Interrupted Polypropylene Sutures Research Articles

Primary versus secondary closure of stoma reversal skin wound: Randomized controlled trial.

To compare the efficacy of primary versus secondary closure of stoma reversal skin wound in terms of wound infection. The study was conducted at Surgical B Unit of Ayub Teaching Hospital, Abbottabad, Pakistan, from January 1 to December 31, 2020, and comprised adult patients of either gender undergoing stoma reversal. The patients were randomised into primary closure group A and secondary closure group B. Surgical procedure was similar in both the groups except the skin closure technique. In group A, skin was closed with interrupted polypropylene sutures, while in group B, wound was dressed with saline-soaked gauze daily using aseptic technique and was allowed to heal by secondary intention or delayed primary closure later on. Postoperatively, the wound was assessed for infection till 30th postoperative day or complete wound healing. Data was analysed using SPSS 16. Of the 50 patients, 35(70%) were males and 15(30%) were females. The overall mean age was 28±1.65years. There were 25(50%) patients in each of the two groups. There were 19(76%) males and 6(24%) females in group A with a mean age of 32±2.8years. There were 16(64%) males and 9(36%) females in group B with a mean age of 23±3.5years. Overall, 10(20%) patients had wound-site infections; 9(36%) in group A versus 1(4%) in group B (p=0.005). Frequency of wound infection with respect to gender, type of stoma and length of hospital stay was not significant (p>0.05). Secondary skin closure was found to be associated with significantly reduced wound infection rate after stoma reversal. https://clinicaltrials.gov/ct2/show/NCT04785404.

Comparison of 2-octyl cyanoacrylate skin adhesive and interrupted polypropylene sutures for wound closure in total ankle arthroplasty

BackgroundAdhesive skin materials have increasingly been used in orthopedic surgery. We aimed to compare the efficacy and safety of skin adhesive (2-octyl cyanoacrylate and polymer mesh, Dermabond Prineo) and interrupted polypropylene sutures for wound closure in patients undergoing total ankle arthroplasty (TAA).MethodsWe prospectively enrolled 107 consecutive patients (108 ankles) undergoing TAA and divided them into two groups: skin adhesive group (36 ankles) and suture group (72 ankles). The primary outcome assessment included wound complications and patient satisfaction for wound cosmesis. The secondary outcome assessment included duration of surgery, length of hospital stay, and the Ankle Osteoarthritis Scale (AOS) pain and disability score.ResultsThere was one case of allergic contact dermatitis, three cases of wound dehiscence, and one case of superficial surgical site infection in the skin adhesive group. Among them, one case each with allergic contact dermatitis and wound dehiscence finally progressed to deep surgical site infection. Three cases of wound dehiscence were also reported in the suture group; however, there was no case of surgical site infection. Patient satisfaction for wound cosmesis was significantly higher in the skin adhesive group than in the suture group (p = 0.001). There was no statistically significant difference between the groups in terms of secondary outcomes (p > 0.05).ConclusionsAlthough the use of Dermabond Prineo showed better patient satisfaction for wound cosmesis, it showed significantly high wound complication rates and no other clinical benefits compared to interrupted polypropylene suture in TAA. Our results suggest that awareness of the possibility of wound complications is necessary when Dermabond Prineo is used in TAA.

Comparative Columellar Scar Analysis Between W Incisions and Inverted-V Incision in Open Technique Nasal Surgery.

A visible scar on the columella is undesirable result for both patient and surgeon. So it is one of the major disadvantage of open nose surgery. Different columellar incision types have been used in open technique of nasal surgery. In this prospective study, we compare W incisions and inverted-V columellar incisions with a scar assessment scale. In this prospective randomized study, open nasal surgery (open rhinoplasty and open technique septoplasty) were performed on 93 patients between November 2009 and July 2012. The inverted-V incision was used on 31 patients (24 males, 7 females). The "W" incision was used on 62 patients (40 males, 22 females). The entire surgical procedure was performed by a single surgeon. The columellar incision was closed using 6-0 interrupted polypropylene sutures. All sutures were removed on the seventh postoperative day. Scars were assessed at 6 moths, with 3 items scar assessment scale, we observed satisfactory scar, pigmentation, and notching. We compared both groups and found that the scar pigmentation, notching and scar formation are similar to each other. As a result of this study we concluded that the inverted-V incision or "W" incision might be a similar choice in open nasal surgery.

The extramucosal interrupted end-to-end intestinal anastomosis in infants and children; a single surgeon 21 year experience

Background/PurposeTo report outcomes of a standardised technique for intestinal anastomosis in infants and children. MethodsData were prospectively collected on all paediatric intestinal anastomosis by a single surgeon over a 21year period. Anastomoses were constructed using an end-to-end extramucosal technique with interrupted polypropylene sutures. Demographic and clinical data were recorded. ResultsSix-hundred and thirteen anastomoses were constructed in 550 patients. Median age at time of anastomosis was 6months (range 1day–226months). The most common reason for anastomosis was stoma closure (n=271, 49%). For those patients that required multiple anastomoses the most common pathology was acute NEC (n=22/41, 54%). One-hundred and one (18.4%) patients passed stool within 24hours of surgery, 175 (31.8%) between 24–48 hours and 95 (17.3%) between 48–72 hours. Anastomotic complications occurred in 7 patients (1.3%) including anastomotic leakage (n=5, 0.9%) and anastomotic stricture (n=2, 0.4%). The majority of anastomotic leakages (80%) followed resection of acute NEC. ConclusionsThe interrupted extramucosal anastomosis is safe and effective. The return of bowel function is rapid and the complication rate acceptable. We recommend this technique be used for all intestinal anastomoses in children and infants.

Effectiveness of cyanoacrylate adhesive in rabbit aortorrhaphy

BACKGROUND: Even when properly performed, arterial sutures are not always absolutely hemostatic. Tissue sealants and adhesives have become available that can be used to complete sutures, preventing hemorrhage problems.OBJECTIVES: To evaluate the effectiveness of cyanoacrylate adhesive for sealing aortotomies in rabbits in a coagulopathic state, by analyzing survival of the animals and the time taken to achieve hemostasis.METHODS: Ten-mm long aortotomies were performed on the infrarenal aortas of 12 animals. In four animals, aortorrhaphy was conducted using four interrupted polypropylene sutures and in the remaining animals aortorrhaphy was performed using four or fewer polypropylene stitches, followed by application of a cyanoacrylate adhesive.RESULTS: The four animals sutured without adhesive died within the postoperative period due to severe hemorrhage (3 animals) or intestinal ischemia. The eight animals to which the adhesive was applied exhibited no transoperative bleeding, but one animal died during the postoperative period. Using cyanoacrylate permitted more rapid procedures (p<0.004) and no local reactions were observed in macroscopic examination of tissues.CONCLUSIONS: The cyanoacrylate adhesive demonstrated effectiveness for sealing aortotomies, considering the survival outcomes, duration of procedures and absence of local reactions on macroscopic examination.

The outcome of combined urethropexy and colposuspension for management of bitches with urinary incontinence associated with urethral sphincter mechanism incompetence

To report 1) a combined technique of urethropexy and colposuspension; 2) intra- and postoperative complications; and 3) medium term outcome. Retrospective case series. Female dogs (n = 30) with urinary incontinence associated with urethral sphincter mechanism incompetence (USMI) unresponsive to medical management. Through a ventral median celiotomy, the bladder was positioned abdominally to permit the urethra to be anchored with single interrupted polypropylene sutures to the prepubic tendon and linea alba. The vagina was freed from the vesicovaginal and rectovaginal attachments and advanced cranially by traction before attachment to the prepubic tendon with polypropylene mattress sutures. Bitches were re-examined 2 weeks postoperatively; medium term outcome (>6 months) was evaluated by telephone interview of owners. At a median follow up of 39.5 months, 21 bitches (70%) were considered to have an "excellent" medium term outcome with complete resolution of their urinary signs; 8 (26.6%) had a "good" outcome, and 3 (10%) had mild transient dysuria postoperatively. Combined urethropexy and colposuspension resulted in complete resolution of urinary incontinence in 70% of bitches with USMI and was not associated with major complications.

Growing Cava Vein Anastomosis: Comparison of Cross-Clamping and Suture Times Using VCS Metallic Clips, Interrupted Nonabsorbable, or Continuous Absorbable Suturing Techniques

The latest generation in titanium clip application systems, the AnastoClip Vessel Closure System (VCS; LeMaitre Vascular, Burlington, MA), allows surgeons to perform vascular anastomosis more easily and faster than conventional sutures. This system may become the option of choice for vascular reconstruction in pediatric surgery where, as in the case transplant surgery, decreasing vascular occlusion times may influence outcome. The aim of this study was to determine whether VCS metallic clips would allow shorter anastomosis times than conventional interrupted polypropylene or running polyglycolic acid suturing in end-to-end anastomosis performed in the abdominal cava of young pigs. Thirty-two domestic swine, 45days old, were used for this study. All animals were subjected to an end-to-end anastomosis in the abdominal cava. VCS clips are easier to use for the surgeon, significantly decreasing cross-clamping time in caval anastomosis (VCS 10.33±1.75min vs. interrupted polypropylene sutures 46.00±6.16min vs. continuous polyglycolic acid sutures 18.16±1.47min). VCS clips significantly decrease the time needed for performing an end-to-end anastomosis in the abdominal cava, decreasing cross-clamping time when compared to interrupted polypropylene or running polyglycolic acid sutures.

Large arteriovenous fistula between the common iliac artery and the vein after blunt trauma

A 62-year-old man presented to the emergency department with dyspnea on exertion and bilateral leg edema 4 days after falling down stairs and sustaining injuries. The physical examination showed mild respiratory distress and blood pressure of 130/80 mm Hg. Lung examination revealed bilateral basilar rales. A chest radiograph showed mild pulmonary congestion and pleural effusion but no cardiomegaly (A). An axial computed tomography scan (B) showed fracture and spondylosis of the lower lumbar spine and sacrum (*) and a 50-mm thrombosed pseudoaneurysm of the right common iliac artery (CIA) that communicated with the right common iliac vein (CIV) near the distal inferior vena cava (C and D). Transthoracic echocardiography revealed normal mitral, aortic and tricuspid valves, mild dilatation of all cardiac chambers, and normal contraction of the ventricles. There was moderate pulmonary hypertension (right ventricular systolic pressure, 60 mm Hg). The patient’s arteriovenous fistula (AVF) was surgically repaired through a median laparotomy. After proximal and distal control of the aorta and the inferior vena cava was obtained, the pseudoaneurysm was excised, and the AVF defect was repaired with interrupted polypropylene sutures. The size of the AVF was 40 10 mm. After a proximal anastomosis at the distal abdominal aorta and obliteration of both common iliac arteries, distal anastomoses were constructed to the external iliac arteries with a Dacron graft. The patient had an uneventful recovery and was discharged 10 days after surgery. Postoperative computed tomography showed successful excision of the pseudoaneurysm and repair of the AVF.

Comparative Columellar Scar Analysis Between Transverse and Inverted-V Incision in Open Rhinoplasty

Rhinoplasty can be performed using both open and closed approaches. A visible scar on the columella is the major disadvantage of open rhinoplasty. Different columellar incision types have been used in open rhinoplasty. In this retrospective study, we compare transverse and inverted-V columellar incisions with a scar assessment scale. In this retrospective study, open rhinoplasty was performed on 84 patients between 2001 and 2006. The transverse incision was used on 39 patients (18 males, 21 females). The inverted-V incision was used on 45 patients (21 males, 24 females). The entire surgical procedure was performed by a single surgeon. The columellar incision was closed using 6-0 interrupted polypropylene sutures. All sutures were removed on the fifth postoperative day. With this assessment scale, we observed satisfactory scar, pigmentation, and notching. We compared both groups and found that the inverted-V incision resulted in better scar formation (p < 0.05) and less notching (p < 0.07). Scar pigmentation was found to be irrelevant to the incision technique employed (p < 0.3). As a result of this study we concluded that the inverted-V incision might be a better choice in open rhinoplasty.

Relationship Between Tissue Ingrowth and Mesh Contraction

Contraction is a well-documented phenomenon occurring within two months of mesh implantation. Its etiology is unknown, but it is suggested to occur as a result of inadequate tissue ingrowth into the mesh and has been associated with hernia recurrence. In continuation of our previous studies, we compared tissue ingrowth characteristics of large patches of polyester (PE) and heavyweight polypropylene (PP) and their effect on mesh contraction. The materials used were eight PE and eight PP meshes measuring 10 x 10 cm2. After random assignment to the implantation sites, the meshes were fixed to the abdominal wall fascia of swine using interrupted polypropylene sutures. A necropsy was performed three months after surgery for evaluation of mesh contraction/shrinkage. Using a tensiometer, tissue ingrowth was assessed by measuring the force necessary to detach the mesh from the fascia. Histologic analysis included inflammatory and fibroblastic reactions, scored on a 0-4 point scale. One swine developed a severe wound infection that involved two PP meshes and was therefore excluded from the study. The mean area covered by the PE meshes (87 +/- 7 cm2) was significantly larger than the area covered by the PP meshes (67 +/- 14 cm2) (p = 0.006). Tissue ingrowth force of the PE meshes (194 +/- 37 N) had a trend toward being higher than that of the PP meshes (159 +/- 43 N), although it did not reach statistical significance. There was no difference in histologic inflammatory and fibroblastic reactions between mesh types. There was a significant correlation between tissue ingrowth force and mesh size (p = 0.03, 95% CI: 0.05-0.84). Our results confirm those from previous studies in that mesh materials undergo significant contraction after suture fixation to the fascia. PE resulted in less contraction than polypropylene. A strong integration of the mesh into the tissue helps prevent this phenomenon, which is evidenced by a significant correlation between tissue ingrowth force and mesh size.

Foreign-body excretion through the bronchial stump after extrapleural pneumonectomy

Foreign-body excretion is a bioresponse of the human body. Bronchial foreign bodies commonly occur through aspiration or inhalation. We present a rare case of the excretion of a foreign body through the bronchial stump 19 months after pneumonectomy. A 52-year-old man had a high fever and chest discomfort. He underwent a left extrapleural pneumonectomy for malignant pleural mesothelioma 19 months earlier. He received postoperative chemotherapy, which consisted of 4 cycles of cisplatin, doxorubicin, and cyclophosphamide, and sequential radiation therapy for the entire hemithorax of 56 Gy in total.1Sugarbaker D.J. Strauss G.M. Lynch T.J. Richard W. Mentzer S.J. Lee T.H. et al.Node status has prognostic significance in the multimodality therapy of diffuse malignant mesothelioma.J Clin Oncol. 1993; 11: 1172-1178Crossref PubMed Scopus (200) Google Scholar, 2Sugarbaker D.J. Grarcia J.P. Richards W.G. Harpole Jr, D.H. Healy-Baldini E. DeCamp Jr, M.M. et al.Extrapleural pneumonectomy in the multimodality therapy of malignant pleural mesothelioma Result in 120 consecutive patients.Ann Surg. 1996; 224: 288-294Crossref PubMed Scopus (196) Google Scholar Blood count showed luekocytosis, and chemistry showed an increased C-reactive protein level. Chest radiography showed no abnormal lesions except for left-side opacity after pneumonectomy. Computed tomography of the chest and the abdomen showed no evidence of recurrence of malignant pleural mesothelioma. Culture of thoracentesis fluid showed no growth of microorganisms. Bronchoscopic examination revealed a foreign body, a whitish cottony material, at the left main bronchial stump (Figure 1). Endoscopic extraction with forceps identified a hemostat of oxidized cellulose (Figure 2). After the extraction, a blue suture was translucently identified in the mucosa of the bronchial stump. Bronchopleural fistula was not seen during or after the extraction. Culture of the material revealed Haemophilus species. After the removal of the infected foreign body, the patient recovered quickly and has been doing well for 3 years.Figure 2Oxidized cellulose extracted with forceps broncho-scopically.View Large Image Figure ViewerDownload (PPT) The bronchial stump at the left extrapleural pneumonectomy was hand sutured with interrupted polypropylene sutures (3-0 Prolene; Ethicon Inc, Somerville, NJ) and reinforced with a pedicled intercostal muscle by using the same polypropylene sutures for bronchus. On the next day, the patient underwent a re-exploration of the thorax as a result of the excessive blood loss. After hemostasis was obtained, cotton-type oxidized cellulose (Oxycel; Sankyo Co, Tokyo, Japan) was inserted into the mediastinum as a hemostat. Bronchoscopic examination 4 weeks after the pneumonectomy showed normal findings at the bronchial closure. For 19 months of postoperative follow-up, the patient had been without any symptoms of bronchopleural fistula, and chest radiography had never shown an air-fluid level in the left thorax. The bronchial stump should have been airtight since the extrapleural pneumonectomy. In the literature most foreign bodies found in the airway are the result of aspiration or inhalation. On the other hand, several bronchial foreign bodies that were not inhaled have been reported. Migration of shrapnel from the pulmonary parenchyma into a bronchus 64 years after the injury was reported.3Bogedain W. Migration of shrapnel from lung to bronchus.JAMA. 1984; 251: 1862-1863Crossref PubMed Scopus (11) Google Scholar Two foreign bodies with uncommon ways of entry were removed with a bronchoscope: one was a bullet that eroded in the right lower bronchus after having penetrated through a wound in the chest wall, and the other was a fragment of circular saw lodged in the right main bronchus after penetration through a wound in the neck.4Aprigliano F. Bronchial foreign bodies: an uncommon way to entry.Ann Otol Rhinol Laryngol. 1990; 99: 695-697PubMed Google Scholar Recent literature also described expectoration of titanium staples in 3 patients many months after volume-reduction surgery for pulmonary emphysema.5Oey I. Waller D.A. Metalloptysis: a late complication of lung volume reduction surgery.Ann Thorac Surg. 2001; 71: 1694-1695Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar Jackson and Jackson6Jackson C. Jackson C.L. Bronchoesophagology. WB Saunders, Philadelphia (PA)1950Crossref Google Scholar mentioned that foreign bodies, especially metallic ones that cause little specific reaction, can reach the bronchi through penetration of the chest wall. However, few nonmetallic foreign bodies migrating into the airway have been reported. Our patient appeared to have excreted a hemostat of oxidized cellulose from the thoracic cavity into the endobronchial lumen through the sutures of the bronchial stump. The foreign-body reaction of cellulose has been known to be mild in in vivo experiments.7Miyamoto T. Takahashi S. Ito H. Inagaki H. Noishiki Y. Tissue biocompatibility of cellulose and its derivatives.J Biomed Mater Res. 1989; 23: 125-133Crossref PubMed Scopus (304) Google Scholar Although the mechanisms of the migration remain unknown, we would provide evidence of a rare nonmetallic foreign body in the airway through the bronchial stump.

Intracardiac ultrasonic suture welding for knotless mitral valve replacement.

The difficulty in tying multiple knots with endoscopic instruments constitutes a technical obstacle to the development of closed-chest valve surgery. The following set of experiments was undertaken to ascertain the in-vivo feasibility of using an intracardiac ultrasonic welding device for knotless suture fixation during mitral valve replacement (MVR). Five adult sheep weighing 48-52 kg underwent MVR with a commercially available mechanical prosthesis, using pledgetted interrupted polypropylene sutures. An ultrasonic suture welder designed for intracardiac use was used to adjust suture tension and fuse strands together without knots. Echocardiographic assessment of the mitral prosthesis was carried out at baseline and after maintenance of supraphysiologic arterial pressures for 60 min. Subsequently, the animals' explanted hearts were assessed under sustained left ventricular (LV) pressurization to 180 mmHg in an ex-vivo pressure-loop system. MVR was successfully performed in all animals and welds reliably completed in less than 1 s. One sheep could not successfully be weaned off cardiopulmonary bypass; however, a normal prosthetic valve implant was confirmed at post-mortem examination. Echocardiographic assessment prior to and during LV pressurization revealed normal seating and function of the prosthesis in all cases. At post-mortem examination all valves were adequately implanted, suture tails laid flat on the surface of the prosthesis' sewing ring, welded suture strands were intact and accurately point-fused together, and no evidence of perivalvular leak was found around any of the prostheses despite sustained LV pressurization. This new modality proved reliable in an acute sheep model of MVR and could constitute a promising avenue towards facilitation of total endoscopic valve procedures in humans.