Nonabsorbable Sutures Research Articles

Successful Use of Percutaneous Dissolvable Sutures During COVID-19 Pandemic: A Retrospective Review.

The COVID-19 pandemic has had dramatic effects on all fields of medicine, including an effort to limit in-person visits. Within dermatologic surgery, one strategy is to close surgical incisions using percutaneous absorbable sutures. To the authors' knowledge, there are no large studies comparing changes in suture preferences and subsequent outcomes during the pandemic. To assess changes in suture preference and frequency of post-operative complications for percutaneous absorbable and non-absorbable sutures during the pandemic. A retrospective review of 1358 Mohs surgeries completed at the Cleveland Clinic during a 2-month period prior to COVID-19 and a matched 2-month period during the pandemic. Sutures were used to close 1103 cases. Significantly more closures were performed with percutaneous absorbable sutures during COVID-19 (87.6%, 39.6%; P < .0001). There was no significant difference in the frequency of post-operative complications between suture materials (P = .48). The use of absorbable sutures were associated with a significantly higher frequency of suture hypersensitivity reaction (P = .020) but significantly lower frequency of infection (P = .021) and wound dehiscence (P < .0001). Suture preference shifted towards absorbable sutures during the COVID-19 pandemic. Percutaneous absorbable sutures offered a formidable alternative to non-absorbable sutures and could reduce in-person follow-up visits without increasing post-operative complications.

Application of the Falciform Ligament Patch for the Prevention of Duodenal Stump Leakage After Gastrectomy: Technical Report on a Case Series.

Background: Duodenal stump leakage (DSL) is a serious complication after gastrectomy. In this study, we developed a novel prevention technique using a falciform ligament patch (FLP) to prevent DSL among high-risk patients after gastrectomy. Materials and Methods: From January 2019 to July 2021, 14 patients who were judged to be at high risk for DSL during preoperative examinations or surgery were included in this retrospective study, and the FLP was applied to the duodenal stump. The falciform ligament was separated from the liver after duodenal transection during gastrectomy; the end part was used to cover the duodenal stump and was fixed using nonabsorbable polypropylene sutures. Results: In total, 14 patients who underwent FLP had one or two risk factors that were identified: 5 patients, gastric cancer duodenal invasion; 4 patients, gastric outlet obstruction (GOO); 1 patient, cancer involving the distal resection margin; 1 patient, duodenal gastrointestinal stromal tumor involving the distal resection margin; 1 patient, gastric cancer duodenal invasion and GOO; and 2 patients, cancer involving the distal resection margin and GOO. FLP construction was successful, and no patient developed complications of DSL. The average hospital stay was 11.9 days, and the patients were discharged without any morbidities after surgery. Conclusions: Therefore, the FLP can be used to prevent DSL among high-risk patients after gastrectomy.

Foot &amp; Ankle

The December 2022 Foot &amp; Ankle Roundup360 looks at: Evans calcaneal osteotomy and multiplanar correction in flat foot deformity; Inflammatory biomarkers in tibialis posterior tendon dysfunction; Takedown of ankle fusions and conversion to total ankle arthroplasty; Surgical incision closure with three different materials; Absorbable sutures are not inferior to nonabsorbable sutures for tendo Achilles repair; Zadek’s osteotomy is a reliable technique for treating Haglund’s syndrome; How to best assess patient limitations after acute Achilles tendon injury; Advances in the management of infected nonunion of the foot and ankle.

Awareness on the management strategy of stitch abscess among dental students.

Stitch abscesses are abscesses that develop following surgical procedures as a result of suture infections. Because of nonabsorbable sutures, the material reacts with connective tissue, generating adhesions around the stitch. The use of this type of material increases the risk of infection. The aim of this study was to establish awareness on the management strategy of suture stitch abscess among dental students. An online survey consisting of ten questions about suture stitch abscess along with sociodemographic factors was circulated among equal numbers of 2nd years, 3rd years, final years, and compulsory rotatory residential internship (CRRI). The data obtained from the questionnaire were transferred to Microsoft Excel and imported to SPSS software for statistical analysis. Interns are more aware about the complications and management strategy of suture stitch abscesses compared to others. Awareness on the management strategy of suture stitch abscess is important, and it helps to reduce the side effects to improve the outcomes. Educating the risk factors, signs and symptoms, and management strategy is the best way to help raise awareness.

Comparison of Wound Infection with Absorbable Suture Versus Non-Absorbable Suture after Cesarean Section

Objective: To compare the frequency of wound infection with absorbable suture and non-absorbable suture after cesarean section. Study Design: A randomized controlled trial. Place and Duration: Department of Obstetrics and Gynaecology, Nisthar Hospital, Multan from August 2021 to June 2022. Methodology: A total of 826 women (413 in each group) undergoing cesarean section were included. In Group-A absorbable suture was employed while in Group-B, non-absorbable suture was used. Post-operatively, all patients were followed up weekly and the final assessment of wound infection was done after 15 days. Results: In a total of 826 cases, mean age was 26.47±3.42 years. Mean body mass index was 25.62±1.87 kg/m2 and obesity was present in 166 (20.1%). Of these 826 study cases, emergency cesarean section was performed in 593 (71.8%). Mean duration of procedure was 38.43±12.21 minutes and 562 (68.0%) had duration of procedure below 40 minutes. Overall, wound infection was noted in 145 (17.6%) women, In Group-A, wound infection was noted in 96 (23.2%) women and in Group-B it was in 49 (11.9%) (p&lt;0.0001). Practical Implications: Clinicians can employ non-absorbable sutures to decrease the risk of post-operative wound infection after cesarean section. Conclusion: We found non-absorbable sutures after cesarean section to yield significantly less rates of wound infection when compared to absorbable sutures. Keywords: Absorbable suture, Non-absorbable suture, wound infection, cesarean section.

Frequency of Surgical Outcome of Patients Who Underwent Basicervical Femur Fractures Treatment with Dynamic Hip Screw Combiner with Derotation Hip Screw at Teritay Care Hospital, Karachi

Background: A basicervical fracture occurs when the femoral neck breaks below its intertrochanteric connection1. It's between a femoral neck fracture, treated with cancellous screws, and an intertrochanteric fracture, treated with sliding screws2. Previous studies revealed basicervical fractures might be treated with the DHS like intertrochanteric fractures. Basicervical fractures are less stable than intertrochanteric fractures 3,4, hence the DHS alone may not lead to a good functional outcome 5. A basal femoral neck fracture is one type of femoral fracture. Objective: To determine the frequency of surgical outcome of patients who underwent basicervical femur fractures treatment with dynamic hip screw combined with derotation hip screw at Tertiary Care Hospital, Karachi. Study Design: Descriptive Case study. Setting: This study was conducted at Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan. Duration: Six months after the approval of synopsis from August 23, 2019 to February 22, 2020. Methodology: JPMC in Karachi treated all included patients. Participants consented after learning about the study's methods, risks, and benefits. The wound was shaved and dressed the night before surgery. The patient's arms and legs were tied to the traction foot component using a fracture table. Image intensifiers were employed to verify the closed reduction. Straight cut from the greater trochanter down the thigh. Using an angle guide, a threaded guide pin was placed into the femoral head. Non-absorbable sutures closed the wound. Incision closed with suction drainage. All obtained data was kept in a performa and evaluated electronically for research. Results: Mean ± SD of age was 51.3±7.16 years. In distribution of gender, 67 (64.4%) were male while 37 (35.6%) were female. Surgical outcome was divided into two parts i.e. functional and radiological outcome. In Functional outcome 17 (16.35%) were having excellent hip score, 38 (36.55%) having good score, 22 (21.15%) having fair score while 27 (25.95%) having poor score. In radiological outcomes 33 (31.75%) had fracture reduction, 51 (49.02%) had fracture fixation, 20 (19.23%) had fracture union. Practical Implication: This study will help to determine the patient’s surgical outcomes on implying the dynamic hip screw combined with derotation hip screw, in treating basicervical femur fractures. Conclusion: It is to be concluded that DHS may allow better restoration of functional and radiological outcomes for the treatment of basicervical femur fractures in well selected patients that meet the indications for surgery whenever the technical competence and facilities exist. Keywords: Basicervical Femur Fractures, Dynamic Hip Screw, Derotation Hip Screw, Fracture, Hip Fracture

Repair of Quadriceps and Patellar Tendon Tears

Tears of the quadriceps or patellar tendon usually occur after a sudden eabccentric contraction and are diagnosed by a palpable gap at the injury site combined with an inability to perform a straight leg raise. Bilateral knee radiographs may demonstrate patella alta with patellar tendon tears and patella baja with quadriceps tendon tears compared with the uninjured knee. Ultrasound and magnetic resonance imaging can be helpful when there is uncertainty in the diagnosis. Surgical treatment is indicated for complete tears and some high-grade, partial tears. Nonabsorbable high-strength sutures or suture tape are placed in running locking fashion along the injured tendon and secured to the patella with bone tunnels (i.e., transosseous) or suture anchors. The transosseous technique requires exposure of the length of the patella to drill 3 bone tunnels to shuttle the sutures and tie over either pole of the patella. The suture anchor technique allows for a smaller incision and less soft-tissue dissection and may use a knotted or knotless technique. Biomechanical testing with load to failure is not statistically different between the transosseous and anchor techniques, although anchors have been shown to have less gap formation at the repair site. Repair augmentation with a graft may be beneficial in mid-substance injuries, chronic tears, and in cases of compromised tissue quality. Rehabilitation usually can be initiated immediately with protected weight-bearing in an orthosis, safe-zone knee passive range of motion, and avoidance of active extension. After a period of 6 weeks, rehabilitation can progress with full range of motion and a concentric strengthening program.

Laparoscopic Nerve-Sparing Sacropexy: Tips and Tricks for a Safe and Anatomical Surgical Procedure

Study Objective to demonstrate a nerve-sparing technique during laparoscopic sacropexy (LSP) for treatment of multicompartment pelvic organ prolapse. Design A step-by-step demonstration of our surgical procedure of laparoscopic sacropexy (LSP). Setting Sacropexy is the 'gold standard' procedure for apical prolapse. This procedure is characterized by a complete dissection of the avascular spaces and is nerve sparing technique saving superior and inferior hypogastric plexus and the hypogastric nerves. Patients or Participants Patients with POP-Q Stage III and IV/prolapse of uterine Interventions Our surgical nerve-sparing LSP technique proceeds in 10 steps: Step 1: Suspension of the sigma to the abdominal wall. Step 2: Opening the peritoneum and exposure of sacral promontory and of the longitudinal anterior vertebral ligament. Step 3: Dissection of the right medial pararectal space (Okabayashi's Space), respecting the integrity of the presacral fascia and of the rHN contained within it. Step 4: Dissection of the rectovaginal space with a latero-medial approach expecting the integrity of the rectal fascia. The lateral limits were defined by the uterosacral and rectovaginal ligaments, and the base was represented by the perineal body and levator ani muscle. Step 5: Dissection of the vesicovaginal space through the creation of an avascular space with the apex at the dorsal end of the bladder trigone and laterally limited by the vesicouterine ligaments. Step 6: Subtotal hysterectomy. Step 7: A first synthetic mesh (posterior) fixed with a total of five no. 3–0 non-absorbable sutures. Step 8: A second synthetic mesh (anterior) fixed with five no. 3–0 non-absorbable sutures. Step 9: Mesh fixation on the cervical stump and ligamentum longitudinale. Step 10: Mesh peritonealization. Measurements and Main Results LSP combines the high efficacy of reconstructive surgery using non-absorbable mesh with the fast recovery and low complication rate resulting from minimal tissue trauma and laparoscopicalprocedure precision. Conclusion A nerve-sparing approach to pelvic spaces during LSP is feasible following well-defined surgical steps. to demonstrate a nerve-sparing technique during laparoscopic sacropexy (LSP) for treatment of multicompartment pelvic organ prolapse. A step-by-step demonstration of our surgical procedure of laparoscopic sacropexy (LSP). Sacropexy is the 'gold standard' procedure for apical prolapse. This procedure is characterized by a complete dissection of the avascular spaces and is nerve sparing technique saving superior and inferior hypogastric plexus and the hypogastric nerves. Patients with POP-Q Stage III and IV/prolapse of uterine Our surgical nerve-sparing LSP technique proceeds in 10 steps: Step 1: Suspension of the sigma to the abdominal wall. Step 2: Opening the peritoneum and exposure of sacral promontory and of the longitudinal anterior vertebral ligament. Step 3: Dissection of the right medial pararectal space (Okabayashi's Space), respecting the integrity of the presacral fascia and of the rHN contained within it. Step 4: Dissection of the rectovaginal space with a latero-medial approach expecting the integrity of the rectal fascia. The lateral limits were defined by the uterosacral and rectovaginal ligaments, and the base was represented by the perineal body and levator ani muscle. Step 5: Dissection of the vesicovaginal space through the creation of an avascular space with the apex at the dorsal end of the bladder trigone and laterally limited by the vesicouterine ligaments. Step 6: Subtotal hysterectomy. Step 7: A first synthetic mesh (posterior) fixed with a total of five no. 3–0 non-absorbable sutures. Step 8: A second synthetic mesh (anterior) fixed with five no. 3–0 non-absorbable sutures. Step 9: Mesh fixation on the cervical stump and ligamentum longitudinale. Step 10: Mesh peritonealization. LSP combines the high efficacy of reconstructive surgery using non-absorbable mesh with the fast recovery and low complication rate resulting from minimal tissue trauma and laparoscopicalprocedure precision. A nerve-sparing approach to pelvic spaces during LSP is feasible following well-defined surgical steps.

Evaluation of tensile strength of surgical absorbable and nonabsorbable suture materials after immersion in different fruit juices: An in vitro study.

Surgical sutures are the most well-known surgical biomaterial device for ligating blood vessels. The primary goal of wound closure is to align wound margins to provide a closed and stable environment. Sutures with lesser tensile strength are susceptible to break throughout the healing process due to edema. To evaluate the tensile strength of absorbable and nonabsorbable suture materials after immersion in fruit juices. In this in vitro study, eight samples of commercially available sutures such as black silk and vicryl were divided into two groups: sample -1 were immersed in grape juice and sample -2 were immersed in lemon juice for 1 week. Universal testing machine INSTRON E300 UTM was used to test the tensile strength of various suture materials. The data are statistically analyzed using an independent t-test. The P < 0.05 was considered to be statistically significant. The mean of vicryl suture after immersion in grape and lemon juice was found to be 34.445 and 43.39; the mean value of black silk after immersion in grape and lemon juice was found to be 36.95 and 33.1. The tensile strength of black silk was slightly lower than the vicryl. Independent sample t-test showed that P = 0.561 (>0.05) which is statistically insignificant. Vicryl suture tested to have the highest tensile strength along with excellent knot holding capacity than black silk suture after immersion in fruit juices.

The Effect of Topical Agents on the Tensile Strength of Absorbable and Non-absorbable Suture Materials-An in Vitro Study.

Topical agents are sometimes applied to surgical wounds after closure; these may include antiseptics or antibiotics. Minimal research has been undertaken to investigate the effect of topical regimens on the tensile strength of suture materials. To investigate the effect of four commonly used wound care regimens on the tensile strength of suture materials. The failure load of 9 different suture materials was tested using the Instron Electroplus E3000 tensile testing machine (Instron Corporation, Norwood, Massachusetts). Tensile strength was represented as the failure load, measured in Newtons (N), and defined as the maximal load that could be applied across the suture prior to failure. Each suture was tested dry and after immersion in one of 4 products for 7days and tested on day 7. The immersion agents tested were: sodium chloride 0.9%, MicroSafe® (Sonoma Pharmaceuticals, Petaluma, CA), Aqueous Povidone-iodine 10% solution (Betadine-Mundipharma), and Fucidin ointment. Sodium chloride 0.9%, MicroSafe®, Aqueous Povidone-iodine 10%, and Fucidin seem to increase the failure load of most absorbable and non-absorbable sutures. However, the failure load of Polyglactin 910 suture (Surgilactin, coated, violet-Ethicon) is reduced by long-term exposure to either sodium chloride 0.9% or MicroSafe®, while the failure load of the Polydioxanone suture (PDS Plus-Ethicon) is reduced by long-term exposure to MicroSafe® only. In our experiment, the commonly used wound care products have been shown to alter the tensile strength of suture materials. Further human studies are required to ascertain the clinical validity and applicability of our findings.

Primary tendon repair in a case of acute traumatic tibialis anterior with extensor hallucis longus tendon rupture in a young male-a case report

&lt;p&gt;Tibialis anterior tendon rupture is a rare entity which can be either traumatic and non-traumatic. It often presents late due to mild clinical symptoms and signs. Acute ruptures are traumatic occurring in young individuals while chronic ruptures are due to degenerative processes occurring in elderly individuals, commonly after 45 years of age. Tibia anterior along with extensor hallucis tendon is an even rarer entity, operative management of which becomes mandatory, more so in a young active individual for better outcome. We have a 31-year-old male patient, who presented to us with an acute post traumatic tibialis anterior tendon rupture of 3 days duration which was diagnosed following an initial clinical examination, an unremarkable X-ray picture, and Ultrasonography confirming the diagnosis. The patient was managed with primary repair of the tibialis anterior tendon along with Extensor hallucis tendon (which was found intra-operatively) with 2-0 ethibond sutures using a cross-linked Bunnell technique. The patient regained full ankle range of motion at 8 weeks post operative period with ankle dorsiflexion and great toe extension back to pre-injury state.As we have seen with this case, early primary repair in a case of acute rupture at tibialis anterior and extensor hallucis longus rupture with non-absorbable suture has significant improved post operative outcome in terms of return of the affected range of motion and can be practice safely in new hands with limited resources as material of suture and technique has not significant effect in post operative outcome. Acute tibialis anterior and extensor hallucis tendon rupture, non absorbable suture, ethibond, cross linked Bunnell technique.&lt;/p&gt;&lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;

Simultaneous Winslow and Petersen’s Hernias after a Roux-en-Y Gastric Bypass Causing Bowel Obstruction: Laparoscopic Management and Review of the Literature

AbstractInternal hernias after Roux-en-Y gastric bypass are one of the most common complications in bariatric surgery leading to hospital readmissions with or without surgery. Due to the insidious and non-specific clinical presentation combined with difficult radiological identification, internal hernias remain a diagnostic and therapeutic challenge. Delay in diagnosis and treatment can lead to severe morbidity and mortality. We report the case of a patient presenting an unusual intestinal obstruction due to two simultaneous and distinct internals hernias affecting the Petersen’s defect and the foramen of Winslow 4 years after a laparoscopic gastric bypass. A 41-year-old female patient with a history of robotic laparoscopic Roux-en-Y gastric bypass presented with proximal small bowel obstruction symptoms and epigastric pain. Computed tomography showed two simultaneous internal hernias, one affecting the Petersen’s defect and the other affecting the foramen of Winslow with an incarcerated transverse colon. We performed an explorative laparoscopy to reduce both hernias and, after an assessment of bowel viability by indocyanine green angiography, we closed both defects with interrupted non-absorbable sutures to prevent recurrence. The follow-up of more than 1 year has been uneventful. In the cases of obstruction and hospital admission after gastric bypass, we suggest that patients undergo a computed tomography directly after the initial examination. Internal hernia diagnosis is often delicate and requires surgical exploration since bowel strangulation can lead to dramatic outcomes. The operation can be safely done laparoscopically, and all internal hernia defects should be repaired with non-absorbable sutures.

Tendoscopic-Assisted Repair of Distal Peroneus Longus Rupture: A Novel Approach and 2 Case Reports.

Level IV: Case Series.

P-018 ACUTE APPENDICITIS IN DE GARENGEOT'S HERNIA - A LITERATURE REVIEW

Abstract Aim This study aims to undertake a systematic review of published data, focussing on the incidence of acute appendicitis within a de Garengeot hernia, the relationship between pre-operative diagnosis, surgical technique, incidence and surgical outcomes. Methods A PRISMA modelled literature search was carried out across PubMed, ProQuest, and BMW Case Report databases with the search terms ‘Femoral Hernia’, ‘Appendix’, ‘de Garengeot's’ in combinations, limited to English language, published between 1960 to 2019. Authors report another case study that was not included in the systematic review. Results Systematic review identified 84 published data reporting 112 such cases. 74(66%) presented with painful groin swellings. CT performed in 43(38%) accurately diagnosed de Garengeot's in 32(74%) patients. The most common surgical approach was low approach 35(31%) followed by the inguinal approach 23 (21%). 81 (72%) underwent herniorrhaphy with non-absorbable sutures and 20 had mesh repairs (18%). Ten (9%) patients were reported to have postoperative morbidity with wound infection being the most common complication and one recorded death. Conclusion Rarity of de Garengeot's hernia is shown by the limited availability of data that restricted our ability to conclude a single diagnostic pathway or a specific surgical technique for this condition. CT has shown, relatively accurate form of imaging tool, as well as Ultrasound scans in some. Sequestrated appendicectomy and hernia repair via laparoscopy is an option, however, there is lack of data to warrant its effectiveness as the surgical option of choice over an open groin approach in the presence of incarcerated groin swelling.

P-120 LAPAROSCOPIC REPAIR OF INCISIONAL HERNIA USING A NON-ABSORBABLE TRANSPARENT COMPOSITE PROSTHESIS TOTALLY IN POLYPROPYLENE - OUR EXPERIENCE

Abstract Introduction Incisional ventral hernia is one of the most common surgical complications after laparotomy. The aim of this retrospective observational study is an evaluation of clinical outcomes after laparoscopic repair of incisional hernias with a non-absorbable and transparent composite prosthesis composed of a macro-porous monofilament polypropylene mesh and a transparent polypropylene film. Materials and Methods 63 patients, from January 2016 to December 2021, were treated for incisional hernia at Center of minimal invasive surgery Nis, Serbia. The mesh was always positioned intraperitoneally after closing the defects and fixed with absorbable tacks and non-absorbable suture. Results In the considered cohort (54% female and 46% male) the median age and BMI were 54 years (range: 39–68) and 25,1 kg/m2 (range: 21.5–30.3), respectively. Concerning hernia position, 93.7% of the hernias were medial, 4.8% lumbar and 1.6% medio-lumbar. According to EHS classification, 58.7% of the hernias were W1, 36.5% W2 and 12.7% W3. The average duration of hospitalization was 2 days. The rate of early post-operative complications was 6.3%, including 1 seroma (1.6%) and 3 patients reporting pain (4.8%). At a median follow up of 48 months (range: 6–60) we registered 2 cases of hernia recurrency (3.2%, both at 36 months follow-up) and 1 case of bowel obstruction (1.6%). All the considered variables did not result statistically significative in relation to post-operative complications. Conclusion Our clinical experience showed that intraperitoneal treatment of incisional hernia using a transparent composite prosthesis. The minimally invasive procedure allows a fast postoperative recovery and a consequent low economical cost.

Clinical Features and Treatment of Intra-Tendinous Suture Reaction Following Achilles Tendon Repair Using Nonabsorbable Suture Material: A Retrospective Case Series Study.

We aimed to investigate the clinical manifestations, radiological findings, and therapeutic outcome of treatment for patients with surgically confirmed foreign body reaction following an Achilles tendon repair using non-absorbable suture material. Eight consecutive patients who were confirmed as having an intra-tendinous suture foreign body reaction in the histopathological report were enrolled in this study. Medical records of all patients in terms of clinical and radiological features were retrieved. Also, the outcome of treatment was evaluated at a follow-up of at least 12 months. All the patients complained of pain and a palpable mass around a previous surgical site at mean 25.1 months (range, 4–72 months) after the initial surgery. Magnetic resonance imaging (MRI) or ultrasound were used to detect the lesion. All the patients underwent surgical excision of foreign body reaction tissue and primary repair using absorbable suture material. After the treatment, the wounds were healed completely in all, and the average FAOS (foot and ankle outcome score) was 91.32 at mean follow-up for 22.4 months. In conclusion, intra-tendinous suture reaction is a rare complication following an Achilles tendon repair using nonabsorbable suture material, but it can be treated adequately with only surgical excision of foreign body reaction tissue and primary repair using absorbable suture material.

Using Absorbable Sutures for Traumatic Wound Closure to Avoid Additional Hospital Visits for Suture Removal During the COVID-19 Pandemic: A Randomized Controlled Trial.

Introduction The COVID-19 pandemic worldwide forced governments to undertake intervention measures to encourage social distancing. Meanwhile, traumatic skin lacerations require multiple hospital visits for dressing changing and suture removal since they are usually repaired with non-absorbable sutures. These visits can be avoided by using absorbable sutures instead. However, absorbable sutures carry the "potential" risk of wound infection. In the current study, our first objective was to determine the non-inferiority of absorbable sutures regarding infection rateafter repairing traumatic wound lacerations in comparisonto the conventional non-absorbable ones. Our secondobjective was to evaluate the superiority of absorbable sutures in regardto postoperative clinic visits for suture removal and wound dressing compared to the non-absorbable ones. Methods A sample of 471 patients with traumatic skin lacerations was analyzed during the COVID-19 pandemic in April 2020. In the control group, wounds were repaired using non-absorbable sutures, while rapid-onset absorbable sutures were used in the treatment group. By conducting a phone/video call follow-up after 21 days, several parameters regarding infection signs and clinic visits were compared between both groups. Results A significant decrease in total trauma patients (45.4%) and those who required suturing (51.2%) was observed in April 2020 compared to the same month of the previous four years (p = 0.001 (2016), p = 0.027 (2017), p = 0.027 (2018), and p = 0.001 (2019)). Regarding wound infection, no statistically significant difference(p = 0.623) was observed between the absorbable (3.2%) and non-absorbable (4.9%) groups. Using absorbable sutures resulted in significantly(p < 0.001) fewer postoperative hospital visits compared to using non-absorbable sutures (mean: one versus three visits). Conclusion Using absorbable sutures to repair traumatic wound lacerations is safe regarding wound healing and infection rates. They also reduce postoperative hospital visits since they are not intended to be removed. Therefore, they should be considered during a pandemic to reduce hospital visits for suture removal, which will subsequently enhance social distancing and relieve hospital load.

Complications and Clinical Outcomes Following Zone I Flexor Tendon Repair Using All-Inside Suture Fixation

The purpose of this study was to evaluate complications and outcomes of an all-inside repair technique for flexor digitorum profundus (FDP) avulsions. A retrospective review of a single institution database identified all FDP avulsions that were repaired using an all-inside technique by a single surgeon. In this method, 2 Keith needles are drilled from the volar to dorsal aspect, exiting proximal to the nail matrix and within the extensor tendon. Nonabsorbable sutures were placed in the flexor tendon and passed through the bone tunnels, tying dorsally over the distal phalanx. The demographics characteristics, injury characteristics, the surgical procedure, postoperative complications, and outcomes were reviewed. Seventeen patients were included in the study. The average age was 40 years (range, 21-68 years), and 2 patients were women. Seventeen fingers were included: 14 ring fingers, 1 index finger, and 2 little fingers. Six patients had an associated distal phalanx fracture and one had an associated distal interphalangeal joint dislocation. The average time between injury and surgery was 9 days (range, 2-18 days). Four patients had complications: 3 with erythema related to infection, which appeared to be a reaction to the suture prompting removal, and 1 with a subungual mass related to the suture at removal. One patient had persistent pain. Postoperative range of motion, assessed using the Strickland criteria, was excellent or good in 5 (33%) of 15 patients, but this was predominantly due to motion at the proximal joints as overall DIP motion was limited. Patients had a mean distal interphalangeal joint range of motion of 24° (range, 0° to 55°). In our series, repair of FDP avulsions via all-inside suture fixation is associated with limited distal interphalangeal joint motion and an incidence of infection (24%) at final follow-up. Therapeutic V.

Limited Open Achilles Repair without Instrument Guided Assistance: A Surgical Technique

Category: Sports Introduction/Purpose: The limited open Achilles tendon repair technique has recently gained popularity as a treatment option for acute Achilles tendon ruptures. This surgical technique video describes a limited open Achilles tendon repair without instrument guided assistance, demonstrating improved clinical outcomes for patients while also reducing reliance on operative equipment, cost, and the duration of surgery. Methods: The indications for this limited open Achilles tendon repair technique include an Achilles tendon rupture less than six weeks from injury occurring in the watershed area. The patient is prone and a two to three centimeter longitudinal incision is made over the Achilles tear. In the proximal stump, three non-absorbable sutures are passed horizontally from proximal to distal direction. In the distal stump, the same is done in a non-locking manner. The stumps are then reflected and the deep fascial compartment is released. The foot is plantarflexed to reduce tension on the repair site. The non-locking sutures are tied sequentially from distal-distal to proximal-proximal direction. A running box suture using a non-absorbable suture followed by 0- Vicryl around the rupture site is performed. Results: This technique has demonstrated, at a median follow-up of 3.7 years, restored preinjury function along with no wound complications, reruptures, or reoperations in 33 patients. The median time from injury to surgery was 10 (range, 1-45) days and the mean time for returning to preinjury level of activity was 5.6 (range, 1.7-22.1) months. After the procedure, patients demonstrated significant improvements in mean Foot and Ankle Disability Index (49.1 to 98.4), mean Visual Analog Scale pain score (4.8 to 0.2), and mean Foot and Ankle Outcome Score (FAOS) subscales such as FAOS pain (54.8 to 99.2), FAOS symptoms (84.6 to 97.0), FAOS activities of daily living (61.4 to 97.2), FAOS sports and recreational activity (39.5 to 98.5), and FAOS quality of life (39.7 to 88.7). Conclusion: Patients who underwent a limited open Achilles tendon repair without instrument guided assistance demonstrated significant improvements in outcome scores with minimal complications.

Outcomes Following Broström Repair with Internalbrace Ligament Augmentation vs Broström Repair Alone for the Treatment of Anterior Talofibular Ligament Injury of the Lateral Ankle

Category: Ankle; Sports Introduction/Purpose: The Broström procedure is indicated for lateral ankle instability in the setting of acute or chronic ankle sprains, with injury of the anterior talofibular ligament (ATFL) being the most common. While the procedure is anatomically favorable, one disadvantage of the Broström procedure is significantly reduced strength of the repair when compared with the native ligament. Broström repair with augmentation of an InternalBrace (Arthrex, Naples, FL), nonabsorbable suture tape fixed directly to the bone, has demonstrated increased strength and stiffness of the repaired ATFL; however, there is a paucity of literature published on clinical outcomes. The purpose of this study is to compare clinical outcomes following treatment of ATFL injuries with Broström repair alone versus Broström repair with InternalBrace augmentation. Methods: Between January 2009 and December 2017, patients 18-75 years old who underwent surgical treatment for an ATFL injury of the lateral ankle injury with either a Broström repair alone (Cohort A) or Broström repair with InternalBrace augmentation (Cohort B) performed by two surgeons (TOC or CTH) and at least 2 years post-operative were identified. Minimum 2-year follow-up was obtained with patients completing subjective questionnaires including Foot and Ankle Ability Measure (FAAM) with Activities of Daily Living (ADL) and Sport subscales, Short Form-12 (SF-12) Mental Component Summary (MCS) and Physical Component Summary (PCS), Tegner activity scale, and patient satisfaction with surgical outcome. Demographics and patient-reported outcomes were compared between groups. Results: In total, 103 patients were included in the study. Cohort A had 54 patients (29 females) with median age of 32 (range: 19 to 68) and 49 of 54 patients (91%) completed follow-up at an median of 2.32 years (range: 2 to 12 years). Cohort B had 49 patients (29 females) with median age of 37 (range: 18 to 66) and 38 of 49 patients (78%) completed follow-up at an median of 3.07 years (range 2 to 7 years). There was no significant difference in age or sex between cohorts (p&gt;0.05 for all). At earliest minimum 2-year follow-up, there was no significant difference in median post-operative FAAM ADL (97% vs 98%, p=0. 979), FAAM Sport (91% vs 91%, p=0.976), SF-12 PCS (56 vs 54, p=0.143), SF-12 MCS (56.6 vs 57.0, p=0.155), Tegner score (6 vs 5, p=0.214), or patient satisfaction (9 vs 9, p=0.781). Conclusion: Patients treated for ATFL injury of the lateral ankle with Broström repair with InternalBrace augmentation demonstrated similar clinical outcomes to those treated with Broström repair alone. With its advantages in strength and stiffness, the InternalBrace should be considered when treating lateral ankle instability in the setting of ligamentous injury since it allowed an earlier return to full weight bearing and a quicker rehabilitation protocol.