Sample records for arterial suture closure

  1. Percutaneous repair of iatrogenic subclavian artery injury by suture-mediated closure device

    Rahul S Chivate


    Full Text Available Central venous catheterization through internal jugular vein is done routinely in intensive care units. It is generally safe, more so when the procedure is performed under ultrasound guidance. However, there could be inadvertent puncture of other vessels in the neck when the procedure is not performed under real-time sonographic guidance. Closure of this vessel opening can pose a challenge if it is an artery, in a location difficult to compress, and is further complicated by deranged coagulation profile. Here, we discuss the removal of an inadvertently placed catheter from subclavian artery with closure of arteriotomy percutaneously using arterial suture-mediated closure device.

  2. Safety and efficacy of the Perclose suture-mediated closure device following carotid artery stenting under clopidogrel platelet blockade

    Zorger, Niels; Finkenzeller, Thomas; Lenhart, Markus; Hamer, Okka; Paetzel, Christian; Borisch, Inghita; Toepel, Ingolf; Feuerbach, Stefan; Link, Johann [University of Regensburg Klinikum, Franz-Josef-Strauss-Allee 11, 93042, Regensburg (Germany)


    The aim of this study was evaluation of a closure device (Perclose, Menlo Park, Calif.) for closure of the femoral artery access site in patients undergoing aggressive anticoagulation and platelet blockade after carotid stenting. Fifty-five patients who received clopidogrel in addition to aspirin and heparin as medication for carotid stenting were included for suture of the femoral access site after using 7- or 8-F guide catheters. The technical success, the time for suture, the clotting parameters, and complications were examined. Follow-up investigations, including ultrasound and clinical examinations, were performed. The groin was checked for possible hematoma, pseudoaneurysm, arteriovenous fistula, and local infection. Technical success was obtained in 51 of 54 patients (94%) after a mean procedure time of 6 min (range 5-10 min). The suture device was not used in one patient (2%) for anatomical reasons and failed to obtain hemostasis in 3 of 54 (6%) patients. In 4 of 54 patients (7%) bleeding was observed at the punctured site 4-6 h after intervention which was treated by a compression bandage. The mean dedicated activated clotting time was 137 s (range 29-287 s) before intervention and 349 s (150-958 s) just before deploying the Perclose device. During follow-up after 2 days (range 2-6 days) and 6 months no further complications of the puncture site were observed except for two large groin hematomas. No major complications occurred. Closure of the femoral access site after carotid stenting using a Perclose closure device is safe and effective even in patients receiving an aggressive anticoagulation and antiplatelet therapy. (orig.)

  3. Short- and midterm results of the fascia suture technique for closure of femoral artery access sites after endovascular aneurysm repair.

    Montán, Carl; Lehti, Leena; Holst, Jan; Björses, Katarina; Resch, Timothy A


    To evaluate the midterm outcomes and potential risk factors associated with the fascia suture technique (FST) for closure of femoral artery access sites after percutaneous endovascular aneurysm repair (EVAR). Between April 2007 and April 2008, 100 consecutive EVAR cases were evaluated retrospectively. A third of the procedures were emergent (16 ruptured aneurysms). Of the 187 femoral access sites, 160 (85.5%) were closed by the FST as a first choice. Pre- and postoperative chart and imaging data were collected from computerized medical records for analysis of demographics and the rate of complications (bleeding, infection, thrombosis, pseudoaneurysms, and stenosis). Preoperative risk factors for FST failure were analyzed with regard to obesity (based on the subcutaneous fat layer), plaque at the femoral access site, and stenosis based on the pre- and 1-year postoperative computed tomography scans. Of the 160 FST closures, 146 (91.3%) were technically successful. The 14 (8.8%) technical failures were converted to open cutdown intraoperatively because of bleeding (11, 6.8%), inadequate limb perfusion (2, 1.2%), and a broken guidewire (1, 0.6%). Two (1.2%) pseudoaneurysms required surgical repair after 2 weeks. Data from the 1-year follow-up showed no signs of increased stenosis, thrombosis, or formation of plaque. Nine small (<1 cm(3)) pseudoaneurysms were detected and managed conservatively. No preoperative risk factors were associated with FST failure. The fascia suture technique seems to be safe, effective, and simple to use for closing percutaneous access sites after EVAR. Complications are rare, and the outcome is not affected by obesity, femoral calcification, or femoral artery stenosis.

  4. Suture-induced right coronary artery stenosis.

    Seltmann, Martin; Achenbach, Stephan; Muschiol, Gerd; Feyrer, Richard


    An 82-year-old patient developed right heart failure in the days after surgical aortic valve replacement. Coronary CT angiography showed a high-grade stenosis of the mid-right coronary artery. Adjacent suture material seen on noncontrast CT suggested that the lesion was related to surgical closure of the right atrial cannulation site. Invasive angiography confirmed the stenosis, and percutaneous intervention was successfully performed.

  5. Intercostal thoracotomy closure: transcostal sutures as a less painful alternative to circumcostal suture placement.

    Rooney, Matthew B; Mehl, Margo; Monnet, Eric


    To determine if transcostal thoracotomy closure resulted in less pain than circumcostal closure. Experimental cadaver and prospective clinical study. Two canine cadavers and 13 adult, 22-29 kg dogs. Phase 1: In 2 cadavers, 4 suture passage techniques were evaluated to determine the incidence of nerve entrapment in circumcostal intercostal thoracotomy closure. Phase 2: Pain after circumcostal closure (7 dogs) or transcostal closure (6 dogs) of a 4th intercostal space thoracotomy was evaluated by use of pain threshold scores, fentanyl administration rates, heart and respiratory rates, and numerical ratings for behavior. Arterial blood gas analyses were obtained 4 hours postoperatively. Transcostal closure was accomplished by drilling 5-6 small holes in the 5th rib and passing sutures through the holes and around the 4th rib to achieve closure. Pain threshold scores (PTS) were measured by an observer unaware of closure assignment, at 2, 4, 12, and 24 hours after closure by applying slowly increasing pressure to the incision line using a load cell. Rates of fentanyl administration were adjusted based on subjective impressions of dog comfort by a second observer unaware of closure assignment. A 70-100% incidence of nerve entrapment was found for all circumcostal techniques. PTS was higher (P=.045) and fentanyl infusion rates were lower (P=.001) for the transcostal group at 2, 4, 12, and 24 hour postoperatively compared with the circumcostal group. There is a high incidence of nerve entrapment using circumcostal closure techniques. A transcostal technique appears to be associated with less pain during the first 24 hours postoperatively. Based on lower pain scores, transcostal thoracotomy closure may be preferable to circumcostal closure techniques.

  6. Endovascular Repair Using Suture-Mediated Closure Devices and Balloon Tamponade following Inadvertent Subclavian Artery Catheterization with Large-Caliber Hemodialysis Catheter.

    Park, Taek Kyu; Yang, Jeong Hoon; Choi, Seung-Hyuk


    Accidental subclavian artery cannulation is an uncommon but potentially serious complication of central venous catheterization. Removal of a catheter inadvertently placed in the subclavian artery can lead to substantial bleeding, as achieving hemostasis in this area through manual compression presents considerable difficulty. Additionally, surgical treatment might be unsuitable for high-risk patients due to comorbidities. Here, we report a case of an inadvertently-inserted 11.5-French hemodialysis catheter in the subclavian artery during internal jugular venous catheterization. We performed percutaneous closure of the subclavian artery using three 6-French Perclose Proglide® devices with a balloon tamponade in the proximal part of the subclavian artery. Closure was completed without embolic neurological complications.

  7. Skin closure in vascular neurosurgery: A prospective study on absorbable intradermal suture versus nonabsorbable suture.

    Pereira, Julio Leonardo Barbosa; Vieira, Gerival; de Albuquerque, Lucas Alverne Freitas; Mendes, George de Albuquerque Cavalcanti; Salles, Ludmila Rezende; de Souza, André Felipe Ferreira; Dellaretti, Marcos; de Sousa, Atos Alves


    The craniotomy performed with minimal hair removal and closure with intradermal suture alone is an option in neurosurgical procedures, which can help faster psychological recovery of the patient, as it allows a better cosmetic result. This study is aimed at evaluating if such method is safe and effective, compared with continuous skin sutures with 2-0 nylon. We analyzed the sutures in 117 patients undergoing craniotomies for cerebral aneurysm clipping. In the case group (n = 49), closure of the scalp was performed only with intradermal absorbable sutures using wire Monocryl(®) 2-0. In the control group (n = 68), closure was performed with continuous suture using 2-0 nylon. The case group was composed of 49 patients in whom just intradermal suture was performed. One (2.2%) patient developed wound infection and was given proper medical treatment. No cases of dehiscence or cerebrospinal fluid leaks were observed. The control group was composed of 68 patients in whom the skin was closed with 2-0 nylon continuous suture. Three (5.3%) patients developed wound infection and were given proper medical treatment. There were no cases of wound dehiscence. The overall infection rate in the control group was 4%. There was no statistically significant difference in the number of wound infections between the two groups (P = 0.73). The closure with intradermal suture alone in craniotomies is as safe as the traditional skin closure with nylon sutures, besides eliminating the need for suture removal and providing a cosmetic advantage.

  8. No-drain DIEP Flap Donor-site Closure Using Barbed Progressive Tension Sutures

    Nagarkar, Purushottam; Lakhiani, Chrisovalantis; Cheng, Angela; Lee, Michael; Teotia, Sumeet; Saint-Cyr, Michel


    Background: The use of progressive tension sutures has been shown to be comparable to the use of abdominal drains in abdominoplasty. However, the use of barbed progressive tension sutures (B-PTSs) in deep inferior epigastric artery perforator (DIEP) flap donor-site closure has not been investigated. Methods: A retrospective chart review was performed on patients with DIEP flap reconstruction in a 3-year period at 2 institutions by 2 surgeons. Patients were compared by method of DIEP donor-sit...

  9. Skin closure in vascular neurosurgery: A prospective study on absorbable intradermal suture versus nonabsorbable suture

    Pereira, Julio Leonardo Barbosa; Vieira,Gerival; de Albuquerque, Lucas Alverne Freitas; Mendes, George de Albuquerque Cavalcanti; Salles, Ludmila Rezende; de Souza, André Felipe Ferreira; Dellaretti, Marcos; Sousa,Atos Alves de


    Background: The craniotomy performed with minimal hair removal and closure with intradermal suture alone is an option in neurosurgical procedures, which can help faster psychological recovery of the patient, as it allows a better cosmetic result. This study is aimed at evaluating if such method is safe and effective, compared with continuous skin sutures with 2-0 nylon. Methods: We analyzed the sutures in 117 patients undergoing craniotomies for cerebral aneurysm clipping. In the case group (...

  10. Comparison of Subcuticular Suture Materials in Cesarean Skin Closure

    Pınar Solmaz Hasdemir


    Full Text Available Aim. Comparison of the rate of wound complications, pain, and patient satisfaction based on used subcuticular suture material. Methods. A total of 250 consecutive women undergoing primary and repeat cesarean section with low transverse incision were prospectively included. The primary outcome was wound complication rate including infection, dehiscence, hematoma, and hypertrophic scar formation within a 6-week period after operation. Secondary outcomes were skin closure time, the need for use of additional analgesic agent, pain score on numeric rating scale, cosmetic score, and patient scar satisfaction scale. Results. Absorbable polyglactin was used in 108 patients and nonabsorbable polypropylene was used in 142 patients. Wound complication rates were similar in primary and repeat cesarean groups based on the type of suture material. Skin closure time is longer in nonabsorbable suture material group in both primary and repeat cesarean groups. There was no difference between groups in terms of postoperative pain, need for additional analgesic use, late phase pain, and itching at the scar. Although the cosmetic results tended to be better in the nonabsorbable group in primary surgery patients, there was no significant difference in the visual satisfaction of the patients. Conclusions. Absorbable and nonabsorbable suture materials are comparable in cesarean section operation skin closure.

  11. Evaluation of Sternal Closure with Absorbable Polydioxanone Sutures in Children

    Hamid Bigdelian


    Full Text Available Introduction: Sternal dehiscence, sternal wound infection and mediastinitis are troublesome complications following median sternotomy which are major causes of morbidity and mortality of patients. Synthetic polydioxanone absorbable suture seems effective in prevention of these complications in children undergoing open heart surgery.Methods: During 2 years period, 620 patients who underwent median sternotomy were studied. The efficacy of absorbable polydioxanone suture was tested on patients using figure-of-eight suture technique. The patients’ age ranged from newborn to 15 years old. All surgical interventions were performed according to a standard protocol.Results: No sternal sutures were broken during the sternal closure and no case of mediastinitis was seen. Two patients experienced sternal dehiscence (0.32%. Follow-up period of patients were established between 1 to 132 months after open heart surgery.Conclusion: Sternal closure with the polydioxanone suture in combination with figure-of-eight technique is a safe and suitable method in children with good clinical results.

  12. The Gore-Tex Suture in Periareolar Closure: A Modified Closure Technique.

    Chapman, Jade; Ingram, Scott


    In breast reduction and mastopexy procedures, the periareolar closure forms a vital component of the surgery. Periareolar closures completed with an absorbable suture may be prone to significant widening, hypertrophy and/or areolar distortion. In an effort to avoid this, some surgeons use a non-absorbable/permanent suture material [Franco (Arch Plast Surg 41 (6): 728-733, 2014)]. Hammond (Plast Reconstr Surg 119 (3):804-809, 2007) recommends the use of a Gore-Tex® suture for this purpose in view of the supple, pliable nature of the material; however, there remain at least occasional instances of infection and extrusion of the knot used to tie off the Gore-Tex "purse-string" [Franco (Arch Plast Surg 41 (6): 728-733, 2014); Salgarello (Aesthet Plast Surg 37 (5):1061-1062, 2013)]. We describe a method of securing the suture ends, which avoids the creation of a bulky knot, thus minimising the risk of infection and suture extrusion. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

  13. A comparative study of outcome of the absorbable suture polydioxanone and nonabsorbable suture polypropylene in laparotomy wound closure

    Kiran Shankar H.


    Full Text Available Background: Abdominal wound closure is one of the common operations for a general surgeon. Prevention of complications is important to reduce post-operative morbidity and mortality. Post-operative wound pain, wound infection, wound dehiscence, suture sinus formation; palpable knots and incisional hernia are the parameters are to be studied. Therefore, the present study was undertaken to compare polydioxanone and polypropylene suture material for abdominal fascial closure regarding morbidity in terms of post-operative wound complications. Methods: Patients admitted in the department of surgery, who undergo laparotomy operations, with midline abdominal incisions were included in the study. The recruited subjects were divided into Group-A, whom abdominal incisions are closed with non-absorbable suture material polypropylene and Group-B whom abdominal incisions are closed with absorbable suture material polydioxanone. Data was expressed as percentages. Results: The incidence of wound pain was observed in all the patients in both immediate and delayed post-operative period in the polypropylene suture material compared to polydioxanone. The incidence of wound infection was higher in polypropylene (24% compared to PDS (2%. There were 4% cases of wound dehiscence in the present study. The incidence of suture sinus formation was higher in the polypropylene suture material (9% compared to the polydioxanone suture material (2% in the delayed postoperative period. The incidence of palpable knots was higher in the polypropylene suture material (23% compared to the polydioxanone suture material. No cases of incisional hernia were reported with polydioxanone suture material. Conclusions: The overall morbidity from abdominal closure was considerably reduced in the Polydioxanone group. We encountered reduction in wound complications like burst abdomen, wound infection, wound pain, suture sinus formation, palpable knots and incisional hernia. Therefore

  14. Photometric analysis of absorbable barbed suture for periareolar closure in mastopexy

    Allen D Rosen; Alanna M Guzman; Teresa Hartman


    Aim:The primary author previously described his technique for periareolar closure in mastopexy using a pinwheel interlocking purse string with absorbable barbed suture and now reports the results of a retrospective photometric analysis comparing this technique with the same closure using Gortex® suture. This study is designed to compare the degree of areolar widening and safety proifle of using absorbable barbed sutures for periareolar closure versus permanent smooth suture. Methods:A retrospective chart review was conducted of all patients whose periareolar closures were performed using an interlocking purse-string technique over a 10-year period. Only patients undergoing circumvertical mastopexy were included. All had photometric evaluation and follow-up performed within 6-24 months. Results:In total, 20 patients (40 areolas), which were closed with absorbable barbed suture, were analyzed photometrically. In this suture group, areola size increased a mean of 4.9%from baseline, and no complications (0%) were observed. This compared favorably with previously reported complication rates using permanent sutures and with a series of cases presented herein in which permanent smooth suture was used for purse string closure. The degree to which absorbable barbed suture controls areolar spread was shown to be signiifcantly better than those where permanent smooth purse string techniques were employed. Conclusion:Circumvertical mastopexy closures using absorbable barbed suture was shown to be safe and effective and compared favorably to older techniques using permanent smooth suture for similar closures. This paper lends support to the safety of using absorbable barbed suture in circumareolar closures to limit areolar spread.

  15. Craniosynostosis of coronal suture in twist1 mice occurs through endochondral ossification recapitulating the physiological closure of posterior frontal suture.

    Behr, Björn; Longaker, Michael T; Quarto, Natalina


    Craniosynostosis, the premature closure of cranial suture, is a pathologic condition that affects 1/2000 live births. Saethre-Chotzen syndrome is a genetic condition characterized by craniosynostosis. The Saethre-Chotzen syndrome, which is defined by loss-of-function mutations in the TWIST gene, is the second most prevalent craniosynostosis. Although much of the genetics and phenotypes in craniosynostosis syndromes is understood, less is known about the underlying ossification mechanism during suture closure. We have previously demonstrated that physiological closure of the posterior frontal suture occurs through endochondral ossification. Moreover, we revealed that antagonizing canonical Wnt-signaling in the sagittal suture leads to endochondral ossification of the suture mesenchyme and sagittal synostosis, presumably by inhibiting Twist1. Classic Saethre-Chotzen syndrome is characterized by coronal synostosis, and the haploinsufficient Twist1(+/-) mice represents a suitable model for studying this syndrome. Thus, we seeked to understand the underlying ossification process in coronal craniosynostosis in Twist1(+/-) mice. Our data indicate that coronal suture closure in Twist1(+/-) mice occurs between postnatal day 9 and 13 by endochondral ossification, as shown by histology, gene expression analysis, and immunohistochemistry. In conclusion, this study reveals that coronal craniosynostosis in Twist1(+/-) mice occurs through endochondral ossification. Moreover, it suggests that haploinsufficiency of Twist1 gene, a target of canonical Wnt-signaling, and inhibitor of chondrogenesis, mimics conditions of inactive canonical Wnt-signaling leading to craniosynostosis.

  16. Craniosynostosis of coronal suture in Twist1+/- mice occurs through endochondral ossification recapitulating the physiological closure of posterior frontal suture

    Bjorn eBehr


    Full Text Available Craniosynostosis, the premature closure of cranial suture, is a pathologic condition that affects 1/2000 live births. Saethre-Chotzen syndrome is a genetic condition characterized by craniosynostosis. The Saethre-Chotzen syndrome, which is defined by loss-of-function mutations in the TWIST gene, is the second most prevalent craniosynostosis. Although much of the genetics and phenotypes in craniosynostosis syndromes is understood, less is known about the underlying ossification mechanism during suture closure. We have previously demonstrated that physiological closure of the posterior frontal (PF suture occurs through endochondral ossification. Moreover, we revealed that antagonizing canonical Wnt signaling in the sagittal suture leads to endochondral ossification of the suture mesenchyme and sagittal synostosis, presumably by inhibiting Twist1. Classic Saethre-Chotzen syndrome is characterized by coronal synostosis, and the haploinsufficient Twist1+/- mice represents a suitable model for studying this syndrome. Thus, we seeked to understand the underlying ossification process in coronal craniosynostosis in Twist1+/- mice. Our data indicate that coronal suture closure in Twist1+/- mice occurs between postnatal day 9 to 13 by endochondral ossification, as shown by histology, gene expression analysis and immunohistochemistry. In conclusion, this study reveals that coronal craniosynostosis in Twist1+/- mice occurs through endochondral ossification. Moreover, it suggests that haploinsufficency of Twist1 gene, a target of canonical Wnt-signaling, and inhibitor of chondrogenesis, mimics conditions of inactive canonical Wnt-signaling leading to craniosynostosis.

  17. Use of Absorbable Sutures in Canine Carotid Arteries

    Rey, Alejandro R.; Carrillo-Farga, Joaquin; Velasco, Carlos O.; Valencia, Martin O.V.


    To study the functional and microstructural characteristics of polydioxanone sutures in vascular surgery, we created 48 vascular anastomoses in the right and left common carotid arteries of 24 mongrel dogs. In each animal, polydioxanone sutures were used in 1 carotid artery, and polypropylene sutures were used in the contralateral carotid artery. Twelve groups of 2 animals each were then formed. The 1st group was observed for 1 month, the 2nd for 2 months, the 3rd for 3 months, and so on unti...

  18. Cranial Suture Closure in Domestic Dog Breeds and Its Relationships to Skull Morphology.

    Geiger, Madeleine; Haussman, Sinah


    Bulldog-type brachycephalic domestic dog breeds are characterized by a relatively short and broad skull with a dorsally rotated rostrum (airorhynchy). Not much is known about the association between a bulldog-type skull conformation and peculiar patterns of suture and synchondrosis closure in domestic dogs. In this study, we aim to explore breed-specific patterns of cranial suture and synchondrosis closure in relation to the prebasial angle (proxy for airorhynchy and thus bulldog-type skull conformation) in domestic dogs. For this purpose, we coded closure of 18 sutures and synchondroses in 26 wolves, that is, the wild ancestor of all domestic dogs, and 134 domestic dogs comprising 11 breeds. Comparisons of the relative amount of closing and closed sutures and synchondroses (closure scores) in adult individuals showed that bulldog-type breeds have significantly higher closure scores than non-bulldog-type breeds and that domestic dogs have significantly higher closure scores than the wolf. We further found that the prebasial angle is significantly positively correlated with the amount of closure of the basispheno-presphenoid synchondrosis and sutures of the nose (premaxillo-nasal and maxillo-nasal) and the palate (premaxillo-maxillary and interpalatine). Our results show that there is a correlation between patterns of suture and synchondrosis closure and skull shape in domestic dogs, although the causal relationships remain elusive.

  19. Comparison of suture types in the closure of scalp wounds.

    Bonham, Joseph


    Innovation in practice can benefit patients and healthcare providers but must be evidence based. This article describes a quantitative study of whether absorbable sutures are as beneficial as non-absorbable sutures in the management of simple scalp lacerations in adults. The results suggest that absorbable sutures can provide the same cosmetic and functional results as non-absorbable sutures. Their use can also reduce patient returns and save money and resources.

  20. Use of Absorbable Sutures in Canine Carotid Arteries

    Rey, Alejandro R.; Carrillo-Farga, Joaquin; Velasco, Carlos O.; Valencia, Martin O.V.


    To study the functional and microstructural characteristics of polydioxanone sutures in vascular surgery, we created 48 vascular anastomoses in the right and left common carotid arteries of 24 mongrel dogs. In each animal, polydioxanone sutures were used in 1 carotid artery, and polypropylene sutures were used in the contralateral carotid artery. Twelve groups of 2 animals each were then formed. The 1st group was observed for 1 month, the 2nd for 2 months, the 3rd for 3 months, and so on until the 12th group, which was observed for 12 months. At the end of each observation period, reoperation was undertaken to evaluate the vascular anastomoses by means of angiography and microscopy. The polypropylene anastomoses showed a marked deformity, with tissue retraction and a foreign body reaction. In contrast, the polydioxanone anastomoses exhibited satisfactory healing, without deformity, and were well tolerated histologically. We believe that polydioxanone may be a useful, alternative vascular suture material. (Texas Heart Institute Journal 1990;17:99-102) Images PMID:15227391

  1. Ameloblastin inhibits cranial suture closure by modulating MSX2 expression and proliferation.

    Phimon Atsawasuwan

    Full Text Available Deformities of cranial sutures such as craniosynostosis and enlarged parietal foramina greatly impact human development and quality of life. Here we have examined the role of the extracellular matrix protein ameloblastin (Ambn, a recent addition to the family of non-collagenous extracellular bone matrix proteins, in craniofacial bone development and suture formation. Using RT-PCR, western blot and immunohistochemistry, Ambn was localized in mouse calvarial bone and adjacent condensed mesenchyme. Five-fold Ambn overexpression in a K14-driven transgenic mouse model resulted in delayed posterior frontal suture fusion and incomplete suture closure. Moreover, Ambn overexpressor skulls weighed 13.2% less, their interfrontal bones were 35.3% thinner, and the width between frontal bones plus interfrontal suture was 14.3% wider. Ambn overexpressing mice also featured reduced cell proliferation in suture blastemas and in mesenchymal cells from posterior frontal sutures. There was a more than 2-fold reduction of Msx2 in Ambn overexpressing calvariae and suture mesenchymal cells, and this effect was inversely proportionate to the level of Ambn overexpression in different cell lines. The reduction of Msx2 expression as a result of Ambn overexpression was further enhanced in the presence of the MEK/ERK pathway inhibitor O126. Finally, Ambn overexpression significantly reduced Msx2 down-stream target gene expression levels, including osteogenic transcription factors Runx2 and Osx, the bone matrix proteins Ibsp, ColI, Ocn and Opn, and the cell cycle-related gene CcnD1. Together, these data suggest that Ambn plays a crucial role in the regulation of cranial bone growth and suture closure via Msx 2 suppression and proliferation inhibition.

  2. Comparison of suture materials for subcuticular skin closure at cesarean delivery.

    Tuuli, Methodius G; Stout, Molly J; Martin, Shannon; Rampersad, Roxane M; Cahill, Alison G; Macones, George A


    Subcuticular skin closure with suture after cesarean has been shown to result in lower rates of wound complications than with staple closure. However, the optimal choice of suture material for subcuticular skin closure is unclear. Vicryl (a braided multifilament synthetic suture; Ethicon, Somerville, NJ) and Monocryl (a monofilament synthetic suture; Ethicon) are the commonly used suture materials for subcuticular closure of transverse skin incisions after cesarean in the United States. Whereas in vitro and animal studies suggest multifilament suture materials may be associated with a higher risk of wound infection than monofilament sutures, clinical data on their relative effectiveness are limited. We sought to test the hypothesis that Vicryl is associated with a higher rate of wound complications than Monocryl. This is a secondary analysis of data from a randomized trial in which pregnant women undergoing scheduled or unscheduled cesareans were randomly assigned to preoperative skin preparation with either chlorhexidine-alcohol or iodine-alcohol. Women with low transverse skin incisions who were closed with either 4-0 Monocryl or 4-0 Vicryl were included in this analysis. Choice of suture material was at the discretion of the operating physician. The primary outcome was superficial or deep surgical site infection within 30 days after cesarean. Secondary outcomes were other wound complications. Outcomes were compared between the 2 groups using univariable and multivariable statistics. Of 1082 patients who had follow-up after discharge in the primary trial, 871 had subcuticular suture: 180 with 4-0 Vicryl and 691 with 4-0 Monocryl. Skin closure with Vicryl or Monocryl did not significantly differ between women allocated to chlorhexidine-alcohol or iodine-alcohol (51.1% vs 49.4%, P = .67). There was no significant difference in the risk of surgical site infection in women closed with Vicryl compared with Monocryl (11 [6.1%] vs 35 [5.1%]; P = .58; adjusted odds

  3. Elastic suture (shoelace technique) for fasciotomy closure after treatment of compartmental syndrome associated to tibial fracture.

    Branco, Paulo Sergio Martins Castelo; Cardoso Junior, Mauricio; Rotbande, Isaac; Ciraudo, José Antonio Fraga; Silva, Celso Ricardo Correa de Melo; Leal, Paulo Cesar Dos Santos


    This article reports the use of elastic suture as an adjuvant in surgical wound closure caused by decompressive fasciotomy after compartment syndrome associated with a compound fracture of the tibia. Widely used in other medico-surgical specialties, this technique is unusual in orthopedics surgery, but the simplicity of the procedure and the successful outcome observed in this case allows for its consideration as indicated for situations similar to that presented in this study.

  4. The “excluding” suture technique for surgical closure of ventricular septal defects: A retrospective study comparing the standard technique

    Roy Varghese


    Conclusion: Surgical closure of VSDs can be accomplished by placing sutures along the margins or away with comparable results. The incidence of CHB, however, seems to be less when the “excluding” technique is employed.

  5. Abdominal wound closure. A randomized prospective study of 571 patients comparing continuous vs. interrupted suture techniques.

    Richards, P C; Balch, C M; Aldrete, J S


    A randomized, prospective study was designed to compare a continuous with an interrupted technique for closing an abdominal incision. Five hundred seventy-one patients were randomized between the closure methods and stratified as to type of wound: clean, clean-contaminated, or contaminated. In mid-line incisions, the dehiscence rate was 2.0% (5/244) for the continuous group versus 0.9% (2/229) for the interrupted group. The difference was not statistically significant. Ventral hernias formed in 2.0% (4/201) of the continuous group vs. 0.5% (1/184) of the interrupted group. The type of wound had no influence on the results. In oblique incisions, 0% (0/39) of wounds closed continuously dehised while 2% (1/50) of incisions closed interruptedly dehised. No ventral hernias formed. Further analysis of the data indicated that dehiscence was more likely related to improper surgical technique than to the method of closure. An abdominal incision could be closed with a continuous suture in approximately half the time required for placing interrupted sutures (20 vs. 40 minutes). A continuous closure is preferred because it is more expedient and because it has the same incidence of wound disruption compared with an interrupted closure. PMID:6297417

  6. Surgical staples compared with subcuticular suture for skin closure after cesarean delivery: a randomized controlled trial

    Sahar Assadi


    Full Text Available Background: Cesarean delivery is the most common surgical procedure and this prevalence is on the rise. Given these trends, cesarean wound complications, such as disruption or infection, remain an important cause of post-cesarean morbidity. Methods: We conducted a single-center randomized controlled trial that included women with viable pregnancies (≥24 weeks undergoing cesarean delivery at Motahary University Hospital, Urmia, Iran from April to November 2014. All cesarean types were included: scheduled or unscheduled and primary or repeat cesareans. Women were excluded for the following reasons: inability to obtain informed consent, immune compromising disease (e.g. AIDS, chronic steroid use, diabetic mellitus and BMI≥30. Of 266 women, 133 were randomized to staples and 133 women to suture group. Results: The mean±SD age of the staples group was 27.6±5.4 years and mean±SD age of suture was 28.7±5.9 years. Multiparity is the most frequent in both groups that by using Chi-square test, no significant differences were observed between the two groups (P=0.393. The most frequent indication for cesarean section in both groups was history of cesarean section in staple 40 cases (30.1% and suture 32 cases (24.1%. The survey was conducted using the Chi-square test was not significant (P=0.381. Pain at 6 weeks postoperatively was significantly less in the staple group (P=0.001. Operative time was longer with suture closure (4.68±0.67 versus 1.03±0.07 minute, P<0.001. The Vancouver scale score was significantly less in suture closure (6.6±0.8 versus 7.5±0.9, P=0.001. Wound disruption was significantly less in suture closure (3.8% versus 11.3%, P=0.017. Conclusion: The staple group had low pain and operation time but had a significant wound disruption and scar. The patients who have suffered a significant wound disruption were affected by age (P=0.022 and BMI (P=0.001 at compared those who were not affected by factors such as age or high BMI as

  7. Sutures versus staples for wound closure in orthopaedic surgery: a randomized controlled trial

    Shantz Jesse A


    Full Text Available Abstract Background A recently published meta-analysis comparing metallic staples to sutures in orthopaedic procedures revealed three fold increase in risk for infection in stapled wounds. The studies included in the meta-analysis are at risk of bias due to experimental design limitations. A large randomized controlled trial is proposed to direct orthopaedic surgeons in their choice of wound closure material. Methods/Design A parallel group randomized controlled trial with institutional review board approval will be conducted. Patients will be randomized intraoperatively to have skin wounds closed with sutures or staples. Dressings will be used to maintain blinding outcome assessors. The primary outcome measure will be a composite all-cause wound complication outcome measure composed of: infection, wound drainage, wound necrosis, blistering, dehiscence, suture abscess and material sensitivity reaction. An independent review board blinded to treatment assignment will adjudicate suspected complications based on clinical data. All deceased patients will also be reviewed. An interim analysis of complications will take place after half of the patients have been recruited. All data will be analyzed by a blinded statistician. Dichotomous primary and secondary outcome measures will be analyzed using the Chi-squared statistic. Continuous outcome measures will be analyzed using Student's t-test. Subgroup analysis will compare infection rates using sutures versus staples in each anatomic area (upper extremity, pelvis/acetabulum, hip/femur, knee, ankle. A further subgroup analysis will be conducted comparing trauma patients to elective surgery patients. Non-infected revision surgery will also be compared to primary surgery. Discussion Wound closure material is an afterthought for many orthopaedic surgeons. The combined results of several comparative trials suggests that the choice of wound closure materials may have an impact on the rate of surgical site

  8. Evaluation of four suture materials for surgical incision closure in Siberian sturgeon

    Boone, S. Shaun; Hernandez, Sonia M.; Camus, Alvin C.; Peterson, Douglas C.; Jennings, Cecil A.; Shelton, James L.; Divers, Stephen J.


    The visual and microscopic tissue reactions to the absorbable monofilament Monocryl, absorbable monofilament triclosan-coated Monocryl-Plus, absorbable multifilament Vicryl, and nonabsorbable monofilament Prolene were evaluated for their use of surgical closure in Siberian Sturgeon Acipenser baerii. Postoperative assessments were conducted at 1, 2, 8, 12, and 26 and 55 weeks to visually evaluate the surgical incision for suture retention, incision healing, erythema, and swelling. Incisions were also assessed microscopically at 1, 2, and 8 weeks for necrosis, inflammation, hemorrhage, and fibroplasia. The results indicated that incisions closed with either Vicryl or Prolene suture materials were more likely to exhibit more erythema or incomplete healing compared with those closed with Monocryl or Monocryl-Plus. The surgical implantation of a transmitter in the coelomic cavity did not significantly affect the response variables among the four suture materials. Monocryl or Monocryl-Plus were equally effective and superior to other suture materials used for closing surgical incisions in Siberian Sturgeon or closely related species of sturgeon. Furthermore, Monocryl or Monocryl-Plus may decrease the risk of transmitter expulsion through the incision, as surgical wounds appear to heal faster and exhibit less erythema compared with those closed with Vicryl.

  9. 24h and 30 day outcome of Perclose Proglide suture mediated vascular closure device: An Indian experience.

    Vinayakumar, Desabandhu; Kayakkal, Shajudeen; Rajasekharan, Sandeep; Thottian, Julian Johny; Sankaran, Prasanth; Bastian, Cicy

    Advantages of vascular closure device over manual compression include patient comfort, early mobilisation and discharge, avoidance of interruption of anticoagulation, avoidance of local compression and its sequelae and less time constraint on staff. No published Indian data exist regarding Perclose Proglide suture mediated vascular closure device (SMC). To study the 24h and 30 day outcome of Perclose Proglide SMC retrospectively. Retrospective observational study conducted in the Department of Cardiology, Government Medical College, Calicut, Kerala from June 2013 to June 2015. All consecutive patients with Perclose Proglide SMC deployment done by a single operator for achieving access site haemostasis where 24h and 30 day post-procedure data were available were included. Major and minor complications, procedure success, device failure were predefined. 323 patients were analysed. Procedure success rate was 99.7% (322/323). Transient oozing occurred in 44 patients (13.6%), minor and major complications occurred in 2% and 1.5% of patients respectively. Major complication included one case of retroperitoneal bleed, one access site infection, one pseudo aneurysm formation and two access site arterial stenosis. There was no death or complication requiring limb amputation. "Preclose" technique was used successfully in six patients. Primary device failure occurred in 12 cases which were tackled successfully with second Proglide in all except one. Perclose Proglide SMC is a safe and effective method to achieve haemostasis up to 22F with less complication rate. Copyright © 2016. Published by Elsevier B.V.

  10. Percutaneous suture-mediated closure of femoral access sites deployed through the procedure sheath: initial clinical experience with a novel vascular closure device.

    Eggebrecht, Holger; Naber, Christoph; Woertgen, Uta; Ringe, Sonia; Konorza, Thomas F M; Schmermund, Axel; von Birgelen, Clemens; Haude, Michael; Kroeger, Knut; Erbel, Raimund; Baumgart, Dietrich


    The objective of this study was to assess the initial safety and feasibility of a novel suture-mediated device for closure of femoral access sites immediately after diagnostic or interventional cardiac catheterization. In a prospective study, 150 patients (mean age, 61.5 years; 109 male) underwent femoral access closure with a novel suture closure device (Superstitch, Sutura) immediately after diagnostic (n = 106) or interventional (n = 44) catheterization procedures, independently of the coagulation status. All patients were monitored for 24 hr after the procedure. The closure device was successfully deployed in 92% of patients. Immediate hemostasis was achieved in 77% of patients with no differences between patients undergoing diagnostic catheterization or coronary interventions (79% vs. 73%; P = 0.659). After 2 min of additional light manual compression, hemostasis was achieved in 92% of patients. There was one major complication requiring vascular surgery (0.7%). The novel suture closure device is a safe and effective device that allows for immediate closure of femoral puncture sites after both diagnostic and interventional procedures with a low rate of major complications.

  11. Systematic review of absorbable vs non-absorbable sutures used for the closure of surgical incisions

    Muhammad; S; Sajid; Malcolm; R; Mc; Fall; Pauline; A; Whitehouse; Parv; S; Sains


    AIM: To report a systematic review of published randomized controlled trials(RCTs) investigating the role of absorbable suture(AS) against non-AS(NAS) used for the closure of surgical incisions.METHODS: RCTs investigating the use of AS vs NAS for the closure of surgical incisions were statistically analysed based upon the principles of meta-analysis and the summated outcomes were represented as OR.RESULTS: The systematic search of medical literature yielded 10 RCTs on 1354 patients. Prevalence of wound infection(OR = 0.97; 95%CI: 0.56, 1.69; Z = 0.11; P = 0.92) and operative morbidity(P = 0.45) was comparable in both groups. Nonetheless, the use of AS lead to lower risk of wound break-down(OR = 0.12; 95%CI: 0.04, 0.39; Z = 3.52; P < 0.0004).CONCLUSION: This meta-analysis of 10 RCTs demonstrates that the use of AS is similar to NAS for skin closure for surgical site infection and other operative morbidities. AS do not increase the risk of skin wound dehiscence,rather lead to a reduced risk of wound dehiscence compared to NAS.

  12. Modality of wound closure after total knee replacement: are staples as safe as sutures? A retrospective study of 181 patients

    Hammerberg E Mark


    Full Text Available Abstract Background Surgical site wound closure plays a vital role in post-operative success. This effect is magnified in regard to commonly performed elective procedures such as total knee arthroplasty. The use of either sutures or staples for skin re-approximation remains a contested subject, which may have a significant impact on both patient safety and surgical outcome. The literature remains divided on this topic. Methods Two cohorts of patients at a level one trauma and regional referral center were reviewed. Cohorts consisted of consecutive total knee arthroplasties performed by two surgeons who achieved surgical wound re-approximation by either staples or absorbable subcuticular sutures. Outcome variables included time of surgery, wound dehiscence, surgical site infection per Center for Disease Control criteria and repeat procedures for debridement and re-closure. Results 181 patients qualified for study inclusion. Staples were employed in 82 cases (45.3% of total and sutures in 99 cases (54.7%. The staples group had no complications while the sutures group had 9 (9.1%. These consisted of: 4 infections (2 superficial, one deep, one organ/space; three patients required re-suturing for dehiscence; one allergic type reaction to suture material; and one gout flare resulting in dehiscence. The mean surgical time with sutures was 122.3 minutes (sd = 33.4 and with staples was 114 minutes (sd = 24.4. Conclusion This study demonstrated significantly fewer complications with staple use than with suture use. While all complications found in this study cannot be directly attributed to skin re-approximation method, the need for further prospective, randomized trials is established.

  13. Prospective comparison of collagen plug (angio-seal{sup TM}) and suture-mediated (the closer S{sup TM}) closure devices at femoral access sites

    Park, Yulri; Roh, Hong Gee; Choo, Sung Wook; Lee, Sung Hoon; Shin, Sung Wook; Do, Young Soo; Byun, Hong Sik; Park, Kwang Bo; Jeon, Pyoung [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)


    Rapid and effective hemostasis at femoral puncture sites minimizes both the hospital stay and patient discomfort. Therefore, a variety of arterial closure devices have been developed to facilitate the closure of femoral arteriotomy. The objective of this prospective study was to compare the efficacy of two different closure devices; a collagen plug device (Angio-Seal) and a suture-mediated closure device (the Closer S). From March 28, 2003 to August 31, 2004, we conducted a prospective study in which 1,676 cases of 1,180 patients were treated with two different types of closure device. Angio-Seal was used in 961 cases and the Closer S in 715 cases. The efficacy of the closure devices was assessed, as well as complications occurring at the puncture sites. Successful immediate hemostasis was achieved in 95.2% of the cases treated with Angio-Seal, and in 89.5% of the cases treated with the Closer S ({rho} < 0.05). The rates of minor and major complications occurring between the two groups were not significantly different. In the Closer S group, we observed four major complications (0.6%), that consisted of one massive retroperitoneal hemorrhage (surgically explored) and three pseudoaneurysms. In the Angio-Seal group, we observed three major complications (0.3%) that consisted of one femoral artery occlusion, one case of infection treated with intravenous antibiotics and one pseudoaneurysm. The use of Angio-Seal was found to be more effective than that of the Closer S with regard to the immediate hemostasis of the femoral puncture sites. However, we detected no significant differences in the rate at which complications occurred.

  14. Suitability of Exoseal Vascular Closure Device for Antegrade Femoral Artery Puncture Site Closure

    Schmelter, Christopher, E-mail:; Liebl, Andrea; Poullos, Nektarios [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany); Ruppert, Volker [Klinikum Ingolstadt, Department of Vascular Surgery (Germany); Vorwerk, Dierk [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany)


    Purpose. To assess the efficacy and safety of the Exoseal vascular closure device for antegrade puncture of the femoral artery. Methods. In a prospective study from February 2011 to January 2012, a total of 93 consecutive patients received a total of 100 interventional procedures via an antegrade puncture of the femoral artery. An Exoseal vascular closure device (6F) was used for closure in all cases. Puncture technique, duration of manual compression, and use of compression bandages were documented. All patients were monitored by vascular ultrasound and color-coded duplex sonography of their respective femoral artery puncture site within 12 to 36 h after angiography to check for vascular complications. Results. In 100 antegrade interventional procedures, the Exoseal vascular closure device was applied successfully for closure of the femoral artery puncture site in 96 cases (96 of 100, 96.0 %). The vascular closure device could not be deployed in one case as a result of kinking of the vascular sheath introducer and in three cases because the bioabsorbable plug was not properly delivered to the extravascular space adjacent to the arterial puncture site, but instead fully removed with the delivery system (4.0 %). Twelve to 36 h after the procedure, vascular ultrasound revealed no complications at the femoral artery puncture site in 93 cases (93.0 %). Minor vascular complications were found in seven cases (7.0 %), with four cases (4.0 %) of pseudoaneurysm and three cases (3.0 %) of significant late bleeding, none of which required surgery. Conclusion. The Exoseal vascular closure device was safely used for antegrade puncture of the femoral artery, with a high rate of procedural success (96.0 %), a low rate of minor vascular complications (7.0 %), and no major adverse events.

  15. Coaptive film versus subcuticular suture: comparing skin closure time following identical, single-session, bilateral limb surgery in children.

    Rebello, Gleeson; Parikh, Ravi; Grottkau, Brian


    This study is a randomized controlled trial comparing skin closure time between coaptive film and subcuticular monocryl sutures in children undergoing identical single session, bilateral limb multiple soft tissue releases. Eight children less than 18 years of age (mean 14.5) with cerebral palsy underwent identical, single session bilateral multiple soft tissue releases in the lower limb from August 2005 to March 2007. There were 50 incisions in all in which 25 incisions were closed with 4-0 intracuticular monocryl sutures and 25 were closed with coaptive film (Steri Strip S; 3M company). Time taken for closure using either technique was recorded. A blinded plastic surgeon used a visual analog scale to assess the cosmetic results at the end of a 3 month follow-up. The average length of incisions closed with coaptive film was almost identical to the corresponding incision on the contralateral limb that was closed with subcuticular monocryl suture (4.45 and 4.81 cm, P=0.66). The average time for skin closure using monocryl sutures was 167.04 seconds compared with the average time of 79.36 seconds when using coaptive film (P <0.0001). There was no significant difference in the cosmetic results or the number of wound complications using either technique. Coaptive film is an attractive and cost-effective option for skin closure after pediatric surgery. The time saved, comparable cosmetic results and lack of complications makes coaptive film an attractive option for skin closure in the pediatric age group.

  16. Randomized comparison of polyglycolic acid and polyglyconate sutures for abdominal fascial closure after laparotomy in patients with suspected impaired wound healing

    Osther, P J; Gjøde, P; Mortensen, Sophie Berit Bondegaard


    A randomized study of abdominal fascial closure using interrupted polyglyconate and polyglycolic acid sutures after laparotomy was carried out in 204 consecutive patients with suspected impaired wound healing. There were no statistically significant differences between the two sutures with regard...... to the development of fascial disruption and incisional hernia. Wound infection demanding surgical intervention was found in 7 per cent of patients with polyglyconate sutures and in 16 per cent of those with polyglycolic acid sutures (P = 0.04). Monofilament polyglyconate suture does not reduce the incidence...

  17. A randomised controlled trial of absorbable versus non-absorbable sutures for skin closure after open carpal tunnel release.

    Theopold, C


    We compared the aesthetic outcome of scars after closure of open carpal tunnel incisions with either absorbable 4-0 Vicryl Rapide or non-absorbable 4-0 Novafil. Patients were recruited in a randomized controlled trial and scars were scored at 6 weeks using a modified Patient and Observer Scar Assessment Scale. Scores demonstrated differences only for pain, vascularity and cross-hatching between both groups, though none of these were statistically significant. The dissolving and falling out of Vicryl Rapide was significantly more comfortable than removal of 4-0 Novafil sutures, assessed on a numerical analogue scale. There was no difference in infection rate between both study groups, supporting overall the use of Vicryl Rapide for the closure of palmar hand incisions, in light of the convenience and cost savings associated with absorbable sutures.

  18. Is spontaneous closure of a patent arterial duct common?

    Hoffman, Julien I E


    As closing a patent arterial duct is relatively simple, safe, and successful, most children with a patent arterial duct have it closed soon after diagnosis. The larger ducts are closed to prevent congestive heart failure, pulmonary vascular disease, or aneurysmal dilatation of the ductus, and smaller ducts are closed to prevent infective endocarditis. Consequently, there is no opportunity to determine whether spontaneous closure or diminution in size of the patent arterial duct is common. If the duct does become smaller, flow through it may be so low that no murmur is produced - the silent ductus. The frequency and best management of the silent patent arterial duct are unknown, and we do not know whether these tiny ducts are the last stage before spontaneous closure.

  19. Guitar-String Suture to Facilitate Closure of a Finger-like Flap for Reconstruction of the Nose.

    Querol-Cisneros, E; Redondo, P


    The basic principle of a lobed or finger-like transposition flap is that, after covering the defect with the transposed tissue, the donor site is closed primarily. With large defects, a second lobe may be added to the flap if primary closure of the area left by the first lobe is not possible. The flap can often be made to adapt to the defect, but this maneuver, in combination with primary closure of the adjacent tissue, can sometimes produce excessive tension and compromise the blood supply. We present a series of 4 patients with epithelial tumors of the lateral wall of the nose. The defects left by surgical excision were covered by finger-like transposition flaps. Subcutaneous sutures called guitar-string sutures were used to reduce the size of the defect and facilitate tension-free closure. We propose use of the guitar-string subcutaneous suture in those cases in which the defect is larger than the area that can be covered by the flap. This will make it easier to adapt the flap to the defect and will reduce the risk of excessive tension causing necrosis of the transposed tissue. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  20. Security and biomechanical strength of three end-pass configurations for the terminal end of intradermal closures performed with unidirectional barbed suture material in dogs.

    Regier, Penny J; Smeak, Daniel D; McGilvray, Kirk C


    OBJECTIVE To compare security of continuous intradermal suture lines closed by use of barbed suture with 3 end-pass configurations or without an end-pass configuration. SAMPLE 40 full-thickness, 4-cm-long, parasagittal wounds in canine cadavers. PROCEDURES Each continuous intradermal closure was terminated with 1 of 3 end-pass techniques or without an end-pass configuration (control group). A servohydraulic machine applied tensile load perpendicular to the long axis of the suture line. A load-displacement curve was generated for each sample; maximum load, displacement, stiffness, mode of construct failure, and load at first suture slippage at termination (ie, terminal end of the suture line) were recorded. RESULTS Values for maximum load, displacement, and stiffness did not differ significantly among the 3 end-pass techniques, and load at first suture slippage at termination was not significantly different among the 4 groups. A 1-pass technique slipped in 5 of 9 samples; 3 of these 5 slips caused failure of wound closure. A 2-pass technique slipped in 3 of 9 samples, none of which caused failure of wound closure. Another 2-pass technique slipped in 4 of 10 samples; 2 of these 4 slips caused failure of wound closure. The control group had slippage in 10 of 10 samples; 9 of 10 slips caused failure of wound closure CONCLUSIONS AND CLINICAL RELEVANCE An end-pass anchor was necessary to terminate a continuous intradermal suture line, and all 3 end-pass anchor techniques were suitable to prevent wound disruption. The 2-pass technique for which none of the suture slippages caused wound closure failure provided the most reliable configuration.

  1. Efficacy of Murva (Sansevieria roxburghiana Schult. and Schult.f.) as a suture material in closure of incisions in third molar surgeries: A prospective study.

    Lambade, Pravin; Thorat, Ashutosh


    Adequate closure of the surgical wound is one of the most important aspects of surgery; improper suturing techniques or improper suturing materials sometimes compromise the success of surgery. Many synthetic materials have replaced the natural materials, which were once used for suturing in the ancient era, and Murva is one of them. There are references of Murva (Sansevieria roxburghiana Schult. and Schult.f.) at various contexts of "Sushruta Samhita" where it has been used as a suture material. It is a xerophytic herbaceous plant occurring abundantly in the eastern coastal region of India. The aim of this study is to evaluate the efficacy of Murva fibers as a suturing material in closure of intraoral incision in third molar surgeries. Fifty incisions (Wards incision) placed for the surgical removal of mandibular third molar were sutured with Murva, and follow-up was carried out postoperatively on 1(st), 2(nd), 3(rd), and 7(th) day. Patients were evaluated for pain, swelling, bleeding, infection, wound dehiscence, local tissue irritation, and bacterial colonization. On various follow-ups, progressively significant and predictable healing was observed without any uneventful evidence. The use of Murva as a suture material proved to be effective in closure of intraoral incisions.

  2. Comperative analysis of unilateral cleft lip closure using absorbable and nonabsorbable sutures: a randomised clinical study

    Abhay Nilkanth Datarkar


    Full Text Available Aim: Patients with cleft lip usually undergo multiple procedures that require hospitalization resulting in emotional stress to their family members. Young patients often require sedation or general anesthesia (GA for suture removal on a sensitive area to prevent disruption of the repair. In this study, we compared absorbable and nonabsorbable sutures for primary cleft lip repair. Methods: Patients with cleft lip who presented to Smile Train Unit, Child Hospital and Research Institute, Nagpur, India, were randomly assigned to two groups and underwent surgical repair using either Vicryl Rapid suture (Group 1 or Prolene suture (Group 2. Patients were followed up at 1 month, 6 months, and 1 year. Photographs of the patients were obtained at these visits and rated using a validated 100-mm cosmesis visual analogue scale (VAS by three people (social worker, surgeon, and patient's mother. A VAS score of 15 mm or greater was considered as clinically important difference. Results: A total of 60 patients were enrolled in this study, and they were equally divided into two groups. There was no difference in age, race, sex, wound length, number of sutures, and layered repair rates between the groups. The average age of the patient was 3 months. There was no significant difference in the rates of infection which was 6% in this study, wound dehiscence, and hypertrophic scar formation. No significant difference was found in cosmetic outcome in both the mean VAS score of 90.3 in Group 1 and 91.7 in Group 2. Conclusion: Absorbable sutures are a viable alternative to nonabsorbable sutures in the repair of primary cleft lip repair. We prefer absorbable sutures because they do not require removal under GA or sedation.

  3. Side-to-side anastomosis using 4 interrupted sutures in small coronary arteries.

    Kawahito, Koji; Muraoka, Arata; Misawa, Yoshio


    Side-to-side anastomosis in sequential bypass grafting of coronary arteries 1.0 mm in diameter or smaller, requires delicate surgical techniques with a high degree of technical difficulty. However, using only 4 interrupted sutures, we have performed side-to-side anastomosis in sequential grafting without difficulty in a short operative duration. We applied this technique in 58 distal anastomosis procedures, achieving an early angiographic graft patency rate of 100%.

  4. A prospective study on the effect of modified alar cinch sutures and V-Y closure versus simple closing sutures on nasolabial changes after Le Fort I intrusion and advancement osteotomies.

    Muradin, M.S.; Seubring, K.; Stoelinga, P.J.W.; Bilt, A. van der; Koole, R.; Rosenberg, A.J.


    PURPOSE: The purpose of this study was to determine whether a modified alar cinch suture and V-Y closure (mACVY) have a beneficial effect on labial form after Le Fort I intrusion and advancement osteotomies and whether they result in excessive upward nasal tip rotation. Both are possible effects com

  5. A Prospective Study on the Effect of Modified Alar Cinch Sutures and V-Y Closure Versus Simple Closing Sutures on Nasolabial Changes After Le Fort I Intrusion and Advancement Osteotomies

    Muradin, Marvick S. M.; Seubring, Karlien; Stoelinga, Paul J. W.; Bilt, Andries Vd; Koole, Ronald; Rosenberg, Antoine J. W. P.


    Purpose: The purpose of this study was to determine whether a modified alar cinch suture and V-Y closure (mACVY) have a beneficial effect on labial form after Le Fort I intrusion and advancement osteotomies and whether they result in excessive upward nasal tip rotation. Both are possible effects com

  6. Subtotal cranial vault remodelling in anterior sagittal suture closure: impact of age on surgical outcome

    Engel, M.; Hoffmann, J.; Muhling, J.; Castrillon-Oberndorfer, G.; Seeberger, R.; Freudlsperger, C.


    Isolated fusion of the sagittal suture is usually treated before 1 year of age, but some patients present at a later age. The aim of this study was to evaluate the impact of children's age on the surgical outcome. The authors investigated 46 patients with isolated nonsyndromic sagittal craniosynosto

  7. Comparison between stainless steel staples and silk sutures for primary closure of skin in patients undergoing neck dissection: A comparative clinical study

    Abhishek Ghosh


    Full Text Available Introduction: Comparison between stainless steel staples and silk sutures for primary closure of skin in patients undergoing neck dissection, in context of rapid application, approximation of the skin edges, economy and aesthetics of the resultant scar. Aim: (1 To compare surgical stainless steel staples and silk sutures for primary wound closure, with respect to presence/absence of wound infection and dehiscence (2 To compare the resultant scar following the two different methods of the closure at 3 rd month postoperatively with the help of visual analog scale and analyze the result statistically Design: This study was designed to compare skin closure using staples and silk sutures in patients undergoing neck dissection, using both methods in one-half of the same wound; thus each wound affording its own control. Materials and Methods: The study was conducted on patients requiring collar line incision (high submandibular incision with or without a cephalad extension of midline lower lip split incision for surgical access, who presented to the Department of Oral and Maxillo-Facial Surgery. (1 Sample size: 10 (2 Study design: Prospective Comparative study (3 Study duration: One and half years (4 Surgical stainless steel staples: Proximate Plus MD 35 W, Ethicon Endo Surgery (5 Sutures: 3-0 Ethiprime NW 5003, Non-Absorbable Surgical Suture, Mersilk-90 cm, Ethicon, (16 mm 3/8 circle cutting needle. Conclusion: It wass concluded that there is no significant difference between the scars observed in the regions of incision which underwent primary closure by two different methods, that is surgical stainless steel staples and 3-0 Mersilk Sutures.

  8. A new method to catheterize a femoral artery in mice using a nylon suture as a 'guide wire'.

    Fukui, S; Nawshiro, H; Wada, K; Shima, K; Hallenbeck, J M


    Mice are commonly used in laboratory experiments. Their femoral arteries are so tiny that catheterization is quite difficult. We describe a new method to catheterize the femoral artery in mice. The key feature of this new method is the use of a nylon suture as a 'guide wire'. The full catheterization system consists of two sizes of polyethylene tubes (PE-10, PE-50) and a 4-0 nylon suture. We have been able to repeatedly catheterize mouse femoral arteries (n = 57) successfully and easily with this new system. We believe that this new method can facilitate vascular catheterization in small animals such as mice.

  9. The effect of alar cinch sutures and V-Y closure on soft tissue dynamics after Le Fort I intrusion osteotomies.

    Muradin, M.S.; Rosenberg, A.; Bilt, A. van der; Stoelinga, P.J.W.; Koole, R.


    Adverse effects on the soft tissues after Le Fort I osteotomies include: broadening of the alar base, loss of vermilion show of the upper lip and down sloping of the commissures. In theory, an alar cinch suture combined with a muco-musculo-periosteal V-Y closure (ACVY) should improve not only the na

  10. The effect of alar cinch sutures and V-Y closure on soft tissue dynamics after Le Fort I intrusion osteotomies.

    Muradin, M.S.; Rosenberg, A.; Bilt, A. van der; Stoelinga, P.J.W.; Koole, R.


    Adverse effects on the soft tissues after Le Fort I osteotomies include: broadening of the alar base, loss of vermilion show of the upper lip and down sloping of the commissures. In theory, an alar cinch suture combined with a muco-musculo-periosteal V-Y closure (ACVY) should improve not only the na

  11. From puncture to closure of the common femoral artery in endovascular aortic repair

    Lönn, Lars; Larzon, Thomas; Van Den Berg, Jos C


    or epidural anesthesia. The evolving stent-technology with smaller sheath sizes has broadened the scenario for alternative approaches for access and closure of the common femoral arteries. The following review presents an introduction on technical aspects of puncture of the femoral artery and closure...

  12. A comparison of single-suture and double-suture incision closures in seaward-migrating juvenile Chinook salmon implanted with acoustic transmitters: implications for research in river basins containing hydropower structures

    Brown, Richard S.; Deters, Katherine A.; Cook, Katrina V.; Eppard, M. B.


    Reductions in the size of acoustic transmitters implanted in migrating juvenile salmonids have resulted in the ability to make shorter incisions that may warrant using only a single suture for closure. However, it is not known if one suture will sufficiently hold the incision closed, particularly when outward pressure is placed on the surgical site such as when migrating fish experience pressure changes associated with passage at hydroelectric dams. The objective of this research was to evaluate the effectiveness of single-suture incision closures on juvenile Chinook salmon (Oncorhynchus tshawytscha). Juvenile Chinook salmon were surgically implanted with a 2012 Juvenile Salmon Acoustic Telemetry System (JSATS) transmitter (0.30 g) and a passive integrated transponder tag (0.10 g) and incisions were closed with either one suture or two sutures. Mortality and tag retention were monitored and fish were examined after 7 and 14 days to evaluate tissue responses. In a separate experiment, surgically implanted fish were exposed to simulated turbine passage and then examined for expulsion of transmitters, expulsion of viscera through the incision, and mortal injury. With incisions closed using a single suture, there was no mortality or tag loss and similar or reduced tissue reaction compared to incisions closed with two sutures. Further, surgery time was significantly reduced when one suture was used, which leads to less handling and reduced stress. No tags were expelled during pressure scenarios and expulsion of viscera only occurred in two non-mortally injured fish (5%) with single sutures that were also exposed to very high pressure changes. No viscera expulsion was present in fish exposed to pressure scenarios likely representative of hydroturbine passage at many Columbia River dams (e.g. <2.7 ratio of pressure change; an acclimation pressure of 146.2 absolute kpa and a lowest exposure pressure of ~ 53.3 absolute kpa). Based on these results, we recommend the use of a

  13. Transcatheter Closure of Congenital Coronary Artery Fistulas with a Giant Coronary Artery Aneurysm in Children: Experiences from a Single Center

    Li, Yi-Fan; Zhang, Zhi-Wei; Wang, Shu-Shui; Xie, Zhao-Feng; Zhang, Xu; Li, Yu-Fen


    Background: Transcatheter closure of congenital coronary artery fistulas (CCAFs) is an alternative therapy to surgery; however, data regarding transcatheter closure for CCAF with a giant coronary artery aneurysm (CAA) in pediatric patients are still limited due to the rarity of the disease. We aimed to evaluate the efficacy and safety of transcatheter closure for CCAF with a giant CAA in a pediatric population at a single center. Methods: Medical records of pediatric patients (aneurysm dilation after the second intervention. One patient experienced thrombus formation within the CAA after the procedure. Among those with closure at the entry point of the CAA, a mild-to-moderate residual shunt was detected in three patients. Conclusions: Transcatheter closure appears to be a safe and effective alternative therapy for CCAF with a giant CAA in the pediatric population. Closure at the entry point of the CAA, and closure at both the entry and exit points when feasible, may reduce the risk of postinterventional complications. PMID:28776543

  14. Geochemical characteristics of the Permian basins and their provenances across the Solonker Suture Zone: Assessment of net crustal growth during the closure of the Palaeo-Asian Ocean

    Eizenhöfer, Paul R.; Zhao, Guochun; Zhang, Jian; Han, Yigui; Hou, Wenzhu; Liu, Dongxing; Wang, Bo


    The Solonker Suture Zone is commonly recognised as the location of the Late Permian to Early Triassic closure of the Palaeo-Asian Ocean in the southeastern segment of the Central Asian Orogenic Belt. However, the absence of typical suture-related features, as a consequence of uncommon collisional geometries, gave it a cryptic nature. Thus, the tectonic setting, which led to suturing, still remains enigmatic. A geochemical characterisation of Permian sedimentary and volcanic rocks across the suture was carried out. Supplemented with Hf and Nd isotopic analyses, this approach enables not only a better definition of such regional suture, but also estimates on the long-controversial issue of net crustal growth in accretionary tectonic environments. The results indicate short sedimentary transport distances between the arc basins and their provenances, of which the studied volcanic rocks were a major contributor. Similar enrichment and depletion patterns with respect to N-MORB and average continental crust further corroborate a close source-sediment relationship. Immobile element provenance analyses indicate that the active continental northern margin of the North China Craton was a major source for arc basins to the south of the Solonker Suture Zone. To its north, arc basins are interpreted to be sourced by a more complex mixture of provenances, e.g., the Baolidao volcanic arc suite and the heterogenous Precambrian basement of southern Mongolia. An overall collisional tectonic setting across the suture is recognised. The geochemical signature of sedimentary rocks to the south of the suture points at an active continental arc setting, whereas the bimodal geochemical distribution of the samples to the north shows a contemporaneous active oceanic island arc as well as a passive margin environment. These features favour a double-sided subduction of the Palaeo-Asian Ocean beneath the North China Craton and the Mongolian Arcs throughout the Palaeozoic, including back

  15. Preliminary results from 28 cases of pilonidal cyst treated by excision and primary closure of the wound, reinforced with support suturing

    Nelson de Souza Liboni


    Full Text Available Objectives: To describe the results of the surgical technique of pilonidalcyst excision with margins and primary closure of the operative woundwith support suturing. Methods: Twenty-eight patients with pilonidaldisease admitted to a private clinic between 1999 and 2006 underwentsurgical treatment by means of an elliptical longitudinal medial incisionproportional to the palpable tumor size and excision of cyst with 2-cmmargins above, below and laterally, and primary closure of the wound.To reduce the tension in the operative wound, suturing was performed,with a single support stitch of horizontal U-shape. The patients werefollowed up for periods ranging from 6 months to 3 years. Results:Two patients developed abscesses at the surgical site (7.1%, andone required complete opening of the operative wound for drainage.Both underwent excision and primary closure again. The pathologicalexamination demonstrated that these were not cases of relapse, butof recurrent abscess. No cases of non-infected collection (seroma andhematoma, spontaneous dehiscence of the operative wound or diseaserecurrence were recorded. Conclusions: The technique of pilonidal cystexcision with margins and primary closure of the wound reinforcedwith support suturing seems to be attractive, since it is characterizedby low complexity and low infection rate. Studies with larger samplesare needed to validate this surgical technique.

  16. The relationship between suture number and the healing process of end-to-end arterial anastomosis

    Winston B Yoshida


    Full Text Available In spite of the grate experience accumulated in vascular repairing, the ideal number of sutures for vascular anastomosis remains controversial. It is generally thought that the more stitches applied in a vascular anastomosis, the lesser resistant the anastomosis will be. The purpose of this study was to test this hypothesis in 20 rabbits, in which both carotid arteries were cross sectioned and repaired by end-to-end anastomosis with 8 interrupted sutures in one side (G1 and 16 in the other side (G2. After 3 and 15 days, the animals were randomly allocated for tensile strength, hydroxyproline determination (7 animals and for histologic analysis of the anastomosis (3 animals. Conventional staining procedures (hematoxylin-eosin and Masson methods and the picrosirius red polarization (PSP technique for collagen type determination were used. From 3 to 15 days, the tensile strength increased in both groups, from 265.0±-44.4g to 391.2±-49.0g in G1 and from 310.0±-71.5g to 348.7±-84.0g in G2 (p<0.005, with no statistical difference between the groups in each period of study. The hydroxyproline content, expressed as hydroxyproline/protein ratio, varied from 0.04±-0.01 to 0.05±-0.02 in G1 and from 0.05±-0.01 to 0.05±-0.02 in G2, with no significant difference between periods and groups. The histology showed similar inflammatory and reparative aspects in both groups. In both groups and periods the PSP technique demonstrated predominantly type I collagen in relation to type III collagen in the anastomosis. We concluded that even doubling the number of stitches, the healing process and strength did not change in the arterial anastomosis.

  17. Retrospective analysis of risk factors affecting pacreatic fistula formation after the closure of the pancreatic stump with sutures in distal pancreatectomy.

    Unek, Tarkan; Egeli, Tufan; Ozbilgin, Mucahit; Arslan, Naciye Cigdem; Astarcioglu, Huseyin; Karademir, Sedat; Atasoy, Gulsen; Astarcioglu, Ibrahim


    Development of pancreatic fistula after distal pancreatectomy is still a major problem. Various methods have been defined to prevent the development of the fistula. In this study, the results of suture closure of pancreatic duct and closure of pancreatic stump with “U” sutures passing through each other and the risk factors affecting the development of fistula are studied. Fifty-one patients with prospectively collected data were included in the study. In all patients, pancreatic stump was closed with the same surgical technique. Risk factors that may affect fistula formation were studied between groups with and without fistula. Pancreatic fistula definition was made according to the International Study Group on Pancreatic Fistulas classification. Eight (15.7%) of the 51 patients had fistula. Clinically significant fistula ratio was 9.8% (according to ISGPF B and C). Additional organ resections were performed in 18 patients (35.3%). In multivariate analysis, the soft texture of pancreatic parenchyma (OR: 12.420, p = 0.048) and over 150 mL of blood loss (OR: 1.003, p = 0.043) were found as risk factors for the development of fistula. Closure of pancreatic stump after distal pancreatectomy with “U” shaped sutures passing through each other is a method that can be performed safely.

  18. Live 3D image overlay for arterial duct closure with Amplatzer Duct Occluder II additional size.

    Goreczny, Sebstian; Morgan, Gareth J; Dryzek, Pawel


    Despite several reports describing echocardiography for the guidance of ductal closure, two-dimensional angiography remains the mainstay imaging tool; three-dimensional rotational angiography has the potential to overcome some of the drawbacks of standard angiography, and reconstructed image overlay provides reliable guidance for device placement. We describe arterial duct closure solely from venous approach guided by live three-dimensional image overlay.


    Josephine Pudumai Selvi


    Full Text Available BACKGROUND Surgical site infection (SSI is an immense burden on healthcare resources even in the modern era of immaculate sterilization approaches and highly effective antibiotics. An estimated 234 million various surgical procedures, involving skin incisions requiring various types of wound closure techniques, are performed in the world, with the majority resulting in a wound healing by primary intention. Triclosan (5-chloro-2-(2, 4-dichlorophenoxy phenol is a broad-spectrum bactericidal agent that has been used for more than 40 years in various products, such as toothpaste and soaps. Higher concentrations of Triclosan work as a bactericide by attacking different structures in the bacterial cytoplasm and cell membrane. Use of Triclosan-coated sutures should theoretically result in the reduction of SSI. The aim of the study is to assess the abdominal closure with antibacterial coated suture materials and its relation to the incidence of post-operative superficial surgical site infection rates. MATERIALS AND METHODS The data will be collected from hospital records of surgery performed, post-operative daily progress notes and outpatient folders and telephonic conversations with patients after discharge. All patients undergoing laparotomy procedure for any cause. 100 patients divided as 50 in each group. RESULTS The positive outcome of infection (21.5% in patients using ordinary sutures was significantly differed with the positive outcome of infection (11.4% of Triclosan coated sutures. CONCLUSION In conclusion since there was a definite advantage inferred to the patients by using Triclosan coated polyglactin 910, it is the opinion of the researcher that Triclosan coated sutures has a role to play in reducing SSI in clean wounds and its use should be confined to areas where its application has proven benefits. However more studies should be done to clearly define its role and indications in surgery.

  20. First clinical experience with Celt ACD(®) : a femoral arterial puncture closure device.

    Jan, Aftab


    This prospective nonrandomized study compared the safety and efficacy of a novel arterial closure device (ACD) in common femoral artery procedures to that of the FDA submitted historical manual pressure control group, who underwent either a diagnostic angiogram (DA) or a percutaneous coronary intervention (PCI) procedure.

  1. The archaeology of uncommon interventions: Articulating the rationale for transcatheter closure of congenital coronary artery fistulas in asymptomatic children.

    McElhinney, Doff B


    Transcatheter closure of coronary artery fistulas can be executed successfully in infants and children with few serious procedural complications. Indications for and long-term outcomes of closure of coronary artery fistulas remain poorly defined. Registries may offer the best opportunity for advancing our knowledge about uncommon interventions such as coil or device closure of coronary artery fistulas, but to do so, they must include sufficient data and evaluate factors potentially associated with salutary or adverse outcome.

  2. The timing of final closure along the Changchun-Yanji suture zone: Constraints from detrital zircon U-Pb dating of the Triassic Dajianggang Formation, NE China

    Wang, Bin; Zhou, Jian-Bo; Wilde, Simon A.; Zhang, Xing-Zhou; Ren, Shou-Mai


    The Dajianggang Formation is located in the Changchun-Yanji suture zone of central Jilin Province and unconformably overlies the Changchun-Yanji Accretionary Complex (CYAC), which is a mélange resulting from subduction of the Jiamusi-Khanka Block (JKB) beneath the North China Craton (NCC). LA-MC-ICP-MS U-Pb dating of detrital zircon from four samples of the formation yields ages of 2516 to 216 Ma. Zircons with U-Pb ages at 2516-2501 Ma and 1897-1832 Ma indicate a provenance from Precambrian basement rocks of the NCC. The 525-482 Ma ages indicate a provenance from metamorphic rocks of Late Pan-African age in the JKB that have a tectonic affinity to the Central Asian Orogenic Belt (CAOB). Zircon grains with ages of 383-314 Ma and 275-250 Ma were likely derived from the underlying CYAC. The youngest population has a peak age of ca. 225 Ma, which together with Late Triassic fossils, suggests that deposition of the Dajianggang Formation was Late Triassic or younger. This result supports the view that the final collision of the JKB and NCC along the Changchun-Yanji suture took place before the Late Triassic. Furthermore, this closure time is at least 10-20 Ma later than closure along the Solonker-Xar Moron-Changchun suture in the Late Permian. We thus establish that the Changchun-Yanji suture is not related to the collision between the Siberia Craton (SC) and the NCC but was instead related to the Paleo-Pacific plate subduction. Consequently, the Changchun-Yanji suture is not the eastward extension of the Solonker-Xar Moron-Changchun suture as previously considered, but the southern margin of the Jilin-Heilongjiang high-pressure metamorphic belt (Ji-Hei HP belt), and resulted from westward subduction of the Paleo-Pacific Ocean. Thus, the Late Triassic marked the switch in subduction from the Paleo-Asian Ocean to the Paleo-Pacific Ocean in NE China.

  3. Hand-suture versus stapling for closure of loop ileostomy: HASTA-Trial: a study rationale and design for a randomized controlled trial

    Krüger Matthias


    Full Text Available Abstract Background Colorectal cancer is the second most common tumor in developed countries, with a lifetime prevalence of 5%. About one third of these tumors are located in the rectum. Surgery in terms of low anterior resection with mesorectal excision is the central element in the treatment of rectal cancer being the only option for definite cure. Creating a protective diverting stoma prevents complications like anastomotic failure and meanwhile is the standard procedure. Bowel obstruction is one of the main and the clinically and economically most relevant complication following closure of loop ileostomy. The best surgical technique for closure of loop ileostomy has not been defined yet. Methods/Design A study protocol was developed on the basis of the only randomized controlled mono-center trial to solve clinical equipoise concerning the optimal surgical technique for closure of loop ileostomy after low anterior resection due to rectal cancer. The HASTA trial is a multi-center pragmatic randomized controlled surgical trial with two parallel groups to compare hand-suture versus stapling for closure of loop ileostomy. It will include 334 randomized patients undergoing closure of loop ileostomy after low anterior resection with protective ileostomy due to rectal cancer in approximately 20 centers consisting of German hospitals of all level of health care. The primary endpoint is the rate of bowel obstruction within 30 days after ileostomy closure. In addition, a set of surgical and general variables including quality of life will be analyzed with a follow-up of 12 months. An investigators meeting with a practical session will help to minimize performance bias and enforce protocol adherence. Centers are monitored centrally as well as on-site before and during recruitment phase to assure inclusion, treatment and follow up according to the protocol. Discussion Aim of the HASTA trial is to evaluate the efficacy of hand-suture versus stapling for

  4. Endoscopy-based early enterostomy closure for superior mesenteric arterial occlusion

    Takatsugu; Oida; Hisao; Kano; Kenji; Mimatsu; Atsushi; Kawasaki; Youichi; Kuboi; Nobutada; Fukino; Sadao; Amano


    AIM:To evaluate the efficacy of endoscopic examination of blood flow and edema in the remnant bowel.METHODS:We retrospectively studied 15 patients who underwent massive bowel resection with enterostomy for superior mesenteric arterial occlusion (SMAO); the patients were divided into a delayed closure group (D group) and an early closure group (E group).RESULTS:The mean duration from initial operation to enterostomy closure was significantly shorter in the E group (18.3 ± 2.1 d) than in the D group (34.3 ± 5...

  5. Dead space closure with quilting suture versus conventional closure with drainage for the prevention of seroma after mastectomy for breast cancer (QUISERMAS): protocol for a multicentre randomised controlled trial.

    Ouldamer, Lobna; Bonastre, Julia; Brunet-Houdard, Solène; Body, Gilles; Giraudeau, Bruno; Caille, Agnès


    Postoperative wound seroma is common after mastectomy. This complication is associated with significant impact on patient outcomes and healthcare costs. The optimal closure approach for seroma prevention remains unknown but some evidence suggests that quilting suture of the dead space could lower the incidence of seroma. The aim of this trial is to compare seroma formation using quilting suture versus conventional closure with drainage in patients undergoing mastectomy. This is a multicentre, superiority, randomised controlled trial in women undergoing mastectomy with or without axillary involvement. Exclusion criteria include indication of bilateral mastectomy or immediate reconstruction and any physical or psychiatric condition that could impair patient's ability to cooperate with postoperative data collection or that do not allow an informed consent. 320 participants will be randomised in a 1:1 ratio to receive either quilting suture or conventional wound closure with drain. The primary outcome is seroma requiring either aspiration or surgical intervention within 21 days following mastectomy. Secondary outcomes include seroma regardless of whether or not it requires an intervention, surgical site infection, pain score, cosmetic result, patient's quality of life, costs and cost-effectiveness. The primary analysis will be an intention-to treat analysis performed with a χ(2) test (or Fisher's exact test). Written informed consent will be obtained from all participants. This study was approved by Tours Research ethics committee (CPP TOURS-Region Centre-Ouest 1, 2014-R20, 16 December 2014). Study findings will be published in peer-reviewed journals and presented at relevant national and international breast cancer conferences. NCT02263651. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  6. Percutaneous transfemoral placement of a new flexible stent-graft into the thoracic aorta followed by a percutaneous suture-mediated closure of the access site - initial experience; Perkutane transfemorale implantation einer neuen, flexiblen thorakalen Aortenendoprothese unter Verwendung eines perkutanen Nahtsystems zum Gefaessverschluss - erste Erfahrungen

    Manke, C.; Lenhart, M.; Strotzer, M.; Feuerbach, S.; Link, J. [Klinikum der Univ. Regensburg (Germany). Inst. fuer Roentgendiagnostik; Kobuch, R.; Merk, J.; Birnbaum, F. [Klinikum der Univ. Regensburg (Germany). Klinik und Poliklinik fuer Herz-, Thorax- und herznahe Gefaesschirurgie


    To evaluate the transfemoral placement of a new, flexible stent-graft into the thoracic aorta and the suture-mediated closure of the femoral access. Patients and Methods: five patients were treated endovascularly with a stent-graft for an aneurysm (n = 3) or acute dissection (n = 2) of the thoracic aorta via a femoral 24 F sheath. The femoral access site was closed with two suture-mediated closure devices after placement of the stent-graft. Results: the aneurysm or the false lumen was excluded from perfusion by the placement of the stent-graft in all patients. Hemostasis at the femoral access site was successful in all patients with the percutaneous suture device. A minor stenosis of the femoral artery was found angiographically in four patients after suture-mediated closure. Besides a reversible renal failure due to the medically induced hypotension for the treatment of an acutely ruptured aneurysm, no complications resulted from the stent-graft placement or the percutaneous suture. Conclusion: the percutaneous transfemoral placement of stent-grafts in the thoracic aorta using a suture-mediated closure of the access site is technically feasible. Long-term results of the technique have to be awaited. (orig.) [German] Evaluation der transfemoralen Implantation einer neuen, flexiblen thorakalen Aortenprothese unter Verwendung eines perkutanen Nahtsystems zum Verschluss des femoralen Zugangs. Patienten und Methoden: fuenf Patienten wurden wegen Aneurysma (n = 3) oder akuter Dissektion (n = 2) der thorakalen Aorta endovaskulaer ueber eine perkutan eingebrachte 24F-Schleuse mit einem Stentgraft versogt. Der femorale Zugang wurde nach Plazierung der Endoprothese mit zwei perkutanen Nahtgeraeten verschlossen. Ergebnisse: bei allen Patienten fuehrte die Platzierung der Prothese zur Ausschaltung des Aneurysmas oder des falschen Lumens von der Perfusion. Mit der perkutanen Gefae paragraph naht konnte in allen Faellen ein Verschluss des femoralen Zugangs erreicht werden. In

  7. Anastomose arterial com fio de polidioxanona e fio de polipropileno. Estudo comparativo em cães Arterial anastomose with polydioxanone and polypropilene suture. Comparative study in dogs

    Eloísa de Brida Tormena


    Full Text Available Este estudo teve por objetivo comparar os efeitos do fio absorvível de polidioxanona com o fio inabsorvível de polipropileno, em anastomoses término-terminais, em artérias femorais de cães. Foram utilizados 20 cães, separados em dois grupos, para observação no 7º e no 30º dia de pós-operatório. Cada cão teve suas artérias femorais seccionadas e aproximadas em um lado com pontos separados de fio de polidioxanona 6-0, e no lado contralateral com o fio de polipropileno 6-0. A escolha do fio foi feita por sorteio, totalizando 40 anastomoses. Para análise estatística dos resultados aplicaram-se os testes de Fisher, Mac Nemar, Wilcoxon, Mann-Witney e o teste T de Student (a ≤ 0,05. Nas avaliações clínicas não foram observadas diferenças significantes entre os fios utilizados. Os resultados obtidos nas avaliações arteriográfica e macroscópica dos segmentos arteriais foram semelhantes, assim como na análise histológica morfológica. Na análise histológica morfométrica o fio de polipropileno apresentou número de células gigantes de corpo estranho significativamente maior que o fio de polidioxanona aos 7 e 30 dias de pós-operatório. Os resultados nos permitem concluir que, apesar da maior reação de corpo estranho observada com o fio de polipropileno, o fio de polidioxanona apresentou resultados semelhantes ao fio de polipropileno, em anastomoses arteriais em cães.The objetive of this study was to compare the effects of the absorbable polidioxanone suture to the nonabsorbable polypropylene suture, in end-to-end anastomoses, using dog’s femoral arteries. Twenty dogs were separated in two groups for observation on the 7th and 30th post-operatory day. Each dog had its femoral arteries seccioned and then aproximated one side with separate stitches of polidioxanone 6-0 suture, and the other side with polypropylene 6-0 suture. For the statistical studies Fisher, Mac nemar, Wilsoxon, Mann-Witney and T of Student tests (a

  8. Use of StarClose for brachial artery closure after percutaneous endovascular interventions.

    Puggioni, Alessandra; Boesmans, Evelyne; Deloose, Koen; Peeters, Patrick; Bosiers, Marc


    The objective of this study was to evaluate a percutaneous extravascular closure device (StarClose, Abbott Vascular, Redwood City, CA) after brachial endovascular approach. From 2004 to 2006, 29 patients received StarClose for brachial closure. Primary endpoints were successful deployment and absence of procedure-related morbidity, secondary endpoints were brachial artery patency on duplex and absence of late (> 30 days) complications. The device was successfully deployed in all patients. In two patients (6.8%) local complications occurred: one patient developed a large hematoma successfully treated with prolonged compression and a second patient presented with brachial artery occlusion requiring operative intervention. After a mean follow-up of 7.5+/-7.2 months, all patients had a palpable brachial/radial pulse; none had signs of infection, distal embolization or neurological deficits. On ultrasound b-mode imaging, the clip was visible as a 4 mm echolucent area at the outer anterior wall of the artery. Based on the peak systolic velocity ratios between the site of StarClose and proximal brachial artery (mean 1.08+/-0.2), none of the studied patients had a significant stenosis at the site of closure. StarClose is safe and effective in providing hemostasis following interventional procedures through the brachial artery; further advantages include patients comfort and early discharge.

  9. Transcatheter closure of a giant coronary artery fistula with patent duct occluder

    ZHOU Tao; SHEN Xiang-qian; FANG Zhen-fei; ZHOU Sheng-hua; QI Shu-shan; L(U) Xiao-ling


    @@ Coronary artery fistula (CAF), an uncommon form of congenital heart disease, is characterized by abnormal communication between a coronary artery and a cardiac chamber or vessel.1 This disease is often found incidentally in asymptomatic individuals,and leads to cardiac failure, myocardial ischemia and angina, infective endocarditis, and heart rupture in later life. Both surgical repair and transcatheter closure were effective and safe in the treatment of CAF,2 but percutaneous management of CAF can obviate median sternotomy and cardiopulmonary bypass, and there may be less morbidity with transcatheter embolization techniques,3,4 including the use of occluders or microcoils. We report a successful percutaneous closure of a giant CAF from the left coronary artery to the right ventricle using patent duct occluder.

  10. Closure

    Stigter, C.J.


    At least an easier task than I have carried out the previous hour when we discussed the preliminary conclusions and recommendations has, as a compensation I guess, been given to me as well. To say a few words as a closure of this symposium. The beginning of such a series of closing statements is mos

  11. Comparison between absorbable and nonabsorbable sutures in arterial anastomoses in growing dogs.

    Gersak, B


    Five dogs, 10 weeks old, underwent operation using ketamin-HCl anesthesia and end-to-end anastomoses of the femoral and brachial arteries were made using polyfilament nonabsorbable material (Ethibond), monofilament nonabsorbable material (Prolene), polyfilament absorbable material (Vicryl) and monofilament absorbable material (PDS). The arterial diameter using a micrometer and blood flow using an electromagnetic flow meter were determined. After six months another operation was performed and diameter and blood flow were measured again. No statistically significant differences were found between the different materials used with respect to growth related increases either in arterial diameter or blood flow.

  12. Comparative study of suture and cyanoacrylates in skin closure of rats Estudo comparativo entre sutura e cianoacrilatos no fechamento de pele de ratos

    Sandro Cilindro de Souza


    Full Text Available PURPOSE: To compare the biocompatibility of ethyl-cyanoacrylate (ECA and octylcyanoacrylate (OCA wound closures to sutures in rat skin. METHODS: Twenty-four male Wistar rats were subjected to three incisions which were closed using ECA, OCA or sutures . Rats were divided into four groups which received biopsies on the 3rd, 7th, 14th or 21st post-operative days. Necrosis, inflammation, dermatitis, infection, dehiscence, cicatricial enlargement and costs were examined; the histopathology evaluated was epithelialization, deep openings, foreign substance reaction, residues of synthesis material, fibrosis, inflammation, dehiscence and necrosis. RESULTS: The tissue adhesives presented the largest dehiscence levels, and ECA the lowest cost while the other measures were similar. Regarding histopathology, deep openings were more common with OCA and granulomas were most frequently obtained with ECA. The two tissue adhesives produces less inflammation than the inicial suture from post-operative day 7, while ECA and OCA cause similar inflammatory reactions. ECA did not differ significantly from OCA and sutures on other measures. CONCLUSION: ECA was well tolerated in this study and did not induce necrosis, allergic reactions or infections, presenting several advantages in relation to OCA and sutures, including lower costs and fewer complications.OBJETIVO: Investigar a biocompatibilidade do etil-cianoacrilato (ECA em fechamento de pele em ratos comparativamente ao octil-cianoacrilato (OCA e à sutura. MÉTODOS: Rattus norvegicus albinus (n=24 foram submetidos a três incisões, cada uma fechada por um dos métodos de síntese estudados. Quatro grupos (n=6 foram feitos, conforme o dia pós-operatório (DPO em que foram eutanasiados: 3DPO, 7DPO,14DPO e 21DPO. Necrose, edema, eritema, dermatite, infecção, deiscência, alargamento cicatricial e custos foram os itens examinados; histopatologicamente avaliou-se epitelização, abertura profunda, reação de corpo

  13. Endovascular repair of inadvertent arterial injury induced by central venous catheterization using a vascular closure device: A case report

    Kim, So Hee; Jang, Woo Jin; Oh, Ju Heyon; Song, Yun Gyu [Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Korea, Republic of)


    Central venous catheterization can cause various complications. Inadvertent subclavian artery catheterization was performed during insertion of a central venous catheter in a 73-year-old man suffering from panperitonitis due to small-bowel perforation. Endovascular treatment was conducted to treat the injured subclavian artery with a FemoSeal vascular closure device.

  14. Peratrial Device Closure of a Congenital Coronary Artery Fistula through a Right Parasternal Approach: Innovative Use of Available Technology.

    Jia, Yanting; Hongxin, Li; Wenbin, Guo; Zhang, Haizhou; Zou, Chengwei


    Current treatments for congenital coronary artery fistulas (CAFs) include surgical obliteration and transcatheter occlusion. However, surgical techniques involve significant trauma. Transcatheter occlusion is performed under fluoroscopy and angiography, in which radiation injury is inevitable. We present a patient, with a CAF from the left coronary artery to the right atrium, who underwent peratrial device closure of the CAF with a right parasternal approach under transesophageal echocardiography guidance. Complete occlusion was achieved by a symmetric ventricular septal occluder. We suggest that peratrial device closure of a congenital coronary artery fistula through a right parasternal approach may be a safe and effective option.

  15. Ease of Using a Dedicated Percutaneous Closure Device after Inadvertent Cannulation of the Subclavian Artery: Case Report

    Arnaud Devriendt


    Full Text Available Inadvertent puncture of the subclavian artery is a relatively frequent and potentially disastrous complication of attempted central venous access. Due to its noncompressible location, accidental subclavian arterial cannulation may result in hemorrhage as the sheath is removed. We report a new case of successful percutaneous closure of the subclavian artery which had been inadvertently cannulated, using a closure device based on a collagen plug (Angio-Seal, St. Jude Medical. This was performed in a patient who had received maximal antiplatelet and anticoagulation therapies because of prior coronary stenting in the context of cardiogenic shock. There was no prior angiographic assessment, as arterial puncture was presumed to have been distal to the right common artery and vertebral arteries. No complications were observed in this high-risk patient, suggesting that this technique could be used once the procedure has been evaluated prospectively.

  16. Triclosan-coated sutures and sternal wound infections: a prospective randomized clinical trial.

    Steingrimsson, S; Thimour-Bergström, L; Roman-Emanuel, C; Scherstén, H; Friberg, Ö; Gudbjartsson, T; Jeppsson, A


    Surgical site infection is a common complication following cardiac surgery. Triclosan-coated sutures have been shown to reduce the rate of infections in various surgical wounds, including wounds after vein harvesting in coronary artery bypass grafting patients. Our purpose was to compare the rate of infections in sternotomy wounds closed with triclosan-coated or conventional sutures. A total of 357 patients that underwent coronary artery bypass grafting were included in a prospective randomized double-blind single-center study. The patients were randomized to closure of the sternal wound with either triclosan-coated sutures (Vicryl Plus and Monocryl Plus, Ethicon, Inc., Somerville, NJ, USA) (n = 179) or identical sutures without triclosan (n = 178). Patients were followed up after 30 days (clinical visit) and 60 days (telephone interview). The primary endpoint was the prevalence of sternal wound infection according to the Centers for Disease Control and Prevention (CDC) criteria. The demographics in both groups were comparable, including age, gender, body mass index, and rate of diabetes and smoking. Sternal wound infection was diagnosed in 43 patients; 23 (12.8%) sutured with triclosan-coated sutures compared to 20 (11.2%) sutured without triclosan (p = 0.640). Most infections were superficial (n = 36, 10.1%), while 7 (2.0%) were deep sternal wound infections. There were 16 positive cultures in the triclosan group and 17 in the non-coated suture group (p = 0.842). The most commonly identified main pathogens were Staphylococcus aureus (45.4%) and coagulase-negative staphylococci (36.4%). Skin closure with triclosan-coated sutures did not reduce the rate of sternal wound infection after coronary artery bypass grafting. ( NCT01212315).

  17. Torsion of monofilament and polyfilament sutures under tension decreases suture strength and increases risk of suture fracture.

    Hennessey, D B


    A continuous running suture is the preferential method for abdominal closure. In this technique the suture is secured with an initial knot and successive tissue bites are taken. At each tissue bite, the needle is rotated through the tissue; in doing so, the suture can twist around the knot which acts as an anchor.

  18. The safety and efficacy of hemostasis with Clo-Sur P.A.D. after transcatheter arterial chemoembolization

    Jung, Seung Chai; Jae, Hwan Jun; Kim, Sang Youn; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    We wanted to evaluate the safety and efficacy of a new hemostatic device, Clo-Sur P.A.D., at an arterial access site after performing femoral arterial catheterization to achieve transcatheter arterial chemoembolization (TACE). From August 2002 to March 2005, 113 patients who underwent TACE and agreed on using the Clo-Sur P.A.D. were enrolled in this study. We evaluated the mean time interval from compression to the first movement and also to the first walk. We also evaluated such complications as rebleeding, pseudoaneurysm, vascular occlusion, hematoma, infection and pain. For 92 patients who had previous experiences with manual compression, we evaluated their preference of hemostatic method by asking them. Successful hemostasis was achieved with the Clo-Sur P.A.D. in 105 subjects (92%). The mean time interval from compression to the first movement was 201 minutes, and that to the first walk was 267 minutes. There was no statistical difference between the complicated and the uncomplicated groups for the mean time, prothrombin time, Child-Pugh class and platelet count ({rho} > 0.05). Rebleeding occurred in 3 patients (2.7%) and mild hematoma around puncture site was noted in 5 patients (5.4%). Eighty-seven patients (95%) preferred Clo-Sur P.A.D. to the manual compression method. The Clo-Sur P.A.D. is a safe and effective hemostatic device and it provides early ambulation after TACE.

  19. 水胶体拉合免缝法在老年患者腹部二期愈合切口中的应用%Hydrocolloid: application to phase Ⅱ abdominal wound closure without suture for elderly patients

    杨静; 黄金


    目的探讨水胶体拉合免缝法在老年患者二期愈合切口中的应用效果.方法 将40例老年腹部手术后二期愈合切口患者随机分为观察组与对照组各20例,于二期愈合切口换药处理至红色期创面后,分别采用水胶体拉合免缝法和传统缝合处理,比较两组切口愈合时间、疼痛程度、换药费用.结果 两组愈合时间比较,差异无统计学意义(P>0.05),但观察组在切口处理过程中的疼痛程度及医疗费用显著低于对照组(均P<0.01).结论 水胶体拉合免缝法应用于老年患者腹部二期愈合切口效果优于传统缝合法,能减轻患者的疼痛,降低医疗费用,且切口更美观.%Objective To reveal effect of hydrocolloid on phase Ⅱ abdominal wound closure without suture for elderly patients.Methods Forty elderly patients with phase Ⅱ abdominal wound were randomly divided into two groups, with 20 cases in each group. When the wound surface became red after dressing change, they were treated either by hydrocolloid for closure without suture (the observation group) or traditional suture (the control group). Wound healing time, degree of pain, and expense of dressing change were compared between the two groups. Results There was no significant difference in wound healing time between the two groups (P>0.05) ; degree of pain during wound dressing and medical expense in the observation group were significantly lower than those in the control group (P<0.01 for both). Conclusion Hydrocolloid used in phase Ⅱ abdominal wound closure without suture for elderly patients is superior to traditional suture, which could relieve pain, decrease medical expense, and make the wound artistic.

  20. The Observation on Efficacy of Angio-seal Closure Device in the Femoral Arterial Puncture Site after PCI

    Zhang Bin; Jin Lijun; Wei Shuishen; Fang Xianhong; Wu Handong; Dong Taiming; Yan hong; Liao Hongtao


    Objective To evaluatereliability and safety of Angio-seal hemostasis device applied to the femoral arterial puncture site after percutaneous coronary intervention (PCI). Methods In 40 patients after PCI in our institute during the period between May 2002 and December 2003, Angioseal device were used to seal the femoral arterial puncture site. Results All the Angioseal devices were successfully deployed in 40 patients (successful rate:100%); the mean time to hemostasis was 45±12 sec;the mean time to ambulate after angioseal closure was 1.9±0.5 hours. No major groin and systemic complication was observed. There was minor groin oozing in 2 cases and small hemotoma in 1 patient.Conclusions Angio-seal closure device of the femoral artery puncture site after a percutaneous coronary procedure is safe. It can shorten the time to hemostasis,leads to early mobilization, and reduce groin complication. The disadvantage is relatively expensive.

  1. Reserved sutures for incision closure of transvesical natural orifice transluminal endoscopic surgery in pigs%预留线关闭猪经膀胱自然腔道内镜手术切口的初步尝试

    王辉清; 杨波; 肖亮; 牟燕清; 吴震杰; 徐斌; 王林辉; 许传亮; 孙颖浩


    Objective To close the incision of transvesical natural orifice transluminal endoscopic surgery (NOTES) with reserved sutures in pigs, and to assess the feasibility and safety of the technique, so as to lay a foundation for future clinical application. Methods Five female pigs were inserted with self-made Trocar into the bladder under general anesthesia. Guided by ureteroscope, the needle passed the top wall of the anterior bladder and reached the abdominal wall, with two suture ends reserved for closure, one at the abdominal wall and the other in the urethra(out of Trocar). After finishing the transvesical NOTES, we pulled the suture end at the abdominal wall to the bladder and knotted outside the Trocar; then we dragged the urethra suture end to make the knot on the abdominal wall locating on the lateral wall of bladder, and then the urethral suture was knotted in Trocar and the knot was pushed to the bladder wall using a knot pushing device; finally the bladder incision was closed. The closure of the bladder incision was observed and tested with water filling method. Results The first two cases failed due to the overweight and large size of the pigs, or because the bladder incision was to close to the bladder neck, or due to the poor quality of the suture. The procedures were successful in the following 3 pigs, with the operation time periods being 45 min, 30 min, and 25 min, and with satisfactory closure. Conclusion Reserved suture for incision closure of transvesical NOTES procedure is safe and feasible; the technique is easy to perform and needs no special surgery devices; and it deserves further study.%目的 尝试预留线关闭猪经膀胱自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)切口,探讨其可行性、安全性,总结操作经验,为后续临床应用奠定基础.方法 雌香猪5只,全麻下置入自制膀胱鞘至膀胱.在输尿管镜的引导下,穿刺针穿刺膀胱顶前壁到腹下壁,预留2根关闭

  2. Transcatheter Closure of Congenital Coronary Artery Fistulas with a Giant Coronary Artery Aneurysm in Children: Experiences from a Single Center

    Yi-Fan Li


    Conclusions: Transcatheter closure appears to be a safe and effective alternative therapy for CCAF with a giant CAA in the pediatric population. Closure at the entry point of the CAA, and closure at both the entry and exit points when feasible, may reduce the risk of postinterventional complications.

  3. Conservative management of post-partum hemorrhage secondary to placenta previa-accreta with hypogastric artery ligation and endo-uterine hemostatic suture.

    Rauf, Melekoglu; Ebru, Celik; Sevil, Eraslan; Selim, Buyukkurt


    The aim of this study was to investigate maternal and neonatal outcomes of conservative management of post-partum hemorrhage due to placenta previa-accreta using hypogastric artery ligation and endo-uterine hemostatic suture to lower uterine segment. The records of 38 patients who were managed conservatively with hypogastric artery ligation and endo-uterine hemostatic suture to control post-partum hemorrhage secondary to placenta previa-accreta between April 2014 and January 2016, were reviewed retrospectively. Placenta previa-accreta was diagnosed according to gray-scale, color and 3-D power Doppler ultrasonography in addition to the intraoperative findings based on fragmentary or difficult separation of the placenta. In the case of conservative treatment protocol failure, cesarean hysterectomy was performed. Of these patients, 55.2% were between 25 and 35 years old; 97.5% were multiparous; 71.2% had two or more previous cesarean section and 68.5% had preterm delivery. Women with placenta accreta had a median estimated blood loss of 450 mL; 57.8% of patients had blood transfusion (mean intraoperative transfusion, 2 units packed red blood cells; range, 0-9 units). Median duration of operation was 112.5 min (range, 45-305 min) and 32 patients (84.3%) with placenta accreta did not undergo cesarean hysterectomy. Conservative treatment of post-partum hemorrhage secondary to placenta previa-accreta with hypogastric artery ligation and endo-uterine hemostatic sutures to the lower segment of the uterus is associated with lower hysterectomy rate compared with the other conservative methods reported in the literature. © 2016 Japan Society of Obstetrics and Gynecology.

  4. Closure of digital arteries in high vascular tone states as demonstrated by measurement of systolic blood pressure in the fingers

    Krähenbühl, B; Nielsen, S L; Lassen, N A


    Finger systolic blood pressure (FSP) was measured indirectly in normal subjects and patients with primary Raynaud phenomenon by applying a thin-walled plastic cuff around the finger and a strain gauge more distally to detect volume changes. Inducing a high vascular tone in one or more fingers...... by direct cooling or intra-arterial noradrenaline infusion caused a marked drop in FSP in the exposed fingers, but not in the non-exposed fingers of the same hand. The fact that the non-exposed fingers retained the normal (arm systolic) pressure level is taken to indicate that palmar arch blood pressure...... also remained normal. In the high vascular tone state, a large transmural pressure difference must apparently be established before the digital arteries are forced open. The lowered opening pressure constitutes a manifestation of the closure phenomenon of the digital arteries described in patients...

  5. Closure of digital arteries in high vascular tone states as demonstrated by measurement of systolic blood pressure in the fingers

    Krähenbühl, B; Nielsen, S L; Lassen, N A


    Finger systolic blood pressure (FSP) was measured indirectly in normal subjects and patients with primary Raynaud phenomenon by applying a thin-walled plastic cuff around the finger and a strain gauge more distally to detect volume changes. Inducing a high vascular tone in one or more fingers...... by direct cooling or intra-arterial noradrenaline infusion caused a marked drop in FSP in the exposed fingers, but not in the non-exposed fingers of the same hand. The fact that the non-exposed fingers retained the normal (arm systolic) pressure level is taken to indicate that palmar arch blood pressure...... also remained normal. In the high vascular tone state, a large transmural pressure difference must apparently be established before the digital arteries are forced open. The lowered opening pressure constitutes a manifestation of the closure phenomenon of the digital arteries described in patients...

  6. Safety and efficacy of femoral artery closure with the FemoSeal(R) device after coronary angiography using a 7 French sheath.

    Wanitschek, M M; Suessenbacher, A; Dörler, J; Pachinger, O; Moes, N; Alber, H F


    Post-cardiac catheterization femoral artery hemostasis can be accomplished with several mechanisms, including the FemoSeal® hemostasis device which has been designed and approved for closure of 6 French (F) arterial puncture sites. The aim of this study was to investigate whether the FemoSeal® vascular closure device can effectively and safely seal 7F arterial puncture sites after diagnostic and interventional cardiac catheterizations. Femoral artery puncture sites of 50 consecutive patients undergoing cardiac catheterization were closed with the FemoSeal® vascular closure device, according to the manufacturer's instructions. Efficacy endpoints were time to hemostasis and successful ambulation. Safety endpoints included bleeding complications, vessel occlusion and pseudoaneurysms. Mean time to hemostasis was 57.8±26.3 seconds (0-125 seconds). Hemostasis was achieved in 100 percent of the 50 patients. One patient suffered minor bleeding the next day, i.e. local hematoma. This clinical study demonstrates that the FemoSeal® vascular closure device, initially approved for closure of 6F arterial puncture sites, shows promising efficacy and safety to seal a larger (7F) femoral arterial puncture sites after diagnostic and interventional cardiac catheterizations.

  7. 全层连续缝合法与分层间断缝合法对急诊腹部手术切口愈合的影响分析%Influence analysis of full-thickness continuous suture method and layer interrupted suture method in emergency abdominal operation closure

    马启明; 徐小东


    Objective To assess the influence of full-thickness continuous suture method and layer interrupted suture method in emergency abdominal operation closure.Methods Two hundred and thirtyseven patients of emergency abdominal operation were divided into full-thickness continuous suture method group (145 cases) and layer interrupted suture method group (92 cases) according to the suture method.The rate of incision liquefaction and infection,time of incision suture were compared between the 2 groups,the patients with incision liquefaction and infection were given bacterial culture.Results The time of incision suture in full-thickness continuous suture method group was significantly shorter than that in layer interrupted suture method group [(18.37 ± 7.42) min vs.(25.92 ± 5.79) min],there was statistical difference (P <0.01).There were no statistical differences in the rate of incision liquefaction and infection,the rate of incision primary healing between the 2 groups (P > 0.05).In full-thickness continuous suture method group,the rate of incision liquefaction and infection in median incision was significantly lower than that in rectus abdominis incision [18.58% (21/113) vs.31.25% (10/32)],the rate of incision primary healing was significantly higher than that in rectus abdominis incision [81.42% (92/113) vs.68.75% (22/32)],there were statistical differences (P < 0.05).In layer interrupted suture method group,there were no statistical differences in the rate of incision liquefaction and infection,the rate of incision primary healing between median incision and rectus abdominis incision [33.33% (23/69) vs.26.09%(6/23),66.67% (46/69) vs.73.91% (17/23),P > 0.05].The rate of incision liquefaction and infection in median incision of full-thickness continuous suture method group was significantly lower than that in median incision of layer interrupted suture method group,and the rate of incision primary healing was significantly higher than that in


    Josephine Pudumai Selvi; Celine Foustina Mary; Karthikeyan Rajashekar


    BACKGROUND Surgical site infection (SSI) is an immense burden on healthcare resources even in the modern era of immaculate sterilization approaches and highly effective antibiotics. An estimated 234 million various surgical procedures, involving skin incisions requiring various types of wound closure techniques, are performed in the world, with the majority resulting in a wound healing by primary intention. Triclosan (5-chloro-2-(2, 4-dichlorophenoxy) phenol) is a broad-spectrum b...

  9. Feasibility and Safety of Vascular Closure Devices in an Antegrade Approach to Either the Common Femoral Artery or the Superficial Femoral Artery

    Gutzeit, Andreas, E-mail:; Schie, Bram van, E-mail:; Schoch, Eric, E-mail: [Cantonal Hospital Winterthur, Department of Radiology (Switzerland); Hergan, Klaus, E-mail: [Paracelsus Medical University Salzburg, Department of Radiology (Austria); Graf, Nicole, E-mail:; Binkert, Christoph A., E-mail: [Cantonal Hospital Winterthur, Department of Radiology (Switzerland)


    Introduction: The purpose of the present study was to analyze complications following antegrade puncture of the common femoral artery (CFA) and the superficial femoral artery (SFA) using vascular closure systems (VCS). Methods: A single-center, retrospective study was performed after obtaining approval from the institutional review board and informed consent from all patients. At our center, the CFA or SFA are used for arterial access. All patients were evaluated clinically on the same day. If there was any suspicion of an access site problem, Duplex ultrasound was performed. Results: Access location was the CFA in 50 patients and the SFA in 130 patients. The sheath size ranged from 4F to 10F. Two patients had to be excluded because of lack of follow-up. Successful hemostasis was achieved in 162 of 178 cases (91 %). The following complications were observed in 16 patients (8.9 %): 4 pseudoaneurysms (2.2 %), 11 hematomas (6.2 %), and 1 vascular occlusion (0.5 %). The two pseudoaneurysms healed spontaneously, in one case an ultrasound-guided thrombin injection was performed, and one aneurysm was compressed manually. No further medical therapy was needed for the hematomas. The one vascular occlusion was treated immediately with angioplasty using a contralateral approach. No significant difference was noted between the CFA and the SFA group with respect to complications (p = 1.000). Conclusions: The use of closure devices for an antegrade approach up to 10F is feasible and safe. No differences in low complication rates were observed between CFA and SFA.

  10. Surgical outcomes of mitomycin C combined with adjustable suture trabeculectomy for primary angle-closure glaucoma%丝裂霉素C联合可拆除缝线在小梁切除术中的临床应用



    目的:观察丝裂霉素 C 联合可拆除缝线在青光眼小梁切除术中的效果。方法对30例(35眼)青光眼患者进行丝裂霉素联合可拆除缝线的小梁切除术,术后随诊观察视力、眼压和滤过泡状况。结果手术后第1周眼压为(12.49±1.68) mmHg,第1个月眼压为(14.28±2.22)mmHg,第1年眼压为(17.29±2.87)mmHg 与手术前眼压相比较差异有统计学意义(P <0.05);术后1年功能型滤过泡35眼(82.86%)。结论丝裂霉素 C 联合可拆除缝线在小梁切除术中能有效降低眼压,减少术后并发症,提高手术成功率。%Objective To investigate the safety and efficacy of mitomycin C combined with adjustable suture trabeculectomyin treating primary angle-closure glaucoma.Methods This study included 30 patients(35 eyes)who underwent adjustable suture trabeculectomy combined with mitomycin C.Visual acuity,intraocular pressure and filtering blebs were measured.Results Mean postoperative intraoc-ular pressures were (12.49 ±1.68)mmHg at 1 week,(14.28 ±2.22)mmHg at 1 month and (17.29 ±2.87)mmHg at 1 year,re-spectively.There was significant difference between preoperation and postoperation(P <0.05).The rate of effective filtering bleb was 82.86% at 1 year.Conclusions Mitomycin C combined with adjustable suture trabeculectomy is a safe and effective surgical proce-dure to decrease intraocular pressure,reduce postoperative complications and raise success rate of the surgery.

  11. Intermediate- and long-term follow-up of device closure of patent arterial duct with severe pulmonary hypertension: factors predicting outcome.

    Sadiq, Masood; Rehman, Asif U; Hyder, Najam; Qureshi, Ahmad U; Kazmi, Tehmina; Qureshi, Shakeel A


    In patients with large patent arterial ducts and severe pulmonary hypertension, the natural history of progression of pulmonary hypertension is very variable. Whether to close or not to close is often a difficult decision, as there are no established haemodynamic parameters predicting reversibility. The objectives of this study were to evaluate the results of device closure of large patent arterial ducts with severe pulmonary hypertension after 2 years of age and to determine haemodynamic variables associated with its regression during long-term follow-up. A total of 45 patients, with median age of 10 (2-27) years, with large patent arterial ducts and severe pulmonary hypertension, were considered. Haemodynamic variables were assessed in air, oxygen, and after occlusion. The follow-up was performed to assess regression of pulmonary hypertension. Device closure was successful in 43 (96%) patients. Pulmonary artery systolic and mean pressures decreased from 79 to 67 mmHg and from 59 to 50 mmHg, respectively (p25% (both in oxygen) (p=0.007). Device closure of large patent arterial ducts with severe pulmonary hypertension is safe and effective. Pulmonary vascular resistance index and systolic and mean pulmonary artery pressures in oxygen are the key prognostic variables predicting regression of pulmonary hypertension.

  12. The intra-oceanic Cretaceous (~ 108 Ma) Kata-Rash arc fragment in the Kurdistan segment of Iraqi Zagros suture zone: Implications for Neotethys evolution and closure

    Ali, Sarmad A.; Ismail, Sabah A.; Nutman, Allen P.; Bennett, Vickie C.; Jones, Brian G.; Buckman, Solomon


    The Kata-Rash arc fragment is an allochthonous thrust-bound body situated near Penjween, 100 km northeast of Sulymannia city, Kurdistan Region, within the Iraqi portion of the Zagros suture zone. It forms part of the suprasubduction zone 'Upper Allochthon' terranes (designated as the Gimo-Qandil Group), which is dominated by calc-alkaline andesite and basaltic-andesite, rhyodacite to rhyolite, crosscut by granitic, granodioritic, and dioritic dykes. Previously, rocks of the Kata-Rash arc fragment were interpreted as a part of the Eocene Walash volcanic group. However, SHRIMP zircon U-Pb dates on them of 108.1 ± 2.9 Ma (Harbar volcanic rocks) and 107.7 ± 1.9 Ma (Aulan intrusion) indicate an Albian-Cenomanian age, which is interpreted as the time of igneous crystallisation. The Aulan intrusion zircons have initial εHf values of + 8.6 ± 0.2. On a Nb/Yb-Th/Yb diagram, all Kata-Rash samples fall within the compositional field of arc-related rocks, i.e. above the mid-ocean-ridge basalt (MORB)-ocean island basalt (OIB) mantle array. Primitive-mantle-normalised trace-element patterns for the Kata-Rash samples show enrichment in the large ion lithophile elements and depletion in the high-field-strength elements supporting their subduction-related character. Low Ba/La coupled with low La/Yb and Hf/Hf* 3000 km continuity of Cretaceous arc activity (Oman to Cyprus), that consumed Neotethyian oceanic crust between Eurasia and the Gondwanan fragment Arabia.

  13. Surgical closure of the larynx for intractable aspiration pneumonia: cannula-free care and minimizing the risk of developing trachea-innominate artery fistula.

    Ise, Kazuya; Kano, Makoto; Yamashita, Michitoshi; Ishii, Show; Shimizu, Hirofumi; Nakayama, Kei; Gotoh, Mitsukazu


    There is a risk of developing a fatal trachea-innominate artery fistula following laryngotracheal separation for the prevention of intractable aspiration pneumonia. We developed a novel technique of surgical closure of the larynx to avoid this complication and provide long-term cannula-free care.

  14. Safety and Efficacy of the Prostar XL Vascular Closing Device for Percutaneous Closure of Large Arterial Access Sites

    Christoph Thomas


    Full Text Available Purpose. The purpose of this study is to retrospectively evaluate the efficacy and safety of the Prostar XL device for percutaneous large access site closure in an unselected patient and operator collective. Materials and Methods. All patients ( who had received percutaneous vascular closing with the Prostar XL device in our institution with follow-up data of at least 6 months were retrospectively included. Primary (freedom from surgical conversion and continued (freedom from groin surgery in further course technical success and major (deviations from expected outcome requiring surgery and minor (other deviations from expected outcome complications were assessed. Success and complications rates were correlated with delivery system size (Mann-Whitney Rank Sum Tests and operator experience (paired samples t-test. Results. Rates of primary and continued technical success as well as major and minor complications were 93.6%, 89.7%, 10.3%, and 10.3% (groin based and 90.0%, 84.0%, 16.0%, and 16.0% (patient based, respectively. No correlation of success and complications rate was found with delivery system sizes and operator experience. Conclusions. Application of the Prostar XL device for percutaneous closure of large arterial access sites is safe with a relatively high rate of technical success and low rate of major complications. Sizes of the delivery systems and the experience of the operator did not influence the results.

  15. The Use of ExoSeal Vascular Closure Device for Direct Antegrade Superficial Femoral Artery Puncture Site Hemostasis

    Rimon, Uri, E-mail:; Khaitovich, Boris, E-mail: [Tel-Aviv University, Diagnostic and Interventional Imaging Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel); Yakubovich, Dmitry, E-mail: [Tel-Aviv University, Vascular Surgery Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel); Bensaid, Paul, E-mail:; Golan, Gil, E-mail: [Tel-Aviv University, Diagnostic and Interventional Imaging Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel); Silverberg, Daniel, E-mail: [Tel-Aviv University, Vascular Surgery Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel)


    PurposeThis study was designed to assess the efficacy and safety of the ExoSeal vascular closure device (VCD) to achieve hemostasis in antegrade access of the superficial femoral artery (SFA).MethodsWe retrospectively reviewed the outcome of ExoSeal VCD used for hemostasis in 110 accesses to the SFA in 93 patients between July 2011 and July 2013. All patients had patent proximal SFA based on computer tomography angiography or ultrasound duplex. Arterial calcifications at puncture site were graded using fluoroscopy. The SFA was accessed in an antegrade fashion with ultrasound or fluoroscopic guidance. In all patients, 5–7F vascular sheaths were used. The ExoSeal VCD was applied to achieve hemostasis at the end of the procedure. All patients were clinically examined and had ultrasound duplex exam for any puncture site complications during the 24 h postprocedure.ResultsIn all procedures, the ExoSeal was applied successfully. We did not encounter any device-related technical failure. There were four major complications in four patients (3.6 %): three pseudoaneurysms, which were treated with direct thrombin injection, and one hematoma, which necessitated transfusion of two blood units. All patients with complications were treated with anticoagulation preprocedure or received thrombolytic therapy.ConclusionsThe ExoSeal VCD can be safely used for antegrade puncture of the SFA, with a high procedural success rate (100 %) and a low rate of access site complications (3.6 %)

  16. A novel method of creation of a fenestration in nitinol occluder devices used in closure of hypertensive patent arterial ducts

    Anil Kumar Singhi


    Full Text Available Test occlusion with a balloon is done to predict operability of large hypertensive patent ductus arteriosus (PDA. If the fall in the pulmonary artery pressures is inadequate, a complete closure is not desired. To create a predictable premeasured fenestration in a nitinol occluder device used for closing hypertensive PDA. A large nitinol occluder device was punctured with an 18G needle to advance a 0.035½ stiff guide wire through the occluder before loading it into the delivery system. The occluder with the guidewire was then deployed across the PDA. A coronary guide catheter was later threaded through the guidewire into the fabric of the device, which was still held by the delivery cable. A coronary stent was deployed across the fenestration in the occluder to keep it patent. An 8-year-old boy with Down syndrome and hypertensive PDA was hemodynamically assessed. Even though there was a fall in the pulmonary vascular resistance index and pressures on test occlusion, the pulmonary artery pressures were labile with fluctuations. A customized fenestration was made in a 16 mm muscular ventricular septal defect occluder (MVSO with a 4.5 mm bare-metal coronary stent. The pulmonary artery pressures remained at half of the aortic pressures after the procedure. This fenestration model precisely and predictably fenestrated a large occluder device used to close a hypertensive large PDA. Long-term patency of these fenestrations has to be assessed on the follow-up, and may be improved through larger fenestrations, systemic anticoagulation and use of covered stents.

  17. Postoperative washing of sutured wounds

    Conrad Harrison


    Full Text Available A best evidence topic was written according to the structured protocol. The three part question addressed was: [In patients undergoing closure of surgical wounds with sutures] does [keeping the wound dry for the first 48 h after closure] [reduce the incidence of surgical site infections (SSIs]? 4 relevant papers were culled from the literature and appraised. The authors, date, country, population, study type, main outcomes, key results and study weaknesses were tabulated. Current NICE guidelines recommend cleaning surgical wounds with sterile saline only for the first 48 h following skin closure. We found no evidence that washing wounds with tap water during this period increases the incidence of SSIs compared to keeping them dry. Further randomised controlled trials will enable the construction of conclusive systematic reviews and meta-analyses.

  18. A minimally invasive technique for closing an iatrogenic subclavian artery cannulation using the Angio-Seal closure device: two case reports

    Szkup Peter L


    Full Text Available Abstract Introduction In the two cases described here, the subclavian artery was inadvertently cannulated during unsuccessful access to the internal jugular vein. The puncture was successfully closed using a closure device based on a collagen plug (Angio-Seal, St Jude Medical, St Paul, MN, USA. This technique is relatively simple and inexpensive. It can provide clinicians, such as intensive care physicians and anesthesiologists, with a safe and straightforward alternative to major surgery and can be a life-saving procedure. Case presentation In the first case, an anesthetist attempted ultrasound-guided access to the right internal jugular vein during the preoperative preparation of a 66-year-old Caucasian man. A 7-French (Fr triple-lumen catheter was inadvertently placed into his arterial system. In the second case, an emergency physician inadvertently placed a 7-Fr catheter into the subclavian artery of a 77-year-old Caucasian woman whilst attempting access to her right internal jugular vein. Both arterial punctures were successfully closed by means of a percutaneous closure device (Angio-Seal. No complications were observed. Conclusions Inadvertent subclavian arterial puncture can be successfully managed with no adverse clinical sequelae by using a percutaneous vascular closure device. This minimally invasive technique may be an option for patients with non-compressible arterial punctures. This report demonstrates two practical points that may help clinicians in decision-making during daily practice. First, it provides a practical solution to a well-known vascular complication. Second, it emphasizes a role for proper vascular ultrasound training for the non-radiologist.

  19. A minimally invasive technique for closing an iatrogenic subclavian artery cannulation using the Angio-Seal closure device: two case reports


    Abstract Introduction In the two cases described here, the subclavian artery was inadvertently cannulated during unsuccessful access to the internal jugular vein. The puncture was successfully closed using a closure device based on a collagen plug (Angio-Seal, St Jude Medical, St Paul, MN, USA). This technique is relatively simple and inexpensive. It can provide clinicians, such as intensive care physicians and anesthesiologists, with a safe and straightforward alternative to major surgery an...

  20. Day-case peripheral angioplasty using nurse-led admission, discharge, and follow-up procedures: arterial closure devices are not necessary

    Kasthuri, R.; Karunaratne, D.; Andrew, H.; Sumner, J. [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL (United Kingdom); Chalmers, N. [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL (United Kingdom)], E-mail:


    Aim: To audit the safety of day-case peripheral arterial intervention without the use of arterial-closure devices using nurse-led admission, discharge, and follow-up procedures. Materials and methods: Patients referred for elective, peripheral vascular intervention were selected for day-case care according to pre-determined criteria using telephone triage. Post-procedure haemostasis was achieved using manual compression. After 3 h bed-rest, patients were mobilized and discharged at 5 h. Patients were contacted by telephone next working day to audit complications. Results: One hundred and eighty-three elective day-case peripheral interventions were performed over 2 years, predominantly using 6 F sheaths. No closure devices were used. Five patients (2%) returned to the department because of persistent groin symptoms the next day. One of these had a false aneurysm. Four required no further treatment. A single patient returned at day 6 with a delayed false aneurysm. Conclusion: Day-case peripheral vascular intervention can be safely performed in appropriately selected patients without the use of arterial closure devices. Specialist radiology nurses have a major role in the counselling, care, and follow-up of these patients.

  1. Patient Satisfaction After Femoral Arterial Access Site Closure Using the ExoSeal{sup ®} Vascular Closure Device Compared to Manual Compression: A Prospective Intra-individual Comparative Study

    Pieper, Claus Christian, E-mail:; Thomas, Daniel, E-mail: [University of Bonn, Department of Radiology (Germany); Nadal, Jennifer, E-mail: [University of Bonn, Institute for Medical Biometry, Informatics and Epidemiology (Germany); Willinek, Winfried A., E-mail:; Schild, Hans Heinz, E-mail:; Meyer, Carsten, E-mail: [University of Bonn, Department of Radiology (Germany)


    PurposeTo intra-individually compare discomfort levels and patient satisfaction after arterial access closure using the ExoSeal{sup ®} vascular closure device (VCD) and manual compression (MC) in a prospective study design.MethodsPatients undergoing two planned interventions from 07/2013 to 09/2014 could participate in the study. Access closure was performed with an ExoSeal{sup ®}-VCD in one and MC in the other intervention. Patients were clinically and sonographically examined and were given questionnaires 1 day after intervention [groin- and back-pain during bedrest (100-point visual analog scale; 0: no pain); comfortability of bedrest (10-point Likert scale, 1: comfortable), satisfaction with closure (10-point Likert scale, 1: very satisfied)]. Results were analyzed in a cross-over design.Results48 patients (29 male, median age 62.5 (32–88) years) were included. An ExoSeal{sup ®}-VCD was used first in 25 cases. As four of these subsequently refused MC as second intervention, data from 44 patients could be analyzed. All closures were technically successful (successful device deployment) without major complications. Groin- and back-pain after VCD-use/MC was 0 (0–15) vs. 10 (0–80) and 0 (0–75) vs. 25 (0–90), respectively (p < 0.0001). Bedrest after VCD-use was more comfortable than after MC [1 (range 1–7) vs. 6 (2–10); p < 0.0001]. Satisfaction with the closure procedure and with the intervention in general was higher after VCD-use compared to MC [1 (1–3) vs. 5 (2–10) and 1 (1–2) vs. 2 (1–4), respectively; p < 0.0001].ConclusionIntra-individual comparison showed pain levels and discomfort to be significantly lower after ExoSeal{sup ®} use compared to MC. VCD closure was associated with higher satisfaction both with the closure itself and with the intervention in general.

  2. Utility of pulmonary venous flow diastolic deceleration time in an adult patient undergoing surgical closure of atrial septal defect and coronary artery bypass grafting

    Dharmesh R Agrawal


    Full Text Available Acute left ventricular (LV failure has been reported after surgical closure of atrial septal defect (ASD in adult patients. We report acute LV failure in a 56 year old gentleman following coronary artery bypass grafting (CABG and surgical closure of ASD. Transesophageal echocardiography examination of the patient following closure of ASD and CABG showed a residual ASD and a shunt (Qp :Qs = 1.5. The residual ASD was closed after re-institution of cardiopulmonary bypass (CPB under cardioplegic cardiac arrest. However, the patient did not tolerate closure of the residual ASD. The CPB was re-established and under cardioplegic cardiac arrest residual ASD was reopened to create a fenestration. This time patient was weaned easily from CPB. Postoperatively, 16 hours after extubation, patient became hemodynamically unstable, the patient was electively put on ventilator and intra-aortic balloon pump. Later the patient was weaned off successfully from ventilator. Retrospective analysis of pulmonary venous flow diastolic deceleration time (PVDT D recorded during prebypass period measured 102 msec suggestive of high left atrial pressure which indicate possibility of LV failure after ASD closure.

  3. Sutura arterial com técnicas contínua e de pontos separados, utilizando-se os fios polipropilene e polidioxanone: estudo experimental em coelhos Arterial suture with continuous and interrupted techniques, using polypropylene and polydioxanone threads: experimental study in rabbits

    Nelson Leonardo Kerdahi Leite de Campos


    Full Text Available OBJETIVO: Observar o comportamento da sutura arterial em aortas abdominais de coelhos em crescimento, comparando-se as técnicas contínua e com pontos separados, empregando-se dois tipos de fios: Polipropilene 7-0 (inabsorvível e Polidioxanone 7-0 (absorvível. MÉTODOS: Grupos: GI - Controle (sem sutura; GII - Polipropilene, Pontos Separados; GIII - Polipropilene, Contínua; GIV - Polidioxanone, Pontos Separados e GV - Polidioxanone, Contínua. Cada grupo foi subdividido em quatro Momentos de Eutanásia: aos 7, 14, 30 e 60 dias de pós-operatório. Foram avaliados: peso dos animais, diâmetros e pulsos arteriais, estenose, trombose, aderências, aortografia, visibilidade do fio, cicatrização e microscopia. RESULTADOS: a após 60 dias, o local da linha de sutura cresceu de forma significativa em todos os grupos; b a técnica de sutura com pontos separados causou menor estenose da linha de sutura, observada tanto no ato cirúrgico, como na eutanásia dos animais; c no exame histopatológico, as diferenças encontradas entre grupos foram transitórias, não persistindo após 60 dias de pós-operatório. CONCLUSÃO: O polidioxanone mostrou ser a melhor opção, entre os dois fios, para sutura de artérias em crescimento, pois causa pouca ou nenhuma restrição ao crescimento arterial na linha de sutura, mesmo quando se emprega a técnica contínua.PURPOSE: To assess the arterial suture, comparing continuous and interrupted techniques, in abdominal aorta of growing rabbbits, using two types of suture material: Polypropylene 7-0 (nonabsorbable and Polydioxanone 7-0 (absorbable. METHODS: Groups: GI - Control, without arterial suture; GII - Polypropylene, Interrupted technique; GIII - Polipropilene, Continuous technique; GIV - Polydioxanone, Interrupted technique and GV - Polydioxanone, Continuous technique. Each group was subdivided in four Moments of Euthanasia , according with the number of days after surgery: 7 , 14 , 30 and 60 days. The

  4. MRI after implantation of a novel femoral closure device following intra-arterial catheterisation: implications for subsequent contrast-enhanced MR angiography.

    Mohrs, Oliver K; Petersen, Steffen E; Nowak, Bernd; Kauczor, Hans-Ulrich; Voigtlaender, Thomas


    To assess MRI safety aspects and artefacts of a novel femoral artery closure device during contrast-enhanced MR angiography in patients following intra-arterial catheterisation. Ten consecutive patients underwent MRI within 24 h of coronary angiography and placement of a femoral artery closure device. We used a T2-weighted gradient-echo MRI sequence to measure the device-related artefact size in comparison with a phantom image, phase-contrast flow measurement proximal to, at the level of and distal to the device to quantify potential differences in flow velocity and contrast-enhanced 3D gradient-echo MR angiography to differentiate potential femoral artery stenosis from device-related artefacts. The mean size of the oval-shaped artefact was 8.4 x 6.6 mm (+/-1.0 x 0.8 mm) and was almost identical to the maximum artefact size of the phantom measurement (8.3 x 5.7 mm). Device placement did not result in an increased peak velocity (proximal 69 +/- 23 cm/s, at the level of 64 +/- 11 cm/s and distal to the device 63 +/- 12 cm/s, p = 0.67). The mean artefact penetration into the vessel lumen was 0.5 +/- 0.5 mm (percentage vessel narrowing 7.0 +/- 6%; range 0-16%). The MR conditional StarClose femoral artery closure device was used safely within 24 h of deployment at 1.5 T. Despite clip-related artefacts MR angiography will allow for easy differentiation of clip-related artefacts from high-grade atherosclerotic stenosis.

  5. MRI after implantation of a novel femoral closure device following intra-arterial catheterisation: implications for subsequent contrast-enhanced MR angiography

    Mohrs, Oliver K. [University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Darmstadt Radiology, Department of Cardiovascular Imaging at Alice-Hospital, Darmstadt (Germany); Petersen, Steffen E. [The London Chest Hospital, William Harvey Research Institute, Centre Lead for Advanced Cardiovascular Imaging, London (United Kingdom); Nowak, Bernd; Voigtlaender, Thomas [Cardiovascular Center Bethanien (CCB), Frankfurt/Main (Germany); Kauczor, Hans-Ulrich [University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany)


    To assess MRI safety aspects and artefacts of a novel femoral artery closure device during contrast-enhanced MR angiography in patients following intra-arterial catheterisation. Ten consecutive patients underwent MRI within 24 h of coronary angiography and placement of a femoral artery closure device. We used a T2-weighted gradient-echo MRI sequence to measure the device-related artefact size in comparison with a phantom image, phase-contrast flow measurement proximal to, at the level of and distal to the device to quantify potential differences in flow velocity and contrast-enhanced 3D gradient-echo MR angiography to differentiate potential femoral artery stenosis from device-related artefacts. The mean size of the oval-shaped artefact was 8.4 x 6.6 mm ({+-}1.0 x 0.8 mm) and was almost identical to the maximum artefact size of the phantom measurement (8.3 x 5.7 mm). Device placement did not result in an increased peak velocity (proximal 69 {+-} 23 cm/s, at the level of 64 {+-} 11 cm/s and distal to the device 63 {+-} 12 cm/s, p = 0.67). The mean artefact penetration into the vessel lumen was 0.5 {+-} 0.5 mm (percentage vessel narrowing 7.0 {+-} 6%; range 0-16%). The MR conditional StarClose femoral artery closure device was used safely within 24 h of deployment at 1.5 T. Despite clip-related artefacts MR angiography will allow for easy differentiation of clip-related artefacts from high-grade atherosclerotic stenosis. (orig.)

  6. [Pediatric case of congenital coronary artery fistula; surgical result and late changes in coronary artery aneurysm].

    Sugawara, Masaaki; Oguma, Fumiaki; Hirahara, Hiroyuki


    Congenital coronary artery fistula is an uncommon heart anomaly involving the coronary arteries. We report here a case of a 4-year-old boy who had a coronary fistula from the right coronary artery to the right ventricle, with a coronary aneurysm. He was asymptomatic, but the calculated ratio of pulmonary blood flow to systemic blood flow was shown to be high [pulmonary flow (Qp)/systemic flow(Qs)=1.78]. The coronary angiography showed that the right coronary artery was dilated beginning at the ostium and had an aneurysm at the acute marginal portion. A large spherical aneurysm approximately 20 mm in diameter was found to have been connected with coronary fistula opening into the right ventricle. Surgical repair by closure of the fistula under direct vision, partial resection and suture closure of the aneurysm was performed. Plication of the proximal portion of the right coronary artery was not performed, and the diffusely dilated artery was left untouched. After this operation, he recovered well under anticoagulant treatment with warfarin and aspirin. Postoperative angiography was performed 17 months after the surgery to evaluate morphological changes in the coronary artery. The angiography confirmed the closure of the fistula and the regression of coronary artery dilatation.

  7. Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension in adults: immediate and two-year follow-up results

    ZHANG Cao-jin; HUANG Yi-gao; HUANG Xin-sheng; HUANG Tao; HUANG Wen-hui; XIA Chun-li; MO Yu-jing


    Background Transcatheter closure of patent ductus arteriosus (PDA) is a well established procedure and an accepted treatment modality for small to moderate-sized PDA.This study aimed to evaluate the immediate and follow-up results of transcatheter closure of large PDAs with severe pulmonary arterial hypertension (PAH) in adults.Methods After a complete hemodynamic evaluation differentiating from the reversibility of severe PAH,transcatheter closure of PDA was performed.Patients were followed up clinically and echocardiographically at 24 hours,1 month,3months,6 months,12 months and 24 months after occlusion.Results Twenty-nine patients had successful occlusion,pulmonary artery pressure (PAP),left ventricular ejection fraction (LVEF) and fractional shortening (FS) significantly decreased immediately after occlusion ((106±25) mmHg vs.(50±14) mmHg,P <0.01; (63.7±7.2)% vs.(51.4±10.1)%,P <0.01 and (36.9±8.2)% vs.(28.9±8.6)%,P <0.05,respectively).At 1 month after PDA closure,the signs and symptoms improved markedly in all 29 patients,and PDAs were completely closed and remained closed during the follow-up.Eighteen patients having different degrees of dyspnea were treated with angiotensin converting enzyme inhibitor (ACEI) and/or digoxin after occlusion.Nine patients whose pulmonary vascular resistence (PVR) >6 Wood units accepted targeted PAH therapy.After 1 to 3 months of peroral drug therapy,their exercise tolerance improved from New York Heart Association (NYHA) class Ⅲ-Ⅳ to NYHA class Ⅰ.During follow-up,no latent arrhythmias were found,the left atrial diameter (LAD),left ventricular end-diastolic diameter (LVEDD),left ventricular end-systolic diameter (LVESD),left ventricular mass index (LVMI) and pulmonary artery systolic pressure (PASP) decreased significantly (P <0.05),and FS and LVEF recovered compared to the immediate postclosure state.However,FS and LVEF remained low compared to the preclosure state.Conclusions Transcatheter closure

  8. Fiber from ramie plant (Boehmeria nivea): A novel suture biomaterial

    Kandimalla, Raghuram; Kalita, Sanjeeb; Choudhury, Bhaswati [Drug discovery laboratory, Institute of Advanced Study in Science and Technology, Guwahati, Assam 781035 (India); Devi, Dipali [Seri biotech laboratory, Institute of Advanced Study in Science and Technology, Guwahati, Assam 781035 (India); Kalita, Dhaneswar [Government Ayurvedic College and Hospital, Jalukbari, Guwahati, Assam 781014 (India); Kalita, Kasturi [Department of Pathology, Hayat Hospital, Guwahati, Assam 781034 (India); Dash, Suvakanta [Girijananda Chowdhury Institute of pharmaceutical science, Azara, Guwahati, Assam 781017 (India); Kotoky, Jibon, E-mail: [Drug discovery laboratory, Institute of Advanced Study in Science and Technology, Guwahati, Assam 781035 (India)


    The quest for developing an ideal suture material prompted our interest to develop a novel suture with advantageous characters to market available ones. From natural origin only silk, cotton and linen fibers are presently available in market as non-absorbable suture biomaterials. In this study, we have developed a novel, cost-effective, and biocompatible suture biomaterial from ramie plant, Boehmeria nivea fiber. Field emission scanning electron microscopy (FE-SEM), energy-dispersive X-ray spectroscopy (EDX), attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) and thermo gravimetric analysis (TGA) results revealed the physicochemical properties of raw and degummed ramie fiber, where the former one showed desirable characteristics for suture preparation. The braided multifilament ramie suture prepared from degummed fiber exhibited excellent tensile strength. The suture found to be biocompatible towards human erythrocytes and nontoxic to mammalian cells. The fabricated ramie suture exhibited significant antibacterial activity against Escherichia coli, Bacillus subtilis and Staphylococcus aureus; which can be attributed to the inherent bacteriostatic ability of ramie plant fiber. In vivo wound closure efficacy was evaluated in adult male wister rats by suturing the superficial wound incisions. Within seven days of surgery the wound got completely healed leaving no rash and scar. The role of the ramie suture in complete wound healing was supported by the reduced levels of serum inflammatory mediators. Histopathology studies confirmed the wound healing ability of ramie suture, as rapid synthesis of collagen, connective tissue and other skin adnexal structures were observed within seven days of surgery. Tensile properties, biocompatibility and wound closure efficacy of the ramie suture were comparable with market available BMSF suture. The outcome of this study can drive tremendous possibility for the utilization of ramie plant fiber for

  9. The hidden X suture: a technical note on a novel suture technique for alveolar ridge preservation


    Purpose The present study investigated the impact of 2 different suture techniques, the conventional crossed mattress suture (X suture) and the novel hidden X suture, for alveolar ridge preservation (ARP) with an open healing approach. Methods This study was a prospective randomized controlled clinical trial. Fourteen patients requiring extraction of the maxillary or mandibular posterior teeth were enrolled and allocated into 2 groups. After extraction, demineralized bovine bone matrix mixed with 10% collagen (DBBM-C) was grafted and the socket was covered by porcine collagen membrane in a double-layer fashion. No attempt to obtain primary closure was made. The hidden X suture and conventional X suture techniques were performed in the test and control groups, respectively. Cone-beam computed tomographic (CBCT) images were taken immediately after the graft procedure and before implant surgery 4 months later. Additionally, the change in the mucogingival junction (MGJ) position was measured and was compared after extraction, after suturing, and 4 months after the operation. Results All sites healed without any complications. Clinical evaluations showed that the MGJ line shifted to the lingual side immediately after the application of the X suture by 1.56±0.90 mm in the control group, while the application of the hidden X suture rather pushed the MGJ line slightly to the buccal side by 0.25±0.66 mm. It was demonstrated that the amount of keratinized tissue (KT) preserved on the buccal side was significantly greater in the hidden X suture group 4 months after the procedure (Pclinical and radiographic verification of the efficacy of the hidden X suture in preserving the width of KT and the dimensions of the alveolar ridge after ARP. PMID:28050319

  10. Postoperative rescue closure of patent foramen ovale in the clinical setting of acute hypoxemic respiratory failure and stroke following coronary artery bypass surgery

    José L Díaz-Gómez


    Full Text Available We describe a case of intraoperative diagnosis and successful deferred percutaneous closure of a patent foramen ovale (PFO in the clinical setting of acute refractory hypoxemic respiratory failure and new-onset ischemic stroke in an elderly patient after coronary artery bypass graft. Perioperative morbidity (i.e. severe hypoxemia, worsening right ventricular dysfunction, and embolic stroke that is potentially related to intraoperatively diagnosed PFO during cardiac surgery can complicate management in the Intensive Care Unit and perhaps affect the patient′s outcome. Although the PFO closure can be challenging in the clinical setting of hypoxemic respiratory failure and stroke following cardiac surgery, it can be a reasonable perioperative option.

  11. Percutaneous closure of huge patent ductus arterious associated with anomalous inferior vein cava drainage and dextrocardia with muscular ventricular septal defect occluder


    @@ Transcatheter occlusion of patent ductus arterious (PDA) using various occluders and coils has been a well-established method1-5 since Porstmann and colleagues6 reported the first case in 1967. However, when patients associated with anomalous inferior vein cava drainage or/and huge high pulmonary artery pressure ductus (HPAP-PDA), the method is not suitable. First, it is unfeasible to carry out the procedure via femoral vein. Second, in the presence of high pulmonary artery pressure such devices including the Amplatzer ductu occluder carry the risk of embolising into the aorta.7 The muscular ventricular septal defect occluder (MVSDO), which is a device for transcatheter closure of muscular ventricular septal defect, may be more suitable for using with HPAP-PDA as its double disk tends to anchor the device, preventing embolisation into the aorta. We present a patient, who is suffering from huge PDA associated with anomalous inferior vein cava drainage and dextrocardia, in whom percutaneous closure of PDA using MVSDO was successfully accomplished via transjugular approach.

  12. Management of iatrogenic RV injury - RV packing and CPB through PTFE graft attached to femoral artery.

    Mangukia, Chirantan V; Agarwal, Saket; Satyarthy, Subodh; Aggarwal, Satish Kumar; Datt, Vishnu; Satsangi, Deepak Kumar


    Cardiac injuries during repeat sternotomy are rare. While undergoing debridement for chronic osteomyelitis (post arterial septal defect closure), a 4-year-old girl sustained significant right ventricular (RV) injury. Bleeding from the RV was controlled by packing the injury site, which helped in maintaining stable hemodynamics till arrangements were made for instituting cardiopulmonary bypass (CPB). Since the femoral artery was very small and unsuitable for direct cannulation, a polytetrafluoroethylene (PTFE) graft sutured end-to-side to the femoral artery was used for establishing CPB. The injury was successfully repaired.

  13. Suitability of a 7-F ExoSeal Vascular Closure Device for Femoral Artery Punctures Made by 8-F or 9-F Introducer Sheaths.

    Goto, Shunsaku; Ohshima, Tomotaka; Ishikawa, Kojiro; Yamamoto, Taiki; Nishizawa, Toshihisa; Shimato, Shinji; Kato, Kyozo


    To establish the safety and efficacy of the 7-F ExoSeal device for the closure of femoral puncture sites made by 8-F or 9-F introducer sheaths. Between January 2013 and December 2016, 332 patients (mean age 68.4±12.1 years; 195 men) underwent neurointerventional procedures via percutaneous puncture of the common femoral artery and an 8-F (n=272, 81.9%) or 9-F (n=60, 18.1%) introducer. The access sites were sealed with a 7-F ExoSeal in all cases. Procedure success and closure-related complication rates were evaluated, and risk factors for complications were analyzed by comparing patient characteristics between those who did and did not experience complications. Procedure success rates were 99.3% in the 8-F group and 100% in the 9-F group. The overall complication rate was 6.3% (n=17; all in the 8-F group), of which 13 (4.8%) were minor sequelae, including access-site hematoma (n=8), oozing (n=3), pseudoaneurysm (n=1), and retroperitoneal bleeding (n=1). Among the 4 (1.5%) major complications were 3 instances of bleeding requiring a blood transfusion and 1 surgical vascular repair. No complications were observed in the 9-F group. Patients who experienced complications had significantly longer activated clotting times (262±46 vs 218±55 seconds; pF ExoSeal vascular closure device is safe and effective for the closure of femoral puncture sites made by 8-F or 9-F introducer sheaths.


    Veerendra Kumar


    Full Text Available BACKGROUND: The choice of wound closure after a surgical procedure has been a surgeon’s dilemma . The concerns have been as to how fast , uneventful , less painful , with minimal complications and comfortable will the patient’s recovery be. A well - known technology is surgical staples which are easier to use , less time consuming and a needle free method o f wound closure. OBJECTIVE: To compare skin staples with non - absorbable skin suture for skin closure in surgical laparotomy procedures for the following character : wound infection , dehiscence , cosmesis and postoperative pain . METHODS: This is a comparative study conducted on 100 patients divided in two groups randomly at Bapuji Hospital for cases undergoing surgical laparotomy procedures. Skin closure was done with 2 - 0 polyamide skin sutures in one group and skin closure was achieved with skin staples in th e other group. The outcome of wound was assessed on 3rd , 5th and 7th postoperative days using ASEPSIS score. Wound cosmesis was assessed on the 7th postoperative day and followed up at 1st month and 3rd month , using modified Hollander cosmesis scale. Postoperative pain was assessed using the visual analogue scale on the 1st , 3rd and 7th postoperative days. RESULTS : The mean wound ASPESIS scores on day 3 for skin staples and sutured group was 0.28 and 0.36 (p=0.7 respectively. The score on day 5 for staples and sutured group was 0.12 and 0.28 (p=0.4 respectively. The results in both the groups were the same , 0.08 on day 7(p=0. Wound cosmesis mean score assessment on day 7 for skin staples suturing group was 5.84 and 5.68 respectively (p=0.3. The mean score for cosmesis assessment at 1 month , and 3 rd month for skin staples and suturing group was 5.92 and 5.68 (p=0.1 and was 6.00 and 5.92 (p=0.36 respectively which was not satistically significant . The visual analogue scale score for postopera tive pain on 1st day , 3 rd and 7 th day for skin staples and suturing group 54

  15. Cyanoacrylate for Intraoral Wound Closure: A Possibility?

    Parimala Sagar


    Full Text Available Wound closure is a part of any surgical procedure and the objective of laceration repair or incision closure is to approximate the edges of a wound so that natural healing process may occur. Over the years new biomaterials have been discovered as an alternate to conventional suture materials. Cyanoacrylate bioadhesives are one among them. They carry the advantages of rapid application, patient comfort, resistance to infection, hemostatic properties, and no suture removal anxiety. Hence this study was undertaken to study the effect of long chain cyanoacrylate as an adhesive for intraoral wound closure and also to explore its hemostatic and antibacterial effects. Isoamyl-2-cyanoacrylate (AMCRYLATE was used as the adhesive in the study. In conclusion isoamyl cyanoacrylate can be used for intraoral wound closure, as an alternative to sutures for gluing the mucoperiosteum to bone, for example, after impaction removal, periapical surgeries, and cleft repair. Its hemostatic and antibacterial activity has to be further evaluated.

  16. How we do it:the Running-X suture technique

    Nathaniel L Villanueva; Kyle Sanniec; Ronald Mancini


    There are a myriad of suture techniques available to close incisions of the brow and forehead, each with their own advantages and disadvantages. The ideal suture technique would provide excellent cosmetic results, offer expedient wound closure, optimize skin eversion and wound edge apposition, and provide excellent cosmetic results. The authors describe a new suture technique, the Running-X suture, a running horizontal mattress suture that has successfully been used by the senior author for many years to re-approximate surgical wounds of the brow and forehead in an expeditious and aesthetic manner.

  17. Network Meta-analysis of Randomized Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis

    Jun Jiang; Junjie Zou; Hao Ma; Yuanyong Jiao; Hongyu Yang; Xiwei Zhang; Yi Miao


    The safety of vascular closure devices (VCDs) is still debated. The emergence of more related randomized controlled trials (RCTs) and newer VCDs makes it necessary to further evaluate the safety of VCDs. Relevant RCTs were identified by searching PubMed, EMBASE, Google Scholar and the Cochrane Central Register of Controlled Trials electronic databases updated in December 2014. Traditional and network meta-analyses were conducted to evaluate the rate of combined adverse vascular events (CAVEs)...

  18. Cardiac Resynchronization for Corrected Transposition of the Great Arteries with Systemic Right Ventricle Failure after Tricuspid Valve Replacement and Ventricle Septal Defect Closure

    Kosuke Fujii, MD


    Full Text Available A 32-year-old man developed systemic right ventricular (RV heart failure after ventricular septal defect (VSD closure and tricuspid valve replacement for corrected transposition of the great arteries with VSD and Ebstein anomaly. He subsequently experienced RV failure with wide QRS and atrial fibrillation (AF. Because corrective surgery for this condition seemed over risky, we decided to perform cardiac resynchronization therapy with implantation of an implantable cardioverter defibrillator (CRT-D. After CRT-D device implantation, the patient showed improved performance status in terms of New York Heart Association functional class, B-type brain natriuretic peptide levels, RV ejection fraction and cardiac electrical rhythm. CRT-D implantation is a useful approach for systemic RV failure with wide QRS duration showing right bundle branch block and AF.

  19. Efficacy of femoral vascular closure devices in patients treated with anticoagulant, abciximab or thrombolytics during percutaneous endovascular procedures

    Kim, Ha Young; Choo, Sung Wook [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Roh, Hong Gee [Konkuk University School of Medicine, Seoul (Korea, Republic of)] (and others)


    This study assessed the outcomes of using vascular closure devices following percutaneous transfemoral endovascular procedures in the patients who were treated with heparin, abciximab thrombolytics (urokinase or t-PA) during the procedures. From March 28, 2003 to August 31, 2004, we conducted a prospective and randomized study in which 1,676 cases of 1.180 patients were treated with one of the two different closure devices (the collagen plug device was Angio-Seal{sup TM.}, the suture-mediated closure device was The Closer S{sup TM}) at the femoral access site after instituting percutaneous endovascular procedures. Among the 1,676 cases, 108 cases (the drug group) were treated with heparin only (n=94), thrombolytics only (n=10), heparin and thrombolytics (n=3), or abciximab and thrombolytics (n=1) during the procedures; 1,568 cases (the no-drug group) were treated without any medication. We compared the efficacy and complications between the two groups. Of the drug group, 42 cases underwent arterial closures with the collagen plug devices and 66 cases underwent arterial closures with the suture-mediated closure devices. We also compared the efficacy and complications between these two group. The immediate hemostasis rates were 92.9% (1,456/1,568) in the no drug group and 91.7% (99/108) in the drug group. Early complications occurred in four cases of the drug group. These included two episodes of rebleeding with using the Closer S, which required manual compression for at least 10 minutes, and two episodes of minor oozing with using one Angio-Seal and one Closer S, which required two hours of additional bed rest. There was no late complication. So, the total success rates were 90.8% (1,423/1,568) in the no-drug group and 88.0% (95/108) in the drug group. These results were not significantly different between the two groups ({rho}=0.34). In the drug group, the difference of the successful hemostasis rate between the collagen plug devices and the suture

  20. Efficacy and Safety of a Novel Vascular Closure Device (Glubran 2 Seal) After Diagnostic and Interventional Angiography in Patients with Peripheral Arterial Occlusive Disease

    Del Corso, Andrea [University of Pisa, Department of Vascular Surgery (Italy); Bargellini, Irene, E-mail:; Cicorelli, Antonio; Perrone, Orsola [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy); Leo, Michele [University of Pisa, Department of Vascular Surgery (Italy); Lunardi, Alessandro [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy); Alberti, Aldo; Tomei, Francesca [University of Pisa, Department of Vascular Surgery (Italy); Cioni, Roberto [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy); Ferrari, Mauro [University of Pisa, Department of Vascular Surgery (Italy); Bartolozzi, Carlo [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy)


    To prospectively evaluate safety and efficacy of a novel vascular closure device (Glubran 2 Seal) after peripheral angiography in patients with peripheral arterial occlusive disease (PAOD). From December 2010 to June 2011, all consecutive patients with PAOD undergoing peripheral angiography were prospectively enrolled onto the study after percutaneous antegrade or retrograde puncture of the common femoral artery. After angiography, the Glubran 2 Seal device was used to achieve hemostasis. The following data were registered: technical success and manual compression duration, patients' discomfort (scale 0-5), operators' technical difficulty (scale 0-5), and vascular complications. The site of hemostasis was evaluated by clinical inspection and color-coded Duplex ultrasound performed 1 day and 1 month after the procedure. One hundred seventy-eight patients were enrolled (112 male, mean age 70.8 years) with a total of 206 puncture sites, including 104 (50.5 %) antegrade accesses. The device was successful in 198(96.1 %) of 206 procedures, with 8 cases of manual compression lasting longer than 5 min (maximum 20 min). No major vascular complications were observed, resulting in 100 % procedural success. Minor complications occurred in seven procedures (3.4 %), including two cases of pseudoaneurysms, successfully treated by ultrasound-guided glue injection. The mean {+-} standard deviation score for patients' discomfort was 0.9 {+-} 0.7, whereas the mean score for operators' difficulty was 1.2 {+-} 0.9. In patients with PAOD, the Glubran 2 Seal represents a simple, painless, and efficient vascular closure device, able to achieve hemostasis both in antegrade and retrograde accesses.

  1. 一种新颖的内镜缝合设备在内镜全层切除术后修补消化道缺损的初步应用(含视频)%Endoscopic suturing closure of gastrointestinal wall defect after endoscopic full-thickness resection (with video)

    朱俊宇; 王萍; 蔡明琰; 周平红; 姚礼庆; 徐美东; 陈世耀; 陈巍峰; 胡健卫; 秦文政


    目的:探讨利用一种新颖的内镜缝合设备(OverStitchTM )修补内镜全层切除术(EFTR)后消化道缺损的临床疗效。方法回顾性分析应用 OverStitchTM设备缝合经 EFTR 治疗消化道黏膜下肿瘤后消化道缺损患者的临床资料,评价其有效性、可行性及安全性。结果共计5例患者,4例病灶位于胃部,1例病灶位于十二指肠降部,病灶大小20~50 cm,平均32 cm;患者均顺利完整切除病灶,完全修补缺损,修补时间110~220 min,平均166 min;住院时间4~6 d,平均5 d。2例患者术后第1天出现上腹部隐痛,体温升高症状,1例患者术后 CT 提示左侧胸腔少量积液,均予以半卧位休息,抗感染、制酸、胃肠减压治疗,3~4 d 后好转出院。结论 OverStitchTM作为一种新颖的内镜缝合技术,对于修补 EFTR 治疗后消化道缺损具有一定的可行性、有效性和安全性。%Objective To evaluate the efficacy of a new endoscopic suturing device(OverStitchTM, Apollo Endosurgery, USA)for gastrointestinal wall defect after endoscopic full⁃thickness resection (EFTR). Methods Clinical data of the patients with submucosal tumors who underwent endoscopic suturing closure of gastrointestinal wall defect at the Endoscopy Center of Zhongshan Hospital from April 2015 to June 2015 were retrospectively analyzed. Results Five patients were included in this research with 4 lesions located in stom⁃ach and 1 lesion located in descendent duodenum. The mean diameter of lesions was 3 2 cm (ranging 2 0⁃5 0 cm). All patients underwent complete closure and none of them was converted to laparoscopic surgery or laparotomy. The mean repairing time was 16 6 min (ranging 11 0⁃22 0 min). The mean postoperative hospi⁃talization time was 5 days ( ranging 4⁃6 d). Two patients complained about slight abdominal pain and elevated body temperature. CT showed minor pleural effusion in one case. These patients received

  2. Fechamento de canal arterial por minitoracotomia: técnica e resultados Patent ductus arteriosus (PDA closure with minithoracotomy: technique and results

    Pedro R. SALERNO


    Full Text Available CASUÍSTICA E MÉTODOS: No período de novembro de 1996 a dezembro de 1997, 15 crianças portadoras de canal arterial (CA, sendo 12 do sexo feminino, com idade média de 2,7 anos, peso médio de 13,9 kg foram submetidas a fechamento do CA por minitoracotomia. O ecodopplercardiograma confirmou o diagnóstico em todos o casos e mostrou o diâmetro do CA entre 2 mm e 10 mm, com média de 4,06 mm. A indicação cirúrgica foi eletiva em todos os casos. A operação consistiu de minitoracotomia esquerda no 4º espaço intercostal de 2,5 cm a 3,0 cm, seguida de dissecção do CA e clipagem do mesmo com 2 clips metálicos. Não foi utilizada drenagem pleural em nenhum dos casos. RESULTADOS: Todos os pacientes receberam alta em média no 4º dia de pós-operatório, sem nenhum escape pelo CA ao ecodopplercardiograma. CONCLUSÃO: O fechamento de CA por minitoracotomia é uma alternativa de tratamento que reduz o período de internação, bom efeito cosmético e baixo índice de complicações.OBJECTIVE:The purpose of this study was to describe a new technique for closure of patent ductus arteriosus (PDA by minithoracotomy (2.5 a 3.0 cm and clipping the PDA with titanium clips. MATERIAL AND METHODS: From November 1996 to December 1997, 15 children with PDA underwent surgical closure. The mean age at the time of operation was 2.7 years, mean weight was 13.9 kg. The procedure was through a left minithoracotomy at the 4º intercostal space. The ductus was identified, dissected and isolated. Interruption of ductal flow was performed by direct clipping with two clips. The chest was closed without a chest drain. Unless the patient was ventilator dependent before the closure, the child usually was extubated in the operating room. RESULTS: Color doppler echocardiography demonstrated total occlusion of the ductus in all patients. All 15 patients were discharged from the hospital on the 4º postoperative day (mean. CONCLUSION: We conclude that surgical closure of

  3. Caveolar disruption causes contraction of rat femoral arteries via reduced basal NO release and subsequent closure of BKCa channels

    AY Al-Brakati


    Full Text Available Background and Purpose. Caveolae act as signalling hubs in endothelial and smooth muscle cells. Caveolar disruption by the membrane cholesterol depleting agent methyl-β-cyclodextrin (M-β-CD has various functional effects on arteries including (i impairment of endothelium-dependent relaxation, and (ii alteration of smooth muscle cell (SMC contraction independently of the endothelium. The aim of this study was to explore the effects of M-β-CD on rat femoral arteries.Methods. Isometric force was measured in rat femoral arteries stimulated to contract with a solution containing 20 mM K+ and 200 nM Bay K 8644 (20 K/Bay K or with one containing 80 mM K+(80 K.Results. Incubation of arteries with M-β-CD (5 mM, 60 min increased force in response to 20 K/Bay K but not that induced by 80 K. Application of cholesterol saturated M-β-CD (Ch-MCD, 5 mM, 50 min reversed the effects of M-β-CD. After mechanical removal of endothelial cells M-β-CD caused only a small enhancement of contractions to 20 K/Bay K. This result suggests M-β-CD acts via altering release of an endothelial-derived vasodilator or vasoconstrictor. When nitric oxide synthase was blocked by pre-incubation of arteries with L-NAME (250 µM the contraction of arteries to 20 K/Bay K was enhanced, and this effect was abolished by pre-treatment with M-β-CD. This suggests M-β-CD is inhibiting endothelial NO release. Inhibition of large conductance voltage- and Ca2+-activated (BKCa channels with 2 mM TEA+ or 100 nM Iberiotoxin (IbTX enhanced 20 K/Bay K contractions. L-NAME attenuated the contractile effect of IbTX, as did endothelial removal.Conclusions. Our results suggest caveolar disruption results in decreased release of endothelial-derived nitric oxide in rat femoral artery, resulting in a reduced contribution of BKCa channels to the smooth muscle cell membrane potential, causing depolarisation and contraction.

  4. Videotoracoscopia para fechamento de fístula coronário-pulmonar: relato de caso Video-thoracoscopy closure of coronary artery fistula: case report

    Jeronimo Antonio Fortunato Júnior


    Full Text Available As fístulas da artéria coronária (FAC são raras e, muitas vezes, achado ocasional. O tratamento convencional é realizado por fechamento cirúrgico com toracotomia mediana ou por meio de embolização por procedimento hemodinâmico. Descrevemos uma técnica inovadora para ligadura da FAC de forma totalmente endoscópica. Mulher, 45 anos, com fístula sintomática entre artéria coronária descendente anterior e tronco de artéria pulmonar onde se realizou toracoscopia esquerda, pericardiotomia e ligadura do pertuito com clipe metálico. Não houve intercorrência, a paciente permaneceu 24 horas na UTI e teve alta hospitalar no 4º dia. A técnica foi efetiva, permitiu fácil acessibilidade cirúrgica e rápida recuperação pós-operatória.The coronary artery fistulas (FAC are rare and often found occasionally. The conventional treatment can be made by surgical closure with median thoracotomy or with embolization by catheterization. We describe an innovative technique to ligature of FAC, on a full endoscopy. Women, 45 years with symptomatic fistula between coronary artery anterior descending and trunk artery pulmonary, which took thoracoscopy left, pericardiotomy and ligation of fistula with metal clip without thoracotomy. There were no complications, stayed 24 hours in the ICU and was in hospital 4 days. The technique was effective, allows easy accessibility surgical and quick post-operative recovery.

  5. Hypersensitivity to Suture Anchors

    Masafumi Goto


    Full Text Available Hypersensitivity to suture anchor is extremely rare. Herein, we present a case in which hypersensitivity to suture anchor was strongly suspected. The right rotator cuff of a 50-year-old woman was repaired with a metal suture anchor. Three weeks after the surgery, she developed erythema around her face, trunk, and hands, accompanied by itching. Infection was unlikely because no abnormalities were detected by blood testing or by medical examination. Suspicious of a metallic allergy, a dermatologist performed a patch testing 6 months after the first surgery. The patient had negative reactions to tests for titanium, aluminum, and vanadium, which were the principal components of the suture anchor. The anchor was removed 7 months after the first surgery, and the erythema disappeared immediately. When allergic symptoms occur and persist after the use of a metal anchor, removal should be considered as a treatment option even if the patch test result is negative.

  6. Techniques and materials for skin closure in caesarean section

    Mackeen, A Dhanya; Berghella, Vincenzo; Larsen, Mie-Louise


    Caesarean section is a common operation with no agreed upon standard regarding certain operative techniques or materials to use. With regard to skin closure, the skin incision can be re-approximated by a subcuticular suture immediately below the skin layer, by an interrupted suture, or by staples....... A great variety of materials and techniques are used for skin closure after caesarean section and there is a need to identify which provide the best outcomes for women....

  7. Adhesive strip wound closure after thyroidectomy/parathyroidectomy: a prospective, randomized controlled trial.

    O'Leary, D Peter


    Conventional collar incision closure in thyroid and parathyroid surgery involves the insertion of an epidermal layer of subcutaneous absorbable sutures that are reinforced by a deep layer of sutures. Adhesive strips offer an alternative method to close the epidermal layer. The aim of this study was to compare adhesive strip closure with absorbable sutures for collar incisions in a prospective, single-blinded, randomized controlled trial.

  8. Usefulness of continuous suture using short-thread double-armed micro-suture for cerebral vascular anastomosis

    Sei Haga


    Full Text Available Background: When microvascular anastomosis is performed in a deep, narrow operating field, securing space to throw knots is difficult. To simplify the procedure and avoid obstruction of the anastomosis, we use a continuous suturing with short-thread double-armed micro-suture. Methods: Sixty-four patients (38 cerebral revasculazation, 16 moyamoya disease, and 10 aneurysm surgery undergoing microvaucular anastomosis were included. During anastomosis, a continuous suture was placed with short-thread double-armed micro-suture. Results: During 64 microanastomosis procedures, 64 consecutive continuous sutures were performed with 1-year follow up. All patients showed patency of anastomosis with long-term follow up. Conclusions: This technique is especially useful for anastomosis in a deep, narrow surgical field, such as in superior cerebellar artery anastomosis.

  9. Development and characterization of antibacterial braided polyamide suture coated with chitosan-citric acid biopolymer.

    Debbabi, Faten; Gargoubi, Sondes; Hadj Ayed, Mohamed Adnene; Abdessalem, Saber Ben


    Braided polyamide sutures are frequently used in dermatologic surgery for wound closure. However, braided sutures promote bacteria proliferation. In order to prevent wound complications due to this effect, antibacterial sutures should be used. The main objective of this study is the development of new non-absorbable antibacterial polyamide braided suture. This paper suggests new coating process that leads to obtain suture uniformly covered by antibacterial film enclosing chitosan, which is known for its antibacterial benefit. Mechanical properties and surface morphology of developed sutures were investigated by using mechanical tests. Sutures surfaces were also examined by scanning electron microscope, to perceive spreading of coating product on suture surface. In order to identify potential reactions between chemical compounds present in coating solution and suture material, sutures were analyzed by ATR-IF spectroscopy. It has been demonstrated that many eventual bonds between compounds present in coating solutions and polyamide macromolecular chain may occur. The existence of these bonds implies the fixation of biopolymer coating on suture surface. It has been demonstrated that uniform surface may be obtained by progressively applying coating solution containing little amount of chitosan on suture surface. We have also found that developed coating process has not affected mechanical properties of suture, which still meet United States Pharmacopeia requirement. Finally, antibacterial effects against four colonies, very widespread in hospitals, were studied. Prominent antibacterial effects of braided polyamide suture against two gram-positive ( S Aureus, S epidermidis) and two gram-negative ( E coli and P aeruginosa) colonies are presented. Optimal result of best properties is obtained by applying three layers of biopolymer coating comprising 1% chitosan and 10% citric acid. The new developed suture coating process appears as a promising method for obtaining

  10. Cosmetic outcome and surgical site infection rates of antibacterial absorbable (Polyglactin 910) suture compared to Chinese silk suture in breast cancer surgery: a randomized pilot research

    ZHANG Zhong-tao; Jessica Shen; Martin Weisberg; ZHANG Hong-wei; FANG Xue-dong; WANG Li-ming; LI Xiao-xi; LI Ya-fen; SUN Xiao-wei; Judith Carver; Dorella Simpkins


    Background The primary objective of this multicenter post-market study was to compare the cosmetic outcome of triclosan-coated VICRYL* Plus sutures with Chinese silk sutures for skin closure of modified radical mastectomy. A secondary objective was to assess the incidence of surgical site infection (SSI).Methods Patients undergoing modified radical mastectomy were randomly assigned to coated VICRYL* Plus antibacterial (Polyglactin 910) suture or Chinese silk suture. Cosmetic outcomes were evaluated postoperatively at days 12 (±2) and 30 (±5), and the evidence of SSI was assessed at days 3, 5, 7, 12 (±2), 30 (±5), and 90 (±7). Cosmetic outcomes were independently assessed via visual analogue scale (VAS) score evaluations of blinded incision photographs (primary endpoint) and surgeon-assessed modified Hollander Scale (mHCS) scores (secondary endpoint).SSI assessments used both CDC criteria and ASEPSIS scores.Results Six Chinese hospitals randomized 101 women undergoing modified radical mastectomy to closure with coated VICRYL* Plus suture (n=51) or Chinese silk suture (n=50). Mean VAS cosmetic outcome scores for antibacterial suture (67.2) were better than for Chinese silk (45.4) at day 30 (P<0.0001)). Mean mHCS cosmetic outcome total scores, were also higher for antibacterial suture (5.7) than for Chinese silk (5.0) at day 30 (P=0.002).Conclusions Patients using coated VICRYL* Plus suture had significantly better cosmetic outcomes than those with Chinese silk sutures. Patients using coated VICRYL* Plus suture had a lower SSI incidence compared to the Chinese silk sutures, although the difference did not reach statistical significance. ( NCT 00768222)

  11. Network Meta-analysis of Randomized Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis.

    Jiang, Jun; Zou, Junjie; Ma, Hao; Jiao, Yuanyong; Yang, Hongyu; Zhang, Xiwei; Miao, Yi


    The safety of vascular closure devices (VCDs) is still debated. The emergence of more related randomized controlled trials (RCTs) and newer VCDs makes it necessary to further evaluate the safety of VCDs. Relevant RCTs were identified by searching PubMed, EMBASE, Google Scholar and the Cochrane Central Register of Controlled Trials electronic databases updated in December 2014. Traditional and network meta-analyses were conducted to evaluate the rate of combined adverse vascular events (CAVEs) and haematomas by calculating the risk ratios and 95% confidence intervals. Forty RCTs including 16868 patients were included. Traditional meta-analysis demonstrated that there was no significant difference in the rate of CAVEs between all the VCDs and manual compression (MC). Subgroup analysis showed that FemoSeal and VCDs reported after the year 2005 reduced CAVEs. Moreover, the use of VCDs reduced the risk of haematomas compared with MC. Network meta-analysis showed that AngioSeal, which might be the best VCD among all the included VCDs, was associated with reduced rates of both CAVE and haematomas compared with MC. In conclusion, the use of VCDs is associated with a decreased risk of haematomas, and FemoSeal and AngioSeal appears to be better than MC for reducing the rate of CAVEs.

  12. Bacterial adhesion to suture material in a contaminated wound model: Comparison of monofilament, braided, and barbed sutures.

    Dhom, Jonas; Bloes, Dominik A; Peschel, Andreas; Hofmann, Ulf Krister


    Contaminated suture material plays an important role in the physiopathology of surgical site infections. Recently, suture material has been developed characterized by barbs projecting from a monofilament base. Claimed advantages for barbed sutures are a shortened wound closure time and reduced maximum wound tension. It has also been suggested that these sutures would be advantageous microbiologically. The aim of this study was to test the microbiological characteristics of the barbed Quill in comparison to the monofilament Ethilon II and the braided sutures Vicryl and triclosan-coated Vicryl Plus. In our study, sutures were cultivated on color-change agar with Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecium, Escherichia coli, and Pseudomonas aeruginosa and the halo size was measured. In a second study arm with longer cultivation bacterial growth was followed by antibiotic treatment. Ethilon II and Quill showed good comparable results, whereas large halos were found around Vicryl. Vicryl Plus results depended on triclosan sensitivity. After longer bacterial cultivation and antibiotic treatment, halos were up to 3.6 times smaller on Quill than on Vicryl (P <.001), but 1.4 times larger than on Ethilon II (P <.001) regarding S. aureus. Confocal microscopy analysis showed bacterial colonization between the braided filaments on Vicryl and beneath the barbs on Quill. From a microbiological perspective, barbed sutures can be recommended in aseptic surgery, but should only be used carefully in septic surgery. This article is protected by copyright. All rights reserved.

  13. MonoMax Suture: A New Long-Term Absorbable Monofilament Suture Made from Poly-4-Hydroxybutyrate

    Erich K. Odermatt


    Full Text Available A long-term absorbable monofilament suture was developed using poly-4-hydroxybutyrate (P4HB made from a biosynthetically produced homopolymer of the natural metabolite 4-hydroxybutyrate. The suture, called MonoMax, has prolonged strength retention. At 12 weeks, a size 3-0 MonoMax suture retains approximately 50% of its initial tensile strength in vivo and is substantially degraded in one year with minimal tissue reaction. In contrast, PDS II monofilament suture (Ethicon, Inc., Somerville, NJ has no residual strength in vivo after 12 weeks. In vivo, the MonoMax suture is hydrolyzed primarily by bulk hydrolysis, and is then degraded via the Krebs cycle. MonoMax is substantially more compliant than other monofilament sutures, and incorporates an element of elasticity. Its tensile modulus of 0.48 GPa is approximately one-third of the value of the PDS II fiber providing an exceptionally flexible and pliable fiber with excellent knot strength and security. These features are further enhanced by the fiber's elasticity, which also improves knot security and may help prevent wound dehiscence. Because of its performance advantages, this suture may find clinical utility in applications where prolonged strength retention, and greater flexibility are required, particularly in procedures like abdominal wall closure where wound dehiscence is still a significant post-surgical complication.

  14. Timing of ectocranial suture activity in Gorilla gorilla as related to cranial volume and dental eruption.

    Cray, James; Cooper, Gregory M; Mooney, Mark P; Siegel, Michael I


    Research has shown that Pan and Homo have similar ectocranial suture synostosis patterns and a similar suture ontogeny (relative timing of suture fusion during the species ontogeny). This ontogeny includes patency during and after neurocranial expansion with a delayed bony response associated with adaptation to biomechanical forces generated by mastication. Here we investigate these relationships for Gorilla by examining the association among ectocranial suture morphology, cranial volume (as a proxy for neurocranial expansion) and dental development (as a proxy for the length of time that it has been masticating hard foods and exerting such strains on the cranial vault) in a large sample of Gorilla gorilla skulls. Two-hundred and fifty-five Gorilla gorilla skulls were examined for ectocranial suture closure status, cranial volume and dental eruption. Regression models were calculated for cranial volumes by suture activity, and Kendall's tau (a non-parametric measure of association) was calculated for dental eruption status by suture activity. Results suggest that, as reported for Pan and Homo, neurocranial expansion precedes suture synostosis activity. Here, Gorilla was shown to have a strong relationship between dental development and suture activity (synostosis). These data are suggestive of suture fusion extending further into ontogeny than brain expansion, similar to Homo and Pan. This finding allows for the possibility that masticatory forces influence ectocranial suture morphology.

  15. Keratometric astigmatism after ECCE in eastern Nepal. Continuous versus interrupted sutures.

    Sood, Archana; Thakur, Sanjay Kumar D; Kumar, Sandeep; Badhu, Badri


    The study aimed to compute and compare the keratometric astigmatism induced by wound closure with continuous and interrupted sutures in conventional extracapsular cataract extraction with intraocular lens implantation at a single centre in eastern Nepal. Sixty eyes of 60 patients were included in the study. All patients received conventional extracapsular cataract extraction and single piece modified C-loop posterior chamber intraocular lens. Thirty eyes were sutured with continuous (Group 1) and 30 eyes with interrupted sutures (Group 2). The results were analysed by the unpaired student's t-test. At the end of 6 weeks, Group 1 patients had significantly higher astigmatism (3.53 +/- 2.19D) compared to Group 2 patients (1.7 +/- 1.35). A majority of patients in both groups had with-the-rule astigmatism throughout the postoperative period. Interrupted sutures cause less astigmatism than continuous suture. The factors responsible for high astigmatism in continuous sutures call for further analysis.

  16. Craniofacial clefting and sutural dystopia.

    Moore, M H; Edwards, T J; David, D J


    Sutural anomalies in conjunction with craniofacial clefting are unusual. A case of median frontal clefting is presented in which there was an absence of a normal metopic suture and replacement by paramedian frontal sutures. The association of an underlying brain anomaly, with attendant surgical difficulties, is noted, as are the radiological techniques of preoperative diagnosis.

  17. 40Ar/39Ar hornblende and biotite geochronology of the Bulfat Igneous Complex, Zagros Suture Zone, NE Iraq: New insights on complexities of Paleogene arc magmatism during closure of the Neotethys Ocean

    Aswad, Khalid J.; Ali, Sarmad A.; Al. Sheraefy, Ruaa M.; Nutman, Allen P.; Buckman, Solomon; Jones, Brian G.; Jourdan, F.


    In NE Iraq, the eastern edge of the Arabian plate is overlain by arc rock allochthons whose genesis and tectonic emplacement were related to the consumption and closure of the Neotethys Ocean. This paper demonstrates the occurrence of unrelated Paleogene arc rocks in two adjacent allochthons. The Bulfat Igneous Complex at Wadi Rashid (NE Iraq) is an intrusion within the Upper Allochthon Albian-Cenomanian Gimo-Qandil sequence suprasubduction zone assemblage. A thrust separates this allochthon from the underlying Lower Allochthon of the Eocene-Oligocene Walash-Naopurdan volcanic-sedimentary arc rocks. The Bulfat Igneous Complex at Wadi Rashid consists of gabbro and granitic composite intrusions in which components mingle down to a small scale. Textural relationships in the Bulfat Igneous Complex rocks indicate emplacement at high crustal levels with rapid cooling, which is consistent with amphibole geobarometry indicating crystallisation pressures between 250 and 300 Mpa. Ti-rich igneous pargasite and Ti-rich igneous Fe-biotite from gabbroic and granitic components yielded 40Ar/39Ar ages of 39.23 ± 0.21 and 38.87 ± 0.24 Ma respectively. These ages agree within analytical error and suggest coeval emplacement and rapid cooling of mafic and felsic magmas in the Eocene, in an event that was distinct and much younger than the host Albian-Cenomanian rocks. This igneous event was unrelated to formation of Cenozoic rocks in the underlying, tectonically separate, lower allochthon. The trace element signatures of the Wadi Rashi volcanic rocks show volcanic-arc characteristics for the granites and the gabbroic rocks resemble E type MORB. The presence of Eocene arc-related rocks in two allochthons suggests complexity in Paleogene subduction systems, with possibly two subduction zones operating at that time.

  18. Experimental evaluation of horse hair as a nonabsorbable monofilament suture

    Swati R Yedke


    Full Text Available Background: Success of surgery depends on wound closure and healing. Ancients had coated many suture materials from plant and animal origin. As the quest for natural nonabsorbable, monofilament surgical suture continues, horsehair has been taken for study, which is mentioned in ancient literature. Objectives: Aim of the study was to evaluate detail mechanical and biophysical properties of horsehair. Materials and Methods: Physical properties, that are diameter, straight pull and knot pull tensile strength, bioburden, sterility tests were performed. Visual and histological wound healing parameters were studied in experimental Wistar rat incision wound model. Two experimental wounds about 5 cm long were created on each side of dorsal midline. Each animal received two sutures-Horsehair 4-0 and Ethilon 4-0. The sutured areas were grossly examined on 3 rd and 7 th days for visual observations like congestion, edema, infection, wound disruption, and impression of suture material on healed wound and then subjected for histological study. Results: Revealed that horsehair has got diameter of 0.19 mm which complies with the 4-0 size USP standard. Straight pull tensile strength was found 0.5851 ± 0.122 kg and knot pull tensile strength was 0.3998 ± 0.078 kg, which complies with the standards of United State Pharmacopia for class II nonabsorbable suture materials. In vivo study revealed that there was no evidence of edema, congestion, and discharge in both the groups. Wounds healed with minimum impressions of suture material with minimum scar mark. Mean histological scoring shows very mild tissue reaction. Conclusion: Horsehair has got properties of standard suture material except low tensile strength and hence can be used in reconstructive, plastic surgeries, and ophthalmic surgeries.

  19. Clinical inquiries. How does tissue adhesive compare with suturing for superficial lacerations?

    Aukerman, Douglas F; Sebastianelli, Wayne J; Nashelsky, Joan


    Tissue adhesives are effective and yield results comparable to those with conventional suturing of superficial, linear, and low-tension lacerations. The cosmetic outcome is similar; wound complications, such as infection and dehiscence, may be lower with tissue adhesives. Wound closure of superficial lacerations by tissue adhesives is quicker and less painful compared with conventional suturing (strength of recommendation: A, systematic reviews of randomized trials).

  20. Suture Materials in Ophthalmic Surgery

    KÖHLE, Ülkü; Demir, Canser Yılmaz


    Suture materials is one of the basic subjects which every surgeon should know. The operation of suturing, sewing together two sides of a wound, is probably one of the oldest in the history of medicine. Its purpose is to aid healing as atraumatically as possible and it has mainly the mechanical effect of holding the wound edges together. Different suture materials have been manufactured. Each material is suited to different types of tissue, but all must posses certain character...

  1. Watertight dural closure! An in vitro study to explore the myth

    Sudipkumar Sengupta


    Full Text Available Aim: The watertight closure of the dura mater is fundamental to intracranial supratentorial procedures in neurosurgery. Controversies exist claiming the superiority of one closure technique over another. But is ′Water-tight′ dural closure really achievable ? An in vitro study system was developed to test the pressures at which dural incisions, closed with sutures, leaked. Materials and Methods: Bovine dura was secured to the lower end of an open ended calibrated plastic cylinder. Multiple interrupted stitches were applied over a two 2 cm length of the dura without any incision. Similarly a 2 cm incision was made and closed with interrupted and continuous stitches. Cylinder was filled with colored saline gradually. Height of the water column at which sutured dura leaked was recorded. The tests were conducted with the dura both in lax and tense conditions. Inlay closure technique was also tested on the same model using a dural substitute. Results: Even without an incision, needle puncture sites over a dura, leak, at a very low hydrostatic pressure (30 < mm of H2O, though a continuous interlocking suture performs slightly better than an interrupted suture technique. If the needle puncture sites are closed with glue, both the suture techniques can achieve a watertight closure against a hydrostatic pressure of 240 mm of H2O. Conclusion : In the experimental model described, ′Water-tight′ dural closure appears to be impossible with suture closure of a dural defect.

  2. Effect of the suture technique on postoperative pain, swelling and trismus after removal of lower third molars: A randomized clinical trial.

    Gay-Escoda, Cosme; Gómez-Santos, Laila; Sánchez-Torres, Alba; Herráez-Vilas, José-María


    To evaluate the intensity of pain, swelling and trismus after the removal of impacted lower third molars comparing two different suture techniques of the triangular flap: the complete suture of the distal incision and relieving incision and the partial suture with only one suture knot for closure of the corner of the flap and the closure of the distal incision, without suturing the relieving incision. A prospective, randomized, cross-over clinical trial was conducted in 40 patients aged from 18 to 45 years who underwent surgical extraction of impacted lower third molars at the Department of Oral Surgery in the Odontological Hospital of the University of Barcelona during the year 2011. Patients were randomly divided in 2 groups. Two different techniques (hermetical closure and partial closure of the wound) were performed separated by a one month washout period in each patient. Postoperative pain, swelling and trismus were evaluated prior to the surgical procedure and also at 2 and 7 days postoperatively. No statistically significant differences were observed for pain (ptrismus (p<0.71) and swelling (p<0.05) between the test and the control group. However, the values of the three parameters related to the test group were lower than those for the control group. Partial closure of the flap without suturing the relieving incision after surgical extraction of lower third molars reduces operating time and it does not produce any postoperative complications compared with complete closure of the wound.

  3. Changes of pulmonary artery pressure after interventional transcatheter closure in patients with patent ductus arteriosus%动脉导管未闭介入治疗后肺动脉压改变的研究

    张克成; 袁杰; 于波; 孙勇


    目的:探讨动脉导管未闭(PDA)患者介入封堵治疗后肺动脉压改变的影响因素.方法:回顾性分析2008年1月至2011年9月在我院行介入封堵治疗的43例PDA患者的临床及介入手术资料.结果:与治疗前比较,PDA患者介入封堵治疗后肺动脉收缩压[PASP,(76±51)mmHg比(46.26±17.26)mmHg]、肺动脉舒张压[PADP,(39.47±17.11)mmHg比(15.84±10.74)mmHg]、平均肺动脉压[MPAP,(54.72±19.21)mmHg比(28.53±14.41)mmHg]均显著降低(P均=0.0001),PADP下降程度比PASP更明显[(0.54±0.38)比(0.38±0.15),P=0.012]; PDA患者介入治疗后PASP、MPAP下降程度与年龄呈负相关(B=-0.04,P=0.012;B=-0.006,P=0.009);术后MPAP下降程度与动脉导管管径呈正相关(B=0.022,P=0.01).结论:介入封堵治疗对动脉导管未闭有益,应在年龄较小时尽早手术.%Objective; To analyze influencing factors of change of pulmonary artery pressure after interventional transcatheter closure in patients with patent ductus arteriosus (PDA). Methods: Clinical and intervention data of 43 PDA patients undergoing interventional transcatheter closure in our hospital from Jan 2008 to Sep 2011 were retrospectively analyzed. Results: Compared with before treatment, there were significant decrease in pulmonary arterial systolic pressure [PASP, (76 ?51) mmHg vs. (46. 26 ?17. 26) mmHg], pulmonary arterial diastolic pressure [PADP, (39. 47 ?7. 11) mmHg vs. (15. 84 + 10. 74) mmHg] and mean pulmonary arterial pressure [MPAP, (54.72 + 19. 21) mmHg vs. (28. 53 ?14. 41) mmHg] in PDA patients after interventional transcatheter closure (P = 0. 0001 all), decrease degree of PADP was more significant than that of PASP [ (0. 54 + 0. 38) vs. (0. 38 ?0.15), P = 0. 012]; decrease degree of PASP and MPAP in PDA patients after interventional transcatheter closure were negatively correlated with age (B= - 0. 04, P= 0. 012; B= - 0. 006, P = 0. 009); decrease degree of MPAP after operation was positively correlated with ductus arteriosus

  4. Clinical Outcome and Wound Healing following Carpal Tunnel Decompression: A Comparison of Two Common Suture Materials

    Robert J. MacFarlane


    Full Text Available Introduction. Debate exists amongst surgeons regarding the ideal suture material for skin closure in carpal tunnel decompression (CTD. This study compares wound related complications, patient satisfaction, and functional outcome following open carpal tunnel decompression in patients undergoing wound closure with either of two common absorbable and nonabsorbable suture types. Materials and Methods. 53 patients underwent CTD with either 4/0 polypropylene (ProleneTM, n = 28 or 4/0 polyglactin (Vicryl RapideTM, n = 25 for skin closure. QuickDASH, VAS satisfaction scores, and Southampton wound scores were assessed preoperatively and at 2 and 6 weeks postoperatively. Results. At 6 weeks the mean QuickDASH scores postoperatively were 18.54 and 17.70 for absorbable and nonabsorbable sutures, respectively, (P = 0.86. The mean VAS scores were 0.61 and 0.42 (P = 0.91, respectively. All patients achieved a Southampton wound score of 0 by 6 weeks except one, who achieved 1C in the nonabsorbable group, equivalent to mild erythema. There were no complications in either group. Conclusion. Both suture types are safe and effective materials for CTD, and we recommend surgeons to choose according to personal preference, handling properties, and resources available for suture removal.

  5. Abdominal wound closure: current perspectives

    Williams ZF


    Full Text Available Zachary F Williams, William W Hope Department of Surgery, South East Area Health Education Center, New Hanover Regional Medical Center, Wilmington, NC, USA Abstract: This review examines both early and late wound complications following laparotomy closure, with particular emphasis on technical aspects that reduce hernia formation. Abdominal fascial closure is an area of considerable variation within the field of general surgery. The formation of hernias following abdominal wall incisions continues to be a challenging problem. Ventral hernia repairs are among the most common surgeries performed by general surgeons, and despite many technical advances in the field, incisional hernia rates remain high. Much attention and research has been directed to the surgical management of hernias. Less focus has been placed on prevention of hernia formation despite its obvious importance. This review examines the effects of factors such as the type of incision, suture type and size, closure method, patient risk factors, and the use of prophylactic mesh. Keywords: incisional, abdominal, hernia, prevention, wound closure techniques 

  6. Cranial suture biology and dental development: genetic and clinical perspectives.

    De Coster, P J; Mortier, G; Marks, L A; Martens, L C


    Premature fusion of the calvarial bones at the sutures, or craniosynostosis (CS), is a relatively common birth defect (1:2000-3000) frequently associated with limb deformity. Patients with CS may present oral defects, such as cleft soft palate, hypodontia, hyperdontia, and delayed tooth eruption, but also unusual associations of major dental anomalies such as taurodontism, microdontia, multiple dens invaginatus, and dentin dysplasia. The list of genes that are involved in CS includes those coding for the different fibroblast growth factor receptors and a ligand of ephrin receptors, but also genes encoding transcription factors, such as MSX2 and TWIST. Most of these genes are equally involved in odontogenesis, providing a pausible explanation for clinical associations of CS with dental agenesis or tooth malformations. On the basis of the present knowledge on genes and transcription factors that are involved in craniofacial morphogenesis, and from dental clinics of CS syndromes, the molecular mechanisms that control suture formation and suture closure are expected to play key roles in patterning events and development of teeth. The purpose of this article is to review and merge the recent advances in the field of suture research at the genetic and cellular levels with those of tooth development, and to apply them to the dental clinics of CS syndromes. These new perspectives and future challenges in the field of both dental clinics and molecular genetics, more in particular the identification of possible candidate genes involved in both CS and dental defects, are discussed.

  7. Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes

    Bamigboye, Anthony A; Hofmeyr, G Justus


    Background Caesarean section is a very common surgical procedure worldwide. Suturing the peritoneal layers at caesarean section may or may not confer benefit, hence the need to evaluate whether this step should be omitted or routinely performed. Objectives The objective of this review was to assess the effects of non-closure as an alternative to closure of the peritoneum at caesarean section on intraoperative and immediate- and long-term postoperative outcomes. Search methods We searched the ...

  8. Technical note: subclavian artery misplacement of a 12F Shaldon catheter: percutaneous repair with a local closure device under temporary balloon tamponade; Technische Mitteilung: Entfernung eines fehlplatzierten 12F Shaldon Katheters aus der A. subclavia und Abdichtung mittels Verschlusssystem bei temporaerer Ballonblockade

    Wildberger, J.E.; Katoh, M.; Guenther, R.W. [Klinik fuer Radiologische Diagnostik, RWTH Aachen (Germany); Fussen, R. [Anaesthesiologische Klinik, Medizinisches Zentrum Kreis Aachen GmbH (Germany)


    A case of subsequent percutaneous repair using a local closure device with a collagen block (VasoSeal {sup registered}) and temporary balloon tamponade after inadvertent subclavian artery misplacement of a 12F Shaldon catheter is reported. Balloon occlusion safely prevented displacement of collagen into the vascular lumen by occluding the 12F entry site. Furthermore, collagen-induced coagulation was facilitated. (orig.)

  9. Restaurant closures

    Novae Restauration


    Christmas Restaurant closures Please note that the Restaurant 1 and Restaurant 3 will be closed from Friday, 21 December at 5 p.m. to Sunday, 6 January, inclusive. They will reopen on Monday, 7 January 2013.   Restaurant 2 closure for renovation To meet greater demand and to modernize its infrastructure, Restaurant 2 will be closed from Monday, 17 December. On Monday, 14 January 2013, Sophie Vuetaz’s team will welcome you to a renovated self-service area on the 1st floor. The selections on the ground floor will also be expanded to include pasta and pizza, as well as snacks to eat in or take away. To ensure a continuity of service, we suggest you take your break at Restaurant 1 or Restaurant 3 (Prévessin).

  10. Effectiveness of ultrasonographic evaluation of the cranial sutures in children with suspected craniosynostosis

    Simanovsky, Natalia; Hiller, Nurith; Koplewitz, Benjamin; Rozovsky, Katya [Hadassah Hebrew University Medical Center, Department of Medical Imaging, Mount, Scopus, P.O. Box 24035, Jerusalem (Israel)


    Computed tomography (CT) is the 'gold standard' for evaluation of the cranial sutures. While prenatal cranial suture evaluation with ultrasound (US) is common, US has not been established as a postnatal screening tool. We evaluated the effectiveness of US for diagnosis of craniosynostosis (CS). During 2006, 24 infants with questionable CS were assessed with US of the sagittal, metopic, and bilateral coronal and lambdoid sutures. US findings and clinical records were reviewed retrospectively. Sixteen boys and eight girls (ages 1-11 months, mean 4.3) underwent US. The correct diagnosis was provided in 23 (95%), with equivocal findings in one patient. Cranial sutures appeared normal in 15 infants, who had normal clinical presentation at mean 5.8 months follow-up; CT confirmation was obtained in two. In eight children, US identified premature closure of one or more cranial sutures. Three-dimensional CT was performed as a preparation for surgery in four, with classical CS findings. In one case with inconclusive US findings, CT showed narrow but open sutures. Sonographic examination of cranial sutures may serve as a first imaging tool for evaluation of craniosynostosis. CT may be reserved for children with abnormal or equivocal ultrasound and for preoperative planning. (orig.)

  11. Comparative study of the healing process of the aponeurosis of the anterior abdominal wall of rats after wound closure using 3-0 nylon suture and N-butil-2-cyanoacrylate tissue adhesive Estudo comparativo da cicatrização da aponeurose da parede abdominal anterior com a utilização do fio de poliamida monofilamentar 3-0 e o adesivo N-Butil-2-Cianoacrilato em ratos

    Carlos Augusto Marques Batista


    Full Text Available PURPOSE: To investigate the healing process of the aponeurosis of the anterior abdominal wall of rats, comparing two different materials for wound closure: 3-0 nylon suture and tissue adhesive N-butyl-2-cyanoacrylate. METHODS: Forty-four Wistar rats were randomly divided into four groups according to the type of material used (suture or adhesive and the number of days until reoperation (seven or 14 days. After a 4 cm incision in the aponeurosis, 22 rats underwent wound closure using 3-0 nylon suture and the other 22, the tissue adhesive. After seven days, 11 rats from each group were weighed again, submitted to reoperation and then euthanized. The same procedure was carried out after 14 days with the remaining rats. The surgical wound was macroscopically examined, the tensile strength was measured and the tissue edges were histologically examined. The statistical analysis was performed using analysis of variance and Cox's proportional hazards model. Significance level was set at p OBJETIVO: Investigar o processo de cicatrização da aponeurose da parede abdominal anterior em ratos, comparando dois diferentes materiais de sutura: fio de poliamida monofilamentar 3-0 e adesivo N-butil-2-cianoacrilato. MÉTODOS: Quarenta e quatro ratos Wistar, foram divididos aleatoriamente em quatro grupos, de acordo com o material de síntese (fio e adesivo cirúrgico e o tempo de reoperação (7 e 14 dias. Após uma incisão de 4 cm na aponeurose, 22 animais foram submetidos à síntese com o fio de poliamida e os outros 22 animais com o adesivo proposto. Após o procedimento, aguardou-se um período de 7 e 14 dias, quando os animais, 11 de cada grupo, foram novamente pesados e submetidos à eutanásia, sendo realizada a avaliação macroscópica da ferida operatória, mensuração da força de ruptura da parede abdominal e estudo histológico das bordas da incisão. A análise estatística foi realizada através de um modelo de análise de variância e de riscos

  12. An innovative method to evaluate the suture compliance in sealing the surgical wound lips

    Farid Saleh, Beniamino Palmieri, Danielle Lodi, Khalid Al-Sebeih


    Full Text Available Background and aim: The increasing number of surgical procedures performed with local anesthesia, followed by immediate patient discharge from the hospital, emphasizes the need for a tight waterproof suture that is capable of maintaining its tensile strength in the postoperative phase when the wound tumescence, edema due to the anesthetic drug, and surgical trauma disappear. Moreover, the issue of having an accurate surgical wound closure is very relevant in vivo in order to prevent hemorrhage and exogenous microbial infections. This study aimed at designing a new a lab technique that could be used for evaluating the best surgical material. Using such a technique, we compared the wound-lip-sealing properties of three commonly-used suture threads, namely polyurethane, polypropylene, and polyamide. Materials and methods: The mechanical properties of same-size suture threads made from polyurethane, polypropylene, and polyamide, were compared in order to define the one that possess the best elastic properties by being able to counteract the tension-relaxation process in the first 12 hours following surgery. The tension holding capacity of the suture materials was measured in both in vivo and in vitro experiments. The surface area of the scar associated with the three different suture threads was measured and compared, and the permeability of the three different suture threads was assessed at 0 minute, 2 minute, 4 minute, 6 minute, and 8 minute- interval. Results: Results showed that polyurethane suture threads had significantly (P < 0.05 better tensile strength, elongation endurance before breakage, and better elasticity coefficient as compared to polypropylene and polyamide suture threads. Moreover, polyurethane suture threads were significantly (P < 0.05 more impermeable as compared to the other two suture thread types (polypropylene and polyamide. This impermeability was also associated with a tighter wound-lip-sealing ability, and with

  13. Endoscopic management of common patologies with a new suturing system

    Fernando González-Panizo-Tamargo

    Full Text Available Background: Overstitch endoscopic suturing system (Apollo Endosurgery. Austin, Texas was created for NOTES procedures. As it demonstrated to be feasible, secure and effective in this field, further studies have evaluated its use in common gastrointestinal disorders in which current therapeutic tools, endoscopic or not, are not efficient or safe enough. Published results are promising. We present our initial experience with this system in the management of pathologies we usually face in our clinical practice. Method: Suturing system was evaluated for: 1. Endoscopic fixation of metallic stent to prevent migration in patients with gastrointestinal non-neoformative pathology. 2. Outlet reduction in patients with weight regain following Roux-en-Y gastric bypass. Results: During a period of 6 months Overstitch endoscopic suturing system was used in 5 patients: For stent fixation in 3 and for outlet reduction in 2. Technical success: Suture was performed in all the patients. Only 1 stitch was lost. Effectiveness: Stent fixation and outlet reduction were achieved in all the patients. However, in 1 patient the final anastomotic size was not close enough. Clinical success: Clinical recovery was achieved in all the patients in whom endoscopic stent fixation was performed. The patient which appropriated outlet closure developed a significant weight loss. The patient in which final size was not close enough did not lose weight. Conclusions: We found Overstitch endoscopic suturing system feasible, safe and effective, as it has been previously described. We encourage the publication of further studies evaluating the real utility of this tool, mostly taking into account that it allows a successful management of usual disorders for which there are not current effective therapies.

  14. Comparison of Exo-Seal(®) and Angio-Seal (®) for arterial puncture site closure: A randomized, multicenter, single-blind trial.

    Ketterle, Johannes; Rittger, Harald; Helmig, Inga; Klinghammer, Lutz; Zimmermann, Stefan; Hohenforst-Schmidt, Wolfgang; Brachmann, Johannes; Nef, Holger; Achenbach, Stephan; Schlundt, Christian


    The use of extravascular femoral closure devices in patients undergoing coronary angiography/intervention has not been sufficiently evaluated. We sought to define the impact of an extravascular polyglycolic acid (PGA) plug for the closure of a femoral access site in patients undergoing coronary angiography and/or percutaneous coronary intervention. In this prospective, single-blind, multicenter trial we randomly assigned 319 patients to vessel closure with Angio-Seal(®) or Exo-Seal(®). We hypothesized that the use of an extravascular closure device is not inferior to an anchor/plug-mediated device regarding the occurrence of the composite primary endpoint: hematoma > 5 cm, significant groin bleeding (TIMI major bleed), false aneurysm, and device failure. There was no significant difference in patient baseline characteristics or procedural results. After 24 h the primary endpoint occurred in nine patients (5.6 %) in the Angio-Seal(®) group and in 13 patients (8.2 %) inthe Exo-Seal(®) group (p = 0.38). Hematoma > 5 cm was noted in three patients (1.9 %) receiving Angio-Seal(®) vs. two patients (1.3 %) receiving Exo-Seal(®) (p = 0.99). In one patient (0.6 %) of the Exo-Seal(®) group, TIMI major bleeding occurred, requiring transfusion (p = 0.49). There were four (2.5 %) false aneurysms found in patients treated with Angio-Seal(®) and two (1.3 %) in patients treated with Exo-Seal(®) (p = 0.68). There was a trend for a higher incidence of device failure in the Exo-Seal(®) group (1.2 vs. 5.2 %, p = 0.06). At telephone interview after 30 days, there was no significant difference found regarding the events readmission with surgery of puncture site, infection, bleeding, hematoma, or pain. In the present study, there were no significant differences found regarding the occurrence of hematoma > 5 cm, major bleeding, false aneurysm, and device failure between Angio-Seal(®) and Exo-Seal(®) 24 h after device implantation.

  15. Intracardiac ultrasonic suture welding for knotless mitral valve replacement.

    Ruel, Marc; Streeter, Richard B; de la Torre, Ralph; Liddicoat, John R; Cohn, William E


    The difficulty in tying multiple knots with endoscopic instruments constitutes a technical obstacle to the development of closed-chest valve surgery. The following set of experiments was undertaken to ascertain the in-vivo feasibility of using an intracardiac ultrasonic welding device for knotless suture fixation during mitral valve replacement (MVR). Five adult sheep weighing 48-52 kg underwent MVR with a commercially available mechanical prosthesis, using pledgetted interrupted polypropylene sutures. An ultrasonic suture welder designed for intracardiac use was used to adjust suture tension and fuse strands together without knots. Echocardiographic assessment of the mitral prosthesis was carried out at baseline and after maintenance of supraphysiologic arterial pressures for 60 min. Subsequently, the animals' explanted hearts were assessed under sustained left ventricular (LV) pressurization to 180 mmHg in an ex-vivo pressure-loop system. MVR was successfully performed in all animals and welds reliably completed in less than 1 s. One sheep could not successfully be weaned off cardiopulmonary bypass; however, a normal prosthetic valve implant was confirmed at post-mortem examination. Echocardiographic assessment prior to and during LV pressurization revealed normal seating and function of the prosthesis in all cases. At post-mortem examination all valves were adequately implanted, suture tails laid flat on the surface of the prosthesis' sewing ring, welded suture strands were intact and accurately point-fused together, and no evidence of perivalvular leak was found around any of the prostheses despite sustained LV pressurization. This new modality proved reliable in an acute sheep model of MVR and could constitute a promising avenue towards facilitation of total endoscopic valve procedures in humans.

  16. Application analysis on different suture of scleral flap in trabeculectomy

    Ning Liu


    Full Text Available AIM: To research the application of scleral flap suture in trabeculectomy. METHODS: Totally 114 primary angle-closure glaucoma patients, aged from 36-72 years old, were selected as the objects, and randomly divided into research group and control group. The two groups received different administration methods. Traditional sewing method of sclera flap was used in research group and improved sewing method of sclera flap was used in control group. RESULTS: There was statistical differences between postoperative intraocular pressure of the patients in the observation group and the control group after 1d; 2wk; 1, 3mo(PPP>0.05.CONCLUSION: It is safe and effective that the improved sewing method of sclera flap for trabeculectomy of acute angle-closure glaucoma, and it is a better method to avoid the occurrence of shallow anterior chamber than the traditional sewing method in the early stage after operation.

  17. Sutured Floer homology and hypergraphs

    Juhász, András; Rasmussen, Jacob


    By applying Seifert's algorithm to a special alternating diagram of a link L, one obtains a Seifert surface F of L. We show that the support of the sutured Floer homology of the sutured manifold complementary to F is affine isomorphic to the set of lattice points given as hypertrees in a certain hypergraph that is naturally associated to the diagram. This implies that the Floer groups in question are supported in a set of Spin^c structures that are the integer lattice points of a convex polytope. This property has an immediate extension to Seifert surfaces arising from homogeneous link diagrams (including all alternating and positive diagrams). In another direction, together with work in progress of the second author and others, our correspondence suggests a method for computing the "top" coefficients of the HOMFLY polynomial of a special alternating link from the sutured Floer homology of a Seifert surface complement for a certain dual link.

  18. Treatment of a coronary artery to superior vena cava fistula resulting from early closure of a Possis Perma-Flow graft.

    Graham, M M; Kells, C M; Sullivan, J; O'Neill, B J


    The Perma-Flow graft used in bypass surgery achieves more complete revascularization when paucity of native conduits exists. We report a coronary artery to superior vena cava fistula as a complication of this graft, leading to severe right heart failure. The fistula was successfully occluded percutaneously, improving the patient's clinical situation.

  19. Vascular anomalies, sutures and small canals of the temporal bone on axial CT

    Koesling, Sabrina [Department of Diagnostic Radiology, University of Halle, E. Grube Str. 40, 06097 Halle (Germany)]. E-mail:; Kunkel, Petra [Department of Diagnostic Radiology, University of Leipzig (Germany); Schul, Thomas [Department of Diagnostic Radiology, University of Leipzig (Germany)


    Purpose: Subtle bony structures, small canals and fine sutures cause sometimes problems in the analysis of CTs of the temporal bone. The aim of this study was: to analyze the visibility of subtle structures and to estimate the incidence of vascular anomalies. Patients and method: We retrospectively analyzed axial scans of 223 high-resolution CTs of the temporal bone obtained as single slice or spiral CT with 1 mm slice thickness. All CTs had clinical indications. Two experienced radiologists studied CTs regarding the visibility of the fine sutures, fissures and small canals and the occurrence of vascular anomalies. Results: The following structures were seen commonly: sphenosquamosal suture (76%), arcuate artery canal (93%), vestibular aqueduct (89%), mastoid emissary vein (82%), singular canal (56%). Not so commonly were observed: tympanosquamosal suture (31%), mastoid canaliculus (28%), lateral sigmoid sinus (28%), petrotympanic fissure (24%), tympanomastoid suture (10%). Seldom we identified: the inferior tympanic canaliculus (6%), high jugular bulb (6%), anterior sigmoid sinus (5%), dehiscent internal carotid artery canal (2%), persistent petrosquamosal sinus (1%), dehiscent jugular bulb (1%). Persistent stapedial artery, aberrant internal carotid artery, dehiscent jugular bulb, high jugular bulb with diverticulum, anterior and dehiscent sigmoid sinus were detected in below 1% of the analyzed temporal bones. The frequency of asymmetry of the jugular foramen, which varied between 3% and 42%, depended on different criterions of size. Conclusion: A profound knowledge of normal anatomy and anomalies of the temporal bone avoids misinterpretation as pathological lesions and iatrogenic bleedings.

  20. Surgical repair of true left ventricular aneurysm in an infant: a rare complication after unsuccessful perventricular VSD closure.

    Ozyilmaz, Isa; Saygi, Murat; Yildiz, Okan; Erek, Ersin; Guzeltas, Alper


    A 2.5-month-old female patient presented for closure of a ventricular septal defect (VSD). Transthoracic echocardiography showed a large muscular ventricular septal defect. After perventricular closure of the defect was performed with an Amplatzer muscular VSD occluder, peroperative transesophageal echocardiography revealed that the device had been implanted in the wrong area of the ventricular septum. The device was retrieved and a large mid-muscular defect with extension to the outlet septum was closed with a patch of Dacron which was secured with 5-0 sutures. A perforation in the ventricular septum due to attempted perventricular device delivery was seen, and it was repaired primarily. In the eighth month of follow-up, transthoracic echocardiography revealed an aneurysm in the posterior wall of the left ventricle. The patient's electrocardiogram showed pathological Q waves and ST-segment elevation in leads DII, DIII, and aVF consistent with subacute inferior myocardial infarction. At subsequent surgery, this was found to be a true aneurysm, located in area of distribution of the obtuse marginal branch of the left circumflex coronary artery in the posterior wall of the left ventricle. The aneurysm was closed off using a Dacron patch, and the sac was resected. Development of a true aneurysm is a rare but important complication of attempted perventricular VSD closure.

  1. [Percutaneous closure of patent ductus arteriosus: results and costs compared to surgical closure].

    Vieu, T; Beaurain, S; Angel, C; Leriche, H; Petit, J; Conso, J F; Planché, C; Losay, J


    The comparison of the clinical results and costs of the two methods of closure of patient ductus arteriosus was undertaken in two comparable groups of 40 patients treated in the same period in the same hospital. After transcatheter closure there was a 9% residual shunt rate at 3 years, the 2 patients with a residual continuous murmur being operated secondarily. The only complication was severe haemolysis which regressed after transcatheter ablation of the prosthesis. After surgical closure, there were no residual shunt. Some postoperative complications were observed in 20% of cases, usually benign (ventilatory problems, dysphonia or urinary infection), but occasionally more serious (peroperative lesion of the pulmonary artery). Morbidity, inherent to the technique of closure, was very different and much less in catheter closure. The average cost (daily cost x average length of hospital stay) was much less with transcatheter closure 38,558 francs versus 11,240 francs. On the other hand, the direct cost of transcatheter closure was greater than that of surgery: 32,798 francs versus 20,903 francs, the difference being related to the actual price of the prosthesis. The authors conclude that the 3 year results of transcatheter closure of patent ductus arterious make this technique a reasonable therapeutic alternative to surgery. From the safety point of view, the two techniques are comparable bu patient confort is greater with transcatheter closure for an increase in cost of the initial procedure which should decrease in relation to the types and prices of the prosthesis used.

  2. Experimental study on tissue phantoms to understand the effect of injury and suturing on human skin mechanical properties.

    Chanda, Arnab; Unnikrishnan, Vinu; Flynn, Zachary; Lackey, Kim


    Skin injuries are the most common type of injuries occurring in day-to-day life. A skin injury usually manifests itself in the form of a wound or a cut. While a shallow wound may heal by itself within a short time, deep wounds require surgical interventions such as suturing for timely healing. To date, suturing practices are based on a surgeon's experience and may vary widely from one situation to another. Understanding the mechanics of wound closure and suturing of the skin is crucial to improve clinical suturing practices and also to plan automated robotic surgeries. In the literature, phenomenological two-dimensional computational skin models have been developed to study the mechanics of wound closure. Additionally, the effect of skin pre-stress (due to the natural tension of the skin) on wound closure mechanics has been studied. However, in most of these analyses, idealistic two-dimensional skin geometries, materials and loads have been assumed, which are far from reality, and would clearly generate inaccurate quantitative results. In this work, for the first time, a biofidelic human skin tissue phantom was developed using a two-part silicone material. A wound was created on the phantom material and sutures were placed to close the wound. Uniaxial mechanical tests were carried out on the phantom specimens to study the effect of varying wound size, quantity, suture and pre-stress on the mechanical behavior of human skin. Also, the average mechanical behavior of the human skin surrogate was characterized using hyperelastic material models, in the presence of a wound and sutures. To date, such a robust experimental study on the effect of injury and sutures on human skin mechanics has not been attempted. The results of this novel investigation will provide important guidelines for surgical planning and validation of results from computational models in the future.

  3. Unusual sutural bones at pterion

    Nayak SB


    Full Text Available The existence of Wormian (sutural bones in the skull is well known. We found three unusual Wormian bones at the right pterion in an adult Indian skull. The variation noted was unilateral. This type of variation has not been reported yet.

  4. Design of closure works

    Verhagen, H.J.


    This chapter discusses the design aspects of estuary and river closures and those of reservoir dams and certain other hydraulic structures. The focus of this chapter is on closures, not on the situation after the closure has been completed.

  5. Braiding Parameters of Medical Silk Braided Suture

    张佩华; 吴建华


    The relationships between braiding parameters and properties of medical silk braided suture are investigated. Experimental results indicate that the main factors affecting the suture properties include the proportion of core silk and shell silk, braiding density and braiding tension. The results show that the braiding technology significantly influences the suture properties and the optimal braiding parameters were obtained by using the regression method.

  6. Keratometric astigmatism after ECCE in eastern Nepal. Continuous versus interrupted sutures.

    Sood Archana


    Full Text Available Purpose: The study aimed to compute and compare the keratometric astigmatism induced by wound closure with continuous and interrupted sutures in conventional extracapsular cataract extraction with intraocular lens implantation at a single centre in eastern Nepal. Methods: Sixty eyes of 60 patients were included in the study. All patients received conventional extracapsular cataract extraction and single piece modified C-loop posterior chamber intraocular lens. Thirty eyes were sutured with continuous (Group 1 and 30 eyes with interrupted sutures (Group 2. The results were analysed by the unpaired student′s t-test. Results: At the end of 6 weeks, Group 1 patients had significantly higher astigmatism (3.53 ± 2.19D compared to Group 2 patients (1.7 ± 1.35. A majority of patients in both groups had with-the-rule astigmatism throughout the postoperative period. Conclusion: Interrupted sutures cause less astigmatism than continuous suture. The factors responsible for high astigmatism in continuous sutures call for further analysis.

  7. Combined suture and clipping for the reconstruction of a ruptured blister-like aneurysm.

    Kantelhardt, Sven R; Archavlis, Eleftherios; Giese, Alf


    Blister-like aneurysms of the internal carotid artery (ICA) present a severe therapeutical challenge. While several reconstructive techniques are in use in case of acute rupture sacrifice of the parent vessel may be required. We present a combined technique of micro-sutures and clip application to repair the parent vessel in an intraoperatively ruptured blister-like aneurysm. Following temporary trapping of an intraoperatively ruptured 7-mm blister-like aneurysm four 8-0 nylon sutures were applied to adapt the vessel walls and support the branches of subsequently applied mini-clips. The combination of micro-sutures and mini-clips might be a valuable alternative to direct clipping or suturing in some cases with intraoperative rupture of blister-like aneurysms.

  8. Chitosan pads vs. manual compression to control bleeding sites after transbrachial arterial catheterization in a randomized trial; Randomisierte Untersuchung zur Anwendung eines Chitosan-Gerinnungspads zur Blutstillung bei transbrachialen Angiographien

    Poretti, F.; Rosen, T.; Koerner, B.; Vorwerk, D. [Inst. fuer diagnostische und interventionelle Radiologie, Klinikum Ingolstadt (Germany)


    Purpose: until now, no mechanical closure devices were available to achieve fast and secure hemostasis for vessel closure after catheterization of small arterial vessels. Material and methods: eighty patients were randomized to evaluate the effect on hemostasis by use of a chitosan pad (Chito-Seal, Abbott Vascular Devices, Galway/Ireland) in comparison to manual compression after diagnostic transbrachial arterial catheterization. Hemostasis after three minutes and one hour as well as local development of a hematoma after one and twenty-four hours were assessed. Results: the use of chitosan pads significantly decreased the bleeding time in the first three minutes after manual compression time (p < 0.01). Significant decrease in bleeding risk at three minutes by use of the chitosan closure pads was also found in subgroups of patients with hypertension (p < 0.001) or diabetes (p < 0.01) and also in patients under anticoagulation therapy (p < 0.01). In addition, long-term protection from bleeding complications such as the risk of hematoma was decreased by the use of chitosan closure pads one hour (p < 0.01) or twenty-four hours (p < 0.001) after catheter removal. Conclusion: the use of an intravascular anchor or suture system is not safely applicable in these vessels due to the small diameter of the brachial artery. Our results document a significant improvement in hemostasis by using chitosan pads in these cases. (orig.)

  9. An Alternative Alar Cinch Suture

    Rauso, Raffaele; Freda, Nicola; Curinga, Giuseppe; Del Pero, Claudio; Tartaro, Gianpaolo


    Nasal widening is commonly associated to maxillary osteotomies, but it is only partially dependent on the amount of skeletal movement. Techniques for controlling lateralization of the ala, including the alar base cinch technique, originally described by Millard, have been well reported by Collins and Epker and later modified by others. In this article, authors report the effect of a new alar cinch suture technique on a sample of 32 patients. PMID:21187940

  10. Suture anchor versus suture through tunnel fixation for quadriceps tendon rupture: a biomechanical study.

    Lighthart, William A; Cohen, David A; Levine, Richard G; Parks, Brent G; Boucher, Henry R


    This biomechanical study compared suture anchors versus transosseous sutures for repair of quadriceps tendon ruptures using a force of 150 N at a frequency of 0.5 Hz. No significant difference in displacement was found between the 2 techniques with initial loading or with load or no load after 1000 cycles. Displacement after 1000 cycles for suture anchors and bone tunnels was 4.65 and 4.50 mm, respectively. These findings suggest a possible role for suture anchors in repairing quadriceps tendon ruptures. Suture anchors are relatively expensive but require less dissection over the patella and do not involve suture placement about the patella tendon.

  11. Tracheocutaneous fistula closure using a Cartilo-musculo-cutaneous bilobed flap.

    Petersen, Wiebke; Amr, Amro; Held, Manuel; Werner, Jan-Ole; Schaller, Hans-Eberhard; Rahmanian-Schwarz, Afshin


    In general, the development of a tracheocutaneous fistula (TCF) after tracheotomy is a seldom but recurrent clinical problem in long-term ventilated patients. In cases of prolonged wound healing with no spontaneous wound closure or insufficient later closure by secondary suture, different surgical procedures have been previously described for the closure of TCFs. Nonetheless, each procedure has its individually associated complications so that definite closure of TCFs still remains a challenge. The purpose of this case report is to present a unique case of a patient with a persistent TCF that was successfully closed using a local cartilo-musculo-cutaneous bilobed flap.

  12. Is the pterygopalatomaxillary suture (sutura sphenomaxillaris) a growing suture in the fetus?

    Vacher, C; Onolfo, J P; Barbet, J P


    The pterygopalatomaxillary suture is considered as having an important role in the posteroanterior growing of the maxilla. To determine whether this suture is a growing suture in the fetus, we performed a histological study of this suture in a fetus aged of 16 weeks of amenorrhea. Serial sections (5 microm) of the pterygopalatomaxillary suture area have been performed. Fibrous sutures are separating four pieces of ossification (maxilla, palatine bone, lateral and medial plates of the pterygoid process). A fibroblastic growing site has been observed on the dorsal aspect of the pterygopalatomaxillary suture, in contact to the anterior border of the lateral plate of the pterygoid process. The posteroanterior growing of maxilla is dependent on a growing suture located on the anterior border of the pterygoid process. The pterygoid process (via its lateral plate) makes the junction between the maxilla and both the cranial base and the condylar mandibular site of growth.

  13. Influence of surgical sutures on wound healing

    Mirković Siniša


    Full Text Available Historical data on closing and suturing of surgical wounds describe a wide range of various suture materials. The choice of the surgical catgut, i.e. the type and diameter, depends on the locality, characteristics and condition of the tissue to be treated. From the standpoint of oral-surgical practice the following clinical parameters are of outstanding importance with respect to the selection of suture material: accumulation of soft deposits on the sutures, score of the adjacent soft tissues and dehiscence of the operative wound. Our prospective clinical study included 150 patients distributed into three groups of 50 subjects. The surgical procedure performed on each patient involved resection (apicotomy of the tooth root end in the intercanine sector of the upper jaw. The following suture materials were applied: Black Silc 5-0, Nylon 5-0 and Vicryl 5-0. The effects of the selected sutures were evaluated according to the wound dehiscence. The effects of the applied sutures were recorded on Days 2, 5 and 7 after the surgery. The comparison of cited parameters of the investigated materials after suturing the oral mucosa revealed that none of the used material was ideal; however, a certain advantage might be given to the synthetic monofilament suture materials.

  14. Current practice of abdominal wall closure in elective surgery – Is there any consensus?

    Ridwelski Karsten


    Full Text Available Abstract Background Development of incisional hernia after open abdominal surgery remains a major cause of post-operative morbidity. The aim of this study was to determine the current practice of surgeons in terms of access to and closure of the abdominal cavity in elective open surgery. Methods Twelve surgical departments of the INSECT-Trial group documented the following variables for 50 consecutive patients undergoing abdominal surgery: fascial closure techniques, applied suture materials, application of subcutaneous sutures, subcutaneous drains, methods for skin closure. Descriptive analysis was performed and consensus of treatment variables was categorized into four levels: Strong consensus >95%, consensus 75–95%, overall agreement 50–75%, no consensus Results 157 out of 599 patients were eligible for analysis (85 (54% midline, 54 (35% transverse incisions. After midline incisions the fascia was closed continuously in 55 patients (65%, using slowly absorbable (n = 47, 55%, braided (n = 32, 38% sutures with a strength of 1 (n = 48, 57%. In the transverse setting the fascia was closed continuously in 39 patients (72% with slowly absorbable (n = 22, 41% braided sutures (n = 27, 50% with a strength of 1 (n = 30, 56%. Conclusion In the present evaluation midline incision was the most frequently applied access in elective open abdominal surgery. None of the treatments for abdominal wall closure (except skin closure in the midline group is performed on a consensus level.

  15. Randomized Clinical Trial of Anal Cushion Suture-fixation Comparing with Doppler-Guided Haemor-rhoid Artery Ligation for Grade III Haemorrhoids%肛垫缝扎修复术治疗III度痔的临床对照研究

    翟敏; 巫益珍; 张永安; 李金德; 张旗; 周峰; 徐慧磊


    目的:探讨肛垫缝扎修复术治疗III度痔的疗效。方法:对100例III度痔患者随机分组,50例采用肛垫缝扎修复术(治疗组)治疗,50例采用超声多普勒痔动脉结扎术(DG-HAL,对照组)治疗,对两组疗效、并发症及患者满意度进行对比分析。结果:治疗组治愈率为86%,优于对照组的70%,(P<0.05);治疗组治疗费用为3138.09元,对照组为4020.43元(二者比较P<0.05)。随访24个月,治疗组痔脱垂(2.3%)及总体复发率(7.0%)低于对照组(19.0%,23.8%,P<0.05);治疗组患者认为“好”、“很好”者分别为42例(95.4%)、39例(90.7%),对照组分别为37例(88.9%)、32例(76.2%);两组术后疼痛、Wexner评分、继发出血、肛门不适等均具有较好的安全性(P>0.05)。结论:肛垫缝扎修复术与DG-HAL相比,能有效解除III度痔病症状,有效、经济、安全,具有更高的患者满意度。%Objective To investigate anal cushion suture-fixation operation in the treatment of grade III hem⁃orrhoids. Methods One hundred cases of grade III hemorrhoids were randomly divided into treatment group (anal cushion suture-fixation operation,50 cases)and control group(Doppler-guided hemorrhoidal artery ligation DG-HAL),50 cases.The clinical effects and complications were compared between the two groups. Results Cure rates were 86% in treatment group and 70% in the control(P0.05)in complications, in postoperative pain scores,Wexner scores,bleeding, and the anal discomfort. Conclusion Anal cushion suture-fixation operation is valid in eliminating symptoms induced by grade III hemorrhoids.It is effective, economical and with better sat⁃isfaction than by DG-HAL.

  16. Comparative histology of some craniofacial sutures and skull-base synchondroses in non-avian dinosaurs and their extant phylogenetic bracket.

    Bailleul, Alida M; Horner, John R


    Sutures and synchondroses, the fibrous and cartilaginous articulations found in the skulls of vertebrates, have been studied for many biological applications at the morphological scale. However, little is known about these articulations at the microscopic scale in non-mammalian vertebrates, including extant archosaurs (birds and crocodilians). The major goals of this paper were to: (i) document the microstructure of some sutures and synchondroses through ontogeny in archosaurs; (ii) compare these microstructures with previously published sutural histology (i.e. that of mammals); and (iii) document how these articulations with different morphological degrees of closure (open or obliterated) appear histologically. This was performed with histological analyses of skulls of emus, American alligators, a fossil crocodilian and ornithischian dinosaurs (hadrosaurids, pachycephalosaurids and ceratopsids). Emus and mammals possess a sutural periosteum until sutural fusion, but it disappears rapidly during ontogeny in American alligators. This study identified seven types of sutural mineralized tissues in extant and extinct archosaurs and grouped them into four categories: periosteal tissues; acellular tissues; fibrous tissues; and intratendinous tissues. Due to the presence of a periosteum in their sutures, emus and mammals possess periosteal tissues at their sutural borders. The mineralized sutural tissues of crocodilians and ornithischian dinosaurs are more variable and can also develop via a form of necrosis for acellular tissues and metaplasia for fibrous and intratendinous tissues. It was hypothesized that non-avian dinosaurs, like the American alligator, lacked a sutural periosteum and that their primary mode of ossification involved the direct mineralization of craniofacial sutures (instead of intramembranous ossification found in mammals and birds). However, we keep in mind that a bird-like sutural microstructure might have arisen within non-avian saurichians. While

  17. Closure Issues with Families.

    Craig, Steven E.; Bischof, Gary H.

    Closure of the counseling relationship constitutes both an ending and a beginning. Although closure signifies the ending of the present counseling relationship, many family counselors conceptualize closure as the start of a working relationship between counselor and family that may be summoned in future times of crisis or during a difficult life…

  18. Mesenchymal stem cell-coated sutures enhance collagen depositions in sutured tissues.

    Casado, Javier G; Blazquez, Rebeca; Jorge, Inmaculada; Alvarez, Veronica; Gomez-Mauricio, Guadalupe; Ortega-Muñoz, Mariano; Vazquez, Jesus; Sanchez-Margallo, Francisco M


    Sutures are commonly used for surgical procedures and new sutures are being developed to improve wound healing. In the past decade, it has been extensively shown that mesenchymal stem cells (MSCs) have a wound healing potential. To benefit the overall wound healing process, we aimed to analyze the usage of pretreated sutures for improving the implantation of MSCs in the tissues. Our results firstly showed that suture pretreatments with gelatin, poly-L-lysine, and NaOH improved the adhesive strength of MSCs to sutures. These cells remained surrounding the sutured tissue and no significant phenotypic changes were found in those cells cultured onto pretreated sutures. In vivo experiments showed that the implantation of MSCs by suturing increases the collagen content in the sutured tissue. Moreover, proteomics analysis of secreted proteins showed that collagen alpha-1(I) chain was the most abundant collagen found. To our knowledge, this is the first report that aimed to improve the implantation of MSCs in tissue by suture pretreatments. Moreover, in vivo experiments suggest that MSC-coated sutures may enhance wound healing and tissue remodeling through the release of different collagen types being applicable for those patients that tend to have difficulty healing.

  19. Comparison between tenocutaneous suture and Kessler suture techniques in treating acute closed Achilles tendon rupture.

    Ding, Wen-Ge; Li, Huan; Zhu, Ya-Ping; Liu, Zhi-wei


    To compare the effectiveness of tenocutaneous suture and conventional Kessler suture techniques in treating acute closed Achilles tendon rupture. A total of 33 patients with acute closed Achilles tendon rupture who were admitted to our hospital from February 1998 to December 2008 underwent repair with either a tenocutaneous suture or Kessler suture technique. All patients were followed up for 1-5 years (mean, 3 years). According to the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, the excellence rate was 91% in the Kessler suture group and 98% in the tenocutaneous suture group, with a significant difference between groups. Our tenocutaneous suture technique is an effective method for treating Achilles tendon rupture. It has certain advantages compared with the conventional incision method and is worthy of wide clinical application. Copyright © 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  20. New adjustable suture technique for trabeculectomy

    Vespasiano Rebouças-Santos


    Full Text Available PURPOSE: To describe an adjustable suture (AS experimental model that allows for tightening, loosening and retightening of the suture tension in trabeculectomy. METHODS: Standard trabeculectomy was performed in fifteen pig eyeballs. All pig eyes were tested twice: one test with conventional suture in both flap's corners (conventional suture group and another test with a conventional suture at one corner and an adjustable suture in the other corner (AS group. The order in which each test was performed was defined by randomization. Intraocular pressure was measured at three time points: T1 when the knots were tightened; T2 when the AS was loosened or the conventional knot was removed; and T3 when the AS was retightened in the AS group or five minutes after the knot removal in the conventional suture group. RESULTS: The mean Intraocular pressure was similar between the two groups at time point 1 (p=0.97. However, significant Intraocular pressure differences were found between eyes in the conventional and adjustable suture groups at time points 2 (12.6 ± 4.2 vs 16.3 ± 2.3 cmH2O, respectively, p=0.006 and 3 (12.2 ± 4.0 vs 26.4 ± 1.7cmH2O, respectively; p=0.001. While the conventional technique allowed only Intraocular pressure reduction (following the knot removal; T2 and T3, the AS technique allowed both Intraocular pressure reduction (T2 and elevation (T3 through the management (loosening and retightening of the suture. CONCLUSION: This experimental model provides an effective noninvasive postoperative mechanism of suture tension adjustment.

  1. Evaluation of cosmetic appearance of herniotomy wound scars in African children: Comparison of tissue glue and subcuticular suturing

    Ademuyiwa A


    Full Text Available Aim: To evaluate the cosmetic appearance of herniotomy wound scars closed using either the tissue glue or subcuticular suturing technique. Materials and Methods: Prospective randomised control study; randomisation into tissue glue and suturing groups. Ethical clearance obtained. Cosmetic outcome were based on visual analogue scale by parents and Hollander wound evaluation scale by a Plastic Surgeon blinded to the wound closure method. Results: Fifty one wounds were evaluated, 26 in the tissue glue group and 25 in the suturing group. Parents′ evaluation using Visual Analogue scale (VAS showed that in the suturing group, 17 parents (68% gave a VAS of 8cm while six parents (24% gave a score of 7cm. Two parents (8% gave a score of 9cm. In the tissue glue group, 22 parents (84.6% scored the scar of their children as 8 or 9cm on the VAS while four parents (15.4% gave a score of 7cm. The median VAS was 8cm for both groups with a range of 7 to 9cm. The Chi- square test showed that the parents preferred tissue glue compared with subcuticular suturing (X2 = 7.90, P < 0.05. The Hollander Wound Evaluation Scale (HWES used by Plastic Surgeon showed 21 herniotomy wounds (84% had a score of 6 in the suturing group while four wounds (16% had a score of 5. In the tissue glue group, 19 wounds (73% had a score of 6, six wounds (23.1% had a score of 5 and a patient (3.8% had a score of 4. The median score is 6 for both groups. There was no statistically significant difference between both groups (X 2 = 1.481, P = 0.393. Conclusion: This study has shown that the cosmetic outcome of wound closure using the tissue glue technique and subcuticular suturing technique are similar.

  2. Technique of temporary subcutaneous "Figure-of-Eight" sutures to achieve hemostasis after removal of large-caliber femoral venous sheaths.

    Cilingiroglu, Mehmet; Salinger, Michael; Zhao, David; Feldman, Ted


    Over the last decade, significant advances have been made in percutaneous treatment of structural heart diseases. Many of these interventions require insertion of large caliber sheaths in the femoral veins. Manual compression, compression devices, and various closure devices have been used for removal of large-sized venous sheaths. Here, we describe the use of a temporary subcutaneous "Figure-of-Eight" suture technique for venous access site closure after removal of large-caliber sheaths.

  3. Inadvertent Entrapment of a Central Venous Catheter by a Purse-String Suture during Cardiopulmonary Bypass: A Case Report

    Abdorasoul Anvaripour


    Full Text Available A 65-year-old female patient with severe mitral valve stenosis plus coronary artery disease was scheduled for mitral valve replacement and 2-vessel coronary artery bypass graft (CABG surgeries simultaneously. After a successful procedure, resistance was met on a CVC withdrawal. During postoperative fluoroscopy, fixation of the catheter at the heart was confirmed which necessitated reopening the chest, cutting the suture, and removing the catheter. When a catheter became hard to withdraw after open heart surgery, we should never withdraw it forcefully and blindly. Although rare, one should consider inadvertent entrapment of CVC by a suture as the possible cause.

  4. Closure The Definitive Guide

    Bolin, Michael


    If you're ready to use Closure to build rich web applications with JavaScript, this hands-on guide has precisely what you need to learn this suite of tools in depth. Closure makes it easy for experienced JavaScript developers to write and maintain large and complex codebases -- as Google has demonstrated by using Closure with Gmail, Google Docs, and Google Maps. Author and Closure contributor Michael Bolin has included numerous code examples and best practices, as well as valuable information not available publicly until now. You'll learn all about Closure's Library, Compiler, Templates, tes

  5. Comparison between two thoracotomy closure techniques: postoperative pain and pulmonary function

    Juliana Duarte Leandro


    Full Text Available OBJECTIVE: To compare two thoracotomy closure techniques (pericostal and transcostal suture in terms of postoperative pain and pulmonary function. METHODS: This was a prospective, randomized, double-blind study carried out in the Department of Thoracic Surgery of the Luzia de Pinho Melo Hospital das Clínicas and at the University of Mogi das Cruzes, both located in the city of Mogi das Cruzes, Brazil. We included 30 patients (18-75 years of age undergoing posterolateral or anterolateral thoracotomy. The patients were randomized into two groups by the type of thoracotomy closure: pericostal suture (PS; n = 16 and transcostal suture (TS; n = 14. Pain intensity during the immediate and late postoperative periods was assessed by a visual analogic scale and the McGill Pain Questionnaire. Spirometry variables (FEV1, FVC, FEV1/FVC ratio, and PEF were determined in the preoperative period and on postoperative days 21 and 60. RESULTS: Pain intensity was significantly greater in the PS group than in the TS group. Between the preoperative and postoperative periods, there were decreases in the spirometry variables studied. Those decreases were significant in the PS group but not in the TS group. CONCLUSIONS: The patients in the TS group experienced less immediate and late post-thoracotomy pain than did those in the PS group, as well as showing smaller reductions in the spirometry parameters. Therefore, transcostal suture is recommended over pericostal suture as the thoracotomy closure technique of choice.

  6. Rash with DERMABOND PRINEO Skin Closure System Use in Bilateral Reduction Mammoplasty: A Case Series

    R. W. Knackstedt


    Full Text Available Background. Bilateral reduction mammoplasty is a common plastic surgery procedure that can be complicated by unfavorable scar formation along incision sites. Surgical adhesives can be utilized as an alternative or as an adjunct to conventional suture closures to help achieve good wound tension and provide an adequate barrier with excellent cosmesis. The recently introduced DERMABOND PRINEO Skin Closure System Skin Closure System combines the skin adhesive 2-octyl cyanoacrylate with a self-adhering polyester-based mesh. Proposed benefits of wound closure with DERMABOND PRINEO Skin Closure System, used with or without sutures, include its watertight seal, easy removal, microbial barrier, even distribution of tension, and reduction in wound closure time. Although allergic reactions to 2-octyl cyanoacrylate have been reported, few allergic reactions to DERMABOND PRINEO Skin Closure System have been noted in the literature. This case series describes three patients who experienced an allergic reaction to DERMABOND PRINEO Skin Closure System after undergoing elective bilateral reduction mammoplasties at our institution to further explore this topic. Methods. Retrospective chart review of bilateral reduction mammoplasty patients who received DERMABOND PRINEO Skin Closure System dressing at our institution was performed. Results. Three patients were identified as having a rash in reaction to DERMABOND PRINEO Skin Closure System after bilateral reduction mammoplasty. All three patients required systemic steroid treatment to resolve the rash. One patient was identified as having a prior adhesive reaction. Conclusions. DERMABOND PRINEO Skin Closure System has demonstrated its efficacy in optimizing scar healing and appearance. However, as we demonstrate these three allergic reactions to DERMABOND PRINEO Skin Closure System, caution must be utilized in its usage, namely, in patients with a prior adhesive allergy and in sites where moisture or friction may

  7. Induction of immune gene expression and inflammatory mediator release by commonly used surgical suture materials: an experimental in vitro study.

    Lock, Alistair M; Gao, Ryan; Naot, Dorit; Coleman, Brendan; Cornish, Jillian; Musson, David S


    Surgeons have a range of materials to choose from to complete wound closure, yet surprisingly very little is still known about the body's immune response to the suture materials in current use. The growing literature of adverse suture material reactions provided the objective of this study, to use in vitro assays to quantify levels of inflammation produced by seven commonly used suture materials in surgical procedures. Human monocyte/macrophage THP-1 cells were exposed to suture materials for 1, 3 and 5 days. Gene expression and protein secretion of six inflammatory cytokines and two cell surface markers were assessed using qPCR and ELISA respectively, with LPS exposure providing a positive control. Furthermore, a IL-1β/IL-1RA marker ratio was assessed to determine the balance between pro-/anti-inflammatory expression. The findings from our in vitro study suggest that four commonly used suture materials cause upregulation of pro-inflammatory markers indicative of an early foreign body reaction, with no balance from anti-inflammatory markers. As prolonged early pro-inflammation is known to produce delayed wound healing responses, the knowledge produced from this study has potential to improve informed surgical decision making and patient safety. This work has the capability to reduce suture-related adverse immune reactions, and therefore positively affect patient outcomes.

  8. Pectoralis major tendon repair: a biomechanical study of suture button versus transosseous suture techniques.

    Thomas, William; Gheduzzi, Sabina; Packham, Iain


    Pectoralis major tendon avulsion injury benefits from surgical repair. The technique used and speed of rehabilitation in this demanding population remains subject to debate. We performed a biomechanical study comparing suture button (Pec Button™, Arthrex, Naples, FL) with a transosseous suture technique (FibreWire, Arthrex, Naples, FL). Freshly slaughtered porcine humeri were prepared to model a single transosseous suture or suture button repair. A static, tensile load to failure experiment and a cyclic, tensile load experiment to model standard (10,000 cycles) and accelerated rehabilitation (20,000 cycles) philosophies were tested. The mode of failure, yield and ultimate failure load, extension (clinical failure >10 mm) and the resistance to cyclic loading was measured. The mode of failure was suture fracture in all the static load experiments with 10/11 occurring as the suture passed through the button and 7/11 as the suture passed through the bone tunnels. There was a significant difference in yield load, favouring transosseous suture [p = 0.009, suture button (SB) 673.0 N (647.2-691.7 N), transosseous suture (TOS) 855.0 N (750.0-891.4 N)] and median extension, favouring suture button [p = 0.009, SB 8.8 mm (5.0-12.4 mm), TOS 15.2 mm (13.2-17.1 mm)]. 2/3 transosseous suture and 0/3 suture buttons failed before completing 20,000 cycles. The difference in mean number of cycles completed was non-significant. The difference in mean extension was 5.1 mm (SB 6.7 mm, TOS 11.7 mm). Both techniques show advantages. The difference in extension is likely to be more clinically relevant than load tolerated at failure, which is well above physiological levels. The findings do not support an accelerated rehabilitation model.

  9. Comparison of Closure of Gastric Perforation Ulcers With Biodegradable Lactide-Glycolide-Caprolactone or Omental Patches

    Bertleff, Marietta J. O. E.; Stegmann, Toon; Liem, Robert S. B.; Kors, Geert; Robinson, Peter H.; Nicolai, Jean Philippe; Lange, Johan F.


    Background: The current treatment of perforated peptic ulcers is primary closure, supported by the application of an omental patch. It is difficult and time consuming to perform this procedure by laparoscopic surgery, largely because of the required suturing. It was our aim to develop and test a new

  10. Uterine Closure in Cesarean Delivery: A New Technique

    K M Babu


    Full Text Available Fear of scar rupture is one of risks involved in a post caesarean pregnancy. This had led to an increased rate of repeat cesarean delivery in today′s times. Closure of the uterine incision is a key step in cesarean section, and it is imperative that an optimal surgical technique be employed for closing a uterine scar. This technique should be able to withstand the stress of subsequent labor. In the existing techniques of uterine closure, single or double layer, correct approximation of the cut margins, that is, decidua-to-decidua, myometrium to myometrium, serosa to serosa is not guaranteed. Also, there are high chances of inter surgeon variability. It was felt that if a suturing technique which ensures correct approximation of all the layers mentioned above with nil or minimal possibility of inter operator variability existed, there will not be any thinning of lower segment caesarean section (LSCS. Further, a scarred uterus repaired in this manner will be able to withstand the stress of labor in future. We hereby report a new technique for uterine closure devised by us, which incorporates a continuous modified mattress suture technique as a modification of the existing surgical technique of uterine closure.

  11. Influence of different length of core suture purchase among suture row on the strength of 6-strand tendon repairs.

    Okubo, Hirotaka; Kusano, Nozomu; Kinjo, Masaki; Kanaya, Fuminori


    In multi-strand suture methods consisting of several suture rows, the different length of core suture purchase between each suture row may affect the strength of repairs. We evaluated the influence of the different length of core suture purchase between each suture row on the strength of 6-strand tendon repairs. Rabbit flexor tendons were repaired by using a triple-looped suture technique in which the suture purchase length in each suture row was modified. Group 1, all lengths are 8-mm. Group 2, all lengths are 10-mm. Group 3, two are 10-mm and one is 8-mm. Group 4, one is 10-mm and two are 8-mm. The repaired tendons were subjected to load-to-failure test. The gap strength was significantly greater in Group 1 and Group 2 than in Group 3 and Group 4. This study demonstrates that maintaining equal core suture purchase lengths of each suture row increases the gap resistance.

  12. Suture slippage in knotless suture anchors resulting in subacromial-subdeltoid bursitis.

    Hayeri, Mohammad Reza; Keefe, Daniel T; Chang, Eric Y


    Rotator cuff repair using a suture bridge and knotless suture anchors is a relatively new, but increasingly used technique. The suture bridge technique creates an anatomically similar and more secure rotator cuff repair compared with conventional arthroscopic techniques and the use of knotless anchors eliminates the challenges associated with knot tying during arthroscopic surgery. However, previous in vitro biomechanical tests have shown that the hold of the suture in a knotless suture anchor is far lower than the pullout strength of the anchor from bone. Up until now slippage has been a theoretical concern. We present a prospectively diagnosed case of in vivo suture loosening after rotator cuff repair using a knotless bridge technique resulting in subacromial-subdeltoid bursitis.

  13. MANTA, a novel plug-based vascular closure device for large bore arteriotomies: technical report.

    van Gils, Lennart; Daemen, Joost; Walters, Greg; Sorzano, Todd; Grintz, Todd; Nardone, Sam; Lenzen, Mattie; De Jaegere, Peter P T; Roubin, Gary; Van Mieghem, Nicolas M


    Catheter-based interventions have become a less invasive alternative to conventional surgical techniques for a wide array of cardiovascular diseases but often create large arteriotomies. A completely percutaneous technique is attractive as it may reduce the overall complication rate and procedure time. Currently, large bore arteriotomy closure relies on suture-based techniques. Access-site complications are not uncommon and often seem related to closure device failure. The MANTA VCD is a novel collagen-based closure device that specifically targets arteriotomies between 10 and 22 Fr. This technical report discusses the MANTA design concept, practical instructions for use and preliminary clinical experience.

  14. Healing of intraoral wounds closed using silk sutures and isoamyl 2-cyanoacrylate glue: a comparative clinical and histologic study.

    Vastani, Ankita; Maria, Anisha


    To compare the clinical and histologic healing of intraoral wounds closed using No. 3-0 silk suture with that obtained with isoamyl 2-cyanoacrylate glue. We performed alveoloplasty in 30 cases in the mandibular anterior region of edentulous arches; the length of incision in all cases was the same distance from the midline. The closure was performed on 1 side with No. 3-0 silk suture, and the other side was closed with isoamyl 2-cyanoacrylate. The surgical sites were evaluated on the first, seventh, fourteenth, and twenty-first postoperative days for tenderness and erythema. In 15 cases (group A), incisional biopsies on both sutured and glued sides were performed on the seventh postoperative day. In the other 15 patients, similar biopsies were executed on the fourteenth postoperative day (group B). All specimens were examined under a microscope for inflammatory cell infiltration, vascularity, and fibroblastic activity. The incidence of tenderness and erythema was increased on the sutured side on the first, seventh, and fourteenth postoperative days but was similar to that on the glued side on the twenty-first postoperative day. In the patients biopsied on the seventh postoperative day, values of inflammatory cell infiltration and vascularity were higher on the sutured side, whereas in patients biopsied on the fourteenth postoperative day, only vascularity was higher on the sutured side. On the seventh postoperative day, both clinical and histologic indicators of inflammation were higher on the sutured side, but these indicators had reached similar values on the fourteenth postoperative day on both the sutured and glued sides. This suggests that isoamyl 2-cyanoacrylate may aid initial healing. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Closure Operators and Closure Systems on Quantaloid-Enriched Categories

    Min LIU; Bin ZHAO


    In this paper,we introduce the fundamental notions of closure operator and closure system in the framework of quantaloid-enriched category.We mainly discuss the relationship between closure operators and adjunctions and establish the one-to-one correspondence between closure operators and closure systems on quantaloid-enriched categories.

  16. 21 CFR 878.5030 - Natural nonabsorbable silk surgical suture.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Natural nonabsorbable silk surgical suture. 878... Natural nonabsorbable silk surgical suture. (a) Identification. Natural nonabsorbable silk surgical suture... Bombycidae. Natural nonabsorbable silk surgical suture is indicated for use in soft tissue...

  17. 21 CFR 878.4495 - Stainless steel suture.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Stainless steel suture. 878.4495 Section 878.4495...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4495 Stainless steel suture. (a) Identification. A stainless steel suture is a needled or unneedled nonabsorbable surgical suture composed of...

  18. Strength of different meniscus suturing techniques.

    Aşik, M; Sener, N; Akpinar, S; Durmaz, H; Göksan, A


    We measured and compared the primary stabilities of five different meniscal suturing techniques. The techniques tested were horizontal mattress, vertical mattress, knot-end, vertical, and vertical loop. Twenty bovine medial menisci were cut to simulate peripheral longitudinal tears and repaired with one of the five suture techniques. Then the two parts of the meniscus were pulled using the Instron Tensometer until failure occurred. Knot-end techniques gave inferior results (mean ultimate failure strength 64 +/- 5 N) compared with the other techniques. Vertical mattress failed at 130 +/- 3 N, vertical loop at 128 +/- 4.5 N, horizontal mattress at 98 +/- 5 N and vertical suturing at 136 +/- 2.7 N. This study shows the superior mechanical characteristic of the vertical suturing technique.

  19. Frimand Needle Holder Reduces Suturing Time and Surgical Stress When Suturing in Palm Grip.

    Frimand Rönnow, Carl-Fredrik; Jeppsson, Bengt; Thorlacius, Henrik


    Purpose The Frimand needle holder (FNH) was developed to facilitate palm grip suturing. In the present study, we wanted to examine the impact of the FNH compared with a conventional Hegar-styled needle holder (HSNH) on suture time and surgical stress. Methods Thirty-two surgeons were enrolled and they performed sets of 3 continuous sutures on a polyurethane pad with premarked insert and exit points and the time for suturing was measured. Surgical stress was quantified by having the surgeons to perform 10 release maneuvers with the FNH and the HSNH on a needle attached to a scale. The scale sent 5 values per second to a computer. The first measurement of each series was regarded as the starting weight and all subsequent measurements were either regarded as neutral, pressure or traction. The sum of these measurements represented total surgical stress. Results We found that all surgeons reduced their median suturing time by 16% when using FNH for palm grip suturing with no difference between junior and senior surgeons. Moreover, it was observed that FNH decreased median surgical stress by 62% for all surgeons performing palm grip suturing compared with a conventional HSNH. Conclusion We conclude that the FNH reduces suture time and surgical stress compared with HSNH when performing palm grip suturing. These findings warrant studies in surgical patients in order to evaluate the potential clinical impact of FNH.

  20. Performance Assessment of Bi-Directional Knotless Tissue-Closure Devices in Juvenile Chinook Salmon Surgically Implanted with Acoustic Transmitters, 2009 - Final Report

    Woodley, Christa M.; Wagner, Katie A.; Bryson, Amanda J.


    The purpose of this report is to assess the performance of bi-directional knotless tissue-closure devices for use in tagging juvenile salmon. This study is part of an ongoing effort at Pacific Northwest National Laboratory (PNNL) to reduce unwanted effects of tags and tagging procedures on the survival and behavior of juvenile salmonids, by assessing and refining suturing techniques, suture materials, and tag burdens. The objective of this study was to compare the performance of the knotless (barbed) suture, using three different suture patterns (treatments: 6-point, Wide “N”, Wide “N” Knot), to the current method of suturing (MonocrylTM monofilament, discontinuous sutures with a 2×2×2×2 knot) used in monitoring and research programs with a novel antiseptic barrier on the wound (“Second Skin”).

  1. Vascular Clips in Anastomoses of Femoropopliteal Arterial Reconstruction.

    Aarnio; Järvinen; Varjo


    The vascular anastomoses are usually made with sutures. Some mainly experimental studies have been published about a new method of doing the vascular anastomoses with metal clips. We studied the suitability of vascular closure staple (VCS) clip applier system for making the anastomoses in femoropopliteal and femorotibial arterial reconstruction. During an 11-month period, VCS clips were used in 17 out of 27 patients who were operated due to severe claudication or incipient gangrena of the foot. Altogether 26 anastomoses were made with VCS clips using either great saphenous vein or PTFE graft. The making of anastomosis was easy and reliable. No postoperative bleeding was noticed. All anastomoses were patent 4-6 weeks postoperatively studied by palpation and measured by ankle brachial pressure index (mean 0.96). In Duplex Doppler examination all studied patients had well patent anastomoses on an average 11 months after the operation. With VCS clip applier system, it is possible to do anastomoses in arteriosclerotic arteries like in femoropopliteal reconstructions. This method helps making reliable anastomoses more easily.

  2. Rejuvenation of Fossil Sutures and Related Mesozoic Intracontinental Orogenies in South China


    The Huanan (South China) subcontinent was created by amalgamation of the Yangtze, Xianggan, Cathaysia and Zhemin microcontinents by the Guangxi orogeny in the Early Palaeozoic. The closure of the Tethyan Ocean and subsequent collision event outside the amalgamated continent reactivated fossil sutures and resulted in intracontinental (ensialic) orogenies in the Mesozoic. Based on evidence from deformation, molasse and granitoids, the Sichuan-Guizhou-Hunan-southern Hubei and Hunan-Jiangxi-Fujian Yanshanian fold-thrust systems and the Lower Yangtze-northwestern Fujian Indosinian fold-thrust system are thought to be intracontinental orogens. Their main features are as follows: intracontinental orogenies occurred areally, thrusting propagated towards the interior of the continental, they extend parallelly to the strikes of the fossil sutures, and the details of the temporal-spatial evolution of the orogens depend on subduction-collision events.

  3. 后腹腔镜bulldog夹阻断肾动脉连续缝合行肾部分切除术24例分析%Retroperitoneal laparoscopic partial nephrectomy utilizing bulldog clamp blocking renal artery and continuous suture technique in 24 cases

    王德林; 蒲军; 张尧; 杨军; 吴小候


    目的 评价后腹腔镜下bulldog夹阻断肾动脉连续缝合行肾部分切除术的临床疗效及价值.方法 回顾性分析24例后腹腔镜肾部分切除术患者的一般临床资料、手术结果及预后情况.结果 所有患者手术均成功,术中无输血及中转开腹手术,平均手术时间为143.3 min,平均热缺血时间为24 min;术后无继发出血、感染及漏尿,术后病理检查证实8例为肾透明细胞癌,16例为平滑肌脂肪瘤;随访2~36个月无转移、局部复发.结论 后腹腔镜下bulldog夹阻断肾动脉连续缝合行肾部分切除术治疗直径小于4.5 cm肾肿瘤安全、有效.%Objective To evaluate clinical efficacy and value of retroperitoneal laparoscopic partial nephrectomy utilizing bulldog clamp blocking renal artery and continuous suture technique. Methods 24 cases of retroperitoneal laparoscopic partial nephrectomy in patients were retrospectively analyzed, with the clinical data, surgical results, prognosis for their treatment. Results All operations were successful without intraoperative conversion and transfusion,and no post-operative bleeding,inflammation and leakage of urine was found. The average operative time was 143. 3 min,the average warm ischemia time was 24 min. Pathology showed 8 cases of renal cell carcinoma, 16 cases of angiomyolipoma. The follow-up time was 2-36 months without local recurrence and metastasis. Conclusion retroperitoneal laparoscopic partial nephrectomy for diameter less than 4. 5 cm renal tumor is safe and effective.

  4. The appendiceal stump closure during laparoscopy: historical, surgical, and future perspectives.

    Gomes, Carlos Augusto; Nunes, Tarcizo Afonso; Soares, Cleber; Gomes, Camila Couto


    During a laparoscopic appendectomy, the closure of the appendiceal stump is an important step because of postoperative complications from its inappropriate management. The development of life-threatening events such as stercoral fistulas, postoperative peritonitis, and sepsis is feared and unwanted. The tactical modification of the appendiceal stump closure with a single endoligature, replacing the invaginating suture, adjusted very well to laparoscopic appendectomy, and nowadays is the procedure of choice, whenever possible. Among the alternatives that do not make use of an invaginating suture, studies advocate the use of an endostapler, endoligature (endo-loop), metal clips, bipolar endocoagulation, and polymeric clips. All alternatives have advantages and disadvantages against the different clinical stages of acute appendicitis, and it should be noted that the different forms of appendiceal stump closure have never been assessed in prospective randomized studies. Knowledge about and appropriate use of all of them are important for a safe and more cost-effective procedure.

  5. Vulnus Cordis. Heart Suture. (Vulnus Cordis. Sutur af Hjertet),


    fourth rib. Diastole not palpable . In the four th intercost al spacs in the mid—axijIar line on the left side, a non—gaping stab wound 1 centimeter in...chlorofo rm narcosis . The wound was widened: no lesion found on the intercostal artery. resection of the fourth rib , length 6 cent...periesteal resect ion of 5 cm of the third rib and supporting piece of the rib cartilage . Blood y parts split as bef ore. The cut in the pericardiun could

  6. Shear lag sutures: Improved suture repair through the use of adhesives.

    Linderman, Stephen W; Kormpakis, Ioannis; Gelberman, Richard H; Birman, Victor; Wegst, Ulrike G K; Genin, Guy M; Thomopoulos, Stavros


    Suture materials and surgical knot tying techniques have improved dramatically since their first use over five millennia ago. However, the approach remains limited by the ability of the suture to transfer load to tissue at suture anchor points. Here, we predict that adhesive-coated sutures can improve mechanical load transfer beyond the range of performance of existing suture methods, thereby strengthening repairs and decreasing the risk of failure. The mechanical properties of suitable adhesives were identified using a shear lag model. Examination of the design space for an optimal adhesive demonstrated requirements for strong adhesion and low stiffness to maximize the strength of the adhesive-coated suture repair construct. To experimentally assess the model, we evaluated single strands of sutures coated with highly flexible cyanoacrylates (Loctite 4903 and 4902), cyanoacrylate (Loctite QuickTite Instant Adhesive Gel), rubber cement, rubber/gasket adhesive (1300 Scotch-Weld Neoprene High Performance Rubber & Gasket Adhesive), an albumin-glutaraldehyde adhesive (BioGlue), or poly(dopamine). As a clinically relevant proof-of-concept, cyanoacrylate-coated sutures were then used to perform a clinically relevant flexor digitorum tendon repair in cadaver tissue. The repair performed with adhesive-coated suture had significantly higher strength compared to the standard repair without adhesive. Notably, cyanoacrylate provides strong adhesion with high stiffness and brittle behavior, and is therefore not an ideal adhesive for enhancing suture repair. Nevertheless, the improvement in repair properties in a clinically relevant setting, even using a non-ideal adhesive, demonstrates the potential for the proposed approach to improve outcomes for treatments requiring suture fixation. Further study is necessary to develop a strongly adherent, compliant adhesive within the optimal design space described by the model.

  7. Functional implications of squamosal suture size in paranthropus boisei.

    Dzialo, Christine; Wood, Sarah A; Berthaume, Michael; Smith, Amanda; Dumont, Elizabeth R; Benazzi, Stefano; Weber, Gerhard W; Strait, David S; Grosse, Ian R


    It has been hypothesized that the extensively overlapping temporal and parietal bones of the squamosal sutures in Paranthropus boisei are adaptations for withstanding loads associated with feeding. Finite element analysis (FEA) was used to investigate the biomechanical effects of suture size (i.e., the area of overlap between the temporal and parietal bones) on stress, strain energy, and strain ratio in the squamosal sutures of Pan troglodytes and P. boisei (specimen OH 5) during biting. Finite element models (FEMs) of OH 5 and a P. troglodytes cranium were constructed from CT scans. These models contain sutures that approximate the actual suture sizes preserved in both crania. The FEM of Pan was then modified to create two additional FEMs with squamosal sutures that are 50% smaller and 25% larger than those in the original model. Comparisons among the models test the effect of suture size on the structural integrity of the squamosal suture as the temporal squama and parietal bone move relative to each other during simulated premolar biting. Results indicate that with increasing suture size there is a decreased risk of suture failure, and that maximum stress values in the OH 5 suture were favorable compared to values in the Pan model with the normal suture size. Strain ratios suggest that shear is an important strain regime in the squamosal suture. This study is consistent with the hypothesis that larger sutures help reduce the likelihood of suture failure under high biting loads. Copyright © 2013 Wiley Periodicals, Inc.

  8. Transcatheter closure of patent ductus arteriosus: past, present and future.

    Baruteau, Alban-Elouen; Hascoët, Sébastien; Baruteau, Julien; Boudjemline, Younes; Lambert, Virginie; Angel, Claude-Yves; Belli, Emre; Petit, Jérôme; Pass, Robert


    This review aims to describe the past history, present techniques and future directions in transcatheter treatment of patent ductus arteriosus (PDA). Transcatheter PDA closure is the standard of care in most cases and PDA closure is indicated in any patient with signs of left ventricular volume overload due to a ductus. In cases of left-to-right PDA with severe pulmonary arterial hypertension, closure may be performed under specific conditions. The management of clinically silent or very tiny PDAs remains highly controversial. Techniques have evolved and the transcatheter approach to PDA closure is now feasible and safe with current devices. Coils and the Amplatzer Duct Occluder are used most frequently for PDA closure worldwide, with a high occlusion rate and few complications. Transcatheter PDA closure in preterm or low-bodyweight infants remains a highly challenging procedure and further device and catheter design development is indicated before transcatheter closure is the treatment of choice in this delicate patient population. The evolution of transcatheter PDA closure from just 40 years ago with 18F sheaths to device delivery via a 3F sheath is remarkable and it is anticipated that further improvements will result in better safety and efficacy of transcatheter PDA closure techniques.

  9. Evaluation of absorbable and nonabsorbable sutures for repair of achilles tendon rupture with a suture-guiding device.

    Kocaoglu, Baris; Ulku, Tekin Kerem; Gereli, Arel; Karahan, Mustafa; Turkmen, Metin


    The purpose of this study was to compare the functional and clinical results of Achilles tendon repairs with an Achilles tendon suture-guiding device using nonabsorbable versus absorbable sutures. We hypothesized that the absorbable suture would have clinical results comparable to those of the nonabsorbable suture for Achilles tendon repair with an Achilles tendon suture-guiding system. From January 2010 to September 2013, 48 consecutive patients who had sustained a spontaneous rupture of the Achilles tendon underwent operative repair with an Achilles tendon suture-guiding device using 2 different suture types. All ruptures were acute. The patients were divided equally into 2 groups according to suture type. In the nonabsorbable suture group, No. 2 braided nonabsorbable polyethylene terephthalate sutures were used, and in the absorbable suture group, braided absorbable polyglactin sutures were used. The average age of the patients was 38 years (range, 28-50 years). Functional outcome scores and complications were evaluated. All patients had an intact Achilles repair after surgery. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot clinical outcome scores were 98 (range, 90-100) in the nonabsorbable suture group and 96.8 (range, 87-100) in the absorbable suture group. All patients returned to their previous work. The absorbable suture group had fewer postoperative complications (0%) than the nonabsorbable suture group (12.5%) (P Achilles tendon repair by an Achilles tendon suture-guiding system was associated with a lower incidence of suture reaction; however, functionally the results were not notably different from those using a traditional nonabsorbable suture. We conclude that repair with absorbable sutures is appropriate for Achilles tendon ruptures. Level II, prospective comparative study. © The Author(s) 2015.

  10. Modified method for bronchial suture by Ramirez Gama compared to separate stitches suture: experimental study

    Vitor Mayer de Moura

    Full Text Available OBJECTIVE: To experimentally compare two classic techniques described for manual suture of the bronchial stump. METHODS: We used organs of pigs, with isolated trachea and lungs, preserved by refrigeration. We dissected 30 bronchi, which were divided into three groups of ten bronchi each, of 3mm, 5mm, and 7mm, respectively. In each, we performed the suture with simple, separated, extramucosal stitches in five other bronchi, and the technique proposed by Ramirez and modified by Santos et al in the other five. Once the sutures were finished, the anastomoses were tested using compressed air ventilation, applying an endotracheal pressure of 20mmHg. RESULTS: the Ramirez Gama suture was more effective in the bronchi of 3, 5 and 7 mm, and there was no air leak even after subjecting them to a tracheal pressure of 20mmHg. The simple interrupted sutures were less effective, with extravasation in six of the 15 tested bronchi, especially in the angles of the sutures. These figures were not significant (p = 0.08. CONCLUSION: manual sutures of the bronchial stumps were more effective when the modified Ramirez Gama suture was used in the caliber bronchi arms when tested with increased endotracheal pressure.

  11. Revisiting the Variscan transpressional tectonics in the Southwestern Iberian suture

    Pérez Cáceres, Irene; Martínez Poyatos, David; Simancas, José Fernando; Azor, Antonio


    The boundary between the Ossa-Morena Zone (OMZ) and the South Portuguese Zone (SPZ) in southwest Iberia is a Variscan collisional suture with transpressive left-lateral kinematics, contrasting with the dextral component that characterizes most of the Variscan convergence in other regions of the Orogen. Recent work including new structural and radiometric data has improved our knowledge on the geometry and timing of deformations affecting the OMZ/SPZ suture, which can be summarized as follows: Closure of the Rheic Ocean in Late Devonian time is attested by high-pressure and ophiolitic thin allochthonous units emplaced on the southern border of the OMZ. The kinematic interpretation of early stretching lineations and tectonic fabrics indicate that these units were emplaced in a tectonic regime of oblique left-lateral convergence. Transient transtension in Early Carboniferous time gave way to a narrow aisle of newly-formed oceanic-like crust just over the foregoing Rheic Ocean suture, accompanied by mafic magmatism intruded/extruded at both continental sides. Radiometric dating has yielded the same age of around 340 Ma for the oceanic-like mafic protholiths and their granulite/amphibolite facies tectonic fabric, thus indicating the very ephemeral life of the oceanic-like strip. Oblique convergence was resumed immediately after transtension, first causing northward obduction of the oceanic-like unit and north-verging folding in metasedimentary units of the southern border of the suture. Later on, a south-vergent regional fold was developed synchronous with left-lateral granulite-amphibolite facies shearing. Finally, shear deformation gave way to a low pitch stretching lineation, thrusting the OMZ over SPZ, concentrated on the southern limb of this regional fold and constituting a complex ductile 2-3 km-thick shear band evolving from amphibolite to greenschist facies, developing: (i) high-temperature greenschists at the southern border of the mafic oceanic-like unit

  12. Mechanical performance of gamma irradiated surgical sutures

    Pino, Eddy S.; Rela, Paulo P. [Instituto de Pesquisas Energeticas e Nucleares (IPEN), Sao Paulo, SP (Brazil)


    Surgical sutures are medical devices made of natural or synthetic polymeric materials that, due to its end-use, have to be sterilized. Historically, the sterilization by heat or using ethylene oxide had presented so numerous drawbacks that today the non-pollutant radiation sterilization has become a well established sterilization process, that brings, environmental, technical, and economical advantages. The amount of irradiation doses required for sterilization of health care products is 25 kGy in most instances to achieve the necessary sterility assurance level. As high energy radiation produces modifications in the molecular structure of organic materials with changes in its mechanical properties, the aim of this work was to evaluate the mechanical behavior of surgical sutures under irradiation. Silk, polyamide and catgut sutures were gamma irradiated up to doses of 50 kGy in an industrial irradiation sterilization plant. Afterwards, these sutures were mechanical tested for tensile strength under knot following the specifications of the NBR13904 draft standard, using the CTRD-INSTRON at IPEN. The mechanical lab results show that sutures made of Silk and Polyamide do not present any change in their mechanical performance up to the dose of 50 kGy. On the other hand, Catgut present mechanical stability up to 30 kGy and afterwards, a slight decrease in its tensile strength was detected. (author)

  13. Facial thread lifting with suture suspension.

    Tavares, Joana de Pinho; Oliveira, Carlos Augusto Costa Pires; Torres, Rodolfo Prado; Bahmad, Fayez


    The increased interest in minimally-invasive treatments, such as the thread lifting, with lower risk of complications, minimum length of time away from work and effectiveness in correcting ptosis and aging characteristics has led many specialists to adopt this technique, but many doubts about its safety and effectiveness still limit its overall use. To analyze data published in the literature on the durability of results, their effectiveness, safety, and risk of serious adverse events associated with procedures using several types of threading sutures. Literature review using the key words "thread lift", "barbed suture", "suture suspension" and "APTOS". Due to the scarcity of literature, recent reports of facial lifting using threads were also selected, complemented with bibliographical references. The first outcomes of facial lifting with barbed sutures remain inconclusive. Adverse events may occur, although they are mostly minor, self-limiting, and short-lived. The data on the maximum effect of the correction, the durability of results, and the consequences of the long-term suture stay are yet to be clarified. Interest in thread lifting is currently high, but this review suggests that it should not yet be adopted as an alternative to rhytidectomy. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  14. Closure of fascial defect at trocar sites after laparoscopic surgery.

    Sahin, Mustafa; Eryilmaz, Ramazan; Okan, Ismail


    As laparoscopic surgery evolves, a growing number of different abdominal operations can now be performed. This necessitates the use of multiple large trocars. Herniation through the fascial defect created by trocar entry in laparoscopic interventions has been reported at a rate of 1-6%. We describe a simple closure technique for fascial defects at trocar sites after laparoscopic surgery. To facilitate the closure of the fascial defects of > or = 10 mm trocar entry sites, the surgeon places the upper end of a dissecting forceps through the fascial defect and tilts it so that the abdominal of the peritoneum comes into contact with its flat surface. The assistant retracts the skin and subcutaneous tissue and the "J" needle with the appropriate suture material is then used to take a stitch through the fascia under direct vision. The sharp end of the needle is prevented from coming into contact with any deeper structure as it slides on the flat surface of the dissecting forceps. The stitch is then pulled up to lift the edge of the fascia and the needle is passed from the opposite edge of the fascia in the same manner and then the suture is ligated. The aforementioned technique is easy to perform and facilitates the closure of the fascial defect at trocar sites, and there is no extra cost for the procedure.

  15. Livergraftvascularvariantwith 3 extra-hepatic arteries

    Paulo N Martins


     Vascular anatomy of the liver is varied, and the"standard"anatomy is seen in 55%-80%of cases. It is very important that extrahepatic arteries are identiifed precisely at the time of graft procurement to avoid injuries that might compromise the liver function. In the present case the liver donor had the vascular anatomy of Michels type Ⅶ, e.g. a hepatic artery originating from the celiac trunk and going to the left lobe, an accessory left hepatic artery coming from the left gastric artery, and a replaced right hepatic artery coming from the superior mesenteric artery. This pattern of vascular supply is uncommon, representing less than 5%of cases. The replaced hepatic artery was reconstructed in the back-table with polypropylene suture 7.0 by connecting it to the stump of the splenic artery, and the celiac trunk of the graft was anastomosed to the recipient common hepatic artery.

  16. Internal inguinal ring closure by laparoscopy using homologous pericardium grafts in horses

    Julio David Spagnolo


    Full Text Available ABSTRACT: The occlusion of inguinal ring is the treatment to avoid the inguinal hernia in horses. The aim of this study is evaluate the efficacy of homologous pericardium grafts for internal inguinal ring closure in horses, comparing mechanical or manual laparoscopic suture. Cross over study, using six healthy intact male Mangalarga breed horses aged between 3 and 12 years. Horses were operated under general anesthesia in 25º Trendelenburg position. Five laparoscopic portals were employed. Pericardium grafts measuring 4x5cm were anchored covering the left and right internal inguinal rings using either manual intracorporeal suture or laparoscopic stapler. Horses were followed-up during 11 weeks when were submitted to a laparoscopic control. Surgical time, trans and postoperative complications and effectiveness of internal inguinal closure were evaluated and statistically analyzed. The level of significance was set at 5% P<0.05. The procedures were realized without complications and the mean time required for manual and mechanical suture procedures differed significantly (67.8±15.3 and 14.1±2.1 min respectively; P<0.05. All manually sutured grafts remained in place and partial suture dehiscence with incomplete occlusion of the internal inguinal ring was observed in two stapled grafts. Non-severe complications were observed trans or postoperatively. One synechiae and three omental adhesions were observed by laparoscopic control on day 77, but without clinical relevance in the evaluated period. The use of homologous pericardium grafts was effectiveness to internal inguinal ring closure by laparoscopy. Mechanical suture was faster to perform than manual, but provided less satisfactory results concerning safety of graft fixation.

  17. Mesozoic metamorphism and its tectonic implication along the Solonker suture zone in central Inner Mongolia, China

    Zhang, Jinrui; Wei, Chunjing; Chu, Hang; Chen, Yaping


    The Xing'an-Inner Mongolia Orogenic Belt (XIMOB) exposed in the eastern section of the Central Asian Orogenic Belt (CAOB) is generally thought to have resulted from closure of the Paleo-Asian Ocean. However, disputations still exist on the age and detailed tectonic processes involved in its final amalgamation. The Solonker suture zone in the central Inner Mongolia, once recognized as the major paleo-plate boundary recording the terminal collision of the XIMOB, is characterized by extensive regional low-temperature metamorphism of greenschist to epidote-amphibolite facies with local presence of blueschists, which lacks systematic study. Four metabasite and garnet-mica schist samples were studied for determination of metamorphic P-T evolution using pseudosection and conventional thermobarometry. The two metabasite samples from Wulangou and Daqing Pasture contain actinolite, albite, epidote, chlorite and hornblende (in Daqing Pasture) and are estimated to have peak P-T conditions of 5.2-5.9 kbar/415-450 °C in Wulangou and 7.0-7.9 kbar/470-475 °C in Daqing Pasture. Two garnet-mica schist samples from Shuangjing (or Shuangjing schist) contain garnet porphyroblasts, muscovite, quartz, plagioclase, chlorite with or without potassium feldspar, biotite, and calcite, and are modeled to record prograde P-T vectors respectively of 3.0 kbar/482 °C-3.3 kbar/495 °C and 4.2 kbar/478 °C-4.8 kbar/483 °C, followed by near-isothermal decompression. The zircon U-Pb dating analyses suggest that the metamorphism probably occurred soon afterwards in the Early Mesozoic. The peak P-T conditions for the metabasite and garnet-mica schist samples yield thermal gradients respectively of 18-22 °C/km and 26-33 °C/km, being intermediate and low P/T series, and the metamorphic evolution in these rocks characteristic of clockwise P-T paths may correspond to tectonic thickening and thinning processes. The extensive low-temperature metamorphism of intermediate to low P/T types along the

  18. Cauterization technique for suture erosion in transscleralfixation of intraocular lenses

    Xu-Ting Hu


    Full Text Available Transscleral suturing is a commonly applied technique to fix intraocular implants in the sulcus. A major problem after transscleral implantation is suture erosion that normally happens in the late post-surgery period and may result in an increased incidence of endophthalmitis. Here we describe an original cauterization method by using a glass rod to melt the exposed suture end without damaging the suture knot in the sclera to avoid suture exposure in sclera-fixed IOL implantation. This is a simple, quick and effective technique that can be performed without conjunctiva incisions and will help to reduce suture erosion related complications.

  19. A Rare Case of Pulmonary Artery Dissection Associated With Infective Endocarditis.

    Shi, Xiaoqing; Wang, Xiaoqin; Wang, Chuan; Zhou, Kaiyu; Li, Yifei; Hua, Yimin


    Pulmonary artery dissection (PAD) is a rare condition with high mortality and has not been reported in patient with infective endocarditis (IE). Here, we report the first case of such patient who experienced PDA and survived after surgical intervention.A 10-year-old female child was diagnosed as IE with a patent ductus arteriosis (PDA) and a vegetation on the left side of pulmonary artery trunk (10 × 5 mm). Following 3-week antibacterial treatment, the body temperature of patient returned to normal, and the size of vegetation reduced (7 × 3 mm). However, the patient had a sudden attack of sustained and crushing right chest pain, orthopnea with increasing respiratory rate (> 60/min), and acute high fever. Echocardiography revealed the detachment of vegetation on the first day and dissection of pulmonary artery on the next day. The patient received immediate surgical intervention. It was found that aneurysm had a size of 28 × 20 mm and its orifice (the dissecting site) located on the opposite side of the PDA opening (right side of the pulmonary artery trunk). The dissected left wall of pulmonary artery trunk was reconstructed followed by the closure of PDA with suture. The patient recovered uneventfully.From this case, we learned that the surgical intervention should be considered at an early time for IE patients who have a vegetation in pulmonary artery and PDA. After the infection is under control, the earlier surgery may prevent severe complications.

  20. Sonographic Determination of Residual Bladder Volume after Application of Different Cystotomy Closure Techniques in Dogs

    IU Khan1*, MA Khan2, SG Bokhari2, A Safdar2, M Shoaib1, H Akbar2, S Aslam2, MA Khan2 and A Noor2


    Full Text Available Residual urine volume is measured to diagnose various neurogenic and obstructive disorders of the urinary bladder. However, it is hypothesized that cystotomy closure using inverting patterns decreases intraluminal diameter of urinary bladder which consequently reduce residual bladder volume. This study aimed to investigate the ideal suturing style for cystotomy incision closure which would exert the least effect on residual bladder volume. The effect of various suturing styles on residual bladder volume was studied sonographically. Residual Bladder Volume (RBV was calculated by the formula, i.e. RBV=L×W× (DL+DT/2×0.625, where L=longitudinal diameter, W=transverse diameter, DL= depth at longitudinal diameter, DT=depth at transverse diameter. 24 healthy mongrel dogs were selected and randomly divided into four equal groups A, B, C and D (n=6. In groups A, B and C, the cystotomy incision was subsequently closed by two-layered appositional suturing pattern, two-layered inverting pattern and three layers (using a combination of appositional and inverting styles, respectively. Group-D remained as sham-operated Control. The results clearly showed that the three-layered closure technique using a combination of appositional and inverting patterns (Group-C, significantly reduced the bladder volume (P<0.01. Two-layered inverting patterns (Group B, also reduced the bladder volume but not up to a significant level, whereas, the appositional suturing technique (group-A exerted the least effect on residual bladder volume. Conclusively, it was inferred that a two-layered appositional suturing pattern should be preferred for closure of cystotomy incision to avoid significant changes in residual bladder volume.

  1. Polypropylene suture--is it safe?

    Calhoun, T R; Kitten, C M


    Polypropylene suture has steadily gained popularity for use in vascular and cardiac surgical procedures because of its long-term tensile strength and minimal tissue trauma. However, recently some questions have arisen concerning its safety. We recently had two cases of polypropylene fracture, one occurring early and the other late after operation. Comparison and collation of these two cases with other reports leads to the conclusion that polypropylene suture is safe in most situations, but care must be taken to avoid instrumentation trauma and kinking stresses at knots, which probably explain most of the reported cases of polypropylene failure. In addition, polypropylene probably should not be used in graft-to-graft anastomoses in which the continual sawing stresses of two rigid structures appears to lead to an excessive incidence of late suture fracture with resultant false aneurysm formation.

  2. Eyelid closure at death

    A D Macleod


    Full Text Available Aim: To observe the incidence of full or partial eyelid closure at death. Materials and Methods: The presence of ptosis was recorded in 100 consecutive hospice patient deaths. Results: Majority (63% of the patients died with their eyes fully closed, however, 37% had bilateral ptosis at death, with incomplete eye closure. In this study, central nervous system tumor involvement and/or acute hepatic encephalopathy appeared to be pre-mortem risk factors of bilateral ptosis at death. Conclusion: Organicity and not psychogenicity is, therefore, the likely etiology of failure of full eyelid closure at death.

  3. Flexor Tenorrhaphy Using Absorbable Suture Materials

    Hyung Joo Kang


    Full Text Available Background Nonabsorbable sutures are favorable for repairing flexor tendons. However,absorbable sutures have performed favorably in an animal model.Methods Two-strand sutures using the interlocking modified Kessler method with polydioxanoneabsorbable sutures 4-0 were used to repair completely ruptured flexor tendons in 55 fingersfrom 41 consecutive patients. The medical records of average 42 follow up weeks were analyzedretrospectively. The data analyzed using the chi-squared test, and Fisher’s exact test was used forpostoperative complications. The results were compared with those of other studies.Results Among the index, middle, ring, and little fingers were injured in 9, 17, 16, and13 fingers, respectively. The injury levels varied from zone 1 to 5. Of the 55 digits in ourstudy, there were 26 (47% isolated flexor digitorum profundus (FDP injuries and 29 (53%combined FDP and with flexor digitorum superficialis injuries. Pulley repair was also conducted.Concomitant injuries of blood vessels and nerves were found in 17 patients (23 fingers; nerveinjuries occurred in 5 patients (10 fingers. Two patients had ruptures (3.6%, and one patienthad two adhesions (3.6%. Using the original Strickland criteria, all the patients were assessedto be excellent or good. Also, fibrosis and long-term foreign body tissue reactions such as stitchgranuloma were less likely occurred in our study. Compared to the Cullen’s report that usednonabsorbable sutures, there was no significant difference in the rupture or adhesion rates.Conclusions Therefore, this study suggests that appropriate absorbable core sutures can beused safely for flexor tendon repairs.

  4. [Assessing the effect of subcuticular buried sutures with subcutaneous closed suction drain to prevent surgical site infection in patients undergoing total cystectomy with urinary diversion using intestine].

    Kanamaru, Sojun; Tsuchihashi, Kazunari; Makino, Yuki; Shimizu, Yosuke; Ito, Noriyuki


    We assessed the effect of subcuticular buried sutures with subcutaneous closed suction drain to prevent surgical site infection (SSI) in patients undergoing total cystectomy with urinary diversion using the intestine. We reviewed the clinical charts of 43 consecutive patients who underwent total cystectomy with urinary diversion using the intestine from February 2006 to March 2011 at Nishi-Kobe Medical Center. All patients received intravenous prophylactic antibiotics before and throughout surgery as well as for three days after surgery. Skin closure was performed with interrupted vertical mattress sutures with 2-0 nylon on the first 22 patients (mattress group), and with interrupted subcuticular buried sutures with 4-0 absorbable monofilament with subcutaneous closed suction drain on the remaining 21 patients (subcuticular buried suture with subcutaneous drain; SBD group). SSI occurred in 7 (31.8%) patients in the mattress group, but did not affect any patient in the SBD group. We compared risk factors for SSI between the groups, and found that the method of skin closure was significant risk factor for SSI (P = 0.005). We concluded that interrupted subcuticular buried sutures with 4-0 absorbable monofilament with subcutaneous suction drain is effective for prevention of SSI in total cystectomy with urinary diversion using the intestine.

  5. Colecistectomia laparoscópica: experiência em 500 casos, enfatizando as vantagens da colecistocolangiografia e da ligadura do ducto e artéria cística utilizando fio de náilon Advantages of cholecystocholangiography and ligature of the cystic duct and artery with nylon suture: analysis of 500 laparoscopic cholecystectomies

    Carlos Alberto Perim


    with nylon suture instead of metallic clips. Most (79, 4% patients were female and the median age was 48.2 years. Chronic cholecystitis was found in 424 patients, acute cholecystitis in 68, gallbladder cancer in four; acalculous cholecystitis in three and gallbladder polyp in a single patient. Stones in the CBD were diagnosed in twenty (4% patients. The mean operating time was 84 minutes. Of the 500 patients, 93.4% were discharged from the hospital within 48 hours after LC. Convertion was required in 39 (7.8% cases, mainly due to choledocholithisasis (15 patients and acute cholecystitis (14 patients. Clinically important complications developed in 12 (2.4% patients, including one (0,2% commom bile duct injury. The mortality rate was 0.4%. Cholecystocholangiography was satisfactory in 80.5% and inconclusive in 19.5% of the patients. This method is an excellent option for intraoperative cholangiography in LC because it is technically very simple and affords good results, mainly in chronic cholecystitis. Nevertheless, when there is obvious cystic duct obstruction, or when the gallbladder is filled with biliary mud, it is better to do primarely transcystic cholangiography. Numerous studies have indicated that the use o metallic clips in LC is associated with higher risks of bile peritonitis and hemorrhage. Besides that, this study has shown that the use of clips make the procedure much more expensive, when the great number of LC performed yearly is considered. On the other hand, the cystic duct and artery ligation with nylon suture is very segure and cost saving.

  6. Postoperative recovery after mandibular third molar surgery: a criteria for selection of type of surgical site closure.

    Damodar, Neeliahgari Durga Akhila; Nandakumar, Hanumanthaiah; Srinath, Narashimha Murthy


    This study sought to evaluate postoperative recovery after mandibular third molar surgery, with and without the use of sutures. This study utilized 50 healthy subjects (19 females and 31 males, 18-40 years of age) with bilateral impacted third molars. Two impacted teeth were removed from each patient (60 min maximum operating time). For each patient, the surgical site on one side of the mouth was closed for primary healing by using nonresorbable sutures, while the surgical site on the other side of the mouth was left open for secondary healing. Postoperative recovery was assessed by determining pain (using a visual analog scale) and swelling (by measuring anatomical landmarks pre- and postoperatively on Days 2, 5, and 7) Any incidence of socket infection and hemorrhage were considered to be complications. Both statistical analysis and clinical observation showed that the surgical sites with nonresorbable sutures showed greater swelling and a higher intensity of pain than the surgical sites without sutures; however, there were no statistical or clinical differences in pain and swelling postsurgery at Day 7. The results suggest secondary closure (that is, without sutures) after third molar surgery will produce less postoperative discomfort than primary closure (with nonresorbable sutures).

  7. Barbed sutures in general and digestive surgery. Review.

    Ferrer-Márquez, Manuel; Belda-Lozano, Ricardo


    The appearance of new barbed sutures is an advance in making knots and anastomosis, mainly in laparoscopic surgery, where the majority of the surgeons find themselves limited dealing with these sutures. Through this review we aim to evaluate both the use and the safety of the sutures in General and Laparoscopic Surgery. Barbed sutures seem to ease the procedures improving key aspects such as reproducibility and operative time.

  8. Non-suture methods of vascular anastomosis

    Zeebregts, CJ; Heijmen, RH; van den Dungen, JJ; van Schilfgaarde, R


    Background: The main aim of performing a vascular anastomosis is to achieve maximal patency rates. An important factor to achieve that goal is to minimize damage to the vessel walls. Sutures inevitably induce vascular wall damage, which influences the healing of the anastomosis. Over time, several a

  9. Laparoscopic sacral suture hysteropexy for uterine prolapse.

    Krause, Hannah G; Goh, Judith T W; Sloane, Kate; Higgs, Peta; Carey, Marcus P


    This study aims to describe and review a new method of uterine conservation in pelvic reconstruction for women with uterine prolapse. This is a prospective study of women who have undergone laparoscopic sacral suture hysteropexy. Structured questions, visual analogue patient satisfaction score (VAS), and vaginal examination were undertaken. Follow-up was performed by non-surgical reviewers. From July 2001 until August 2003, a total of 81 women underwent laparoscopic sacral suture hysteropexy for uterine prolapse. At a mean of 20.3 months follow-up, 76 women (93.8%) were available for questioning and 57 (70.3%) attended for examination. Sixty-five women (87.8%) had no symptoms of pelvic floor prolapse, 54 women (94.7%) had no objective evidence of uterine prolapse, and 61 women (82.4%) were satisfied with their surgery (VAS > or = 80%). Laparoscopic sacral suture hysteropexy attaches the posterior cervix to the sacral promontory via the right uterosacral ligament. Follow-up data of laparoscopic sacral suture hysteropexy indicate it to be an effective method in the management of uterine prolapse.

  10. Case Study: Reduction of Gluteal Implant Infection Rates with Use of Retention Sutures

    Arsalan Salamat, MD


    Full Text Available Summary: The intramuscular technique has been the most popular technique among plastic surgeons for gluteal implantation. Complication rates of up to 30% including infection, hematoma, seromas, and dehiscence are reported in several studies. One main question that arises is whether the wound dehiscence occurs first followed by infection or vice versa. We present a case study of 3 patients who received gluteal augmentation. We used an alternative technique in closure of the gluteal flap which included the use of retention sutures along the sacral incision. Follow-up included postoperative day 2, every week for 6 weeks, and then every month for 6 months. Postoperatively patients were advised to not sleep in supine position for 3 weeks and avoid pressure to the area. The 3 patients remained infection free at 2 days and weekly for 6 weeks. The use of retention sutures along the flap closure site may be a useful and simple technique to avoid high gluteal implant infection rates that have been reported in the literature. We plan to apply this technique to all of our future gluteal augmentations and track long-term results. Preventing complications will result in improved aesthetic results, increased patient satisfaction, less frequent office visits, and less financial cost to both patient and physician.

  11. 21 CFR 878.4930 - Suture retention device.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Suture retention device. 878.4930 Section 878.4930 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... button, or a suture bolster, intended to aid wound healing by distributing suture tension over a larger...

  12. The effect of sutureless wound closure on postoperative pain and swelling after impacted mandibular third molar surgery.

    Hashemi, Hamid Mahmood; Beshkar, Majid; Aghajani, Reihaneh


    Our aim was to assess the influence of sutureless and multiple-suture closure of wounds on postoperative complications after extraction of bilateral, impacted, mandibular third molars in 30 patients in a split mouth study. After the teeth had been removed, on one side the flap was replaced but with no suture to hold it in place (study side), and on the other side the wound was closed primarily with three sutures (control side). Recorded complications included pain, swelling, bleeding, and formation of periodontal pockets. The results showed that patients had significantly less postoperative pain and swelling when no sutures were used (p=0.005). There were no signs of excessive bleeding or oozing postoperatively on either side. Six months postoperatively there was no significant difference in the depth of the periodontal pocket around the second molar.

  13. The influence of stenosis degrees and graft suture position on local hemodynamics of coronary bypass

    Totorean, A. F.; Bernad, S. I.; Susan-Resiga, R. F.


    Bypass graft failure is mainly caused by intimal hyperplasia (IH) that occurs at the graft anastomosis after coronary artery bypass grafting (CABG) surgery. It has been shown that local hemodynamics influences the process of IH initiation and progression. A main concern at this type of surgery is to increase the graft patency, respectively to improve the local hemodynamics. This paper analyzes the influence of different degree of stenosis severity and graft suture position on graft patency, taking into consideration the local hemodynamics. Bypass configurations with anastomosis angle of 45° were numerically investigated, with respect to wall shear stress and pressure variation. We can assume that in the conditions of our study, different stenosis degrees and position of the graft suture influence the local blood flow conditions, and, nevertheless, the graft patency.

  14. A pulled sutures technique for bony Bankart lesion.

    Lee, Byung Ill; Choi, Hyung Suk; Min, Kyung Dae; Kwon, Sai Won; Kim, Jun Bum; Kim, Yong-Beom; Chun, Dong-Il


    In an attempt to present a new surgical technique for arthroscopic bony Bankart fixation, the authors developed the pulled sutures technique. In executing the new method, the authors first passed several non-absorbable sutures through labroligamentous tissue with displaced articular fragment by mimicking transglenoid suture technique. Aimed at achieving a safe and stable fixation, using a knotless anchor rather than transglenoid suture, was deployed. Overall, this pulled sutures technique was shown to be effective with the result of direct reduction, stable, and safe fixation for bony Bankart's lesion.

  15. The myth of closure.

    Boss, Pauline; Carnes, Donna


    Therapies for grief and loss have traditionally focused on the work of grieving. The goal was to reach an endpoint, now popularly called closure. There are, however, many people who, through no fault of their own, find a loss so unclear that there can be no end to grief. They have not failed in the work of grieving, but rather have suffered ambiguous loss, a type of loss that is inherently open ended. Instead of closure, the therapeutic goal is to help people find meaning despite the lack of definitive information and finality. Hope lies in increasing a family's tolerance for ambiguity, but first, professionals must increase their own comfort with unanswered questions. In this article, the authors, one a poet, the other a family therapist and theorist, offer a unique blending of theory, reflection, and poetry to experientially deepen the process of self-reflection about a kind of loss that defies closure. © FPI, Inc.

  16. Conduction Disorders in Continuous Versus Interrupted Suturing Technique in Ventricular Septal Defect Surgical Repair



    Full Text Available Background Ventricular septal defects (VSD is one of the most frequent congenital cardiac malformations and cardiac conduction disorders are still one of the serious postoperative complications in this surgery. Objectives This study aimed to compare the incidence of conduction disorders with the use of continuous compared to interrupted suturing techniques in VSD surgical repair. Patients and Methods Previously recorded data of 231 patients who underwent surgical closure of VSD between January 2009 and January 2012 at the Rajaie cardiovascular medical and research center were retrospectively reviewed. VSD surgical repair was performed using continues suturing technique in group A patients (n = 163, 70.6% and interrupted suturing technique in group B patients (n = 68, 29.4%. Results The most common concomitant congenital anomaly was Tetralogy of Fallot (27.3%. Twenty-four (10.4% patients had intraoperative cardiac arrhythmia, including 19 (8.2% transient and 5 (2.2 % permanent arrhythmia. During their ICU stay, ventricular arrhythmia and complete heart block were observed in 34 (14.7% and 5 patients (2.2%, respectively. At the time of the last follow-up, incomplete right bundle branch block (RBBB, complete RBBB, RBBB with left anterior hemi-block, and complete heart block were identified in 84 (36.4%, 42 (18.2%, 29 (12.6%, and 5 patients (2.2%, respectively. The results revealed that group A patients were most likely to have had cardiac arrhythmias during their ICU stay and at the time of last follow-up (P < 0.001, while the intraoperative incidence of cardiac arrhythmia during surgery was not statistically significant between the two groups (P = 0.06. Conclusions In the absence of any statistical differences in the other risk factors between the two groups, the difference in the incidence of conduction disorders can be attributed to the type of suturing used during the procedure.

  17. Biomechanical Dynamics of Cranial Sutures during Simulated Impulsive Loading

    Z. Q. Zhang


    Full Text Available Background. Cranial sutures are deformable joints between the bones of the skull, bridged by collagen fibres. They function to hold the bones of the skull together while allowing for mechanical stress transmission and deformation. Objective. The aim of this study is to investigate how cranial suture morphology, suture material property, and the arrangement of sutural collagen fibres influence the dynamic responses of the suture and surrounding bone under impulsive loads. Methods. An idealized bone-suture-bone complex was analyzed using a two-dimensional finite element model. A uniform impulsive loading was applied to the complex. Outcome variables of von Mises stress and strain energy were evaluated to characterize the sutures’ biomechanical behavior. Results. Parametric studies revealed that the suture strain energy and the patterns of Mises stress in both the suture and surrounding bone were strongly dependent on the suture morphologies. Conclusions. It was concluded that the higher order hierarchical suture morphology, lower suture elastic modulus, and the better collagen fiber orientation must benefit the stress attenuation and energy absorption.

  18. Current manufacturing processes of drug-eluting sutures.

    Champeau, Mathilde; Thomassin, Jean-Michel; Tassaing, Thierry; Jérôme, Christine


    Drug-eluting sutures represent the next generation of surgical sutures since they fulfill their mechanical functions but also deliver the drug in their vicinity after implantation. These implants are produced by a variety of manufacturing processes. Drug-eluting sutures represent the next generation of surgical sutures since they fulfill their mechanical functions but also deliver the drug in their vicinity after implantation. These implants are produced by a variety of manufacturing processes. Two general approaches can be followed: (i) the ones that add the API into the material during the manufacturing process of the suture and (ii) the ones that load the API to an already manufactured suture. Areas covered: This review provides an overview of the current manufacturing processes for drug-eluting suture production and discusses their benefits and drawbacks depending on the type of drugs. The mechanical properties and the drug delivery profile of drug-eluting sutures are highlighted since these implants must fulfill both criteria. Expert opinion: For limited drug contents, melt extrusion and electrospinning are the emerging processes since the drug is added during the suture manufacture process. Advantageously, the drug release profile can be tuned by controlling the processing parameters specific to each process and the composition of the drug-containing polymer. If high drug content is targeted, the coating or grafting of a drug layer on a pre-manufactured suture allows for preservation of the tensile strength requirements of the suture.

  19. Achieving closure at Fernald

    Bradburne, John; Patton, Tisha C.


    When Fluor Fernald took over the management of the Fernald Environmental Management Project in 1992, the estimated closure date of the site was more than 25 years into the future. Fluor Fernald, in conjunction with DOE-Fernald, introduced the Accelerated Cleanup Plan, which was designed to substantially shorten that schedule and save taxpayers more than $3 billion. The management of Fluor Fernald believes there are three fundamental concerns that must be addressed by any contractor hoping to achieve closure of a site within the DOE complex. They are relationship management, resource management and contract management. Relationship management refers to the interaction between the site and local residents, regulators, union leadership, the workforce at large, the media, and any other interested stakeholder groups. Resource management is of course related to the effective administration of the site knowledge base and the skills of the workforce, the attraction and retention of qualified a nd competent technical personnel, and the best recognition and use of appropriate new technologies. Perhaps most importantly, resource management must also include a plan for survival in a flat-funding environment. Lastly, creative and disciplined contract management will be essential to effecting the closure of any DOE site. Fluor Fernald, together with DOE-Fernald, is breaking new ground in the closure arena, and ''business as usual'' has become a thing of the past. How Fluor Fernald has managed its work at the site over the last eight years, and how it will manage the new site closure contract in the future, will be an integral part of achieving successful closure at Fernald.

  20. Tank closure reducing grout

    Caldwell, T.B.


    A reducing grout has been developed for closing high level waste tanks at the Savannah River Site in Aiken, South Carolina. The grout has a low redox potential, which minimizes the mobility of Sr{sup 90}, the radionuclide with the highest dose potential after closure. The grout also has a high pH which reduces the solubility of the plutonium isotopes. The grout has a high compressive strength and low permeability, which enhances its ability to limit the migration of contaminants after closure. The grout was designed and tested by Construction Technology Laboratories, Inc. Placement methods were developed by the Savannah River Site personnel.

  1. The Rhyacian El Cortijo suture zone:Aeromagnetic signature and insights for the geodynamic evolution of the southwestern Rio de la Plata craton, Argentina

    Carlos J. Chernicoff; Eduardo O. Zappettini; Javier Peroni


    The amalgamation of the southern Río de la Plata craton involves two possibly coeval Rhyacian sutures associated with the Transamazonian orogeny, rather than a single one as previously envisaged, i.e. the El Cortijo suture zone and the Salado suture. We circumscribe the Tandilia terrane to the region between these two sutures. The El Cortijo suture zone runs along a roughly WNW oriented magnetic low aligned along the southern boundary of the Tandilia terrane, i.e. boundary between the Tandilia and Balcarce terranes. This extensive magnetic low, ca. 300 km long, and ca. 90 km wide, would be caused by demagnetization associated with shearing. At a more local scale, the trend of the El Cortijo suture zone often turns toward the EeW. At this scale, WNW trending tholeiitic dykes of Statherian age are seen to cut the Rhyacian El Cortijo suture zone. Spatially associated with the El Cortijo suture zone, there are small magnetic highs interpreted to be related to unexposed basic bodies of ophiolitic nature related to those forming part of the El Cortijo Formation. We envisage the pre-Neoproterozoic evolution of the Tandilia belt to have been initiated by the extension of Neoarchean (w2650 Ma) crust occurred during Siderian times (2500e2300 Ma), causing the separation between the Balcarce, Tandilia and Buenos Aires terranes, and the development of narrow oceans at both north and south sides of the Tandilia terrane, accompanied by w2300e2200 Ma sedi-mentation over transitional econtinental to oceanice crust, and arc magmatism developed in the Tan-dilia terrane. The island arc represented by the El Cortijo Formation was also developed at this time. At late Rhyacian times, it occurred in both the closure of the narrow oceans developed previously, the entrapment of the El Cortijo island arc, as well as anatectic magmatism in the Balcarce terrane.

  2. Over-the-scope clip closure of two chronic fistulas after gastric band penetration

    Federico; Iacopini; Nicola; Di; Lorenzo; Fabrizio; Altorio; Marc-Oliver; Schurr; Agostino; Scozzarro


    Gastrointestinal perforations are conservatively managed at endoscopy by through-the-scope endoclips and covered self expandable stents, according to the size and tissue features of the perforation. This is believed to be the first report of successful closure of two gastrocutaneous fistulas with over-the-scope clips (OTSCs). After laparoscopic gastric banding, a 45-year old woman presented with band erosion and penetration. Despite surgical band removal and gastric wall suturing, external drainage of enter...

  3. Skin tension related to tension reduction sutures.

    Hwang, Kun; Kim, Han Joon; Kim, Kyung Yong; Han, Seung Ho; Hwang, Se Jin


    The aim of this study was to compare the skin tension of several fascial/subcutaneous tensile reduction sutures. Six upper limbs and 8 lower limbs of 4 fresh cadavers were used. At the deltoid area (10 cm below the palpable acromion) and lateral thigh (midpoint from the palpable greater trochanter to the lateral border of the patella), and within a 3 × 6-cm fusiform area of skin, subcutaneous tissue defects were created. At the midpoint of the defect, a no. 5 silk suture was passed through the dermis at a 5-mm margin of the defect, and the defect was approximated. The initial tension to approximate the margins was measured using a tensiometer.The tension needed to approximate skin without any tension reduction suture (S) was 6.5 ± 4.6 N (Newton). The tensions needed to approximate superficial fascia (SF) and deep fascia (DF) were 7.8 ± 3.4 N and 10.3 ± 5.1 N, respectively. The tension needed to approximate the skin after approximating the SF was 4.1 ± 3.4 N. The tension needed to approximate the skin after approximating the DF was 4.9 ± 4.0 N. The tension reduction effect of approximating the SF was 38.8 ± 16.4% (2.4 ± 1.5 N, P = 0.000 [ANOVA, Scheffé]). The tension reduction effect of approximating the DF was 25.2% ± 21.9% (1.5 ± 1.4 N, P = 0.001 [ANOVA, Scheffé]). The reason for this is thought to be that the SF is located closely to the skin unlike the DF. The results of this study might be a basis for tension reduction sutures.

  4. Laser-assisted skin closure at 1.32 microns: the use of a software-driven medical laser system

    Dew, Douglas K.; Hsu, Tung M.; Hsu, Long S.; Halpern, Steven J.; Michaels, Charles E.


    This study investigated the use of a computerized 1 .3 micron Nd:YAG laser to seal approximated wound edges in pig skin. The medical laser system used was the DLS Type 1 , 1 .32 micron Nd:YAG laser (Laser Surgery Software, Inc.). The purpose of this study was to evaluate the effectiveness of laser assisted skin closure using the DLS YAG laser in a large animal model. Effectiveness was judged on the basis of wound dehiscence, infection, unusual healing result and consistency of results. Comparative cosmetic result was also evaluated. In this study, the DLS YAG laser was used to close scalpel-induced, full-thickness wounds. The pig model was chosen for its many integumentary similarities to man. Controls included scalpel-induced wounds closed using suture, staple and some with norepair. After adequate anesthesia was achieved, the dorsum of Yucutan pigs (approximately 75- 100 pounds) each was clipped with animal hair clippers from the shoulder area to the hind legs. The area was then shaved with a razor blade, avoiding any inadvertent cuts or abrasions of the skin. The dorsum was divided into four rows of four parallel incisions made by a #15 scalpel blade. Full-thickness incisions, 9 cm long, were placed over the dorsum of the pigs and then closed either with one loosely approximating Prolene" suture (the "no repair' group), multiple interrupted 6-0 nylon sutures, staples or laser. The experimental tissue sealing group consisted of 1 69 laser assisted closures on 1 3 pigs. Sutured control wounds were closed with 6-0 nylon, full thickness, simple, interrupted sutures. Eight sutures were placed 1 cm apart along the 9 cm incision. Stapled control wounds were approximated using two evenly spaced 3-0 VicryP' sub-dermal sutures and the dermis closed using Proximate' skin staples. Eight staples were placed 1 cm apart along the 9 cm incision. The no-repair incisions were grossly approximated using a single 2-0 Prolene full thickness, simple, interrupted suture located at the

  5. Blepharoptosis correction with buried suture method.

    Park, Jang Woo; Kang, Moon Seok; Nam, Seung Min; Kim, Yong Bae


    Many surgical techniques have been developed to correct blepharoptosis, including the anterior levator resection or advancement, tarsoaponeurectomy, and Fasanella-Servat Müllerectomy. However, to minimize surgical scarring and reduce the postoperative recovery time, the procedure has been developed from a complete incision to a partial incision, which is appealing to patients. To aid the procedural development, this study describes a surgical technique in which the correction of blepharoptosis and a double eyelid fold operation are performed using a buried suture technique during the same operation. A retrospective review was conducted using the medical records and preoperative and postoperative photography of 121 patients who underwent simultaneous correction of blepharoptosis and had a double eyelid fold created between October 2010 and July 2011. All of the patients had mild (1-2 mm) or moderate (3-4 mm) bilateral blepharoptosis and excellent or good levator function (>8 mm). The average preoperative marginal reflex distance (MRD1) measured 1.174 (0.3) mm. No intraoperative complications occurred. The average postoperative MRD1 measured 3.968 (0.2) mm. There was statistical significance improvement between preoperative MRD1 and postoperative MRD1 (Pexposure keratopathy were noted. Blepharoptosis correction using the buried suture technique is an effective technique for young patients experiencing mild to moderate blepharoptosis who want to have the double eyelid fold operation using the buried suture technique.

  6. Successful aortic root replacement and shunt closure in a case with rare coexistence of congenital cardiac malformations: bicuspid aortic valve with annuloaortic ectasia, single coronary artery, and patent foramen ovale.

    Egashira, Toru; Shimizu, Hideyuki; Yamada, Yoshitake; Fukuda, Keiichi


    This is the first report of rare simultaneous complication of three cardiac malformations: bicuspid aortic valve with annuloaortic ectasia, single coronary artery, and patent foramen ovale. We successfully operated to replace the aortic valve and ascending aorta, and to close the patent foramen ovale.

  7. [Results of a national survey on abdominal wall closure].

    Pereira, José Antonio; López-Cano, Manuel; Marsal, Francesc; Feliu, Xavier


    To assess knowledge on the abdominal wall closure through a surgeon cohort survey. A twenty question individual questionnaire on laparotomy in elective surgery. A total of 131 surgeons from seven hospitals responded (72% specialists and 28% in training). 71% of respondents estimated the frequency of incisional hernia to be higher than 15% and 54% considered the technique to be the most significant risk factor. 85% considered midline laparotomy closed with slow absorbable suture (57%) in a single layer (66%) to be the most appropriate technique. 67% believed retention sutures to be the appropriate prevention technique. 50% did not know or could not apply the 4:1 technique. 87% considered that an incisional hernia can be prevented and that the technique is the most important factor on which to act. 84% believed that a prosthesis can prevent the occurrence of incisional hernia, whereas 40% of respondents never use it and only 38% use it in patients at risk. On comparing surveys between specialists and residents, significant differences appeared in terms of a better understanding of the theoretical technical aspects in trainee surgeons. Although the results show an adequate understanding of the epidemiology and risk factors for development of incisional hernia, training and consensus measures are likely to be introduced in some basic technical aspects in order to improve results in laparotomy closure. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  8. Mail Office annual closure


    On the occasion of the annual closure of CERN, there will be no mail distributed on Friday 20 December 2013 but mail will be collected in the morning. Nevertheless, you will still be able to bring your outgoing mail to Building 555-R-002 until 12 noon.  

  9. MNC Subsidiary Closure

    de Faria, Pedro; Preto, Miguel Torres; Sofka, Wolfgang


    We investigate the consequences of MNC subsidiary closures for employees who lose their jobs. We ask to what degree the foreign knowledge that they were exposed to is valued in their new job. We argue theoretically that this foreign knowledge is both valuable and not readily available in the host...

  10. MNC Subsidiary Closure

    de Faria, Pedro; Sofka, Wolfgang; Torres Preto, Miguel

    We investigate the consequences of MNC subsidiary closures for employees who lose their jobs. We ask to what degree the foreign knowledge that they were exposed to is valued in their new job. We argue theoretically that this foreign knowledge is both valuable and not readily available in the host...

  11. Ring closure in actin polymers

    Sinha, Supurna; Chattopadhyay, Sebanti


    We present an analysis for the ring closure probability of semiflexible polymers within the pure bend Worm Like Chain (WLC) model. The ring closure probability predicted from our analysis can be tested against fluorescent actin cyclization experiments. We also discuss the effect of ring closure on bend angle fluctuations in actin polymers.

  12. The use of imbricated sutures in radioactive plaque brachytherapy surgery

    Kaan Gündüz


    Full Text Available Kaan Gündüz1, Jose S Pulido1, Peter D Yeakel2, Michael King3, Kelly L Classic1, Keith M Furutani21Department of Ophthalmology, 2Department of Radiation Oncology, 3Section of Media Support Services, Mayo Clinic, Rochester, MN, USAAbstract: This paper describes a new technique to suture the radioactive plaque to sclera. The radioactive plaque is conventionally sutured to the sclera using 5/0 nylon sutures. The imbricated suture technique involves using a 1/0 silk or 2/0 mersilene suture imbricated with the 5/0 nylon suture when the nylon suture is tied and cut. The imbricated suture technique allows easy identification of the plaque at removal and provides a surface that separates the 5/0 nylon from the surface of the eyelet platform, making suture cutting easier and safer. The radiation exposure times ranged from 9.1 minutes to 14 minutes (mean: 10.8 minutes during plaque insertion and from 2.8 to 3.3 minutes (mean: 3.0 minutes during plaque removal with the imbricated suture technique. This technique may decrease radiation exposure time and may prevent inadvertent scleral damage.Keywords: plaque radiotherapy, Iodine-125, Ruthenium-106, Collaborative Ocular Melanoma Study, choroidal melanoma, ciliary body melanoma, retinoblastoma, plaque placement, plaque removal, radiation exposure

  13. Insertion force in manual and robotic corneal suturing.

    Yang, Yang; Xu, Cunliang; Deng, Shijing; Xiao, Jingjing


    Due to differences in corneal grafting microsurgery between manual and robotic suturing, new challenges have arisen in testing the insertion force and torque of corneal tissue acting on suturing needles in order to guarantee successful completion of surgical procedures. In order to measure the force during the insertion operation, from the needle entering the cornea through the entry point until the puncturing of the exit point along the circular trajectory, a force measurement system was established, including fresh porcine cornea, a corneal-suturing robot, a circular needle, a micro-forceps manipulator with a force transducer, a computer with a data acquisition board and a medical microscope. The force values in the needle coordinate frames were obtained on the basis of a sensor coordinate frame through D-H coordinate transformation, and an index is proposed here to evaluate the insertion performance. Experiments on both manual and robotic suturing were carried out for comparison. The scale and changes of the needle insertion force were obtained using two different suturing methods. The maximal tangent force in robotic suturing is a little larger than in manual suturing, and the maximal resultant force in robotic suturing is somewhat smaller. Although the difference is not very significant, robotic suturing performs in a more stable way. Moreover, the performance evaluation index M(dmax) (the maximum of square root of the quadratic sum of torque components M(OX) and M(OY)) in robotic suturing is much smaller than that in manual suturing. The force measurement system has been verified to be feasible through experimentation. Compared with conventional manual surgery, robotic suturing has some advantages: more stable suturing, smaller distortion torque and fewer invasions to the corneal tissue, showing that its application in minimally invasive surgery is practical. Copyright © 2011 John Wiley & Sons, Ltd.

  14. Cranial suture biology of the Aleutian Island inhabitants.

    Cray, James; Mooney, Mark P; Siegel, Michael I


    Research on cranial suture biology suggests there is biological and taxonomic information to be garnered from the heritable pattern of suture synostosis. Suture synostosis along with brain growth patterns, diet, and biomechanical forces influence phenotypic variability in cranial vault morphology. This study was designed to determine the pattern of ectocranial suture synostosis in skeletal populations from the Aleutian Islands. We address the hypothesis that ectocranial suture synostosis pattern will differ according to cranial vault shape. Ales Hrdlicka identified two phenotypes in remains excavated from the Aleutian Island. The Paleo-Aleutians, exhibiting a dolichocranic phenotype with little prognathism linked to artifacts distinguished from later inhabitants, Aleutians, who exhibited a brachycranic phenotype with a greater amount of prognathism. A total of 212 crania representing Paleo-Aleuts and Aleutian as defined by Hrdlicka were investigated for suture synostosis pattern following standard methodologies. Comparisons were performed using Guttmann analyses. Results revealed similar suture fusion patterns for the Paleo-Aleut and Aleutian, a strong anterior to posterior pattern of suture fusion for the lateral-anterior suture sites, and a pattern of early termination at the sagittal suture sites for the vault. These patterns were found to differ from that reported in the literature. Because these two populations with distinct cranial shapes exhibit similar patterns of suture synostosis it appears pattern is independent of cranial shape in these populations of Homo sapiens. These findings suggest that suture fusion patterns may be population dependent and that a standardized methodology, using suture fusion to determine age-at-death, may not be applicable to all populations.

  15. A case against closure

    Olin, Doris


    Full Text Available Este artigo examina a objeção ao fechamento [dedutivo] que surge no contexto de certos paradoxos epistêmicos, paradoxos cuja conclusão é que a crença justificada pode ser inconsistente. É universalmente aceito que, se essa conclusão é correta, o fechamento deve ser rejeitado, para que se evite a crença justificada em enunciados contraditórios (P, ~P. Mas, mesmo que os argumentos desses paradoxos - o paradoxo da falibilidade (do prefácio e o paradoxo da loteria - seja mal sucedidos, eles, ainda assim, sugerem a existência de evidência independente para uma objeção mais direta contra o fechamento. O exame do argumento da falibilidade revela uma exigência de modéstia epistêmica que viola o fechamento a partir de múltiplas premissas. A reflexão sobre o paradoxo da loteria nos confronta com um dilema em que cada alternativa fornece um contra-exemplo ao fechamento a partir de uma única premissa. Seja ou não possível a inconsistência racional, há uma objeção contra o fechamento. This paper examines the case against closure that arises in the context of certain epistemic paradoxes, paradoxes whose conclusion is that it is possible for justified belief to be inconsistent. It is generally agreed that if this conclusion is correct, closure must be rejected in order to avoid justified belief in contradictory statements (P, ~P. But even if the arguments of these paradoxes – the fallibility (preface paradox and the lottery paradox – are unsuccessful, they nonetheless suggest independent grounds for a more direct case against closure. Examination of the fallibility argument reveals a requirement of epistemic modesty that violates multiple premise closure. Reflection on the lottery paradox presents us with a dilemma in which each alternative provides a counterexample to single premise closure. Whether or not rational inconsistency is possible, there is a case against closure.

  16. A technique for introducing looped sutures in flexor tendon repair

    Kamath B


    Full Text Available Stronger flexor tendon repairs facilitate early active motion therapy protocols. Core sutures using looped suture material provide 1 ½ to twice the strength of Kessler′s technique (with four strand and six strand Tsuge technique respectively. The technique is well-described and uses preformed looped sutures (supramid. This is not available in many countries and we describe a technique whereby looped sutures can be introduced in flexor tendon repair by the use of 23 G hypodermic needle and conventional 4.0 or 5.0 sutures. This is an alternative when the custom made preformed sutures are not available. This can be practiced in zone 3 to zone 5 repairs. Technical difficulties limit its use in zone 2 repairs.

  17. A study of sutural bones in Gujarati (Indian) crania.

    Pal, G P; Bhagwat, S S; Routal, R V


    370 adult crania were examined to find the incidence of sutural bones in Gujarati (Indian) crania and to compare it with other populations to establish the distance between them. The mean measure of difference between Indian and other populations was statistically significant. Comparison of cranial capacity in skulls with and without sutural bones showed no significant difference, and this is interpreted as indicating that sutural bones are not formed secondary to stress.

  18. Safety Pin Suture for Management of Atonic Postpartum Hemorrhage

    Zaitoun, Mostafa M.; Mostfa, Ali Abdelhamed M.


    Objective. To assess the efficacy of a new suture technique in controlling severe resistant uterine atonic postpartum hemorrhage. Patients and Methods. This is a retrospective observational study that included thirteen women with uterine atony and postpartum bleeding that did not react to usual medical management. All these women underwent compressing vertical suture technique in which the anterior and posterior walls of the uterus were attached so as to compress the uterus. The suture is tra...

  19. Needle Path Planning for Autonomous Robotic Surgical Suturing.

    Jackson, Russell C; Cavuşoğlu, M Cenk


    This paper develops a path plan for suture needles used with solid tissue volumes in endoscopic surgery. The path trajectory is based on the best practices that are used by surgeons. The path attempts to minimize the interaction forces between the tissue and the needle. Using surgical guides as a basis, two different techniques for driving a suture needle are developed. The two techniques are compared in hardware experiments by robotically driving the suture needle using both of the motion plans.

  20. Summer season | Cafeteria closures


    Please note the following cafeteria closures over the summer season: Bldg. 54 closed from 29/07/2013 to 06/09/2013. Bldg. 13: closed from 13/07/2013 to 06/09/2013. Restaurant No. 2, table service (brasserie and restaurant): closed from 01/08/2013 to 06/09/2013. Bldg. 864: closed from 29/07/2013 to 06/09/2013. Bldg. 865: closed from 29/07/2013 to 06/09/2013.

  1. Summer season | Cafeteria closures


    Please note the following cafeteria closures over the summer season: Bldg. 54 closed from 29/07/2013 to 06/09/2013. Bldg. 13: closed from 13/07/2013 to 06/09/2013. Restaurant No. 2, table service (brasserie and restaurant): closed from 01/08/2013 to 06/09/2013. Bldg. 864: closed from 29/07/2013 to 06/09/2013. Bldg. 865: closed from 29/07/2013 to 06/09/2013.

  2. Estudio comparativo de microsutura vascular en ratas: punto simple y punto de colchonero horizontal Comparative study about vascular microsurgery on rats: classic interrupted suture versus horizontal mattress suture

    C. Casado Sánchez


    Full Text Available La Microcirugía es la técnica empleada para la realización de la microanastomosis vascular. El objetivo del presente estudio es comparar dos tipos de técnicas de microsutura: los puntos simples clásicos, de empleo habitual en la microcirugía vascular, y los puntos de colchonero horizontales, no evaluados habitualmente para este tipo de cirugía. Fueron intervenidas 20 ratas albinas de la cepa Wistar (peso medio de 250 - 300 gr. bajo anestesia general; realizamos sección transversal en la arteria femoral, procediendo a su reparación microquirúrgica inmediata. Se establecieron 2 grupos de animales: en el grupo A (n=10, la microsutura se hizo mediante 6 puntos sueltos simples, y en el grupo B (n=10, empleando 3 puntos de colchonero horizontal. Comprobamos la patencia en el desclampado inmediato y tras una hora del desclampado (para ambas técnicas fue positiva en el 100% de los casos, y la hemorragia en ambos tiempos (se registró un único caso de sangrado en el postoperatorio inmediato en el grupo B, que requirió la revisión de la microsutura. El tiempo medio de ejecución de la sutura en el grupo B, 15 minutos aproximadamente, fue más corto que en el grupo A, 21 minutos aproximadamente, diferencia estadísticamente significativa (p Microsurgery is the procedure of choice for vascular microanastamoses. The objective of this study was to compare two types of suture techniques: classic interrupted suture anastomoses, commonly used for vascular anastamoses in microsurgery, and another technique using horizontal mattress sutures, rarely evaluated in this type of surgery. Twenty albino Wistar rats were operated (average weight: 250 - 300 gr. under general anaesthesia. A transverse section of the femoral artery was performed and immediately followed by an anastamoses. The animals were placed into two groups of ten. The classic 6 interrupted suture anastomoses technique was performed in group A (n = 10 and another technique using 3

  3. RELAP-7 Closure Correlations

    Zou, Ling [Idaho National Lab. (INL), Idaho Falls, ID (United States); Berry, R. A. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Martineau, R. C. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Andrs, D. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Zhang, H. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Hansel, J. E. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Sharpe, J. P. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Johns, Russell C. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)


    The RELAP-7 code is the next generation nuclear reactor system safety analysis code being developed at the Idaho National Laboratory (INL). The code is based on the INL’s modern scientific software development framework, MOOSE (Multi-Physics Object Oriented Simulation Environment). The overall design goal of RELAP-7 is to take advantage of the previous thirty years of advancements in computer architecture, software design, numerical integration methods, and physical models. The end result will be a reactor systems analysis capability that retains and improves upon RELAP5’s and TRACE’s capabilities and extends their analysis capabilities for all reactor system simulation scenarios. The RELAP-7 code utilizes the well-posed 7-equation two-phase flow model for compressible two-phase flow. Closure models used in the TRACE code has been reviewed and selected to reflect the progress made during the past decades and provide a basis for the colure correlations implemented in the RELAP-7 code. This document provides a summary on the closure correlations that are currently implemented in the RELAP-7 code. The closure correlations include sub-grid models that describe interactions between the fluids and the flow channel, and interactions between the two phases.

  4. Visual Measurement of Suture Strain for Robotic Surgery

    John Martell


    Full Text Available Minimally invasive surgical procedures offer advantages of smaller incisions, decreased hospital length of stay, and rapid postoperative recovery to the patient. Surgical robots improve access and visualization intraoperatively and have expanded the indications for minimally invasive procedures. A limitation of the DaVinci surgical robot is a lack of sensory feedback to the operative surgeon. Experienced robotic surgeons use visual interpretation of tissue and suture deformation as a surrogate for tactile feedback. A difficulty encountered during robotic surgery is maintaining adequate suture tension while tying knots or following a running anastomotic suture. Displaying suture strain in real time has potential to decrease the learning curve and improve the performance and safety of robotic surgical procedures. Conventional strain measurement methods involve installation of complex sensors on the robotic instruments. This paper presents a noninvasive video processing-based method to determine strain in surgical sutures. The method accurately calculates strain in suture by processing video from the existing surgical camera, making implementation uncomplicated. The video analysis method was developed and validated using video of suture strain standards on a servohydraulic testing system. The video-based suture strain algorithm is shown capable of measuring suture strains of 0.2% with subpixel resolution and proven reliability under various conditions.

  5. Bone suture and lateral sinus lift surgery

    Amin Rahpeyma


    Full Text Available Bone suture in lateral sinus lift has four indications. Three of them depend on creating a hole in the lateral maxillary sinus wall above the antrostomy window for securing the elevated medial maxillary sinus membrane to manage perforated Schneiderian membrane. Covering the buccal antrostomy window with the buccal fat pad (BFP for better nourishment of the inserted graft and as an alternative for bone tags in fixation of collagen membrane has been reported previously. A new indication for firmly anchoring the BFP to the medial maxillary sinus wall as the last resort for the management of perforated Schneiderian membrane is explained in this article.

  6. A Prospective Randomized Clinical Trial of Single vs. Double Layer Closure of Hysterotomy at the Time of Cesarean Delivery: The Effect on Uterine Scar Thickness.

    Bamberg, C; Dudenhausen, J W; Bujak, V; Rodekamp, E; Brauer, M; Hinkson, L; Kalache, K; Henrich, W


    Purpose: We undertook a randomized clinical trial to examine the outcome of a single vs. a double layer uterine closure using ultrasound to assess uterine scar thickness. Materials and Methods: Participating women were allocated to one of three uterotomy suture techniques: continuous single layer unlocked suturing, continuous locked single layer suturing, or double layer suturing. Transvaginal ultrasound of uterine scar thickness was performed 6 weeks and 6 - 24 months after Cesarean delivery. Sonographers were blinded to the closure technique. Results: An "intent-to-treat" and "as treated" ANOVA analysis included 435 patients (n = 149 single layer unlocked suturing, n = 157 single layer locked suturing, and n = 129 double layer suturing). 6 weeks postpartum, the median scar thickness did not differ among the three groups: 10.0 (8.5 - 12.3 mm) single layer unlocked vs. 10.1 (8.2 - 12.7 mm) single layer locked vs. 10.8 (8.1 - 12.8 mm) double layer; (p = 0.84). At the time of the second follow-up, the uterine scar was not significantly (p = 0.06) thicker if the uterus had been closed with a double layer closure 7.3 (5.7 - 9.1 mm), compared to single layer unlocked 6.4 (5.0 - 8.8 mm) or locked suturing techniques 6.8 (5.2 - 8.7 mm). Women who underwent primary or elective Cesarean delivery showed a significantly (p = 0.03, p = 0.02, "as treated") increased median scar thickness after double layer closure vs. single layer unlocked suture. Conclusion: A double layer closure of the hysterotomy is associated with a thicker myometrium scar only in primary or elective Cesarean delivery patients.

  7. Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

    Marc Manganiello


    Full Text Available PURPOSE: V-LocTM180 (Covidien Healthcare, Mansfield, MA is a new unidirectional barbed suture that may reduce loss of tension during a running closure. We evaluated the use of the barbed suture for urethrovesical anastomosis (UVA during robotic assisted laparoscopic prostatectomy (RALP. Time to completion of UVA, post-operative anastomotic leak rate, and urinary incontinence were compared in patients undergoing UVA with 3-0 unidirectional-barbed suture vs. 3-0 MonocrylTM (Ethicon, Somerville, NJ. MATERIALS AND METHODS: Data were prospectively collected for 70 consecutive patients undergoing RALP for prostate cancer between November 2009 and October 2010. In the first 35 patients, the UVA was performed using a modified running van Velthoven anastomosis technique using two separate 3-0 monofilament sutures. In the subsequent 35 patients, the UVA was performed using two running novel unidirectional barbed sutures. At 7-12 days postoperatively, all patients were evaluated with a cystogram to determine anastomotic integrity. Urinary incontinence was assessed at two months and five months by total daily pad usage. Clinical symptoms suggestive of bladder neck contracture were elicited. RESULTS: Age, PSA, Gleason score, prostate size, estimated blood loss, body mass index, and clinical and pathologic stage between the 2 groups were similar. Comparing the monofilament group and V-LocTM180 cohorts, average time to complete the anastomosis was similar (27.4 vs. 26.4 minutes, p = 0.73 as was the rate of urinary extravasation on cystogram (5.7 % vs. 8.6%, p = 0.65. There were no symptomatic bladder neck contractures noted at 5 months of follow-up. At 2 months, the percentage of patients using 2 or more pads per day was lower in the V-LocTM180 cohort (24% vs. 44%, p < 0.02. At 5 months, this difference was no longer evident. CONCLUSIONS: Time to complete the UVA was similar in the intervention and control groups. Rates of urine leak were also comparable

  8. Does UV disinfection compromise sutures? An evaluation of tissue response and suture retention in salmon surgically implanted with transmitters

    Walker, Ricardo W.; Brown, Richard S.; Deters, Katherine A.; Eppard, M. B.; Cooke, Steven J.


    Ultraviolet radiation (UVR) can be used as a tool to disinfect surgery tools used for implanting transmitters into fish. However, the use of UVR could possibly degrade monofilament suture material used to close surgical incisions. This research examined the effect of UVR on monofilament sutures to determine if they were compromised and negatively influenced tag and suture retention, incision openness, or tissue reaction. Eighty juvenile Chinook salmon Oncorhynchus tshawytscha were surgically implanted with an acoustic transmitter and a passive integrated transponder. The incision was closed with a single stitch of either a suture exposed to 20 doses of UV radiation (5 minute duration per dose) or a new, sterile suture. Fish were then held for 28 d and examined under a microscope at day 7, 14, 21 and 28 for incision openness, ulceration, redness, and the presence of water mold. There was no significant difference between treatments for incision openness, redness, ulceration or the presence of water mold on any examination day. On day 28 post-surgery, there were no lost sutures; however, 2 fish lost their transmitters (one from each treatment). The results of this study do not show any differences in negative influences such as tissue response, suture retention or tag retention between a new sterile suture and a suture disinfected with UVR.

  9. Printing tattoo effect after use of Dermabond®Prineo® Skin closure system

    Shabeer Ahmad Wani


    Full Text Available Abdominoplasty is a very common procedure in the plastic surgery practice and may lead to a variety of unfavorable results including incision site complications. The surgical adhesives system, which entered into daily practice to replace the need for subcuticular closure for skin, saves time and may have better wound appearance. Dermabond® Prineo® Skin Closure System (Ethicon Inc., Somerville, NJ, USA has two major components: 2–Octyl cyanoacrylate glue and a flexible, self-adhesive polyester mesh. It can be used with or without sutures, and has the added benefit of waterproofing, and microbial resistance. It also saves time. This case describes a male patient who experienced a “printing tattoo” effect following an elective procedure of abdominoplasty and the results after this closure system was used.

  10. Overlay Technique for Transcatheter Left Atrial Appendage Closure.

    Li, Shuang; Zhu, Mengyun; Lu, Yunlan; Tang, Kai; Zhao, Dongdong; Chen, Wei; Xu, Yawei


    The Overlay technique is popular in peripheral artery interventions, but not in coronary or cardiac structural procedures. We present an initial experience using three-episode overlays during a transcatheter left atrial appendage closure. The first overlay was applied to facilitate advancement of the delivery sheath into left atrium. The second overlay was used to navigate the advancement of prepped delivery system containing the compressed occluder into its optimal position in the left atrium. The third overlay facilitated the real-time deployment of the closure device. This case report demonstrates the effectiveness of the overlay technique in facilitating each step of the transcatheter left atrial appendage closure. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  11. [Arthroscopic Bankart repair with suture anchors: results and risk factors of recurrence of instability].

    Yan, Hui; Cui, Guo-Qing; Wang, Jian-Quan; Yin, Yu; Tian, De-Xiang; Ao, Ying-Fang


    To evaluate retrospectively the results of arthroscopic Bankart repair using suture anchors for recurrent anterior shoulder dislocation with a minimum 1-year follow-up and to assess risk factors for recurrence. From March 2002 to March 2010, 259 patients with recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with suture anchors. And 188 patients (50 athletes, 138 nonathletes) were available for follow-up. The mean age at the time of surgery was 25.3 years (range, 13 - 58 years). The mean follow-up was 38.6 months (range, 12 - 110 months). All of the 188 patients were evaluated preoperatively and postoperatively with the American Shoulder and Elbow Society (ASES) shoulder score and Rowe score system. The rate of recurrent instability, range of motion, and risk factors for postoperative recurrence were evaluated. The ASES score was 72.6 preoperatively, and Rowe score was 33.4. The ASES scores improved significantly to 91.9 postoperatively (P Bankart lesion, presence of a superior labrum, anterior and posterior tear, presence of posterior or inferior labrum lesion, presence of rotator cuff tear, ligamentous laxity and rotator interval closure did not influence the recurrence rate (P > 0.05). Arthroscopic Bankart repair is a good option for the treatment of recurrent anterior shoulder dislocation. Identification of risk factors for recurrence allows for consideration of open stabilization. In the series, patients under age 20 and athlete patients are the most important risk factors for recurrence.

  12. Safety pin suture for management of atonic postpartum hemorrhage.

    Mostfa, Ali Abdelhamed M; Zaitoun, Mostafa M


    Objective. To assess the efficacy of a new suture technique in controlling severe resistant uterine atonic postpartum hemorrhage. Patients and Methods. This is a retrospective observational study that included thirteen women with uterine atony and postpartum bleeding that did not react to usual medical management. All these women underwent compressing vertical suture technique in which the anterior and posterior walls of the uterus were attached so as to compress the uterus. The suture is transfixed at the uterine fundus, thus eliminating the risk of sutures sliding off at the uterine fundus (safety pin suture). Results. safety pin uterine compression suture was a sufficient procedure to stop the bleeding immediately in 92.2% of the women. None of the women developed complications related to the procedure. Conclusion. A new safety pin suture is a simple and effective procedure to control bleeding in patients with treatment-resistant, life-threatening atonic postpartum hemorrhage with the advantage of eliminating the risk of the sutures sliding off at the uterine fundus.

  13. Autoadjustable sutures and modified seldinger technique applied to laparoscopic jejunostomy.

    Pili, Diego; Ciotola, Franco; Riganti, Juan Martín; Badaloni, Adolfo; Nieponice, Alejandro


    This is a simple technique to be applied to those patients requiring an alternative feeding method. This technique has been successfully applied to 25 patients suffering from esophageal carcinoma. The procedure involves laparoscopic approach, suture of the selected intestinal loop to the abdominal wall and jejunostomy using Seldinger technique and autoadjustable sutures. No morbidity or mortality was reported.

  14. What is the significance of tendon suture purchase?

    Kim, J B; de Wit, T; Hovius, S E R; McGrouther, D A; Walbeehm, E T


    Repairs have been performed on porcine flexor tendons and subjected to tensile stress measurements to determine the effects and mechanism of core suture purchase (the length of the suture bite). Eighty-four pig trotter flexor profundus tendons were divided and repaired using four lengths of core suture purchase (1.33, 1, 0.66 and 0.33 cm) using a double modified Kessler repair (four strands, two knots) with a peripheral epitendinous suture. Tendon purchase was achieved by either bilateral equal purchase lengths or with one tendon purchase at a fixed depth of 1 cm. A separate group of tendons were incubated in blood for 24 hours to simulate the wound environment prior to testing. Tensile tests demonstrated a progressive increase of repair strength with purchase length. With the exception of the 0.33 cm group, video analysis demonstrated the mode of failure as suture failure and not due to suture pullout. Therefore, the increase in breaking strength cannot be attributed to a better grip of the tendon ends, but to the mechanical characteristics of the suture polymer. The tendency for the incubated tendons to fail more consistently by pullout rather than suture failure, particularly in the shorter purchase lengths, emphasises the importance of studying tendon purchase in vivo. The significance of ex vivo mechanical testing should be considered with caution.

  15. Suture technicians in a children's hospital emergency department.

    Apolo, J O; DiCocco, D


    A program that employs technicians for suturing lacerations is presented. Careful selection of the candidates, intensive training, and ongoing monitoring of their activities have been major factors in the success of the program. The curriculum of a course for suture technicians and their job description are discussed.

  16. Nose tip refinement using interdomal suture in caucasian nose

    Pasinato, Rogério


    Full Text Available Introduction: Refinement of the nose tip can be accomplished by a variety of techniques, but currently, the use of sutures in the nasal tip with conservative resection of the alar cartilage is the most frequently recommended approach. Objective: To classify the nasal tip and to demonstrate the interdomal suture applied to nasal tip refinement in the Caucasian nose, as well as to provide a simple and practical presentation of the surgical steps. Method: Development of surgical algorithm for nasal tip surgery: 1. Interdomal suture (double binding suture, 2. Interdomal suture with alar cartilage weakening (cross-hatching, 3. Interdomal suture with cephalic removal of the alar cartilage (McIndoe technique based on the nasal tip type classification. This classification assesses the interdomal distance (angle of domal divergence and intercrural distance, domal arch width, cartilage consistency, and skin type. Interdomal suture is performed through endonasal rhinoplasty by basic technique without delivery (Converse-Diamond technique under local anesthesia Conclusion: This classification is simple and facilitates the approach of surgical treatment of the nasal tip through interdomal suture, systematizing and standardizing surgical maneuvers for better refinement of the Caucasian nose.

  17. Sandwich wound closure reduces the risk of cerebrospinal fluid leaks in posterior fossa surgery

    Verena Heymanns


    Full Text Available Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8% in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark, Gelfoam® (Pfizer Inc., New York, NY, USA and polymethylmethacrylate (osteoclastic craniotomy. The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.

  18. Signaling mechanisms implicated in cranial sutures pathophysiology: Craniosynostosis

    Maria A. Katsianou


    Full Text Available Normal extension and skull expansion is a synchronized process that prevails along the osteogenic intersections of the cranial sutures. Cranial sutures operate as bone growth sites allowing swift bone generation at the edges of the bone fronts while they remain patent. Premature fusion of one or more cranial sutures can trigger craniosynostosis, a birth defect characterized by dramatic manifestations in appearance and functional impairment. Up until today, surgical correction is the only restorative measure for craniosynostosis associated with considerable mortality. Clinical studies have identified several genes implicated in the pathogenesis of craniosynostosis syndromes with useful insights into the underlying molecular signaling events that determine suture fate. In this review, we exploit the intracellular signal transduction pathways implicated in suture pathobiology, in an attempt to identify key signaling molecules for therapeutic targeting.

  19. Laparoscopic ventral hernia repair: outcomes in primary versus incisional hernias: no effect of defect closure.

    Lambrecht, J R; Vaktskjold, A; Trondsen, E; Øyen, O M; Reiertsen, O


    Supposing divergent aetiology, we found it interesting to investigate outcomes between primary (PH) versus incisional (IH) hernias. In addition, we wanted to analyse the effect of defect closure and mesh fixation techniques. 37 patients with PH and 70 with IH were enrolled in a prospective cohort-study, treated with laparoscopic ventral hernia repair (LVHR) and randomised to ± transfascial sutures. In addition, we analysed results from a retrospective study with 36 PH and 51 IH patients. Mean follow-up time was 38 months in the prospective study and 27 months in the retrospective study. 35 % of PH's and 10 % of IH's were recurrences after previous suture repair. No late infections or mesh removals occurred. Recurrence rates in the prospective study were 0 vs. 4.3 % (p = 0.55) and the complication rates were 16 vs. 27 % (p = 0.24) in favour of the PH cohort. The IH group had a mesh protrusion rate of 13 vs. 5 % in the PH group (p = 0.32), and significantly (p hernias and adhesion score, longer operating time (100 vs. 79 min) and admission time (2.8 vs. 1.6 days). Closure of the hernia defect did not influence rate of seroma, pain at 2 months, protrusion or recurrence. An overall increased complication rate was seen after defect closure (OR 3.42; CI 1.25-9.33). With PH, in comparison to IH treated with LVHR, no differences were observed regarding recurrence, protrusion or complication rates. Defect closure (raphe), when using absorbable suture, did not benefit long-term outcomes and caused a higher overall complication rate. ( number: NCT00455299).

  20. Quadrilobed superior gluteal artery perforator flap for sacrococcygeal defects

    HAI Heng-lin; SHEN Chuan-an; CHAI Jia-ke; LI Hua-tao; YU Yong-ming; LI Da-wei


    Background Perforator flaps are used extensively in repairing soft tissue defects.Superior gluteal artery perforatorflaps are used for repairing sacral defects,but the tension required for direct closure of the donor area after harvesting ofrelatively large flaps carries a risk of postoperative dehiscence.This research was to investigate a modified superiorgluteal artery perforator flap for repairing sacrococcygeal soft tissue defects.Methods From June 2003 to April 2010,we used our newly designed superior gluteal artery perforator flap for repair of sacrococcygeal soft tissue defects in 10 patients (study group).The wound and donor areas were measured,and the flaps were designed accordingly.Wound healing was assessed over a follow-up period of 6-38 months.From January 1998 to February 2003,twelve patients with sacrococcygeal pressure sores were treated with traditional methods,VY advancement flaps or oblong flaps,as control group.Results After debridement,the soft tissue defects ranged from 12 cm × 10 cm to 26 cm × 22 cm (mean 16.3 cm x 13.5cm).Four patients were treated using right-sided flaps ranging from 15 cm × 11 cm to 25 cm × 20 cm (mean 18.2 cm × 14cm).Four patients were treated using left-sided flaps,and two were treated using both right-and left-sided flaps.Suction drains were removed on postoperative Days 3-21 (mean 5.9) and sutures were removed on postoperative Days 12-14.Each flap included 1-2 perforators for each of the donor and recipient sites.Donor sites were closed directly.All flaps survived.In eight patients,the wounds healed after single-stage surgery.After further debridement,the wounds of the remaining two patients were considered healed on postoperative Days 26 and 33,respectively.The rate of first intention in the study group (80%,8/10) significantly increased than that of control group ((25%,3/12),X2=4.583,P=-0.032).Follow-up examinations found that the flaps had a soft texture without ulceration.In the two patients without

  1. Development of Absorbable, Antibiotic-Eluting Sutures for Ophthalmic Surgery

    Kashiwabuchi, Fabiana; Parikh, Kunal S.; Omiadze, Revaz; Zhang, Shuming; Luo, Lixia; Patel, Himatkumar V.; Xu, Qingguo; Ensign, Laura M.; Mao, Hai-Quan; Hanes, Justin; McDonnell, Peter J.


    Purpose To develop and evaluate an antibiotic-eluting suture for ophthalmic surgery. Methods Wet electrospinning was used to manufacture sutures composed of poly(L-lactide), polyethylene glycol (PEG), and levofloxacin. Size, morphology, and mechanical strength were evaluated via scanning electron microscopy and tensile strength, respectively. In vitro drug release was quantified using high performance liquid chromatography. In vitro suture activity against Staphylococcus epidermidis was investigated through bacterial inhibition studies. Biocompatibility was determined via histological analysis of tissue sections surrounding sutures implanted into Sprague-Dawley rat corneas. Results Sutures manufactured via wet electrospinning were 45.1 ± 7.7 μm in diameter and 0.099 ± 0.007 newtons (N) in breaking strength. The antibiotic release profile demonstrated a burst followed by sustained release for greater than 60 days. Increasing PEG in the polymer formulation, from 1% to 4% by weight, improved drug release without negatively affecting tensile strength. Sutures maintained a bacterial zone of inhibition for at least 1 week in vitro and elicited an in vivo tissue reaction comparable to a nylon suture. Conclusions There is a need for local, postoperative delivery of antibiotics following ophthalmic procedures. Wet electrospinning provides a suitable platform for the development of sutures that meet size requirements for ophthalmic surgery and are capable of sustained drug release; however, tensile strength must be improved prior to clinical use. Translational Relevance No antibiotic-eluting suture exists for ophthalmic surgery. A biocompatible, high strength suture capable of sustained antibiotic release could prevent ocular infection and preclude compliance issues with topical eye drops. PMID:28083445

  2. Performance of antegrade suture passers according to tendon thickness

    Myung-Sun Kim


    Full Text Available Purpose: To determine the effect of tendon thickness on the needle penetration ability of four different designs of antegrade suture passers. Materials and Methods: Four antegrade suture passers were tested: (a ExpresSew II (Depuy Mitek Inc., Raynham, MA, (b Arthrex Scorpion (Arthrex, Naples, FL, (c Concept (Linvatec Corp, Largo, FL, and (d ElitePass (Smith and Nephew Endoscopy, Andover, MA. Bovine tendons were divided into five thickness groups: 3, 5, 7, 9 and 11 mm. At each tendon thickness, we performed 15 trials with the suture loaded and 15 unloaded per device. Successful needle penetration was recorded, and in case of success, the exit point of the needle was noted in relation to the superior arm of the grasping component. Results: All tested suture passing devices successfully penetrated tendon thicknesses of 3 and 5 mm. With the suture loaded, one device (Concept only successfully penetrated 7 mm group tendons in 3/15 (20% trials. Success rates at 9 mm with the suture loaded were 40% in ExpresSew II, 53% in Arthrex Scorpion, 0% in Concept and 53% in ElitePass. Among successful passages with a loaded suture in the 7 and 9 mm-groups, about 20-50% of passages were oblique, and the needle came out distal to the superior arm of grasping the component. No trial with any device succeeded with 11 mm tendons in the suture loading condition. Conclusion: Using an antegrade suture passer during arthroscopic rotator cuff repair should be carefully considered when the torn end of the tendon is thicker than about 7-9 mm due to potential failure of needle penetration and/or too oblique a suture passage. Level of Evidence: Controlled laboratory study.

  3. Performance of antegrade suture passers according to tendon thickness

    Kim, Myung-Sun; Kim, Dong Whan; Choi, Young Eun; Bachman, Larry; Kim, Sae Hoon


    Purpose: To determine the effect of tendon thickness on the needle penetration ability of four different designs of antegrade suture passers. Materials and Methods: Four antegrade suture passers were tested: (a) ExpresSew II (Depuy Mitek Inc., Raynham, MA), (b) Arthrex Scorpion (Arthrex, Naples, FL), (c) Concept (Linvatec Corp, Largo, FL), and (d) ElitePass (Smith and Nephew Endoscopy, Andover, MA). Bovine tendons were divided into five thickness groups: 3, 5, 7, 9 and 11 mm. At each tendon thickness, we performed 15 trials with the suture loaded and 15 unloaded per device. Successful needle penetration was recorded, and in case of success, the exit point of the needle was noted in relation to the superior arm of the grasping component. Results: All tested suture passing devices successfully penetrated tendon thicknesses of 3 and 5 mm. With the suture loaded, one device (Concept) only successfully penetrated 7 mm group tendons in 3/15 (20%) trials. Success rates at 9 mm with the suture loaded were 40% in ExpresSew II, 53% in Arthrex Scorpion, 0% in Concept and 53% in ElitePass. Among successful passages with a loaded suture in the 7 and 9 mm-groups, about 20-50% of passages were oblique, and the needle came out distal to the superior arm of grasping the component. No trial with any device succeeded with 11 mm tendons in the suture loading condition. Conclusion: Using an antegrade suture passer during arthroscopic rotator cuff repair should be carefully considered when the torn end of the tendon is thicker than about 7-9 mm due to potential failure of needle penetration and/or too oblique a suture passage. Level of Evidence: Controlled laboratory study. PMID:25937714

  4. 40 CFR 265.280 - Closure and post-closure.


    ... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Closure and post-closure. 265.280 Section 265.280 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES... location, topography, and surrounding land use, with respect to the potential effects of pollutant...


    Lane, J E; Scott, J E; Mathews, S E


    Lawrence Livermore National Laboratory of the University of California (LLNL) operates two Class II surface impoundments that store wastewater that is discharged from a number of buildings located on the Site 300 Facility (Site 300). The wastewater is the by-product of explosives processing. Reduction in the volume of water discharged from these buildings over the past several years has significantly reduced the wastewater storage needs. In addition, the impoundments were constructed in 1984, and the high-density polyethylene (HDPE) geomembrane liners are nearing the end of their service life. The purpose of this project is to clean close the surface impoundments and provide new wastewater storage using portable, above ground storage tanks at six locations. The tanks will be installed prior to closure of the impoundments and will include heaters for allowing evaporation during relatively cool weather. Golder Associates (Golder) has prepared this Final Closure Plan (Closure Plan) on behalf of LLNL to address construction associated with the clean closure of the impoundments. This Closure Plan complies with State Water Resources Control Board (SWRCB) Section 21400 of the California Code of Regulations Title 27 (27 CCR {section}21400). As required by these regulations and guidance, this Plan provides the following information: (1) A site characterization, including the site location, history, current operations, and geology and hydrogeology; (2) The regulatory requirements relevant to clean closure of the impoundments; (3) The closure procedures; and, (4) The procedures for validation and documentation of clean closure.

  6. Healing of periodontal flaps when closed with silk sutures and N-butyl cyanoacrylate: A clinical and histological study

    Kulkarni Sudhindra


    Full Text Available Background: The closure of the periodontal flaps post-surgery is a necessity for attainment of a primary union between the flap margins and the establishment of a healthy dentogingival junction. N-butyl cyanoacrylate is a tissue adhesive, which can be used for the closure of the incised wounds to overcome the problems associated with conventional suture materials like silk. Objective: The present study was carried out to assess the healing of the periodontal flaps when closed with the conventional silk sutures and N-butyl cyanoacrylate. Materials and Methods: The study was carried out on 24 patients who needed flap surgical procedure for pocket therapy. Results: It was found that healing with the cyanoacrylate is associated with less amount of inflammation during the first week when compared with silk. However, over a period of 21 days to 6 weeks, the sites treated with both the materials showed similar healing patterns. Conclusion: It can be concluded that cyanoacrylate aids in early initial healing.

  7. Transumbilical endoscopic technique for complete closure of inguinal hernias in female pediatric patients

    Zhou, Xuewu; Qi, Xi; Jiang, Bing; Sha, Yongliang; Song, Daiqiang


    Laparoscopic percutaneous extraperitoneal closure of inguinal hernia with variable devices as an effective technique in minimal-access surgery for pediatric inguinal hernias in children was investigated in the present study. A Veress needle was inserted into the abdomen. Trocars, laparoscope and needle holder were placed through the umbilical incision. Under laparoscopic monitoring, a round needle was introduced into the peritoneal cavity through the anterior abdominal wall. The end of the suture inside the peritoneal cavity was left outside the peritoneal cavity in favor of ligation. The needle was passed through the peritoneum to place an extraperitoneal purse-string suture around the internal inguinal ring, counterclockwise on the left and clockwise on the right. The needle was then passed back into the peritoneal cavity and out through the abdominal wall, and the needle ends of the stitch were cut. The ends of the suture were tied. We described a technique used for transumbilical endoscopic closure of pediatric inguinal hernias in girls. This technique is simple and can be performed quickly. The cosmetic result is excellent because the two umbilical incisions are only 5-mm long, which make it possible to perform surgery without a visible scar. We performed this procedure in over 96 patients and have had no recurrences. Thus, this method may become the laparoscopic repair of choice for females with inguinal hernias. PMID:28123465

  8. Severe scar problems following use of a locking barbed skin closure system in the foot.

    Chowdhry, Majid; Singh, Samrendu


    Barbed sutures provide a novel technique for knotless wound closure. They have mainly been used in plastic and general surgery. There are no reports about its use in the foot. We present a case series of 11 feet in 8 patients whose wounds were closed with barbed sutures. Ten had primary hallux valgus correction and one had a revision correction. No problems were noted at 2-weeks follow-up. Four of the 11 cases required open suture excision due to an adverse reaction. Five were followed to delayed wound healing. Histology results from one scar showed a localised histiocytic reaction and superficial dermal abscess formation. We feel the thin subcutaneous tissue of the foot, the amount of motion and pressure from the shoe causes the barbs to repeatedly irritate the soft tissue. Based on our short case series we cannot recommend the use of a barbed skin closure system in the foot. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  9. Omental Herniation: A Rare Complication of Vacuum-Assisted Closure of Infected Sternotomy Wound

    Philemon Gukop


    Full Text Available Vacuum-assisted closure (VAC has recently been adopted as an acceptable modality for management of sternotomy wound infections. Although generally efficacious, the use of negative pressure devices has been associated with complications such as bleeding, retention of sponge, and empyema. We report the first case of greater omental hernia as a rare complication of vacuum-assisted closure of sternal wound infection following coronary artery bypass grafting.

  10. Planning for integrated mine closure

    Linda Starke (ed.)


    This document presents an Integrated Mine Closure Planning Toolkit for the mining and metals sector. The toolkit is intended to be used to promote a more disciplined approach to integrated closure planning and to increase the uniformity of good practices across the sector. The concepts apply equally well to both large and small companies. The document is not intended to be prescriptive; it provides a suite of tools that can be brought to bear in formulating well-considered decisions when planning for closure. It uses a risk and opportunity based process to guide the practitioner through the iterative process of preparing for planned closure. The first section, with head office and mine management personnel as the primary audience, describes the participants of effective closure planning. Sections 2 and 3 provide the frameworks for a conceptual closure plan and a detailed plan. The key audiences for these two sections are mine management and head office personnel, financial modellers and estimators, governments, academics and non-governmental organizations. The forth section addresses decommissioning and post closure planning, and Section 5 draws together the conclusions and outlines several unresolved issues. The five narrative sections are followed by Section 6 which outlines 13 tools, some of which are already available in earlier ICMM publications, member practices and other sector-affiliated publications. Others have been developed to cover identified gaps. These tools provide the practitioner with practical work processes, examples and contexts within which to apply closure planning discipline.

  11. Gastrotomy closure using bioabsorbable plugs in a canine model.

    Cios, Theodore J; Reavis, Kevin M; Renton, David R; Hazey, Jeffrey W; Mikami, Dean J; Narula, Vimal K; Allemang, Matthew T; Davis, S Scott; Melvin, W Scott


    The repair of gastric perforation commonly involves simple suture closure using an open or laparoscopic approach. An endolumenal approach using prosthetic materials may be beneficial. The role of bioprosthetics in this instance has not been thoroughly investigated, thus the authors evaluated the feasibility of gastric perforation repair using a bioabsorbable device and quantified gross and histological changes at the injury site. Twelve canines were anesthetized and underwent open gastrotomy. A 1-cm-diameter perforation was created in the anterior wall of the stomach and plugged with a bioabsorbable device. Intralumenal pH was recorded. Canines were sacrificed at one, four, six, eight, and 12 weeks. The stomach was explanted followed by gross and histological examination. The injury site was examined. The relative ability of the device to seal the perforation was recorded, as were postoperative changes. Tissue samples were analyzed for gross and microscopic tissue growth and compared to normal gastric tissue in the same animal as an internal control. A scoring system of -2 to +2 was used to measure injury site healing (-2= leak, -1= no leak and minimal ingrowth, 0= physiologic healing, +1= mild hypertrophic tissue, +2= severe hypertrophic tissue). In all canines, the bioprosthesis successfully sealed the perforation without leak under ex vivo insufflation. At one week, the device maintained its integrity but there was no tissue ingrowth. Histological healing score was -1. At 4-12 weeks, gross examination revealed a healed injury site in all animals. The lumenal portion of the plug was completely absorbed. The gross and histological healing score ranged from -1 to +1. The application of a bioabsorbable device results in durable closure of gastric perforation with physiologic healing of the injury site. This method of gastrotomy closure may aid in the evolution of advanced endoscopic approaches to perforation closure of hollow viscera.

  12. Cranial suture morphology and its relationship to diet in Cebus.

    Byron, Craig D


    Cranial sutures are complex morphological structures. Four Cebus species (C. albifrons, C. apella, C. capucinus, C. olivaceus) are used here to test the hypothesis that sagittal suture complexity is enhanced in animals that eat materially challenging foods. These primates are ideal for such comparative studies because they are closely related and some are known to exhibit differences in the material properties of the foods they ingest and masticate. Specifically, Cebus apella is notable among members of this genus for ingesting food items of high toughness as well as consistently demonstrating a relatively robust cranial morphology. Consistent with previous studies, C. apella demonstrates significantly more robust mandibular and temporal fossa morphology. Also, C. apella possesses sagittal sutures that are more complex than congenerics. These data are used to support the hypothesis that cranial suture complexity is increased in response to consuming diets with more obdurate material properties. One interpretation of this hypothesis is that, compared to non-apelloids, total strain in the apelloid cranial suture connective tissue environment is elevated due to increased jaw muscle activity by increases in either force magnitudes or the number of chewing events. It is argued that greater masticatory function enhances the growth and modeling of cranial suture interdigitation. These data show that cranial suture complexity is one more hard tissue feature from the skull that might be used to inform hypotheses of dietary functional morphology.

  13. Ectocranial suture fusion in primates: pattern and phylogeny.

    Cray, James; Cooper, Gregory M; Mooney, Mark P; Siegel, Michael I


    Patterns of ectocranial suture fusion among Primates are subject to species-specific variation. In this study, we used Guttman Scaling to compare modal progression of ectocranial suture fusion among Hominidae (Homo, Pan, Gorilla, and Pongo), Hylobates, and Cercopithecidae (Macaca and Papio) groups. Our hypothesis is that suture fusion patterns should reflect their evolutionary relationship. For the lateral-anterior suture sites there appear to be three major patterns of fusion, one shared by Homo-Pan-Gorilla, anterior to posterior; one shared by Pongo and Hylobates, superior to inferior; and one shared by Cercopithecidae, posterior to anterior. For the vault suture pattern, the Hominidae groups reflect the known phylogeny. The data for Hylobates and Cercopithecidae groups is less clear. The vault suture site termination pattern of Papio is similar to that reported for Gorilla and Pongo. Thus, it may be that some suture sites are under larger genetic influence for patterns of fusion, while others are influenced by environmental/biomechanic influences. Copyright © 2013 Wiley Periodicals, Inc.

  14. Deep Infections After Syndesmotic Fixation With a Suture Button Device.

    Fantry, Amanda J; O'Donnell, Seth W; Born, Chris T; Hayda, Roman A


    Suture button devices such as the TightRope (Arthrex, Naples, Florida) have been increasingly used for syndesmotic fixation of ankle fractures. Despite proposed advantages, prior studies have shown equivalent outcomes, with a theoretical decreased need for removal of hardware. Complications of suture button fixation of syndesmotic instability may be underreported and include lateral suture knot inflammation with or without granuloma formation, infection, aseptic osteolysis with widening of the tibial drill tunnels, heterotopic ossification, and osteomyelitis. In this case series, the authors review the current literature and describe 3 patients with TightRope fixation for syndesmotic instability who developed deep infection. The authors believe that braided suture within suture button devices may provide an environment conducive to the propagation of infection across the syndesmotic fixation tract. Evidence of suture button migration or osteolysis of the TightRope tract should prompt an infectious workup and removal of hardware. If there is concern for infection associated with the TightRope, the authors recommend removing both metallic buttons and the entirety of the suture to prevent harboring a nidus for further infection. [Orthopedics. 2017; 40(3):e541-e545.]. Copyright 2017, SLACK Incorporated.

  15. Effect of skin coverage method following subcuticular suturing on wound infection rates at cesarean delivery().

    Westcott, Jill M; Crockett, Libby; Qiu, Fang; Berg, Teresa G


    The objective of this study was to determine whether the use of cyanoacrylate skin glue following subcuticular skin closure was associated with a decrease in wound outcomes in comparison with subcuticular closure plus Steri-strips at cesarean delivery. This was a retrospective cohort study of patients undergoing cesarean delivery at a single center over a two-year period. The primary outcome of wound infection and secondary outcomes of wound separation and composite wound complication rate were assessed throughout the six-week postpartum period. Of 660 women who met inclusion criteria, 35 (5.3%) experienced a wound infection and 90 (13.6%) experienced a wound separation. The composite wound complication rate was 16.4% (n = 108). Of the 515 cases with a skin coverage method noted, use of skin glue was associated with a marginal decrease in wound infections (p = 0.057), as well as a significantly reduced incidence of wound separation (p = 0.03) and composite wound complications (p = 0.006). Cyanoacrylate skin glue may be superior to Steri-strips for wound separation and composite wound complication rates when utilized with subcuticular suture at the time of cesarean delivery and may yield some benefit for prevention of wound infection.

  16. Modified technique for reconstructing the visceral arteries in thoracoabdominal aortic repair.

    Kondoh, Haruhiko; Funatsu, Toshihiro; Taniguchi, Kazuhiro


    We present a modified technique for reconstructing the visceral arteries in thoracoabdominal aortic repair. After the proximal and distal anastomosis of a main tubular graft with four pre-sewn side branches, each visceral artery is cannulated and perfused with 25 °C blood (sum total, 800 mL/min). Then, each side branch is placed around the main graft, forming a gently curved loop around it. Finally, the orifice of each visceral artery is sutured to a side branch. This technique prevents kinking of the side branches and enables hemostasis to be secured with a clear view of all the suture lines.

  17. 腹腔镜手术治疗肾动脉瘤1例报告并文献复习%Laparoscopic surgery for renal artery aneurysm: a case report and literature review zhejiang provincial people's hospital endourology cencer

    茅夏娃; 张大宏; 刘锋; 祁小龙; 章越龙; 张琦


    Objective: To evaluate feasibility and method about laparoscopic treatment of renal artery aneurysm.Methods:The patient,female,59 years old,was admitted for "repeated hypertension for 10 years,examination revealed renal artery aneurysm for 1 week".CTA showed: right renal artery aneurysm,2cm with diameter.The renal artery issued two branch arteries and the aneurysm is located near the trunk of one of the two branch.Surgical methods: patients with left lateral position,routine disinfection and draping,establishment of pneumo-peritoneum,dissection of kidney,blood vessels,tumor body respectively.To block the main artery and two branches with lap dogs,complete aneurysm resection with scissors,suturing the artery with 4-0 vascular suture,peri-renal fascia with 2-0 absorbable suture,place one drainage tube in local place.Results:The operation was successful with the operation time 125 min,warm ischemia time 28 min,vascular closure time 8 min.Blood loss was 50 ml.The patients began to eat semi-liquid 24 hours after the .surgery,walking out of bed after 48 hours,discharged after 7 days.7 days later,CT scans showed; no right renal artery stenosis,a small part of the ischemic kidney performance.Conclusions; Laparoscopic renal artery aneurysm resection is feasible,with the key skilled performing and fine suture.%目的:探讨腹腔镜术治疗肾动脉瘤的可行性与方法.方法:报告1例59岁女性患者,因“反复高血压10年,检查发现肾动脉瘤1周”入院.CTA示右肾动脉瘤,直径2 cm,肾动脉主干发出两支二级动脉分支,动脉瘤位于其中一根二级分支近主干处.患者左侧卧位,建立气腹,游离肾脏及血管,分离动脉瘤体,用哈叭狗钳分别阻断主干及两根二级分支,用剪刀将动脉瘤完整切除.4-0血管缝线缝合动脉破口,2 0可吸收线缝合肾周筋膜,局部放置一引流管.结果:手术成功,手术时间125 min,其中热缺血时间28 min,血管缝合时间8 min,术中出血50 ml,患者术后24

  18. Automation of a suturing device for minimally invasive surgery.

    Göpel, Tobias; Härtl, Felix; Schneider, Armin; Buss, Martin; Feussner, Hubertus


    In minimally invasive surgery, hand suturing is categorized as a challenge in technique as well as in its duration. This calls for an easily manageable tool, permitting an all-purpose, cost-efficient, and secure viscerosynthesis. Such a tool for this field already exists: the Autosuture EndoStitch(®). In a series of studies the potential for the EndoStitch to accelerate suturing has been proven. However, its ergonomics still limits its applicability. The goal of this study was twofold: propose an optimized and partially automated EndoStitch and compare the conventional EndoStitch to the optimized and partially automated EndoStitch with respect to the speed and precision of suturing. Based on the EndoStitch, a partially automated suturing tool has been developed. With the aid of a DC motor, triggered by a button, one can suture by one-fingered handling. Using the partially automated suturing manipulator, 20 surgeons with different levels of laparoscopic experience successfully completed a continuous suture with 10 stitches using the conventional and the partially automated suture manipulator. Before that, each participant was given 1 min of instruction and 1 min for training. Absolute suturing time and stitch accuracy were measured. The quality of the automated EndoStitch with respect to manipulation was tested with the aid of a standardized questionnaire. To compare the two instruments, t tests were used for suturing accuracy and time. Of the 20 surgeons with laparoscopic experience (fewer than 5 laparoscopic interventions, n=9; fewer than 20 laparoscopic interventions, n=7; more than 20 laparoscopic interventions, n=4), there was no significant difference between the two tested systems with respect to stitching accuracy. However, the suturing time was significantly shorter with the Autostitch (P=0.01). The difference in accuracy and speed was not statistically significant considering the laparoscopic experience of the surgeons. The weight and size of the

  19. Vascular Closure Devices in Interventional Radiology Practice.

    Patel, Rafiuddin; Muller-Hulsbeck, Stefan; Morgan, Robert; Uberoi, Raman


    Manual compression (MC) is a well-established technique for haemostasis following percutaneous arterial intervention. However, MC is labour and time intensive with potential limitations, particularly for patients who are coagulopathic, unable to comply with bed rest or obese and when large sheaths or anti-coagulants are used. There are a variety of vascular closure devices (VCDs) available to overcome these limitations. This review gives an overview of current VCDs, their mechanism of action, individual strengths and weaknesses, evidence base and utility in interventional radiology (IR) practice. The majority of the published evidence on VCDs is derived from patients undergoing cardiac interventions, which should be borne in mind when considering the applicability and transfer of this data for general IR practice. Overall, the evidence suggests that most VCDs are effective in achieving haemostasis with a similar rate of complications to MC although the complication profile associated with VCDs is distinct to that of MC. There is insufficient evidence to comparatively analyse the different types of VCDs currently available or reliably judge their cost-effectiveness. The interventional radiologist should have a thorough understanding of the available techniques for haemostasis and be able to identify and utilise the most appropriate strategy and closure technique for the individual patient.

  20. Vascular Closure Devices in Interventional Radiology Practice

    Patel, Rafiuddin, E-mail: [John Radcliffe Hospital, Department of Radiology (United Kingdom); Muller-Hulsbeck, Stefan, E-mail: [Diakonissen Hospital, Diagnostic and Interventional Radiology/Neuroradiology (Germany); Morgan, Robert, E-mail: [St George’s Hospital, Department of Radiology (United Kingdom); Uberoi, Raman, E-mail: [John Radcliffe Hospital, Department of Radiology (United Kingdom)


    Manual compression (MC) is a well-established technique for haemostasis following percutaneous arterial intervention. However, MC is labour and time intensive with potential limitations, particularly for patients who are coagulopathic, unable to comply with bed rest or obese and when large sheaths or anti-coagulants are used. There are a variety of vascular closure devices (VCDs) available to overcome these limitations. This review gives an overview of current VCDs, their mechanism of action, individual strengths and weaknesses, evidence base and utility in interventional radiology (IR) practice. The majority of the published evidence on VCDs is derived from patients undergoing cardiac interventions, which should be borne in mind when considering the applicability and transfer of this data for general IR practice. Overall, the evidence suggests that most VCDs are effective in achieving haemostasis with a similar rate of complications to MC although the complication profile associated with VCDs is distinct to that of MC. There is insufficient evidence to comparatively analyse the different types of VCDs currently available or reliably judge their cost-effectiveness. The interventional radiologist should have a thorough understanding of the available techniques for haemostasis and be able to identify and utilise the most appropriate strategy and closure technique for the individual patient.

  1. Mathematical models of wound healing and closure: a comprehensive review.

    Jorgensen, Stephanie N; Sanders, Jonathan R


    Wound healing is a complex process comprised of overlapping phases and events that work to construct a new, functioning tissue. Mathematical models describe these events and yield understanding about the overall process of wound healing. Generally, these models are focused on only one phase (or a few phases) to explain healing for a specific system. A review of the literature reveals insights as reported on herein regarding the variety of overlapping inputs and outputs for any given type of model. Specifically, these models have been characterized with respect to the phases of healing and their mathematical/physical basis in an effort to shed light on new opportunities for model development. Though all phases of wound healing have been modeled, previous work has focused mostly on the proliferation and related contraction phases of healing with fewer results presented regarding other phases. As an example, a gap in the literature has been identified regarding models to describe facilitated wound closure techniques (e.g., suturing and its effect on resultant scarring). Thus, an opportunity exists to create models that tie the transient processes of wound healing, such as cell migration, to resultant scarring when considering tension applied to skin with given suturing techniques.

  2. The Lithospheric Structure of the Solonker Suture Zone and Adjacent Areas: Crustal Structure Revealed by a High-Resolution Magnetotelluric Study

    Ye, Gaofeng; Jin, Sheng; Wei, Wenbo; Jing, Jian'en


    The closure of the Paleo-Asian Ocean along the Solonker Suture Zone (SSZ) during the Late Permian and Triassic represented the final stage in the formation of the Central Asian Orogenic Belt between the Siberian Craton and the North China Craton. In order to better understand the structure and formation of this ancient subduction zone, a high-resolution magnetotelluric (MT) profile was collected with both broadband and long-period MT data. The high resolution mapping of the lithosphere achieved in this study is due to the closely spaced MT stations (2-3 km). With the 2-D resistivity model, a south-dipping conductor was detected and extends through the entire crust. The geometry of this feature provides evidence that a southward directed subduction zone formed the Solonker suture. The enhanced conductivity was interpreted to subducted sulfide-bearing graphitic sediments. The resistive body beneath the northern margin of the North China Craton indicates a thickened lithosphere caused by the southward subduction at this region, and the resistive body beneath the Solonker Suture Zone indicates the subducted oceanic lithosphere. North-dipping low resistivity features were also detected in the crust of both the North China Craton and Central Asian Orogenic Belt, and were interpreted as post-collisional thrust faults. Strong anisotropy was found beneath the suture zone, and can be explained if the high strain rate has rotated the fold axes into the dip direction.

  3. Closure report for N Reactor


    This report has been prepared to satisfy Section 3156(b) of Public Law 101-189 (Reports in Connection with Permanent Closures of Department of Energy Defense Nuclear Facilities), which requires submittal of a Closure Report to Congress by the Secretary of Energy upon the permanent cessation of production operations at a US Department of Energy (DOE) defense nuclear facility (Watkins 1991). This closure report provides: (1) A complete survey of the environmental problems at the facility; (2) Budget quality data indicating the cost of environmental restoration and other remediation and cleanup efforts at the facility; (3) A proposed cleanup schedule.

  4. Midwives conducting perineal repair: The Danish Suture Trial

    Kindberg, Sara


    Midwives conducting perineal repair: The Danish Suture Trial.     Background Suture techniques and materials for repair of 2nd degree perineal lacerations and episiotomies have been tested in several clinical trials. Danish midwives and obstetricians have developed a new, simple and time-efficien......Midwives conducting perineal repair: The Danish Suture Trial.     Background Suture techniques and materials for repair of 2nd degree perineal lacerations and episiotomies have been tested in several clinical trials. Danish midwives and obstetricians have developed a new, simple and time...... assessed day 1-2 and 10 post partum. Secondary outcomes: patient satisfaction with wound healing, need for secondary repair, superficial pain during intercourse.   Data management: Double entry of all data and intention-to-treat analysis.   Results The follow up rate was 97%. Baseline data were evenly...

  5. Selective suture cutting for control of astigmatism following cataract surgery

    Bansal R


    Full Text Available Use of 10-0 monofilament nylon in ECCE cataract surgery leads to high with the rule astigmatism. Many intraoperative and post operative methods have been used to minimise post operative astigmatism. We did selective suture cutting in 38 consecutive patients. Mean keratometric astigmatism at three and six weeks post operative was 5.76 and 5.42 dioptres (D respectively. 77.5% of eyes had astigmatism above 2 D. Selective suture cutting along the axis of the plus high cylinder was done after six weeks of surgery. Mean post suture cutting keratometric astigmatism was 3.3 D and 70% of the eyes had astigmatism below 2 D. After 3 months of surgery mean keratometric astigmatism was reduced to 1.84 D. Axis of the astigmatism also changed following suture cutting. 40% of the eyes showed improvement in their Snellen acuity following reduction in the cylindrical power.

  6. Bone Suture in Management of Mandibular Degloving Injury

    Journal of Surgical Technique and Case Report | Jan-Jun 2013 | Vol-5 | Issue-1. 35 ... bone suture technique. ... Center, Faculty of Dentistry, Mashhad University of Medical. Sciences ... After the administration of local anesthesia (lidocaine 2%.

  7. Corneoscleral abscess resulting from a broken suture after cataract surgery.

    Cameron, J A; Huaman, A


    An 82-year-old man had pain and decreased vision in his right eye 15 months after uncomplicated cataract surgery. Examination revealed a large corneoscleral abscess with a 2 mm x 1 mm area of fluorescein staining at the base of a broken protruding 10-0 nylon suture. Streptococcus pneumoniae was isolated from both the suture and base of the ulcer. Despite intensive topical, subconjunctival, and systemic antibiotics, a large corneal perforation developed, necessitating a 10 mm tectonic penetrating keratoplasty. Long-term follow-up of patients after cataract surgery is important and should include an inspection of the limbal wound and removal of loose or broken exposed sutures. Suture-related complications will be eliminated if clinical studies prove the safety and efficacy of sutureless cataract surgery.

  8. Prenatal ultrasound parameters in single-suture craniosynostosis

    M.J. Cornelissen (Martijn); Apon, I. (Inge); J.J.N.M. van der Meulen (Jacques); I.A.L. Groenenberg (Irene); Kraan – van der Est, M.N. (Mieke N.); I.M.J. Mathijssen (Irene); G.J. Bonsel (Gouke); Cohen – Overbeek, T.E. (Titia E.)


    textabstractIntroduction: Although single-suture craniosynostosis is diagnosed sporadically during pregnancy, timely referral is critical for its treatment. Additionally, craniosynostosis leads to increased maternofetal trauma during birth. In the Netherlands, 95% of pregnant women receive a

  9. Failure strengths of repair devices versus meniscus suturing techniques

    Asik, Mehmet; Sener, Nadir; Dikici, Fatih; Sen, Cengiz


    Objectives: The purpose of this study was to compare the load to failure of different common suturing techniques with that of repair devices. Methods: Seventy-one calf medial menisci were cut to simulate peripheral longitudinal tears and repaired using either one of the two suture techniques or one of the seven repair devices. Then the two parts of the meniscus were pulled using an Instron tensometer until failure occurred. The techniques and repair devices tested included vertical (0 PDS,...

  10. First investigation of spider silk as a braided microsurgical suture.

    Kuhbier, Joern W; Reimers, Kerstin; Kasper, Cornelia; Allmeling, Christina; Hillmer, Anja; Menger, Björn; Vogt, Peter M; Radtke, Christine


    Inhibition of axonal outgrowth accompanied by neuroma formation appears in microsurgical nerve repair as reaction to common microsuture materials like silk, nylon, or polyglycolic acid. In contrast, recent findings revealed advantages of spider silk fibers in guiding Schwann cells in nerve regeneration. Here, we asked if we could braid microsutures from native spider silk fibers. Microsutures braided of native spider dragline silk were manufactured, containing either 2 × 15 or 3 × 10 single fibres strands. Morphologic appearance was studied and tensile strength and stress-strain ratio (SSR) were calculated. The constructed spider silk sutures showed a median thickness of 25 μm, matching the USP definition of 10-0. Maximum load and tensile strength for both spider silk microsutures were significantly more than 2-fold higher than for nylon suture; SSR was 1.5-fold higher. All values except elasticity were higher in 3 × 10 strand sutures compared to 2 × 15 strand sutures, but not significantly. In this pilot study, we demonstrate the successful manufacture of microsutures from spider silk. With regards to the mechanical properties, these sutures were superior to nylon sutures. As spider silk displays high biocompatibility in nerve regeneration, its usage in microsurgical nerve repair should be considered. Copyright © 2011 Wiley Periodicals, Inc.

  11. Development of braided drug-loaded nanofiber sutures

    Hu Wen [School of Materials Science and Engineering, Tongji University, 1239 Siping Road, Shanghai 200092 (China); Huang Zhengming [School of Aerospace Engineering and Applied Mechanics, Tongji University, 1239 Siping Road, Shanghai 200092 (China); Liu Xiangyang, E-mail: [Department of Physics, National University of Singapore, 2 Science Drive 3, 117542 (Singapore)


    The objectives of this work are twofold. Firstly, while most work on electrospinning is limited to the development of only functional materials, a structural application of electrospun nanofibers is explored. Secondly, a drug-loaded tissue suture is fabricated and its various properties are characterized. Braided drug-loaded nanofiber sutures are obtained by combining an electrospinning process with a braiding technique followed by a coating procedure. Two different electrospinning techniques, i.e. blend and coaxial electrospinning, to incorporate a model drug cefotaxime sodium (CFX-Na) into poly(L-lactic acid) (PLLA) nanofibers have been applied and compared with each other. Properties of the braided drug-loaded sutures are characterized through a variety of methods including SEM, TEM and tensile testing. The results show that the nanofibers had a preferable micromorphology. The drug was incorporated into the polymer nanofibers homogeneously, with no cross-linking. The nanofibers maintained their fibrous structures. An in vitro release study indicates that the drug-loaded nanofibers fabricated by blend electrospinning and coaxial electrospinning had a different drug release behavior. An inhibition zone experiment shows that both sutures obtained from the nanofibers of the different electrospinning techniques had favorable antibacterial properties. The drug-loaded sutures had preferable histological compatibility performance compared with commercial silk sutures in an in vivo comparative study.

  12. A new look at an old dogma: wound complications in two methods of skin closure in uncomplicated appendicitis

    Hamid Ghaderi


    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Appendicitis is more common during the second and third decade of life and appendectomy scar is important in terms of cosmetic issues. The scar is an important factor in the patient's satisfaction. Conventional teaching has an emphasis on the closure of skin incision with "separate" sutures. The aim of this study was to reconsider this dogma."n"nMethods: Among 321 patients with acute appendicitis who came to the emergency unit of Imam Khomeini Hospital in Tehran, Iran since april 2007 till april 2008, 278 (86.6% patients had uncomplicated appendicitis and were enrolled in our clinical trial. The patients were randomly assigned to two groups of interrupted suture closure (n=139 and subcuticular suture closure (n=139. Anesthesia method and surgical technique were similar between the two groups. All patients were followed up post-operatively (four weeks for the presence of infectious drainage, pain, erythema, swelling and warmness at the surgical site."n"nResults: The patients' sex and their mean age were not statistically different between the groups. There was no significant difference in the frequency of surgical site complications between the two groups (five cases in the "interrupted" group and

  13. Closure and Sealing Design Calculation

    T. Lahnalampi; J. Case


    The purpose of the ''Closure and Sealing Design Calculation'' is to illustrate closure and sealing methods for sealing shafts, ramps, and identify boreholes that require sealing in order to limit the potential of water infiltration. In addition, this calculation will provide a description of the magma that can reduce the consequences of an igneous event intersecting the repository. This calculation will also include a listing of the project requirements related to closure and sealing. The scope of this calculation is to: summarize applicable project requirements and codes relating to backfilling nonemplacement openings, removal of uncommitted materials from the subsurface, installation of drip shields, and erecting monuments; compile an inventory of boreholes that are found in the area of the subsurface repository; describe the magma bulkhead feature and location; and include figures for the proposed shaft and ramp seals. The objective of this calculation is to: categorize the boreholes for sealing by depth and proximity to the subsurface repository; develop drawing figures which show the location and geometry for the magma bulkhead; include the shaft seal figures and a proposed construction sequence; and include the ramp seal figure and a proposed construction sequence. The intent of this closure and sealing calculation is to support the License Application by providing a description of the closure and sealing methods for the Safety Analysis Report. The closure and sealing calculation will also provide input for Post Closure Activities by describing the location of the magma bulkhead. This calculation is limited to describing the final configuration of the sealing and backfill systems for the underground area. The methods and procedures used to place the backfill and remove uncommitted materials (such as concrete) from the repository and detailed design of the magma bulkhead will be the subject of separate analyses or calculations. Post-closure

  14. Optimal Needle Grasp Selection for Automatic Execution of Suturing Tasks in Robotic Minimally Invasive Surgery

    Liu, Taoming; Çavuşoğlu, M. Cenk


    This paper presents algorithms for optimal selection of needle grasp, for autonomous robotic execution of the minimally invasive surgical suturing task. In order to minimize the tissue trauma during the suturing motion, the best practices of needle path planning that are used by surgeons are applied for autonomous robotic surgical suturing tasks. Once an optimal needle trajectory in a well-defined suturing scenario is chosen, another critical issue for suturing is the choice of needle grasp f...


    Kuldeep Raj


    Full Text Available ABSTRACT : BACK GROUND: Meshplasty is a must in adult patient. P ro lene mesh is widely used and is fixed with prolene suture as well. The aim of this study was to compare the quality of life and pain felt in postoperative phase for 2 years after open inguinal hernia repair by i nterrupted sutures versus continous sutures. METHODS: From Jan 2010 – Dec 2010 , 15 patients were operated using prolene mesh and this mesh was fixed with prolene 2’0’ in continous way starting at pubic tubercle and continues along inguinal ligament beyond deep inguinal r ing and then lateral to deep inguinal ring and above it along conjoint tendon and ends at the pubic tubercle with only single knot , and were compared with 15 patients who underwent same procedure using prolene mesh fixed with p rolene suture but in interrupted way and this creates a lot of knots ( 10 - 12 Av erage . Patients were examined and followed in OPD for 2 years. RESULTS : In the long run the patients treated with continous suture were having comparatively better qua lity of life with less pain and less foreign body sensation of mesh and knots & knots were not felt percutaneously, where as in routine procedure patients were complaining of painful sensation due to pressing of knots in subcutaneous space. CONCLUSION : In this study the quality of life in open hernia repair with prolene suture using continous suture technique versus interrupted suture technique is definitely better , less pain ful and feeling less foreign body sensation.

  16. Alternate Sequential Suture Tightening: A Novel Technique for Uncontrolled Postpartum Hemorrhage

    Sharda Brata Ghosh


    Full Text Available Objective. The most commonly described technique of modified B-Lynch suture may not be suitable for all the patients presenting with flabby, atonic uterus. Study Design. A retrospective analysis of twelve patients with uncontrolled postpartum haemorrhage, who underwent this procedure from March 2007 to September 2012, was conducted. In this novel technique, sutures are passed in the lower uterine segment and are tightened alternately to control uterine bleeding. Results. Average duration of the procedure was 4 minutes (range 2–7 minutes. Average blood loss was 1625 mL (range 1300–1900 mL. Eleven patients (91.66% were seen to have a successful outcome with only this technique. No patient required hysterectomy and one patient (8.33% required additional bilateral internal iliac artery ligation. All the patients had a minimum follow-up of 2 yrs and none of them reported any infertility problems. Conclusion. This technique is simple, quick, and effective. There was no adverse effect on the fertility potential for the observed 2 years; however, a long-term follow-up is required to comment on its actual rate. This technique cannot replace the standard modified B-Lynch technique for uncontrolled postpartum haemorrhage but can be used for unresponsive, flabby, and atonic uterus.

  17. Effects of two alar base suture techniques suture techniques on nasolabial changes after bimaxillary orthognathic surgery in Taiwanese patients with class III malocclusions.

    Chen, C Y-H; Lin, C C-H; Ko, E W-C


    A randomized controlled trial was designed to assess the effectiveness of two alar base cinch techniques on the changes in nasolabial morphology after bimaxillary orthognathic surgery. Sixty patients requiring a Le Fort I osteotomy to correct skeletal discrepancies were selected randomly to receive either conventional or modified alar base cinching during the intraoral wound closure procedure. Conventional cinching passed through nasalis muscle and anterior nasal spine. Modified cinching also passed through dermis tissue to increase the anchorage. Postoperative hard and soft tissue changes were evaluated using cone beam computed tomography and three-dimensional stereophotogrammetry at predefined time points. Forty-eight patients with a skeletal class III malocclusion were included. In the conventional group, there was an increase of 0.31 ± 1.31 mm in nasal width and an increase of 0.97 ± 1.60mm in columellar length. In the modified group, there was an increase of 0.81 ± 1.87 mm in the cutaneous height of the upper lip and a decrease of 0.76 ± 1.56 mm in lower prolabial width. Patients with an initial narrow nasal width, alar base width, and less vertical nostril show were more susceptible to a greater degree of change after surgery. Both alar base suture techniques are effective at controlling nasolabial form changes resulting from class III dual-jaw orthognathic surgery. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. A Study of the Kunlun-Qilian-Qinling Suture System


    palaeomagnetic poles from the western part of the North China Block and their implications. Tectonophysics, 308: 377-402.[21]Jiang Chunfa, Yang Jingshui, Feng Binggui et al., 1992. Opening Closing Tectonics of Kunlun Mountains. Beijing: Geological Publishing House, 135-171 (in Chinese with English abstract).[22]Jiang Chunfa, Wang Zhongqi and Li Jinyi, 2000. Opening Closing Tectonics of the Central Orogenic Belt in China. Beijing: Geological Publishing House, 135-171 (in Chinese with English abstract).[23]Lai Shaocong, Deng Jinfu and Zhao Hailing, 1996. Palaeozoic ophiolites and its tectonic significance on north margin of Qaidam Basin. Geoscience, 10 (1): 18-28 (in Chinese with English abstract).[24]Lai Shaocong and Zhang Guowei, 1999. Ophiolites and their tectonic significance in the Mianlüe suture zone, Qinling Dabie orogenic belt. Geological Review, 45(sup.): 1062-1071 (in Chinese with English abstract).[25]Li Shuguang, Sun Weidong, Zhang Guowei et al., 1996. Chronology and geochemistry of metavolcanic rocks from Heigouxia Valley in the Mianlüe tectonic zone, South Qinling: evidence for a Palaeozoic oceanic basin and its closure time. Science in China (Series D) (English edition), 39(3): 300-310.[26]Li Yaseng, Cao Xuanzuo, Yang Jialu et al., 1994. Sedimentation and Evolution of the Qinling Ancient Ocean Basin in Phanerozoic Eon. Beijing: Geological Publishing House, 166-183 (in Chinese).[27]Li, Z.X., Zhang, L, and Powell C.McA., 1996. Positions of the East Asian cratons in the Neoproterozoic supercontinent Rodinia. Australian Journal of Earth Sciences, 43: 591-592.[28]Liu Liang, Che Zicheng, Wang Yan et al., 1998. The evidence of Sm-Nd isochron age for the early Palaeozoic ophiolite in Mangya area, Altun Mountains. Chinese Science Bulletin (English edition), 43(9): 754-756.[29]Liu Liang, 1999. High-pressure metamorphic rock and ophiolite and their tectonic significance in Altun Mountains. Ph.D paper, the Institute of Geology, Chinese Academy of Sciences.[30]Lu Songnian

  19. Closure of Large Pressure Ulcers utilizing the Principles of Limberg flap

    Kumar Pramod


    Full Text Available A prospective study of 17 patients (21 Limberg flaps in 19 pressure ulcers was done to establish the efficacy of Limberg flap. . Limberg flaps were used in only those cases where primary closure was not possible. This flap was found to be simple to execute and short-term results were satisfactory. Also, it spares underlying muscles for future use. None of the flaps showed necrosis. Partial wound dehiscence was noticed in 7 (33.33% cases, which was managed by secondary suturing in four cases, by split skin graft in one case and by second Limberg flap in one case.

  20. RCRA closure of mixed waste impoundments

    Blaha, F.J. [Doty and Associates (United States); Greengard, T.C.; Arndt, M.B. [Rockwell International (United States)


    A case study of a RCRA closure action at the Rocky Flats Plant is presented. Closure of the solar evaporation ponds involves removal and immobilization of a mixed hazardous/radioactive sludge, treatment of impounded water, groundwater monitoring, plume delineation, and collection and treatment of contaminated groundwater. The site closure is described within the context of regulatory negotiations, project schedules, risk assessment, clean versus dirty closure, cleanup levels, and approval of closure plans and reports. Lessons learned at Rocky Flats are summarized.

  1. Does closure of chronic pilonidal sinus still remain a matter of debate after bilateral rotation flap? (N-shaped closure technique

    Awad Mohamed


    Full Text Available Background: Controversy still exists about the exact cause of pilonidal sinus either acquired or congenital, and also about what is the best surgical technique for the treatment of the disease. We successfully treated chronic pilonidal sinus with a new flap technique {N-shaped bilateral rotation flap} for closure of the defect. Materials and Methods: Thirty-two patients (30 men and two women were treated by eccentric elliptical excision of the diseased tissues down to the postsacral fascia and closure of the defect with our flap [which is a random pattern flap], then a closed suction drain was placed at the base of the wound, with its tip being brought out in the gluteal region at least 5 cm lateral to the lower end of the suture line. Results: All our patients healed completely without recurrence during a period of average follow-up of two years. Mean hospital stay was 1.5 days (range 1-5 days. Mean time to complete healing was 11.9 days (range 6-18 days. Mean time off work was 13.7 days (range 10-21 days. Two patients had wound infection and one patient a partial breakdown. The recurrence rate was 0%. Conclusions: A tension-free suture via bilateral rotation flaps with a good suction at the button of the wound for drainage of blood from the bottom of the wound is the key to the success of repair without recurrence.

  2. Novel use of the medtronic micro vascular plug for PDA closure in preterm infants.

    Wang-Giuffre, Elizabeth W; Breinholt, John P


    To describe a single institution experience with a new endovascular occlusion device used for transcatheter patent ductus arteriosus (PDA) closure in preterm infants. The PDA is a defect largely treated via cardiac catheterization except for the smallest patients. Medical records and catheterization reports of all premature neonates who underwent PDA device closure with the Medtronic Micro Vascular Plug (MVP) (Medtronic, Minneapolis, MN) between September 2015 and June 2016 were reviewed. Procedural details, complications, and short term outcomes were recorded. Eight premature neonates born at a median gestational age of 28 weeks (23 to 35 weeks) underwent PDA closure with a Medtronic MVP. All devices were deployed via a 4F angled Glide catheter in prograde fashion without arterial access. Median age and weight was 52 days (15-112 days) and 2,550 g (1,800-3,500 g), respectively. Fluoroscopy and echocardiography were utilized for the procedure. Complete closure was achieved in all patients with no procedural complications, pulmonary artery or aortic obstruction or death. One device embolized 9 days after deployment and was successfully retrieved. This study describes transcatheter PDA closure with the Medtronic MVP. The major advantage is the ability to deliver the device via a standard catheter in prograde fashion, and avoid the hemodynamic instability produced by rigid delivery sheaths. It also further validates the ability to close the PDA without arterial access, providing improved access to this procedure to smaller and more vulnerable children. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  3. Transcatheter vs. surgical closure of patent ductus arteriosus: outcomes and cost analysis

    Mulyadi M Djer


    Full Text Available Background Patent ductus arterious (PDA is a non-cyanotic congenital heart disease (CHD caused by the patency of the arterial duct after birth. For the last three decades, management of PDA with transcatheter closure has been gaining popularity, including in developing countries. However its effectiveness in terms of clinical outcomes and cost may vary among center and has not been thoroughly evaluated yet in Indonesia. Objectives To compare the cost and clinical effectiveness of PDA closure using transcatheter approach compared to surgical ligation. Methods We performed a retrospective review on patients underwent either transcatheter or surgical closure of PDA between January 2000 and December 2006 in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Clinical outcomes as well as cost were compared using the student T-test and Chi-square for numerical and categorical variables, respectively Results During the study period, 89 patients underwent transcatheter closure using an Amplatzer® device occluder (ADO device and 67 had surgical ligation. Successful PDA closure on first attempt was achieved in 87 (96% and 63 (94% children who underwent transcatheter and surgical closure, respectively (P=1.000. Two children with unsuccessful transcatheter closure eventually had their PDA closed by surgery, whereas one child with residual PDA after surgical closure had his PDA closed by coil. No residual PDA was found in the transcatheter closure group at one-week follow up. Duration of hospitalization was significantly less for patients having transcatheter closure compared to surgery [2.7 (SD 1.5 vs. 6.6 (SD 1.5 days, P<0.0001]. The cost for PDA closure with an Amplatzer® device was more expensive than surgical ligation [Rp. 29,930,000 (SD 57,200 vs. Rp. 12,205,000 (SD 89,300, P< 0.0001]. Conclusion Transcatheter closure is equally effective as surgical ligation in closing the PDA. Less hospitalization is required with transcatheter closure although the

  4. Disposable circumcision suture device: clinical effect and patient satisfaction

    Bo-Dong Lv


    Full Text Available In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the benefits of a new disposable circumcision suture device (DCSD. A total of 942 patients were equally divided into three groups (conventional circumcision, Shang ring and disposable suture device group. Patients in the DCSD group were anesthetized with compound 5% lidocaine cream, the others with a 2% lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were significantly lower in the Shang ring and suture device groups compared to the conventional group (P < 0.001. Intra-operative pain was less in the suture device group compared with the other two groups (P < 0.001; whereas post-operative pain was higher in the conventional group compared to the other two groups (P < 0.001. Patients in the suture device (80.57% and Shang ring (73.57% groups were more satisfied with penile appearances compared with the conventional circumcision group (20.06%, P < 0.05. Patients in suture device group also healed markedly faster than the conventional group (P < 0.01. The overall satisfaction rate was better in the suture device group (78.66% compared with the conventional (47.13% and Shang ring (50.00% groups (P < 0.05. The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances.

  5. Disposable circumcision suture device:clinical effect and patient satisfaction

    BoDong Lv; ShiGeng Zhang; XuanWen Zhu; Jie Zhang; Gang Chen; MinFu Chen; HongLiang Shen; ZaiJun Pei; ZhaoDian Chen


    In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the beneifts of a new disposable circumcision suture device (DCSD). A total of 942 patients were equally divided into three groups (conventional circumcision, Shang ring and disposable suture device group). Patients in the DCSD group were anesthetized with compound 5%lidocaine cream, the others with a 2%lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were signiifcantly lower in the Shang ring and suture device groups compared to the conventional group (P<0.001). Intra-operative pain was less in the suture device group compared with the other two groups (P<0.001);whereas post-operative pain was higher in the conventional group compared to the other two groups (P<0.001). Patients in the suture device (80.57%) and Shang ring (73.57%) groups were more satisifed with penile appearances compared with the conventional circumcision group (20.06%, P<0.05). Patients in suture device group also healed markedly faster than the conventional group (P<0.01). The overall satisfaction rate was better in the suture device group (78.66%) compared with the conventional (47.13%) and Shang ring (50.00%) groups (P<0.05). The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances.

  6. The effect of alar cinch sutures and V-Y closure versus simple closing sutures after Le Fort I osteotomies on nasolabial esthetics and dynamics

    Muradin, M.S.M.|info:eu-repo/dai/nl/304817775


    Surgical reposition of the maxilla by means of a Le Fort I osteotomy is a, widely used, procedure to correct dentofacial deformities. Maxillary intrusion, especially, is known to cause unwanted side effects on the orofacial soft tissues, such as broadening of the alar base, loss of vermilion show of

  7. A modified technique of renal artery anastomosis in rat kidney transplantation.

    Zhang, G; Zhao, H; Sun, Z-Y


    To reduce warm ischemic time and avoid irreversible damage to the graft in rat kidney transplantation. After left nephrectomy, recipients were transplanted with syngeneic kidney grafts using microsurgical techniques. In control rats (n = 20), the renal artery anastomoses were performed with 8-9 interrupted sutures by the conventional technique. In experimental animals (n = 20), a modified anastomosis was performed using fewer (5-6) sutures and fibrin glue devoid of thrombin. The number of sutures in the control group was 8.09 + or - 0.35 while that in the experimental group was 5.65 + or - 0.48 (p experimental group (p experimental and control groups were 90 and 85%, respectively. Our modified technique for renal artery anastomosis significantly reduced the warm ischemic time in rat kidney transplantation. This technique would be a safe and reliable method for rat renal artery anastomosis as well as for other microarterial anastomoses, particularly for novice surgeons. Copyright 2009 S. Karger AG, Basel.

  8. Middle Meningeal Arteriovenous Fistula and Its Spontaneous Closure: A Case Report and Review of the Literature


    Middle meningeal artery pseudo-aneurysms and arteriovenous fistulas are usually post-traumatic, although occasional iatrogenic cases have been reported. The treatment has been obliteration of the fistula by surgical or endovascular means. Spontaneous closure of fistula is uncommon. We report a case of non-traumatic middle meningeal arteriovenous fistula in a patient with alcoholism, which resolved spontaneously without treatment.

  9. Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis.

    Roberge, Stéphanie; Demers, Suzanne; Berghella, Vincenzo; Chaillet, Nils; Moore, Lynne; Bujold, Emmanuel


    A systematic review and metaanalysis were performed through electronic database searches to estimate the effect of uterine closure at cesarean on the risk of adverse maternal outcome and on uterine scar evaluated by ultrasound. Randomized controlled trials, which compared single vs double layers and locking vs unlocking sutures for uterine closure of low transverse cesarean, were included. Outcomes were short-term complications (endometritis, wound infection, maternal infectious morbidity, blood transfusion, duration of surgical procedure, length of hospital stay, mean blood loss), uterine rupture or dehiscence at next pregnancy, and uterine scar evaluation by ultrasound. Twenty of 1278 citations were included in the analysis. We found that all types of closure were comparable for short-term maternal outcomes, except for single-layer closure, which had shorter operative time (-6.1 minutes; 95% confidence interval [CI], -8.7 to -3.4; P type of uterine closure for optimal maternal outcomes and is insufficient to conclude about the risk of uterine rupture. Single-layer closure and locked first layer are possibly coupled with thinner residual myometrium thickness.

  10. Failure strength of repair devices versus meniscus suturing techniques.

    Aşík, Mehmet; Sener, Nadir


    The purpose of this study was to compare the load to failure of different common suturing techniques with repair devices. Seventy-one calf medial menisci were cut to simulate peripheral longitudinal tears and repaired with one of 13 repair techniques. The two parts of the meniscus were pulled using the Instron tensometer until failure occurred. The techniques and repair devices tested were vertical (0 PDS, 2-0 PDS, 2-0 Ethibond), horizontal (0 PDS, 2-0 PDS, 2-0 Ethibond) suturing, T-fix, Mitek, Clearfix screw, Clearfix dart, Biostinger, S-D-sorb, and Artrex dart. The strongest repair method in our study was the vertical sutures with 0 PDS. In this study the mean failure strength of all meniscal repair devices was lower than that of the vertical and horizontal suturing techniques. All meniscus repair devices except T-fix and in some the Arthrex dart (40% broken up) pulled out of the menisci. Devices which had only horizontally placed barbs had lower mean failure strength. Failure strength of T-fix was similar to horizontal sutures with 2-0 Ethibond and 2-0 PDS. In conclusion, because all meniscal repair devices had inferior results, when such devices are used, postoperative rehabilitation should not be hastened, and their inferior primary stability should be kept in mind.


    Fırat SELVİ


    Full Text Available Purpose: The purpose of this study was to investigate the healing differences in between four different widely used suture materials in the oral surgery practice, including silk (Perma- Hand; Ethicon, INC., Somerville, NJ, USA, polypropylene (Prolene; Ethicon, INC., Somerville, NJ, USA, coated polyglactin 910 (Ethicon, INC., Somerville, NJ, USA. and polyglecaprone 25 (Ethicon, INC., Somerville, NJ, USA . Materials and Methods: 20 male rats were randomly allocated into two groups depending on their sacrification days (post-operative 1st and the 7th days. Four longitudinal incision wounds, each 1cm in size, were created on the dorsum of each animal which were then primarily closed with four different types of sutures. Results: The effects of these suture materials on soft tissue healing were compared histopathologically, by means of density of the cells, necrosis, fibrosis, foreign body reaction, the presence of cells of acute and chronic infection. No statistically significant difference was observed between the groups regarding the density of the cells, necrosis, fibrosis, foreign body reaction, and the presence of the cells of acute & chronic infections. Of note, propylene showed slightly less tissue reaction among the other materials. Conclusion: The results of our study showed that there is no only one ideal suture material for surgical practice. The factors related to the patient, the type of the surgery and the quality of the tissue are important to decide an appropriate suture material.

  12. Alar Suspension Sutures in the Management of Nasal Valve Collapse.

    Manickavasagam, Jaiganesh; Iqbal, Isma; Wong, Smeeta; Raghavan, Ullas


    This study assesses the efficacy of alar suspension sutures in the management of nasal valve collapse causing nasal obstruction. These sutures are inserted between the vestibular skin and lateral crura and hitched to the periosteum of the medial inferior orbital margin; this is a variation of the alar (change everywhere) suspension suture technique. A retrospective review of patients who underwent alar suspension suture insertion between January 2009 and December 2010 in the management of nasal obstruction was undertaken. Symptoms of nasal obstruction were assessed using the Visual Analogue Scale (VAS) and peak inspiratory flow rate (PIFR). This was measured preprocedure and repeated at 3, 6, and 12 months postoperatively. A total of 35 patients were identified, and 26 were included in the study; 90% of patients were satisfied with the outcome of surgery, supported by improvement in the VAS and PIFR scores. The mean difference in VAS preprocedure and postprocedure was 4.97 (P value = 0.00), and the average improvement in PIFR was 25.5 L/min (P value = 0.00). Our study shows a significant improvement in patient's symptoms following insertion of alar suspension sutures. It is, therefore, a reliable, safe, and effective technique in treating nasal obstruction secondary to nasal valve collapse. © The Author(s) 2015.

  13. Quantitative evaluation of midpalatal suture maturation via fractal analysis

    Kwak, Kyoung Ho; Kim, Yong-Il; Kim, Yong-Deok


    Objective The purpose of this study was to determine whether the results of fractal analysis can be used as criteria for midpalatal suture maturation evaluation. Methods The study included 131 subjects aged over 18 years of age (range 18.1–53.4 years) who underwent cone-beam computed tomography. Skeletonized images of the midpalatal suture were obtained via image processing software and used to calculate fractal dimensions. Correlations between maturation stage and fractal dimensions were calculated using Spearman's correlation coefficient. Optimal fractal dimension cut-off values were determined using a receiver operating characteristic curve. Results The distribution of maturation stages of the midpalatal suture according to the cervical vertebrae maturation index was highly variable, and there was a strong negative correlation between maturation stage and fractal dimension (−0.623, p Fractal dimension was a statistically significant indicator of dichotomous results with regard to maturation stage (area under curve = 0.794, p fractal dimension was used to predict the resulting variable that splits maturation stages into ABC and D or E yielded an optimal fractal dimension cut-off value of 1.0235. Conclusions There was a strong negative correlation between fractal dimension and midpalatal suture maturation. Fractal analysis is an objective quantitative method, and therefore we suggest that it may be useful for the evaluation of midpalatal suture maturation. PMID:27668195

  14. Biomechanical Study of Two Peripheral Suture Methods on Repaired Tendons

    Qiu, Zhenling


    Flexor digitorum tendon injuries are challenging conditions to manage to ensure optimal patient outcomes. While several surgical approaches with high success rates have been developed, there remains no gold standard for suture technique for the repair of flexor tendon injuries. In this study, we compared two distinct peripheral suture methods on the strength of repaired tendons. Pig flexor digitorum profundus tendons were used in biomechanical studies and the biomechanical influence on tendon repair of continuous running peripheral suture (CRPS) and continuous locking peripheral suture (CLPS), were compared, using stitch length ranging from 1mm to 5mm. In CRPS, the 1mm stitch length group displayed the highest maximum load and breaking power, which was 1.57 fold higher than the 2mm stitch length group. Pairwise comparison revealed that the 1 and 2mm groups were statistically different from the 3, 4, and 5mm stitch length groups while comparison among the latter groups was not statistically significant. For CLPS, the 1mm group exhibited consistently the highest maximum load strength and breaking power, which was twice the strength displayed by the 2mm group. Pairwise comparisons between groups showed statistical significance. For future repairs of flexor tendon injuries, 1mm stitch length is highly recommended for simple peripheral suture.

  15. Suture-Button Reconstruction of the Interosseous Membrane.

    Meals, Clifton G; Forthman, Christopher L; Segalman, Keith A


    Reconstruction of the interosseous membrane (IOM) may play a role in the treatment of acute and chronic longitudinal forearm instability. Several reconstruction techniques have been proposed. Suture-button reconstruction is attractive because it obviates donor site morbidity and is relatively easy to perform. How this method compares to its alternatives, however, is unknown. We review literature describing reconstruction of the forearm axis. We describe how we perform suture-button reconstruction of the IOM, summarize our previously published biomechanical data on the subject, and offer a case report. A suture-button is implanted so as to approximate the course of the interosseous ligament. This may be accomplished percutaneously, or when grafting is desired, through an open approach. Data informing the choice of one reconstruction technique over another consist mostly of biomechanical studies and a small number of case reports. Suture-button reconstruction of the IOM may encourage anatomic healing of acute forearm axis injuries especially as an adjunct to radial head replacement or repair. Chronic injuries may benefit from a combination suture-button graft construct and ulnar shortening osteotomy.

  16. Complexity of serrated sutures of a human skull

    Kochenkova О.V.


    Full Text Available Objective: to reveal the variability mechanism of complexity of serrated sutures of a human skull in the correlation with cranial form. Materials and methods. Researches of 253 arches of male and female skulls of patients at the age of 1 day-105 years without signs of cranial trauma or skeletal systemic diseases with absence of morphological signs of increase of intracranial pressure. Minimal (Min and maximal (Max values, average arithmetic (M, a mistake of average arithmetic (m have been studied. For definition of reliability of average size difference parametrical and non-parametric statistical criteria were used: parametrical criterion (t-criterion of Student applied for parameters submitting to the law of normal distribution (Lakin G. R, 1990. Distinctions of average arithmetic size were considered statistically authentic from 95% (p<0,05 a level of correct judgement (Plokhinskiy N.A., 1970. Results. On the surface of the arch lambdoid and coronal sutures in male skulls and lambdoid and sagittal sutures in female were found out to be of the greatest degree of complexity. Conclusion. The increase of complexity of sutures has been observed in children and adolescents; the directed asymmetry of sutures form is absent

  17. Recognizing surgeon's actions during suture operations from video sequences

    Li, Ye; Ohya, Jun; Chiba, Toshio; Xu, Rong; Yamashita, Hiromasa


    Because of the shortage of nurses in the world, the realization of a robotic nurse that can support surgeries autonomously is very important. More specifically, the robotic nurse should be able to autonomously recognize different situations of surgeries so that the robotic nurse can pass necessary surgical tools to the medical doctors in a timely manner. This paper proposes and explores methods that can classify suture and tying actions during suture operations from the video sequence that observes the surgery scene that includes the surgeon's hands. First, the proposed method uses skin pixel detection and foreground extraction to detect the hand area. Then, interest points are randomly chosen from the hand area so that their 3D SIFT descriptors are computed. A word vocabulary is built by applying hierarchical K-means to these descriptors, and the words' frequency histogram, which corresponds to the feature space, is computed. Finally, to classify the actions, either SVM (Support Vector Machine), Nearest Neighbor rule (NN) for the feature space or a method that combines "sliding window" with NN is performed. We collect 53 suture videos and 53 tying videos to build the training set and to test the proposed method experimentally. It turns out that the NN gives higher than 90% accuracies, which are better recognition than SVM. Negative actions, which are different from either suture or tying action, are recognized with quite good accuracies, while "Sliding window" did not show significant improvements for suture and tying and cannot recognize negative actions.

  18. Closure of the Mongol-Okhotsk Ocean: Insights from seismic tomography and numerical modelling

    Fritzell, E. H.; Bull, A. L.; Shephard, G. E.


    The existence of the Palaeozoic and Mesozoic Mongol-Okhotsk Ocean is evident from the Mongol-Okhotsk suture, which stretches from central Mongolia to the Sea of Okhotsk. A lack of sufficient palaeomagnetic data and an otherwise diffuse suture with an abrupt termination to the west has led to difficulties in reconstructing the history, geometry and closure of this ocean. Both the timing and style of the ocean's closure are unclear and have led to several alternative reconstructions. Closure timing ranges between the Late Jurassic (∼155 Ma) and beginning of the Early Cretaceous (∼120 Ma), and the proposed kinematics include contemporaneous subduction along two opposite margins, subduction along only one margin or with a component of left-lateral shear. In the present study, numerical models of mantle convection are coupled with global plate reconstructions to investigate ambiguities regarding the closure of the Mongol-Okhotsk Ocean. In order to decipher the tectonic history of this enigmatic region, two end-member scenarios of subduction location - either along the present-day northern or the southern margins of the Mongol-Okhotsk Ocean - are imposed as kinematic surface boundary conditions for the past 230 Myrs. Through a comparison to seismic tomography, the results indicate a preferred subduction history along the Siberian margin (relative northern margin) of the Mongol-Okhotsk Ocean. At present-day, the slab remnant is predicted to be located farther west than previously proposed. Furthermore, we find that the subducting slabs in this region generate a hot, dense pile at the same location and with a similar shape as the Perm Anomaly.

  19. 4. Suture-less bio-prosthetic aortic valve replacement: Early clinical and hemodynamic outcome

    A. Arifi


    Full Text Available Suture-less bio-prostheses (SBP are a recent addition in the surgical armamentarium in the surgical treatment of sever aortic valve disease that offer rapid deployment, shorter bypass & ischemic times and excellent hemodynamic performance even in small aortic annulus. We present our initial experience and short-term clinical and hemodynamic results with the use of suture-less bio-prostheses. Between May 2011 and August 2015, 61 patients, with mean age of 72.6 years and severe aortic stenosis underwent aortic valve replacement with a SBP. 28 were males and 19 were females. Mean euroSCORE was 11.5. 55% had coronary artery disease, 8.5% had severe mitral regurgitation and 6.4% had severe tricuspid regurgitation. Left ventricular dysfunction was present in 28% patients and 83% had elevated right ventricular systolic pressure. Average size of aortic annulus was 21.7 mm. 42.5% patients underwent isolated aortic valve replacement while 57.5% had concomitant procedures including coronary artery bypass grafting (25 patients. Average cross clamp time in isolated aortic valve replacement was 34 min and total bypass time was 46 min. Mean gradient across the prostheses was an average of 8.9 mmHg intra-operatively with 4.3% prevalence of mild para-prosthetic leak and 10.6% prevalence of mild prosthetic regurgitation. In-hospital mortality was 2.1% (1 patient. At follow-up, average mean trans-aortic gradients were 15 mmHg and prevalence of mild prosthetic and para-prosthetic leak was 10.5%. Average left ventricular diastolic dimensions changed from 4.93 mm pre-operatively to 4.42 mm post-operatively (p = 0.023 and left ventricular systolic dimensions changed from 3.39 mm pre-operatively to 3.05 mm post-operatively (p = 0.124. Use of suture-less bio-prosthesis for aortic valve replacement produces excellent hemodynamic results with low incidence of para-prosthetic leakage and prosthetic regurgitation. Persistent low trans-aortic gradients and

  20. Anomalous left coronary artery from the pulmonary artery with a large patent ductus arteriosus: aversion of a catastrophe.

    Aggarwal, Sanjeev; Delius, Ralph E; Pettersen, Michael D


    We present an infant who had an anomalous left coronary artery arising from the pulmonary artery (ALCAPA) and a large patent ductus arteriosus (PDA), who was diagnosed before a potentially catastrophic closure of PDA. In the presence of normal left ventricular function and the absence of coronary artery collaterals, it is difficult to diagnose ALCAPA. A disproportionate degree of left ventricular dilation and severity of mitral valve regurgitation relative to the degree of PDA shunt, and echogenic papillary muscles on an echocardiogram should raise a suspicion of coronary artery anomalies. The infant underwent surgical ligation of PDA with translocation of coronary arteries and had an uneventful recovery.

  1. Transhepatic approach to closure of patent foramen ovale: report of 2 cases in adults.

    Hussain, Jamal; Strumpf, Robert; Ghandforoush, Aslan; Jamal, Ayman; Diethrich, Edward


    Patent foramen ovale is increasingly diagnosed in patients who are undergoing clinical study for cryptogenic stroke or migraine. In addition, patent foramen ovale is often suspected as a cause of paradoxical embolism in patients who present with arterial thromboembolism. The femoral venous approach to closure has been the mainstay. When the femoral approach is not feasible, septal occluder devices have been deployed via a transjugular approach.Herein, we describe 2 cases of patent foramen ovale in which the transhepatic approach was used for closure. To our knowledge, this is the 1st report of a transhepatic approach to patent foramen ovale closure in an adult patient. Moreover, no previous case of patent foramen ovale closure has been reported in a patient with interrupted inferior vena cava.

  2. A comparative study of the effect of suture-less and multiple suture techniques on inflammatory complications following third molar surgery.

    Osunde, O D; Adebola, R A; Saheeb, B D


    The aim of this prospective randomized study was to evaluate the effect of not using sutures on postoperative pain, swelling and trismus after lower third molar surgery. 80 patients with impacted lower third molars were referred for surgical extraction (42 males; 38 females; aged 18-38 years). The patients were randomly divided into two equal groups (sutures n=40; suture-less n=40). In the experimental group, the flaps were replaced without suturing. The control group was selected using the same criteria and treated under the same surgical protocol as the experimental group, except that the flaps were apposed using multiple sutures. Pain, swelling and trismus were evaluated at 24 h, 48 h and 1 week postoperatively in both groups. The operation time was found to be significantly longer in the multiple sutures group (p0.05). There is less postoperative pain, swelling and trismus with the suture-less technique in third molar surgery.

  3. [Laparotomy closure in advanced peritonitis].

    Bensman, V M; Savchenko, Yu P; Shcherba, S N; Golikov, I V; Triandafilov, K V; Chaykin, V V; Pyatakov, S N; Saakyan, A S; Saakyan, E A

    to improve the results of advanced peritonitis management. 743 patients with advanced peritonitis were studied. Patients were divided into 2 groups depending on treatment strategy. Programmed relaparotomy combined with removable draining musculoaponeurotic seams during laparotomy closure decreased mortality from 47.8±2.7% to 24.1±2.3% (pperitonitis management. Laparotomy closure with only cutaneous seams is indicated in case of persistent abdominal hypertension. Large eventration always requires abdominal wall repair. APACHE-III scale scores have significant prognostic value in patients with advanced peritonitis.

  4. Closure phase and lucky imaging.

    Rhodes, William T


    Since its introduction by Jennison in 1958, the closure-phase method for removing the effects of electrical path-length errors in radio astronomy and of atmospheric turbulence in optical astronomy has been based on the non-redundant-spacing triple interferometer. It is shown that through application of lucky imaging concepts it is possible to relax this condition, making closure-phase methods possible with redundantly spaced interferometer configurations and thereby widening their range of application. In particular, a quadruple-interferometer can, under lucky imaging conditions, be treated as though it were a triple interferometer. The slit-annulus aperture is investigated as a special case.

  5. Homogeneous orbit closures and applications

    Lindenstrauss, Elon


    We give new classes of examples of orbits of the diagonal group in the space of unit volume lattices in R^d for d > 2 with nice (homogeneous) orbit closures, as well as examples of orbits with explicitly computable but irregular orbit closures. We give Diophantine applications to the former, for instance we show that if x is the cubic root of 2 then for any y,z in R liminf |n|=0 (as |n| goes to infinity), where denotes the distance of a real number c to the integers.

  6. Long Term Outcome after Application of the Angio-Seal Vascular Closure Device in Minipigs

    Kabelitz, Lisa; Nonn, Andrea; Nolte, Kay W.; Nikoubashman, Omid; Othman, Ahmed; Heringer, Sarah; Kramer, Martin; Wiesmann, Martin; Brockmann, Marc A.


    Minipigs are frequently used in (neuro-)interventional research. Longitudinal experiments may require repeated vessel access via the femoral artery. Anticoagulation and incompliance of the animals necessitates the use of a vascular closure device (VCD). The effects of the Angio-Seal VCD in minipigs were longitudinally assessed. Minipig (42±8.4 kg body weight) femoral arteries were sealed using the 8F (n = 6) or 6F (n = 7) Angio-Seal VCD. The pre-interventional femoral artery diameter was 5.1±...

  7. Power scaling of ammonitic suture patterns from the suborder Ancyloceratina

    Peterman, D. J.; Barton, C. C.


    The spatial scaling of suture patterns from 44 ammonite species of the suborder Ancyloceratina was measured using the fractal box counting method. These specimens were selected from every stage in the Cretaceous and range between approximately 145 Ma to 66 Ma in age. The sutures analyzed in this study were found from published literature where half of the three dimensional paths along the last septal margins were projected on a two dimensional surface. The fractal dimension calculated from the suture patterns ranges from 1.23 to 1.58. These values positively correlate to whorl height (the length between the venter and umbilicus through a transverse cross-section at the last septum of an adult specimen) with a least squares regression analysis correlation coefficient r = 0.617. The fractal dimensions of Cretaceous sutures from Ancyloceratina were compared to a study by Olóriz et al. (2002) where fractal dimensions were measured for suture patterns of 280 species of Late Jurassic ammonites. They found a significant positive correlation (r = 0.500) between fractal dimension and whorl height but only for neritic species (ammonites that inhabit the shallow domain before the drop off of the continental shelf), and a less significant relationship (r = 0.148) for epioceanic species (that occupy the zone beyond the drop off of the continental shelf). Of the 44 sutures from Ancyloceratina analyzed in our study, 41 are presumed to inhabit the epioceanic domain, yet they still exhibit a significant positive relationship (r = 0.617) between fractal dimension and whorl height. This means that this correlation is not restricted to neritic ammonites and may be a function of shell size as proxied by whorl height. There is some inconsistency between these two studies including the vastly different heteromorphic shell forms of Ancyloceratina (with many non-planispiral forms) and temporal variation. Nevertheless, our results provide insight on the role of corrugated septal margins

  8. Systematic review and meta-analysis of sutures coated with triclosan for the prevention of surgical site infection after elective colorectal surgery according to the PRISMA statement.

    Sandini, Marta; Mattavelli, Ilaria; Nespoli, Luca; Uggeri, Fabio; Gianotti, Luca


    Several randomized clinical trials (RCTs) conducted to evaluate the effect of triclosan-coated suture on surgical site infection (SSI) yield to controversial results. The primary purpose of this systematic review and meta-analysis was to analyze the available RCTs, comparing the effect of triclosan-coated suture with uncoated suture on the incidence of SSI after elective colorectal operations. As secondary endpoint of the analysis, we considered length of hospital stay after surgery. We performed a systematic literature review through Medline, Embase, Pubmed, Scopus, Ovid, ISI Web of Science, and the Cochrane Controlled Trials Register searching for RCTs published from 1990 to 2015. To conduct these meta-analyses, we followed the guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Study inclusion criteria were as follows: parallel-group RCTs in adult populations reporting the closure of the abdominal wall after elective colorectal operation with triclosan-coated suture or noncoated suture, and reporting the outcomes considered in the meta-analysis. Six trials including 2168 patients (1102 treated and 1066 controls) provided data on SSIs. The overall rate was 11.7% (129/1102) in the triclosan group and 13.4% (143/1066) in the control group (odds ratio 0.81, 95% confidence interval [CI] 0.58-1.13, P = 0.220). Heterogeneity among studies was moderate (I = 44.9%). No evidence of publication bias was detectable. Five RCTs (1783 patients; 914 treated and 689 controls) described hospital length of stay with no significant effect (mean difference: -0.02, 95% CI -0.11 to -0.07, P = 0.668). The I test for heterogeneity was 0% (P = 0.836). Moderator analyses showed no significant differences were detected in analyses comparing the suture materials (polydioxanone vs polyglactin). In open-label trials, the odds ratio for SSI risk was 0.62 (95% CI 0.20-1.93, P = 0.413), 0.77 in single-blind (95% CI 0.31-1.95, P

  9. Interrupted or continuous-intradermal suturing? Statistical analysis of postoperative scars

    Elif Sarı


    Full Text Available Background and Design: Postoperative scar development is an important problem for patients treated in plastic surgery clinics. Most patients think that continuous intradermal suturing is superior to interrupted suturing because they assume that it creates less scarring. We evaluated scars that form following intradermal and interrupted suturing. This article presents our controlled study that objectively compared the scars on patients' faces using a wound evaluation scale. Materials and Methods: Thirty-five patients, who had undergone operations on the bilateral cheeks, were included in this study. Thirty patients were female; five patients were male. Their mean age was 40.05 years. The average scar evaluation time after surgery was 9.05 months. Elliptical excisions were made on the lesions under local anesthesia. The incisions on the right cheeks were sutured with 6/0 monofilament nonabsorbable sutures using the continuous intradermal suturing technique. The left cheek incisions were sutured with same sutures using the interrupted suturing method. Results: The patients were evaluated 7–11 months after operation (mean: 9.05 months using the Stony Brook Scar Evaluation Scale. A Related Samples T-test was used for statistical evaluation of the differences between the suturing techniques. No significant differences were noted in scar formation between the two suturing methods (p>0.05. Conclusion: We found no differences in scar formation between the two frequently used suturing techniques studied here. We believe that the suturing technique is a less important determinant of scar formation than are other factors.

  10. Biocompatibility and biomechanical analysis of elastic TPU threads as new suture material.

    Vogels, Ruben R M; Lambertz, Andreas; Schuster, Philipp; Jockenhoevel, Stefan; Bouvy, Nicole D; Disselhorst-Klug, Catherine; Neumann, Ulf P; Klinge, Uwe; Klink, Christian D


    High suture tension is one of the causes for many wound-healing problems. Constriction of tissue within the suture loops of nonelastic sutures can lead to cutting of the suture through tissues and necrosis of the tissue within these loops. The use of elastic materials in new suture types could give the material the ability to adapt tension to the tissue requirements and subsequently lead to more vital tissue within its loops. We evaluated the foreign body host response, as indicator of biocompatibility, to a new thermoplastic poly(carbonate) urethane (TPU) synthetic suture material in a rat model compared with standard nonelastic polypropylene (PP) sutures. Tissue samples were collected at 7 and 21 days, and host response was evaluated. Subsequently, suture tension curves of the new elastic sutures for the first 30 min after knotting were recorded in a pig model. The new TPU sutures showed an improved foreign body response when compared with that of PP, with a reduction in the amount of macrophages surrounding the material. Tension experiments showed a superior tension curve for TPU sutures, with a major reduction in peak suture tension when compared with that of standard PP sutures, while still retaining adequate tension after 30 min. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 99-106, 2017.

  11. Provenance of the Walash-Naopurdan back-arc-arc clastic sequences in the Iraqi Zagros Suture Zone

    Ali, Sarmad A.; Sleabi, Rajaa S.; Talabani, Mohammad J. A.; Jones, Brian G.


    Marine clastic rocks occurring in the Walash and Naopurdan Groups in the Hasanbag and Qalander areas, Kurdistan region, Iraqi Zagros Suture Zone, are lithic arenites with high proportions of volcanic rock fragments. Geochemical classification of the Eocene Walash and Oligocene Naopurdan clastic rocks indicates that they were mainly derived from associated sub-alkaline basalt and andesitic basalt in back-arc and island arc tectonic settings. Major and trace element geochemical data reveal that the Naopurdan samples are chemically less mature than the Walash samples and both were subjected to moderate weathering. The seaway in the southern Neotethys Ocean was shallow during both Eocene and Oligocene permitting mixing of sediment from the volcanic arcs with sediment derived from the Arabian continental margin. The Walash and Naopurdan clastic rocks enhance an earlier tectonic model of the Zagros Suture Zone with their deposition occurring during the Eocene Walash calc-alkaline back-arc magmatism and Early Oligocene Naopurdan island arc magmatism in the final stages of intra-oceanic subduction before the Miocene closure and obduction of the Neotethys basin.

  12. Absorbable Polydioxanone (PDS) suture provides fewer wound complications than polyester (ethibond) suture in acute Tendo-Achilles rupture repair

    Baig, M N


    We prospectively studied acute Achilles tendon rupture in patients over a two 2-year period and reviewed the causes, outcome and complications. There were 53 patients included with acute Achilles rupture with minimum follow up period of 6 months. We compared the outcomes including infection rate and Boyden score between the two groups repaired by Polydioxanone and Polyester respectively. All infected cases had a suture repair using the polyester suture. The difference in the infection rate was highly significant between the 2 groups (p=0.001). All 34 patients (100%) in the PDS group had good \\/ excellent results based on the Boyden clinical assessment. Conversely, only 16 patients 9(68.4%) had good or excellent results IN Polyester repair group. Patients treated with a non- absorbable suture (ethibond) material for repair had a higher incidence infection and worse Boyden scores than the absorbable PDS group.

  13. Systematization and description of the internal carotid arteries and their main ramifications at the brain base in turtles (Trachemys scripta elegans).

    Voll, Juliana; Campos, Rui


    Thirty turtle brains (Trachemys scripta elegans) were injected with latex to systematize and describe the internal carotid arteries and their main ramifications at the brain base. The internal carotid arteries had one intercarotid anastomosis. At the level of the tuber cinereum, the internal carotid artery bifurcated into its terminal branches, the rostral and the caudal branches. The rostral branch emitted the rostral choroid artery, the orbital artery, and a series of middle cerebral arteries. After giving off the last middle cerebral artery, the rostral branch continued as the rostral cerebral artery in the cerebral longitudinal fissure, and had one anastomosis with its contralateral homologous artery, the rostral communicating artery, making the first rostral closure of the cerebral arterial circle. Next, the rostral cerebral arteries anastomosed forming a rostral interhemispheric artery, making the second rostral closure of the cerebral arterial circle. The internal carotid artery, after emitting its rostral branch, continued caudally as the caudal branch. The caudal branch ran caudally along the ventral surface of the mesencephalic tegmentum, emitted the caudal cerebral artery and the mesencephalic artery, and continued caudomedially while progressively narrowing, and anastomosed with its contralateral homologous artery, forming the basilar artery. The narrower portion also emitted the trigeminal artery. The anastomosis of the caudal branches closed the cerebral arterial circle caudally. The internal carotid arteries exclusively supplied the cerebral arterial circle of the turtle. Anat Rec, 299:1090-1098, 2016. © 2016 Wiley Periodicals, Inc.

  14. Medial grasping sutures significantly improve load to failure of the rotator cuff suture bridge repair.

    Awwad, George E; Eng, Kevin; Bain, Gregory I; McGuire, Duncan; Jones, Claire F


    The suture bridge (SB) transosseous-equivalent rotator cuff repair reduces re-tear rates compared with single-row or other double-row constructs. However, failure rates continue to be high, especially in large and massive tears. The aim of this study was to assess the biomechanical performance of a new SB repair with use of a medial grasping suture compared with the traditional SB repair. Seven matched pairs of sheep infraspinatus tendons were randomly assigned to either SB or suture bridge with grasping suture (SBGS) repair. Each construct was subjected to cyclic loading and then loaded until failure under displacement control in a materials testing machine. Footprint displacement, ultimate load to failure, and mode of failure were assessed. The rotator cuff footprint displacement was less during tensile loading with the addition of the medial grasping suture. The ultimate load to failure was significantly greater for the SBGS repair group than for the SB repair group (334.0 N vs 79.8 N). The mode of failure was the tendon pulling off the footprint in all cases (type 1 tear). There were no failures in which the tendon tore at the medial row of anchors, leaving part of the tendon still on the footprint (type 2 tear). The addition of a medial grasping suture significantly improved the ultimate load to failure and reduced the footprint displacement of the SB rotator cuff repair in a biomechanical model. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  15. Biomechanical Comparison of Modified Suture Bridge Using Rip-Stop versus Traditional Suture Bridge for Rotator Cuff Repair

    ZiYing Wu


    Full Text Available Purpose. To compare the biomechanical properties of 3 suture-bridge techniques for rotator cuff repair. Methods. Twelve pair-matched fresh-frozen shoulder specimens were randomized to 3 groups of different repair types: the medially Knotted Suture Bridge (KSB, the medially Untied Suture Bridge (USB, and the Modified Suture Bridge (MSB. Cyclic loading and load-to-failure test were performed. Parameters of elongation, stiffness, load at failure, and mode of failure were recorded. Results. The MSB technique had the significantly greatest load to failure (515.6±78.0 N, P=0.04 for KSB group; P<0.001 for USB group, stiffness (58.0±10.7 N/mm, P=0.005 for KSB group; P<0.001 for USB group, and lowest elongation (1.49±0.39 mm, P=0.009 for KSB group; P=0.001 for USB group among 3 groups. The KSB repair had significantly higher ultimate load (443.5±65.0 N than USB repair (363.5±52.3 N, P=0.024. However, there was no statistical difference in stiffness and elongation between KSB and USB technique (P=0.396 for stiffness and P=0.242 for elongation, resp.. The failure mode for all specimens was suture pulling through the cuff tendon. Conclusions. Our modified suture bridge technique (MSB may provide enhanced biomechanical properties when compared with medially knotted or knotless repair. Clinical Relevance. Our modified technique may represent a promising alternative in arthroscopic rotator cuff repair.

  16. Telephone switchboard closure | 19 December


    Exceptionally, the telephone switchboard will close at 4 p.m. on Friday, 19 December, instead of the usual time of 6 p.m., to allow time for closing all systems properly before the annual closure. Therefore, switchboard operator assistance to transfer calls from/to external lines will stop. All other phone services will run as usual.

  17. Vacuum assisted closure in coloproctology

    Bemelman, W.A.


    Vacuum-assisted closure has earned its indications in coloproctology. It has been described with variable results in the treatment of large perineal defects after abdominoperineal excision, in the treatment of stoma dehiscence and perirectal abscesses. The most promising indication for

  18. Half-bow sliding knot: modified suture technique for scleral fixation using the corneoscleral pocket.

    Chee, Soon-Phaik


    A modified suture technique for precise knot placement in the Hoffman corneoscleral pocket technique of scleral fixation is described. Both loops of the polypropylene suture passing from the intraocular device through the sclera and conjunctiva are retrieved from the pocket. A loop of suture is pulled through 3 suture throws made using the second suture loop, forming a half bow. Centration of the intraocular lens (IOL)-capsular bag is checked. If the suture tension is too tight, the surgeon can easily undo the knot of the half-bow knot by pulling it free and can then retie the sliding knot. When the IOL-capsular bag is centered, the suture loop is cut and the free end removed. The second suture end is retrieved from the pocket, and knot tying is completed without further adjustment to the tension. Posterior pressure on the intraocular device centers it and settles the knot within the sclera at the fixation point.

  19. Acute arterial occlusion - kidney

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidney can often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury or trauma to ...

  20. Suture supported P C IOL in a homocystinuric child.

    Bhatti S


    Full Text Available A homocystinuric child presented with a secondary pupillary block glaucoma due to anteriorly subluxated lens. After removal of the subluxated lens, a suture supported posterior chamber IOL was implanted. Postoperative complication of cerebral venous thrombosis following general anaesthesia was managed with high doses of pyridoxine special diet and drugs.

  1. Automatic Detection of Wild-type Mouse Cranial Sutures

    Ólafsdóttir, Hildur; Darvann, Tron Andre; Hermann, Nuno V.;

    , automatic detection of the cranial sutures becomes important. We have previously built a craniofacial, wild-type mouse atlas from a set of 10 Micro CT scans using a B-spline-based nonrigid registration method by Rueckert et al. Subsequently, all volumes were registered nonrigidly to the atlas. Using...

  2. Hyperammonemic encephalopathy due to suture line breakdown after bladder operation.

    Boogerd, W; Zoetmulder, F A; Moffie, D


    A patient is described with a severe encephalopathy and hyperammonemia in absence of liver dysfunction, attributed to urine absorption into the systemic circulation due to suture line breakdown after bladder dome resection. At autopsy characteristic Alzheimer type II astrocytes were found in the basal ganglia.

  3. Functional influence on sutural bone apposition in the growing rat.

    Katsaros, C.; Zissis, A.; Bresin, A.; Kiliaridis, S.


    INTRODUCTION: The aim of this study was to quantify the influence of reduced masticatory muscle function on sutural bone apposition in the growing rat. METHODS: Twenty-six growing male albino rats were randomly divided into 2 equal groups; 1 (hard-diet group) received the ordinary diet of hard pelle

  4. Penile torsion correction by diagonal corporal plication sutures

    Brent W. Snow


    Full Text Available Penile torsion is commonly encountered. It can be caused by skin and dartos adherence or Buck’s fascia attachments. The authors suggest a new surgical approach to solve both problems. If Buck’s fascia involvement is demonstrated by artificial erection then a new diagonal corporal plication suture is described to effectively solve this problem.




    Mersilene (polyester monofilament) seems to be suitable for penetrating keratoplasty because it is strong, shows no degradation by ultraviolet light, is insoluble, so that it can be left in situ, and offers the possibility of regulating postoperative astigmatism by suture adjustment. In 12 patients

  6. Stress-Softening and Residual Strain Effects in Suture Materials

    Alex Elías-Zúñiga


    Full Text Available This work focuses on the experimental characterization of suture material samples of MonoPlus, Monosyn, polyglycolic acid, polydioxanone 2–0, polydioxanone 4–0, poly(glycolide-co-epsilon-caprolactone, nylon, and polypropylene when subjected to cyclic loading and unloading conditions. It is found that all tested suture materials exhibit stress-softening and residual strain effects related to the microstructural material damage upon deformation from the natural, undistorted state of the virgin suture material. To predict experimental observations, a new constitutive material model that takes into account stress-softening and residual strain effects is developed. The basis of this model is the inclusion of a phenomenological nonmonotonous softening function that depends on the strain intensity between loading and unloading cycles. The theory is illustrated by modifying the non-Gaussian average-stretch, full-network model to capture stress-softening and residual strains by using pseudoelasticity concepts. It is shown that results obtained from theoretical simulations compare well with suture material experimental data.

  7. Subduction-accretion-collision history along the Gondwana suture in southern India: A laser ablation ICP-MS study of zircon chronology

    Sato, Kei; Santosh, M.; Tsunogae, Toshiaki; Chetty, T. R. K.; Hirata, Takafumi


    We report the petrological characteristics and preliminary zircon geochronology based on laser ablation ICP mass spectrometry of the various units in an accretionary belt within the Palghat-Cauvery Shear/Suture Zone in southern India, a trace of the Cambrian Gondwana suture. Zircons extracted from a plagiogranite in association with an ophiolite suite within this suture possess internal structure that suggests magmatic crystallization, and yield mid Neoproterozoic 206Pb/ 238U age of 817 ± 16 Ma (error: 1 σ) constraining the approximate timing of birth of the Mozambique Ocean floor. Compiled age data on zircons separated from a quartzite and metamorphosed banded iron formation within the accretionary belt yields a younger intercept age of 759 ± 41 Ma (error: 1 σ) which we relate to a mid Neoproteozoic magmatic arc. Detrital zircons extracted from the quartzite yield 207Pb/ 206Pb age peaks of about 1.9-2.6 Ga suggesting that they were sourced from multiple protolithis of Neoarchean and Paleoproterozoic. Metamorphic overgrowths on some zircon grains record ca. 500-550 Ma ages which are in good harmony with the known ages for the timing of high-grade metamorphism in this zone during the final stage of continent collision associated with the birth of the Gondwana supercontinent in the latest Neoproterozoic-Cambrian. The preliminary geochronological results documented in our study correlate with the subduction-accretion-collision history associated with the closure of the Mozambique Ocean and the final amalgamation of the Gondwana supercontinent.

  8. The use of suture anchors to repair the ruptured quadriceps tendon.

    Bushnell, Brandon D; Whitener, George B; Rubright, James H; Creighton, R Alexander; Logel, Kevin J; Wood, Mark L


    Quadriceps tendon rupture is an incapacitating injury that usually requires surgical repair. Traditional repair methods involve transpatellar suture tunnels, but recent reports have introduced the idea of using suture anchors to repair the ruptured tendon. We present 5 cases of our technique of using suture anchors to repair the ruptured quadriceps tendon.




    Nylon and stainless steel sutures separately placed deeply into rabbit corneas by splitting the stroma for a few millimeters, without closing sutures, remained in the cornea for two, four and six weeks respectively. In contrast to the stainless steel sutures an extensive tissue reaction could be obs




    Nylon and stainless steel sutures separately placed deeply into rabbit corneas by splitting the stroma for a few millimeters, without closing sutures, remained in the cornea for two, four and six weeks respectively. In contrast to the stainless steel sutures an extensive tissue reaction could be

  11. 40 CFR 265.112 - Closure plan; amendment of plan.


    ... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Closure plan; amendment of plan. 265... DISPOSAL FACILITIES Closure and Post-Closure § 265.112 Closure plan; amendment of plan. (a) Written plan... have a written closure plan. Until final closure is completed and certified in accordance with §...

  12. Caudal Septal Stabilization Suturing Technique to Treat Crooked Noses.

    Baykal, Bahadir; Erdim, Ibrahim; Guvey, Ali; Oghan, Fatih; Kayhan, Fatma Tulin


    To rotate the nasal axis and septum to the midline using an L-strut graft and a novel caudal septal stabilization suturing technique to treat crooked noses. Thirty-six patients were included in the study. First, an L-strut graft was prepared by excising the deviated cartilage site in all patients. Second, multiple stabilization suturing, which we describe as a caudal septal stabilization suturing technique with a "fishing net"-like appearance, was applied between the anterior nasal spine and caudal septum in all patients. This new surgical technique, used to rotate the caudal septum, was applied to 22 I-type and 14 C-type crooked noses. Correction rates for the crooked noses were compared between the 2 inclination types with angular estimations. Deviation angles were measured using the AutoCAD 2012 software package and frontal (anterior) views, with the Frankfurt horizontal line parallel to the ground. Nasal axis angles showing angle improvement graded 4 categories as excellent, good, acceptable, and unsuccessful for evaluations at 6 months after surgery in the study. The success rate in the C-type nasal inclination was 86.7% (±21.9) and 88% (±16.7) in the I-type. The overall success rate of L-strut grafting and caudal septal stabilization suturing in crooked nose surgeries was 87.5% (±18.6). "Unsuccessful" results were not reported in any of the patients. L-strut grafting and caudal septal stabilization suturing techniques are efficacious in crooked noses according to objective measurement analysis results. However, a longer follow-up duration in a larger patient population is needed.




    Full Text Available Laparoscopic closure of perforated duodenal ulcer was first performed in the year 1990 . Due to its advantage of better view of the peritoneal cavity an opportunity for thorough lavage and avoidance of upper abdominal incision, with its related complication, especially in high – ri sk patients, this procedure has gained popularity all over the world. Approximately 10 - 20% of patients suffering from peptic ulcer develop perforation of stomach or duodenum in which, chemical peritonitis develop initially from gastric secretion and duoden al secretion the condition is life threatening. Early diagnosis and treatment is extremely important. Mortality will increase up if perforation exists more than 24 to 48 hours. Usually surgical intervention of simple closure with omental patch of the perforation is required. this study aims at evaluating efficacy , safety and outcome of laparoscopic surgery for perforated duodenal ulcer patients admitted during period Jan 2009 to Dec 2012 at tertiary hospital in north Karnataka A total of 61cases diagnosed as peritonitis secondary to duodenal ulcer perforation were involved in the study 30underwent open perforation closure and 31 cases underwent lap closure. Peptic ulcers are focal defects in the gastric or duodenal mucosa which extend into the sub mucosa or deeper. they may be acute or chronic and ultimately are caused by on imbalance between the action of peptic acid and mucosal defenses peptic ulcer remains a common outpatient diagnosis, but the number of elective operations for peptic ul cer disease have decreased dramatically over the past 30 decades due to the advent of H2 blockers However the incidence of emergency surgeries, and death rate associated with peptic ulcer are same

  14. Generalized Convective Quasi-Equilibrium Closure

    Yano, Jun-Ichi; Plant, Robert


    Arakawa and Schubert proposed convective quasi-equilibrium as a basic principle for closing their spectrum mass-flux convection parameterization. In deriving this principle, they show that the cloud work function is a key variable that controls the growth of convection. Thus, this closure hypothesis imposes a steadiness of the cloud work function tendency. This presentation shows how this principle can be generalized so that it can also encompasses both the CAPE and the moisture-convergence closures. Note that the majority of the current mass-flux convection parameterization invokes a CAPE closure, whereas the moisture-convergence closure was extremely popular historically. This generalization, in turn, includes both closures as special cases of convective quasi-equilibrium. This generalization further suggests wide range of alternative possibilities for convective closure. In general, a vertical integral of any function depending on both large-scale and convective-scale variables can be adopted as an alternative closure variables, leading to an analogous formulation as Arakawa and Schubert's convective quasi-equilibrium formulation. Among those, probably the most fascinating possibility is to take a vertical integral of the convective-scale moisture for the closure. Use of a convective-scale variable for closure has a particular appeal by not suffering from a loss of predictability of any large-scale variables. That is a main problem with any of the current convective closures, not only for the moisture-convergence based closure as often asserted.

  15. Surgical procedure for coronary artery ectasia associated with saccular fistula.

    Murakami, Masanori; Gohra, Hidenori; Yagi, Takeshi; Jinbou, Mitsutaka; Kobayashi, Toshiro; Saito, Satoshi; Takahashi, Tsuyoshi; Shiomi, Kotaro; Ono, Siro; Hamano, Kimikazu


    Echocardiography of a 60 year-old woman with a three-year history of heart murmur revealed a coronary artery fistula. Coronary angiography indicated right coronary artery ectasia and fistula. The pulmonary-to-systemic blood flow ratio was 1.4, and left-to-right shunt, 29%. On follow-up, infective endocarditis of the tricuspid valve had developed and was treated using antibiotics. The right coronary artery was dilated along its length and was saccular at the distal aspect. At this point, a fistula also connected by the left anterior descending and left circumflex arteries drained into the right ventricle. Fistula closure and reduction aneurysmectomy were performed.

  16. The 2.5 mm PushLock suture anchor system versus a traditional suture anchor for ulnar collateral ligament injuries of the thumb: a biomechanical study.

    Jarrett, C D; McGillivary, G R; Hutton, W C


    We compared the biomechanical strength of the 2.5 mm PushLock suture anchor with a traditional Bio-SutureTak suture anchor in repair of ulnar collateral ligament injuries. Iatrogenic ulnar collateral ligament injuries in 18 cadaveric thumbs were repaired and used to test for load to failure and cyclic loading. The average force required to generate a 2 mm gap was 7.7 N for the 2.5 mm PushLock and 6.3 N for the Bio-SutureTak (p = 0.04). The ultimate load to failure was 28.0 N for the 2.5 mm PushLock and 18.8 N for the Bio-SutureTak (p = 0.16). There were no statistical differences between the two suture anchors under cyclic loading. The 2.5 mm PushLock suture anchor provides significantly stronger resistance to 2 mm gap formation at the repair site and is less likely to fail at the suture-ligament interface. However, there was no difference in the load to failure between the two suture anchors.

  17. Pediatric nonaortic arterial aneurysms.

    Davis, Frank M; Eliason, Jonathan L; Ganesh, Santhi K; Blatt, Neal B; Stanley, James C; Coleman, Dawn M


    Pediatric arterial aneurysms are extremely uncommon. Indications for intervention remain poorly defined and treatments vary. The impetus for this study was to better define the contemporary surgical management of pediatric nonaortic arterial aneurysms. A retrospective analysis was conducted of 41 children with 61 aneurysms who underwent surgical treatment from 1983 to 2015 at the University of Michigan. Arteries affected included: renal (n = 26), femoral (n = 7), iliac (n = 7), superior mesenteric (n = 4), brachial (n = 3), carotid (n = 3), popliteal (n = 3), axillary (n = 2), celiac (n = 2), ulnar (n = 2), common hepatic (n = 1), and temporal (n = 1). Intracranial aneurysms and aortic aneurysms treated during the same time period were not included in this study. Primary outcomes analyzed were postoperative complications, mortality, and freedom from reintervention. The study included 27 boys and 14 girls, with a median age of 9.8 years (range, 2 months-18 years) and a weight of 31.0 kg (range, 3.8-71 kg). Multiple aneurysms existed in 14 children. Obvious factors that contributed to aneurysmal formation included: proximal juxta-aneurysmal stenoses (n = 14), trauma (n = 12), Kawasaki disease (n = 4), Ehlers-Danlos type IV syndrome (n = 1), and infection (n = 1). Preoperative diagnoses were established using arteriography (n = 23), magnetic resonance angiography (n = 6), computed tomographic arteriography (n = 5), or ultrasonography (n = 7), and confirmed during surgery. Indications for surgery included risk of expansion and rupture, potential thrombosis or embolization of aneurysmal thrombus, local soft tissue and nerve compression, and secondary hypertension in the case of renal artery aneurysms. Primary surgical techniques included: aneurysm resection with reanastomsis, reimplantation, or angioplastic closure (n = 16), interposition (n = 10) or bypass grafts (n = 2), ligation (n = 9), plication (n = 8), endovascular occlusion (n = 3), and nephrectomy (n = 4) in

  18. Closure constraints for hyperbolic tetrahedra

    Charles, Christoph


    We investigate the generalization of loop gravity's twisted geometries to a q-deformed gauge group. In the standard undeformed case, loop gravity is a formulation of general relativity as a diffeomorphism-invariant SU(2) gauge theory. Its classical states are graphs provided with algebraic data. In particular closure constraints at every node of the graph ensure their interpretation as twisted geometries. Dual to each node, one has a polyhedron embedded in flat space R^3. One then glues them allowing for both curvature and torsion. It was recently conjectured that q-deforming the gauge group SU(2) would allow to account for a non-vanishing cosmological constant Lambda, and in particular that deforming the loop gravity phase space with real parameter q>0 would lead to a generalization of twisted geometries to a hyperbolic curvature. Following this insight, we look for generalization of the closure constraints to the hyperbolic case. In particular, we introduce two new closure constraints for hyperbolic tetrahe...

  19. Assessment of the role of sutures in a lizard skull: a computer modelling study.

    Moazen, Mehran; Curtis, Neil; O'Higgins, Paul; Jones, Marc E H; Evans, Susan E; Fagan, Michael J


    Sutures form an integral part of the functioning skull, but their role has long been debated among vertebrate morphologists and palaeontologists. Furthermore, the relationship between typical skull sutures, and those involved in cranial kinesis, is poorly understood. In a series of computational modelling studies, complex loading conditions obtained through multibody dynamics analysis were imposed on a finite element model of the skull of Uromastyx hardwickii, an akinetic herbivorous lizard. A finite element analysis (FEA) of a skull with no sutures revealed higher patterns of strain in regions where cranial sutures are located in the skull. From these findings, FEAs were performed on skulls with sutures (individual and groups of sutures) to investigate their role and function more thoroughly. Our results showed that individual sutures relieved strain locally, but only at the expense of elevated strain in other regions of the skull. These findings provide an insight into the behaviour of sutures and show how they are adapted to work together to distribute strain around the skull. Premature fusion of one suture could therefore lead to increased abnormal loading on other regions of the skull causing irregular bone growth and deformities. This detailed investigation also revealed that the frontal-parietal suture of the Uromastyx skull played a substantial role in relieving strain compared with the other sutures. This raises questions about the original role of mesokinesis in squamate evolution.

  20. Delayed cerebrospinal fluid leak after watertight dural closure with a polyethylene glycol hydrogel dural sealant in posterior fossa surgery: case report.

    Jito, Junya; Nitta, Naoki; Nozaki, Kazuhiko


    A polyethylene glycol (PEG) hydrogel sealant recently has been approved as an adjunct to sutured dural closure in Japan. We treated consecutive six patients with PEG hydrogel sealant in posterior fossa operation. Three of six cases suffered delayed cerebrospinal fluid (CSF) leak after watertight dural closure with the PEG hydrogel sealant, although there was no leak case which was treated with fibrin glue, before 2 years until the adoption of the new material. These patients underwent posterior fossa craniotomy and discharged without remarkable CSF leak. The pseudomeningocele under the occipital wound caused the CSF leak occurr from 5th to 7th week postoperatively. All CSF leak cases needed surgical repair. At the repair, the PEG hydrogel was liquefied and almost absorbed. A fistula on the closure line and a dead space after the absorption of the PEG hydrogel was observed. When the absorbable PEG hydrogel sealant plugs in small gaps of sutured dura, its properties to prevent adhesion might suppress healing process of dural closure, so that CSF could leak through the gaps and collect as a pseudomeningocele in the dead space after absorption of the PEG hydrogel. In posterior fossa surgery a PEG hydrogel sealant should be applied when dural edges are closed tightly without any gaps.

  1. Closure of skin incisions by laser-welding with a combination of two near-infrared diode lasers: preliminary study for determination of optimal parameters.

    Hu, Liming; Lu, Zhihua; Wang, Biao; Cao, Junsheng; Ma, Xiaobo; Tian, Zhenhua; Gao, Zhijian; Qin, Li; Wu, Xiaodong; Liu, Yun; Wang, Lijun


    Laser welding has the potential to become an effective method for wound closure and healing without sutures. Closure of skin incisions by laser welding with a combination of two near-infrared lasers (980 and 1064 nm), was performed for the first time in this study. One centimeter long, full-thickness incisions were made on the Wistar rat's dorsal skin. The efficiencies of laser-welding with different parameters were investigated. Incision-healing, histology examination, and a tensile strength test of incisions were recorded. Laser welding with the irradiance level of 15.9 W∕cm(2) for both 980 and 1064-nm lasers and exposure time of 5 s per spot in continuous wave mode yielded a more effective closure and healing with minimal thermal damage, faster recovery, and stronger apposition in comparison with a suturing technique. The conclusion is that skin welding with a combination of two near-infrared diode lasers can be a good candidate for incision closure, and further investigations are in progress for clinical use.




    Full Text Available Metopic suture is formed due to failure of union of the two halves of the frontal bone. Usually the suture disappears by early childhood, but in some cases it persists as complete or incomplete metopic suture throughout life. A complete metopic suture extends from anterior aspect of bregma to the nasion which is known as metopism. The present study is carried out in 126 dry human cadaveric skulls collected from the Dept. of Anatomy, Dept. of Forensic Medicine and Institute of Pharmacy at Assam Medical College & Hospital, Dibrugarh, Assam, and India. Metopic suture was found in 46(36.5% skulls. Metopism was found in 4(3.17% skulls and incomplete metopic suture was seen in 42(33.33% skulls. 80(63.49% skulls did not have metopic suture in any form.

  3. Modified versus classic alar base sutures after LeFort I osteotomy: a systematic review.

    Liu, Xianwen; Zhu, Songsong; Hu, Jing


    The purpose of this systematic review is to evaluate the efficacy of a new modified alar base cinch suture by comparing it with the commonly used classic alar base suture after LeFort I osteotomy. A comprehensive search strategy was performed to include interventional studies involving the comparisons of alar base suturing methods after LeFort I osteotomy. Data analyses were conducted using the random-effects model. Three studies with 146 participants undergoing LeFort I maxillary osteotomy were included in this review. The results showed that, compared with the classic method, both modified transseptal alar base suture and modified reinsertion sutures significantly decreased postoperative alar and alar base widening. The modified alar base cinch suture was more effective than the classic alar base suture in maintaining preoperative alar and alar base width after LeFort I osteotomy. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Randomized clinical trial comparing manual suture and different models of mechanical suture in the mimicking of bariatric surgery in swine

    Fernandes MA


    Full Text Available Marcos AP Fernandes,1 Bruno MT Pereira,2 Sandra M Guimarães,1 Aline Paganelli,3 Carlos Manoel CT Pereira,1 Claudio Sergio Batista4 1Institute of Obesity and Advanced Video Laparoscopic Surgery of Petropolis, Rio de Janeiro, Brazil; 2Division of Trauma, University of Campinas, São Paulo, Brazil; 3Laboratório de Patologia Micron Cell Diagnóstico, Rio de Janeiro, Brazil; 4Department of Gynecology and Obstetrics, Faculty of Medicine of Petropolis, Rio de Janeiro, Brazil Context and objective: Variations in the ability of surgeons served as motivation for the development of devices that, overcoming individual differences, allow the techniques to be properly performed, and of which the end result was the best possible. Every technique must be reproduced reliably by the majority of surgeons for their results to be adopted and recognized as effective. The aim of this study was to compare the results, from the point of view of anatomic pathology, of manual sutures versus mechanical sutures using different models of linear mechanical staplers, in the procedure of gastroenteroanastomosis and enteroanastomosis in swine. Methods: Thirty-six healthy, adult, male Sus scrofa domesticus pigs, weighing between 20.7 and 25.5 kg, were used. The swine were randomly divided into four groups of nine pigs, according to the type of suture employed: group A, manual suture with Polysorb® 3-0 wire; group B, 80-shear linear stapler (Covidien® Gia 8038-S; group C, 75-shear linear stapler (Ethicon® Tlc 75; and group D, 75-shear linear stapler (Resource® Yq 75-3. A temporal study was established on the seventh postoperative day for histopathological analysis, and the degree of inflammation, fibrosis, and newly formed vessels, as well as the presence or absence of granulation tissue, foreign body granuloma, and necrosis were all evaluated qualitatively and semiquantitatively. The results were analyzed statistically. Results: Observations during the histopathological

  5. [Anesthesia for the surgery of delayed postoperative stenosis in the pulmonary suture in children with corrected transposition of the great vessels with Jatene's technique].

    Suán, C; Cerro, J; Ojeda, R; García-Perla, J L


    Any patient with congenital heart disease is at high risk for anesthesia no matter what surgical procedure is performed. Children undergoing D-transposition of the great arteries using Jatene's technique present stenosis of the pulmonary artery in 10-20% of cases and may require surgery to correct that or some other surgically caused anomally. In either case the children must be managed as patients with heart disease, with special attention to cardiovascular depression and rhythm abnormalities. We report the cases of two children who underwent D-transposition of the great arteries in the neonatal period using Jatene's anatomical technique. They were later anesthetized at ages 5 and 6 years to correct pulmonary suture stenosis. Recovery was good.

  6. Single versus double-layer uterine closure at cesarean: impact on lower uterine segment thickness at next pregnancy.

    Vachon-Marceau, Chantale; Demers, Suzanne; Bujold, Emmanuel; Roberge, Stephanie; Gauthier, Robert J; Pasquier, Jean-Charles; Girard, Mario; Chaillet, Nils; Boulvain, Michel; Jastrow, Nicole


    Uterine rupture is a potential life-threatening complication during a trial of labor after cesarean delivery. Single-layer closure of the uterus at cesarean delivery has been associated with an increased risk of uterine rupture compared with double-layer closure. Lower uterine segment thickness measurement by ultrasound has been used to evaluate the quality of the uterine scar after cesarean delivery and is associated with the risk of uterine rupture. To estimate the impact of previous uterine closure on lower uterine segment thickness. Women with a previous single low-transverse cesarean delivery were recruited at 34-38 weeks' gestation. Transabdominal and transvaginal ultrasound evaluation of the lower uterine segment thickness was performed by a sonographer blinded to clinical data. Previous operative reports were reviewed to obtain the type of previous uterine closure. Third-trimester lower uterine segment thickness at the next pregnancy was compared according to the number of layers sutured and according to the type of thread for uterine closure, using weighted mean differences and multivariate logistic regression analyses. Of 1613 women recruited, with operative reports available, 495 (31%) had a single-layer and 1118 (69%) had a double-layer closure. The mean third-trimester lower uterine segment thickness was 3.3 ± 1.3 mm and the proportion with lower uterine segment thickness cesarean delivery is associated with a thicker third-trimester lower uterine segment and a reduced risk of lower uterine segment thickness <2.0 mm in the next pregnancy. The type of thread for uterine closure has no significant impact on lower uterine segment thickness. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. The Use of CT Scans in Estimating Age at Death by Examining the Extent of Ectocranial Suture Closure

    Boyd, Kristen Leigh; Villa, Chiara; Lynnerup, Niels


    -aged individuals. ANOVA test revealed no difference between two groups of scans and between left and right sides (p > 0.05). Interobserver agreement was good, especially considering the score by sides. The results of this study create the base for developing a robust and simple method to estimate the age at death...

  8. Modification of the Bankart reconstruction using a suture anchor.

    Traina, S M; Holtgrewe, J L; King, S


    A prospective study was done to determine the effectiveness of a suture anchor in doing a Modified Bankart Reconstruction on the traumatic unidirectional Bankart lesion shoulder. From 1989 to 1991, 26 patients encompassing 27 shoulders with recurrent instability had modified Bankart reconstructions. A minimum 18-month follow-up was obtained by examination of 24 patients with telephone interviews done on two patients. The average follow-up was 23.6 months. A 93.1% good-to-excellent result was obtained using the Bankart rating scale. There were no failures or complications. The surgeon involved in the study thought the suture anchor facilitated the attachment of the avulsed capsulolabral complex in doing the Bankart procedure.

  9. Brachiomedian artery (arteria brachiomediana revisited: a comprehensive review

    David Kachlik


    Full Text Available This article reviews in detail the superficial brachiomedian artery (arteria brachiomediana superficialis, a very rare variant of the main arterial trunks of the upper limb. It branches either from the axillary artery or the brachial artery, descends superficially in the arm (similar to the course of the superficial brachial artery and continues across the cubital fossa, runs superficially in the forearm, approaches the median nerve and enters the carpal canal to reach the hand. It usually terminates in the superficial palmar arch. The first drawing was published, in 1830, and the first description was published, in 1844. Altogether, to our knowledge, only 31 cases of a true, superficial brachiomedian artery have been reported (Some cases are incorrectly reported as superficial brachioradiomedian artery or superficial brachioulnomedian artery. Based on a meta-analysis of known, available studies, the incidence is 0.23% in Caucasians and 1.48% in Mongolians. Knowing whether or not this arterial variant is present is important in clinical medicine and relevant for: The catheterization via the radial or ulnar artery; harvesting the vascular pedicle for a forearm flap based on the radial, ulnar or superficial brachiomedian arteries; the possible collateral circulation in cases of the arterial closure; and the surgical management of carpal tunnel syndrome. Its presence can elevate the danger of an injury to the superficially located variant artery or of an accidental injection.

  10. Designing Flaps for Closure of Circular and Semicircular Skin Defects.

    Alvarado, Alfredo


    Removing skin lesions from the human body is a simple procedure, but closing the resulting defect may prove a difficult task. The surgeon quite often encounters a problem when the lesion is located in a confined anatomical area where the elasticity of the skin is limited or when the lesion is large. To obviate these difficulties, I present 4 new incisions for closure of circular and semicircular skin defects on difficult parts of the human body such as the scalp, face, axilla, back, and sacrococcygeal areas. This article describes a working model made of white bond paper that can be enlarged or reduced in size using a regular copying machine that can be prepared in advance of surgery to make sure that it adapts to a particular anatomical location. Also, it describes a geometrical analysis in order to determine the distortion of the minimal tension lines of the skin, skin wastage, and length of the suture lines. In summary, it is possible to use a variety of skin incisions, taking advantage of the minimal tension lines of the skin and also taking into consideration the anatomical characteristics of the region involved.

  11. Dynamic Observation on the Effects of Different Suture Techniques on the Biomechanical Properties in the Healing of Tendons


    To identify the best suture techniques for the tendon repair, the biomechanical properties of tendons sutured by different methods were dynamically examined. 140 chickens were divided into 2 groups equally: group A and group B. The tendon of the right side was subjected to injury-repair process, and the tendons of the left sides served as controls in both groups. In group A, "figure-of8" suture, modified Kessler suture and Bunnell suture were used for the 2nd to 4th paws respectively, while in group B, Kleinert suture, Tsuge suture and Ikuta suture were used. On the day 0, 3,7, 14, 21, 28, 42 after operation, 10 animals were sacrificed and the flexor tendons of both sides were harvested for strength test. The results showed that the initial strength of the repaired tendons and the strength after 6 weeks following tendon cut were far below those of intact tendons, irrespective of suture techniques used. With the 6 techniques, the Pmax of tendons repaired by Tsuge suture was increased continually, reaching the highest value on the 42nd day. The Pmax of tendons sutured by the modified Kessler suture was slightly lower than that by Tsuge suture, but it was increased steadily in healing. The tendons repaired by figure-of-8 suture yielded the lowest Pmax. It was concluded that Tsuge suture and modified Kessler suture were the best techniques for tendon repair.

  12. Transcutaneous Serdev Suture For Buttock’s Lift

    Nikolay Serdev


    This article presents the author's technique and experience in the treatment of the flaccid "unhappy buttock" form with his surgical procedure of buttock lift by suture, without incision scars. The author first presented this new operation technique on a national level at the 2nd Annual Meeting of the National Bulgarian Society for Aesthetic Surgery and Aesthetic Medicine in Sofia on March 18, 1994 [1] and internationally at many scientific meetings over the world [2, 3, 4…]. The result is a ...

  13. Microsurgical transverse 2-suture intussusception vasoepididymostomy: effectiveness and rationality

    ZHANG Hao; HUANG Wen-tao; RUAN Xing-xing; LI Liao-yuan; DI Jin-ming; LIU Xiao-peng; XIAO Heng-jun


    Background 2-Suture longitudinal vasoepididymostomy shows superiority to transverse technique in an animal study; to date,this has not been consistently confirmed in human body.In the present study,we evaluated the effectiveness of 2-suture transverse intussusception vasoepididymostomy and compared the rationality between transverse and longitudinal techniques.Methods From May 2007 to December 2008,we performed 2-suture transverse vasoepididymostomy in 19 consecutive patients,as described by Marmar with modification.Between March 2009 and January 2010,the internal diameter of the vas lumen and the outer diameter of the epididymal tube were measured using microruler (21 patients and 37 sides).Results Three patients lost to follow-up.At the first follow-up period (ranged from 10 to 24 months),the patency rate was 56.3% (9/16) and the natural pregnancy rate was 25% (4/16).At the second follow-up period (ranged from 46 to 63months),the patency rate was 68.8% (11/16),the natural pregnancy rate was 37.5% (6/16),respectively,and the takehome baby rate was 31.3% (5/16).The diameter of the vas lumen and the outer diameter of the epididymal tubule were (0.512±0.046) mm and (0.572±0.051) mm (P <0.001),respectively.Conclusion Transverse 2-suture intussusception vasoepididymostomy is still an effective technique in treating obstructive azoospermia.

  14. The south Zagros suture zone in teleseismic images

    Motaghi, K.; Shabanian, E.; Tatar, M.; Cuffaro, M.; Doglioni, C.


    The geometry of intra-continental lithosphere boundaries along the Zagros orogenic belt in the Arabia-Eurasia collision is investigated by means of teleseismic data. The data are gathered over a seismic linear profile extending across south Zagros, the Sanandaj-Sirjan metamorphic zone, the Urumieh-Dokhtar magmatic arc, Central Iran, and the Kopeh Dagh - Binalud mountains. We exploit the P and S receiver functions leading to map the geometry of the crustal and subcrustal interfaces. The migrated depth sections reveal an abrupt crustal thickening and a gentle crustal thinning 60 km north and 30 km south of the Zagros suture, respectively. Associated to the buckled antiformal Moho south of the suture, a deeper synform in the lithospheric lid of the lower Arabia plate is shown by migrated depth sections affecting the lithospheric mantle of the Arabia plate beneath the suture zone. This geometry implies an unexpected intra-lid decoupling. These features imply that the Central Iran lithosphere acts as a relatively strong backstop producing significant internal deformation expressed by shortening and thickening at the edge of the Arabian lithosphere. The 410 km and 660 km transition zones are imaged by P to S converted phases and showed lateral continuity implying an originally low dip angle subduction of the oceanic Arabian plate beneath Central Iran.

  15. Self-directed practice schedule enhances learning of suturing skills.

    Safir, Oleg; Williams, Camille K; Dubrowski, Adam; Backstein, David; Carnahan, Heather


    Most preoperative surgical training programs experience challenges with the availability of expert surgeons to teach trainees. Some research suggests that trainees may benefit from being allowed to actively shape their learning environments, which could alleviate some of the time and resource pressures in surgical training. The purpose of this study was to investigate the effects of self-directed or prescribed practice schedules (random or blocked) on learning suturing skills. Participants watched an instructional video for simple interrupted, vertical mattress and horizontal mattress suturing then completed a pretest to assess baseline skills. Participants were assigned to 1 of 4 practice groups: self-directed practice schedule, prescribed blocked practice schedule, prescribed random practice schedule or matched to the self-directed group (control). Practice of the skill was followed by a delayed (1 h) posttest. Improvement from pretest to posttest was determined based on differences in performance time and expert-based assessments. Analyses revealed a significant effect of group for difference in performance time of the simple interrupted suture. Random practice did not show the expected advantage for skill learning, but there was an advantage of self-directed practice. Self-directed practice schedules may be desirable for optimal learning of simple technical skills, even when expert instruction is available. Instructors must also take into account the interaction between task difficulty and conditions of practice to develop ideal training environments.

  16. The role of antimicrobial sutures in preventing surgical site infection.

    Leaper, D; Wilson, P; Assadian, O; Edmiston, C; Kiernan, M; Miller, A; Bond-Smith, G; Yap, J


    INTRODUCTION Healthcare associated infections (HCAIs) are falling following widespread and enforced introduction of guidelines, particularly those that have addressed antibiotic resistant pathogens such as methicillin resistant Staphylococcus aureus or emergent pathogens such as Clostridium difficile, but no such decline has been seen in the incidence of surgical site infection (SSI), either in the UK, the EU or the US. SSI is one of the HCAIs, which are all avoidable complications of a surgical patient's pathway through both nosocomial and community care. METHODS This report is based on a meeting held at The Royal College of Surgeons of England on 21 July 2016. Using PubMed, members of the panel reviewed the current use of antiseptics and antimicrobial sutures in their specialties to prevent SSI. FINDINGS The group agreed that wider use of antiseptics in surgical practice may help in reducing reliance on antibiotics in infection prevention and control, especially in the perioperative period of open elective colorectal, hepatobiliary and cardiac operative procedures. The wider use of antiseptics includes preoperative showering, promotion of hand hygiene, (including the appropriate use of surgical gloves), preoperative skin preparation (including management of hair removal), antimicrobial sutures and the management of dehisced surgical wounds after infection. The meeting placed emphasis on the level I evidence that supports the use of antimicrobial sutures, particularly in surgical procedures after which the SSI rate is high (colorectal and hepatobiliary surgery) or when a SSI can be life threatening even when the rate of SSI is low (cardiac surgery).

  17. Percutaneous repair of inadvertent subclavian artery cannulation: a case report

    SHI Hong-yu; QIU Xing-biao; CHEN Hui; LIU Zhi-gang; YE Ying; FANG Wei-yi


    @@ Although catheterization of the subclavian vein is a common procedure, it might be associated with life-threatening complications including accidental cannulation of subclavian artery.1-3 Rash sheath removal could result in fatal hemorrhage. We report a case of inadvertent 6F sheath cannulation of the right subclavian artery during a radiofrequency catheter ablation procedure and successful repair of the cannulation by Angio-Seal STS plus (St. Jude Medical, St. Paul, MN, US), a collagen-base vascular closure device.

  18. Stress and strain analysis on the anastomosis site sutured with either epineurial or perineurial sutures after simulation of sciatic nerve injury

    Guangyao Liu; Qiao Zhang; Yan Jin; Zhongli Gao


    The magnitude of tensile stress and tensile strain at an anastomosis site under physiological stress is an important factor for the success of anastomosis following suturing in peripheral nerve injury treatment.Sciatic nerves from fresh adult cadavers were used to create models of sciatic nerve injury.The denervated specimens underwent epineurial and perineurial suturing.The elastic modulus (40.96 ± 2.59 MPa) and Poisson ratio (0.37 ± 0.02) of the normal sciatic nerve were measured by strain electrical measurement.A resistance strain gauge was pasted on the front,back,left,and right of the edge of the anastomosis site after suturing.Strain electrical measurement results showed that the stress and strain values of the sciatic nerve following perineurial suturing were lower than those following epineurial suturing.Scanning electron microscopy revealed that the sciatic nerve fibers were disordered following epineurial compared with perineurial suturing.These results indicate that the effect of perineurial suturing in sciatic nerve injury repair is better than that of epineurial suturing.

  19. Closure constraints for hyperbolic tetrahedra

    Charles, Christoph; Livine, Etera R.


    We investigate the generalization of loop gravity's twisted geometries to a q-deformed gauge group. In the standard undeformed case, loop gravity is a formulation of general relativity as a diffeomorphism-invariant SU(2) gauge theory. Its classical states are graphs provided with algebraic data. In particular, closure constraints at every node of the graph ensure their interpretation as twisted geometries. Dual to each node, one has a polyhedron embedded in flat space {{{R}}3}. One then glues them, allowing for both curvature and torsion. It was recently conjectured that q-deforming the gauge group SU(2) would allow us to account for a non-vanishing cosmological constant Λ \

  20. Fibrin Adhesive: Clinical Application in Coronary Artery Bypass Graft Surgery

    Fundaró, Pino; Velardi, Antonio R.; Santoli, Carmine


    Fibrin adhesive was used 72 times in a group of 67 patients undergoing elective coronary artery bypass graft surgery. The indications were prophylactic sealing of potential sources of bleeding, topical hemostasis (control of bleeding sites dangerous or difficult to suture), and fixation of the graft in the optimal position. The method of glue application under varying circumstances is described and the results are reported. This experience suggests that in some cases the glue expedites the operation and makes it safer. We conclude that the fibrin sealing represents a valid aid in coronary artery bypass graft surgery. PMID:15227018

  1. Fluoroscopy-guided snare retrieval of the celt ACD(®) metallic vascular closure device following failed deployment.

    Cahill, Thomas J; Choji, Kiyoshi; Kardos, Attila


    We report a case of endovascular snare retrieval of a new stainless steel vascular closure device (Celt ACD(®) , Kimal, Middlesex, UK) from the common femoral artery, following device failure after diagnostic coronary angiography. The stainless steel composition of the device aided successful fluoroscopic localization and removal.

  2. Arterial Catheterization

    ... way of keeping the blood pressure up. The arterial catheter allows accurate, second-to-second measurement of the blood pressure; repeated meas- urement is called monitoring. ■ High blood pressure (hypertension)— In some sit- uations, ...

  3. 100-D Ponds closure plan. Revision 1

    Petersen, S.W.


    The 100-D Ponds is a Treatment, Storage, and Disposal (TSD) unit on the Hanford Facility that received both dangerous and nonregulated waste. This Closure Plan (Rev. 1) for the 100-D Ponds TSD unit consists of a RCRA Part A Dangerous Waste Permit Application (Rev. 3), a RCRA Closure Plan, and supporting information contained in the appendices to the plan. The closure plan consists of eight chapters containing facility description, process information, waste characteristics, and groundwater monitoring data. There are also chapters containing the closure strategy and performance standards. The strategy for the closure of the 100-D Ponds TSD unit is clean closure. Appendices A and B of the closure plan demonstrate that soil and groundwater beneath 100-D Ponds are below cleanup limits. All dangerous wastes or dangerous waste constituents or residues associated with the operation of the ponds have been removed, therefore, human health and the environment are protected. Discharges to the 100-D Ponds, which are located in the 100-DR-1 operable unit, were discontinued in June 1994. Contaminated sediment was removed from the ponds in August 1996. Subsequent sampling and analysis demonstrated that there is no contamination remaining in the ponds, therefore, this closure plan is a demonstration of clean closure.

  4. Influence of different types of surgical suture materials on mehanical damage of oral mucosa

    Mirković Siniša


    Full Text Available Introduction. Throughout history many kinds of different suture materials have been used for closing and suturing surgical wounds. Medical literature describes four basic characteristics of suture material: knot safety, tensile strength, tissue reaction and wound safety. The tissue reaction is reflected in an inflammatory response, which, though minimal, occurs during first two to seven days after implanting suture into the tissue. The aim of this research was to investigate whether different suture materials affect the development of decubital damage of oral mucosa, which to a great extent can compromise the process of wound healing. Material and methods. The investigation was designed as a prospective clinical study including 150 patients of both genders, aged between 25 and 60. The patients were distributed into three groups of 50 persons. The suture Black Silk was used in the first group, designated as a control group. Nylon and Vicril were used in the second and third group, i.e. experimental groups, respectively. Decubital damage of the surrounding soft tissues was the main parameter for monitoring the effects of selected suture materials on the oral mucosa. Conclusion. The comparison of results obtained for the investigated suture materials after suturing oral mucosa revealed that certain advan­tage could be given to synthetic monofilament suture materials

  5. Ultrastructure, Histochemistry, and Mineralization Patterns in the Ecdysial Suture of the Blue Crab, Callinectes sapidus

    Priester, Carolina; Dillaman, Richard M.; Gay, D. Mark


    The ecdysial suture is the region of the arthropod exoskeleton that splits to allow the animal to emerge during ecdysis. We examined the morphology and composition of the intermolt and premolt suture of the blue crab using light microscopy and scanning electron microscopy. The suture could not be identified by routine histological techniques; however 3 of 22 fluorescein isothiocyanate-labeled lectins tested (Lens culinaris agglutinin, Vicia faba agglutinin, and Pisum sativum agglutinin) differentiated the suture, binding more intensely to the suture exocuticle and less intensely to the suture endocuticle. Back-scattered electron (BSE) and secondary electron observations of fracture surfaces of intermolt cuticle showed less mineralized regions in the wedge-shaped suture as did BSE analysis of premolt and intermolt resin-embedded cuticle. The prism regions of the suture exocuticle were not calcified. X-ray microanalysis of both the endocuticle and exocuticle demonstrated that the suture was less calcified than the surrounding cuticle with significantly lower magnesium and phosphorus concentrations, potentially making its mineral more soluble. The presence or absence of a glycoprotein in the organic matrix, the extent and composition of the mineral deposited, and the thickness of the cuticle all likely contribute to the suture being removed by molting fluid, thereby ensuring successful ecdysis.

  6. [Production of superoxide anion radical and nitric oxide in renal tissues sutured with different surgical suture material].

    Kostenko, V O; Tsebrzhins'kii, O I


    The generation of superoxide anion radicals (in mitochondria, microsomes and under respiratory burst of leucocytes) and nitric oxide (NO) in renal tissue has been studied in the experiment with white rats, which had been carried out nephrotomy with following usage for suture such absorbable surgical threads as plain and chromic catgut, biofil (of dura mater spinalis of the cattle), Dexon II (polyglycolic acid) and biofil modified with aethonium, succinate and mexidol. The research proves the use of plai and chromic catgut leads to the development longer oxidative stress with increasing of cytotoxic agents production (superoxide anion and NO). The risk of longitudinal oxidative stress decreases under the use of biofil suture modified with biological active compounds (aethonium, succinate and mexidol). In this case, the generation of superoxide anion radicals in mitochondria and microsomes is normalised earlier. The superoxide generation with respiratory burst of leucocytes and NO production decreases in 14 day of postoperative period under the use of biofil suture modified with succinate and mexidol.

  7. Bilayered negative-pressure wound therapy preventing leg incision morbidity in coronary artery bypass graft patients

    Yu, Yongchao; Song, Zhigang; Xu, Zhiyun; Ye, Xiaofei; Xue, Chunyu; Li, Junhui; Bi, Hongda


    Abstract Backgrounds: The harvesting of great saphenous veins for coronary artery bypass graft (CABG) patients may result in significant complications, including lymphorrhagia, lymphoedema, incision infection, wound dehiscence, and skin flap necrosis. We investigated the function of a self-designed bilayered negative pressure wound therapy (b-NPWT) for reducing the above-mentioned complications using a clinical randomized controlled trial. Methods: A single-center, pilot randomized controlled trial was conducted. From December 2013 to March 2014, a total of 72 coronary heart disease patients (48 men and 24 women) received CABG therapy, with great saphenous veins were selected as grafts. Patients were equally randomized into a treatment and a control group. After the harvesting of the great saphenous veins and direct closure of the wound with sutures, b-NPWT was used for the thigh incision in the treatment group for 5 days (treatment thigh). Traditional surgical pads were applied to both the shank incisions of the treatment group patients (treatment shank) and the entire incisions of the control group (control thigh, control shank). Postoperative complications were recorded and statistically analyzed based on outcomes of thigh treatment, shank treatment, thigh control, and shank control groups. Results: The incidence rates of early complications, such as lymphorrhagia, lymphoedema, infection, wound dehiscence, and skin flap necrosis, of the vascular donor site in the thigh treatment group was significantly lower than those in the 3 other groups. Conclusions: The self-designed b-NPWT can effectively reduce postoperative complications, such as lymphedema, incision infection, wound dehiscence, and skin flap necrosis, in CABG patients who underwent great saphenous veins harvesting. Trial registration: The unique registration number is NCT02010996. PMID:28099357

  8. Arterial Stiffness.

    Avolio, Alberto


    Stiffness of large arteries has been long recognized as a significant determinant of pulse pressure. However, it is only in recent decades, with the accumulation of longitudinal data from large and varied epidemiological studies of morbidity and mortality associated with cardiovascular disease, that it has emerged as an independent predictor of cardiovascular risk. This has generated substantial interest in investigations related to intrinsic causative and associated factors responsible for the alteration of mechanical properties of the arterial wall, with the aim to uncover specific pathways that could be interrogated to prevent or reverse arterial stiffening. Much has been written on the haemodynamic relevance of arterial stiffness in terms of the quantification of pulsatile relationships of blood pressure and flow in conduit arteries. Indeed, much of this early work regarded blood vessels as passive elastic conduits, with the endothelial layer considered as an inactive lining of the lumen and as an interface to flowing blood. However, recent advances in molecular biology and increased technological sophistication for the detection of low concentrations of biochemical compounds have elucidated the highly important regulatory role of the endothelial cell affecting vascular function. These techniques have enabled research into the interaction of the underlying passive mechanical properties of the arterial wall with the active cellular and molecular processes that regulate the local environment of the load-bearing components. This review addresses these emerging concepts.

  9. 40 CFR 264.112 - Closure plan; amendment of plan.


    ... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Closure plan; amendment of plan. 264... Closure and Post-Closure § 264.112 Closure plan; amendment of plan. (a) Written plan. (1) The owner or operator of a hazardous waste management facility must have a written closure plan. In addition,...

  10. Bundles of spider silk, braided into sutures, resist basic cyclic tests: potential use for flexor tendon repair.

    Kathleen Hennecke

    Full Text Available Repair success for injuries to the flexor tendon in the hand is often limited by the in vivo behaviour of the suture used for repair. Common problems associated with the choice of suture material include increased risk of infection, foreign body reactions, and inappropriate mechanical responses, particularly decreases in mechanical properties over time. Improved suture materials are therefore needed. As high-performance materials with excellent tensile strength, spider silk fibres are an extremely promising candidate for use in surgical sutures. However, the mechanical behaviour of sutures comprised of individual silk fibres braided together has not been thoroughly investigated. In the present study, we characterise the maximum tensile strength, stress, strain, elastic modulus, and fatigue response of silk sutures produced using different braiding methods to investigate the influence of braiding on the tensile properties of the sutures. The mechanical properties of conventional surgical sutures are also characterised to assess whether silk offers any advantages over conventional suture materials. The results demonstrate that braiding single spider silk fibres together produces strong sutures with excellent fatigue behaviour; the braided silk sutures exhibited tensile strengths comparable to those of conventional sutures and no loss of strength over 1000 fatigue cycles. In addition, the braiding technique had a significant influence on the tensile properties of the braided silk sutures. These results suggest that braided spider silk could be suitable for use as sutures in flexor tendon repair, providing similar tensile behaviour and improved fatigue properties compared with conventional suture materials.

  11. Bundles of Spider Silk, Braided into Sutures, Resist Basic Cyclic Tests: Potential Use for Flexor Tendon Repair

    Hennecke, Kathleen; Redeker, Joern; Kuhbier, Joern W.; Strauss, Sarah; Allmeling, Christina; Kasper, Cornelia; Reimers, Kerstin; Vogt, Peter M.


    Repair success for injuries to the flexor tendon in the hand is often limited by the in vivo behaviour of the suture used for repair. Common problems associated with the choice of suture material include increased risk of infection, foreign body reactions, and inappropriate mechanical responses, particularly decreases in mechanical properties over time. Improved suture materials are therefore needed. As high-performance materials with excellent tensile strength, spider silk fibres are an extremely promising candidate for use in surgical sutures. However, the mechanical behaviour of sutures comprised of individual silk fibres braided together has not been thoroughly investigated. In the present study, we characterise the maximum tensile strength, stress, strain, elastic modulus, and fatigue response of silk sutures produced using different braiding methods to investigate the influence of braiding on the tensile properties of the sutures. The mechanical properties of conventional surgical sutures are also characterised to assess whether silk offers any advantages over conventional suture materials. The results demonstrate that braiding single spider silk fibres together produces strong sutures with excellent fatigue behaviour; the braided silk sutures exhibited tensile strengths comparable to those of conventional sutures and no loss of strength over 1000 fatigue cycles. In addition, the braiding technique had a significant influence on the tensile properties of the braided silk sutures. These results suggest that braided spider silk could be suitable for use as sutures in flexor tendon repair, providing similar tensile behaviour and improved fatigue properties compared with conventional suture materials. PMID:23613793

  12. Structural determinants of hospital closure.

    Longo, D R; Chase, G A


    In a retrospective case-control study, structural characteristics of hospitals that closed during the years 1976-1980 were contrasted with three comparison groups: hospitals that were acquired in a merger; hospitals that joined a multihospital system; and hospitals that remained autonomously opened, to investigate these characteristics as predictors of closure. Characteristics investigated included environmental, structural, and process variables. The independent variables were measured 5 years prior to outcome. Findings indicate that closed hospitals resemble hospitals acquired in a merger ("failure"), and likewise autonomous hospitals resemble hospitals that join a multihospital system ("success"). The most important predictors of hospital failure were the physician-to-population ratio, the East North Central and West North Central census regions, the level of diversification, low occupancy rate, location in a standard metropolitan statistical area, the chief executive officer's lack of affiliation in the American College of Hospital Administrators, profit status, bed size of less than 50, and presence in a state with a rate-setting agency. Surprisingly, this study shows the bed-to-population ratio to be unrelated to closure. In addition, the findings strongly support the open-system perspective, which, unlike the closed-system perspective, is concerned with the vulnerability of the organization to the uncontrollable and often unpredictable influences of the environment.

  13. Zircon U-Pb age and geochemical constraints on the origin of the Birjand ophiolite, Sistan suture zone, eastern Iran

    Zarrinkoub, Mohammad Hossein; Pang, Kwan-Nang; Chung, Sun-Lin; Khatib, Mohammad Mahdi; Mohammadi, Seyyed Saeid; Chiu, Han-Yi; Lee, Hao-Yang


    The Birjand ophiolite is one of the ophiolitic complexes in the northern Sistan suture zone, eastern Iran, which marks the closure of an enigmatic branch of the Neotethys Ocean (called the Sistan Ocean) associated with the collision between the Lut and Afghan continental blocks. Ophiolitic rocks in the suture zone occur as collisional block-to-block geological terranes, or as blocks within tectonic mélange. We present zircon U-Pb age, and whole-rock geochemical and Sr-Nd isotopic data of the Birjand ophiolite to understand its formation age and magma genesis in this poorly constrained part of the Alpine-Himalayan orogenic belt. Varieties of the ophiolitic rocks include clinopyroxene-bearing harzburgites, harzburgites, dunites, massive and pillow basalts, dolerites, gabbros and leucogabbros. Using laser ablation inductively coupled plasma-mass spectrometry, zircon separates from two leucogabbros yield U-Pb ages of 113 ± 1 and 107 ± 1 Ma, which are interpreted to represent the formation ages of the ophiolite. The clinopyroxene-bearing harzburgites can be explained as melting residues after low to moderate extraction of MORB-type melts, whereas the harzburgites require more than one melting event to explain their trace element depletion. Most mafic rocks of the ophiolite display MORB-like trace element patterns and high ɛNd(t) (+ 3.4 to + 8.4), features consistent with derivation from MORB-source mantle. Magma genesis can be explained by low to moderate degrees of melting of moderately depleted spinel peridotite and variable interaction with enriched mantle melts. The Birjand ophiolite represents a MORB-type ophiolite and part of the Middle Cretaceous oceanic lithosphere of the Sistan Ocean that closed during the destruction of a narrow arm of the Neotethys Ocean.

  14. Simultaneous transcatheter closure of intralobar pulmonary sequestration and patent ductus arteriosus in a patient with infantile Scimitar syndrome.

    Aslan, Eyüp; Tanıdır, İbrahim Cansaran; Saygı, Murat; Onan, Sertaç Hanedan; Güzeltaş, Alper


    Scimitar syndrome is a rare disease associated with a right lung sequestration vascularised by arteries arising from the abdominal aorta and abnormal venous drainage into the inferior vena cava. The infantile form is generally presented with severe heart failure, pulmonary hypertension and respiratory distress. It may be associated with various intracardiac defects, including atrial septal defects, ventricular septal defects, patent ductus arteriosus or more complicated structural congenital heart defects. Here, we present a 2-month-old girl with Scimitar syndrome whose pulmonary arterial pressure decreased after transcatheter patent ductus arteriosus closure and embolization of the anomalous systemic arterial supply.

  15. 40 CFR 264.178 - Closure.


    ... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Use and Management of Containers § 264.178 Closure. At closure, all hazardous waste and hazardous waste residues must be removed...

  16. 40 CFR 264.351 - Closure.


    ... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Incinerators § 264.351 Closure. At closure the owner or operator must remove all hazardous waste and hazardous waste...

  17. 50 CFR 665.666 - Closures.


    ... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false Closures. 665.666 Section 665.666 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION... § 665.666 Closures. (a) If the Regional Administrator determines that the harvest quota for any...

  18. Key financial ratios can foretell hospital closures.

    Lynn, M L; Wertheim, P


    An analysis of various financial ratios sampled from open and closed hospitals shows that certain leverage, liquidity, capital efficiency, and resource availability ratios can predict hospital closure up to two years in advance of the closure with an accuracy of nearly 75 percent.

  19. Spontaneous closure of traumatic tympanic membrane perforations

    Jellinge, Marlene Ersgaard; Kristensen, S.; Larsen, K


    BACKGROUND: The treatment of traumatic tympanic membrane perforations varies in different investigations, ranging from observation to early surgical repair. The present study aimed to focus on the closure rate and the closure time in a group of patients treated with a watchful waiting policy. MET...

  20. Acute angle closure glaucoma following ileostomy surgery

    Mariana Meirelles Lopes


    Full Text Available Angle-closure glaucoma can be induced by drugs that may cause pupillary dilatation. We report a case of a patient that developed bilateral angle closure glaucoma after an ileostomy surgery because of systemic atropine injection. This case report highlights the importance of a fast ophthalmologic evaluation in diseases with ocular involvement in order to make accurate diagnoses and appropriate treatments.

  1. Carotid artery surgery

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  2. Clinical Outcomes After Suture Anchor Repair of Recalcitrant Medial Epicondylitis.

    Grawe, Brian M; Fabricant, Peter D; Chin, Christopher S; Allen, Answorth A; DePalma, Brian J; Dines, David M; Altchek, David W; Dines, Joshua S


    This study evaluated clinical and patient-reported outcomes and return to sport after surgical treatment of medial epicondylitis with suture anchor fixation. Consecutive patients were evaluated after undergoing debridement and suture anchor repair of the flexor-pronator mass for the treatment of medial epicondylitis. Demographic variables, a short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, Oxford Elbow Score (OES), and 10-point pain and satisfaction scales were collected. Ability and time to return to sport after surgery were evaluated, and the relationship between predictor variables and both elbow function and return to sport was investigated. Median age at the time of surgery was 55 years (range, 29-65 years), with median follow-up of 40 months (range, 12-67 months). Median QuickDASH score and OES at final follow-up were 2.3 (range, 0-38.6) and 45 (range, 22-48), respectively. Most patients returned to premorbid sporting activities at a median of 4.5 months (range, 2.5-12 months), whereas 4 patients (14%) reported significant limitations at final follow-up. Older age at the time of surgery was predictive of better QuickDASH score and OES (P=.05 and P=.02, respectively). Patients who underwent surgery after a shorter duration of symptoms had better outcomes, but the difference did not reach statistical significance (QuickDASH, P=.09; OES, P=.10). Surgical treatment of recalcitrant medial epicondylitis with suture anchor fixation offers good pain relief and patient satisfaction, with little residual disability. Older age at the time of surgery predicts a better outcome.

  3. Intermittent acute angle closure glaucoma and chronic angle closure following topiramate use with plateau iris configuration

    Rajjoub LZ


    Full Text Available Lamise Z Rajjoub, Nisha Chadha, David A Belyea Department of Ophthalmology, The George Washington University, Washington, DC, USA Abstract: This is a case report describing recurrent intermittent acute angle closure episodes in the setting of topiramate use in a female suffering from migraines. Despite laser peripheral iridotomy placement for the pupillary block component, and the discontinuation of topiramate, the acute angle closure did not resolve in the left eye with chronic angle closure and the patient required urgent trabeculectomy. The right eye responded to laser peripheral iridotomy immediately and further improved after the cessation of topiramate. While secondary angle closure glaucoma due to topiramate use has been widely reported, its effects in patients with underlying primary angle closure glaucoma have not been discussed. Our report highlights the importance of recognizing the often multifactorial etiology of angle closure glaucoma to help guide clinical management. Keywords: angle closure glaucoma, plateau iris, topiramate, secondary glaucoma, drug-induced glaucoma

  4. Effects of suture position on left ventricular fluid mechanics under mitral valve edge-to-edge repair.

    Du, Dongxing; Jiang, Song; Wang, Ze; Hu, Yingying; He, Zhaoming


    Mitral valve (MV) edge-to-edge repair (ETER) is a surgical procedure for the correction of mitral valve regurgitation by suturing the free edge of the leaflets. The leaflets are often sutured at three different positions: central, lateral and commissural portions. To study the effects of position of suture on left ventricular (LV) fluid mechanics under mitral valve ETER, a parametric model of MV-LV system during diastole was developed. The distribution and development of vortex and atrio-ventricular pressure under different suture position were investigated. Results show that the MV sutured at central and lateral in ETER creates two vortex rings around two jets, compared with single vortex ring around one jet of the MV sutured at commissure. Smaller total orifices lead to a higher pressure difference across the atrio-ventricular leaflets in diastole. The central suture generates smaller wall shear stresses than the lateral suture, while the commissural suture generated the minimum wall shear stresses in ETER.

  5. Extrusion of bone anchor suture following flexor digitorum profundus tendon avulsion injury repair.

    Tiong, William H C


    Flexor digitorum profundus (FDP) zone I tendon avulsion injury is traditionally repaired with a pullout suture technique. More recently, bone anchor sutures have been used as a viable alternative and have largely replaced areas in hand surgery where pullout suture technique was once required. To date, there have been very few complications reported related to bone anchor suture use in FDP tendon reattachment to the bone. We report a very unusual case of extrusion of bone anchor through the nailbed, 6 years after zone I FDP tendon avulsion injury repair and a brief review of literature.

  6. Biomechanical study on the suture strength of ligament in cruciate ligament reconstruction

    张春礼; 李起鸿; 杨柳


    Objective: To test the suture strength on the tendon or ligament end and evaluate the stitch in the reconstruction of cruciate ligament and its clinical application. Methods: Twenty-four specimens of patellar tendon with free ends were divided into 3 groups: Group I (3 Krackow stitches), Group II (2 Krackow stitches) and Group III (2 Krackow stitches with the first stitch passing through the tendon tissue as a modified Krackow stitch). These 3 groups were further divided into 6 subgroups according to different suture materials, No 1 Ethilon or stainless steel wire (φ= 0.4 mm). Tensile test was undertaken to find out the least stitches with efficient suture pattern. Results: Two Krackow locking stitches had stronger strength than 0.4 mm-diameter stainless steel wire. The fixation strength of 2 stitches with No 1 Ethilon was more than 80 N, superior to the failure strength of the material itself. The same strength was maintained if the first stitch was across the tendon tissue transversely. There was no statistically significant difference in the suture strength between 2 and 3 Krackow locking stitches. Conclusions: The suture strength is greater than the failure strength of the suture material. Less suture exposure can be achieved when the first stitch is across the tendon tissue while maintaining a comparable strength to other sutures. To attain higher suture strength, stronger materials or multiple strands rather than more stitches are preferred. Therefore, a rapid early rehabilitation of range of motion (ROM) is possible and reliable in practice.

  7. Suture anchor repair of quadriceps tendon rupture after total knee arthroplasty.

    Kim, Tae Won B; Kamath, Atul F; Israelite, Craig L


    Disruption of the extensor mechanism after total knee arthroplasty (TKA) is a devastating complication, usually requiring surgical repair. Although suture anchor fixation is well described for repair of the ruptured native knee quadriceps tendon, no study has discussed the use of suture anchors in quadriceps repair after TKA. We present an illustrative case of successful suture anchor fixation of the quadriceps mechanism after TKA. The procedure has been performed in a total of 3 patients. A surgical technique and brief review of the literature follows. Suture anchor fixation of the quadriceps tendon is a viable option in the setting of rupture after TKA.

  8. Surgical sutures filled with adipose-derived stem cells promote wound healing.

    Ann Katharin Reckhenrich

    Full Text Available Delayed wound healing and scar formation are among the most frequent complications after surgical interventions. Although biodegradable surgical sutures present an excellent drug delivery opportunity, their primary function is tissue fixation. Mesenchymal stem cells (MSC act as trophic mediators and are successful in activating biomaterials. Here biodegradable sutures were filled with adipose-derived mesenchymal stem cells (ASC to provide a pro-regenerative environment at the injured site. Results showed that after filling, ASCs attach to the suture material, distribute equally throughout the filaments, and remain viable in the suture. Among a broad panel of cytokines, cell-filled sutures constantly release vascular endothelial growth factor to supernatants. Such conditioned media was evaluated in an in vitro wound healing assay and showed a significant decrease in the open wound area compared to controls. After suturing in an ex vivo wound model, cells remained in the suture and maintained their metabolic activity. Furthermore, cell-filled sutures can be cryopreserved without losing their viability. This study presents an innovative approach to equip surgical sutures with pro-regenerative features and allows the treatment and fixation of wounds in one step, therefore representing a promising tool to promote wound healing after injury.

  9. Effect of residents' previous laparoscopic surgery experience on initial robotic suturing experience.

    Kilic, Gokhan Sami; Walsh, Teresa M; Borahay, Mostafa; Zeybek, Burak; Wen, Michael; Breitkopf, Daniel


    Objective. To assess the impact of gynecology residents' previous laparoscopic experience on the learning curve of robotic suturing techniques and the value of initial structured teaching in dry lab prior to surgery. Methods. Thirteen gynecology residents with no previous robotic surgery experience were divided into Group 1, consisting of residents with 2 or fewer laparoscopic experiences, and Group 2, consisting of residents with 3 or more laparoscopic experiences. Group 1 had a dry-laboratory training in suturing prior to their initial experience in the operating room. Results. For all residents, it took on average 382 ± 159 seconds for laparoscopic suturing and 326 ± 196 seconds for robotic suturing (P = 0.12). Residents in Group 1 had a lower mean suture time than residents in Group 2 for laparoscopic suturing (P = 0.009). The residents in Group 2, however, had a lower mean suture time on the robot compared to Group 1 (P = 0.5). Conclusion. Residents with previous laparoscopic suturing experience may gain more from a robotic surgery experience than those with limited laparoscopic surgery experience. In addition, dry lab training is more efficient than hands-on training in the initial phase of teaching for both laparoscopic and robotic suturing skills.

  10. Recent advances in biodegradable metals for medical sutures: a critical review.

    Seitz, Jan-Marten; Durisin, Martin; Goldman, Jeremy; Drelich, Jaroslaw W


    Sutures that biodegrade and dissolve over a period of several weeks are in great demand to stitch wounds and surgical incisions. These new materials are receiving increased acceptance across surgical procedures whenever permanent sutures and long-term care are not needed. Unfortunately, both inflammatory responses and adverse local tissue reactions in the close-to-stitching environment are often reported for biodegradable polymeric sutures currently used by the medical community. While bioabsorbable metals are predominantly investigated and tested for vascular stent or osteosynthesis applications, they also appear to possess adequate bio-compatibility, mechanical properties, and corrosion stability to replace biodegradable polymeric sutures. In this Review, biodegradable alloys made of iron, magnesium, and zinc are critically evaluated as potential materials for the manufacturing of soft and hard tissue sutures. In the case of soft tissue closing and stitching, these metals have to compete against currently available degradable polymers. In the case of hard tissue closing and stitching, biodegradable sternal wires could replace the permanent sutures made of stainless steel or titanium alloys. This Review discusses the specific materials and degradation properties required by all suture materials, summarizes current suture testing protocols and provides a well-grounded direction for the potential future development of biodegradable metal based sutures.

  11. Radiographic and microscopic anatomy of the mid-palatal suture in the elderly.

    N'Guyen, T; Ayral, X; Vacher, C


    In a previous radiological study of the mid-palatal suture, it has been demonstrated that its obliteration was occurring during adult life and varied. In order to determine the histological status of mid-palatal suture in elderly men, 20 human palates aged more than 70 were examined by occlusal radiographs and histological study of the suture. In all palates the suture was ossified in the anterior thirds and made of conjunctive tissue in the posterior third. This particular evolution could be correlated to the mastication forces acting on the maxillary bones during the entire life.

  12. Effectivity of intraoperative adjustable suture technique in horizontal strabismus

    Ayse Gul Kocak Altintas


    Full Text Available AIM:To compare the long-term effectivity of intraoperative adjustable suture technique with traditional non-adjustable strabismus surgery.METHODS:Two hundred and thirty-three patients, who underwent strabismus surgery either with traditional procedures or one-stage intraoperative adjustable suture technique, were included in our long-term follow-up study. One hundred and eighteen patients were evaluated in traditional surgery group (TSG and 115 who underwent adjustable suture were in the one-stage intraoperative adjustable surgery group (ASG. In this group 9 patients had paralytic strabismus and 16 had reoperations, 2 patients had restrictive strabismus related to thyroid eye disease. The mean follow up in the TSG was 26.2 months and it was 24.8 months in the ASG group.RESULTS:In patients with exotropia (XT the mean correction of deviation for near fixation in ASG (32.4±13.2PD and in TSG (26.4±8.2PD were similar (P=0.112. The correction for distant fixation in ASG (33.2±11.4PD and TSG (30.9±7.2PD were not significantly different (P=0.321. In patients with esotropia (ET even the mean correction of deviation for both near (31±12PD and distant (30.6±12.8PD fixations were higher in ASG than in TSG, for both near (28.27±14.2PD and distant (28.9±12.9PD fixations, the differences were not significant (P=0.346, 0.824 respectively. The overall success rate of XT patient was 78.9% in TSG and 78.78% in ASG, the difference was not significant (P=0.629. The success rates were 78.75% in TSG and 75.51% in ASG in ET patient, which was also not significantly different (P=0.821.CONCLUSION:Although patients in ASG had more complex deviation such as paralysis, reoperations and restrictive strabismus, success rates of this tecnique was as high as TSG which did not contain complicated deviation. One-stage intraoperative adjustable suture technique is a safe and effective method for cooperative patient who has complex deviation.

  13. Paleomagnetic reconstruction of the Neotethyan Suture in Central Anatolia (Turkey)

    Ozkaptan, M.; Gulyuz, E.; Kaymakci, N.; Langereis, C. G.


    The consumption of the Neo-Tethyan Ocean and the accretion of intervening continental blocks such as the Taurides and Kırşehir Block in the south and the Pontides in the north since the Mesozoic occurred along two sutures. The İzmir-Ankara Suture Zone (IASZ) between the Pontides in the north and the Taurides in the south and Intra-Tauride suture Zone (ITSZ) between the Taurides and the Kırşehir block meets around the Haymana Basin. The IASZ follows roughly an E-W trend and makes a sharp bend of approximately of 90° along the western margin of the Çankırı Basin. The ITSZ, on the other hand, follows a NW-SE trend parallel to the Tuz Gölü Fault Zone and overprinted by the structures related to the İASZ in the north. From West to East; the Haymana, Tuz Gölü and Çankırı basins straddle these suture zones and are developed in relation to the subduction and collision processes, which make them invaluable for unraveling deformation history and evolution of the Neotethys. In this regard we have conducted a very detailed paleomagnetic study to determine vertical axis rotations in the region, mainly on the Late Cretaceous to Recent infill of these basins. Results have shown that the region undergone strong clockwise (CW) and counter-clockwise (CCW) rotations, up to ±90° in places, resulting in the present geometry of the region. The central part of the Haymana Basin rotated as much as 90° CCW sense while its northern parts and the Tuz Gölü basin rotated 30° CW sense, which contradicts with almost all the published paleomagnetic results from the region. The restored geometries, based on new paleomagnetic data indicate that Haymana, Tuz Gölü basins and the SW margin of the Çankırı Basin were initially oriented in N-S direction prior to the Eocene. These results indicate that the most of the paleogeographical maps and evolutionary scenarios and models proposed for the region previously requires major re-thinking and serious revisions.

  14. Closure of the Tornquist sea: Constraints from MONA LISA deep seismic reflection data

    Mona LISA Working Group


    Deep seismic reflection profiles west of Denmark across the suture between Baltica and Eastern Avalonia reveal weak, southward-dipping reflectors within the crystalline basement. These reflectors are interpreted as thrusts resulting from emplacement of Eastern Avalonia onto the southern edge of Baltica. North of these reflectors are the remains of a dissected Silurian foredeep. The presence of this foredeep and the 440 Ma age of metamorphism in rocks recovered from boreholes into Eastern Avalonian rocks suggest that closure of the Tornquist sea occurred in the Late Ordovician, which is consistent with paleobiogeographic data and paleomagnetic apparent polar wander paths for Eastern Avalonia and Baltica. The similarity between these reflection data and the BABEL AC profile permits correlation of reflectors beneath Denmark into the southern North Sea.

  15. Closure of Microcosm for refurbishment


    Since 1994, the Microcosm exhibition has given the opportunity to visitors of all ages and backgrounds to have a first glimpse into the secrets of physics.   To ensure that Microcosm can continue fulfilling its educational aims at the same level of quality for many years to come, it is closing for renovation work on 8 December 2014 and is expected to reopen during Summer 2015. During the closure, the “Fun with Physics” workshop will not take place, but the Universe of Particles exhibition in the Globe and the Passport to the Big Bang circuit will remain accessible to the public, free of charge and with no need to book in advance.  Guided tours of CERN are also available (advance booking required via this page).

  16. Closure for milliliter scale bioreactor

    Klein, David L.; Laidlaw, Robert D.; Andronaco, Gregory; Boyer, Stephen G.


    A closure for a microreactor includes a cap that is configured to be inserted into a well of the microreactor. The cap, or at least a portion of the cap, is compliant so as to form a seal with the well when the cap is inserted. The cap includes an aperture that provides an airway between the inside of the well to the external environment when the cap is inserted into the well. A porous plug is inserted in the aperture, e.g., either directly or in tube that extends through the aperture. The porous plug permits gas within the well to pass through the aperture while preventing liquids from passing through to reduce evaporation and preventing microbes from passing through to provide a sterile environment. A one-way valve may also be used to help control the environment in the well.

  17. How many sutures in the southern Central Asian Orogenic Belt: Insights from East Xinjiang–West Gansu (NW China?

    Wenjiao Xiao


    Full Text Available How ophiolitic mélanges can be defined as sutures is controversial with regard to accretionary orogenesis and continental growth. The Chinese Altay, East Junggar, Tianshan, and Beishan belts of the southern Central Asian Orogenic Belt (CAOB in Northwest China, offer a special natural laboratory to resolve this puzzle. In the Chinese Altay, the Erqis unit consists of ophiolitic mélanges and coherent assemblages, forming a Paleozoic accretionary complex. At least two ophiolitic mélanges (Armantai, and Kelameili in East Junggar, characterized by imbricated ophiolitic mélanges, Nb-enriched basalts, adakitic rocks and volcanic rocks, belong to a Devonian–Carboniferous intra-oceanic island arc with some Paleozoic ophiolites, superimposed by Permian arc volcanism. In the Tianshan, ophiolitic mélanges like Kanggurtag, North Tianshan, and South Tianshan occur as part of some Paleozoic accretionary complexes related to amalgamation of arc terranes. In the Beishan there are also several ophiolitic mélanges, including the Hongshishan, Xingxingxia–Shibangjing, Hongliuhe–Xichangjing, and Liuyuan ophiolitic units. Most ophiolitic mélanges in the study area are characterized by ultramafic, mafic and other components, which are juxtaposed, or even emplaced as lenses and knockers in a matrix of some coherent units. The tectonic settings of various components are different, and some adjacent units in the same mélange show contrasting different tectonic settings. The formation ages of these various components are in a wide spectrum, varying from Neoproterozoic to Permian. Therefore we cannot assume that these ophiolitic mélanges always form in linear sutures as a result of the closure of specific oceans. Often the ophiolitic components formed either as the substrate of intra-oceanic arcs, or were accreted as lenses or knockers in subduction-accretion complexes. Using published age and paleogeographic constraints, we propose the presence of (1 a major

  18. How many sutures in the southern Central Asian Orogenic Belt:Insights from East XinjiangeWest Gansu (NW China)?

    Wenjiao Xiao; Jun Luo; Chunming Han; Wei Liu; Bo Wan; Ji’en Zhang; Songjian Ao; Zhiyong Zhang; Dongfang Song; Zhonghua Tian


    How ophiolitic mélanges can be defined as sutures is controversial with regard to accretionary orogenesis and continental growth. The Chinese Altay, East Junggar, Tianshan, and Beishan belts of the southern Central Asian Orogenic Belt (CAOB) in Northwest China, offer a special natural laboratory to resolve this puzzle. In the Chinese Altay, the Erqis unit consists of ophiolitic mélanges and coherent assemblages, forming a Paleozoic accretionary complex. At least two ophiolitic mélanges (Armantai, and Kelameili) in East Junggar, characterized by imbricated ophiolitic mélanges, Nb-enriched basalts, adakitic rocks and volcanic rocks, belong to a DevonianeCarboniferous intra-oceanic island arc with some Paleozoic ophiolites, superimposed by Permian arc volcanism. In the Tianshan, ophiolitic mélanges like Kanggurtag, North Tianshan, and South Tianshan occur as part of some Paleozoic accretionary complexes related to amalgamation of arc terranes. In the Beishan there are also several ophiolitic mélanges, including the Hongshishan, XingxingxiaeShibangjing, HongliuheeXichangjing, and Liuyuan ophiolitic units. Most ophiolitic mélanges in the study area are characterized by ultramafic, mafic and other components, which are juxtaposed, or even emplaced as lenses and knockers in a matrix of some coherent units. The tectonic settings of various components are different, and some adjacent units in the same mélange show contrasting different tectonic settings. The formation ages of these various com-ponents are in a wide spectrum, varying from Neoproterozoic to Permian. Therefore we cannot assume that these ophiolitic mélanges always form in linear sutures as a result of the closure of specific oceans. Often the ophiolitic components formed either as the substrate of intra-oceanic arcs, or were accreted as lenses or knockers in subduction-accretion complexes. Using published age and paleogeographic con-straints, we propose the presence of (1) a major early Paleozoic

  19. Syn- and Post-Accretionary Structures in the Neoproterozoic Central Allaqi-Heiani Suture Zone, Southeastern Egypt

    Abdeen, M. M.; Abdelghaffar, A. A.


    The Allaqi-Heiani suture (AHS) is the western part of the main Allaqi-Heiani-Gerf-Onib-Sol Hamed-Yanbu suture and represents one of the Neoproterozoic, arc-arc sutures in the Arabian-Nubian Shield (ANS). It separates the ca. 750 Ma South Eastern Desert terrane in the north from the ca. 830-720 Ma Gabgaba terrane in the south. The AHS is a deformed belt of ophiolitic rocks, syn-tectonic granitoids and metasediments. The central AHS zone is divided into three structural domains. The western domain (Ι) is characterized by NNE low thrusts and SSW-vergent folds. The central domain (ΙΙ) includes upright tight to isoclinal NNW-SSE oriented folds and transpressional faults. The eastern domain (ΙΙΙ) shows NNW-SSE oriented open folds. Structural analysis indicates that the area has a poly-phase deformation history involving at least two events. Event D1 was an N-S to NNE-SSW regional shortening generating the SSW-verging folds and the NNE dipping thrusts. Event D2 was an ENE-WSW shortening producing NNW-SSE oriented folds in the central and eastern parts of the study area and reactivating older thrusts with oblique-slip reverse fault movement. The tectonic evolution of the area involves two episodes of collision: an early collision between the South Eastern Desert terrane and the Gabgaba terrane along the AHS after the consumption of a basin floored by oceanic crust above a north-dipping subduction zone; and a later collision between East- and West-Gondwanas at ca. 750-650 Ma, leading to the closure of the Mozambique Ocean. This collision deformed the AHS along N-S trending shortening zones and produced NW-SE and NE-SW oriented sinistral and dextral transpressional faults, respectively. The early collision episode is related to the terrane accretion during the early Pan-African orogen, while the later phase is related to a late Pan-African or Najd orogen.

  20. Experience of one hundred cases of ASD closure

    Jaypal Reddy


    Full Text Available jdjdBackground & Objectives: Atrial Septal Defect is a common congenital heart disease and surgical closure is the treatment of choice in many cases. This article presents the diagnostic criteria, surgical technique and postoperative management of hundred consecutive patients operated by a single surgeon at single centre.Materials and methods: One hundred (100 patients having atrial septal defect (ASD underwent surgery at Osmania General Hospital, OMC, Hyderabad between January 1990 and October 1998. Sixty eight percentages (68% of the patients were females and 32% of the patients were male. Fifty nine percentages (59% of patients were in the age group of 11-30 yrs. Majority of the patients (70% were symptomatic and were in NYHA class II. 'O' Rh-positive blood group was found in 35% of patients. Associated cardiac lesions were present in 28% of cases. One case each of Cortriatrium, Lutembacher's syndrome and Holt-Oram syndrome were present in this series. Eighty nine percentages (89 % were moderate sized defects repaired by direct closure where as rest of 11% needed patch repair. Cold crystalloid cardioplegia with moderate hypothermia (28°C was employed in 83 cases, ventricular fibrillation at normothermia in 5 cases and normothermic warm blood cardioplegia with continuous perfusion of coronary arteries in 12 patients.Results: Total duration of cardiopulmonary bypass ranged from 21 minutes to 100 minutes (mean duration 54.4 minutes and aortic cross clamp time ranged from 10 minutes to 68 minutes (mean duration 22.9 minutes. Blood transfusion requirement ranged from 1 unit to 10 units (mean 3.1 units. There was no hospital death. Postoperative complication rate was 15%.Conclusion: Atrial septal defect closure is a safe, simple and effective operation with excellent long term results.Journal of College of Medical Sciences-Nepal, Vol.11(4 2015: 9-13

  1. Congestive heart failure from suspected ductal closure in utero.

    Arcilla, R A; Thilenius, O G; Ranniger, K


    This is the 1st case report of a ductal closure occurring during fetal growth. The case was a spontaneous delivery in cephalic presentation from a 31-year-old gravida 3, para 3 Black woman who had been treated with isoniazid and spreptomycin up to 2 months before her delivery. Gestational age was 37 weeks when the fetus was delivered weighing 3.15 kgm. The cord had been wrapped around the fetus's neck, and breathing was delayed 2 minutes. In the nursery, the baby's general condition was poor, and congestive heart failure was diagnosed. The newborn had trieuspid insufficiency, severe heart failure, and acidosis at birth. These disappeared the next day. Hemodynamic studies when the baby was 4 hours old showed a large cone-shaped ductus arteriousus extending from the pulmonary artery but ending blindly at the aortic end.

  2. EASApprox® skin-stretching system: A secure and effective method to achieve wound closure

    Song, Mingzhi; Zhang, Zhen; Liu, Tao; Liu, Song; Li, Gang; Liu, Zhaochang; Huang, Jingyang; Chen, Song; Li, Linan; Guo, Li; Qiu, Yang; Wan, Jiajia; Liu, Yuejian; Wu, Tao; Wang, Xiaoyong; Lu, Ming; Wang, Shouyu


    Large skin defects are commonly observed in the clinic and have attracted much attention recently. Therefore, finding an effective solution for large skin defects is a global problem. The objective of the present study was to assess the effectiveness of the EASApprox® skin-stretching system for closing large skin defects. Skin defects (5×5 cm) were created on the forearms of 9 Bama miniature pigs, which were randomly divided into the following three groups: Direct suture, the new EASApprox® skin-stretching device and Kirschner wires. Microcirculation was assessed before surgery and after wound closure. Following the different treatments, the defects were sutured, and wound healing was assessed based on a clinical score. Furthermore, microscopic and ultramicroscopic structures were evaluated, including collagen, elastic fibers and the microvessel density. Significant differences in the clinical score and microvessel density were observed among the groups. Additionally, the mean length obtained for elastic fibers was larger than that obtained for the other two groups. Finally, the new EASApprox® skin-stretching device resulted in successful wound management and with only minor side effects on skin histology and microcirculation. Therefore, this method has the potential to be used for healing large skin defects. PMID:28672963

  3. Coronary artery fistula

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... A coronary artery fistula is often congenital, meaning that it is present at birth. It generally occurs when one of the coronary arteries ...

  4. In vitro evaluation of novel antimicrobial coatings for surgical sutures using octenidine.

    Obermeier, A; Schneider, J; Föhr, P; Wehner, S; Kühn, K-D; Stemberger, A; Schieker, M; Burgkart, R


    Sutures colonized by bacteria represent a challenge in surgery due to their potential to cause surgical site infections. In order to reduce these type of infections antimicrobially coated surgical sutures are currently under development. In this study, we investigated the antimicrobial drug octenidine as a coating agent for surgical sutures. To achieve high antimicrobial efficacy and required biocompatibility for medical devices, we focused on optimizing octenidine coatings based on fatty acids. For this purpose, antimicrobial sutures were prepared with either octenidine-laurate or octenidine-palmitate at 11, 22, and 33 μg/cm drug concentration normalized per length of sutures. Octenidine containing sutures were compared to the commercial triclosan-coated suture Vicryl® Plus. The release of octenidine into aqueous solution was analyzed and long-term antimicrobial efficacy was assessed via agar diffusion tests using Staphylococcus aureus. For determining biocompatibility, cytotoxicity assays (WST-1) were performed using L-929 mouse fibroblasts. In a 7 days elution experiment, octenidine-palmitate coated sutures demonstrated much slower drug release (11 μg/cm: 7%; 22 μg/cm: 5%; 33 μg/cm: 33%) than octenidine-laurate sutures (11 μg/cm: 82%; 22 μg/cm: 88%; 33 μg/cm: 87%). Furthermore sutures at 11 μg/cm drug content were associated with acceptable cytotoxicity according to ISO 10993-5 standard and showed, similar to Vicryl® Plus, relevant efficacy to inhibit surrounding bacterial growth for up to 9 days. Octenidine coated sutures with a concentration of 11 μg/cm revealed high antimicrobial efficacy and biocompatibility. Due to their delayed release, palmitate carriers should be preferred. Such coatings are candidates for clinical testing in regard to their safety and efficacy.

  5. Choice of surgical suture material used in oral cavity: Clinical study

    Mirković Siniša


    Full Text Available Introduction. Historical data on closing and suturing of surgical wounds describe a wide range of various suture materials. The choice of the surgical catgut, i.e. type and diameter, depends on the localization, characteristics and condition of the tissue to be treated. From the stand-point of oral-surgical practice the following clinical parameters are of the outstanding importance regarding the choice of suture material: accumulation of soft deposits on the sutures, decubitus of the adjacent soft tissues and dehiscence of the operative wound. Aim. The aim of this research was to determine the correlation between different types of suture materials and accumulation of soft deposits on the sutures, decubitus of the adjacent soft tissues and dehiscence of the operative wound. Material and methods. Our prospective clinical study included 150 patients distributed into three groups of 50 subjects. The surgical procedure performed on each patient involved resection (apicoectomy of the tooth root end in the intercanine sector of the upper jaw. The following suture materials were applied: BLACK SILK 5-0, NYLON 5-0 and VICRYL 5-0. The effects of the selected sutures were evaluated by using several parameters: accumulation of soft deposits, wound dehiscence and decubitus of the adjacent soft tissues. The effects of the applied sutures were recorded on days 2, 5 and 7 after the surgery. Conclusion. The comparison of cited parameters of the investigated materials after suture of oral cavity mucosa revealed that none of the used material was ideal; however, a certain preference might be given to the synthetic monofilament suture materials.

  6. Subsidence crack closure: rate, magnitude and sequence

    De Graff, J.V.; Romesburg, H.C.


    Tension cracks are a major surface disturbance resulting from subsidence and differential settlement above underground coal mines. Recent engineering studies of subsidence indicate that cracks may close where tensile stresses causing the cracks are reduced or relaxed. This stress reduction occurs as mining in the area is completed. Crack closure was confirmed by a study in the Wasatch Plateau coal field of central Utah. Cracks occurred in both exposed bedrock and regolith in an area with maximum subsidence of 3 m. Mean closure rate was 0.3 cm per week with individual crack closure rates between 0.2 cm and 1.0 cm per week. The mean crack closure magnitude was 80% with closure magnitudes varying between 31% and 100%. Actual magnitude values ranged from 0.6 cm to 6.5 cm with a mean value of 3.8 cm. Statistical analysis compared width change status among cracks over time. It was found that: 1) a 41% probability existed that a crack would exhibit decreasing width per weekly measurement, 2) closure state sequences seem random over time, and 3) real differences in closure state sequence existed among different cracks. (6 refs.) (In English)

  7. Analytic closures for M1 neutrino transport

    Murchikova, E. M.; Abdikamalov, E.; Urbatsch, T.


    Carefully accounting for neutrino transport is an essential component of many astrophysical studies. Solving the full transport equation is too expensive for most realistic applications, especially those involving multiple spatial dimensions. For such cases, resorting to approximations is often the only viable option for obtaining solutions. One such approximation, which recently became popular, is the M1 method. It utilizes the system of the lowest two moments of the transport equation and closes the system with an ad hoc closure relation. The accuracy of the M1 solution depends on the quality of the closure. Several closures have been proposed in the literature and have been used in various studies. We carry out an extensive study of these closures by comparing the results of M1 calculations with precise Monte Carlo calculations of the radiation field around spherically symmetric protoneutron star models. We find that no closure performs consistently better or worse than others in all cases. The level of accuracy that a given closure yields depends on the matter configuration, neutrino type and neutrino energy. Given this limitation, the maximum entropy closure by Minerbo on average yields relatively accurate results in the broadest set of cases considered in this work.

  8. Long-term outcomes of 1326 laparoscopic incisional and ventral hernia repair with the routine suturing concept: a single institution experience.

    Chelala, E; Baraké, H; Estievenart, J; Dessily, M; Charara, F; Allé, J L


    This retrospective chart analysis reports and assesses the long-term (beyond 10 years) safety and efficiency of a single institution's experience in 1326 laparoscopic incisional and ventral hernia repairs (LIVHR), defending the principle of the suturing defect (augmentation repair concept) prior to laparoscopic reinforcement with a composite mesh (IPOM Plus). This study aims to prove the feasibility and validity of IPOM Plus repair, among other concepts, as a well-justified treatment of incisional or ventral hernias, rendering a good long-term outcome result. A single institution's systematic retrospective review of 1326 LIVHR was conducted between the years 2000 and 2014. A standardized technique of routine closure of the defect prior to the intraperitoneal onlay mesh (IPOM) reinforcement was performed in all patients. The standardized technique of "defect closure" by laparoscopy approximating the linea alba under physiological tension was assigned by either the transparietal U reverse interrupted stitches or the extracorporeal closure in larger defects. All patients benefited from the implant Parietex composite mesh through an Intraperitoneal Onlay Mesh placement with transfacial suturing. LIVHR was performed on 1326 patients, 52.57% female and 47.43% male. The majority of our patients were young (mean age 52.19 years) and obese (average BMI 32.57 kg/m2). The mean operating time was 70 min and hospital stay 2 days, with a mean follow-up of 78 months. On the overall early complications of 5.78%, we achieved over time the elimination of the dead space by routine closure of the defect, thus reducing seroma formation to 2.56%, with a low risk of infection technical improvement in the suturing concept and our growing experience, we managed to reduce the incidence of transient pain to a low acceptable rate of 3.24% (VAS 5-7) that decreased to 2.56% on a chronic pain stage, which is comparable to the literature. On the overall rate of late complications of 10.74%, we

  9. Strain assessment in the carotid artery wall using ultrasound speckle tracking: validation in a sheep model

    Larsson, Matilda; Verbrugghe, Peter; Smoljkić, Marija; Verhoeven, Jelle; Heyde, Brecht; Famaey, Nele; Herijgers, Paul; D'hooge, Jan


    The aim of this study was to validate carotid artery strain assessment in-vivo using ultrasound speckle tracking. The left carotid artery of five sheep was exposed and sonomicrometry crystals were sutured onto the artery wall to obtain reference strain. Ultrasound imaging was performed at baseline and stress, followed by strain estimation using an in-house speckle tracking algorithm tuned for vascular applications. The correlation between estimated and reference strain was r = 0.95 (p speckle tracking. However, further studies are needed to test the algorithm on human in-vivo data and to investigate its potential to detect subclinical cardiovascular disease and characterize atherosclerotic plaques.

  10. The Manamedu Complex: Geochemical constraints on Neoproterozoic suprasubduction zone ophiolite formation within the Gondwana suture in southern India

    Yellappa, T.; Chetty, T. R. K.; Tsunogae, T.; Santosh, M.


    Ophiolites provide important clues on the role of subduction and have been widely investigated to reconstruct the history of development and closure of ocean basins in the geological past. The Manamedu Complex within the Palghat-Cauvery Suture Zone in southern India comprises metamorphosed equivalents of the following lithological units: (1) an ultramafic group comprising dominantly of pyroxenite and highly altered dunite, locally preserving cumulate textures; (2) a gabbroic suite consisting of gabbro, gabbro norite, and anorthosite; (3) sheeted mafic dykes of amphibolite to meta-andesite categories, (4) plagiogranite veins and pools; and (5) a thin layer of ferruginous cherts. Cr vs. Y, V vs. Cr, Ti vs. Zr, TiO 2-MnO-P 2O 5 and Fe 2O 3-Na 2O + K 2O-MgO plots of the gabbros and mafic dyke assemblages show that these are related to island arc tholeiite (IAT) group with tholeiitic to calcalkaline signatures. Chondrite normalized REE patterns of mafic dykes do not show any pronounced fractionation and display slight positive Eu anomalies. The normalized MORB plots of the mafic dykes show depletion of HFSE (negative Nb, Ti, Ta, Hf anomalies) and enrichment of LFSE (positive K, Ba, Rb, Th). The petrological and geochemical characteristics of the major lithological units in Manamedu Complex suggest that these rocks represent the remnants of an oceanic crust, developed from mantle-derived arc magmas probably within a suprasubduction zone tectonic setting. From the geological set up and our field observations, we infer that these rocks were obducted on to the continental margin with the closure of an ocean basin during the Neoproterozoic. The Manamedu Complex may represent the remnants of the Mozambique Ocean crust developed during Rodinia breakup and which was destroyed during the amalgamation of the Gondwana supercontinent in the Latest Neoproterozoic-Cambrian.

  11. Yucca Mountain Waste Package Closure System

    shelton-davis; Colleen Shelton-Davis; Greg Housley


    The current disposal path for high-level waste is to place the material into secure waste packages that are inserted into a repository. The Idaho National Laboratory has been tasked with the development, design, and demonstration of the waste package closure system for the repository project. The closure system design includes welding three lids and a purge port cap, four methods of nondestructive examination, and evacuation and backfill of the waste package, all performed in a remote environment. A demonstration of the closure system will be performed with a full-scale waste package.

  12. Yucca Mountain Waste Package Closure System

    Herschel Smartt; Arthur Watkins; David Pace; Rodney Bitsoi; Eric Larsen; Timothy McJunkin; Charles Tolle


    The current disposal path for high-level waste is to place the material into secure waste packages that are inserted into a repository. The Idaho National Laboratory has been tasked with the development, design, and demonstration of the waste package closure system for the repository project. The closure system design includes welding three lids and a purge port cap, four methods of nondestructive examination, and evacuation and backfill of the waste package, all performed in a remote environment. A demonstration of the closure system will be performed with a full-scale waste package.

  13. Interactive Virtual Suturing Simulations: Enhancement of Student Learning in Veterinary Medicine

    Staton, Amy J.; Boyd, Christine B.


    This capstone addresses an instructional gap in the Morehead State University Veterinary Technology Program and in other similar programs around the globe. Students do not retain the knowledge needed to proficiently complete suture patterns nor do students receive sufficient instructional time during the year to master each suture pattern that is…

  14. Interactive Virtual Suturing Simulations: Enhancement of Student Learning in Veterinary Medicine

    Staton, Amy J.; Boyd, Christine B.


    This capstone addresses an instructional gap in the Morehead State University Veterinary Technology Program and in other similar programs around the globe. Students do not retain the knowledge needed to proficiently complete suture patterns nor do students receive sufficient instructional time during the year to master each suture pattern that is…

  15. Antibacterial-Coated Suture in Reducing Surgical Site Infection in Breast Surgery: A Prospective Study

    Enora Laas


    Full Text Available Background. To reduce the incidence of microbial colonization of suture material, Triclosan- (TC-coated suture materials have been developed. The aim of this study was to assess the incidence of suture-related complications (SRC in breast surgery with and without the use of TC-coated sutures. Methods. We performed a study on two consecutive periods: 92 patients underwent breast surgery with conventional sutures (Group 1 and 98 with TC-coated sutures (Group 2. We performed subgroups analyses and developed a model to predict SRC in Group 1 and tested its clinical efficacy in Group 2 using a nomogram-based approach. Results. The SRC rates were 13% in Group 1 and 8% in Group 2. We found that some subgroups may benefit from TC-coated sutures. The discrimination obtained from a logistic regression model developed in Group 1 and based on multifocality, age and axillary lymphadenectomy was 0.88 (95% CI 0.77–0.95 (. There was a significant difference in Group 2 between predicted probabilities and observed percentages (. The predicted and observed proportions of complications in the high-risk group were 38% and 13%, respectively. Conclusion. This study used individual predictions of SRC and showed that using TC-coated suture may prevent SRC. This was particularly significant in high-risk patients.

  16. Laparoscopic suturing learning curve in an open versus closed box trainer

    Rodrigues, S.P.; Horeman, T.; Blomjous, M.S.H.; Hiemstra, E.; Van den Dobbelsteen, J.J.; Jansen, F.W.


    Background The aim of this study was to examine the influence of training under direct vision prior to training with indirect vision on the learning curve of the laparoscopic suture task. Methods Novices were randomized in two groups. Group 1 performed three suturing tasks in a transparent laparosc

  17. Early secondary suture versus healing by second intention of incisional abscesses

    Hermann, G G; Bagi, P; Christoffersen, I


    A controlled trial was set up to compare the treatment of wound abscesses, occurring after laparotomy, with either early secondary suture combined with cefuroxime and metronidazole given intravenously or by healing by second intention. The secondary suture was performed two days after wound...... drainage and resulted in a significant reduction (p less than 0.01) in healing time without complications. No reinfections occurred....

  18. Prospective randomized controlled trial investigating the type of sutures used during hepatectomy

    Norifumi Harimoto; Ken Shirabe; Tomoyuki Abe; Takafumi Yukaya; Eiji Tsujita; Tomonobu Gion; Kiyoshi Kajiyama; Takashi Nagaie


    AIM: To determine whether absorbable sutures or non-absorbable sutures are better in preventing surgical site infection (SSI), in this paper we discuss the results of a randomized clinical trial which examined the type of sutures used during hepatectomy. METHODS: All hepatic resections performed from January 2007 to November 2008 at the Department of Surgery at Iizuka Hospital in Japan were included in this study. There were 125 patients randomly assigned to an absorbable sutures (Vicryl) group or non-absorbable sutures (Silk) group. RESULTS: SSI was observed in 13.6% (17/125) patients participating in this study, 11.3% in the Vicryl group and 15.8% in the Silk group. Incisional SSI including superficial and deep SSI, was observed in 8% of the Vicryl group and 9.5% of the Silk group. Organ/ space SSI was observed in 3.2% of the Vicryl group and 6.0% of the Silk group. There were no significant differences, but among the patients with SSI, the period for recovery was significantly shorter for the Vicryl group compared to the Silk group. CONCLUSION: The incidence of SSI in patients receiving absorbable sutures and silk sutures is not significantly different in this randomized controlled study; however, the period for recovery in patients with SSI was significantly shorter for absorbable sutures.

  19. Age changes in the human frontozygomatic suture from 20 to 95 years.

    Kokich, V G


    The frontozygomatic suture of human cadaver material was examined by a combination of histologic, radiographic, and gross tecniques to determine the aging changes in the suture and the approximate age at which sutural fusion occurs. The sample consisted of sixty-One specimens of human beings ranging in age from 20 to 95 years. Observations were made on specimens at age intervals of 5 years. Since the frontozygomatic suture is bilateral, one suture from each specimens was used for radiographic and gross examination for synostosis, and the opposite side was subjected to histologic analysis. The findings of this study have lead to the following conclusions: 1. The human frontozygomatic suture undergoes synostosis during the eigth decade of life, but does not completely fuse by the age of 95 years. 2. Synostosis is a progressive process which commences as small areas of bony union that occur initially within the internal portion of the suture and then progresses to the orbital perisosteal surface. Bony union is not found at or near the facial periosteal surface. 3. The bony surfaces of the frontozygomatic suture become increasingly irregular with advancing age as a result of the formation of projections or interifitations=

  20. Intracorporeal Suturing and Knot Tying Broadens the Clinical Applicability of Laparoscopy

    Rivas, Homero; Cacchione, Robert N.; Ferzli, George S.


    Objective: As surgeons become more experienced with basic laparoscopic procedures like cholecystectomy, they are able to expand this approach to less common operations. However, without laparoscopic suturing skills, like those obtained with Nissen fundoplication, many operations cannot be completed laparoscopically. We present a series of 10 patients with less common surgical illnesses who were successfully treated with minimal access techniques and intracorporeal suturing. Methods: Over a 6-month period at 2 medical centers, 10 patients underwent operations with laparoscopic intracorporeal suturing and knot tying. Diagnoses included bowel obstruction due to gallstone ileus (n=1), perforated uterus from an intrauterine device (n=1), urinary bladder diverticulum (n=1), bleeding Meckel's diverticulum (n=3), and perforated duodenal ulcer (n=4). Results: Each patient was treated with standard surgical interventions performed entirely laparoscopically with intracorporeal suturing. No morbidity or mortality occurred in any patient due to the operation. Conclusions: Although each of these operations has been previously reported, as a series, they point out the importance of mastering laparoscopic suturing. Although devices are commercially available to facilitate certain suturing scenarios, we encourage residents and fellows to sew manually. We believe that none of these operations could have been completed as effectively by using a suture device. The ability to suture laparoscopically markedly broadens the number of clinical scenarios in which minimal access techniques can be used. PMID:12856844

  1. A novel technique of rotator cuff repair using spinal needle and suture loop

    Muzaffar Nasir


    Full Text Available Abstract Background We present a simple technique of arthroscopic rotator cuff repair using a spinal needle and suture loop. Methods With the arthroscope laterally, a spinal needle looped with PDS is inserted percutaneously into the shoulder posteriorly and penetrated through the healthy posterior cuff tear margin. Anteriorly, another spinal needle loaded with PDS is inserted percutaneously to engage the healthy tissue at the anterior tear margin. The suture in the anterior needle is then delivered into the suture loop of the posterior needle using a suture retriever. The posterior needle and loop are then pulled out carrying the anterior suture with it. The two limbs of this suture are then retrieved through a cannula for knotting. The same procedure is then repeated for additional suturing. Suture anchors placed over the greater tuberosity are used to complete the repair. Conclusion This is an easy method of rotator cuff repair using simple instruments and lesser time, hence can be employed at centers with less equipment and at reduced cost to the patient.

  2. 21 CFR 878.4494 - Absorbable poly(hydroxybutyrate) surgical suture produced by recombinant DNA technology.


    ... produced by recombinant DNA technology. 878.4494 Section 878.4494 Food and Drugs FOOD AND DRUG... recombinant DNA technology. (a) Identification. An absorbable poly(hydroxybutyrate) surgical suture is an...) Surgical Suture Produced by Recombinant DNA Technology.” For the availability of this guidance document...

  3. Risk and fate of residual interatrial shunting after transcatheter closure of patent foramen ovale: a long term follow up study

    Hammerstingl C


    Full Text Available Abstract Background Percutaneous transcatheter closure of patent foramen ovale (PFO in cryptogenic stroke is an alternative to medical therapy. There is still debate on different outcome for each currently available device. The impact of residual shunting after PFO-clo- sure on recurrent arterial embolism is unknown. Aims (i To evaluate the prevalence of residual interatrial shunting after device- closure of PFO, (ii to identify risk factors predicting residual interatrial shunting after device implantation, and (iii to investigate the outcome of patients after PFO-closure during long- term follow- up (FU. Methods and results Between 2000- 2005 PFO-closure was performed in 124 patients using four different devices: Amplatzer PFO-(n = 52, CardioSeal (n = 33, Helex (n = 23 and Premere (n = 16 occluder. All patients underwent serial contrast-enhanced transesophageal echocardiography (TEE for 24 months after PFO- closure; clinical FU was at minimum 5 years up to 9.75 years (mean 6.67 ± 1.31 years. Overall-closure rate was 87% at 2 years, device-specific closure time curves differed significantly (p-logrank = 0.003. Independent risk factors for residual-shunting were implantation of a Helex occluder (hazard ratio [HR] 12.6, 95% confidence interval [CI] 2.6- 57.4, p = 0.002, PFO- canal- lengths (HR 1.2, 95%CI 1.1- 1.3, p = 0.004 and extend of atrial-septal-aneurysm (HR 1.1, 95%CI 0.9- 1.3; p = 0.05. 4 (3.2% arterial embolic events occurred during a FU-period of 817.2 patient-years, actuarial annual thromboembolic-risk was 0.49%. All ischemic events were not related to residual PFO-shunting or device-related thrombus- formation. Conclusion Success rates of PFO- closure are mainly dependent on occluder-type, extend of concomitant atrial-septum-aneurysm and PFO-canal- length. Importantly, residual shunting after PFO-closure was not associated with recurrence of arterial embolism during long-term follow-up.

  4. Responses of intramembranous bone and sutures upon in vivo cyclic tensile and compressive loading.

    Peptan, Alexandra I; Lopez, Aurora; Kopher, Ross A; Mao, Jeremy J


    Cranial vault and facial sutures interpose between mineralized bones of the skull, and may function analogously to appendicular and cranial base growth plates. However, unlike growth plates that are composed of chondrocyte lineage, cranial and facial sutures possess heterogeneous cell lineages such as mesenchymal cells, fibroblasts, and osteoblasts, in addition to vascular-derived cells. Despite recently intensified effort, the biological responses of intramembranous bone and sutures to mechanical loading are not well understood. This study was designed to investigate whether brief doses of tensile or compressive forces induce modeling and growth responses of intramembranous bone and sutures. In different groups of growing rabbits in vivo, cyclic tensile or compressive forces at 1 N and 8 Hz were applied to the maxilla for 20 min/day over 12 consecutive days. Computerized histomorphometric analyses revealed that the average sutural widths of both the premaxillomaxillary suture (PMS) and nasofrontal suture (NFS) loaded in either tension or compression were significantly higher than age- and sex-matched sham controls (P<0.01). The average cell densities of tension- or compression-loaded PMS and NFS were significantly higher than sham controls (P<0.01). The average osteoblast occupied sutural bone surface loaded under tension was significantly higher than that of sham control (P<0.05). Interestingly, tensile loading significantly reduced the average osteoclast surface, in comparison to sham control (P<0.05). For the NFS, tensile loading significantly increased the average osteoblast occupied sutural bone surface, in comparison with that of sham control (P<0.05). Also for the NFS suture, compression significantly reduced the average sutural osteoclast surface in comparison with sham control (P<0.05). Taken together, the present data suggest that high-frequency cyclic forces in either tension or compression induce modeling and growth changes in cranial sutures. Due to




    Full Text Available ABSTRAC T: INTRODUCTION: Cataract as a potent cause of loss of vision in old age persons is probably known since the dawn of human civilization. Post operative astigmatism after cataract extraction remains a big problem for cataract surgeons since Jacques Daviel e ra. Astigmatism is that type of refractive anomaly in which no point focus is formed owing to the unequal refraction of the incident light by the diopteric system of the eye in different meridians. The goal of modern cataract surgery is to produce a pseudo phakic with the quality of vision of a normal phakic eye. Various studies to find out any effect of IOL on post operative astigmatism were carried out but results are controversial. MATERIAL AND METHODS: 60 patients suffering from cataract and fit for extr action were enlisted during the month of August 2008 to February 2009. The general, physical and local examination including preoperative Keratometry, vision and tension were recorded. RESULTS: In the present study, male patients were 38 (63% and female p atients were 22 (37%. Out of the total 60 cases studied, corneo - scleral section of 28 cases (47% were sutured with 10 - 0 nylon suture (Group A while sections of 32 cases were sutured with 8 - 0 black virgin silk suture (Group B.Out of 28 cases of Group A, interrupted sutures were applied in 14 cases (50% (Group A 1 . Cross interrupted sutures were applied in 9 cases (32% Group A 2 , while bootlace continuous sutures were applied in 5 cases (18% (Group A 3 . Out of 32 cases of Group B, interrupted sutures we re applied in 26 cases (80% (Group B 1 , cross interrupted were applied in 3 cases (10% (Group B 2 , while bootlace continuous suture were applied in 3 cases (Group B 3 . In the present series, 19 cases (31% showed with the rule astigmatism, 21 cases (36% showed astigmatism against the rule and 20 cases (33% showed no astigmatism preoperatively, 16 cases were in the range of 0.50D to 1.0D and 12 cases were in the range of 1

  6. Transcutaneous Serdev Suture For Buttock’s Lift

    Nikolay Serdev


    Full Text Available This article presents the author's technique and experience in the treatment of the flaccid "unhappy buttock" form with his surgical procedure of buttock lift by suture, without incision scars. The author first presented this new operation technique on a national level at the 2nd Annual Meeting of the National Bulgarian Society for Aesthetic Surgery and Aesthetic Medicine in Sofia on March 18, 1994 [1] and internationally at many scientific meetings over the world [2, 3, 4…]. The result is a visual change in the buttock position to a higher one, which elongates the lower limbs and changes the proportions between lower and upper half of the body. The aim of this study is to describe a mini-invasive procedure of beautification of the buttock form without scars by creating a lifting effect on the buttock's subcutaneous tissue, using a suture that takes the inferiorly positioned deep fibrose tissue and fixes it upwards to the sacro-cutaneous fascia, discovered by the author. Aesthetic and technical considerations required properly sculpting the buttocks into a higher position, demonstrating nicely rounded form. Preoperative shape is discussed and patient evaluations, operative techniques, postoperative management and results after 4 years of experience are emphasized. 1032 female patients, and 26 male patients aged 18-62 years, with ptosis and cellulite on the buttocks were treated since 1993 on an outpatient basis by the "Serdev suture technique without visible scars". Important instrumentarium is a long, curved, elastic needle and Polycon semi-elastic Bulgarian antimicrobial polycaproamide long term (in 2 years absorbable surgical threads Polycon, produced in Bulgaria. This operation has been performed either alone or after ultrasonic assisted liposculpture (UAL that reduces the amount of fat and heaviness. All patients reported a high degree of satisfaction. A stable improvement in the buttock position and form was observed for the period

  7. Optimal Needle Grasp Selection for Automatic Execution of Suturing Tasks in Robotic Minimally Invasive Surgery.

    Liu, Taoming; Çavuşoğlu, M Cenk


    This paper presents algorithms for optimal selection of needle grasp, for autonomous robotic execution of the minimally invasive surgical suturing task. In order to minimize the tissue trauma during the suturing motion, the best practices of needle path planning that are used by surgeons are applied for autonomous robotic surgical suturing tasks. Once an optimal needle trajectory in a well-defined suturing scenario is chosen, another critical issue for suturing is the choice of needle grasp for the robotic system. Inappropriate needle grasp increases operating time requiring multiple re-grasps to complete the desired task. The proposed methods use manipulability, dexterity and torque metrics for needle grasp selection. A simulation demonstrates the proposed methods and recommends a variety of grasps. Then a realistic demonstration compares the performances of the manipulator using different grasps.

  8. Effects of myrrh on the strength of suture materials: an in vitro study.

    Alshehri, Mohammed A; Baskaradoss, Jagan Kumar; Geevarghese, Amrita; Ramakrishnaiah, Ravikumar; Tatakis, Dimitris N


    The present in vitro study sought to determine the effects of myrrh-containing solutions on common suture materials used in periodontal surgery. Three commonly used suture materials (silk, polyglactin 910, polytetrafluoroethylene) were immersed in four thermostatically controlled experimental media to simulate daily oral rinsing activity, namely -artificial saliva, normal saline solution with 0.2% Commiphora myrrh, full-concentration (100%) Commiphora myrrh oil, and a myrrh-containing commercial mouthwash. Tensile strength was measured at the end of each day using an Instron tensile testing machine. Silk sutures were susceptible to tensile strength loss when exposed to 0.2% myrrh solution once daily for 5 days. Myrrh-containing commercial mouthwash had no effect on tensile strength, but all three suture materials lost tensile strength when exposed to 100% myrrh oil. For patients that routinely use myrrh mouthwashes postoperatively, findings of this study suggested that silk sutures might not be the optimal material choice.

  9. SR and LR Union Suture for the Treatment of Myopic Strabismus Fixus: Is Scleral Fixation Necessary?

    Carol P. S. Lam


    Full Text Available Purpose. To evaluate and compare the effectiveness of scleral fixation SR and LR union suture and nonscleral fixation union suture for the treatment of myopic strabismus fixus. Methods. Retrospective review of 32 eyes of 22 patients with myopic strabismus fixus who had undergone union suture of superior rectus (SR and lateral rectus (LR with or without scleral fixation, and follow-up longer than 6 months at Hong Kong Eye Hospital from 2006 to 2013. Surgical techniques and outcomes in terms of ocular alignment are analyzed. Results. There is significant overall improvement both in postoperative angle of esodeviation (P0.05. Conclusions. Union suture of SR and LR is an effective procedure in correcting myopic strabismus fixus. Fixation of the union suture to the sclera does not improve surgical outcome.

  10. Nonabsorbable-Suture-Induced Osteomyelitis: A Case Report and Review of the Literature

    Cheng Hong Yeo


    Full Text Available We are reporting a case of nonabsorbable suture-induced osteomyelitis in patient who had an open rotator cuff repair with nonabsorbable Ethibond anchor suture. Patient in this case presented with very subtle clinical features of osteomyelitis of the left proximal humerus 15 years after initial rotator cuff repair surgery. Literature had shown that deep infection following rotator cuff repairs, although rare, can be easily missed and can cause severe complications. Absorbable suture had been demonstrated to be more superior, in terms of rate of deep infection, as compared to nonabsorbable suture when used in rotator cuff repair surgery. Both absorbable and nonabsorbable suture had been demonstrated to have similar mechanical properties by several different studies. The case demonstrated that initial presentation of deep infection can be subtle and easily missed by clinicians and leads to further complications.

  11. Basal joint osteoarthritis of the thumb: comparison of suture button versus abductor pollicis longus suspensionplasty.

    Avant, Kristopher R; Nydick, Jason A; White, Brian D; Vaccaro, Lisa; Hess, Alfred V; Stone, Jeffrey D


    Our purpose was to compare the outcomes of patients with severe basilar thumb osteoarthritis treated with trapeziectomy and suspensionplasty using abductor pollicis longus (APL) tendon versus a suture button device. A retrospective study was performed for patients undergoing trapeziectomy and suspensionplasty with APL tendon or suture button fixation. Outcome measures included disabilities of the arm, shoulder, and hand (DASH); visual analog score (VAS); grip strength; key pinch; tip pinch; and thumb opposition. Radiographic measurements, surgical times, and complications were recorded. Thirty-three patients in the APL tendon group and 27 patients in the suture button group had a minimum 6-month follow-up. VAS, DASH, and functional measurements improved after surgery for both groups. Mean operative time was 68 min for the APL tendon group and 48 min for the suture button group. Complications were similar between groups. The use of suture button fixation when compared to APL tendon suspensionplasty offers similar clinical outcomes. Therapeutic III.

  12. Lateral intercrural suture in the caucasian nose: Decreased domal divergence angle in endonasal rhinoplasty without delivery

    Berger, Cezar Augusto Sarraf


    Full Text Available Introduction: Several techniques can be performed to improve nasal tip definition such as cartilage resection, tip grafts, or sutures. Objective: To evaluate the outcome of lateral intercrural suture at the lower lateral cartilage by endonasal rhinoplasty with a basic technique without delivery in decreasing the angle of domal divergence and improving the nasal tip definition. Method: This prospective study was performed in 64 patients in which a suture was made on the board head of the lower lateral cartilage in the joint between the dome and lateral crus, using polydioxanone (PDS with sharp, curved needle. Results: In all of the cases, better definition of the nasal tip was achieved by intercrural suturing for at least 6 months postoperatively. Conclusion: Lateral intercrural suture of the lower lateral cartilage provides improved nasal tip definition and can be performed by endonasal rhinoplasty without delivery in the Caucasian nose.

  13. Late presentation of an anomalous left coronary artery from the pulmonary artery treated with conservative surgical management with long-term cardiac magnetic resonance imaging follow-up

    Gouda, Pishoy; Gouda, John; Butler, Craig; Welsh, Robert C


    Anomalous origin of the left coronary artery from the pulmonary artery is rare congenital abnormality that most commonly presents in childhood and is associated with a high mortality. In the elderly, patients may present acutely with arrhythmias or signs of ischemia or with vague chronic presentations of shortness of breath and fatigue. In the high-risk elderly population, it is unclear as to whether conservative surgical management by means of suture ligation of the left coronary artery is associated with positive long-term outcomes. We present a case of a 69-year-old patient diagnosed with anomalous origin of the left coronary artery from the pulmonary artery, which was treated with conservative surgical management and followed up for 15 years with cardiovascular magnetic resonance imaging, with positive outcomes.

  14. Comparison of antibacterial-coated and non-coated suture material in intraoral surgery by isolation of adherent bacteria

    Klaus Pelz


    In terms of the total number of oral bacteria, and especially oral pathogens, that adhered to suture material, no reduction was demonstrated for Vicryl Plus. The use of triclosan-coated suture material offers no advantage in intraoral surgery.

  15. The primary factor for suture configuration at rotator cuff repair: Width of mattress or distance from tear edge

    Onur Hapa


    Conclusion: Bite size from the edge of the tendon seems to be more important than the width of the mattress. The curve of the suture passing device may also have an effect on the strength of the suture tendon interface.

  16. Systematization of a set of closure techniques.

    Hausken, Kjell; Moxnes, John F


    Approximations in population dynamics are gaining popularity since stochastic models in large populations are time consuming even on a computer. Stochastic modeling causes an infinite set of ordinary differential equations for the moments. Closure models are useful since they recast this infinite set into a finite set of ordinary differential equations. This paper systematizes a set of closure approximations. We develop a system, which we call a power p closure of n moments, where 0≤p≤n. Keeling's (2000a,b) approximation with third order moments is shown to be an instantiation of this system which we call a power 3 closure of 3 moments. We present an epidemiological example and evaluate the system for third and fourth moments compared with Monte Carlo simulations.

  17. Entropy production and collisionless fluid closure

    Sarazin, Y; Zarzoso, D; Garbet, X; Ghendrih, Ph; Grandgirard, V [CEA, IRFM, F-13108 Saint-Paul-lez-Durance (France); Dif-Pradalier, G, E-mail: yanick.sarazin@cea.f [Center for Astrophysics and Space Science, U.C.S.D., La Jolla, CA 92093 (United States)


    A novel method is proposed to construct collisionless fluid closures accounting for some kinetic properties. The idea consists in optimizing the agreement between the fluid and kinetic quasi-linear entropy production rates, so as to constrain the closure coefficients. This procedure is applied to the slab branch of the ion temperature gradient driven instability. Focusing on the kinetic regime characterized by slow waves, the closure proposed by Hammett and Perkins (Hammett and Perkins 1990 Phys. Rev. Lett. 64 3019) naturally emerges from the systematic identification of the kinetic and fluid entropy production rates. This closure is revealed to be extremely powerful well beyond the kinetic regime. Besides, it reconciles the fluid and kinetic linear stability diagrams in the two-dimensional space of the density and temperature gradient lengths. Such a method is systematic and generic. As such, it is applicable to other models and classes of instabilities.

  18. Entropy production and collisionless fluid closure

    Sarazin, Y.; Dif-Pradalier, G.; Zarzoso, D.; Garbet, X.; Ghendrih, Ph; Grandgirard, V.


    A novel method is proposed to construct collisionless fluid closures accounting for some kinetic properties. The idea consists in optimizing the agreement between the fluid and kinetic quasi-linear entropy production rates, so as to constrain the closure coefficients. This procedure is applied to the slab branch of the ion temperature gradient driven instability. Focusing on the kinetic regime characterized by slow waves, the closure proposed by Hammett and Perkins (Hammett and Perkins 1990 Phys. Rev. Lett. 64 3019) naturally emerges from the systematic identification of the kinetic and fluid entropy production rates. This closure is revealed to be extremely powerful well beyond the kinetic regime. Besides, it reconciles the fluid and kinetic linear stability diagrams in the two-dimensional space of the density and temperature gradient lengths. Such a method is systematic and generic. As such, it is applicable to other models and classes of instabilities.

  19. Testing turbulent closure models with convection simulations

    Snellman, J E; Mantere, M J; Rheinhardt, M; Dintrans, B


    Aims: To compare simple analytical closure models of turbulent Boussinesq convection for stellar applications with direct three-dimensional simulations both in homogeneous and inhomogeneous (bounded) setups. Methods: We use simple analytical closure models to compute the fluxes of angular momentum and heat as a function of rotation rate measured by the Taylor number. We also investigate cases with varying angles between the angular velocity and gravity vectors, corresponding to locating the computational domain at different latitudes ranging from the pole to the equator of the star. We perform three-dimensional numerical simulations in the same parameter regimes for comparison. The free parameters appearing in the closure models are calibrated by two fit methods using simulation data. Unique determination of the closure parameters is possible only in the non-rotating case and when the system is placed at the pole. In the other cases the fit procedures yield somewhat differing results. The quality of the closu...

  20. Reliability assessment of underground shaft closure

    Fossum, A.F. [RE/SPEC, Inc., Rapid City, SD (United States); Munson, D.E. [Sandia National Labs., Albuquerque, NM (United States)


    The intent of the WIPP, being constructed in the bedded geologic salt deposits of Southeastern New Mexico, is to provide the technological basis for the safe disposal of radioactive Transuranic (TRU) wastes generated by the defense programs of the United States. In determining this technological basis, advanced reliability and structural analysis techniques are used to determine the probability of time-to-closure of a hypothetical underground shaft located in an argillaceous salt formation and filled with compacted crushed salt. Before being filled with crushed salt for sealing, the shaft provides access to an underground facility. Reliable closure of the shaft depends upon the sealing of the shaft through creep closure and recompaction of crushed backfill. Appropriate methods are demonstrated to calculate cumulative distribution functions of the closure based on laboratory determined random variable uncertainty in salt creep properties.

  1. Technical Considerations of Giant Right Coronary Artery Aneurysm Exclusion

    James Barr


    Full Text Available Giant coronary artery aneurysms are rare clinical entities. We report the case of a 49-year-old man who presented with dyspnoea and exertional chest pain. Investigations confirmed an aneurysmal right coronary artery measuring 4 cm with a fistulous communication to the right atrium. Following right atriotomy, the fistula was oversewn and the aneurysmal right coronary artery ligated at its origin and at several points along its course. A saphenous vein graft was anastomosed to the posterior descending artery. Persistent ventricular fibrillation occurred upon chest closure, attributed to ischaemia following ligation of the aneurysmal coronary artery. Emergent resternotomy and internal defibrillation were successfully performed. The sternum was stented open to reduce right ventricular strain and closed the following day. The patient made an unremarkable recovery. We here address the technical challenges associated with surgical repair of right coronary aneurysms and the physiology and management of potential complications.

  2. Technical Considerations of Giant Right Coronary Artery Aneurysm Exclusion

    Barr, James; Kourliouros, Antonios


    Giant coronary artery aneurysms are rare clinical entities. We report the case of a 49-year-old man who presented with dyspnoea and exertional chest pain. Investigations confirmed an aneurysmal right coronary artery measuring 4 cm with a fistulous communication to the right atrium. Following right atriotomy, the fistula was oversewn and the aneurysmal right coronary artery ligated at its origin and at several points along its course. A saphenous vein graft was anastomosed to the posterior descending artery. Persistent ventricular fibrillation occurred upon chest closure, attributed to ischaemia following ligation of the aneurysmal coronary artery. Emergent resternotomy and internal defibrillation were successfully performed. The sternum was stented open to reduce right ventricular strain and closed the following day. The patient made an unremarkable recovery. We here address the technical challenges associated with surgical repair of right coronary aneurysms and the physiology and management of potential complications. PMID:28018699

  3. TEVAR and covering the celiac artery. Is it safe or not?


    in these patients. If the distal sealing zone above the celiac axis is too short, several endovascular alternatives are possible; hybrid procedures with TEVAR and open by-pass to the celiac artery, custom made stent-grafts with scallop or fenestration for the celiac artery, or intentional coverage of the celiac...... artery. In the latter case, adequate collateral supply to the upper gastrointestinal tract is crucial. Collateral arteries joining the celiac and the superior mesenteric arteries are well characterized in patients with chronic celiac stenosis or occlusion. Are these collateral pathways sufficient also...... for sudden iatrogenic closure of the celiac artery? By performing a preoperative angiography of the superior mesenteric artery with temporary balloon occlusion of the celiac artery, collateral capacity between the two vessels can be tested in advance. Exact positioning of the distal end of a large thoracic...

  4. Primary closure for postoperative mediastinitis in children.

    Ohye, Richard G; Maniker, Robert B; Graves, Holly L; Devaney, Eric J; Bove, Edward L


    Mediastinitis affects approximately 1% of children undergoing median sternotomy. Conventional therapy involves debridement followed by open wound care with delayed closure, days to weeks of closed suction or antimicrobial irrigation, and vacuum-assisted closure or muscle flap closure. We hypothesized that primary closure without prolonged suction or irrigation is an effective, less traumatic treatment for mediastinitis in children. From January 1986 to July 2002, 6705 procedures involving median sternotomy were performed at the C. S. Mott Children's Hospital, resulting in 57 cases of mediastinitis (0.85%). Cases were divided into 2 groups, with 42 cases treated with primary closure and 15 cases treated with delayed or muscle flap closure. The 42 cases of primary closure comprised the primary study group of this institutional review board-approved, retrospective analysis. Patient demographics, surgical variables, mediastinitis-related parameters, and outcomes were evaluated. One patient had recurrent mediastinitis for an overall infection eradication rate of 97% (40/41). Three patients (7%) required re-exploration for suspected ongoing infection. Of these re-explorations, 1 patient had evidence of continued mediastinitis. The remaining 2 patients with sepsis of unclear cause had no clinical or culture evidence of recurrent infection. One of these patients ultimately died of sepsis without active mediastinitis for a hospital survival of 97% (41/42). No significant differences could be detected between the treatment successes and failures in this small cohort of patients. Simple primary closure is an effective means to treat selected cases of postoperative mediastinitis in children. The results compare favorably with other more lengthy or debilitating treatments.

  5. Exceptional closure of UNIQA office at CERN

    HR Department


    The UNIQA office at CERN will be closed from Wednesday 18 February to Friday 20 February due to painting work. During this closure, the Headquarters of UNIQA in Geneva will remain at the disposal of the members. See details The CERN office will re-open on Monday 23 February according to the normal schedule. We apologise for any inconvenience caused by this closure.

  6. Nonabsorbable versus absorbable sutures in large, hang-back medial rectus muscle recessions.

    Awadein, Ahmed; Marsh, Justin D; Guyton, David L


    To investigate the value of nonabsorbable sutures in reducing the incidence of consecutive exotropia after large, "hang-back" medial rectus recessions. The medical records of patients who underwent medial rectus recession of ≥6.5 mm in individuals ≤2 years of age, or ≥7.0 mm in those >2 years were retrospectively reviewed. Patients were divided into two groups based on suture material used: absorbable, polyglactin 910 sutures (44 patients); nonabsorbable, polyester sutures (50 patients). Preoperative measurements, ductions, strabismus surgery, and postoperative results were analyzed. Inadequate anchoring of the medial rectus muscle was suspected when consecutive exotropia developed 4-7 weeks after surgery after initial satisfactory alignment and was confirmed if during reoperation the medial rectus muscle appeared recessed >2 mm beyond the originally intended recession. Consecutive exotropia due to inadequate anchoring of the medial rectus muscle occurred in 11 of 66 muscles (17%) in the absorbable suture group. The muscle was found 6-10 mm posterior to the intended recession. Limited duction in the field of action of the involved medial rectus muscle occurred in 9 of the 11 muscles (82%). None of the eyes with nonabsorbable sutures showed inadequate anchoring. The incidence of consecutive exotropia was higher in the absorbable suture group (30%) than in the nonabsorbable suture group (6%) (P < 0.005). Using nonabsorbable suture for large, hang-back medial rectus recessions greatly reduces the incidence of consecutive exotropia that can occur when absorbable suture dissolves. Copyright © 2016 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

  7. Absorbable versus silk sutures for surgical treatment of trachomatous trichiasis in Ethiopia: a randomised controlled trial.

    Saul N Rajak


    Full Text Available Trachoma causes blindness through an anatomical abnormality called trichiasis (lashes touching the eye. Trichiasis can recur after corrective surgery. We tested the hypothesis that using absorbable sutures instead of silk sutures might reduce the risk of recurrent disease among patients with major trichiasis in a randomised trial.1,300 individuals with major trichiasis from rural villages in the Amhara Region of Ethiopia were recruited and assigned (1:1 by computer-generated randomisation sequence to receive trichiasis surgery using either an absorbable suture (polyglactin-910 or silk sutures (removed at 7-10 days in an otherwise identical surgical technique. Participants were examined every 6 months for 2 years by clinicians masked to allocation. The primary outcome measure was recurrent trichiasis (≥one lash touching the eye at 1 year. There was no difference in prevalence of recurrent trichiasis at 1 year (114 [18.2%] in the absorbable suture group versus 120 [19.7%] in the silk suture group; odds ratio = 0.90, 95% CI 0.68-1.20. The two groups also did not differ in terms of corneal opacification, visual acuity, conjunctival inflammation, and surgical complications.There was no evidence that use of absorbable polyglactin-910 sutures was associated with a lower prevalence of trichiasis recurrence at 1 year postsurgery than silk sutures. However, from a programmatic perspective, polyglactin-910 offers the major advantage that patients do not have to be seen soon after surgery for suture removal. The postoperative review after surgery using absorbable polyglactin-910 sutures can be delayed for 3-6 months, which might allow us to better determine whether a patient needs additional NCT00522860.

  8. A 3-D CT Analysis of Screw and Suture-Button Fixation of the Syndesmosis.

    Schon, Jason M; Williams, Brady T; Venderley, Melanie B; Dornan, Grant J; Backus, Jonathon D; Turnbull, Travis Lee; LaPrade, Robert F; Clanton, Thomas O


    Historically, syndesmosis injuries have been repaired with screw fixation; however, some suggest that suture-button constructs may provide a more accurate anatomic and physiologic reduction. The purpose of this study was to compare changes in the volume of the syndesmotic space following screw or suture-button fixation using a preinjury and postoperative 3-D computed tomography (CT) model. The null hypothesis was that no difference would be observed among repair techniques. Twelve pairs of cadaveric specimens were dissected to identify the syndesmotic ligaments. Specimens were imaged with CT prior to the creation of a complete syndesmosis injury and were subsequently repaired using 1 of 3 randomly assigned techniques: (a) one 3.5-mm cortical screw, (b) 1 suture-button, and (c) 2 suture-buttons. Specimens were imaged postoperatively with CT. 3-D models of all scans and tibiofibular joint space volumes were calculated to assess restoration of the native syndesmosis. Analysis of variance and Tukey's method were used to compare least squares mean differences from the intact syndesmosis among repair techniques. For each of the 3 fixation methods, the total postoperative syndesmosis volume was significantly decreased relative to the intact state. The total mean decreases in volume compared with the intact state for the 1-suture-button construct, 2-suture-button construct, and syndesmotic screw were -561 mm(3) (95% CI, -878 to -244), -964 mm(3) (95% CI, -1281 to -647) and -377 mm(3) (95% CI, -694 to -60), respectively. All repairs notably reduced the volume of the syndesmosis beyond the intact state. Fixation with 1 suture-button was not significantly different from screw or 2-suture-button fixation; however, fixation with 2 suture-buttons resulted in significantly decreased volume compared with screw fixation. The results of this study suggest that the 1-suture-button repair technique and the screw fixation repair technique were comparable for reduction of syndesmosis

  9. Single-incision laparoscopic splenectomy with innovative gastric traction suture

    Srikanth G


    Full Text Available Laparoscopic splenectomy is now the gold standard for patients with idiopathic thrombocytopenic purpura (ITP undergoing splenectomy. There are a few reports in literature on single-incision laparoscopic (SIL splenectomy. Herein, we describe a patient undergoing SIL splenectomy for ITP without the use of a disposable port device. We report a 20-year-old female patient with steroid-refractory ITP having a platelet count of 14,000/cmm who underwent a SIL splenectomy. Dissection was facilitated by the use of a single articulating grasper and a gastric traction suture and splenic vessels were secured at the hilum with an endo-GIA stapler. She made an uneventful postoperative recovery and was discharged on the second postoperative day. She is doing well with no visible scar at 8-month follow-up.

  10. [Refixation of sternoclavicular luxation with a suture anchor system].

    Lehmann, W; Laskowski, J; Grossterlinden, L; Rueger, J M


    Luxations of the sternoclavicular joint are rare injuries. We present a case of anterior dislocation which was caused by a minor fall onto the right shoulder. Diagnosis was delayed by 2 weeks which prevented treatment by closed reduction. As an alternative surgical treatment a PDS cord around the clavicle and the first rib was used to stabilize the clavicle at the vertical level. Subsequently, fixation to the medial side was achieved by a suture anchor that was placed into the manubrium. The presented case highlights this simple and safe method to treat dislocations of the sternoclavicular joint in which standard treatment cannot be performed. A detailed description for each operation step is given and our experience in terms of aftercare and outcome is reported.

  11. The functional significance of the squamosal suture in Australopithecus boisei.

    Rak, Y


    A juvenile Australopithecus boisei specimen from the Omo basin, southern Ethiopia, is found to exhibit and extraordinarily large overlap of the temporal squama on the parietal, a phenomenon shared with at least two adult specimens of A. boisei. An attempt is made to interpret the overlap as a structural (bony/ligamentous) adaptation necessitated by the unique combination of certain components of the masticatory system of A. boisei. These are: (1) the massiveness and strength of the temporalis muscle, (2) its relatively anterior location, and (3) the lateral position of the masseter muscle due to the flaring of the zygomatic arches. The effect of the temporalis muscle is to create excessive pressure on the portion of the squamosal suture along the parietal, while the lateral placement of the masseter and the resultant increase of pressure on the temporal squama via the zygomatic arch tend to "loosen" the contact between the temporal and parietal bones.

  12. [Percutaneus Suture of Achilles Tendon Rupture--Operation for Beginners?].

    Prokop, A; Dolezych, R; Chmielnicki, M


    Acute rupture of the Achilles tendon is the most common tendon injury, with an incidence of 30/100,000 population. With the Dresden instruments, operative tendon suture can be standardised and is safe, quick and minimally invasive. With post-operative functional therapy in a walking boot, very good clinical results can be achieved. Is this operation suitable as an educational procedure and is its performance still economic? Between 1 January 2007 and 31 December 2013, 212 patients with acute rupture of the Achilles tendon were operated using the Dresden instruments. There were 167 males and 45 females, with an average age of 46 years. 99 operations were performed by trainees, 46 by attending surgical staff, and 57 by a senior surgeon. With the trainees, the mean duration of the operation was 29:53 minutes, and with the attending staff 29:10 minutes (n. s., p > 0.1). The rate of complications (re-rupture, infection, and sural nerve damage) was 5/99 (5 %) for the trainees, 4/46 (8.7 %) for the attending staff, and 3/57 (5.3 %) for the senior surgeon. A total cost analysis yielded a total operative cost of 445.76 € for outpatient surgery. With a billed sum of 490.11 €, net income of 44.35 € per case is generated. In patients with reasonable indications for 2-day short inpatient treatment, total treatment cost was 3232.70 €. Percutaneous suture of the Achilles tendon with the Dresden instruments is a standardised and cost-effective surgical procedure. It is suitable as a "beginner's" procedure that can be performed quickly, safely, and cost-effectively. Georg Thieme Verlag KG Stuttgart · New York.

  13. Shyok Suture Zone, N Pakistan: late Mesozoic Tertiary evolution of a critical suture separating the oceanic Ladakh Arc from the Asian continental margin

    Robertson, Alastair H. F.; Collins, Alan S.


    The Shyok Suture Zone (Northern Suture) of North Pakistan is an important Cretaceous-Tertiary suture separating the Asian continent (Karakoram) from the Cretaceous Kohistan-Ladakh oceanic arc to the south. In previously published interpretations, the Shyok Suture Zone marks either the site of subduction of a wide Tethyan ocean, or represents an Early Cretaceous intra-continental marginal basin along the southern margin of Asia. To shed light on alternative hypotheses, a sedimentological, structural and igneous geochemical study was made of a well-exposed traverse in North Pakistan, in the Skardu area (Baltistan). To the south of the Shyok Suture Zone in this area is the Ladakh Arc and its Late Cretaceous, mainly volcanogenic, sedimentary cover (Burje-La Formation). The Shyok Suture Zone extends northwards (ca. 30 km) to the late Tertiary Main Karakoram Thrust that transported Asian, mainly high-grade metamorphic rocks southwards over the suture zone. The Shyok Suture Zone is dominated by four contrasting units separated by thrusts, as follows: (1). The lowermost, Askore amphibolite, is mainly amphibolite facies meta-basites and turbiditic meta-sediments interpreted as early marginal basin rift products, or trapped Tethyan oceanic crust, metamorphosed during later arc rifting. (2). The overlying Pakora Formation is a very thick (ca. 7 km in outcrop) succession of greenschist facies volcaniclastic sandstones, redeposited limestones and subordinate basaltic-andesitic extrusives and flow breccias of at least partly Early Cretaceous age. The Pakora Formation lacks terrigenous continental detritus and is interpreted as a proximal base-of-slope apron related to rifting of the oceanic Ladakh Arc; (3). The Tectonic Melange (Nanga Parbat syntaxis (Hunza River) reveals notable differences, including the presence of terrigenous quartz-rich conglomerates, serpentinite debris-flow deposits and a contrasting structural history. The Shyok Suture Zone in the Skardu area is

  14. Sutura intestinal monoplano extramucosa, discontinua, a bordes invertidos: Su aplicación en 22 años Discontinuos extramucosal single layer intestinal suture on reversed edges: Application of this technique for 22 years

    José Miguel Pérez Morales


    Full Text Available Durante el período de enero de 1982 a diciembre del 2004 se aplicó la sutura intestinal monoplano extramucosa, discontinua y a bordes invertidos (SIMEDI en 580 pacientes con 25 enfermedades del tubo digestivo. El estudio fue prospectivo, analítico y descriptivo. La técnica se aplicó 703 veces porque hubo pacientes con más de una sutura y se empleó solamente en segmentos intestinales con serosa. Se realizaron 463 anastomosis, 171 enterorrafias y 69 cierres de un extremo intestinal. Se operaron 373 pacientes de forma programada y 207 pacientes, de urgencia. Hubo 85 pacientes que presentaron complicaciones, 13 de las cuales eran dependientes de la técnica y 72, no dependientes de ella. Las complicaciones dependientes fueron 12 dehiscencias de suturas y 1 estenosis. La combinación anastomótica término-lateral más latero-lateral y cierre de un extremo intestinal fue la que más complicaciones presentó. La neoplasia maligna gástrica y de colon derecho fueron las enfermedades con más complicaciones dependientes. Se ahorró material de sutura. La SIMEDI constituye una buena opción en la cirugía del tubo digestivosummary In the period from January 1982 to December 2004, discontinuos extramucosal single layer intestinal suture on reversed edges was performed in 580 patients who had presented with 25 diseases of the digestive tract. A prospective, analytical and descriptive study was conducted. The technique was applied 703 times because there were patients with more than one suture and it was used only in intestinal segments with serose. Four hundred and sixty three anastomoses, 171 enterorrhaphies and 69 closures of an intestinal end were performed. Three hundred and seventy three patients were scheduled to be operated on whereas 207 patients were operated on due to emergency situation. There were 85 patients who developed complications, 13 had surgical technique-depending complications and 72 did not. Depending complications covered 12

  15. 105-DR Large Sodium Fire Facility closure activities evaluation report

    Adler, J.G.


    This report evaluates the closure activities at the 105-DR Large Sodium Fire Facility. The closure activities discussed include: the closure activities for the structures, equipment, soil, and gravel scrubber; decontamination methods; materials made available for recycling or reuse; and waste management. The evaluation compares these activities to the regulatory requirements and closure plan requirements. The report concludes that the areas identified in the closure plan can be clean closed.

  16. NPAR- products, applications and closure

    Vora, J.P.


    Almost a decade ago the Office of Nuclear Regulatory Research (RES) developed and implemented a comprehensive research program (NUREG-1144) widely known as NPAR or Nuclear Plant Aging Research. The NPAR program is a structured research program specifically oriented to understanding significant age-related degradation mechanisms and their long term effects on properties and performance of important components and systems and ways to mitigate detrimental effects of aging. It provided a road map and a phased approach to research that is applicable to any structure, system, or component of interest. This hardware-oriented engineering research program led the industry worldwide and communicated a need to understand and manage age-related degradation effects in selected but important structures and components. At the conclusion (1995) of the NPAR program, 22 electrical and mechanical components, 13 safety-related systems, and 10 special topics will have been studied and results summarized in 160 technical reports. This reference library of information listed and summarized in NUREG-1377, Rev. No. 4 provides a foundation upon which individual programs can be built for the specific needs of a utility, a regulator, or equipment manufacturers. During the life of the NPAR program, it has provided technical bases and support for license renewal, codes and standards, resolution of generic safety issues, information notices, regulatory guides and the standard Review Plan, as well as the Office of Nuclear Reactor Regulation and The NRC Regions. All ongoing NPAR activities will either be completed or terminated by the end of 1995. No new initiative will be undertaken. This paper summarizes NPAR products and accomplishments, application of the research results, and its status and closure.

  17. Accelerating cleanup: Paths to closure



    This report describes the status of Environmental Management`s (EM`s) cleanup program and a direction forward to complete achievement of the 2006 vision. Achieving the 2006 vision results in significant benefits related to accomplishing EM program objectives. As DOE sites accelerate cleanup activities, risks to public health, the environment, and worker safety and health are all reduced. Finding more efficient ways to conduct work can result in making compliance with applicable environmental requirements easier to achieve. Finally, as cleanup activities at sites are completed, the EM program can focus attention and resources on the small number of sites with more complex cleanup challenges. Chapter 1 describes the process by which this report has been developed and what it hopes to accomplish, its relationship to the EM decision-making process, and a general background of the EM mission and program. Chapter 2 describes how the site-by-site projections were constructed, and summarizes, for each of DOE`s 11 Operations/Field Offices, the projected costs and schedules for completing the cleanup mission. Chapter 3 presents summaries of the detailed cleanup projections from three of the 11 Operations/Field Offices: Rocky Flats (Colorado), Richland (Washington), and Savannah River (South Carolina). The remaining eight Operations/Field Office summaries are in Appendix E. Chapter 4 reviews the cost drivers, budgetary constraints, and performance enhancements underlying the detailed analysis of the 353 projects that comprise EM`s accelerated cleanup and closure effort. Chapter 5 describes a management system to support the EM program. Chapter 6 provides responses to the general comments received on the February draft of this document.

  18. Comparison of outcome after patent foramen ovale closure in older versus younger patients.

    Luermans, Justin G; Budts, Werner; Ten Berg, Jurriën M; Plokker, Herbert W; Suttorp, Maarten J; Post, Martijn C


    Percutaneous patent foramen ovale (PFO) closure seems to be effective for secondary prevention of cryptogenic stroke in patients younger than 55 years of age. The efficacy in older patients remains uncertain. We compared the efficacy of PFO closure between patients younger and older than 55 years. All 335 patients (mean age 50.2 ± 12.6 years; 205 men) with cryptogenic thromboembolism who underwent PFO closure in our centres between 1998 and 2008 were included. Mean follow-up period was 4.2 ± 1.9 years in the elderly (n=120) and 3.8 ± 2.4 years in the younger patients (n=215) (p=0.15). Prevalence of hypertension, diabetes, hyperlipidaemia and coronary and peripheral artery disease was higher in the elderly (p55 years was an independent predictor of recurrent stroke or TIA (HR 3.2, p=0.03). Percutaneous PFO closure appears to be effective for secondary prevention of cryptogenic stroke in younger patients but seems to be related with less beneficial outcome in elderly. Randomised controlled trials are needed to confirm our findings.

  19. Comparison of two different suture-passing techniques with different suture materials and thicknesses: Biomechanical study of flexor tendons for yield points, gap formation and early post-operative status

    Volkan Ergan


    Conclusion: The yield points with higher forces is expected to be preferred, but their thicknesses can be 3-0 or 4-0. Oblique suture passing should be preferred rather than longitudinal passing. Obviously, suture strengthening methods, like epitendineous running sutures and core sutures, should be used. Without these measures, even passive wrist motion can result in gap formation at the repair site. The results of this study showed that tensile properties of the repaired vary considerably with differences in suture material and design. [Hand Microsurg 2016; 5(3.000: 130-136

  20. An eddy closure for potential vorticity

    Ringler, Todd D [Los Alamos National Laboratory


    The Gent-McWilliams (GM) parameterization is extended to include a direct influence in the momentum equation. The extension is carried out in two stages; an analysis of the inviscid system is followed by an analysis of the viscous system. In the inviscid analysis the momentum equation is modified such that potential vorticity is conserved along particle trajectories following a transport velocity that includes the Bolus velocity in a manner exactly analogous to the continuity and tracer equations. In addition (and in contrast to traditional GM closures), the new formulation of the inviscid momentum equation results in a conservative exchange between potential and kinetic forms of energy. The inviscid form of the eddy closure conserves total energy to within an error proportional to the time derivative of the Bolus velocity. The hypothesis that the viscous term in the momentum equation should give rise to potential vorticity being diffused along isopycnals in a manner analogous to other tracers is examined in detail. While the form of the momentum closure that follows from a strict adherence to this hypothesis is not immediately interpretable within the constructs of traditional momentum closures, three approximations to this hypothesis results in a form of dissipation that is consistent with traditional Laplacian diffusion. The first two approximations are that relative vorticity, not potential vorticity, is diffused along isopyncals and that the flow is in approximate geostrophic balance. An additional approximation to the Jacobian term is required when the dissipation coefficient varies in space. More importantly, the critique of this hypothesis results in the conclusion that the viscosity parameter in the momentum equation should be identical to the tradition GM closure parameter {Kappa}. Overall, we deem the viscous form of the eddy closure for potential vorticity as a viable closure for use in ocean circulation models.