Horizontal Mattress Research Articles

Biomechanical properties of various rat rotator cuff repair techniques

While rat models are frequently used for studying tendon healing, there is a lack of research comparing various rotator cuff repair methods in this animal model. Determining the most effective method to begin with is pivotal for biological studies focused on healing augmentation. No study to date has shown the superiority of one repair over the other for rotator cuff repair in a rat model. We performed a biomechanic study using a rat model to co the strength of four common grasping techniques. We assessed if the bone tunnel trajectory influenced the early biomechanics of the repair at postoperative day 0 (POD0). Sixty cadaveric rat shoulders were divided equally into 6 groups; 4 groups were allocated for the biomechanical strength testing based on either a 1) modified Mason Allen (MM), 2) modified Kessler loop (MK), 3) horizontal mattress (HM), or a 3) simple interrupted stitch (SS) technique. The remaining 2 groups were used to evaluate two tunneling angles: a transverse tunnel (TT) that was perpendicular to the long humeral axis, or a longitudinal tunnel (LT) that was 30◦ angle to the humerus. MM had the highest mean failure load, followed by MK, HM, and SS. Pairwise comparison revealed that MM was stronger than SS and HM (P = 0.025 and P = 0.026, respectively), although similar to the MK (P = 0.881). MM was stiffer than MK (P < 0.001), HM (P = 0.008), and SS (P < 0.001). The TT and LT had similar loads to failure and stiffness. Our study suggests that the MM technique provides a stronger and stiffer rotator cuff repair than the others.

Extensor Tendon Repair.

Extensor tendon injuries are a common condition that hand surgeons must be prepared to treat. The area of extensor tendon injury can traditionally be broken down into 9 zones. Physical examination is the best way to diagnose extensor tendon injury with a loss of active extension in the injured digit. The tenodesis effect may be utilized to aid in diagnosis: wrist flexion should cause passive extension at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints if the extensor tendon is in continuity. Repair of extensor tendon injuries depends on the zone of injury and the thickness of the tendon, which determines its ability to hold core sutures. For zone-I and II injuries, several "figure of 8" buried sutures can be utilized or a running type of suture may be employed. For zone-III to VII injuries, 1 or 2 core sutures and a supplementary running suture can be utilized. Several alternative techniques have been previously described. These include variations in the number of core strands, repair configuration, and suture caliber, as well as the use of epitendinous repair. Alternative treatments also include nonoperative treatment, which is typically reserved for partial tendon injuries and for patients who are unable to tolerate a surgical procedure. The techniques that we describe are tailored to the thickness of the tendon. Running sutures are applicable to any zone, whereas core sutures are best utilized in zones III through VII. The running interlocking horizontal mattress technique has been found to be stiffer and faster to accomplish compared with the other techniques, and was found to have good to excellent clinical results in a study of lacerations in zones IV and V1,2. Repair of extensor tendon lacerations has demonstrated good long-term outcomes if performed in a timely manner after injury. A previous study showed good to excellent function in up to 64% of acute extensor tendon repairs, more fingers lost the ability to flex fully than lost the ability to extend3. Systematic reviews have suggested that dynamic rehabilitation may not provide superior long-term benefit compared with static splinting4. The Elson test should be performed under a digital nerve block in order to properly assess the integrity of the central slip.In distal zone I and III injuries, suture anchors or bone tunnels may be utilized when there is no remaining tendon on the distal end of the laceration.When preparing the tendon ends for repair, it is important to handle the tendon delicately-preferably through the cut end of the tendon rather than the tendon itself.In zone-VII injuries, the injured tendon may lie beneath the extensor retinaculum. In such cases, windowing of the extensor retinaculum may decrease adhesion formation and facilitate repair. MCP = metacarpophalangealPIP = proximal interphalangealDIP = distal interphalangealIP = interphalangealROM = range of motionRMS = relative motion splintRIHM = running interlocking horizontal mattress.

51745 Aesthetic outcome of running subcuticular suture versus running horizontal mattress suture closure of linear wounds on the trunk and extremities: a randomized evaluator blinded split wound comparative effectiveness trial

51745 Aesthetic outcome of running subcuticular suture versus running horizontal mattress suture closure of linear wounds on the trunk and extremities: a randomized evaluator blinded split wound comparative effectiveness trial

Ex vivo biomechanical evaluation of tissue construct strength in an equine colopexy model.

To compare strength of left paramedian colopexies using various techniques in equine ex vivo models. Experimental study. Equine cadavers euthanized for nongastrointestinal pathology (36 specimens derived from 9 horses). Colopexies were performed after euthanasia. Suture pattern (horizontal mattress vs. cruciate) and incorporation of dorsal sheath of the rectus abdominis (partial-thickness) versus incorporation of dorsal and ventral sheath of the rectus abdominis (full-thickness) were evaluated. Single cycle load to failure, work to peak load, stiffness, and mode of failure of colopexy tissue constructs were assessed. Mean load to failure of all constructs ranged from 102.26 to 166.38 N. Partial-thickness bites demonstrated a mean load to failure and standard deviation (SD) of 111.91 (35.88) N and 102.26 (30.06) N (p < .05) which was significantly lower than the mean and SD of full-thickness bites (166.3 [72.42] N and 163.21 [51.40 N]), respectively. All full-thickness bites regardless of suture pattern and over half of partial-thickness bites failed at the colonic wall. There was no significant difference in load to failure compared to mode of failure. A stronger colopexy was achieved with a full-thickness bite regardless of the suture pattern. The most common mode of failure was the colon wall. Incorporating ventral and dorsal fascia of the rectus abdominus provided a stronger colopexy structure, which may necessitate a second incision or subcutaneous palpation of the needle when performing a colopexy. The lateral band of the colon failed in most constructs (77%) regardless of technique, which could weaken the colonic wall and risk colonic rupture.

The Effect of a Horizontal Apical Mattress Suturing Technique on the Width and Thickness of the Keratinized Mucosa After Dental Implant Surgery: A Cohort Study.

Introduction There is general agreement that a thick zone of the keratinized tissues around implants promotes accurate prosthetic procedures, permits oral hygiene maintenance, resists recession, and enables esthetic blending with surrounding tissues. A new procedure called Choukroun's technique has been suggested, and it consists of a combination of horizontal apical mattress suture with regular suture to increase the keratinized tissue in the mandibular arch during the first stage after implantation. The proposed procedure has not been evaluated yet in a cohort of patients. Therefore, this prospective study aimed to evaluate the impact of Choukroun's technique on the width and thickness of the keratinized gingiva after oral surgery. Materials and methods A one-group prospective cohort study was conducted on patients referred to the Department of Oral and Maxillofacial Surgery at the Dental College of Al-Wataniya Private University who had been referred to undergo dental implant surgery.The inclusion criteria for the study group were as follows: patients with mandibular missing teeth, good oral health, good general health, 18-70 years old, at least 1 mm thickness of keratinized gingiva, and at least 1 mm width of the attached gingiva. A total of 14 patients aged 27-67 years were included in the study. After inserting the dental implants, the suturing was accomplished according to Choukroun's method. The width and thickness of the keratinized gingiva were assessed before surgery and at one and two months post-surgery. Repeated measures analysis of variance (ANOVA) was applied to detect significant differences between assessment times. Results The study sample comprised 14 patients, of which four were females (28.6%) and 10 were males (71.4%). Patients' ages ranged from 27 to 67 years, with a mean age of 54.86 ± 11.73 years. The surgical procedure was performed in three different regions: the upper posterior teeth with four patients (28.6%), the upper anterior teeth with three patients (21.4%), and the lower posterior teeth with seven patients (50%). The mean gingival width before surgery was 5.78 mm, whereas the mean gingival thickness was 2.82 mm. There was no significant difference between the three evaluation times in the mean gingival width (P=0.222), and there was a significant difference between the three evaluation times in the mean gingival thickness (P<0.001). The mean mean gingival thickness one month after surgery was significantly greater than its mean value before surgery (mean difference: 0.749 mm). Additionally, the mean gingival thickness two months after surgery was significantly greater than its mean value before(mean differences: 0.636 mm). Conclusions Using horizontal apical mattress sutures (Choukroun's technique) does not provide any advantage in increasing the width of the keratinized gingiva. However, it does lead to an increase in the thickness of keratinized gingiva in the surgical area. Therefore, the use of horizontal apical mattress sutures is recommended.

Evlaution of Different Suturing Techniques in Deep Third Molar Surgery: An Original Research

ABSTRACT Purpose: The purpose of this study was to compare the efficacy of various suturing methods used in deep third molar extraction procedures. Methods: A total of four suturing method groups—simple interrupted, horizontal mattress, vertical mattress, and figure-of-eight—were randomly allocated to 100 patients having deep third molar surgery. Assessments were conducted on wound healing, operation time, intraoperative problems, postoperative pain scores, swelling measures, and patient satisfaction questionnaires. Appropriate tests were used for statistical analysis, with P &lt; 0.05 being regarded as significant. Results: Compared to other procedures, the figure-of-eight technique showed better results in terms of postoperative pain scores, swelling measures, wound healing percentages, and patient satisfaction (P &lt; 0.05). There was no discernible difference in the operating time or intraoperative problems between the groups. Conclusion: In conclusion, there seems to be a benefit to using the figure-of-eight suturing approach for deep third molar surgery in terms of improved postoperative results and patient satisfaction. It is recommended that clinicians give this strategy some thought to improve patient care and surgical results.

A Retrospective Hospital-Based Study to Evaluate the Results of Extensor Tendon Injuries of the Hand, Wrist, and Forearm Treated Surgically in a Tertiary Care Hospital.

Introduction The important factors determining the treatment of extensor tendon injuries include the anatomical zone, type of injury, mode of injury, chronicity, and pathology of the adjacent tissues (principally the skin, bone, and joints). Very few studies have collectively studied the outcomes of all the wrist, forearm, and hand extensors.Hence, the major aim of this study was to evaluate the resultsof extensor tendon injuries of the hand, wrist, and forearm that were treated surgically. Methodology This was a hospital-based retrospective study done in a tertiary teaching hospital in South India. A total of 30 patients (23 males, seven females) were included in the study.All the cases of extended tendon injuries of the wrist, hand, and forearm were treated surgically, and those willing to participate were included in the study afterobtaining institutional ethics committee approval. Results The study included 30 patients, predominantly males (76.66%). The majority were aged 31-40 years (33.33%). Occupational injuries were the most common cause (36.66%), followed by road traffic accidents (RTAs) and glass cuts (26.66%). Right-sided injuries were more frequent (56.66%), with zone VI being the most affected (43.33%). Extensor digitorum communis was the most injured tendon (40%). Various suture techniques were used, including horizontal mattress and modified Kessler's. Complications occurred in four patients, including hematoma and surgical site infections. Functional outcomes, assessed by Miller's Criteria, indicated extension lag and flexion loss as key recovery measures. Conclusion Hand function is essential for daily life activities, and optimal repair and reconstruction of extensor tendon injuries are crucial to avoid functional disability. While the present study demonstrated positive outcomes, further research with larger sample sizes and more rigorous designs is needed to validate these findings and improve treatment strategies for hand injuries.

Aesthetic outcome of running subcuticular suture versus running horizontal mattress suture in closure of linear wounds of the trunk and extremities: A randomized evaluator-blinded split-wound comparative effectiveness trial

Both running horizontal mattress (HM) and running subcuticular (SQ) suturing techniques have been suggested to be superior to other running cuticular suturing techniques. These 2 techniques have not been directly compared. To compare cosmetic outcomes between a running HM and a running SQ technique in a split scar model following linear closure of trunk and extremity defects. Fifty patients were enrolled in a randomized, evaluator-blinded, split-scar study. One side of the surgical wound was randomized to receive one intervention (HM vs SQ) with the other side receiving the alternate intervention. The primary outcome was the Patient and Observer Scar Assessment Scale (POSAS) score at a minimum of 3months postoperatively. Observer POSAS sum of components was 19.49 and 17.76 for HM and SQ, respectively (P=.14). The mean score for patient overall opinion was 4.71 for HM and 3.50 for the SQ technique (P=.02). Overall opinion scores of evaluators were 3.87 and 3.29 for HM and SQ, respectively (P=.03). Single-center study of a relatively homogenous population. Although there was no significant difference in the sum of POSAS components between HM and SQ (P=.14), both patients and evaluators had a superior overall opinion of the SQ-treated side (patient P=.02, evaluator P=.03).

Suture techniques and materials used in oral surgery

This article highlights the importance of proper suturing of mucosa, gingiva, and skin after surgical procedures and trauma. Several factors play a role in promoting good healing, including optimal tension on the sutured wound, adequate blood flow, and careful selection of suture materials. The selected suture material depends on various factors, such as type of tissue, location of the wound, and healing time. Different suture techniques are discussed, including interrupted sutures, continuous sutures, horizontal and vertical mattress sutures, each with their own specific applications and benefits. Skillfulness in suture techniques and appropriate material selection contribute to effective wound healing and optimal outcomes.

Choice of suture technique may mitigate figure-of-8 deformity in slide tracheoplasty

ObjectivesTo demonstrate varying degrees of immediate postoperative figure of 8 deformity following three different methods of tracheal suturing. Study designComparative ex-vivo study. MethodsA fresh, unfixed rabbit trachea was harvested and bisected at its midpoint. The posterior membranous trachea was excised from both segments to mimic the anatomy of complete tracheal rings following longitudinal release. A slide tracheoplasty was performed on the same tracheal segments as an internal control, using three different methods of closure: simple running, running horizontal mattress, and a modified baseball stitch. Endoscopic and external photographs were taken immediately following repair to document the effect of closure technique on external and endoluminal anatomy. ResultsA simple running closure, in which traveling occurs between needle passes, showed the greatest degree of postoperative figure of 8 deformity. A running horizontal mattress suture closure showed less deformity and a modified running closure, in which traveling occurs within needle passes, showed the least deformity. ConclusionsOur study suggests that a minor modification of standard running closure techniques may help limit the common figure-of-8 deformity often noted following slide tracheoplasty. Lay SummaryFigure of-8 deformity is a problem that can occur when repairing a narrow trachea referred to as tracheal stenosis. This deformity may be prevented using particular suture techniques which may decrease the likelihood that the trachea becomes blocked again following repair.

Closing the Gap: Exploring the Role of Cap Grafts in Tracheocutaneous Fistula Closure.

Exploring the Role of Cap Grafts in tracheocutaneous fistula Closure. A tracheocutaneous fistula (TCF) is an abnormal connection that forms between the trachea (windpipe) and the skin of the neck. If spontaneous closure does not occur, fibrosis of the surrounding tissue may result in a persistent TCF and in some cases, iatrogenic laryngotracheal stenosis at the level of tracheostoma, the so-called A-frame deformity. In all 5 patients, Conchal cartilage was harvested. The new de-epithelialized stoma is measured, and the previously harvested graft is cut to match the defect. Passing through the centre of the tracheal cartilage and into the centre of the auricular cartilage graft, 3-0 PDS, horizontal mattress sutures are placed sequentially around the periphery of the graft, stabilised with Right SCM flap and skin was closed in layers. In each of the five cases, we achieved a resounding success by skilfully closing the fistulas and meticulously restoring the structural integrity. Equally noteworthy, all patients expressed contentment with the cosmetic outcomes at both the donor site and the neck region, deeming it as an acceptable aesthetic result.

How We Do It: Horizontal Mattress Pulley Suture for Improved Reconstruction After Staged Excision on Scalp.

How We Do It: Horizontal Mattress Pulley Suture for Improved Reconstruction After Staged Excision on Scalp.

Revision Anterior Glenoid Reconstruction With Distal Tibia Allograft Combined With Open Capsular Shift

Background: Managing patients with recurrent anterior shoulder instability and glenoid bony deficiency remains a challenge. Multiple graft options, including iliac crest, distal clavicle, coracoid, and distal tibia allograft have been used. There is a growing body of evidence that supports distal tibia allograft for glenoid restoration in patients with shoulder instability due to its ability to restore the articular surface as well as the glenoid depth and curvature. Indications: Surgical indications for anterior glenoid reconstruction with distal tibia allograft combined with open capsular shift include patients with recurrent shoulder instability and glenoid bone loss. Technique Description: A deltopectoral interval is utilized and the subscapularis is split in lines with its fibers. The subscapularis and capsule are split together in a horizontal fashion and tagged together. Any prior hardware is then removed utilizing appropriate removal sets, a burr, and a broken screw set if necessary. The anterior glenoid is then prepared and the defect is measured. Bone marrow aspirate is then harvested from the proximal humerus using a vortex needle. The distal tibia allograft is then cut to size and prepared utilizing pulsed lavage, pressurized sterile carbon dioxide, and the bone marrow aspirate. The allograft is then fixed with solid stainless steel 3.5-mm cortical screws with washers. The medial, glenoid based capsular repair it completed by placing 1.8-mm knotless FiberTak anchor at the bottom of the distal tibia allograft. A free needle is utilized to place a horizontal mattress stitch from the anchor to the inferior capsule, which is then loaded onto a shuttling suture, to repair it to the anterior inferior glenoid. A knotless anchor is then placed right off the chondral margin of the humeral head, and this is used to repair both the capsule and subscapularis in the correct position by passing through both inferior and superior leaflets. This is then loaded onto the knotless anchor and reduced, which shifts the subscapularis and capsule laterally. The remainder of the subscapularis split is then closed. Patients are then placed in a sling with an abduction pillow with no shoulder range of motion for 6 weeks. They can then progress their therapy with a goal of returning to sport at 6 months. Results: Several large systemic reviews have shown that return to sport rates after anterior glenoid reconstruction range between 80% and 90%, with returning to the same level of play in the 70% range. Discussion: Anterior glenoid reconstruction utilizing distal tibia allograft combined with an open capsular shift is a durable surgical option for patients presenting with shoulder instability and glenoid bone loss. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Arthroscopic Repair of a Lateral Meniscus Oblique Radial Tear

Background: Lateral meniscal oblique radial tears (LMORTs) are the most common type of lateral meniscal tears and occur concomitantly with anterior cruciate ligament (ACL) tears in up to 12% of cases. Four types of LMORTs have been classified in the literature based on proximity to the meniscal root and extent of the tear. Type 1 and 2 LMORTs represent partial and complete posterior root tears less than 10 mm from the root insertion. Type 3 and 4 LMORTs are partial and complete posterior radial meniscus tears greater than 10 mm from the root insertion. Indications: Type 3 and 4 LMORTs can and should be addressed with an all-inside side-to-side repair at the time of ACL reconstruction. LMORTs that are not repaired at the time of ACL reconstruction can contribute to persistent instability and meniscal extrusion. Technique Description: Diagnostic arthroscopy is performed to evaluate the posterior aspects of both the medial and lateral meniscus. The medial leaflet is commonly flipped into the notch and scarred to ACL remnant. After identifying and isolating the medial leaflet, an arthroscopic suture passer is used to pass a suture from inferior to superior through the medial leaflet. A second suture is passed from inferior to superior through the lateral leaflet. This is used to shuttle the suture pass through the medial leaflet to the bottom of the meniscus, where it can be tied in a horizontal mattress fashion. The sutures are tied down with aide of an arthroscopic knot pusher. A second set of sutures is passed and used to shuttle a second suture that would be tied posterior to the first suture, again in a horizontal mattress fashion. This allows reduction of the fragments in apposition across the tear. Postoperatively, patients are allowed range of motion from 0° to 90° and to toe touch weightbearing for the first 4 weeks. Patients are advanced to weightbearing as tolerated at 5 weeks. Typical return to sport ranges from 6 to 9 months postoperatively. Results: Results have been published for 2-year outcomes of type 3 and 4 LMORT repairs and have demonstrated persistent improved patient-reported outcomes as well as healing rates that are greater than 80% and in some series approach nearly 100%. Discussion/Conclusion: Arthroscopic all-inside side-to-side surgical repair is a durable and reliable treatment option for patients presenting for ACL reconstruction with concomitant type 3 or 4 LMORT. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Novel Technique to Reconstruct Peri-Implant Keratinised Mucosa Width Using Xenogeneic Dermal Matrix. Clinical Case Series.

Reconstruction of sufficient buccal peri-implant keratinised mucosa width (PIKM-W) is reported to reduce the symptoms of peri-implantitis. In order to reduce the drawbacks of autogenous graft harvesting, we investigated a novel porcine dermal matrix (XDM, mucoderm®) using a modified surgical technique for augmentation of PIKM-W. Twenty-four patients were recruited with insufficient (<2 mm) PIKM-W. After split thickness flap preparation, the XDM was trimmed, rehydrated and tightly attached to the recipient periosteal bed using modified internal/external horizontal periosteal mattress sutures via secondary wound healing. Change of the PIKM-W and dimension of the graft remodelling were evaluated at 6 and 12 months postoperatively. The mean PIKM-W changed from 0.42 ± 0.47 to 3.17 ± 1.21 mm at 6 M and to 2.36 ± 1.34 mm at 12 M in the maxilla and from 0.29 ± 0.45 mm to 1.58 ± 1.44 mm at 6 M and to 1.08 ± 1.07 mm at 12 M in the mandible. Graft dimensions decreased by 67.7 ± 11.8% and 81.6 ± 16.6% at 6 M, and continued to 75.9 ± 13.9% and 87.4 ± 12.3% at 12 M, in the maxilla and mandible, respectively. Clinical parameters showed statistically significant intra- and intergroup differences between the baseline and 6 and 12 months (p < 0.05). The present technique using the XDM was safe and successfully reconstructed PIKM-W in both arches. The XDM alone seems to be a suitable alternative to autograft for PIKM-W augmentation in the maxilla.

Comparison of Different Suturing Techniques in Post-Extraction Socket Healing

ABSTRACT Background: The process of post-extraction socket healing is critical for ensuring proper tissue repair and minimizing complications in dental practice. Suturing techniques play a pivotal role in this process, influencing wound closure, hemostasis, and overall healing. Materials and Methods: This prospective clinical trial involved 80 participants who required single-tooth extractions. Patients were randomly assigned to four groups, each receiving a distinct suturing technique: simple interrupted sutures, horizontal mattress sutures, vertical mattress sutures, and continuous sutures. Standardized assessments, including clinical examination and cone-beam computed tomography (CBCT) scans, were performed at baseline, 1 week, and 4 weeks post-extraction. Wound dehiscence, soft tissue healing, and bone preservation were evaluated. Results: At 1-week post-extraction, the continuous suture group exhibited the lowest rate of wound dehiscence (5%) compared to other groups (simple interrupted, 15%; horizontal mattress, 10%; vertical mattress, 12%). Soft tissue healing scores at 4 weeks were significantly higher in the continuous suture group (8.7 ± 0.5) than in the other groups (simple interrupted, 7.2 ± 0.8; horizontal mattress, 7.8 ± 0.7; vertical mattress, 7.5 ± 0.6). CBCT analysis revealed superior bone preservation in the continuous suture group (98% remaining bone volume) compared to the other groups (simple interrupted, 92%; horizontal mattress, 95%; vertical mattress, 94%). Conclusion: This study demonstrates that the continuous suturing technique offers advantages in post-extraction socket healing, including reduced wound dehiscence, improved soft tissue healing, and better bone preservation.

Comparison between four different suture configurations for rotator cuff repair: a biomechanical animal study.

The arthroscopic repair of a massive rotator cuff tear could be surgically challenging. There is a continuous argument regarding the best surgical technique and suture configuration used to treat massive rotator cuff tears. The purpose of this study was to assess the in vitro strength of the new double Mason-Allen suture and compare it to the commonly used other suture configurations. Twenty-five fresh sheep shoulders were randomly divided into five equal groups. Each group had their infraspinatus tendons cut and repaired with one of five suture configurations (simple, horizontal mattress, Mason-Allen, modified Mason-Allen, and double Mason-Allen) using Arthrex® 1.3mm suture tape. The specimens were fixed to the test apparatus through their scapulae and hung with the repair tape to Sartorius® precision balance with sequential load increments till failure. The load to failure was measured for each of the five suture configurations. Study data found the double Mason-Allen configuration to have the highest mean load to failure 423.30±23.05 (Newtons), followed by modified Mason-Allen, Mason-Allen, horizontal mattress, and simple suture respectively. The double Mason-Allen repair configuration has the highest load to failure compared to the other known suture configuration to repair rotator cuff tears.

Management of Post-partum Complete Cervico-uterine Prolapse in Crossbred Jersey Cow

Post-partum uterine prolapse is a very common obstetrical problem as it affects the future breeding and production of an animal. It generally leads to delay in return to oestrus and subsequently reduction in conception rate and thus increase in the inter calving period of a female animal. In the present case, in a postpartum crossbred cow, replacement and repositioning of the cervix and uterus was done under caudal epidural anaesthesia with the horizontal mattress suture on vulva. The suture was removed after 14 days on complete recovery of the animal.

Fractured sternal wire causing a cardiac laceration

BackgroundHemopericardium is a serious complication that can occur after cardiac surgery. While most post-operative causes are due to inflammation and bleeding, patients with broken sternal wires and an unstable sternum may develop hemopericardium from penetrating trauma.Case presentationWe present the case of a 62-year-old male who underwent triple coronary bypass surgery and presented five months later with sudden anterior chest wall pain. Chest computed tomography revealed hemopericardium with an associated broken sternal wire that had penetrated into the pericardial space. The patient underwent a redo-sternotomy which revealed a 3.5 cm bleeding, jagged right ventricular laceration that correlated to the imaging findings of a fractured sternal wire projecting in the pericardial space. The laceration was repaired using interrupted 4 − 0 polypropylene sutures in horizontal mattress fashion between strips of bovine pericardium. The patient’s recovery was uneventful and he was discharged on post-operative day four without complications.ConclusionPatients with broken sternal wires and an unstable sternum require careful evaluation and management as these may have potentially life-threatening complications if left untreated.

Hybrid Repair of a Medial Meniscus Mid-Body Radial Tear

Background: Meniscal radial tears are associated with altered contact mechanics, as they have the potential to disrupt the meniscal hoop stress mechanism. In prior studies, radial tears are associated with higher grade of cartilage damage, as well as higher rate and severity of meniscal extrusion in knees with a radial tear relative to other types of tears. Improved understanding of the meniscus biological potential together with modern developments in surgical technique has paved the way for the current emphasis on repairing even radial tears. Indication: Large or complete radial tears of the meniscus without prohibitive joint space narrowing or severe cartilage damage. Technique Description: A hybrid technique of meniscal radial repair is described, combining (1) 2 transtibial pullout cinch-loop sutures, (2) 2 inside-out vertical rip-stop sutures and 2 oblique sutures in a “cross-tag” configuration, and (3) 1 horizontal mattress all-inside suture. The repair is biologically augmented with a notch marrow-venting procedure. Results: Recent evidence has demonstrated significant biomechanical benefit in terms of increased load to failure and construct strength when adding transtibial tunnel augmentation to radial repairs. In addition, rip-stop sutures decrease the chance of cut-out relative to nonreinforced repairs. Those biomechanical advancements are reflected in excellent patient-reported outcomes as well as healing rates following radial repair. Discussion/Conclusion: We present a hybrid technique encompassing the most biomechanically effective novel radial repair techniques, backed by excellent clinical outcomes following radial repair in the current literature. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.