Mattress Sutures Research Articles

The Efficacy of Low-Level Laser Therapy Combined with Single Flap Periodontal Surgery in the Management of Intrabony Periodontal Defects: A Randomized Controlled Trial

This study aimed at assessing the clinical outcomes of the Single Flap Approach (SFA) with the additional use of Low-level laser therapy (LLLT). The defects were treated as per the principles of SFA, whereby 20 defects received only SFA (control group) and 20 defects received additional LLLT for bio stimulation/bio modulation (test group). Stable primary closure of the flaps was obtained with vertical internal mattress sutures. Plaque indices (FMPS), clinical attachment levels (CAL), probing pocket depth (PPD), and gingival bleeding scores (FMBS) were calculated at baseline, and at the 3rd and 6th months in both groups. An EHI score of 1 was observed at all sites except for two, where a score of 2 in the control group at week 2 was observed. In the test group, the PPD reduction at 6 months was 3.60 ± 0.95 and in the control group it was 3.75 ± 0.91 mm. CAL gain at 6 months was 2.70 ± 1.36 mm and 3.45 ± 1.2 mm in the test group and showed no statistical significance. These data suggested the positive effect of LLLT over CAL gain; thus, LLLT may be combined with SFA to potentially enhance the early wound healing and higher clinical outcomes in terms of increase in CAL and decrease in PPD.

Analysis of Clinical Outcomes in Connective Tissue Donor Site Healing With Two Different Suturing Protocols: A Prospective Case Control Study

Background: Connective tissue harvesting from the hard palate has been practiced since decades and remains the ‘gold standard’ for soft tissue grafts. Very little has been researched on healing patterns of the palatal donor site and the incidence of post-operative complications of donor site. Aim: The aim of the study was to evaluate the influence of two different suturing methods on the healing outcomes of donor site after Connective Tissue Graft (CTG) harvsting. Material and Methods: Thirty patients who had undergone CTG harvest for various procedures were analyzed for the assessment of clinical healing outcomes of palatal donor site. A similar technique for the harvest of CTG in both groups was used using Liu’s class Ia incision. The method of closure of the donor site in these patients was divided into two groups; Group A – combination of criss-cross and horizontal mattress sutures and Group B – simple interrupted sutures. The parameters assessed preoperatively were palatal tissue thickness, intraoperative superficial palatal flap thickness and postoperatively the incidence of post-operative complications and donor site healing was assessed using Wachtel’s index (2003) at 7 days, 14 days and 1 month postoperatively. Results: The incidence of complications was more in Group B in comparison to Group A. The healing outcomes differed significantly between Group A and B at 7 days, 14 days and 1 month postoperatively; however, there was no statistically and clinically significant difference at 03 months post operatively. Conclusion: The combination of criss-cross with horizontal mattress suture for closure of palatal donor site after harvesting with Liu’s Class Ia incision was found to yield superior patient comfort and lesser post-operative complications during the early healing period.

Avulsion of the Lateral Head of the Gastrocnemius in a Dog: Surgical Treatment and an Ex Vivo Study on Pathomechanisms

AbstractA 6-year-old Border Collie presented with a 4-month history of progressive plantigrade stance of the right hindlimb, following a jump when chasing a ball. Avulsion of the lateral head of the gastrocnemius and tearing of the medial muscular belly were confirmed radiographically and ultrasonographically. Surgical repair of the lateral head was performed using two nylon mattress sutures placed around the fabella and through femoral condylar bone tunnels, followed by the application of a cranial half cast for 5 weeks. No complications were reported and follow-up owner's questionnaire at 18 months postoperatively revealed excellent results with the dog returning to normal activity.Avulsion of the lateral fabella was induced in a cadaveric limb and hyperflexion of the tarsus was simulated. Extreme hyperflexion of the tarsus only occurred once a subsequent tear of the medial belly of the gastrocnemius had developed, but without avulsion of the medial fabella.

Paper 07: Biomechanical Evaluation of Posterior Shoulder Instability with a Clinically Relevant Posterior Bone Loss Model

Objectives: Though recognized as a risk factor, posterior glenoid bone loss has only recently been characterized and is distinctly different than anterior glenoid bone loss patterns. Existing biomechanical studies are limited by employment of anterior glenoid bone loss models which are different in both orientation and morphology than posterior glenoid bone loss, and testing in a single neutral arm position thus not fully accounting for the contribution of capsuloligamentous structures in various at-risk arm positions. The purpose of this study was to evaluate the biomechanical effectiveness of a posterior labral repair in the setting of a clinically relevant bone loss model using 3-dimensional computed tomography modeling of patients with recurrent posterior shoulder instability in various at-risk arm positions. Methods: Ten fresh-frozen cadaveric shoulders (mean age: 55.4 years, range: 39-65) were prepared by removing all tissue except the capsule and distal rotator cuff insertions. A joint coordinate frame was established, the specimens were potted, then mounted to a customized fixture on 6-degrees-of-freedom robotic arm. A posterior labral tear was created, then repaired with 3 horizontal mattress sutures and secured by drilling 6 transosseous holes along the peripheral glenoid face exiting the anterior glenoid neck. The sutures were secured for the labral repair states to the mounted fixture under maximal tension and released for the labral tear states and for creating the sequential bone loss models. Bone loss models were created based off a cohort of CT data on patients undergoing revision posterior labral repair surgery to develop 2 clinically relevant 3D models of glenoid bone loss: the first simulating the mean bone loss in this cohort and represented 7% or small bone loss; the second was the mean + 2SD representing 28% or large bone loss. The bone loss was created on each specimen with a 3mm round burr to match each respective 3D printed template (Figure 1). Each specimen was tested in 7 consecutive states: (1) native anatomy, (2) posterior labral tear (6-9 o’clock), (3) posterior labral repair, (4) mean posterior glenoid bone loss with labral tear, (5) mean posterior glenoid bone loss with labral repair, (6) large posterior glenoid bone loss with labral tear, and (7) large posterior glenoid bone loss with labral repair. Each state underwent 75N of posterior-inferior force and 75N of compression during the four tests at 60 and 90 degrees of flexion and 60 and 90 degrees of scaption. Posterior-inferior translation, lateral translation, and dislocation force were measured for each condition. Statistical analysis was performed using two-factor random-intercepts linear mixed-effects models. Results: Compared to the labral tear state, significant increases in dislocation forces occurred with labral repair independent of bone loss state or arm position with values as follows: 14.8N (60° scaption), 12.2N (90° scaption), 11.1N (60° flexion), and 10.1N (90° flexion) with mean 12.1 ± 2.0N across all arm positions (Figure 2). Dislocation force significantly decreased between no bone loss and small bone loss (mean 12.4 ± 0.7N) and between small bone loss and large bone loss (mean 11.8 ± 2.1N) regardless of labral state in all arm positions (table 1). Posterior-inferior translation significantly decreased with labral repair compared to labral tear states independent of bone loss state in all arm positions (Table 1). Lateral translation of the humeral head significant increased when the labrum was repaired independent of bone loss state in all arm positions except 90° scaption and decreased progressively in all bone loss states in all arm positions (table 1). In the native state, the shoulder significantly translated posterior-inferior in scaption at 60° and 90° elevation compared to flexion (p<0.017) and was most unstable in 60° scaption with 29.9 ± 6.1mm posterior-inferior translation (Figure 3). Conclusions: This is the first study to biomechanically evaluate posterior glenoid bone loss using a clinical model in various at-risk arm positions on a 6 degree-of-freedom robot and through a precise linear effects model has established values for the increase in dislocation force posterior labral repair provides regardless of bone loss. The most significant finding of the study is that independent of bone loss, labral repair reduced posterior dislocation forces by 12.1 ± 2.0N and significantly decreased posterior-inferior translation. With a mean decrease in dislocation force of 12.4 ± 0.7N with small (7%) bone loss, labral repair alone may be enough to restore shoulder stability in most individuals. However, significant increases in posterior bone loss may require bony augmentation for adequate stability based on individual factors such as age and activity level. [Table: see text][Figure: see text][Figure: see text]

A Very Simple Suture Technique for Correction of Primary Multiple Folds in Asian Eyelids.

Upper blepharoplasty is 1 of the most popular cosmetic procedures in Asia. As people become older, they develop soft tissue atrophy and multiple folds due to a sunken upper eyelid. Furthermore, people with thin upper eyelid skin are more likely to develop multiple folds, even at a young age. The authors investigated the effectiveness of a transverse mattress suture technique to prevent recurrence during upper blepharoplasty in patients with primary multiple folds. Data on 656 patients with primary multiple folds who underwent upper blepharoplasty from March 2017 to January 2020 were retrospectively reviewed. The authors compared the operative time, patients' satisfaction, panel assessment, and complications according to whether the suture technique was used. Among 656 patients, 228 were lost to follow-up or had incomplete data; therefore, the files of 428 patients were analyzed. In total, 199 patients did not undergo the suture technique, whereas 229 patients did. Statistically significant differences were found between the 2 groups in patients' satisfaction, aesthetic results, and recurrence. However, between-group difference was not significant in terms of symmetry or complications such as hematoma and swelling. People with thin upper eyelid skin or slightly protruding eyes are more likely to develop multiple folds at a young age, even in their teens or 20s. The authors performed a skin suture during upper blepharoplasty, and then performed a transverse mattress suture on the spots where multiple folds are expected. Patients who underwent the suture technique showed better aesthetic results and a significantly lower recurrence rate.

The clinical impact of modified transpancreatic mattress sutures with polyglactin 910 woven mesh on postoperative pancreatic fistula in distal pancreatectomy

BackgroundWe previously reported the stump closure method for the remnant pancreas in distal pancreatectomy, in which soft coagulation and polyglycolic acid felt attached with fibrin glue were utilized. Transpancreatic mattress suture with polyglactin 910 woven mesh was recently reported as a novel stump closure technique. We developed the modified transpancreatic mattress suture with polyglactin 910 woven mesh method, which combined our polyglycolic acid felt method with the transpancreatic mattress suture with polyglactin 910 woven mesh method. MethodsThe polyglycolic acid felt group included patients undergoing distal pancreatectomy in whom the pancreatic stump was closed with the polyglycolic acid felt method from 2017 to 2018 (n = 54); whereas the modified transpancreatic mattress suture with polyglactin 910 woven mesh group included those whose stump was closed with the modified transpancreatic mattress suture with polyglactin 910 woven mesh method from 2019 to 2020 (n = 51). Perioperative parameters, including grade B/C postoperative pancreatic fistula (clinically relevant postoperative pancreatic fistula), were assessed according to the stump closure method. ResultsThe incidence of clinically relevant postoperative pancreatic fistula was significantly lower in the modified transpancreatic mattress suture with polyglactin 910 woven mesh group than in the polyglycolic acid felt group (7.8% vs 22.2%, P = .036). In multivariate analysis, the use of neoadjuvant chemoradiotherapy and the transpancreatic mattress suture with polyglactin 910 woven mesh method were independent factors for preventing clinically relevant postoperative pancreatic fistula (P = .011 and 0.0038, respectively). Moreover, in the modified transpancreatic mattress suture with polyglactin 910 woven mesh group, the incidence of clinically relevant postoperative pancreatic fistula in patients with a thick pancreas (≥13 mm, 6.7%) was comparably as low as that in patients with a thin pancreas (<13 mm, 9.5%). ConclusionThe modified transpancreatic mattress suture with polyglactin 910 woven mesh method is an effective stump closure technique to prevent clinically relevant postoperative pancreatic fistula after distal pancreatectomy. Our results warrant further prospective investigation to evaluate the efficacy of the modified transpancreatic mattress suture with polyglactin 910 woven mesh method compared with other standard closure methods (eg, stapler closure or hand-sewn closure).

A Comparison of Clinical Outcomes Between the Winograd and Modified Winograd Methods for Ingrown Toenails: A Retrospective Study of the Importance of Suturing Techniques.

Aim: This study aimed to compare the effects of the Winograd and modified Winograd methods for nail bed suturing on clinical outcomes in patients with nail ingrown.Methods: In total, 45 patients who underwent surgery for ingrown toenails between December 2019 and December 2020 were randomised retrospectively. In this study, different methods applied by the authors were studied, and the methods applied by each author were divided into two separate groups. All patients had partial germinal matrix and nail bed excisions. Thirty (53.6%) of the nails were dressed in gauze, leaving the excised area of ​​the nail unsutured (group 1). Then, the remaining 26 nails (group 2) were sutured with the mattress suturing technique to ensure that the skin was under the nail. Clinical outcomes, visual analogue scale (VAS) scores, and verbal satisfaction status were statistically evaluated.Results: In our study, 56 nails of 45 patients were evaluated retrospectively. The patients were followed up for an average of 13 (10­19) months. The mean age was 27.13 (15-­48) years. In total, 31 (68.9%) of the patients were men, and 14 (31.1%) were women. The incidence of postoperative bleeding and granulation tissue development decreased in the sutured group. In group 1, the development of hypertrophic granulation tissue after surgery had a significantly negative impact on VAS score and recovery time. In the sutured group, patients returned to work or performed activities of daily living for a shorter period. Approximately 95% of patients were satisfied or extremely satisfied.Conclusion: Partial matrix excision using the appropriate suturing technique is associated with a fast recovery, low recurrence rate, high patient satisfaction, and earlier return to work activities of daily life among patients treated for ingrown toenails.

Comparative evaluation of different techniques for herniorrhaphy in calves

Umbilical hernia is one of the most common problems in young calves. This problem occurs in dairy sector as well as in the local farmers. Present study was conducted to compare outcomes of four different techniques of herniorrhaphy. Twenty four young calves (n=24) were divided in 4 groups (A, B, C, and D) which underwent four different surgical techniques. Group A underwent vicryl plus suture material and pants-over-west technique, Group B underwent mesh application with Dexon suture material by using simple interrupted suture pattern, Group C underwent closed method with Nylon No. 3 suture material by using vertical mattress suture pattern and Group D underwent clamp application method with Silk No. 2 suture material by using simple interrupted suture pattern. The result showed that mesh application method was comparatively better with respect to feed intake, body weight gain and healing time. There was no reoccurrence with non-significant hematological changes (p≤0.05). It is concluded that mesh application method is safer than other three techniques and there are no systemic effects of this surgical intervention on calves' health.

Optimizing the Pulvertaft Weave Technique: A Comprehensive Systematic Review of Comparative Biomechanical Studies.

The Pulvertaft weave continues as a staple technique for tendon coaptations. Many have proposed minor alterations to the original technique to improve its strength, although a lack of consensus exists. The authors' aim was to explore how the number of weaves and suture characteristics contribute to the overall strength of the coaptation. A comprehensive electronic search was conducted using the PubMed, Cochrane Library, and Scopus databases. Criteria for inclusion consisted of cadaveric human or animal biomechanical studies evaluating ultimate failure load (in newtons) and the number of weaves, suture characteristics, tendon source, and number of coaptations. Weaves with minimum averages of 75 N were deemed successful, and those with greater than 120 N were considered high performing. A total of 347 tendon coaptations from 15 studies met inclusion criteria. Average strength by number of weaves was 36.4 N ( n = 52) for one weave, 54.2 N ( n = 58) for two weaves, 115.9 N ( n = 174) for three weaves, and 81.7 N ( n = 63) for four weaves. Statistical differences were observed between one and two weaves ( p < 0.0001); two and three weaves ( p < 0.0001); three and four weaves ( p < 0.003); and two and four weaves ( p < 0.0001). High-performing tendon transfers used three weaves, 3-0 or 4-0 braided sutures, and figure-of-eight or mattress core sutures. Contrary to the current dogma of "the more the better," the authors' findings show that Pulvertaft weave strength is optimized when three weaves are used to combine donor and recipient tendons. Braided sutures with either figure-of-eight or mattress sutures were associated with the highest strength of repair.

Knotless suture and hydrocolloid method improves chest drain wound complication.

Ligation is a widely used wound closure method after chest drain removal in thoracic surgery. Knotless suture, which does not require ligation or suture removal, has been developed and is currently used in our institution. This study compared the efficacy of the drain wound closure method between knotless suture and our previous mattress suture. We examined the clinical performance of knotless suture for chest drain wound closure in 117 patients who underwent surgery following this method in our department from October 2020 to April 2021. We compared outcomes with those of mattress suture using 2-0 nylon in 115 patients who underwent thoracic surgery at our institution between October 2018 and April 2019. Hydrocolloid dressing is applied to the drain wound after chest drain removal in a knotless suture. We conducted an analysis of both groups based on the condition of wound closure and drain wound complication. Appropriate wound closure was obtained and no patient required a prolonged hospital stay because of incomplete wound closure in both methods. The rate of chest drain wound infection for knotless suture (0.0%, 0/117 patient) was significantly lower than that of mattress suture (5.2%, 6/115 patients) at the outpatient follow-up (p = 0.01). The rate of delayed drain wound healing was also significantly lower than that of mattress suture (0.9% vs. 7.0%; p = 0.02). The results of knotless closure were better than those of conventional mattress suture regarding wound complications. Moreover, knotless suturing requires no suture removal, indicating its usefulness.

Non-penetrating deep sclerectomy with the sub flap (Ahmed’s) suture: a 12-month comparative study

PurposeTo assess the IOP-lowering effect of adding a mattress suture (Ahmed’s suture) to non-penetrating deep sclerectomy (NPDS), in patients with open angle glaucoma over a 12-month follow-up period.MethodsThis is a randomized controlled study comparing 52 eyes with a sub-flap Ahmed’s suture modified NPDS (group A) and 51 with a conventional NPDS (group B). Success of surgery was categorized as complete success if the IOP remained between 6 and 18 mmHg without medications and as qualified if topical medications were required.ResultsThe post-operative IOP at the 1st week, 3rd, 6th, 9th & 12th months follow ups in group A were significantly lower (7.3 ± 2.1, 12.0 ± 2.3, 12.6 ± 2.7, 13.6 ± 3.4 & 13.8 ± 3.8 mmHg) than in B (9.2 ± 1.9, 14.0 ± 3.1, 14.8 ± 2.9, 15.4 ± 2.6 & 15.7 ± 2.7 mmHg) (p = 0.001, p = 0.001, p = 0.002, p = 0.027 & p = 0.029 respectively). The percentage of IOP reduction after 1 year was significantly higher in group A than in group B (49% vs. 36.5%). At the end of the 12-month follow-up, 81% of group A and 69% of group B were considered as complete success. Multivariate regression analysis showed lower 1st week post-operative IOP was associated with better outcome.ConclusionIn conclusion, the Ahmed’s suture, a simple, novel and economic modification, maintains lower IOP levels and has a higher success rate over conventional DS, as it is 30% more effective in reducing the IOP.

Modified binding pancreaticogastrostomy vs modified Blumgart pancreaticojejunostomy after laparoscopic pancreaticoduodenectomy for pancreatic or periampullary tumors.

BACKGROUNDLaparoscopic pancreaticoenteric anastomosis is one of the technically challenging steps of minimally invasive pancreaticoduodenectomy (PD), especially during the learning curve. Despite multiple randomized controlled trials and meta-analyses, the type of pancreatico-enteric anastomosis as a risk factor for post-pancreatectomy complications is debatable. Also, the ideal technique of pancreatic reconstruction during the learning curve of laparoscopic PD has not been well studied.AIMTo compare the short-term outcomes of modified binding pancreaticogastrostomy (PG) and Blumgart pancreaticojejunostomy (PJ) during learning curve of laparoscopic PD.METHODSThe first 25 patients with resectable pancreatic or periampullary tumors who underwent laparoscopic PD with modified binding PG or modified Blumgart PJ between January 2015 and May 2020 were retrospectively analyzed to compare perioperative outcomes during the same learning curve. A single layer of the full-thickness purse-string suture was placed around the posterior gastrotomy in the modified binding PG. In the modified Blumgart technique, only a single transpancreatic horizontal mattress suture was placed on either side of the pancreatic duct (total two sutures) to secure the pancreatic parenchyma to the jejunum. Also, on the ventral surface, the knot is tied on the jejunal wall without going through the pancreatic parenchyma. Post pancreatectomy complications are graded as per the International Study Group for Pancreatic Surgery criteria.RESULTSDuring the study period, modified binding PG was performed in 27 patients and modified Blumgart PJ in 29 patients. The demographic and clinical parameters of the first 25 patients included in both groups were comparable. Lower end cholangiocarcinoma and ampullary adenocarcinoma were the primary indications for laparoscopic PD in both groups (32/50, 64%). The median operative time for pancreatic reconstruction was significantly lower in the binding PG group (42 vs 58 min, P = 0.01). The clinically relevant (Grade B/C) postoperative pancreatic fistula (POPF) was significantly more in the modified PJ group (28% vs 4%, P = 0.04). In contrast, intraluminal postpancreatectomy hemorrhage (PPH) was more in the binding PG group (32% vs 4%, P = 0.02). There was no significant difference in the incidence of delayed gastric emptying between the two groups.CONCLUSIONDuring the learning curve of laparoscopic PD, modified binding PG reduces POPF but is associated with increased intraluminal PPH compared to PJ using the modified Blumgart technique.

Biomechanical Comparison of a Horizontal Mattress, Cross Suture and Vertical Mattress for Repair of a Tendon Weave in a Porcine Model.

Background: An effective suture method enables early active motion exercises and optimal post-surgical outcomes. The aim of this study is to evaluate the tensile strength of three suture configurations - horizontal mattress (HM), vertical mattress (VM) and a cross suture for repair of a tendon weave. We hypothesised that the direction of mattress sutures relative to the tendon fibres would affect the tensile strength of tendon repair. Methods: Using porcine flexor tendons and the same number of surgical sutures, three tendon weave constructs differing in the method of suture were compared: HM suture configuration (conventional technique), cross-stitch (CS) configuration (conventional technique) and VM suture configuration (novel technique). Ten pairs of each group were mounted in a material testing machine and subjected to a simple tensile test and a cyclic loading test for their biomechanical comparison. Results: The VM group and CS group had significantly higher ultimate failure load, linear stiffness and fatigue strength as compared to the HM group. The failure mode was suture breakage or tendon rupture for the VM and the CS group, while the suture pullout of the tendon only occurred in the HM group. Conclusion: Among the three techniques used for repair of a tendon weave, the VM suture technique was demonstrated to have the greatest tensile strength and least associated with suture pull-out. The direction of the mattress suture in relation the direction of tendon fibres affects the strength of repair.

The research progress of tension-reducing suture of deep layer skin

To provide systematic information for deep understanding and improvement of tension-reducing suture of deep layer skin. The related literature over the years was extensively collected and precisely processed to summarize the characteristics and applications of different tension-reducing suture of deep layer skin. Throughout the development of plastic surgery, tension-reducing suture of deep layer skin mainly includes vertical mattress suture and its modified styles, horizontal mattress suture and its modified styles, and some special types of suture technique, and each one of them has its own characteristics and is suitable for wounds with different tension and shape. Clinically, surgeons need to select appropriate tension-reducing suture techniques according to specific factors such as wound location and tension, so as to fully reduce the tension of the wound, which can achieve good wound healing and prevent the pathological scaring.

Transumbilical single-site laparoscopic parallel mattress suturing prevents bleeding and chronic pelvic pain in myomectomy: a retrospective cohort study of 124 cases with intramural fibroids

BackgroundThe most common complications of myomectomy are intraoperative hemorrhage and postoperative adhesion. The key point to overcome this problem is to improve suture quality. However, to date, there is still no consensus on the optimal method of uterine repair. In this study, we explored the effectiveness and feasibility of single-site laparoscopic parallel mattress sutures to reduce intraoperative bleeding and postoperative adhesion.MethodsA retrospective cohort analysis was performed, according to the STROBE guidelines, on 124 patients with intramural fibroids admitted between May 2020 and April 2021. The cases were divided into two groups based on the description of the uterine incision suture in the surgical records, including 68 cases in the parallel mattress suture (PMS) group and 56 cases in the simple continuous suture (SCS) group. Operation-related indicators, bleeding indicators, surgical complications, scar reduction index 1 month after surgery, and the incidence of chronic pelvic pain 6 months after the surgery were observed. Independent sample t-tests and Mann–Whitney U tests were performed for the measurement data, and Pearson Chi-square tests were performed for count data. Statistical significance was set at P < 0.05.ResultsThere was no significant difference in the baseline characteristics between the two groups. All operations were performed under transumbilical single-site laparoscopy without conversion. Compared to the SCS group, the PMS group had earlier postoperative anal exhaust (14.3 ± 6.7 h vs. 19.2 ± 9.6 h, P = 0.002), fewer postoperative hemoglobin drops (7.6 ± 3.7 g/L vs. 11.6 ± 4.3 g/L, P = 0.000), smaller uterine scars (3.7 ± 1.9 cm vs. 5.2 ± 1.8 cm, P = 0.000), and a larger uterine scar reduction index (50.2% vs. 31.0%, P = 0.000) one month after surgery and less chronic pelvic pain 6 months after surgery (2.9% vs. 12.5%, P = 0.016). No difference was found in auxiliary trocar usage, transfusion rate, operation time, hospital stay, or perioperative complications between the two groups.ConclusionSeromuscular parallel mattress sutures during myomectomy can prevent pinhole errhysis of the uterine incision, achieve complete serosal and aesthetic incisions, and reduce postoperative chronic pelvic pain. It is effective and feasible to complete a parallel mattress suture during myomectomy via single-site laparoscopy. Further prospective studies are required to determine its efficacy as well as pregnancy outcomes.

Current practice of trabeculectomy in a cohort of experienced glaucoma surgeons in Australia and New Zealand

Background/ObjectivesTo evaluate current routine trabeculectomy technique preferences among Australian and New Zealand Glaucoma Society surgeons regularly performing trabeculectomy surgery.Subjects/MethodsSurvey of experienced surgeons who perform trabeculectomy.ResultsForty-nine surgeons (33 male:16 female) participated in the survey. Trabeculectomy was performed as day surgery (39/47, 83.0%) under local anesthesia (44/47, 93.6%). The surgical techniques most commonly used were a corneal traction suture (44/47, 93.6%), fornix-based conjunctival flap (43/47, 91.5%) and half-thickness scleral flap (38/47, 81.0%). Mitomycin C antifibrotic agent was used in routine cases by 45/46 (97.8%) surgeons. Surgeons applied the antifibrotic agent under the Tenon layer with a pledget (36/46, 78.2%) with a concentration of 0.02% (37/46, 80.4%) for 2 (11/46, 23.9%) or 3 min (30/46, 65.2%). The Kelly (26/46, 56.5%) and the Khaw Descemet (19/46, 41.3%) punches were used to perform the sclerostomy. Most surgeons performed a peripheral iridectomy in all phakic patients (46/47, 97.9%), but less commonly in pseudophakic patients (34/47, 72.3%). Techniques for closure of the limbal conjunctival edge were quite varied with a combination of suturing including purse string (21/47, 57.4%), wing (20/47, 42.6%) and horizontal mattress sutures (33/47, 70.2%). Surgeons reviewed their routine patients four times in the first month (29/47, 61.7%) and continued the postoperative topical steroids for 3–4 months (28/47, 59.6%).ConclusionsAlthough a wide range of techniques for trabeculectomy exists among surgeons, there are consistent procedures currently in use to optimize patient outcomes. This report will assist surgeons in choosing which surgical techniques fit their best practice.

SENILE ENTROPION CORRECTION BY MATTRESS SUTURE - NEW METHOD

To study the effect of mattress future in – the correction of senile entropion In the present study patients with senile entropion were included, with aseptic precaution under. local anesthesia two armed rapid absorbable surgical suture used to correct inturning of the lower lid suture passed from inside through lower tarsal plate to outside tightened surgical knot at outer portion of lower lid just 1mm below the margin tightness applied on surgical knot which later followed by scar formation in the track of stiches placed in the eye lid to turn it outward to achieve normal anatomical lid position. All 100 patients of senile entropion corrected with surgical stiches like mattress suture in the lower lid. In comparison with male patients females were more. In this study involvement of unilateral senile entropion more than bilateral, 8% patients develop minimal intra and postoperative complications while 92% patients have normal restoration of anatomical lid position.

A case of gastrointestinal stromal tumor metastasized to the left ventricular myocardium

BackgroundGastrointestinal stromal tumors (GISTs), which are the most common soft tissue tumors of the gastrointestinal tract, originate from Cajal interneurons. The main metastatic sites of GISTs are the liver and intra-abdominal cavity, and metastasis to the heart is rare.Case presentationThe patient was a 78-year-old man who was diagnosed with a rectal GIST 20 years previously. Since then, he had undergone repeated operations for metastasis. A follow-up thoracoabdominal computed tomography scan 4 months prior to the operation revealed GIST metastasis to the left ventricular myocardium. The patient wanted the tumor removed and consequently underwent an operation. The surgical findings showed a 3-cm × 3-cm mass in the lateral wall of the left ventricle. The mass was resected from the left ventricular wall in the shape of a tear drop. The left ventricular cavity was closed with a 4–0 polypropylene mattress suture and continuous suture. Postoperative histopathological findings showed nodular tumor growth consisting of bundles of spindle-shaped cells in the myocardium. The margins were negative. Immunostaining showed c-KIT (CD17) positivity and CD34 positivity, consistent with GIST metastasis.ConclusionsThis case involved GIST metastasis to the heart muscle, which has rarely been reported worldwide.

Technical modification and safe explantation of the Melody valve in the mitral position in small children.

Technical modification and safe explantation of the Melody valve in the mitral position in small children.

Effects of Enhanced Expectancies and Autonomy Support on Learning Medical Motor Skills

Background: The optimizing performance through intrinsic motivation and attention for learning (OPTIMAL) theory proposes that enhancing expectancies for future performance and supporting learners’ autonomy facilitate motor performance and learning. However, the effects of these factors on the performance of medical motor skills such as suturing have not been understood. Objectives: This study aimed to investigate the effects of enhanced expectancies and autonomy support (AU) on motor performance, learning, and self-efficacy of a medical motor skill. Methods: Participants were 63 right-handed medical students in the pre-clinical stage of their studies (years 1 and 2 of medical education). They were randomly assigned to 3 groups: (a) social-comparative feedback (SCF), (b) AU, and (c) control (CO) groups. A vertical mattress suture was chosen as a motor task. Following the pretest with 2 trials, all participants were exposed to a 5-day practice phase. The retention test was performed 1 week after the practice phase. During the practice phase, the SCF group received positive feedback at the end of the day. The AU group was given the option of choosing the color of silk sutures. The participants in the CO group practiced without any feedback or choosing the color of silk sutures. Suturing quality and self-efficacy were measured as dependent variables. Results: Positive SCF led to a better suturing performance on the retention test; however, AU did not enhance motor learning of a suturing motor task. Moreover, positive SCF increased self-efficacy during the acquisition phase and on the retention test, while AU had no positive effects on self-efficacy. Conclusions: The present findings support the OPTIMAL theory by demonstrating that enhanced expectancies in the form of positive SCF can facilitate learning medical motor skills (i.e., vertical mattress suturing).