Prolene Suture Research Articles

Surgical Outcome of Epicanthus and Telecanthus Correction by Double Z-Plasty and Trans-Nasal Fixation with Prolene Suture in Blepharophimosis Syndrome.

Blepharophimosis Syndrome (BPES) is a complex and rare disease characterized by epicanthus inversus, telecanthus, lateral ectropion, narrowed or shortened inter-palpebral fissure distance and ptosis. It is mostly bilateral and may or may not be symmetrical. It is typically inherited as an autosomal dominant trait. In sporadic cases, the disease may occur without a prior family history as a genetic mutation from a deletion or translocation of the FOXL2 gene, which maps to chromosome 3q23. Surgical treatment of this disease poses an oculoplastic challenge due to multiple complex eyelid deformities. To evaluate the functional and cosmetic outcome of telecanthus and epicanthus correction by a Mustarde's rectangular double Z-Plasty and trans-nasal fixation using 1-0 prolene suture in BPES. This was prospective, interventional study of 16 patients over a period of three years. In this study, all patients had BPES with prominent epicanthus and telecanthus. Mustarde's double Z-plasty and trans-nasal fixation with 1-0 prolene suture was performed in the first of a two-stage operation. If ectropion was present, the lateral ectropion was corrected by a base-out flap transfer from the upper eyelid to the lower eyelid. After three months, a 2nd stage was undertaken, involving a lateral canthoplasty for horizontal widening of a short palpebral fissure and a tarso frontalis sling with silicone rod for correction of moderate to severe ptosis. Patients were followed up for six months to one year with postoperative ophthalmologic examinations and photographs. Out of 16 patients, 10 were females and six were males. All the patients had bilateral involvement. In this study preoperative Inner Intercanthal Distance (IICD) ranged from 38 mm to 42 mm and the mean IICD was 41.2±0.57 mm. Postoperative IICD ranged from 31 mm to 34 mm. Horizontal Palpebral Fissure Length (HPFL) ranged from 20 mm to 23 mm and the mean value of HPFL was 21.50 mm preoperatively. Postoperative HPFL ranged from 26 mm to 29 mm and had a mean value of 28.50 mm, which was much improved after a combined correction of telecanthus and lateral canthoplasty. The mean preoperative IICD and HPFL ratio was 1.77 and was reduced to a postoperative value of 1.2. The Marginal Reflex Distance1 (MRD-1) test value improved from +1.25 mm to +3.50 mm postoperatively after placement of a tarsofrontalis sling with silicone rod using the Fox's Pentagon technique. In this study, two eyes had minimal unequal correction but were cosmetically and functionally acceptable. Correction of IICD is possible up to 6 mm. No major complication e.g., CSF rhinorrhea was noted in this series and preoperative prominent epicanthal folds were abolished. Here we propose a two-staged procedure involving a combined Mustarde's double Z-plasty with transnasal fixation using a 1-0 prolene suture with a flap transfer from the upper lid to the lower lid in the first stage and a lateral canthoplasty with a tarsofrontalis sling and silicone rod in the second stage. This technique is effective to correct epicanthus, telecanthus, ptosis and lateral ectropion in BPES with good cosmetic and functional outcome.

Comparison of fasica lata and prolene suture in frontalis suspension surgery: frontalis muscle suspension

Objectives The aim of the study was to compare prolene suture, polytetrafluoroethylene sheet, and fascia lata for frontalis suspension surgery in the treatment of congenital ptosis with poor levator function. Background Eyelid frontalis suspension surgery is a common operative procedure used to correct severe blepharoptosis in eyes with poor levator muscle function. The main indication for frontalis suspension surgery is severe blepharoptosis secondary to myogenic, neurogenic, mechanical, and traumatic disorders. Patients and methods Eyelids were divided into three groups. In group I (20 eyelids), the upper-eyelid tarsus was suspended to the frontalis muscle using autogenous fascia lata. In group II (20 eyelids), the upper-eyelid tarsus was suspended to the frontalis muscle using a ribbon of 0.3 mm Gore-tex sheet. In group III (20 eyelids), the upper-eyelid tarsus was suspended to the frontalis muscle using prolene suture. Follow-up of eyelid level and reporting of postoperative complications and incidence of recurrence were done. Results At 12 months postoperatively (end of the follow-up period), there was no statistically significant difference between group I and group II regarding eyelid level. Fascia lata-related complications were detected in three eyelids of group I. Gore-tex-related complications were detected in five eyelids of group II. Prolene-related complications were detected in eight eyelids of group III. There was no statistically significant difference in complications between the three groups. The recurrence rate was 5% (one of 20 eyelids) in group I, 10% (two of 20 eyelids) in group II, and 40% (eight of 20 eyelids) in group III. The difference in recurrence rates was statistically nonsignificant. Conclusion Fascia lata is a good sling material, followed by Gore-tex sheet. Prolene suture has many complications and is associated with a high rate of recurrence.

Single incision laparoscopic cholecystectomy with conventional instruments and ports: Initial experience at tertiary care public sector Hospital.

Objective:To find out safety and feasibility of single incision laparoscopic cholecystectomy (SLIC) using conventional instruments.Methods:This study was conducted at surgical department of LUMHS Jamshoro Pakistan from Jan: 2014 to Dec: 2015. All cases of symptomatic cholelithiasis that consented for laparoscopic surgery were included. The exclusion criteria were acute cholecystitis, acute gall stone pancreatitis, common bile duct stones and patients with co-morbid. A midline 3cm incision made supraumbilically and 10mm port placed. Two 5mm ports placed on either side of umbilicus slightly superior and laterally in or-der to triangulate. A 2/0 prolene suture placed through the infundibulum of the gall bladder to achieve retraction. The rest of the procedure is like standard 4 ports laparoscopic cholecystectomy.Results:Total no of cases were 50. The age ranged from 30-59 years (mean 35.20 years ±4.886.) There were 43(86%) females and 07(14%) males. The mean operating time was 80 minutes (range 50-120 ±16.020). Four (8%) cases were converted to standard four ports laparoscopic cholecystectomy due to bleeding and difficult dissection in Calot’s triangle. Minimal blood loss was observed during the procedure with no postoperative complications. The range of hospital stay was 1-2 days (mean 1.08 ±0.274).Conclusion:SILC is a safe and feasible procedure with conventional laparoscopic instruments without additional cost of single port and articulated instruments. The cosmetic results are excellent with minimal increase in the operating time.

Results of a new "mirror tuck technique" for fixation of lacrimal bypass tube in conjunctivodacryocystorhinostomy.

Context:Conjunctivodacryocystorhinostomy (CDCR) is the procedure of choice for proximal canalicular blocks. However, the complications of tube migration and extrusion limit its widespread practice.Aim:The aim of this study is to evaluate the efficacy and complications of the new “mirror tuck technique” for fixation of lacrimal bypass glass tube without holes in proximal canalicular blocks in laser CDCR.Materials and Methods:A prospective interventional study was conducted in forty consecutive eyes of adult patients, undergoing 980 nm diode laser CDCR for proximal canalicular blocks. After creating the tract under endoscopic guidance, the collar of the glass tube was fixed to the conjunctiva with 6-0 prolene suture by “mirror tuck technique.” Success was defined as the absence of extrusion of tube with patent tract and relief in epiphora at 1 year of follow-up.Results:Both anatomical and functional success was achieved in 39 (97.5%) cases. Tube displacement occurred in one patient suffering from allergic conjunctivitis in which the tube had to be removed. A temporary heaviness was reported by 5 (12.5%) patients till about 2 weeks. Conjunctival overgrowth over the tube occurred in 1 (2.5%) eye at 5 months which was excised and treated with application of 0.02% mitomycin C with no subsequent recurrence. There were no cases of suture abscess or suture intolerance warranting tube removal.Conclusion:“Mirror tuck technique” is an effective method for tube fixation (for tube without holes) in CDCR. However, it is important to position the conjunctival opening so as to leave sufficient space for passage of sutures for anchorage medially.

Punctal occlusion with Prolene suture material in the patients with dry eye

Aim: To analyze the efficacy and outcomes of punctal occlusion with 5-0 Prolene suture material for the treatment of dry eye. Materials and Methods: A total of 20 patients with moderate and severe dry eyes, recalcitrant to maximal medical therapy, underwent temporary punctal occlusion with 5-0 Prolene suture material. The lower punctum was dilated with a punctum dilator. Prolene suture pieces with sizes ranging from 1.5 to 2 mm were made. A total of 8–10 such pieces were inserted into the lower punctum. The patients were followed up on the 1st, 3rd and 6th months, and their values of Schirmer’s test, Teat film break up time and ocular surface staining were compared with the baseline values, which were taken as control. Results: Punctal occlusion has been shown to improve the objective and subjective measures of dry eye. The patients obtained significant relief from the symptoms of dry eye by the end of 2 months. Recurrence of symptoms was noted at 6 months. Statistically significant difference was noted in the Schirmer’s and TBUT values between the baseline and at the end of the 3rd and 6th months. However, this difference was less than that at the end of the 1st month. The corneal surface staining was improved at the end of the 1st month, but it again began to deteriorate by the end of the 6th month. Conclusion: Prolene is a biologically inert, efficacious and cheaper alternative to collagen punctal plug. Occlusion of the puctum with a temporary punctal plug such as a Prolene suture material helps an ophthalmologist to plan for permanent punctal occlusion. Improvement in the eye condition after the use of temporary punctal occlusion suggests that the patient may benefit from permanent punctal occlusion.

Off-Pump Atrial Septectomy for Infants With Restrictive Atrial Septal Defect

The management of some subsets of patients with an unsuccessful balloon atrial septostomy (BAS) and poor general condition is typically challenging. Our novel technique involves off-pump atrial septectomy using laparoscopic forceps guided by intraoperative direct pericardial echocardiography. The technique was first used in a case of tricuspid atresia in a patient in preshock and was then used in 2 more patients with hypoplastic left heart syndrome (HLHS) (age, 10-116 days; body weight, 2.4-3.7 kg). There were no operative complications of embolism or bleeding in our series. Our off-pump atrial septectomy technique is an effective approach in specific cases.

“The magic finger technique” a simplified approach for more symmetric results in alar base resection

Alar base surgery is one of the most important and challenging steps of aesthetic rhinoplasty. While an ideally shaped alar base is the goal in a desired nose, nearly all patients have asymmetric nostrils preoperatively. Ethnicity, trauma, cocaine use, or previous rhinoplasties are some factors affecting the width and shape of the nasal base. After the conclusion of all planned rhinoplasty sequences and closure of the mid-columellarincision, we mark the midline inferior to the columella at the nasolabial junction and use acaliper to measure an equal distance from the mid-columellar point to the alar creases on eachside, and mark the medial points of the alar creases. Next we draw on the natural creasesbilaterally extending to 3 o’clock on the right side and 9 o‘clock on the left side as the limit ofthe lateral excisions to avoid scarring. We then gently depress the alae and alar-facial grooveswith the index finger and allow the formation of new creases superior to the original alarcreases in order to detect excess skin to remove. After marking, the resection was performed with a no. 15 blade. The excision was closed using 6-0 Prolene sutures. We aimed to describe a simple technique for making asymmetric resections in which theapplication of pressure by a finger reveals excess skin in both nostril sill and nostril flareindependently for each alar base. With these asymmetric excisions from the right and left alar bases, a more symmetric nostrils and nasal base can be achieved. Level of Evidence: Level IV, therapeutic study.

Granuloma after sling surgery: an attempt to answer the 'why' and 'what to do next'.

To review cases of granuloma formation after sling surgery with a view to find out possible aetiological factors and propose a further plan of management MATERIALS AND METHODS: A retrospective analysis of 120 eyes of 108 patients who underwent frontalis sling surgery with silicone rod from Jan 2008 to Dec 2015 was conducted. All patients with severe ptosis and poor levator function who underwent frontalis sling surgery with silicone rod were included in the study irrespective of the cause of ptosis and method of passing the sling. A complete ophthalmic and ptosis examination was done. In all the cases, the prolene suture was tied over the sleeve to tighten it and it was buried along with the silicone rod in forehead pocket. All the cases with granuloma formation were first subjected to a microbiological examination including culture and sensitivity to antibiotics. All the patients were given a trial of antibiotics. We encountered 10 cases of granuloma in 120 eyes of 108 patients operated during this period. The duration between time of surgery and presentation varied from 2weeks to 4months. The microbiological examination revealed positive culture in 5 cases. None of the cases responded to the course of antibiotics given for 10days. The histopathological examination done in 5 cases (2 of them culture positive and 3 of them culture negative) revealed granulomatous inflammation of non-specific type. The sling was explanted in all cases which resulted in prompt resolution of granuloma in 7-10days. The granuloma is primarily due to exposure of the sling itself or the sleeve enveloping the sling or the suture tied around the sleeve thereby. They do not respond to antibiotics but respond very well to explantation. These patients can be taken up for re-sling surgery after a waiting period of 3months.

Successful Management of a Stab Wound to the Left Ventricle

A 24 year old male presented to the emergency room with a 2 hour history of knife stab wound. He was haemodynamically stable with good bilateral air entry. However on X-ray an enlarged cardiac silhouette was seen. The patient suddenly became hypotensive and on suspicion of cardiac tamponade a catheter was introduced in pericardial space, but the measure was unsuccessful and he was rushed to the Operating Room. During the surgery a 2 cm long laceration was identified in the mid-left ventricular (LV) wall less than 1mm away from the Left Anterior Descending (LAD) Artery. The Left Anterior Descending Vein was damaged which was then repaired along with the ventricular wall by the interrupted pledgeted 3-0 prolene suture, whilst a cardiopulmonary bypass was kept on the stand by. The patient was checked for a ventricular septal defect via an intraoperative echocardiography. Subsequently, he had an uneventful recovery and was discharged.Cardiovasc. j. 2016; 9(1): 60-63

An innovative method for retrograde tracheal intubation using prolene suture and enteric feeding catheter

Retrograde intubation is a well established technique for intubating a patient with difficult airway. Since the first description of retrograde intubation in 1960 several modifications have been reported. However, all techniques require a cricothyroid membrane puncture by a thick needle usually <16G, and specialized catheters. We have devised a novel technique of retrograde intubation using a 20G intravenous catheter, prolene suture (size 0) and an enteric feeding catheter (EFC) size 14F for retrograde intubation. All of the required items are economical and easily available in operation theatre. Till now, we have successfully used this technique in seven patients with difficult airway.

Endoscopic control of enterocutaneous fistula by dual intussuscepting stent technique.

Large high-output enterocutaneous fistulas pose great difficulties, especially in the setting of recent surgery and compromised skin integrity. This video demonstrates a new technique of endoscopic control of enterocutaneous fistula by using two covered overlapping stents. In brief, the two stents are each inserted endoscopically, one proximal, and the other distal to the fistula with 2cm of each stent protruding cutaneously. Following this, the proximal stent is crimped and intussuscepted into the distal stent with an adequate overlap. A prolene suture is passed through the anterior wall of both stents to prevent migration. The two stents used were evolution esophageal stents-10cm long, fully covered, double-flared with non-flared and flared diameters being 20 and 25mm, respectively (product number EVO-FC-20-25-10-E, Cook Medical, Bloomington, IN, USA). The patient featured in this video developed a high-output enterocutaneous fistula proximal to a loop ileostomy, which was created following a small bowel leak after a curative surgery for bladder cancer. Using the technique featured in this video (schematic depicted in Fig.1), the patient was nutritionally optimized with oral feeds from albumin of 0.9-3.4g/dl within 2months despite prior failure to achieve nutrition optimization and adequate skin protection with combination of oral and/or parenteral nutrition. Three months after stenting, following nutritional optimization and improvement of skin coverage, definitive procedure consisted of uncomplicated fistula resection with primary stapled side-to-side functional end-to-end anastomosis. The stents were not completely incorporated into the mucosa and were rather easily pulled through the residual fistula opening just prior to the surgery. Only minimal fibrosis was noted and less than 20cm of involved small bowel needed to be resected. Had the fistula have closed completely, the options would have included (1) proceeding to bowel resection with removal of the stents regardless of closure, or (2) cutting the securing prolene stitch and observation. Considering the placement of the stents in mid-small bowel, their endoscopic retrieval would have been difficult unless they were to migrate into the colon. Although a prior attempt at managing an enterocutaneous fistula with a stent deployed through a colostomy site was previously reported [1], there is no published account of bridging an enterocutaneous fistula with overlapping endoscopic stents through the fistula itself. This video serves as a proof of concept for temporizing enterocutaneous fistulas with endoscopic stenting.

Usage of “Reversal Penetrating Technique” with Ancillary Trocar in Minimally Invasive Ivor Lewis Esophagectomy

We present a "Reversal Penetrating Technique" (RPT) to perform thoracoscopic esophagogastric anastomosis in Ivor Lewis minimally invasive esophagectomy (MIE). The safety and efficiency of this technique are evaluated. RPT was used in Ivor Lewis MIE for treating patients with distal esophageal cancer. A specific anvil set is inserted into proximal esophagus lumen to allow its prefixed Prolene suture to pierce from the inside out. Then, the suture is pulled until the anvil rod penetrates the esophageal wall. The esophageal stump and anvil placement are completed after the esophagus is transected by a linear stapler. After the circular stapler is docked with the anvil, the intrathoracic anastomosis is performed in a side-to-side manner. Since August 2012, RPT anastomosis was successfully performed in 30 consecutive patients without conversion to other anastomotic techniques or open surgery. No patient experienced anastomotic leak or gastric tube necrosis. No postoperative deaths occurred. No patient complained of remarkable dysphasia during follow-up. Twenty six patients were checked by gastroscopy, no localized recurrence or anastomotic stricture was identified. RPT is less technically challenging as it eliminates the need for sewing and trimming of esophageal remnant. This technique is safe and efficient, and is particularly suited to those who do not have access to the Orvil device when performing Ivor Lewis MIE.

Does plastic suture deformation induce gapping after tendon repair? A biomechanical comparison of different suture materials

Plastic deformation of sutures creates an irreversible extension during load. To test our hypothesis that such plastic deformation causes gap formation after tendon repair, we determined the plasticity of five different suture materials commonly used in tendon surgery. Prolene, Polydioxanone (PDS), Ethibond, Vicryl, and FiberWire sutures were biomechanically tested to determine their offset yield strength, initial extension, creep, relaxed elongation, peak-to-peak displacement, stiffness, and maximum tensile strength under static, constant, and cyclic loading. In addition, 35 porcine hindlimb tendons were used to evaluate gap formation and the biomechanical behavior of the suture materials after tendon repair. Prolene had a low offset yield strength and high initial extensions at 30, 60, and 90N combined with relatively large creep, relaxed elongation, and peak-to-peak displacement. Aside from the low maximum tensile strength and stiffness, these parameters indicate an early plastic deformation during loading. The material properties of PDS were generally better for suturing than those of Prolene, but no difference was found in offset yield strength or initial extension. In contrast to the monofilament materials Prolene and PDS, the braided Ethibond, Vicryl, and FiberWire materials showed significantly less plastic deformation. The lowest amount of plastic deformation was found in the FiberWire and the results for Ethibond and Vicryl were equal. Gap formation occurred at the lowest tension force in the Prolene group, but only FiberWire required a significantly larger tension force to produce gapping at the repair site, indicating a higher resistance to gap formation. The results of this study show that plastic deformation occurs at a lower tension force in the monofilament sutures Prolene and PDS than in the braided materials Ethibond, Vicryl, and FiberWire. After tendon repair, FiberWire likely prevents gap formation, whereas Prolene induces gapping through low-tension plastic deformation. Therefore, plastic deformation should be considered when selecting suture materials for tendon repair surgery.

Thoracotomy for Traumatic Diaphragmatic Hernia.

The aim of this retrospective study is to review our experience in the diagnosis and role of thoracotomy for traumatic diaphragmatic hernia (TDH). Between January 2008 and June 2014, 23 patients from Yangzhou Medical College (Yangzhou China) and Lishui Center Hospital (Lishui China), who underwent thoracotomy for TDH, were analyzed. The clinical features, imaging findings, operative findings, and outcome of treatment in these patients are presented. There were 23 patients (18 males and 5 females) who underwent surgical procedures due to TDH. The median age of the patients was 43.2years (range, 15-68years). The cause of rupture was penetrating trauma in 1 (4.3%) patient and blunt trauma in 22 (95.7%) patients. The TDH was left sided in 21 patients and right sided in two patients. The diagnosis was made by chest X-ray (n = 2) and chest or abdominal CT (n = 13) and at thoracotomy based on a high index of suspicion (n = 8). Associated injuries were seen in 21 patients (91.3%). Twenty-two patients underwent thoracotomy, and one underwent thoracotomy with laparotomy. The mean operating time was 112min (range, 60-185min) and the mean blood loss was 116mL (range, 20-400mL). The most common herniated organs were the omentum (n = 15), stomach (n = 14), spleen (n = 11), colon (n = 10), small bowel (n = 2), and liver (n = 1). All diaphragmatic defects were repaired using interrupted prolene sutures. The overall mortality rate was 4.3% (n = 1). The diagnosis of TDH is easily missed or delayed. Chest X-ray and computer tomography (CT), especially chest and abdominal CT, are useful in the diagnosis of diaphragmatic ruptures, and thoracotomy is an effective and successful treatment for TDH.

Long-term outcome of combined vitrectomy and transscleral suture fixation of posterior chamber intraocular lenses in the management of posteriorly dislocated lenses

BackgroundThere is no general consensus on the optimal choice of intraocular lenses (IOLs) or fixation methods in eyes with inadequate capsular support. The purpose of this study was to determine the long-term safety, efficacy and refractive status of combined vitrectomy and transscleral suture fixation of posterior chamber (PC) IOLs in the management of posteriorly dislocated lenses in Taiwan. MethodsWe conducted a retrospective interventional study at our medical facility. The posteriorly dislocated crystalline lenses (or dislocated IOL) were removed with pars plana vitrectomy followed by transscleral suture fixation of PC IOLs at the same setting. Additionally, preexisting ocular condition, postoperative visual acuity (VA) and refraction were recorded. ResultsFifteen patients were enrolled for analysis, including traumatic posteriorly dislocated IOLs in seven cases, and traumatic posteriorly dislocated crystalline lenses or retained lens nuclei after cataract surgery in eight cases. The end result of our study showed that best-corrected VA of 6/12 or better was achieved in 13 patients (87%) after a mean 45 months follow-up. The mean VA significantly improved from 0.98 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.14 logMAR at last follow-up (p < 0.01). The refractive status after suture fixation of PC IOL revealed a mean myopic shift of −1.18 ± 1.47 D from the predicted spherical equivalent. Overall, most complications were minor. Ciliary body hemorrhage occurred during operation in one case and was cleared without visual compromise. Erosion of prolene suture through conjunctiva was noted in three patients. Elevated intraocular pressure was well controlled by topical antiglaucoma medications in three cases. No suture breakage or IOL dislocation was noted in any of the patients. There were no serious adverse events of retinal detachment, corneal compromise, or endophthalmitis in any of the patients. ConclusionOur data showed that use of combined vitrectomy and transscleral suture fixation of PC IOLs is a safe and efficient technique to correct aphakia in eyes without adequate capsular support. Our study demonstrated good long-term visual outcome with only minor complications. Furthermore, we recommend that the IOL power should be adjusted 1.00 D less for transscleral suture fixation.

The simplicity of en bloc resection of diaphragm and liver tumours: a safe and effective technique of primary diaphragmatic repair with low respiratory-related morbidities

Introduction: En bloc resection of diaphragm-involved liver tumours is essential to avoid tumour spillage resulting and adverse oncological outcomes. Diaphragm resection commonly results in respiratory morbidities, up to 25% in previous reports. This study aims to review the respiratory-related morbidities and mortality in a series of patients surgically treated with en bloc diaphragm and liver resection. Methods: Liver resection with diaphragmatic excision was performed in 13 patients. Diaphragmatic defect was primarily closed in the coronal plane with initial approximation of diaphragmatic edges using 2–0 prolene sutures from lateral to medial. A Yankauer suction tip was inserted through the middle of the remaining defect to evacuate iatrogenic pneumothorax with subsequent continuation of suturing crossing over the suction tip. Valsalva manoeuvre applied, the suction tip was withdrawn synchronously with tightening of both sutures. Following removal of Valsalva manoeuvre, sutures were advanced and subsequently terminated at the contralateral ends from their starting points. Results: Between January 2007 and September 2015, a total of 515 patients with liver tumours were surgically treated by the senior author (KH). Of these, 13 patients with liver tumours contiguously involving the diaphragm were identified. Resection was performed for 11 malignant liver tumours and 2 benign lesions. Post-operatively, one patient required intercostal catheter (ICC) insertion for symptomatic pleural effusion. No other morbidity was observed. There was no peri-operative mortalities. Conclusion: The described technique of primary diaphragmatic repair is relatively safe with 1 case of pleural effusion requiring ICC drainage post-operatively and no perioperative mortalities.

A simplified approach for bicanalicular silicone tube intubation for the management of canalicular lacerations

We report the surgery of a bicanalicular laceration of the lacrimal system in which a simplified annular intubation of silicone tube had been used. After passing the silicone tube through the canalicular system guided by the prolene suture, the tip of the silicone tube was stuck and advancing it through the lach - rymal system was not possible. Then this threaded 6-0 prolene suture was tied to the wall of the silicone tube at the tip and pulled gently from the opposite side. The silicone tube was threaded easily with no obstacle. We hope that our result in this case will create an alternative way for surgeons while repairing canalicular system lacerations

Post Stab Injury Subclavin Artery Pseudoaneurysm Excision

Figure 1: Stab wound in supraclavicular region already sewn at local hospital. Figure 2: CT angiography showing subclavin artery pseudoaneurysm with two openings in subclavin artery anterior and posterior. Figure 3: A) Supraclavicular inscision to expose proximal subclavin artery B) Exposed subclavin artery. Figure 4: A) Excised pseudoaneurysm B) Opening in subclavin artery closed with vein patch. Figure 5: Closed tranaxillary and supraclavicular surgical incision with negative suction drain in situ. Abstract A pseudoaneurysm, also known as a false aneurysm, is a hematoma that forms as a result of a leaking hole in artery. Hematoma was contained by the surrounding tissues. Also it must continue to communicate with the artery to be considered a pseudoaneurysm. Post stab injury subclavin artery pseudoaneurysm is rare entity with great significance because of risk of complications like thrombosis, rupture, gangrene, limb loss and should be operated early whenever diagnosed. Our case report has 24 year male patient with history of stab injury to left supraclavicular region followed by pulsatile swelling after two days due to subclavin artery pseudoaneurysm. We excised pseudoaneurysm with vein patch closure of opening in subclavin artery. Introduction According to the literature data, post traumatic pseudoaneurysm is rare entity [1]. Most common site is common femoral artery, followed by radial and brachial artery but subclavin artery is very rare because trauma to it is rare. Incidence of complications associated with such pseudoaneurysm is estimated around 2-6% [2]. We present a case of the patient in whom pseudoaneurysm of left subclavin artery developed after two days of stab injury by pointed object and was successfully treated by surgical excision and vein patch closure of opening in subclavin artery. Case Report A 24 -years-old male patient was admitted at our Institute with history of stab injury to left supraclavicular region lateral side that was closed at local hospital (Figure 1). After two days the patient noticed gradually increasing pulsatile swelling at closed stab injury site. Clinical examination revealed presence of pulsating mass at stab injury site of 10 by 10 cm in diameter. Left brachial, radial and ulnar artery pulsations are palpable. Ultrasonography and CT angiography verified presence of pseudoaneurysm connected by two opening in third part of left subclavin artery (10 cm in diameter) (Figure 2). After short preoperative preparation, the patient underwent surgical intervention under general anaesthesia. Left supraclavicular incision taken to access and loop the proximal subclavin artery (Figure 3A and 3B). Left side transaxillary incision taken to access and loop the axillary artery. Intravenous heparin (5000 IU) was administered. Proximal subclavin artery and axillary artery both clamped. Dissection and separation of pseudoaneurysm followed by excision was done with cautery along with its content the clotted blood (Figure 4A and 4B). The opening of pseudoaneurysm in left subclavin artery was closed with vein patch with prolene 6-0. The vein patch was prepared from small axillary vein tributary. After putting 14 number negative suction romovac drain n supraclavicular and axillary region, wound closed in layer (Figure 5). Skin closed with stappler. Radial and ulnar artery pulsation checked. Drain removed after 48 hours. On the tenth postoperative day the patient was discharged. Discussion Post traumatic pseudoaneurysm is rare. The most common cause for such pseudoaneurysm is itragenic like post av fistula dialysis needle puncture or invasive procedures like percutaneous coronary interventions. Most common site for such pseudoaneurysm is radial, brachial and common femoral artery. Post stab injury pseudoaneurysm is rare in that subclavin artery pseudoaneurysm was rarest. If such pseudoaneurysm became infected, the surgical treatment can be extremely difficult. Although recently published, meta-analyses showed no superiority of subclavin artery stenting in such pseudoaneurysm because even after closing the opening which connect subclavin artery with pseudoaneurysm, the already formed pseudoaneurysm is high risk of infection [3,4]. So excision of that pseudoaneurysm is must. If the subclavin artery is normal with clearly visible opening that connect with pseudoaneurysm then pseudoaneurysm can be excised without sacrificing the part of subclavin artery by just vein patch closure of that opening with prolene suture. Sometimes rarely excision of part of subclavin artery with interposition grafting may be required. Conclusion The pseudo aneurysm excision was simple and safe even in inexperienced hands by proper anatomical knowledge. Proximal and distal control of artery is must for safe excision of pseudoaneurysm. By proper anatomical dissection pseudo aneurysm can be excised without damaging the surrounding vital structure like brachial plexus and axillary vein. Timely management was important to prevent complications like infection, rupture and gangrene. If the subclavin artery is normal with clearly visible opening feeding pseudoaneurysm then pseudoaneurysm can be excised without sacrificing the part of subclavin artery by just vein patch closure of opening in subclavin artery with prolene. Sometimes rarely excision of part of subclavin artery with interposition grafting may be required.

Canaloplasty: Current Value in the Management of Glaucoma.

Canaloplasty is a nonpenetrating blebless surgical technique for open-angle glaucoma, in which a flexible microcatheter is inserted within Schlemm's canal for the entire 360 degrees. When the microcatheter exits the opposite end, a 10-0 prolene suture is tied and it is then withdrawn, by pulling microcatheter back through the canal in the opposite direction. Ligation of prolene suture provides tension on the canal and facilitates aqueous outflow. The main advantage of canaloplasty is that this technique avoids the major complications of fistulating surgery related to blebs and hypotony. Currently, canaloplasty is performed in glaucoma patients with early to moderate disease and combination with cataract surgery is a suitable option in patients with clinically significant lens opacities.

Application of duct-to-mucosa continuous anastomosis in the pancreaticojejunostomy

Objective: Pancreaticojejunostomy is the most important anastomosis in Whipple operations, it's closely related to the pancreatic fistula. Present a variety of pancreatic enteric anastomosis methods have advantages and disadvantages, this study was to explore a method of pancreaticojejunostomy in pancreaticoduodenectomy. Methods: Clinical data from June 2013 to June 2015 of 165 pancreaticoduodenectomy resection patients were retrospectively analyzed, at the FourthHospital ofHebeiMedicalUniversity,HepatobiliarySurgery.Of the patients, 53 patients with Prolene line continuous duct-to-mucosa, and 112 patients with end-to-side of pancreatic anastomosis were used. Diagnostic criteria referenced the International pancreatic fistula Study Group (ISGPF) defined in 2005. Statistical analysis was performed with the c2 test. A probability value of less than 0.05 was considered statistically significant. Descriptionof operateprocess: Select themainpancreatic ductdiameterover 1.5mm patients. Briefly, upon completion of the PD, the pancreatic remnant was mobilized for 1e2 cm to allow adequate placement of the posterior outer-layer sutures.Find the main pancreatic duct, and suture the bleeding section. The posterior outer-layer anastomosis was performed by using continuous suture technique. Generally, double needle 4-0 prolene sutures were placed starting at the pancreatic remnant andwere continued through the seromuscular layer of the backwall of the jejunum.A 2mmdiameter hole was poked on the jejunum nearing the main pancreatic duct. Double needle 5-0 prolene line continuous suture the whole jejunal wall and the paries posterior of pancreatic duct. Select appropriate diameter internal plastic stent, the end of the stent was positioned within the pancreatic duct. Place the other end of the stent into the jejunum. Then the similar process was performedwith 5-0 prolene line continuous suturing the whole jejunal wall and the antetheca of pancreatic duct. Finally 4-0Prolene continuous suture the seromuscular layer of the jejunum and the anterior wall of pancreas. Results: The incidence of pancreatic fistulas in patients with prolene line continuous suture was 3.8%(2/53), and in those with end-to-side suture it was 15.2% (17/112) (P < 0.05). According to the international clinical grading system, grade A of POPF was found in 2 patients of the prolene line continuous suture group, and were successfully discharged under the conservative treatment. Conclusion: This method of duct-to-mucosa anastomosis with Prolene line continuous suturing is simple and time-saving with obviously reducing incidence of pancreatic fistula. It's continuous anastomosis of main pancreatic duct and the whole jejunum layer, exactly, not easy to occur pancreatic fistula, less affected by the pancreas texture. The Prolene thread and Needle as a whole, lines of smooth, less friction, is suitable for continuous anastomosis. This method of anastomosis is proved to be safe and efficient in preventing pancreatic fistula.