Suture Knot Research Articles

A Prospective Randomized Controlled Study of Stratafix versus Standard-of-Care for Deep Tissue Closure in Orthopedic Surgery.

Orthopedic deep surgical incisions require the approximation of 1 or multiple tissue layers. This prospective randomized controlled study aimed to assess the usefulness and effectiveness of a barbed suture technique (Stratafix symmetric PDS plus) versus the conventional interrupted knotted suture technique for deep tissue closure in orthopedic surgery by comparing deep fascia suture time, relative cost, and wound-related complications. A total of 254 patients with deep surgical incisions who underwent orthopedic surgery between October 1, 2020, and June 30, 2021, were recruited. Their general characteristics (age, sex, weight, height, body mass index, American Society of Anesthesiologists physical status score, total operation time, and length of deep incision) and factors related to deep incision wounds (suture type and number, wound closure time, and operation site outcomes) were collected. The general characteristics did not differ between the Stratafix and conventional groups. There were no between-group differences observed in total operation time or total anesthesia time. The wound suture times differed significantly. In the conventional group, the suture time per unit length was lower in the group with the length of deep incision under 20 cm but did not differ significantly for each wound size. In the Stratafix group, the suture time per unit length was lower in the group under 15 cm, with the shortest time observed for 10-14.9 cm, followed by 5.0-9.9 cm and the group under 5 cm. The conventional group developed 4 cases of superficial wound infection or surgical wound necrosis. One case of protruded suture tap occurred in the Stratafix group. The average suture time per unit length increased for lengths under 5 cm as barbed sutures required more time from the start of the first suture to finish of the last suture. There was no significant benefit for very short suture length. One barbed suture material allows a suture of approximately 10-12 cm; sutures beyond that require more time because the surgeon has to start again. The Stratafix group used less suture material than the conventional group.

A novel 4-point scleral fixation technique with a hydrophobic IOL: The LOTO technique.

to describe a new surgical technique that combines 4-point, flanged polypropylene scleral fixation with a hydrophobic IOL. Using the Envista MX60 and 6.0 polypropylene, scleral 4-point fixation was achieved using a flanged-suture technique 5 times in a model eye and in a case series of 8 patients, retrospectively reviewed. The polypropylene is passed through each eyelet in a novel configuration (LOTO: Loop to Optic and Trailing ends to Outside). Conjunctival peritomies, scleral flaps/pockets, glue, and suture knots are avoided. The load needed for haptic fracture and scanning electron microscopy (SEM) at fracture sites were studied. Haptic fracture occurred once following the first model eye implantation due to excessive suture tension. The fracture load was similar between the LOTO and the simple-pass technique (1.08 ± 0.52 N vs 1.09 ± 0.32 N), suggesting no safety compromise. SEM did not disclose cheese-wiring effect. Over a mean follow-up of 10.8 months (range: 3 to 19; median 11.5 months), all cases experienced visual improvement with best-achieved-postoperative uncorrected visual acuity (BAPUCVA) of 20/25-20/200, and the IOL was well-centered. Postoperative IOL tilt averaged 2.9 degrees (range: 0 to 9.6; median: 2.9 degrees). Two patients developed post-operative CME treated topically. The first case developed flange extrusion that was readily repaired in clinic. This novel technique adds 2 main advantages to previously described flanged-suture techniques: 1) 4-point fixation of a hydrophobic IOL and 2) immediate application at the time of initial complicated cataract surgery since it requires no additional supply, IOL, or instrumentation.

Green Guidewire Combined with Epidural Needle-Saline Separating Minimize Invasiveness and Optimize Outcomes in Single-Port Laparoscopic Treatment for Pediatric Inguinal Hernia.

Objective: To investigate the application value, feasibility, and safety of modified single-port laparoscopic surgery in the treatment of pediatric inguinal hernia. Methods: One hundred and twenty cases of children with indirect inguinal hernia admitted from 2017 to 2022 were enrolled in the Control and Observation groups, with 80 and 40 cases, respectively. They underwent traditional open high ligation of the hernia sac and modified single-port laparoscopic high ligation of the hernia sac, respectively. The operation duration, surgical incision size, intraoperative bleeding, postoperative hospital stay, first ambulation time, and hospitalization expenses were compared between the two groups, as well as the incidence of surgical complications in the two groups. Results: The surgical incision size, intraoperative bleeding, postoperative hospital stay, and first ambulation time of the Observation group were less than those of the Control group. There was no significant difference in operation duration or hospitalization expenses between the two groups. Only two cases in the Observation group showed suture knot reactions after surgery, with no incision infection, inguinal hematoma, iatrogenic cryptorchidism, etc. The overall incidence of complications in the Observation group was lower than that of the Control group. Conclusion: Modified single-port laparoscopic surgery for inguinal hernia in children has the advantages of minimal invasiveness, and enhanced recovery, along with fewer complications and recurrence, hence it is worthy of recommendation in clinical practice.

A novel custom bent 27G needle-guided suture snare technique for scleral fixation of posterior chamber intraocular lenses

PURPOSE: To describe a custom bent 27G needle-guided suture snare technique for scleral fixation of posterior chamber intraocular lenses (PCIOL). METHODS: An 8-0 polypropylene suture was threaded into the lumen of a custom bent 27G needle, and the needle tip was advanced into the eye from the IOL fixation point. The suture was threaded through the posterior limbal incision inside the IOL haptic loop and pulled out. The needle tip was advanced into the eye again, going around the IOL haptic loop through the same limbal incision. The suture was threaded in again, and the needle was withdrawn from the eye, completing fixation of the IOL haptic loop. The suture knot was buried in the stroma of the sclera. RESULTS: The technique was performed in 10 eyes of 10 patients, with a preoperative logarithm of the minimum resolution angle corrected visual acuity of 0.73 ± 0.55 (Snellen 20/107), improvement of 0.24 ± 0.27 (Snellen 20/35) at the final follow-up visit, and a mean postoperative PCIOL tilt of 2.78 ± 1.32°. There were no cases of pupillary capture or suture-related complications during follow-up. CONCLUSION: The curved needle-guided suture snare technique provides a simple minimally-invasive method of scleral suture fixation of PCIOL.

METHOD OF TRIGONIZATION (LOWERING) OF THE NECK OF THE BLADDER INTO THE PROSTATE BED WHEN PERFORMING LAPAROSCOPIC VALUED PROSTATECTOMY IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

For the prevention of stricture of the bladder neck during laparoscopic prostatectomy, faster epithelialization of the prostate bed, trigonization (lowering) of the lower semicircle of the urethral neck into the prostate bed with knotted sutures is used, which remain in the lumen of the bed and can cause infl ammatory processes in it with the formation of calculi.The purpose of the study: to present a method of trigonization of the lower semicircle of the bladder neck during laparoscopic extraperitoneal pubic (transcapsular) prostatectomy in patients with benign prostatic hyperplasia.Material and methods. In the center of plastic, reconstructive and minimally invasive oncourology of the Cherkasy regional oncological dispensary and the urological department of the Vinnytsia regional hospital named after Pirogov in 2021-2023, 55 laparoscopic extraperitoneal retropubic prostatectomies were performed in patients with benign prostatic hyperplasia. In 3 patients with large lateral and middle parts of the prostate, a large bed of the prostate with a bladder neck of a small diameter (up to 1 cm) was formed. To prevent the formation of a stricture of the bladder neck and to speed up the regeneration of the prostate bed, the trigonization of the bladder neck in the prostate bed was performed by placing two P-like vicryl sutures on the lower semicircle of the bladder neck with sutures on the lateral surfaces of the prostate capsule and tying the ends of the ligatures.The results. The method made it possible to perform trigonization of the bladder neck without leaving ligatures and their ends in the lumen of the prostate bed and infl ammatory processes in it.Conclusion. The method is recommended for use in the practical work of urologists when performing onemoment laparoscopic retropubic prostatectomy in patients with benign prostatic hyperplasia with a large middle part of the prostate.

PECULIARITIES OF DIAGNOSTICS AND THERAPEUTIC TACTICS IN BLEEDING IN THE EARLY POSTOPERATIVE PERIOD AFTER BARIATRIC SURGERIES

Methods. We retrospectively analyzed the results of diagnostics and treatment of 14 patients who had internal bleeding in the early postoperative period after bariatric surgeries. The following parameters were studied: age and sex of the patients, average body mass index, comorbidities, volume of the performed bariatric surgery, type of internal bleeding (intraluminal/intra-abdominal), technical peculiarities of each operation, average postoperative bed-day, efficiency of instrumental diagnostic methods, types and methods of hemostasis. Results. Clinical manifestations of bleeding in all patients operated on for morbid obesity were detected on 1-2 postoperative days. The main symptoms: weakness and dizziness - in 12 cases (86%), BP decrease up to 90±60 mmHg. - in 4 (28%), tachycardia (HR 100 and more beats per minute) - in 100% of cases. Development of melena and vomiting with blood admixture was noted in 6 (42%) cases, blood flow by drainage - in 8 (58%). In 4 patients (28%) the development of bleeding was preceded by BP increase up to 180-200/100-110 mmHg. In all 14 patients hemoglobin level decreased: in 6 (42%) not lower than 100g/L (but more than 20% of the initial hemoglobin level), and in 8 (58%) - below 100g/L. Esophagogastroduodenoscopy (EGDS) was used to diagnose bleeding inside the lumen of the stomach, intestine, anastomosis, and computerized tomography (CT) of the abdominal cavity with intravenous and oral contrast for intra-abdominal bleeding. In 6 patients with intra-abdominal bleeding revision laparoscopy was performed as an emergency procedure. When the source of bleeding from the stapler line was revealed, the bleeding zone was additionally sutured with Vicryl 3\0 thread using separate knotted sutures. In case of bleeding from the trocar wound, hemostasis was performed with the help of Bersi needle using 1/0 capron thread.No lethal outcomes were observed. All patients were discharged in satisfactory condition. The average bed-day due to the complication increased on average by 2-3 days. Conclusion. Effective methods of diagnostics and treatment of intraluminal bleedings are endoscopic techniques with the possibility of reliable hemostasis. In case of intra-abdominal bleeding relaparoscopy with stitching or clipping of the bleeding source is shown.

Laparoscopic Treatment of Perforated Peptic Ulcer: A Propensity Score-Matched Comparison of Interrupted Stitches Repair versus Knotless Barbed Suture.

Background: Peptic ulcers result from imbalanced acid production, and in recent decades, proton pump inhibitors have proven effective in treating them. However, perforated peptic ulcers (PPU) continue to occur with a persistent high mortality rate when not managed properly. The advantages of the laparoscopic approach have been widely acknowledged. Nevertheless, concerning certain technical aspects of this method, such as the best gastrorrhaphy technique, the consensus remains elusive. Consequently, the choice tends to rely on individual surgical experiences. Our study aimed to compare interrupted stitches versus running barbed suture for laparoscopic PPU repair. Methods: We conducted a retrospective study utilizing propensity score matching analysis on patients who underwent laparoscopic PPU repair. Patients were categorised into two groups: Interrupted Stitches Suture (IStiS) and Knotless Suture (KnotS). We then compared the clinical and pathological characteristics of patients in both groups. Results: A total of 265 patients underwent laparoscopic PPU repair: 198 patients with interrupted stitches technique and 67 with barbed knotless suture. Following propensity score matching, each group (IStiS and KnotS) comprised 56 patients. The analysis revealed that operative time did not differ between groups: 87.9 ± 39.7 vs. 92.8 ± 42.6 min (p = 0.537). Postoperative morbidity (24.0% vs. 32.7%, p = 0.331) and Clavien-Dindo III (10.7% vs. 5.4%, p = 0.489) were more frequently observed in the KnotS group, without any significant difference. In contrast, we found a slightly higher mortality rate in the IStiS group (10.7% vs. 7.1%, p = 0.742). Concerning leaks, no differences emerged between groups (3.6% vs. 5.4%, p = 1.000). Conclusions: Laparoscopic PPU repair with knotless barbed sutures is a non-inferior alternative to interrupted stitches repair. Nevertheless, further research such as randomised trials, with a standardised treatment protocol according to ulcer size, are required to identify the best gastrorraphy technique.

Knot-and-ear sign: a pathognomonic ultrasonographic feature of suture granuloma after thyroid surgery.

This study investigated the clinical and ultrasonographic (US) findings of suture granulomas and recurrent tumors, and aimed to identify specific characteristics of suture granulomas through an experimental study. This retrospective study included 20 pathologically confirmed suture granulomas and 40 recurrent tumors between January 2010 and December 2020. The clinical findings included suture material, surgery, and initial TNM stage. The US findings included shape, size, margin, echogenicity, heterogeneity, vascularity, and internal echogenic foci. The distribution, paired appearance, and "knot-and-ear" appearance of internal echogenic foci were assessed. An experiment using pork meat investigated the US configuration of suture knots. Eighteen patients with 20 suture granulomas (15 women; mean age, 52±13 years) and 37 patients with 40 recurrent tumors (24 women; 54±18 years) were included. Patients with suture granulomas exhibited earlier initial T and N stages than those with recurrent tumors. The knot-and-ear appearance, defined as an echogenic dot accompanied by two adjacent echogenic dots or lines based on experimental findings, was observed in 50% of suture granulomas, but not in recurrent tumors (P<0.001). Central internal echogenic foci (68.8%, P=0.023) and paired appearance (75.0%, P<0.001) were more frequent in suture granulomas. During follow-up, 94.1% of suture granulomas shrunk. The knot-and-ear appearance is a potential pathognomonic finding of suture granuloma, and central internal echogenic foci with paired appearance were typical US features. Clinically, suture granulomas showed early T and N stages and size reduction during follow-up. Understanding these features can prevent unnecessary biopsy or diagnostic surgery.

Evaluation of veterinary students’ suture performance according to three different instructional modalities

Background: Higher education attempts to ameliorate learning experience through match between learning subjects and students' learning styles. Aim: This study evaluates efficacy of three different instructional modalities aimed at teaching veterinary students how to make simple suture knots. Methods: A cohort of 43 fourth-year students were split into 3 groups and provided with different instructional modalities: presentation with pictures and descriptions, hard copy text, and muted video. Student’s surgical simulation performance was evaluated. Then, they answered a 23 question-survey, Fleming VARK questionnaire based, investigating their learning profile. Kruskal Wallis test evaluated different instructional modalities effect on student’s performance. Chi square test assessed differences between instructional modalities and learning profiles, profile self evaluation, and training session comprehension. Results: Students shown auditory unimodal VARK profile (16/43), did not know their learning profile (26/43), and favoured personalised teaching strategies (43/43). No differences were found for: surgical performance, except for forceps handling; and between instructional modalities: either for learning profiles (p-value=0.43), or profile self evaluation (p-value=0.42). Differences were found between instructional modalities and training session comprehension. As limitations, auditory instructional modalities, participants’ age and gender were not recorded or evaluated. Conclusion: Our study provides feedback on modern teaching modalities in which students play a kye role. Participants showed a variety of learning profiles although displaying no significant performance differences.

"Coronal Split/Overlap Repair" Patellar Tendon Shortening in Skeletally Immature Patients.

"Coronal split/overlap repair" patellar tendon shortening (PTS) is a technique that is utilized to treat patella alta and can be combined with distal femoral extension osteotomy (DFEO) for the treatment of crouch gait in skeletally immature patients with cerebral palsy. The patellar tendon is split in the coronal plane. The ventral patellar tendon flap is released from its patellar attachment and is reflected distally over its tibial attachment, exposing a dorsal flap. Two patellar/tibial no. 5 Ethibond (Ethicon) sutures are passed through 2 crossing patellar tunnels and 2 parallel tibial tunnels. The patella is then pushed distally until its distal pole lies at the level of the tibiofemoral joint. The Ethibond sutures are tied and tensioned to the desired level. The knee should be able to be passively flexed to 90°. The intact redundant dorsal flap of the patellar tendon is imbricated. Lastly, the ventral flap is advanced proximally and sutured to the anterior surface of the patella and to the edges of the dorsal flap without shortening. A hinged knee brace is utilized postoperatively with a range of motion of 0° to 30°, progressing to 90° by 6 weeks. No resistive quadriceps contractions are permitted for the first 3 weeks. Patellar tendon advancement in skeletally immature patients can be performed by releasing the tibial attachment and the free end is advanced deep to the T-shaped tibial periosteal flap1-3. Other PTS techniques can be grouped into the categories of (1) patellar tendon imbrication4, (2) patellar tendon detaching techniques in which the tendon is detached from the patellar attachment or cut in its midsubstance and shortened2,5-7, and (3) patellar tendon semi-detaching techniques in which patellar tendon flaps are created and shortened8,9. The presently described technique is a semi-detaching technique, preserving a good part of the patellar tendon while avoiding complete dehiscence of the extensor mechanism. Moreover, the 2 patellar/tibial sutures would protect the patellar tendon repair and allow early rehabilitation and knee range-of-motion exercises. Satisfactory correction of the patella alta was reported with PTS techniques with or without DFEO to correct concomitant fixed flexion deformity in patients with cerebral palsy. Furthermore, there was reported improvement of total knee range of motion with restoration of adequate knee extension during the stance phase1,3,8. Reported complications with this technique were mainly superficial infection. Any substantial fixed flexion deformity of the knee (>10°) should be corrected with hamstring lengthening or DFEO prior to PTS.A mid-patellar coronal split is made with use of a no.-15 blade and extended proximally and distally with use of 2 mosquito clips.To avoid difficulties with crossing of the patellar sutures, always keep the straight needle inside the 1st tunnel until the 2nd tunnel is created and its respective suture is passed.To distalize the patella, the patellar/tibial sutures are tied in a simple knot and held by a mosquito clip in order to allow retensioning until the desired patellar height is reached.The 2 patellar/tibial suture knots are slid to the proximal and distal ends of the surgical field. 3DGA = 3-dimensional gait analysisADL = activities of daily livingCP = cerebral palsyCPM = continuous passive motionDFEO = distal femoral extension osteotomyFAQ = Functional Assessment QuestionnaireFMS = Functional Mobility ScaleGMFCS = Gross Motor Function Classification SystemGMFM = Gross Motor Function MeasureGPS = Gait Profile ScoreGVS = Gait Variable ScoreK-wires = Kirschner wiresPTA = patellar tendon advancementPTS = patellar tendon shorteningSEMLS = single event multi-level surgery.

Scleral Fixation of a Single-Piece AcrySof Toric Intraocular Lens: A Case Report

Purpose: To describe a simple and least invasive surgical method of transscleral fixation of a dislocated single-piece AcrySof® toric intraocular lens (IOL).Case summary: A 62-year-old male was referred with dislocated toric IOL (SN6AT4, AcrySof® IQ Toric; Alcon Laboratories, Fort Worth, TX, USA) in his right eye after an uneventful cataract surgery. Scleral fixation using the toric IOL was performed by placing the suture knot at the optic-haptic junction right beside the toric axis markings which easily achieved the desired positioning of the axis. The preoperative uncorrected distance visual acuity was 20/400 and it improved to 20/60 at 1 week after repositioning of the IOL and the IOL was well-centered with its toric alignment within 5 degrees of the intended axis.Conclusions: Transscleral fixation of single-piece AcrySof toric IOLs is easy to learn technique, which reduces surgical time with minimal manipulation and enables IOL stability with good postoperative toric axis alignment.

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.

Clinically Translatable Solid-State Dye for NIR-II Imaging of Medical Devices.

Medical devices are commonly implanted underneath the skin, but how to real-time noninvasively monitor their migration, integrity, and biodegradation in human body is still a formidable challenge. Here, the study demonstrates that benzyl violet 4B (BV-4B), a main component in the FDA-approved surgical suture, is found to produce fluorescence signal in the first near-infrared window (NIR-I, 700-900nm) in polar solutions, whereas BV-4B self-assembles into highly crystalline aggregates upon a formation of ultrasmall nanodots and can emit strong fluorescence in the second near-infrared window (NIR-II, 1000-1700nm) with a dramatic bathochromic shift in the absorption spectrum of ≈200nm. Intriguingly, BV-4B-involved suture knots underneath the skin can be facilely monitored during the whole degradation process in vivo, and the rupture of the customized BV-4B-coated silicone catheter is noninvasively diagnosed by NIR-II imaging. Furthermore, BV-4B suspended in embolization glue achieves hybrid fluorescence-guided surgery (hybrid FGS) for arteriovenous malformation. As a proof-of-concept study, the solid-state BV-4B is successfully used for NIR-II imaging of surgical sutures in operations of patients. Overall, as a clinically translatable solid-state dye, BV-4B can be applied for in vivo monitoring the fate of medical devices by NIR-II imaging.

Healing strength of tendon repair with or without knots between two tendon ends and histological changes in a chicken model

We studied the healing strength and histological changes of digital flexor tendons repaired using Kessler (core suture knots placed over the tendon surface) and modified Kessler (core suture knots placed between two tendon ends) in 31 long toes of chicken. Four weeks after surgery, the healing tendons were measured in a tensile testing machine, and the adhesion formation and histological changes were observed. The strength of the Kessler repairs was significantly greater than that of the modified Kessler repairs with a 35% mean difference. No significant difference was found between the adhesion scores of the tendons repaired with both techniques. In histological sections, the arrangement of collagen fibers in the modified Kessler repair group was more disordered. We conclude that the tendons repaired with the Kessler method are stronger than those with the modified Kessler technique. The knots between tendon ends are detrimental to the early healing strength of digital flexor tendons.

Modified Outside-In Plus Suture Technique for Repair of the Anterior and Middle Segments of the Meniscus: Technical Note

Traditionally, an outside-in suture technique is appropriate to repair longitudinal tears of the anterior and middle segments of the meniscus. However, it has a fundamental weakness of not creating a vertical mattress–type suture. To overcome this weakness, the modified outside-in technique was developed using a suture hook to create a vertical mattress–type suture in the inner fragment. However, it still has the disadvantage of requiring an open skin incision to prevent neurovascular damage during knot tying. Thus, we developed the modified outside-in plus technique to make a vertical mattress suture without an open skin incision in the knee joint. With this technique, the use of both vertical and horizontal mattress sutures is possible. Although this technique is similar to the modified outside-in technique, a suture knot is made inside the knee joint. Therefore, it compensates for the disadvantage of the outside-in technique. The modified outside-in plus technique is able to achieve good reduction and sufficient stability through a vertical mattress suture technique without additional skin incisions.

Meniscus Allograft Transplantation With Bone Plugs Using Knotless All-Suture Anchors and Cortical Button Suspensory Fixation

Meniscus allograft transplantation can be successful for treatment of meniscal deficiency using a number of transplant techniques. In this Technical Note, we describe a double bone plug medial meniscus allograft transplantation technique that uses knotless all-suture anchors with cortical-button suspensory fixation. This technique maintains the reported advantages for bone-plug fixation while mitigating the risk for meniscal root damage, facilitating easier bone plug insertion and seating, expanding tensioning capabilities, and preventing soft-tissue irritation from suture knot stacks.

4 A Quantitative Image Analysis Study of Modified Kessler Extensor Repair

Abstract Aim The aims of this study were to compare and measure the amount of 4.0 Prolene suture material at the tendon repair site with 2 types of knot placement in a modified Kessler technique, as placement of suture knot can impact extensor tendon healing. Method Thirty-two extensor tendons of 2 fresh frozen cadaveric hands were divided and repaired using the modified Kessler technique with either intratendinous or extratendinous knot placement of a 4.0 Prolene suture. Tendon repairs were sectioned, and cross-sectional photographs were analysed using quantitative image analysis. Results Comparison of percentage change in tendon dimension surface area showed no significant difference (p = 0.4750) between intratendinous and extratendinous knot placement to demonstrate consistency of repair. Quantitative image analysis revealed suture material occupied a significantly (p = 0.0103) larger percentage of tendon cross sectional area in intratendinous than extratendinous knot placement. In both groups this represented &amp;lt;10% of the total cross-sectional area of the tendon at the repair site (7.49% vs 2.92%). There was no significant relation between digit, tendon or repair zone and percentage of repair zone occupied by suture material. Conclusions Intratendinous knot placement occupies a larger proportion of tendon cross sectional area than extratendinous knot placement, though this is still comparatively small when a 4’0 monofilament suture is used.

Quaternary Knot Technique: Suture Knot Burial without Scleral Flap or Incision for Trans-scleral Fixation.

Despite the introduction of novel sutureless posterior chamber intraocular lens (IOL) fixation techniques, some conditions still require suture-assisted scleral fixation. If the scleral fixation suture knot is left directly under the conjunctiva, it may become exposed, resulting in an increased risk of endophthalmitis. To avoid this problem, we offer a new alternative, simple, and safe way for burying the end of the suture using knots in this report.

Four-Point Refixation for In-the-Bag Intraocular Lens Dislocation Into Vitreous Cavity With Implantable Capsular Hooks.

Four-Point Refixation for In-the-Bag Intraocular Lens Dislocation Into Vitreous Cavity With Implantable Capsular Hooks.

Scleral Suture Fixation of Dislocated Posterior Chamber Intraocular Lens: Modification for Tapered Haptics.

To present a surgical modification to a previously published technique that allows repositioning and scleral fixation of one-piece acrylic intraocular lenses with tapered haptics. A retrospective review of three consecutive cases. Our technique modification enables repositioning using scleral suture fixation of one-piece intraocular lenses with tapered haptics by looping the haptic at its proximal, notched junction to the optic with the polypropylene suture. The suture knot is internalized which effectively suspends the intraocular lens and allows for better adjustment of the intraocular lens centration. Two cases were endocapsular dislocations; the third case was dislocated extracapsularly due through a posterior capsule rupture. All showed adequate lens centration at 3 months of follow-up. One case had suffered a vitreous hemorrhage a month postoperatively that is clearing. Repositioning using scleral fixation of one-piece intraocular lenses with tapered haptics is possible with a minor technique modification. This offers an alternative to intraocular lens exchange.