Authors: J M EnriquezNavascues J I Emparanza M Alkorta C Placer
Publish Date: 2014/04/30
Volume: 18, Issue: 10, Pages: 863-872
Abstract
To compare the results of different closure surgical techniques we performed a metaanalysis of randomized controlled trials RCT comparing 1 open wide excision versus open limited excision sinusectomy or unroofing sinotomy 2 midline closure conventional and tensionfree versus offmidline 3 advancing versus rotation flaps and 4 sinusectomy/sinotomy versus primary closureData extraction and risk of bias assessment were conducted independently by the authors using the Cochrane Collaboration’s tool Data were pooled using fixed and randomeffects models Primary outcomes were rate of healing recurrence wound infection and dehiscence Twentyfive trials 2949 patients were includedFour trials compared limited versus radical open healing Although recurrence rate did not differ all other outcomes favored the limited approach Ten studies compared midline versus offmidline primary closure wound infection and dehiscence were significantly higher after midline closure Six RCT compared Karydakis/Bascom versus Limberg No difference was found in recurrence or wound complications rate Six RCT compared sinusectomy/sinotomy versus primary closure Recurrence rate was significantly lower after sinusectomy/sinotomy no significant differences were found in other outcomesOur metaanalysis suggest that some of the questions of which is the best surgical technique for CPD have now been answered open radical excision and primary midline closure should be abandoned Sinusotomy/sinectomy or en bloc resection with off midline primary closure are the preferred approaches
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