Nylon Suture Research Articles

Biomechanical comparison of four isometric prosthetic ligament repair techniques for tarsal medial collateral ligament injury.

To compare the stability, ultimate strength, and isometry of 4 prosthetic ligament repairs for canine tarsal medial collateral ligament injury. 24 cadaveric canine distal hind limbs with induced medial tarsal instability were randomly divided into 4 groups. Simulated medial shearing injury of the collateral and medial malleolus were repaired using 1 of 4 isometric suture techniques: bone tunnels with nylon suture (TN), ultrahigh-molecular-weight polyethylene (UHMWPE) suture (TU), tibial bone anchor with nylon suture (AN), or talar bone anchor with UHMWPE suture (AU). Each repair was evaluated for medial stability before and after cyclic range of motion. 3 of 4 repair configurations allowed string potentiometer isometry data collection during cyclic range of motion. Each construct was subsequently tested to failure; the strength and failure mode were recorded. All repair groups showed statistically increased laxity compared to intact ligament. There was no difference in joint laxity between repair techniques. Cyclic range-of-motion testing did not increase joint laxity at any tested joint angle. Strength to failure was no different between repair groups. Isometry was achieved in the TU and TN groups. All 4 techniques improved medial stability compared to that medial collateral ligament injury; however, no technique returned stability to the tarsal of the intact ligament. All 4 techniques maintained stability after range-of-motion testing. Isometric placement of the prosthetic suture was achievable. The constructs did not provide sufficient resistance to physiologic valgus stress. Isometric placement of a prosthetic ligament is possible; secondary stabilization appears necessary to support the repair postoperatively.

Cervical heterotopic heart transplantation in mice using a novel suture technique

BackgroundVascularized transplantation models in mice are critical to understand mechanisms that mediate rejection and to develop new therapeutics. Standard abdominal heterotopic heart transplantation techniques employ an end-to-side suture technique and are the workhouse of transplant immunology research laboratories. Recently, cervical heterotopic heart transplantation in mice has emerged as an alternative due to several advantages but is conventionally performed by suture or cuff techniques in an end-to-end fashion. Therefore, we introduce an end-to-side anastomosis technique. MethodsThe donor pulmonary artery is end-to-side anastomosed to the recipient right external jugular vein, using a continuous 10-0 nylon suture. Vascular suturing is accomplished inside the vessel on the posterior wall, and then outside the vessel on the anterior wall. Finally, the donor ascending aorta is end-to-side anastomosed to the recipient common carotid artery with an identical suture technique. ResultsThe median times for the donor heart harvest, recipient preparation, anastomoses of the pulmonary artery to the external jugular vein, and the ascending aorta to the common carotid artery were 12, 10, 12 and 11 min, respectively. The survival rate was 100% (n=20). ConclusionsWe provide a detailed description of how to perform end-to-side anastomoses using a suture technique in the mouse cervical heart transplantation model. This procedure reconstitutes coronary blood flow in the heart graft with minimal interruption to recipient anatomy and provides an experimental platform to study transplant immunology.

Lamellar scleral patch autograft after ballistic accident: A case report

Scleral graft has been used in clinical situations including perforating eye trauma to treat traumatic scleral dehiscence. A 28-year-old male patient presented for a painful left eye following a firearm-related injury few hours ago. Visual acuity was limited to light perception with a 2 mm wide, oval-shaped inferior scleral gap. Due to the size of the scleral defect, we decided to perform a scleral autograft. The graft was fashioned from the inferonasal sclera, deposited over the recipient hole, and secured with 10–0 nylon sutures on the corneal and scleral sides of the surgical bed with favorable anatomical and refractive outcomes.

Impact of Needle Design and Suture Gauge on Tissue Tearing During Skin Suturing: A Comparative Analysis.

Surgeons face numerous choices in selecting sutures for skin closure, with potential adverse effects such as tissue tearing. To investigate the influence of needle design and suture gauge on tissue tearing during suturing procedures. The authors tested the tear-through force in Newtons for 3 needle types and 3 suture gauges using an artificial skin model and a professional-grade tensiometer. Suture material was secured into the skin model, and force was applied to the suture at a constant rate, resulting in tearing. Force-displacement and force-time curves were generated. Evaluation included conventional cutting (PC-3), reverse cutting (PS-3), and taper point (BB) needles with a 5-0 polypropylene suture. In addition, nylon sutures with a reverse cutting needle (PS-2) were tested at 3 suture gauges (5-0, 4-0, 3-0). The mean tear-through forces for PC-3, PS-3, and BB were 3.26 N, 3.75 N, and 4.07 N, respectively. For the 5-0, 4-0, and 3-0 nylon sutures, the mean tear-through forces were 3.44 N, 3.81 N, and 4.04 N, respectively. Statistical analysis revealed a significant impact of suture gauge size (p < .001) and needle geometry (p < .001) on tear-through force. Larger suture diameter and taper needles minimize tissue tearing.

Spontaneous filtering bleb: Diagnosis and treatment

Abstract: A 72-year-old patient presented with decreased visual acuity and ocular discomfort. The patient had not undergone previous ocular surgery or had a history of ocular trauma. Physical examination revealed decreased intraocular pressure (IOP) (9 mmHg), a subconjunctival filtering bleb, and hypotonic maculopathy. Ultrasound biomicroscopy revealed a fistula between the anterior chamber and the subconjunctival space at Schwalbe’s line. The patient presented no findings suggestive of systemic disease or dysmorphic facial features. Surgical closure of the fistula was attempted using multiple transconjunctival 10-0 nylon sutures and staining using trypan blue 0.06%. Although the fistula was not sealed, the bleb became flatter, IOP increased (18 mmHg), and hypotonic maculopathy resolved. Spontaneous formation of subconjunctival filtering blebs is exceedingly rare; most reported cases are associated with concomitant systemic or local disease. Our novel surgical approach successfully treated the hypotony and revealed that intraoperative use of trypan blue 0.06% in phakic patients causes temporary capsular staining.

Managing surgical aphakia and posterior capsular rupture with suture-assisted intraocular lens implantation

Abstract: OBJECTIVE: This study aims to describe a novel technique for implanting an intraocular lens (IOL) in the sulcus using a 10-0 nylon suture in cases of intraoperative posterior capsular rupture (PCR) with inadequate capsular support, anterior capsular extension during continuous curvilinear capsulorrhexis extending to the posterior capsule, or posttraumatic cataract. METHODS: The study included 52 patients who underwent surgery at our hospital, during which an IOL was implanted with the assistance of a 10-0 nylon suture. All patients completed a 1-year follow-up period. RESULTS: In 48 of the 52 patients, the IOL remained stable. However, in two patients, the IOL dropped into the vitreous cavity approximately 1-month postsurgery. These two individuals required IOL explantation, pars plana vitrectomy, and secondary IOL (SFIOL) implantation. CONCLUSION: Implanting an IOL in cases involving intraoperative PCR with inadequate capsular support, anterior capsular extension to the posterior capsule during continuous curvilinear capsulorrhexis, or posttraumatic cataract can be challenging. The technique of IOL implantation with the assistance of a 10-0 nylon suture, as described in this study, offers a straightforward and safe approach. In addition, it can help alleviate the financial and psychological trauma associated with a second surgery for both the patient and the surgeon.

Surgical Treatment of Synovial Cyst in Scapholunate Joint

Ganglion cysts are the most common soft-tissue mass in the hand and wrist, making up 50% to 70% of all masses. They are most common in individuals in their twenties and forties, with women being affected three times more than males. The primary symptoms reported by people with wrist ganglion cysts are pain, weakness, and a visually unappealing look. Approximately 10% of patients report a prior traumatic experience being linked to the emergence of a ganglion cyst. Surgical treatment is often performed on an outpatient basis, using general anesthesia or axillary block anesthesia. A pneumatic tourniquet ensures a field without blood. Using a magnifying loupe is recommended to avoid detecting the pedicle and its connection to the ligaments below. Dorsal ganglion cysts involve making a transverse incision immediately above the cyst, dislodging the primary cyst from surrounding tissues using tenotomy scissors. Angelides' approach involves making a curved cut through the capsule next to the cyst, allowing for the removal of capsular attachments and mucin ducts. To alleviate severe pain caused by dorsal ganglion cysts, it is recommended to surgically remove the posterior interosseous nerve above the extensor retinaculum. Volar wrist ganglion cysts involve making an incision along the radial side of the cyst, enabling both proximal and distal extension to reach distant capsular attachments. The ganglion is released from all adjacent connective tissue, and the radial artery is moved both towards the body and away from it. Precise control of bleeding is achieved using bipolar electrocautery, and the wound is thoroughly flushed with fluid. Skin margins are infused with a prolonged-acting local anesthetic, and the wound is sealed with intermittent 4-0 or 5-0 nylon sutures. Prompt mobilization is recommended, but a splint is not used until significant dissection has occurred. Article Details

A New Technique of Sterile Polyethylene Instrument Cover as Temporary Corneal Patch to Reconstruct Anterior Chamber in Penetrating Keratoplasty Combined with Intraocular Surgery.

Complications such as explosive choroidal hemorrhage, residual cortex, and capsule rupture often occur during intraocular surgery combined with penetrating keratoplasty (PKP) due to poor maintenance of the anterior chamber. To address these challenges, we have innovatively utilized a sterile polyethylene instrument cover to temporarily reconstruct the anterior chamber. In this report, we describe a technique where a 'temporary corneal patch' was created from a sterile instrument cover, using a trephine to ensure a diameter approximately 1-2 mm wider than the corneal bed or perforation. This patch was then sutured into the host corneal bed or the perforation with 10-0 nylon sutures during intraocular surgery combined with PKP. Each case was evaluated for surgical efficacy and complications. We successfully applied this technique in three cases of combined corneal transplantation surgery. In two cases, PKP, phacoemulsification, and intraocular lens implantation were successfully performed. In the third case, PKP, vitrectomy, and other intraocular procedures were performed. No intraoperative or postoperative complications were observed. The use of a sterile polyethylene material as a temporary corneal patch for anterior chamber reconstruction represents a safe, effective, and cost-efficient approach for intraocular surgery combined with PKP or posterior segment surgery as a keratoprosthesis.

Various handcrafted artificial vessels: Evaluation of practicality and feasibility for supermicrosurgery training

BackgroundSupermicrosurgery demands more refined skills compared to traditional microsurgery, necessitating comprehensive training prior to clinical implementation. Despite the existence of various training models, they often fall short in terms of cost, ethical considerations, and infection risk. Our objective was to develop and evaluate novel training models for supermicrosurgery that are cost-effective, ethical, and risk-free. MethodsWe fabricated tubes using polyvinyl alcohol (PVA) liquid glue, polyvinyl acetate resin (PAR) wood glue, and hydrocolloid dressing (HCD), aiming to identify suitable, low-cost candidates for a supermicrosurgery training model. These tubes were anastomosed under a microscope using 10-0 or 11-0 nylon sutures. We assessed the time and cost involved in tube creation, their diameters, and the overall feasibility of the models. ResultsThe average time and cost to fabricate a 15-mm-long luminal tube were 33.5minutes and $0.02 USD for the PVA group, 23minutes and $0.02 USD for the PAR group, and 63seconds and $0.40 USD for the HCD group, respectively. The average diameter of the tubes was 0.49mm in the PVA group, 0.58mm in the PAR group, and 1.55mm in the HCD group. The PVA and PAR tubes, with their transparent and thin walls, facilitated easier evaluation of anastomosis patency compared to the HCD tubes. ConclusionWe have successfully developed new supermicrosurgery training models using non-living materials, characterized by their low cost, absence of ethical concerns, and elimination of infection risk. The PAR and PVA tubes, in particular, are suitable for residents' training in supermicrosurgery.

Comparison of nylon, vicryl, and fibrin glue for nerve grafting in rats

ABSTRACT Objectives For nerve injuries, not amendable to tensionless epineural coaptation of the nerve, autografts are the preferred treatment. Although absorbable sutures are not recommended for nerve repair, there is no evidence that non-absorbable sutures are superior to absorbable sutures. This study aims to assess the effectiveness of non-absorbable monofilament nylon sutures, absorbable monofilament vicryl sutures, and fibrin glue when used for nerve grafting. Methods Lewis rats (N = 32) were subjected to a sciatic nerve transection and randomly assigned to a group: graft with Nylon, graft with Vicryl, graft with Fibrin Glue, or no graft. Motor function, sensory function, and thermal pain were assessed during a 12-week recovery period, and immunohistochemistry was used to assess macrophage response. Results At 12 weeks, the Vicryl and Nylon groups had significantly larger ankle angles at to lift off, which is a measure of motor function, compared to injured controls (p < 0.05). Grafted rats displayed no difference in thermal response but hypersensitivity to mechanical stimuli compared to the uninjured hindlimb. The Nylon, Vicryl, and Fibrin Glue groups all had significantly less atrophy of the gastrocnemius muscle compared to injured controls (p < 0.0001). In the Fibrin Glue group, 3/9 grafts did not incorporate. The Nylon group had significantly less (p = 0.0004) axon growth surrounding the suture holes compared to the Vicryl group. There were no differences in the axon counts, motor neurons, or sensory neurons between all grafted rats. Conclusions These results demonstrate that vicryl sutures work just as well as nylon for nerve recovery after injury and grafting.

Skimmianine Showed Neuroprotection against Cerebral Ischemia/Reperfusion Injury.

The aim of this study was to investigate the antioxidant and anti-inflammatory effects of skimmianine on cerebral ischemia-reperfusion (IR) injury. Twenty-four female Wistar albino rats were randomly divided into three groups: Sham, Ischemia-Reperfusion (IR), and IR + Skimmianine (40 mg/kg Skimmianine). Cerebral ischemia was induced using a monofilament nylon suture to occlude the middle cerebral artery for 60 min. Following 23 h of reperfusion, the animals were sacrificed 14 days later. The effects of skimmianine on brain tissue post-IR injury were examined through biochemical and immunochemical analyses. In silico analysis using the Enrichr platform explored skimmianine's potential biological processes involving IBA-1, IL-6, and NF-κB proteins. In the IR group, MDA levels increased, while SOD and CAT antioxidant enzyme activities decreased. In the IR + Skimmianine group, skimmianine treatment resulted in decreased MDA levels and increased SOD and CAT activities. Significant increases in IBA-1 expression were observed in the IR group, which skimmianine treatment significantly reduced, modulating microglial activation. High levels of IL-6 expression were noted in pyramidal neurons, vascular structures, and neuroglial cells in the IR group; skimmianine treatment reduced IL-6 expression, demonstrating anti-inflammatory effects. Increased NF-κB expression was observed in neurons and blood vessels in the gray and white matter in the IR group; skimmianine treatment reduced NF-κB expression. Gene Ontology results suggest skimmianine impacts immune and inflammatory responses via IBA-1 and IL-6, with potential effects on estrogen mechanisms mediated by NF-κB. Skimmianine may be a potential therapeutic strategy due to its antioxidant and anti-inflammatory effects on cerebral IR injury.

Challenging diagnosis and repair of an extensive cyclodialysis cleft

Introduction: This report describes a challenging case involving the diagnosis and surgical repair of an extensive cyclodialysis cleft (CDC) in a young, phakic patient. Patient and Clinical Findings: A 25-year-old man presented with ocular pain, visual impairment, eyelid hematoma, subconjunctival hemorrhage, and Berlin edema after blunt trauma to the right eye. Initial conservative treatment with medications was converted to surgery due to hypotony-induced maculopathy. Diagnosis, Intervention, and Outcomes: Ultrasound biomicroscopy (UBM) and gonioscopy revealed extensive supraciliary and suprachoroidal fluid and a CDC whose dimensions were inconclusive. However, consequent intraoperative UBM provided precise real-time anatomical evidence of an extensive CDC extending 8 clock hours and mandating closure with a direct cycloplexy approach. Layered scleral dissection and direct suturing of the ciliary body to the sclera were performed with 8-0 nylon sutures, resulting in CDC resolution, supraciliary and suprachoroidal fluid absorption, visual acuity improvement, and intraocular pressure stabilization. Conclusions: This case highlights the innovative use of intraoperative UBM as a critical tool, offering real-time guidance in managing an extensive CDC. The successful closure and improved visual outcomes in this case further validate the efficacy of direct cycloplexy for extensive CDCs.

Minimally invasive surgical approach to model hypertrophic scarring in the rabbit ear.

Current strategies for hypertrophic scar prevention and treatment are limited. To facilitate these efforts, a minimally invasive hypertrophic scar model was created in a rabbit ear for the first time based on previous methods used to induce ischemia. Six New Zealand white rabbits (12 ears total) were studied. First, ischemia was achieved by ligating the cranial artery, cranial vein and central artery, while preserving the caudal artery, caudal vein and central vein, respectively. The relative level of ischemia induced at time of surgery, both baseline and maximum perfusion, was assessed with a fluorescent light-assisted angiography and demonstrated lower rates of perfusion in the ischemic ears. Following vascular injury, a 2-cm full thickness linear wound was created on the ventral ear and closed with 4 - 0 Nylon sutures under high tension. For each rabbit, one ear received a combination of ischemia and wounding with suture tension (n = 6), while the other ear was non-ischemic with wounding and suture tension alone (n = 6). Four weeks post-operatively, ischemic ears developed scar hypertrophy (histological scar thickness: 1.1 ± 0.2mm versus 0.5 ± 0.1mm, p < 0.05). Herein, we describe a novel, prototypical minimally invasive rabbit ear model of hypertrophic scar formation that can allow investigation of new drugs for scar prevention.

Functional inferior canalicular reconstruction using a monocanalicular probe after tumor resection of the medial third of the lower eyelid

Purpose: To describe a surgical technique for functionally reconstructing a lacrimal drainage duct and to assess its long-term functionality.Methods: This observational review includes six cases involving reconstruction of the inferior canaliculus after surgical resection of lower eyelid carcinoma. Following lesion excision with safety margins, the epithelium of the distal portion of the inferior canaliculus is located and intubated with a monocanalicular probe. Subsequently, the eyelid lamellae are reconstructed without displacing the probe. The Monoka collarette is then sutured using a 10/0 nylon suture. Data collection included anatomic pathology of the lesion and data from ophthalmic examinations at each visit (including epiphora, inferior canalicular irrigation, and fluorescein dye disappearance test (FDDT)), as well as stent extrusion or other complications.Results: No complications were observed during the surgeries. The stents remained in place for an average of 4 months, with no extrusions prior to removal. The mean follow-up period was 4.8 years (SD=2.0), during which no other complications were noted. Only one patient experienced intermittent epiphora, also present in the fellow eye. At the final visit, FDDT was normal in all eyes, and all patients demonstrated patency of the inferior canaliculus upon irrigation.Conclusion: Primary reconstruction of an inferior lacrimal drainage duct following tumor resection can be successfully performed, resulting in favorable functional recovery.

Comparison of Three Techniques for Skin Closure in Caesarean Delivery (Absorbable Subcuticular Sutures, Non-absorbable Nylon Sutures, Surgical Staplers): A Randomized Controlled Trial

Comparison of Three Techniques for Skin Closure in Caesarean Delivery (Absorbable Subcuticular Sutures, Non-absorbable Nylon Sutures, Surgical Staplers): A Randomized Controlled Trial

A Modified Model Preparation for Middle Cerebral Artery Occlusion Reperfusion.

The middle cerebral artery occlusion reperfusion (MCAO/R) model is crucial for understanding the pathological mechanisms of stroke and for drug development.However, among the commonly used modeling methods, the Koizumi method often faces scrutiny due to its ligation of the common carotid artery (CCA) and its inability to achieve adequate reperfusion. Similarly, the Longa method has been criticized for disconnecting and ligating the external carotid artery (ECA). This study aims to introduce a modified model preparation method that preserves the integrity of the ECA, involves inserting a monofilament nylon suture through the CCA, repairing the ligated CCA incision, and maintaining reperfusion from the CCA. Reperfusion of blood flow was confirmed using laser speckle flow imaging. Evaluation methods such as the Longa scale, Modified Neurological Severity Score, triphenyltetrazolium chloride (TTC) staining, and immunofluorescence labeling of neurons demonstrated that this approach could induce stable ischemic nerve damage. This modified MCAO/R model protocol is simple and stable, providing valuable guidance for practitioners in the field of cerebral ischemia.

SUTURE CHOICE IN CARPAL TUNNEL SURGERY: A RANDOMIZED CONTROLLED TRIAL

ObjectiveCarpal tunnel release surgery is a commonly performed procedure for alleviating symptoms of median nerve compression and restoring hand function. With pressure on theatre time these procedures are now commonly performed in a step-down out-patient facility under local anaesthetic. The choice of suture for skin closure in this procedure can impact the quality of wound healing, patient outcomes and the follow-up required however the question of the best type of suture remains unanswered. The purpose of this study was to compare the outcomes of absorbable and non-absorbable sutures using a randomised control trial design.MethodsEighty patients diagnosed with bilateral carpal tunnel syndrome were enrolled and underwent outpatient carpal tunnel release surgery under local anaesthetic in a staged fashion. Random number generation was used to assign each hand to receive interrupted nylon or Vicryl Rapide sutures. Pre-operative data collection included patient demographics, ASA, inflammatory conditions, smoking status as well as a Boston Carpal Tunnel Questionnaire (BCTQ) for each hand. Patients were followed up at 2 and 6 weeks after each operation and the BCTQ was repeated along with the Patient and Observer Scar Assessment Scale and the VAS score for wound discomfort. This study has approval from the DHB ethics committee, Local Iwi, HDC and ANZ Clinical Trials:ACTRN12623000100695.ResultsStatistical analysis assessed patient preference and the scores between the groups. Multi-variate analysis was performed to assess the factors that may be contributing to patient choice.ConclusionInsights into patient preference and clinical outcomes associated with absorbable sutures and non-absorbable sutures in the setting of out-patient surgery are discussed.

Experimental investigation of tension-reducing effectiveness of keystone perforator island flap.

Nowadays, the reconstruction of large and complex defects with keystone perforator island flaps (KPIF) has gained popularity in plastic and reconstructive surgery. The keystone perforator island flap was described as a curvilinear shaped trapezoidal design flap, with two V-Y advancement flaps end-to-side. It is a multiperforator advancement flap, based on multiple fasciocutaneous or musculocutaneous perforators, described by Behan in 2003. These flaps have a simple harvest technique, an easy-to-implement design, and they are time and cost-saving. Their blood supply lends a versatile and robust character, with less complications. Nonetheless, their biomechanical properties and effectiveness are unclear, the wound-closure tension-reducing effect is not well documented in existing literature. The present study aims to investigate the wound closure tension-reducing effect of type I, type IIA, type Sidney Melanoma Unit I (SMU) and type SMU II KPIFs. The main purpose of this study was to clarify the tension-reducing effect of the KPIF technique, which can contribute to the understanding of the biomechanical benefits of the KPIF. This is an experimental, in vivo study, based on twelve white race porcine models (PIC-FII-377), as their anatomy and wound healing process is very similar to that of humans. In this study, 42 wounds that could not be closed by primary wound closure, known as 'unclosable' elliptical defects, were created in six different anatomical regions. The criteria used for not achieving primary wound closure were the breaking of 0 nylon suture or the edges of the wound. Each defect was closed with different types of keystone perforator island flap: type I, type IIA, type Sydney Melanoma Unit I and type Sydney Melanoma Unit II. Keystone perforator island flaps were used in 42 cases. Intraoperative tissue tension was measured by an AXIS FB50, 50 N force gauge tensiometer. In all cases a wide elliptical excision was performed for the primary defect. Before reconstruction, tissue tension was measured across the widest point of the elliptical primary defect. Skin incision was performed for the first flap, without division of deep fascia. After preparing first flap, tension was measured at the widest point of the wound. Furthermore, deep fascia for the second flap was divided, tissue tension across the widest point of the primary defect was measured. Finally, tension was measurement across the widest point of the donor-site after closure of the defect-side flap and V-Y closure of either end of keystone perforator island flap. In this study were included 12 porcine model (PIC-FII-377). A number of 42 keystone perforator island flaps were performed in this study, in six different anatomical regions, ranging between 3.3 x 12 cm and 16 x 30 cm. All elliptical defects were unclosable, with varying sizes ranging between 2 x 4 cm and 8 x 20 cm. The mean tension that was required to close all wounds with primary closure initially was 24.51 N 10.73 N. After using a type I KPIF a tension decrease of -7.04 N ± 4.93 N was seen, in the case of type IIA KPIF the tension decreased to -12.43 N± 5.63 N. Furthermore, after reconstruction with type SMU I KPIF the tension decreased to -7.38N ± 5.21N. After using a type SMU II KPIF a tension decrease of -10.52 N± 5.74 N was seen. The main purpose of this study was to clarify the tension-reducing effect of the KPIF technique, which can contribute to the understanding of the biomechanical benefits of the KPIF. The outcomes of the present study suggest that type I, type IIA, type SMU I, and SMU II of keystone perforator island flaps have a significant tension-reducing effects, especially the technique that involves the division of the deep fascia. The results of this experimental research thoroughly explain the benefits of these flaps. The effectiveness of the flap and doubts on biomechanical properties have not been answered so far. It will encourage more plastic surgeons to use the flap, especially given its proven benefits.

Security Comparison of Various Surgical Knots Using Nylon Suture.

To evaluate the strengths of various surgical knot techniques, including square knot, surgeon's knot, granny knot, and random knot with the same three throws. The authors tested each of the four knot techniques using four different gauges of nylon (polyamide [Ethicon]): 4-0, 5-0, 6-0, and 7-0. Each knot type was tested 20 times per nylon gauge, for a total of 320 knots tested. The authors used a static pull machine to measure elongation at yield and maximal force to break. A comparison of elongation at yield revealed that the surgeon's knot was superior to the square knot, granny knot, and random knots across all gauges of nylons. Further, a comparison of maximal force to break revealed that the surgeon's knot was superior to the square knot, granny knot, and random knots when using 4-0, 5-0, and 6-0 nylon but not when using 7-0 nylon. The surgeon's knot was the strongest, and random knot was the weakest when the authors used nylon 4-0, 5-0, and 6-0. While handling fine suture materials such as 7-0 nylon, knot failure appears to be unrelated to the knot technique used. This study provides not only fundamental guidance for tying surgical knots using nylon, but also a rational basis for an adequately strong knot choice in various fields of surgery.

A Technical Note on a Modified Subcrestal Buccal Flap Approach to All-on-Four: A Case Report.

This case report describes a dual full-arch rehabilitation focusing on a modified buccal incision for installation of four implants for full-arch rehabilitation of an edentulous maxilla. A modified buccal incision was performed in the subcrestal buccal region to promote direct access to the periosteum without incising the muscles in the region. For the installation of anterior implants, an 8.5 mm implant was locked in the cortical bone of the alveolar ridge and in the cortical bone of the floor of the pyriform cavity. The drilling point of the posterior implants was defined using the anterior implants as a visual reference, and the entry point could be visually estimated from the topography of the palatal surface of the maxilla. After bone leveling, the drilling enlargement sequence was carried out using drills that allowed the installation of long implants (18 mm). Straight mini-abutments were installed in the anterior implants and angled at 30º in the posterior implants. The flap was then perforated in the exact region where the mini-abutments were located. The buccal incision line was sutured with continuous 5-0 nylon suture. On the following day, aesthetic tests were carried out with teeth mounting. The patient presented minimal edema, and the lip motricity and smile width were completely preserved. The prosthesis was delivered five days after surgery. The suture was removed, and the prosthesis was installed while maintaining compression on the gingival tissue. The patient reported no pain during the prosthesis installation. The modified buccal flap enables implant placement for full-arch rehabilitation of an edentulous maxilla.