Nonabsorbable Sutures Research Articles

Therapeutic effect of two methods on avulsion fracture of tibial insertion of anterior cruciate ligament.

BACKGROUNDThe tibial stop of anterior cruciate ligament (ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine, which is located between the anterior horn of the medial and lateral meniscus. The incidence of this fracture is low previously reported, which is common in children and adolescents. With the increase of sports injury and traffic injury and the deepening of under-standing, it is found that the incidence of the disease is high at present.AIMTo explore the difference between open reduction and internal fixation with small incision and high-intensity non-absorbable suture under arthroscopy in the treatment of tibial avulsion fracture of ACL.METHODSSeventy-six patients with tibial avulsion fracture of anterior cruciate ligament diagnosed and treated in Guanyun County People's Hospital from April 2018 to June 2020 were retrospectively analyzed. According to the surgical methods, they were divided into group A (40 cases) and group B (36 cases). Patients in group A were treated with arthroscopic high-strength non-absorbable suture, and patients in group B were treated with small incision open reduction and internal fixation. The operation time, fracture healing time, knee joint activity and functional score before and after operation, and surgical complications of the two groups were compared.RESULTSThe operation time of group A was higher than that of group B, and the difference was statistically significant (P < 0.05); the fracture healing time of group A was compared with that of group B, and the difference was not statistically significant (P > 0.05); The knee joint function activity was compared between two groups before operation, 3 mo and 6 mo after operation, and the difference was not statistically significant (P > 0.05); the knee joint function activity of group A and group B at 3 mo and 6 mo after operation was significantly higher than that before operation (P < 0.05); the limp, support, lock, instability, swelling, upstairs, squatting, pain and Lysholm score were compared between the two groups before and 6 mo after operation, and the difference was not statistically significant (P > 0.05); the scores of limp, support, lock, instability, swelling, upstairs, squatting, pain and Lysholm in group A and group B at 6 mo after operation were significantly higher than those before operation (P > 0.05); the surgical complication rate of group A was 2.63%, which was lower than 18.42% of group B, and the difference was statistically significant (P > 0.05).CONCLUSIONBoth small incision open reduction and internal fixation and arthroscopic high-strength non-absorbable sutures can achieve good results in the treatment of anterior cruciate ligament tibial avulsion fractures. The operation time of arthroscopic high-strength non-absorbable sutures is slightly longer, but the complication rate is lower.

631. OPERATIVE OUTCOMES OF ROBOTIC GASTROPEXY IN THE TREATMENT OF GIANT PARAESOPHAGEAL HERNIA IN PATIENTS WITH PREDOMINANTLY OBSTRUCTIVE SYMPTOMS

Abstract Our approach to the repair of giant paraesophageal hernia (GPEH) has undergone a paradigm shift. In cases with predominantly obstructive symptoms, following hernia repair, we have transitioned from a mandatory antireflux procedure to a comprehensive extended gastropexy. Further, we have successfully adopted the robotic platform, faithfully replicating the tenets of the operation that we previously refined using the laparoscopic approach. The objective of this study was to describe operative outcomes with this approach. With IRB approval, we retrospectively analyzed prospectively collected data. Operative technique included complete mediastinal dissection of the hernia sac, reduction of contents, tension free return of the stomach to its normal intraabdominal position, preservation of the crural lining, and repair of the crura with nonabsorbable suture. For patients with predominantly obstructive symptoms and minimal reflux, in lieu of an antireflux procedure, we performed an extended gastropexy involving accentuation of the angle of His and placement of a series of horizontal mattress sutures between the greater curvature of the stomach along the line of the short gastric vessels and the diaphragm. Between 2014 and 2021, 113 patients underwent robotic GPEH repair with gastropexy (median age 74.3 ± 9.05 years, 79.6% female, elective 78.7% vs. 21.2% urgent). Majority were Type III GPEH (75.2% vs 24.7% Type IV) and 22.3% had an organ-axial volvulus. Most common presenting symptoms were dysphagia (35.4%), vomiting (23.8%) and chest pain (17.7%). All operations were completed robotically. Cardinal tenets of GPEH repair were achieved in all cases. Average length of stay was 5.85 ± 5.18 days. Two patients (1.7%) died within 30 days, and 24.7% developed a postoperative complication, 13 (11.5%) were readmitted and 4 (3.5%) required reoperation. In patients with a GPEH who have predominantly obstructive symptoms, a robotic approach that adheres to the principal tenets of GPEH repair with an extended gastropexy in lieu of an antireflux procedure appears to be feasible and safe. Further studies that evaluate functional outcome and long-term follow-up to assess durability appear to be warranted.

Does Knot Configuration Improve Tensile Characteristics of Monofilament Suture Materials?

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

Uterosacral Ligament Dissection during McCall Culdoplasty to Prevent Ureteral Kinking, and Round Ligament Fixation to Support Vaginal Vault: A New Surgical Technique

Objective: This study aims to describe a new surgical technique to prevent ureteral kinking via dissection uterosacral ligament from parietal peritoneum before McCall culdoplasty suture placement, and vaginal cuff fixation to round ligament to prevent apical vaginal vault prolapse after vaginal hysterectomy. Materials and Methods: At the initial step of vaginal hysterectomy, a circumferential incision was done on vaginal tissue, which covers the uterine cervix. Then posterior cul-de-sac was entered. Bilateral uterosacral ligament was identified, separately clamped, cut and sutured. Classical vaginal hysterectomy was completed up to the round ligament, which was separately grasped, cut and sutured. After the vaginal hysterectomy, the uterosacral ligament dissected from cardinal ligament and parietal peritoneum to prevent ureteral kinking during McCall Culdoplasty suture placement. Two internal McCall sutures with non-absorbable sutures and one external suture with absorbable sutures were place on the uterosacral ligament. Then bilateral apical lateral vaginal walls were fixated to ipsilateral round ligament to further support to vaginal vault. Results: I have applied the new technique to my patients with pelvic organ prolapse for about one year. Ureteral kinking has not occurred in any patient. Early complications such as hemorrhage, bladder and ureter injury did not observed. Conclusion: Ureteral kinking is a challenging problem for gynecologists during suture placement on the uterosacral ligament. Dissection of the uterosacral ligament from the cardinal ligament and parietal peritoneum yielded the surgeon to safe suture passage during McCall Culdoplasty suture placement and eliminated the requirement of cystoscopy evaluation to check ureteral competency.

Open reduction and internal fixation of Ideberg type IA glenoid fractures: Tricks, pearls, and potential pitfalls based on a retrospective cohort of 33 patients focusing on the rehabilitation protocol.

The standard treatment of anterior glenaoid fractures carrying > 20% of the glenoid fossa is open reduction and internal fixation (ORIF). In the herein study, we report our outcomes in a retrospective cohort of anterior and anteroinferior glenoid rim fractures using an accelerated postoperative rehabilitation protocol. A secondary aim is to describe the surgical steps for ORIF of anterior and anteroinferior glenoid rim fractures using the anterior axillary approach, describing the tricks, pearls, and pitfalls of this surgical technique. A retrospective cohort of skeletally mature patients treated for an anterior glenoid rim fracture carrying > 20% of the glenoid fossa during a 10-year period were operated on using a vertical axillary incision, osteosynthesis with 2.0-mm cortical screws, and labral repair with small diameter metallic anchors and non-absorbable sutures. Rehabilitation began on the first postoperative day, including passive external rotation exercises and active-assisted flexion, adduction, and abduction exercises as tolerated. The exercises are performed with the patient sitting or lying down. Phase 1 is continued for 6-10weeks until the patient regains painless, normal, or near-normal ROM. Usually by 10weeks, the fracture and labrum are healed, so phase 2 rehabilitation begins with strengthening and ROM exercises. Radiologic and clinical outcomes, including active range of motion (ROM), glenohumeral stability, and visual analogue scale (VAS) were measured. About 33 patients (35 fractures) had complete medical records and pre- and post-operative imaging exams available for further analysis regarding the surgical protocol, with a mean of 4.8years. The mean DASH questionnaire was 3.75 ± 9.0 and the mean CM score was 62.5 ± 0.1. Active flexion and internal rotation were recovered in all patients, while external rotation presented an average loss of 8° (p = 0.12) and abduction of 5° (p = 0.33). The mean VAS was 1.1 ± 0.8. No patient reported major or disabling symptoms, or great difficulty or inability to perform daily or recreational activities. No patient presented residual instability of the glenohumeral joint. In this retrospective cohort, ORIF using a vertical axillary incision, osteosynthesis with 2.0-mm screws, and labral repair with small diameter metallic anchors and non-absorbable sutures was a safe approach, with a minimal risk of complications and residual instability. The accelerated postoperative rehabilitation protocol, allowing immediate passive external rotation of the operated shoulder, resulted in a non-significant loss of ROM compared to the contralateral side. Therefore, we recommend this management strategy for anterior glenoid rim fractures in patients with unstable shoulder joint after traumatic glenohumeral dislocation. Therapeutic Study (Surgical technique and Retrospective cohort).

Rupture of the Short Head of the Biceps Brachii: Arthroscopic Repair

Background: Short head of the biceps brachii rupture is a rare lesion, and usually happens in high-speed sports such as parachuting and wakeboarding in traction mechanism, resulting in loss of biceps function. Early surgical treatment achieves better clinical outcomes. There is no isolated short head of the biceps brachii arthroscopic repair described in literature. Indications: Acute traumatic short head of the biceps brachii rupture in active patients. Technique Description: Short head of the biceps brachii and coracobrachialis nonabsorbable double suture. Short head of the biceps brachii reinsertion in coracoid process with an anchor. Results: Satisfactory repair of the biceps lesion. The patient regained active range of motion in 8 weeks and full return to sport in 16 weeks. Conclusion: Isolated short head of the biceps brachii arthroscopic repair is a minimally invasive technique with good functional result and has not been described in the literature yet. It restores bicep’s function and a satisfactory return to sport. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Comment on "Sutured Versus Mesh-augmented Hiatus Hernia Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials".

Comment on "Sutured Versus Mesh-augmented Hiatus Hernia Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials".

Modified Graft Loop Technique Augmented With Nonabsorbable Suture Tape for Chronic Elbow Dislocation.

The task of achieving a good clinical outcome on patients with chronic elbow dislocation is arduous. Any stabilization method used should be robust enough in order to allow for early elbow motion. Immobilization of the elbow for a prolonged time period may lead to stiffness and heterotopic ossification. Several methods of ligament reconstruction have tried to address the global instability that is present in such scenarios. We describe a technique of reconstructing both bands of the medial ligament, and the lateral ulnar collateral ligament of the elbow, by using a looped tendon graft and reinforcing the lateral side with nonabsorbable tape and anchors. The graft is passed as a loop once through the humerus and ulna, recreating the anterior portion of the medial collateral ligament and the lateral ulnar collateral ligament. Then the lateral side is augmented with the tape and anchors and the loop is fixed. Lastly, the medial tail of the graft is used in order to recreate the posterior part of the medial ligament. This technique uses a single graft along with nonabsorbable tape and anchors to make a robust construct that will withstand early range of motion, without jeopardizing elbow stability. Potential complications include damage to the ulnar nerve, infection, elbow stiffness, or persistent instability in complex cases with bone involvement.

Ethibond Suture with Underlying Infection – A Knotty Complication

The surgical site infection is a therapeutic challenge and requires additional interventions, prolonged treatment, and increased health-care expenditure. Superficial infections are easier to treat with debridement, regular dressing, and an appropriate antibiotic regimen. Retained and buried sutures are an occasional source of infection and are reported in the literature. Braided nonabsorbable sutures like Ethibond may be the uncommon reason for adjacent area infection that may present later as nonhealing draining sinuses. We report one such encounter in which an adult patient with chronic nonhealing sinuses over the proximal tibia region underwent debridement to unearth embedded sutures used in previous surgery, the removal of which led to gradual recovery and healing of wounds.

Basic fibroblast growth factor-impregnated collagen gelatin sponge completes formation of dermis-like tissue within 2 weeks: Aprospective cohort study.

IntroductionThis study included patients who underwent full-thickness skin reconstruction using a two-stage procedure comprising basic fibroblast growth factor-impregnated collagen gelatin sponge (bFGF-CGS) implantation and autologous skin grafting, and the take rate of skin grafts was compared between groups of patients who underwent autologous skin grafting after a waiting period of <2 weeks or ≥2 weeks.MethodsAn acute, full-thickness skin defect was treated with thorough debridement of contaminated/necrotic tissue, followed by washing with saline and hemostasis with electrocautery. Then, an FGF-CGS was fixed to the skin defect wound using non-absorbable sutures, and after confirming regeneration of sufficient dermis-like tissue, the second-stage autologous skin grafting was performed for wound closure. Patients were divided into two groups according to the waiting period before the second operation, namely, <2 weeks (early group) and ≥2 weeks (late group), and the take rate of skin grafts was compared.ResultsWe enrolled and treated 25 cases (18 men, 7 women; mean age: 49 [range 2–86] years). The mean take rate of skin grafts was 93% (range 80%–100%) in the early group and 92% (range 65%–100%) in the late group, with no significant difference between the two groups. There was a significant difference between the groups in mean time to complete healing: 25.2 ± 9.7 days in the early group vs 44.7 ± 27 days in the late group (p < 0.05).ConclusionOur data suggest that bFGF-CGF can form dermis-like granulation tissue with sufficient quality as a graft bed for skin transplantation within 2 weeks.

A Case Series on Whether Arthroscopic Bankart Repair Following Primary Traumatic Anterior Shoulder Dislocation or Recurrent Dislocation in Soldiers Has an Effect on the Postoperative Recurrence Rate.

BackgroundAnterior traumatic shoulder dislocation is very common among soldiers or any young population following injury, which is invariably treated by closed reduction. The dislocation when treated nonsurgically has a 71% high rate of recurrence. There is not much data available on the rate of recurrence when primary dislocation (first time) was treated by arthroscopic Bankart repair and in those who have recurrent (multiple) dislocations before surgery.AimThis study aims to report the postoperative recurrence rate in soldiers with first-time dislocation versus those with recurrent dislocations before surgery.Study designThe present study is a level IV case series treatment study.MethodsIn this prospective study, 143 soldiers were included, of which 82 patients had first-time dislocation (F group) and 61 patients had recurrent dislocation before surgery (R group). The patients were evaluated and followed up for over three years. Nonabsorbable PEEK suture anchors (Chetan Meditech, India) were used for arthroscopic Bankart repair. The recurrence rates, Rowe scores, visual analog scale (VAS) scores, subjective shoulder values (SSVs), and satisfaction were compared. We also used the Simple Shoulder Test (SST) score for evaluation. The scores were recorded preoperatively and at three-year follow-up. The range of motion, postoperative function, recurrence rates, and return to pre-injury state was evaluated.ResultsA total of 143 patients were included, providing 97.3% follow-up at an average of 36 months. The postoperative recurrence rate was 19.7% in the F group and 58.3% in the R group (P < 0.001). The odds of postoperative recurrence were five times higher in the recurrent dislocation group (odds ratio (OR): 5.23).ConclusionPatients who underwent repair after first-time dislocation show a lower postoperative recurrence rate as compared with those who had multiple dislocations before surgery. It is prudent to advise early repair even after the first dislocation especially in young active soldiers to reduce the risk of postoperative recurrence.

Absorbable versus nonabsorbable sutures for the Krackow suture repair of acute Achilles tendon rupture: a prospective randomized controlled trial.

Although absorbable sutures for the repair of acute Achilles tendon rupture (ATR) have been attracting attention, the rationale for their use remains insufficient. This study prospectively compared the outcomes of absorbable and nonabsorbable sutures for the repair of acute ATR. A total of 40 patients were randomly assigned to either braided absorbable polyglactin suture or braided nonabsorbable polyethylene terephthalate suture groups. ATR was then repaired using the Krackow suture method. At three and six months after surgery, the isokinetic muscle strength of ankle plantar flexion was measured using a computer-based Cybex dynamometer. At six and 12 months after surgery, patient-reported outcomes were measured using the Achilles tendon Total Rupture Score (ATRS), visual analogue scale for pain (VAS pain), and EuroQoL five-dimension health questionnaire (EQ-5D). Overall, 37 patients completed 12 months of follow-up. No difference was observed between the two groups in terms of isokinetic plantar flexion strength, ATRS, VAS pain, or EQ-5D. No re-rupture was observed in either group. The use of absorbable sutures for the repair of acute ATR was not inferior to that of nonabsorbable sutures. This finding suggests that absorbable sutures can be considered for the repair of acute ATRs. Cite this article: Bone Joint J2022;104-B(8):938-945.

Impact of Whole-Layer Barbed Suture Closure on the Postoperative Effect and Aesthetic Satisfaction with Incision After Knee Arthroplasty

ObjectiveTo evaluate the effect of whole-layer barbed suture for incision closure on the clinical outcome and aesthetic satisfaction of patients with the incision following total knee arthroplasty (TKA).Materials and MethodsA retrospective analysis was conducted on 94 patients (37 men and 57 women, 50–84 years old) who underwent a first TKA between May 2018 and April 2021. The enrolled patients were divided into two groups according to the suture mode, with 45 cases (group A) receiving closure of the deep tissue with a barbed suture and intradermal suture of the incision with another barbed suture and 49 cases (group B) receiving closure of the deep tissue with absorbable suture and interrupted suture of the incision with nonabsorbable suture. Further comparisons were performed regarding incision length, suture time, postoperative incision complications, Hollander Wound Evaluation Score (HWES), Hospital for Special Surgery (HSS) knee score, American Knee Society (AKS) score, and Patient and Observer Scar Assessment Scale (POSAS). The clinical effects of the two suture modes in TKA and the patients’ aesthetic satisfaction with the incision were also evaluated at 2 weeks, 3 months and 6 months after the operation.ResultsCompared with group B, group A had higher HWES at 2 weeks after the operation (P < 0.05), shorter suture times (P < 0.05) and lower POSAS scores at 3 and 6 months after the operation (P < 0.05). However, no significant difference was observed between the two groups in incision length, complication rate, HSS or AKS scores (P > 0.05).ConclusionCompared with the interrupted suture, the use of whole-layer barbed suture for incision closure after TKA has the advantages of a safe and effective outcome, short operation time, high cosmesis degree of the wound scar and high patient satisfaction.

Suture selection in repair of traumatic pediatric corneal injuries

10-0 nonabsorbable nylon suture has traditionally been used for corneal wound repair. These sutures require eventual removal to prevent complications such as suture abscess. Efficacy of nonabsorbable versus absorbable sutures has been primarily assessed in the context of penetrating keratoplasty or cataract surgery. Limited data exists discussing the suture selection for corneal injury in the context of pediatric ocular trauma.

A Comparison of the Outcomes of Fiber-Wire® versus Stainless Steel Wire in Transosseous Wiring for Intra-Articular Fractures of the Distal Interphalangeal Joint.

Background: Different surgical techniques have been described for the treatment of intra-articular fractures involving extensor tendon insertion of the distal interphalangeal joint (DIPJ), including acute and chronic bony mallet injuries. We have been using transosseous stainless-steel wire (SSW) in select patients. In 2015, we started using a non-absorbable polyester suture (2-0 Fiber-Wire®, Arthrex, Naples, FL, USA) instead of SSWs. The aim of this study is to compare the outcomes of SSW and Fiber-Wire® (FBW) in transosseous wiring for intra-articular fractures of the DIPJ. Methods: This is a retrospective review of patients who underwent fixation of intra-articular fractures, including extensor tendon insertion of the DIPJ using a transosseous wiring technique, in the period from 2013 to 2018. SSW was used in the period from 2013 to 2014, and FBW was used from 2015 to 2018. Outcomes with regard to age, gender, time to union, range of motion at the DIPJ and complications were recorded and compared between the SSW and FBW groups. Results: Nine patients (mean age: 38 years) underwent fixation with SSW and 10 patients (mean age: 31 years) with FBW. The operative time was significantly lower in the FBW group, and all the fractures united. There were no statistically significant differences between both groups with regard to time to union or range of motion at the DIPJ. Similar complication rates were observed in both groups. Conclusions: The use of FBW in transosseous wiring for intra-articular fractures of the DIPJ can reduce operative time and provide functional results similar to that of SSWs. It can be considered as an alternative fixation technique for difficult intra-articular comminuted fractures of the DIPJ, including acute and chronic bony mallet injuries with joint subluxation. Level of Evidence: Level III (Therapeutic).

Minute Colon Perforation by a Nonabsorbable Suture Knot after Uterine Myomectomy

We report a rare case of suture material-related colon perforation. A 60-year-old woman visited clinics because of the nonspecific abdominal discomfort for several months. There were no specific medical history except previous laparoscopic myomectomy 15 years ago. Colonoscopy and abdomen-pelvis computed tomography revealed an unknown foreign body penetrating the sigmoid colon wall adjacent to the uterus. We performed laparoscopic exploration with foreign body removal and primary colon wall repair. The foreign body was identified as a non-absorbable suture material suggestive of used in previous myomectomy. With recent trends for minimally invasive procedures in the field of pelvic organ surgery, surgeons, especially those without sufficient training have to pay attention to selecting the proper surgical suture materials. (Ewha Med J 2022;45(3):e7)

Closed Suction Drain Placement Using a Carroll Tendon Retriever.

The technique used for closed suction drain placement in plastic surgery is dependent on surgeon preference and experience. Drains assist in preventing accumulation of inflammatory seroma fluid, but they also present a possible nidus for infection, which is particularly concerning in implant-based breast reconstruction. Murray et al.1 retrospectively reviewed 200 cases of breast reconstruction with tissue expander placement and found that subcutaneous tunneling is one factor that may defend against infection by means of in vivo protection of the prosthesis from the drain. This clinical practice is echoed in the neurosurgery literature, where several studies have shown that long subcutaneous tunneling decreases the incidence of surgical site infection in neurosurgical procedures.2,3 Yoshida et al.4 recently described a method of drain placement into the breast pocket utilizing a liposuction cannula. While their method is innovative and effective, we would like to propose another technique with the similar advantage of using readily available operating room instruments but that is simpler and more ergonomic. The method utilizes a Carroll tendon retriever, commonly referred to as a tendon passer by plastic and hand surgeons, to place a tunneled closed-suction drain for implant-based breast reconstruction through a long subcutaneous plane with minimal disruption and stress to surrounding tissues. We begin by selecting a drain insertion site lateral to the breast pocket at the level of the inframammary fold to allow for at least 5 cm of subcutaneous tunneling. This location permits the scar to be hidden by a bra. After creating a stab incision, the surgeon inserts a Carroll tendon retriever with jaws closed and advances it manually with gentle, constant pressure through the subcutaneous plane into the breast pocket. The jaws are then opened to grasp the external end of the drain and draw it out from the upper outer breast pocket through the tunnel. The drain is secured with nonabsorbable suture and dressed with a sterile adhesive dressing. [See Video (online), which demonstrates the use of a Carroll tendon retriever to facilitate drain placement into a breast pocket.] {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video.","caption":"This video demonstrates the use of a Carroll tendon retriever to place a drain tube into a breast pocket.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_acjzm5ek"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} The Carroll tendon retriever has several advantages over other common methods of placing tunneled drains. This technique facilitates atraumatic creation of a long subcutaneous tunnel. In contrast to either a tonsil or a hemostat, both of which have a shank that splays widely toward the handle in the tissue, the Carroll tendon retriever has a static, narrow body that forms a uniform-sized tunnel. Its blunt tip makes it a safer alternative to using a trocar for drain placement. Lastly, the Carroll tendon retriever is well known to plastic and hand surgeons and is reusable and reasonably inexpensive. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. No direct funding was provided for this study.

Effect of Nasal Wall Fixation with Nonabsorbable Sutures during Nasolacrimal Silicone Intubation in Adults

Purpose: We explored the effects of silicone tube fixation using a nonabsorbable suture on the adult nasal wall during silicone tube intubation.Methods: The medical records of patients (50; 54 eyes) diagnosed with nasolacrimal duct stenosis and canalicular lacerations who underwent silicone tube fixation to the nasal wall (using nonabsorbable sutures) during silicone tube intubation from January 2019 to June 2021 and who were followed-up for more than 3 months after surgery were retrospectively investigated. We recorded the percentages of early silicone tube displacement and noted other complications.Results: We enrolled 22 males and 28 females of average age 65.28 ± 8.88 years. The silicone tubes were maintained for an average of 9.13 ± 1.77 weeks in the nasolacrimal duct stenosis group and 20.13 ± 3.36 weeks in the canalicular laceration group. Early tube displacement occurred in two of 46 eyes (4.4%) in the nasolacrimal duct stenosis group and in 0 of eight eyes (0%) in the canalicular laceration group. Overall, early displacement occurred in only two of 54 eyes (3.7%). Other complications included nasal irritation in four cases (7.4%), canaliculitis in three (5.6%), and loss of fixed nonabsorbable sutures in three (5.6%).Conclusions: Silicone tube fixation to the nasal wall using a nonabsorbable suture during silicone tube intubation simply and effectively prevents early tube displacement and loss, associated with minimal complications.

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

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

Nonabsorbable Transosseous Sutures for Lower Pole Patella Fractures

Background: Treatment alternatives for patella fractures with the inferior pole are still being deliberated. In addition to tension-band wiring, metal implant-related complications are also not uncommon to occur in patellar fracture treatment. It is common to encounter implant-related complications such as implants failing, palpable hardware which require supplementary techniques to resolve. We evaluated participants with inferior poles of patella fracture treated with transosseous nonabsorbable sutures on functional outcomes. Methodology: This study encompasses observation of patients having transosseous suture fixation by no. 5 Ethibond for fixation of distal pole patella fractures. This was a longitudinal study piloted at a tertiary care center between January 2020 and June 2022. Patients' functional outcomes were assessed using the Bostman score. Results: The Bostman scoring system was used to evaluate the outcome at the final follow-up. In 19 patients, 7 (36.84%) patients showed outstanding and 11 (57.89%) patients showed good outcomes at the termination of 9 months follow-up. Only one patient established an unsatisfactory result. Conclusion: Distal pole patella fractures can be effectively fixed via transosseous suturing with unabsorbable sutures. Fast recovery and minimal implant-related complications are possible with this procedure. The resurgery rate is also significantly reduced.