Absorbable Suture Research Articles

The comparison of interrupted and continuous suturing technique in Snodgrass urethroplasty in patients with primary hypospadias: A systematic review and meta-analysis

Hypospadias is among the common congenital anomalies in boys. Snodgrass urethroplasty is one of the most popular techniques for correcting distal and mid hypospadias. Although there is consensus among pediatric surgeons on using absorbable sutures for urethroplasty, there are no established guidelines about the suturing techniques (interrupted suturing [IS] or continuous suturing [CS]) for neourethra creation in Snodgrass urethroplasty. This analysis aims to compare the reported outcomes of both the urethroplasty suturing techniques. This systematic review and meta-analysis was conducted as per the preferred reporting items for systematic review and meta-analyses guidelines. A systematic, detailed search was carried out by the authors in the electronic databases - MEDLINE, PubMed Central, Scopus, Google Scholar, and Clinical Trial Registry. Studies were selected and compared based on primary outcomes - development of urethrocutaneous fistula (UCF), meatal stenosis, and secondary outcomes - wound infection, urethral stricture, and operative time. Statistical analysis was performed using a fixed-effect model, pooled risk ratio, and I2 heterogeneity. Five randomized studies with a total of 521 patients met our inclusion criteria. Pooled analysis for total complications, UCF, meatal stenosis, and wound infection showed no significant difference between the CS and IS groups. Subgroup analysis of patients with the use of polyglactin sutures showed a decrease in total complications and UCF in the IS group. There is no difference in total complication rates among the CS and the IS group with the use of absorbable sutures in Snodgrass urethroplasty; however, there is a decrease in the incidence of total complications and UCF in the IS group when polyglactin was preferred over polydioxanone suture for urethroplasty.

The comparison of the suture materials on intestinal anastomotic healing: an experimental study.

This experimental comparative study was to evaluate the local effects of three different suture materials on in-testinal anastomosis healing. Ethical approval was obtained from the University of Ethical Committee (E-60758568-020-176720). A prospective, experimental comparative analysis was conducted on 24 rats. They were divided into three equal groups; Group 1 underwent colonic anastomosis with Vicryl suture material, Group 2 underwent colonic anastomosis with polypropylene suture; and Group 3 underwent colonic anastomosis with polydioxanone (PDS) suture. The second operation underwent the 7th post-operative day. Adhesion score, anastomotic leakage, anastomotic bursting pressure, hydroxyproline levels, and histopathologic examination were evaluated. All animals survived, and no leakage, intestinal obstruction, or wound infection was observed during the experiment. The adhesion score was evaluated according to the Diamond classification and same in all groups. Median anastomotic bursting pressure was 125.75 mmHg (10-241) in the Vicryl group, 159.25 mmHg (113-190) in the polypropylene group, and 154.50 mmHg (20-212) in the PDS group. Hydroxyproline tissue concentrations were in the Vicryl group 1699.92±220.8 ng/mg (range: 1509.81-2186.47), in the polypropylene group 1126.24±607.12 ng/mg (range: 53.22-1815.63), and 1547.86±335.2 ng/mg (range: 973.66-1973.2) in PDS group. There was no difference among groups regarding the inflammatory response evaluated by histopathology. There was no statistical significance in all variables evaluated. This experimental study demonstrates that suture materials did not worsen tissue healing during intestinal anastomosis. Absorbable, slowly-absorbable, and non-absorbable suture materials could be used safely in every situation.

Pectoralis Major Repair with Double Button Sliding Tension Technique

Background: Pectoralis major rupture is often is weightlifters, commonly during benchpressing, eccentric phase of contraction and external rotation under maximum contraction. Preoperative imaging is use to differentiate between complete, partial, or intermuscular tear. In athelete patient, operative treatment has shown better result in return of strength and overall satisfaction over nonoperative treatment. Objectives: We described a surgical technique in 6 patients with acute pectoralis major rupture, with double button sliding technique. Methods: A deltopectoral approach is performed, and identify pectoralis major tendon and each tendon is secured with No.2 non absorbable braided suture using a modified krackow configuration. A 3.2 mm drill is used to make a unicortical hole at footprint. Two button were inserted and tensioned follow by knot-tying. Results: After six months evaluation, all patients underwent surgery with double button sliding tension technique returned to their pre-injury level. Conclusion: Double button tension sliding technique in pectoralis major rupture had excellent result, patients have returned to sport without complication.

Smart sensing flexible sutures for glucose monitoring in house sparrows.

There is a need for flexible chemical sensors for the ecological and physiological research of avian species such as house sparrows (Passer domesticus). Current methods in this field are invasive and require multiple physical interactions with the birds. Emerging research in flexible bioelectronics can enable realization of implantable devices that are mechanically compliant with the underlying tissues for continuous real-time sensing in situ. However, challenges still remain in forming an intimate flexible interface. One of the promising flexible bioelectronic platforms for tissue-embedded sensing is based on functionalizing surgical sutures or threads. Threads have three-dimensional flexibility, high surface-area-to-volume ratio, inherent wicking properties, and are easily functionalizable using reel-to-reel dip coating. Threads are ideal as they are lightweight, therefore, would not interfere with flight motion and would only require minimal interaction with the bird. However, the challenge remains in achieving a highly conductive yet flexible electrode for electrochemical sensing using materials such as gold. In this study, we address this issue through novel gold deposition directly on thread substrate followed by enzyme immobilization to realize flexible electrochemical glucose biosensors on medical-grade sutures. These sensors were calibrated and tested in a range that is wide enough to include the expected range of glucose concentration in house sparrows (0-8.55 mM). Glucose monitoring in house sparrows will provide insights into energy metabolism and regulation during stress responses. In addition, the stability, repeatability, and selectivity of the sensor were tested with final validation in a real bird. Our innovative gold-coated, thread-based flexible electrochemical glucose sensor can also be used in other small and large animals. This can also be extended to monitoring other metabolites in future.

Partial Purse String Suture with Delayed Reconstruction for a Large Defect Abutting a Free Margin.

Partial Purse String Suture with Delayed Reconstruction for a Large Defect Abutting a Free Margin.

Upper Ureteral Reconstruction with a Tapered Descending Colon after Failed Pyeloplasties in a 13-Year-Old Boy

An 11-year-old boy was referred for further management of a 6-cm-long grossly stenosed ureter following two failed left ureteropelvic junction (UPJ) obstruction repairs elsewhere. A tapered segment of the descending colon (TDC) was used successfully for ureteral reconstruction. The UPJ was exposed through a left flank incision. The stenosed segment was excised; both ends appeared severely inflamed and thickened. Tissue interposition was required and ureteroplasty with a TDC was performed by incising the peritoneum adjacent to the excised ureter to mobilize the descending colon to the retroperitoneal space. To prepare the TDC, an 8-cm segment of the colon with intact blood vessels was isolated, tapered, and sutured into a funnel shape using a 14-Fr catheter as a temporary stent. After colocolostomy, the colon was returned to the abdominal cavity, the peritoneum was closed carefully to prevent vascular compromise, and the TDC was anastomosed to the ureter and renal calyx with interrupted absorbable sutures. A double J stent (DJS) and percutaneous nephrostomy tube were placed. Postoperative recovery was uneventful. The DJS was removed on day 50 after confirming smooth urine flow through both the ureter-TDC and calyx-TDC anastomoses. Diuretic renography performed 68 days postoperatively was unobstructed. The patient is currently well after 12 months follow-up. This would appear to be the first report of a TDC being used to create a funnel-shaped segment to reconstruct a long, grossly stenosed ureter. The TDC is simpler than the re-tubularizing colon but requires monitoring for postoperative mucus-related complications and malignant transformation.

Clinical Equivalence of Monoglyde® and Monocryl® Absorbable Poliglecaprone-25 Sutures: A Single-Blind, Randomized Study

Objectives: Poliglecaprone-25 is a synthetic monofilament suture, commonly used for post-cesarean subcuticular skin closure. The present study was designed to assess the effect of subcuticular skin closure using Monoglyde® vs. Monocryl® poliglecaprone-25 absorbable sutures, on the risk of wound composite outcomes in the first 30 days postpartum [surgical site infection (SSI), wound dehiscence, hematoma or seroma]. Study Design: This is a prospective, single-blind, randomized (1:1), multicentric, two-arm, study performed between September 2020 and December 2021 at two different centres across India. Women (18-40 years) with a singleton pregnancy, requiring cesarean delivery were randomized to Monoglyde® (n=62) or Monocryl® (n=62) suture groups. The primary endpoint is incidence of wound composite outcomes in the first 30 days postpartum (SSI, wound dehiscence, seroma, or hematoma). In addition, the secondary outcomes, incidence of wound composite outcome at all visits (till 4 months), suture extrusion and loosening, suture removal and evaluation of microbial deposits on sutures (in case not absorbed or infection), operative time, intraoperative suture handling, postoperative pain, return to normal day-to-day activities, modified Hollander cosmesis score, subject satisfaction score, and adverse events were noted. Results: Non-significant difference between the groups regarding demographic characteristics and primary endpoint, incidence of wound composite outcome was observed. Moreover, no significant difference in suture extrusion and loosening, suture removal and evaluation of microbial deposits on sutures, operative time, intraoperative suture handling, pain, return to normal day-to-day activities, modified Hollander cosmesis, and subject satisfaction score were registered between the groups. Conclusions: This study establishes the clinical equivalence of Monoglyde® and Monocryl® poliglecaprone-25 sutures and both sutures can be used for subcuticular skin closure following cesarean delivery with minimal risk for wound complications.

Эффективность и перспективы использования амниотической оболочки при повторном кесаревом сечении

This article presents a new method of uterine closure in repeat cesarean section using absorbable suture anchors and additional sealing of the scar with amniotic membrane. The proposed method is not followed by excessive blood loss, does not prolong the duration of surgical intervention and postoperative hospitalization. This method also reduces the incidence of intra- and postoperative complications and cesarean scar defect, eliminates the need for additional hemostatic suturing of the uterus, and promotes myometrial regeneration. Key words: amnion, amniotic membrane, cesarean section, cesarean scar defect

Retracted: Application of Absorbable Suture in Strabismus Correction and Nursing Management Advantage of Watson Care Theory in Perioperative Period.

[This retracts the article DOI: 10.1155/2022/8739551.].

A Surgical Technique for Closure of 10 mm and Larger Laparoscopic Port Fascial Defects Using a Graham's Nerve Hook.

In order to avoid potential complications from incisional hernias in patients undergoing laparoscopic or robotic procedures with 10 mm or larger ports, a surgeon closes the fascial defects using various techniques. We compared several different techniques of port site closure, which uses the open technique that can be performed with or without laparoscopic visualization. We modified the technique initially described by Dr. H. Aziz. We are introducing a new surgical technique to close the larger port site using Graham's nerve-hook. This new technique is easy to learn, replicate and implement for all body types. We use the commonly available Graham's nerve-hook and two S-retractors to visualize the entire layers of fascia and peritoneum and to pull up both layers to close the larger port site safely and securely with 0 polyglactin absorbable suture. We illustrated this new Lee's port site closure technique with eight separate drawings in this paper. We performed 493 consecutive laparoscopic cases using this new technique. Four years follow up revealed only one incisional hernia using this technique. The patients are routinely followed in one month and six months and a year after the operation. However, not all of the patients are seen after six months unless there was a specific complaint. The new port site closure technique introduced in this paper is found to be easy to learn, fast, and very cost effective due to the reusable, commonly found S-retractors and Graham's nerve hook. After four years of consistent use, this new technique was found to be safe and effective in closure of 10 mm or larger port sites.

Needle control during laparoscopic pancreaticojejunostomy

Background: Laparoscopic pancreaticoduodenectomy is a technically challenging procedure with a long learning curve. One of the most challenging aspects is the suturing involved during the pancreaticojejunostomy (PJ). During this anastomosis, proper control of the suturing needle is critical.

Complicações associadas à hemilaminectomia toracolombar e fenestração de disco intervertebral: estudo prospectivo em 64 cães

ABSTRACT: Hemilaminectomy and intervertebral disc fenestration are commonly used to treat intervertebral disc extrusion (IVDE); however, they are associated with surgical complications. Sixty-four dogs were assessed during the intraoperative, immediate postoperative, and late postoperative periods to evaluate complications resulting from these surgical procedures. During this study, 15.62% (n=10) of the dogs presented with complications during at least one of the evaluations. Iatrogenic rhizotomy, access to the spinal canal contralateral to the lesion, and cardiorespiratory arrest were observed intraoperatively. Abdominal wall flaccidity, neurological worsening, hematoma, dehiscence, and superficial wound infections were observed during the immediate postoperative period. Adverse reactions to the surgical thread, scar adhesion, and superficial wound infection were the most frequent complications during the late postoperative period. Dogs that undergo hemilaminectomy and intervertebral disc fenestration because of IVDE may experience complications during the intraoperative, immediate postoperative, and late postoperative periods. However, these complications are often transitory and rarely cause death.

Performance and Strength Characteristics of Suture Knots in Periodontal Microsurgery: An In Vitro Study.

This study is aimed to investigate the types of knot failure (untying or breaking) and the tension required to break different sutures diameters. One hundred and fifty knots were fabricated using polyamide sutures diameters of 6/0, 7/0, and 8/0. The studied knots were either squared or slipped with different numbers of throws (2, 3, 4, 5 and 6), and the following data were recorded: type of failure (untied or broken), number of throws, the tension required to untie or break each knot, slippage, and elongation of the knot. The knots were created in a standardized way. with a device and weights and then subjected to a controlled tension. The knots that got untied were: 1&#61;1, 1x1, 2&#61;1, and 2x1, whereas the remaining knots got broken. Notably, at least three throws were required to prevent untying, but separately, as in 1&#61;1&#61;1 or 1x1x1. The mean tension to break the knots of 6/0, 7/0, and 8/0 sutures were 3.1, 1.3, and 0.6 N, respectively (P < 0.05), and they were independent of the knot type. Results from this study demonstrated that the knots with geometries of 2&#61;2/2x2 and 1&#61;1&#61;1/1x1x1 were secure, and additional throws does not increase their security. Furthermore, tensile strength reduces with decreased suture size.

Comparison of the Efficacy of Absorbable Versus Non-Absorbable Sutures after Lichtenstein Mesh Hernioplasty Regarding Post Operative Pain

Objective: Comparison of the efficacy of absorbable versus non-absorbable sutures after Lichtenstein mesh hernioplasty. Methodology: We planned this Randomized Control Trial consisting of 200 cases, from Surgical outdoor booked for hernioplasty. All patients were examined in a comfortable environment. All the information was kept confidential. The patients were not aware of the randomization arm and selected via lottery method. All patients underwent Lichtenstein mesh hernioplasty under local anesthesia. Before surgery, a course of prophylactic antibiotics consisting of 1 g of IV cefazolin was administered to each patient. All procedures were done by skilled post graduate general surgical residents under consultant supervision. Predictable bias and confounding factors were controlled by restriction (inclusion and exclusion criteria) and randomization. Rest was addressed during final analysis through stratification. GROUP A patients undergo mesh fixation using Prolene 1. (non-absorbable) GROUP B patients undergo mesh fixation using Vicryl 0. (absorbable). For all treatments, a conventional tension-free uniformed surgical method was adopted. Patients were evaluated at 3 months followup to record the efficacy. Results: Mean age was calculated as 44.7+9.45, mean pain score on VAS was calculated as 2.04+0.72 in Group-A and 1.54+0.76 in Group-B,p-value=0.018. Comparison of efficacy of absorbable versus non-absorbable sutures after Lichtenstein mesh Hernioplasty shows that 83(n=83%) in Group-A and 94(n=94) in Group-B had efficacy while, p value 0.014 showing a significant difference. Conclusion: Our findings indicate that, following Lichtenstein mesh hernioplasty, absorbable suture is more effective than non-absorbable suture regarding post operative pain. Keywords: Inguinal hernia, hernioplasty, absorbable versus non-absorbable sutures, efficacy

The Use of Different Suture Methods in Tilapia (Oreochromis niloticus) Fish

In this study, it is aimed to compare the suture methods in wounds created for different purposes in the field of aquaculture. For this purpose, Tilapia fish, which took the second place after carp in the inland waters fish breeding of hot countries, were used. In the study, Control group (n = 3), simple suture (n = 3), U suture (n = 3) and X (Sultan) suture (n = 3) applications were performed. The fish were subjected to 7 days of adaptation before starting the study. During the study, feeding was done once a day with Tetra Discus food. For the formation of cut wounds, scales were removed in Tilapia fish under anesthesia, and 2 cm long incision were performed. As a result of the study, it was observed that the cut wounds were closed on the 6th day in the U suture group, at the end of the 7th day in the control group and simple suture groups, and the 9th day in the X suture group. It was observed that the absorbable suture materials were absorbed in all fish in which they were applied, but in the X suture group, 1 fish was absorbed at the end of the 9th day. It is concluded that it is healthier to prefer simple suture and U suture primarily in areas such as marking, remote sensing, monitoring and management of fish methods, and fish health.

Application of Social Marketing Mix Strategies During the COVID-19 Pandemic

Social marketing tends to use commercial marketing tools and strategies to change people’s behavior for the betterment of the individual. Social marketing campaigns are used to deliver messages tothe target groups. Social marketing campaigns disseminate information to the target groups to bring awareness about social causes or issues. The campaign provides messages to modify the knowledge, attitudes and behaviour of a large proportion of the population. This paper discusses the 8 Ps of social marketing mix (product, price, place, promotion, public, policy, partnership, and purse strings) and its application during the global pandemic of COVID-19. The comprehensive qualitative synthesis did of previously published information. The original research articles were extracted from google scholar in November 2021 by using search keywords “social marketing” OR “social marketing mix” AND“COVID-19” OR “ Coronavirus Disease 2019”. The study’s primary finding of this paper was that social marketing mix strategies (8 ps) had significantly applied to increase public awareness during the global pandemic of COVID-19. In addition, the research paper identifies some emerging areas for future research. The quantitative review techniques would be a valuable future extension such as systematic,bibliometric, and meta-analysis. This research paper offers an application of social marketing mix strategies to prevent such a pandemic and provides a guide for future research on social marketing mix.

Real-Time Suture Thread Detection with an Image Classifier

Micro-anastomosis is considered to be a difficult task even for skilled surgeons. Our group has developed a surgical robotic system to assist surgeons. Going further, the detection of surgically relevant objects in the microscopic view is indispensable for the automation or semi-automation of the system. This paper proposes a novel surgical thread detector inspired by an automatic crack detection method. The proposed method achieved a Dice score of 76.30% and an intersection over union (IOU) of 66.08% at 34.50 fps.

Mechanical mechanism of suture passer needle break in rotator cuff repair.

Suture passer needle, as one of commonly used instrument in the arthroscopic rotator cuff repair, often breaks at the notch of the needle, which originally was designed to facilitate suture with thread. Our study aimed to evaluate the suture failure rate and stitch success rate between intact suture needle and broken needle and explore the mechanism of the needle breakage and achieving better future designs. From 2017 to 2021, consecutive 437 shoulders (11 cases were bilateral) underwent arthroscopic repair for full-thickness rotator cuff tear at the authors' institution. The breakage of needles was recorded. Finite elements analysis and mechanical test were utilized to compare stress distribution, puncture performance, and loaded puncture performance between the broken needle and the intact needle. We identified 19 consecutive patients for whom the needle tip of the TruePass™ suture passer was broken in the 437 shoulder surgeries. Based on the finite element analysis of Abaqus, around the tip and the notch of the intact needle was a large stress concentration. The average puncture force required by intact needle tip and the broken tip is 61.78N and 78.23N respectively. While the intact tip with notch is easier to break than the broken tip. The notch of the needle is a weak point in mechanics. The broken needle without the notch still has good tendon piercing and thread passing ability. The notch of needle may be not necessary, and the tip of the needle should be modified.

Investigating the Relationship Between Special Medical Waste Disposal and Needle Sticking of Staff in Hospitals of Iran University of Medical Sciences

Background: Infectious hospital waste, including needles and sharp instruments, is one of the most important causes of needle sticks. Objectives: The study aimed to investigate the factors affecting the disposal of special medical waste with needle sticks among healthcare workers in hospitals at the Iran University of Medical Sciences. Methods: This descriptive-analytical, retrospective, and cross-sectional study were done regarding the data in the autumn of 2019. Among 6119 medical-service staff, 180 subjects have been exposed to the needle stick at least once. Data were collected in two parts. The data were analyzed using correlation tests by SPSS software version 25. Results: The most devices leading to injury were needles (58%), angiocatheter (21%), ampoules (17%), suture needles (12%), scalpels (9%), other tools (8%), and razor blades (7%). The five wards with the highest needle sticks were the operating room (24.44%), surgery (22.22%), emergency (15%), internal wards (10%), and paraclinical (8.33%). Also, several factors, such as work shifts and the amount of work experience of individuals, can play an essential role in the rate of needle stitching of medical personnel. Importantly, we found a significant relationship between the volume of medical waste and employee needlestick rates. Conclusions: According to the results, we found a significant positive relationship between the volume of medical waste and employees' needle sticking rate. The observance of standard guidelines and the development and increase of occupational safety protection training courses have the most significant role in reducing needle sticks.

Treatment of osteochondral fracture of lateral femoral condyle after patella dislocation with anchor absorbable sutures: A new surgical technique and a case report

Osteochondral fracture (OCF) in weight-bearing area of lateral femoral condyle (LFC) is a rare combined injury caused by patellar dislocation. A 15-year-old female student accidentally sprained her right knee while participating in sports activities. The patient felt pain in his right knee and limited movement. After hospitalization, the patients underwent computed tomography scan and magnetic resonance examination. According to the imaging results, patellar dislocation combined with OCF of LFC was considered in diagnosis. Through the lateral parapatellar approach, we reduced the osteochondral mass and bundled it with absorbable sutures of anchors. The functional and radiographic outcome were satisfactory at 18 months after operation. Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical.