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Sample records for suture repair techniques

  1. Suture materials and suture techniques used in tendon repair.

    Science.gov (United States)

    Ketchum, L D

    1985-02-01

    Immediately after a tendon repair, the tendon contributes nothing to the strength of repair. During that time, the suture itself and suture technique are the sole contributors to the strength of repair. Although stainless steel is the strongest material that can be used at the time of repair, it has serious disadvantages. It is difficult to work with and makes a bulky knot. Conversely, all absorbable sutures become too weak too soon to be of value. At this time, nonabsorbable, synthetic fibers that are relatively strong, such as Supramid or prolene, are the most desirable materials available. Regarding suture techniques, the lateral trap and end-weave techniques produce the strongest repairs; however, the end-weave technique can only be used with tendon grafts and the lateral trap, though it can be used for end-to-end primary repairs. It is too bulky for use in the fingers and hand but is ideal for the forearm and wrist. In the hand and fingers, the strongest repair techniques available are the Bunnell, Kessler, and Mason-Allen; however, the Bunnell stitch is more strangulating to the microcirculation of the tendon than the latter two stitches; thus, it contributes to tendomalacia and gap formation. The simplest and least traumatic suture technique, though weakest at first, will allow tendon healing to proceed more rapidly. If such a repair is protected from tension by splinting the wrist and metacarpophalangeal joints in flexion during healing (while allowing controlled passive motion of the finger joints), there will be a rapid increase in tensile strength of the tendon juncture with minimal gap formation, as the repaired hand is progressively stressed up until about 90 days postrepair. At that point, strength plateaus and maximum stress can be applied to the repaired tendon. Somewhere between three and six weeks post-tendon repair, the suture material and technique become secondary to tendon healing as the primary provider of tensile strength to the tendon wound

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

    Directory of Open Access Journals (Sweden)

    Kamath B

    2006-01-01

    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.

  3. Comparison of All-Inside Suture Technique with Traditional Pull-out Suture and Suture Anchor Repair Techniques for Flexor Digitorum Profundus Attachment to Bone

    Science.gov (United States)

    Chu, Jennifer Y; Chen, Tony; Awad, Hani A.; Elfar, John; Hammert, Warren C.

    2015-01-01

    Purpose One goal in repairing Zone 1 flexor digitorum profundus (FDP) injuries is to create a tendon-bone construct strong enough to allow early rehabilitation while minimizing morbidity. This study introduces an alternative all-inside suture repair technique and compares it biomechanically with pull-out suture and double suture anchor repairs. Methods Repairs were performed on thirty cadaver fingers. In all-inside suture repairs (n=8), the FDP tendon was attached to bone with two 3-0 Ethibond sutures and tied over the dorsal aspect of distal phalanx. Pull-out suture repairs (n=8) were performed with 2-0 Prolene suture and tied over a dorsal button. There were two suture anchor repair groups: Arthrex Micro Corkscrew anchors preloaded with 2-0 FiberWire suture (n=7) and Depuy Micro Mitek anchors preloaded with 3-0 Orthocord suture (n=7). Repair constructs were tested using a servohydraulic materials testing system and loaded until the repair lost 75% of its strength. Results There were no statistically significant differences in tensile stiffness, ultimate load, or work to failure between the repairs. Failure mode was suture stretch and gap formation >2mm at the repair site for all pull-out suture repairs and 7 of 8 all-inside suture repairs. Two of the Arthrex Micro Corkscrew repairs and five of the Depuy Micro Mitek repairs failed by anchor pull out. Conclusions This cadaveric biomechanical study showed no difference in tensile stiffness, ultimate load, and work to failures between an all-inside suture repair technique for zone 1 FDP repairs and previously described pull-out suture and suture anchor repair techniques. The all-inside suture technique also has the advantages of avoiding an external button and the cost of anchors. Therefore, it should be considered as an alternative to other techniques. Clinical Relevance This study introduces a new FDP reattachment technique that avoids some of the complications of current techniques. PMID:23578439

  4. Arthroscopic Lateral Meniscus Root Repair With Soft Suture Anchor Technique

    OpenAIRE

    Prasathaporn, Niti; Kuptniratsaikul, Somsak; Kongrukgreatiyos, Kitiphong

    2013-01-01

    Meniscus root tear leads to circumferential hoop tension loss and increases femorotibial contact force, which causes irreversible cartilage degeneration. Biomechanical studies have shown that meniscus root repair provides better femorotibial contact force than meniscectomy. Many techniques for meniscus root repair have been published in recent years. The soft suture anchor is widely used in the glenoid labral repair. It is a small low-profile soft anchor. This article presents a new and simpl...

  5. Comparison of an all-inside suture technique with traditional pull-out suture and suture anchor repair techniques for flexor digitorum profundus attachment to bone.

    Science.gov (United States)

    Chu, Jennifer Y; Chen, Tony; Awad, Hani A; Elfar, John; Hammert, Warren C

    2013-06-01

    One goal in repairing zone 1 flexor digitorum profundus (FDP) injuries is to create a tendon-bone construct strong enough to allow early rehabilitation while minimizing morbidity. This study compares an all-inside suture repair technique biomechanically with pull-out suture and double-suture anchor repairs. Repairs were performed on 30 cadaver fingers. In all-inside suture repairs (n = 8), the FDP tendon was attached to bone with two 3-0 Ethibond sutures and tied over the dorsal aspect of distal phalanx. Pull-out suture repairs (n = 8) were performed with 2-0 Prolene suture and tied over a dorsal button. There were 2 suture anchor repair groups: Arthrex Micro Corkscrew anchors preloaded with 2-0 FiberWire suture (n = 7) and Depuy Micro Mitek anchors preloaded with 3-0 Orthocord suture (n = 7). Repair constructs were tested using a servohydraulic materials testing system and loaded until the repair lost 75% of its strength. There were no statistically significant differences in tensile stiffness, ultimate load, or work to failure between the repairs. Failure mode was suture stretch and gap formation greater than 2 mm at the repair site for all pull-out suture repairs and for 7 of 8 all-inside suture repairs. Two of the Arthrex Micro Corkscrew repairs and 5 of the Depuy Micro Mitek repairs failed by anchor pull-out. This cadaveric biomechanical study showed no difference in tensile stiffness, ultimate load, and work to failures between an all-inside suture repair technique for zone 1 FDP repairs and previously described pull-out suture and suture anchor repair techniques. The all-inside suture technique also has the advantages of avoiding an external button and the cost of anchors. Therefore, it should be considered as an alternative to other techniques. This study introduces a new FDP reattachment technique that avoids some of the shortcomings of current techniques. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights

  6. The Strength of Transosseous Medial Meniscal Root Repair Using a Simple Suture Technique Is Dependent on Suture Material and Position.

    Science.gov (United States)

    Robinson, James R; Frank, Evelyn G; Hunter, Alan J; Jermin, Paul J; Gill, Harinderjit S

    2018-01-01

    A simple suture technique in transosseous meniscal root repair can provide equivalent resistance to cyclic load and is less technically demanding to perform compared with more complex suture configurations, yet maximum yield loads are lower. Various suture materials have been investigated for repair, but it is currently not clear which material is optimal in terms of repair strength. Meniscal root anatomy is also complex; consisting of the ligamentous mid-substance (root ligament), the transition zone between the meniscal body and root ligament; the relationship between suture location and maximum failure load has not been investigated in a simulated surgical repair. (A) Using a knottable, 2-mm-wide, ultra-high-molecular-weight polyethylene (UHMWPE) braided tape for transosseous meniscal root repair with a simple suture technique will give rise to a higher maximum failure load than a repair made using No. 2 UHMWPE standard suture material for simple suture repair. (B) Suture position is an important factor in determining the maximum failure load. Controlled laboratory study. In part A, the posterior root attachment of the medial meniscus was divided in 19 porcine knees. The tibias were potted, and repair of the medial meniscus posterior root was performed. A suture-passing device was used to place 2 simple sutures into the posterior root of the medial meniscus during a repair procedure that closely replicated single-tunnel, transosseous surgical repair commonly used in clinical practice. Ten tibias were randomized to repair with No. 2 suture (Suture group) and 9 tibias to repair with 2-mm-wide knottable braided tape (Tape group). The repair strength was assessed by maximum failure load measured by use of a materials testing machine. Micro-computed tomography (CT) scans were obtained to assess suture positions within the meniscus. The wide range of maximum failure load appeared related to suture position. In part B, 10 additional porcine knees were prepared. Five

  7. Does Suture Technique Affect Re-Rupture in Arthroscopic Rotator Cuff Repair? A Meta-analysis.

    Science.gov (United States)

    Brown, Matthew J; Pula, David A; Kluczynski, Melissa A; Mashtare, Terry; Bisson, Leslie J

    2015-08-01

    To evaluate the effects of suture configuration, repair method, and tear size on rotator cuff (RC) repair healing. We conducted a literature search of articles that examined surgical treatment of RC tears published between January 2003 and September 2014. For single-row (SR) repairs, we calculated rerupture rates for simple, mattress, and modified Mason-Allen sutures while stratifying by tear size. All double-row repairs-those using 2 rows of suture anchors (DA) and those using a suture bridge (SB)--were performed using mattress sutures, and we compared rerupture rates by repair method while stratifying by tear size. A random-effects model with pooled estimates for between-study variance was used to estimate the overall rerupture proportion and corresponding 95% confidence interval for each group. Statistical significance was defined as P sutures versus simple sutures (P = .18). For SR repairs of tears measuring 3 cm or more, there was no significant difference in rerupture rates for mattress sutures versus simple sutures (P = .23). The rates of rerupture did not differ between SB and DA repairs for tears measuring less than 3 cm (P = .29) and 3 cm or more (P = .50). For SR repairs, there were no significant differences in rerupture rates between suture techniques for any repair method or tear size. All DA and SB repairs were secured with mattress sutures, and there were no differences in the rates of rerupture between these methods for either size category. These findings suggest that suture technique may not affect rerupture rates after RC repair. Level IV, systematic review of Level I through IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  8. Current Biomechanical Concepts of Suture Bridge Repair Technique for Rotator Cuff Tear

    Directory of Open Access Journals (Sweden)

    Ming-Long Yeh

    2015-06-01

    Full Text Available Rotator cuff tears are one of the most common disorders of the shoulder and can have significant effects on daily activities as a result of pain, loss of motion and strength. The goal of rotator cuff repair is aimed at anatomic restoration of the rotator cuff tendon to reduce pain and improve the joint function. Recently, arthroscopic repair has been widely accepted for treatment of rotator cuff tears due to its equal or better results than those from open repair. In 2006, a transosseousequivalent (TOE or “suture bridge” technique was introduced by Park et al. This technique maximizes the utility of the conventional double-row technique by using the suture limbs to form the media mattress sutures to bridge and compress the repaired tendon. This technique has been proven to provide biomechanical properties that are superior to other arthroscopic repair techniques regarding the initial fixation strength, contact area and contact pressure at the tendon-bone interface. Since suture bridge techniques have been evolving over time, further biomechanical investigations have been carried out. These studies include examination of the effects of dynamic humeral external rotation on the mechanic stability of the repaired tendon construct, the effects of various modifications of the suture bridge configurations on the biomechanical characteristics of the medial mattress suture, biomechanical implications of medial row failure, and biomechanical performance of the repaired constructs over time. In this review, the biomechanical concepts behind the suture bridge technique for rotator cuff repair were reviewed and discussed.

  9. Two different suturing techniques in distal hypospadias repair using ...

    African Journals Online (AJOL)

    follow-up were excluded from this study. The ages of the patients ranged from 8 to 48 months (mean 13.6±6.9 months). All patients underwent repair using the ... 8–42. 0.276. Mean ± SD. 14.4 ± 6.8. 12.8 ± 7.1. Hypospadias type. Distal penile. 26. 29. 0.315. Coronal. 14. 11. Hypoplastic urethra. 3. 7. 0.155. Suture size. 5/0.

  10. Healing of the goat anterior cruciate ligament after a new suture repair technique and bioscaffold treatment

    NARCIS (Netherlands)

    Nguyen, D. Tan; Geel, Jurre; Schulze, Martin; Raschke, Michael J.; Woo, Savio L.-Y.; van Dijk, C. Niek; Blankevoort, Leendert

    2013-01-01

    Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining

  11. Comparison of arthroscopic medial meniscal suture repair techniques: inside-out versus all-inside repair.

    Science.gov (United States)

    Choi, Nam-Hong; Kim, Tae-Hyung; Victoroff, Brian N

    2009-11-01

    There are no reports comparing meniscal healing between inside-out and all-inside repairs using sutures. No difference in healing rate exists between meniscal repairs with inside-out and all-inside suture repair in conjunction with anterior cruciate ligament reconstruction with hamstring tendon. Cohort study; Level of evidence, 2. Forty-eight consecutive patients underwent meniscal repairs of longitudinal tears of the posterior horn of the medial meniscus combined with anterior cruciate ligament reconstructions. All-inside repair was attempted when the tears were located in the red-red zone or the ramp area of the meniscus. If a tear that was in the ramp area or red-red zone extended to the midbody of the meniscus, or if there was a tear in red-white zone, the inside-out repair technique was used. Fourteen patients had all-inside meniscal repairs, and 34 patients had inside-out meniscal repairs with absorbable sutures. Identical postoperative rehabilitation protocols were used. Postoperative evaluations included Lysholm knee scoring scale, Tegner activity levels, Lachman and pivot-shift tests, and KT-1000 arthrometer. Assessment of meniscal status was performed using joint line tenderness, McMurray test, and range of motion. Follow-up magnetic resonance imaging scans were obtained on all patients. Mean follow-up was 35.7 months. No patient had joint line tenderness or reported pain or clicking on McMurray test. There was no significant difference in range of motion between groups. Follow-up magnetic resonance imaging scans demonstrated that 10 (71.4%) menisci were healed and 4 (28.6%) partially healed in the all-inside group; 24 (70.6%) menisci were healed and 10 (29.4%) partially healed in the inside-out group. There was no significant difference in meniscal healing between groups. There were no differences in Lachman test, KT-1000 arthrometer side-to-side differences measurements, Lysholm scores, and Tegner activity scales. There was a significant difference in

  12. Triple-Row Modification of the Suture-Bridge Technique for Arthroscopic Rotator Cuff Repair.

    Science.gov (United States)

    Ostrander, Roger V; Smith, Jarrod; Saper, Michael

    2016-10-01

    Recent advances to improve outcomes in rotator cuff repair include using arthroscopic double-row suture-bridge techniques in an effort to reconstruct the rotator cuff footprint and improve fixation. However, when using this technique for larger tears, it can be difficult to get the lateral portion of the rotator cuff into an anatomic position. This report describes a triple-row modification of the suture-bridge technique that results in significantly more footprint contact area and contact pressure compared with the double-row and standard suture-bridge techniques. Maximizing the rotator cuff footprint contact area exposes more of the tendon to bone and may improve the healing potential.

  13. The "flying swan" technique: a novel method for anterior labral repair using a tensioned suture bridge.

    Science.gov (United States)

    Alexander, Susan; Wallace, Andrew L

    2014-02-01

    Arthroscopic labral repair is an effective technique for most cases of traumatic shoulder instability. However, patients with anterior labroligamentous periosteal sleeve avulsion lesions frequently have multiple episodes of subluxation or dislocation and a high recurrence rate after surgery, even with modern methods of labral repair. One reason may be failure of biological healing of the labrum due to an inadequate "footprint" of contact between the capsulolabral tissue and the glenoid bone. We have developed a technique that facilitates a tensioned suture bridge between suture anchors that may improve the results of labral repair in patients with anterior labroligamentous periosteal sleeve avulsion lesions.

  14. A novel technique of rotator cuff repair using spinal needle and suture loop

    Directory of Open Access Journals (Sweden)

    Muzaffar Nasir

    2010-11-01

    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.

  15. Traumatic lumbar hernia repair: a laparoscopic technique for mesh fixation with an iliac crest suture anchor.

    Science.gov (United States)

    Links, D J R; Berney, C R

    2011-12-01

    Traumatic lumbar hernia (TLH) is a rare presentation. Traditionally, these have been repaired via an open approach. Recurrence can be a problem due to the often limited tissue available for mesh fixation at the inferior aspect of the hernia defect. We report the successful use of bone suture anchors placed in the iliac crest during transperitoneal laparoscopy for mesh fixation to repair a recurrent TLH. This technique may be particularly useful after previous failed attempts at open TLH repair.

  16. Suture-bridge subscapularis tendon repair technique using low anterior portals.

    Science.gov (United States)

    Park, Jin-Young; Park, Jun-Suk; Jung, Jae-Kyung; Kumar, Praveen; Oh, Kyung-Soo

    2011-02-01

    A suture-bridge technique has been introduced to facilitate fixation procedures and to achieve increased holding strength in posterosuperior rotator cuff. Based on biomechanical studies, this technique has been suggested as an effective method that could optimize rotator cuff tendon-footprint contact area and mean pressure, as well as holding strength. In this technique, the suture-bridge creation is adapted for arthroscopic subscapularis repair to attain the ideal cuff integrity and footprint restoration. To obtain enough working portals and space, two accessory portals were made on the anterior aspect of the shoulder and use an elevator to retract the conjoined tendons and deltoid muscle. This technique could be useful for the repair of subscapularis tears, which are not easily approached using other arthroscopic techniques. From a biomechanical point of view, the subscapularis tendon could be restored more ideally using the suture-bridge technique.

  17. Novel Suture Anchor Technique with Continuous Locking Stitch for Collateral Ligament Repair.

    Science.gov (United States)

    Tokunaga, Susumu; Abe, Yoshihiro

    2016-06-01

    Collateral ligaments are difficult to repair due to large amount of fraying in detached ligaments and attenuated stumps that may not provide enough strength after the repair. Although strong locking sutures are used to repair the ligament with proper tension, these damages can cause pull-out failure or relaxation of the repaired ligaments even from undersized load that may extend postoperative splinting or casting time. Furthermore, current suture techniques can repair varus or valgus instability of the elbow and radial or ulnar instability of the fingers, but these techniques do not offer rotatory stability of these areas. We have developed a novel suture anchor technique that has overcome this problem of current suture techniques, and this can be used to correct rotatory instability in the elbow and fingers. We used this procedure in seven cases with injury of collateral ligament in the elbow and eight cases with detached collateral ligaments of finger joint. No patient experienced rerupture or any kind of residual instability. We believe that the proposed method can produce much stronger repair and may shorten the postoperative immobilization period.

  18. Biomechanical Evaluation of Suture Anchor Versus Transosseous Tunnel Quadriceps Tendon Repair Techniques.

    Science.gov (United States)

    Sherman, Seth L; Copeland, Marilyn E; Milles, Jeffrey L; Flood, David A; Pfeiffer, Ferris M

    2016-06-01

    To evaluate the biomechanical fixation strength of suture anchor and transosseous tunnel repair of the quadriceps tendon in a standardized cadaveric repair model. Twelve "patella-only" specimens were used. Dual-energy X-ray absorptiometry measurement was performed to ensure equal bone quality amongst groups. Specimens were randomly assigned to either a suture anchor repair of quadriceps tendon group (n = 6) or a transosseous tunnel repair group (n = 6). Suture type and repair configuration were equivalent. After the respective procedures were performed, each patella was mounted into a gripping jig. Tensile load was applied at a rate of 0.1 mm/s up to 100 N after which cyclic loading was applied at a rate of 1 Hz between magnitudes of 50 to 150 N, 50 to 200 N, 50 to 250 N, and tensile load at a rate of 0.1 mm/s until failure. Outcome measures included load to failure, displacement at 1st 100 N load, and displacement after each 10th cycle of loading. The measured cyclic displacement to the first 100 N, 50 to 150 N, 50 to 200 N, and 50 to 250 N was significantly less for suture anchors than transosseous tunnels. There was no statistically significant difference in ultimate load to failure between the 2 groups (P = .40). Failure mode for all suture anchors except one was through the soft tissue. Failure mode for all transosseous specimens but one was pulling the repair through the transosseous tunnel. Suture anchor quadriceps tendon repairs had significantly decreased gapping during cyclic loading, but no statistically significant difference in ultimate load to failure when compared with transosseous tunnel repairs. Although suture anchor quadriceps tendon repair appears to be a biomechanically superior construct, a clinical study is needed to confirm this technique as a viable alternative to gold standard transosseous techniques. Although in vivo studies are needed, these results support the suture anchor technique as a viable alternative to

  19. Arthroscopic rotator cuff repair using a triple-loaded suture anchor and a modified Mason-Allen technique (Alex stitch).

    Science.gov (United States)

    Castagna, Alessandro; Garofalo, Raffaele; Conti, Marco; Borroni, Mario; Snyder, Stephen J

    2007-04-01

    Surgical repair of the rotator cuff must have good resistance and should restore the tendon footprint. To attain this goal, a stitch with a strong biomechanical profile that avoids tissue strangulation should be used. We describe an arthroscopic suture technique undertaken to repair rotator cuff tears with a single triple-loaded suture anchor. The technique consists of a combination of a horizontal mattress and 2 vertical simple sutures that are positioned medial to the mattress suture. The suture anchor used is the 5-mm self-tapping ThRevo (Linvatec). This anchor is loaded with 3 sutures: 2 No. 2 nonabsorbable braided polyester sutures of different colors and a central high-strength No. 2 polyethylene suture. The shape of the anchor eyelet permits all 3 sutures to glide freely. A modified Mason-Allen technique (Alex stitch) that combines a horizontal side-to-side suture and 2 simples sutures as vertical loops is used. With use of the Spectrum suture passing device and shuttle relay system (Linvatec), both limbs of the centrally located polyethylene suture are passed through the cuff from bottom to top, approximately 1 cm from the tendon edge. This suture is not immediately tied. Next, with use of the same system, the other 2 sutures are placed medially and over the previous horizontal suture. Simple sutures are placed at an approximately 30 degrees angle from the center of the anchor; 1 is placed anterior and the other posterior. The sutures are tied through the lateral portal. The mattress horizontal central stitch is always tied first, followed by the 2 vertical sutures. The horizontal mattress suture serves as a "rip stop stitch" and theoretically reduces the possibility of cutting out of the simple sutures.

  20. END-TO-SIDE NERVE SUTURE - A TECHNIQUE TO REPAIR ...

    African Journals Online (AJOL)

    End-to-side nerve suture (ETSNS) has until recently been extensively researched in the laboratory animal (rat and baboon). Lateral sprouting from an intact nerve into an attached nerve does occi.rr, and functional recovery (sensory and motor) has been demonstrated. We have demonstrated conclusively that ETSNS in the ...

  1. Outcome of repair of chronic tear of the pectoralis major using corkscrew suture anchors by box suture sliding technique

    Science.gov (United States)

    Joshi, Deepak; Jain, Jitesh Kumar; Chaudhary, Deepak; Singh, Utkarsh; Jain, Vineet; Lal, Ajay

    2016-01-01

    AIM To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique. METHODS In this retrospective study, we reviewed the results of pectoralis major repair in 11 chronic cases (> 6 wk) done between September 2011 and December 2014 at our institute. In all cases repair was done by same surgeon using corkscrew suture anchors and box suture sliding technique. At 6 mo, after surgery magnetic resonance imaging was done to see the integrity of the repair. Functional evaluation was done using Penn and ASES scores. Pre and postoperative Isokinetic strength was measured. RESULTS Average follow-up was 48.27 ± 21.0 mo. The Wilcoxon signed rank test was used to evaluate the outcome scores. The average ASES score increased from an average of 54.63 ± 13.0 preoperatively to 95.09 ± 2.60 after surgery at their last follow-up. The average Penn score also increased from 5.72 ± 0.78, 2.81 ± 1.32 and 45.81 ± 1.72 to 9.36 ± 0.80, 8.27 ± 0.90 and 59 ± 1.34 for pain, satisfaction and function respectively. Follow up magnetic resonance imaging (MRI) (at 6 mo) showed continuity and the bulk of pectoralis major muscle in all cases. Average isokinetic strength deficiency in horizontal adduction at 60° was 13.63% ± 6.93% and at 120° was 10.18% ± 4.93% and in flexion at 60° was 10.72% ± 5.08% and at 120° was 6.63% + 3.74%. Results showed that both ASES and Penn score improved significantly (2 tailed P value = 0.0036). CONCLUSION We could conclude from this series that pectoralis major repair even in chronic cases using 5.5 mm corkscrew anchors give excellent functional and cosmetic results. In chronic cases the repairable length of the tendon is not available and sliding suture technique allows for fixation of worn out tendomuscular junction to bone without letting cutting through the muscle. PMID:27795949

  2. Two Different Suturing Techniques in Distal Hypospadias Repair ...

    African Journals Online (AJOL)

    Background: Hypospadias is one of the most common congenital anomalies, occurring in Bone of 200 to one of 300 live births. Tubularized incised plate (TIP) urethroplasty or the Snodgrass procedure has gained worldwide acceptance for distal hypospadias repair because of its low complication rate and technical ...

  3. Comparison of the Suture Anchor and Transosseous Techniques for Patellar Tendon Repair: A Biomechanical Study.

    Science.gov (United States)

    Lanzi, Joseph T; Felix, Justin; Tucker, Christopher J; Cameron, Kenneth L; Rogers, John; Owens, Brett D; Svoboda, Steven J

    2016-08-01

    Minimizing gap formation and maximizing the strength of patellar tendon repairs are 2 critical factors for successful healing of these injuries. The purpose of this study was to compare transosseous and screw-in anchor repair techniques to determine if there is a difference in gap formation and load to failure of the 2 constructs. The research hypotheses were that the anchor construct would have significantly less gap formation and would also have significantly greater load-to-failure strength. Controlled laboratory study. A total of 24 porcine specimens were randomly assigned into transosseous and 4.75-mm polyetheretherketone (PEEK) screw-in anchor repair groups. The repairs were then completed using 2 No. 2 FiberWire sutures, and each specimen was cyclically loaded on a tensile test machine to 250 N for a total of 1000 cycles. Gap formation was measured at 1, 10, 250, 500, and 1000 cycles. Each specimen was loaded to failure after 1000 cycles. Independent t tests were conducted. Statistically significant gap formation and load-to-failure differences were found between the 2 repair techniques. The mean gap in the anchor group (2.16 ± 1.81 mm) was significantly less than that seen in the transosseous group (5.71 ± 1.58 mm) (P anchor group (669.9 ± 91.8 N) was significantly higher than that of the transosseous group (582.8 ± 92.6 N) (P = .03). The results support the 2 study hypotheses. These findings suggest that the 4.75-mm PEEK screw-in anchor construct may be superior to the transosseous technique for minimizing gap formation and improving load-to-failure strength after surgical repair of the patellar tendon. The use of the suture anchor technique in patellar tendon repair may support early load-bearing rehabilitation. © 2016 The Author(s).

  4. Impingement syndrome of the shoulder following double row suture anchor technique for arthroscopic rotator cuff repair: a case report

    Directory of Open Access Journals (Sweden)

    Rambani Rohit

    2009-06-01

    Full Text Available Abstract Introduction Arthroscopic repair of the rotator cuff is a demanding surgery. Accurate placement of anchors is key to success. Case presentation A 38-year-old woman received arthroscopic repair of her rotator cuff using a double row suture anchor technique. Postoperatively, she developed impingement syndrome which resulted from vertical displacement of a suture anchor once the shoulder was mobilised. The anchor was removed eight weeks following initial surgery and the patient had an uneventful recovery. Conclusion Impingement syndrome following arthroscopic repair of the rotator cuffs using double row suture anchor has not been widely reported. This is the first such case where anchoring has resulted in impingement syndrome.

  5. Impingement syndrome of the shoulder following double row suture anchor technique for arthroscopic rotator cuff repair: a case report

    OpenAIRE

    Rambani Rohit; Hackney Roger G

    2009-01-01

    Abstract Introduction Arthroscopic repair of the rotator cuff is a demanding surgery. Accurate placement of anchors is key to success. Case presentation A 38-year-old woman received arthroscopic repair of her rotator cuff using a double row suture anchor technique. Postoperatively, she developed impingement syndrome which resulted from vertical displacement of a suture anchor once the shoulder was mobilised. The anchor was removed eight weeks following initial surgery and the patient had an u...

  6. [PART-KESSLER TECHNIQUE WITH SUTURE ANCHOR IN REPAIR OF SPONTANEOUS Achilles TENDON RUPTURE].

    Science.gov (United States)

    Qi, Jie; Duan, Liang; Li, Weiwei; Wei, Wenbo

    2016-02-01

    To summarize the application and experience of repairing spontaneous Achilles tendon rupture by part-Kessler technique with suture anchor. Between January 2011 and December 2013, 31 patients with spontaneous Achilles tendon rupture were treated by part-Kessler technique with suture anchor. Of 31 cases, 23 were male and 8 were female, aged 16-53 years (mean, 38 years). The left side was involved in 15 cases and the right side in 16 cases. The causes of injury included sudden heel pain and walking weakness during sports in 22 cases; no surefooted down-stairs, slip, and carrying heavy loads in 9 cases. The distance from broken site to the calcaneus adhension of Achilles tendon was 3-6 cm (mean, 4.2 cm). The time from injury to operation was 7 hours to 4 days (mean, 36.8 hours). All incisions healed by first intention without nerve injury or adhering with skin. The patients were followed up 6-24 months (mean, 15 months). All patients could complete 25 times heel raising without difficulty at 6 months after operation. No Achilles tendon rupture occurred again during follow-up. At 6 months after operation, the range of motion of the ankle joint in dorsiflexion and plantar flexion showed no significant difference between normal and affected sides (t=0.648, P=0.525; t=0.524, P=0.605). The circumference of the affected leg was significantly smaller than that of normal leg at 6 months after operation (t=2.074, P=0.041), but no significant difference was found between affected and normal sides at 12 months after operation (t=0.905, P=0.426). The American Orthopedic Foot and Ankle Society (AOFAS) scores at 6, 12, 18, and 24 months after operation were significantly higher than preoperative score (P0.05). Repairing spontaneous Achilles tendon rupture by part-Kessler technique with suture anchor can supply strong strain and decrease the shear forces of suture. So part-Kessler technique with suture anchor is successful in repairing spontaneous Achilles tendon rupture.

  7. Four-Strand Core Suture Improves Flexor Tendon Repair Compared to Two-Strand Technique in a Rabbit Model

    Directory of Open Access Journals (Sweden)

    Alice Wichelhaus

    2016-01-01

    Full Text Available Introduction. This study was designed to investigate the influence of the amount of suture material on the formation of peritendinous adhesions of intrasynovial flexor tendon repairs. Materials and Methods. In 14 rabbits, the flexor tendons of the third and the fourth digit of the right hind leg were cut and repaired using a 2- or 4-strand core suture technique. The repaired tendons were harvested after three and eight weeks. The range of motion of the affected toes was measured and the tendons were processed histologically. The distance between the transected tendon ends, the changes in the peritendinous space, and cellular and extracellular inflammatory reaction were quantified by different staining. Results. A 4-strand core suture resulted in significantly less gap formation. The 2-strand core suture showed a tendency to less adhesion formation. Doubling of the intratendinous suture material was accompanied by an initial increase in leukocyte infiltration and showed a greater amount of formation of myofibroblasts. From the third to the eighth week after flexor tendon repair, both the cellular and the extracellular inflammation decreased significantly. Conclusion. A 4-strand core suture repair leads to a significantly better tendon healing process with less diastasis between the sutured tendon ends despite initially pronounced inflammatory response.

  8. Advantages of Arthroscopic Rotator Cuff Repair With a Transosseous Suture Technique: A Prospective Randomized Controlled Trial.

    Science.gov (United States)

    Randelli, Pietro; Stoppani, Carlo Alberto; Zaolino, Carlo; Menon, Alessandra; Randelli, Filippo; Cabitza, Paolo

    2017-07-01

    Rotator cuff tear is a common finding in patients with painful, poorly functioning shoulders. The surgical management of this disorder has improved greatly and can now be fully arthroscopic. To evaluate clinical and radiological results of arthroscopic rotator cuff repair using 2 different techniques: single-row anchor fixation versus transosseous hardware-free suture repair. Randomized controlled trial; Level of evidence, 1. Sixty-nine patients with rotator cuff tears were enrolled: 35 patients were operated with metal anchors and 34 with standardized transosseous repair. The patients were clinically evaluated before surgery, during the 28 days after surgery, and at least 1 year after the operation by the use of validated rating scores (Constant score, QuickDASH, and numerical rating scale [NRS]). Final follow-up was obtained at more than 3 years by a QuickDASH evaluation to detect any difference from the previous follow-up. During the follow-up, rotator cuff integrity was determined through magnetic resonance imaging and was classified according to the 5 Sugaya categories. Patients operated with the transosseous technique had significantly less pain, especially from the 15th postoperative day: In the third week, the mean NRS value for the anchor group was 3.00 while that for transosseous group was 2.46 ( P = .02); in the fourth week, the values were 2.44 and 1.76, respectively ( P < .01). No differences in functional outcome were noted between the 2 groups at the final evaluation. In the evaluation of rotator cuff repair integrity, based on Sugaya magnetic resonance imaging classification, no significant difference was found between the 2 techniques in terms of retear rate ( P = .81). No significant differences were found between the 2 arthroscopic repair techniques in terms of functional and radiological results. However, postoperative pain decreased more quickly after the transosseous procedure, which therefore emerges as a possible improvement in the surgical

  9. Anatomic suture anchor versus the Broström technique for anterior talofibular ligament repair: a biomechanical comparison.

    Science.gov (United States)

    Waldrop, Norman E; Wijdicks, Coen A; Jansson, Kyle S; LaPrade, Robert F; Clanton, Thomas O

    2012-11-01

    Despite the popularity of the Broström procedure for secondary repair of chronic lateral ankle instability, there have been no biomechanical studies reporting on the strength of this secondary repair method, whether using suture fixation or suture anchors. The purpose of our study was to perform a biomechanical comparison of the ultimate load to failure and stiffness of the traditional Broström technique using only a suture repair compared with a suture anchor repair of the anterior talofibular ligament (ATFL) at time zero. We believed that fixation strength of the suture anchor repair would be closer to the strength of the native ligament and allow more aggressive rehabilitation. Controlled laboratory study. Twenty-four fresh-frozen cadaveric ankles were randomly divided into 4 groups of 6 specimens. One group was an intact control group, and the other groups consisted of the traditional Broström and 2 suture anchor modifications (suture anchors in talus or fibula) of the Broström procedure. The specimens were loaded to failure to determine the strength and stiffness of each construct. In load-to-failure testing, ultimate failure loads of the Broström (68.2 ± 27.8 N; P = .013), suture anchor fibula (79.2 ± 34.3 N; P = .037), and suture anchor talus (75.3 ± 45.6 N; P = .027) repairs were significantly lower than that of the intact (160.9 ± 72.2 N) ATFL group. Stiffness of the Broström (6.0 ± 2.5 N/mm; P = .02), suture anchor fibula (6.8 N/mm ± 2.7; P = .05), and suture anchor talus (6.6 N/mm ± 4.0; P = .04) repairs were significantly lower than that of the intact (12.4 N/mm ± 4.1 N/mm) ATFL group. The 3 repair groups were not significantly different from each other, but all 3 were substantially lower in strength and stiffness when compared to the intact ATFL. The use of suture anchors to repair the ATFL produces a repair that can withstand loads to failure similar to the suture-only Broström repair. However, all 3 repair groups were much weaker than

  10. Biomechanical evaluation of different suture techniques for arthroscopic transtibial pull-out repair of posterior medial meniscus root tears.

    Science.gov (United States)

    Feucht, Matthias J; Grande, Eduardo; Brunhuber, Johannes; Burgkart, Rainer; Imhoff, Andreas B; Braun, Sepp

    2013-12-01

    A tear of the posterior medial meniscus root (PMMR) is increasingly recognized as a serious knee joint injury. Several suture techniques for arthroscopic transtibial pull-out repair have been described; however, only limited data about the biomechanical properties of these techniques are currently available. There are significant differences between the tested suture techniques, with more complex suture configurations providing superior biomechanical properties. Controlled laboratory study. A total of 40 porcine medial menisci were randomly assigned to 1 of 4 groups (10 specimens each) according to suture technique: two simple stitches (TSS), horizontal mattress suture (HMS), modified Mason-Allen suture (MMA), and two modified loop stitches (TLS). Meniscus-suture constructs were subjected to cyclic loading followed by load-to-failure testing in a servohydraulic material testing machine. During cyclic loading, the HMS and TLS groups showed a significantly higher displacement after 100, 500, and 1000 cycles compared with the TSS and MMA groups. After 1000 cycles, the highest displacement was found for the TLS group, with significant differences compared with all other groups. During load-to-failure testing, the highest maximum load and yield load were observed for the MMA group, with statistically significant differences compared with the TSS and TLS groups. With regard to stiffness, the TSS and MMA groups showed significantly higher values compared with the HMS and TLS groups. The MMA technique provided the best biomechanical properties with regard to cyclic loading and load-to-failure testing. The TSS technique seems to be a valuable alternative. Both the HMS and TLS techniques have the disadvantage of lower stiffness and higher displacement during cyclic loading. Using a MMA technique may improve healing rates and avoid progressive extrusion of the medial meniscus after transtibial pull-out repair of PMMR tears. The TSS technique may be used as an alternative that

  11. Evaluation of the functional results after rotator cuff arthroscopic repair with the suture bridge technique

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the results of arthroscopic treatment of large and extensive rotator cuff injuries (RCI that involved the supra and infraspinatus muscles using the suture bridge (SB technique. METHODS: Between July 2010 and November 2014, 37 patients with RCI who were treated with SB technique were evaluated. The study included all patients with a minimum follow-up of 12 months who underwent primary surgery of the shoulder. Twenty-four patients were male and 13 were female. The mean age was 60 years (45-75. The dominant side was affected in 32 cases. The most common cause of injury was trauma (18 cases. The mean preoperative motion was 123°, 58°, T11. Through magnetic resonance imaging, 36 fatty degenerations were classified according to Goutallier. Patients underwent rotator cuff repair with SB technique, which consists of using a medial row anchor with two Corkscrew(r fibertape(r or fiberwire(r at the articular margin, associated with lateral fixation without stitch using PushLocks(r or SwiveLocks(r. RESULTS: The mean age was 60 years and mean fatty degeneration was 2.6. The mean range of motion (following the AAOS in the postoperative evaluation was 148° of forward elevation, 55° in lateral rotation and medial rotation in T9. Using the criteria of the University of California at Los Angeles (UCLA, 35 (94% patients had excellent and good results; one (2.7%, fair; and one (2.7%, poor. CONCLUSION: Arthroscopic repair of a large and extensive RCI using SB technique had good and excellent results in 94% of the patients.

  12. Evaluation of the functional results after rotator cuff arthroscopic repair with the suture bridge technique.

    Science.gov (United States)

    Miyazaki, Alberto Naoki; Santos, Pedro Doneux; Sella, Guilherme do Val; Checchia, Caio Santos; Salata, Thiago Roncoletta; Checchia, Sergio Luiz

    2017-01-01

    To evaluate the results of arthroscopic treatment of large and extensive rotator cuff injuries (RCI) that involved the supra and infraspinatus muscles using the suture bridge (SB) technique. Between July 2010 and November 2014, 37 patients with RCI who were treated with SB technique were evaluated. The study included all patients with a minimum follow-up of 12 months who underwent primary surgery of the shoulder. Twenty-four patients were male and 13 were female. The mean age was 60 years (45-75). The dominant side was affected in 32 cases. The most common cause of injury was trauma (18 cases). The mean preoperative motion was 123°, 58°, T11. Through magnetic resonance imaging, 36 fatty degenerations were classified according to Goutallier. Patients underwent rotator cuff repair with SB technique, which consists of using a medial row anchor with two Corkscrew(®) fibertape(®) or fiberwire(®) at the articular margin, associated with lateral fixation without stitch using PushLocks(®) or SwiveLocks(®). The mean age was 60 years and mean fatty degeneration was 2.6. The mean range of motion (following the AAOS) in the postoperative evaluation was 148° of forward elevation, 55° in lateral rotation and medial rotation in T9. Using the criteria of the University of California at Los Angeles (UCLA), 35 (94%) patients had excellent and good results; one (2.7%), fair; and one (2.7%), poor. Arthroscopic repair of a large and extensive RCI using SB technique had good and excellent results in 94% of the patients.

  13. Modified suture-bridge technique to prevent a marginal dog-ear deformity improves structural integrity after rotator cuff repair.

    Science.gov (United States)

    Ryu, Keun Jung; Kim, Bang Hyun; Lee, Yohan; Lee, Yoon Seok; Kim, Jae Hwa

    2015-03-01

    The arthroscopic suture-bridge technique has proved to provide biomechanically firm fixation of the torn rotator cuff to the tuberosity by increasing the footprint contact area and pressure. However, a marginal dog-ear deformity is encountered not infrequently when this technique is used, impeding full restoration of the torn cuff. To evaluate the structural and functional outcomes of the use of a modified suture-bridge technique to prevent a marginal dog-ear deformity compared with a conventional suture-bridge method in rotator cuff repair. Cohort study; Level of evidence 2. A consecutive series of 71 patients aged 50 to 65 years who underwent arthroscopic rotator cuff repair for full-thickness medium-sized to massive tears was evaluated. Patients were divided into 2 groups according to repair technique: a conventional suture-bridge technique (34 patients; group A) versus a modified suture-bridge technique to prevent a marginal dog-ear deformity (37 patients; group B). Radiographic evaluations included postoperative cuff integrity using MRI. Functional evaluations included pre- and postoperative range of motion (ROM), pain visual analog scale (VAS), the University of California, Los Angeles (UCLA) shoulder rating scale, the Constant score, and the American Shoulder and Elbow Surgeons (ASES) score. All patients were followed up clinically at a minimum of 1 year. When the 2 surgical techniques were compared, postoperative structural integrity by Sugaya classification showed the distribution of types I:II:III:IV:V to be 4:20:2:4:4 in group A and 20:12:4:0:1 in group B. More subjects in group B had a favorable Sugaya type compared with group A (P bridge technique repairs were found in the retear group (P = .03). There were significant differences between healed and retear groups in functional outcome scores, with worse results in the retear group. A modified suture-bridge technique to prevent a marginal dog-ear deformity provided better structural outcomes than a

  14. A Biomechanical Evaluation of a 2-Suture Anchor Repair Technique for Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injuries.

    Science.gov (United States)

    Gil, Joseph A; Chambers, Alison; Shah, Kalpit N; Crisco, Joseph J; Got, Christopher; Akelman, Edward

    2017-08-01

    A complete thumb ulnar collateral ligament (UCL) repaired with 1-suture anchor has been demonstrated to be significantly weaker compared with the intact UCL. The objective of this study is to test the biomechanical strength of a 2-anchor thumb UCL repair. Nine paired fresh-frozen hands were used for this biomechanical analysis. One thumb from each pair was randomized to the control group and one to the repair group. In the control group, the UCL was loaded to failure in tension. In the repair group, the UCL was dissected off of the proximal phalanx, subsequently repaired with a 2-anchor technique, and then tested to failure. The mean yield load was 342 N (95% confidence interval [CI], 215-470 N) in the control group and 68 N (95% CI, 45-91 N) in the repair group. The mean maximum load at failure was 379 N (95% CI, 246-513 N) in the control group and 84 N (95% CI, 62-105 N) in the repair group. The mean stiffness was 72 N/m (95% CI, 48-96 N/m) in the control group and 17 N/m (95% CI, 13-21 N) in the repair group. The mean displacement at failure was 7.8 mm (95% CI, 7-9 mm) in the control group and 7.8 mm (95% CI, 7-9 mm) in the repair group. The 2-anchor repair technique we tested does not acutely reestablish the strength of the insertion of the native insertion of the UCL with this technique.

  15. Mesh Sutured Repairs of Abdominal Wall Defects

    Science.gov (United States)

    Lanier, Steven T.; Jordan, Sumanas W.; Miller, Kyle R.; Ali, Nada A.; Stock, Stuart R.

    2016-01-01

    Background: A new closure technique is introduced, which uses strips of macroporous polypropylene mesh as a suture for closure of abdominal wall defects due to failures of standard sutures and difficulties with planar meshes. Methods: Strips of macroporous polypropylene mesh of 2 cm width were passed through the abdominal wall and tied as simple interrupted sutures. The surgical technique and surgical outcomes are presented. Results: One hundred and seven patients underwent a mesh sutured abdominal wall closure. Seventy-six patients had preoperative hernias, and the mean hernia width by CT scan for those with scans was 9.1 cm. Forty-nine surgical fields were clean-contaminated, contaminated, or dirty. Five patients had infections within the first 30 days. Only one knot was removed as an office procedure. Mean follow-up at 234 days revealed 4 recurrent hernias. Conclusions: Mesh sutured repairs reliably appose tissue under tension using concepts of force distribution and resistance to suture pull-through. The technique reduces the amount of foreign material required in comparison to sheet meshes, and avoids the shortcomings of monofilament sutures. Mesh sutured closures seem to be tolerant of bacterial contamination with low hernia recurrence rates and have replaced our routine use of mesh sheets and bioprosthetic grafts. PMID:27757361

  16. The all-inside meniscal repair technique has less risk of injury to the lateral geniculate artery than the inside-out repair technique when suturing the lateral meniscus.

    Science.gov (United States)

    Cuéllar, Adrián; Cuéllar, Ricardo; Heredia, Jorge Díaz; Cuéllar, Asier; García-Alonso, Ignacio; Ruiz-Ibán, Miguel Angel

    2017-03-13

    To evaluate the risk of injury to the inferior lateral geniculate artery with two different techniques for lateral meniscus repair. Eight cadaveric knees were used. Inside-out sutures and an all-inside suture device were placed at the most lateral edge of the popliteal hiatus, and 15 and 30 mm anterior to this point. The minimum distances between the sutures and the inferior lateral geniculate artery were measured through a limited lateral arthrotomy. Artery penetration or collapse due to the sutures was also evaluated. The median distance between the sutures and the artery when inserted at the lateral edge of the popliteal hiatus was 1.5 mm (interquartile range: 1.3) for the inside-out technique and 1.5 mm (1.3) for the all-inside technique (differences not significant, n.s.). When the sutures were inserted 15 mm anterior to the popliteal hiatus the distances were 1.0 mm (1.1) and 1.3 mm (1.0) for the inside-out technique and the all-inside technique, respectively (n.s.). When the sutures were inserted 30 mm anterior to the popliteal hiatus the distances were 1.0 mm (1.0) and 1.5 mm (1.0) for the inside-out technique and the all-inside technique, respectively (n.s.). The artery was punctured with two of the inside-out sutures placed 15 mm from the popliteal hiatus, no puncturing occurred in the all-inside technique (n.s.). Tying of the inside-out sutures resulted in obliteration of the artery in four of eight sutures placed at 15 mm from the popliteal hiatus and three of eight sutures at 30 mm; no obliteration of the artery was found using the all-inside device (significant differences, p = 0.002). Although both all-inside and inside-out lateral meniscal repair techniques place sutures very close to the lateral geniculate artery, the inside-out technique is riskier as extra-articular knot tying can cause artery obliteration when suturing the part of the meniscus immediately lateral to the popliteal hiatus. Therefore, all-inside meniscal repair

  17. Suture-Only Repair Versus Suture Anchor–Augmented Repair for Achilles Tendon Ruptures With a Short Distal Stump

    Science.gov (United States)

    Boin, Michael A.; Dorweiler, Matthew A.; McMellen, Christopher J.; Gould, Gregory C.; Laughlin, Richard T.

    2017-01-01

    Background: Chronic noninsertional Achilles tendinosis can result in an acute Achilles tendon rupture with a short distal stump. In such tendon ruptures, there is a limited amount of adequate tissue that can hold suture, thus presenting a challenge for surgeons who elect to treat the rupture operatively. Hypothesis: Adding suture anchors to the repair construct may result in biomechanically stronger repairs compared with a suture-only technique. Study Design: Controlled laboratory study. Methods: Nine paired Achilles-calcaneus complexes were harvested from cadavers. An artificial Achilles rupture was created 2 cm proximal to the insertion on the calcaneus. One specimen from each cadaver was assigned to a suture-only or a suture anchor–augmented repair. The contralateral specimen of the same cadaver received the opposing repair. Cyclic testing was then performed at 10 to 100 N for 2000 cycles, and load-to-failure testing was performed at 0.2 mm/s. This was followed by analysis of repair displacement, gapping at repair site, peak load to failure, and failure mode. Results: The suture anchor–augmented repair exhibited a 116% lower displacement compared with the suture-only repair (mean ± SD, 1.54 ± 1.13 vs 3.33 ± 1.47 mm, respectively; P suture anchor–augmented repair also exhibited a 45% greater load to failure compared with the suture-only repair (303.50 ± 102.81 vs 209.09 ± 48.12 N, respectively; P Suture anchor–augmented repairs performed on acute Achilles tendon ruptures with a short distal stump are biomechanically stronger than suture-only repairs. Clinical Relevance: Our results support the use of suture anchor–augmented repairs for a biomechanically stronger construct in Achilles tendon ruptures with a short distal stump. Biomechanically stronger repairs may lead to less tendon repair gapping and failure, increasing the ability to start early active rehabilitation protocols and thus improving patient outcomes. PMID:28203592

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

    Science.gov (United States)

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

    2015-01-01

    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.

  19. Biomechanical properties of suture anchor repair compared with transosseous sutures in patellar tendon ruptures: a cadaveric study.

    Science.gov (United States)

    Ettinger, Max; Dratzidis, Antonios; Hurschler, Christof; Brand, Stephan; Calliess, Tilman; Krettek, Christian; Jagodzinski, Michael; Petri, Maximilian

    2013-11-01

    Ruptures of the patellar tendon are debilitating injuries requiring surgical repair. Reliable data about the most appropriate suture technique and suture material are missing. The standard procedure consists of refixing the tendon with sutures in transpatellar tunnels, sometimes combined with augmentation. Suture anchors provide at least equal results concerning gap formation during cyclic loading and ultimate failure load compared with transosseous suture repair. Controlled laboratory study. A total of 30 human cadaveric patellar tendons underwent tenotomy followed by repair with 5.5-mm titanium suture anchors, 5.5-mm resorbable hydroxyapatite suture anchors, or transpatellar suture tunnels with No. 2 Ultrabraid and the Krackow whipstitch technique. Biomechanical analysis included pretensioning the constructs at 20 N for 30 seconds and then cyclic loading of 250 cycles between 20 and 100 N at 1 Hz in a servohydraulic testing machine with measurement of elongation. After this, ultimate failure load and failure mode analysis was performed. Compared with transosseous sutures, tendon repairs with suture anchors yielded significantly less gap formation during cyclic loading (P suture anchor in the hydroxyapatite anchor group and rupture of the suture in the titanium anchor group and-at lower load to failure-in the transosseous group. Patellar tendon repair with suture anchors yields significantly better biomechanical results than repair with the commonly applied transosseous sutures. These findings may be of relevance for future clinical treatment of patellar tendon ruptures. Randomized controlled clinical trials comparing suture anchors to transosseous suture repair are desirable.

  20. Comparison of elastic versus rigid suture material for peripheral sutures in tendon repair.

    Science.gov (United States)

    Nozaki, Kenji; Mori, Ryuji; Ryoke, Koji; Uchio, Yuji

    2012-06-01

    For secure tendon repair, while core suture materials have been previously investigated, the optimum material for peripheral sutures remains unclear. Transected bovine gastrocnemius tendons were repaired by 2-strand side-locking loop technique using no.2 braided polyblend polyethylene thread for the core suture. Then, 8-strand peripheral cross-stitches were added using either 2-0 rigid sutures (braided polyblend polyethylene) or USP 2-0-sized elastic sutures (nylon). The holding area of each peripheral suture was set at either 3 × 1 mm (shallow holding) or 6 × 2 mm (deep holding). Therefore, 4 groups were compared (the shallow-rigid, deep-rigid, shallow-elastic, and deep-elastic groups). The gap formation, ultimate tensile strength, and suture migration state were measured after 500 cyclic loadings (from 10 to 200 N). The shallow-rigid group had inferior outcomes compared to the other groups. Although the deep-rigid group had the smallest gap and highest ultimate strength, all peripheral sutures had failure prior to core suture rupture. The two elastic groups showed no significant differences, irrespective of the size of the holding area. Suture migration did not occur in the two elastic groups until the ultimate strength was reached and the core suture ruptured. Depending on the suturing method, rigid suture material may not be appropriate for peripheral sutures, when accompanying rigid core suture material. If peripheral sutures can be made with accurate deep holding, rigid suture material will provide favorable outcome. However, in other cases, elastic suture material is considered best for supporting a rigid core suture, as elasticity is another important factor for peripheral sutures. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. Knotless Suture Anchor With Suture Tape Quadriceps Tendon Repair Is Biomechanically Superior to Transosseous and Traditional Suture Anchor-Based Repairs in a Cadaveric Model.

    Science.gov (United States)

    Kindya, Michael C; Konicek, John; Rizzi, Angelo; Komatsu, David E; Paci, James M

    2017-01-01

    To compare the biomechanical properties of a knotless suture anchor with suture tape quadriceps tendon repair technique with transosseous and suture anchor repair techniques. Twenty matched pairs of cadaveric knees underwent a quadriceps tendon avulsion followed by repair via the use of transosseous tunnels with #2 high-strength sutures, 5.5-mm biocomposite fully threaded suture anchors with #2 high-strength sutures, or 4.75-mm biocomposite knotless suture anchors with suture tape. Ten knees were repaired via transosseous repair and 10 via fully threaded suture anchor repair, and their matched specimens were repaired with suture tape and knotless anchors. Biomechanical analysis included displacement during cyclic loading over 250 cycles, construct stiffness, ultimate load to failure, and failure mode analysis. Compared with transosseous repairs, quadriceps tendons repaired with knotless suture tape demonstrated significantly less displacement during cyclic loading (cycles 1-20 3.6 ± 1.3 vs 6.3 ± 1.9 mm, P = .003; cycles 20-250 2.0 ± 0.4 vs 3.1 ± 0.9 mm, P = .011), improved construct stiffness (67 ± 25 vs 26 ± 12 N/mm, P = .001), and greater ultimate load to failure (616 ± 149 vs 413 ± 107 N, P = .004). Our repair technique also demonstrated improved biomechanical parameters compared with fully threaded suture anchor repair in initial displacement during cyclic loading (cycles 1-20 3.0 ± 0.8 vs 5.1 ± 0.9 mm, P suture anchor with suture tape repair technique is biomechanically superior in cyclic displacement, construct stiffness, and ultimate load to failure compared with transosseous and fully threaded suture anchor techniques in cadaveric specimens. The demonstration that our repair technique is biomechanically superior to previously described techniques in a cadaveric setting suggests that consideration should be given to this technique. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. End-to-side nerve suture – a technique to repair peripheral nerve ...

    African Journals Online (AJOL)

    End-to-side nerve suture (ETSNS) has until recently been extensively researched in the laboratory animal (rat and baboon). Lateral sprouting from an intact nerve into an attached nerve does occur, and functional recovery (sensory and motor) has been demonstrated. We have demonstrated conclusively that ETSNS in the ...

  3. Clinical Results of Arthroscopic Repair of Isolated Longitudinal Tear of Medial Meniscus by Vertical Cruciate Double Mattress Sutures with Outside-in Technique

    Directory of Open Access Journals (Sweden)

    Seyied Hamid Barzgar

    2013-09-01

    Full Text Available Introduction : Meniscal tears are one of the most common injuries treated by arthroscopic techniques. Arthroscopic meniscal repair is an accepted way of treatment for meniscal tears. Different arthroscopic techniques for meniscal repair are: inside-out, outside-in and all inside. In the first 2 techniques, meniscus is repaired by sutures and in the later by suture or by commercial ready implants . The goal of current study is assessing clinical results of arthroscopic repair of longitudinal meniscal tears with vertical cruciate double mattress sutures by outside-in technique after 9 months.   Methods: In this case series study, in 13 patients having criteria for engaging the study with longitudinal isolated meniscus tear, arthroscopic meniscal repair was done with vertical cruciate double mattress sutures by outside-in technique and patients were followed for 9 months.   Results: Of 13 patients, there were 12 males (92.3% and one female (7.7% aged 15-38 (average 28.3 years. In follow up period, there was one case (7.7% of irritation by subcutaneous knot. There was not any failure of repair. Average Lysholm score increased from 55.23 to 91.23 after 9 months of follow up, which was statistically significant (p<0.001. At the end of follow up period, there was not any medial joint line tenderness of knee, giving way or significant effusion or pain.   Conclusion: This study shows that this technique has a good short term outcome with no failure and low complications but it is necessary to do more long term studies to prove it.

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

    Science.gov (United States)

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

    2015-09-01

    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. Copyright © 2015 Acta Materialia Inc. Published by Elsevier

  5. Flexor tendons repair: effect of core sutures caliber with increased number of suture strands and peripheral sutures. A sheep model.

    Science.gov (United States)

    Uslu, M; Isik, C; Ozsahin, M; Ozkan, A; Yasar, M; Orhan, Z; Erkan Inanmaz, M; Sarman, H

    2014-10-01

    Surgeons have aimed to achieve strong repair so as to begin early active rehabilitation programs for flexor tendon injury. Multi-strand suture techniques were developed to gain improved gap resistance and ultimate force compared with the respective two-strand techniques. In vivo studies indicate that multiple strands may cause ischemia during the intrinsic healing process by decreasing the total cross-sectional area of the injured site, unless the total cross-sectional area of the sutures is not decreased. The hypothesis was to design an in vitro study to understand the biomechanical relationship between suture calibers of core sutures with increased number of suture strands and peripheral suture on final repair strength. Sixty fresh sheep forelimb flexor digitorum profundus tendons were randomly placed into three groups (A, B, and C), each containing 20 specimens, for tendon repair. Two-, four-, and eight-strand suture techniques were respectively used in Groups A, B, and C. A simple running peripheral suture technique was used in Subgroups A2, B2, and C2. For each repaired tendon, the 2-mm gap-formation force, 2-mm gap-formation strength, maximum breaking force and maximum breaking strength were determined. Differences in 2-mm gap-formation force and 2-mm gap-formation strength were found between Subgroups A1 and A2, B1 and B2, and C1 and C2. Between Groups A and B, A and C, and B and C, there was no difference as well. Both the number of strands and the ratio between the total suture volume and tendon volume at the repair site are important for ideal repair. If the total cross-sectional area of the sutures is equal in 2-strand, 4-strand, and 8-strand procedure, there is no difference in the strength of the repair. A decrease in caliber size suture requires more passes to achieve the same strength. Instead, it is much better to use peripheral suture techniques to improve the strength of the repair with larger diameter 2-strand core sutures. Copyright © 2014

  6. Releasable suture technique for trabeculectomy

    Directory of Open Access Journals (Sweden)

    Jacob Pushpa

    1993-01-01

    Full Text Available We studied the effect of the releasable suture technique on immediate postoperative intraocular pressure (IOP. Nine eyes of nine patients with glaucoma had trabeculectomy with a releasable suture. In the six eyes that did not receive antimitotics, the suture was released by the fifth postoperative day; in the others suture release was delayed up to the fourteenth day. Of the nine patients, one had an acceptable postoperative IOP and did not need suture release; in another the suture broke and could not be released. In the remaining seven patients, the difference between the pre-release and post-release IOP was statistically significant (p < 0.001. The complications of this technique include failed suture release, subconjunctival hematoma and a distinctive "windshield wiper" keratopathy.

  7. Mesh Sutured Repairs of Abdominal Wall Defects

    National Research Council Canada - National Science Library

    Lanier, Steven T; Dumanian, Gregory A; Jordan, Sumanas W; Miller, Kyle R; Ali, Nada A; Stock, Stuart R

    2016-01-01

    BACKGROUND:A new closure technique is introduced, which uses strips of macroporous polypropylene mesh as a suture for closure of abdominal wall defects due to failures of standard sutures and difficulties with planar meshes...

  8. Suture-Only Repair Versus Suture Anchor-Augmented Repair for Achilles Tendon Ruptures With a Short Distal Stump: A Biomechanical Comparison.

    Science.gov (United States)

    Boin, Michael A; Dorweiler, Matthew A; McMellen, Christopher J; Gould, Gregory C; Laughlin, Richard T

    2017-01-01

    Chronic noninsertional Achilles tendinosis can result in an acute Achilles tendon rupture with a short distal stump. In such tendon ruptures, there is a limited amount of adequate tissue that can hold suture, thus presenting a challenge for surgeons who elect to treat the rupture operatively. Adding suture anchors to the repair construct may result in biomechanically stronger repairs compared with a suture-only technique. Controlled laboratory study. Nine paired Achilles-calcaneus complexes were harvested from cadavers. An artificial Achilles rupture was created 2 cm proximal to the insertion on the calcaneus. One specimen from each cadaver was assigned to a suture-only or a suture anchor-augmented repair. The contralateral specimen of the same cadaver received the opposing repair. Cyclic testing was then performed at 10 to 100 N for 2000 cycles, and load-to-failure testing was performed at 0.2 mm/s. This was followed by analysis of repair displacement, gapping at repair site, peak load to failure, and failure mode. The suture anchor-augmented repair exhibited a 116% lower displacement compared with the suture-only repair (mean ± SD, 1.54 ± 1.13 vs 3.33 ± 1.47 mm, respectively; P suture anchor-augmented repair also exhibited a 45% greater load to failure compared with the suture-only repair (303.50 ± 102.81 vs 209.09 ± 48.12 N, respectively; P Suture anchor-augmented repairs performed on acute Achilles tendon ruptures with a short distal stump are biomechanically stronger than suture-only repairs. Our results support the use of suture anchor-augmented repairs for a biomechanically stronger construct in Achilles tendon ruptures with a short distal stump. Biomechanically stronger repairs may lead to less tendon repair gapping and failure, increasing the ability to start early active rehabilitation protocols and thus improving patient outcomes.

  9. Midwives conducting perineal repair: The Danish Suture Trial

    DEFF Research Database (Denmark)

    Kindberg, Sara

    2007-01-01

    haemorrhage >1000 ml, Diabetes, mental disorders. Both suture techniques were 2-layered using a polyglactin 910 multifilament suture (Vicryl Rapid or Vicryl). Treatment A was a continuous suture technique and treatment B was interrupted, inverted stitches. Primary outcomes: Perineal pain and wound healing...... 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...

  10. Postpartum perineal reapir performed by midwives: A randomised trial comparing two suture techniques for perineal repair leaving the skin unsutured

    DEFF Research Database (Denmark)

    Kindberg, Sara; Misan, Stehouwer; Hvidman, Lone

    2008-01-01

    interviews and systematic assessment of perineal healing was performed by research midwives blinded to treatment allocation at 24 to 48 hours, ten days and six months postpartum. Pain was evaluated using a Visual Analogue Scale and the McGill Pain Questionnaire. Wound healing was evaluated using the REEDA...... scale and by assessment of gaping wounds >0.5 cm. Analysis complied with the intention-to-treat principle.   Main Outcome measures The primary outcome was perineal pain ten days after delivery. Secondary outcomes were wound healing, patient satisfaction, dyspareunia, need for resuturing, time elapsed...... during repair and amount of suture material used.   Results          400 women were randomised; five withdrew consent leaving 395 for follow-up. The follow-up rate was 98% for all assessments after delivery. No difference was seen in perineal pain ten days after delivery. No difference was seen in wound...

  11. [Suture techniques and material in surgery of flexor tendons].

    Science.gov (United States)

    Pillukat, T; Fuhrmann, R; Windolf, J; van Schoonhoven, J

    2017-03-01

    Adhesions and scar formation between flexor tendons and the surrounding tissue are only contemporarily avoidable by movement of flexor tendons. Concepts with active follow-up protocols are more favorable than passive mobilization. The main risks of flexor tendon repair are rupture of the tendon suture, insidious gap formation and resistance to tendon gliding within the tendon sheath. Currently, there is no consensus with respect to the optimal suture technique or suture material. Nevertheless, there are some principles worth paying attention to, such as using stronger suture material, blocking stitches, suture techniques with four or more strands as well as circular running sutures. A technically acceptable compromise, even for the less experienced, is currently the four-strand suture combined with a circular running suture. It maintains sufficient stability for active motion follow-up protocols without resistance.

  12. Bridging Suture Repair for Acetabular Chondral Carpet Delamination.

    Science.gov (United States)

    Kaya, Mitsunori; Hirose, Toshiaki; Yamashita, Toshihiko

    2015-08-01

    Acetabular chondral carpet delamination is a frequent finding at hip arthroscopy. The cartilage is macroscopically normal but deboned from the subchondral bone, without a disruption at the chondrolabral junction. Arthroscopic anatomic repair of delaminated cartilage is challenging. We propose that a combination of microfracture and use of stitches to press the delaminated cartilage against the subchondral bone using a suture limb offers an effective method to provide an environment for cartilage repair. This article describes the technique of bridging suture repair for carpet delamination in detail; the technique enables the surgeon to stabilize the delaminated acetabular cartilage. Intra-articular soft anchors and an acetabular rim knotless anchor footprint provide a stable repair for delaminated cartilage. This technique is especially helpful in cases with acetabular cartilage carpet delamination.

  13. Nasal tip sutures: Techniques and indications.

    Science.gov (United States)

    Cingi, Cemal; Muluk, Nuray Bayar; Ulusoy, Seçkin; Söken, Hakan; Altıntoprak, Niyazi; Şahin, Ethem; Ada, Servet

    2015-01-01

    The surgical anatomy of the nasal tip is determined by intrinsic factors, such as the nasal tip volume, shape, definition, and symmetry. These factors are intimately related to the morphology of the lower lateral cartilages. Tip sutures reduce the need for grafts and allow the surgeon to manipulate the tip with a high degree of precision and better long-term clinical outcomes. In this review, we evaluated common nasal tip suture techniques to clarify the similarities and differences among them. The following nasal tip suture techniques were investigated: medial crural fixation suture, middle crura suture, transdomal (dome creating, dome binding, domal definition) suture, interdomal suture, lateral crural mattress suture, columella septal suture, intercrural suture, tip rotation suture, craniocaudal transdomal suture, lateral crural spanning suture, suspension suture, tongue-in-groove technique, and lateral crural steal. Tip sutures increase tip projection, narrow the tip, provide stabilization, and provide tip rotation. The sutures may be used separately or together. Nasal tip sutures have long been used as noninvasive suture techniques. Each suture technique has unique benefits, and various key points must be considered when using these techniques.

  14. BIOMECHANICS AND HISTOLOGICAL ANALYSIS IN RABBIT FLEXOR TENDONS REPAIRED USING THREE SUTURE TECHNIQUES (FOUR AND SIX STRANDS) WITH EARLY ACTIVE MOBILIZATION.

    Science.gov (United States)

    Severo, Antônio Lourenço; Arenhart, Rodrigo; Silveira, Daniela; Ávila, Aluísio Otávio Vargas; Berral, Francisco José; Lemos, Marcelo Barreto; Piluski, Paulo César Faiad; Lech, Osvandré Luís Canfield; Fukushima, Walter Yoshinori

    2012-01-01

    Analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand breed (Oryctolagus cuniculus) were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). For the flexor tendons of the hind paws, sterile and driven techniques were used in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6- strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands) (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15(th) day and in 66.7% on the 30(th) day, making the biological tissue stronger and more resistant (p=0.095). This study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques applied.

  15. BIOMECHANICS AND HISTOLOGICAL ANALYSIS IN RABBIT FLEXOR TENDONS REPAIRED USING THREE SUTURE TECHNIQUES (FOUR AND SIX STRANDS) WITH EARLY ACTIVE MOBILIZATION

    Science.gov (United States)

    Severo, Antônio Lourenço; Arenhart, Rodrigo; Silveira, Daniela; Ávila, Aluísio Otávio Vargas; Berral, Francisco José; Lemos, Marcelo Barreto; Piluski, Paulo César Faiad; Lech, Osvandré Luís Canfield; Fukushima, Walter Yoshinori

    2015-01-01

    Objective: Analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. Methods: The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand breed (Oryctolagus cuniculus) were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). For the flexor tendons of the hind paws, sterile and driven techniques were used in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). Results: In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6- strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands) (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15th day and in 66.7% on the 30th day, making the biological tissue stronger and more resistant (p=0.095). Conclusion: This study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques

  16. The effect of suture caliber and number of core suture strands on zone II flexor tendon repair: a study in human cadavers.

    Science.gov (United States)

    Osei, Daniel A; Stepan, Jeffrey G; Calfee, Ryan P; Thomopoulos, Stavros; Boyer, Martin I; Potter, Ryan; Gelberman, Richard H

    2014-02-01

    To compare the tensile properties of a 3-0, 4-strand flexor tendon repair with a 4-0, 4-strand repair and a 4-0, 8-strand repair. Following evaluation of the intrinsic material properties of the 2 core suture calibers most commonly used in tendon repair (3-0 and 4-0), we tested the mechanical properties of 40 cadaver flexor digitorum profundus tendons after zone II repair with 1 of 3 techniques: a 3-0, 4-strand core repair, a 4-0, 8-strand repair, or a 4-0, 4-strand repair. We compared results across suture caliber for the 2 sutures and across tendon repair methods. Maximum load to failure of 3-0 polyfilament caprolactam suture was 49% greater than that of 4-0 polyfilament caprolactam suture. The cross-sectional area of 3-0 polyfilament caprolactam was 42% greater than that of 4-0 polyfilament caprolactam. The 4-0, 8-strand repair produced greater maximum load to failure when compared with the 2 4-strand techniques. Load at 2-mm gap, stiffness, and work to yield were significantly greater in the 4-0, 8-strand repair than in the 3-0, 4-strand repair. In an ex vivo model, an 8-strand repair using 4-0 suture was 43% stronger than a 4-strand repair using 3-0 suture, despite the finding that 3-0 polyfilament caprolactam was 49% stronger than 4-0 polyfilament caprolactam. These results suggest that, although larger-caliber suture has superior tensile properties, the number of core suture strands across a repair site has an important effect on time zero, ex vivo flexor tendon repair strength. Surgeons should consider using techniques that prioritize multistrand core suture repair over an increase in suture caliber. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  17. The Effect of Suture Caliber and Number of Core Suture Strands on Zone II Flexor Tendon Repair; A Study in Human Cadavers

    Science.gov (United States)

    Osei, Daniel A.; Stepan, Jeffrey G.; Calfee, Ryan P.; Thomopoulos, Stavros; Boyer, Martin I.; Potter, Ryan; Gelberman, Richard H.

    2014-01-01

    Purpose To compare the tensile properties of a 3-0, 4-strand flexor tendon repair to a 4-0, 4 strand repair and a 4-0, 8-strand repair. Methods Following evaluation of the intrinsic material properties of the 2 core suture calibers most commonly used in tendon repair (3-0 and 4-0), we tested the mechanical properties of 40 cadaver flexor digitorum profundus tendons after zone II repair with one of 3 techniques: a 3-0, 4-strand core repair, a 4-0, 8-strand repair, or a 4-0, 4-strand repair. We compared results across suture caliber for the 2 sutures and across tendon repair methods. Results Maximum load to failure of 3-0 polyfilament caprolactam suture was 49% greater than that of 4-0 polyfilament caprolactam suture. The cross sectional area of 3-0 Supramid was 42% greater than that of 4-0 Supramid. The 4-0, 8 strand, repair produced greater maximum load to failure when compared to the 2 4-strand techniques. Load at 2 mm gap, stiffness, and work to yield were significantly greater in the 4-0, 8-strand repair when compared to the 3-0, 4-strand repair. Discussion In an ex vivo model, an 8-strand repair using 4-0 suture was 43% stronger than a 4-strand repair using 3-0 suture, despite the finding that 3-0 polyfilament caprolactam was 49% stronger than was 4-0 polyfilament caprolactam. These results suggest that, although larger caliber suture has superior tensile properties, the number of core suture strands across a repair site has an important effect on time zero, ex vivo flexor tendon repair strength. Clinical Relevance Surgeons should consider using techniques that prioritize multi-strand core suture repair over an increase in suture caliber. PMID:24342261

  18. Delayed Repair of Infected Ruptured Patellar Tendon using Suture Anchors

    Directory of Open Access Journals (Sweden)

    Himanshu Kataria

    2017-10-01

    Full Text Available Patellar tendon rupture are rare injuries that are easily missed in acute phases if careful clinical examination is not carried out. The delayed condition is further difficult to treat and augmentation of end to end repair is generally required. However, literature presents no such case of delayed presentation with presence of infection. We here present one such case of delayed presentation of patellar tendon rupture at three weeks in a 52-year-old male patient. Usual techniques were not sufficient to allow early rehabilitation. Technique of suture anchors was planned for repair after thorough debridement. After this intervention, patient was put on aggressive rehabilitation protocol and he gained excellent range of motion. Patient was followed for one year and he showed no loss of movement or signs of infection. We thus recommend using anchor suture repair of patellar tendon that provides a stable and rigid fixation with possibility of early active rehabilitation even in delayed setting.

  19. Clinical and radiological outcomes of rotator cuff repair by single-row suture-anchor technique with mini-open approach

    Directory of Open Access Journals (Sweden)

    Serhat Karapınar

    2014-06-01

    Full Text Available Objective: The aim of this study was to evaluate the clinical results and re-rupture rate of single row suture anchor repair with mini open surgical technique, in the treatment of full thickness rotator cuff tear. Methods: Patients with full thickness rotator cuff tears were included. Single row suture anchor technic with mini-open approach was used for treatment. The mean follow-up period was 9.8 months. The preoperative and postoperative functional and clinical status of patients was evaluated by UCLA (University of California at Los Angeles and Constant scoring systems. The re-rupture of the rotator cuff was detected by MRI (Magnetic Resonance Imaging at the last control. Preoperative and postoperative datas were compared to each other. Results: Twenty-three patients, (13 male, 10 female were included. The mean age was 52 years (range 18 to 68 years. At the pre-operative evaluation, the mean results of UCLA score was 11.7, the Constant scores was 26.83 whereas the postoperative scores were found as 29.91, 82.04, respectively. The increases in these scores at the postoperative period were statistically significant (p<0.05. 95% of patients declared that they were satisfied with the treatment. In the control MRI (Magnetic Resonance Imaging only one re-rupture was detected. Conclusion: the results of this study has shown that in the treatment of full thickness rotator cuff tear, mini open, single row suture anchor technique has good clinical results and re-rupture is seen very rarely.

  20. A novel silk suture-assisted laparoscopic technique for the repair of a gastrocolic fistula in a pediatric patient

    Directory of Open Access Journals (Sweden)

    Seher Mughal

    2016-10-01

    Full Text Available Percutaneous placement of gastrostomy was first described in 1980. Since then it has become widely used in pediatric surgery throughout the world. Inherent in the technique is the possibility of inadvertent damage to adjacent anatomical structures, most commonly the transverse colon. Management previously had involved laparotomy and correction of the gastrocolic fistula. Here we describe a novel laparoscopic approach to the repair of a gastrocolic fistula following percutaneous gastrostomy, avoiding the morbidity of laparotomy in an immunocompromised patient with a rotund abdomen secondary to steroid usage.

  1. The influence of suture material on the strength of horizontal mattress suture configuration for meniscus repair.

    Science.gov (United States)

    Hapa, Onur; Akşahin, Ertuğrul; Erduran, Mehmet; Davul, Serkan; Havitçioğlu, Hasan; LaPrade, Robert F; Bozdağ, Ergun; Sünbüloğlu, Emin

    2013-12-01

    Comparison of the mechanical characteristics of meniscal repair fixation using horizontal sutures and six different sutures under submaximal cyclic and load to failure test conditions may aid physicians in selecting a suture type. A 2-cm long anteroposterior vertical longitudinal incision was created in six groups of bovine medial menisci. Lesions were repaired using a No. 2 suture either composed of polyester or polyester and ultra high-molecular weight polyethylene (UHMWPE), or UHMWPE and polydioxanone or pure UHMWPE. Endpoints included ultimate failure load (N), pull-out stiffness (N/mm), pull-out displacement (mm), cyclic displacement (mm) after 100cycles, after 500cycles, and mode of failure. Polyester suture had lower ultimate load than all groups except the suture composed of polyester and UHMWPE (Psuture had higher ultimate failure load than sutures composed of either polyester or polyester plus UHMWPE (Psuture cutting through the meniscus for the groups except for polyester suture which failed by suture rupture. Under cyclic loading conditions in bovine meniscus, braided polyester suture fixation provided lower initial fixation strength than fixation with various high strength sutures composed of pure UHMWPE or a combination of absorbable monofilament polydioxanone and UHMWPE, except for combination of polyester and UHMWPE sutures. Present study does not support the usage of the braided polyester sutures instead of high strength sutures composed either partially or totally of ultra-high molecular weight polyethylene for the horizontal suture configuration of meniscus repair. Copyright © 2012 Elsevier B.V. All rights reserved.

  2. A biomechanical analysis of anterior Bankart repair using suture anchors.

    Science.gov (United States)

    Nho, Shane J; Frank, Rachel M; Van Thiel, Geoffrey S; Wang, Fan Chia; Wang, Vincent M; Provencher, Matthew T; Verma, Nikhil N

    2010-07-01

    Arthroscopic repair of anterior Bankart lesions is typically done with single-loaded suture anchors tied with simple stitch configuration. The knotless suture anchor will have similar biomechanical properties compared with two types of conventional suture anchors. Controlled laboratory study. Fresh-frozen shoulders were dissected and an anteroinferior Bankart lesion was created. For phase 1, specimens were randomized into either simple stitch (SSA) or knotless suture anchors (KSA) and loaded to failure. For phase 2, specimens were randomized into 1 of 4 repair techniques and cyclically loaded then loaded to failure: (1) SSA, (2) suture anchor with horizontal mattress configuration, (3) double-loaded suture anchor with simple stitch configuration, or (4) KSA. Data recorded included mode of failure, ultimate load to failure, load at 2 mm of displacement, as well as displacement during cyclical loading. For phase 1, the load required to 2 mm displacement of the repair construct was significantly greater in SSA (66.5 +/- 21.7 N) than KSA (35.0 +/- 12.5 N, P = .02). For phase 2, there was a statistically significant difference in ultimate load to failure among the 4groups, with both the single-loaded suture anchor with simple stitch (184.0 +/- 64.5 N), horizontal mattress stitch (189.0 +/- 65.3N), and double-loaded suture anchor with simple stitch (216.7 +/- 61.7 N) groups having significantly (P .05) among the 4 groups in displacement after cyclical loading or load at 2 mm of displacement. Both knotless and simple anchor configurations demonstrated similar single loads to failure (without cycling); however, the knotless device required less single load to displace 2 mm. All repair stitches, including simple, horizontal, and double-loaded performed similarly. The findings may suggest that with cyclical loading up to 25 N there is no difference in gapping greater than 2mm, but a macrotraumatic event may demonstrate a difference in fixation during the initial

  3. Diagonal tarsal suture technique sine marginal sutures for closure of full-thickness eyelid defects.

    Science.gov (United States)

    Willey, Andrea; Caesar, Richard H

    2013-01-01

    Precise apposition of the tarsal plates and meticulous alignment of the eyelid margins are essential to ensure a seamless repair and avoid notching of the eyelid margin. The authors present a simple and reliable technique that firmly apposes and precisely aligns the eyelid margin in the x, y, and z axes, obviating the need for marginal sutures. A retrospective audit of electronic medical records was performed for all patients who underwent reconstructive procedures that included the repair of a full-thickness defect in the eyelid margin using the diagonal suture technique from 2003 to 2012. Of the 652 surgeries performed in the past 9 years, 9 incidences of notching occurred, all of which were associated with infections. The diagonal tarsal suture technique is a simple and effective method for the repair of full-thickness defects with a high degree of patient satisfaction.

  4. Flexor tendon repair: a comparative study between a knotless barbed suture repair and a traditional four-strand monofilament suture repair.

    LENUS (Irish Health Repository)

    Joyce, C W

    2014-01-01

    We compared the tensile strength of a novel knotless barbed suture method with a traditional four-strand Adelaide technique for flexor tendon repairs. Forty fresh porcine flexor tendons were transected and randomly assigned to one of the repair groups before repair. Biomechanical testing demonstrated that the tensile strengths between both tendon groups were very similar. However, less force was required to create a 2 mm gap in the four-strand repair method compared with the knotless barbed technique. There was a significant reduction in the cross-sectional area in the barbed suture group after repair compared with the Adelaide group. This would create better gliding within the pulley system in vivo and could decrease gapping and tendon rupture.

  5. Extrusion of bone anchor suture following flexor digitorum profundus tendon avulsion injury repair.

    LENUS (Irish Health Repository)

    Tiong, William H C

    2011-09-01

    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. The search for the ideal tendon repair in zone 2: strand number, anchor points and suture thickness.

    Science.gov (United States)

    Savage, R

    2014-01-01

    This review article examines the mechanical factors involved in tendon repair by sutures. The repair strength, repair stiffness and gap resistance can be increased by increasing the number of core strands and anchor points, by increased anchor point efficiency and the use of peripheral sutures, and by using thicker sutures. In the future, laboratory tests could be standardized to a specific animal model and to a defined cyclic motion programme. Clinical studies support the use of multi-strand core and peripheral sutures, but two-strand core sutures are not adequate to ensure consistently good clinical results. Training surgeons in complex tendon repair techniques is essential.

  7. The mechanical interaction between three geometric types of nylon core suture and a running epitenon suture in repair of porcine flexor tendons

    NARCIS (Netherlands)

    Wit, T.; Walbeehm, E.T.; Hovius, S.E.; McGrouther, D.A.

    2013-01-01

    The effect of core suture geometry on the mechanical interaction with the epitenon suture in terms of gap prevention, failure strength and mode of failure was investigated in a flexor tendon repair model. A total of 48 porcine flexor tendons were repaired using three techniques with distinct core

  8. Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint: a retrospective comparison of pull-out sutures and bone anchor techniques.

    Science.gov (United States)

    Katolik, Leonid I; Friedrich, Jeffrey; Trumble, Thomas E

    2008-11-01

    The use of intraosseous suture anchors in the treatment of ruptures of the ulnar collateral ligament of the thumb metacarpophalangeal joint has previously been described. However, no direct comparisons exist of ulnar collateral ligament repair with bone anchor versus repair with a pull-out button and immobilization. Two cohorts of patients with complete rupture of the ulnar collateral ligament of the thumb metacarpophalangeal joint were compared. Thirty patients in each cohort underwent repair of the ulnar collateral ligament with either an intraosseous suture anchor followed by early mobilization or a pull-out suture tied over a button with cast immobilization. Average follow-up was 29 months. At follow-up, range of motion at the metacarpophalangeal and interphalangeal joints for the anchor group averaged 97 percent of that of the contralateral side compared with 86 percent and 87 percent, respectively, for the button group. For the anchor group, pinch strength averaged 101 percent that of the contralateral side compared with 95 percent for the button group. No significant difference was noted between the groups for grip strength. Average tourniquet time for the anchor group was 28 minutes compared with 43 minutes for the button group. Soft-tissue complications were present in 27 percent of patients (eight of 30) in the pull-out button group compared with 7 percent (two of 30) in the anchor group. Cost analysis demonstrates an approximately $140-per-patient savings when using the suture anchor. Both repair methods are safe and effective for treating thumb ulnar collateral ligament injuries. Suture anchors allow for an accelerated rehabilitation protocol, which may account for the improved range of motion and pinch strength at follow-up.

  9. Simple versus horizontal suture anchor repair of Bankart lesions: which better restores labral anatomy?

    Science.gov (United States)

    Hagstrom, Lindsey S; Marzo, John M

    2013-02-01

    The goal of this study was to determine which suture repair technique better restores glenoid labrum height: horizontal sutures or simple sutures. Sixteen cadaveric glenoids, 8 per repair technique, were used to measure native labral height at the 3:00 to 6:00 positions in half-hour increments. A Bankart lesion was then created from 3:00 to 6:30. Height measurements at each time point were again taken after creation of the Bankart lesion. Repair with a 3-mm knotted suture anchor was then performed at 3:30, 4:30, and 5:30 with either a simple or horizontal suture technique, and postrepair heights were measured across all time points. Significant decreases in height, as compared with native height, were observed at 3:30, 4:30, and 5:30 in the simple repair group. Decreases in height of 1.4 mm (P = .044), 2.1 mm (P = .030), and 1.1 (P = .034) were observed at 3:30, 4:30, and 5:30. There was no significant decrease in height at these respective time points in the horizontal repair group. The in vitro horizontal mattress suture technique better restores labral height and anatomy when compared with a simple suture technique in the repair of acute Bankart lesions. Compared with the simple suture technique, horizontal suture repair may provide increased stability to the glenohumeral construct. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  10. Biomechanical Comparison of Modified Suture Bridge Using Rip-Stop versus Traditional Suture Bridge for Rotator Cuff Repair

    Directory of Open Access Journals (Sweden)

    ZiYing Wu

    2016-01-01

    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.

  11. Arthroscopic repair of triangular fibrocartilage tears: a biomechanical comparison of a knotless suture anchor and the traditional outside-in repairs.

    Science.gov (United States)

    Desai, Mihir J; Hutton, William C; Jarrett, Claudius D

    2013-11-01

    To compare the biomechanical strength of a knotless suture anchor repair and the traditional outside-in repair of peripheral triangular fibrocartilage complex (TFCC) tears in a cadaveric model. We dissected the distal ulna and TFCC from 6 matched cadaveric wrist pairs and made iatrogenic complete peripheral TFCC tears in each wrist. In 6 wrists, the TFCC tears were repaired using the standard outside-in technique using 2 2-0 polydioxane sutures placed in a vertical mattress fashion. In the other 6 wrists, we repaired the TFCC tears using mini-pushlock suture anchors to the fovea. The strength of the repairs was then determined using a materials testing machine with the load placed across the repair site. We loaded the repairs until a gap of 2 mm formed across the repair site, and then subsequently loaded them to failure. Thus, for each repair we obtained the load at 2-mm gap formation, load to failure, and mode of failure. At the 2-mm gap formation, the suture anchor repairs were statistically stronger than the outside-in repairs. For load to failure, the suture anchor repairs were also statistically stronger than the outside-in repairs. Failure in both techniques occurred most commonly as suture pull-out from the soft tissues. The all-arthroscopic suture anchor TFCC repair was biomechanically stronger than an outside-in repair. The suture anchor technique allows for repair of both the superficial and deep layers of the articular disk directly to bone, restoring the native TFCC anatomy. By being knotless, the suture anchor repair avoids irritation to the surrounding soft tissues by suture knots. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. Suture anchor repair yields better biomechanical properties than transosseous sutures in ruptured quadriceps tendons.

    Science.gov (United States)

    Petri, M; Dratzidis, A; Brand, S; Calliess, T; Hurschler, C; Krettek, C; Jagodzinski, M; Ettinger, M

    2015-04-01

    This human cadaveric study compares the biomechanical properties of quadriceps tendon repair with suture anchors and the commonly applied transosseous sutures. The hypothesis was that suture anchors provide at least equal results concerning gap formation and ultimate failure load compared with transosseous suture repair. Thirty human cadaveric knees underwent tenotomy followed by repair with either 5.5-mm-double-loaded suture anchors [titanium (TA) vs. resorbable hydroxyapatite (HA)] or transpatellar suture tunnels using No. 2 Ultrabraid™ and the Krackow whipstitch. Biomechanical analysis included pretensioning the constructs with 20 N for 30 s and then cyclic loading of 250 cycles between 20 and 100 N at 1 Hz in a servohydraulic testing machine with measurement of elongation. Ultimate failure load analysis and failure mode analysis were performed subsequently. Tendon repairs with suture anchors yielded significantly less gap formation during cyclic loading (20th-250th cycle: TA 1.9 ± 0.1, HA 1.5 ± 0.5, TS 33.3 ± 1.9 mm, p sutures. Common failure mode was pull-out of the eyelet within the suture anchor in the HA group and rupture of the suture in the TA and TS group. Quadriceps tendon repair with suture anchors yields significantly better biomechanical results than the commonly applied transosseous sutures in this human cadaveric study. These biomechanical findings may change the future clinical treatment for quadriceps tendon ruptures. Randomised controlled clinical trials are desirable for the future. Not applicable, controlled laboratory human cadaveric study.

  13. Bundles of spider silk, braided into sutures, resist basic cyclic tests: potential use for flexor tendon repair.

    Directory of Open Access Journals (Sweden)

    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.

  14. Arthroscopic repair of the posterior root of the medial meniscus using knotless suture anchor: A technical note.

    Science.gov (United States)

    Eun, Sang Soo; Lee, Sang Ho; Sabal, Luigi Andrew

    2016-08-01

    There are numerous methods for repairing posterior root tears of the medial meniscus (PRTMM). Repair techniques using suture anchors through a high posteromedial portal have been reported. The present study found that using a knotless suture anchor instead of suture anchor seemed easier and faster because it avoided passing the sutures through the meniscus and tying a knot in a small space. This study describes a knotless suture anchor technique through a high posteromedial portal, and its clinical results. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Biomechanical comparison of screw-in suture anchor-suture combinations used for Bankart repair.

    Science.gov (United States)

    Sparks, Brad S; Nyland, John; Nawab, Akbar; Blackburn, Ethan; Krupp, Ryan; Caborn, David N M

    2010-03-01

    Bankart repair laxity may contribute to pathologic joint instability. This biomechanical study compared two screw-in suture anchor-suture combinations under tensile loads. Twelve pairs of scapulae were implanted with either a 3 mm diameter, 14 mm long poly-L/D-lactide suture anchor with a suture eyelet (Group 1) or a 3.1 mm diameter, 11 mm long polylactide suture anchor with a molded eyelet (Group 2). Constructs were cyclically loaded between 25 and 50 N with a 25 N load increase every 25 cycles. Group 2 displayed greater displacement at failure, had more specimens with > or =2 mm displacement by the 50 N interval (P = 0.014), and had displaced more by 100 N (P suture anchor-suture loops, the rehabilitation timetable, and the timing of return to unrestricted activities.

  16. Lower Reoperation Rate for Recurrence after Mesh versus Sutured Elective Repair in Small Umbilical and Epigastric Hernias. A Nationwide Register Study

    DEFF Research Database (Denmark)

    Christoffersen, Mette Willaume; Helgstrand, F; Rosenberg, J

    2013-01-01

    Repair for a small (≤2 cm) umbilical and epigastric hernia is a minor surgical procedure. The most common surgical repair techniques are a sutured repair or a repair with mesh reinforcement. However, the optimal repair technique with regard to risk of reoperation for recurrence is not well...... documented. The aim of the present study was in a nationwide setup to investigate the reoperation rate for recurrence after small open umbilical and epigastric hernia repairs using either sutured or mesh repair....

  17. A biomechanical evaluation of all-inside 2-stitch meniscal repair devices with matched inside-out suture repair.

    Science.gov (United States)

    Ramappa, Arun J; Chen, Alvin; Hertz, Benjamin; Wexler, Michael; Grimaldi Bournissaint, Leandro; DeAngelis, Joseph P; Nazarian, Ara

    2014-01-01

    Many all-inside suture-based devices are currently available, including the Meniscal Cinch, FasT-Fix, Ultra FasT-Fix, RapidLoc, MaxFire, and CrossFix System. These different devices have been compared in various configurations, but to our knowledge, the Sequent meniscal repair device, which applies running sutures, has not been compared with the Ultra FasT-Fix, nor has it been compared with its suture, No. 0 Hi-Fi, using an inside-out repair technique. To assess the quality of the meniscal repair, all new devices should be compared with the gold standard: the inside-out repair. To that end, this study aims to compare the biomechanical characteristics of running sutures delivered by the Sequent meniscal repair device with 2 vertical mattress sutures applied using the Ultra FasT-Fix device and with 2 vertical mattress sutures using an inside-out repair technique with No. 0 Hi-Fi suture. Controlled laboratory study. Paired (medial and lateral), fresh-frozen porcine menisci were randomly assigned to 1 of 3 groups: Sequent (n = 17), Ultra FasT-Fix (n = 19), and No. 0 Hi-Fi inside-out repair (n = 20). Bucket-handle tears were created in all menisci and were subjected to repair according to their grouping. Once repaired, the specimens were subjected to cyclic loading (100, 300, and 500 cycles), followed by loading to failure. The Sequent and Ultra FasT-Fix device repairs and the suture repair exhibited low initial displacements. The Sequent meniscal repair device demonstrated the lowest displacement in response to cyclic loading. No. 0 Hi-Fi suture yielded the highest load to failure. With the development of the next generation of all-inside meniscal repair devices, surgeons may use these findings to select the method best suited for their patients. The Sequent meniscal repair device displays the least amount of displacement during cyclic loading but has a similar failure load to other devices.

  18. Omental pedicle transposition and suture repair of peripheral nerve ...

    African Journals Online (AJOL)

    In the primary epineural repair group or control group (CG), the left sciatic nerve was skeletonized from the sciatic notch till the point of bifurcation. The nerve was transected at the mid shaft of the femoral bone and repaired with six epineural sutures. In the treatment group (TG), the epineural repaired sciatic nerve was ...

  19. Biomechanical Analysis of an Arthroscopic Broström Ankle Ligament Repair and a Suture Anchor-Augmented Repair.

    Science.gov (United States)

    Giza, Eric; Whitlow, Scott R; Williams, Brady T; Acevedo, Jorge I; Mangone, Peter G; Haytmanek, C Thomas; Curry, Eugene E; Turnbull, Travis Lee; LaPrade, Robert F; Wijdicks, Coen A; Clanton, Thomas O

    2015-07-01

    Secondary surgical repair of ankle ligaments is often indicated in cases of chronic lateral ankle instability. Recently, arthroscopic Broström techniques have been described, but biomechanical information is limited. The purpose of the present study was to analyze the biomechanical properties of an arthroscopic Broström repair and augmented repair with a proximally placed suture anchor. It was hypothesized that the arthroscopic Broström repairs would compare favorably to open techniques and that augmentation would increase the mean repair strength at time zero. Twenty (10 matched pairs) fresh-frozen foot and ankle cadaveric specimens were obtained. After sectioning of the lateral ankle ligaments, an arthroscopic Broström procedure was performed on each ankle using two 3.0-mm suture anchors with #0 braided polyethylene/polyester multifilament sutures. One specimen from each pair was augmented with a 2.9-mm suture anchor placed 3 cm proximal to the inferior tip of the lateral malleolus. Repairs were isolated and positioned in 20 degrees of inversion and 10 degrees of plantarflexion and loaded to failure using a dynamic tensile testing machine. Maximum load (N), stiffness (N/mm), and displacement at maximum load (mm) were recorded. There were no significant differences between standard arthroscopic repairs and the augmented repairs for mean maximum load and stiffness (154.4 ± 60.3 N, 9.8 ± 2.6 N/mm vs 194.2 ± 157.7 N, 10.5 ± 4.7 N/mm, P = .222, P = .685). Repair augmentation did not confer a significantly higher mean strength or stiffness at time zero. Mean strength and stiffness for the arthroscopic Broström repair compared favorably with previous similarly tested open repair and reconstruction methods, validating the clinical feasibility of an arthroscopic repair. However, augmentation with an additional proximal suture anchor did not significantly strengthen the repair. © The Author(s) 2015.

  20. EVALUATION OF ADJUSTABLE SUTURE TECHNIQUE IN OUTCOME OF PTOSIS SURGERY

    Directory of Open Access Journals (Sweden)

    Nagaraju

    2015-10-01

    Full Text Available AIM: To evaluate the outcome of adjustable suture technique in ptosis surgery. INTRODUCTION : Surgical management of blepharoptosis is indicated in multiple situations and the post - operative outcomes can be as variable as the indications for surgery. Adjustable suture techniques in ptosis repair have been introduced and variable efficacies have been reported. MATERIALS AND METHODS: A retrospective case review of medical records from June 2010 to May 2011 (12 months of 5 eyes of 5 consecutive patients operated by a single surgeon at a Tertiary Eye care center in South India were reviewed. The clinical profile of patients included was r ecorded and results of adjustable suture technique described by Borman and collegues for these patients was reported. RESULTS: 5 eyes of 5 patients underwent adjustable suture ptosis repair in the study duration. 4 patients with moderate and 1 with severe ptosis, all having good levator function were diagnosed to have c ongenital ptosis in 3 cases and a cquired involutional ptosis in 2 cases. All 5 cases had a satisfactory outcome at day 4 post - operative after adjustment of lid height in the out - patient clini c. 1 patient with acquired involutional ptosis, identified with levator dehiscence intra - operatively had overcorrection at 6 months warranting re - surgery while the other 4 patients had satisfactory cosmetic lid height and functional outcome at 6 months fol low up after the adjustable suture technique for ptosis repair. CONCLUSION: Use of adjustable sutures in ptosis surgery can eliminate the intraoperative lid factors that can lead to unpredictable results. The technique described is easy to adapt and perfor m and can give repeatable and well acceptable results in the properly selected cases

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

    Science.gov (United States)

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

    2015-06-01

    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 suture in the treatment of 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.

  2. Effect of Additional Sutures per Suture Anchor in Arthroscopic Bankart Repair: A Review of Single-loaded Versus Double-loaded Suture Anchors.

    Science.gov (United States)

    Chen, Jeffrey S; Novikov, David; Kaplan, Daniel J; Meislin, Robert J

    2016-07-01

    To directly compare single-loaded suture anchors (SSA) with double-loaded suture anchors (DSA) to help surgeons optimize the operative technique, time, and cost of Bankart repairs. A literature review was performed using the PubMed and SCOPUS databases. Studies that directly compared SSA and DSA for Bankart repairs, or indirectly compared them by collecting relevant data despite a different objective, were included. A total of two studies were included, both of which were cadaveric laboratory studies. A total of 28 shoulders were tested. Tests conducted include loading to failure and cyclic loading. One study found SSA to be biomechanically equivalent to DSA, and one found DSA to be superior. Based on limited cadaveric study, DSA are at least equivalent biomechanically to SSA, and may be superior. By using DSA, surgeons create repair constructs that are as strong as, or stronger than, those made with SSA, but with fewer anchors. This reduces the amount of holes drilled and implants placed in the glenoid, while also minimizing cost. Quantifying the benefit of additional sutures in a suture anchor can help optimize the quality of repair, time, and cost in arthroscopic shoulder repair. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  3. Anatomic and Biomechanical Comparison of Traditional Bankart Repair With Bone Tunnels and Bankart Repair Utilizing Suture Anchors.

    Science.gov (United States)

    Judson, Christopher H; Charette, Ryan; Cavanaugh, Zachary; Shea, Kevin P

    2016-01-01

    Traditional Bankart repair using bone tunnels has a reported failure rate between 0% and 5% in long-term studies. Arthroscopic Bankart repair using suture anchors has become more popular; however, reported failure rates have been cited between 4% and 18%. There have been no satisfactory explanations for the differences in these outcomes. Bone tunnels will provide increased coverage of the native labral footprint and demonstrate greater load to failure and stiffness and decreased cyclic displacement in biomechanical testing. Controlled laboratory study. Twenty-two fresh-frozen cadaveric shoulders were used. For footprint analysis, the labral footprint area was marked and measured using a Microscribe technique in 6 specimens. A 3-suture anchor repair was performed, and the area of the uncovered footprint was measured. This was repeated with traditional bone tunnel repair. For the biomechanical analysis, 8 paired specimens were randomly assigned to bone tunnel or suture anchor repair with the contralateral specimen assigned to the other technique. Each specimen underwent cyclic loading (5-25 N, 1 Hz, 100 cycles) and load to failure (15 mm/min). Displacement was measured using a digitized video recording system. Bankart repair with bone tunnels provided significantly more coverage of the native labral footprint than repair with suture anchors (100% vs 27%, P tunnels (21.9 ± 8.7 N/mm) showed significantly greater stiffness than suture anchor repair (17.1 ± 3.5 N/mm, P = .032). Mean load to failure and gap formation after cyclic loading were not statistically different between bone tunnel (259 ± 76.8 N, 0.209 ± 0.064 mm) and suture anchor repairs (221.5 ± 59.0 N [P = .071], 0.161 ± 0.51 mm [P = .100]). Bankart repair with bone tunnels completely covered the footprint anatomy while suture anchor repair covered less than 30% of the native footprint. Repair using bone tunnels resulted in significantly greater stiffness than repair with suture anchors. Load to failure

  4. [Predictable tip suture techniques in rhinoplasty].

    Science.gov (United States)

    Papel, I D

    2010-09-01

    Recontouring the nasal tip in rhinoplastic procedures has generated a wide range of surgical techniques. These range from aggressive cartilage resection, division, grafting, or suture methods. Each of these categories contains many variations described in hundreds of publications. The goal of this communication is to describe a predictable, reproducible technique that can be used in a wide variety of rhinoplasty operations. Based on pre-existing anatomy variations of this technique can be adopted. The author described the basic technique in 2004 [1].The cornerstone of the technique is a predictable method of narrowing the interdomal space utilizing a suture technique. This procedure employs a pair of permanent sutures designed to minimize distortion, valve impingement and overcorrection. It can be performed through intranasal or external approaches. This paper will define the wide interdomal space, describe the technique, and demonstrate the efficacy of the technique in 250 rhinoplasty procedures. In addition, variations of the technique for specific goals will be shown.

  5. Biomechanical comparison of an all-soft suture anchor with a modified Broström-Gould suture repair for lateral ligament reconstruction.

    Science.gov (United States)

    Brown, Christopher A; Hurwit, Daniel; Behn, Anthony; Hunt, Kenneth J

    2014-02-01

    Anatomic repair is indicated for patients who have recurrent lateral ankle instability despite nonoperative measures. There is no difference in repair stiffness, failure torque, or failure angle between specimens repaired with all-soft suture anchors versus the modified Broström-Gould technique with sutures only. Controlled laboratory study. In 10 matched pairs of human cadaveric ankles, the anterior talofibular ligament (ATFL) was incised from its origin on the fibula. After randomization, 1 ankle was repaired to its anatomic insertion using two 1.4-mm JuggerKnot all-soft suture anchors; the other ankle was repaired with a modified Broström-Gould technique using 2-0 FiberWire. All were augmented using the inferior extensor retinaculum. All ankles were mounted to the testing machine in 20° of plantar flexion and 15° of internal rotation and loaded to failure after the repair. Stiffness, failure torque, and failure angle were recorded and compared using a paired Student t test with a significance level set at P anchors pulled out of bone. The primary mode of failure was pulling through the ATFL tissue. There was no statistical difference in strength or stiffness between a 1.4-mm all-soft suture anchor and a modified Broström-Gould repair with 2-0 FiberWire. The primary mode of failure was at the tissue level rather than knot failure or anchor pullout. The particular implant choice (suture only, tunnel, anchor) in repairing the lateral ligament complex may not be as important as the time to biological healing. The suture-only construct as described in the Broström-Gould repair was as strong as all-soft suture anchors, and the majority of the ankles failed at the tissue level. For those surgeons whose preference is to use anchor repair, this novel all-soft suture anchor may be an alternative to other larger anchors, as none failed by pullout.

  6. New adjustable suture technique for trabeculectomy

    Directory of Open Access Journals (Sweden)

    Vespasiano Rebouças-Santos

    2013-06-01

    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.

  7. Novel Spiked-Washer Repair Is Biomechanically Superior to Suture and Bone Tunnels for Arcuate Fracture Repair.

    Science.gov (United States)

    Vojdani, Saman; Fernandez, Laviel; Jiao, Jian; Enders, Tyler; Ortiz, Steven; Lin, Liangjun; Qin, Yi-Xian; Komatsu, David E; Penna, James; Ruotolo, Charles J

    2017-03-01

    Injuries to the posterolateral corner of the knee can lead to chronic degenerative changes, external rotation instability, and varus instability if not repaired adequately. A proximal fibula avulsion fracture, referred to as an arcuate fracture, has been described in the literature, but a definitive repair technique has yet to be described. The objective of this study was to present a novel arcuate fracture repair technique, using a spiked-washer with an intramedullary screw, and to compare its biomechanical integrity to a previously described suture and bone tunnel method. Ten fresh-frozen cadaveric knees underwent a proximal fibula osteotomy to simulate a proximal fibula avulsion fracture. The lateral knee capsule and posterior cruciate ligament were also sectioned to create maximal varus instability. Five fibulas were repaired using a novel spiked-washer technique and the other 5 were repaired using the suture and bone tunnel method. The repaired knees were subjected to a monotonic varus load using a mechanical testing system instrument until failure of the repair or associated posterolateral corner structures. Compared with the suture repair group, the spiked-washer repair group demonstrated a 100% increase in stiffness, 100% increase in yield, 110% increase in failure force, and 108% increase in energy to failure. The spiked-washer technique offers superior quasi-static biomechanical performance compared with suture repair with bone tunnels for arcuate fractures of the proximal fibula. Further clinical investigation of this technique is warranted and the results of this testing may lead to improved outcomes and patient satisfaction for proximal fibula avulsion fractures.

  8. A Comparison of Two Monofilament Suture Materials for Repair of Partial Flexor Tendon Lacerations: A Controlled In-vitro Study.

    Science.gov (United States)

    Gulihar, Abhinav; Whitehead-Clarke, Thomas; Hajipour, Ladan; Dias, Joe J

    2017-03-01

    Surgical repair is advocated for flexor tendon lacerations deeper than 70%. Repair can be undertaken with different suturing techniques and using different materials. Different materials used for tendon repair will have a different gliding resistance (GR) at the joint. Previous studies have compared strength of repair and gliding resistance for various braided suture materials and for 100% laceration of flexor tendons. We directly compare the GR of two monofilament sutures when used for a peripheral running suture repair of partially lacerated tendons. Sixteen flexor tendons and A2 pulleys were harvested from Turkey feet. They were prepared, partially lacerated to 50% depth, and then repaired with a core suture (modified Kessler technique with 4-0 Ethibond) as well as an additional superficial running suture of either 6-0 Prolene or Nylon (half randomised to each). Gliding resistance was measured for all tendons before and after repair, at different flexion angles (40 and 60 degrees) and for different loads (2N and 4N). After surgical repair, gliding resistance was increased for all tendons (P resistance than those repaired with Nylon (P = 0.02). Increased flexion angle and load amplified the gliding resistance (both P resistance than 6-0 Prolene but the minor differences bare unknown clinical significance.

  9. Load to Failure and Stiffness: Anchor Placement and Suture Pattern Effects on Load to Failure in Rotator Cuff Repairs.

    Science.gov (United States)

    Esquivel, Amanda O; Duncan, Douglas D; Dobrasevic, Nikola; Marsh, Stephanie M; Lemos, Stephen E

    2015-04-01

    Rotator cuff tendinopathy is a frequent cause of shoulder pain that can lead to decreased strength and range of motion. Failures after using the single-row technique of rotator cuff repair have led to the development of the double-row technique, which is said to allow for more anatomical restoration of the footprint. To compare 5 different types of suture patterns while maintaining equality in number of anchors. The hypothesis was that the Mason-Allen-crossed cruciform transosseous-equivalent technique is superior to other suture configurations while maintaining equality in suture limbs and anchors. Controlled laboratory study. A total of 25 fresh-frozen cadaveric shoulders were randomized into 5 suture configuration groups: single-row repair with simple stitch technique; single-row repair with modified Mason-Allen technique; double-row Mason-Allen technique; double-row cross-bridge technique; and double-row suture bridge technique. Load and displacement were recorded at 100 Hz until failure. Stiffness and bone mineral density were also measured. There was no significant difference in peak load at failure, stiffness, maximum displacement at failure, or mean bone mineral density among the 5 suture configuration groups (P sutures in the repair should be considered to judge the strength of the repair. Previous in vitro studies have shown the double-row rotator cuff repair to be superior to the single-row repair; however, clinical research does not necessarily support this. This study found no difference when comparing 5 different repair methods, supporting research that suggests the number of sutures and not the pattern can affect biomechanical properties.

  10. Patellar Tendon Repair Augmentation With a Knotless Suture Anchor Internal Brace: A Biomechanical Cadaveric Study.

    Science.gov (United States)

    Rothfeld, Alex; Pawlak, Amanda; Liebler, Stephenie A H; Morris, Michael; Paci, James M

    2018-02-01

    Patellar tendon repair with braided polyethylene suture alone is subject to knot slippage and failure. Several techniques to augment the primary repair have been described. Purpose/Hypothesis: The purpose was to evaluate a novel patellar tendon repair technique augmented with a knotless suture anchor internal brace with suture tape (SAIB). The hypothesis was that this technique would be biomechanically superior to a nonaugmented repair and equivalent to a standard augmentation with an 18-gauge steel wire. Controlled laboratory study. Midsubstance patellar tendon tears were created in 32 human cadaveric knees. Two comparison groups were created. Group 1 compared #2 supersuture repair without augmentation to #2 supersuture repair with SAIB augmentation. Group 2 compared #2 supersuture repair with an 18-gauge stainless steel cerclage wire augmentation to #2 supersuture repair with SAIB augmentation. The specimens were potted and biomechanically loaded on a materials testing machine. Yield load, maximum load, mode of failure, plastic displacement, elastic displacement, and total displacement were calculated for each sample. Standard statistical analysis was performed. There was a statistically significant increase in the mean ± SD yield load and maximum load in the SAIB augmentation group compared with supersuture alone (mean yield load: 646 ± 202 N vs 229 ± 60 N; mean maximum load: 868 ± 162 N vs 365 ± 54 N; P load: 495 ± 213 N vs 566 ± 172 N; P = .476; mean maximum load: 737 ± 210 N vs 697 ± 130 N; P = .721). Patellar tendon repair augmented with SAIB is biomechanically superior to repair without augmentation and is equivalent to repair with augmentation with an 18-gauge stainless steel cerclage wire. This novel patellar tendon repair augmentation is equivalent to standard 18-gauge wire augmentation at time zero. It does not require a second surgery for removal, and it is biomechanically superior to primary repair alone.

  11. A COMPARATIVE STUDY OF TWO SUTURE CONFIGURATIONS IN ZONE II FLEXOR TENDON REPAIR IN ADULTS

    Directory of Open Access Journals (Sweden)

    A. M. Navali

    2008-06-01

    Full Text Available Although the increase in the number of core sutures during flexor tendon repair increases the tensile strength of the repair, both increased handling at the time of repair and increased bulk at the repair site have been hypothesized as affecting clinical outcomes by increasing gliding resistance. The purpose of our study was to assess whether increasing the number of core sutures from two strands to four strands in zone II flexor tendon repair could improve the clinical results. A total of 42 patients with 60 flexor tendon lacerations in zone II were enrolled in this study. The injured tendon randomly underwent surgical repair by using one of the 2-strand or 4-strand modified Strickland techniques. Postoperative rehabilitation was the active extension-rubber band flexion method of Kleinert in all patients. The average duration of follow up was 8 months. The mean total active motion was 155.16˚ in 2-strand group (excluding two ruptures and 154.33˚ in 4-strand group (P > 0.05. Using Strickland's original score, this corresponds to excellent result in 83.3% and 86.6% of patients in 2-strand group and 4-strand group, respectively. Statistically, there was no significant difference between the clinical outcomes obtained in these groups. Concerning the tendon rupture after the repair, all of the ruptures (2 cases occurred in the 2-strand group (P > 0.05. We concluded that both suture strength and gliding resistance have influence on the result of flexor tendon repair in zone II, and increasing the number of core sutures and the resulting suture strength may be negatively affected by increase in gliding resistance.

  12. Suture, synthetic, or biologic in contaminated ventral hernia repair.

    Science.gov (United States)

    Bondre, Ioana L; Holihan, Julie L; Askenasy, Erik P; Greenberg, Jacob A; Keith, Jerrod N; Martindale, Robert G; Roth, J Scott; Liang, Mike K

    2016-02-01

    Data are lacking to support the choice between suture, synthetic mesh, or biologic matrix in contaminated ventral hernia repair (VHR). We hypothesize that in contaminated VHR, suture repair is associated with the lowest rate of surgical site infection (SSI). A multicenter database of all open VHR performed at from 2010-2011 was reviewed. All patients with follow-up of 1 mo and longer were included. The primary outcome was SSI as defined by the Centers for Disease Control and Prevention. The secondary outcome was hernia recurrence (assessed clinically or radiographically). Multivariate analysis (stepwise regression for SSI and Cox proportional hazard model for recurrence) was performed. A total of 761 VHR were reviewed for a median (range) follow-up of 15 (1-50) mo: there were 291(38%) suture, 303 (40%) low-density and/or mid-density synthetic mesh, and 167(22%) biologic matrix repair. On univariate analysis, there were differences in the three groups including ethnicity, ASA, body mass index, institution, diabetes, primary versus incisional hernia, wound class, hernia size, prior VHR, fascial release, skin flaps, and acute repair. The unadjusted outcomes for SSI (15.1%; 17.8%; 21.0%; P = 0.280) and recurrence (17.8%; 13.5%; 21.5%; P = 0.074) were not statistically different between groups. On multivariate analysis, biologic matrix was associated with a nonsignificant reduction in both SSI and recurrences, whereas synthetic mesh associated with fewer recurrences compared to suture (hazard ratio = 0.60; P = 0.015) and nonsignificant increase in SSI. Interval estimates favored biologic matrix repair in contaminated VHR; however, these results were not statistically significant. In the absence of higher level evidence, surgeons should carefully balance risk, cost, and benefits in managing contaminated ventral hernia repair. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Randomized clinical trial of self-gripping mesh versus sutured mesh for Lichtenstein hernia repair

    DEFF Research Database (Denmark)

    Jorgensen, L N; Sommer, Thorbjørn; Assaadzadeh, S

    2013-01-01

    BACKGROUND: Many patients develop discomfort after open repair of a groin hernia. It was hypothesized that suture fixation of the mesh is a cause of these symptoms. METHODS: This patient- and assessor-blinded randomized multicentre clinical trial compared a self-gripping mesh (Parietene Progrip......(®) ) and sutured mesh for open primary repair of uncomplicated inguinal hernia by the Lichtenstein technique. Patients were assessed before surgery, on the day of operation, and at 1 and 12 months after surgery. The primary endpoint was moderate or severe symptoms after 12 months, including a combination...... of chronic pain, numbness and discomfort. RESULTS: The intention-to-treat population comprised 163 patients with self-gripping mesh and 171 with sutured mesh. The 12-month prevalence of moderate or severe symptoms was 17·4 and 20·2 per cent respectively (P = 0·573). There were no significant differences...

  14. Comparison of a new multifilament stainless steel suture with frequently used sutures for flexor tendon repair.

    Science.gov (United States)

    McDonald, Erik; Gordon, Joshua A; Buckley, Jenni M; Gordon, Leonard

    2011-06-01

    To investigate the mechanical properties of some common suture materials currently in use and compare them with a new multifilament stainless steel suture. We investigated the mechanical properties of 3-0 and 4-0 Fiberwire, 3-0 Supramid, 3-0 Ethibond, and a new 3-0 and 4-0 multifilament stainless steel suture. All suture material was tested in a knotted configuration and all but the Supramid was tested in an unknotted configuration. We measured the load, elongation at failure, and stiffness during both tests. The 4-0 multifilament stainless steel showed the least elongation, whereas the 3-0 multifilament stainless steel withstood the highest load of any material in both the knotted and unknotted tests. There was no difference in stiffness between the 3-0 and 4-0 multifilament stainless steel when untied; however, the 3-0 multifilament stainless steel was stiffer when tied. Soaking in a saline solution had no significant effect on the ultimate load, elongation at failure, or stiffness of any of the sutures. The 3-0 Fiberwire and 3-0 Ethibond required at least 5 throws to resist untying. Multifilament stainless steel exhibited promising mechanical advantages over the other sutures tested. More research is needed to determine how this material will affect the clinical outcomes of primary flexor tendon repair. With a secure attachment to the tendon, the multifilament stainless steel's lower elongation and better knot-holding ability may result in a higher force to produce a 2-mm gap and a higher ultimate tensile strength in a tendon repair. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. Groin hernia repair in young males: mesh or sutured repair?

    DEFF Research Database (Denmark)

    Bisgaard, T; Bay-Nielsen, M; Kehlet, H

    2010-01-01

    Large-scale data for the optimal inguinal hernia repair in younger men with an indirect hernia is not available. We analysed nationwide data for risk of reoperation in younger men after a primary repair using a Lichtenstein operation or a conventional non-mesh hernia repair....

  16. [Repair of rotator cuff tear by allogenic cortical bone anchor with suture bridge].

    Science.gov (United States)

    Wang, Ming-xin; Liu, Yu-jie; He, Wei; Li, Hai-feng; An, Bai-jing

    2012-07-03

    To evaluate the repair of rotator cuff tear by allogenic cortical bone anchors with the technique of suture bridge. A total of 18 patients with rotator cuff tear were recruited during the period of June 2006 to June 2009. There were 7 males and 11 females with an average age of 45.2 years old (range: 34 - 65). The locations included left shoulder (n = 11) and right shoulder (n = 7). Rotator cuff tear was repaired by allogenic cortical bone anchors with the technique of suture bridge under arthroscopy. The efficacy was evaluated by University of California Los Angeles (UCLA) standard score. The average follow-up period was 17.6 months (range: 12 - 36). The excellent rate of treatment was 100%. All rotator cuff tears were healed. Only 2 cases had minor pain and there was no limitation of joint activity. The bone anchor fully integrated with the subject area at Month 3 post-operation. The advantages of repairing rotator cuff tear by allograft cortical bone anchors with the technique of suture bridge includes minimal trauma, a large tendon bone area, firm fixation and a low cost. It is a better approach of repairing rotator cuff tear.

  17. The optimum tension for bridging sutures in transosseous-equivalent rotator cuff repair: a cadaveric biomechanical study.

    Science.gov (United States)

    Park, Ji Soon; McGarry, Michelle H; Campbell, Sean T; Seo, Hyuk Jun; Lee, Yeon Soo; Kim, Sae Hoon; Lee, Thay Q; Oh, Joo Han

    2015-09-01

    Transosseous-equivalent (TOE) rotator cuff repair can increase contact area and contact pressure between the repaired cuff tendon and bony footprint and can show higher ultimate loads to failure and smaller gap formation compared with other repair techniques. However, it has been suggested that medial rotator cuff failure after TOE repair may result from increased bridging suture tension. To determine optimum bridging suture tension in TOE repair by evaluating footprint contact and construct failure characteristics at different tensions. Controlled laboratory study. A total of 18 fresh-frozen cadaveric shoulders, randomly divided into 3 groups, were constructed with a TOE configuration using the same medial suture anchor and placing a Tekscan sensing pad between the repaired rotator cuff tendon and footprint. Nine of the 18 shoulders were used to measure footprint contact characteristics. With use of the Tekscan measurement system, the contact pressure and area between the rotator cuff tendon and greater tuberosity were quantified for bridging suture tensions of 60, 90, and 120 N with glenohumeral abduction angles of 0° and 30° and humeral rotation angles of 30° (internal), 0°, and 30° (external). TOE constructs of all 18 shoulders then underwent construct failure testing (cyclic loading and load to failure) to determine the yield load, ultimate load, stiffness, hysteresis, strain, and failure mode at 60 and 120 N of tension. As bridging suture tension increased, contact force, contact pressure, and peak pressure increased significantly at all positions (P .05 for all). Increasing bridging suture tension to over 90 N did not improve contact area but did increase contact force and pressure. Bridging suture tension did not significantly affect ultimate failure loads. Considering the risks of overtensioning bridging sutures, it may be clinically more beneficial to keep bridging suture tension below 90 N. © 2015 The Author(s).

  18. Double-Row Suture Anchor Repair of Posterolateral Corner Avulsion Fractures.

    Science.gov (United States)

    Gilmer, Brian B

    2017-08-01

    Posterolateral corner avulsion fractures are a rare variant of ligamentous knee injury primarily described in the skeletally immature population. Injury is often related to a direct varus moment placed on the knee during sporting activities. Various treatment strategies have been discussed ranging from nonoperative management, to excision of the bony fragment, to primary repair with screws or suture. The described technique is a means for achieving fixation of the bony avulsion using principles familiar to double-row transosseous equivalent rotator cuff repair. Proximal anchors are placed in the epiphysis, and sutures are passed in horizontal mattress fashion. Once tied, the limbs of these same sutures are then passed to more distal anchors. Remaining eyelet sutures can be used to manage peripheral tissue. The final repair provides anatomic reduction and compression of the fragment to its bony bed with minimal extracortical hardware prominence and no violation of the physis. Risks include potential for physeal injury or chondral damage to the lateral femoral condyle through aberrant anchor placement. Postoperative care includes toe-touch weight-bearing restrictions and range of motion restrictions of 0°-90° in a hinged brace for 6 weeks followed by gradual return to activity.

  19. Repairing Posteromedial Meniscocapsular Separation: A Technique Using Inside-Out Meniscal Repair Needles.

    Science.gov (United States)

    Joshi, Anant; Usman, Sajeer; Sabnis, Bhushan; Kini, Abhishek

    2016-02-01

    Posteromedial meniscocapsular separation of the knee has received renewed interest, with many articles describing a high incidence in association with anterior cruciate ligament injury. Various techniques have been described to address these lesions using all-inside meniscal repair sutures or using rotator cuff repair instruments through the posteromedial portal. Most orthopaedic surgeons are accustomed to using the "inside-out" meniscal repair technique with a double-armed suture. This technique is cost-effective and, in our opinion, more efficient in repairing such tears. We present our technique of repairing peripheral meniscocapsular lesions using an inside-out meniscal repair system. We believe that this technique is easily reproducible, is less time-consuming, and ensures a good "bite" of the capsular tissue, producing a robust repair.

  20. Distal biceps tendon repair: a cadaveric analysis of suture anchor and interference screw restoration of the anatomic footprint.

    Science.gov (United States)

    Jobin, Charles M; Kippe, Matthew A; Gardner, Thomas R; Levine, William N; Ahmad, Christopher S

    2009-11-01

    Distal biceps tendon repair with interference screw or double suture-anchor fixation are 2 successful techniques performed with either 1- or 2-incision approaches. No study has examined the accuracy and quality of the repaired tendon footprint with these devices and approaches. A 2-incision approach will allow a more anatomic repair of the distal biceps footprint compared with a 1-incision anterior approach. Fixation technique will affect insertional footprint location and footprint contact area. Controlled laboratory study. After randomization, 36 distal biceps repairs were performed on human cadaveric upper extremity specimens, with 1- or 2-incision approaches and with fixation devices of either two 5.5-mm suture anchors or an 8-mm interference screw. Native and repaired footprint areas and centroid location were calculated with a 3-dimensional digitizer. Interference screw repair had the smallest footprint area (135 mm(2)) compared with suture anchor repair (197 mm(2)) and the native tendon (259 mm(2)) (P = .013). The 2-incision approach repaired the footprint to a more posterior and anatomic position (2.5 mm) than a 1-incision approach (P = .001). The fixation device did not affect footprint location significantly. Suture anchor repair more closely re-creates the footprint area on the radial tuberosity of the native distal biceps tendon compared with the interference screw repair. A 2-incision approach more closely re-creates footprint position compared with the 1-incision approach. A 2-incision approach with double suture-anchor fixation may yield a more anatomic distal biceps repair based on reproduction of the footprint compared with a 1-incision approach.

  1. Tension Regulation at the Suture Lines for Repair of Neglected Achilles Tendon Laceration.

    Science.gov (United States)

    Massoud, Elsayed Ibraheem Elsayed

    2017-03-01

    Operative intervention is the preferred option for management of the neglected laceration of the Achilles tendon. However, the commonly used techniques rarely follow the principles of the regenerative medicine for the restoration of the lost tissue. This study postulated that incorporation of the autogenous tendon graft would properly progress when the interplay between mechanical loading and healing phases was correctly applied. A prospective study included 15 patients who were treated for neglected Achilles tendon laceration using the technique of lengthening of the proximal tendon stump. An absorbable reinforcement suture was used for control of the mechanical environment at the suture lines. By an average 5 years of the prospective follow-up, all the repaired tendons had restored continuity and length. The calf circumference equalized to the uninjured side in 12 patients. However, 3 patients had calf atrophy but they improved compared to the preoperative measurements. Sonogram confirmed the restoration of the normal thickness and the gliding characteristics of the repaired tendon. The technique restored continuity and tension of the repaired tendon, preserved the calf circumference, and prevented peritendinous adhesions. The absorbable reinforcement suture spontaneously allowed for the mechanical loading of the grafted tendon. Level IV, case series.

  2. Fast Absorbing Gut Suture versus Cyanoacrylate Tissue Adhesive in the Epidermal Closure of Linear Repairs Following Mohs Micrographic Surgery

    OpenAIRE

    Kim, June; Singh Maan, Harjot; Cool, Alicia J.; Hanlon, Allison M.; Leffell, David J.

    2015-01-01

    Background: Cyanoacrylate topical adhesives and fast absorbing gut sutures are increasingly utilized by dermatologic surgeons as they provide satisfactory surgical outcomes while eliminating an additional patient visit for suture removal. To date, no head-to-head studies have compared the wound healing characteristics of these epidermal closure techniques in the repair of facial wounds after Mohs micrographic surgery. Objective: To compare the cosmetic outcome of epidermal closure by cyanoacr...

  3. Comparison of all-inside meniscal repair devices with matched inside-out suture repair.

    Science.gov (United States)

    Rosso, Claudio; Kovtun, Konstantin; Dow, William; McKenzie, Brett; Nazarian, Ara; DeAngelis, Joseph P; Ramappa, Arun J

    2011-12-01

    All-inside meniscal repairs are performed with increasing frequency because of the availability of newly developed devices. A comparison of their biomechanical characteristics may aid physicians in selecting a method of meniscal repair. All-inside meniscal repairs will be superior to their inside-out controls in response to cyclic loading and load-to-failure testing. Controlled laboratory study. Sixty-six bucket-handle tears in matched porcine menisci were repaired using the Ultra FasT-Fix, Meniscal Cinch, Ultrabraid No. 0, and FiberWire 2-0 sutures. Initial displacement, cyclic loading (100, 300, and 500 cycles), and load-to-failure testing were performed. The displacement, response to cyclic loading, and mode of failure were recorded. The stiffness was calculated. The Meniscal Cinch demonstrated a significantly higher initial displacement than the other methods tested (P = .04). No significant difference was found among the methods in response to cyclic loading. The inside-out FiberWire repair demonstrated the highest load to failure (120.8 ± 23.5 N) and was significantly higher than both the Meniscal Cinch (64.8 ± 24.1 N, P inside-out Ultrabraid suture repair (98.8 ± 29.2 N). The inside-out FiberWire repair had the highest stiffness (28.7 ± 7.8 N/mm). It was significantly higher than the Meniscal Cinch (18.0 ± 8.8 N/mm, P = .01). The most common mode of failure in all methods was suture failure. An inside-out suture repair affords surgeons the best overall biomechanical characteristics of the devices tested (initial displacement, response to cyclic loading, and load to failure). For an all-inside repair, the Ultra FasT-Fix reproduces the characteristics of its matched inside-out suture repair more closely than the Meniscal Cinch. Inside-out sutures and all-inside devices have similar responses to cyclic loading.

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

    Science.gov (United States)

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

    2015-02-01

    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.

  5. Understanding the logic of common suturing techniques in dermatologic surgery

    OpenAIRE

    Yazdani Abyaneh, Mohammad-Ali; Levitt, Jacob O

    2015-01-01

    Although most trainees in dermatology learn that different suturing techniques are designated for a specific purpose (i.e., certain functional and cosmetic outcomes), students often have a difficult time visualizing how a given suture functions in its designated capacity. In this article, we address the logic behind the most common suturing techniques in dermatologic surgery, including the direction and magnitude of their pulling force with respect to the wound edges and the ensuing displacem...

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

    LENUS (Irish Health Repository)

    Baig, M N

    2017-05-01

    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.

  7. Early results of all-inside meniscal repairs using a pre-loaded suture anchor.

    Science.gov (United States)

    Fok, August W M; Yau, W P

    2013-04-01

    To report the clinical and radiological results of all-inside meniscal repairs using a pre-loaded suture anchor. Case series. Regional hospital, Hong Kong. From January 2008 to June 2010, 51 patients with a mean age of 26 (range, 15-48) years with 57 meniscal tears underwent meniscal repair utilising the all-inside meniscal repair technique entailing a pre-loaded suture anchor. All tears were located at red-red or red-white zones. Concurrent anterior cruciate ligament reconstruction was performed in 37 (73%) of the patients. Patients were evaluated postoperatively based on the International Knee Documentation Committee score, clinical examination, and magnetic resonance imaging. Presence of locking, joint-line tenderness, effusion, and positive McMurray test were considered to indicate clinical failure. The mean follow-up was 19 (range, 12-39) months. An average of 2 (range, 1 to 4) suture devices was used per patient. The mean tear size was 20 (range, 10-40) mm. In all, 10 (18%) of the tears had failed clinically and 11 (19%) appeared unhealed on postoperative imaging. The mean International Knee Documentation Committee score improved significantly from 62 preoperatively to 81 postoperatively (Psuture anchor is safe and effective, and yielded an 83% clinical and 81% radiological success rate.

  8. Entrapment of Common Peroneal Nerve by Surgical Suture following Distal Biceps Femoris Tendon Repair

    OpenAIRE

    Fukuda, Aki; Nishimura, Akinobu; Nakazora, Shigeto; Kato, Ko; Sudo, Akihiro

    2016-01-01

    We describe entrapment of the common peroneal nerve by a suture after surgical repair of the distal biceps femoris tendon. Complete rupture of the distal biceps femoris tendon of a 16-year-old male athlete was surgically repaired. Postoperative common peroneal nerve palsy was evident, but conservative treatment did not cause any neurological improvement. Reexploration revealed that the common peroneal nerve was entrapped by the surgical suture. Complete removal of the suture and external neur...

  9. Chronic complaints after simple sutured repair for umbilical or epigastric hernias may be related to recurrence

    DEFF Research Database (Denmark)

    Westen, Mikkel; Christoffersen, Mette W; Jorgensen, Lars N

    2014-01-01

    PURPOSE: Umbilical and epigastric hernia repairs are minor, but are commonly conducted surgical procedures. Long-term results have only been sparsely investigated. Our objective was to investigate the risk of chronic complaints after a simple sutured repair for small umbilical and epigastric...... hernias. METHODS: A retrospective cohort study with a 5-year questionnaire and clinical follow-up was conducted. Patients undergoing primary elective, open non-mesh umbilical or epigastric sutured hernia repair were included. Patients completed a structured questionnaire regarding chronic complaints...... or mild complaints (78.6 vs. 22.2 % (P suture (20.1 %) compared with non-absorbable suture repair (4.2 %) (P sutured umbilical or epigastric repair...

  10. Optimal suture anchor direction in arthroscopic lateral ankle ligament repair.

    Science.gov (United States)

    Yoshimura, Ichiro; Hagio, Tomonobu; Noda, Masahiro; Kanazawa, Kazuki; Minokawa, So; Yamamoto, Takuaki

    2017-05-26

    In this study, the distance between the insertion point of the suture anchors and posterior surface of the fibula during arthroscopic lateral ankle ligament repair was investigated on computed tomography (CT) images. The hypothesis of this study was that there is an optimal insertional direction of the suture anchor to avoid anchor-related complications. One hundred eleven ankles of 98 patients who had undergone three-dimensional CT scans for foot or ankle disorders without deformity of the fibula were assessed (59 males, 52 females; median age 25.5 years; age range 12-78 years). The shortest distance from the insertion point of the suture anchor to the deepest point of the fossa/top of the convex aspect of the fibula was measured on the axial plane, tilting from the longitudinal axis of the fibula at 90°, 75°, 60°, and 45°. The distance from the insertion point of the suture anchor to the posterior surface of the fibula was also measured in a direction parallel to the sagittal plane of the lateral surface of the talus on the axial plane, tilting from the longitudinal axis of the fibula at 90°, 75°, 60°, and 45°. The posterior fossa was observed in all cases on the 90° and 75° images. The distance from the insertion point to the posterior surface of the fibula in the parallel direction was 15.0 ± 3.4 mm at 90°, 17.5 ± 3.2 mm at 75°, 21.7 ± 3.3 mm at 60°, and 25.7 ± 3.6 mm at 45°. The posterior points in the parallel direction were located on the posterior fossa in 36.0% of cases at 90°, in 12.6% at 75°, and in 0.0% at 60° and 45°. The suture anchor should be directed from anterior to posterior at an angle of <45° to the longitudinal axis of the fibula, parallel to the lateral surface of the talus, to avoid passing through the fibula. Cohort study, Level III.

  11. Medial grasping sutures significantly improve load to failure of the rotator cuff suture bridge repair.

    Science.gov (United States)

    Awwad, George E; Eng, Kevin; Bain, Gregory I; McGuire, Duncan; Jones, Claire F

    2014-05-01

    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.

  12. Suture welding for arthroscopic repair of peripheral triangular fibrocartilage complex tears.

    Science.gov (United States)

    Badia, Alejandro; Khanchandani, Prakash

    2007-03-01

    This report presents a method of arthroscopic repair of the peripheral triangular fibrocartilage tears by using ultrasonic suture welding technique, thus avoiding the need for traditional suture knots. This technique eliminates the potential causes of ulnar-sided wrist discomfort especially during the postoperative period. Twenty-three patients (9 women and 14 men; mean age, 35 years; range, 18-52 years) were operated during a 1-year period in 2001 for Palmer grade 1B triangular fibrocartilage complex tear and followed up for 17 months. At the final follow-up, the average wrist arc of motion was as follows: extension, 65 degrees; flexion, 56 degrees; supination, 80 degrees; pronation, 78 degrees; radial deviation, 12 degrees; and ulnar deviation, 25 degrees. Grip strength measured with a dynamometer (Jamar) averaged 81% of the contralateral side at the final evaluation (range, 53%-105%).

  13. FasT-Fix versus inside-out suture meniscal repair in the goat model.

    Science.gov (United States)

    Hospodar, Steven J; Schmitz, Matthew R; Golish, S Raymond; Ruder, Craig R; Miller, Mark D

    2009-02-01

    Recent all-inside meniscal repair devices are available, but in vivo studies with these devices are sparse. The FasT-Fix has inferior meniscal healing compared with the inside-out suture technique in the goat model. Controlled laboratory study. After Institutional Review Board approval, 73 male castrated goats (Capra hircus) underwent a 2-cm meniscal incision and subsequent repair with the FasT-Fix device on one knee and inside-out meniscal repair on the contralateral knee. Both repairs used a vertical mattress suture technique. Access to the menisci was via an open technique with an extra-articular osteotomy of the medial collateral ligament origin on the femur. The animals were then allowed to ambulate unrestricted in a pasture after a 7-day stay in cages. Necropsy was carried out 6 months postoperatively, and the menisci and articular cartilage were studied with gross and microscopic inspection. Nine of the 73 animals were excluded before necropsy. A total of 64 animals underwent necropsy, gross measurement of residual lesions, gross evaluation for chondral damage, histologic evaluation of meniscal repair, histologic evaluation of any adjacent inflammatory reaction to implants, and data analysis. Compared with the inside-out group, the FasT-Fix group had longer residual full-thickness defects (1.2 +/- 2.9 mm vs 0.2 +/- 1.1 mm; P = .011) and longer residual partial-thickness defects (8.4 +/- 6.3 mm vs 3.6 +/- 5.5 mm; P inside-out meniscal repair technique in the goat model. The clinical significance of this finding is not known. Further clinical study of the FasT-Fix implant is warranted.

  14. Hydrostatic comparison of nonpenetrating titanium clips versus conventional suture for repair of spinal durotomies.

    Science.gov (United States)

    Faulkner, Nathan D; Finn, Michael A; Anderson, Paul A

    2012-04-20

    Biomechanics. To compare the hydrostatic strength of suture and nonpenetrating titanium clip repairs of standard spinal durotomies. Dural tears are a frequent complication of spine surgery and can be associated with significant morbidity. Primary repair of durotomies with suture typically is attempted, but a true watertight closure can be difficult to obtain because of leakage through suture tracts. Nonpenetrating titanium clips have been developed for vascular anastomoses and provide a close apposition of the tissues without the creation of a suture tract. Twenty-four calf spines were prepared with laminectomies and the spinal cord was evacuated leaving an intact dura. After Foley catheters were inserted from each end and inflated adjacent to a planned dural defect, the basal flow rate was measured and a 1-cm longitudinal durotomy was made with a scalpel. Eight repairs were performed for each material, which included monofilament suture, braided suture, and nonpenetrating titanium clips. The flow rate at 30, 60, and 90 cm of water and the time needed for each closure were measured. There was no statistically significant difference in the baseline leak rate for all 3 groups. There was no difference in the leakage rate of durotomies repaired with clips and intact specimens at any pressure. Monofilament and braided suture repairs allowed significantly more leakage than both intact and clip-repaired specimens at all pressures. The difference in leak rate increased as the pressure increased. Closing the durotomy with clips took less than half the time of closure with suture. Nonpenetrating titanium clips provide a durotomy closure with immediate hydrostatic strength similar to intact dura whereas suture repair with either suture was significantly less robust. The use of titanium clips was more rapid than that of suture repair.

  15. Repair of the Thumb Ulnar Collateral Ligament With Suture Tape Augmentation.

    Science.gov (United States)

    De Giacomo, Anthony F; Shin, Steven S

    2017-09-08

    One of the most commonly injured structures of the thumb metacarpophalangeal (MCP) joint is the ulnar collateral ligament (UCL). An acute injury of this ligament is often amenable to primary repair. Despite the favorable outcomes of primary repair, the thumb is often restricted during initial healing of the ligament with immobilization and delayed rehabilitation. We present a novel technique to augment the repair of the UCL with suture tape to provide immediate biomechanical support and strength during the critical time of ligament healing. We describe the surgical technique of suture tape augmentation for thumb UCL repair. At the ulnar aspect of the thumb MCP joint, a longitudinal midaxial incision is made. Subsequently, the adductor pollicis aponeurosis and extensor mechanism are identified, incised, and retracted. The UCL is exposed and usually torn off the volar-ulnar base of the proximal phalanx. A 2.5-mm PushLock anchor loaded with 1.3-mm SutureTape and 3-0 FiberWire suture, is placed into a hole at the volar-ulnar base of the proximal phalanx after preparation with a 1.8-mm drill bit. The 3-0 FiberWire is used for direct repair of the ligament. Both tails of the 1.3-mm SutureTape is then brought proximally over the ligament and loaded into a 3.5-mm SwiveLock anchor. A 3.2-mm drill bit is then used to make a hole at the ulnar aspect of the metacarpal head, just proximal to the attachment of the proximal UCL. With the thumb MCP joint held in at least 30 degrees of flexion, the tape-loaded 3.5-mm SwiveLock anchor is inserted into metacarpal head. Reinforcement of the repair is then carried out with fine absorbable suture to surrounding capsular tissue. We present a representative case of a professional basketball player treated with this novel procedure. After the surgical repair, the patient was placed in a plaster splint for 3 days to immobilize the thumb and wrist. At 3 days postsurgery, the splint was removed and therapy initiated. Practice drills were

  16. Fast Absorbing Gut Suture versus Cyanoacrylate Tissue Adhesive in the Epidermal Closure of Linear Repairs Following Mohs Micrographic Surgery.

    Science.gov (United States)

    Kim, June; Singh Maan, Harjot; Cool, Alicia J; Hanlon, Allison M; Leffell, David J

    2015-02-01

    Cyanoacrylate topical adhesives and fast absorbing gut sutures are increasingly utilized by dermatologic surgeons as they provide satisfactory surgical outcomes while eliminating an additional patient visit for suture removal. To date, no head-to-head studies have compared the wound healing characteristics of these epidermal closure techniques in the repair of facial wounds after Mohs micrographic surgery. To compare the cosmetic outcome of epidermal closure by cyanoacrylate topical adhesive with fast absorbing gut suture in linear repairs of the face following Mohs micrographic surgery. Fourteen patients with wound length greater than 3cm who underwent Mohs micrographic surgery for nonmelanoma skin cancer of the face were enrolled in this randomized right-left comparative study. Following placement of dermal sutures, half of the wound was randomly selected for closure with cyanoacrylate and the contralateral side with fast absorbing gut suture. Using photographs from the three-month postoperative visit, six blinded individuals rated the overall cosmetic outcome. The present study shows no significant difference in cosmetic outcomes between cyanoacrylate and fast absorbing gut suture for closure of linear facial wounds resulting from Mohs micrographic surgery. Cyanoacrylate tissue adhesive may not be as effective in achieving optimal cosmesis for wounds on the forehead or of longer repair lengths. The majority of patients did not have a preference for wound closure techniques, but when a preference was given, cyanoacrylate was significantly favored over sutures. Cyanoacrylate tissue adhesive and fast absorbing gut suture both result in comparable aesthetic outcomes for epidermal closure of linear facial wounds following Mohs micrographic surgery. Consideration should be given to factors such as need for eversion, hemostasis, and wound tension when selecting an epidermal wound closure method. (ClinicalTrials.gov, Identifier: NCT01298167, http

  17. Introduction of a New Suture Method in Repair of Peripheral Nerves Injured with a Sharp Mechanism

    Directory of Open Access Journals (Sweden)

    Alireza Saied

    2015-09-01

    Full Text Available Background: The standard method for repair of an injured peripheal nerve is epineural repair with separate sutures. Herein we describe a method in which the nerve is sutured with continous sutures. In fact this method has not been utilized for nerve repair previously and our purpose was to compare it to the standard method. If it proved to be successful it would replace the standard method in certain circumstances. Methods: The proposal of the clinical trial was given a reference number form the ethics comitee. 25 dogs in which the scaitic nerve was cut by a sharp blade under genaeral anesthesia were divided randomly into three groups: control (5 dogs, repair of sciatic nerve with simple sutures (10 and repair with continous sutures (10. In the control group the nerve was not repaired at all. After 6 weeks the dogs were killed and the nerve was studied by light and electronic microscopes. The amount of consumed suture material, time of repair, myelin thickness and axon diiameter were examined. Ultrastructural studies were performed to assess degeneration and regeneration findings. Results: Time of repair and the amount of consumed suture material were significantly lower in the continous group (P

  18. Aqua splint suture technique in isolated zygomatic arch fractures.

    Science.gov (United States)

    Kim, Dong-Kyu; Kim, Seung Kyun; Lee, Jun Ho; Park, Chan Hum

    2014-04-01

    Various methods have been used to treat zygomatic arch fractures, but no optimal modality exists for reducing these fractures and supporting the depressed bone fragments without causing esthetic problems and discomfort for life. We developed a novel aqua splint and suture technique for stabilizing isolated zygomatic arch fractures. The objective of this study is to evaluate the effect of novel aqua splint and suture technique in isolated zygomatic arch fractures. Patients with isolated zygomatic arch fractures were treated by a single surgeon in a single center from January 2000 through December 2012. Classic Gillies approach without external fixation was performed from January 2000 to December 2003, while the novel technique has been performed since 2004. 67 consecutive patients were included (Classic method, n = 32 and Novel method, n = 35). An informed consent was obtained from all patients. The novel aqua splint and suture technique was performed by the following fashion: first, we evaluated intraoperatively the bony alignment by ultrasonography and then, reduced the depressed fracture surgically using the Gillies approach. Thereafter, to stabilize the fracture and obtain the smooth facial figure, we made an aqua splint that fit the facial contour and placed monofilament nonabsorbable sutures around the fractured zygomatic arch. The novel aqua splint and suture technique showed significantly correlated with better cosmetic and functional results. In conclusion, the aqua splint suture technique is very simple, quick, safe, and effective for stabilizing repositioned zygomatic arch fractures. The aqua splint suture technique can be a good alternative procedure in isolated zygomatic arch fractures.

  19. Optimal Suturing Technique and Number of Sutures for Surgical Implantation of Acoustic Transmitters in Juvenile Salmonids

    Energy Technology Data Exchange (ETDEWEB)

    Deters, Katherine A.; Brown, Richard S.; Boyd, James W.; Eppard, M. B.; Seaburg, Adam

    2012-01-02

    The size reduction of acoustic transmitters has led to a reduction in the length of incision needed to implant a transmitter. Smaller suture knot profiles and fewer sutures may be adequate for closing an incision used to surgically implant an acoustic microtransmitter. As a result, faster surgery times and reduced tissue trauma could lead to increased survival and decreased infection for implanted fish. The objective of this study was to assess the effects of five suturing techniques on mortality, tag and suture retention, incision openness, ulceration, and redness in juvenile Chinook salmon Oncorhynchus tshawytscha implanted with acoustic microtransmitters. Suturing was performed by three surgeons, and study fish were held at two water temperatures (12°C and 17°C). Mortality was low and tag retention was high for all treatments on all examination days (7, 14, 21, and 28 days post-surgery). Because there was surgeon variation in suture retention among treatments, further analyses included only the one surgeon who received feedback training in all suturing techniques. Incision openness and tissue redness did not differ among treatments. The only difference observed among treatments was in tissue ulceration. Incisions closed with a horizontal mattress pattern had more ulceration than other treatments among fish held for 28 days at 17°C. Results from this study suggest that one simple interrupted 1 × 1 × 1 × 1 suture is adequate for closing incisions on fish under most circumstances. However, in dynamic environments, two simple interrupted 1 × 1 × 1 × 1 sutures should provide adequate incision closure. Reducing bias in survival and behavior tagging studies is important when making comparisons to the migrating salmon population. Therefore, by minimizing the effects of tagging on juvenile salmon (reduced tissue trauma and reduced surgery time), researchers can more accurately estimate survival and behavior.

  20. Biomechanic comparison of the Teno Fix tendon repair device with the cruciate and modified Kessler techniques.

    Science.gov (United States)

    Wolfe, Scott W; Willis, Andrew A; Campbell, Deidre; Clabeaux, Jonathan; Wright, Timothy M

    2007-03-01

    To compare the mechanical behavior of a novel internal tendon repair device with commonly used 2-strand and 4-strand repair techniques for zone II flexor tendon lacerations. Thirty cadaveric flexor digitorum profundus tendons were randomized to 1 of 3 core sutures: (1) cruciate locked 4-strand technique, (2) modified Kessler 2-strand core suture technique, or (3) Teno Fix multifilament wire tendon repair device. Each repair was tested in the load control setting on a Instron controller coupled to an MTS materials testing machine load frame by using an incremental cyclic linear loading protocol. A differential variable reluctance transducer was used to record displacement across the repair site. Cyclic force (n-cycles) to 1-mm gap and repair failure was recorded using serial digital photography. There was no significant difference in differential variable reluctance transducer displacement between the cruciate, modified Kessler, and Teno Fix repairs. The cruciate repair had greater resistance to visual 1-mm repair-site gap formation and repair-site failure when compared with the Kessler and Teno Fix repairs. No significant difference was found between the modified Kessler repair and the Teno Fix repair. In all specimens, the epitenon suture failed before the core suture. Repair failure occurred by suture rupture in the 7 cruciate specimens that failed, with evidence of gap formation before failure. Seven of 10 modified Kessler repairs failed by suture rupture. All of the Teno Fix repairs failed by pullout of the metal anchor. The Teno Fix repair system did not confer a mechanical advantage over the locked cruciate or modified Kessler suture techniques for zone II lacerations in cadaveric flexor tendons during cyclic loading in a linear testing model. This information may help to define safe boundaries for postoperative rehabilitation when using this internal tendon repair device.

  1. One strategy for arthroscopic suture fixation of tibial intercondylar eminence fractures using the Meniscal Viper Repair System

    Directory of Open Access Journals (Sweden)

    Ochiai Satoshi

    2011-08-01

    Full Text Available Abstract Background Principles for the treatment of tibial intercondylar eminence fracture are early reduction and stable fixation. Numerous ways to treatment of this fracture have been invented. We designed a simple, low-invasive, and arthroscopic surgical strategy for tibial intercondylar eminence fracture utilizing the Meniscal Viper Repair System used for arthroscopic meniscal suture. Methods We studied 5 patients, who underwent arthroscopic suture fixation that we modified. The present technique utilized the Meniscal Viper Repair System for arthroscopic suture of the meniscus. With one handling, a high-strength ultra-high molecular weight polyethylene(UHMWPE suture can be passed through the anterior cruciate ligament (ACL and the loops for suture retrieval placed at both sides of ACL. Surgical results were evaluated by the presence or absence of bone union on plain radiographs, postoperative range of motion of the knee joint, the side-to-side differences measured by Telos SE, and Lysholm scores. Results The reduced position achieved after surgery was maintained and good function was obtained in all cases. The mean distance of tibia anterior displacement and assessment by Lysholm score showed good surgical results. Conclusion This method simplified the conventional arthroscopic suture fixation and increased its precision, and was applicable to Type II fractures that could be reduced, as well as surgically indicated Types III and IV. The present series suggested that our surgical approach was a useful surgical intervention for tibial intercondylar eminence fracture.

  2. Suture slippage in knotless suture anchors as a potential failure mechanism in rotator cuff repair.

    Science.gov (United States)

    Wieser, Karl; Farshad, Mazda; Vlachopoulos, Lazaros; Ruffieux, Kurt; Gerber, Christian; Meyer, Dominik C

    2012-11-01

    To quantify the strength of suture fixation of knotless suture anchors in relation to the anchors' pullout strength and to compare these results with the static friction between different sutures and anchor materials. Suture slippage within the anchor and pullout strength of 4 different knotless suture anchor models were assessed in a bovine bone model. Furthermore, the peak force before onset of slippage of different sutures trapped between increasingly loaded 4-mm rods made of commonly used anchor material (polyetheretherketone, poly-L-lactide acid, metal) was assessed. In all but 1 of the tested anchors, there was a relevantly lower load needed for slippage of the sutures than to pull out the anchor from bone. The mean load to anchor pullout ranged between 156 and 269 N. The load to suture slippage ranged between 66 and 109 N. All sutures were better held between the metal rods (mean, 21; 95% confidence interval [CI], 19.2 to 23.3) than with polyetheretherketone rods (mean, 17; 95% CI, 15.7 to 18.1) or poly-L-lactide acid rods (mean, 18; 95% CI, 17.6 to 18.4). In the case of suture anchors that hold the sutures by clamping, the hold of the suture in the anchor may be far lower than the pullout strength of the anchor from bone, because the sutures just slip out from the anchor through the clamping mechanism. This is well explained by the low static friction achieved between the tested sutures and the test rods made of anchor materials. The use of knotless suture anchors appears quick and easy to perform; however, most of the anchor systems could not even reach half of the anchor pullout strength from bone before suture slippage occurred. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  3. Suture choice matters in rabbit model of laparoscopic, preperitoneal, inguinal hernia repair.

    Science.gov (United States)

    Kelly, Katherine B; Krpata, David M; Blatnik, Jeffrey A; Ponsky, Todd A

    2014-06-01

    We evaluated the effect of different suture materials in a laparoscopic preperitoneal ligation of the patent processus vaginalis in a rabbit survival model. New Zealand White rabbits underwent laparoscopic assisted preperitoneal ligation of the patent processus vaginalis. The processus vaginalis was closed with silk (n=10), polyglactin 910 (Vicryl(®); Ethicon, a Johnson & Johnson Company, Somerville, NJ) (n=10), or polypropylene (Prolene(®); Ethicon) (n=10). At necropsy, the suture was removed, and repair integrity was evaluated. All rabbits survived to necropsy without complications. No suture material was identified during necropsy of the Vicryl group. Eight (80%) of the Vicryl closures failed, with six (60%) failing at initial inspection. Following removal of suture material, nine (90%) of the Prolene closures failed, and only one (10%) of the silk closures failed (P=.009). The silk suture resulted in an improved closure rate. Ligation with silk suture probably incited an increased inflammatory response that likely created a scar while persisting long enough for the scar to become established. In contrast, the Vicryl sutures probably failed because the sutures dissolved before a scar was able to fully develop. Finally, the Prolene closures were suture dependent as evidenced by failure when the suture was removed. Nonabsorbable braided suture may improve closure of pediatric indirect inguinal hernias during laparoscopic-assisted preperitoneal ligation.

  4. Pullout strength of suture anchors in comparison with transosseous sutures for rotator cuff repair.

    Science.gov (United States)

    Pietschmann, Matthias F; Fröhlich, Valerie; Ficklscherer, Andreas; Hausdorf, Jörg; Utzschneider, Sandra; Jansson, Volkmar; Müller, Peter E

    2008-05-01

    Suture anchors are increasingly gaining importance in rotator cuff surgery. This means they will be gradually replacing transosseous sutures. The purpose of this study was to compare the stability of transosseous sutures with different suture anchors with regard to their pullout strength depending on bone density. By means of bone densitometry (CT scans), two groups of human humeral head specimens were determined: a healthy and a osteopenic bone group. Following anchor systems were being tested: SPIRALOK 5.0 mm (resorbable, DePuy Mitek), Super Revo 5 mm (titanium, Linvatec), UltraSorb (resorbable, Linvatec) and the double U-sutures with Orthocord USP 2 (partly resorbable, DePuy Mitek) and Ethibond Excel 2 (non-resorbable, Ethicon). The suture anchors/double U-sutures were inserted in the greater tuberosity 12 times. An electromechanical testing machine was used for cyclic loading with power increasing in stages. We recorded the ultimate failure loads, the system displacements and the modes of failure. The suture anchors tended to bring about higher ultimate failure loads than the transosseous double U-sutures. This difference was significant in the comparison of the Ethibond suture and the SPIRALOK 5.0 mm-both in healthy and osteopenic bone. Both the suture materials and the SPIRALOK 5.0 mm showed a significant difference in pullout strength on either healthy or osteopenic bone; the titanium anchor SuperRevo 5 mm and the tilting anchor UltraSorb did not show any significant difference in healthy or osteopenic bone. There was no significant difference concerning system displacement (healthy and osteopenic bone) between the five anchor systems tested. The pullout strength of transosseous sutures is neither on healthy nor on osteopenic bone higher than that of suture anchors. Therefore, even osteopenic bone does not constitute a valid reason for the surgeon to perform open surgery by means of transosseous sutures. The choice of sutures in osteopenic bone is of little

  5. Suture repair of umbilical hernia during caesarean section: a case-control study.

    Science.gov (United States)

    Steinemann, D C; Limani, P; Ochsenbein, N; Krähenmann, F; Clavien, P-A; Zimmermann, R; Hahnloser, D

    2013-08-01

    The objective of this study was to investigate the additional burdens in terms of pain, prolongation of surgery and morbidity which is added to elective caesarean section if umbilical hernia suture repair is performed simultaneously. Secondly, patient's satisfaction and hernia recurrence rate were assessed. Consecutive women with symptomatic umbilical hernia undergoing internal or external suture repair during elective caesarean were included in this retrospective cohort-control study. Data on post-operative pain, duration of surgery and morbidity of a combined procedure were collected. These patients were matched 1:10 to women undergoing caesarean section only. Additionally, two subgroups were assessed separately: external and internal suture hernia repair. These subgroups were compared for patient's satisfaction, cosmesis, body image and recurrence rate. Fourteen patients with a mean age of 37 years were analysed. Internal suture repair (n = 7) prolonged caesarean section by 20 min (p = 0.001) and external suture repair (n = 7) by 34 min (p umbilical hernia during elective caesarean section should be offered to women if requested. No additional morbidity or scar is added to caesarean section. Internal repair is faster, and cosmetic results are better, additional skin or fascia dissection is avoided, and it seems to be as effective as an external approach. Yet, women must be informed on the high recurrence rate.

  6. Biomechanical comparison between suture anchor and transtibial pull-out repair for posterior medial meniscus root tears.

    Science.gov (United States)

    Feucht, Matthias J; Grande, Eduardo; Brunhuber, Johannes; Rosenstiel, Nikolaus; Burgkart, Rainer; Imhoff, Andreas B; Braun, Sepp

    2014-01-01

    Posterior medial meniscus root (PMMR) tears have a serious effect on knee joint biomechanics. Currently used techniques for refixation of the PMMR include the transtibial pull-out repair (TP) and suture anchor repair (SA). These techniques have not been compared biomechanically. The SA technique provides superior biomechanical properties compared with the TP technique. Controlled laboratory study. A total of 24 fresh-frozen porcine tibiae with attached intact medial menisci were used. The specimens were randomly assigned to 3 groups (8 specimens each). A standardized PMMR tear was created in 16 specimens. Refixation of the PMMR was performed by either the TP or SA technique. The native PMMR was left intact in 8 specimens. All specimens were subjected to cyclic loading followed by load-to-failure testing. Displacement after 100, 500, and 1000 cycles; maximum load to failure; stiffness; and displacement at failure were recorded. Both repair techniques showed a significantly higher displacement during cyclic loading and a significantly lower maximum load and stiffness during load-to-failure testing compared with the native PMMR (P .05). The SA technique provided superior biomechanical properties compared with the TP technique. Both repair techniques did not reach the strength of the native PMMR. The favorable biomechanical properties of the SA technique might be beneficial for healing of the repaired PMMR and restoration of meniscus function. Because of inferior time zero stability compared with the native PMMR, slow rehabilitation is recommended after meniscus root repair.

  7. An in-vitro study of rotator cuff tear and repair kinematics using single- and double-row suture anchor fixation.

    Science.gov (United States)

    Kedgley, Angela E; Shore, Benjamin J; Athwal, George S; Johnson, James A; Faber, Kenneth J

    2013-04-01

    Double-row suture anchor fixation of the rotator cuff was developed to reduce repair failure rates. The purpose of this study was to determine the effects of simulated rotator cuff tears and subsequent repairs using single- and double-row suture anchor fixation on three-dimensional shoulder kinematics. It was hypothesized that both single- and double-row repairs would be effective in restoring active intact kinematics of the shoulder. Sixteen fresh-frozen cadaveric shoulder specimens (eight matched pairs) were tested using a custom loading apparatus designed to simulate unconstrained motion of the shoulder. In each specimen, the rotator cuff was sectioned to create a medium-sized (2 cm) tear. Within each pair, one specimen was randomized to a single-row suture anchor repair, while the contralateral side underwent a double-row suture anchor repair. Joint kinematics were recorded for intact, torn, and repaired scenarios using an electromagnetic tracking device. Active kinematics confirmed that a medium-sized rotator cuff tear affected glenohumeral kinematics when compared to the intact state. Single- and double-row suture anchor repairs restored the kinematics of the intact specimen. This study illustrates the effects of medium-sized rotator cuff tears and their repairs on active glenohumeral kinematics. No significant difference (P ≥ 0.10) was found between the kinematics of single- and double-row techniques in medium-sized rotator cuff repairs. Determining the relative effects of single- and double-row suture anchor repairs of the rotator cuff will allow physicians to be better equipped to treat patients with rotator cuff disease.

  8. Closure of a direct inguinal hernia defect in laparoscopic repair with barbed suture: a simple method to prevent seroma formation?

    Science.gov (United States)

    Li, Junsheng; Zhang, Weiyu

    2018-02-01

    Seroma is a frequent postoperative complication after laparoscopic direct inguinal hernia repair (both in TAPP and TEP). There are several methods to address this problem; however, these techniques are not without problems. The purpose of this study was to introduce and evaluate a new technique to address this problem. This is a prospective study of consecutive patients. All patients diagnosed with direct inguinal hernias eligible for laparoscopic repair were included. A single surgeon performed all the included operations. During laparoscopic inguinal hernia repair (TAPP or TEP), we closed the direct hernia defect with barbed sutures around the transversalis fascia, inverted the apex of the attenuated transversalis fascia, and sutured it at the base to completely eradicate the defect cavity. Prosthetic mesh was not additionally fixed in all patients. The primary postoperative outcome parameter was seroma formation, and secondary outcome parameters included groin pain, surgical complications, and hernia recurrence. Twenty-five male patients with 36 sides of direct hernias were included in this study, and all procedures were carried out laparoscopically and successfully. Only one patient developed significant seroma, which resolved 1 month later. The early postoperative pain was minimal, and no recurrence and chronic pain occurred during the follow-up period (4-13 months). The present direct inguinal hernia defect closing technique with barbed suture is a simple, easily reproducible, and effective method for the prevention of seroma formation.

  9. All-inside meniscal repair devices compared with their matched inside-out vertical mattress suture repair: introducing 10,000 and 100,000 loading cycles.

    Science.gov (United States)

    Rosso, Claudio; Müller, Sebastian; Buckland, Daniel M; Schwenk, Tanja; Zimmermann, Simon; de Wild, Michael; Valderrabano, Victor

    2014-09-01

    All-inside arthroscopic meniscal repairs are favored by most clinicians because of their lower complication rate and decreased morbidity compared with inside-out techniques. Until now, only 1000 cycles have been used for biomechanical testing. All-inside meniscal repairs will show inferior biomechanical response to cyclic loading (up to 100,000 cycles) and load-to-failure testing compared with inside-out suture controls. Controlled laboratory study. Bucket-handle tears in 72 porcine menisci were repaired using the Omnispan and Fast-Fix 360 (all-inside devices) and Orthocord 2-0 and Ultrabraid 2-0 sutures (matched controls). Initial displacement, displacement after cyclic loading (100, 500, 1000, 2000, 5000, 10,000, and 100,000 cycles) between 5 and 20 N, ultimate load to failure, and mode of failure were recorded, as well as stiffness. Initial displacement and displacement after cyclic loading were not different between the groups. The Omnispan repair demonstrated the highest load-to-failure force (mean ± SD, 151.3 ± 21.5 N) and was significantly stronger than all the other constructs (Orthocord 2-0, 105.5 ± 20.4 N; Ultrabraid 2-0, 93.4 ± 22.5 N; Fast-Fix 360, 76.6 ± 14.2 N) (P inside-out mattress repair was significantly stronger than the Fast-Fix 360 repair (P = .003). The Omnispan (30.8 ± 3.5 N/mm) showed significantly higher stiffness compared with the Ultrabraid 2-0 (22.9 ± 6.9 N/mm, P inside meniscal devices show comparable biomechanical properties compared with inside-out suture repair in cyclic loading, even after 100,000 cycles. Eight to 10 weeks of rehabilitation might not pose a problem for all repairs in this worst-case scenario. © 2014 The Author(s).

  10. Biomechanical characteristics of suture anchor implants for flexor digitorum profundus repair.

    Science.gov (United States)

    Halát, Gabriel; Negrin, Lukas; Koch, Thomas; Erhart, Jochen; Platzer, Patrick; Hajdu, Stefan; Streicher, Johannes

    2014-02-01

    To determine strength and failure characteristics of 2 suture anchors used to repair simulated flexor digitorum profundus avulsions during passive mobilization protocol simulation. We simulated avulsion of the flexor digitorum profundus tendon in 30 distal phalanges from fresh-frozen human cadavers. Repair was performed with a 1.3 × 3.7 mm Micro-Mitek suture anchor (3-0 Orthocord suture) and a 2.2 × 4.0-mm Corkscrew suture anchor (2-0 FiberWire suture). All specimens were loaded cyclically from 2 to 15 N at 5 N/s for a total of 500 cycles. Samples were tested to failure at the completion of 500 cycles. Load at failure, load at first noteworthy displacement (> 2 mm), elongation of the system, gap formation at the tendon-bone interface, and the mechanism of failure were assessed. Suture failure at maximum load was the prevalent failure mechanism in both groups. No statistically significant difference in elongation of the tendon-suture complex was observed. The Corkscrew suture anchor showed a significantly superior performance in load to failure, load at first significant displacement, and gap formation at the tendon-bone interface. The significantly higher load capacity at first displacement (> 2 mm) and the significance of a lower gap formation at the repair site seem to be the most relevant clinical parameters. Based on this concept, the Corkscrew anchor may be superior biomechanically to the Micro-Mitek when considering an early passive mobilization protocol. The choice of an appropriate implant may influence the postoperative mobilization protocol and thereby improve currently reported success rates. Defining a biomechanically superior implant will provide an essential basis for further studies in flexor tendon repair research. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  11. Effects of wound architecture and suture technique on postoperative astigmatism.

    Science.gov (United States)

    Gimbel, H V; Sun, R; DeBroff, B M

    1995-01-01

    A prospective randomized investigation was performed to evaluate the effects of wound architecture and suture techniques on postoperative astigmatism after phacoemulsification and intraocular lens implantation. Two hundred eyes with preexisting with-the-rule astigmatism were randomized into four groups: (1) sutureless scleral tunnel frown incision, (2) scleral tunnel frown incision with a horizontal suture, (3) scleral tunnel frown incision with both a horizontal and a running suture, and (4) posterior limbal acute beveled cataract incision with a running suture. All the incisions were placed in the vertical steep meridian. Data were analyzed from 128 cases with 1-year follow-up. The results revealed that at the 2-month postoperative visit, preexisting astigmatism was significantly reduced in group 1 (P = .029) and significantly increased in groups 3 (P = .020) and 4 (P = .005). There was no significant change in group 2 (P = .06). By the 1-year postoperative visit, there was no significant difference in astigmatism from preoperative levels for all four groups. Vector analysis revealed no significant difference in the mean surgically induced cylinder at 1 year in all four groups. The number of eyes with induced against-the-rule astigmatism, however, was significantly higher than the number of eyes with induced with-the-rule astigmatism in all four groups (P sutured wounds placed in the vertical steep meridian may initially increase with-the-rule astigmatism, whereas nonsutured wounds placed in the vertical steep meridian may initially reduce with-the-rule astigmatism. By 1 year, however, a mean flattening of the vertical steep meridian was observed in the three groups with sutures as well as in the group without sutures.

  12. Entrapment of Common Peroneal Nerve by Surgical Suture following Distal Biceps Femoris Tendon Repair

    Directory of Open Access Journals (Sweden)

    Aki Fukuda

    2016-01-01

    Full Text Available We describe entrapment of the common peroneal nerve by a suture after surgical repair of the distal biceps femoris tendon. Complete rupture of the distal biceps femoris tendon of a 16-year-old male athlete was surgically repaired. Postoperative common peroneal nerve palsy was evident, but conservative treatment did not cause any neurological improvement. Reexploration revealed that the common peroneal nerve was entrapped by the surgical suture. Complete removal of the suture and external neurolysis significantly improved the palsy. The common peroneal nerve is prone to damage as a result of its close proximity to the biceps femoris tendon and it should be identified during surgical repair of a ruptured distal biceps femoris tendon.

  13. Repair of distal biceps tendon rupture using a suture anchor: description of a new endoscopic procedure.

    Science.gov (United States)

    Grégory, Thomas; Roure, Philippe; Fontès, Didier

    2009-03-01

    Repair of a distal biceps tendon rupture is a challenging procedure and, to date, there is no consensus as to which technique should be used because of the specific complications reported for each. A new endoscopic technique is described that uses a suture anchor to repair distal biceps tendon ruptures. Case series; Level of evidence, 4. The results of a cohort of 23 patients (25 elbows) are reported with a median follow-up of 26 months. All patients were male and their median age was 44 years (range, 30-58). Ten of the patients (12 ruptures) were professional athletes or had a high level of physical activity. All repairs were performed via a 3-cm incision made in the "safe area" of the anterior crease of the forearm. The whole procedure was performed within the tendon sheath. The tendon was reinserted using a single anchor. Of the 23 patients, 22 were satisfied and 20 patients returned to their preinjury sports and jobs. There was a mean loss of 8.6 degrees of pronation and 5 degrees of supination. A single severe neurologic complication, which required a second surgical procedure, was reported. There were also 2 ectopic ossifications without clinical consequences and a transitory radial nerve paralysis. This study clearly demonstrated that endoscopic repair of the ruptured distal biceps tendon is safe, effective, and reproducible. It provides good functional outcome and early recovery with few complications. Postoperative median nerve palsy due to edema is a possible concern for patients involved in athletic activity and with a history of nerve entrapment; thus this technique should be used with caution in this group of patients.

  14. Randomized clinical trial of mesh fixation with glue or sutures for Lichtenstein hernia repair.

    Science.gov (United States)

    Hoyuela, C; Juvany, M; Carvajal, F; Veres, A; Troyano, D; Trias, M; Martrat, A; Ardid, J; Obiols, J; López-Cano, M

    2017-05-01

    Pain is the most likely reason for delay in resuming normal activities after groin hernia repair. The primary aim of this study was to determine whether the use of glue to fix the mesh instead of sutures reduced acute postoperative pain after inguinal hernia repair. Secondary objectives were to compare postoperative complications, chronic pain and early recurrence rates during 1-year follow-up. Some 370 patients who underwent Lichtenstein hernia repair were randomized to receive either glue (Histoacryl®) or non-absorbable polypropylene sutures for fixation of lightweight polypropylene mesh. Postoperative complications, pain and recurrence were evaluated by an independent blinded observer. Postoperative pain at 8 h, 24 h, 7 days and 30 days was less when glue was used instead of sutures for all measures (P < 0·001). The operation was significantly quicker using glue (mean(s.d.) 35·3(8·7) min versus 39·9(11·1) min for sutures; P < 0·001). There were no significant differences between the groups in terms of postoperative complications, chronic pain and early recurrence at 1-year follow-up. Atraumatic mesh fixation with glue was quicker and resulted in less acute postoperative pain than sutures for Lichtenstein hernia repair. Registration number: NCT02632097 (http://www.clinicaltrials.gov). © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  15. Rotator cuff tendon repair morphology comparing 2 single-anchor repair techniques.

    Science.gov (United States)

    Park, Maxwell C; Bui, Christopher; Park, Chong J; Oh, Joo H; Lee, Thay Q

    2013-07-01

    To compare the effect of 2 common rotator cuff repair techniques, for smaller tears limited to the use of a single anchor, on tendon morphology in relation to the footprint. Six matched pairs of human shoulders were dissected, and a standardized 10-mm supraspinatus tendon tear was created. Two single-anchor repairs were performed: simple repair with the anchor on the footprint or inverted-mattress repair with the anchor 1 cm distal-lateral to the footprint. The repaired specimens were frozen in situ with liquid nitrogen. Coronal cross sections through the intact and repaired tendon were made. A digitizer was used to measure variables including tendon area and radius of tendon curvature. Comparing between repairs, we found significantly more gap formation for the simple repair at the repair cross section (3.67 ± 0.32 mm v 0.68 ± 0.10 mm, P = .00050). The simple repair had less tendon area (38.28 ± 2.50 mm(2)v 58.65 ± 4.06 mm(2), P = .0036) and a smaller radius of curvature (8.47 ± 1.39 mm v 32.51 ± 3.94 mm, P = .0046). For the simple repair, there was significantly more gap formation, less tendon area, and a smaller radius of tendon curvature for all repair cross sections compared with the intact cross sections (P anchor, using a distal-lateral anchor position with tape-type suture can provide better maintenance of native tendon morphology and footprint dimensions when compared with repair that uses standard sutures and places the anchor on the footprint. For smaller tears, the inverted-mattress repair described in this article may provide a relatively improved healing environment compared with a simple repair on the footprint, potentially optimizing the prevention of early tear progression. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  16. [A case of intractable fistula after low anterior resection repaired by transsacral direct suture].

    Science.gov (United States)

    Yamada, Takanobu; Kodato, Takashi; Shirai, Junya; Kamiya, Mariko; Sujishi, Ken; Kumazu, Yuta; Sugano, Nobuhiro; Hatori, Shinsuke; Osaragi, Tomohiko; Yoneyama, Katsuya; Kasahara, Akio; Rino, Yasushi; Masuda, Munetaka; Yamamoto, Yuji

    2014-11-01

    We report a case of an intractable fistula repaired by transsacral direct suture. A 65-year-old man underwent low anterior resection for rectal cancer. He subsequently underwent ileostomy due to anastomosis leakage. The fistula of the anastomosis persisted 3 months after surgery. He underwent surgery to repair the fistula using a transsacral approach. After removing the coccyx, the fistula in the postrectal space was exposed directly. The presence of the fistula was confirmed by an air leak test and was closed by direct suture. After 33 days, the patient underwent ileostomy closure.

  17. A simple technique for repair of rectus sheath defects.

    Science.gov (United States)

    Asaadi, M; Haramis, H T

    1994-01-01

    Several approaches for repair of diastasis recti during abdominoplasty and repair of rectus sheath defect during transverse rectus abdominis musculocutaneous flap harvest have been described. Although these have generally been effective, we feel our procedure to be advantageous. The method presented is quick, easy, and efficient. In addition, because a looped (double), monofilament suture is used, a stronger, more aesthetic repair is accomplished. This technique has been used in 39 patients over a 25-month period. No recurrences of diastasis recti and no hernias have been observed. Furthermore, all patients remain without complaint.

  18. Arthroscopic Rotator Cuff Repair With Absorbable Sutures in the Medial-Row Anchors.

    Science.gov (United States)

    Tanaka, Makoto; Hayashida, Kenji; Kobayashi, Atsushi; Kakiuchi, Masaaki

    2015-11-01

    To report the retear rate and retear pattern after double-row arthroscopic rotator cuff repair (DR-ARCR) with the use of absorbable sutures as medial anchor sutures and to address the advantage of the use of absorbable sutures in medial-row anchors. Fifty-seven shoulders (22 male and 35 female patients; mean age, 66.1 years) with complete rotator cuff tears treated with DR-ARCR using absorbable mattress sutures as medial-row anchor sutures were included in the study. They included 35 medium, 17 large, and 5 massive tears. For the medial row, medial anchor sutures were replaced with absorbable mattress sutures. High-strength simple sutures were used for the lateral anchors. We evaluated retear patterns by magnetic resonance imaging examinations performed at 1 month, 3 months, 6 months, and 1 year postoperatively. The clinical conditions of all patients preoperatively and 2 years postoperatively were assessed by the University of California, Los Angeles rating scale and the American Shoulder and Elbow Surgeons shoulder index. A complete retear of the tendon at the footprint was observed in 5 shoulders. Complete discontinuity at the middle of the tendon around the medial-row anchors with a footprint remnant was observed in 1 shoulder. A thinned repaired rotator cuff was observed in 2 shoulders because of a partial retear of the deep layer. The overall retear rate was 14%. From before to after surgery, the University of California, Los Angeles score significantly improved from 18.4 to 32.9 (P sutures as medial-row anchors were 8.8% for complete retears of the tendon at the footprint and 1.7% for complete discontinuity of tendon around the medial-row anchors. This procedure provided a low retear rate around the medial-row anchors. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  19. Nylon Hang Back Sutures in the Repair of Secondary Ptosis Following Overcorrected Dysthyroid Upper Eyelid Retraction.

    Science.gov (United States)

    Shah-Desai, Sabrina; Azarbod, Parham; Szamocki, Sonia; Rose, Geoffrey E

    2016-01-01

    (median 9, range: 5-15 mm) to 8.7 mm at 3 months (median 8, range: 7-12 mm; p = 0.1412) and 8.9 mm at 12-month follow up (median 9, range: 7-11 mm; p = 0.2930). Only 3 patients had postoperative lagophthalmos (one patient 3 mm and two patients 1 mm) at 3 months after surgery, this resolving by the 12-month postoperative visit. Thirteen cases (93%) had a good functional, symmetrical, and aesthetic result at 12 month follow up, with a late recurrence of ptosis in 1 patient (7%). The "hang-back" semi-permanent suture technique for repair of over-corrected upper eyelid lowering in thyroid eye disease appears to provide an excellent and predictable long-term result with a low incidence of late recurrence of ptosis.

  20. Downsizing annuloplasty in ischemic mitral regurgitation: double row overlapping suture to avoid ring disinsertion in valve repair.

    Science.gov (United States)

    Nappi, Francesco; Spadaccio, Cristiano; Al-Attar, Nawwar; Chello, Massimo; Lusini, Mario; Barbato, Raffaele; Acar, Christophe

    2014-11-01

    The long-term outcomes of undersizing annuloplasty for the treatment of ischemic mitral regurgitation (IMR) is affected by the progressive dilation of the annulus, which carries increased risk for ring disinsertion. Reasons underlying this phenomenon might be found in the excess of physical stress on the annuloplasty sutures during the ventricular remodeling process. We report a technique based on the placement of a double row of overlapping sutures aiming at reducing the potential for ring disinsertion. Eleven patients with IMR undergoing mitral valve repair associated with coronary bypass grafting were treated with this technique and echocardiographically followed up at 6 and 12 months. The overall annular dimension decreased significantly with a significant reduction of the tenting area and no recurrence of mitral regurgitation at 1 year. A double row of overlapping sutures allowed firm attachment of the prosthetic ring while downsizing the annulus in IMR, limiting the consequences of changes in subannular ventricular geometry. This technique might therefore be considered a useful aid during mitral valve repair.

  1. Effects of suture position on left ventricular fluid mechanics under mitral valve edge-to-edge repair.

    Science.gov (United States)

    Du, Dongxing; Jiang, Song; Wang, Ze; Hu, Yingying; He, Zhaoming

    2014-01-01

    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.

  2. Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size?

    Science.gov (United States)

    Lee, Sung Hyun; Kim, Jeong Woo; Kim, Tae Kyun; Kweon, Seok Hyun; Kang, Hong Je; Kim, Se Jin; Park, Jin Sung

    2017-07-01

    The purpose of this study was to compare functional outcomes and tendon integrity between the suture bridge and modified tension band techniques for arthroscopic rotator cuff repair. A consecutive series of 128 patients who underwent the modified tension band (MTB group; 69 patients) and suture bridge (SB group; 59 patients) techniques were enrolled. The pain visual analogue scale (VAS), Constant, and American Shoulder and Elbow Surgeons (ASES) scores were determined preoperatively and at the final follow-up. Rotator cuff hypotrophy was quantified by calculating the occupation ratio (OR). Rotator cuff integrity and the global fatty degeneration index were determined by using magnetic resonance imaging at 6 months postoperatively. The average VAS, Constant, and ASES scores improved significantly at the final follow-up in both groups (p bridge groups (7.0 vs. 6.8%, respectively; p = n.s.). The retear rate of large-to-massive tears was significantly lower in the suture bridge group than in the modified tension band group (33.3 vs. 70%; p = 0.035). Fatty infiltration (postoperative global fatty degeneration index, p = 0.022) and muscle hypotrophy (postoperative OR, p = 0.038) outcomes were significantly better with the suture bridge technique. The retear rate was lower with the suture bridge technique in the case of large-to-massive rotator cuff tears. Additionally, significant improvements in hypotrophy and fatty infiltration of the rotator cuff were obtained with the suture bridge technique, possibly resulting in better anatomical outcomes. The suture bridge technique was a more effective method for the repair of rotator cuff tears of all sizes as compared to the modified tension band technique. Retrospective Cohort Design, Treatment Study, level III.

  3. Suspension suture techniques in nasal valve surgery

    NARCIS (Netherlands)

    Page, Meile S.; Menger, Dirk J.

    2011-01-01

    Impaired nasal breathing or collapse of the lateral side wall of the nasal valve region during inspiration is a frequently encountered symptom. In general, this is caused by a cross-sectional area that is too small, a weak lateral side wall, or a combination of both. Over the years, many techniques

  4. Mechanical properties of all-suture anchors for rotator cuff repair

    Science.gov (United States)

    Zargar, N.; Smith, R. D. J.; Carr, A. J.

    2017-01-01

    Objectives All-suture anchors are increasingly used in rotator cuff repair procedures. Potential benefits include decreased bone damage. However, there is limited published evidence for the relative strength of fixation for all-suture anchors compared with traditional anchors. Materials and Methods A total of four commercially available all-suture anchors, the ‘Y-Knot’ (ConMed), Q-FIX (Smith & Nephew), ICONIX (Stryker) and JuggerKnot (Zimmer Biomet) and a traditional anchor control TWINFIX Ultra PK Suture Anchor (Smith & Nephew) were tested in cadaveric human humeral head rotator cuff repair models (n = 24). This construct underwent cyclic loading applied by a mechanical testing rig (Zwick/Roell). Ultimate load to failure, gap formation at 50, 100, 150 and 200 cycles, and failure mechanism were recorded. Significance was set at p anchor (181.0 N, standard error (se) 17.6) compared with the all-suture anchors (mean 133.1 N se 16.7) (p = 0.04). The JuggerKnot anchor had greatest displacement at 50, 100 and 150 cycles, and at failure, reaching statistical significance over the control at 100 and 150 cycles (22.6 mm se 2.5 versus 12.5 mm se 0.3; and 29.6 mm se 4.8 versus 17.0 mm se 0.7). Every all-suture anchor tested showed substantial (> 5 mm) displacement between 50 and 100 cycles (6.2 to 14.3). All-suture anchors predominantly failed due to anchor pull-out (95% versus 25% of traditional anchors), whereas a higher proportion of traditional anchors failed secondary to suture breakage. Conclusion We demonstrate decreased failure load, increased total displacement, and variable failure mechanisms in all-suture anchors, compared with traditional anchors designed for rotator cuff repair. These findings will aid the surgeon’s choice of implant, in the context of the clinical scenario. Cite this article: N. S. Nagra, N. Zargar, R. D. J. Smith, A. J. Carr. Mechanical properties of all-suture anchors for rotator cuff repair. Bone Joint Res 2017;6:82–89. DOI: 10

  5. Use of Suture-Mediated Closure Device in Percutaneous Direct Carotid Puncture During Chimney-Thoracic Endovascular Aortic Repair

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Gabriel, E-mail: dr.changabriel@gmail.com; Quek, Lawrence Hwee Han, E-mail: lawrence-quek@ttsh.com.sg [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore); Tan, Glenn Leong Wei, E-mail: glenn-tan@ttsh.com.sg [Tan Tock Seng Hospital, Department of General Surgery (Singapore); Pua, Uei, E-mail: druei@yahoo.com [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore)

    2016-07-15

    BackgroundInsertion of a carotid chimney graft during thoracic endovascular aortic repair (Ch-TEVAR) is a recognized technique to extend the proximal landing zone into the aortic arch in the treatment of thoracic aortic disease. Conventional technique requires surgical exposure of the carotid artery for insertion of the carotid chimney graft.MethodologyWe describe our experience in the use of a suture-mediated closure device in percutaneous Ch-TEVAR in four patients.ResultsSuccessful hemostasis was achieved in all four patients. No complications related to the carotid puncture were recorded.ConclusionWe conclude that using suture-mediated closure device for carotid closure appears feasible and deserves further studies as a potential alternative to conventional surgical approach.

  6. The effect of different suturing techniques on astigmatism after penetrating keratoplasty.

    Science.gov (United States)

    Kim, Sang Jin; Wee, Won Ryang; Lee, Jin Hak; Kim, Mee Kum

    2008-12-01

    The purpose of this study was to compare the effects on astigmatism after penetrating keratoplasty with three different suture techniques. In this prospective study, 38 eyes of 38 patients underwent penetrating keratoplasty with three suturing techniques: interrupted, single running, and double running. Topographic astigmatism was measured at 2, 6, 12, and 18 months after keratoplasty. During 18 months after surgery, the interrupted suture group had higher astigmatism than the double running suture group. There was no significant difference in the amounts of astigmatism during the first year after keratoplasty between the single running and the double running suture group. However, at 18 months after surgery, when all sutures were out, the double running suture group (3.60+/-1.58 diopters) showed significantly less astigmatism than the single running group (5.65+/-1.61 diopters). In conclusion, post-keratoplasty astigmatism was the least in the double running suture group of the three suturing techniques at 18 months after penetrating keratoplasty.

  7. Development of a surgically optimized graft insertion suture technique to accommodate a tissue-engineered tendon in vivo.

    Science.gov (United States)

    Sawadkar, Prasad; Alexander, Susan; Tolk, Marten; Wong, Jason; McGrouther, Duncan; Bozec, Laurent; Mudera, Vivek

    2013-10-01

    The traumatic rupture of tendons is a common clinical problem. Tendon repair is surgically challenging because the tendon often retracts, resulting in a gap between the torn end and its bony insertion. Tendon grafts are currently used to fill this deficit but are associated with potential complications relating to donor site morbidity and graft necrosis. We have developed a highly reproducible, rapid process technique to manufacture compressed cell-seeded type I collagen constructs to replace tendon grafts. However, the material properties of the engineered constructs are currently unsuitable to withstand complete load bearing in vivo. A modified suture technique has been developed to withstand physiological loading and off load the artificial construct while integration occurs. Lapine tendons were used ex vivo to test the strength of different suture techniques with different sizes of Prolene sutures and tissue-engineered collagen constructs in situ. The data were compared to standard modified Kessler suture using a standard tendon graft. Mechanical testing was carried out and a finite element analysis stress distribution model constructed using COMSOL 3.5 software. The break point for modified suture technique with a tissue-engineered scaffold was significantly higher (50.62 N) compared to a standard modified Kessler suture (12.49 N, ptechnique is suitable for testing in vivo, and this will be the next stage of our research.

  8. Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty.

    Science.gov (United States)

    Steinbichler, Teresa B; Bender, Birte; Giotakis, Aristeidis I; Dejaco, Daniel; Url, Christoph; Riechelmann, Herbert

    2018-02-01

    Uvulopalatopharyngoplasty (UPPP) and expansion sphincter pharyngoplasty (ESP) are two standard surgical procedures for treatment of snoring and sleep apnea. In a prospective clinical trial, we compared a standard simple interrupted suture technique for closure of the tonsillar pillars with a running locked suture. Each suture technique was randomly assigned either to the left or the right tonsillar pillars in 28 patients. During the first week, patients were daily checked for suture dehiscence and again on days 10 and 21, the end of followup. Time to perform the sutures was measured intraoperative and surgical complications were recorded. During followup, suture dehiscence was observed in 15/28 interrupted and 16/28 running sutures (p > 0.5). If a dehiscence occurred during the observation period, the median day of dehiscence was 10 (1 and 3 quartile: 5.75 and 17) days for the interrupted suture and 10 (5-11) days for the running locked suture technique (p > 0.05). The mean (± SD) surgical time for the interrupted suture was 5.2 ± 1.9 and 3.5 ± 1.8 min for the running locked suture (p sutures and 2/28 interrupted sutures. The running locked suture technique is an equally safe and time saving way of wound closure in UPPP and ESP.

  9. Functional outcomes of distal triceps tendon repair comparing transosseous bone tunnels with suture anchor constructs.

    Science.gov (United States)

    Horneff, John G; Aleem, Alexander; Nicholson, Thema; Lervick, Gregory; Murthi, Anand; Sethi, Paul; Getz, Charles; Lazarus, Mark D; Ramsey, Matthew L; Abboud, Joseph A; Tashjian, Robert

    2017-12-01

    Distal triceps tendon ruptures are relatively rare. Few studies have investigated functional outcomes after repair. There is no consensus on fixation methods for this injury. The purpose of this study was to compare the functional outcomes and the reoperation rates after distal triceps tendon repairs using transosseous tunnels and suture anchors. A multicenter, retrospective review of all primary triceps repairs done between 2006 and 2015 was performed. Patients were included if they had a minimum of 2 years of follow-up. Intraoperative data recorded included repair method and number of anchors used when applicable. Patients were contacted for functional assessment with the Mayo Elbow Performance Score (MEPS). Postoperative complications were also queried. There were 56 cases of primary triceps repair identified in an all-male cohort. Average age at time of surgery was 52.7 years; 58.9% of patients had transosseous repair, and 41.1% had suture anchor repair. The average follow-up was 4.26 years. The average postoperative MEPS score for all patients was 94. There was no difference in MEPS outcomes based on construct type. Postoperative Disabilities of the Arm, Shoulder, and Hand scores had an overall average of 4.81. A statistically significant difference was found, with the transosseous group averaging 2.98 points lower than the suture anchor group. This difference was not found to be clinically relevant. Only 4 patients had rerupture of the triceps requiring revision. Primary repair of distal triceps tendon ruptures yields good, durable patient outcomes with minimal rerupture regardless of repair construct. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  10. Biomechanical effects of a 2 suture-pass medial inter-implant mattress on transosseous-equivalent rotator cuff repair and considerations for a "technical efficiency ratio".

    Science.gov (United States)

    Park, Maxwell C; Peterson, Alexander; Patton, John; McGarry, Michelle H; Park, Chong J; Lee, Thay Q

    2014-03-01

    Rotator cuff repair involving fewer tendon suture passes without compromising biomechanical performance would represent a technical advancement. An inter-implant "medial pulley-mattress" transosseous-equivalent (MP-TOE) repair requiring fewer tendon suture-passes was hypothesized to provide equivalent biomechanical characteristics compared to the control. In 6 human cadaveric shoulders, a transosseous-equivalent (TOE) repair (control) was performed utilizing 2 separate medial mattresses resulting in 4 tendon-bridging sutures. In 6 matched-pairs, 2 single-loaded anchors were used to create a medial inter-implant mattress construct (all sutures shuttled in 1 tendon pass per anchor)-after knot-tying, the same tendon-bridging pattern as the control was created. A materials testing machine cyclically loaded each repair from 10-180 N for 30 cycles; each repair subsequently underwent failure testing. Gap and strain were measured with a video digitizing system. A "technical efficiency ratio" (TER) was defined as: (#knots + #suture passes + #suture limbs)/#fixation points. Cyclic and failure testing demonstrated no significant differences between constructs. Gap formation at cycle 30 was 5.3 ± 0.8 mm (TOE) and 5.0 ± 0.3 mm (MP-TOE) (P = .62). Cycle 30 anterior strain values were -16.0 ± 7.3% (TOE) and -15.8 ± 6.6% (MP-TOE) (P = .99). Yield loads were 208.7 ± 2.7 N (TOE) and 204.0 ± 1.3 N (MP-TOE) (P = .17). Mode of failure demonstrated less tendon cut-out with the MP-TOE repair. The MP-TOE repair has a TER of 2.0 vs 2.5 for the control. The MP-TOE repair requiring fewer tendon suture passes, yet creating an additional inter-implant mattress configuration, is biomechanically equivalent to the original TOE technique, and may limit failure with improved medial load-sharing capacity. A TER may help quantify technical ease and help standardize comparisons between repair techniques. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights

  11. ARTHROSCOPIC REPAIR OF BANKART’S LESION USING SUTURE ANCHORS IN RECURRENT ANTERIOR SHOULDER INSTABILITY

    Directory of Open Access Journals (Sweden)

    Santosh Kumar

    2015-06-01

    Full Text Available BACKGROUND : Shoulder instability and its treatment were described even in ancient times by the Greek and Egyptian physicians. Evidence of shoulder dislocation has been found in archaeological and paleopathological examinations of human shoulders several thousand years old. 1 Many techniques have been described in literature for treatment of recurrent shoulder dislocation. Arthroscopic repair of Bankart’s lesion using suture anchors is a noble technique. A suture anchor is a tiny screw with a thread attached to it. The screw is inserted into the bone over the glenoid rim while the sutures hold onto the labral tissue. These anchors provide a stable base for reattachment of the capsulolabral complex. We conducted a study on evaluation of long term effe ct of arthroscopic repair of Bankart’s lesion using suture anchors and compared our results with other studies published in literature . MATERIALS & METHODS : Since June 2012, arthroscopic Bankart’s repair using suture anchors was performed on 35 patients, who presented with recurrent anterior dislocation of shoulder. 34 man and 1 woman patients were included in the study. METHOD OF COLLECTION OF DATA: Adult patients with recurrent dislocations of shoulder with . INCLUSION CRITERIA: All patients > 15 years but =2 . EXCLUSION CRITERIA: Age group 60 years. Clinical evidence of multidirectional instability. Surgery of injured shou lder before 1 st episode of traumatic shoulder dislocation. Number o f dislocations <2 . Generalised ligamentous laxity. Presence of neuromuscular disorders. Presence of other comorbid conditions . Majority of patients were in the age group between 17 years to 49years, with mean age of 27.43 years. Most patients were young active individuals in the age group of 25 to 35 years. 20 patients (57% were involved in significant occupation requiring overhead activity such as students with sporting activities, agricul turists. 21(60% patients had their Right shoulder involved

  12. Inferior suture anchor placement during arthroscopic Bankart repair: influence of portal placement and curved drill guide.

    Science.gov (United States)

    Frank, Rachel M; Mall, Nathan A; Gupta, Deepti; Shewman, Elizabeth; Wang, Vincent M; Romeo, Anthony A; Cole, Brian J; Bach, Bernard R; Provencher, Matthew T; Verma, Nikhil N

    2014-05-01

    During arthroscopic Bankart repair, inferior anchor placement is critical to a successful outcome. Low anterior anchors may be placed with a standard straight guide via midglenoid portal, with a straight guide with trans-subscapularis placement, or with curved guide systems. Purpose/ To evaluate glenoid suture anchor trajectory, position, and biomechanical performance as a function of portal location and insertion technique. It is hypothesized that a trans-subscapularis portal or curved guide will improve anchor position, decrease risk of opposite cortex breach, and confer improved biomechanical properties. Controlled laboratory study. Thirty cadaveric shoulders were randomized to 1 of 3 groups: straight guide, midglenoid portal (MG); straight guide, trans-subscapularis portal (TS); and curved guide, midglenoid portal (CG). Three BioRaptor PK 2.3-mm anchors were inserted arthroscopically, with an anchor placed at 3, 5, and 7 o'clock. Specimens were dissected with any anchor perforation of the opposite cortex noted. An "en face" image was used to evaluate actual anchor position on a clockface scale. Each suture anchor underwent cyclic loading (10-60 N, 250 cycles), followed by a load-to-failure test (12.5 mm/s). Fisher exact test and mixed effects regression modeling were used to compare outcomes among groups. Anchor placement deviated from the desired position by 9.9° ± 11.4° in MG specimens, 11.1° ± 13.8° in TS, and 13.1° ± 14.5° in CG. After dissection, opposite cortex perforation at 5 o'clock occurred in 50% of MG anchors, 0% of TS, and 40% of CG. Of the 90 anchors tested, 17 (19%) failed during cyclic loading, with a similar failure rate across groups (P = .816). The maximum load was significantly higher for the 3-o'clock anchors when compared with the 5-o'clock anchors, regardless of portal or guide (P = .021). For the 5-o'clock position, there were significantly fewer "out" anchors in the TS group versus the CG or MG group (P = .038). There was no

  13. A simple and secure anchoring system for Caspari's transglenoid multiple suture technique using a biodegradable poly-l-lactic acid button.

    Science.gov (United States)

    Yoneda, M; Hayashida, K; Izawa, K; Shimada, K; Shino, K

    1996-06-01

    To manage a difficulty in tying sutures over the infraspinatus fascia when using Caspari's transglenoid multiple suture technique, we developed a new anchoring system using a biodegradable poly-L-lactic acid (PLLA) button and investigated its clinical efficacy in 28 patients who were followed-up for more than 2 years postoperatively (mean, 26.5 months). Twenty-four patients had Bankart lesions and 4 had detachment of the superior glenoid labrum. The mean age at operation was 22.1 years. The PLLA button measured 8 x 8 x 1.2 mm and had two holes. After multiple sutures were inserted by the routine Caspari technique (mean, 7.3 sutures), the sutures were divided into 2 bundles, passed through the holes in the button, and tied over it on the posterior scapular neck under traction. The arm was immobilized in a Velpeau bandage for 3 weeks after Bankart repair and for 1 to 2 weeks after superior labral repair. The results of Bankart repair were excellent in 13 patients, good in 7, and poor in 4 according to Rowe's rating scale (success rate, 83%), while the outcome of superior labral repair was excellent in 3 and good in 1 according to our own criteria. All 4 patients who showed a poor outcome were contact athletes who developed resubluxation postoperatively. There were no complications, but transient damages to the suprascapular nerve occurred in 2 patients. In conclusion, the PLLA button provided simple and secure suture fixation for the Caspari technique.

  14. A safety technique for Mitek anchor suture rupture: a useful trick.

    Science.gov (United States)

    Othman, Diaa; Le Cocq, Heather; Majumder, Sanjib

    2011-09-01

    We propose that the simple method of passing an extra suture through the Mitek anchor eyelet before bony insertion provides a safety net against failure of the preloaded suture and gives extra strength to the core repair. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. Double row of overlapping sutures for downsizing annuloplasty decreases the risk of residual regurgitation in ischaemic mitral valve repair.

    Science.gov (United States)

    Nappi, Francesco; Spadaccio, Cristiano; Chello, Massimo; Lusini, Mario; Acar, Christophe

    2016-04-01

    The aim of this study was to evaluate a novel insertion technique of the prosthetic ring that would further magnify the degree of annulus narrowing, thereby reducing the potential for a residual leak in ischaemic mitral valve repair. Thirty-six patients with ischaemic mitral regurgitation (MR) were randomly assigned into two groups. In 18 patients, the prosthetic ring was inserted in the conventional manner with a single row of sutures (control group). In the remaining 18 patients, the ring was attached using a double row of sutures tied both on the inner and on the outer part of the sewing cuff. Both groups had similar preoperative clinical and echocardiographic characteristics with severe leaflet tethering: mean tenting area >2.5 cm(2), mean anterior leaflet angle >25° and posterior leaflet angle >45°. The mean prosthetic ring sizes inserted in both groups were identical (mean: 27.3 mm). At 12 months, there was no clinical event except for 1 rehospitalization in the control group. The mean mitral regurgitation grade was higher in the control group than in the group with the double row of sutures at 1.6 ± 0.9 vs 0.7 ± 0.3 (P = 0.0003). Annulus diameter reduction was less pronounced in the control group when compared with the group with the double row of sutures, both in the parasternal long-axis: 29.3 ± 3 vs 26.3 ± 3 mm (P = 0.0003) and in apical four-chamber views: 31 ± 3 vs 28 ± 2 mm (P = 0.003). Leaflet tethering indices were greater in the control group than in the group with the double row of sutures: tenting area: 1.42 ± 0.3 vs 1.1 ± 0.5 cm(2) (P = 0.002), anterior leaflet angle: 33 ± 3° vs 28 ± 5° (P = 0.0009) and posterior leaflet angle: 110 ± 13° vs 80 ± 11° (P = 0.0001). Left ventricular function parameters were not statistically different among the two groups. A double row of overlapping sutures for attaching the prosthetic ring in downsizing annuloplasty is more efficient in narrowing the mitral annulus than the conventional technique

  16. Infected shoulder joint with loose Suture Anchor in the joint after Bankart's Repair- A Case Report.

    Science.gov (United States)

    Kumar, Mukesh; Thilak, Jai

    2016-01-01

    The glenoid labrum is frequently torn in traumatic glenohumeral dislocation; arthroscopic repair is the standard method of treatment. The complications associated with this repair are pulling out of metal suture anchors, chondrolysis and joint infection. The infection of joint after arthroscopy is less than 1%. Staphylococcus is most common organism and rarely followed by Pseudomonas aeruginosa. We report a case of infected shoulder with chondrolysis of the joint and pulled out metal suture anchor lying inside the joint after Bankart's repair. A 22-year-old gentleman came to us with complaints of shoulder joint pain & gross restriction of movements for one year, with history of intermittent fever and treatment in nearby hospital. He also gives past history of recurrent dislocation of shoulder with last episode 18 months back, which was diagnosed as Bankart's lesion and arthroscopic Bankart's repair was done 15 months back. He was evaluated at our institute and suspected to have infection of shoulder joint with pulled out metal suture anchor inside the joint. Arthroscopic removal of suture anchor and debridement of shoulder joint was done, Culture was obtained and culture specific antibiotics were given for six weeks, and significant improvement was observed with this line of treatment. At lyear follow up, the patient was able to perform his daily activities with terminal restriction of range of motion. Shoulder joint infection is rare after Bankart's repair and required a high degree of suspicion. Any foreign materials inside the joint should be taken out & followed with aggressive treatment by debridement, irrigation and culture specific antibiotics. Suppression of joint infection with antibiotics should be avoided specially when there is foreign body inside the joint.

  17. Radar rainfall image repair techniques

    OpenAIRE

    Wesson, Stephen M.; Pegram, Geoffrey G. S.

    2004-01-01

    There are various quality problems associated with radar rainfall data viewed in images that include ground clutter, beam blocking and anomalous propagation, to name a few. To obtain the best rainfall estimate possible, techniques for removing ground clutter (non-meteorological echoes that influence radar data quality) on 2-D radar rainfall image data sets are presented here. These techniques concentrate on repairing the images in both a computationally fast and accurate manner, and...

  18. Radar rainfall image repair techniques

    OpenAIRE

    Wesson, Stephen M.; Pegram, Geoffrey G. S.

    2004-01-01

    There are various quality problems associated with radar rainfall data viewed in images that include ground clutter, beam blocking and anomalous propagation, to name a few. To obtain the best rainfall estimate possible, techniques for removing ground clutter (non-meteorological echoes that influence radar data quality) on 2-D radar rainfall image data sets are presented here. These techniques concentrate on repairing the images in both a computationally fast...

  19. A Pentagram Suture Technique for Closing Tumor Resection Sites in the Face

    OpenAIRE

    Matsumine, Hajime; Takeuchi, Masaki; Mori, Satoko; Sakurai, Hiroyuki

    2015-01-01

    Background: Resection of facial skin tumors aims to remove the tumors completely and make the surgical scar unnoticeable as much as possible. By improving the purse string suture method, we developed a new pentagram suture technique that enables simple and safe suturing of small to large defects with early satisfactory esthetic outcomes. The surgical outcomes of a case series were examined in this report. Methods: As in drawing a unicursal star, 5 suture sites were marked at specific interval...

  20. Cyclic Testing of the 6-Strand Tang and Modified Lim-Tsai Flexor Tendon Repair Techniques.

    Science.gov (United States)

    Kang, Gavrielle Hui-Ying; Wong, Yoke-Rung; Lim, Rebecca Qian-Ru; Loke, Austin Mun-Kitt; Tay, Shian-Chao

    2017-09-26

    In this study, we compared the Tang repair technique with the 6-strand modified Lim-Tsai repair technique under cyclic testing conditions. Twenty fresh-frozen porcine flexor tendons were randomized into 2 groups for repair with either the modified Lim-Tsai or the Tang technique using Supramid 4-0 core sutures and Ethilon 6-0 epitendinous running suture. The repaired tendons were subjected to 2 stage cyclic loading. The survival rate and gap formation at the repair site were recorded. Tendons repaired by the Tang technique achieved an 80% survival rate. None of the modified Lim-Tsai repairs survived. The mean gap formed at the end of 1000 cycles was 1.09 mm in the Tang repairs compared with 4.15 mm in the modified Lim-Tsai repairs. The Tang repair is biomechanically stronger than the modified Lim-Tsai repair under cyclic loading. The Tang repair technique may exhibit a higher tolerance for active mobilization after surgery with less propensity for gap formation. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  1. Diode laser welding for cornea suturing: an experimental study of the repair process

    Science.gov (United States)

    Pini, Roberto; Rossi, Francesca; Menabuoni, Luca; Mencucci, Rita; Menchini, Ugo; Ambrosini, Stefano; Vannelli, Gabriella

    2004-07-01

    We present an experimental study, performed in vivo, to evaluate the application of laser welding of the cornea. The welding technique is based on controlled irradiation provided by a diode laser (810 nm) operating at low power (60-90 mW), in association with the chromophore Indocyanine Green which was applied locally in the corneal wound to be repaired. Thirty-four rabbits were selected to undergo both conventional and laser-induced suturing of corneal wounds, to simulate cataract surgery and penetrating keratoplasty. A follow-up study 7-30 days after surgery was carried out by means of histological examinations of cornea slices, in order to investigate the healing process induced by laser welding. In the laser group, the analyses evidenced a faster and more effective restoration of the architecture of the stroma, with re-organization of both epithelium and endothelium. We also present measurements of the spectral absorption of Indocyanine Green and of the temperature rise in the corneal surface during laser welding.

  2. Biomechanical validation of rotator cuff repair techniques and considerations for a "technical efficiency ratio".

    Science.gov (United States)

    Park, Maxwell C

    2013-07-01

    Biomechanical studies are commonly used to validate new or modified rotator cuff repair techniques. Additional knots, more tendon suture passes, and obligatory suture management requirements are often the "cost" for improved biomechanical results. This cost can amount to increased technical difficulty and surgical times. However, technical ease or difficulty as a measurable variable has not been quantified. A basic measure for technical ease would allow surgeons the ability to objectively assess and compare rotator cuff repair practicality and potentially help in the design of future studies to standardize repair techniques alongside biomechanical measures. A proposed rotator cuff repair "technical efficiency ratio" is defined as follows: (No. of knots + No. of tendon suture passes + No. of suture limbs)/No. of pilot holes created. This can give a measure of "work" or utility achieved per fixation point created for a particular type of repair (e.g., single or double row), with a smaller number representing relatively more efficiency per anchor or fixation point used. If repairs validated in the laboratory are too cumbersome to perform in vivo from a practical standpoint, technical ease should be a prerequisite measure, and the success of a repair technique should not necessarily be based on biomechanics alone. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  3. Progressive tension sutures: a technique to reduce local complications in abdominoplasty.

    Science.gov (United States)

    Pollock, H; Pollock, T

    2000-06-01

    Abdominoplasty has evolved as a very effective and satisfactory procedure, especially when combined with liposuction and the repair of diastasis recti. However, local complications, including hematoma and seroma formation, flap necrosis, and hypertrophic scars, continue to plague this procedure. The authors present a relatively simple and reproducible technique that allows extensive liposuction in conjunction with abdominoplasty; they think this technique reduces the incidence of local complications. This technique, the use of progressive tension sutures, has been used in their practice for more than 15 years. A retrospective review of 65 consecutive abdominoplasty patients demonstrates a very low local complication rate when compared with historical controls. In this series of both full and modified abdominoplasty patients who were followed for an average of 18 months, the authors had no hematomas, seromas, or skin flap necrosis.

  4. Evaluation of BioCorkscrew and Bioknotless RC suture anchor rotator cuff repair fixation: an in vitro biomechanical study.

    Science.gov (United States)

    Ammon, Jennifer Tucker; Nyland, John; Chang, Haw Chong; Burden, Robert; Caborn, David N M

    2007-11-01

    This in vitro biomechanical study used cadaveric specimens to compare the rotator cuff repair fixation provided by BioCorkscrew and Bioknotless RC suture anchors. Three cm wide by 1-cm long full-thickness supraspinatus defects were repaired using either two BioCorkscrew suture anchors with combined vertical and horizontal mattress sutures (n = 7) or three Bioknotless RC suture anchors with simple sutures (n = 7). Therefore, the BioCorkscrew suture anchor group had two sutures per anchor (four total sutures), while the Bioknotless RC suture anchor group had one suture per anchor (three total sutures). Two-phase cyclic (5-100 N, 1,000 cycles and 5-180 N, 2,000 cycles) and load to failure tests (31 mm/s) were performed. Non-parametric statistics were used to compare group differences (P /= 5 mm, compared to only three of seven of the Bioknotless RC group (Fisher's Exact test = 0.03). Groups did not differ for repair site gapping during the 5-100 N cyclic test phase (Fisher's Exact test = 0.77), however more of the Bioknotless RC group displayed gapping >/= 5 mm during the 5-180 N cyclic test phase than the BioCorkscrew group (P = 0.02). The BioCorkscrew group also displayed greater yield load during load to failure testing (492.2 +/- 204 N vs. 296.4 +/- 155 N, P = 0.03). In this in vitro biomechanical study, the BioCorkscrew group with combined vertical and horizontal mattress sutures displayed greater cyclic test survival, less repair site gapping, and superior yield load compared to the Bioknotless RC group with simple sutures. These results in human cadaveric rotator cuff-humerus specimens suggest better immediate post-operative repair site strength and a reduced need for post-operative restrictions. Clinical studies are needed to determine how these rotator cuff repair modes withstand the forces of early rehabilitation and activities of daily living that potentially influence patient outcomes.

  5. The global percutaneous shuttling technique tip for arthroscopic rotator cuff repair

    Directory of Open Access Journals (Sweden)

    Bryan G. Vopat

    2014-05-01

    Full Text Available Most arthroscopic rotator cuff repairs utilize suture passing devices placed through arthro- scopic cannulas. These devices are limited by the size of the passing device where the suture is passed through the tendon. An alternative technique has been used in the senior author’s practice for the past ten years, where sutures are placed through the rotator cuff tendon using percutaneous passing devices. This technique, dubbed the global percutaneous shuttling technique of rotator cuff repair, affords the placement of sutures from nearly any angle and location in the shoulder, and has the potential advantage of larger suture bites through the tendon edge. These advantages may increase the area of tendon available to compress to the rotator cuff footprint and improve tendon healing and outcomes. The aim of this study is to describe the global percutaneous shuttling (GPS technique and report our results using this method. The GPS technique can be used for any full thickness rotator cuff tear and is particularly useful for massive cuff tears with poor tissue quality. We recently followed up 22 patients with an average follow up of 32 months to validate its usefulness. American Shoulder and Elbow Surgeons scores improved significantly from 37 preoperatively to 90 postoperatively (P<0.0001. This data supports the use of the GPS technique for arthroscopic rotator cuff repair. Further biomechanical studies are currently being performed to assess the improvements in tendon footprint area with this technique.

  6. A 5‑year Review of Darning Technique of Inguinal Hernia Repair

    African Journals Online (AJOL)

    with the sutures forming a weave in the posterior wall of the inguinal canal.[3,4]. Studies evaluating the Darning technique have shown satisfactory outcomes in terms of recurrence and other postoperative complications. Some of these are comparable to Lichtenstein technique of inguinal hernia repair,[5,6] which is currently ...

  7. The Effect of Different Suturing Techniques on Astigmatism after Penetrating Keratoplasty

    OpenAIRE

    Kim, Sang Jin; Wee, Won Ryang; Lee, Jin Hak; Kim, Mee Kum

    2008-01-01

    The purpose of this study was to compare the effects on astigmatism after penetrating keratoplasty with three different suture techniques. In this prospective study, 38 eyes of 38 patients underwent penetrating keratoplasty with three suturing techniques: interrupted, single running, and double running. Topographic astigmatism was measured at 2, 6, 12, and 18 months after keratoplasty. During 18 months after surgery, the interrupted suture group had higher astigmatism than the double running ...

  8. A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation.

    Science.gov (United States)

    Singh, Rohit; Rymer, Ben; Theobald, Peter; Thomas, Peter B M

    2015-12-28

    Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man's land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs.

  9. Propionibacterium acnes Suture Contamination in Arthroscopic Rotator Cuff Repair: A Prospective Randomized Study.

    Science.gov (United States)

    Yamakado, Kotaro

    2018-01-17

    To examine the contamination rate of the anchor-suture and to determine the efficacy of 2 different surgical skin preparation solutions with or without a plastic adhesive drape from suture contamination in arthroscopic rotator cuff repair. A prospective randomized study was undertaken to evaluate 126 consecutive patients undergoing arthroscopic rotator cuff repair. Each shoulder was prepared with one of 2 randomly selected solutions according to an assigned envelope that indicated the procedure to be used: chlorhexidine-alcohol (1% chlorhexidine gluconate and 70% isopropyl alcohol) or povidone-iodine. Then, each group was further divided according to the usage of a plastic drape. The first cut-tails of the anchor-suture after cuff fixation were submitted to aerobic and anaerobic cultures. The overall rate of Propionibacterium acnes-positive cultures was 47% (14 of 31 cases) in the povidone-iodine group, 33% (11 of 33 cases) in the povidone-iodine with a drape group, 33% (10 of 30 cases) in the chlorhexidine-alcohol group, and 9.3% (3 of 32 cases) in the chlorhexidine-alcohol with a drape group. The positive culture rate in the chlorhexidine-alcohol with a drape group was lower than that in the povidone-iodine group (relative risk, 0.2; 95% confidence interval: 0.064-0.63; number needed to treat, 2.7; P suture contamination. However, the usage of a plastic drape slightly increased the risk of coagulase-negative Staphylococcus proliferation. Level I, therapeutic, prospective, randomized trial. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  10. Analysis of a new all-inside versus inside-out technique for repairing radial meniscal tears.

    Science.gov (United States)

    Beamer, Brandon S; Masoudi, Aidin; Walley, Kempland C; Harlow, Ethan R; Manoukian, Ohan S; Hertz, Ben; Haeussler, Claudia; Olson, Jeffrey J; Deangelis, Joseph P; Nazarian, Ara; Ramappa, Arun J

    2015-02-01

    The purpose of this study was to compare gap formation, strength, and stiffness of repaired radial tears of the meniscus treated using a new all-inside technique versus a traditional inside-out suture technique. Radial tears were created in 36 fresh-frozen porcine menisci. Repairs were performed using a novel all-inside suture-based meniscal repair device or an inside-out technique. The repairs were tested for cyclic loading and load to failure. The displacement, response to cyclic loading (100, 300, and 500 cycles), and mode of failure were recorded, and the construct's stiffness was calculated. The all-inside repairs using the novel device resulted in a significantly lower displacement (gap formation) after 100, 300, and 500 cycles (P = .002, P = .001, and P = .001, respectively). The ultimate load to failure was significantly greater for the all-inside repairs (111.61 N v 95.01 N; P = .03). The all-inside repairs showed greater stiffness (14.53 N/mm v 11.19 N/mm; P = .02). The all-inside repairs failed most often by suture breakage (suture failure). The inside-out repairs failed most commonly when the suture pulled through the tissue (tissue failure) (P inside technique resulted in lower displacement, higher load to failure, and greater stiffness compared with the horizontal inside-out technique. In a porcine specimen meniscus repair model, the biomechanical properties of a vertical all-inside technique were superior to that of a horizontal inside-out technique. Future studies of biomechanical and clinical outcomes in human meniscal repairs with this device are warranted to explore whether this repair method is valuable to clinical practice and patient outcomes. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  11. Dynamic observation of biomechanic properties of sciatic nerve at the suture site in rats following repairing.

    Science.gov (United States)

    Jiang, Baoguo; Zhang, Peixun; Yan, Jiazhi; Zhang, Hongbo

    2008-01-01

    To observe the biomechanic properties of the sciatic nerve at the suture site following repairing in rats. The right sciatic nerves of 40 white Sprague-Dawley 300~350 gm rats were exposed, cut and then repaired with 10-0 nylon sutures with four stitches, laced in the epineurium 0, 1, 3, and 6 weeks after operation, the tensile strength of the sciatic nerves were measured, and the data analyzed statistically. The load elongation curves for both the normal unoperated and operated nerves had similar shape. There were significant differences between the tensile strength of the 0th and the 1st, 3rd, and 6th weeks (P < 0.01). No significant difference was found among the 1st, 3rd, and 6th weeks. The tensile strength of the injured nerves recovered 48% of the normal nerve in the 1st week and 54% in 6 weeks after repairing. It may be concluded that the injured nerves can acquire mostly tensile strength stability in 1 week quickly and can maintain this relative tensile strength stability in 6 weeks.

  12. The outcome study of arthroscopic repair with anchor suture for anterior shoulder instabilities

    Directory of Open Access Journals (Sweden)

    Guity MR

    2010-10-01

    Full Text Available "nBackground: Anterior glenohumeral instabilities can be corrected with open and arthroscopic surgery. The purpose of this study was to evaluate retrospectively the surgical outcomes of arthroscopic repair of anterior glenohumeral instabilities with use of suture anchors in a series of patients who were followed for twenty to fifty months."n "nMethods: The results of arthroscopic Bankart repair with use of suture anchors in 30 patients with traumatic recurrent anterior instability of the shoulder were evaluated. At the time of follow-up (mean of thirty-three months, the patients were assessed with two outcome measurement tools (the Rowe score, the Constant score. The recurrence rate, range of motion, and risk factors for postoperative recurrence were evaluated."n "nResults: According to the Rowe scale, 12 patients (40% had an excellent score; 13 (43%, a good score; 4 (13%, a fair score; and 1 (4%, a poor score. The mean ROWE score was 81.8 and the mean CONSTANT score was 85.5. Overall, the rate of postoperative recurrence of instability was 10% (two dislocations, one subluxation. The mean delay to recurrence was 20 months. Loss of external rotation in regard to uninvolved extremity was less than 10 degrees in 30% and more than 10 degrees in 10% of patients. The average number of anchors used was 3.2 which follow-up radiographs showed all of them in the osseous glenoid without pullout. In preoperative studies, shoulder 3D CT scan was not performed routinely. Radiographic signs of degenerative changes were noted in one shoulder."n "nConclusion: Arthroscopic capsulolabral repair with use of suture anchors can provide satisfactory outcomes in terms of recurrence rate, activity, and range of motion.

  13. Radar rainfall image repair techniques

    Directory of Open Access Journals (Sweden)

    Stephen M. Wesson

    2004-01-01

    Full Text Available There are various quality problems associated with radar rainfall data viewed in images that include ground clutter, beam blocking and anomalous propagation, to name a few. To obtain the best rainfall estimate possible, techniques for removing ground clutter (non-meteorological echoes that influence radar data quality on 2-D radar rainfall image data sets are presented here. These techniques concentrate on repairing the images in both a computationally fast and accurate manner, and are nearest neighbour techniques of two sub-types: Individual Target and Border Tracing. The contaminated data is estimated through Kriging, considered the optimal technique for the spatial interpolation of Gaussian data, where the 'screening effect' that occurs with the Kriging weighting distribution around target points is exploited to ensure computational efficiency. Matrix rank reduction techniques in combination with Singular Value Decomposition (SVD are also suggested for finding an efficient solution to the Kriging Equations which can cope with near singular systems. Rainfall estimation at ground level from radar rainfall volume scan data is of interest and importance in earth bound applications such as hydrology and agriculture. As an extension of the above, Ordinary Kriging is applied to three-dimensional radar rainfall data to estimate rainfall rate at ground level. Keywords: ground clutter, data infilling, Ordinary Kriging, nearest neighbours, Singular Value Decomposition, border tracing, computation time, ground level rainfall estimation

  14. Single-port laparoscopic repair of a Morgagni diaphragmatic hernia in a pediatric patient: advancement in single-port technology allows effective intracorporeal suturing.

    Science.gov (United States)

    Danielson, Paul D; Chandler, Nicole M

    2010-03-01

    We report a case of a foramen of Morgagni hernia repaired by a single-port laparoscopic technique. A 20-month-old (10 kg) boy underwent a 97-minute procedure through a 15-mm umbilical incision and had no complications. Although other pediatric single-port case series have been reported in the literature, this case represents the first time a diaphragmatic defect has been addressed. Moreover, unlike previous experiences that involved procedures of resection (appendectomy, cholecystectomy, etc), this case required operative repair and reconstruction with intracorporeal suturing via a single-access site. Advancement in instrument and port technology makes such procedures feasible in pediatric patients.

  15. The "Inside-out" Technique for Hernia Repair with Mesh Underlay.

    Science.gov (United States)

    Berhanu, Aaron E; Talbot, Simon G

    2015-06-01

    An improved method for mesh repair of ventral/incisional hernias after component separation is presented. The use of a Carter-Thomason suture passer (Cooper Surgical, http://www.coopersurgical.com) allows for safe passage of preplaced sutures on the mesh from within the abdominal cavity through the anterior rectus sheath. This "inside-out" method makes the underlay of mesh fast and easy by improving visualization and control of sharp instruments as they are passed through the abdominal cavity. Preplacement of sutures circumferentially on the mesh also improves the distribution of tension around the repair, which may ultimately reduce the risk of hernia recurrence. The "inside-out" technique was performed on 23 patients at a single tertiary academic medical center from November 2011 to February 2014. We have followed these patients for a median of 24.5 months to assess for postoperative complications and hernia recurrence. We report an acceptable hernia recurrence rate (2 of 23 = 8.7%). One recurrence was observed in a patient who underwent repair of a recurrent ventral hernia and the other had significant loss of domain requiring an inlay mesh. The "inside-out" technique for ventral hernia repair with a mesh underlay after component separation using a Carter-Thomason suture passer is easy, safe, and reliable. We have observed no hernia recurrence in patients who underwent repair for a primary ventral hernia with an underlay technique.

  16. Outcomes following arthroscopic transosseous equivalent suture bridge double row rotator cuff repair: a prospective study and short-term results

    Directory of Open Access Journals (Sweden)

    Imam Mohamed Abdelnabi

    2016-01-01

    Full Text Available Background: The transosseous-equivalent cross bridge double row (TESBDR rotator cuff (RC repair technique has been developed to optimize healing biology at a repaired RC tendon insertion. It has been shown in the laboratory to improve pressurized contact area and mean foot print pressure when compared with a double row anchor technique. Pressure has been shown to influence healing between tendon and bone, and the tendon compression vector provided by the transosseous-equivalent suture bridges may enhance healing. The purpose was to prospectively evaluate the outcomes of arthroscopic TESBDR RC repair. Methods: Single center prospective case series study. Sixty-nine patients were selected to undergo arthroscopic TESBDR RC repair and were included in the current study. Primary outcome measures included the Oxford Shoulder Score (OSS, the University of California, Los Angeles (UCLA score, the Constant-Murley (CM Score and Range of motion (ROM. Secondary outcome measures included a Visual Analogue Scale (VAS for pain, another VAS for patient satisfaction from the operative procedure, EuroQoL 5-Dimensions Questionnaire (EQ-5D for quality of life assessment. Results: At 24 months post-operative, average OSS score was 44, average UCLA score was 31, average CM score was 88, average forward flexion was 145°, average internal rotation was 35°, average external rotation was 79°, average abduction was 150°, average EQ-5D score was 0.73, average VAS for pain was 2.3, and average VAS for patient satisfaction was 9.2. Conclusion: Arthroscopic TESBDR RC repair is a procedure with good post-operative functional outcome and low re-tear rate based on a short term follow-up.

  17. Biomechanical evaluation of different suture materials for arthroscopic transtibial pull-out repair of posterior meniscus root tears.

    Science.gov (United States)

    Feucht, Matthias J; Grande, Eduardo; Brunhuber, Johannes; Rosenstiel, Nikolaus; Burgkart, Rainer; Imhoff, Andreas B; Braun, Sepp

    2015-01-01

    To evaluate the biomechanical properties of four different suture materials for arthroscopic transtibial pull-out repair of posterior meniscus root tears, with special focus on the meniscus-suture interface. Forty fresh-frozen lateral porcine menisci were used. The posterior meniscus root was sutured in a standardized fashion with a simple stitch using four different suture materials: group A, No. 2 PDS™; group B, No. 2 Ethibond™; group C, No. 2 FiberWire™; and group D, 2-mm Fibertape™. Meniscus-suture constructs were subjected to cyclic loading followed by load-to-failure testing using a servo-hydraulic material testing machine. During cyclic loading, group D showed a significantly higher displacement after 100, 500, and 1,000 cycles compared to group A (p provided clearly superior properties over the others during both cyclic loading and load-to-failure testing. Based on the results of this study, FiberWire™ may be the preferred suture material for transtibial pull-out repair of posterior meniscus root tears because of comparably low displacement during cyclic loading and high values for maximum load and stiffness. In the clinical setting, FiberWire™ may improve healing rates and avoid progressive extrusion of the meniscus after transtibial pull-out repair of posterior meniscus root tears.

  18. Improved Upper Blepharoplasty Outcome Using an Internal Intradermal Suture Technique : A Prospective Randomized Study

    NARCIS (Netherlands)

    Pool, Shariselle M. W.; Krabbe-Timmerman, Irene S.; Cromheecke, Michel; van der Lei, Berend

    OBJECTIVETo assess whether a suture technique in upper blepharoplasty may be the cause of differences in the occurrence of suture abscess formation and focal inflammation.MATERIALS AND METHODSA Level I, randomized controlled trial. The upper blepharoplasty wound was closed with a running intradermal

  19. Return to football and long-term clinical outcomes after thumb ulnar collateral ligament suture anchor repair in collegiate athletes.

    Science.gov (United States)

    Werner, Brian C; Hadeed, Michael M; Lyons, Matthew L; Gluck, Joshua S; Diduch, David R; Chhabra, A Bobby

    2014-10-01

    To evaluate return to play after complete thumb ulnar collateral ligament (UCL) injury treated with suture anchor repair for both skill position and non-skill position collegiate football athletes and report minimum 2-year clinical outcomes in this population. For this retrospective study, inclusion criteria were complete rupture of the thumb UCL and suture anchor repair in a collegiate football athlete performed by a single surgeon who used an identical technique for all patients. Data collection included chart review, determination of return to play, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) outcomes. A total of 18 collegiate football athletes were identified, all of whom were evaluated for follow-up by telephone, e-mail, or regular mail at an average 6-year follow-up. Nine were skill position players; the remaining 9 played in nonskill positions. All players returned to at least the same level of play. The average QuickDASH score for the entire cohort was 1 out of 100; QuickDASH work score, 0 out of 100; and sport score, 1 out of 100. Average time to surgery for skill position players was 12 days compared with 43 for non-skill position players. Average return to play for skill position players was 7 weeks postoperatively compared with 4 weeks for non-skill position players. There was no difference in average QuickDASH overall scores or subgroup scores between cohorts. Collegiate football athletes treated for thumb UCL injuries with suture anchor repair had quick return to play, reliable return to the same level of activity, and excellent long-term clinical outcomes. Skill position players had surgery sooner after injury and returned to play later than non-skill position players, with no differences in final level of play or clinical outcomes. Management of thumb UCL injuries in collegiate football athletes can be safely and effectively tailored according to the demands of the player's football position. Therapeutic IV. Copyright © 2014

  20. Viability and proliferation of pluripotential cells delivered to tendon repair sites using bioactive sutures--an in vitro study.

    Science.gov (United States)

    Yao, Jeffrey; Korotkova, Tatiana; Smith, R Lane

    2011-02-01

    We evaluated the fate of pluripotential stem cells adherent to a suture carrier after being passed through tendon tissue in vitro. FiberWire suture segments were coated with poly-L-lysine (PLL) and a 2 × 10(6) C3H10T1/2 (a mouse embryo pluripotential cell line) cell suspension. The sutures were incubated for 7 days, passed through two 1-cm segments of acellularized rabbit Achilles tendons and tied (horizontal mattress). The repairs were frozen and sectioned (6 μm). The sections were stained with 4',6-diamidino-2-phenylindole and a live/dead viability/cytotoxicity (calcein/ethidium homodimer) kit and examined with fluorescent microscopy to evaluate cell presence and viability. Alamar Blue was used in parallel to assess metabolic activity. PLL-coated sutures showed a 3-fold increase in fluorescence when compared with the phosphate-buffered saline-coated controls. At day 3, fluorescence was 2.2 times greater. At day 5, a 2-fold increase was found, and at day 8 there was no significant difference in values. Furthermore, after delivery of the cells into tendon, fluorescence readings for the samples (n = 19) showed 9450 compared with the positive control at 21,218. At 96 hours the mean was 27,609 compared with 34,850 for the positive control. The difference in fluorescence means at 48 hours and 96 hours were significant (p cells at the tendon repair site. Sutures seeded with pluripotential embryonic cells deliver cells to a tendon repair site. The cells deposited at the repair site survive the trauma of passage and remain metabolically active, as seen in staining and metabolic assay studies. Use of bioactive sutures leads to repopulation of the acellular zone surrounding sutures within the tendon. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2016-05-01

    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.

  2. Calvarial Suture-Derived Stem Cells and Their Contribution to Cranial Bone Repair

    Directory of Open Access Journals (Sweden)

    Daniel H. Doro

    2017-11-01

    Full Text Available In addition to the natural turnover during life, the bones in the skeleton possess the ability to self-repair in response to injury or disease-related bone loss. Based on studies of bone defect models, both processes are largely supported by resident stem cells. In the long bones, the source of skeletal stem cells has been widely investigated over the years, where the major stem cell population is thought to reside in the perivascular niche of the bone marrow. In contrast, we have very limited knowledge about the stem cells contributing to the repair of calvarial bones. In fact, until recently, the presence of specific stem cells in adult craniofacial bones was uncertain. These flat bones are mainly formed via intramembranous rather than endochondral ossification and thus contain minimal bone marrow space. It has been previously proposed that the overlying periosteum and underlying dura mater provide osteoprogenitors for calvarial bone repair. Nonetheless, recent studies have identified a major stem cell population within the suture mesenchyme with multiple differentiation abilities and intrinsic reparative potential. Here we provide an updated review of calvarial stem cells and potential mechanisms of regulation in the context of skull injury repair.

  3. Suture material for flexor tendon repair: 3–0 V-Loc versus 3–0 Stratafix in a biomechanical comparison ex vivo

    OpenAIRE

    Schmidt, Karsten; Jordan, Martin C.; Hölscher-Doht, Stefanie; Jakubietz, Michael G.; Jakubietz, Rafael G.; Meffert, Rainer H.

    2015-01-01

    Background Barbed suture material offers the possibility of knotless flexor tendon repair, as suggested in an increasing number of biomechanical studies. There are currently two different absorbable barbed suture products available, V-Loc™ and Stratafix™, and both have not been compared to each other with regard to flexor tendon repair. The purpose of this study was to evaluate both suture materials for primary stability under static and cyclic loading in a biomechanical ex vivo model. ...

  4. Comparison of Semi-Invasive "Internal Splinting" and Open Suturing Techniques in Achilles Tendon Rupture Surgery.

    Science.gov (United States)

    Sarman, Hakan; Muezzinoglu, Umit Sefa; Memisoglu, Kaya; Aydin, Adem; Atmaca, Halil; Baran, Tuncay; Odabas Ozgur, Bahar; Ozgur, Turgay; Kantar, Cengizhan

    2016-01-01

    The goal of the present study was to evaluate the semi-invasive "internal splinting" (SIIS) method for repair of Achilles tendon rupture relative to open repair with Krakow sutures. Efficacy was evaluated based on the clinical and functional outcomes, postoperative magnetic resonance imaging measurements, isokinetic results, and surgical complication rates. Functional measurements included the Thermann and American Orthopaedic Foot and Ankle Society (AOFAS) ankle scores, bilateral ankle dorsiflexion, and plantar flexion measurements. Magnetic resonance imaging was used to compare the bilateral length and thickness of each Achilles tendon. The isokinetic outcomes were evaluated using a Biodex System 3 dynamometer. Of the 45 patients meeting the inclusion criteria, 24 were treated by SIIS and 21 by the open Krackow suture technique. The mean follow-up time for all patients was 43.7 (range 6 to 116) months. In the SIIS group, patients returned to normal daily activities after 7.2 (range 6 to 8) weeks compared with 14.3 (range 12 to 15) weeks in the open surgery group. The AOFAS ankle scores were 93.5 (range 82 to 100) points in the open repair group and 96.2 (range 86 to 100) points in the SIIS group. The Thermann scores were 80.4 (range 53 to 91) points for the open repair group and 87.9 (range 81 to 100) points for the SIIS method. The mean Achilles length on the operated side measured using magnetic resonance imaging was 175.06 (range 110 to 224) mm and 177.76 (range 149 to 214) mm for the open surgery and SIIS groups, respectively. Sensory impairment in the territory of the sural nerve was identified in 1 patient immediately after SIIS surgery, although this defect had completely resolved within 12 months. SIIS yielded better outcomes relative to the open surgery group according to the isokinetic measurements. Taken together, these data indicate the SIIS method for Achilles tendon ruptures performed better in terms of both functional and objective outcomes

  5. Inside-Out or Outside-In Suturing Should Not Be Considered the Standard Repair Method for Radial Tears of the Midbody of the Lateral Meniscus: A Systematic Review and Meta-Analysis of Biomechanical Studies.

    Science.gov (United States)

    Alentorn-Geli, Eduard; Choi, J H James; Stuart, Joseph J; Toth, Alison P; Garrett, William E; Taylor, Dean C; Moorman, Claude T

    2016-10-01

    The purpose was to evaluate which meniscal repair technique for radial tears of the midbody of the lateral meniscus demonstrates the best biomechanical properties. An electronic literature search was conducted using PubMed, EMBASE, CINAHL, and ScienceDirect databases. Biomechanical studies investigating the repair characteristics of radial tears in the midbody of the lateral meniscus were included. After appropriate screening, a total of 54 studies were reviewed in detail (full text), and 6 met inclusion criteria. The most common cause of exclusion was the investigation of longitudinal tears. Only two studies could be meta-analyzed. Stiffness was significantly higher for all-inside compared with inside-out repair techniques (p = 0.0009). No significant differences were observed between both suture methods for load to failure (p = 0.45). However, both studies used different all-inside devices and suture constructs. No clear conclusions can be drawn from the comparison of both types of repairs for displacement, site of failure, or contact pressure changes. Overall, there are no conclusive data to suggest that inside-out or outside-in suture repair has better load to failure or stiffness, less displacement, or different site of failure compared with all-inside repair. According to biomechanical data, it is under surgeon's preference to elect one repair technique over the other. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. Effects of Suture Choice on Biomechanics and Physeal Status After Bioenhanced Anterior Cruciate Ligament Repair in Skeletally Immature Patients: A Large-Animal Study

    Science.gov (United States)

    Vavken, Patrick; Proffen, Benedikt; Peterson, Chris; Fleming, Braden C.; Machan, Jason T.; Murray, Martha M.

    2012-01-01

    Purpose The objective of this study was to assess the effect of absorbable or nonabsorbable sutures in bioenhanced anterior cruciate ligament (ACL) repair in a skeletally immature pig model on suture tunnel and growth plate healing and biomechanical outcomes. Methods Sixteen female skeletally immature Yorkshire pigs were randomly allocated to receive unilateral, bioenhanced ACL repair with an absorbable (Vicryl) or nonabsorbable (Ethibond) suture augmented by an extracellular matrix-based scaffold (MIACH). After 15 weeks of healing, micro–computed tomography was used to measure residual tunnel diameters and growth plate status, and biomechanical outcomes were assessed. Results At 15 weeks postoperatively, there was a significant difference in tunnel diameter with significantly larger diameters in the nonabsorbable suture group (4.4 ± 0.3 mm; mean ± SD) than in the absorbable group (1.8 ± 0.5 mm; P sutures, P = .531), but load to failure was higher in the nonabsorbable suture group (211 ± 121.5 N) than in the absorbable suture group (173 ± 101.4 N, P =.002). There was no difference between the 2 groups in anteroposterior laxity at 30° (P = .5117), 60° (P = .3150), and 90° (P = .4297) of knee flexion. Conclusions The use of absorbable sutures for ACL repair resulted in decreased physeal plate damage after 15 weeks of healing; however, use of nonabsorbable sutures resulted in 20% stronger repairs. Clinical Relevance Choice of suture type for ACL repair or repair of tibial avulsion fractures may depend on patient skeletal age and size, with absorbable sutures preferred in very young, small patients at higher risk with physeal damage and nonabsorbable sutures preferred in larger, prepubescent patients who may place higher loads on the repair. PMID:23200845

  7. Comparison of sutures and cyanoacrylate tissue adhesives for wound repair in a rat model of corneal laceration.

    Science.gov (United States)

    Nuhoglu, Fadime; Altiparmak, Ugur E; Hazirolan, Dicle O; Kasim, Remzi; Duman, Sunay

    2013-01-01

    The aim of the present study was to evaluate the cicatricial repair of a corneal artificial perforation in rats with 10-0 nylon suture, N-butyl-2-cyanoacrylate (NBCA) adhesive, or NBCA + methacryloxysulfolane (NBCA-MS) adhesive through microscopic and histological assays. Twenty Wistar rats were randomly divided into 4 groups each containing 5 rats: (1) control group (corneal trauma without suturing and tissue adhesives), (2) suture group, (3) NBCA group and (4) NBCA-MS group. A central full-thickness 2-mm laceration was performed in the left eyes of the studied rats in all 4 groups. The presence of corneal edema, corneal neovascularization and tissue adhesive/suture were evaluated. On the 21st day, the rats were sacrificed and histological examination was performed to determine irregularity of corneal layers, superficial epithelization, polymorphonuclear leucocytes and neovascularization. Tissue adhesives were as effective as suturing in closing full-thickness corneal wounds and no difference in postoperative healing was observed clinically. As for the histological results, suture-treated eyes had persistent corneal irregularity that can limit visual acuity and may also lead to astigmatism. The use of tissue adhesives constitutes a viable alternative clinical procedure to conventional sutures. Possible influences on astigmatism are hypothetical, as no objective measure of astigmatism was performed in the test animals. Copyright © 2013 S. Karger AG, Basel.

  8. Laparoscopic repair of a Morgagni diaphragmatic hernia in a child, using a trans-sternal technique

    Directory of Open Access Journals (Sweden)

    Shah Amar

    2005-01-01

    Full Text Available Laparoscopic repair of Morgagni hernia has been described in adults and children. In the published reports, the crux of the repair consists of suturing the posterior part of the diaphragmatic defect to the undersurface of the sternum or the posterior rectus sheath. The tissue on the undersurface of the sternum is variable is in its nature and may be inadequate for suturing, hence compromising the strength of the repair. A technique that circumvents this problem and offers a strong anatomical repair is described. A Morgagni hernia was diagnosed in a 2-year-old girl with trisomy 21, who presented with recurrent chest infections. She underwent laparoscopic repair of the hernia using three ports. The tissue on the undersurface of the sternum was inadequate for a conventional repair. The procedure was modified as follows: a small transverse incision was made over the lower end of the sternum. Three nonabsorbable mattress sutures were inserted through the sternum, the anterior edge of the diaphragmatic defect, and back through the sternum and tied with extracorporeal knots. The child was discharged home on the second postoperative day. At 6-month follow up, the child was asymptomatic, and had been infection free. A chest radiograph was normal. This is a simple, novel, noninvasive method, which offers a secure anatomical repair and it is not dependent on the adequacy of the tissue on the undersurface of the sternum.

  9. A novel technique for modified all-inside repair of bucket-handle meniscus tears using standard arthroscopic portals.

    Science.gov (United States)

    Yik, Jing Hui; Koh, Bryan Thean Howe; Wang, Wilson

    2017-12-04

    Bucket-handle meniscus tears (BHMT) are often displaced and unstable. The inside-out technique of repairing such tears is currently the gold standard. All-inside repair with meniscal fixators is getting increasingly popular. Shortcomings of the inside-out technique include neurovascular complications, especially saphenous nerve palsy, and retention of a non-resorbable suture which can result in discomfort to patient, granuloma formation, and a foci of infection. Hence, the purpose of this project was to innovate a novel all-inside technique to precisely reduce and fix BHMT while avoiding neurovascular complications and retention of a non-resorbable suture. Routine arthroscopic portals were created on a patient's left knee with a displaced BHMT. Through the anteromedial portal, a conjoint pseudo double lumen cannula was inserted. Two limbs of a reduction suture were passed through the cannula, one over the "femoral" surface of the meniscus, one over the "tibial" surface of the meniscus anterior to the biceps femoris tendon, with the knee flexed at 20° to avoid injury to the saphenous nerve. Suture limbs were passed out percutaneously and tensioned. Anatomic reduction was ensured under arthroscopic visualization with ease. All inside repair was performed using the vertical mattress suture configuration. Reduction sutures were subsequently removed by cutting flush to the skin and pulling on one suture limb. The patient was back to full activities with minimal discomfort 8 months post-operatively. The technique described is superior to existing techniques for the following reasons: (1) Reduction of the displaced meniscal tear is "extra-meniscal," avoiding further trauma to a damaged meniscus. (2) Tensioning of the two suture limbs created promotes better control of reduction through tensioning. (3) Risk of discomfort, infection, and neurovascular damage caused by a retained suture is reduced. (4) No additional portals/equipment is required. We encourage this novel

  10. Randomized, Controlled, Blinded Trial of Tisseel/Tissucol for Mesh Fixation in Patients Undergoing Lichtenstein Technique for Primary Inguinal Hernia Repair

    DEFF Research Database (Denmark)

    Campanelli, Giampiero; Pascual, Manuel Hidalgo; Hoeferlin, Andreas

    2012-01-01

    : Test the hypothesis that fibrin sealant mesh fixation can reduce the incidence of postoperative pain/numbness/groin discomfort by up to 50% compared with sutures for repair of inguinal hernias using the Lichtenstein technique.......: Test the hypothesis that fibrin sealant mesh fixation can reduce the incidence of postoperative pain/numbness/groin discomfort by up to 50% compared with sutures for repair of inguinal hernias using the Lichtenstein technique....

  11. Effects of suture site or penetration depth on anchor location in all-inside meniscal repair.

    Science.gov (United States)

    Uchida, Ryohei; Mae, Tatsuo; Hiramatsu, Kunihiko; Iuchi, Ryo; Kinugasa, Kazutaka; Shino, Konsei; Yoshikawa, Hideki; Nakata, Ken

    2016-12-01

    To evaluate the effects of suture site or penetration depth on anchor location in all-inside meniscal repair. Eight fresh-frozen cadaveric knees were evaluated after meniscal repair using eight FasT-Fix360 (FF360) devices (Smith & Nephew Endoscopy, Andover, MA) (16 anchors) for each knee. The penetration depth was 14mm, the distance same from the periphery to insertion point, in four knees (Group A) and that in the remaining four knees (Group B) was 18mm. The anchor location in two groups was evaluated after attentive dissection. Of 32 anchors for the medial meniscus, 94% were on the capsule, including the superficial medial collateral ligament (sMCL) in both groups. For the lateral meniscus, 47% anchors in Group A and 44% anchors in Group B were on the capsule. Total three anchors were over the lateral collateral ligament (LCL), whereas 15 anchors were behind the popliteus tendon (POP). Although all three anchors settled in the subcutaneous fat were in Group B, no significant difference was observed in anchor location between two groups. Secure fixation to thin membranous tissue can be achieved for the medial meniscal repair using FF360, while some were located in/on bunchy LCL or POP in lateral meniscal repair. Only anchors with additional four-millimeter penetration depth were in the subcutaneous fat, although there was no effect of the penetration depth to anchor location. Clinically, for lateral meniscal repair, penetrating toward POP/LCL should be avoided and four-millimeter deeper penetration depth might be a risk for the subcutaneous irritation. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. The “Labral Bridge”: A Novel Technique for Arthroscopic Anatomic Knotless Bankart Repair

    Science.gov (United States)

    Ostermann, Roman C.; Hofbauer, Marcus; Platzer, Patrick; Moen, Todd C.

    2015-01-01

    Arthroscopic Bankart repair with suture anchors is widely considered a mainstay for surgical treatment of anterior shoulder instability after recurrent anterior shoulder dislocations. Traditionally, the displaced capsulolabral complex is restored and firmly attached to the glenoid by placing multiple suture anchors individually from a 5- to 3-o'clock position. A variety of different techniques using different anchor designs and materials have been described. Knotless anchors are widely used nowadays for shoulder instability repair, providing a fast and secure way of labral fixation with favorable long-term outcomes. However, these techniques result in a concentrated point load of the reduced labrum to the glenoid at each suture anchor. We describe a technique, developed by the first author, using a 1.5-mm LabralTape (Arthrex, Naples, FL) in combination with knotless suture anchors (3.5-mm PEEK [polyether ether ketone] PushLock anchors; Arthrex), for hybrid fixation of the labrum. The LabralTape is used to secure the torn labrum to the glenoid between each suture anchor, thus potentially providing a more even pressure distribution. PMID:26052499

  13. Bankart Repair Using Modern Arthroscopic Technique.

    Science.gov (United States)

    Hendawi, Tariq; Milchteim, Charles; Ostrander, Roger

    2017-06-01

    As technology continues to improve, surgeons must regularly re-evaluate techniques to improve efficacy and outcomes. The Bankart repair for shoulder instability has evolved from open reconstruction to minimally invasive arthroscopic techniques, which have the benefit of less pain and morbidity. This technical description and video present a modern arthroscopic technique for Bankart repair used at our institution with high success in an athletic population.

  14. Bankart Repair Using Modern Arthroscopic Technique

    OpenAIRE

    Hendawi, Tariq; Milchteim, Charles; Ostrander, Roger

    2017-01-01

    As technology continues to improve, surgeons must regularly re-evaluate techniques to improve efficacy and outcomes. The Bankart repair for shoulder instability has evolved from open reconstruction to minimally invasive arthroscopic techniques, which have the benefit of less pain and morbidity. This technical description and video present a modern arthroscopic technique for Bankart repair used at our institution with high success in an athletic population.

  15. [Ligament bracing--augmented primary suture repair in multiligamentous knee injuries].

    Science.gov (United States)

    Heitmann, M; Gerau, M; Hötzel, J; Giannakos, A; Frosch, K-H; Preiss, A

    2014-02-01

    Reconstruction of knee stability by primary ligament sutures and additional augmentation after knee dislocation. Acute knee dislocation Schenck type III and IV. Operative treatment should be performed within 7 days after injury. Chronic instability after knee dislocation, refixable bony avulsions, critical soft tissue, infection, lack of compliance. Supine position with electric leg holder. Short arthroscopic assessment of concomitant injuries. Schenck type III medial injuries and Schenck IV injuries: anteromedial parapatellar arthrotomy. Injuries type Schenck III lateral: anteromedian arthrotomy. Armoring of ligament stumps for transosseus sutures. Placement of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) drill tunnels. Extracortical diversion of the suture armorings and insertion of augmentation systems. Fixation of the PCL augmentation in 70-90° flexion. Fixation of the ACL augmentation in 20-30° flexion. Knotting of the transosseus ligament sutures. If necessary (postero-)lateral and/or medial stabilization. Limited weight bearing with 20 kg for 6 weeks. Stabilizing brace (e.g., Hypex-Lite®, Albrecht) generally for 12 weeks. Mobilization under tension of the quadriceps muscle for 6 weeks. In total, 20 patients have been treated using the principle of "ligament bracing". So far 8 patients (aged 18-60 years, median 33 years) have been assessed with a follow-up of 10-15 months (median 12 months) postoperatively. In all, 6 patients showed stable knees with good results. Recurrent instability of the ACL was observed in 2 patients; the collateral ligaments and PCL were stable. For the evaluation the following scores were used: IKDC score, Tegner score, and Lysholm score. To objectify the data, stress radiography and physical examination were performed. Using the operative technique mentioned above, no complications occurred. During follow-up 2 patients reported a deficiency of flexion.

  16. Parastomal hernia-repair using mesh and an open technique.

    Science.gov (United States)

    Guzmán-Valdivia, Gilberto; Guerrero, Teresa Soto; Laurrabaquio, Hilda Varela

    2008-03-01

    Parastomal hernia occurs in 35%-50% of patients who have had a stoma formed, whether for the digestive tract or the urinary tract. There are many repair techniques including primary repair and repair using different types of mesh prosthesis, and the surgical approach may be open or laparoscopic. However, all techniques suffer the disadvantage of a high index of hernia recurrence. This study included 125 patients from the stoma clinic at our hospital. Hernia repair was performed on 25 of these patients who had a terminal colostomy because of either cancer or inflammatory disease. Preoperative colon preparation involved a cathartic, an evacuating enema, and antibiotic therapy in the preoperative period. The repair was conducted via an anterior approach, dissecting the skin around the stoma in the way a plastic surgeon handles an umbilical scar during abdominoplasty, in order to enter the hernia site. The hernial sac was left intact to form a bed on which to lay a lightweight polypropylene mesh, and this was then fixed to the deep face of the aponeurosis all around the stoma, with sutures placed in a U-shape with 1/0 or 2/0 non-absorbent material. The mesh was also fixed to the external surface of the colon with simple sutures of 3/0 polyglycocolic acid. A closed supra-aponeurotic drain was left in situ, and the skin was closed with 3/0 nylon. Of the corpus, 50 patients presented with parastomal hernia (40%), and 25 of them underwent surgery. These patients were followed for a period of 12 months, on average (range: 8-24 months). After operation, 2 patients (8%) experienced hernia recurrence and underwent further surgery to reinforce the abdominal wall with a new insertion of mesh prosthesis; 2 patients (8%) suffered surgical wound infection; and 2 patients (8%) developed a seroma. There was no rejection of the mesh, erosion of the colon, or fistula formation. Inserting a mesh prosthesis by this technique is a safe effective treatment for parastomal hernia, adding

  17. A Biomechanical Analysis of the Interlock Suture and a Modified Kessler-Loop Lock Flexor Tendon Suture

    Directory of Open Access Journals (Sweden)

    Wenfeng Yang

    Full Text Available OBJECTIVE: In this work, we attempted to develop a modified single-knot Kessler-loop lock suture technique and compare the biomechanical properties associated with this single-knot suture technique with those associated with the conventional modified Kessler and interlock suture techniques. METHODS: In this experiment, a total of 18 porcine flexor digitorum profundus tendons were harvested and randomly divided into three groups. The tendons were transected and then repaired using three different techniques, including modified Kessler suture with peritendinous suture, interlock suture with peritendinous suture, and modified Kessler-loop lock suture with peritendinous suture. Times required for suturing were recorded and compared among groups. The groups were also compared with respect to 2-mm gap load, ultimate failure load, and gap at failure. RESULTS: For tendon repair, compared with the conventional modified Kessler suture technique, the interlock and modified Kessler-loop lock suture techniques resulted in significantly improved biomechanical properties. However, there were no significant differences between the interlock and modified Kessler-loop lock techniques with respect to biomechanical properties, gap at failure, and time required. CONCLUSIONS: The interlock and modified Kessler-loop lock techniques for flexor tendon sutures produce similar mechanical characteristics in vitro.

  18. 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

    Directory of Open Access Journals (Sweden)

    Volkan Ergan

    2016-12-01

    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

  19. Análise biomecânica e histológica de tendões flexores reparados em coelhos usando três técnicas de sutura (quatro e seis passadas com mobilização ativa precoce Biomechanics and histological analysis in rabbit flexor tendons repaired using three suture techniques (four and six strands with early active mobilization

    Directory of Open Access Journals (Sweden)

    Antônio Lourenço Severo

    2012-02-01

    Full Text Available OBJETIVO: Analisar o tempo das suturas, a biomecânica (deformidade entre os cotos tendíneos e a histologia dos três grupos de reparo cirúrgico tendíneo: Brasil-2 (quatro passadas, com técnica de sutura central em que o nó final se encontra fora do tendão; Indiana (quatro passadas; e Tsai (seis passadas, com técnicas de sutura central em que o nó final se encontra no interior do tendão reparado, associados de mobilização ativa precoce. MÉTODOS: O tendão calcâneo direito de 36 coelhos da raça New Zealand foi escolhido para a análise. Este apresenta calibre semelhante ao tendão flexor humano, o qual tem aproximadamente 4,5mm (variando 2mm para mais ou menos. A amostra selecionada apresentava a mesma massa (2,5 a 3kg e eram adultos machos ou fêmeas (a partir de 8½ meses de idade. RESULTADOS: Na análise biomecânica, não houve diferença estatisticamente significativa (p > 0,01. Não houve diferença estatística com relação ao tempo cirúrgico na realização das três técnicas de suturas (p > 0,01. Evidenciou-se, qualitativamente e quantitativamente, com a mobilidade ativa precoce, um espessamento da fibra de colágeno em 38,9% dentro do 15º dia e de 66,7% dentro do período do 30º dia (p = 0,095. CONCLUSÃO: Esta investigação serviu para demonstrar que não houve diferença histológica do nó final da sutura central dentro ou fora do tendão reparado, bem como o número de passadas, no que diz respeito à cicatrização, vascularização ou deformidade do tendão no túnel osteofibroso com as técnicas de reparo aplicadas, associados de mobilização ativa precoce.OBJECTIVE: analyzing suture time, biomechanics (deformity between the stumps and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands which the end knot (core is located outside the tendon, Indiana (4-strands and Tsai (6-strands with sutures technique which the end knot (core is inner of the tendon, associated with early active

  20. Suture anchor fixation of displaced olecranon fractures in the elderly: a case series and surgical technique.

    Science.gov (United States)

    Bateman, Dexter K; Barlow, Jonathan D; VanBeek, Corinne; Abboud, Joseph A

    2015-07-01

    Olecranon fractures are common in elderly patients, causing significant morbidity and functional impairment. Traditional surgical treatments are often complicated by hardware failure and prominence, frequently requiring reoperation. To address these concerns, a suture anchor fixation technique was developed and clinically evaluated. A consecutive series of elderly patients treated with this technique from 2006 to 2013 at a single institution were studied. All cases were surgically repaired with nonmetallic fully threaded suture anchors in a double-row fashion. Clinical outcome measures including the shortened Disabilities of the Arm, Shoulder, and Hand score, the Oxford Elbow Score, and the 12-Item Short Form Health Survey score were obtained. Eight female patients with Mayo IIA or IIB fractures were identified. The mean age of the patients at time of operation was 73.5 ± 10.7 years (range, 59.3-88.8 years). The average time from injury to operation was 5.7 ± 3.7 days. The average follow-up was 5.1 ± 2.5 years (range, 0.8-7.4 years). Six patients were available for long-term follow-up; 1 patient had died, and 1 patient was unable to be contacted despite multiple attempts. There were no intraoperative complications or reoperations. All 8 patients healed uneventfully in an acceptable position without displacement. Postoperatively, the average Oxford Elbow Score was 47.17 ± 2.04; the average shortened Disabilities of the Arm, Shoulder, and Hand score was 6.43 ± 9.47; and the average 12-Item Short Form Health Survey scores were 49.02 ± 16.59 and 55.38 ± 4.05 for the physical and mental component scales, respectively. Suture anchor fixation of olecranon fractures in the elderly population provides excellent long-term radiographic and clinical outcomes without hardware complications associated with traditional fixation methods. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  1. Sportsmen’s Groin—Diagnostic Approach and Treatment With the Minimal Repair Technique

    Science.gov (United States)

    Muschaweck, Ulrike; Berger, Luise Masami

    2010-01-01

    Context: Sportsmen’s groin, also called sports hernia and Gilmore groin, is one of the most frequent sports injuries in athletes and may place an athletic career at risk. It presents with acute or chronic groin pain exacerbated with physical activity. So far, there is little consensus regarding pathogenesis, diagnostic criteria, or treatment. There have been various attempts to explain the cause of the groin pain. The assumption is that a circumscribed weakness in the posterior wall of the inguinal canal, which leads to a localized bulge, induces a compression of the genital branch of the genitofemoral nerve, considered responsible for the symptoms. Methods: The authors developed an innovative open suture repair—the Minimal Repair technique—to fit the needs of professional athletes. With this technique, the circumscribed weakness of the posterior wall of the inguinal canal is repaired by an elastic suture; the compression on the nerve is abolished, and the cause of the pain is removed. In contrast with that of common open suture repairs, the defect of the posterior wall is not enlarged, the suture is nearly tension free, and the patient can return to full training and athletic activity within a shorter time. The outcome of patients undergoing operations with the Minimal Repair technique was compared with that of commonly used surgical procedures. Results: The following advantages of the Minimal Repair technique were found: no insertion of prosthetic mesh, no general anesthesia required, less traumatization, and lower risk of severe complications with equal or even faster convalescence. In 2009, a prospective cohort of 129 patients resumed training in 7 days and experienced complete pain relief in an average of 14 days. Professional athletes (67%) returned to full activity in 14 days (median). Conclusion: The Minimal Repair technique is an effective and safe way to treat sportsmen’s groin. PMID:23015941

  2. [Dynamic observation of the biomechanic properties of sciatic nerve at the suture site in rats following repairing].

    Science.gov (United States)

    Yan, Jia-zhi; Jiang, Bao-guo; Zhao, Fu-qiang; Wei, Guang-ru; Shang, Yong-gang; Zhang, Pei-xun; Liu, Bo; Zhang, Hong-bo

    2005-06-15

    To observe the biomechanic properties of sciatic nerve at the suture site in rats following repairing. The right sciatic nerves of 40 white Sprague-Dawley 300-350 gm rats were exposed, cut and then repaired with 10-0 nylon sutures, laced in the epineurium. 0, 1, 3, 6 weeks after operation, the tensile strength of the sciatic nerves were measured, the data analyzed statistically. The load-elongation curves for both the normal unoperated and operated nerves had the similar shape. The tensile strength of the 0 week was significant difference to 1, 3 and 6 weeks (P < 0.01). No significant difference was found among 1, 3 and 6 weeks. The tensile strength of the injured nerves are recovered in the first week and resistant in 6 weeks after repairing.

  3. Tacks, staples, or suture: method of peritoneal closure in laparoscopic transabdominal preperitoneal inguinal hernia repair effects early quality of life.

    Science.gov (United States)

    Ross, Samuel W; Oommen, Bindhu; Kim, Mimi; Walters, Amanda L; Augenstein, Vedra A; Heniford, B Todd; Todd Heniford, B

    2015-07-01

    TAPP inguinal hernia repair (IHR) entails the development of a peritoneal flap (PF) in order to reduce the hernia sac and create a preperitoneal space in which to place mesh. Many methods for closure of the PF exist including sutures, tacks, and staples. We hypothesized that patients who had PF closure with suture would have better short-term QOL outcomes. A prospective institutional hernia-specific database was queried for all adult, TAPP IHRs from July 2012 to August 2013. Unilateral and bilateral patients were included and each hernia was analyzed separately. The main outcome of interest was quality of life (QOL) at two- and four-week follow-up, as measured by the Carolinas Comfort Scale. There were 227 patients who underwent TAPP, with 99 bilateral and 128 unilateral IHR, for a total of 326 IHR. PF closure was performed using tacks in 45.1%, suture in 19.0%, and staples in 35.9%. Patient characteristics were statistically similar between the tack, suture, and staple group. There were 32.9% direct, 46.5% indirect, and 20.6% pantaloon hernias, which were not significantly different when compared by PF closure method. Post-operative complications and length of stay were same for the three groups. There were no hernia recurrences. Post-operative activity limitation at two weeks was significantly better in the suture group when compared to the stapled group (p = 0.005). Additionally, sutured PF closure had less early post-operative pain when compared to the tack group (p = 0.038). Following TAPP IHR, suture closure of the PF significantly improves 2-week post-operative movement limitation compared to stapled and tacked PF closure. Continued randomized studies are needed to determine the best surgical hernia repair methods for ideal post-op QOL.

  4. Electrophysiologic assessment of regeneration in rat sciatic nerve repair using suture, fibrin glue or a combination of both techniques Avaliação eletrofisiológica da eficácia de três tipos de reparo após a secção do nervo ciático do rato

    Directory of Open Access Journals (Sweden)

    Roberto Sergio Martins

    2005-09-01

    Full Text Available We evaluated the repair of seccioned rat sciatic nerve by the comparison of electrophysiologic parameters. The repair was effected with suture (group A, fibrin glue (group B or a combination of both techniques (group C. The amplitude, latency and conduction velocity of the motor and nerve action potentials were assessed before the nerve section and at reoperation after 24 weeks. There was no difference between the groups when the nerve action potential was evaluated. Rats of group B presented better results than those of group A (pForam comparados os parâmetros obtidos na avaliação eletrofisiológica do potencial de ação do nervo e do potencial de ação motor antes e após 24 semanas do reparo no nervo ciático do rato previamente seccionado no lado direito com a utilização de sutura (grupo A, adesivo de fibrina (grupo B ou uma combinação das duas técnicas (grupo C. Não houve diferença entre os grupos na avaliação do potencial de ação do nervo. Quando consideradas a latência e a velocidade de condução mensurados na reoperação e a razão entre a velocidade de condução medida na reoperação e o mesmo parâmetro antes da secção do nervo, durante a mensuração do potencial de ação motor, os animais do grupo B apresentaram melhores resultados em relação aos do grupo A (p<0,05. Os animais do grupo C apresentaram melhores resultados em comparação com os do grupo A quando considerada a razão entre a velocidade de condução medida 24 semanas do reparo e antes da secção do nervo durante a avaliação do potencial de ação motor. Conclui-se que os animais em que o reparo dos nervos foi realizado com o adesivo de fibrina apresentaram melhores resultados em comparação com a sutura quando considerados os parâmetros obtidos na mensuração do potencial de ação motor.

  5. A systematic review and meta-analysis of mesh vs suture cruroplasty in laparoscopic large hiatal hernia repair.

    Science.gov (United States)

    Tam, Vernissia; Winger, Daniel G; Nason, Katie S

    2016-01-01

    Equipoise exists regarding whether mesh cruroplasty during laparoscopic large hiatal hernia repair improves symptomatic outcomes compared with suture repair. Systematic literature review (MEDLINE and EMBASE) identified 13 studies (1,194 patients; 521 suture and 673 mesh) comparing mesh versus suture cruroplasty during laparoscopic repair of large hiatal hernia. We abstracted data regarding symptom assessment, objective recurrence, and reoperation and performed meta-analysis. The majority of studies reported significant symptom improvement. Data were insufficient to evaluate symptomatic versus asymptomatic recurrence. Time to evaluation was skewed toward longer follow-up after suture cruroplasty. Odds of recurrence (odds ratio .51, 95% confidence interval .30 to .87; overall P = .014) but not need for reoperation (odds ratio .42, 95% confidence interval .13 to 1.37; overall P = .149) were less after mesh cruroplasty. Quality of evidence supporting routine use of mesh cruroplasty is low. Mesh should be used at surgeon discretion until additional studies evaluating symptomatic outcomes, quality of life, and long-term recurrence are available. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. A systematic review and meta-analysis of mesh versus suture cruroplasty in laparoscopic large hiatal hernia repair

    Science.gov (United States)

    Tam, Vernissia; Winger, Daniel G.; Nason, Katie S.

    2015-01-01

    Structured Abstract Background Equipoise exists regarding whether mesh cruroplasty during laparoscopic large hiatal hernia repair improves symptomatic outcomes compared to suture repair. Data Source Systematic literature review (MEDLINE and EMBASE) identified 13 studies (1194 patients; 521 suture and 673 mesh) comparing mesh versus suture cruroplasty during laparoscopic repair of large hiatal hernia. We abstracted data regarding symptom assessment, objective recurrence, and reoperation and performed meta-analysis. Conclusions The majority of studies reported significant symptom improvement. Data were insufficient to evaluate symptomatic versus asymptomatic recurrence. Time to evaluation was skewed toward longer follow-up after suture cruroplasty. Odds of recurrence (OR 0.51, 95% CI 0.30–0.87; overall p=0.014) but not need for reoperation (OR 0.42, 95% CI 0.13–1.37; overall p=0.149) were less after mesh cruroplasty. Quality of evidence supporting routine use of mesh cruroplasty is low. Mesh should be used at surgeon discretion until additional studies evaluating symptomatic outcomes, quality of life and long-term recurrence are available. PMID:26520872

  7. Shouldice Versus Lichtenstein Hernia Repair Techniques: A ...

    African Journals Online (AJOL)

    Lichtenstein), and the 4-layer tissue repair (Shouldice) techniques of inguinal hernia surgery and to determine to what extent doctors in a general surgical unit were able to reproduce the excellent results reported from specialist hernia centres.

  8. Progrip self-gripping mesh in Rives-Stoppa repair: Are there any differences in outcomes versus a retromuscular polypropylene mesh fixed with sutures? A "case series" study.

    Science.gov (United States)

    Bueno-Lledó, José; Torregrosa, Antonio; Arguelles, Brenda; Carreño, Omar; García, Providencia; Bonafé, Santiago; Iserte, José

    2017-01-01

    Rives-Stoppa repair is widely accepted technique in large midline IH, and appears to be advantageous compared to other surgical techniques concerning complications and recurrence rates. The aim of this case series study was to analyze 1-year outcomes in patients with IH treated with Progrip self-gripping mesh compared to polypropylene (PPL) mesh fixed with sutures during the Rives-Stoppa technique. Between June 2014 and June 2015, we performed a prospective comparative non-randomized (case series) analysis between 25 patients with IH using retromuscular Progrip self-gripping mesh and 25 patients with retromuscular PPL mesh fixed with sutures, under Rives-Stoppa repair. All intraoperative and perioperative morbidities were reported with particular attention to wound infection, seroma or hematoma formation, duration of hospital stay, presence of abdominal wall pain (VAS) and recurrence during long-term follow-up. Mean operative time in Progrip group was shorter than Non-Progrip group (101±29.5 versus 121±39.8min). In Progrip group, the only postoperative complication was seroma in two patients; however, in Non-Progrip group, we reported seroma in three patients, and hematoma in 4 patients (p=0.03). The median hospital stay was shorter in Progrip group (5.8±2.2days versus 6.6±2.9days). Mean VAS score in the first 48h was higher in Non-Progrip group than Progrip group (4.9±2.1 versus 8.1±2)(p=0.01). The median follow-up was 13 months (range 12-20 months) and none of the 50 patients had a hernia recurrence. In Rives-Stoppa repair, retromuscular Progrip mesh causes less postoperative pain in the first 48h and lower rate of hematoma than PPL mesh fixed with sutures in the short term follow-up. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. A new surgical technique using steel suture for trans-scleral fixation of posterior chamber intraocular lenses

    OpenAIRE

    Ram, Jagat; Gupta, Nishant; Chaudhary, Manish; Verma, Neelam

    2013-01-01

    Background: A new emerging complication of trans-scleral fixation of posterior chamber (PC) intraocular lens (IOL) with polypropylene suture is high rates of spontaneous dislocation of the IOL due to disintegration or breakage of suture. Materials: We report a new surgical technique of trans-scleral fixation of posterior chamber intraocular lens (SF PCIOL) with steel suture to eliminate the complication of dislocation of IOL fixed with polypropylene suture in one adult and a child. Results: W...

  10. Suturing techniques and postoperative management in penetrating keratoplasty in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Lee RM

    2012-08-01

    Full Text Available Richard MH Lee,1 Fook Chang Lam,1 Tassos Georgiou,1 Bobby Paul,1 Kong Yong Then,1 Ioannis Mavrikakis,1 Venkata S Avadhanam,1 Christopher SC Liu1,21Sussex Eye Hospital, Brighton, United Kingdom; 2Tongdean Eye Clinic, Hove, United KingdomAims: To report on the suturing techniques and aspects of postoperative management in penetrating keratoplasty in the United Kingdom.Methods: A postal questionnaire was sent to 137 ophthalmic consultants identified from a Royal College of Ophthalmology database as having a special interest in anterior segment surgery. The questionnaire surveyed surgeon preferences for surgical and suturing technique for penetrating keratoplasty surgery, and the postoperative care of corneal grafts.Results: In all, 68% of questionnaires were completed and returned: 73% of respondents used a Flieringa ring or equivalent, 94% routinely used cardinal sutures, with 50.5% removing them at the end of the procedure. The most common suturing technique for routine penetrating keratoplasty was a single continuous suture (35%. In these cases, a 10/0 nylon suture was used by 89%. Sixty-six percent changed their technique in high-risk cases, 52% used a 3-1-1 knot, and 75% made a distinction between a reef and granny knot, with 76% using a reef. Thirty percent buried the knots within the donor material, and 29% within the host tissue. Twenty-five percent had no routine time for graft suture removal, but 41% removed them between 1 and 2 years post-surgery. After suture removal, 98% used steroids and 88% used topical antibiotics. Thirty-four percent stopped topical steroids before suture removal, with 38% stopping topical steroids more than 3 months prior to suture removal.Conclusion: This survey demonstrates that there is considerable variation in suturing techniques and postoperative care for penetrating keratoplasty. These significant variations in practice need to be considered when interpreting outcomes and research.Keywords: corneal graft

  11. Suture material for flexor tendon repair: 3–0 V-Loc versus 3–0 Stratafix in a biomechanical comparison ex vivo

    Science.gov (United States)

    2014-01-01

    Background Barbed suture material offers the possibility of knotless flexor tendon repair, as suggested in an increasing number of biomechanical studies. There are currently two different absorbable barbed suture products available, V-Loc™ and Stratafix™, and both have not been compared to each other with regard to flexor tendon repair. The purpose of this study was to evaluate both suture materials for primary stability under static and cyclic loading in a biomechanical ex vivo model. Methods Forty fresh porcine flexor digitorum profundus tendons were randomized in two groups. A four-strand modified Kessler suture technique was used to repair the tendon either with a 3–0 V-Loc™ or 3–0 Stratafix™ without a knot. Parameters of interest were mode of failure, 2-mm gap formation force, displacement, stiffness and maximum load under static and cyclic testing. Results The maximum load was 42.3 ± 7.2 for the Stratafix™ group and 50.7 ± 8.8 N for the V-Loc™ group. Thus, the ultimate tensile strength was significantly higher for V-Loc™ (p Stratafix™ group in comparison to 26.5 ± 2.12 N in the V-Loc™ group (n.s.). Displacement was 2.65 ± 0.56 mm in the V-Loc™ group and 2.71 ± 0.59 mm in the Stratafix™ group (n.s.). Stiffness was 4.24 ± 0.68 (N/mm) in the V-Loc™ group and 3.85 ± 0.55 (N/mm) the Stratafix™ group (n.s.). Those measured differences were not significant. Conclusion V-Loc™ demonstrates a higher maximum load in tendon reconstruction. The differences in 2-mm gap formation force, displacement and stiffness were not significant. Hereby, the V-Loc™ has an advantage when used as unidirectional barbed suture for knotless flexor tendon repair. PMID:25205062

  12. Suture material for flexor tendon repair: 3-0 V-Loc versus 3-0 Stratafix in a biomechanical comparison ex vivo.

    Science.gov (United States)

    Jordan, Martin C; Hölscher-Doht, Stefanie; Jakubietz, Michael G; Jakubietz, Rafael G; Meffert, Rainer H; Schmidt, Karsten

    2014-08-21

    Barbed suture material offers the possibility of knotless flexor tendon repair, as suggested in an increasing number of biomechanical studies. There are currently two different absorbable barbed suture products available, V-Loc and Stratafix, and both have not been compared to each other with regard to flexor tendon repair. The purpose of this study was to evaluate both suture materials for primary stability under static and cyclic loading in a biomechanical ex vivo model. Forty fresh porcine flexor digitorum profundus tendons were randomized in two groups. A four-strand modified Kessler suture technique was used to repair the tendon either with a 3-0 V-Loc or 3-0 Stratafix without a knot. Parameters of interest were mode of failure, 2-mm gap formation force, displacement, stiffness and maximum load under static and cyclic testing. The maximum load was 42.3 ± 7.2 for the Stratafix group and 50.7 ± 8.8 N for the V-Loc group. Thus, the ultimate tensile strength was significantly higher for V-Loc (p Stratafix group in comparison to 26.5 ± 2.12 N in the V-Loc group (n.s.). Displacement was 2.65 ± 0.56 mm in the V-Loc group and 2.71 ± 0.59 mm in the Stratafix group (n.s.). Stiffness was 4.24 ± 0.68 (N/mm) in the V-Loc group and 3.85 ± 0.55 (N/mm) the Stratafix group (n.s.). Those measured differences were not significant. V-Loc demonstrates a higher maximum load in tendon reconstruction. The differences in 2-mm gap formation force, displacement and stiffness were not significant. Hereby, the V-Loc™ has an advantage when used as unidirectional barbed suture for knotless flexor tendon repair.

  13. Laparoscopic stepwise-cut double initial stay suture pyeloplasty: our novel surgical technique.

    Science.gov (United States)

    Ates, Mutlu; Ozgok, Yasar; Akin, Yigit; Arslan, Murat; Akand, Murat; Hoscan, Mustafa Burak

    2015-03-01

    To describe a novel surgical technique, laparoscopic stepwise-cut double initial stay suture (LASDISS) pyeloplasty for ureteropelvic junction obstruction (UPJO). Additionally, we evaluated the safety and short-term results. This was a nonrandomized study with a series of 6 patients with UPJO, operated on between March 2012 and August 2013. Perioperative and short-term outcomes were evaluated. In brief, a "T shape cut" was performed from the dilated pelvis to the ureter. The initial stay suture was placed between the lower edge of the pelvis and the distal end of the spatulated anterolateral part of the ureter. The pelvis was closed with a continuous suture starting from the opened upper edge of the pelvis that was secured after leaving enough space for ureteral anastomosis. The second initial stay suture was placed after passing the ureter and pelvis two times. The dilated part of the renal pelvis and the stenotic segment were excised. A double-J stent was inserted. The remaining space between the two initial sutures was closed with these continuous sutures. We performed the LASDISS pyeloplasty technique in all cases. Median operation time was 177 minutes (range, 100-290 minutes). Mean follow-up was 7.5 months (range, 3-18 months). The mean pre- and postoperative split renal function on diuretic renography was 33% (range, 25%-56%) and 42% (range, 30%-52%), respectively. The LASDISS pyeloplasty surgical technique represents a safe and effective option in surgical treatment of UPJO.

  14. Acetabular All-Suture Anchor for Labral Repair: Incidence of Intraoperative Failure due to Pullout.

    Science.gov (United States)

    Byrd, J W Thomas; Jones, Kay S; Loring, Cynthia L; Sparks, Stephanie L

    2018-01-17

    To report on the incidence and features of intraoperative anchor pullout in a consecutive series of patients undergoing arthroscopic labral repair of the hip. Over an 18-month period, 434 consecutive cases underwent labral repair by a single surgeon with a particular anchor system. The following data were recorded: (1) age and gender of all cases; (2) number of anchors used; (3) number of cases in which intraoperative anchor failure occurred; (4) number of anchors that failed; and (5) age and gender of those cases in which anchor failure occurred. Failures were reported for 3-month intervals. One patient underwent repair with an alternative anchor system during this time period and was excluded. Mean age was 34.2 (14-71) years with 180 males and 254 females. A total of 2,007 anchors were used, averaging 4.6 per case (1-8). Thirty-three anchors pulled out among 30 patients, representing a 1.6% incidence among all anchors. Mean age among pullouts was 37.8 (17-54) years with 11 males and 19 females. There was no difference compared with patient population in which no anchor pulled: mean 33.9 (14-71) years (P = .085) with 169 males and 235 females (P = .578). Pullouts were evenly distributed over the 3-month intervals (4, 4, 6, 6, 5, 8). Pullout was mostly due to failure to securely imbed the anchor in bone. Only 2 were known to pull out in the presence of being securely seated in bone. These data support that the security of this particular all-suture anchor at implantation is exceptionally reliable for a single experienced surgeon, and there is no demonstrable learning curve. LEVEL OF EVIDENCE: Level IV, retrospective review of a case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  15. Achilles tendon reattachment after surgical treatment of insertional tendinosis using the suture bridge technique: a case series.

    Science.gov (United States)

    Witt, Bryan L; Hyer, Christopher F

    2012-01-01

    to 10.71). The suture bridge technique is a viable option for Achilles tendon repair after surgical management of insertional Achilles tendinosis. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Skin closure after groin hernia repair in children: a comparative ...

    African Journals Online (AJOL)

    Skin closure after groin hernia repair in children: a comparative study of three suture materials and two suture techniques La fermeture de la peau après la réparation de l'hernie de l'aine chez les enfants: une étude comparative de trois matériaux de suture et de deux techniques de suture.

  17. Comparative Study of High Powerful Magnet with Conventional Repair of Suture in the Intestinal Anastomosis of Rats

    Directory of Open Access Journals (Sweden)

    Marjan Joudi

    2016-02-01

    Full Text Available Background In this study, given the importance of gastrointestinal anastomosis in surgical procedures, attempts have been made to compare the results of employing magnetic compression anastomosis and magnetic coils in intestinal anastomosis of rats. Materials and Methods This study was an experimental trial on 60 rats which had been randomly divided into two experiment (30 and control (30 groups. First, the rat intestine was cut off from a relatively fixed point and then magnet anastomosis was performed at the both ends of bowel in the control group and manual suture in the experiment group.  Anastomosis was then examined 10 days after the surgery for possible complications with a histological analysis of the indices of tissue repair. Results The mean time required for performing anastomosis of the rat intestine was 735 and 366 seconds for the control and experiment groups, respectively. Also, the laparotomy performed 10 days after the first operation did not show any significant difference between two groups in terms of surgical complications such as infiltration factor of inflammatory cell and fibroblast activity (P>0.05. The microscopic examination indicated that the tissue reaction in the anastomosis site was better in terms of tissue repair of neo-angiogenesis intestine and collagen deposition in the magnet group(P>0.05.   Conclusion Given the shorter duration of the anastomosis by magnets and more favorable histological results reported in the experiment group, as well as the lack of any significant difference in complications of the two techniques, magnetic compressive anastomosis can be used as a new technique for intestinal surgeries and pertaining anastomosis. Although, we recommend that study will be done with large sample size to obtain reliable results.

  18. Composite mesh and gluteal fasciocutaneous rotation flap for perineal hernia repair after abdominoperineal resection: a novel technique.

    Science.gov (United States)

    Papadakis, Marios; Hübner, Gunnar; Bednarek, Marzena; Arafkas, Mohamed

    2017-03-01

    Perineal hernia is an uncommon complication following abdominoperineal rectum resection. Several surgical procedures have been proposed for perineal hernia repair, including perineal, laparoscopic and abdominal approaches. Repair techniques can be classified into primary suture techniques, mesh placements and repairs with autogenous tissue. We report a 68-year-old man with a perineal hernia, who underwent a pelvic floor reconstruction with a transperineal composite mesh and a gluteal fasciocutaneous rotation flap. We conclude that a combined approach with transperineal mesh reconstruction and gluteal fasciocutaneous flap could be an alternative choice in perineal hernia repair after abdominoperineal resection.

  19. Arthroscopic suture bridge technique for intratendinous tear of rotator cuff in chronically painful calcific tendinitis of the shoulder.

    Science.gov (United States)

    Ji, Jong-Hun; Shafi, Mohamed; Moon, Chang-Yun; Park, Sang-Eun; Kim, Yeon-Jun; Kim, Sung-Eun

    2013-11-01

    Arthroscopic removal, now the main treatment option, has almost replaced open surgery for treatment of resistant calcific tendinitis. In some cases of chronic calcific tendinitis of the shoulder, the calcific materials are hard and adherent to the tendon. Removal of these materials can cause significant intratendinous tears between the superficial and deep layers of the degenerated rotator cuff. Thus far, there are no established surgical techniques for removing the calcific materials while ensuring cuff integrity. Good clinical results for rotator cuff repair were achieved by using an arthroscopic suture bridge technique in patients with long-standing calcific tendinitis. Intact rotator cuff integrity and recovery of signal change on follow-up magnetic resonance imaging scans were confirmed. This is a technical note about a surgical technique and its clinical results with a review of relevant published reports. © 2013 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  20. Teflon-buttressed sutures plus pericardium patch repair left ventricular rupture caused by radiofrequency catheter ablation: A case report.

    Science.gov (United States)

    Cao, Hao; Zhang, Qi; He, Yanzhong; Feng, Xiaodong; Liu, Zhongmin

    2016-09-01

    Cardiac rupture often occurs after myocardial infarction or chest trauma with a high mortality rate. However, left ventricular rupture caused by radiofrequency catheter ablation (RFCA) is extremely rare. We describe a case of a 61-year-old male who survived from left ventricular rupture caused by a RFCA procedure for frequent ventricular premature contractions. Surgical exploration with cardiopulmonary bypass (CPB) was performed when the signs of cardiac tamponade developed 7 hours after the ablation surgery. Teflon-buttressed sutures of the tear in the left ventricular posterolateral wall and pericardium patch applied to the contusion region on the wall repaired the rupture safely and effectively. Timely surgical intervention under CPB facilitated the survival of the patient. Teflon-buttressed sutures plus pericardium patch achieved the successful repair of the rupture.

  1. New pull out technique for flexor tendon repair

    Directory of Open Access Journals (Sweden)

    Kamrani RS

    2009-10-01

    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:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; 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: Flexor tendon injury is one of the unanswered problems in reconstructive surgery of the hand. Although pull out method is one of the best reconstructive approaches but still is controversial. Surgeons prefer immobilization to prevent laceration at the site of the suture but it may cause adhesion and lead to surgical failure. The aim of this study was to perform a new surgical method to achieve a tendon repair without these problems."n"nMethods: In this case-series study, 80 fingers with flexor tendon impairment selected and divided into four groups (tendon laceration & avulsion, tendon graft reconstructed in 1 & 2 stages then patients were surgically treated by the new technique. The most important aspect of the technique is the placement of the suture in the direction of strength therefore, following any tension the suture would be tighter and this point help us to mobilize the injured tendon immediately after the surgery then we analyzed the results depends on the patient's group."n"nResults: The pull out and surgical (functional results were evaluated. 97% of the pull out results were good and 3% were poor and surgical results were 23.9% excellent, 52.2% good, 17.9% fair and 6% poor

  2. [Impact of joint capsule repair and external rotators suture on prognosis in primary total hip arthroplasty by posterolateral approach].

    Science.gov (United States)

    Shen, Pengcheng; Xu, Neng; Jiang, Fugui; Zhu, Lifan; Weng, Fengbiao; Wang, Youhua

    2012-11-01

    To investigate the impact of joint capsule repair and external rotators suture on the prognosis in primary total hip arthroplasty (THA) by posterolateral approach. Between January 2006 and June 2009, 159 patients with femoral neck fracture underwent primary THA by posterolateral approach, and were divided into 4 groups according to different treatments: joint capsule repair and external rotators suture were given in group A (n=38), only joint capsule repair in group B (n=39), only external rotators suture in group C (n=41), and no joint capsule repair or external rotators suture in group D (n=41). There was no significant difference in gender, age, cause of injure, disease duration, type of fracture, combined medical disease, or prosthesis selection among 4 groups (P > 0.05). The bleeding volume, drainage, postoperative hip dislocation rate, hip Harris score, and the hip range of motion (ROM) in internal rotation and external rotation were compared. There was no significant difference in operative time, bleeding volume, or drainage among 4 groups (P > 0.05). Postoperative hip dislocation occurred in 0, 0, 4 (9.8%), and 4 (9.8%) cases of groups A, B, C, and D, respectively, showing significant difference in incidence of postoperative hip dislocation among 4 groups (chi2=7.910, P=0.048). The hip Harris scores were significantly improved after operation when compared with preoperative scores in 4 groups (P hip Harris score at 6 weeks and 6 months after operation among 4 groups (P hip ROM in internal rotation among 4 groups at 6 weeks and 6, 12 months after operation (P > 0.05); but the hip ROM in external rotation were significantly bigger in groups A and C than in groups B and D at 6 weeks and 6 months after operation (P Joint capsule repair and external rotators suture in primary THA by posterolateral approach do not increase the bleeding volume and drainage, but can reduce the early postoperative hip dislocation risk, increase the Harris score, and recover the

  3. A Novel Surgical Pre-suturing Technique for the Management of ...

    African Journals Online (AJOL)

    Journal of Surgical Technique and Case Report | Jul-Dec 2014 | Vol-6 | Issue-2. 49. A Novel Surgical Pre-suturing Technique for ... mandibular lingual gingival recession. The severity of ankyloglossia is variable and ... infants, toddlers and adults but strictly requires postsurgical speech therapy to achieve pleasing results.

  4. [Effectiveness comparison of micro-anchor repair and modified pull-out suture in treatment of mallet fingers].

    Science.gov (United States)

    Zhu, Lifan; Xu, Hao; Zhang, Xiaojian; Hou, Qingfan

    2012-09-01

    To compare the effectiveness between micro-anchor repair and modified pull-out suture in the treatment of mallet fingers. Between June 2010 and March 2011, 33 patients with mallet fingers were treated by micro-anchor repair method (n = 18, group A) and by modified pull-out suture method in which the broken tendons were sutured with double metal needle Bunnell's suture and a knot was tied palmarly (n = 15, group B). There was no significant difference in age, gender, and disease duration between 2 groups (P > 0.05). The operation time was (62.5 +/- 3.1) minutes in group A and (65.0 +/- 4.6) minutes in group B, showing no significant difference (t = 1.85, P = 0.07). The treatment expense in group A [(8 566.2 +/- 135.0) yuan] was significantly higher than that in group B [(5 297.0 +/- 183.5) yuan] (t = 58.92, P = 0.00). Incision infection occurred in 2 cases of group A and 1 case of group B; the other patients obtained healing of incision by first intention. Relapsed mallet finger was observed in 1 case of group B. All patients in 2 groups were followed up 12-21 months. According to the Crawford functional assessment system, the results were excellent in 5 cases, good in 10 cases, fair in 2 cases, and poor in 1 case at the last follow-up with an excellent and good rate of 83.3% in group A; the results were excellent in 4 cases, good in 9 cases, fair in 1 case, and poor in 1 case with an excellent and good rate of 86.7% in group B. There was no significant difference in the excellent and good rate between 2 groups (chi 2 = 0.23, P = 0.97). Both micro-anchor repair and modified pull-out suture are simple and effective methods in the treatment of mallet finger. But compared with micro-anchor repair, pull-out suture has lower expense.

  5. A review of current concepts in flexor tendon repair: physiology, biomechanics, surgical technique and rehabilitation.

    Directory of Open Access Journals (Sweden)

    Rohit Singh

    2015-12-01

    Full Text Available Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into world-wide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biomechanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs.

  6. Does the type of suturing technique used affect astigmatism after deep anterior lamellar keratoplasty in keratoconus patients?

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    Acar BT

    2011-04-01

    Full Text Available Banu Torun Acar, Ece Turan Vural, Suphi AcarHaydarpasa Numune Education and Research Hospital, Ophthalmology Clinic, Istanbul, TurkeyPurpose: To compare the effect of three different suturing techniques on astigmatism after deep anterior lamellar keratoplasty (DALK in patients with keratoconus.Methods: In this retrospective study, 54 eyes of 54 patients with advanced keratoconus underwent DALK with three suturing techniques: single running, interrupted running, and combined interrupted and running. Postkeratoplasty astigmatism was evaluated during examinations 1, 3, and 6 months postoperatively and 2 months after completing suture removal.Results: Twenty-four eyes had single running sutures, 16 eyes had interrupted sutures, and in 14 eyes the suturing technique used was combined interrupted and running sutures. Mean age was 25.6 ± 5.9 years, 27.3 ± 6.8 years, and 26.5 ± 5.7 years (P = 0.422, and postoperative astigmatism 1 month after surgery was 3.79 ± 1.19 D, 5.56 ± 1.78 D, and 4.21 ± 1.55 D in the three groups, respectively (P = 0.012. However, 2 months after completing the suture removal, final postoperative astigmatism was 3.43 ± 1.44 D, 3.87 ± 1.38 D, and 3.71 ± 1.46 D (P = 0.846. Final astigmatism less than 4 D was seen in 18 cases (75% in the single running group, nine cases (56.2% in the interrupted running group, and nine cases (64.2% in the combined interrupted and running group (P = 0.08.Conclusion: Postkeratoplasty astigmatism is comparable with three different suturing techniques used in patients with keratoconus after completing suture removal in DALK. Due to earlier suture removal in DALK, the type of suturing technique used is not considerably important.Keywords: astigmatism, deep anterior lamellar keratoplasty, suturing technique

  7. A Pentagram Suture Technique for Closing Tumor Resection Sites in the Face.

    Science.gov (United States)

    Matsumine, Hajime; Takeuchi, Masaki; Mori, Satoko; Sakurai, Hiroyuki

    2015-08-01

    Resection of facial skin tumors aims to remove the tumors completely and make the surgical scar unnoticeable as much as possible. By improving the purse string suture method, we developed a new pentagram suture technique that enables simple and safe suturing of small to large defects with early satisfactory esthetic outcomes. The surgical outcomes of a case series were examined in this report. As in drawing a unicursal star, 5 suture sites were marked at specific intervals around the defect area. A needle with 5-0 polydioxanone suture was passed from the subcutaneous tissue to the superficial dermal layer at one site and then from the superficial dermal layer to the subcutaneous layer at the next site, and the process was repeated until the pentagram was complete. When apposition was not tight enough, a couple of external stitches were added using 6-0 nylon suture. In 13 patients (16 benign or malignant tumors; mean age, 51.1 years) with a mean tumor size of 10.1 ± 5.2 mm and postoperative skin defect diameter of 12.1 ± 8.2 mm, closure did not result in high tension on the suture, and there was reduced mechanical stress at the wound margin. Surgical outcomes were good esthetically at 6 months after surgery without keloid formation or scar contracture. None of the patients had postoperative pain, infection, or tumor recurrence. This simple alternative method for the closure of facial skin defects after skin tumor excision could be performed easily and provided satisfactory surgical outcomes.

  8. Shouldice Versus Lichtenstein Hernia Repair Techniques: A ...

    African Journals Online (AJOL)

    Shouldice method being the more cost effective procedure should be encouraged in men with primary unilateral inguinal hernias. Key Words: Hernia, Lichtenstein, Shouldice, Clinical. Trial. CLINICAL TRIAL. Shouldice Versus Lichtenstein Hernia Repair. Techniques: A Prospective Randomized Study. Wamalwa AO1, Siwo ...

  9. Uterine compression suture technique in the management of severe postpartum haemorrhage as an alternative to hysterectomy

    Directory of Open Access Journals (Sweden)

    Stanojević Dušan

    2009-01-01

    Full Text Available Introduction. One of the most dramatic conditions in obstetrics is definitely bleeding from the uterus which fails to compress. This condition is known as postpartum atony. When such a condition is diagnosed, the obstetrician has a choice of several conservative methods to stimulate the uterus to contract and several surgical methods to stop the bleeding. The most extreme measure used to save the patient's life and stop the bleeding is hysterectomy. This surgery is characterized by high morbidity, primarily by the loss of woman's fertility. In order to avoid hysterectomy, several authors have introduced the compressive uterine suture technique into gynaecological practice. Objective. The aim of the paper is to demonstrate the technique of applying compressive uterine suture after delivery to stop excessive bleeding, and to present results obtained by this technique. Methods. The paper explains the technique of applying compressive suture to the atonic uterus in cases when all other procedures to stop excessive bleeding after delivery fail. Since uterine atony is the main reason for excessive and uncontrollable bleeding after childbirth, the need to perform such surgery is rather common. Authors demonstrate the technique of applying four compressive sutures which prevent uterus dilation and thus stop the bleeding. Results. Compressive suture technique was used by the authors eight times, seven of which during caesarean section and one after spontaneous delivery. All patients had normal postpartum period and normal involution of the uterus. Conclusion. Although this surgery requires a skilful and experienced obstetrician, the authors find it rather easy to perform and it is suggested to be applied in all cases of uterine atony when excessive bleeding cannot be stopped by other any other method except hysterectomy. This surgical procedure saves the uterus and facilitates quick and easy patient's recovery.

  10. Sportsmen's Groin-Diagnostic Approach and Treatment With the Minimal Repair Technique: A Single-Center Uncontrolled Clinical Review.

    Science.gov (United States)

    Muschaweck, Ulrike; Berger, Luise Masami

    2010-05-01

    Sportsmen's groin, also called sports hernia and Gilmore groin, is one of the most frequent sports injuries in athletes and may place an athletic career at risk. It presents with acute or chronic groin pain exacerbated with physical activity. So far, there is little consensus regarding pathogenesis, diagnostic criteria, or treatment. There have been various attempts to explain the cause of the groin pain. The assumption is that a circumscribed weakness in the posterior wall of the inguinal canal, which leads to a localized bulge, induces a compression of the genital branch of the genitofemoral nerve, considered responsible for the symptoms. The authors developed an innovative open suture repair-the Minimal Repair technique-to fit the needs of professional athletes. With this technique, the circumscribed weakness of the posterior wall of the inguinal canal is repaired by an elastic suture; the compression on the nerve is abolished, and the cause of the pain is removed. In contrast with that of common open suture repairs, the defect of the posterior wall is not enlarged, the suture is nearly tension free, and the patient can return to full training and athletic activity within a shorter time. The outcome of patients undergoing operations with the Minimal Repair technique was compared with that of commonly used surgical procedures. THE FOLLOWING ADVANTAGES OF THE MINIMAL REPAIR TECHNIQUE WERE FOUND: no insertion of prosthetic mesh, no general anesthesia required, less traumatization, and lower risk of severe complications with equal or even faster convalescence. In 2009, a prospective cohort of 129 patients resumed training in 7 days and experienced complete pain relief in an average of 14 days. Professional athletes (67%) returned to full activity in 14 days (median). The Minimal Repair technique is an effective and safe way to treat sportsmen's groin.

  11. A new persistent suture technique for correction of caudal septal dislocation.

    Science.gov (United States)

    Batioglu-Karaaltin, Aysegul; Yigit, Ozgur; Donmez, Zehra

    2014-11-01

    Caudal septal dislocation is both a functional and an aesthetic problem. The caudal septum that causes nasal obstruction displaces the right or left of columella. Despite the various maneuvers currently available for treatment, this issue is still controversial. We describe a new technique that uses a nonabsorbable suture material to keep the septum in the midline in mild and moderate caudal septal dislocations and can be used in addition to other current techniques. A full-length (lengthways) pocket is opened between the medial cruras, and the dislocated caudal septum is placed in it and then fixed to the soft tissue in the region of columella under the skin by a nonabsorbable suture. It is used as a complementary technique for both the swinging door and the Goldman technique. This technique prevents redeviation in the same direction, especially in the superior portion of the caudal end, due to the memory of cartilage tissue. It will therefore reduce revision rates.

  12. Biomechanical Comparison of All-Suture Anchor Fixation and Interference Screw Technique for Subpectoral Biceps Tenodesis.

    Science.gov (United States)

    Chiang, Florence L; Hong, Chih-Kai; Chang, Chih-Hsun; Lin, Cheng-Li; Jou, I-Ming; Su, Wei-Ren

    2016-07-01

    To compare the biomechanical characteristics of the subpectoral Y-knot all-suture anchor fixation with those of the interference screw technique. Sixteen fresh-frozen human cadaveric shoulders with a mean age of 67.6 ± 5.8 years (range, 52 to 74 years) were studied. The specimens were randomly grouped into 2 experimental biceps tenodesis groups (n = 8): Y-knot all-suture anchor or interference screw. The specimens were cyclically tested to failure by applying tensile forces parallel to the longitudinal axis of the humerus. A preload of 5 N was applied for 2 minutes prior to cyclic loading for 500 cycles from 5 to 70 N at 1 Hz; subsequently, a load-to-failure test at 1 mm/s was performed. The ultimate failure load, stiffness, displacement at cyclic and failure loading, and mode of failure were recorded. The all-suture anchor technique displayed values of ultimate failure load and stiffness comparable to that of the interference screw technique. The displacement at cyclic and failure loading of the all-suture anchor trials were significantly greater than the interference screw (P = .0002). The all-suture anchor specimens experienced anchor pullout and tendon tear equally during the trials, whereas the interference screw group experienced tendon tear in most of the cases and screw pullout in 2 trials. The Y-knot all-suture anchor fixation provides equivalent ultimate failure load and stiffness when compared with the interference screw technique in tenodesis of the proximal biceps tendon from a subpectoral approach. However, the interference screw technique demonstrates significantly less displacement in response to cyclic and failure loading. The all-suture anchor fixation is an alternative technique for subpectoral biceps tenodesis even at greater displacement when compared with the interference screw fixation during cyclic and failure loading. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  13. Using a Posterolateral Portal to Pass and Tie the Suture of the Inferior Anchor During Arthroscopic Bankart Repair.

    Science.gov (United States)

    Reda, Walid; Khedr, Ahmed

    2016-12-01

    Using a posterolateral portal in passing and tying the inferior knot allows good labral reduction and adequate capsular shift to treat anterior shoulder instability. In this technique, the most inferior anchor is placed through a low anterolateral portal. A penetrating grasper is introduced from a posterolateral portal situated 2 to 3 cm distal and lateral to the viewing portal. This portal is used to pass the 2 limbs of the anchor suture as inferior as possible through the labrum and capsule close to 6 o'clock position to form the 2 limbs of the first mattress suture. Finally, knot tying is performed through this posterolateral portal, thus allowing better superior shift of the capsulolabral tissue. The other 2 anchor sutures are passed and tied through the low anterolateral portal.

  14. Complications after subpectoral biceps tenodesis using a dual suture anchor technique.

    Science.gov (United States)

    Abtahi, Amir M; Granger, Erin K; Tashjian, Robert Z

    2014-04-01

    A variety of fixation techniques for subpectoral biceps tenodeses have been described including interference screw and suture anchor fixation. Biomechanical data suggests that dual suture anchor fixation has equivalent strength compared to interference screw fixation. The purpose of the study is to determine the early complication rate after subpectoral biceps tenodesis utilizing a dual suture anchor technique. A total of 103 open subpectoral biceps tenodeses were performed over a 3-year period using a dual suture anchor technique. There were 72 male and 31 female shoulders. The average age at the time of tenodesis was 45.5 years. 41 patients had a minimum of 6 months clinical follow-up (range, 6 to 45 months). The tenodesis was performed for biceps tendonitis, superior labral tears, biceps tendon subluxation, biceps tendon partial tears, and revisions of prior tenodeses. There were a total of 7 complications (7%) in the entire group. There were 4 superficial wound infections (4%). There were 2 temporary nerve palsies (2%) resulting from the interscalene block. One patient had persistent numbness of the ear and a second patient had a temporary phrenic nerve palsy resulting in respiratory dysfunction and hospital admission. One patient developed a pulmonary embolism requiring hospital admission and anticoagulation. There were no hematomas, wound dehiscences, peripheral nerve injuries, or ruptures. In the sub-group of patients with a minimum of 6 months clinical follow-up, the only complication was a single wound infection treated with oral antibiotics. Subpectoral biceps tenodesis utilizing a dual suture anchor technique has a low early complication rate with no ruptures or deep infections. The complication rate is comparable to those previously reported for interference screw subpectoral tenodesis and should be considered as a reasonable alternative to interference screw fixation. Level IV-Retrospective Case Series.

  15. Single-Layer Plication for Repair of Diastasis Recti: The Most Rapid and Efficient Technique.

    Science.gov (United States)

    Gama, Luiz José Muaccad; Barbosa, Marcus Vinicius Jardini; Czapkowski, Adriano; Ajzen, Sergio; Ferreira, Lydia Masako; Nahas, Fábio Xerfan

    2017-06-01

    Plication of the anterior rectus sheath is the most commonly used technique for repair of diastasis recti, but is also a time-consuming procedure. The aim of this study was to compare the efficacy and time required to repair diastasis recti using different plication techniques. Thirty women with similar abdominal deformities, who had had at least one pregnancy, were randomized into three groups to undergo abdominoplasty. Plication of the anterior rectus sheath was performed in two layers with 2-0 monofilament nylon suture (control group) or in a single layer with either a continuous 2-0 monofilament nylon suture (group I) or using a continuous barbed suture (group II). Operative time was recorded. All patients underwent ultrasound examination preoperatively and at 3 weeks and 6 months postoperatively to monitor for diastasis recurrence. The force required to bring the anterior rectus sheath to the midline was measured at the supraumbilical and infraumbilical levels. Patient age ranged from 26 to 50 years and body mass index from 20.56 to 29.17 kg/m2. A significant difference in mean operative time was found between the control and study groups (control group, 35 min:22 s; group I, 14 min:22 s; group II, 15 min:23 s; P diastasis. There were no significant within- and between-group differences in tensile force on the aponeurosis. Plication of the anterior rectus sheath in a single-layer with a continuous suture showed to be an efficient and rapid technique for repair of diastasis recti.

  16. A new surgical technique using steel suture for trans-scleral fixation of posterior chamber intraocular lenses

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    Jagat Ram

    2013-01-01

    Full Text Available Background: A new emerging complication of trans-scleral fixation of posterior chamber (PC intraocular lens (IOL with polypropylene suture is high rates of spontaneous dislocation of the IOL due to disintegration or breakage of suture. Materials: We report a new surgical technique of trans-scleral fixation of posterior chamber intraocular lens (SF PCIOL with steel suture to eliminate the complication of dislocation of IOL fixed with polypropylene suture in one adult and a child. Results: We successfully achieved stable fixation and good centration of IOL after SF PCIOL with steel suture in these patient having inadequate posterior capsular support. Both eyes achieved best corrected visual acuity 20/40 at 18 months follow-up. Conclusions: Steel suture is a viable option for trans-scleral fixation of posterior chamber intraocular lens.

  17. Functional Outcomes of Achilles Tendon Minimally Invasive Repair Using 4- and 6-Strand Nonabsorbable Suture: A Cohort Comparison Study

    Science.gov (United States)

    Carmont, Michael R.; Zellers, Jennifer A.; Brorsson, Annelie; Olsson, Nicklas; Nilsson-Helander, Katarina; Karlsson, Jon; Silbernagel, Karin Grävare

    2017-01-01

    Background: The aim of management of Achilles tendon rupture is to reduce tendon lengthening and maximize function while reducing the rerupture rate and minimizing other complications. Purpose: To determine changes in Achilles tendon resting angle (ATRA), heel-rise height, patient-reported outcomes, return to play, and occurrence of complications after minimally invasive repair of Achilles tendon ruptures using nonabsorbable sutures. Study Design: Cohort study; Level of evidence, 3. Methods: Between March 2013 and August 2015, a total of 70 patients (58 males, 12 females) with a mean age of 42 ± 8 years were included and evaluated at 6 weeks and 3, 6, 9, and 12 months after repair of an Achilles tendon rupture. Surgical repair was performed using either 4-strand or 6-strand nonabsorbable sutures. After surgery, patients were mobilized, fully weightbearing using a functional brace. Early active movement was permitted starting at 2 weeks. Results: There were no significant differences in the ATRA, Achilles Tendon Total Rupture Score (ATRS), and Heel-Rise Height Index (HRHI) between the 4- and 6-strand repairs. The mean (SD) relative ATRA was –13.1° (6.6°) (dorsiflexion) following injury; this was reduced to 7.6° (4.8°) (plantar flexion) directly after surgery. During initial rehabilitation at 6 weeks, the relative ATRA was 0.6° (7.4°) (neutral) and –7.0° (5.3°) (dorsiflexion) at 3 months, after which ATRA improved significantly with time to 12 months (P = .005). At 12 months, the median ATRS was 93 (range, 35-100), and the mean (SD) HRHI and Heel-Rise Repetition Index were 81% (0.22%) and 82.9% (0.17%), respectively. The relative ATRA at 3 and 12 months correlated with HRHI (r = 0.617, P Achilles tendon repair. The use of a nonabsorbable suture during minimally invasive repair when used together with accelerated rehabilitation did not prevent the development of an increased relative ATRA. The ATRA at 3 months after surgery correlated with heel

  18. Operative procedures of single-incision laparoscopic repair of pediatric epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle

    Directory of Open Access Journals (Sweden)

    Kyoichi Deie

    2016-01-01

    Full Text Available We describe a simple and feasible procedure for single-incision laparoscopic repair of a pediatric epigastric hernia using a novel suture-assisting needle. A multichannel port was inserted through the umbilical vertical incision. After the orifice of the hernia was identified, a suture-assisting needle, which can hold a suture at its tip, with a 2-0 thread was pierced through the skin into one side of the rectus muscle sheath into the abdominal cavity. Next, after releasing the thread, the needle was pulled out to the subcutis and pierced through another side of the rectus muscle sheath. The needle, grasping the thread again, was subsequently pulled out through the abdominal wall outside, and the thread was tied extracorporeally. This knot was buried subcutaneously. Operative procedures of single-incision laparoscopic repair of an epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle with an excellent cosmetic result.

  19. Is the Dresden technique a mechanical design of choice suitable for the repair of middle third Achilles tendon ruptures? A biomechanical study.

    Science.gov (United States)

    de la Fuente, C; Carreño-Zillmann, G; Marambio, H; Henríquez, H

    2016-01-01

    To compare the mechanical failure of the Dresden technique for Achilles tendon repair with the double modified Kessler technique controlled repair technique. The maximum resistance of the two repair techniques are also compared. A total of 30 Achilles tendon ruptures in bovine specimens were repaired with an Ethibond(®) suture to 4.5cm from the calcaneal insertion. Each rupture was randomly distributed into one of two surgical groups. After repair, each specimen was subjected to a maximum traction test. The mechanical failure (tendon, suture, or knot) rates (proportions) were compared using the exact Fisher test (α=.05), and the maximum resistances using the Student t test (α=.05). There was a difference in the proportions of mechanical failures, with the most frequent being a tendon tear in the Dresden technique, and a rupture of the suture in the Kessler technique. The repair using the Dresden technique performed in the open mode, compared to the Kessler technique, has a more suitable mechanical design for the repair of middle third Achilles tendon ruptures on developing a higher tensile resistance in 58.7%. However, its most common mechanical failure was a tendon tear, which due to inappropriate loads could lead to lengthening of the Achilles tendon. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Percutaneous Repair Technique for Acute Achilles Tendon Rupture with Assistance of Kirschner Wire.

    Science.gov (United States)

    He, Ze-yang; Chai, Ming-xiang; Liu, Yue-ju; Zhang, Xiao-ran; Zhang, Tao; Song, Lian-xin; Ren, Zhi-xin; Wu, Xi-rui

    2015-11-01

    The aim of this study is to introduce a self-designed, minimally invasive technique for repairing an acute Achilles tendon rupture percutaneously. Comparing with the traditional open repair, the new technique provides obvious advantages of minimized operation-related lesions, fewer wound complications as well as a higher healing rate. However, a percutaneous technique without direct vision may be criticized by its insufficient anastomosis of Achilles tendon and may also lead to the lengthening of the Achilles tendon and a reduction in the strength of the gastrocnemius. To address the potential problems, we have improved our technique using a percutaneous Kirschner wire leverage process before suturing, which can effectively recover the length of the Achilles tendon and ensure the broken ends are in tight contact. With this improvement in technique, we have great confidence that it will become the treatment of choice for acute Achilles tendon ruptures. © 2015 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  1. A novel technique of midline mesh repair for umbilical hernia associated with diastasis recti.

    Science.gov (United States)

    Matei, Ovidio-Angel; Runkel, Norbert

    2014-03-01

    Mesh repair has evolved as the gold standard for umbilical hernias. Surgical reconstruction of umbilical hernias in association with diastasis recti has not been discussed in the recent literature. We describe a novel surgical technique of midline mesh repair for this combined lesion. This is a retrospective review of 44 consecutive patients. Forty-four patients underwent surgery for umbilical hernia with diastasis recti between January 2010 and August 2012. All excess skin, subcutaneous tissue, and distracted midline (linea alba) were excised supraumbilically and paraumbilically according to preoperative marking. Surgical repair began with a midline running suture of the posterior rectal sheath. A light prolene mesh was placed retromuscularly into this sheath and anchored in all directions with a distance of about 5 cm from the midline using U-shaped stitches. The anterior rectal fascia was closed with a continuous suture. All information was obtained from the hospital records. The median operative time was 93.3 minutes (28 to 219 minutes). The median length of postoperative hospital stay was 5.9 days (3 to 12 days). There was no major complication. One minimal umbilical skin necrosis was observed. Analgesic medication was required in all patients. Opiods were added in 84.0% of patients on day 1, in 75.0% on day 3, and in 2.3% on day 7. Our novel technique of sublay mesh repair for combined umbilical hernia and diastasis recti is safe and effectively restores the abdominal midline.

  2. Temporomandibular Joint Disc Repositioning Using an Orthopedic Suture Anchor: A Modified Disc Anchoring Technique.

    Science.gov (United States)

    Rajkumar, K; Mukhopadhyay, P; Sinha, Ramen

    2016-09-01

    The study assessed the efficacy of orthopedic suture anchor as a modified suture anchor for disc repositioning in case of a closed lock of TMJ. Disc repositioning was undertaken via a mini preauricular approach. The disc was repositioned on the surface of the condyle and stabilized using an orthopedic suture anchor. Postoperatively functional outcomes were assessed in terms of reduction in pain, joint movement and absence of joint noise and clicking sounds. Postoperative MRI was used to assess the disc position and morphological changes in the disc and arthritic changes in the condyle at the end of six months. Patients were post surgically followed up at regular intervals of 1, 3 and 6 months. Patient experienced significant improvement in mouth opening with good functional outcomes and stable repositioning of disc as noticed By MRI at the end of six months. We describe a modified technique of disc repositioning using an orthopedic suture anchor for more favorable disc position and joint function. However the long term functional sequel of the procedure and changes in the articular disc needs to be assessed.

  3. Operative treatment of acromioclavicular joint dislocation: a new technique with suture anchors

    Directory of Open Access Journals (Sweden)

    Zhang Jingwei

    2014-07-01

    Full Text Available 【Abstract】Objective: To evaluate clinical outcome of suture anchors in strengthening both acromioclavicular and coracoclavicular ligaments in the surgical treatment of acromioclavicular joint dislocation. Methods: Twenty-eight patients with acute traumatic Rockwood III, IV and V dislocations of the acromioclavicular joint surgically treated at our institute between October 2010 and January 2012 were recruited. All patients underwent open reduction combined with suture anchors. Function was evaluated using the ConstantMurley shoulder score. Clinical and radiographic shoulder ratings were evaluated using Taft criteria at 3, 6 and 12 months. Results:Two cases with fixation loosening were not included in final statistical analysis. Other patients obtained full joint reposition on immediate postoperative radiographs. Follow-up was performed with an average of 15.6 months (range, 12-19. After early range of motion exercises, 96.2% of the patients (25/26 could abduct and elevate their shoulders more than 90 degrees within postoperative 3 months. There was no infection. Average Constant-Murley score was 96.3 points (range, 94-100 and mean Taft shoulder rating was 10.7 points (range, 8-12 at 12 months. Conclusion: The suture anchor is a relatively simple technique and can avoid screw removal which is helpful in reconstructing both acromioclavicular and coracoclavicular ligaments in acute traumatic acromioclavicular joint dislocation. Key words: Acromioclavicular joint; Dislocations; Surgery; Suture anchors

  4. Eccentric circummeatal based flap with limited urethral mobilization: An easy technique for distal hypospadias repair.

    Science.gov (United States)

    Ekinci, Saniye; Çiftçi, Arbay Özden; Karnak, İbrahim; Şenocak, Mehmet Emin

    2016-04-01

    Hypospadias is a common congenital anomaly. Over 300 techniques have been described for repairing hypospadias. Eccentric circummeatal based flap with combined limited urethral mobilization technique (ECMB-LUM) is a simple procedure to repair distal hypospadias with minimal complication rate. This study presents results of this technique, highlighting surgical pitfalls to achieve the best result. Medical records of patients with distal hypospadias operated on using the same technique between 1998 and 2011 were reviewed retrospectively. Age at surgery, position of meatus preoperatively and postoperatively, duration of urethral catheterization and hospitalization, early and late complications, previous hypospadias repairs, and secondary surgical interventions were evaluated. In the surgical technique an eccentric circummeatal based flap is outlined. The proximal part of the flap is dissected from the underlying urethra and Buck's fascia. If the flap is not long enough, the distal urethra is mobilized a few millimeters (Figure). The eccentric flap is sutured to the tip of the glans. The glans wings are approximated in the midline. A urethral catheter of 6 Fr or 8 Fr is passed and left in the bulbous urethra or the urinary bladder. Diverged limbs of corpus spongiosum are approximated on the urethra, then, the glans and skin of the penile shaft are sutured. Of the 171 consecutive patients operated on using the ECMB-LUM technique; 115 had coronal, 47 had subcoronal, and nine had glanular meatus. The mean age at surgery was 4.5 (1-17) years. Patients were hospitalized for 2.2 ± 0.7 days. Mean duration of urethral catheterization was 2.3 ± 0.5 days. All but eight patients had ECBF-LUM as primary repair. There were no early complications such as bleeding, hematoma, and wound infection. All patients voided spontaneously after catheter removal. Late complications were meatal stenosis, urethrocutaneous fistula, meatal regression, and glandular dehiscence (Table). These

  5. Knot integrity using different suture types and different knot-tying techniques for reconstructive pelvic floor procedures.

    Science.gov (United States)

    Dueñas-Garcia, Omar F; Sullivan, Gina M; Leung, Katherine; Billiar, Kristen L; Flynn, Michael K

    2017-06-20

    Surgeons use a variety of sutures and knot-tying methods during pelvic reconstructive procedures. We hypothesized that knot-strength integrity will be similar with regards to type of knot, type of suture, and the knot-tying process. Using six different suture materials, flat square knots and slip knots were tied robotically and by hand by two surgeons. Knot integrity was evaluated using an Instron 5544 machine. We measured force and elongation at suture failure or knot slippage (whichever came first) as well as force at 3-mm displacement. Four hundred and thirty-two knots were tie; one unraveled before the analysis, and 431 were tested. Three hundred and ninety-two knots reached or surpassed tensile strength of 30 N, the force at which tissue itself will fail. Knots tied with polyglyconate suture achieved the greatest tensile strength and those with OO-polydioxanone had the lowest. Hand-tied knots, regardless of technique and suture material, had greater tensile strength but greater elongation than robotically tied knots. Slip knots and flat square knots have similar integrity regardless of the tying technique. Hand-tied knots had greater tensile strength than robotic knots, but the strength to break all knots required supraphysiological conditions. The decision to use a specific type of suture based on strength is not supported by our results, suggesting that surgeons may choose sutures based on other characteristics and personal comfort.

  6. Lumbar hernia repaired using a new technique.

    Science.gov (United States)

    Di Carlo, Isidoro; Toro, Adriana; Sparatore, Francesca; Corsale, Giuseppe

    2007-01-01

    Lumbar hernia is uncommon and occurs in Grynfeltt's triangle on the left side, more frequently in men than in women. Acquired lumbar hernias are the result of iliac crest bone harvest or blunt trauma and seat belt injuries in road accidents. Many surgical options have been reported for repairing this hernia through primary closure of the defect or through use of aponeurotic or prosthetic materials. The Dowd technique is the technique most often used. The authors describe a patient with posttraumatic inferior triangle lumbar hernia who underwent laparoscopy and, 10 days later, laparotomy. Both procedures failed. Finally, a novel lumbotomic surgical approach was used, involving the Dowd technique and prosthetic mesh. The patient was free of recurrence 3 months after the procedure.

  7. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair

    NARCIS (Netherlands)

    Schepers, Tim

    2012-01-01

    Recently, a new suture-button fixation device has emerged for the treatment of acute distal tibiofibular syndesmotic injuries and its use is rapidly increasing. The current systematic review was undertaken to compare the biomechanical properties, functional outcome, need for implant removal, and the

  8. Pectoralis Major Repair: A Biomechanical Analysis of Modern Repair Configurations Versus Traditional Repair Configuration.

    Science.gov (United States)

    Edgar, Cory M; Singh, Hardeep; Obopilwe, Elifho; Voss, Andreas; Divenere, Jessica; Tassavor, Michael; Comer, Brendan; Sanchez, George; Mazzocca, Augustus D; Provencher, Matthew T

    2017-10-01

    Pectoralis major (PM) ruptures are increasingly common, and a variety of surgical techniques have been described. However, tested techniques have demonstrated diminished strength with inadequate restoration of the footprint and suture failure at relatively low loads. Purpose/Hypothesis: The purpose was to biomechanically compare PM transosseous suture repair (current gold standard) to modern PM repair techniques that use larger caliber sutures, suture tape, and unicortical button fixation (UBF). The null hypothesis was that there would be no mechanical difference between repair techniques and no difference in the amount of footprint restoration. Controlled laboratory study. Twenty-four fresh-frozen cadaveric shoulders controlled for age and bone mineral density were randomized equally to 4 groups: (1) UBF, suture tape; (2) UBF, No. 5 suture, suture tape; (3) bone trough with No. 2 suture; and (4) native PM tendon group; all groups were tested to failure. The specimens were tested under cycling loads (10 N to 125 N) with a final load-to-failure test at 1 mm/s. Failure modes were classified by location and cause of rupture based on optical markers, while tendon footprint length was measured to determine amount of footprint restoration. For fixation strength, the mean peak load was significantly greater in the native tendon (1816 ± 706 N) versus UBF/No. 5 suture/suture tape (794 ± 168 N), UBF/suture tape (502 ± 201 N), and bone trough (492 ± 151 N) ( P biomechanical model and may be advantageous for repair. Cortical button fixation with larger caliber suture and suture tape allows for a significantly better PM repair than more traditional techniques at the time of surgery, which may ultimately result in improved clinical outcomes if implemented in surgical practice.

  9. An Anatomic and Biomechanical Comparison of Bankart Repair Configurations.

    Science.gov (United States)

    Judson, Christopher H; Voss, Andreas; Obopilwe, Elifho; Dyrna, Felix; Arciero, Robert A; Shea, Kevin P

    2017-11-01

    Suture anchor repair for anterior shoulder instability can be performed using a number of different repair techniques, but none has been proven superior in terms of anatomic and biomechanical properties. Purpose/Hypothesis: The purpose was to compare the anatomic footprint coverage and biomechanical characteristics of 4 different Bankart repair techniques: (1) single row with simple sutures, (2) single row with horizontal mattress sutures, (3) double row with sutures, and (4) double row with labral tape. The hypotheses were as follows: (1) double-row techniques would improve the footprint coverage and biomechanical properties compared with single-row techniques, (2) horizontal mattress sutures would increase the footprint coverage compared with simple sutures, and (3) repair techniques with labral tape and sutures would not show different biomechanical properties. Controlled laboratory study. Twenty-four fresh-frozen cadaveric specimens were dissected. The native labrum was removed and the footprint marked and measured. Repair for each of the 4 groups was performed, and the uncovered footprint was measured using a 3-dimensional digitizer. The strength of the repair sites was assessed using a servohydraulic testing machine and a digital video system to record load to failure, cyclic displacement, and stiffness. The double-row repair techniques with sutures and labral tape covered 73.4% and 77.0% of the footprint, respectively. These percentages were significantly higher than the footprint coverage achieved by single-row repair techniques using simple sutures (38.1%) and horizontal mattress sutures (32.8%) ( P footprint coverage of the simple suture and horizontal mattress suture groups was not significantly different ( P = .44). There were no significant differences in load to failure, cyclic displacement, or stiffness between the single-row and double-row groups or between the simple suture and horizontal mattress suture techniques. Likewise, there was no

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

    Directory of Open Access Journals (Sweden)

    Sharda Brata Ghosh

    2015-01-01

    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.

  11. Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males

    DEFF Research Database (Denmark)

    Bay-Nielsen, M; Nilsson, E; Nordin, P

    2004-01-01

    males operated on for an indirect inguinal hernia with a Lichtenstein mesh repair, Shouldice or Marcy (annulorrhaphy) repair. METHODS: This was a postal questionnaire study carried out within the Danish and Swedish Hernia Database Collaboration. Some 2612 patients responded (response rate 80.9 per cent...... it as worse after than before surgery, and 56.6 per cent stated that it interfered with social activities. CONCLUSION: Chronic pain is common after primary inguinal hernia repair in young males, but there is no difference in the pain associated with open mesh and non-mesh repair....

  12. [Water-tight closure of spinal dura with a new clot suture technique (author's transl)].

    Science.gov (United States)

    Matras, H; Jesch, W; Kletter, G; Dinges, H P

    1978-06-09

    A new clot-suturing Technique (using high-concentration fibrinogen solutions) for water-tight closure of the dura is reported. Six dogs underwent laminectomy of the thoracic spine with medial longitudinal incision in the chordal dura. After the dural split had been sealed with natural tissue adhesive and closure of the wound in layers, the animals were sacrificed at intervals of 1 to 21 days postoperatively and the chordal segments involved were removed and histologically examined. Early fibrinolysis of the clot was prevented by adding a natural proteinase inhibitor and factor XIII concentrate to the clotting substances. Histological analysis showed that healing was almost complete after 2 weeks, with delicate connective tissue overgrowing the dural split. After complete reabsorption of fibrin, the originally abundant absorbent granulation tissue had largely disappeared. Among the satisfactory results of fibrin suturing are optimum healing tendency in the fibrin-sutured region, absence of tissue irritation and neurotoxicity, which are known attributes of the synthetic alkl-cyano-acrylate tissue adhesives.

  13. Umbilical cord sparing technique for repair of congenital hernia into the cord and small omphalocele.

    Science.gov (United States)

    Ceccanti, Silvia; Falconi, Ilaria; Frediani, Simone; Boscarelli, Alessandro; Musleh, Layla; Cozzi, Denis A

    2017-01-01

    Current repair of small omphaloceles and hernias into the umbilical cord is a straightforward procedure, whose repair may result in a suboptimal cosmetic outcome. We describe a novel repair technique retaining the umbilical cord elements in an attempt to improve the cosmetic appearance of the umbilicus. Eight neonates were consecutively treated more than a ten-year period. Size of the fascial defects ranged 1 to 3cm (median, 2). Present technique entails incision of the amniotic sac without its detachment from the skin, reduction of the extruded contents under direct vision, and closure of the abdominal wall defect by circumferential suturing of peritoneum and fascia around the base of the amniotic sac. The amniotic sac is then re-approximated and folded to create an umbilical stump, which is trimmed and left to shed naturally. All patients achieved a scarless abdomen with a normal appearing umbilicus in 6. The remaining 2 patients are awaiting surgery for persisting umbilical hernia repair and umbilicoplasty, respectively. Poor esthetic outcome was significantly associated with initial fascial defect ≥2.5cm in size (p=0.03). Present technique is a simple and cosmetically appealing repair for umbilical cord hernias and small omphaloceles, especially effective when the size of the fascial defect is less than 2.5cm. IV (Treatment Study). Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Comparison of Reinforcement Techniques Using Suture on Staple-Line in Sleeve Gastrectomy.

    Science.gov (United States)

    Rogula, Tomasz; Khorgami, Zhamak; Bazan, Martin; Mamolea, Cristina; Acquafresca, Pablo; El-Shazly, Omar; Aminian, Ali; Schauer, Philip

    2015-11-01

    Sleeve gastrectomy is a common procedure in recent years for treatment of morbid obesity however leak from staple-line is its main challenging complication. Despite numerous studies regarding leak after sleeve gastrectomy, there is still no conclusion on reinforcement of staple-line in this procedure. The purpose of this study was to compare two methods of oversewing staple-line versus no reinforcement. Resected stomachs of 30 patients undergoing laparoscopic sleeve gastrectomy were evaluated for bursting pressure immediately after extraction from the abdomen. Reinforcement technique was applied in random order to 3 segments of the staple-line on each specimen: continuous Lembert's sutures, continuous through-and-through sutures, and no reinforcement. Bursting pressure was determined by injection of methylene blue solution into lumen of resected stomach and recording pressure at which leakage occurs. Location of leak, intragastric pressure, and volume at first leak were recorded. Baseline characteristics of patients were similar in randomized groups for order of reinforcement technique. Mean ischemia time of specimens was 17.4 ± 10.4 min. No leaks were observed in segments reinforced with Lembert's oversewing technique. The through-and-through reinforcement segments were first to leak in 21 out of 30 cases (70 %) with mean leak pressure of 570 mmHg and mean leak volume of 399 ml. Leakage occurred in 9 segments (30 %) with no reinforcement with a leak pressure of 329 mmHg and volume of 380 ml. In vitro, Lembert's suture reinforcement technique on stapled human stomach is associated with less leakage rate in comparison to through-and-through reinforcement and non-reinforced staple-line.

  15. Comparison of Time to Recurrence of Instability After Open and Arthroscopic Bankart Repair Techniques

    Science.gov (United States)

    Virk, Mandeep S.; Manzo, Richard L.; Cote, Mark; Ware, James K.; Mazzocca, Augustus D.; Nissen, Carl W.; Shea, Kevin P.; Arciero, Robert A.

    2016-01-01

    Background: The results of open and arthroscopic instability repairs have been shown to be equivalent in recent literature. Purpose: To compare the time to recurrence (TTR) of instability and disease-specific outcome measures in patients undergoing open and arthroscopic Bankart repair. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with recurrent traumatic anterior shoulder instability and a Bankart lesion on diagnostic arthroscopy underwent either open Bankart repair (OB) or arthroscopic Bankart and suture capsulorrhaphy (ABSC) using suture anchors. There was a minimum follow-up of 24 months. The primary outcome measures included Western Ontario Shoulder Instability Index (WOSI) score and time to recurrence of instability (dislocation or subluxation). Rowe score, Simple Shoulder Test, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Short Form–12 (SF-12) score were also compared. Results: A total of 82 shoulders in 80 patients (ABSC, n = 58; OB, n = 24) were evaluated at a mean of 39 months postoperatively. There were 4 clinical failures in the OB group (4 dislocations) and 7 clinical failures in the ABSC group (2 dislocations and 5 subluxations; P = .72 vs OB). The mean time to recurrence of postoperative instability was significantly shorter in the ABSC group (12.6 ± 2.7 months) compared with the OB group (34.2 ± 12 months; P = .04). The WOSI score in the OB group (265 ± 48.1) was better but not statistically significantly compared with the ABSC group (449.8 ± 63.8; P = .06). Conclusion: The time to recurrence of instability after open Bankart repair is significantly longer compared with arthroscopic Bankart repair. Clinical Relevance: Delayed time to recurrence after open Bankart repair suggests that the open technique may be more suited to withstand the high stress and demands of a heavy-duty profession (contact athletes and heavy manual labor). PMID:27570783

  16. Long-term outcomes of 1326 laparoscopic incisional and ventral hernia repair with the routine suturing concept: a single institution experience.

    Science.gov (United States)

    Chelala, E; Baraké, H; Estievenart, J; Dessily, M; Charara, F; Allé, J L

    2016-02-01

    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 benefits to the conventional advantages of LIVHR in terms of reducing the overall morbidity, with a low rate of recurrences. Based on our experience and study, the current best indications for a successful LIVHR procedure should be tailored upon the limitations of the defect's width and proper patient selection, to

  17. Low reoperation rates in young males after sutured repair of indirect inguinal hernia

    DEFF Research Database (Denmark)

    Haastrup, Emil; Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    Background: The aim of this study was to investigate the reoperation rates after open indirect inguinal hernia repair with and without mesh in young males and other age groups. Younger males have higher risk of developing chronic pain after open inguinal hernia repair with mesh compared with older...... males with primary indirect inguinal hernia, repaired with Lichtenstein or annulorrhaphy from the period January 1, 1998 to December 31, 2015. Reoperation rate for recurrence was used as outcome. Results: In total 52,281 primary repairs of open indirect inguinal hernia were included of which 49,951 were...... the results indicate, that annulorrhaphy could be a valid option for young men with indirect inguinal hernias. Thus, we propose a tailored approach for this patient group. Summary for the table of contents: Avoiding mesh among younger patients with inguinal hernias could be justified, if an acceptable low...

  18. [Repair of a huge Bochdalek hernia by direct suture and mesh reconstruction].

    Science.gov (United States)

    Sato, Hiroki; Yamashita, Kazuki; Waki, Naohisa; Kawai, Hiroshi; Ishizaki, Masahiro; Nishi, Hideyuki

    2014-12-01

    A 72-year-old man presented with complaints of sudden abdominal pain and vomiting. After a thorough examination, the patient was diagnosed with a left-sided Bochdalek hernia with strangulation of the stomach and spleen. The impaction was cleared by drainage of the stomach contents by a nasogastric tube;then, surgical repair through thoracic approach was performed. The herinia port size was large, and the defect of diaphragm was successfully repaired by both direct closure and mesh reconstruction.

  19. LAPROSCOPIC REPAIR OF UMBLICAL HERNIA BY EXTRACORPOREAL KNOTTING - AN INNOVATIVE SUCCESSFUL NON MESH TECHNIQUE: LOW RECURRENCE RATES ON LONG TERM FOLLOW UP

    Directory of Open Access Journals (Sweden)

    Dhamotharan

    2015-11-01

    Full Text Available : BACKGROUND: This study evaluates the feasibility of laparoscopic transfascial suture and extracorporeal knotting repair of umbilical hernias. METHODS: From August 2005 to August 2015, 45 patients underwent laparoscopic umbilical suture repair. The repair was performed with the Carter-Thomason suture passer and cobbler’s needle. RESULTS: Of the 45, 36 patients with more than 1-year follow-up were included in the study. The mean diameter of the umbilical hernia defect was 1.30 cm (range, 0.5 to 2. At a mean follow-up of 34 months (range, 12 to 60, there were only 1 recurrence (2.77% which happened in patients with hernia defects larger than 1.5 cm in diameter. Apart from 2 wound infections, no other complications occurred. CONCLUSION: Laparoscopic suture repair of umbilical hernias with the suture passer method is effective and durable. The cobblers needle proved a simple and cosmetically acceptable device with which to close the umbilical hernia defect extracorporeally.This technique can be done simultaneously during other laproscopic procedures such as laproscopic cholecystectomy,laproscopic appendicectomy where mesh placement is not feasible in view of contamination.We tried this new innovative method and proved successful on long term followup

  20. Novel technique for repair of severed peripheral nerves in rats using polyurea crosslinked silica aerogel scaffold.

    Science.gov (United States)

    Sabri, Firouzeh; Gerth, David; Tamula, George-Rudolph M; Phung, Thien-Chuong N; Lynch, Kyle J; Boughter, John D

    2014-10-01

    To design, synthesize, and test in vivo an aerogel-based top-open peripheral nerve scaffold to simultaneously support and guide multiple completely severed peripheral nerves in a rat model. Also, to explore options for immobilizing severed nerves on the aerogel material without the use of sutures resulting in reduced surgical time. A novel material and approach was developed for the reattachment of severed peripheral nerves. Nerve confinement and alignment in this case relies on the surface properties of a lightweight, highly porous, polyurea crosslinked silica aerogel scaffold. The distal and proximal ends of completely transected nerve terminals were positioned inside prefabricated "top-open" corrugated channels that cradled approximately two thirds of the circumference of the nerve trunk and connectivity of the severed nerves was evaluated using sciatic function index (SFI) technique for five months post-surgery on 10 female Sprague-Dawley rats then compared with the gold standard for peripheral nerve repair. The interaction of nerves with the surface of the scaffold was investigated also. Multichannel aerogel-based nerve support scaffold showed similar SFI recovery trend as the case suture repair technique. Usage of an adhesion-promoting coating reduced the friction between the nerve and the scaffold leading to slippage and lack of attachment between nerve and surface. The aerogel scaffold used in this study did not collapse under pressure during the incubation period and allowed for a rapid and non-invasive peripheral nerve repair approach without the demands of microsurgery on both time and surgical expertise. This technique may allow for simultaneous repair and reconnection of multiple severed nerves particularly relevant to nerve branching sites.

  1. Cyclic test comparison of all-inside device and inside-out sutures for radial meniscus lesion repair: an in vitro porcine model study.

    Science.gov (United States)

    Lee, Yee Han Dave; Nyland, John; Burden, Robert; Caborn, David N M

    2012-12-01

    To compare biomechanical fixation and gapping characteristics of a new all-inside meniscus repair method for radial meniscus lesion repair versus conventional inside-out suture repair under submaximal cyclic loading and load-to-failure test conditions. Fresh-frozen porcine tibiae with attached lateral menisci and joint capsules were harvested and stored for 48 hours at -20°C. After thawing for 12 hours, equivalent-size healthy specimens were randomly assigned to 2 groups of 8 specimens each. Standardized radial lesions were repaired with the Sequent device (ConMed Linvatec, Largo, FL) (group 1) or conventional inside-out suturing with No. 2-0 braided polyester suture (group 2). Repaired specimens were placed in custom clamps and mounted on a servohydraulic device. After a 2-N preload, specimens were cycled from 5 to 20 N (0.1 Hz), before undergoing 1,000 submaximal loading cycles between 5 and 20 N (0.5 Hz). A 40-second delay at 100, 500, and 1,000 cycles enabled digital photographs to be taken for gapping measurement determination. Specimens then underwent load-to-failure testing (12.5 mm/s). Fixation failure mode was documented. Group displacement did not differ after 1, 100, 500, and 1,000 submaximal loading cycles. Group peak gapping did not differ at 100, 500, and 1,000 submaximal loading cycles. Load at failure and displacement and stiffness during load-to-failure testing did not differ between groups. During load-to-failure testing, all-inside specimens failed by implant dislodgement from the meniscus periphery whereas the inside-out repaired specimens failed by suture rupture. Under controlled in vitro biomechanical test conditions, the all-inside device provided radial meniscus lesion fixation that was comparable, but not superior, to conventional inside-out suturing. The all-inside radial lateral meniscus lesion repair method may provide comparable fixation to conventional inside-out suturing without the need for additional incisions and their associated

  2. Efficacy of Achilles Suture Bridge Technique for Insertional Achilles Tendinosis in an Obese and Athletic Patient.

    Science.gov (United States)

    Mineta, Kazuaki; Suzue, Naoto; Matsuura, Tetsuya; Sairyo, Koichi

    2016-01-01

    Here, we report the efficacy of the suture bridge technique for treating insertional Achilles tendinosis in an obese and athletic patient. A 48-year-old man presented to our department with a 6-month history of left posterior heel pain. The patient was an athlete (triathlon) and appeared obese (height: 197 cm, body weight: 120 kg, body mass index: 30.9). A diagnosis of insertional Achilles tendinosis was made. Because 6 months of conservative treatments had failed, we performed open resection of the calcaneal exostosis and Haglund's deformity along with debridement of the degenerative tissue of the tendon. Wide detachment of the insertion of the Achilles tendon was necessary, and reattachment of the tendon was performed using the Arthrex SpeedBridge(TM) system (Arthrex, Inc., Naples, FL). Six weeks postoperatively, this patient was allowed to walk with full weight bearing. Twelve weeks after surgery, this patient started jogging with neither pain nor evidence of Achilles tendon rupture. The suture bridge technique was effective for the reconstruction of the Achilles tendon in an obese and athletic patient. J. Med. Invest. 63: 310-314, August, 2016.

  3. Loop securities of arthroscopic sliding-knot techniques when the suture loop is not evenly tensioned.

    Science.gov (United States)

    Kim, Sae Hoon; Glaser, Diana; Doan, Josh; Chung, Seok Won; Choi, Hye Yeon; Oh, Joo Han; Hargens, Alan R

    2013-08-01

    The purpose of this study was to evaluate the loop security of arthroscopic sliding knots when tension is only applied to the post strand and not the loop strand. Six different locking sliding knots (Weston, Nicky, Roeder, SMC, San Diego, and Dines) were included. Loop securities were evaluated in 2 ways: with a conventional method (equal tension applied to the suture loop) and with a worst-case scenario (WCS) method (only the post strand of the suture loop was tensioned). Differences between test methods were evaluated for significance. To help assess the applicability of each test method, loop-security testing in a cadaveric shoulder was performed with 1 type of knot (SMC). Loop securities with the conventional method versus the WCS method were as follows: 10.74 ± 4.20 N versus 6.90 ± 3.90 N for Weston, 21.25 ± 14.74 N versus 8.73 ± 3.35 N for Nicky, 26.14 ± 15.57 N versus 7.95 ± 4.23 N for Roeder, 42.67 ± 22.96 N versus 8.67 ± 4.33 N for SMC, 52.99 ± 21.36 N versus 18.25 ± 10.58 N for San Diego, and 89.27 ± 27.96 N versus 12.48 ± 3.40 N for Dines (P security of 5.53 ± 6.06 N, which was similar to the WCS setting. The locking mechanism of the sliding knots is maintained when the suture loop is evenly tensioned at both post and non-post strands. When tension is not applied to the non-post strand side, the knots slide more easily and fail at lower loads than previously reported. When surgeons tie locking sliding knots in single-row rotator cuff repair, they should be aware that the knots could fail at much lower loads than previously reported. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  4. Nickel-Titanium Wire as Suture Material: A New Technique for the Fixation of Skin.

    Science.gov (United States)

    Li, Haidong; Song, Tao

    2018-01-29

    To introduce nickel-titanium wire as suture material for closure of incisions in cleft lip procedures. Closure of skin incisions using nickel-titanium wire as suture material, with postoperative follow-up wound evaluation. There was excellent patient satisfaction and good cosmetic outcome. Nickel-titanium wire is an excellent alternative for suture closure of cleft lip surgical incisions.

  5. Endoscopic sutured gastroplasty: procedure evolution from first-in-man cases through current technique.

    Science.gov (United States)

    Kumar, Nitin; Abu Dayyeh, Barham K; Lopez-Nava Breviere, Gontrand; Galvao Neto, Manoel P; Sahdala, Nicole P; Shaikh, Sohail N; Hawes, Robert H; Gostout, Christopher J; Goenka, Mahesh K; Orillac, Jorge R; Alvarado, Alonso; Jirapinyo, Pichamol; Zundel, Natan; Thompson, Christopher C

    2017-10-26

    Endoscopic sutured gastroplasty (ESG) has evolved over time. With the advent of full-thickness endoscopic suturing, an efficient technique for ESG was developed and refined. This prospective first-in-man trial started in April 2012 and represents the first use of full-thickness endoscopic suturing for primary obesity therapy. The trial focused on procedure development, reproducibility, safety, and short-term efficacy. The trial was performed at centers in five countries, in three phases. Phase I was evaluation of safety and technical feasibility of various procedure techniques; stitch patterns and sequences were assessed for efficiency, safety, and feasibility. Phase II entailed continued procedure refinement to establish a standardized technique. Phase III entailed evaluation of technical feasibility and weight loss outcomes in 77 patients; the procedure was performed using the standardized technique, and there was no procedure development. Data were prospectively collected into a registry. In Phase I, the procedure was created and modified to improve time efficiency. Safety and technical feasibility were established, and short-term weight loss was demonstrated. In Phase II, a number of stitch patterns were attempted, and the stitch pattern was modified and finalized. 22 patients were included, and 1-year total weight loss was 17.3 ± 2.6%. In Phase III, conformity with the final technique was high. 77 patients were included, with a mean BMI of 36.1 ± 0.6 kg/m 2 . Mean weight loss was 16.0 ± 0.8% at 6 months and 17.4 ± 1.2% at 12 months (n = 44). Postprocedural nausea, vomiting, and epigastric pain were frequently reported; there were no reported significant adverse events post-procedure or during the follow-up period. Following a methodical procedure development phase, ESG demonstrated safety and short-term efficacy in this trial. The procedure also achieved meaningful weight loss during the follow-up period.

  6. A novel suture anchor constructed of cortical bone for rotator cuff repair: a biomechanical study on sheep humerus specimens.

    Science.gov (United States)

    Guo, Qi; Li, Chunbao; Qi, Wei; Li, Hongliang; Lu, Xi; Shen, Xuezhen; Qu, Feng; Liu, Yujie

    2016-09-01

    The aim of this study was to evaluate biomechanical properties of a new type of suture anchors constructed of human cortical allograft bone and compare it with the similar standard titanium screw anchor for rotator cuff tears in sheep humerus model. Twenty-four paired sheep humeri were harvested from 12 male sheep aged 18 months. Specimens were divided into cortical bone anchor group and titanium screw anchor group. The anchors loaded with two sutures were placed at the footprint of infraspinatus tendon. Cyclic loading test was performed from 10 to 60 N at 1 Hz for 500 cycles and followed by a load-to-failure test at 33 mm/sec. A paired t-test was used to compare the biomechanical properties of the anchors of each type. No anchors failed during the cyclic phase, and the cortical bone anchors were all pulled out intact. The cyclic displacement of the cortical bone anchor was not significantly greater than that of the titanium screw anchor (P > 0.05). Student's t test showed no statistically significant difference between anchors in terms of failure load (cortical bone anchor: 304.74 ± 64.46 N versus titanium screw anchor: 328.45 ± 89.58 N; P = 0.213), ultimate load (cortical bone anchor: 325.82 ± 76.45 N versus titanium screw anchor: 345.61 ± 83.56 N; P = 0.183), yield load (cortical bone anchor: 273.78 ± 44.75 N versus titanium screw anchor: 284.72 ± 56.37 N; P = 0.326) or stiffness (cortical bone anchor: 52.97 ± 14.28 N/mm versus titanium screw anchor: 62.38 ± 18.35 N/mm; P = 0.112). In vitro, this experimental study suggested no statistically significant difference in initial fixation stability between the new type anchor and titanium screw anchor at a chosen level of significance (P suture anchor constructed of cortical bone provides comparable initial fixation strength to a similar metallic anchor for rotator cuff repair.

  7. Arthroscopic Fixation of Tibial Eminence Fractures: A Biomechanical Comparative Study of Screw, Suture, and Suture Anchor.

    Science.gov (United States)

    Li, Ji; Yu, Yang; Liu, Chunhui; Su, Xiangzheng; Liao, Weixiong; Li, Zhongli

    2018-01-31

    To compare biomechanical outcomes of 4 different arthroscopic techniques for fixation of tibial eminence fractures. Twenty-four skeletally mature, fresh-frozen cadaveric knees were divided into 4 comparison groups based on the fixation method: screw fixation (group A), traditional sutures fixation with 2 FiberWire sutures (group B), a modified suture technique with 2 FiberWire sutures that created neckwear knots to firmly trap the fracture fragment (group C), or suture anchors which was based on the suture bridge technique primarily used in the shoulder for repair of rotator cuff tears and greater tuberosity fractures (group D). A tibial eminence fracture was created in each knee for subsequent fixation. After fixation, each knee underwent cyclic loading of 100 N to assess the displacement change after 500 cycles of the fixation construct. Afterward, a single tensile failure test load was performed to assess the ultimate failure load, stiffness, and failure mode for each specimen. All specimens survived cyclic testing and were subsequently loaded to failure. Group C had the highest ultimate failure load (P Suture fixation using the neckwear knots technique provides superior fixation with regard to higher ultimate failure load, and absorbable suture anchor fixation with the suture bridge technique provides less displacement under cyclic loading conditions. Both techniques exhibited superior biomechanical properties compared with traditional screw and suture fixation. The new techniques showed satisfactory biomechanical properties and provided more choice for surgeons in the treatment of tibial eminence fractures. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  8. Posttraumatic tricuspid insufficiency successfully repaired by conventional technique.

    Science.gov (United States)

    Tatebe, Shoh; Uehara, Akifumi; Shinonaga, Mayumi; Kuraoka, Setsuo

    2005-01-01

    A 22-year-old man developed exertional dyspnea 2 years after blunt chest trauma due to a horse kick. Preoperative echocardiography showed severe tricuspid insufficiency (TI) caused by chordal rupture and prolapse of the anterior leaflet. A novel repair technique, the "clover technique," was applied, but was unsuccessful in this case. The valve was then repaired successfully using conventional techniques, that is, insertion of an artificial chordae, plication of the prolapsing leaflet, and DeVega's annuloplasty. We present here a brief review of posttraumatic TI, and discuss effective and less expensive techniques for repair.

  9. Deep patch technique for landslide repair. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Helwany, B.M.

    1994-10-01

    The report describes the laboratory testing of the `USFS deep patch` technique and a CTI modification of this technique for repairing landslides with geosynthetic reinforcement. The technique involves replacing sections of roadway lost due to landslides on top of a geosynthetically-reinforced embankment. The CTI modification involves replacing the reinforced slope with a geosynthetically-reinforced retaining wall with a truncated base. Both techniques rely on the cantilevering ability of the reinforced mass to limit the load on the foundation with a high slide potential. The tests with road base showed that (1) both the USFS and CTI repair reduced effectively the adverse effects of local landsliding on the highway pavement by preventing crack propagation; (2) the USFS repair increased the stability of the repaired slope, which was in progressive failure, by reducing the stresses exerted on it; and (3) the CTI repair produced substantially greater stresses on its foundation due to the truncated base of the reinforced mass.

  10. Innovative Concrete Repairing Technique Using Post Tensioning Steel Straps

    Directory of Open Access Journals (Sweden)

    Ma Chau-Khun

    2017-01-01

    Full Text Available In this paper, innovative technique using low-cost recycled steel straps confinement to repair load-induced damaged high-strength concrete (HSC columns were studied. This paper explains the effects of repairing technique using post tensioning steel straps. A series of experimental test was carried out to investigate the stress-strain relationships of such concrete. A total of 6 HSC columns were compressed 50% of their ultimate strength, then repaired by using steel straps. The proposed repairing technique significantly improved the performance of damaged concrete columns, in both strength and ductility. It was evidenced from this study that the steel strapping confining technique is effective in repairing of damaged HSC columns but ensured reasonable operating costs.

  11. Hypersensitivity to Suture Anchors

    OpenAIRE

    Masafumi Goto; Masafumi Gotoh; Yasuhiro Mitsui; Ryo Tanesue; Takahiro Okawa; Fujio Higuchi; Naoto Shiba

    2013-01-01

    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 dermatolo...

  12. Progrip self-gripping mesh in Rives-Stoppa repair: Are there any differences in outcomes versus a retromuscular polypropylene mesh fixed with sutures? A “case series” study

    Directory of Open Access Journals (Sweden)

    José Bueno-Lledó

    2017-01-01

    Conclusions: In Rives-Stoppa repair, retromuscular Progrip mesh causes less postoperative pain in the first 48 h and lower rate of hematoma than PPL mesh fixed with sutures in the short term follow-up.

  13. Single instrument intracorporeal knot tying during single port laparoscopic hernia repair in children: a new simplified technique.

    Science.gov (United States)

    Ismail, Magid; Shalaby, Rafik

    2014-06-01

    With the increasing number of open surgical procedures shifting to laparoscopy, laparoscopic suturing and knot tying are becoming integral parts of the skills that any laparoscopist must acquire. It is the most difficult step in laparoscopic surgery, especially in single incision pediatric endosurgery (SIPES). It needs special laparoscopic skills and very long learning curve. The aim of this study is to introduce a new simplified technique for single instrument intracorporeal suture tying during single incision laparoscopic hernia repair (SILHR). This study was conducted at Al-Azhar University Hospitals between June 2008 and June 2010. Three-hundred and eighty three patients with 402 congenital inguinal hernias were subjected to SILHR using percutaneous insertion of purse string suture by Reverdin Needle (RN) with single instrument intracorporeal suture knot tie. Under general endotracheal tube anesthesia, a 0.8-1.2-cm. longitudinal transumilical skin incision was done for insertion of the umbilical port and a 3-mm Maryland forceps. RN was used for insertion of a purse string suture with single instrument intracorporeal suture tie around internal inguinal ring (IIR). The purse-string knot airtightness was stress-tested by raising the intraperitoneal CO2 pressure to 16-24mm Hg for about 30seconds. A total of 383 patients with 402 congenital inguinal hernias were subjected to SILHR. They were 304 males and 79 females with a mean age of 2.2±2.25years. A single instrument technique was used for intracorporeal suture knot tie and all cases were completed laparoscopically without conversion. The mean operative time was 12.5±3.3minutes for unilateral hernia repair and 17±4.37 for bilateral cases. All patients achieved full recovery without intraoperative or postoperative complications. Single instrument intracorporeal suture tie is feasible, simple, and rapid as it resulted in marked decrease of operative time. It is of low cost, secure and gives great help during

  14. Achilles Tendon Repair, A Modified Technique

    Directory of Open Access Journals (Sweden)

    Sohrab Keyhani

    2013-12-01

    Full Text Available   Background: Wound complications following open repair for acute Achilles tendon ruptures (AATR remain the subject of significant debate. The aim of this study is to investigate the effects of covering repaired AATR using well-nourished connective tissues (paratenon and deep fascia to avoid complications after open repair.   Methods: In this case series study, open repair was performed for 32 active young patients with AATR. After the tendon was repaired, the deep fascia and paratenon was used to cover the Achilles tendon. Patients were followed for two years and any wound complication was recorded. During the last visit, the American Orthopedic Foot and Ankle Society (AOFAS ankle-hind foot score was completed for all patients. Calf circumference and ankle range of motion were measured and compared with the contralateral side. Patients were asked about returning to previous sports activities and limitations with footwear. Results: Only, one patient developed deep wound infection (3%. None of the patients had any discomfort around the operation area, limitation with footwear, sural nerve injury, re-rupture, and skin adhesion. The AOFAS score averaged 92.5±6. Two patients (7% were unable to return to previous sports activities because of moderate pain in heavy physical exercises. The calf circumference and ankle ROM were similar between healthy and operated sides. Conclusion: The present study showed that fascial envelope for full covering of the repaired Achilles tendon may help to prevent the occurrence of wound complications.

  15. Triple-Loaded Single-Row Versus Suture-Bridge Double-Row Rotator Cuff Tendon Repair With Platelet-Rich Plasma Fibrin Membrane: A Randomized Controlled Trial.

    Science.gov (United States)

    Barber, F Alan

    2016-05-01

    To compare the structural healing and clinical outcomes of triple-loaded single-row with suture-bridging double-row repairs of full-thickness rotator cuff tendons when both repair constructs are augmented with platelet-rich plasma fibrin membrane. A prospective, randomized, consecutive series of patients diagnosed with full-thickness rotator cuff tears no greater than 3 cm in anteroposterior length were treated with a triple-loaded single-row (20) or suture-bridging double-row (20) repair augmented with platelet-rich plasma fibrin membrane. The primary outcome measure was cuff integrity by magnetic resonance imaging (MRI) at 12 months postoperatively. Secondary clinical outcome measures were American Shoulder and Elbow Surgeons, Rowe, Simple Shoulder Test, Constant, and Single Assessment Numeric Evaluation scores. The mean MRI interval was 12.6 months (range, 12-17 months). A total of 3 of 20 single-row repairs and 3 of 20 double-row repairs (15%) had tears at follow-up MRI. The single-row group had re-tears in 1 single tendon repair and 2 double tendon repairs. All 3 tears failed at the original attachment site (Cho type 1). In the double-row group, re-tears were found in 3 double tendon repairs. All 3 tears failed medial to the medial row near the musculotendinous junction (Cho type 2). All clinical outcome measures were significantly improved from the preoperative level (P plasma fibrin membrane. No difference could be demonstrated between these repairs on clinical outcome scores. I, Prospective randomized study. Copyright © 2016 Arthroscopy Association of North America. All rights reserved.

  16. Early weightbearing using Achilles suture bridge technique for insertional Achilles tendinosis: a review of 43 patients.

    Science.gov (United States)

    Rigby, Ryan B; Cottom, James M; Vora, Anand

    2013-01-01

    Posterior heel pain caused by insertional Achilles tendinosis can necessitate surgical intervention when recalcitrant to conservative care. Surgical treatment can necessitate near complete detachment of the Achilles tendon to fully eradicate the offending pathologic features and, consequently, result in long periods of non-weightbearing. A suture bridge technique using bone anchors is available for reattachment of the Achilles tendon. This provides restoration of the Achilles footprint on the calcaneus, including not only contact, but also actual pressure between the tendon and bone. We performed a review of 43 patients who underwent surgical treatment of insertional Achilles tendinosis with reattachment of the Achilles tendon using the suture bridge technique. The mean age was 53 (range 29 to 87) years. The mean follow-up period was 24 (range 13 to 52) months. The mean postoperative American Orthopaedic Foot and Ankle Society score was 90 (range 65 to 100). The mean preoperative visual analog scale pain score was 6.8 (range 2 to 10) and the mean postoperative visual analog scale pain score was 1.3 (range 0 to 6). The mean interval to weightbearing was 10 (range 0 to 28) days. No postoperative ruptures occurred. Of the 43 patients, 42 (97.6%) successfully performed the single heel rise test at the final postoperative visit. Concomitant procedures were performed in 35 patients, including 33 (77%) requiring open gastrocnemius recession and 2 (5%) requiring flexor hallucis longus tendon transfer. A total of 42 patients (97.6%) returned to regular shoe gear, and 42 (97.6%) returned to their activities of daily living, including running for 20 athletic patients (100%). Complications included postoperative wound dehiscense requiring surgical debridement in 2 patients (5%) and soft tissue infection requiring antibiotics and surgical debridement in 1 (2%) patient. Our findings support using the Achilles tendon suture bridge for reattachment of the Achilles tendon in the

  17. The "washing line" suture technique for securing the Subepithelial Connective Tissue Graft.

    Science.gov (United States)

    McCrea, Shane J J

    2014-07-01

    Following tooth extraction, resorption of the buccal wall of the socket will occur; this will be true for both the maxilla and the mandible. Where the extraction site is surrounded by natural dentition, the loss of the buccal alveolar plate can degrade the visual aesthetics of an implant-supported prosthetic rehabilitation. To aid the harmonization of the hard and soft tissue morphology, both hard and soft tissue augmentation can be carried out either consecutively with an extraction/immediate implant placement or prior to an implant placement in the delayed scenario. The contemporary method of increasing soft tissue volume is to use the Subepithelial Connective Tissue (auto) Graft (the SCTG). The graft requires fixation, otherwise it can be extruded from the recipient site. This article presents a novel suturing technique which can confidently secure the SCTG, thus resisting its dislodgement.

  18. A biomechanical comparison of tendon-bone interface motion and cyclic loading between single-row, triple-loaded cuff repairs and double-row, suture-tape cuff repairs using biocomposite anchors.

    Science.gov (United States)

    Barber, F Alan; Drew, Otis R

    2012-09-01

    To compare tendon-bone interface motion and cyclic loading in a single-row, triple-loaded anchor repair with a suture-tape, rip-stop, double-row rotator cuff repair. Using 18 human shoulders from 9 matched cadaveric pairs, we created 2 groups of rotator cuff repairs. Group 1 was a double-row, rip-stop, suture-tape construct. Group 2 was a single-row, triple-loaded construct. Before mechanical testing, the supraspinatus footprint was measured with calipers. A superiorly positioned digital camera optically measured the tendon footprint motion during 60° of humeral internal and external rotation. Specimens were secured at a fixed angle not exceeding 45° in reference to the load. After preloading, each sample was cycled between 10 N and 100 N for 200 cycles at 1 Hz, followed by destructive testing at 33 mm/s. A digital camera with tracking software measured the repair displacement at 100 and 200 cycles. Ultimate load and failure mode for each sample were recorded. The exposed anterior footprint border (6.5% ± 6%) and posterior footprint border (0.9% ± 1.7%) in group 1 were statistically less than the exposed anterior footprint border (30.3% ± 17%) and posterior footprint border (29.8% ± 14%) in group 2 (P = .003 and P footprint displacements in group 1 (1.6 mm and 1.4 mm, respectively) were less than those in group 2 (both 3.6 mm) (P = .007 and P = .004, respectively). Mean displacement after 100 cycles for group 1 and group 2 was 2.0 mm and 3.2 mm, respectively, and at 200 cycles, mean displacement was 2.5 mm and 4.2 mm, respectively (P = .02). The mean ultimate failure load in group 1 (586 N) was greater than that in group 2 (393 N) (P = .02). The suture-tendon interface was the site of most construct failures. The suture-tape, rip-stop, double-row rotator cuff repair had greater footprint coverage, less rotational footprint displacement, and a greater mean ultimate failure load than the triple-loaded, single-row repair on mechanical testing. No double-row or

  19. Factors Influencing Choice of Inguinal Hernia Repair Technique

    African Journals Online (AJOL)

    may influence decisions concerning inguinal hernia repair techniques. Methods: This descriptive cross- sectional study was carried out in September 2014 among surgical trainees and surgeons. Data collected included: qualification of the operating doctor, level at which practical training on inguinal hernia repair occurred ...

  20. Factors Influencing Choice of Inguinal Hernia Repair Technique ...

    African Journals Online (AJOL)

    Background: Inguinal hernia repair surgery is one of the most frequently performed surgical procedures worldwide. This study sought to highlight factors that may influence decisions concerning inguinal hernia repair techniques. Methods: This descriptive crosssectional study was carried out in September 2014 among ...

  1. Comparison of Barbed Sutures in Porcine Flexor Tenorrhaphy

    Science.gov (United States)

    Sull, Alan; Inceoglu, Serkan; August, Alicia; Gregorius, Stephen; Wongworawat, Montri D.

    2016-01-01

    Background: Barbed suture use has become more popular as technology and materials have advanced. Minimal data exist regarding performance of the 2 commercially available products, V-LocTM and StratafixTM in tendon repairs. The purpose of this study was to compare gap resistance and ultimate tensile strength of both suture materials and nonbarbed suture in a porcine ex vivo model. Methods: Porcine flexor tendons were harvested and divided into 3 groups of 10 of varying suture material (3-0 PDS™, 3-0 V- V-Loc 180™, or 3-0 Stratafix™). A modified 4-strand cruciate technique was used to repair each tendon. Knotless repair was performed using barbed suture, whereas a buried 6-throw square knot was done using conventional suture. A servohydrolic tester was used for biomechanical testing of linear 2-mm gap resistance and maximum tensile strength. Results: No difference was found in 2-mm gap resistance among the 3 groups. No difference was found in ultimate tensile strength between V-Loc™ (76.0 ± 9.4 N) and Stratafix™ (68.1 ± 8.4 N) repairs, but the ultimate strength of the PDS™ control group (83.4 ± 10.0 N) was significantly higher than that of Stratafix™. Conclusions: Barbed (knotless) and nonbarbed suture repairs demonstrate equivalent 2-mm gap resistance. Stratafix™ repairs show slightly inferior performance to nonbarbed repairs in ultimate tensile strength, although this occurred at gap distances far beyond the 2-mm threshold for normal tendon gliding. Both barbed and nonbarbed 4-strand cruciate flexor tendon repairs may require peripheral repair to withstand physiologic loads. PMID:28149217

  2. Sutures - ridged

    Science.gov (United States)

    Ridged sutures ... The borders where these plates intersect are called sutures or suture lines. In an infant only a few minutes ... This makes the bony plates overlap at the sutures and creates a small ridge. This is normal ...

  3. The Biomechanical Role of Scaffolds in Augmented Rotator Cuff Tendon Repairs

    Science.gov (United States)

    2012-01-01

    double-row suture anchor repair for rotator cuff tears: a random- ized controlled trial. Am J Sports Med 2007;35:1254-60. doi:10.1177/ 0363546507302218... sutures cutting through the tendon was reduced, occurring in 17 of 20 nonaugmented repairs but in only 7 of 20 augmented repairs. In another study...tuberosity using a double-row transosseous technique with 2 Mason Allen sutures per row.20 The prototypical augmen- tation graft used for the augmented

  4. Augmentation techniques for rotator cuff repair.

    Science.gov (United States)

    Papalia, Rocco; Franceschi, Francesco; Zampogna, Biagio; D'Adamio, Stefano; Maffulli, Nicola; Denaro, Vincenzo

    2013-01-01

    There is a high rate of recurrence of tear and failed healing after rotator cuff repair. Several strategies have proposed to augment rotator cuff repairs to improve postoperative outcome and shoulder performance. We systematically review the literature on clinical outcome following rotator cuff augmentation. We performed a comprehensive search of Medline, CINAHL, Embase and the Cochrane Central Registry of Controlled Trials, from inception of the database to 20 June 2012, using various combinations of keywords. The reference lists of the previously selected articles were then examined by hand. Only studies focusing on clinical outcomes of human patients who had undergone augmented rotator cuff repair were selected. We then evaluated the methodological quality of each article using the Coleman methodology score (CMS), a 10 criteria scoring list assessing the methodological quality of the selected studies (CMS). Thirty-two articles were included in the present review. Two were retrospective studies, and 30 were prospective. Biologic, synthetic and cellular devices were used in 24, 7 and 1 studies, respectively. The mean modified Coleman methodology score was 64.0. Heterogeneity of the clinical outcome scores makes it difficult to compare different studies. None of the augmentation devices available is without problems, and each one presents intrinsic weaknesses. There is no dramatic increase in clinical and functional assessment after augmented procedures, especially if compared with control groups. More and better scientific evidence is necessary to use augmentation of rotator cuff repairs in routine clinical practice.

  5. Nasal septum perforation repair using differently designed, bilateral intranasal flaps, with nonopposing suture lines

    NARCIS (Netherlands)

    André, R. F.; Lohuis, P. J. F. M.; Vuyk, H. D.

    2006-01-01

    In this article, we briefly review the aetiology and symptoms of nasal septal perforations, and focus on a surgical reconstruction technique of which the results were retrospectively studied. The technique described, involves the interposition of a connective tissue graft between differently

  6. Proposed technique for inguinal hernia repair with self-gripping mesh: avoiding fixation to undesired structures.

    Science.gov (United States)

    Porrero, J L; Cano-Valderrama, O; Castillo, M J; Alonso, M T

    2015-10-01

    Self-gripping meshes have been developed to avoid fixing sutures during inguinal hernia repair. Operative time is shorter when using a self-gripping mesh than with conventional Lichtenstein repair. However, these meshes can be difficult to handle because they fix to undesired structures. The aim of this report is to describe a new technique to avoid this problem. Inguinal hernia dissection is made as usual. Once dissection is finished, a Parietex ProGrip(®) (Covidien, Dublin, Ireland) flat sheet mesh is cut depending on the size needed. A small split is made between the lower and medium third of the mesh to mark where the split for the spermatic cord will be. Using this mark, the upper third of the mesh is folded over the medium third, hiding the microgrips that make this a self-gripping mesh. In this way, only the lower third of the mesh has the microgrips exposed and the mesh can be fixed to the pubic bone and inguinal ligament without fixation to undesired structures. Once the lower third of the mesh is fixed, the split for the spermatic cord is completed and the upper part of the mesh is passed below the spermatic cord. Then, the mesh is unfolded to expose the microgrips again and the medium and upper third of the mesh are descended to its final position. This proposed technique for inguinal hernia repair with self-gripping mesh makes the surgery easier, avoiding mesh fixation to undesired structures.

  7. Acute Achilles Tendon Rupture Treated by Double Side-Locking Loop Suture Technique With Early Rehabilitation.

    Science.gov (United States)

    Miyamoto, Wataru; Imade, Shinji; Innami, Ken; Kawano, Hirotaka; Takao, Masato

    2017-02-01

    Although early accelerated rehabilitation is recommended for the treatment of acute Achilles tendon rupture, most traditional rehabilitation techniques require some type of brace. We retrospectively analyzed 44 feet of 44 patients (25 male and 19 female) with a mean age of 31.8 years who had an acute Achilles tendon rupture related to athletic activity. Patients had been treated by a double side-locking loop suture (SLLS) technique using double antislip knots between stumps and had undergone early accelerated rehabilitation, including active and passive range of motion exercises on the day following the operation and full weight-bearing at 4 weeks. No brace was applied postoperatively. The evaluation criteria included the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale (AOFAS) score; active plantar flexion and dorsiflexion angles; and the intervals between surgery and the time when patients could walk normally without any support, perform double-leg heel raises, and perform 20 continuous single-leg heel raises of the operated foot. Despite postoperative early accelerated rehabilitation, the AOFAS score and active dorsiflexion angles improved over time (6, 12, and 24 weeks and 2 years). A mean of 4.3 ± 0.6 weeks was required for patients to be able to walk normally without any support. The mean period to perform double-leg heel raises and 20 continuous single-leg heel raises of the injured foot was 8.0 ± 1.3 weeks and 10.9 ± 2.1 weeks, respectively. All patients, except one who was engaged in classical ballet, could return to their preinjury level of athletic activities, and the interval between operation and return to athletic activities was 17.1 ± 3.7 weeks. The double SLLS technique with double antislip knots between stumps adjusted the tension of the sutured Achilles tendon at the ideal ankle position and provided good clinical outcomes following accelerated rehabilitation after surgery without the use of a brace. Level IV, retrospective case

  8. A biomechanical comparison of the primary stability of two minimally invasive techniques for repair of ruptured Achilles tendon.

    Science.gov (United States)

    Longo, Umile Giuseppe; Forriol, Francisco; Campi, Stefano; Maffulli, Nicola; Denaro, Vincenzo

    2012-07-01

    To compare the primary stability of two minimally invasive procedures of Achilles tendon (AT) repair, namely a modified percutaneous repair of ruptured AT and the Achillon suture configuration. Eighteen (nine matched pairs) frozen ovine ATs were tenotomized 5 cm from the calcaneal insertion. In each pair, one tendon was randomly allocated to one of the two techniques: a modified percutaneous repair group and the Achillon device suture configuration. Specimens were tested performing an unidirectional tensile load to failure using a servo-hydraulic testing device (MTS Systems, Eden Prairie, MN, USA), controlled by an electropulse e3000 INSTRON machine (Instron Ltd, Buckinghamshire, UK). The tendons were then loaded to failure at a rate of 10 mm/s. Two of the nine pairs of specimens were discarded because one specimen for each of the pair pulled out of the pneumatic clamp during mechanical testing. The remaining seven matched pairs were successfully tested. There were no differences in mean strength, mean maximum load, mean failure elongation, tension, stiffness and mode of failure between the two groups. The Achillon-like configuration and the modified percutaneous repair of ruptured AT provided similar biomechanical performance.

  9. Replacement of chordae tendineae with polytetrafluoroethylene (PTFE) sutures in mitral valve repair: early and long-term results.

    Science.gov (United States)

    Chiappini, Bruno; Sanchez, Alvaro; Noirhomme, Philippe; Verhelst, Robert; Rubay, Jean; Poncelet, Alain; Funken, Jean Christophe; El Khoury, Gebrine

    2006-09-01

    A variety of reliable techniques are now available for chordal disease management and repair of the anterior mitral valve leaflet prolapse. The study aim was to review the authors' experience with polytetrafluoroethylene (PTFE), using a standardized technique for length adjustment, and to analyze the long-term results in patients who underwent mitral valve repair. A total of 111 patients (mean age 56.2 +/- 16.1 years) underwent mitral valve repair with PTFE neochordae, in addition to a variety of other surgical procedures. Etiologies were degenerative in 82 patients (73.9%), Barlow disease in 13 (11.7%), rheumatic in 10 (9%), and infection in six (5.4%). Prolapse of the anterior leaflet was present in 78 patients (70.3%), of the posterior leaflet in 15 (13.5%), a bileaflet prolapse was present in 12 (10.8%), and a commissural prolapse in six (5.4%). In all cases the anterior annulus was used as the reference level in order to assess the appropriate length of the PTFE neochordae. The mean number of PTFE neochordae used was 6 +/- 4 per patient. In-hospital mortality was 1.8% (n = 2); mean follow up was 36.8 +/- 25.6 months (range: 12-94 months). There were no late deaths. At five years postoperatively the patient overall survival was 98.2 +/- 1.8%, freedom from reoperation rate 100%, and freedom from grade 1+ mitral regurgitation rate 97.2 +/- 2.8%. There were no documented thromboembolism or hemorrhagic events. In degenerative and myxomatous mitral valve disease, leaflet prolapse can be successfully repaired by implantation of PTFE neochordae. Both immediate and long-term results proved the versatility, efficiency and durability of this technique.

  10. A biomechanical comparison of the FasT-Fix meniscal repair suture system and the RapidLoc device in cadaver meniscus.

    Science.gov (United States)

    Kocabey, Yavuz; Chang, Haw Chong; Brand, Jeff C; Nawab, Akbar; Nyland, John; Caborn, David N M

    2006-04-01

    This biomechanical study compared the fixation characteristics of horizontally or vertically implanted FasT-Fix devices (Smith & Nephew, Endoscopy Division, Andover, MA) consisting of two 5-mm PLLA suture T-bar anchors with a pretied self-sliding knot (No. 0 nonabsorbable, USP, braided polyester suture material) and the RapidLoc device (Mitek Surgical Products, Westwood, MA) consisting of a PLLA T-bar anchor or "backstop," a connecting suture (No. 2 nonbiodegradable Ethibond; Ethicon, Somerville, NJ), and a PLLA grommet, for repairing posterior third lesions in human menisci. Controlled laboratory biomechanical study. After repair of a vertical longitudinal meniscus lesion with either vertically or horizontally implanted FasT-Fix devices or RapidLoc devices, 3 groups of 6 specimens underwent cyclic loading (5 mm/minute, cycling between 5 and 50 N at 1 Hz for 500 cycles) before load to failure testing on a servo hydraulic device. One-way analysis of variance and Tukey HSD post hoc tests were used to evaluate group differences (P biomechanical characteristics for meniscal fixation during cyclic and load to failure testing compared with horizontal FasT-Fix or RapidLoc devices. Although the RapidLoc devices provided fixation characteristics comparable to horizontally implanted FasT-Fix devices, vertically implanted FasT-Fix devices may provide superior all-inside fixation.

  11. Proposed technique for open repair of a small umbilical hernia and rectus divarication with self-gripping mesh.

    Science.gov (United States)

    Privett, B J; Ghusn, M

    2016-08-01

    There are a group of patients in which umbilical or epigastric hernias co-exist with rectus divarication. These patients have weak abdominal musculature and are likely to pose a higher risk of recurrence following umbilical hernia repair. We would like to describe a technique for open repair of small (hernias in patients with co-existing rectus divarication using self-adhesive synthetic mesh. The use of a self-adhesive mesh avoids the need for suture fixation of the mesh in the superior portion of the abdomen, allowing for a smaller skin incision. In 173 patients, preperitoneal self-fixating mesh has been used for the repair of midline hernias hernias in patients with co-existing rectus divarication, to decrease the risk of upper midline recurrence in an at-risk patient group. This initial case series is able to demonstrate a suitably low rate of recurrence and complications.

  12. Suture anchor placement technique around the insertion of the ventral rectus muscle for the replacement of the prolapsed gland of the third eyelid in dogs: 100 dogs.

    Science.gov (United States)

    Sapienza, John S; Mayordomo, Aloma; Beyer, Anne M

    2014-03-01

    To evaluate a rapid and efficacious procedure to anchor the prolapsed gland of the third eyelid in dogs. This is a retrospective study of 100 affected dogs (122 eyes) with third eyelid gland prolapse that were surgically anchored with a nonabsorbable suture around the insertion of the ventral rectus muscle. Hundred dogs (122 eyes) were included in this study. Twenty-three pure-bred and several mixed-breed dogs were represented with the right eye affected in 60 cases and the left eye in 62 cases. Thirty-four eyes (27.9%) were previously operated on at another facility prior to referral. The average age of the patients was 2.2 years (57 days to 11 years). No recurrences of gland prolapse were observed over the course of study. Minor intraoperative conjunctival perforations were observed and easily repaired at the time of the surgery in 21 cases (17.2%). Five cases demonstrated preexistent keratoconjunctivitis sicca (KCS), and all had improved Schirmer tear test following surgical correction and medical therapy. The suture anchor placement technique provides a cosmetic, rapid, and successful replacement of the prolapsed gland of the third eyelid in dogs. No recurrences were noted. Complications were easily addressed. © 2013 American College of Veterinary Ophthalmologists.

  13. Non-absorbable sutures are associated with lower recurrence rates in laparoscopic percutaneous inguinal hernia ligation.

    Science.gov (United States)

    Grimsby, G M; Keays, M A; Villanueva, C; Bush, N C; Snodgrass, W T; Gargollo, P C; Jacobs, M A

    2015-10-01

    Laparoscopic hernia repair with percutaneous ligation of the patent processes vaginalis is a minimally invasive alternative to open inguinal herniorrhaphy in children. With the camera port concealed at the umbilicus, this technique offers an excellent cosmetic result. It is also faster than the traditional laparoscopic repair with no differences in complication rates or hospital stay. The goal of this study was to describe a series of consecutive patients, emphasizing the impact of suture materials (absorbable vs. non-absorbable) on hernia recurrences. A retrospective review was performed of consecutive transperitoneal laparoscopic subcutaneous ligations of a symptomatic hernia and/or communicating hydrocele by 4 surgeons. Patients > Tanner 2 or with prior hernia repair were excluded. The success of the procedure and number of sutures used was compared between cases performed with absorbable vs. non-absorbable suture. Risk factors for surgical failure (age, weight, number of sutures used, suture type) were assessed with logistic regression. 94 patients underwent laparoscopic percutaneous hernia ligation at a mean age of 4.9 years. Outcomes in 85 (90%) patients with 97 hernia repairs at a mean of 8 months after surgery revealed 26% polyglactin vs 4% polyester recurrences (p = 0.004) which occurred at mean of 3.6 months after surgery, Table 1. Repairs performed with non-absorbable suture required only 1 suture more often than those performed with absorbable suture (76% vs 60%, p = 0.163). Logistic regression revealed suture type was an independent predictor for failure (p = 0.017). Weight (p = 0.249), age (p = 0.055), and number of sutures (p = 0.469) were not significantly associated with recurrent hernia. Our review of consecutive hernia repairs using the single port percutaneous ligation revealed a significantly higher recurrent hernia rate with absorbable (26%) versus non-absorbable (4%) suture. This finding remained significant in a logistic regression model

  14. New "loop" suture for FDP zone I injuries.

    Science.gov (United States)

    Kapickis, Martins

    2009-09-01

    There are many methods describing distal juncture fixation techniques of the injured flexor digitorum profundus (FDP) or flexor tendon graft. We have noted a tendency in the surgical repair of tissues toward the more expensive and technology-dependent methods. New suture type was developed to find better FDP distal juncture suture not indulging into expensive technology-dependent techniques. The positive aspect of the most popular Bunnell pullout technique is eventual removal of the suture. The negative aspect is necessity to use tie over button to secure the end of the tendon in the bone canal and thus externalizing suture. This can be complicated with maceration, decubitus, and infection. In addition, any device secured to the finger nail can be caught by external objects. We propose buttonless method of the tendon-to-bone fixation. The only negative aspect is retaining suture. Suture is easy to perform and cheaper than any of the anchor sutures. Twelve patients were included in this preliminary study. Seven patients had acute FDP tendon zone I bone juncture injuries. Five patients had second stage flexor tendon reconstruction with tendon grafts. No infections, ruptures of the FDP or nail growth disturbances were noted. Three patients presented with slight DIP joint flexion contracture. One patient had "mallet" deformity. Our tendon-to-bone fixation is easy to perform. It is as cheap as standard Bunnell fixation and excludes complications encountered in standard pullout sutures. Although bone suture anchors with modified Becker core suture are superior in tensile strength to 2-stranded sutures, many hand surgeons are limited by the price of the bone anchors and can find our suture more affordable.

  15. Single-incision multiport laparoendoscopic technique to repair retrocaval ureter using the Santosh PGI ureteric tacking fixation technique.

    Science.gov (United States)

    Kumar, Santosh; Shankaregowda, Sriharsha Ajjoor; Devana, Sudheer Kumar; Jain, Siddharth; Singh, Shrawan Kumar

    2014-11-01

    A retrocaval ureter is a rare congenital anomaly associated with upper urinary tract obstruction. It can cause varying degrees of ureteral obstruction, and surgical intervention is often necessary. Here, we present a case of a retrocaval ureter repaired with the single-incision multiport laparoendoscopic technique. We used a new fixation technique, Santosh PGI (Postgraduate Institute) ureteric tacking fixation technique, on both ureteric ends for easy ureteroureteric anastomosis. A 45-year-old man presented with right loin pain. CT urography showed a retrocaval ureter. Because the patient was symptomatic, he underwent retrocaval ureter repair by the single-incision multiport laparoendoscopic technique. A double-J stent was placed in the right ureter with the patient in the lithotomy position. Then, the patient was placed in a modified flank position. After pneumoperitoneum was created, a 2.5-cm incision was made in the umbilicus, and three conventional laparoscopic ports were inserted. The narrow retrocaval segment of ureter was resected, and both spatulated ureteric ends were fixed using the Santosh PGI ureteric tacking fixation technique, and ureteroureteral anastamosis was done. The duration of the procedure was 105 min. The patient was discharged from the hospital on postoperative day 3. Follow-up intravenous pyelography at 3 months showed normal drainage. The single-incision multiport laparoendoscopic technique is feasible and cost effective, has good cosmesis, and has minimal morbidity when performed by an expert laparoscopic surgeon. The Santosh PGI ureteric tacking fixation technique enabled us to suture easily and rapidly within the limited range of motion allowed by conventional laparoscopic instruments in SILS. © 2014 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  16. Double-V scrotoplasty for repair of congenital penoscrotal webbing: a hidden scar technique.

    Science.gov (United States)

    McLeod, Daryl J; Alpert, Seth A

    2014-10-01

    Penoscrotal webbing (PSW) is a common reason for deferral of neonatal circumcision. Reports of successful procedures and outcomes in the literature are sparse. We have performed double-V scrotoplasty (DVS), a modification of a V-Y technique, in 138 patients with excellent results. We retrospectively reviewed the charts of boys who had undergone DVS for PSW since January 2009 by a single surgeon (S.A.A.). The indications, intraoperative findings, concomitant procedures, outcomes, and complications were recorded. A total of 138 DVSs were performed. Concomitant genital surgeries included 81 hidden penis repairs and 10 other (hernia, hypospadias, chordee, orchidopexy). The median age at the time of surgery was 9.6 months (6.1 months-9.8 years). Patients were evaluated about 1 month postoperatively. In seven cases (5%), minor skin separation occurred at the penoscrotal junction but all healed completely. Superficial skin infection occurred in one patient. None required reoperation and cosmetic results were subjectively excellent. PSW has been corrected in 138 patients without significant complications and with excellent results. This is the largest known peer-reviewed series evaluating a surgical technique for congenital PSW repair. We believe our technique is simple, reproducible, and, with no diverging suture lines lateral to the median raphe, improves cosmesis. Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  17. Mesh fixation with a barbed anchor suture results in significantly less strangulation of the abdominal wall.

    Science.gov (United States)

    Lyons, Calvin; Joseph, Rohan; Salas, Nilson; Reardon, Patrick R; Bass, Barbara L; Dunkin, Brian J

    2012-05-01

    Laparoscopic ventral hernia repair using an underlay mesh frequently requires suture fixation across the abdominal wall, which results in significant postoperative pain. This study investigates the utility of a novel mesh fixation technique to reduce the strangulation force on the abdominal wall. Multiple 2-cm(2) pieces of polyester mesh (Parietex Composite, Covidien) were placed as an underlay against a porcine abdominal wall. Fixation was accomplished using either the standard 0-polyglyconate or the 0-polyglyconate barbed anchor suture designed to hold in tissue without the need to tie a knot (V-Loc 180; Covidien). Suture fixation began with a stab wound incision in the skin. A suture-passing device then was used to pass the suture across the abdominal wall and through the mesh. The suture passer was removed and reintroduced through the same stab wound incision but at a different fascial entry point 1.5 cm away. The tail of the suture was grasped and pulled up through both the mesh and the abdominal wall, creating a full-thickness U-stitch. One tail of the suture was attached to a tensiometer, and the strangulation force on the abdominal wall was measured while the suture was tied (standard) or looped (barbed). To compare pullout force, the tensiometer was attached to either the mesh or the suture, and traction was applied until material failure or suture pull through. Results are expressed as mean ± standard deviation. Comparisons were performed using Student's t-test. Eight pieces of mesh were placed for each suture. The average force required to secure the barbed suture (0.59 ± 0.08 kg) was significantly less than the force needed to secure the standard suture (2.17 ± 0.58 kg) (P suture pullout forces with the mesh failure forces. Although the pullout force for the standard suture is significantly greater than for the barbed suture, both sutures have a pullout strength significantly greater than the mesh failure force. Table 1 Suture fixation forces for

  18. Subcutaneous Achilles tendon rupture: A comparison between open technique and mini-invasive tenorrhaphy with Achillon® suture system.

    Science.gov (United States)

    Daghino, W; Enrietti, E; Sprio, A E; di Prun, N Barbasetti; Berta, G N; Massè, A

    2016-11-01

    Surgical management of Achilles tendon rupture is still controversial: open techniques have a higher rate of soft tissue complications but a lower incidence of re-rupture than percutaneous tenorrhaphies. The aim of our retrospective study was to analyze and compare clinical and functional results in patients treated with either the conventional open or minimally invasive suture treatment with the Achillon® system. A retrospective review of 140 patients was performed; 72 were treated with open tenorrhaphy, 68 with the minimally invasive Achillon® suture system. With a comparable re-rupture rate, there was a statistically significant reduction in surgical time, incidence of minor complications, time required to return to sport activities and return to work in the minimally invasive group. Achillon® mini-invasive suture system is a reliable tool for the Achilles tendon ruptures, able to reduce the incidence of soft tissues complications if compared to the classic open tenorrhaphy, while maintaining strength of the suture and leading to superimposed functional outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Components separation technique combined with a double-mesh repair for large midline incisional hernia repair

    NARCIS (Netherlands)

    M.E.E. Bröker (Mirelle); E. Verdaasdonk (Emiel); T.M. Karsten (Thomas)

    2011-01-01

    textabstractBackground The surgical treatment of large midline incisional hernias remains a challenge. The aim of this report is to present the results of a new technique for large midline incisional hernia repair which combines the components- separation technique with a double-prostheticmesh

  20. Polyethylene glycol hydrogel spinal sealant (DuraSeal Spinal Sealant) as an adjunct to sutured dural repair in the spine: results of a prospective, multicenter, randomized controlled study.

    Science.gov (United States)

    Kim, Kee D; Wright, Neill M

    2011-11-01

    A prospective, multicenter, randomized, two-arm, single-blind, investigational device exemption pivotal study. To assess the efficacy and the safety of a polyethylene glycol (PEG) hydrogel spinal sealant (DuraSeal Spinal Sealant) as an adjunct to sutured dural repair compared with standard of care methods (control) to obtain a watertight dural closure in patients undergoing an intentional durotomy during spinal surgery. If a watertight dural closure is not achieved, cerebrospinal fluid leak with associated complications may occur. The PEG hydrogel spinal sealant is an Food and Drug Administration (FDA)-approved adjunct to sutured dural repair in spine surgery. This synthetic, absorbable hydrogel sealant works in the presence of fluid, conforms to irregular surfaces, and demonstrates strong adherence and compliance to tissue, without interfering with underlying tissue visibility. A total of 158 patients were treated at 24 centers after they were randomized on the basis of an approximately 2:1 ratio (sealant:control); 102 received the PEG hydrogel spinal sealant and 56 received standard care. The primary end point was intraoperative watertight closure. Secondary end points included evaluations of postoperative cerebrospinal fluid leak, infection, and wound healing. Patients treated with the PEG hydrogel spinal sealant had a significantly higher rate of watertight closure than the control (100% vs. 64.3%, P hydrogel spinal sealant evaluated in this study is safe and effective for providing watertight closure when used as an adjunct to sutured dural repair during spinal surgery. This readily available tool is superior to other standard of care technologies commonly used to achieve intraoperative watertight dural closure.

  1. Cost-utility analysis of the use of prophylactic mesh augmentation compared with primary fascial suture repair in patients at high risk for incisional hernia.

    Science.gov (United States)

    Fischer, John P; Basta, Marten N; Wink, Jason D; Krishnan, Naveen M; Kovach, Stephen J

    2015-09-01

    Although hernia repair with mesh can be successful, prophylactic mesh augmentation (PMA) represents a potentially useful preventative technique to mitigate incisional hernia risk in select high-risk patients. The efficacy, cost-benefit, and societal value of such an intervention are not known. The aim of this study was to determine the cost-utility of using prophylactic mesh to augment fascial incisions. A decision tree model was employed to evaluate the cost-utility of using PMA relative to primary suture closure (PSC) after elective laparotomy. The authors adopted the societal perspective for cost and utility estimates. A systematic review of the literature on PMA was performed. The costs in this study included direct hospital costs and indirect costs to society, and utilities were obtained through a survey of 300 English-speaking members of the general public evaluating 14 health state scenarios relating to ventral hernia. PSC without mesh demonstrated an expected average cost of $17,182 (average quality-adjusted life-year [QALY] of 21.17) compared with $15,450 (expected QALY was 21.21) for PMA. PSC was associated with an incremental cost-efficacy ratio (ICER) of -$42,444/QALY compared with PMA such that PMA was more effective and less costly. Monte Carlo sensitivity analysis was performed demonstrating more simulations resulting in ICERs for PSC above the willingness-to-pay threshold of $50,000/QALY, supporting the finding that PMA is superior. Cost-utility analysis of PSC compared to PMA for abdominal laparotomy closure demonstrates PMA to be more effective, less costly, and overall more cost-effective than PSC. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Rodent facial nerve recovery after selected lesions and repair techniques.

    Science.gov (United States)

    Hadlock, Tessa A; Kowaleski, Jeffrey; Lo, David; Mackinnon, Susan E; Heaton, James T

    2010-01-01

    Measuring rodent facial movements is a reliable method for studying recovery from facial nerve manipulation and for examining the behavioral correlates of aberrant regeneration. The authors quantitatively compared recovery of vibrissal and ocular function following three types of clinically relevant nerve injury. One hundred seventy-eight adult rats underwent facial nerve manipulation and testing. In the experimental groups, the left facial nerve was either crushed, transected, and repaired epineurially, or transected and the stumps suture-secured into a tube with a 2-mm gap between them. Facial recovery was measured for the ensuing 1 to 4 months. Data were analyzed for whisking recovery. Previously developed markers of co-contraction of the upper and midfacial zones (possible synkinesis markers) were also examined. Animals in the crush groups recovered nearly normal whisking parameters within 25 days. The distal branch crush group showed improved recovery over the main trunk crush group for several days during early recovery. By week 9, the transection/repair groups showed evidence of recovery that trended further upward throughout the study period. The entubulation groups followed a similar recovery pattern, although they did not maintain significant recovery levels by the study conclusion. Markers of potential synkinesis increased in selected groups following facial nerve injury. Rodent vibrissal function recovers in a predictable fashion following manipulation. Generalized co-contraction of the upper and midfacial zones emerges following facial nerve manipulation, possibly related to aberrant regeneration, polyterminal axons, or hypersensitivity of the rodent to sensory stimuli following nerve manipulation.

  3. A Review of Hard Palate Fracture Repair Techniques.

    Science.gov (United States)

    Moss, William J; Kedarisetty, Suraj; Jafari, Aria; Schaerer, Daniel E; Husseman, Jacob W

    2016-02-01

    Hard palate trauma is a relatively infrequent occurrence compared with other craniofacial injuries. Several techniques of hard palate fracture repair have been described. To date, there is no consensus on the optimal management of this type of fracture. The purpose of this study was to compile and analyze studies describing hard palate fracture repair techniques with outcomes data. A systematic review of the Medline, Scopus, and Web of Science databases was performed for articles describing hard palate fracture repair techniques. Eight articles were ultimately included in the review. Of the collective 310 fractures reported, postoperative malocclusion occurred in 21 of 235 cases (8.9%) and other complications occurred in 13 of 299 cases (4.3%). The most important variability in technique was the method of palatal vault stabilization. Three studies described wiring techniques, 3 described internal fixation techniques, and 2 described external fixation techniques. Studies describing internal fixation techniques reported higher rates of wound complications. Proponents of rigid internal fixation believe that this technique provides better fracture reduction. External fixation techniques appear to impart low rates of wound complications, but their overall effectiveness remains in question. Hard palate fractures are associated with high rates of malocclusion and wound complications. The most established methods of palatal vault stabilization are closed reduction with wiring and internal plate fixation. Depending on the fracture type, patient comorbidities, and associated injuries, either technique might be preferable in a given circumstance. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  4. A Prospective Randomized Study Comparing Skin Staples and Polypropylene Sutures for Securing the Mesh in Lichtenstein's Repair

    Directory of Open Access Journals (Sweden)

    Pankaj Shivhare

    2014-06-01

    Results: Mesh fixation with skin staples is as effective as conventional sutures with the added advantage of significant reduction in the operating time and complications. Conclusions: The staples can be applied much more quickly than sutures for fixing the mesh, thus saving the operating time. The infection rate is significantly decreased with staples. The staples are not associated with any significant complications or recurrence. [Arch Clin Exp Surg 2014; 3(3.000: 147-152

  5. [Umbilical hernia. New repair technique with a minimal scar].

    Science.gov (United States)

    Cannistrà, C; Marmuse, J P; Madelenat, P

    2003-05-01

    Describe a surgical technique concerning the treatment of umbilical hernias that have a diameter less than 5 cm, with a reduction of scars. After analysing the different techniques of umbilical hernias repair, the authors suggest a new personal technique. The surgical treatment consists in removing the hernia sack after double M incision of the umbilical skin, repairing the abdominal wall by Quenu technique, folding the abdominal muscles and reconstructing the umbilicus. The results, which are achieved on nine patients, with check up two years after, confirm the validity of the technique. The scars after umbilical hernia surgical treatment are very important and visible because of their being located on the middle line of the abdominal wall. For the female patient in particular, this scar represents a great psychological annoyance. The double M technique leaves only an invisible scar with a good functional result.

  6. Conservative management equally effective to new suture anchor technique for acute mallet finger deformity: A prospective randomized clinical trial.

    Science.gov (United States)

    Batıbay, Sefa Giray; Akgül, Turgut; Bayram, Serkan; Ayık, Ömer; Durmaz, Hayati

    2017-09-28

    Prospective randomized controlled trial. This study was designed to compare our new suture anchor technique with conservative management in acute Wehbe-Schneider type I A-B and II A-B mallet fingers. Twenty nine patients who presented to our clinic between 2013 and 2015 were randomized for surgical or conservative treatment. Wehbe-Schneider subtype C fractures were excluded. Fourteen were treated with surgery, and 15 were treated with conservative treatment. Primary outcomes were visual analog scale score, active distal interphalangeal (DIP) joint flexion, return to work, extension deficit and DIP joint degeneration. Follow-up time was 12 months. The mean visual analog scale was 2.0, and return to work was on average in 63.2 days in the surgical group and 1.47 and 53.7 days in the conservative group. Extension deficit was 8.1° in the surgical group and 6.1° in the conservative group. The mean DIP flexion at final follow-up was 54.5° (40-65) in the surgery group and 58.3° (45-70) in the conservative group. DIP joint degeneration was observed with X-rays in 4 patients in surgical group, and none of the patients in the conservative group had DIP degeneration at 1 year after treatment. The therapeutic effectiveness of suture anchor technique was not statistically different from conservative treatment. Subluxation seen after fixation treatment with suture anchors may be due to inadequate anchor fixation. DIP joint degeneration was seen significantly more in the surgical group. Our study suggests that the new suture anchor technique is not superior to conservative treatment. Ib. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  7. Obstetrics anal sphincter injury and repair technique: a review.

    Science.gov (United States)

    Temtanakitpaisan, Teerayut; Bunyacejchevin, Suvit; Koyama, Masayasu

    2015-03-01

    The Urogynecology Committee of the Asia and Oceania Federation of Obstetrics and Gynaecology (AOFOG) has held seminars and workshops on various urogynecological problems in each country in the Asia-Oceania area in order to encourage young obstetricians and gynecologists. In 2013, we organized the operative seminar for obstetrical anal sphincter injuries (OASIS) in which we prepared porcine models to educate young physicians in a hands-on workshop at the 23rd Asian and Oceanic Congress of Obstetrics and Gynaecology in Bangkok, Thailand. Laceration of the anal sphincter mostly occurs during vaginal delivery and it can develop into anal sphincter deficiency, which causes fecal incontinence, if an appropriate suture is not performed. OASIS has become an important issue, especially in developing countries. The prevalence of OASIS of more than the third degree is around 5% in primary parous women and the frequency is higher when detected by ultrasonographic evaluation. Several risk factors, such as macrosomia, instrumental labor, perineal episiotomy and high maternal age, have been recognized. In a society where pregnant women are getting older, OASIS is becoming a more serious issue. An intrapartum primary appropriate stitch is important, but the 1-year outcome of a delayed operation after 2 weeks postpartum is similar. A randomized controlled study showed that overlapping suture of the external sphincter is better than that of end-to-end surgical repair. The Urogynecology Committee of the AOFOG would like to continue with educative programs about the appropriate therapy for OASIS. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  8. A novel technique of concealed penis repair.

    Science.gov (United States)

    Kim, Jung Jun; Lee, Dong-Gi; Park, Kwan Hyun; Baek, Minki

    2014-04-01

    The correction of concealed penis requires challenging surgical techniques. We describe a novel technique involving inner preputial skin substitution after degloving through a ventral approach that allows sufficient penile skin coverage and evaluated the efficacy and safety of our technique. From February 2009 to March 2009, 12 boys with concealed penises underwent correction via our novel technique. We administered a questionnaire about penile size, morphology, and voiding status to parents to evaluate their satisfaction with the results. The mean age of patients at the time of operation was 4.71 ± 4.01 years, and the mean duration of follow-up was 5.11 ± 1.45 months. Parental satisfaction grades (0 to 4) concerning penile size increased from 1.00 ± 1.04 to 2.83 ± 0.94 (p = 0.002) after surgery, penile morphology from 1.00 ± 0.95 to 3.00 ± 0.85 (p = 0.001), and voiding status from 1.08 ± 1.00 to 3.33 ± 0.78 (p penis was demonstrated to be technically feasible and safe. It provides a good cosmetic appearance and excellent parental satisfaction ratings regarding size, morphology, and voiding function. Georg Thieme Verlag KG Stuttgart · New York.

  9. A very simple technique to repair Grynfeltt-Lesshaft hernia.

    Science.gov (United States)

    Solaini, Leonardo; di Francesco, F; Gourgiotis, S; Solaini, Luciano

    2010-08-01

    A very simple technique to repair a superior lumbar hernia is described. The location of this type of hernia, also known as the Grynfeltt-Lesshaft hernia, is defined by a triangle placed in the lumbar region. An unusual case of a 67-year-old woman with a superior lumbar hernia is reported. The diagnosis was made by physical examination. The defect of the posterior abdominal wall was repaired with a polypropylene dart mesh. The patient had no evidence of recurrence at 11 months follow up. The surgical approach described in this paper is simple and easy to perform, and its result is comparable with other techniques that are much more sophisticated. No cases on the use of dart mesh to repair Grynfeltt-Lesshaft hernia have been reported by surgical journals indexed in PubMed.

  10. Interrupted or continuous slowly absorbable sutures – Design of a multi-centre randomised trial to evaluate abdominal closure techniques INSECT-Trial [ISRCTN24023541

    Directory of Open Access Journals (Sweden)

    Büchler Markus W

    2005-03-01

    Full Text Available Abstract Background The closure of the abdomen after median laparotomy is still a matter of debate among surgeons. Further well designed and performed randomised controlled trials determining the optimal method of abdominal fascial closure are needed. Design This is a three armed, multi-centre, intra-operatively randomised, controlled, patient blinded trial. Over 20 surgical departments will enrol 600 patients who are planned for an elective primary abdominal operation. The objective of this study is to compare the frequency of abdominal incisional hernias between two continuous suture techniques with different, slowly absorbable monofilament materials and an interrupted suture using an absorbable braided suture material at one year postoperatively. Conclusion This trial will answer the question whether the continuous abdominal wall closure with a slowly absorbable material with longitudinal elasticity is superior to the continuous suture with a material lacking elasticity and to interrupted sutures with braided thread.

  11. Comparação dos gastos com material para reparação de perfurações de córnea com cola de cianoacrilato e sutura de córnea Comparative cost evaluation in corneal perforation repair with cyanoacrylate adhesive versus corneal suture

    Directory of Open Access Journals (Sweden)

    Emerson Lioji Ueda

    2004-02-01

    Full Text Available OBJETIVO: Avaliação comparativa de custos de reparação de pequenas perfurações oculares utilizando a técnica da cola de cianoacrilato Super Bonder® (2-metil-cianoacrilato comparada à técnica de sutura de córnea. MÉTODOS: A fim de avaliar comparativamente os custos do uso da técnica de cola de cianoacrilato com a técnica de sutura de córnea, realizou-se análise dos materiais usados em ambas técnicas. RESULTADOS: A análise de custos comparativos entre o uso da técnica de cola de cianoacrilato em pequenas perfurações, versus a técnica de sutura de córnea demonstrou menor gasto com uso do adesivo. CONCLUSÃO: A utilização da técnica de cola de cianoacrilato, para reparação de perfuração de córnea, apresentou custos menores quando comparada com a técnica de sutura de córnea.PURPOSE: The aim of this study was performing a comparative evaluation of cost in small ocular perforation repair using cyanoacrylate adhesive technique Super BonderTM (methyl-2-cyanoacrylate as compared with corneal suture technique. METHODS: In order to compare evaluations of cost a cost analysis in "reais" (R$ was conducted for both techniques according to the materials used in cyanoacrylate glue technique and the corneal suture. RESULTS: The analysis of comparative cost of the cyanoacrylate adhesive technique in small perforations versus corneal suture showed a lower cost of the former. CONCLUSION: Lower cost was found for the cyanoacrylate glue technique for corneal perforation repair when compared to the corneal suture technique.

  12. Técnica de suturas ajustables: Resultados Technique of adjustable sutures: Results

    Directory of Open Access Journals (Sweden)

    Lourdes R. Hernández Santos

    2001-06-01

    Full Text Available Se realizó un estudio sensorial y motor preoperatorio y posoperatorio a 84 pacientes que acudieron a la consulta de Visión Binocular con el diagnóstico de estrabismo horizontal a partir de los 13 años de edad. El método estadístico utilizado fue "t" o Chi cuadrado. Nos trazamos como objetivo determinar los resultados posoperatorios de la cirugía de estrabismo realizada con la técnica de suturas ajustables, que fueron los siguientes: el 61 % de los pacientes con exotropía y el 71,4 % con el diagnóstico de exotropía se encontraban en ortotropía a los 6 meses de la intervención. El 71,4 % de los pacientes con esotropía y el 83,3 % con el diagnóstico de esotropía se encontraban en ortotropía al año de la intervención. Esta técnica quirúrgica permite la modificación de la desviación en el posoperatorio inmediato.A preoperative and postoperative sensorial and motor study was conducted among 84 patients who received attention at the consultation room of Binocular Vision with the diagnosis of horizontal strabismus from the age of 13 years old on. The statistical method used was "t" or chi square test. Our objective was to determine the postoperative results of the strabismus surgery performed by the technique of adjustable sutures. The results were as follows: 61 % of the patients with exotropia and 71.4 % with the diagnosis of exotropia were in orthotropia 6 months after the operation. 71.4 % of the patients with exotropia and 83.3 % with the diagnosis of exotropia were in orthotropia a year after the operation. This surgical technique allows the modification of the deviation in the immediate postoperative.

  13. Wound closure and wound healing. Suture techniques in contemporary periodontal and implant surgery: Interactions, requirements, and practical considerations.

    Science.gov (United States)

    Zuhr, Otto; Akakpo, Dodji Lukas; Hürzeler, Markus

    2017-07-20

    In contemporary reconstructive periodontal and implant surgery, attaining uncomplicated wound healing in the early postoperative healing phase is the key to achieving a successful treatment outcome and is of central interest, from the clinical as well as the scientific perspective. The realization of primary wound healing is the central challenge in most cases. Two of the evidence-based factors that affect postoperative wound healing can be influenced by the surgeon: the blood supply to the surgical site and postoperative wound stability. The surgical suture is a key determinant of whether adequate wound stability is achieved in this context without complicating the course of wound healing by exerting unnecessary trauma or excessive tensile strain on the wound edges. Therefore, the inclusion of anchors in the suturing process that make it possible to achieve the best wound stability possible is often an important key to success. This article provides an overview of the principles of successful wound closure that are relevant to postoperative wound healing in order to equip dentists with the tools needed for the correct, indication-specific selection and performance of surgical suturing techniques in daily practice.

  14. A stitch in time saves nine: suture technique does not affect intestinal growth in a young, growing animal model.

    Science.gov (United States)

    Gurien, Lori A; Wyrick, Deidre L; Smith, Samuel D; Maxson, R Todd

    2016-05-01

    Although this issue remains unexamined, pediatric surgeons commonly use simple interrupted suture for bowel anastomosis, as it is thought to improve intestinal growth postoperatively compared to continuous running suture. However, effects on intestinal growth are unclear. We compared intestinal growth using different anastomotic techniques during the postoperative period in young rats. Young, growing rats underwent small bowel transection and anastomosis using either simple interrupted or continuous running technique. At 7-weeks postoperatively after a four-fold growth, the anastomotic site was resected. Diameters and burst pressures were measured. Thirteen rats underwent anastomosis with simple interrupted technique and sixteen with continuous running method. No differences were found in body weight at first (102.46 vs 109.75g) or second operations (413.85 vs 430.63g). Neither the diameters (0.69 vs 0.79cm) nor burst pressures were statistically different, although the calculated circumference was smaller in the simple interrupted group (2.18 vs 2.59cm; p=0.03). No ruptures occurred at the anastomotic line. This pilot study is the first to compare continuous running to simple interrupted intestinal anastomosis in a pediatric model and showed no difference in growth. Adopting continuous running techniques for bowel anastomosis in young children may lead to faster operative time without affecting intestinal growth. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Reoperation Rates for Laparoscopic vs Open Repair of Femoral Hernias in Denmark

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Bisgaard, Thue; Kehlet, Henrik

    2014-01-01

    IMPORTANCE: In Denmark approximately 10 000 groin hernias are repaired annually, of which 2% to 4% are femoral hernias. Several methods for repair of femoral hernias are used including sutured repair and different types of mesh repair with either open or laparoscopic techniques. The use of many...

  16. Return to sports after arthroscopic capsulolabral repair using knotless suture anchors for anterior shoulder instability in soccer players: minimum 5-year follow-up study.

    Science.gov (United States)

    Alentorn-Geli, Eduard; Álvarez-Díaz, Pedro; Doblas, Jesús; Steinbacher, Gilbert; Seijas, Roberto; Ares, Oscar; Boffa, Juan José; Cuscó, Xavier; Cugat, Ramón

    2016-02-01

    To report the return to sports and recurrence rates in competitive soccer players after arthroscopic capsulolabral repair using knotless suture anchors at a minimum of 5 years of follow-up. All competitive soccer players with anterior glenohumeral instability treated by arthroscopic capsulolabral repair using knotless suture anchors between 2002 and 2009 were retrospectively identified through the medical records. Inclusion criteria were: no previous surgical treatment of the involved shoulder, absence of glenoid or tuberosity fractures, absence of large Hill-Sachs or glenoid bone defect, minimum follow-up of 5 years, instability during soccer practice or games, and failure of non-surgical treatment. The charts of included players were reviewed, and a phone call was performed in a cross-sectional manner to obtain information on: current soccer, return to soccer, recurrence of instability, shoulder function (Rowe score), and disability [Quick-Disability of the Arm, Shoulder, and Hand (DASH) score and Quick-DASH Sports/Performing Arts Module]. Fifty-seven young male soccer players were finally included with a median (range) follow-up of 8 (5-10) years. Forty-nine (86 %) of the soccer players were able to return to soccer and 36 of them (73 %) at the same pre-injury level. There were 6 (10.5 %) re-dislocations in the 57 players, all of them of traumatic origin produced during soccer and other unrelated activities. The main reasons to not return to soccer were: knee injuries (two players), changes in personal life (two players), and job-related (three players). None of the players quit playing soccer because of their shoulder instability injury. The median (range) Rowe score, Quick-DASH score, and Quick-DASH sports score were 80 (25-100), 2.3 (0-12.5), and 0 (0-18.8), respectively. Competitive soccer players undergoing arthroscopic capsulolabral repair with knotless suture anchors for shoulder instability without significant bone loss demonstrate excellent return to

  17. Estudo comparativo do tratamento de ferimento de colon de coelho com reparo seroso da parede de jejunum e sutura primária Comparative study of colon wound repair using jejunal serosal wall and primary suture, in rabbits

    Directory of Open Access Journals (Sweden)

    Carlos Edmundo Fontes

    2000-03-01

    Full Text Available Os animais foram submetidos a procedimento operatório sob anestesia geral para a produção de dois ferimentos padronizados em colo não preparado, usando instrumento desenvolvido para esta finalidade. O primeiro ferimento foi produzido a 2 cm do ceco e o segundo 20 cm eqüidistante deste, no sentido caudal. Estes ferimentos foram reparados obedecendo a resultado de sorteio que determinou a técnica a ser usada, se com o lado seroso da parede de jejuno ou por sutura primária. Nas duas técnicas foram usados pontos separados de fio monofilamentar de poliglecaprone 4-0 , sendo que o animal serviu de controle para si mesmo. Realizou-se eutanásia no 7º P.O. para os animais do sub-grupo A e no 30º P.O. para os animais do sub-grupo B para avaliação macroscópica e microscópica. O experimento demonstrou que é viável o uso do lado seroso da parede de jejuno para reparar ferimento em colo não preparado e apresentou resultados com tendências a serem superiores aos da sutura primária , não dual de MaringáThe present research aimed to compare the repair of colon wound using both the jejunal wall and the primary suture . Thirty young rabbits white New Zeland were used, weighing about 3,2 Kg. and were born and raised at the University of Maringá's Experimental farm. The animals were deeply anaesthetized and then submited to a surgery during wich two similar wounds were made in unprepared colon . An instrument created for this purpose was used. The first wound was made 2 cm away from the ceco , and the second one was made 20 cm from the first wound in the caudal location. The wounds were repaired using either the jejunal serosal wall or the primary suture. In both techniques were used separated stitches , made by monofilament poliglecaprone 4-0. The animal was used to control itself. The animals were submited to euthanasia either in the 7th or in 30th day after surgery, at random.Then a macroscopic and microscopic study was made. This research

  18. Hypersensitivity to Suture Anchors

    Directory of Open Access Journals (Sweden)

    Masafumi Goto

    2013-01-01

    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.

  19. Serial MRI evaluation following arthroscopic rotator cuff repair in double-row technique.

    Science.gov (United States)

    Stahnke, Katharina; Nikulka, Constanze; Diederichs, Gerd; Haneveld, Hendrik; Scheibel, Markus; Gerhardt, Christian

    2016-05-01

    So far, recurrent rotator cuff defects are described to occur in the early postoperative period after arthroscopic repair. The aim of this study was to evaluate the musculotendinous structure of the supraspinatus, as well as bone marrow edema or osteolysis after arthroscopic double-row repair. Therefore, magnetic resonance (MR) images were performed at defined intervals up to 2 years postoperatively. Case series; Level of evidence, 3. MR imaging was performed within 7 days, 3, 6, 12, 26, 52 and 108 weeks after surgery. All patients were operated using an arthroscopic modified suture bridge technique. Tendon integrity, tendon retraction ["foot-print-coverage" (FPC)], muscular atrophy and fatty infiltration (signal intensity analysis) were measured at all time points. Furthermore, postoperative bone marrow edema and signs of osteolysis were assessed. MR images of 13 non-consecutive patients (6f/7m, ∅ age 61.05 ± 7.7 years) could be evaluated at all time points until ∅ 108 weeks postoperatively. 5/6 patients with recurrent defect at final follow-up displayed a time of failure between 12 and 24 months after surgery. Predominant mode of failure was medial cuff failures in 4/6 cases. The initial FPC increased significantly up to 2 years follow-up (p = 0.004). Evaluations of muscular atrophy or fatty infiltration were not significant different comparing the results of all time points (p > 0.05). Postoperative bone marrow edema disappeared completely at 6 months after surgery, whereas signs of osteolysis appeared at 3 months follow-up and increased to final follow-up. Recurrent defects after arthroscopic reconstruction of supraspinatus tears in modified suture bridge technique seem to occur between 12 and 24 months after surgery. Serial MRI evaluation shows good muscle structure at all time points. Postoperative bone marrow edema disappears completely several months after surgery. Signs of osteolysis seem to appear caused by bio-absorbable anchor

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

    Science.gov (United States)

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

    2015-05-01

    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.

  1. Pectus excavatum repair: experience with standard and minimal invasive techniques.

    Science.gov (United States)

    Molik, K A; Engum, S A; Rescorla, F J; West, K W; Scherer, L R; Grosfeld, J L

    2001-02-01

    The Nuss procedure is a minimally invasive pectus repair that helps avoid cartilage resection and osteotomy. This report compares outcomes in patients undergoing a standard pectus repair to patients with the Nuss procedure. One hundred three children (ages 5 to 20 years) with severe pectus excavatum underwent repair. Patients were evaluated for type of repair performed, associated anomalies, cardiopulmonary function, operating time, analgesia requirements, complications, length of hospital stay, hospital and operative charges, and cosmetic result. Statistical analysis was performed using the Mann-Whitney rank sum test. There were 68 patients (average age, 12.6 years) in the standard group and 35, (average age, 9.5 years) in the Nuss group. Associated anomalies were found in 6 standard group and 2 Nuss group patients. Average operating time in Nuss was 3.3 hours and in open procedures, 4.7 hours. Postoperative complications occurred in 13 (20%) standard repair patients and 15 (43%) after the Nuss. In the standard group, 14 patients received intrathecal and 3 received epidural analgesia, while 35 (52%) required an intravenous patient-controlled anesthetic device (PCA; average, 1.8 days). In the Nuss group, 25 patients (71%) received epidural anesthesia (average, 3 days), and 31 (89%) utilized PCA (average 3.8 days). Four (6%) standard patients and 8 Nuss patients (29%) required reoperation. Length of stay averaged 4.0 days (range 2 to 30) in the standard group and 4.8 days (range, 2 to 11) in the Nuss group. Average operating room charge was $8,325 in the standard group and $9,480 in the Nuss group. Average hospital charge was $4,137 for the standard patient and $4,044 for the Nuss group. Analgesic requirements and length of hospital stay were increased (P cosmetic and functional outcomes and define the overall risks and benefits of this procedure as compared with the standard technique.

  2. Varicocele repair in the era of modern assisted reproductive techniques.

    Science.gov (United States)

    McIntyre, Matthew; Hsieh, Tung-Chin; Lipshultz, Larry

    2012-11-01

    This review looks at the literature on varicocele repair and its effect on assisted reproductive techniques. The effects of varicocele correction on improved sperm production have been well documented with semen analysis data. What remain to be elucidated are the causes of the varicocele effect and how correction of the resultant pathophysiology may affect the outcomes of modern assisted reproductive technology. Basic science research shows us that varicoceles exert deleterious effects on Leydig cells, Sertoli cells, and germ cells via very different mechanisms. The effects of varicocele correction on the reproductive potential of sperm are less well understood. Clinical research has shown improved semen parameters, DNA integrity, and assisted reproductive technology outcomes after varicocele repair. Varicocele correction presents a possible method to optimize a couples' reproductive potential or decrease the need for complex assisted reproductive technology.

  3. Evolution of Autologous Chondrocyte Repair and Comparison to Other Cartilage Repair Techniques

    Directory of Open Access Journals (Sweden)

    Ashvin K. Dewan

    2014-01-01

    Full Text Available Articular cartilage defects have been addressed using microfracture, abrasion chondroplasty, or osteochondral grafting, but these strategies do not generate tissue that adequately recapitulates native cartilage. During the past 25 years, promising new strategies using assorted scaffolds and cell sources to induce chondrocyte expansion have emerged. We reviewed the evolution of autologous chondrocyte implantation and compared it to other cartilage repair techniques. Methods. We searched PubMed from 1949 to 2014 for the keywords “autologous chondrocyte implantation” (ACI and “cartilage repair” in clinical trials, meta-analyses, and review articles. We analyzed these articles, their bibliographies, our experience, and cartilage regeneration textbooks. Results. Microfracture, abrasion chondroplasty, osteochondral grafting, ACI, and autologous matrix-induced chondrogenesis are distinguishable by cell source (including chondrocytes and stem cells and associated scaffolds (natural or synthetic, hydrogels or membranes. ACI seems to be as good as, if not better than, microfracture for repairing large chondral defects in a young patient’s knee as evaluated by multiple clinical indices and the quality of regenerated tissue. Conclusion. Although there is not enough evidence to determine the best repair technique, ACI is the most established cell-based treatment for full-thickness chondral defects in young patients.

  4. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia

    NARCIS (Netherlands)

    J.W.A. Burger (Jacobus); R.W. Luijendijk; W.C.J. Hop (Wim); J.A. Halm (Jens); E.G. Verdaasdonk; J. Jeekel (Hans)

    2004-01-01

    textabstractOBJECTIVE: The objective of this study was to determine the best treatment of incisional hernia, taking into account recurrence, complications, discomfort, cosmetic result, and patient satisfaction. BACKGROUND: Long-term results of incisional hernia repair are lacking.

  5. A novel technique for repair of mid-penile hypospadias using a preputial skin flap: results of 110 patients.

    Science.gov (United States)

    Elmoghazy, Hazem; Hussein, Mohamed M; Mohamed, Elnisr; Badawy, Abdelbasset; Alsagheer, Gamal; Abd Elhamed, Ahmed Mamdouh

    2016-12-01

    Several techniques have been used to repair mid-penile hypospadias; however, high failure rates and major complications have been reported. In this study, we describe a novel technique using a well-vascularized flap of the inner and outer preputial skin. A total of 110 male children with hypospadias underwent repair by our technique between 2008 and 2015. The inclusion criteria were children with mid-penile or slightly more proximal hypospadias, with or without ventral chordae, and an intact prepuce of the cobra eyes variety. Recurrent cases, patients with other preputial types, and circumcised children were excluded from this study. The prepared flap was sutured in its natural longitudinal orientation to the created urethral plate strip to form a neo-urethra over a urethral catheter. Outcome measures included surgical success without the formation of a urethra-cutaneous fistula, no ischaemia of the flaps, glans dehiscence or infection and functional outcome and cosmetic appearance. The median follow-up duration was 3.3 years. There were 63 cases of mid-penile hypospadias (57.3 %), and in 47 cases (42.7 %), the meatus was slightly more proximal. The age of the patients ranged from 1.1 to 8.0 years, with a mean age of 4.6 ± 1.2 years. Surgery was successful in 106 (96.4 %) cases. Minor complications occurred in 11 patients (10 %) and included oedema of glans in ten patients and bluish discoloration on the ventral aspect of the glans close to the suture line in three patients. All patients improved within 2 weeks after surgery. Long-term follow-up revealed a properly functioning urethra with a forward, projectile, single, compact, and rifled urinary stream of adequate calibre and cosmetically acceptable repair. No cases of meatal retraction, meatal stenosis, urethral stricture, or acquired urethral diverticulum occurred. Our technique is different from the split prepuce in situ technique. We create a narrow strip of the urethral plate that facilitates

  6. A reusable suture anchor for arthroscopy psychomotor skills training.

    Science.gov (United States)

    Tillett, Edward D; Rogers, Rainie; Nyland, John

    2003-03-01

    For residents to adequately develop the early arthroscopy psychomotor skills required to better learn how to manage the improvisational situations they will encounter during actual patient cases, they need to experience sufficient practice repetitions within a contextually relevant environment. Unfortunately, the cost of suture anchors can be a practice repetition-limiting factor in learning arthroscopic knot-tying techniques. We describe a technique for creating inexpensive reusable suture anchors and provide an example of their application to repair the anterior glenoid labrum during an arthroscopy psychomotor skills laboratory training session.

  7. Case of colonic intussusception secondary to mobile cecum syndrome repaired by laparoscopic cecopexy using a barbed wound suture device.

    Science.gov (United States)

    Yamamoto, Tetsu; Tajima, Yoshitsugu; Hyakudomi, Ryoji; Hirayama, Takanori; Taniura, Takahito; Ishitobi, Kazunari; Hirahara, Noriyuki

    2017-09-21

    A 27-year-old man with recurrent right lower quadrant pain was admitted to our hospital. Ultrasonography and computed tomography examination of the abdomen revealed a target sign in the ascending colon, which was compatible with the diagnosis of cecal intussusception. The intussusception was spontaneously resolved at that time, but it relapsed 6 mo later. The patient underwent a successful colonoscopic disinvagination; there was no evidence of neoplastic or inflammatory lesions in the colon and terminal ileum. The patient underwent laparoscopic surgery for recurring cecal intussusception. During laparoscopy, we observed an unfixed cecum on the posterior peritoneum (i.e. a mobile cecum). Thus, we performed laparoscopic appendectomy and cecopexy with a lateral peritoneal flap using a barbed wound suture device. The patient's post-operative course was uneventful, and he continued to do well without recurrence at 10 mo after surgery. Laparoscopic cecopexy using a barbed wound suture device is a simple and reliable procedure that can be the treatment of choice for recurrent cecal intussusception associated with a mobile cecum.

  8. Surgical Repair of Leaking Filtering Blebs Using Two Different Techniques

    Directory of Open Access Journals (Sweden)

    António B Melo

    2012-01-01

    Full Text Available Purpose: To report the outcomes of two different surgical techniques for the repair of late onset bleb leakage following trabeculectomy. Methods: This retrospective study includes 21 eyes of 20 patients with prior trabeculectomy and late-onset bleb leaks; 14 eyes underwent excision of the filtering bleb together with conjunctival advancement while in the other 7 eyes the bleb was retained but de-epithelialized before conjunctival advancement. Success was defined as resolution of leakage with no need for additional glaucoma surgery together with intraocular pressure (IOP of 5-21 mmHg. Complete and qualified success was considered when the above mentioned was achieved without or with glaucoma medications, respectively. Results: Mean duration of follow-up was 20.3΁14.4 months. No significant difference was observed between the two groups in terms of complete, qualified and overall success rates (P>0.05, however more antiglaucoma medications were necessary in the bleb excision group (P=0.02. Conclusions: Both surgical techniques of bleb repair were comparably effective, however the bleb de-epithelialization technique was associated with less need for glaucoma medications after the procedure.

  9. Efficacy and Safety of Augmenting the Preclose Technique with a Collagen-Based Closure Device for Percutaneous Endovascular Aneurysm Repair

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Rafiuddin, E-mail: rafiuddin.patel@ouh.nhs.uk [Oxford University Hospitals NHS Trust, Department of Radiology, John Radcliffe Hospital (United Kingdom); Juszczak, Maciej T. [Oxford University Hospitals NHS Trust, Department of Vascular Surgery, John Radcliffe Hospital (United Kingdom); Bratby, Mark J. [Oxford University Hospitals NHS Trust, Department of Radiology, John Radcliffe Hospital (United Kingdom); Sideso, Ediri [Oxford University Hospitals NHS Trust, Department of Vascular Surgery, John Radcliffe Hospital (United Kingdom); Anthony, Susan; Tapping, Charles R. [Oxford University Hospitals NHS Trust, Department of Radiology, John Radcliffe Hospital (United Kingdom); Handa, Ashok; Darby, Christopher R.; Perkins, Jeremy [Oxford University Hospitals NHS Trust, Department of Vascular Surgery, John Radcliffe Hospital (United Kingdom); Uberoi, Raman [Oxford University Hospitals NHS Trust, Department of Radiology, John Radcliffe Hospital (United Kingdom)

    2015-08-15

    PurposeTo report our experience of selectively augmenting the preclose technique for percutaneous endovascular aneurysm repair (p-EVAR) with an Angio-Seal device as a haemostatic adjunct in cases of significant bleeding after tensioning the sutures of the suture-mediated closure devices.Materials and MethodsProspectively collected data for p-EVAR patients at our institute were analysed. Outcomes included technical success and access site complications. A logistic regression model was used to analyse the effects of sheath size, CFA features and stent graft type on primary failure of the preclose technique necessitating augmentation and also on the development of complications.Resultsp-EVAR was attempted via 122 CFA access sites with a median sheath size of 18-French (range 12- to 28-French). Primary success of the preclose technique was 75.4 % (92/122). Angio-Seal augmentation was utilised as an adjunct to the preclose technique in 20.5 % (25/122). The overall p-EVAR success rate was 95.1 % (116/122). There was a statistically significant relationship (p = 0.0093) between depth of CFA and primary failure of preclose technique. CFA diameter, calcification, type of stent graft and sheath size did not have significant effects on primary preclose technique failure. Overall 4.9 % (6/122) required surgical conversion but otherwise there were no major complications.ConclusionAugmentation with an Angio-Seal device is a safe and effective adjunct to increase the success rate of the preclose technique in p-EVAR.

  10. Clinical Outcomes and Complications of Percutaneous Achilles Repair System Versus Open Technique for Acute Achilles Tendon Ruptures.

    Science.gov (United States)

    Hsu, Andrew R; Jones, Carroll P; Cohen, Bruce E; Davis, W Hodges; Ellington, J Kent; Anderson, Robert B

    2015-11-01

    Limited incision techniques for acute Achilles tendon ruptures have been developed in recent years to improve recovery and reduce postoperative complications compared with traditional open repair. The purpose of this retrospective cohort study was to analyze the clinical outcomes and postoperative complications between acute Achilles tendon ruptures treated using a percutaneous Achilles repair system (PARS [Arthrex, Inc, Naples, FL]) versus open repair and evaluate the overall outcomes for operatively treated Achilles ruptures. Between 2005 and 2014, 270 consecutive cases of operatively treated acute Achilles tendon ruptures were reviewed (101 PARS, 169 open). Patients with Achilles tendinopathy, insertional ruptures, chronic tears, or less than 3-month follow-up were excluded. Operative treatment consisted of a percutaneous technique (PARS) using a 2-cm transverse incision with FiberWire (Arthrex, Inc, Naples, FL) sutures or open repair using a 5- to 8-cm posteromedial incision with FiberWire in a Krackow fashion reinforced with absorbable sutures. Patient demographics were recorded along with medical comorbidities, activity at injury, time from injury to surgery, length of follow-up, return to baseline activities by 5 months, and postoperative complications. The most common activity during injury for both groups was basketball (PARS: 39%, open: 47%). A greater number of patients treated with PARS were able to return to baseline physical activities by 5 months compared with the open group (PARS: 98%, open: 82%; P = .0001). There were no significant differences (P > .05) between groups in rates of rerupture (P = 1.0), sural neuritis (P = .16), wound dehiscence (P = .74), superficial (P = .29) and/or deep infection (P = .29), or reoperation (P = .13). There were no deep vein thromboses (DVTs) or reruptures in either group. In the PARS group, there were no cases of sural neuritis, 3 cases (3%) of superficial wound dehiscence, and 2 reoperations (2%) for superficial

  11. Treatment of chronic lateral ankle instability: a modified broström technique using three suture anchors

    Directory of Open Access Journals (Sweden)

    Busconi Brian D

    2009-12-01

    Full Text Available Abstract Ankle sprains are very common injuries seen in the athletic and young population. Majority of patients will improve with a course of rest and physical therapy. However, with conservative management about twenty percent of all patients will go on to develop chronic lateral ankle instability. This manuscript describes our detailed surgical technique of a modification to the original Broström procedure using three suture anchors to anatomically reconstruct the lateral ankle ligaments to treat high demand patients who have developed chronic lateral ankle instability. The rationale for this modification along with patient selection and workup are discussed. Both the functional outcomes at the two year follow up along with the complications and the detailed postoperative rehabilitation protocol for the high demand athletes are also presented. This modified Broström procedure is shown in both illustrative format and intra-operative photos.

  12. Pars plana suture fixation for intraocular lenses dislocated into the vitreous cavity using a closed-eye cow-hitch technique.

    Science.gov (United States)

    Nakashizuka, Hiroyuki; Shimada, Hiroyuki; Iwasaki, Yutaka; Matsumoto, Yoko; Sato, Yukihiro

    2004-02-01

    We describe a modified intraocular cow-hitch technique for pars plana suture fixation of intraocular lenses (IOLs) that dislocated into the vitreous cavity in 3 patients who had a 3-port vitrectomy and IOL implantation because of retinal disease. To reposition the dislocated IOL after the residual vitreous was removed, 2 additional sclerotomies for suture fixation were made 3.0 mm posterior to the limbus. A loop (cow-hitch knot) was made with 10-0 polypropylene for suture fixation. After the neck of the cow-hitch loop was grasped with an intraocular forceps, the loop was used to lasso a haptic of the dislocated IOL, which was then pulled forward to the sclerotomy. The same procedure was used for the other haptic, and both sutures were secured to the sclera under scleral flaps. In all patients, the dislocated IOLs were repositioned without the need for extraction. The procedures were uneventful. Pars plana suture fixation with the intraocular cow-hitch technique can be used to reposition an IOL that has dislocated into the vitreous cavity.

  13. TECHNIQUES OF LEFT VENTRICULAR ANEURYSM REPAIR: CHALLENGES AND OUTCOME

    Directory of Open Access Journals (Sweden)

    Jignesh

    2015-10-01

    Full Text Available INTRODUCTION: Left ventricular aneurysm is commonly secondary to coronary artery disease. The resulting abnormal geometry after surgical treatment is most important. Many techniques have evolved over a period to restore near normal geometry of left ventricle (LV. It is mandatory to address atherosclerotic lesions which are root ca use of ischemia and its sequel. METHOD AND MATERIALS : Four patients with myocardial infarction presented to our institute were investigated with 2 Dimensional Echocardiography and contrast enha nced computerized tomography (CECT of thorax. All patients underwent left ventricle aneurysm repair and two patients also underwent Coronary Artery Bypass Grafting (CABG. We followed all of them with CECT and clinical examination. RESULT: All patients ha d good post - operative recovery. Their Intensive Care Unit parameters were within acceptable limits. The functional class improved to New York Heart Association class II for these patients. Post - operative CECT showed significant reduction in LV dimension an d no alteration in LV geometry. CONCLUSION: The technique of Left Ventricle aneurysm repair should be determined by pre - operative evaluation and CABG must be attempted if possible

  14. A new and simple suturing technique applied after surgery to correct ingrown toenails may improve clinical outcomes: A randomized controlled trial.

    Science.gov (United States)

    Uygur, Esat; Çarkçi, Engin; Şenel, Ahmet; Kemah, Bahattin; Turhan, Yalçın

    2016-10-01

    In the present study, we investigated the efficacy of a new suturing technique applied after the Winograd procedure has been completed. This study was prospective, randomized, and controlled. In total, 128 patients were recruited and divided into two groups. The outcomes of those treated with the new suturing technique (group I) were compared with those of patients treated with the traditional suturing technique (group II), both of which were applied after the Winograd procedure had been completed. The clinical outcomes and recurrence rates of the two groups were compared. Patients in group I required significantly more time to return to work or school than did those in group II (p = 0.015). We found no significant difference between youths (age < 18 years, n = 55) and adults (age ≥ 19 years, n = 69) in this context (p = 0.161). The recurrence rate was significantly higher in group II than in group I (p = 0.011). The extent of satisfaction was significantly higher in group I (p = 0.042). Our new suturing technique is associated with lower recurrence and higher satisfaction rates. However, the times elapsing before shoes could be worn were similar in the two groups. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  15. Lumbar hernia: surgical anatomy, embryology, and technique of repair.

    Science.gov (United States)

    Stamatiou, Dimitrios; Skandalakis, John E; Skandalakis, Lee J; Mirilas, Petros

    2009-03-01

    Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a defect of the posterolateral abdominal wall. Barbette was the first, in 1672, to suggest the existence of lumbar hernias. The first case was reported by Garangeot in 1731. Petit and Grynfeltt delineated the boundaries of the inferior and superior lumbar triangles in 1783 and 1866, respectively. These two anatomical sites account for about 95 per cent of lumbar hernias. Approximately 20 per cent of lumbar hernias are congenital. The rest are either primarily or secondarily acquired. The most common cause of primarily acquired lumbar hernias is increased intra-abdominal pressure. Secondarily acquired lumbar hernias are associated with prior surgical incisions, trauma, and abscess formation. During embryologic development, weakening of the area of the aponeuroses of the layered abdominal muscles that derive from somitic mesoderm, which invades the somatopleure, may potentially lead to lumbar hernias. Repair of lumbar hernias should be performed as early as possible to avoid incarceration and strangulation. The classic repair technique uses the open approach, where closure of the defect is performed either directly or using prosthetic mesh. The laparoscopic approach, either transabdominal or extraperitoneal, is an alternative.

  16. Surgical outcome after using a modified technique of the pi-procedure for posterior sagittal suture closure

    NARCIS (Netherlands)

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

    2012-01-01

    Fusion of the sagittal suture is the most prevalent form of craniosynostosis. Due to the variety of deformities of scaphocephaly depending on the location of the fused sagittal suture, the surgical procedure has to be adjusted to the individual case. In this study, 38 patients with a predominantly

  17. The totally extraperitoneal method versus Lichtenstein's technique for inguinal hernia repair

    DEFF Research Database (Denmark)

    Koning, G G; Wetterslev, J; van Laarhoven, C J H M

    2013-01-01

    Lichtenstein's technique is considered the reference technique for inguinal hernia repair. Recent trials suggest that the totally extraperitoneal (TEP) technique may lead to reduced proportions of chronic pain. A systematic review evaluating the benefits and harms of the TEP compared...

  18. A 5‑year Review of Darning Technique of Inguinal Hernia Repair ...

    African Journals Online (AJOL)

    Context: The Darning technique of inguinal hernia repair is a tissue‑based technique with documented low recurrence rate in some parts of the world. Though practiced in our setting, little is documented on its outcome. Aims: The aim was to review the outcome of Darning technique of inguinal hernia repair in our setting.

  19. Which uterine sparing technique should be used for uterine atony during cesarean section? The Bakri balloon or the B-Lynch suture?

    Science.gov (United States)

    Kaya, Baris; Guralp, Onur; Tuten, Abdullah; Unal, Orhan; Celik, Melih Ozgur; Dogan, Askın

    2016-09-01

    To evaluate various aspects of two popular uterine sparing techniques, the B-Lynch uterine compression suture and Bakri balloon tamponade, in severe postpartum hemorrhage (PPH). 21 women who underwent the Bakri balloon procedure and 24 women who underwent the B-Lynch suture as primary uterus-sparing methods, due to PPH not responding to medical treatment, were retrospectively evaluated. The success rates of the B-Lynch procedure and the Bakri balloon were 79.1 and 80 %, respectively. The success rates of the B-Lynch + IIAL and the Bakri balloon + IIAL were 91.6 and 95 %, respectively. There was no significant difference in success rates, mean duration of time to stop bleeding, estimated blood loss, transfused packed red blood cells or mean duration of hospital stay between the B-Lynch and the Bakri balloon groups. The duration of operation was significantly longer in the Bakri balloon compared to the B-Lynch group (p = 0.01). In our study, the Bakri balloon and the B-Lynch suture had similar success rates in uterine atony during CS. The advantages of the B-Lynch suture include rapid application with no need for lithotomy position or extra material; whereas the Bakri balloon is less invasive and easier to learn, but more time consuming and expensive compared to the B-Lynch suture. We suggest that the B-Lynch suture may be preferred in uterine atony during CS in low resource settings; however, the less invasive Bakri balloon should be the first line in full resource settings. Further studies are needed to evaluate the advantages and disadvantages of the two methods.

  20. New suture techniques for best esthetic skin healing Novas técnicas de suturas para melhor cicatrização estética da pele

    Directory of Open Access Journals (Sweden)

    Otoni Moreira Gomes

    2012-07-01

    Full Text Available PURPOSE: To report two new suture techniques for best esthetic skin healing. METHODS: Using the pig skin slices routinely employed for surgical technique training two new types of skin sutures were performed. One defined as inverted or hidden X point suture and other as totally hidden intradermal running suture. The first were performed using 4-0 polypropilene stitch and the intradermal with 4-0 poliglicolic stitch. RESULTS: It was confirmed good skin layers union and contention with best esthetic result than observed with the traditional X and intradermal suture techniques. CONCLUSION: Macroscopic examination of the hidden X point and totally hidden intra-dermal sutures and centrifuge skin traction confirmed good skin layers union and contention with best esthetic result than observed with the traditional X and intradermal sutures techniques.OBJETIVO: Apresentar dois novos tipos de suturas para melhor resultado estético na cicatrização da pele. METODOS: Utilizando fragmentos de pele de porco rotineiramente empregados no ensino e treinamento de técnica operatória, dois novos tipos de suturas da pele foram desenvolvidos. Um deles definido como sutura com pontos em X invertidos ou ocultos e outro como sutura intradérmica totalmente oculta. A primeira foi realizada com fio de polipropileno 4-0, e a intradérmica oculta com fio poliglicólico 4-0. RESULTADOS: Foram confirmados contenção e união adequada das camadas da pele com melhores resultados estético do que observados com as suturas tradicionais em X e intradémica. CONCLUSÃO: A análise macroscópica das suturas com pontos em X oculto e intradermica totalmente oculta e a tração centrífuga da bordas suturadas confirmaram boa união das camadas da pele com melhor resultado estético do que observado com as suturas em X e intradérmicas tradicionais.

  1. Effect of human urine on the tensile strength of sutures used for hypospadias surgery.

    Science.gov (United States)

    Kerstein, Ryan L; Sedaghati, Tina; Seifalian, Alexander M; Kang, Norbert

    2013-06-01

    Hypospadias is the most common congenital condition affecting between 1 in 250 and 300 live births. Even in experienced hands, surgery to repair this congenital defect can have a high complication rate. Wound dehiscence is reported to occur in 5% and fistula formation in 6%-40% depending on technique. The choice of suture material has been shown to affect the complication rate although there is (currently) no consensus about the best suture material to use. Ideally, the sutures used for urethroplasty should be absorbable while maintaining sufficient mechanical strength to support the wounds until they are self-supporting and able to resist urinary flow. Previous studies have compared the effects of human urine on different suture materials especially catgut. However, catgut is now banned in Europe. Our study examined the tensile and breaking strength as well as rate of degradation for four types of absorbable suture now commonly used for hypospadias repairs in the UK. We examined the effect of prolonged storage (up to 27 days) in human urine on 6/0 gauge Vicryl, Vicryl Rapide, Monocryl and polydioxanone (PDS) sutures. These four suture materials are commonly used by the senior plastic consultant surgeon (NK) for hypospadias repairs. 50 mm sections of these suture materials were stored in either urine or saline as control. At specified time points, each suture was placed in a uniaxial load testing machine to assess the stress-strain profile and the mechanical load required to break the suture was measured. Exposure to urine reduced the tensile and breaking strength of all the suture materials tested. PDS demonstrated the greatest resilience. Vicryl Rapide was the weakest suture and degraded completely by day 6. Vicryl and Monocryl had similar degradation profiles, but Vicryl retained more of its tensile strength for longer. There is a balance to be struck between the duration that a suture material must remain in any surgical wound and the risk that it causes

  2. A Novel Surgical Pre-suturing Technique for the Management of ...

    African Journals Online (AJOL)

    Ankyloglossia or “tongue‑tie” is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using ...

  3. Clamp fixation to prevent unfolding of a suture knot decreases tensile strength of polypropylene sutures.

    Science.gov (United States)

    Türker, Mehmet; Yalçinozan, Mehmet; Çirpar, Meriç; Çetik, Özgür; Kalaycioğlu, Barış

    2012-12-01

    Although sutures evolved in last decade and the product spectrum broadened largely, they can be still classified into two: monofilament and multifilament. Sutures are the mainstay of orthopedic procedures like fascial closures, tendon repairs or tenodesis. In every repair, a suture loop is created. This suture loop is prone to failure due to suture elongation, knot slip and suture breakage. As the knot is the stress riser in a suture loop, the majority of acute loop failure occurs just adjacent to the knot. Monofilament sutures have higher bending stiffness and tendency to untie than multifilament sutures. The first throw of monofilament sutures have tendency to untie, which decrease loop tension and result in loss of achieved tissue approximation. Although a common practice is to fix the first throw via a clamp before the locking one is tied, it can be hypothesized that a potential deforming effect can lead to a decrease in ultimate failure load of a monofilament suture loop. Fixing the first throw significantly reduced the ultimate failure load of monofilament nonabsorbable polypropylene sutures (Prolene) (62.2 ± 8 N vs. 72.7 ± 9 N, p = 0.019). The ultimate failure load achieved by monofilament sutures Polyglyconate (Maxon) and Nylon (Ethilon) and braided absorbable Polyglactin (Vicryl) were not affected by fixing the first throw. Under microscopic examination, polypropylene sutures were found to be deformed by clamp fixation, while the others were not. Polypropylene sutures can be easily damaged when it is fixed by a clamp during knot tying. Presented data demonstrated that in real surgical situations clamp fixation of polypropylene knots can damage the suture loop and carry the risk of acute failure of repair site during early rehabilitation.

  4. Outcomes of Bankart Repairs Using Modern Arthroscopic Technique in an Athletic Population

    OpenAIRE

    Milchteim, Charles; Tucker, Scott A.; Lamour, Richard J.; Nye, Darin D.; Andrews, James R.; Ostrander, Roger V.

    2015-01-01

    Objectives: The ideal technique for management of traumatic anterior shoulder instability is yet to be determined. Although open Bankart repairs have remained the gold standard, arthroscopic indications and techniques for Bankart repairs have significantly evolved over the last decade. The purpose of this study was to report a large number of highly active patients who underwent arthroscopic Bankart repair at our institution over the last decade. Methods: A retrospective analysis of all patie...

  5. Endoscopic mini/less open sublay technique (EMILOS)-a new technique for ventral hernia repair.

    Science.gov (United States)

    Schwarz, J; Reinpold, W; Bittner, Reinhard

    2017-02-01

    The "MILOS concept" (mini/less open sublay repair) was developed to realize the benefits of minimally invasive surgery and avoid the disadvantages of traditional open techniques in repair of primary and secondary abdominal wall hernias. Utilizing the MILOS concept, the mesh can be placed in the retromuscular position without opening of the abdominal cavity or without the necessity to perform a large skin incision. The dissection of the retromuscular plane may be done by an open technique (MILOS) or endoscopically (EMILOS). From June 2015 to July 2016, a total of 33 patients were operated using the MILOS concept, 8 patients underwent the original MILOS technique, and 25 patients had the EMILOS operation. The operative steps of this novel endoscopic variation, the EMILOS procedure (endoscopic mini/less open sublay), are described in detail. Operative indications were a midline umbilical, epigastric, or incisional hernia with a coexisting rectus diastasis. In all cases, a large mesh (20 × 30) was implanted in the retromuscular space without any fixation. The average skin incision was 5.2 cm; mean operative time was 157 min and 122 min in the last five cases. The average hospital stay was 3.2 days. The median pain score (VAS) under physical stress (e.g., climbing stairs) was 2.7. The EMILOS operation has the potential to become an important supplementary method in the spectrum of surgical techniques for repair of abdominal wall hernias. The technique is reliable, reproducible, and easy to standardize.

  6. Degenerative mitral valve disease-contemporary surgical approaches and repair techniques.

    Science.gov (United States)

    Koprivanac, Marijan; Kelava, Marta; Alansari, Shehab; Javadikasgari, Hoda; Tappuni, Bassman; Mick, Stephanie; Marc, Gillinov A; Suri, Rakesh; Mihaljevic, Tomislav

    2017-01-01

    Given the increasing age of the US population and the accompanying rise in cardiovascular disease, we expect to see an increasing number of patients affected by degenerative mitral valve disease in a more complex patient population. Therefore, increasing the overall rate of mitral valve repair will become even more important than it is today, and the capability to provide a universally and uniformly accepted quality of repair will have important medical, economic, and societal implications. This article will describe preoperative and intraoperative considerations and the currently practiced mitral valve repair approaches and techniques. The aim of the article is to present our contemporary approach to mitral valve repair in the hope that it can be adopted at other institutions that may have low repair rates. Adoption of simple and reproducible mitral valve repair techniques is of paramount importance if we as a profession are to accomplish overall higher rates of mitral valve repair with optimal outcomes.

  7. Optimization of Suture-Free Laser-Assisted Vessel Repair by Solder-Doped Electrospun Poly(ε-caprolactone) Scaffold

    Science.gov (United States)

    Pabittei, Dara R.; Heger, Michal; Beek, Johan F.; van Tuijl, Sjoerd; Simonet, Marc; van der Wal, Allard C.; de Mol, Bas A.

    2010-01-01

    Poor welding strength constitutes an obstacle in the clinical employment of laser-assisted vascular repair (LAVR) and anastomosis. We therefore investigated the feasibility of using electrospun poly(ε-caprolactone) (PCL) scaffold as reinforcement material in LAVR of medium-sized vessels. In vitro solder-doped scaffold LAVR (ssLAVR) was performed on porcine carotid arteries or abdominal aortas using a 670-nm diode laser, a solder composed of 50% bovine serum albumin and 0.5% methylene blue, and electrospun PCL scaffolds. The correlation between leaking point pressures (LPPs) and arterial diameter, the extent of thermal damage, structural and mechanical alterations of the scaffold following ssLAVR, and the weak point were investigated. A strong negative correlation existed between LPP and vessel diameter, albeit LPP (484 ± 111 mmHg) remained well above pathophysiological pressures. Histological analysis revealed that thermal damage extended into the medial layer with a well-preserved internal elastic lamina and endothelial cells. Laser irradiation of PCL fibers and coagulation of solder material resulted in a strong and stiff scaffold. The weak point of the ssLAVR modality was predominantly characterized by cohesive failure. In conclusion, ssLAVR produced supraphysiological LPPs and limited tissue damage. Despite heat-induced structural/mechanical alterations of the scaffold, PCL is a suitable polymer for weld reinforcement in medium-sized vessel ssLAVR. PMID:20835847

  8. In vivo evaluation of a novel mesh suture design for abdominal wall closure.

    Science.gov (United States)

    Souza, Jason M; Dumanian, Zari P; Gurjala, Anandev N; Dumanian, Gregory A

    2015-02-01

    The authors present a novel mesh suture design aimed at minimizing the early laparotomy dehiscence that drives ventral hernia formation. The authors hypothesized that modulation of the suture-tissue interface through use of a macroporous structure and increased aspect ratio (width-to-height ratio) would decrease the suture pull-through that leads to laparotomy dehiscence. Incisional hernias were produced in 30 rats according to an established hernia model. The rat hernias were randomized to repair with either two 5-0 polypropylene sutures or two midweight polypropylene mesh sutures. Standardized photographs were taken before repair and 1 month after repair. Edge-detection software was used to define the border of the hernia defect and calculate the defect area. Histologic analysis was performed on all mesh suture specimens. Seventeen hernias were repaired with mesh sutures and 13 were repaired with conventional sutures. The mean area of the recurrent defects following repair with mesh suture was 177.8 ± 27.1 mm2, compared with 267.3 ± 34.1 mm2 following conventional suture repair. This correlated to a 57.4 percent reduction in defect area after mesh suture repair, compared with a 10.1 percent increase in defect area following conventional suture repair (p sutures pulled through the surrounding tissue, whereas 65 percent (17 of 26) of the conventional sutures demonstrated complete pull-through. Excellent fibrocollagenous ingrowth was observed in 13 of 17 mesh suture specimens. Mesh sutures better resisted suture pull-through than conventional polypropylene sutures. The design elements of mesh sutures may prevent early laparotomy dehiscence by more evenly distributing distracting forces at the suture-tissue interface and permitting tissue incorporation of the suture itself.

  9. Rapid repair techniques for severely earthquake-damaged circular bridge piers with flexural failure mode

    Science.gov (United States)

    Sun, Zhiguo; Li, Hongnan; Bi, Kaiming; Si, Bingjun; Wang, Dongsheng

    2017-04-01

    In this study, three rapid repair techniques are proposed to retrofit circular bridge piers that are severely damaged by the flexural failure mode in major earthquakes. The quasi-static tests on three 1:2.5 scaled circular pier specimens are conducted to evaluate the efficiency of the proposed repair techniques. For the purpose of rapid repair, the repair procedure for all the specimens is conducted within four days, and the behavior of the repaired specimens is evaluated and compared with the original ones. A finite element model is developed to predict the cyclic behavior of the repaired specimens and the numerical results are compared with the test data. It is found that all the repaired specimens exhibit similar or larger lateral strength and deformation capacity than the original ones. The initial lateral stiffness of all the repaired specimens is lower than that of the original ones, while they show a higher lateral stiffness at the later stage of the test. No noticeable difference is observed for the energy dissipation capacity between the original and repaired pier specimens. It is suggested that the repair technique using the early-strength concrete jacket confined by carbon fiber reinforced polymer (CFRP) sheets can be an optimal method for the rapid repair of severely earthquake-damaged circular bridge piers with flexural failure mode.

  10. Single site and conventional totally extraperitoneal techniques for uncomplicated inguinal hernia repair: A comparative study

    OpenAIRE

    Felipe Araujo; Eduardo Simao Starling; Marco Maricevich; Marcos Tobias-Machado

    2014-01-01

    Objective: To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS) inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP) technique. Background : TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS) is an emerging approach and has been reported for a number of surgical procedures with superior...

  11. A 5‑year Review of Darning Technique of Inguinal Hernia Repair

    African Journals Online (AJOL)

    Inguinal hernia repair has undergone several modifications since the description of the Bassini technique.[1] The various techniques described are aimed at improving outcome, particularly recurrence rate. The underlying factor identified as a cause of recurrence in most of these methods of repair is the fraying and tearing ...

  12. Novel technique for closure of defect in laparoscopic ventral hernia repair

    Directory of Open Access Journals (Sweden)

    Sharma Deborshi

    2010-01-01

    Full Text Available Laparoscopic repair of ventral hernia is the standard of care in today`s era. With increasing experience, different theories and techniques have been described by different authors to overcome the intraoperative and postoperative problems. We describe a novel technique for closure of defect in laparoscopic hernia repair which has the added advantage.

  13. Comparing the da Vinci si single console and dual console in teaching novice surgeons suturing techniques.

    Science.gov (United States)

    Crusco, Salvatore; Jackson, Tiffany; Advincula, Arnold

    2014-01-01

    Robot-assisted laparoscopic surgery is often taught with the surgical mentor at the surgeon console and the trainee at the patient's bedside. The da Vinci dual console (Intuitive Surgical, Sunnyvale, California) allows a surgical mentor to teach with both the mentor and the trainee working at a surgeon console simultaneously. The purpose of this study is to evaluate the effectiveness of the dual console versus the single console for teaching medical students robotic tasks. Forty novice medical students were randomized to either the da Vinci single-console or dual-console group and were taught 4 knot-tying techniques by a surgical mentor. The students were timed while performing the tasks. No statistically significant differences in mean task times were observed between the single- and dual-console groups: interrupted stitch with a 2-handed knot (300 seconds for single vs 294 seconds for dual, P=.59), interrupted stitch with a 1-handed knot (198 seconds for single vs 212 seconds for dual, P=.88), figure-of-8 stitch with a 2-handed knot (261 seconds for single vs 219 seconds for dual, P=.20), and figure-of-8 stitch with a 1-handed knot (200 seconds for single vs 199 seconds for dual, P=.53). No significant difference was observed in performance time when teaching knot-tying techniques to medical students using the da Vinci dual console compared with the single console. More research needs to be performed on the utility of the da Vinci dual console in surgical training.

  14. Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: A randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures.

    Science.gov (United States)

    Emanuelsson, Peter; Gunnarsson, Ulf; Dahlstrand, Ursula; Strigård, Karin; Stark, Birgit

    2016-11-01

    The primary aim of this prospective, randomized, clinical, 2-armed trial was to evaluate the risk for recurrence using 2 different operative techniques for repair of abdominal rectus diastasis. Secondary aims were comparison of pain, abdominal muscle strength, and quality of life and to compare those outcomes to a control group receiving physical training only. Eighty-six patients were enrolled. Twenty-nine patients were allocated to retromuscular polypropylene mesh and 27 to double-row plication with Quill technology. Thirty-two patients participated in a 3-month training program. Diastasis was evaluated with computed tomography scan and clinically. Pain was assessed using the ventral hernia pain questionnaire, a quality-of-life survey, SF-36, and abdominal muscle strength using the Biodex System-4. One early recurrence occurred in the Quill group, 2 encapsulated seromas in the mesh group, and 3 in the suture group. Significant improvements in perceived pain, the ventral hernia pain questionnaire, and quality of life appeared at the 1-year follow-up with no difference between the 2 operative groups. Significant muscular improvement was obtained in all groups (Biodex System-4). Patient perceived gain in muscle strength assessed with a visual analog scale improved similarly in both operative groups. This improvement was significantly greater than that seen in the training group. Patients in the training group still experienced bodily pain at follow-up. There was no difference between the Quill technique and retromuscular mesh in the effect on abdominal wall stability, with a similar complication rate 1 year after operation. An operation improves functional ability and quality of life. Training strengthens the abdominal muscles, but patients still experience discomfort and pain. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Bioactive Sutures: A Review of Advances in Surgical Suture Functionalisation.

    Science.gov (United States)

    Alshomer, Feras; Madhavan, Arul; Pathan, Omar; Song, Wenhui

    2017-01-01

    Sutures have been at the forefront of surgical medicine throughout time. With recent advances in suture technology, it is possible to incorporate biologically active substances to enhance suture function and capability. Bioactive sutures represent a modality interest in controlled drug and cell delivery to traumatic sites. In this article, a comprehensive literature search of key bibliographic databases focusing on suture material fabrication and advanced modification was performed. The history, manufacturing process and cost-effectiveness of bioactive sutures are presented. Several novel modifications to enhance function in drug and growth factor delivery and cell therapy are also reviewed. Different antimicrobial drugs and anaesthetics have been shown to be effective in reducing inflammation and bacterial infection. Cellular therapy represents a unique modality augmenting the surgical repair of various soft tissue injuries. We propose a definition of bio-active sutures as biomaterials that are engineered to have controlled tissue interaction to optimise wound/defect healing, in addition to their essential function in tissue approximation. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  16. Current options in inguinal hernia repair in adult patients

    Science.gov (United States)

    Kulacoglu, H

    2011-01-01

    Inguinal hernia is a very common problem. Surgical repair is the current approach, whereas asymptomatic or minimally symptomatic hernias may be good candidate for watchful waiting. Prophylactic antibiotics can be used in centers with high rate of wound infection. Local anesthesia is a suitable and economic option for open repairs, and should be popularized in day-case setting. Numerous repair methods have been described to date. Mesh repairs are superior to "nonmesh" tissue-suture repairs. Lichtenstein repair and endoscopic/laparoscopic techniques have similar efficacy. Standard polypropylene mesh is still the choice, whereas use of partially absorbable lightweight meshes seems to have some advantages. PMID:22435019

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

    LENUS (Irish Health Repository)

    Hennessey, D B

    2012-08-01

    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. Triple labrum tears repaired with the JuggerKnot™ soft anchor: Technique and results

    Science.gov (United States)

    Agrawal, Vivek; Pietrzak, William S.

    2015-01-01

    Purpose: The 2-year outcomes of patients undergoing repair of triple labrum tears using an all-suture anchor device were assessed. Materials and Methods: Eighteen patients (17 male, one female; mean age 36.4 years, range: 14.2-62.3 years) with triple labrum tears underwent arthroscopic repair using the 1.4 mm JuggerKnot Soft Anchor (mean number of anchors 11.5, range: 9-19 anchors). Five patients had prior surgeries performed on their operative shoulder. Patients were followed for a mean of 2.0 years (range: 1.6-3.0 years). Constant–Murley shoulder score (CS) and Flexilevel scale of shoulder function (FLEX-SF) scores were measured, with preoperative and final postoperative mean scores compared with a paired Student's t-test (P Anchor tracts appeared to heal with fibrous tissue, complete bony healing, or combined fibro-osseous healing. Conclusion: Our results are encouraging, demonstrating a consistent healing of the anchor tunnels through arthroscopic treatment of complex labrum lesions with a completely suture-based implant. It further demonstrates a meaningful improvement in patient outcomes, a predictable return to activity, and a high rate of patient satisfaction. Level of Evidence: Level IV case series. PMID:26288537

  19. Cost-effective and rapid concrete repair techniques.

    Science.gov (United States)

    2016-02-08

    Concrete is a principal component of many transportation structures. While highly durable, a : variety of processes degrade and damage concrete. Replacement is expensive. Many cases : warrant repair instead of replacement. Since many damage processes...

  20. Repair vs replacement of direct composite restorations: a survey of teaching and operative techniques in Oceania.

    Science.gov (United States)

    Brunton, Paul A; Ghazali, Amna; Tarif, Zahidah H; Loch, Carolina; Lynch, Christopher; Wilson, Nairn; Blum, Igor R

    2017-04-01

    To evaluate the teaching and operative techniques for the repair and/or replacement of direct resin-based composite restorations (DCRs) in dental schools in Oceania. A 14-item questionnaire was mailed to the heads of operative dentistry in 16 dental schools in Oceania (Australia, New Zealand, Fiji and Papua New Guinea). The survey asked whether the repair of DCRs was taught within the curriculum; the rationale behind the teaching; how techniques were taught, indications for repair, operative techniques, materials used, patient acceptability, expected longevity and recall systems. All 16 schools participated in the study. Thirteen (81%) reported the teaching of composite repairs as an alternative to replacement. Most schools taught the theoretical and practical aspects of repair at a clinical level only. All 13 schools (100%) agreed on tooth substance preservation being the main reason for teaching repair. The main indications for repair were marginal defects (100%), followed by secondary caries (69%). All 13 schools that performed repairs reported high patient acceptability, and considered it a definitive measure. Only three schools (23%) claimed to have a recall system in place following repair of DCRs. Most respondents either did not know or did not answer when asked about the longevity of DCRs. Repair of DCRs seems to be a viable alternative to replacement, which is actively taught within Oceania. Advantages include it being minimally invasive, preserving tooth structure, and time and money saving. However, standardised guidelines need to be developed and further clinical long-term studies need to be carried out. The decision between replacing or repairing a defective composite restoration tends to be based on what clinicians have been taught, tempered by experience and judgement. This study investigated the current status of teaching and operative techniques of repair of direct composite restorations in dental schools in Oceania. Copyright © 2017 Elsevier Ltd

  1. EFFECT OF CONJUNCTIVA-LIMBUS TRANSPLANTATION WITH FIBRIN GLUE COMPARE TO SUTURE TECHNIQUE ON STABILITY OF THE GRAFT ATTACHMENT IN PTERYGIUM SURGERY

    Directory of Open Access Journals (Sweden)

    Eka Sutyawan

    2013-01-01

    Full Text Available Objective: Pterygium is a growth that develops on the conjunctiva or mucous membrane covers the white part of eye. It is a benign or noncancerous growth that is often shaped like a wedge. This study aims to assess the efficacy and safety attachment graft on conjunctiva-limbus autograft transplantation using fibrin glue compared with suture technique in pterygium patient.Method: Single-blindrandomized clinical trials. The samples were all pterygium patients with grade two or more who underwent pterygium surgery at the eye clinic and central operating theatre Sanglah General Hospital Denpasar, Bali-Indonesia and met the eligibility criteria. Samples were divided into suture and fibringlue groups based on permutation-block randomization. Mann-Whitney U test and repeated measurement of ANOVA Analyses were performed to determine the different between two treatments.Results: There were no significant differences in the stability of graft’s attachment between the two groups either on the first day, first week and first month despite fibrin glue technique showed lower results in the first week and first month (p = 0.787, p = 0.233, and p = 0.475. The average time it takes the fibrin glue technique 21.80 ± 2:37 minutes, much shorter than 41.67 ± 6.99 min in the suture technique (p = 0.001. Postoperative comfort in the fibrin glue group showed lower scores on the first day, first week and first month compared with the suture group (p = 0.000, p =0.000 and p = 0.035. During the follow-up period no complications were found.Conclusion: The stability of graft attachment between the fibrin glue and suture technique is not significantly different. Fibrin glue could be chosen as an alternative method in the conjunctiva-limbus autograft and helpful in shortening the operating time and improve comfort postoperatively.

  2. Anterior glenoid perforation with suture anchor causing subscapularis irritation and pain.

    Science.gov (United States)

    Marx, Robert G; Verkuil, Lana; Wilson, Sean; Foo, Li Foong

    2013-07-01

    Suture anchors for labral repair have been associated with complications including suprascapular notch encroachment and osteolysis. We present a case of suture anchor penetration of the anterior glenoid neck leading to pain secondary to subscapularis muscle irritation in a 14-year-old boy. The patient had labral repair and subsequent anterior shoulder pain which resolved after anchor removal. Chondrolysis of the glenohumeral joint has been described following labral repair with knotless anchors. There have also been cases of injury to the suprascapular nerve following labral repair. However, we are not aware of any reports describing suture anchor penetration of the anterior glenoid neck leading to pain secondary to subscapularis muscle irritation. Labral repair has become a common and routine procedure, but complications can occur. We report a new complication related to osseous penetration of the anterior glenoid neck of the scapula by a suture anchor. We identified the complication using magnetic resonance imaging, an important part in reproducible, noninvasive, and objective assessment of the postoperative shoulder. We also present the technique for anchor removal used to resolve the patient's anterior shoulder pain.

  3. Adjustable suture strabismus surgery

    Science.gov (United States)

    Nihalani, B R; Hunter, D G

    2011-01-01

    Surgical management of strabismus remains a challenge because surgical success rates, short-term and long-term, are not ideal. Adjustable suture strabismus surgery has been available for decades as a tool to potentially enhance the surgical outcomes. Intellectually, it seems logical that having a second chance to improve the outcome of a strabismus procedure should increase the overall success rate and reduce the reoperation rate. Yet, adjustable suture surgery has not gained universal acceptance, partly because Level 1 evidence of its advantages is lacking, and partly because the learning curve for accurate decision making during suture adjustment may span a decade or more. In this review we describe the indications, techniques, and published results of adjustable suture surgery. We will discuss the option of ‘no adjustment' in cases with satisfactory alignment with emphasis on recent advances allowing for delayed adjustment. The use of adjustable sutures in special circumstances will also be reviewed. Consistently improved outcomes in the adjustable arm of nearly all retrospective studies support the advantage of the adjustable option, and strabismus surgeons are advised to become facile in the application of this approach. PMID:21760626

  4. Quality assessment of hypospadias repair with emphasis on techniques used and experience of pediatric urologic surgeons

    NARCIS (Netherlands)

    Chrzan, Rafal; Dik, Pieter; Klijn, Aart J.; de Jong, Tom P. V. M.

    2007-01-01

    To assess outcomes in hypospadias repair at our institution, as compared with the literature, with repair technique and surgeon considered as risk factors. The results of 299 primary hypospadias corrections were analyzed. All procedures were performed by three experienced pediatric urologists. Mean

  5. The classic elephant trunk technique for staged thoracic and thoracoabdominal aortic repair: Long-term results.

    NARCIS (Netherlands)

    Castrovinci, S.; Murana, G.; Maat, G.E. de; Smith, T.; Schepens, M.A.A.M.; Heijmen, R.H.; Morshuis, W.J.

    2015-01-01

    OBJECTIVE: The classic elephant trunk (ET) technique has become the standard approach for patients with diffuse aortic disease requiring a staged thoracic and thoracoabdominal aortic repair. The aim of this study was to assess long-term outcomes and predictors for survival after surgical repair of

  6. Postpartum perineal repair performed by midwives

    DEFF Research Database (Denmark)

    Kindberg, S; Stehouwer, M; Hvidman, L

    2008-01-01

    OBJECTIVE: To compare a continuous suture technique with interrupted stitches using inverted knots for postpartum perineal repair of second-degree lacerations and episiotomies. DESIGN: A double-blind randomised controlled trial. SETTING: A Danish university hospital with more than 4800 deliveries...

  7. Recurrence mechanisms after inguinal hernia repair by the Onstep technique

    DEFF Research Database (Denmark)

    Öberg, S; Andresen, K; Hauge, D

    2016-01-01

    PURPOSE: Inguinal hernia repairs should have few complications and a short learning curve. A new operation called Onstep has promising results, but still some recurrences. The aim of the study was to find reasons for recurrence, by studying the re-operations. METHODS: The study is a case series......, where 565 patients operated with Onstep at six hospitals between December 2011 and April 2015 were identified. If a recurrence had occurred, the description of the re-operation was studied and compared to the primary Onstep operation. RESULTS: We found 26 inguinal hernia recurrences, giving a recurrence...... further improvement in the Onstep method for inguinal hernia repair....

  8. Recycling Suture Limbs from Knotless Suture Anchors for Arthroscopic Shoulder Stabilization

    OpenAIRE

    Johnson, Timothy S.; DiPompeo, Christine M.; Ismaeli, Zahra C.; Porter, Polly A.; Nicholson, Shannon L.; Johnson, David C.

    2014-01-01

    Recurrent shoulder instability often leads to labral abnormality that requires surgical intervention that may require fixation with suture anchors. The proposed surgical technique allows the surgeon to achieve 2 points of fixation around the labrum and/or capsule with a single suture secured to the glenoid with a knotless anchor. Instead of cutting and discarding the residual suture limbs after anchor insertion, this technique uses the residual suture limbs of the knotless anchor for a second...

  9. Repair of bilateral incomplete cleft lip: techniques and outcomes.

    Science.gov (United States)

    Mulliken, John B; Kim, David C

    2013-10-01

    Primary repair of bilateral incomplete cleft lip appears to be uncomplicated but requires attention to technical details in the third dimension in anticipation of changes in the fourth dimension. Direct anthropometry was used to document nasolabial dimensions before and immediately after repair in 51 infants with bilateral incomplete cleft lip. Technical details were analyzed in 48 patients; serial anthropometry was plotted in 22 male patients aged 2 to 20 years and compared to Farkas's normal growth lines. Revisions were also documented (n = 46). Nasal width was made narrow and widened to normal by adolescence. Nasal tip protrusion was elongated and grew parallel to normal. Columellar length was constructed above normal, lengthened slowly in childhood, and was slightly short by adulthood. The Cupid's bow was designed narrow, widened slightly, and maintained normal dimension in adulthood. The upper philtrum was tapered and remained less wide than the lower philtrum. Although maximum available cutaneous prolabium was used in repair, it was short postoperatively and philtral height failed to exhibit catchup growth. The median tubercle was constructed overly full, but growth frequently fell behind in adolescence; 39 percent of patients required secondary augmentation. Total upper labial height closely followed the normal growth curve. Serial anthropometry documented postoperative changes in nasolabial dimensions compared with normal growth lines. Repair of bilateral incomplete cleft lip requires primary correction of nasal and labial features based on their differential growth. Therapeutic, IV.

  10. Fact Sheet: Control Techniques Guidelines (CTG) for Shipbuilding and Ship Repair Facilities Operation (Surface Coating)

    Science.gov (United States)

    This page contains an August 1996 fact sheet with information regarding the CTG and Alternative Control Techniques (ACT) for Surface Coating at Shipbuilding and Ship Repair Facilities Operations. This document provides a summary of this guidance

  11. Surgical techniques for parastomal hernia repair: a systematic review of the literature.

    NARCIS (Netherlands)

    Hansson, B.M.; Slater, N.J.; Velden, A.S. van der; Groenewoud, H.M.; Buyne, O.R.; Hingh, I.H.J.T. de; Bleichrodt, R.P.

    2012-01-01

    BACKGROUND: Parastomal hernias are a frequent complication of enterostomies that require surgical treatment in approximately half of patients. This systematic review aimed to evaluate and compare the safety and effectiveness of the surgical techniques available for parastomal hernia repair. METHODS:

  12. Reparação microcirúrgica de nervo periférico por meio de sutura, cola de fibrina ou bainha de BioFill® em ratos Wistar Microsurgical repair of peripheral nerve by means of suture, fibrin glue or BioFill® sheath in Wistar rats

    Directory of Open Access Journals (Sweden)

    M.F.P. Torres

    2003-10-01

    with the granulomatous reaction to the suture string. Thus, changes such as Wallerian degeneration, formation of a neurome and proliferation of fibrous tissue were noticed in all three treatments, being more evident in the group that received three stitches of epineural suture. Based on histological results obtained from the use of the BioFill® sheath and the fibrine glue, the efficiency of these techniques for repairing damaged peripheral nerves was evident. However, the use of the BioFill® sheath ensures advantages such as availability, technical simplicity and low cost. Therefore, it becomes a better alternative for microsurgical repair of peripheral nerve.

  13. Strategies for repair of radial tears close to the meniscal rim--biomechanical analysis with a cyclic loading protocol.

    Science.gov (United States)

    Herbort, Mirco; Siam, Sami; Lenschow, Simon; Petersen, Wolf; Zantop, Thore

    2010-11-01

    Lateral meniscectomy contributes to early-onset osteoarthritis. Biomechanical properties of sutures repairs for complete radial meniscal tears remain unknown. Double horizontal suture techniques for repair of radial meniscal tears with a shorter distance from the meniscal rim provide significantly higher structural properties than do comparable single-suture techniques with a wider distance from the meniscal rim. Controlled laboratory study. In 55 fresh-frozen porcine menisci, standardized complete radial meniscal tears were repaired with different distances from the meniscal rim and tear edges and with different numbers of sutures. In group A, the suture was 4 mm from the tear and 8 mm from the meniscal rim; group B, 2 mm from tear; group C, 2 mm from tear, 12 mm from rim; group D, double-loop technique, 2 mm from tear, 5 mm and 10 mm from rim; group E, longitudinal tear sutured with 1 loop, 8 mm from rim, and 4 mm between stitches. The specimens were cyclically loaded 1000 times between 5 and 20 N and loaded to failure. All repaired constructs survived the cyclic loading protocol. Compared with the single-loop techniques, the double-loop technique (group D) showed a significantly higher maximum load and yield load and significantly lower displacement after 1000 cycles. Compared with group B, group C had a higher displacement after 1000 cycles (P cycling testing in group C was higher than in groups B and D (P < .05). Repair of radial meniscal tears with a second suture and shorter distance from the meniscal rim has a positive influence on primary stability. Different distances from tear edges apparently have no influence on structural properties. Horizontal sutures for repair of radial meniscal tears provide high stability and can be enhanced with a second horizontal suture and shorter distance from the meniscal rim.

  14. Comparison of bone tunnel and suture anchor techniques in the modified Broström procedure for chronic lateral ankle instability.

    Science.gov (United States)

    Hu, Chang-Yong; Lee, Keun-Bae; Song, Eun-Kyoo; Kim, Myung-Sun; Park, Kyung-Soon

    2013-08-01

    The modified Broström procedure is frequently used to treat chronic lateral ankle instability. There are 2 common methods of the modified Broström procedure, which are the bone tunnel and suture anchor techniques. To compare the clinical outcomes of the modified Broström procedure using the bone tunnel and suture anchor techniques. Cohort study; Level of evidence, 2. Eighty-one patients (81 ankles) treated with the modified Broström procedure for chronic lateral ankle instability constituted the study cohort. The 81 ankles were divided into 2 groups, namely, a bone tunnel technique (BT group; 40 ankles) and a suture anchor technique (SA group; 41 ankles). The Karlsson score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, anterior talar translation, and talar tilt angle were used to evaluate clinical and radiographic outcomes. The BT group consisted of 32 men and 8 women with a mean age of 34.8 years at surgery and a mean follow-up duration of 34.2 months. The SA group consisted of 33 men and 8 women with a mean age of 33.3 years at surgery and a mean follow-up duration of 32.8 months. Mean Karlsson scores improved significantly from 57.0 points preoperatively to 94.9 points at final follow-up in the BT group and from 59.9 points preoperatively to 96.4 points at final follow-up in the SA group. Mean AOFAS scores also improved from 64.2 points preoperatively to 97.8 points at final follow-up in the BT group and from 70.3 points preoperatively to 97.4 points at final follow-up in the SA group. Mean anterior talar translations in the BT group and SA group improved from 9.0 mm and 9.2 mm preoperatively to 6.5 mm and 6.8 mm at final follow-up, respectively. Mean talar tilt angles were 12.0° in the BT group and 12.5° in the SA group preoperatively and 8.8° at final follow-up for both groups. No significant differences were found between the 2 groups in terms of the Karlsson score, AOFAS score, anterior talar translation, and talar tilt

  15. Integrated technique of planning the capital repair of residential buildings and objects of transport infrastructure

    Science.gov (United States)

    Dement’eva, Marina

    2017-10-01

    The paper presents the results of a comparative analysis of two fundamentally different methods for planning capital repairs of objects of transport infrastructure and residential development. The first method was based on perspective long-term plans. Normative service life were the basis for planning the periodicity of repairs. The second method was based on the performance of repairs in fact of the onset of the malfunction. Problems of financing repair work, of the uneven aging of constructs and engineering systems, different wear mechanism in different conditions of exploitation, absence of methods of planning repairs of administrative and production buildings (depots, stations, etc.) justify the need to optimize methods of planning the repair and the relevance of this paper. The aim of the study was to develop the main provisions of an integrated technique for planning the capital repair of buildings of any functional purpose, which combines the advantages of each of the discussed planning methods. For this purpose, the consequences of technical and economic risk were analyzed of the buildings, including stations, depots, transport transfer hubs, administrative buildings, etc when choosing different planning methods. One of the significant results of the study is the possibility of justifying the optimal period of capital repairs on the basis of the proposed technical and economic criteria. The adjustment of the planned repair schedule is carried out taking into account the reliability and cost-effectiveness of the exploitation process.

  16. New Surface-Treatment Technique of Concrete Structures Using Crack Repair Stick with Healing Ingredients.

    Science.gov (United States)

    Ahn, Tae-Ho; Kim, Hong-Gi; Ryou, Jae-Suk

    2016-08-04

    This study focused on the development of a crack repair stick as a new repair method along with self-healing materials that can be used to easily repair the cracks in a concrete structure at the construction site. In developing this new repair technique, the self-healing efficiency of various cementitious materials was considered. Likewise, a crack repair stick was developed to apply to concrete structures with 0.3 mm or lower crack widths. The crack repair stick was made with different materials, such as cement, an expansive material (C12A₇), a swelling material, and calcium carbonate, to endow it with a self-healing property. To verify the performance of the crack repair stick for concrete structures, two types of procedures (field experiment and field absorption test) were carried out. As a result of such procedures, it was concluded that the developed crack repair stick could be used on concrete structures to reduce repair expenses and for the improved workability, usability, and serviceability of such structures. On the other hand, to evaluate the self-healing performance of the crack repair stick, various tests were conducted, such as the relative dynamic modulus of elasticity test, the water tightness test, the water permeability test, observation via a microscope, and scanning electron microscope (SEM) analysis. From the results, it is found that water leakage can be prevented and that the durability of a concrete structure can be improved through self-healing. Also, it was verified that the cracks were perfectly closed after 28 days due to application of the crack repair stick. These results indicate the usability of the crack repair stick for concrete structures, and its self-healing efficiency.

  17. New Surface-Treatment Technique of Concrete Structures Using Crack Repair Stick with Healing Ingredients

    Directory of Open Access Journals (Sweden)

    Tae-Ho Ahn

    2016-08-01

    Full Text Available This study focused on the development of a crack repair stick as a new repair method along with self-healing materials that can be used to easily repair the cracks in a concrete structure at the construction site. In developing this new repair technique, the self-healing efficiency of various cementitious materials was considered. Likewise, a crack repair stick was developed to apply to concrete structures with 0.3 mm or lower crack widths. The crack repair stick was made with different materials, such as cement, an expansive material (C12A7, a swelling material, and calcium carbonate, to endow it with a self-healing property. To verify the performance of the crack repair stick for concrete structures, two types of procedures (field experiment and field absorption test were carried out. As a result of such procedures, it was concluded that the developed crack repair stick could be used on concrete structures to reduce repair expenses and for the improved workability, usability, and serviceability of such structures. On the other hand, to evaluate the self-healing performance of the crack repair stick, various tests were conducted, such as the relative dynamic modulus of elasticity test, the water tightness test, the water permeability test, observation via a microscope, and scanning electron microscope (SEM analysis. From the results, it is found that water leakage can be prevented and that the durability of a concrete structure can be improved through self-healing. Also, it was verified that the cracks were perfectly closed after 28 days due to application of the crack repair stick. These results indicate the usability of the crack repair stick for concrete structures, and its self-healing efficiency.

  18. Ex vivo biomechanical comparison of barbed suture and standard polypropylene suture for acute tendon laceration in a canine model.

    Science.gov (United States)

    Duffy, D J; Main, R P; Moore, G E; Breur, G J; Millard, R P

    2015-01-01

    Evaluate performance and resistance to gap formation of a non-absorbable, barbed, monofilament suture, in comparison with a non-absorbable, smooth, monofilament polypropylene suture, in two different suture patterns: three-loop pulley (3LP) and modified Bunnell-Mayer (BM). Seventy-two medium-sized cadaveric superficial digital flexor muscle tendon units. After manual transection and suture repair, individual specimens were placed in an electromechanical tensile testing machine and tested to monotonic failure using tensile ramp loading. Video data acquisition allowed evaluation of failure mode and quantification of gap formation. Incidence of gap formation between tendon ends was significantly greater in tenorrhaphies repaired with barbed suture compared to those repaired with smooth polypropylene. Use of a 3LP suture pattern caused significantly less gapping between tendon ends when compared to the BM pattern. Smooth polypropylene suture was consistently superior in load performance than a unidirectional barbed suture. The 3LP pattern was more resistant than a BM pattern at preventing gap formation. Smooth polypropylene should be recommended over barbed unidirectional suture for use in canine tendinous repair to provide increased resistance to gap formation. The 3LP is superior to the BM suture pattern, requiring significantly more force to cause tenorrhaphy gap formation and failure, which may translate to increased accrual of repair site strength and tendinous healing in clinical situations.

  19. Absorbable and non-absorbable suture fixation results in similar outcomes for tibial eminence fractures in children and adolescents.

    Science.gov (United States)

    Brunner, Stefan; Vavken, Patrick; Kilger, Robert; Vavken, Julia; Rutz, Erich; Brunner, Reinald; Camathias, Carlo

    2016-03-01

    To evaluate efficacy and safety of extraphyseal tibial eminence avulsion fracture repair with absorbable sutures and a distal bone bridge fixation in comparison to previously described technique with non-absorbable sutures and distal screw fixation. In a physeal-sparing technique, tibial eminence fractures (n = 25; McKeever type II/III n = 11/14) were either treated in group A (n = 15, follow-up 28.1 months) using an absorbable suture fixed over a bone bridge or in group B (n = 10, follow-up 47.4 months) with a non-absorbable suture wrapped around an extraarticular tibial screw. IKDC and Lysholm scores were assessed, and the difference between the surgical and contralateral knee in anteroposterior (AP) translation, measured with a Rolimeter. There was no significant difference between group A and group B in IKDC and Lysholm scores with 90.1 points ± 10.2 and 94.1 points ± 8.1, respectively (n.s.). AP translation did not differ between groups (n.s.). Eight of ten screws in group B had to be removed in a second intervention. A total of four arthrofibroses were counted (three in group A). Extraphyseal tibial eminence repair with absorbable sutures and a distal bone bridge fixation results in similar rates of radiographic and clinical healing at 3 months after surgery as non-absorbable sutures tied around a screw, while avoiding the need for hardware removal. The minimal invasive technique to fix an eminence fracture without any permanent sutures or hardware is advantageous for children. To our knowledge, this is the first study that compares non-absorbable with absorbable sutures for a physeal-sparing technique. III.

  20. Technique using interference fixation repair for plantar plate ligament disruption of lesser metatarsophalangeal joints.

    Science.gov (United States)

    Sung, Wenjay

    2015-01-01

    Lesser metatarsophalangeal joint instability is a challenging disorder for the foot and ankle surgeon to repair. We believe that disruption of the plantar plate is common, and its repair should be carefully considered. However, we believe that most current techniques inadequately address repair of the complete plantar plate ligament tear, and, thus, instability and pain commonly persist after disruption of the plantar plate. In the present report, we present a technique we have found useful for repair of a complete plantar plate ligament rupture. The method we have described uses interference screw fixation through a dorsal incision to stabilize the lesser metatarsophalangeal joint. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Groin Pain Characteristics and Recurrence Rates: Three-year Results of a Randomized Controlled Trial Comparing Self-gripping Progrip Mesh and Sutured Polypropylene Mesh for Open Inguinal Hernia Repair.

    Science.gov (United States)

    Zwaans, Willem A R; Verhagen, Tim; Wouters, Luuk; Loos, Maarten J A; Roumen, Rudi M H; Scheltinga, Marc R M

    2017-06-07

    The aim of this study was to investigate long-term groin pain and inguinal hernia recurrence rates of 2 types of mesh and to describe the evolution of postoperative groin sensory disturbances. Some patients with an inguinal hernia develop chronic pain following open mesh insertion. Previous trials comparing a semi-resorbable, self-gripping Progrip mesh with a standard sutured polypropylene mesh found conflicting results regarding recurrence rates and residual groin pain. Patients aged >18 years scheduled for open primary hernia repair were randomized to a self-gripping mesh (Progrip) or a polypropylene mesh (standard). Removal of the inguinal nerves was left to the discretion of the surgeon. Pain was measured using Visual Analogue Scale (VAS) over a 3-year period. Pain characteristics and hernia recurrences were determined using physical examination. Data of 274 patients were complete (75% three-year follow-up rate). Pain steadily decreased over time in both groups in a similar fashion (moderate pain 3.7% in each group). Hyperesthesia was experienced by 2.2% and 3.7% and hypoesthesia in 12% and 19% in Progrip and standard group, respectively. One of seven Progrip patients reported a foreign body feeling versus 1 of 5 standard patients (P = 0.06). Altered skin sensations were not related to a neurectomy. Hernia recurrence rate was 11.5% in the Progrip and 5% in the standard group (P = 0.05). Three years after insertion of a self-gripping Progrip mesh or a sutured polypropylene mesh for an open primary inguinal hernia repair, groin pain is minimal, although altered groin skin sensations and foreign body feeling are quite common. A Progrip hernia repair is associated with a high recurrence rate.

  2. Inside-out meniscus repair.

    Science.gov (United States)

    Nelson, Clay G; Bonner, Kevin F

    2013-01-01

    Meniscus repair over resection, when feasible, should be strongly considered in an effort to preserve meniscus integrity and function, especially in younger patients. Currently, a number of techniques and implants may be used to achieve a successful result. Although all-inside meniscus repair devices have evolved significantly since their introduction and have become the repair technique of choice for many surgeons, the classic inside-out repair technique is still very useful to have in one's armamentarium. Though less popular because of the ease of current-generation fixators, the inside-out technique can still offer advantages for those surgeons who are proficient. With the versatility to address most tear patterns, the ability to deliver sutures with smaller needle diameters, and proven long-term results, it has been considered the gold standard in meniscus repair. We review the inside-out repair technique for both a medial and lateral meniscus tear with some helpful tips when performing the technique, and we present a video demonstration of the lateral meniscus repair technique.

  3. A non-invasive technique for standing surgical repair of urinary bladder rupture in a post-partum mare: a case report

    Directory of Open Access Journals (Sweden)

    Stephen JO

    2009-11-01

    Full Text Available Abstract An 11-year-old mare presented 36 hours after foaling with a ruptured bladder. Uroperitoneum was diagnosed on ultrasound and from the creatinine concentration of the peritoneal fluid. Bladder endoscopy demonstrated tissue necrosis and a rent in the dorsocranial aspect of the bladder. Following stabilisation, including abdominal drainage and lavage, the mare was taken to standing surgery. Under continuous sedation and epidural anaesthesia, and after surgical preparation, a Balfour retractor was placed in the vagina. Using sterile lubricant and moderate force, it was possible to insert a hand into the bladder. The tear was easily palpable on the dorsal portion of the bladder. Two fingers were inserted through the tear and used to provide traction to evert the bladder completely into the vagina where it could grasped with the surgeons other hand to prevent further trauma. A second surgeon could then visualise the entire tear and repaired this using a single layer of size zero PDS suture in a single continuous pattern. As soon as the bladder was repaired, it was replaced via the urethra. The mare did well after surgery and was discharged after 48 hours, apparently normal. This report is the first describing repair of the bladder without an abdominal incision or incision into the urethral sphincter. This greatly reduces the chance of possible complications such as urine pooling after surgery with the previously described standing technique or bladder trauma due to traction with abdominal surgery.

  4. A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation

    OpenAIRE

    Singh, Rohit; Rymer, Ben; Theobald, Peter; Thomas, Peter B.M.

    2015-01-01

    Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into world-wide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilita...

  5. IVO develops a new repair technique for underwater sites. Viscous doughlike substance underwater cracks

    Energy Technology Data Exchange (ETDEWEB)

    Klingstedt, G.; Leisio, C. [ed.

    1998-07-01

    A viscous sealant is revolutionizing repair of the stone and concrete masonry of underwater dams, bridges and canals. There is now no need for expensive and time-consuming cofferdams, since a diver can extrude quick-setting mortar into underwater structures needing repair. This technique has worked well in recent years in various parts of Finland even in strongly flowing water. IVO experts are now starting to look more beyond the borders of Finland

  6. Techniques and outcome of repair of cleft of the secondary palate at ...

    African Journals Online (AJOL)

    Background: The technique adopted in the repair of cleft of the secondary palate must not just be based on the choice of the surgeon but on several factors which include the width of the cleft, length of palate and age of the patient. The aim of the article was to document our 4-year experience of the techniques and outcome ...

  7. Experimental study of the characteristics of a novel mesh suture.

    Science.gov (United States)

    Dumanian, G A; Tulaimat, A; Dumanian, Z P

    2015-09-01

    The failure of sutures to maintain tissue in apposition is well characterized in hernia repairs. A mesh suture designed to facilitate tissue integration into and around the filaments may improve tissue hold and decrease suture pull-through. In vitro, the sutures were compared for resistance to pull-through in ballistics gel. In vivo, closure of midline laparotomy incisions was done with both sutures in 11 female pigs. Tissue segments were subsequently subjected to mechanical and histological testing. The mesh suture had tensile characteristics nearly identical to those of 0-polypropylene suture. Mesh suture demonstrated greater resistance to pull-through than standard suture (mean(s.d.) 4.27(0.42) versus 2.23(0.48) N; P suture (320(57) versus 160(56) N; P suture. Histological examination at 8 and 90 days showed complete tissue integration of the mesh suture. The novel mesh suture structure increased the strength of early wound healing in an experimental model. Surgical relevance Traditional sutures have the significant drawback of cutting and pulling through tissues in high-tension closures. A new mesh suture design with a flexible macroporous outer wall and a hollow core allows the tissues to grow into the suture, improving early wound strength and decreasing suture pull-through. This technology may dramatically increase the reliability of high-tension closures, thereby preventing incisional hernia after laparotomy. As suture pull-through is a problem relevant to all surgical disciplines, numerous additional indications are envisioned with mesh suture formulations of different physical properties and materials. © 2015 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

  8. The sandwich technique for repair of pectus carinatum and excavatum/carinatum complex.

    Science.gov (United States)

    Park, Hyung Joo; Kim, Kyung Soo

    2016-09-01

    Simple external compression of pectus carinatum seems to have its limitations, particularly the repair of asymmetric pectus carinatum or excavatum/carinatum complex. We devised the sandwich technique (press-molding) to remodel the entire chest wall. The purpose of this study is to introduce the sandwich technique and appraise the early results. Between January 2007 and January 2016, 523 consecutive patients with pectus carinatum and its variants were analyzed retrospectively. No patients were excluded during the study period. The sandwich 1 and 2 techniques using the internal and external pectus bars were for pectus carinatum repair. Modified techniques using the external string and the internal bar were to treat the lower costal flare (the flare-buster) and focal protuberances (the magic string) in pectus excavatum repair. Statistical analyses were carried out using paired and unpaired t-test or Wilcoxon signed rank tests. The sandwich repair with the external and internal bars was applied to 58 pectus carinatum patients: seven symmetric (12.1%), 14 asymmetric (24.1%), and 37 carinatum-excavatum complex (63.8%). After pectus excavatum repair, 426 patients had the flare-buster and 39 patients received the magic string. The sandwich 1 technique achieved near-complete resolution of carinatum in 52 patients (86.2%). The sandwich 2 technique accomplished almost symmetric configuration with no residual carinatum in all six cases. The sandwich technique using the external and internal bars seems to be effective in treating asymmetric pectus carinatum and complex excavatum/carinatum deformities. The flare-buster and the magic string effectively relieve the costal flare and focal protuberances in pectus excavatum repair.

  9. Comparison between suture anchor and transosseous suture for the modified-Broström procedure.

    Science.gov (United States)

    Cho, Byung-Ki; Kim, Yong-Min; Kim, Dong-Soo; Choi, Eui-Sung; Shon, Hyun-Chul; Park, Kyoung-Jin

    2012-06-01

    This prospective, randomized study was conducted to compare clinical outcomes of the modified Broström procedure using suture anchor or transosseous suture technique for chronic ankle instability. Forty patients were followed for more than 2 years after modified Broström procedure. Twenty procedures using a suture anchor and 20 procedures using a transosseous suture were performed by one surgeon. The clinical evaluation consisted of the Karlsson scale and the Sefton grading system. Talar tilt and anterior talar translation were measured on anterior and varus stress radiographs. The Karlsson scale had improved significantly to 90.8 points in the suture anchor group, and to 89.2 points in the transosseous suture group. According to Sefton grading system, 18 patients (90%) in suture anchor group and 17 patients (85%) in transosseous suture group achieved satisfactory results. The talar tilt angle and anterior talar translation improved significantly to 5.9 degrees and 4.2 mm in suture anchor group, and to 5.4 degrees and 4.1 mm in transosseous suture group, respectively. No significant differences existed in clinical and functional outcomes between the two techniques for ligament reattachment. Both modified Broström procedures using the suture anchor and transosseous suture seem to be effective treatment methods for chronic lateral ankle instability.

  10. Short-term outcome after Onstep versus Lichtenstein technique for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, K; Burcharth, J; Fonnes, S

    2015-01-01

    PURPOSE: Because of the high number of patients with chronic pain following inguinal hernia repair, a new, simple and safe method of repair is needed. Onstep is a new type of inguinal hernia repair that might be able to reduce postoperative acute and chronic pain. The aim of this study was to inv......PURPOSE: Because of the high number of patients with chronic pain following inguinal hernia repair, a new, simple and safe method of repair is needed. Onstep is a new type of inguinal hernia repair that might be able to reduce postoperative acute and chronic pain. The aim of this study...... for this study were male patients, >18 years, with a primary inguinal hernia. Experimental treatment in this study was the Onstep technique, which was compared with the Lichtenstein repair. Primary outcome was postoperative pain during the first 10 days following surgery. Secondary outcomes included duration...... of surgery, period for return to normal daily activities (days), and recurrence. Randomization was done in blocks and stratified on centers. Participants and study personnel handling questionnaires and analysis were blinded to the allocation. RESULTS: In total, 290 participants were randomized. We found...

  11. Sexual dysfunction after inguinal hernia repair with the Onstep versus Lichtenstein technique

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Burcharth, Jakob; Fonnes, Siv

    2017-01-01

    Background. Sequelae after inguinal hernia repair include pain-related impairment of sexual function. Pain during intercourse can originate from the scar, scrotum, penis, or during ejaculation. The aim of this study was to investigate if the Onstep technique resulted in better results than...... the Lichtenstein technique regarding pain-related impairment of sexual function. Methods. This study was part of the randomized ONLI trial (NCT01753219, Onstep versus Lichtenstein for inguinal hernia repair). Separate reporting of pain-related impairment of sexual function was planned before the study start......, with a separate sample size calculation. Participants were randomized to the Onstep or Lichtenstein technique for repair of their primary inguinal hernia and followed up at 6 months postoperative with the use of a questionnaire specific for pain-related impairment of sexual function. Results. A total of 259...

  12. The Primary Stability of a Bioabsorbable Poly-L-Lactic Acid Suture Anchor for Rotator Cuff Repair Is Not Improved with Polymethylmethacrylate or Bioabsorbable Bone Cement Augmentation.

    Science.gov (United States)

    Güleçyüz, Mehmet F; Kraus-Petersen, Michael; Schröder, Christian; Ficklscherer, Andreas; Wagenhäuser, Markus U; Braun, Christian; Müller, Peter E; Pietschmann, Matthias F

    2018-02-01

    The incidence of osteoporosis and rotator cuff tears increases with age. Cement augmentation of bones is an established method in orthopedic and trauma surgery. This study analyses if polymethylmethacrylate or bioabsorbable cement can improve the primary stability of a bioabsorbable suture anchor in vitro in comparison to a non-augmented suture anchor in osteoporotic human humeri. The trabecular bone mineral density was measured to ensure osteopenic human specimens. Then the poly-l-lactic acid Bio-Corkscrew® FT was implanted in the greater tuberosity footprint with polymethylmethacrylate Refobacin® cement augmentation (n = 8), with Cerament™ Bone Void Filler augmentation (n = 8) and without augmentation (n = 8). Using a cyclic testing protocol, the failure loads, system displacement, and failure modes were recorded. The Cerament™ augmented Bio-Corkscrew® FT yielded the highest failure loads (206.7 N), followed by polymethylmethacrylate Refobacin® augmentation (206.1 N) and without augmentation (160.0 N). The system displacement was lowest for Cerament™ augmentation (0.72 mm), followed by polymethylmethacrylate (0.82 mm) and without augmentation (1.50 mm). Statistical analysis showed no significant differences regarding the maximum failure loads (p = 0.1644) or system displacement (p = 0.4199). The main mode of failure for all three groups was suture slippage. The primary stability of the Bio-Corkscrew® FT is not influenced by bone cement augmentation with polymethylmethacrylate Refobacin® or with bioabsorbable Cerament™ in comparison to the non-cemented anchors. The cement augmentation of rotator cuff suture anchors in osteoporotic bones remains questionable since biomechanical tests show no significant advantage.

  13. Single-Port Laparoscopic Parastomal Hernia Repair with Modified Sugarbaker Technique

    Science.gov (United States)

    Turingan, Isidro; Zajkowska, Marta; Tran, Kim

    2014-01-01

    Introduction: Laparoscopic parastomal hernia repair with modified Sugarbaker technique has become increasingly the operation of choice because of its low recurrence rates. This study aimed to assess feasibility, safety, and efficiency of performing the same operation with single-incision laparoscopic surgery. Materials and Methods: All patients referred from March 2010 to February 2013 were considered for single-port laparoscopic repair with modified Sugarbaker technique. A SILS port (Covidien, Norwalk, Connecticut, USA) was used together with conventional straight dissecting instruments and a 5.5- mm/52-cm/30° laparoscope. Important technical aspects include modified dissection techniques, namely, “inline” and “chopsticks” to overcome loss of triangulation, insertion of a urinary catheter into an ostomy for ostomy limb identification, safe adhesiolysis by avoiding electocautery, saline -jet dissection to demarcate tissue planes, dissection of an entire laparotomy scar to expose incidental incisional hernias, adequate mobilization of an ostomy limb for lateralization, and wide overlapping of defect with antiadhesive mesh. Results: Of 6 patients, 5 underwent single-port laparoscopic repair, and 1 (whose body mass index [BMI] of 39.4 kg/m2 did not permit SILS port placement) underwent multiport repair. Mean defect size was 10 cm, and mean mesh size was 660 cm2 with 4 patients having incidental incisional hernias repaired by the same mesh. Mean operation time was 270 minutes, and mean hospital stay was 4 days. Appliance malfunction ceased immediately, and pain associated with parastomal hernia disappeared. There was no recurrence with a follow-up of 2 to 36 months. Conclusion: Compared with multiport repair, single-port laparoscopic parastomal repair with modified Sugarbaker technique is safe and efficient, and it may eventually become the standard of care. PMID:24680140

  14. Single-port laparoscopic parastomal hernia repair with modified sugarbaker technique.

    Science.gov (United States)

    Tran, Hanh; Turingan, Isidro; Zajkowska, Marta; Tran, Kim

    2014-01-01

    Laparoscopic parastomal hernia repair with modified Sugarbaker technique has become increasingly the operation of choice because of its low recurrence rates. This study aimed to assess feasibility, safety, and efficiency of performing the same operation with single-incision laparoscopic surgery. All patients referred from March 2010 to February 2013 were considered for single-port laparoscopic repair with modified Sugarbaker technique. A SILS port (Covidien, Norwalk, Connecticut, USA) was used together with conventional straight dissecting instruments and a 5.5- mm/52-cm/30° laparoscope. Important technical aspects include modified dissection techniques, namely, "inline" and "chopsticks" to overcome loss of triangulation, insertion of a urinary catheter into an ostomy for ostomy limb identification, safe adhesiolysis by avoiding electocautery, saline -jet dissection to demarcate tissue planes, dissection of an entire laparotomy scar to expose incidental incisional hernias, adequate mobilization of an ostomy limb for lateralization, and wide overlapping of defect with antiadhesive mesh. Of 6 patients, 5 underwent single-port laparoscopic repair, and 1 (whose body mass index [BMI] of 39.4 kg/m(2) did not permit SILS port placement) underwent multiport repair. Mean defect size was 10 cm, and mean mesh size was 660 cm(2) with 4 patients having incidental incisional hernias repaired by the same mesh. Mean operation time was 270 minutes, and mean hospital stay was 4 days. Appliance malfunction ceased immediately, and pain associated with parastomal hernia disappeared. There was no recurrence with a follow-up of 2 to 36 months. Compared with multiport repair, single-port laparoscopic parastomal repair with modified Sugarbaker technique is safe and efficient, and it may eventually become the standard of care.

  15. Cartilage Repair Surgery: Outcome Evaluation by Using Noninvasive Cartilage Biomarkers Based on Quantitative MRI Techniques?

    Directory of Open Access Journals (Sweden)

    Pia M. Jungmann

    2014-01-01

    Full Text Available Background. New quantitative magnetic resonance imaging (MRI techniques are increasingly applied as outcome measures after cartilage repair. Objective. To review the current literature on the use of quantitative MRI biomarkers for evaluation of cartilage repair at the knee and ankle. Methods. Using PubMed literature research, studies on biochemical, quantitative MR imaging of cartilage repair were identified and reviewed. Results. Quantitative MR biomarkers detect early degeneration of articular cartilage, mainly represented by an increasing water content, collagen disruption, and proteoglycan loss. Recently, feasibility of biochemical MR imaging of cartilage repair tissue and surrounding cartilage was demonstrated. Ultrastructural properties of the tissue after different repair procedures resulted in differences in imaging characteristics. T2 mapping, T1rho mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC, and diffusion weighted imaging (DWI are applicable on most clinical 1.5 T and 3 T MR scanners. Currently, a standard of reference is difficult to define and knowledge is limited concerning correlation of clinical and MR findings. The lack of histological correlations complicates the identification of the exact tissue composition. Conclusions. A multimodal approach combining several quantitative MRI techniques in addition to morphological and clinical evaluation might be promising. Further investigations are required to demonstrate the potential for outcome evaluation after cartilage repair.

  16. Cartilage Repair Surgery: Outcome Evaluation by Using Noninvasive Cartilage Biomarkers Based on Quantitative MRI Techniques?

    Science.gov (United States)

    Jungmann, Pia M.; Baum, Thomas; Bauer, Jan S.; Karampinos, Dimitrios C.; Link, Thomas M.; Li, Xiaojuan; Trattnig, Siegfried; Rummeny, Ernst J.; Woertler, Klaus; Welsch, Goetz H.

    2014-01-01

    Background. New quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as outcome measures after cartilage repair. Objective. To review the current literature on the use of quantitative MRI biomarkers for evaluation of cartilage repair at the knee and ankle. Methods. Using PubMed literature research, studies on biochemical, quantitative MR imaging of cartilage repair were identified and reviewed. Results. Quantitative MR biomarkers detect early degeneration of articular cartilage, mainly represented by an increasing water content, collagen disruption, and proteoglycan loss. Recently, feasibility of biochemical MR imaging of cartilage repair tissue and surrounding cartilage was demonstrated. Ultrastructural properties of the tissue after different repair procedures resulted in differences in imaging characteristics. T2 mapping, T1rho mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), and diffusion weighted imaging (DWI) are applicable on most clinical 1.5 T and 3 T MR scanners. Currently, a standard of reference is difficult to define and knowledge is limited concerning correlation of clinical and MR findings. The lack of histological correlations complicates the identification of the exact tissue composition. Conclusions. A multimodal approach combining several quantitative MRI techniques in addition to morphological and clinical evaluation might be promising. Further investigations are required to demonstrate the potential for outcome evaluation after cartilage repair. PMID:24877139

  17. [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].

    Science.gov (United States)

    Suán, C; Cerro, J; Ojeda, R; García-Perla, J L

    1996-11-01

    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.

  18. Endovascular Aortic Aneurysm Repair with Chimney and Snorkel Grafts: Indications, Techniques and Results

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Rakesh P., E-mail: rpatel9@nhs.net [Northwick Park Hospital, Department of Vascular Radiology (United Kingdom); Katsargyris, Athanasios, E-mail: kthanassos@yahoo.com; Verhoeven, Eric L. G., E-mail: Eric.Verhoeven@klinikum-nuernberg.de [Klinikum Nuernberg, Department of Vascular and Endovascular Surgery (Germany); Adam, Donald J., E-mail: donald.adam@tiscali.co.uk [Heartlands Hospital, Department of Vascular Surgery (United Kingdom); Hardman, John A., E-mail: johnhardman@doctors.org.uk [Royal United Hospital Bath, Department of Vascular Radiology (United Kingdom)

    2013-12-15

    The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.

  19. Effect of Suture Material and Bone Quality on the Mechanical Properties of Zone I Flexor Tendon–Bone Reattachment With Bone Anchors

    Science.gov (United States)

    Matsuzaki, Hironori; Zaegel, Melissa A.; Gelberman, Richard H.; Silva, Matthew J.

    2015-01-01

    Purpose To compare the initial biomechanical properties of zone I flexor tendon to bone repairs performed using pull-out and anchor techniques and to investigate the effect of bone quality and suture materials on the strength of anchor repairs. Methods Using computed tomography, we measured bone mineral density and cortical thickness of the distal phalanx of 60 cadaver fingers (mean age, 77 years). Flexor digitorum profundus tendons were then transected at their insertion sites and repaired using a 4-strand grasping suture and either pull-out or anchor fixation. For pull-out repair (n = 20), the suture strands (Supramid 3-0; S. Jackson, Inc., Alexandria, VA) were passed through the distal phalanx and tied over a dorsal button. For anchor repair, 2 bone anchors were inserted into the distal phalanx, and tendons were grasped using either Supramid (n = 21), Ethibond (Ethicon, Inc., Somerville, NJ; n = 10), or FiberWire suture (Arthrex Inc., Naples, FL; n = 9) (all 3-0). Mechanical properties of the repaired tendon– bone constructs were determined in linear, load-to-failure loading and correlated with bone characteristics. Results The FiberWire-anchor repair group had the best combination of mechanical properties, with ultimate force to failure no different from the pull-out repairs but with greater stiffness and reduced displacement. Pull-out suture repairs had significantly higher ultimate force-to-failure values than did Ethibond-anchor and Supramid-anchor repairs (p anchor repairs from all groups (p anchors pulled out for bone mineral density below 420 mg/cm3 or cortical thickness less than0.31 mm, which occurred only for specimens aged greater than75 years. Conclusions The mechanical properties of the double Mitek bone anchors were sensitive to both suture material and bone quality. FiberWire-anchor repairs provided the best combination of mechanical properties. Pull-out suture repairs had good strength but poor stiffness. Anchor fixation may be contraindicated

  20. Barbed suture vs traditional suture in single-port total laparoscopic hysterectomy.

    Science.gov (United States)

    Song, Taejong; Lee, San-Hui

    2014-01-01

    To compare surgical outcomes between barbed suture and traditional suture used in repair of the vaginal vault during single-port total laparoscopic hysterectomy (TLH). Case-control study (Canadian Task Force classification II-2). Two institutions. One hundred two patients with benign uterine disease. Single-port TLH using barbed suture (n = 43) or traditional suture (n = 59). Patient characteristics (age, body mass index, demographic data), procedures performed, uterine weight, and uterine disease were similar between the 2 study groups. There were also no differences in operative complications, conversion to other surgical approaches, operative blood loss, postoperative pain, and duration of hospital stay between the 2 groups. Use of barbed suture significantly reduced the time required for vaginal cuff suturing (11.4 vs 22.5 minutes; p suture is less technically demanding than traditional suture (p suture in single-port TLH may aid surgeons by reducing operative time, suturing time, and surgical difficulty. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  1. Computational techniques for the assessment of fracture repair.

    Science.gov (United States)

    Anderson, Donald D; Thomas, Thaddeus P; Campos Marin, Ana; Elkins, Jacob M; Lack, William D; Lacroix, Damien

    2014-06-01

    The combination of high-resolution three-dimensional medical imaging, increased computing power, and modern computational methods provide unprecedented capabilities for assessing the repair and healing of fractured bone. Fracture healing is a natural process that restores the mechanical integrity of bone and is greatly influenced by the prevailing mechanical environment. Mechanobiological theories have been proposed to provide greater insight into the relationships between mechanics (stress and strain) and biology. Computational approaches for modelling these relationships have evolved from simple tools to analyze fracture healing at a single point in time to current models that capture complex biological events such as angiogenesis, stochasticity in cellular activities, and cell-phenotype specific activities. The predictive capacity of these models has been established using corroborating physical experiments. For clinical application, mechanobiological models accounting for patient-to-patient variability hold the potential to predict fracture healing and thereby help clinicians to customize treatment. Advanced imaging tools permit patient-specific geometries to be used in such models. Refining the models to study the strain fields within a fracture gap and adapting the models for case-specific simulation may provide more accurate examination of the relationship between strain and fracture healing in actual patients. Medical imaging systems have significantly advanced the capability for less invasive visualization of injured musculoskeletal tissues, but all too often the consideration of these rich datasets has stopped at the level of subjective observation. Computational image analysis methods have not yet been applied to study fracture healing, but two comparable challenges which have been addressed in this general area are the evaluation of fracture severity and of fracture-associated soft tissue injury. CT-based methodologies developed to assess and quantify

  2. Is there one optimal repair technique for all composites?

    NARCIS (Netherlands)

    Loomans, B.A.C.; Cardoso, M.V.; Roeters, F.J.M.; Opdam, N.J.M.; Munck, J. De; Huysmans, M.C.D.N.J.M.; Meerbeek, B. Van

    2011-01-01

    OBJECTIVES: The aim of this study was to investigate the effectiveness of a variety of techniques to bond new composite to artificially aged composite of different compositions. METHODS: Composite resin blocks were made of five different commercially available composites (n=30) (Clearfil AP-X,

  3. New minimally invasive technique of parastomal hernia repair – methods and review

    Science.gov (United States)

    Skoneczny, Paweł; Przywózka, Alicja; Czyżewski, Piotr; Bury, Kamil

    2015-01-01

    Introduction Parastomal hernia is described as the most common complication in patients with ostomy. It is reported that its incidence varies from 3% to 39% for colostomies and 0 to 6% for ileostomies. Surgical repair remains the treatment of choice. There are three types of surgical treatment – fascial repair, stoma relocation and repair using prosthetic mesh via a laparoscopic or open approach. Recently there have been several meta-analyses and systematic reviews aiming to compare the results of surgical treatment, and the authors agreed that the quality of evidence precludes firm conclusions. Aim To describe the novel concept of parastomal hernia repair – HyPER/SPHR technique (hybrid parastomal endoscopic re-do/Szczepkowski parastomal hernia repair) and its early results in 12 consecutive cases. Material and methods Twelve consecutive patients were operated on due to parastomal hernia using the new HyPER hybrid technique between June 2013 and May 2014. The patients’ condition was evaluated during the perioperative period, 6 weeks and then every 3 months after surgery. Results After 6 weeks of follow-up we have not observed any mesh-related complications. All 12 patients were examined 3 months and 6 months after repair surgery for evaluation. No recurrence, stoma site infection or stoma-related problems were found. None of the patients complained of pain and none of them needed to be hospitalized again. Reported quality of life on a 0–10 scale after 6 weeks of follow-up was 8 (range: 7–10). Conclusions The HyPER procedure for treatment of parastomal hernias proposed by the authors is a safe and feasible surgical technique with a high patient satisfaction rate and a low number of complications. The hybrid procedure seems to be a promising method for parastomal hernia repair. PMID:25960785

  4. Bifurcated-bifurcated aneurysm repair is a novel technique to repair infrarenal aortic aneurysms in the setting of iliac aneurysms.

    Science.gov (United States)

    Shin, Susanna Hewon; Starnes, Benjamin Ware

    2017-11-01

    Up to 40% of abdominal aortic aneurysms (AAAs) have coexistent iliac artery aneurysms (IAAs). In the past, successful endovascular repair required internal iliac artery (IIA) embolization, which can lead to pelvic or buttock ischemia. This study describes a technique that uses a readily available solution with a minimally altered off-the-shelf bifurcated graft in the IAA to maintain IIA perfusion. From August 2009 to May 2015, 14 patients with AAAs and coexisting IAAs underwent repair with a bifurcated-bifurcated approach. A 22-mm or 24-mm bifurcated main body device was used in the IAA with extension of the "contralateral" limb into the IIA. Intraoperative details including operative time, fluoroscopy time, and contrast agent use were recorded. Outcome measures assessed were operative technical success and a composite outcome measure of IIA patency, freedom from reintervention, and clinically significant endoleak at 1 year. Fourteen patients underwent bifurcated-bifurcated repair during the study period. Technical success was achieved in 93% of patients, with successful treatment of the AAA and IAA and preservation of flow to at least one IIA. The procedure was performed with a completely percutaneous bilateral femoral approach in 92% of patients. Three patients had a type II endoleak on initial follow-up imaging, but none were clinically significant. There were no cases of bowel ischemia or erectile dysfunction. One patient had buttock claudication ipsilateral to IIA coil embolization (contralateral to bifurcated iliac repair and preserved IIA) that resolved by 6-month follow-up. Two patients required reinterventions. One patient presented to his first follow-up visit on postoperative day 25 with thrombosis of the right external iliac limb ipsilateral to the bifurcated iliac repair, which was successfully treated with thrombectomy and stenting of the limb. This same patient presented at 83 months with growth of the preserved IIA to 3.9 cm and underwent coil

  5. Damage Tolerant Repair Techniques for Pressurized Aircraft Fuselages

    Science.gov (United States)

    1994-01-01

    methods of strain measurement used in stress analysis. Strain gages, photoelastic coatings and thermoelastic measurements are practically limited to the...techniques (e.g., strain gages, photoelastic and thermoelastic methods). The outer surfaces were always loaded much less severely than the inner...following adhesive characteristics are highly desirable: * long storage life (> one year) and limited need for refrigeration , * ease of handling (good tack

  6. Valgus instability of the knee joint: a simple surgical repair ...

    African Journals Online (AJOL)

    The technique described for the lare treatment of valgus instability of the knee joint appears to be far simpler rhan the grear variety of alternative methods. In these late cases, the deep part of the medial ligament is almost always unsuitable for direct repair by suture or stapling. Generally it shows extensive fibrosis and ...

  7. Patella fracture fixation with suture and wire: you reap what you sew.

    Science.gov (United States)

    Egol, Kenneth; Howard, Daniel; Monroy, Alexa; Crespo, Alexander; Tejwani, Nirmal; Davidovitch, Roy

    2014-01-01

    Operative fixation of displaced inferior pole patella fractures has now become the standard of care. This study aims to quantify clinical, radiographic and functional outcomes, as well as identify complications in a cohort of patients treated with non-absorbable braided suture fixation for inferior pole patellar fractures. These patients were then compared to a control group of patients treated for mid-pole fractures with K-wires or cannulated screws with tension band wiring. In this IRB approved study, we identified a cohort of patients who were diagnosed and treated surgically for a displaced patella fracture. Demographic, injury, and surgical information were recorded. All patients were treated with a standard surgical technique utilizing non-absorbable braided suture woven through the patellar tendon and placed through drill holes to achieve reduction and fracture fixation. All patients were treated with a similar post-operative protocol and followed up at standard intervals. Data were collected concurrently at follow up visits. For purpose of comparison, we identified a control cohort with middle third patella fractures treated with either k-wires or cannulated screws and tension band technique. Patients were followed by the treating surgeon at regular follow-up intervals. Outcomes included self-reported function and knee range of motion compared to the uninjured side. Forty-nine patients with 49 patella fractures identified retrospectively were treated over 9 years. This cohort consisted of 31 females (63.3%) and 18 males (36.7%) with an average age of 57.1 years (range 26-88 years). Patients had an average BMI of 26.48 (range 19-44.08). Thirteen patients with inferior pole fractures underwent suture fixation and 36 patients with mid-pole fractures underwent tension band fixation (K-wire or cannulated screws with tension band). In the suture cohort, one fracture failed open repair (7.6%), which was revised again with sutures and progressed to union. Of the 36

  8. Biomechanical comparison of the four-strand cruciate and Strickland techniques in animal tendons

    Directory of Open Access Journals (Sweden)

    Raquel Bernardelli Iamaguchi

    2013-12-01

    Full Text Available OBJECTIVE: The objective of this study was to compare two four-strand techniques: the traditional Strickland and cruciate techniques. METHODS: Thirty-eight Achilles tendons were removed from 19 rabbits and were assigned to two groups based on suture technique (Group 1, Strickland suture; Group 2, cruciate repair. The sutured tendons were subjected to constant progressive distraction using a universal testing machine (Kratos®. Based on data from the instrument, which were synchronized with the visualized gap at the suture site and at the time of suture rupture, the following data were obtained: maximum load to rupture, maximum deformation or gap, time elapsed until failure, and stiffness. RESULTS: In the statistical analysis, the data were parametric and unpaired, and by Kolmogorov-Smirnov test, the sample distribution was normal. By Student's t-test, there was no significant difference in any of the data: the cruciate repair sutures had slightly better mean stiffness, and the Strickland sutures had longer time-elapsed suture ruptures and higher average maximum deformation. CONCLUSIONS: The cruciate and Strickland techniques for flexor tendon sutures have similar mechanical characteristics in vitro.

  9. On failure of the pruning technique in "error repair in shift-reduce parsers"

    NARCIS (Netherlands)

    Bertsch, E; Nederhof, MJ

    A previous article presented a technique to compute the least-cost error repair by incrementally generating configurations that result from inserting and deleting tokens in a syntactically incorrect input. An additional mechanism to improve the run-time efficiency of this algorithm by pruning some

  10. The Role of Current Techniques and Concepts in Peripheral Nerve Repair

    Directory of Open Access Journals (Sweden)

    K. S. Houschyar

    2016-01-01

    Full Text Available Patients with peripheral nerve injuries, especially severe injury, often face poor nerve regeneration and incomplete functional recovery, even after surgical nerve repair. This review summarizes treatment options of peripheral nerve injuries with current techniques and concepts and reviews developments in research and clinical application of these therapies.

  11. The Role of Current Techniques and Concepts in Peripheral Nerve Repair.

    Science.gov (United States)

    Houschyar, K S; Momeni, A; Pyles, M N; Cha, J Y; Maan, Z N; Duscher, D; Jew, O S; Siemers, F; van Schoonhoven, J

    2016-01-01

    Patients with peripheral nerve injuries, especially severe injury, often face poor nerve regeneration and incomplete functional recovery, even after surgical nerve repair. This review summarizes treatment options of peripheral nerve injuries with current techniques and concepts and reviews developments in research and clinical application of these therapies.

  12. Upper Eyelid Coloboma Repair Using Accessory Preauricular Cartilage in a Patient With Goldenhar Syndrome: Technique Revisited.

    Science.gov (United States)

    Sinkin, Jeremy C; Yi, Sojung; Wood, Benjamin C; Kwon, Susie; Gavaris, Lauren Z; Gavaris, Paul T; Rogers, Gary F; Sauerhammer, Tina M

    We present an unusual case of upper eyelid coloboma repair in a patient with Goldenhar syndrome. We describe the use of a modified Cutler-Beard flap with concurrent inlay graft using cartilage from a preauricular appendage. This technique provides the benefits of autologous tissue, while minimizing donor site morbidity and reducing the risk of upper eyelid retraction.

  13. Minilaparoscopic technique for inguinal hernia repair combining transabdominal pre-peritoneal and totally extraperitoneal approaches.

    Science.gov (United States)

    Carvalho, Gustavo L; Loureiro, Marcelo P; Bonin, Eduardo A; Claus, Christiano P; Silva, Frederico W; Cury, Antonio M; Fernandes, Flavio A M

    2012-01-01

    Endoscopic surgical repair of inguinal hernia is currently conducted using 2 techniques: the totally extraperitoneal (TEP) and the transabdominal (TAPP) hernia repair. The TEP procedure is technically advantageous, because of the use of no mesh fixation and the elimination of the peritoneal flap, leading to less postoperative pain and faster recovery. The drawback is that TEP is not performed as frequently, because of its complexity and longer learning curve. In this study, we propose a hybrid technique that could potentially become the gold standard of minimally invasive inguinal hernia surgery. This will be achieved by combining established advantages of TEP and TAPP associated with the precision and cosmetics of minilaparoscopy (MINI). Between January and July 2011, 22 patients were admitted for endoscopic inguinal hernia repair. The combined technique was initiated with TAPP inspection and direct visualization of a minilaparoscopic trocar dissection of the preperitoneum space. A10-mm trocar was then placed inside the previously dissected preperitoneal space, using the same umbilical TAPP skin incision. Minilaparoscopic retroperitoneal dissection was completed by TEP, and the surgical procedure was finalized with intraperitoneal review and correction of the preperitoneal work. The minilaparoscopic TEP-TAPP combined approach for inguinal hernia is feasible, safe, and allows a simple endoscopic repair. This is achieved by combining features and advantages of both TAPP and TEP techniques using precise and sophisticated MINI instruments. Minilaparoscopic preperitoneal dissection allows a faster and easier creation of the preperitoneal space for the TEP component of the procedure.

  14. A new technique of arthroscopic subscapularis repair with 2-year clinical outcomes in an Asian population.

    Science.gov (United States)

    Goh Keng Meng, Jeremy; Chen, Jerry Yong Qiang; Lie, Denny Tjiauw Tjoen

    2017-01-01

    Tears of the subscapularis are not as common as the other rotator cuff muscles and hence not as many arthroscopic repair techniques have been previously described in the literature. The purpose of this study is to evaluate the clinical outcomes in patients undergoing arthroscopic subscapularis repairs (with and without repairs of the other cuff muscles) using a technique devised by the senior author of this study. A retrospective study of 40 consecutive patients who underwent arthroscopic subscapularis repair at a single centre, by a single surgeon from 2009 to 2014. All patients were assessed preoperatively and post-operatively at 3, 6, 12 and 24 months. The Visual Analogue Scale (VAS), Constant-Murley Shoulder Score (CMSS), University of California at Los Angeles (UCLA) Shoulder Score and Oxford Shoulder Score (OSS) were recorded and used. At 24 months follow-up, the VAS for pain improved from 6 (±2) points preoperation to 0 (±1) points. The CMSS improved from 41 (±18) points preoperation to 71 (±15). The relative CMSS improved from 55 (±24%) preoperation to 96 (±22%; % of the uninjured side). The ULCA Shoulder Score improved from 15 (±5) points preoperation to 30 (±4). The OSS improved from 28 (±12) points preoperation to 45 (±5). p arthroscopic subscapularis repair in the Asian population.

  15. The "turtleneck" pulley plasty for finger flexor tendon repair.

    Science.gov (United States)

    Goubier, Jean-Noel; Lafosse, Thibault; Teboul, Frédéric

    2014-03-01

    Injuries to the flexor tendons are frequent. Even when correctly treated, they can cause a loss of mobility of the digits secondary to postoperative adhesions. Further, conflicts between the tendon suture and the pulleys can limit the range of motion of the tendon and the flexion of the fingers. We propose a new pulley plasty that permits immediate retraining and avoids conflict with the tendon suture. Ten patients underwent surgery for a tendon injury in zone II, with no lesions of the associated pedicles. The tendons were repaired by a 4-strand stitch technique associated with a continuous peritendinous suture. Pulley plasty was systematically performed on A2, A4, or both. Eight patients recovered a satisfactory range of motion with a finger to palm distance of pulleys was necessary. This plasty technique is simple to carry out, reliable, and reproducible. Because it facilitates tendon repair and reinforces the existing pulleys, it permits immediate retraining and controlled active mobilization.

  16. Suture anchor fixation strength with or without augmentation in osteopenic and severely osteoporotic bones in rotator cuff repair: a biomechanical study on polyurethane foam model

    Science.gov (United States)

    2014-01-01

    Background The purpose of the present study was to compare the results of various types of anchor applications with or without augmentation in both osteopenic and severely osteoporotic bone models. Methods Two different types of suture anchors were tested in severely osteoporotic (SOP) and osteopenic polyurethane (PU) foam blocks using an established protocol. An Instron machine applied static loading parallel to the axis of insertion until failure, and the mean anchor failure strengths were calculated. The mode of failure (anchor pullout, suture tear) was recorded. The anchors tested included the Corkscrew® (CS) (Arthrex Inc., Naples, FL, USA) (without augmentation, polymethylmethacrylate (PMMA)-augmented, and bioabsorbable tricalcium phosphate (TCP) cement-augmented) and Corkscrew® FT II (CS FT II) 5.5 mm (without augmentation as used routinely). Results The mean failure loads for both SOP and osteopenic PU foam blocks, respectively, were as follows: CS, 16.2 and 212.4 N; CS with TCP, 75.2 and 396 N; CS with PMMA, 101.2 and 528.8 N; CS FT II, 13.8 and 339.8 N. Conclusions Augmentation of CS with TCP or PMMA would be essential to SOP bones. In the osteopenic bone model, although anchor fixation augmented with PMMA is the best fixation method, CS augmented with TCP cement or CS FT II without any need for augmentation may also be used as an alternative. PMID:25148925

  17. 'Batman excision' of ventral skin in hypospadias repair, clue to aesthetic repair (point of technique).

    Science.gov (United States)

    Hoebeke, P B; De Kuyper, P; Van Laecke, E

    2002-11-01

    In the hypospadiac penis the ventral skin is poorly developed, while dorsal skin is redundant. The classical Byars' flaps are a way to use the excess dorsal skin to cover the penile shaft. The appearance after Byars' flaps however is not natural. We use a more natural looking skin allocation with superior aesthetic results. The clue in this reconstruction is an inverted triangle shaped excision of ventral skin expanding over the edges of the hooded prepuce (which makes it look like Batman). After excision of the ventral skin it is possible to close the penile skin in the midline, thus mimicking the natural raphe. In case of preputial reconstruction the excised ventral skin makes the prepuce look more natural. The trend of further refining aesthetic appearance of the hypospadiac penis often neglects the penile skin reconstruction. A technique is presented by which the total penile appearances after surgery ameliorates due to better skin reconstruction.

  18. Components separation technique and laparoscopic approach: a review of two evolving strategies for ventral hernia repair.

    Science.gov (United States)

    Gonzalez, Rodrigo; Rehnke, Robert D; Ramaswamy, Archana; Smith, C Daniel; Clarke, John M; Ramshaw, Bruce J

    2005-07-01

    When faced with large ventral hernias, surgeons frequently must choose between higher incidence of recurrence after primary repair and higher incidence of wound complications after repair with mesh. The aim of this study is to compare early outcomes between laparoscopic repair (LR) and components separation technique (CST), two evolving strategies for the management of large ventral hernias. We reviewed 42 consecutive patients who underwent CST and 45 consecutive patients who underwent LR of ventral hernia defects of at least 12 cm2. Demographics, hernia characteristics, and short-term outcomes were compared between groups. Patients in the LR group were younger (53 +/- 2 vs 68 +/- 2 years, P advantage over the CST in terms of incidence of ileus, wound complications, and hospital stay. Because of their unique advantage over traditional hernia repairs, both techniques may play a significant role in the future treatment of large ventral hernias. Adequate training will be essential for the safe and effective implementation of these techniques within the surgical community.

  19. Current Biomechanical Concepts for Rotator Cuff Repair

    Science.gov (United States)

    2013-01-01

    For the past few decades, the repair of rotator cuff tears has evolved significantly with advances in arthroscopy techniques, suture anchors and instrumentation. From the biomechanical perspective, the focus in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. To accomplish these objectives, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. In addition, the healing response may be compromised by intrinsic factors such as decreased vascularity, hypoxia, and fibrocartilaginous changes or aforementioned extrinsic compression factors. Furthermore, it is well documented that torn rotator cuff muscles have a tendency to atrophy and become subject to fatty infiltration which may affect the longevity of the repair. Despite all the aforementioned factors, initial fixation strength is an essential consideration in optimizing rotator cuff repair. Therefore, numerous biomechanical studies have focused on elucidating the strongest devices, knots, and repair configurations to improve contact characteristics for rotator cuff repair. In this review, the biomechanical concepts behind current rotator cuff repair techniques will be reviewed and discussed. PMID:23730471

  20. Femoral fracture repair using a locking plate technique in an adult captive polar bear (Ursus maritimus).

    Science.gov (United States)

    Zimmerman, Dawn M; Dew, Terry; Douglass, Michael; Perez, Edward

    2010-02-01

    To report successful femoral fracture repair in a polar bear. Case report. Female polar bear (Ursus maritimus) 5 years and approximately 250 kg. A closed, complete, comminuted fracture of the distal midshaft femur was successfully reduced and stabilized using a compression plating technique with 2 specialized human femur plates offering axial, rotational, and bending support, and allowing the bone to share loads with the implant. Postoperative radiographs were obtained at 11.5 weeks, 11 months, and 24 months. Bone healing characterized by marked periosteal reaction was evident at 11 months with extensive remodeling evident at 24 months. No complications were noted. Distal mid shaft femoral fracture was reduced, stabilized, and healed in an adult polar bear with a locking plate technique using 2 plates. Previously, femoral fractures in polar bears were considered irreparable. Use of 2 plates applied with a locking plate technique can result in successful fracture repair despite large body weight and inability to restrict postoperative activity.

  1. Biomechanical comparison of tibial eminence fracture fixation with high-strength suture, EndoButton, and suture anchor.

    Science.gov (United States)

    Hapa, Onur; Barber, F Alan; Süner, Ganim; Özden, Raif; Davul, Serkan; Bozdağ, Ergun; Sünbüloğlu, Emin

    2012-05-01

    To biomechanically compare anterior cruciate ligament (ACL) tibial bony avulsion fixation by suture anchors, EndoButtons (Smith & Nephew, Andover, MA), and high-strength sutures subjected to cyclic loading. Type III tibial eminence fractures were created in 49 ovine knees, and 7 different types of repairs were performed. Each repair group contained 7 specimens. The repair groups were as follows: No. 2 FiberWire (Arthrex, Naples, FL); No. 2 UltraBraid (Smith & Nephew); No. 2 MaxBraid (Arthrotek, Warsaw, IN); No. 2 Hi-Fi (ConMed Linvatec, Largo, FL); No. 2 OrthoCord (DePuy Mitek, Raynham, MA); Ti-Screw suture anchor (Arthrotek); and titanium EndoButton. These constructs were cyclically loaded (500 cycles, 0 to 100 N, 1 Hz) in the direction of the native ACL and loaded to failure (100 mm/min). Endpoints included ultimate failure load (in Newtons); pullout stiffness (in Newtons per millimeter); cyclic displacement (in millimeters) after 100 cycles, between 100 and 500 cycles, and after 500 cycles; and mode of failure. Bone density testing was performed in all knees. Bone density was not different among the groups. The EndoButton group had a higher ultimate failure load than the FiberWire, UltraBraid, Hi-Fi, and suture anchor groups (P suture anchor group (P suture anchor group had less displacement than the Hi-Fi and FiberWire groups (P suture rupture. Under cyclic loading conditions in an ovine model, EndoButton fixation of tibial eminence fractures provided greater initial fixation strength than suture anchor fixation or fixation with various high-strength sutures except for OrthoCord. During initial cyclic loading of ACL tibial eminence fractures, the strength of the repair construct should be taken into consideration because conventional suture repair even with ultrahigh-molecular-weight polyethylene sutures may not provide enough strength. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. Sutureless off-pump repair of post-infarction left ventricular free wall rupture

    Directory of Open Access Journals (Sweden)

    Butler Rob

    2006-05-01

    Full Text Available Abstract Left ventricular free wall rupture after myocardial infarction has a high mortality. Suturing techniques of repair may be technically difficult and require cardiopulmonary bypass. We report a case of left ventricular rupture in a 47 year old man managed off pump employing a sutureless technique with Gelatine-Resorcin-Formalin glue and bovine pericardial patches.

  3. A biomechanic study of the surgical repair technique of pars defect in spondylolysis.

    Science.gov (United States)

    Vathana, P; Prasartritha, T

    1998-11-01

    To find out which wiring technique of direct repair of the pars defect is the strongest in resisting anteroposterior translation displacement, fifteen fresh human cadaveric L4-L5 spines were biomechanically tested by a universal testing machine. Two millimeters wide pars defect was created on both sides of L4 vertebrae. Each of the five specimens was wired using Nicol's technique (A), modified Nicol's technique (B) and modified pedicular screw technique respectively (C). At each test, motion was observed to occur initially at the pars defect. The mean minimum tensile strength (increment of the pars defect) for technique A, B and C was 87.64, 82.04 and 110.08 Kg Force respectively. By statistical analysis, technique C was the strongest in resisting anteroposterior displacement of the spinal column. There was no statistically significant difference between technique A and B.

  4. Fratura proximal de tíbia após cirurgia extracapsular para correção de ruptura de ligamento cruzado cranial em cão Tibial fracture caused by complications after an extracapsular suture for the repair of cranial cruciate ligament rupture in a dog

    Directory of Open Access Journals (Sweden)

    Jaqueline França dos Santos

    2013-03-01

    Full Text Available Ruptura de ligamento cruzado cranial (RLCCr é a afecção ortopédica mais frequente no joelho de cães e a sutura fabelo-tibial é frequentemente utilizada na sua correção. Essa técnica pode estar associada com complicações incisionais, lesão tardia de menisco, edema associado ao material de sutura e infecção. O objetivo desta nota foi relatar a ocorrência de fratura proximal de tíbia em um cão, causada por complicação em sutura fabelo-tibial para correção de RLCCr. Um canino atendido em outro serviço foi submetido à osteossíntese com placa 2,0mm para correção de complicação em técnica extra-capsular, na qual houve fratura da tíbia na região do orifício criado para confecção da sutura fabelo-tibial. Houve falha dos implantes e a placa foi removida. A fratura foi estabilizada com fixador esquelético externo circular, sendo constatada, após 120 dias, consolidação.Cranial cruciate ligament rupture (CCLR is one of the most common orthopedic diseases in dogs and extracapsular suture with nylon is often used for its correction. This technique may be associated with incisional complications, post-surgical meniscus injury, swelling associated with suture material and infection. The objective of this study is to report a tibial fracture in a dog, caused by complications after an extracapsular suture for the repair of CCLR. An adult dog, which suffered a tibial fracture after an extracapsular fixation for a CCLR, underwent surgery for the fixation of the fracture with a 2.0mm plate, by a referring veterinarian, but the implant failed. The plate was removed and the fracture was stabilized with a circular fixator. Bone consolidation was observed after 120 days.

  5. Congenital superior sternal cleft repair using our modified Sally technique: A case report

    Directory of Open Access Journals (Sweden)

    Tomoyuki Kuwata

    2014-12-01

    Full Text Available We report the case of an 8-month-old male neonate who underwent reconstructive surgery for a congenital superior sternal cleft to decrease the risk of commotio cordis. With regard to use of the Sally technique for the repair of a relatively wide cleft (4 × 4 cm, we were concerned about respiratory problems caused by compression following closure of the sternal halves. By closing the sternal halves imperfectly, elevation of intrapleural pressure can be avoided to some extent. By bridging the surplus resected cartilage from the lower sternum over the gap of the upper sternum, the heart is protected by more rigid material. We recommend our modified Sally technique because it is both flexible and effective for sternal cleft repair.

  6. Intrastromal corneal suture for small incision cataract surgery.

    Science.gov (United States)

    Chipont Benabent, E; Artola Roig, A; Martínez Toldos, J J

    1996-01-01

    Proper wound closure is important in preventing postoperative endophthalmitis. We developed an intrastromal corneal suture technique that uses some principles of the running, locked, intradermal suture for light-tension skin wounds. It achieves close approximation of the wound edges, reduces postoperative wound care and the risk of wound infection in clean surgical wounds, and obviates suture removal. It may also help prevent endophthalmitis and early against-the-rule astigmatism without the complications associated with external suture exposure.

  7. A new technique for interrupted aortic arch repair: the Neville tube.

    Science.gov (United States)

    Bergoënd, Eric; Bouissou, Antoine; Paoli, Florent; Roullet-Renoleau, Nicolas; Duchalais, Alain; Neville, Paul

    2010-10-01

    We have developed a new technique for interrupted aortic arch repair in which the pulmonary artery anterior wall is cut off and tailored so as to re-establish aortic continuity with an autologous tube. We are describing this method herein, with an 8-year follow-up of the first patient. Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Repair of a Perforated Sinus Membrane with a Subepithelial Palatal Conjunctive Flap: Technique Report and Evaluation

    OpenAIRE

    Gehrke, S. A.; Taschieri, S.; Del Fabbro, M.; Corbella, S.

    2012-01-01

    The maxillary sinus grafting procedure has proven to be an acceptable modality for bone augmentation to provide a base for endosseous implants, routinely used for the rehabilitation of posterior maxilla. Perforation of the membrane is the most common complication in this type of procedure. This paper presents a technique for repairing a perforated Schneiderian membrane with a conjunctive connective tissue graft harvested from the palate and shows the histological and radiographic evaluation o...

  9. Outcomes of Bankart Repairs Using Modern Arthroscopic Technique in an Athletic Population.

    Science.gov (United States)

    Milchteim, Charles; Tucker, Scott A; Nye, Darin D; Lamour, Richard J; Liu, Wei; Andrews, James R; Ostrander, Roger V

    2016-07-01

    To report a large number of highly active patients who underwent arthroscopic Bankart repair at our institution over the last decade. A retrospective analysis of patients who underwent primary and revision arthroscopic Bankart repairs using bioabsorbable anchors was performed. Outcome measures included recurrence of dislocation, American Shoulder and Elbow Scores (ASES), Rowe, visual analog scale (VAS), return to sports, and satisfaction scores. A total of 94 shoulders met the inclusion criteria. The recurrence rate was 6/94 (6.4%) at a mean follow-up of 5 years (range, 3 to 8.3). The mean postoperative scores were as follows: ASES = 91.5/100; Rowe = 84.3/100; VAS = 0.8/10; satisfaction = 8.8/10. In those who attempted to return to sports, 82.5% were able to return to the same level of competition. Statistical analyses revealed a significant increase in risk of recurrence among high school and recreational athletes. No recurrences were observed among professional or college-level athletes. No significant difference in recurrence rates was observed in regards to age, time to surgery, type of athlete (collision v limited contact), repair of SLAP lesion, number of anchors, or revision surgery. Although several repair techniques exist for traumatic anterior shoulder instability, arthroscopic repair remains a viable option even in a highly active patient population. This study uniquely identified high school and recreational athletes at higher risk for recurrence. This is perhaps due to inferior shoulder development and technique as well as to limited access to postoperative physical therapy. Level IV, therapeutic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  10. Comparison of inside-out and all-inside techniques for the repair of isolated meniscal tears: a systematic review.

    Science.gov (United States)

    Grant, John A; Wilde, Jeff; Miller, Bruce S; Bedi, Asheesh

    2012-02-01

    Arthroscopic meniscal repair techniques are continuing to evolve. Most studies to date comparing the healing rate of inside-out to all-inside meniscal repair techniques are confounded by associated anterior cruciate ligament reconstruction or deficiency. This review was conducted to compare the effectiveness and complications of the inside-out repair technique to that of the all-inside repair technique in isolated unstable peripheral longitudinal ("bucket-handle") meniscal tears. Systematic review. Computerized keyword searches of MEDLINE, EMBASE, CINAHL, ACP Journal Club, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews were performed. Two reviewers independently performed searches and article reduction. Studies that included stratified data for isolated unstable longitudinal meniscal tears in stable knees, repaired with either an inside-out or all-inside repair technique, were selected. Data on clinical failure, subjective outcome measures, and complications were summarized. Nineteen studies included data specific to isolated meniscal tears. The rate of clinical failure was 17% for inside-out repairs and 19% for all-inside repairs. Lysholm scores and Tegner activity scores were similar between the 2 repair methods (87.8 vs 90.2 and 5.6 vs 5.5, respectively). The prevalence of nerve injury/irritation was higher with the inside-out technique (9% vs 2%). All-inside techniques had a higher rate of local soft tissue irritation, swelling, and implant migration or breakage. The use of older generation, rigid, all-inside implants is associated with chondral injury. There are no differences in clinical failure rate or subjective outcome between inside-out and all-inside meniscus repair techniques. Complications are associated with both techniques. More nerve symptoms are associated with the inside-out repair and more implant-related complications are associated with the all-inside technique. Rates of structural healing

  11. Horizontal running mattress suture modified with intermittent simple loops.

    Science.gov (United States)

    Chacon, Anna H; Shiman, Michael I; Strozier, Narissa; Zaiac, Martin N

    2013-01-01

    Using the combination of a horizontal running mattress suture with intermittent loops achieves both good eversion with the horizontal running mattress plus the ease of removal of the simple loops. This combination technique also avoids the characteristic railroad track marks that result from prolonged non-absorbable suture retention. The unique feature of our technique is the incorporation of one simple running suture after every two runs of the horizontal running mattress suture. To demonstrate its utility, we used the suturing technique on several patients and analyzed the cosmetic outcome with post-operative photographs in comparison to other suturing techniques. In summary, the combination of running horizontal mattress suture with simple intermittent loops demonstrates functional and cosmetic benefits that can be readily taught, comprehended, and employed, leading to desirable aesthetic results and wound edge eversion.

  12. Replacement of a string jejunostomy if the suture is lost: first time a technique with no need to cut.

    Science.gov (United States)

    De Bernardis, Gaston; Mayr, Johannes

    2013-06-01

    The aim of the study was to present the first case of replacement of a string jejunostomy with an enteroscopic percutaneous technique after the string was lost. The replaceable string jejunostomy is a well-established method for the enteral feeding in patients where the swallowing process is impaired and gastroesophageal reflux impedes the option of a gastrostomy. In the frequent case of obstruction, rupture or malfunction of the jejunostomy, it is easily replaced in an outpatient setting without anesthesia, with the help of the string that holds the tip of the feeding tube in place. In our case the string was lost. The jejunostomy was replaced with a fully percutaneous technique with the help of a pediatric cystoscope. This technique is well practicable and obviated the need for a laparotomy in a polymorbid patient. The technique seems promising, but we report an anecdotal case description. Further experience is needed to investigate its safety.

  13. Meniscal repair by all-inside technique with Fast-Fix device

    Directory of Open Access Journals (Sweden)

    Leonardo Jose Bernardes Albertoni

    2013-09-01

    Full Text Available OBJECTIVE: The objective of this study is to evaluate the results and effectiveness of the technique of meniscal repair type all-inside using Fast-Fix device. METHODS: A retrospective cohort study evaluating 22 patients with meniscal surgery between January 2004 and December 2010 underwent meniscal repair technique for all-inside with the Fast-Fix device with or without ACL reconstruction. Function and quality of life outcomes were chosen by the IKDC and Lysholm score, before and postoperatively, and reoperation rates, relying to the time of final follow-up. Statistical analysis was performed using the Student's t test. RESULTS: The mean follow-up was 59 months (16-84. The Lysholm score showed 72% (16 patients of excellent and good results (84-100 points, 27% (6 patients fair (65-83 points and no cases classified as poor (<64 points. According to the IKDC: 81% (18 patients of excellent and good results (75-100 points, 18% of cases regular (50-75 points and no patient had poor results (<50 points. There were no failures or complications. CONCLUSION: The technique of meniscal repair type all-inside using the Fast-Fix device is safe and effective for the treatment of meniscal lesions in the red zone or red-white with or without simultaneous ACL reconstruction, with good and excellent results in most patients Level 4 Study.

  14. Comparison of Barbed Sutures in Porcine Flexor Tenorrhaphy

    OpenAIRE

    Sull, Alan; Inceoglu, Serkan; August, Alicia; Gregorius, Stephen; Wongworawat, Montri D.

    2016-01-01

    Background: Barbed suture use has become more popular as technology and materials have advanced. Minimal data exist regarding performance of the 2 commercially available products, V-LocTM and StratafixTM in tendon repairs. The purpose of this study was to compare gap resistance and ultimate tensile strength of both suture materials and nonbarbed suture in a porcine ex vivo model. Methods: Porcine flexor tendons were harvested and divided into 3 groups of 10 of varying suture material (3-0 PDS...

  15. The initial experience of introducing the Onstep technique for inguinal hernia repair in a general surgical department

    DEFF Research Database (Denmark)

    Andresen, K; Burcharth, Jakob Hornstrup Frølunde; Rosenberg, J

    2015-01-01

    BACKGROUND AND AIMS: A new technique for the repair of inguinal hernia, called Onstep, has been described. This technique places the mesh in the preperitoneal space medially and between the internal and external oblique muscles laterally. The Onstep technique has not yet been described outside...... the inventors' departments. This study was based on the first 80 patients operated by the Onstep technique in a general surgical department. The objective of the study was to investigate postoperative pain and complications following the Onstep repair of inguinal hernia. MATERIAL AND METHODS: A total of 80...... repair. Inguinal Pain Questionnaire results: 95.5% reported no pain or pain that was easily ignored. CONCLUSIONS: It seems from this study that the Onstep technique is a safe method for inguinal hernia repair regarding perioperative and postoperative complications. The postoperative pain seems...

  16. Cut-and-place technique of pterygium excision with autograft without using sutures or glue: Our experience

    Directory of Open Access Journals (Sweden)

    Jagdish Bhatia

    2017-01-01

    CONCLUSION: This simple technique for pterygium surgery is not only cost effective and quick but also may prevent potential adverse reactions encountered with the use of foreign materials and in this large series provided safe and comparable results to current methods.

  17. One-Step Cartilage Repair Technique as a Next Generation of Cell Therapy for Cartilage Defects: Biological Characteristics, Preclinical Application, Surgical Techniques, and Clinical Developments.

    Science.gov (United States)

    Zhang, Chi; Cai, You-Zhi; Lin, Xiang-Jin

    2016-07-01

    To provide a comprehensive overview of the basic science rationale, surgical technique, and clinical outcomes of 1-step cartilage repair technique used as a treatment strategy for cartilage defects. A systematic review was performed in the main medical databases to evaluate the several studies concerning 1-step procedures for cartilage repair. The characteristics of cell-seed scaffolds, behavior of cells seeded into scaffolds, and surgical techniques were also discussed. Clinical outcomes and quality of repaired tissue were assessed using several standardized outcome assessment tools, magnetic resonance imaging scans, and biopsy histology. One-step cartilage repair could be divided into 2 types: chondrocyte-matrix complex (CMC) and autologous matrix-induced chondrogenesis (AMIC), both of which allow a simplified surgical approach. Studies with Level IV evidence have shown that 1-step cartilage repair techniques could significantly relieve symptoms and improve functional assessment (P step cartilage repair technique, with its potential for effective, homogeneous distribution of chondrocytes and multipotent stem cells on the surface of the cartilage defect, is able to regenerate hyaline-like cartilage tissue, and it could be applied to cartilage repair by arthroscopy. Level IV, systematic review of Level II and IV studies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  18. Development and validation of nondestructive inspection techniques for composite doubler repairs on commercial aircraft

    Energy Technology Data Exchange (ETDEWEB)

    Roach, D.; Walkington, P.

    1998-05-01

    Composite doublers, or repair patches, provide an innovative repair technique which can enhance the way aircraft are maintained. Instead of riveting multiple steel or aluminum plates to facilitate an aircraft repair, it is possible to bond a single boron-epoxy composite doubler to the damaged structure. In order for the use of composite doublers to achieve widespread use in the civil aviation industry, it is imperative that methods be developed which can quickly and reliably assess the integrity of the doubler. In this study, a specific composite application was chosen on an L-1011 aircraft in order to focus the tasks on application and operation issues. Primary among inspection requirements for these doublers is the identification of disbonds, between the composite laminate and aluminum parent material, and delaminations in the composite laminate. Surveillance of cracks or corrosion in the parent aluminum material beneath the doubler is also a concern. No single nondestructive inspection (NDI) method can inspect for every flaw type, therefore it is important to be aware of available NDI techniques and to properly address their capabilities and limitations. A series of NDI tests were conducted on laboratory test structures and on full-scale aircraft fuselage sections. Specific challenges, unique to bonded composite doubler applications, were highlighted. An array of conventional and advanced NDI techniques were evaluated. Flaw detection sensitivity studies were conducted on applicable eddy current, ultrasonic, X-ray and thermography based devices. The application of these NDI techniques to composite doublers and the results from test specimens, which were loaded to provide a changing flaw profile, are presented in this report. It was found that a team of these techniques can identify flaws in composite doubler installations well before they reach critical size.

  19. Parastomal hernia repair with the Sugarbaker technique using e-PTFE mesh.

    Science.gov (United States)

    Funayama, Yuji; Takahashi, Ken-Ichi; Ikezawa, Fumie; Haneda, Sho; Saijo, Fumito; Saito, Masumi; Tokumura, Hiromi

    2016-01-01

    Although surgery is commonly used to treat parastomal hernia, it is very difficult and has shown poor results. Recently, repair with prosthetic materials has been thought to be a more promising method. The Sugarbaker technique with e-PTFE mesh (Dualmesh(®)) performed via open surgery was adopted for seven patients with parastomal hernia. Two of them were recurrent cases. Three of the patients experienced incarceration of the intestine and recovered conservatively before surgery. The median age of the patients at the parastomal hernia repair was 77.6 years old (range 37.7-84.7). The median operative time was 211 min (range 147-256). The median hernia size was 28 cm(2) (range 7.5-60 cm(2)). The median amount of blood loss during the operation was 158 g (range 0-370 g). Surgical site infection was not observed. The postoperative median hospital stay was 17 days (range 13-40) and the median follow-up was 2.4 years (range 1.0-3.7). During the follow-up period, we did not observe recurrence or readmission. The surgical results were satisfactory with minimal morbidity and no recurrences. The Sugarbaker technique for parastomal repair using e-PTFE mesh may be suitable as a standard method for treating parastomal hernia.

  20. Reconstruction of displaced acromio-clavicular joint dislocations using a triple suture-cerclage: description of a safe and efficient surgical technique

    National Research Council Canada - National Science Library

    Sandmann, Gunther H; Martetschläger, Frank; Mey, Lisa; Kraus, Tobias M; Buchholz, Arne; Ahrens, Philipp; Stöckle, Ulrich; Freude, Thomas; Siebenlist, Sebastian

    2012-01-01

    ...) cerclages and one coracoclavicular (CC) cerclage with resorbable sutures. Between 2007 and 2009 a total of 39 patients fit the inclusion criteria after operative treatment of acute AC joint dislocation...

  1. Relationship of tibial plateau slope to limb function in dogs treated with a lateral suture technique for stabilization of cranial cruciate ligament deficient stifles.

    Science.gov (United States)

    Havig, Marc E; Dyce, Jonathan; Kowaleski, Michael P; Reynolds, Lisa R; Budsberg, Steven C

    2007-04-01

    To evaluate the effect of a lateral suture technique (LST) on tibial plateau angle (TPA) measurement and to compare TPA with functional outcome in dogs treated for cranial cruciate ligament (CrCL) rupture with LST. Prospective clinical study. Dogs (n=34) with unilateral CrCL instability. All dogs had lameness examination, survey stifle radiographs, and force plate analysis before and at 6, 12, 24, and 48 weeks after surgery. Radiographic osteoarthritis (OA) scores and lameness scores were assigned using previously reported methods. Preoperative radiographs were performed in all dogs, and postoperative serial radiographs were performed in 6 dogs for measurement of TPA. Differences in TPA measurements were evaluated with a random effects repeated measures model. The significance of LST on TPA measurement was established in 6 dogs and the effect of TPA on vertical impulse, peak vertical force, progression of radiographic scores, and lameness score were analyzed by general linear models in all dogs. Differences were considered significant if P<.05. Significant differences were not noted between pre- and serial postoperative measurements of TPA. A significant correlation was not established between TPA and postoperative vertical impulse, peak vertical force, lameness score, or radiographic OA scores. TPA values were unchanged after LST and TPA does not affect outcome measures in dogs treated with LST. TPA has no predictive value on clinical outcome in dogs treated with LST for stabilization of CrCL deficient stifles.

  2. Nonsuture dural repair using polyglycolic acid mesh and fibrin glue: clinical application to spinal surgery

    OpenAIRE

    Hida, Kazutoshi; Yamaguchi, Satoshi; Seki, Toshitaka; Yano, Shunsuke; Akino, Minoru; Terasaka, Shunsuke; Uchida, Takanori; Iwasaki, Yoshinobu

    2006-01-01

    Background: In spinal surgery, repair of the dura is difficult when it is torn, fragile, or is ossified as in cases with OPLL. We report our experience with a non-suture dural repair technique in patients undergoing spinal surgery; it employs a dura substitute composed of polyglycolic acid (PGA) mesh and fibrin glue. Here we report the efficacy and safety of non-suture duroplasty using PGA mesh and fibrin glue (PGA-fibrin sheet). Methods: The artificial dura mater is composed o...

  3. Our experience of proximal hypospadias repair using the Cloutier–Bracka technique at the Gynaeco-Obstetric and Paediatric Hospital, Yaounde-Cameroon

    Directory of Open Access Journals (Sweden)

    Mouafo Tambo Faustin Felicien

    2016-01-01

    Full Text Available Background: In parts of Africa, routine circumcision is practised and sometimes even on children with hypospadias. The lack of preputial foreskin renders urethroplasty more difficult and often requires to use of a mucosal graft as described by Bracka. Objective: The authors describe their experience of hypospadias repair using Bracka's technique. Materials and Methods: Over a period of 5 years, 100 cases of proximal hypospadias were operated in our institution. All patients aged 0–18 years who had already been circumcised were included in this study. Results: The outcome of the 12 cases operated according to Bracka's technique was analysed. The mean age was 11.5 years. The ectopic meatus was penoscrotal in three cases, scrotal in one case and perineal in eight cases. After reconstruction, the new meatus was sutured at the top of the glans in one case, at the prepuce in seven cases and at the penile midshaft in one case. The main complications noted were surgical site infection, wound dehiscence, residual chordee and urethrocutaneous fistula. No neourethral stenosis nor uretrocele was recorded. Discussion: The buccal mucosal graft urethroplasty as described by Bracka is associated with a lower risk of meatal strictures compared to other free mucosal grafts. The buccal mucosa is easier to harvest and causes less scarring than bladder mucosa. Conclusion: Repair of severe hypospadias remains a challenge for paediatric surgeons. The functional and cosmetic outcomes depend on the choice of the donor site for the graft and objective assessment of successful reconstruction criteria during follow-up.

  4. Petit lumbar hernia--a double-layer technique for tension-free repair.

    Science.gov (United States)

    Bigolin, André Vicente; Rodrigues, André Petter; Trevisan, Camila Gueresi; Geist, Ana Brochado; Coral, Roberto Viña; Rinaldi, Natalino; Coral, Roberto Pelegrini

    2014-01-01

    This report describes an alternative technique for Petit hernia repair. The treatment of lumbar hernias should follow the concept of tension-free surgery, and the preperitoneal space can be the best place for prosthesis placement. An obese patient had a bulge in the right lumbar region, which gradually grew and became symptomatic, limiting her daily activities and jeopardizing her quality of life. She had previously undergone 2 surgical procedures with different incisions. We created a preperitoneal space and attached a mesh in this position. Another prosthesis was placed on the muscles, with a suitable edge beyond the limits of the defect. There were no complications. It has been described as a safe and tension-free repair for Petit hernia. In larger defects, a second mesh can be used to prevent further enlargement of the triangle and also to provide additional protection beyond the bone limits.

  5. Petit Lumbar Hernia—a Double-Layer Technique for Tension-Free Repair

    Science.gov (United States)

    Bigolin, André Vicente; Rodrigues, André Petter; Trevisan, Camila Gueresi; Geist, Ana Brochado; Coral, Roberto Viña; Rinaldi, Natalino; Coral, Roberto Pelegrini

    2014-01-01

    This report describes an alternative technique for Petit hernia repair. The treatment of lumbar hernias should follow the concept of tension-free surgery, and the preperitoneal space can be the best place for prosthesis placement. An obese patient had a bulge in the right lumbar region, which gradually grew and became symptomatic, limiting her daily activities and jeopardizing her quality of life. She had previously undergone 2 surgical procedures with different incisions. We created a preperitoneal space and attached a mesh in this position. Another prosthesis was placed on the muscles, with a suitable edge beyond the limits of the defect. There were no complications. It has been described as a safe and tension-free repair for Petit hernia. In larger defects, a second mesh can be used to prevent further enlargement of the triangle and also to provide additional protection beyond the bone limits. PMID:25216420

  6. Urethral advancement technique for repair of distal penile hypospadias: A revisit

    Directory of Open Access Journals (Sweden)

    Awad Mohamed

    2006-01-01

    Full Text Available Background: Numerous ingenious methods have been described to repair hypospadias with variable results. The anterior urethral advancement technique reported by Chang[1] to repair distal hypospadias has shown encouraging results. We have reevaluated this technique with some modifications to improve its results. Materials and Methods: This study was done on 72 patients, 19 cases with glanular hypospadias, 20 cases with co