Application Of Suture Research Articles

Removal of aqueous humor and conjunctival compression sutures for a dysesthesic filtering bleb: A surgical technique and case report.

To present a novel surgical technique for the treatment of a steep-walled filtering bleb following an Ahmed glaucoma valve implant. The primary aim was to alleviate the patient's discomfort and address associated corneal thinning, complications that can arise from this condition. Case report and surgical technique. This case report describes a 29-year-old female who developed a dysesthesic filtering bleb following the implantation of a glaucoma drainage device. The employed surgical technique to address this complication involved the drainage of aqueous from the bleb using a 30-G needle, which effectively reduced its height. Subsequently, a compression suture was applied to maintain an appropriate bleb size. With the presented surgical technique, the ultimate control of an overhigh filtering bleb associated to a glaucoma drainage device was possible. Following the procedure, the patient's symptoms and the corneal thinning linked to the bleb's excessive size were successfully managed. Furthermore, the anatomy of the filtering bleb was preserved, and an optimal intraocular pressure outcome was achieved. The removal of aqueous and the application of a compression suture are two surgical techniques traditionally used for managing the hypertensive phase of glaucoma drainage devices and for alleviating discomfort from blebs after classical filtering surgery, respectively. In the case presented, the combination of these two techniques effectively reduced the size of an excessively high filtering bleb associated with a glaucoma drainage device. This approach successfully resolved the patient's discomfort and corneal issues related to this complication.

The Comparison and Application of 3D-modeled Sutures in the Ironclad Beetle Phloeodes diabolicus for Use in Load-Bearing Construction

The Comparison and Application of 3D-modeled Sutures in the Ironclad Beetle Phloeodes diabolicus for Use in Load-Bearing Construction

Analysis of the efficacy of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicle fractures with coracoclavicular ligament injuries

ObjectiveTo investigate the efficacy of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicular fractures with coracoclavicular ligament injuries.MethodsA retrospective analysis was performed on 43 patients who sustained distal clavicular fractures along with injuries to the coracoclavicular ligament. These patients were treated between January 2017 and December 2023. The fractures were classified according to the fixation method: high-strength Nice knot suture fixation (experimental group, n = 23) and acromioclavicular Kirschner wire fixation (control group, n = 20). The basic information of the two groups of patients, including age, gender, cause of injury, fracture classification, hospitalization duration, fracture healing time and complications, was collected and analyzed. The increase rate of coracoclavicular space on the affected side was collected and analyzed. The pain level of the affected shoulder was assessed using the visual analog scale (VAS). The shoulder joint function was assessed using the American Shoulder and Elbow Surgeons (ASES) scores and Constant-Murley scores before and after surgery.ResultsNo significant differences were observed in the general demographic data, including age, gender, injury etiology, Craig classification, and hospitalization duration between the two groups (p > 0.05). Both groups were followed for a period ranging from 12 to 33 months, with an average follow-up of 20.53 ± 5.16 months. The bone healing time in the experimental group was significantly shorter than in the control group (12.82 ± 1.12 weeks vs. 17.25 ± 1.71 weeks, p < 0.05). At the final follow-up, The increase rate of coracoclavicular space was (9.25 ± 2.53) % in the experimental group and (8.10 ± 2.53) % in the control group, which was not significantly different (p > 0.05). Both groups demonstrated significant improvements in VAS scores, Constant-Murley scores, and ASES scores post-operatively compared to pre-operative values (p < 0.05). One month after surgery, the Constant-Murley and ASES scores were significantly superior in the experimental group compared to the control group (p < 0.05). However, no statistical difference was observed three months post-surgery or during the final follow-up (p > 0.05). The control group reported one case of infection related to the Kirschner wire and one case of Kirschner wire displacement postoperatively. Conversely, no significant complications were reported in the experimental group.ConclusionIn the management of distal clavicle fractures accompanied by coracoclavicular ligament injuries, particularly oblique fractures or those with butterfly-shaped fragments, the application of a high-strength Nice knot suture in conjunction with Endobutton plate fixation can effectively stabilize the fracture site. This approach not only mitigates complications associated with Kirschner wire fixation but also enhances fracture healing, leading to favorable postoperative outcomes.

Development of keratin-based fibers fabricated by interfacial polyelectrolyte complexation for suture applications

Interfacial Polyelectrolyte Complexation (IPC) is a convenient way to produce composite, micro-scale fibers. In this paper, we report the successful development of novel keratin-based IPC fibers and also demonstrate the feasibility of using these fibers as sutures through a proof-of-concept in vivo study. Two composite fibers were produced: chitosan-keratin (CK) and keratin-keratin (KK). These fibers were evaluated for their physico-chemical, mechanical and biochemical properties. In the dry state, the CK fiber had a greater Young's modulus of about 2 GPa while the KK fiber registered a longer strain-at-break of about 100 % due to the strain-stiffening effect. Notably, the keratins were found to assemble into amyloids within the composite fibers based on Congo red staining and Wide-Angle X-Ray Scattering. Functionally, both fibers were malleable could be weaved, braided and knotted. When used as sutures to close incisional wounds in mice over 21 days, these fibers were found to elicit minimal host tissue response and were partially degraded over the duration. Interestingly, the KK fiber evoked a lower extent of immune cell response and fibrous capsule encapsulation that was comparable to commercial, non-absorbable Dafilon® sutures. This work demonstrated the possibility of producing keratin-based IPC fibers which may find practicality as medical sutures.

Application of tuberosity suture combined with autogenous bone grafting in reverse total shoulder arthroplasty for elderly patients with proximal humeral fractures

To analyze the effectiveness of tuberosity suture combined with autogenous bone grafting in reverse total shoulder arthroplasty for elderly patients with proximal humerus fracture. A clinical data of 28 patients with fresh proximal humerus fractures, who met the selection criteria and admitted between June 2014 and April 2022, was retrospectively analyzed. There were 7 males and 21 females. Age ranged from 65 to 81 years, with an average of 73.8 years. The causes of injury were 21 cases of fall, 6 cases of traffic accident, and 1 case of falling from height. The time from injury to operation ranged from 5 to 20 days with an average of 9.2 days. There were 8 cases of Neer three-part fracture and 20 cases of four-part fracture. The reverse total shoulder arthroplasty was performed, and the greater and lesser tuberosities were sutered and reconstructed with autogenous bone grafting. After operation, the Constant score, American Society for Shoulder Surgery (ASES) score, and visual analogue scale (VAS) score were used to evaluate shoulder function and pain; and the active range of motion of the shoulder joint was recorded, including flexion, external rotation, and internal rotation. X-ray films were taken to observe the position of prosthesis. According to the evaluation criteria proposed by Boileau, the healing of greater tuberosity was evaluated, and the effectiveness was compared between the patients with healed and non-healed (displacement and absorption) greater tuberosity. All incisions healed by first intention after operation. All patients were followed up 24-106 months, with an average of 60.9 months. At last follow-up, the VAS score of shoulder joint ranged from 0 to 6 (mean, 1.1). The Constant score ranged from 45 to 100 (mean, 80.1). The ASES score ranged from 57 to 100 (mean, 84.7). The active range of motions of shoulder joint were 60°-160° (mean, 118°) in flexion, 0°-50° (mean, 30°) in external rotation, and corresponding to reaching the S 5-T 8 vertebral body level in internal rotation. During follow-up, no shoulder joint re-dislocation or severe shoulder instability occurred, and no revision surgery was performed. X-ray film reexamination showed that there was no loosening of the prosthesis. According to the evaluation criteria proposed by Boileau, the greater tuberosity fused in 22 cases (78.6%), displaced in 3 cases (10.7%), and absorbed in 3 cases (10.7%). The shoulder joint function and pain related evaluation indicators in the healed group were significantly better than those in the non-healed group ( P<0.05). Tuberosity suture combined with autogenous bone grafting is a relatively simple procedure that provides a reliable fixation for the anatomic recovery of greater and lesser tuberosities and is beneficial for the recovery of shoulder function in elderly patients with proximal humeral fractures.

Challenging Convention in Laparoscopic Pyeloplasty: A Prospective Analysis on the Successful Application of Knotless Continuous Barbed Suture

Challenging Convention in Laparoscopic Pyeloplasty: A Prospective Analysis on the Successful Application of Knotless Continuous Barbed Suture

Application of endoscopic purse-string sutures in refractory nonvariceal GI bleeding: a multicenter study (with video)

Background and AimsNon-variceal gastrointestinal bleeding is a common medical emergency. Endoscopic hemostasis is recommended and some patients experienced rebleeding after conventional endoscopic hemostasis. Originally, the purse-string suture (PSS) was employed for lesion closure during endoscopic mucosal resection (EMR). We aimed to learn whether endoscopic PSS is effective in controlling the refractory bleeding. MethodsWe retrospectively collected data of patients who underwent endoscopic PSS for refractory non-variceal gastrointestinal bleeding from 3 hospitals. Clinical success was defined as no recurrent bleeding, and patients were discharged according to medical advice. ResultsFrom October 2017 to May 2024, 36 patients who received PSS treatments were included. 83.3% (30/36) of patients achieved clinical success. In refractory upper gastrointestinal bleeding, the clinical success rate was 81.25% (26/32), and it was 100% (4/4) in lower gastrointestinal bleeding. ConclusionThe endoscopic PSS is effective in treating refractory non-variceal gastrointestinal bleeding.

Barbed Sutures Compared With Conventional Sutures During Laparoscopic Myomectomy: A Systematic Review and Meta-analysis.

To accumulate the currently available literature on the safety and efficacy of the use of knotless barbed sutures for the reconstruction of the uterine wall during laparoscopic myomectomy based on comparison with traditional suture studies. We searched PubMed/Medline, Scopus, ClinicalTrials.gov, and Google Scholar up to February 29, 2024. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and PICO criteria, we included all English-language, full-text articles that evaluated the perioperative outcomes of patients who had laparoscopic myomectomy and repair of the uterine wall defect with either barbed or traditional (extracorporeal or intracorporeal sutures). The application of barbed sutures resulted in significantly reduced operative time (2,111 patients, mean difference -12.04 minutes, 95% CI, -16.94 to -7.14, P <.001). This was also reflected when suturing time was separately analyzed (437 patients, mean difference -6.04 minutes, 95% CI, -7.43 to -4.65, P <.001) The mean difference in hemoglobin levels before and after surgery was significantly lower in the barbed suture group (1,277 patients, mean difference -0.40 g/dL, 95% CI, -0.72 to -0.09, P <.01) This was also observed in case of estimated blood loss, which was found to be lower in the barbed suture group (1,823 patients, mean difference -47.22 mL, 95% CI, -78.54 to -15.90, P =.003). Finally, the barbed suture group presented lower transfusion rates (1,217 patients, odds ratio 0.43, 95% CI, 0.19-1.00, P =.05). Concerning visual analog scale (VAS) score as evaluated by the surgeons for surgical difficulty, the control group proved to be more technically challenging compared with the barbed sutures group (184 patients, mean difference -1.66 95% CI, -2.37 to -0.94, P <.001). The VAS score for pain at 24 hours postoperatively, postoperative complication rates, and length of hospital stay were similar for both groups. Regarding reproductive outcomes, there was no difference in pregnancy, live birth, and birth complication rates. The use of barbed sutures during laparoscopic myomectomy presents many clinical benefits for the patient and the surgeon in terms of shorter operative and suturing time, less estimated blood loss, and ease of use. This pioneer technology may contribute to the expansion of laparoscopy on more complex myomectomies. PROSPERO, CRD42023477304.

Barbed vs conventional sutures for cesarean uterine scar defects: a randomized clinical trial

BackgroundThe role of barbed sutures in preventing myometrial defects and enhancing postpartum outcomes after cesarean section (C-section) is uncertain. ObjectiveThis study compared clinical and ultrasonographic outcomes of uterine scar defects after C-section with barbed and conventional smooth thread sutures. Study DesignThis was a multicenter, parallel-group, randomized, controlled clinical trial. Four obstetrics and gynecology departments across three Japanese healthcare regions were included. The participants were women requiring their first cesarean delivery between May 2020 and March 2023. Of the 1211 participants enrolled, 298 underwent C-section and 253 were followed up until July 2023. Participants with singleton pregnancies were randomly assigned (1:1 ratio) to receive either conventional or spiral thread sutures with a double-layer continuous suture. The study period comprised the time of consent to the 6- to 7-month examination. The primary endpoint was the rate of scar niches >2 mm evaluated using transvaginal ultrasonography at 6 to 7 months after surgery. Additional metrics included the total operative time, suture application time, operative blood loss, number of additional sutures required for hemostasis, maternal surgical complications, postoperative infections, surgeon's years of experience, and individual subscale scores. ResultsAll data of the 220 participants (barbed suture group: 110; conventional suture group: 110) were available, thus enabling a full analysis set. A comparison of the barbed and conventional suture groups, respectively, revealed the following: niche length, 2.45±1.65 mm (range: 1.0–6.7) vs 3.79±1.84 mm (range: 1.0–11.0) (P<.001); niche depth, 1.78±1.07 mm (range: 1.0–5.7) vs 2.70±1.34 mm (range: 1.0–7.3) (P<.001); residual myometrial thickness (RMT), 8.46±1.74 mm (range: 4.8–13.0) vs 7.07±2.186 mm (range: 2.2–16.2) (P<.001); and niche width, 1.58±2.73 mm (range: 0.0–14.0) vs 2.88±2.36 mm (range: 0.0–11.0) (P<.001), respectively. The barbed suture group exhibited no defects and an RMT <3 mm. Furthermore, the barbed suture group had a lower rate of uterine niches (29.1%; n=32/110) than the conventional suture group (68.2%; n=75/110). Secondary outcomes showed no significant differences in operative times, maternal surgical complications, or postoperative complications. ConclusionDouble-layer barbed sutures during cesarean delivery may prevent C-section scar defects and postoperative complications.El resumen está disponible en Español al final del artículo.

Compression sutures: A rescue to failed intracameral gas injection in massive non-resolving corneal hydrops of long duration in advanced pellucid marginal corneal degeneration (PMCD)

To describe the application of full-thickness compression corneal sutures along with intracameral gas injection in a case of non-resolving long-duration hydrops of pellucid marginal corneal degeneration with a large Descemet membrane (DM) tear. Corneal hydrops is a complication of conditions such as keratoconus (KC), pellucid marginal corneal degeneration (PMCD), and keratoglobus. Intracameral gas injection in the form of sulfur hexafluoride (SF6) or perfluoro propane (C3F8) has been known to shorten the recovery period by tamponading the break. The application of corneal sutures to approximate the widely separated ends of the DM tear may also be performed. All these are management options described for acute hydrops. We report two cases of application of full-thickness compression corneal sutures along with intracameral gas injection in a case of non-resolving long-duration hydrops of more than 2 months duration in PMCD with a large DM tear. Full-thickness corneal compression sutures and intracameral gas injection can restore the imperviousness of posterior stroma after hydrops. This technique is safe and effective for faster resolution of corneal edema post hydrops and early visual rehabilitation.

1236 Challenging Convention in Laparoscopic Pyeloplasty: A Prospective Analysis on the Successful Application of Knotless Continuous Barbed Suture

1236 Challenging Convention in Laparoscopic Pyeloplasty: A Prospective Analysis on the Successful Application of Knotless Continuous Barbed Suture

Application of integral suture for medial hernia defect closure in eTEP hernioplasty for direct inguinal hernia

The OBJECTIVE was to evaluate the immediate and long-term results of integral suture application and to determine the indications for its use in eTEP hernioplasty for primary rectal inguinal hernia in men.METHODS AND MATERIALS. A prospective single-center double-blind randomized controlled study on the basis of the City Clinical Hospital named after S. S. Yudin was conducted. The study included patients with the first-diagnosed direct inguinal hernias for eTEP hernioplasty with hernia gate size from 1.5 cm to 3 cm corresponding to MP2 according to EHS (2009). Patients were allocated to a comparison group with hernia defect closure and a control group using the ALEA randomization program. The following parameters were evaluated in patients: the presence of seroma on the 1st day after laparoscopic hernioplasty according to the ultrasound results, the dynamics of seroma volume, the degree of pain syndrome according to the visual analog scale (VAS), the duration of surgical intervention, 30-day adverse events, as well as the patients’ quality of life according to the Likert scale.RESULTS. A total of 142 patients were included (n1=71; n2=71). There were no significant differences in baseline characteristics between the two groups. Suturing the hernia defect using the integral suture technique was associated with less development of postoperative seromas ∆p=0.32 (95 % confidence interval [CI] 0.14–0.5, p=0.05). There were no statistical differences in pain and quality of life among patients. No 30-day adverse events were observed in the two groups. A statistically significant increase in the duration of the operation when using the integral suture was revealed, but not more than 7 minutes.CONCLUSION. Since anatomical justification has made laparoscopic hernioplasty a safer operation, we believe that endoscopic suturing of rectal inguinal hernia defect larger than 2.5 cm (P=0.052) with the use of integral suture in the MP2 group according to EHS is associated with a lower incidence of seroma development, low risk of recurrence, absence of significant pain syndrome after suturing.

Poly(hexamethylene biguanide) immobilized non-absorbable and antimicrobial PET fiber for surgical suture applications: synthesis, characterization and in vitro cytocompatibility assessment

Poly(hexamethylene biguanide) immobilized non-absorbable and antimicrobial PET fiber for surgical suture applications: synthesis, characterization and in vitro cytocompatibility assessment

High-Performance Dopamine-Based Supramolecular Bio-Adhesives.

The need for wound closure or surgical procedures has been commonly met by the application of sutures. Unfortunately, these are often invasive or subject to contamination. Alternative solutions are offered by surgical adhesives that can be applied and set without major disruption; a new class of supramolecular-based adhesives provides potential solutions to some of these challenges. In this study, a series of polymers utilizing dopamine as a self-assembling unit are synthesized. It is found that these motifs act as extremely effective adhesives, with control over the mechanical strength of the adhesion and materials' tensile properties enabled by changing monomer feed ratios and levels of cross-linking. These materials significantly outperform commercially available bio-adhesives, showing yield strengths after adhesion at least two times higher than that of BioGlue and Tisseel, as well as the ability to re-adhere with significant recovery of adhesion strength. Promisingly, the materials are shown to be non-cytotoxic, with cell viability > 90%, and able to perform in aqueous environments without significant loss in strength. Finally, the removal of the materials, is possible using benign organic solvents such as ethanol. These properties all demonstrate the effectiveness of the materials as potential bio-adhesives, with potential advantages for use in surgery.

Application and effect of tension-reducing suture in surgical treatment of hypertrophic scar

PurposeTo investigate the application and effectiveness of tension-reducing suture in the repair of hypertrophic scars.MethodsA retrospective analysis of clinical data was conducted on 82 patients with hypertrophic scars treated at the Department of Burns and Plastic Surgery of Nanjing Drum Tower Hospital from September 2021 to December 2022. Patients were operated with combination of heart-shaped tension-reducing suturing technique and looped, broad, and deep buried (LBD) suturing technique or conventional suture method. Outcomes of surgical treatment were assessed before and 6 months after surgery using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS).ResultsImprovements were achieved on scar quality compared to that preoperatively, with a reduction in scar width (1.7 ± 0.6 cm vs. 0.7 ± 0.2 cm, P < 0.001). Assessment using the POSAS and VSS scales showed significant improvements in each single parameter and total score compared to preoperative values (P < 0.05). The Combination method group achieved better score in total score of VSS scale, in color, stiffness, thickness and overall opinion of PSAS scale, and in vascularity, thickness, pliability and overall opinion of OSAS scale.ConclusionThe amalgamation of the heart-shaped tension-reducing suturing technique and the LBD suturing technique has shown promising outcomes, garnering notably high levels of patient satisfaction in the context of hypertrophic scar repair. Patients have exhibited favorable postoperative recoveries, underscoring the clinical merit and the prospective broader applicability of this approach in the realm of hypertrophic scar management.

Application of anterior region suture of popliteal hiatus in treatment of discoid lateral meniscus injury with instability in popliteal tendon region

To discuss the application of anterior region suture of the popliteal hiatus (PH) under arthroscopy in the treatment of discoid lateral meniscus (DLM) injury with instability in the popliteal tendon region. The clinical data of 53 patients (56 knees) with DLM injury who met the selection criteria between March 2014 and November 2022 were retrospectively analyzed. There were 15 males and 38 females, aged 8-55 years with an average age of 36.5 years. Fourteen cases had a history of trauma, while the remaining 39 cases had no clear history of trauma. The disease duration ranged from 1 day to 6 years, with an average duration of 15.6 months. According to the Watanabe classification, there were 40 knees of complete type and 16 knees of incomplete type. The preoperative International Knee Documentation Committee (IKDC) knee joint score was 51.2±8.3, the Lysholm score was 59.6±11.2, and the visual analogue scale (VAS) score was 4.7±1.3. After the arthroscopic meniscal plasty, the instability of the popliteal tendon region meniscus was checked by probing traction. Subsequently, the Out-inside technique or a combination of Out-inside and All-inside techniques was used to suture the anterior region of the PH. The stability of the meniscus after suturing was assessed, and if necessary, further suturing using the All-inside technique at the posterior region of the PH, the posterior horn of the meniscus, and using the Out-inside technique at the anterior horn of the meniscus was performed. Postoperative complications were recorded. The effectiveness was evaluated using pre- and post-operative IKDC scores, Lysholm scores, and VAS scores. After operation, knee joint pain, crepitus, and locking disappeared, with McMurray and grinding tests turning negative. All patients were followed up 12-93 months with an average of 57.5 months. There was no complication such as common peroneal nerve injury, deep vein thrombosis of the lower limbs, joint infection, or joint stiffness. At last follow-up, the IKDC knee joint score was 76.7±5.5, the Lysholm score was 94.0±4.1, and the VAS score was 1.1±0.8. The differences compared with preoperative scores were significant ( t=-22.090, P<0.001; t=-23.704, P<0.001; t=19.767, P<0.001). Suturing of the anterior region of the PH is crucial in the treatment of DLM injury with instability in the popliteal tendon region.

Assessing the application of barbed sutures in comparison to conventional sutures for surgical applications: a global systematic review and meta-analysis of preclinical animal studies.

Following an initiative published by Lancet in 2002 and an IDEAL-D framework, the value of preclinical animal studies has garnered increasing attention in recent research. Numerous preclinical animal experiments tried to generate evidence to guide the development of barbed sutures. However, discernible drawbacks and incongruities in outcomes have emerged between clinical and preclinical animal studies. Therefore, this meta-analysis aimed to review the preclinical animal experiments comparing barbed sutures with conventional sutures. The authors hope to facilitate clinical translation of barbed sutures by evaluating effectiveness, safety, and physical properties/reliability. A systematic search of PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov was conducted to identify controlled preclinical animal experiments comparing barbed sutures with conventional sutures. The risk of bias was assessed using SYRCLE. GRADE approach was used to evaluate evidence quality. Revman was applied to analyze all the data. Subgroup, sensitivity, and meta-regression analyses were also performed. A total of 62 articles were eligible with low to moderate quality, including 2158 samples from 10 different animal species across 27 surgical procedures. Barbed suture exhibited a significant reduction in suture time, limited change in Cross-Sectional Area (CSA), and decreased instances of tissue disruption (all P <0.05). Subgroup analyses, considering both clinical and research significance, indicated that barbed sutures might cause more specific adverse events and demonstrate suboptimal performance of physical properties/reliability. Meta-regression suggested that heterogeneity resulted from variations in studies and animal models. Although barbed suture demonstrated superiority in numerous surgeries for time efficiency, its safety and physical properties/reliability might be influenced by diverse preclinical models, sutures' brand, surgeries, and anatomical sites. Further evaluation, based on standardized and well-designed animal experiments, is essential for medical device development and applications in human beings.

Strategies and Application of Compression Sutures With a Modified Technique for Rapid Resolution of Large (Grade III) Hydrops: A Prospective Interventional Study.

The aim of this study was to describe the strategies and outcomes, with a modified technique, of compression sutures in large acute hydrops. This was a prospective interventional study in 29 eyes of 28 patients who underwent compression sutures using a modified technique. The degree of resolution after surgical intervention was quantified by 3 masked observers, using the slit-lamp photographic documentation and optical coherence tomography. The degree of resolution, best-corrected visual acuity, and complications were analyzed. The mean age was 20.89 (7-46) years. Five patients had pellucid marginal degeneration (pellucid marginal corneal degeneration), 23 had keratoconus, and 1 had posttrauma hydrops. The preoperative visual acuity was hand motions in all eyes. The reduction in edema was 76% on day 1, 91.6% on 6 ± 2 days, 98.6% on 18 ± 3 days from surgical intervention. The baseline pachymetry assessed on optical coherence tomography was beyond measurement in 26 eyes. The mean pachymetry at day 1 was 704 μm (range 480-950) which reduced to 607 (range 422-850) microns at 6 ± 2 days and 518 (range 415-718) microns at 18 ± 3 days postintervention (P < 0.0001). The mean duration between the surgery and complete suture removal was 48 (35-68) days. No suture-related complications were noted. Twenty eyes could attain good visual rehabilitation with glasses/contact lenses (vision could not be assessed in 5 eyes). Penetrating keratoplasty was performed on 1 patient. Compression sutures using the modified technique was safe and effective in the rapid resolution of acute hydrops in keratoconus and pellucid marginal corneal degeneration. No complications were noted, and visual restoration with spectacles and contact lenses was satisfactory.

Extraocular muscle bridle traction suture assisted Paul glaucoma implant surgery for severe conjunctival scarring

Abstract: Glaucoma drainage device implantation can be complex and challenging, particularly in patients with conjunctival scarring. However, in this case, involving a young man with refractory glaucoma who had undergone multiple ocular surgeries, the implantation of a Paul glaucoma drainage device was successfully performed after the application of extraocular muscle bridle sutures. The patient exhibited a stable intraocular pressure ranging from 12 to 18 mmHg without antiglaucoma medication during the 3-month follow-up period. Thus, this surgical technique improves the accuracy and ease of inferior-temporal quadrant glaucoma drainage implantation, resulting in good treatment outcomes.

Arm Contouring and Beautification Without Incision: Application of Arm Net Suture.

Arm contouring has been a challenging issue for many years. Patients request contouring of their arms without incisions and with a shorter recovery time. Making an incision on the arm does not always lead to a nice scar, and in case of complications, it may be catastrophic. The use of "arm net suture" can replace the incision during the arm contour surgery. The author has developed a simple technique of arm contouring with arm net suture that leads to eliminating the need for making an incision, preventing of sagging in the proximal part of the arm, and a shorter recovery time. A retrospective study was conducted on 157 patients who underwent arm contouring surgery. Through a small 5 mm incision in the medial elbow, normal saline solution containing Xylocaine (Fresenius Kabi, Bad Homburg, Germany) and adrenaline was infiltrated. After 20 min, liposuction was started from the most superficial layer with a 3 mm cannula, and then, deeper layers superficial to the fascia were suctioned with a 4 mm cannula. The author usually utilizes traditional suction-assisted lipectomy or power-assisted lipectomy. After completing liposuction, the laxity of the skin along the arm was checked. Most of the laxity of the skin occurred in the proximal third of the arm; while the assistant pulled the skin of the proximal part lateral and downward, the net sutures were inserted. On the third or fourth day (based on the severity of laxity of the skin), the sutures start to be removed from the distal rows, with all sutures removed by the fifth to sixth day. The follow-up times were between 3 and 12 months. All patients were female, and their age range was from 19 to 62 years (mean, 40.45 years). The volume of liposuction was from a minimum of 1200 cc to a maximum of 2500 cc (mean, 1645 cc), and the reduction of the arm diameter was occurred in the range of 6 to 14 cm. No immediate postoperative problems were observed in the patients. Revision was not needed for any patients. Arm net suture is a simple and safe method to replace the incision during arm contour surgery.