Special Suture Research Articles

Arthroscopic evaluation and treatment of the rotator cuff and superior labrum anterior posterior lesion

This report will review in detail the recent technical advancements for the arthroscopic evaluation and treatment of rotator cuff tears and superior labrum anterior posterior (SLAP) lesions. Proper techniques of arthroscopic diagnosis of rotator cuff tears including glenohumeral arthroscopy, subacromial bursoscopy, portal establishment, bursal entry technique, suture marker placement, arthroscopic classification of cuff tears, and the modified classification of the arch view will be presented. The principles of management for “small partial,” “significant partial,” “full thickness,” and “massive” tears will be discussed. The mini-lateral deltoid splitting approach, the Southern California Orthopedic Institute suture technique, the preparation of the greater tuberosity, and special suture passing techniques will be presented. In addition, the etiology, diagnosis, classification, and arthroscopic treatment of SLAP lesions will be reviewed in detail.

A Simple Device for Laser Suture Lysis After Trabeculectomy

To the Editor. —The recent trend in trabeculectomy is to suture the scleral flap rather tightly to prevent immediate postoperative hypotony. 1 If intraocular pressure is not reduced to the desired level, then one or more of the flap sutures are selectively cut using the argon or krypton laser within the first week after surgery to improve filtration. Quite often, however, the fine sutures used to close the scleral flap (usually 10-0 monofilament nylon) are difficult to visualize through the conjunctiva (Fig 1). This necessitates the use of special lenses to press the conjunctiva against the sclera so that the sutures become visible. The Zeiss gonioprism 1 and the special suture lysis lens described by Hoskins and Migliazzo 2 are two such devices that have been recommended. I describe herein the use of a disposable glass pipette, the Micro/Pipettor (Scientific Manufacturing Industries Inc, Berkeley, Calif) (Fig 2), which is readily

Nerve regeneration following primary repair.

In nine selected cases a primary nerve repair was done. In all these patients a special suture was used. Applying clinical and neurophysiological tests, regeneration of the motor and sensory nerve fibres was followed for two years. A remarkable difference in growth rates of sensory and motor nerve fibres was observed. The average rate of growth of sensory nerve fibres was 5 mm a day, and of motor nerve fibres it was 1.7 mm a day. At the end of a two years' interval after operation, good recovery from the initial muscular atrophy was observed in all but two cases. Function of previously denervated muscles was nearly normal. Discrimination of points 4-10 mm apart was possible. Normal terminal conduction times along motor nerve fibres were found in five cases. Slightly prolonged times were found in four. Calculated conduction velocities in sensory nerve fibres were half to three quarters of normal times. All patients resumed their previous occupations.

The true incidence of silent rupture of cesarean section scars: A prospective analysis of 403 cases

1.1. Four hundred three consecutive repeat cesarean sections in patients with 482 scars have been reviewed. There were 48 ruptures, of which 22 were in previous transverse incisions, 20 in vertical incisions, and 6 in classical. The incidence of rupture in transverse scar was 8.3 per cent, in vertical 12.9 per cent, and in classical 18.2 per cent.2.2. The two most important factors for evaluating scar potentiality, namely, surgical technique and healing power of the patient, cannot be ascertained from all available data.3.3. An afebrile postoperative course does not guarantee a good scar, nor a febrile course indicate a poor scar.4.4. Most defective scars develop during the puerperium of the previous pregnancy, and are accentuated by the present pregnancy.5.5. The operative record should include the number of special sutures required for hemostasis. This may serve as an aid in evaluating the integrity of the scar in future pregnancies.6.6. Symptomatic rupture of a previous scar during pregnancy almost invariably occurs in the classical type of incision. Lower segment scars rarely produce symptomatic rupture prior to labor.7.7. Elimination of the classical incision will minimize the occurrence of symptomatic rupture prior to the anticipated date of repeat section.8.8. There is no means of predicting accurately the behavior of a uterine scar during the course of a subsequent pregnancy.