Manabe, Shin-Ichi; Sawaguchi, Shoichi; Hayashi, Ken
To report 2 cases of secondary glaucoma combined with scleromalacia that were successfully treated with trabeculotomy ab interno. Retrospective case report : Trabeculotomy ab interno was used to treat secondary glaucoma combined with scleromalacia, which occurred due to refractory scleritis, in 2 cases. In case 2, goniosynechialysis was performed before the trabeculotomy to identify the trabecular meshwork. The sclera and conjunctiva were not incised in either case. The patients' postoperative intraocular pressure (IOP) levels (which were achieved without medication) were lower than their preoperative IOP levels (which were recorded during the administration of the maximum tolerable medication dosage); that is, they had dropped from 24 to 12 mm Hg in case 1 and from 33 to 11 mm Hg in case 2 by 12 postoperative months. No recurrent scleritis or postoperative worsening of the patient's scleromalacia was seen in either case. Trabeculotomy ab interno is a very valuable treatment for secondary glaucoma combined with scleromalacia.
Grover, Davinder S; Godfrey, David G; Smith, Oluwatosin; Feuer, William J; Montes de Oca, Ildamaris; Fellman, Ronald L
To introduce a minimally invasive, ab interno approach to a circumferential 360-degree trabeculotomy and to report the preliminary results. Retrospective, noncomparative cases series. Eighty-five eyes of 85 consecutive patients who sought treatment at Glaucoma Associates of Texas with uncontrolled open-angle glaucoma and underwent gonioscopy-assisted transluminal trabeculotomy (GATT) for whom there was at least 6 months of follow-up data. Retrospective chart review of patients who underwent GATT by 4 of the authors (D.S.G., D.G.G., O.S., R.L.F.) between October 2011 and October 2012. The surgery was performed in adults with various open-angle glaucomas. Intraocular pressure (IOP), glaucoma medications, visual acuity, and intraoperative as well as postoperative complications. Eighty-five patients with an age range of 24 to 88 years underwent GATT with at least 6 months of follow-up. In 57 patients with primary open-angle glaucoma, the IOP decreased by 7.7 mmHg (standard deviation [SD], 6.2 mm Hg; 30.0% [SD, 22.7%]) with an average decrease in glaucoma medications of 0.9 (SD, 1.3) at 6 months. In this group, the IOP decreased by 11.1 mmHg (SD, 6.1 mmHg; 39.8% [SD, 16.0%]) with 1.1 fewer glaucoma medications at 12 months. In the secondary glaucoma group of 28 patients, IOP decreased by 17.2 mmHg (SD, 10.8 mmHg; 52.7% [SD, 15.8%]) with an average of 2.2 fewer glaucoma medications at 6 months. In this group, the IOP decreased by 19.9 mmHg (SD, 10.2 mmHg; 56.8% [SD, 17.4%]) with an average of 1.9 fewer medications (SD, 2.1) at 12 months. Treatment was considered to have failed in 9% (8/85) of patients because of the need for further glaucoma surgery. The cumulative proportion of failure at 1 year ranged from 0.1 to 0.32, depending on the group. Lens status or concurrent cataract surgery did not have a statistically significant effect on IOP in eyes that underwent GATT at either 6 or 12 months (P > 0.35). The most common complication was transient hyphema, seen in
Full Text Available We studied the effect of the releasable suture technique on immediate postoperative intraocular pressure (IOP. Nine eyes of nine patients with glaucoma had trabeculectomy with a releasable suture. In the six eyes that did not receive antimitotics, the suture was released by the fifth postoperative day; in the others suture release was delayed up to the fourteenth day. Of the nine patients, one had an acceptable postoperative IOP and did not need suture release; in another the suture broke and could not be released. In the remaining seven patients, the difference between the pre-release and post-release IOP was statistically significant (p < 0.001. The complications of this technique include failed suture release, subconjunctival hematoma and a distinctive "windshield wiper" keratopathy.
Full Text Available Robert M Saltzmann, Steven Reinecke, Xihui Lin, H Dwight Cavanagh, Jess T WhitsonUniversity of Texas Southwestern Medical Center, Department of Ophthalmology, Dallas, TX, USAPurpose: To quantify the long-term outcomes of congenital glaucoma and surgical success rates following pseudo 360-degree trabeculotomy surgery at Children's Medical Center in Dallas.Patients and methods: An International Classification of Diseases (ICD-9 database was utilized for a retrospective chart review. Thirty-eight eyes of 24 who underwent primary trabeculotomy with a pseudo 360-degree technique between June 1, 1992 and December 31, 2005 were studied.Results: Mean age at the time of trabeculotomy was 11.1 ± 3.0 months, with seven eyes operated on after 1 year of age. Mean follow-up was 85.1 ± 9.0 months. Mean intraocular pressure (IOP at the time of glaucoma diagnosis was 32.7 ± 1.1 mmHg, and final mean IOP for all eyes (after trabeculotomy and any additional surgery and/or glaucoma medications was 17.9 ± 0.8 mmHg. With trabeculotomy and medication alone, mean final IOP was 19.9 ± 1.1 mmHg, with a mean drop in IOP of 12.5 ± 1.4 mmHg. Surgical success, defined by adequate IOP control, was achieved in 30 eyes (78.96% at most recent follow-up. Kaplan–Meier analysis demonstrated 5- and 10-year survival probabilities of 93.1% and 66.8%, respectively. Seventeen eyes (44.7% of all eyes achieved complete success, meaning IOP control <21 mmHg without additional medical therapy. All seventeen had primary congenital glaucoma (PCG; no eyes with aphakic glaucoma (AG or Sturge–Weber syndrome (SWS achieved complete success. Seven eyes (18.4% failed primary trabeculotomy. Mean time to failure was 46.9 ± 8.6 months. Eyes with SWS had a significantly higher failure rate (P = 0.009 and a 5.81 relative risk of failure (P = 0.026.Conclusions: Our long-term trabeculotomy success rates for congenital glaucoma compare favorably with existing reports in the literature. Eyes with
Cingi, Cemal; Muluk, Nuray Bayar; Ulusoy, Seçkin; Söken, Hakan; Altıntoprak, Niyazi; Şahin, Ethem; Ada, Servet
The surgical anatomy of the nasal tip is determined by intrinsic factors, such as the nasal tip volume, shape, definition, and symmetry. These factors are intimately related to the morphology of the lower lateral cartilages. Tip sutures reduce the need for grafts and allow the surgeon to manipulate the tip with a high degree of precision and better long-term clinical outcomes. In this review, we evaluated common nasal tip suture techniques to clarify the similarities and differences among them. The following nasal tip suture techniques were investigated: medial crural fixation suture, middle crura suture, transdomal (dome creating, dome binding, domal definition) suture, interdomal suture, lateral crural mattress suture, columella septal suture, intercrural suture, tip rotation suture, craniocaudal transdomal suture, lateral crural spanning suture, suspension suture, tongue-in-groove technique, and lateral crural steal. Tip sutures increase tip projection, narrow the tip, provide stabilization, and provide tip rotation. The sutures may be used separately or together. Nasal tip sutures have long been used as noninvasive suture techniques. Each suture technique has unique benefits, and various key points must be considered when using these techniques.
Sato, Tomoki; Hirata, Akira; Mizoguchi, Takanori
In this paper, we describe 360° suture trabeculotomy (360°LOT) ab interno and the short-term course in patients who underwent this procedure. We prospectively studied 12 patients (12 eyes) with open-angle glaucoma who underwent 360°LOT ab interno at the Sato Eye Clinic between February and July 2014. The surgical procedure involved making a 1.7 mm temporal corneal incision, exposing an approximately 15° opening in the inner wall of Schlemm's canal (nasal side) using a Trabectome with a gonioscope, and inserting a 5-0 nylon suture rounded at the tip into Schlemm's canal opened via the anterior chamber. The suture was then threaded around Schlemm's canal, and the tip of the suture that emerged on the other side was then advanced through the opening to make a circumferential incision. Intraocular pressure (IOP), number of anti-glaucoma medications used, complications, and the surgery completion rate were prospectively studied. Mean IOP, which was 19.4 mmHg at baseline, showed a significant decrease at each of the monthly observation points, reaching 13.8 mmHg at 6 months after surgery (P=0.0004, paired t-test). The mean number of anti-glaucoma medications decreased from 3.2 at baseline to 1.1 at 6 months after surgery. IOP spikes ≥30 mmHg were seen in 25% of patients, but there were no other serious complications and the surgery completion rate was 92%. The 360°LOT ab interno procedure preserves the conjunctiva and sclera, and has a high surgery completion rate when using the anterior chamber approach, and could therefore be an effective short-term treatment of open-angle glaucoma.
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
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 .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.
Full Text Available PURPOSE: To describe an adjustable suture (AS experimental model that allows for tightening, loosening and retightening of the suture tension in trabeculectomy. METHODS: Standard trabeculectomy was performed in fifteen pig eyeballs. All pig eyes were tested twice: one test with conventional suture in both flap's corners (conventional suture group and another test with a conventional suture at one corner and an adjustable suture in the other corner (AS group. The order in which each test was performed was defined by randomization. Intraocular pressure was measured at three time points: T1 when the knots were tightened; T2 when the AS was loosened or the conventional knot was removed; and T3 when the AS was retightened in the AS group or five minutes after the knot removal in the conventional suture group. RESULTS: The mean Intraocular pressure was similar between the two groups at time point 1 (p=0.97. However, significant Intraocular pressure differences were found between eyes in the conventional and adjustable suture groups at time points 2 (12.6 ± 4.2 vs 16.3 ± 2.3 cmH2O, respectively, p=0.006 and 3 (12.2 ± 4.0 vs 26.4 ± 1.7cmH2O, respectively; p=0.001. While the conventional technique allowed only Intraocular pressure reduction (following the knot removal; T2 and T3, the AS technique allowed both Intraocular pressure reduction (T2 and elevation (T3 through the management (loosening and retightening of the suture. CONCLUSION: This experimental model provides an effective noninvasive postoperative mechanism of suture tension adjustment.
Chu, Jennifer Y; Chen, Tony; Awad, Hani A.; Elfar, John; Hammert, Warren C.
Purpose One goal in repairing Zone 1 flexor digitorum profundus (FDP) injuries is to create a tendon-bone construct strong enough to allow early rehabilitation while minimizing morbidity. This study introduces an alternative all-inside suture repair technique and compares it biomechanically with pull-out suture and double suture anchor repairs. Methods Repairs were performed on thirty cadaver fingers. In all-inside suture repairs (n=8), the FDP tendon was attached to bone with two 3-0 Ethibond sutures and tied over the dorsal aspect of distal phalanx. Pull-out suture repairs (n=8) were performed with 2-0 Prolene suture and tied over a dorsal button. There were two suture anchor repair groups: Arthrex Micro Corkscrew anchors preloaded with 2-0 FiberWire suture (n=7) and Depuy Micro Mitek anchors preloaded with 3-0 Orthocord suture (n=7). Repair constructs were tested using a servohydraulic materials testing system and loaded until the repair lost 75% of its strength. Results There were no statistically significant differences in tensile stiffness, ultimate load, or work to failure between the repairs. Failure mode was suture stretch and gap formation >2mm at the repair site for all pull-out suture repairs and 7 of 8 all-inside suture repairs. Two of the Arthrex Micro Corkscrew repairs and five of the Depuy Micro Mitek repairs failed by anchor pull out. Conclusions This cadaveric biomechanical study showed no difference in tensile stiffness, ultimate load, and work to failures between an all-inside suture repair technique for zone 1 FDP repairs and previously described pull-out suture and suture anchor repair techniques. The all-inside suture technique also has the advantages of avoiding an external button and the cost of anchors. Therefore, it should be considered as an alternative to other techniques. Clinical Relevance This study introduces a new FDP reattachment technique that avoids some of the complications of current techniques. PMID:23578439
Pillukat, T; Fuhrmann, R; Windolf, J; van Schoonhoven, J
Adhesions and scar formation between flexor tendons and the surrounding tissue are only contemporarily avoidable by movement of flexor tendons. Concepts with active follow-up protocols are more favorable than passive mobilization. The main risks of flexor tendon repair are rupture of the tendon suture, insidious gap formation and resistance to tendon gliding within the tendon sheath. Currently, there is no consensus with respect to the optimal suture technique or suture material. Nevertheless, there are some principles worth paying attention to, such as using stronger suture material, blocking stitches, suture techniques with four or more strands as well as circular running sutures. A technically acceptable compromise, even for the less experienced, is currently the four-strand suture combined with a circular running suture. It maintains sufficient stability for active motion follow-up protocols without resistance.
Pili, Diego; Ciotola, Franco; Riganti, Juan Martín; Badaloni, Adolfo; Nieponice, Alejandro
This is a simple technique to be applied to those patients requiring an alternative feeding method. This technique has been successfully applied to 25 patients suffering from esophageal carcinoma. The procedure involves laparoscopic approach, suture of the selected intestinal loop to the abdominal wall and jejunostomy using Seldinger technique and autoadjustable sutures. No morbidity or mortality was reported.
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.
Yazdani Abyaneh, Mohammad-Ali; Levitt, Jacob O
Although most trainees in dermatology learn that different suturing techniques are designated for a specific purpose (i.e., certain functional and cosmetic outcomes), students often have a difficult time visualizing how a given suture functions in its designated capacity. In this article, we address the logic behind the most common suturing techniques in dermatologic surgery, including the direction and magnitude of their pulling force with respect to the wound edges and the ensuing displacem...
Chu, Jennifer Y; Chen, Tony; Awad, Hani A; Elfar, John; Hammert, Warren C
One goal in repairing zone 1 flexor digitorum profundus (FDP) injuries is to create a tendon-bone construct strong enough to allow early rehabilitation while minimizing morbidity. This study compares an all-inside suture repair technique biomechanically with pull-out suture and double-suture anchor repairs. Repairs were performed on 30 cadaver fingers. In all-inside suture repairs (n = 8), the FDP tendon was attached to bone with two 3-0 Ethibond sutures and tied over the dorsal aspect of distal phalanx. Pull-out suture repairs (n = 8) were performed with 2-0 Prolene suture and tied over a dorsal button. There were 2 suture anchor repair groups: Arthrex Micro Corkscrew anchors preloaded with 2-0 FiberWire suture (n = 7) and Depuy Micro Mitek anchors preloaded with 3-0 Orthocord suture (n = 7). Repair constructs were tested using a servohydraulic materials testing system and loaded until the repair lost 75% of its strength. There were no statistically significant differences in tensile stiffness, ultimate load, or work to failure between the repairs. Failure mode was suture stretch and gap formation greater than 2 mm at the repair site for all pull-out suture repairs and for 7 of 8 all-inside suture repairs. Two of the Arthrex Micro Corkscrew repairs and 5 of the Depuy Micro Mitek repairs failed by anchor pull-out. This cadaveric biomechanical study showed no difference in tensile stiffness, ultimate load, and work to failures between an all-inside suture repair technique for zone 1 FDP repairs and previously described pull-out suture and suture anchor repair techniques. The all-inside suture technique also has the advantages of avoiding an external button and the cost of anchors. Therefore, it should be considered as an alternative to other techniques. This study introduces a new FDP reattachment technique that avoids some of the shortcomings of current techniques. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights
Kim, Dong-Kyu; Kim, Seung Kyun; Lee, Jun Ho; Park, Chan Hum
Various methods have been used to treat zygomatic arch fractures, but no optimal modality exists for reducing these fractures and supporting the depressed bone fragments without causing esthetic problems and discomfort for life. We developed a novel aqua splint and suture technique for stabilizing isolated zygomatic arch fractures. The objective of this study is to evaluate the effect of novel aqua splint and suture technique in isolated zygomatic arch fractures. Patients with isolated zygomatic arch fractures were treated by a single surgeon in a single center from January 2000 through December 2012. Classic Gillies approach without external fixation was performed from January 2000 to December 2003, while the novel technique has been performed since 2004. 67 consecutive patients were included (Classic method, n = 32 and Novel method, n = 35). An informed consent was obtained from all patients. The novel aqua splint and suture technique was performed by the following fashion: first, we evaluated intraoperatively the bony alignment by ultrasonography and then, reduced the depressed fracture surgically using the Gillies approach. Thereafter, to stabilize the fracture and obtain the smooth facial figure, we made an aqua splint that fit the facial contour and placed monofilament nonabsorbable sutures around the fractured zygomatic arch. The novel aqua splint and suture technique showed significantly correlated with better cosmetic and functional results. In conclusion, the aqua splint suture technique is very simple, quick, safe, and effective for stabilizing repositioned zygomatic arch fractures. The aqua splint suture technique can be a good alternative procedure in isolated zygomatic arch fractures.
Deters, Katherine A.; Brown, Richard S.; Boyd, James W.; Eppard, M. B.; Seaburg, Adam
The size reduction of acoustic transmitters has led to a reduction in the length of incision needed to implant a transmitter. Smaller suture knot profiles and fewer sutures may be adequate for closing an incision used to surgically implant an acoustic microtransmitter. As a result, faster surgery times and reduced tissue trauma could lead to increased survival and decreased infection for implanted fish. The objective of this study was to assess the effects of five suturing techniques on mortality, tag and suture retention, incision openness, ulceration, and redness in juvenile Chinook salmon Oncorhynchus tshawytscha implanted with acoustic microtransmitters. Suturing was performed by three surgeons, and study fish were held at two water temperatures (12°C and 17°C). Mortality was low and tag retention was high for all treatments on all examination days (7, 14, 21, and 28 days post-surgery). Because there was surgeon variation in suture retention among treatments, further analyses included only the one surgeon who received feedback training in all suturing techniques. Incision openness and tissue redness did not differ among treatments. The only difference observed among treatments was in tissue ulceration. Incisions closed with a horizontal mattress pattern had more ulceration than other treatments among fish held for 28 days at 17°C. Results from this study suggest that one simple interrupted 1 × 1 × 1 × 1 suture is adequate for closing incisions on fish under most circumstances. However, in dynamic environments, two simple interrupted 1 × 1 × 1 × 1 sutures should provide adequate incision closure. Reducing bias in survival and behavior tagging studies is important when making comparisons to the migrating salmon population. Therefore, by minimizing the effects of tagging on juvenile salmon (reduced tissue trauma and reduced surgery time), researchers can more accurately estimate survival and behavior.
Willey, Andrea; Caesar, Richard H
Precise apposition of the tarsal plates and meticulous alignment of the eyelid margins are essential to ensure a seamless repair and avoid notching of the eyelid margin. The authors present a simple and reliable technique that firmly apposes and precisely aligns the eyelid margin in the x, y, and z axes, obviating the need for marginal sutures. A retrospective audit of electronic medical records was performed for all patients who underwent reconstructive procedures that included the repair of a full-thickness defect in the eyelid margin using the diagonal suture technique from 2003 to 2012. Of the 652 surgeries performed in the past 9 years, 9 incidences of notching occurred, all of which were associated with infections. The diagonal tarsal suture technique is a simple and effective method for the repair of full-thickness defects with a high degree of patient satisfaction.
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
Gimbel, H V; Sun, R; DeBroff, B M
A prospective randomized investigation was performed to evaluate the effects of wound architecture and suture techniques on postoperative astigmatism after phacoemulsification and intraocular lens implantation. Two hundred eyes with preexisting with-the-rule astigmatism were randomized into four groups: (1) sutureless scleral tunnel frown incision, (2) scleral tunnel frown incision with a horizontal suture, (3) scleral tunnel frown incision with both a horizontal and a running suture, and (4) posterior limbal acute beveled cataract incision with a running suture. All the incisions were placed in the vertical steep meridian. Data were analyzed from 128 cases with 1-year follow-up. The results revealed that at the 2-month postoperative visit, preexisting astigmatism was significantly reduced in group 1 (P = .029) and significantly increased in groups 3 (P = .020) and 4 (P = .005). There was no significant change in group 2 (P = .06). By the 1-year postoperative visit, there was no significant difference in astigmatism from preoperative levels for all four groups. Vector analysis revealed no significant difference in the mean surgically induced cylinder at 1 year in all four groups. The number of eyes with induced against-the-rule astigmatism, however, was significantly higher than the number of eyes with induced with-the-rule astigmatism in all four groups (P sutured wounds placed in the vertical steep meridian may initially increase with-the-rule astigmatism, whereas nonsutured wounds placed in the vertical steep meridian may initially reduce with-the-rule astigmatism. By 1 year, however, a mean flattening of the vertical steep meridian was observed in the three groups with sutures as well as in the group without sutures.
Page, Meile S.; Menger, Dirk J.
Impaired nasal breathing or collapse of the lateral side wall of the nasal valve region during inspiration is a frequently encountered symptom. In general, this is caused by a cross-sectional area that is too small, a weak lateral side wall, or a combination of both. Over the years, many techniques
Kim, Sang Jin; Wee, Won Ryang; Lee, Jin Hak; Kim, Mee Kum
The purpose of this study was to compare the effects on astigmatism after penetrating keratoplasty with three different suture techniques. In this prospective study, 38 eyes of 38 patients underwent penetrating keratoplasty with three suturing techniques: interrupted, single running, and double running. Topographic astigmatism was measured at 2, 6, 12, and 18 months after keratoplasty. During 18 months after surgery, the interrupted suture group had higher astigmatism than the double running suture group. There was no significant difference in the amounts of astigmatism during the first year after keratoplasty between the single running and the double running suture group. However, at 18 months after surgery, when all sutures were out, the double running suture group (3.60+/-1.58 diopters) showed significantly less astigmatism than the single running group (5.65+/-1.61 diopters). In conclusion, post-keratoplasty astigmatism was the least in the double running suture group of the three suturing techniques at 18 months after penetrating keratoplasty.
Prasathaporn, Niti; Kuptniratsaikul, Somsak; Kongrukgreatiyos, Kitiphong
Meniscus root tear leads to circumferential hoop tension loss and increases femorotibial contact force, which causes irreversible cartilage degeneration. Biomechanical studies have shown that meniscus root repair provides better femorotibial contact force than meniscectomy. Many techniques for meniscus root repair have been published in recent years. The soft suture anchor is widely used in the glenoid labral repair. It is a small low-profile soft anchor. This article presents a new and simpl...
Steinbichler, Teresa B; Bender, Birte; Giotakis, Aristeidis I; Dejaco, Daniel; Url, Christoph; Riechelmann, Herbert
Uvulopalatopharyngoplasty (UPPP) and expansion sphincter pharyngoplasty (ESP) are two standard surgical procedures for treatment of snoring and sleep apnea. In a prospective clinical trial, we compared a standard simple interrupted suture technique for closure of the tonsillar pillars with a running locked suture. Each suture technique was randomly assigned either to the left or the right tonsillar pillars in 28 patients. During the first week, patients were daily checked for suture dehiscence and again on days 10 and 21, the end of followup. Time to perform the sutures was measured intraoperative and surgical complications were recorded. During followup, suture dehiscence was observed in 15/28 interrupted and 16/28 running sutures (p > 0.5). If a dehiscence occurred during the observation period, the median day of dehiscence was 10 (1 and 3 quartile: 5.75 and 17) days for the interrupted suture and 10 (5-11) days for the running locked suture technique (p > 0.05). The mean (± SD) surgical time for the interrupted suture was 5.2 ± 1.9 and 3.5 ± 1.8 min for the running locked suture (p sutures and 2/28 interrupted sutures. The running locked suture technique is an equally safe and time saving way of wound closure in UPPP and ESP.
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
Matsumine, Hajime; Takeuchi, Masaki; Mori, Satoko; Sakurai, Hiroyuki
Background: Resection of facial skin tumors aims to remove the tumors completely and make the surgical scar unnoticeable as much as possible. By improving the purse string suture method, we developed a new pentagram suture technique that enables simple and safe suturing of small to large defects with early satisfactory esthetic outcomes. The surgical outcomes of a case series were examined in this report. Methods: As in drawing a unicursal star, 5 suture sites were marked at specific interval...
Kim, Sang Jin; Wee, Won Ryang; Lee, Jin Hak; Kim, Mee Kum
The purpose of this study was to compare the effects on astigmatism after penetrating keratoplasty with three different suture techniques. In this prospective study, 38 eyes of 38 patients underwent penetrating keratoplasty with three suturing techniques: interrupted, single running, and double running. Topographic astigmatism was measured at 2, 6, 12, and 18 months after keratoplasty. During 18 months after surgery, the interrupted suture group had higher astigmatism than the double running ...
Castagna, Alessandro; Garofalo, Raffaele; Conti, Marco; Borroni, Mario; Snyder, Stephen J
Surgical repair of the rotator cuff must have good resistance and should restore the tendon footprint. To attain this goal, a stitch with a strong biomechanical profile that avoids tissue strangulation should be used. We describe an arthroscopic suture technique undertaken to repair rotator cuff tears with a single triple-loaded suture anchor. The technique consists of a combination of a horizontal mattress and 2 vertical simple sutures that are positioned medial to the mattress suture. The suture anchor used is the 5-mm self-tapping ThRevo (Linvatec). This anchor is loaded with 3 sutures: 2 No. 2 nonabsorbable braided polyester sutures of different colors and a central high-strength No. 2 polyethylene suture. The shape of the anchor eyelet permits all 3 sutures to glide freely. A modified Mason-Allen technique (Alex stitch) that combines a horizontal side-to-side suture and 2 simples sutures as vertical loops is used. With use of the Spectrum suture passing device and shuttle relay system (Linvatec), both limbs of the centrally located polyethylene suture are passed through the cuff from bottom to top, approximately 1 cm from the tendon edge. This suture is not immediately tied. Next, with use of the same system, the other 2 sutures are placed medially and over the previous horizontal suture. Simple sutures are placed at an approximately 30 degrees angle from the center of the anchor; 1 is placed anterior and the other posterior. The sutures are tied through the lateral portal. The mattress horizontal central stitch is always tied first, followed by the 2 vertical sutures. The horizontal mattress suture serves as a "rip stop stitch" and theoretically reduces the possibility of cutting out of the simple sutures.
Brown, Matthew J; Pula, David A; Kluczynski, Melissa A; Mashtare, Terry; Bisson, Leslie J
To evaluate the effects of suture configuration, repair method, and tear size on rotator cuff (RC) repair healing. We conducted a literature search of articles that examined surgical treatment of RC tears published between January 2003 and September 2014. For single-row (SR) repairs, we calculated rerupture rates for simple, mattress, and modified Mason-Allen sutures while stratifying by tear size. All double-row repairs-those using 2 rows of suture anchors (DA) and those using a suture bridge (SB)--were performed using mattress sutures, and we compared rerupture rates by repair method while stratifying by tear size. A random-effects model with pooled estimates for between-study variance was used to estimate the overall rerupture proportion and corresponding 95% confidence interval for each group. Statistical significance was defined as P sutures versus simple sutures (P = .18). For SR repairs of tears measuring 3 cm or more, there was no significant difference in rerupture rates for mattress sutures versus simple sutures (P = .23). The rates of rerupture did not differ between SB and DA repairs for tears measuring less than 3 cm (P = .29) and 3 cm or more (P = .50). For SR repairs, there were no significant differences in rerupture rates between suture techniques for any repair method or tear size. All DA and SB repairs were secured with mattress sutures, and there were no differences in the rates of rerupture between these methods for either size category. These findings suggest that suture technique may not affect rerupture rates after RC repair. Level IV, systematic review of Level I through IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Ostrander, Roger V; Smith, Jarrod; Saper, Michael
Recent advances to improve outcomes in rotator cuff repair include using arthroscopic double-row suture-bridge techniques in an effort to reconstruct the rotator cuff footprint and improve fixation. However, when using this technique for larger tears, it can be difficult to get the lateral portion of the rotator cuff into an anatomic position. This report describes a triple-row modification of the suture-bridge technique that results in significantly more footprint contact area and contact pressure compared with the double-row and standard suture-bridge techniques. Maximizing the rotator cuff footprint contact area exposes more of the tendon to bone and may improve the healing potential.
Pool, Shariselle M. W.; Krabbe-Timmerman, Irene S.; Cromheecke, Michel; van der Lei, Berend
OBJECTIVETo assess whether a suture technique in upper blepharoplasty may be the cause of differences in the occurrence of suture abscess formation and focal inflammation.MATERIALS AND METHODSA Level I, randomized controlled trial. The upper blepharoplasty wound was closed with a running intradermal
Nguyen, D. Tan; Geel, Jurre; Schulze, Martin; Raschke, Michael J.; Woo, Savio L.-Y.; van Dijk, C. Niek; Blankevoort, Leendert
Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining
Full Text Available Rotator cuff tears are one of the most common disorders of the shoulder and can have significant effects on daily activities as a result of pain, loss of motion and strength. The goal of rotator cuff repair is aimed at anatomic restoration of the rotator cuff tendon to reduce pain and improve the joint function. Recently, arthroscopic repair has been widely accepted for treatment of rotator cuff tears due to its equal or better results than those from open repair. In 2006, a transosseousequivalent (TOE or “suture bridge” technique was introduced by Park et al. This technique maximizes the utility of the conventional double-row technique by using the suture limbs to form the media mattress sutures to bridge and compress the repaired tendon. This technique has been proven to provide biomechanical properties that are superior to other arthroscopic repair techniques regarding the initial fixation strength, contact area and contact pressure at the tendon-bone interface. Since suture bridge techniques have been evolving over time, further biomechanical investigations have been carried out. These studies include examination of the effects of dynamic humeral external rotation on the mechanic stability of the repaired tendon construct, the effects of various modifications of the suture bridge configurations on the biomechanical characteristics of the medial mattress suture, biomechanical implications of medial row failure, and biomechanical performance of the repaired constructs over time. In this review, the biomechanical concepts behind the suture bridge technique for rotator cuff repair were reviewed and discussed.
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.
End-to-side nerve suture (ETSNS) has until recently been extensively researched in the laboratory animal (rat and baboon). Lateral sprouting from an intact nerve into an attached nerve does occi.rr, and functional recovery (sensory and motor) has been demonstrated. We have demonstrated conclusively that ETSNS in the ...
follow-up were excluded from this study. The ages of the patients ranged from 8 to 48 months (mean 13.6±6.9 months). All patients underwent repair using the ... 8–42. 0.276. Mean ± SD. 14.4 ± 6.8. 12.8 ± 7.1. Hypospadias type. Distal penile. 26. 29. 0.315. Coronal. 14. 11. Hypoplastic urethra. 3. 7. 0.155. Suture size. 5/0.
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.
Ram, Jagat; Gupta, Nishant; Chaudhary, Manish; Verma, Neelam
Background: A new emerging complication of trans-scleral fixation of posterior chamber (PC) intraocular lens (IOL) with polypropylene suture is high rates of spontaneous dislocation of the IOL due to disintegration or breakage of suture. Materials: We report a new surgical technique of trans-scleral fixation of posterior chamber intraocular lens (SF PCIOL) with steel suture to eliminate the complication of dislocation of IOL fixed with polypropylene suture in one adult and a child. Results: W...
Full Text Available Richard MH Lee,1 Fook Chang Lam,1 Tassos Georgiou,1 Bobby Paul,1 Kong Yong Then,1 Ioannis Mavrikakis,1 Venkata S Avadhanam,1 Christopher SC Liu1,21Sussex Eye Hospital, Brighton, United Kingdom; 2Tongdean Eye Clinic, Hove, United KingdomAims: To report on the suturing techniques and aspects of postoperative management in penetrating keratoplasty in the United Kingdom.Methods: A postal questionnaire was sent to 137 ophthalmic consultants identified from a Royal College of Ophthalmology database as having a special interest in anterior segment surgery. The questionnaire surveyed surgeon preferences for surgical and suturing technique for penetrating keratoplasty surgery, and the postoperative care of corneal grafts.Results: In all, 68% of questionnaires were completed and returned: 73% of respondents used a Flieringa ring or equivalent, 94% routinely used cardinal sutures, with 50.5% removing them at the end of the procedure. The most common suturing technique for routine penetrating keratoplasty was a single continuous suture (35%. In these cases, a 10/0 nylon suture was used by 89%. Sixty-six percent changed their technique in high-risk cases, 52% used a 3-1-1 knot, and 75% made a distinction between a reef and granny knot, with 76% using a reef. Thirty percent buried the knots within the donor material, and 29% within the host tissue. Twenty-five percent had no routine time for graft suture removal, but 41% removed them between 1 and 2 years post-surgery. After suture removal, 98% used steroids and 88% used topical antibiotics. Thirty-four percent stopped topical steroids before suture removal, with 38% stopping topical steroids more than 3 months prior to suture removal.Conclusion: This survey demonstrates that there is considerable variation in suturing techniques and postoperative care for penetrating keratoplasty. These significant variations in practice need to be considered when interpreting outcomes and research.Keywords: corneal graft
Ates, Mutlu; Ozgok, Yasar; Akin, Yigit; Arslan, Murat; Akand, Murat; Hoscan, Mustafa Burak
To describe a novel surgical technique, laparoscopic stepwise-cut double initial stay suture (LASDISS) pyeloplasty for ureteropelvic junction obstruction (UPJO). Additionally, we evaluated the safety and short-term results. This was a nonrandomized study with a series of 6 patients with UPJO, operated on between March 2012 and August 2013. Perioperative and short-term outcomes were evaluated. In brief, a "T shape cut" was performed from the dilated pelvis to the ureter. The initial stay suture was placed between the lower edge of the pelvis and the distal end of the spatulated anterolateral part of the ureter. The pelvis was closed with a continuous suture starting from the opened upper edge of the pelvis that was secured after leaving enough space for ureteral anastomosis. The second initial stay suture was placed after passing the ureter and pelvis two times. The dilated part of the renal pelvis and the stenotic segment were excised. A double-J stent was inserted. The remaining space between the two initial sutures was closed with these continuous sutures. We performed the LASDISS pyeloplasty technique in all cases. Median operation time was 177 minutes (range, 100-290 minutes). Mean follow-up was 7.5 months (range, 3-18 months). The mean pre- and postoperative split renal function on diuretic renography was 33% (range, 25%-56%) and 42% (range, 30%-52%), respectively. The LASDISS pyeloplasty surgical technique represents a safe and effective option in surgical treatment of UPJO.
Joshi, Deepak; Jain, Jitesh Kumar; Chaudhary, Deepak; Singh, Utkarsh; Jain, Vineet; Lal, Ajay
AIM To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique. METHODS In this retrospective study, we reviewed the results of pectoralis major repair in 11 chronic cases (> 6 wk) done between September 2011 and December 2014 at our institute. In all cases repair was done by same surgeon using corkscrew suture anchors and box suture sliding technique. At 6 mo, after surgery magnetic resonance imaging was done to see the integrity of the repair. Functional evaluation was done using Penn and ASES scores. Pre and postoperative Isokinetic strength was measured. RESULTS Average follow-up was 48.27 ± 21.0 mo. The Wilcoxon signed rank test was used to evaluate the outcome scores. The average ASES score increased from an average of 54.63 ± 13.0 preoperatively to 95.09 ± 2.60 after surgery at their last follow-up. The average Penn score also increased from 5.72 ± 0.78, 2.81 ± 1.32 and 45.81 ± 1.72 to 9.36 ± 0.80, 8.27 ± 0.90 and 59 ± 1.34 for pain, satisfaction and function respectively. Follow up magnetic resonance imaging (MRI) (at 6 mo) showed continuity and the bulk of pectoralis major muscle in all cases. Average isokinetic strength deficiency in horizontal adduction at 60° was 13.63% ± 6.93% and at 120° was 10.18% ± 4.93% and in flexion at 60° was 10.72% ± 5.08% and at 120° was 6.63% + 3.74%. Results showed that both ASES and Penn score improved significantly (2 tailed P value = 0.0036). CONCLUSION We could conclude from this series that pectoralis major repair even in chronic cases using 5.5 mm corkscrew anchors give excellent functional and cosmetic results. In chronic cases the repairable length of the tendon is not available and sliding suture technique allows for fixation of worn out tendomuscular junction to bone without letting cutting through the muscle. PMID:27795949
Journal of Surgical Technique and Case Report | Jul-Dec 2014 | Vol-6 | Issue-2. 49. A Novel Surgical Pre-suturing Technique for ... mandibular lingual gingival recession. The severity of ankyloglossia is variable and ... infants, toddlers and adults but strictly requires postsurgical speech therapy to achieve pleasing results.
Full Text Available Banu Torun Acar, Ece Turan Vural, Suphi AcarHaydarpasa Numune Education and Research Hospital, Ophthalmology Clinic, Istanbul, TurkeyPurpose: To compare the effect of three different suturing techniques on astigmatism after deep anterior lamellar keratoplasty (DALK in patients with keratoconus.Methods: In this retrospective study, 54 eyes of 54 patients with advanced keratoconus underwent DALK with three suturing techniques: single running, interrupted running, and combined interrupted and running. Postkeratoplasty astigmatism was evaluated during examinations 1, 3, and 6 months postoperatively and 2 months after completing suture removal.Results: Twenty-four eyes had single running sutures, 16 eyes had interrupted sutures, and in 14 eyes the suturing technique used was combined interrupted and running sutures. Mean age was 25.6 ± 5.9 years, 27.3 ± 6.8 years, and 26.5 ± 5.7 years (P = 0.422, and postoperative astigmatism 1 month after surgery was 3.79 ± 1.19 D, 5.56 ± 1.78 D, and 4.21 ± 1.55 D in the three groups, respectively (P = 0.012. However, 2 months after completing the suture removal, final postoperative astigmatism was 3.43 ± 1.44 D, 3.87 ± 1.38 D, and 3.71 ± 1.46 D (P = 0.846. Final astigmatism less than 4 D was seen in 18 cases (75% in the single running group, nine cases (56.2% in the interrupted running group, and nine cases (64.2% in the combined interrupted and running group (P = 0.08.Conclusion: Postkeratoplasty astigmatism is comparable with three different suturing techniques used in patients with keratoconus after completing suture removal in DALK. Due to earlier suture removal in DALK, the type of suturing technique used is not considerably important.Keywords: astigmatism, deep anterior lamellar keratoplasty, suturing technique
Alexander, Susan; Wallace, Andrew L
Arthroscopic labral repair is an effective technique for most cases of traumatic shoulder instability. However, patients with anterior labroligamentous periosteal sleeve avulsion lesions frequently have multiple episodes of subluxation or dislocation and a high recurrence rate after surgery, even with modern methods of labral repair. One reason may be failure of biological healing of the labrum due to an inadequate "footprint" of contact between the capsulolabral tissue and the glenoid bone. We have developed a technique that facilitates a tensioned suture bridge between suture anchors that may improve the results of labral repair in patients with anterior labroligamentous periosteal sleeve avulsion lesions.
Matsumine, Hajime; Takeuchi, Masaki; Mori, Satoko; Sakurai, Hiroyuki
Resection of facial skin tumors aims to remove the tumors completely and make the surgical scar unnoticeable as much as possible. By improving the purse string suture method, we developed a new pentagram suture technique that enables simple and safe suturing of small to large defects with early satisfactory esthetic outcomes. The surgical outcomes of a case series were examined in this report. As in drawing a unicursal star, 5 suture sites were marked at specific intervals around the defect area. A needle with 5-0 polydioxanone suture was passed from the subcutaneous tissue to the superficial dermal layer at one site and then from the superficial dermal layer to the subcutaneous layer at the next site, and the process was repeated until the pentagram was complete. When apposition was not tight enough, a couple of external stitches were added using 6-0 nylon suture. In 13 patients (16 benign or malignant tumors; mean age, 51.1 years) with a mean tumor size of 10.1 ± 5.2 mm and postoperative skin defect diameter of 12.1 ± 8.2 mm, closure did not result in high tension on the suture, and there was reduced mechanical stress at the wound margin. Surgical outcomes were good esthetically at 6 months after surgery without keloid formation or scar contracture. None of the patients had postoperative pain, infection, or tumor recurrence. This simple alternative method for the closure of facial skin defects after skin tumor excision could be performed easily and provided satisfactory surgical outcomes.
El Sayed, Yasmine; Gawdat, Ghada
To compare the outcomes of microcatheter-assisted circumferential trabeculotomy to standard rigid probe trabeculotomy in childhood glaucomas. Eyes of children requiring trabeculotomy for primary congenital or secondary paediatric glaucoma were randomized to undergo either trabeculotomy using the Glaucolight illuminated microcatheter, or a rigid probe trabeculotomy. Complete success was defined as an intraocular pressure (IOP) of glaucoma. The need for reoperation for glaucoma was significantly lower in the microcatheter group. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Tokunaga, Susumu; Abe, Yoshihiro
Collateral ligaments are difficult to repair due to large amount of fraying in detached ligaments and attenuated stumps that may not provide enough strength after the repair. Although strong locking sutures are used to repair the ligament with proper tension, these damages can cause pull-out failure or relaxation of the repaired ligaments even from undersized load that may extend postoperative splinting or casting time. Furthermore, current suture techniques can repair varus or valgus instability of the elbow and radial or ulnar instability of the fingers, but these techniques do not offer rotatory stability of these areas. We have developed a novel suture anchor technique that has overcome this problem of current suture techniques, and this can be used to correct rotatory instability in the elbow and fingers. We used this procedure in seven cases with injury of collateral ligament in the elbow and eight cases with detached collateral ligaments of finger joint. No patient experienced rerupture or any kind of residual instability. We believe that the proposed method can produce much stronger repair and may shorten the postoperative immobilization period.
Full Text Available Introduction. One of the most dramatic conditions in obstetrics is definitely bleeding from the uterus which fails to compress. This condition is known as postpartum atony. When such a condition is diagnosed, the obstetrician has a choice of several conservative methods to stimulate the uterus to contract and several surgical methods to stop the bleeding. The most extreme measure used to save the patient's life and stop the bleeding is hysterectomy. This surgery is characterized by high morbidity, primarily by the loss of woman's fertility. In order to avoid hysterectomy, several authors have introduced the compressive uterine suture technique into gynaecological practice. Objective. The aim of the paper is to demonstrate the technique of applying compressive uterine suture after delivery to stop excessive bleeding, and to present results obtained by this technique. Methods. The paper explains the technique of applying compressive suture to the atonic uterus in cases when all other procedures to stop excessive bleeding after delivery fail. Since uterine atony is the main reason for excessive and uncontrollable bleeding after childbirth, the need to perform such surgery is rather common. Authors demonstrate the technique of applying four compressive sutures which prevent uterus dilation and thus stop the bleeding. Results. Compressive suture technique was used by the authors eight times, seven of which during caesarean section and one after spontaneous delivery. All patients had normal postpartum period and normal involution of the uterus. Conclusion. Although this surgery requires a skilful and experienced obstetrician, the authors find it rather easy to perform and it is suggested to be applied in all cases of uterine atony when excessive bleeding cannot be stopped by other any other method except hysterectomy. This surgical procedure saves the uterus and facilitates quick and easy patient's recovery.
Batioglu-Karaaltin, Aysegul; Yigit, Ozgur; Donmez, Zehra
Caudal septal dislocation is both a functional and an aesthetic problem. The caudal septum that causes nasal obstruction displaces the right or left of columella. Despite the various maneuvers currently available for treatment, this issue is still controversial. We describe a new technique that uses a nonabsorbable suture material to keep the septum in the midline in mild and moderate caudal septal dislocations and can be used in addition to other current techniques. A full-length (lengthways) pocket is opened between the medial cruras, and the dislocated caudal septum is placed in it and then fixed to the soft tissue in the region of columella under the skin by a nonabsorbable suture. It is used as a complementary technique for both the swinging door and the Goldman technique. This technique prevents redeviation in the same direction, especially in the superior portion of the caudal end, due to the memory of cartilage tissue. It will therefore reduce revision rates.
Sherman, Seth L; Copeland, Marilyn E; Milles, Jeffrey L; Flood, David A; Pfeiffer, Ferris M
To evaluate the biomechanical fixation strength of suture anchor and transosseous tunnel repair of the quadriceps tendon in a standardized cadaveric repair model. Twelve "patella-only" specimens were used. Dual-energy X-ray absorptiometry measurement was performed to ensure equal bone quality amongst groups. Specimens were randomly assigned to either a suture anchor repair of quadriceps tendon group (n = 6) or a transosseous tunnel repair group (n = 6). Suture type and repair configuration were equivalent. After the respective procedures were performed, each patella was mounted into a gripping jig. Tensile load was applied at a rate of 0.1 mm/s up to 100 N after which cyclic loading was applied at a rate of 1 Hz between magnitudes of 50 to 150 N, 50 to 200 N, 50 to 250 N, and tensile load at a rate of 0.1 mm/s until failure. Outcome measures included load to failure, displacement at 1st 100 N load, and displacement after each 10th cycle of loading. The measured cyclic displacement to the first 100 N, 50 to 150 N, 50 to 200 N, and 50 to 250 N was significantly less for suture anchors than transosseous tunnels. There was no statistically significant difference in ultimate load to failure between the 2 groups (P = .40). Failure mode for all suture anchors except one was through the soft tissue. Failure mode for all transosseous specimens but one was pulling the repair through the transosseous tunnel. Suture anchor quadriceps tendon repairs had significantly decreased gapping during cyclic loading, but no statistically significant difference in ultimate load to failure when compared with transosseous tunnel repairs. Although suture anchor quadriceps tendon repair appears to be a biomechanically superior construct, a clinical study is needed to confirm this technique as a viable alternative to gold standard transosseous techniques. Although in vivo studies are needed, these results support the suture anchor technique as a viable alternative to
Chiang, Florence L; Hong, Chih-Kai; Chang, Chih-Hsun; Lin, Cheng-Li; Jou, I-Ming; Su, Wei-Ren
To compare the biomechanical characteristics of the subpectoral Y-knot all-suture anchor fixation with those of the interference screw technique. Sixteen fresh-frozen human cadaveric shoulders with a mean age of 67.6 ± 5.8 years (range, 52 to 74 years) were studied. The specimens were randomly grouped into 2 experimental biceps tenodesis groups (n = 8): Y-knot all-suture anchor or interference screw. The specimens were cyclically tested to failure by applying tensile forces parallel to the longitudinal axis of the humerus. A preload of 5 N was applied for 2 minutes prior to cyclic loading for 500 cycles from 5 to 70 N at 1 Hz; subsequently, a load-to-failure test at 1 mm/s was performed. The ultimate failure load, stiffness, displacement at cyclic and failure loading, and mode of failure were recorded. The all-suture anchor technique displayed values of ultimate failure load and stiffness comparable to that of the interference screw technique. The displacement at cyclic and failure loading of the all-suture anchor trials were significantly greater than the interference screw (P = .0002). The all-suture anchor specimens experienced anchor pullout and tendon tear equally during the trials, whereas the interference screw group experienced tendon tear in most of the cases and screw pullout in 2 trials. The Y-knot all-suture anchor fixation provides equivalent ultimate failure load and stiffness when compared with the interference screw technique in tenodesis of the proximal biceps tendon from a subpectoral approach. However, the interference screw technique demonstrates significantly less displacement in response to cyclic and failure loading. The all-suture anchor fixation is an alternative technique for subpectoral biceps tenodesis even at greater displacement when compared with the interference screw fixation during cyclic and failure loading. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Abtahi, Amir M; Granger, Erin K; Tashjian, Robert Z
A variety of fixation techniques for subpectoral biceps tenodeses have been described including interference screw and suture anchor fixation. Biomechanical data suggests that dual suture anchor fixation has equivalent strength compared to interference screw fixation. The purpose of the study is to determine the early complication rate after subpectoral biceps tenodesis utilizing a dual suture anchor technique. A total of 103 open subpectoral biceps tenodeses were performed over a 3-year period using a dual suture anchor technique. There were 72 male and 31 female shoulders. The average age at the time of tenodesis was 45.5 years. 41 patients had a minimum of 6 months clinical follow-up (range, 6 to 45 months). The tenodesis was performed for biceps tendonitis, superior labral tears, biceps tendon subluxation, biceps tendon partial tears, and revisions of prior tenodeses. There were a total of 7 complications (7%) in the entire group. There were 4 superficial wound infections (4%). There were 2 temporary nerve palsies (2%) resulting from the interscalene block. One patient had persistent numbness of the ear and a second patient had a temporary phrenic nerve palsy resulting in respiratory dysfunction and hospital admission. One patient developed a pulmonary embolism requiring hospital admission and anticoagulation. There were no hematomas, wound dehiscences, peripheral nerve injuries, or ruptures. In the sub-group of patients with a minimum of 6 months clinical follow-up, the only complication was a single wound infection treated with oral antibiotics. Subpectoral biceps tenodesis utilizing a dual suture anchor technique has a low early complication rate with no ruptures or deep infections. The complication rate is comparable to those previously reported for interference screw subpectoral tenodesis and should be considered as a reasonable alternative to interference screw fixation. Level IV-Retrospective Case Series.
Full Text Available Background: A new emerging complication of trans-scleral fixation of posterior chamber (PC intraocular lens (IOL with polypropylene suture is high rates of spontaneous dislocation of the IOL due to disintegration or breakage of suture. Materials: We report a new surgical technique of trans-scleral fixation of posterior chamber intraocular lens (SF PCIOL with steel suture to eliminate the complication of dislocation of IOL fixed with polypropylene suture in one adult and a child. Results: We successfully achieved stable fixation and good centration of IOL after SF PCIOL with steel suture in these patient having inadequate posterior capsular support. Both eyes achieved best corrected visual acuity 20/40 at 18 months follow-up. Conclusions: Steel suture is a viable option for trans-scleral fixation of posterior chamber intraocular lens.
Rajkumar, K; Mukhopadhyay, P; Sinha, Ramen
The study assessed the efficacy of orthopedic suture anchor as a modified suture anchor for disc repositioning in case of a closed lock of TMJ. Disc repositioning was undertaken via a mini preauricular approach. The disc was repositioned on the surface of the condyle and stabilized using an orthopedic suture anchor. Postoperatively functional outcomes were assessed in terms of reduction in pain, joint movement and absence of joint noise and clicking sounds. Postoperative MRI was used to assess the disc position and morphological changes in the disc and arthritic changes in the condyle at the end of six months. Patients were post surgically followed up at regular intervals of 1, 3 and 6 months. Patient experienced significant improvement in mouth opening with good functional outcomes and stable repositioning of disc as noticed By MRI at the end of six months. We describe a modified technique of disc repositioning using an orthopedic suture anchor for more favorable disc position and joint function. However the long term functional sequel of the procedure and changes in the articular disc needs to be assessed.
Full Text Available 【Abstract】Objective: To evaluate clinical outcome of suture anchors in strengthening both acromioclavicular and coracoclavicular ligaments in the surgical treatment of acromioclavicular joint dislocation. Methods: Twenty-eight patients with acute traumatic Rockwood III, IV and V dislocations of the acromioclavicular joint surgically treated at our institute between October 2010 and January 2012 were recruited. All patients underwent open reduction combined with suture anchors. Function was evaluated using the ConstantMurley shoulder score. Clinical and radiographic shoulder ratings were evaluated using Taft criteria at 3, 6 and 12 months. Results:Two cases with fixation loosening were not included in final statistical analysis. Other patients obtained full joint reposition on immediate postoperative radiographs. Follow-up was performed with an average of 15.6 months (range, 12-19. After early range of motion exercises, 96.2% of the patients (25/26 could abduct and elevate their shoulders more than 90 degrees within postoperative 3 months. There was no infection. Average Constant-Murley score was 96.3 points (range, 94-100 and mean Taft shoulder rating was 10.7 points (range, 8-12 at 12 months. Conclusion: The suture anchor is a relatively simple technique and can avoid screw removal which is helpful in reconstructing both acromioclavicular and coracoclavicular ligaments in acute traumatic acromioclavicular joint dislocation. Key words: Acromioclavicular joint; Dislocations; Surgery; Suture anchors
Links, D J R; Berney, C R
Traumatic lumbar hernia (TLH) is a rare presentation. Traditionally, these have been repaired via an open approach. Recurrence can be a problem due to the often limited tissue available for mesh fixation at the inferior aspect of the hernia defect. We report the successful use of bone suture anchors placed in the iliac crest during transperitoneal laparoscopy for mesh fixation to repair a recurrent TLH. This technique may be particularly useful after previous failed attempts at open TLH repair.
Bayoumi, Nader H
To compare releasable and regular sutures in combined angle and filtering surgery for primary congenital glaucoma. A prospective study was conducted on 39 eyes (26 right eyes) of 39 children (20 boys; 19 girls) who had primary congenital glaucoma treated with combined trabeculotomy-trabeculectomy with mitomycin C and scleral flap closure with regular or releasable sutures. Follow-up was 24 months. Success rates (defined as an intraocular pressure [IOP] suture group (20 eyes) and 5.3 ± 2.8 months (range: 1 to 13 months; median: 5 months) in the releasable suture group (19 eyes). The initial glaucoma surgery was successful in 13 (65%) and 13 (68.4%) eyes in the regular suture and releasable suture groups, respectively. The mean IOP was 17.4 ± 7.3 and 16.0 ± 5.4 mm Hg (P = .84) preoperatively and 8.0 ± 9.7 and 5.8 ± 3.6 mm Hg (P = .40) at the end of follow-up in the regular suture and releasable suture groups, respectively. There was no statistically significant difference in the clinical parameters between the two groups. Complications included rhegmatogenous retinal detachment, cataract, and superior lens subluxation, with each complication developing in one eye. Releasable sutures were not more advantageous than regular sutures in combined trabeculotomy-trabeculectomy with mitomycin C surgery for primary congenital glaucoma. [J Pediatr Ophthalmol Strabismus. 2017;54(5):295-301.]. Copyright 2017, SLACK Incorporated.
Conclusions: Trabeculotomy proves to be a safe and effective treatment in reducing IOP in this group of Chinese newborns with PCG. The outcomes of vision function were satisfactory in most of the patients.
Dueñas-Garcia, Omar F; Sullivan, Gina M; Leung, Katherine; Billiar, Kristen L; Flynn, Michael K
Surgeons use a variety of sutures and knot-tying methods during pelvic reconstructive procedures. We hypothesized that knot-strength integrity will be similar with regards to type of knot, type of suture, and the knot-tying process. Using six different suture materials, flat square knots and slip knots were tied robotically and by hand by two surgeons. Knot integrity was evaluated using an Instron 5544 machine. We measured force and elongation at suture failure or knot slippage (whichever came first) as well as force at 3-mm displacement. Four hundred and thirty-two knots were tie; one unraveled before the analysis, and 431 were tested. Three hundred and ninety-two knots reached or surpassed tensile strength of 30 N, the force at which tissue itself will fail. Knots tied with polyglyconate suture achieved the greatest tensile strength and those with OO-polydioxanone had the lowest. Hand-tied knots, regardless of technique and suture material, had greater tensile strength but greater elongation than robotically tied knots. Slip knots and flat square knots have similar integrity regardless of the tying technique. Hand-tied knots had greater tensile strength than robotic knots, but the strength to break all knots required supraphysiological conditions. The decision to use a specific type of suture based on strength is not supported by our results, suggesting that surgeons may choose sutures based on other characteristics and personal comfort.
Qi, Jie; Duan, Liang; Li, Weiwei; Wei, Wenbo
To summarize the application and experience of repairing spontaneous Achilles tendon rupture by part-Kessler technique with suture anchor. Between January 2011 and December 2013, 31 patients with spontaneous Achilles tendon rupture were treated by part-Kessler technique with suture anchor. Of 31 cases, 23 were male and 8 were female, aged 16-53 years (mean, 38 years). The left side was involved in 15 cases and the right side in 16 cases. The causes of injury included sudden heel pain and walking weakness during sports in 22 cases; no surefooted down-stairs, slip, and carrying heavy loads in 9 cases. The distance from broken site to the calcaneus adhension of Achilles tendon was 3-6 cm (mean, 4.2 cm). The time from injury to operation was 7 hours to 4 days (mean, 36.8 hours). All incisions healed by first intention without nerve injury or adhering with skin. The patients were followed up 6-24 months (mean, 15 months). All patients could complete 25 times heel raising without difficulty at 6 months after operation. No Achilles tendon rupture occurred again during follow-up. At 6 months after operation, the range of motion of the ankle joint in dorsiflexion and plantar flexion showed no significant difference between normal and affected sides (t=0.648, P=0.525; t=0.524, P=0.605). The circumference of the affected leg was significantly smaller than that of normal leg at 6 months after operation (t=2.074, P=0.041), but no significant difference was found between affected and normal sides at 12 months after operation (t=0.905, P=0.426). The American Orthopedic Foot and Ankle Society (AOFAS) scores at 6, 12, 18, and 24 months after operation were significantly higher than preoperative score (P0.05). Repairing spontaneous Achilles tendon rupture by part-Kessler technique with suture anchor can supply strong strain and decrease the shear forces of suture. So part-Kessler technique with suture anchor is successful in repairing spontaneous Achilles tendon rupture.
Sharda Brata Ghosh
Full Text Available Objective. The most commonly described technique of modified B-Lynch suture may not be suitable for all the patients presenting with flabby, atonic uterus. Study Design. A retrospective analysis of twelve patients with uncontrolled postpartum haemorrhage, who underwent this procedure from March 2007 to September 2012, was conducted. In this novel technique, sutures are passed in the lower uterine segment and are tightened alternately to control uterine bleeding. Results. Average duration of the procedure was 4 minutes (range 2–7 minutes. Average blood loss was 1625 mL (range 1300–1900 mL. Eleven patients (91.66% were seen to have a successful outcome with only this technique. No patient required hysterectomy and one patient (8.33% required additional bilateral internal iliac artery ligation. All the patients had a minimum follow-up of 2 yrs and none of them reported any infertility problems. Conclusion. This technique is simple, quick, and effective. There was no adverse effect on the fertility potential for the observed 2 years; however, a long-term follow-up is required to comment on its actual rate. This technique cannot replace the standard modified B-Lynch technique for uncontrolled postpartum haemorrhage but can be used for unresponsive, flabby, and atonic uterus.
Matras, H; Jesch, W; Kletter, G; Dinges, H P
A new clot-suturing Technique (using high-concentration fibrinogen solutions) for water-tight closure of the dura is reported. Six dogs underwent laminectomy of the thoracic spine with medial longitudinal incision in the chordal dura. After the dural split had been sealed with natural tissue adhesive and closure of the wound in layers, the animals were sacrificed at intervals of 1 to 21 days postoperatively and the chordal segments involved were removed and histologically examined. Early fibrinolysis of the clot was prevented by adding a natural proteinase inhibitor and factor XIII concentrate to the clotting substances. Histological analysis showed that healing was almost complete after 2 weeks, with delicate connective tissue overgrowing the dural split. After complete reabsorption of fibrin, the originally abundant absorbent granulation tissue had largely disappeared. Among the satisfactory results of fibrin suturing are optimum healing tendency in the fibrin-sutured region, absence of tissue irritation and neurotoxicity, which are known attributes of the synthetic alkl-cyano-acrylate tissue adhesives.
Rogula, Tomasz; Khorgami, Zhamak; Bazan, Martin; Mamolea, Cristina; Acquafresca, Pablo; El-Shazly, Omar; Aminian, Ali; Schauer, Philip
Sleeve gastrectomy is a common procedure in recent years for treatment of morbid obesity however leak from staple-line is its main challenging complication. Despite numerous studies regarding leak after sleeve gastrectomy, there is still no conclusion on reinforcement of staple-line in this procedure. The purpose of this study was to compare two methods of oversewing staple-line versus no reinforcement. Resected stomachs of 30 patients undergoing laparoscopic sleeve gastrectomy were evaluated for bursting pressure immediately after extraction from the abdomen. Reinforcement technique was applied in random order to 3 segments of the staple-line on each specimen: continuous Lembert's sutures, continuous through-and-through sutures, and no reinforcement. Bursting pressure was determined by injection of methylene blue solution into lumen of resected stomach and recording pressure at which leakage occurs. Location of leak, intragastric pressure, and volume at first leak were recorded. Baseline characteristics of patients were similar in randomized groups for order of reinforcement technique. Mean ischemia time of specimens was 17.4 ± 10.4 min. No leaks were observed in segments reinforced with Lembert's oversewing technique. The through-and-through reinforcement segments were first to leak in 21 out of 30 cases (70 %) with mean leak pressure of 570 mmHg and mean leak volume of 399 ml. Leakage occurred in 9 segments (30 %) with no reinforcement with a leak pressure of 329 mmHg and volume of 380 ml. In vitro, Lembert's suture reinforcement technique on stapled human stomach is associated with less leakage rate in comparison to through-and-through reinforcement and non-reinforced staple-line.
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.
Feucht, Matthias J; Grande, Eduardo; Brunhuber, Johannes; Burgkart, Rainer; Imhoff, Andreas B; Braun, Sepp
A tear of the posterior medial meniscus root (PMMR) is increasingly recognized as a serious knee joint injury. Several suture techniques for arthroscopic transtibial pull-out repair have been described; however, only limited data about the biomechanical properties of these techniques are currently available. There are significant differences between the tested suture techniques, with more complex suture configurations providing superior biomechanical properties. Controlled laboratory study. A total of 40 porcine medial menisci were randomly assigned to 1 of 4 groups (10 specimens each) according to suture technique: two simple stitches (TSS), horizontal mattress suture (HMS), modified Mason-Allen suture (MMA), and two modified loop stitches (TLS). Meniscus-suture constructs were subjected to cyclic loading followed by load-to-failure testing in a servohydraulic material testing machine. During cyclic loading, the HMS and TLS groups showed a significantly higher displacement after 100, 500, and 1000 cycles compared with the TSS and MMA groups. After 1000 cycles, the highest displacement was found for the TLS group, with significant differences compared with all other groups. During load-to-failure testing, the highest maximum load and yield load were observed for the MMA group, with statistically significant differences compared with the TSS and TLS groups. With regard to stiffness, the TSS and MMA groups showed significantly higher values compared with the HMS and TLS groups. The MMA technique provided the best biomechanical properties with regard to cyclic loading and load-to-failure testing. The TSS technique seems to be a valuable alternative. Both the HMS and TLS techniques have the disadvantage of lower stiffness and higher displacement during cyclic loading. Using a MMA technique may improve healing rates and avoid progressive extrusion of the medial meniscus after transtibial pull-out repair of PMMR tears. The TSS technique may be used as an alternative that
Sawadkar, Prasad; Alexander, Susan; Tolk, Marten; Wong, Jason; McGrouther, Duncan; Bozec, Laurent; Mudera, Vivek
The traumatic rupture of tendons is a common clinical problem. Tendon repair is surgically challenging because the tendon often retracts, resulting in a gap between the torn end and its bony insertion. Tendon grafts are currently used to fill this deficit but are associated with potential complications relating to donor site morbidity and graft necrosis. We have developed a highly reproducible, rapid process technique to manufacture compressed cell-seeded type I collagen constructs to replace tendon grafts. However, the material properties of the engineered constructs are currently unsuitable to withstand complete load bearing in vivo. A modified suture technique has been developed to withstand physiological loading and off load the artificial construct while integration occurs. Lapine tendons were used ex vivo to test the strength of different suture techniques with different sizes of Prolene sutures and tissue-engineered collagen constructs in situ. The data were compared to standard modified Kessler suture using a standard tendon graft. Mechanical testing was carried out and a finite element analysis stress distribution model constructed using COMSOL 3.5 software. The break point for modified suture technique with a tissue-engineered scaffold was significantly higher (50.62 N) compared to a standard modified Kessler suture (12.49 N, ptechnique is suitable for testing in vivo, and this will be the next stage of our research.
Rambani Rohit; Hackney Roger G
Abstract Introduction Arthroscopic repair of the rotator cuff is a demanding surgery. Accurate placement of anchors is key to success. Case presentation A 38-year-old woman received arthroscopic repair of her rotator cuff using a double row suture anchor technique. Postoperatively, she developed impingement syndrome which resulted from vertical displacement of a suture anchor once the shoulder was mobilised. The anchor was removed eight weeks following initial surgery and the patient had an u...
Full Text Available Introduction. This study was designed to investigate the influence of the amount of suture material on the formation of peritendinous adhesions of intrasynovial flexor tendon repairs. Materials and Methods. In 14 rabbits, the flexor tendons of the third and the fourth digit of the right hind leg were cut and repaired using a 2- or 4-strand core suture technique. The repaired tendons were harvested after three and eight weeks. The range of motion of the affected toes was measured and the tendons were processed histologically. The distance between the transected tendon ends, the changes in the peritendinous space, and cellular and extracellular inflammatory reaction were quantified by different staining. Results. A 4-strand core suture resulted in significantly less gap formation. The 2-strand core suture showed a tendency to less adhesion formation. Doubling of the intratendinous suture material was accompanied by an initial increase in leukocyte infiltration and showed a greater amount of formation of myofibroblasts. From the third to the eighth week after flexor tendon repair, both the cellular and the extracellular inflammation decreased significantly. Conclusion. A 4-strand core suture repair leads to a significantly better tendon healing process with less diastasis between the sutured tendon ends despite initially pronounced inflammatory response.
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.
Pollock, H; Pollock, T
Abdominoplasty has evolved as a very effective and satisfactory procedure, especially when combined with liposuction and the repair of diastasis recti. However, local complications, including hematoma and seroma formation, flap necrosis, and hypertrophic scars, continue to plague this procedure. The authors present a relatively simple and reproducible technique that allows extensive liposuction in conjunction with abdominoplasty; they think this technique reduces the incidence of local complications. This technique, the use of progressive tension sutures, has been used in their practice for more than 15 years. A retrospective review of 65 consecutive abdominoplasty patients demonstrates a very low local complication rate when compared with historical controls. In this series of both full and modified abdominoplasty patients who were followed for an average of 18 months, the authors had no hematomas, seromas, or skin flap necrosis.
Mineta, Kazuaki; Suzue, Naoto; Matsuura, Tetsuya; Sairyo, Koichi
Here, we report the efficacy of the suture bridge technique for treating insertional Achilles tendinosis in an obese and athletic patient. A 48-year-old man presented to our department with a 6-month history of left posterior heel pain. The patient was an athlete (triathlon) and appeared obese (height: 197 cm, body weight: 120 kg, body mass index: 30.9). A diagnosis of insertional Achilles tendinosis was made. Because 6 months of conservative treatments had failed, we performed open resection of the calcaneal exostosis and Haglund's deformity along with debridement of the degenerative tissue of the tendon. Wide detachment of the insertion of the Achilles tendon was necessary, and reattachment of the tendon was performed using the Arthrex SpeedBridge(TM) system (Arthrex, Inc., Naples, FL). Six weeks postoperatively, this patient was allowed to walk with full weight bearing. Twelve weeks after surgery, this patient started jogging with neither pain nor evidence of Achilles tendon rupture. The suture bridge technique was effective for the reconstruction of the Achilles tendon in an obese and athletic patient. J. Med. Invest. 63: 310-314, August, 2016.
Li, Haidong; Song, Tao
To introduce nickel-titanium wire as suture material for closure of incisions in cleft lip procedures. Closure of skin incisions using nickel-titanium wire as suture material, with postoperative follow-up wound evaluation. There was excellent patient satisfaction and good cosmetic outcome. Nickel-titanium wire is an excellent alternative for suture closure of cleft lip surgical incisions.
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.
Lanzi, Joseph T; Felix, Justin; Tucker, Christopher J; Cameron, Kenneth L; Rogers, John; Owens, Brett D; Svoboda, Steven J
Minimizing gap formation and maximizing the strength of patellar tendon repairs are 2 critical factors for successful healing of these injuries. The purpose of this study was to compare transosseous and screw-in anchor repair techniques to determine if there is a difference in gap formation and load to failure of the 2 constructs. The research hypotheses were that the anchor construct would have significantly less gap formation and would also have significantly greater load-to-failure strength. Controlled laboratory study. A total of 24 porcine specimens were randomly assigned into transosseous and 4.75-mm polyetheretherketone (PEEK) screw-in anchor repair groups. The repairs were then completed using 2 No. 2 FiberWire sutures, and each specimen was cyclically loaded on a tensile test machine to 250 N for a total of 1000 cycles. Gap formation was measured at 1, 10, 250, 500, and 1000 cycles. Each specimen was loaded to failure after 1000 cycles. Independent t tests were conducted. Statistically significant gap formation and load-to-failure differences were found between the 2 repair techniques. The mean gap in the anchor group (2.16 ± 1.81 mm) was significantly less than that seen in the transosseous group (5.71 ± 1.58 mm) (P anchor group (669.9 ± 91.8 N) was significantly higher than that of the transosseous group (582.8 ± 92.6 N) (P = .03). The results support the 2 study hypotheses. These findings suggest that the 4.75-mm PEEK screw-in anchor construct may be superior to the transosseous technique for minimizing gap formation and improving load-to-failure strength after surgical repair of the patellar tendon. The use of the suture anchor technique in patellar tendon repair may support early load-bearing rehabilitation. © 2016 The Author(s).
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
Rigby, Ryan B; Cottom, James M; Vora, Anand
Posterior heel pain caused by insertional Achilles tendinosis can necessitate surgical intervention when recalcitrant to conservative care. Surgical treatment can necessitate near complete detachment of the Achilles tendon to fully eradicate the offending pathologic features and, consequently, result in long periods of non-weightbearing. A suture bridge technique using bone anchors is available for reattachment of the Achilles tendon. This provides restoration of the Achilles footprint on the calcaneus, including not only contact, but also actual pressure between the tendon and bone. We performed a review of 43 patients who underwent surgical treatment of insertional Achilles tendinosis with reattachment of the Achilles tendon using the suture bridge technique. The mean age was 53 (range 29 to 87) years. The mean follow-up period was 24 (range 13 to 52) months. The mean postoperative American Orthopaedic Foot and Ankle Society score was 90 (range 65 to 100). The mean preoperative visual analog scale pain score was 6.8 (range 2 to 10) and the mean postoperative visual analog scale pain score was 1.3 (range 0 to 6). The mean interval to weightbearing was 10 (range 0 to 28) days. No postoperative ruptures occurred. Of the 43 patients, 42 (97.6%) successfully performed the single heel rise test at the final postoperative visit. Concomitant procedures were performed in 35 patients, including 33 (77%) requiring open gastrocnemius recession and 2 (5%) requiring flexor hallucis longus tendon transfer. A total of 42 patients (97.6%) returned to regular shoe gear, and 42 (97.6%) returned to their activities of daily living, including running for 20 athletic patients (100%). Complications included postoperative wound dehiscense requiring surgical debridement in 2 patients (5%) and soft tissue infection requiring antibiotics and surgical debridement in 1 (2%) patient. Our findings support using the Achilles tendon suture bridge for reattachment of the Achilles tendon in the
Bateman, Dexter K; Barlow, Jonathan D; VanBeek, Corinne; Abboud, Joseph A
Olecranon fractures are common in elderly patients, causing significant morbidity and functional impairment. Traditional surgical treatments are often complicated by hardware failure and prominence, frequently requiring reoperation. To address these concerns, a suture anchor fixation technique was developed and clinically evaluated. A consecutive series of elderly patients treated with this technique from 2006 to 2013 at a single institution were studied. All cases were surgically repaired with nonmetallic fully threaded suture anchors in a double-row fashion. Clinical outcome measures including the shortened Disabilities of the Arm, Shoulder, and Hand score, the Oxford Elbow Score, and the 12-Item Short Form Health Survey score were obtained. Eight female patients with Mayo IIA or IIB fractures were identified. The mean age of the patients at time of operation was 73.5 ± 10.7 years (range, 59.3-88.8 years). The average time from injury to operation was 5.7 ± 3.7 days. The average follow-up was 5.1 ± 2.5 years (range, 0.8-7.4 years). Six patients were available for long-term follow-up; 1 patient had died, and 1 patient was unable to be contacted despite multiple attempts. There were no intraoperative complications or reoperations. All 8 patients healed uneventfully in an acceptable position without displacement. Postoperatively, the average Oxford Elbow Score was 47.17 ± 2.04; the average shortened Disabilities of the Arm, Shoulder, and Hand score was 6.43 ± 9.47; and the average 12-Item Short Form Health Survey scores were 49.02 ± 16.59 and 55.38 ± 4.05 for the physical and mental component scales, respectively. Suture anchor fixation of olecranon fractures in the elderly population provides excellent long-term radiographic and clinical outcomes without hardware complications associated with traditional fixation methods. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
Choi, Nam-Hong; Kim, Tae-Hyung; Victoroff, Brian N
There are no reports comparing meniscal healing between inside-out and all-inside repairs using sutures. No difference in healing rate exists between meniscal repairs with inside-out and all-inside suture repair in conjunction with anterior cruciate ligament reconstruction with hamstring tendon. Cohort study; Level of evidence, 2. Forty-eight consecutive patients underwent meniscal repairs of longitudinal tears of the posterior horn of the medial meniscus combined with anterior cruciate ligament reconstructions. All-inside repair was attempted when the tears were located in the red-red zone or the ramp area of the meniscus. If a tear that was in the ramp area or red-red zone extended to the midbody of the meniscus, or if there was a tear in red-white zone, the inside-out repair technique was used. Fourteen patients had all-inside meniscal repairs, and 34 patients had inside-out meniscal repairs with absorbable sutures. Identical postoperative rehabilitation protocols were used. Postoperative evaluations included Lysholm knee scoring scale, Tegner activity levels, Lachman and pivot-shift tests, and KT-1000 arthrometer. Assessment of meniscal status was performed using joint line tenderness, McMurray test, and range of motion. Follow-up magnetic resonance imaging scans were obtained on all patients. Mean follow-up was 35.7 months. No patient had joint line tenderness or reported pain or clicking on McMurray test. There was no significant difference in range of motion between groups. Follow-up magnetic resonance imaging scans demonstrated that 10 (71.4%) menisci were healed and 4 (28.6%) partially healed in the all-inside group; 24 (70.6%) menisci were healed and 10 (29.4%) partially healed in the inside-out group. There was no significant difference in meniscal healing between groups. There were no differences in Lachman test, KT-1000 arthrometer side-to-side differences measurements, Lysholm scores, and Tegner activity scales. There was a significant difference in
McCrea, Shane J J
Following tooth extraction, resorption of the buccal wall of the socket will occur; this will be true for both the maxilla and the mandible. Where the extraction site is surrounded by natural dentition, the loss of the buccal alveolar plate can degrade the visual aesthetics of an implant-supported prosthetic rehabilitation. To aid the harmonization of the hard and soft tissue morphology, both hard and soft tissue augmentation can be carried out either consecutively with an extraction/immediate implant placement or prior to an implant placement in the delayed scenario. The contemporary method of increasing soft tissue volume is to use the Subepithelial Connective Tissue (auto) Graft (the SCTG). The graft requires fixation, otherwise it can be extruded from the recipient site. This article presents a novel suturing technique which can confidently secure the SCTG, thus resisting its dislodgement.
Waldrop, Norman E; Wijdicks, Coen A; Jansson, Kyle S; LaPrade, Robert F; Clanton, Thomas O
Despite the popularity of the Broström procedure for secondary repair of chronic lateral ankle instability, there have been no biomechanical studies reporting on the strength of this secondary repair method, whether using suture fixation or suture anchors. The purpose of our study was to perform a biomechanical comparison of the ultimate load to failure and stiffness of the traditional Broström technique using only a suture repair compared with a suture anchor repair of the anterior talofibular ligament (ATFL) at time zero. We believed that fixation strength of the suture anchor repair would be closer to the strength of the native ligament and allow more aggressive rehabilitation. Controlled laboratory study. Twenty-four fresh-frozen cadaveric ankles were randomly divided into 4 groups of 6 specimens. One group was an intact control group, and the other groups consisted of the traditional Broström and 2 suture anchor modifications (suture anchors in talus or fibula) of the Broström procedure. The specimens were loaded to failure to determine the strength and stiffness of each construct. In load-to-failure testing, ultimate failure loads of the Broström (68.2 ± 27.8 N; P = .013), suture anchor fibula (79.2 ± 34.3 N; P = .037), and suture anchor talus (75.3 ± 45.6 N; P = .027) repairs were significantly lower than that of the intact (160.9 ± 72.2 N) ATFL group. Stiffness of the Broström (6.0 ± 2.5 N/mm; P = .02), suture anchor fibula (6.8 N/mm ± 2.7; P = .05), and suture anchor talus (6.6 N/mm ± 4.0; P = .04) repairs were significantly lower than that of the intact (12.4 N/mm ± 4.1 N/mm) ATFL group. The 3 repair groups were not significantly different from each other, but all 3 were substantially lower in strength and stiffness when compared to the intact ATFL. The use of suture anchors to repair the ATFL produces a repair that can withstand loads to failure similar to the suture-only Broström repair. However, all 3 repair groups were much weaker than
Ridged sutures ... The borders where these plates intersect are called sutures or suture lines. In an infant only a few minutes ... This makes the bony plates overlap at the sutures and creates a small ridge. This is normal ...
Othman, Diaa; Le Cocq, Heather; Majumder, Sanjib
We propose that the simple method of passing an extra suture through the Mitek anchor eyelet before bony insertion provides a safety net against failure of the preloaded suture and gives extra strength to the core repair. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Miyamoto, Wataru; Imade, Shinji; Innami, Ken; Kawano, Hirotaka; Takao, Masato
Although early accelerated rehabilitation is recommended for the treatment of acute Achilles tendon rupture, most traditional rehabilitation techniques require some type of brace. We retrospectively analyzed 44 feet of 44 patients (25 male and 19 female) with a mean age of 31.8 years who had an acute Achilles tendon rupture related to athletic activity. Patients had been treated by a double side-locking loop suture (SLLS) technique using double antislip knots between stumps and had undergone early accelerated rehabilitation, including active and passive range of motion exercises on the day following the operation and full weight-bearing at 4 weeks. No brace was applied postoperatively. The evaluation criteria included the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale (AOFAS) score; active plantar flexion and dorsiflexion angles; and the intervals between surgery and the time when patients could walk normally without any support, perform double-leg heel raises, and perform 20 continuous single-leg heel raises of the operated foot. Despite postoperative early accelerated rehabilitation, the AOFAS score and active dorsiflexion angles improved over time (6, 12, and 24 weeks and 2 years). A mean of 4.3 ± 0.6 weeks was required for patients to be able to walk normally without any support. The mean period to perform double-leg heel raises and 20 continuous single-leg heel raises of the injured foot was 8.0 ± 1.3 weeks and 10.9 ± 2.1 weeks, respectively. All patients, except one who was engaged in classical ballet, could return to their preinjury level of athletic activities, and the interval between operation and return to athletic activities was 17.1 ± 3.7 weeks. The double SLLS technique with double antislip knots between stumps adjusted the tension of the sutured Achilles tendon at the ideal ankle position and provided good clinical outcomes following accelerated rehabilitation after surgery without the use of a brace. Level IV, retrospective case
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.
Miyazaki, Alberto Naoki; Santos, Pedro Doneux; Sella, Guilherme do Val; Checchia, Caio Santos; Salata, Thiago Roncoletta; Checchia, Sergio Luiz
To evaluate the results of arthroscopic treatment of large and extensive rotator cuff injuries (RCI) that involved the supra and infraspinatus muscles using the suture bridge (SB) technique. Between July 2010 and November 2014, 37 patients with RCI who were treated with SB technique were evaluated. The study included all patients with a minimum follow-up of 12 months who underwent primary surgery of the shoulder. Twenty-four patients were male and 13 were female. The mean age was 60 years (45-75). The dominant side was affected in 32 cases. The most common cause of injury was trauma (18 cases). The mean preoperative motion was 123°, 58°, T11. Through magnetic resonance imaging, 36 fatty degenerations were classified according to Goutallier. Patients underwent rotator cuff repair with SB technique, which consists of using a medial row anchor with two Corkscrew(®) fibertape(®) or fiberwire(®) at the articular margin, associated with lateral fixation without stitch using PushLocks(®) or SwiveLocks(®). The mean age was 60 years and mean fatty degeneration was 2.6. The mean range of motion (following the AAOS) in the postoperative evaluation was 148° of forward elevation, 55° in lateral rotation and medial rotation in T9. Using the criteria of the University of California at Los Angeles (UCLA), 35 (94%) patients had excellent and good results; one (2.7%), fair; and one (2.7%), poor. Arthroscopic repair of a large and extensive RCI using SB technique had good and excellent results in 94% of the patients.
Randelli, Pietro; Stoppani, Carlo Alberto; Zaolino, Carlo; Menon, Alessandra; Randelli, Filippo; Cabitza, Paolo
Rotator cuff tear is a common finding in patients with painful, poorly functioning shoulders. The surgical management of this disorder has improved greatly and can now be fully arthroscopic. To evaluate clinical and radiological results of arthroscopic rotator cuff repair using 2 different techniques: single-row anchor fixation versus transosseous hardware-free suture repair. Randomized controlled trial; Level of evidence, 1. Sixty-nine patients with rotator cuff tears were enrolled: 35 patients were operated with metal anchors and 34 with standardized transosseous repair. The patients were clinically evaluated before surgery, during the 28 days after surgery, and at least 1 year after the operation by the use of validated rating scores (Constant score, QuickDASH, and numerical rating scale [NRS]). Final follow-up was obtained at more than 3 years by a QuickDASH evaluation to detect any difference from the previous follow-up. During the follow-up, rotator cuff integrity was determined through magnetic resonance imaging and was classified according to the 5 Sugaya categories. Patients operated with the transosseous technique had significantly less pain, especially from the 15th postoperative day: In the third week, the mean NRS value for the anchor group was 3.00 while that for transosseous group was 2.46 ( P = .02); in the fourth week, the values were 2.44 and 1.76, respectively ( P < .01). No differences in functional outcome were noted between the 2 groups at the final evaluation. In the evaluation of rotator cuff repair integrity, based on Sugaya magnetic resonance imaging classification, no significant difference was found between the 2 techniques in terms of retear rate ( P = .81). No significant differences were found between the 2 arthroscopic repair techniques in terms of functional and radiological results. However, postoperative pain decreased more quickly after the transosseous procedure, which therefore emerges as a possible improvement in the surgical
Full Text Available Purpose: To evaluate the results of previously described viscotrabeculotomy technique and to compare them with those of conventional trabeculotomy in longer-term follow-up. Material and Method: This retrospective study included the eyes of 64 patients who underwent either viscotrabeculotomy (group 1 or conventional trabeculotomy (group 2 between February 1992 and April 2011. Group 1 consisted of 58 eyes of 34 patients who underwent viscotrabeculotomy surgery and group 2 consisted of 51 eyes of 30 patients who underwent conventional trabeculotomy. 3 patients (5 eyes in group 1 and 2 patients (3 eyes in group 2 left the follow-up for some reasons. At the last visit, group 1 comprised 53 eyes of 31 patients and group 2 comprised 48 eyes of 28 patients. Outcome measures were intraocular pressure (IOP, antiglaucomatous medications, horizontal corneal diameter, and success rate. Results: Success rates in group 1 at 12, 36, 60, 72, 96, 120 months, and at the last visit were 93.10%, 91.30% 89.30%, 87.00%, 84.90%, 83.00%, and 83.00%, respectively. The success rates in group 2 at the above-mentioned follow-up visits were 72.50%, 68.60%, 68.60%, 66.10%, 66.00%, 64.50%, and 62.50%, respectively. The success rate in group 1 was statistically significantly higher than in group 2 at the last visit (p=0.027. IOP and anti-glaucomatous medications at each follow-up examination were lower in group 1 compared to group 2, and these differences were with statistical significance (for each, p<0.05. Horizontal corneal diameters did not differ between the two groups in the postoperative follow-up. Discussion: Viscotrabeculotomy has been found safer and more effective than classical trabeculotomy in longer-term evaluation. Viscodissection of the trabecular meshwork, viscodilation of the Schlemm’s canal, keeping away the lips of trabeculotomy incision, and possibly prevention of postoperative hemorrhage and fibroblastic proliferation by means of high-viscosity sodium
Sarman, Hakan; Muezzinoglu, Umit Sefa; Memisoglu, Kaya; Aydin, Adem; Atmaca, Halil; Baran, Tuncay; Odabas Ozgur, Bahar; Ozgur, Turgay; Kantar, Cengizhan
The goal of the present study was to evaluate the semi-invasive "internal splinting" (SIIS) method for repair of Achilles tendon rupture relative to open repair with Krakow sutures. Efficacy was evaluated based on the clinical and functional outcomes, postoperative magnetic resonance imaging measurements, isokinetic results, and surgical complication rates. Functional measurements included the Thermann and American Orthopaedic Foot and Ankle Society (AOFAS) ankle scores, bilateral ankle dorsiflexion, and plantar flexion measurements. Magnetic resonance imaging was used to compare the bilateral length and thickness of each Achilles tendon. The isokinetic outcomes were evaluated using a Biodex System 3 dynamometer. Of the 45 patients meeting the inclusion criteria, 24 were treated by SIIS and 21 by the open Krackow suture technique. The mean follow-up time for all patients was 43.7 (range 6 to 116) months. In the SIIS group, patients returned to normal daily activities after 7.2 (range 6 to 8) weeks compared with 14.3 (range 12 to 15) weeks in the open surgery group. The AOFAS ankle scores were 93.5 (range 82 to 100) points in the open repair group and 96.2 (range 86 to 100) points in the SIIS group. The Thermann scores were 80.4 (range 53 to 91) points for the open repair group and 87.9 (range 81 to 100) points for the SIIS method. The mean Achilles length on the operated side measured using magnetic resonance imaging was 175.06 (range 110 to 224) mm and 177.76 (range 149 to 214) mm for the open surgery and SIIS groups, respectively. Sensory impairment in the territory of the sural nerve was identified in 1 patient immediately after SIIS surgery, although this defect had completely resolved within 12 months. SIIS yielded better outcomes relative to the open surgery group according to the isokinetic measurements. Taken together, these data indicate the SIIS method for Achilles tendon ruptures performed better in terms of both functional and objective outcomes
Daghino, W; Enrietti, E; Sprio, A E; di Prun, N Barbasetti; Berta, G N; Massè, A
Surgical management of Achilles tendon rupture is still controversial: open techniques have a higher rate of soft tissue complications but a lower incidence of re-rupture than percutaneous tenorrhaphies. The aim of our retrospective study was to analyze and compare clinical and functional results in patients treated with either the conventional open or minimally invasive suture treatment with the Achillon® system. A retrospective review of 140 patients was performed; 72 were treated with open tenorrhaphy, 68 with the minimally invasive Achillon® suture system. With a comparable re-rupture rate, there was a statistically significant reduction in surgical time, incidence of minor complications, time required to return to sport activities and return to work in the minimally invasive group. Achillon® mini-invasive suture system is a reliable tool for the Achilles tendon ruptures, able to reduce the incidence of soft tissues complications if compared to the classic open tenorrhaphy, while maintaining strength of the suture and leading to superimposed functional outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.
Batıbay, Sefa Giray; Akgül, Turgut; Bayram, Serkan; Ayık, Ömer; Durmaz, Hayati
Prospective randomized controlled trial. This study was designed to compare our new suture anchor technique with conservative management in acute Wehbe-Schneider type I A-B and II A-B mallet fingers. Twenty nine patients who presented to our clinic between 2013 and 2015 were randomized for surgical or conservative treatment. Wehbe-Schneider subtype C fractures were excluded. Fourteen were treated with surgery, and 15 were treated with conservative treatment. Primary outcomes were visual analog scale score, active distal interphalangeal (DIP) joint flexion, return to work, extension deficit and DIP joint degeneration. Follow-up time was 12 months. The mean visual analog scale was 2.0, and return to work was on average in 63.2 days in the surgical group and 1.47 and 53.7 days in the conservative group. Extension deficit was 8.1° in the surgical group and 6.1° in the conservative group. The mean DIP flexion at final follow-up was 54.5° (40-65) in the surgery group and 58.3° (45-70) in the conservative group. DIP joint degeneration was observed with X-rays in 4 patients in surgical group, and none of the patients in the conservative group had DIP degeneration at 1 year after treatment. The therapeutic effectiveness of suture anchor technique was not statistically different from conservative treatment. Subluxation seen after fixation treatment with suture anchors may be due to inadequate anchor fixation. DIP joint degeneration was seen significantly more in the surgical group. Our study suggests that the new suture anchor technique is not superior to conservative treatment. Ib. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
Berk, Thomas A; An, Jella A; Ahmed, Iqbal Ike K
To report the first case of inadvertent cyclodialysis cleft and hypotony requiring surgical repair following ab-interno trabeculotomy (AIT) using the Trabectome device, and the postoperative clinical results following direct suture cyclopexy. A 55-year-old man with hypotonous maculopathy secondary to cyclodialysis cleft inadvertently created 3 years earlier during AIT using the Trabectome device was referred for repair. Direct suture cyclopexy was performed and topical homatropine and dexamethasone drops were prescribed postoperatively. Gonioscopic examination revealed complete cleft closure on postoperative day 1 confirmed by anterior segment optical coherence tomography. At 11 weeks postoperatively, visual acuity had improved from 20/400 to 20/40, with resolution of preoperative macular folds on fundoscopic examination. At 9 months postoperatively, visual acuity had further improved to 20/20 with intraocular pressure stable at 9 mm Hg maintained on travoprost and brimonidine. Inadvertent cyclodialysis cleft from a malpositioned AIT and resultant hypotony is rare and in this case was successfully treated by direct suture cyclopexy.
Büchler Markus W
Full Text Available Abstract Background The closure of the abdomen after median laparotomy is still a matter of debate among surgeons. Further well designed and performed randomised controlled trials determining the optimal method of abdominal fascial closure are needed. Design This is a three armed, multi-centre, intra-operatively randomised, controlled, patient blinded trial. Over 20 surgical departments will enrol 600 patients who are planned for an elective primary abdominal operation. The objective of this study is to compare the frequency of abdominal incisional hernias between two continuous suture techniques with different, slowly absorbable monofilament materials and an interrupted suture using an absorbable braided suture material at one year postoperatively. Conclusion This trial will answer the question whether the continuous abdominal wall closure with a slowly absorbable material with longitudinal elasticity is superior to the continuous suture with a material lacking elasticity and to interrupted sutures with braided thread.
Witt, Bryan L; Hyer, Christopher F
Achilles tendinopathy is a clinical diagnosis characterized as a triad of symptoms including pain, swelling, and impaired performance of the diseased tendon. Achilles tendinopathy is divided into Achilles tendonitis and tendinosis based on histopathological examination. Achilles tendinosis is viewed microscopically as disorganized collagen, abnormal neovascularization, necrosis, and mucoid degeneration. Insertional Achilles tendinosis is a degenerative process of the tendon at the junction of the tendon and calcaneus. This disease is initially treated conservatively with activity modification, custom orthotic devices, heel lifts, and immobilization. After 3 to 6 months of conservative therapy has failed to alleviate symptoms, surgical management is indicated. Surgical management of insertional Achilles tendinosis includes Achilles tendon debridement, calcaneal exostosis ostectomy, and retrocalcaneal bursa excision. In this case series, we present 4 patients who underwent surgical management of insertional Achilles tendinosis with complete tendon detachment. All patients underwent reattachment of the Achilles tendon with the suture bridge technique. The Arthrex SutureBridge(®) (Arthrex, Inc., Naples, FL) device uses a series of 4 suture anchors and FiberWire(®) (Arthrex Inc.) to reattach the Achilles tendon to its calcaneal insertion. This hourglass pattern of FiberWire(®) provides a greater area of tendon compression, consequently allowing greater stability and possible earlier return to weightbearing activities. The patients were followed up for approximately 2 years' duration. There were no intraoperative or postoperative complications. At final follow-up there was no evidence of Achilles tendon ruptures or device failures. All patients were able to return to their activities of daily living without the use of assistive devices. The patients' average visual analog pain scale was 1 (range 0 to 4), and their average foot functional index score was 3.41 (range 0
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.
End-to-side nerve suture (ETSNS) has until recently been extensively researched in the laboratory animal (rat and baboon). Lateral sprouting from an intact nerve into an attached nerve does occur, and functional recovery (sensory and motor) has been demonstrated. We have demonstrated conclusively that ETSNS in the ...
Zuhr, Otto; Akakpo, Dodji Lukas; Hürzeler, Markus
In contemporary reconstructive periodontal and implant surgery, attaining uncomplicated wound healing in the early postoperative healing phase is the key to achieving a successful treatment outcome and is of central interest, from the clinical as well as the scientific perspective. The realization of primary wound healing is the central challenge in most cases. Two of the evidence-based factors that affect postoperative wound healing can be influenced by the surgeon: the blood supply to the surgical site and postoperative wound stability. The surgical suture is a key determinant of whether adequate wound stability is achieved in this context without complicating the course of wound healing by exerting unnecessary trauma or excessive tensile strain on the wound edges. Therefore, the inclusion of anchors in the suturing process that make it possible to achieve the best wound stability possible is often an important key to success. This article provides an overview of the principles of successful wound closure that are relevant to postoperative wound healing in order to equip dentists with the tools needed for the correct, indication-specific selection and performance of surgical suturing techniques in daily practice.
Gurien, Lori A; Wyrick, Deidre L; Smith, Samuel D; Maxson, R Todd
Although this issue remains unexamined, pediatric surgeons commonly use simple interrupted suture for bowel anastomosis, as it is thought to improve intestinal growth postoperatively compared to continuous running suture. However, effects on intestinal growth are unclear. We compared intestinal growth using different anastomotic techniques during the postoperative period in young rats. Young, growing rats underwent small bowel transection and anastomosis using either simple interrupted or continuous running technique. At 7-weeks postoperatively after a four-fold growth, the anastomotic site was resected. Diameters and burst pressures were measured. Thirteen rats underwent anastomosis with simple interrupted technique and sixteen with continuous running method. No differences were found in body weight at first (102.46 vs 109.75g) or second operations (413.85 vs 430.63g). Neither the diameters (0.69 vs 0.79cm) nor burst pressures were statistically different, although the calculated circumference was smaller in the simple interrupted group (2.18 vs 2.59cm; p=0.03). No ruptures occurred at the anastomotic line. This pilot study is the first to compare continuous running to simple interrupted intestinal anastomosis in a pediatric model and showed no difference in growth. Adopting continuous running techniques for bowel anastomosis in young children may lead to faster operative time without affecting intestinal growth. Copyright © 2016 Elsevier Inc. All rights reserved.
Cuéllar, Adrián; Cuéllar, Ricardo; Heredia, Jorge Díaz; Cuéllar, Asier; García-Alonso, Ignacio; Ruiz-Ibán, Miguel Angel
To evaluate the risk of injury to the inferior lateral geniculate artery with two different techniques for lateral meniscus repair. Eight cadaveric knees were used. Inside-out sutures and an all-inside suture device were placed at the most lateral edge of the popliteal hiatus, and 15 and 30 mm anterior to this point. The minimum distances between the sutures and the inferior lateral geniculate artery were measured through a limited lateral arthrotomy. Artery penetration or collapse due to the sutures was also evaluated. The median distance between the sutures and the artery when inserted at the lateral edge of the popliteal hiatus was 1.5 mm (interquartile range: 1.3) for the inside-out technique and 1.5 mm (1.3) for the all-inside technique (differences not significant, n.s.). When the sutures were inserted 15 mm anterior to the popliteal hiatus the distances were 1.0 mm (1.1) and 1.3 mm (1.0) for the inside-out technique and the all-inside technique, respectively (n.s.). When the sutures were inserted 30 mm anterior to the popliteal hiatus the distances were 1.0 mm (1.0) and 1.5 mm (1.0) for the inside-out technique and the all-inside technique, respectively (n.s.). The artery was punctured with two of the inside-out sutures placed 15 mm from the popliteal hiatus, no puncturing occurred in the all-inside technique (n.s.). Tying of the inside-out sutures resulted in obliteration of the artery in four of eight sutures placed at 15 mm from the popliteal hiatus and three of eight sutures at 30 mm; no obliteration of the artery was found using the all-inside device (significant differences, p = 0.002). Although both all-inside and inside-out lateral meniscal repair techniques place sutures very close to the lateral geniculate artery, the inside-out technique is riskier as extra-articular knot tying can cause artery obliteration when suturing the part of the meniscus immediately lateral to the popliteal hiatus. Therefore, all-inside meniscal repair
Yoneda, M; Hayashida, K; Izawa, K; Shimada, K; Shino, K
To manage a difficulty in tying sutures over the infraspinatus fascia when using Caspari's transglenoid multiple suture technique, we developed a new anchoring system using a biodegradable poly-L-lactic acid (PLLA) button and investigated its clinical efficacy in 28 patients who were followed-up for more than 2 years postoperatively (mean, 26.5 months). Twenty-four patients had Bankart lesions and 4 had detachment of the superior glenoid labrum. The mean age at operation was 22.1 years. The PLLA button measured 8 x 8 x 1.2 mm and had two holes. After multiple sutures were inserted by the routine Caspari technique (mean, 7.3 sutures), the sutures were divided into 2 bundles, passed through the holes in the button, and tied over it on the posterior scapular neck under traction. The arm was immobilized in a Velpeau bandage for 3 weeks after Bankart repair and for 1 to 2 weeks after superior labral repair. The results of Bankart repair were excellent in 13 patients, good in 7, and poor in 4 according to Rowe's rating scale (success rate, 83%), while the outcome of superior labral repair was excellent in 3 and good in 1 according to our own criteria. All 4 patients who showed a poor outcome were contact athletes who developed resubluxation postoperatively. There were no complications, but transient damages to the suprascapular nerve occurred in 2 patients. In conclusion, the PLLA button provided simple and secure suture fixation for the Caspari technique.
Ji, Jong-Hun; Shafi, Mohamed; Moon, Chang-Yun; Park, Sang-Eun; Kim, Yeon-Jun; Kim, Sung-Eun
Arthroscopic removal, now the main treatment option, has almost replaced open surgery for treatment of resistant calcific tendinitis. In some cases of chronic calcific tendinitis of the shoulder, the calcific materials are hard and adherent to the tendon. Removal of these materials can cause significant intratendinous tears between the superficial and deep layers of the degenerated rotator cuff. Thus far, there are no established surgical techniques for removing the calcific materials while ensuring cuff integrity. Good clinical results for rotator cuff repair were achieved by using an arthroscopic suture bridge technique in patients with long-standing calcific tendinitis. Intact rotator cuff integrity and recovery of signal change on follow-up magnetic resonance imaging scans were confirmed. This is a technical note about a surgical technique and its clinical results with a review of relevant published reports. © 2013 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.
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.
Ozawa, Hiroko; Yamane, Mio; Inoue, Eisuke; Yoshida-Uemura, Tomoyo; Katagiri, Satoshi; Yokoi, Tadashi; Nishina, Sachiko; Azuma, Noriyuki
To investigate the long-term surgical outcomes of conventional trabeculotomy in eyes with childhood glaucoma in a Japanese population. In this retrospective observational study, we enrolled Japanese patients with childhood glaucoma who underwent a conventional trabeculotomy at least once before age 3 years from 1986 to 2014 in our hospital. One hundred seven eyes of 64 patients (24 girls, 40 boys; mean age, 2.8 ± 5.1 months) were included. Sixty-eight (64%) eyes had primary childhood glaucoma (PCG) and 39 (36%) eyes had secondary childhood glaucoma (SCG). The average numbers of surgical operations performed to treat the two glaucoma types that resulted in significantly (p < 0.001) different surgical success rates were 1.4 ± 0.7 and 2.1 ± 0.8. Statistical analysis showed that eyes with PCG, compared with those with SCG, were successfully treated by one trabeculotomy and up to three trabeculotomies (hazard ratios 6.66 and 4.02, respectively). Age, gender, systemic complications, corneal diameter, corneal edema, and preoperative intraocular pressure did not significantly affect the surgical outcomes. Most eyes with PCG are treatable with a maximum of three trabeculotomies. However, SCG usually is refractory to trabeculotomy, and a more promising surgery must be designed.
Kim, Sae Hoon; Glaser, Diana; Doan, Josh; Chung, Seok Won; Choi, Hye Yeon; Oh, Joo Han; Hargens, Alan R
The purpose of this study was to evaluate the loop security of arthroscopic sliding knots when tension is only applied to the post strand and not the loop strand. Six different locking sliding knots (Weston, Nicky, Roeder, SMC, San Diego, and Dines) were included. Loop securities were evaluated in 2 ways: with a conventional method (equal tension applied to the suture loop) and with a worst-case scenario (WCS) method (only the post strand of the suture loop was tensioned). Differences between test methods were evaluated for significance. To help assess the applicability of each test method, loop-security testing in a cadaveric shoulder was performed with 1 type of knot (SMC). Loop securities with the conventional method versus the WCS method were as follows: 10.74 ± 4.20 N versus 6.90 ± 3.90 N for Weston, 21.25 ± 14.74 N versus 8.73 ± 3.35 N for Nicky, 26.14 ± 15.57 N versus 7.95 ± 4.23 N for Roeder, 42.67 ± 22.96 N versus 8.67 ± 4.33 N for SMC, 52.99 ± 21.36 N versus 18.25 ± 10.58 N for San Diego, and 89.27 ± 27.96 N versus 12.48 ± 3.40 N for Dines (P security of 5.53 ± 6.06 N, which was similar to the WCS setting. The locking mechanism of the sliding knots is maintained when the suture loop is evenly tensioned at both post and non-post strands. When tension is not applied to the non-post strand side, the knots slide more easily and fail at lower loads than previously reported. When surgeons tie locking sliding knots in single-row rotator cuff repair, they should be aware that the knots could fail at much lower loads than previously reported. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Busconi Brian D
Full Text Available Abstract Ankle sprains are very common injuries seen in the athletic and young population. Majority of patients will improve with a course of rest and physical therapy. However, with conservative management about twenty percent of all patients will go on to develop chronic lateral ankle instability. This manuscript describes our detailed surgical technique of a modification to the original Broström procedure using three suture anchors to anatomically reconstruct the lateral ankle ligaments to treat high demand patients who have developed chronic lateral ankle instability. The rationale for this modification along with patient selection and workup are discussed. Both the functional outcomes at the two year follow up along with the complications and the detailed postoperative rehabilitation protocol for the high demand athletes are also presented. This modified Broström procedure is shown in both illustrative format and intra-operative photos.
Nakashizuka, Hiroyuki; Shimada, Hiroyuki; Iwasaki, Yutaka; Matsumoto, Yoko; Sato, Yukihiro
We describe a modified intraocular cow-hitch technique for pars plana suture fixation of intraocular lenses (IOLs) that dislocated into the vitreous cavity in 3 patients who had a 3-port vitrectomy and IOL implantation because of retinal disease. To reposition the dislocated IOL after the residual vitreous was removed, 2 additional sclerotomies for suture fixation were made 3.0 mm posterior to the limbus. A loop (cow-hitch knot) was made with 10-0 polypropylene for suture fixation. After the neck of the cow-hitch loop was grasped with an intraocular forceps, the loop was used to lasso a haptic of the dislocated IOL, which was then pulled forward to the sclerotomy. The same procedure was used for the other haptic, and both sutures were secured to the sclera under scleral flaps. In all patients, the dislocated IOLs were repositioned without the need for extraction. The procedures were uneventful. Pars plana suture fixation with the intraocular cow-hitch technique can be used to reposition an IOL that has dislocated into the vitreous cavity.
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.
Engel, M.; Freudlsperger, C.; Hoffmann, J.; Muhling, J.; Castrillon-Oberndorfer, G.; Seeberger, R.
Fusion of the sagittal suture is the most prevalent form of craniosynostosis. Due to the variety of deformities of scaphocephaly depending on the location of the fused sagittal suture, the surgical procedure has to be adjusted to the individual case. In this study, 38 patients with a predominantly
Nakasato, Houmei; Uemoto, Riyo; Isozaki, Masaru; Meguro, Akira; Kawagoe, Tatsukata; Mizuki, Nobuhisa
To describe a new technique to perform trabeculotomy ab interno on eyes with open-angle glaucoma (OAG). This was a retrospective study. We inserted a 25-gauge forceps that is usually used for internal limiting membrane peeling into the anterior chamber, and grasped and pulled the inner wall of Schlemm's canal away from the canal. The inner wall of Schlemm's canal was stripped for about 100° to 120° in 26 eyes of 23 patients. The intraocular pressure (IOP) and number of glaucoma medications were recorded before, and 1 day, 1 week, 2 weeks, and 1, 3, 6, 10, 12, 15, 17, 19, 24, 27, 30, and 33 months after the surgery. The intra- and postoperative complications were recorded. The mean ± standard deviation of the preoperative IOP was 20.0 ± 6.8 mmHg with a range from 10 to 38 mmHg (n = 26). The IOP was significantly reduced (P interno for OAG is effective but with some minor complications. A larger number of patients with longer follow-up periods are needed to determine the long-term effectiveness of this procedure.
Kaya, Baris; Guralp, Onur; Tuten, Abdullah; Unal, Orhan; Celik, Melih Ozgur; Dogan, Askın
To evaluate various aspects of two popular uterine sparing techniques, the B-Lynch uterine compression suture and Bakri balloon tamponade, in severe postpartum hemorrhage (PPH). 21 women who underwent the Bakri balloon procedure and 24 women who underwent the B-Lynch suture as primary uterus-sparing methods, due to PPH not responding to medical treatment, were retrospectively evaluated. The success rates of the B-Lynch procedure and the Bakri balloon were 79.1 and 80 %, respectively. The success rates of the B-Lynch + IIAL and the Bakri balloon + IIAL were 91.6 and 95 %, respectively. There was no significant difference in success rates, mean duration of time to stop bleeding, estimated blood loss, transfused packed red blood cells or mean duration of hospital stay between the B-Lynch and the Bakri balloon groups. The duration of operation was significantly longer in the Bakri balloon compared to the B-Lynch group (p = 0.01). In our study, the Bakri balloon and the B-Lynch suture had similar success rates in uterine atony during CS. The advantages of the B-Lynch suture include rapid application with no need for lithotomy position or extra material; whereas the Bakri balloon is less invasive and easier to learn, but more time consuming and expensive compared to the B-Lynch suture. We suggest that the B-Lynch suture may be preferred in uterine atony during CS in low resource settings; however, the less invasive Bakri balloon should be the first line in full resource settings. Further studies are needed to evaluate the advantages and disadvantages of the two methods.
Otoni Moreira Gomes
Full Text Available PURPOSE: To report two new suture techniques for best esthetic skin healing. METHODS: Using the pig skin slices routinely employed for surgical technique training two new types of skin sutures were performed. One defined as inverted or hidden X point suture and other as totally hidden intradermal running suture. The first were performed using 4-0 polypropilene stitch and the intradermal with 4-0 poliglicolic stitch. RESULTS: It was confirmed good skin layers union and contention with best esthetic result than observed with the traditional X and intradermal suture techniques. CONCLUSION: Macroscopic examination of the hidden X point and totally hidden intra-dermal sutures and centrifuge skin traction confirmed good skin layers union and contention with best esthetic result than observed with the traditional X and intradermal sutures techniques.OBJETIVO: Apresentar dois novos tipos de suturas para melhor resultado estético na cicatrização da pele. METODOS: Utilizando fragmentos de pele de porco rotineiramente empregados no ensino e treinamento de técnica operatória, dois novos tipos de suturas da pele foram desenvolvidos. Um deles definido como sutura com pontos em X invertidos ou ocultos e outro como sutura intradérmica totalmente oculta. A primeira foi realizada com fio de polipropileno 4-0, e a intradérmica oculta com fio poliglicólico 4-0. RESULTADOS: Foram confirmados contenção e união adequada das camadas da pele com melhores resultados estético do que observados com as suturas tradicionais em X e intradémica. CONCLUSÃO: A análise macroscópica das suturas com pontos em X oculto e intradermica totalmente oculta e a tração centrífuga da bordas suturadas confirmaram boa união das camadas da pele com melhor resultado estético do que observado com as suturas em X e intradérmicas tradicionais.
Ankyloglossia or “tongue‑tie” is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using ...
Lanier, Steven T; Dumanian, Gregory A; Jordan, Sumanas W; Miller, Kyle R; Ali, Nada A; Stock, Stuart R
BACKGROUND:A new closure technique is introduced, which uses strips of macroporous polypropylene mesh as a suture for closure of abdominal wall defects due to failures of standard sutures and difficulties with planar meshes...
Gil, Joseph A; Chambers, Alison; Shah, Kalpit N; Crisco, Joseph J; Got, Christopher; Akelman, Edward
A complete thumb ulnar collateral ligament (UCL) repaired with 1-suture anchor has been demonstrated to be significantly weaker compared with the intact UCL. The objective of this study is to test the biomechanical strength of a 2-anchor thumb UCL repair. Nine paired fresh-frozen hands were used for this biomechanical analysis. One thumb from each pair was randomized to the control group and one to the repair group. In the control group, the UCL was loaded to failure in tension. In the repair group, the UCL was dissected off of the proximal phalanx, subsequently repaired with a 2-anchor technique, and then tested to failure. The mean yield load was 342 N (95% confidence interval [CI], 215-470 N) in the control group and 68 N (95% CI, 45-91 N) in the repair group. The mean maximum load at failure was 379 N (95% CI, 246-513 N) in the control group and 84 N (95% CI, 62-105 N) in the repair group. The mean stiffness was 72 N/m (95% CI, 48-96 N/m) in the control group and 17 N/m (95% CI, 13-21 N) in the repair group. The mean displacement at failure was 7.8 mm (95% CI, 7-9 mm) in the control group and 7.8 mm (95% CI, 7-9 mm) in the repair group. The 2-anchor repair technique we tested does not acutely reestablish the strength of the insertion of the native insertion of the UCL with this technique.
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.
Crusco, Salvatore; Jackson, Tiffany; Advincula, Arnold
Robot-assisted laparoscopic surgery is often taught with the surgical mentor at the surgeon console and the trainee at the patient's bedside. The da Vinci dual console (Intuitive Surgical, Sunnyvale, California) allows a surgical mentor to teach with both the mentor and the trainee working at a surgeon console simultaneously. The purpose of this study is to evaluate the effectiveness of the dual console versus the single console for teaching medical students robotic tasks. Forty novice medical students were randomized to either the da Vinci single-console or dual-console group and were taught 4 knot-tying techniques by a surgical mentor. The students were timed while performing the tasks. No statistically significant differences in mean task times were observed between the single- and dual-console groups: interrupted stitch with a 2-handed knot (300 seconds for single vs 294 seconds for dual, P=.59), interrupted stitch with a 1-handed knot (198 seconds for single vs 212 seconds for dual, P=.88), figure-of-8 stitch with a 2-handed knot (261 seconds for single vs 219 seconds for dual, P=.20), and figure-of-8 stitch with a 1-handed knot (200 seconds for single vs 199 seconds for dual, P=.53). No significant difference was observed in performance time when teaching knot-tying techniques to medical students using the da Vinci dual console compared with the single console. More research needs to be performed on the utility of the da Vinci dual console in surgical training.
Grover, Davinder S; Smith, Oluwatosin; Fellman, Ronald L; Godfrey, David G; Butler, Michelle R; Montes de Oca, Ildamaris; Feuer, William J
To introduce a novel ab interno 360° trabeculotomy for treating primary congenital glaucoma (PCG) and juvenile open angle glaucoma (JOAG) and report preliminary results. A retrospective chart review of patients who underwent a gonioscopy assisted transluminal trabeculotomy (GATT) procedure by four of the authors (DSG, OS, RLF and DGG) between October 2011 and October 2013. The surgery was performed in patients ≤30 years old with a dysgenic anterior segment angle and uncontrolled PCG and JOAG. Fourteen eyes of 10 patients underwent GATT with follow-up >12 months (12-33 months; mean 20.4). Patients ranged in age from 17 months to 30 years (mean=18.4 years), and five (50%) were female patients. No complications occurred during or following surgery except for early postoperative hyphema in five (36%) of eyes, all cleared by 1 month. The mean intraocular pressure (IOP) decreased from 27.3 to 14.8 mm Hg and the mean number of medications required decreased from 2.6 to 0.86. Five eyes had a drop in IOP ≥15 mm Hg (range 15-39). The preliminary results and safety for GATT, a minimally invasive conjunctival sparing circumferential trabeculotomy, are promising and at least equivalent to previous results for ab externo trabeculotomy for the treatment of PCG and JOAG. All eyes in the study were considered a clinical success. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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.
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
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
Mansouri, Kaweh; Medeiros, Felipe A; Weinreb, Robert N
We report the results of repeated ambulatory continuous 24-hour intraocular pressure (IOP) monitoring with a contact lens sensor (CLS) in a glaucoma patient with ocular pain after ab interno trabeculotomy (Trabectome™) surgery. Our findings show that a combined prostaglandin-pilocarpine treatment reduced nighttime IOP peaks and relieved the patient's symptoms.
Ahuja, Yachna; Malihi, Mehrdad; Sit, Arthur J
To describe patients who have experienced delayed-onset hyphema after ab interno trabeculotomy surgery with the Trabectome (Neomedix Corp) for open-angle glaucoma. Retrospective case series. study population: Patients at Mayo Clinic, Rochester, Minnesota, who underwent Trabectome surgery between September 1, 2006, and December 31, 2010, and who had symptomatic hyphema at least 2 months after surgery. observation procedure: Patients with blurred vision at least 2 months after Trabectome surgery were examined for the presence of hyphema using a slit lamp and gonioscopy. main outcome measures: Proportion of patients experiencing delayed-onset symptomatic hyphema after Trabectome surgery. Associated factors and clinical course for these patients. Of 262 cases of Trabectome surgery, there were 12 cases of delayed-onset symptomatic hyphema (4.6%). The average age was 74.3 years (range, 66 to 82 years). Median time to onset of hyphema was 8.6 months (range, 2 to 31 months) after surgery. Symptom onset commonly occurred on awakening. The most common characteristic was maintaining a sleep position on the surgical side. Most hyphemas resolved within 1 to 2 weeks, except in 1 patient, who required trabeculectomy for a refractory intraocular pressure spike. This is a series of patients with symptomatic delayed-onset hyphema after Trabectome surgery in the absence of further surgeries or trauma. Likely mechanisms are exertion-related increase in episcleral venous pressure or ocular compression from sleeping on the surgical side, followed by sudden decompression and blood reflux. Symptomatic patients should identify and avoid associated triggers because delayed-onset hyphema may be associated with intermittent intraocular pressure spikes that may require medical or surgical treatment. Copyright © 2012 Elsevier Inc. All rights reserved.
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.
Nihalani, B R; Hunter, D G
Surgical management of strabismus remains a challenge because surgical success rates, short-term and long-term, are not ideal. Adjustable suture strabismus surgery has been available for decades as a tool to potentially enhance the surgical outcomes. Intellectually, it seems logical that having a second chance to improve the outcome of a strabismus procedure should increase the overall success rate and reduce the reoperation rate. Yet, adjustable suture surgery has not gained universal acceptance, partly because Level 1 evidence of its advantages is lacking, and partly because the learning curve for accurate decision making during suture adjustment may span a decade or more. In this review we describe the indications, techniques, and published results of adjustable suture surgery. We will discuss the option of ‘no adjustment' in cases with satisfactory alignment with emphasis on recent advances allowing for delayed adjustment. The use of adjustable sutures in special circumstances will also be reviewed. Consistently improved outcomes in the adjustable arm of nearly all retrospective studies support the advantage of the adjustable option, and strabismus surgeons are advised to become facile in the application of this approach. PMID:21760626
Nozaki, Kenji; Mori, Ryuji; Ryoke, Koji; Uchio, Yuji
For secure tendon repair, while core suture materials have been previously investigated, the optimum material for peripheral sutures remains unclear. Transected bovine gastrocnemius tendons were repaired by 2-strand side-locking loop technique using no.2 braided polyblend polyethylene thread for the core suture. Then, 8-strand peripheral cross-stitches were added using either 2-0 rigid sutures (braided polyblend polyethylene) or USP 2-0-sized elastic sutures (nylon). The holding area of each peripheral suture was set at either 3 × 1 mm (shallow holding) or 6 × 2 mm (deep holding). Therefore, 4 groups were compared (the shallow-rigid, deep-rigid, shallow-elastic, and deep-elastic groups). The gap formation, ultimate tensile strength, and suture migration state were measured after 500 cyclic loadings (from 10 to 200 N). The shallow-rigid group had inferior outcomes compared to the other groups. Although the deep-rigid group had the smallest gap and highest ultimate strength, all peripheral sutures had failure prior to core suture rupture. The two elastic groups showed no significant differences, irrespective of the size of the holding area. Suture migration did not occur in the two elastic groups until the ultimate strength was reached and the core suture ruptured. Depending on the suturing method, rigid suture material may not be appropriate for peripheral sutures, when accompanying rigid core suture material. If peripheral sutures can be made with accurate deep holding, rigid suture material will provide favorable outcome. However, in other cases, elastic suture material is considered best for supporting a rigid core suture, as elasticity is another important factor for peripheral sutures. Copyright © 2011 Elsevier Ltd. All rights reserved.
Johnson, Timothy S.; DiPompeo, Christine M.; Ismaeli, Zahra C.; Porter, Polly A.; Nicholson, Shannon L.; Johnson, David C.
Recurrent shoulder instability often leads to labral abnormality that requires surgical intervention that may require fixation with suture anchors. The proposed surgical technique allows the surgeon to achieve 2 points of fixation around the labrum and/or capsule with a single suture secured to the glenoid with a knotless anchor. Instead of cutting and discarding the residual suture limbs after anchor insertion, this technique uses the residual suture limbs of the knotless anchor for a second...
Hu, Chang-Yong; Lee, Keun-Bae; Song, Eun-Kyoo; Kim, Myung-Sun; Park, Kyung-Soon
The modified Broström procedure is frequently used to treat chronic lateral ankle instability. There are 2 common methods of the modified Broström procedure, which are the bone tunnel and suture anchor techniques. To compare the clinical outcomes of the modified Broström procedure using the bone tunnel and suture anchor techniques. Cohort study; Level of evidence, 2. Eighty-one patients (81 ankles) treated with the modified Broström procedure for chronic lateral ankle instability constituted the study cohort. The 81 ankles were divided into 2 groups, namely, a bone tunnel technique (BT group; 40 ankles) and a suture anchor technique (SA group; 41 ankles). The Karlsson score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, anterior talar translation, and talar tilt angle were used to evaluate clinical and radiographic outcomes. The BT group consisted of 32 men and 8 women with a mean age of 34.8 years at surgery and a mean follow-up duration of 34.2 months. The SA group consisted of 33 men and 8 women with a mean age of 33.3 years at surgery and a mean follow-up duration of 32.8 months. Mean Karlsson scores improved significantly from 57.0 points preoperatively to 94.9 points at final follow-up in the BT group and from 59.9 points preoperatively to 96.4 points at final follow-up in the SA group. Mean AOFAS scores also improved from 64.2 points preoperatively to 97.8 points at final follow-up in the BT group and from 70.3 points preoperatively to 97.4 points at final follow-up in the SA group. Mean anterior talar translations in the BT group and SA group improved from 9.0 mm and 9.2 mm preoperatively to 6.5 mm and 6.8 mm at final follow-up, respectively. Mean talar tilt angles were 12.0° in the BT group and 12.5° in the SA group preoperatively and 8.8° at final follow-up for both groups. No significant differences were found between the 2 groups in terms of the Karlsson score, AOFAS score, anterior talar translation, and talar tilt
Okubo, Hirotaka; Kusano, Nozomu; Kinjo, Masaki; Kanaya, Fuminori
In multi-strand suture methods consisting of several suture rows, the different length of core suture purchase between each suture row may affect the strength of repairs. We evaluated the influence of the different length of core suture purchase between each suture row on the strength of 6-strand tendon repairs. Rabbit flexor tendons were repaired by using a triple-looped suture technique in which the suture purchase length in each suture row was modified. Group 1, all lengths are 8-mm. Group 2, all lengths are 10-mm. Group 3, two are 10-mm and one is 8-mm. Group 4, one is 10-mm and two are 8-mm. The repaired tendons were subjected to load-to-failure test. The gap strength was significantly greater in Group 1 and Group 2 than in Group 3 and Group 4. This study demonstrates that maintaining equal core suture purchase lengths of each suture row increases the gap resistance.
Full Text Available Objective: The aim of this study was to evaluate the clinical results and re-rupture rate of single row suture anchor repair with mini open surgical technique, in the treatment of full thickness rotator cuff tear. Methods: Patients with full thickness rotator cuff tears were included. Single row suture anchor technic with mini-open approach was used for treatment. The mean follow-up period was 9.8 months. The preoperative and postoperative functional and clinical status of patients was evaluated by UCLA (University of California at Los Angeles and Constant scoring systems. The re-rupture of the rotator cuff was detected by MRI (Magnetic Resonance Imaging at the last control. Preoperative and postoperative datas were compared to each other. Results: Twenty-three patients, (13 male, 10 female were included. The mean age was 52 years (range 18 to 68 years. At the pre-operative evaluation, the mean results of UCLA score was 11.7, the Constant scores was 26.83 whereas the postoperative scores were found as 29.91, 82.04, respectively. The increases in these scores at the postoperative period were statistically significant (p<0.05. 95% of patients declared that they were satisfied with the treatment. In the control MRI (Magnetic Resonance Imaging only one re-rupture was detected. Conclusion: the results of this study has shown that in the treatment of full thickness rotator cuff tear, mini open, single row suture anchor technique has good clinical results and re-rupture is seen very rarely.
Full Text Available Introduction. Intraoperative observation of ocular structures using microscope-integrated optical coherence tomography (iOCT has been adopted recently. I report my initial feasibility assessment of iOCT for the incised trabecular meshwork observation during microhook ab interno trabeculotomy. Case Series. Both the nasal and temporal sides or either side of the trabecular meshwork/inner wall of Schlemm’s canal was incised more than 3 clock hours. After then, under observation using a Swan-Jacob gonioprism lens with the real-time 5-line scan mode, OCT images of the area were successfully acquired in 10 (83% of 12 sides in nine eyes. Based on the appearance of the acquired images of the 10 sides, the trabeculotomy cleft could be classified into three incisional patterns, that is, six (60% anterior-opening patterns (posterior-based flap, three (30% middle-opening patterns (posterior- and anterior-based flaps, and one (10% posterior-opening pattern (anterior-based flap, according to the predominant locations of the trabecular meshwork flaps. Conclusion. Intraoperative observation of the gonio structures including the trabeculotomy cleft was feasible using the RESCAN 700 in combination with a gonioprism.
Intraoperative observation of ocular structures using microscope-integrated optical coherence tomography (iOCT) has been adopted recently. I report my initial feasibility assessment of iOCT for the incised trabecular meshwork observation during microhook ab interno trabeculotomy. Both the nasal and temporal sides or either side of the trabecular meshwork/inner wall of Schlemm's canal was incised more than 3 clock hours. After then, under observation using a Swan-Jacob gonioprism lens with the real-time 5-line scan mode, OCT images of the area were successfully acquired in 10 (83%) of 12 sides in nine eyes. Based on the appearance of the acquired images of the 10 sides, the trabeculotomy cleft could be classified into three incisional patterns, that is, six (60%) anterior-opening patterns (posterior-based flap), three (30%) middle-opening patterns (posterior- and anterior-based flaps), and one (10%) posterior-opening pattern (anterior-based flap), according to the predominant locations of the trabecular meshwork flaps. Intraoperative observation of the gonio structures including the trabeculotomy cleft was feasible using the RESCAN 700 in combination with a gonioprism.
Ettinger, Max; Dratzidis, Antonios; Hurschler, Christof; Brand, Stephan; Calliess, Tilman; Krettek, Christian; Jagodzinski, Michael; Petri, Maximilian
Ruptures of the patellar tendon are debilitating injuries requiring surgical repair. Reliable data about the most appropriate suture technique and suture material are missing. The standard procedure consists of refixing the tendon with sutures in transpatellar tunnels, sometimes combined with augmentation. Suture anchors provide at least equal results concerning gap formation during cyclic loading and ultimate failure load compared with transosseous suture repair. Controlled laboratory study. A total of 30 human cadaveric patellar tendons underwent tenotomy followed by repair with 5.5-mm titanium suture anchors, 5.5-mm resorbable hydroxyapatite suture anchors, or transpatellar suture tunnels with No. 2 Ultrabraid and the Krackow whipstitch technique. Biomechanical analysis included pretensioning the constructs at 20 N for 30 seconds and then cyclic loading of 250 cycles between 20 and 100 N at 1 Hz in a servohydraulic testing machine with measurement of elongation. After this, ultimate failure load and failure mode analysis was performed. Compared with transosseous sutures, tendon repairs with suture anchors yielded significantly less gap formation during cyclic loading (P suture anchor in the hydroxyapatite anchor group and rupture of the suture in the titanium anchor group and-at lower load to failure-in the transosseous group. Patellar tendon repair with suture anchors yields significantly better biomechanical results than repair with the commonly applied transosseous sutures. These findings may be of relevance for future clinical treatment of patellar tendon ruptures. Randomized controlled clinical trials comparing suture anchors to transosseous suture repair are desirable.
Cho, Byung-Ki; Kim, Yong-Min; Kim, Dong-Soo; Choi, Eui-Sung; Shon, Hyun-Chul; Park, Kyoung-Jin
This prospective, randomized study was conducted to compare clinical outcomes of the modified Broström procedure using suture anchor or transosseous suture technique for chronic ankle instability. Forty patients were followed for more than 2 years after modified Broström procedure. Twenty procedures using a suture anchor and 20 procedures using a transosseous suture were performed by one surgeon. The clinical evaluation consisted of the Karlsson scale and the Sefton grading system. Talar tilt and anterior talar translation were measured on anterior and varus stress radiographs. The Karlsson scale had improved significantly to 90.8 points in the suture anchor group, and to 89.2 points in the transosseous suture group. According to Sefton grading system, 18 patients (90%) in suture anchor group and 17 patients (85%) in transosseous suture group achieved satisfactory results. The talar tilt angle and anterior talar translation improved significantly to 5.9 degrees and 4.2 mm in suture anchor group, and to 5.4 degrees and 4.1 mm in transosseous suture group, respectively. No significant differences existed in clinical and functional outcomes between the two techniques for ligament reattachment. Both modified Broström procedures using the suture anchor and transosseous suture seem to be effective treatment methods for chronic lateral ankle instability.
Full Text Available OBJECTIVE: In this work, we attempted to develop a modified single-knot Kessler-loop lock suture technique and compare the biomechanical properties associated with this single-knot suture technique with those associated with the conventional modified Kessler and interlock suture techniques. METHODS: In this experiment, a total of 18 porcine flexor digitorum profundus tendons were harvested and randomly divided into three groups. The tendons were transected and then repaired using three different techniques, including modified Kessler suture with peritendinous suture, interlock suture with peritendinous suture, and modified Kessler-loop lock suture with peritendinous suture. Times required for suturing were recorded and compared among groups. The groups were also compared with respect to 2-mm gap load, ultimate failure load, and gap at failure. RESULTS: For tendon repair, compared with the conventional modified Kessler suture technique, the interlock and modified Kessler-loop lock suture techniques resulted in significantly improved biomechanical properties. However, there were no significant differences between the interlock and modified Kessler-loop lock techniques with respect to biomechanical properties, gap at failure, and time required. CONCLUSIONS: The interlock and modified Kessler-loop lock techniques for flexor tendon sutures produce similar mechanical characteristics in vitro.
Suán, C; Cerro, J; Ojeda, R; García-Perla, J L
Any patient with congenital heart disease is at high risk for anesthesia no matter what surgical procedure is performed. Children undergoing D-transposition of the great arteries using Jatene's technique present stenosis of the pulmonary artery in 10-20% of cases and may require surgery to correct that or some other surgically caused anomally. In either case the children must be managed as patients with heart disease, with special attention to cardiovascular depression and rhythm abnormalities. We report the cases of two children who underwent D-transposition of the great arteries in the neonatal period using Jatene's anatomical technique. They were later anesthetized at ages 5 and 6 years to correct pulmonary suture stenosis. Recovery was good.
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.
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
Objective: Analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. Methods: The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand breed (Oryctolagus cuniculus) were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). For the flexor tendons of the hind paws, sterile and driven techniques were used in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). Results: In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6- strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands) (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15th day and in 66.7% on the 30th day, making the biological tissue stronger and more resistant (p=0.095). Conclusion: This study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques
Sapienza, John S; Mayordomo, Aloma; Beyer, Anne M
To evaluate a rapid and efficacious procedure to anchor the prolapsed gland of the third eyelid in dogs. This is a retrospective study of 100 affected dogs (122 eyes) with third eyelid gland prolapse that were surgically anchored with a nonabsorbable suture around the insertion of the ventral rectus muscle. Hundred dogs (122 eyes) were included in this study. Twenty-three pure-bred and several mixed-breed dogs were represented with the right eye affected in 60 cases and the left eye in 62 cases. Thirty-four eyes (27.9%) were previously operated on at another facility prior to referral. The average age of the patients was 2.2 years (57 days to 11 years). No recurrences of gland prolapse were observed over the course of study. Minor intraoperative conjunctival perforations were observed and easily repaired at the time of the surgery in 21 cases (17.2%). Five cases demonstrated preexistent keratoconjunctivitis sicca (KCS), and all had improved Schirmer tear test following surgical correction and medical therapy. The suture anchor placement technique provides a cosmetic, rapid, and successful replacement of the prolapsed gland of the third eyelid in dogs. No recurrences were noted. Complications were easily addressed. © 2013 American College of Veterinary Ophthalmologists.
Kindberg, Sara; Misan, Stehouwer; Hvidman, Lone
interviews and systematic assessment of perineal healing was performed by research midwives blinded to treatment allocation at 24 to 48 hours, ten days and six months postpartum. Pain was evaluated using a Visual Analogue Scale and the McGill Pain Questionnaire. Wound healing was evaluated using the REEDA...... scale and by assessment of gaping wounds >0.5 cm. Analysis complied with the intention-to-treat principle. Main Outcome measures The primary outcome was perineal pain ten days after delivery. Secondary outcomes were wound healing, patient satisfaction, dyspareunia, need for resuturing, time elapsed...... during repair and amount of suture material used. Results 400 women were randomised; five withdrew consent leaving 395 for follow-up. The follow-up rate was 98% for all assessments after delivery. No difference was seen in perineal pain ten days after delivery. No difference was seen in wound...
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.
Khan, Michelle; Saheb, Hady; Neelakantan, Arvind; Fellman, Ronald; Vest, Zachary; Harasymowycz, Paul; Ahmed, Iqbal Ike K
To compare the outcomes of combined cataract surgery with trabecular microbypass stents and ab interno trabeculotomy in patients with open-angle glaucoma. University of Toronto, Toronto, Ontario, and University of Montreal, Montreal, Quebec, Canada, and Glaucoma Associates of Texas, Dallas, Texas, USA. Retrospective case series. Patients with primary open-angle, pseudoexfoliative, or pigmentary dispersion glaucoma were included. Primary outcome measures were intraocular pressure (IOP), postoperative medications, success (IOP ≤18 mm Hg, no glaucoma medications or reoperations), and postoperative adverse events. The average patient age was 76.5 years ± 12 [SD]. Forty-nine eyes had phacoemulsification and 2 had stent implantations; 52 eyes had phacoemulsification and trabeculotomy surgery with a 12-month postoperative follow-up. The analysis of variance indicated a significant reduction in mean IOP from baseline to 12 months for stent (19.6 ± 5.3 mm Hg to 14.3 ± 3.1 mm Hg; P < .001) and trabeculotomy (20.6 ± 6.8 mm Hg to 17.3 ± 6.5 mm Hg; P < .001) and lower mean IOP at 12 months in the stent group (P = .01). The median number of glaucoma medications decreased from baseline to 12 months in both groups and was lower in the stent group at 3, 6, and 12 months. Thirty-nine percent (19 eyes) in the stent group and 14% (7 eyes) in the trabeculotomy group achieved success at 12 months (P = .006). The incidence of hyphema was lower in the stent group (P = .008). Both types of surgery achieved a significant reduction in IOP and medication use at 12 months, with the stent group achieving higher success and a reduced incidence of postoperative hyphema. Dr. Ahmed is a consultant to and investigator for Glaukos Corp., Ivantis, Inc., Transcend Medical, Inc., and Aquesys, Inc., and has received speaker honoraria from Neomedix, Inc. Dr. Saheb has received travel funding from Glaukos Corp., Ivantis, Inc., and Transcend Medical, Inc., and a research grant from Ivantis, Inc. Dr
Full Text Available Purpose: To establish the safety and efficacy of simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma. Methods: We studied 109 consecutive patients who underwent planned simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma by a single surgeon from January 1990 through December 1999. The main outcome measures were postoperative intraocular pressure (IOP, corneal clarity and diameter, visual acuity, bleb characteristics, time of surgical failure and complications. Postoperative complications including endophthalmitis and anaesthetic morbidity and mortality were also analysed. Results: The series consisted of 218 primary combined trabeculotomy-trabeculectomy surgeries during 109 anaesthesias. The mean follow-up period was 16.33 ± 16.22 months. The IOP reduced from 26.4 ± 5.9 mmHg to 13.5 ± 4.5 mmHg, with a mean percentage reduction of 46.2 ± 23.7 (P < 0.0001. The success (IOP < 16 mmHg probabilities were 90.9%, 88.0% and 69.3% at first, second and third year respectively (Kaplan-Meier analysis. The success probability of 69.3% obtained at third year was maintained till 6 years of follow-up. One hundred and sixty six (76.1% eyes had significant corneal oedema. Postoperatively, the cornea cleared in 93 (57.8 % eyes. Clinically, well functioning blebs were present in 114 of 171 eyes (66.6%. Postoperatively, 18 (8.3% eyes developed shallow anterior chamber and 6 (33.3% of them required surgical reformation. There was no incidence of endophthalmitis or any other sight-threatening complication. Of the anesthetic complications, apnea occurred in 17 (15.6% patients and all were successfully resuscitated. The most serious post-anaesthetic complication was cardio-pulmonary arrest that occurred 5 hours postoperatively following aspiration during feeding in one child; this child could not be resuscitated. Two children had delayed recovery (2 and 4 hours respectively. The
Lanier, Steven T.; Jordan, Sumanas W.; Miller, Kyle R.; Ali, Nada A.; Stock, Stuart R.
Background: A new closure technique is introduced, which uses strips of macroporous polypropylene mesh as a suture for closure of abdominal wall defects due to failures of standard sutures and difficulties with planar meshes. Methods: Strips of macroporous polypropylene mesh of 2 cm width were passed through the abdominal wall and tied as simple interrupted sutures. The surgical technique and surgical outcomes are presented. Results: One hundred and seven patients underwent a mesh sutured abdominal wall closure. Seventy-six patients had preoperative hernias, and the mean hernia width by CT scan for those with scans was 9.1 cm. Forty-nine surgical fields were clean-contaminated, contaminated, or dirty. Five patients had infections within the first 30 days. Only one knot was removed as an office procedure. Mean follow-up at 234 days revealed 4 recurrent hernias. Conclusions: Mesh sutured repairs reliably appose tissue under tension using concepts of force distribution and resistance to suture pull-through. The technique reduces the amount of foreign material required in comparison to sheet meshes, and avoids the shortcomings of monofilament sutures. Mesh sutured closures seem to be tolerant of bacterial contamination with low hernia recurrence rates and have replaced our routine use of mesh sheets and bioprosthetic grafts. PMID:27757361
Alekseev, B N; Ermolaev, A P
We made a total of 96 surgeries of extracapsular cataract extraction and IOL implantation combined with trabeculotomy ab interno during a period of 7 years. Patients with both open-angle and narrow-angle glaucoma of stages I and II and with the intraocular pressure (IOP) below or equal to 23 mm Hg according to Goldman under the conditions of hypotensive medicamental regimen were selected for surgery. After IOL was implanted into the lens bag, trabeculotomy ab interno was implemented as stage 2. A special mirror, introduced through the cataract incision, was used for direct gonioscopic monitoring. The trabecula was incised by the edge of a curved surgical knife under direct visual control. We regarded bleeding from the opened sinus as a favorable sign indicative of that the intrascleral collectors were intact. Only minor hyphemas were registered as postoperative complications; there was not a single case of ciliary-and-choroidal detachment. IOP was compensated for, in 6 months after surgery, in 94% of patients--69.8% of them did not use any hypotensive drops.
Chipont Benabent, E; Artola Roig, A; Martínez Toldos, J J
Proper wound closure is important in preventing postoperative endophthalmitis. We developed an intrastromal corneal suture technique that uses some principles of the running, locked, intradermal suture for light-tension skin wounds. It achieves close approximation of the wound edges, reduces postoperative wound care and the risk of wound infection in clean surgical wounds, and obviates suture removal. It may also help prevent endophthalmitis and early against-the-rule astigmatism without the complications associated with external suture exposure.
Chacon, Anna H; Shiman, Michael I; Strozier, Narissa; Zaiac, Martin N
Using the combination of a horizontal running mattress suture with intermittent loops achieves both good eversion with the horizontal running mattress plus the ease of removal of the simple loops. This combination technique also avoids the characteristic railroad track marks that result from prolonged non-absorbable suture retention. The unique feature of our technique is the incorporation of one simple running suture after every two runs of the horizontal running mattress suture. To demonstrate its utility, we used the suturing technique on several patients and analyzed the cosmetic outcome with post-operative photographs in comparison to other suturing techniques. In summary, the combination of running horizontal mattress suture with simple intermittent loops demonstrates functional and cosmetic benefits that can be readily taught, comprehended, and employed, leading to desirable aesthetic results and wound edge eversion.
De Bernardis, Gaston; Mayr, Johannes
The aim of the study was to present the first case of replacement of a string jejunostomy with an enteroscopic percutaneous technique after the string was lost. The replaceable string jejunostomy is a well-established method for the enteral feeding in patients where the swallowing process is impaired and gastroesophageal reflux impedes the option of a gastrostomy. In the frequent case of obstruction, rupture or malfunction of the jejunostomy, it is easily replaced in an outpatient setting without anesthesia, with the help of the string that holds the tip of the feeding tube in place. In our case the string was lost. The jejunostomy was replaced with a fully percutaneous technique with the help of a pediatric cystoscope. This technique is well practicable and obviated the need for a laparotomy in a polymorbid patient. The technique seems promising, but we report an anecdotal case description. Further experience is needed to investigate its safety.
Uslu, M; Isik, C; Ozsahin, M; Ozkan, A; Yasar, M; Orhan, Z; Erkan Inanmaz, M; Sarman, H
Surgeons have aimed to achieve strong repair so as to begin early active rehabilitation programs for flexor tendon injury. Multi-strand suture techniques were developed to gain improved gap resistance and ultimate force compared with the respective two-strand techniques. In vivo studies indicate that multiple strands may cause ischemia during the intrinsic healing process by decreasing the total cross-sectional area of the injured site, unless the total cross-sectional area of the sutures is not decreased. The hypothesis was to design an in vitro study to understand the biomechanical relationship between suture calibers of core sutures with increased number of suture strands and peripheral suture on final repair strength. Sixty fresh sheep forelimb flexor digitorum profundus tendons were randomly placed into three groups (A, B, and C), each containing 20 specimens, for tendon repair. Two-, four-, and eight-strand suture techniques were respectively used in Groups A, B, and C. A simple running peripheral suture technique was used in Subgroups A2, B2, and C2. For each repaired tendon, the 2-mm gap-formation force, 2-mm gap-formation strength, maximum breaking force and maximum breaking strength were determined. Differences in 2-mm gap-formation force and 2-mm gap-formation strength were found between Subgroups A1 and A2, B1 and B2, and C1 and C2. Between Groups A and B, A and C, and B and C, there was no difference as well. Both the number of strands and the ratio between the total suture volume and tendon volume at the repair site are important for ideal repair. If the total cross-sectional area of the sutures is equal in 2-strand, 4-strand, and 8-strand procedure, there is no difference in the strength of the repair. A decrease in caliber size suture requires more passes to achieve the same strength. Instead, it is much better to use peripheral suture techniques to improve the strength of the repair with larger diameter 2-strand core sutures. Copyright © 2014
Ahuja, Yachna; Ma Khin Pyi, Son; Malihi, Mehrdad; Hodge, David O; Sit, Arthur J
To determine outcomes of ab interno trabeculotomy for treatment of open-angle glaucoma (OAG). Retrospective interventional single-surgeon, single-center case series. Data were collected from 246 patients undergoing ab interno trabeculotomy between September 1, 2006, and December 1, 2010, with 3 months' follow-up or longer. Kaplan-Meier analysis was performed using Criteria A (postoperative intraocular pressure [IOP] ≤21 mm Hg or ≥20% reduction from preoperative IOP) and Criteria B (IOP ≤18 mm Hg and ≥20% reduction in IOP). Failure included increased glaucoma medications or subsequent surgery. Failure risk factors were identified using Cox proportional hazards ratio (HR). Of 88 cases of ab interno trabeculotomy-only and 158 cases of ab interno trabeculotomy with cataract extraction, the retention rate was 70% for 1 year and 62% for 2 years. Preoperative mean IOP was 21.6 ± 8.6 mm Hg; the number of glaucoma medications was 3.1 ± 1.1. At 24 months postoperatively, mean IOP was reduced 29% to 15.3 ± 4.6 mm Hg (P interno trabeculotomy. For criteria involving IOP ≤18 mm Hg, the 24-month survival of ab interno trabeculotomy is low. This surgery is appropriate for patients requiring a target IOP of 21 mm Hg or above. Copyright © 2013 Elsevier Inc. All rights reserved.
CONCLUSION: This simple technique for pterygium surgery is not only cost effective and quick but also may prevent potential adverse reactions encountered with the use of foreign materials and in this large series provided safe and comparable results to current methods.
Sandmann, Gunther H; Martetschläger, Frank; Mey, Lisa; Kraus, Tobias M; Buchholz, Arne; Ahrens, Philipp; Stöckle, Ulrich; Freude, Thomas; Siebenlist, Sebastian
...) cerclages and one coracoclavicular (CC) cerclage with resorbable sutures. Between 2007 and 2009 a total of 39 patients fit the inclusion criteria after operative treatment of acute AC joint dislocation...
Havig, Marc E; Dyce, Jonathan; Kowaleski, Michael P; Reynolds, Lisa R; Budsberg, Steven C
To evaluate the effect of a lateral suture technique (LST) on tibial plateau angle (TPA) measurement and to compare TPA with functional outcome in dogs treated for cranial cruciate ligament (CrCL) rupture with LST. Prospective clinical study. Dogs (n=34) with unilateral CrCL instability. All dogs had lameness examination, survey stifle radiographs, and force plate analysis before and at 6, 12, 24, and 48 weeks after surgery. Radiographic osteoarthritis (OA) scores and lameness scores were assigned using previously reported methods. Preoperative radiographs were performed in all dogs, and postoperative serial radiographs were performed in 6 dogs for measurement of TPA. Differences in TPA measurements were evaluated with a random effects repeated measures model. The significance of LST on TPA measurement was established in 6 dogs and the effect of TPA on vertical impulse, peak vertical force, progression of radiographic scores, and lameness score were analyzed by general linear models in all dogs. Differences were considered significant if P<.05. Significant differences were not noted between pre- and serial postoperative measurements of TPA. A significant correlation was not established between TPA and postoperative vertical impulse, peak vertical force, lameness score, or radiographic OA scores. TPA values were unchanged after LST and TPA does not affect outcome measures in dogs treated with LST. TPA has no predictive value on clinical outcome in dogs treated with LST for stabilization of CrCL deficient stifles.
Li, Ji; Yu, Yang; Liu, Chunhui; Su, Xiangzheng; Liao, Weixiong; Li, Zhongli
To compare biomechanical outcomes of 4 different arthroscopic techniques for fixation of tibial eminence fractures. Twenty-four skeletally mature, fresh-frozen cadaveric knees were divided into 4 comparison groups based on the fixation method: screw fixation (group A), traditional sutures fixation with 2 FiberWire sutures (group B), a modified suture technique with 2 FiberWire sutures that created neckwear knots to firmly trap the fracture fragment (group C), or suture anchors which was based on the suture bridge technique primarily used in the shoulder for repair of rotator cuff tears and greater tuberosity fractures (group D). A tibial eminence fracture was created in each knee for subsequent fixation. After fixation, each knee underwent cyclic loading of 100 N to assess the displacement change after 500 cycles of the fixation construct. Afterward, a single tensile failure test load was performed to assess the ultimate failure load, stiffness, and failure mode for each specimen. All specimens survived cyclic testing and were subsequently loaded to failure. Group C had the highest ultimate failure load (P Suture fixation using the neckwear knots technique provides superior fixation with regard to higher ultimate failure load, and absorbable suture anchor fixation with the suture bridge technique provides less displacement under cyclic loading conditions. Both techniques exhibited superior biomechanical properties compared with traditional screw and suture fixation. The new techniques showed satisfactory biomechanical properties and provided more choice for surgeons in the treatment of tibial eminence fractures. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Full Text Available Percutaneous placement of gastrostomy was first described in 1980. Since then it has become widely used in pediatric surgery throughout the world. Inherent in the technique is the possibility of inadvertent damage to adjacent anatomical structures, most commonly the transverse colon. Management previously had involved laparotomy and correction of the gastrocolic fistula. Here we describe a novel laparoscopic approach to the repair of a gastrocolic fistula following percutaneous gastrostomy, avoiding the morbidity of laparotomy in an immunocompromised patient with a rotund abdomen secondary to steroid usage.
Cetinkaya, M A; Olcay, B
The coxofemoral joint is the most commonly luxated joint in dogs and cats. Coxofemoral luxations are generally craniodorsal; caudoventral coxofemoral luxations are relatively rare occurrences and may be accompanied by fracture of the greater trochanter. The aim of our study was to report the results of a modified Knowles toggle pin application in two caudoventral hip luxations for which closed reduction had not been achieved. Medical records of dogs and cats, which had been presented at our institution between September 1999 and October 2007, were reviewed for cases of coxofemoral luxation. In total, the case records of 67 cats and 147 dogs were found. Of these cases, there was one cat and one dog with caudoventral coxofemoral luxation. For both cases, the toggle pin technique was the method of treatment. The cat had a good clinical recovery within three days after surgery. The dog, which also had a cruciate ligament rupture in the same limb and medial patellar luxation in the contralateral limb, was presented with severe lameness and pain approximately two and a half months after surgery, at which time fracture of the femoral head was diagnosed. Functional recovery was achieved after a femoral head and neck ostectomy had been performed.
van Veelen, Marie-Lise C; Kamst, Nathalie; Touw, Carolina; Mauff, Katya; Versnel, Sarah; Dammers, Ruben; de Jong, T H Rob; Prasad, Vani; Mathijssen, Irene M
This series describes the results of minimally invasive strip craniotomy with additional spring distraction. Included are the first 83 consecutive patients who underwent this procedure (January 1, 2010, to January 1, 2014). Outcome parameters were collected prospectively and included surgical parameters and complications, the occurrence of papilledema, skull growth, cephalic index, and photographic scores. Duration of surgery was 63 minutes, 19 percent required blood transfusion, and complications were minor. Postoperative papilledema occurred in two patients (2.4 percent). Head growth increased after insertion of the springs and declined afterward to 0.7 SD, comparable to earlier cohorts in the authors' center. The cephalic index increased from 67 before surgery to 74 after surgery and showed a small decrease during the 4-year follow-up. Photographic scores confirmed the initial improvement and showed a trend to further improvement during follow-up. In this cohort, spring-assisted, minimally invasive strip craniotomy was safe and effective. Results were similar to those from other techniques but with smaller incisions, shorter interventions, reduced blood loss, and a lower incidence of postoperative papilledema. Therapeutic, IV.
Masafumi Goto; Masafumi Gotoh; Yasuhiro Mitsui; Ryo Tanesue; Takahiro Okawa; Fujio Higuchi; Naoto Shiba
Hypersensitivity to suture anchor is extremely rare. Herein, we present a case in which hypersensitivity to suture anchor was strongly suspected. The right rotator cuff of a 50-year-old woman was repaired with a metal suture anchor. Three weeks after the surgery, she developed erythema around her face, trunk, and hands, accompanied by itching. Infection was unlikely because no abnormalities were detected by blood testing or by medical examination. Suspicious of a metallic allergy, a dermatolo...
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.
Barber, F Alan; Herbert, Morley A; Coons, David A; Boothby, Michael H
To evaluate recently introduced sutures and suture anchors for single pull load to failure strength and failure mode. Suture anchors were tested in fresh porcine metaphyseal cortex and cancellous troughs with the use of an established protocol. An Instron machine applied tensile loads parallel to the axis of insertion at a rate of 12.5 mm/sec until failure, and mean anchor failure strengths were calculated. The mode of failure (anchor pull-out, suture eyelet cut-out, or suture failure) was recorded. Anchors tested included the BioRaptor 2.9, BioZip, Super Revo, Impact, Allograft cortical anchor, SpiraLok, Herculon, AxyaLoop titanium anchors 3, 5, and 6.5 mm, AxyaLoop bioabsorbable anchors 3, 5, and 6.5, ParaFix titanium anchors 3, 5, and 6.5, ParaSorb BioAnchors 3, 5.5, and 6.5, and Bio-Corkscrew FT. Sutures were also tested through an established protocol for load to failure. Sutures tested consisted of Orthocord, Ultrabraid (White and CoBraid), ForceFiber, Hi-Fi, MagnumWire, and Maxbraid Polyethylene Plus. Mean failure loads were as follows: BioRaptor 238 N, BioZip 366 N, double-loaded Super Revo 486 N, triple-loaded Super Revo 362 N, Impact 202 N, Allograft cortical anchor 240 N, SpiraLok 289 N, Herculon 819 N, AxyaLoop titanium anchors 3.0 (335 N), 5.0 (485 N), and 6.5 mm (465 N), AxyaLoop bioabsorbable anchors 3 (143 N), 5 (395 N), and 6.5 (369 N), ParaFix titanium anchors 3 (335 N), 5 (485 N), and 6.5 (465 N), ParaSorb BioAnchors 3 (143 N), 5.5 (395 N), and 6.5 (369 N), and Bio-Corkscrew FT (260 N). The sutures all broke at the mid point of their tested strands away from the grips. Mean suture strength for No. 2 Orthocord was 92 N; for No. 2 Ultrabraid CoBraid and White, strengths were 265 N and 280 N, respectively; strength for No. 2 Force Fiber was 289 N, for No. 2 Hi-Fi 250 N, for No. 2 MagnumWire 303 N, and for No. 2 Maxbraid Polyethylene Plus 256 N. Newer suture products showed significant improvements in load to failure values when compared with braided
Hennessey, D B; Carey, E; Simms, C K; Hanly, A; Winter, D C
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. To determine the effect of axial torsional forces on sutures used in abdominal closure. The effect of axial twisting on polydioxanone (PDS*II), polyglactin (Vicryl), polypropylene (Prolene) and nylon (Ethilon) sutures was investigated using a uniaxial testing device. The maximum tensile force withstood for untwisted sutures was determined: polydioxanone failed at a tensile force of 116.4±0.84 N, polyglactin failed at 113.9±2.4 N, polypropylene failed at 71.1±1.5 N and nylon failed at 61.8±0.5 N. Twisting decreased the maximum tensile force of all sutures; one complete twist per 10 mm (i.e., 15 twists) decreased the tensile strength of polydioxanone by 21%, polyglactin by 23%, polypropylene by 16% and nylon by 13%, psuture strength, with one twist per 75 mm (i.e., 20 twists) of polydioxanone decreasing strength by 39%, Psutures is a previously unrecognised phenomenon. Surgeons should be aware that this can result in a decrease in suture strength and reduce the elasticity of the material, and therefore need to adapt their practice to reduce the torsional force placed on sutures. Copyright © 2012 Elsevier Ltd. All rights reserved.
Linderman, Stephen W; Kormpakis, Ioannis; Gelberman, Richard H; Birman, Victor; Wegst, Ulrike G K; Genin, Guy M; Thomopoulos, Stavros
Suture materials and surgical knot tying techniques have improved dramatically since their first use over five millennia ago. However, the approach remains limited by the ability of the suture to transfer load to tissue at suture anchor points. Here, we predict that adhesive-coated sutures can improve mechanical load transfer beyond the range of performance of existing suture methods, thereby strengthening repairs and decreasing the risk of failure. The mechanical properties of suitable adhesives were identified using a shear lag model. Examination of the design space for an optimal adhesive demonstrated requirements for strong adhesion and low stiffness to maximize the strength of the adhesive-coated suture repair construct. To experimentally assess the model, we evaluated single strands of sutures coated with highly flexible cyanoacrylates (Loctite 4903 and 4902), cyanoacrylate (Loctite QuickTite Instant Adhesive Gel), rubber cement, rubber/gasket adhesive (1300 Scotch-Weld Neoprene High Performance Rubber & Gasket Adhesive), an albumin-glutaraldehyde adhesive (BioGlue), or poly(dopamine). As a clinically relevant proof-of-concept, cyanoacrylate-coated sutures were then used to perform a clinically relevant flexor digitorum tendon repair in cadaver tissue. The repair performed with adhesive-coated suture had significantly higher strength compared to the standard repair without adhesive. Notably, cyanoacrylate provides strong adhesion with high stiffness and brittle behavior, and is therefore not an ideal adhesive for enhancing suture repair. Nevertheless, the improvement in repair properties in a clinically relevant setting, even using a non-ideal adhesive, demonstrates the potential for the proposed approach to improve outcomes for treatments requiring suture fixation. Further study is necessary to develop a strongly adherent, compliant adhesive within the optimal design space described by the model. Copyright © 2015 Acta Materialia Inc. Published by Elsevier
Zayed, Mohamed A; Fouda, Usama M; Elsetohy, Khaled A; Zayed, Shereef M; Hashem, Ahmed T; Youssef, Mohamed A
The aim of this randomized control trial was to compare the operative data and the early postoperative outcomes of cesarean sections in which the uterine incision was closed with a barbed suture (STRATAFIX™ Spiral PDO Knotless Tissue Control Device, SXPD2B405, Ethicon Inc.) with those of cesarean sections in which the uterine incision was closed with a conventional smooth suture (VICRYL™; Ethicon Inc.). One hundred pregnant patients were randomized in a 1:1 ratio to the Stratafix group or the Vicryl group. The uterine incision was closed by two layers of sutures in both groups. In the Vicryl group, the first layer was continuous and the second layer was interrupted. In the Stratafix group, both layers were continuous. The uterine closure time was significantly lower in the Stratafix group (224 ± 46 versus 343 ± 75 s, p Stratafix group required additional sutures to achieve hemostasis (p value = .009). The mean blood loss during closure of uterine incision and mean hospital stay were lower in the Stratafix group but these differences failed to reach statistical significance. The use of barbed suture for uterine incision closure at cesarean section is associated with shorter uterine closure time and similar early perioperative complications compared with conventional smooth suture. The difference between both groups in the technique of suturing the second layer of the uterine incision may be the cause of the reduction in the uterine closure time and the need for additional sutures to achieve hemostasis during suturing the uterine incision with a barbed suture. Further, well designed randomized controlled trials should be conducted to investigate the association between the type of suture (barbed or conventional smooth) and remote complications of cesarean section (infertility, pelvic pain, abnormal placentation and rupture uterus).
Kindya, Michael C; Konicek, John; Rizzi, Angelo; Komatsu, David E; Paci, James M
To compare the biomechanical properties of a knotless suture anchor with suture tape quadriceps tendon repair technique with transosseous and suture anchor repair techniques. Twenty matched pairs of cadaveric knees underwent a quadriceps tendon avulsion followed by repair via the use of transosseous tunnels with #2 high-strength sutures, 5.5-mm biocomposite fully threaded suture anchors with #2 high-strength sutures, or 4.75-mm biocomposite knotless suture anchors with suture tape. Ten knees were repaired via transosseous repair and 10 via fully threaded suture anchor repair, and their matched specimens were repaired with suture tape and knotless anchors. Biomechanical analysis included displacement during cyclic loading over 250 cycles, construct stiffness, ultimate load to failure, and failure mode analysis. Compared with transosseous repairs, quadriceps tendons repaired with knotless suture tape demonstrated significantly less displacement during cyclic loading (cycles 1-20 3.6 ± 1.3 vs 6.3 ± 1.9 mm, P = .003; cycles 20-250 2.0 ± 0.4 vs 3.1 ± 0.9 mm, P = .011), improved construct stiffness (67 ± 25 vs 26 ± 12 N/mm, P = .001), and greater ultimate load to failure (616 ± 149 vs 413 ± 107 N, P = .004). Our repair technique also demonstrated improved biomechanical parameters compared with fully threaded suture anchor repair in initial displacement during cyclic loading (cycles 1-20 3.0 ± 0.8 vs 5.1 ± 0.9 mm, P suture anchor with suture tape repair technique is biomechanically superior in cyclic displacement, construct stiffness, and ultimate load to failure compared with transosseous and fully threaded suture anchor techniques in cadaveric specimens. The demonstration that our repair technique is biomechanically superior to previously described techniques in a cadaveric setting suggests that consideration should be given to this technique. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Wang, Hong-De; Dong, Jiang-Tao; Gao, Shi-Jun
Graft fixation is critical to the restoration of the medial patella of femoral ligament function and long-term success. Numerous fixations at the patella have been described, while the complications including patellar fractures, violation of the posterior patella and delay of tendon-to-bone healing remain significant challenges. Here, we describe a safe and firm fixation at the patellar for medial patellofemoral ligament (MPFL) reconstruction and explore the safety angle of drilling the suture anchor at different morphology of the patellar. Moreover, we evaluate the results at a 3-year follow-up. Combined bone groove and suture anchor fixation at the patella was performed on 26 patients (16 females, 10 males; mean age 26.3 ± 4.7 years) diagnosed with recurrent patellar dislocation. The drilling direction of the suture anchor referred to the safety angle according to the Wiberg type classification. The safety angle was defined as the angle between the drill tunnel and a line that connected the medial and lateral margins of the patella and was established following computed tomography assessment of 117 patients who were diagnosed with patellar dislocation in our hospital according to the Wiberg type classification (I:29, II:65, III:23). X-ray, Lysholm, Kujala and Tegner scores were obtained preoperatively and at the time of final follow-up. There were no patellar complications, including fracture and redislocation. Average congruence, patella tilt angles and lateral patella angle were significantly changed (P suture anchor should be more vertical. When fixing the patellar of female patients, the drilling suture anchor should be more sloping.
Katolik, Leonid I; Friedrich, Jeffrey; Trumble, Thomas E
The use of intraosseous suture anchors in the treatment of ruptures of the ulnar collateral ligament of the thumb metacarpophalangeal joint has previously been described. However, no direct comparisons exist of ulnar collateral ligament repair with bone anchor versus repair with a pull-out button and immobilization. Two cohorts of patients with complete rupture of the ulnar collateral ligament of the thumb metacarpophalangeal joint were compared. Thirty patients in each cohort underwent repair of the ulnar collateral ligament with either an intraosseous suture anchor followed by early mobilization or a pull-out suture tied over a button with cast immobilization. Average follow-up was 29 months. At follow-up, range of motion at the metacarpophalangeal and interphalangeal joints for the anchor group averaged 97 percent of that of the contralateral side compared with 86 percent and 87 percent, respectively, for the button group. For the anchor group, pinch strength averaged 101 percent that of the contralateral side compared with 95 percent for the button group. No significant difference was noted between the groups for grip strength. Average tourniquet time for the anchor group was 28 minutes compared with 43 minutes for the button group. Soft-tissue complications were present in 27 percent of patients (eight of 30) in the pull-out button group compared with 7 percent (two of 30) in the anchor group. Cost analysis demonstrates an approximately $140-per-patient savings when using the suture anchor. Both repair methods are safe and effective for treating thumb ulnar collateral ligament injuries. Suture anchors allow for an accelerated rehabilitation protocol, which may account for the improved range of motion and pinch strength at follow-up.
Sutura intestinal monoplano extramucosa, discontinua, a bordes invertidos: Su aplicación en 22 años Discontinuos extramucosal single layer intestinal suture on reversed edges: Application of this technique for 22 years
José Miguel Pérez Morales
Full Text Available Durante el período de enero de 1982 a diciembre del 2004 se aplicó la sutura intestinal monoplano extramucosa, discontinua y a bordes invertidos (SIMEDI en 580 pacientes con 25 enfermedades del tubo digestivo. El estudio fue prospectivo, analítico y descriptivo. La técnica se aplicó 703 veces porque hubo pacientes con más de una sutura y se empleó solamente en segmentos intestinales con serosa. Se realizaron 463 anastomosis, 171 enterorrafias y 69 cierres de un extremo intestinal. Se operaron 373 pacientes de forma programada y 207 pacientes, de urgencia. Hubo 85 pacientes que presentaron complicaciones, 13 de las cuales eran dependientes de la técnica y 72, no dependientes de ella. Las complicaciones dependientes fueron 12 dehiscencias de suturas y 1 estenosis. La combinación anastomótica término-lateral más latero-lateral y cierre de un extremo intestinal fue la que más complicaciones presentó. La neoplasia maligna gástrica y de colon derecho fueron las enfermedades con más complicaciones dependientes. Se ahorró material de sutura. La SIMEDI constituye una buena opción en la cirugía del tubo digestivosummary In the period from January 1982 to December 2004, discontinuos extramucosal single layer intestinal suture on reversed edges was performed in 580 patients who had presented with 25 diseases of the digestive tract. A prospective, analytical and descriptive study was conducted. The technique was applied 703 times because there were patients with more than one suture and it was used only in intestinal segments with serose. Four hundred and sixty three anastomoses, 171 enterorrhaphies and 69 closures of an intestinal end were performed. Three hundred and seventy three patients were scheduled to be operated on whereas 207 patients were operated on due to emergency situation. There were 85 patients who developed complications, 13 had surgical technique-depending complications and 72 did not. Depending complications covered 12
[Calculating the induced, computerized tomography measured corneal astigmatism after cataract surgery with small incision technique and wound closure with single suture technique based on various mathematical models].
Rauber, M; Grewing, R; Mester, U
Small-incision cataract surgery with scleral tunnel incision and one-stitch horizontal or sutureless wound closure has been found to be an effective way to reduce postoperative astigmatism and to guarantee greater stability of the wound with rapid visual rehabilitation. In some studies surgically induced astigmatism by different wound constructions and wound-closure techniques has been compared to determine the astigmatism induced. Different calculation methods were used leading to different results. Therefore, we evaluated the induced astigmatism in 50 patients operated on by scleral tunnel incision, phacoemulsification with PCL implantation and single-stitch wound closure. We analyzed induced astigmatism on the first postoperative day and 3 months postoperatively by different methods: the simple subtraction method (0.91 and 0.30 D), Naeser's polar value method (-0.74 and -0.75 D), the vector analysis method of Jaffe (2.53 and 1.19 D) and two calculations described by Cravy. Depending on the formula used, different results were obtained. The subtraction method disregards axis change and is less precise. The vector analysis methods obtain the highest values for induced astigmatism and seem to be the most precise for evaluating the real amount of induced postoperative astigmatism.
Neustein, Rebecca F; Beck, Allen D
This study compares the long-term efficacy of circumferential trabeculotomy to that of conventional angle surgeries in primary congenital glaucoma (PCG), as judged by glaucoma and visual outcomes. Retrospective observational case series. Setting: Emory Eye Center, Atlanta, Georgia. This was a single-institution retrospective study involving children with PCG who underwent circumferential trabeculotomy, standard trabeculotomy, or goniotomy with ≥2-year follow-up. Postoperative success (intraocular pressure [IOP] glaucoma medications, without glaucoma progression/additional IOP-lowering surgery), Snellen-equivalent visual acuity (VA), and IOP at last follow-up. Kaplan-Meier method estimated the probability of glaucoma control vs time postoperatively, and values were compared between angle surgery cohorts using Wilcoxon signed rank tests, Mann-Whitney U tests, and Fisher exact tests. Included were 58 eyes (33 children) after circumferential trabeculotomy and 42 eyes (27 children) after standard trabeculotomy/goniotomy, with mean follow-up of 7.2 ± 4.0 and 8.2 ± 4.5 years, respectively. Postoperative success at last follow-up in the circumferential vs conventional cohorts was 81% (47 of 58 eyes) vs 31% (13 of 42 eyes) (P glaucoma medications (0.55 ± 1.2 vs 1.61 ± 1.51, P < .0001), had lower IOP in first operated eye (15.2 ± 3.6 vs 18.2 ± 7.0, P = .048), and had comparable incidence of devastating complications (P = .065). In this retrospective study, circumferential trabeculotomy afforded better long-term success and visual outcomes than conventional angle surgery for children with PCG. Copyright © 2017 Elsevier Inc. All rights reserved.
Full Text Available Background. Delayed postoperative suprachoroidal hemorrhage (DSCH may occur following intraocular surgery for the treatment of glaucoma. It is considered to be a rare and debilitating event if not managed appropriately. Reported herewith is a case of Primary Congenital Glaucoma followed by DSCH with successful immediate surgical intervention and visual restoration. Patient and Method. An 8-month-old male child had bilateral Primary Congenital Glaucoma (PCG. Combined Trabeculotomy Trabeculectomy with 5-Fluorouracil (5FU was performed. He developed delayed suprachoroidal hemorrhage (DSCH within 24 hours after intraocular surgery which was drained. In addition, he developed exposure keratopathy and left amblyopia. Outcome. Resolution of the DSCH was seen with surgical drainage in addition to treatments for exposure keratopathy and amblyopia. These resulted in reduced intraocular pressure and improved visual acuities. Conclusion. There appears to be a difference in the overall management of PCG and DSCH between adults and children. A high index of suspicion as well as emergency surgical treatment for DSCH and associated conditions should be performed on pediatric patients that present with these challenges.
Paulo César Leonardi
Full Text Available INTRODUÇÃO: A realização de suturas e nós é das mais difíceis manobras cirúrgicas em videolaparoscopia. A habilidade de realizá-las durante os procedimentos videolaparoscópicos determinou grande expansão nas indicações laparoscópicas, bem como permitiu aos cirurgiões realizarem procedimentos de maior complexidade com mais segurança. O treinamento deve seguir as mesmas orientações do ensino de procedimentos básicos. Para tanto, meios podem ser encontrados no comércio ou serem confeccionados pelo cirurgião. OBJETIVO: Dar atualização aos nós e técnicas de suturas usadas em videocirurgia. MÉTODOS: Descreve-se as técnicas mais práticas e usadas em nosso meio com figuras demonstrativas de como realizá-las. CONCLUSÃO: Existe uma lacuna importante da literatura científica na descrição e demonstração das diferentes técnicas de sutura em videocirurgia, como também existem muitas modalidades técnicas para a confecção de nós cirúrgicos. O seu conhecimento é importante para permitir ao cirurgião a escolha adequada nas diferentes situações e estratégias cirúrgicas existentes. A sistematização técnica dos nós e suturas em videocirurgia torna o procedimento mais fácil e seguro e deve ser cada vez mais divulgado.INTRODUCTION: The completion of sutures and knots are the most difficult surgical maneuvers at laparoscopy. The ability to perform them during videolaparoscopy allowed surgeons to perform procedures of greater complexity with more security. The training should follow the same guidelines as the teaching of basic procedures. For this purpose, means may be found in trade or being prepared by a surgeon. AIM: To update techniques used in laparoscopic suturing. METHODS: Are described the techniques used with figures to demonstrate how to accomplish them. CONCLUSION: There is a significant gap in the scientific literature describing and illustrating the different suturing techniques in laparoscopic surgery
Full Text Available Hypersensitivity to suture anchor is extremely rare. Herein, we present a case in which hypersensitivity to suture anchor was strongly suspected. The right rotator cuff of a 50-year-old woman was repaired with a metal suture anchor. Three weeks after the surgery, she developed erythema around her face, trunk, and hands, accompanied by itching. Infection was unlikely because no abnormalities were detected by blood testing or by medical examination. Suspicious of a metallic allergy, a dermatologist performed a patch testing 6 months after the first surgery. The patient had negative reactions to tests for titanium, aluminum, and vanadium, which were the principal components of the suture anchor. The anchor was removed 7 months after the first surgery, and the erythema disappeared immediately. When allergic symptoms occur and persist after the use of a metal anchor, removal should be considered as a treatment option even if the patch test result is negative.
There are many methods describing distal juncture fixation techniques of the injured flexor digitorum profundus (FDP) or flexor tendon graft. We have noted a tendency in the surgical repair of tissues toward the more expensive and technology-dependent methods. New suture type was developed to find better FDP distal juncture suture not indulging into expensive technology-dependent techniques. The positive aspect of the most popular Bunnell pullout technique is eventual removal of the suture. The negative aspect is necessity to use tie over button to secure the end of the tendon in the bone canal and thus externalizing suture. This can be complicated with maceration, decubitus, and infection. In addition, any device secured to the finger nail can be caught by external objects. We propose buttonless method of the tendon-to-bone fixation. The only negative aspect is retaining suture. Suture is easy to perform and cheaper than any of the anchor sutures. Twelve patients were included in this preliminary study. Seven patients had acute FDP tendon zone I bone juncture injuries. Five patients had second stage flexor tendon reconstruction with tendon grafts. No infections, ruptures of the FDP or nail growth disturbances were noted. Three patients presented with slight DIP joint flexion contracture. One patient had "mallet" deformity. Our tendon-to-bone fixation is easy to perform. It is as cheap as standard Bunnell fixation and excludes complications encountered in standard pullout sutures. Although bone suture anchors with modified Becker core suture are superior in tensile strength to 2-stranded sutures, many hand surgeons are limited by the price of the bone anchors and can find our suture more affordable.
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.
Mitchell, Ryan T M; Bengtson, Bradley P
The breadth of literature regarding barbed suture applications in plastic surgical procedures and of importance to this article, barbed suture applications in breast surgery, is growing dramatically as surgical practitioners are becoming more familiar with the advantages of this new suture technology. Barbed suture devices were first implemented by plastic surgeons for the use in various minimally invasive techniques for facial rejuvenation, but have now surpassed these applications and are now much more commonly used in Breast and Body closures. Copyright © 2015 Elsevier Inc. All rights reserved.
Hong, Chih-Kai; Lin, Cheng-Li; Chang, Chih-Hsun; Jou, I-Ming; Su, Wei-Ren
We aimed to investigate the effect of the number of suture throws on biomechanical characteristics of the suture-tendon construct for 3 currently used suture configurations in this ex vivo biomechanical study. Three stitch configurations-the Krackow stitch, the locking SpeedWhip (LSW) stitch, and the modified finger trap (MFT) suture-were assessed with 3, 5, and 7 throws using porcine flexor profundus tendons randomly divided into 9 groups of 11 specimens. The Krackow stitch and MFT suture were completed with nonabsorbable No. 2 braided sutures, whereas the LSW stitch was completed with loops of nonabsorbable No. 2 braided sutures. Each tendon was pretensioned to 100 N for 3 cycles and then cyclically loaded to 200 N for 200 cycles. Finally, each tendon was loaded to failure. Percent elongation, load to failure, and mode of failure for each suture-tendon construct were measured. After being pretensioned, there were no significant differences in the elongation between different suture throws in the LSW and MFT suture groups (P = .38 and P = .34, respectively). The elongation of the Krackow 7-throw suture group was significantly greater than that of the 5-throw (P = .01) and 3-throw groups (P = .03). After cyclic loading, there was no significant difference in the elongation of each suture technique with respect to different suture throws. The elongation after 200 loading cycles of the MFT sutures was significantly less than that of the Krackow and LSW sutures for all throws. The load to failure and cross-sectional area (43.1 ± 4.6 mm(2); P = .398) were not significantly different across all groups. This ex vivo biomechanical study showed that there are no significant differences in elongation after cyclic loading and load to failure among the various suture throws for the 3 types of sutures investigated. CLINICAL The 3-suture throw configuration may provide sufficient fixation of the tendon graft regarding biomechanical characteristics of elongation
Full Text Available Introduction: Refinement of the nose tip can be accomplished by a variety of techniques, but currently, the use of sutures in the nasal tip with conservative resection of the alar cartilage is the most frequently recommended approach. Objective: To classify the nasal tip and to demonstrate the interdomal suture applied to nasal tip refinement in the Caucasian nose, as well as to provide a simple and practical presentation of the surgical steps. Method: Development of surgical algorithm for nasal tip surgery: 1. Interdomal suture (double binding suture, 2. Interdomal suture with alar cartilage weakening (cross-hatching, 3. Interdomal suture with cephalic removal of the alar cartilage (McIndoe technique based on the nasal tip type classification. This classification assesses the interdomal distance (angle of domal divergence and intercrural distance, domal arch width, cartilage consistency, and skin type. Interdomal suture is performed through endonasal rhinoplasty by basic technique without delivery (Converse-Diamond technique under local anesthesia Conclusion: This classification is simple and facilitates the approach of surgical treatment of the nasal tip through interdomal suture, systematizing and standardizing surgical maneuvers for better refinement of the Caucasian nose.
Burkhardt, Rino; Lang, Niklaus P
The present article describes the significance of suturing and appropriate suture materials in current periodontal and implant surgery. Synthetic, nonresorbable, monofilament threads appear to be advantageous. The physical and biological properties of such threads remain unchanged with use and, when used in small diameters (i.e. with lower breaking resistance), seem to promote passive wound closure. Wound healing at hard, nonshedding surfaces is conceptually a more complex process than is wound healing in most other sites of the oral cavity. Firm adaptation and stabilization of the flaps by optimal suturing ensures adhesion of the delicate fibrin clot to the nonshedding surface. The early formation and mechanical stability of the blood clot between the mucosal or mucoperiosteal flap and the wound bed are of paramount importance and hence suturing techniques must be considered as a key prerequisite to ensure optimal surgical outcomes. With the sophisticated surgical procedures now applied, there is a greater need for knowledge with regard to the various types of suturing techniques and materials available in order to achieve the above-mentioned goals. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Alan Barber, F; Boothby, Michael H; Richards, David P
Arthroscopic surgery requires appropriate surgical implants for effective fixation of tendons and ligaments to bone. Biodegradable suture anchors are being used with increasing frequency for various procedures in sports medicine. As companions to these biodegradable suture anchors, new sutures have been developed which possess greater strength and different material properties from the conventional braided polyester suture. Biodegradable polymers currently found in sutures and suture anchors include poly-L-lactic acid, poly-D, L lactic acid, polydioxanone, polyglycolic acid and their copolymers. Suture anchors are now available preloaded with a choice of conventional braided polyester sutures or some version of ultrahigh molecular weight polyethylene ("super") sutures. Most new suture anchors come with 2 sutures. The manner in which these sutures are attached to the anchor varies and may consist of 2 separate eyelets or 2 slots either parallel to one another or at different angles to one another. Some anchors have a very large single eyelet that allows for 2 or more sutures.
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 suture pullout forces with the mesh failure forces. Although the pullout force for the standard suture is significantly greater than for the barbed suture, both sutures have a pullout strength significantly greater than the mesh failure force. Table 1 Suture fixation forces for
Boin, Michael A.; Dorweiler, Matthew A.; McMellen, Christopher J.; Gould, Gregory C.; Laughlin, Richard T.
Background: Chronic noninsertional Achilles tendinosis can result in an acute Achilles tendon rupture with a short distal stump. In such tendon ruptures, there is a limited amount of adequate tissue that can hold suture, thus presenting a challenge for surgeons who elect to treat the rupture operatively. Hypothesis: Adding suture anchors to the repair construct may result in biomechanically stronger repairs compared with a suture-only technique. Study Design: Controlled laboratory study. Methods: Nine paired Achilles-calcaneus complexes were harvested from cadavers. An artificial Achilles rupture was created 2 cm proximal to the insertion on the calcaneus. One specimen from each cadaver was assigned to a suture-only or a suture anchor–augmented repair. The contralateral specimen of the same cadaver received the opposing repair. Cyclic testing was then performed at 10 to 100 N for 2000 cycles, and load-to-failure testing was performed at 0.2 mm/s. This was followed by analysis of repair displacement, gapping at repair site, peak load to failure, and failure mode. Results: The suture anchor–augmented repair exhibited a 116% lower displacement compared with the suture-only repair (mean ± SD, 1.54 ± 1.13 vs 3.33 ± 1.47 mm, respectively; P suture anchor–augmented repair also exhibited a 45% greater load to failure compared with the suture-only repair (303.50 ± 102.81 vs 209.09 ± 48.12 N, respectively; P Suture anchor–augmented repairs performed on acute Achilles tendon ruptures with a short distal stump are biomechanically stronger than suture-only repairs. Clinical Relevance: Our results support the use of suture anchor–augmented repairs for a biomechanically stronger construct in Achilles tendon ruptures with a short distal stump. Biomechanically stronger repairs may lead to less tendon repair gapping and failure, increasing the ability to start early active rehabilitation protocols and thus improving patient outcomes. PMID:28203592
Jacxsens, Matthijs; Granger, Erin K; Tashjian, Robert Z
The purpose of this study was to evaluate the clinical outcomes and integrity of an open subpectoral biceps tenodesis using a dual suture anchor construct. Patients with at least 2 years of follow-up were retrospectively evaluated for simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES) score, and visual analog scales (VAS) for pain, function and satisfaction. A physical exam assessed shoulder range of motion and elbow strength. Ultrasonography visualized construct integrity. Of 43 eligible patients, 36 completed questionnaire evaluation and 22 completed an additional physical examination. Indications included superior labral anterior-posterior (SLAP) lesions (4), partial thickness tears (6), instability (6), and tenosynovitis of the biceps tendon (20). Eighteen patients (50%) had an associated rotator cuff tear. Patient-reported outcomes improved pre- vs postoperatively: ASES score (45.4 vs 78.6, P suture anchor technique is a treatment option for SLAP lesions, partial thickness tears, subluxation, and tenosynovitis of the long head of the biceps with high rates of postoperative patient satisfaction, a low failure rate, and improved outcome scores. The presence of a concomitant rotator cuff tear did not influence clinical outcomes.
Joana de Pinho Tavares
Full Text Available Abstract Introduction: The increased interest in minimally-invasive treatments, such as the thread lifting, with lower risk of complications, minimum length of time away from work and effectiveness in correcting ptosis and aging characteristics has led many specialists to adopt this technique, but many doubts about its safety and effectiveness still limit its overall use. Objective: To analyze data published in the literature on the durability of results, their effectiveness, safety, and risk of serious adverse events associated with procedures using several types of threading sutures. Methods: Literature review using the key words "thread lift", "barbed suture", "suture suspension" and "APTOS". Due to the scarcity of literature, recent reports of facial lifting using threads were also selected, complemented with bibliographical references. Result: The first outcomes of facial lifting with barbed sutures remain inconclusive. Adverse events may occur, although they are mostly minor, self-limiting, and short-lived. The data on the maximum effect of the correction, the durability of results, and the consequences of the long-term suture stay are yet to be clarified. Conclusion: Interest in thread lifting is currently high, but this review suggests that it should not yet be adopted as an alternative to rhytidectomy.
Tavares, Joana de Pinho; Oliveira, Carlos Augusto Costa Pires; Torres, Rodolfo Prado; Bahmad, Fayez
The increased interest in minimally-invasive treatments, such as the thread lifting, with lower risk of complications, minimum length of time away from work and effectiveness in correcting ptosis and aging characteristics has led many specialists to adopt this technique, but many doubts about its safety and effectiveness still limit its overall use. To analyze data published in the literature on the durability of results, their effectiveness, safety, and risk of serious adverse events associated with procedures using several types of threading sutures. Literature review using the key words "thread lift", "barbed suture", "suture suspension" and "APTOS". Due to the scarcity of literature, recent reports of facial lifting using threads were also selected, complemented with bibliographical references. The first outcomes of facial lifting with barbed sutures remain inconclusive. Adverse events may occur, although they are mostly minor, self-limiting, and short-lived. The data on the maximum effect of the correction, the durability of results, and the consequences of the long-term suture stay are yet to be clarified. Interest in thread lifting is currently high, but this review suggests that it should not yet be adopted as an alternative to rhytidectomy. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.
Sandmann Gunther H
Full Text Available Abstract Purpose In this retrospective study we investigated the clinical and radiological outcome after operative treatment of acute Rockwood III-V injuries of the AC-joint using two acromioclavicular (AC cerclages and one coracoclavicular (CC cerclage with resorbable sutures. Methods Between 2007 and 2009 a total of 39 patients fit the inclusion criteria after operative treatment of acute AC joint dislocation. All patients underwent open reduction and anatomic reconstruction of the AC and CC-ligaments using PDS® sutures (Polydioxane, Ethicon, Norderstedt, Germany. Thirty-three patients could be investigated at a mean follow up of 32±9 months (range 24–56 months. Results The mean Constant score was 94.3±7.1 (range 73–100 with an age and gender correlated score of 104.2%±6.9 (88-123%. The DASH score (mean 3.46±6.6 points, the ASES score (94.6±9.7points and the Visual Analogue Scale (mean 0.5±0,6 revealed a good to excellent clinical outcome. The difference in the coracoclavicular distance compared to the contralateral side was Conclusion Open AC joint reconstruction using AC and CC PDS cerclages provides good to excellent clinical results in the majority of cases. However, radiographically, the CC distance increased significantly at final follow up, but neither the amount of re-dislocation nor calcifications of the CC ligaments or osteoarthritis of the AC joint had significant influence on the outcome. Level of evidence Case series, Level IV
Purpose In this retrospective study we investigated the clinical and radiological outcome after operative treatment of acute Rockwood III-V injuries of the AC-joint using two acromioclavicular (AC) cerclages and one coracoclavicular (CC) cerclage with resorbable sutures. Methods Between 2007 and 2009 a total of 39 patients fit the inclusion criteria after operative treatment of acute AC joint dislocation. All patients underwent open reduction and anatomic reconstruction of the AC and CC-ligaments using PDS® sutures (Polydioxane, Ethicon, Norderstedt, Germany). Thirty-three patients could be investigated at a mean follow up of 32±9 months (range 24–56 months). Results The mean Constant score was 94.3±7.1 (range 73–100) with an age and gender correlated score of 104.2%±6.9 (88-123%). The DASH score (mean 3.46±6.6 points), the ASES score (94.6±9.7points) and the Visual Analogue Scale (mean 0.5±0,6) revealed a good to excellent clinical outcome. The difference in the coracoclavicular distance compared to the contralateral side was dislocations occured in three patients (9%). Conclusion Open AC joint reconstruction using AC and CC PDS cerclages provides good to excellent clinical results in the majority of cases. However, radiographically, the CC distance increased significantly at final follow up, but neither the amount of re-dislocation nor calcifications of the CC ligaments or osteoarthritis of the AC joint had significant influence on the outcome. Level of evidence Case series, Level IV PMID:23098339
Tanaka, Masaaki; Hori, Yoshiaki; Shirafuji, Aya; Kato, Mitsunori; Kato, Jyun; Kobayashi, Hiroto; Tsuchida, Toru; Fukae, Tsukasa
To create awareness about a surgical technique termed bridge suture, which is performed as a pretreatment before a McDonald cerclage is performed on an emergency to treat severe cervical insufficiency. Procedures for bridge suture were reviewed in detail and outcomes of 16 patients treated with bridge suture followed by McDonald cerclage were evaluated retrospectively. Using the bridge suture, the edges of uterine cervix were temporarily sutured and the external uterine os was closed, while the hourglass-shaped fetal membranes were concomitantly confined within the cervix; subsequently, a McDonald cerclage was performed. Over a 22-year period, 16 patients with a dilated cervix and bulging fetal membranes were treated using the technique of bridge suture followed by an emergency cerclage. The mean gestational age at cerclage was 22.5 weeks; the mean gestational age at delivery was 30.7 weeks; and the mean interval between cerclage and delivery was 8.2 weeks. In 15 out of 16 cases, cerclage was performed without encountering any complications. No maternal complications, including cervical laceration, were observed. The mean body weight of 17 neonates, including that of a twin, was 1,516 g and of them, 15 neonates survived. The important outcome of bridge suture is the replacement of fetal membranes back into the uterine cavity before McDonald's cerclage is performed. Pretreatment with bridge suture may facilitate the performance of a successful emergency cerclage and contribute to good maternal and neonatal outcomes. © 2016 S. Karger AG, Basel.
Eustis, H Sprague; Rhodes, Annette
To document the contamination rate of sutures used in strabismus surgery and evaluate the reduction of contamination using antibiotic-coated and antiseptic/antibiotic-coated sutures. This was a prospective randomized analysis of suture contamination and potential prophylaxis measures after strabismus surgery. Muscle sutures (6-0 polyglactin) used in 302 consecutive cases of strabismus from October 2008 to May 2009 were collected and randomly assigned to three groups: (1) a control without pretreatment sutures (61); (2) antibiotic/steroid-coated sutures (200); and (3) antiseptic-soaked and antibiotic/steroid-coated sutures (141). The sutures were used under sterile conditions and then cut into pieces and transferred to blood agar plates, which were incubated for 48 hours and then checked for growth. Group 1 had bacterial growth in 17 of 61 (28%) sutures; group 2 had growth in 44 of 200 (22%) sutures; and group 3 had growth in 12 of 141 (9%) sutures. The reduction in bacterial growth using the antibiotic/antiseptic coating was significant (P = .006). One patient developed coagulase-negative Staphylococcus epidermidis endophthalmitis 1 week after surgery, which was promptly diagnosed and successfully treated. No complications from the antibiotic-coated or antiseptic-soaked sutures were noted. Although endophthalmitis after strabismus surgery is rare, estimated at 1 in 35,000 to 1 in 185,000, visual outcome is uniformly poor. The authors hypothesize that strabismus sutures can be contaminated via contact with the eyelashes and skin, providing a possible conduit for endophthalmitis. Bacterial contamination of strabismus sutures is high (28%) and can be reduced significantly if sutures are soaked in antiseptic before use. Copyright 2012, SLACK Incorporated.
Nett, Michael; Avelar, Rui; Sheehan, Michael; Cushner, Fred
Standard medial parapatellar arthrotomies of 10 cadaveric knees were closed with either conventional interrupted absorbable sutures (control group, mean of 19.4 sutures) or a single running knotless bidirectional barbed absorbable suture (experimental group). Water-tightness of the arthrotomy closure was compared by simulating a tense hemarthrosis and measuring arthrotomy leakage over 3 minutes. Mean total leakage was 356 mL and 89 mL in the control and experimental groups, respectively (p = 0.027). Using 8 of the 10 knees (4 closed with control sutures, 4 closed with an experimental suture), a tense hemarthrosis was again created, and iatrogenic suture rupture was performed: a proximal suture was cut at 1 minute; a distal suture was cut at 2 minutes. The impact of suture rupture was compared by measuring total arthrotomy leakage over 3 minutes. Mean total leakage was 601 mL and 174 mL in the control and experimental groups, respectively (p = 0.3). In summary, using a cadaveric model, arthrotomies closed with a single bidirectional barbed running suture were statistically significantly more water-tight than those closed using a standard interrupted technique. The sample size was insufficient to determine whether the two closure techniques differed in leakage volume after suture rupture.
haemorrhage >1000 ml, Diabetes, mental disorders. Both suture techniques were 2-layered using a polyglactin 910 multifilament suture (Vicryl Rapid or Vicryl). Treatment A was a continuous suture technique and treatment B was interrupted, inverted stitches. Primary outcomes: Perineal pain and wound healing...... assessed day 1-2 and 10 post partum. Secondary outcomes: patient satisfaction with wound healing, need for secondary repair, superficial pain during intercourse. Data management: Double entry of all data and intention-to-treat analysis. Results The follow up rate was 97%. Baseline data were evenly...
Zheng, J; Xiong, X; Ma, Q; Zhang, X; Li, M
Postpartum haemorrhage (PPH) is a major cause of worldwide maternal mortality and is still associated with significant morbidity. After the B-Lynch suture was reported in 1997, several different uterine compression sutures were found to be successful in controlling PPH. In this paper, we describe another simple variation of the uterine compression suture technique, which was performed without an incision in the uterine wall, without entering the uterine cavity and without suturing the anterior and posterior walls of the uterus together, so minimising the trauma to the uterus. This new uterine compression suture is an effective and safe surgical treatment for PPH caused by atony. It has the potential to apply to intractable PPH after vaginal delivery.
Santos, Marcos P; Gutierrez-Nibeyro, Santiago D; Horn, Gavin P; Johnson, Amy J Wagoner; Stewart, Matthew C; Schaeffer, David J
To compare the mechanical properties of laryngeal tie-forward (LTF) surrogate constructs prepared with steel fixtures and No. 5 braided polyester or braided polyethylene by use of a standard or a modified suture placement technique. 32 LTF surrogate constructs. Surrogate constructs were prepared with steel fixtures and sutures (polyester or polyethylene) by use of a standard or modified suture placement technique. Constructs underwent single-load-to-failure testing. Maximal load at failure, elongation at failure, stiffness, and suture breakage sites were compared among constructs prepared with polyester sutures by means of the standard (n = 10) or modified (10) technique and those prepared with polyethylene sutures with the standard (6) or modified (6) technique. Polyethylene suture constructs had higher stiffness, higher load at failure, and lower elongation at failure than did polyester suture constructs. Constructs prepared with the modified technique had higher load at failure than did those prepared with the standard technique for both suture materials. All sutures broke at the knot in constructs prepared with the standard technique. Sutures broke at a location away from the knot in 13 of 16 constructs prepared with the modified technique (3 such constructs with polyethylene sutures broke at the knot). Results suggested LTF surrogate constructs prepared with polyethylene sutures or the modified technique were stronger than those prepared with polyester sutures or the standard technique.
Aktay, Sevima A; Kowaleski, Michael P
To compare mechanical performance of 2 orientations of the 5 mm Corkscrew® suture anchor with #5 Fiberwire® . In vitro biomechanical study. Suture anchor-suture constructs (n=40). Acute and cyclic tensile loads were applied to suture threaded through eyelets of 40 anchors perpendicular to the long axis of the anchor. Eyelets were positioned so that the suture pull was in line with (anchor rotation angle of 0° [ARA 0]) or 90° (ARA 90) to the eyelet plane. Load at failure, stiffness, and cycles to failure were determined. All constructs failed by suture breakage at the eyelet. Mean load at failure was significantly higher in the ARA 90 group (634 ± 93 N) compared with the ARA 0 group (495 ± 52 N; P=.0015). No significant difference was found between groups for mean number of cycles to failure (270 ± 177 versus 178 ± 109; P=.2166) and stiffness (50 ± 4 versus 48 ± 5 N/mm; P=.3141). The Corkscrew® 5 mm suture anchor with Fiberwire® suture fails via suture breakage at the eyelet under higher acute loads if the suture is loaded at an angle of 90° compared with 0° with respect to the plane of the eyelet. © Copyright 2011 by The American College of Veterinary Surgeons.
Full Text Available Repair success for injuries to the flexor tendon in the hand is often limited by the in vivo behaviour of the suture used for repair. Common problems associated with the choice of suture material include increased risk of infection, foreign body reactions, and inappropriate mechanical responses, particularly decreases in mechanical properties over time. Improved suture materials are therefore needed. As high-performance materials with excellent tensile strength, spider silk fibres are an extremely promising candidate for use in surgical sutures. However, the mechanical behaviour of sutures comprised of individual silk fibres braided together has not been thoroughly investigated. In the present study, we characterise the maximum tensile strength, stress, strain, elastic modulus, and fatigue response of silk sutures produced using different braiding methods to investigate the influence of braiding on the tensile properties of the sutures. The mechanical properties of conventional surgical sutures are also characterised to assess whether silk offers any advantages over conventional suture materials. The results demonstrate that braiding single spider silk fibres together produces strong sutures with excellent fatigue behaviour; the braided silk sutures exhibited tensile strengths comparable to those of conventional sutures and no loss of strength over 1000 fatigue cycles. In addition, the braiding technique had a significant influence on the tensile properties of the braided silk sutures. These results suggest that braided spider silk could be suitable for use as sutures in flexor tendon repair, providing similar tensile behaviour and improved fatigue properties compared with conventional suture materials.
Dave, Paaraj; Senthil, Sirisha; Choudhari, Nikhil; Sekhar, Garudadri Chandra
The aim was to report the outcome of Ahmed glaucoma valve (AGV) (New World Medical, Inc., Rancho Cucamonga, CA, USA) implantation as a surgical intervention following an initial failed combined trabeculotomy + trabeculectomy (trab + trab) in refractory primary congenital glaucoma (RPCG). Retrospective chart review of 11 eyes of 8 patients who underwent implantation of AGV (model FP8) for RPCG between 2009 and 2011. Prior trab + trab had failed in all the eyes. Success was defined as an intraocular pressure (IOP) >5 and ≤ 18 mmHg during examination under anesthesia with or without medications and without serious complications or additional glaucoma surgery. The mean age at AGV implantation was 15.4 ± 4.9 months. The mean preoperative IOP was 28 ± 5.7 mmHg which reduced to 13.6 ± 3.4 mmHg postoperatively at the last follow-up (P AGV implant was successful in a significant proportion of cases.
Uchino, Motoi; Ikeuchi, Hiroki; Matsuoka, Hiroki; Bando, Toshihiro; Okayamaz, Kanako; Takesue, Yoshio; Tomita, Naohiro
Ostomy creation is a fundamental technique. However, little information is available concerning the procedure and the associated complications. We reviewed the relationship between the ostomy procedure and complications. The records of patients who were diagnosed with ulcerative colitis and underwent ostomy creation between January 2007 and July 2012 were reviewed. Stoma complications, including muco-cutaneous dehiscence, fistula and granulation were also reviewed. The study included 176 patients who received interrupted sutures with removal of the stitches and 202 patients who received subcutaneous sutures without removal of the stitches. Among the patients with buried sutures, 108 received braided absorbable sutures and 94 received with mono filament absorbable sutures. The incidence of dehiscence was significantly higher with the interrupted sutures (43.2%) than with the buried sutures (31.2%), although the granulation and fistula rates were not significantly different. Among the patients with buried sutures, fistula (6.4%) and granulation (21.3%) rates were slightly increased with the mono filament sutures compared with the braided sutures, although the differences were not significant. CONCLUSIONS. Suture removal appeared to be an unnecessary manipulation at ostomy creation. Further study for all colorectal surgery is needed to investigate whether the incidence of fistula increases with buried sutures.
Lin, Siying; Gupta, Bhaskar; Rossiter, Jonathan
Minimally invasive glaucoma surgery is a developing area that has the potential to replace traditional glaucoma surgery, with its known risk profile, but at present there are no randomised controlled data to validate its use. We report on a case where sequential bilateral combined ab interno trabeculotomy and lens extraction surgery was performed on a 45-year-old woman with combined uveitic and chronic narrow angle raised intraocular pressure. Maximal medical management alone could not control the intraocular pressure. At 12-month follow-up, the patient had achieved stable intraocular pressure in both eyes on a combination of topical ocular antiglaucomatous and steroid therapies. This case demonstrates the effectiveness of trabecular meshwork ablation via ab interno trabeculotomy in a case of complex mixed mechanism glaucoma. 2016 BMJ Publishing Group Ltd.
Babighian, Silvia; Rapizzi, Emilio; Galan, Alessandro
Ab interno trabeculotomy was performed using the recently developed XeCl excimer laser in 21 eyes of 21 patients with primary open-angle glaucoma refractory to medical therapy. The patients were followed at the Eye Department of S. Antonio Hospital in Padova, for an average of 25.3 +/- 1.3 months. Intraocular pressure (IOP), visual acuity and ocular complications were evaluated. The laser procedure was quick and relatively easy, with minimal manipulation of tissues; complications were clinically insignificant. At the last follow-up, a marked IOP-lowering effect compared to baseline was observed (from 24.8 +/- 2.0 to 16.9 +/- 2.1 mm Hg; -31.8%, p interno excimer laser trabeculotomy seems effective to decrease IOP, serves to reduce the number of antiglaucoma medications and is relatively safe, proving to be a promising therapeutic option in glaucoma surgery. Copyright 2006 S. Karger AG, Basel.
Garcia Filho, Fernando Cal; Guarniero, Roberto; de Godoy Júnior, Rui Maciel; Pereira, César Augusto Martins; Matos, Marcos Almeida; Garcia, Lucas Cortizo
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, and group 2 underwent capsulorrhaphy with titanium anchors. After a four-week postoperative period, the animals were euthanized and the hip joints were frozen. On the same day of the biomechanical studies, after the hip joints were previously unfrozen, the following parameters were evaluated: rigidity, maximum force, maximum deformity and energy. Results There was no relevant statistical difference in rigidity, maximum force, maximum deformity and energy between the simple suture and anchor groups. Conclusion Through biomechanical analyses, using parameters of rigidity, maximum force, maximum deformity and energy, it has been shown that capsulorrhaphy with simple suture and with anchors has similar results in rabbit hip joints. Level of Evidence II, Prospective Comparative Study. PMID:24453618
Liao, Weixiong; Li, Zhongli; Zhang, Hao; Li, Ji; Wang, Ketao; Yang, Yimeng
To compare clinical outcomes of arthroscopic therapy for tibial eminence fracture with nonabsorbable suture and absorbable suture anchor. Between February 2010 and September 2012, a total of 60 tibial eminence fracture patients were treated with nonabsorbable suture fixation or absorbable suture anchor fixation under arthroscopy. Patients with tibial plateau fractures and other significant injuries, including osteochondral lesions, meniscal tear, and anterior cruciate ligament (ACL) or mutiligament injuries, were excluded from the study. Radiographs, anterior drawer test (ADT), Lachman test, Lysholm score, and International Knee Documentation Committee (IKDC) 2000 subjective score were employed to evaluate clinical outcomes in follow-up. A total of 41 patients were analyzed. Among these patients, 22 were treated with nonabsorbable suture fixation and 19 with absorbable suture anchor fixation. According to the modified Meyers-McKeever classification, 15 cases were categorized as type II, 21 as type III, and 5 as type IV fractures. The mean time from injury to surgery was 7.1 days (range, 3 to 12 days). All patients were followed up for a median period of 33.7 months (range, 24 to 45 months). Radiographic evaluation showed optimal reduction immediately after operation and bone union within 3 months in all patients. At the final follow-up, there was no limitation of knee motion range in any patient. Grade II laxity was found in 2 cases from suture group and 1 from suture anchor group, showing no significant difference based on ADT (χ(2) = 0.538, P = .764) and Lachman test (χ(2) = 0.550, P = .760). Lysholm and IKDC 2000 subjective scores were significantly improved (P suture fixation and absorbable suture anchor fixation are equivalent techniques in terms of the clinical efficacy of arthroscopic tibial eminence fracture treatment. Level III, retrospective comparative study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc
Sutura arterial com técnicas contínua e de pontos separados, utilizando-se os fios polipropilene e polidioxanone: estudo experimental em coelhos Arterial suture with continuous and interrupted techniques, using polypropylene and polydioxanone threads: experimental study in rabbits
Nelson Leonardo Kerdahi Leite de Campos
Full Text Available OBJETIVO: Observar o comportamento da sutura arterial em aortas abdominais de coelhos em crescimento, comparando-se as técnicas contínua e com pontos separados, empregando-se dois tipos de fios: Polipropilene 7-0 (inabsorvível e Polidioxanone 7-0 (absorvível. MÉTODOS: Grupos: GI - Controle (sem sutura; GII - Polipropilene, Pontos Separados; GIII - Polipropilene, Contínua; GIV - Polidioxanone, Pontos Separados e GV - Polidioxanone, Contínua. Cada grupo foi subdividido em quatro Momentos de Eutanásia: aos 7, 14, 30 e 60 dias de pós-operatório. Foram avaliados: peso dos animais, diâmetros e pulsos arteriais, estenose, trombose, aderências, aortografia, visibilidade do fio, cicatrização e microscopia. RESULTADOS: a após 60 dias, o local da linha de sutura cresceu de forma significativa em todos os grupos; b a técnica de sutura com pontos separados causou menor estenose da linha de sutura, observada tanto no ato cirúrgico, como na eutanásia dos animais; c no exame histopatológico, as diferenças encontradas entre grupos foram transitórias, não persistindo após 60 dias de pós-operatório. CONCLUSÃO: O polidioxanone mostrou ser a melhor opção, entre os dois fios, para sutura de artérias em crescimento, pois causa pouca ou nenhuma restrição ao crescimento arterial na linha de sutura, mesmo quando se emprega a técnica contínua.PURPOSE: To assess the arterial suture, comparing continuous and interrupted techniques, in abdominal aorta of growing rabbbits, using two types of suture material: Polypropylene 7-0 (nonabsorbable and Polydioxanone 7-0 (absorbable. METHODS: Groups: GI - Control, without arterial suture; GII - Polypropylene, Interrupted technique; GIII - Polipropilene, Continuous technique; GIV - Polydioxanone, Interrupted technique and GV - Polydioxanone, Continuous technique. Each group was subdivided in four Moments of Euthanasia , according with the number of days after surgery: 7 , 14 , 30 and 60 days. The
Qian, Xiaohua; Tan, Hua; Zhang, Jian; Zhuang, Xiahai; Branch, Leslie; Sanger, Chaire; Thompson, Allison; Zhao, Weiling; Li, King Chuen; David, Lisa; Zhou, Xiaobo
Purpose: Spring-assisted surgery is an effective and minimally invasive treatment for sagittal craniosynostosis (CSO). The principal barrier to the advancement of spring-assisted surgery is the patient-specific spring selection. The selection of spring force depends on the suture involved, subtypes of sagittal CSO, and age of the infant, among other factors. Clinically, physicians manually judge the subtype of sagittal CSO patients based on their CT image data, which may cause bias from different clinicians. An objective system would be helpful to stratify the sagittal CSO patients and make spring choice less subjective. Methods: The authors developed a novel informatics system to automatically segment and characterize sutures and classify sagittal CSO. The proposed system is composed of three phases: preprocessing, sutures segmentation, and classification. First, the three-dimensional (3D) skull was extracted from the CT images and aligned with the symmetry of the cranial vault. Second, a “hemispherical projection” algorithm was developed to transform 3D surface of the skull to a polar two-dimensional plane. Through the transformation, an “effective” projected region can be obtained to enable easy segmentation of sutures. Then, the different types of sutures, such as coronal sutures, lambdoid sutures, sagittal suture, and metopic suture, obtained from the segmented sutures were further identified by a dual-projection technique of the midline of the sutures. Finally, 108 quantified features of sutures were extracted and selected by a proposed multiclass feature scoring system. The sagittal CSO patients were classified into four subtypes: anterior, central, posterior, and complex with the support vector machine approach. Fivefold cross validation (CV) was employed to evaluate the capability of selected features in discriminating the four subtypes in 33 sagittal CSO patients. Receiver operating characteristics (ROC) curves were used to assess the robustness
Tasman, A-J; Palma, P
Over the last two decades, the use of the external approach for primary and secondary rhinoplasties has become increasingly popular. This article illustrates the versatility of endonasal techniques for the correction of nasal tip deformities on the basis of four cases. The approach to the nasal tip and the chosen technique as used in 100 consecutive rhinoplasties were reviewed. For primary and revision tip plasty, endonasal approaches were used in 81% of cases. Preferred incisions were the infracartilaginous approach and the transfixion incision. Using these approaches, correction of the tip was achieved by using sutures to reposition and reshape the alar cartilages and the columella without grafts to the nasal tip in most cases. Nasal tip plasty via endonasal approaches using sutures is technically more challenging compared to the external approach with its superior exposure. This drawback is outweighed by less operating time and faster patient recovery. Contrary to the general trend, the authors believe that endonasal tip plasty techniques using sutures can obviate the external approach and grafts in many cases and should form an integral part of the rhino-surgeon's repertoire.
Hu Wen [School of Materials Science and Engineering, Tongji University, 1239 Siping Road, Shanghai 200092 (China); Huang Zhengming [School of Aerospace Engineering and Applied Mechanics, Tongji University, 1239 Siping Road, Shanghai 200092 (China); Liu Xiangyang, E-mail: email@example.com [Department of Physics, National University of Singapore, 2 Science Drive 3, 117542 (Singapore)
The objectives of this work are twofold. Firstly, while most work on electrospinning is limited to the development of only functional materials, a structural application of electrospun nanofibers is explored. Secondly, a drug-loaded tissue suture is fabricated and its various properties are characterized. Braided drug-loaded nanofiber sutures are obtained by combining an electrospinning process with a braiding technique followed by a coating procedure. Two different electrospinning techniques, i.e. blend and coaxial electrospinning, to incorporate a model drug cefotaxime sodium (CFX-Na) into poly(L-lactic acid) (PLLA) nanofibers have been applied and compared with each other. Properties of the braided drug-loaded sutures are characterized through a variety of methods including SEM, TEM and tensile testing. The results show that the nanofibers had a preferable micromorphology. The drug was incorporated into the polymer nanofibers homogeneously, with no cross-linking. The nanofibers maintained their fibrous structures. An in vitro release study indicates that the drug-loaded nanofibers fabricated by blend electrospinning and coaxial electrospinning had a different drug release behavior. An inhibition zone experiment shows that both sutures obtained from the nanofibers of the different electrospinning techniques had favorable antibacterial properties. The drug-loaded sutures had preferable histological compatibility performance compared with commercial silk sutures in an in vivo comparative study.
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
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
Nagaraja, Prem Anand; Shetty, Devi
Surgical suture packs are opened (and external packaging removed) on the operating table prior to surgery. Some of these suture packs may not be used in the surgery for reasons of inappropriateness or change in the surgical technique or following accidental contact with a non-sterile surface. These unused sutures with their foil packs still unopened are sometimes re-sterilized using ethylene oxide to allow for reuse. This re-sterilization of unopened suture packs can be contentious, due to legislation and health regulations in developed countries. The purpose of the present paper was to measure the effect of such repeated gas sterilization on sutures. The knot tensile strength was measured for new sterile sutures and ethylene oxide re-sterilized sutures. The tests were conducted on two available brands of sutures, including both absorbable and non-absorbable synthetic sutures. No statistically significant difference was observed in the tensile strengths between the two sets of sutures, before and after re-sterilization. Some foil packs showed slight crimping after re-sterilization, but remained intact. No humidity was observed inside the foil packs. Re-sterilization of unused suture foil packs can be carried out without loss of tensile strength.
Akagi, Tadamichi; Nakano, Eri; Nakanishi, Hideo; Uji, Akihito; Yoshimura, Nagahisa
Although trabeculotomy is a glaucoma surgical procedure for modest intraocular pressure (IOP) reduction, some eyes exhibit very low IOP during the early postoperative period. To our knowledge, the reason and its effect have not been investigated. To investigate ciliochoroidal detachment (CCD) immediately after ab interno trabeculotomy and evaluate its effect on IOP immediately after surgery. This prospective, observational, case series was conducted at Kyoto University Hospital, Kyoto, Japan. Patients with open-angle glaucoma who underwent ab interno trabeculotomy using a microsurgical device by a single surgeon between July 1, 2014, and May 31, 2015, were included. Thirty-seven consecutive patients were enrolled, 33 of whom were included in the analysis. The dates of the analysis were August 1 to August 15, 2015. Imaging of CCD using anterior-segment optical coherence tomography (AS-OCT). The incidence of CCD immediately after ab interno trabeculotomy and its effect on IOP in the early postoperative period. The study cohort comprised 33 patients. Their mean (SD) age was 69.4 (13.2) years, and 19 (58%) were male. At postoperative day 3, CCD was detected in 14 of 33 eyes (42%) (CCD group) using AS-OCT. The CCD group had shorter axial length (mean [SD], 23.66 [1.67] vs 25.16 [1.59] mm) and thinner central corneal thickness (mean [SD], 505.9 [35.8] vs 533.9 [39.1] μm) than the non-CCD group. Only 5 eyes had CCD at postoperative day 10, and 4 of these eyes had CCD at 1 month after surgery. The postoperative IOPs at all follow-up periods were lower in the CCD group than in the non-CCD group, but the difference in the postoperative IOPs between the groups decreased as time passed. The mean (SD) IOPs for the CCD group vs the non-CCD group were 9.1 (3.0) vs 14.2 (5.8) mm Hg at day 1, 8.4 (2.4) vs 13.4 (5.0) mm Hg at day 3, 11.0 (3.0) vs 15.5 (6.3) mm Hg at day 10, 13.4 (2.4) vs 15.5 (3.3) mm Hg at 1 month, and 13.9 (3.4) vs 15.5 (4.0) mm Hg at 3 months. In several eyes in
Alshomer, Feras; Madhavan, Arul; Pathan, Omar; Song, Wenhui
Sutures have been at the forefront of surgical medicine throughout time. With recent advances in suture technology, it is possible to incorporate biologically active substances to enhance suture function and capability. Bioactive sutures represent a modality interest in controlled drug and cell delivery to traumatic sites. In this article, a comprehensive literature search of key bibliographic databases focusing on suture material fabrication and advanced modification was performed. The history, manufacturing process and cost-effectiveness of bioactive sutures are presented. Several novel modifications to enhance function in drug and growth factor delivery and cell therapy are also reviewed. Different antimicrobial drugs and anaesthetics have been shown to be effective in reducing inflammation and bacterial infection. Cellular therapy represents a unique modality augmenting the surgical repair of various soft tissue injuries. We propose a definition of bio-active sutures as biomaterials that are engineered to have controlled tissue interaction to optimise wound/defect healing, in addition to their essential function in tissue approximation. Copyright© Bentham Science Publishers; For any queries, please email at firstname.lastname@example.org.
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.
Eun, Sang Soo; Lee, Sang Ho; Sabal, Luigi Andrew
There are numerous methods for repairing posterior root tears of the medial meniscus (PRTMM). Repair techniques using suture anchors through a high posteromedial portal have been reported. The present study found that using a knotless suture anchor instead of suture anchor seemed easier and faster because it avoided passing the sutures through the meniscus and tying a knot in a small space. This study describes a knotless suture anchor technique through a high posteromedial portal, and its clinical results. Copyright © 2016 Elsevier B.V. All rights reserved.
Wit, T.; Walbeehm, E.T.; Hovius, S.E.; McGrouther, D.A.
The effect of core suture geometry on the mechanical interaction with the epitenon suture in terms of gap prevention, failure strength and mode of failure was investigated in a flexor tendon repair model. A total of 48 porcine flexor tendons were repaired using three techniques with distinct core
Osei, Daniel A; Stepan, Jeffrey G; Calfee, Ryan P; Thomopoulos, Stavros; Boyer, Martin I; Potter, Ryan; Gelberman, Richard H
To compare the tensile properties of a 3-0, 4-strand flexor tendon repair with a 4-0, 4-strand repair and a 4-0, 8-strand repair. Following evaluation of the intrinsic material properties of the 2 core suture calibers most commonly used in tendon repair (3-0 and 4-0), we tested the mechanical properties of 40 cadaver flexor digitorum profundus tendons after zone II repair with 1 of 3 techniques: a 3-0, 4-strand core repair, a 4-0, 8-strand repair, or a 4-0, 4-strand repair. We compared results across suture caliber for the 2 sutures and across tendon repair methods. Maximum load to failure of 3-0 polyfilament caprolactam suture was 49% greater than that of 4-0 polyfilament caprolactam suture. The cross-sectional area of 3-0 polyfilament caprolactam was 42% greater than that of 4-0 polyfilament caprolactam. The 4-0, 8-strand repair produced greater maximum load to failure when compared with the 2 4-strand techniques. Load at 2-mm gap, stiffness, and work to yield were significantly greater in the 4-0, 8-strand repair than in the 3-0, 4-strand repair. In an ex vivo model, an 8-strand repair using 4-0 suture was 43% stronger than a 4-strand repair using 3-0 suture, despite the finding that 3-0 polyfilament caprolactam was 49% stronger than 4-0 polyfilament caprolactam. These results suggest that, although larger-caliber suture has superior tensile properties, the number of core suture strands across a repair site has an important effect on time zero, ex vivo flexor tendon repair strength. Surgeons should consider using techniques that prioritize multistrand core suture repair over an increase in suture caliber. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Osei, Daniel A.; Stepan, Jeffrey G.; Calfee, Ryan P.; Thomopoulos, Stavros; Boyer, Martin I.; Potter, Ryan; Gelberman, Richard H.
Purpose To compare the tensile properties of a 3-0, 4-strand flexor tendon repair to a 4-0, 4 strand repair and a 4-0, 8-strand repair. Methods Following evaluation of the intrinsic material properties of the 2 core suture calibers most commonly used in tendon repair (3-0 and 4-0), we tested the mechanical properties of 40 cadaver flexor digitorum profundus tendons after zone II repair with one of 3 techniques: a 3-0, 4-strand core repair, a 4-0, 8-strand repair, or a 4-0, 4-strand repair. We compared results across suture caliber for the 2 sutures and across tendon repair methods. Results Maximum load to failure of 3-0 polyfilament caprolactam suture was 49% greater than that of 4-0 polyfilament caprolactam suture. The cross sectional area of 3-0 Supramid was 42% greater than that of 4-0 Supramid. The 4-0, 8 strand, repair produced greater maximum load to failure when compared to the 2 4-strand techniques. Load at 2 mm gap, stiffness, and work to yield were significantly greater in the 4-0, 8-strand repair when compared to the 3-0, 4-strand repair. Discussion In an ex vivo model, an 8-strand repair using 4-0 suture was 43% stronger than a 4-strand repair using 3-0 suture, despite the finding that 3-0 polyfilament caprolactam was 49% stronger than was 4-0 polyfilament caprolactam. These results suggest that, although larger caliber suture has superior tensile properties, the number of core suture strands across a repair site has an important effect on time zero, ex vivo flexor tendon repair strength. Clinical Relevance Surgeons should consider using techniques that prioritize multi-strand core suture repair over an increase in suture caliber. PMID:24342261
Boin, Michael A; Dorweiler, Matthew A; McMellen, Christopher J; Gould, Gregory C; Laughlin, Richard T
Chronic noninsertional Achilles tendinosis can result in an acute Achilles tendon rupture with a short distal stump. In such tendon ruptures, there is a limited amount of adequate tissue that can hold suture, thus presenting a challenge for surgeons who elect to treat the rupture operatively. Adding suture anchors to the repair construct may result in biomechanically stronger repairs compared with a suture-only technique. Controlled laboratory study. Nine paired Achilles-calcaneus complexes were harvested from cadavers. An artificial Achilles rupture was created 2 cm proximal to the insertion on the calcaneus. One specimen from each cadaver was assigned to a suture-only or a suture anchor-augmented repair. The contralateral specimen of the same cadaver received the opposing repair. Cyclic testing was then performed at 10 to 100 N for 2000 cycles, and load-to-failure testing was performed at 0.2 mm/s. This was followed by analysis of repair displacement, gapping at repair site, peak load to failure, and failure mode. The suture anchor-augmented repair exhibited a 116% lower displacement compared with the suture-only repair (mean ± SD, 1.54 ± 1.13 vs 3.33 ± 1.47 mm, respectively; P suture anchor-augmented repair also exhibited a 45% greater load to failure compared with the suture-only repair (303.50 ± 102.81 vs 209.09 ± 48.12 N, respectively; P Suture anchor-augmented repairs performed on acute Achilles tendon ruptures with a short distal stump are biomechanically stronger than suture-only repairs. Our results support the use of suture anchor-augmented repairs for a biomechanically stronger construct in Achilles tendon ruptures with a short distal stump. Biomechanically stronger repairs may lead to less tendon repair gapping and failure, increasing the ability to start early active rehabilitation protocols and thus improving patient outcomes.
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
Alekseev, B N; Voronin, G V
Main factors of hermetic closure of an operative wound in cataract extraction with intracapsular implantation of intraocular lens are discussed. A new method for closure of operation wound in this operation is proposed. Opposition intracorneal mattress sutures are made over the incision plane. Their principal feature is that the thread is not thrown over the external edge of corneal incision, as in traditional non-opposition sutures, and during pulling and suture the thread does not deform the external surface of the cornea in the central zone and hence, causes no postoperative corneal astigmatism. A method combining opposition and interrupted non-opposition sutures is proposed, and various combinations of these sutures are compared. Forty-five patients (45 eyes) were operated on using the proposed technique. Opposition sutures made in accordance with the methods proposed by the authors do not cause high postoperative corneal astigmatism, or it approximates the normal values of corneal astigmatism. A special marker is proposed for preliminary marking of sites for nonperforating incisions on the cornea and the site of cataract incision.
Shao, Kai; Han, Baoqin; Gao, Jinning; Jiang, Zhiwen; Liu, Weizhi; Liu, Wanshun; Liang, Ye
Diacetyl chitin (DAC) is an acidylated chitin obtained using acetic anhydride mixed perchloric acid system. By wet spinning and weaving technique, DAC has been successfully developed into a novel absorbable surgical suture. Thanks to the unique properties of chitins, the potential application of this novel monocomponent multifilament DAC suture may break the monopoly of synthetic polymer sutures in wound closure area. In this study, DAC was synthesized and characterized by multiple approaches including elemental analysis, Fourier transform infrared spectrometry (FTIR), and X-ray diffraction (XRD). In addition, we performed the feasibility assessment of DAC suture (USP 2-0) as absorbable suture for wound healing. Several lines of evidences suggested that DAC suture had comparable mechanical properties as synthetic polymer sutures. Moreover, DAC suture retained approximately 63% of the original strength at 14 days and completely absorbed in 42 days with no remarkable tissue reaction in vivo. Most important of all, DAC suture significantly promoted skin regeneration with faster tissue reconstruction and higher wound breaking strength on a linear incisional wound model. All these results demonstrated the potential use of DAC suture in short- or middle-term wound healing, such as epithelial and connective tissue. © 2015 Wiley Periodicals, Inc.
Priester, Carolina; Dillaman, Richard M.; Gay, D. Mark
The ecdysial suture is the region of the arthropod exoskeleton that splits to allow the animal to emerge during ecdysis. We examined the morphology and composition of the intermolt and premolt suture of the blue crab using light microscopy and scanning electron microscopy. The suture could not be identified by routine histological techniques; however 3 of 22 fluorescein isothiocyanate-labeled lectins tested (Lens culinaris agglutinin, Vicia faba agglutinin, and Pisum sativum agglutinin) differentiated the suture, binding more intensely to the suture exocuticle and less intensely to the suture endocuticle. Back-scattered electron (BSE) and secondary electron observations of fracture surfaces of intermolt cuticle showed less mineralized regions in the wedge-shaped suture as did BSE analysis of premolt and intermolt resin-embedded cuticle. The prism regions of the suture exocuticle were not calcified. X-ray microanalysis of both the endocuticle and exocuticle demonstrated that the suture was less calcified than the surrounding cuticle with significantly lower magnesium and phosphorus concentrations, potentially making its mineral more soluble. The presence or absence of a glycoprotein in the organic matrix, the extent and composition of the mineral deposited, and the thickness of the cuticle all likely contribute to the suture being removed by molting fluid, thereby ensuring successful ecdysis.
Shih, Chien-An; Chiang, Florence L; Hong, Chih-Kai; Lin, Cheng-Wei; Wang, Ping-Hui; Jou, I-Ming; Su, Wei-Ren
There are several methods for long head of the biceps (LHB) tenodesis, yet the optimal option is still debatable. Here we introduce a technique for arthroscopic suprapectoral biceps tenodesis with an all-suture anchor, the transtendinous biceps tenodesis technique. The LHB tenodesis is performed by using the Y-Knot anchor (1.3-mm). A standard suprapectoral approach is used for the tenodesis. A 1.3-mm drill bit is used to drill through the midportion of the biceps tendon and underlying bone to make a pilot hole. Next, the Y-Knot anchor is passed through the tendon and anchored on the underlying bone. A wrapping suture technique is then used to wrap around, tension, and secure the LHB tendon with the aid of a shuttling polydioxanone suture. The construct is fixed by tying down both suture limbs in a nonsliding fashion. This Technical Note describes an alternative method for all-arthroscopic suprapectoral biceps tenodesis using an all-suture anchor with a small diameter to minimize trauma to the tendon.
Bainbridge, J W; Teimory, M; Kirwan, J F; Rostron, C K
To evaluate the performance of a 10/0 monofilament absorbable polyglactin suture for temporal 5.2 mm corneal incision phacoemulsification. A prospective randomised controlled study of 49 patients undergoing phacoemulsification with a sutured temporal 5.2 mm corneal section was conducted to compare the refractive results and complications of a 10/0 monofilament absorbable polyglactin suture with 10/0 nylon. Thirty-eight patients completed the study. There was no significant difference in induced astigmatism between the two groups. All absorbable sutures were intact at 1 week. Six weeks post-operatively the absorbable suture was still intact in 1 (6%) patient, present but broken in 4 (24%) and completely absent in 12 (70%) patients. All polyglactin sutures had been completely absorbed by 12 weeks. Absorption of the polyglactin sutures was associated with mild localised corneal haze in 3(18%) cases (p = 0.055). One of the 18 patients (6%) in the polyglactin suture group presented with iris prolapse associated with knot failure 1 week post-operatively. There was no significant difference in foreign body symptoms between the two groups. 10/0 polyglactin sutures maintain adequate tensile strength during the immediate post-operative period for small incision surgery and are associated with minimal induction of astigmatism. Their subsequent absorption obviates the need for routine suture removal. Suture absorption is well tolerated although in some cases a mild degree of local tissue reaction raises concern about possible mechanisms of absorption. The risk of knot failure may be reduced by an alternative suture tying technique. 10/0 monofilament polyglactin is an attractive option when a suture is required during small incision cataract surgery.
Acosta Rodríguez, Eduardo; Almazán Díaz, Arturo
It is necessary to slide the suture into the articulation in the arthroscopic techniques, this produce friction and abrasion of the suture, this is the principal cause of failure in the union of anchor-suture. We used a Fastak 2.4 anchor, Sawbones, No 2 Ethibond, No 2 Fiberwire and No 2 Herculine. Each suture was introduce to the anchor eyelet and was cycled in four times with 40N. The angles of traction were 0 degrees and 45 degrees at the same direction of the anchor eyelet and 45 degrees with different direction of the anchor eyelet. Five sutures were used in every test. We performed the Kolmogorov-Smirnof and "t" Student tests. In all the tests there were a significant differences. The strength of the suture is affected by the abrasion in the anchor eyelet.
This review article examines the mechanical factors involved in tendon repair by sutures. The repair strength, repair stiffness and gap resistance can be increased by increasing the number of core strands and anchor points, by increased anchor point efficiency and the use of peripheral sutures, and by using thicker sutures. In the future, laboratory tests could be standardized to a specific animal model and to a defined cyclic motion programme. Clinical studies support the use of multi-strand core and peripheral sutures, but two-strand core sutures are not adequate to ensure consistently good clinical results. Training surgeons in complex tendon repair techniques is essential.
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.
De Sousa, R; Sutcliffe, M; Rousset, N; Holmes, M; Langley-Hobbs, S J
To determine whether a lateral suture placed with bone anchors between quasi-isometric points in a cat is superior to a standard fabella-tibial suture for the stabilization of cranial cruciate ligament (CrCL) rupture compared to an intact stifle joint. Biomechanical cadaveric study. Six stifle joints with intact cruciate ligaments from three skeletally mature cats were placed in a loading mounting set and tested with axial loads of 20N and 60N at three different joint angles (75°,130° and 160°). The procedure was repeated with a transected CrCL; a stabilized stifle joint after a combination of three lateral suture techniques (fabella-tibial suture technique [SFT]; femoro-tibial suture technique 1 [FTS-1] and femoro-tibial suture technique 2 [FTS-2]). Radiographic examination of the relative position of the tibia to the fixed femur was compared. Stabilization of the stifle joint with lateral sutures had comparable stability to the intact specimens in the cranio-caudal direction (p = 0.2) but not in the proximo-distal direction for the SFT (p = 0.04) and FTS-2 technique (p = 0.03). There was no significant difference between the three stabilization techniques (p >0.05). Lateral sutures placed with bone anchors at quasi-isometric points performed better than SFT and FTS-2 in stabilizing the feline stifle after CrCL rupture in the proximo-distal plane. Biomechanical stability in the cranio-caudal plane after placement of a lateral suture across the feline stifle was similar to the intact CrCL.
Full Text Available Purpose. To compare the biomechanical properties of 3 suture-bridge techniques for rotator cuff repair. Methods. Twelve pair-matched fresh-frozen shoulder specimens were randomized to 3 groups of different repair types: the medially Knotted Suture Bridge (KSB, the medially Untied Suture Bridge (USB, and the Modified Suture Bridge (MSB. Cyclic loading and load-to-failure test were performed. Parameters of elongation, stiffness, load at failure, and mode of failure were recorded. Results. The MSB technique had the significantly greatest load to failure (515.6±78.0 N, P=0.04 for KSB group; P<0.001 for USB group, stiffness (58.0±10.7 N/mm, P=0.005 for KSB group; P<0.001 for USB group, and lowest elongation (1.49±0.39 mm, P=0.009 for KSB group; P=0.001 for USB group among 3 groups. The KSB repair had significantly higher ultimate load (443.5±65.0 N than USB repair (363.5±52.3 N, P=0.024. However, there was no statistical difference in stiffness and elongation between KSB and USB technique (P=0.396 for stiffness and P=0.242 for elongation, resp.. The failure mode for all specimens was suture pulling through the cuff tendon. Conclusions. Our modified suture bridge technique (MSB may provide enhanced biomechanical properties when compared with medially knotted or knotless repair. Clinical Relevance. Our modified technique may represent a promising alternative in arthroscopic rotator cuff repair.
Grimsby, G M; Keays, M A; Villanueva, C; Bush, N C; Snodgrass, W T; Gargollo, P C; Jacobs, M A
Laparoscopic hernia repair with percutaneous ligation of the patent processes vaginalis is a minimally invasive alternative to open inguinal herniorrhaphy in children. With the camera port concealed at the umbilicus, this technique offers an excellent cosmetic result. It is also faster than the traditional laparoscopic repair with no differences in complication rates or hospital stay. The goal of this study was to describe a series of consecutive patients, emphasizing the impact of suture materials (absorbable vs. non-absorbable) on hernia recurrences. A retrospective review was performed of consecutive transperitoneal laparoscopic subcutaneous ligations of a symptomatic hernia and/or communicating hydrocele by 4 surgeons. Patients > Tanner 2 or with prior hernia repair were excluded. The success of the procedure and number of sutures used was compared between cases performed with absorbable vs. non-absorbable suture. Risk factors for surgical failure (age, weight, number of sutures used, suture type) were assessed with logistic regression. 94 patients underwent laparoscopic percutaneous hernia ligation at a mean age of 4.9 years. Outcomes in 85 (90%) patients with 97 hernia repairs at a mean of 8 months after surgery revealed 26% polyglactin vs 4% polyester recurrences (p = 0.004) which occurred at mean of 3.6 months after surgery, Table 1. Repairs performed with non-absorbable suture required only 1 suture more often than those performed with absorbable suture (76% vs 60%, p = 0.163). Logistic regression revealed suture type was an independent predictor for failure (p = 0.017). Weight (p = 0.249), age (p = 0.055), and number of sutures (p = 0.469) were not significantly associated with recurrent hernia. Our review of consecutive hernia repairs using the single port percutaneous ligation revealed a significantly higher recurrent hernia rate with absorbable (26%) versus non-absorbable (4%) suture. This finding remained significant in a logistic regression model
Sull, Alan; Inceoglu, Serkan; August, Alicia; Gregorius, Stephen; Wongworawat, Montri D.
Background: Barbed suture use has become more popular as technology and materials have advanced. Minimal data exist regarding performance of the 2 commercially available products, V-LocTM and StratafixTM in tendon repairs. The purpose of this study was to compare gap resistance and ultimate tensile strength of both suture materials and nonbarbed suture in a porcine ex vivo model. Methods: Porcine flexor tendons were harvested and divided into 3 groups of 10 of varying suture material (3-0 PDS™, 3-0 V- V-Loc 180™, or 3-0 Stratafix™). A modified 4-strand cruciate technique was used to repair each tendon. Knotless repair was performed using barbed suture, whereas a buried 6-throw square knot was done using conventional suture. A servohydrolic tester was used for biomechanical testing of linear 2-mm gap resistance and maximum tensile strength. Results: No difference was found in 2-mm gap resistance among the 3 groups. No difference was found in ultimate tensile strength between V-Loc™ (76.0 ± 9.4 N) and Stratafix™ (68.1 ± 8.4 N) repairs, but the ultimate strength of the PDS™ control group (83.4 ± 10.0 N) was significantly higher than that of Stratafix™. Conclusions: Barbed (knotless) and nonbarbed suture repairs demonstrate equivalent 2-mm gap resistance. Stratafix™ repairs show slightly inferior performance to nonbarbed repairs in ultimate tensile strength, although this occurred at gap distances far beyond the 2-mm threshold for normal tendon gliding. Both barbed and nonbarbed 4-strand cruciate flexor tendon repairs may require peripheral repair to withstand physiologic loads. PMID:28149217
Berger, Cezar Augusto Sarraf
Full Text Available Introduction: Several techniques can be performed to improve nasal tip definition such as cartilage resection, tip grafts, or sutures. Objective: To evaluate the outcome of lateral intercrural suture at the lower lateral cartilage by endonasal rhinoplasty with a basic technique without delivery in decreasing the angle of domal divergence and improving the nasal tip definition. Method: This prospective study was performed in 64 patients in which a suture was made on the board head of the lower lateral cartilage in the joint between the dome and lateral crus, using polydioxanone (PDS with sharp, curved needle. Results: In all of the cases, better definition of the nasal tip was achieved by intercrural suturing for at least 6 months postoperatively. Conclusion: Lateral intercrural suture of the lower lateral cartilage provides improved nasal tip definition and can be performed by endonasal rhinoplasty without delivery in the Caucasian nose.
In this article, the author describes the mandibular degloving injury, characterized by the separation of periosteum and soft tissues of the anterior buccal side of the mandible, and the bone suture technique. This article outlines that a correct diagnostic assessment and appropriate treatment plan can reduce the complications ...
Werblin, T P
Radial suturing of 6.5-millimeter scleral tunnel incisions following cataract surgery can create significant with-the-rule astigmatism in the immediate postoperative period. Because of the significant visual distortion and slow visual recovery seen with radial suturing, this study was undertaken to compare two other suturing techniques which induce lesser amounts of with-the-rule astigmatism in the immediate postoperative period. The refractive behavior of eyes closed with loose radial sutures and with horizontal sutures was compared to the behavior of eyes closed with the more traditional "tight" radial sutures following phacoemulsification surgery. Eyes sutured with loosely tied radial sutures demonstrated minimal with-the-rule cylinder immediately following surgery (1.25 D) and showed a more rapid stabilization of astigmatism than did the eyes tied with tight radial sutures, 2 months versus up to 6 months. However, the eyes tied with horizontal sutures, which showed no induced with-the-rule astigmatism at the time of surgery, showed even more rapid stabilization between 5 days and 1 month from the time of surgery. To get the most rapid visual rehabilitation following cataract surgery, a wound closure which generates no induced with-the-rule cylinder such as horizontal sutures would be required.
Burks, David; Rosenbury, Sarah B.; Kennelly, Michael J.; Fried, Nathaniel M.
Complications from polypropylene mesh after surgery for female stress urinary incontinence (SUI) may require tedious surgical revision and removal of mesh materials with risk of damage to healthy adjacent tissue. This study explores selective laser vaporization of polypropylene suture/mesh materials commonly used in SUI. A compact, 7 Watt, 647-nm, red diode laser was operated with a radiant exposure of 81 J/cm2, pulse duration of 100 ms, and 1.0-mm-diameter laser spot. The 647-nm wavelength was selected because its absorption by water, hemoglobin, and other major tissue chromophores is low, while polypropylene absorption is high. Laser vaporization of ~200-μm-diameter polypropylene suture/mesh strands, in contact with fresh urinary tissue samples, ex vivo, was performed. Non-contact temperature mapping of the suture/mesh samples with a thermal camera was also conducted. Photoselective vaporization of polypropylene suture and mesh using a single laser pulse was achieved with peak temperatures of 180 and 232 °C, respectively. In control (safety) studies, direct laser irradiation of tissue alone resulted in only a 1 °C temperature increase. Selective laser vaporization of polypropylene suture/mesh materials is feasible without significant thermal damage to tissue. This technique may be useful for SUI procedures requiring surgical revision.
Saleh, Farid; Palmieri, Beniamino; Lodi, Danielle; Al-Sebeih, Khalid
Background and aim: The increasing number of surgical procedures performed with local anesthesia, followed by immediate patient discharge from the hospital, emphasizes the need for a tight waterproof suture that is capable of maintaining its tensile strength in the postoperative phase when the wound tumescence, edema due to the anesthetic drug, and surgical trauma disappear. Moreover, the issue of having an accurate surgical wound closure is very relevant in vivo in order to prevent hemorrhage and exogenous microbial infections. This study aimed at designing a new a lab technique that could be used for evaluating the best surgical material. Using such a technique, we compared the wound-lip-sealing properties of three commonly-used suture threads, namely polyurethane, polypropylene, and polyamide. Materials and methods: The mechanical properties of same-size suture threads made from polyurethane, polypropylene, and polyamide, were compared in order to define the one that possess the best elastic properties by being able to counteract the tension-relaxation process in the first 12 hours following surgery. The tension holding capacity of the suture materials was measured in both in vivo and in vitro experiments. The surface area of the scar associated with the three different suture threads was measured and compared, and the permeability of the three different suture threads was assessed at 0 minute, 2 minute, 4 minute, 6 minute, and 8 minute- interval. Results: Results showed that polyurethane suture threads had significantly (P suture threads. Moreover, polyurethane suture threads were significantly (P suture thread types (polypropylene and polyamide). This impermeability was also associated with a tighter wound-lip-sealing ability, and with significantly (P suturing. This always raises the question about which suture to use to avoid the above problems. This study provides evidence that the new technique developed in our lab could be used to compare the wound
Kataoka, Toshiyuki; Kuriyama, Kohji; Yasui, Yukihiko
Few cases in which open reduction and internal fixation was performed for displaced pisiform fractures have been reported. We present a new surgical technique for the treatment of depressed intra-articular pisiform fractures. First, the depressed fragment was reduced by pushing the bone tamp. Then, the fracture void resulting from the reduction of the depressed fragment was filled with a shaped hydroxyapatite block. Finally, the fragments were sutured using braided polyblend polyethylene sutures. The postoperative radiography could achieve a well-reduced articular facet, and this procedure had a good clinical outcome.
Hagstrom, Lindsey S; Marzo, John M
The goal of this study was to determine which suture repair technique better restores glenoid labrum height: horizontal sutures or simple sutures. Sixteen cadaveric glenoids, 8 per repair technique, were used to measure native labral height at the 3:00 to 6:00 positions in half-hour increments. A Bankart lesion was then created from 3:00 to 6:30. Height measurements at each time point were again taken after creation of the Bankart lesion. Repair with a 3-mm knotted suture anchor was then performed at 3:30, 4:30, and 5:30 with either a simple or horizontal suture technique, and postrepair heights were measured across all time points. Significant decreases in height, as compared with native height, were observed at 3:30, 4:30, and 5:30 in the simple repair group. Decreases in height of 1.4 mm (P = .044), 2.1 mm (P = .030), and 1.1 (P = .034) were observed at 3:30, 4:30, and 5:30. There was no significant decrease in height at these respective time points in the horizontal repair group. The in vitro horizontal mattress suture technique better restores labral height and anatomy when compared with a simple suture technique in the repair of acute Bankart lesions. Compared with the simple suture technique, horizontal suture repair may provide increased stability to the glenohumeral construct. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Hapa, Onur; Akşahin, Ertuğrul; Erduran, Mehmet; Davul, Serkan; Havitçioğlu, Hasan; LaPrade, Robert F; Bozdağ, Ergun; Sünbüloğlu, Emin
Comparison of the mechanical characteristics of meniscal repair fixation using horizontal sutures and six different sutures under submaximal cyclic and load to failure test conditions may aid physicians in selecting a suture type. A 2-cm long anteroposterior vertical longitudinal incision was created in six groups of bovine medial menisci. Lesions were repaired using a No. 2 suture either composed of polyester or polyester and ultra high-molecular weight polyethylene (UHMWPE), or UHMWPE and polydioxanone or pure UHMWPE. Endpoints included ultimate failure load (N), pull-out stiffness (N/mm), pull-out displacement (mm), cyclic displacement (mm) after 100cycles, after 500cycles, and mode of failure. Polyester suture had lower ultimate load than all groups except the suture composed of polyester and UHMWPE (Psuture had higher ultimate failure load than sutures composed of either polyester or polyester plus UHMWPE (Psuture cutting through the meniscus for the groups except for polyester suture which failed by suture rupture. Under cyclic loading conditions in bovine meniscus, braided polyester suture fixation provided lower initial fixation strength than fixation with various high strength sutures composed of pure UHMWPE or a combination of absorbable monofilament polydioxanone and UHMWPE, except for combination of polyester and UHMWPE sutures. Present study does not support the usage of the braided polyester sutures instead of high strength sutures composed either partially or totally of ultra-high molecular weight polyethylene for the horizontal suture configuration of meniscus repair. Copyright © 2012 Elsevier B.V. All rights reserved.
Kahlenberg, Cynthia A; Garcia, Grant H; Degen, Ryan M; Liu, Joseph N; Dines, Joshua S
In arthroscopic remplissage, surgeons may inadvertently pass sutures through the teres minor rather than the infraspinatus tendon. This misplacement of the sutures may lead to poor outcomes. The authors describe the novel use of the posterior band of the inferior glenohumeral ligament, known as the "wave sign," as a reliable intra-articular landmark for suture anchor placement to improve suture passage accuracy. Twelve cadaveric shoulders underwent arthroscopic remplissage by a fellowship-trained surgeon. During the first phase of the study, remplissage was performed on 6 specimens with standard technique. The intra-articular wave sign was visualized on all specimens. Specimens were dissected to the level of the joint, and the location of each suture anchor and suture pass was noted. Using the results from the first set of specimens, the surgeon performed remplissage in the second set of 6 specimens using specific measurements from intra-articular landmarks. On dissection of the initial 6 specimens, 75% of sutures were passed through the infraspinatus and 25% were passed through the teres minor. For the remaining 6 specimens, care was taken to place 1 suture anchor at the superior edge of the wave sign and 1 suture anchor 1 cm superior to the wave sign. When suture anchors were successfully passed above the superior tip of the wave sign, the likelihood of infraspinatus tendon penetration was 17 times greater. Placement of the suture anchors at or above the superior tip of the intra-articular wave sign most reliably produced capsulotenodesis of the infraspinatus muscle. [Orthopedics. 2017; 40(5):e831-e835.]. Copyright 2017, SLACK Incorporated.
Chen, Jeffrey S; Novikov, David; Kaplan, Daniel J; Meislin, Robert J
To directly compare single-loaded suture anchors (SSA) with double-loaded suture anchors (DSA) to help surgeons optimize the operative technique, time, and cost of Bankart repairs. A literature review was performed using the PubMed and SCOPUS databases. Studies that directly compared SSA and DSA for Bankart repairs, or indirectly compared them by collecting relevant data despite a different objective, were included. A total of two studies were included, both of which were cadaveric laboratory studies. A total of 28 shoulders were tested. Tests conducted include loading to failure and cyclic loading. One study found SSA to be biomechanically equivalent to DSA, and one found DSA to be superior. Based on limited cadaveric study, DSA are at least equivalent biomechanically to SSA, and may be superior. By using DSA, surgeons create repair constructs that are as strong as, or stronger than, those made with SSA, but with fewer anchors. This reduces the amount of holes drilled and implants placed in the glenoid, while also minimizing cost. Quantifying the benefit of additional sutures in a suture anchor can help optimize the quality of repair, time, and cost in arthroscopic shoulder repair. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Tanito, Masaki; Sano, Ichiya; Ikeda, Yoshifumi; Fujihara, Etsuko
To report the first early postoperative results and safety profile after microhook ab interno trabeculotomy (μLOT). This initial retrospective observational case series included 24 consecutive glaucomatous eyes of 17 Japanese patients (7 men, 10 women; mean age ± standard deviation, 66.7 ± 17.9 years) who underwent μLOT. The trabeculotomy extent, surgical time, perioperative complications, interventions for complications and additional glaucoma surgeries during the follow-up for more than 3 months were collected by reviewing the medical and surgical records. The intraocular pressure (IOP), numbers of antiglaucoma medications, logarithm of the minimum angle of resolution visual acuity (VA), anterior chamber (AC) flare and corneal endothelial cell density (CECD) were compared preoperatively and postoperatively. The trabecular meshwork was incised for a mean of 3.6 ± 0.5 clock hours temporally, 3.7 ± 0.5 clock hours nasally and total 7.3 ± 0.6 clock hours during the 6.2 ± 1.6-min surgery. The mean preoperative IOP of 25.9 ± 14.3 mmHg and number of antiglaucoma medication of 3.3 ± 1.0 decreased significantly (p = 0.0002 and p = 0.005, respectively) to 14.7 ± 3.6 mmHg and 2.8 ± 0.8 at the final visit at 188.6 ± 68.8 days postoperatively. Compared with preoperatively, the final VA, AC flare and CECD did not change significantly. Hyphema with niveau formation (nine eyes, 38%) and washout of hyphema (two eyes, 8%) were the most common postoperative complication and intervention, respectively. At the final visit, 19 eyes (79%) achieved successful IOP control of 18 mmHg or less and a 15% reduction or greater. Microhook trabeculotomy normalizes the IOP during the early postoperative period in patients with glaucoma. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Dennis, Christopher; Sethu, Swaminathan; Nayak, Sunita; Mohan, Loganathan; Morsi, Yosry Yos; Manivasagam, Geetha
Surgical sutures are used to facilitate closure and healing of surgical- or trauma-induced wounds by upholding tissues together to facilitate healing process. There is a wide range of suture materials for medical purpose and the main types include absorbable and nonabsorbable. Recently, there is a growth in the development of classes of suture materials based on their properties and capabilities to improve tissue approximation and wound closure. This review outlines and discusses the current and emerging trends in suture technology including knotless barbed sutures, antimicrobial sutures, bio-active sutures such as drug-eluting and stem cells seeded sutures, and smart sutures including elastic, and electronic sutures. These newer strategies expand the versatility of sutures from being used as just a physical entity approximating opposing tissues to a more biologically active component enabling delivery of drugs and cells to the desired site with immense application potential in both therapeutics and diagnostics. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 1544-1559, 2016. © 2016 Wiley Periodicals, Inc.
Nho, Shane J; Frank, Rachel M; Van Thiel, Geoffrey S; Wang, Fan Chia; Wang, Vincent M; Provencher, Matthew T; Verma, Nikhil N
Arthroscopic repair of anterior Bankart lesions is typically done with single-loaded suture anchors tied with simple stitch configuration. The knotless suture anchor will have similar biomechanical properties compared with two types of conventional suture anchors. Controlled laboratory study. Fresh-frozen shoulders were dissected and an anteroinferior Bankart lesion was created. For phase 1, specimens were randomized into either simple stitch (SSA) or knotless suture anchors (KSA) and loaded to failure. For phase 2, specimens were randomized into 1 of 4 repair techniques and cyclically loaded then loaded to failure: (1) SSA, (2) suture anchor with horizontal mattress configuration, (3) double-loaded suture anchor with simple stitch configuration, or (4) KSA. Data recorded included mode of failure, ultimate load to failure, load at 2 mm of displacement, as well as displacement during cyclical loading. For phase 1, the load required to 2 mm displacement of the repair construct was significantly greater in SSA (66.5 +/- 21.7 N) than KSA (35.0 +/- 12.5 N, P = .02). For phase 2, there was a statistically significant difference in ultimate load to failure among the 4groups, with both the single-loaded suture anchor with simple stitch (184.0 +/- 64.5 N), horizontal mattress stitch (189.0 +/- 65.3N), and double-loaded suture anchor with simple stitch (216.7 +/- 61.7 N) groups having significantly (P .05) among the 4 groups in displacement after cyclical loading or load at 2 mm of displacement. Both knotless and simple anchor configurations demonstrated similar single loads to failure (without cycling); however, the knotless device required less single load to displace 2 mm. All repair stitches, including simple, horizontal, and double-loaded performed similarly. The findings may suggest that with cyclical loading up to 25 N there is no difference in gapping greater than 2mm, but a macrotraumatic event may demonstrate a difference in fixation during the initial
Kaya, Mitsunori; Hirose, Toshiaki; Yamashita, Toshihiko
Acetabular chondral carpet delamination is a frequent finding at hip arthroscopy. The cartilage is macroscopically normal but deboned from the subchondral bone, without a disruption at the chondrolabral junction. Arthroscopic anatomic repair of delaminated cartilage is challenging. We propose that a combination of microfracture and use of stitches to press the delaminated cartilage against the subchondral bone using a suture limb offers an effective method to provide an environment for cartilage repair. This article describes the technique of bridging suture repair for carpet delamination in detail; the technique enables the surgeon to stabilize the delaminated acetabular cartilage. Intra-articular soft anchors and an acetabular rim knotless anchor footprint provide a stable repair for delaminated cartilage. This technique is especially helpful in cases with acetabular cartilage carpet delamination.
Kerstein, Ryan L; Sedaghati, Tina; Seifalian, Alexander M; Kang, Norbert
Hypospadias is the most common congenital condition affecting between 1 in 250 and 300 live births. Even in experienced hands, surgery to repair this congenital defect can have a high complication rate. Wound dehiscence is reported to occur in 5% and fistula formation in 6%-40% depending on technique. The choice of suture material has been shown to affect the complication rate although there is (currently) no consensus about the best suture material to use. Ideally, the sutures used for urethroplasty should be absorbable while maintaining sufficient mechanical strength to support the wounds until they are self-supporting and able to resist urinary flow. Previous studies have compared the effects of human urine on different suture materials especially catgut. However, catgut is now banned in Europe. Our study examined the tensile and breaking strength as well as rate of degradation for four types of absorbable suture now commonly used for hypospadias repairs in the UK. We examined the effect of prolonged storage (up to 27 days) in human urine on 6/0 gauge Vicryl, Vicryl Rapide, Monocryl and polydioxanone (PDS) sutures. These four suture materials are commonly used by the senior plastic consultant surgeon (NK) for hypospadias repairs. 50 mm sections of these suture materials were stored in either urine or saline as control. At specified time points, each suture was placed in a uniaxial load testing machine to assess the stress-strain profile and the mechanical load required to break the suture was measured. Exposure to urine reduced the tensile and breaking strength of all the suture materials tested. PDS demonstrated the greatest resilience. Vicryl Rapide was the weakest suture and degraded completely by day 6. Vicryl and Monocryl had similar degradation profiles, but Vicryl retained more of its tensile strength for longer. There is a balance to be struck between the duration that a suture material must remain in any surgical wound and the risk that it causes
Kaya, Baris; Tuten, Abdullah; Daglar, Korkut; Onkun, Murat; Sucu, Seyhun; Dogan, Askin; Unal, Orhan; Guralp, Onur
To evaluate the success rate and possible complications of the B-Lynch uterine compression sutures in women who suffered from postpartum uterine atony unresponsive to medical treatment. A total of 36 women who were managed with the B-Lynch suture, with or without additional surgical procedures following uterine atony unresponsive to medical treatment, were evaluated retrospectively. Sixteen women were primarily managed with the B-Lynch compression sutures, and 11 women had the B-Lynch compression sutures following failure of achievement of hemostasis by ligation of uterine artery alone (n = 4), or uterine artery plus uterine branch of ovarian artery (n = 7). Eight women had bilateral internal iliac artery ligation (BIIAL) following failure of achievement of hemostasis by the B-Lynch compression sutures. Two women (5.5%) underwent post-cesarean hysterectomy. The overall success rate of B-Lynch was 75% (27/36), and the overall success rate of B-Lynch plus BIIAL was 94.4% (34/36). Three women were admitted to the intensive care unit. There was no death related to the hemorrhage in our series. No short-term complications such as uterine necrosis, hematometra, pyometra, or uterine erosion related to the uterine compression suture were observed. Overall success rate of the B-Lynch sutures and B-Lynch sutures plus BIIAL was 75 and 94.4%, respectively. The B-Lynch technique does not necessarily require specific suture material. Uterine devascularization or BIIAL did not increase the risk of the possible short-term complications such as uterine necrosis. In case of failure of the B-Lynch uterine compression sutures, BIIAL may be beneficial to save the uterus.
Nascimento Luiz Roberto do
Full Text Available The techniques of gastrointestinal surgical sutures have been frequently focused in controversial publications. These ones concern not only anastomosis? types but also about thread types and how to apply them. The values of the submucosa as layer of greatest resistence of the digestive tube was already known since the past century. The aim of this study is to avaluate the suture in an extramucosal single-layer suture with double anchoring of the submucosa, a technical detail not found in the searched literature. This experiment was carried out using 36 white,male adults New Zealand, rabbits divided into three groups which differed only regarding day of re-operation and euthanasia, as followed: group I ( 4 days, group II (7 days and group III ( 15 days. Two transversal and parallel gastrotomies were perfomed in the same animal, one distal and other proximal, of with 4 cm extension each. In these gastrotomies two types of sutures were alternated : 1- End-on extramucosal single-layer suture and 2- End-on extramucosal single-layer suture, with double anchoring in the submucosa. Macroscopic and microscopic studies were perfomed on the suture line in both gastrotomies and in each period of euthanasia. Except for the serosa item whose results were similar for both sutures, statiscally, the extramucosal single-layer suture, with double anchoring of submucosa layer showed better macro and microscopic results than the extramucosal single-layer suture in group I (4 days. In the others periods of euthanasia (groups II and III, the statistical results were similar.
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.
Jasinoski, Sandra C; Rayfield, Emily J; Chinsamy, Anusuya
Cranial suture morphology of Lystrosaurus and the generalized dicynodont Oudenodon was investigated to determine the strain environment during mastication, which in turn may indicate a difference in cranial function between the two taxa. Finite element (FE) analysis indicated that less strain accumulated in the cranium of Lystrosaurus during orthal bite simulations than in Oudenodon. Despite the overall difference in strain magnitude, moderate to high FE-predicted strain accumulated in similar areas of the cranium of both taxa. The suture morphology in these cranial regions of Lystrosaurus and Oudenodon was investigated further by examination of histological sections and supplemented by observations of serial sections and computed tomography (CT) scans. The predominant type of strain from selected blocks of finite elements that contain sutures was determined, enabling comparison of suture morphology to strain type. Drawing from strain-suture correlations established in extant taxa, the observed patterns of sutural morphology for both dicynodonts were used to deduce cranial function. The moderate to high compressive and tensile strain experienced by the infraorbital bar, zygomatic arch, and postorbital bar of Oudenodon and Lystrosaurus may have been decreased by small adjustive movements at the scarf sutures in those regions. Disparities in cranial suture morphology between the two taxa may reflect differences in cranial function. For instance, the tongue and groove morphology of the postorbital-parietal suture in Oudenodon could have withstood the higher FE-predicted tensile strain in the posterior skull roof. The scarf premaxilla-nasal suture of Lystrosaurus provided an additional region of sutural mobility in the anterior surface of the snout, suggesting that Lystrosaurus may have employed a different biting regime than Oudenodon. The morphology of several sutures sampled in this study correlated with the FE-predicted strain, although other cranial functional
Brown, Christopher A; Hurwit, Daniel; Behn, Anthony; Hunt, Kenneth J
Anatomic repair is indicated for patients who have recurrent lateral ankle instability despite nonoperative measures. There is no difference in repair stiffness, failure torque, or failure angle between specimens repaired with all-soft suture anchors versus the modified Broström-Gould technique with sutures only. Controlled laboratory study. In 10 matched pairs of human cadaveric ankles, the anterior talofibular ligament (ATFL) was incised from its origin on the fibula. After randomization, 1 ankle was repaired to its anatomic insertion using two 1.4-mm JuggerKnot all-soft suture anchors; the other ankle was repaired with a modified Broström-Gould technique using 2-0 FiberWire. All were augmented using the inferior extensor retinaculum. All ankles were mounted to the testing machine in 20° of plantar flexion and 15° of internal rotation and loaded to failure after the repair. Stiffness, failure torque, and failure angle were recorded and compared using a paired Student t test with a significance level set at P anchors pulled out of bone. The primary mode of failure was pulling through the ATFL tissue. There was no statistical difference in strength or stiffness between a 1.4-mm all-soft suture anchor and a modified Broström-Gould repair with 2-0 FiberWire. The primary mode of failure was at the tissue level rather than knot failure or anchor pullout. The particular implant choice (suture only, tunnel, anchor) in repairing the lateral ligament complex may not be as important as the time to biological healing. The suture-only construct as described in the Broström-Gould repair was as strong as all-soft suture anchors, and the majority of the ankles failed at the tissue level. For those surgeons whose preference is to use anchor repair, this novel all-soft suture anchor may be an alternative to other larger anchors, as none failed by pullout.
Wieser, Karl; Farshad, Mazda; Vlachopoulos, Lazaros; Ruffieux, Kurt; Gerber, Christian; Meyer, Dominik C
To quantify the strength of suture fixation of knotless suture anchors in relation to the anchors' pullout strength and to compare these results with the static friction between different sutures and anchor materials. Suture slippage within the anchor and pullout strength of 4 different knotless suture anchor models were assessed in a bovine bone model. Furthermore, the peak force before onset of slippage of different sutures trapped between increasingly loaded 4-mm rods made of commonly used anchor material (polyetheretherketone, poly-L-lactide acid, metal) was assessed. In all but 1 of the tested anchors, there was a relevantly lower load needed for slippage of the sutures than to pull out the anchor from bone. The mean load to anchor pullout ranged between 156 and 269 N. The load to suture slippage ranged between 66 and 109 N. All sutures were better held between the metal rods (mean, 21; 95% confidence interval [CI], 19.2 to 23.3) than with polyetheretherketone rods (mean, 17; 95% CI, 15.7 to 18.1) or poly-L-lactide acid rods (mean, 18; 95% CI, 17.6 to 18.4). In the case of suture anchors that hold the sutures by clamping, the hold of the suture in the anchor may be far lower than the pullout strength of the anchor from bone, because the sutures just slip out from the anchor through the clamping mechanism. This is well explained by the low static friction achieved between the tested sutures and the test rods made of anchor materials. The use of knotless suture anchors appears quick and easy to perform; however, most of the anchor systems could not even reach half of the anchor pullout strength from bone before suture slippage occurred. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Türker, Mehmet; Yalçinozan, Mehmet; Çirpar, Meriç; Çetik, Özgür; Kalaycioğlu, Barış
Although sutures evolved in last decade and the product spectrum broadened largely, they can be still classified into two: monofilament and multifilament. Sutures are the mainstay of orthopedic procedures like fascial closures, tendon repairs or tenodesis. In every repair, a suture loop is created. This suture loop is prone to failure due to suture elongation, knot slip and suture breakage. As the knot is the stress riser in a suture loop, the majority of acute loop failure occurs just adjacent to the knot. Monofilament sutures have higher bending stiffness and tendency to untie than multifilament sutures. The first throw of monofilament sutures have tendency to untie, which decrease loop tension and result in loss of achieved tissue approximation. Although a common practice is to fix the first throw via a clamp before the locking one is tied, it can be hypothesized that a potential deforming effect can lead to a decrease in ultimate failure load of a monofilament suture loop. Fixing the first throw significantly reduced the ultimate failure load of monofilament nonabsorbable polypropylene sutures (Prolene) (62.2 ± 8 N vs. 72.7 ± 9 N, p = 0.019). The ultimate failure load achieved by monofilament sutures Polyglyconate (Maxon) and Nylon (Ethilon) and braided absorbable Polyglactin (Vicryl) were not affected by fixing the first throw. Under microscopic examination, polypropylene sutures were found to be deformed by clamp fixation, while the others were not. Polypropylene sutures can be easily damaged when it is fixed by a clamp during knot tying. Presented data demonstrated that in real surgical situations clamp fixation of polypropylene knots can damage the suture loop and carry the risk of acute failure of repair site during early rehabilitation.
Yazdany, Tajnoos; Yip, Sallis; Bhatia, Narender N.; Nguyen, John N.
Introduction and hypothesis Our study aimed to identify the rate of suture complications over a 5-year period using braided permanent suture for uterosacral ligament suspension (USLS) surgery. Methods We reviewed the medical records of patients who underwent vaginal uterosacral ligament suspensions using braided polyester suture. Outcome measures included rate and timing of suture complications, patient symptoms post-operatively, efficacy of treatment modalities and surgical success. Results ...
Indeyeva, Y A; Lee, T S; Gordin, E; Chan, D; Ducic, Y
Caudal septal deviation leads to unfavorable esthetic as well as functional effects on the nasal airway. A modification to the tongue-in-groove (TIG) technique to correct these caudal septal deformities is described. With placement of a temporary suspension suture to the caudal septum, manual traction is applied, assuring that the caudal septum remains in the midline position while it is being secured with multiple through-and-through, trans-columellar and trans-septal sutures. From 2003 to 2016, 148 patients underwent endonasal septoplasty using this modified technique, with excellent functional and cosmetic outcomes and a revision rate of 1.4%. This modified TIG technique replaces the periosteal suture that secures the caudal septum to the midline nasal crest in the original TIG technique. This simplifies the procedure and minimizes the risk of securing the caudal septum off-midline when used in endonasal septoplasty. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
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
Deakin, Mark; Stubbs, David; Bruce, Warwick; Goldberg, Jerome; Gillies, Ronald M; Walsh, William R
To assess the effect of suture material, anchor orientation, and anchor eyelet design on the static loading properties of suture anchors. Biomechanical bench study. Two metallic suture anchors, Mitek GII (Mitek, Westwood, MA) and Corkscrew (Arthrex, Naples, FL) and a bioabsorbable anchor (Biocorkscrew; Arthrex) were tested with single strand of No. 2 Ethibond (Ethicon, Norderstedt, Germany) or No. 2 FiberWire (Arthrex) suture. Suture pull angle was varied through 0 degrees, 45 degrees, and 90 degrees with the anchor rotation angle in either a sagittal or coronal plane. Constructs were tested to failure using an MTS 858 Bionix testing machine (Material Testing Systems, Eden Prairie, MN). Peak loads, stiffness, energy to peak load, and failure modes were determined for all samples. FiberWire showed superior static mechanical properties when compared with single-strand Ethibond over all testing conditions (P Suture pull angle had a significant effect on load to failure with both metallic anchors but not on the bioabsorbable anchor (P Suture pull angle and anchor rotation angle play an important role in the failure load of suture when placed in an eyelet. The polyaxial nature of the Biocorkscrew eyelet allows for increased degrees of freedom but introduces failure of the suture eyelet as a new failure mode. The loading direction and placement of the suture anchor plays a role in the performance of the suture anchor-suture complex.
Full Text Available Patellar tendon rupture are rare injuries that are easily missed in acute phases if careful clinical examination is not carried out. The delayed condition is further difficult to treat and augmentation of end to end repair is generally required. However, literature presents no such case of delayed presentation with presence of infection. We here present one such case of delayed presentation of patellar tendon rupture at three weeks in a 52-year-old male patient. Usual techniques were not sufficient to allow early rehabilitation. Technique of suture anchors was planned for repair after thorough debridement. After this intervention, patient was put on aggressive rehabilitation protocol and he gained excellent range of motion. Patient was followed for one year and he showed no loss of movement or signs of infection. We thus recommend using anchor suture repair of patellar tendon that provides a stable and rigid fixation with possibility of early active rehabilitation even in delayed setting.
Legner, Andras; Altorjay, Aron; Juhasz, Arpad; Stadlhuber, Rudolph; Reich, Viktor; Hunt, Brandon; Rothstein, Richard
Introduction. An outpatient transoral endoscopic procedure for gastroesophageal reflux disease (GERD) and obesity would be appealing if safe, effective, and durable. We present the first in human experience with a new system. Methods. Eight patients with GERD (3) and obesity (5) were selected according to a preapproved study protocol. All GERD patients had preprocedure manometry and pH monitoring to document GERD as well as quality of life and symptom questionnaires. Obese patients (body mass index >35) underwent a psychological evaluation and tests for comorbidities. Under general anesthesia, a procedure was performed at the gastroesophageal junction including mucosal excision, suturing of the excision beds for apposition, and suture knotting. Results. One patient with micrognathia could not undergo the required preprocedural passage of a 60 F dilator and was excluded. The first 2 GERD patients had incomplete procedures due to instrument malfunction. The subsequent 5 subjects had a successfully completed procedure. Four patients were treated for obesity and had an average excess weight loss of 30.3% at 2-year follow-up. Of these patients, one had an 8-mm outlet at the end of the procedure recognized on video review—a correctable error—and another vomited multiple times postoperatively and loosened the gastroplasty sutures. The treated GERD patient had resolution of reflux-related symptoms and is off all antisecretory medications at 2-year follow-up. Her DeMeester score was 8.9 at 24 months. Conclusion. The initial human clinical experience showed promising results for effective and safe GERD and obesity therapy. PMID:24623807
Miyawaki, Takaya; Yaguchi, Shigeo; Hanemoto, Tsukasa; Ando, Mikihiko; Kozawa, Tadahiko
To retrospectively evaluate the efficacy and safety of limbal-based trabeculectomy with anchor sutures compared to standard limbal-based trabeculectomy. Limbal-based trabeculectomy was performed with a new technique using anchor sutures, which involved tying the conjunctiva to the sclera at a deep fornix incision to prevent bleb localization induced by slippage of the conjunctival suture scar toward the scleral flap. In this retrospective, comparative, interventional case series, 45 eyes that underwent limbal-based trabeculectomy with anchor sutures and 27 eyes that underwent standard limbal-based trabeculectomy were analyzed (primary surgery). At a target intraocular pressure of 15 mm Hg, the 3-year survival rate using Kaplan-Meier analysis was 76.2% in the limbal-based trabeculectomy with anchor sutures group and 55.6% in the standard limbal-based trabeculectomy group. Bleb morphology analysis using the Moorfields Bleb Grading System showed that blebs in the limbal-based trabeculectomy with anchor sutures group were more diffused than those in the standard limbal-based trabeculectomy group. Limbal-based trabeculectomy with anchor sutures appears to be an effective method for decreasing intraocular pressure and improving morphology of blebs. Copyright 2010, SLACK Incorporated.
Sarnat, B G
A series of experiments was performed on monkeys, rabbits, and turtles to study gross sutural growth of bones. Radiopaque implants in conjunction with serial gross and radiographic measurements were employed. Differences in growth were observed between 5 facial sutures and also the same suture at different times. Growth was greatest at the zygomaticotemporal suture and least at the premaxillomaxillary suture. The nasal bone side of the frontonasal suture grew about twice as fact as the frontal bone side. In the turtle shell the midsagittal suture grew faster than a transverse suture. In all of the animals the rate of sutural growth decreased with increase in age. No gross regional growth disturbance was noted after resection of the frontonasal, midpalatine, or transpalatine sutures. After extirpation of the median palatine suture, it re-formed, in an eccentric position, in a number of instances. We concluded that bone growth that occurred at sutures was secondary or compensatory to some other factor.
Burton, A F; Horstman, C; Mason, D R
To compare suture tension on a simulated lateral fabellotibial suture model using various methods of application of tension, fixation, and suture materials. Veterinarians constructed simulated lateral fabellotibial suture constructs on a tying stand with a force sensor. Participants used combinations of 45 kg test monofilament nylon, metric 7 braided polyethylene, crimps, crimper, or knots, with their choice of instruments to secure the constructs. The tension in completed constructs was measured and comparisons were made between nylon and polyethylene, the use of crimps compared to knots, and the use of a mechanical distractor compared to hand tightening techniques. A value of p tensions generated ranged from 1.4-171.0N. The median tension of nylon sutures (43.9N ± 44.7N) was significantly greater than polyethylene sutures (9.5 N ± 19.6N). The median tension of constructs secured with crimps (62.8N ± 42.4N) was significantly greater than constructs secured with knots (11.8 N ± 14.8N). The mechanical distractor generated significantly higher median tension (78N ± 50.4N), compared to methods without the device (18.6 N ± 25.1N). There was a large variability in the tension generated in simulated lateral fabellotibial constructs. Veterinarians who used nylon, crimps, and the mechanical tensioner generated constructs with greater tensions.
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.
Sparks, Brad S; Nyland, John; Nawab, Akbar; Blackburn, Ethan; Krupp, Ryan; Caborn, David N M
Bankart repair laxity may contribute to pathologic joint instability. This biomechanical study compared two screw-in suture anchor-suture combinations under tensile loads. Twelve pairs of scapulae were implanted with either a 3 mm diameter, 14 mm long poly-L/D-lactide suture anchor with a suture eyelet (Group 1) or a 3.1 mm diameter, 11 mm long polylactide suture anchor with a molded eyelet (Group 2). Constructs were cyclically loaded between 25 and 50 N with a 25 N load increase every 25 cycles. Group 2 displayed greater displacement at failure, had more specimens with > or =2 mm displacement by the 50 N interval (P = 0.014), and had displaced more by 100 N (P suture anchor-suture loops, the rehabilitation timetable, and the timing of return to unrestricted activities.
Safir, Oleg; Williams, Camille K; Dubrowski, Adam; Backstein, David; Carnahan, Heather
...) 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...
Garconnet, J; Foletti, J-M; Guyot, L; Chossegros, C
Because of its anatomical position, the lingual nerve may be severed during oral surgical procedures, such as third molar removal. Early suturing of the nerve promotes better recovery. We describe the end-to-end suture of this nerve. The suture is carried-out under general anesthesia. The approach is made in the mouth floor, in the same way as for submandibular gland lithiasis transoral removal. This approach allows good exposure and some laxity to displace the nerve stumps. The latter can then be sutured under microscope assistance before closing the mucosa. Lingual nerve suture is a simple, quick and inexpensive procedure. Unlike other procedures, it cannot be used in case of large loss of substance because of the small amount of laxity of the nerve. Nerve function recovery is better if performed before the 6th post-traumatic month, and in young patients. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
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.
Angelo Ferreira Passos
Full Text Available Objetivo: Avaliar os resultados da associação trabeculotomia-trabeculectomia (Tro-Trec em pacientes de 12 a 50 anos, com glaucoma moderado ou avançado. Métodos: estudo prospectivo de 19 olhos de 13 pacientes, de 12 a 50 anos (média de 33,77 ± 11,43, submetidos à Tro-Trec e seguidos por 21,6 ± 7,2 (5,1 a 29,7 meses. Resultados: A pressão intraocular, (PIO média inicial de 32,03 ± 10,01 mmHg (variando de 12 a 50, foi reduzida para 9,42 mmHg ± 3,50 (2 e 16, com redução da medicação tópica de 1,47 ± 1,54 (0 a 4 para 0,16 ± 0,37 (0 a 1 medicamentos. A PIO alvo foi atingida em 15 (78,94% olhos. Houve acentuada redução da PIO mesmo em olhos sem bolhas significativas. O procedimento resultou em hipotonia persistente em três olhos. Conclusão: A cirurgia proposta foi eficaz. A acentuada redução da PIO em olhos sem bolhas significativas sugere que, na faixa etária analisada, a trabeculotomia isolada pode ser suficiente para controle da PIO em alguns pacientes. A incidência de hipotonia foi significativa, porém não superior à relacionada à trabeculectomia isolada, para a mesma faixa etária.Purpose: To evaluate the results of the trabeculotomy-trabeculectomy combined procedure in 12 to 50 years old patients with moderate and advanced glaucoma. Methods: Nineteen eyes of thirteen patients underwent a trabeculotomy-trabeculectomy procedure and were prospectively analyzed and followed up for 21,6 ± 7,2 (5,1 a 29,7 months. Results: IOP was reduced from 32,03 ± 10,01 (12 to 50 mmHg to 9,42 ± 3,50 (2 e 16 mmHg with the number of topical medications being reduced from 1,47 ± 1,54 (0 a 4 to 0,16 ± 0,37 (0 a 1. The target IOP was obtained in 15 of the eyes (78,94%. A great IOP reduction was obtained in eyes without significant blebs. Three eyes developed persistent hipotony. Conclusion: The procedure proved to be effective. The IOP reduction in eyes without significant blebs make us to infer that isolated trabeculotomy should be
Brand, Jefferson; Hardy, Richard; Westerberg, Paul
Lateral patellar dislocations can damage the medial patella femoral ligament. Nonoperative care is preferred but some tears may require a surgical intervention. Patella fractures are considered a risk factor after surgery. The technique described in this Technical Note avoids any bone tunnel drilling, which may eliminate the possibility of a patella fracture. The surgical procedure uses periosteal fibro-osseous tunnels to a double-limbed gracilis graft to reconstruct the upper and lower borders as conventionally used for medial patella femoral ligament reconstruction. Once the graft is tensioned, it is sutured to the periosteal fibro-osseous tunnel with 2 sutures on the medial side and at least 1 suture on the lateral side of each periosteal fibro-osseous sleeve. Each of the 2 periosteal fibro-osseous tunnels has 3 to 4 sutures securing the graft. After surgery, the patients complete 5 phases of rehabilitation to reduce swelling and to regain their strength and range of motion.
Chen, Simon X; Lee, Lawrence R; Sii, Freda; Rowley, Adrian
To evaluate the long-term safety and efficacy of a new technique using a modified cow-hitch knot for transscleral suture fixation of posterior chamber intraocular lenses (PC IOLs). Public hospital in Brisbane, Australia. A retrospective chart review was conducted of consecutive patients who had transscleral sutured PC IOL implantation from March 2000 to June 2006 using the new technique, which was modified to eliminate free suture ends and minimize the risk for knot slippage. Data collected included demographic data, ocular history, preoperative and final best corrected visual acuities (BCVAs), preoperative and postoperative intraocular pressure (IOP), and postoperative complications. Eighty-two eyes of 79 patients (51 men, 28 women) with a mean age of 62.5 years+/-18.9 (SD) were included in the study. The mean follow-up was 22.9+/-21.2 months (range 5 to 76 months). The BCVA was 20/40 or better in 45 eyes (54.9%) and 20/200 or worse in 10 eyes (12.2%). The final BCVA was largely determined by the preoperative underlying ocular pathology. Postoperative complications included temporary increased IOP in 14 eyes (17.1%), escalated glaucoma in 7 eyes (8.5%), temporary hypotony in 7 eyes (8.5%), and retinal detachment, hyphema, and irregular astigmatism in 1 eye (1.2%) each. The PC IOLs remained well centered and without tilt in all eyes. The technique provided excellent PC IOL centration in the presence of no adequate capsule support. It was effective and safe for transscleral suturing of PC IOLs.
Junejo, Sameen Afzal; Jatoi, Shafi Muhammad; Khan, Nisar Ahmed
Non Phaco suture less cataract extraction through temporal approach retains most of the advantages of phacoemulsification but can be delivered at lower cost with better visual out come. Extra capsular cataract extraction followed by posterior chamber intraocular lens implantation was performed, on 300 eyes of 250 patients. The technique involved was posterior limbal corneal tunnel incision through temporal approach, followed by implantation of PMMA posterior chamber intraocular lens. Visual acuity at the time of discharge, third post operative week and sixth week was recorded. Surgically induced astigmatism was reported. The uncorrected visual acuity at discharge was 6/18 or better in 63.2% eyes. The best corrected visual acuity was 6/9 and better in 96.0% subjects at six weeks. Poor visual outcome (astigmatism, as the corneal incision was given through temporal approach. Suture less manual extra capsular cataract surgery through temporal approach ensures rapid visual recovery with minimum astigmatism against rule.
Full Text Available A best evidence topic was written according to the structured protocol. The three part question addressed was: [In patients undergoing closure of surgical wounds with sutures] does [keeping the wound dry for the first 48 h after closure] [reduce the incidence of surgical site infections (SSIs]? 4 relevant papers were culled from the literature and appraised. The authors, date, country, population, study type, main outcomes, key results and study weaknesses were tabulated. Current NICE guidelines recommend cleaning surgical wounds with sterile saline only for the first 48 h following skin closure. We found no evidence that washing wounds with tap water during this period increases the incidence of SSIs compared to keeping them dry. Further randomised controlled trials will enable the construction of conclusive systematic reviews and meta-analyses.
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
Song, Taejong; Lee, San-Hui
To compare surgical outcomes between barbed suture and traditional suture used in repair of the vaginal vault during single-port total laparoscopic hysterectomy (TLH). Case-control study (Canadian Task Force classification II-2). Two institutions. One hundred two patients with benign uterine disease. Single-port TLH using barbed suture (n = 43) or traditional suture (n = 59). Patient characteristics (age, body mass index, demographic data), procedures performed, uterine weight, and uterine disease were similar between the 2 study groups. There were also no differences in operative complications, conversion to other surgical approaches, operative blood loss, postoperative pain, and duration of hospital stay between the 2 groups. Use of barbed suture significantly reduced the time required for vaginal cuff suturing (11.4 vs 22.5 minutes; p suture is less technically demanding than traditional suture (p suture in single-port TLH may aid surgeons by reducing operative time, suturing time, and surgical difficulty. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.
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
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
Austin, Daniel C; Keeney, Benjamin J; Dempsey, Brendan E; Koenig, Karl M
wound-related reoperation (OR, 2.73; 95% CI, 0.97-7.69; p = 0.058). A 0.6% (five of 884) arthrotomy failure rate was observed in the barbed cohort while no (0 of 1598) arthrotomy failures were noted in the traditional group (p = 0.003). Deep infections were rare in both groups (two of 884 barbed sutures, 0 of 1598 standard sutures) and could not be compared. Although we saw no difference in overall and wound-related 90-day reoperation rates by suture type with the numbers available, we observed a higher frequency in our secondary question of arthrotomy failures when barbed sutures are used for arthrotomy closure during TKA. Given the widespread use of this closure technique, our preliminary pilot results warrant further investigation in larger multicenter cohorts. Level III, therapeutic study.
Esquivel, Amanda O; Duncan, Douglas D; Dobrasevic, Nikola; Marsh, Stephanie M; Lemos, Stephen E
Rotator cuff tendinopathy is a frequent cause of shoulder pain that can lead to decreased strength and range of motion. Failures after using the single-row technique of rotator cuff repair have led to the development of the double-row technique, which is said to allow for more anatomical restoration of the footprint. To compare 5 different types of suture patterns while maintaining equality in number of anchors. The hypothesis was that the Mason-Allen-crossed cruciform transosseous-equivalent technique is superior to other suture configurations while maintaining equality in suture limbs and anchors. Controlled laboratory study. A total of 25 fresh-frozen cadaveric shoulders were randomized into 5 suture configuration groups: single-row repair with simple stitch technique; single-row repair with modified Mason-Allen technique; double-row Mason-Allen technique; double-row cross-bridge technique; and double-row suture bridge technique. Load and displacement were recorded at 100 Hz until failure. Stiffness and bone mineral density were also measured. There was no significant difference in peak load at failure, stiffness, maximum displacement at failure, or mean bone mineral density among the 5 suture configuration groups (P sutures in the repair should be considered to judge the strength of the repair. Previous in vitro studies have shown the double-row rotator cuff repair to be superior to the single-row repair; however, clinical research does not necessarily support this. This study found no difference when comparing 5 different repair methods, supporting research that suggests the number of sutures and not the pattern can affect biomechanical properties.
Can, Ertu?rul; Ko?ak, Nurullah; Y?cel, ?zlem E?ki; G?l, Adem; ?zt?rk, Hilal Eser; Say?n, Osman
Aim of Study: To describe a simplified ab-interno cow-hitch suture fixation technique for repositioning decentered posterior chamber intraocular lens (PC IOL). Materials and Methods: Two cases are presented with the surgical correction of decentered and subluxated IOL. Ab-interno scleral suture fixation technique with hitch-cow knot in the eye was performed with a ciliary sulcus guide instrument and 1 year follow-up was completed. Results: Both of the patients had well centered lenses postope...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Absorbable surgical gut suture. 878.4830 Section... surgical gut suture. (a) Identification. An absorbable surgical gut suture, both plain and chromic, is an... “Class II Special Controls Guidance Document: Surgical Sutures; Guidance for Industry and FDA.” See § 878...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Absorbable polydioxanone surgical suture. 878.4840... polydioxanone surgical suture. (a) Identification. An absorbable polydioxanone surgical suture is an absorbable... for the device is FDA's “Class II Special Controls Guidance Document: Surgical Sutures; Guidance for...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonabsorbable polyamide surgical suture. 878.5020... polyamide surgical suture. (a) Identification. Nonabsorbable polyamide surgical suture is a nonabsorbable... indicated for use in soft tissue approximation. The polyamide surgical suture meets United States...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Neurosurgical suture needle. 882.4650 Section 882...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4650 Neurosurgical suture needle. (a) Identification. A neurosurgical suture needle is a needle used in suturing during neurosurgical...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Stainless steel suture. 878.4495 Section 878.4495...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4495 Stainless steel suture. (a) Identification. A stainless steel suture is a needled or unneedled nonabsorbable surgical suture composed of 316L...
... 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... suture meets United States Pharmacopeia (U.S.P.) requirements as described in the U.S.P. Monograph for...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Natural nonabsorbable silk surgical suture. 878... Natural nonabsorbable silk surgical suture. (a) Identification. Natural nonabsorbable silk surgical suture... Bombycidae. Natural nonabsorbable silk surgical suture is indicated for use in soft tissue approximation...
Bou, Hideki; Suzuki, Hideyuki; Maejima, Kentarou; Uchida, Eiji; Tokunaga, Akira
This study examined whether subcuticular absorbable sutures actually reduce incisional SSI in patients undergoing surgery for gastrointestinal (GI) cancer. Surgical site infection (SSI) is still a source of major complications in digestive tract surgery. Reportedly, incisional SSI can be reduced using subcuticular suturing. We performed subcuticular suturing using a 4-0 absorbable monofilament in patients undergoing elective surgery for GI cancer beginning in 2008. Using an interrupted technique, sutures were placed 1.5-2.0cm from the edge of the wound, with everted subcuticular sutures created at intervals of 1.5-2.0cm. The control group consisted of cases in which the common subcutaneous suture method using clip. One hundred cases were examined in the subcuticular group. The incidence of SSI was 0% in the subcuticular suture group, compared with 13.9% in the control group; this difference was significant. Incisional SSI can be prevented using the devised subcuticular absorbable sutures in patients undergoing elective surgery for GI cancer.
Tanito, Masaki; Ikeda, Yoshifumi; Fujihara, Etsuko
To report the early postoperative results and safety profile of ab interno microhook trabeculotomy (μLOT) combined with cataract surgery. This retrospective observational case series included 68 consecutive glaucomatous eyes of 23 Japanese men and 25 Japanese women [mean (SD) age, 76.0 ± 8.5 years] who underwent μLOT for intraocular pressure (IOP) and visually relevant cataracts. The LOT site/extent, perioperative complications, and complication treatments were collected from the medical and surgical records. The preoperative and postoperative IOP, numbers of antiglaucoma medications, logarithm of the minimum angle of resolution visual acuity (VA), anterior chamber (AC) flare, and corneal endothelial cell density (CECD) were compared. After small incisional cataract surgery, the trabecular meshwork was incised in the nasal (6 eyes, 3.6 ± 0.5 clock hours), temporal (6 eyes, 3.8 ± 0.8 clock hours), or both nasal and temporal (56 eyes, 6.5 ± 0.6 clock hours) angles. The mean preoperative IOP (16.4 ± 2.9 mmHg) and number of antiglaucoma medications (2.4 ± 1.2) decreased significantly (P control of 15 mmHg or less and IOP reduction of 15% or greater. Combined μLOT and cataract surgery improves IOP and VA during the early postoperative period in patients with glaucoma and cataract.
Petri, M; Dratzidis, A; Brand, S; Calliess, T; Hurschler, C; Krettek, C; Jagodzinski, M; Ettinger, M
This human cadaveric study compares the biomechanical properties of quadriceps tendon repair with suture anchors and the commonly applied transosseous sutures. The hypothesis was that suture anchors provide at least equal results concerning gap formation and ultimate failure load compared with transosseous suture repair. Thirty human cadaveric knees underwent tenotomy followed by repair with either 5.5-mm-double-loaded suture anchors [titanium (TA) vs. resorbable hydroxyapatite (HA)] or transpatellar suture tunnels using No. 2 Ultrabraid™ and the Krackow whipstitch. Biomechanical analysis included pretensioning the constructs with 20 N for 30 s and then cyclic loading of 250 cycles between 20 and 100 N at 1 Hz in a servohydraulic testing machine with measurement of elongation. Ultimate failure load analysis and failure mode analysis were performed subsequently. Tendon repairs with suture anchors yielded significantly less gap formation during cyclic loading (20th-250th cycle: TA 1.9 ± 0.1, HA 1.5 ± 0.5, TS 33.3 ± 1.9 mm, p sutures. Common failure mode was pull-out of the eyelet within the suture anchor in the HA group and rupture of the suture in the TA and TS group. Quadriceps tendon repair with suture anchors yields significantly better biomechanical results than the commonly applied transosseous sutures in this human cadaveric study. These biomechanical findings may change the future clinical treatment for quadriceps tendon ruptures. Randomised controlled clinical trials are desirable for the future. Not applicable, controlled laboratory human cadaveric study.
Aanning, H L; Van Osdol, Andrew; Allamargot, Chantal; Becker, Brandt E; Howard, Thomas C; Likness, Micah L; Merkwan, Courtney E; Tarver, Dan D
A previous study showed that running polypropylene sutures anchored with square knots retain only 75% of their strength compared with half hitches. The aim of this study was to investigate whether anchor knot geometry similarly affects the tensile strength of other types of sutures used in continuous closures. Monofilament and multifilament sutures (all 3-0) were anchored with either square knots or half hitches to 1 tensionometer post, and the running ends were secured to the other. The force required to break the running suture and the site of suture failure were recorded. The running sutures anchored with square knots retained only 50% to 84% of the strength of the identical sutures secured with half hitches (P suture anchored with half hitches is stronger and safer in comparison with the same suture anchored with square knots. This study provokes a fundamental reconsideration of the use of square knots to anchor running sutures. Copyright © 2012 Elsevier Inc. All rights reserved.
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.
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 suture in the treatment of Achilles tendon repair by an Achilles tendon suture-guiding system was associated with a lower incidence of suture reaction; however, functionally the results were not notably different from those using a traditional nonabsorbable suture. We conclude that repair with absorbable sutures is appropriate for Achilles tendon ruptures. Level II, prospective comparative study. © The Author(s) 2015.
Joana de Pinho Tavares; Carlos Augusto Costa Pires Oliveira; Rodolfo Prado Torres; Fayez Bahmad Jr
...: To analyze data published in the literature on the durability of results, their effectiveness, safety, and risk of serious adverse events associated with procedures using several types of threading sutures. Methods...
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; Psutures. 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.
Pietschmann, Matthias F; Fröhlich, Valerie; Ficklscherer, Andreas; Hausdorf, Jörg; Utzschneider, Sandra; Jansson, Volkmar; Müller, Peter E
Suture anchors are increasingly gaining importance in rotator cuff surgery. This means they will be gradually replacing transosseous sutures. The purpose of this study was to compare the stability of transosseous sutures with different suture anchors with regard to their pullout strength depending on bone density. By means of bone densitometry (CT scans), two groups of human humeral head specimens were determined: a healthy and a osteopenic bone group. Following anchor systems were being tested: SPIRALOK 5.0 mm (resorbable, DePuy Mitek), Super Revo 5 mm (titanium, Linvatec), UltraSorb (resorbable, Linvatec) and the double U-sutures with Orthocord USP 2 (partly resorbable, DePuy Mitek) and Ethibond Excel 2 (non-resorbable, Ethicon). The suture anchors/double U-sutures were inserted in the greater tuberosity 12 times. An electromechanical testing machine was used for cyclic loading with power increasing in stages. We recorded the ultimate failure loads, the system displacements and the modes of failure. The suture anchors tended to bring about higher ultimate failure loads than the transosseous double U-sutures. This difference was significant in the comparison of the Ethibond suture and the SPIRALOK 5.0 mm-both in healthy and osteopenic bone. Both the suture materials and the SPIRALOK 5.0 mm showed a significant difference in pullout strength on either healthy or osteopenic bone; the titanium anchor SuperRevo 5 mm and the tilting anchor UltraSorb did not show any significant difference in healthy or osteopenic bone. There was no significant difference concerning system displacement (healthy and osteopenic bone) between the five anchor systems tested. The pullout strength of transosseous sutures is neither on healthy nor on osteopenic bone higher than that of suture anchors. Therefore, even osteopenic bone does not constitute a valid reason for the surgeon to perform open surgery by means of transosseous sutures. The choice of sutures in osteopenic bone is of little
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 suture (320(57) versus 160(56) N; P suture. Histological examination at 8 and 90 days showed complete tissue integration of the mesh suture. The novel mesh suture structure increased the strength of early wound healing in an experimental model. Surgical relevance Traditional sutures have the significant drawback of cutting and pulling through tissues in high-tension closures. A new mesh suture design with a flexible macroporous outer wall and a hollow core allows the tissues to grow into the suture, improving early wound strength and decreasing suture pull-through. This technology may dramatically increase the reliability of high-tension closures, thereby preventing incisional hernia after laparotomy. As suture pull-through is a problem relevant to all surgical disciplines, numerous additional indications are envisioned with mesh suture formulations of different physical properties and materials. © 2015 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.
Lustbader, J M; Lemp, M A
We describe a surgical technique for correction of astigmatism following penetrating keratoplasty performed after all keratoplasty sutures have been removed. Two relaxing incisions of 3 clock hours, at 3/4 depth, 0.5 mm inside the keratoplasty wound are used in combination with two sets of three compression sutures placed 90 degrees from the incisions. Selective removal of the compression sutures allows for a graded reduction in overcorrection. With this technique, a mean preoperative astigmatism in 10 patients of 14.25 diopters was reduced to 6.33 D 3 months postoperatively (P less than .002). There were no intraoperative or postoperative complications such as inadvertent perforation, wound dehiscence, or graft rejection.
Muffly, Tyler M; Tizzano, Anthony P; Walters, Mark D
Summary The purpose of the study is to review the history and innovations of sutures used in pelvic surgery. Based on a review of the literature using electronic- and hand-searched databases we identified appropriate articles and gynaecology surgical textbooks regarding suture for wound closure. The first documented uses of suture are explored and then the article focuses on the use of knotted materials in pelvic surgery. The development of suture of natural materials is followed chronologically until the present time where synthetic suture is implanted during countless surgeries every day. This millennial history of suture contains an appreciation of the early work of Susruta, Celsus, Paré and Lister, including a survey of some significant developments of suture methods over the last 100 years. Most surgeons know little about the history and science of sutures. A retrospective view of suture is critical to the appreciation of the current work and development of this common tool. PMID:21357979
Zollikofer, Christoph P E; Weissmann, John David
Interosseous sutures exhibit highly variable patterns of interdigitation and corrugation. Recent research has identified fundamental molecular mechanisms of suture formation, and computer models have been used to simulate suture morphogenesis. However, the role of bone strain in the development of complex sutures is largely unknown, and measuring suture morphologies beyond the evaluation of fractal dimensions remains a challenge. Here we propose a morphogenetic model of suture formation, which is based on the paradigm of Laplacian interface growth. Computer simulations of suture morphogenesis under various boundary conditions generate a wide variety of synthetic sutural forms. Their morphologies are quantified with a combination of Fourier analysis and principal components analysis, and compared with natural morphological variation in an ontogenetic sample of human interparietal suture lines. Morphometric analyses indicate that natural sutural shapes exhibit a complex distribution in morphospace. The distribution of synthetic sutures closely matches the natural distribution. In both natural and synthetic systems, sutural complexity increases during morphogenesis. Exploration of the parameter space of the simulation system indicates that variation in strain and/or morphogen sensitivity and viscosity of sutural tissue may be key factors in generating the large variability of natural suture complexity. PMID:21539540
Meyermann, R; Ahyai, A; Pini, C
Since the development of microvascular surgery by Jacobson and Suarez, adaptation of vessel ends of less than 1 mm diameter has been performed by means of 8-10 interrupted sutures. Even the finest suture material, however, produces a foreign body reaction. In addition, necrosis of the media can be seen after insertion of interrupted sutures. After the initial demonstration in 1940 that divided nerves could be successfully rejoined by means of factors from the blood coagulation system, this technique was introduced to microsurgery in 1977. The present investigation was carried out on 50 end-to-end anastomoses in rat common carotid arteries. Subsequently, the healing process was studied by light and electron microscopy. The adhesive used was fibrinogen cryoprecipitate (Fibrinkleber-Human-Immuno), which polymerises after simultaneous application of thrombin. Electron microscopy shows no basic difference between the healing after this technique and the healing process after trauma to the vessel wall. This method, however, prevents regional necrosis of the vessel wall and reduces intimal thickening. The condition of the intimal lining appears better than in sutured anastomoses. The question, whether this change is due only to the absence of sutures or due also to application of fibrinogen, cannot be answered, however.
Bar-Sela, Shai M; Spierer, Oriel; Spierer, Abraham
To evaluate 10-0 polyester sutures (Mersilene) and 10-0 absorbable polyglactin sutures (Vicryl) for small-incision congenital cataract surgery. Goldschleger Eye Institute, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel. A retrospective review comprised 51 patients (70 eyes) who had small-incision congenital cataract extraction and intraocular lens implantation between 1999 and 2005. Surgery was done using Mersilene sutures or Vicryl sutures. Retinoscopy and a careful examination for suture-related complications were done 1 week after surgery and then every month for 6 months. The sutures were removed in cases of local tissue reaction but not for high postoperative astigmatism. The t test was used to evaluate postoperative astigmatism and the Fisher exact test, to evaluate the difference in the incidence of suture-related complications. The patients' age ranged from 2 months to 15 years. Ten cases (18%) of corneal vascularization occurred in the Mersilene group during the 6-month follow-up period. This necessitated suture removal, after which 1 incident of endophthalmitis occurred. In contrast, no suture-related complications were noted in the Vicryl group during that time. The difference in the incidence of complications between the 2 groups approached statistical significance (P = .07). Mean astigmatism 1 week postoperatively was 2.3 diopters (D) +/- 2.1 (SD) in the Mersilene group, which was significantly higher than in the Vicryl group (mean 1.4 +/- 1.1 D) (P = .038). However, the mean astigmatism decreased to less than 1.0 D in both groups during the 6-month follow-up period. Vicryl sutures are recommended for small-incision congenital cataract surgery.
Full Text Available Aim of Study: To describe a simplified ab-interno cow-hitch suture fixation technique for repositioning decentered posterior chamber intraocular lens (PC IOL. Materials and Methods: Two cases are presented with the surgical correction of decentered and subluxated IOL. Ab-interno scleral suture fixation technique with hitch-cow knot in the eye was performed with a ciliary sulcus guide instrument and 1 year follow-up was completed. Results: Both of the patients had well centered lenses postoperatively. Corrected distant and near visual acuities of the patients were improved. There was no significant postoperative complication. In the follow-up period of 1 year, no evidence of suture erosion was found. Conclusions: Ab-interno scleral suture loop fixation with hitch-cow knot in the eye was effective in repositioning decentered or subluxated PC IOLs with excellent postoperative centered lenses and visual outcomes.
Can, Ertuğrul; Koçak, Nurullah; Yücel, Özlem Eşki; Gül, Adem; Öztürk, Hilal Eser; Sayin, Osman
To describe a simplified ab-interno cow-hitch suture fixation technique for repositioning decentered posterior chamber intraocular lens (PC IOL). Two cases are presented with the surgical correction of decentered and subluxated IOL. Ab-interno scleral suture fixation technique with hitch-cow knot in the eye was performed with a ciliary sulcus guide instrument and 1 year follow-up was completed. Both of the patients had well centered lenses postoperatively. Corrected distant and near visual acuities of the patients were improved. There was no significant postoperative complication. In the follow-up period of 1 year, no evidence of suture erosion was found. Ab-interno scleral suture loop fixation with hitch-cow knot in the eye was effective in repositioning decentered or subluxated PC IOLs with excellent postoperative centered lenses and visual outcomes.
Brunner, Stefan; Vavken, Patrick; Kilger, Robert; Vavken, Julia; Rutz, Erich; Brunner, Reinald; Camathias, Carlo
To evaluate efficacy and safety of extraphyseal tibial eminence avulsion fracture repair with absorbable sutures and a distal bone bridge fixation in comparison to previously described technique with non-absorbable sutures and distal screw fixation. In a physeal-sparing technique, tibial eminence fractures (n = 25; McKeever type II/III n = 11/14) were either treated in group A (n = 15, follow-up 28.1 months) using an absorbable suture fixed over a bone bridge or in group B (n = 10, follow-up 47.4 months) with a non-absorbable suture wrapped around an extraarticular tibial screw. IKDC and Lysholm scores were assessed, and the difference between the surgical and contralateral knee in anteroposterior (AP) translation, measured with a Rolimeter. There was no significant difference between group A and group B in IKDC and Lysholm scores with 90.1 points ± 10.2 and 94.1 points ± 8.1, respectively (n.s.). AP translation did not differ between groups (n.s.). Eight of ten screws in group B had to be removed in a second intervention. A total of four arthrofibroses were counted (three in group A). Extraphyseal tibial eminence repair with absorbable sutures and a distal bone bridge fixation results in similar rates of radiographic and clinical healing at 3 months after surgery as non-absorbable sutures tied around a screw, while avoiding the need for hardware removal. The minimal invasive technique to fix an eminence fracture without any permanent sutures or hardware is advantageous for children. To our knowledge, this is the first study that compares non-absorbable with absorbable sutures for a physeal-sparing technique. III.
Kim, June; Singh Maan, Harjot; Cool, Alicia J.; Hanlon, Allison M.; Leffell, David J.
Background: Cyanoacrylate topical adhesives and fast absorbing gut sutures are increasingly utilized by dermatologic surgeons as they provide satisfactory surgical outcomes while eliminating an additional patient visit for suture removal. To date, no head-to-head studies have compared the wound healing characteristics of these epidermal closure techniques in the repair of facial wounds after Mohs micrographic surgery. Objective: To compare the cosmetic outcome of epidermal closure by cyanoacr...
Javadi, Mohammad Ali; Feizi, Sepehr; Mirbabaee, Firooz; Rastegarpour, Ali
To find an effective and reliable method to correct astigmatism after deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. This interventional case series included 14 eyes of 14 patients with keratoconus (12 males) undergoing graft refractive surgery (GRS) for intolerable post-DALK astigmatism. The technique of GRS for the 5 initial cases consisted of only relaxing incisions at the steep meridian in the graft-host interface down to Descemet membrane. For the rest, the relaxing incisions at the steep meridian were accompanied by simultaneous suturing and the effect of the relaxing incisions was controlled through selective suture removal starting a few days after the operation. The main outcomes were uncorrected and corrected visual acuity and change in refractive and keratometric astigmatism using subtraction and vector analysis methods. Mean patient age was 29.36 +/- 6.2 years. Mean time interval from complete suture removal to GRS and follow-up period were 4.5 +/- 2.0 months and 12.0 +/- 7.4 months, respectively. Mean preoperative best-corrected visual acuity was 0.29 +/- 0.1, increasing to 0.22 +/- 0.1 logarithm of minimum angle of resolution after the operation (P = 0.007). Average keratometric astigmatism was reduced by 3.8 and 5.5 diopters measured with subtraction and vector analysis methods, respectively. Four of 5 eyes that had only relaxing incisions initially required suturing of the incisions because of overcorrection, whereas preliminary results showed none of the 9 patients undergoing simultaneous relaxing incisions and suturing required further intervention. Relaxing incisions and suturing at the steep meridian followed by selective suture removal can effectively and predictably reduce post-DALK astigmatism in patients with keratoconus.
Roussis, P C; Giannakopoulos, A E; Charalambous, H P
End-to-side vascular anastomosis has a considerable complexity regarding the suturing of the juncture line between the artery and the graft. The present study proposes a stress-concentration methodology for the prediction of the stress distribution at the juncture line, aiming to provide generic expressions describing the response of an end-to-side anastomosis. The proposed methodology is based on general results obtained from the analysis of pipe connections, a topic that has been investigated in recent years in the field of offshore structural engineering. A key aspect for implementing the stress-concentration-factor approach is the recognition that the axial load due to pressure and flow dynamics exerted along the graft axis controls the "hot spots" on the juncture line, which in turn affects the mechanical response of the sutures. Several parameters, identified to influence the suture line response, are introduced in closed-form expressions for the suture line response calculations. The obtained results compare favorably with finite element results published in the literature. The proposed model predicts analytically the suture line response of end-to-side anastomosis, while capturing the influence of and interdependence among the problem parameters. Lower values of the graft radius, the distance between sequential stitches, and the intersecting angle between the artery and the graft are some of the key parameters that reduce the suture line response. The findings of this study are broad in scope and potentially applicable to improving the end-to-side anastomosis technique through improved functionality of the sutures and optimal selection of materials and anastomosis angle.
Consiglio, Fabio; Pizzamiglio, Roberto; Parodi, Pier Camillo; De Biasio, Fabrizio; Machin, Pier Nicola; Di Loreto, Carla; Gamboa, Mabel
Background Silhouette Sutures (Kolster Methods, Inc., Corona, CA) exhibit different biological characteristics at various time points after their placement. Objectives The goals of this study were to understand the biological reactions of Silhouette Sutures in human tissues at different time intervals and to determine the index of resistance of the sutures in subcutaneous tissue. Methods Histologic examination was performed on section soft tissue containing the sutures at 1 month, 3 months, 6 months, and 1 year after suture placement. The study comprised 8 patients, each of whom received 4 sutures in the lower abdomen under local anesthesia. The sutures were placed exactly 1 month, 3 months, 6 months, and 1 year before planned post-bariatric abdominal surgery. Dynamometric evaluation was performed on a never-used suture and on sutures removed from 1 year after placement. The scar process around the threads was also examined. Results A progressive increase in scar tissue around the sutures was observed. One year after placement, there was a reduction of 16.7% in yield and tensile strength and a reduction of 14.29% in elongation at break, relative to the never-used suture. By 1 year, the cones in polylactic and glycolic acids had been replaced by scar tissue. Conclusions Fibrous tissue around the sutures increased progressively over time, and was most prominent at the level of the nodes. Cones were completely resorbed within 6 months. A reduction in the index of resistance of the suspension sutures occurred over 1 year. PMID:26879301
Noone, R Barrett
The elements of midfacial aging include elongation of the lower eyelid, flattening of the malar eminence, hollowing in the submalar area, laxity of the jowls, and deepening of the nasolabial crease. Attention to rejuvenation of these areas has included various techniques involving movement of the superficial musculoaponeurotic system (SMAS) and elevation of the malar fat pad. A trend toward simplification in midface lifting has introduced the use of suspension sutures. This paper describes an approach to midfacial rejuvenation that combines the elements of SMAS plication and lateral SMASectomy with a suture suspension of the malar fat pad to achieve long-lasting improvement of the aging midface. The ptotic malar fat pad is suspended by suture to the deep temporal fascia. The suture passes from the subcutaneous position where it is fixed to the malar fat pad, through the SMAS, and over the periosteum of the zygoma, and is fixed to the deep temporal fascia. Plication of the SMAS over the suture, combined with lateral SMASectomy, provides three vectors of elevation beneath the skin in midface rhytidectomy. This technique was used in 259 patients between October of 2000 and October of 2004, producing effective long-lasting results with limited convalescence and minimal complication rates. Safe dissection in the subcutaneous plane avoids injury to facial nerve branches. Plication of the SMAS with suture suspension of the malar fat pad avoids the prolonged convalescence and other morbidities of extensive sub-SMAS or deep plane dissections. This simplified approach can be quickly and easily performed under local anesthesia as an isolated midface procedure, or can be combined with surgery of the forehead, eyebrows, eyelids, or neck by standard techniques of rejuvenation.
Chmielnicki, M; Prokop, A
Rupture of the Achilles tendon is the most common rupture of a tendon in man. Acute rupture of the Achilles tendon may be treated in a variety of manners, including conservative treatment, open suture and percutaneous suture. Surgical treatment of active patients is recommended, as the risk of re-rupture is greater after non-surgical treatment. The aim of surgery is adequate treatment of Achilles tendon rupture with a low rate of complications, high comfort for patients and fast social and occupational rehabilitation. The indication for surgical treatment of Achilles tendon rupture predominantly includes ruptures in active patients, with the goal of optimal functional rehabilitation. Furthermore, the percutaneous technique protects soft tissue, with a lower rate of wound healing disorders and infection than with open surgical treatment. In our clinic we perform the percutaneous suturing technique with the Dresden instruments. The surgical technique and functional aftercare are shown in a video clip. Between 2007 and 2013, we treated 212 patients with acute Achilles tendon rupture by surgery with the Dresden instruments. There were 7 re-ruptures (3.3 %) and one case of infection within one year of surgery. Percutaneous Achilles tendon suture technique with the Dresden instruments is a safe operation that protects soft tissue. Patient satisfaction is high and the rate of complications is low. This allows rapid social and occupational rehabilitation. Georg Thieme Verlag KG Stuttgart · New York.
Balamurugan, R; Mohamed, Masroor; Pandey, Vijayendra; Katikaneni, Hari Krishna Rao; Kumar, K R Ashok
Any suture material, absorbable or nonabsorbable, elicits a kind of inflammatory reaction within the tissue. Nonabsorbable black silk suture and absorbable polyglycolic acid suture were compared clinically and histologically on various parameters. This study consisted of 50 patients requiring minor surgical procedure, who were referred to the Department of Oral and Maxillofacial Surgery. Patients were selected randomly and sutures were placed in the oral cavity 7 days preoperatively. Polyglycolic acid was placed on one side and black silk suture material on the other. Seven days later, prior to surgical procedure the sutures will be assessed. After the surgical procedure the sutures will be placed postoperatively in the same way for 7 days, after which the sutures will be assessed clinically and histologically. The results of this study showed that all the sutures were retained in case of polyglycolic acid suture whereas four cases were not retained in case of black silk suture. As far as polyglycolic acid suture is concerned 25 cases were mild, 18 cases moderate and seven cases were severe. Black silk showed 20 mild cases, 21 moderate cases and six severe cases. The histological results showed that 33 cases showed mild, 14 cases moderate and three cases severe in case of polyglycolic acid suture. Whereas in case of black silk suture 41 cases were mild. Seven cases were moderate and two cases were severe. Black silk showed milder response than polyglycolic acid suture histologically. The polyglycolic acid suture was more superior because in all 50 patients the suture was retained. It had less tissue reaction, better handling characteristics and knotting capacity.
Wilshire, Candice L; Kaufer, James W; Gorea, Heather R; Sauer, Jude S; Knight, Peter A
A safe and reliable direct percutaneous approach for transapical access to the left ventricle would be a significant advance toward decreasing the invasiveness of intracardiac interventions. This report presents results from a surviving porcine beating heart model in which transapical access sites were closed using an automated suturing technique ultimately intended for percutaneous use. Through an approved protocol including general anesthesia, the cardiac apex in 10 beating pig hearts was surgically exposed, permitting transapical passage of a 0.035-in guidewire and a 5.5F, 0.9-mL Fogarty balloon catheter. An automated suturing device was passed over the guidewire and the Fogarty onto the transapical access site. Two pledgeted horizontal mattress sutures were simultaneously placed concentrically around the apical access site with a single squeeze of the device's lever. A 25F dilator was passed into the left ventricle over the guidewire and subsequently removed. The sutures were then secured using pledgeted titanium knots. Chest wall and skin incisions were closed. The animals were recovered from anesthesia and resumed a normal diet. Under general anesthesia, the transapical access site of each animal was re-exposed, five at 1-week and five at 2-week intervals. Hemostasis was complete, and all wounds healed well. The evaluation of transapical wound closures in this surviving porcine heart model demonstrates complete hemostasis and excellent healing through the use of this automated remote suturing technology.
Hughes, David T; Forest, Stephen J; Foitl, Rosangela; Chao, Edward
Medical students often cite their ability to excel at technical tasks as justification for choosing surgery as a career path. We sought to investigate how medical students' dexterity skills and past experiences correlated with suturing performance. Sixty-four 3rd-year medical students were surveyed about previous experiences that involved manual dexterity. Technical skills were then measured using a validated test of manual dexterity and subcuticular closure of a pig's foot incision. Spearman's rank correlation coefficients determined correlation between variables. Previous experiences, self-assessment of dexterity, prior suturing, and current interest in surgery did not significantly correlate with manual dexterity or suturing skill scores. Innate manual dexterity score was the only significant correlating factor to suture skill score (Spearman's rank correlation coefficient = .336; P = .007). Innate manual dexterity skills are predictive of initial surgical suturing performance regardless of past student experiences. Interventions aimed at improving early surgical technique should be optimally focused on dexterity training. Copyright © 2014 Elsevier Inc. All rights reserved.
Park, Ji Soon; McGarry, Michelle H; Campbell, Sean T; Seo, Hyuk Jun; Lee, Yeon Soo; Kim, Sae Hoon; Lee, Thay Q; Oh, Joo Han
Transosseous-equivalent (TOE) rotator cuff repair can increase contact area and contact pressure between the repaired cuff tendon and bony footprint and can show higher ultimate loads to failure and smaller gap formation compared with other repair techniques. However, it has been suggested that medial rotator cuff failure after TOE repair may result from increased bridging suture tension. To determine optimum bridging suture tension in TOE repair by evaluating footprint contact and construct failure characteristics at different tensions. Controlled laboratory study. A total of 18 fresh-frozen cadaveric shoulders, randomly divided into 3 groups, were constructed with a TOE configuration using the same medial suture anchor and placing a Tekscan sensing pad between the repaired rotator cuff tendon and footprint. Nine of the 18 shoulders were used to measure footprint contact characteristics. With use of the Tekscan measurement system, the contact pressure and area between the rotator cuff tendon and greater tuberosity were quantified for bridging suture tensions of 60, 90, and 120 N with glenohumeral abduction angles of 0° and 30° and humeral rotation angles of 30° (internal), 0°, and 30° (external). TOE constructs of all 18 shoulders then underwent construct failure testing (cyclic loading and load to failure) to determine the yield load, ultimate load, stiffness, hysteresis, strain, and failure mode at 60 and 120 N of tension. As bridging suture tension increased, contact force, contact pressure, and peak pressure increased significantly at all positions (P .05 for all). Increasing bridging suture tension to over 90 N did not improve contact area but did increase contact force and pressure. Bridging suture tension did not significantly affect ultimate failure loads. Considering the risks of overtensioning bridging sutures, it may be clinically more beneficial to keep bridging suture tension below 90 N. © 2015 The Author(s).
Dhinsa, Baljinder Singh; Bhamra, Jagmeet Singh; James, Chris; Dunnet, William; Zahn, Helmut
The medial patellofemoral ligament (MPFL) acts as a soft tissue restraint to lateral subluxation of the patella, and is frequently damaged following patellar dislocation. A number of techniques for repair or reconstructions of the MPFL have been reported. We report two cases of patellar fracture following MPFL reconstruction utilizing suture anchors and bone tunnels that do not completely traverse the patella. The first case occurred seven months after surgery and the second case was at six weeks following surgery. There have been previous reports of patellar fracture following MPFL reconstruction, particularly when patellar tunnels completely traverse the patella. The authors decided to use suture anchors to reduce the risk of patellar fracture, and they feel that the fractures reported in this paper resulted from surgical error rather than system error. We feel that this is an important learning point when initially using this technique, and should be disseminated to other surgeons who undertake this surgery. Copyright © 2013 Elsevier B.V. All rights reserved.
Motta, Pierorazio; Maderni, Alberto; Bruno, Laura; Mariotti, Umberto
Acute acromioclavicular joint dislocations (ACDs) may be treated arthroscopically with flip buttons. This extra-articular fixation is easy to implant and is well tolerated. Between 2007 and 2009, 20 ACD patients (2 women and 18 men; mean age, 32 years) had surgery by the arthroscopic TightRope technique (Arthrex, Naples, FL). The main complication of this technique that has been reported is the partial loss of reduction at follow-up due to clavicular osteolysis under the superior flip button. We describe 4 cases with loss of reduction due to rupture of the sutures running across the buttons: 2 women with joint hyperlaxity and acute Rockwood grade IV ACD and 2 men, heavy manual workers, with joint hyperlaxity and acute Rockwood grade IV ACD. The use of flip buttons might not be indicated in patients with joint hyperlaxity because they are able to obtain immediate stability only on the vertical plane and not on the horizontal plane. Anteroposterior movements of the acromioclavicular joint might rub the suture against the bone tunnels leading to wear and cutting. Copyright Â© 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Jorgensen, L N; Sommer, Thorbjørn; Assaadzadeh, S
BACKGROUND: Many patients develop discomfort after open repair of a groin hernia. It was hypothesized that suture fixation of the mesh is a cause of these symptoms. METHODS: This patient- and assessor-blinded randomized multicentre clinical trial compared a self-gripping mesh (Parietene Progrip......(®) ) and sutured mesh for open primary repair of uncomplicated inguinal hernia by the Lichtenstein technique. Patients were assessed before surgery, on the day of operation, and at 1 and 12 months after surgery. The primary endpoint was moderate or severe symptoms after 12 months, including a combination...... of chronic pain, numbness and discomfort. RESULTS: The intention-to-treat population comprised 163 patients with self-gripping mesh and 171 with sutured mesh. The 12-month prevalence of moderate or severe symptoms was 17·4 and 20·2 per cent respectively (P = 0·573). There were no significant differences...
Porreca, Angelo; Salvaggio, Antonio; Dandrea, Matteo; Cappa, Emanuele; Zuccala, Alessio; Del Rosso, Alessandro; D'Agostino, Daniele
The aim of this study is to analyze the principal advantages of posterior muscolo-fascial reconstruction using knotless barbed sutures (BS) during robot-assisted radical prostatectomy (RARP). We analyzed the available evidence regarding the efficacy and safety of principal BS (Quill SRS Angiotech Pharmaceuticals Inc., Vancouver, Canada; V-Loc Medtronic, Dublin, Ireland; STRATAFIX Ethicon Inc., Somerville, New Jersey; Filbloc® Assut Europe S.p.A., Rome, Italy). We analysed the principal outcomes (operative time and suturing time of urethra-vesical anastomosis, length of catheterization, hospital stay, and postoperative complications rate) reported in literature. In light of our experience, we believe that the utilization of BS during RARP is safe as the development of a new surgical technique of urethrovesical anastomosis offers advantages in terms of continence rate, length of catheterization, and other surgical outcomes. Other studies (prospective trials) are necessary to investigate the real benefits of BS in comparison to conventional sutures (CS).
Ardelt, Michael; Dittmar, Yves; Schulz, Birte; Rauchfuss, Falk; Scheuerlein, Hubert; Settmacher, Utz
Sacro-coccygeal pilonidal sinus disease is classified as an asymptomatic, acutely abscess-forming or chronic subcutaneous inflammation in the sacro-coccygeal region featuring characteristic pits in the bottom cleft. Due to high rates of recurrence, two flap techniques have been established in the course of the past three decades. One of them is the Karydakis operation, the other option is a rotation flap named Limberg procedure. We report about a case of suture granuloma in the area of a Limberg flap after recurrent pilonidal sinus with extrusion of the suture material, thus mimicking recurrence. In case of recurrent pilonidal sinus following plastic coverage or primary closure, respectively, the differential diagnosis of suture granuloma should be considered. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.
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.
... surgical suture. 878.5035 Section 878.5035 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Devices § 878.5035 Nonabsorbable expanded polytetrafluoroethylene surgical suture. (a) Identification. Nonabsorbable expanded polytetrafluoroethylene (ePTFE) surgical suture is a monofilament, nonabsorbable, sterile...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Suture retention device. 878.4930 Section 878.4930...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4930 Suture retention device. (a) Identification. A suture retention device is a device, such as a retention bridge, a surgical...
Goel, Ruchi; Kamal, Saurabh; Bodh, Sonam A; Kumar, Sushil; Kishore, Jugal; Malik, K P S; Singh, Madhu; Bansal, Smriti
To evaluate the efficacy and complications of lower eyelid suspension with the modified Safdarjung hospital technique using 5:0 polypropylene suture for punctal ectropion. Prospective case series. Thirty one eyelids in 19 patients with mild and moderate ectropion and all types of laxity including involutional and paralytic were included. All patients underwent lower eyelid suspension with the modified Safdarjung hospital technique. A 5:0 polypropylene suture was passed in the pre-tarsal plane between the attachments of the lateral and medial canthal tendons near their insertion at the orbital rim. Successful outcome was judged by the anatomical restoration of the apposition of the punctum to the globe in the upward gaze and the physiological relief of epiphora. The recurrence of lid laxity, overall lid/globe apposition and complications were also noted. At 1 year follow up anatomical success was achieved in 28 (90%) patients and functional success noted in 27 (87%) patients. Recurrence of lid laxity was noted in 2 patients. There was a suture exposure in one case and a suture granuloma in another case. The results did not correlate to the degree of ectropion and type of laxity. Lower eyelid suspension using 5:0 polypropylene suture is a useful procedure for the treatment of involutional and paralytic punctal ectropion. It is simple and effective with minimal complications. However, the effect on scleral show and the concern related to suture material biodegradation over years needs to be further evaluated. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
The frontal bone was then removed as indicated. The most lateral aspect of the coronal suture was radically removed with rongeurs, including a part of the greater and lesser wings of the sphenoid bone. The frontal and temporal lobes of the brain were gently repositioned to allow for safe upper orbital osteotomies through ...
Zeebregts, CJ; Heijmen, RH; van den Dungen, JJ; van Schilfgaarde, R
Background: The main aim of performing a vascular anastomosis is to achieve maximal patency rates. An important factor to achieve that goal is to minimize damage to the vessel walls. Sutures inevitably induce vascular wall damage, which influences the healing of the anastomosis. Over time, several
Gulihar, Abhinav; Whitehead-Clarke, Thomas; Hajipour, Ladan; Dias, Joe J
Surgical repair is advocated for flexor tendon lacerations deeper than 70%. Repair can be undertaken with different suturing techniques and using different materials. Different materials used for tendon repair will have a different gliding resistance (GR) at the joint. Previous studies have compared strength of repair and gliding resistance for various braided suture materials and for 100% laceration of flexor tendons. We directly compare the GR of two monofilament sutures when used for a peripheral running suture repair of partially lacerated tendons. Sixteen flexor tendons and A2 pulleys were harvested from Turkey feet. They were prepared, partially lacerated to 50% depth, and then repaired with a core suture (modified Kessler technique with 4-0 Ethibond) as well as an additional superficial running suture of either 6-0 Prolene or Nylon (half randomised to each). Gliding resistance was measured for all tendons before and after repair, at different flexion angles (40 and 60 degrees) and for different loads (2N and 4N). After surgical repair, gliding resistance was increased for all tendons (P resistance than those repaired with Nylon (P = 0.02). Increased flexion angle and load amplified the gliding resistance (both P resistance than 6-0 Prolene but the minor differences bare unknown clinical significance.
Torres-Lagares, Daniel; Barranco-Piedra, Sebastian; Rodríguez-Caballero, Angela; Serrera-Figallo, María-Angeles; Segura-Egea, Juan-José; Gutiérrez-Pérez, José-Luis
This study examined whether the number and type of sutures used in oral surgery influence two ad hoc variables (incision plane and displaced area), which are two variables related to whether the suture needle is suitable for the task. Seventy-five TB-15 needles were studied, which were used to suture between zero and three mucosa and/subperiosteal sutures, producing 15 groups with 5 needles in each one. The incision plane and displaced area were measured for each group, which are two variables related to how the needle has worn and altered. Statistical treatment was conducted using the Kruskal-Wallis H test to compare multiple values and the Mann-Whitney U test to compare pairs. A multi-stage regression model was applied with the aim of predicting the changes in the dependent variables based on the number and type of sutures performed. The incision plane ranged from 126.67 to 346.24 µm among the different groups. The displaced area was measured as being between 14 524.83 µm² and 128 311.91 µm². The best predictive model for the incision plane obtained a coefficient of determination (R2) of 0.149, while it reached 0.249 for the displaced area. Subperiosteal sutures held more weighting among the variables studied. Mucosal sutures did not seem to greatly affect needle wear. Observations reported in this paper indicate that the needle should be changed after having performed two subperiosteal sutures, given the wear and change to the incision plane that is produced, which causes the needle's cutting ability to reduce.
Desai, Mihir J; Hutton, William C; Jarrett, Claudius D
To compare the biomechanical strength of a knotless suture anchor repair and the traditional outside-in repair of peripheral triangular fibrocartilage complex (TFCC) tears in a cadaveric model. We dissected the distal ulna and TFCC from 6 matched cadaveric wrist pairs and made iatrogenic complete peripheral TFCC tears in each wrist. In 6 wrists, the TFCC tears were repaired using the standard outside-in technique using 2 2-0 polydioxane sutures placed in a vertical mattress fashion. In the other 6 wrists, we repaired the TFCC tears using mini-pushlock suture anchors to the fovea. The strength of the repairs was then determined using a materials testing machine with the load placed across the repair site. We loaded the repairs until a gap of 2 mm formed across the repair site, and then subsequently loaded them to failure. Thus, for each repair we obtained the load at 2-mm gap formation, load to failure, and mode of failure. At the 2-mm gap formation, the suture anchor repairs were statistically stronger than the outside-in repairs. For load to failure, the suture anchor repairs were also statistically stronger than the outside-in repairs. Failure in both techniques occurred most commonly as suture pull-out from the soft tissues. The all-arthroscopic suture anchor TFCC repair was biomechanically stronger than an outside-in repair. The suture anchor technique allows for repair of both the superficial and deep layers of the articular disk directly to bone, restoring the native TFCC anatomy. By being knotless, the suture anchor repair avoids irritation to the surrounding soft tissues by suture knots. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Kim, June; Singh Maan, Harjot; Cool, Alicia J; Hanlon, Allison M; Leffell, David J
Cyanoacrylate topical adhesives and fast absorbing gut sutures are increasingly utilized by dermatologic surgeons as they provide satisfactory surgical outcomes while eliminating an additional patient visit for suture removal. To date, no head-to-head studies have compared the wound healing characteristics of these epidermal closure techniques in the repair of facial wounds after Mohs micrographic surgery. To compare the cosmetic outcome of epidermal closure by cyanoacrylate topical adhesive with fast absorbing gut suture in linear repairs of the face following Mohs micrographic surgery. Fourteen patients with wound length greater than 3cm who underwent Mohs micrographic surgery for nonmelanoma skin cancer of the face were enrolled in this randomized right-left comparative study. Following placement of dermal sutures, half of the wound was randomly selected for closure with cyanoacrylate and the contralateral side with fast absorbing gut suture. Using photographs from the three-month postoperative visit, six blinded individuals rated the overall cosmetic outcome. The present study shows no significant difference in cosmetic outcomes between cyanoacrylate and fast absorbing gut suture for closure of linear facial wounds resulting from Mohs micrographic surgery. Cyanoacrylate tissue adhesive may not be as effective in achieving optimal cosmesis for wounds on the forehead or of longer repair lengths. The majority of patients did not have a preference for wound closure techniques, but when a preference was given, cyanoacrylate was significantly favored over sutures. Cyanoacrylate tissue adhesive and fast absorbing gut suture both result in comparable aesthetic outcomes for epidermal closure of linear facial wounds following Mohs micrographic surgery. Consideration should be given to factors such as need for eversion, hemostasis, and wound tension when selecting an epidermal wound closure method. (ClinicalTrials.gov, Identifier: NCT01298167, http
Jolanta M Topczewska
Full Text Available Using morphological, histological, and TEM analyses of the cranium, we provide a detailed description of bone and suture growth in zebrafish. Based on expression patterns and localization, we identified osteoblasts at different degrees of maturation. Our data confirm that, unlike in humans, zebrafish cranial sutures maintain lifelong patency to sustain skull growth. The cranial vault develops in a coordinated manner resulting in a structure that protects the brain. The zebrafish cranial roof parallels that of higher vertebrates and contains five major bones: one pair of frontal bones, one pair of parietal bones, and the supraoccipital bone. Parietal and frontal bones are formed by intramembranous ossification within a layer of mesenchyme positioned between the dermal mesenchyme and meninges surrounding the brain. The supraoccipital bone has an endochondral origin. Cranial bones are separated by connective tissue with a distinctive architecture of osteogenic cells and collagen fibrils. Here we show RNA in situ hybridization for col1a1a, col2a1a, col10a1, bglap/osteocalcin, fgfr1a, fgfr1b, fgfr2, fgfr3, foxq1, twist2, twist3, runx2a, runx2b, sp7/osterix, and spp1/ osteopontin, indicating that the expression of genes involved in suture development in mammals is preserved in zebrafish. We also present methods for examining the cranium and its sutures, which permit the study of the mechanisms involved in suture patency as well as their pathological obliteration. The model we develop has implications for the study of human disorders, including craniosynostosis, which affects 1 in 2,500 live births.
Full Text Available Cosmesis is a vital concern for patients undergoing plastic and reconstructive surgery. Many variations in wound closure are employed when attempting to minimize a surgical scar’s appearance. Barbed sutures are one potential method of achieving improved wound cosmesis and are more common in recent years. To determine if barbed sutures differ from nonbarbed in wound cosmesis, we conducted a single-blinded, randomized, controlled trial of 18 patients undergoing bilateral reduction mammoplasty or panniculectomy. Patients were their own controls, receiving barbed sutures on one side and standard sutures on the contralateral side. Surgical scars were evaluated postoperatively by patient preference self-assessment and an observer. Ten patients were evaluated at 3 months postoperatively, yielding a mean Stony Brook Scar Evaluation Scale (SBSES rating of 4.4 for barbed suture and 3.5 for regular suture (p=0.15. At 6 months, 8 patients performed self-assessment to determine their preference; 4 preferred the barbed sutures, 1 preferred the regular sutures, and 3 had no preference. Further research with larger sample sizes is needed to determine if barbed sutures convey any advantage over standard sutures in wound healing. However, our results suggest that barbed sutures are a reasonable alternative to standard sutures particularly with regard to wound cosmesis.
Cooney, Gerard M; Lake, Spencer P; Thompson, Dominic M; Castile, Ryan M; Winter, Des C; Simms, Ciaran K
There is a substantial prevalence of post-operative incisional hernia for both laparoscopic and laparotomy procedures, but there have been few attempts at quantifying abdominal wound closure methodology in the literature. One method to ascertain a more robust method of wound closure is the identification of the influence of suture placement parameters on suture pullout force. Current surgical practice involves a recommended bite depth and bite separation of 10mm, but the evidence base for this is not clear. In this paper, the suture pullout characteristics of both porcine and human linea alba were investigated to ascertain a suture placement protocol for surgical wound closure. Uniaxial suture pullout force testing on fresh frozen porcine and human linea alba samples was performed using standard materials testing machines. The influence of the number of suture loops, the bite depth and the bite separation of the sutures and the orientation of the sutures with respect to the principal fibre direction in the linea alba were assessed. Results showed a clearly identifiable relationship between pullout force of the suture, bite separation and bite depth, with low suture separation and high suture depth as optimal parameters for increasing pullout force. Resistance to pullout could be improved by as much as 290% when optimizing test conditions. Both human and porcine tissue were observed to exhibit very similar pullout force characteristics, corroborating the use of a porcine model for investigations into wound closure methodology. Orientation of suture application was also found to significantly affect the magnitude of suture pullout, with suturing applied longitudinally across a transverse defect resulting in higher pullout forces for small suture bite separations. Although further assessment in an environment more representative of in vivo conditions is required, these findings indicate that increasing the bite depth and reducing the bite separation with respect to
Janco, M; Pikus, P
The authors present the first experience in the treatment of fresh ruptures of the Achilles tendon by their own surgical technique--suture end to end with augmentation using plantaris tendon graft. The results were evaluated on a small group of 9 patients (average age 45 years) operated on in the period of 1999-2000. The most important criterion was the subjective evaluation of the patient and the post-operative limitation in sport, job and ordinary activity. We did not record any preoperative or post-operative complication and the limitation of the range of motion was negligible with regard to the needs of the patient. The authors are aware of the fact that post-operative follow-up of the patients is relatively short-term. The surgical technique is described in detail.
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
Kaback, Lee A; Gowda, Ashok L; Paller, David; Green, Andrew; Blaine, Theodore
The purpose of this study was to evaluate the initial fixation strength of 3 techniques of arthroscopic tenodesis of the long head of the biceps (LHB). Eighteen human cadaveric shoulders were randomly assigned to one of 3 simulated arthroscopic biceps tenodesis techniques-simple suture (SS), Krakow stitch (KS), or lasso loop (LL)-combined with a knotless fixation implant (3.5-mm Piton Anchor; Tornier, Minneapolis, MN). Biomechanical parameters were evaluated by cyclic loading and load to failure. The mean failure load (P = .007) was 158.3 ± 32.2 N, 109.8 ± 41.1 N, and 46.6 ± 3.8 N for the KS, SS, and LL techniques, respectively. Mean stiffness was greater (statistically significant) in the KS (21.4 ± 3.0 N/mm) and SS (20.7 ± 7.9 N/mm) treatment groups compared with the LL group (4.5 ± 1.5 N/mm) (P = .011). Biceps tenodesis performed with a more secure tendon suturing technique, such as the Krakow technique, provides superior ultimate and fatigue strength and thus may be more secure in clinical application and yield better clinical results. The mechanical properties of the LL technique were especially poor in comparison. Although more complex suturing techniques for arthroscopic biceps tenodesis can be technically challenging, more secure tendon fixation may improve clinical outcomes. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
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.
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.
Christoffersen, Mette Willaume; Helgstrand, F; Rosenberg, J
Repair for a small (≤2 cm) umbilical and epigastric hernia is a minor surgical procedure. The most common surgical repair techniques are a sutured repair or a repair with mesh reinforcement. However, the optimal repair technique with regard to risk of reoperation for recurrence is not well...... documented. The aim of the present study was in a nationwide setup to investigate the reoperation rate for recurrence after small open umbilical and epigastric hernia repairs using either sutured or mesh repair....
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.
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: email@example.com [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
Elmallah, Randa K; Khlopas, Anton; Faour, Mhamad; Chughtai, Morad; Malkani, Arthur L; Bonutti, Peter M; Roche, Martin; Harwin, Steven F; Mont, Michael A
Healthcare systems are receiving increasing pressures from payers, such as the Centers for Medicare and Medicaid (CMS), to reduce the costs associated with procedures, and with the implementation of the Affordable Care Act, high costs are addressed through pay-for-performance programs. Thus, multiple areas of total knee arthroplasty (TKA) surgery are under scrutiny, including surgical times, material costs, and the costs of associated complications and readmissions. Suture type has been determined to be a factor that may influence closure times, as well as direct material costs. Therefore, the purpose of this review was to compare: (I) the cost of using barbed vs. conventional interrupted sutures; (II) the additional cost of differences in complications, if any; (III) to extrapolate cost savings on a hospital and national level; and (IV) to discuss the role of these findings on hospital savings and the effect on bundled payments. It was found that the main factors affecting differences in overall costs between barbed and standard interrupted suture were material cost and closure time. Many studies have demonstrated greater cost savings with the barbed suture due to shorter operative times, despite the higher material costs. The majority of studies also demonstrated similar complication rates between the suture types, and thus these are unlikely to affect the cost difference. However, to the best of our knowledge, there are no TKA studies in the literature evaluating the effect of suture type and associated complications on lengths of stay and readmission rates. Thus, it is unclear how these cost savings will translate to reimbursements rates and the role that they might play in bundled payments. Several studies in other specialties demonstrate decreased infection rates with the use of barbed sutures, which, if found to be true for TKA can be extrapolated to 3 million dollars of savings in revision TKA costs. Further studies on this topic are needed to define these
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.
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.
Tanaka, Yoichi; Sadahiro, Sotaro; Ishikawa, Kenji; Suzuki, Toshiyuki; Kamijo, Akemi; Tazume, Seiki; Yasuda, Masanori
Suture materials are selected based on the following factors: absorbable/non-absorbable, monofilament/multifilament, duration with sufficiently high tensile strength, and the tissue to be sutured. Absorbable sutures are hydrolyzed in tissues. However, little is known about the influence of infection on the hydrolysis and decrease in the tensile strength. Four kinds of sutures, i.e., non-absorbable multifilament silk, non-absorbable monofilament polypropylene (Prolene(®)), absorbable multifilament polyglactin 910 (Vicryl(®)), and absorbable monofilament polydioxanone (PDS(®)) were implanted in the back of rats. A suspension of Escherichia coli + Bacteroides fragilis or saline was injected subcutaneously into the contaminated and clean condition groups, respectively. The sutures were removed 1, 2, 4 or 8 weeks after the implantation. There was significantly more severe inflammation macroscopically for the silk sutures under the contaminated conditions (p = 0.03), however, no significant differences were observed among the other three sutures. All 4 kinds of sutures showed a reduction of the tensile strength over time. There were no significant differences in the magnitude of reduction between both the clean and contaminated conditions for any of the sutures. The reduction of the tensile strength with time did not differ significantly between sutures exposed to contaminated and clean conditions, even for the absorbable sutures.
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.
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.
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.
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
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
Full Text Available Jarret M Woodmass,1 Graeme Matthewson,1 Yohei Ono,1,2 Aaron J Bois,1 Richard S Boorman,1 Ian KY Lo,1 Gail M Thornton1,31Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada; 2Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; 3Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada Purpose: The purpose of this study was to evaluate the mechanical performance of different suture locking mechanisms including: i interference fit between the anchor and the bone (eg, 4.5 mm PushLock, 5.5 mm SwiveLock, ii internal locking mechanism within the anchor itself (eg, 5.5 mm SpeedScrew, or iii a combination of interference fit and internal locking (eg, 4.5 mm MultiFIX P, 5.5 mm MultiFIX S. Methods: Anchors were tested in foam blocks representing normal (20/8 foam or osteopenic (8/8 foam bone, using standard suture loops pulled in-line with the anchor to isolate suture locking. Mechanical testing included cyclic testing for 500 cycles from 10 N to 60 N at 60 mm/min, followed by failure testing at 60 mm/min. Displacement after 500 cycles at 60 N, number of cycles at 3 mm displacement, load at 3 mm displacement, and maximum load were evaluated. Results: Comparing 8/8 foam to 20/8 foam, load at 3 mm displacement and maximum load were significantly decreased (P<0.05 with decreased bone quality for anchors that, even in part, relied on an interference fit suture locking mechanism (ie, 4.5 mm PushLock, 5.5 mm SwiveLock, 4.5 mm MultiFIX P, 5.5 mm MultiFIX S. Bone quality did not affect the mechanical performance of 5.5 mm SpeedScrew anchors which have an isolated internal locking mechanism. Conclusion: The mechanical performance of anchors that relied, even in part, on interference fit were affected by bone quality. Isolated internal locking knotless suture anchors functioned independently of bone quality
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.
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.
Yang, Yang; Xu, Cunliang; Deng, Shijing; Xiao, Jingjing
Due to differences in corneal grafting microsurgery between manual and robotic suturing, new challenges have arisen in testing the insertion force and torque of corneal tissue acting on suturing needles in order to guarantee successful completion of surgical procedures. In order to measure the force during the insertion operation, from the needle entering the cornea through the entry point until the puncturing of the exit point along the circular trajectory, a force measurement system was established, including fresh porcine cornea, a corneal-suturing robot, a circular needle, a micro-forceps manipulator with a force transducer, a computer with a data acquisition board and a medical microscope. The force values in the needle coordinate frames were obtained on the basis of a sensor coordinate frame through D-H coordinate transformation, and an index is proposed here to evaluate the insertion performance. Experiments on both manual and robotic suturing were carried out for comparison. The scale and changes of the needle insertion force were obtained using two different suturing methods. The maximal tangent force in robotic suturing is a little larger than in manual suturing, and the maximal resultant force in robotic suturing is somewhat smaller. Although the difference is not very significant, robotic suturing performs in a more stable way. Moreover, the performance evaluation index M(dmax) (the maximum of square root of the quadratic sum of torque components M(OX) and M(OY)) in robotic suturing is much smaller than that in manual suturing. The force measurement system has been verified to be feasible through experimentation. Compared with conventional manual surgery, robotic suturing has some advantages: more stable suturing, smaller distortion torque and fewer invasions to the corneal tissue, showing that its application in minimally invasive surgery is practical. Copyright © 2011 John Wiley & Sons, Ltd.
Consiglio, Fabio; Pizzamiglio, Roberto; Parodi, Pier Camillo; De Biasio, Fabrizio; Machin, Pier Nicola; Di Loreto, Carla; Gamboa, Mabel
Silhouette Sutures (Kolster Methods, Inc., Corona, CA) exhibit different biological characteristics at various time points after their placement. The goals of this study were to understand the biological reactions of Silhouette Sutures in human tissues at different time intervals and to determine the index of resistance of the sutures in subcutaneous tissue. Histologic examination was performed on section soft tissue containing the sutures at 1 month, 3 months, 6 months, and 1 year after suture placement. The study comprised 8 patients, each of whom received 4 sutures in the lower abdomen under local anesthesia. The sutures were placed exactly 1 month, 3 months, 6 months, and 1 year before planned post-bariatric abdominal surgery. Dynamometric evaluation was performed on a never-used suture and on sutures removed from 1 year after placement. The scar process around the threads was also examined. A progressive increase in scar tissue around the sutures was observed. One year after placement, there was a reduction of 16.7% in yield and tensile strength and a reduction of 14.29% in elongation at break, relative to the never-used suture. By 1 year, the cones in polylactic and glycolic acids had been replaced by scar tissue. Fibrous tissue around the sutures increased progressively over time, and was most prominent at the level of the nodes. Cones were completely resorbed within 6 months. A reduction in the index of resistance of the suspension sutures occurred over 1 year. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: firstname.lastname@example.org.
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
Ono, Y; Woodmass, J M; Nelson, A A; Boorman, R S; Thornton, G M; Lo, I K Y
This study evaluated the mechanical performance, under low-load cyclic loading, of two different knotless suture anchor designs: sutures completely internal to the anchor body (SpeedScrew) and sutures external to the anchor body and adjacent to bone (MultiFIX P). Using standard suture loops pulled in-line with the rotator cuff (approximately 60°), anchors were tested in cadaveric bone and foam blocks representing normal to osteopenic bone. Mechanical testing included preloading to 10 N and cyclic loading for 500 cycles from 10 N to 60 N at 60 mm/min. The parameters evaluated were initial displacement, cyclic displacement and number of cycles and load at 3 mm displacement relative to preload. Video recording throughout testing documented the predominant source of suture displacement and the distance of 'suture cutting through bone'. In cadaveric bone and foam blocks, MultiFIX P anchors had significantly greater initial displacement, and lower number of cycles and lower load at 3 mm displacement than SpeedScrew anchors. Video analysis revealed 'suture cutting through bone' as the predominant source of suture displacement in cadaveric bone (qualitative) and greater 'suture cutting through bone' comparing MultiFIX P with SpeedScrew anchors in foam blocks (quantitative). The greater suture displacement in MultiFIX P anchors was predominantly from suture cutting through bone, which was enhanced in an osteopenic bone model. Anchors with sutures external to the anchor body are at risk for suture cutting through bone since the suture eyelet is at the distal tip of the implant and the suture directly abrades against the bone edge during cyclic loading. Suture cutting through bone may be a significant source of fixation failure, particularly in osteopenic bone.Cite this article: Y. Ono, J. M. Woodmass, A. A. Nelson, R. S. Boorman, G. M. Thornton, I. K. Y. Lo. Knotless anchors with sutures external to the anchor body may be at risk for suture cutting through osteopenic bone
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.
Faria, Mun Y; Ferreira, Nuno P; Canastro, Mario
Subluxated or malpositioned intraocular lenses (IOLs) and inadequate capsular support is a challenge for every ophthalmic surgeon. Iris suture of an IOL seems to be an easy technique for the management of dislocated 3-piece IOL, allowing the IOL to be placed behind the iris, far from the trabecular meshwork and corneal endothelium. The purpose of this study is to assess the results of pars plana vitrectomy (PPV) and iris suture of dislocated 3-piece acrylic IOLs. In this retrospective, nonrandomized, interventional case consecutive study, of a total of 103 dislocated IOLs, 36 eyes were considered for analysis. All 36 eyes had subluxated or totally luxated 3-piece IOL and underwent iris suture at the Ophthalmology Department of Santa Maria Hospital-North Lisbon Hospital Center, Portugal, from January 2011 until November 2015. All patients underwent 3-port 23-G PPV. The optic zone of the dislocated IOL was placed anterior to the iris with the haptics behind, in the posterior chamber. Haptics were sutured to iris followed by placement of the optics behind iris plane. Postoperative measures included best-corrected visual acuity (BCVA), IOL position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, and development of macular edema. A total of 36 eyes of 36 patients were included. All underwent successful iris fixation of dislocated 3-piece IOL. Mean overall follow-up was 15.9 months (range 3-58 months). At presentation, 16 eyes (44.4%) had a luxated IOL and 20 eyes (55.6%) a subluxated IOL. As underlying cause, 17 eyes (47.2%) had a history of complicated cataract surgery, 5 eyes (13.9%) had a traumatic dislocation of the IOL, and 6 eyes (16.7%) had a previous vitreoretinal surgery. A total of 8 eyes (22.2%) had late spontaneous IOL dislocation after uneventful cataract surgery. The mean preoperative BCVA was 1.09 ± 0.70 logarithm of the minimal angle of resolution (logMAR) units and mean postoperative BCVA was 0.48 ± 0.58 of log
Background: Hypospadias is one of the most common congenital anomalies, occurring in Bone of 200 to one of 300 live births. Tubularized incised plate (TIP) urethroplasty or the Snodgrass procedure has gained worldwide acceptance for distal hypospadias repair because of its low complication rate and technical ...
Duffy, D J; Main, R P; Moore, G E; Breur, G J; Millard, R P
Evaluate performance and resistance to gap formation of a non-absorbable, barbed, monofilament suture, in comparison with a non-absorbable, smooth, monofilament polypropylene suture, in two different suture patterns: three-loop pulley (3LP) and modified Bunnell-Mayer (BM). Seventy-two medium-sized cadaveric superficial digital flexor muscle tendon units. After manual transection and suture repair, individual specimens were placed in an electromechanical tensile testing machine and tested to monotonic failure using tensile ramp loading. Video data acquisition allowed evaluation of failure mode and quantification of gap formation. Incidence of gap formation between tendon ends was significantly greater in tenorrhaphies repaired with barbed suture compared to those repaired with smooth polypropylene. Use of a 3LP suture pattern caused significantly less gapping between tendon ends when compared to the BM pattern. Smooth polypropylene suture was consistently superior in load performance than a unidirectional barbed suture. The 3LP pattern was more resistant than a BM pattern at preventing gap formation. Smooth polypropylene should be recommended over barbed unidirectional suture for use in canine tendinous repair to provide increased resistance to gap formation. The 3LP is superior to the BM suture pattern, requiring significantly more force to cause tenorrhaphy gap formation and failure, which may translate to increased accrual of repair site strength and tendinous healing in clinical situations.
McDonald, Erik; Gordon, Joshua A; Buckley, Jenni M; Gordon, Leonard
To investigate the mechanical properties of some common suture materials currently in use and compare them with a new multifilament stainless steel suture. We investigated the mechanical properties of 3-0 and 4-0 Fiberwire, 3-0 Supramid, 3-0 Ethibond, and a new 3-0 and 4-0 multifilament stainless steel suture. All suture material was tested in a knotted configuration and all but the Supramid was tested in an unknotted configuration. We measured the load, elongation at failure, and stiffness during both tests. The 4-0 multifilament stainless steel showed the least elongation, whereas the 3-0 multifilament stainless steel withstood the highest load of any material in both the knotted and unknotted tests. There was no difference in stiffness between the 3-0 and 4-0 multifilament stainless steel when untied; however, the 3-0 multifilament stainless steel was stiffer when tied. Soaking in a saline solution had no significant effect on the ultimate load, elongation at failure, or stiffness of any of the sutures. The 3-0 Fiberwire and 3-0 Ethibond required at least 5 throws to resist untying. Multifilament stainless steel exhibited promising mechanical advantages over the other sutures tested. More research is needed to determine how this material will affect the clinical outcomes of primary flexor tendon repair. With a secure attachment to the tendon, the multifilament stainless steel's lower elongation and better knot-holding ability may result in a higher force to produce a 2-mm gap and a higher ultimate tensile strength in a tendon repair. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Estudio comparativo de microsutura vascular en ratas: punto simple y punto de colchonero horizontal Comparative study about vascular microsurgery on rats: classic interrupted suture versus horizontal mattress suture
C. Casado Sánchez
Full Text Available La Microcirugía es la técnica empleada para la realización de la microanastomosis vascular. El objetivo del presente estudio es comparar dos tipos de técnicas de microsutura: los puntos simples clásicos, de empleo habitual en la microcirugía vascular, y los puntos de colchonero horizontales, no evaluados habitualmente para este tipo de cirugía. Fueron intervenidas 20 ratas albinas de la cepa Wistar (peso medio de 250 - 300 gr. bajo anestesia general; realizamos sección transversal en la arteria femoral, procediendo a su reparación microquirúrgica inmediata. Se establecieron 2 grupos de animales: en el grupo A (n=10, la microsutura se hizo mediante 6 puntos sueltos simples, y en el grupo B (n=10, empleando 3 puntos de colchonero horizontal. Comprobamos la patencia en el desclampado inmediato y tras una hora del desclampado (para ambas técnicas fue positiva en el 100% de los casos, y la hemorragia en ambos tiempos (se registró un único caso de sangrado en el postoperatorio inmediato en el grupo B, que requirió la revisión de la microsutura. El tiempo medio de ejecución de la sutura en el grupo B, 15 minutos aproximadamente, fue más corto que en el grupo A, 21 minutos aproximadamente, diferencia estadísticamente significativa (p Microsurgery is the procedure of choice for vascular microanastamoses. The objective of this study was to compare two types of suture techniques: classic interrupted suture anastomoses, commonly used for vascular anastamoses in microsurgery, and another technique using horizontal mattress sutures, rarely evaluated in this type of surgery. Twenty albino Wistar rats were operated (average weight: 250 - 300 gr. under general anaesthesia. A transverse section of the femoral artery was performed and immediately followed by an anastamoses. The animals were placed into two groups of ten. The classic 6 interrupted suture anastomoses technique was performed in group A (n = 10 and another technique using 3
Song, Dongzhe; Zhang, Fugui; Reid, Russell R; Ye, Jixing; Wei, Qiang; Liao, Junyi; Zou, Yulong; Fan, Jiaming; Ma, Chao; Hu, Xue; Qu, Xiangyang; Chen, Liqun; Li, Li; Yu, Yichun; Yu, Xinyi; Zhang, Zhicai; Zhao, Chen; Zeng, Zongyue; Zhang, Ruyi; Yan, Shujuan; Wu, Tingting; Wu, Xingye; Shu, Yi; Lei, Jiayan; Li, Yasha; Zhang, Wenwen; Wang, Jia; Lee, Michael J; Wolf, Jennifer Moriatis; Huang, Dingming; He, Tong-Chuan
The cranial suture complex is a heterogeneous tissue consisting of osteogenic progenitor cells and mesenchymal stem cells (MSCs) from bone marrow and suture mesenchyme. The fusion of cranial sutures is a highly coordinated and tightly regulated process during development. Craniosynostosis is a congenital malformation caused by premature fusion of cranial sutures. While the progenitor cells derived from the cranial suture complex should prove valuable for studying the molecular mechanisms underlying suture development and pathogenic premature suture fusion, primary human cranial suture progenitors (SuPs) have limited life span and gradually lose osteoblastic ability over passages. To overcome technical challenges in maintaining sufficient and long-term culture of SuPs for suture biology studies, we establish and characterize the reversibly immortalized human cranial suture progenitors (iSuPs). Using a reversible immortalization system expressing SV40 T flanked with FRT sites, we demonstrate that primary human suture progenitor cells derived from the patent sutures of craniosynostosis patients can be efficiently immortalized. The iSuPs maintain long-term proliferative activity, express most of the consensus MSC markers and can differentiate into osteogenic and adipogenic lineages upon BMP9 stimulation in vitro and in vivo. The removal of SV40 T antigen by FLP recombinase results in a decrease in cell proliferation and an increase in the endogenous osteogenic and adipogenic capability in the iSuPs. Therefore, the iSuPs should be a valuable resource to study suture development, intramembranous ossification and the pathogenesis of craniosynostosis, as well as to explore cranial bone tissue engineering. © 2017 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.
Horoz, Levent; Hapa, Onur; Barber, F Alan; Hüsemoğlu, Buğra; Özkan, Mustafa; Havitçioğlu, Hasan
To evaluate the load to failure strength of anchor techniques suitable for osteoporotic bone. Using an osteoporotic ovine model in 72 humeri, 6 fixation techniques were tested. Group 1: two interlocking 5-mm anchors with fewer, wider threads; group 2: one 5-mm anchor; group 3: one 5-mm anchor reinforced laterally by a 6.5-mm cancellous screw; group 4: one 5-mm anchor in an area reinforced with a cancellous plug; group 5: two interlocking 5-mm anchors with smaller threads; group 6: one 5-mm smaller threaded anchor. After a 10-N preload, the specimens were cyclically loaded between 10 N and 30 N for 50 cycles and then destructively tested. Peak-to-peak displacement, cyclic elongation, ultimate load, stiffness, and failure mode were recorded. Group 1 had lower peak-to-peak displacement than group 3 (P = .001), group 5 (P = .001), and group 6 (P = .033). In addition, group 1 showed lower cyclic elongation than group 3 (P = .001), group 5 (P = .035), and group 6 (P = .001). Group 1 had a higher ultimate load than group 2 (P = .002), group 3 (P = .019), and group 6 (P = .006). Group 1 also showed higher stiffness than group 2 (P = .007) and group 3 (P = .022). Mode of failure was predominantly caused by anchor pullout for all of the groups except group 3, which mainly failed by suture rupture. Two interlocking suture anchors are stronger than a single anchor in osteoporotic bone. The anchor with fewer, wider threads and a smaller core diameter showed greater strength and less elongation than the other constructs. Reinforcement by cancellous autografting increased suture anchor strength. Considering concerns about suture anchor pullout from osteoporotic bone, interlocking a second suture anchor with the first increases load to failure resistance. Anchors with small core diameters and fewer but wider threads are more efficient in osteoporotic bone. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Mathijssen, Irene M.J.; Meulen, Jacques J.N.M. van der; Adrichem, Leon N.A. van; Vaandrager, J.M.; Vermeij-Keers, Christl [Erasmus MC, University Medical Centre, Department of Plastic and Reconstructive Surgery, Rotterdam (Netherlands); Hulst, Rene R.W.J. van der [University Hospital Maastricht, Department of Plastic and Reconstructive Surgery, Maastricht (Netherlands); Lequin, Maarten H. [Erasmus MC, University Medical Centre, Department of Radiology, Rotterdam (Netherlands)
Isolated synostosis of the frontosphenoidal suture is very rare and difficult to diagnose. Little has been reported on the clinical presentation and fetal development of this suture. To understand the development of the frontosphenoidal suture and the outcome of its synostosis. We studied the normal fetal development of the frontosphenoidal suture in dry human skulls and the clinical features of four patients with isolated synostosis of the frontosphenoidal suture. The frontosphenoidal suture develops relatively late during the second trimester of pregnancy, which explains the mild phenotype when there is synostosis. This rare craniosynostosis results in a deformity that causes recession of the lateral part of the frontal bone and supraorbital rim, with minimal facial asymmetry. Three-dimensional CT is the best examination to confirm the diagnosis. Isolated frontosphenoidal synostosis should be considered in patients with unilateral flattening of the forehead at birth that does not improve within the first few months of life. (orig.)
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.
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.
Gilmer, Brian B
Posterolateral corner avulsion fractures are a rare variant of ligamentous knee injury primarily described in the skeletally immature population. Injury is often related to a direct varus moment placed on the knee during sporting activities. Various treatment strategies have been discussed ranging from nonoperative management, to excision of the bony fragment, to primary repair with screws or suture. The described technique is a means for achieving fixation of the bony avulsion using principles familiar to double-row transosseous equivalent rotator cuff repair. Proximal anchors are placed in the epiphysis, and sutures are passed in horizontal mattress fashion. Once tied, the limbs of these same sutures are then passed to more distal anchors. Remaining eyelet sutures can be used to manage peripheral tissue. The final repair provides anatomic reduction and compression of the fragment to its bony bed with minimal extracortical hardware prominence and no violation of the physis. Risks include potential for physeal injury or chondral damage to the lateral femoral condyle through aberrant anchor placement. Postoperative care includes toe-touch weight-bearing restrictions and range of motion restrictions of 0°-90° in a hinged brace for 6 weeks followed by gradual return to activity.
McElvanney, A M; Adhikary, H P
A surgical technique employing orbital septum sutures during ptosis surgery in children is described. A retrospective study of 16 children (age range 6 months to 14 years) undergoing surgery for congenital ptosis over a 6 year period was undertaken with regard to cosmetic outcome. All surgery was performed by one consultant ophthalmic surgeon with the patient under general anaesthesia. A standard levator resection was undertaken, following which the orbital septum was redefined and sutured with interrupted 5-0 catgut. This resulted in a well-defined lid crease post-operatively, with a good cosmetic outcome. The only significant post-operative complication was the occurrence of a suture-related granuloma in one patient. All achieved a good cosmetic result. A mild residual ptosis occurred in 3 cases, requiring a further procedure. Special attention to suturing of orbital septum as a separate tissue layer during levator resection for congenital ptosis gives good lid crease definition which may enhance the overall cosmetic outcome.
Marx, Robert G; Verkuil, Lana; Wilson, Sean; Foo, Li Foong
Suture anchors for labral repair have been associated with complications including suprascapular notch encroachment and osteolysis. We present a case of suture anchor penetration of the anterior glenoid neck leading to pain secondary to subscapularis muscle irritation in a 14-year-old boy. The patient had labral repair and subsequent anterior shoulder pain which resolved after anchor removal. Chondrolysis of the glenohumeral joint has been described following labral repair with knotless anchors. There have also been cases of injury to the suprascapular nerve following labral repair. However, we are not aware of any reports describing suture anchor penetration of the anterior glenoid neck leading to pain secondary to subscapularis muscle irritation. Labral repair has become a common and routine procedure, but complications can occur. We report a new complication related to osseous penetration of the anterior glenoid neck of the scapula by a suture anchor. We identified the complication using magnetic resonance imaging, an important part in reproducible, noninvasive, and objective assessment of the postoperative shoulder. We also present the technique for anchor removal used to resolve the patient's anterior shoulder pain.
Egol, Kenneth; Howard, Daniel; Monroy, Alexa; Crespo, Alexander; Tejwani, Nirmal; Davidovitch, Roy
Operative fixation of displaced inferior pole patella fractures has now become the standard of care. This study aims to quantify clinical, radiographic and functional outcomes, as well as identify complications in a cohort of patients treated with non-absorbable braided suture fixation for inferior pole patellar fractures. These patients were then compared to a control group of patients treated for mid-pole fractures with K-wires or cannulated screws with tension band wiring. In this IRB approved study, we identified a cohort of patients who were diagnosed and treated surgically for a displaced patella fracture. Demographic, injury, and surgical information were recorded. All patients were treated with a standard surgical technique utilizing non-absorbable braided suture woven through the patellar tendon and placed through drill holes to achieve reduction and fracture fixation. All patients were treated with a similar post-operative protocol and followed up at standard intervals. Data were collected concurrently at follow up visits. For purpose of comparison, we identified a control cohort with middle third patella fractures treated with either k-wires or cannulated screws and tension band technique. Patients were followed by the treating surgeon at regular follow-up intervals. Outcomes included self-reported function and knee range of motion compared to the uninjured side. Forty-nine patients with 49 patella fractures identified retrospectively were treated over 9 years. This cohort consisted of 31 females (63.3%) and 18 males (36.7%) with an average age of 57.1 years (range 26-88 years). Patients had an average BMI of 26.48 (range 19-44.08). Thirteen patients with inferior pole fractures underwent suture fixation and 36 patients with mid-pole fractures underwent tension band fixation (K-wire or cannulated screws with tension band). In the suture cohort, one fracture failed open repair (7.6%), which was revised again with sutures and progressed to union. Of the 36
Leffler, Christopher T; Vaziri, Kamyar; Cavuoto, Kara M; McKeown, Craig A; Schwartz, Stephen G; Kishor, Krishna S; Pariyadath, Allison
To determine the association of strabismus surgery reoperation rates with adjustable or conventional sutures. Retrospective cross-sectional study. setting: Review of a large national private insurance database. Adults aged 18-89 having strabismus surgery between 2007 and 2011. Adjustable vs conventional suture strabismus surgery. Reoperation rate in the first postoperative year. Overall, 526 of 6178 surgical patients had a reoperation (8.5%). Reoperations were performed after 8.1% of adjustable suture surgeries and after 8.6% of conventional suture surgeries (P = .57). Of the 4357 horizontal muscle surgeries, reoperations were performed after 5.8% of adjustable suture surgeries, and after 7.8% of conventional suture surgeries (P = .02). Of the 1072 vertical muscle surgeries, reoperations were performed after 15.2% of adjustable suture surgeries and after 10.4% of conventional suture surgeries (P = .05). Younger age (18-39 years) was associated with a lower reoperation rate (P ≤ .02). The significant multivariable predictors of reoperation for horizontal surgery were adjustable sutures (odds ratio [OR] 0.69, 95% confidence interval 0.52-0.91), monocular deviation (OR 0.64), complex surgery (OR 1.63), and unilateral surgery on 2 horizontal muscles (OR 0.70, all P ≤ .01). Adjustable sutures were not significantly associated with reoperation rates after vertical muscle surgery (multivariable OR 1.45, P = .07). Adjustable sutures were associated with significantly fewer reoperations for horizontal muscle surgery. Adjustable sutures tended to be associated with more reoperations for vertical muscle surgery, but this observation was not statistically significant in the primary analysis after controlling for age. Copyright © 2015 Elsevier Inc. All rights reserved.
Pal, G P; Bhagwat, S S; Routal, R V
370 adult crania were examined to find the incidence of sutural bones in Gujarati (Indian) crania and to compare it with other populations to establish the distance between them. The mean measure of difference between Indian and other populations was statistically significant. Comparison of cranial capacity in skulls with and without sutural bones showed no significant difference, and this is interpreted as indicating that sutural bones are not formed secondary to stress.
Full Text Available Minimally invasive surgical procedures offer advantages of smaller incisions, decreased hospital length of stay, and rapid postoperative recovery to the patient. Surgical robots improve access and visualization intraoperatively and have expanded the indications for minimally invasive procedures. A limitation of the DaVinci surgical robot is a lack of sensory feedback to the operative surgeon. Experienced robotic surgeons use visual interpretation of tissue and suture deformation as a surrogate for tactile feedback. A difficulty encountered during robotic surgery is maintaining adequate suture tension while tying knots or following a running anastomotic suture. Displaying suture strain in real time has potential to decrease the learning curve and improve the performance and safety of robotic surgical procedures. Conventional strain measurement methods involve installation of complex sensors on the robotic instruments. This paper presents a noninvasive video processing-based method to determine strain in surgical sutures. The method accurately calculates strain in suture by processing video from the existing surgical camera, making implementation uncomplicated. The video analysis method was developed and validated using video of suture strain standards on a servohydraulic testing system. The video-based suture strain algorithm is shown capable of measuring suture strains of 0.2% with subpixel resolution and proven reliability under various conditions.
Martell, John; Elmer, Thomas; Gopalsami, Nachappa; Park, Young Soo
Minimally invasive surgical procedures offer advantages of smaller incisions, decreased hospital length of stay, and rapid postoperative recovery to the patient. Surgical robots improve access and visualization intraoperatively and have expanded the indications for minimally invasive procedures. A limitation of the DaVinci surgical robot is a lack of sensory feedback to the operative surgeon. Experienced robotic surgeons use visual interpretation of tissue and suture deformation as a surrogate for tactile feedback. A difficulty encountered during robotic surgery is maintaining adequate suture tension while tying knots or following a running anastomotic suture. Displaying suture strain in real time has potential to decrease the learning curve and improve the performance and safety of robotic surgical procedures. Conventional strain measurement methods involve installation of complex sensors on the robotic instruments. This paper presents a noninvasive video processing-based method to determine strain in surgical sutures. The method accurately calculates strain in suture by processing video from the existing surgical camera, making implementation uncomplicated. The video analysis method was developed and validated using video of suture strain standards on a servohydraulic testing system. The video-based suture strain algorithm is shown capable of measuring suture strains of 0.2% with subpixel resolution and proven reliability under various conditions.
Sull, Alan; Inceoglu, Serkan; August, Alicia; Gregorius, Stephen; Wongworawat, Montri D.
Background: Barbed suture use has become more popular as technology and materials have advanced. Minimal data exist regarding performance of the 2 commercially available products, V-LocTM and StratafixTM in tendon repairs. The purpose of this study was to compare gap resistance and ultimate tensile strength of both suture materials and nonbarbed suture in a porcine ex vivo model. Methods: Porcine flexor tendons were harvested and divided into 3 groups of 10 of varying suture material (3-0 PDS...
Sparks, Brad S; Nyland, John; Nawab, Akbar; Blackburn, Ethan; Krupp, Ryan; Burden, Robert
This study compared tap-in Bio-SutureTak suture anchor-#2 FiberWire suture (Group 1) and screw-in Bio Mini-Revo suture anchor-#2 Hi-Fi suture (Group 2) fixation in the glenoid region of interest for Bankart repair, in addition to evaluation of isolated suture loop biomechanical properties under progressive incremental cyclic loads. With knowledge of glenoid apparent bone mineral density (BMD), implant preparation and fit characteristics, and following application of a light manual tensile load, the primary investigator scored each specimen for perceived within group biomechanical test performance using a 0-10 point modified visual analog scale. After scoring, 12 paired constructs were placed in a servo hydraulic device clamp, preloaded to 25 N, and cycled between 25 and 50 Hz with a 25 N load increase every 25 cycles. Group 2 withstood greater load (104.1 +/- 56 vs. 70 +/- 36.9 N, P = 0.04) and displaced more at failure (13 +/- 4.5 vs. 8.6 +/- 3.3 mm, P = 0.04). All Group 1 specimens failed prior to reaching 150 N, whereas 25% of Group 2 specimens (n = 3) failed at 200 N. All specimens failed by anchor pullout except for three Group 2 specimens that failed by eyelet breakage at 200 N. Isolated suture testing revealed that Group 1 sutures displaced less at each cyclic load (P = 0.028) and withstood greater failure loads (P = 0.028) than that of Group 2 sutures. Group 2 constructs displayed moderately strong relationships between perceived within group biomechanical test performance and ultimate load (r (2) = 0.55) and displacement at failure (r (2) = 0.67). Group 1 did not display significant relationships. Similar biomechanical performance between 50 and 125 N, greater load at failure, and superior biomechanical test prediction accuracy suggest that the screw-in type Bio Mini-Revo suture anchor-#2 Hi-Fi suture combination may be preferred for Bankart lesion repair in low apparent BMD glenoid processes. The #2 Hi-Fi suture, however, allowed significantly greater
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.
Badia, Alejandro; Khanchandani, Prakash
This report presents a method of arthroscopic repair of the peripheral triangular fibrocartilage tears by using ultrasonic suture welding technique, thus avoiding the need for traditional suture knots. This technique eliminates the potential causes of ulnar-sided wrist discomfort especially during the postoperative period. Twenty-three patients (9 women and 14 men; mean age, 35 years; range, 18-52 years) were operated during a 1-year period in 2001 for Palmer grade 1B triangular fibrocartilage complex tear and followed up for 17 months. At the final follow-up, the average wrist arc of motion was as follows: extension, 65 degrees; flexion, 56 degrees; supination, 80 degrees; pronation, 78 degrees; radial deviation, 12 degrees; and ulnar deviation, 25 degrees. Grip strength measured with a dynamometer (Jamar) averaged 81% of the contralateral side at the final evaluation (range, 53%-105%).
Sei Haga; Shinji Nagata
Background: When microvascular anastomosis is performed in a deep, narrow operating field, securing space to throw knots is difficult. To simplify the procedure and avoid obstruction of the anastomosis, we use a continuous suturing with short-thread double-armed micro-suture. Methods: Sixty-four patients (38 cerebral revasculazation, 16 moyamoya disease, and 10 aneurysm surgery) undergoing microvaucular anastomosis were included. During anastomosis, a continuous suture was placed with sho...
Gillis, Robert C; Donaldson, Christopher T; Kim, Hyunchul; Love, James M; Dreese, James C
The purpose of this study was to establish whether suture anchor capsulorrhaphy (SAC) is biomechanically superior to suture capsulorrhaphy (SC) in the management of recurrent anterior shoulder instability without a labral avulsion. Twelve matched pairs of shoulders were randomized to either SC or SAC. Specimens were mounted in 60° of abduction and 90° of external rotation. Testing was conducted on an MTS servohydraulic load testing device (MTS, Eden Prairie, MN). A compressive load of 22 N was applied, followed by a 2-N anterior and posterior force to establish a 0 point. Translation with 10-N anterior and posterior loads was recorded for baseline laxity measurement. Arthroscopic capsulorrhaphy was performed with either 3 solitary sutures or 3 suture anchors. Specimens were remounted and returned to the 0 point. Translation was measured with 10-N anterior and posterior loads to determine reduction in translation. Specimens were then loaded to failure to the 0 point at a rate of 0.1 mm/s. Load to failure was significantly greater (P = .02) in the SC group (13.6 ± 1.0 N) versus the SAC group (20.5 ± 2.8 N). No differences were found between SC (2.7 ± 0.7 mm) and SAC (2.3 ± 0.6 mm) when we compared reduction of anterior translation with a 10-N load. The percent reduction of anterior displacement with a 10-N load was similar for the SC (49.9%) and SAC (49.6%) groups. The dominant mode of failure in the study was suture pull-through of the capsular tissue. Our study indicates that labral-based SC and SAC similarly reduce anterior glenohumeral translation at low loading conditions. Load-to-failure studies indicate that SAC exhibits significantly greater resistance to translation at higher loading conditions. Our study suggests that the use of a suture anchor when one is performing a capsulorrhaphy may provide biomechanical advantage at high loading conditions. Our study suggests that when one is performing capsulorrhaphy, the use of a suture anchor may provide
Woodmass, Jarret M; Matthewson, Graeme; Ono, Yohei; Bois, Aaron J; Boorman, Richard S; Lo, Ian KY; Thornton, Gail M
Purpose The purpose of this study was to evaluate the mechanical performance of different suture locking mechanisms including: i) interference fit between the anchor and the bone (eg, 4.5 mm PushLock, 5.5 mm SwiveLock), ii) internal locking mechanism within the anchor itself (eg, 5.5 mm SpeedScrew), or iii) a combination of interference fit and internal locking (eg, 4.5 mm MultiFIX P, 5.5 mm MultiFIX S). Methods Anchors were tested in foam blocks representing normal (20/8 foam) or osteopenic (8/8 foam) bone, using standard suture loops pulled in-line with the anchor to isolate suture locking. Mechanical testing included cyclic testing for 500 cycles from 10 N to 60 N at 60 mm/min, followed by failure testing at 60 mm/min. Displacement after 500 cycles at 60 N, number of cycles at 3 mm displacement, load at 3 mm displacement, and maximum load were evaluated. Results Comparing 8/8 foam to 20/8 foam, load at 3 mm displacement and maximum load were significantly decreased (Panchors that, even in part, relied on an interference fit suture locking mechanism (ie, 4.5 mm PushLock, 5.5 mm SwiveLock, 4.5 mm MultiFIX P, 5.5 mm MultiFIX S). Bone quality did not affect the mechanical performance of 5.5 mm SpeedScrew anchors which have an isolated internal locking mechanism. Conclusion The mechanical performance of anchors that relied, even in part, on interference fit were affected by bone quality. Isolated internal locking knotless suture anchors functioned independently of bone quality. Anchors with a combined type (interference fit and internal locking) suture locking mechanism demonstrated similar mechanical performance to isolated internal locking anchors in osteopenic foam comparing similar sized anchors. Clinical relevance In osteopenic bone, knotless suture anchors that have an internal locking mechanism (isolated or combined type) may be advantageous for secure tendon fixation to bone. PMID:26124683
Rosenblatt, Gregory S; Fuchs, Gerhard J
During laparoscopic partial nephrectomy, the importance of the initial suture placed under warm ischemic conditions cannot be underestimated. Inadequate hemostasis may lead to further surgical complications. Our goal was to determine which method of suture ligation (running vs figure-8 interrupted) provides better initial hemostasis when performing partial nephrectomy in an ex-vivo porcine model. Deep partial nephrectomy defects were cut in the lateral aspect of six porcine kidneys. The renal artery was cannulated, and the kidneys were perfused from a water reservoir. The level (cm H(2)O) at which parenchymal leakage occurred was measured and recorded in three situations: No parenchymal suture; running suture along the base of the defect; and interrupted figure-8 sutures placed in parallel along the base of the defect. Six kidneys were studied. Using interrupted figure-8 sutures, the mean leak pressure was 56.7 cm H(2)O (over baseline). Using a running suture, the mean leak pressure was 147.5 cm H(2)O (over baseline). Mean values were compared using two-tailed t test and found to be statistically significant (P = 0.05). In an ex-vivo porcine kidney model, use of a running suture along the base of a renal tumor defect (simulating that which is seen during partial nephrectomy) appears to allow for better initial hemostatic control, as compared with interrupted figure-8 sutures placed in parallel.
Koay, P Y; McGhee, C N; Crawford, G J
To analyze the efficacy of a standardized paired arcuate incision and augmentation suture technique in the treatment of various levels of post-penetrating keratoplasty (PKP) astigmatism. Lions Eye Institute, Royal Perth Hospital, Perth, Australia, and University of Dundee Department of Ophthalmology, Dundee, United Kingdom.A standardized paired arcuate incision and paired augmentation suture technique was used to treat 34 eyes with post-PKP astigmatism ranging from -3.50 to -20.00 diopters (D) at the spectacle plane. The technique consisted of paired arcuate incisions of 3 clock hours, 480 microm deep in the graft-host junction, and 2 pairs of augmentation 10-0 nylon sutures. The mean preoperative cylinder was -9.14 D +/- 4.38 (SD) and the mean postoperative cylinder, -3.59 +/- 1.92 D at the corneal plane after a mean follow-up of 50 +/- 43 weeks. This represents an empirical reduction in mean cylinder of 5. 55 D (60.7%). The Alpins correction index (surgically induced astigmatism [SIA] divided by target induced astigmatism) was calculated for each case, and the mean was 1.01 +/- 0.34, with a median of 0.91. Approximately 53.1% of cases achieved a correction index between 0.80 and 1.20, and the correction index correlated poorly with the initial magnitude of cylinder. A direct numerical relationship between SIA and the initial magnitude of cylinder was observed, although a standard surgical procedure was used in all cases.A simple standardized technique using paired arcuate incisions in the graft-host junction with paired augmentation sutures reduces the amount of cylinder in proportion to the magnitude of the preoperative cylinder and effectively reduces post-PKP astigmatism.
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.
Electrophysiologic assessment of regeneration in rat sciatic nerve repair using suture, fibrin glue or a combination of both techniques Avaliação eletrofisiológica da eficácia de três tipos de reparo após a secção do nervo ciático do rato
Roberto Sergio Martins
Full Text Available We evaluated the repair of seccioned rat sciatic nerve by the comparison of electrophysiologic parameters. The repair was effected with suture (group A, fibrin glue (group B or a combination of both techniques (group C. The amplitude, latency and conduction velocity of the motor and nerve action potentials were assessed before the nerve section and at reoperation after 24 weeks. There was no difference between the groups when the nerve action potential was evaluated. Rats of group B presented better results than those of group A (pForam comparados os parâmetros obtidos na avaliação eletrofisiológica do potencial de ação do nervo e do potencial de ação motor antes e após 24 semanas do reparo no nervo ciático do rato previamente seccionado no lado direito com a utilização de sutura (grupo A, adesivo de fibrina (grupo B ou uma combinação das duas técnicas (grupo C. Não houve diferença entre os grupos na avaliação do potencial de ação do nervo. Quando consideradas a latência e a velocidade de condução mensurados na reoperação e a razão entre a velocidade de condução medida na reoperação e o mesmo parâmetro antes da secção do nervo, durante a mensuração do potencial de ação motor, os animais do grupo B apresentaram melhores resultados em relação aos do grupo A (p<0,05. Os animais do grupo C apresentaram melhores resultados em comparação com os do grupo A quando considerada a razão entre a velocidade de condução medida 24 semanas do reparo e antes da secção do nervo durante a avaliação do potencial de ação motor. Conclui-se que os animais em que o reparo dos nervos foi realizado com o adesivo de fibrina apresentaram melhores resultados em comparação com a sutura quando considerados os parâmetros obtidos na mensuração do potencial de ação motor.
Lambade, Pravin; Thorat, Ashutosh
Adequate closure of the surgical wound is one of the most important aspects of surgery; improper suturing techniques or improper suturing materials sometimes compromise the success of surgery. Many synthetic materials have replaced the natural materials, which were once used for suturing in the ancient era, and Murva is one of them. There are references of Murva (Sansevieria roxburghiana Schult. and Schult.f.) at various contexts of "Sushruta Samhita" where it has been used as a suture material. It is a xerophytic herbaceous plant occurring abundantly in the eastern coastal region of India. The aim of this study is to evaluate the efficacy of Murva fibers as a suturing material in closure of intraoral incision in third molar surgeries. Fifty incisions (Wards incision) placed for the surgical removal of mandibular third molar were sutured with Murva, and follow-up was carried out postoperatively on 1st, 2nd, 3rd, and 7th day. Patients were evaluated for pain, swelling, bleeding, infection, wound dehiscence, local tissue irritation, and bacterial colonization. On various follow-ups, progressively significant and predictable healing was observed without any uneventful evidence. The use of Murva as a suture material proved to be effective in closure of intraoral incisions.
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.
Lu, Yen-Ting; Tai, Shyh-Kuan; Lee, Tsung-Lun
The aim of this study is to introduce pterygomandibular suspension suture as a simple modification of uvulopalatopharyngoplasty for severe obstructive sleep apnea in dealing with lateral pharyngeal wall and retropalatal space collapse. This retrospective study was conducted at Taipei Veterans General Hospital, Taiwan. Ten adult patients underwent modified uvulopalatopharyngoplasty with pterygomandibular suspension suture according to following inclusion criteria: severe obstructive sleep apnea (apnea-hypopnea index [AHI] > 30 events/h), type I Fujita with lateral pharyngeal wall collapse, and failure for continuous positive airway pressure (CPAP) therapy. The philosophy of this modification technique is to create a firm anterolateral suspension of the lateral pharyngeal wall and soft palate by sutures. The mean operative time of modified uvulopalatopharyngoplasty with pterygomandibular suspension suture was 60 min. The mean AHI decreased significantly from 77.2 ± 25.0 preoperatively to 28.7 ± 18.8 postoperatively (P = 0.005) and the lowest oxygen saturation increased from 69.9 ± 11.4 to 81.1 ± 7.19% (P = 0.005). No major perioperative complication such as massive bleeding or respiratory distress was noted. No patient experienced a swallowing disturbance, taste change, or voice change 6 months postoperatively. The mean period for resuming a normal diet was 15 days. Modified uvulopalatopharyngoplasty with pterygomandibular suspension suture is a simplified and effective surgical approach with satisfactory functional recovery for selective patients with severe obstructive sleep apnea.
A. M. Navali
Full Text Available Although the increase in the number of core sutures during flexor tendon repair increases the tensile strength of the repair, both increased handling at the time of repair and increased bulk at the repair site have been hypothesized as affecting clinical outcomes by increasing gliding resistance. The purpose of our study was to assess whether increasing the number of core sutures from two strands to four strands in zone II flexor tendon repair could improve the clinical results. A total of 42 patients with 60 flexor tendon lacerations in zone II were enrolled in this study. The injured tendon randomly underwent surgical repair by using one of the 2-strand or 4-strand modified Strickland techniques. Postoperative rehabilitation was the active extension-rubber band flexion method of Kleinert in all patients. The average duration of follow up was 8 months. The mean total active motion was 155.16˚ in 2-strand group (excluding two ruptures and 154.33˚ in 4-strand group (P > 0.05. Using Strickland's original score, this corresponds to excellent result in 83.3% and 86.6% of patients in 2-strand group and 4-strand group, respectively. Statistically, there was no significant difference between the clinical outcomes obtained in these groups. Concerning the tendon rupture after the repair, all of the ruptures (2 cases occurred in the 2-strand group (P > 0.05. We concluded that both suture strength and gliding resistance have influence on the result of flexor tendon repair in zone II, and increasing the number of core sutures and the resulting suture strength may be negatively affected by increase in gliding resistance.
Background Midline laparotomy closure carries a significant risk of incisional hernia. This study examines the behavior of two new suture materials, an elastic material, polyurethane (PUe), and a barbed polydioxanone (PDXb) suture thread in a rabbit model of midline incision closure. Methods Three 2-cm midline incisions were made in 68 New Zealand White rabbits. The incisions were closed by running suture using four 3/0 threads: polypropylene (PP) (Surgipro®, Covidien), PUe (Assuplus®, Assut Europe), PDX (Assufil®, Assut Europe) or PDXb (Filbloc®, Assut Europe). Animals in each suture group were euthanized 3 weeks and 6 months after surgery. Histological sections of the tissue-embedded sutures were subjected to morphological, collagen expression, macrophage response and uniaxial tensiometry studies. Results No signs of wound dehiscence or complications were observed. At 3 weeks, all sutures were surrounded by connective tissue composed mainly of collagen III. PUe showed greater collagen I expression than the other sutures. All sutures elicited a macrophage response that diminished from 3 weeks to 6 months (p sutures (PP and PUe) yet PDXb showed a significantly greater response than the other reabsorbable suture (PDX) at 3 weeks (p 0.05). Conclusion Three weeks after surgery, PUe revealed more collagen I deposition than the remaining materials and this translated to a similar biomechanical behavior to linea alba, that could avoid the appearance of short term dehiscences and thus reduce the incidence of incisional hernia. PDXb provides no additional advantages in their behavior regarding PDX suture. PMID:25231161
Giles, James T; Coker, Demir; Rochat, Mark C; Payton, Mark E; Subramarian, Vijay; Bartels, Kenneth E
Biomechanical analysis of acute load to failure (ALF) of 3 veterinary and 1 human suture anchor and cyclic load to failure with two suture material/suture anchor constructs in canine femoral condyles. Biomechanical in vitro study. Cadaveric femora from 20-30 kg dogs. Three veterinary and 1 human suture anchor were placed in the cranial and caudal aspects of the femoral condyle and subjected to 0 degrees ALF. Anchors were loaded with 5 USP Fiberwire or 27 kg test nylon leader line (NLL) and subjected to 90 degrees cyclic testing for 10,000 cycles followed by ALF at 90 degrees. No significant difference in ALF for any anchor type was detected in the cranial aspect of the femoral condyle; however all veterinary anchors had higher ALF in the caudal aspect of the femoral condyle. In cyclic testing, the constructs in descending order (most cycles to least) were: (1) FlexiTwist/NLL, (2) Securos/Fiberwire, Securos/NLL, (3) IMEX/Fiberwire, IMEX/NLL, and (4) FlexiTwist/Fiberwire, Fastin/Fiberwire. Fiberwire was significantly stronger than NLL in post-cycling ALF testing. Veterinary anchors had higher ALF in the caudal versus cranial aspect of the femoral condyle. Except for the FlexiTwist in which NLL performed better, Fiberwire and NLL both had similar cyclic performance with each veterinary anchor type. The veterinary anchors exceeded the human anchor in ALF and cycles to failure. The tested veterinary suture anchors with Fiberwire or NLL may be used in the femoral condyle, preferably in the caudal aspect, and should withstand estimated loading conditions in appropriately confined postoperative canine patients.
Wang, Ming-xin; Liu, Yu-jie; He, Wei; Li, Hai-feng; An, Bai-jing
To evaluate the repair of rotator cuff tear by allogenic cortical bone anchors with the technique of suture bridge. A total of 18 patients with rotator cuff tear were recruited during the period of June 2006 to June 2009. There were 7 males and 11 females with an average age of 45.2 years old (range: 34 - 65). The locations included left shoulder (n = 11) and right shoulder (n = 7). Rotator cuff tear was repaired by allogenic cortical bone anchors with the technique of suture bridge under arthroscopy. The efficacy was evaluated by University of California Los Angeles (UCLA) standard score. The average follow-up period was 17.6 months (range: 12 - 36). The excellent rate of treatment was 100%. All rotator cuff tears were healed. Only 2 cases had minor pain and there was no limitation of joint activity. The bone anchor fully integrated with the subject area at Month 3 post-operation. The advantages of repairing rotator cuff tear by allograft cortical bone anchors with the technique of suture bridge includes minimal trauma, a large tendon bone area, firm fixation and a low cost. It is a better approach of repairing rotator cuff tear.
Massoud, Elsayed Ibraheem Elsayed
Operative intervention is the preferred option for management of the neglected laceration of the Achilles tendon. However, the commonly used techniques rarely follow the principles of the regenerative medicine for the restoration of the lost tissue. This study postulated that incorporation of the autogenous tendon graft would properly progress when the interplay between mechanical loading and healing phases was correctly applied. A prospective study included 15 patients who were treated for neglected Achilles tendon laceration using the technique of lengthening of the proximal tendon stump. An absorbable reinforcement suture was used for control of the mechanical environment at the suture lines. By an average 5 years of the prospective follow-up, all the repaired tendons had restored continuity and length. The calf circumference equalized to the uninjured side in 12 patients. However, 3 patients had calf atrophy but they improved compared to the preoperative measurements. Sonogram confirmed the restoration of the normal thickness and the gliding characteristics of the repaired tendon. The technique restored continuity and tension of the repaired tendon, preserved the calf circumference, and prevented peritendinous adhesions. The absorbable reinforcement suture spontaneously allowed for the mechanical loading of the grafted tendon. Level IV, case series.
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.
Ventura, Liliane; Oliveira, Gunter C. D.; De Groote, Jean-Jacques; Sousa, Sidney J. F.; Saia, Paula
A system for ophthalmic surgery support has been developed in order to minimize the residual astigmatism due to the induced irregular shape of the cornea by corneal suture. The system projects 36 light spots, from LEDs, displayed in a precise circle at the lachrymal film of the examined cornea. The displacement, the size and deformation of the reflected image of these light spots are analyzed providing the keratometry and the circularity of the suture. Measurements in the range of 32D - 55D (up to 23D of astigmatism are possible to be obtained) and a self-calibration system has been designed in order to keep the system calibrated. Steel precision spheres have been submitted to the system and the results show 99% of correlation with the fabricant's nominal values. The system has been tested in 13 persons in order to evaluate its clinical applicability and has been compared to a commercial keratometer Topcon OM-4. The correlation factors are 0,92 for the astigmatism and 0.99 for the associated axis. The system indicates that the surgeon should achieve circularity >=98% in order to do not induce astigmatisms over 3D.
Hapa, Onur; Barber, F Alan; Süner, Ganim; Özden, Raif; Davul, Serkan; Bozdağ, Ergun; Sünbüloğlu, Emin
To biomechanically compare anterior cruciate ligament (ACL) tibial bony avulsion fixation by suture anchors, EndoButtons (Smith & Nephew, Andover, MA), and high-strength sutures subjected to cyclic loading. Type III tibial eminence fractures were created in 49 ovine knees, and 7 different types of repairs were performed. Each repair group contained 7 specimens. The repair groups were as follows: No. 2 FiberWire (Arthrex, Naples, FL); No. 2 UltraBraid (Smith & Nephew); No. 2 MaxBraid (Arthrotek, Warsaw, IN); No. 2 Hi-Fi (ConMed Linvatec, Largo, FL); No. 2 OrthoCord (DePuy Mitek, Raynham, MA); Ti-Screw suture anchor (Arthrotek); and titanium EndoButton. These constructs were cyclically loaded (500 cycles, 0 to 100 N, 1 Hz) in the direction of the native ACL and loaded to failure (100 mm/min). Endpoints included ultimate failure load (in Newtons); pullout stiffness (in Newtons per millimeter); cyclic displacement (in millimeters) after 100 cycles, between 100 and 500 cycles, and after 500 cycles; and mode of failure. Bone density testing was performed in all knees. Bone density was not different among the groups. The EndoButton group had a higher ultimate failure load than the FiberWire, UltraBraid, Hi-Fi, and suture anchor groups (P suture anchor group (P suture anchor group had less displacement than the Hi-Fi and FiberWire groups (P suture rupture. Under cyclic loading conditions in an ovine model, EndoButton fixation of tibial eminence fractures provided greater initial fixation strength than suture anchor fixation or fixation with various high-strength sutures except for OrthoCord. During initial cyclic loading of ACL tibial eminence fractures, the strength of the repair construct should be taken into consideration because conventional suture repair even with ultrahigh-molecular-weight polyethylene sutures may not provide enough strength. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
A variety of suture materials and skin staples (SS) are used for skin closure after caesarean section (CS). Some of these suture materials have been associated with lower wound infection rates, reduced pain, improved cosmetic outcomes and cost-effectiveness.1 On the other hand, SS are easier to use and are associated ...
To prospectively compare the clinical results of 10-0 and 9-0 monofilament nylon sutures after phacoemulsification with poly(methyl methacrylate) intraocular lens implantation through a 4.0 mm cruciate incision. Department of Ophthalmology, Ramón y Cajal Hospital, Madrid, Spain. One hundred eyes with cataract were randomly assigned to have surgery using a 10-0 or a 9-0 nylon suture. Except for suture diameter, identical surgical methods were used in every case. Data on uncorrected visual acuity, keratometry and postoperative astigmatism were analyzed up to 12 months after surgery. Both groups had similar uncorrected visual acuity. Mean postoperative corneal astigmatism was against the rule in the 10-0 nylon suture group and with the rule in the 9-0 nylon suture group. Significant differences were found between groups (P suture diameters offered satisfactory clinical results. Patients with preoperative with-the-rule astigmatism might benefit from 10-0 nylon sutures and those with preoperative against-the-rule astigmatism, from 9-0 nylon sutures.
Full Text Available ABSTRACTSuture granuloma is a mass forming benign lesion that develops at the site of surgery as a foreign body reaction to non-absorbable suture material. We present a case of suture granuloma that developed at the inguinal region after orchiectomy, and define the sonography, color Doppler sonography and real-time ultrasound elastography findings in correlation with the histopathological findings.
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.
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 ...
The Role of Thyroid Eye Disease and Other Factors in the Overcorrection of Hypotropia Following Unilateral Adjustable Suture Recession of the Inferior Rectus (An American Ophthalmological Society Thesis)
Kerr, Natalie C.
Purpose Overcorrection of hypotropia subsequent to adjustable suture surgery following inferior rectus recession is undesirable, often resulting in persistent diplopia and reoperation. I hypothesized that overcorrection shift after suture adjustment may be unique to thyroid eye disease, and the use of a nonabsorbable suture may reduce the occurrence of overcorrection. Methods A retrospective chart review of adult patients who had undergone eye muscle surgery with an adjustable suture technique was performed. Overcorrection shifts that occurred between the time of suture adjustment and 2 months postoperatively were examined. Descriptive statistics, linear regression, Anderson-Darling tests, generalized Pareto distributions, odds ratios, and Fisher tests were performed for two overcorrection shift thresholds (>2 and >5 prism diopters [PD]). Results Seventy-seven patients were found: 34 had thyroid eye disease and inferior rectus recession, 30 had no thyroid eye disease and inferior rectus recession, and 13 patients had thyroid eye disease and medial rectus recession. Eighteen cases exceeded the 2 PD threshold, and 12 exceeded the 5 PD threshold. Statistical analyses indicated that overcorrection was associated with thyroid eye disease (P=6.7E-06), inferior rectus surgery (P=6.7E-06), and absorbable sutures (>2 PD: OR=3.7, 95% CI=0.4–35.0, P=0.19; and >5 PD: OR=6.0, 95% CI=1.1–33.5, P=0.041). Conclusions After unilateral muscle recession for hypotropia, overcorrection shifts are associated with thyroid eye disease, surgery of the inferior rectus, and use of absorbable sutures. Surgeons performing unilateral inferior rectus recession on adjustable suture in the setting of thyroid eye disease should consider using a nonabsorbable suture to reduce the incidence of postoperative overcorrection. PMID:22253487
The role of thyroid eye disease and other factors in the overcorrection of hypotropia following unilateral adjustable suture recession of the inferior rectus (an American Ophthalmological Society thesis).
Kerr, Natalie C
Overcorrection of hypotropia subsequent to adjustable suture surgery following inferior rectus recession is undesirable, often resulting in persistent diplopia and reoperation. I hypothesized that overcorrection shift after suture adjustment may be unique to thyroid eye disease, and the use of a nonabsorbable suture may reduce the occurrence of overcorrection. A retrospective chart review of adult patients who had undergone eye muscle surgery with an adjustable suture technique was performed. Overcorrection shifts that occurred between the time of suture adjustment and 2 months postoperatively were examined. Descriptive statistics, linear regression, Anderson-Darling tests, generalized Pareto distributions, odds ratios, and Fisher tests were performed for two overcorrection shift thresholds (>2 and >5 prism diopters [PD]). Seventy-seven patients were found: 34 had thyroid eye disease and inferior rectus recession, 30 had no thyroid eye disease and inferior rectus recession, and 13 patients had thyroid eye disease and medial rectus recession. Eighteen cases exceeded the 2 PD threshold, and 12 exceeded the 5 PD threshold. Statistical analyses indicated that overcorrection was associated with thyroid eye disease (P=6.7E-06), inferior rectus surgery (P=6.7E-06), and absorbable sutures (>2 PD: OR=3.7, 95% CI=0.4-35.0, P=0.19; and >5 PD: OR=6.0, 95% CI=1.1-33.5, P=0.041). After unilateral muscle recession for hypotropia, overcorrection shifts are associated with thyroid eye disease, surgery of the inferior rectus, and use of absorbable sutures. Surgeons performing unilateral inferior rectus recession on adjustable suture in the setting of thyroid eye disease should consider using a nonabsorbable suture to reduce the incidence of postoperative overcorrection.
Chipont-Benabent, E; Artola Roig, A; Pérez-Santonja, J J; Guisbert Medel, M; Alió Sanz, J L
To evaluate the course of astigmatic evolution and complications after clear corneal incisions using an intrastromal corneal suture. Instituto Oftalmologico de Alicante, University of Alicante, Spain. Eighty eyes of 62 patients had endocapsular phacoemulsification. A foldable intraocular lens was implanted through a 4.0 mm clear corneal incision. A 10-0 nylon intrastromal corneal suture was used in all eyes. Change sin corneal astigmatism were calculated by vector analysis; follow-up was 6 months. Early and late suture-related complications were also evaluated. Mean induced cylinder was 1.25 diopters (D) +/- 1.24 (SD) with the wound 1 day postoperatively and 0.19 +/- 0.81 D against the wound at 6 months. There were no incision- or suture-related complications postoperatively. Use of the intrastromal corneal suture led to astigmatically neutral closure of multiplanar corneal incisions.
Yoshimura, Kenji; Kobayashi, Ryo; Ohmura, Tomohisa; Kajimoto, Yoshinaga; Miura, Takashi
Cranial sutures are narrow mesenchymal tissues that connect skull bones to each other. Given that they serve as growth centers in the skull, these undifferentiated tissues play crucial roles in skull development. Cranial sutures are also of clinical importance, because the premature fusion of skull bones results in a pathological condition called craniosynostosis. In newborns, skull sutures are wide and straight; during adolescence, they become thinner and start winding to form an interdigitating pattern. From a functional aspect, as the degree of interdigitation becomes larger, the strength of the connection between bones increases. However, the mechanisms underlying the maintenance of mesenchymal narrow bands or formation of interdigitation remain poorly understood. In the present study, we presented a new mathematical model that can reproduce the suture width maintenance and interdigitation formation. We can predict the width of the mesenchyme bands and wavelengths of suture interdigitations from the model. Copyright © 2016 Elsevier Ltd. All rights reserved.
Maria A. Katsianou
Full Text Available Normal extension and skull expansion is a synchronized process that prevails along the osteogenic intersections of the cranial sutures. Cranial sutures operate as bone growth sites allowing swift bone generation at the edges of the bone fronts while they remain patent. Premature fusion of one or more cranial sutures can trigger craniosynostosis, a birth defect characterized by dramatic manifestations in appearance and functional impairment. Up until today, surgical correction is the only restorative measure for craniosynostosis associated with considerable mortality. Clinical studies have identified several genes implicated in the pathogenesis of craniosynostosis syndromes with useful insights into the underlying molecular signaling events that determine suture fate. In this review, we exploit the intracellular signal transduction pathways implicated in suture pathobiology, in an attempt to identify key signaling molecules for therapeutic targeting.
Reda, Walid; Khedr, Ahmed
Using a posterolateral portal in passing and tying the inferior knot allows good labral reduction and adequate capsular shift to treat anterior shoulder instability. In this technique, the most inferior anchor is placed through a low anterolateral portal. A penetrating grasper is introduced from a posterolateral portal situated 2 to 3 cm distal and lateral to the viewing portal. This portal is used to pass the 2 limbs of the anchor suture as inferior as possible through the labrum and capsule close to 6 o'clock position to form the 2 limbs of the first mattress suture. Finally, knot tying is performed through this posterolateral portal, thus allowing better superior shift of the capsulolabral tissue. The other 2 anchor sutures are passed and tied through the low anterolateral portal.
Moorthy, Sonia; Graue, Enrique; Jhanji, Vishal; Constantinou, Marios; Vajpayee, Rasik B
To determine the impact of presence or absence of sutures in cases with post-penetrating keratoplasty (PKP) microbial keratitis. A 10-year retrospective chart review of post-PKP patients admitted with microbial keratitis at the Royal Victorian Eye and Ear Hospital, Melbourne, between January 1998 and December 2008 was undertaken. Patients were categorized in 2 groups, "sutures present" and "sutures absent." Main parameters evaluated were clinical and microbiological profile and treatment outcome. One hundred and twenty-two episodes of microbial keratitis were noted in 101 patients: 71 (58.2%) with sutures present and 51 (41.8%) with sutures absent. Overall, pseudophakic bullous keratopathy was the most common indication for keratoplasty (P=.92). Ocular surface disorder was the commonest risk factor associated with the occurrence of infection in both groups (P=.17). Infections caused by Moraxella sp. (P=.001) were significantly more common in the "sutures absent" group. Surgical interventions were required for 47 episodes (39%), with corneal gluing performed in significantly higher number of cases in the "sutures absent" group (40% vs 15%; P=.05). Multivariate analyses did not reveal any significant associations. Final mean visual acuity outcome was poorer in the "sutures absent" group (logMAR 2.10 ± 0.92 vs 1.76 ± 0.96; P=.04). Corneal graft infections, in the presence and absence of sutures, share similar indications and risk factors. However, infections caused by indolent microorganisms were more prevalent in grafts without sutures. This group of patients required a higher number of surgical interventions in the form of corneal gluing and the overall visual outcome was poor. Copyright © 2011 Elsevier Inc. All rights reserved.
Henry-Stanley, Michelle J.; Hess, Donavon J.; Barnes, Aaron M.T.; Dunny, Gary M.
Abstract Background Although much attention is currently directed to studying microbial biofilms on a variety of surfaces, few studies are designed to study bacterial growth on surgical suture. The purpose of this study was to compare the kinetic development of Staphylococcus aureus and Enterococcus faecalis on five surgical suture materials and to clarify factors that might influence this growth. Methods Pure cultures of S. aureus and E. faecalis were incubated with five types of suture for four days using either tissue culture medium or a bacterial growth medium. Suture-associated bacteria were quantified daily. In selected experiments, the bacterial growth medium was supplemented with heparin, a substance known to promote S. aureus biofilm formation. The ultrastructure of S. aureus biofilm developing on braided suture was studied with scanning electron microscopy. Results Staphylococcus aureus and E. faecalis were recovered in greater numbers (typically p suture, and the numbers of bacteria were greater (often p sutures incubated in bacterial growth medium rather than tissue culture medium. Addition of heparin 1,000 U/mL to silk or braided polyglactin 910 suture incubated three days with S. aureus resulted in greater numbers of bacteria on day one but not on subsequent days. Scanning electron microscopy showed a maturing S. aureus biofilm that developed from small clusters of cells among amorphous material and fibrillar elements to larger clusters of cells that appeared covered by more consolidated extracellular material. Conclusions Bacterial growth was favored on braided vs. monofilament suture, and heparin enhanced bacterial adherence after day one, but not at subsequent times. Staphylococcus aureus adhered to suture material and formed a structure consistent with a bacterial biofilm. PMID:20673144
Full Text Available A modified method of continuous loop technique for microvascular anastomosis is described. The handling of loop is easier & even last suture is placed under vision. This makes the microvascular anastomosis easier and simpler.
Li, Hong-Yun; Hua, Ying-Hui; Wu, Zi-Ying; Chen, Bo; Chen, Shi-Yi
The purpose of this study was to compare the biomechanical characteristics of fixation with 2-suture anchors versus transosseous tunnel fixation in anatomic reconstruction of the ankle lateral ligaments. Six matched pairs of human cadaveric ankles underwent anatomic lateral ankle reconstruction, and fixation of the graft on the talus was achieved with 2 suture anchors or a transosseous tunnel. Ankles for the transosseous tunnel group were chosen at random, with the paired contralateral ankles used for the 2-suture anchor group. Half of the peroneus brevis tendon was harvested as a graft. For each technique, one end of the tendon was secured to the original insertion point of the anterior talofibular ligament (ATFL) at the talus, whereas the other end was armed with 2 No. 5 nonabsorbable sutures (Ethicon, Somerville, NJ) and passed through the bone tunnel in the fibula. Biomechanical testing was performed by applying the force in line with the graft. Load to failure was determined at a displacement rate of 50 mm/min. The load-displacement curve, maximum load at failure (N), and stiffness (N/mm) were recorded and compared between the 2 techniques. There was no difference between constructs in the 2-suture anchor group and the transosseous tunnel group in terms of the ultimate load and stiffness (161.8 ± 47.6 N v 171.9 ± 76.0 N; P = .92; 4.59 ± 1.85 N/mm v 5.77 ± 1.98 N/mm; P = .35). Most constructs failed because of anchor pullout in the 2-suture anchor group (5 of 6) and fracture of the bony bridge in the transosseous tunnel group (6 of 6). The strength of fixation with suture anchors in anatomic reconstruction of the ankle lateral ligaments was equivalent to transosseous tunnel fixation as determined with biomechanical testing. However, this study did not prove that one is advantageous over the other. Both techniques showed excellent biomechanical results. Therefore, the 2-suture anchor fixation approach can be safely used in anatomic reconstruction of the
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.
Akpinar, Haluk; Karadag, Mert Ali; Dönmez, Muhammet İrfan; Altunrende, Fatih
Background and Objectives: The search for the perfect suture is going on and has resulted in the introduction of many different suture types into the market. The purpose of this study is to investigate the holding strength (HS) of different sutures in the renal parenchyma in an experimental study on pig kidneys. Methods: The HS that caused sliding of the suture was investigated in 5 adult porcine kidneys with 7 suture variants. HS-caused tearing of the kidney was investigated with 3 suture types on 5 kidneys. The third investigation, performed on 5 porcine kidneys, was a comparison between 2-0 Vicryl sutures with a Hem-o-lok clip and 2-0 V-Loc sutures with 1 knot. The Friedman test was used to compare the groups. Post hoc analysis was performed with the Wilcoxon signed ranks test (Bonferroni corrected). Results: For HS causing sliding of the suture, the mean HSs of the tested sutures were as follows: 2-0 Vicryl with 1 Hem-o-lok clip, 3.26 ± 0.55 N; 2-0 Vicryl with 2 Hem-o-lok clips, 4.1 ± 0.46 N; 2-0 V-Loc, 2.52 ± 0.63 N; 4-0 V-Loc, 1.62 ± 0.17 N; 0 Quill, 0.48 ± 0.16 N; 2-0 Vicryl with 1 Hem-o-lok clip (halfway), 3.62 ± 0.66 N; and 2-0 V-Loc (halfway), 1.02 ± 0.40 N. For HS causing tearing of the kidney, the mean value of 2-way 2-0 Vicryl (Hem-o-lok in the middle) was 13.28 ± 1.38 N, 2-0 2-way Vicryl (Hem-o-lok at the end) was 5.86 ± 0.75 N, and 2-way 2-0 V-Loc was 3.98 ± 1.60 N. For the third group, the difference between the 2 suture variants was not statistically significant. Conclusion: Our study revealed that 2-0 Vicryl (polyglactin 910) sutures with 2 Hem-o-lok clips had the maximum HS in renal parenchyma when compared with other sutures. PMID:28729782
Özkuvanci, Ünsal; Akpinar, Haluk; Karadag, Mert Ali; Dönmez, Muhammet İrfan; Altunrende, Fatih
The search for the perfect suture is going on and has resulted in the introduction of many different suture types into the market. The purpose of this study is to investigate the holding strength (HS) of different sutures in the renal parenchyma in an experimental study on pig kidneys. The HS that caused sliding of the suture was investigated in 5 adult porcine kidneys with 7 suture variants. HS-caused tearing of the kidney was investigated with 3 suture types on 5 kidneys. The third investigation, performed on 5 porcine kidneys, was a comparison between 2-0 Vicryl sutures with a Hem-o-lok clip and 2-0 V-Loc sutures with 1 knot. The Friedman test was used to compare the groups. Post hoc analysis was performed with the Wilcoxon signed ranks test (Bonferroni corrected). For HS causing sliding of the suture, the mean HSs of the tested sutures were as follows: 2-0 Vicryl with 1 Hem-o-lok clip, 3.26 ± 0.55 N; 2-0 Vicryl with 2 Hem-o-lok clips, 4.1 ± 0.46 N; 2-0 V-Loc, 2.52 ± 0.63 N; 4-0 V-Loc, 1.62 ± 0.17 N; 0 Quill, 0.48 ± 0.16 N; 2-0 Vicryl with 1 Hem-o-lok clip (halfway), 3.62 ± 0.66 N; and 2-0 V-Loc (halfway), 1.02 ± 0.40 N. For HS causing tearing of the kidney, the mean value of 2-way 2-0 Vicryl (Hem-o-lok in the middle) was 13.28 ± 1.38 N, 2-0 2-way Vicryl (Hem-o-lok at the end) was 5.86 ± 0.75 N, and 2-way 2-0 V-Loc was 3.98 ± 1.60 N. For the third group, the difference between the 2 suture variants was not statistically significant. Our study revealed that 2-0 Vicryl (polyglactin 910) sutures with 2 Hem-o-lok clips had the maximum HS in renal parenchyma when compared with other sutures.
Wilson, L; Banks, Ta; Luckman, P; Smith, B
To compare two Krackow sutures with a three-loop pulley suture for the reattachment of canine gastrocnemius tendons, using a tendon avulsion model. In vitro biomechanical study. Ten paired gastrocnemius tendons were severed at their insertions on the calcaneal tuberosity and repaired with either two modified Krackow sutures or a modified three-loop pulley suture. Sutures were placed in the tendon ends and through diverging bone tunnels in the medial and lateral processes of the calcaneal tuberosity. Tensile loads required to (a) create a 3-mm gap and (b) induce construct failure were measured. The mean load to achieve a 3-mm gap was 77.22 ± 9.72 and 55.85 ± 9.91 N, and to result in construct failure was 106.88 ± 12.74 and 80.86 ± 12.23 N for the Krackow and three-loop pulley suture patterns, respectively. These differences were statistically significant (P sutures were superior to the three-loop pulley pattern in both resistance to 3-mm gap formation and load to failure in a canine gastrocnemius avulsion model. The prevention of gap formation is critical for the success of tenorrhaphy. These results indicate that a suture pattern using two Krackow sutures may be clinically superior to the three-loop pulley suture pattern in the repair of canine gastrocnemius avulsion. Further work is required to determine if this superiority is mirrored in the repair of other tendon avulsion or laceration scenarios. © 2014 Australian Veterinary Association.
Kamburoğlu, Haldun Onuralp; Kayıkçıoğlu, Aycan Uğur
Two main well-known approaches are used in rhinoplasty: open and closed techniques. This study aimed to define two new tip suture modifications that enhance and stabilize tip shape, projection, and position through an extended infracartilaginous incision with an open rhinoplasty exposure. This study investigated 56 consecutive primary rhinoplasty patients 18-51 years of age (mean age 27.8 years) who underwent surgery between June 2011 and June 2012 and had at least a 1-year postoperative follow-up period. Rhinoplasty was performed through an extended infracartilaginous incision with an open exposure. Transdomal suture modification for columella-lobular angle augmentation and a footplate repositioning suture for tip projection (and position) enhancement also were defined. A postoperative satisfaction survey was applied to all the patients at their 1-year follow-up visit. The postoperative satisfaction rate was 96 %. The nasal tip positions and projections of the patients were fine and stable in all the patients after a 1-year postoperative period. At this writing, no over- or underprojection, supratip deformity, saddle-nose deformity, or dorsal-surface irregularities have been encountered. Representative cases are displayed. This study defined two new tip suture techniques and combined them with an extended infracartilaginous incision. Also, control of the entire nose and nasal valve area was possible through this incision. 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 www.springer.com/00266 .
Fares, Usama; Mokashi, Aashish A; Al-Aqaba, Mouhamed Ali; Otri, Ahmad Muneer; Miri, Ammar; Dua, Harminder Singh
To analyse the efficacy of paired arcuate incisions and compression sutures technique in the management of post penetrating keratoplasty (PK) astigmatism. A paired arcuate incision with compression sutures procedure was used to treat 26 eyes with post-PK astigmatism ranging from 6.00 to 16.50 dioptres (D). The incisions were placed at the 7.0 mm optical zone inside the graft-host junction at a depth of 80% of corneal thickness. A 45° paired arc length was planned for eyes with preoperative astigmatism between 6D and 9D, and a 60° paired arc length was planned for eyes with preoperative astigmatism of >9D. At 3 months, corneal topography and refraction was performed and suture(s) removed if indicated. Net and vector astigmatism changes were calculated to determine the efficacy of the procedure. The indications for PK included keratoconus, Fuch's endothelial dystrophy, pseudophakic bullous keratopathy and corneal scar. There was a statistically significant reduction in the mean magnitude of astigmatism from 9.66 ± 2.90D preoperatively to 4.37 ± 2.53D postoperatively in the whole group. The mean decrease in the astigmatism was 4.37 ± 2.05D (58.4%) and 6.23 ± 3.63D (52.6%) in patients with 6-9D and >9D, respectively. Vector power calculations also showed a significant astigmatism reduction in all groups. The safety and efficacy indices were 1.40 and 0.28, respectively. Manual astigmatic keratotomy is a viable technique with relatively good safety and efficacy outcomes. Based on the results we propose that increasing the arc length to a minimum of 60° for astigmatism of 6-9D, and to 75° for astigmatism >9D, is likely to have a greater beneficial effect.
Martini, F M; Simonazzi, B; Del Bue, M
To evaluate the effectiveness of an extra-articular surgical technique using absorbable suture material for the stabilization of traumatic coxofemoral luxation in dogs. Prospective, clinical study. Fourteen client-owned dogs with recent and long-standing traumatic coxofemoral luxation (13 craniodorsal and 1 ventral). Coxofemoral luxations were surgically reduced and maintained in place with an extra-articular iliofemoral multifilamentous absorbable suture (3 to 6 strands of 2 USP Polyglactin 910). No external support was employed, and all the dogs were encouraged to use the affected limb postoperatively. The average time of clinical and radiographic follow-up was 11.6 +/- 6.3 months (from 2 to 22 months). During the follow-up period, no reluxations occurred and no complications associated with the surgical technique were identified. The dogs started bearing weight from 1 to 10 days after the surgery (mean, 4.3 +/- 2.9 days) and the period of lameness ranged from 7 to 30 days (20 +/- 8.6 days). At the final clinical examination, the dogs did not demonstrate any lameness or pain during passive flexo-extension movements, and there was no significant limitation of the range of motion. Extra-articular stabilization with multifilamentous absorbable sutures is a simple, effective method of treatment for acute and chronic coxofemoral luxation. The absorbable material used is strong enough to maintain articular stability during the period of scar tissue formation even in large-breed dogs. Absorbable sutures avoid the possible complications related to the use of nonabsorbable material and seem to be sufficient to maintain articular stability during the capsular healing process. Copyright 2001 by The American College of Veterinary Surgeons
Gurjar, Vipul; Halvadia, B M; Bharaney, R P; Ajwani, Vicky; Shah, S M; Rai, Samir; Trivedi, Mitesh
To study the results of two techniques, simple interrupted closure and continuous with intermittent Aberdeen knot technique for midline laparotomy fascial wound closure. A random selection of 200 midline laparotomy cases was done. In one group (group A) of 100 cases, midline fascial wound closure was done with continuous sutures with intermittent Aberdeen knot technique using Prolene No. 1 suture material. In the other group (group B) of 100 cases, closure was done with the technique of simple interrupted sutures with Prolene No.1 suture material. Comparison of both the techniques regarding preoperative status and postoperative complication such as incisional hernia, wound dehiscence, suture sinus formation, stitch granuloma, and chronic wound pain was done according to clinical examination and recorded in the pro forma prepared. In group A, postoperative complications were incisional hernia 3 %, wound dehiscence 4 %, and suture sinus formation 1 %. In group B, postoperative complication were incisional hernia 5 %, wound dehiscence 4 %, and suture sinus formation 1 %. All these complications were statistically insignificant, in both group comparisons. While the complication such as stitch granuloma 3 %, chronic wound pain 3 %, and wound infection 4 % in group A was significantly less than in group B where the complication of stitch granuloma was 12 %, chronic wound pain 13 %, and wound infection 13 % (P value 0.03, P value 0.018, and P value 0.048, respectively). Both the techniques, simple interrupted suture closure and continuous with intermittent Aberdeen knot closure for midline laparotomy fascial wounds, show a similar rate of postoperative complication such as incisional hernia, wound dehiscence, and suture sinus formation. But the continuous suturing with intermittent Aberdeen knot technique is a better option to prevent complications such as stitch granuloma, chronic wound pain, and wound infection, which are higher in the simple interrupted
Holberg, Christof; Holberg, Nikola; Rudzki-Janson, Ingrid
The goal of this study was to analyze the strains induced in the sutures of the midface and the cranial base by headgear therapy involving orthopedic forces. Does the mechanical signal induced in the sutures sufficiently account for a growth-influencing effect? A finite element model of the viscerocranium and the neurocranium was used. It consisted of 53,555 tetrahedral elements and 97,550 nodes. The strain induced in the sutures of the cranial base and the midface when applying orthopedic headgear forces of 5 and 10 N was computed and recorded with an interactive measurement tool. The magnitude and the distribution of the measured strains depended on the level and the direction of the acting force. Overall, the strain values measured at the sutures of the midface and the cranial base were moderate. The measured peak values at a load of 5 N per side were usually just below 20 microstrain irrespective of the force direction. A characteristic distribution of strain values appeared on the anatomical structures of the midface and the cranial base for each vector direction. The measurements based on the finite element method provided a good overview of the approximate magnitudes of sutural strains with orthopedic headgear therapy. The signal arriving in the sutures is apparently well below threshold, since the maximum measured strains in most sutures were about 100 fold lower than the minimal effective strain. A skeletal effect of the orthopedic headgear due to a mechanical effect on sutural growth cannot be confirmed from these results. The good clinical efficacy of headgear therapy with orthopedic forces is apparently based mainly on dentoalveolar effects, whereas the skeletal effect due to inhibition of sutural growth is somewhat questionable.
Judson, Christopher H; Charette, Ryan; Cavanaugh, Zachary; Shea, Kevin P
Traditional Bankart repair using bone tunnels has a reported failure rate between 0% and 5% in long-term studies. Arthroscopic Bankart repair using suture anchors has become more popular; however, reported failure rates have been cited between 4% and 18%. There have been no satisfactory explanations for the differences in these outcomes. Bone tunnels will provide increased coverage of the native labral footprint and demonstrate greater load to failure and stiffness and decreased cyclic displacement in biomechanical testing. Controlled laboratory study. Twenty-two fresh-frozen cadaveric shoulders were used. For footprint analysis, the labral footprint area was marked and measured using a Microscribe technique in 6 specimens. A 3-suture anchor repair was performed, and the area of the uncovered footprint was measured. This was repeated with traditional bone tunnel repair. For the biomechanical analysis, 8 paired specimens were randomly assigned to bone tunnel or suture anchor repair with the contralateral specimen assigned to the other technique. Each specimen underwent cyclic loading (5-25 N, 1 Hz, 100 cycles) and load to failure (15 mm/min). Displacement was measured using a digitized video recording system. Bankart repair with bone tunnels provided significantly more coverage of the native labral footprint than repair with suture anchors (100% vs 27%, P tunnels (21.9 ± 8.7 N/mm) showed significantly greater stiffness than suture anchor repair (17.1 ± 3.5 N/mm, P = .032). Mean load to failure and gap formation after cyclic loading were not statistically different between bone tunnel (259 ± 76.8 N, 0.209 ± 0.064 mm) and suture anchor repairs (221.5 ± 59.0 N [P = .071], 0.161 ± 0.51 mm [P = .100]). Bankart repair with bone tunnels completely covered the footprint anatomy while suture anchor repair covered less than 30% of the native footprint. Repair using bone tunnels resulted in significantly greater stiffness than repair with suture anchors. Load to failure
Cho, Yang Kyeung; Kim, Man Soo
To evaluate the factors that affect postoperative astigmatism and post-suture removal astigmatism, and to evaluate the risk factors associated with astigmatism axis shift. We performed a retrospective chart review of 130 eyes that had undergone uneventful phacoemulsification cataract surgery. Preoperative astigmatism was divided into four groups (Groups I, II, III, and IV) according to the differences between the axis of preoperative astigmatism (flattest axis) and the incision axis (105 degrees). We analyzed the magnitude and axis of the induced astigmatism after the operation and after suture removal in each group. We also analyzed the factors which affected the postoperative astigmatism and post-suture removal astigmatism in each sub-group of Groups I, II, III, and IV, excluding postoperative or post-suture removal axis shift (specifically, Group I(WAS), II(WAS), III(WAS), and IV(WAS)). We identified the variables associated with the prevalence of postoperative astigmatism axis shift and those associated with the prevalence of post-suture removal axis shift. An increase in the magnitude of postoperative astigmatism was associated with an increase in the preoperative magnitude of astigmatism in Groups I(WAS), II(WAS), and III(WAS) (pastigmatism was associated with an increase in the corneal tunnel length in Groups III(WAS) and IV(WAS) (psuture removal astigmatism was associated with an increase in the magnitude of postoperative astigmatism in Groups I(WAS) and IV(WAS) (psuture removal in Group IV(WAS) (psuture removal astigmatism was associated with late suture removal in Groups I(WAS) and II(WAS). A logistic regression analysis showed that the prevalence of post-suture removal astigmatism axis shift was associated with increased corneal tunnel length, decreased magnitude of postoperative astigmatism, and early suture removal. In order to reduce postoperative and post-suture removal astigmatism, we recommend a short corneal tunnel length and late suture removal
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 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.
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.
Souza, Jason M; Dumanian, Zari P; Gurjala, Anandev N; Dumanian, Gregory A
The authors present a novel mesh suture design aimed at minimizing the early laparotomy dehiscence that drives ventral hernia formation. The authors hypothesized that modulation of the suture-tissue interface through use of a macroporous structure and increased aspect ratio (width-to-height ratio) would decrease the suture pull-through that leads to laparotomy dehiscence. Incisional hernias were produced in 30 rats according to an established hernia model. The rat hernias were randomized to repair with either two 5-0 polypropylene sutures or two midweight polypropylene mesh sutures. Standardized photographs were taken before repair and 1 month after repair. Edge-detection software was used to define the border of the hernia defect and calculate the defect area. Histologic analysis was performed on all mesh suture specimens. Seventeen hernias were repaired with mesh sutures and 13 were repaired with conventional sutures. The mean area of the recurrent defects following repair with mesh suture was 177.8 ± 27.1 mm2, compared with 267.3 ± 34.1 mm2 following conventional suture repair. This correlated to a 57.4 percent reduction in defect area after mesh suture repair, compared with a 10.1 percent increase in defect area following conventional suture repair (p sutures pulled through the surrounding tissue, whereas 65 percent (17 of 26) of the conventional sutures demonstrated complete pull-through. Excellent fibrocollagenous ingrowth was observed in 13 of 17 mesh suture specimens. Mesh sutures better resisted suture pull-through than conventional polypropylene sutures. The design elements of mesh sutures may prevent early laparotomy dehiscence by more evenly distributing distracting forces at the suture-tissue interface and permitting tissue incorporation of the suture itself.
... suture. 878.4493 Section 878.4493 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND....4493 Absorbable poly(glycolide/l-lactide) surgical suture. (a) Identification. An absorbable poly(glycolide/l-lactide) surgical suture (PGL suture) is an absorbable sterile, flexible strand as prepared and...
Kumar, Nitin; Thompson, Christopher C
Perforation of the GI tract during endoscopy can result in significant morbidity and mortality. Early recognition and immediate management of endoscopic perforation are essential to optimize outcome. Larger perforations, defects with complex geometry, and those complicated by leakage of luminal contents have traditionally required surgical management. To assess the feasibility of a new method for managing complex perforations that incorporates abdominal exploration and endoscopic sutured closure. Case series. Tertiary care center. Two patients with large, complicated perforations and peritoneal contamination. Endoscopic exploration of abdomen with angiocatheter placement under direct visualization, management of leaked luminal contents, and full-thickness sutured defect closure. Endoscopic abdominal exploration through the perforation site allowed safe placement of an angiocatheter for management of pneumoperitoneum, inspection for injury that may warrant surgical management, and removal of leaked luminal contents. Endoscopic sutured closure allowed safe and robust perforation management. Repair of gastrojejunal anastomotic perforation required 2 sutures and 63 minutes. Repair of gastric perforation required 4 sutures and 48 minutes. Patients had successful endoscopic defect closure confirmed by an upper GI series and were discharged 1 day later. Report of a new method in 2 patients performed at tertiary care center. We demonstrate successful management of complex perforations with peritoneal contamination by incorporating endoscopic exploration and sutured closure with standard treatment measures. Traditional practice would have directed these patients to surgical management, which introduces additional morbidity and cost. A means for safe and broad implementation of these techniques should be evaluated. Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
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...
Rigal, J; Thelen, T; Angelliaume, A; Pontailler, J-R; Lefevre, Y
We present a new bone suture anchor technique for fractures of the medial epicondyle. The hypothesis was that the results would be similar to those with the divergent K-wire fixation. This retrospective study included 40 patients who presented with displaced fractures of the medial epicondyle: one group was treated with a Mitek(®) non-resorbable bone suture anchor (group A: n=21), the other by K-wire fixation (group B: n=19). A medial approach was taken with an anchor placed above the olecranon fossa. The epicondyle was then repositioned by bone suture. After a mean follow-up of 18.6 months, union was obtained in all epicondyles. There was no difference in flexion-extension of the elbow. The rate of hypertrophy of the medial epicondyle was similar in both groups (57%). The bone suture anchor of the medial epicondyle is an effective technique that does not require hardware removal and is an alternative treatment option to divergent K-wire fixation. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
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.
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.
Fok, August W M; Yau, W P
To report the clinical and radiological results of all-inside meniscal repairs using a pre-loaded suture anchor. Case series. Regional hospital, Hong Kong. From January 2008 to June 2010, 51 patients with a mean age of 26 (range, 15-48) years with 57 meniscal tears underwent meniscal repair utilising the all-inside meniscal repair technique entailing a pre-loaded suture anchor. All tears were located at red-red or red-white zones. Concurrent anterior cruciate ligament reconstruction was performed in 37 (73%) of the patients. Patients were evaluated postoperatively based on the International Knee Documentation Committee score, clinical examination, and magnetic resonance imaging. Presence of locking, joint-line tenderness, effusion, and positive McMurray test were considered to indicate clinical failure. The mean follow-up was 19 (range, 12-39) months. An average of 2 (range, 1 to 4) suture devices was used per patient. The mean tear size was 20 (range, 10-40) mm. In all, 10 (18%) of the tears had failed clinically and 11 (19%) appeared unhealed on postoperative imaging. The mean International Knee Documentation Committee score improved significantly from 62 preoperatively to 81 postoperatively (Psuture anchor is safe and effective, and yielded an 83% clinical and 81% radiological success rate.
Nishiyama, Kouichirou; Hirose, Hajime; Iguchi, Yoshiaki; Yamamoto, Kazuhiro; Masaki, Takashi; Kamijo, Takahiro; Ino, Takeshi; Yamanaka, Jun; Yao, Kazuo; Okamoto, Makito
To improve low-pitched voices in cases with polypoid vocal cords, YAG laser irradiation combined with a mucosal suturing technique was attempted in 9 female cases with severe polypoid changes in their vocal cords. A YAG laser beam (5 to 10 W) was used to irradiate the upper surface of the polypoid vocal cord. The polypoid content of the cord was gradually coagulated, and the free edge of the cord appeared to slide up toward the burned area. The polypoid content was then removed and squeezed through an open wound made in the burned area using a conventional method. Bleeding was successfully controlled using the laser. After the excessive mucosal margin was trimmed and the contour of the vocal cord was adjusted, the wound was closed by 7-0 monofilament absorbable suture. Suturing was relatively easy because the mucosal edge was also coagulated. Postoperative evaluations of voice quality revealed an improvement in the GRBAS scale of voice quality as well as an elevation in voice pitch and an upwards shift in the voice range in all cases.
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.
Jae Jun Lee
Full Text Available BackgroundFracture-dislocation of the proximal interphalangeal (PIP joint is a relatively common injury. Various treatments for fracture-dislocation of the PIP joint have been reported. In the present study, we performed open reduction through a midlateral incision using absorbable sutures to reduce the small bone fragments and performed volar plate repair.MethodsWe treated nine patients with fracture-dislocation of the PIP joint with small fractured bone fragments too small for pinning or screw fixation. Patients with volar plate injury were treated with open reduction and volar plate repair at the periosteum of the middle phalangeal bone base by the modified Kessler method using absorbable sutures. All patients were placed in a dorsal aluminum extension block splint, which maintained the PIP joint in approximately 30 degrees of flexion to avoid excessive tension on the sutured volar plate.ResultsAt a mean final follow-up of postoperative 9 months, all patients were evaluated radiographically and had adequate alignment of the PIP joint and reduction of the displaced bone fragments. Range of motion was improved and there were no complications.ConclusionsThis technique is an excellent alternative to the current method of treating patients with fracture-dislocations that include small fragments that are too small for pinning or screw fixation. It is a less invasive surgical method and enables stable reduction and early exercise without noticeable complications.
Ólafsdóttir, Hildur; Darvann, Tron Andre; Hermann, Nuno V.
In the study of craniofacial malformations, the cranial sutures are often of interest. The premature fusion of sutures occurring in e.g. Crouzon and Apert syndrome can lead to asymmetric head shape, enlarged intracranial pressure and blindness. In large population studies of such syndromes......, 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...
Heitmann, M; Gerau, M; Hötzel, J; Giannakos, A; Frosch, K-H; Preiss, A
Reconstruction of knee stability by primary ligament sutures and additional augmentation after knee dislocation. Acute knee dislocation Schenck type III and IV. Operative treatment should be performed within 7 days after injury. Chronic instability after knee dislocation, refixable bony avulsions, critical soft tissue, infection, lack of compliance. Supine position with electric leg holder. Short arthroscopic assessment of concomitant injuries. Schenck type III medial injuries and Schenck IV injuries: anteromedial parapatellar arthrotomy. Injuries type Schenck III lateral: anteromedian arthrotomy. Armoring of ligament stumps for transosseus sutures. Placement of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) drill tunnels. Extracortical diversion of the suture armorings and insertion of augmentation systems. Fixation of the PCL augmentation in 70-90° flexion. Fixation of the ACL augmentation in 20-30° flexion. Knotting of the transosseus ligament sutures. If necessary (postero-)lateral and/or medial stabilization. Limited weight bearing with 20 kg for 6 weeks. Stabilizing brace (e.g., Hypex-Lite®, Albrecht) generally for 12 weeks. Mobilization under tension of the quadriceps muscle for 6 weeks. In total, 20 patients have been treated using the principle of "ligament bracing". So far 8 patients (aged 18-60 years, median 33 years) have been assessed with a follow-up of 10-15 months (median 12 months) postoperatively. In all, 6 patients showed stable knees with good results. Recurrent instability of the ACL was observed in 2 patients; the collateral ligaments and PCL were stable. For the evaluation the following scores were used: IKDC score, Tegner score, and Lysholm score. To objectify the data, stress radiography and physical examination were performed. Using the operative technique mentioned above, no complications occurred. During follow-up 2 patients reported a deficiency of flexion.
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.
Hjortdal, Jesper; Søndergaard, Anders; Fledelius, Walther; Ehlers, Niels
To investigate whether suture regularity affects corneal astigmatism after keratoplasty. Twenty-one patients undergoing penetrating keratoplasty for various corneal diseases were included in the study. The grafts were sutured in place using a single-running Nylon 10-0 suture, taking 24 bites. Immediately after surgery, standard calibrated images of the grafted eye were captured and stored. Using a dedicated image analysis programme, stitches and needle points were identified, and a number of suture regularity variables were calculated. Corneal topographic images were obtained before suture removal (12 months after surgery) and 3 months after suture removal (18 months after surgery). Topographic measures of astigmatism [surface regularity (SRI), surface asymmetry index (SAI) and simulated keratometric astigmatism] were calculated and correlated with the computed suture regularity variables. The average stitch length was 3.04 ± 0.28 mm and the distance between the outer needle points was 2.53 ± 0.09 mm. The SRI was 1.26 ± 0.36 and the SAI was 1.59 ± 0.67 after 12 months; these decreased to 1.03 ± 0.48 and 0.92 ± 0.46 after 18 months, respectively. Corneal astigmatism was 6.38 ± 2.99 and 5.87 ± 3.13 dioptres after 12 and 18 months, respectively. Suture regularity did not affect SAI, SRI or corneal astigmatism significantly 12 months after surgery. Eighteen months after surgery (3 months after suture removal), the standard deviation on the original stitch length was found to significantly increase corneal astigmatism. In addition, the size of the counter-clockwise angle between stitch and graft radian was correlated significantly with a lower SRI. The origin of corneal astigmatism after penetrating keratoplasty is multifaceted. Regular stitch length and stitch advancement on the surface appears to improve the optical quality of the graft after suture removal. Factors such as stitch depth, suture tension and variations in wound construction might also be
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.
Fu, Arthur D; McDonald, H Richard; Jumper, J Michael; Aaberg, Thomas M; Smiddy, William E; Robertson, Joseph E; Johnson, Robert N; Ai, Everett
To describe the clinical course and management of patients with late vitreous hemorrhage after scleral suturing of posterior chamber intraocular lenses (PCIOL). The authors reviewed patient demographics, ocular findings, and clinical course of six patients with late (>3 weeks) vitreous hemorrhage after sclera-sutured PCIOL. Intraoperative endoscopy was performed on two patients to better assess the haptic sulcus interaction. Patient age ranged from 39 to 84 years (median 77 years). The interval between scleral suturing of the PCIOL and vitreous hemorrhage ranged from 3 weeks to 68 months (median 5 months). The number of hemorrhages ranged from one to four. The hemorrhage cleared spontaneously in three eyes. Three patients underwent surgery after the hemorrhages including sutured PCIOL removal with concurrent placement of an anterior chamber IOL (ACIOL) (two patients) and resuturing of a PCIOL in a different meridian (one patient). Follow-up ranged from 4 to 36 months, median 19.5 months, starting from the time of the initial postsuturing vitreous hemorrhage. Final vision ranged from 20/20 to hand motions, with four eyes having 20/40 or better vision. Endoscopy revealed a haptic embedded into the pars plicata in one eye but no evidence of neovascularization. Recurrent vitreous hemorrhage may occur as a complication of scleral suturing of PCIOL. The etiology of these hemorrhages does not appear to be related to neovascular proliferation at the haptic suture site, but may be secondary to erosion of the haptic into uveal structures. Not all eyes require reoperation after these hemorrhages; however, good visual results may be achieved by replacing the sutured PCIOL with an ACIOL or by suturing the PCIOL in a different meridian.
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 < 0.001). PURS cohort reported significantly superior pad-free rates at both postoperative month 1 (73% vs 35%, p < 0.0001) and month 3 (83% vs 53%, p = 0.0004). On multivariable analysis, younger age and the new anastomosis technique were two independent predictors to improve early continence. Four patients in modified anastomosis group (4/60) and 1 in standard anastomosis group (1/60) necessitated temporary urethral recatheterization because of urinary retention. We describe a simple and time-efficient modified urethrovesical anastomosis technique by using anastomosis sutures as stay sutures to prevent perineal retraction of the urethral stump. Our results demonstrated that the technique is an independent factor impacting early recovery of urinary continence. Future randomized controlled studies would be
Barber, F Alan; Herbert, Morley A; Crates, John M
Lateral ankle ligament repairs increasingly use suture anchors instead of bone tunnels. Our purpose was to compare the biomechanical properties of a knotted and knotless suture anchor appropriate for a lateral ankle ligament reconstruction. In porcine distal fibulae, 10 samples of 2 different PEEK anchors were inserted. The attached sutures were cyclically loaded between 10N and 60N for 200 cycles. A destructive pull was performed and failure loads, cyclic displacement, stiffness, and failure mode recorded. PushLock 2.5 anchors failed before 200 cycles. PushLock 100 cycle displacement was less than Morphix 2.5 displacement (panchors completing 200 cycles was 86.5N (PushLock) and 252.1N (Morphix) (psuture breaking for all PushLocks while the Morphix failed equally by anchor breaking and suture breakage. The knotted Morphix demonstrated more displacement and greater failure strength than the knotless PushLock. The PushLock failed consistently with suture breaking. The Morphix anchor failed both by anchor breaking and by suture breaking. Copyright © 2012 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
Jang, Suk-Hwan; Song, Han-Eui; Choi, Seung-Hyuk
The purpose of the study was to evaluate the clinical and radiographic outcomes of treatment in patients with isolated greater tuberosity (GT) fractures of humerus using arthroscopic percutaneous inverted mattress suture fixation technique. We attempted to use the arthroscopic percutaneous inverted mattress suture fixation technique in 17 consecutive cases with isolated displaced GT fractures. Fourteen patients were successfully treated without switching to other methods and were available for follow-up at a mean of 22 months (range: 17-38 months) after surgery. For assessment of clinical outcomes, we evaluated the range of motion and the visual analog scale (VAS) score, the shoulder index of the American Shoulder and Elbow Surgeons (ASES), and the Korean Shoulder Scale (KSS). At the final follow-up, the VAS improved to 1.0 points (range: 0-3), the mean ASES score improved to 86.9 points (range: 78.3-100) and the KSS improved to 88.6 points (range: 82-100) postoperatively. Mean union time was 10 weeks. Mean forward flexion was 167.8° (range: 140-180°), mean external rotation in neutral position was 36° (range: 20-70°), and mean internal rotation was at the 12th thoracic level (range: T6-L3) at final follow-up. Three cases were switched to open surgery after attempted arthroscopic technique due to large fragment or osteoporosis. In select cases, the arthroscopic percutaneous inverted mattress suture fixation of GT fracture is a simple and reproducible technique with encouraging early results.
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 < .01) using this strategy compared to single puncture techniques used to anchor current investigational devices. Serious complications were related to apical access. PASTA reduces annular dimensions and 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
Hong, Chih-Kai; Kuo, Ting-Hsuan; Yeh, Ming-Long; Jou, I-Ming; Lin, Cheng-Li; Su, Wei-Ren
Numerous needleless techniques for tendon graft fixation that feature several advantages have been reported. However, there are few studies that have compared the holding strength between the needleless techniques (rolling hitch and modified rolling hitch) and traditional suture methods. To compare the tendon graft-holding strength of the rolling hitch and modified rolling hitch with the Krackow stitch in an in vitro porcine biomechanical model. Thirty fresh-frozen porcine flexor profundus tendons were randomly divided into three groups of 10 specimens. The experimental procedure was designed to assess elongation of the suture-tendon construct across the needleless tendon-grasping techniques and the Krackow stitch. All suture configurations were completed with a braided nonabsorbable suture. Each tendon was pretensioned to 100 N for three cycles, cyclically loaded from 50 to 200 N for 200 cycles, and then finally loaded to failure. Elongation, load to failure, and mode of failure were recorded for each specimen. Five of the 10 rolling hitch specimens failed during cyclic loading. With the numbers available, elongation after cyclic loading was not different among the successful rolling hitch specimens (19% [1.19 cm/6.17 cm] ± 6%), modified rolling hitch fixations (19% [1.11 cm/ 5.93 cm] ± 6%), and Krackow stitch fixations (26% [1.41 cm/5.43 cm] ± 6%); ultimate failure loads also were not different among the rolling hitch fixations (316 ± 35 N), modified rolling hitch fixations (342 ± 14 N), and Krackow stitches (327 ± 33 N) with the numbers available. With the numbers available, the rolling hitch, modified rolling hitch, and Krackow stitch techniques were not different in terms of elongation after cyclic loading and to failure in this in vitro biomechanical evaluation. Based on the biomechanical properties from this in vitro animal study, the modified rolling hitch may be an attractive alternative for tendon graft fixation in ligament-reconstruction surgery
Full Text Available Craniosynostosis, the premature closure of cranial suture, is a pathologic condition that affects 1/2000 live births. Saethre-Chotzen syndrome is a genetic condition characterized by craniosynostosis. The Saethre-Chotzen syndrome, which is defined by loss-of-function mutations in the TWIST gene, is the second most prevalent craniosynostosis. Although much of the genetics and phenotypes in craniosynostosis syndromes is understood, less is known about the underlying ossification mechanism during suture closure. We have previously demonstrated that physiological closure of the posterior frontal (PF suture occurs through endochondral ossification. Moreover, we revealed that antagonizing canonical Wnt signaling in the sagittal suture leads to endochondral ossification of the suture mesenchyme and sagittal synostosis, presumably by inhibiting Twist1. Classic Saethre-Chotzen syndrome is characterized by coronal synostosis, and the haploinsufficient Twist1+/- mice represents a suitable model for studying this syndrome. Thus, we seeked to understand the underlying ossification process in coronal craniosynostosis in Twist1+/- mice. Our data indicate that coronal suture closure in Twist1+/- mice occurs between postnatal day 9 to 13 by endochondral ossification, as shown by histology, gene expression analysis and immunohistochemistry. In conclusion, this study reveals that coronal craniosynostosis in Twist1+/- mice occurs through endochondral ossification. Moreover, it suggests that haploinsufficency of Twist1 gene, a target of canonical Wnt-signaling, and inhibitor of chondrogenesis, mimics conditions of inactive canonical Wnt-signaling leading to craniosynostosis.
Giza, Eric; Whitlow, Scott R; Williams, Brady T; Acevedo, Jorge I; Mangone, Peter G; Haytmanek, C Thomas; Curry, Eugene E; Turnbull, Travis Lee; LaPrade, Robert F; Wijdicks, Coen A; Clanton, Thomas O
Secondary surgical repair of ankle ligaments is often indicated in cases of chronic lateral ankle instability. Recently, arthroscopic Broström techniques have been described, but biomechanical information is limited. The purpose of the present study was to analyze the biomechanical properties of an arthroscopic Broström repair and augmented repair with a proximally placed suture anchor. It was hypothesized that the arthroscopic Broström repairs would compare favorably to open techniques and that augmentation would increase the mean repair strength at time zero. Twenty (10 matched pairs) fresh-frozen foot and ankle cadaveric specimens were obtained. After sectioning of the lateral ankle ligaments, an arthroscopic Broström procedure was performed on each ankle using two 3.0-mm suture anchors with #0 braided polyethylene/polyester multifilament sutures. One specimen from each pair was augmented with a 2.9-mm suture anchor placed 3 cm proximal to the inferior tip of the lateral malleolus. Repairs were isolated and positioned in 20 degrees of inversion and 10 degrees of plantarflexion and loaded to failure using a dynamic tensile testing machine. Maximum load (N), stiffness (N/mm), and displacement at maximum load (mm) were recorded. There were no significant differences between standard arthroscopic repairs and the augmented repairs for mean maximum load and stiffness (154.4 ± 60.3 N, 9.8 ± 2.6 N/mm vs 194.2 ± 157.7 N, 10.5 ± 4.7 N/mm, P = .222, P = .685). Repair augmentation did not confer a significantly higher mean strength or stiffness at time zero. Mean strength and stiffness for the arthroscopic Broström repair compared favorably with previous similarly tested open repair and reconstruction methods, validating the clinical feasibility of an arthroscopic repair. However, augmentation with an additional proximal suture anchor did not significantly strengthen the repair. © The Author(s) 2015.
Jobin, Charles M; Kippe, Matthew A; Gardner, Thomas R; Levine, William N; Ahmad, Christopher S
Distal biceps tendon repair with interference screw or double suture-anchor fixation are 2 successful techniques performed with either 1- or 2-incision approaches. No study has examined the accuracy and quality of the repaired tendon footprint with these devices and approaches. A 2-incision approach will allow a more anatomic repair of the distal biceps footprint compared with a 1-incision anterior approach. Fixation technique will affect insertional footprint location and footprint contact area. Controlled laboratory study. After randomization, 36 distal biceps repairs were performed on human cadaveric upper extremity specimens, with 1- or 2-incision approaches and with fixation devices of either two 5.5-mm suture anchors or an 8-mm interference screw. Native and repaired footprint areas and centroid location were calculated with a 3-dimensional digitizer. Interference screw repair had the smallest footprint area (135 mm(2)) compared with suture anchor repair (197 mm(2)) and the native tendon (259 mm(2)) (P = .013). The 2-incision approach repaired the footprint to a more posterior and anatomic position (2.5 mm) than a 1-incision approach (P = .001). The fixation device did not affect footprint location significantly. Suture anchor repair more closely re-creates the footprint area on the radial tuberosity of the native distal biceps tendon compared with the interference screw repair. A 2-incision approach more closely re-creates footprint position compared with the 1-incision approach. A 2-incision approach with double suture-anchor fixation may yield a more anatomic distal biceps repair based on reproduction of the footprint compared with a 1-incision approach.
Rothfeld, Alex; Pawlak, Amanda; Liebler, Stephenie A H; Morris, Michael; Paci, James M
Patellar tendon repair with braided polyethylene suture alone is subject to knot slippage and failure. Several techniques to augment the primary repair have been described. Purpose/Hypothesis: The purpose was to evaluate a novel patellar tendon repair technique augmented with a knotless suture anchor internal brace with suture tape (SAIB). The hypothesis was that this technique would be biomechanically superior to a nonaugmented repair and equivalent to a standard augmentation with an 18-gauge steel wire. Controlled laboratory study. Midsubstance patellar tendon tears were created in 32 human cadaveric knees. Two comparison groups were created. Group 1 compared #2 supersuture repair without augmentation to #2 supersuture repair with SAIB augmentation. Group 2 compared #2 supersuture repair with an 18-gauge stainless steel cerclage wire augmentation to #2 supersuture repair with SAIB augmentation. The specimens were potted and biomechanically loaded on a materials testing machine. Yield load, maximum load, mode of failure, plastic displacement, elastic displacement, and total displacement were calculated for each sample. Standard statistical analysis was performed. There was a statistically significant increase in the mean ± SD yield load and maximum load in the SAIB augmentation group compared with supersuture alone (mean yield load: 646 ± 202 N vs 229 ± 60 N; mean maximum load: 868 ± 162 N vs 365 ± 54 N; P load: 495 ± 213 N vs 566 ± 172 N; P = .476; mean maximum load: 737 ± 210 N vs 697 ± 130 N; P = .721). Patellar tendon repair augmented with SAIB is biomechanically superior to repair without augmentation and is equivalent to repair with augmentation with an 18-gauge stainless steel cerclage wire. This novel patellar tendon repair augmentation is equivalent to standard 18-gauge wire augmentation at time zero. It does not require a second surgery for removal, and it is biomechanically superior to primary repair alone.
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.
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.
Full Text Available PURPOSE: V-LocTM180 (Covidien Healthcare, Mansfield, MA is a new unidirectional barbed suture that may reduce loss of tension during a running closure. We evaluated the use of the barbed suture for urethrovesical anastomosis (UVA during robotic assisted laparoscopic prostatectomy (RALP. Time to completion of UVA, post-operative anastomotic leak rate, and urinary incontinence were compared in patients undergoing UVA with 3-0 unidirectional-barbed suture vs. 3-0 MonocrylTM (Ethicon, Somerville, NJ. MATERIALS AND METHODS: Data were prospectively collected for 70 consecutive patients undergoing RALP for prostate cancer between November 2009 and October 2010. In the first 35 patients, the UVA was performed using a modified running van Velthoven anastomosis technique using two separate 3-0 monofilament sutures. In the subsequent 35 patients, the UVA was performed using two running novel unidirectional barbed sutures. At 7-12 days postoperatively, all patients were evaluated with a cystogram to determine anastomotic integrity. Urinary incontinence was assessed at two months and five months by total daily pad usage. Clinical symptoms suggestive of bladder neck contracture were elicited. RESULTS: Age, PSA, Gleason score, prostate size, estimated blood loss, body mass index, and clinical and pathologic stage between the 2 groups were similar. Comparing the monofilament group and V-LocTM180 cohorts, average time to complete the anastomosis was similar (27.4 vs. 26.4 minutes, p = 0.73 as was the rate of urinary extravasation on cystogram (5.7 % vs. 8.6%, p = 0.65. There were no symptomatic bladder neck contractures noted at 5 months of follow-up. At 2 months, the percentage of patients using 2 or more pads per day was lower in the V-LocTM180 cohort (24% vs. 44%, p < 0.02. At 5 months, this difference was no longer evident. CONCLUSIONS: Time to complete the UVA was similar in the intervention and control groups. Rates of urine leak were also comparable
Urminský, J; Rozsíval, P; Lorencová, V; Jirásková, N
Authors refer about the effect of adjusting (adjustment of the suture tension) of the running corneal suture on the final cylindrical refraction in patients who underwent penetrating keratoplasty due to keratoconus. In our article we evaluate two groups of patients. The group I consists 76 patients (76 eyes) who regularly visited our department of ophthalmology. There were 52.6% of females and 47.4% of males. The average age at the time of surgery was 33.5 +/- 5.2 years (range, 18-52 years). In this group of patients, the adjusting was performed during the surgery. In the group II 35 patients (40 eyes) underwent the adjusting procedure of the running corneal suture in the early postoperative period. There were 19 (54.0%) women and 16 (46.0%) men. The average age of the whole group at the time of surgery was 34.6 +/- 3.8 years (range, 18-50 years). The indication to carry out the adjusting was topographically verified astigmatism of more then 3.5 cylindrical diopters (D cyl). The purpose of this study was to find the ultimate surgery technique to get not only the clearness and good healing of the corneal graft, but first of all to prevent extensive ametropia already during the surgery. In the early stage after the surgery we are trying to reduce emerged refractive error and to get faster recovery of good visual acuity of the operated eye. In the sense of the least final postoperative astigmatism, the best results we have reached in cases where the donor corneal graft was 0.25 mm larger in diameter and the suture was adjusted during the surgery using light circles according to Serdarevic. In this group of patients the average final cylindrical refractive error after the surgery was 2.00 +/- 0.81 D cyl. When adjusting the corneal suture in postoperative period, the mean final refractive error decreased of about 3.09 +/- 1.62 D cyl.
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.
Rossetto, Julia D; Suwannaraj, Sirinya; Cavuoto, Kara M; Spierer, Oriel; Miller, Darlene; McKeown, Craig A; Capo, Hilda
Although the association between suture colonization and postoperative infections remains hypothetical, measures to reduce perioperative suture colonization may minimize postoperative infections. The suture colonization rate in adjustable suture strabismus surgery is not well defined, and the effect of povidone-iodine use on suture colonization is unknown. To assess whether povidone-iodine application at the end of adjustable suture strabismus surgery decreases the suture colonization rate. In this randomized clinical trial designed in 2015 and performed from June 1 through October 31, 2015, a total of 65 adjustable and 43 control suture specimens from 65 demographically similar adults undergoing adjustable suture strabismus surgery were studied. A random sampling assigned participants into group 1 (with povidone-iodine) or group 2 (without povidone-iodine) at the end of surgery. A control suture specimen was obtained if ipsilateral nonadjustable surgery was performed. Both groups received antibiotic ointment at the end of the procedure. No patients refused participation or withdrew. Data analysis was performed from October 1 to December 31, 2015. Observers were unaware of patient grouping. One drop of 5% povidone-iodine directly over the sliding noose of the adjustable suture at the end of surgery. The suture colonization rate after adjustment in group 1, group 2, and the control group. Of 65 adults undergoing surgery, there were 17 men (49%) and 18 women (51%) in group 1 and 10 men (33%) and 20 women (67%) in group 2, as well as 20 men (47%) and 23 women (53%)