Prolene Suture Research Articles

Type IIB Thyroplasty for Phonic Tics in a Pediatric Patient With Autism Spectrum Disorder: A Case Report

Autism spectrum disorders (ASDs) are commonly associated with Tourette syndrome (TS). TS is classically associated with tic production. A tic is defined as sudden, brief, involuntary production of movement (motor tics) or sound (phonic tics). Case report. We present a case report of a 14-year-old boy with ASD and vocal tics. Vocal tic frequency was nearly 2000 per day and 90 dB in volume. He presented to our laryngology clinic after multiple failed attempts of pharmacologic management of vocal fold botulinum toxin injection. After evaluation in our clinic, we recommended a lateralization (type IIB) thyroplasty. An autologous cartilage graft from the superior thyroid ala was used and held in place with a bioresorbable mesh. Using 4-0 prolene sutures, the mesh was secured in place. The operation was well tolerated with minimal signs of aspiration, and he was discharged to his home within 48 hours. Six months postoperatively, there was 90% reduction in tic frequency and 50% reduction in intensity. Additionally, he has shown improved ability to converse with his peers, participate in school activities, and even has improved nutritional status. Alteration of laryngeal geometry could serve as an effective site of intervention for intractable phonic tics. Reduction of phonic tic frequency and intensity may also stimulate language development in patients ASD. We also demonstrate additional use of bioresorbable plates in pediatric laryngeal framework surgery. Additional neurophysiologic studies are needed to explore the mechanism by which midline lateralization thyroplasty influences phonic tic generation.

Image fusion for hybrid repair of dislocated superior mesenteric branch of a branched endovascular aortic graft

Recent advances in imaging technology allow the projection of volumetric imaging data from the preacquired computed tomography angiography over live fluoroscopy during interventions. This "fusion" technology is currently underused, although its application carries distinct advantages. We introduce a case in which fusion technology was used for the placement of two thoracic and one branched abdominal aortic endograft and to treat late dislocation of its side branch using a hybrid technique.

Giant pseudoaneurysm of the ascending aorta after double-valve replacement

A 47-year old man presented with a large chest swelling 10 months following aortic and mitral valve replacement. Computed tomography revealed a huge ascending aortic pseudoaneurysm (Fig. 1A and B). After establishing hypothermic circulatory arrest through an axillary-femoral bypass, a median sternotomy was performed. The defects were directly closed using two interrupted, pledgeted 4-0 Prolene sutures (Fig. 2A and B).

Frozen Elephant Trunk Procedure

Frozen Elephant Trunk Procedure

Gamma-irradiated Cornea Allograft for Glaucoma Surgery

To describe the clinical outcomes and surgical applications of γ-irradiated cornea allograft in glaucoma surgery. We reviewed 10 consecutive patients who underwent primary or secondary glaucoma procedures using sterile cornea allograft. Ten eyes of 10 patients (5 males, mean age 50 y) were treated with sterile, irradiated cornea allograft. Mean follow-up was 24 months (range, 22.4 to 26.8 mo). The allograft was used for coverage of a primary glaucoma tube shunt in 3 patients, coverage of a revised glaucoma tube shunt in 5 patients, tectonic support of a revised trabeculectomy flap in 1 patient, and coverage of subconjunctival prolene sutures following a surgical iridoplasty in 1 patient. The allografts were stable and biocompatibile in all 10 cases during the follow-up period, evidenced by maintained clarity of the corneal tissue, absence of clinical signs of immunologic rejection or ocular inflammation, and integrity of the sterile cornea and the conjunctiva over the graft. Cosmetic results were satisfactory and there were no complications during the follow-up period. In this small case series, sterile, γ-irradiated cornea allograft appeared to be safe and effective when used in glaucoma and anterior segment surgical procedures. Our results suggest advantages of sterile cornea allograft for coverage of glaucoma drainage implant tubes, including tissue transparency, resilience, and ease of surgical use.

A rare complication of pre-Eisenmenger patent ductus arteriosus: Pulmonary artery dissection

INTRODUCTIONPulmonary artery dissection associated with patent ductus arteriosus is usually seen in patients with pulmonary hypertension and Eisenmenger's syndrome. This paper presents a case with pre-Eisenmenger patent ductus arteriosus complicated by pulmonary artery dissection, and explains how she was surgically treated. PRESENTATION OF CASEThe transthoracic echocardiography of a 21-year-old woman complaining of effort dyspnea revealed patent ductus arteriosus. Contrast-enhanced thoracic computed tomography scan showed patent ductus arteriosus and dissection in the main pulmonary artery extending from the edge of the patent ductus arteriosus orifice to the pulmonary valve. The patent ductus arteriosus was divided with pledgeted prolene suture and the dissected aneurysmal portion of the pulmonary artery was resected by surgery. Dacron graft interposition was applied to the main pulmonary artery. DISCUSSIONBecause rupture causes cardiogenic shock and sudden death, diagnosis is rare in the living subject and pulmonary artery dissection is frequently detected in autopsy. A case with pulmonary artery dissection as a result of patent ductus arteriosus has been reported in the literature, but the patient died in the preoperative period. In our study, the patient was not diagnosed to have Eisenmenger's syndrome, but had pulmonary artery dissection, a complication arising from patent ductus arteriosus. The patient underwent curative surgery that included pulmonary artery dissection repair and closure of the patent ductus arteriosus. CONCLUSIONIn addition to pulmonary artery aneurysm, pulmonary artery dissection must also be considered as a complication in cases of patent ductus arteriosus with high pulmonary artery pressure diagnosed in adulthood.

Twenty-four years after liver transplantation, the recipient becomes a body donor

Twenty-four years after liver transplantation, the recipient becomes a body donor

Modified Tenodesis Method for Treatment of Mallet Fractures

Mallet fractures are avulsions of the terminal extensor tendon from the base of the distal phalangeal bone with a bony fragment. Surgical treatment, which provides accurate anatomical reduction and rigid fixation, is recommended for mallet fractures with involvement of more than one third of the base of the distal phalangeal bone. Various surgical methods have been reported, but there is still no standard treatment modality. The purpose of this investigation was to assess the results of our modified tenodesis method for mallet fractures. Using our method, the dorsal fracture fragment was reduced and fixed to the main part of the distal phalangeal bone by 2 stitches of "figure-of-eight" 4-0 Prolene sutures. We reviewed 12 consecutive patients with 13 mallet fractures treated with our modified tenodesis method between January 2009 and March 2012. This retrospective study was composed of 7 male and 5 female patients, with a mean age of 35.7 years (range, 25-56 years). All patients underwent surgical treatment and sequent 3-week finger splinting. Patient follow-up lasted 3 to 6 months, with a mean period of 5.2 months. The modified tenodesis method allowed accurate anatomical reconstruction of the injured extensor mechanism. Grading by Crawford criteria showed that the outcome was "excellent" in 8 of 13 digits and "good" in 5 of 13 digits. The follow-up hand x-rays also revealed congruent joint surfaces of distal interphalangeal joints with no evidence of joint space narrowing. No wound complications were encountered, and all the patients returned to normal activities without any disability. The modified tenodesis method is simple and effective to provide accurate anatomical reduction and fixation for treatment of type I mallet fractures. No device penetration of the small bony fragment or pinning through the distal interphalangeal joint is required, and the surgical complication rate is low. We recommend this treatment modality for all but chronic cases.

Nasal tip abscess due to adverse skin reaction to Prolene: an unusual long term complication of rhinoplasty

Allergic reactions to Prolene are rare. This paper reports a nasal tip abscess which developed in a patient with an adverse skin reaction to Prolene after rhinoplasty. A 26-year-old woman presented with painful, progressive nasal tip swelling and redness. She had undergone septo-rhinoplasty two years previously. She was initially treated with endonasal drainage of the abscess and antibiotics, but a revision rhinoplasty three months later became necessary because of recurrent abscess formation. Intra-operative findings included granulation tissue with pockets of pus and knotted Prolene sutures at the tip-defining points of the lower lateral cartilages. She was patch-tested with Prolene and a cutaneous Prolene suture was placed on her back; an adverse skin reaction was seen for the latter. Use of non-absorbable sutures, such as Prolene, in the subcutaneous layer may be a potential, rare risk factor for adverse skin reactions.

Pursestring Stapled Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy

We describe a pursestring stapled anastomotic technique for minimally invasive Ivor Lewis esophagectomy, in which a pursestring is hand sewn through the muscular layer of the intact esophagus by using one piece of 3-0 Prolene suture. The anvil of a circular stapler is inserted through an esophageal incision, 2 to 3 cm distal to the pursestring, and secured by the pursestring. The esophagus is transected, and the mucosa of the proximal stump is retained 5 mm longer than the adjacent muscular layer. The gastroesophageal anastomosis is completed and embedded by using the previously reserved 2 cm of mediastinal pleura.

Ventral spinal cerebrospinal fluid leak as the cause of persistent post–dural puncture headache in children

Headache occurs after dural puncture in about 1%-25% of children who undergo the procedure-a rate similar to that seen in adults. Persistence of post-dural puncture headache in spite of bed rest, increased fluid intake, and epidural blood patch treatment, however, is rare. The authors reviewed the medical records and imaging studies of all patients 19 years of age or younger who they evaluated between 2001 and 2010 for intracranial hypotension, and they identified 8 children who had persistent post-dural puncture headache despite maximal medical treatment and placement of epidural blood patches. A CSF leak could be demonstrated radiologically and treated surgically in 3 of these patients, and the authors report these 3 cases. The patients were 2 girls (ages 14 and 16 years) who had undergone lumbar puncture for evaluation of headache and fever and 1 boy (age 13 years) who had undergone placement of a lumboperitoneal shunt using a Tuohy needle for treatment of pseudotumor cerebri. The boy also had undergone a laminectomy and exploration of the posterior dural sac, but no CSF leak could be identified. All 3 patients presented with new-onset orthostatic headaches, and in all 3 cases MRI demonstrated a large ventral lumbar or thoracolumbar CSF collection. Conventional myelography or digital subtraction myelography revealed a ventral dural defect at L2-3 requiring surgical repair. Through a posterior transdural approach, the dural defect was repaired using 6-0 Prolene sutures and a dural substitute. Postoperative recovery was uneventful, with complete resolution of orthostatic headache and of the ventral cerebrospinal fluid leak on MRI. The authors conclude that persistent postdural puncture headache requiring surgical repair is rare in children. They note that the CSF leak may be located ventrally and may require conventional or digital subtraction myelography for exact localization and that transdural repair is safe and effective in eliminating the headaches.

Anterior vesical hitch – A step to enhance safety of percutaneous access to bladder

PurposeTo describe the novel technique of anterior vesical hitch to enhance the efficacy and safety of percutaneous bladder surgery. Materials and methodsThe anterior bladder wall is anchored to the anterior abdominal wall with the help of a prolene suture passed slightly lateral to the midline midway between the pubic symphysis and umbilicus. Percutaneous cystolitholapaxy and antegrade posterior urethral valve ablation were performed after anterior vesical hitch in five pediatric male patients. Data collected included operative parameters and complications related to the technique. ResultsMean patient age was 2.9 years (range 1.5–6 years). Three patients had bladder stones and two had posterior urethral valves. Mean time to achieve bilateral parietal fixation of the bladder was 7 min 20 s. There was no intraoperative slippage of Amplatz sheath or suture cut through. No bleeding from the puncture site was encountered. No postoperative complication related to the percutaneous access tract was noted in any patient. ConclusionsThe anterior vesical hitch procedure is safe and easy. It prevents slippage of Amplatz sheath during percutaneous access to the bladder lumen.

Cutaneous and Vulvar/Vaginal Melanoma; Do They Behave Same?

Study Objective: Injury of obturator nerve has rarely been reported during laparoscopic lymphadenectomy in surgery for gynecological malignancies. Injury of this nerve causes claudication and paresthesia of thigh. Here in we report a case of laparoscopic injury and repair of obturator nerve during pelvic lymphadenectomy. Patients: A 43-year-old woman with FIGO clinical stage IB1 uterine cervical cancer was treated with laparoscopic radical hysterectomy and bilateral pelvic lymphadenectomy. Intervention: The right obturator nerve was unintentionally transected during right obturator lymph nodes dissection by LigaSure and immediately repaired by laparoscopic reapproximation with PROLENE suture and GORE-TEX suture. After six months of follow-up, she did not complained any sign and symptom of obturator nerve injury and was doing well.

A Case of Laparoscopic Neurorrhaphy for Right Obturator Nerve Injury Occurred during Laparoscopic Pelvic Lymphadenectomy

Study Objective: Injury of obturator nerve has rarely been reported during laparoscopic lymphadenectomy in surgery for gynecological malignancies. Injury of this nerve causes claudication and paresthesia of thigh. Here in we report a case of laparoscopic injury and repair of obturator nerve during pelvic lymphadenectomy. Patients: A 43-year-old woman with FIGO clinical stage IB1 uterine cervical cancer was treated with laparoscopic radical hysterectomy and bilateral pelvic lymphadenectomy. Intervention: The right obturator nerve was unintentionally transected during right obturator lymph nodes dissection by LigaSure and immediately repaired by laparoscopic reapproximation with PROLENE suture and GORE-TEX suture. After six months of follow-up, she did not complained any sign and symptom of obturator nerve injury and was doing well.

Clinical Importance of the Number of Dissected Lymph Nodes as a Prognostic Factor in Node Negative, Early Stage Cervical Cancer

Study Objective: Injury of obturator nerve has rarely been reported during laparoscopic lymphadenectomy in surgery for gynecological malignancies. Injury of this nerve causes claudication and paresthesia of thigh. Here in we report a case of laparoscopic injury and repair of obturator nerve during pelvic lymphadenectomy. Patients: A 43-year-old woman with FIGO clinical stage IB1 uterine cervical cancer was treated with laparoscopic radical hysterectomy and bilateral pelvic lymphadenectomy. Intervention: The right obturator nerve was unintentionally transected during right obturator lymph nodes dissection by LigaSure and immediately repaired by laparoscopic reapproximation with PROLENE suture and GORE-TEX suture. After six months of follow-up, she did not complained any sign and symptom of obturator nerve injury and was doing well.

Two-port Laparoscopic Donor Nephrectomy With Simple Retraction Technique

To present our experience of 2-port laparoscopic donor nephrectomy (TPLDN) and to introduce a simple retraction suture technique. From October 2010 to November 2010, 10 consecutive, left TPLDNs were performed. The SILS Port was inserted through the umbilicus and was used for 5-mm laparoscope and laparoscopic instruments. A 12-mm trocar, for another working channel, was inserted along the midclavicular line at the umbilicus level. No articulating or bent laparoscopic instruments were needed. Two retraction sutures were used; a 3-0 Prolene suture was passed through the pericolic fat and then brought out of the abdominal wall and secured to the skin. Another suture was passed around the lower pole fat of the kidney, which was then fixed on the abdominal wall with a clamp. TPLDN was performed successfully in all patients, with no conversions to a conventional laparoscopic procedure or additional trocar insertion needed. The mean operative time was 152 ± 16.3 minutes, and the mean warm ischemia time was 2.9 ± 0.9. The average estimated blood loss was 77.3 ± 70 mL, and the postoperative hospital stay was 3.6 ± 0.6 days. No perioperative or postoperative complications were observed. Cosmesis was excellent, with a mean incision length of 5.6 ± 0.4 cm. All allografts functioned after transplantation. Our initial experience suggests that TPLDN appears safe and cosmetically effective and a feasibleoption for donor nephrectomy. The appropriate use of retraction sutures, during TPLDN, helps toovercome the technical problems associated with the inadequate retraction and exposure.

External Tracheal Stabilization Technique for Acquired Tracheomalacia Using a Tailored Silicone Tube

Here, we describe an external tracheal stabilization technique used in a patient with tracheomalacia. A 56-year-old man presented with tracheomalacia due to prolonged mechanical ventilation. The malacic tracheal segment was approximately 2 cm in length. The malacic segment was covered with a silicone tube sutured in place using Prolene sutures (Ethicon, Somerville, NJ). Several anchoring sutures were placed between the tracheal mucosa and the silicone tube without violating the mucosal continuity. The patient was discharged on postoperative day 5 without complication. This method of external tracheal stabilization is a less invasive alternative for the management of this particular patient.

Late favorable results of duroplasty with biocellulose: clinical retrospective study of 20 cases

Abstract Objective: Considering the importance of dural replacement in neurosurgery, mainly in times of advanced endoscopic skull base approaches, the authors report the late results after implanting of pure biocellulose membrane in 20 patients harboring different types of lesion, from 1996 to 1999, with objective of demonstrate its use in neurosurgery. Method: The casuistic was followed clinically and image studies were indicated when necessary. Dural substitution was achieved by continuous 4:0 prolene suture without additional glue. Results: The casuistic is constituted by four convexity or parasagittal meningiomas, three single cortical metastasis (melanoma, lung and renal carcinomas), two cerebellar gliomas (one multicentric GBM, one pilocytic cerebellar astrocytoma), one decompressive craniectomy for brain edema due to vasosespasm after aneurysm clipping one decompressive craniotomy for cerebral edema after hemorrhage of a giant fronto-parietal AVM, two mirror MCA aneurysms, one pineal and mesencephalic astrocitoma, one quadrigeminal cistern cyst, one accoustic schwanoma, one spontaneous cerebellar hematoma, one decompressive neurovascular operation for trigeminal neuralgia; 1 cauda equina ependimoma, one lombar myelomeningocele. Currently nine patients are alive, none had direct complication of implant. Recent NMR images of survivors do not show the membrane. Three wound infections could not be definitively attributed to patch. Conclusion: The material was considered safe for dural replacement. Due to inadequate elasticity of pure cellulose, the research was interrupted, waiting for a better product, which is currently being tested.

Penetrating chest trauma by an arrow

Arrows have considerable penetrating capacity in soft tissue and flat bones. The extraction of an arrow, especially in the thoracic injuries, requires thorough evaluation. An 18 year old patient was admitted 26 h after the incident with normal vitals. The arrow was in situ penetrating the left thorax in fourth intercostal space in anterior axillary line (Fig. 1). Chest x-ray film showed mild pleural effusion in the left diaphragmatic recess (Fig. 2). The arrow was retrieved under direct visual control and injured lung segments were closed directly with 3-0 prolene suture (Fig. 3). Injuries caused by arrows are usually less destructive than those caused by bullets because of lesser velocity and energy. Barbed arrows are an exception because of the risk of extensive damage to major structures when retrieved [1]. The ballistics of arrows was described in the Karger et al. report of 1998 [2]. Investigations such as enhanced spiral computed tomography and reformatted 2Dimensinal echo images should be performed to clarify the relationships between the arrow and any major structures. Videothoracoscopy has been described as effective and safe for initial diagnosis, evaluation, and management in Fig. 1 Preoperative photo with arrow in situ

STUDY OF SKIN STAPLES AND CONVENTIONAL SUTURE FOR ABDOMINAL SKIN WOUND CLOSURE

Introduction: The use of automatic stapling device for skin closure has become more popular due to its minimum disadvantages as compared to conventional suturing. Hence, this study was undertaken to compare the time required for abdominal skin closure and pain during suture removal, between skin staplers and conventional suture. Materials and Methods: The study includes 100 patients with age group of 45yrs-75yrs undergoing elective surgery, of which 50 patients underwent wound closure by staplers (Group-I) and 50 patients underwent closure using prolene suturing (Group-II), during June 2009 to June 2011 at Basaweshwar Teaching and General Hospital, Gulbarga. Patients were randomly selected for conventional suture and skin staple. Time duration for wound closure was recorded and pain scoring was given during suture removal, between both groups. Results and conclusion: In our study duration of wound closure was statistically significant (P<0.001) with staplers requiring lesser time than conventional prolene sutures, we also found that pain during suture removal between both groups was statistically significant (P<0.001). We believe the advantages of speed and convenience of skin staples outweigh the extra cost, provided the disposable instruments are reused until empty.