Nylon Stitches Research Articles

Study on denervated rat skeletal muscle by 7.0 T 31P-MR phosphorus spectroscopy

Objective To investigate the changes of 31P-MRS in denervated skeletal muscle at 7.0 T MR system. Methods In the experiment group, a total of 18 male Sprague-Dawley rats aged 6-8 weeks old and weighing 200-250 g were obtained. The right posterior femoral nerve were transected, and the proximal stumps were ligated by using 5-0 nylon stitches to preclude spontaneous repair. A sham surgery (incision and exploration of the nerve) was performed at the same time (n=6). Before rat model established and at varying times after initial surgery (3 d, and 1, 2, 4, 6, and 8 weeks). 31P-MR spectra of rat quadriceps femoris were acquired on 7.0 T Agilent small animal MR imaging system. We quantified the phosphocreatine (PCr), adenosine triphosphate(β-ATP), and inorganic phosphate (Pi) using Creatine phosphate disodium salt(10 mmol/L) as an external standard. The ratios, include PCr/Pi, Pi/β-ATP, PCr/β-ATP, PCr/(PCr+Pi) and Pi/(PCr+Pi) were quantified in jMRUI. All data were analyzed by one way analysis of variance (ANOVA) with posttest inter-group comparisons using Bonferroni test. Comparative analysis methods between the experimental and control group were performed via independent samples t test. P<0.05 was considered as statistically significance. Results The average measured concentrations of β-ATP, PCr, and Pi in control groups were (6.654±0.178) μmol/g, (25.656±0.738) μmol/g, and (1.594±0.096) μmol/g, respectively. There were significant statistically differences in β-ATP, PCr, Pi, PCr/Pi, PCr/PCr+Pi,Pi/PCr+Pi between the study and control group(P<0.05) at any measurement time point after denervation. Pi/β-ATP,PCr/β-ATP and pHi in the experimental group significantly statistically differed from those of the control group (all P<0.05)at each time point except on day 3 after operation. The total concentrations of β-ATP and PCr were reduced by 11.5% and 19.7% respectively on day 3. Thereafter, β-ATP and PCr declined rapidly by 63.1% and 68.8% at week 4 respectively, then decreased slowely by 74.0%和82.3% till week 10. The change of PCr/Pi is similar to β-ATP and PCr, but more remarkable. Pi, Pi/PCr+Pi, Pi/ATP showed a progressively increase till week 10. The intra-cellular pH (pHi) of normal rat muscles was 7.033±0.017, While the pHi gently in experiment rat muscles decreased during the entire experiment. Conclusion 31P-MRS with 7.0 T can quantify the temporal changes of energy metabolism and pHi in normal and denervated rat muscles. It shows that the dysfunction of energy metabolism are progressive with time and that they begin within a short period following the nerve section, the change of β-ATP, PCr, PCr/Pi take place primarily within 4 weeks after denervation. β-ATP, PCr, and PCr/Pi may be potential biomarkers of energy metabolism in the evaluation of denervated muscle atrophy. Key words: Magnetic resonance spectroscopy; Muscular disorders, atrophic; Denervation; Energy metabolism; Intracellular pH

A randomised controlled trial comparing skin closure in total knee arthroplasty in the same knee: nylon sutures versus skin staples.

ObjectivesNylon sutures and skin staples are used commonly in total knee arthroplasty (TKA) surgical wound closure. However, there is no study that compares the wound healing efficacy and patient satisfaction scores of both techniques in the same knee.MethodsWe randomised 70 patients who underwent primary TKA into two groups. In one group of 34 patients, the skin at the upper half of the wound was closed with skin staples and the lower half of the wound was closed with simple interrupted nylon sutures. In the other group of 36 patients, the skin at the upper half of the wound was closed with nylon stitches and the lower half of the wound was closed with skin staples. We recorded the wound closure time, pain score at the time of stitch removal, wound complication rate, patient satisfaction score, and the Hollander wound evaluation score at the post-operative periods of five days, 14 days, six weeks, three months, and six months. Each half wound was analysed separately.ResultsThe mean patient body mass index was 26.8 kg/m2 (standard deviation 6.3). A total of 70 nylon stitched wounds and 70 skin stapled wounds were analysed. There were no significant differences in wound complication rates, patient satisfaction score, and the Hollander wound evaluation score between both types of wounds (p > 0.05). The wound closure time for skin stapled wounds was significantly lower than the nylon stitched wounds (p < 0.001). However, the skin stapled wounds had a significantly higher pain score at the time of stitch removal (p < 0.001).ConclusionSkin staples and nylon stitches had comparable results with respect to wound healing and patient satisfaction in TKA wound closure in non-obese patients. The benefit of skin staples over nylon stitches was a decrease in operative time, but was more painful upon removal.Cite this article: V. Yuenyongviwat. A randomised controlled trial comparing skin closure in total knee arthroplasty in the same knee: nylon sutures versus skin staples. Bone Joint Res 2016;5:185–190. DOI: 10.1302/2046-3758.55.2000629.

Fat Transfer for Breast Reconstruction

Sir: Fat grafting to the breast is an old concept. Czerny first described breast reconstruction by fat transfer in 1895.1 After a long and controversial history, fat grafting has become an invaluable tool in breast reconstruction. It is used for core reconstruction and as an ancillary technique after various procedures for breast reconstruction. Unfortunately, in many cases, the recipient area is deformed by previous oncologic surgery, radiotherapy, or other pathologic circumstances. To address this issue, we use the three-dimensional ligamentous band release technique, or “rigottomy.” This technique was first described by Gino Rigotti, who used a pickle fork to release heavily scarred, recipient-site–radiated tissue.2 Three-dimensional ligamentous band release followed by adipose tissue grafting can be used effectively in breast reconstructive surgery, breast augmentation, and for the treatment of Dupuytren contracture.3–5 Breast deformities due to internal ligamentous bands and extensive scars can be successfully treated percutaneously. Immediately before fat injections to the breast, an 18-gauge Tuohy needle is inserted into multiple sites to release parenchymal tethering and scars, thereby creating a matrix that is the scaffold that will better accept fat grafts. In fact, decreased interstitial pressure leads to increased tissue perfusion and more engraftment potential. At our institution, from September of 2011 to September of 2012, we performed 11 three-dimensional ligamentous band release procedures before fat grafting to the breast. Eight patients were treated after breast-conserving surgery and three patients after expander-implant breast reconstruction. The sequelae of breast-conserving surgery are a challenge for plastic surgeons. Fat grafting with the release of parenchymal tethering and constriction bands improves breast contour, which appears smoother and more harmonious after the procedure. Before fat injections, once adipose tissue has been harvested and purified, the skin of the breast is raised and placed under tension using two nylon stitches. Multiple breast puncture wounds are then made with a Tuohy epidural needle, and the constriction bands are progressively and extensively severed through slight transverse oscillations at each puncture point (Fig. 1). The 18-gauge Tuohy needle we use is 9 cm long and has a blunt bevel with a 30-degree curve at the tip. With its long and firm cannula, the Tuohy needle can be handled efficiently by the surgeon, allowing a stable hold. Tension is maintained by constantly stretching the skin of the breast using the nylon suture, as the ligamentous bands progressively give way. Frequently, it is necessary to replace the stitches during the procedure if the area to be addressed is wide. Residual parenchymal tethering and scars are localized by palpation and treated in the same fashion. We carefully avoid creating an empty space where the adipose-grafted tissue cannot be nourished. Otherwise, we mesh the ligamentous band in multiple levels and planes, converting the cicatrix into a three-dimensional matrix that subsequently will be filled by adipose tissue grafts. In our practice, we have found that percutaneous three-dimensional ligamentous band release is also very useful in expander-implant breast reconstruction, mostly for the treatment of acquired contour deformities due to cicatricial adhesions secondary to extensive postoperative scarring or radiotherapy. Constriction bands are broken up through slight transverse oscillations of a Tuohy needle under the scar, taking care not to damage the implant.Fig. 1: Three-dimensional ligamentous band release with a Tuohy needle, intraoperative view. Constriction bands are progressively severed in multiple planes through slight transverse oscillations at each puncture point.In conclusion, three-dimensional ligamentous band release with a Tuohy needle has dual beneficial effects: it allows the surgeon to break the constriction bands, and it increases parenchymal space, thereby reducing graft crowding and filling pressure. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Autologous Fibrin Membrane Combined With Solid Platelet-Rich Plasma in the Management of Perforated Corneal Ulcers

The combined use of autologous fibrin membrane and the eye platelet-rich plasma (E-PRP) clot could be considered as a new surgical alternative for the closure of corneal perforations. To evaluate the use of autologous solid platelet-rich plasma in combination with an autologous fibrin membrane as a surgical alternative for wound closure in perforated corneal ulcers. Both the fibrin membrane and the E-PRP clot were prepared with the patient's own blood just before the operation. Nylon stitches were used to fixate the fibrin membrane to the conjunctiva and then the E-PRP clot was placed over the corneal perforation, underneath the fibrin membrane. A temporal partial tarsorrhaphy was performed at the end of the procedure. We conducted postoperative monitoring for 3 months. SETTING Vissum Corporacion Oftalmologica, Alicante, Spain. Eleven patients with perforated corneal ulcers. Surgical alternative for the closure of corneal perforation. Corneal biomicroscopy, fluorescein test, digital tonometry. In all cases the corneal perforation was sealed. The fibrin membrane was present over the corneal surface for the first 3 to 5 days and then gradually disappeared. No evidence of infection or inflammation was detected. Digital tonometry confirmed acceptable levels of ocular tonus in all cases from day 2 after the operation. No patients reported pain, discomfort, or other symptoms, and no complications were observed. After 3 months' follow-up, there was no evidence of relapses or perforations. Corneal grafting was eventually performed in 7 of the 11 cases. The combined use of autologous fibrin membrane and E-PRP clot is a safe and effective surgical alternative for the closure of corneal perforations. This technique can be considered as a temporary measure until the condition of the cornea permits definite intervention.

Bovine Pericardium Membrane (Tutopatch) Combined With Solid Platelet-Rich Plasma for the Management of Perforated Corneal Ulcers

To evaluate the use of a collagenous patch derived from bovine pericardium (Tutopatch) associated to a clot of autologous eye platelet-rich plasma (E-PRP) as a surgical alternative for the closure of perforated corneal ulcers. A total of 6 patients with perforated corneal ulcers were treated. The Tutopatch was fixed to the conjunctiva with nylon stitches and then the E-PRP clot was placed on the corneal surface, underneath the patch. At the end of the procedure, a partial temporal tarsorrhaphy was done. Patients were observed daily for the following 10 days. In all cases, the corneal perforation was sealed. The bovine pericardium patch was present over the corneal surface until the tarsorrhaphy was opened. No evidence of infection or inflammation was detected. Digital tonometry confirmed acceptable ocular pressure in all cases from day 2 after the surgery. No patients reported pain, discomfort, or any subjective symptoms, and no complications were observed. The tarsorrhaphy was opened 2 to 3 weeks after the surgery, and the ocular surface was inspected without signs of leakage. The patients were followed up for 3 months with no evidence of relapses or perforations in 5 of them. The combined use of Tutopatch and E-PRP clot was found to be a safe and effective surgical technique for the closure of perforated corneal ulcers. This technique could be an alternative for the urgent management of perforated corneal ulcers although additional studies are needed to determine the technique's overall effectiveness.

Intraoperative Videokeratography in Penetrating Keratoplasty and Excimer Laser-Assisted Lamellar Keratoplasty for Keratoconus

To evaluate the usefulness of intraoperative computerized corneal topographic data in excimer laser-assisted lamellar keratoplasty (ELLK) and penetrating keratoplasty (PK). Prospective, comparative, interventional case series. Intra- and postoperative videokeratography (Keratron Scout) evaluation was performed on 30 eyes of 30 consecutive patients affected by keratoconus (16 men and 14 women; mean age 32.63±8.02 years) submitted to ELLK (15 eyes) using 16 interrupted 10-0 nylon stitches or to PK (15 eyes) using a 12-bite 10-0 nylon double-running continuous suture. In the ELLK group, the mean intraoperative keratometric astigmatism was 12.06±4.86 diopters (D), which changed to 5.19±2.51 D after topography-guided intraoperative suture adjustment. In the PK group, intraoperative keratometric astigmatism was 10.18±3.88 D, which changed to 3.49±0.41 D. After 24 months (sutures out), the mean videokeratographic keratometric astigmatism was 3.35±1.96 D in the ELLK group and 3.37±0.92 D in the PK group. The Alpins method of vector analysis showed some significant changes especially in the ELLK group. In keratoplasty surgery, videokeratography is useful for suture adjustment. In the PK group, using a double-running suture technique, the postoperative astigmatism (after all sutures were removed) was similar to the astigmatism measured intraoperatively by videokeratography.

Transumbilical Approach for Pseudogynecomastia Liposuction

Pseudogynecomastia, a common phenomenon caused by increased male breast subcutaneous fat deposition, usually occurs bilaterally. The development of pseudogynecomastia may cause significant psychological distress and embarrassment, particularly in young men and adolescents. Unfortunately, pseudogynecomastia responds poorly to diet and exercise. For this reason, surgery is the first-line treatment. Liposuction (using a vacuum-suction cannula) via the axillary approach usually is recommended [1]. Liposuction provides a well-defined contour for the male breast with small axillary scars. However, even after successful operations, this approach could leave visible postoperative skin scars. To avoid these axillary scars, we have used a transumbilical approach for pseudogynecomastia liposuction, as in transumbilical breast augmentation (TUBA). Using the transumbilical approach, we make only one vertical incision inside the umbilicus at the 12 o’clock position and remove the fatty tissue with a traditional tumescent liposuction (Fig. 1). Tumescence is accomplished using one ampule of adrenalin (1 mg.) per liter of infiltrated isotonic saline solution. The cannulas most often used are 3 and 4 mm in diameter and 30 to 35 cm long. The liposuction is always performed starting in the deep plane and ending in the superficial plane using the thinnest stems. The umbilical incision is closed with 5-0 nylon stitches. After liposuction, all the patients are wrapped with compressive bandages for 6 weeks to improve contraction of the skin. The advantages of the transumbilical approach are the easy access it provides to both breasts with only one incision. Furthermore, it permits a more comfortable position for the surgeon and leaves a small and inconspicuous skin scar inside the umbilicus, eliminating the stigma of breast surgery. We have used this approach for 10 patients with mild to moderate pseudogymecomastias, and none of the patients had postoperative complications. There were no treatmentinduced asymmetries, contour deformities, or irregularities (Fig. 2). No open excision or skin reduction procedures were required. Tumescent liposuction using a single entry site inside the umbilicus is a new access for the treatment of pseudogynecomastia, resulting in a high level of patient satisfaction.

Healing Process at the Flap Edge in Its Influence in the Development of Corneal Ectasia After LASIK

Purpose: Post–laser in situ keratomileusis (LASIK) corneal ectasia is a progressive deformation of the gross corneal anatomy that occurs after surgery. However, this is a rare event even after deep lamellar keratoplasty. We hypothesize that the strength of the lamellar keratoplasty wound is derived from the sutures that enhance the wound edge healing response. This study compares, in a rabbit model, the stability of previously sutured and unsutured microkeratome flaps. Methods: Unilateral 160-μm-thick LASIK flaps using a mechanical microkeratome was performed in 20 rabbit eyes. Animals were then divided in two groups: In group A, the flap was left without sutures. In group B, the flap was sutured with 12 interrupted 10/0 nylon stitches that were removed after 3 weeks under general anesthesia. Six weeks after surgery, all rabbits had corneal topographies performed at their baseline intraocular pressure (IOP) (14 mmHg) and at two artificially increased pressures (25 and 45 mmHg) using an anterior chamber maintainer implanted in the inferior limbal area. The animals were humanely euthanized, and immunohistological analysis of the corneas was performed. Results: A delta K1 value, which indicates the difference in the simulated keratometric value at baseline and the one measured at 25 mmHg, was calculated for all eyes. It showed a mean steepening effect of 2.74 D ± 0.38 D in group A compared with 1.08 D ± 0.27 D in group B (p < 0.05). Similarly, a delta K2 value, which indicates the difference in the simulated keratometric value at baseline and the one obtained at 45 mmHg, was registered. It showed a mean steepening effect of 3.02 D ± 0.87 D in group A compared with 0.75 D ± 0.44 D in group B (p < 0.05). Six weeks after surgery, the peripheral flap interface in group B consisted of 14.3% ± 4.15% of positive monoclonal mouse anti-alpha smooth muscle actin (α-SMA) cells compared with 4.18 ± 3.76% in group A (p < 0.05). Conclusions: The addition of sutures in the corneal flap after LASIK appears to reduce the amount of corneal steepening when the IOP is artificially increased up to 25 mmHg in this rabbit model. Our results suggest that an increase in the amount of myofibroblastas induced by the sutures may be responsible for this behavior. Corneal ectasia may be related to the clinically observed lack of corneal wound-healing at the edge of the flap that allows the cornea to bulge. By stimulating a stronger wound-healing response at the edge of the flap, the cornea may better resist steepening under increased IOP conditions and improve the long-term stability of LASIK surgery in borderline thin corneas.

Mersilene Sutures for Corneal Surgery

We studied the complications resulting from using running Mersilene suture in 14 patients who underwent penetrating keratoplasty for keratoconus. 11-0 Mersilene running suture and 12 interrupted 10-0 nylon stitches were used in each procedure and the patients were followed for 22 to 48 months. None of the Mersilene sutures broke, but four were removed in two patients: in one, due to astigmatism or loosening of the suture as a result of sterile ulceration, and in the other, due to herpetic keratitis. Marked scarring manifested along the loops of the sutures in 11 of the Mersilene sutures. Despite these problems, we conclude that the use of Mersilene sutures, alone or combined with nylon sutures, in penetrating keratoplasty is sufficiently advantageous to warrant further study.

Postoperative adhesion after uterine horn surgery in the rat, with the use of TC7

The influence of TC7 in adhesion prevention was tested on 24, 2.5-month-old Wistar rats. Their right and left uterine horns were homogeneously allotted into four experimental groups, each of 12 horns. The groups were as follows: Group C ( n = 12), that underwent cuts along 1 cm in the serosal layer; Group TC ( n = 12), where the uterine horn was only surrounded with 3 layers of TC7, 1 × 1 cm in size; Group C + TC ( n = 12) in which the serosal cuts were covered with TC7, as in group TC and an untouched control group ( n = 12). All uterine horns were kept in uniform contact with the intestinal serosa layer by means of two 8 0 nylon stitches spaced 2 cm apart, so that the adhesion surfaces were the same in all groups. Lengths in mm and severity adhesions (0 = no adhesion to 3 = severe adhesion) were recorded. The injury in group C caused extensive (8.83 ± 4.77 mm) and dense adhesions (score 2.42 ± 1.11) in 83.33% of the cases. No significant differences were observed compared with the C + TC group (8.08 ± 5.45 mm, score 2.25 ± 1.30; P > 0.05, ANOVA). Significantly, more adhesions were observed on the C and C + TC Groups than in the control (1.00 ± 2.27 mm, score 0.16 ± 0.37) and TC (3.08 ± 3.38 mm, score 1.00 ± 1.15) groups ( P < 0.05, ANOVA). TC7 does not appear to be an effective agent for preventing postoperative adhesions in this animal model.

The permanence of otoplasty in the rabbit ear: a comparison of techniques.

Otoplasty should restructure the cartilage framework of the ear with permanent results. Major techniques include the placement of permanent sutures, with or without concomitant cartilage scoring, and cartilage abrasion alone. Our study evaluates the durability of the results of each method. Fifteen New Zealand white rabbits were divided into two groups. In 10 rabbits, the posterior surface of the right ear cartilage was abraded, and the ear was folded forward and secured with nylon stitches. A similar procedure was performed on the left ear, omitting the cartilage abrasion. In 4 rabbits, both ears were abraded transversely on the posterior cartilaginous surface and no sutures were placed. In 1 rabbit only the posterior skin was undermined on both ears. For one week dressings maintained a right-angle fold at the operative site. Rabbit ears reshaped with abrasion only failed to maintain the desired conformation. Ears with suture and abrasion did not maintain the full 90-degree angle created at surgery, although they did not fully straighten. Ears reshaped with suture alone maintained a folded angle close to the original right angle. Three months after operation the sutures within the cartilage were removed to approximate the clinical situation of late suture disruption from trauma to the operated ear and the shape was assessed.