Suture Method Research Articles

A Modified Two-Layer Suture Technique for Transperitoneal Laparoscopic Partial Nephrectomy: Single-Center Clinical Experience.

PurposesThis study aims to evaluate the feasibility and efficacy of a modified two-layer suture method during laparoscopic partial nephrectomy (LPN) by a comparative analysis with the traditional two-layer suture.MethodsA total of 60 LPN patients were enrolled in this study, of which 30 patients received the modified two-layer suture method and the remaining 30 patients underwent the traditional two-layer suture. Then, surgical characteristics including operative time, warm ischemic time (WIT), estimated blood loss (EBL), and glomerular filtration rate (GFR) were recorded. Finally, univariable and multivariable linear regression analyses were used to evaluate the correlations of tumor characteristics, suture methods, and postoperative renal function.ResultsThere was no significant difference between the two suture groups with respect to patient and tumor characteristics, postoperative creatinine level, and blood urea nitrogen (BUN) level. The modified suture group showed a significantly shorter clamping time and a less GFR level reduction than the traditional two-layer suture group (15 vs. 23 min; 42.32 ± 9.48 vs. 27.07 ± 7.88; p < 0.05). Additionally, the modified two-layer suture was an independent factor that influenced the clamping time and the level of GFR reduction.ConclusionThe modified two-layer suture method is feasible and effective for LPN.

Baicalin treats cerebral ischemia reperfusion-induced brain edema in rats by inhibiting TRPV4 and AQP4 of astrocytes

This study aims to explore the pharmacodynamic effect of baicalin on rat brain edema induced by cerebral ischemia reperfusion injury and discuss the mechanism from the perspective of inhibiting astrocyte swelling, which is expected to serve as a refe-rence for the treatment of cerebral ischemia with Chinese medicine. To be specific, middle cerebral artery occlusion(suture method) was used to induce cerebral ischemia in rats. Rats were randomized into normal group, model group, high-dose baicalin(20 mg·kg~(-1)) group, and low-dose baicalin(10 mg·kg~(-1)) group. The neurobehavior, brain index, brain water content, and cerebral infarction area of rats were measured 6 h and 24 h after cerebral ischemia. Brain slices were stained with hematoxylin and eosin(HE) for the observation of pathological morphology of cerebral cortex after baicalin treatment. Enzyme-linked immunosorbent assay(ELISA) was employed to determine the content of total L-glutathione(GSH) and glutamic acid(Glu) in brain tissue, Western blot to measure the content of glial fibrillary acidic protein(GFAP), aquaporin-4(AQP4), and transient receptor potential vanilloid type 4(TRPV4), and immunohistochemical staining to observe the expression of GFAP. The low-dose baicalin was used for exploring the mechanism. The experimental results showed that the neurobehavioral scores(6 h and 24 h of cerebral ischemia), brain water content, and cerebral infarction area of the model group were increased, and both high-dose and low-dose baicalin can lower the above three indexes. The content of GSH dropped but the content of Glu raised in brain tissue of rats in the model group. Low-dose baicalin can elevate the content of GSH and lower the content of Glu. According to the immunohistochemical staining result, the model group demonstrated the increase in GFAP expression, and swelling and proliferation of astrocytes, and the low-dose baicalin can significantly improve this situation. The results of Western blot showed that the expression of GFAP, TRPV4, and AQP4 in the cerebral cortex of the model group increased, and the low-dose baicalin reduce their expression. The cerebral cortex of rats in the model group was severely damaged, and the low-dose baicalin can significantly alleviate the damage. The above results indicate that baicalin can effectively relieve the brain edema caused by cerebral ischemia reperfusion injury in rats, possibly by suppressing astrocyte swelling and TRPV4 and AQP4.

Comparison of functional recovery of distal radius fracture by suture of pronator muscle through modified Henry approach

To investigate the effect of suture of pronator muscle on forearm function after modified Henry approach for distal radius fractures. from January 2018 to December 2020, 220 patients with distal radius fractures were treated with open reduction and locking plate internal fixation through the modified Henry approach. They were divided into two groups according to different suture methods. There were 112 cases in the intraoperative suture group, including 35 males and 77 females;The age ranged from 37 to 65(48.5±7.4) years;AO classification of fracture, 46 cases of type B and 66 cases of type C;After fracture reduction and locking plate fixation, the pronator muscle was opened and sutured. There were 108 cases in the non suture group, 32 males and 76 females;The age ranged from 34 to 67(47.6±7.8) years;There were 41 cases of fracture type B and 67 cases of fracture type C;After fracture reduction and locking plate fixation, the open pronator muscle was not sutured, and it was laid on the surface of the plate in situ. The range of wrist motion (pronation, supination, palmar inclination and dorsiflexion), the score of disability of arm shoulder and hand dash and visual analog scale(VAS) were compared between the two groups at 6 weeks and 6 months after operation. All 220 patients were followed up for 6 to 18 (8.5±1.3) months. There was no significant difference in the range of motion and DASH score of forearm and wrist between the two groups 6 weeks after operation (P>0.05);There was significant difference in VAS score between suture group (2.6±1.2) and non suture group (5.8±2.3)(P<0.05). Six months after operation, there was no significant difference in the range of motion, DASH score and VAS score of forearm and wrist between the two groups(P>0.05). The modified Henry approach has no obvious advantages in the range of wrist movement and upper limb function, but the intraoperative suture of pronator can reduce the early postoperative pain. It is suggested that the pronator should be sutured during the operation.

The Two-Pore Domain Potassium Channel TREK-1 Promotes Blood-Brain Barrier Breakdown and Exacerbates Neuronal Death After Focal Cerebral Ischemia in Mice.

Earlier studies have shown the neuroprotective role of TWIK-related K+ channel 1 (TREK-1) in global cerebral and spinal cord ischemia, while its function in focal cerebral ischemia has long been debated. This study used TREK-1-deficient mice to directly investigate the role of TREK-1 after focal cerebral ischemia. First, immunofluorescence assays in the mouse cerebral cortex indicated that TREK-1 expression was mostly abundant in astrocytes, neurons, and oligodendrocyte precursor cells but was low in myelinating oligodendrocytes, microglia, or endothelial cells. TREK-1 deficiency did not affect brain weight and morphology or the number of neurons, astrocytes, or microglia but did increase glial fibrillary acidic protein (GFAP) expression in astrocytes of the cerebral cortex. The anatomy of the major cerebral vasculature, number and structure of brain micro blood vessels, and blood-brain barrier integrity were unaltered. Next, mice underwent 60min of focal cerebral ischemia and 72h of reperfusion induced by the intraluminal suture method. TREK-1-deficient mice showed less neuronal death, smaller infarction size, milder blood-brain barrier (BBB) breakdown, reduced immune cell invasion, and better neurological function. Finally, the specific pharmacological inhibition of TREK-1 also decreased infarction size and improved neurological function. These results demonstrated that TREK-1 might play a detrimental rather than beneficial role in focal cerebral ischemia, and inhibition of TREK-1 would be a strategy to treat ischemic stroke in the clinic.

Feasibility of the “Cuff-Sleeve” Suture Method for Functional Neocervix Reconstruction in Laparoscopic Radical Trachelectomy: A Retrospective Analysis

The purpose of this study was to evaluate the feasibility of "cuff-sleeve" sutures for reconstructing a functional neocervix in laparoscopic radical trachelectomy (RT). A retrospective analysis of a case series. A teaching hospital. Twenty-five patients who were diagnosed as early-stage cervical cancer from June 2017 to October 2020 in Sun Yat-sen Memorial Hospital. Laparoscopic RT with the "cuff-sleeve" suture method for cervicovaginal reconstruction. Twenty-five patients successfully underwent the laparoscopic RT with the "cuff-sleeve" suture method for cervicovaginal reconstruction, and no intraoperative complications occurred or conversion to laparotomy was needed. For all patients, approximately 80% of the cervical length was removed. Surgical radicality and negative surgical margins were also confirmed. During a median follow-up time of 29 months (range 8-48 months), no severe postoperative complications were observed. No cervical stenosis or secondary abnormal menstruation was reported. After the removal of the uterine stent 6 months after surgery, the neocervix length was approximately 14 mm (range 10-19 mm) and almost all the neocervixes were restored closely to the original anatomy. Four of 8 patients attempting actively to conceive were successful, and the cervical length of these pregnant patients was greater than or equal to 15 mm in all but one measurement at different gestational age. Three patients were ongoing pregnant, and the other had delivered successfully with a 16- mm cervix at term without cerclage. The "cuff-sleeve" suture method in cervicovaginal reconstruction is feasible in laparoscopic RT. This simplified suture technique can provide a functional neocervix to reduce cervical stenosis and incompetence.

Novel Suturing Methods for the Management of Traumatic Choroidal Avulsion in Globe Injuries

PurposeTo explore the long-term efficacy of novel choroidal suturing methods including trans-scleral mattress suturing (TSS) and intraocular suturing (IOS) in the treatment of choroidal avulsion.DesignProspective cohort, hospital-based study.MethodsA total of 24 patients who were diagnosed with choroidal avulsion were enrolled in this study. The demographic characteristics, baseline information of trauma, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were collected before surgery, and the anatomic abnormities of the globe were recorded before or during surgery. All patients were diagnosed with choroidal avulsion and underwent choroid suturing treatment during vitrectomy, postoperative functional variables including BCVA and IOP, anatomic variables including retinal and choroidal reattachment rate, and silicone oil migration rate, which were recorded at the regular follow-ups at least 1 year after surgery.ResultsAll patients with open globe injury involved zone III, 70.8% of the patients presented with two quadrants of the avulsed choroid, and 29.2% with one quadrant involved; moreover, all patients had complications with retinal detachment (RD), of which 58.3% of patients had closed funnel retinal detachment. TSS was applied in nineteen patients and IOS in five patients. Postoperatively, a significant improvement on LogMAR BCVA was observed at each follow-up from 3.57 ± 0.69 before surgery to 2.82 ± 0.98 at the last follow-up (p < 0.05), and the proportion of no light perception (NLP) was also reduced from 69.6 to 37.5%. IOP was markedly elevated from 6.4 ± 4.1 mmHg preoperatively to 11.3 ± 4.3 mmHg at the last follow-up (p < 0.05). Choroidal reattachment was achieved in 91.7% of patients; two patients were observed with silicone oil migration at 3 months after surgery and underwent drainage of suprachoroidal silicone oil and sclera buckling. Meanwhile, retinal attachment was observed in 95.8% of patients, only one patient developed partial RD due to postoperative proliferative vitreoretinopathy, and secondary vitrectomy was performed; all patients were observed with complete retinal and choroidal attachment at the last follow-up. Eventually, four patients were silicone oil-free, and 20 patients were silicone oil-dependent.ConclusionsChoroidal suturing proved to be an effective method to fix the avulsed choroid, which greatly improved the BCVA and maintained the IOP, and efficiently increased the choroidal and retinal reattachment rate and preservation of the eyeball.

A novel corneal adhesive based on functionally coupled PEG-lysozyme hydrogel for wound closure after surgical eye surgery

Corneal wound closure for surgical eye surgeries or accidents is typically performed to prevent pathogens from the sterile intraocular environment and avoid potential postoperative complications. Tissue adhesives are increasingly employed for corneal wound closure with superior treatment efficiency and less adverse effects. In this study, we successfully develop a novel corneal adhesive based on functionally coupled PEG-lysozyme (PEG-LZ) hydrogels for wound closure after surgical eye surgeries. PEG-LZ hydrogels have plenty of micropores and gradually decreased pore size with increasing concentration from 10%, 15% to 20% (w/v), in which PEG-LZ (15%) represents the suitable pH value, gelation time and elastic modulus. PEG-LZ hydrogels have no in vitro cytotoxicity and excellent ex vivo wound closure effectiveness in porcine eyes. The in vivo wound sealant in rabbit eyes by PEG-LZ hydrogels presents a superior therapeutic effect compared with the conventional methods of stromal hydration and suture, in terms of the wound closure percent, mean corneal thickness, percent of wound gaping, and the Descemet membrane detachment. PEG-LZ hydrogels do not induce obvious histological pathology changes. The PEG-LZ corneal adhesive is considered as a tissue adhesive alternative for wound closure after surgical eye surgeries.

Ghrelin reduces cerebral ischemic injury in rats by reducing M1 microglia/macrophages.

The purpose of this study was to investigate the effect of Ghrelin on the polarization of microglia/ macrophages after cerebral ischemia (CI) in rats. 60 wild-type SD rats were randomly divided into sham group, CI group, CI+Ghrelin group, 20 rats in each group. The modified Longa suture method was used to establish the middle cerebral artery occlusion (MCAO) model in rats. Before surgery, Ghrelin was injected subcutaneously (100 μg/kg, twice a day) for 4 consecutive weeks. After modeling, neurological function scores were performed with three behavioral experiments: mNSS score, Corner test, and Rotarod test, to evaluate the recovery of neurological function after Ghrelin treatment. At the same time, the brain tissues were collected and stained with 2,3,5- triphenyltetrazolium chloride (TTC) to detect the cerebral infarct volume. RT-qPCR was used to detect the expression of TNF-α and IL-1β in the ischemic brain tissue, and the TUNEL staining was used to detect the apoptosis of brain tissue. Flow cytometry was used to detect the percentage of M1 type microglia/macrophages which were isolated by trypsin digestion of fresh cerebral cortex. Then, the Western blotting and immunofluorescence method were used to detect the phosphorylation level of AKT (P-AKT) and AKT. Compared with the CI group, the neurological function of the rats in the CI+Ghrelin group was dramatically improved, and the cerebral infarction area was dramatically reduced. At the same time, the expression of TNF-α and IL-1β in the ischemic brain tissue of rats in the CI+Ghrelin group decreased, and the apoptotic cells in the brain tissue also decreased. Compared with the CI treatment group, the activation of M1 microglia/macrophages in the cortex of the ischemic side of the infarct and the peri-infarct area in the CI+Ghrelin group was dramatically inhibited. At the same time, the ratio of P-AKT/AKT of the brain tissue in the CI+Ghrelin group was dramatically higher than that of the CI group. In the rat cerebral ischemia model, Ghrelin can promote the repair of brain damage and the recovery of neurological function after ischemia. Its mechanism may be related to activating AKT to selectively reduce M1 microglia/macrophages, reducing inflammation and cell apoptosis in brain tissue.

Лечение пациентов с повреждениями менисков коленного сустава

The aim: to study the results of surgical treatment of patients with injuries of the meniscus of the knee joint, in whom arthroscopic suturing of the meniscus was used according to the developed technique.Methods. In this paper, we studied the results of surgical treatment of 134 patients with chronic injuries of the meniscus of the knee joint, who were treated at the City Clinical Hospital No. 7 in Almaty for the period from 2017 to 2021. 70 (52.3%) patients made up the control group, who underwent meniscus resection using arthroscopic technique. The main group included 64 (47.7%) patients with ruptures of the meniscus of the knee joint. He performed a meniscus suture under arthroscopic control according to the method developed by us (RK patent No. 35413 dated 12/10/2021). Results. Clinical application of a new method of arthroscopic meniscus suturing in patients of the main group allowed to increase the frequency of excellent results by 7.3% (p=0.012), good treatment results by 19.7% (p&lt;0.001) according to the Lysholm scale compared with the control group. The treatment outcomes of patients in the study groups, analyzed using the criteria of evidence-based medicine, indicate the effectiveness of a new method of arthroscopic meniscus suturing, which reduces the frequency of unsatisfactory outcomes in the long-term period of surgical treatment by 5.5% (p=0.184) compared with the control group.Сonclusions.The results of the research work support the arthroscopic repair of meniscal tears with good long-term results and a low risk of complications. Thus, a new method of arthroscopic suturing of the meniscus provides prevention of the development of contractures, gonarthrosis in the postoperative period in patients with injuries of the meniscus of the knee joint and allows for early functional treatment compared to traditional arthroscopic meniscectomy.Keywords: knee joint, menisci, meniscus injury, osteoarthritis, arthroscopy, meniscus suture, meniscus resection.

Effects of edaravone combined with Oxiracetam on neuronal apoptosis in rats with cerebral infarction through targeting SIRT1/NF-κB inflammatory pathway.

The objective of this study was to investigate the effects of edaravone combined with oxiracetam on neuronal apoptosis in rats with cerebral infarction (CI) and to explore the potential molecular mechanism. A total of 36 Sprague-Dawley rats were randomly divided into sham-operation group (n=12), model group (n=12) and treatment group (n=12). Only the external carotid artery was exposed in sham-operation group, while the models of CI were established using suture method in the other two groups. After modeling, the rats in sham-operation group and model group were intraperitoneally injected with normal saline, and those in treatment group were administered with edaravone and oxiracetam solutions via intraperitoneal injection. Then, the specimens were obtained at 2 weeks after intervention. The cognitive function of the rats was evaluated using a water maze, Nissl staining was applied to observe the neuronal morphology, and the relative protein expressions of silent information regulator 1 (SIRT1) and NF-κB were measured by means of Western blotting. Furthermore, quantitative polymerase chain reaction (qPCR) was performed to determine the messenger ribonucleic acid (mRNA) expressions of interleukin-1 beta (IL-1β) and IL-6, the content of IL-1β and IL-6 was detected by enzyme-linked immunosorbent assay (ELISA), and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay was conducted to examine the cell apoptosis. Model group displayed a significantly longer escape latency and significantly fewer times of crossing the original platform than sham-operation group (p<0.05), whereas treatment group had a significantly shorter escape latency but significantly more times of crossing the original platform than model group (p<0.05). The relative protein expression level of SIRT1 was lowered significantly, while that of NF-κB was elevated significantly in model group in comparison with those in sham-operation group (p<0.05), and the opposite results were observed between model group and treatment group (p<0.05). Besides, the content of IL-1β and IL-6 in brain tissues was increased significantly in model group compared with that in sham-operation group (p<0.05), but it was decreased significantly in treatment group in comparison with that in model group (p<0.05). The relative mRNA expression levels of IL-1β and IL-6 were significantly higher in model group than those in sham-operation group (p<0.05). Moreover, model group exhibited more positive apoptotic cells and a significantly higher apoptosis rate than sham-operation group (p<0.05) and treatment group (p<0.05). No apparent abnormalities of neuronal morphology and structure were detected in sham-operation group, with many Nissl bodies. The neurons were damaged, with abnormal morphology and structure, and there were a small number of Nissl bodies in model group. The neurons were damaged in treatment group, but their morphology and structure were improved evidently compared with those in model group. Edaravone combined with oxiracetam can inhibit the neuronal apoptosis in CI rats by regulating the SIRT1/NF-κB signaling pathway, thereby exerting a neuroprotective effect.

Comparing Clinical and Hemodynamic Parameters between the Two Aortic Valve Replacement in Patients with Severe Aortic Stenosis.

Context:Various techniques have been proposed for suturing following prosthetic aortic valve implantation, but each has its potential side effects such as patient-prosthesis mismatch (PPM) and paravalvular leak (PVL).Aims:In the present study, we aimed to compare the postoperative sequels of aortic valve replacement (AVR) following the use of two suturing techniques including from the inside of the aorta as the common and classic suturing techniques as compared to new approach including from the outside of the aorta.Settings and Design:This cross-sectional study was performed on patients suffering from symptomatic severe aortic valve disease and candidates for AVR in one of three referral hospitals for cardiovascular disease patients in Shiraz from 2019–2021.Subjects and Methods:The patients underwent one of the two considered surgical techniques for AVR including traditional approach (n = 60) or the tested approach (suturing from the outside of the aorta) (n = 30).Statistical Analysis Used:For statistical analysis, results were presented as mean ± standard deviation for quantitative variables and were summarized by frequency (percentage) for categorical variables.Results:PVL and PPM were revealed in none of the participants undergoing the tested approach, while the pointed complications were found in 41.7% and 25.0% of patients underwent traditional approach, respectively, indicating a significant difference. There was no evidence of abnormal dimensionless valve index (DVI) in the patients undergoing sutures from outside the aorta, whereas the rate of DVI abnormality in the patients undergoing traditional procedures was shown to be 18.3%. The mean aortic valve gradient was significantly higher in the group scheduling for the traditional surgical method.Conclusions:Applying new suturing method as suturing from the outside of the aorta, due to the selection of appropriate valve size, the risk for adverse consequences including PPM, PVL, or DVI can be significantly reduced.

Can a Two Simple Stitches Method Provide Secure Fixation Strength in Biceps Tenodesis?: Biomechanical Evaluation of Various Suture Techniques.

BackgroundThe purpose of this study was to compare the initial fixation strength between four different suture methods for the long head of the biceps.MethodsForty-eight fresh frozen porcine flexor hallucis longus tendons (mean width at suture site, 8.5 ± 0.9 mm) and phalanx bones were randomly assigned to one of the four arthroscopic biceps tenodesis techniques: simple stitch (SS), mattress suture (MS), lasso-loop (LL), and two simple stitches (2SS). A biceps tenodesis was performed according to the four techniques using all-suture type suture anchors (1.9-mm SUTUREFIX anchor with No. 1 ULTRABRAID sutures). Biomechanical evaluations were performed to test load to failure (N), stiffness (N/mm), stress (N/m2), and mode of failure.ResultsAs for the SS, MS, LL, and 2SS, the mean load to failure was 50.9 ± 14.61 N, 82.3 ± 24.8 N, 116.2 ± 26.7 N, and 130.8 ± 22.5 N (p < 0.001), respectively; mean stiffness was 6.1 ± 1.3 N/mm, 6.7 ± 2.6 N/mm, 7.8 ± 1.4 N/mm, and 8.1 ± 4.2 N/mm, respectively (p = 0.258); and mean stress was 0.7 ± 0.3 N/m2, 1.4 ± 0.8 N/m2, 2.9 ± 0.7 N/m2, and 2.7 ± 0.8 N/m2, respectively (p < 0.001). All the failures happened by the suture cutting through the tendon along its longitudinal fibers.ConclusionsNeither the SS nor the MS method was enough to securely fix the biceps tendon with a significantly lower mechanical strength; however, the 2SS method showed similar initial fixation strength as the LL technique.

Investigation on bone fusion of spinous process in microscopic lumbar spinous process splitting laminoplasty using crossing suture method of lamina and spinous process for two spinous process

Investigation on bone fusion of spinous process in microscopic lumbar spinous process splitting laminoplasty using crossing suture method of lamina and spinous process for two spinous process

A reinforced suture method for stapled gastrointestinal anastomosis to reduce gastrointestinal hemorrhage during Whipple operation in laparoscopy.

PurposeLaparoscopy is being increasingly accepted for pancreaticoduodenectomy. Stapled anastomosis (SA) is used extensively to facilitate laparoscopic pancreaticoduodenectomy (LPD); however, the incidence of anastomotic bleeding after stapled gastrointestinal anastomosis is still high.MethodsOne hundred and thirty-nine patients who underwent LPD using Whipple method were enrolled in our study. We performed the SA with our reinforced method (n = 68, R method) and without the method (n = 71, NR method). We compared the clinical characteristics and anastomosis methods of patients with or without gastrointestinal-anastomotic hemorrhage (GAH), and operative parameters were also compared between the anastomotic methods.ResultsOf the 139 patients undergoing LPD, 15 of them developed GAH. The clinical characteristics of patients with or without GAH were not significantly different except in the anastomotic method (P < 0.001). In the univariate logistic regression analyses, only the anastomotic method was associated with GAH. Furthermore, patients with the NR method had significantly higher incidences of GAH (P < 0.001) and Clavien-Dindo grade ≥ III complications (P < 0.001).ConclusionOur retrospective analysis showed that the SA performed with reinforced method might be a reform of SA without the reinforcement, as indicated by the lower incidence of GAH. However, further research is necessary to evaluate the utility of this reinforced method.

A Modified Suturing Protocol for Tripod Stabilization of Connective Tissue Graft and Coronal Advancement of Tunnel Flap for Treatment of Isolated Gingival Recession.

Preserving a sufficient blood supply and maintaining wound stability during the healing phase are the most crucial factors for success in root coverage procedures. Selecting the surgical technique and suturing protocol used to achieve these goals is therefore indispensable for predictable treatment outcomes. Tunneling flap procedures have evolved as a technical advancement in periodontal plastic surgery, particularly focusing on improving the vascular supply at the surgical site. Along with the development of newer flap designs for recession coverage, several suturing protocols for flap stability have been described. This paper illustrates the use of a modified suturing method for soft tissue graft stabilization in a coronally advanced tunnel flap procedure for the treatment of isolated gingival recession. It allows precise three-dimensional positioning and tripod stabilization of the graft in the tunnel as an independent step, differing from previously described techniques. A modified tissue-supported vertical mattress suture is then placed for coronal advancement and improved wound adaptation. The present authors have found that the proposed suturing protocol achieves successful integration of graft, maximum root coverage, excellent esthetic results, and limited postoperative morbidity. The suturing technique is described in detail with schematic illustrations and clinical cases, and its advantages and potential limitations are discussed.

Addressing Transverse Plane Instability in the Modified Lapidus Arthrodesis: A Comparative Study of Screw Versus Suture and Button Fixation Device Technique

The Lapidus arthrodesis is a powerful procedure for the correction of hallux valgus with metatarsus primus varus. Yet, first ray instability may persist despite correction of the primary deformity with 2 crossed screw fixation. A third screw is often utilized as the additional point of fixation for noteworthy residual transverse plane motion, but it is not without potential complications. The suture and button fixation device may be an appropriate alternative to the third screw construct. This retrospective cohort study identified clinical / radiographic outcomes and complication rates following a third point of fixation with either a screw or suture and button fixation device in patients undergoing a modified Lapidus arthrodesis. One surgeon performed all of the Lapidus procedure with a third screw while the other surgeon performed all with a suture and button fixation device. Of 136 consecutive patients who underwent a modified Lapidus arthrodesis, 83 (61%) patients required a third point of fixation for satisfactory stabilization of the first ray. Surgical technique was similar between the 2 surgeons; however, one utilized the suture and button fixation device method (n = 36), while the other used a third screw for fixation (n = 47). Many of the clinical outcomes, radiographic results, and the union rate were similar between the 2 methods. Nineteen (40%) complications occurred in the third screw group compared to 6 (17%) in the suture and button fixation device group. However, the third screw group demonstrated 100% maintenance of deformity correction at 1 year versus 95% in the suture and button fixation device group. Although fixation with a suture and button fixation device was associated with fewer complications, a larger study is necessary to determine if these variations are statistically significant.

Laparoscopic Surgery for Hernias of the Anterior Abdominal Wall

Introduction. Surgical interventions for hernias of the anterior abdominal wall are among the most common in pediatric surgical clinics. In newborns, especially premature infants, the frequency of hernias of the anterior abdominal wall is inversely proportional to gestational age and significantly exceeds the rates in older children.&#x0D; The aim of the study is to compare outcomes of laparoscopic treatment using the Percutaneous Internal Ring Suturing (PIRS) method and conventional methods in newborns with hernias of the anterior abdominal wall.&#x0D; Materials and methods. Laparoscopic interventions in children older than 2-3 years are gradually becoming the standard of treatment, while in newborns, conventional open methods are more often used to treat hernias of the anterior abdominal wall, which is associated with complexity of the surgical technique, presence of concomitant pathology and a high anesthetic risk. Timing (early or delayed) of hernia surgical correction of the anterior abdominal wall in these patients remains the issue under discussion.&#x0D; Results. According to the study results, the duration of PIRS surgery was shorter than that of an open surgery. The long duration of laparoscopic surgery, which some surgeons note, is explained by the laparoscopic correction technique the imposition of an intracorporeal suture requires more time and experience of a surgeon. Furthermore, an inverse relationship was found between the weight of a child and the time of laparoscopic intervention.&#x0D; Conclusion. Laparoscopic treatment of hernias of the anterior abdominal wall with PIRS method in newborns is not easier for the surgeon, but also safer for the patient.

Loosening of Posteromedial Meniscal Root Repairs Affects Knee Mechanics: A Finite Element Study.

Meniscal root repairs are susceptible to unrecoverable loosening that may displace the meniscus from the initial position reduced during surgery. Despite this, the effects of a loosened meniscal root repair on knee mechanics are unknown. We hypothesized that anatomic root repairs without loosening would restore knee mechanics to the intact condition better than loosened anatomic root repairs, but that loosened repairs would restore mechanics better than untreated meniscal root tears. Finite element knee models were used to evaluate changes in cartilage and meniscus mechanics due to repair loosening. The mechanical response from loosened anatomic root repairs was compared to anatomic repairs without loosening and untreated root tears. All conditions were evaluated at three flexion angles, 0 deg, 30 deg, and 60 deg, and a compressive force of 1000 N to simulate return-to-activity loading. The two-simple suture method was represented within the models to simulate posteromedial meniscal root repairs and the loosening of repairs was derived from previous biomechanical experimental data. Loosening decreased hoop stresses throughout the meniscus, increased posterior extrusion, and shifted loading through the meniscus-cartilage region to the cartilage-cartilage region compared to the anatomic root repair without loosening. Despite differences between repairs and loosened repairs, the changes from loosened repairs more closely resembled the anatomic repair without loosening than the untreated root repair condition. Therefore, meniscal root repairs are susceptible to loosening that will prevent a successful initial repair from remaining in the intended position and will alter cartilage and meniscus mechanics, although repairs that loosen appear better than leaving tears untreated.

MANAGEMENT AND OUTCOME OF ABDOMINAL WALL CLOSURE IN EMERGENCY LAPAROTOMY AT A TERTIARY CARE CENTRE

Objective: Abdominal wall closure of an emergency laparotomy involves a great deal of consideration. An ideal laparotomy wound closure should be efficient. provide strength and serve as a barrier to infection. The aim of this study is to compare and evaluate the advantages of layered closure in comparison with the mass layered closure, the types of suture materials used in the closure, absorbable/nonabsorbable and its correlation with post operative complications such as wound sepsis, burst abdomen and incisional hernia. Methods: This prospective study was carried out over a period of 18 months enrolling a total of 90 patients split into two groups with group 1 undergoing mass closure using both interrupted and continuous methods and group 2 undergoing layered closure using both interrupted and continuous methods of suturing. Results: A higher rate of wound complications was noted in the layered closure group (37.7%) than the mass closure group (17%). Wound complications were also noted to be higher in closures done with prolene suture (37.7%) than PDS (20%). As far as techniques were concerned, interrupted and continuous suturing had a similar rate of complications. Of all the comorbidities, considered in the study, the highest rate of wound related complications were seen in patients with pulmonary complications (13.3%). Conclusion: Although the ideal way to close an abdomen post laparotomy has not yet been discovered, our study shows that mass closure with PDS suture to close the abdominal wall should be advocated as there is decreased early and late post operative wound complications Keywords: PDS.

Use of Porcine-derived Block Bone Substitutes for Guided Bone Regeneration in the Peri-implant Dehiscence Defects of the Mandibular Anterior Region

Purpose: Various bone graf t materials are currently used for guided bone regeneration (GBR), but data are lacking on the superiority of one biomaterial relative to the other. In addition, achieving successf ul bone augmentation remains challenging. When used in GBR, block bone substitutes show better augmentation stability of the bone than particulated bone substitutes. Recently developed sof ttype block bone substitutes are widely used in clinical practice.Materials and Methods: This study enrolled 12 patients who underwent implant placement with GBR in the mandibular anterior region between September 2016 and May 2021 in the Department of Periodontology, Daejeon Dental Hospital, Wonkwang University. GBR was performed using demineralized porcine bone mineral with 10% collagen (DPBM-C; LegoGraf t®) and a resorbable collagen membrane (Bio-Gide® or Ossix Plus®). The surgical site was sutured with 4-0 e-PTFE (Biotex®) and 5-0 nylon (Monosof®) by using modified horizontal mattress and interrupted suture methods. Stitch-out was perf ormed two weeks af ter the operation, and reentry surgery was performed within four to six months af ter the implant surgery.Results: There was a significant decrease in bone thickness af ter five months of implant surgery with GBR compared with the decrease immediately af ter surgery. However, bone gains of more than 1.5 mm were observed at all measurement sites compared with those at baseline.Conclusion: GBR perf ormed using demineralized porcine bone mineral with 10% collagen in combination with a resorbable collagen membrane is an effective and favorable treatment modality for peri-implant dehiscence defects in terms of clinical and radiographic outcomes during the healing period.