Sample records for suture techniques

  1. Suture materials and suture techniques used in tendon repair. (United States)

    Ketchum, L D


    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. [Predictable tip suture techniques in rhinoplasty]. (United States)

    Papel, I D


    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.

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

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    Kamath B


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

  4. The hidden X suture: a technical note on a novel suture technique for alveolar ridge preservation. (United States)

    Park, Jung-Chul; Koo, Ki-Tae; Lim, Hyun-Chang


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

  5. Suture techniques in nasal tip sculpture: current concepts. (United States)

    Lo, S; Rowe-Jones, J


    The three-dimensional anatomy and conspicuous location of the nasal tip makes it one of the most challenging sites of facial plastic surgery. This article reviews literature on nasal tip sculpture using suture techniques, as well as the authors' own experience. A search was conducted using Pubmed, the Google internet search engine and the authors' files, using the keywords 'nasal tip', 'suture', 'rhinoplasty' and 'septorhinoplasty'. Common nasal tip suture techniques and suture algorithms are presented, along with a summary of the indications and side effects of each technique. Predictable long-term results are more likely to occur with minimal local tissue excision. Suture techniques remodel the shape of the nasal tip by altering the configuration of, and the relationship between, the tip cartilages and their supporting structures; they also preserve nasal tip anatomy and limit resection. Intra-operatively, the effects are immediately visible, and can be adjusted or reversed. Tip sutures should therefore be considered instead of tissue excision whenever possible.


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    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

  7. An absorbable thread suture technique to treat snoring. (United States)

    Kwon, Jang-Woo; Kong, Tae-Hoon; Ha, Tae-Hyoung; Park, Dong-Joon


    We investigated a novel, minimally invasive surgery that uses an absorbable suture technique to treat snoring and mild obstructive sleep apnea. This simple procedure was developed to increase the stiffness of the soft palate and to promote uvula elevation with sutures. Thirty-five snorer and mild obstructive sleep apnea syndrome patients were included in this study. The palate was sutured with the newly developed technique. The results of our surgery were evaluated using polysomnography (PSG), the Epworth sleepiness scale (ESS), and a visual analogue scale (VAS) before surgery and 90 days after surgery. One year after surgery, telephone interviews were performed to assess patient satisfaction. Postoperative physical examinations of all patients showed increased stiffness of the soft palate and superiorly displaced uvula. These findings were consistent after the postoperative day 90. The patients' snoring symptoms and their bed partners' complaints, assessed by ESS and VAS, significantly improved compared to the pre-treatment value (p snoring and mild obstructive sleep apnea.

  8. Effects of three suture techniques on complications after choledochojejunostomy

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    ZHOU Jinhang


    Full Text Available ObjectiveTo observe the effects of different suture techniques on complications after choledochojejunostomy. MethodsA retrospective analysis was performed on the clinical data of 162 patients who underwent choledochojejunostomy from January 2005 to December 2014 in our hospital. The patients were divided into group A undergoing simple interrupted suture (n=68, group B undergoing simple continuous suture (n=45, and group C undergoing parachute type continuous suture (n=49. The intraoperative conditions and postoperative complications were compared between the three groups. Comparison of continuous data between the three groups was made by ANOVA and pairwise comparison between any two groups was made by LSD t-tests; comparison of categorical data between the groups was made by chi-square test. ResultsThe anastomosis time and the rate of T-tube insertion showed significant differences between the three groups (P<0.05. Groups B and C had significantly shorter anastomosis time than group A(P<0.001, but there was no significant difference in the anastomosis time between groups B and C (P>0.05. Among the three groups, group A had the highest rate of T-tube insertion; group B had the second highest rate; group C had the lowest rate. Significant differences were found between any two groups in the rate of T-tube insertion by pairwise comparison (P<0.05. However, there were no significant differences between the three groups in the incidence rates of postoperative bile leakage and choleperitonitis (P>0.05. There was significant difference in biliary stricture between the three groups in the follow-up examination 6 months after surgery (P<0.001 and the differences analyzed by pairwise comparison were also significant (P<0.05. Among the three groups, the degree of biliary stricture in the group A was the highest and that in the group C was the lowest. ConclusionParachute-type continuous suture is a fine suture technique for

  9. The Strength of Transosseous Medial Meniscal Root Repair Using a Simple Suture Technique Is Dependent on Suture Material and Position. (United States)

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


    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

  10. Single Incision Distal Biceps Repair With Hemi-Krackow Suture Technique: Surgical Technique and Early Outcomes


    Goljan, Peter; Patel, Nimit; Stull, Justin D.; Donnelly, Brandon P.; Culp, Randall W.


    Background: Many surgical methods exist for distal biceps repair. We present the technique and early outcomes of a series of distal biceps repairs completed with a novel suturing technique utilizing a hemi-Krackow locking stitch at the tendon-bone interface. Methods: A retrospective review was performed of patients who underwent primary distal biceps repair using a single anterior incision with 2 suture anchors utilizing a hemi-Krackow stitch. With both anchors, a locking stitch along the ten...

  11. The impact of different peripheral suture techniques on the biomechanical stability in flexor tendon repair. (United States)

    Wieskötter, B; Herbort, M; Langer, M; Raschke, M J; Wähnert, D


    Flexor tendon repair consists of circumferential peripheral sutures in combination with core sutures to avoid fraying and reduces the exposure of suture material on tendon surface. The peripheral suture adds up to a tenfold increase of the biomechanical stability compared to the core suture alone. The purpose of our study was to determine the most favourable peripheral repair technique for tendon repair. Seventy-two porcine flexor tendons underwent standardized tenotomy and repair using one of the following six methods (n = 12): simple-running (SR), simple-locking (SL), Halsted-mattress (HM), lin-locking (LL), Lembert-mattress (LM), and Silfverskiöld cross-stich (SCS) suture technique. The SL- suture was placed 2 mm; the HM, LM, SC, and LL suture were placed 5 mm from the tendon gap. The SR suture was placed 1, 2, and 3 mm from tendon ends; no additional core suture was applied. For cyclic testing (1000 cycles), elongation was calculated; for load to failure construct stiffness, yield load and maximum load were determined. The mean cyclic elongation for all tested suture techniques was less than 2 mm; there was no significant difference between the groups regarding elongation as well as yield load. The HM, LM, SCS, and LL suture techniques presented significantly higher maximum loads compared to the SR- and SL-sutures. The 3 mm SR showed significantly higher maximum loads compared to the 2 and 1 mm SR. Beside the distance from tendon gap, the type of linkage of the suture material across and beneath the epitendineum is important for biomechanical stability. Simple-running suture is easy to use, even with a slight increase of the distance from tendon gap significantly increases biomechanical strength. For future repairs of flexor tendon injuries, 3 mm stitch length is highly recommended for simple peripheral suture, while the Halsted-mattress suture unites the most important qualities: biomechanically strong, most part of suture material placed

  12. Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part I: primary rhinoplasty. (United States)

    Daniel, R K


    Tip suture techniques offer a reliable and dramatic method of tip modification without needing to interrupt the alar rim strip or add tip grafts. The present simplified three-stitch technique consists of the following: (1) a strut suture to fix the columella strut between the crura, (2) bilateral domal creation sutures to create tip definition, and (3) a domal equalization suture to narrow and align the domes. If required, columella septal sutures can be added; either a dorsal rotational suture or a transfixion projection suture can be used. This simplified method represents a refinement based on more than 13 years of experience with tip suture techniques. It does not require a complex operative sequence or specialized sutures. Primary indications are moderate tip deformities of inadequate definition and excessive width and certain specific tip deformities, including the parenthesis tip and nostril/tip disproportion. The primary contraindications are for patients with minor tip deformities that are best done through a closed approach and those with severe tip deformities requiring an open structure graft. The technique is simple, efficacious, and easily learned.

  13. Biomechanical testing of new meniscal repair techniques containing ultra high-molecular weight polyethylene suture. (United States)

    Barber, F Alan; Herbert, Morley A; Schroeder, F Alexander; Aziz-Jacobo, Jorge; Sutker, Michael J


    To evaluate the biomechanical characteristics of current meniscal repair techniques containing ultra high-molecular weight polyethylene (UHMWPE) suture with and without cyclic loading. Vertical longitudinal cuts made in porcine menisci were secured with a single repair device. Noncycled and cycled (500 cycles) biomechanical tests were performed on the following groups: group 1, No. 2-0 Mersilene vertical suture (Ethicon, Somerville, NJ); group 2, No. 2-0 Orthocord vertical suture (DePuy Mitek, Westwood, MA); group 3, No. 0 Ultrabraid vertical suture (Smith & Nephew Endoscopy, Andover, MA); group 4, No. 2-0 FiberWire vertical suture (Arthrex, Naples, FL); group 5, vertically oriented mattress suture by use of an Ultra FasT-Fix device (Smith & Nephew Endoscopy) with No. 0 Ultrabraid; group 6, vertically oriented mattress suture by use of a RapidLoc A2 device (DePuy Mitek) with No. 2-0 Orthocord suture; group 7, vertically oriented stitch by use of a MaxFire device with MaxBraid PE suture (Biomet Sports Medicine, Warsaw, IN); and group 8, an obliquely oriented stitch of No. 0 UHMWPE suture inserted by use of a CrossFix device (Cayenne Medical, Scottsdale, AZ). Endpoints were failure loads, failure modes, stiffness, and cyclic displacement. Mean single-pull loads were calculated for Ultra FasT-Fix (121 N), FiberWire (110 N), MaxFire (130 N), Mersilene (84 N), Orthocord (124 N), RapidLoc A2 (86 N), CrossFix (77 N), and Ultrabraid (109 N). After 500 cyclic loads, the Orthocord (222 N) repair was stronger than the others: Ultra FasT-Fix (110 N), FiberWire (117 N), MaxFire (132 N), Mersilene (89 N), RapidLoc A2 (108 N), CrossFix (95 N), and Ultrabraid (126 N) (P Fix, RapidLoc A2, and MaxFire) were comparable to the isolated UHMWPE-containing suture repairs on single-failure load testing. UHMWPE-containing suture repairs are stronger than braided polyester suture repairs, but pure UHMWPE suture (Ultrabraid) elongated more during cycling. Orthocord suture is significantly

  14. The Roman Bridge: a "double pulley – suture bridges" technique for rotator cuff repair

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    Maffulli Nicola


    Full Text Available Abstract Background With advances in arthroscopic surgery, many techniques have been developed to increase the tendon-bone contact area, reconstituting a more anatomic configuration of the rotator cuff footprint and providing a better environment for tendon healing. Methods We present an arthroscopic rotator cuff repair technique which uses suture bridges to optimize rotator cuff tendon-footprint contact area and mean pressure. Results Two medial row 5.5-mm Bio-Corkscrew suture anchors (Arthrex, Naples, FL, which are double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL, are placed in the medial aspect of the footprint. Two suture limbs from a single suture are both passed through a single point in the rotator cuff. This is performed for both anchors. The medial row sutures are tied using the double pulley technique. A suture limb is retrieved from each of the medial anchors through the lateral portal, and manually tied as a six-throw surgeon's knot over a metal rod. The two free suture limbs are pulled to transport the knot over the top of the tendon bridge. Then the two free suture limbs that were used to pull the knot down are tied. The end of the sutures are cut. The same double pulley technique is repeated for the other two suture limbs from the two medial anchors, but the two free suture limbs are used to produce suture bridges over the tendon, by means of a Pushlock (Arthrex, Naples, FL, placed 1 cm distal to the lateral edge of the footprint. Conclusion This technique maximizes the advantages of two techniques. On the one hand, the double pulley technique provides an extremely secure fixation in the medial aspect of the footprint. On the other hand, the suture bridges allow to improve pressurized contact area and mean footprint pressure. In this way, the bony footprint in not compromised by the distal-lateral fixation, and it is thus possible to share the load between fixation points. This maximizes the strength of the repair

  15. Influence of knot configuration and tying technique on the mechanical performance of sutures. (United States)

    Zimmer, C A; Thacker, J G; Powell, D M; Bellian, K T; Becker, D G; Rodeheaver, G T; Edlich, R F


    The purpose of this investigation was to determine the influence of knot configuration and tying technique on the mechanical performance of surgical sutures. Multifilament and monofilament nylon sutures were selected for this evaluation because they are commonly used in wound closure. The mechanical performance of these sutures was judged by the following parameters: knot breakage force, configuration of secure knots, and knot run down force. During each test, tension was applied at either rapid or slow rates, which correlates with the physician's speed of tying knots. On the basis of these mechanical performance tests, four throw square (1 = 1 = 1 =1) knots and five throw square (1 = 1 = 1 = 1 = 1) knots are recommended for monofilament nylon and multifilament nylon sutures, respectively, in which the speed of application of forces to the knots is relatively slow. Because these tests can easily be replicated in any laboratory, manufacturers now have a scientific basis for recommending specific tying techniques for their surgical sutures.

  16. Basic interrupted versus continuous suturing techniques in bronchial anastomosis following sleeve lobectomy in dogs. (United States)

    Bayram, Ahmet Sami; Erol, Mehmet Muharrem; Salci, Hakan; Ozyiğit, Ozgür; Görgül, Sacit; Gebitekin, Cengiz


    Sleeve resection with or without lung resection is a valid conservative operation for patients with benign or malignant tumors; it enables the preservation of lung parenchyma. The aim of this prospective randomized study was to compare complications, operating time, and bronchial healing between the techniques of interrupted and continuous suturing for bronchial anastomosis in dogs. Twenty adult mongrel dogs each weighing 18-22 kg (average: 20 kg) were divided into two groups according to the anastomosis technique performed: group A, interrupted suturing and group B, continuous suturing. Each group comprised of 10 dogs. Following right thoracotomy, sleeve resection of the right cranial lobe was performed in all dogs. Basic interrupted sutures using 4/0 Vicryl (Ethicon, USA) were used in group A, and continuous sutures were used in group B. The median anastomosis time was 15.2 min (range: 13-21 min) in group A and 9.6 min (range: 8-13 min) in group B. In all dogs, the anastomosis line was resected via right pneumonectomy for histopathological investigation 1 month after sleeve resection. Histopathological examination revealed that the healing of the anastomosis was not affected by the suturing technique applied. One dog from each group died on the fourth postoperative day; Fisher's exact test, p=0.763. Our research revealed that the healing of the anastomosis was not affected by the suturing technique performed.

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

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    Muzaffar Nasir


    Full Text Available Abstract Background We present a simple technique of arthroscopic rotator cuff repair using a spinal needle and suture loop. Methods With the arthroscope laterally, a spinal needle looped with PDS is inserted percutaneously into the shoulder posteriorly and penetrated through the healthy posterior cuff tear margin. Anteriorly, another spinal needle loaded with PDS is inserted percutaneously to engage the healthy tissue at the anterior tear margin. The suture in the anterior needle is then delivered into the suture loop of the posterior needle using a suture retriever. The posterior needle and loop are then pulled out carrying the anterior suture with it. The two limbs of this suture are then retrieved through a cannula for knotting. The same procedure is then repeated for additional suturing. Suture anchors placed over the greater tuberosity are used to complete the repair. Conclusion This is an easy method of rotator cuff repair using simple instruments and lesser time, hence can be employed at centers with less equipment and at reduced cost to the patient.

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

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    Roy Varghese


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

  19. Suture-bridge subscapularis tendon repair technique using low anterior portals. (United States)

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


    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.

  20. Successful term delivery after Khairy’s modified B-lynch suture technique: First case rep

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    Ahmed M. Abbas


    Full Text Available Postpartum hemorrhage (PPH is a life-threatening obstetric complication. Uterine atony is the most common cause presenting in approximately 80% of cases. As regards management options, B-lynch brace suture, and its modifications have been used for more than a decade with a great success as a substitution for hysterectomy. Their efficiency in preserving future fertility is not well-established. This case reports the first successful pregnancy and delivery after one of the recent B-lynch suture modifications “Khairy’s modification” for control of atonic PPH during cesarean delivery. The patient got pregnant two months after the surgery. The course of pregnancy was smooth and she was delivered by Repeat cesarean section with no deformities of uterine cavity or contour. Khairy’s modified B-lynch suture is an effective technique that has no reported complications of the classic B-lynch suture or affection of subsequent fertility.

  1. Assessing suturing techniques using a virtual reality surgical simulator. (United States)

    Kazemi, Hamed; Rappel, James K; Poston, Timothy; Hai Lim, Beng; Burdet, Etienne; Leong Teo, Chee


    Advantages of virtual-reality simulators surgical skill assessment and training include more training time, no risk to patient, repeatable difficulty level, reliable feedback, without the resource demands, and ethical issues of animal-based training. We tested this for a key subtask and showed a strong link between skill in the simulator and in reality. Suturing performance was assessed for four groups of participants, including experienced surgeons and naive subjects, on a custom-made virtual-reality simulator. Each subject tried the experiment 30 times using five different types of needles to perform a standardized suture placement task. Traditional metrics of performance as well as new metrics enabled by our system were proposed, and the data indicate difference between trained and untrained performance. In all traditional parameters such as time, number of attempts, and motion quantity, the medical surgeons outperformed the other three groups, though differences were not significant. However, motion smoothness, penetration and exit angles, tear size areas, and orientation change were statistically significant in the trained group when compared with untrained group. This suggests that these parameters can be used in virtual microsurgery training.

  2. Closure of round cutaneous defects progressively with the purse string suture technique. (United States)

    Küçükdurmaz, Fatih; Agir, Ismail; Gümüstas, Seyitali; Kivilcim, Hakan; Tetik, Cihangir


    There are many closure techniques available to cutaneous surgeons. One of them is the purse-string suture which is used to provide complete or partial closure of round skin defects. In our animal study; we closed skin defects with using subcuticular purse string suture technique by progressively cinching wound and we aim to more rapidly healing according to secondary healing. After anaesthetize, we created a 4 cm diameter circular full thickness skin defect on dorsal area of rats. In group 1, subcuticular purse string suture was applied by using a nonabsorbable and monofilament suture and a sliding arthroscopic knot was applied to both ends. Arthroscopic suture was shift 1 cm forward every day. In group 2 skin defect was leaved open and daily dressing was made and in both group defect diameters were measured every day and noted. The skin defects were closed totally after 15 days in group 1 but in group 2 defects were reduced but still had a mean 1,5-cm diameter sircular defect. Closing large circular wound with purse string suture and gradual tightening decreases the healing time and expand the skin tissue without using any tissue expander.

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

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    Kindberg, Sara; Misan, Stehouwer; Hvidman, Lone


    healing, patient satisfaction, dyspareunia or need for resuturing. The continuous suture technique was significantly faster (15 min. vs. 17 min, p=0.03) and less suture material was used (1 vs. 2 packets, pleaving the skin unsutured...... appears to be equivalent to the continuous suture technique in relation to perineal pain, wound healing, patient satisfaction, dyspareunia and need for resuturing. The continuous technique, however, is faster and requires less suture material thus leaving it the more cost-effective of the two techniques......Postpartum perineal repair performed by midwives: A randomised trial comparing two suture techniques leaving the skin unsutured. Objective      To compare a continuous suture technique to interrupted stitches using inverted knots for postpartum perineal repair of second-degree lacerations...

  4. The efficacy of laparoscopic intracorporeal linear suture technique as a strategy for reducing recurrences in pediatric inguinal hernia. (United States)

    Lee, S R; Choi, S B


    Pediatric laparoscopic herniorrhaphy has rare complications, but recurrence might occur. The purpose of this manuscript is to evaluate the efficacy of linear suture technique of laparoscopic pediatric herniorrhaphy in reducing recurrences. Laparoscopic surgery was performed on 2223 pediatric patients (under 10 years old) from September 2012 to December 2014 in Damsoyu Hospital, Seoul, Republic of Korea. The causes of recurrence were investigated case by case. The patients were categorized into two groups according to the suture method used in closing the hernia orifice: Group 1 (purse-string suture, 1009 patients) and Group 2 (linear suture, 1214 patients). There were 1413 (63.6%) male and 810 (36.4%) female patients. Mean age was 30.5 ± 29.2 months. A significantly higher proportion of male patients, contralateral patent processus vaginalis, and less proportion of recurrence were observed in Group 2. There were ten cases of recurrence in Group 1 because the internal ring suture could not endure the tension. One recurrence occurred in Group 2. The suture technique and age were found to be a significant risk factor for recurrence. Linear suture technique had a lower recurrence rate (odds ratio = 0.07, with 95% confidence interval 0.01-0.53, and p = 0.004). Purse-string suture technique causes significantly higher occurrence of hernia recurrences than linear suture technique. Linear suture technique can reduce recurrence by increasing the endurance to tension around the internal ring by distributing pressure to a wider area along the linear suture line. Linear suture technique can effectively reduce recurrence in pediatric inguinal herniorrhaphy.

  5. Two Techniques of Intestinal Wall Suture in Surgical Treatment of Ileus in Dogs and the Importance of Omentalisation

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    M. Crha


    Full Text Available Model experimental studies focused on the intestinal suture techniques in relation to healing, postoperative narrowing of the intestinal lumen or adhesion formation can not comprise a number of clinical factors (foreign body presence in the intestine, haematological abnormalities, septic peritonitis, different age of patients, etc. that under clinical practice conditions may have an effect on the healing of the intestinal suture. The aim of this clinical study was to confirm in a group of dogs surgically treated for small bowel obstruction, whether different techniques of its wall suture may affect the frequency of possible dehiscence occurrence. This study compares two different techniques of intestinal wall suture in relation to postoperative dehiscence of the intestinal wall closure. Based on the clinical observation with regard to the risk of postoperative dehiscence and possible complications in form of adhesions, also the importance of omentalisation in the suture of small bowel was evaluated. No significant difference was demonstrated (p > 0.05 in the frequency of postoperative dehiscence at the site of the intestinal wall closure between the two-layer inverting and singlelayer appositional techniques of suture. Likewise, no significant difference was demonstrated (p > 0.05 in the frequency of dehiscence of intestinal wall suture between patients that underwent intestinal suture omentalisation and those whose intestinal wall suture was not complemented with omentalisation. Based on the results of this clinical study it may be stated that both manual single-layer approximation technique and two-layer inverting technique of the intestinal wall suture are equally safe from the viewpoint of possible dehiscence, and it depends on the surgeon's preference, which one of the said techniques he or she chooses. Concurrently it may be assumed that an exactly performed suture of the intestinal wall does not necessarily require omentalisation.

  6. A novel technique for distal fingertip replantation: Polypropylene suture guided interpositional vein graft. (United States)

    Dadaci, Mehmet; Ince, Bilsev; Altuntas, Zeynep; Bitik, Ozan; Uzun, Hakan; Bilgen, Fatma


    Despite current advances in microsurgery, fingertip replantation is still controversial, mainly due to its difficulty and cost. The purpose of this study is to describe a new technique of interposition vein graft guided by polypropylene suture in distal fingertip replantation. A total of eight consecutive Tamai zone 1 fingertip replantations performed by the same author were included. All replantations were performed using interposition vein graft guided by polypropylene suture. This technique involved a vein graft of ∼ 2 cm, with appropriate calibration, obtained from the volar part of the forearm and a 2-0 polyprolene suture passed through the interposition vein graft. Then, a polypropylene suture guide carrying the vein graft was inserted into the artery. The anastomosis was easily performed with the aid of 10-0 or 11-0 nylon in a bloodless medium and without encountering the posterior wall problem. Average surgery time was 2.5 hours (range = 2-3 hours). Among eight Tamai zone 1 replantations, six were successful (75%). There were two replantations lost because of arterial failure. This technique may ease fingertip replantations and increase the success rate for Tamai zone 1 injuries.

  7. Influence of suture technique and suture material selection on the mechanics of end-to-end and end-to-side anastomoses. (United States)

    Baumgartner, N; Dobrin, P B; Morasch, M; Dong, Q S; Mrkvicka, R


    Experiments were performed in dogs to evaluate the mechanics of 26 end-to-end and 42 end-to-side artery-vein graft anastomoses constructed with continuous polypropylene sutures (Surgilene; Davis & Geck, Division of American Cyanamid Co., Danbury, Conn.), continuous polybutester sutures (Novafil; Davis & Geck), and interrupted stitches with either suture material. After construction, the grafts and adjoining arteries were excised, mounted in vitro at in situ length, filled with a dilute barium sulfate suspension, and pressurized in 25 mm Hg steps up to 200 mm Hg. Radiographs were obtained at each pressure. The computed cross-sectional areas of the anastomoses were compared with those of the native arteries at corresponding pressures. Results showed that for the end-to-end anastomoses at 100 mm Hg the cross-sectional areas of the continuous Surgilene anastomoses were 70% of the native artery cross-sectional areas, the cross-sectional areas of the continuous Novafil anastomoses were 90% of the native artery cross-sectional areas, and the cross-sectional areas of the interrupted anastomoses were 107% of the native artery cross-sectional areas (p anastomoses demonstrated no differences in cross-sectional areas or compliance for the three suture techniques. This suggests that, unlike with end-to-end anastomoses, when constructing an end-to-side anastomosis in patients any of the three suture techniques may be acceptable.

  8. Two Suturing Techniques for the Prevention and Treatment of Nasal Valve Collapse After Mohs Micrographic Surgery. (United States)

    Miladi, Anis; McGowan, Joseph W; Donnelly, Heidi B


    Tumor extirpation of nonmelanoma skin cancer (NMSC) adjacent to the alar groove, using Mohs micrographic surgery (MMS), may risk causing internal nasal valve (INV) collapse, resulting in reduced airflow during inspiration. There are many surgical options described in the literature to repair INV collapse as a postoperative corrective procedure, but few exist as an intra-operative preventative procedure. The authors present 2 distinct methods to prevent and treat INV collapse during the repair of a perialar surgical defect caused by MMS. A 3-point stitch method or a modified suspension suture technique was used to prevent INV collapse during the repair of MMS defects overlying the alar groove, for nonmelanoma skin cancers. The 3-point stitch was used with a complex repair. The modified suspension suture was used with flap reconstruction. The 3-point stitch and the modified suspension suture are simple, single-stage surgical solutions for perialar defects with collapse of the INV caused by loss of subcutaneous tissue during MMS. Once executed, patients experienced immediate subjective airflow improvement which was also supported by clinical examination. Patients were followed at 1 week and at 3 months postoperatively. Thirty-four of 35 patients reported good functional and cosmetic results and were satisfied with the final outcome. The 3-point stitch and the modified suspension suture techniques are easy and simple methods that can be incorporated into reconstruction after MMS for defects of variable depth covering any multisubunit perialar region to prevent or correct INV collapse.

  9. Reinforcement of the pelvic diaphragm using a purse-string suture in dogs: description of technique

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    P.C. Moraes

    Full Text Available ABSTRACT Recurrence of perineal hernias is frequent, and is associated to poor identification of anatomical structures during surgery, inadequate suture placement, and failure of physical support of the pelvic diaphragm after surgical reconstruction. The objective of this work is to describe a novel surgical technique for reinforcement of the pelvic diaphragm after performing the internal obturator transposition technique in dogs with perineal hernia.

  10. Novel Technique to Overcome the Nonavailability of a Long Needle 9-0 Polypropylene Suture for Sutured Scleral Fixation of the Posterior Chamber Intraocular Lens Using a Single Fisherman’s Knot

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    Yong Un Shin


    Full Text Available Purpose. To describe a method to overcome the nonavailability of a long needle 9-0 polypropylene suture for sutured scleral fixation of the posterior chamber intraocular lens (PC-IOL using a single fisherman’s knot (SFK. Methods. First, a 10-0 polypropylene suture was passed from the sclera to the ciliary sulcus using a long needle. A 9-0 suture was tied to the unpassed portion of the 10-0 suture with an SFK. We pulled the 10-0 suture to pass the SFK through the sclera, and then we cut the knot and removed the 10-0 suture. IOL fixation with 9-0 sutures used the conventional techniques used for sutured scleral-fixated IOL. Preoperative and postoperative visual acuity, corneal astigmatism, and endothelial cell count and intraoperative/postoperative complications were evaluated. Results. An SFK joining the two sutures was passed through the sclera without breakage or slippage. A total of 35 eyes from 35 patients who underwent sutured scleral fixation of the IOL. An intraoperative complication (minor intraocular hemorrhage was recorded in four cases. Knot exposure, IOL dislocation, subluxation, and retinal detachment were not observed. Conclusions. The SFK offers the opportunity to use 9-0 sutures for the long-term safety and may not require the surgeon to learn any new technique.

  11. Novel Technique to Overcome the Nonavailability of a Long Needle 9-0 Polypropylene Suture for Sutured Scleral Fixation of the Posterior Chamber Intraocular Lens Using a Single Fisherman's Knot. (United States)

    Shin, Yong Un; Seong, Mincheol; Cho, Hee Yoon; Kang, Min Ho


    To describe a method to overcome the nonavailability of a long needle 9-0 polypropylene suture for sutured scleral fixation of the posterior chamber intraocular lens (PC-IOL) using a single fisherman's knot (SFK). First, a 10-0 polypropylene suture was passed from the sclera to the ciliary sulcus using a long needle. A 9-0 suture was tied to the unpassed portion of the 10-0 suture with an SFK. We pulled the 10-0 suture to pass the SFK through the sclera, and then we cut the knot and removed the 10-0 suture. IOL fixation with 9-0 sutures used the conventional techniques used for sutured scleral-fixated IOL. Preoperative and postoperative visual acuity, corneal astigmatism, and endothelial cell count and intraoperative/postoperative complications were evaluated. An SFK joining the two sutures was passed through the sclera without breakage or slippage. A total of 35 eyes from 35 patients who underwent sutured scleral fixation of the IOL. An intraoperative complication (minor intraocular hemorrhage) was recorded in four cases. Knot exposure, IOL dislocation, subluxation, and retinal detachment were not observed. The SFK offers the opportunity to use 9-0 sutures for the long-term safety and may not require the surgeon to learn any new technique.

  12. New technique for iridodialysis correction: Single-knot sewing-machine suture. (United States)

    Silva, João Luis; Póvoa, João; Lobo, Conceição; Murta, Joaquim


    Iridodialysis is a common occurrence after trauma and can be the source of considerable morbidity for the patients. Several options to repair iridodialysis are described in the literature. We present a new technique-a single-thread single-knot suture. This simple approach does not require special material and uses a single thread and a single knot, avoiding the need for using multiple sutures or placing multiple knots. We used this technique in several patients, and it appears to be an effective alternative to iridodialysis repair. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  13. Tip-Oriented Closed Rhinoplasty Built on Septocolumellar Suture and a New Caudal Septal Graft Technique. (United States)

    Tezel, Erdem; Ersoy, Burak


    A beautiful and appealing nose receives the greatest contribution from the nasal tip subunit, which should be regarded as the primary center of attention during a rhinoplasty procedure. In achieving the desired shape and position of the nasal tip during closed rhinoplasty, the septocolumellar suture functions as the major determinant together with the caudal portion of the septal cartilage, which has a significant influence on the versatility of the septocolumellar suture. The purpose of this study was to present the analysis of the indications, the technical steps, and the advantages of caudal septal graft and septocolumellar suture utilization in closed rhinoplasty. The septocolumellar suture with or without the caudal septal graft combination procedure has been performed in 2286 patients via a closed rhinoplasty approach. Intraoperatively, the septal cartilage at hand was thoroughly evaluated and one of the 5 types of caudal septal grafts was used when necessary. After the establishment of a strong and straight septal cartilage with sufficient height and length, 4 different septocolumellar sutures in a specific order were used to modify the relationship between the lower lateral cartilages and the nasal septum. Of the 2286 cases, 1837 (80.3%) were primary and 449 (19.7%) secondary rhinoplasties, which have been followed up for 9 to 48 months. The caudal septal graft was combined to the septocolumellar suture in 621 (27.1%) patients. Of the caudal septal grafts, 69.7% were used for primary rhinoplasty cases, and 30.3% for secondary rhinoplasties. At the 18th month postoperatively, tip projection was found to be satisfactory for 98% of the patients. The septocolumellar suture combined with caudal septal graft in closed rhinoplasty substantially facilitates the achievement of a cosmetically and functionally pleasing end result, bringing the solution for a wide array of problems such as short nose, supratip deformity, nasolabial angle change, or columellar bowing

  14. Comparison of three suture techniques in closure of caprine skin incision: cosmetic and cost considerations


    Adamu Abdul Abubakar; John Bayo Adeyanju; Raphael O. Chukudi Kene; Mohammad Legbo Sonfada; Abubakar Sadiq Yakubu; Umaru Adamu


    The cosmetic and economic evaluations of three suture techniques were evaluated in closure of caprine skin incision. Fifteen apparently healthy male and female intact goats, free of any dermatological lesions were used for the investigation. They were randomly grouped into three; A (Subcuticular); B (Ford interlocking) and C (Simple interrupted). Cosmetic appearance of the surgical site was assessed on day 7, 14 and 21 post surgery using standard procedure as described by Sakka et al, 1995...

  15. Evaluation of Reduction Accuracy of Suture-Button and Screw Fixation Techniques for Syndesmotic Injuries. (United States)

    Kocadal, Onur; Yucel, Mehmet; Pepe, Murad; Aksahin, Ertugrul; Aktekin, Cem Nuri


    Among the most important predictors of functional results of treatment of syndesmotic injuries is the accurate restoration of the syndesmotic space. The purpose of this study was to investigate the reduction performance of screw fixation and suture-button techniques using images obtained from computed tomography (CT) scans. Patients at or below 65 years who were treated with screw or suture-button fixation for syndesmotic injuries accompanying ankle fractures between January 2012 and March 2015 were retrospectively reviewed in our regional trauma unit. A total of 52 patients were included in the present study. Fixation was performed with syndesmotic screws in 26 patients and suture-button fixation in 26 patients. The patients were divided into 2 groups according to the fixation methods. Postoperative CT scans were used for radiologic evaluation. Four parameters (anteroposterior reduction, rotational reduction, the cross-sectional syndesmotic area, and the distal tibiofibular volumes) were taken into consideration for the radiologic assessment. Functional evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale at the final follow-up. The mean follow-up period was 16.7 ± 11.0 months, and the mean age was 44.1 ± 13.2. There was a statistically significant decrease in the degree of fibular rotation (P = .03) and an increase in the upper syndesmotic area (P = .006) compared with the contralateral limb in the screw fixation group. In the suture-button fixation group, there was a statistically significant increase in the lower syndesmotic area (P = .02) and distal tibiofibular volumes (P = .04) compared with the contralateral limbs. The mean AOFAS scores were 88.4 ± 9.2 and 86.1 ± 14.0 in the suture-button fixation and screw fixation group, respectively. There was no statistically significant difference in the functional ankle joint scores between the groups. Although the functional outcomes were similar, the

  16. 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


    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.

  17. Two Techniques of Intestinal Wall Suture in Surgical Treatment of Ileus in Dogs and the Importance of Omentalisation


    M. Crha; J. Lorenzová; L. Urbanová; T. Fichtel; A. Nečas


    Model experimental studies focused on the intestinal suture techniques in relation to healing, postoperative narrowing of the intestinal lumen or adhesion formation can not comprise a number of clinical factors (foreign body presence in the intestine, haematological abnormalities, septic peritonitis, different age of patients, etc.) that under clinical practice conditions may have an effect on the healing of the intestinal suture. The aim of this clinical study was to confirm in a group of do...

  18. Use of a Barbed Suture Tie-Over Technique for Skin Graft Dressings: A Case Series

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    Kenneth M Joyce


    Full Text Available BackgroundA tie-over dressing is the accepted method to secure skin grafts in order to prevent haematoma or seroma formation. We describe the novel application of a barbed suture tie-over for skin graft dressing. The barbs act as anchors in the skin so constant tensioning of the suture is not required.MethodsFrom January 2014 to August 2014 we used the technique in 30 patients with skin defects requiring split-thickness or full-thickness grafts. Patient demographics, clinicopathological details and graft outcome were collected prospectively.ResultsThe majority of cases were carried out for split-thickness skin grafts (n=19 used on the lower limb (n=20. The results of this novel technique were excellent with complete (100% graft take in all patients.ConclusionsOur results demonstrate the clinical application of a barbed device for securing skin grafts with excellent results. We find the technique quick to perform and the barbed device easy to handle, which can be applied without the need for an assistant.

  19. Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size? (United States)

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


    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.

  20. Single Incision Distal Biceps Repair With Hemi-Krackow Suture Technique (United States)

    Goljan, Peter; Patel, Nimit; Stull, Justin D.; Donnelly, Brandon P.; Culp, Randall W.


    Background: Many surgical methods exist for distal biceps repair. We present the technique and early outcomes of a series of distal biceps repairs completed with a novel suturing technique utilizing a hemi-Krackow locking stitch at the tendon-bone interface. Methods: A retrospective review was performed of patients who underwent primary distal biceps repair using a single anterior incision with 2 suture anchors utilizing a hemi-Krackow stitch. With both anchors, a locking stitch along the tendon edge was complimented by the other strand passing through the central aspect of the distal tendon and advanced to pull the tendon edge down to the bone with appropriate tension. Patients with revision surgery and the use of allograft were excluded. Clinical outcomes included elbow range of motion and grip strength. All patients completed a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire and reported satisfaction level, pain level, and any postoperative complications. Results: Fourteen patients with an average age of 51.3 years (range, 27.8-66.4 years) were included in the study. The dominant arm was injured in 9 cases. At an average of 16.4 months’ follow-up (range, 6.8-34.3 months), all patients had elbow range of motion of 0° to >130°, and grip strength was 101.5% of the uninjured arm (range, 70.6%-121.4%). The Average QuickDASH score was 6.5 (range, 0-36.5). Conclusion: Single incision biceps repair with suture anchor fixation using our hemi-Krackow stitch provided a strong repair allowing easy tensioning of the biceps tendon to bone and showed satisfactory functional outcomes at early follow-up. No patients required revision surgery, and there was only 1 case of transient nerve complaints. PMID:27390570

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


    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.

  2. Simplified ab externo fixation technique to treat late dislocation of scleral-sutured polymethyl methacrylate intraocular lenses. (United States)

    Lyu, J; Zhao, P-Q


    PurposeWe report a simplified ab externo scleral fixation technique to manage the late dislocation of scleral-sutured polymethyl methacrylate (PMMA) intraocular lenses (IOLs) in the absence of capsule support.Materials and methodsThe technique was performed on five eyes of five patients. Symmetrical scleral pocket tunnels without conjunctival peritomy were created. An anterior vitrectomy via a limbal approach with an anterior chamber infusion or a 3-port pars plana vitrectomy was performed to rescue the dislocated IOL. A long straight suture needle and 23-gauge vitreoretinal forceps were used to conveniently reposition the IOL and loop sutures through the IOL positioning eyelets without externalizing IOL haptics. The outside suture knots were buried under the roof of the scleral tunnels.ResultsThe patients were followed for 5-14 months after surgery. All the operated eyes quickly recovered with negligible corneal endothelial cell loss and mild inflammation. Visual acuity improvement and IOL centration were achieved in all eyes with no major complications.ConclusionThe simplified ab externo scleral fixation technique offers an effective and minimally invasive surgical alternative to salvage dislocated previously scleral-sutured PMMA IOLs.

  3. Laparoscopic repair of perforated peptic ulcers: the sutured omental patch and focused sequential lavage technique. (United States)

    Siow, Sze Li; Mahendran, Hans Alexander


    We propose a standardized technique of repair and lavage with the outcomes of 50 consecutive patients treated at our institution. The perforation was closed primarily and reinforced with omental patch. It was then followed by peritoneal lavage in a focused sequential manner that involved quadrant to quadrant lavage with tilting of operating table and changing of position between the surgeon and the camera surgeon. None of our patients had postoperative intra-abdominal complications, but unfortunately 1 patient succumbed to respiratory complications. Respiratory complications was the most common postoperative complication in our series (9 patients), whereas 2 patients had ileus. There were no leaks or reoperations in our series. Laparoscopic repair and sutured omentoplasty, followed by focused sequential lavage in a systematic manner, if performed diligently, will yield good outcomes.

  4. Modified suture-bridge technique to prevent a marginal dog-ear deformity improves structural integrity after rotator cuff repair. (United States)

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


    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

  5. end-to-side nerve suture - a technique to repair peripheral nerve injury

    African Journals Online (AJOL)

    Raubenheimer, Head of the Department of Oral Pathology and. Oral Biology, Faculty of Dentistry, MEDUNSA, for the meticulous histology investigations. References. 1. Mennen U. End-lo-side nerve suture in the non-human primate. Hand Surgery 1998; 3(1): 1-6. 2. Mennen U. End-to-side nerve suture in the human patient.

  6. Use of the iTClamp versus standard suturing techniques for securing chest tubes: A randomized controlled cadaver study

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    Jessica Mckee


    Full Text Available Objectives: Tube thoracostomy (TT is a common yet potentially life-saving trauma procedure. After successful placement however, securing a TT through suturing is a skillset that requires practice, risking that the TT may become dislodged during prehospital transport. The purpose of this study was to examine if the iTClamp was a simpler technique with equivalent effectiveness for securing TTs. Materials and methods: In a cadaver model, a 1.5 inch incision was utilized along the upper border of the rib below the 5th intercostal space at the anterior axillary line. TTs (sizes 28Fr, 32Fr, 36Fr and 40Fr were inserted and secured with both suturing and iTClamp techniques according to the preset randomization. TT were then functionally tested for positive and negative pressure as well as the force required to remove the TT (pull test-up to 5 lbs. Time to secure the TT was also recorded. Results: When sutured is placed by a trained surgeon, the sutures and iTClamp were functionally equivalent for holding a positive and negative pressure. Mean pull force for both sutures and iTClamp exceeded the 5 lb threshold; there was no significant difference between the groups. Securing the TT with the iTClamp was significantly faster (p < 0.0001 with the iTClamp having a mean application time of 37.0 ± 22.8 s and using a suture had a man application time of 96.3 ± 29.0 s. Conclusion: The iTClamp was effective in securing TTs. The main benefit to the iTClamp is that minimal skill is required to adequately secure a TT to ensure that it does not become dislodged during transport to a trauma center. Keywords: Chest tube, Tube thoracostomy, Securing chest tubes

  7. Bronchus anastomosis after sleeve resection for lung cancer: does the suture technique have an impact on postoperative complication rate? (United States)

    Palade, Emanuel; Holdt, Holger; Passlick, Bernward


    Bronchoplastic resections emerged as an alternative to pneumonectomy for patients with impaired pulmonary function and have gained popularity due to a marked decrease in morbidity and at least similar oncological outcome. Actual guidelines recommend sleeve resections whenever technically feasible, even in cases with adequate pulmonary reserve for pneumonectomy, in order to maximally preserve functional lung parenchyma. Various suture techniques were described; the existing evidence, however, is insufficient to recommend one of them as standard. The aim of this study was to compare two suture techniques for bronchus repair after sleeve resection. Two groups of patients from two separate institutions were retrospectively analysed. In Group A (n = 20), the anastomosis was performed with a running suture at the membranous part and an interrupted suture for the rest of the circumference. In Group B (n = 40), a telescoping continuous suture was used. Intra- and postoperative findings directly related to the anastomosis were compared. The parameters were assessed as absolute numbers and percentages; the statistical significance was determined using Pearson's χ(2) test for categorical variables and Student's t-test for continuous data (P resection type (predominance of the right upper lobe for Group B), the groups were comparable regarding patient characteristics. The intraoperative anastomotic assessment revealed: patency 100% in both groups, initial air tightness (100 vs 82.5%; P = 0.047) and buttressing 85 vs 5%. No suture revision was necessary in both groups. The analysis of anastomosis-related morbidity revealed no significant difference: atelectasis (1 in Group A and 2 in Group B; P = 1), reversible anastomotic changes (0 vs 2; P = 0.309), early stenosis (0 vs 0), bronchopleural fistula (1 vs 0; P = 0.154), bronchovascular fistula (0 vs 0), late stenosis (1 vs 0; P = 0.119) and reoperations (15 vs 5%; P = 0.186). The operative mortality rate was similar (2 vs 3; P

  8. Avoiding vaginal cuff dehiscence after robotic oncological surgery: reliable suturing technique. (United States)

    Zapardiel, Ignacio; Zanagnolo, Vanna; Peiretti, Michele; Maggioni, Angelo; Bocciolone, Lucca


    The rate of vaginal cuff dehiscence seems to have been shown to increase after both robotic and laparoscopic surgeries compared with that after the open approach. The aim of this study was to describe the vaginal cuff dehiscence rate with a novel vaginal suturing technique performed by a robotic approach in the treatment of oncological conditions. Medical records of all robotic procedures from January 1, 2009, until August 10, 2009, performed at the European Institute of Oncology of Milan were reviewed. Forty vaginal closures were carried out with a novel technique after extrafascial or radical hysterectomy for an oncological diagnosis. Outcomes were compared with those of 41 parallel vaginal closures performed with other techniques. Among the 40 patients treated with the novel technique, an endometrial pathological feature was observed in 15 (37.5%); ovarian disease, 13 (32.5%); and cervical malignancies, 12 (30%). No vaginal cuff dehiscences were observed after a median follow-up time of 126 days (range, 36-248 days). On the other group, an endometrial pathological feature was observed in 12 patients (29.6%); ovarian disease, 6 (14.6%); cervical malignancies, 22 (53.6%); and tubal cancer, 1 (2.2%). Three vaginal cuff dehiscences were observed after a median follow-up time of 130 days (range, 39-261 days). The results of the study suggest that vaginal closure technique may decrease the vaginal cuff dehiscence rate for robotic surgery, although longer follow-up time is needed, and larger studies should be carried out, encouraging gynecologic surgeons to perform it.


    Leung, Ella H; Mohsenin, Amir; Smiddy, William E


    To apply a previously published scleral fixation technique to secure one-piece acrylic intraocular lenses (IOLs) to the sclera. Retrospective, consecutive, noncomparative case series. All patients (16 eyes of 15 patients) who underwent scleral fixation of 1-piece acrylic IOLs using the loop method from 2014 to 2016 were included. The mean follow-up was 8.1 months. Repositioning of dislocated 1-piece acrylic IOLs was performed in 8 eyes, a primary implantation in 5 eyes, and IOL exchange in 3 eyes. All IOLs remained well-centered postoperatively. The vision improved from an initial best-corrected visual acuity of 0.97 ± 0.74 logMAR (Snellen equivalent ≈20/190) to 0.47 ± 0.49 logMAR (≈20/60, P = 0.031) at the last follow-up. The postoperative complications were self-limited. The previously reported scleral suture fixation technique can be readily applied to one-piece acrylic IOLs.

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

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    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.

  11. Dynamic augmentation restores anterior tibial translation in ACL suture repair: a biomechanical comparison of non-, static and dynamic augmentation techniques. (United States)

    Hoogeslag, Roy A G; Brouwer, Reinoud W; Huis In 't Veld, Rianne; Stephen, Joanna M; Amis, Andrew A


    There is a lack of objective evidence investigating how previous non-augmented ACL suture repair techniques and contemporary augmentation techniques in ACL suture repair restrain anterior tibial translation (ATT) across the arc of flexion, and after cyclic loading of the knee. The purpose of this work was to test the null hypotheses that there would be no statistically significant difference in ATT after non-, static- and dynamic-augmented ACL suture repair, and they will not restore ATT to normal values across the arc of flexion of the knee after cyclic loading. Eleven human cadaveric knees were mounted in a test rig, and knee kinematics from 0° to 90° of flexion were recorded by use of an optical tracking system. Measurements were recorded without load and with 89-N tibial anterior force. The knees were tested in the following states: ACL-intact, ACL-deficient, non-augmented suture repair, static tape augmentation and dynamic augmentation after 10 and 300 loading cycles. Only static tape augmentation and dynamic augmentation restored ATT to values similar to the ACL-intact state directly postoperation, and maintained this after cyclic loading. However, contrary to dynamic augmentation, the ATT after static tape augmentation failed to remain statistically less than for the ACL-deficient state after cyclic loading. Moreover, after cyclic loading, ATT was significantly less with dynamic augmentation when compared to static tape augmentation. In contrast to non-augmented ACL suture repair and static tape augmentation, only dynamic augmentation resulted in restoration of ATT values similar to the ACL-intact knee and decreased ATT values when compared to the ACL-deficient knee immediately post-operation and also after cyclic loading, across the arc of flexion, thus allowing the null hypotheses to be rejected. This may assist healing of the ruptured ACL. Therefore, this study would support further clinical evaluation of dynamic augmentation of ACL repair.

  12. A barbed suture repair for flexor tendons: a novel technique with no exposed barbs. (United States)

    Joyce, Cormac W; Sugrue, Conor; Chan, Jeffrey C; Delgado, Luis; Zeugolis, Dimitrios; Carroll, Seam M; Kelly, Jack L


    Barbed suture technology has shown promise in flexor tendon repairs, as there is an even distribution of load and the need for a knot is eliminated. We propose that a quick and simple, novel, barbed technique without any exposed barbs on the tendon surface has comparable strength and a smaller cross-sectional area at the repair site than traditional methods of repair. Forty porcine flexor tendons were randomized to polybutester 4-strand barbed repair or to 4-strand Adelaide monofilament repair. The cross-sectional area was measured before and after repair. Biomechanical testing was carried out and 2-mm gap formation force, ultimate strength of repair, and method of failure were recorded. The mean ultimate strength of the barbed repairs was 54.51 ± 17.9 while that of the Adelaide repairs was 53.17 ± 16.35. The mean 2-mm gap formation force for the barbed group was 44.71 ± 17.86 whereas that of the Adelaide group was 20.25 ± 4.99. The postrepair percentage change in cross-sectional area at the repair site for the Adelaide group and barbed group was 12.0 ± 2.3 and 4.6 ± 2.8, respectively. We demonstrated that a 4-strand knotless, barbed method attained comparable strength to that of the traditional Adelaide repair technique. The barbed method had a significantly reduced cross-sectional area at the repair site compared with the Adelaide group. The 2-mm gap formation force was less in the barbed group than the Adelaide group. Barbed repairs show promise for tendon repairs; this simple method warrants further study in an animal model.

  13. The Gore-Tex Suture in Periareolar Closure: A Modified Closure Technique. (United States)

    Chapman, Jade; Ingram, Scott


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

  14. A new technique for the quantitative analysis of cranial suture biology. (United States)

    Sherick, D G; Buchman, S R; Goulet, R W; Goldstein, S A


    Our objective was to assess the ability of the microcomputed tomography scanner to correctly image normal and synostosed cranial sutures at the ultrastructural level. Two specimens of coronal sutures were collected from operative specimens. After appropriate preparation, histological sections were obtained and stained with toluene blue for evaluation. Representative histological sections were compared to microcomputed tomography slices. With microcomputed tomography, we successfully imaged one normal and one synostosed human coronal suture and performed a quantitative analysis of these specimens. Microcomputed tomography scanning was found to be a highly accurate imaging device for the evaluation of cranial suture development. Microcomputed tomography offers three-dimensional imaging at the microscopic level and allows for rapid quantitative analysis of bone architecture, including several measurements unavailable through histologic analysis. We believe that microcomputed tomography can play an important role in imaging and in the quantitative analysis of the stereology of bone microarchitecture. Among its advantages, microcomputed tomography is able to image many more slices than are obtainable through histology, and the method is not prone to human error. Microcomputed tomography slices are generated without destruction of the specimen and without loss or corruption of reproducible data. Structure-oriented slices from microcomputed tomography together with cellular-oriented sections from histology are complementary in the overall quantitative analysis of cranial sutures.

  15. Surgical management of vertical ocular misalignment in thyroid eye disease using an adjustable suture technique. (United States)

    Volpe, Nicholas J; Mirza-George, Naureen; Binenbaum, Gil


    To report a surgical approach to managing hypotropia associated with thyroid eye disease (TED) that uses adjustable sutures. The medical records of consecutive patients with TED and hypotropia who underwent adjustable suture inferior rectus muscle recession with or without superior rectus muscle recession of the hypertropic eye were reviewed retrospectively. The initial goal was undercorrection in primary gaze and no hyperdeviation in downgaze. Outcomes were rated according to the presence of diplopia in primary and reading positions as excellent (none), good (no diplopia with managed by the use of adjustable sutures and by surgeons operating on multiple muscles, anticipating drift toward overcorrection of the recessed inferior rectus muscle, and using prism for residual deviation. Copyright © 2012 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

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

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    Lourdes R. Hernández Santos


    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.

  17. Suture-free technique for canine ureteral resection-anastomosis using a microvascular anastomotic system: a cadaveric study. (United States)

    Wavreille, Vincent; Adin, Christopher A; Arango, Johnattan; Ham, Kathleen L; Byron, Julie K; McLoughlin, Mary A


    To describe a suture-free technique for canine ureteral resection-anastomosis using a microvascular anastomotic system (MAS) and to compare surgical time and burst pressure of hand-sewn (HS) ureteral end-to-end anastomosis with the MAS technique. Experimental ex vivo study. Canine cadavers (n = 8). For each cadaver, 1 ureter was randomly assigned to undergo HS anastomosis and the contralateral ureter had MAS anastomosis. The first 3 cadavers (6 ureters) were used to refine the MAS technique. In the other 5 dogs, surgical time and ureteral burst pressure were compared between groups (n = 5 ureters/group). Preliminary procedures showed that selective impaling of the mucosa and submucosa (without muscularis and adventitia) is necessary to allow complete mechanical interlock of the anastomotic rings for the MAS technique. Median anastomotic time was significantly shorter for MAS (7.6 min) than HS (16.6 min; p = .029) and burst pressure higher for MAS (393 cm H2 O) than HS (180 cm H2 O; p = .012). This study demonstrated the feasibility of a suture-free technique of canine ureteral resection-anastomosis using a commercially available MAS. The MAS anastomosis was faster and had higher burst strength compared with the HS anastomosis. © Copyright 2014 by The American College of Veterinary Surgeons.

  18. Suture Coding: A Novel Educational Guide for Suture Patterns. (United States)

    Gaber, Mohamed; Abdel-Wahed, Ramadan


    This study aims to provide a helpful guide to perform tissue suturing successfully using suture coding-a method for identification of suture patterns and techniques by giving full information about the method of application of each pattern using numbers and symbols. Suture coding helps construct an infrastructure for surgical suture science. It facilitates the easy understanding and learning of suturing techniques and patterns as well as detects the relationship between the different patterns. Guide points are fixed on both edges of the wound to act as a guideline to help practice suture pattern techniques. The arrangement is fixed as 1-3-5-7 and a-c-e-g on one side (whether right or left) and as 2-4-6-8 and b-d-f-h on the other side. Needle placement must start from number 1 or letter "a" and continue to follow the code till the end of the stitching. Some rules are created to be adopted for the application of suture coding. A suture trainer containing guide points that simulate the coding process is used to facilitate the learning of the coding method. (120) Is the code of simple interrupted suture pattern; (ab210) is the code of vertical mattress suture pattern, and (013465)²/3 is the code of Cushing suture pattern. (0A1) Is suggested as a surgical suture language that gives the name and type of the suture pattern used to facilitate its identification. All suture patterns known in the world should start with (0), (A), or (1). There is a relationship between 2 or more surgical patterns according to their codes. It can be concluded that every suture pattern has its own code that helps in the identification of its type, structure, and method of application. Combination between numbers and symbols helps in the understanding of suture techniques easily without complication. There are specific relationships that can be identified between different suture patterns. Coding methods facilitate suture patterns learning process. The use of suture coding can be a good

  19. Suture midface suspension

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    Murthy Rachna


    Full Text Available Abstract Objective To describe a simple and effective facelift technique useful as an adjunct to other oculoplastic procedures Methods Retrospective, non-comparative case series. Thirty five patients undergoing suture midface suspension from 1998 to 2000. Suspension sutures were passed from the nasolabial fold to the temporalis fascia to elevate the midface and the corner of the mouth. Results A satisfactory and stable outcome is obtained in 2 years of follow up. Conclusion Suture midface suspension is a safe and effective technique for the management of midface descent.

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

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


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

  1. Lower lip suspension with gore-tex suture: technique and literature review. (United States)

    Tutela, John Paul; Davis, Jared; Zeiderman, Matthew; Kelishadi, Sharooz Sean; Wilhelmi, Bradon


    Oral incompetence is a problem frequently experienced after free-flap reconstruction of the oral cavity for patients with oral carcinoma. We describe an interesting treatment modality to deal with this pathology. A 60-year-old woman diagnosed with squamous cell carcinoma of her oral floor was treated with chemoradiation with complete response, and after suffering recurrence underwent composite mandibulectomy via visor flap and immediate fibular free flap reconstruction. Postoperatively, she was treated with adjuvant chemoradiation and developed oral incompetence months afterward. We performed lower lip suspension with Gore-Tex (Gore - Flagstaff, Arizona) suture with good functional and aesthetic outcome. As of 9 months postoperatively, oral competence was achieved with good functional and aesthetic outcome. This approach is a viable, simple means of restoring oral competence secondary to loss of static control of the lower lip.

  2. Repair of Unstable Posterior Sternoclavicular Dislocation Using Nonabsorbable Tape Suture and Tension Band Technique: A Case Report with Good Results

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    Ekrem Aydın


    Full Text Available Posterior sternoclavicular joint dislocation (PSCJD is quite a rare condition. Nearly half of the closed reduction attempts fail due to various reasons. In this paper, we present a 25-year-old male patient who was admitted to the emergency department in our hospital after having a motor-vehicle accident. It was decided to do PSCJD after physical and imaging studies. Following necessary preparations, closed reduction was attempted with abduction-traction maneuver under general anesthesia; however, adequate stabilization could not be achieved and redislocation was detected during control. Therefore, joint was stabilized with tension band technique using 6 mm polyamide nonabsorbable type suture during open reduction. Painless and complete range of motion in shoulder was achieved at the postoperative 10th week.

  3. Technique of ‘suture less’ appendicectomy by laparoscopy in children: Preliminary communication (United States)

    Bajpai, Minu


    Objective: Objective of this study is to present our experience by harmonic scalpel enabled, single external port appendicectomy using extracorporeally inserted ‘pick and fix’ stitch in three cases. Materials and Methods: Of the eighteen appendicectomies performed with only the use of harmonic scalpel in the last 11 months, the last three were performed using a single external port with the second port accessed under the subcutaneous tissues. The procedure consists of anchoring the mesoappendix to anterior abdominal wall by an extracorporeally inserted ‘pick and fix’ stitch followed by dissection and division of mesoappendix and appendix only with harmonic scalpel. Results: There were three patients, one female and two males aged 5, 7, and 11 years, respectively. Two were elective and one was emergency appendicectomy. Mean operating time was 30 min without any surgical complications. All patients are in follow-up with no complications. Conclusion: This study demonstrates the combined virtue of single external port, use of harmonic scalpel, and ‘pick and fix’ suture in laparoscopic appendicectomy in children. This approach avoids the use of an additional port as well as endosuture; and is safe, efficient, cost-effective, and is associated with reduced surgical time. PMID:24604981

  4. Technique of ′suture less′ appendicectomy by laparoscopy in children: Preliminary communication

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    Minu Bajpai


    Full Text Available Objective: Objective of this study is to present our experience by harmonic scalpel enabled, single external port appendicectomy using extracorporeally inserted ′pick and fix′ stitch in three cases. Materials and Methods: Of the eighteen appendicectomies performed with only the use of harmonic scalpel in the last 11 months, the last three were performed using a single external port with the second port accessed under the subcutaneous tissues. The procedure consists of anchoring the mesoappendix to anterior abdominal wall by an extracorporeally inserted ′pick and fix′ stitch followed by dissection and division of mesoappendix and appendix only with harmonic scalpel. Results: There were three patients, one female and two males aged 5, 7, and 11 years, respectively. Two were elective and one was emergency appendicectomy. Mean operating time was 30 min without any surgical complications. All patients are in follow-up with no complications. Conclusion: This study demonstrates the combined virtue of single external port, use of harmonic scalpel, and ′pick and fix′ suture in laparoscopic appendicectomy in children. This approach avoids the use of an additional port as well as endosuture; and is safe, efficient, cost-effective, and is associated with reduced surgical time.

  5. Technique of 'suture less' appendicectomy by laparoscopy in children: Preliminary communication. (United States)

    Bajpai, Minu


    Objective of this study is to present our experience by harmonic scalpel enabled, single external port appendicectomy using extracorporeally inserted 'pick and fix' stitch in three cases. Of the eighteen appendicectomies performed with only the use of harmonic scalpel in the last 11 months, the last three were performed using a single external port with the second port accessed under the subcutaneous tissues. The procedure consists of anchoring the mesoappendix to anterior abdominal wall by an extracorporeally inserted 'pick and fix' stitch followed by dissection and division of mesoappendix and appendix only with harmonic scalpel. There were three patients, one female and two males aged 5, 7, and 11 years, respectively. Two were elective and one was emergency appendicectomy. Mean operating time was 30 min without any surgical complications. All patients are in follow-up with no complications. This study demonstrates the combined virtue of single external port, use of harmonic scalpel, and 'pick and fix' suture in laparoscopic appendicectomy in children. This approach avoids the use of an additional port as well as endosuture; and is safe, efficient, cost-effective, and is associated with reduced surgical time.

  6. Effects of Laparascopic Hernia Repair by PIRS (Percutan Internal Ring Suturing) Technique on Testicular Artery Blood Supply. (United States)

    Oral, Akgun; Karaca, Leyla; Ahiskalioglu, Ali; Yildiz, Abdullah; Yigiter, Murat; Celikkaya, Mehmet Emin; Chyndolotov, Temirlan; Salman, Ahmet Bedii


    Percutaneous internal ring suturing technique (PIRS) is a minimally invasive technique in pediatric inguinal hernia repair. In the present study, a negative effect on testicular blood flow using PIRS technique has been investigated. Forty male patients were included in the study prospectively. Two groups were formed as conventional open surgery (Group I) and PIRS technique (Group II). The resistive index (RI) value of the testicular artery was measured prospectively by using SMI (superb micro-vascular imaging) software with the color doppler ultrasound technique preoperatively and postoperatively at the first month. Inguinal hernia was present on the left in 35% (n = 14) of the patients and on the right in 65% (n = 26) of the patients. There was no statistically significant difference (p = 0.727) between Group I and II with regard to preoperative RI value (0.66 ± 0.07 vs. 0.66 ± 0.45, respectively). Similarly, there was no statistically significant difference (p = 0.220) between Group I and II with regard to the RI values measured at the postoperative first month (0.58 ± 0.04 vs. 0.60 ± 0.04, respectively). Although the postoperative RI values decreased compared to the preoperative values in both groups, this difference was not statistically significant. (p = 0.447 in Group I, and p = 0.175 in Group II for intragroup comparison). Besides PIRS technique has the advantages provided by all other laparoscopic techniques defined for inguinal hernia repair, there is no significant difference between this technique and conventional open surgery with regard to testicular blood flow. It is an innovative candidate technique instead of the open surgery method besides its additional advantages.

  7. Ability of the Tightrope® and percutaneous lateral fabellar suture techniques to control cranial tibial translation. (United States)

    Biskup, Jeffery J; Griffon, Dominique J; Socie, Mike; Schaeffer, David J; Kurath, Peter


    To compare the ability of the Tightrope® (TR) cranial cruciate ligament (CCL) technique, percutaneous lateral fabella suture (pLFS) technique, and normal CCL to control cranial tibial translation (CTT). In vitro biomechanical study. Cadaveric canine pelvic limbs (n = 18 pairs). Six small animal surgical residents (1 pair each) and a Diplomate of the American College of Veterinary Surgeons (10 pairs) performed TR and pLFS techniques on paired limbs. Two intact limb pairs served as controls. Limbs were assessed by palpation, radiographs, and dissection before mechanical testing of resistance to CTT. Forces resisted during displacement were compared between groups with a mixed ANOVA and post hoc tests. With 5 mm of displacement, the pLFS resisted 72 ± 45 N and the TR resisted 66 ± 48 N of load. The intact CCL resisted 400 ± 35 N. The intact CCL resisted displacement significantly more than either surgical technique. TR and pLFS had similar ability to resist CTT but neither restored the biomechanical properties of an intact CCL. © Copyright 2014 by The American College of Veterinary Surgeons.

  8. A new and simple suturing technique applied after surgery to correct ingrown toenails may improve clinical outcomes: A randomized controlled trial. (United States)

    Uygur, Esat; Çarkçi, Engin; Şenel, Ahmet; Kemah, Bahattin; Turhan, Yalçın


    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.

  9. Application of split gluteus maximus muscle--adipofascial turnover flap and subcutaneous tension-reducing suture technique in repair of decubitus ulcers. (United States)

    Liang, Weizhong; Zhou, Zheng; Zhao, Zuojun


    The purpose of this study was to study the clinical effect of split gluteus maximus muscle-adipofascial turnover flap and tension-reducing suture in the treatment of decubitus ulcers. Thirty-one cases of sacrococcygeal decubitus ulcers were repaired by split gluteus maximus muscle-adipofascial turnover flap. The surface of flaps ranged from 5×6 cm to 7×8 cm. The skin was then closed, primarily using subcutaneous tension-reducing suture. Eighty-eight percent of the flaps (27 of 31) healed primarily. The split gluteus maximus muscle-adipofascial turnover flap and tension-reducing suture technique was found to be a highly efficient method of repairing decubitus ulcers with a relatively low ratio of recurrence.

  10. Application of Split Gluteus Maximus Muscle–Adipofascial Turnover Flap and Subcutaneous Tension-Reducing Suture Technique in Repair of Decubitus Ulcers (United States)

    Weizhong, Liang; Zheng, Zhou; Zoujun, Zhao


    The purpose of this study was to study the clinical effect of split gluteus maximus muscle–adipofascial turnover flap and tension-reducing suture in the treatment of decubitus ulcers. Thirty-one cases of sacrococcygeal decubitus ulcers were repaired by split gluteus maximus muscle–adipofascial turnover flap. The surface of flaps ranged from 5 × 6 cm to 7 × 8 cm. The skin was then closed, primarily using subcutaneous tension-reducing suture. Eighty-eight percent of the flaps (27 of 31) healed primarily. The split gluteus maximus muscle–adipofascial turnover flap and tension-reducing suture technique was found to be a highly efficient method of repairing decubitus ulcers with a relatively low ratio of recurrence. PMID:25058782

  11. Parallel suture technique with ProGlide: a novel method for management of vascular access during transcatheter aortic valve implantation (TAVI). (United States)

    Ott, Ilka; Shivaraju, Anupama; Schäffer, Nina R; Frangieh, Antonio H; Michel, Jonathan; Husser, Oliver; Hengstenberg, Christian; Mayr, Patrick; Colleran, Roisin; Pellegrini, Constanza; Cassese, Salvatore; Fusaro, Massimiliano; Schunkert, Heribert; Kastrati, Adnan; Kasel, Albert M


    The aim of this study was to evaluate vascular complications using the "parallel suture technique" in patients receiving an Edwards SAPIEN XT (SXT) or SAPIEN S3 (S3) transcatheter heart valve (THV). Two hundred consecutive patients with symptomatic severe aortic stenosis treated with TF-TAVI were included in this study where the "parallel suture technique" was applied for vascular access-site closure. This was achieved by placing the sutures medial and lateral to the puncture site. Vascular access-site complications were defined as vascular dissection, perforation, obstruction, arteriovenous fistula or pseudoaneurysms, and classified according to the Valve Academic Research Consortium-2 (VARC-2) criteria. Duplex sonography was performed routinely in every patient. In patients receiving the S3, the sheath to femoral and iliac artery ratio was significantly lower than in the SXT group, reflecting reduction in sheath sizes for S3. More endovascular interventions were required after SXT implantation as compared to S3 (4% versus 1%, p=0.02). This was due to vascular obstruction or device failure. Moreover, increased life-threatening, major bleedings, and pseudoaneurysms were found in the SXT group (6% versus 1%, p=0.06, 13% versus 3%, p=0.009, 7% versus 1%, p=0.03, respectively). The "parallel suture technique" using the ProGlide is associated with a low number of vascular complications, even when using larger sheath sizes.

  12. Surgical Treatment of Corneal Ectasia with Motowa's Trephine and Selective Suturing Technique. (United States)

    Al-Motowa, Saeed; Al-Harby, Mosa


    A 40-year-old male presented with bilateral ectasia, contact lens intolerance, and astigmatism >10 D in both eyes. The patient had end-stage pellucid marginal degeneration that warranted surgical treatment. We present a unique surgical technique to stabilize the cornea, minimize astigmatism, improve vision and corneal status, and avoid penetrating keratoplasty.

  13. A Barbed Suture Repair For Flexor Tendons: A Novel Technique With No Exposed Barbs

    Directory of Open Access Journals (Sweden)

    Cormac W. Joyce, MB BCh


    Conclusions: We demonstrated that a 4-strand knotless, barbed method attained comparable strength to that of the traditional Adelaide repair technique. The barbed method had a significantly reduced cross-sectional area at the repair site compared with the Adelaide group. The 2-mm gap formation force was less in the barbed group than the Adelaide group. Barbed repairs show promise for tendon repairs; this simple method warrants further study in an animal model.

  14. 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


    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.

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

    LENUS (Irish Health Repository)

    Hennessey, D B


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

  16. Evaluation of Midterm Clinical Results of All inside Suture Technique in Meniscus Repair

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    Murat Gül


    Full Text Available Aim: The aim of this study was to evaluate the functional outcomes of arthroscopic all-inside meniscal repair at an average 5-year follow-up. Methods: Thirty-two patients (29 males 3 females; 19 right knees, 13 left knees, who underwent arthroscopic all-inside meniscal repair, were included in the study. Clinical examination and magnetic resonance imaging were the main diagnostic tools. The mean age of the patients was 28 years (23-41 years. ACL reconstruction was performed in the same session in 12 patients with meniscal injury associated with ACL tear. Preoperative and postoperative functional knee scores of the patients were assessed by modified Marshall functional knee scores in their last follow-up. Results: The mean follow-up period was 58 months (range 49- 81. Marshall knee scores in the last follow-up were found to be excellent in 23 patients, good - in 8 patients, and moderate in 1 patient. ACL reconstruction was performed in the same session in 12 patients with meniscal injury associated with ACL tear. A statistically significant functional improvement was detected in patients with meniscal repair after 5 years. Conclusion: This study showed that all-inside meniscal repair technique is an easy and reliable method for the treatment of meniscus tears. (The Medical Bulletin of Haseki 2015; 53:47-51

  17. 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

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    Volkan Ergan


    Conclusion: The yield points with higher forces is expected to be preferred, but their thicknesses can be 3-0 or 4-0. Oblique suture passing should be preferred rather than longitudinal passing. Obviously, suture strengthening methods, like epitendineous running sutures and core sutures, should be used. Without these measures, even passive wrist motion can result in gap formation at the repair site. The results of this study showed that tensile properties of the repaired vary considerably with differences in suture material and design. [Hand Microsurg 2016; 5(3.000: 130-136


    Directory of Open Access Journals (Sweden)

    Eka Sutyawan


    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.

  19. Vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique for bilateral vocal fold immobility: long-term results. (United States)

    Songu, Murat; Aslan, Hale; Denizoglu, Ilter; Ozkul, Yilmaz; Basoglu, Sinan; Ates, Duzgun; Ozturkcan, Sedat; Katilmis, Huseyin


    Vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique is an effective and durable procedure for the management of patients with bilateral vocal fold immobility. To review the long-term results of bilateral vocal fold immobility in 26 patients treated with vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique over a 6-year period. This retrospective study examined patients with a minimum follow-up of 1 year. The main outcome measures used were the modified Medical Research Council (MRC) dyspnoea scale and the assessment of voice quality pre- and postoperatively using the Likert method. The mean follow-up period was 23.77 ± 12.01 months. All patients reported marked symptomatic improvement in dyspnoea (p = 0.0001). The voice quality worsened as expected; however, this difference did not reach a significant level (p = 0.642). Transient microaspiration was noted in seven of the patients and resolved in 1 or 2 days. The procedure was performed for the contralateral vocal fold in one case, due to the loss of suture tension. No patient showed aspiration postoperatively or during follow-up. All patients were regularly followed up for the beginning of movement of the lateralized or contralateral vocal folds in our outpatient clinic.

  20. Transaxillary approach with use of traction suture for excision of breast fibroadenoma: a new technique and its results. (United States)

    Khan, Parwez Sajad; Hayat, Humera; Hayat, Gazala


    Avoiding a scar on the breast is an inherent feminine desire. We devised a new approach for breast fibroadenoma excision:Transaxillary approach with use of traction suture (TATS), in 50 patients with breast fibroadenoma. The swelling was present in the outer breast. The wound healed without noticeable scarring and the original shape of the breast was preserved. All the patients expressed their great satisfaction with the procedure.

  1. High pregnancy rate after microsurgical tubal reanastomosis by temporary loose parallel 4-quadrant sutures technique: a long long-term follow-up report on 961 cases. (United States)

    Moon, Hwa Sook; Joo, Bo Sun; Park, Gun Sik; Moon, Sung Eun; Kim, Sang Gap; Koo, Ja Seong


    Only a limited portion of sterilized women undergo tubal reanastomosis due to high costs, limited availability of qualified practitioners willing to perform the procedure and increasing success rates with IVF. However, IVF has complications and an increased risk of ectopic pregnancy and multiple pregnancies. Recently, the importance of specialized training for tubal anastomosis has been re-emphasized. This study aimed to report the procedure of our microsurgical tubal reanastomosis by a temporary loose parallel 4-quadrant suture technique and its high pregnancy outcome over the last 20 years. This clinical study retrospectively analyzed data on 961 consecutive patients who underwent tubal reversal between March 1988 and August 2007 in a large urban medical center. All surgical operations were performed by microsurgical tubal reanastomosis using a temporary loose parallel 4-quadrant suture technique by a single surgeon. Subsequent pregnancy outcomes were evaluated. The overall pregnancy rate was 85.1, 82.6 being intrauterine and 2.5% ectopic. The pregnancy rate was significantly reduced in patients over 40 years old (53.9%) compared with patients aged 40 years or less (90.3%) (P technique resulted in a high pregnancy rate comparable with the level of natural fertility. The study also reveals that ectopic pregnancy frequently occurs in tubal reanastomosis of the interstitial-ampulla site compared with other sites.

  2. Ovarian Suspension With Adjustable Sutures: An Easy and Helpful Technique for Facilitating Laparoendoscopic Single-Site Gynecologic Surgery. (United States)

    Chen, Kuo-Hu; Chen, Li-Ru; Seow, Kok-Min


    To describe a method of ovarian suspension with adjustable sutures (OSAS) for facilitating laparoendoscopic single-site gynecologic surgery (LESS) and to investigate the effect of OSAS on LESS. Prospective cohort study (Canadian Task Force classification: II-2). University teaching hospital. One hundred seventy-eight patients with benign 5- to 15-cm cystic ovarian tumors who underwent LESS with OSAS (suspension group, n = 90) and without OSAS (control group, n = 88). For patients who underwent OSAS (suspension group), 1 end of double-head straight needles with a polypropylene suture was inserted into the pelvic cavity through the abdominal skin to penetrate the cyst or ovarian parenchyma and puncture outside the abdominal skin. After cutting off the needles, both sides of the remaining suture were held together by a clamp, without knotting, so that the manipulator could "lift," "loosen," or "fix" the stitches to adjust the tension. The average time to create OSAS was 2.9 min. For the suspension and control groups, the average blood loss was 81.4 and 131.8 mL (p < .001), and the operative time was 42.0 and 61.3 min (p < .001), respectively. There were no significant differences in the incidence of complications (5.6% vs 9.1%; p = .365), but there were significant differences in conversions to standard non-single-site laparoscopy (5.6% vs 15.9%; p = .025) and laparotomy (1.1% vs 6.8%; p = .040). Logistic regression analysis revealed that the ratios of conversion to standard non-single-site laparoscopy (odds ratio [OR], 0.126; 95% confidence interval [CI], 0.311-0.508) and laparotomy (OR, 0.032; 95% CI, 0.002-0.479) were much lower in the suspension group; the risk of complications was comparable (OR, 0.346; 95% CI, 0.085-1.403). OSAS is an easy, safe, and feasible method that offers advantages during LESS. Although routine use of OSAS is not necessary, OSAS can be considered during LESS to facilitate the surgery. Copyright © 2015 AAGL. Published by Elsevier Inc. All


    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


    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.

  4. A Novel Repair Method for Radial Tears of the Medial Meniscus: Biomechanical Comparison of Transtibial 2-Tunnel and Double Horizontal Mattress Suture Techniques Under Cyclic Loading. (United States)

    Bhatia, Sanjeev; Civitarese, David M; Turnbull, Travis Lee; LaPrade, Christopher M; Nitri, Marco; Wijdicks, Coen A; LaPrade, Robert F


    Complete radial tears of the medial meniscus have been reported to be functionally similar to a total meniscectomy. At present, there is no consensus on an ideal technique for repair of radial midbody tears of the medial meniscus. Prior attempts at repair with double horizontal mattress suture techniques have led to a reportedly high rate of incomplete healing or healing in a nonanatomic (gapped) position, which compromises the ability of the meniscus to withstand hoop stresses. A newly proposed 2-tunnel radial meniscal repair method will result in decreased gapping and increased ultimate failure loads compared with the double horizontal mattress suture repair technique under cyclic loading. Controlled laboratory study. Ten matched pairs of male human cadaveric knees (average age, 58.6 years; range, 48-66 years) were used. A complete radial medial meniscal tear was made at the junction of the posterior one-third and middle third of the meniscus. One knee underwent a horizontal mattress inside-out repair, while the contralateral knee underwent a radial meniscal repair entailing the same technique with a concurrent novel 2-tunnel repair. Specimens were potted and mounted on a universal testing machine. Each specimen was cyclically loaded 1000 times with loads between 5 and 20 N before experiencing a load to failure. Gap distances at the tear site and failure load were measured. The 2-tunnel repairs exhibited a significantly stronger ultimate failure load (median, 196 N; range, 163-212 N) than did the double horizontal mattress suture repairs (median, 106 N; range, 63-229 N) (P = .004). In addition, the 2-tunnel repairs demonstrated decreased gapping at all testing states (P meniscus significantly decrease the ability of the meniscus to dissipate tibiofemoral loads, predisposing patients to early osteoarthritis. Improving the ability to repair medial meniscal radial tears in a way that withstands cyclic loads and heals in an anatomic position could significantly

  5. Suture slippage in knotless suture anchors resulting in subacromial-subdeltoid bursitis. (United States)

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


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

  6. Comparison of lateral fabellar suture and tibial plateau leveling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease. (United States)

    Gordon-Evans, Wanda J; Griffon, Dominique J; Bubb, Carrie; Knap, Kim M; Sullivan, Meghan; Evans, Richard B


    To compare 1-year outcomes after lateral fabellar suture stabilization (LFS) and tibial plateau leveling osteotomy (TPLO) for the treatment of dogs with cranial cruciate ligament disease. Randomized blinded controlled clinical trial. 80 dogs with naturally occurring unilateral cranial cruciate ligament disease. All dogs were randomly assigned to undergo LFS (n = 40) or TPLO (40). Clinical data collected included age, weight, body condition score, history information, stifle joint instability, radiographic findings, surgical findings, and complications. Outcome measures were determined prior to surgery and at 6 and 12 weeks and 6 and 12 months after surgery, including values of pressure platform gait analysis variables, Canine Brief Pain Inventory scores, owner satisfaction ratings, thigh circumference, and stifle joint goniometry values. Signalment and data for possible confounding variables were similar between groups. Peak vertical force of affected hind limbs at a walk and trot was 5% to 11% higher for dogs in the TPLO group versus those in the LFS group during the 12 months after surgery. Canine Brief Pain Inventory, goniometry, and thigh circumference results indicated dogs in both groups improved after surgery, but significant differences between groups were not detected. Owner satisfaction ratings at 12 months after surgery were significantly different between groups; 93% and 75% of owners of dogs in the TPLO and LFS groups indicated a satisfaction score ≥ 9 (scale, 1 to 10), respectively. Kinematic and owner satisfaction results indicated dogs that underwent TPLO had better outcomes than those that underwent LFS.

  7. Outcomes following 50 consecutive endoscopic gastrojejunal revisions for weight gain following Roux-en-Y gastric bypass: a comparison of endoscopic suturing techniques for stoma reduction. (United States)

    Patel, Lava Y; Lapin, Brittany; Brown, Craig S; Stringer, Thomas; Gitelis, Matthew E; Linn, John G; Denham, Woody E; Farwell, Elizabeth; Haggerty, Stephen; Ujiki, Michael B


    Approximately 20-30 % of morbidly obese patients undergoing Roux-en-Y gastric bypass (RYGB) will experience significant weight regain in the years following surgery. Endoscopic gastrojejunal revision (EGJR) has been shown to be a safe, effective and less invasive alternative to revisional surgery, with promising weight loss outcomes. However, minimal data exist regarding how to perform the procedure most effectively and what factors may predict good outcomes. We compared weight loss outcomes between patients undergoing endoscopic stoma revision by one of two full-thickness suturing techniques. A retrospective review of patients undergoing EGJR between 06/2012 and 09/2015 was performed. Included patients were adults 18-74 years of age who had experienced weight regain ≥2 years after initial RYGB with stoma dilation ≥15 mm in diameter. Revision was done with either an interrupted (IRT) or purse-string (PST) suture technique. A linear mixed effects model was constructed to predict postoperative weight loss. Fifty revisions (IRT = 36, PST = 14) were performed in 47 patients (92 % female, mean age of 50.9 ± 10.9 years and body mass index of 41.4 ± 7.1 kg/m 2 ). Technical success (stoma diameter ≤10 mm) was achieved in all cases. Final diameter was significantly smaller in the PST group, 6.6 ± 2.2 mm versus 4.8 ± 1.8 mm (p weight loss over time compared to IRT. Sixteen comorbid conditions resolved among 12 patients. No major complications occurred. Endoscopic revision of the gastric outlet results in meaningful weight loss and comorbidity resolution in select patients experiencing weight regain following RYGB. A PST revision likely results in higher and more sustainable weight loss when compared to IRT.

  8. Midwives conducting perineal repair: The Danish Suture Trial

    DEFF Research Database (Denmark)

    Kindberg, Sara


    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......Midwives conducting perineal repair: The Danish Suture Trial.     Background Suture techniques and materials for repair of 2nd degree perineal lacerations and episiotomies have been tested in several clinical trials. Danish midwives and obstetricians have developed a new, simple and time......-efficient suture technique which needed systematic evaluation. Objective To compare two standardized suture techniques for perineal repair of 2nd degree perineal lacerations or episiotomies. Design and setting A double-blind randomised clinical trial conducted in Aarhus University Hospital, Denmark. Initiated...

  9. Subluxation of iris-sutured intraocular lenses and results of a closed chamber technique for repositioning after penetrating keratoplasty. (United States)

    Jabbur, Nada S; Akpek, Esen Karamursel; Stark, Walter J


    To describe subluxation of iris-fixated intraocular lenses (IOLs) after penetrating keratoplasty (PK) as a postoperative complication and report the long-term outcomes of a closed-chamber refixation technique used in the management. This was a retrospective, noncomparative interventional case series in which 19 consecutive patient charts with a subluxated iris-fixated IOL after PK were retrospectively reviewed. Fourteen of the patients underwent surgery using a closed-chamber refixation technique. These patients were evaluated for visual outcome and surgical complications associated with the procedure. In 13 patients, postoperative follow-up was available. In all 13 cases, the fixated IOL appeared stable and remained well positioned during a follow-up period of 56 months (range, 6-122). All patients (100%) achieved improved uncorrected visual acuity. The postoperative visual acuity ranged from 20/20 to 20/100 with a mean of 20/40. Vitreous hemorrhage occurred in 1 patient, and an additional patient required a second surgery using the same technique. Both of these patients did well with a final visual acuity of 20/40 and 20/50, respectively. Subluxation of iris-fixated IOL after PK can occur as a postoperative complication. The technique that we herein describe enables secure refixation of subluxated IOLs and yields favorable long-term results.

  10. Cranial suture complexity in white-tailed deer (Odocoileus virginianus). (United States)

    Nicolay, Christopher W; Vaders, Mark J


    Neurocranial expansion and mastication are commonly implicated as the two major biomechanical factors affecting suture morphology. In deer the antlers provide an additional source of biomechanical stress acting on the skull. Equivalent stresses are not found in females, who lack antlers. We analyzed the complexity and interdigitation of the interfrontal and coronal sutures that surround the antler-bearing frontal bones of (n = 67) white-tailed deer (Odocoileus virginianus) to 1) evaluate changes in suture morphology throughout ontogeny, and 2) test the hypothesis that male deer have more complex sutures than females. Two methods were used to quantify suture morphology: fractal analysis and length-ratios (actual suture length divided by direct straightline length). Both techniques produced similar results, although the two methods cannot be considered equivalent. Suture complexity increases markedly throughout ontogeny, but appears to level off after animals have reached adulthood. Cranial size in males, but not females, continues to increase in adults. No significant increase in suture complexity with age in the adult cohort was detected. While deer are highly dimorphic in size and the presence of antlers, no significant differences existed between males and females for any measure of suture complexity. No consistent patterns emerged between suture complexity and skull size or antler characteristics. The presence of antlers appears to have a minimal effect on suture complexity in white-tailed deer. Factors that may contribute to the lack of dimorphism in suture complexity are discussed. (c) 2006 Wiley-Liss, Inc.

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

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    Vitor Mayer de Moura

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

  12. Celebrity arcade suture blepharoplasty for double eyelid. (United States)

    Liao, Wen-Chieh; Tung, Tung-Chain; Tsai, Tzong-Ru; Wang, Chia-Yi; Lin, Chiu-Hwa


    In Taiwan, double-eyelid surgery is the most popular cosmetic surgical procedure. The technique preferred by plastic surgeons is the incision method because it is believed that this method can provide stable double-eyelid results. It is the authors' observation that patients prefer an invagination fold rather than a significantly high fold. Suture blepharoplasty may create a relatively even and symmetric invagination fold. In the past, the major disadvantage of the suture technique has been the opinion that the double fold fades away. The celebrity arcade suture (CAS) technique was applied in double-eyelid operations. The CAS technique includes three major techniques: stabbing incision, transtarsal suture, and bridge connection. The whole procedure can be completed in 15 min. From June 2001 to November 2004, 312 patients underwent the CAS technique. Of the 312 patients who underwent the CAS technique, 5 required a revisit, with 3 of these returning patients reporting fold disappearance. These three patients received repeat suture procedures. The findings show that the CAS technique is a reliable method for establishing a smooth, constant, and symmetric double eyelid, and that CAS requires only a short recovery time.


    Directory of Open Access Journals (Sweden)



    Full Text Available PURPOSE: The aim of study is to compare Continuous technique with non - absorbable sutures, Interrupted technique with non - absorbable sutures and Continuous technique with slowly absorbable sutures Focusing mainly on incidence of incisional hernias, burst abdomen, wound infections, chronic wound pain, suture sinus, stitch granuloma, time for rectus closure. METHODOLOGY : Study was conducted for a period of one year on 271 randomized patients with primary elective midline laparotomy in our hospital . patients are divided into group I includes 102 patients with continuous technique using non absorbable polypropylene, group II includes 91 patients with interrupted technique using non absorbable polypropylene and group III includes 78 patients with continuous slowly absorbable polyhydroxybutyrate. RESULTS: No significant difference observed in incidence of wound infections and burst abdomen in all the 3 groups but relatively higher incidence of wound infections in noted our hospital. Incidence of stich granuloma suture sinus and chronic wound pain is more with interrupted technique than continuous technique and are more with non - absor bable suture material. CONCLUSION: Incidence of incisional hernias, suture complications like suture sinus, stitch granuloma can be more effectively reduced with slowly absorbable continuous sutures.

  14. Distal biceps brachii tendon repairs: a single-incision technique using a cortical button with interference screw versus a double-incision technique using suture fixation through bone tunnels. (United States)

    Shields, Edward; Olsen, Joshua R; Williams, Richard B; Rouse, Lucien; Maloney, Michael; Voloshin, Ilya


    Distal biceps brachii tendon repairs performed with a tension slide technique using a cortical button (CB) and interference screw are stronger than those based on suture fixation through bone tunnels (BTs) in biomechanical studies. However, clinical comparison of these 2 techniques is lacking in the literature. To perform a clinical comparison of the single-incision CB and double-incision BT techniques. Cohort study; Level of evidence, 3. Distal biceps tendon ruptures repaired through either the single-incision CB or double-incision BT technique were retrospectively identified at a single institution. Patients>1 year out from surgery were assessed for range of motion, strength, and complications, and they completed a DASH questionnaire (Disabilities of the Arm, Shoulder, and Hand). Patients in the CB group (n=20) were older (52±9.5 vs 43.7±8.7 years; P=.008), had a shorter interval from surgery to evaluation (17.7±5 vs 30.8±16.5 months; P=.001), and were less likely to smoke (0% vs 28.5%; P=.02) compared with the BT patients (n=21). DASH scores were similar between groups (4.46±4.4 [CB] vs 5.7±7.5 [BT]; P=.65). Multivariate analysis revealed no differences in range of motion or strength between groups. More CB patients (30%; n=6) experienced a complication compared with those in the BT group (4.8%; n=1) (P=.04), and these complications were predominantly paresthesias of the superficial radial nerve that did not resolve. There were no reoperations or repair failures in either group. Both the single-incision CB and double-incision BT techniques provided excellent clinical results. Complications were more common in the single-incision CB group and most commonly involved paresthesias of the superficial radial nerve. © 2015 The Author(s).

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

    Directory of Open Access Journals (Sweden)

    Elif Sarı


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

  16. Mesh fixation with a barbed anchor suture results in significantly less strangulation of the abdominal wall. (United States)

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


    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 < 0.0001). Table 1 compares the 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

  17. Tensile strength and failure load of sutures for robotic surgery. (United States)

    Abiri, Ahmad; Paydar, Omeed; Tao, Anna; LaRocca, Megan; Liu, Kang; Genovese, Bradley; Candler, Robert; Grundfest, Warren S; Dutson, Erik P


    Robotic surgical platforms have seen increased use among minimally invasive gastrointestinal surgeons (von Fraunhofer et al. in J Biomed Mater Res 19(5):595-600, 1985. doi: 10.1002/jbm.820190511 ). However, these systems still suffer from lack of haptic feedback, which results in exertion of excessive force, often leading to suture failures (Barbash et al. in Ann Surg 259(1):1-6, 2014. doi: 10.1097/SLA.0b013e3182a5c8b8 ). This work catalogs tensile strength and failure load among commonly used sutures in an effort to prevent robotic surgical consoles from exceeding identified thresholds. Trials were thus conducted on common sutures varying in material type, gauge size, rate of pulling force, and method of applied force. Polydioxanone, Silk, Vicryl, and Prolene, gauges 5-0 to 1-0, were pulled till failure using a commercial mechanical testing system. 2-0 and 3-0 sutures were further tested for the effect of pull rate on failure load at rates of 50, 200, and 400 mm/min. 3-0 sutures were also pulled till failure using a da Vinci robotic surgical system in unlooped, looped, and at the needle body arrangements. Generally, Vicryl and PDS sutures had the highest mechanical strength (47-179 kN/cm 2 ), while Silk had the lowest (40-106 kN/cm 2 ). Larger diameter sutures withstand higher total force, but finer gauges consistently show higher force per unit area. The difference between material types becomes increasingly significant as the diameters decrease. Comparisons of identical suture materials and gauges show 27-50% improvement in the tensile strength over data obtained in 1985 (Ballantyne in Surg Endosc Other Interv Tech 16(10):1389-1402, 2002. doi: 10.1007/s00464-001-8283-7 ). No significant differences were observed when sutures were pulled at different rates. Reduction in suture strength appeared to be strongly affected by the technique used to manipulate the suture. Availability of suture tensile strength and failure load data will help define software safety

  18. Technique Tip: The Use of McGlamry Elevator to Assist Suture Passing in the Dorsal Technique of Plantar Plate Repair With Weil Osteotomy for Lesser Metatarsophalangeal Joint Instability. (United States)

    Sullivan, Martin; Panti, Juan Paulo


    The combination of a dorsal approach to the plantar plate with a Weil's metatarsal osteotomy has been shown to provide an adequate exposure for plantar plate repair. However, soft tissues in a restricted area of the metatarsophalangeal joint could present as a technical difficulty during suture retrieval during repair of the plantar plate. The purpose of this article is to describe the use of the McGlamry elevator for assistance in the retrieval of sutures through the proximal phalanx. Level V: Expert opinion. © 2015 The Author(s).

  19. Arthroscopic management of traumatic anterior shoulder instability in collision athletes: analysis of 204 cases with a 4- to 9-year follow-up and results with the suture anchor technique. (United States)

    Larrain, Mario Victor; Montenegro, Hugo Jorge; Mauas, David Marcelo; Collazo, Cristian Carlos; Pavón, Facundo


    The purpose of this study was to determine the effectiveness of arthroscopy in the selection of surgical procedure and treatment of both acute and recurrent traumatic anterior shoulder instability in rugby players by use of pre-established selection criteria. We describe the injury mechanisms, analyze the pathologic lesions and treatment indications based on surgical findings, and assess the results in patients treated with the arthroscopic suture anchor technique. From November 1996 to November 2001, 204 rugby players with acute or recurrent traumatic anterior instability underwent an initial arthroscopic examination. Criteria such as type of Bankart lesion, tissue quality, and presence of bony defects were evaluated and used to determine the method of stabilization: arthroscopy or open stabilization. Open surgery was indicated in patients with bone humeral deficiencies greater than one fourth of the articular humeral head, bone glenoid deficiencies greater than 25% of the glenoid extension, capsular laxity with poor tissue quality, and humeral avulsion of the glenohumeral ligament; all other patients underwent arthroscopic reconstruction via the bone suture anchor technique. The mean follow-up was 5.9 years (range, 3.9 to 8.9 years). We performed arthroscopic stabilization in 39 cases of acute instability; only 1 case (2.5%) required the mini-open technique for reinsertion of humeral avulsion of the glenohumeral ligament. Of 158 cases of recurrent instability, 121 underwent arthroscopic stabilization, and 37 (23.4%) required reconstruction with open surgery. The main cause was bony deficiency (treated with the Latarjet procedure). The results of the arthroscopic reconstructions were evaluated by use of the Rowe scale and analyzed according to stability and range of motion. Good or excellent results were found in 94.9% of cases in the acute instability group and in 91.8% in the recurrent instability group, the poor results were due to instability recurrence. In

  20. Replacement for sutures. (United States)


    Davis and Geek has introduced a blue tissue adhesive, Histoacryl, for use as a gentle alternative to stitches for children who need treatment for minor skin wounds. The company says that accident and emergency departments have found it provides an excellent alternative to sutures because there is no need for an anaesthetic nor a return visit to have the stitches removed. It takes away some of the trauma for the young patients and parents as well as the staff who treat them.

  1. Blepharoptosis correction with buried suture method. (United States)

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


    Many surgical techniques have been developed to correct blepharoptosis, including the anterior levator resection or advancement, tarsoaponeurectomy, and Fasanella-Servat Müllerectomy. However, to minimize surgical scarring and reduce the postoperative recovery time, the procedure has been developed from a complete incision to a partial incision, which is appealing to patients. To aid the procedural development, this study describes a surgical technique in which the correction of blepharoptosis and a double eyelid fold operation are performed using a buried suture technique during the same operation. A retrospective review was conducted using the medical records and preoperative and postoperative photography of 121 patients who underwent simultaneous correction of blepharoptosis and had a double eyelid fold created between October 2010 and July 2011. All of the patients had mild (1-2 mm) or moderate (3-4 mm) bilateral blepharoptosis and excellent or good levator function (>8 mm). The average preoperative marginal reflex distance (MRD1) measured 1.174 (0.3) mm. No intraoperative complications occurred. The average postoperative MRD1 measured 3.968 (0.2) mm. There was statistical significance improvement between preoperative MRD1 and postoperative MRD1 (P<0.05). No symptomatic dry eye and exposure keratopathy were noted. Blepharoptosis correction using the buried suture technique is an effective technique for young patients experiencing mild to moderate blepharoptosis who want to have the double eyelid fold operation using the buried suture technique.

  2. Force sensing in surgical sutures

    NARCIS (Netherlands)

    T. Horeman (Tim); E.-J. Meijer (Evert-Jan); J.J. Harlaar (Joris Jan); J.F. Lange (Johan); J.J. van den Dobbelsteen (John); J. Dankelman (Jenny)


    textabstractThe tension in a suture is an important factor in the process of wound healing. If there is too much tension in the suture, the blood flow is restricted and necrosis can occur. If the tension is too low, the incision opens up and cannot heal properly. The purpose of this paper is to

  3. Force sensing in surgical sutures

    NARCIS (Netherlands)

    Horeman, T.; Meijer, E.J.; Harlaar, J.J.; Lange, J.F.; Van den Dobbelsteen, J.J.; Dankelman, J.


    The tension in a suture is an important factor in the process of wound healing. If there is too much tension in the suture, the blood flow is restricted and necrosis can occur. If the tension is too low, the incision opens up and cannot heal properly. The purpose of this paper is to describe the

  4. Development of braided drug-loaded nanofiber sutures

    International Nuclear Information System (INIS)

    Hu Wen; Huang Zhengming; Liu Xiangyang


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

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

    Directory of Open Access Journals (Sweden)

    Nelson Leonardo Kerdahi Leite de Campos


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

  6. Force sensing in surgical sutures.

    Directory of Open Access Journals (Sweden)

    Tim Horeman

    Full Text Available The tension in a suture is an important factor in the process of wound healing. If there is too much tension in the suture, the blood flow is restricted and necrosis can occur. If the tension is too low, the incision opens up and cannot heal properly. The purpose of this paper is to describe the design and evaluation of the Stitch Force (SF sensor and the Hook-In Force (HIF sensor. These sensors were developed to measure the force on a tensioned suture inside a closed incision and to measure the pulling force used to close the incision. The accuracy of both sensors is high enough to determine the relation between the force in the thread of a stitch and the pulling force applied on the suture by the physician. In a pilot study, a continuous suture of 7 stitches was applied on the fascia of the abdominal wall of multiple pigs to study this relationship. The results show that the max force in the thread of the second stitch drops from 3 (SD 1.2 to 1 (SD 0.3 newton after the 4(th stitch was placed. During placement of the 5(th, 6(th and 7(th stitch, the force in the 2(nd stitch was not influenced anymore. This study indicates that in a continuous suture the force in the thread remains constant up to more than 3 stiches away from the pulled loose end of the suture. When a force feedback tool is developed specially for suturing in surgery on patients, the proposed sensors can be used to determine safety threshold for different types of tissue and sutures.

  7. Force sensing in surgical sutures. (United States)

    Horeman, Tim; Meijer, Evert-Jan; Harlaar, Joris J; Lange, Johan F; van den Dobbelsteen, John J; Dankelman, Jenny


    The tension in a suture is an important factor in the process of wound healing. If there is too much tension in the suture, the blood flow is restricted and necrosis can occur. If the tension is too low, the incision opens up and cannot heal properly. The purpose of this paper is to describe the design and evaluation of the Stitch Force (SF) sensor and the Hook-In Force (HIF) sensor. These sensors were developed to measure the force on a tensioned suture inside a closed incision and to measure the pulling force used to close the incision. The accuracy of both sensors is high enough to determine the relation between the force in the thread of a stitch and the pulling force applied on the suture by the physician. In a pilot study, a continuous suture of 7 stitches was applied on the fascia of the abdominal wall of multiple pigs to study this relationship. The results show that the max force in the thread of the second stitch drops from 3 (SD 1.2) to 1 (SD 0.3) newton after the 4(th) stitch was placed. During placement of the 5(th), 6(th) and 7(th) stitch, the force in the 2(nd) stitch was not influenced anymore. This study indicates that in a continuous suture the force in the thread remains constant up to more than 3 stiches away from the pulled loose end of the suture. When a force feedback tool is developed specially for suturing in surgery on patients, the proposed sensors can be used to determine safety threshold for different types of tissue and sutures.

  8. Syneture stainless STEEL suture. A collective review of its performance in surgical wound closure. (United States)

    Edlich, Richard F; Drake, David B; Rodeheaver, George T; Winters, Kathryne L; Greene, Jill A; Gubler, K Dean; Long, William B; Britt, L D; Winters, Samuel P; Scott, Christine C; Lin, Kant Y


    Syneture (division of U.S. Surgical, division of Tyco Healthcare, Norwalk, Connecticut, USA) STEEL sutures are monofilament stainless steel sutures composed of 316L stainless steel conforming to ASTM Standard F138 grade 2 (" Stainless steel bar and wire for surgical implant"). STEEL sutures meet all requirements established by the United States Pharmacopeia (USP) for nonabsorbable surgical sutures. Steel sutures are for use in abdominal wound closure, intestinal anastomosis, hernia repair, sternal closure, and skin closure. They are attached to the following types of surgical needles: Roto-Grip Needles and SCC Needle. The sutures and needles are packaged in a Mylar/Tyvek outer envelope. The purposes of this clinical review are two fold. First, we will report the performance of the Syneture STEEL suture product in the largest studies of suture performance ever reported in the literature. In addition, we will provide comprehensive information from the surgical literature that highlights the unique benefits of stainless steel sutures for the following wound closure techniques: sternal fixation, abdominal wound repair, inguinal hernia repair, and skin wound closure. Consorta Inc. (Rolling Meadows, Illinois), a leading healthcare resource management group purchasing organization, and Syneture, jointly with a clinician task force, designed a reproducible surgical evaluation program for needles and sutures in a large cooperative of healthcare systems. Because of the subjective nature of the more commonly used suture selection techniques, a nonexperimental observational study approach was designed to replace perception of performance characteristics with actual clinical experience. In a report involving 19 Consorta shareholder hospitals, they discussed the preliminary part (Phase I) of a large nonexperimental observational study of the clinical performance of surgical needles and sutures. Performance characteristics of the sutures and needles produced by Syneture that were

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

    LENUS (Irish Health Repository)

    Tiong, William H C


    Flexor digitorum profundus (FDP) zone I tendon avulsion injury is traditionally repaired with a pullout suture technique. More recently, bone anchor sutures have been used as a viable alternative and have largely replaced areas in hand surgery where pullout suture technique was once required. To date, there have been very few complications reported related to bone anchor suture use in FDP tendon reattachment to the bone. We report a very unusual case of extrusion of bone anchor through the nailbed, 6 years after zone I FDP tendon avulsion injury repair and a brief review of literature.

  10. The history of barbed sutures. (United States)

    Ruff, Gregory L


    Ligatures have been used for millennia to close wounds. Sterilization and synthetic polymers that degrade in a commensurate fashion with wound healing have been the most significant improvements in these age-old devices. However, the constricting loop of a traditional suture and subsequent ischemia ("approximate, don't strangulate") still account for the most common cause of wound dehiscence-necrosis. Inspired by the quill of the North American porcupine, I envisioned a bidirectional array of barbs that could secure tissue without relying on constricting loops. One set of barbs could anchor the other. In this article, I document the development process of these barbed sutures from concept to patent to manufacture and US Food and Drug Administration approval. Knotless, strong, and easy to place, barbed sutures could foreseeably supplant conventional sutures, particularly as endoscopic procedures become more common. They also offer the intriguing potential to suspend ptotic tissues without surgical intervention.

  11. A Modified Fisherman's Knot for Laparoscopic Suturing. (United States)

    Meylemans, Diederik; Handojo, Karen; Devroe, Kurt; Aelvoet, Chris; Vermeiren, Koen; Tollens, Tim


    Suturing is an essential surgical technique, because there is no resection without the need for reconstruction. Therefore, every surgeon should master a set of suturing techniques so he can adapt his approach to the specificity of the situation. The development of laparoscopic surgery poses a new challenge as not all open techniques are amendable for laparoscopic use. We would like to propose a modified fisherman's knot, which has been optimised in our center for laparoscopic use. The technique can be used with every monofilament non-braided wire. The needle is placed through the tissue to be sutured and both wires are externalised through the trocar. First, a simple knot is placed by crossing the left over the right wire. Next, the left is turned around the right wire four times proximal to the starting knot and crossed to the left wire where an additional two turns are made moving away from the trocar. The knot is closed gently, making sure not to lock the knot. Then the instrument of Drouard is used to gently glide the knot over the right wire back through the trocar into the abdomen. After making sure that adequate pressure has been delivered to the knot, to firmly close the tissue, the wire must be cut at a length of at least 3 mm. A new wire should be used for every knot and in this manner several knots can be delivered to make sure the tissue is adequately closed. In our center, no known complications due to loosening or failure of these knots have occurred since we incorporated this knotting technique into our daily practice more than 20 years ago.

  12. A New Coating for Non-resorbable Surgical Suture

    Directory of Open Access Journals (Sweden)

    Ahmed Salah Hameed


    Full Text Available Suture is a biomaterial used to approximate wound edges to facilitate the healing process. This task could be compromised as a result of wound infection. Zinc is an element that has antibacterial action and can be a member of silicate glasses. The zinc-silicate glasses can be used as a coating for surgical suture to combat wound infection. However, zinc has a negative effect on glass degradation and its  antibacterial action is a pH sensitive. In this work, silicate glasseswith ZnO at 14 and 17 mole% were used as a coating for non-resorbable Mersilk suture using a slurry-dipping technique. The coating morphology was studied using SEM and itsanti-bacterial action was investigated in vitroagainstgram positive and negative bacteria at neutral and acidic conditions.The effect of the coating on tensile strength of the sutures wasstudied as well.The results revealed that the coatingwas well-adhered to the suture and had anti-bacterial action atacidic condition.The coating had no effect on the tensile strength of the surgical suture

  13. [Clinical experience in using a metallic suture in eye microsurgery]. (United States)

    Kumar Vinod, Dushin N V


    The use of a metallic suture in eye microsurgery is described in the paper. The metallic suture made from a 0.05-0.05 mm vanadic stainless steel wire (corresponding to 8:0) was applied in 1202 cataract extractions, penetrating injuries, antiglaucomatous surgeries and in removal of pterygium at the medical-and-sanitary facility of steel works in the town of Bokaro (India). The observation period ranged, on the average, from 3 months to 3 years. There were no complications during the procedure of applying the suture. However, it caused a minor response in the ocular tissues during the early postoperative period. Small bullae were observed in the corneal surface near the suture in 7 cases (0.58%), which disappeared spontaneously in 3-4 days. Irritations inflicted by the suture ends were registered in 2.58% of cases (31 patients). The mean postoperative astigmatism was, 3 months after surgery, 1.65 diopters. The sutures were removed in 132 cases (10.98%), including in 16 patients with irritation, and in 116 patients for the purpose of correcting a high astigmatism. The share of patients with a visual acuity of 0.5 and higher was, in one week, 43.59% and went up, one month later, to 78.20%. The suture was well tolerated by patients, it was quickly covered by the corneal epithelium, there was no rejection and it can be easily manufactured. The suture is sterilized by routine techniques without need for any extra treatment before use; it is a reactive, biologically inactive, efficient, convenient and causes minimal operative and postoperative complications.

  14. Use of a barbed suture for laparoscopic closure of the internal inguinal rings in a horse. (United States)

    Ragle, Claude A; Yiannikouris, Stavros; Tibary, Ahmed A; Fransson, Boel A


    A 4-year-old castrated Arabian horse was evaluated for a history of a right-sided nonstrangulating inguinal hernia that was manually reducable. Physical examination revealed a right-sided hydrocele and bilateral enlargement of the inguinal rings detectable by both external digital and rectal palpation. Biportal laparoscopic internal inguinal ring closure was performed with a continuous suture line of unidirectional barbed suture applied with a mechanical suturing instrument. The barbed suture contributed to a secure closure with the added benefit of not requiring knots to be tied at either the beginning or end of the suture line. Follow-up physical examination and laparoscopy confirmed healing of the surgical sites and a reduction in size of the inguinal rings. The horse exercised for 20 months following surgery without recurrence of the inguinal hernia. In horses, laparoscopic application of unidirectional barbed sutures should be considered among the treatment options for recurrent inguinal herniation. This technique was accomplished with only 2 portals/side, in contrast to the additional 3 to 4 portals that are most commonly required. The use of a barbed suture with a mechanical suturing instrument offered added security to the closure. The difficulties of dual instrument suturing and intracorporeal knot tying were eliminated, dramatically reducing the challenges of performing suture reduction of the internal inguinal ring.

  15. A National Survey of Undergraduate Suture and Local Anesthetic Training in the United Kingdom. (United States)

    Rufai, Sohaib R; Holland, Luke C; Dimovska, Eleonora O F; Bing Chuo, Cher; Tilley, Simon; Ellis, Harold


    Suturing is a skill expected to be attained by all medical students on graduation, according to the General Medical Council's (GMC) Tomorrow's Doctors. There are no GMC recommendations for the amount of suture training required at medical school nor the level of competence to be achieved. This study examines the state of undergraduate suture training by surveying a sample of medical students across the United Kingdom. We distributed a survey to 17 medical schools to be completed by undergraduates who have undergone curricular suture training. The survey included questions relating to career intention, hours of curricular suture training, hours of additional paid training, confidence in performing various suture techniques and knowledge of their indications. We also asked about the students' perceived proficiency at injecting local anesthetic and their overall opinion of medical school suture training. We received responses from 705 medical students at 16 UK medical schools. A total of 607 (86.1%) medical students had completed their scheduled curricular suture training. Among them, 526 (86.5%) students reported inadequate suture training in medical school and 133 (21.9%) students had paid for additional training. Results for all competence markers were significantly lower than the required GMC standards (p Students who had paid for additional training were significantly more confident across all areas examined (p students surveyed. These findings suggest that medical schools should provide more opportunities for students to develop their suturing skills to achieve the GMC standard. Copyright © 2015. Published by Elsevier Inc.

  16. Enterotomy closure using knotless and barbed suture in laparoscopic upper gastrointestinal surgeries. (United States)

    Bautista, Therese; Shabbir, Asim; Rao, Jaideepraj; So, Jimmy; Kono, Koji; Durai, Pradeep


    Barbed sutures are recently being employed in intracorporeal suturing in various laparoscopic digestive surgeries. The purpose of this paper was to present our initial experience of enterotomy closure with barbed sutures in upper gastrointestinal and bariatric surgeries, and share optimal technique of using such sutures for enterotomy closure. Fifty patients who underwent laparoscopic closure of enterotomies using barbed sutures were identified in two institutions in Singapore from January 2012 to December 2013. Patient demographics, short-term operative outcomes including anastomotic time, onset of diet, hospital stay, and early post-operative complications are reported. In 50 patients a total of 62 anastomotic sites were closed with barbed sutures. The barbed sutures appear to reduce mean anastomotic suturing time of the Roux-en-Y gastrojejunal closure (17.34 vs 44.55 min, p value 0.0001) and jejunojejunal closure (19.46 vs 31.01 min, p value 0.0013) when compared to a subgroup of patients with the same anastomotic sites closed using the standard non-barbed suture. The mean onset to start on diet was 2 ± 1.5 days and mean duration of hospital stay is 7 + 5.3 days. One (1.6%) anastomotic leak was observed day 3 after a gastric bypass in the series. This leak was the result of a technical error due to inappropriate suturing technique. There were no mortalities, other complications or readmission. While applying traction on the suture brings two tissue edges closer, we observed that pushing the tissues toward each other provided more apposition and prevented unnecessary tearing of tissues that could potentially result in complications Barbed closure sutures appear to be safe and effective in laparoscopic upper gastrointestinal procedures for closing enterotomies provided appropriate technique is used. The potential benefit is simplifying intracorporeal enterotomy closure.

  17. A reusable suture anchor for arthroscopy psychomotor skills training. (United States)

    Tillett, Edward D; Rogers, Rainie; Nyland, John


    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.

  18. A 3-D CT Analysis of Screw and Suture-Button Fixation of the Syndesmosis. (United States)

    Schon, Jason M; Williams, Brady T; Venderley, Melanie B; Dornan, Grant J; Backus, Jonathon D; Turnbull, Travis Lee; LaPrade, Robert F; Clanton, Thomas O


    Historically, syndesmosis injuries have been repaired with screw fixation; however, some suggest that suture-button constructs may provide a more accurate anatomic and physiologic reduction. The purpose of this study was to compare changes in the volume of the syndesmotic space following screw or suture-button fixation using a preinjury and postoperative 3-D computed tomography (CT) model. The null hypothesis was that no difference would be observed among repair techniques. Twelve pairs of cadaveric specimens were dissected to identify the syndesmotic ligaments. Specimens were imaged with CT prior to the creation of a complete syndesmosis injury and were subsequently repaired using 1 of 3 randomly assigned techniques: (a) one 3.5-mm cortical screw, (b) 1 suture-button, and (c) 2 suture-buttons. Specimens were imaged postoperatively with CT. 3-D models of all scans and tibiofibular joint space volumes were calculated to assess restoration of the native syndesmosis. Analysis of variance and Tukey's method were used to compare least squares mean differences from the intact syndesmosis among repair techniques. For each of the 3 fixation methods, the total postoperative syndesmosis volume was significantly decreased relative to the intact state. The total mean decreases in volume compared with the intact state for the 1-suture-button construct, 2-suture-button construct, and syndesmotic screw were -561 mm 3 (95% CI, -878 to -244), -964 mm 3 (95% CI, -1281 to -647) and -377 mm 3 (95% CI, -694 to -60), respectively. All repairs notably reduced the volume of the syndesmosis beyond the intact state. Fixation with 1 suture-button was not significantly different from screw or 2-suture-button fixation; however, fixation with 2 suture-buttons resulted in significantly decreased volume compared with screw fixation. The results of this study suggest that the 1-suture-button repair technique and the screw fixation repair technique were comparable for reduction of syndesmosis

  19. Primary suture of amputation wound: pro et contra. (United States)

    Muminagic, Sahib N


    During the First World War and the Second World War more than 80 % of wounded persons had injuries of upper or lower limbs. In the recent war in the Former Yugoslavia the percentage of persons with these injuries was above 80%. Each war is also characterized by the high percentage of wounded persons with amputations of upper or lower extremities. These amputations occurred mostly in the cases of polytrauma. In other cases we faced with severely wounded extremities with an extensive destruction of soft tissues, bones, blood vessels and joints, where the amputation is the only possible intervention to save the patient. In the previous World Wars, the surgeons have tried to shorten the time of treatment and to accept the surgical technique, by the application of primary suture of the wound. During the aggression on Bosnia and Herzegovina we were faced with a large number of wounded persons with amputations i.e. cases where we applied the primary suture. The results were still surprising and in many cases the wounds had primarily healed. The results were better when they were using primary suture on the upper extremities, measured at 61.9 % while the percentage of using the same suture on the lower limbs was of 48.8 %. The results of the war year 1995 were improved in comparison to the percentages listed above. The statistical analysis indicated that early application of the primary suture to the amputation wound was possible and largely successful, but, only when performed under certain conditions.

  20. Comparative study between purse–string suture and peritoneal ...

    African Journals Online (AJOL)

    Comparative study between purse–string suture and peritoneal disconnection with ligation techniques in the laparoscopic repair of inguinal hernia in infants and ... The main outcome measurement was recurrence, and secondary outcome measurements were operative time, hospital stay, intraoperative complications, ...

  1. Intracorporeal suture closure of the internal inguinal and vaginal rings in foals and horses. (United States)

    Caron, John P; Brakenhoff, Jeffrey


    To report a technique for repair or prevention of inguinal hernia in horses using intracorporeal suture closure of the internal inguinal and vaginal rings. Case series. Foals (n=6) and geldings (n=2). After selection of a peri-umbilical telescope portal, instrument portals were made unilaterally or bilaterally, as needed. Herniated viscera was reduced, castration (foals) or spermatic cord remnant transection at the internal inguinal ring (adults) performed, and then simple interrupted intracorporeal sutures of synthetic absorbable suture material were used to close the internal inguinal and vaginal rings. There was no recurrence of inguinal hernia. Postoperative morbidity was minimal and cosmetic outcome was comparable to that achieved with conventional, open techniques. Laparoscopic, primary closure of the internal inguinal ring by use of intracorporeal sutures provides a secure barrier to herniation and costs considerably less than using endoscopic staples. Laparoscopic suture closure of the internal inguinal and vaginal rings provides safe and effective repair of inguinal hernia in horses.

  2. Cosmetic outcomes of cesarean section scar; subcuticular suture versus intradermal buried suture. (United States)

    Yang, Juseok; Kim, Ki Hyung; Song, Yong Jung; Kim, Seung-Chul; Sung, Nayoung; Kim, Haneul; Lee, Dong Hyung


    The objective of the study was to compare cosmetic outcomes and overall satisfaction rate of cesarean section scar between conventional subcuticular suture and intradermal buried vertical mattress. Patients were enrolled to the study by chart review. A scar assessment was obtained retrospectively through a telephone survey. The patient component of the patient and observer scar assessment scale (POSAS) was utilized along with the overall satisfaction of the patient regarding their cesarean section scar and their willingness to choose the same skin closure technique when anticipating their next cesarean section. A total of 303 cases of cesarean section was recruited, 102 finished telephone surveys were calculated for the analyses. Subcuticular suture was regarded as control group (n=52) and intradermal buried suture as test group (n=50). The PSAS score of the test group (mean, 21.8) was lower than that of the control group (mean, 28), with a statistical significance ( P =0.02). Overall satisfaction rate did not differ between the two groups. Two parameters of the PSAS score and the level of overall satisfaction showed significant correlation (Pearson's r , -0.63; P cesarean sections over subcuticular stitch.

  3. [Laparoscopic suture or open suture in perforated duodenal ulcer]. (United States)

    Nicolau, A E; Ionescu, G; Iordache, F; Mehic, R; Spătaru, A


    Between Nov. 1994-Jan. 2001 we performed laparoscopic suture with omentoplasty of perforated duodenal ulcer (PDU) in 51 patients out of 56 it was intended (this constituted the laparoscopic group--LG). The selection criteria were young patients, age < 40 years, no associated diseases, onset of the operation under 12 hours from the occurrence of the perforation, absence of clear ulcer history. In the same period, we performed an open suture based on the same criteria in 105 patients (open group--OP). The results showed a difference between needed analgesia (2.8 days for LG vs. 5.2 days for OG) and a hospital stay of 6.1 days in LG vs. 7.7 days in OG. The incidence of postoperative complications was 5.88% in the LG and 7.61% in the OG with 1.96% and respective 1.90% reoperation rate. In conclusion laparoscopic suture of PDU with associated postoperative modern therapy of ulcer disease could be the treatment of choice in young patients.

  4. SR and LR Union Suture for the Treatment of Myopic Strabismus Fixus: Is Scleral Fixation Necessary?

    Directory of Open Access Journals (Sweden)

    Carol P. S. Lam


    Full Text Available Purpose. To evaluate and compare the effectiveness of scleral fixation SR and LR union suture and nonscleral fixation union suture for the treatment of myopic strabismus fixus. Methods. Retrospective review of 32 eyes of 22 patients with myopic strabismus fixus who had undergone union suture of superior rectus (SR and lateral rectus (LR with or without scleral fixation, and follow-up longer than 6 months at Hong Kong Eye Hospital from 2006 to 2013. Surgical techniques and outcomes in terms of ocular alignment are analyzed. Results. There is significant overall improvement both in postoperative angle of esodeviation (P0.05. Conclusions. Union suture of SR and LR is an effective procedure in correcting myopic strabismus fixus. Fixation of the union suture to the sclera does not improve surgical outcome.

  5. Should nylon corneal sutures be routinely removed? (United States)

    Jackson, H.; Bosanquet, R.


    Three groups of patients who had undergone cataract extraction through a corneal incision closed with 10/0 nylon sutures one, two, and three years previously were recalled to determine the incidence of suture related complications. Broken corneal sutures were found in 87.5% of patients after two years and 90% after three years and were causing symptoms in over half the patients. It is recommended that 10/0 nylon corneal sutures be routinely removed no later than one year after surgery. Images PMID:1751460

  6. Single-suture scleral fixation of subluxated foldable intraocular lenses. (United States)

    Yarangumeli, Alper; Alp, Mehmet Numan; Kural, Gulcan


    To evaluate the results of single-suture scleral fixation of subluxated foldable intraocular lenses (IOL) in eyes with sufficient residual capsular support. The results of IOL repositioning by single-suture scleral fixation in 6 eyes of 6 patients with IOL subluxation were included. All subluxated IOLs were single-piece hydrophilic acrylic. Subluxation resulted from posterior capsule tears in 3 eyes, zonular dialyses in 2 eyes, and zonular dialysis with a capsulorhexis tear in 1 eye. A similar technique was used in all eyes in which one haptic was externalized through a superior clear corneal incision and tied with a Pair-PAK 10-0 polypropylene suture, and was finally retracted and fixated behind the iris close to the ciliary sulcus at the 12:00 meridian. All patients were followed up for at least 6 months. Best-corrected visual acuities ranged between finger counting and 20/70 (mean logMAR 1.02±0.64) preoperatively, and between 20/100 and 20/20 (mean logMAR 0.22±0.26) at the final postoperative visit. All IOLs remained centered and no significant postoperative complications were encountered except for an IOL tilt which resulted in a considerable oblique astigmatism in one eye. Subluxated foldable IOLs may safely be repositioned and secured with a single scleral fixation suture in selected cases with adequate amount of capsular remnants.

  7. Absorbable versus silk sutures for surgical treatment of trachomatous trichiasis in Ethiopia: a randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Saul N Rajak


    Full Text Available Trachoma causes blindness through an anatomical abnormality called trichiasis (lashes touching the eye. Trichiasis can recur after corrective surgery. We tested the hypothesis that using absorbable sutures instead of silk sutures might reduce the risk of recurrent disease among patients with major trichiasis in a randomised trial.1,300 individuals with major trichiasis from rural villages in the Amhara Region of Ethiopia were recruited and assigned (1:1 by computer-generated randomisation sequence to receive trichiasis surgery using either an absorbable suture (polyglactin-910 or silk sutures (removed at 7-10 days in an otherwise identical surgical technique. Participants were examined every 6 months for 2 years by clinicians masked to allocation. The primary outcome measure was recurrent trichiasis (≥one lash touching the eye at 1 year. There was no difference in prevalence of recurrent trichiasis at 1 year (114 [18.2%] in the absorbable suture group versus 120 [19.7%] in the silk suture group; odds ratio = 0.90, 95% CI 0.68-1.20. The two groups also did not differ in terms of corneal opacification, visual acuity, conjunctival inflammation, and surgical complications.There was no evidence that use of absorbable polyglactin-910 sutures was associated with a lower prevalence of trichiasis recurrence at 1 year postsurgery than silk sutures. However, from a programmatic perspective, polyglactin-910 offers the major advantage that patients do not have to be seen soon after surgery for suture removal. The postoperative review after surgery using absorbable polyglactin-910 sutures can be delayed for 3-6 months, which might allow us to better determine whether a patient needs additional NCT00522860.

  8. Rupture of uterus treated with suture. (United States)

    Klungsøyr, P; Kiserud, T


    Between August 1983 and August 1985, 63 patients in labor with uterine rupture were treated at Sidamo Regional Hospital, Yirgaalem, South Ethiopia, mainly by suture of the uterus. None of those operated on died. We recommend suturing as the treatment of choice. Hysterectomy is rarely indicated.

  9. Modified suturing contact lens for penetrating keratoplasty. (United States)

    Kramer, S G; Stewart, H L


    The authors have previously described a suturing contact lens that protects the corneal endothelium by aiding in the maintenance of the anterior chamber during penetrating keratoplasty. This report describes structural modifications of the suturing contact lens, which improve its stability and effectiveness. An additional configuration for use in corneal lacerations is presented.

  10. The Effect of Instrumentation on Suture Tensile Strength and Knot Pullout Strength of Common Suture Materials. (United States)

    Johnson, Peter C; Roberts, Aaron D; Hire, Justin M; Mueller, Terry L


    To determine the effect of instrumentation of suture material on knot security and tensile strength. In all, 5 types of suture material were used; 10 knots were tied without any instrumentation and 10 knots were tied with a hemostat holding tension on the first throw while the second throw was made for each suture type. Each group was tested to failure with the maximum load and mode of failure recorded. The maximum load between groups of each suture type was compared; frequency of failure through knot slippage vs material fracture was also compared between groups. There was no significant difference observed in the maximum load to failure for any suture type between instrumented and noninstrumented groups. Additionally, there was no difference between any instrumented and noninstrumented groups for material failure vs failure due to knot slippage. Instrumentation of suture material during two-hand tying does not affect the strength of suture material or knot security. Published by Elsevier Inc.

  11. Comparison of Knotless Barbed Suture Versus Monofilament Suture in the Oral Cavity of Cats. (United States)

    Durand, Corinne L


    The present study compares a knotless, barbed, absorbable suture material against a conventional monofilament absorbable suture material in oral mucosal wound closure. The parameters measured include time of closure and differences in healing at 2 and 4 weeks postoperatively. A prospective study comparing a knotless, barbed suture system with conventional absorbable sutures was undertaken in 19 cats. Nineteen cats had full mouth extractions performed. Following the extraction procedures, the incisions in the arcades (maxillary and mandibular) were apposed with the barbed, knotless suture system in a continuous pattern on one side and with a conventional smooth suture in an interrupted pattern on the other. Suturing times for each arcade were recorded. The material used to close the first side of each cat varied. Healing, dehiscence, and other complications were assessed at 2 and 4 weeks postoperatively. The average closure time (± standard deviation) per quadrant with conventional monofilament suture was 8.7 (±1.3) minutes, while barbed suture required an average of 5.1 (±1.1) minutes per quadrant to complete the suture. This difference (95% confidence interval) of 3.6 (±3.2-4.1) minutes per quadrant was statistically significant ( P < .001). Dehiscence and ranula-like swelling formation were noted as uncommon postoperative complications, but the differences were not significant between the groups. Barbed, knotless sutures resulted in faster closure times than conventional, simple interrupted, monofilament sutures with similar healing and complication rates. To the author's knowledge, there is no current literature comparing conventional absorbable monofilament sutures to a knotless, barbed, absorbable suture system for closure of oral mucosal incisions in cats.

  12. Shape memory alloy fixator system for suturing tissue in minimal access surgery. (United States)

    Xu, W; Frank, T G; Stockham, G; Cuschieri, A


    A new technique for suturing human tissue is described in which tissue closure is achieved by means of small fixators made from shape memory alloy. The aim of the development is to provide an alternative to thread suturing in minimal access surgery, which is quicker and requires less skill to achieve the required suturing quality. The design of the fixators is described in terms of the thermal shape recovery of shape memory alloy and a novel form of finite element analysis, which uses a nonlinear elastic element for the material property. Thermal analysis of the fixators and surrounding tissue is used to predict the temperature distribution during and after the application of electric current heating. This was checked in an in vitro experiment, which confirmed that deployment caused no detectable collateral damage to surrounding tissue. In vivo animal studies on the use of the shape memory alloy fixator for suturing tissue are ongoing to establish safety and healing effects.

  13. Randomized clinical trial comparing manual suture and different models of mechanical suture in the mimicking of bariatric surgery in swine

    Directory of Open Access Journals (Sweden)

    Fernandes MA


    Full Text Available Marcos AP Fernandes,1 Bruno MT Pereira,2 Sandra M Guimarães,1 Aline Paganelli,3 Carlos Manoel CT Pereira,1 Claudio Sergio Batista4 1Institute of Obesity and Advanced Video Laparoscopic Surgery of Petropolis, Rio de Janeiro, Brazil; 2Division of Trauma, University of Campinas, São Paulo, Brazil; 3Laboratório de Patologia Micron Cell Diagnóstico, Rio de Janeiro, Brazil; 4Department of Gynecology and Obstetrics, Faculty of Medicine of Petropolis, Rio de Janeiro, Brazil Context and objective: Variations in the ability of surgeons served as motivation for the development of devices that, overcoming individual differences, allow the techniques to be properly performed, and of which the end result was the best possible. Every technique must be reproduced reliably by the majority of surgeons for their results to be adopted and recognized as effective. The aim of this study was to compare the results, from the point of view of anatomic pathology, of manual sutures versus mechanical sutures using different models of linear mechanical staplers, in the procedure of gastroenteroanastomosis and enteroanastomosis in swine. Methods: Thirty-six healthy, adult, male Sus scrofa domesticus pigs, weighing between 20.7 and 25.5 kg, were used. The swine were randomly divided into four groups of nine pigs, according to the type of suture employed: group A, manual suture with Polysorb® 3-0 wire; group B, 80-shear linear stapler (Covidien® Gia 8038-S; group C, 75-shear linear stapler (Ethicon® Tlc 75; and group D, 75-shear linear stapler (Resource® Yq 75-3. A temporal study was established on the seventh postoperative day for histopathological analysis, and the degree of inflammation, fibrosis, and newly formed vessels, as well as the presence or absence of granulation tissue, foreign body granuloma, and necrosis were all evaluated qualitatively and semiquantitatively. The results were analyzed statistically. Results: Observations during the histopathological

  14. Symbol "&" suture to control atonic postpartum hemorrhage with placenta previa accreta. (United States)

    Li, Guang Tai; Li, Xiao Fan; Liu, Ya Jing; Li, Wei; Xu, Hong Mei


    To evaluate the efficacy and safety of a symbol "&" compression suture technique in controlling severe atonic postpartum hemorrhage with placenta previa accreta during cesarean delivery. Nine women with heavy postpartum bleeding from uterine inertia and placenta previa percret, which did not react to conventional initial management protocols, were underwent the suture in the shape of symbol "&" in China Meitan General Hospital. The suture procedure was to staple the anterior and posterior walls (of the lower uterine segment as well as corpus uterus) together using number 1 chromic catgut, with a cross at about 2 cm above the upper boundary of lower uterine segment. Symbol "&" compression suture was capable of stanching the postpartum hemorrhage immediately in all nine women. None of these patients developed complications related to this method. Subsequent pregnancies after the suture were occurred in two women and delivered with repeat cesarean section. Symbol "&" compression suture is a simple, safe and highly effective technique to control the treatment-resistant uterine atonic bleeding, particularly in previous cesarean scar at lower segment and placenta previa accreta.

  15. A multicenter randomized controlled trial comparing absorbable barbed sutures versus conventional absorbable sutures for dermal closure in open surgical procedures. (United States)

    Rubin, J Peter; Hunstad, Joseph P; Polynice, Alain; Gusenoff, Jeffrey A; Schoeller, Thomas; Dunn, Raymond; Walgenbach, Klaus J; Hansen, Juliana E


    Barbed sutures were developed to reduce operative time and improve security of wound closure. The authors compare absorbable barbed sutures (V-Loc, Covidien, Mansfield, Massachusetts) with conventional (smooth) absorbable sutures for soft tissue approximation. A prospective multicenter randomized study comparing barbed sutures with smooth sutures was undertaken between August 13, 2009, and January 31, 2010, in 241 patients undergoing abdominoplasty, mastopexy, and reduction mammaplasty. Each patient received barbed sutures on 1 side of the body, with deep dermal sutures eliminated or reduced. Smooth sutures with deep dermal and subcuticular closure were used on the other side as a control. The primary endpoint was dermal closure time. Safety was assessed through adverse event reporting through a 12-week follow-up. A total of 229 patients were ultimately treated (115 with slow-absorbing polymer and 114 with rapid-absorbing polymer). Mean dermal closure time was significantly quicker with the barbed suture compared with the smooth suture (12.0 vs 19.2 minutes; P<.001), primarily due to the need for fewer deep dermal sutures. The rapid-absorbing barbed suture showed a complication profile equivalent to the smooth suture, while the slow-absorbing barbed suture had a higher incidence of minor suture extrusion. Barbed sutures enabled faster dermal closure quicker than smooth sutures, with a comparable complication profile. 1.

  16. Albert-Lembert versus hybrid-layered suture in hand sewn end-to-end cervical esophagogastric anastomosis after esophageal squamous cell carcinoma resection. (United States)

    Feng, Fan; Sun, Li; Xu, Guanghui; Hong, Liu; Yang, Jianjun; Cai, Lei; Li, Guocai; Guo, Man; Lian, Xiao; Zhang, Hongwei


    Hand sewn cervical esophagogastric anastomosis (CEGA) is regarded as preferred technique by surgeons after esophagectomy. However, considering the anastomotic leakage and stricture, the optimal technique for performing this anastomosis is still under debate. Between November 2010 and September 2012, 230 patients who underwent esophagectomy with hand sewn end-to-end (ETE) CEGA for esophageal squamous cell carcinoma (ESCC) were analyzed retrospectively, including 111 patients underwent Albert-Lembert suture anastomosis and 119 patients underwent hybrid-layered suture anastomosis. Anastomosis construction time was recorded during operation. Anastomotic leakage was recorded through upper gastrointestinal water-soluble contrast examination. Anastomotic stricture was recorded during follow up. The hybrid-layered suture was faster than Albert-Lembert suture (29.40±1.24 min vs. 33.83±1.41 min, P=0.02). The overall anastomotic leak rate was 7.82%, the leak rate in hybrid-layered suture group was significantly lower than that in Albert-Lembert suture group (3.36% vs. 12.61%, P=0.01). The overall anastomotic stricture rate was 9.13%, the stricture rate in hybrid-layered suture group was significantly lower than that in Albert-Lembert suture group (5.04% vs. 13.51%, P=0.04). Hand sewn ETE CEGA with hybrid-layered suture is associated with lower anastomotic leakage and stricture rate compared to hand sewn ETE CEGA with Albert-Lembert suture.

  17. Mini-open Subpectoral Biceps Tenodesis Using a Suture Anchor. (United States)

    Arena, Christopher; Dhawan, Aman


    The long head of the biceps (LHB) tendon is a potential source of shoulder pain encountered by orthopaedic surgeons. A multitude of approaches to addressing LHB tendinopathy have been described. These include various surgical techniques such as tenodesis versus tenotomy, an arthroscopic versus an open approach, and differing methods of tenodesis fixation. Our preferred approach to addressing LHB tendinopathy is through a mini-open approach using a double-loaded 4.5-mm suture anchor. This Technical Note with accompanying video describes our technique for performing this procedure, as well as supporting clinical evidence and technical pearls.

  18. Biomechanical characteristics of single-row repair in comparison to double-row repair with consideration of the suture configuration and suture material. (United States)

    Baums, M H; Buchhorn, G H; Spahn, G; Poppendieck, B; Schultz, W; Klinger, H-M


    The aim of the study was to evaluate the time zero mechanical properties of single- versus double-row configuration for rotator cuff repair in an animal model with consideration of the stitch technique and suture material. Thirty-two fresh-frozen sheep shoulders were randomly assigned to four repair groups: suture anchor single-row repair coupled with (1) braided, nonabsorbable polyester suture sized USP No. 2 (SRAE) or (2) braided polyblend polyethylene suture sized No. 2 (SRAH). The double-row repair was coupled with (3) USP No. 2 (DRAE) or (4) braided polyblend polyethylene suture No. 2 (DRAH). Arthroscopic Mason-Allen stitches were used (single-row) and combined with medial horizontal mattress stitches (double-row). Shoulders were cyclically loaded from 10 to 180 N. Displacement to gap formation of 5- and 10-mm at the repair site, cycles to failure, and the mode of failure were determined. The ultimate tensile strength was verified in specimens that resisted to 3,000 cycles. DRAE and DRAH had a lower frequency of 5- (P = 0.135) and 10-mm gap formation (P = 0.135). All DRAE and DRAH resisted 3,000 cycles while only three SRAE and one SRAH resisted 3,000 cycles (P 0.05). Double-row suture anchor repair with arthroscopic Mason-Allen/medial mattress stitches provides initial strength superior to single-row repair with arthroscopic Mason-Allen stitches under isometric cyclic loading as well as under ultimate loading conditions. Our results support the concept of double-row fixation with arthroscopic Mason-Allen/medial mattress stitches in rotator cuff tears with improvement of initial fixation strength and ultimate tensile load. Use of new polyblend polyethylene suture material seems not to increase the initial biomechanical aspects of the repair construct.

  19. Tarsal platform show after upper eyelid blepharoplasty with or without brassiere sutures

    Directory of Open Access Journals (Sweden)

    Marisa Novaes de Figueiredo

    Full Text Available ABSTRACT Purpose: Increased tarsal platform show (TPS and decreased brow fat span (BFS are associated with favorable results in women undergoing cosmetic blepharoplasty. We conducted a study to evaluate the efficacy of upper blepharoplasty with or without a technique (brassiere sutures to increase TPS and decrease BFS. Methods: This is a prospective, randomized, comparative, case series study of 100 eyelids (50 consecutive women patients treated with cosmetic upper blepharoplasty performed by a single surgeon. Patients were randomized to receive traditional upper blepharoplasty with a single running suture skin closure versus orbicularis oculi muscle fixation to the periosteum (brassiere sutures prior to skin closure. Data on patient age, duration of follow-up, complications, and treatment were analyzed. The mean TPS, mean BFS, and mean TPS/BFS ratio were measured at three anatomic landmarks before and after surgery. Results: Fifty-six eyelids (28 patients were treated with traditional single suture blepharoplasty, and 44 eyelids (22 patients had brassiere sutures. In both groups, paired t-tests indicate significant differences between preoperative and postoperative evaluations (p0.05. Conclusions: Brassiere sutures during upper blepharoplasty and traditional blepharoplasty were associated with postoperative increase in TPS, decrease in BFS, and increase in TPS/BFS, without statistically significant differences between these surgeries.

  20. Investigation of the best suture pattern to close a stuffed Christmas turkey. (United States)

    Verwilghen, D; Busoni, V; van Galen, G; Wilke, M

    Instructions on how to debone and stuff a turkey are available, but what is the best way to close it up? A randomised trial involving 15 turkeys was performed in order to evaluate skin disruption scores and cosmetic outcomes following the use of different suture patterns. Turkeys were deboned, stuffed and cooked according to guidelines of the US Department of Agriculture Food Safety and Inspection Services. After stuffing, they were randomly assigned to one of five closure groups: simple continuous Lembert; simple continuous Cushing; simple continuous Utrecht; simple continuous; or staples. Turkeys were cooked at 180 °C for two hours ensuring core temperature reached 75 °C. Suture line integrity was evaluated after removal of the sutures and the cosmetic aspect was graded. Before cooking, the Utrecht pattern and skin staples offered the best cosmetic result. After removal of the sutures, the skin remained intact only in the stapled group. All other suture patterns disrupted the skin after removal of the sutures, rendering the turkey less cosmetically appealing for serving. Closure of a stuffed turkey was best performed using skin staples to achieve the best cosmetic results. Using this technique you will be able to impress family and friends at a Christmas dinner, and finally show them your surgical skills.

  1. Randomized controlled clinical trial on two perineal trauma suture techniques in normal delivery Ensayo aleatorio clínico controlado para dos técnicas de sutura perineal en parto normal Ensaio clínico controlado aleatório sobre duas técnicas de sutura do trauma perineal no parto normal

    Directory of Open Access Journals (Sweden)

    Sandra Ferreira Silva de Almeida


    Full Text Available The aim was to compare healing and perineal pain with the use of continuous and interrupted suture techniques in women after normal delivery. A randomized controlled trial was carried out at a hospital birth center in Itapecirica da Serra, Sao Paulo, Brazil. A total of 61 women participated with episiotomy or second degree perineal tear, allocated in two groups according to the continuous (n=31 or interrupted (n=30 suture techniques. The main outcomes evaluated were edema, ecchymosis, hyperemia, secretion, dehiscence, fibrosis, frequency and degree of pain (evaluated by numerical scale from 1 to 10. Data were collected during hospitalization and after discharge (four and 41 days after birth. Healing occurred by first intention in 100% of cases in both suture techniques. There were no statistically significant differences for the occurrence of morbidities, except for perineal pain due to palpation at four days after delivery, which was more frequent among women with interrupted suture.El objetivo fue comparar la cicatrización y el dolor perineal utilizando técnicas de sutura continua y separada, en mujeres que realizaron parto normal. El estudio fue controlado aleatorio, realizado en un centro para parto normal en Itapecerica de la Sierra, Sao Paulo. Participaron 61 mujeres con episiotomía o desgarro perineal de segundo grado, distribuidas en dos grupos (sutura continua n=31 y sutura separada n=30. Las principales medidas evaluadas fueron edema, equimosis, hiperemia, secreción, dehiscencia de herida, fibrosis, frecuencia y magnitud del dolor (evaluada por escala numérica de 1 a 10. Los datos fueron recolectados durante la hospitalización y después del alta (de 4 a 41 días post-parto. La cicatrización fue por primera intención en 100% de los casos, para las dos técnicas de sutura. No se encontró diferencia estadísticamente significativa en los casos de morbilidad, con excepción del dolor perineal a la palpación al cuarto día post

  2. Functional implications of squamosal suture size in paranthropus boisei. (United States)

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


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

  3. Longitudinal parallel compression suture to control postopartum hemorrhage due to placenta previa and accrete. (United States)

    Li, Guang-Tai; Li, Xiao-Fan; Wu, Baoping; Li, Guangrui


    To assess the efficacy and safety of longitudinal parallel compression suture to control heavy postpartum hemorrhage (PPH) in patients with placenta previa/accreta. Fifteen women received a longitudinal parallel compression suture to stop life-threatening PPH due to placenta previa with or without accreta during cesarean section. The suture apposed the anterior and posterior walls of the lower uterine segment together using an absorbable thread A 70-mm round needle with a Number-1 absorbable thread was used. The point of needle entry was 1 cm above the upper margin of the cervix and 1 cm from the right lateral border of the lower segment of the anterior wall. The suture was threaded through the uterine cavity to the serosa of the posterior wall. Then, it was directed upward and threaded from the posterior to the anterior wall at ∼1-2 cm above the upper boundary of the lower uterine segment and 3-cm medial to the right margin of the uterus. Both ends of the suture were tied on the anterior aspect of uterus. The left side was sutured in the same way. The success rate of the procedure was 86.7% (13/15). Two of 15 cases were concurrently administered gauze packing and achieved satisfactory hemostasis. All patients resumed a normal menstrual flow, and no postoperative anatomical or physiological abnormalities related to the suture were observed. Three women achieved further pregnancies after the procedure. Longitudinal parallel compression suture is a safe, easy, effective, practical, and conservative surgical technique to stop intractable PPH from the lower uterine segment, particularly in women who have a cesarean scar and placenta previa/accreta. Copyright © 2016. Published by Elsevier B.V.

  4. Single-layer versus double-layer laparoscopic intracorporeally sutured gastrointestinal anastomoses in the canine model. (United States)

    Tavakoli, Azine; Bakhtiari, Jalal; Khalaj, Ali Reza; Gharagozlou, Mohammad Javad; Veshkini, Abbas


    The objective of this study was to compare the gross and histopathologic changes following 1- versus 2-layer hand-sewn suture techniques in laparoscopic gastrointestinal anastomosis in dogs. This was an experimental prospective study of 16 healthy mixed breed male and female dogs. Animals were randomly divided into 2 groups. Two-layer side-to-side hand-sewn laparoscopic gastrojejunostomies were performed in group A, so that simple interrupted sutures were placed in the outer layer and simple continuous suture was used in the inner layer. The 1-layer simple continuous anastomosis between the stomach and jejunum was done in group B precisely. Specimen were collected from the sites of anastomosis, and H&E statining was performed for light microscopic studies. All animals survived the surgery. There was no gross inflammation, ischemia, apparent granulation tissue, abscess or fistula formation, leakage or stricture formation, and all sites of anastomosis were patent. Several adhesion formations were found in the abdomen with the higher incidence in the control group. Mean scores of leukocyte infiltration and granulation tissue formation at the sites of anastomosis were statistically insignificant between groups (P>0.05). Gross and histopathologic findings revealed that hand-sewn laparoscopic gastrointestinal anastomosis with the 1-layer suture technique is comparable to the 2-layer suture technique.

  5. The 'WiFi' otoplasty : Combined concentric posterior microchondrectomies and sutures for correction of prominent ears. (United States)

    Hendrickx, Benoit I M M; Hamdi, Moustapha; Zeltzer, Assaf; Greensmith, Andrew


    Prominent ears are by far the most common congenital ear deformity. Many techniques have been described using one or a combination of 3 basic methods: cartilage cutting, cartilage weakening and pure cartilage shaping techniques. The ideal otoplasty technique should yield a natural correction of the deformity, with low recurrence rates and with little risk of complications. A new cartilage shaping technique using closing wedge concentric microchondrectomies through an entirely posterior approach is presented. Between 2006 and 2017, 200 bilateral otoplasties using this 'WiFi' pattern technique were performed. This technique combined with Mustarde sutures is based on the excision of concentric partial thickness cartilage wedges designed in the pattern of the WiFi symbol. There were no major complications such as anterior skin necrosis and no returns to theatre for infections or haematomas. 3 patients (1.5%) had complete recurrence of the deformity and 10 patients (5%) had to undergo a minor revision for recurrence at the upper pole. 5 patients have had exposure of the end of the permanent upper pole scapho-temporal suture more than 3 months after surgery requiring simple outpatient suture trimming/removal without any recurrence of results. Palpable or bridging sutures were present upon clinical examination in 10 patients (5%) but did not require revision surgery. Here, we describe a fast, safe and reliable technique for otoplasty with no need for extensive dissection, which is applicable to the full range of deformity. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

  6. Experimental study of the characteristics of a novel mesh suture. (United States)

    Dumanian, G A; Tulaimat, A; Dumanian, Z P


    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 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.

  7. A randomized clinical trial of knotless barbed suture vs conventional suture for closure of the uterine incision at cesarean delivery. (United States)

    Peleg, David; Ahmad, Ronan Said; Warsof, Steven L; Marcus-Braun, Naama; Sciaky-Tamir, Yael; Ben Shachar, Inbar


    Knotless barbed sutures are monofilament sutures with barbs cut into them. These sutures self-anchor, maintaining tissue approximation without the need for surgical knots. The hypothesis of this study was that knotless barbed suture could be used on the myometrium to close the hysterotomy at cesarean delivery. The objective was to compare uterine closure time, need for additional sutures, and blood loss between this and a conventional suture. This was a prospective, unblinded, randomized controlled trial conducted at the Ziv Medical Center, Zefat, Israel. The primary outcome was the length of time needed to close the uterine incision, which was measured from the start of the first suture on the uterus until obtaining uterine hemostasis. To minimize provider bias, women were randomized by sealed envelopes that were opened in the operating room just prior to uterine closure with either a bidirectional knotless barbed suture or conventional suture. Secondary outcomes included the number of additional hemostatic sutures needed and blood loss during incision closure. Patients were enrolled from August 2016 until March 2017. One hundred two women were randomized. Fifty-one had uterine closure with knotless barbed suture and 51 with conventional suture. The groups were similar for demographics as well as number of previous cesarean deliveries. Uterine closure time using the knotless barbed suture was significantly shorter than the conventional suture by a mean of 1 minute 43 seconds (P barbed sutures were associated with a lower need for hemostatic sutures (median 0 vs 1, P barbed suture is a reasonable alternative to conventional sutures because it reduced the closure time of the uterine incision. There was also less need for additional hemostatic sutures and slightly reduced estimated blood loss. Copyright © 2018 Elsevier Inc. All rights reserved.

  8. Evaluation of absorbable and nonabsorbable sutures for repair of achilles tendon rupture with a suture-guiding device. (United States)

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


    The purpose of this study was to compare the functional and clinical results of Achilles tendon repairs with an Achilles tendon suture-guiding device using nonabsorbable versus absorbable sutures. We hypothesized that the absorbable suture would have clinical results comparable to those of the nonabsorbable suture for Achilles tendon repair with an Achilles tendon suture-guiding system. From January 2010 to September 2013, 48 consecutive patients who had sustained a spontaneous rupture of the Achilles tendon underwent operative repair with an Achilles tendon suture-guiding device using 2 different suture types. All ruptures were acute. The patients were divided equally into 2 groups according to suture type. In the nonabsorbable suture group, No. 2 braided nonabsorbable polyethylene terephthalate sutures were used, and in the absorbable suture group, braided absorbable polyglactin sutures were used. The average age of the patients was 38 years (range, 28-50 years). Functional outcome scores and complications were evaluated. All patients had an intact Achilles repair after surgery. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot clinical outcome scores were 98 (range, 90-100) in the nonabsorbable suture group and 96.8 (range, 87-100) in the absorbable suture group. All patients returned to their previous work. The absorbable suture group had fewer postoperative complications (0%) than the nonabsorbable suture group (12.5%) (P 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.

  9. Correção cirúrgica do aneurisma de ventrículo esquerdo: comparação entre as técnicas de sutura linear e reconstrução geométrica Surgical correction of left ventricular aneurysm: comparison between linear suture and geometric reconstruction techniques

    Directory of Open Access Journals (Sweden)

    Cássio José SGARBI


    na evolução dos pacientes revascularizados.OBJECTIVE: To evaluate the evolution up to 15 years of patients who underwent surgical correction of left ventricular aneurysm and to compare the techniques of linear suture and geometric reconstruction. METHODS: We studied 213 patients, of which 166 (77.9% were men. The mean age was 53.1 years (SD=9.9 years. Of these, 145 (68% underwent repair using the linear suture technique and 68 (32% underwent the geometric reconstruction technique. The Kaplan - Meier method was used to evaluate late survival. We evaluated the presence of mural thrombus, in and out of hospital mortality and the possibility of myocardial revascularization in the same procedure. Statistical differences were measured using the Log Rank method for actuarial curves and the nonparametric test in the remaining data compared. RESULTS: Our survival curves after a follow up of 10 years demonstrated that patients submitted to the linear suture and LV geometric reconstruction had a survival of 47.19% (SEM=0.056 and 63,55% (SEM=0.068, respectively, which were not statistically significantly different (p= 0.56. The overall survival in the 2 groups together was 51.34% (SEM=0.0473 at 10 years and 35,77%(SEM=0.0684 at 15 years. The in hospital death was 9.5% for the linear suture and 16.6% for the geometric reconstruction (p=0.17. The removal of LV thrombus was 31.29% and 45.45%, respectively (p=0.07. Revascularization was performed in, 69% of the patients in the linear suture group and 85.3% in the geometric reconstruction group. Comparing patients who were revascularized with those who were not, there was a better survival at 10 years for the first group (p=0.008. CONCLUSIONS: There was no statistically significant difference in the survival of patients who underwent linear suture compared to geometric reconstruction of the LV for aneurysm repair. Our results demonstrated superior survival in those patients who could undergo revascularization in the same procedure.

  10. Mechanical performance of gamma irradiated surgical sutures

    Energy Technology Data Exchange (ETDEWEB)

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


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

  11. Intracorporal suturing--driving license necessary? (United States)

    Romero, P; Brands, O; Nickel, F; Müller, B; Günther, P; Holland-Cunz, S


    Intracorporeal suturing and knot tying (ICKT) in minimal invasive surgery (MIS) represents a key skill for advanced procedures. Different methods exist for measuring knot quality and performance, but the heterogeneity of these methods makes direct comparisons difficult. The aim of this study is to compare the quality of a laparoscopic knot to one that is performed open. To compare open and laparoscopic knot-tying methods we used a surgeon's square knot. For laparoscopic knot tying we used a Pelvitrainer. The 32 participants were divided among 4 groups of different skill levels. Group 1 consisted of 6 senior physicians. Group 2 was made up of 10 first to fourth year interns. Groups 3 and 4 contained 16 medical students who had never performed either laparoscopic procedures or open sutures before. Group 3 participants received a 1-hour hands-on training in suturing, whereas group 4 participants received no prior training. Total time, knot quality, suture placement accuracy, and performance defined the parameters for assessment in this study. All participants, irrespective of education level were inferior in ICKT compared to open suturing. Only Group 1 showed no significant difference in knot quality and accuracy between the open and laparoscopic suture performance. It is well documented that psychomotor skills need to be developed before more advanced skills can be put into practice. Training centres for minimally invasive surgery should be an integral part of surgical education. The variables in our study are meaningful and easy to implement. They can be used to measure personal progress and as objective parameters in the development of laparoscopic trainee education. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. A novel specialized suture and inserting device for the resuspension of ptotic facial tissues: early results. (United States)

    Bisaccia, Emil; Kadry, Razan; Saap, Liliana; Rogachefsky, Arlene; Scarborough, Dwight


    In the past decade, the popularity of minimally invasive procedures for facial rejuvenation has increased. To describe a new specialized suture, and its associated technique, used to elevate sagging tissues of the face and neck. A detailed description of the technique and the results obtained in 20 patients in whom we have used this novel approach. Attention was given to appropriate patient selection. The primary focus was on the correction of the jowl, jawline, and neck subunits. It involves the percutaneous introduction of a novel 3-0 polypropylene suture that has 10 absorbable hollow cones along its axis that are equally interspersed with knots. Once the absorbable cones are resorbed into the surrounding tissues, the non-absorbable suture component can be removed without compromising the aesthetic outcome. All patients demonstrated improvement in these areas, with minimal complications. One patient required resuspension using the open technique. (Excessive ptotic tissue was later excised for an optimal cosmetic result.) The suture and technique described in this article provide a major contribution to the correction of ptosis of facial tissues. When done in conjunction with other procedures, such as neck and jowl microliposuction, this technique has proven to be a useful addition to facial rejuvenation.

  13. A new method for sex estimation from maxillary suture length in a Thai population (United States)

    Sinthubua, Apichat; Ruengdit, Sittiporn; Das, Srijit


    Sex estimation is one of the crucial procedures in the biological profile identification of human skeletal remains. Knowing sex of unknown case can lead to accurate and appropriate methods for predicting age, stature, ancestry, or even personal identification. Skull is one of the most reliable one among other skeletons and it is usually retained for both archaeological and forensic contexts. Although many morphological features and metric measurements of skull have been studied for sexing, but to the best of our knowledge is no study on maxillary suture length for sex estimation. Therefore, this study aims to develop a new sex estimation method for a Thai population by determining three maxillary suture lengths: anterior, transverse, and posterior maxillary suture, by computerizing amount of pixel obtained from photographs of these sutures. The present study was conducted on 190 Thai bone samples of which 96 were males and 94 were females. Independent t test revealed statistically significant difference (P<0.01) between males and females in all maxillary suture measurements. Equations derived from prediction model, which required three maxillary suture lengths gave 76.8421% accuracy from the leave-one-out cross validation in estimating sex percentage accuracies in predicting sex from these equations, which were relatively moderate. This study provides a novel and objective sex estimation method for Thais. It suggests that maxillary suture length can be applied for sex estimation. The new computerized technique will contribute basis knowledge and method for sex estimation, especially when only base of skull is available in forensic circumstance. PMID:29354297

  14. 21 CFR 878.5020 - Nonabsorbable polyamide surgical suture. (United States)


    ... polyamide surgical suture. (a) Identification. Nonabsorbable polyamide surgical suture is a nonabsorbable, sterile, flexible thread prepared from long-chain aliphatic polymers Nylon 6 and Nylon 6,6 and is...

  15. 21 CFR 878.4930 - Suture retention device. (United States)


    ... button, or a suture bolster, intended to aid wound healing by distributing suture tension over a larger area in the patient. (b) Classification. Class I (general controls). The device is exempt from the...

  16. High-Tensile Strength Tape Versus High-Tensile Strength Suture: A Biomechanical Study. (United States)

    Gnandt, Ryan J; Smith, Jennifer L; Nguyen-Ta, Kim; McDonald, Lucas; LeClere, Lance E


    To determine which suture design, high-tensile strength tape or high-tensile strength suture, performed better at securing human tissue across 4 selected suture techniques commonly used in tendinous repair, by comparing the total load at failure measured during a fixed-rate longitudinal single load to failure using a biomechanical testing machine. Matched sets of tendon specimens with bony attachments were dissected from 15 human cadaveric lower extremities in a manner allowing for direct comparison testing. With the use of selected techniques (simple Mason-Allen in the patellar tendon specimens, whip stitch in the quadriceps tendon specimens, and Krackow stitch in the Achilles tendon specimens), 1 sample of each set was sutured with a 2-mm braided, nonabsorbable, high-tensile strength tape and the other with a No. 2 braided, nonabsorbable, high-tensile strength suture. A total of 120 specimens were tested. Each model was loaded to failure at a fixed longitudinal traction rate of 100 mm/min. The maximum load and failure method were recorded. In the whip stitch and the Krackow-stitch models, the high-tensile strength tape had a significantly greater mean load at failure with a difference of 181 N (P = .001) and 94 N (P = .015) respectively. No significant difference was found in the Mason-Allen and simple stitch models. Pull-through remained the most common method of failure at an overall rate of 56.7% (suture = 55%; tape = 58.3%). In biomechanical testing during a single load to failure, high-tensile strength tape performs more favorably than high-tensile strength suture, with a greater mean load to failure, in both the whip- and Krackow-stitch models. Although suture pull-through remains the most common method of failure, high-tensile strength tape requires a significantly greater load to pull-through in a whip-stitch and Krakow-stitch model. The biomechanical data obtained in the current study indicates that high-tensile strength tape may provide better repair

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

    LENUS (Irish Health Repository)

    Bonham, Joseph


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

  18. 21 CFR 878.5010 - Nonabsorbable polypropylene surgical suture. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonabsorbable polypropylene surgical suture. 878... Nonabsorbable polypropylene surgical suture. (a) Identification. Nonabsorbable polypropylene surgical suture is... known as polypropylene and is indicated for use in soft tissue approximation. The polypropylene surgical...

  19. Bidirectional lift of the anterior midcheek with Gore-Tex cable sutures. (United States)

    Sasaki, Gordon H; Oberg, Kerby C; Kim, E Yoonah


    The reader is presumed to have a broad understanding of the anatomy of the anterior midface. After reading this article, the participant should be able to: Physicians may earn 1 hour of Category 1 CME credit by successfully completing the examination on the basis of material covered in this article. The examination begins on page 257. We have previously described a technique of anterior midface soft tissue repositioning using 2 cable sutures directed only in a superolateral direction. This technique achieves a more normal distribution of subcutaneous fat laterally over the malar bag prominence but does little to overcome central and medial hollowness in the palpebromalar and tear-trough areas. We describe an alteration of our original technique that introduces a vertical lift of the anterior midface soft tissue utilizing Gore-Tex, (W.L. Gore & Associates, Flagstaff, AZ) cable sutures while elevating the preperiosteal soft tissue. We used a transconjunctival approach to expose the postseptal fat, orbital rim, and arcus marginalis. Subperiosteal dissection over the orbital rim was performed to prepare a pocket for the malar fat pads. Using 6.5-cm Keith needles, we placed a braided suture medially, lateral to the location of the infraorbital nerve and foramen, and maneuvered it through the soft tissue until all signs of dimpling at the nasolabial line or upward distortion of the upper lip were removed. A Gore-Tex graft was introduced and seated in a cupped configuration that anchored the caudal fat pad at the nasolabial line. The medial fat pad and vascular pedicle were transposed over the orbital rim into the predissected pocket; the central fat pad was also fashioned into a pedicle and moved into its pocket. The Gore-Tex sutures were tightened, elevating the supraperiosteal soft tissue vertically. A second set of Gore-Tex sutures elevated the anterior midface soft tissue toward the deep temporal fascia. Between 1999 and 2002, 197 patients underwent bidirectional

  20. All-Suture Transosseous Repair for Rotator Cuff Tear Fixation Using Medial Calcar Fixation (United States)

    Aramberri-Gutiérrez, Mikel; Martínez-Menduiña, Amaia; Valencia-Mora, María; Boyle, Simon


    We describe an all-suture transosseous repair technique used in the management of rotator cuff tears by means of an all-suture anchor secured on the intra-articular side of the humeral calcar. The technique uses an anterior cruciate ligament guide to ensure accurate positioning of the tunnels, avoiding the articular cartilage and minimizing risk to the neurovascular structures. The distal end of the guide is inserted through a rotator interval portal and passed down to the axillary pouch. The proximal end of the guide is approximated to the greater tuberosity at the cuff footprint, and a complete transosseous tunnel is created with a 2.4-mm drill. An all-suture implant is inserted through this tunnel down to the calcar, and its deployment is visualized under arthroscopy. Gentle traction is applied to the anchor, resulting in a 4-mm concertina of the suture anchor that rests opposed to the medial cortex. The major advantage of this technique is the fixation strength gained from the biomechanically superior cortical bone of the calcar. Furthermore, this method permits greater preservation of bone surface area at the level of the footprint for a larger tendon-to-bone healing surface. This technique also provides an excellent alternative in revision situations. PMID:26052495

  1. Thread-Lift Sutures : Still in the Lift? A Systematic Review of the Literature

    NARCIS (Netherlands)

    Gulbitti, Haydar Aslan; Colebunders, Britt; Pirayesh, Ali; Bertossi, Dario; van der Lei, Berend

    Background: In 2006, Villa et al. published a review article concerning the use of thread-lift sutures and concluded that the technique was still in its infancy but had great potential to become a useful and effective procedure for nonsurgical lifting of sagged facial tissues. As 11 years have

  2. Thyroid hormone action on rat calvarial sutures. (United States)

    Akita, S; Nakamura, T; Hirano, A; Fujii, T; Yamashita, S


    To clarify the effect of thyroid hormone on the calvarial sutures, the morphology, histology, and bone mineral density were analyzed in thyroid hormone-injected rats. A total of 80 female Wistar rats at the age of 10 days were divided into 2 groups; the triiodothyronine (T3)-treated rats (n = 40, T3 100 micrograms/kg body weight/day) were maintained under the same conditions as controls (n = 40, saline-vehicle only), and both were sacrificed at 50, 80, and 200 experimental days, respectively. T3-treated animals showed smaller values of lambda-asterion and pterion-bregma distances at the various periods of examination, resulting in smaller sizes in right-left direction of the skull. The sagittal suture distance in the skull specimens observed by Goldner's staining (fibrous tissue content) appeared smaller and the osseous margin widths greatly increased in the T3-treated rats. Fluorescent microscopy revealed that the tetracycline-calcein double labelings were not interrupted from the periosteal to the endosteal areas in any specimens indicating the scantiness of osteoclastic activity in the suture areas. Mineral apposition rates at the osseous edges of the suture were significantly increased in the T3-treated rats (p < 0.01 at the age of 90 days). The distance between the second labels and the distance between the first labels were significantly larger in the T3-treated rats. Bone mineral density (BMD) measurement showed that the T3 administration decreased only the calvarial BMD at the age of 210 days (p < 0.01), but did not decrease lumbar or femur BMD. This experiment demonstrated clear evidence of excess thyroid hormone action on the early narrowing of the sagittal suture in infantile hyperthyroid rats, probably due to the enhanced osteogenic activity caused by the hormone.

  3. Preliminary results with sutured colonic anastomoses reinforced with dye-enhanced fibrinogen and a diode laser (United States)

    Libutti, Steven K.; Williams, Matthew R.; Oz, Mehmet C.; Forde, Kenneth A.; Bass, Lawrence S.; Weinstein, Samuel; Auteri, Joseph S.; Treat, Michael R.; Nowygrod, Roman


    A common cause of morbidity in patients recovering from bowel surgery is leakage from colonic anastomoses. A technique utilizing a laser activated protein solder to strengthen colonic anastomoses in a canine model was evaluated. Following creation of six single-layer interrupted suture anastomoses in four dogs, a protein solder consisting of indocyanine green dye and fibrinogen was topically appied to the serosal surface and exposed to 808 nm continuous wave diode laser energy. Immediately following anastomosis, the mean leakage pressure of sutures alone was 129 +/- 14 mm hg (n equals 6), while the mean leakage pressure of sutures reinforced with the laser welded solder was 312 +/- 32 mm hg (n equals 6) (p anastomoses without causing appreciable thermal injury to surrounding tissues.

  4. Safety of Uterine Compression Suture in the Management of Postpartum Hemorrhage: A Case Report

    Directory of Open Access Journals (Sweden)

    Malihe Amirian


    Full Text Available Uterine atony is the main cause of postpartum hemorrhage (PPH. Uterine compression suture is a common technique to control PPH in caesarean delivery. This article aimed to report a complication of this method for post-delivery atony. A 27-year-old primigravida woman with term pregnancy underwent caesarean delivery and was unresponsive to medical therapy and uterine artery ligation due to uterine atony. Two compression sutures were placed on her uterus. However, after 11 days, the patient underwent surgery again due to severe fever, infection, and a necrotic mass in the uterine cavity. The necrotic mass was we removed during the surgery. Although uterine compression suture is an effective method for the treatment of PPH, we witnessed some side effects in the patient, especially myometrium necrosis.

  5. Septal anchoring suture: a key suture to improve the nasolabial symmetry in unilateral cheiloplasty. (United States)

    Lu, T-C; Filson, S; Yao, C-F; Chen, P K-T


    Since 2008, a septal anchoring suture has been used in unilateral cleft lip repair at Chang Gung Memorial Hospital in order to stabilize the lateral lip centrally. This study compared the symmetry of two groups of patients: those treated with and without an anchoring suture. Multiple standardized direct and photographic facial measurements were performed on the faces of all patients pre-cheiloplasty and at 5 years post-cheiloplasty. The degree of nasolabial symmetry was evaluated by comparing the ratios of measurements of the cleft vs. non-cleft sides. The ratio of change in these measurements was also compared postoperatively. The vertical lip length ratio approached 1 in the septal anchoring suture group, which differed significantly from the group without the suture (0.968 vs. 0.873, P<0.001). As expected, the horizontal lip length and central lip height ratios showed no statistically significant change. The ratio of change from pre- to postoperative also showed a significant improvement (P=0.028) in the vertical lip length of the group with the septal anchoring suture compared to the one without. The septal anchoring suture is a useful method to correct the tendency of the lip to shift to the cleft side. Copyright © 2018 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Use of a mattress suture to eliminate dog ears in double-stapled and triple-stapled anastomoses. (United States)

    Asao, Takayuki; Kuwano, Hiroyuki; Nakamura, Jun-ichi; Hirayama, Isao; Ide, Munenori; Moringa, Nobuhiro; Fujita, Kin-ichi


    Double-stapling techniques for restorative rectal resection have been effective in minimizing local contamination compared with open circular stapling techniques. Inclusion of the transverse staple line closure of the distal rectal stump in the circular stapled anastomosis may minimize the risk of suture line recurrence. A technique for formation of such an anastomosis is described that avoids use of a distal purse string.

  7. Suture Choice in Lumbar Dural Closure Contributes to Variation in Leak Pressures: Experimental Model. (United States)

    Ghobrial, George M; Maulucci, Christopher M; Viereck, Matthew J; Beygi, Sara; Chitale, Ameet; Prasad, Srinivas; Jallo, Jack; Heller, Joshua; Sharan, Ashwini D; Harrop, James S


    Open-label laboratory investigational study; non-animal surgical simulation. The authors perform a comparison of dural closure strength in a durotomy simulator across 2 different suture materials. Incidental durotomy leading to persistent cerebrospinal fluid leak adds considerable morbidity to spinal procedures, often complicating routine elective lumbar spinal procedures. Using an experimental durotomy simulation, the authors compare the strength of closure using Gore-Tex with other suture types and sizes, using various closure techniques. A comparison of dural closures was performed through an analysis of the peak pressure at which leakage occurred from a standardized durotomy closure in an established cerebrospinal fluid repair model with a premade L3 laminectomy. Nurolon was compared with Gore-Tex sutures sizes (for Gore-Tex, CV-6/5-0 and CV-5/4-0 was compared with Nurolon 4-0, 5-0, and 6-0). Thirty-six trials were performed with Nurolon 4-0, 5-0, and 6-0, whereas 21 trials were performed for 4-0 and 5-0 Gore-Tex. The mean peak pressure at which fluid leakage was observed was 21 cm H2O for Nurolon and 34 cm H2O for Gore-Tex. Irrespective of suture choice, all trials were grouped by closure technique: running suture, locked continuous, and interrupted suture. No significant difference was noted between the groups. For each of the 3 trials groups by closure technique, running, locked continuous, and interrupted, Gore-Tex closures had a significantly higher peak pressure to failure. Interrupted Gore-Tex was significantly higher than Interrupted Nurolon (P=0.007), running Gore-Tex was significantly higher than running Nurolon (P=0.034), and locked Gore-Tex was significantly higher than locked Nurolon (P=0.014). Durotomy closure in the lumbar spine with Gore-Tex suture may be a reasonable option for providing a watertight closure. In this laboratory study, Gore-Tex suture provided watertight dural closures that withstood higher peak pressures.

  8. Comparison of barbed unidirectional suture with figure-of-eight standard sutures in vaginal cuff closure in total laparoscopic hysterectomy. (United States)

    Karacan, Tolga; Ozyurek, Eser; Usta, Taner; Odacilar, Eylem; Hanli, Ulviye; Kovalak, Ebru; Dayan, Huseyin


    The aim of the study was to compare postoperative vaginal cuff complications due to the use of barbed sutures (V-Loc™ 180 unidirectional suture; Covidien, Mansfield, MA) and standard braided sutures (Vicryl ® ; Ethicon Inc., Somerville, MA) during vaginal cuff closure of patients undergoing a total laparoscopic hysterectomy (TLH) due to benign diseases. Eighty-nine patients were in the standard suture group and 208 patients were included in the barbed suture group. Vaginal cuff dehiscence was identified in only three (3.3%) patients within the standard suture group and none in the barbed suture group. Five (5.6%) patients in the standard suture group and two (0.9%) patients in the barbed suture group developed postoperative cuff infection/cellulitis. Duration of the surgery was significantly shorter in the barbed suture group than in the standard suture group (p barbed suture, which is used during TLH for vaginal cuff closure, is an applicable, safe and tolerable alternative to a standard suture. IMPACT STATEMENT What is already known on this subject: Barbed sutures are a relatively new type of suture that include sharp barbs inserted on monofilament material in various configurations, and are used for approximating tissues without any need for surgical knotting. They have increasingly been used in obstetrics and gynaecology in recent years, particularly in total laparoscopic hysterectomy and laparoscopic myomectomy. At present, there are a limited number of studies of V-Loc™ suture in the literature. What the results of this study add: We demonstrated that barbed sutures used for enabling vaginal cuff integrity did not cause major morbidity and mortality for the patient. We suggest that V-Loc™ 180 barbed sutures offer a practical, safe and tolerable alternative for surgeons because they are easy to use, do not cause a significant increase in vaginal cuff complications, and shorten the operating time. Our study with V-Loc™ 180 unidirectional barbed

  9. Biomechanical Dynamics of Cranial Sutures during Simulated Impulsive Loading

    Directory of Open Access Journals (Sweden)

    Z. Q. Zhang


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

  10. Current manufacturing processes of drug-eluting sutures. (United States)

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


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

  11. Cost analysis of stapling versus suturing for skin closure. (United States)

    Orlinsky, M; Goldberg, R M; Chan, L; Puertos, A; Slajer, H L


    A randomized, prospective study was performed to test the null hypothesis that there is no difference between the cost of stapling and suturing for skin closure of selected linear lacerations. Appropriate wounds were randomly assigned to be closed by staples or sutures. Wound lengths, skin closure times, and the number of staples or the number and types of sutures used were recorded. Costs for materials and labor were calculated. The average total cost per case was $17.69 (with suture kit) and $7.84 (without suture kit) for the staple Group compared with $21.58 for the suture Group (P = .0001 for each). It is concluded that stapling is less costly than suturing and that the advantage appears to increase as laceration length increases.

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

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

    International Nuclear Information System (INIS)

    Kandimalla, Raghuram; Kalita, Sanjeeb; Choudhury, Bhaswati; Devi, Dipali; Kalita, Dhaneswar; Kalita, Kasturi; Dash, Suvakanta; Kotoky, Jibon


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

  14. Achondroplasia and multiple-suture craniosynostosis. (United States)

    Albino, Frank P; Wood, Benjamin C; Oluigbo, Chima O; Lee, Angela C; Oh, Albert K; Rogers, Gary F


    Genetic mutations in the fibroblast growth factor receptor 3 gene may lead to achondroplasia or syndromic forms of craniosynostosis. Despite sharing a common genetic basis, craniosynostosis has rarely been described in cases of confirmed achondroplasia. We report an infant with achondroplasia who developed progressive multiple-suture craniosynostosis to discuss the genetic link between these clinical entities and to describe the technical challenges associated with the operative management.

  15. Skin tension related to tension reduction sutures. (United States)

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


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

  16. 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


    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.

  17. Sutural expansion osteogenesis for management of the bony-tissue defect in cleft palate repair: experimental studies in dogs. (United States)

    Liu, C; Song, R; Song, Y


    A series of experimental studies on sutural expansion osteogenesis for management of the bony-tissue defect in cleft palate repair was performed between 1995 and 1997. Forty-five young dogs in weaning were used in four experiments that were divided into two parts. Part I probed the possibility of closing the surgically constructed hard palate cleft not only with mucoperiosteum but also with bony tissue by the technique of sutural expansion of lateral palatine sutures. Part II explored the possibility of pushing the palatine bone posteriorly and advancing the maxillary segment anteriorly by transverse palatine suture expansion. In Part I, a ring-shaped suture expander made of nickel-titanium shape memory alloy was used to expand the lateral suture of palatine bones. Expansion forces of 200 G, 360 G, and 480 G were used for the first experiment. A force of 360 G was chosen for two other experiments; this force is equivalent to the distraction rate of 0.5 mm per day of a jackscrew device. The ring-shaped suture expander was opened and its two feet were fixed in the medial sides of residual horizontal plates of the palatine bones immediately after a hard palate cleft was constructed surgically under endotracheal general anesthesia. At the eighth postoperative day, under the traction of 360 G, the two sides of the 8-mm-wide hard palate cleft were brought into contact with each other, and 8 or 9 days later the closed palatal cleft had healed completely with mucosal tissue. This experiment was repeated twice and yielded the same results. Sutural expansion osteogenesis was evaluated physically, fluorescently, histologically, and ultrastructurally to examine the deposition of the regenerated bone in the suture areas. Additionally, the influence of sutural expansion osteogenesis of the palatal bones on other facial bones was also studied cephalometrically. In Part II, a bow-shaped suture expander made of nickel-titanium shape memory alloy was applied to expand either the

  18. Use of a Purse-String Suture to Reduce Skin Graft Requirements. (United States)

    McCue, Jonathan; Kalliainen, Loree K


    When a wound cannot be closed in a linear fashion and either a local flap or skin graft is needed, a purse-string suture can be a useful adjunct to wound closure. Local tissue architecture is maintained in cases where clear surgical margins have not been achieved at the time of extirpative skin cancer surgery. We hypothesized that this technique could be applied to a range of wound sizes and locations to avoid or reduce the need for skin grafting. We applied a non-absorbable purse-string suture to wounds in 18 patients over a 15-month period and measured the defect size before and after application of the suture intraoperatively. Residual defects were covered with full- or split-thickness skin grafts. Postoperative wound area, scar hypertrophy, partial graft loss and dehiscence following suture removal were additional outcomes. Ten patients achieved primary wound closure with the purse-string suture, while additional skin grafting was required in eight patients. Wounds closed primarily did not re-expand. Skin-grafted subjects had a 53.8% intraoperative wound area reduction but the skin grafts expanded during recovery, and ultimate reduction diminished to 11% on late follow-up. Wounds accounting for this late re-expansion were located on the extremities. Purse-string sutures are helpful for wound closure in wounds that cannot be closed primarily. They can decrease the size of a skin graft if the wound cannot be closed completely. Wound re-expansion, particularly in extremity defects, may occur following early removal of the tension-bearing purse string.

  19. Interference Screw vs. Suture Anchor Fixation for Open Subpectoral Biceps Tenodesis: Does it Matter?

    Directory of Open Access Journals (Sweden)

    Gobezie Reuben


    Full Text Available Abstract Background Bioabsorbable interference screw fixation has superior biomechanical properties compared to suture anchor fixation for biceps tenodesis. However, it is unknown whether fixation technique influences clinical results. Hypothesis We hypothesize that subpectoral interference screw fixation offers relevant clinical advantages over suture anchor fixation for biceps tenodesis. Study Design Case Series. Methods We performed a retrospective review of a consecutive series of 88 patients receiving open subpectoral biceps tenodesis with either interference screw fixation (34 patients or suture anchor fixation (54 patients. Average follow up was 13 months. Outcomes included Visual Analogue Pain Scale (0–10, ASES score, modified Constant score, pain at the tenodesis site, failure of fixation, cosmesis, deformity (popeye and complications. Results There were no failures of fixation in this study. All patients showed significant improvement between their preoperative and postoperative status with regard to pain, ASES score, and abbreviated modified Constant scores. When comparing IF screw versus anchor outcomes, there was no statistical significance difference for VAS (p = 0.4, ASES score (p = 0.2, and modified Constant score (P = 0.09. One patient (3% treated with IF screw complained of persistent bicipital groove tenderness, versus four patients (7% in the SA group (nonsignificant. Conclusion Subpectoral biceps tenodesis reliably relieves pain and improves function. There was no statistically significant difference in the outcomes studied between the two fixation techniques. Residual pain at the site of tenodesis may be an issue when suture anchors are used in the subpectoral location.

  20. Comparison of two- and three-point sutures for advancing the levator aponeurosis in Asian eyelids. (United States)

    Kim, Y S; Yoon, J S; Jang, S Y


    To compare the functional and cosmetic outcomes of two- and three-point sutures for advancing the levator aponeurosis in blepharoptosis surgery on Asians. This retrospective study examined 60 Asian patients with blepharoptosis who had undergone advancement of the levator aponeurosis: 34 patients (46 eyelids) had ptosis correction using the two-point suture technique and 26 patients (41 eyelids) had ptosis correction using the three-point suture technique. The postoperative marginal reflex distance (MRD1), lid height difference, and eyelid contour were evaluated. Twenty-seven (79.4%) of the 34 patients in the two-point group and 19 (73.1%) of 26 patients in the three-point group had a postoperative MRD1 of 2-4 mm, lids within 0.5 mm of each other, and a satisfactory eyelid contour; this difference was not significant. The rate of reoperation did not differ significantly between the two groups. Two- and three-point sutures for advancing the levator aponeurosis were equally effective for correcting blepharoptosis in Asians.

  1. Dorsal stabilization of atlantoaxial subluxation using non-absorbable sutures in toy breed dogs. (United States)

    Sánchez-Masian, D; Luján-Feliu-Pascual, A; Font, C; Mascort, J


    To describe a novel dorsal technique for stabilization of atlantoaxial subluxation in toy breed dogs using 3-metric nylon suture. Retrospective study. Fifteen toy breed dogs with a body weight of 2 kg or less with atlantoaxial subluxation. The atlantoaxial joint of each dog was surgically stabilized through a dorsal approach by placing a double strand of non-absorbable, 3-metric, nylon suture material between the dorsal muscles of the atlanto-occipital and the atlantoaxial joint muscles. Pre- and postoperative neurological status, diagnostic imaging, and complications were reviewed. Clinical follow-up examination was performed at six months. For long-term assessment, a telephone follow-up was performed. No intra-operative complications were observed. Functional improvement occurred in 12 dogs. One dog did not improve and four dogs required revision surgery. In two of those four cases, suture material breakage was proven and it was suspected in the other two. Two cases underwent a second dorsal approach with the same suture material and two cases underwent a ventral approach (transarticular fixation and multiple implants embedded with polymethylmethacrylate). Dorsal stabilization using 3-metric nylon may be adequate as a safe, effective, and simple alternative technique for atlantoaxial stabilization in toy breed dogs of ≤1.5 kg of weight, in which the use of ventral screws and pins is challenging.

  2. A Newly‑devised Technique for the Fixation of Mesh Skin Graft

    African Journals Online (AJOL)

    cyanoacrylate (Dermabond; Ethicon), which was termed “Dendritic bonding.” This technique exhibits several advantages over surgical stapling and suturing with absorbable sutures. Key words: Dermabond, mesh, octyl-2-cyanoacrylate, skin graft.

  3. Fiber from ramie plant (Boehmeria nivea): A novel suture biomaterial. (United States)

    Kandimalla, Raghuram; Kalita, Sanjeeb; Choudhury, Bhaswati; Devi, Dipali; Kalita, Dhaneswar; Kalita, Kasturi; Dash, Suvakanta; Kotoky, Jibon


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

  4. O controle da hemorragia pós-parto com a técnica de sutura de B-Lynch: série de casos The control of postpartum hemorrhage with the B-Lynch suture technique: a case series

    Directory of Open Access Journals (Sweden)

    Gilberto Nagahama


    Full Text Available OBJETIVO: apresentar uma técnica cirúrgica para pacientes submetidas ao parto cesáreo e que evoluem com hemorragia refratária ao uso de medicamentos. MÉTODOS: o critério de seleção das pacientes era falha do tratamento farmacológico no controle da hemorragia pós-parto e o desejo da paciente em preservar o útero. As pacientes foram submetidas ao parto cesáreo e evoluíram com hemorragia pós-parto imediata refratária ao uso de ocitocina, ergometrina e misoprostol. Aplicamos a técnica de sutura descrita por B-Lynch sem modificações. Com fio cromado catgut-2 ou poliglactina-1, transfixamos o útero em seis pontos, conforme padronização. Após compressão manual do útero realizada pelo assistente, o fio é tracionado pelas suas extremidades pelo cirurgião e é aplicado um nó duplo seguido de dois nós simples, para em seguida realizar-se a histerorrafia. RESULTADOS: utilizamos o fio cromado catgut-2 agulhado em três casos e poliglactina-1 agulhado em um. Nos quatro casos houve parada imediata do sangramento vaginal após aplicação da sutura. Não houve qualquer complicação durante a realização do procedimento e nem no puerpério imediato e tardio das quatro pacientes. CONCLUSÕES: esta técnica representa uma alternativa cirúrgica para o manejo da hemorragia pós-parto. Com sua aplicação relativamente fácil, rápida e segura, pode representar uma redução da morbimortalidade materna em nosso país.PURPOSE: to present a surgical technique for patients submitted to caesarean section, which evolves to medicine refractory hemorrhage. METHODS: a case report study, of which the including criteria were failure in the pharmacological treatment to control post-partum hemorrhage, and the patients' request to preserve their uterus. Four patients submitted to caesarean section which evolved to immediate post-partum hemorrhage, refractory to the use of ocytocin, ergometrine and misoprostol, were treated with the suture technique

  5. 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


    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.

  6. Comparison of nylon monofilament suture and polytetrafluoroethylene sheet for frontalis suspension surgery in eyes with congenital ptosis. (United States)

    Hayashi, Kengo; Katori, Nobutada; Kasai, Kenichiro; Kamisasanuki, Taro; Kokubo, Kenichi; Ohno-Matsui, Kyoko


    To compare nylon monofilament suture with polytetrafluoroethylene sheet for frontalis suspension surgery to treat eyes with congenital ptosis. Retrospective, nonrandomized, comparative, interventional case series. We reviewed the medical records of 49 patients who had undergone 79 eyelid frontalis suspension surgeries to treat congenital ptosis. All of the patients were younger than 16 years and had congenital ptosis with poor levator muscle function. They were treated with frontalis suspension surgery with either a nylon suture or a polytetrafluoroethylene sheet and were followed up for at least 1 year. A single rhomboid loop sling was used for the nylon suture surgery. For the polytetrafluoroethylene sheet, an incision was made in the eyelid crease, and one end of the sheet was fixed to the tarsus and the other was fixed to the frontalis muscle. The main outcome measures were postoperative recurrences and complications. We evaluated 37 eyelids of 25 patients after nylon suture surgery and 42 eyelids of 31 patients after polytetrafluoroethylene sheet surgery. Among these, 9 eyelids of 7 patients were included in both groups. The median postoperative follow-up period was 32 months in both groups. The recurrence rates were 62.2% for the nylon suture group and 0% for the polytetrafluoroethylene sheet group (P nylon suture group and 7.1% for the polytetrafluoroethylene sheet group (P > .05). Frontalis suspension using a polytetrafluoroethylene sheet with direct tarsus and frontalis muscle fixation is a reasonable technique with low rates of recurrences and complications. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. A simple suture-guiding device for minimally invasive Achilles tendon repair. (United States)

    Obut, Sinan; Gultekin, Alper; Unal, Meric; Serarslan, Ulaş; Tuhanioğlu, Ümit


    Our hypothesis is to utilize a simple suture-guiding device for minimally invasive repair of Achilles tendon without any extra cost with a minimal risk of rerupture. The purpose of this study is to investigate the results of our minimally invasive technique for Achilles tendon repair using a simple ovarian clamp for suture guiding. Twenty patients with acute Achilles tendon rupture were treated with minimally invasive repair by an expert orthopaedic surgeon. Instead of an Achillon device, an ovarian clamp was directed to the proximal and distal parts of the Achilles tendon. All data relating to daily activities, walking, climbing stairs, sports activity, American Orthopaedic Foot and Ankle Society (AOFAS) and Thermannscores were recorded. Sural nerve was evaluated with physical examination for paraesthesia, hyperaesthesia, lateralis cruris and foot pain in all patient controls. The average AOFAS score was 97.06 (76-100). All patients had intact Achilles tendon at last control. No rerupture was observed. Average time taken to return to work was 30.8 days (28-60 days). After 6 months, all patients returned to their previous sports activities. For Achilles tendon ruptures, minimally invasive repair techniques have shown successful results with low complication rates. Besides their success, some suture-guiding devices bring extra costs for patients or health insurance. Minimally invasive techniques may be performed with devices without any extra cost. Our new suture-guiding device provides knot placement under paratenon like Achillon device to improve outcomes, provides early return to work and minimizes the complications. Finally, our suture-guiding device has no extra cost.

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

    Directory of Open Access Journals (Sweden)

    Ademuyiwa A


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

  9. Thread-Lift Sutures: Still in the Lift? A Systematic Review of the Literature. (United States)

    Gülbitti, Haydar Aslan; Colebunders, Britt; Pirayesh, Ali; Bertossi, Dario; van der Lei, Berend


    In 2006, Villa et al. published a review article concerning the use of thread-lift sutures and concluded that the technique was still in its infancy but had great potential to become a useful and effective procedure for nonsurgical lifting of sagged facial tissues. As 11 years have passed, the authors now performed again a systematic review to determine the real scientific current state of the art on the use of thread-lift sutures. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed database and using the Medical Subject Headings search term "Rhytidoplasty." "Rhytidoplasty" and the following entry terms were included by this Medical Subject Headings term: "facelift," "facelifts," "face Lift," "Face Lifts," "Lift," "Face," "Lifts," "Platysmotomy," "Platysmotomies," "Rhytidectomy," "Rhytidectomies," "Platysmaplasty," "and "Platysmaplasties." The Medical Subject Headings term "Rhytidoplasty" was combined with the following search terms: "Barbed suture," "Thread lift," "APTOS," "Suture suspension," "Percutaneous," and "Silhouette suture." RefWorks was used to filter duplicates. Three of the authors (H.A.G., B.C., and B.L.) performed the search independently. The initial search with all search terms resulted in 188 articles. After filtering the duplicates and the articles about open procedures, a total of 41 articles remained. Of these, the review articles, case reports, and letters to the editor were subsequently excluded, as were reports dealing with nonbarbed sutures, such as Vicryl and Prolene with Gore-Tex. This resulted in a total of 12 articles, seven additional articles since the five articles reviewed by Villa et al. The authors' review demonstrated that, within the past decade, little or no substantial evidence has been added to the peer-reviewed literature to support or sustain the promising statement about thread-lift sutures as made by Villa et al. in 2006 in terms of

  10. Bidirectional Barbed Sutures for Wound Closure: Evolution and Applications (United States)

    Paul, Malcolm D.


    Traditionally, wound closure sutures have in common the need to tie knots with the inherent risk of extrusion, palpability, microinfarcts, breakage, and slippage. Bidirectional barbed sutures have barbs arrayed in a helical fashion in opposing directions on either side of an unbarbed midsegment. This suture is inserted at the midpoint of a wound and pulled through till resistance is encountered from the opposing barbs; each half of the suture is then advanced to the lateral ends of the wound. This design provides a method of evenly distributing tension along the incision line, a faster suture placement and closure time with no need to tie knots, and the possibility of improved cosmesis. Bidirectional barbed sutures, which are available in both absorbable and nonabsorbable forms, can be used for simple closures, multilayered closures, and closure of high-tension wounds in a variety of surgical settings. PMID:24527114

  11. Automatic Detection of Wild-type Mouse Cranial Sutures

    DEFF Research Database (Denmark)

    Ólafsdóttir, Hildur; Darvann, Tron Andre; Hermann, Nuno V.

    , automatic detection of the cranial sutures becomes important. We have previously built a craniofacial, wild-type mouse atlas from a set of 10 Micro CT scans using a B-spline-based nonrigid registration method by Rueckert et al. Subsequently, all volumes were registered nonrigidly to the atlas. Using...... these transformations, any annotation on the atlas can automatically be transformed back to all cases. For this study, two rounds of tracing seven of the cranial sutures, were performed on the atlas by one observer. The average of the two rounds was automatically propagated to all the cases. For validation......, the observer traced the sutures on each of the mouse volumes as well. The observer outperforms the automatic approach by approximately 0.1 mm. All mice have similar errors while the suture error plots reveal that suture 1 and 2 are cumbersome, both for the observer and the automatic approach. These sutures can...

  12. 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


    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

  13. Role of the osteoclast in cranial suture waveform patterning. (United States)

    Byron, Craig Daniel


    This study investigates the role of bone resorption in defining interdigitations characteristic of cranial suture waveform. Male mice from the CD-1 (ICR) background were analyzed at six age groups (n = 5 mice per group) in order to study the ontogenetic changes of osteoclast counts using tartrate-resistant acid phosphatase-stained histological sections of sagittal sutures. Additionally, the complexity of suture lines were measured ectocranially from the same age groups (n = 5 per group) using image capture and fractal geometry (ruler dimension method). The results suggest that osteoclast resorption is a contributor to suture patterning. Specifically, osteoclasts show the greatest activity along concave suture regions at 42 and 84 days (Kruskal-Wallis test statistic = 14.9; P weaning and the transition to a hard chow diet. These data demonstrate osteoclasts along the bone margin of the cranial suture and also indicate that sutures attain their complex shape at the same age when osteoclast number is highest along concave suture margins, underscoring the role of osteoclasts in generating the suture waveform pattern. 2006 Wiley-Liss, Inc.

  14. Sutural simplification in Physodoceratinae (Aspidoceratidae, Ammonitina

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    Checa, A.


    Full Text Available The estructural analysis of the shell septum interrelationship in sorne Jurassic ammonites allows us to conclude that sutural simplifications occurred throughout the phylogeny, were originated by alterations in the external morphology of the shell. In the case of Physodoceratinae the simplification observed in the morphology of the septal suture may have a double origin. First, an increase in the size of periumbilical tubercles may determine a shallowing of sutural elements and a shortening of saddle and lobe frilling. In other cases, shallowing is determined by a decrease in the whorl expansion rate, an apparent shortening of secondary branching not being observed.El análisis estructural de la interrelación concha-septo en algunos ammonites del Jurásico superior lleva a concluir que las simplificaciones suturales aparecidas a lo largo de la filogenia fueron originadas por alteraciones ocurridas en la morfología externa de la concha. En el caso concreto de la subfamilia Physodoceratinae, la simplificación observada en la morfología de la sutura puede tener un doble origen. En primer lugar, un incremento en el tamaño de los tubérculos periumbilicales puede determinar una pérdida de profundidad de los elementos de la sutura. siempre acompañada de una disminución en las indentaciones (frilling de sillas y lóbulos. En otros casos el acortamiento en profundidad está determinado por una disminución de la tasa de expansión de la espira, sin que se observe un acortamiento aparente de las ramificaciones secundarias.

  15. Bone suture and lateral sinus lift surgery

    Directory of Open Access Journals (Sweden)

    Amin Rahpeyma


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

  16. Evolution of Complexity in Paleozoic Ammonoid Sutures. (United States)

    Saunders; Work; Nikolaeva


    The septal sutures of 588 genera of Paleozoic ammonoids showed a 1600 percent increase in mean complexity over 140 million years. Within 475 ancestor/descendant pairs, descendants were more than twice as likely to be more complex than their ancestors. Twelve subclades (373 genera) averaged 34 percent increased complexity. These patterns are compatible with an active or driven system of long-term bias for increased complexity. Mass extinctions acted in opposition to this long-term trend, tending to eliminate more-complex forms and resetting the trend with each extinction event.

  17. Presence of calcium in the vessel walls after end-to-end arterial anastomoses with polydioxanone and polypropylene sutures in growing dogs. (United States)

    Gersak, B


    The presence of calcium in the vessel walls after end-to-end arterial anastomoses performed with polydioxanone and polypropylene interrupted sutures was studied in 140 anastomoses in 35 10-week-old German shepherd dogs. Histologic examination with hematoxylin and eosin, van Gieson, and von Kossa staining techniques was performed after the animals were killed 6 months after the operation. Ketamine hydrochloride was used as an anesthetic agent. At the start of the investigation the dogs weighed 14.5 +/- 2.6 kg (mean +/- standard deviation, n = 35), and after 6 months they weighed 45.3 +/- 3.1 kg (mean +/- standard deviation, n = 35). The diameter of the sutured arteries in the first operation was 2.6 +/- 0.5 mm (mean +/- standard deviation, n = 140). With each dog, both brachial and both femoral arteries were used--one artery for each different type of suture. In different dogs, different arteries were used for the same type of suture. The prevalence of calcifications after 6 months was determined from the numeric density of calcifications with standard stereologic techniques. The sutured and sutureless parts taken from longitudinal sections from each artery were studied, and t test values were calculated as follows: In paired samples, statistically significant differences in numerical density of calcifications were seen between sutured and sutureless arterial parts for both materials (sutureless part versus part with polydioxanone sutures, p 0.05, n = 70) and sutureless parts (p > 0.05, n = 70).

  18. Endoscopic suturing versus endoscopic clip closure of the mucosotomy during a per-oral endoscopic myotomy (POEM): a case-control study. (United States)

    Pescarus, Radu; Shlomovitz, Eran; Sharata, Ahmed M; Cassera, Maria A; Reavis, Kevin M; Dunst, Christy M; Swanström, Lee L


    Obtaining an adequate mucosal closure is one of the crucial steps in per-oral endoscopic myotomy (POEM). Thus far, there have been no objective data comparing the various available closure techniques. This case-controlled study attempts to compare the application of endoscopic clips versus endoscopic suturing for mucosotomy closure during POEM cases. A retrospective review of our prospective POEM database was performed. All cases in which endoscopic suturing was used to close the mucosotomy were matched to cases in which standard endoclips were used. Overall complication rate, closure time and mucosal closure costs between the two groups were compared. Both techniques offer good clinical results with good mucosal closure and the absence of postoperative leak. Closure time was significantly shorter (p = 0.044) with endoscopic clips (16 ± 12 min) when compared to endoscopic suturing (33 ± 11 min). Overall, the total closure cost analysis showed a trend toward lower cost with clips (1502 ± 849 USD) versus endoscopic suturing (2521 ± 575 USD) without reaching statistical significance (p = 0.073). The use of endoscopic suturing seems to be a safe method for mucosal closure in POEM cases. Closure time is longer with suturing than conventional closure with clips, and there is a trend toward higher overall cost. Endoscopic suturing is likely most cost-effective for difficult cases where conventional closure methods fail.

  19. Comparative study of cotton, polyglactin and polyglecaprone sutures in intestinal anastomoses in dogs. (United States)

    Bernis-Filho, Walter Octaviano; Wouters, Flademir; Wouters, Angélica Aparecida Barth; Bernis, Valéria Magro Octaviano; Lopes, Luiz Roberto; Andreollo, Nelson Adami


    Over the years, many sutures were developed and then abandoned. Until now was not found an ideal suture to the intestinal tract or other tissues in general, making the choice a difficult task. To evaluate, macroscopically and microscopically, the healing process of intestinal anastomoses in dogs using polyglecaprone 25, polyglactin 910 and cotton sutures. Twenty adult male dogs were operated on and underwent to three small bowel anastomosis using the technique with submucosal sutures. Were used three threads and the anastomoses were evaluated at different postoperative periods - group I - three days; group II - seven days; group III - 14 days and group IV - 21days. Macroscopic analysis was to assess the presence or absence of peritonitis, aspect of the anastomosis and adhesions. Histological studies of the anastomoses, using hematoxylin and eosin and Masson's trichrome analyzed the exudative inflammation, granulomatous inflammation, the mucosal epithelial coating and collagen fibers. The macroscopic analysis showed good coaptation of the edges with a moderate degree of adhesion between the intestines and omentum three to 21 days after surgery. The microscopic evaluation revealed exudative inflammation with neutrophils and fibrin, which ranged from mild to moderate until the 14th day; granulomatous inflammation with macrophages, multinucleated giant cells and epithelioid cells were more evident at 14th day for the cotton, presence of granulation tissue (fibroblasts) and collagen fibers, a moderate way, from the 7th for the three threads. All three threads showed similar behavior and thus they can be indicated for anastomoses of the small intestine.

  20. Comparison of functional results of two fixation systems using single-row suturing of rotator cuff. (United States)

    Muniesa-Herrero, M P; Torres-Campos, A; Urgel-Granados, A; Blanco-Llorca, J A; Floría-Arnal, L J; Roncal-Boj, J C; Castro-Sauras, A


    Arthroscopic repair of rotator cuff disorders is a technically demanding but successful procedure. Many anchor and suture alternatives are now available. The choice of the implant by the surgeon is less important than the configuration of the suture used to fix the tendon, however it is necessary to know if there are differences in the results, using each one of them. The aim of the study is to evaluate if there are differences between the knotted and non-knotted implant in terms of functional and satisfaction results. A retrospective study was carried out on 83 patients operated between 2010 and 2014 in our center using 2anchoring systems with and without knotting (39 versus 44 patients respectively), with single row in complete rupture of the rotator cuff. At the end of the follow-up, an average score was obtained on the Constant scale of 74.6 points. 98% of the patients considered the result of the surgery satisfactory. Statistically, there were no significant differences between the 2groups in terms of functionality, satisfaction or reincorporation to activities. The functional results of the single-row cuff suture are satisfactory, although biomechanical studies show advantages in favor of sutures that reproduce a transoseo system. It our series of patients the presence of knotting does not show per se a significant functional difference being both superimposable techniques in absolute values of functionality and patient satisfaction. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. (United States)

    Ji, Jong-Hun; Kim, Weon-Yoo; Ra, Ki-Hang


    In cases of displaced greater tuberosity fractures, treatments by arthroscopic-assisted reduction and percutaneous screw fixation have been reported. However, in cases in which there is a comminuted fracture or a minimally displaced fracture combined with concomitant lesions such as rotator cuff tear or labral pathology, it is difficult to reduce the fracture and to treat other pathologies by use of a percutaneous screw. Recently, many surgeons have used the double-row repair method in rotator cuff repair, which provides a tendon-bone interface better suited for biologic healing and restoring normal anatomy. In accordance with this method, we used the arthroscopic technique of double-row suture anchor fixation for a minimally displaced greater tuberosity fracture without additional incision. Initially, debridement was performed on the fracture surface by use of a shaver, and the medial-row anchor was inserted through the anterior portal or the intact cuff. Two lateral-row anchors were inserted just anterior and posterior to the lower margin of the fractured fragment under C-arm guidance. The medial-row sutures and lateral-row sutures were then placed. Arthroscopic double-row suture anchor fixation of a displaced greater tuberosity fracture restores the original footprint of the rotator cuff and normal tendon-bone interface of the displaced greater tuberosity fracture.

  2. Virtual suturing simulation based on commodity physics engine for medical learning. (United States)

    Choi, Kup-Sze; Chan, Sze-Ho; Pang, Wai-Man


    Development of virtual-reality medical applications is usually a complicated and labour intensive task. This paper explores the feasibility of using commodity physics engine to develop a suturing simulator prototype for manual skills training in the fields of nursing and medicine, so as to enjoy the benefits of rapid development and hardware-accelerated computation. In the prototype, spring-connected boxes of finite dimension are used to simulate soft tissues, whereas needle and thread are modelled with chained segments. Spherical joints are used to simulate suture's flexibility and to facilitate thread cutting. An algorithm is developed to simulate needle insertion and thread advancement through the tissue. Two-handed manipulations and force feedback are enabled with two haptic devices. Experiments on the closure of a wound show that the prototype is able to simulate suturing procedures at interactive rates. The simulator is also used to study a curvature-adaptive suture modelling technique. Issues and limitations of the proposed approach and future development are discussed.

  3. A comparison of simple continuous versus simple interrupted suture patterns for tracheal anastomosis after large-segment tracheal resection in dogs. (United States)

    Fingland, R B; Layton, C I; Kennedy, G A; Galland, J C


    Two suture techniques for tracheal anastomosis after large-segment tracheal resection were compared. Eight cartilages were resected from the trachea of each of 12 dogs; anastomoses with 4-0 polydioxanone suture were created using a simple continuous suture technique in six dogs and a simple interrupted suture technique in six dogs. Surgical time was shorter but apposition of tracheal segments at the time of surgery was less precise with the simple continuous suture technique. The dogs were evaluated for 150 days after surgery. Clinical abnormalities after tracheal resection and anastomosis were not observed. Percent dorsoventral luminal stenosis was calculated by measuring the tracheal lumen diameter on lateral cervical radiographs. Percent luminal stenosis was calculated planimetrically using a computerized digitizing tablet. Anastomotic stenosis was mild in all dogs; however, the mean percent.luminal stenosis determined planimetrically was significantly greater for dogs that had the simple continuous suture technique. Planimetric measurements of cross-sectional area made before and after formalin fixation were not significantly different. Radiographic determination of percent dorsoventral luminal stenosis was a poor predictor of diminution of cross-sectional area determined planimetrically.

  4. A Novel Clinical-Simulated Suture Education for Basic Surgical Skill: Suture on the Biological Tissue Fixed on Standardized Patient Evaluated with Objective Structured Assessment of Technical Skill (OSATS) Tools. (United States)

    Shen, Zhanlong; Yang, Fan; Gao, Pengji; Zeng, Li; Jiang, Guanchao; Wang, Shan; Ye, Yingjiang; Zhu, Fengxue


    Clinical-simulated training has shown benefit in the education of medical students. However, the role of clinical simulation for surgical basic skill training such as suturing techniques remains unclear. Forty-two medical students were asked to perform specific suturing tasks at three stations with the different settings within four minutes (Station 1: Synthetic suture pad fixed on the bench, Station 2: Synthetic suture pad fixed on the standardized patient, Station 3: Pig skin fixed on the standardized patient); the OSATS (Objective Structured Assessment of Technical Skill) tool was used to evaluate the performance of students. A questionnaire was distributed to the students following the examination. Mean performance score of Station 3 was significant lower than that of Station 1 and 2 in the general performance including tissue handling, time, and motion. The suturing techniques of students at Station 2 and 3 were not as accurate as that at Station 1. Inappropriate tension was applied to the knot at Station 2 compared with Station 1 and 3. On the questionnaire, 93% of students considered clinical-simulated training of basic surgical skills was necessary and may increase their confidence in future clinical work as surgeons; 98% of students thought the assessment was more objective when OSATS tool was used for evaluation. Clinical simulation examination assessed with OSATS might throw a novel light on the education of basic surgical skills and may be worthy of wider adoption in the surgical education of medical students.

  5. Comparison of Arterial Repair through the Suture, Suture with Fibrin or Cyanoacrylate Adhesive in Ex-Vivo Porcine Aortic Segment

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius H. de Carvalho

    Full Text Available Abstract Introduction: Tissue adhesives can be used as adjacent to sutures to drop or avoid bleeding in cardiovascular operations. Objective: To verify the efficiency of fibrin and cyanoacrylate adhesive to seal arterial sutures and if the adhesives penetrate through suture line to the inner of arteries. Methods: 20 abdominal aorta segments of pigs were divided into two groups according to the adhesive which would be used as adjacent to the suture. In every arterial segment an arteriotomy was done, followed by a conventional artery closure. Afterwards a colloidal fluid was injected inside the arterial segment with a simultaneous intravascular pressure monitoring up to a fluid leakage through the suture. This procedure was repeated after application of one of the adhesives on the suture in order to check if the bursting pressure increases. The inner aorta segments also were analyzed in order to check if there was intraluminal adhesive penetration. Results: In Suture 1 group, the mean arterial pressure sustained by the arterial suture reached 86±5.35 mmHg and after the fibrin adhesive application reached 104±11.96 (P<0.002. In the Suture 2 group, the mean arterial pressure sustained by the suture reached 83±2.67 mmHg and after the cyanoacrylate adhesive application reached 152±14.58 mmHg (P<0.002. Intraluminal adhesive penetration has not been noticed. Conclusion: There was a significant rise in the bursting pressure when tissue adhesives were used as adjacent to arterial suture, and this rise was higher if the cyanoacrylate adhesive was used. In addition, the adhesives do not penetrate through the suture line into the arteries.

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

    African Journals Online (AJOL)

    urethra and to achieve a penis with a satisfactory cosmetic result and that is .... edema, which resolved spontaneously, was reported in 20 patients. ... Acute PO edema. 7. 13. 0.098. Hospital stay (days). Range. 4–8. 3–7. 0.14. Mean ± SD. 5.1 ± 0.9. 4.8 ± 0.9. Follow-up (months). Range. 4–13. 5–12. 0.127. Mean ± SD.

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  8. Oesophageal flap valvuloplasty and wrapping suturing prevent gastrooesophageal reflux disease in dogs after oesophageal anastomosis (United States)

    Dai, Ji-Gang; Liu, Quan-Xing; Den, Xu-Feng; Min, Jia-Xin


    AIM: To examine the efficiency of oesophageal flap valvuloplasty and wrapping suturing technique in decreasing the rate of postoperative gastrooesophageal reflux disease in a dog model. METHODS: We operated on 10 dogs in this study. First, we resected a 5-cm portion of the distal oesophagus and then restored the continuity of the oesophageal and gastric walls by end-to-end anastomosis. A group of five dogs was subjected to the oesophageal flap valvuloplasty and wrapping suturing technique, whereas another group (control) of five dogs was subjected to the stapling technique after oesophagectomy. The symptom of gastrooesophageal reflux was recorded by 24-h pH oesophageal monitoring. Endoscopy and barium swallow examination were performed on all dogs. Anastomotic leakage was observed by X-ray imaging, whereas benign anastomotic stricture and mucosal damage were observed by endoscopy. RESULTS: None of the 10 dogs experienced anastomotic leakage after oesophagectomy. Four dogs in the new technology group resumed regular feeding, whereas only two of the dogs in the control group tolerated solid food intake. pH monitoring demonstrated that 25% of the dogs in the experimental group exhibited reflux and that none had mucosal damage consistent with reflux. Conversely, both reflux and mucosal damage were observed in all dogs in the control group. CONCLUSION: The oesophageal flap valvuloplasty and wrapping suturing technique can improve the postoperative quality of life through the long-term elimination of reflux oesophagitis and decreased stricture formation after primary oesophageal anastomosis. PMID:25516655

  9. In Vitro Comparison of Two Barbed Suture Configurations for Flexor Tendon Repair. (United States)

    Engel, Jamie L; Gabra, Joseph N; Esterle, Andrew R; Lanzinger, William D; Elias, John J


    Purpose  The current study compares the strength of a previously studied technique for flexor tendon repair with barbed sutures to an experimental approach that aligns all the barbs to oppose distraction. Methods  Twelve flexor tendons from cadaveric specimens were mechanically tested following repair of simulated zone II tendon injuries. Two repair techniques utilizing barbed sutures were studied: the Marrero-Amadeo four-core barbed suture approach and the experimental configuration with all barbs on four cores opposing distraction. Maximum applied load at failure, that is, ultimate load, and 2-mm gap force were compared between the two repair techniques, both as raw values and after normalization to cross-sectional area of the intact tendon. Statistical testing was performed using t -tests and Mann-Whitney U -tests, where appropriate, with a significance level of 0.05. Results  The ultimate loads, raw (58.2 N) and normalized (4.8 N/mm 2 ), were significantly larger for the Marrero-Amadeo repair than the proposed experimental approach (35.6 N and 2.7 N/mm 2 ; p  barbs to oppose distraction does not improve strength of the repaired tendon. The Marrero-Amadeo technique was found to have superior strength for use in traumatic zone II flexor tendon injuries.

  10. Oesophageal flap valvuloplasty and wrapping suturing prevent gastrooesophageal reflux disease in dogs after oesophageal anastomosis. (United States)

    Dai, Ji-Gang; Liu, Quan-Xing; Den, Xu-Feng; Min, Jia-Xin


    To examine the efficiency of oesophageal flap valvuloplasty and wrapping suturing technique in decreasing the rate of postoperative gastrooesophageal reflux disease in a dog model. We operated on 10 dogs in this study. First, we resected a 5-cm portion of the distal oesophagus and then restored the continuity of the oesophageal and gastric walls by end-to-end anastomosis. A group of five dogs was subjected to the oesophageal flap valvuloplasty and wrapping suturing technique, whereas another group (control) of five dogs was subjected to the stapling technique after oesophagectomy. The symptom of gastrooesophageal reflux was recorded by 24-h pH oesophageal monitoring. Endoscopy and barium swallow examination were performed on all dogs. Anastomotic leakage was observed by X-ray imaging, whereas benign anastomotic stricture and mucosal damage were observed by endoscopy. None of the 10 dogs experienced anastomotic leakage after oesophagectomy. Four dogs in the new technology group resumed regular feeding, whereas only two of the dogs in the control group tolerated solid food intake. pH monitoring demonstrated that 25% of the dogs in the experimental group exhibited reflux and that none had mucosal damage consistent with reflux. Conversely, both reflux and mucosal damage were observed in all dogs in the control group. The oesophageal flap valvuloplasty and wrapping suturing technique can improve the postoperative quality of life through the long-term elimination of reflux oesophagitis and decreased stricture formation after primary oesophageal anastomosis.

  11. Geophysical exploration of the Kalahari Suture Zone (United States)

    Brett, J. S.; Mason, R.; Smith, P. H.


    Fancamp Resources Limited of Montreal, Canada, commenced exploration of the Kalahari Suture Zone in southwest Botswana in 1996, following the interpretation of airborne magnetic surveys covering 400 km of strike along the Kalahari Suture Zone. Initial focus was on mafic/ultramafic intrusions associated with the Tshane Complex as potential targets for CuNiPGM mineralization, but these targets are now considered to be too deeply buried (> 700 m) to be of economic significance at this time. The exploration focus has been redirected to several prospective large coincident magnetic/gravity anomalies. These are considered prospective targets for Olympic Dam-type CuCo mineralisation associated with alkaline intrusive complexes, and/or NiCuCoPGM mineralisation associated with basic intrusive complexes. The two most important and prospective targets are the so-called 'Great Red Spot' and Tsetseng Complex. Additional ground geophysical surveys and deep drilling are planned for the next phase of exploration. These large targets are of high priority and represent tremendous potential for mineral development in the sparsely populated area of western Botswana.

  12. Reduced Rate of Dehiscence After Implementation of a Standardized Fascial Closure Technique in Patients Undergoing Emergency Laparotomy

    DEFF Research Database (Denmark)

    Tolstrup, Mai-Britt; Watt, Sara Kehlet; Gögenur, Ismail


    is lacking. We aimed to investigate whether this technique would reduce the rate of dehiscence. METHODS: A standardized procedure of closing the midline laparotomy by using a "small steps" technique of continuous suturing with a slowly absorbable (polydioxanone) suture material in a wound-suture ratio...

  13. Contralateral eye surgery with adjustable suture for management of third nerve palsy with aberrant regeneration

    Directory of Open Access Journals (Sweden)

    Phuong Thi Thanh Nguyen


    Full Text Available Aberrant regeneration of the third nerve following its palsy is commonly seen after trauma and compressive lesions. This phenomenon is thought to result due to misdirection of the regenerating axons. Surgical management is a great challenge in the third nerve palsy owing to multiple muscle involvement and is often accompanied by ptosis and poor Bell's phenomenon. We present a case of a 27-year-old male who developed isolated complete third nerve palsy of the left eye following head trauma. Features of aberrant regeneration were seen after 6 months, namely, inverse Duane's sign and Pseudo-Von Graefe's sign. He underwent recess-resect procedure in the unaffected eye with adjustable suture technique which not only corrected the deviation but also the ptosis by utilizing the oculomotor synkinesis. Thus, contralateral eye surgery combined with adjustable suture technique resulted in an accurate alignment of the eye and obviated the need for ptosis correction.

  14. Frequency of Dehiscence in Hand-Sutured and Stapled Intestinal Anastomoses in Dogs. (United States)

    Duell, Jason R; Thieman Mankin, Kelley M; Rochat, Mark C; Regier, Penny J; Singh, Ameet; Luther, Jill K; Mison, Michael B; Leeman, Jessica J; Budke, Christine M


    To determine the frequency of dehiscence of hand-sutured and stapled intestinal anastomoses in the dog and compare the surgery duration for the methods of anastomosis. Historical cohort study. Two hundred fourteen client-owned dogs undergoing hand-sutured (n = 142) or stapled (n = 72) intestinal anastomoses. Medical records from 5 referral institutions were searched for dogs undergoing intestinal resection and anastomosis between March 2006 and February 2014. Demographic data, presence of septic peritonitis before surgery, surgical technique (hand-sutured or stapled), surgery duration, surgeon (resident versus faculty member), indication for surgical intervention, anatomic location of resection and anastomosis, and if dehiscence was noted postoperatively were retrieved. Estimated frequencies were summarized and presented as proportions and 95% confidence intervals (CI) and continuous outcomes as mean (95% CI). Comparisons were made across methods of anastomosis. Overall, 29/205 dogs (0.14, 95% CI 0.10-00.19) had dehiscence, including 21/134 dogs (0.16, 0.11-0.23) undergoing hand-sutured anastomosis and 8/71 dogs (0.11, 0.06-0.21) undergoing stapled anastomosis. There was no significant difference in the frequency of dehiscence across anastomosis methods (χ(2), P = .389). The mean (95% CI) surgery duration of 140 minutes (132-147) for hand- sutured anastomoses and 108 minutes (99-119) for stapled anastomoses was significantly different (t-test, P dogs but surgery duration is significantly reduced by the use of staples for intestinal closure. © Copyright 2015 by The American College of Veterinary Surgeons.

  15. Removable purse-string suture of the bladder neck in transvesical prostatectomy. (United States)

    Alfthan, O; Koskela, E


    Insertion of the provisional Malament purse-string suture of the bladder neck proved an effective haemostatic method of treating serious haemorrhage following suprapubic prostatectomy. In a series of 15 patients, bladder-neck stenosis developed in one case, but in this patient the technique had been used incorrectly. In the other cases there were no serious complications. The method is suitable for bleeding which cannot otherwise be stopped during the operation.

  16. The malament suture: any role in transvesical prostatectomy ...

    African Journals Online (AJOL)

    Conclusion: From our study, the Malament suture does not increase the incidence of bladder neck stenosis; neither does it reduce the need for blood transfusion. Prospective studies are required to further investigate these and find out if the Malament suture reduces the volume of fluid required for irrigation or the need to ...

  17. Mechanical model of suture joints with fibrous connective layer (United States)

    Miroshnichenko, Kateryna; Liu, Lei; Tsukrov, Igor; Li, Yaning


    A composite model for suture joints with a connective layer of aligned fibers embedded in soft matrix is proposed. Based on the principle of complementary virtual work, composite cylinder assemblage (CCA) approach and generalized self-consistent micro-mechanical models, a hierarchical homogenization methodology is developed to systematically quantify the synergistic effects of suture morphology and fiber orientation on the overall mechanical properties of sutures. Suture joints with regular triangular wave-form serve as an example material system to apply this methodology. Both theoretical and finite element mechanical models are developed and compared to evaluate the overall normal stiffness of sutures as a function of wavy morphology of sutures, fiber orientation, fiber volume fraction, and the mechanical properties of fibers and matrix in the interfacial layer. It is found that generally due to the anisotropy-induced coupling effects between tensile and shear deformation, the effective normal stiffness of sutures is highly dependent on the fiber orientation in the connective layer. Also, the effective shear modulus of the connective layer and the stiffness ratio between the fiber and matrix significantly influence the effects of fiber orientation. In addition, optimal fiber orientations are found to maximize the stiffness of suture joints.

  18. Punctal occlusion with Prolene suture material in the patients with ...

    African Journals Online (AJOL)

    Aim: To analyze the efficacy and outcomes of punctal occlusion with 5-0 Prolene suture material for the treatment of dry eye. Materials and. Methods: A total of 20 patients with moderate and severe dry eyes, recalcitrant to maximal medical therapy, underwent temporary punctal occlusion with 5-0 Prolene suture material.

  19. Suture associated corneal abscess three years after cataract surgery ...

    African Journals Online (AJOL)

    We describe a case of corneal abscess presenting three years after uneventful cataract extraction with posterior chamber lens implantation through a limbal incision secured with threesutures placed in the clear cornea. After removing the abscess, a loose10/0 nylon suture was found at the base of an ulcer. The suture was ...

  20. Suture associated corneal abscess three years after cataract surgery ...

    African Journals Online (AJOL)

    The abscess was carefully removed on slit lamp using blunt tipped forceps without breaking the thin membrane covering it. There was a deep corneal depression at the bottom of which was found a loose 10/0 nylon corneoscleral suture. Another loose suture was present at the 12 o'clock position surrounded by stromal ...


    Directory of Open Access Journals (Sweden)



    Full Text Available OBJECTIVES The objectives of this study were to compare the two techniques, skin staplers and conventional sutures in abdominal skin wound closure with respect to the total cost, operative time required, incidence of wound infection, postoperative pain and cosmetic outcome. MATERIALS AND METHODS The study was conducted on 100 patients undergoing elective surgery for GI malignancies from December 2013 to May 2015 in the Department of General Surgery, Government Medical College, Kozhikode. The patients were randomly assigned to closure by suture or staple. RESULT The study groups included 50 patients who underwent wound closure by staplers and 50 patients who underwent closure by non-absorbable ethilon sutures. The time taken for wound closure was found to be statistically significant, with staplers requiring five times less duration than conventional sutures. The average cost of using stapler was found to be significantly more expensive than suture. There was no significant difference in post-operative pain between the two groups. The incidence of wound infection was more in stapler group than in suture group although statistically non-significant. The cosmetic outcome with stapler closure was found to be significantly superior to that with sutures.

  2. A biomechanical evaluation of all-inside 2-stitch meniscal repair devices with matched inside-out suture repair. (United States)

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


    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.

  3. A randomized trial comparing skin closure in cesarean section: interrupted suture with nylon vs subcuticular suture with No '1' polyfilament. (United States)

    Shrestha, A; Napit, J; Neupane, B; Sedhai, L B


    Cesarean section is one of the most commonly performed operations in most countries of the world including Nepal. Hence there is a load on the financial resources of healthcare system. The rational of this study was to utilize the remaining No '1' polyfilament after closing rectus sheath to stitch skin. So, the primary objective was to determine the wound complication rates for subcuticular suture with No'1' petcryl (polyfilamentpolyglycolic acid) Vs intermittent suture with nylon 2-0 for skin closure at cesarean delivery and secondary objective was to compare postoperative pain and patient satisfaction about the scar. One hundred and thirty eight women undergoing cesarean section at Chitwan Medical College was randomized to either intermittent skin suture with nylon 2-0 or subcuticular with polyfilament No '1' (remaining suture after closing rectus sheath). Evidence of wound infection, pain and overall satisfaction were assessed postoperatively. The overall wound complications rate in subcuticular stitch with No'1' polyfilament suture were similar as in intermittent mattress stitch with nylon 2-0 (15.9% vs. 14.49%). Pain on postoperative third day and six weeks and overall satisfaction about wound were similar in both groups. Only prolong rupture of membrane >18 hours was found to be a significant risk factor of wound infection (OR: 3.4; p=0.04). The remaining no '1' polyfilament suture (petcryl) after suturing rectus sheath can be safely used to close skin suture in cesarean section.

  4. Meso-Tethyan oceanic sutures and their deformation (United States)

    Burtman, V. S.


    On the basis of comparative stratigraphie and paleontologic analysis, supported by some key paleomagnetic data and interpretations, it is shown that during the Mesozoic and the Cenozoic the Eurasian continent grew by accretion of microcontinents. These microcontinents separated basins with oceanic crust from the main ocean. During the Late Cretaceous and the early Cenozoic the collision of the microcontinents with Eurasia resulted in the closure of the basins, and Meso-Tethyan oceanic sutures originated. In the region under consideration, from the Carpathians to Tibet, there are two main Meso-Tethyan sutures: the Carpathian-Lesser Caucasus and the Afghan-Tibet suture. The above-mentioned main structures also had branches, which remained as sutures of small basins: the Kamennopotock, Interpontide, Nain-Baft basins and others. In the West Carpathians the Carpathian-Lesser Caucasus suture is overlain by a widespread Gemeric-Tatric allochton. From the West Carpathians the suture passes through the Pannonian basin into the Vardar ophiolite zone and farther to the ophiolites of the Izmir-Ankara zone. Being displaced along the North Anatolian right-lateral strike-slip fault, the main suture passes from the Eastern Pontides into the Lesser Caucasus, where it is marked by ophiolites of the Amasia area, the Shirak, Bozum and Zangezur ridges. Sunsequently, it can be observed through the Iranian Qara Dagh mountains to Lake Urumiyeh and the North Anatolian strike-slip fault. Being again shifted along the strike-slip fault, the Carpathian-Lesser Caucasus Meso-Tethyan suture ends in the Western Zagros near the Cenozoic Neo-Tethyan suture. The Afghan-Tibet Meso-Tethyan suture is situated in the Pamirs in the Rushan-Pshart zone. The east prolongation of the suture has been displaced along the Pamir-Karakorum right-lateral strike-slip fault in Tibet. West of the Pamirs this suture is also displaced along strike-slip faults and continues in the Farahrud zone in Afghanistan, and than

  5. A Mechanical Evaluation of Zone II Flexor Tendon Repair Using a Knotless Barbed Suture Versus a Traditional Braided Suture. (United States)

    Nayak, Aniruddh N; Nguyen, Dzi-Viet; Brabender, Robert C; Hiro, Matthew E; Miles, Jeremy J; Smithson, Ian R; Santoni, Brandon G; Stone, Jeffery D; Hess, Alfred V


    To determine repair site bulk, gliding resistance, work of flexion, and 1-mm gap formation force in zone II flexor tendon lacerations repaired with knotless barbed or traditional braided suture. Transverse zone II lacerations of the flexor digitorum profundus (FDP) tendon were created in 36 digits from 6 matched human cadaveric pairs. Repair was performed with 2-0 barbed suture (n = 18) or 3-0 polyethylene braided suture (n = 18). Pre- and postrepair cross-sectional area was measured followed by quantification of gliding resistance and work of flexion during cyclic flexion-extension loading at 10 mm/min. Thereafter, the repaired tendons were loaded to failure. The force at 1 mm of gap formation was recorded. Repaired FDP tendon cross-sectional area increased significantly from intact, with no difference noted between suture types. Gliding resistance and work of flexion were significantly higher for both suture repairs; however, we identified no significant differences in either nondestructive biomechanical parameters between repair types. Average 1-mm gap formation force with the knotless barbed suture (52 N) was greater than that of the traditional braided suture (43 N). We identified no significant advantage in using knotless barbed suture for zone II FDP repair in our primary, nondestructive mechanical outcomes in this in vitro study. In vivo studies may be warranted to determine if one suture method has an advantage with respect to the parameters tested at 4, 6, and 12 plus weeks postrepair and the degree of adhesion formation. The combined laboratory and clinical data, in additional to cost considerations, may better define the role of barbed knotless suture for zone II flexor tendon repair. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  6. Complications with mechanical suture use in colorectal surgery

    International Nuclear Information System (INIS)

    Bruno, G.; Ruso, L.; Gatti, A.; Quiros, F.; Balboa, O.


    The great development of mechanical suture and its qualitative impact in colorectal surgery has not been able to avoid persistent mortality due to suture failure which is still about 5% and rectal stenosis, which is significantly higher than with manual sutures.The present paper analyses 63 cases of colorrectal anastomosis performed of coordination with mechanical suture at CASMU, in a period of four years (1991-1995).There were 51 rectum resections and colorrectal anastomosis and 12 reconstruction of intestinal transit.There were 28 females and 35 males with and average age of 66 years.Three patients died (4,7%), 20 (31,7%) suffered various complications among which some are pointed out in relation to mechanical suture to suture failures(3,1%) who died and 8 rectal stenosis(12,9%)with favourable evolution after dilations.The authors analyse the issues that incide on the production of complications in colorrectal surgery and conclude that the incidence of global complications in their series is elevated, although mortality, suture failure and rectal stenosis figures are comparable to those in international literature analysed.The incidence of machine width proximal ostomies and radiotherapy on the development of stenosis in our milieu require a multicentric studie with a greater number of patients

  7. Politetrafluorene suture used as artificial mitral chord: mechanical properties and surgical implications. (United States)

    Caimmi, Philippe P; Sabbatini, Maurizio; Fusaro, Luca; Cannas, Mario


    Novel surgical approach to repair degenerative mitral regurgitation such as transapical chordae tendineae replacement and "loop in loop" in loop techniques, need of artificial chordae longer than that used in the older techniques of chordae tendineae replacement. This difference in length has been reported as potential critical point for durability of artificial chordae. In the present paper we have investigated the elastic behavior of different diameter and length politetrafluorene (PTFE) suture threads as substitute of native chordae, to identify their reliability to use as long artificial chordae. PTFE suture threads with different diameters were investigated in their mechanical properties at different length from 2 to 14 cm, by a servo hydraulic testing machine, to test the elastic properties of the sample in their use as mitral chordae substitutes. Our study shows that the chordae length is an important parameter that can change the performance of chordae itself. The analysis of elastic/properties of suture threads specimen, reveals that long PTFE chords have an optimal mechanical behavior in which elongation is accompanied by a safe elastic properties that make them well resistance during multiple tractions. In conclusion the use of PTFE as an artificial chordae may represent a valid choice in case of insertion of artificial chordae with extra anatomic length.

  8. [Operative treatment of flexor pollicis longus tendon with Krackow suture, functional results--preliminary results]. (United States)

    Bumbasirević, Marko Z; Andjelković, Sladjana; Lesić, Aleksandar R; Sudjić, Vojo S; Palibrk, Tomislav; Tulić, Goran Dz; Radenković, Dejan V; Bajec, Djordje D


    Surgical treatment of the injuried flexor tensons is the important part of hand surgery. Tendon adhesions, ruptures, joint contcatures-stifness are only one part of the problem one is faced during the tendon treatment. In spite of improvement in surgical technique and suture material, the end result of sutured flexor tendons still represent a serious problem. To present of operative treatment of flexor pollicis longus injury with Krakow suture technique. All patients are treated in the first 48 hours after the accident. The regional anesthesia was performed with use of turniquet. Beside spare debridement, the reconstruction of digital nerves was done. All patients started with active and pasive movements-excercises on the first postoperative day. Follow-up was from 6 to 24 months. In evaluation of functional recovery the grip strenght, pinch strenght, range of movements of interphalangeal and metacarpophalangeal joiht and DASH score were used. In the last two years there were 30 patients, 25 males (83.33%) and 5 females (16.66%). Mean age was 39.8 years, ranged from 17 to 65 years. According to mechanism of injury the patients were divided in two groups: one with sharp and other with wider zone of injury. Concomitant digital nerve lesions was noticed in 15 patients (50%). the Krackow sutrue allowed early rehabilitation, which prevent tendon adhesions, enabled faster and better functional recovery.

  9. Effect of suture material on gap formation and failure in type 1 FDP avulsion repairs in a cadaver model. (United States)

    Schreuder, F B; Scougall, P J; Puchert, E; Vizesi, F; Walsh, W R


    An in vitro cyclical testing simulating a passive mobilisation protocol was used to compare repair of flexor digitorum profundus tendon with modified-Bunnell two-strand pullout technique using a monofilament (Prolene), braided polyester (Ethibond) and a synthetic polyfilament ensheathed by caprolactan (Supramid) sutures. Eighteen fresh-frozen cadaveric fingers were randomly divided into three repair groups (n = 6); modified-Bunnell technique with 3/0 Prolene, Ethibond or Supramid. After repair, specimens were cyclically loaded from 2 to 15N at 5N/s, for a total of 500 cycles. Gap formation at the tendon-bone interface was assessed every 100 cycles. Samples were tested to failure at the completion of 500 cycles. All sutures held in all specimens during cyclic testing. The gap formation after 500 cycles was greatest with Prolene suture (6.8 mm, SD 1.2) followed by Supramid suture (4.0 mm, SD 1.1) and Ethibond suture (1.7 mm, SD 1.7) (P failure load (52.7 N, SD 5.5) as compared to Prolene (37.6N, SD 4.7) (P = 0.001) but not compared to Ethibond (44.9 N, SD 7.1). The failure loads between Prolene and Ethibond did not differ (P = 0.130). Gap formation with Ethibond was significantly lower compared to Supramid and Prolene. The four strand nature of the Supramid repair was superior to Prolene but did not differ compared to Ethibond with respect to failure load. Prolene is the least favourable suture when considering gap formation and failure load, while Ethibond is the most favourable.

  10. Anatomic and Biomechanical Comparison of Traditional Bankart Repair With Bone Tunnels and Bankart Repair Utilizing Suture Anchors (United States)

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


    Background: 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. Hypothesis: 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. Study Design: Controlled laboratory study. Methods: 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. Results: Bankart repair with bone tunnels provided significantly more coverage of the native labral footprint than repair with suture anchors (100% vs 27%, P 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 and gap formation were not significantly different. PMID:26779555

  11. Single suture iris-to-capsulorhexis fixation for in-the-bag intraocular lens subluxation. (United States)

    Siegel, Michael J; Condon, Garry P


    We present a simplified modification to a technique for early or mild in-the-bag subluxation that avoids conjunctival and scleral incisions and minimizes intraocular manipulation. While the capsulorhexis edge is grasped with an intraocular forceps to stabilize the IOL-capsular bag complex, a 10-0 polypropylene suture on a long curved needle is used to secure the fibrotic superior capsulorhexis edge to the midperipheral iris at 12 o'clock using a combination of a modified McCannel suture and a Siepser sliding knot. Dr. Condon receives speaker and consultant fees from Alcon Surgical, Inc., Allergan, Inc., and Microsurgical Technology. Although the Microsurgical Technology Condon snare instrument is named after him, Dr. Condon reports no patents, fees, or payments related to it. Dr. Siegel has no financial or proprietary interest in any material or method mentioned. Copyright © 2015. Published by Elsevier Inc.

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

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


    Contaminated suture material plays an important role in the physiopathology of surgical site infections. Recently, suture material has been developed characterized by barbs projecting from a monofilament base. Claimed advantages for barbed sutures are a shortened wound closure time and reduced maximum wound tension. It has also been suggested that these sutures would be advantageous microbiologically. The aim of this study was to test the microbiological characteristics of the barbed Quill in comparison to the monofilament Ethilon II and the braided sutures Vicryl and triclosan-coated Vicryl Plus. In our study, sutures were cultivated on color-change agar with Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecium, Escherichia coli, and Pseudomonas aeruginosa and the halo size was measured. In a second study arm with longer cultivation bacterial growth was followed by antibiotic treatment. Ethilon II and Quill showed good comparable results, whereas large halos were found around Vicryl. Vicryl Plus results depended on triclosan sensitivity. After longer bacterial cultivation and antibiotic treatment, halos were up to 3.6 times smaller on Quill than on Vicryl (p barbs on Quill. From a microbiological perspective, barbed sutures can be recommended in aseptic surgery, but should only be used carefully in septic surgery. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:925-933, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

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

    Directory of Open Access Journals (Sweden)

    Erich K. Odermatt


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

  14. The effectiveness of the double B-lynch suture as a modification in the treatment of intractable postpartum haemorrhage. (United States)

    Şahin, Hanifi; Soylu Karapınar, Oya; Şahin, Eda Adeviye; Dolapçıoğlu, Kenan; Baloğlu, Ali


    A broader range of more effective compression techniques are needed in the patients who have an intractable postpartum haemorrhage due to uterine atony despite medical treatment and B-Lynch sutures. The aim of this study was to report the outcome of a series of patients with haemorrhage who were managed by double B-Lynch suture. Fourteen patients who were treated in a tertiary hospital between July 2010 and February 2015 were included in the study. The intractable haemorrhage rate was 0.35% over 5 years (14/4000 births). Bleeding was controlled in all the patients with a double B-Lynch suture. The mean age of the patients was 24 ± 3.4 years. The mean estimated blood loss was 1696 ± 272.075 mL, and the mean transfusion rate was 4.2 ± 2.5 units. Pregnancy was observed in five patients at follow up. The double B-Lynch suture seems to be an effective and reliable solution to an intractable postpartum haemorrhage resulting from uterine atony and has no unfavourable impacts on fertility. It should be considered before the use of any aggressive surgical techniques such as a hypogastric artery ligation or a hysterectomy. This the first study to investigate the effectiveness of the double B-Lynch suture, and we showed that the hysterectomy and/or hypogastric artery ligation rate can be decreased by adding a second B-Lynch suture in cases where the medical treatment or a single B-Lynch has failed. Impact statement What is already known on the subject? Uterine atony is the most common cause of a primary postpartum haemorrhage. When a simple massage of the uterus and medication failed to manage this condition, various surgical solutions have been sought, including uterine compression sutures, uterine artery ligation, devascularisation of the uterus, internal iliac artery ligation and, ultimately, a hysterectomy. The B-Lynch suturing technique is particularly useful because of its simplicity of application, life-saving potential, relative safety and capacity

  15. Meta-analysis on Materials and Techniques for Laparotomy Closure: The MATCH Review. (United States)

    Henriksen, N A; Deerenberg, E B; Venclauskas, L; Fortelny, R H; Miserez, M; Muysoms, F E


    The aim of this systematic review and meta-analysis was to evaluate closure materials and suture techniques for emergency and elective laparotomies. The primary outcome was incisional hernia after 12 months, and the secondary outcomes were burst abdomen and surgical site infection. A systematic literature search was conducted until September 2017. The quality of the RCTs was evaluated by at least 3 assessors using critical appraisal checklists. Meta-analyses were performed. A total of 23 RCTs were included in the meta-analysis. There was no evidence from RCTs using the same suture technique in both study arms that any suture material (fast-absorbable/slowly absorbable/non-absorbable) is superior in reducing incisional hernias. There is no evidence that continuous suturing is superior in reducing incisional hernias compared to interrupted suturing. When using a slowly absorbable suture for continuous suturing in elective midline closure, the small bites technique results in significantly less incisional hernias than a large bites technique (OR 0.41; 95% CI 0.19, 0.86). There is no high-quality evidence available concerning the best suture material or technique to reduce incisional hernia rate when closing a laparotomy. When using a slowly absorbable suture and a continuous suturing technique with small tissue bites, the incisional hernia rate is significantly reduced compared with a large bites technique.

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

    Directory of Open Access Journals (Sweden)

    Swati R Yedke


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


    Directory of Open Access Journals (Sweden)

    Jafar Nader


    Full Text Available plastic adhesives, normal butyl cyanoacrylate monomer, isobutyl cyanoacrylate monomer and methyl 2 _ cyaooacrylate monomer, have been utilized in a comparative study with 5-{ silk suture in the repair of transected carotid arteries. Follow _ up arteriog ramS indicate isobutyl cyanoacrylate monomer and normal butyl cyanoacrylate monomer as having the most impressive rerults with only tWO thrombosis each. The silk suture had three thromboses and the adhesive methyl 2 _ cyanoacrylate monomer had nine, one of which a delayed

  18. The Efficacy of Polydioxanone Monofilament Absorbable Suture for Tracheal Anastomosis


    Kawahara, Katsunobu; Yamasaki, Naoya; Yamamoto, Satoshi; Nagayasu, Takeshi; Kusano, Hiroyuki; Akamine, Shinji; Takahashi, Takao; Tomita, Masao


    To evaluate the efficacy of polydioxanon absorbable suture for tracheal anastomoses, we performed an experimental study using dose. Eight adult mongrel dogs underwent sleeve resection of the mediastinal trachea. A length of ten to twelve cartilage rings was resected. An end-to-end anastomosis was performed using either interrupted or continuous running 4-0 polydioxanone (PDS) suture. There was no detectable difference bronchoscopically, microangiografically, or histologically, in tracheal ana...

  19. Flexor Tendon Repair With Looped Suture: 1 Versus 2 Knots. (United States)

    Gil, Joseph A; Skjong, Christian; Katarincic, Julia A; Got, Christopher


    To assess the strength of flexor tendon repair with looped suture. We hypothesized that, after passing the intact looped suture in the desired repair configuration, splitting the loop and tying 2 independent knots would increase the strength of flexor tendon repair. Thirty-two flexor tendons were harvested and were sharply transected in zone II. The tendons were repaired with a 4-strand core suture repair using 3-0 looped nonabsorbable nylon suture. The harvested tendons were randomly assigned and repaired with either a 1- or a 2-knot construct. The repaired flexor tendons were fixed in a servohydraulic material testing system and were loaded to failure either with uniaxial tension or cyclically. The average force at failure was 43 N for the 1-knot repair and 28 N for the 2-knot repair. The mode of failure of 15 of the flexor tendon repairs that were cyclically loaded to failure was suture pull-out. The average number of cycles and force in cyclic testing that caused failure of flexor tendon repairs was 134 cycles and 31 N for tendons repaired with looped 3-0 suture tied with 1 knot and 94 cycles and 33 N for tendons repaired with looped 3-0 suture tied with 2 knots. Our hypothesis was disproved by the results of this study. This study suggests that, when using looped suture, tying 2 independent knots instead of tying a single knot does not increase the strength of the flexor tendon repair. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  20. Aneurysm jig for anastomosis technique. (United States)

    Greenhalgh, R. M.; Eastcott, H. H.; Mansfield, A. O.; Taylor, D. E.


    A new jig is described which enables the technique for abdominal aortic aneurysm to be taught and practiced as it is performed by arterial surgeons at the present time. The aneurysm jig enables a plastic simulated aortic aneurysm to be opened as at operation to allow the inlaying of a Dacron tube sutured into place with continuous sutures. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 PMID:3674680

  1. [A pancreas suture-less type II binding pancreaticogastrostomy]. (United States)

    Peng, Shu-you; Hong, De-fei; Liu, Ying-bin; Li, Jiang-tao; Tao, Feng; Tan, Zhi-jian


    To explore the feasibility and safety of type II binding pancreaticogastrostomy (BPG) in pancreaticoduodenectomy and mid-segmentectomy of pancreas. From November 2008 to May 2009, 26 patients underwent pancreaticoduodenectomy and mid-segmentectomy of pancreas with type II BPG reconstruction, including 13 cases of pancreatic head cancer, 3 cases of duodenal adenocarcinoma, 2 cases of ampullary carcinoma, 4 cases of cholangiocarcinoma, 1 case of bile duct cell severe atypical hyperplasia, and 1 case of stomach cancer. The process of type II BPG was described as the following: after pancreas remnant was mobilized for 2-3 cm, a piece of sero-muscular layer at the posterior gastric wall was excised and then a sero-muscular depth purse-suturing with 3-0 prolene was pre-placed (outer purse-string). Incising anterior gastric wall or opening part of the closed distal gastric stump, the mucosa layer at the sero-muscular defect was incised and then purse-suture at the mucosal tube was pre-placed (inner purse-string). Through the two pre-placed purse-strings, the pancreas remnant was pulled into the gastric lumen and then posterior gastric wall was pushed backward to keep it closely in contact with the retro-peritoneal wall. Thereafter, the outer purse-string was tied (outer binding) and then the inner purse-string was tied (inner binding). All cases underwent BPG of type II. The operative time ranged from 3 to 5.5 hours. The postoperative hospital stay ranged from 6 to 48 days. Postoperative complications included 1 case of ascites, 2 cases of delayed gastric emptying and 1 case of intra-abdominal bleeding. All cases with complications were cured after nonsurgical treatment. No mortality or pancreatic leakage occurred. Pancreaticogastrostomy is good for accommodating a large pancreas stump. Binding technique is very helpful in minimizing the leak rate of pancreaticogastrostomy. While type I BPG is safe and easy to perform, type II is even safer and easier to be done.

  2. Fixation in laparoscopic incisional hernia repair: Suture versus tacks

    Directory of Open Access Journals (Sweden)

    Adil Bangash


    Full Text Available Aims and Objectives: To compare the frequency of complications of laparoscopic repair of incisional hernia using fixation of mesh with transabdominal sutures tacks. Materials and Methods: This study was conducted as part of an interventional multicenter trial at the Rehman Medical Institute, Peshawar, Peshawar Institute of Medical Sciences, and Pakistan Institute of Medical Science, Islamabad, from the 1 st of November 2008 till 31 st October 2011. The frequency of complications was calculated as the measure of comparing two methods of fixation in laparoscopic repair of incisional hernia using the IPOM technique. These patients were admitted via the outpatient department and their demographic data were collected on a pro forma basis. Forty-five patients were alternately placed in either group, and group I comprised patients with a ventral hernia that was fixed using spiral tacks whereas the other group was fixed with transabdominal sutures. A polytetraflouroethylene (Dual R mesh was applied in all cases. All data were collected onthe individual pro forma of each patient and was loaded on the SPSS R version 13.0. Results: The BMI in both groups was similar (P=0.94 The mean hospital stay was higher in the PTFE mesh group but the values were not significant (P=1.22.No perioperative death was observed in either group. One patient (2.2% from group I was readmitted with varying complaints and was diagnosed as having subacute intestinal obstruction (P>0.05. A higher but insignificant recurrence rate was observed in the polyester group over a one-year period of follow-up. Three patients (6.6% were diagnosed with recurrences in group I. Instead the PTFE group had a similar recurrence rate recurrence (P=1.00. Conclusion: The rate of recurrence in this study showed no significant difference by either mode of fixation. But statistically significant pain scores and increased operative time to fixation favors the use of tacks that limits to the few inner

  3. [Value of laparoscopic virtual reality simulator in laparoscopic suture ability training of catechumen]. (United States)

    Cai, Jian-liang; Zhang, Yi; Sun, Guo-feng; Li, Ning-chen; Zhang, Xiang-hua; Na, Yan-qun


    To investigate the value of laparoscopic virtual reality simulator in laparoscopic suture ability training of catechumen. After finishing the virtual reality training of basic laparoscopic skills, 26 catechumen were divided randomly into 2 groups, one group undertook advanced laparoscopic skill (suture technique) training with laparoscopic virtual reality simulator (virtual group), another used laparoscopic box trainer (box group). Using our homemade simulations, before grouping and after training, every trainee performed nephropyeloureterostomy under laparoscopy, the running time, anastomosis quality and proficiency were recorded and assessed. For virtual group, the running time, anastomosis quality and proficiency scores before grouping were (98 ± 11) minutes, 3.20 ± 0.41, 3.47 ± 0.64, respectively, after training were (53 ± 8) minutes, 6.87 ± 0.74, 6.33 ± 0.82, respectively, all the differences were statistically significant (all P training were (52 ± 9) minutes, 6.08 ± 0.90, 6.33 ± 0.78, respectively, all the differences also were statistically significant (all P training, the running time and proficiency scores of virtual group were similar to box group (all P > 0.05), however, anstomosis quality scores in virtual group were higher than in box group (P = 0.02). The laparoscopic virtual reality simulator is better than traditional box trainer in advanced laparoscopic suture ability training of catechumen.

  4. Effect of Suturation Plus Surgicel Application on Post-Tonsillectomy Bleeding and Pain. (United States)

    Cetiner, Hasan; Cavusoglu, Ilker; Duzer, Sertac; Sakallioglu, Oner; Susaman, Nihat; Yildirim, Yavuz Sultan Selim


    The aim of this study was to evaluate the effect of suturation (tonsillary fossa closure) plus Surgicel application on postoperative bleeding and pain after tonsillectomies performed using a classical dissection method. A prospective, randomized, double-blind, clinical trial was performed on 760 patients undergoing tonsillectomy or adenotonsillectomy during a 5-year period. After excluding patients with hemorrhagic disorder, chronic disease, and peritonsillar abscess, both tonsils were removed via classic dissection technique (cold knife or blunt dissection) and then electrocauterized for hemostasis. The tonsillar fossa randomly assigned to the treatment protocol (Group 1) was closed by sutures, following Surgicel application. The other side was unaltered and acted as the control (Group 2). Pain was evaluated every day for 10 days postoperatively, and bleeding was reported at any time. A total of 760 patients (393 males, 367 females) between the ages of 4 and 35 years (mean age 13.46 ± 7.98) were included in the study. Bleeding was observed in 31 patients: 8 from Group 1; and 23 from Group 2 (95% confidence interval [CI], P < 0.05). The average pain score was greater in Group 1 than in Group 2 on each postoperative day (95% CI, P < 0.05). Suturation plus Surgicel application increased pain levels while decreasing bleeding incidence during the postoperative period.

  5. [Treatment of congenital ptosis by frontalis suspension with monofilament polypropylene suture: results of a study of 21 cases]. (United States)

    Bouazza, M; Elbelhadji, M; Mchachi, A; Benhmidoune, L; Amraoui, A


    Frontalis suspension of the upper eyelid using suture in the treatment of congenital ptosis has long been considered a temporary solution when there is a risk of amblyopia. It helps to clear the visual axis pending further surgery after the age of 4 years. Polypropylene suture (Prolene(®)), which is an inert material with optimum scarring properties and tensile strength and good knot stability, has shown very encouraging functional and aesthetic results and low recurrence rates. Retrospective descriptive study of a series of 21 patients, between January 2008 and December 2012, with severe congenital ptosis and poor or no function of the levator muscle of the upper eyelid. In our series, the recurrence rate of ptosis was 14.3% with a mean follow-up of 25.9 ± 10.8 months. We found 3 cases of under-correction, and one case of granulomatous inflammation with infection. The use of polypropylene suture seems to be a very good alternative to conventional materials for suspension, such as fascia lata, temporalis fascia and polytetrafluoroethylene (PTFE or Goretex(®)). The advantages of this technique are the ease of removal, low cost and lower associated morbidity. Eyelid suspension with polypropylene suture is an easy, rapid, reversible and inexpensive technique. The results in the short and medium terms are very encouraging, and we need longer follow-up to evaluate the long-term results. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

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

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    Arsalan Salamat, MD


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

  7. Why make monofilament sutures out of polyvinylidene fluoride? (United States)

    Urban, E; King, M W; Guidoin, R; Laroche, G; Marois, Y; Martin, L; Cardou, A; Douville, Y


    In recent years some clinical reports have associated suture failures with polypropylene monofilaments. Therefore there is interest in developing an alternative suture material that is less thrombogenic than polyester and similar in handling characteristics but less prone to mechanical failure than polypropylene. To this end, Peters Laboratoire Pharmaceutique has developed a new monofilament suture material from polyvinylidene fluoride (PVDF), which has been subjected to a special treatment to modify its crystalline form and level of crystallinity. The purpose of this study was to evaluate its mechanical, chemical, and biologic properties and to compare its performance, in a peripheral vascular application, to that of a polypropylene control. A series of in vitro tests were performed to study the morphology, tensile properties, creep, surface chemistry, thermal characteristics, and resistance to iatrogenic trauma. In addition, an in vivo trial was undertaken in which vascular prostheses anastomosed with either PVDF or polypropylene sutures were implanted as a thoracoabdominal bypass for 6 months in the dog. Histologic and degradation analyses were performed on the explants. The results from the mechanical tests on 4-0, 5-0, and 6-0 PVDF and polypropylene sutures demonstrated that although both materials have similar breaking strengths, the PVDF has a higher extension at break, has less delayed extension when under tensile creep testing, and suffers less trauma than the polypropylene when compressed by a standard needle holder. While chemical analyses found evidence of surface oxidation on both types of sutures, thermal analysis confirmed that the level of crystallinity of the PVDF polymer is higher than that of the polypropylene control. During the pilot study in animals, PVDF sutures were found to have good handling and frictional characteristics that facilitated the tying of knots. Histologic analysis of the explants found no inflammatory cells in the tissue

  8. Arthroscopic Trapeziectomy With Suture Button Suspensionplasty (United States)

    Landes, Genevieve; Gaspar, Michael P.; Goljan, Peter; Jacoby, Sidney M.; Bachoura, Abdo; Culp, Randall W.


    Background: Arthroscopic trapeziectomy with suture button suspensionplasty (ATBS) is a relatively new surgical option for the treatment of thumb carpometacarpal (CMC) osteoarthritis. Although ATBS has many potential benefits over alternative surgical treatments for CMC arthritis, little data exist regarding its safety and complication rates. The purpose of this study was to demonstrate that ATBS is associated with a low risk of complications within 1 year of surgery. Methods: A retrospective review of patients treated with ATBS by one senior hand surgeon over a span of 3 years was performed. Results: A total of 153 cases of ATBS were performed in 136 patients. Ninety-seven cases involved arthroscopic hemitrapeziectomies, and 56 involved arthroscopic complete trapeziectomies. There were 44 males and 92 females with a mean age of 62. Thirty-eight percent of the cases were graded as Eaton stage IV, 46% stage III, and 14% stage II CMC arthritis, while 3 cases (2%) were performed as revisions. Mean follow-up duration was 58 weeks. Mean preoperative key pinch strength of the affected versus the unaffected side was 92% compared with 95% postoperatively. Revision surgery was performed in 9 out of 153 cases (<6%). Of those 9 cases, 5 had additional minor bony debridement with subsequent improvement in pain, 3 had the implant repositioned due to button prominence, and 1 patient presented with osteomyelitis of the first and second metacarpals that was successfully treated with button removal and an antibiotic regimen. Conclusions: ATBS is a safe, minimally invasive procedure for treatment of symptomatic stages II through IV thumb CMC arthritis. PMID:27390569

  9. [Treatment of calcaneal avulsion fractures with twinfix suture anchors fixation]. (United States)

    Zhao, Bin-xiu; Wang, Kun-zheng; Wang, Chun-sheng; Xie, Yue; Dai, Zhi-tang; Liu, Gang; Liu, Wei-dong


    For the calcaneal avulsion fracture, the current method is more commonly used screws or Kirschner wire to fix fracture fragment. This article intended to explore the feasibility and clinical efficacy for the treatment of avulsion fractures with TwinFix suture anchors. From July 2007 to November 2010, 21 patients were reviewed, including 15 males and 6 females, ranging in age from 49 to 65 years,with a mean of 58.7 years. Twelve patients had nodules in the right heel and 9 patients had nodules in the left heel. All the patients had closed fractures. The typical preoperative symptoms of the patients included pain in the upper heel and weak in heel lift. Body examination results: palpable sense of bone rubbing in the back of the heel, and swelling in the heel. Surgery treatment with TwinFix suture anchors performed as follows : to fix TwinFix suture anchors into the calcaneal body, then to drill the fracture block, to make the double strand suture through the fracture holes, to knot the suture eachother to fix the block, and to use stitch to fix the remaining suture in the Achilles tendon in order to improve the block fixation. The criteria of the AOFAS Foot and Ankle Surgery by the United States Association of ankle-rear foot functional recovery was used to evaluate the Achilles tendon. Total average score was (95.5 +/- 3.12) points, including pain items of(38.5 +/- 2.18) points,the average score of functional items of (49.5 +/- 3.09) points,and power lines of 10 points in all patients. Twenty-one patients got an excellent result, 16 good and 5 poor. The methods of treatment for the calcaneal avulsion fractures with TwinFix suture anchors is a simple operation, and have excellent clinical effect, which is worthy of promotion.

  10. Positioning of the cross-stitch on the modified Kessler core tendon suture. (United States)

    Gil-Santos, L; Monleón-Pradas, M; Gomar-Sancho, F; Más-Estellés, J


    Cryopreserved human tendons were sutured with different variations of a modified Kessler-type grasping suture in a series of different designs in order to assess the influence of the distance between the cross-stitch on the core suture (5 and 10 mm from the cut tendon edge) on the peripheral suture. An original mathematical model was employed to explain the mechanical behavior (strength, deformation, and distribution of load) of the different suture designs. The effect of the peripheral epitendinous suture, combined with the distance of the core suture, was evaluated. The variation of core suture distance had no relevant consequences on the overall resilience of the design. However, increasing the distance between the cross-stitches of the core suture reduces the deformation that is absorbed not only by the core suture itself but also by the peripheral suture. Adding a peripheral epitendinous suture to a 10-mm design almost doubles the breaking load in absolute values. The mathematical model predicts that the peripheral suture will support a greater load when the distance of the core suture cross-stitches is increased. The evidence level is II. Copyright © 2018 Elsevier Ltd. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Fırat SELVİ


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

  12. A generalized mechanical model for suture interfaces of arbitrary geometry (United States)

    Li, Yaning; Ortiz, Christine; Boyce, Mary C.


    Suture interfaces with a triangular wave form commonly found in nature have recently been shown to exhibit exceptional mechanical behavior, where geometric parameters such as amplitude, frequency, and hierarchy can be used to nonlinearly tailor and amplify mechanical properties. In this study, using the principle of complementary virtual work, we formulate a generalized, composite mechanical model for arbitrarily-shaped interdigitating suture interfaces in order to more broadly investigate the influence of wave-form geometry on load transmission, deformation mechanisms, anisotropy, and stiffness, strength, and toughness of the suture interface for tensile and shear loading conditions. The application of this suture interface model is exemplified for the case of the general trapezoidal wave-form. Expressions for the in-plane stiffness, strength and fracture toughness and failure mechanisms are derived as nonlinear functions of shape factor β (which characterizes the general trapezoidal shape as triangular, trapezoidal, rectangular or anti-trapezoidal), the wavelength/amplitude ratio, the interface width/wavelength ratio, and the stiffness and strength ratios of the skeletal/interfacial phases. These results provide guidelines for choosing and tailoring interface geometry to optimize the mechanical performance in resisting different loads. The presented model provides insights into the relation between the mechanical function and the morphological diversity of suture interface geometries observed in natural systems.

  13. Mechanical Behavior of Bio-inspired Model Suture Joints (United States)

    Li, Yaning; Lin, Erica; Ortiz, Christine; Boyce, Mary


    Suture joints of varying degrees of geometric complexity are prevalent throughout nature as a means of joining structural elements while providing locally tailored mechanical performance. Here, micromechanical models of general trapezoidal waveforms of varying hierarchy are formulated to reveal the role of geometric complexity in governing stiffness, strength, toughness and corresponding deformation and failure mechanisms. Physical constructs of model composite suture systems are fabricated via multi-material 3D printing (Object Connex500). Tensile tests are conducted on samples covering a range in geometry, thus providing quantitative measures of stiffness, strength, and failure. The experiments include direct visualization of the deformation and failure mechanisms and their progression, as well as their dependence on suture geometry, showing the interplay between shear and tension/compression of the interfacial layers and tension of the skeletal teeth and the transition in failure modes with geometry. The results provide quantitative guidelines for the design and tailoring of suture geometry to achieve the desired mechanical properties and also facilitate understanding of suture growth and fusion, and evolutionary phenotype.

  14. Transcatheter pledget-assisted suture tricuspid annuloplasty (PASTA) to create a double-orifice valve. (United States)

    Khan, Jaffar M; Rogers, Toby; Schenke, William H; Greenbaum, Adam B; Babaliaros, Vasilis C; Paone, Gaetano; Ramasawmy, Rajiv; Chen, Marcus Y; Herzka, Daniel A; Lederman, Robert J


    Pledget-assisted suture tricuspid valve annuloplasty (PASTA) is a novel technique using marketed equipment to deliver percutaneous trans-annular sutures to create a double-orifice tricuspid valve. Tricuspid regurgitation is a malignant disease with high surgical mortality and no commercially available transcatheter solution in the US. Two iterations of PASTA were tested using trans-apical or trans-jugular access in swine. Catheters directed paired coronary guidewires to septal and lateral targets on the tricuspid annulus under fluoroscopic and echocardiographic guidance. Guidewires were electrified to traverse the annular targets and exchanged for pledgeted sutures. The sutures were drawn together and knotted, apposing septal and lateral targets, creating a double orifice tricuspid valve. Twenty-two pigs underwent PASTA. Annular and chamber dimensions were reduced (annular area, 10.1 ± 0.8 cm 2 to 3.8 ± 1.5 cm 2 (naïve) and 13.1 ± 1.5 cm 2 to 6.2 ± 1.0 cm 2 (diseased); septal-lateral diameter, 3.9 ± 0.3 mm to 1.4 ± 0.6 mm (naïve) and 4.4 ± 0.4 mm to 1.7 ± 1.0 mm (diseased); and right ventricular end-diastolic volume, 94 ± 13 ml to 85 ± 14 ml (naïve) and 157 ± 25 ml to 143 ± 20 ml (diseased)). MRI derived tricuspid regurgitation fraction fell from 32 ± 12% to 4 ± 5%. Results were sustained at 30 days. Pledget pull-through force was five-fold higher (40.6 ± 11.7N vs 8.0 ± 2.6N, P tricuspid regurgitation in pigs. It may be cautiously applied to selected patients with severe tricuspid regurgitation and no options. This is the first transcatheter procedure, to our knowledge, to deliver standard pledgeted sutures to repair cardiac pathology. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

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


    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.

  16. Hand movements in laparoscopic suturing: a simple vector analysis. (United States)

    Hansen, A J; Schlinkert, R T


    Laparoscopic suturing is a complex task that is vital to the performance of many advanced laparoscopic procedures. Mastery can be difficult and problematic for surgical trainees. We present a description of hand movements in laparoscopic suturing. Complex maneuvers are simplified into linear motions using vectors. The analysis is intended to be a tool for training in the art of laparoscopic surgery. Linear hand movements in the x and y axes produce opposite motions at the instrument tip. Position along the z axis influences the extent of hand movement relative to the instrument tip. Rotational movements of the hand produce an equal rotation of the instrument tip. Revolution is a complex motion that combines movements in x and y axes. Vector analysis reveals that the arc of revolution must be reversed to produce the desired needle motion. A conceptual understanding of hand-movement vectors facilitates the efficient mastery of the complex skills required for laparoscopic suturing.

  17. Virtual interactive suturing for the Fundamentals of Laparoscopic Surgery (FLS). (United States)

    Qi, Di; Panneerselvam, Karthikeyan; Ahn, Woojin; Arikatla, Venkata; Enquobahrie, Andinet; De, Suvranu


    Suturing with intracorporeal knot-tying is one of the five tasks of the Fundamentals of Laparoscopic Surgery (FLS), which is a pre-requisite for board certification in general surgery. This task involves placing a short suture through two marks in a penrose drain and then tying a double-throw knot followed by two single-throw knots using two needle graspers operated by both hands. A virtual basic laparoscopic skill trainer (VBLaST©) is being developed to represent the virtual versions of the FLS tasks, including automated, real time performance measurement and feedback. In this paper, we present the development of a VBLaST suturing simulator (VBLaST-SS©). Developing such a simulator involves solving multiple challenges associated with fast collision detection, response and force feedback. In this paper, we present a novel projection-intersection based knot detection method, which can identify the validity of different types of knots at haptic update rates. A simple and robust edge-edge based collision detection algorithm is introduced to support interactive knot tying and needle insertion operations. A bimanual hardware interface integrates actual surgical instruments with haptic devices enabling not only interactive rendering of force feedback but also realistic sensation of needle grasping, which realizes an immersive surgical suturing environment. Experiments on performing the FLS intracorporeal suturing task show that the simulator is able to run on a standard personal computer at interactive rates. VBLaST-SS© is a computer-based interactive virtual simulation system for FLS intracorporeal knot-tying suturing task that can provide real-time objective assessment for the user's performance. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Triclosan sutures for surgical site infection in colorectal cancer. (United States)

    Yamashita, Kanefumi; Takeno, Shinsuke; Hoshino, Seiichiro; Shiwaku, Hironari; Aisu, Naoya; Yoshida, Yoichiro; Tanimura, Syu; Yamashita, Yuichi


    Among all procedures, surgical site infections (SSIs) in colorectal surgery continue to have the highest rate, accounting for 5%-45%. To prevent the bacterial colonization of suture material, which disables local mechanisms of wound decontamination, triclosan-coated sutures were developed. We assessed the effectiveness of triclosan-coated sutures used for skin closure on the rate of SSIs in colorectal cancer surgery. Until August 2012, we used conventional methods for skin closure in colorectal cancer surgery at the Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine. Therefore, for the control group, we retrospectively collected surveillance data over a 1.5-y period. From September 2012, we began using triclosan-coated polydioxanone antimicrobial sutures (PDS plus) for skin and fascia closure. Hence, we collected data for the study group from September 2012 to October 2013. Differences in baseline characteristics and selection bias were adjusted using the propensity score-matching method. A total of 399 patients who underwent colorectal surgery were included in this study. There were 214 patients in the control group and 185 patients in the study group. Baseline patient characteristics were similar between the propensity score-matched groups. The incidence of SSIs was less in the study group. Multivariate logistic regression analysis showed that the site of the procedure, laparoscopic surgery, and using triclosan-coated sutures remained the independent predictors of SSIs. The use of triclosan-coated sutures was advantageous for decreasing the risk of SSIs after colorectal surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Force Comparison of Commercially Available Transfascial Suture Passers. (United States)

    Shope, Alexander J; Winder, Joshua S; Bliggenstorfer, Jonathan T; Crowell, Kristen T; Haluck, Randy S; Pauli, Eric M


    Transfascial suture passers (TSPs) are a commonly used surgical tool available in a wide array of tip configurations. We assessed the insertion force of various TSPs in an ex vivo porcine model. Uniform sections of porcine abdominal wall were secured to a 3D-printed platform. Nine TSPs were passed through the abdominal wall both without and with prolene suture under the following scenarios: abdominal wall only and abdominal wall plus underlay ePTFE or composite ePTFE/polypropylene mesh. Insertion forces were recorded in Newton (N). When passed without suture through the abdominal wall, smaller diameter TSPs required less insertional force (1.50 ± 0.17 N vs 9.68 ± 1.50 N [ P = 0.00072]). Through composite mesh, the solid tipped TSPs required less force than hollow tipped ones (3.87 ± 0.25 N vs 7.88 ± 0.20 N [ P = 0.00026]). Overall, smaller diameter TSPs required less force than the larger TSPs when passed through ePTFE empty (Gore 2.95 ± 0.83 N vs Carter-Thomason 16.07 ± 2.10 N [ P = .0005]) or with suture (Gore 8.37 ± 2.59 N vs Carter-Thomason 19.12 ± 1.10 N [ P = .003]). Diameter plays the greatest role in the force required for TSP penetration. However, when passed through underlay mesh or while holding suture, distal tip shape, the mechanism of suture holding, and shaft diameter all contribute to the forces necessary for penetration. These factors should be considered when choosing a TSP for intraoperative use.

  20. 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:; Quek, Lawrence Hwee Han, E-mail: [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore); Tan, Glenn Leong Wei, E-mail: [Tan Tock Seng Hospital, Department of General Surgery (Singapore); Pua, Uei, E-mail: [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore)


    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.

  1. Effect of robotic manipulation on unidirectional barbed suture integrity: evaluation of tensile strength and sliding force. (United States)

    Kaushik, Dharam; Clay, Kevin; Hossain, S G M; Park, Eugene; Nelson, Carl A; LaGrange, Chad A


    One of the more challenging portions of robot-assisted radical prostatectomy (RARP) is the urethrovesical anastomosis. Because of this, a unidirectional absorbable barbed suture (V-Loc(™)) has been used to complete the anastomosis with better efficiency and less tension. The effect of robotic needle driver manipulation on barbed suture is unknown. Therefore, the aim of this study is to determine whether robotic manipulation decreases the tensile strength and peak sliding force of V-Loc barbed suture. Fifty-six V-Loc sutures were compared with 56 Maxon sutures. All sutures were 3-0 caliber. Half of the sutures in each group were manipulated with a da Vinci(®) robot large needle driver five times over a 5 cm length of suture. The other half was not manipulated. Breaking force was determined by placing sutures in a Bose ElectroForce load testing device. For sliding force testing, 28 V-Loc sutures were manipulated in the same fashion and compared with 28 nonmanipulated V-Loc sutures. Peak force needed to make the suture slip backward in porcine small intestine was determined to be the sliding force. Scanning electron microscopy of the barbs before and after robotic manipulation was also performed. The mean difference in breaking forces for manipulated vs nonmanipulated Maxon sutures was 4.52 N (P=0.004). The mean difference in breaking forces for manipulated vs nonmanipulated V-Loc sutures was 1.30 N (P=0.046). The manipulated V-Loc group demonstrated a lower peak sliding force compared with the nonmanipulated group (0.76 vs 0.88 N, P=0.199). Electron microscopy revealed minor structural damage to the barbs and suture. Tensile strength and peak sliding force of V-Loc suture is decreased by robotic manipulation. This is likely because of structural damage to the suture and barbs. This structural damage, however, is likely not clinically significant.

  2. The Stress Relaxation Process in Sutures Tied with a Surgeon's Knot in a Simulated Biological Environment. (United States)

    Liber-Kneć, Aneta; Łagan, Sylwia


    The exact characteristics of sutures are not only the basis for selecting from among different types of suture, but also provide the necessary information for the design of new surgical sutures. Apart from information relating to the breaking load of a suture reported in pharmacopoeias, the viscoelastic properties of sutures can be an additional selection criterium - one that influences stitching quality, especially when there is a risk of wound dehiscence. The aim of the study was to assess the stress relaxation process for 3 polymeric sutures in an environment simulating the conditions in a living organism and (for comparison) in room conditions. Stress relaxation testing was carried out on 3 polymeric sutures: polypropylene (PP), polydioxanone (PDS) and polyglycolic acid (PGA). To identify the mechanical properties of the sutures, uniaxial tensile tests were conducted according to the Polish Pharmacopoeia. The relaxation test was carried out in room conditions and in the bath simulating a biological environment. The sutures being tested were tied with a surgeon's knot. The PP suture exhibited the greatest stress relaxation (18% of the initial stress in room conditions and 21% of the initial stress in the bath). The PGA suture exhibited the least stress relaxation (approximately 60% of the initial stress in room conditions and 59% of the initial stress in the bath). The PDS suture was tested at a lower strain level and showed stress relaxation similar to the PGA suture (approximately 63% of the initial stress in room conditions and 55% in the bath). Multifilament braided absorbable (PGA) sutures and monofilament absorbable (PDS) sutures had a higher stress relaxation ratio over time than monofilament non-absorbable (PP) sutures. These findings may indicate higher stress maintained over time in PDS and PGA sutures, and thus higher tension at wound edges, sufficient to resist wound dehiscence.

  3. Techniques and materials for skin closure in caesarean section

    DEFF Research Database (Denmark)

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


    Caesarean section is a common operation with no agreed upon standard regarding certain operative techniques or materials to use. With regard to skin closure, the skin incision can be re-approximated by a subcuticular suture immediately below the skin layer, by an interrupted suture, or by staples...

  4. Synchrotron-microcomputed tomography studies of normal and pathological cranial sutures: further insight. (United States)

    Regelsberger, Jan; Schmidt, Tobias; Busse, Björn; Herzen, Julia; Tsokos, Michael; Amling, Michael; Beckmann, Felix


    Both CT and high-frequency ultrasound have been shown to be reliable diagnostic tools used to differentiate normal cranial sutures from suture synostosis. In nonsynostotic plagiocephaly, overlapping of the bony plates and the so-called "sticky suture" is still controversial and is believed to represent a pathological fusion process. Synchrotron-microcomputed tomography (SRmCT) studies were undertaken to determine whether positional head deformities can be assumed to be true suture pathologies. Morphological features and growth development of 6 normal cranial sutures between the ages of 3 and 12 months were analyzed histologically. Additionally 6 pathological sutures, including sagittal synostosis and nonsynostotic plagiocephaly (NSP), were compared with the group of normal sutures by histological and SRmCT studies. Synchrotron-microcomputed tomography is a special synchrotron radiation source with a high photon flux providing a monochromatic x-ray beam with a very high spatial resolution. Morphological characteristics of the different suture types were evaluated and bone density alongside the sutures was measured to compare the osseous structure of the adjacent bony plates of normal and pathological sutures. Histologically jointlike osseous edges of the normal sutures were seen in the 1st month of life and interlocking at the age of approximately 12 months. During this 1st year, bone thickness increases and suture width decreases. The SRmCT studies showed that: 1) sutures and adjacent bones in NSP are comparable to normal sutures in terms of their morphological aspects; 2) bone densities in the adjacent bony plates of NSP and normal sutures are not different; 3) thickening of the diploe with ridging of the bone in sagittal synostosis is associated with significantly higher bone density; 4) synostotic sutures are only partially fused but vary in their extent; and 5) nonfused sections in sagittal synostosis behave like normal sutures without any signs of pathological

  5. Coaptive film versus subcuticular suture: comparing skin closure time after posterior spinal instrumented fusion in pediatric patients with spinal deformity. (United States)

    Grottkau, Brian E; Rebello, Gleeson; Merlin, Gabriel; Winograd, Jonathan M


    A prospective, randomized trial comparing skin closure time between coaptive film and subcuticular Monocryl sutures in children undergoing posterior instrumented spinal fusion. To prospectively compare skin closure time, complication rate and cosmetic result between coaptive film and subcuticular Monocryl wound closures in pediatric spine surgery. Posterior instrumented spinal fusions for spinal deformity in children are time-consuming ventures that are demanding on both the patient and physician. Minimizing the time for skin closure at the end of prolonged surgery diminishes the physical burden on the surgeon, the operating room personnel, and reduces operating room costs. Twenty-five children (mean age, 14.1 year) underwent posterior instrumented spinal fusion. Twenty-five incisions in 25 patients (12 closed with 3-0 subcuticular Monocryl sutures, 13 closed with coaptive film [Steri Strip S; 3 M company]) were evaluated. The method of skin closure was randomized before beginning the procedure and the surgeon informed just before skin closure. Closure time was recorded. A blinded plastic surgeon using a visual analogue scale assessed the cosmetic results at a minimum 3-month follow-up. Incisions closed with coaptive film required less time to complete than incisions closed with subcuticular suture. The mean time for skin closure using coaptive film was 290.62 seconds compared to the mean time of 674.75 seconds using Monocryl sutures (P < 0.000001). The average length of incisions closed with coaptive film was similar to the corresponding incisions that were closed with subcuticular Monocryl sutures (30.8 and 34.0 cm, respectively, P = 0.22). There was no significant difference in the cosmetic results or the number of wound complications using either technique. Coaptive film is a time-saving option for skin closure following pediatric spine surgery with comparable cosmetic results and no difference in complication rates.

  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


    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. Achondroplasia with multiple-suture craniosynostosis: a report of a new case of this rare association

    NARCIS (Netherlands)

    Bessenyei, Beáta; Nagy, Andrea; Balogh, Erzsébet; Novák, László; Bognár, László; Knegt, Alida C.; Oláh, Eva


    We report on a female patient with an exceedingly rare combination of achondroplasia and multiple-suture craniosynostosis. Besides the specific features of achondroplasia, synostosis of the metopic, coronal, lambdoid, and squamosal sutures was found. Series of neurosurgical interventions were

  8. [Subluxation of scleral-fixated PC IOL caused by polypropylene suture degradation--case report]. (United States)

    Kanigowska, Krystyna; Grałek, Mirosława; Czarnowska, Elzbieta; Zajaczkowska, Agnieszka


    The purpose of the study is to evaluate factors related to late-onset of lens subluxation in transscleral sutured posterior chamber IOL. We report a child, which required surgical treatment for dislocation of a scleral-sutured PC IOL. 11 years earlier the secondary lens implantation with scleral fixation was performed in 4 years old boy. The first surgical procedure included an anterior victrectomy and suturing a single- piece PMMA IOL under the scleral flaps with a 10-0 polipropylene suture. The second--included explantation of the dislocated lens. Optic and scanning electron microscopy was used to analyze the surface of the explanted remnants of the breakage suture. Microscopic findings indicate that the late suture breakage and subluxation of suture-fixated PC IOL was due to the degradation of polypropylene suture.

  9. Arthroscopic suture fixation in patients with a tibial intercondylar eminence fracture using a simple device to penetrate the anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Masato Aratake


    Full Text Available Displaced tibial intercondylar eminence fractures require early reduction and stable fixation to prevent nonunion, knee instability, and a lack of extension. Many types of surgical procedure are recommended including arthrotomy or an arthroscopic technique to stabilize the fracture segment using Kirschner wire, screws, staples, and suture fixation. However, contemporary arthroscopic techniques and devices can facilitate intra-articular surgery and have been applied to the treatment of this fracture. In our current report, we describe a simple suture fixation method under arthroscopy for the treatment of tibial intercondylar eminence fractures. We treated eight knees of eight patients. One patient had a Type II fracture and seven patients had a Type III fracture according to Meyer's classification. Following the arthroscopic inspection of concomitant injuries, debridement of hematoma, and reduction of the fragment, two nonabsorbable sutures (Ethibond No. 2, Johnson & Johnson, Somerville, NJ, USA were advanced through the suture passer device, which is used to penetrate the anterior cruciate ligament (ACL near to the insertion site of the displaced fragment. Two surgical sutures were pulled out by the suture retriever from the anterior proximal tibia hole and were fixed to the tibia cortex bone with a double-spike plate. At follow-up, radiographic examinations showed that bone union was achieved in all cases. All but one patient could resume normal activities with no restrictions and no ligamentous instability. All knees had a negative Lachman's test and showed a gain of stable ligament function by KT2000 arthrometer evaluation. One patient had an insignificant extension limitation and experienced slight pain after walking but these symptoms were minimal. In conclusion current arthroscopic surgery techniques for tibial intercondylar fractures can be easily performed and reproducibly achieve secure fixation and early mobilization of the knee.

  10. Comparison of the cheese-wiring effects among three sutures used in rotator cuff repair. (United States)

    Lambrechts, Mark; Nazari, Behrooz; Dini, Arash; O'Brien, Michael J; Heard, Wendell M R; Savoie, Felix H; You, Zongbing


    The goal of this study was to compare the cheese-wiring effects of three sutures with different coefficients of friction. Sixteen human cadaveric shoulders were dissected to expose the distal supraspinatus and infraspinatus muscle tendons. Three sutures were stitched through the tendons: #2 Orthocord(™) suture (reference #223114, DePuy Mitek, Inc., Raynham, MA), #2 ETHIBOND* EXCEL Suture, and #2 FiberWire(®) suture (FiberWire(®), Arthrex, Naples, FL). The sutures were pulled by cyclic axial forces from 10 to 70 N at 1 Hz for 1000 cycles through a MTS machine. The cut-through distance on the tendon was measured with a digital caliper. The cut-through distance in the supraspinatus tendons (mean ± standard deviation, n = 12) were 2.9 ± 0.6 mm for #2 Orthocord(™) suture, 3.2 ± 1.2 mm for #2 ETHIBOND* suture, and 4.2 ± 1.7 mm for #2 FiberWire(®) suture. The differences were statistically significant analyzing with analysis of variance (P = 0.047) and two-tailed Student's t-test, which showed significance between Orthocord(™) and FiberWire(®) sutures (P = 0.026), but not significant between Orthocord(™) and ETHIBOND* sutures (P = 0.607) or between ETHIBOND* and FiberWire(®) sutures (P = 0.103). The cheese-wiring effect is less in the Orthocord(™) suture than in the FiberWire(®) suture in human cadaveric supraspinatus tendons. Identification of sutures that cause high levels of tendon cheese-wiring after rotator cuff repair can lead to better suture selection.

  11. Polymeric Medical Sutures: An Exploration of Polymers and Green Chemistry (United States)

    Knutson, Cassandra M.; Schneiderman, Deborah K.; Yu, Ming; Javner, Cassidy H.; Distefano, Mark D.; Wissinger, Jane E.


    With new K-12 national science standards emerging, there is an increased need for experiments that integrate engineering into the context of society. Here we describe a chemistry experiment that combines science and engineering principles while introducing basic polymer and green chemistry concepts. Using medical sutures as a platform for…

  12. Probing electrical conductivity of the Trans-European Suture Zone

    Czech Academy of Sciences Publication Activity Database

    Brasse, H.; Červ, Václav; Ernst, T.; Hoffmann, N.; Jankowski, J.; Józwiak, W.; Korja, T.; Kreutzmann, A.; Neska, A.; Palshin, N.; Pedersen, L. B.; Schwarz, G.; Smirnov, M.; Sokolova, E.; Varentsov, I. M.


    Roč. 87, č. 29 (2006), 281, 287 ISSN 0096-3941 R&D Projects: GA ČR GA205/04/0740 Institutional research plan: CEZ:AV0Z30120515 Keywords : electrical conductivity * Trans-European Suture Zone * EMTESZ-Pomerania Subject RIV: DE - Earth Magnetism, Geodesy, Geography

  13. Sterilization effects on tensile strength of non-conventional suture ...

    African Journals Online (AJOL)

    An experiment was carried out to determine the tensile strength of embroidery, braiding, cobbler's thread and nylon mono-filament fishing line (NMFL) use as non-conventional suture material. Their tensile strength were determined pre- sterilization using various calibrated weights (50gm, 100gm, 500gm).

  14. Outcome of Strabismus Surgery by Nonadjustable Suture among ...

    African Journals Online (AJOL)


    Mar 6, 2017 ... Outcome of strabismus surgery by nonadjustable suture among adults attending a university hospital of. Saudi Arabia. Niger J Clin Pract 2017;20:335-40. This is an open access article distributed under the terms of the Creative Commons. Attribution-Non Commercial-Share Alike 3.0 License, which allows ...

  15. Outcome of strabismus surgery by nonadjustable suture among ...

    African Journals Online (AJOL)

    Objective: To describe the outcome and safety of surgical treatment of Saudi adult patients with strabismus by nonadjustable suture and to evaluate the prevalence of diplopia and binocularity after strabismus correction. Materials and Methods: Retrospective analysis of medical records of 96 patients above the age of ...

  16. Penile torsion correction by diagonal corporal plication sutures

    Directory of Open Access Journals (Sweden)

    Brent W. Snow


    Full Text Available Penile torsion is commonly encountered. It can be caused by skin and dartos adherence or Buck’s fascia attachments. The authors suggest a new surgical approach to solve both problems. If Buck’s fascia involvement is demonstrated by artificial erection then a new diagonal corporal plication suture is described to effectively solve this problem.

  17. Suture supported P C IOL in a homocystinuric child.

    Directory of Open Access Journals (Sweden)

    Bhatti S


    Full Text Available A homocystinuric child presented with a secondary pupillary block glaucoma due to anteriorly subluxated lens. After removal of the subluxated lens, a suture supported posterior chamber IOL was implanted. Postoperative complication of cerebral venous thrombosis following general anaesthesia was managed with high doses of pyridoxine special diet and drugs.

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

    African Journals Online (AJOL)

    Abu wael

    immediately under a dissecting microscope (Kruss, Germany). Six equidistant epineurial simple interrupted sutures were ... strong, and muscle mass atrophy graded as severe, moderate, mild or normal. Sensory functions evaluation .... could secrete analgesic substances such as opioids, neurotransmitters including gamma ...

  19. non absorbable sutures in the urinary bladder resulting

    African Journals Online (AJOL)

    The vesical calculus. Urol Clin North AM. 2000, 27:333-346. 3. Evans JW, Chapple CR, Ralph DJ, Millory EJ: Bladder calculus formation as a complication of the Stamey procedure. Br J Urol 1990,. 65:580-582. 4. Sheng-Tsun Su, He-Fu Haung, Shu-Fen. Chang. Encrusted Bladder stone on Non- absorbable sutures after a ...

  20. Stress-Softening and Residual Strain Effects in Suture Materials

    Directory of Open Access Journals (Sweden)

    Alex Elías-Zúñiga


    Full Text Available This work focuses on the experimental characterization of suture material samples of MonoPlus, Monosyn, polyglycolic acid, polydioxanone 2–0, polydioxanone 4–0, poly(glycolide-co-epsilon-caprolactone, nylon, and polypropylene when subjected to cyclic loading and unloading conditions. It is found that all tested suture materials exhibit stress-softening and residual strain effects related to the microstructural material damage upon deformation from the natural, undistorted state of the virgin suture material. To predict experimental observations, a new constitutive material model that takes into account stress-softening and residual strain effects is developed. The basis of this model is the inclusion of a phenomenological nonmonotonous softening function that depends on the strain intensity between loading and unloading cycles. The theory is illustrated by modifying the non-Gaussian average-stretch, full-network model to capture stress-softening and residual strains by using pseudoelasticity concepts. It is shown that results obtained from theoretical simulations compare well with suture material experimental data.

  1. Healing of the suture line in the irradiated small intestine

    International Nuclear Information System (INIS)

    Da Costa, S.A.


    With the help of data from literature the author goes more deeply into the aetiology, treatment and possible prevention of lesions of the small intestine related to preceding irradiation. In a clinical retrospective study at twenty patients who, after irradiation of the abdominal and pelvic areas, have been submitted to abdominal surgery, the relation is studied between predistion factors for gastrointestinal complications after irradiation, the surgeries applied in case of small-intestine problems and postoperative complications. The third part of the thesis covers an experimental part in which the healing process of suture line in the terminal ileum has been studied after resection and reanastomosis in previously irradiated bowel of the rat. It was investigated whether differences occurred in the healing process of suture line after various periods - 4, 10 and 40 weeks, after irradiation. Also comparison took place with a control group which underwent a similar procedure with the exception of the radiation treatment, which was simulated in this group. In a second experiment it was investigated if the healing process of suture line depends on the type of anastomosis. An end-to-end anastomosis was chosen versus side-to-side anastomosis. Also in this experiment an irradiated group was compared with a control group. Furthermore a method was developed for performing micro-angiographies of the rat intestine in order to demonstrate obliteration of blood vessels in irradiated intestine and to assess neovascularization in the intestinal wall at the suture line. (author). 84 refs.; 18 figs.; 27 tabs

  2. Comparison of Subcuticular Suture Materials in Cesarean Skin Closure

    Directory of Open Access Journals (Sweden)

    Pınar Solmaz Hasdemir


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

  3. Punctal Occlusion with Prolene Suture Material in the Patients with ...

    African Journals Online (AJOL)

    polypropene, a synthetic linear polyolefin. This suture is pigment blue to enhance visibility. Prolene is neither absorbable nor elastic [Figure 9]. The size (such as the diameter of the cross-section and the thickness) of the Prolene material as measured with an optical microscope (Nikon Eclipse Me600) and a digital calliper.

  4. Nonsuturing or Skin Adhesives versus Suturing of the Perineal Skin After Childbirth: A Systematic Review

    NARCIS (Netherlands)

    Seijmonsbergen-Schermers, A.E.; Sahami, S.; Lucas, C.; de Jonge, A.


    Background: Suturing of perineal trauma after childbirth can cause problems such as pain, discomfort because of tight sutures, the need for suture removal, and dyspareunia. It is unclear whether leaving the perineal skin unsutured or using skin adhesives might prevent these problems. Methods:

  5. Nonsuturing or Skin Adhesives versus Suturing of the Perineal Skin After Childbirth: A Systematic Review

    NARCIS (Netherlands)

    Seijmonsbergen-Schermers, Anna E.; Sahami, Saloomeh; Lucas, Cees; Jonge, Ank de


    Suturing of perineal trauma after childbirth can cause problems such as pain, discomfort because of tight sutures, the need for suture removal, and dyspareunia. It is unclear whether leaving the perineal skin unsutured or using skin adhesives might prevent these problems. CENTRAL, MEDLINE, EMBASE,


    NARCIS (Netherlands)



    Nylon and stainless steel sutures separately placed deeply into rabbit corneas by splitting the stroma for a few millimeters, without closing sutures, remained in the cornea for two, four and six weeks respectively. In contrast to the stainless steel sutures an extensive tissue reaction could be

  7. Microbial adherence on various intraoral suture materials in patients undergoing dental surgery. (United States)

    Banche, Giuliana; Roana, Janira; Mandras, Narcisa; Amasio, Mario; Gallesio, Cesare; Allizond, Valeria; Angeretti, Alessandra; Tullio, Vivian; Cuffini, Anna Maria


    Sutures used in oral surgery should avoid or limit bacterial adhesion and proliferation to those parts exposed to oral fluids. Hence, microbial colonization on various intraoral suture materials from patients undergoing dental surgery was compared. During dentoalveolar surgery, various suture materials were used in 60 patients, who were randomly divided into 5 groups of 12. In each group, silk was placed intraorally in association with a different type of suture (ie, Supramid, Synthofil, Ethibond Excel, Ti-cron, Monocryl) at the same site to compare microbial colonization intraindividually. Eight days postoperatively, the sutures were removed, and adhered micro-organisms were isolated, counted, and identified through enzymatic activities and fermentation of sugars. In all 60 patients, silk sutures exhibited the smallest affinity toward the adhesion of bacteria compared with considerable proliferation with nonresorbable multifilament sutures (Supramid, Synthofil, Ethibond Excel, Ti-cron). On the contrary, the microbial load was significantly lower when absorbable monofilament Monocryl was used. A greater quantity of bacteria was found on nonresorbable sutures than on absorbable ones, and nearly 2 times more facultative anaerobic bacteria were isolated in total. Our results show that bacteria adhere with different affinity to various types of suture materials. Absorbable silk and Monocryl exhibited the smallest number of adherent bacteria. Colonization by pathogens on sutures leads to the recommendation that sutures should be removed as early as possible after surgery is performed, to eliminate or to limit the reservoir for oral pathogens. This recommendation is dependent on whether the suture is absorbable.

  8. Feasibility and safety of temporary subcutaneous venous figure-of-eight suture to achieve haemostasis after ablation of atrial fibrillation. (United States)

    Traullé, Sarah; Kubala, Maciej; Doucy, Alexandre; Quenum, Serge; Hermida, Jean-Sylvain


    This prospective study was carried out to assess the feasibility and safety of venous figure-of-eight suture to achieve haemostasis after atrial fibrillation (AF) ablation. Consecutive patients who underwent catheter ablation of AF were prospectively enrolled from February 2012 to September 2013. At the end of the procedure, a temporary subcutaneous 'Figure-of-eight' suture technique was used to achieve haemostasis. Anticoagulation strategy evolved during the study. Initially, vitamin K antagonists (VKAs) were stopped and replaced by administration of low-molecular-weight heparin. It was subsequently decided to perform these procedures without stopping VKA. With the arrival of direct oral anticoagulants (DOACs), it was decided to miss the evening dose before the procedure. One hundred and twenty-four patients were included. Seventy-three per cent of patients were male, and the mean age was 58 ± 10 years old. One hundred and twelve patients (90%) experienced paroxysmal AF and were treated by cryotherapy with the use of a 15 Fr outer diameter Flexcath Advance sheath. The 'Figure-of-eight' suture technique was able to be performed in all patients and was sufficient in 114 patients. Mechanical external compression was required for 10 patients. Three patients developed a haematoma. The overall incidence of haematoma was therefore 2.4%. Figure-of-eight suture is a fast closure technique that can be used as an efficient alternative to usual compression methods to prevent bleeding during high-intensity anticoagulation and the use of large-diameter venous sheaths and multiple femoral venous accesses. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email:

  9. How much do we need experts during laparoscopic suturing training? (United States)

    Van Bruwaene, Siska; De Win, Gunter; Miserez, Marc


    Because of the complex nature of laparoscopic suturing, numerous curricula have been developed to overcome the steep learning curve in a patient-free environment. Distributed training leads to better acquisition and retention of skill compared with massed training. However, this requires considerable time commitment of experts that supervise these training sessions. This study investigates the possibility of replacing expert supervision by structured training with video demonstrations and peer feedback. The study population consisted of two balanced groups of ten senior medical students with minimal experience in laparoscopy. The control group trained with continuous expert feedback while for the experimental group only video demonstrations and external feedback from peers were available. Training was completed when a previously determined expert level was achieved on two consecutive attempts (proficiency criterion). Students were tested on their suturing skills 1 week after the training as well as after 4 months. A composite score assessing quality and quantity of suturing performance was used. Data are shown as median (interquartile range, IQR). Students' performance improved more than 200% after training. Learning curves did not differ between groups (p = 0.28). One week after training, scores were 192 s (IQR 65 s) for the control and 190 s (IQR 27 s) for the experimental group (p = 0.63). After 4 months this was 223 s (IQR 88 s) and 220 s (IQR 37 s), respectively (p = 0.60). Both training methods are very efficient at improving laparoscopic suturing skills and provide excellent skill retention. We therefore conclude that structured training with video demonstrations and peer feedback can replace expert supervision to teach laparoscopic suturing skills to novices. This will facilitate practical organization of skills training.

  10. Horizontal suture placement influences meniscal repair fixation strength. (United States)

    Kocabey, Yavuz; Taser, Omer; Nyland, John; Ince, Haluk; Sahin, Feyzi; Sunbuloglu, Emin; Baysal, Gokhan


    This in vitro biomechanical study investigated the influence of horizontal suture placement distance from the medial meniscal lesion repair site on fixation characteristics during submaximal cyclic and load to failure test conditions. Eighteen cadaveric (20-45 years of age) medial menisci with intact joint capsules were harvested within 24-48 h after death and divided into two groups of 9 specimens each for biomechanical testing. A 2.0-cm-long antero-posterior vertical longitudinal lesion was created with a #15 scalpel 2.0-3.0 mm from the outer edge of each meniscus. Menisci were repaired using #2-0 suture material with two horizontal suture loops placed either 1.0 mm (Group 1) or 3.0 mm (Group 2) from the lesion site. Following repair, the lesion was extended completely through the meniscal horns so that no tissue secured the repair, only the two horizontal suture loops representing a "worst-case" testing scenario. Following repair, specimens were placed in a servo hydraulic device using a pair of 1.2-mm-diameter steel wire loops and underwent submaximal cyclic loading between 5 and 50 N (1 Hz) for 500 cycles prior to load to failure testing (5 mm/min crosshead speed, 20 Hz data collection). An alpha level of P lesion displayed superior repair fixation than sutures placed closer to the lesion. The superior biomechanical meniscal repair fixation provided by capturing greater tissue volume may enable safe earlier participation in functional exercise activities. Studies are needed to verify these findings in vivo.

  11. Multilevel treatment of moderate and severe obstructive sleep apnea with bone-anchored pharyngeal suspension sutures. (United States)

    Berg, Eric E; Bunge, Frederick; Delgaudio, John M


    Success rates for the surgical treatment of obstructive sleep apnea (OSA) vary, with phase I surgical success ranging from 40 to 75%. Pharyngeal suspension suture procedures are minimally invasive techniques with a reported efficacy of 20 to 78%. We conducted a study to evaluate the effectiveness of pharyngeal suspension suture procedures in conjunction with uvulopalatopharyngoplasty (UPPP) as a multilevel treatment for OSA. We retrospectively reviewed the charts of 30 adults-22 men and 8 women, with a mean age of 49 years and a mean BMI of 30.6-who were treated at a tertiary care academic medical center and a private otolaryngology practice. All patients had moderate or severe OSA, and all had failed continuous positive airway pressure therapy. Of this group, 20 patients underwent tongue base and hyoid suspension (TBHS) and 10 underwent tongue base suspension (TBS) alone; 23 patients had undergone concurrent or previous UPPP, 13 in the TBHS group and all 10 in the TBS group. Polysomnography was performed an average of 3.9 months postoperatively. Surgical success was defined as a reduction in respiratory distress index (RDI) of more than 50% and a postoperative RDI of 20 or less. The overall surgical success rate was 63% (19/30). In the surgical success group, the mean RDI fell from 44.6 to 9.4 (p breaks, and 1 dislodged screw. We conclude that pharyngeal suspension suture procedures as part of the multilevel treatment of moderate and severe OSA yields better outcomes than conventional surgical treatments with the added benefit of being minimally invasive.

  12. Meniscus suture repair: minimum 10-year outcomes in patients younger than 40 years compared with patients 40 and older. (United States)

    Steadman, J Richard; Matheny, Lauren M; Singleton, Steven B; Johnson, Nicholas S; Rodkey, William G; Crespo, Bernardo; Briggs, Karen K


    Few studies have compared outcomes after meniscus suture repair in patients younger than 40 years versus patients 40 years and older. To document failure rates and long-term outcomes after meniscus suture repair by a single surgeon, using the inside-out technique, at a minimum 10-year follow-up in patients younger than 40 years versus those 40 years and older. Cohort study; Level of evidence, 3. This study included all patients 18 years or older who underwent meniscus suture repair with the inside-out technique by a single surgeon between January 1992 and December 2003. Patients were divided into 2 cohorts according to age: meniscus as repaired in the index surgery. Patients completed a subjective questionnaire at minimum of 10 years after arthroscopy. Outcomes measures included Lysholm, Tegner, and patient satisfaction with outcome. All data were collected prospectively. The surgeon performed 339 meniscus repairs between 1992 and 2003. The study included 181 knees in 178 patients, who had a mean age of 33 years (range, 18-70 years). Cohort 1 contained 136 knees; 16 patients (12%) were lost to follow-up and 47 (35%) underwent a subsequent knee arthroscopy. Cohort 2 contained 45 knees; 2 patients (4.4%) were lost to follow-up, 3 patients had a total knee arthroplasty, and 12 patients (28%) underwent a subsequent knee arthroscopy. In cohort 1, the meniscus repair failure rate was 5.5% (6/110), and in cohort 2 it was 5.3% (2/38) (P = .927). There was no significant difference in failure rate based on which meniscus was repaired (P = .257), concomitant anterior cruciate ligament (ACL) reconstruction (P = .092), or microfracture (P = .674). Average follow-up time for cohort 1 was 16.1 years (range, 10.0-21.9 years), with 82% follow-up (n = 73/89); average follow-up time for cohort 2 was 16.2 years (range, 10.1-21.0 years), with 93% follow-up (n = 28/30). There were no significant differences in outcomes scores after meniscus suture repair based on age cohort or meniscus

  13. The Incidence and Topographic Distribution of Sutures Including Wormian Bones in Human Skulls. (United States)

    Cirpan, Sibel; Aksu, Funda; Mas, Nuket


    The Wormian Bones are accessory bones located within the cranial sutures and fontanelles. The present article examines the incidence of Wormian Bones and compares the number and topographic distribution between the sutures including Wormian Bones in skulls of West Anatolian Population. One hundred fifty crania were examined. The parameters evaluated in the present study were as follows: the rate of skulls including Wormian Bones; the topographic distribution and frequencies of the sutures including Wormian Bones; the number of these sutures for each skull; the name and number of sutures that were bilaterally and symmetrically located on the right and left side of skull (paired sutures) and which coincidentally had Wormian Bones for each skull; the differences of frequencies between the paired sutures including Wormian Bones. The rate of skulls including Wormian Bones was determined as 59.3%. The maximum and minimum numbers of sutures, including Wormian Bones, were 6 in 1 skull and 1 in each of 30 skulls, respectively. The maximum and minimum rates of sutures that had Wormian Bones were found in left lambdoid 40.7% and right occipitomastoid 1.3% sutures, respectively. There was only a significant difference between the rate of right and left squamous sutures (P = 0.04). Forty-five skulls were including 55 pairs of bilaterally and symmetrically located sutures that coincidentally had Wormian Bones in each pair. Each of 35 skulls had 1 pair of sutures including Wormian Bones and each of 10 skulls had 2 pairs. In the present study, the rate of Wormian Bones was determined as 59.3% in West Anatolian Population. This incidence rate is considerably lower than the other reports, and it may be as a result of racial variations. These divergent bones were more frequently found in left lambdoid sutures (40.7%) and less frequently in right occipitomastoid sutures (1.3%). This study may guide the investigators dealing with the neurosurgery, orthopedy, radiology, anatomy, and

  14. Internal fixation of displaced inferior pole of the patella fractures using vertical wiring augmented with Krachow suturing. (United States)

    Oh, Hyoung-Keun; Choo, Suk-Kyu; Kim, Ji-Wan; Lee, Mark


    We present the surgical technique of separate vertical wiring for displaced inferior pole fractures of the patella combined with Krachow suture and report the surgical outcomes. Between September 2007 to May 2012, 11 consecutive patients (mean age, 54.6 years) with inferior pole fractures of the patella (AO/OTA 34-A1) were retrospectively enrolled in this study. Through longitudinal incision, all patients underwent open reduction and internal fixation by separate vertical wiring combined with Krackow suture. The range of motion, loss of fixation, and Bostman score were primary outcome measures. The union time was 10 weeks after surgery on average (range: 8-12). No patient had nonunion, loss of reduction and wire breakage. There was no case of wound problem and irritation from the implant. At final follow-up, the average range of motion arc was 129.4° (range: 120-140). The mean Bostman score at last follow-up was 29.6 points (range: 28-30) and graded excellent in all cases. Separate vertical wiring combined with Krackow suture for inferior pole fractures of the patella is a useful technique that is easy to perform and can provide stable fixation with excellent results in knee function. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Unravelling the molecular control of calvarial suture fusion in children with craniosynostosis

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    Morris C Phillip


    Full Text Available Abstract Background Craniosynostosis, the premature fusion of calvarial sutures, is a common craniofacial abnormality. Causative mutations in more than 10 genes have been identified, involving fibroblast growth factor, transforming growth factor beta, and Eph/ephrin signalling pathways. Mutations affect each human calvarial suture (coronal, sagittal, metopic, and lambdoid differently, suggesting different gene expression patterns exist in each human suture. To better understand the molecular control of human suture morphogenesis we used microarray analysis to identify genes differentially expressed during suture fusion in children with craniosynostosis. Expression differences were also analysed between each unfused suture type, between sutures from syndromic and non-syndromic craniosynostosis patients, and between unfused sutures from individuals with and without craniosynostosis. Results We identified genes with increased expression in unfused sutures compared to fusing/fused sutures that may be pivotal to the maintenance of suture patency or in controlling early osteoblast differentiation (i.e. RBP4, GPC3, C1QTNF3, IL11RA, PTN, POSTN. In addition, we have identified genes with increased expression in fusing/fused suture tissue that we suggest could have a role in premature suture fusion (i.e. WIF1, ANXA3, CYFIP2. Proteins of two of these genes, glypican 3 and retinol binding protein 4, were investigated by immunohistochemistry and localised to the suture mesenchyme and osteogenic fronts of developing human calvaria, respectively, suggesting novel roles for these proteins in the maintenance of suture patency or in controlling early osteoblast differentiation. We show that there is limited difference in whole genome expression between sutures isolated from patients with syndromic and non-syndromic craniosynostosis and confirmed this by quantitative RT-PCR. Furthermore, distinct expression profiles for each unfused suture type were noted, with

  16. Biomechanical comparison of the four-strand cruciate and Strickland techniques in animal tendons

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    Raquel Bernardelli Iamaguchi


    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.

  17. Preliminary study of virtual reality and model simulation for learning laparoscopic suturing skills. (United States)

    McDougall, Elspeth M; Kolla, Surendra B; Santos, Rosanne T; Gan, Jennifer M; Box, Geoffrey N; Louie, Michael K; Gamboa, Aldrin J R; Kaplan, Adam G; Moskowitz, Ross M; Andrade, Lorena A; Skarecky, Douglas W; Osann, Kathryn E; Clayman, Ralph V


    Repetitive practice of laparoscopic suturing and knot tying can facilitate surgeon proficiency in performing this reconstructive technique. We compared a silicone model and pelvic trainer to a virtual reality simulator in the learning of laparoscopic suturing and knot tying by laparoscopically naïve medical students, and evaluated the subsequent performance of porcine laparoscopic cystorrhaphy. A total of 20 medical students underwent a 1-hour didactic session with video demonstration of laparoscopic suturing and knot tying by an expert laparoscopic surgeon. The students were randomized to a pelvic trainer (10) or virtual reality simulator (10) for a minimum of 2 hours of laparoscopic suturing and knot tying training. Within 1 week of the training session the medical students performed laparoscopic closure of a 2 cm cystotomy in a porcine model. Objective structured assessment of technical skills for laparoscopic cystorrhaphy was performed at the procedure by laparoscopic surgeons blinded to the medical student training format. A video of the procedure was evaluated with an objective structured assessment of technical skills by an expert laparoscopic surgeon blinded to medical student identity and training format. The medical students completed an evaluation questionnaire regarding the training format after the laparoscopic cystorrhaphy. All students were able to complete the laparoscopic cystorrhaphy. There was no difference between the pelvic trainer and virtual reality groups in mean +/- SD time to perform the porcine cystorrhaphy at 40 +/- 15 vs 41 +/- 10 minutes (p = 0.87) or the objective structured assessment of technical skills score of 8.8 +/- 2.3 vs 8.2 +/- 2.2 (p = 0.24), respectively. Bladder leak occurred in 3 (30%) of the pelvic trainer trained and 6 (60%) of the virtual reality trained medical student laparoscopic cystorrhaphy procedures (Fisher exact test p = 0.37). The only significant difference between the 2 groups was that 4 virtual reality

  18. Meniscal repair: Technique. (United States)

    Beaufils, P; Pujol, N


    Meniscal repair aims to achieve meniscal healing, avoiding the adverse effects of meniscectomy. Longitudinal vertical tears in a vascularized area are the reference indication. The technique generally uses hybrid all-inside implants. The outside-in technique has other indications in more anterior tears. Healing has been demonstrated on CT-arthrography and arthroscopy. Specific techniques have been developed for other pathological situations. Posterior meniscosynovial lesions in a context of chronic anterior laxity are identified by exploration of the posterior compartment, and fixed by all-inside hook suture. Horizontal lesions in young athletes can be treated by open meniscal suture. Radial tears, when deep, can be repaired. Root tears, when traumatic, can be treated by transosseous pullout reinsertion. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  19. Prevention of Urethral Retraction with Stay Sutures (PURS) During Robot-Assisted Radical Prostatectomy Improves Early Urinary Control: A Prospective Cohort Study. (United States)

    Argun, Omer Burak; Tuna, Mustafa Bilal; Doganca, Tunkut; Obek, Can; Mourmouris, Panagiotis; Tufek, Ilter; Erdogan, Sarper; Cetinel, Bulent; Kural, Ali Rıza


    To evaluate early continence rates with a novel modified vesicourethral anastomosis technique based on prevention of urethral retraction using anastomosis sutures as stay sutures (PURS) during robot-assisted radical prostatectomy. Sixty patients operated by a single surgeon were enrolled and data collected prospectively. This cohort was compared with another consecutive 60 patients operated with standard anastomosis. The new technique is based on preventing urethral retraction of the posterior urethra with two anastomosis sutures being used as stay sutures. The outcomes were prospectively followed and groups compared regarding early continence. International Consultation on Incontinence Questionnaire Short Form was used to assess incontinence and its impact on the quality of life. Pad use (yes or no pads) was evaluated as a more stringent criterion. Preoperative patient characteristics were similar between the two groups. Anastomosis was completed faster in PURS group (15.1 vs 18.5 min, p = 0.05). At postoperative week 1 and month 1, the severity and bother of incontinence were significantly less in the PURS group (12.7 vs 4.1 and 10.1 vs 2.6, p controlled studies would be required to further test the reproducibility of this technique.

  20. An implantable sensor device measuring suture tension dynamics: results of developmental and experimental work. (United States)

    Schachtrupp, A; Wetter, O; Höer, J


    Knowledge about suture tension dynamics after laparotomy closure is limited due to the lack of adequate measurement tools. As a consequence, a miniaturized implantable sensor and data logger were developed and applied experimentally in a porcine model to measure suture tension dynamics after laparotomy closure. We developed an implantable device (6 × 3 × 1 mm) fitted with silicon strain gauges and an implantable data logger allowing long-term registration. In nine domestic pigs, sensors and loggers were implanted along the suture closing a median laparotomy registering suture tension over a period of 23 h. Fascial closure was achieved by a mean suture tension of 1.07 N. After 30 minutes, suture tension was reduced to 0.81N (-24.3 %, p = 0.0003). After 12 h, tension showed a further decrease to 0.69 N (-35.5 %, n.s.), after 23 h mean suture tension reached 0.56 N, (-47.7 %, p = 0.014). The aim to develop an implantable miniaturized sensor device registering long-term suture tension dynamics was achieved. The use in the animal experiment was feasible and safe. We observed a loss of almost 50 % of suture tension 23 h after fascial closure. This could mean that up to 50 % of initial suture tension may be an unnecessary surplus not contributing to tissue stability but to the risk of suture failure.


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    Harpal Singh


    Full Text Available BACKGROUND Pterygium is a degenerative and hyperplastic condition of conjunctiva. In this, subconjunctival tissue proliferates as vascularised granulation tissue, thus invading the cornea and destroying the superficial stroma and Bowman’s membrane. It varies from small asymptomatic lesion to large, rapidly growing lesion, thus leading to impairment of vision. Pterygium occurs more frequently between 30 degrees latitude north and south of the equator called as “pterygium belt.” The most challenging situation after pterygium excision is the recurrence of the pterygium. Many techniques had been used, but none of them is universally accepted due to variable recurrence rate. The aim of the study is to compare the two modalities of treatment in pterygium excision with postoperative outcomes. MATERIALS AND METHODS A comparative study was conducted from July 2016 to August 2017 in the Department of Ophthalmology, People’s College of Medical Sciences and Research Centre, Bhopal (M.P.. Total 50 patients with primary nasal pterygium of grade 2 or more were enrolled from eye outpatient department. The patients were randomly divided into two groups for pterygium excision with conjunctival autografting using either autologous blood (group A or sutures (group B. Two groups were compared for postoperative discomfort, recurrence and graft displacement. RESULTS Out of 50 patients, 28 were in group A and 22 were in group B. Maximum numbers of patients were involved in outdoor activities. In comparison to autologous blood technique, postoperative discomfort was more in suture group after pterygium excision. In group A, the graft displacement was found in 2 (7.1% patients, whereas in group B, there was no graft displacement seen. While in group B2 (9.1% patients had granuloma formation. The recurrence of pterygium was high (22.7% in group B as compared to group A (3.6%. There was a significant correlation between rate of recurrence and type of surgery (P

  2. Suture anchor reinsertion of distal biceps rupture: clinical results and radiological assessment of tendon healing. (United States)

    Gallinet, D; Dietsch, E; Barbier-Brion, B; Lerais, J-M; Obert, L


    The present study consisted in a clinical follow-up of patients with distal rupture of the biceps brachii tendon managed by suture anchor reinsertion to the radial tuberosity. Tendon apposition on the cortical bone is the least resistant reinsertion technique according to biomechanical studies. A parallel radiological (X-ray and MRI) study was therefore performed to assess the exact quality of tendon healing and its correlation to clinical results. Twenty-eight patients were followed up retrospectively at a mean 22 months (minimum FU: six months) with clinical examination (mobility, force, satisfaction, residual pain, and return to work) and radiological assessment (standard X-ray exploration for heterotopic ossification, and MRI for quality of healing of the tendon apposed to the cortical bone). Forty percent of cases showed complications (mainly neurological) which resolved without sequelae under medical treatment. Mobility was normal in all but eight patients who showed -5° to -20° supination loss. Force in flexion-supination was 91% of that on the contralateral side. On X-ray, only 46% of patients were free of ossification. On MRI, reinsertion was judged anatomic in 19 patients (70%), moderate in six and poor in two, with one iterative rupture. Statistical analysis revealed that the greater the number of suture tacks through the tendon, the greater the force in patients with less than two weeks' interval to surgery and satisfactory reinsertion on MRI. Many reinsertion techniques have been reported, giving clinical results similar to one another and to the present findings. The complications rate, in contrast, varies according to technique and surgical approach. Radiologically, 70% of reinsertions were satisfactory: healing with the tendon apposed on the cortical bone is thus a reliable technique. Heterotopic ossification is considered benign in the literature. The present radiological study refined this notion by identifying three types of ossification: pure

  3. Self-directed practice schedule enhances learning of suturing skills. (United States)

    Safir, Oleg; Williams, Camille K; Dubrowski, Adam; Backstein, David; Carnahan, Heather


    Most preoperative surgical training programs experience challenges with the availability of expert surgeons to teach trainees. Some research suggests that trainees may benefit from being allowed to actively shape their learning environments, which could alleviate some of the time and resource pressures in surgical training. The purpose of this study was to investigate the effects of self-directed or prescribed practice schedules (random or blocked) on learning suturing skills. Participants watched an instructional video for simple interrupted, vertical mattress and horizontal mattress suturing then completed a pretest to assess baseline skills. Participants were assigned to 1 of 4 practice groups: self-directed practice schedule, prescribed blocked practice schedule, prescribed random practice schedule or matched to the self-directed group (control). Practice of the skill was followed by a delayed (1 h) posttest. Improvement from pretest to posttest was determined based on differences in performance time and expert-based assessments. Analyses revealed a significant effect of group for difference in performance time of the simple interrupted suture. Random practice did not show the expected advantage for skill learning, but there was an advantage of self-directed practice. Self-directed practice schedules may be desirable for optimal learning of simple technical skills, even when expert instruction is available. Instructors must also take into account the interaction between task difficulty and conditions of practice to develop ideal training environments.

  4. Intraoperative adjustable suture surgery for bilateral superior oblique palsy. (United States)

    Ohtsuki, H; Hasebe, S; Hanabusa, K; Fujimoto, Y; Furuse, T


    The modified Harada-Ito procedure has been reported to be an effective treatment for correction of cyclotorsion in bilateral superior oblique palsy. However, there are no reports regarding its use in intraoperative adjustable suture surgery. The authors performed a retrospective study of 12 patients with traumatic bilateral superior oblique palsy who were classified as having either symmetric or asymmetric palsy according to the symmetry of the alternate hyperdeviation on side gazes. Cyclotorsion and vertical and horizontal deviation in the nine diagnostic positions were measured preoperatively and postoperatively. Of the 12 patients, 6 were determined to have symmetric palsy and 6 asymmetric palsy. Intraoperative adjustable suture surgery with the modified Harada-Ito procedure was performed bilaterally in the six patients with symmetric palsy and unilaterally in those with asymmetric palsy. The median measured value of extorsion in the primary position was reduced from 14.5 degrees to 2.5 degrees in patients with symmetric palsy and from 9.5 degrees to 2.0 degrees in those with asymmetric palsy. In downgaze, some degree of residual extorsion remained, and there was no significant change in esodeviation after surgery. In five patients with symmetric palsy and in all of those with asymmetric palsy, normal single binocular vision in the primary position but did not that in downgaze was restored after surgery. Intraoperative adjustable suture surgery is an effective treatment in correcting torsion, but may not be as effective for esodeviation in downgaze.


    Khan, M Ali; Gupta, Omesh P; Pendi, Kasim; Chiang, Allen; Vander, James; Regillo, Carl D; Hsu, Jason


    To compare clinical outcomes of combined pars plana vitrectomy (PPV) with anterior chamber intraocular lens (ACIOL) placement versus scleral fixation of a posterior chamber intraocular lens (PCIOL) using Gore-Tex suture. Retrospective, interventional case series of eyes undergoing combined PPV and IOL placement for retained lens material, aphakia, or dislocated IOL. Eyes with history of amblyopia, corneal opacity, retinal, or optic nerve disease were excluded. Outcome measures were change in visual acuity and occurrence of postoperative complications with minimum follow-up of 1 year. Sixty-three eyes of 60 patients were identified. Thirty-three eyes underwent combined PPV and ACIOL placement and 30 eyes underwent combined PPV and scleral fixation of a PCIOL using Gore-Tex suture. Mean follow-up was 502 ± 165 days (median 450, range 365-1,095 days). In the ACIOL group, mean visual acuity improved from 20/914 preoperatively to 20/50 postoperatively (P Gore-Tex suture were well tolerated. The techniques resulted in similar visual outcomes at minimum follow-up of 1 year.

  6. A Comparison of Screw Fixation and Suture-Button Fixation in a Syndesmosis Injury in an Ankle Fracture. (United States)

    Kim, Jung-Han; Gwak, Heui-Chul; Lee, Chang-Rack; Choo, Hye-Jeung; Kim, Jeon-Gyo; Kim, Dae-Yoo


    The present study compared the quality of reduction and the clinical assessment between screw fixation and suture-button fixation with an ankle fracture accompanied by syndesmosis injury. We studied the clinical and radiologic findings 1 year postoperatively through retrospective examination of 24 patients who had undergone screw fixation from January 2011 to December 2012 and prospective examination of 20 patients who had undergone suture button fixation from January 2013 to May 2014. Regarding the tibiofibular clear space, tibiofibular overlap, and medial clear space, the screw fixation group had improvement from a preoperative mean of 6.97 (range 2.79 to 15.81) mm, 4.43 (range 0 to 7.87) mm, 7.90 (range 4.24 to 19.50) mm to a postoperative mean of 4.95 (range 2.72 to 9.08) mm, 6.29 (range 0 to 10.37) mm, and 4.32 (range 1.98 to 6.57) mm, respectively. The corresponding improvement for the suture-button fixation group was from a preoperative mean of 6.65 (range 3.94 to 13.73) mm, 5.39 (range 0 to 9.44) mm, 7.27 (range 4.04 to 16.00) mm to a postoperative mean of 5.15 (range 2.93 to 7.30) mm, 7.21 (range 2.15 to 10.30) mm, and 4.25 (range 2.97 to 5.71) mm. No statistically significant difference was found between the 2 techniques. Both suture-button and metal screw fixation are effective treatment methods for an ankle fracture accompanied by syndesmosis injury. However, a long-term and prospective analysis is needed. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Evaluation of a novel suture material for closure of intestinal anastomoses in canine cadavers. (United States)

    Hansen, Lane A; Monnet, Eric L


    To compare leakage and maximum intraluminal pressures for a novel suture material with pressures for comparable suture material when used in closure of intestinal anastomoses in canine cadavers. Healthy intestines from cadavers of dogs euthanized for reasons unrelated to the study. 18 anastomoses were performed on intestinal sections within 72 hours after dogs were euthanized and intestinal samples collected. Anastomoses were performed with a simple continuous suture pattern. Leakage and maximum intraluminal pressures were measured and recorded for 6 control segments and 18 anastomosed sections. A barbed glycomer 631 suture (size 4-0 United States Pharmacopeia [USP]) was compared with glycomer 631 sutures (sizes 3-0 and 4-0 USP). Results for leakage and maximum intraluminal pressures were compared via an ANOVA. The barbed glycomer 631 suture material leaked at a significantly higher pressure than did the comparable glycomer 631 suture materials. Maximum intraluminal pressures were not significantly different among the suture materials. Barbed glycomer 631 4-0 USP suture material was as effective as glycomer 631 suture materials and may be a safe alternative for use in closure of enterectomies in dogs.

  8. Skull morphometry and vault sutures of Myrmecophaga tridactyla and Tamandua tetradactyla

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    Camila M. de S. Hossotani


    Full Text Available ABSTRACT This study aimed to examine the relationship between skull size and the level of cranial vault suture closure. A total of 50 Myrmecophaga tridactyla Linnaeus, 1758 and 178 Tamandua tetradactyla Linnaeus, 1758 skulls were analyzed in relation to 18 skull dimensions. The skulls were grouped into three levels of suture closure: no sutures closed (level 0, one or all the fallowing sutures closed: interfrontalis, sagitalis and coronalis (level 1 and all sutures closed (level 2. The results indicated that among the 18 variables measured, 17 showed significant differences (p ≤ 0.01 between level 0 and level 1 skulls of T. tetradactyla; as well as between level 0 and level 1, and level 0 and level 2 skulls of M. tridactyla. M. tridactyla level 1 and level 2 had no significant difference among any of the 18 dimensions. The foramen magnum height in both species showed no significant difference (p > 0.05 among any suture categories. In principle, suture closure level and cranial dimensions are related. The specimens with larger cranial dimensions showed greater number of cranial vault sutures closed for both species of anteaters. Tamandua tetradactyla and M. tridactyla specimens with none of the cranial vault suture closed have a foramen magnum height similar to those with cranial vault suture closed.

  9. Optimal suture anchor direction in arthroscopic lateral ankle ligament repair. (United States)

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


    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.

  10. Suture compression induced midpalatal suture chondrocyte apoptosis with increased caspase-3, caspase-9, Bad, Bak, Bax and Bid expression. (United States)

    Lan, Tingting; Zhao, Hanchi; Xiang, Bilu; Wang, Jun; Liu, Yang


    Previous studies found bone resorption and chondrocytes loss in mouse models of mid-palatal suture when given continuous compressive force, although chondrocytes response remained unknown. Herein, we design this study to determine how continuous compression force induces chondrocytes apoptosis. Thirty C57BL/6 male mice (aged 6 weeks) were randomly assigned into controls (not ligated to a spring), blank controls (ligated with no compression) and the compression group (ligated with 20-g compression). After 4 d, palatal tissues were sampled and stained by TB and safranin-O. Tunel staining measured the percentage of apoptotic chondrocytes, and immunohistochemistry was performed to label apoptosis-associated proteins (e.g., Bcl-2, Bcl-xl, Bax, Bak, Bid, Bad, caspase-3, caspase-8 and caspase-9). Intergroup comparison was made by the rank sum test, and P compression group was significantly decreased, while the control group remained largely unaltered. Tunel staining showed that apoptotic cell numbers in the mid-palatal suture were significantly higher than the control group. Immunohistochemistry showed that mice in the compression group had significantly increased expression of caspase-3, caspase-9, Bad, Bak, Bax and Bid; However, caspase-8 remained unaltered. No expression of Bcl-2 and Bcl-xl was detected. Continuous compression force induces chondrocytes apoptosis in the mid-palatal suture. This process might be associated with the mitochondrial pathway. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Sutura de menisco com implantes absorvíveis Meniscus suture with absorbable implants

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    Arnaldo José Hernandez


    Full Text Available Os autores avaliam clinicamente 19 pacientes (19 joelhos - 15 meniscos mediais e 5 laterais submetidos à sutura de menisco, utilizando 2 tipos de implantes absorvíveis (ácido polilático Arrow® e Clear fix®. O estudo compõe-se de 15 homens e 4 mulheres com idades entre 16 e 44 anos, com média de 26,8 anos. O tempo de seguimento médio foi de 24 meses, com mínimo de 18 e máximo de 32 meses. A técnica operatória constituiu-se da sutura de um ou ambos os meniscos (1 caso, via artroscópica com Arrow® em 15 pacientes e Clear fix® em 4. Dos 19 indivíduos, 6 foram submetidos à sutura meniscal isolada, 11 associada à reconstrução do LCA e 2 à reconstrução do LCA com osteotomia valgizante da tíbia. Os resultados foram avaliados segundo exame físico incluindo as manobras de Appley e Mc Murray. A avaliação funcional pré e pós-operatória do joelho foi realizada pela escala de Lysholm modificada. Todos os pacientes tiveram suas manobras meniscais negativadas no pós-operatório. A pontuação média pré-operatória segundo a escala de Lysholm foi de 39,8 subindo para 91,5 no pós-operatório. Os autores concluem que a sutura de menisco, utilizando implantes absorvíveis, tem se mostrado eficiente até o momento, e que tecnicamente ela é mais simples que a sutura convencional.The authors clinically assessed 19 patients (19 knees - 15 medial meniscus and 5 lateral meniscus submitted to meniscus suture using 2 kinds of absorbable implants (polylactic acid Arrow® and Clear fix®. The study is composed of 15 males and 4 females, ages ranging 16 - 44 years old (average = 26.8 years old. The mean follow-up time was 24 months, ranging from 18 to 32 months, at most. The surgical technique was constituted of a suture in one or both meniscus (1 case, through arthroscopy with Arrow® in 15 patients and Clear fix® in 4. From the 19 individuals, 6 were submitted to isolated meniscal suture, 11 combined to ACL reconstruction and 2 to ACL

  12. Half-leaflet suspension with a thin Gore-Tex suture for aortic leaflet prolapse. (United States)

    Shimamoto, Takeshi; Komiya, Tatsuhiko; Sakaguchi, Genichi


    The treatment of aortic root dilatation accompanied by a leaking valve requires a multimodal approach involving root reimplantation or remodeling with tailoring of the sinotubular junction or valvular apparatus, or both. We report a patient with annuloaortic ectasia with a leaking valve that was successfully treated by performing aortic valve repair and root reimplantation. The operation was performed by placing a thin Gore-Tex CV7 suture (W. L. Gore and Assoc, Flagstaff, AZ) halfway along the prolapsed right coronary leaflet to suspend the leaflet. By using this surgical technique, we easily repaired the prolapsed leaflet by meticulously adjusting the length of the edge of the diseased leaflet. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  13. A simple suture-retrieval device for the placement of u-stitches during laparoscopic gastrostomy. (United States)

    Mattei, Peter


    During minimally invasive operations, it is sometimes necessary to retrieve the end of a suture or a suture needle and bring it out through the abdominal wall. Using a standard needle and a length of suture, we have developed a simple device that allows the retrieval of a suture end during minimally invasive operations that require the placement of U-or stay stitches. The author has used the device described during more than 100 laparoscopic gastrostomy placement procedures and other operations involving the placement of U- or stay stitches with excellent results and no complications. Using a beveled hollow-bore needle and a loop of polypropylene suture, one can construct a simple device that allows the retrieval of a suture from within a body cavity during minimally invasive surgery, making the placement of U- and stay stitches easier and more precise.

  14. Intraspecific variation of the interparietal suture closure in Siberian roe deer Capreolus pygargus from Jeju Island. (United States)

    Oh, Jinwoo; Oh, Hong-Shik; Kimura, Junpei; Koyabu, Daisuke


    The sequence of cranial suture closure among cervids is reported to be generally species-specific and highly conservative within species. On the other hand, it is known that intraspecific variation often exists to some extent in other mammalian taxa. Here we studied the cranial suture closures of Capreolus pygargus from Jeju Island and compared it with other cervid species. We found that the timing of the interparietal suture closure is highly variable within C. pygargus. Capreolus capreolus similarly shows intraspecific variation of the interparietal suture closure, whereas other cervid species studied to date do not show any intraspecific variation in the sequence of cranial suture closure. Such high intraspecific variation of the interparietal suture may be a derived character for Capreolus.

  15. Meniscal repair using large diameter horizontal sutures increases fixation strength: an in vitro study. (United States)

    Kocabey, Yavuz; Taşer, Omer; Hapa, Onur; Güçlü, Aycan; Bozdag, Ergun; Sünbüloglu, Emin; Doral, Mahmutnedim


    the purpose of this study was to compare the mechanical characteristics of meniscal repair fixation using horizontal sutures and two different diameter sutures under submaximal cyclic and load to failure test conditions. a 2-cm long anteroposterior vertical longitudinal incision was created in two groups of bovine medial menisci. Lesions were repaired using either #2-0 (Group 1), or #2 (Group 2) Fiberwire suture. Following repair, the lesion was extended through the posterior and anterior meniscal horns so that no tissue secured the repair site. Specimens underwent submaximal cyclic (5-50 N at 1 Hz for 500 cycles) and load to failure testing (5 mm/min crosshead speed) in a servo hydraulic device. Specimen failure mode was verified by the primary investigator. An alpha level of P meniscal tissue. Larger diameter suture provided superior mechanical meniscal fixation. if horizontal suture would be used in meniscal repair, the most suitable larger diameter suture should be used.

  16. Evaluating the Effectiveness of the Lateral Intercrural Suture to Decrease the Interdomal Distance to Improve the Definition of the Nasal Tip in Primary Rhinoplasty

    Directory of Open Access Journals (Sweden)

    Soares, Caio Márcio Correia


    Full Text Available Introduction Several surgical techniques emphasizing sutures on the lower lateral cartilage have been studied by surgeons as instruments to improve nasal tip remodeling. It is already known that the domal divergence angle and its definition angle can be modified by lateral intercrural suture (LIS. Techniques for measuring these structures are not yet standardized. Objectives Assess the efficacy of LIS using polydioxanone 4–0 absorbable thread by interdomal distance and systematize the LIS technique to improve nasal tip definition. Materials and Methods This prospective study measured and analyzed interdomal distances measured preoperatively and perioperatively compared with 3- and 6-month postoperative measurements. Results LIS was efficient on reducing interdomal distances. Conclusion LIS is statistically safe and efficient and has low morbidity when utilized in patients with mild to moderate deformities, because it reduces the domal divergence angle, effectively sustaining the nasal tip.

  17. Intracorporeal Circular Stapled Esophagojejunostomy Using Conventional Purse-String Suture Instrument After Laparoscopic Total Gastrectomy. (United States)

    Liu, Weiguo; Guo, Yongfang; Qiu, Zhigang; Niu, Dongguang; Zhang, Jianli


    An optimal alimentary tract reconstruction technique after laparoscopic total gastrectomy (LTG) remains controversial. The authors developed a new simple technique for intracorporeal esophagojejunal anastomosis that employs a conventional purse-string suture instrument (PSI) and circular stapler. From May 2014 to April 2016, 41 consecutive patients with gastric cancer underwent LTG in the author's institution. Intracorporeal esophagojejunal anastomosis using the following method was attempted for all patients. After total gastrectomy was completed laparoscopically, a small vertical incision (about 40 mm) was created at the left midclavicular line and retracted by a wound retractor. An anvil of a 25 mm circular stapler was introduced into the abdominal cavity. Then a previously prepared surgical glove, which was cut open at the thumb and the little finger through which the two hand shafts of the PSI were passed separately and sealed by ties, was attached to the wound retractor to maintain airtightness, and the PSI was introduced into the abdominal cavity. The following procedure was similar to conventional open surgery except that it was performed under laparoscopic vision. Intracorporeal esophagojejunal anastomosis was performed successfully for all 41 patients. No case required extension of the initial incision for difficulties during anastomosis. The mean operation time was 245 minutes, and the mean time for the purse-string suture and anvil placement was 15 minutes. Tumor-free margins were achieved in all 41 patients. There were no anastomosis-related complications or other major surgical complications. With the described method, intracorporeal esophagojejunal anastomosis can be performed easily and safely.

  18. Endoscopic suture repair of full-thickness esophagotomy during per-oral esophageal myotomy for achalasia. (United States)

    Kurian, Ashwin A; Bhayani, Neil H; Reavis, Kevin; Dunst, Christy; Swanström, Lee


    Per-oral endoscopic myotomy (POEM) requires advanced flexible endoscopic skills, especially in the management of complications. We present a full-thickness esophagotomy while performing POEM and repair using an endoscopic suturing device. An anterior esophageal 2 cm mucosectomy is created 7-10 cm proximal to the gastroesophageal junction after a submucosal wheal is raised. A submucosal tunnel is created and extended to 2 cm on the gastric cardia. A selective circular myotomy is performed. The mucosectomy is closed using endoscopic clips. An inadvertent full-thickness esophagotomy was created while performing the mucosotomy on an inadequate submucosal wheal. We were able to resume the POEM technique at the initial esophagotomy site. There was a discussion to convert to laparoscopy. However, as we succeeded in creating the tunnel, we continued with the POEM technique. After the selective myotomy was completed, we used an endoluminal suturing device (Overstitch, Apollo Endosurgery, Austin TX) to close the full-thickness esophagotomy in two layers (muscular, mucosal). A covered stent was not an option because the esophagus was dilated, which precluded adequate apposition. The patient had an uneventful postoperative course. At 9-month follow-up, had excellent palliation of dysphagia without reflux. This case demonstrates the importance of identifying extramucosal intrathoracic anatomy, thus emphasizing the need for an experienced surgeon to perform these procedures, or at a minimum to be highly involved. Raising an adequate wheal is crucial before mucosectomy. Inadequacy of the wheal may reflect local esophageal fibrosis. If this fails at multiple locations in the esophagus, it may be prudent to convert to laparoscopy. This case also demonstrates the need for advanced flexible endoscopic therapeutic tools and a multidisciplinary approach to manage potential complications.

  19. Quantitative physical and handling characteristics of novel antibacterial braided silk suture materials. (United States)

    Chen, Xiaojie; Hou, Dandan; Tang, Xiaoqi; Wang, Lu


    Surgical braided silk sutures have been widely used because these materials exhibit good handling characteristics, ease of use, and ideal knot security. However, surgical silk sutures likely cause surgical site infections because these sutures are composed of natural protein materials with a braided structure. As such, antibacterial silk sutures for clinical wound closure should be developed. Braided silk suture could be treated and modified with antibacterial agent, provided that excellent physical and handling characteristics of this material should maximize maintained. This study aimed to quantitatively investigate the effect of antibacterial treatment with different parameters on physical and handling characteristics of novel antibacterial braided silk sutures. Physical and handling characteristics, including appearance, knot-pull tensile strength, pullout friction resistance, tissue drag friction resistance, and bending stiffness, were evaluated. After physical and handling tests were conducted, images showed morphological characteristics were obtained and evaluated to investigate the relationship between antibacterial treatment and physical and handling properties. Results showed that suture diameter increased and reached the nearest thick size specification; knot-pull tensile strength decreased but remained higher than the standard value by at least 40.73%. Fracture asynchronism during knot-pull tensile strength test suggested that the fineness ratio of shell and core strands may enhance knot-pull tensile strength. Static and dynamic frictions of suture-to-suture friction behavior were slightly affected by antibacterial treatment, and changed to less than 16.07% and 32.77%, respectively. Suture-to-tissue friction and bending stiffness increased by approximately 50%; the bending stiffness of the proposed suture remained efficient compared with that of synthetic sutures. Therefore, good physical and handling characteristics can be maintained by selecting

  20. Effects of suture position on left ventricular fluid mechanics under mitral valve edge-to-edge repair. (United States)

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


    Mitral valve (MV) edge-to-edge repair (ETER) is a surgical procedure for the correction of mitral valve regurgitation by suturing the free edge of the leaflets. The leaflets are often sutured at three different positions: central, lateral and commissural portions. To study the effects of position of suture on left ventricular (LV) fluid mechanics under mitral valve ETER, a parametric model of MV-LV system during diastole was developed. The distribution and development of vortex and atrio-ventricular pressure under different suture position were investigated. Results show that the MV sutured at central and lateral in ETER creates two vortex rings around two jets, compared with single vortex ring around one jet of the MV sutured at commissure. Smaller total orifices lead to a higher pressure difference across the atrio-ventricular leaflets in diastole. The central suture generates smaller wall shear stresses than the lateral suture, while the commissural suture generated the minimum wall shear stresses in ETER.

  1. Comparison of 10-0 polypropylene and 10-0 nylon sutures in rat arterial anastomosis. (United States)

    Chen, L E; Seaber, A V; Urbaniak, J R


    The selection of suture materials is an important factor in further improving the results of microsurgical operations. In this study, two kinds of nonabsorbable suture materials, 10-0 polypropylene and 10-0 nylon monofilament, were compared in end-to-end anastomosis of 66 femoral arteries of adult rats. Both suture types were of identical size (70 microns needle/28 microns suture) and each artery received eight sutures. The vessels were harvested at various intervals from 2 hr to 180 days postoperatively and were evaluated by pathology, radiology, and tensile strength test. The results show that both sutures are capable of achieving excellent long-term patency (100%) of anastomosed sites. Polypropylene suture was equivalent to nylon in mechanical integrity of the anastomosis sites but was superior in handling, knotting, and biocompatibility. These physical and biological properties of polypropylene sutures may offer the benefits of diminished early and late complications at anastomosis sites and reduced operation time. Enhancement of contrast against surrounding tissue may make polypropylene a superior alternative to nylon sutures for microsurgical use.

  2. Risk factors for suture requirement and early hypotony in 23-gauge vitrectomy for complex vitreoretinal diseases. (United States)

    Küçük, Erkut; Yılmaz, Uğur; Zor, Kürşad Ramazan; Kalaycı, Defne; Sarıkatipoğlu, Hikmet


    To find out the rate of suture requirement and post-operative hypotony in a series of 23-gauge pars plana vitrectomy cases and analyze the factors affecting post-operative hypotony and leakage of sclerotomy leading to suture placement. This is a single-center retrospective interventional case series. Eighty-four eyes underwent 23-gauge vitrectomy. Primary endpoint measures were rate of leakage of 23-gauge sclerotomies requiring suture placement at the end of surgery and rate of early post-operative hypotony. Secondary endpoint measures were risk factors for early hypotony and leakage requiring suture placement at the end of surgery. Suture placement in at least one sclerotomy because of sclerotomy leakage was required in 28.6 % (24 of 84) of eyes at the end of surgery. Early post-operative hypotony was seen in 14.3 % (12 of 84). Silicone oil endotamponade and single-step surgery were found as factors increasing the risk of sclerotomy leakage leading to suture placement. Suture placement was the only significant factor increasing the risk of early post-operative hypotony. Sclerotomy sutures may be required in 23-gauge surgery, more frequently in cases of single-step sclerotomy and/or silicone oil endotamponade. Meticulous suturation of leaking sclerotomies may decrease the rate of post-operative hypotony.

  3. Osteoprotegerin deficiency results in disruption of posterofrontal suture closure in mice: implications in nonsyndromic craniosynostosis. (United States)

    Beederman, Maureen; Kim, Stephanie H; Rogers, M Rose; Lyon, Sarah M; He, Tong-Chuan; Reid, Russell R


    Little is known about the role of osteoclasts in cranial suture fusion. Osteoclasts are predominantly regulated by receptor activator of nuclear factor kappa B and receptor activator of nuclear factor kappa B ligand, both of which lead to osteoclast differentiation, activation, and survival; and osteoprotegerin, a soluble inhibitor of receptor activator of nuclear factor kappa B. The authors' work examines the role of osteoprotegerin in this process using knockout technology. Wild-type, osteoprotegerin-heterozygous, and osteoprotegerin-knockout mice were imaged by serial micro-computed tomography at 3, 5, 7, 9, and 16 weeks. Suture density measurements and craniometric analysis were performed at these same time points. Posterofrontal sutures were harvested from mice after the week-16 time point and analyzed by means of histochemistry. Micro-computed tomographic analysis of the posterofrontal suture revealed reduced suture fusion in osteoprotegerin-knockout mice compared with wild-type and heterozygous littermates. Osteoprotegerin deficiency resulted in a statistically significant decrease in suture bone density in knockout mice. There was no reduction in the density of non-suture-containing calvarial bone between wild-type and osteoprotegerin-knockout mice. Histochemistry of suture sections supported these micro-computed tomographic findings. Finally, osteoprotegerin-knockout mice had reduced anteroposterior skull distance at all time points and an increased interorbital distance at the week-16 time point. The authors' data suggest that perturbations in the expression of osteoprotegerin and subsequent changes in osteoclastogenesis lead to alterations in murine cranial and posterofrontal suture morphology.

  4. Surgical sutures filled with adipose-derived stem cells promote wound healing.

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    Ann Katharin Reckhenrich

    Full Text Available Delayed wound healing and scar formation are among the most frequent complications after surgical interventions. Although biodegradable surgical sutures present an excellent drug delivery opportunity, their primary function is tissue fixation. Mesenchymal stem cells (MSC act as trophic mediators and are successful in activating biomaterials. Here biodegradable sutures were filled with adipose-derived mesenchymal stem cells (ASC to provide a pro-regenerative environment at the injured site. Results showed that after filling, ASCs attach to the suture material, distribute equally throughout the filaments, and remain viable in the suture. Among a broad panel of cytokines, cell-filled sutures constantly release vascular endothelial growth factor to supernatants. Such conditioned media was evaluated in an in vitro wound healing assay and showed a significant decrease in the open wound area compared to controls. After suturing in an ex vivo wound model, cells remained in the suture and maintained their metabolic activity. Furthermore, cell-filled sutures can be cryopreserved without losing their viability. This study presents an innovative approach to equip surgical sutures with pro-regenerative features and allows the treatment and fixation of wounds in one step, therefore representing a promising tool to promote wound healing after injury.

  5. Median sternotomy: comparative testing of braided superelastic and monofilament stainless steel sternal sutures. (United States)

    Baril, Y; Brailovski, V; Chartrand, M; Terriault, P; Cartier, R


    A new device to reduce the risk of post-operative complications following median sternotomy is proposed, made of a superelastic shape memory alloy and called a braided tubular superelastic (BTS) suture. This study compares the viability of the BTS suture with that of the standard monofilament stainless steel (MSS) suture. A custom test bench was developed to perform comparative testing of the two sternal closure systems. Sternal models made of polyurethane were closed using common wiring configurations. Static and dynamic tensile separation forces, up to a maximum of 1200 N, were then applied to the closed sternums. The MSS and BTS sutures are compared in terms of the force required to open completely the sternum, the compression force at the sternum midline, and the permanent sternum opening. With a smaller sternum opening and a higher tensile separation force, the MSS suture showed greater rigidity than the BTS suture. The BTS suture, however, displayed a better capacity to reapply compression forces at the sternum midline following the repetitive application and release of tensile separation forces. These results confirm the potential of the BTS suture technology, but further studies using cadaveric sterna are needed to attest definitely to the benefits of using the BTS suture to improve bone healing.

  6. Hysteresis of a biomaterial: influence of sutures and biological adhesives. (United States)

    García Páez, J M; Carrera, A; Jorge, E; Millán, I; Cordón, A; Rocha, A; Maestro, M; Castillo-Olivares, J L


    We studied the changes in energy consumption of samples of calf pericardium, when joined or not joined by sutures and adhesives, by means of hysteretic cycles. Sixty-four samples were subsequently subjected to tensile stress until rupture. An overlapping suture sewn in the form of a rectangle presented an acceptable mean resistance to rupture of over 10 MPa, although lower than the mean values in an unsutured control series where the mean resistance surpassed 15 MPa. The contribution of an acrylic adhesive to the resistance to rupture was negligible. The sutured samples that were reinforced with adhesives and had not been subjected to hysteretic cycles prior to rupture showed an anisotropic behavior. This behavior appeared to be lost in all the samples that underwent hysteretic cycles. We found an inflection point in the stress/strain curve following the stepwise increase in the load, with a value greater than and proximate to the final load applied. This inflection should be analyzed by means of microscopy. Finally, the mathematical relationship between the energy consumed and the stress applied, the strain or deformation produced and the number of cycles of hysteresis to which the samples were subjected was established as the ultimate objective of this study. The bonding systems provoked a greater consumption of energy, with the greatest consumption corresponding to the first cycle in all the series assayed. An equation relating the energy consumption in a sample to the number of hysteretic cycles to which it was subjected was obtained. Its asymptote on the x-axis indicates the energy consumption for a theoretical number of cycles, making it possible to estimate the durability of the sample.

  7. Oesophageal elongation with traction sutures (FOKER procedure in a newborn baby with long-gap oesophageal atresia (LGEA: Maybe too early, maybe too dangerous?

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    Holger Till


    Full Text Available In children with long gap oesophageal atresia (LGEA, the FOKER technique (oesophageal elongation with traction sutures has been criticized for its high complication rate. We advocate analysing such problems to increase the safety in the future. The present case report will focus on timing. A female newborn (3000 g with LGEA (gap of 5 cm was delivered in an outward hospital. On day two of life, she received traction sutures on both pouches. By day five, all sutures had torn out, and a primary anastomosis was attempted. However, it leaked severely. Thus, on day ten, the oesophagus was approached from the neck converting the proximal end into a spit fistula and closing the distal end blindly. Furthermore, the gastro-oesophageal (GE- junction was wrapped with a Teflon sling. When the baby arrived in our institution, she suffered from cavernous oesophageal masses extending from the thoracic inlet down to the diaphragm and fistulas draining them into the neck as well as into the right lung. Moreover, the Teflon sling had dislodged allowing for GE-reflux. In several stages, the oesophageal remnants were resected without any complications. Finally, Prof. Alaa Hamza performed a colonic interposition, which is working well today. In conclusion, the present case aims to caution paediatric surgeons to apply traction sutures for oesophageal elongation in newborns with LGEA.

  8. Comparison of staples vs subcuticular suture in class III obese women undergoing cesarean: a randomized controlled trial. (United States)

    Zaki, Mary N; Wing, Deborah A; McNulty, Jennifer A


    Obesity is a risk factor for infectious morbidity and wound complications after cesarean delivery. There are currently insufficient data to determine optimal skin closure technique for cesarean delivery, specifically for those women with class III obesity, defined as a body mass index ≥40 kg/m 2 . We sought to compare stainless steel staples vs subcuticular suture for skin closure for cesarean delivery in class III obese women with body mass index ≥40 kg/m 2 . We conducted a randomized controlled trial at 2 teaching hospitals from 2015 through 2016 in which women with body mass index ≥40 kg/m 2 undergoing cesarean delivery were randomly assigned to stainless steel staples or subcuticular suture skin closure. The primary outcome was composite wound complication defined as superficial or deep separation and infection occurring up to 6 weeks following delivery. Secondary outcomes included operative time, and patient pain and satisfaction scores. A total of 242 women were enrolled. In all, 119 in the staples group and 119 in the subcuticular suture group were analyzed. Maternal demographics and characteristics were similar in both groups. The composite wound complication frequency was 19.3% in the staples group and 17.6% in the subcuticular suture group (P = .74) with an overall wound complication incidence of 18.5% in the entire study cohort. There were also no differences in the frequencies of infection, or in superficial or deep wound separation between the 2 study groups. In a univariate analysis of predictors of wound complications, only current tobacco use was a significant predictor of wound complications (relative risk, 4.97; 95% confidence interval, 1.37-18.03; P = .02). Fewer women with staple closure would choose the same method with a future delivery (P = .01), however, self-reported pain and concern about wound healing were equal between the 2 groups. In class III obese women undergoing cesarean delivery, there was no difference in composite wound

  9. Inhibition of bone resorption by bisphosphonates interferes with orthodontically induced midpalatal suture expansion in mice. (United States)

    Koehne, Till; Kahl-Nieke, Bärbel; Amling, Michael; Korbmacher-Steiner, Heike


    Craniofacial sutures are important growth sites for skull development and are sensitive to mechanical stress. In order to determine the role of bone resorption in stress-mediated sutural bone growth, midpalatal suture expansion was performed in mice receiving alendronate, an anti-resorptive bisphosphonate. The midpalatal sutures of 8-week-old C57BL/6 mice were expanded by orthodontic wires over the period of 2 weeks. Mice with maxillary expansion without drug treatment as well as untreated animals served as controls. Skulls were analyzed with micro-computed tomography (micro-CT), immunohistochemistry and histology. Maxillary expansion in mice without drug treatment resulted in an increase of TRAP-positive osteoclasts. In contrast, no increase in osteoclasts was observed in expanded sutures of mice with bisphosphonate treatment. Double calcein labeling demonstrated rapid bone formation on the oral edges of the expanded sutures in mice without bisphosphonate treatment. Less bone formation was observed in bisphosphonate-treated mice after expansion. Histology revealed that the sutural architecture was reestablished in expanded sutures of mice without bisphosphonate treatment. In contrast, the sutural architecture was disorganized and the cartilage had an irregular form, following expansion in bisphosphonate-treated mice. Finally, micro-CT imaging demonstrated that the total amount of maxillary expansion was significantly lower in mice with bisphosphonate treatment as compared to those of mice without drug treatment. In conclusion, our results indicate that osteoclast-mediated bone resorption is needed for maxillary suture expansion and reorganization of sutural architecture. Orthodontic palatal expansion can be complicated in patients with inherited or drug-induced diseases of osteoclast dysfunction.

  10. Subluxation of suture-fixated posterior chamber intraocular lenses a clinicopathologic study. (United States)

    Parekh, Parag; Green, W Richard; Stark, Walter J; Akpek, Esen Karamursel


    To report the occurrence of subluxation of suture-fixated posterior chamber (PC) intraocular lenses (IOL) and elucidate the mechanisms involved. Prospective clinicopathologic study. A single 10-0 Prolene suture explanted from a patient who experienced subluxation of his PC-IOL, 11.5 years after placement. Furthermore, multiple 10-0 Prolene sutures and PC-IOLs used for iris fixation were studied as controls. Scanning electron microscopy (SEM) was used to analyze the surface of the explanted suture. In addition, randomly selected 10-0 Prolene sutures cut with Vannas scissors and cut with the positioning holes of a randomly selected PC-IOL identical to that implanted in the patient's eye were examined as controls. Finally, the positioning holes of several randomly selected, iris-fixated PC-IOLs were studied using SEM with particular attention to surface quality and edge finish. Presence of any signs of suture degradation, the character of the cut edge of the suture, as well as the characteristics of the positioning holes of the PC-IOLs. Scanning electron microscopy of the explanted suture revealed sharply cut edges, without significant degradation of the suture, and no intact loop. Scanning electron microscopy of the control suture cut with a PC-IOL demonstrated a similarly cut edge. The positioning holes of the examined PC-IOLs had a sharp edge, and some also had an imperfect finish. We conclude that the surface properties of the positioning holes lead to cutting of the suture, and subsequent subluxation of the PC-IOL.

  11. Mechanical testing of different knot types using high-performance suture material. (United States)

    Baums, M H; Sachs, Ch; Kostuj, T; Schmidt-Horlohé, K; Schultz, W; Klinger, H-M


    This laboratory study aimed to evaluate the loop security, knot security, cyclic loading resistance and load-to-failure rate of three different knot types with establishing a new experimental set-up. Additionally, the mode of failure of each knot was evaluated. With the use of nonabsorbable, braided polyethylene sutures, USP size No. 2 [Hi-Fi ® ; ConMed Linvatec], the arthroscopic knot types Dines, SMC as well as the surgeon's knot were tested using a material testing machine. The knots were tied openly as well as arthroscopically. The set-up enables testing of knot configurations while eliminating friction between knot loop and its suspension points. Including all test procedures, a total of 216 knots were tested. All openly tied knot types and ten of each type of arthroscopically tied knots resisted against cyclic loading of 1,000 cycles. With subsequent load-to-failure testing, openly tied knot types achieved significantly higher values of tensile strength than arthroscopically tied knots. Regarding clinical failure, defined as an elongation of 3 mm, Dines knot reached highest loop as well as knot security. Knot slippage was the most common failure mechanism at an elongation of 3 mm, whereas suture breakage was evaluated most at an elongation of 6 mm. The new experimental set-up confirms the loop security of arthroscopic knot types. Using a knot pusher clinically is a key factor to attain this as compared to openly hand-tied techniques. The Dines knot presented the highest reliability. It may provide a secure tissue healing during rehabilitation and consequently can be recommended for clinical application.

  12. Skin suturing and cortical surface viral infusion improves imaging of neuronal ensemble activity with head-mounted miniature microscopes. (United States)

    Li, Xinjian; Cao, Vania Y; Zhang, Wenyu; Mastwal, Surjeet S; Liu, Qing; Otte, Stephani; Wang, Kuan Hong


    In vivo optical imaging of neural activity provides important insights into brain functions at the single-cell level. Cranial windows and virally delivered calcium indicators are commonly used for imaging cortical activity through two-photon microscopes in head-fixed animals. Recently, head-mounted one-photon microscopes have been developed for freely behaving animals. However, minimizing tissue damage from the virus injection procedure and maintaining window clarity for imaging can be technically challenging. We used a wide-diameter glass pipette at the cortical surface for infusing the viral calcium reporter AAV-GCaMP6 into the cortex. After infusion, the scalp skin over the implanted optical window was sutured to facilitate postoperative recovery. The sutured scalp was removed approximately two weeks later and a miniature microscope was attached above the window to image neuronal activity in freely moving mice. We found that cortical surface virus infusion efficiently labeled neurons in superficial layers, and scalp skin suturing helped to maintain the long-term clarity of optical windows. As a result, several hundred neurons could be recorded in freely moving animals. Compared to intracortical virus injection and open-scalp postoperative recovery, our methods minimized tissue damage and dura overgrowth underneath the optical window, and significantly increased the experimental success rate and the yield of identified neurons. Our improved cranial surgery technique allows for high-yield calcium imaging of cortical neurons with head-mounted microscopes in freely behaving animals. This technique may be beneficial for other optical applications such as two-photon microscopy, multi-site imaging, and optogenetic modulation. Published by Elsevier B.V.

  13. Reconstruction techniques in renal injury

    International Nuclear Information System (INIS)

    Akay, Ali F.; Sahin, H.; Aflay, U.; Bircan, Mehmet K.; Nergiz, Y.


    Kidney repair reconstruction techniques are controversial. The conventional technique is suturing, but this is usually with further loss of viable tissue as it promotes scaring. In this animal model, we investigated the parenchymal effect of different sutures and methods. We carried out this study in the year 2000 in the Animal Laboratory of Dicle University, Diyarbakir, Turkey. We used 40 New Zealand white rabbits in this study, randomized into 5 groups. We separated the left kidney from Gerota's fascia, and performed standard lacerations with incisions 5 mm deep and 10 mm in length. We performed no reconstruction procedure in group 1, and used homeostatic collagen powder in group 2. We primarily sutured the lacerations with chromic gut (4/0) in group 3, and sutured the kidney in group 4 with polyglactin (4/0). We wrapped the kidney with a polyglactin mesh in group 5. We sacrificed 2 rabbits in each group postoperatively on day 2, 15, 45 and 90, and performed left nephrectomy for histological investigation, and assessed interstitial inflammation. While group 5 established the best results, the other 4 groups had similar intermediate results. The pseudocapsule was visible macroscopically in the polyglactin mesh group. We could see mononuclear cell infiltration, dilatation of tubules, atrophy of tubules, and interstitial fibrosis in all groups except group 5. In this animal model, we found that the most appropriate repair material for kidney surgery was polyglactin mesh. (author)


    Directory of Open Access Journals (Sweden)

    Josephine Pudumai Selvi


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

  15. [Prevention of surgical infection using reabsorbable antibacterial suture (Vicryl Plus) versus reabsorbable conventional suture in hernioplasty. An experimental study in animals]. (United States)

    Suárez Grau, Juan Manuel; De Toro Crespo, María; Docobo Durántez, Fernando; Rubio Chaves, Carolina; Martín Cartes, Juan Antonio; Docobo Pérez, Fernando


    Surgical site infections are frequent in daily surgical practice. One of the main challenges currently facing surgeons is the prevention and treatment of infections, especially those involving prosthetic material. A new suture (Vicryl Plus) has become available. In vitro studies and experimental models have demonstrated the ability of this suture to inhibit bacterial growth and consequently prevent postsurgical infection. To compare infections provoked in prosthetic implants fixed with reabsorbable conventional sutures with those in meshes fixed with reabsorbable sutures with antiseptic impregnation. Twenty white Wistar rats were used. In each rat, two hernioplasties were performed: one fixed with Vicryl Plus and the other with normal Vicryl. Subsequently, each polypropylene mesh was infected with S. aureus, and the rats remained in individual cages for a week. After 1 week, the rats were sacrificed and the meshes were extracted for macroscopic, microscopic and microbiologic study. Most of the meshes fixed with the new suture (Vicryl Plus) showed macroscopically fewer infections than those fixed with conventional suture, without abscesses and without dehiscence of the hernioplasty. In the microbiological quantitative bacterial study, the number of bacteria quantified per gram of sample was also lower in prostheses fixed with Vicryl Plus. Pathological analysis showed lesser colonization of the mesh and lower inflammatory response with Vicryl Plus than with normal Vicryl. In the statistical analysis, comparison of the medians of both groups and the interquartile ranges of microbial quantification revealed a lower infection rate in the Vicryl Plus group. The infection rate in the surgical site can be reduced by mesh fixation using the new antimicrobial suture (Vicryl Plus). We believe that this type of suture constitutes a new weapon in the fight against postoperative infection, especially in hernioplasty, emergency surgery, and dirty or potentially contaminated

  16. Interactive Virtual Suturing Simulations: Enhancement of Student Learning in Veterinary Medicine (United States)

    Staton, Amy J.; Boyd, Christine B.


    This capstone addresses an instructional gap in the Morehead State University Veterinary Technology Program and in other similar programs around the globe. Students do not retain the knowledge needed to proficiently complete suture patterns nor do students receive sufficient instructional time during the year to master each suture pattern that is…

  17. Critical Anatomy Relative to the Sacral Suture: A Postoperative Imaging Study After Robotic Sacrocolpopexy. (United States)

    Crisp, Catrina C; Herfel, Charles V; Pauls, Rachel N; Westermann, Lauren B; Kleeman, Steven D


    This study aimed to characterize pertinent anatomy relative to the sacral suture placed at time of robotic sacrocolpopexy using postoperative computed tomography and magnetic resonance imaging. A vascular clip was placed at the base of the sacral suture at the time of robotic sacrocolpopexy. Six weeks postoperatively, subjects returned for a computed tomography scan and magnetic resonance imaging. Ten subjects completed the study. The middle sacral artery and vein coursed midline or to the left of midline in all the subjects. The left common iliac vein was an average of 26 mm from the sacral suture. To the right of the suture, the right common iliac artery was 18 mm away. Following the right common iliac artery to its bifurcation, the right internal iliac was on average 10 mm from the suture. The bifurcations of the inferior vena cava and the aorta were 33 mm and 54 mm further cephalad, respectively.The right ureter, on average, was 18 mm from the suture. The thickness of the anterior longitudinal ligament was 2 mm.The mean angle of descent of the sacrum was 70 degrees. Lastly, we found that 70% of the time, a vertebral body was directly below the suture; the disc was noted in 30%. We describe critical anatomy surrounding the sacral suture placed during robotic sacrocolpopexy. Proximity of both vascular and urologic structures within 10 to 18 mm, as well as anterior ligament thickness of only 2 mm highlights the importance of adequate exposure, careful dissection, and surgeon expertise.

  18. Early secondary suture versus healing by second intention of incisional abscesses

    DEFF Research Database (Denmark)

    Hermann, G G; Bagi, P; Christoffersen, I


    A controlled trial was set up to compare the treatment of wound abscesses, occurring after laparotomy, with either early secondary suture combined with cefuroxime and metronidazole given intravenously or by healing by second intention. The secondary suture was performed two days after wound...... drainage and resulted in a significant reduction (p less than 0.01) in healing time without complications. No reinfections occurred....

  19. Antibacterial-Coated Suture in Reducing Surgical Site Infection in Breast Surgery: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Enora Laas


    Full Text Available Background. To reduce the incidence of microbial colonization of suture material, Triclosan- (TC-coated suture materials have been developed. The aim of this study was to assess the incidence of suture-related complications (SRC in breast surgery with and without the use of TC-coated sutures. Methods. We performed a study on two consecutive periods: 92 patients underwent breast surgery with conventional sutures (Group 1 and 98 with TC-coated sutures (Group 2. We performed subgroups analyses and developed a model to predict SRC in Group 1 and tested its clinical efficacy in Group 2 using a nomogram-based approach. Results. The SRC rates were 13% in Group 1 and 8% in Group 2. We found that some subgroups may benefit from TC-coated sutures. The discrimination obtained from a logistic regression model developed in Group 1 and based on multifocality, age and axillary lymphadenectomy was 0.88 (95% CI 0.77–0.95 (. There was a significant difference in Group 2 between predicted probabilities and observed percentages (. The predicted and observed proportions of complications in the high-risk group were 38% and 13%, respectively. Conclusion. This study used individual predictions of SRC and showed that using TC-coated suture may prevent SRC. This was particularly significant in high-risk patients.

  20. Sutures coated with antiseptic pomade to prevent bacterial colonization: a randomized clinical trial. (United States)

    Cruz, Fernando; Leite, Fabiola; Cruz, Gustavo; Cruz, Silvia; Reis, Juarez; Pierce, Matthew; Cruz, Mauro


    The aim of this study was to assess if an antiseptic pomade could reduce the bacterial colonization on multifilament sutures. A randomized clinical trial was conducted with 40 volunteer patients of both sexes aged 18-70, randomly separated into experimental (n = 20) and control (n = 20) groups. The experimental group received pomade-coated sutures (iodoform + calendula) and the control group uncoated sutures. Two millimeters of the suture was harvested from each patient from the 1st to the 15th postoperative day. The bacteria that had adhered to them were cultured. The number of colony-forming units per milliliter (CFU/mL) was determined and the groups were compared using the Mann-Whitney statistical test (P antiseptic pomade was effective in reducing bacterial colonization on silk braided sutures. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Nonabsorbable-Suture-Induced Osteomyelitis: A Case Report and Review of the Literature

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    Cheng Hong Yeo


    Full Text Available We are reporting a case of nonabsorbable suture-induced osteomyelitis in patient who had an open rotator cuff repair with nonabsorbable Ethibond anchor suture. Patient in this case presented with very subtle clinical features of osteomyelitis of the left proximal humerus 15 years after initial rotator cuff repair surgery. Literature had shown that deep infection following rotator cuff repairs, although rare, can be easily missed and can cause severe complications. Absorbable suture had been demonstrated to be more superior, in terms of rate of deep infection, as compared to nonabsorbable suture when used in rotator cuff repair surgery. Both absorbable and nonabsorbable suture had been demonstrated to have similar mechanical properties by several different studies. The case demonstrated that initial presentation of deep infection can be subtle and easily missed by clinicians and leads to further complications.

  2. Comparison of antibacterial-coated and non-coated suture material in intraoral surgery by isolation of adherent bacteria

    Directory of Open Access Journals (Sweden)

    Klaus Pelz


    In terms of the total number of oral bacteria, and especially oral pathogens, that adhered to suture material, no reduction was demonstrated for Vicryl Plus. The use of triclosan-coated suture material offers no advantage in intraoral surgery.

  3. Nylon Hang Back Sutures in the Repair of Secondary Ptosis Following Overcorrected Dysthyroid Upper Eyelid Retraction. (United States)

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


    (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.

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

    Directory of Open Access Journals (Sweden)

    Nelson de Souza Liboni


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


    Directory of Open Access Journals (Sweden)

    Santosh Kumar


    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


    Directory of Open Access Journals (Sweden)

    Predrag Spirić


    Full Text Available Surgical technique of total laryngectomy is well presented in many surgical textbooks. Essentially, it has remained the same since Gluck an Soerensen in 1922 described all its details. Generally, it stresses the U shape skin incision with releasing laryngeal structures and removing larynx from up to down. Further, pharyngeal reconstruction is performed with different kinds of sutures in two or more layers and is finished with skin suture and suction drainage. One of worst complications following this surgery is pharyngocutaneous fistula (PF. Modifications proposed in this this article suggests vertical skin incision with larynx removal from below upwards. In pharyngeal reconstruction we used the running locked suture in submucosal plan with „tobacco sac“ at the end on the tongue base instead of traditional T shaped suture. Suction drains were not used.The aim of study was to present the modified surgical technique of total laryingectomy and its impact on hospital stay duration and pharyngocutanous fistula formation. In this randomized study we analyzed 49 patients operated with modified surgical technique compared to 49 patient operated with traditional surgical technique of total laryngectomy. The modified technique of total laryngectomy was presented. Using modified technique we managed to decrease the PF percentage from previous 20,41% to acceptable 8,16% (p=0,0334. Also, the average hospital stay was shortened from 14,96 to 10,63 days (t =-2.9850; p=0.0358.The modified technique of total laryngectomy is safe, short and efficient surgical intervention which decreases the number of pharyngocutaneos fistulas and shortens the hospital stay.

  7. Biomechanical performance of a collagen meniscus implant with regard to suture material and irrigation fluid. (United States)

    Gwinner, Clemens; von Roth, Philipp; Schmidt, Sebastian; Ode, Jan-Erik; Wulsten, Dag; Hoburg, Arnd


    The role of meniscus scaffolds remains controversial as failure rates remain high. The aim of this study was to evaluate the pullout strength of different suture materials used for fixation of the Collagen Meniscus Implant (CMI) regarding different suture materials, and type or temperature of irrigation fluid. One-hundred and twelve specimens were utilized with horizontal sutures and mounted to a dedicated test device. Loads were applied perpendicular to the CMI, until failure. Two differing suture materials - polydioxanone (PDS) and non-absorbable, braided polyester sutures (NABP) - were evaluated. Additionally, two common irrigation fluids - lactated Ringer's and electrolyte-free, hypotonic Mannitol-Sorbitol solution - were evaluated. Specimens were further evaluated according to different temperatures of the irrigation fluid. Half of the constructs were tested at room temperature (20°C) and half were evaluated at near-core body temperature (37°C). PDS sutures showed a significantly higher load-to-failure compared to NABP sutures (P=0.0008). Regarding the type of irrigation fluid, the electrolyte-free Mannitol-Sorbitol solution showed a significantly higher load-to-failure compared to the overall Ringer group (P b 0.0001). This was equivalent for both the PDS (P=0.015) and for the NABP sutures (P b 0.0001). The temperature of the irrigation fluid did not significantly influence load-to-failure. PDS sutures and electrolyte-free Mannitol-Sorbitol irrigation fluid provided the best biomechanical properties regarding load-to-failure testing. This study underlines the potential to improve construct stability for the CMI by alteration of the suture material and the type of irrigation fluid, which should be considered whenever scaffold fixation is conducted. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Mitral annuloplasty ring suture forces: Impact of surgeon, ring, and use conditions. (United States)

    Pierce, Eric L; Bloodworth, Charles H; Siefert, Andrew W; Easley, Thomas F; Takayama, Tetsushi; Kawamura, Tomonori; Gorman, Robert C; Gorman, Joseph H; Yoganathan, Ajit P


    The study objective was to quantify the effect of ring type, ring-annulus sizing, suture position, and surgeon on the forces required to tie down and constrain a mitral annuloplasty ring to a beating heart. Physio (Edwards Lifesciences, Irvine, Calif) or Profile 3D (Medtronic, Dublin, Ireland) annuloplasty rings were instrumented with suture force transducers and implanted in ovine subjects (N = 23). Tie-down forces and cyclic contractile forces were recorded and analyzed at 10 suture positions and at 3 levels of increasing peak left ventricular pressure. Across all conditions, tie-down force was 2.7 ± 1.4 N and cyclic contractile force was 2.0 ± 1.2 N. Tie-down force was not meaningfully affected by any factor except surgeon. Significant differences in overall and individual tie-down forces were observed between the 2 primary implanting surgeons. No other factors were observed to significantly affect tie-down force. Contractile suture forces were significantly reduced by ring-annulus true sizing. This was driven almost exclusively by Physio cases and by reduction along the anterior aspect, where dehiscence is less common clinically. Contractile suture forces did not differ significantly between ring types. However, when undersizing, Profile 3D forces were significantly more uniform around the annular circumference. A suture's tie-down force did not correlate to its eventual contractile force. Mitral annuloplasty suture loading is influenced by ring type, ring-annulus sizing, suture position, and surgeon, suggesting that reports of dehiscence may not be merely a series of isolated errors. When compared with forces known to cause suture dehiscence, these in vivo suture loading data aid in establishing potential targets for reducing the occurrence of ring dehiscence. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  9. Nonabsorbable versus absorbable sutures in large, hang-back medial rectus muscle recessions. (United States)

    Awadein, Ahmed; Marsh, Justin D; Guyton, David L


    To investigate the value of nonabsorbable sutures in reducing the incidence of consecutive exotropia after large, "hang-back" medial rectus recessions. The medical records of patients who underwent medial rectus recession of ≥6.5 mm in individuals ≤2 years of age, or ≥7.0 mm in those >2 years were retrospectively reviewed. Patients were divided into two groups based on suture material used: absorbable, polyglactin 910 sutures (44 patients); nonabsorbable, polyester sutures (50 patients). Preoperative measurements, ductions, strabismus surgery, and postoperative results were analyzed. Inadequate anchoring of the medial rectus muscle was suspected when consecutive exotropia developed 4-7 weeks after surgery after initial satisfactory alignment and was confirmed if during reoperation the medial rectus muscle appeared recessed >2 mm beyond the originally intended recession. Consecutive exotropia due to inadequate anchoring of the medial rectus muscle occurred in 11 of 66 muscles (17%) in the absorbable suture group. The muscle was found 6-10 mm posterior to the intended recession. Limited duction in the field of action of the involved medial rectus muscle occurred in 9 of the 11 muscles (82%). None of the eyes with nonabsorbable sutures showed inadequate anchoring. The incidence of consecutive exotropia was higher in the absorbable suture group (30%) than in the nonabsorbable suture group (6%) (P < 0.005). Using nonabsorbable suture for large, hang-back medial rectus recessions greatly reduces the incidence of consecutive exotropia that can occur when absorbable suture dissolves. Copyright © 2016 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

  10. Use of the Taguchi method for biomechanical comparison of flexor-tendon-repair techniques to allow immediate active flexion. A new method of analysis and optimization of technique to improve the quality of the repair. (United States)

    Singer, G; Ebramzadeh, E; Jones, N F; Meals, R


    The current trend toward early active flexion after repair of the flexor tendons necessitates a stronger repair than that provided by a modified Kessler technique with use of 4-0 nylon suture. The purpose of the current study was to determine, with use of the Taguchi method of analysis, the strongest and most consistent repair of the flexor tendons. Flexor tendons were obtained from fresh-frozen hands of human cadavera. Eight flexor tendons initially were repaired with the modified Kessler technique with use of 4-0 nylon core suture and 6-0 nylon epitenon suture. A test matrix was used to analyze a total of twenty variables in sixty-four tests. These variables included eight techniques for core-suture repair, four types of core suture, two sizes of core suture, four techniques for suture of the epitenon, and two distances from the repair site for placement of the core suture. After each repair, the specimens were mounted in a servohydraulic mechanical testing machine for tension-testing to failure. The optimum combination of variables was determined, with the Taguchi method, to be an augmented Becker technique with use of 3-0 Mersilene core suture, placed 0.75 centimeter from the cut edge with volar epitenon suture. The four-strand, double modified Kessler technique provided the second strongest repair. Five tendons that had been repaired with use of the optimum combination then were tested and compared with tendons that had been repaired with the standard modified Kessler technique. With the optimum combination of variables, the strength of the repair improved from a mean (and standard deviation) of 17.2 +/- 2.9 to 128 +/- 5.6 newtons, and the stiffness improved from a mean of 4.6 to 16.2 newtons per millimeter.

  11. Single-incision laparoscopic splenectomy with innovative gastric traction suture

    Directory of Open Access Journals (Sweden)

    Srikanth G


    Full Text Available Laparoscopic splenectomy is now the gold standard for patients with idiopathic thrombocytopenic purpura (ITP undergoing splenectomy. There are a few reports in literature on single-incision laparoscopic (SIL splenectomy. Herein, we describe a patient undergoing SIL splenectomy for ITP without the use of a disposable port device. We report a 20-year-old female patient with steroid-refractory ITP having a platelet count of 14,000/cmm who underwent a SIL splenectomy. Dissection was facilitated by the use of a single articulating grasper and a gastric traction suture and splenic vessels were secured at the hilum with an endo-GIA stapler. She made an uneventful postoperative recovery and was discharged on the second postoperative day. She is doing well with no visible scar at 8-month follow-up.

  12. [Animal experiment study of healing of the sutured flexor tendon]. (United States)

    Martini, A K; Blimke, B


    The purpose of the present study was to determine whether tendons contain intrinsic cells capable of repair. To accomplish this, rabbit flexor tendons were exposed microsurgically, cut through, resutured and transferred as free transplant into the knee-joint. Immobilisation of the knee-joint will cause progressive formation of adhesions permitting neovascularisation of the transplant. Both is not observed when sutured flexor tendons were put in a knee articulation with full range of joint motion. Transmission electron micrography revealed up to 8 weeks after implantation vital cells and incidences of collagen neosynthesis independently whether adhesions existed or not. Histologically intrinsic repair was confirmed in mobile transplants and mainly initiated by cells of the visceral synovial sheet which form an anatomic-surgical unity with the tendon. In conclusion the importance of the synovial fluid for the tendon nutrition is underlined by the fact that an intrinsic healing of flexor tendon is possible without formation of adhesions.

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

    Directory of Open Access Journals (Sweden)

    Ning Liu


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

  14. Identification of IGF-I in the calvarial suture of young rats: histochemical analysis of the cranial sagittal sutures in a hyperthyroid rat model. (United States)

    Akita, S; Hirano, A; Fujii, T


    Premature closure of cranial sutures has been known as one of the complications of juvenile or congenital hyperthyroidism. Thyroid hormone is an anabolic agent for bone formation in the early stages of childhood development. In children, excess thyroid hormone acts as an acceleration factor for the skeletal bone, whereas in adult hyperthyroidism, it causes bone mineral loss due to the high turnover rate of bone formation and consequently bone resorption. In addition, there are numerous literature descriptions concerning the interactions among bone metabolism, hormones, and growth factors, among which insulin-like growth factor I (IGF-I) is the most abundantly found growth factor in osteoblasts and in bone models in vivo. We therefore investigated whether or not the cranial sutures show accelerated closure and how the local growth factors or cytokines participate and function in local bone metabolism after administration of exogenous excess thyroid hormone in a rat model. A total of 60 female Wistar rats, aged 10 days, were divided into two groups, the triiodothyronine (T3)-treated group (n = 30, T3 0.1 microgram/gm of body weight per day) and the control group (n = 30, saline vehicle only), and were maintained and subsequently sacrificed at 15, 30, and 60 days. The parameters of cranial width derived from the morphologic measurements of the skull indicated that the lambda-asterion distance at 30 days and the pterion-bregma distance at 60 days in the T3-treated group were significantly decreased compared with those of the control group. Furthermore, the fluorescent histologic findings showed fluorescent labeling with no interruption along the suture edges, suggesting continuous bone formation, and displayed narrowing of the suture gap of the sagittal suture in the T3-treated group. Tartrate resistant acid phosphatase staining showed very little osteoclastic activity in the sagittal suture, especially in the T3-treated group. The intensity of immunohistochemical

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

    International Nuclear Information System (INIS)

    Simanovsky, Natalia; Hiller, Nurith; Koplewitz, Benjamin; Rozovsky, Katya


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

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  17. Immunostimulatory sutures that treat local disease recurrence following primary tumor resection

    Energy Technology Data Exchange (ETDEWEB)

    Intra, Janjira; Zhang Xueqing; Salem, Aliasger K [Division of Pharmaceutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242 (United States); Williams, Robin L; Zhu Xiaoyan [Department of Surgery, Roy J and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA 52242 (United States); Sandler, Anthony D, E-mail: [Department of Surgery and Center for Cancer and Immunology Research, Children' s National Medical Center, Washington DC 20010 (United States)


    Neuroblastoma is a common childhood cancer that often results in progressive minimal residual disease after primary tumor resection. Cytosine-phosphorothioate-guanine oligonucleotides (CpG ODN) have been reported to induce potent anti-tumor immune responses. In this communication, we report on the development of a CpG ODN-loaded suture that can close up the wound following tumor excision and provide sustained localized delivery of CpG ODN to treat local disease recurrence. The suture was prepared by melt extruding a mixture of polylactic acid-co-glycolic acid (PLGA 75:25 0.47 dL g{sup -1}) pellets and CpG ODN 1826. Scanning electron microscopy images showed that the sutures were free of defects and cracks. UV spectrophotometry measurements at 260 nm showed that sutures provide sustained release of CpG ODN over 35 days. Syngeneic female A/J mice were inoculated subcutaneously with 1 x 10{sup 6} Neuro-2a murine neuroblastoma wild-type cells and tumors were grown between 5 to 10 mm before the tumors were excised. Wounds from the tumor resection were closed using CpG ODN-loaded sutures and/or polyglycolic acid Vicryl suture. Suppression of neuroblastoma recurrence and mouse survival were significantly higher in mice where wounds were closed using the CpG ODN-loaded sutures relative to all other groups. (communication)

  18. Mechanical properties of commercially available nylon sutures in the United States. (United States)

    Callahan, Travis L; Lear, William; Kruzic, Jamie J; Maughan, Cory B


    Surgeons can choose from a wide selection of commercially available suture brands, which come at a range of prices. There is currently limited evidence in the literature to guide this selection process. This investigation examined the breaking force, stress, and elongation of a variety of commercially available nylon sutures compared to their relative prices. Seven 5-0, nonabsorbable, nylon suture brands were tensile tested in straight, knotted and knot-security configurations according to the procedures outlined by the United States Pharmacopeia for the tensile testing of sutures. Covidien, the cheapest brand tested, had the highest failure load of straight and knot-security tests. Dafilon was found to have the highest breaking force and percent elongation of knot-pull tests. J&J Ethicon and Supramid had the highest percent elongation to failure for straight-pull and knot-security tests, respectively. This study was limited to specific in vitro tensile properties of nylon suture. Other factors affecting suture quality and price, such as needle properties, were not investigated. The data presented in the study provide information for guiding the selection and purchase of sutures according to tensile properties. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 815-819, 2017. © 2016 Wiley Periodicals, Inc.

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

    Directory of Open Access Journals (Sweden)

    Alireza Saied


    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

  20. [An experimental assessment of methods for applying intestinal sutures in intestinal obstruction]. (United States)

    Akhmadudinov, M G


    The results of various methods used in applying intestinal sutures in obturation were studied. Three series of experiments were conducted on 30 dogs--resection of the intestine after obstruction with the formation of anastomoses by means of double-row suture (Albert--Shmiden--Lambert) in the first series (10 dogs), by a single-row suture after V. M. Mateshchuk [correction of Mateshuku] in the second series, and bu a single-row stretching suture suggested by the author in the third series. The postoperative complications and the parameters of physical airtightness of the intestinal anastomosis were studied in dynamics in the experimental animals. The results of the study: incompetence of the anastomosis sutures in the first series 6, in the second 4, and in the third series one. Adhesions occurred in all animals of the first and second series and in 2 of the third series. Six dogs of the first series died, 4 of the second, and one of the third. Study of the dynamics of the results showed a direct connection of the complications with the parameters of the physical airtightness of the anastomosis, and the last-named with the method of the intestinal suture. Relatively better results were noted in formation of the anastomosis by means of our suggested stretshing continuous suture passed through the serous, muscular, and submucous coats of the intestine.

  1. Triclosan-coated sutures and sternal wound infections: a prospective randomized clinical trial. (United States)

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


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

  2. Triclosan-coated sutures reduce wound infections after spinal surgery: a retrospective, nonrandomized, clinical study. (United States)

    Ueno, Masaki; Saito, Wataru; Yamagata, Megumu; Imura, Takayuki; Inoue, Gen; Nakazawa, Toshiyuki; Takahira, Naonobu; Uchida, Kentaro; Fukahori, Nobuko; Shimomura, Kiyomi; Takaso, Masashi


    Surgical site infection (SSI) is a serious postoperative complication. The incidence of SSIs is lower in clean orthopedic surgery than in other fields, but it is higher after spinal surgery, reaching 4.15% in high-risk patients. Several studies reported that triclosan-coated polyglactin 910 sutures (Vicryl Plus; Ethicon, Inc., Somerville, NJ, USA) significantly reduced the infection rate in the general surgical, neurosurgical, and thoracic surgical fields. However, there have been no studies on the effects of such coated sutures on the incidence of SSIs in orthopedics. To compare the incidence of wound infections after spinal surgery using triclosan-coated suture materials with that of noncoated ones. A retrospective, nonrandomized, and clinical study. From May 2010 to April 2012, 405 patients underwent a spinal surgical procedure in the Department of Orthopedic Surgery of two university hospitals. The primary outcome was the number of wound infections and dehiscences. Two hundred five patients had a conventional wound closure with polyglactin 910 suture (Vicryl) between May 2010 and April 2011 (Time Period 1 [TP1]), and 200 patients underwent wound closure with triclosan-coated polyglactin 910 suture (Vicryl Plus) between May 2011 and April 2012 (TP2). Statistical comparisons of wound infections, dehiscence, and risk factors for poor wound healing or infection were performed. None of the authors has any conflict of interest associated with this study. There were two cases of wound dehiscence in TP1 and one in TP2 (p=.509). Using noncoated sutures in TP1, eight patients (3.90%) had wound infections, whereas one patient (0.50%) had wound infections in TP2 (using triclosan-coated sutures); the difference was significant (p=.020). The use of triclosan-coated polyglactin 910 sutures instead of polyglactin 910 sutures may reduce the number of wound infections after spinal surgery. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Phimon Atsawasuwan

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

  4. Outcomes of scleral-sutured conventional and aniridia intraocular lens implantation performed in a university hospital setting. (United States)

    Lockington, David; Ali, Noor Q; Al-Taie, Rasha; Patel, Dipika V; McGhee, Charles N J


    To evaluate the outcomes of transscleral sutured posterior chamber intraocular lens (PC IOL) implantation. Public university hospital, Auckland, New Zealand. Retrospective case series. A modified no-touch transscleral sutured PC IOL implantation technique with a 1-piece monofocal IOL (Alcon CZ70BD) or an aniridia IOL (type 67G, Morcher) was assessed. Seventy-eight cases (80.8% men; 53.9% aphakic) were identified. The mean follow-up was 35.5 months and the mean age at surgery, 41 years±21 (SD). The preoperative corrected distance visual acuity (CDVA) was worse than 6/30 in 66.7%. Indications included ocular trauma (46.2%), nontraumatic crystalline lens subluxation (16.7%), post-complicated cataract surgery (10.3%), idiopathic IOL dislocation (10.3%), and congenital cataract/aphakia (10.3%). An aniridia IOL was required in 39.7% of eyes. There were no significant intraoperative complications in 74.4% of eyes. Postoperative complications included transient corneal edema (15.4%), wound leak requiring resuturing (7.7%), retinal detachment (7.7%), and cystoid macular edema (6.4%). One eye (1.3%) developed suture breakage-related late IOL dislocation. Overall, 91.3% of eyes had improved visual acuity or were within 1 line of the presenting CDVA. In eyes with a guarded prognosis, 34.8% achieved a CDVA of 6/12 or better and 43.5% a CDVA of 6/15 to 6/48. In the better prognosis group, 73.9% achieved a CDVA of better than 6/12 and all achieved better than 6/30. Scleral-sutured IOLs achieved good visual outcomes in a public hospital setting. The rate of complications was moderate in this series with a high proportion of severe ocular trauma and a large percentage of aniridia IOLs. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  5. Brief communication: age and fractal dimensions of human sagittal and coronal sutures

    DEFF Research Database (Denmark)

    Lynnerup, Niels; Jacobsen, Jens Christian Brings


    The fractal dimensions of human sagittal and coronal sutures were calculated on 31 complete skulls from the Terry Collection. The aim was to investigate whether the fractal dimension, relying on the whole sutural length, might yield a better description of age-related changes in sutural morphology......, as opposed to other methods of quantification, which generally rely on more arbitrary scoring systems. However, the fractal dimension did not yield better age correlations than other previously described methods. At best, the results reflected the general observation that young adults below age 40 years...

  6. Biomechanical Comparison of a First- and a Second-Generation All-Soft Suture Glenoid Anchor (United States)

    Erickson, John; Chiarappa, Frank; Haskel, Jonathan; Rice, Justin; Hyatt, Adam; Monica, James; Dhawan, Aman


    Background: All–soft tissue suture anchors provide advantages of decreased removal of bone and decreased glenoid volume occupied compared with traditional tap or screw-in suture anchors. Previous published data have led to biomechanical concerns with the use of first-generation all-soft suture anchors. Purpose/Hypothesis: The purpose of this study was to evaluate the load to 2-mm displacement and ultimate load to failure of a second-generation all-soft suture anchor, compared with a first-generation anchor and a traditional PEEK (polyether ether ketone) anchor. The null hypothesis was that the newer second-generation anchor will demonstrate no difference in loads to 2-mm displacement after cycling compared with first-generation all-soft suture anchors. Study Design: Controlled laboratory study. Methods: Twenty human cadaveric glenoids were utilized to create 97 total suture anchor sites, and 1 of 3 anchors were randomized and placed into each site: (1) first-generation all-soft suture anchor (Juggerknot; Biomet), (2) second-generation all-soft suture anchor (Suturefix; Smith & Nephew), and (3) a control PEEK anchor (Bioraptor; Smith & Nephew). After initial cyclic loading, load to 2 mm of displacement and ultimate load to failure were measured for each anchor. Results: After cyclic loading, the load to 2-mm displacement was significantly less in first-generation anchors compared with controls (P .05). Conclusion: The newer generation all-soft suture anchors with a theoretically more rigid construct and deployment configuration demonstrate biomechanical characteristics (specifically, with load to 2-mm displacement after cyclic loading) that are improved over first-generation all-soft suture anchors and similar to a traditional solid tap-in anchor. The configuration of these newer generation all-soft suture anchors appears to mitigate the biomechanical concerns of decreased load to failure with first-generation all–soft tissue suture anchors. Clinical Relevance

  7. A new, removable, sliding noose for adjustable-suture strabismus surgery. (United States)

    Deschler, Emily K; Irsch, Kristina; Guyton, Kristina L; Guyton, David L


    We describe a new removable sliding polyglactin 910 suture noose for postoperative suture adjustment following extraocular muscle surgery. No excess suture material remains after adjustment has been completed, helping to reduce discomfort, inflammation, and scarring. We have used this noose with the cul-de-sac conjunctival incision in approximately 360 patients over a period of 18 months. This report details how to fashion, use, and remove the noose. Copyright © 2013 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

  8. Modified edge-to-edge technique for correction of congenital mitral regurgitation in infants and children. (United States)

    Zhang, Gang; Zhang, Fusheng; Zhu, Mei; Zhang, Wenlong; Fan, Quanxin; Zou, Chengwei; Wang, Anbiao


    Since 2008, 28 patients with congenital mitral regurgitation have undergone mitral valve repair with a modified edge-to-edge technique at our institution. The regurgitant mitral leaflet was sutured with a pledget-reinforced, horizontal mattress suture with No. 4-0 polypropylene on the ventricle side and a pledget-reinforced mattress suture with Gore-Tex sutures (W.L. Gore & Associates, Flagstaff, AZ) and Dacron pledgets (Chest, Shanghai) placed on the anterior and posterior annulus corresponding to the edge-to-edge suturing site. Early results are encouraging, but a longer follow-up is needed. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. A new simplified technique of arterial reconstruction in pediatric living-donor liver transplantation: a comparison with the classical technique. (United States)

    Tannuri, Ana Cristina Aoun; Monteiro, Roberta Figueiredo; Santos, Maria Mercês; Miyatani, Helena Thie; Tannuri, Uenis


    Hepatic artery anastomosis (HAA) is the most important aspect of living donor liver transplantation (LDLT), and it is currently performed by a specialized microsurgeon using micro surgical techniques, with interrupted sutures and the aid of an operative microscope. To simplify the procedure, we studied a new, simpler technique performed by pediatric transplant surgeons with continuous sutures and the same 3.5× magnification loupe used during other transplant procedures. The aim of this study was to compare these two hepatic artery reconstruction techniques in two pediatric LDLT series. This study was initiated in January 2010 and finished in June 2013. In the first period, the arterial reconstruction was performed with an operating microscope and the classical technique of 9-0 separate sutures. In the second period, the arterial reconstruction was performed using a simpler technique, with surgical loupe and continuous 8-0 Prolene sutures. The incidences and outcomes of complications within the two periods were analyzed and compared. A total of 82 LDLTs were performed, 38 in the first period and 44 in the second period. There were no differences between the periods, except for the arterial ischemia time, which was lower in the second period. Hepatic artery anastomosis can be safely performed with low complication rates by a pediatric transplant surgeon using continuous sutures with a 3.5× magnifying loupe. This technique is simpler, less time consuming and simplifies the complex pediatric LDLT procedure. Published by Elsevier Inc.

  10. Study on the tribological behavior of surgical suture interacting with a skin substitute by using a penetration friction apparatus. (United States)

    Zhang, Gangqiang; Ren, Tianhui; Zhang, Sheng; Zeng, Xiangqiong; van der Heide, Emile


    Surgical sutures have different sizes, structures, whereas they are being used for various surgeries. The high friction performance of surgical sutures in the suturing process may cause inflammation and pain, leading to a longer recovery time. This paper presents an understanding of the tribological behavior of surgical suture with monofilament and multifilament structures, by means of a penetration friction apparatus (PFA). The results indicated that structure and surface topography of the surgical suture had a pronounced effect on the tribological interactions. It was found that the friction force and abrasion area of skin substitute with the penetration of polyglycolic acid (PGA) multifilament surgical suture were larger than that of Nylon monofilament surgical suture. Meanwhile, more abrasion at the pull-in boundary of skin substitute was observed compared with that at the pull-out boundary. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Safety and Efficacy of Single-site Phacotrabeculectomy With Mitomicin C Using Nylon and Polyglactin Suture for Scleral Tunnel Closure. (United States)

    Vijaya, Lingam; David, Rathini L


    To evaluate the efficacy of polyglactin use along with nylon suture in scleral tunnel closure after single-site phacotrabeculectomy. This retrospective case series included 139 eyes of 139 patients who had scleral tunnel closure with 1 polyglactin and 1 nylon suture after single-site phacotrabeculectomy with a low dose of mitomycin C between 2002 and 2005. The intraocular pressure (IOP), the visual acuity, the number of glaucoma medications, postoperative complications, and interventions were the outcomes measured. The majority of them had primary open-angle glaucoma (93 eyes, 67%), 93 eyes (67%) had severe glaucomatous optic neuropathy, and 77 eyes (55.3%) had severe visual-field loss. The IOP decreased from a mean preoperative value of 18.1±5.3 mm Hg on a mean number of 1.8±0.8 glaucoma medications to mean IOPs of 13.3±4.6, 14.0±4.3, and 11.8±3.9 mm Hg on a mean number of 0.2±0.6, 0.3±0.7, 0.5±1.0 glaucoma medications (PNylon suturelysis with laser was performed in 16 eyes (11.5%). The technique used here seems to be effective in controlling the IOP and has very minimal associated complications.

  12. The simple transverse intraosseous phalangeal suture for zone 1 flexor digitorum profundus injuries: case series and review of the literature. (United States)

    Markeson, Daniel Benjamin; Evgeniou, Evgenios; Choa, Robert; Iyer, Srinivasan


    Zone 1 flexor digitorum profundus injury often precludes the use of a simple core suture as a result of a distal remnant that is too short. The aim of this study was to assess the senior author's (S.I.) simple technique for reinsertion of the flexor digitorum profundus tendon. The case series consisted of 12 patients who required a primary flexor digitorum profundus repair in zone 1, with all repairs performed by the senior author. A Bruner incision was extended to the pulp to expose the base of the distal phalanx. A two-strand repair was anchored to the distal phalanx using the author's technique, which involved passing a 3-0 polypropylene suture on a straight needle through a hypodermic needle that had been drilled through the base of the distal phalanx. This provided a stable, intraosseous, internal repair, allowing a standard early active mobilization regimen. Two patients had excellent results and 10 had good results in terms of distal interphalangeal joint range of movement (mean, 57 degrees; range, 51 to 80 degrees) and Quick Disabilities of the Arm, Shoulder and Hand questionnaire scores (mean, 12; range, 0 to 31.8). There were no reported tendon ruptures at the time of writing this article (range, 6 to 37 months after surgery). The authors present a technique for the repair of zone 1 flexor digitorum profundus injuries that is simple, can be performed quickly, is easily learned, and has results that compare favorably with other techniques in the literature. Furthermore, there is limited morbidity to surrounding fingertip structures. Therapeutic, IV.

  13. Comparison of surgical time and complication rate of subcutaneous and skin closure using barbed suture or traditional knotted suture in dogs. (United States)

    Nutt, Laura K; Wilson, Megan L; Sakals, Sherisse


    This prospective study evaluated the handling, intraoperative and postoperative complication rates of a barbed knotless suture for closure of subcutaneous tissue and skin in 17 client-owned dogs (group A) following a tibial plateau leveling osteotomy procedure. Clinical characteristics, surgical time, and complication rates were compared to a control group of 17 client-owned dogs (group B) with subcutaneous tissue and skin closure using traditional suture material. Signalment was not significantly different between groups and did not have an effect on complication rates. Surgical times were not significantly different for subcutaneous tissue or skin closure between the 2 groups. There were significantly more intraoperative complications in the barbed suture group (A: 4/17; B: 0/17; P = 0.033) but no difference in minor or major postoperative complication rates (minor A: 2/16; B: 1/14; P = 0.626, major A: 2/16; B: 0/14; P = 0.171).

  14. Graft Suturing for Lenticule Dislocation after Descemet Stripping Automated Endothelial Keratoplasty

    Directory of Open Access Journals (Sweden)

    Wai-Kwan Wu


    Full Text Available Purpose: To report the mid-term outcomes of graft suturing in a patient with lenticule dislocation after Descemet stripping automated endothelial keratoplasty (DSAEK. Case Report: A 78-year old woman was found to have graft dislocation involving the nasal half of the cornea after uneventful DSAEK. Graft repositioning, refilling the anterior chamber with air, and placement of four full-thickness 10/0 nylon sutures over the detached area were performed two weeks after the initial surgery. The sutures were removed 6 weeks later. Serial specular microscopy and anterior segment optical coherence tomography were performed. At 18 months, there was good lenticule apposition and a clear graft. Conclusion: Anchoring sutures seem to be effective for management of graft detachment following DSAEK.

  15. An automated interrupted suturing device for coronary artery bypass grafting: automated coronary anastomosis. (United States)

    Shennib, H; Korkola, S J; Bousette, N; Giaid, A


    The purpose of this study was to have a preliminary assessment of the safety and efficacy of an automated vascular suturing device. The device (Heartflo, Perclose/Abbott Labs, Redwood City, CA), which delivers 10 interrupted 7-0 polypropylene sutures between side-to-side arteriotomies, was evaluated in animals (8 Yorkshire pigs). Tissue edge capture and quality of anastomosis were highly rated. Time of anastomoses averaged 22 minutes. This time was prolonged primarily due to suture management, tying of interrupted sutures, and learning curve effects. Six of the anastomoses were hemostatic and two required an additional stitch each. Angiography and histology of the anastomosis confirmed patency and quality of the anastomosis. Our preliminary results indicate that the Heartflo automated anastomotic device is safe and effective. Preclinical and clinical studies to validate its acute and long-term effectiveness will commence shortly.

  16. Safety and efficacy of unidirectional barbed suture in mini-laparotomy myomectomy

    Directory of Open Access Journals (Sweden)

    Ming-Chao Huang


    Conclusion: The unidirectional knotless barbed suture may facilitate the repair of uterine defects during mini-laparotomy myomectomy by significantly lowering operative time. It may also reduce the intraoperative blood loss.

  17. Evaluation of Polybutylate-Coated Braided Polyester (Ethibond) Sutures for Levator-Advancement Blepharoptosis Repair (United States)

    Yulish, Michael; Pikkel, Joseph


    Purpose. To evaluate the efficacy and safety of polybutylate-coated braided polyester (Ethibond* 5-0) suture for levator aponeurosis suturing to the anterior tarsal surface in involutional blepharoptosis repair surgery. Methods. Ten consecutive patients (16 eyes) with acquired blepharoptosis which resulted from levator aponeurosis dehiscence with good levator function had gone through surgery and were followed up for, at least, one year. Results. There was no significant change between postoperative MRD1 measurements. No serious complications, such as infection of the sutures, inflammation, granuloma formation or ptosis recurrence, were registered. Conclusion. Polybutylate-coated braided polyester (Ethibond* 5-0) suture is a safe and effective material for involutional blepharoptosis repair surgery. PMID:24558592

  18. Evaluation of endoscopic laser excision of polypropylene mesh/sutures following anti-incontinence procedures.

    LENUS (Irish Health Repository)

    Davis, N F


    We reviewed our experience with and outcome of the largest series to our knowledge of patients who underwent endoscopic laser excision of eroded polypropylene mesh or sutures as a complication of previous anti-incontinence procedures.

  19. Stretch force guides finger-like pattern of bone formation in suture. (United States)

    Wu, Bo-Hai; Kou, Xiao-Xing; Zhang, Ci; Zhang, Yi-Mei; Cui, Zhen; Wang, Xue-Dong; Liu, Yan; Liu, Da-Wei; Zhou, Yan-Heng


    Mechanical tension is widely applied on the suture to modulate the growth of craniofacial bones. Deeply understanding the features of bone formation in expanding sutures could help us to improve the outcomes of clinical treatment and avoid some side effects. Although there are reports that have uncovered some biological characteristics, the regular pattern of sutural bone formation in response to expansion forces is still unknown. Our study was to investigate the shape, arrangement and orientation of new bone formation in expanding sutures and explore related clinical implications. The premaxillary sutures of rat, which histologically resembles the sutures of human beings, became wider progressively under stretch force. Micro-CT detected new bones at day 3. Morphologically, these bones were forming in a finger-like pattern, projecting from the maxillae into the expanded sutures. There were about 4 finger-like bones appearing on the selected micro-CT sections at day 3 and this number increased to about 18 at day 7. The average length of these projections increased from 0.14 mm at day 3 to 0.81 mm at day 7. The volume of these bony protuberances increased to the highest level of 0.12 mm3 at day 7. HE staining demonstrated that these finger-like bones had thick bases connecting with the maxillae and thin fronts stretching into the expanded suture. Nasal sections had a higher frequency of finger-like bones occuring than the oral sections at day 3 and day 5. Masson-stained sections showed stretched fibers embedding into maxillary margins. Osteocalcin-positive osteoblasts changed their shapes from cuboidal to spindle and covered the surfaces of finger-like bones continuously. Alizarin red S and calcein deposited in the inner and outer layers of finger-like bones respectively, which showed that longer and larger bones formed on the nasal side of expanded sutures compared with the oral side. Interestingly, these finger-like bones were almost paralleling with the direction

  20. A single centre comparative study of laparoscopic mesh rectopexy versus suture rectopexy

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo


    Full Text Available Aim: The aim of our study is to compare the results of laparoscopic mesh vs. suture rectopexy. Materials and Methods: In this retrospective study, 70 patients including both male and female of age ranging between 20 years and 65 years (mean 42.5 yrs were subjected to laparoscopic rectopexy during the period between March 2007 and June 2012, of which 38 patients underwent laparoscopic mesh rectopexy and 32 patients laparoscopic suture rectopexy. These patients were followed up for a mean period of 12 months assessing first bowel movement, hospital stay, duration of surgery, faecal incontinence, constipation, recurrence and morbidity. Results: Duration of surgery was 100.8 ± 12.4 minutes in laparoscopic suture rectopexy and 120 ± 10.8 min in laparoscopic mesh rectopexy. Postoperatively, the mean time for the first bowel movement was 38 hrs and 40 hrs, respectively, for suture and mesh rectopexy. Mean hospital stay was five (range: 4-7 days. There was no significant postoperative complication except for one port site infection in mesh rectopexy group. Patients who had varying degree of incontinence preoperatively showed improvement after surgery. Eleven out of 18 (61.1% patients who underwent laparoscopic suture rectopexy as compared to nine of 19 (47.3% patients who underwent laparoscopic mesh rectopexy improved as regards constipation after surgery. Conclusion: There were no significant difference in both groups who underwent surgery except for patients undergoing suture rectopexy had better symptomatic improvement of continence and constipation. Also, cost of mesh used in laparoscopic mesh rectopexy is absent in lap suture rectopexy group. To conclude that laparoscopic suture rectopexy is a safe and feasible procedure and have comparable results as regards operative time, morbidity, bowel function, cost and recurrence or even slightly better results than mesh rectopexy.

  1. Physical and Mechanical Evaluation of Five Suture Materials on Three Knot Configurations: An in Vitro Study

    Directory of Open Access Journals (Sweden)

    Desire Abellán


    Full Text Available The aim of this study was to evaluate and compare the mechanical properties of five suture materials on three knot configurations when subjected to different physical conditions. Five 5-0 (silk, polyamide 6/66, polyglycolic acid, glycolide-e-caprolactone copolymer, polytetrafluoroethylene suture materials were used. Ten samples per group of each material were used. Three knot configurations were compared A.2=1=1 (forward–forward–reverse, B.2=1=1 (forward–reverse–forward, C.1=2=1 (forward–forward–reverse. Mechanical properties (failure load, elongation, knot slippage/breakage were measured using a universal testing machine. Samples were immersed in three different pH concentrations (4,7,9 at room temperature for 7 and 14 days. For the thermal cycle process, sutures were immersed in two water tanks at different temperatures (5 and 55 °C. Elongation and failure load were directly dependent on the suture material. Polyglycolic acid followed by glycolide-e-caprolactone copolymer showed the most knot failure load, while polytetrafluoroethylene showed the lowest (P < 0.001. Physical conditions had no effect on knot failure load (P = 0.494. Statistically significant differences were observed between knot configurations (P = 0.008. Additionally, individual assessment of suture material showed statistically significant results for combinations of particular knot configurations. Physical conditions, such as pH concentration and thermal cycle process, have no influence on suture mechanical properties. However, knot failure load depends on the suture material and knot configuration used. Consequently, specific suturing protocols might be recommended to obtain higher results of knot security.

  2. Assessment of the role of sutures in a lizard skull: a computer modelling study


    Moazen, Mehran; Curtis, Neil; O'Higgins, Paul; Jones, Marc E.H; Evans, Susan E; Fagan, Michael J


    Sutures form an integral part of the functioning skull, but their role has long been debated among vertebrate morphologists and palaeontologists. Furthermore, the relationship between typical skull sutures, and those involved in cranial kinesis, is poorly understood. In a series of computational modelling studies, complex loading conditions obtained through multibody dynamics analysis were imposed on a finite element model of the skull of Uromastyx hardwickii, an akinetic herbivorous lizard. ...

  3. [Mechanical suture during resection of the rectum through the abdomen (author's transl)]. (United States)

    Gauthier-Benoît, C; Prat, A


    A mechanical suture using the URSS PKZ 28 or SPTU stapler was used in 30 low colo-rectal anastomoses. There were two deaths related to anastomotic complications. It is safe to establish a colostomy when the colon is not well prepared. Fistulae are frequent after palliative operations: this is a poor indication. Local recurrences are no more frequent with stapling than with manual suture.

  4. Clinical inquiries. How does tissue adhesive compare with suturing for superficial lacerations? (United States)

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


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

  5. Progressive tension sutures in abdominoplasty: a review of 597 consecutive cases. (United States)

    Pollock, Todd A; Pollock, Harlan


    Although abdominoplasty and other body-contouring procedures are being performed more frequently, the incidence of seroma and other complications has remained relatively unchanged. In 2000, a small retrospective series introduced progressive tension sutures (PTS) in abdominoplasty to reduce seroma without the use of drains. The authors review the PTS technique and their experience with the procedure. A retrospective chart review of 597 consecutive abdominoplasty patients treated over 12 years was performed. Collected data included surgical setting, concomitant procedures, and complications. Of the 597 abdominoplasties, 52.4% were performed in the hospital and 47.6% in an American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)-accredited facility. In 63.7% of cases, abdominoplasty was combined with another procedure(s). Liposuction was performed on the abdominoplasty flap or an adjacent area to the abdominoplasty dissection in 67% of patients. The average amount fat aspirate from these areas was 953 mL. No drains were placed. The rate of local complications was 4.2%; all but one of these complications (seroma; 0.1%) were minor. There were no systemic complications related to PTS and no venous thromboembolisms. PTS are an adjunct to abdominoplasty that can minimize seroma and potentially decrease other local complications. They provide secure fixation of the flap to eliminate motion and broadly transfer tension to the superficial fascial system. Drains can safely be eliminated from abdominoplasty, even when liposuction is performed. Systemic complications may be avoided and patient recovery expedited.

  6. Trapezium excision and suture suspensionplasty (TESS) for the treatment of thumb carpometacarpal arthritis. (United States)

    Putnam, Matthew D; Meyer, Nicholas J; Baker, Daniel; Brehmer, Jess; Carlson, Brent D


    Basilar thumb arthritis, or first carpometacarpal arthritis, is a common condition affecting older women and some men. It is estimated that as many as one third of postmenopausal woman are affected. Surgical treatment of this condition includes options ranging from arthrodesis to prosthetic arthroplasty. Intermediate options include complete or partial trapezial excision with or without interposition of a cushioning/stabilizing material (auto source, allo source, synthetic source). A multitude of methods appear to offer similar end results, although some methods definitely involve more surgical work and perhaps greater patient risk. Through retrospective evaluation of a cohort of patients who underwent suture suspensionplasty, we determined the postoperative effect on strength, motion, patient satisfaction, complications, and radiographic maintenance of the scaphoid-metacarpal distance. This review shows the method to be clinically effective and, by comparison with a more traditional ligament reconstruction trapezial interposition arthroplasty, the method does not require use of autograft or allograft tendon and has fewer surgical steps. Forty-four patients were included in this retrospective study. The results showed that 91% of patients were satisfied with the procedure. Pinch and grip strength remained the same preoperatively and postoperatively. A Disabilities of the Arm, Shoulder, and Hand patient-reported outcome instrument (DASH) scores averaged 30 at final follow-up. Three patients developed a late complication requiring further surgical intervention. In summary, this technique appears to be technically reproducible, requires no additional tendon material, and achieves objectively and subjectively similar results to other reported procedures used to manage first CMC Arthritis.

  7. An alternative to conventional hand-sewing colocolic anastomosis: anastomosis with absorbable surgical barrier film without sutures. (United States)

    Nejdet, Bildik; Ayhan, Cevik; Doğan, Fakıoğlu; Mehmet, Altıntaş; Hüseyin, Ekinci; Gülay, Dalkılıç; Mustafa, Gülmen; Nagehan, Barışık


    As a result of its high morbidity and mortality rates, anastomotic leakage is one of the most feared complications in colorectal surgery. Therefore, this issue is one of the most relevant in colorectal surgery and a lot of work has been conducted to research it. The aim of this experimental study was to compare colocolic anastomosis performed by using absorbable surgical barrier film without suture and conventional anastomosis performed by hand-sewing technique in terms of anastomosis safety. In this study, 40 Norway Wistar Albino 3-month-old female rats were used. Each weighed between 250 and 300g. The rates were divided into two groups, a control group and an experimental group. Full-thickness incisions were made on the ascending colon of both groups of rats. The control group's anastomoses were conducted using a hand-sewn technique consisting of one layer of nonabsorbable sutures (Gambee suture). The experimental group's anastomoses were performed using absorbable surgical barrier film without sutures. Afterwards, sample pieces of the anastomosis area were taken from all rats on either the 3rd or the 7th day following the operation, resulting in subgroups that led to a total of four test groups. The samples taken were subjected first to an anastomosis bursting pressure test followed by histopathological examinations and a test to detect the levels of hydroxyproline in the tissue. The control groups (groups 1 and 3) had average anastomotic bursting pressures of 33.0±9.49mmHg and 146.0±15.06mmHg respectively, whereas experimental groups (groups 2 and 4) had average anastomotic bursting pressures of 58.0±10.33mmHg and 190.0±25.82mmHg respectively. Mann-Whitney U-test analysis of the bursting pressure values indicates the differences between groups 1 and 2 (3rd day postoperatively) and groups 3 and 4 (7th day postoperatively) to be statistically significant (P=0.0001 and P=0.0003 respectively). Values obtained from histopathological staging conducted according

  8. Morphology of cranial sutures and radiologic evaluation of the variations of intersutural bones. (United States)

    Çalışkan, Selma; Oğuz, Kader Karlı; Tunalı, Selçuk; Aldur, Muhammed Mustafa; Erçakmak, Burcu; Sargon, Mustafa Fevzi


    As far as our literature searches showed us, morphological characteristics of cranium such as sutures, sutural bones and fontanelles had been examined from the skulls in the museums and dry specimens until now. As a modern method, 3D virtual remodeling of cranial bones by using MDCT-CTA can display in vivo morphological characteristics. In our study, we aimed to determine the presence and incidence of these morphological characteristics that can be clinically significant in our population, by using radiologic methods. We examined head and neck regions of 185 patients via MDCT-CTA. We evaluated radiologically detectable variations of the metopic sutures, lambda, bregma, asterion and pterion, which can be very easily confused with fractures. Additionally, the differences between the genders and incidence of coexistence of these variations were evaluated. According to our study, the incidence of persistent metopic suture was 8.1% and the incidence of lambda variations was 5.9%. Variations were most commonly encountered on the left asterion, and least commonly on the bregma and left pterion. In the evaluation of the coexistence of the parameters and combinations; the wormian bones located at the right and left asterions were detected. There were no statistically significant differences between genders. Variations of the sutures and sutural bones can be easily misdiagnosed with the fractures of related bony regions in unconscious patients with multiple traumas. During surgical interventions in these type of patients; surgeons must take this fact into consideration in order to make differential diagnosis of fractures and intersutural bone variations.

  9. Instructional PowerPoint presentations for cutaneous wound healing and tissue response to sutures. (United States)

    Stroncek, John D; Bell, Nicole; Reichert, W Monty


    Wound healing is an intricate process involving the interaction of cells and molecules, resulting in a complex series of events that change the morphology and characteristics of the wounded area. Interactive animations are useful for illustrating challenging concepts, helping students learn and retain new material. Instructional PowerPoint presentations describing the basic elements of cutaneous wound healing and the response of cutaneous tissue to sutures were developed by seven biomedical engineering students at Duke University. "Cutaneous Wound Healing.ppt" is an interactive presentation reviewing the four phases of wound healing (hemostasis, inflammation, repair, and remodeling) as well as the major molecular and cellular mechanisms that comprise these processes for cutaneous tissue. "Tissue Response to Sutures.ppt" is an interactive presentation that uses sutures to illustrate the foreign body response to biomaterials in cutaneous tissue. The tissue response program reviews the basics of suturing, common suture materials, and the tissue, cellular, and molecular responses to absorbable and nonabsorbable sutures. This manuscript provides a brief overview of the programs that are freely available on the Duke Center for Biomolecular and Tissue Engineering web site at Copyright 2008 Wiley Periodicals, Inc.

  10. Augmentation of tendon healing with butyric acid-impregnated sutures: biomechanical evaluation in a rabbit model. (United States)

    Leek, Bryan T; Tasto, James P; Tibor, Lisa M; Healey, Robert M; Freemont, Anthony; Linn, Michael S; Chase, Derek E; Amiel, David


    Butyric acid (BA) has been shown to be angiogenic and to enhance transcriptional activity in tissue. These properties of BA have the potential to augment biological healing of a repaired tendon. To evaluate this possibility both biomechanically and histologically in an animal tendon repair model. Controlled laboratory study. A rabbit Achilles tendon healing model was used to evaluate the biomechanical strength and histological properties at 6 and 12 weeks after repair. Unilateral tendon defects were created in the middle bundle of the Achilles tendon of each rabbit, which were repaired equivalently with either Ultrabraid BA-impregnated sutures or control Ultrabraid sutures. After 6 weeks, BA-impregnated suture repairs had a significantly increased (P Tendons repaired with BA-impregnated sutures demonstrated improved biomechanical properties at 6 weeks relative to control sutures, suggesting a neoangiogenic mechanism of enhanced healing through an increased myofibroblast presence. These findings demonstrate that a relatively simple alteration of suture material may augment early tendon healing to create a stronger repair construct during this time.

  11. Cranial Suture Closure in Domestic Dog Breeds and Its Relationships to Skull Morphology. (United States)

    Geiger, Madeleine; Haussman, Sinah


    Bulldog-type brachycephalic domestic dog breeds are characterized by a relatively short and broad skull with a dorsally rotated rostrum (airorhynchy). Not much is known about the association between a bulldog-type skull conformation and peculiar patterns of suture and synchondrosis closure in domestic dogs. In this study, we aim to explore breed-specific patterns of cranial suture and synchondrosis closure in relation to the prebasial angle (proxy for airorhynchy and thus bulldog-type skull conformation) in domestic dogs. For this purpose, we coded closure of 18 sutures and synchondroses in 26 wolves, that is, the wild ancestor of all domestic dogs, and 134 domestic dogs comprising 11 breeds. Comparisons of the relative amount of closing and closed sutures and synchondroses (closure scores) in adult individuals showed that bulldog-type breeds have significantly higher closure scores than non-bulldog-type breeds and that domestic dogs have significantly higher closure scores than the wolf. We further found that the prebasial angle is significantly positively correlated with the amount of closure of the basispheno-presphenoid synchondrosis and sutures of the nose (premaxillo-nasal and maxillo-nasal) and the palate (premaxillo-maxillary and interpalatine). Our results show that there is a correlation between patterns of suture and synchondrosis closure and skull shape in domestic dogs, although the causal relationships remain elusive. © 2016 Wiley Periodicals, Inc.

  12. Bile duct stone formation around a nylon suture after gastrectomy: a case report. (United States)

    Maeda, Chiyo; Yokoyama, Naoyuki; Otani, Tetsuya; Katada, Tomohiro; Sudo, Natsuru; Ikeno, Yoshinobu; Matsuura, Fumiaki; Iwaya, Akira; Yamazaki, Toshiyuki; Kuwabara, Shirou; Katayanagi, Norio


    Many cases of choledocholiths formed around sutures and clips used during cholecystectomy have been reported. We describe a case of gallstone formation around a nylon suture after non-biliary surgery. To the best of our knowledge, this is the first report of such a case. A 75-year-old Japanese man, who had undergone distal gastrectomy for gastric cancer and reconstruction with the Billroth II method 8 years earlier, presented with gastric discomfort. Abdominal ultrasonography was conducted and we diagnosed cholecysto-choledocholithiasis with dilatation of the intrahepatic bile duct. He underwent cholecystectomy and cholangioduodenostomy for choledocholith removal. Gallstones, which had formed around a nylon suture used during the previous gastrectomy, were found in the bile duct. Sutures of the same material had also been placed on the duodenum. Chemical analysis revealed that the stones were composed of calcium bilirubinate. The patient was discharged on postoperative day 19, and choledocholithiasis has not recurred thus far. The findings from this case suggest that standard, non-resorbable sutures used in gastrectomy may be associated with the formation of bile duct stones; therefore, absorbable suture material may be required to avert gallstone formation even in the case of gastrectomy.

  13. A clinical study on the influence of suturing material on oral wound healing

    Directory of Open Access Journals (Sweden)

    Gazivoda Dragan


    Full Text Available Background/Aim. Suture materials play an important role in healing, enabling reconstruction and reassembly of tissue separated by the surgical procedure or trauma, and at the same time facilitating and promoting healing and hemostasis. Suture materials are used daily in oral surgery, and are considered to be substances most commonly implanted in human body. The aim of this clinical study was to examine the speed of wound healing and complications incidence, after the use of three different absorbable synthetic suture materials in oral surgery (catgut, Dexon and Vicryl rapide, and to ascertain which one is the most suitable for oral surgery. Methods. The study was conducted on 96 patients undergoing root resection or surgical extraction of third molars. Each of the suture materials (catgut, Dexon and Vicryl rapide was used for 8 root resections and 8 surgical third molar extractions in the maxilla, as well as in the mandible (a total of 32 surgical interventions for each suture material. Results. The faster wound healing was obtained with Vicryl rapide compared to other two suturing material tested. There was no significant difference regarding the presence of local reaction in all the three groups of patients on the 21st postoperative day. Conclusion. The results of our clinical study point out that Vycrilrapid contributes more than catgut or Dexon to faster healing of human wounds, with fewer incidences of wound dehiscence and milder local reactions.

  14. Bio-inspired ``jigsaw''-like interlocking sutures: Modeling, optimization, 3D printing and testing (United States)

    Malik, I. A.; Mirkhalaf, M.; Barthelat, F.


    Structural biological materials such as bone, teeth or mollusk shells draw their remarkable performance from a sophisticated interplay of architectures and weak interfaces. Pushed to the extreme, this concept leads to sutured materials, which contain thin lines with complex geometries. Sutured materials are prominent in nature, and have recently served as bioinspiration for toughened ceramics and glasses. Sutures can generate large deformations, toughness and damping in otherwise all brittle systems and materials. In this study we examine the design and optimization of sutures with a jigsaw puzzle-like geometry, focusing on the non-linear traction behavior generated by the frictional pullout of the jigsaw tabs. We present analytical models which accurately predict the entire pullout response. Pullout strength and energy absorption increase with higher interlocking angles and for higher coefficients of friction, but the associated high stresses in the solid may fracture the tabs. Systematic optimization reveals a counter-intuitive result: the best pullout performance is achieved with interfaces with low coefficient of friction and high interlocking angle. We finally use 3D printing and mechanical testing to verify the accuracy of the models and of the optimization. The models and guidelines we present here can be extended to other types of geometries and sutured materials subjected to other loading/boundary conditions. The nonlinear responses of sutures are particularly attractive to augment the properties and functionalities of inherently brittle materials such as ceramics and glasses.

  15. Fusion Patterns in the Skulls of Modern Archosaurs Reveal That Sutures Are Ambiguous Maturity Indicators for the Dinosauria.

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    Alida M Bailleul

    Full Text Available The sutures of the skulls of vertebrates are generally open early in life and slowly close as maturity is attained. The assumption that all vertebrates follow this pattern of progressive sutural closure has been used to assess maturity in the fossil remains of non-avian dinosaurs. Here, we test this assumption in two members of the Extant Phylogenetic Bracket of the Dinosauria, the emu, Dromaius novaehollandiae and the American alligator, Alligator mississippiensis, by investigating the sequence and timing of sutural fusion in their skulls. As expected, almost all the sutures in the emu skull progressively close (i.e., they get narrower and then obliterate during ontogeny. However, in the American alligator, only two sutures out of 36 obliterate completely and they do so during embryonic development. Surprisingly, as maturity progresses, many sutures of alligators become wider in large individuals compared to younger, smaller individuals. Histological and histomorphometric analyses on two sutures and one synchondrosis in an ontogenetic series of American alligator confirmed our morphological observations. This pattern of sutural widening might reflect feeding biomechanics and dietary changes through ontogeny. Our findings show that progressive sutural closure is not always observed in extant archosaurs, and therefore suggest that cranial sutural fusion is an ambiguous proxy for assessing maturity in non-avian dinosaurs.

  16. Parachute technique for partial penectomy

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    Fernando Korkes


    Full Text Available PURPOSE: Penile carcinoma is a rare but mutilating malignancy. In this context, partial penectomy is the most commonly applied approach for best oncological results. We herein propose a simple modification of the classic technique of partial penectomy, for better cosmetic and functional results. TECHNIQUE: If partial penectomy is indicated, the present technique can bring additional benefits. Different from classical technique, the urethra is spatulated only ventrally. An inverted "V" skin flap with 0.5 cm of extension is sectioned ventrally. The suture is performed with vicryl 4-0 in a "parachute" fashion, beginning from the ventral portion of the urethra and the "V" flap, followed by the "V" flap angles and than by the dorsal portion of the penis. After completion of the suture, a Foley catheter and light dressing are placed for 24 hours. CONCLUSIONS: Several complex reconstructive techniques have been previously proposed, but normally require specific surgical abilities, adequate patient selection and staged procedures. We believe that these reconstructive techniques are very useful in some specific subsets of patients. However, the technique herein proposed is a simple alternative that can be applied to all men after a partial penectomy, and takes the same amount of time as that in the classic technique. In conclusion, the "parachute" technique for penile reconstruction after partial amputation not only improves the appearance of the penis, but also maintains an adequate function.

  17. Evaluation of Midterm Clinical Results of All inside Suture Technique in Meniscus Repair


    Murat Gül; Engin Çetinkaya; Yavuz Arıkan


    Aim: The aim of this study was to evaluate the functional outcomes of arthroscopic all-inside meniscal repair at an average 5-year follow-up. Methods: Thirty-two patients (29 males 3 females; 19 right knees, 13 left knees), who underwent arthroscopic all-inside meniscal repair, were included in the study. Clinical examination and magnetic resonance imaging were the main diagnostic tools. The mean age of the patients was 28 years (23-41 years). ACL reconstruction was pe...

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

    African Journals Online (AJOL)

    social movements of tongue like licking an ice‑cream, sucking, playing musical instrument particularly wood wind or kissing, etc. Several conservative, as well as surgical options, exist for the management of tongue tie. It includes observation, speech therapy, otolaryngotherapy, frenotomy, frenectomy,. Z‑plasty and laser ...

  19. Technique of ‘suture less’ appendicectomy by laparoscopy in children: Preliminary communication


    Bajpai, Minu


    Objective: Objective of this study is to present our experience by harmonic scalpel enabled, single external port appendicectomy using extracorporeally inserted ′pick and fix′ stitch in three cases. Materials and Methods: Of the eighteen appendicectomies performed with only the use of harmonic scalpel in the last 11 months, the last three were performed using a single external port with the second port accessed under the subcutaneous tissues. The procedure consists of anchoring the mesoappend...

  20. Suture Technique to Prevent Air Leakage during Negative-Pressure Wound Therapy in Fournier Gangrene

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    Feng-Shu Chang, MD


    Conclusions:. The present results suggest that partial wound-edge closure and in situ GranuFoam fixation improve the NPWT leaks in Fournier gangrene wounds. Furthermore, this method is simple to learn and can be useful in applying NPWT to anatomically difficult areas.

  1. Suture Technique to Prevent Air Leakage during Negative-Pressure Wound Therapy in Fournier Gangrene. (United States)

    Chang, Feng-Shu; Chou, Chieh; Hu, Chuan-Yu; Huang, Shu-Hung


    The use of negative-pressure wound therapy (NPWT) for Fournier gangrene management is well documented; however, it is difficult to fixate GranuFoam dressings and maintain an airtight seal over the perineum area. We developed a simple method to facilitate GranuFoam fixation and improve airtight sealing. The Fournier's gangrene severity index (FGSI) score less than 9 was collected in from January 2015 to October 2016. All 13 patients underwent fasciotomy, and NPWT was applied directly on fasciotomy wounds after the debridement of infected tissue. Partial wound closure was performed, and a portion of GranuFoam was inserted to facilitate fixation. The seal check was converted to a 0-10 scale score that was recorded every 4 hours during NPWT. Patient profiles including medical history, FGSI, method of wound closure, and length of stay were collected in this study. The median age of the patients was 62 (38-76) years. The mean FGSI score was 4.3 ± 3.1. The average duration of NPWT was 17.5 ± 11.5 days, and the average seal check score was 0.8 ± 0.5. No seal check alarms were noted during the study. Successful wound closure was achieved in all patients without using additional reconstruction methods such as skin grafting or muscle flap coverage. The present results suggest that partial wound-edge closure and in situ GranuFoam fixation improve the NPWT leaks in Fournier gangrene wounds. Furthermore, this method is simple to learn and can be useful in applying NPWT to anatomically difficult areas.


    Liang, Jinying; Zheng, Jiapeng; Ll, Qiang; Zhong, Shuyu; Chen, Minzhen


    To investigate the clinical effects of the Ultrabraid suture with FOOTPRINT rivet by arthroscopic technique for the treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture. Between May 2011 and December 2013, 19 adolescent patients with ACL tibial eminence avulsion fracture were treated with arthroscopic reduction and fixation by Ultrabraid sutures with FOOTPRINT rivet. There were 13 males and 6 females with an average age of 15.8 years (range, 8-18 years). The left knees were involved in 10 cases and the right knees in 9 cases. The injury causes included traffic accident injury in 8 cases, sport injury in 6 cases, and sprain injury in 5 cases. Three patients had old fractures, and the others had fresh fractures. The results of Lachman test and anterior drawer test were both positive. The International Knee Documentation Committee (IKDC) subject score was 54.2 ± 4.0. Based on Meyers-McKeever classification, there were 3 cases of type II, 10 cases of type III, and 6 cases of type IV. The operation time was 50-60 minutes (mean, 55.2 minutes). X-ray film showed satisfactory fracture reduction at 1 day after operation. Primary healing of incision was obtained with no infection. Eighteen patients were followed up for 1-3 years (mean, 1.7 years). All fractures healed with smooth joint surface on the X-ray film at 3 months after operation. The results of Lachman test and anterior drawer test were both negative in 17 cases, and the results was negative for anterior drawer test and was weakly positive for Lachman test in 1 case. The IKDC subject score was significantly improved to 96.1 ± 2.1 at last follow-up (t = 34.600, P = 0.000). It could achieve early restoration of knee joint function to treat the ACL tibial eminence avulsion fracture by arthroscopic technique of the Ultrabraid suture with FOOTPRINT rivet because of satisfactory reduction, reliable fixation, small wound, and early rehabilitation.



    Hässig, Marc; Rolland, Yann; Topuz, G.; Çelik, Ö.; Sosson, Marc


    International audience; In order to better understand the tectonic evolution of the Sevan-Akera suture zone, particularly its connection westward into the Ankara-Erzincan suture, field observations and sampling were carried out on the Erzincan suture zone (near Erzincan). The goal of this study is to solve the problem of linking both odbucted ophiolitic domains. As in Armenia, the structures in Turkey are complex and have been reworked and reactivated because of post-obduction collision stage...

  4. [Laparoscopic resection of an interstitial ectopic twin pregnancy resection: the role of barbed sutures in haemostatic control]. (United States)

    Cardoso Medina, Byron; Hernández Giraldo, Cristian; Manual Clavijo, Juan; Sarmiento, Piedad


    Interstitial pregnancy is a dangerous and uncommon variation of ectopic pregnancy occurring in the interstitial part of the fallopian tube and extending beyond the muscular layer of the uterus. This ectopic pregnancy-related mortality rate has been reported to be as high as 2%-2,5% due to complications involving bleeding and hypervascularity. No prospective clinical trials have evaluated available treatment options for interstitial ectopic pregnancy due to its low incidence; there is thus no consensus regarding optimal treatment. Surgical treatment can be divided into conservative approaches, such as cornuectomy or cornuostomy, and radical approaches such as hysterectomy. However, intraoperative hemorrhage is an ever-present risk, regardless of the surgical approach adopted. This paper presents a case involving a patient who underwent laparoscopic resection of an interstitial twin ectopic pregnancy; a barbed suture pursestring was used which proved useful during the surgical technique and improved hemostasia.

  5. Acute Achilles tendon rupture: Mini-incision repair with double-Tsuge loop suture vs. open repair with modified Kessler suture. (United States)

    Fu, Chongyang; Qu, Wei


    Achilles tendon rupture is a common injury of the foot and ankle. However, the optimal treatment strategy for Achilles tendon rupture is still not established. This study was conducted to compare the efficacy and complications of mini-incision repair with double-Tsuge loop sutures and open repair with modified Kessler sutures. We evaluated data from 60 patients with acute closed Achilles tendon ruptures who underwent mini-incision repair with double-Tsuge loop sutures (n = 30) or open repair with modified Kessler sutures (n = 30) from 2006 to 2010 in an ongoing prospective study conducted by us and have finished at least 18-month follow-up or finished the study. The AOFAS Ankle-Hindfoot score, ATRS, maximal ankle range of motion and the time to achieve 20 continuous single heel raises after operation were recorded to compare the efficacy. The complications were also evaluated. During a mean follow-up of 25 months after surgery, the time to achieve 20 continuous single heel raises after operation of patients in Group Mini was significantly shorter than patients in Group Open. Moreover, the mini-incision with double-Tsuge repair was associated with a significantly shorter operating time, smaller incision length, and lower rate of complications. The mini-incision with double-Tsuge suture method in our study was shown to provide earlier strength recovery, as well as shorter operation time, less complications and improved cosmetic appearance. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  6. Influence of suturing material on wound healing: Experimental study in dogs

    Directory of Open Access Journals (Sweden)

    Gazivoda Dragan


    Full Text Available Background/Aim. The most common materials implanted in the human organism are suture materials that are classified on the basis of several criteria, usually the origin, structure, and properties. The properties of suture materials are related to its absorbability and non-absorbability. When using resorbable materials it is of great importance to determine whether its absorbability and tensile strength help wound healing in function of time. Sutures themselves can become a source of inflammation, that may reduce or compromise the potential of reparation and regeneration. The aim of this experimental study on dogs was to ascertain whether the absorption rate and the degree of local tissue reactions differ from information provided by the manufacturers, whether there are differences between the applied suture materials and which of the used suture materials have better effect on wound healing. Methods. Experimental testing of the selected suture materials basic characteristics was performed on 6 German Shepherd dogs, which, after induction of general anesthesia, were made 3 identical incisions each in all 4 quadrants (left and right side of the upper and lower jaws, so that 12 horizontal incisions were formed, 10 mm long, 20-25 mm distant from one another, on each animal. Randomly, incisions were stitched up in the following order, starting from back to front: catgut, Dexon®, Vicryl-Rapid®. The experiment was terminated by histopathological examination of tissue samples, taken on postoperative day 3, 7, 14 and 21 in order to identify the effect of healing and the degree of local reaction. Results. The obtained results suggest that catgut has the highest absorption rate, while Dexon® the lowest. Vicryl-Rapid® causes the lowest level of local reactions, while Dexon® the highest. Conclusion. There is no ideal suture material because various patient factors also influence the wound healing process.

  7. Comparison of efficacy of polypropylene with chromic catgut suture in stitching paediatric facial lacerations

    International Nuclear Information System (INIS)

    Hussain, A.; Ahmed, R.; Aziz, O.B.A.; Aamir, M.


    Objective: The objective of this study was to compare 5/0 polypropylene suture with 5/0 chromic catgut in small clean pediatric facial laceration repair in terms of cosmetic outcome. Study Design: Randomized controlled trial.Place and Duration of Study: Combined Military Hospital, Rawalpindi from 26th May 2012 to 25th Nov 2012.Patients and Methods: A total of 300 patients of both gender under 12 years of age, with small clean facial lacerations were selected and divided in two equal groups using random number tables. All the patients underwent suturing in minor operating theater of trauma centre CMH Rawalpindi as day care cases, under local anesthesia and aseptic measures. In group 1, polypropylene 5/0 suture was used where as in group 2 chromic catgut 5/0 was used for suturing. Aseptic dressing was applied. All patients were reviewed on 5th day (for stitch removal in polypropylene group) and 3 months post-operatively to establish cosmetic outcome which was determined by scar visual analog score both by parents of the child and consultant surgeon. Results: The mean VAS (visual analog score) as observed by Consultant surgeon was 79.14 and 78.63 for polypropylene and chromic catgut groups respectively. The mean VAS observed by the parents of the child for respective groups was 76.67 and 76.03. The significance value was 0.961 for parental VAS and 0.988 for surgeons VAS depicting insignificant difference in both suture groups.Conclusion: There is no long-term difference in cosmetic outcomes of both the sutures in the repair of facial lacerations in the pediatric population. No difference in complication rate of wound was observed. In addition, the parents of the children in absorbable suture group expressed satisfaction over prevention of psychological trauma of stitch removal. (author)

  8. Randomized clinical trial comparing cold knife conization of the cervix with and without lateral hemostatic sutures. (United States)

    Bueno, Letícia Rossi; Binda, Marcia; Monego, Heleusa; Scherer, Roberta Luísa; Rolim, Karen Machado; Bottini, Alessandra Leal; Fregnani, José H T G; dos Reis, Ricardo


    Compare blood loss during cold knife conization of the cervix with and without lateral hemostatic sutures in the cervical branches of the uterine arteries. Randomized clinical trial. Hospital de Clínicas de Porto Alegre (HCPA). 102 patients that underwent cold knife conization. Women that underwent cold knife conization of the cervix were randomized to undergo the procedure with or without lateral hemostatic sutures. blood loss measured in grams. operative time and postoperative intervention. Only the participants were blinded to group assignment. From March 2009 to August 2012, patients were randomly assigned to one of the study groups. There were no differences in amount of blood loss between patients that underwent the procedure with and without sutures (p = 0.39). Operative time was shorter in the group without suture (p = 0.020). There were no differences in intervention due to bleeding (p = 0.20). Blood loss was greater among menstruating women than for menopausal women (p = 0.011). There were no differences in amount of blood lost between smoking and nonsmoking patients (p = 0.082). Lateral hemostatic sutures do not affect the amount of intraoperative bleeding or the number of postoperative interventions. Their use is not necessary because they result in longer operative time, have a higher cost due to the use of suture material and pose the risk of ureter lesion in case the sutures are not placed at a lower position in the cervix. ClinicalTrials. gov identifier: NCT02184975. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  9. Translaryngeal percutaneous arytenoid lateralization technique in a canine cadaveric study. (United States)

    Hardie, Robert J


    To describe the technique for translaryngeal percutaneous arytenoid lateralization (TPAL) and the effect on rima glottidis cross-sectional area using a canine cadaveric model. Ex vivo study. Canine cadavers (n = 9). With the aid of a laryngoscope, the larynx was visualized and a mattress suture (double-armed 2-0 polypropylene) was placed through the right arytenoid cartilage and exited the skin ventral to the jugular vein. The ends of the suture were passed through a button and tied on the skin to lateralize the right arytenoid cartilage. Digital images of the larynx were made before and after suture placement. Mean (±SD) rima glottidis cross-sectional area (mm(2) ) was calculated from the digital images and values before and after suture placement were compared using a paired t-test. A P value dogs. Mean (±SD) cross-sectional area of the rima glottidis was 126.3 mm(2) (±7.74) before and 172.1 mm(2) (±24.7) after suture placement (P = 0.004). Mean percent increase in cross-sectional area was 25%. The TPAL technique was effective at enlarging the rima glottidis in this canine cadaveric model. TPAL is rapid to perform and does not require specialized instrumentation. Results of this study support further investigation of the TPAL technique as an alternative to temporary tracheostomy for dogs in severe respiratory distress due to laryngeal paralysis. © Veterinary Emergency and Critical Care Society 2016.

  10. Scalp swelling crossing the suture line on skull radiograph: is it always a sign of caput succedaneum?

    International Nuclear Information System (INIS)

    Choi, Jae Woong; Lee, Chang Hee; Suh, Sang Il


    Caput succedaneum is the soft swelling of the neonatal scalp that may extend over the suture line, as opposed to cephalhaematoma, which is restricted by the suture. However, if caput succedaneum and cephalhaematoma coexist and the swelling crosses the suture line, it may be diagnosed as caput succedaneum and the cephalhaematoma will be easily missed, both on the radiograph and clinically. We report an interesting MR finding in a neonate who simultaneously showed both caput succedaneum and cephalhaematoma. (orig.)

  11. Gastric full-thickness suturing during EMR and for treatment of gastric-wall defects (with video). (United States)

    von Renteln, Daniel; Schmidt, Arthur; Riecken, Bettina; Caca, Karel


    The endoscopic full-thickness Plicator device was initially developed to provide an endoscopic treatment option for patients with GERD. Because the endoscopic full-thickness Plicator enables rapid and easy placement of transmural sutures, comparable with surgical sutures, we used the Plicator device for endoscopic treatment or prevention of GI-wall defects. To describe the outcomes and complications of endoscopic full-thickness suturing during EMR and for the treatment of gastric-wall defects. A report of 4 cases treated with the endoscopic full-thickness suturing between June 2006 and April 2007. A large tertiary-referral center. Four subjects received endoscopic full-thickness suturing. The subjects were women, with a mean age of 67 years. Of the 4 subjects, 3 received endoscopic full-thickness suturing during or after an EMR. One subject received endoscopic full-thickness suturing for treatment of a fistula. Primary outcome measurements were clinical procedural success and procedure-related adverse events. The mean time for endoscopic full-thickness suturing was 15 minutes. In all cases, GI-wall patency was restored or ensured, and no procedure-related complications occurred. All subjects responded well to endoscopic full-thickness suturing. The resection of one GI stromal tumor was incomplete. Because of the Plicator's 60F distal-end diameter, endoscopic full-thickness suturing could only be performed with the patient under midazolam and propofol sedation. The durable Plicator suture might compromise the endoscopic follow-up after EMR. The endoscopic full-thickness Plicator permits rapid and easy placement of transmural sutures and seems to be a safe and effective alternative to surgical intervention to restore GI-wall defects or to ensure GI-wall patency during EMR procedures.

  12. Evaluation of the histologic reactions to commonly used suture materials in the skin and musculature of ball pythons (Python regius). (United States)

    McFadden, Michael S; Bennett, R Avery; Kinsel, Michael J; Mitchell, Mark A


    To evaluate histologic reactions to 8 suture materials and cyanoacrylate tissue adhesive (CTA) in the musculature and skin of ball pythons. 30 hatchling ball pythons. In each snake, ten 1-cm skin incisions were made (day 0). At 8 sites, a suture of 1 of 8 materials was placed in the epaxial musculature, and the incision was closed with the same material. One incision was closed by use of CTA. No suture material was placed in the tenth incision, which was allowed to heal by second intention (negative control). Snakes (n = 5/group) were euthanized for harvest of treatment-site tissues at days 3, 7, 14, 30, 60, and 90. Skin and muscle sections were examined microscopically and assigned a subjective score (0 to 4) for each of the following: overall severity of inflammation, fibrosis, number of macrophages, number of granulocytes, number of perivascular lymphocytes, and degree of suture fragmentation. Subjective score analysis revealed that CTA did not cause a significant inflammatory response, compared with the negative control. All suture materials caused significantly more inflammation over all time points; for all suture materials, inflammatory response scores were significantly higher than values for the negative control 90 days after implantation. No sutures were completely absorbed by the end of the study period, and several sutures appeared to be in the process of extrusion. In snakes, CTA can be used to close small superficial incisions or lacerations with minimal inflammatory response, and sutures may undergo extrusion from tissues prior to complete absorption.

  13. Long-term efficacy of anchored barbed sutures in the face and neck. (United States)

    Kaminer, Michael S; Bogart, Megan; Choi, Christine; Wee, Sue Ann


    The thread lift is a minimally invasive procedure that uses barbed sutures, inserted subcutaneously, to produce lifting of ptotic tissue of the face and neck. There are currently very limited data on longevity and patient satisfaction following barbed suture lifting procedures. The purpose of this study was to assess long-term efficacy following the use of barbed sutures. A satisfaction survey was mailed to 20 patients who were a minimum of 6 months (range, 6 to 16 months) postprocedure. Physician assessment of pre- and postprocedure photographs was also performed. At an average of 11.5 months postprocedure, patients felt that the barbed suture lift met their expectations, rating their satisfaction a 6.9 on a scale of 1 to 10. Independent physicians rated the overall improvement an average of 4.6 of 10. Higher scores were noted in Zone 1 (tear trough/malar fat pad and nasolabial folds) compared to Zone 2 (marionette lines, jowls, and jawline definition) and Zone 3 (platysmal bands and neck contour). The barbed suture lift procedure provides moderate long-term and sustained improvement for facial laxity, with most improvement seen in the tear trough/malar fat pads and nasolabial folds. In this study, clinical efficacy was seen up to 16 months postprocedure.

  14. Sutured clear corneal incision: wound apposition and permeability to bacterial-sized particles. (United States)

    May, William N; Castro-Combs, Juan; Kashiwabuchi, Renata T; Tattiyakul, Woranart; Qureshi-Said, Saima; Hirai, Flavio; Behrens, Ashley


    To determine the effects of single radial or horizontal suture placement in 2-step clear corneal incision (CCI) wound apposition and permeability to particles of India ink. Five fresh human globes were included. Two 25-gauge needles connected to a saline solution bag and to a digital manometer were inserted through the limbus, 120 degrees apart from each other. Four 2-step CCIs (2.75 mm wide and 3 mm length) were constructed in each cornea. Incisions were divided into 3 groups: single radial suture (SRS), single horizontal suture (SHS), and unsutured group. Optical coherence tomography (OCT) was performed before and after suture placement. With a preset 10 mm Hg intraocular pressure (IOP), India ink was applied to the incision site and a standardized sudden IOP fluctuation was induced. OCT and superficial images were recorded before and after suture placement. India ink inflow and internal and external CCI gapping were outlined and measured by planimeter. The area and linear distance of India ink inflow after pressure challenge in all study groups were higher when compared with pre-pressure measurements; however, this increase was significant in the SRS and SHS groups (P < 0.05). Additionally, SRS placement significantly increased inner wound gapping (P = 0.018), and SHS significantly widened outer wound gape (P = 0.02). Well-constructed unsutured 2-step CCI seems to be more efficient at preventing bacterial-sized particles inflow during sudden changes in IOP, and it seems to offer better wound apposition as assessed by OCT.

  15. The unidirectional barbed suture for renorrhaphy during laparoscopic partial nephrectomy: Stanford experience. (United States)

    Jeon, Seung Hyun; Jung, Saebin; Son, Hee-Seo; Kimm, Simon Y; Chung, Benjamin I


    Using barbed suture represents a novel technical modification in the performance of minimally invasive partial nephrectomy. Our purpose of this study was to evaluate the safety and efficacy of this suture for renorrhaphy during laparoscopic partial nephrectomy (LPN). Thirteen consecutive patients underwent LPN using V-Loc™ 180 (Covidien, Dublin, Ireland) suture, and a nonconsecutive control group of 24 patients, matched according to tumor size and R.E.N.A.L. nephrometry score, underwent LPN using absorbable polyglactin suture. All 37 patients underwent LPN performed by a single surgeon. Perioperative and postoperative indicators of morbidity, estimated blood loss, and warm ischemia time (WIT) were compared between the groups. Baseline characteristics including age, body mass index, American Society of Anesthesiologists score, tumor size, laterality, and R.E.N.A.L nephrometry score were identical between the groups. On multivariable analysis, there were no significant differences between the two groups with regard to operative time, estimated blood loss, transfusion rates, rates of surgical complications, and length of hospital stay. However, mean WIT was significantly shorter in the V-Loc group compared with the control group (24.5±5.3 minutes versus 31.9±8.9 minutes, P=.01). The use of V-Loc sutures for renorrhaphy during LPN is safe and feasible and, in our series, significantly reduces WIT. Further studies are needed to corroborate these findings, but these results indicate a promising development in reducing WIT during minimally invasive partial nephrectomy.

  16. Effect of the use of carprofen in dogs undergoing intense rehabilitation after lateral fabellar suture stabilization. (United States)

    Gordon-Evans, Wanda J; Dunning, Diane; Johnson, Ann L; Knap, Kim E


    To determine whether carprofen, a commercially available NSAID, would decrease perceived exertion and signs of pain in dogs and therefore increase muscle mass and hind limb function without decreasing range of motion after lateral fabellar suture stabilization. Randomized, blinded, controlled clinical trial. 35 dogs with cranial cruciate ligament rupture and lateral fabellar suture stabilization followed by rehabilitation. All dogs underwent surgical stabilization of cranial cruciate ligament rupture by placement of a lateral fabellar suture. Dogs received carprofen (2.2 mg/kg [1 mg/lb], PO, q 12 h) for the first 7 days after surgery and underwent concentrated rehabilitation exercises during weeks 3, 5, and 7 after surgery. Eighteen dogs also received carprofen (2.2 mg/kg, PO, q 12 h) during the weeks of concentrated rehabilitation. Outcomes were measured by a single investigator, who was blinded to group assignments, using pressure platform gait analysis, goniometry, thigh circumference, and mean workout speed at a consistent level of exertion. There were no differences between the 2 groups in ground reaction forces, thigh circumference, or exertion (mean workout speed) over time or at any individual time point. However, both groups improved significantly over time for all outcome measures. Providing carprofen to dogs during concentrated rehabilitation after lateral fabellar suture stabilization did not improve hind limb function, range of motion, or thigh circumference, nor did it decrease perceived exertion, compared with control dogs. Carprofen was not a compulsory component of a physical therapy regimen after lateral fabellar suture stabilization.

  17. Effects of expansive force on the differentiation of midpalatal suture cartilage in rats. (United States)

    Takahashi, I; Mizoguchi, I; Nakamura, M; Sasano, Y; Saitoh, S; Kagayama, M; Mitani, H


    In an attempt to clarify the effects of biomechanical tensional force on chondrogenic and osteogenic differentiation of secondary cartilage, the midpalatal sutures of 4-week-old Wistar male rats were expanded by orthodontic wires which applied 20 g force for 4, 7, 10, and 14 days. The differentiation pathways in the midpalatal suture cartilage were examined by immunohistochemistry for osteocalcin, type I and type II collagen, and von Kossa histochemistry. Although the midpalatal sutures of the control animals consisted mainly of two separate secondary cartilages with mesenchyme-like cells at their midlines, type I collagen-rich fibrous tissue began to appear at day 4 and increased at the midline of the cartilage with days of experiment. At the end of the experiment, type I collagen-rich and calcified bone matrix appeared at the boundary between the precartilaginous and the cartilaginous cell layers. Most of the cartilaginous tissues were separated from each other and the midpalatal suture was replaced by osteocalcin-positive intramembranous bone and fibrous sutural tissue. These results strongly suggest that tensional force changed the phenotypic expression of collagenous components in secondary cartilage, which may reflect the differentiation pathway of osteochondro progenitor cells.

  18. LED phototherapy on midpalatal suture after rapid maxilla expansion: a Raman spectroscopic study (United States)

    Rosa, Cristiane B.; Habib, Fernando Antonio L.; de Araújo, Telma M.; dos Santos, Jean N.; Cangussu, Maria Cristina T.; Barbosa, Artur Felipe S.; de Castro, Isabele Cardoso V.; Soares, Luiz Guilherme P.; Pinheiro, Antonio L. B.


    A quick bone formation after maxillary expansion would reduce treatment timeand the biomodulating effects of LED light could contribute for it. The aim of this study was to analyze the effect of LED phototherapy on the acceleration of bone formation at the midpalatal suture after maxilla expansion. Thirty rats divided into 6 groups were used on the study at 2 time points - 7 days: Control; Expansion; and Expansion + LED; and 14 days: Expansion; Expansion + LED in the first week; Expansion and LED in the first and second weeks. LED irradiation occurred at every 48 h during 2 weeks. Expansion was accomplished using a spatula and maintained with a triple helicoid of 0.020" stainless steel orthodontic wire. A LED light (λ850 ± 10nm, 150mW ± 10mW, spot of 0.5cm2, t=120 sec, SAEF of 18J/cm2) was applied in one point in the midpalatal suture immediately behind the upper incisors. Near infrared Raman spectroscopic analysis of the suture region was carried and data submitted to statistical analyzes (p≤0.05). Raman spectrum analysis demonstrated that irradiation increased hydroxyapatite in the midpalatal suture after expansion. The results of this indicate that LED irradiation; have a positive biomodulation contributing to the acceleration of bone formation in the midpalatal suture after expansion procedure.

  19. Relationship of squamosal suture to asterion in pongids (Pan): relevance to early hominid brain evolution. (United States)

    Holloway, R L; Shapiro, J S


    Based on 244 measurements of the relationship of the squamosal suture to the landmark asterion in 49 chimpanzee skulls, it is shown that in the normal lateral view the squamosal suture is very rarely inferior to asterion. In hominid crania, the squamosal suture is always well superior to asterion. Even in Pan, that part of the squamosal suture most homologous with the remnant found on the Hadar AL 162-28 Australopithecus afarensis hominid cranial fragment is very rarely inferior to asterion. Such variability suggests that Falk's (Nature 313:45-47, 1985) orientation of the Hadar specimen is incorrect; she places asterion superior to the position of the squamosal suture if projected endocranially. The implication for the brain endocast is that, however the fragment is oriented, the posterior aspect of the intraparietal (IP) sulcus is in a very posterior position relative to any chimpanzee brain. The distance from the posterior aspect of IP to occipital pole is twice as great in chimpanzee brain casts than on the Hadar AL 162-28 endocast, even though the chimpanzee brain casts are smaller in overall size. This suggests that brain reorganization, at least as exemplified as a reduction in primary visual striate cortex (area 17 of Brodmann), occurred early in hominid evolution, prior to any major brain expansion.

  20. Comparative Study Between Coaptive Film Versus Suture For Wound Closure After Long Bone Fracture Fixation

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    IM Anuar Ramdhan


    Full Text Available INTRODUCTION: Coaptive film (i.e., Steri-StripsTM is an adhesive tape used to replace sutures in wound closure. The use of coaptive film for wound closure after long bone fracture fixation has not been well documented in the literature. METHODS: The aim of this prospective, randomized controlled trial comparing coaptive film with sutures for wound closure after long bone fracture fixation was skin closure time, incidence of wound complications and scar width at 12 week follow-up. Forty-five patients underwent femur fracture fixation (22 patients’ wound closed with sutures, 23 with coaptive film. RESULTS: The mean time for skin closure using coaptive film was 171.13 seconds compared to 437.27 seconds using suture. The mean wound lengths in the coaptive film group and suture group were 187.65 mm and 196.73 mm, respectively. One patient in each group had wound complications. CONCLUSION: Coaptive film is a time-saving procedure for skin closure following long bone fracture fixation. There is no difference in the incidence of wound complications and scar width between these two methods of skin closure.


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    Balakrishna Nanjundappa Setty


    Full Text Available BACKGROUND Rectal prolapse is defined as protrusion of rectal wall through the anal canal. It is further classified into 3 different categories based on the extent of rectal prolapse called partial thickness (mucosal rectal prolapse when only the mucosa is prolapsed through the anal verge, complete rectal prolapse (procidentia involves full thickness of rectal wall prolapsing out of the anal verge and internal rectal prolapse (rectal intussusception involves intussusception of the rectum into the anal canal without protrusion beyond the anal verge. Rectal prolapse can be partial to begin with and may or may not progress to complete rectal prolapse. The aim of our study is to analyse and compare two surgical techniques laparoscopic suture rectopexy and Altemeier’s procedure available for the management of rectal prolapse along with the outcomes of both in a single centre. MATERIALS AND METHODS The study was conducted in Department of Surgical Gastroenterology, Bangalore Medical College and Research Institute, Karnataka. It’s a retrospective observational study conducted between August 2012 and May 2016. The presenting feature, intraoperative events, postoperative course, complications and follow up were noted with regard to faecal incontinence, constipation and recurrent prolapse. RESULTS A total of 35 patients were included in this study. The male-to-female ratio was 1.7:1. The presenting feature being intermittent rectal prolapse in 31 (88%, irreducible rectal prolapse in 2 (5.7% and 2 (5.7% patients were operated for recurrent rectal prolapse. The presenting symptom in the patients were constipation in 14 (40%, incontinence in 5 (14.28% and solitary rectal ulcer syndrome in 3 (8.6%. 20 patients (57.14% underwent laparoscopic suture rectopexy with conversion to open in two patients. 15 (42.8% patients underwent Altemeier’s procedure. The average total duration of hospital stay for patients with suture rectopexy was 3.05263 days and for

  2. Return to football and long-term clinical outcomes after thumb ulnar collateral ligament suture anchor repair in collegiate athletes. (United States)

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


    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

  3. Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI) (United States)

    Schneider, Jochen; Harrasser, Norbert; Tübel, Jutta; Mühlhofer, Heinrich; Pförringer, Dominik; von Deimling, Constantin; Foehr, Peter; Kiefel, Barbara; Krämer, Christina; Stemberger, Axel; Schieker, Matthias


    Background Surgical sutures can promote migration of bacteria and thus start infections. Antiseptic coating of sutures may inhibit proliferation of adhered bacteria and avoid such complications. Objectives This study investigated the inhibition of viable adhering bacteria on novel antimicrobially coated surgical sutures using chlorhexidine or octenidine, a critical factor for proliferation at the onset of local infections. The medical need, a rapid eradication of bacteria in wounds, can be fulfilled by a high antimicrobial efficacy during the first days after wound closure. Methods As a pretesting on antibacterial efficacy against relevant bacterial pathogens a zone of inhibition assay was conducted with middle ranged concentrated suture coatings (22 μg/cm). For further investigation of adhering bacteria in detail the most clinically relevant Staphylococcus aureus (ATCC®49230™) was used. Absorbable braided sutures were coated with chlorhexidine-laurate, chlorhexidine-palmitate, octenidine-laurate, and octenidine-palmitate. Each coating type resulted in 11, 22, or 33 μg/cm drug content on sutures. Scanning electron microscopy (SEM) was performed once to inspect the coating quality and twice to investigate if bacteria have colonized on sutures. Adhesion experiments were assessed by exposing coated sutures to S. aureus suspensions for 3 h at 37°C. Subsequently, sutures were sonicated and the number of viable bacteria released from the suture surface was determined. Furthermore, the number of viable planktonic bacteria was measured in suspensions containing antimicrobial sutures. Commercially available sutures without drugs (Vicryl®, PGA Resorba®, and Gunze PGA), as well as triclosan-containing Vicryl® Plus were used as control groups. Results Zone of inhibition assay documented a multispecies efficacy of novel coated sutures against tested bacterial strains, comparable to most relevant S. aureus over 48 hours. SEM pictures demonstrated uniform layers on

  4. Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI). (United States)

    Obermeier, Andreas; Schneider, Jochen; Harrasser, Norbert; Tübel, Jutta; Mühlhofer, Heinrich; Pförringer, Dominik; Deimling, Constantin von; Foehr, Peter; Kiefel, Barbara; Krämer, Christina; Stemberger, Axel; Schieker, Matthias; Burgkart, Rainer; von Eisenhart-Rothe, Rüdiger


    Surgical sutures can promote migration of bacteria and thus start infections. Antiseptic coating of sutures may inhibit proliferation of adhered bacteria and avoid such complications. This study investigated the inhibition of viable adhering bacteria on novel antimicrobially coated surgical sutures using chlorhexidine or octenidine, a critical factor for proliferation at the onset of local infections. The medical need, a rapid eradication of bacteria in wounds, can be fulfilled by a high antimicrobial efficacy during the first days after wound closure. As a pretesting on antibacterial efficacy against relevant bacterial pathogens a zone of inhibition assay was conducted with middle ranged concentrated suture coatings (22 μg/cm). For further investigation of adhering bacteria in detail the most clinically relevant Staphylococcus aureus (ATCC®49230™) was used. Absorbable braided sutures were coated with chlorhexidine-laurate, chlorhexidine-palmitate, octenidine-laurate, and octenidine-palmitate. Each coating type resulted in 11, 22, or 33 μg/cm drug content on sutures. Scanning electron microscopy (SEM) was performed once to inspect the coating quality and twice to investigate if bacteria have colonized on sutures. Adhesion experiments were assessed by exposing coated sutures to S. aureus suspensions for 3 h at 37°C. Subsequently, sutures were sonicated and the number of viable bacteria released from the suture surface was determined. Furthermore, the number of viable planktonic bacteria was measured in suspensions containing antimicrobial sutures. Commercially available sutures without drugs (Vicryl®, PGA Resorba®, and Gunze PGA), as well as triclosan-containing Vicryl® Plus were used as control groups. Zone of inhibition assay documented a multispecies efficacy of novel coated sutures against tested bacterial strains, comparable to most relevant S. aureus over 48 hours. SEM pictures demonstrated uniform layers on coated sutures with higher roughness for

  5. Premaxillary-maxillary suture asymmetry in a juvenile Gorilla. Implications for understanding dentofacial growth and development. (United States)

    Schwartz, J H


    A specimen of juvenile gorilla was found that had the premaxillary-maxillary suture coursing between the lateral deciduous incisor and deciduous canine on one side of the jaw, but between the central and lateral deciduous incisors on the other; in the latter, the suture also separates the alveolus of the lateral deciduous incisor from the crypt of the growing successional lateral incisor. Rather than dismiss this exception to the traditional dictum of tooth identification--which is based on the position to teeth relative to this suture--as some inconsequential anomaly, an attempt is made to understand how this can occur within the confines of present understanding of dentofacial growth and development and developmental theory. An hypothesis relating tooth and tooth class identification is presented in the context of ectomesenchymally predifferentiated stem progenitors and subsequent tooth class proliferation.

  6. Performance Assessment of Suture Type in Juvenile Chinook Salmon Surgically Implanted with Acoustic Transmitters

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    Deters, Katherine A.; Brown, Richard S.; Carter, Kathleen M.; Boyd, James W.


    The objective of this study was to determine the best overall suture material to close incisions from the surgical implantation of Juvenile Salmon Acoustic Telemetry System (JSATS) acoustic microtransmitters in subyearling Chinook salmon Oncorhynchus tshawytscha. The effects of seven suture materials, four surgeons, and two water temperatures on suture retention, incision openness, tag retention, tissue inflammation, and tissue ulceration were quantified. The laboratory study, conducted by researchers at the Pacific Northwest National Laboratory, supports a larger effort under way for the U.S. Army Corps of Engineers, Portland District, aimed at determining the suitability of acoustic telemetry for estimating short- and longer-term (30-60 days) juvenile-salmonid survival at Columbia and Snake River dams and through the lower Columbia River.

  7. Allergy to Prolene Sutures in a Dural Graft for Chiari Decompression

    Directory of Open Access Journals (Sweden)

    Iahn Cajigas


    Full Text Available Allergy to Prolene suture is exceedingly rare with only 5 cases reported in the literature. There have been no such cases associated with neurosurgical procedures. Diagnosis is nearly always delayed in spite of persistent symptomatology. A 27-year-old girl with suspected Ehlers-Danlos, connective tissue disorder, underwent posterior fossa decompression for Chiari Type 1 malformation. One year later, the patient presented with urticarial rash from the neck to chest. Cerebrospinal fluid and blood testing, magnetic resonance imaging, and intraoperative exploration did not suggest allergic reaction. Eventually skin testing proved specific Prolene allergy. After suture material was removed, the patient no longer complained of pruritus or rash. This single case highlights the important entity of allergic reaction to suture material, namely, Prolene, which can present in a delayed basis. Symptomatology can be vague but has typical allergic characteristics. Multidisciplinary approach is helpful with confirmatory skin testing as a vital part of the workup.

  8. Novel High Efficient Coatings for Anti-Microbial Surgical Sutures Using Chlorhexidine in Fatty Acid Slow-Release Carrier Systems (United States)

    Obermeier, Andreas; Schneider, Jochen; Wehner, Steffen; Matl, Florian Dominik; Schieker, Matthias; von Eisenhart-Rothe, Rüdiger; Stemberger, Axel; Burgkart, Rainer


    Sutures can cause challenging surgical site infections, due to capillary effects resulting in bacteria permeating wounds. Anti-microbial sutures may avoid these complications by inhibiting bacterial pathogens. Recently, first triclosan-resistances were reported and therefore alternative substances are becoming clinically relevant. As triclosan alternative chlorhexidine, the “gold standard” in oral antiseptics was used. The aim of the study was to optimize novel slow release chlorhexidine coatings based on fatty acids in surgical sutures, to reach a high anti-microbial efficacy and simultaneously high biocompatibility. Sutures were coated with chlorhexidine laurate and chlorhexidine palmitate solutions leading to 11, 22 or 33 µg/cm drug concentration per length. Drug release profiles were determined in aqueous elutions. Antibacterial efficacy against Staphylococcus aureus was assessed in agar diffusion tests. Biocompatibility was evaluated via established cytotoxicity assay (WST-1). A commercially triclosan-containing suture (Vicryl Plus), was used as anti-microbial reference. All coated sutures fulfilled European Pharmacopoeia required tensile strength and proved continuous slow drug release over 96 hours without complete wash out of the coated drug. High anti-microbial efficacy for up to 5 days was observed. Regarding biocompatibility, sutures using 11 µg/cm drug content displayed acceptable cytotoxic levels according to ISO 10993-5. The highest potential for human application were shown by the 11 µg/cm chlorhexidine coated sutures with palmitic acid. These novel coated sutures might be alternatives to already established anti-microbial sutures such as Vicryl Plus in case of triclosan-resistance. Chlorhexidine is already an established oral antiseptic, safety and efficacy should be proven for clinical applications in anti-microbial sutures. PMID:24983633

  9. Novel high efficient coatings for anti-microbial surgical sutures using chlorhexidine in fatty acid slow-release carrier systems. (United States)

    Obermeier, Andreas; Schneider, Jochen; Wehner, Steffen; Matl, Florian Dominik; Schieker, Matthias; von Eisenhart-Rothe, Rüdiger; Stemberger, Axel; Burgkart, Rainer


    Sutures can cause challenging surgical site infections, due to capillary effects resulting in bacteria permeating wounds. Anti-microbial sutures may avoid these complications by inhibiting bacterial pathogens. Recently, first triclosan-resistances were reported and therefore alternative substances are becoming clinically relevant. As triclosan alternative chlorhexidine, the "gold standard" in oral antiseptics was used. The aim of the study was to optimize novel slow release chlorhexidine coatings based on fatty acids in surgical sutures, to reach a high anti-microbial efficacy and simultaneously high biocompatibility. Sutures were coated with chlorhexidine laurate and chlorhexidine palmitate solutions leading to 11, 22 or 33 µg/cm drug concentration per length. Drug release profiles were determined in aqueous elutions. Antibacterial efficacy against Staphylococcus aureus was assessed in agar diffusion tests. Biocompatibility was evaluated via established cytotoxicity assay (WST-1). A commercially triclosan-containing suture (Vicryl Plus), was used as anti-microbial reference. All coated sutures fulfilled European Pharmacopoeia required tensile strength and proved continuous slow drug release over 96 hours without complete wash out of the coated drug. High anti-microbial efficacy for up to 5 days was observed. Regarding biocompatibility, sutures using 11 µg/cm drug content displayed acceptable cytotoxic levels according to ISO 10993-5. The highest potential for human application were shown by the 11 µg/cm chlorhexidine coated sutures with palmitic acid. These novel coated sutures might be alternatives to already established anti-microbial sutures such as Vicryl Plus in case of triclosan-resistance. Chlorhexidine is already an established oral antiseptic, safety and efficacy should be proven for clinical applications in anti-microbial sutures.

  10. Comparison of fibrin sealant versus suture for wound closure in Müller muscle-conjunctiva resection ptosis repair. (United States)

    Kavanagh, Marsha C; Ohr, Matthew P; Czyz, Craig N; Cahill, Kenneth V; Perry, Julian D; Holck, David E E; Foster, Jill A


    To compare fibrin sealant (Tisseel) versus suture for wound closure in Müller muscle-conjunctiva resection ptosis repair. The charts of 114 patients (211 eyelids) who had undergone Müller muscle-conjunctiva resection were retrospectively reviewed. Suture versus Tisseel were used for wound closure. Preoperative and postoperative eyelid measurements, postoperative symmetry within 0.5 mm, and complications were compared. Müller muscle-conjunctiva resection ptosis repair was performed on 211 eyelids of 114 patients. Seventeen cases were unilateral and 97 cases were bilateral. Method of wound closure included suture (45 eyelids of 31 patients) versus Tisseel (166 eyelids of 83 patients). For the suture group, the mean preoperative MRD1 was 1.2 mm and the postoperative MRD1 was 3.0 mm; the difference was 1.9. For the Tisseel group, the mean preoperative MRD1 was 1.2 mm and the postoperative MRD1 was 3.0 mm; the difference was 1.8. The 2 groups did not differ statistically in preoperative (p = 0.97) or postoperative MRD1 values (p = 0.53), the difference (p = 0.63), or postoperative symmetry within 0.5 mm (p = 0.39). In the suture group, complications included moderate to severe pain (10%), suture granuloma (6%), corneal abrasion (3%), loose suture (3%), and persistent keratopathy (3%). We found no evidence of keratopathy attributable to the Tisseel (p = 0.0001). This difference in the prevalence of complications was statistically significant (p = 0.0001). Four patients in the suture group (13%) underwent subsequent procedures including suture granuloma removal (2) and suture removal (1); 1 patient (3%) required levator resection. Three patients in the Tisseel group (4%) subsequently underwent levator resection. Müller muscle-conjunctiva resection ptosis repair using fibrin sealant for wound closure offers comparable eyelid position results compared with suture. Use of Tisseel showed fewer postoperative complications and was associated with fewer subsequent surgical

  11. Effects of circular myotomy on the healing of esophageal suture anastomosis: an experimental study. (United States)

    Tannuri, U; Tannuri, A C; Fukutaki, M F; de Oliveira, M S; Muoio, V M; Massaguer, A A


    For esophageal reconstruction in newborns with esophageal atresia, esophageal reunion with an end-to-end anastomosis is the ideal procedure, although it may result in leaks and strictures due to tension on the suture line, mainly in cases with a wide gap between the ends. Circular myotomy (Livaditis' procedure) is the best method to elongate the proximal esophageal pouch and reduce anastomotic tension. This experimental investigation in dogs was undertaken to attempt to verify that circular myotomy decreases the anastomotic leak rate in newborns with wide gap esophageal atresia, and to analyze whether the technique promotes morphologic changes in the anastomotic scar. A pilot study demonstrated that it is necessary to resect more than 8 cm (40% of the total esophageal length) in order to obtain high leak rates. In the experimental project, such resection was performed in dogs divided into two groups (control group, anastomosis only, and experimental group, anastomosis plus circular myotomy in the proximal esophageal segment). The animals were killed in the 14th postoperative day, submitted to autopsy, and were evaluated as to the presence of leaks and strictures, as well as to the features (macroscopic and microscopic aspects) of the anastomosis. Leak rates were the same in both groups. Morphometric analysis revealed that in animals in the experimental group, the anastomotic scar was thinner than the control animals, and the isolated muscular manchette distal to the site of myotomy was replaced by fibrous tissue. Correspondingly, a decreased number of newly formed small vessels were noted in the experimental animals, compared to control animals. We concluded that circular myotomy does not decrease the incidence of anastomotic leaks, and it also promotes deleterious changes in anastomotic healing.

  12. Effects of circular myotomy on the healing of esophageal suture anastomosis: an experimental study

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    Tannuri Uenis


    Full Text Available For esophageal reconstruction in newborns with esophageal atresia, esophageal reunion with an end-to-end anastomosis is the ideal procedure, although it may result in leaks and strictures due to tension on the suture line, mainly in cases with a wide gap between the ends. Circular myotomy (Livaditis' procedure is the best method to elongate the proximal esophageal pouch and reduce anastomotic tension. This experimental investigation in dogs was undertaken to attempt to verify that circular myotomy decreases the anastomotic leak rate in newborns with wide gap esophageal atresia, and to analyze whether the technique promotes morphologic changes in the anastomotic scar. A pilot study demonstrated that it is necessary to resect more than 8 cm (40% of the total esophageal length in order to obtain high leak rates. In the experimental project, such resection was performed in dogs divided into two groups (control group, anastomosis only, and experimental group, anastomosis plus circular myotomy in the proximal esophageal segment. The animals were killed in the 14th postoperative day, submitted to autopsy, and were evaluated as to the presence of leaks and strictures, as well as to the features (macroscopic and microscopic aspects of the anastomosis. Leak rates were the same in both groups. Morphometric analysis revealed that in animals in the experimental group, the anastomotic scar was thinner than the control animals, and the isolated muscular manchette distal to the site of myotomy was replaced by fibrous tissue. Correspondingly, a decreased number of newly formed small vessels were noted in the experimental animals, compared to control animals. We concluded that circular myotomy does not decrease the incidence of anastomotic leaks, and it also promotes deleterious changes in anastomotic healing.

  13. Craniotomy of the Fused Sagittal Suture Over the Superior Sagittal Sinus Is a Safe Procedure. (United States)

    Kölby, David; Fischer, Sara; Arab, Khalid; Maltese, Giovanni; Olsson, Robert; Paganini, Anna; Tarnow, Peter; Kölby, Lars


    Spring-assisted cranioplasty to correct sagittal synostosis is based on midline craniotomy through the closed sagittal suture, over the superior sagittal sinus (SSS). The aim of the present study was to evaluate the perioperative safety of this technique. This is a retrospective study of all patients operated with median craniotomy and springs from 1998 to the end of 2015. For comparison, all Pi-plasties performed during the same time interval were also evaluated. The safety measures were evaluated based on incidence of damage to SSS, incidence of dural tears, perioperative blood loss, operative time, and hospital stay. In the group that had undergone midline craniotomy combined with springs (n = 225), 4 perioperative damages to SSS and 1 dural tear were seen. The perioperative blood loss was 62.8 ± 65.3 mL (mean ± standard deviation). The operative time was 67.9 ± 21.5 minutes and the hospital stay was 4.8 ± 1.1 days. In the group that had undergone pi-plasty (n = 105), no damages to SSS but 3 dural tears were seen. The perioperative blood loss was 352.8 ± 174.4 mL. The operative time was 126.0 ± 31.7 minutes and the hospital stay was 7.1 ± 1.4 days. Craniotomy SSS in sagittal synostosis is a safe procedure with low morbidity in terms of damage to the SSS. Midline craniotomy combined with springs has significantly lower preoperative blood loss, operative time, and hospital stay (P < 0.001 for all) compared to pi-plasty.

  14. Synthetic Augmented Suture Anchor Reconstruction for a Complete Traumatic Distal Triceps Tendon Rupture in a Male Professional Bodybuilder with Postoperative Biomechanical Assessment (United States)

    Nikolaidou, Maria-Elissavet; Banke, Ingo J.; Laios, Thomas; Petsogiannis, Konstantinos; Mourikis, Anastasios


    Bodybuilding is a high-risk sport for distal triceps tendon ruptures. Management, especially in high-demanding athletes, is operative with suture anchor refixation technique being frequently used. However, the rate of rerupture is high due to underlying poor tendon quality. Thus, additional augmentation could be useful. This case report presents a reconstruction technique for a complete traumatic distal triceps tendon rupture in a bodybuilder with postoperative biomechanical assessment. A 28-year-old male professional bodybuilder was treated with a synthetic augmented suture anchor reconstruction for a complete triceps tendon rupture of his right dominant elbow. Postoperative biomechanical assessment included isokinetic elbow strength and endurance testing by using multiple angular velocities to simulate the “off-season” and “precompetition” phases of training. Eighteen months postoperatively and after full return to training, the biomechanical assessment indicated that the strength and endurance of the operated elbow joint was fully restored with even higher ratings compared to the contralateral healthy arm. The described reconstruction technique can be considered as an advisable option in high-performance athletes with underlying poor tendon quality due to high tensile strength and lack of donor site morbidity, thus enabling them to restore preinjury status and achieve safe return to sports. PMID:24711944

  15. Synthetic Augmented Suture Anchor Reconstruction for a Complete Traumatic Distal Triceps Tendon Rupture in a Male Professional Bodybuilder with Postoperative Biomechanical Assessment

    Directory of Open Access Journals (Sweden)

    Maria-Elissavet Nikolaidou


    Full Text Available Bodybuilding is a high-risk sport for distal triceps tendon ruptures. Management, especially in high-demanding athletes, is operative with suture anchor refixation technique being frequently used. However, the rate of rerupture is high due to underlying poor tendon quality. Thus, additional augmentation could be useful. This case report presents a reconstruction technique for a complete traumatic distal triceps tendon rupture in a bodybuilder with postoperative biomechanical assessment. A 28-year-old male professional bodybuilder was treated with a synthetic augmented suture anchor reconstruction for a complete triceps tendon rupture of his right dominant elbow. Postoperative biomechanical assessment included isokinetic elbow strength and endurance testing by using multiple angular velocities to simulate the “off-season” and “precompetition” phases of training. Eighteen months postoperatively and after full return to training, the biomechanical assessment indicated that the strength and endurance of the operated elbow joint was fully restored with even higher ratings compared to the contralateral healthy arm. The described reconstruction technique can be considered as an advisable option in high-performance athletes with underlying poor tendon quality due to high tensile strength and lack of donor site morbidity, thus enabling them to restore preinjury status and achieve safe return to sports.

  16. Intimal Surface Suture Line (End-Product Assessment of End-to-Side Microvascular Anastomosis

    Directory of Open Access Journals (Sweden)

    Georgios Pafitanis, MD


    Full Text Available Summary:. Microsurgery simulation courses increasingly use assessment methodologies to evaluate the quality of microvascular anastomosis and to provide constructive feedback in competency-based training. Assessment tools evaluating the “journey” of skill acquisition in anastomosis have evolved, including global rating scores, hand motion analysis, and evaluation of the final outcome, that is, “end-product” assessment. Anastomotic patency is the gold standard end-product in clinical microvascular surgery, and in vivo end-to-side anastomosis, which can be confirmed using the Acland-test. Microsurgery simulation training is moving to include nonliving models, where possible, according to the principles of the replacement, reduction, and refinement of the use of animals in research. While a standardized end-product assessment tool for nonliving end-to-end anastomosis exists, there is no similar tool for end-to-side anastomosis. Intimal surface suture line assessment is an error list-based tool, which involves exposing the intimal surface of a vessel and analysis of the quality of suture placement. Errors in end-to side anastomosis were classified according to the potential clinical significance (high, medium, or low perceived by the senior authors. Intimal surface suture line assessment provides constructive feedback during microsurgery training, helping to minimize technical errors, which are likely to impact on the final outcome in a clinical environment. Intimal surface suture line assessment lends itself to nonliving simulation training courses as an end-product self-assessment tool, especially during the early learning curve, to demonstrate progression. It has intraoperative relevance by assessment of the intimal surface suture line as the final sutures are placed in an end-to-side anastomosis to provide objective feedback to trainees in relation to likely physiological anastomotic outcome.

  17. Biomechanical Analysis of Suture Anchor vs Tenodesis Screw for FHL Transfer. (United States)

    Drakos, Mark C; Gott, Michael; Karnovsky, Sydney C; Murphy, Conor I; DeSandis, Bridget A; Chinitz, Noah; Grande, Daniel; Chahine, Nadeen


    Chronic Achilles injury is often treated with flexor hallucis longus (FHL) tendon transfer to the calcaneus using 1 or 2 incisions. A single incision avoids the risks of extended dissections yet yields smaller grafts, which may limit fixation options. We investigated the required length of FHL autograft and biomechanical profiles for suture anchor and biotenodesis screw fixation. Single-incision FHL transfer with suture anchor or biotenodesis screw fixation to the calcaneus was performed on 20 fresh cadaveric specimens. Specimens were cyclically loaded until maximal load to failure. Length of FHL tendon harvest, ultimate load, stiffness, and mode of failure were recorded. Tendon harvest length needed for suture anchor fixation was 16.8 ± 2.1 mm vs 29.6 ± 2.4 mm for biotenodesis screw ( P = .002). Ultimate load to failure was not significantly different between groups. A significant inverse correlation existed between failure load and donor age when all specimens were pooled (ρ = -0.49, P Screws in younger specimens (fewer than 70) resulted in significantly greater failure loads ( P screw fixation were either tunnel pullout (n = 6) or tendon rupture (n = 4). Anchor failure occurred mostly by suture breakage (n = 8). Adequate FHL tendon length could be harvested through a single posterior incision for fixation to the calcaneus with either fixation option, but suture anchor required significantly less graft length. Stiffness, fixation strength, and load to failure were comparable between groups. An inverse correlation existed between failure load and donor age. Younger specimens with screw fixation demonstrated significantly greater failure loads. Adequate harvest length for FHL transfer could be achieved with a single posterior incision. There was no difference in strength of fixation between suture anchor and biotenodesis screw.

  18. Using external magnet guidance and endoscopically placed magnets to create suture-free gastro-enteral anastomoses. (United States)

    Myers, Christopher; Yellen, Benjamin; Evans, John; DeMaria, Eric; Pryor, Aurora


    To facilitate endolumenal and natural orifice procedures, this study evaluated a novel technique using external and endoscopically placed magnets to create suture-free gastroenteral anastomoses. Seven anesthetized adult swine underwent endoscopic placement of magnets into the small bowel and stomach. Using external magnets, the endoscopically placed internal magnets were brought into opposition under endoscopic view. After 1-2 weeks, the pigs were killed and analyzed. At laparotomy and under sterile conditions, peritoneal cultures were obtained. The anastomoses were evaluated endoscopically and tested using an air insufflation test. Finally, the anastomoses were resected and evaluated microscopically. The average operative time for endoscopic placement of the magnets was 34.3 +/- 14.8 min. Successful placement and creation of anastomoses occurred in six of the pigs. One pig did not form an anastomosis because the magnets were too large to pass through the pylorus at the time of attempted magnet placement. Six swine experienced uncomplicated postoperative courses. One pig's postoperative course involved constipation for several days, requiring additional fluids and fiber supplementation. The findings at endoscopy showed that the magnets were adhered to the anastomosis, which were easily freed, or within the stomach. The air insufflation test results were negative for all the pigs. At laparotomy, there was no evidence of infection, abscess, or leak, but two peritoneal culture results were positive with scant growth of Staphylococcus aureus and coagulase-negative staphylococcus, presumably contaminants. Microscopically, the anastomoses illustrated granulation and fibrous connective tissue without evidence of infection or leak. Endoscopically placed magnets with external magnet guidance is a feasible and novel approach to creating patent gastroenteral anastomoses without abdominal incisions or sutures.

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

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    Bryan G. Vopat


    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.

  20. Funnel compression suture: a conservative procedure to control postpartum bleeding from the lower uterine segment. (United States)

    Li, G T; Li, G R; Li, X F; Wu, B P


    Bleeding from the lower uterine segment (LUS) during caesarean section remains a life-threatening obstetric problem, particularly in women with placenta praevia or partial placenta accreta in the LUS. Various conservative measures for the surgical treatment of postpartum haemorrhage have been studied for decades. In this paper we describe a funnel compression suture to staunch intractable bleeding from LUS for placenta praevia accreta. The suture brings the anterior and posterior walls of the LUS together using absorbable thread and was successful in the overwhelming majority of women. It is an easy, safe and effective conservative surgical treatment to stop severe bleeding of the LUS. © 2015 Royal College of Obstetricians and Gynaecologists.

  1. Suture Granuloma Showing False-Positive Findings on FDG-PET

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    Kohei Takahara


    Full Text Available We report a case of a 33-year-old male with a mixed germ-cell testicular tumor. Postoperative follow-up FDG-PET revealed concentration of FDG in the left inguinal area which is not tumor metastasis or local recurrence but suture reactivity granuloma. In this paper, we reviewed suture granulomas associated with false-positive findings on FDG-PET after surgery. If FDG-PET will be used more frequently in the future, it will be necessary to refrain from using silk thread in order to prevent any unnecessary surgery.

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


    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.

  3. In Vitro Oral Biofilm Formation on Triclosan-Coated Sutures in the Absence and Presence of Additional Antiplaque Treatment

    NARCIS (Netherlands)

    Venema, Sebastiaan; Abbas, Frank; van de Belt-Gritter, Betsy; van der Mei, Henny C.; Busscher, Henk J.; van Hoogmoed, Chris G.

    Purpose: This study evaluated the in vitro plaque inhibitory effect of triclosan-coated polyglactin 910 sutures in the absence and presence of an additional antiplaque agent commonly used after oral surgery. Materials and Methods: Triclosan-coated sutures were incubated for 4 hours in freshly

  4. Association of abnormal metopic suture causing hypertelorism, interfrontal encephalocele with craniofacial cosmetic deformity associated with myelomeningocele: management literature review

    Directory of Open Access Journals (Sweden)

    Calderon-Miranda Willem Guillermo


    Full Text Available Myelomeningocele may be associated with other neural and extraneural anomalies. Authors present association of metopic suture abnormality, an interfrontal encephalocele with widening of metopic suture and abnormal shape frontal bones in the forehead in those associated with hydrocephalus. Authors describes two neonates with interfrontal encephalocele, representing first series reporting in neonate. Management and pertinent literature is briefly discussed.

  5. Report of a 10-0 polypropylene suture that did not undergo biodegradation after 13 years in the eye (United States)

    Coleman, Michael; Soiberman, Uri; Stark, Walter J.


    Summary We report the case of a 70-year-old man who underwent surgery to fixate a subluxated intraocular lens. A 10-0 polypropylene suture that had been placed 13 years prior was retrieved intraoperatively and subsequently imaged using electron microscopy. The suture showed no clinically significant signs of biodegradation. PMID:28924405

  6. Biomechanical evaluation of the long head of the biceps brachii tendon fixed by three techniques: a sheep model

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    Carlos Henrique Ramos

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the biomechanical properties of the fixation of the long head of the biceps brachii into the humeral bone with suture anchors, interference screw, and soft tissue suture, comparing strength, highest traction load, and types of fixation failure. METHODS: Thirty fresh-frozen sheep shoulders were used, separated into three groups of ten for each technique. After fixation, the tendons were subjected to longitudinal continuous loading, obtaining load-to-failure (N and displacement (mm. RESULTS: The mean load-to-failure for suture anchors was 95 ± 35.3 N, 152.7 ± 52.7 N for interference screw, and 104.7 ± 23.54 N for soft tissue technique. There was a statistically significant difference (p < 0.05, with interference screw demonstrating higher load-to-failure than suture anchor fixation (p = 0.00307 and soft tissue (p = 0.00473. The strength of interference screw was also superior when compared with the other two methods (p = 0.0000127 and p = 0.00000295, respectively. There were no differences between suture anchors and soft tissue technique regarding load-to-failure (p = 0.9420 and strength (p = 0.141. CONCLUSION: Tenodesis of the long head of the biceps brachii with interference screw was stronger than the suture anchors and soft tissue techniques. The other two techniques did not differ between themselves.

  7. Sutura simples e âncora em quadris de coelhos Simple suture and anchor in rabbit hips

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    Fernando Cal Garcia Filho


    Full Text Available OBJETIVO: Por meio de ensaios biomecânicos, comparar as capsulorrafias com sutura simples e com âncoras, em quadris de coelhos. MÉTODO: Foram utilizados 13 coelhos, 26 quadris, todos machos da raça Nova Zelândia albinos (Oryctolaguscuniculus. Inicialmente, realizamos um projeto piloto em três coelhos (seis quadris. Este experimento constou de 10 coelhos, divididos em 2 grupos: o Grupo 1 submetido à capsulorrafia (quadris direito e esquerdo com sutura simples utilizando fio absorvível de ácido poliglicólico e o Grupo 2 submetido a capsulorrafia (quadris direito e esquerdo com âncora de titânio. Após o período de quatro semanas de operados, todos animais foram submetidos à eutanásia e seus quadris congelados. Após um descongelamento prévio das peças, no mesmo dia das análises biomecânicas, foram avaliados os parâmetros de rigidez, força máxima, deformidade máxima e energia. RESULTADOS: Não houve diferença estatisticamente significante em relação à força no limite de proporcionalidade, rigidez e força máxima entre os grupos com sutura simples e com âncora. CONCLUSÃO: Por meio dos ensaios biomecânicos, tendo como parâmetro a rigidez, a força máxima, a deformidade máxima e a energia, ficou demonstrado que as capsulorrafias em quadris de coelhos com sutura simples e com âncora são semelhantes entre si. Nível de Evidência II, Estudo Prospectivo Comparativo.OBJECTIVE: Using biomechanical studies, this research aims to compare hip capsulorrhaphy in rabbits, carried out with two different techniques: capsulorrhaphy with simple sutures and with anchors. METHOD: Thirteen New Zealand Albino (Oryctolaguscuniculus male rabbits, twenty-six hip joints, were used. First, a pilot project was performed with three rabbits (six hip joints. This experiment consisted of ten rabbits divided into two groups: group 1 underwent capsulorrhaphy on both right and left hips with simple suture using polyglycolic acid absorbable thread

  8. Growing skull fracture - rupture of coronal suture caused by vacuum extraction

    International Nuclear Information System (INIS)

    Hansen, K.N.; Pedersen, H.; Petersen, M.B.


    Growing skull fracture is a well known complication to calvarian fracture with underlying dural tear and brain injury in infancy and early childhood. This has been reported in three cases after forceps delivery. To our best knowledge it has never been described after disruption of a calvarian suture caused by vacuum extraction delivery. (orig.)

  9. ERCP-induced duodenal perforation successfully treated with endoscopic purse-string suture: a case report. (United States)

    Li, Quanpeng; Ji, Jie; Wang, Fei; Ge, Xianxiu; Nie, Junjie; Xu, Boming; Zhang, Xiuhua; Jiang, Guobing; Miao, Lin


    Duodenal perforation is one of the most serious complications of endoscopic retrograde cholangiopancreatography (ERCP) and is difficult to manage. Recently, endoscopic purse-string suture, using endoloops with endoclips, is a relatively new technology and has provided good clinical results. However, the study and use of endoscopic purse-string suture on duodenal perforation is less and its feasibility and safety are unknown. Here, we report a case of ERCP-induced duodenal perforation successfully treated with endoscopic purse-string suture. During ERCP, fluoroscopy revealed abnormal perinephric gas shadowing after breaking and extracting the stones with a stone-removal basket. Then duodenal endoscopy showed an approximately 2.0 cm × 1.5 cm perforation on the lateral duodenal wall, with visible retroperitoneal loose connective tissue. Titanium clips were used to attempt closure of the perforation but failed because of the long diameter of the injury. Therefore, an endoscopic purse-string suture, using endoloops with endoclips, was employed with an Olympus double-lumen endoscope. The perforation was successfully closed. At the 2-month follow-up visit, the patient had no complaints or symptoms. Our case once again proved its feasibility and safety and provided a new perspective for surgeons.

  10. Scleral fixation of intraocular lenses using Gore-Tex suture: clinical outcomes and safety profile. (United States)

    Khan, M Ali; Gupta, Omesh P; Smith, Ryan G; Ayres, Brandon D; Raber, Irving M; Bailey, Robert S; Hsu, Jason; Spirn, Marc J


    To report the short-term safety profile and clinical outcomes of scleral fixation of intraocular lenses (IOLs) using Gore-Tex suture. Retrospective, interventional case series. 85 eyes of 84 patients undergoing ab externo scleral fixation of a Bausch and Lomb Akreos AO60 or Alcon CZ70BD IOL using Gore-Tex suture. Primary outcome measures were change in visual acuity and occurrence of intraoperative and postoperative complications with minimum follow-up of 90 days. 85 eyes of 84 patients were identified. Mean logarithm of the minimum angle of resolution visual acuity improved from 1.43±0.72 (20/538 Snellen equivalent) preoperatively to 0.64±0.61 (20/87 Snellen equivalent) postoperatively (pGore-Tex suture was well tolerated in all cases. No suture-related complications were encountered. This procedure led to improvement in visual acuity and was not associated with significant intraoperative or postoperative complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  11. Evaluation of four suture materials for surgical incision closure in Siberian sturgeon (United States)

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


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

  12. 21 CFR 878.4494 - Absorbable poly(hydroxybutyrate) surgical suture produced by recombinant DNA technology. (United States)


    ... recombinant DNA technology. (a) Identification. An absorbable poly(hydroxybutyrate) surgical suture is an... produced by recombinant DNA technology. 878.4494 Section 878.4494 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY...

  13. Tensile strength of a weave tendon suture using tendons of different sizes. (United States)

    Mazurek, Tomasz; Strankowski, Michał; Ceynowa, Marcin; Rocławski, Marek


    This study compared the maximum load, stress, elongation at failure and the mode of failure of three kinds of tendons most frequently used for tendon grafting and tendon transfers, using the Pulvertaft weave suture. Sixty tendons were used from fresh human cadaver upper and lower extremities. The performed repairs included: 9 specimens of flexor digitorum superficialis or profundus tendon with flexor digitorum superficialis or profundus tendon (thick-thick suture), 10 specimens of flexor digitorum superficialis or profundus tendon with palmaris longus tendon (thick-medium thin suture), and 10 specimens of flexor digitorum superficialis or profundus tendon with plantaris tendon (thick-thin suture). Material testing machine was used to test repairs to failure. The mean maximum load at failure increased with the thickness of donor tendon. For the thick-thick specimen, the maximum load at failure was 125 newtons (N), for the thick-medium thin specimen it was 86,8N, and for the thick-thin it was 65,2N. These differences were all statistically significant. The active rehabilitation protocol is possible only with thick-thick connections used, the strength of the thick-medium thin connection is on the border of indications for the active rehabilitation protocol, and the thick-thin connection strength is sufficient only for the passive rehabilitation protocol. Copyright © 2010. Published by Elsevier Ltd.

  14. Adjustment of gamma radiation doses for sterilization of Egyptian surgical sutures

    International Nuclear Information System (INIS)

    Tawfik, Z.S.; Helmy, M.M.; Roushdy, H.M.


    The adjustment of gamma radiation doses for sterilization of catguts under local manufacturing conditions has been performed. Average total initial counts for aerobic and anaerobic bacteria per item were relatively low, in the range of 1000 counts for aerobic and 10 counts for anaerobic bacteria. The microfiora (aerobic bacteria) of the studied sutures were isolated and identified to be: Bacillus sp.; Micrococcus varians, Micrococcus roseus, and Staphylococcus. Each purified and identified isolate was exposed to gamma radiation both in liquid media (broth) and in the preservative in which the sutures were supplied by the company. The LD values of the most resistant microorganisms in both case of liquid media and preservative, were obtained to be around 5 KGy. Deliberately contaminated sterile sutures with each isolate and with mixture of isolates were studied. The sterilizing dose was obtained to be 20KGy for most heavily contaminated items (10 10 counts) irradiated both in saline and in preservative. This sterilizing dose was found to be dependent of the initial viable counts. This value was considered to be a safe value for radiosterilization of the studied sutures preserved in isopropyl alcohol, glycerin, and water (90:3.5:16)

  15. Endoscopic Management of Gastrocutaneous Fistula Using Clipping, Suturing, and Plugging Methods

    Directory of Open Access Journals (Sweden)

    Shou-jiang Tang


    Conclusions: Health care providers need to be aware of this uncommon complication after PEG tube removal and management it with appropriate minimally invasive options where expertise and devices are available. Currently, tissue approximation with clips, intra-gastric and/or trans-abdominal suture placement is the preferred endoscopic options for fistula closure.

  16. Performance of fast-absorbable suture and histo-glue in closing incisions in Brown trout

    DEFF Research Database (Denmark)

    Jepsen, Niels; Larsen, Martin Hage; Aarestrup, Kim


    , growth, tag expulsion rate and incision healing was compared among three groups of dummy transmitter-tagged wild brown trout Salmo trutta where incisions were closed with two types of suture material (absorbable vs. fast absorbable) and Histo-glue. The tagged fish were kept in semi-natural ponds for 20...

  17. 77 FR 8117 - Medical Devices; Cardiovascular Devices; Classification of the Endovascular Suturing System (United States)


    ... or fracture of the endovascular Bench testing suture. Animal testing Clinical evaluation Imaging... inability to deploy.. Bench testing Animal testing Clinical evaluation Software validation Failure to... accordance with section 513(f)(1) of the Federal Food, Drug, and Cosmetic Act (FD&C Act) (21 U.S.C. 360c(f)(1...

  18. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial

    NARCIS (Netherlands)

    Lakeman, M. M. E.; The, S.; Schellart, R. P.; Dietz, V.; ter Haar, J. F.; Thurkow, A.; Scholten, P. C.; Dijkgraaf, M. G. W.; Roovers, J. P. W. R.


    Please cite this paper as: Lakeman M, The S, Schellart R, Dietz V, ter Haar J, Thurkow A, Scholten P, Dijkgraaf M, Roovers J. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial. BJOG 2012;119:14731482. Objective To

  19. Polypropylene suture versus skin staples for securing mesh in lichtenstein inguinal hernioplasty. (United States)

    Khan, Awais Ali; Majeed, Shahid; Shahzadi, Maria; Hussain, Syed Mukarram; Ali, Mujahid Zulfiqar; Siddique, Khalid


    To compare polypropylene suture and skin staples for securing mesh in Lichtenstein inguinal hernioplasty in terms of mean operating time and postoperative pain. Randomized clinical trial. Surgical Ward, Combined Military Hospital, Kharian, from August 2011 to February 2012. All individuals fulfilling inclusion criteria underwent elective Lichtenstein inguinal hernioplasty as admitted patients, under spinal anaesthesia and with aseptic measures. In group 1, during the operation, mesh fixation was done with 2/0 polypropylene suture and skin was closed with subcuticular 2/0 polypropylene suture whereas in group 2, the anchorage of mesh was done with skin staples and skin was closed with staples from the same stapler. Mean operative time and postoperative pain, assessed on a visual analog score, were compared between the groups. The overall postoperative pain was lower (p = 0.026) when staples were used to anchor mesh. Moreover, operative time was also lower (37.42 ± 2.69 minutes) in staple group versus (42.44 ± 2.55 minutes in polypropylene group). Mean operating time and postoperative pain is less in securing mesh with skin staples as compared to polypropylene suture in Lichtenstein inguinal hernioplasty.

  20. 'The Closer'-percutaneous vascular suture device: evaluation of safety and performance in neuroangiography

    International Nuclear Information System (INIS)

    Henk, Christine B.; Grampp, Stephan; Heimberger, Karl; Czerny, Christian; Schindler, Erwin; Mostbeck, Gerhard H.


    Objective: To evaluate the use of the suture mediated vascular closure device concerning practicability and safety in clinical angiography practice. Material and methods: One hundred and seventeen patients (59 female, 58 male, mean age 40.9±13.4) underwent percutaneous closure of common femoral arterial puncture sites following diagnostic neuroangiography using the suture device 'the Closer' (Perclose Inc., Redwood City, CA, USA). Primary success, early problems (within 24 h) and late complications were evaluated. Complications were graded as minor and severe with or without need of surgical intervention and categorized by type. Parameters such as age, gender, sheath size and number of previous arterial punctures were evaluated with respect to complications. Results: Percutaneous closure was primary successful in 85% (100/117). The overall complication rate was 32% (28% mild n=35, 4% severe n=6, which needed surgical intervention). All but one problem occurred within the first 24 h after the suture. Additional manual compression was necessary in 32 cases (25%). There was no significant difference in age and gender between the groups with and without complications. Sheath size was significantly larger (P<0.01) and numbers of preceding angiograms were significantly higher (P<0.01) in the complications group compared with uncomplicated cases. Conclusion: The evaluated percutaneous vascular suture device is useful in clinical practice but limitations concerning patient selection seem to emerge in order to avoid complications

  1. A novel suture method to place and adjust peripheral nerve catheters

    DEFF Research Database (Denmark)

    Rothe, C.; Steen-Hansen, C.; Madsen, M. H.


    We have developed a peripheral nerve catheter, attached to a needle, which works like an adjustable suture. We used in-plane ultrasound guidance to place 45 catheters close to the femoral, saphenous, sciatic and distal tibial nerves in cadaver legs. We displaced catheters after their initial...

  2. Conization of the cervix uteri. Complications in connection with plain catgut or silk suturing

    DEFF Research Database (Denmark)

    Holmskov, A; Qvist, N; Møller, A


    During a retrospective study on postoperative complications in 213 patients who had undergone conization, a (non-significant) reduction in the bleeding rate from 27.9% to 18.6% was found when using silk sutures (102 patients) instead of plain catgut (111 patients) for adaption of the edges of the...

  3. Tracing the influence of the Trans-European Suture Zone into the mantle transition zone

    Czech Academy of Sciences Publication Activity Database

    Knapmeyer-Endrun, B.; Krüger, F.; Legendre, C. P.; Geissler, W.H.; Plomerová, Jaroslava; Babuška, Vladislav; Gaždová, Renata; Jedlička, Petr; Kolínský, Petr; Málek, Jiří; Novotný, Oldřich; Růžek, Bohuslav


    Roč. 363, FEB 1 (2013), s. 73-87 ISSN 0012-821X Institutional support: RVO:67985530 ; RVO:67985891 Keywords : mantle transition zone * Trans-European Suture Zone * East European Craton Subject RIV: DC - Siesmology, Volcanology, Earth Structure Impact factor: 4.724, year: 2013

  4. Influence of microvascular sutures on shear strain rate in realistic pulsatile flow. (United States)

    Wain, R A J; Smith, D J; Hammond, D R; Whitty, J P M


    Arterial thrombus formation is directly related to the mechanical shear experienced by platelets within flow. High shear strain rates (SSRs) and large shear gradients cause platelet activation, aggregation and production of thrombus. This study, for the first time, investigates the influence of pulsatile flow on local haemodynamics within sutured microarterial anastomoses. We measured physiological arterial waveform velocities experimentally using Doppler ultrasound velocimetry, and a representative example was applied to a realistic sutured microarterial geometry. Computational geometries were created using measurements taken from sutured chicken femoral arteries. Arterial SSRs were predicted using computational fluid dynamics (CFD) software, to indicate the potential for platelet activation, deposition and thrombus formation. Predictions of steady and sinusoidal inputs were compared to analyse whether the addition of physiological pulse characteristics affects local intravascular flow characteristics. Simulations were designed to evaluate flow in pristine and hand-sutured microarterial anastomoses, each with a steady-state and sinusoidal pulse component. The presence of sutures increased SSR max in the anastomotic region by factors of 2.1 and 2.3 in steady-state and pulsatile flows respectively, when compared to a pristine vessel. SSR values seen in these simulations are analogous to the presence of moderate arterial stenosis. Steady-state simulations, driven by a constant inflow velocity equal to the peak systolic velocity (PSV) of the measured pulsatile flow, underestimated SSRs by ∼ 9% in pristine, and ∼ 19% in sutured vessels compared with a realistic pulse. Sinusoidal flows, with equivalent frequency and amplitude to a measured arterial waveform, represent a slight improvement on steady-state simulations, but still SSRs are underestimated by 1-2%. We recommend using a measured arterial waveform, of the form presented here, for simulating pulsatile flows

  5. Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo. (United States)

    Younesi, Mousa; Knapik, Derrick M; Cumsky, Jameson; Donmez, Baris Ozgur; He, Ping; Islam, Anowarul; Learn, Greg; McClellan, Philip; Bohl, Michael; Gillespie, Robert J; Akkus, Ozan


    Flexor tendon lacerations are traditionally repaired by using non-absorbable monofilament sutures. Recent investigations have explored to improve the healing process by growth factor delivery from the sutures. However, it is difficult to conjugate growth factors to nylon or other synthetic sutures. This study explores the performance of a novel electrochemically aligned collagen suture in a flexor tendon repair model with and without platelet derived growth factor following complete tendon laceration in vivo. Collagen suture was fabricated via electrochemical alignment process. Heparin was covalently bound to electrochemically aligned collagen sutures (ELAS) to facilitate affinity bound delivery of platelet-derived growth factor-BB (PDGF-BB). Complete laceration of the flexor digitorum profundus in the third digit of the foot was performed in 36 skeletally mature White Leghorn chickens. The left foot was used as the positive control. Animals were randomly divided into three groups: control specimens treated with standard nylon suture (n=12), specimens repaired with heparinated ELAS suture without PDGF-BB (n=12) and specimens repaired with heparinated ELAS suture with affinity bound PDGF-BB (n=12). Specimens were harvested at either 4weeks or 12weeks following tendon repair. Differences between groups were evaluated by the degree of gross tendon excursion, failure load/stress, stiffness/modulus, absorbed energy at failure, elongation/strain at failure. Quantitative histological scoring was performed to assess cellularity and vascularity. Closed flexion angle measurements demonstrated no significant differences in tendon excursion between the study groups at 4 or 12weeks. Biomechanical testing showed that the group treated with PDGF-BB bound heparinated ELAS suture had si