subcutaneous fat stitch reduces the incidence of haematoma formation , infection and wound dehiscence following saphenous vein excision for coronary revascularization . Two groups of patients undergoing coronary revascularization were studied . In the first group of 100 patients the saphenous vein was harvested from both legs . Legs were r and omized to have either a fat stitch or no fat stitch during wound closure . By using both legs of each patient we eliminated the effect of general factors on wound healing , thus the patients acted as their own controls . In the second group of 200 patients , the saphenous vein was harvested from the thigh , and patients r and omly allocated to either a fat stitch or no fat stitch during wound closure . The wounds were examined daily for 7 days , and again after 6 weeks at the follow-up . There was no difference in the rate of wound complication in the fat stitch groups ( 9 % ) compared with the no fat stitch groups ( 8 % ) , however , the fat stitch groups required more surgical intervention for skin edge necrosis . It appears that closure of the subcutaneous fat following saphenectomy is unnecessary , and may be detrimental to skin healing Objective . The aim of the study was to evaluate the impact of an 
    Output:
    
There is currently evidence of very low quality which is insufficient to support or refute subcutaneous closure after non-caesarean operations .
The use of subcutaneous closure has the potential to affect patient outcomes and utilisation of healthcare re sources .