Conventional Suture Technique Research Articles

Comparison of early effectiveness of arthroscopic suture bridge technique and conventional double tunnel suture technique in treatment of avulsion fracture of posterior cruciate ligament insertion

To compare the early effectiveness of arthroscopic suture bridge technique and conventional double tunnel suture technique in the treatment of avulsion fracture of posterior cruciate ligament (PCL) insertion. Between June 2013 and December 2018, 62 patients with tibial avulsion fracture of PCL insertion that met the criteria were selected and randomly divided into trial group (using arthroscopic suture bridge technique) and control group (using conventional double tunnel suture technique), 31 cases in each group. There was no significant difference in gender, age, injured side, cause of injury, time from injury to operation, Meyers & McKeever classification, Kellgren-Lawrence classification, and preoperative knee range of motion, difference of posterior relaxation of bilateral knee joints, International Knee Documentation Committee (IKDC) score, and Lysholm score between the two groups ( P>0.05). The operation time and IKDC score, Lysholm score, knee range of motion, the difference of posterior relaxation of bilateral knee joints (measured by KT-2000 under knee flexion of 90° and 30 lbs) were recorded and compared between the two groups before operation and at 3 and 12 months after operation. Both groups successfully completed the operation, and the operation time of the trial group and the control group were (61.81±6.83) minutes and (80.42±4.22) minutes respectively, showing significant difference between the two groups ( t=12.911, P=0.000). All the incisions healed by first intention, and there was no wound infection and other early postoperative related complications. All patients were followed up 13-18 months (mean, 14.6 months). The fractures in both groups healed at 3 months after operation. No knee pain, limited movement, or other complications occurred. At 3 and 12 months after operation, the IKDC score, Lysholm score, knee range of motion, and the difference of posterior relaxation of bilateral knee joints in both groups were significantly improved when compared with preoperative ones, and further improved at 12 months after operation when compared with at 3 months after operation ( P<0.05). At each time point after operation, the above indexes and the grade of the difference of posterior relaxation of bilateral knee joints in the trial group were significantly better than those in the control group ( P<0.05). Arthroscopic suture bridge technique in the treatment avulsion fracture of PCL insertion is simple and reliable, which can significantly improve the function and stability of the knee joint and obtain satisfactory early effectiveness.

Sutureless Glue Free Versus Sutured Limbal Conjunctival Autografts in Primary Pterygium Surgery.

Surgical excision is the definitive treatment for pterygium. Following excision, conjunctival autograft is usually preferred. Various methods for grafting with sutures, glue or autologous serum from the recipient bed are in use. The objective of this study was to compare surgical outcomes of sutureless glue free conjunctival autograft with sutured (vicryl 8-0) conjunctival autograft in primary pterygium excision. A prospective randomized interventional study was carried out in 100 eyes with primary pterygium. They were divided into two groups for conjunctival graft adhesion; sutureless glue free (group 1; n=50 eyes) and sutured with absorbable (vicryl 8-0) suture (group 2; n=50 eyes). Time taken for surgery, complications, postoperative symptoms and overall satisfaction score were noted. The patients were followed up on day 1, day 14 and 6 weeks after surgery. Recurrence was noted till 1 year after surgery. The mean age was 46.76 ± 11.97 years (group 1) and 47.24±12.76 years (group 2). Group 1 had shorter duration of surgery (p<0.001), less postoperative complaints (p<0.001) and better patient satisfaction (p<0.001) than group 2. Postoperative complications and gain in visual acuity in both the groups were not clinically significant. Recurrence was not significant in both groups until 1 year of follow up. Pterygium surgery with sutureless glue free conjunctival autograft had fewer postoperative complaints and better patient satisfaction than pterygium surgery with sutured conjunctival autograft. The postoperative complications, recurrence were comparable to conventional sutured technique.

Clinical Evaluation of Efficacy of Cyanoacrylate Glue and Conventional Polypropylene Suturing in Cutaneous Wounds-A Comparitive Study

Introduction: The benefits of assisting closure by holding the opposing edges of a wound together have been recognized in the last 5000 years. There are several well-proven techniques of skin closure using a variety of materials like braided or monofilament material, absorbable and nonabsorbable conventional suture materials, metal clips and adhesive tapes. Conventional skin suturing techniques do have certain disadvantages. From the past three decades, many new biomaterials have been discovered in the medical field. Bio-adhesives are one among them. These materials when applied on the incised tissues possess the ability to bind them together. This group of adhesives are called Cyanoacrylates. The purpose of the study was to compare the efficacy and clinical outcome of the two techniques of wound closure by using conventional polypropylene suturing and cyanoacrylate glue.

Versatility and clinical effectiveness of a synthetic sealing hemostatic patch as alternative to parenchyma suturing in laparoscopic partial nephrectomy

BackgroundImprovements in laparoscopic partial nephrectomy (LPN) in order to minimize perioperative warm ischemia time (WIT), complications, and consequently patient outcome are desirable. Veriset™ is a ready-to-use hemostatic patch of absorbable oxidized cellulose and hydrogel components that has earlier been implemented in vascular and hepatic surgery. We report our experience using this device in LPN.MethodsPatients with a solitary malignant renal mass suspicious for renal cancer underwent LPN with either the use of Veriset™ hemostatic patch (n = 40) or conventional suture technique (n = 40). Patient characteristics, operation time and WIT, postoperative course and complications were recorded retrospectively. Tumor complexity was calculated according to the R.E.N.A.L. score. Outcome was determined according to the “trifecta” criteria (negative surgical margin, WIT < 25 min, no complications within 30 days).ResultsNo significant differences with regard to clinical parameters and median R.E.N.A.L. score (6) were observed between both groups. Operation time (mean 127.1 min vs. 162. 8 min; p = 0.001) and WIT were both lower in the Veriset™ group (14.6 min vs. 20.6 min; p = 0.01). No differences in surgical margins (p = 0.602) and overall complication rates at 30 (p = 0.599) and 90 days (p = 0.611) postoperatively were noticed. The surgical outcome according to “trifecta” was achieved in 65% of patients using Veriset™ and in 57.5% of patients by suture closure, respectively.ConclusionThe hemostatic Veriset™ patch can successfully be implemented in LPN. Handling and application appear favorable, thereby reducing operation time and WIT. The present results suggest that the device may represent an alternative to parenchyma suturing in LPN.

Evaluating the Safety and Toxicity of a Modified Dextran-based Biopolymer as a Hemostat

Background:As an effective alternative to conventional suture techniques, topical hemostatic agents are widely used to control bleeding and close wounds in surgeries.Objective:This study was conducted to evaluate the efficacy and safety of a novel hydrogel hemostat that is easy to use in an applicator under normal conditions according to ISO 10993.Methods:The safety of DexGel, a natural surgical hemostat containing mainly dextran that is an effective hydrogel in bleeding stop, was evaluated and compared to that of AristaTM. APTT test and cytotoxicity tests (i.e., MTT assay, Crystal violet assay, and qualitative estimation) were carried out for considering safety in skin sensitization in a guinea pig model.Results:This study has shown that DexGel does not cause any noticeable sensitization such as edema and erythema or observable toxicity for skin and does not disturb the coagulation process. In addition, cytotoxicity results approve its safety for cell survival.Conclusion:It can be concluded that the safety and efficacy of DexGel (5 g) are comparable or even better to that of AristaTM, which is a commercial and frequently used hemostat, and the lack of skin irritation and toxicity for DexGel alleviates initial safety concerns for products based on these polymers and oligomers.

Sutureless Versus Suture Technique for Conjunctivolimbal Autografting in Primary Pterygium Excision: A Prospective Study.

PURPOSE:Conjunctivolimbal autograft is proposed to be the best treatment for pterygium and autograft can be fixed either with sutures or without. This study was undertaken to assess and compare the efficacy of sutureless versus suture techniques for conjunctivolimbal autografting in primary pterygium.METHODS:A prospective observational study was conducted in the department of ophthalmology in a tertiary care center from March 2018 to September 2019. Twenty consecutive patients in the age group of 20 to 70 years with primary pterygium were included. Ten patients underwent suture technique for autograft placement, whereas ten patients underwent sutureless technique. Comparison of both the groups was done in terms of duration of surgery and postoperative symptoms. Data were entered into Microsoft Excel software and analyzed using SPSS software.RESULTS:In the first group, the mean duration of surgery was 48 min and it was 38 min in the second group. The difference was statistically significant (P = 0.000). Postoperatively, foreign-body sensation was present in nine patients in the first group, whereas it was absent among the patients in the second group. The difference was statistically significant (P = 0.000). Four patients in the first group and two patients in the second group had postoperative hyperemia and only one patient in the first group had conjunctival chemosis. A graft-related complication was present in one patient in the second group.CONCLUSION:Sutureless technique is a better technique as compared to conventional suture technique.

LIGACLIP-assisted venous anastomosis: a faster, cost-effective, and easy to master technique for venous anastomosis

In the advancing field of microsurgery, as more complex procedures are being performed, new advances and ideas are necessities. Suturing a vein remains a challenging task for young plastic surgeons, owing to its technical difficulty and labor intensity, leaving them underconfident to perform anastomosis in their practice. Not only does this lead them to delay the process of performing free flaps independently, but it also affects their work efficacy. With the advent of couplers, it does seem to theoretically reduce these disadvantages; however, it has not been proven clinically. These devices have complex and cumbersome instrumentation, reducing vascular distensibility, hence disabling them for significant vessel size discrepancies or end-to-side anastomosis. We have devised a quick, easy to perform modality of venous anastomosis which can aid a young surgeon to quickly acclimatize this domain of microsurgery as they pass out of their residency programs. The technique utilizes the creation of 4 flaps in the vessel wall and everting them as they oppose the corresponding vessel, followed by the use of LIGACLIPs to seal these flaps, thereby utilizing minimal micro-suture knots to finish the anastomosis.The study population of 50 patients underwent venous anastomosis done for free flaps having vessel diameter > 2.5 mm. Of the 50 recruited patients, 25 of them underwent conventional suturing technique and they represented the control group, whereas, on the other hand, the remaining 25 patients underwent LIGACLIP-assisted venous anastomosis. Data was then analyzed after assessing the total duration to perform anastomosis and re-exploration rates. The 25 participants who underwent LIGACLIP-assisted venous closure (M = 13.5 mins) compared to the 25 participants in the control group (M = 29.5) demonstrated significantly lesser anastomosis time (p < 0.05). In the case group, there was no flap failure in any of the patients. In the control group, three patients were re-explored, one of the patients was found to have hematoma (in head and neck reconstruction) which was cleared off and the flap survived. The other two patients had thrombosis (both for lower limb reconstruction), one of which was successfully re-vascularized and the other went into flap necrosis. LIGACLIP-assisted venous anastomosis is a safe, faster, and simple technique to master venous anastomosis. It omits the tedious process of placing multiple micro-sutures in large-caliber venous walls and provides us with a simpler solution. We believe that this technique should encourage young surgeons to take up microsurgery early in their practice and thereby adding more options in reconstruction. Level of evidence: Level II, therapeutic study

Comparison of peripheral nerve repair using ethyl-cyanoacrylate and conventional suture technique in a rat sciatic nerve injury model.

The aim of this study was to compare the outcomes of primary nerve repair using either ethyl-cyanoacrylate or conventional microsuture technique in a rat peripheral nerve injury model. In this study, a total of 30 Wistar Albino rats weighing between 220 and 275 g were used. The rats were randomly divided into three groups (10 in each), including one control (group 1) and two experimental groups (group 2, conventional microsuture repair; group 3, cyanoacrylate repair). In each group, the sciatic nerve was identified and transected. No further intervention was performed in group 1. The nerve was repaired using the epineural technique with a 10/0 atraumatic nylon in group 2 and synthetic cyanoacrylate adhesive in group 3. At the fifth postoperative week, needle electromyography (EMG) was performed to measure distal latency, combined muscle action potential (CMAP), and motor nerve conduction velocity (MNCV). Following the EMG recordings, animals were euthanized. Nerve samples were collected to evaluate vacuolar degeneration, fibrosis, and foreign body reaction histopathologically. In the EMG analysis, mean distal latency was significantly shorter in group 1 (0.85±0.09 ms) than in groups 2 (1.17±0.25 ms) (p=0.0052) and 3 (1.14±0.14 ms) (p=0.0026) while no significant differences existed between groups 2 and 3 (p>0.9999). The mean CMAP was greater in group 1 (10.5±0.35 mV) than in groups 2 (2.86±1.28 mV) (p=0.011) and 3 (2.16±1.34 mV) (p=0.0002), but there was no significant difference between groups 2 and 3 (p>0.9999). The mean MNCV was 53.5±5.95, 39.62±7.31, and 39.84±4.73 mm/sec in groups 1, 2, and 3, respectively. There was a significant difference between groups 1 and 2 (p=0.0052) and between 1 and 3 (p=0.0026), but not between 2 and 3 (p>0.9999). In the histopathological evaluation, the mean vacuolar degeneration score was 0, 2.12, and 1.88 in groups 1, 2, and 3, respectively. No obvious difference was observed between groups 2 and 3 (p=0.743). The mean fibrosis score was 0, 1.62, and 1.77 in groups 1, 2, and 3, respectively. There was no significant difference between groups 2 and 3 (p=0.888). The mean foreign body reaction score was 0, 2.5, and 2.44 in groups 1, 2, and 3, respectively. No difference was present between groups 2 and 3 (p=0.743). Primary nerve repair using the cyanoacrylate adhesive may provide similar electrophysiological and histopathological results as compared to the conventional microsuture repair.

Purse-String Suture for Skin Closure Following Large Thyroidectomy

Introduction. The total number of patients with thyroid nodules, especially large thyroid nodules (> 6 cm diameter), is increasing. However, the conventional suturing technique for closure of thyroidectomies is still only recommended as the standard for the tumor with a diameter up to 6 cm. Hence, this study aims to prove another surgical technique, purse-string stitching technique, for better esthetic outcomes on large thyroidectomy.

Comparative Study to Evaluate the Outcome of Sutures Versus Sutureless in Attachment of Conjunctival Autograft for Pterygium Excision

Background: Suturing of conjunctival graft is a traditional technique for pterygium excision surgery. Owing to its many disadvantages &amp; complications many newer techniques like autologous fibrin glue have been introduced &amp; accepted as an alternative method of graft adhesion. Methodology: The present study was conducted at the Department of Ophthalmology, MMIMSR, Mullana (Maharishi Markandeshwar Deemed to be University) in the time period extending between December 2017 and January 2019. 100 eyes of patients of either sex with primary pterygium were selected and divided into 2 groups of 50 each in Group 1- patient underwent conjunctival auto graft with 10-0 ethilon sutures while in Group 2 suture less conjunctival auto graft was done with patient’s own blood fibrin. Results: Parameters such as mean operating time, presenting complaints like pain, watering, burning and foreign body sensation, complications &amp; recurrence were compared between the two groups on postoperative Day 1, Day 7, 2 weeks, 1 month, 2 month, 3 month &amp; 6th month. Statistical significant difference (p&lt;0.01) was found between the suture and sutureless surgery for pterygium in relation to post-operative discomfort grading. There was a significant difference (t = 22.149, p = 0.001) in the duration of surgery for GROUP I surgery. Conclusion: Conjunctival auto graft with autologous serum is a safe and fast method. It is equally effective as conventional sutured autograft technique. Post operative discomfort is significantly less in this method. It also prevents suture related complications.

A Modified Suture Technique in Hepaticojejunostomy.

BACKGROUND Hepaticojejunostomy is a common biliary reconstruction procedure in hepatobiliary surgery. The suture technique plays a key role in the procedure. The conventional suture technique is complex and time-consuming. To facilitate the procedure, we performed it with a modified suture technique. In the present study, we evaluated the efficacy and safety of the technique in hepaticojejunostomy. MATERIAL AND METHODS We enrolled 120 adult patients who underwent hepaticojejunostomy. The patients were divided into a conventional group and a modified suture group according to the suture technique used. Clinical data were collected for analysis. RESULTS No significant differences were found between the 2 groups in terms of demographic data. No significant differences were found between the 2 groups in terms of serum bilirubin, albumin, AST, ALT, or hemoglobin (p>0.05). There were no significant differences between the 2 groups in terms of bile hemorrhage, fever, or cholangitis (p>0.05). The incidences of stenosis and cholelithiasis were similar in the 2 groups (p>0.05). The incidence of bile leakage was lower in the modified suture group than in the conventional group (p=0.04). The average bile duct diameter was 25±6 mm in the modified continuous suture group and 29±7mm in the conventional group, but the difference was not statistically significant (p=0.5). The duration of the anastomosis procedure was 15.4±4.4 min in the modified continuous suture group, which was shorter than in the conventional group (p<0.05). CONCLUSIONS The modified continuous suture technique is efficient and safe for use in hepaticojejunostomy. It can facilitate the procedure and reduce the incidence of bile leakage after hepaticojejunostomy.

An ambidextrous suture technique for vesicourethral anastomosis in laparoscopic radical prostatectomy

Objective To explore the advantages and application value of the ambidextrous suture technique for vesicourethral anastomosis in laparoscopic radical prostatectomy (LRP). Methods A randomized study among 62 patients with prostate cancer undergoing LRP from January 2013 to October 2014, 32 patients using the ambidextrous continuous suture technique(ambidextrous group) and 30 patients using the conventional right hand continuous suture technique (control group) in the reconstruction of vesico-urethral were collected and follow-up at our institution.Preoperative baseline data, operative time, intraoperative blood loss, postoperative incontinence rate and average hospital stay were compared between the two groups.T-test and Chi-square test were used for statistical analysis. Results The 62 patients underwent LRP successfully, and no one was converted to open surgery.Operating time for the ambidextrous group versus the control group was (97.8± 23.5) min vs.(123.7± 27.8)min(P 0.05). Meanwhile, the ambidextrous group possessed shorter negative pressure drainage time and hospital stay. There were six postoperative complications(anastomotic stricture): one in ambidextrous group and five in control group.No urinary retention or anastomosis leak was observed. Conclusions Obtained results support the use of ambidextrous continuous suture technique in LRP. This may significantly improve the surgical skills of surgeons and the quality of life of patients. Limitations include the small sample size and the long learning curve. Key words: Prostatectomy; Laparoscopes; Suture Techniques

All-Inside Suture Repair for Isolated Radial Tears at the Midbody of the Lateral Meniscus

In young athletes, radial tear of the midbody on the semilunar lateral meniscus in stable knees is most common. Conventionally, for this type of tear, meniscectomy has been considered as a first-line treatment. However, meniscectomy does not prevent degenerative change. Therefore, repair is another treatment option for a full radial tear, though this type of tear can be difficult to repair because of the lack of a vascular supply. Compared with conventional transcapsular suture techniques (e.g., inside-out/outside-in techniques or all-inside techniques with implants), all-inside suture (AIS) repair techniques can avoid bunching of the meniscus to the capsule. AIS is considered suitable for restoration of normal structure and movement of the meniscus after repair, which can be advantageous for meniscal healing. However, AIS repair for an isolated radial tear at the midbody of the lateral meniscus has rarely been reported. Therefore, we applied the AIS repair technique for isolated radial tear at the midbody of the semilunar lateral meniscus using a QuickPass SutureLasso with 2-0 FiberWire. This procedure is easier and less invasive, shortening the gap by drawing each stump of the meniscus in the direction of the circumference.

Comparison between noninvasive and conventional skin closure methods in off-pump coronary artery bypass grafting using bilateral internal thoracic artery.

Sternal wound complications could increase the hospital cost while decreasing the satisfaction of surgery. Furthermore, it can potentially also lead to life-threatening mediastinitis especially after coronary artery bypass grafting using bilateral internal thoracic artery (BITA). Skill levels of suture technique vary among surgeons and may contribute to an increased wound complication rate. Thus, standardization of surgical wound closure could potentially decrease the surgeon factor. The aim of the study is to compare the wound complication rate between non-invasive surgical skin closure devices (zip surgical skin closure device, Zipline Medical, Campbell, CA, USA) and conventional suture closure. Three hundred seventy-nine patients who underwent off-pump coronary artery bypass grafting (OPCAB) using BITAs at our institution between 2016 and 2018 were included in this study. Patients were divided into two groups; the Zipline group (zip-group, N=100), and conventional group (con-group, N=279). Following propensity score matching, 95 con-group patients were matched to 169 zip-group patients. The average age and history of cancer were significantly higher in the zip-group (P=0.021 and P=0.023, respectively). However, after propensity score matching, no differences were observed in the demographic data between the groups. In total patients (unmatched), although there was no significant difference in the incidence of deep sternal wound infection (DSWI) between the two groups (zip vs. con, 0% vs. 1.1%, P=0.569), the incidence of post-operative superficial sternal wound infection (SSWI) or dehiscence was significantly higher in the con-group than in the zip-group (1.0% vs. 7.9%, P=0.013). The results were consistent in the matched patients. (DSWI: 0% vs. 0.6%, P>0.999; SSWI or dehiscence: 1.1% vs. 7.1%, P=0.036). Multivariable analysis revealed use of the zip surgical skin closure device showed a preventive effect against wound complications [odds ratio (OR): 0.128, 95% confidence interval (CI): 0.017-0.976, P=0.029]. Zip surgical skin closure devices could decrease superficial wound complication rates compared to conventional suture techniques in OPCAB using BITAs.

Dermal suture only versus layered closure: A randomized, split wound comparative effectiveness trial

Layered closure of cutaneous wounds is a commonly used surgical practice. However, there are studies that suggest the additional layer of epidermal sutures might not be necessary. To compare scar outcomes between the single-layer deep-dermal suture technique and the conventional layered suture technique for primary closure of cutaneous wounds. A total of 49 patients were enrolled in a prospective, randomized, evaluator-blinded, split scar study to compare the conventional bilayered closure technique with the single-layer deep-dermal suturing technique for primary closure of wounds. The primary outcome measure was mean sum Patient and Observer Scar Assessment Scale (POSAS) score at 3 and 12months. At the 3-month follow-up, there was a statistically significant difference in the mean total POSAS scores for both the blinded observer and patients, indicating a preference for the side with the standard layered closure. However, at the 12-month follow-up, this difference was lost, with the exception of scar color, which was significantly more noticeable on the wound side closed with only dermal sutures. Single-center study. Three months after surgery, the layered closure technique resulted in a slightly better scaroutcome than the single-layered closure containing only dermal sutures. At 12-months' follow-up, thisdifference diminished, with scars for both sides appearing similar.

Implementation of the small bites closure of abdominal midline incisions in clinical practice is correlated with a reduction in surgical site infections.

Small steps wound closure of midline laparotomy has been reported to decrease the incidence of incisional hernia development in two randomized controlled trials. The aim of the present study was to evaluate the effect of implementing the small steps wound closure technique in clinical practice with regards to the development of incisional ventral hernia (IVH) and surgical site infections (SSI) in clinical practice. Implementation of the small steps wound closure technique using the small tissue bites technique as the standard closure technique for abdominal midline incisions in our clinical practice was done in March 2015. For this study, all patients from June 2013 until June 2016 with a midline laparotomy, either long or small in case of specimen extraction in laparoscopic surgery, in either elective or emergency setting were included. Conventional large bite wound closure was compared to small steps wound closure with regards to the development of SSI, IVH as well as burst abdomen. A total of 327 patients were included. The small steps suture technique was used in 136 (42%) of the patients, whereas the conventional large bites suture technique was used in 191 patients (58%). A total of 54 patients in the large bites group developed SSI (28%) compared to 23 (17%) patients in the small steps group (p = 0.02). A total number of 10 patients (7%) developed IVH in the small steps group compared to 27 patients (14%) in the large bites group (p = 0.08). Implementation of small bites wound closure of abdominal midline incisions in clinical practice was correlated with a reduction in surgical site infections.

Clinical and ultrasonographic evaluation of three suture techniques for closure of the equine linea alba

SummarySurgical technique plays an important role in preventing ventral midline incisional complications. The aim of this study was to compare the clinical and ultrasonographic outcome of three suture techniques for closure of the linea alba. In this prospective case series (n = 43), horses operated for acute abdominal intestinal disease through a midline incision were randomised in three groups: closure with a conventional continuous technique (Group 1), a small stitches continuous technique (Group 2) and the UX‐technique (shoe‐lace configuration, Group 3). Age, sex, body weight, type and duration of surgery were recorded and the suture to wound length ratio was calculated. Clinical evaluation of the wound (wound discharge) was performed daily during hospitalisation. At 7 weeks post‐operatively the linea alba was evaluated clinically and ultrasonographically. The linea alba width was measured halfway along the length of the incision. One horse in Group 1 had acute incisional dehiscence, but there were no further significant differences between the groups in the short term. Seven weeks post‐operatively two horses had complete herniation in Group 1 and one horse had partial herniation in Group 2. In the UX group no herniation occurred. The incidence of herniation was not significantly different between the groups. On ultrasound at 7 weeks the linea alba width was significantly smaller in Group 2 (P = 0.00029) and Group 3 (P = 0.0018) compared with Group 1, even with exclusion of the acute incisional dehiscence and two herniated horses. Limitations were the small group size and relatively low incidence of incisional complications for statistical analysis. It was concluded that the use of small stitches and the UX‐technique resulted in a smaller linea alba width compared with the conventional continuous suture technique and might therefore be preferred for closure of the linea alba in equine colic surgery.

Biomechanical comparison of meniscus-suture constructs for pullout repair of medial meniscus posterior root tears

BackgroundTranstibial pullout repair for posterior meniscus root tear is widely performed to restore meniscal function. However, it is sometimes technically difficult to pass the suture through the posterior medial meniscus root in narrow joint space. To address this limitation, a new suture technique using an all-inside meniscal suture device through the tibial tunnel was proposed. The purpose of the present study was to compare the biomechanical properties of a meniscus-suture construct prepared using an all-inside meniscal suture device and those of the construct prepared using conventional suture techniques.MethodsA total of 18 fresh-frozen porcine medial menisci were used and randomly divided into three groups according to the type of suturing technique applied. Three suturing methods were evaluated: suturing with all-inside meniscal suture device, single simple suture, and double simple sutures. All specimens were subjected to cyclic loading of 300 cycles followed by a load-to-failure test. The displacement after cyclic loading, the ultimate failure load, and the mode of failure were evaluated.ResultsThere was no significant difference among the three suturing techniques regarding both displacement after cyclic loading and ultimate failure load. Suture breakage was the most common failure mode in each group.ConclusionsThe biomechanical properties of meniscus-suture construct with the all-inside meniscal suture device were equivalent to those obtained using conventional suture techniques. Our results suggest that pullout repair using the all-inside meniscal suture device through the tibial tunnel could serve as an alternative suture technique for the repair of posterior meniscus root tears.

Clinical Outcomes of VasoRing Connector in Patients With Acute Type A Aortic Dissection

Outcomes of acute type A aortic dissection repair may be improved when VasoRing connectors (VRC [Sunwei Technology, Taipei, Taiwan]) are used to facilitate aortic anastomosis. In the present study, we compared the results of acute type A aortic dissection repair using VRC and conventional suture technique. A total of 68 patients who underwent acute type A aortic dissection repair by total arch replacement and antegrade frozen elephant trunk procedure at our institution were enrolled. Records of patients receiving aorta anastomosis with VRC (n= 33) and conventional suture (n= 35) were retrospectively compared. All the surgical results were collected and analyzed. The results showed that the VRC group exhibited significance in total operative time (326 ± 80 minutes versus 362 ± 34 minutes, p= 0.023), cardiopulmonary bypass time (97 ± 10 minutes versus 134 ± 15 minutes, p < 0.001), aortic cross-clamp time (97 ± 10 minutes versus 134 ± 15 minutes, p < 0.001), and circulatory arrest time (15 ± 4 minutes versus 50 ± 8 minutes, p<0.001) compared with the suture group. Use of VRC for aortic anastomosis led to significantly less perioperative blood loss (442 ± 75 mL versus 849 ± 419 mL, p<0.001) compared with conventional suture for aortic anastomosis There was no reoperation for postoperative bleeding in the VRC group whereas reoperation for postoperative bleeding occurred in 20% of the suture group (0% versus 20%, p= 0.011). Postoperative blood loss, amount of blood transfusion, and acute kidney injury requiring hemodialysis were also significantly less in the VRC group than the suture group. Use of VRC shortened operative time and improved bleeding control incorporating standard methods for aortic anastomoses during acute type A aortic dissection repair by total arch replacement and antegrade frozen elephant trunk procedure. Long-term follow-up and randomized comparison are needed to confirm VRC efficacy.

Sutureless Belt Loops versus Sutured Buckle Technique in Combination with Vitrectomy for Retinal Detachment Repair: A Comparative Analysis

Objective: To compare the anatomic and visual outcomes in primary rhegmatogenous retinal detachment repair involving combined pars plana vitrectomy (PPV)/scleral buckle (SB) using a sutureless belt loops technique versus a conventional sutured buckle technique. Methods: This is a retrospective, consecutive, interventional, comparative case series study using patients treated for primary retinal detachment who underwent the SB procedure in combination with PPV. Details regarding anatomic and visual outcome were analyzed. Results: Thirty-five eyes were included in this study: 18 eyes (18 patients) treated with combined PPV and SB performed using a sutureless belt loops technique (group A) and 17 eyes (17 patients) treated with combined PPV and SB sutured to the sclera (group B). Successful anatomic attachment and appropriate buckle height were achieved in all 35 cases. There was 1 case of redetachment in each group during the follow-up: 1/17 (5.9%) in group A and 1/18 (5.6%) in group B (p = 0.97). No cases of buckle infection, extrusion, or intrusion were noted during the follow-up period. Conclusion: SBs installed using a belt loops sutureless technique appear to be as safe and effective as those applied using conventional suturing for repair of retinal detachment, with similar anatomic and functional outcomes.