Simple Interrupted Sutures Research Articles

Novel Technique to Close Stellate Corneal Lacerations.

The study was performed to evaluate and optimize a novel technique to close stellate corneal lacerations in a wet laboratory environment. Twenty-one ex vivo porcine eyes with standardized, experimentally created stellate corneal lacerations were assigned to one of three surgical repair techniques. In Group 1 (n = 9), lacerations were closed with simple interrupted sutures only. In Group 2 (n = 7), a large-radius central purse string was used in addition to simple interrupted sutures. In Group 3 (n = 5), a small-radius central purse string was used in addition to simple interrupted sutures. Wound stability was assessed by determining the intraocular pressure (IOP) at which wound leak occurred. Group 3 eyes demonstrated a mean wound leak IOP of 56.1 mm Hg (range 32-90.3) compared with groups 1 and 2, which demonstrated mean wound leak IOPs of 6.4 mm Hg (range 1.9-19) and 13.3 mm Hg (range 2.8-31), respectively. These differences were highly statistically significant (P<0.002 and P<0.015, respectively, compared with Group 3). The use of a small-radius internal purse-string suture, when combined with simple interrupted sutures, produced a highly effective watertight closure in experimentally created stellate corneal lacerations, significantly outperforming approaches using only interrupted sutures or a large-radius purse string. The use of a small-radius purse-string suture should be considered for clinical use in the repair of stellate corneal lacerations.

MEDIAN EPISIOTOMY APPROACH IN A MINIATURE POMERANIAN WITH VULVAL HYPOPLASIA: A CASE REPORT

This case report details the episiotomy approach employed in managing vulval hypoplasia in a two year old Miniature Pomeranian bitch. The animal was presented to the Teaching Veterinary Clinical Complex, Veterinary Gynaecology and Obstetrical Unit, Madras Veterinary College, displaying a history of greenish black discharge and continuous straining for two hours. The animal was bred before 64 days. Physical examination revealed a small vaginal opening, measuring approximately 1.5 cm in length. Digital examination indicated fetal hind limbs and tail extending into the vaginal passage, while all other vital parameters were within the normal range. Attempts to induce uterine contractions using Inj. Oxytocin and 10 % Calcium gluconate in 5 % DNS proved unsuccessful. Therefore, under local anesthesia (2 % Lignocaine injection), median episiotomy was made and a single live male puppy was successfully delivered with mild traction. Closure of the incision site was accomplished using PGA 1/0 with a simple interrupted suture pattern. The patient had uneventful recovery after 5 day treatment regimen, involving a single dose of subcutaneous Inj. Cefovecin (antibiotic) and anti-inflammatory drugs, along with meticulous wound management.

Reconstruction of deep and perforating corneal defects in dogs-A review (Part III/III): The use of corneal sutures and reporting of ocular discomfort.

The surgical reconstruction of severe corneal disease is a common and crucial component of the clinical practice of veterinary ophthalmology. The first part of the present review described procedures that utilize autogenous ocular tissues, homologous donor tissues, and heterologous donor tissues in dogs, while the second part reviewed the use of biomaterials and keratoprosthetics in this species. This third part is dedicated to the review of the use of corneal sutures including suture type and suture pattern in corneal reconstruction of small animals including dogs and cats. The review also focused on the way studies report postoperative ocular discomfort/pain and how this is treated. Lastly, the author briefly presents the simple but effective techniques available to bury corneal knots for corneal reconstructive surgery in small animal patients, such as the "tugging" and "deep-superficial-superficial-deep" methods for simple interrupted sutures, and the adaptation of the latter for simple continuous sutures.

Pleomorphic adenoma of hard palate: Review of updated literature and "case report".

Pleomorphic adenoma (PA) is a rare benign tumor mainly affecting the major salivary glands, known for its diverse histological appearances that can mimic malignancies. When it occurs in the hard palate it present diagnostic and management challenges compared to other sites due to the anatomical location and potential proximity to critical structures. This case reports a rare presentation PA starting as an ulcer, alongside a review of rare cases of PA reported in last 5 years. We aim to highlight clinical challenges and emphasize the need for awareness in diagnosis of this diverse entity amongst the clinicians before reaching a definitive conclusion. A 41-year-old female reported an asymptomatic large swelling on the right side of the posterior palatal region. Clinical diagnosis revealed a firm, rubbery, and non-tender swelling of approximately 4 cm × 4 cm diameter. A triangular incisional biopsy was performed to confirm the diagnosis. The histopathological evaluation confirmed the presence of a PA with a well-encapsulated and compressed salivary gland. A wide surgical dissection was made to remove the entire encapsulated tumor mass, including the mucoperiosteum and eroded bone of the palate. The borderline of the tumor was carefully identified in the surrounding healthy tissue. The hemostasis was obtained using a simple interrupted suture. The diagnosis of PA is difficult as it usually involves extensive squamous and mucous metaplasia, confusing it with malignant disorders. Histopathological and clinical examinations are important for differentiating this lesion from other tumors. Complete surgical excision is reported as the first line of treatment.

Objective Comparison of the First-Person-View Live Streaming Method Versus Face-to-Face Teaching Method in Improving Wound Suturing Skills for Skin Closure in Surgical Clerkship Students: Randomized Controlled Trial.

The use of digital online teaching media in improving the surgical skills of medical students is indispensable, yet it is still not widely explored objectively. The first-person-view online teaching method may be more effective as it provides more realism to surgical clerkship students in achieving basic surgical skills. This study aims to objectively assess the effectiveness of the first-person-view live streaming (LS) method using a GoPro camera compared to the standard face-to-face (FTF) teaching method in improving simple wound suturing skills in surgical clerkship students. A prospective, parallel, nonblinded, single-center, randomized controlled trial was performed. Between January and April 2023, clerkship students of the Department of Surgery, Pelita Harapan University, were randomly selected and recruited into either the LS or FTF teaching method for simple interrupted suturing skills. All the participants were assessed objectively before and 1 week after training, using the direct observational procedural skills (DOPS) method. DOPS results and poststudy questionnaires were analyzed. A total of 74 students were included in this study, with 37 (50%) participants in each group. Paired analysis of each participant's pre-experiment and postexperiment DOPS scores revealed that the LS method's outcome is comparable to the FTF method's outcome (LS: mean 27.5, SD 20.6 vs FTF: mean 24.4, SD 16.7; P=.48) in improving the students' surgical skills. First-person-view LS training sessions could enhance students' ability to master simple procedural skills such as simple wound suturing and has comparable results to the current FTF teaching method. Teaching a practical skill using the LS method also gives more confidence for the participants to perform the procedure independently. Other advantages of the LS method, such as the ability to study from outside the sterile environment, are also promising. We recommend improvements in the audiovisual quality of the camera and a stable internet connection before performing the LS teaching method.

The Catheter Fell Out

BackgroundAccidental catheter removal or drain dislodgment, including tube thoracostomy, is a common, high-risk complication in hospitalized and ambulatory patients that often necessitates an additional procedure, increased length of stay, and increased cost. MethodsThe aim of this study was to compare the tensile strength of pigtail catheter fixation using a simple interrupted suture, a U-stitch suture, or 2 simple interrupted skin sutures in a standardized skin model. Catheters were sutured to the skin, penetrating the collagen layer, with 1 of the 3 suture techniques and varying suture combinations. ResultsFor each trial, breakage occurred at the suture or knot. The mean breakpoint varied significantly between 2 simple interrupted sutures and both the 1 simple interrupted suture and the U-stitch technique (analysis of variance post hoc test P < .001), with the 2 simple interrupted suture technique withholding nearly 40% more force. Using the strongest suture, 0 silk, on a deceased adult sheep to secure a pigtail thoracostomy catheter yielded identical data compared with the standardized skin model. ConclusionsIn conclusion, 2 simple interrupted skin sutures to secure a pigtail catheter has very low risk with a strongly positive benefit.

Commercial suture passer improves efficiency and ease of use versus conventional needle in minimally invasive thoracolumbar fascia closure: a cadaveric analysis

BackgroundLow-profile suture passers have been introduced to facilitate thoracolumbar fascia closure in minimally invasive spine (MIS) surgery. The purpose of this study was to evaluate the closure time of a modern suture passer to a conventional curved need for MIS fascia closure in a cadaveric model. MethodsSix clinicians specializing in orthopedic spine surgery were recruited for the study and randomly assigned 1 cadaveric torso. Subcutaneous tissue was resected at L4-L5, replicating MIS surgery, followed by placement of a 60×18-mm or 100×18-mm tubular retractor for access. Clinicians were required to close the fascia with three unknotted, simple interrupted sutures using a swaged curved needle or suture passer (Spine Scorpion™, Arthrex, Inc., Naples, FL). The completion time was recorded, starting immediately before suturing and ending after the last pass. A time cutoff of 10 min was implemented in consideration of reasonable operating room time, and the number of achieved suture passes (of 6) were recorded. Clinicians were asked to qualitatively grade ease of use in relation to prior fascial closure experience per a 0-5 scale, where 0 is impossible and 5 is easiest. ResultsThe mean change in fascial closure completion time (Δ) was significantly reduced with the Spine Scorpion compared to the curved needle with the 60×18-mm retractor (Δ=5.80 min; 95% CI, 2.92-8.67 min; p=.004) and 100 × 18-mm retractor (Δ=5.28 min; 95% CI, 2.76-7.80 min; p=.003). Full closure was achieved within the time limit for all trials of the Spine Scorpion, while the standard needle achieved full closure in 67% (4 of 6) and 50% (3 of 6) of trials with the 60 × 18-mm and 100×18-mm retractors, respectively. Median ease-of-use scores with the 60×18-mm and 100×18-mm retractors, respectively, were 4.5 (range, 4-5) and 4.5 (range, 3-5) for the Spine Scorpion, and both 1.0 (range, 1-2) for the curved needle. ConclusionResults from this laboratory investigation using a suture passer for thoracolumbar fascia closure show a significant reduction in closure time and completion of the procedure compared to a conventional curved needle.

The Direct Tendon Suture and Paratenon Repair Technique for Acute Tendinous Mallet Finger: A Case Series.

(1) Introduction: Tendinous mallet finger is a frequent deformity that occurs after an extensor tendon injury during sports or daily life activities. Despite the existence of numerous non-operative and operative techniques to address this deformity, there is a controversy on its optimal management. In this study, we aimed to present a direct tendon suture technique using the distal interphalangeal (DIP) joint open approach for treating tendinous mallet finger injury. (2) Methods: Between 2019 and 2021, 19 patients with closed non-fracture tendinous mallet fingers underwent the direct tendon and paratenon repair technique. After skin incision, we opened the paratenon with lazy S shape incision and found the ruptured proximal and distal tendon ends. We reapproximated the tendons using a simple interrupted suture with Prolene #6/0. After that, we meticulously performed paratenon repair using PDS #6/0 for preventing readherence. Temporary trans-articular Kirschner wire fixation was used for 4 weeks. (3) Results: All patients were followed-up for 3-8 months (mean: 4.8 months). The mean final extension lag was 6.5 degrees, and the overall rate of cases with excellent and good outcomes using Crawford's criteria was 85%. (4) Conclusions: In conclusion, this surgical approach could be a reliable alternative for the treatment of tendinous mallet finger injuries.

Immersive virtual reality as a surgical training tool: A cohort study

BackgroundFew studies have studied the efficacy of using immersive virtual reality (iVR) to teach surgical skills, especially by using real-world iVR recordings rather than simulations. This study aimed to investigate whether viewing 360° iVR instructional recordings produces greater improvements in basic suturing skills of students without prior medical training, beyond traditional methods like reading written manuals or watching 2D instructional videos. Materials and methodsThis was a partially blinded randomized cohort study. 44 pre-university students (aged 17) were randomized equally to either the written instruction manual, 2D instructional video, or iVR recordings. All students first watched a silent 2D demonstration video of the suturing task, before attempting to place three simple interrupted sutures on a piece of meat as a baseline. The time taken for the first attempt was recorded. Students were then given an hour to train using their allocated modality. They attempted the suturing task again, and timings were re-recorded. Four blinded surgically-trained judges independently assessed the quality of the stitches placed both pre and post-intervention. One-way analysis of variance tests (ANOVAs) and independent two-sample t-tests were used to determine the effect of training modality on improvements in suturing scores and time taken to complete suturing from pre to post-training. ResultsFor suturing scores, the iVR group showed significantly larger score improvements than the Written Manual group (p = 0.031, Cohen's D = 0.92), while this iVR advantage was less pronounced when compared with the 2D Video group (p = 0.16, Cohen's D = 0.65). Similarly for time taken to complete suturing, the iVR group had significantly larger time improvements than the Written Manual group (p = 0.045), although this difference was less robust compared to the 2D Instructional Video group (p = 0.34). ConclusionThis study demonstrates that iVR training using real-world 360° instructional recordings produced significantly greater training gains in suturing scores and efficiency compared to reading written text. iVR training also led to larger training gains in both outcome measures than viewing 2D instructional videos, although the differences between them did not reach statistical significance.

A Comparison of Models for Teaching Suturing and Surgical Skills to Dental Students.

Learning suturing skills is an important area of the undergraduate curriculum and ideally requires realistic and anatomically accurate surgical training models to prepare students for treating patients. Little is currently understood regarding which model might be perceived by students to be the best or which might most effectively facilitate their learning. The aim of this study was to compare four teaching models: a tabletop silicon dental model, a restricted access tabletop model, a traditional phantom head mounted model, and a Thiel cadaver. Student preferences were explored for each of the models. Following lecture and video-based teaching 67 fourth-year students attended a practical suturing teaching session followed by the second session more focused on the experience of cutting and suturing mucoperiosteal flaps. Forty-six students (67%) gave online anonymous feedback on the first session. The majority (95%) felt prepared to place a simple interrupted suture on a patient, and 88% felt confident to do so. Twenty-eight students (40%) provided feedback on the second session with 82% agreeing that they were prepared to cut a mucoperiosteal flap and 48% felt confident to do this for a patient. The cadaver model was rated as the best of the four models for both suturing and mucoperiosteal flap skills. These results support its use for teaching students to suturing and surgical skills. However, despite this teaching student-rated confidence to cut and suture flaps for a patient remains poor.

Comparing teaching with tactile guidance with video modeling with self-evaluative video feedback to train medical skills.

Modern medical training consists largely of lecture-based instruction and in vivo or video modeling of specific skills. Other instructional methods, such as teaching with acoustical guidance (TAGteach), have rarely been evaluated. In this study, we compared teaching with tactile guidance, or tactile TAGteach in which a vibratory stimulus is delivered to indicate a correct response, with video modeling and self-evaluative video feedback to teach four participants two medical skills: simple interrupted suture and endotracheal intubation. The results showed that both instructional methods improved performance. However, three participants met the mastery criterion in the tactile TAGteach condition first, although this instructional method required more time to train the skills. We discuss the implications of these findings for training skills to medical practitioners.

Comparison of Different Suturing Techniques in Post-Extraction Socket Healing

ABSTRACT Background: The process of post-extraction socket healing is critical for ensuring proper tissue repair and minimizing complications in dental practice. Suturing techniques play a pivotal role in this process, influencing wound closure, hemostasis, and overall healing. Materials and Methods: This prospective clinical trial involved 80 participants who required single-tooth extractions. Patients were randomly assigned to four groups, each receiving a distinct suturing technique: simple interrupted sutures, horizontal mattress sutures, vertical mattress sutures, and continuous sutures. Standardized assessments, including clinical examination and cone-beam computed tomography (CBCT) scans, were performed at baseline, 1 week, and 4 weeks post-extraction. Wound dehiscence, soft tissue healing, and bone preservation were evaluated. Results: At 1-week post-extraction, the continuous suture group exhibited the lowest rate of wound dehiscence (5%) compared to other groups (simple interrupted, 15%; horizontal mattress, 10%; vertical mattress, 12%). Soft tissue healing scores at 4 weeks were significantly higher in the continuous suture group (8.7 ± 0.5) than in the other groups (simple interrupted, 7.2 ± 0.8; horizontal mattress, 7.8 ± 0.7; vertical mattress, 7.5 ± 0.6). CBCT analysis revealed superior bone preservation in the continuous suture group (98% remaining bone volume) compared to the other groups (simple interrupted, 92%; horizontal mattress, 95%; vertical mattress, 94%). Conclusion: This study demonstrates that the continuous suturing technique offers advantages in post-extraction socket healing, including reduced wound dehiscence, improved soft tissue healing, and better bone preservation.

Collagen imaging reveals synergistic effects of sutures and host-donor misalignment on topographical irregularities in penetrating keratoplasty.

Mitigating unwanted refractive errors is crucial for surgeons to ensure quality vision after penetrating keratoplasty (PK). The primary objective of the present study is to highlight the importance of microstructural matching of the host and the donor cornea during PK on the distribution of the corneal tissue while suturing. For this purpose, the present study undertakes an in-vitro PK model to analyse the effect of suturing and host-donor misalignment on corneal birefringence. Five groups of experiments were performed using five corneoscleral buttons. In each group, N = 16 data points (corresponding to 16 simple interrupted sutures) were assessed before and after PK with five degrees of misalignments, 0°, 30°, 45°, 60° and 90° to detect the variations in corneal birefringence post-PK. The technique of digital photoelasticity is utilized to capture the corneal birefringence experimentally. The local and global features of corneal birefringence provided interesting insights into the nuances of corneal birefringence in PK. Statistical analysis was performed to study the effects of suturing on the birefringence around the suture bites. It was observed that the interaction of the suture tension and structural misalignment between the host and the donor cornea influences the corneal birefringence in PK. Conclusions The zero-degree structural misalignment of the host and the donor tissue is preferable to minimize the topographical irregularities and related astigmatism post-PK. The findings of the present study envisage an additional step of structurally aligning the donor tissue with the host before suturing to minimize topographical irregularities in PK.

Laparoscopic surgical treatment for sliding hiatal hernia is associated with an owner-perceived improvement in clinical outcome in dogs

Abstract OBJECTIVE To report perioperative complications and client-perceived outcome following laparoscopic surgical treatment for sliding hiatal hernia (SHH) in dogs. ANIMALS Client-owned dogs (n = 9). METHODS Medical records were reviewed and perioperative data collected including preoperative diagnostic imaging, operative details, complications, and need for conversion to open celiotomy. A single-incision, multicannulated port was inserted in the subumbilical region followed by placement of an additional 2 or 3 instrument portals. Hiatal plication, esophagopexy, and left-sided gastropexy were performed laparoscopically. Follow-up information was collected with telephone interview with the owners and/or referring veterinarian. A standardized questionnaire was completed by dog owners postoperatively. RESULTS Intraoperative pneumothorax occurred in 5 of 9 (55.6%) dogs and resulted in conversion to open celiotomy in 2 (22.2%) dogs. In 4 dogs, pneumothorax was suspected to be the result of progressive leakage of capnoperitoneum through the suture bite holes of the esophageal hiatal plication sutures. Hiatal plication was performed using intracorporeal simple interrupted sutures (n = 4) or a simple continuous pattern with barbed suture (4). Esophagopexy was performed using barbed suture in all dogs. Gastropexy was performed using a total laparoscopic technique (n = 4) or laparoscopic-assisted technique (3). Using a standardized questionnaire, dog owners perceived a postoperative improvement in regurgitation after eating and regurgitation after excitement/increased activity. CLINICAL RELEVANCE Laparoscopic treatment of SHH resulted in owner-perceived improvement in clinical signs. Intraoperative pneumothorax occurred in a high proportion of dogs but did not result in long-term sequelae.

Standardization of the Simple Methodology for Experimentally Induced Ischemic Stroke in Rat Models

Stroke is a globally significant and devastating disease that requires prompt treatment. Animal models are commonly used to investigate stroke therapy, often through experimentally induced ischemic stroke (EIIS). However, challenges arise in implementing EIIS in animal models. The current study aimed to present a simple EIIS methodology for animal models. A total of 60 male Sprague-Dawley rats were randomly divided into five groups, namely Group 1 (sham-operated), Groups 2 to 5 (EIIS groups) with different duration of common carotid artery (CCA) ligation, including 1, 2, 4, and 8 hours, respectively. The ligation was performed on the CCA and its branches. Before the experiment, the rats were anesthetized, and the incision area was shaved and disinfected. The sagittal ventral midline was incised, with neck muscles retracted to expose the right CCA. The occlusion was performed on three sides of a carotid artery (common, external, and internal) using a simple interrupted suture. The occlusion of blood flow using ligation was performed at different times depending on the groups. After that, the CCA ligations were re-perfused by cutting the suture knot. The brain and blood were collected on days 1 and 7 after reperfusion. The results indicated that 4 and 8 hours of CCA ligation significantly impacted the general condition and neuro-deficit score. Moreover, 4 and 8 hours of CCA ligation could induce ischemic stroke by its capacity to cause infarction within the brain parenchyma and increase the platelet-to-white blood cell ratio, C-reactive protein, and De Ritis ratio. In contrast, 1 and 2 hours of CCA ligation did not significantly affect the observed parameters. It can be concluded that the EIIS using 4 and 8 hours of CCA ligation can be applied to induce ischemic stroke in rat models with consistent impacts on general conditions, neuro-deficit, hematology, and serology.

Assessment of suturing and scaling skills of periodontology and oral medicine residents by OSATS method: a pilot study

IntroductionUpdating the method for evaluating suturing and scaling skills in dental education has attracted relatively little attention and there is no consensus to what should be assessed and how. The purpose of this study was to investigate the applicability of the Objective Structured Assessment of Technical Skill (OSATS) method for these two basic skills, the possible association between the scores and demographic factors, and the level of satisfaction of residents with this method.MethodsAll six periodontics and three oral medicine residents were recruited by census method and video-recorded while performing a simple interrupted suture, a figure eight suture and scaling on a model. Then, the videos were evaluated independently via a checklist and a global rating scale (GRS) by two expert raters. Agreement between raters and residents’ satisfaction were evaluated. Correlation between demographic factors of participants and scores was also assessed. T-test and linear regression analysis were used.ResultsThere was no significant difference between the scores based on the views of the two raters for each of the checklist (ICC = 0.99, CI = 0.96–0.99, P < 0.001) and GRS (ICC = 0.97, CI = 0.86–0.99, P < 0.001). Linear regression showed no correlation between gender and scores but periodontics major and higher year of education showed correlation with higher scores.ConclusionConsidering the excellent agreement between raters in using both the checklist and GRS components of OSATS, and satisfaction of 88% the residents with this method, it seems to be able to provide a reliable assessment.

Biomechanical and tissue reaction: the effects of varying sutures size on canine abdominal wall stitching.

Larger diameter sutures can provide sufficient tensile strength to surgical incisions but may exacerbate the inflammatory response caused by the amount of implanted foreign material. This experiment aims to investigate the differences in biomechanical stability and tissue reactivity after suturing canine midline abdominal incisions with different suture sizes. Assessing the biomechanical differences between USP 2-0, 3-0, and 4-0 PGA sutures using uniaxial tensile testing on ex vivo canine midline skin and fascial muscle tissues using either a simple continuous or simple interrupted technique. mRNA and protein expression levels of inflammatory factors were measured through RT-PCR and ELISA. Tissue reactivity was evaluated using a semi-quantitative scoring system. For strains below 30% in skin and below 50% in muscle, there were no significant differences among groups. The results of skin biomechanical testing showed that the USP 4-0 PGA suture group demonstrated significantly lower maximum tensile strength compared to the USP 2-0 PGA or USP 3-0 PGA suture groups. However, it remained capable of providing at least 56.3 N (1.03 MPa) tensile strength for canine skin incisions, matching the tensile strength requirements of general canine abdominal wall surgical incisions. In addition, there were no statistically significant differences observed in the maximum tensile strength among different size of sutures according to the data of biomechanical testing in muscle. Larger diameter sutures led to increased levels of inflammatory factors (IL-1β, IL-6, TNF-ɑ) and tissue reactivity. Simple interrupted sutures caused higher levels of inflammatory factors in muscular tissue compared to simple continuous sutures. USP 4-0 PGA sutures provide sufficient biomechanical stability for suturing canine abdominal skin and linea alba. Suture size significantly influences tissue reactivity after suturing, with smaller gauge sutures reducing early tissue inflammatory response. Thus, USP 4-0 PGA suture has more advantages to suturing canine abdominal surgical incisions.

Feedback Versus Compliments Versus Both in Suturing and Knot Tying Simulation: A Randomized Controlled Trial

IntroductionSuturing is an expected skill for students graduating from health professions programs. Previous studies investigated student experience with teaching sessions utilizing constructive feedback versus compliments but did not investigate the combination of both. MethodsIn this parallel, randomized controlled trial, participants were divided into three groups: feedback (F), compliments (C), or feedback and compliments (FC). Participants received standardized instruction on simple interrupted suturing and two-handed knot-tying, and were videotaped performing this skill before and after the intervention. Performance was evaluated using a validated Objective Structured Assessment of Technical Skills (OSATS) instrument. Participants completed a preintervention and postintervention survey rating their task enjoyment and self-assessment of performance. Analysis was performed to determine differences between and within the groups using Kruskal–Wallis, Wilcoxon rank-sum, and Mann–Whitney U tests. ResultsA total of 31 students participated: 11 in C, 10 in F, and 10 in FC. The groups had similar preintervention OSATS scores. The F and FC groups demonstrated significant improvement in OSATS score after intervention, group C was not significantly different: F median of 11.25-19.75 points (P = 0.002); FC median of 11.75-21 points (P = 0.002); C median of 13-14 points (P = 0.2266). Between the groups FC and F both had significant performance improvement compared with C (P < 0.001 and P = 0.001 respectively). The FC group had a significantly higher rating of their enjoyment of the task on the postintervention survey compared with both the C and F groups with a median rating of 10 compared with 8 and 8 (P = 0.0052 and P = 0.0126, respectively). ConclusionsThe combination of feedback and compliments was associated with improvement in performance on suturing and knot-tying similar to the feedback-only group. The FC group rated a higher level of enjoyment of the activity compared to feedback or compliments alone.

Reinforcement of colon anastomosis healing with leukocyte platelet-rich fibrin in rabbit model

AimThis study investigated the regenerative efficacy of leukocyte platelet-rich fibrin (L-PRF) on colon anastomotic healing in rabbits. Main methodsThirty-six healthy male white New Zealand rabbits were subjected to complete transactions of the ascending colon. The rabbits were equally divided into two groups: the control group, where the transected colon ends were anastomosed by a simple interrupted suture pattern, and the L-PRF-treated group, in which L-PRF was wrapped entirely around the anastomotic line. The postoperative acute pain scale was assessed using the Bristol Rabbit Pain Scale before surgery and at each four-hour interval post-operatively. After euthanizing the rabbits, the adhesion degree score, anastomotic bursting pressure, and stenosis degree of the anastomotic colon were assessed, and histopathological examination at the 7th, 14th, and 28th days postoperatively. Key findingsRabbits in both groups showed a significant increase in pain scores compared to baseline. Postoperatively, the L-PRF group exhibited significantly lower pain scores, adhesion scores, and stenosis degrees than the control group. However, the anastomotic bursting pressure was significantly higher in the L-PRF group. Re-epithelialization, polymorphonuclear neutrophil infiltration, granulation tissue formation, and collagen deposition scores were improved considerably in the L-PRF group compared to the control group. Immunostaining of growth factor expression was significantly lower in the control than in the L-PRF group. SignificanceThe L-PRF can augment collagen deposition, re-epithelialize the mucosa, promote angiogenesis, reduce adhesions, and diminish the stenosis degree scores. Therefore, it can be considered a promising aid in healing bowel anastomoses.

Improved Confidence and Clinical Application: The Effects of a Longitudinal Suture Curriculum for Medical Students.

The ability to competently suture is an expected skill for graduating medical students, but many graduates report feeling unprepared to perform this skill. This study aimed to improve student confidence and clinical readiness for third-year clerkships by implementing a novel, mandatory 7.5-hour longitudinal suturing skills curriculum across the first 3 years of medical school. The required suturing skills curriculum was implemented for all medical students throughout the first 3 years of medical school at a large academic health center in the mid-South United States. Precurriculum (n = 167) and postcourse (n = 148) surveys were administered to first-year students in the first year of the curriculum (2017-2018), and a parallel follow-up survey was administered to this cohort in 2020 after students completed their clinical clerkship year (n = 82). Aggregate changes in students' survey responses were analyzed for proper instrument position, simple interrupted sutures, and instrument ties using independent groups Mann-Whitney U tests and Rosenthal correlation coefficients for effect sizes. Statistically significant improvement from pre to post was observed in student comfort in performing three basic skills: proper instrument position (P < 0.001), simple interrupted suture (P < 0.001), and instrument ties (P < 0.001). These pre-post gains were sustained at 2-year follow-up (P < 0.001). Also, the majority of students (66%) reported they were very or completely prepared to suture wounds during their clerkships. Most (83%) also reported they had successfully sutured patient wounds during third-year clerkships without needing significant direction or guidance. We found that a longitudinal suture curriculum with dedicated faculty involvement can improve student confidence in suturing and overall preparedness for third-year clerkships. Although the study is limited to ratings of student comfort and self-reported performance as well as some attrition of responses at postcourse survey and postclerkship survey, the findings highlight the importance of a focused curriculum dedicated to teaching basic suturing skills. Our findings also contribute to the limited body of work examining longitudinal surgical skills development for medical students.