Purse-string Method Research Articles

Preserving the Nipple Projection in Breast Reduction with the Free Nipple-Areolar Graft Technique: Purse-String Suture.

Breast reduction with the free nipple-areolar graft (FNG) technique has disadvantages such as loss of nipple projection, loss of nipple sensation, and depigmentation of the nipple-areolar complex. In this study, patients in whom a purse-string (PS) suture was used in the center of the de-epithelialized area to prevent loss of nipple projection were compared with patients who underwent the conventional method. A retrospective analysis of the patients who underwent breast reduction with the FNG was conducted in our department. Patients were divided into two groups according to the FNG placement. In the PS suture method group, a 1-cm-diameter circumferential suture was placed with a 5-0 Monocryl® (poliglecaprone 25) suture to gain a 6-mm-nipple projection. In the conventional method group, the FNG was placed directly over the de-epithelized area. Graft viability was evaluated after 3 weeks postoperatively. The final nipple projection and depigmentation were evaluated after 6 months postoperatively. The results were evaluated with statistical tests. The number of patients with the conventional method was 10, and the PS suture method was 12. There was no statistically significant difference between two groups regarding graft loss and depigmentation (p > 0.05). Nipple projection was significantly higher in the PS method group (p < 0.05). We observed that PS circumferential suture made an acceptable nipple projection compared to the conventional method in breast reduction with the FNG technique. Since the method is easy to apply and has relatively low risk, it would contribute to clinical practice. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

COMPARAÇÃO ENTRE O FECHAMENTO DE OSTOMIA EM BOLSA VS. GRAMPEAMENTO LINEAR EM CRIANÇAS

Type of ostomy closure has connection with some complications and also cosmetic effects. This study aimed to compare result of colostomy closure using purse-string method versus linear method in terms of surgical site infection, surgical time, and patient satisfaction. In this study, 50 patients who underwent purse-string ostomy closure and 50 patients who underwent linear closure were included. Two groups were compared for surgical time, wound infection, patient satisfaction, scar length. A p-value <0.05 was considered significant. Wound infection was not reported among purse-string group compared to 10% in linear group (p=0.022). Scar length was 24.09±0.1 mm in purse string and 52.15±1.0 mm in linear group (p=0.033). Duration of hospital admission was significantly shorter in purse-string group (6.4±1.1 days) compared to linear (15.5±4.6 days, p=0.0001). The Patient and Observer Scar Assessment Scale scale for observer (p=0.038) and parents (p=0.045) was more favorable among purse-string group compared to linear. Purse-string technique has the less frequent surgical site infection, shorter duration of hospital admission, less scar length, and more favorable cosmetic outcome, compared to linear technique.

Surgical left atrial appendage closure: success rate and its relationship with cerebrovascular accident

Background: Several surgical procedures such as excision or exclusion are recommended for the closure of the left atrial appendage (LAA). This study was conducted with the aim to evaluate the success rate of different surgical techniques for LAA closure, their respective complications, and the rate of post-surgical cerebrovascular accident (CVA). Methods: This retrospective study included 150 consecutive patients who underwent LAA closure most commonly after mitral valve surgery within 3 to 6 months after surgery. An expert echocardiographic fellow collected the data on patients’ surgical LAA closure methods and history of CVA, types of prosthetic valves, mortality, and bleeding. Results: The failure rate for complete LAA closure was 36.7% (55 patients) in our study. The greatest success rate of complete LAA closure was seen in purse-string method (75.5%), followed by resection method (71.4%), while the lowest success rate (≈ 33.3%) was observed in ligation method. A significant relationship was observed between clots on the surface of metallic valve and postoperative CVA (P = 0.001; likelihood ratio: 32).In multivariate analysis, there was also no statistically significant relationship between partial LAA closure and the incidence of post-surgical CVA (P > 0.050). Conclusion: We observed the highest success rate of complete LAA closure in purse-string method followed by resection method. Interestingly, our results showed that despite the higher rate of residual LAA clot in cases of partial LAA closure, the occurrence of post-surgical CVA was mostly related to the presence of clots on the surface of metallic mitral prostheses rather than the presence of partial LAA closure.

Vaginal prolapse due to ring womb in a 3-year old Sudanese-Balami cross breed Ewe

This report presented a case of vaginal prolapse complicated with dystocia due to ring womb, the ewe was presented with the chief complaint of protruding mass around the vulva. On physical examination, vaginal prolapse was established and corrected gently by pushing the mass through the vulva opening and stay sutures were placed using buried purse-string method. Two days post-management the ewe was observed to be at term and the sutures were removed but the ewe was unable to deliver. It was then prepared for caesarean operation and two foetuses were removed alive, the foetuses died a day after the caesarean section. The post mortem findings on the foetuses revealed pulmonary atelectasis. The ewe recovered and the sutures were removed 14 days after the surgery.

Leak-proof technique in laparoscopic surgery for large ovarian cysts

The aim of this study was to compare the spillage rate and surgical outcomes between the leak-proof technique and the conventional technique in laparoscopy for large ovarian cysts (more than 15 cm in diameter) presumed to be benign tumours and free from adhesion. Thirty-five consecutive patients who underwent laparoscopy with the leak-proof technique between 2017 and 2019 (the practice change cohort) were compared retrospectively with 35 case-matched consecutive patients who underwent the conventional purse-string method between 2014 and 2016 (the historical cohort). In the practice change cohort, through the wound retractor in the umbilicus, large ovarian cysts were first covered with a sterilised vinyl membrane applied with a skin adhesive, then punctured, and the contents directly aspirated. The primary outcome was tumour spillage. The two cohorts had similar baseline characteristics. The spillage rate in the practice change cohort was significantly lower than in the historical cohort (0% vs 28.6%; p = .001). Other surgical outcomes, including operative time, operative blood loss, hospital stay, and operative complications were similar between the cohorts. In conclusion, laparoscopy with the leak-proof technique is reliable, safe, and easily implemented in the management of selected patients with large ovarian tumours and low probability of malignancy. IMPACT STATEMENT What is already known on this subject: Large ovarian cysts preclude the laparoscopic surgery because the size of the cyst interferes with adequate visualisation of the pelvic anatomy and confines the mobilisation of laparoscopic devices. What do the results of this study add: Laparoscopy with the leak-proof technique is reliable, safe, and easily implemented in the management of selected patients with large ovarian tumours and low probability of malignancy. What are the implications of these findings for clinical practice and/or further research: This technique is easily implemented and useful for most gynaecologic surgeons in treating extremely large ovarian cysts.

Outcomes of laparoscopic incarcerated inguinal hernia repair in children.

Aim:Laparoscopic inguinal hernia repair (LIHR) is gaining widespread acceptance, but its role in the management of incarcerated cases is not well outlined. This review analyses the outcomes of laparoscopic repair of incarcerated inguinal hernia in children.Patients and Methods:Literature was searched on PubMed® using terms 'laparoscopic', 'incarcerated', 'inguinal', 'hernia' and 'children'. Age, sex, side, sac content, operative technique, follow-up period, complication and recurrence rate were analysed.Results:Fifteen articles with 689 paediatric incarcerated inguinal hernias were identified between 1998 and 2018. Median age of patients was 22.4 months (2 weeks–16 years; M:F = 2.2:1). Side was mentioned in n = 576: n = 398 (69.1%) right and n = 178 (30.9%) left. In n = 355 (51.5%) manual reduction and delayed surgery (MRDS), in n = 34 (4.9%) manual reduction in general anaesthesia (MRGA) followed by emergency LHR and in n = 300 (43.5%) intraoperative reduction (IOR) was necessary. Incarcerated contents were documented in n = 68: intestine n = 36 (52.9%), ovary n = 14 (20.6%), omentum n = 11 (16.2%), appendix n = 5 (7.4%) and Meckel's diverticulum n = 2 (2.9%). Among the n = 18 girls in IOR group, n = 14 (77.8%) had ovaries incarcerated. For LHR, the hook method was used in 376 (54.6%) and purse-string suture in 313 (45.4%), with two conversions in IOR group. Mean followup was 15 months (3–80 months), with one (0.15%) testicular atrophy, and 4 (0.58%) recurrences in MRDS and 1 (0.15%) in IOR. All five cases were closed with pursestring technique. Total recurrence rate was 0.73%; significantly higher (P = 0.014) with pursestring (n = 5, 1.6%) than with the hook (none).Conclusion:Hook and purse-string methods are equally popular in LHR for paediatric incarcerated hernias, with 50% hernia reductions possible at the time of surgery. Recurrence rate is low and comparable with non-incarcerated hernias; however, it is significantly higher in purse-string method than hook technique.

Comparing Surgical Site Infection and Scar Cosmesis Between Conventional Linear Skin Closure Versus Purse-string Skin Closure in Stoma Reversal - A Randomized Controlled Trial.

IntroductionStoma closure is one of the most frequently performed surgeries. The common complications are surgical site infection (SSI) and poor scar cosmesis. Purse-string sutures are expected to have less incidence of SSI due to the free drainage of secretions from the wound and possibly the early detection of a wound infection. Compared to the conventional linear closure, the purse-string closure technique is expected to have less wound infection, improved scar cosmesis, and good patient satisfaction because of a smaller size scar. Hence, a well-structured study is required to substantiate the advantage of this technique.MethodologyThis randomized control trial was carried out for two years in a tertiary care centre in Southern India. Patients with various stoma reversals, including colostomy, as well as ileostomy reversal, were included in the study. Patients were divided into Group I - conventional linear skin suturing (n = 40) and Group II - purse-string closure (n = 40). After the closure of rectus muscle, the skin is closed using the purse-string method (subcuticular) in the experimental group.ResultsBoth the groups were comparable with respect to age, gender, body mass index (BMI), the presence of co-morbidities, and indication for surgery. Stomal procedures were done (26.3%) for malignant cases. The difference in mean hospital days for both groups were statistically insignificant (11.95 vs. 9.9; p = 0.927). The incidence of SSI between the groups were statistically significant (17 vs. 3; p = 0.003). The mean Patient and Observer Scar Assessment Scoring (POSAS) scores between the groups (65.30 vs. 83.40; p = 0.012) were statistically significant. This proved significant improvement in scar cosmesis in purse-string skin closure. At one month postoperative, the purse-string group had better patient satisfaction (3.08 vs. 4.48; p = 0.001), which was evidenced by a mean Likert 3 scale score. The mean visual analogue scale (VAS) score did not show any significant difference in pain between the groups.ConclusionPurse-string skin closure for stoma reversal had significantly less incidence of SSI. The duration of antibiotic therapy was also less in purse-string skin closure patients as compared to linear skin closure patients. Purse-string skin closures significantly improved the scar outcome and patient satisfaction.

Effect of a purse-string approximation following stoma takedown on wound infection and satisfaction.

See Article on Page 29-33 A temporary stoma is commonly used following rectal cancer surgery because a stoma has been reported to lower the clinical leak rate and the reoperation rate [1]. The use of a temporary stoma has been increasing due to the introduction and increased use of preoperative chemoradiotherapy (PCRT) in the era of rectal cancer surgery because PCRT was expected to facilitate sphincter preservation in patients with low-lying rectal cancer [2, 3]. Morbidity after stoma takedown, however, is not negligible, and surgical site infection (SSI) is a very common complication; its incidence which varies widely and has been reported to be as high as 40% [4, 5]. Although various methods have been employed to reduce the SSI rate, which technique for closure of a stoma would be the most effective in reducing the SSI rate is still being debated. The pursestring stoma closure described by Banerjee [6] was based on the concept of leaving the wound open to provide drainage and minimize SSI while providing some degree of wound approximation to minimize the healing time. From a morphological viewpoint, an elliptical or circular incision should be closed in a linear fashion for the primary ileostomy takedown wound, so it looked unnatural and the wound was usually larger than the stoma opening made by using an elliptical incision. Recently, a number of studies have reported that the purse-string closure technique resulted in a lower SSI rate than conventional primary closure [7, 8]. The authors of Clinical trial on the incidence of wound infection and patient satisfaction after stoma closure: Comparison of two skin closure techniques comparing purse-string with primary closure for ileostomy wounds demonstrated a lower incidence of SSI and a higher patient satisfaction when ileostomy wounds were closed using the purse-string method [9]. Although the study was a retrospective one, the patient populations in the two arms of the trial were well matched in most respects such as indications, types of stoma, and times to stoma closure. However, because the follow-up time was not long, at best, the study shows a short-term benefit. Regarding patients satisfaction based on a cosmetic viewpoint, that satisfaction might be improved after a longer follow-up because scar shrinkage would have progressed further. In this regard, most studies have shown a more contracted wound at a 1-year follow-up and, thus, and an improved patient satisfaction [7, 8]. The purse-string closure method has been criticized because of the time required for wound healing. However, the wound healing time following purse-string closure has been reported to be shorter than that following primary closure [5, 7], which is the same as the results reported by the authors of Clinical trial on the incidence of wound infection and patient satisfaction after stoma closure: Comparison of two skin closure techniques [9]. The way in which an open wound affects the quality of life of a patient needs to be investigated further because a higher infection rates is also associated with patient dissatisfaction. With the purse-string closure procedure, the wound must be kept clean at home; however, the patient does not need to go to the hospital to receive any special treatment.

Randomized Clinical Trial of Intestinal Ostomy Takedown Comparing Pursestring Wound Closure vs Conventional Closure to Eliminate the Risk of Wound Infection

The use of temporary stomas has been demonstrated to reduce septic complications, especially in high-risk anastomosis; therefore, it is necessary to reduce the number of complications secondary to ostomy takedowns, namely wound infection, anastomotic leaks, and intestinal obstruction. To compare the rates of superficial wound infection and patient satisfaction after pursestring closure of ostomy wound vs conventional linear closure. Patients undergoing colostomy or ileostomy closure between January 2010 and February 2011 were randomly assigned to linear closure (n = 30) or pursestring closure (n = 31) of their ostomy wound. Wound infection within 30 days of surgery was defined as the presence of purulent discharge, pain, erythema, warmth, or positive culture for bacteria. Patient satisfaction, healing time, difficulty managing the wound, and limitation of activities were analyzed with the Likert questionnaire. The infection rate for the control group was 36.6% (n = 11) vs 0% in the pursestring closure group (p < 0.0001). Healing time was 5.9 weeks in the linear closure group and 3.8 weeks in the pursestring group (p = 0.0002). Seventy percent of the patients with pursestring closure were very satisfied in comparison with 20% in the other group (p = 0.0001). This study was limited by the heterogeneity in the type of stoma in both groups. The pursestring method resulted in the absence of infection after ostomy wound closure (shorter healing time and improved patient satisfaction).

Medial Kantal Bölge Defektleri İçin Uygun Bir Seçenek: Purse-String Kapama

Objective: Reconstruction of the defects in the medial canthal region are often challenging for the plastic surgeons because of the particular properties of the surrounding skin. Although there are several reconstructive options reported for this region, there is no single procedure that achieves the best result. In this paper we reported the use of the purse string closure method in medial canthal region defects. Material and Methods: Eight patients with lesions in the medial canthal region were operated in our clinic. All of the defects were closed with the purse string method. Sutures were removed after 3 weeks and patients were followed for 6 to 36 months (median:16.5 months). Results: All of the lesions were diagnosed as basal cell carcinomas. In the early postoperative period, 4 patients complained about skin tension and restriction of eyelid movements, one patient additionally had a minimal wound dehiscence. Eyelid movements and skin tension improved at the end of 1st week. The wound dehiscence healed after the 2nd week without any intervention. Rugae formation and skin distortion disappeared within 6 to 8 weeks. No tumor recurrences were observed. Conclusion: The convenience and the facility of the method to deal with complications offers a good choice for reconstruction of the defects in medial canthal region.

Randomized clinical trial of short-term outcomes following purse-string versus conventional closure of ileostomy wounds

Ileostomy closure is an operation with an underappreciated morbidity, including surgical-site infection, small bowel obstruction and anastomotic leakage. Surgical-site infections, in particular, are a frequent occurrence following closure of contaminated wounds. This randomized controlled trial compared a purse-string closure technique with conventional linear closure. Sixty-one patients were randomized to conventional or purse-string closure of ileostomy wounds. The primary endpoint was the incidence of surgical-site infection, including infections requiring hospital or community treatment. Purse-string closure resulted in fewer surgical-site infections than conventional closure: two of 30 versus 12 of 31 respectively (P = 0.005). The purse-string method results in a clinically relevant reduction in surgical-site infections after ileostomy closure. ACTRN12609000021279 (Australian New Zealand Clinical Trials Registry: http://www.anzctr.org.au/).

EXPERIMENTAL CLOSURE OF LARGE BRONCHI

From the experience had in France with lung wounds; from the experience gained afterward in civil practice with empyema associated with bronchial fistulas, and from a review of the literature, it seemed that one of the great obstacles which now remained in the path of chest surgery was the failure of the large bronchi to close. We set about endeavoring to develop a technic for closing bronchi. We were greatly cheered by the article of Heuer 1 and his associates, who claimed that the closure of a large bronchus was a simple matter. The purse string method, the invagination method and even the simple mass ligature gave good results in their hands. It must be admitted that, while reading their article, it was rather disconcerting to recall our own numerous failures, and those reported from the clinics of Lilienthal, Sauerbruch and many others. After a protracted study of the subject

HEMORRHAGE FROM THE BOWEL FOLLOWING APPENDECTOMY.

The question of hemorrhage from the stump of the amputated appendix, treated by inversion and pursestring suture, was brought to the attention of the profession in 1904 by Dr. M. G. Seelig, 1 who quoted three cases of severe hemorrhage from the rectum following operation. In a paper read before the Chicago Medical Society Dr. William Hessert 2 reported three cases of postoperative hemorrhage from the stump, with a fatal issue in one instance. In the discussion that followed four cases of hemorrhage were reported, with one fatality. In Dr. John A. Wyeth's paper entitled the Technic of Appendectomy, read before the American Medical Association at the Fifty-eighth Annual Session, 3 a number of similar cases were reported, the purse-string method was considered unsafe and the ligature and the cauterization method was recommended. A careful perusal of the above articles shows that postoperative hemorrhage has been observed when the following