Nonabsorbable Sutures Research Articles

The Efficacy of Ab Externo Canaloplasty by Using a Nonabsorbable Suture and No Viscoelastics; IOP Results, Intraoperative and Early Complication Rates within 6-Month Follow-Up Period.

To report the efficacy of ab externo canaloplasty by exclusively using only a nonabsorbable suture as a standalone operation or combined with phacoemulsification in terms of mean intraocular pressure (IOP), medication reduction, and intra- and postoperative complication rates as well as additional glaucoma surgery. Forty-eight patients with primary open-angle glaucoma (POAG) and 50 eyes were divided into two groups according to the operation performed (Group A canaloplasty, n = 34 and Group B canaloplasty combined with phaco, n = 16), respectively. The success criteria were evaluated between three IOP ranges: a) IOP ≤ 16 mmHg, b)≤ 18 mmHg, and c) ≤ 21 mmHg. Complete success was considered the percentage of eyes reaching these goals with no medication and qualified success with or without medication. Groups A and B were compared with the Kaplan-Meier test. Mean IOP and medication reduction as well as additional glaucoma surgery were also evaluated. The follow-up time was 6 months. Statistical importance was given at p < 0.05. Fail rate and intraoperative conversion of canaloplasty to other surgery (trabeculotomy due to extensive cheese-wiring) accounted for 12% (6 eyes), while a mandatory usage of the iTrack 250A microcatheter to successfully overcome intracanalicular bridging of the Schlemm's canal accounted for 20% (10 eyes). The most common early postoperative complications in both groups were hyphema, cheese wiring, and transient IOP rising. The mean IOP in Group A reduced from 23.67 ± 6.06 mmHg to 13.35 ± 4.23 mmHg and in Group B, it reduced from 23.55 ± 6.19 mmHg to 12.75 ± 1.5 mmHg at 6months (p < 0.001). Group A's absolute success rates accounted for a)44%, b)47.1%, and c) 52.9% in comparison to Group B [a) 50%, b)50%, and c) 56.3%] at 6 months (p < 0.05). Qualified success with or without medication showed no statistical differences between the groups. The mean medication reduction was significantly lower (p < 0.001) in both groups (Group A from baseline 3.2 ± 1.23 to 0.95 ± 1.35 and Group B from 3.12 ± 0.88 to 1.12 ± 0.75 at 6 months, respectively). Five eyes (10%) required additional glaucoma surgery. Ab externo canaloplasty by exclusively using only a nonabsorbable suture as a standalone operation or combined with phacoemulsification seems to lower the mean IOP and medication sufficiently. However, they pose a greater surgical challenge and intraoperative complication rate. Additional glaucoma surgery or medication following both procedures may be necessary to achieve an optimal target IOP.

HISTOLOGICAL AND MICROBIOLOGICAL EVALUATION IN MICE OF CYANOACRYLATE (HISTOACRYL) AS POSSIBLE REGENERATIVE AGENT TO REPLACE TRADITIONAL SUTURES

<h3>Background</h3> Traditional sutures, staples and surgical tapes are the most common methods used to close wounds in veterinary patients. However, these methods can induce granuloma and fistulas formation, loose sutures and wound leaks. Lately, tissue adhesives such as cyanoacrylates (Histoacryl®) have become popular, this glue can bond tissues such as endothelium, mucosa, skin, blood and bone rapidly. Studies using cyanoacrylates have shown bond strength, bacteriostatic and hemostatic properties. The objective of this work is to compare the use of n-butyl-cyanoacrylate with non-absorbable sutures in tissue regeneration by histology and microbiological analysis in mice. (All procedures were approved by the USFQ Ethics Committee on Animal Experimentation, Doc# 2020-001). <h3>Methods</h3> Two cuts of 1 cm were perfomed in the dorsal skin of each mouse: one cut was bonded by simple suture (control), and the other with tissue adhesive (Histoacryl). Albino mice were anesthetized before the surgical procedure; analgesics were provided in the water after the surgery to minimize pain. After 48 hours of the surgical procedure, the mice were euthanized and biopsies of 2 cm2 were collected for each cut. Three mice were used for histological evaluation and two for microbiology tests. Assays were repeated 4 times. For microbiology tests, samples were resuspended in 1 ml of TBS culture broth by vortex. Colony forming units (CFU) were evaluated for two dilutions after incubation on Nutrient Agar for 48 hours. For histological analysis, biopsies were fixed with formaldehyde, cut by a microtome (Leyca RM2155) and stained with trichrome, haematoxylin and eosin. Statistical analysis was performed by Mann-Whitney and Kruskal-Wallis tests using GraphPad Prism software. <h3>Results</h3> No differences were found in the microbiological and histological analysis. <h3>Conclusions</h3> The results showed that there is no significant diference between n-butyl-cyanoacrylate and non-absorbable sutures, no increased risk of microbiological contamination or regenerative improvements were shown.

Tension Suture Fixation of Olecranon Fractures.

Mayo type-IIA olecranon fractures are characterized by a transverse or short oblique fracture without articular comminution or ulnohumeral instability. Traditionally, these fractures are treated with a tension-band wiring technique. Despite good rates of fracture union, tension-band wiring is associated with a reoperation rate of 30% to 60%, usually for removal of prominent metalwork. The tension suture technique was developed as an alternative method of fixing Mayo type-IIA fractures using only high-tensile braided nonabsorbable number-2 sutures, with the aim of reducing the reoperation rate associated with tension-band wiring without compromising outcomes. The tension suture technique has subsequently become the only technique we use when treating these fractures. The patient is positioned in the lateral decubitus position under general or regional anesthesia. A direct posterior approach is made, centered over the fracture. The fracture is identified, cleared of hematoma, and reduced with use of a large, pointed reduction clamp to provide interfragmentary compression. A 2.5-mm transverse drill hole is made through the ulna distal to the fracture site. Two sets of number-2 braided nonabsorbable sutures are utilized. The first sutures are passed lateral to medial through the drill hole and used to grasp the medial triceps insertion onto the proximal fragment, then passed back through the transverse drill hole from medial to lateral and used to grasp the lateral triceps insertion onto the proximal fragment. The suture ends are tensioned to remove slack and tied on the lateral aspect of the olecranon. The second sutures are then passed lateral to medial through the transverse drill hole but this time used to grasp the posterolateral triceps insertion on the proximal fragment, then re-passed through the transverse drill hole from medial to lateral, and finally used to grasp the posteromedial triceps insertion. The suture limbs are tensioned and tied on the lateral aspect of the ulna next to the first suture. The clamp is removed, and the construct is tested under full range of motion to ensure there is no evidence of gapping. Fluoroscopy is utilized to confirm reduction before the wound is irrigated and closed in a standard fashion. Mayo type-IIA fractures may be treated nonoperatively in frail or low-demand patients. Surgical treatment is traditionally performed with the tension-band wiring technique, but plate or intramedullary fixation may also be utilized. This technique negates the metalwork-related complications associated with all other surgical techniques for this fracture type. In a recent study comparing the tension suture technique with tension-band wiring and plate fixation for Mayo type-IIA fractures, the tension suture technique had a significantly lower reoperation rate compared with tension-band wiring and a lower complication rate compared with plate fixation. The tension-suture technique is primarily for Mayo type-IIA fractures without ulnohumeral instability or marked articular comminution.Ensure the transverse tunnel in the ulna is at least 3 cm distal to the fracture site and 1 cm anterior to the dorsal cortex of the ulna in order to prevent fracture of the tunnel.Grasp as much of the triceps tendon as possible when placing the sutures through the proximal fragment to prevent pull-out.Tension and tie the sutures with the elbow semi-extended to prevent the construct slackening in elbow extension and to facilitate interfragmentary compression during flexion.

Laparoscopic repair of giant hiatal hernia for elderly patients.

BackgroundGiant hiatal hernias are more common in older patients and can significantly reduce their quality of life. However, open surgery for patients of advanced age is thought to be associated with high morbidity and mortality. The aim of this retrospective study was to evaluate the safety of laparoscopic giant hiatal hernia repair for elderly patients as compared to younger patients.MethodsFrom January 2015 to January 2020, 152 consecutive patients underwent laparoscopic mesh repair of giant hiatal hernia. Two cases of missing follow up were excluded. Patients were divided into an elderly group (N=62, age ≥75) and a younger group (N=88, age <75). Interrupted non-absorbable suture was applied for crus closure and as an additional reinforcement, the mesh was fixed with absorbable tacks or medical glue. Procedure-related complications, score-based variation tendency of symptoms, gastrointestinal quality of life index (GIQLI), mortality, recurrence rate, hemoglobin, and the use of PPI were investigated.ResultsAll patients underwent the procedure uneventfully. Dor fundoplication was used in 39 patients (62.9%) in the elderly group and 44 (50.0%) in the younger group and no case was converted to open. While the elderly group had a significantly higher percentage of ASA Class level 3 and cardiovascular and cerebrovascular diseases as compared to the younger group, the two groups had similar operative times, intraoperative blood loss, and percentage of intrathoracic stomach. Elderly group patients tended to have higher perioperative complications including pneumonia (3.2%) and atelectasis (3.2%) without statistical significance, as well as transfer to the intensive care unit compared, to younger patients (9.7% vs. 3.2%; P=0.144). The mean post-operative hospital stay was also significantly shorter in the younger group (2.8 days) compared with the elderly group (3.5 days; P=0.001). There was no mortality, recurrence, mesh-related complications such as visceral erosion, adhesion, or severe dysphagia during follow up in the two groups, and both groups demonstrated significant improvement in GIQLI scores and hemoglobin. The percentage of patients who needed PPI was also reduced in both groups.ConclusionsLaparoscopic mesh repair of giant hiatal hernia for elderly patients is safe and effective when performed at experienced centers.

Acute Achilles Tendon Rupture Repair in Athletically Active Patients: Results on 188 Tendons

We report on the outcome of acute Achilles tendon ruptures by a single surgeon using open and percutaneous techniques was performed. This prospective study included 186 patients with 188 ruptured Achilles tendons. A traditional open technique was primarily performed on patients from January 2001 to December 2011. From January 2012 to January 2018, a percutaneous repair was primarily performed. Outcome measures included the Roles and Maudsley (RM) score, ability to perform a single leg heel raise, calf atrophy and return to activity. There were 149 males (average age 42.5 ± 12.7 years) and 39 females (average age 41.7 ± 11.4 years). Of the 188 ruptured tendons (92 repairs on the right Achilles and 96 on the left), 103 were repaired percutaneously and 85 had open repairs. There were 18 (9.6%) complications. Three re-ruptures occurred, one following open and two following percutaneous repairs, all within 12 weeks of the original repair. Two patients developed a Venousthromboembolism (1.0%). Thirteen patients had suture reactions; three infections (1.6%), 11 wound complications (5.8%), and 3 required surgical excision of the suture material (1.6%). Non-absorbable sutures were associated with more wound complications and were more frequently used in open repairs (p = .003). Patients who underwent open repair experienced more wound complications (p = .0001). Patients who underwent percutaneous repair using absorbable suture experienced a lower rate of overall complications (p = .0007). Basketball (n = 29) was the most common sport during which ruptures occurred. Return to activity (RTA) was 8.2 ± 2.9 months. There was no difference for RTA between males and females (p = .54) and RM scores (p= .69), nor surgical technique, and no difference for RTA based on the desired activity (p = .47). 123 of the 188 patients returned to their desired activity (65.5%). There was a statistically significant evidence of a positive association between inability to perform heel-raises and decreased activity (p = .01).

Long-term absorbable versus non-absorbable suture in laparoscopic percutaneous extraperitoneal closure of internal ring for inguinal hernia in children

AimTo compare the results of using long-term absorbable (LTAS) versus non-absorbable suture (NAS) in laparoscopic percutaneous extraperitoneal closure of internal ring (LPEC) for indirect inguinal hernia (IH) in children MethodsProspectively collected data from children undergoing LPEC for IH at our center were retrospectively reviewed to compare group A repaired with NAS (2.0 monofilament polypropylene or braided polytetrafluoroethilene) to group B repaired with LTAS 2.0 polydioxanone. Results481 patients with 499 IHs in group A were compared to 277 patients with 283 IHs in group B. There were no significant differences in terms of age, bodyweight and laterality of IH between the two groups. At a median follow up period of 30 months, the incidence of suture knot reaction (SKR) and hernia recurrence were 3.1% and 1.0% in group A vs. 0% and 6.4% in group B with p = 0.002 and p<0.001, respectively. Monofilament NAS was associated with a low rate of both recurrence and SKR. ConclusionsLPEC repair for pediatric IH using LTAS is associated with no SKR but a higher recurrence rate compared to NAS. Monofilament NAS such as Prolene could be a good choice in LPEC because of its low rate of both recurrence and SKR.

Polydioxanone Sutures Instead of Polypropylene Sutures for Abdominal Closure to Prevent Wound Sinuses

Abdominal closure after laparotomy takes several weeks to get 80% of its previous strength in this periodthe fascial sheath should be hold by sutures. Several materials used in the abdominal closures but the mostcommon suture used is polypropylene, others used nylon, less common used is absorbable sutures but woundsinus is a complication may fellow the use of non-absorbable sutures. For two years we collect 235 patientsin all of them abdominal wall incision was Pfannenstiel, in 133 patients the incision closed by polypropylene(non-absorbable), for other 102 patients the incision closed by polydioxanone (slow absorbable) the resultwas significant for wound sinus formation in polypropylene group but insignificant for hernia, conclusionof the study the polydioxanone look the same strength of polypropylene and may be without wound sinusformation.

Antibacterial functionalization of nylon monofilament surgical sutures through in situ deposition of biogenic silver nanoparticles

Antibacterial coating of nylon monofilament sutures presents difficulties unlike non-absorbable braided sutures due to the nature of nylon material and absence of interstices. To solve these problems, a new technique using in situ deposition of biogenic silver nanoparticles (AgNPs) has been developed to coat nylon surgical sutures. The effect of AgNPs deposition on the surface roughness was observed, with significant reduction in average roughness (9.41 ± 0.96 nm), compared with uncoated sutures (12.35 ± 0.20 nm) (P < 0.05). The ICP-OES analysis of coated sutures revealed total Ag+ concentration of 11.25 ± 0.14 μg/mL, with an AgNPs release of 11.25, 11.27, 19.94, and 24.03% at 1, 3, 5, and 7 days, respectively. The sutures demonstrated bactericidal effects on Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae) wound pathogens with more than 99.9% reduction. The coated sutures indicated stable antibacterial activity against representative Gram-positive and Gram-negative isolates after 12-week storage. Haemolytic evaluation of coated sutures showed less than 1% lysis of human erythrocytes. In addition, coated sutures inhibited lipopolysaccharide-induced nitric oxide generation by 15.46 μM reduction. Cytocompatibility test on L929 fibroblast cells revealed approximately 81% cell viability and promoted cell migration by 51% after 24 h treatment. The study revealed that in situ deposition of AgNPs on nylon monofilament sutures did not alter the mechanical properties of the sutures, but conferred antibacterial and wound healing properties.

Pediatric and adolescent bone-anchored implant. Skin changes and complications

Objective: To assess the contributing factors for development of skin changes and local complications in the pediatric and adolescent population who underwent bone-anchored implantation (BAI). &lt;br/&gt;&lt;br/&gt;Methods: Retrospective chart review of pediatric and adolescent patients (age 017 years) who underwent BAI for mixed hearing loss, conductive hearing loss, and single-sided deafness, at a tertiary care academic center. Demographic, clinical, implant type and surgical variables were collected and analyzed to identify their contribution to the development of skin changes and local complications. &lt;br/&gt;&lt;br/&gt;Results: Thirty-nine BAI surgeries were performed in 28 subjects during the review period. The mean age of implantation was 10.5 3.4 years (516 years). Skin changes and local complications occurred in 61.5% (24/39) of BAIs performed. In total, 75% (18/24) were attributed to local complications, and 25% (6/24) to skin changes. Revision surgery was required in 41.0% (16/39) of cases. The mean age upon revision with either skin changes or local complications, local complications alone, and skin changes alone was 14.6 3.3 years (7.2519), 13.4 4.0 years (7.317), and 16.1 1.2 years (13.817) respectively with no difference between the groups. Among implants with skin changes and local complications the abutment survival was found to be 33.3% at 6.75 years following implantation. No significant difference of demographic and clinical factors was noted when looking at cases with and without skin changes and local complications. Higher rates of skin changes and local complications were noted in two-stage techniques, non-linear incision and the use of absorbable sutures. &lt;br/&gt;&lt;br/&gt;Conclusion: Fewer skin changes/local complications were observed with linear incision/punch technique, single stage, and non-absorbable skin sutures. Abutment survival with skin changes and local complications plateaus at 6.75 years following implantation. The potential need for revision surgery and longer abutment replacement during puberty, presumably when scalp soft tissue thickens, should be considered prior to initial implantation of younger children, with information given to their care givers

Burch kolposüspansiyonu ve abdominal histerektomi sonrası polipropilen sütüre ikincil mesane taşı oluşumu

Bladder calculies are stones or calcified materials found in the bladder. Foreign bodies that come into contact with the urine may cause bladder stones. Examples of foreign body include suture materials, clips, catheters, ureteral stents, urinary incontinence meshes or migration of an intrauterine device. A 63-year-old female patient was admitted to our urology clinic with dysuria, frequent urination and mixed type urinary incontinence for a year. The patient had a history of abdominal hysterectomy and Burch colposuspension two years ago. Computerized tomography of the patient revealed a bladder stone measuring 2.9 x 2.6 cm.The patient underwent cystolithotripsy with Holmium (Ho: YAG) laser. The bladder stone was found to be attached to the bladder wall by a polypropylene suture. The suture material was removed endoscopically. The patient has no complaints during the 2-year follow-up. . The presence of nonabsorbable suture material in the bladder is a well-known cause of urinary tract infection and stone formation, and defined complication of hysterectomy and colposuspension. . Information on the lithogenic properties of various suture materials is unfortunately limited to only in vitro and in vivo animal studies. In humans, experience with stone formation related to suture materials is limited to case reports. It has been observed that lithogenicity is related to the longevity of the suture material and in the studies carried out, it has been observed that the rate of calcification with non-absorbable sutures is higher. Treatment includes disintegration of the stone and removal of the foreign body causing the stone.

Use of Absorbable Cutaneous Sutures Amid the COVID-19 Pandemic

The use of absorbable epicuticular sutures is highlighted as a measure to decrease the number of patient visits, eliminating the risk of additional exposures for patients and medical staff during the COVID-19 pandemic. We present a case where the use of absorbable epicuticular sutures was preferred over non-absorbable sutures. Studies have shown no significant difference in cosmetic outcomes between non-absorbing suture and absorbable suture. Many patients express anxiety over the thought of suture removal, and often ask if the sutures will “dissolve on their own” during the surgery. Use of absorbable top sutures is one way surgeons can help allay this fear, and studies have shown similar patient satisfaction between absorbable and non-absorbable sutures. Additional stress may be prominent during the current pandemic. Dermatologic surgeons should strongly consider the use of absorbable cutaneous sutures during this pandemic, as this likely improves patient and staff safety, and studies have shown similar cosmetic outcomes and patient satisfaction.

Superior Rectus Transposition and Medial Rectus Recession for Treatment of Duane Retraction Syndrome and Sixth Nerve Palsy

ABSTRACT Purpose: To evaluate the outcome of augmented superior rectus transposition (SRT) with medial rectus (MR) recession in patients with Duane Retraction Syndrome (DRS) and sixth nerve palsy. Methods: Twenty four patients (16 DRS and 8 sixth nerve palsy) that underwent the procedure were included. The superior rectus muscle was secured, detached, and re-attached to the sclera along the spiral of Tilaux, adjacent to lateral rectus insertion. A non-absorbable augmentation suture was passed through the sclera, 8 mm posterior to the insertion of the lateral rectus. Results: At the last follow-up, the effect of surgery in decreasing esotropia in both groups was significant (P = .001 for DRS group, P = .002 for sixth nerve palsy). In both groups, abduction deficit improved significantly (P < .001 for DRS and P = .008 for sixth nerve palsy). After the surgery, small, asymptomatic vertical deviation in primary position was induced in five patients (20.8%). Post-operatively, none of the patients complained of torsional diplopia. In the 6-month follow-up, compared with the first postoperative visit, an eso-drift at distance or near developed in 11 patients (45.8%). Of the 11 patients with eso-drift, overcorrection (exotropia of 3–14 PD) was present at the first post-operative visit in 5 cases. Four cases showed an exo-drift (2–5 PD) at distance or near over time. Conclusion: SRT with medial rectus recession improves esotropia and abduction limitation without inducing significant vertical deviations and torsional diplopia. Some of the cases that underwent SRT with MR recession may show an eso-drift. The eso-drift can correct initial exotropia in some cases.

Comparing the Treatment Outcomes of Absorbable Sutures, Nonabsorbable Sutures, and Tissue Adhesives in Cleft Lip Repair: A Systematic Review.

To examine the literature and synthesize the available reports for the best possible option between absorbable, nonabsorbable, and tissue adhesives in cleft lip skin closure. We conducted systematic searches for randomized controlled trials and controlled clinical trials in PubMed, Cochrane, Ovid Medline, and OpenGrey databases. Identified studies were retrieved and assessed for eligibility. All statistical analyses were done with Revman, version 5.4. The intervention considered in this systematic review were techniques of cleft lip repair using resorbable sutures, nonabsorbable sutures, medical adhesives, or any combination of these. The primary outcomes assessed in the trials had to include any combination of the following: wound healing cosmesis and wound healing complications. While secondary outcomes considered were quality of life, direct and indirect costs to patients and health services, and participant satisfaction. Only 6 studies met all inclusion criteria and were selected for qualitative analysis. A more favorable wound healing cosmesis was seen when nonabsorbable suture was used in cleft lip repair compared to absorbable sutures and tissue adhesives (CI, 0.65-4.35). This advantage was overshadowed by the significantly higher prevalence of postoperative complications when nonabsorbable sutures are used. Although the results point to more favorable cosmesis with nonabsorbable sutures and an overall more favorable outcome with either absorbable sutures or tissue adhesives, the 6 selected studies were assessed at an unclear risk of bias; therefore, the results of this study should be interpreted with caution and regarded as low-certainty evidence.

Distal Iliotibial Band Z-lengthening for Iliotibial Band Syndrome

Background: This technique video reviews an iliotibial band Z-lengthening procedure for iliotibial band (ITB) syndrome using a patient case example. Indications: Indications for considering surgical intervention include a diagnosis of iliotibial band syndrome, ruling out other possible etiologies of knee pain, and a minimum of 6 months of failed conservative treatment. Technique Description: There are several surgical techniques described in the literature, although the ITB Z-lengthening procedure is preferred at our institution. This technique uses a “Z”-type incision through the distal ITB to allow lengthening of the ITB and to allow access for surgical debridement of the underlying inflamed bursa. Nonabsorbable suture is then used for a side-to-side repair of the ITB in the elongated position. Results: Complications from this technique are uncommon, and the few published outcomes from this procedure show good clinical results and return to preactivity levels. Discussion/Conclusion: Preoperative planning should include analysis of lower extremity alignment and can include advanced imaging to rule out intra-articular pathology. Diagnostic arthroscopy is typically used at the start of the case for completeness. Distal iliotibial band Z-lenghtening can be a successful surgical option for patients who have failed extensive conservative treatment for iliotibial band syndrome.

An Isolated Transosseous Flexible Suture Frame in the Treatment of Patellar Tendon Rupture Provides Adequate Mechanical Resistance.

Acute patellar tendon ruptures are frequently observed in patients with metabolic comorbidities, and the benchmark treatment is surgical repair. It is desirable not to harm an already fragile biologic environment with sutures and hardware. We aimed to compare the mechanical requirements of an isolated, flexible, high-strength nonabsorbable transosseous suture frame with that of the Krackow suture technique. A total of 12 cadaveric pieces were randomized into two groups: the isolated flexible frame group (n = 6) and the standard Krackow fixation group (n = 6). A traumatic rupture of the patellar tendon was performed, and a transosseous displacement sensor was installed on a validated biomechanical system. Gap formation was measured during 50 cycles of flexion and extension with traction on the quadriceps (250 N). Subsequently, specimens underwent progressive loading in a fixed flexion position until failure occurred. The data were analyzed using nonparametric statistical tools with a significance level of 5%. The isolated frame group had a smaller gap formation (1.7 mm) than the Krackow group (3.4 mm; P = 0.01). No significant difference existed in the median failure end points of the two groups (676 and 530 N, respectively; P = 0.11). Patellar tendon repair using an isolated, transosseous, flexible, suture frame outperformed using the traditional Krakow repair technique in gap formation. Further studies are needed to determine if this will result in better functional outcomes or fewer clinical failures. Level IV, experimental case series.

Comparison of suture material and technique of closure of subcutaneous fat and skin in caesarean section

Background: A large number of women undergo caesarean section throughout the world. These women pass through a period of post operative pain and a morbidity period. These women translate into a substantial portion of population and hence there is a load on the financial resources of healthcare system. Use of the appropriate technique to approximate the wound after caesarean section would not only avoid financial load but also help in early recovery of the patient. Aim: The aim of this study is to compare the effects of alternative techniques for closure of subcutaneous fat and skin on maternal health and use of healthcare resources in caesarean section.Material & Methods: The present study was conducted in department of Gyane and Obs. department of J. L. N. Medical College, Ajmer. In this study 200 cases were included during period of July 2020 to December 2020. Patients undergoing Caesarean section were divided in two groups of one thousand patients each. In all the patients, after stitching the uterus, the rectus sheath was stitched with thread vicryl No.1 (synthetic absorbable braided sutures with polyglycolic acid, polycaprolactone and calcium stearate coating), using a round body needle. Then the patients were divided into two groups. In group I, vicryl No.1 thread used in stitching of the rectus sheath was continued into the skin with application of subcuticular stitches, after securing the edges with a knot. In group II, after stitching the rectus sheath with vicryl No. 1, the thread was cut and interrupted sutures were applied in subcutaneous fat with thread vicryl No. 2. Skin was stitched with subcuticular stitches using proline 2, a non-absorbable propylene suture. Results: In our study post CS complications were found in 14% of cases with wound infection has been the most common complication occurring in 6.5% of cases studied. Other complication included were wound seroma (4%), wound dehiscence (2%), wound haematoma (2%), and suture sinuses (0%).Conclusion: On the basis of this study, it was concluded that inspite of using best closure technique and keeping in mind the patient related factors complication arising after C.S. are frequent and most commonly associated with non closure of fat.

Right pulmonary artery anastomosis. Pulmonary artery anastomosis was performed with a simple continuous suture with 6-0 monofilament non-absorbable sutures

Right pulmonary artery anastomosis. Pulmonary artery anastomosis was performed with a simple continuous suture with 6-0 monofilament non-absorbable sutures

Right pulmonary vein anastomosis. Staple lines of the right superior and inferior veins were amputated and the bridge of them was transected to prepare atrial cuff for anastomosis in the recipient. Then left atrium cuffs of the donor and recipient were anastomosed with a continuous suture with 5-0 monofilament non-absorbable sutures

Right pulmonary vein anastomosis. Staple lines of the right superior and inferior veins were amputated and the bridge of them was transected to prepare atrial cuff for anastomosis in the recipient. Then left atrium cuffs of the donor and recipient were anastomosed with a continuous suture with 5-0 monofilament non-absorbable sutures

Scapulothoracic fusion using nonabsorbable suture fixation: surgical technique and review of the literature

Historically, scapulothoracic fusion (STF) is performed using steel wire and plate construct fixation. The purpose of this study is to report a recent fusion achieved through ultra-high-molecular-weight polyethylene-reinforced suture fixation as well as to perform a systematic literature review of techniques, fusion rates, complications, and reoperation. Patient data were gathered from chart review and clinical encounters. For the review, MEDLINE, Embase, and Ovid databases were queried for STF cases. Thirty articles reporting on 386 fusion procedures were included. Including this patient, 5 of 387 (1.3%) STFs have been attempted with fiber suture. Fusion rates of metal-only constructs is 90.8% (346 of 381) with 11.3% (43 of 381) requiring wire removal or trimming because of symptomatic hardware and 7% (27 of 381) causing a postoperative pneumothorax. Although a small sample size, all fiber-suture constructs have achieved union without implant removal and without pneumothorax development. In this patient, fusion was determined radiographically at 6 months with substantial improvement in pain level and function. Scapulothoracic fusion has benefit to patients to have failed other management options for winged scapula, most commonly those with neurologic trauma or facioscapulohumeral muscular dystrophy. With advancements in surgical options, fiber-suture offers an alternative to steel wire to achieve fusion. Further cases with longer term follow-up are needed to determine if significant differences in outcomes exist between constructs.

The prevention of extraction site incisional hernia after robotic-assisted radical prostatectomy.

Extraction site incisional hernia (IH) has been recognized as an important complication in minimally invasive procedures but has not been as well characterized following robotic-assisted laparoscopic prostatectomy (RALP). Approximately 29% of IH required surgical repair. A number of techniques have been utilized to reduce the rates of IH following minimally invasive procedures. First, off-midline extraction was investigated, this did not demonstrate a reduction in incisional hernia rates. Recently, supra-umbilical transverse incisions have been utilized to extract prostate specimen and this method decreased the extraction site IH rate compared to the vertical midline incision. In addition, the choice of fascial closure technique and choice of the suture may influence the incidence of extraction site IH. For example, studies showed that abdominal fascial closure using a nonabsorbable suture and a continuous running suture technique decreased IH rate from 32 to 17%. Finally, "the small bites technique" has been recommended to reduce hernia incidence after midline fascial closure following a randomized controlled trial (RCT) which demonstrated the superiority of the small-bite technique. In summary, a supra-umbilical transverse incision to extract the specimen was shown to decrease the rate of extraction site IH. In vertical midline incisional closure, the small bites technique with slowly- or non-absorbable suture, such as #0 or 2-0 PDS II with SH or CT-2 needle (26mm arch length), reduces the IH rate. Urologists should consider this data to reduce the risk of IH following RALP.