Horizontal Sutures Research Articles

Clinical Results of Meniscal Repair Using Submeniscal Horizontal Sutures.

Parts of the implants placed over the meniscus during meniscal repair can wear down the cartilage in the contact zones and cause chronic synovitis. Placing horizontal sutures under the meniscus may overcome this potential hazard. The purpose of this prospective study was to evaluate the midterm results of arthroscopic meniscal repair using submeniscally placed out-in horizontal sutures. One hundred and three meniscal repairs with submeniscal horizontal out-in technique in 103 patients were performed between 2009 and 2012. Our indications for meniscal repair were all longitudinal tear in red-red and red-white zone with acceptable tissue quality. Clinical evaluation included the Tegner and Lysholm knee scores and clinical success was defined as absence of joint-line tenderness, locking, swelling, and a negative McMurray test. The average follow-up was 19 months (range, 14 to 40 months). The time interval from injury to meniscal repair ranged from 2 days to 390 days (median, 96 days). At the end of follow-up, the clinical success rate was 86.5%. Fourteen of 103 repaired menisci (13.5%) were considered failures according to Barrett's criteria. The mean Lysholm score significantly improved from 39.6 preoperatively to 84.5 postoperatively (P<0.001). Eighty five patients (82.5%) had an excellent or good result according to Lysholm knee score. Tegner activity score improved significantly (P<0.01) from an average of 3.4 (range, 2-6) preoperatively to 5.9 (range, 5-8) postoperatively. Statistical analysis showed that age, simultaneous anterior cruciate ligament reconstruction, chronicity of injury did not affect the clinical outcome. Our results showed that acceptable midterm results are expected from submeniscal horizontal out-in repair technique. This technique is cheap, safe and has the advantage of avoiding chondral abrasion caused by solid implants and suture materials placed over the meniscus.

Vaginal bilateral cervical lips suture in combination with intrauterine Foley catheter to arrest postpartum hemorrhage

Vaginal bilateral cervical lips suture allows retention of intrauterine Foley catheter in women with a dilated cervix. This novel indication for vaginal bilateral cervix suture may be a useful adjunct to intrauterine balloon tamponade in the management of postpartum hemorrhage. Objective: To describe an effective, minimally invasive surgical technique for avoiding intrauterine balloon tamponade prolapse. Materials and Methods: This procedure was performed in the delivery room with or without bladder retraction. The cervix was grasped with two ring forceps and firmly pulled outward, two cm horizontal suture of the cervical lips was made at both the three and nine o’clock positions, which were placed two cm as close to the cervix external os, without transversing the cervicovesical reflection anteriorly and the pouch of Douglas posteriorly, then one or more Foley catheters were inserted through the cervix and inflated with saline 60-80 ml each. Results: The balloons remained in place and hemorrhage abated in all nine cases. Conclusion: vaginal bilateral cervical lips suture can prevent intrauterine balloon prolapse, which may be a useful adjunct to intrauterine balloon tamponade in management of postpartum hemorrhage.

Study of Os Zygomaticum Bipartitum In Skulls of Central India

Zygomatic bone is commonly known as cheek bone, forms prominence of cheek. Present study was conducted on 228 zygomatic bones of 114 dry skulls. Zygomatic bone may divide into two parts either by horizontal or vertical suture. A horizontal suture was observed dividing the zygomatic bone into two parts in two zygomatic bones out of 228 zygomatic bones studied (0.87%). An inferior type of horizontal suture was observed dividing the zygomatic bone. Two zygomatic bones belong to the same skull i.e. bilateral bipartite zygomatic bone. Suture can be well identified by radiography and CT scan.

Suture Placement Near the Musculotendinous Junction in the Supraspinatus

Background: Transosseous-equivalent rotator cuff repair has an increased incidence of medial rotator cuff failure compared with single-row repair. No studies have evaluated the influence of the proximity of the suture row to the musculotendinous junction (MTJ) on cyclic gapping and failure properties. Hypothesis: A single row of horizontal mattress sutures placed within the supraspinatus tendon lateral to the MTJ will experience less gap formation and higher failure loads than a similar suture row placed at the MTJ. Study Design: Controlled laboratory study. Methods: Paired supraspinatus tendons were isolated from human cadaveric specimens and resected at the tendon insertion to the humerus. Randomized within a pair, a single row of 4 horizontal mattress sutures was placed either in the tendon 5 mm lateral to the MTJ or at the MTJ. The tied sutures secured the tendon to a fixture that ensured consistent placement of the suture row in the tendon and static fixation of the row. The muscle belly was gripped in a cryoclamp, and a servohydraulic materials testing machine was used to provide uniaxial tensile deformation for 500 cycles at 1 Hz, followed by load to failure at 1 mm/s. Fiducial markers with video tracking were used to quantify gap formation at the suture line, while the materials testing machine recorded loading for the cyclic and failure tests. Results: During cyclic loading, both constructs experienced gross initial gap formation, followed by progressive gap formation that plateaued after cycle 200. The MTJ specimens had significantly higher mean cumulative gapping than the tendon specimens: 3.6 ± 1.0 mm versus 2.4 ± 0.6 mm, respectively (P = .012). The tendon specimens had significantly higher mean loads to failure than did the MTJ specimens: 567.1 ± 121.8 N versus 434.2 ± 148.1 N, respectively (P = .013). The mean failure displacement did not differ between groups for the tendon and MTJ: 5.7 ± 2.5 mm versus 4.5 ± 2.0 mm, respectively (P = .144). Conclusion: A horizontal suture row placed at the MTJ has inferior mechanical properties (increased gapping, decreased load support) as compared with a suture row placed 5 mm laterally within the tendon. Clinical Relevance: The integrity of rotator cuff repair may be compromised if sutures are placed too close to the MTJ.

Short- to mid-term results of arthroscopic meniscal repair of long vertical longitudinal tears using combined cruciate and horizontal suture techniques: a retrospective study.

The purpose was to evaluate the clinical results of arthroscopic meniscal repair of long vertical longitudinal tears using combined cruciate and horizontal suture techniques. Single surgeon retrospective case series study. A total of 38 patients having long vertical longitudinal tears were operated using combined cruciate and horizontal suture techniques. Two patients had to undergo a meniscectomy procedure within the 1st year postoperative and those were considered failure cases; 32 patients were available for follow-up evaluation (average 4.6 years) and six were lost including the two failures. Objective IKDC, modified Lysholm knee score, SF-36 score, VAS for patients' satisfaction and VAS for pain were used for follow-up evaluation. Kellgren and Lawrence (K/L) classification of osteoarthritis was also used. Successful rate was 94.1% (32 patients), while failure was 5.9% (2 patients). Objective IKDC score revealed that 27 patients had grade "A" and 5 had grade "B," while no single patient had neither grade "C" nor "D." The average modified Lysholm score was 91.3. Average SF-36 score was 88.4. The average VAS for operation satisfaction was eight. Average VAS for pain was 1.5. Preoperatively, 30 patients were classified as normal K/L classification, while two patients were K/L classification grade "1." At the time of the follow-up, 24 patients were classified as normal K/L classification, six were grade "1," two were grade "2," and thus, six had osteoarthritis progression. Arthroscopic meniscal repair of long vertical longitudinal tears using combined cruciate and horizontal suture techniques is a safe surgical procedure with good clinical outcome. Level IV.

Dermal flaps in breast reduction: Prospective study in 100 breasts

The most common complication of breast reduction with inverted T-scar technique is wound dehiscence at the junction of the vertical and horizontal sutures. In this study, a technique involving three triangular dermal flaps is presented with the results for healing in the junctional T zone. Fifty women were included in a comparative, single-center randomized double-blind prospective study to evaluate the efficiency of the three-triangular dermal-flap technique in healing in the junctional T zone. All patients were seen for follow-up at 7 days, 14 days, 21 days, 28 days, 35 days, 42 days, and 49 days after surgery to evaluate primary healing in the T zone. Average healing time was 19.7 days in the triangular-skin-flap series and 25.48 days in the control series, with a statistically significant difference (p < 0.01). One patient in the triangular-skin-flap series experienced dehiscence in the T zone (2%) versus eight patients (16%) in the control series. A statistically significant difference was noted (p = 0.012). This technique is based on the association of two principles. First, ischemia on the edges as well as skin necrosis is limited by suturing the two superior skin flaps rather than directly suturing the cutaneous angles. In addition, this technique brings an underlying dermal support. Second, the inferior flap width allows fixing two sutures laterally to limit the central tension. This easy technique does not lengthen total operative time and significantly improves healing time. It is applicable to all breast reductions with inverted T scars.

Laparoscopic plication and mesh repair for diastasis recti: A case series

Diastasis rectiis a disorder defined as a separation of therectus abdominis muscleinto right and left halves which occurs principally innewbornsandpregnant women. Reports on laparoscopic repair are rare. Usually, the patients themselves request treatment. We here present a series of three patients who underwent laparoscopic repair for diastasis recti. Three patients, all female, presented with something bulging out of the abdomen with no other symptoms. All were multiparous. Laparoscopically linea alba was plicated in the midline after taking simple horizontal sutures all along the defect from xiphisternum to just below umbilical region creating a neo-linea alba. Then a tissue separating mesh was used to reinforce the plication either using tackers or transfascial sutures. Postoperatively, there was significant decrease in abdominal girth and patients complained of pain which decreased in 34 days and tightness in the abdomen which gradually reduced with time after discharge. Conclusion: Laparoscopic plication of linea alba and placement of prosthetic mesh is very promising, safe operation for diastasis recti and could be the future for treatment of the same.

EComment: partial cardiac autotransplantation with a concomitant mitral valve, aortic valve replacement and tricuspid plasty.

We read the paper of Pan et al. [1] with great interest. We agree that cardiac autotransplantation is a good approach for reduction of redundant tissue in giant left atrium (GLA). Nevertheless we believe that total cardiac autotransplantation can be technically more suitable than partial. It provides better exposure both for the left atrium (LA) and the cardiac valves, and the latter can be corrected in situ before cardiac reimplantation. According to our experience, this technique can provide a good long-term result even if LA volume is more than 2 l. A patient in whom we undertook surgery seven years ago [2] is still alive and in a satisfactory condition. In our case we excluded incisions on the right atrium which turned out to be thin and fragile. As for the LA, we thought it was possible to perform LA reduction by reefing the LA posterior wall and pulmonary veins, which had been previously carefully mobilized. Cardiac autotransplantation is technically identical to cardiac transplantation using a bicaval technique, and our experience with the latter procedure (more than 30 cardiac transplantations annually) suggested a total technique of cardiac autotransplantation. We also had a curious case of GLA in a patient who underwent cardiac transplantation with rheumatic heart disease. Twenty-three years ago, prior to the transplant procedure, he underwent mitral valve replacement with a disk graft EMIKS 27 (produced in the USSR) [3]. Preoperative echocardiography showed GLA and its calculated volume of 350 ml. After excision of the right atrium, right ventricle and LA, the LA presented a particularly difficult situation. The residual posterior wall of the LA was considerably enlarged to 18 x 16 cm, calcified pulmonary veins were immovable and fixed to surrounding tissues. We exposed the pulmonary veins widely from the surrounding tissues and with two monofilaments (Prolene 4-0) on felt pads (4 x 7 mm) we approximated the ostia of the pulmonary veins laterally along the posterior wall with gathering sutures. Each horizontal suture was located between the upper and lower pulmonary veins. This was supplemented with sutures (Prolene 4-0) on felt pads introduced vertically. Using stitches only on the posterior wall of the LA, we implanted the LA of the donor heart. Posterior wall reduction and donor LA implantation was performed in 57 min. Therefore, using our approach, we can avoid dissection of the posterior wall of the LA, especially in patients with previous surgery and a huge LA, where the surgeon always finds thin tissue. We do not believe that the residual surface will lead to thromboemboli in patients on life-long anticoagulant medication. Conflict of interest: none declared

Biomechanical Evaluation Of Knee Kinematics After ACL Reconstruction In Anatomic SB- And DB – Technique With Additional Medial Meniscus Suture

Biomechanical Evaluation Of Knee Kinematics After ACL Reconstruction In Anatomic SB- And DB – Technique With Additional Medial Meniscus Suture

The effect of inclination angle on the strength of vertical mattress configuration for meniscus repair

Vertical mattress configuration is the strongest of all other configurations and the repairing devices of meniscus repair. The purpose was whether increasing the inclination angle between two strands of the vertical mattress configuration by increasing the amount of meniscus tissue captured would enhance the initial strength of the construction. A 2-cm long anteroposterior vertical longitudinal incision was created in two groups of bovine medial menisci. In the first group, the distance between the two vertical suture strands and the vertical horizontal sutures on the capsular side of the meniscal lesion was 2 mm (Group 1). In the second group, the distance was 5 mm (Group 2). The following repair specimens underwent cyclic loading prior to loading the failure testing. The endpoints included ultimate failure load (N), stiffness (N/mm) and cyclic displacement (mm) after the 100 cycles and the mode of failure. Group 1 (2 mm) (90.7 (±19.9) N) had lower ultimate load than Group 2 (5 mm) (120.8 (±24.5)) (P < 0.05). Stiffness and displacements during the cycling were not different between the groups (n.s.). All specimens failed by suture rupture. Increased inclination angle with increased distance between the two vertical suture strands on the capsular side of the meniscal lesion resulted in higher failure load compared to control group with lower inclination angle and distance on the capsular side.

Sutured Clear Corneal Incision

To determine the effects of single radial or horizontal suture placement in 2-step clear corneal incision (CCI) wound apposition and permeability to particles of India ink. Five fresh human globes were included. Two 25-gauge needles connected to a saline solution bag and to a digital manometer were inserted through the limbus, 120 degrees apart from each other. Four 2-step CCIs (2.75 mm wide and 3 mm length) were constructed in each cornea. Incisions were divided into 3 groups: single radial suture (SRS), single horizontal suture (SHS), and unsutured group. Optical coherence tomography (OCT) was performed before and after suture placement. With a preset 10 mm Hg intraocular pressure (IOP), India ink was applied to the incision site and a standardized sudden IOP fluctuation was induced. OCT and superficial images were recorded before and after suture placement. India ink inflow and internal and external CCI gapping were outlined and measured by planimeter. The area and linear distance of India ink inflow after pressure challenge in all study groups were higher when compared with pre-pressure measurements; however, this increase was significant in the SRS and SHS groups (P < 0.05). Additionally, SRS placement significantly increased inner wound gapping (P = 0.018), and SHS significantly widened outer wound gape (P = 0.02). Well-constructed unsutured 2-step CCI seems to be more efficient at preventing bacterial-sized particles inflow during sudden changes in IOP, and it seems to offer better wound apposition as assessed by OCT.

The concept of three-dimensional hold of both circumferential and radial collagen fibres of the meniscus

Collagen fibres of the meniscus arrange into two main orientations: circumferential fibres parallel to the long axis of the meniscus and radial fibres perpendicular to the long axis of the meniscus. Meniscal sutures are placed either in vertical or in horizontal orientations. Vertical sutures better hold circumferential fibres because it encircles them like a rope holding a bunch of tree branches. In the same manner, horizontal sutures better hold radial fibres. The "Simplified Cruciate Suture" consists of two vertical oblique sutures. Placing two vertical sutures in an oblique orientation captures greater meniscal tissue volume, holds and grasps both circumferential and radial collagen fibres of the meniscus into a three-dimensional plane with eventual high fixation strength of the repaired meniscal tear. Simplified cruciate suture is indicated for the repair of long bucket handle tears where it is placed in the middle of the tear like an anchor, and additional vertical and horizontal sutures are placed anterior and posterior to it as needed. Level of evidence V.

The influence of suture material on the strength of horizontal mattress suture configuration for meniscus repair

PurposeComparison of the mechanical characteristics of meniscal repair fixation using horizontal sutures and six different sutures under submaximal cyclic and load to failure test conditions may aid physicians in selecting a suture type. MethodsA 2-cm long anteroposterior vertical longitudinal incision was created in six groups of bovine medial menisci. Lesions were repaired using a No. 2 suture either composed of polyester or polyester and ultra high-molecular weight polyethylene (UHMWPE), or UHMWPE and polydioxanone or pure UHMWPE. Endpoints included ultimate failure load (N), pull-out stiffness (N/mm), pull-out displacement (mm), cyclic displacement (mm) after 100cycles, after 500cycles, and mode of failure. ResultsPolyester suture had lower ultimate load than all groups except the suture composed of polyester and UHMWPE (P<.05). Pure UHMWPE suture had higher ultimate failure load than sutures composed of either polyester or polyester plus UHMWPE (P<.05).Predominant failure mode was suture cutting through the meniscus for the groups except for polyester suture which failed by suture rupture. ConclusionUnder cyclic loading conditions in bovine meniscus, braided polyester suture fixation provided lower initial fixation strength than fixation with various high strength sutures composed of pure UHMWPE or a combination of absorbable monofilament polydioxanone and UHMWPE, except for combination of polyester and UHMWPE sutures. Clinical relevancePresent study does not support the usage of the braided polyester sutures instead of high strength sutures composed either partially or totally of ultra-high molecular weight polyethylene for the horizontal suture configuration of meniscus repair.

Simple Versus Horizontal Suture Anchor Repair of Bankart Lesions: Which Better Restores Labral Anatomy?

The goal of this study was to determine which suture repair technique better restores glenoid labrum height: horizontal sutures or simple sutures. Sixteen cadaveric glenoids, 8 per repair technique, were used to measure native labral height at the 3:00 to 6:00 positions in half-hour increments. A Bankart lesion was then created from 3:00 to 6:30. Height measurements at each time point were again taken after creation of the Bankart lesion. Repair with a 3-mm knotted suture anchor was then performed at 3:30, 4:30, and 5:30 with either a simple or horizontal suture technique, and postrepair heights were measured across all time points. Significant decreases in height, as compared with native height, were observed at 3:30, 4:30, and 5:30 in the simple repair group. Decreases in height of 1.4mm (P= .044), 2.1 mm (P= .030), and 1.1 (P= .034) were observed at 3:30, 4:30, and 5:30. There was no significant decrease in height at these respective time points in the horizontal repair group. The in vitro horizontal mattress suture technique better restores labral height and anatomy when compared with a simple suture technique in the repair of acute Bankart lesions. Compared with the simple suture technique, horizontal suture repair may provide increased stability to the glenohumeral construct.

Biomechanical Evaluation of Knee Kinematics after ACL Reconstructions in Anatomic SB and DB - Technique with Additional Medial Meniscus Suture

Objectives:Biomechanical evaluation of knee laxity after single- and double-bundle ACL reconstruction with additional medial meniscus suture.Methods:Kinematics of the intact knee were determined in 12 human cadaver specimens in response to a 134-N anterior tibial load (aTT) and a combined rotatory load of 10 Nm valgus and 4 Nm internal tibial rotation using a robotic/universal force moment sensor testing system. Subsequently, the ACL was resected following the creation of a bucket-handle tear of the medial meniscus. A standard repair of the medial meniscus was performed using 3 inside-out horizontal sutures. Finally, The ACL was reconstructed using an anatomic single-bundle (6) or double-bundle technique (6). Knee kinematics were determined following every sub-step.Results:Significant increase of aTT in the ACL-deficient knee was found with significant increase in the ACL-deficient knee with additional medial meniscal injury (p=.003; p=.009). ACL reconstructions significantly decreased aTT compared to the ACL-deficient knee. No significant differences were found between the intact knee and the ACL reconstructed knee with additional meniscal repair. In response to a simulated pivot shift, aTT in the intact knee significantly increased in the ACL-deficient knee as well as in the meniscus injured/meniscus-sutured knee (p=.003;p=.007). No significant differences were found between the ACL-deficient and ACL reconstructed knee with additional meniscal repair. SB as well as DB ACL reconstruction with additional medial meniscal repair restored knee kinematics compared to the intact knee. Comparison of SB versus DB ACL reconstruction did not reveal any significant differences neither in a simulated Lachman test nor in response to a simulated pivot shift (p=.05).Conclusion:aTT as well as aTT in response to a combined rotatory load significantly increased with ACL deficiency compared to the intact knee, additional medial meniscal injury further increased aTT. Anatomic ACL reconstruction with medial meniscal repair restored knee kinematics compared to the intact knee. Comparison of anatomic SB vs. DB ACL reconstruction with additional repair of the medial meniscus did not reveal significant differences in aTT as well as aTT under a combined rotatory load.

Simple Continuous Suture Versus Continuous Horizontal Mattress Suture for Plication of Abdominal Fascia: Which is Better?

Abdominal fascia plication using a simple continuous suture can sometimes cause tears in the fascia. This problem can be circumvented when the continuous horizontal mattress suture is used. No data exist from comparing the two suturing techniques. The aim of this study was to examine which technique can potentially cause greater tissue damage. The time required to perform each type of suture was also recorded. Wound closure pads were plicated using the simple continuous and continuous horizontal mattress techniques performed by a single operator using Ethilon 2-0 nylon sutures. To verify their resilience, plastic bags were inflated beneath the pads to 30, 60, and 120 mmHg and tears were recorded. The time needed to perform the procedures was recorded using a stopwatch. Mean time for the continuous vertical mattress suture was 87 s and for the simple continuous suture 116 s. Tears in the pad that was plicated with the simple continuous pattern were significantly longer than those in the pad plicated with the continuous horizontal mattress pattern (fissure mean length ± SD = 3.958 ± 0.157 vs. 2.736 ± 0.157, respectively, p < 0.001). This finding was true for each of the three measured pressures (fissure mean length for 30 mmHg was 3.40 ± 1.807 vs. 2.12 ± 1.709 cm; for 60 mmHg, 3.94 ± 2.90 vs. 2.90 ± 1.893 cm; and for 120 mmHg, 4.54 ± 1.924 vs. 3.19 ± 2.110 cm; p < 0.001). Continuous horizontal mattress pattern sutures were found to be superior to simple continuous pattern sutures in the suggested model, in terms of suturing time and damage to the pad. Further research in human subjects is still required. This journal requires that authors assign a level of evidence to each article.

Meniscal Repair Using the Inside-Out Technique with Cross Stitch

The treatment of meniscal tears continues to evolve. A few years ago most tears were treated with total meniscectomy, which evolved to partial meniscectomy and then to meniscal repair. The purpose is to preserve as much of the menisci as possible, to maintain their potential biomechanical properties, and to preserve normal knee function. Different repair techniques have been used many of them involving both vertical and horizontal sutures. We are proposing an inside-out meniscal repair technique with cross-shaped stitches that provides a 4-point fixation construct.

Horizontal suture placement influences meniscal repair fixation strength

This in vitro biomechanical study investigated the influence of horizontal suture placement distance from the medial meniscal lesion repair site on fixation characteristics during submaximal cyclic and load to failure test conditions. Eighteen cadaveric (20-45years of age) medial menisci with intact joint capsules were harvested within 24-48h after death and divided into two groups of 9 specimens each for biomechanical testing. A 2.0-cm-long antero-posterior vertical longitudinal lesion was created with a #15 scalpel 2.0-3.0mm from the outer edge of each meniscus. Menisci were repaired using #2-0 suture material with two horizontal suture loops placed either 1.0mm (Group 1) or 3.0mm (Group 2) from the lesion site. Following repair, the lesion was extended completely through the meniscal horns so that no tissue secured the repair, only the two horizontal suture loops representing a "worst-case" testing scenario. Following repair, specimens were placed in a servo hydraulic device using a pair of 1.2-mm-diameter steel wire loops and underwent submaximal cyclic loading between 5 and 50N (1Hz) for 500 cycles prior to load to failure testing (5mm/min crosshead speed, 20Hz data collection). An alpha level of P<0.05 was selected to indicate statistical significance. Five of nine (55.6%) Group 1 specimens did not complete submaximal cyclic testing. All Group 2 specimens completed submaximal cyclic testing (Fisher's exact test P=0.029). Statistically significant mean group differences were not observed for displacement during submaximal cyclic loading (Group 1=5.0±1.5mm and Group 2=5.7±1.6mm) or for construct stiffness during load to failure testing (Group 1=50.1±6.3N/mm and Group 2=52.6±11.9N/mm). Group 2 displayed greater mean load at failure (112.1±40.8N vs. 72.7±11.2N, P=0.02) and mean displacement at failure (11.1±2.2mm vs. 7.6±1.4mm, P=0.03) than Group 1. Horizontal sutures placed slightly farther away from the meniscus lesion displayed superior repair fixation than sutures placed closer to the lesion. The superior biomechanical meniscal repair fixation provided by capturing greater tissue volume may enable safe earlier participation in functional exercise activities. Studies are needed to verify these findings in vivo.

An improved suturing reattachment operation for traumatic cyclodialysis

Objective To evaluate the effect of an improved suturing reattachment operation for traumatic cyclodialysis.Methods An improved suturing reattachment operation with horizontal stack fault suture for dialysis was performed in 20 cases (20 eyes) of traumatic cyclodialysis and the effects were analyzed.Results The visions were improved to various degrees in 18 eyes.The intraocular pressures(IOP)increased in all patients and recovered to normal in 18 eyes postoperatively.Hyphema occurred in 3 eyes.Conclusion The improved suturing reattachment operation is an effective technique for traumatic cyclodialysis. Key words: Ciliary detachment; Suturing; Reattachment operation; Ocular contusion

Os zygomaticum bipartitum na lobanjama sa srednjovekovnog nalazista manastiriste u Majdanu

Os zygomaticum bipartium presents zygomatic bone divided by a horizontal suture into two parts. This rare non metric-trait, with genetic background, is most frequent in East Asians. This paper presents zygomatic division frequency in middle aged sample from archaeological site Manastiriste in Majdan (North Banat). Since there was a lack of sexual dimorphism and there were no significant differences between males and females, the observed sample was divided into three groups according to archaeological context of findings: skulls from graves, skulls from pits or commingled human remains which present earlier, disturbed burial units, and sporadic zygomatic bone findings. The presence of divided zygomatic bones was detected in two adult male individuals - complete and partial division. Overall sample frequency (0,48 %, 3/616) is similar to European sample (Hanihara et al., 1998), but there is a great difference in comparison with east parts of the Old World. Until present os zygomaticum partitum was not documented in Serbia, and regional significance is reflected in the presence of the people of East Asian origin, Mongols and Cumans, who invaded Banat in the Middle Ages.