Intermittent Suture Research Articles

A modified Park's technique for creating a natural-looking double eyelid.

This study aimed to evaluate an improved park's technique to create a natural double eyelid and reduce scar formation. The levator aponeurosis, orbicularis oculi muscle, and dermis were fixed using subcutaneous intermittent sutures, and then the skin and the levator aponeurosis were sutured. Postoperative evaluation included double-eyelid stability, symmetry, double-eyelid curve, scar formation, and patient satisfaction. Between January 2021 and August 2021, a total of 89 patients (178 eyes) underwent double-eyelid blepharoplasty by the same surgeon using this improved technique. The mean follow-up period was 15.5 months (range 10 to 18 months). Seventy-six patients were very satisfied with this surgical method, six patients were rather satisfied, and seven patients were dissatisfied. The overall satisfaction rate was 92.1%. This new blepharoplasty method generates a stable, natural double-eyelid line with minimal scarring.

Creating of "fascial sheath" around subcutaneous lumboperitoneal shunt catheters largely prevents postoperative subcutaneous shunt catheter migration.

Spinal catheter migration into the subcutaneous tissue is common after lumboperitoneal shunt (LPS) placement. This study proposed a new method (i.e., wrapping fascia around the catheter like a sheath) to prevent LPS spinal catheter migration. After a LPS spinal catheter was inserted under routine fluoroscopic guidance, and the paravertebral muscle fascia was closed, the fascia was sutured to wrap the catheter like a sheath using intermittent sutures. Before the introduction of this technique, the rate of LPS spinal catheter subcutaneous migration was 4.6%. In this study, following LPS shunt placement in 18 consecutive patients with normal pressure hydrocephalus, no further spinal catheter migrations were observed. This novel method of "wrapping the LPS catheter with intermittent suture like a sheath" was found to be safe and effective for preventing further spinal catheter subcutaneous migration.

Laparoscopic Repair of Morgagni Hernia in Children.

Background: This study aims to review laparoscopic repair techniques of Morgagni hernias at a tertiary referral center. Methods: This retrospective study includes pediatric patients who underwent laparoscopic repair of Morgagni hernia between March 2004 and March 2021. The patients' demographics, presenting symptoms, operative approach, and postoperative outcomes were recorded. Results: Fourteen patients underwent laparoscopic repair of Morgagni hernia. The mean age at the time of operation was 24.7 months. Defect closing techniques were intracorporeal knot tying (n: 2), extracorporeal knot tying, and subcutaneous knot placement (n: 10), combination with intracorporeal continuous suturing and several extracorporeal intermittent sutures (n: 2). Different approaches were used during removal of the needle from the insertion point in the extracorporeal knot tying: intracorporeally, using a laparoscopic needle holder (n: 6), with an 18-gauge injector tip (n: 1), and extracorporeally with suture passer forceps (n: 3). In the intracorporeal knot tying technique, the mean operation time was 127 minutes (range 90-180 minutes). In the extracorporeal knot tying technique, the mean operation time was 75 minutes (range 30-180 minutes). The mean operation time in the technique that used suture passer forceps for removing the needle from the same point of insertion was 40 minutes. There was no intraoperative complication. Conclusions: In the laparoscopic repair of Morgagni hernia, full-thickness anterior abdominal wall repair with interrupted sutures that are tied extracorporeally in the subcutaneous tissue by separated minor skin incisions is the easy approach. Using suture passer forceps during removal of the needle facilitates this technique and shortens the operation time.

Clinical effects of transplantation of turbocharged bipedicle deep inferior epigastric perforator flap in breast reconstruction

Objective: To explore the clinical effects of transplantation of turbocharged bipedicle deep inferior epigastric perforator (DIEP) flap in breast reconstruction. Methods: A retrospective observational study was used. From December 2008 to December 2016, 24 patients who met the inclusion criteria were treated in the Department of Plastic Surgery of Hunan Cancer Hospital, all patients were female, aged 28-51 (36.5±1.6) years. All cases received turbocharged bipedicle DIEP flap for two-staged breast reconstruction. According to the patterns of turbocharged vessels anastomosis, the turbocharged bipedicle DIEP flaps with length of (27.5±0.3) cm and width of (12.8±1.4) cm, were divided into three types: distal end of pedicle anastomosis type, main branch of pedicle anastomosis type, and muscular branch of pedicle anastomosis type. After complete hemostasis in the donor region, the anterior sheath was repaired with intermittent suture, and umbilical reconstruction was completed. Two negative pressure drainage tubes were indwelled, and subcutaneous tissue and skin were sutured layer by layer. The specific ways of vascular anastomosis of the flap pedicle with the internal thoracic vessels of recipient site included anastomosing the proximal end of one artery and one vein, anastomosing the proximal and distal end of one artery and one vein, and anastomosing the proximal end of one artery and two veins. Postoperatively, the survival and blood supply of flaps were observed. The patients were followed up to observe the reconstructed breast shape satisfaction, donor site complications, abdominal wall function, and scar hyperplasia. Results: All turbocharged bipedicle DIEP flaps for two-staged breast reconstruction survived well, with good blood supply. During follow-up for 14 to 56 (20±6) months, the shape of reconstructed breasts was satisfied. Only linear scar was left in the donor sites of abdomen with no complications, and the function of abdominal wall was not affected. Conclusions: For patients with clear indications, transplantation of free turbocharged bipedicle DIEP flap is a safe, reliable, and satisfactory choice for breast reconstruction with autologous tissue.

In vivo male african catfish sperm obtaining and evaluation for artificial reproduction

African catfish is a valuable unpretentious object of breeding. It is successfully grown in re-circulating aquaculture systems in mild climate areas. However, artificial reproduction of the African catfish has problems with the collecting of high-quality sperm for fertilization of eggs. Abdominal massage does not give results even after appropriate hormonal stimulation: sperm is released in a small volume, often with an admixture of urine and blood. At the same time, most spermatozoa are motionless. This is due to the morphological features of the gonad structure: the seminal tubules are of the percoid type, in which there are seminal vesicles that prevent sperm release. When breeding catfish, the method of slaughtering males is mainly used, followed by the extraction of gonads, their grinding and straining through gauze or a sieve. Therefore, an urgent task is to develop methods for in vivo male African catfish high-quality sperm collecting. This report shows the technique of gonadectomy and surgery techniques for extracting one or both gonads. General anesthesia was performed by immersing the fish in a solution of clove oil. The optimal dose of clove oil for anesthesia was determined as 0.10–0.20 ml/l. The surgical area was treated with an antiseptic solution. The skin was dissected and separated from abdominal muscles. After acutorsion of testicular vessels, the gonad was excised entirely, since with partial resection, the remaining part of the parenchyma oozes, causing inflammation of the abdominal cavity and impaired healing of the surgical wound. Intermittent octal sutures were applied separately to the peritoneum with abdominal muscles and skin to create additional anastomoses and prevent complications.

Stapled transperineal repair for low- and mid-level rectovaginal fistulas: A 5-year experience and comparison with sutured repair.

BACKGROUNDCurrently, rectovaginal fistula (RVF) continues to be a surgical challenge worldwide, with a relatively low healing rate. Unclosed intermittent suture and poor suture materials may be the main reasons for this.AIMTo evaluate the efficacy and safety of stapled transperineal repair in treating RVF.METHODSThis was a retrospective cohort study conducted in the Coloproctology Department of The Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). Adult patients presenting with RVF who were surgically managed by perineal repair between May 2015 and May 2020 were included. Among the 82 total patients, 37 underwent repair with direct suturing and 45 underwent repair with stapling. Patient demographic data, Wexner faecal incontinence score, and operative data were analyzed. Recurrence rate and associated risk factors were assessed.RESULTSThe direct suture and stapled repair groups showed similar clinical characteristics for aetiology, surgical history, fistula features, and perioperative Wexner score. The stapled repair group did not show superior results over the suture repair group in regard to operative time, blood loss, and hospital stay. However, the stapled repair group showed better postoperative Wexner score (1.04 ± 1.89 vs 2.73 ± 3.75, P = 0.021), less intercourse pain (1/45 vs 17/37, P = 0.045), and lower recurrence rate (6/45 vs 17/37, P = 0.001). There was no protective effect from previous repair history, smaller diameter of fistula (< 0.5 cm), better control of defecation (Wexner < 10), or stapled repair. Direct suture repair and preoperative high Wexner score (> 10) were risk factors for fistula recurrence. Furthermore, stapled repair gave better efficacy in treating complex RVFs (i.e., multiple transperineal repair history, mid-level fistula position, and poor control of defecation).CONCLUSIONStapled transperineal repair is advantageous for management of RVF, providing a high primary healing rate and low recurrence rate.

Primary complete colporrhexis

Primary spontaneous colporrhexis is rare a condition characterised by rupture of the upper one third of the vaginal wall without extension from uterus or cervix in a parous women with an unscarred uterus. In our case the colporrhexis was also a complete one with rupture of the entire vaginal wall layers.A 31-year old, second gravida was booked in our hospital at 36 wks of gestation. She had no comorbities. She had previous full term normal vaginal delivery of an alive baby weighing 2.75kg.At 39 weeks and 4 days gestation she was admitted for induction of labour as she had borderline liquor. Induction was done with 2 doses of misoprostol 25mcg kept vaginally 4 hrs apart. 2 hours after placing the 2ndmisoprost she had spontaneous rupture of membranes with clear liquor draining PV. With strong uterine contractions. She delivered within 45 minutes a live healthy baby of 3kg weight. Placenta was delivered by AMTSL. Bleeding per vagina was within normal limits. During visualization of cervix and vagina prior to closure of episiotomy, omentum was seen coming out of upper part of posterior fornix of vagina. An irregular transverse rent was found and felt behind the cervix. Cervix was intact Uterus had contracted well. There was no excessive bleeding from vagina. Patients vitals were stable. Vagina was immediately packed and patient was shifted to OT after explaining about the unexpected complication and obtaining informed consent from patient and her relatives. Under anaesthesia, Visualisation of cervix and Examination of uterus was done. They were found to be intact. No extension of episiotomy seen. There was a transverse tear of 5 cm involving the posterior fornix. The left edge of the tear was found to be extending slightly upwards for about 2 cm. Omentum was seen protruding through the rent. The edges were dilineated, omentum was pushed inside. The delineated edges of the rent were sutured with 1-0 vicryl with intermittent sutures in two layers. Complete hemostasis was ensured.

The application of the percutaneous suturing technique in thoracoscopic repair of congenital diaphragmatic hernia.

Thoracoscopic surgery of congenital diaphragmatic hernia (CDH) is connected with a higher incidence of recurrence than open repair is. This is usually caused by the dehiscence of sutures in the lateral part of the defect. This area is characterized by increased tension on proximate tissues and difficult thoracoscopic suturing. For more effective repair, the authors adopted a variant of percutaneous internal ring suturing (PIRS) technique. To present and evaluate the efficacy of the PIRS technique for the repair of CDH. The study is based on retrospective analysis of the medical data of patients with CDH treated in the Department of Pediatric Surgery of the Jagiellonian University Medical College (Kraków, Poland) from January 2013 to July 2019. The PIRS technique was applied when thoracoscopic repair under acceptable tension appeared impossible. Fifty-one patients were identified. Of these, 11 children died before surgery and 1 after, leaving 39 (76%) who were operated on and survived. Thoracoscopy was used in 27 cases (69%), with 3 conversions. The recurrence rate in patients who underwent thoracoscopic closure of the defect with intermittent sutures was 27% (3 out of 11 children), while in the group that underwent thoracoscopic repair with the additional use of percutaneous suturing, the recurrence rate was 6.25% (1 out of 16 patients). The follow-up periods ranged from 4 months to 6 years. The applied PIRS technique permits safe and effective closure of intermediate-size diaphragmatic defects under acceptable tension. The method is feasible and can be listed among countermeasures against recurrence.

Clinical effects of modified fascia flap from cutaneous branch of dorsal metacarpal artery in repairing the wound at the proximal and middle finger segments

Objective: To investigate the clinical effects of modified fascia flap from cutaneous branch of dorsal metacarpal artery in repairing the wound at the proximal and middle finger segments. Methods: From January 2017 to September 2018, 12 patients with wounds at the proximal and middle finger segments were admitted to the Affiliated Hospital of Zunyi Medical University, including 8 males and 4 females, aged 35-70 years. The areas of wounds ranged from 3.4 cm×2.4 cm to 6.5 cm×4.0 cm. The modified fascia flaps from cutaneous branch of dorsal metacarpal artery were resected to repair the wounds, with the size ranging from 3.5 cm×2.5 cm to 6.7 cm×4.1 cm. The flap donor sites of 5 patients were repaired with direct intermittent suture, the flap donor sites of 4 patients were repaired with full-thickness skin grafts from ipsilateral medial forearm, and the flap donor sites of 3 patients were repaired with wrist pedicled flaps. The survival of the flaps was recorded. Healing of donor site and recipient site was followed. The hand functions were evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association. Results: All the flaps survived in 12 cases. During 3 to 12 months of follow-up, the flaps recovered satisfactorily in texture and shape. The donor sites of 11 patients were healed, and the skin graft edge area was partially necrotic in the other patient but healed later after dressing change. The distances of two-point discrimination of the patients ranged from 5.6 to 9.0 mm. Hand functions were evaluated as excellent in 5 cases, good in 4 cases, and fair in 3 cases. Conclusions: Modified fascia flap from cutaneous branch of dorsal metacarpal artery for repairing the wounds at the proximal and middle finger segments has reliable blood supply. The operation is simple and safe with short course of treatment, which is worthy of clinical promotion.

Safety of double and a half-layered esophagojejunal anastomosis in total gastrectomy with gastric cancer.

e16563 Background: Esophageal jejunal anastomotic fistula is still one of the serious postoperative complications of gastric cancer, the incidence was 1% ~ 16.5%. The aim of this study was to evaluate the safety of double and a half layered esophagojejunal anastomosis in total gastrectomy. Methods: The new method was called double and a half layered esophagojejunal anastomosis: esophagojejunal anastomosis was performed with a tubular stapler, then the anastomosis was reinforced by absorbable suture (Full-layer continuous suture, slurry muscularis embedding). The new method was used in observation group (n = 295). In the control group(n = 469),the esophagojejunal anastomosis was performed with a tubular stapler, then reinforced by intermittent suture with absorbable sutures. Data analysis including operating time, blood loss, anastomosis time, types and cases of postoperative complications, and postoperative hospitalization time. Results: The data of 764 patients who performed radical gastrectomy between May 2015 and May 2019 were analyzed retrospectively. 1.Surgery situations: The operating time (140.66±26.96 min vs 139.61±22.75min, t= 0.581, P&gt; 0.05) blood loss (200.61±111.03ml vs214.45±114.09ml, t= -1.481, P&gt; 0.05), anastomosis time (20.44±4.31min vs19.92±4.58min, t= 1.573, P&gt; 0.05), postoperative hospitalization time (15.35±6.46 d vs15.89±5.58d, t= -1.229, P&gt; 0.05) .2. Postoperative situations: the rates of anastomotic complications in observation group was 1.69% (5/295) and 4.69% (22/469) in control group, with a statistically significant difference between two groups( χ2 = 4.768, P&lt; 0.05). The rates of anastomotic leakage in observation group was lower than that in the control group 1.02% (3/295) vs 3.41% (16/469) ( χ2 = 4.282, P&lt; 0.05) . The severity of anastomotic leakage, anastomotic stenosis, anastomotic bleeding were no statistically significant differences between two groups( χ 2= 2.030,1.261,0.075, P&gt; 0.05). Total postoperative complications: 101 cases (34.24%) in the observation group, 14 cases (4.75%) with severe complications, and 1 case death. 151 cases (32.2%) in the control group, 34 cases (7.25%) with serious complications, and 2 cases death ( χ2 = 0.838, Z = -1.465, P &gt; 0.05). Conclusions: Double and a half layered esophagojejunal anastomosis is safe and feasible in total gastrectomy, which can reduce the incidence of anastomosis complications.

A Study to Evaluate the Outcome of Umbilical Hernia Anatomical Repair with both Intermittent and Continuous Polypropylene Suture

A Study to Evaluate the Outcome of Umbilical Hernia Anatomical Repair with both Intermittent and Continuous Polypropylene Suture

English

Auricular haematoma of pinna usually occurs secondary to trauma. If left untreated usually result in a deformity known as cauliflower ear. Various treatments are employed so as to produce the best cosmetic results. The aim of this article was to evaluate the outcome and complications of the treatment of auricular haematoma using non-absorbable 3-0 prolene intermittent sutures. This study has been performed upon eight patients presented with auricular haematoma at tertiary center, Govt. ENT Hospital, Koti, Hyderabad between August 2013 to August 2014. Follow up was continued for 6 months. The commonest cause behind auricular haematoma was personal insult. It was found that incision and drainage followed by suturing with non- absorbable intermittent mattress sutures appear to be simple, well tolerated and excellent method in treatment and preventing re-accumulation of auricular haematoma and to avoid ear deformity (Cauliflower ear).

USE OF CONTINUOUS HORIZONTAL MATTRESS SUTURE TECHNIQUE IN END-TO-SIDE MICROSURGICAL ANASTOMOSIS

The aim of our study was to improve the new suturing method which increases the success rate of end to side microsurgical anastomosis. Thirty-six Sprague-Dawrey rats were randomly divided into three groups that consist of 12 rats in closed envelope method. The end-to-side microsurgical anastomosis procedures were applied by the same surgeon between left main carotid artey and left external jugular vein. The surgical evaluations were performed with anastomosis duration, leakage evaluation, vessels patency, aneurysm improvement and histological assesment. End-to-side anastomosis, which was applied with Continuous Horizontal Mattress suture, gave significantly better results in terms of leakage, anastomosis openness, aneurysm and histologic assesment. Also anastomosis duration of Continuous Horizontal suture was significantly faster than Simple Intermittent suture. Our study revealed that the Continuous Horizontal Mattress suture technique had the advantages of providing uninterrupted vessel flow in a shorter time, and minimal intraluminal suture material, which increase thrombosis risk. Also 'sac-mouth' effect of Continuous suture technique was prevented by Horizontal Mattress technique.

Partial aortic annulus avulsion and formation of aortic-left ventricle tunnel through interventricular septum after blunt cardiac trauma

Traumatic aortic-left ventricle tunnel through interventricular septum was particularly a rare event that has never previously been described. A 58-year-old male, with a history of blunt thoracic trauma caused by falling from height, was admitted to our institute for effort dyspnea. Chest computed tomography scan showed subaortic interventricular septal lumen communicating with coronary sinus and left ventricular outflow tract (LVOT). Transthoracic echocardiography revealed a shuttle flow from coronary sinus to LVOT bypassing aortic annulus during diastole. Operation examination found partial aortic annulus avulsion outside right coronary cusp involving superior interventricular septum dissection forming a tunnel breakthrough into left ventricular outflow tract. Both aortic orifice and LVOT orifice of the tunnel were closed with running Prolene suture and right coronary cusp annulus was fastened to aortic root with intermittent mattress suture. The postoperative course was uneventful. Echocardiography confirmed complete closure of the tunnel with residual trivial to mild aortic regurgitation during 1-month follow-up.

The Rare Insertion of B4 With Trifurcated Portal Vein in Live Donor

Correct understanding of the anatomic variations of the vascular and biliary systems is important to avoid postoperative complications in live-donor hepatectomy. We reported biliary variations associated with trifurcated portal vein in right-lobe grafts (1, 2). In general, anatomic variations requiring multiple vascular and biliary anastomoses are more frequently encountered in right-lobe graft than in left-lobe graft. We report here an extremely rare case of biliary anomaly in a left-lobe graft donor. This live donor, who was a 64-year-old man, was admitted to our hospital for donor surgery with his wife with hepatitis B virus-related liver cirrhosis being the recipient. Preoperative three- or two-dimensional computed tomography demonstrated trifurcation of the portal vein (Fig. 1a), but there were no anomalies of the hepatic vein or artery. We do not routinely perform preoperative evaluation of biliary systems such as magnetic resonance cholangiopancreatography and drip-infusion cholangiography. On the basis of the image and volume analysis of the liver by HepaVision2 (MeVis, Bremen, Germany), the donor patient underwent left hepatectomy with caudate lobe as a live-donor procedure.FIGURE 1.: (a) On the basis of computed tomography scans, preoperative three-dimensional visualization of portal vein demonstrated trifurcation of the portal vein. (b) Intraoperative cholangiography demonstrated that B4 and the LHD independently bifurcated from the common hepatic duct. Moreover, the posterior branch bifurcated from LHD. (c) Intraoperative cholangiography after dissection and closure of B4. (d) Intraoperative cholangiography at the end of the surgery. There was no bile leakage or no biliary stenosis of the posterior branch.Intraoperative cholangiography demonstrated that a branch of segment 4 (B4) and left hepatic duct (LHD) (B2 and B3) independently bifurcated from the common hepatic duct. Moreover, the posterior branch bifurcated from LHD (Fig. 1b). After hepatic parenchymal dissection to disclose the hepatic hilum, bulk dissection of Glisson's pedicle around the origin of B4 and LHD was performed without dissection of pericholedochal tissue. After carefully confirming the biliary anatomy by repeated intraoperative cholangiography, B4 was dissected first (Fig. 1c) followed by LHD dissection (Fig. 1d). Eventually, the left-lobe graft contained two bile duct holes (LHD and B4). The cut edges of LHD and B4 were closed by intermittent suture and continuous suture of 6-0 polydiaxanone suture, respectively. We confirmed that there was no bile leakage and no biliary stenosis of the posterior branch by cholangiography (Fig. 1d). The postoperative course was uneventful, and the patient was discharged from our hospital on postoperative day 16. Previous reports have demonstrated that the incidence of multiple bile ducts in the donor was significantly higher in grafts with a trifurcated portal vein than in grafts with a dual portal vein. Some investigators reported anomalous insertion of B4, especially the fashion in which B4 drained into the common hepatic duct was rare (3). In this case, B4 and LHD independently arise from the common hepatic duct, and the posterior branch bifurcates from LHD. This type of anomaly has not been described previously. Preoperative evaluation of biliary anatomy should be performed for donors showing a trifurcated portal vein. Taku Iida1 Toshimi Kaido1 Akira Mori1 Hiromitsu Nagata1 Koichiro Hata1 Masayuki Koizumi1 Masaki Mizumoto1 Yasuhiro Ogura1 Fumitaka Oike1 Shinji Uemoto1 1Department of Hepatobiliary Pancreas and Transplant surgery Kyoto University Graduate School of Medicine Kyoto, Japan

Laparoscopic nephron sparing nephrectomy

Objective To explore the safety and efficacy of laparoscopic nephron sparing nephrectomy for renal tumor. Methods The data of 72 patients diagnosed as renal rumor and treated with laparoscopic nephron sparing nephrectomy were retrospectively analyzed.Procedure detailed as following:firstly,the renal tumor was exposed completely after routine institution of 4 passages;secondly,the tissue 3 cm around the tumor was labeled and then incised using cool scissors after Bulldog occlusion of the renal artery;thirdly,the lesion was covered with anti-bleeding gauze and then intermittently sutured using 1-0 absorbable Dixon suture and crossing Hem-o-lok. Results Operation time was 90-190 min,with warm ischemia time 12-40 min.Bleeding volume was 20-600 m1.with one intra-operative infusion and 4 post-operative infusions.Pathological diagnosis was clear cell RCC in 52 cases,angiomyolipoma in 14,chromophobe RCC in 5,and collective duct cancer in 1 case.Hospitalization time was 5-12 days.With 1-52 months follow-up,no tumor recurrence and metastasis was observed. Conclusions Treatment by laparoscopic nephron sparing nephrectomy for renal tumor could be safe and efficient,but operative experiences and skills are needed.The method of intermittent suture and crossing Hem-o-lok could be useful to shorten the operation time and reduce the complications. Key words: Laparoscopes; Kidney neoplasms; Nephrons

Combined autologous and allograft limbal cell transplantation with penetrating keratoplasty in a case of chemical corneal burn patient

A patient with chemical corneal burn presented two months after the acute episode of chemical injury to his right eye (OD) and was diagnosed with severe limbal stem cell deficiency and with vascularized corneal opacity OD. Limbal cell transplantation and penetrating keratoplasty (PKP) was performed. The autologous and allograft limbal tissue included peripheral cornea, limbus and conjunctiva obtained from contralateral eye and cadaveric eye bank cornea. Central corneal button was used for a PKP with 32 intermittent sutures. One year after the procedure, the corneal surface remains clear with a best corrected visual acuity of 6/12 (-2.00 DS / -2.75 DC-/ 150°. Eighteen sutures are still in place; no vascularization has extended beyond the host graft junction. Ocular surface is wetting well with no filamentary keratitis.Combined autologous and allograft limbal cell transplant can be performed for severe deficiency of corneal stem cells in a patient with chemical corneal burn.

Diagnosis and treatment of hepatic artery thrombosis after liver transplantation

To summarize the experience in prevention, diagnosis, and management of hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT). The clinical data of 198 patients undergoing OLT from April 1993 to September 2003 were analyzed among which 96 underwent anastomosis of hepatic artery with 7/0 prolene by running suture (group 1) and 102 by intermittent suture (group 2). Ultrasonic examination was routinely performed every day within two weeks after operation and then performed selectively afterwards. The incidence rate of HAT in group 2 was 1.0% (1/102), significantly lower than that in group 1 (6.3%, 6/96) (chi(2) = 4.027, P = 0.045). HAT was discovered by color ultrasonography in 6 of the 7 cases, and by exploratory laparotomy in 1 case. Out of the 7 patients with HAT, 6 received emergency thrombectomy, and 1 received conservative therapy but died from tumor recurrence eventually. Biliary complication developed in 3 out of the 6 cases after thrombectomy of whom 2 died of liver failure and one waited for retransplantation. One of the other 3 cases died of renal failure, and 2 cases survived. The mortality of patients with HAT was 57.1% (4/7). The technique of hepatic artery anastomosis is the key factor for the prevention of HAT. Routine ultrasonography is important in early detection of HAT after OLT. Biliary complication is a severe outcome secondary to HAT.