Simple Stitch Research Articles

The Augmentation Technique for Anatomical Reduction of Shortened Lateral Ligament Complex in Modified Broström Procedure

Category:Ankle, SportsIntroduction/Purpose:The modified Broström procedure(MBP) is clinically standard surgical treatment of lateral ankle instability with or without subfibular ossicle. But if there is a large ossicle or distal malposition of lateral ligament complex(LLC), it can result in a lack of remnant ligamentous tissue and leave gap that may not be approximated. Thus, we have proposed an augmentation technique for anatomical reduction of shortened LLC in MBP and evaluated radiologic and clinical findings.Methods:From December 2013 to February 2018, fifty two of fifty six patients who had shortened LLC treated with the augmentation technique with MBP using absorbable suture material. LLC(anterior talofibular ligament(ATFL) and calcaneofibular ligament(CFL)) was exposed after inferior extensor retinaculum(IER) was incised. Then, we identified shortened LLC. Then, we incised just distal part of connecting soft tissue of ATFL and CFL additionally for reduction to anatomic footprint. After confirmation of reduction, 4 or 5 bone tunnels were made and deep fiber of LLC was repaired tightly with foot in neutral dorsiflexion and 5° eversion by using horizontal mattress and simple stitch. Then, superficial fiber with capsule of LLC was repaired by priorly tied suture without cutting. Finally, IER was reinforced.Results:Mean AOFAS scores improved from 59.2 to 91.4 at final follow-up. Mean Karlsson scores also improved from 61.3 to 89.5 at final follow-up. Mean talar tilt angles were 13.4° preoperatively and 5.8° postoperatively. Mean anterior talar translations were 9.1 mm preoperatively and 5.7 mm postoperatively. There was significant improvement between preoperative & final follow- up in all parameters (all p < .05). During follow up, no clinical symptom like experience of instability or irritation of skin were encountered after surgery, and no patient underwent revision lateral ligament surgery.Conclusion:Augmentation technique of LLC flap in MBP enabled anatomical reduction of shortened LLC to footprint, and provided good clinical and radiographic outcomes. If further comparative and mechanical study is supported, this technique would be a good treatment option.

Using simple interrupted suture anastomoses may impair translatability of experimental rodent oesophageal surgery

Background/purpose: Irreproducibility and missing translatability are major drawbacks in experimental animal studies. Hand-sewn anastomoses in oesophageal surgery are usually continuous, whereas those in experimental oesophageal surgery are widely performed using the simple interrupted technique. It has been implicated to be inferior in tolerating anastomotic tension, which we aimed to test in rats due to their importance as an animal model in oesophageal surgery.Methods: We determined linear breaking strengths for the native oesophagus (n = 10), the simple interrupted suture anastomosis (n = 11), and the simple stitch (n = 9) in 8-week old Sprague–Dawley rats. Experiments were powered to a margin of error of 10% around the results of exploratory investigations. The comparison of anastomotic resilience between native organ and simple interrupted suture anastomosis was a priori powered to 99%.Results: Native oesophagi sustained traction forces of 4.25 N (95% CI: 4.03–4.58 N), but the simple interrupted suture anastomosis had only 38.6% (Δ= −2.78 N, 95% CI: −2.46 to −3.11 N, p < .0001) of the resilience of native oesophagi.Conclusions: Oesophageal division and re-anastomosis markedly decreases resilience to traction forces compared to the native organ. This effect is even more pronounced in rats compared to other species and might impair transferability of results.

Sashiko Needlework Reborn: From Functional Technology to Decorative Art

ABSTRACTThe term ‘sashiko’ refers to a quilting stitch used to sew together layers of material. The stitch itself is a simple running stitch, with the beauty created by complex interlocking stitching patterns. In Japan there is a long-standing tradition of layering and re-stitching material to create a thicker, warmer more durable garment. This was particularly true in the poorer regions of Tohoku during the Edo and early Meiji period where the lower classes used this stitching to create and decorate garments made out of homespun hemp and other plant fibres. After first contextualising the sashiko tradition, both in terms of its Edo origins and decreasing popularity in late Meiji, this paper focuses on the contemporary rebirth of sashiko as a form of decorative embroidery, and increasingly as a pure art form. In discussing the rekindled interest in this form of stitching, in both the contemporary quilting world and in the context of the global revival of traditional handicrafts, the paper concludes with reference to the work of contemporary sashiko artists and also to the use of sashiko garments in the final film made by the great director, Akira Kurosawa, Yume.

Comparison of Bronchial Anastomotic Techniques in Lung Transplantation by 3D CT Analysis

Purpose Different techniques of bronchial anastomosis have been described for lung transplantation. The membranous portion is usually performed with continuous suture, but there is no consensus about the cartilagineous part, if interrupted or continuous. The objective of this study was to compare two different techniques of bronchial anastomosis, assessing differences in bronchial narrowing. Methods CT scans obtained three months after the surgery were subject to analysis. The cross-sectional area of the airway at the point of anastomosis was compared with an average of the cross sections of the bronchus 5mm proximal and distal to the point of anastomosis, determining the anastomotic index (AI). Data of 32 bronchi anastomosed with continuous suture from 19 patients were compared to data of 37 bronchi anastomosed with interrupted suture from 20 patients. Results Multivariate analysis showed significant difference in bronchial diameter reduction between patients subjected to the two techniques, with no difference between the two sides in any of the groups. The bronchi anastomosed with simple stitches had a significantly larger AI than those anastomosed with running suture (mean AI 0.98 vs 0.82, p<0.001). A significantly larger number of bronchi subjected to this method had an AI greater than 1 comparing to bronchi anastomosed with a running suture (13 vs 1, p<0.001). Conclusion The use of simple stitches to join the anterior bronchial wall surpasses a running suture in terms of bronchial narrowing. The interrupted suture technique seems to result in a mechanical widening at the point of anastomosis. Different techniques of bronchial anastomosis have been described for lung transplantation. The membranous portion is usually performed with continuous suture, but there is no consensus about the cartilagineous part, if interrupted or continuous. The objective of this study was to compare two different techniques of bronchial anastomosis, assessing differences in bronchial narrowing. CT scans obtained three months after the surgery were subject to analysis. The cross-sectional area of the airway at the point of anastomosis was compared with an average of the cross sections of the bronchus 5mm proximal and distal to the point of anastomosis, determining the anastomotic index (AI). Data of 32 bronchi anastomosed with continuous suture from 19 patients were compared to data of 37 bronchi anastomosed with interrupted suture from 20 patients. Multivariate analysis showed significant difference in bronchial diameter reduction between patients subjected to the two techniques, with no difference between the two sides in any of the groups. The bronchi anastomosed with simple stitches had a significantly larger AI than those anastomosed with running suture (mean AI 0.98 vs 0.82, p<0.001). A significantly larger number of bronchi subjected to this method had an AI greater than 1 comparing to bronchi anastomosed with a running suture (13 vs 1, p<0.001). The use of simple stitches to join the anterior bronchial wall surpasses a running suture in terms of bronchial narrowing. The interrupted suture technique seems to result in a mechanical widening at the point of anastomosis.

Esophageal Biomechanics Revisited: A Tale of Tenacity, Anastomoses, and Suture Bite Lengths in Swine

Anastomotic tension has repeatedly been associated with anastomotic leakages after esophagectomy for cancer or esophageal atresia repair. We therefore aimed to determine which anastomotic technique would come as close as possible to the native esophagus in sustaining traction forces. Constant traction for several minutes at esophageal remnants and large suture bites are also considered relevant in long-gap esophageal atresia repair. Porcine esophagi were subjected to linear traction using a motorized horizontal test stand. We compared breaking strengths of native esophagi to simple continuous, simple interrupted, stapled, and barbed suture anastomoses. We also investigated the effects of suture bite length and phases of constant traction on breaking strengths and powered all experiments to at least 80% using exploratory investigations (n= 5 per group). Continuous suture anastomoses had a breaking strength comparable to native esophagi (Δ=-5.25 Newton, 95% confidence interval:-10.69 to 0.19 Newton, p= 0.058) and outperformed all other investigated anastomoses (Δ ≥14.01 Newton, p ≤ 0.02). Breaking strength correlated with suture bite length (R= 0.905) and predicted breaking strength for the simple stitch (adjusted R2= 0.812, p < 0.0001), but not for anastomoses. Phases of incrementally increasing constant traction resulted in higher breaking strengths (Δ= 13.36 Newton, 95% confidence interval: 9.93 to 16.79 Newton, p< 0.0001) and higher length gain (Δ= 1.06 cm, 95% confidence interval: 0.65 to 1.48 cm, p < 0.0001) compared with controls. Only simple continuous anastomoses achieved the linear breaking strength of native tissue. Our study provides important insights in tolerance to traction forces, but its results have to be corroborated in living animals as anastomotic leakages are multifactorial processes.

Comparison of Clinical and Radiographic Outcomes of Vertical Simple Stitch Versus Modified Mason-Allen Stitch in Arthroscopic Bankart Repairs: A Prospective Randomized Controlled Study

Background: In spite of the probable advantages of Bankart repair with modified Mason-Allen technique, there has been no study to evaluate the clinical outcomes of the modified Mason-Allen technique for Bankart repair. Purpose: To prospectively compare the anatomic and clinical outcomes between the vertical simple stitch and the modified Mason-Allen stitch with respect to the labral height, retear rate, redislocation/apprehension, and various functional outcome scores. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients who underwent arthroscopic Bankart repair with double-loaded suture anchors were randomly allocated to 1 of 2 groups: the vertical simple stitch method (SS; n = 45) or the Bankart repair using modified Mason-Allen technique (BRUMA; n = 41). All patients underwent computed tomography arthrography at 6 months postoperatively and various functional outcome measurements at least 2 years postoperatively. The labral height and width at the 3-, 4-, and 5-o’clock positions were measured preoperatively and at 6 months after surgery on axial computed tomography arthrography; the redislocation/apprehension rate, the retear rate, and various functional outcome scores were evaluated at each follow-up visit. Results: Postoperative labral height and width were significantly increased at all locations (all P < .001) in both groups, but they were not statistically different between groups (all P > .05). Two patients in the SS group (4.4%) and 2 in the BRUMA group (4.9%) experienced redislocation after surgery, and 4 patients in the SS group (8.9%) and 2 in the BRUMA group (4.9%) group showed apprehension after surgery. Additionally, 5 patients in the SS group (11.1%) and 2 in the BRUMA group (4.9%) showed retear at 6 months (P = .239). There were no differences in any functional outcome scores (all P > .05). Conclusion: There was no difference in the radiologic outcomes at 6 months and the clinical outcomes assessed at least 2 years after surgery between the groups.

Healing Rates and Functional Outcomes After Triple-Loaded Single-Row Versus Transosseous-Equivalent Double-Row Rotator Cuff Tendon Repair.

Background:Although healing rates and outcomes of arthroscopic single-row rotator cuff repairs have been compared with double-row repairs, none have utilized triple-loaded anchors.Purpose:To compare healing and function after single-row repairs with triple-loaded anchors versus double-row repairs with a suture-bridge technique.Study Design:Cohort study; Level of evidence, 3.Methods:A single surgeon performed arthroscopic rotator cuff repair on 47 consecutive patients with an easily reducible full-thickness rotator cuff tear of medium size (1-3 cm). A retrospective cohort study was performed in which the first 25 patients underwent repair with a double-row suture-bridge (DRSB) technique. The next 22 patients underwent repair with a single-row technique with triple-loaded anchors and simple stitches (SRTL) after a change in technique by the surgeon. Twenty-one DRSB and 18 SRTL repairs were evaluated preoperatively and at a minimum of 12 months postoperatively with a visual analog scale for pain, the American Shoulder and Elbow Surgeons form, and the Simple Shoulder Test. Healing was evaluated with magnetic resonance imaging at a minimum of 12 months.Results:When DRSB repairs were compared with SRTL repairs, there were no significant differences in patient age (61 vs 65 years), tear size (2.3 vs 2.1 in the sagittal plane; 2.0 vs 1.8 cm in the coronal plane), Goutallier fatty infiltration (supraspinatus grade: stage 0, 38%; stage 1, 38%; stage 2, 19%; stage 3, 5%; vs stage 0, 56%; stage 1, 39%; stage 2, 5%; stage 3, 0%), tendon healing (71% vs 78%), improvement in visual analog scale pain score (3.7 vs 3.2), or improvement in American Shoulder and Elbow Surgeons scores (34.6 vs 36.9), with P > .05 in all cases. SRTL repairs had significantly greater improvement in Simple Shoulder Test scores versus DRSB repairs (6.6 vs 4.5; P = .03).Conclusion:DRSB and SRTL repairs have similar improvements in pain and function with equivalent healing rates for arthroscopic repair of mobile full-thickness rotator cuff tears of medium size (1-3 cm).

A comparison of two bronchial anastomotic techniques in lung transplantation by means of tridimensional tomographic analysis:

Background: The objective of this study was to compare two different techniques of bronchial anastomosis in lungtransplant, assessing differences in bronchial narrowing post-surgery.Methods: The surgical team at our center switched between simple stitches to continuous suture to anastomose the anterior bronchial wall in lung transplant procedures. CT scans of the patients obtained three months after the surgery were subject to analysis. The cross section area of the airway at the point of anastomosis was compared with an average of the cross sections of the bronchus 5mm proximal and distal to the point of anastomosis, determining the anastomotic index (AI). Data of 32 bronchi anastomosed with continuous suture from 19 patients were compared to data of 37 bronchi anastomosedwith interrupted suture from 20 patients.Results: Multivariate analysis showed significant difference in bronchial diameter reduction between patients subjected to the two techniques, with no difference between the two sides in any of the groups. The bronchi anastomosed with simple stitches had a significantly larger AI than those anastomosed with running suture (mean AI 0.98 vs 0.82, p &lt; 0.001). A significantly larger number of bronchi subjected to this method had their AI greater than 1 comparing to bronchi anastomosed with a running suture (13 vs 1, p &lt; 0.001).Discussion: The use of simple stitches to join the anterior bronchial wall surpasses a running suture in terms of bronchial narrowing. The interrupted suture technique seems to result in a mechanical widening at the point of anastomosis.

A comparative study of using Kessler Suture Pattern versus Polypropylene meshes implantation to repair Tenotomized Achilles tendon in bucks

The aim of the current study was to compare the efficacy of Kessler suture pattern and polypropylene meshes implantation to repair severed Achilles tendons in bucks. For this purpos 16 local adult bucks, weighing 30-35kg were used and equally distributed into two groups, the first group: (control group) and the second group (mesh group). Animals were sedated with xylazine 2% and anesthetized locally with lidocaine hydrochloride 2% infiltrated subcutaneously. Skin incision approximately 5 cm. in length was made over the Achilles tendon. The tendon was isolated by blunt dissection from the underlying tissue, then the left Achilles tendon was transected in its mid portion. In the control group, tenorrhaphy of Achilles tendons were immediately performed by using Kessler suture technique using (polypropylene No. 1). In the second group, a polypropylene mesh was wrapped around the cut ends and fixed to the tendon by simple interrupted stitches of polypropylene thread (No.1). Then skin was sutured by interrupted horizontal mattress using silk No.1. Finally plaster of Paris with window was applied. The skin stitches were removed after 10 days. The clinical signs of all animals showed severe lameness during the first three weeks with no significant differences between the two groups. Lameness reflected significant differences (P&lt;0.05) between groups with the progress of postoperative duration (i.e., starting from 4th week). Rapid absence of lameness was more observed in second group (at 4th week) than in first group (at 6th week). At two months post-operative, a higher percentage (100%) was recorded in first group. While a lower percentage (25%) was showed in the second group. Microscopical examination at two month post-suturing revealed proliferation of fibrous connective tissue around suture materials infiltrated by inflammatory cells, in addition to necrotic tissue attachment to the tendon. In mesh implantation and at the same time there were granulations tissues surrounding the narrow mesh holes with tendon fibers expressed proliferation of tenocytes. At four months, first group revealed few blood vessels, and thickened collagen fibers with mononuclear cells infiltration in cut tendon fibers. In mesh implantation the tendon was retained to its nearly normal structure with few (MNCs) in epitenon. It seemed that both groups gave best outcome in healing of operated tendons with superiority of the second group in comparison with the first group.

Can Genipin-coated Sutures Deliver a Collagen Crosslinking Agent to Improve Suture Pullout in Degenerated Tendon? An Ex Vivo Animal Study.

BackgroundThe suture-tendon interface is often the weakest link in tendon-to-tendon or tendon-to-bone repair. Genipin is an exogenous collagen crosslink agent derived from the gardenia fruit that can enhance suture force to failure of the tendon-suture interface. Viable methods for intraoperative clinical delivery of genipin could be of clinical utility, but to our knowledge have not yet been extensively studied.Questions/purposesThe purposes of this study were (1) to evaluate whether sutures precoated with genipin can augment the suture-tendon interface to improve force to failure, stiffness, and work to failure in healthy and degenerated tendons; and (2) to determine the effect of genipin on the extent and distribution of crosslinking.MethodsSingle-stitch suture pullout tests were performed ex vivo on 25 bovine superficial digital flexor tendons. To assess effects on native tissue, one group of 12 tendons was cut in proximal and distal halves and randomized to treatment (n = 12) and control groups (n = 12) in a matched-pair design. One simple stitch with a loop with either a normal suture or genipin-coated suture was applied to tendons in both groups. To simulate a degenerative tendon condition, a second group of 13 tendons was cut in proximal and distal halves, injected with 0.2 mL of collagenase D (8 mg/mL) and incubated for 24 hours before suturing with either a genipin-coated suture (n = 13) or their matched controls (n = 13). Sutures from all groups then were loaded to failure on a universal materials testing machine 24 hours after suturing. Suture pullout force, stiffness, and work to failure were calculated from force-displacement data and compared between the groups. Additionally, fluorescence was measured to determine the degree of crosslinking quantitatively and a qualitative analysis of the distribution pattern was performed by microscopy.ResultsIn healthy tendon pairs, the median maximum pullout force was greater with genipin-coated sutures than with control sutures (median, 42 N [range, 24–73 N] versus 29 N [range, 13–48 N]; difference of medians, 13 N; p = 0.003) with corresponding increases in the required work to failure (median, 275 mJ [range, 48–369 mJ] versus 148 mJ [range, 83–369 mJ]; difference of medians, 127 mJ; p = 0.025) but not stiffness (median, 4.1 N/mm [range, 2.3–8.1 N/mm] versus 3.3 N/mm [range, 1.1–9.6 N/mm]; difference of medians, 0.8 N/mm; p = 0.052). In degenerated tendons, median maximum pullout force was greater with genipin-coated sutures than with control sutures (median, 16 N [range, 9-36 N] versus 13 N [range, 5-28 N]; difference of medians, 3 N; p = 0.034) with no differences in work to failure (median, 75 mJ [range, 11–249 mJ] versus 53 mJ [range, 14–143 mJ]; difference of medians, 22 mJ; p = 0.636) or stiffness (median, 1.9 N/mm [range, 0.7–13.4 N/mm] versus 1.6 N/mm [range, 0.5–5.6 N/mm]; difference of medians, 0.3 N/mm; p = 0.285). Fluorescence was higher in tendons treated with genipin-coated sutures compared with the control group, whereas higher fluorescence was observed in the treated healthy compared with the degenerated tendons (difference of means -3.16; standard error 1.08; 95% confidence interval [CI], 0.97–5.34; p = 0.006/healthy genipin: mean 13.04; standard error 0.78; 95% CI, 11.47-14.62; p < 0.001/degenerated genipin: mean 9.88; SD 0.75; 95% CI, 8.34-11.40; p < 0.001).ConclusionsGenipin-coated sutures improved force to failure of a simple stitch at the tendon-suture interface in healthy and degenerated tendons in an ex vivo animal model. Fluorescence was higher in tendons treated with genipin-coated sutures compared with the control group.Clinical RelevanceA genipin-coated suture represents a potential delivery vehicle for exogenous crosslink agents to augment suture retention properties. In vivo animal studies are the next logical step to assess safety and efficacy of the approach.

A method using simple stitches around the safety margin for hemostasis in scalp surgery

A method using simple stitches around the safety margin for hemostasis in scalp surgery

Three single loops enhance the biomechanical behavior of the transtibial pull-out technique for posterior meniscal root repair.

To investigate the effect of applying an additional suture to enhance the biomechanical behavior of the suture-meniscus construct used during the transtibial pull-out repair technique. A total of 20 fresh-frozen porcine tibiae with intact medial menisci were used. In one half of all specimens (N=10), two non-absorbable sutures were passed directly over the meniscal root from the tibia side of the meniscus to the femoral side (2SS). In other ten specimens, three sutures were passed over the meniscal root (3SS). All specimens were subjected to cyclic loading followed by load-to-failure testing. Displacement of the construct was recorded at 100, 500, and 1000 cycles. Further, stiffness (500-1000 cycles) and ultimate load and modes of failure of the suture-meniscus construct were also recorded. There was no statistically significant difference between the Group 2SS and Group 3SS at the 1st (1.6±0.7 vs 1.4±0.4mm) and the 100th cycle (2±0.7 vs 1.8±0.4mm). At 500 and 1000 cycles, the 2SS fixation technique resulted in significantly more displacement than the 3SS fixation technique (2.8±0.6 vs 2.3±0.5mm; 3.1±0.7 vs 2.5±0.5mm) (p<0.05). No differences between two groups were noted concerning ultimate load to failure and stiffness (500-1000 cycles). Three single sutures technique provided superior biomechanical properties compared with the two single sutures technique during the conducted fatigue tests. Applying three simple stitches during meniscal root repair might be beneficial for healing of the posterior meniscal root, potentially reducing the post-operative immobilization time.

Hernioplasty with polypropylene implant after an abdominal trauma of a pregnant cat

The incidence of accidents with cats and its consequences on the health of these animals have been reported frequently in the literature. The abdominal hernia is an example of a condition developed as a result of trauma. Abdominal hernia is a defect of the inner wall of the abdomen that can allow part of the abdominal contents to protrude. In this case report, a pregnant cat has developed an abdominal hernia after disappearing for a week. The animal was clinically well, but the abdominal volume was considerable. Surgical intervention was necessary as soon as possible, because it was an irreducible hernia. A significant amount of devitalized muscle tissue and fragile tissue were observed. Because of the abdominal necrosis, there was no possibility to perform conventional suturing technique in the abdominal wall to correct the hernia. It was necessary to apply a polypropylene mesh implant, which is anchored by means of simple interrupted stitches. Besides hernioplasty, a lumpectomy and ovariohysterectomy were performed due to the presence of a suppurative inflammation of the mammary glands and fetal maceration in the uterus. The review of the patient, after 10 days, revealed no signs of infection of the surgical wound and the implant remained stable. The patient continued feeding and drinking water normally. The goal of this study is to describe the surgical technique of hernia repair using polypropylene implant in a cat that has lost approximately 50% of the abdominal muscle tissue caused by an abdominal trauma.

Repair of the Anterolateral Structures in the Acutely Injured Anterior Cruciate Ligament

Repair of the acutely injured anterolateral complex is a surgical procedure justified by biomechanical studies, surgical findings, and clinical results. In a lack of specific radiological protocols able to reliably detect such injuries, indications are still related to the degree of pivot test, as evaluated preoperatively under anesthesia (explosive pivot shift). Repair techniques, to be always performed along with an anterior cruciate ligament reconstruction, are simple procedures strictly related to the type of injury. In type I and II tears, when a clear stretching is encountered (limited to the anterolateral capsule and ligament or extended toward the posterolateral capsule), repair consists of retensioning the capsule by means of plicating it with simple stitches. In type III tears, when a complete rupture of the capsule is found, an end-to-end suture is performed, possibly reproducing native tension. In type IV tears (bony avulsion, Segond fracture), repair is performed using periosteal stitches, suture anchors, or cancellous bone screws, according to the size of the fragment. In selected cases of generalized hyperlaxity or when a severely damaged tissue is found, augmentation with fascia lata or other autologous or allogenic grafts could be considered. Old prejudices about the possible complications of extra-articular procedures associated with intra-articular anterior cruciate ligament reconstructions for overconstraint, reduced range of motion, and higher rate of degenerative osteoarthritis seem to be overtaken, when modern surgical and rehabilitative procedure are used.

The lasso-loop, lasso-mattress and simple-cinch stitch for arthroscopic rotator cuff repair: are there biomechanical differences?

Various stitching techniques have been described to facilitate arthroscopic repair of rotator cuff tears. The aim of the present study was to compare the biomechanical properties of the lasso-loop, lasso-mattress and simple-cinch stitch for rotator cuff repair. Twelve infraspinatus tendons were harvested from sheep and split in half. The tendons were randomized into three different stitch configuration groups for biomechanical testing: lasso-loop, lasso-mattress and simple-cinch stitch. Each specimen was first cyclically loaded on a universal materials testing machine under force control from 5 to 30N at 0.25Hz for twenty cycles. Then, each specimen was loaded to failure under displacement control at a rate of 1mm/s. Cyclic elongation, peak-to-peak displacement and ultimate tensile load were reported as mean±standard error and compared using one way analysis of variance. The type of failure was recorded. No differences in cyclic elongation (1.31±0.09mm for the simple-cinch vs. 1.49±0.07mm for the lasso-mattress vs. 1.61±0.09mm for the lasso-loop stitch, p=0.063) or peak-to-peak displacement (0.58±0.04mm for the simple-cinch, 0.50±0.03mm for the lasso-mattress and 0.62±0.06mm for the lasso-loop stitch, p=0.141) were seen between all tested stitch configurations. In the load-to-failure test, the simple cinch stitch (149.38±11.89N) and the lasso-mattress (149.38±10.33N) stitch demonstrated significantly higher ultimate load than the lasso-loop stitch (65.88±4.75N, p<0.001). All stitch configurations failed with suture pull out. The lasso-mattress and the simple-cinch stitch showed similar biomechanical properties with significant higher tensile loads needed for failure than the lasso-loop stitch.

FACTORS INFLUENCING THE OPERATION TECHNIQUE OF PEFORATED DUODENAL ULCER REPAIR BY SINGLEPORT LAPAROSCOPIC SURGERY

Background: Single-port laparoscopic surgery (SPLS) is increasingly used in surgery and in the treatment of perforated duodenal ulcer. The aim of this study was to evaluate technical factors for perforated duodenal ulcer repair by SPLS. Methods: A prospective study on 42 consecutive patients diagnosed with perforated duodenal ulcer and treated with SPLS at Hue university of medicine and pharmacy hospital and Hue central hospital from January 2012 to February 2015. Results: The mean age was 48.1 ± 14.2 (17 - 79) years. 40 patients were treated with suture of the perforation by pure SPLS. There was one case (2.4%) in which one additional trocar was required. Conversion to open surgery was necessary in one patient (2.4%) in which the perforation was situated on the posterior duodenal wall. Two patients (4.8%) with history of abdominal surgery were successfully treated by pure SPLS. The size of perforation was correlated with suturing time (correlation coefficient r = 0.459) and operative time (correlation coefficient r = 0.528). Considering suture type, X stitches were used in 95.5% cases, simple stitches were used in one case (2.4%) while Graham patch repair technique was utilized in one case (2.4%) with large perforation. Most cases (95.1%) required only simple suture without omental patch. Peritoneal drainage was spared in most cases (90.2%). Conclusions: SPLS is a safe method for the treatment of perforated duodenal ulcer. Posterior duodenal location is the main cause of conversion to open surgery. Factor related to operative time is perforation size. Key words: perforated duodenal ulcer, single port laparoscopic repair, single port laparoscopy

Biomechanical evaluation of the simple cinch stitch for arthroscopic rotator cuff repair

BackgroundThe tissue-suture interface is described as the most vulnerable and susceptible area in the muscle–tendon–bone construction of arthroscopic rotator cuff repair. Various stitching techniques have been described to enhance the strength, fixation and stability of the repair, but technical and biomechanical challenges remain.Purpose was to examine the biomechanical properties of the simple cinch stitch in comparison to other stitches commonly used for rotator cuff repair. MethodsInfraspinatus tendons were harvested from sheep and split in half. The tendons were randomized into five different stitch configuration groups for biomechanical testing: simple stitch; horizontal stitch; FiberChain®; simple cinch stitch; and modified Mason-Allen stitch. Each specimen was first cyclically loaded on a universal materials testing machine under force control from 5 to 30N at 0.25Hz for twenty cycles. Then, each specimen was loaded to failure under displacement control at a rate of 1mm/s. Cyclic elongation, peak-to-peak displacement and ultimate tensile load were measured. The type of failure was recorded. FindingsNo differences in cyclic elongation or peak-to-peak displacement were seen between stitch configurations. In the load-to-failure test, the simple cinch stitch demonstrated significantly higher ultimate load than the simple and the horizontal stitch configurations. The comparison to the FiberChain® Suture revealed no statistical significant differences.The FiberChain® Suture demonstrated significantly higher ultimate load than the simple stitch. No statistical significance could be demonstrated in comparison to the horizontal stitch or the simple cinch stitch.The ultimate tensile load of the modified Mason-Allen stitch was significantly higher than that of the other stitch configurations. InterpretationThe simple cinch stitch has an ultimate tensile load comparable to the FiberChain® suture and is superior to the simple stitch and the horizontal stitch. The major advantage of the simple cinch technique is that it is possible to perform the stitch entirely arthroscopically, without the need to perforate the tissue a second time or to use special suture materials. Study designControlled laboratory study.

Tendon Collagen Crosslinking Offers Potential to Improve Suture Pullout in Rotator Cuff Repair: An Ex Vivo Sheep Study.

The suture-tendon interface is often the weakest link in tendon to bone repair of massive rotator cuff tears. Genipin is a low-toxicity collagen crosslinker derived from the gardenia fruit that has been shown to augment collagen tissue strength and mechanically arrest tendon-tear progression. The purpose of the current study was to evaluate whether genipin crosslinking can sufficiently augment the suture-tendon interface to improve suture pullout strength using simple single-loop sutures and the modified Mason-Allen technique. The study also aimed to assess whether time of genipin treatment is a relevant factor in efficacy. In an ex vivo (cadaveric) sheep rotator cuff tendon model, a total of 142 suture pullout tests were performed on 32 infraspinatus tendons. Each tendon was prepared with three single-loop stitches. Two groups were pretreated by incubation in genipin solution for either 4 hours or 24 hours. Two corresponding control groups were incubated in phosphate buffered saline for the same periods. The same test protocol was applied to tendons using modified Mason-Allen technique stitch patterns. Each suture was loaded to failure on a universal materials testing machine. Suture pullout force, stiffness, and work to failure were calculated from force-displacement data, and then compared among the groups. Median single-loop pullout force on tendons incubated for 24 hours in genipin yielded an approximately 30% increase in maximum pullout force for single-loop stitches with a median of 73 N (range, 56-114 N) compared with 56 N (range, 40-69 N; difference of medians = 17 N; p = 0.028), with corresponding increases in the required work to failure but not stiffness. Genipin treatment for 4 hours showed no added benefit for suture-pullout behavior (46 N, [range, 35-95 N] versus 45 N, [range, 28-63 N]; difference of medians, 1 N; p = 1). No tested genipin crosslinking conditions indicated benefit for tendons grasped using the modified Mason-Allen technique after 4 hours (162 N, [range, 143-193 N] versus 140 N, [range, 129-151 N]; difference of medians, 22 N; p = 0.114) or after 24 hours of crosslinking (172 N, [range, 42-183 N] versus 164 N [range, 151-180 N]; difference of medians, 8 N; p = 0.886). Exogenous collagen crosslinking in genipin can markedly improve resistance to pullout at the tendon-suture interface for simple stitch patterns while the modified Mason-Allen stitch showed no benefit in an ex vivo animal model. Tendon strength augmentation by genipin pretreatment offers the potential to improve suture retention properties. Future studies are warranted for the development of clinically viable intraoperative delivery strategies and in vivo testing for safety and efficacy.

Pinealectomia em ratas Wistar (Rattus norvegicus albinus): descrição de um novo método cirúrgico

A necessidade de manejo adequado antes, durante e após a implementação de procedimentos em animais de laboratório é essencial para proporcionar bem-estar. Portanto, no presente trabalho, objetivou-se padronizar uma nova técnica de pinealectomia em ratas Wistar. Trinta fêmeas nulíparas aos 90 dias de idade foram submetidas à anestesia dissociativa. Após a tricotomia e a assepsia, realizou-se uma incisão na linha média dorsal da cabeça. Com um micromotor e uma broca de aço PM 03, realizou-se a craniotomia; a glândula pineal foi removida por intermédio de um fórceps cápsula arruga. Em seguida, o fragmento ósseo foi recolocado em seu lugar de origem, e a pele aproximada por pontos simples. Finalizado o procedimento cirúrgico, foi realizada antibioticoterapia e soroterapia parenteral. O acompanhamento diário dos animais não evidenciou nenhum comprometimento da ferida operatória com padrão de cicatrização por primeira intenção. Os animais apresentaram normalidade de atos fisiológicos, como alimentação, defecação e micção, assim como socialização com o grupo. Técnicas cirúrgicas vêm sendo realizadas com o desenvolvimento das pesquisas envolvendo a glândula pineal. A técnica ideal para pinealectomia consiste no pouco sangramento, na curta duração da cirurgia e na nitidez da glândula pineal, diminuindo a probabilidade de acidentes neurológicos. Considerando-se os resultados obtidos ao longo do desenvolvimento experimental e clínico, o aprimoramento da técnica cirúrgica utilizando a broca PM03 associada ao fórceps cápsula arruga foi exímio na pesquisa científica da pinealectomia de ratas Wistar em virtude da rapidez e praticidade alcançadas. Tem-se a perspectiva de que este artigo sirva de subsídio para o aprimoramento e a otimização do modelo experimental para posteriores estudos acerca de pesquisas com a glândula pineal e, assim, maior compreensão de sua complexidade sobre todos os sistemas do organismo.

Arthroscopic Medial Meniscus Posterior Root Fixation Using a Modified Mason-Allen Stitch

A complete radial tear of the meniscus posterior root, which can effectively cause a state of total meniscectomy via loss of hoop tension, requires that the torn root be repaired. Several methods have been used to repair medial meniscus posterior root tears, most of which are based on a simple stitch technique that is known to have stitch-holding strength. We applied a modified version of the Mason-Allen stitch technique, which is recognized as a method for rotator cuff repair surgery because its locking effect overcomes the potential weakness of simple stitches. This article introduces the medial meniscus posterior root tears repair procedure based on a modified Mason-Allen stitch technique in which 2 strands (i.e., 1 simple horizontal and 1 simple vertical stitch) are used.