Nonabsorbable Sutures Research Articles

Arthroscopic Repair of a “Floating” Posterior Inferior Glenohumeral Ligament

Background: Combined posterior glenoid labrum lesions with posterior humeral avulsion of the glenohumeral ligament, also known as the “floating” posterior inferior glenohumeral ligament (PIGL), occur infrequently. These combined lesions are frequently missed on magnetic resonance imaging in the workup of posterior shoulder instability. Correct identification of the “floating” PIGL lesion allows for appropriate preoperative planning and treatment to decrease the risk of recurrent posterior shoulder instability. Indications: A “floating” PIGL lesion is a cause of posterior shoulder instability and demonstrates increased translation when compared with isolated labral lesions. Surgical repair of an acute “floating” PIGL lesion with concomitant superior labral tear is described. Technique Description: The patient is placed in the lateral decubitus position. Standard posterior and anterior portals are created. In this case, a superior labral tear with anterior labral tear extension was also identified and repaired. The posterior labrum was repaired prior to the posterior humeral avulsion of the glenohumeral ligament (HAGL). The torn posterior labrum is mobilized and glenoid bony bed prepared. Short, 2.9-mm biocomposite knotless suture anchors loaded with suture tape are used for labral fixation. A 70° arthroscope is used to visualize the posterior HAGL from the anterior cannula and an additional posterior inferior portal established. The footprint of PIGL on the humerus is identified, debrided, and two 3.0-mm anchors loaded with suture placed. The sutures are passed through the capsule and PIGL and tied in a mattress pattern external to the capsule and ligament. The posterior portals are closed with nonabsorbable suture. Results: While few outcomes are described in the literature for the “floating” PIGL, the literature suggests good outcomes following surgical repair. Conclusion: The “floating” PIGL lesion is a rare cause of posterior shoulder instability. It is important to perform a thorough evaluation for concomitant pathology in patients with posterior shoulder instability as multiple structures can be injured. Arthroscopic repair of the posterior labrum and posterior humeral avulsion of the glenohumeral ligament can be performed to restore posterior stability to the shoulder in the setting of a “floating” PIGL.

A COMPARATIVE STUDY OF STAPLERS VERSUS HAND SEWN ANASTOMOSIS IN INTESTINAL SURGERIES

INTRODUCTION: Intestinal anastomosis is a surgical procedure to establish communication between two separated portions of the intestine. This procedure restores intestinal continuity after removal of a pathological condition affecting the bowel. Intestinal anastomosis can be performed by a hand-sewn technique using absorbable or non-absorbable sutures, mechanical stapling devices. Sutured anastomosis (hand-sewn technique) is the commonly used method. The newer stapling devices for intestinal anastomosis has provided an alternative option to perform rapid anastomosis.1 Various studies have contradictory results in terms of duration of procedure, post operative recovery and anastomotic leak. There are insufcient evidence to demonstrate superiority of either technique and more studies are needed to demonstrate the superiority of either technique. AIM MATERIAL AND METHODS:: To study and compare the effectiveness of staplers vs hand sewn anastomosis in Intestinal surgeries. A comparative observational study Consists of patients presenting with need of bowel resection and anastomosis inclusion criteria at Apollo Hospital Gandhinagar, Gujarat. The patients who are admitted for elective as well as emergency resection & anastomosis of small and large intestines for various illnesses are selected after thorough clinical examination and investigations to conrm the diagnosis co- morbid conditions. Details were recorded in the proforma prepared. : 62.5% complications in comorbid subjects and 37.5% complications in non comorbid subjects.RESULTS The mean of anastomotic time for hand sewn group was 27.8 minutes whereas for the stapler group it was 9.0 minutes mins .With respect to return of bowel sounds, mean time was 46.32 hours in the hand sewn group and 35 hours in the stapler group Mean day of hospitalization was 8.16 days in hand sewn and 7.8 days in stapler technique. mean time taken for resumption of oral feeds the was 66.96 hours in hand sewn group and was 59.52 hours in stapler group .hand sewn group had total ve complications(20%), whereas stapler group had three complications(12%) Both the groups did not have any mortality. The mean cost of hand sewn anastomosis is 717.4 Rs which is signicantly less than mean cost of stapled anastomosis which is 33,754 Rs. : Stapler anastomosis signicantly reduces operative time and time taken for return of normal bowel sounds.CONCLUSION Because of the shortened total operating time in the stapled anastomosis .There is increased risk of overall complications in patients having co- morbidities in both hand sewn and stapled anastomosis. Mechanical staplers are far more costly than suture materials. Stapling technique can be used safely and effectively

Paper 41: Suture-Bridge Fixation of Osteochondral Fractures and Osteochondritis Dissecans in the Knee: Excellent Rates of Early Lesion Stability and Osseous Union

Objectives:Preservation of articular cartilage in the setting of acute or chronic injury in the knee is paramount for long-term joint health. Achieving osseous union, minimizing implant related injury, and eliminating the need for reoperation for osteochondral fracture lesions (OCL) and osteochondritis dissecans (OCD) remain a challenge for the orthopedic surgeon. To evaluate osseous and chondral integration following a suture and non-metallic anchor (suture-bridge) construct utilizing magnetic resonance imaging (MRI). A secondary purpose was to assess the outcomes and short-term complications of suture bridge fixation of OCL and OCD in the knee.Methods:Consecutive patients (n=39, 41 knees) treated within a single academic sports medicine institution who underwent suture-bridge fixation of an OCL or OCD of the knee from initiation of the technique in 10/2019 through 03/2021 were reviewed with IRB approval. The suture-bridge technique employed 1.5 or2.9mm bioabsorbable knotless anchors (avg n= 3.93; 3-6) placed on the outside margins of the lesion with multiple strands (2-8) of hand-tensioned absorbable (87.5%; #0 or #1Vicryl) or non-absorbable (2-0 braided polyester) bridging suture. A minimum of six months follow up to assess bony union was required for inclusion, resulting in 40 knees in 38 patients available for study. Demographics, pre-operative MRI lesion characteristics, including lesion type (OCL vs OCD), presence of bone in within the fragment, size, and location, were documented. Healing was assessed by radiographs and MRI, with MRI obtained on all OCDs and any chondral-only OCL lesions. MRI was available on 33/40 (82.5%) knees within one year of surgery and was rated for lesion healing: Full Union = 100% cancellous or cancellous-chondral lesion continuity, Stable Union = >50% continuity with some fibrous tissue present, Un-united = < 50% continuity and extensive fibrous signal or fluid below the lesion. Complications, and rates and timing of return to sport (RTS) were evaluated. For assessment of early pain and functional improvement in the setting of isolated osteochondral treatment (without confounding concurrent patellar instability, or other treatment in conjunction with OCL), KOOS patient reported outcomes were analyzed in the OCD cohort at 6 and 12 months.Results:33 (82.5%) of all lesions demonstrated Full Union and no lesions failed treatment. MRI assessment of healing (5.8 months; 3-12 months) demonstrated 9 (64.3%) OCDs with Full union, 5 (35.7%) OCDs with Stable union, and none un-united (Figure 1); while OCLs demonstrated 17 (89.5%) with Full union, 2 (10.5%) with Stable union, and none un-united. (Figure 2) All 7 bony OCL without an MRI demonstrated radiographic union. 30 (75%) lesions returned to sports at an average of 6.5 months (3.8-10.2). KOOS Daily Living, Pain, Quality of Life, and Symptom scores all demonstrated significant improvement from baseline at 6months and 1 year. (Table 2). There were 2 (5%) complications consisting of re-operation for marginal chondroplasty on otherwise stable lesions, and no re-operations for failure or revision of the suture-bridge construct.Conclusions:In this series of OCL and OCD of the knee, suture-bridge fixation demonstrates excellent rates of MRI and radiographic union and good early outcomes with minimal short-term complications. This technique may be utilized for lesion salvage as preferred over loose body removal and marrow-stimulation and may have significant benefits in comparison to metallic and non-metallic screw/tack constructs in the treatment of these challenging lesions. Longer term follow-up and investigation is warranted.UPLOAD-https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/96288f30-99be-431a-9937-0218d3245043/1/Suture_Bridge_AOSSMFinalfigures.docx

Unilateral pectineal suspension - A new surgical approach for apical correction of pelvic organ prolapse.

There are numerous vaginal and abdominal surgical approaches for the treatment of pelvic organ prolapse (POP). Even the standard techniques show great variability due to modifications depending on anatomy, available instruments and materials. Recently, the role of hysterectomy in prolapse surgery as well as the use of synthetic meshes have been questioned. Here, we present a standardised mesh-free minimally invasive pelvic floor reconstruction technique with uterus preservation. Unilateral pectineal suspension (UPS) is carried out in five defined steps with the use of the da Vinci Xi ® surgical system. The desired anatomical result is simulated by intraoperative uterus manipulation. The cranial part of the pectineal ligament is used for lateral fixation. A non-absorbable suture is placed between the pectineal ligament and the anterior cervix to suspend the uterus in its natural anatomical position. For outcome measurement, degree of prolapse was assessed pre- and postoperatively according to the POP-Q system. Unilateral pectineal suspension offers several advantages. Medial tension-free positioning of the uterus is achieved. The use of the cervix as fixation structure allows for excellent pelvic floor support and stable results. Normal pelvic floor mobility and natural axis of the vagina are restored. Unilateral pectineal suspension is an efficient minimal-invasive mesh-free procedure which allows uterus preservation and offers reliable level I support respecting the physiological pelvic anatomy. In addition, there is no need for ureteral dissection or bowel manipulation. The technique offers clinical standardization and can easily be integrated into the spectrum of modern surgical POP repair.

A BURST-BAUS consensus document for best practice in the conduct of scrotal exploration for suspected testicular torsion: the Finding consensus for orchIdopeXy In Torsion (FIX-IT) study.

To produce a best practice consensus guideline for the conduct of scrotal exploration for suspected testicular torsion using formal consensus methodology. A panel of 16 expert urologists, representing adult, paediatric, general, and andrological urology used the RAND/UCLA Appropriateness Consensus Methodology to score a 184 statement pre-meeting questionnaire on the conduct of scrotal exploration for suspected testicular torsion. The collated responses were presented at a face-to-face online meeting and each item was rescored anonymously after a group discussion, facilitated by an independent chair with expertise in consensus methodology. Items were scored for agreement and consensus and the items scored with consensus were used to derive a set of best practice guidelines. Statements scored as with consensus increased from Round 1 (122/184, 66.3%) to Round 2 (149/200, 74.5%). Recommendations were generated in ten categories: consent, assessment under anaesthetic, initial incision, intraoperative decision making, fixation, medical photography, closure, operation note, logistics and follow-up after scrotal exploration. Our statements assume that the decision to operate has already been made. Key recommendations in the consent process included the discussion of the possibility of orchidectomy and the possibility of subsequent infection of the affected testis or wound requiring antibiotic therapy. If after the examination under anaesthesia, the index of suspicion of testicular torsion is lower than previously thought, then the surgeon should still proceed to scrotal exploration as planned. A flow chart guiding decision making dependent on intraoperative findings has been designed. If no torsion is present on exploration and the bell clapper deformity is absent, the testis should not be fixed. When fixing a testis using sutures, 3 or 4-point is acceptable and non-absorbable sutures are preferred. We have produced consensus recommendations to inform best practice in the conduct of scrotal exploration for suspected testicular torsion.

Comparison of scar outcomes of alar flare region using absorbable and non-absorbable sutures: a single-blind study

ObjectiveFormation of scar on the face after septorhinoplasty may disturb the patient due to cosmetic concerns. One of the main factors affecting scar outcomes is probably the suture material used. The aim of this study was to examine the effect of different suture materials on scar outcomes of alar base in patients undergoing septorhinoplasty. MethodsThirty-one patients who underwent alar base intervention during primary septorhinoplasty were divided into two groups according to the suture material used as the Polypropylene group (n = 16), (Polypropylene, Prolene 6/0; Ethicon Inc., Somerville, NJ, USA) and the Polyglactin group (n = 15), (Irradiated polyglactin 911, Vicryl Rapid™ 6/0; Ethicon Inc., Somerville, NJ, USA). The scar outcomes of alar base were compared between the Polypropylene and Polyglactin groups. The modified Stony Brook Scar Evaluation Scale was used to measure wound healing results at one and 12-months postoperatively for objective evaluation. Patient satisfaction questionnaire was used for subjective evaluation. ResultsThere were no statistically significant differences in the Stony Brook Scar Evaluation Scale and patient questionnaire scores between Polypropylene and Polyglactin groups. Irradiated Vicryl Rapid had poor cosmetic outcomes in the alar base when compared to polypropylene, indicating no statistically significant difference. ConclusionBoth sutures can be used for closure of alar base considering their advantages and disadvantages, in patients undergoing septorhinoplasty. Level of evidenceTreatment Benefits; Level 2 (Randomized Trial).

Vesicovaginal fistula with bladder and vaginal stone.

IntroductionIn developing countries, Vesico-vaginal fistula (VVF) results following obstetric trauma or iatrogenic during hysterectomy. Large calculus associated with VVF is relatively rare, with the risk factor are presence of foreign body, urinary tract infection, and prolonged duration of disease. Most bladder stones can be found among patients who are bedridden, indwelling urethral catheter, bladder outlet obstruction, infection, and other similar characteristic. We report a case of VVF with bladder and vaginal stone in 37 years old woman and reviews the evaluation and treatment and highlights the role of the healthcare team in managing patients with this condition.Presentation of caseA 37-year-old, P2A0, woman with a history of hysterectomy three years ago. Intermittent small amounts of watery vaginal discharge developed 1,5 years after the operation. A physical examination revealed mild tenderness over the suprapubic area and no evidence of uterine prolapse. Cystography computed tomography scan with contrast confirmed a fistula vesicovagina with a connection between posterosuperior wall of vesica urinaria and anterosuperior wall of vagina with vesicolithiasis, size 15 × 26 × 14 mm and two vaginal stone with size of 7 × 12 × 17 mm and 4 × 4 × 5 mm. Cystoscopy revealed a grayish stone identified in supratrigone with size of 30 × 12 mm.DiscussionA hanging intravesical stone on the dome of urinary bladder is scarce, possibly caused by any synthetic and non-absorbable suture material inside of the bladder were encrusted forming a bladder stone. Important risk factors known, which is specific in developing countries, are poor socioeconomic status, malnourishment, low literacy rate, early marriage and childbearing, and inadequate obstetrical care.ConclusionAlthough the incidence of VVF accompanied by hanging vaginal stone and a large bladder stone is scarce, reports of any case regarding this study can be beneficial to other studies. Due to its harmful effect, the usage of non-absorbable sutures material during surgery isn't suggested. Hence, the absorbable suture material usage with careful dissection is suggested for any gynecological or pelvic surgery.

Total Elbow Arthroplasty in the Context of an Olecranon Nonunion: A Surgical Technique and Report of Three Cases.

The deficiency of the triceps tendon has been considered a relative contraindication to performing a total elbow arthroplasty. One of the conditions that may compromise triceps integrity is the presence of an olecranon non-union (ON). In this scenario, the placement of a total elbow arthroplasty in a patient with end-stage elbow arthritis is a complex problem to be solved. The aim of this study is to describe the surgical technique for the placement of a TEA in the context of a previous ON and to report the results of three cases. Surgical technique: the focus of the nonunion is identified, and the olecranon fragment is proximally reflected with the triceps tendon to allow accurate exposure of the medullary canal of the ulna and easy access to the joint. With the elbow in a fully flexed position, the previously assembled test prosthesis is placed and the proximal ulna fragment should then be reduced to match the distal ulna. Osteosynthesis with a tension band technique was performed at 45° of elbow extension. A non-absorbable Krackow suture (Ti-Cron 2-0) from the triceps's tendon to the hole of the wire in the distal ulna is applied to decrease the triceps tension traction. Bone grafting is performed when a persistent gap is present at the fracture site following reduction. This technique enables us to achieve a stable elbow with little pain and maintains the extensor apparatus's continuity.

New surgical model to induce irreversible liver fibrosis by surgical closure of major duodenal orifice in dogs

This study was conducted to induce and evaluate irreversible hepatic fibrosis in dogs by surgical closure of the major duodenal orifice. The study was performed on six healthy local adult dogs. Irreversible hepatic fibrosis was surgically induced in all animals by surgical closure of major duodenal papilla using non-absorbable suture material for 60 days. Induced hepatic fibrosis was evaluated by clinical, ultrasonographical examination, laboratory and histopathological methods. The clinical manifestation of the jaundiced dogs showed reduced food intake, pale-yellowish mucus membrane, inflammatory signs of wound site and severe post-operative pain. Biochemically, there was significant increased values of the aspartate aminotransferase , alkaline phosphatase , alanine aminotransferase , indirect bilirubin, direct bilirubin and total bilirubin especially during first two days after surgery followed by a gradual decrease of these values until the end of the but still higher than normal values. Ultrasonographic examinations showed abnormal change in the liver tissue such as increase in both size and wall thickness of the gall bladder and mottled heterogeneous appearance of the liver during the first two weeks following the surgical induction of the hepatic fibrosis and lasted until the end of the study. Histopathological evaluation of liver samples revealed necrosis of hepatocytes and deposition of eosinophilic material, infiltration of inflammatory cells, recent thrombus in the hepatic vein, fatty change. In conclusion, surgical induction of irreversible hepatic fibrosis in dogs was feasible technique by surgical closure of major duodenal papilla and the results were confirmed by the clinical, ultrasonographical, laboratory and histopathological examination.

Effectiveness of Bovine Tunica Vaginalis Powder in the Prevention of Tendon Adherence Following Tendon Repair Process in Bucks

The current study was designed to investigate the efficacy of lyophilized bovine tunica vaginalis powder on peritendinous adhesion of induced defect in superficial digital flexor tendon (SDFT) in goats. The study was carried out on 18 adult bucks, the surgical procedure was done under highly aseptic conditions. Prior to surgery, animals were sedated by intramuscular injection of 2 % xylazine in a dose 0.5 mg/kg body weight, then the site of the operation is anesthetized by linear infiltration of 2% lidocaine hydrochloride. The surgical incision is made on the skin on the palmer surface of the metacarpal bone of the left forelimb to expose the (SDFT), a (0.1 depth, 0.2 width, and l Long) cm defect is made on the exposed tendon, this gap is filled with drops of sterile normal saline in (9) animals, and mentioned as a control group, while the gap of the rest (9) animals is filled with the lyophilized powder as treated group. Subcutaneous tissue was closed using absorbable suture material by simple continuous suture technique, and a simple interrupted suture mattress using non-absorbable suture material for closing the skin. The macroscopic findings exhibited a significant difference in adhesion scores between the 2nd, and 3rd periods of assessment post-operation in the first and second groups, with no significant differences between groups. The conclusion of this study is the tunica vaginalis scaffold has no obvious effect on decreasing adhesion between a tendon and surrounding tissues.

Skin Closure with Vicryl Vs Prolene in Day Case Surgeries

Objective: To compare the post-operative outcomes after skin closure with Vicryl as compared to Prolene in paediatric day case surgeries. Study Design: Comparative Cross-sectional Study Place and Duration of Study: Department of Paediatric Surgery, Children Hospital, Pakistan Institute of Medical Sciences, Islamabad for six months (1st November,2021 to 30th April,2022) Patients and Methods: A total of sixty patients under the age of 12 years, who presented for day-case surgeries were divided into two groups: Vicryl (group A) and Prolene (group B). A single surgical team performed all the surgeries. The incidence of outcomes, such as pain, hematoma, infection, suture breakage and keloid formation was recorded after the procedure. At the 30th post-operative day, the scar assessment scale was used to evaluate the wound's healing. Results: Comparitive Cross-sectional study was conducted on 60 patients who underwent surgeries, having 30 in each group. Age and scar score for both the groups were compared. There was no sigfnificant difference observed for age p = 0.628 and it was significant for scars p = 0.007. Incidence of pain and infection was not statistically significant p ≥ 0.05. No hematoma, keloids and suture breakage were observed in both the sutures. Success Rate of Vicryl was 76.7% and that of Prolene was 93.3%. Success was positively correlated with scar r = 0.685. Conclusion: In our paediatric samples, we analyzed and concluded that prolene suture was better as compared to vicryl in terms of pain and infection. Keywords: Absorbable sutures, Day-case surgeries, Non-absorbable sutures, Prolene, Vicryl.

Is there any advantage in the use of absorbable sutures in congenital penile curvature surgery performed in childhood?

ObjectiveTo compare the long-term outcomes of corporeal plication using absorbable versus nonabsorbable sutures for the treatment of congenital penile curvature in childhood. Materials and methodsForty seven children who underwent congenital penile curvature repair between 11 and 140 months of age were included in the study. All children were operated on using the incisional plication technique and were divided into two groups: Absorbable-polyglactine (PLG, n=23, 48.93%) and nonabsorbable-polypropilen (PP, n=24, 51.06%) according to the suture material used for plication. Surgical outcomes were compared between groups. ResultsMean follow-up period was 19.02±4.66 months. There was no significant difference between the mean age of the children in two groups included in the study (PLG=41.39±34.63 months vs PP=53.66±37.42 months, p=0.250). There was no significant difference in penile straightening degree between the two groups in the postoperative follow-up (PLG=27.39±6.88 vs PP=31.08±6.38, p=0.06). Similarly, there was no significant difference between two groups in terms of postoperative curvature recurrence (p=0.681). However, palpable suture knots in the plication area was significantly higher in the PP group in the postoperative period (25.0% vs 4.3%, p=0.047). ConclusionThe use of absorbable sutures in congenital penile curvature surgery in childhood has similar success rates with the use of nonabsorbable sutures and provides lower complications that are secondary to nonabsorbable sutures.

Comparative study between continuous and interrupted suturing for rectus sheath closure in exploratory laparotomy

Background: Exploratory laparotomy is a major surgical procedure. Midline laparotomy is the most common technique of opening the abdomen as it is simple, provides adequate exposure to all four quadrants, and affords quick exposure with minimal blood loss. Laparotomy wounds have been closed in various ways in terms of continuous versus interrupted closure, single layer versus mass closure, and absorbable versus non-absorbable sutures. Aims and Objectives: The aim of the study was to find out the technique of rectus sheath closure in patients undergoing exploratory laparotomy that can reduce the burden of complications in post-operative period. Materials and Methods: It is a hospital-based prospective randomized observational study which was conducted in a rural-based tertiary care hospital and medical college with a time frame of about 1½ years. A total number of 74 patients of adult age group (21–70 yrs) admitted in general surgery ward of Bankura Sammilani Medical College and Hospital, undergoing exploratory laparotomy. Results: Thirty-seven (50%) patients of midline laparotomy were closed in continuous technique. Rest 37 (50%) patients were closed in interrupted technique. The hospital stay was similar in both groups. There was no significant difference in incidence of wound infection (P=0.4687). Wound dehiscence and requirement of burst abdomen repair was significantly higher in continuous suture group as compared to interrupted suture group, but mean closure time (P&lt;0.0001) and mean suture length (P=0.0436) were significantly higher in interrupted suture group. Conclusion: The major complication of emergency laparotomy is wound dehiscence which leads to increased morbidity and subsequent requirement of re-operation of burst abdomen and hospital cost. In our study, we found that interrupted suturing method of abdominal closure is better in respect to major post-operative complications though it requires more suture length and time.

Laparoscopic repair of suprapubic incisional hernia using a modified transabdominal partial extraperitoneal technique.

Herein, we describe a novel technique for suprapubic incisional hernia repair using a modified transabdominal partial extraperitoneal technique in four patients. We implemented four-trocar placement to achieve a coaxial setting for the pubic bone. The pubic bone and Cooper's ligament were exposed by an incision dorsal to the hernial orifice, and the bladder was mobilized as an inferior peritoneal flap. The retropubic space was dissected approximately 5cm from the hernial defect and this was closed with an intracorporeal non-absorbable barbed suture. A mesh was introduced into the intra-abdominal cavity, positioned to cover the closed defect, and tied to Cooper's ligament, the pubic bone, and rectus muscles. The dissected peritoneal flap was reattached to the abdominal wall by tacking and suturing. The modified transabdominal partial extraperitoneal technique for suprapubic incisional hernia repair may contribute to decreased recurrence and seroma formation.

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.

Electrospun Medical Sutures for Wound Healing: A Review.

With the increasing demand for wound healing around the world, the level of medical equipment is also increasing, but sutures are still the preferred medical equipment for medical personnel to solve wound closures. Compared with the traditional sutures, the nanofiber sutures produced by combining the preparation technology of drug-eluting sutures have greatly improved both mechanical properties and biological properties. Electrospinning technology has attracted more attention as one of the most convenient and simple methods for preparing functional nanofibers and the related sutures. This review firstly discusses the structural classification of sutures and the performance analysis affecting the manufacture and use of sutures, followed by the discussion and classification of electrospinning technology, and then summarizes the relevant research on absorbable and non-absorbable sutures. Finally, several common polymers and biologically active substances used in creating sutures are concluded, the related applications of sutures are discussed, and the future prospects of electrospinning sutures are suggested.

Non–absorbable versus Absorbable Sutures for Medial Rectus Advancement in Consecutive Exotropia, a Pilot Randomized Clinical Trial

ABSTRACT Purpose To compare non–absorbable and absorbable sutures for medial rectus advancement in consecutive exotropia Methods In a pilot randomized clinical trial, 40 subjects with consecutive exotropia >15 PD that underwent unilateral medial rectus advancement with or without resection were randomly assigned to two groups: using non-absorbable (polyester) suture in the non-absorbable group and absorbable (vicryl) suture in the absorbable group. The success rate was defined as the final postoperative angle of deviation <10 PD. Results Thirty-three patients (18 in the non-absorbable and 15 in the absorbable group) had completed the study. At last follow-up, the distance deviation improved from 29.2 ± 15.5 to 7.6 ± 7.9 in the non-absorbable group and from 25.9 ± 8.4 to 8.1 ± 10.7 in the absorbable group. The near deviation improved from 31.4 ± 15.9 to 7.2 ± 8.0 in the non-absorbable and from 29.0 ± 7.6 to 6.8 ± 11.9 in the absorbable group. The amount of the final correction of the distance and near deviation was not statistically different between the groups (P = .80 and P = .99, respectively). At the final examination, the exoshifts for distance and near were not statistically different between 2 groups (p = .61 and 0.54, respectively). At the final examination, the success was obtained in 12 patients (66.7%) and 8 patients (53.3%) in the non-absorbable and absorbable group, respectively (p = .73). Conclusion In our study, there was no statistical difference in success rate or exoshift between non-absorbable and absorbable sutures. So, considering local inflammation induced by non-absorbable sutures in some cases, the absorbable sutures can be an appropriate option for the treatment of consecutive exotropia.

Mesh fixation techniques in Lichtenstein tension-free repair: a network meta-analysis.

To compare the clinical effectiveness of different mesh fixation techniques in Lichtenstein tension-free repair using network meta-analysis. Cochrane Library, Medline, EMBASE, and Web of Science databases were searched until 1 December 2020, and randomized controlled trials (RCTs) comparing outcomes between different mesh fixation techniques were included. The primary endpoints were chronic postoperative inguinal pain (CPIP) and hernia recurrence. The second endpoint was seroma and infection. Data were processed using Stata MP16.0, and R x64 3.6.1. The results demonstrated that 32 RCTs (n=6362) were eligible for pooling. Six types of mesh fixation techniques were used: non-absorbable suture, absorbable suture, chemical glue, fibrin glue, self-gripping mesh, and staple fixation. Network meta-analysis indicated that the incidence of CPIP with fibrin glue was lower than that with non-absorbable sutures (relative risk [RR]=0.23, 95% credibility interval [95%CrI] [0.09, 0.50]), absorbable sutures (RR=0.24, 95%CrI [0.08, 0.60]), chemical glue (RR=0.36, 95%CrI [0.13, 0.87]), and self-gripping mesh (RR=0.27 95%CrI [0.09, 0.62]). Self-gripping mesh was superior to non-absorbable sutures (RR=0.44, 95%CrI [0.23, 0.74]) in reducing postoperative infection. This network meta-analysis suggests that fibrin glue might be best for reducing CPIP and recurrence. However, a large-scale RCT is warranted to confirm the results.

ACL repair for athletes?

BackgroundThe current gold standard treatment for an anterior cruciate ligament (ACL) tear in an athlete is an arthroscopic ACL reconstruction with autografts. This restores the knee stability but is associated with unique complications like graft re-tear, kinesiophobia and graft donor site morbidity. ACL suture repair (ACLSR) is an attractive alternative method of surgical management of this injury. Current science of ACLSRThe potential advantages of performing a repair are the preservation of native biology and proprioceptive function of ACL, elimination of a graft and preservation of bone stock. The purported benefits are better stability, reduction of kinesiophobia and faster rehabilitation. ACLSR is now performed only for proximal (femoral-sided) tears in the acute phase, when the tissue quality is good and using high-strength nonabsorbable sutures. There are several techniques for performing ACLSR but broadly speaking are either non-augmented, static augmented with suture tape, dynamic augmented or using bio-scaffolds. Clinical outcome of ACLSRThere is a lot of literature on ACLSRs including case series, cohort studies and randomized controlled trials. The results from these studies are encouraging but mostly pertain to patient reported outcome measures, are in small numbers and in the short-term. The results are also inconsistent across different studies and not specifically performed for the athletic population. Moreover, most of these studies are from the innovator or designer surgeons and groups and have not been independently validated. ConclusionCurrently, there is insufficient evidence to recommend ACLSR as a preferred method of managing even acute proximal tears in athletes. Improved rates of return to sports, lower retear rate and lesser kinesiophobia needs to be proven in athletes.

Congenital pyriform sinus fistula in a child: Transoral semiconductor laser cauterization and closure by nonabsorbable suture using the ORBEYE exoscope

Pyriform sinus fistula (PSF) is a congenital disease derived from the remnants of the third or fourth branchial cleft. Until now, open neck surgery has been the main curative treatment, but recent years have seen reports of cases treated using endoscopic oral fistulectomy, chemocauterization, or ablation. We used the ORBEYE 4K 3-dimensional surgical microscope system (Olympus, Japan) to cauterize the fistula cavity with a semiconductor laser and to close the fistula opening with a monofilament non-absorbent thread. The use of the ORBEYE exoscope, with which a good view of the surgical field can be shared with all surgical staff, and which provides a sufficient working space, has rarely been reported for PSF surgery, but indications for PSF cases are expected to increase in the future with the adoption of such methods. In addition, laser ablation of the fistula lumen alone poses an initial risk of influx of infection sources after surgery, so closure of the opening with nonabsorbable thread was considered important for improving curability. •Some kinds of transoral treatment for pyriform sinus fistula have been reported. •Transoral laser surgery using ORBEYE is proved to be a useful method. •Closure of the opening with nonabsorbable suture can suppress the recurrence.