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Wound ComplicationNCT03148496

Tissue Reinforcement of Incisional Closure Among High Risk Patients

A study testing Biologic Mesh, Small Bites and Large Bites in people with Wound Complication, run by The University of Texas Health Science Center, Houston at 2 sites in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

Half of all individuals will undergo abdominal surgery in their lifetime. Following abdominal surgery, 30% of patients will suffer a major chronic complication with their wound closure in the first post-operative year. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Wound Complication
What is being tested?
Biologic Mesh, Small Bites and Large Bites
Could I receive a placebo?
No, everyone receives an active treatment
How many people
163 participants
Where
2 sitesUnited States
Study dates
13 Sep 2017to 19 Jun 2021
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • All high-risk patients undergoing laparotomy or laparoscopic-assisted abdominal surgery. This includes:
  • all overweight patients (BMI>=25 kg/m2),
  • current smokers,
  • those who are immunosuppressed,
  • those who are malnourished, or
  • those who are undergoing a contaminated case (CDC wound classification of 2 or 3).

Who cannot join

  • patients unlikely to follow-up in a year (e.g. no phone or lives out of state),
  • patients unlikely to survive more than 2 years based upon surgeon judgment (e.g. metastatic cancer, end-stage cirrhosis),
  • patients where the clinician would not place prosthetic (e.g. pregnant patient, pediatric patient during growth stage),
  • patient has a planned second surgery within the next year (e.g. ostomy reversal).

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • Lyndon B. Johnson (LBJ) Hospital

    Houston, Texas, 77026

  • The University of Texas Health Science Center at Houston

    Houston, Texas, 77030

Other trials in United States

About this study

Half of all individuals will undergo abdominal surgery in their lifetime. Following abdominal surgery, 30% of patients will suffer a major chronic complication with their wound closure in the first post-operative year. This may include significant wound infections, open wounds, fluid collections, fascial dehiscence, or incisional hernia. These complications not only have a substantial impact on the health care system (cost and chronic disease) and the hospital (cost and space), but most importantly have a substantial impact on the patient. Major chronic wound complications adversely impact patient quality of life and function. Potential methods to reduce major wound complications include utilizing specific suturing techniques or reinforcing the incision line. Suturing technique of small-bites (0.5x0.5 cm bites) as opposed to large bites (1.0x1.0 cm bites) has been shown to be efficacious in European populations with a typical body mass index of 20-25 kg/m2. Tissue reinforcement has been shown to decrease rates of major wound complications in small randomized controlled trials.

However, the lack of widespread adoption of these practices may be due to issues of generalizability including strict inclusion criteria, careful patient selection, and small study size. For example, the generalizability of small bites to an overweight population (mean BMI in the United States is 28 kg/m2) as opposed to a normal-weight population are unclear. The use of synthetic materials in comorbid patients or complex settings may risk major wound complications such as prosthetic infection. Biologic materials have been shown to be effective in decreasing major wound complications but in different settings. This study is being done to assess the effectiveness of different efficacious strategies to decrease the rate of major wound complications following abdominal surgery among high-risk individuals The researchers hypothesize:

  1. Among high-risk patients undergoing abdominal surgery, the use of "small-bites" closure as opposed to "large-bites" closure will increase the proportion of patients who are free of major, chronic wound complications at 1-year post-operative.
  2. Among high-risk patients undergoing abdominal surgery, the biologic tissue reinforcement of the suture line as opposed to no reinforcement will increase the proportion of patients who are free of major, chronic wound complications at 1-year post-operative.
Being tested
Biologic Mesh, Small Bites, Large Bites
Keywords
abdominal surgery, wound complication

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Biologic MeshDevice

    Biologic mesh placed during surgery

  • Small BitesProcedure or surgery

    0.5 cm x 0.5 cm sutures used

  • Large BitesProcedure or surgery

    1.0 x 1.0 sutures used

Study groups in NCT03148496
Study groupRoleWhat they receive
Biologic Mesh and Small BitesExperimentalBiologic mesh placement and small bites used for suturing.
Receives: Device: Biologic Mesh; Procedure: Small Bites
Small Bites and No Biologic MeshExperimentalSmall bites used for suturing with no placement of biologic mesh
Receives: Procedure: Small Bites
Biologic mesh and Large BitesExperimentalBiologic mesh placement and large bites used for suturing
Receives: Device: Biologic Mesh; Procedure: Large Bites
Large Bites and no biologic meshActive comparatorLarge bites used for suturing and no placement of biologic mesh.
Receives: Procedure: Large Bites

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Proportion of Participants Major Chronic Wound Infection

    Proportion of participants with major chronic wound infection

    Measured: 1 year after surgery

Secondary outcomes (15)
  1. Number of Participants With Major Complications

    Major complications include surgical site infection, ventral incisional hernia, and/or reoperation

    Measured: 1 year after surgery

  2. Number of Participants With Surgical Site Infections

    Measured: 1 year after surgery

  3. Number of Participants With Reoperations

    any unplanned invasive procedure involving the fascia, mesh, or peritoneal cavity

    Measured: 1 year after surgery

  4. Operative Duration

    length of the entire procedure

    Measured: about 119 minutes to 337 minutes

  5. Participants Quality of Life as Assessed by Activities Assessment Scale

    Quality of life is scored from 1 to 100, where the higher the score the higher quality of life

    Measured: 1 year after surgery

  6. Participants Health Status as Assessed by the Euroqol-5D Questionnaire

    Health Status is scored from 0 to 100, where the higher the score the better the health

    Measured: 1 year after surgery

  7. Cost Analyses

    calculated from the hospital's perspective by assessing charges for all patient visits, admissions, and procedures

    Measured: 1 year after surgery

  8. Surgeon Perception

    likert type and open ended questions assessing perception, barriers and likelihood of utilizing interventions outside of the trial

    Measured: 1 year after surgery

  9. Number of Participants With Major Complications

    Major complications include surgical site infection, ventral incisional hernia, and/or reoperation

    Measured: 3 years after surgery

  10. Number of Participants With Surgical Site Infections

    Measured: 3 years after surgery

  11. Number of Participants With Reoperations

    any unplanned invasive procedure involving the fascia, mesh, or peritoneal cavity

    Measured: 3 years after surgery

  12. Participants Quality of Life as Assessed by Activities Assessment Scale

    Quality of life is scored from 1 to 100, where the higher the score the higher quality of life

    Measured: 3 years after surgery

  13. Participants Health Status as Assessed by the Euroqol-5D Questionnaire

    Health Status is scored from 0 to 100, where the higher the score the better the health

    Measured: 3 years after surgery

  14. Cost Analyses

    calculated from the hospital's perspective by assessing charges for all patient visits, admissions, and procedures

    Measured: 3 years after surgery

  15. Surgeon Perception

    likert type and open ended questions assessing perception, barriers and likelihood of utilizing interventions outside of the trial

    Measured: 3 years after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 May 2017
  2. Study start13 Sep 2017
  3. Primary completion19 Jun 2021
  4. Study completion19 Jun 2021

Why it stopped: COVID-19 pandemic and the halt to elective surgeries hindered enrollment; PI left insitution

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Factorial
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
163 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03148496
Sponsor's protocol ID
HSC-MS-17-0063
Status last verified
Jul 2022
First submitted
5 May 2017
Last updated
22 Jul 2022
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Publications

  • Goodenough CJ, Ko TC, Kao LS, Nguyen MT, Holihan JL, Alawadi Z, Nguyen DH, Flores JR, Arita NT, Roth JS, Liang MK. Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: hernia expectation rates in intra-abdominal surgery (the HERNIA Project). J Am Coll Surg. 2015 Apr;220(4):405-13. doi: 10.1016/j.jamcollsurg.2014.12.027. Epub 2015 Jan 2.

    PubMed 25690673
  • Armananzas L, Ruiz-Tovar J, Arroyo A, Garcia-Peche P, Armananzas E, Diez M, Galindo I, Calpena R. Prophylactic mesh vs suture in the closure of the umbilical trocar site after laparoscopic cholecystectomy in high-risk patients for incisional hernia. A randomized clinical trial. J Am Coll Surg. 2014 May;218(5):960-8. doi: 10.1016/j.jamcollsurg.2014.01.049. Epub 2014 Feb 18.

    PubMed 24680572
  • McCarthy M Jr, Jonasson O, Chang CH, Pickard AS, Giobbie-Hurder A, Gibbs J, Edelman P, Fitzgibbons R, Neumayer L. Assessment of patient functional status after surgery. J Am Coll Surg. 2005 Aug;201(2):171-8. doi: 10.1016/j.jamcollsurg.2005.03.035.

    PubMed 16038812
  • Hawn MT, Itani KM, Giobbie-Hurder A, McCarthy M Jr, Jonasson O, Neumayer LA. Patient-reported outcomes after inguinal herniorrhaphy. Surgery. 2006 Aug;140(2):198-205. doi: 10.1016/j.surg.2006.02.003.

    PubMed 16904970
  • Blackstock R, Hernandez NC. Characterization of the macrophage subset affected and its response to a T suppressor factor (TsFmp) found in cryptococcosis. Infect Immun. 1989 Oct;57(10):2931-7. doi: 10.1128/iai.57.10.2931-2937.1989.

    PubMed 2777368
  • Holihan JL, Henchcliffe BE, Mo J, Flores-Gonzalez JR, Ko TC, Kao LS, Liang MK. Is Nonoperative Management Warranted in Ventral Hernia Patients With Comorbidities?: A Case-matched, Prospective, Patient-centered Study. Ann Surg. 2016 Oct;264(4):585-90. doi: 10.1097/SLA.0000000000001865.

    PubMed 27355269
  • Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, Wijnhoven BP, Schouten WR, Cense HA, Stockmann HB, Berends FJ, Dijkhuizen FPH, Dwarkasing RS, Jairam AP, van Ramshorst GH, Kleinrensink GJ, Jeekel J, Lange JF. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet. 2015 Sep 26;386(10000):1254-1260. doi: 10.1016/S0140-6736(15)60459-7. Epub 2015 Jul 15.

    PubMed 26188742
  • Millbourn D, Cengiz Y, Israelsson LA. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg. 2009 Nov;144(11):1056-9. doi: 10.1001/archsurg.2009.189.

    PubMed 19917943
  • Millbourn D, Cengiz Y, Israelsson LA. Risk factors for wound complications in midline abdominal incisions related to the size of stitches. Hernia. 2011 Jun;15(3):261-6. doi: 10.1007/s10029-010-0775-8. Epub 2011 Jan 30.

    PubMed 21279664
  • Bhangu A, Fitzgerald JE, Singh P, Battersby N, Marriott P, Pinkney T. Systematic review and meta-analysis of prophylactic mesh placement for prevention of incisional hernia following midline laparotomy. Hernia. 2013 Aug;17(4):445-55. doi: 10.1007/s10029-013-1119-2. Epub 2013 May 28.

    PubMed 23712289
  • Fortelny RH, Hofmann A, May C, Kockerling F; BioMesh Study Group. Prevention of a Parastomal Hernia by Biological Mesh Reinforcement. Front Surg. 2015 Oct 22;2:53. doi: 10.3389/fsurg.2015.00053. eCollection 2015.

    PubMed 26557646
  • Muysoms FE, Detry O, Vierendeels T, Huyghe M, Miserez M, Ruppert M, Tollens T, Defraigne JO, Berrevoet F. Prevention of Incisional Hernias by Prophylactic Mesh-augmented Reinforcement of Midline Laparotomies for Abdominal Aortic Aneurysm Treatment: A Randomized Controlled Trial. Ann Surg. 2016 Apr;263(4):638-45. doi: 10.1097/SLA.0000000000001369.

    PubMed 26943336
  • Sarr MG, Hutcher NE, Snyder S, Hodde J, Carmody B. A prospective, randomized, multicenter trial of Surgisis Gold, a biologic prosthetic, as a sublay reinforcement of the fascial closure after open bariatric surgery. Surgery. 2014 Oct;156(4):902-8. doi: 10.1016/j.surg.2014.06.022.

    PubMed 25239343
  • Bali C, Papakostas J, Georgiou G, Kouvelos G, Avgos S, Arnaoutoglou E, Papadopoulos G, Matsagkas M. A comparative study of sutured versus bovine pericardium mesh abdominal closure after open abdominal aortic aneurysm repair. Hernia. 2015 Apr;19(2):267-71. doi: 10.1007/s10029-014-1262-4. Epub 2014 May 13.

    PubMed 24820007
  • Ferzoco SJ. A systematic review of outcomes following repair of complex ventral incisional hernias with biologic mesh. Int Surg. 2013 Oct-Dec;98(4):399-408. doi: 10.9738/INTSURG-D-12-00002.1.

    PubMed 24229031

Questions about this trial

What is this clinical trial studying?

A study testing Biologic Mesh, Small Bites and Large Bites in people with Wound Complication, run by The University of Texas Health Science Center, Houston at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 22 Jul 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 22 Jul 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of Participants Major Chronic Wound Infection (time frame: 1 year after surgery). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03148496, which also lists 17 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Jul 2022.

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