Prolene Suture Research Articles

Novel Use of Prolene Suture for Duct Delineation during Microductectomy

Classically, microductectomy is performed using a probe inserted via the offending duct to delineate and identify the responsible duct [...]

Laparoscopic slit mesh repair of parastomal hernia using a designated mesh: long-term results

Parastomal hernia (PH) is a frequent complication of colorectal surgery, which incidence reaches 55% of all stoma formation. Currently, there is no definitive strategy for its repair. This study was designed to assess the outcome in patients who underwent laparoscopic PH repair using a slit mesh/keyhole technique. We undertook a retrospective case review of all patients who underwent laparoscopic PH repair with a designed slit mesh/keyhole between 2005 and 2010. Three ports were placed opposite the stoma site, and careful adhesiolysis and hernia content reduction were performed. The parastomal fascial defect was measured and covered with a designated mesh. Fixation of the mesh was achieved with concentric tacks and transcutaneous Prolene suture. Recurrence was diagnosed after examination of patients by two surgeons or by imaging demonstrating an indolent hernia. Twenty-nine laparoscopic PH mesh repairs were performed with an average age of 63.5 (range 42-81, median 64) years to treat paracolostomy hernia in 18 of 29 cases (62.1%), para-ileostomy hernia in 10 of 29 cases (34.5%), and for an ileal conduit site hernia in 1 of 29 cases (3.4%). The average operative time was 179 (range, 80-300; median, 180) min. Two operations (6.9%) were converted to an open approach. Early postoperative complications were documented in four patients (13.8%), including one elderly patient with severe comorbidities who died from postoperative sepsis (mortality rate, 3.4%). Only one late complication was recorded (3.4%). The average hospital stay was 4.7 (range, 1-19; median, 3) days. Average follow-up time was 28 (range, 12-53; median, 30) months. Recurrence of the hernia was found in 13 of 28 patients (46.4%). Laparoscopic slit mesh/keyhole repair is feasible, although it is a complex surgery reflected by extended operative time. The high recurrence rate suggests that technical improvement of the method is essential.

Quantifying Osteotome Sharpness: Comparing the Major Manufacturers

Objective: 1) Develop a method for quantification of osteotome sharpness in a rhinoplasty model, using artificial bone; 2) demonstrate changes in osteotome sharpness over multiple uses; and, 3) compare sharpness of osteotomes from different manufacturers at baseline and after multiple uses. Method: Osteotomes were passed through synthetic bone blocks. Sharpness was measured using the Instron Universal Tester (force required to cut #2 Prolene suture) at baseline and after 1, 4, 7, and 10 osteotomies. Changes in sharpness over time were assessed using within-sample t tests. Comparison of manufacturers was performed with multiway ANOVA. Results: A novel, prospective surgical model was developed. Osteotomes from 5 manufacturers were tested (Nextedge, Black & Black, Storz, Miltex, and Biomet). Baseline measurements showed that the Storz osteotome was sharpest (1.74 lbs, P < .001), followed by Miltex and Biomet (2.50 lbs, 2.68 lbs), and Nextedge and Black & Black (3.48 lbs, 3.40 lbs). All osteotomes except Nextedge ( P = .098) demonstrated a significant decrease in sharpness over time ( P = .02 to P < .001), though relative changes and absolute sharpness varied widely between instruments. ANOVA showed the Storz osteotome was significantly sharper across all uses and timepoints ( P < .001). The greatest decrease in sharpness over time was seen with Black & Black (-1.28 lbs). Conclusion: Otolaryngologists use osteotomes in cosmetic and functional rhinoplasty. Millimeter-level accuracy in these procedures is essential to maximize outcome and minimize complications. Multiple similar-appearing instruments are available, but their relative efficacy is infrequently tested. We have demonstrated that, at least in the case of osteotomes, not all instruments are created equally.

A Novel Technique for Precise Placement and Secure Fixation of Onlay Grafts in Rhinoplasty: Our 4-Year Experience

Sir: Cartilage grafting has been widely used to improve aesthetic and functional rhinoplasty outcomes. Autologous onlay grafts, in particular, can be used to camouflage contour irregularities, address open roof deformities, and minimize the effects of overaggressive and reductive rhinoplasty.1 Numerous grafting techniques have been reported.2–5 We present a novel technique for precise placement and secure fixation of onlay autologous grafts that can be applied in open or closed rhinoplasty, and review our 4-year results. Onlay graft placement is performed after all necessary nasal sculpturing has been completed. The existing or created defect is outlined with a marker on the nasal skin. The graft is molded to the desired shape, and its edges are beveled to ensure a smooth transition between the graft and the native nasal cartilages and bones. Once graft fashioning is completed, it is accurately placed over the marked skin and fixed temporarily with two 27-gauge needles, which pierce the graft close to its cephalic and caudal edges. Then, the graft is removed together with the needles, and a pull-out double arm 5-0 Prolene suture is passed through the graft. The needles of the suture are stuck into the tip of the 27-gauge needles (Fig. 1). Thus, removing the 27-gauge needles, the suture threads pass exactly from the points at which the 27-gauge needles had pierced the graft. Before insetting the graft, the marked nasal skin is squeezed until a drop of blood appears at the point of each needle entrance. These points serve as skin markings for precise graft placement. The suture needles, with the use of a needle holder, are inserted through the rhinoplasty incisions between the nasal skeleton and the skin and delivered on the nasal skin through the corresponding markings to ensure proper orientation of the graft (Fig. 2). The graft is inset precisely into the desired position with traction on the suture threads, which are secured on the skin using sterile strips only. Finally, typical taping and casting is applied, and the suture is left in place until cast removal at 8 days postoperatively.Fig. 1.: (Left) Temporary fixation of the graft on the nasal skin with the use of 27-gauge needles. (Right) The suture needle is shown stuck into the tip of the 27-gauge needle.Fig. 2.: (Left) Drops of blood, which are the marking points of entrance of the 27-gauge needles. (Right) The suture needle is shown passing exactly from the proximal marking point.Twenty-nine patients underwent onlay grafting with the use of the aforementioned technique. No postoperative complications were noted; follow-up, ranging from 3 months to 4 years, revealed no cases of graft migration or step-off deformities; and a pleasing functional and aesthetic outcome was achieved in all cases. The technique described is simple and reliable, ensures both precise graft placement and secure fixation, and precludes any injury to the osteocartilaginous skeleton. The use of sterile strips, instead of tying the suture, prevents the suture from cutting into the skin, allows the skin room to expand during the phase of tissue edema, obviates the need for a bolster dressing, and permits the application of the typical taping and casting to the nose. Consequently, the graft is kept in close contact with both the skin and the osteocartilaginous skeleton, the dead space between the graft and surrounding tissues is eliminated, fluid accumulation and tissue edema are diminished, and minimal or no scarring is induced. Efstathios G. Lykoudis, M.D., Ph.D. Konstantinos Seretis, M.D., M.Sc. George E. Papanikolaou, M.D. Department of Plastic Surgery Ioannina University School of Medicine Ioannina, Greece DISCLOSURE The authors have no financial interests to disclose.

Delayed presentation of post traumatic diaphragmatic hernia

Blunt traumatic diaphragmatic rupture is an uncommon but severe problem that is usually seen in polytraumatized patients including blunt abdomino-thoracic trauma due to road traffic accidents, fall from height and penetrating injuries. Regardless of the mechanism, diagnosis is often missed and high index of suspicion is vital. Late presentations are associated with increased morbidity. We report an interesting case of blunt traumatic diaphragmatic hernia in a 32-year-old man presenting 4 years after the initial abdomino-thoracic injury due to fall from height. He had herniation of the spleen and stomach. Through a left sub costal incision, the herniated organs were reduced and diaphragmatic defect closed with interrupted prolene suture.

Minimizing hepatic trauma with a novel liver retraction method: a simple liver suspension using gauze suture

Prolonged liver retraction during radical gastrectomy for adequate exposure of the hepatogastric ligament may lead to hepatic trauma. The authors offer a new minimally traumatic liver retraction method using a simple liver suspension with a gauze suture and compare it with the modified liver-puncture method. This study retrospectively evaluated 92 patients who underwent the liver-suspension or liver-puncture method during gastric resections in 2010. Their clinical and operative characteristics were analyzed together with perioperative transaminases, and the two groups were compared. Patients with a history of liver disease, abnormal preoperative liver function test results, postoperative complications, or combined operations were excluded from the study. The liver-suspension method was performed using two 4 × 4-in. gauze pads threaded with a 2-0 Prolene suture, which were secured to the pars condensa with surgical clips and externally tied to suspend the liver toward the abdominal wall. Each liver retraction was completed without intraoperative complications. The patients in the liver-suspension group had more nonhepatic comorbidities than those in the liver-puncture group (P = 0.029). Other patient characteristics such as age, gender, and body mass index (BMI) did not differ between the two groups. No differences were found between the groups in terms of mean operative time (200.3 ± 66.9 vs 214.9 ± 74.4) or preoperative mean alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels. However, the patients in the liver-suspension group had significantly lower postoperative mean ALT levels (postoperative days 0, 1, 2, 3, and 5) and mean AST levels (postoperative days 0 and 1). Compared with the liver-puncture method, the authors' novel liver-suspension with suture-gauze technique is a safe and effective method for retracting the liver during laparoscopic and robotic upper abdominal surgeries.

A randomized, controlled study comparing the cosmetic outcome of a new wound closure device with Prolene suture closing caesarean wounds

A prospective, randomised study was conducted to compare the wound closure performance and cosmetic outcome of caesarean section wounds closed with traditional Prolene suture or a new wound closure device (Leukosan(®) SkinLink). Sixty-one patients referred to primary section were allocated to wound closure with either Leukosan(®) SkinLink or Prolene suture. Cosmetic outcome as the primary measure was evaluated by the patient, the surgeon as well as by independent examiners blinded to the method of wound closure. Evaluations were recorded at 3, 6 and 12 months following wound closure. Both methods of wound closure scored equally high on the visual analogue scale for cosmetic evaluation at the 3-, 6- and 12-month follow-ups as assessed by the patient, surgeon and the blinded observers. The study has shown that innovative methods for wound closure compared with traditional methods such as suture providing excellent cosmetic results represent a valid alternative to physician and patient for surgical incisions.

Effectiveness of ovarian suspension in preventing post-operative ovarian adhesions in women with pelvic endometriosis: A randomised controlled trial

BackgroundEndometriosis is a common benign condition, which is characterized by the growth of endometrial-like tissue in ectopic sites outside the uterus. Laparoscopic excision of the disease is frequently carried out for the treatment of severe endometriosis. Pelvic adhesions often develop following surgery and they can compromise the success of treatment. Ovarian suspension (elevating both ovaries to the anterior abdominal wall using a Prolene suture) is a simple procedure which has been used to facilitate ovarian retraction during surgery for severe pelvic endometriosis. The study aims to assess the effect of temporary ovarian suspension following laparoscopic surgery for severe pelvic endometriosis on the prevalence of post-operative ovarian adhesions.MethodsA prospective double blind randomised controlled trial for patients with severe pelvic endometriosis requiring extensive laparoscopic dissection with preservation of the uterus and ovaries. Severity of the disease and eligibility for inclusion will be confirmed at surgery. Patients unable to provide written consent, inability to tolerate a transvaginal ultrasound scan, unsuccessful surgeries or suffer complications leading to oophorectomies, bowel injuries or open surgery will be excluded.Both ovaries are routinely suspended to the anterior abdominal wall during surgery. At the end of the operation, each participant will be randomised to having only one ovary suspended post-operatively. A new transabdominal suture will be reinserted to act as a placebo. Both sutures will be cut 36 to 48 hours after surgery before the woman is discharged home. Three months after surgery, all randomised patients will have a transvaginal ultrasound scan to assess for ovarian mobility. Both the patients and the person performing the scan will be blinded to the randomisation process.The primary outcome is the prevalence of ovarian adhesions on ultrasound examination. Secondary outcomes are the presence, intensity and site of post-operative pain.DiscussionThis controlled trial will provide evidence as to whether temporary ovarian suspension should be included into the routine surgical treatment of women with severe pelvic endometriosis.Trial registrationISRCTN: ISRCTN24242218

Barbed Suture Suspension Technique for Prevention of Lower Eyelid Ectropion After Mohs Micrographic Surgery

Mohs micrographic surgery of the lower eyelid poses a risk of ectropion. Even though the lower eyelid is a very frequent location for basal cell carcinoma, prevention techniques for ectropion after Mohs micrographic surgery have rarely been introduced. After Mohs micrographic surgery of the lower eyelid, the authors applied a barbed suture suspension technique for the prevention of lower eyelid ectropion. Following primary wound closure, barbed sutures were prepared by cutting one side of a 4-0 Prolene suture and applied around the lower eyelid. Sutures were maintained for 7 days and then removed. Evaluation 10 weeks after surgery found that ectropion had been minimized or prevented entirely.

Biliary Complications in 106 Consecutive Duct-to-Duct Biliary Reconstruction in Right-Lobe Living Donor Liver Transplantation Performed in 1 Year in a Single Center: A New Surgical Technique

Objective Biliary complications remain a major source of morbidity after living donor liver transplantation (LDLT). Of 109 consecutive right lobe (RL)-LDLTs performed in 1 year in our institution, we present the biliary complications among 106 patients who underwent a new duct-to-duct anastomosis technique known as University of Inonu. Methods Of 153 liver transplantations performed in 1 year from January to December of 2008, 128 were LDLTs including 109 RL-LDLTs. The others were left or left lateral grafts. All RL-LDLT patients were adults, all of whom except three included a duct-to-duct anastomosis. Results All, but three, biliary reconstructions were completed with a surgical technique, so called UI, in which 6-0 prolene sutures were used. Nine bile leaks were seen in 106 recipients (8.49%) performed in a duct-to-duct fashion in a time period of 1 to 4 weeks. Seventeen patients (16.03%) posed bile duct stricture (BDS). Five patients had both. Although endoscopic stent placement and percutaneous balloon dilatation, 4 patients continued to suffer from BDS on whom a permanent access hepatico-jejunostomy (PAHJ) procedures were performed. Conclusion We recommend a duct-to-duct biliary reconstruction because of its de facto advantages over other types of anastomosis provided the native duct is not diseased. After almost 2 years, the bile tract complication rate was 22.64%.

Prolene frontalis suspension in paediatric ptosis

The aim of this study was to assess the efficacy of frontalis suspension using 4-0 prolene sutures for paediatric ptosis with poor levator function. A retrospective chart review was performed on children who underwent 4-0 prolene frontalis suspension from 2000 to 2008 with a minimum of 6 months' follow-up. Functional success was defined when three criteria were met: (a) satisfactory lid height (defined as margin-to-reflex distance ≥3 mm with minimal frontalis muscle tone); (b) satisfactory lid symmetry (≤2 mm asymmetry in margin-to-reflex distance); and (c) satisfactory cosmesis. Recurrence was defined by a drop in lid height of ≥3 mm from the initial post-operative level. A total of 23 patients (30 eyelids) were included. The mean follow-up duration was 28.7 months (range 6.3 to 100 months). The functional success rate was 74% (17/23 patients). Ptosis recurred in 22% (5/23) of patients. Only one patient (4%) developed a complication: a case of minor wound infection. In paediatric ptosis with poor levator function, prolene frontalis suspension has good efficacy and an excellent safety profile. The results of prolene frontalis suspension are comparable to those of other non-autogenous materials.

Prolene monofilament suture in Boston Keratoprosthesis surgery

Toxic reaction to nylon following uncomplicated cataract surgery and vitrectomy has been documented in the literature. We report the case of an aniridic patient with a known adverse reaction to nylon in whom Prolene suture was used in Boston Keratoprosthesis type 1 (KPro) surgery. During follow-up the cornea was checked for signs of inflammation and toxic reaction; at last follow-up (18 months) the patient showed no signs of complications due to Prolene. Our study suggests that Prolene suture may be used as an alternative to nylon in Boston KPro surgery in patients with a history of nylon toxicity.

Endoscopically Assisted Triple-Suture Midface Lift: A Refined Cable-Suture Technique

Superior repositioning of ptotic malar fat pads in an aging face is considered a key element in midface rejuvenation [2, 4, 5]. Several surgical techniques have been developed to achieve this goal, but many remain technically challenging or are associated with increased patient morbidity [6, 7]. The unique anatomy of the malar fat pad, loosely attached to the superficial musculoaponeurotic system (SMAS), makes elevation of the malar fat pads via traditional methods of SMAS rhytidectomy less than optimal [1, 2]. The principle of transcutaneous suspension of malar fat pads with cable sutures was introduced in 2002 [7]. The cable-suture technique can provide both restoration of volume and optimal repositioning of fat pads. Based on this, we developed the endoscopically assisted triple-suture midface lift (‘‘3S’’ midface lift) technique to enhance the midface lift through three sets of suspension sutures, all anchored to the deep temporal fascia: (set 1) transcutaneous suspension cable suture around the nasolabial fold, (set 2) suspension suture on the apex of the malar fat pad, and (set 3) temporal scalp dermal suspension suture. Preoperative markings are drawn with the patient sitting. The nasolabial crease is marked, and a point is marked on the midpoint along a line 5 mm lateral and parallel to the nasolabial crease. This is where a stab incision will be made for the insertion of a cable suture. The vector along which the cable suture will be pulled is perpendicular to the nasolabial crease. Another point 20 mm below the lateral canthus is marked, indicating where the suspension suture on the apex of malar fat pad will be placed. This point is similar to Tonnard’s point [8, 9] The temporal scalp incision is about 20 mm behind the hairline. This procedure can be performed with the patient under local or general anesthesia depending on what other accompanying procedures are being performed simultaneously. The temporal incision can be extended caudally to join the preauricular incision of open rhytidectomy or be a standard temporal working port for an endoscopic forehead lift. The dissection is performed with the help of a 3-mm 30 endoscope on the plane between the superficial and deep temporal fascia. The dissection is carried gradually into the midface between the suborbicularis oculi fat and the orbicularis oculi muscle [3]. After the midface is entered, further dissection is performed bluntly into the cheek region. Figure 1 shows the extent of the dissection. The cable suture is inserted through the stab wound lateral to the nasolabial crease using the method described by Sasaki and Cohen [7]. The thread of the cable suture is passed through to the temporal incision. Under direct vision by the endoscope, a hemostat is inserted to grasp the apex of the malar fat pad at the previously marked point below the lateral canthus. After confirmation of adequate malar fat pad movement, a 4-0 Prolene suture is passed through and also brought out through the temporal incision. Both the cable suture and the malar fat pad suture are anchored to the deep temporal fascia and tied with maximal tension. The medial edge of the temporal scalp wound then is deepithelialized to a width of about 3 mm. The deepithelialized portion is anchored to the deep temporal C.-C. Yu R. Tsai T.-C. Tung (&) Celebrity Cosmetic Center, 3F-1, 243, Sec. 1, Fu-Hsing S. Rd, Taipei City 10666, Taiwan e-mail: tung@celebritycosmetic.com

Infected Coronary Artery Pseudoaneurysm After Repeated Percutaneous Coronary Intervention

Coronary stent infection is exceedingly rare, with only 23 reported cases. We present a patient with an everolimus-coated stent infection that led to an infected pseudoaneurysm in the left anterior descending artery. Medical therapy failed and the patient underwent emergent surgical intervention; however, he died of multiorgan failure after the operation.

Transcorneal Suture Fixation of Posterior Lamellar Grafts in Eyes With Minimal or Absent Iris–Lens Diaphragm

To describe a technique that uses a transcorneal suture for safe delivery and fixation of donor tissue during Descemet stripping automated endothelial keratoplasty in patients that are at risk of graft dislocation into the vitreous cavity as a result of minimal or absent iris-lens diaphragm. Interventional case series. Thirteen eyes with endothelial decompensation and inadequate iris-lens diaphragm underwent modified Descemet stripping automated endothelial keratoplasty surgery. A 10-0 Prolene suture (Ethicon Inc) was passed through the endothelial graft and used to pull the graft into the eye and anchor it onto the recipient cornea. Best-corrected visual acuity, refraction, and complications were recorded. Preoperative best-corrected visual acuity was less than 20/200 in all cases. Eleven patients had a pre-existing comorbidity (glaucoma, n = 8; previous retinal detachment, n = 2; epiretinal membrane n = 1). Average follow-up was 11.3 months (range, 3 to 36 months). No graft dislocation occurred during surgery. After surgery, graft detachment was noted in 2 cases and rebubbling succeeded in achieving reattachment. All patients had successful attachment of the endothelial graft. Postoperative best-corrected visual acuity improved in 11 of 13 patients and remained unchanged in 2 patients. In patients with insufficient iris-lens diaphragm, this technique allowed safe graft delivery, prevented intraoperative and postoperative graft dislocation, and facilitated successful rebubbling in case of postoperative graft detachment.

Technique for the Repair of Truncus Arteriosus to Maintain Pulmonary Artery Architecture

Technique for the Repair of Truncus Arteriosus to Maintain Pulmonary Artery Architecture

Preventing Tip Modifications and Alar Retractions: The “Joy-Ride” Stitch

Sir: We congratulate Gruber et al. on their article1 that describes a new technique for correcting tip bulbosity without resecting the cephalic component of the lateral crus. In that technique, the cephalic part of the lateral crus is used as a lateral crural strut and effectively avoids alar retractions. Tip stabilization is an open issue in rhinoplasty, and several techniques have been described over time. At present, the most popular options are medial crural-septal sutures, interdomal-septal sutures, and columellar struts. These techniques are widely used to stabilize the medial crura and to contour tip projection. In primary or secondary rhinoplasty, columellar struts are also evaluated when the nasal tip is underprojected and/or the nasal tip skin is thick. Nevertheless, strut malposition, problems with graft visibility, and unnatural appearance have been described.2 Moreover, tip instability and retraction could occur, especially in tension noses or where the nasal lobule is subject to strain forces, both absolute (where strain forces are applied on the lobule by other nasal structures) and relative (produced by the interface of tip components with different rheologic properties). In fact, the excessive length of triangular cartilages could stress the cranial portion of lateral crura while the overburden size of septal cartilage acts on medial crura. These forces could be magnified by the excessive function of the depressor septi nasi. Tip stabilization and projection have been addressed by several authors who reported different solutions with graft struts, such as the columellar strut-tip graft3 and the dorsal columellar strut.4 Classically, tip stabilization and contouring are performed with a columella-septal suture that affects both tip projection and rotation. This suture could correct an existing hanging columella and provide a small amount of tip projection, whereas greater corrections require columellar struts5 with interdomal-septum or crural-septum sutures. Nevertheless, these sutures could alter the shape of the previously modeled nasal tip, especially where the columella is weak. We propose a different technique for fixing columellar struts to achieve durable tip projection and stabilization without interfering with tip contour. A pocket is dissected between the alar cartilages and the strut graft is placed anterior to the caudal septum (Fig. 1). The strut is sandwiched between the alar cartilages and fixed with a 5-0 Prolene suture. At this point, the graft is secured to the caudal septum with a so-called joy-ride stitch. The joy-ride stitch consists of a simple stitch performed between the columellar strut and the caudal septum (Fig. 2). Strut, alar cartilages, and septum are then fixed together without interdomal-septum or crural-septum sutures, which could alter tip contour in tightening the knot. The placement of the strut is symmetric and precise.Fig. 1.: The columellar strut graft is placed anterior to the septum, thus avoiding alterations in tip symmetry and profile.Fig. 2.: The joy-ride stitch secures the strut graft directly to the septum. The stitch is performed with 5-0 Prolene suture between the lateral edge of the columellar strut and the caudal septum. The placement of the strut is then symmetric and precise, avoiding interdomal-septum or crural-septum sutures that could alter tip contour.In fact, use of the joy-ride stitch, which fixes the strut to the caudal septum, avoids unintended further distortions and gives the surgeon greater control in securing columellar strut grafts. The surgeon is free to model the tip after having placed the strut graft, thus giving predictable, stable, and durable results. DISCLOSURE The authors have no financial interest to declare. Luciano Ariel Lanfranchi, M.D. Riccardo Gazzola, M.D. Franz Wilhelm Baruffaldi Preis, M.D. Unit of Plastic and Reconstructive Surgery IRCCS San Raffaele Hospital, and Unit of Plastic and Reconstructive Surgery IRCCS Istituto Ortopedico Galeazzi Milano, Italy

Tricuspid Valve Reconstruction in a Patient with Ventricular Septal Defect and Subacute Endocarditis

Objective Tricuspid valve reconstruction was advocated as the operative method for the treatment of tricus-pid valve endocarditis recently. Many people accept that valve replacement therapy should be performed if more than two valve leaflets are involved. The aim of the study to discuss if reconstructive surgery could be done to treat two valve leaflets involved in tricuspid valve endocarditis. Methods A 17-year-old boy with ventricular septal defect (VSD) and tricuspid valve subacute endocarditis was surgical treated through extra-corporeal circulation. two-thirds of the defective septal cusp, and half of the defective anterior cusp were ex-cised during operation. The tricuspid valve was reconstructed with autologous pericardial strip, cusp com-missuroplasty and 4-0 prolene sutures made as chordae tendineaes. VSD was repaired using a pericardial patch. Results The patient was discharged post-operation with excellent restoration of the tricuspid valve ac-tivity. Cardiac ultrasound revealed normal tricuspid valve activity and low degree of regurgitation two years follow-up. Conclusions It seems that tricuspid valve reconstruction could be performed for two defective leaflets or half of the tricuspid valve.

Silicone Oil Retention Sutures in Aphakic Eyes With Iris Loss

Silicone oil (SO) is a long-term intraocular tamponade used for a variety of retinal disorders. In aphakic eyes with an intact iris, the use of an inferior peripheral iridectomy prevents SO prolapse into the anterior chamber, thereby preventing glaucoma and keratopathy. We have developed a technique for preventing SO from entering the anterior chamber in aphakic eyes with iris loss. The technique involves placing 10-0 prolene sutures (SO retention sutures) across the anterior chamber to simulate an iris diaphragm. The sutures act as a barrier between the SO and aqueous, preventing SO-corneal contact. Images of this phenomenon were obtained by high-frequency ultrasound biomicroscopy with patients in the supine position. Silicone oil retention sutures may be an effective means to prevent SO-corneal touch in aphakic eyes with iris loss.

Partial aortic annulus avulsion and formation of aortic-left ventricle tunnel through interventricular septum after blunt cardiac trauma

Traumatic aortic-left ventricle tunnel through interventricular septum was particularly a rare event that has never previously been described. A 58-year-old male, with a history of blunt thoracic trauma caused by falling from height, was admitted to our institute for effort dyspnea. Chest computed tomography scan showed subaortic interventricular septal lumen communicating with coronary sinus and left ventricular outflow tract (LVOT). Transthoracic echocardiography revealed a shuttle flow from coronary sinus to LVOT bypassing aortic annulus during diastole. Operation examination found partial aortic annulus avulsion outside right coronary cusp involving superior interventricular septum dissection forming a tunnel breakthrough into left ventricular outflow tract. Both aortic orifice and LVOT orifice of the tunnel were closed with running Prolene suture and right coronary cusp annulus was fastened to aortic root with intermittent mattress suture. The postoperative course was uneventful. Echocardiography confirmed complete closure of the tunnel with residual trivial to mild aortic regurgitation during 1-month follow-up.