To investigate the safety and feasibility of improving incision suture and drainage tube fixation after thoracoscopic surgery.

A total of 210 patients who underwent thoracoscopic surgery for pulmonary or mediastinal diseases from January 2025 to January 2026 were prospectively included. They were divided into Group 1, Group 2, and Group 3 according to the different incision suture and drainage tube fixation methods. Group 1 (70 patients) received layered suture with double-layer barbed suture combined with fixation under the suture of the deep tissue within the incision (method 1); Group 2 (70 patients) received layered suture combined with fixation in the Trocar tunnel independent of the incision (method 2); Group 3 (70 cases) received traditional interrupted suture combined with fixed catheter placement at the same incision skin layer (method 3). The incision healing time, total postoperative drainage volume, pain Visual Analog Score (VAS) in the first 3 days after surgery, scar score [Vancouver Scar Scale (VSS) and Observer Scar Assessment Scale (OSAS)] at one month after surgery and the incidence of postoperative incision complications were analyzed and compared among the three groups.

Finally, 185 patients were included in the study—Group 1 (58 patients), Group 2 (62 patients), and Group 3 (65 patients). There were no statistical differences between Group 1 and Group 2 in terms of scar scores (OSAS, VSS) and the incidence of complications such as suture knot reaction, early incision infection, subcutaneous emphysema, and poor incision healing (P>0.05), but both groups were lower than Group 3 (P<0.05). In terms of the incidence of incision exudation or the number of days of incision healing, Group 2 < Group 1 < Group 3 (P<0.05). For postoperative days 1 and 2, the VAS pain scores followed a pattern of Group 1 < Group 3 < Group 2 (P<0.05). There were no statistically significant differences among the three groups on postoperative day 3 (P>0.05), nor in total postoperative drainage volume (P>0.05) or the incidence of complications such as fat liquefaction (P>0.05) and tube dislodgement (P>0.05).

Compared with traditional suture and fixation methods, methods 1 and 2 have better safety and effectiveness, reduce the incidence of related incision complications, reduce excessive scar hyperplasia, and promote primary healing of the incision. Among them, method 2 has advantages in reducing the incidence of incision exudation and accelerating incision healing time, but it has poor postoperative pain control, and still needs further exploration and improvement. To sum up, the first two suture and fixation methods proposed in this study are effective, feasible and worthy of application in clinical practice in specific environments.