Monofilament Suture Research Articles

Knot strength and antimicrobial evaluations of partially absorbable suture.

Partially absorbable suture is useful for orthopedic repair as it possesses the capacity to promote a balance between strength, degradation rate and minimal inflammation. Still, the availability of partially absorbable suture is scarce. So far, no study has examined the mechanical strength and anti-microbial properties of partially absorbable monofilament suture made of low-density polyethylene (LDPE)/polylactide (PLA)/chitosan (CHS); hence, the reason for this study with a view to improve knot strength, antimicrobial property and degradation rate. In this study, monofilament suture was extruded using different weight fractions of LDPE, PLA and CHS. In vitro degradation studies were carried out using phosphate buffer solution (PBS). Mechanical and morphological changes were also examined. A standard Fourier transform infrared spectral of 3433, 2909-2840, 1738, 1452, 1174, 1062, 706cm-1 were assigned to OH group, C-H stretch, C=O vibration of ester, CH3 bending, alkyl ester and CH2 stretch, respectively. Tensile strength of knotted neat LDPE (4.84MPa) exhibited 48.7% improvement in LDPE/PLA/CHS (60/39.5/0.5). This suggests that a good knot can be achieved to 40% weight fraction of PLA. The monofilament suture also demonstrated better antimicrobial property as the monofilament, LDPE/PLA/CHS (60/39.5/0.5) and LDPE/PLA/CHS (50/49.5/0.5) covered 12.7mm zone of inhibition which is greater than the standard 1mm. The suture's morphological phases show dark fibre-like rough surfaces with microstructural irregularities as PLA and CHS were added to the matrix, which is required for enhanced degradation. Thus, the partially absorbable suture produced in this study could serve as a suture for tendon repair.

Predictability of free gingival graft in management of gingival recession: A case series

This case series study predictability of free gingival graft in management of gingival recession. 3 cases with mucogingival problems needing free gingival grafts were selected. First, the recipient site was anesthetized and de-epithelialization was done and recipient bed was prepared. After tracing the palatal donor site with the aluminium foil template, bleeding points marked and graft was harvested. For root modification of the recipient tooth, conditioning of the dentin was done by the EDTA. Graft is closely adapted over the recipient with Oschenbein and circumferential sutures so there was no dead space left between the root surface and graft, by 5-0 monofilament suture. In case I and III where Miller’s Class II and I gingival recession respectively, there is complete root coverage achieved and in case II Miller’s Class III type of gingival recession present 80% root coverage possible. FGG best alternative for the treatment of gingival recession presents with inadequate width of attached gingiva and depth of vestibular fornix but main disadvantage of FGG is unesthetic appearance, two donor site, donor site morbidity, age and limitation of patient systemic condition. So proper case selection along with definitive treatment planning for every case is necessary.

Intra-socket application of medical-grade honey after tooth extraction attenuates inflammation and promotes healing in cats.

Dental diseases are a major problem in cats and often necessitate tooth extraction. Medical-grade honey (MGH) has antimicrobial and wound-healing properties, and therefore the aim of this study was to investigate whether intra-socket application improved healing after tooth extraction. It was postulated that applying MGH would reduce inflammation, improve the viability of the surgical flap and enhance healing following tooth extraction. A prospective randomised controlled trial was performed in client-owned cats undergoing bilateral tooth extractions of the same element of the canine or (pre)molar tooth. A split-mouth design was used in which every animal served as its own control. After surgical extraction of the elements, the sockets on one side were filled with an MGH-based ointment (L-Mesitran Soft), whereas the contralateral side received no treatment (control). A mucoperiosteal flap was used on both sides, and simple interrupted monofilament sutures were placed. No antimicrobial drugs were administered. Clinical parameters (inflammation/redness, flap viability and wound healing) were subjectively analysed on days 3 and 7 post-extraction by a veterinarian blinded to the treatment. Twenty-one cats were included. MGH significantly decreased signs of inflammation (P <0.01), improved mucoperiosteal flap viability (P <0.01) and promoted wound healing (P = 0.01), at both time points. MGH was easy to apply and there were no adverse events. Intra-socket application of MGH after tooth extraction positively affects the surgical wound, as it reduces redness, improves flap viability and enhances wound healing. Applying MGH represents a potent adjuvant therapy to support intra-oral wound healing after tooth extraction.

Practice Patterns in Operative Flexor Tendon Laceration Repair: A 15-Year Analysis of Continuous Certification Data from the American Board of Plastic Surgery.

Background:The American Board of Plastic Surgery has been collecting practice data on operative repair of flexor tendon lacerations since 2006, as part of its Continuous Certification program.Methods:Data on operative repair of flexor tendon lacerations from 2006 to 2014 were reviewed and compared with those from 2015 to 2020. National practice trends observed in these data were evaluated and reviewed alongside published literature and evidence-based medicine.Results:In total, 780 patients with flexor tendon laceration injuries were included. Mean patient age was 38 years; mean time between tendon injury and first evaluation was 4 days, and the mean time from injury to operative repair was 12 days. Four-strand sutures remain the most common technique of tendon repair (57%). In the recent cohort, there were significant decreases in tourniquet use (94% versus 89%), general anesthesia (88% versus 74%), and monofilament sutures (44% versus 35%), with a significant increase reported in preserving the A1 pulley (20% versus 29%). Postoperative movement was described as “almost full range of motion” or “good” in 70% of cases, and 74% of patients were satisfied with their results. Postoperative adverse events were reported in 26% of cases, with the most common complications being tendon adhesions (14%) and rupture (3%).Conclusions:Review of The American Board of Plastic Surgery tracer data for operative repair of flexor tendon lacerations establishes a framework by which surgeons can evaluate how their current practice aligns with that of their peers, and whether their practice patterns remain current relative to recommendations from evidence-based medicine.

Monofilament suture versus braided suture thread to improve pregnancy outcomes after vaginal cervical cerclage (C-STICH): a pragmatic randomised, controlled, phase 3, superiority trial

Miscarriage in the second trimester and preterm birth are significant global problems. Vaginal cervical cerclage is performed to prevent pregnancy loss and preterm birth. We aimed to determine the effectiveness of a monofilament suture thread compared with braided suture thread on pregnancy loss rates in women undergoing a cervical cerclage. C-STICH was a pragmatic, randomised, controlled, superiority trial done at 75 obstetric units in the UK. Women with a singleton pregnancy who received a vaginal cervical cerclage due to a history of pregnancy loss or premature birth, or if indicated by ultrasound, were centrally randomised (1:1) using minimisation to receive a monofilament suture or braided suture thread for their cervical cerclage. Women and outcome assessors were masked to allocation as far as possible. The primary outcome was pregnancy loss, defined as miscarriage, stillbirth, or neonatal death in the first week of life, analysed in the intention-to-treat population (ie, all women who were randomly assigned). Safety was also assessed in the intention-to-treat population. The trial was registered with ISRCTN, ISRCTN15373349. Between Aug 21, 2015, and Jan 28, 2021, 2049 women were randomly assigned to receive a monofilament suture (n=1025) or braided suture (n=1024). The primary outcome was ascertained in 1003 women in the monofilament suture group and 993 women in the braided suture group. Pregnancy loss occurred in 80 (8·0%) of 1003 women in the monofilament suture group and 75 (7·6%) of 993 women in the braided suture group (adjusted risk ratio 1·05 [95% CI 0·79 to 1·40]; adjusted risk difference 0·002 [95% CI -0·02 to 0·03]). Monofilament suture did not reduce rate of pregnancy loss when compared with a braided suture. Clinicians should use the results of this trial to facilitate discussions around the choice of suture thread to optimise outcomes. National Institute of Health Research Health Technology Assessment Programme.

Does Knot Configuration Improve Tensile Characteristics of Monofilament Suture Materials?

The effects of knot configuration used in surgical procedures are often overlooked when surgeons are looking for an ideal suture material. This study aimed to investigate the mechanical properties of monofilament suture materials used in oral and maxillofacial surgery under diverse knot configurations. A custom-made experimental platform and a microtensile test device were used to evaluate the mechanical properties of the tested subjects. There were 2 predictor variables: suture material and knot configuration. Three types of nonabsorbable and monofilament suture materials with 4-0 gauge, including nylon, polypropylene, and polytetrafluoroethylene, were tested. Four different knot configurations-a surgeon's knot square plus a square knot (2=1=1), a surgeon's knot granny plus a square knot (2×1=1), a reverse surgeon's knot granny plus a square knot (1×2=1), and a reverse surgeon's knot square plus a square knot (1=2=1)-were also used with each of the suture materials. The tensile strength (N) and elongation (μm) of each sample were measured as the outcomes. The data were statistically analyzed using 2-way analysis of variance and Tukey's honestly significant difference tests. The significance level was set at P<.05. Overall, 120 samples were tested. Statistical analysis revealed that the highest tensile strength (28.6N) was found for nylon in the surgeon's knot square plus a square knot (P<.05). Polypropylene showed a similar high tensile strength value (24.7N) in the reverse surgeon's knot granny plus a square knot (P>.05). Polytetrafluoroethylene demonstrated significantly lower values for both tensile strength in tested configurations (within the range of 5.2-8.5N). Under diverse configurations, polypropylene suture samples offered the most stable tensile strength and elongation. The present study demonstrated that different knot configurations might improve the mechanical profile of commonly used monofilament suture materials. The surgeon's knot square (2=1), commonly used by surgeons worldwide, proved to be the most beneficial knot configuration in this study in terms of tensile strength and elongation. Further research on optimal knot configuration may be just as important as seeking an ideal suture material.

The clinical and histopathological study, the effects of platelet-rich fibrin on skin pedicle graft healing

Background: Tissue engineering aims to repair or replace damaged tissue in response to various injury circumstances. One of these sectors is platelet-rich fibrin (PRF), extensively employed for soft tissue regeneration in recent years. Objective: The research aimed to examine the clinical and histological effects of allogenic PRF on skin pedicle grafts used to treat experimental avulsion wounds. Materials and method: Fifteen adult female goats were used for this study. Under heavy sedation and complete aseptic conditions, 2 skin marks (2×2 cm) were created on both sides of the trunk region of the animal. Two total thicknesses of the blotchy skin are cut carefully. Advancement (sliding) flaps (2×6 cm) are harvested parallel to the lines of most minor tension and slid over the adjacent wound. These wounds are allocated into two groups, the first one as the control group and the second group treated with autogenic platelet-rich fibrin. Each goat has two groups represented. The edges of the wounds were closed by 2-0 nylon monofilament sutures with a simple interrupted pattern. Results: Clinical examination showed the amount of wound exudation in the treated group significantly increased compared to the control group.

Robotic Hernia Repair using a Barbed Suture.

Barbed sutures became available in the mid-1960's, when a popular bidirectional barbed suture was primarily used by plastic surgeons for skin closure. As laparoscopic surgery became more commonplace, so did the need for intracorporeal sewing, but the challenges of tying sutures under tension became apparent. While surgical devices such as the Endostich™ (Covidien, Dublin, Ireland) aided in overcoming the learning curve for laparoscopic sewing, over time, the introduction of a unidirectional barbed suture helped minimally invasive surgeons overcome the challenges of sewing laparoscopically. It is particularly difficult to secure knots under tension using commonly available monofilament and multifilament sutures. Barbed sutures allow for the distribution of tension along the suture closure without the need for securing knots. However, with the introduction of the daVinci™ robot by Intuitive (Sunnyvale, CA) in 2001, sewing has become easier and more popular with the availability of a 3-dimensional, high-definition view and wristed instruments. As robotic general surgery has become increasingly accepted, it is fitting that the use of a barbed suture in hernia surgery has become critical for primary fascia closure of the hernia defect and various layer closures.

Biomechanical Evaluation of a Novel Double-Strand (Looped) Polyamide Monofilament Suture for Canine Flexor Tendon Repair

Objective: Determine the influence of a novel looped polyamide suture on the biomechanical properties and gap formation of repaired canine flexor tendons. Study Design: Tendons were assigned to 3 groups (n=12/group). Following transection, tendons were repaired with a Kessler pattern using monofilament polypropylene, Kessler pattern using looped polyamide suture and a Kessler pattern using looped polyamide augmented with a continuous Epitendinous Suture (ES) representing groups 1, 2, and 3 respectively. Constructs were tested to simulate clinical failure. Yield, peak and failure loads, loads at -1 and 3mm gap formation and failure modes were analyzed. Results: Looped polyamide suture is equivalent to monofilament polypropylene using a Kessler core pattern. Looped polyamide suture augmented with a running ES significantly increased yield, peak and failure loads by 3.2x, 3.0x and 2.6x respectively, compared to core suture use alone. Use of an ES required significantly greater force to cause 3mm gap formation while reducing occurrence of gapping in tested constructs. Mode of failure differed among experimental constructs. Conclusion: Looped polyamide suture is equivalent to monofilament polypropylene in the same pattern. Our results support the addition of ES augmentation, a simple technique modification that demonstrates substantially improved repair strength while reducing the occurrence of gapping between tendon ends. Future in-vivo studies investigating effect of suture placement on tendinous healing, blood supply, and glide function are warranted.

Effects of platelet-rich fibrin on skin pedicle graft healing

Objective: Avulsion injuries mostly lead to serious lesions. and those wounds become a challenge to be repaired by surgeons. The aim of the study was to evaluate the effect of autogenic PRF on skin pedicle graft to treat experimental avulsion wounds including clinical and hydroxyproline evaluations. Materials and methods: The experiment was performed on 15 adult female goats, aged between 7-8 months and weighted 18-20 Kg. Surgery was performed under heavy sedation and complete aseptic conditions, 2 skin marks (2×2 cm) were created on both sides of the trunk region of the animal. Two full thickness of the marked skin is cut carefully. A sliding flap (2×6 cm) are harvested parallel to the lines of least tension and are then slid over the adjacent wound which were closed by 2-0 nylon monofilament suture. These wounds are classified into two groups, the first one as the control group and the second group treated with autogenic platelet-rich fibrin. The two groups are represented in each goat. Results: Clinical examination showed the amount of wound exudation in the treated group was a significant increase compared to the control group.

Improving the antithrombogenicity of nylon monofilament for surgical suture by coating a protease from Euphorbia resinifera latex

This study developed a method to improve the antithrombogenicity of a blue nylon monofilament suture (USP 3/0) by coating a plant serine protease purified from Euphorbia resinifera latex (EuRP-61) onto the surface of nylon using a combination of dipping and ultrasonication methods. EuRP-61 was a selected protease because the enzyme had been previously reported to have antithrombotic and anticoagulant activities, high stability and biological safety. Analyses of the fibrinogenolytic and fibrinolytic activities using sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS–PAGE) and microwell plate assays revealed that the proper concentration of protease was 1 mg/ml for each coating of 20 strips of 10-mm nylon. The enzyme-coated nylon was disinfected by ethylene oxide (EO) sterilization. After EO sterilization, the enzyme-coated nylon presented fibrinogenolytic and fibrinolytic activities. Comparing the enzyme-coated and bare nylon, the enzyme-coated nylon prevented the human fibrin clot from adhering to its surface. In contrast, the fibrin clot stuck and was unable to be removed from the surface of the bare nylon. The antithrombogenicity of the protease-coated nylon evaluated in this study suggests its potential application as a surgical suture, especially for vessel anastomosis.

A comparative study of mesh fixation with non-absorbable versus delayed-absorbable monofilament suture in Lichtenstein tension-free hernioplasty in a medical college

Background: Mesh placement and subsequent fixation are an important aspect of hernia surgery. Different methods are available in modern days for fixing the mesh in inguinal hernioplasty surgery in both open and laparoscopic approach. However, sutures are still preferred by most of the surgeons because of its easy availability and cost- effectiveness. Conventionally, non-absorbable sutures are used to fix mesh. Aims and Objectives: The objective of our present study is to compare the post-surgical outcomes of mesh fixation with monofilament non-absorbable sutures versus monofilament delayed absorbablesutures. Materials and Methods: This prospective and randomized study was conducted at the Department of Surgery, ESIC-PGIMSR, Joka during the period of January 2017 –March 2019. Total 160 patients having unilateral uncomplicated inguinal hernia were included in this study; operated by the same surgical team. The patients were divided into two groups, each of 80 patients. In Group I, mesh fixation was done with delayed absorbable sutures whereas, in Group II, mesh was fixed with non-absorbable sutures. The data were analyzed with appropriate statistical tests such as Chi-square test and P &lt; 0.05 that were considered as statistically significant. Results: The development of post-operative pain was more common in Group II. The difference was statistically significant at 6 months post-operative time (P =0.042). When we compared the post-operative par esthesia in both surgical groups, more number of patients developed it in Group II but no significant statistical difference was observed (P-value came as 0.784, 0,221, and 0.385 after analyzing 3 months, 6 months, and 1 year data, respectively). Regarding other complications such ash ematoma, wound infection, seroma formation, and scrotal/ cord edema, no statistically significant differences were observed in either group (P-values were 0.339, 0.149, 0.313, and 0.117, respectively). No patient developed chronic discharging sinus post operatively in either group. No recurrence was noted in any patients included in this study, after 1 year of follow- up. Conclusion: Using delayed-absorbable suture material with air knotting technique for mesh fixation in Lichtenstein tension-free open inguinal hernioplasty causes less chance of post-operative inguinal pain and pare sthesia. Hence, it is a good alternative choice for surgeons; in terms of safety and efficacy.

Do Antiseptic Coated Sutures Reduce Colo-Colonic Anastomotic Leaks?

Colorectal anastomotic leaks remain one of the most significant complications following colorectal surgery. Various interventions to reduce anastomotic leaks have been investigated, however few have resulted in a significant improvement. To date antiseptic coated monofilament sutures for sutured bowel anastomoses have not been assessed, hence this study was undertaken to investigate whether or not triclosan impregnated polydioxanone suture material (PDS) results in fewer anastomotic leaks. A rabbit colo-colonic anastomotic model was developed to compare the tensile strength and local inflammatory response between triclosan coated PDS and uncoated PDS. Of the 42 anastomoses there were 4 (9.5%) leaks. Of the remaining 38 anastomoses neither the leak pressures, degree of bowel wall inflammation or fibrosis were statistically different (P = .11; .813 and .658 respectively) when comparing the two suture materials. In an animal model, triclosan coated PDS is as safe as uncoated PDS in performing colo-colonic anastomosis.

Comparison of the mechanical properties and anchoring performance of polyvinylidene fluoride and polypropylene barbed sutures for tendon repair.

Polyvinylidene fluoride (PVDF) has been considered as an alternative suture material to replace polypropylene (PP) due to its superior biocompatibility and mechanical properties, but it has never been examined for use in barbed sutures, particularly for tendon repair. This study fabricated size 2–0 PVDF and PP bidirectional barbed sutures and compared their mechanical properties and anchoring performance in patellar tendons. The mechanical properties were evaluated via tensile testing, and the anchoring performance of the barbed sutures was assessed by a tendon suture pullout test. Sixty porcine patellar tendons were harvested, transected to mimic a full‐thickness injury, and repaired using a cross‐locked cruciate suturing technique. The ultimate tensile force was 60% higher for the PVDF barbed sutures (22.4 ± 2.1 N) than for the PP barbed sutures (14.0 ± 1.7 N). The maximum pullout force was 35% higher for PVDF barbed sutures (70.8 ± 7.8 N) than for PP barbed sutures (52.4 ± 5.8 N). The force needed to form a 2‐mm gap, indicative of repair failure, was similar between the PVDF (29.2 ± 5.0 N) and PP (25.6 ± 3.1 N) barbed sutures, but both were greater than the 2‐mm‐gap forces for non‐barbed sutures of the same size. In this study, PVDF barbed sutures provided better mechanical properties and improved tissue anchoring performance compared to the barbed PP sutures for porcine patellar tendon repair, demonstrating that PVDF monofilament sutures can be barbed and used effectively for tendon repair.

Influence of barbed suture oversew of the transverse staple line during functional end-to-end stapled anastomosis in a canine jejunal enterectomy model.

ObjectiveTo evaluate the influence of barbed suture oversew of the transverse staple line during functional end‐to‐end stapled anastomosis (FEESA) in dogs.Study designRandomized, experimental, ex vivo.Animals or sample populationGrossly normal jejunal segments from 14 adult canine cadavers.MethodsNinety‐eight jejunal segments (n = 14/FEESA group, n = 14 controls) were harvested and randomly assigned to a control group, FEESA + monofilament suture oversew, FEESA + unidirectional barbed suture oversew or FEESA + bidirectional barbed suture oversew. Oversew techniques were performed using a Cushing suture pattern. Initial (ILP) and maximum leakage pressure (MLP), repair time (s), and location of observed leakage were recorded.ResultsNo differences were detected in ILP (p = .439) or MLP (p = .644) respectively between experimental groups. Repairs times using barbed suture were ~ 18% faster (~25 s faster; p < .001) compared to monofilament suture. There was no difference between barbed suture types (p = .697). Mean ILP (p < .001) and MLP (p < .0001) were 6.6x and 5.1x greater respectively in the control group. Leakage location occurred predominately at the crotch of the FEESA in all groups.ConclusionFEESAs closed with a transverse staple line oversew using barbed suture, regardless of barb orientation, were completed faster and resulted in similar resistance to anastomotic leakage compared to monofilament suture.Clinical significanceOversewing the transverse staple line following FEESA using barbed suture offers similar resistance to anastomotic leakage, and may be associated with decreased surgical times in dogs compared to monofilament suture. Further studies are necessary to determine the benefits of barbed suture use in both open and laparoscopic gastrointestinal surgical applications following FEESA in dogs.

Wound Dillemmas: Investigating the Effect of Barbed Knotless Suture Versus Smooth Suture for Subcuticular Tissue Closure During Knee Surgery in Youth Athletes

Background:Surgical procedures of the knee are commonly performed on youth athletes for a myriad of conditions. Restoration of motion is paramount following surgery and wound healing issues may arise. Studies have investigated wound closure technique and its’ effect on wound healing in arthroplasty, but there is a paucity of information in youth sports medicine.Purpose:To investigate wound healing following knee surgery as affected by smooth running monofilament versus barbed running knotless suture for subcuticular closure.Methods:A retrospective investigation was conducted of a single surgeon’s knee procedures between January 2013 to December 2020. Suture type for closure of the operative wound as well as any wound healing dilemmas (i.e., wound dehiscence and formal operative debridement) encountered during the post-operative period were recorded. The surgical procedure, perioperative antibiotics, wound lavage, dressing type and patient demographics were also recorded. Group 1 underwent subcuticular wound closure performed with a running smooth non-barbed monofilament suture and was compared to Group 2 where closure was performed with barbed monofilament suture. Exclusion criteria was a history of ipsilateral knee surgery and congenital syndromes. Statistical analysis was performed.Results:486 patients were identified of which 21 were excluded leaving 202 patients in Group 1 and 263 in Group 2. Average age was 15.8 years (range 10 to 25 years). 277 were female. Wound dehiscence occurred in 17 patients in Group 1 (8.42%) and 25 in Group 2 (9.51%) (p=0.684). Formal debridement was performed in 8 patients in Group 1 (3.96%) and 4 (1.52%) in Group 2 (p=0.100). There was a significantly higher tourniquet time (p<0.001), number of meniscus repairs (p<0.001) and trochleoplasties (P=0.011) in Group 2. There was no difference between groups regarding comorbidities, body mass index, and age. A power analysis yielded to reach 80% power (p<0.05) 12,405 patients per group would be needed for investigating the rate of dehiscence and 868 patients per group for formal debridement.Conclusion:Subcuticular suture type did not significantly affect the rate of wound healing dilemmas encountered following knee surgery in this young cohort. Formal debridement was required at a diminished rate in the barbed suture group but not significant enough to recommend routine use. Larger cohort studies are needed to further investigate this trend.Table 1.Patient characteristics

Reducing complications in reconstruction of the cervical esophagus with anterolateral thigh flap: The five points protocol

Patients suffering from hypopharyngeal cancer commonly present in the advanced stage and undergo a circumferential pharyngolaryngectomy. The possibility to reconstruct the esophagus and achieve an oral alimentation can significantly reduce the additional burden of a jejunostomy. The cervical esophagus is usually reconstructed with jejunal free flap (JFF) or fasciocutaneous free flap such as the anterolateral thigh (ALT) free flap. The latter has proved its donor-site safety and fast recovery. However, it is burdened by a high fistula rate. We present our five points protocol for reducing fistula rate and improving outcome. Twenty-eight patients underwent total pharyngolaryngectomy and required esophageal reconstruction with ALT flap from 2015 to 2020. In each patient, we performed five adjustments: a thicker dermal layer, a two-layer closure, a barrier from the tracheostomy, a nonabsorbable monofilament suture, and two NG tubes to enhance neoesophageal drainage. Twenty-five (89%) patients returned to solid or soft food diet after the reconstruction. Three patients had liquid diet. Contrast media leakage was observed in only 2 (7%) patients during esophagography at three weeks, with only one needing surgical revision. Our five points protocol for ALT reconstruction of cervical esophagus proved to be effective in achieving an incredibly low rate of complications, without the burden of significant donor-site complications.

Comparison of Tensile Properties and Knot Security of Surgical Sutures: An In Vitro Mechanical Study

Studies on the mechanical properties and knot security of smaller sutures used in oral and maxillofacial surgery are limited. The objective of this study is to measure the tensile properties and knot security depending on the suture materials, knotting techniques, and number of throws using 5-0 sized sutures. Seven 5-0 sized sutures were measured in both straight-pull and knot-pull according to the procedures outlined by the United States Pharmacopeia. Regarding knot security, there were 3 predictor variables: suture material, knot technique, and number of throws. Two surgical tying techniques were square knot and surgeon's knot and the number of throws were 3, 4, and 5. One-way analysis of variance was applied to test tensile properties (α=0.05). The dichotomous outcome of knot security (stable or unstable) was analyzed using logistic regression analysis and odds ratios with Tukey-adjusted 95% confidence intervals. Ethicon polyglactin 910 was found to have the highest failure load (18.0N) of straight, while silk sutures had the lowest of both straight and knotted. A higher elongation rate was found in the 2 monofilament suture materials polypropylene and polydioxanone. Knot security depended on the suture technique, material, and number of throws. Surgeon's knots were stronger than square knots. The number of throws required to achieve knot security depends on the specific combination. For polypropylene or Jinhuan silk with the surgeon's knot, 3 throws can probably achieve knot security. The new data presented in the study provided important information for guiding the selection of smaller suture materials for oral and maxillofacial surgery. A wider range of suture combinations should be tested, and more invivo studies are needed to clarify the characteristics of sutures and knots.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery Meshless Anterior Repair for the Treatment of Pelvic Organ Prolapse

To demonstrate the feasibility of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) meshless anterior repair for the treatment of pelvic organ prolapse (POP). Stepwise demonstration of the technique with narrated video footage. The vNOTES approach is a recent and rapidly developing technique that allows safe endoscopic transvaginal treatment of benign uterine pathologies [1]. Its use in the treatment of POP is still in its early stages; however, the first results are encouraging in terms of anatomy, functionality, and safety [2]. We describe the vNOTES technique of meshless anterior POP repair using a vaginal plastron [3]. The "vaginal plastron" technique uses an autologous vaginal strip that is left attached to the bladder and suspended from the arcus tendineus. After the delimitation of a 6 cm square vaginal strip, a lateral dissection is performed on each side between the bladder and the vaginal fascia to enter the paravesical space. The vaginal strip is left attached to the bladder wall and will later be fixed laterally to the arcus tendineus with 6 nonabsorbable monofilament sutures, caliber 0 (3 on each side of the plastron). The fixation points on the arcus tendineus concern the internal obturator fascia ventrally and the iliococcygeus fascia dorsally. The sutures are placed under endoscopic view using a transvaginal access platform (GelPOINT V-Path, Applied Medical, Rancho Santa Margarita, CA). After deflation and removal of the platform, the sutures are attached to the vaginal strip. Once the vaginal plastron is secured, the anterior vaginal wall is closed. The vNOTES approach offers an endoscopic anatomic view of the paravesical space, thus reducing any blind surgical procedure. It provides an alternative route in the performance of meshless anterior POP repair.

A Novel Application of the Hemostatic Net in Aesthetic Breast Surgery: A Preliminary Report.

Obtaining optimum breast aesthetics can be challenging in secondary aesthetic breast surgery, particularly with poor-quality skin, when downsizing implants, and in cases where patients will not accept additional mastopexy scars. Most techniques described in these cases rely on internal suturing and capsulorrhaphy, which can lack precision in tailoring the skin over the internal pocket. The aim of this study was to present the authors' experience with utilizing the hemostatic net to help address a range of challenging breast cases in their practices. A multicentre retrospective analysis of patients undergoing aesthetic and reconstructive breast surgery between 2019 and 2021 was conducted. A database was established to record patient demographics, indications for surgery, surgical technique, and complications. Following capsulorrhaphy, the hemostatic net was applied in as many rows as required with monofilament sutures and removed 3 to 7 days postoperatively. Twenty-four women (aged 23-67 years) underwent aesthetic or reconstructive breast surgery with the hemostatic net. This approach optimized stabilization of the inframammary fold and redraping of lax skin or irregularities in the skin envelope. At follow-up review, only 1 instance of the net failing to successfully redrape the skin was seen. The application of the hemostatic net is an option for patients who might otherwise require mastopexy but refuse to accept the scars. The technique has now been extended to primary cases where implant malposition or skin tailoring issues are anticipated, thus securing its place as a part of the surgical armamentarium.