Suture Method Research Articles

Application of a New Retraction Method in Laparoscopic Gastrectomy for Gastric Cancer.

Better exposition is important for lymph node dissection in the suprapancreatic region and lesser curvature region of the stomach, and digestive tract reconstruction, especially without excellent assistants. We developed a new laparoscopic retraction method with the use of two internal retractors (TIRs) punctured along with suture. Clinicopathological data, surgical data, and postoperative outcomes were assessed. Of the 143 patients included, 51 underwent surgery with the double-sling suture method and 92 underwent surgery with the TIRs method. Laparoscopic radical gastrectomy was successfully performed in all patients. There were no significant differences in patient characteristics or preoperative data in the 2 groups. The operative time was significantly shorter in the TIR group, but the amount of bleeding did not differ. No retraction-related complications both in clipped tissue and liver occurred in all patients. Our new retraction technique provided an optimal surgical field and make surgery lower requirements for assistants.

Learning Curve of Wrist-level Tendon Repairs Using a Novel Tendon Stapler versus Traditional Suture Methods.

Numerous effective techniques for primary tendon coaptations exist. However, these techniques are complex and require a substantial amount of training to become proficient. Recently, a novel tendon stapler device (TSD) was developed that could potentially diminish the discrepancies among surgeons of varying levels of training. We hypothesized that the TSD would be easier to learn and would demonstrate improved learning curve efficiencies across participants of differing tendon repair experience compared with traditional suture methods. Participants included a novice, intermediate, and expert in tendon repairs. Comparisons were performed on wrist-level flexors and extensors from human donor arms. The suture repairs were performed with a modified Kessler with a horizontal mattress and were performed in one session on two donor arms by each participant. In a second session, each participant performed the TSD repairs on the matched, contralateral donor arms. Scatterplots fitted with Loess curves, one-way analysis of variance, Tukey pairwise comparisons, two-sided independent samples t test, and Fisher exact test were used to analyze findings. Results of our study showed that TSD repair times did not vary significantly by experience level. Suture repairs reached a stable "learned" level around repair #30, whereas the TSD repairs showed a more efficient curve that stabilized around repair #23. The TSD required less educational time, demonstrated a more efficient learning curve, and showed less variability across participants and repair order. Overall, the TSD is easy to adopt and may carry positive implications for surgeons and patients.

Shallow suture at ventricular septal defect may safely reduce right bundle branch block.

To avoid rhythm disturbance, sutures for ventricular septal defect closure have been traditionally placed 2∼5 mm or more away from the edge of the ventricular septal defect. However, the traditional suturing method appears to induce right bundle branch block and tricuspid valve regurgitation after ventricular septal defect closure more than our alternative technique, shallow suturing just at the edge of the ventricular septal defect (shallower bites at the postero-inferior margin). We aimed to verify our clinical experience of perimembranous ventricular septal defect repair. The alternative shallow suturing method has been applied since 2003 at our institution. We retrospectively reviewed the clinical data of 556 isolated perimembranous ventricular septal defect patients who underwent surgical closure from 2000 to 2019. We investigated the postoperative occurrence of right bundle branch block or progression of tricuspid regurgitation and analysed risk factors for right bundle branch block and tricuspid regurgitation. Traditional suturing method (Group T) was used in 374 cases (66.8%), and alternative suturing method (Group A) was used in 186 cases (33.2%). The right bundle branch block occurred more frequently in Group T (39.6%) than in Group A (14.9%). In multivariable logistic regression analysis, Group T and patch material were significant risk factors for late right bundle branch block. More patients with progression of tricuspid regurgitation were found in Group T. Shallow suturing just at the edge of the ventricular septal defect may reduce the rate of right bundle branch block occurrence and tricuspid regurgitation progression without other complications.

Cases requiring reoperation for recurrence of myelopathy by lamina closure after a double-door laminoplasty using a modified Kirita–Miyazaki suture method

BackgroundProgression of kyphosis after laminoplasty sometimes results in the recurrence of myelopathy with lamina closure. However, only a few case reports have been published on the reoperation of double-door laminoplasty using the suture method. This study investigated the incidence and clinical features of reoperation cases caused by the recurrence of myelopathy with lamina closure after double-door laminoplasty using a modified Kirita–Miyazaki suture method. MethodsA total of 169 patients who underwent double-door laminoplasty were included in this study, with a mean follow-up duration of 6.6 years (range: 2–16). All surgeries were double-door laminoplasties in which the open lamina was sutured to the paravertebral muscle. The reoperation rate for myelopathy recurrence due to lamina closure and the associated risk factors were investigated. The risk factors included age, history, cervical alignment, C2–7 lordosis, the cervical sagittal vertical axis, and C7 slope. ResultsThe reoperation rate for recurrence of myelopathy by lamina closure was 3.0% (5/169). All patients showed kyphosis progression after surgery; the spinal cord was more compressed by closed lamina than before the initial surgery. The reoperation group had more patients with neuromuscular or psychiatric disorders (60% [3/5] vs. 2% [4/164]; p < 0.001), kyphotic alignments (60% [3/5] vs. 10% [16/164]; p < 0.001), and cases with less than −10° of C2–7 lordosis (60% [3/5] vs. 7% [11/164]; p < 0.001). ConclusionsDouble-door laminoplasty with the suture method may not be suitable for patients with a neuromuscular or psychiatric disease or those with preoperative C2–7 lordosis less than −10°.

Laparoscopic Pediatric Inguinal Hernia Repair with Percutaneous İnternal Ring Suturing with Finer Needle and Suture; A 5-Year Experience of A Single Surgeon

Introduction: Percutaneous internal ring suturing (PIRS) method is an effective minimally invasive laparoscopic method that was preferred for indirect hernia repair in children. Purpose: The aim of this study is to report the evaluation of surgical results in our PIRS series modified with finer needle and suture with the diagnosis of indirect inguinal hernia, communicating hydrocele and incarcerated inguinal hernia. Methods: This was a retrospective study that included children aged 3 months to 12 years who underwent PIRS technique due to inguinal hernia between 2017 and 2022. Per-operative findings, surgical time, follow-up findings, complications, and recurrence data were evaluated. Results: One hundred patients underwent a total of 129 PIRS procedures. Right inguinal hernias were diagnosed in 63 (63%) of the patients (1 communicating hydrocele and 1 recurrent inguinal hernia). One communicating hydrocele and one recurrent inguinal hernia were present on the left side of 32 (32%) patients. Five patients were diagnosed bilaterally (one incarcerated hernia). 24 patients (29%) with no symptoms were found to have contralateral hernias: 11 on the right (45%) and 13 on the left (55%) side. The average duration of surgery for unilateral PIRS was 13.5 minutes and bilateral PIRS was 24.3 minutes. Average follow-up duration was nine months. There were complications in nine patients (9%). Recurrence was observed in 3 (or 3%) of 100 (or 100) patients. Conclusion: PIRS is a simple and safe alternative to open hernia repair in terms of surgical outcomes for the management of inguinal hernia in children.

Modified vulval truss technique to prevent recurrence of cervico-vaginal prolapse in water buffaloes

A retrospective study was conducted in a total of 89 water buffaloes reported with cervico-vaginal prolapse (CVP) in various degrees and were initially examined for their physiological and haematological parameters. The affected buffaloes were classified into 3 groups based on the degree of CVP and were treated with 8 'R' principles and as a recurrence prevention strategy, they were managed with modified conventional vulval truss method, vulval retention suture method and both in all the three groups. The buffaloes handled with modified conventional vulval truss method showed reduced straining, genital injury and no obstetrical complications. The buffaloes treated with vulval retention suture showed mild straining, wound around the sutured site and those buffaloes treated with both modified conventional vulval truss method and vulval retention suture showed relatively effective results. Based on this study, it is concluded that the buffaloes affected with any degree of CVP and treated with modified conventional vulval truss method showed effective recurrence prevention with relatively no swelling, straining, haemorrhage, injury, maggot wound and postpartum obstetrical complications.

O-109 Avoiding the C-section scar defect

Abstract The cesarean scar defect was first described in 1961 by Poidevin et al. Cesarean delivery is one of the most common surgeries today, and millions of women give birth this way every year. The prevalence of cesarean scar defect is increasing due to increasing cesarean section rates. The cesarean scar defect is called by different names in the literatüre, such as isthmocele, niche, diverticulum, dehiscence of the cesarean scar. It was discovered that the prevalence of isthmocele varied widely. Using contrast-enhanced sonohysterography, the prevalence in a random group of women with a history of CS was between 56% and 84%, whereas the incidence in pelvic ultrasonography fluctuates between 6% and 36%. The most common gynecological problems that may occur due to isthmocele are menstrual spotting, dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. The likelihood of scar pregnancy, placentation abnormalities, and uterine rupture increases with subsequent pregnancies. Both hysteroscopic and laparoscopic isthmocele repair techniques are highly effective. Therefore, precautions against isthmocele during cesarean delivery should be made more transparent. The development of isthmocele is influenced by the timing of the cesarean section (during pre/early or advanced labor), the position of the uterine incision (its distance or proximity to the internal os of the cervix), and the opening and closing (suturation) method of the uterine incision. Once more, both gestational diabetes and being overweight might be viewed as independent risk factors. Understanding the risk factors for isthmocele development will aid in the development of preventative measures. The two most crucial elements in the formation of isthmocele, according to our knowledge of the literature, are the site of the uterine incision and the suture methods. In this presentation, we will discuss ways to prevent the development of isthmocele.

Sustainable Antibacterial Surgical Suture Based on Recycled Silk Resource by an Internal Combination of Inorganic Nanomaterials.

The current antibacterial treatment methods of silk sutures can only be finished by surface modification, leading to problems of short antibacterial effects, easy slow-release consumption, prominent toxicity, and susceptibility to drug resistance. Speculatively, surgical sutures combining antibacterial material internally will possess a more promising efficacy. Hence, we extracted recycled regenerated silk fibroin (RRSF) from waste silk resources to make RRSF solutions. Internally combining with inorganic titanium dioxide (TiO2) nanoparticles, we fabricated antibacterial RRSF-based surgical sutures. The morphologies, mechanical and antibacterial properties, biocompatibility tests, and in vivo experiments were carried out. The results showed that the surgical sutures with 1.25 wt % TiO2 acquired 2.40 N knot strength (143 μm diameter) and achieved a sustainable antibacterial effect of 93.58%. Surprisingly, the sutures significantly reduced inflammatory reactions and promoted wound healing. Surgical sutures in this paper realize high-value recovery of waste silk fibers and provide a novel approach to preparing multifunctional sutures.

Preserving the Nipple Projection in Breast Reduction with the Free Nipple-Areolar Graft Technique: Purse-String Suture.

Breast reduction with the free nipple-areolar graft (FNG) technique has disadvantages such as loss of nipple projection, loss of nipple sensation, and depigmentation of the nipple-areolar complex. In this study, patients in whom a purse-string (PS) suture was used in the center of the de-epithelialized area to prevent loss of nipple projection were compared with patients who underwent the conventional method. A retrospective analysis of the patients who underwent breast reduction with the FNG was conducted in our department. Patients were divided into two groups according to the FNG placement. In the PS suture method group, a 1-cm-diameter circumferential suture was placed with a 5-0 Monocryl® (poliglecaprone 25) suture to gain a 6-mm-nipple projection. In the conventional method group, the FNG was placed directly over the de-epithelized area. Graft viability was evaluated after 3 weeks postoperatively. The final nipple projection and depigmentation were evaluated after 6 months postoperatively. The results were evaluated with statistical tests. The number of patients with the conventional method was 10, and the PS suture method was 12. There was no statistically significant difference between two groups regarding graft loss and depigmentation (p > 0.05). Nipple projection was significantly higher in the PS method group (p < 0.05). We observed that PS circumferential suture made an acceptable nipple projection compared to the conventional method in breast reduction with the FNG technique. Since the method is easy to apply and has relatively low risk, it would contribute to clinical practice. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Quality control mechanism of mitochondria by 3,4-dihydroxybenzaldehyde through OGT-PINK1 pathway

Based on the O-GlcNAc transferase(OGT)-PTEN-induced putative kinase 1(PINK1) pathway, the mechanism of 3,4-dihydroxybenzaldehyde(DBD) on mitochondrial quality control was investigated. Middle cerebral artery occlusion/reperfusion(MCAO/R) rats were established. SD rats were randomized into sham operation group(sham), model group(MCAO/R), DBD-L group(5 mg·kg~(-1)), and DBD-H group(10 mg·kg~(-1)). After 7 days of administration(ig), MCAO/R was induced in rats except the sham group with the suture method. Twenty-four h after reperfusion, the neurological function and the percentage of cerebral infarct area were measured. Based on hematoxylin and eosin(HE) staining and Nissl staining, the pathological damage of cerebral neurons was examined. Then the ultrastructure of mitochondria was observed under the electron microscope, and the co-localization of light chain-3(LC3), sequestosome-1(SQSTM1/P62), and Beclin1 was further detected by immunofluorescence staining. It has been reported that the quality of mitochondria can be ensured by inducing mitochondrial autophagy through the OGT-PINK1 pathway. Therefore, Western blot was employed to detect the expression of OGT, mitophagy-related proteins PINK1 and E3 ubiquitin ligase(Parkin), and mitochondrial kinetic proteins dynamin-like protein 1(Drp1) and optic atrophy 1(Opa1). The results showed that MCAO/R group had neurological dysfunction, large cerebral infarct area(P&lt;0.01), damaged morphological structure of neurons, decreased number of Nissl bodies, mitochondrial swelling, disappearance of mitochondrial cristae, decrease of cells with LC3 and Beclin1, rise of cells with P62(P&lt;0.01), inhibited expression of OGT, PINK1, and Parkin, up-regulated expression of Drp1, and down-regulated expression of Opa1 compared with the sham group(P&lt;0.01). However, DBD improved the behavioral deficits and mitochondrial health of MCAO/R rats, as manifested by the improved morphology and structure of neurons and mitochondria and the increased Nissl bodies. Moreover, DBD increased cells with LC3 and Beclin1 and decreased cells with P62(P&lt;0.01). In addition, DBD promoted the expression of OGT, PINK1, Parkin, and Opa1 and inhibited the expression of Drp1, enhancing mitophagy(P&lt;0.05, P&lt;0.01). In conclusion, DBD can trigger PINK1/Parkin-mediated brain mitophagy through the OGT-PINK1 pathway, which plays a positive role in maintaining the health of the mitochondrial network. This may be a mitochondrial therapeutic mechanism to promote nerve cell survival and improve cerebral ischemia/reperfusion injury.

Biliary-enteric reconstruction in laparoscopic radical resection of hilar cholangiocarcinoma: a single-center retrospective cohort study

ObjectiveTo evaluate the feasibility and quality of biliary-enteric reconstruction (BER) in laparoscopic radical resection of hilar cholangiocarcinoma (LsRRH) versus open surgery and propose technical recommendations.MethodsData of 38 LsRRH and 54 radical laparotomy resections of hilar cholangiocarcinoma (LtRRH) cases were collected from our institution. BER was evaluated via biliary residuals numbers, number of anastomoses, anastomosis manner, suture method, time consumption, and postoperative complication.ResultsIn the LsRRH group, patients were relatively younger; Bismuth type I had a higher proportion while type IIIa and IV were less and required no revascularization. In LsRRH and LtRRH groups, respectively, the biliary residuals number was 2.54 ± 1.62 and 2.47 ± 1.46 (p > 0.05); the number of anastomoses was 2.04 ± 1.27 and 2.57 ± 1.33 (p > 0.05); the time of BER was 65.67 ± 21.53 and 42.5 ± 19.77 min (p < 0.05), 15.08 ± 3.64% and 11.76 ± 2.54% of the total operation time (p < 0.05); postoperative bile leakage incidence was 15.79% and 16.67% (p > 0.05); 14 ± 10.28 and 17 ± 9.73 days for healing (p < 0.05); anastomosis stenosis rate was 2.63% and 1.85% (p > 0.05). Neither group had a biliary hemorrhage or bile leakage-related death.ConclusionThe selection bias in LsRRH mainly affects tumor resection than BER. Our cohort study indicates that BER in LsRRH is technically feasible and equals anastomotic quality to open surgery. However, its longer and a more significant proportion of total operation time represent that BER has higher technical requirements and is one of the critical rate-limiting steps affecting the minimal invasiveness of LsRRH.

Double Opposing U Suture For Septal Multiple Axis Deviations: A Multi-Vectoral Approach.

Septal cartilage deviations comprise the majority of deformities related to revision rhinoplasty operations. Therefore, the primary operation should be as eventless and durable as possible. Many techniques have been suggested, but most present with a monoplanar correction and fixation of the septum. This study aims to demonstrate a suture method that fixates and broadens the deviated septum. This method employs a single-stranded suture passing below the spinal periosteum, pulling the posterior and anterior portions of the septal base separately. It was utilized in 1578 patients, of which only 36 necessitated a revision of septoplasty in the past 11 years (2010-2021). With a revision rate of 2.29%, this method should be considered a preferable choice over many techniques described in the literature.

Anatomic Arthroscopic Primary Repair of Proximal Anterior Cruciate Ligament Tears

Within the last decade, various highly diverse anterior cruciate ligament (ACL) preservation techniques have been proposed, as contemporary selective arthroscopic ACL preservation experienced a resurgence. Among surgical techniques, there are a variety of suturing, fixation, and augmentation methods, whereas a common thread, considering essential anatomic and biomechanical properties, is missing. This technique aims to anatomically reapproximate both the anteromedial (AM) and posterolateral (PL) bundles to their respective femoral footprints. Additionally, a PL compression stitch is performed to increase the ligament-bone contact area and recreate the anatomic vectors of the native bundles, therefore, creating a more anatomic and biomechanical construct. This technique is a minimally invasive procedure, with no graft harvesting nor tunnel drilling, which leads to decreased pain levels, earlier return of full range motion (ROM), and faster rehabilitation, while failure rates seem to be comparable to that of ACL reconstruction. We present an updated surgical technique of anatomic arthroscopic primary repair with suture anchor fixation for patients with proximal ACL tears.

Endotracheal suture through extending tracheostoma for post-tracheostomy tracheal laceration: a case report

BackgroundTracheal laceration is very rare but can be life-threatening if proper treatment is not provided. The general concept for the management of tracheal laceration is surgical repair through cervical incision or via thoracotomy. However, in the case of tracheal laceration after tracheostomy, tracheostoma could be extended to avoid urgent surgical repair and additional incision.Case presentationA 30-year-old Asian woman suffered intracerebral hemorrhage. Tracheostomy was necessary for prolonged ventilator care. While tracheostomy was performed, the posterior tracheal wall was torn. After observing that, we reinserted endotracheal tube through the oral orifice. Following bronchoscopy showed torn posterior tracheal wall. The tearing wound was 5–6 cm in length, from the middle to distal parts of the trachea. We used minimally invasive procedure for extending the already existing tracheostoma.ConclusionsIn the case of tracheal laceration related to tracheostomy, a new incision is not necessary because the tracheal opening already exists. Using the extended tracheostomy technique, tracheal laceration can be repaired by endotracheal suture method.

Evaluation of the efficacy of a modified method of treating the incisions of the single-port video-assisted thoracoscopic surgery using V-Loc™ barbed sutures.

This paper describes a modified method of applying unidirectional barbed sutures to treat the incisions of the single-port video-assisted thoracoscopic surgery (VATS) and discusses its safety and feasibility. This was a retrospective analysis of 108 patients who underwent single-port VATS admitted to the Department of Thoracic Surgery, the China-Japan Union Hospital of Jilin University, from April 2019 to April 2020. The experimental group (65 patients) was given unidirectional barbed sutures (V-Loc™ sutures) to treat the incision, and the control group (43 patients) had a skin stapler to treat the incision. The complications related to the incisions of the two groups were compared. There was no statistically significant difference between the experimental and control groups regarding incisional infection, incisional splitting, fat liquefaction, and incisional resewing. The pleural fluid outflow from the drainage orifice after removal of the chest tube (0 cases in the experimental group and 7 cases in the control group, P = 0.001) was significantly lower in the experimental group than in the control group. The scores of the scars showed that the experimental group was significantly better than the control group. The modified method of treating the incisions of the single-port VATS with V-Loc™ sutures has good efficacy and safety. It reduces the incidence of pleural fluid outflow from the drainage orifice after removal of the chest tube compared with the traditional stapler suture method, and it has superior cosmetic outcomes.

Importance of correcting alar base ptosis during primary cleft lip repair.

Until 1999 at our hospital, primary cleft lip repair was performed by the straight-line method and external rhinoplasty was performed by the inverted trapezoidal suture method with bilateral reverse-U incisions for children with cleft lip and palate. Subsequently, repeated surgical corrections of the external nasal morphology became necessary during the growth period, often with unsatisfactory results because repeated external rhinoplasty results in a stronger scar contracture. From 2000 to 2004, we performed external rhinoplasty after patients had stopped growing; however, delaying surgery created a psychological burden for patients. Therefore, since 2005, we have focused on improving alar base ptosis and forming the nostril sill during the primary surgery. This study was performed to subjectively and objectively evaluate whether the current surgical method or the earlier technique produces a better treatment outcome. We subjectively and objectively evaluated alar base asymmetry after primary cleft lip repair but before bone grafting for alveolar cleft repair. For the objective evaluation, we measured the angle of alar base ptosis in frontal view photographs taken at the age of 6 or 7 years in patients who underwent repair before 1999 (Group A) and after 2005 (Group B). The median angle was 2.75° in Group A and 1.50° in Group B, demonstrating a significant difference (P=0.04). The current surgical method, which reflects our focus on improving alar base ptosis and forming the nostril sill, subjectively and objectively improved the external nasal morphology.

Calycosin alleviates cerebral ischemia/reperfusion injury by repressing autophagy via STAT3/FOXO3a signaling pathway

BackgroundAs a common cerebrovascular disease (CVD) of the elderly, ischemic stroke (IS) is characterized by high disability and mortality. Excessive autophagy induced by IS is implicated in neuronal death, therefore, the inhibition of immoderate autophagy is viewed as a potential therapeutic avenue to treat IS. Calysoin (CA) is a bioactive component of Radix Astragali, which has been widely used to treat CVDs. However, the mechanism of the treatment of IS by CA is still problematic. PurposeBased on the result of network pharmacology, whether CA inhibited autophagy by regulating the STAT3/FOXO3a pathway to alleviate cerebral ischemia-reperfusion injury (CIRI) was investigated in vivo and in vitro for the first time. Study designIntegrate computational prediction and experimental validation based on network pharmacology. MethodsIn current study, network pharmacology was applied to predict the mechanism of the treatment of IS by CA, and it was shown that CA alleviated CIRI by inhibiting autophagy via STAT3/FOXO3a signaling pathway. One hundred and twenty adult male specific pathogen-free Sprague-Dawley rats in vivo and PC12 cells in vitro were used to verify the above prediction results. The rat middle cerebral artery occlusion/reperfusion (MCAO/R) model was established by suture method, and oxygen glucose deprivation/re-oxygenation (OGD/R) model was used to simulate cerebral ischemia in vivo. The content of MDA, TNF-α, ROS and TGF-β1 in rat serum were detected by ELISA kits. The mRNA and protein expressions in brain tissue were detected by RT-PCR and Western Blotting. The expressions of LC3 in brain were detected immunofluorescent staining. ResultsThe experimental results demonstrated that administration of CA dosage-dependently improved rat CIRI as evidenced by the reduction in the cerebral infarct volume, amelioration of the neurological deficits. HE staining and transmission electron microscopy results revealed that CA ameliorated cerebral histopathological damage, abnormal mitochondrial morphology, and damaged mitochondrial cristae structure in MCAO/R rats. CA treatment exerted protective effects in CIRI by inhibiting inflammation response, oxidative stress injury, and cell apoptosis in rat and PC12 cells. CA relieved excessive autophagy induced by MCAO/R or OGD/R through downregulating the LC3Ⅱ/LC3Ⅰ ratio and upregulating the SQSTM1 expression. CA treatment also decreased p-STAT3/STAT3 and p-FOXO3a/FOXO3a ratio in the cytoplasm and modulated the autophagy-related gene expression both in vivo and in vitro. ConclusionTreatment with CA attenuated CIRI by reducing excessive autophagy via STAT3/FOXO3a signal pathway in rat and PC12 cells.

A Suture Tips Applied to Rotating Flaps in Reconstructing Facial Defects to Optimize Scarring: A Retrospective Study

Background: Local flap reconstruction is the most common method to repair facial defects. In this study, authors have explored and introduced a modified suture technique with rotation flap to repair facial defects that makes scarring more discreet and easier to perform. Methods: Patients with facial defects who underwent surgical treatment of the rotation flaps reconstructions and were admitted to our department between October 2014 and October 2019 were included in this retrospective study. The rotating flap is designed along the Relaxed Skin Tension Line (RSTLs) and contour lines, parts of patients received modified suture depending on the shape and size of the defect. Observe the flaps’ survival and complications. Assessments of the scars with Vancouver Scar Scale (VSS) regularly and follow-ups. Results: This five-year retrospective study evaluated a total of 56 patients; of these, 45 patients underwent modified suture surgery, the average defects were 19.7±4.5×25.5±5.2mm, and the average duration of follow-up was 13.8±5.0 months. Scar appearance was evaluated using the VSS score, range from 0-5, with an average of 1.6±1.1, and mainly reflected in pigmentation and vascularity. Postsurgical scar concealment is made afterward, and all flaps survive. No hemodynamic disorder or necrosis was found. Conclusion: The rotation flap was designed based on RSTLs/ contour lines to repair the facial defect and make the scarring well concealed. The modified suture method makes the flap line consistent with the RSTLs/ contour line of the facial skin to the maximum extent and leads to better facial aesthetics results.

The Buried Guide Suture Method: A Novel Technique to Correct Traumatic Facial Dimples.

Facial dimpling, frequently occurring after blunt trauma, presents as soft-tissue depression, which is particularly apparent during facial expression. The displacement of subcutaneous tissue can be detected and measured by high-frequency ultrasound. Limited surgical methods have been applied in these closed-injury cases. Repositioning the subcutaneous tissue without incisions on unscarred skin is challenging. The authors propose a novel three-dimensional technique to suture and fix the subcutaneous tissue at a distance through a concealed incision. The buried guide suture method was used in the treatment of 22 patients with traumatic facial dimples on the cheek. All patients showed great improvement in their depressed deformity with minor complications. This technique provides an option to correct soft-tissue depression without leaving a visible scar, especially for mimetic rupture caused by blunt trauma.

Bipolar high-frequency electric welding in radical resection of frontal sinus tumors.

The aim of study is to develop a new method of connecting the dura mater (DM) defects in frontal sinus tumors with intracranial spread using high-frequency bipolar coagulation for welding of living tissues. Depending on the method of DM defect repair, patients were divided into two groups. The 1st group (control) included patients whose DM defect was connected according to the conventional method (suturing with polypropylene threads), in the 2nd group-the DM defect was connected by high-frequency bipolar electric welding using EKVZ-300, Patonmed. As a result of the study, the authors proposed an effective method of connecting the DM defects after the removal of frontal sinus tumors spreading intracranially. Such methods include a high-frequency bipolar electric welding method, the use of which contributed to a minimal destructive effect on adjacent tissues, but at the same time hermetically connected the DM. This was possible due to the supply of current with certain wave characteristics in a certain modulation at a temperature of 40-48°C, resulting in the connection of tissues without the formation of a coagulation scab due to the mechanism of protein-associated electrothermal adhesion of tissues. Presented data indicate significant advantages of using high-frequency bipolar electric welding the DM defects and fascia lata to restore the closed physiological circuit of cerebrospinal fluid circulation, compared to the traditional suture method. This approach has reduced intra- and post-operative complications, the time of surgery, and the length of the postoperative period.