Muscle Suture Research Articles

Comparative Three-dimensional Analysis of Philtral Ridge Projection in Unilateral Cleft Lip Repair enhanced with Muscle to sub-Dermis suture

Introduction: Recreating the philtral ridge and restoring orbicularis oris muscle continuity in cleft patients is a challenging task. Our muscle to sub-dermis technique introduces an effective method for achieving the desired philtral ridge reconstruction. Method: From August 2015 to July 2023, a retrospective study was conducted with a follow-up period of at least 6 months. This procedure involved a suture technique using muscle-to-sub-dermis sutures. Measurements of philtral projection were taken at two distinct points: one above the cupid's bow and the other at the mid-philtral level. In the comparative analysis of philtral ridges between the cleft and non-cleft sides, the root mean square (RMS) projection value was assessed. Additionally, an analysis of the restoration of the orbicularis oris muscle included the use of color mapping from the mid-sagittal plane and covered seven different points across three distinct horizontal planes: below subnasale, at the mid-philtral level, and above the cupid's bow. Results: Total 134 patients were included with a 37.8-month follow-up(SD 9.4). Philtral side projection was well-maintained, measuring -0.36(0.43)mm, -0.24(0.49)mm on the classical group vs. 0.23(0.29)mm, 0.20(0.21)mm on the muscle to sub-dermis group(p=0.001). The RMS projection value was 0.57(0.46) vs. 0.14(0.046), indicating greater symmetry in the muscle to sub-dermis group, with no difference in sagittal vector analysis of the orbicularis oris muscle between normal and cleft sides. Conclusion: A suturing technique utilizing muscle to sub-dermis sutures has shown promising results in philtral projection and dimple formation. This improvement can be attributed to the combined effect of sub-dermis and less muscle sutures.

FEATURES OF THE MANAGEMENT OF PATIENTS WITH POSTPARTUM PURULENT-SEPTIC COMPLICATIONS

Postpartum purulent-septic diseases are one of the topical issues of modern obstetrics due to their high prevalence and absence of a downward trend toward reduction in the disease incidence.Aim. Іmprove the management of high risk puerperas to prevent the development of purulent-septic complications in the postpartum period.Material and methods. The cohort prospective comparative study included 78 puerperas who experienced spontaneous labour complicated by injuries to birth canals. The patients were divided into two groups according to the risk of developing purulent-septic complications and the management of patients. Group 1, (n = 20) included the puerperas who did not show any signs of inflammatory diseases of the genital tract during pregnancy. Group 2 included patients, who were diagnosed with various forms of vaginal dysbiosis based on the results of bacterioscopic and bacteriological examination of the genital tract. The group was further divided into two subgroups depending on the type of treatment. Subgroup 1 of Group 2 (n = 28) only received standard hygiene care, and Subgroup 2 (n = 30) received standard hygiene procedures combined with vaginal irrigation using chlorhexidin solution for 3 days in the obstetric hospital.Research results. The study resulted in improving postpartum care of high-risk puerperas to prevent purulent-septic complications.Discussion. The test results showed that the use of chlorhexidin in the postpartum period prevents the purulent-septic complications of puerperium, such as inflammation and disruption of perineal muscle sutures and endometritis, as well as relieves pain and discomfort, and improves the puerperas’ quality of life.Conclusion. Based on the study results, we recommend the use of this drug in the early postpartum period to prevent purulentseptic complications in the high-risk groups.

Protocol of a Nerve Neurotmesis Sciatic Repair using Polyvinyl Alcohol Biofilm in Wistar Rats

Abstract Background Animal models are commonly used to assess the efficacy of new materials to be employed in the surgical repair of a nerve injury. However, there is no published surgical repair protocol for sciatic nerve neurotmesis in rats. Objective To produce and evaluate a protocol for the tubing technique using a polyvinyl alcohol biofilm after sciatic nerve neurotmesis. Methods Eighteen rats were randomized into 3 groups (n = 6 per group): control group - CG, neurotmesis group - NG, and neurotmesis biofilm group - NBG. The NG and NBG animals were submitted to neurotmesis of the sciatic nerve at 60 days of life, followed by suture of the nerve stumps; in the NBG, the animals had the suture involved by polyvinyl alcohol biofilm. A descriptive evaluation of the surgical technique was performed after the experimental period. The Shapiro-Wilk normality test was used for body weight, and analysis of variance (ANOVA) with Bonferroni posthoc (p < 0.05) was applied. Results All groups showed good repair of the skin and muscle sutures; however, 33.30% of the CG presented disruption of skin points. Furthermore, 16.70% of the stumps were not structurally aligned and 33.30% had neuromas in the NG, while in the NBG, all stumps were aligned and none of them had neuroma . Conclusions The present study was able to produce a protocol with high reproducibility in view of the mechanical stability, targeting of the nerve stumps, muscle healing, the low frequency of skin breakage and the low complexity level of the technique, and it can be used in future studies that aim to evaluate other biomaterials for nerve repair in rats.

An ex vivo model for education and training of unilateral cleft lip surgery

BackgroundUnilateral cleft lip surgery is a complex procedure, and the outcome depends highly on the surgeon’s experience. Digital simulations and low-fidelity models seem inadequate for effective surgical education and training. There are only few realistic models for haptic simulation of cleft surgery, which are all based on synthetic materials that are costly and complex to produce. Hence, they are not fully available to train and educate surgical trainees. This study aims to develop an inexpensive, widely available, high-fidelity, ex vivo model of a unilateral cleft lip using a porcine snout disc.MethodsA foil template was manufactured combining anatomical landmarks of the porcine snout disc and the anatomical situation of a child with a unilateral cleft. This template was used to create an ex vivo model of a unilateral cleft lip from the snout disc. Millard II technique was applied on the model to proof its suitability. The individual steps of the surgical cleft closure were photo-documented and three-dimensional scans of the model were analysed digitally. Sixteen surgical trainees were instructed to create a unilateral cleft model and perform a unilateral lip plasty. Their self-assessment was evaluated by means of a questionnaire.ResultsThe porcine snout disc proved highly suitable to serve as a simulation model for unilateral cleft lip surgery. Millard II technique was successfully performed as we were able to perform all steps of unilateral cleft surgery, including muscle suturing. The developed foil-template is reusable on any porcine snout disc. The creation of the ex vivo model is simple and inexpensive. Self-assessment of the participants showed a strong increase in comprehension and an eagerness to use the model for surgical training.ConclusionsA porcine snout disc ex vivo model of unilateral cleft lips was developed successfully. It shows many advantages, including a haptic close to human tissue, multiple layers, low cost, and wide and rapid availability. It is therefore very suitable for teaching and training beginners in cleft surgery and subsequently improving surgical skills and knowledge. Further research is needed to finally assess the ex vivo model’s value in different stages of the curriculum of surgical residency.

Orbicularis muscle fixation downward for the correction of congenital epiblepharon in Chinese patients

Congenital epiblepharon (CE) is a congenital eyelid deformity unique to young individuals of Asian descendants, and it might cause a sequence of other complications such as corneal damage and ocular foreign body sensation. Surgery is the most effective approach to treat this condition. Here, this study evaluated the effectiveness and safety of the orbicularis muscle fixation downward (OMFD) procedure for correcting CE. This study enrolled 29 patients who were diagnosed with CE. These patients experienced significant ocular irritation leading to epiphora and corneal injury and, therefore, they underwent the OMFD procedure that was performed by the same surgeon. The cases were divided into 3 grades according to postoperative outcomes. The OMFD procedure was performed on 55 lower lids of the 29 patients. The average age of the patients was 9.6 years. The mean follow-up duration was 17 months. No perioperative complications were observed, and successful surgical outcomes were achieved in all 29 patients. No postoperative necrosis, infection, or corneal epithelial injury occurred. None of the patients exhibited significant scarring. Three patients showed residual 1-3 eyelashes touching the nasal corneal or bulbar conjunctiva at the inner canthus during the last postoperative examination. These patients did not undergo further surgery as there were no obvious irritation symptoms or corneal damage. The fixation of the pretarsal orbicularis muscle is a simple and effective modification of the Hotz procedure to correct CE. The key aspect of this procedure is the suturing of the pretarsal orbicularis muscle and the lower eyelid retractors.

"Pinch and Stretch" technique to overcome ocular hypotony during scleral suturing of recti muscles.

During extraocular muscle surgery, an uneventful scleral suture pass is very essential. In presence of normal intraocular tension, the surgery is quite predictable and safe. However, in the presence of significant hypotony, it becomes challenging. Therefore, to mitigate complication rate in these cases, we have adopted a simple technique, that is, the "pinch and stretch" technique. The surgical steps of this technique are as follows: In eyes with significant ocular hypotony, the surgery is initiated with a routine forniceal/limbal peritomy, following which the muscle is sutured and dis-inserted. Using three tissue fixation forceps, the scleral surface is stabilized. Using first forceps, the surgeon rotates the globe toward themself from the muscle stump, and with the remaining two forceps, the assistant pinches and stretches the episcleral tissue in an outward and upward direction just beneath the intended marks. This creates a flat scleral surface with significant firmness. Sutures are passed over this rigid sclera and the surgery is completed without any complications.

Endoscopic treatment of diastasis recti: Training method and literature review

Endoscopic treatment of diastasis rectus abdominis offers the possibility of correcting the condition without complete abdominoplasty. The purpose of this study was to develop a training method on fresh cadavers models based on a literature review on this surgery. The endoscopic procedure considered involved the insertion of a 10mm suprapubic trocar and of 5mm trocars in each iliac fossae. The muscle suture is done using running barbed suture. The surgery was performed on eight fresh cadavers to estimate the learning curve for this intervention, which was estimated with the CUSUM method. A systematic literature review in the PubMed database was performed, and 20 articles that met the inclusion criteria were analyzed. The learning curve threshold was reached after 6 operations and can be separated into two phases. The most common complication of this surgery is seroma, it is encountered in 3 to 27% of cases according to the studies. Diastasis recurrence is rare, occurring in less than 2% of cases. In comparison, open surgical treatment of diastasis recti is associated with a higher risk of hematoma, skin necrosis and longer operating times. Recurrence rates are similarly low after open and endoscopic repair. Mesh reinforcement is indicated in cases of diastasis wider than 5cm, diastasis recurrence, severe musculoaponeurotic laxity, or hernia larger than 1cm. The data in the literature indicate that laparoscopic surgery is an efficient and safe approach to correct diastasis of the rectus muscles and can be offered by plastic surgeons to selected patients.

Video-Assisted Cleft Palate Surgery: Preclinical Comparison Between Endoscope- and Exoscope-Based Approaches.

Using both endoscope and exoscope in cleft soft palate surgery is not widespread, despite the potential advantages related to view magnification, ergonomic posture of the surgeon, and involvement of the surgical team. The aim of the current study is to compare endoscopic (Olympus Visera©) and exoscopic (Karl-Storz Vitom©) assistance in cleft soft palate surgery in a preclinical cadaver setting. A formalin fixed specimen was dissected to mimic the anatomical conditions of a cleft soft palate. Ten young surgeons with limited experience in transoral surgery were involved in the exercitation on the specimen. The exercitation consisted of 4 tasks: (1) device setting; (2) identification of muscle plane; (3) muscle suturing; (4) oral mucosa suturing. Participants were timed while performing each task both with exoscope and endoscope and asked to fill in 2 questionnaires related to the visual systems used (NASA Task Load System TLS and VAS 1-10). All surgeons completed the 4 tasks with both the endoscope and exoscope. The execution times were similar except for faster setting of the exoscope. Participants felt that completing surgical exercises using the exoscope required less physical, intellectual, and temporal efforts compared to the endoscope. The exoscope was also more appreciated for its handling, 3D visualization, and limited encumbrance. Exoscope scored better both at NASA TLS and VAS 1-10 and required a faster setting than endoscope. Further clinical in-vivo studies are required to explore the advantages of these devices in cleft palate repair.

Novel Automated Suturing Technology for Minimally Invasive Mitral Chord Implantation: A Preclinical Evaluation Study.

This study evaluated the ergonomics and time requirements of using a novel automated suturing and titanium fastener deployment technology for chordal replacement in human heart specimens in open and minimally invasive cardiac surgery (MICS) simulators. Five cardiac surgeons used novel, manually powered expanded polytetrafluoroethylene (ePTFE) suturing devices to automate suture placement between mitral leaflets and papillary muscles in explanted cadaver hearts, along with customized titanium fastener delivery devices to secure suture and trim suture tails. This mitral chordal replacement test was conducted using surgical models simulating open and MICS mitral repair access. The study was approved by the institutional ethical board. After a brief introduction to this technique using plastic models, study surgeons performed 48 chordal replacements in human mitral valves, placing 18 in an open model and 30 in a right minithoracotomy model. The time range to complete a single chordal replacement was between 55 s and 8 min, with an overall mean duration of 3.6 ± 1.5 min. No difference in duration of implantation was recorded for the MICS and open sternotomy simulators used. Good control of suture delivery was reported in 95.8% (n = 46) of leaflet aspect of the sutures and in 100% (N = 48) of papillary muscle sutures. Automated mitral chordal ePTFE suturing simulated through open and MICS access demonstrated quality handling and accurate placement of sutures in human heart specimens. A clinical trial using this technology is currently ongoing. This innovation may present an important advance facilitating enhanced minimally invasive mitral valve repair.

Comparison of Post-operative Pain in Patients with Platysma Muscle Suture versus no Suture for Wound Closure after Thyroid Surgery

Objective: To assess the post-operative pain in patients with platysma muscle suture versus without platysma muscle suture used for wound closure after thyroidectomy.
 Study Design: Randomized clinical trial.
 Duration: January 2020 to March 2021.
 Setting: Department of General Surgery, Jinnah Postgraduate Medical Center, Karachi.
 Methods: A total number of 68 patients planned for primary thyroid surgery, aged 18-60 years of both genders were included in this study. Patients were divided into two equal groups using draw randomization. In Group I: platysma muscle suture was used during wound closure after thyroidectomy. In Group II: No platysma suture was used during wound closure after thyroidectomy. Postoperative pain score was noted at 24 hours after thyroidectomy.
 Results: Mean age of patients was 39.25±11.68 years. Mean body mass index (BMI) of patients was 24.48±3.60 kg/m2. Mean duration of surgery was 88.81±15.22 minutes. Mean postoperative pain score was 2.78±1.37. There were 39 (57.35%) females and 29 (42.65%) female patients. There were 18 (26.47%) patients having ASA I, 44 (64.71%) having ASA status II and 06 (8.82%) patients having ASA status III. There were 18 (26.47%) patients with hemi-thyroidectomy and 50 (73.53%) with total thyroidectomy. Post-operative pain score was 3.26±1.50 in with platysma muscle suture and 2.29±1.03 in without platysma suture (p-value 0.003).
 Conclusion: As per current research, postoperatively, there was less discomfort related to the incision when the platysma muscle suture was not used. Further studies with a larger sample size is warranted.

Perioperative Therapie bei proktologischen Eingriffen

BackgroundAnorectal surgery is typically associated with pain due to anatomical reasons. Since most wounds remain open, wound healing is usually prolonged (lasting up to 3 months) in the regular postoperative course.AimThe goal of the work is to present the currently available and recommended perioperative options in anorectal surgery.MethodsOriginal articles, meta-analyses and expert opinions are discussed taking into account the experience of the authors.ResultsPerioperative therapy in anorectal surgery can be stratified into pre-, intra- and postoperative phases. There are specific options to positively influence wound healing in each of these phases. The armamentarium of perioperative surgery includes change of stool habits, preoperative evacuation of the rectum, antibiotics, pain relief, postoperative dietary restrictions and wound management. The extent and type of surgery as well as use of muscle sutures influence the perioperative therapy. In addition, wounds in the rectum have to be addressed differently.ConclusionsPerioperative therapy in anorectal surgery has to address the individual patient’s conditions and the method and extent of surgery; there is no “one fits all” approach.

Повреждения магистральных сосудов конечностей с полным нарушением кровотока у детей (результаты клинических наблюдений)

Background Trauma with associated damage to major arteries and veins typically occurs in adults; reports on such injuries in children are rare. In the organization of their treatment, difficulties are encountered such as formation of teams that must include angiosurgeons. The issues of restoring limb function after injuries with damage to muscle, nerve trunks or complete amputation of the limb remain relevant in children, despite their high abilities to recover. Each particular case in health care institutions has its own characteristics and difficulties for treatment, which was the reason for this communication. Purpose To share our clinical experience and details of providing urgent medical care to injured children with complete impairment of the main arteriovenous blood flow. Materials and methods Three cases with complete damage to major arteries and veins, including their defects, were studied. We describe the details of tactics and features of their surgical management. All patients underwent clinical and laboratory examination; emergency assistance was provided by orthopedic traumatologists and angiosurgeons. All patients were admitted in a state of hemorrhagic shock in stage 2 or 3. Surgical aid was provided in patients with a critical, almost terminal condition. Results On admission 40 minutes after the injury, one patient was diagnosed with a deep cut wound on the posterior surface of the right thigh with damage to the flexor muscles of the leg, femoral artery and vein with their defects up to 3 cm, and a cut wound on the right lower leg. Combined plasty of vascular defects with grafts from the great saphenous vein of the thigh and muscle suture were performed. An excellent result was noted after 3 months. In the second patient, there was an injury with glass in the area of the left axillary fossa with a transverse cut of all nerves, brachial artery and vein, tendons of the biceps and triceps muscles of the shoulder. An excellent result of primary reconstruction was diagnosed 1.5 years later. In the third case, the patient was admitted with a complete traumatic amputation of the right forearm in the lower third due to the use of a mechanical wood splitter; replantation began 5 hours after the cut off. Replantation was successful. It included 4 stages of treatment; the 2nd one was repeated revision and suture of the vessels 16 hours after the onset of thrombosis following the 1st operation. The next two stages included combined plastic surgery of muscles and tendons, first on the extensor and then of the flexor surface of the forearm. Movements appeared 6 months after the injury during the restoration of sensitivity. A completely satisfactory result of treatment was obtained; the patient began to use his hand in everyday life and to write after one year. Conclusion Damage to the main arteriovenous formations requires urgent surgical treatment, aimed at preserving the limb, restoring blood supply, nerve formations, and bone integrity. In complete amputation, restoration of muscle-tendon formations may be postponed for subsequent stages. In primary care, one should consider the need for subsequent, sometimes long-term rehabilitation, the result of which directly depends on the restoration of neurotrophic and sensitive functions.

Lateral Approach in Thyroidectomy- a Comparative Study

Introduction: To enter the thyroid gland, the lateral "backdoor" technique (LA) uses the same central neck incision as the anterior border of the sternocleidomastoid (SCM) and strap muscles. Typically, this treatment is done to redo thyroid surgery. The results of the two procedures were compared in people who were having their first conventional thyroidectomy. Methods: A case-control study was undertaken on 30 people who received a routine open thyroidectomy from January 1, 2018 to December 31, 2019. The first 15 patients were given MA, then another 15 were given LA. All patients received 10 mL of 1 percent Marcaine infiltration before the neck incision was closed. Basic demographic data, surgery time, incision length, gland weight, strap muscle transection required, and complications were all recorded. The study excluded thyroid revision surgery and minimally invasive thyroid surgery. Results: Demographics, surgery time, gland weight, and incisional length did not differ significantly. The LA group experienced significantly reduced post-operative pain. 5 patients (11%) in the MA group required horizontal transection of strap muscles to remove large goitres, compared to 1 patient (2.2%) in the LA group. In neither group, there were any major issues. Conclusion: The LA approach is equally safe as the midline surgery, with a similar surgical time and substantially lower pain levels. By avoiding midline separation and suturing of strap muscles, it reduces the need for strap muscle transection to remove large goitres.

Observation on the Curative Effect of Microsurgery in 154 Children with Strabismus and Analysis of Its Influencing Factors.

Strabismus is a common ophthalmic disease in the process of child body development, in which the two eyes cannot gaze at the target at the same time, and the incidence of this disease of children is higher. In children with esotropia, exotropia, and up and down strabismus and other typical symptoms, the cause is genetic, innerve, and refractive and regulated, and not receiving timely treatment may lead to stereo vision and diplopia and other phenomena, affecting their learning and life. Surgical treatment is the main treatment for strabismus at present. Traditional orthodontic surgery is performed by doctors under the naked eye, often due to improper operation or suture error and other factors, resulting in more postoperative complications, such as more tissue damage, conjunctival congestion, and muscle suture reaction, which seriously affect the clinical effect of surgical treatment. In recent years, with the continuous development of microsurgical technology, the correction of strabismus under a microscope has been widely carried out in clinic. The operation under the microscope makes the operation more delicate and accurate, overcomes the defects of traditional surgery, and highlights the advantages of minimally invasive surgery. The purpose of this study was to investigate the effect of microsurgical techniques in the treatment of strabismus in children and to analyze the factors influencing the outcome. The results showed that microsurgical strabismus correction in the treatment of strabismus children has short operation time, less intraoperative blood loss, short hospital stay, high efficiency, and less complications, which is worthy of popularization. Age, preoperative strabismus angle, refractive error, distance stereopsis injury, near stereoscopic injury, and duration of disease were all independent influencing factors of postoperative efficacy.

Current practice of thyroid surgery in Germany: a nationwide survey.

Due to the lack of perioperative standards in thyroid surgery, this study aimed to evaluate the perioperative management and wound closure techniques used in a nationwide survey. A questionnaire evaluating preferred technique in thyroid resection, postoperative management, and the occurrence of complications was sent to all hospitals in Germany performing more than 50 thyroid operations p.a. (N.=362, response rate 78% [N.=283]). Subsequently, hospitals were subdivided into university and maximum care hospitals (Category A, N.=54) and tertiary hospitals and basic care hospitals (Category B, N.=229). According to our results, 10.6% of the hospitals were certified as a center for thyroid surgery, with a significantly higher percentage in Category A (20.4% vs. 8.3%; P<0.01). Concerning the surgical techniques, Kocher's incision was the favored cervical approach in 96% of the hospitals. A minimally invasive approach was performed in 30.1%, with a significantly more common description in Category A; 97.8% of all clinics stated that they perform a platysma muscle suture, primarily as a single stitch interrupted. Skin closure was predominantly performed via intracutaneous suture in 84.5% using absorbable suture material in 63.1%. There was no difference in the technology used in terms of hospital size. The mean in-hospital stay was significantly shorter in Category A hospitals (P=0.035). The suture technique used in thyroid surgery in Germany is a simple interrupted suture technique for platysma and a continuous suture with absorbable skin closure material. Maximum care hospitals are characterized by shorter in-hospital stays and improved quality assurance.

To suture or not to suture? Does globe immobilisation technique affect clinical outcome in stereotactic radiosurgery for uveal melanoma?

Introduction Stereotactic radiosurgery (SRS) is a valuable treatment option for uveal melanoma, offering excellent tumour control rates and eye preservation. Its efficacy relies upon accurate localisation of the tumour, which is challenging in the mobile eye. Various methods of globe immobilisation have been used, including non-invasive devices, such as eye movement tracking and suction cups, but common practice is to use local anaesthetic block with or without transconjunctival suturing of the extraocular muscles. Some studies have suggested that the addition of muscle suturing to local anaesthetic block provides better immobilisation of the globe, when compared to anaesthetic block alone. Controversy exists regarding the clinical relevance of this observation and ocular oncologists differ in their choice of immobilisation technique. Methods In order to establish if the addition of muscle suturing to local anaesthetic block improves clinical outcomes, we performed a retrospective review of all cases that underwent SRS for uveal melanoma over a 10-year period (May 2008 to May 2018). Based on surgeon preference, all patients received either local anaesthetic block plus muscle suturing (Group A) or local anaesthetic block alone (Group B) to induce globe akinesia. Outcomes assessed were primary treatment failure, tumour recurrence, secondary enucleation and death rate. Results In our cohort of 290 eyes; 118 patients were in group A and 172 patients were in group B. There were no cases of primary treatment failure in either group. With a minimum of 24 months follow-up, only 3 patients experienced tumour recurrence (1 in group A and 2 in group B). There was no significant difference in recurrence, enucleation and all-cause death rates between the two groups. Conclusion Our retrospective review suggests that although extraocular muscle suturing may be considered by some units to provide superior globe immobilisation for SRS, it does not alter the clinical outcome.

A prospective, randomised study of the effect of fixation sutures during phacotrabeculectomy on intraocular pressure and incidence of ptosis

We investigated the effects of different intraoperative eyeball fixation techniques (superior rectus muscle suture [MS] and traction suture at the corneal limbus [CS]), on intraocular pressure (IOP) and the incidence of ptosis after phacotrabeculectomy. Forty-one eyes with different glaucoma types which qualified for phacotrabeculectomy were included. Twenty-three and eighteen patients were included in the CS and MS groups, respectively. The IOP, best-corrected visual acuity (BCVA), and margin reflex distance were assessed preoperatively and 3, 6, and 12 months post-operatively. Preoperatively, the mean IOPs (± standard deviation) in the CS and MS groups were 23.6 ± 7.3 mmHg and 24.3 ± 6.6 mmHg (p > 0.05), respectively. At 3 and 6 months post-surgery, the mean IOPs were significantly lower in the CS group than in the MS group: 13.9 ± 3.0 mmHg vs. 17.7 ± 3.5 mmHg (p = 0.001), and 13.9 ± 4.9 mmHg vs. 17.2 ± 3.5 mmHg (p = 0.005), respectively (mean difference: 3.9, 95% confidence interval 1.7–6.1). At 12 months, the mean postoperative IOPs were 15.2 ± 3.5 mmHg and 14.9 ± 3.6 mmHg in the CS and MS groups, respectively (p > 0.05). At 6 months, the BCVAs were 0.91 ± 0.15 and 0.71 ± 0.3 (p = 0.029) in the CS and MS groups, respectively; BCVAs were 0.91 ± 0.15 and 0.71 ± 0.3 (p = 0.029) in the CS and MS groups, respectively; the difference was non-significant 12 months post-surgery (0.78 ± 0.32 vs. 0.74 ± 0.30, p = 0.553). Postoperative ptosis was observed in 4 (17%) and zero patients in the CS and MS groups, respectively, but the difference was not statistically significant (p = 0.118). The study was not powered sufficiently to detect statistically significant changes in exploratory endpoints. The study was not powered sufficiently to detect statistically significant differences between groups in exploratory endpoints.

Application of platysma muscle suture after thyroidectomy

Introduction: Thyroidectomy is a common surgery in the neck area, in which the application of platysma muscle suture after thyroidectomy is still being discussed. This study was conducted to compare the application (currently common) or non-application of suture for platysma muscle. Methods: In this retrospective cross-sectional study, 117 patients underwent thyroidectomy, among which 63 cases without suturing platysma (control group) and 54 subjects with suturing platysma (Intervention group ) were examined in terms of postoperative pain based on visual analogue scale score measured 24 h post-operation. The samples were also investigated regarding hematoma and seroma, wound infection, length of hospitalization, scarring (1 year after surgery), duration of surgery, and the number of cases using opioids during the hospitalization. Patients with diabetes, previous neck surgery, coagulopathy, and radiation history were excluded from the study. The gathered data were analyzed statistically in SPSS software (version 18) using the Chi-square test and the Mann–Whitney U test. A p-value of less than (0.05) was considered significant. Results: Based on the findings, the mean age of the patients in the Intervention group was calculated at 51 years, of which 41 and 13 cases were females and males, respectively. In the Intervention group, 34 patients underwent complete thyroidectomy and 20 patients had hemithyroidectomy. The mean age score of subjects in the control group was calculated at 50 years, of which 44 and 19 patients were respectively female and male. No significant difference was revealed considering wound infection, length of hospitalization, created scarring, the amount of opioid use (opioids), and postoperative pain. However, only the length of surgery was different between the groups (P-value&lt;0.05). Conclusions: There was no difference between wound and surgical complications and cosmetic results between both groups; nevertheless, due to the duration of the surgery and other benefits, such as consuming less thread, not suturing the platysma is recommended.

Laser-Assisted Adjustable Suture Technique in Strabismus Surgery.

PurposeThe aim of this study was to assess the efficacy and safety of a new technique (argon laser-assisted lysis of the adjustable suture) in strabismus surgery.Patients and MethodsRecession of lateral rectus muscle was done and was secured to the sclera at the predetermined recession position after suspending it 1.5–2.5 mm farther. A 10-0 nylon suture was placed at the original insertion site, passed under the previously tied muscle suture knot, and tied, advancing the muscle to the new scleral insertion. Postoperatively in the same day of surgery, if the targeted slight overcorrection was not achieved, a topical anesthetic was given, and argon laser was used to cut the nylon suture providing additional muscle recession.ResultsForty-two patients with exotropia were included: 11 children and 31 adults. Eleven (26.2%) patients became orthophoric immediately following muscle recession. Thirty-one (73.8%) patients were undercorrected with a mean residual angle of 8.2±3.3 pd. After laser-assisted release of the suture, 12 (28.6%) patients were orthophoric, with 4 (9.5%) patients still undercorrected and 26 (61.9%) patients overcorrected. By the end of 6 months postoperatively, the overall success rate of the procedure was 88.1%, with only 5 (11.9%) patients with exotropia.ConclusionThe laser-assisted adjustable suture technique had an overall success rate of 88.1% with only 11.9% of the patients showing exotropia. The technique can help achieve successful alignment.

Factors influencing the result of superior oblique weakening procedures in patients with superior oblique overaction in horizontal strabismus

BackgroundFew studies have evaluated the surgical outcome of superior oblique weakening procedures in patients with superior oblique overaction associated with exotropia or esotropia. This study aimed to evaluate the outcome of superior oblique muscle weakening and the influencing factors in patients with superior oblique overaction.MethodsThe medical charts of 37 patients (55 eyes) with superior oblique overaction associated with esotropia or exotropia who were treated with a superior oblique weakening procedure at the Seoul National University Hospital from January 2010 to June 2017 were retrospectively reviewed. Superior oblique overaction was graded using, a 6-point scale ranging from + 0.5 to + 3, and pre- and postoperative grades were recorded for all patients.ResultsThe mean age of the patients was 91.81 ± 59.37 months. Superior oblique muscle suture spacer and superior oblique posterior tenectomy were performed for 17 (23 eyes) and 20 (32 eyes) patients, respectively. Surgical success was achieved in 15 (65.2%) eyes in the suture spacer group and 23 (71.9%) eyes in the posterior tenectomy group. Surgical success was achieved for 69.1% (38/55 eyes) of patients. Dissociated vertical deviation exhibited a significant negative association with the surgical success rate (p < 0.001).ConclusionsThere was no significant difference in surgical success rate between the superior oblique posterior tenectomy and superior oblique suture spacer groups in superior oblique overaction associated with horizontal strabismus. Associated dissociated vertical deviation can affect the surgical success of the superior oblique weakening procedure.