Suture Reconstruction Research Articles

Biomechanical evaluation of fixation of the coracoclavicular stand-alone cow-hitch suture reconstruction in comparison to two established techniques for highly unstable distal clavicle fractures (Neer type V)

BackgroundTreatment of displaced distal clavicle fractures with bony avulsion of the coracoclavicular (CC) ligaments often warrants surgical fixation, yet a gold-standard surgical technique is to be defined. The purpose of this study was to compare the biomechanical fixation strength of a new fixation technique, the CC stand-alone Cow-Hitch suture reconstruction, and to compare this technique with a clavicle hook plate and a lateral locking plate with CC suture reconstruction. MethodsSimulated Neer type V distal clavicle fractures fractures of the clavicle were created in 18 cadaveric shoulders, which were matched by age and gender in 3 groups: (1) clavicle hook plate (Group HP), (2) lateral locking plate fixation with CC suture reconstruction (Group LPCC) and (3) CC stand-alone suture reconstruction using the Cow-Hitch technique (Group CH). After preconditioning with 25 N for 10 cycles the specimens were cycled in the coronal plane for 500 cycles from 10N to 70N. Displacement and ultimate load to failure were documented and analyzed with the data acquisition system. ResultsThere was a significant difference in the fracture displacement during cyclic loading between the LPCC group and the HP group (0.6 vs. 1.7 mm; p=0.02), and between CH and HP groups (0.5 vs. 1.7 mm; p=0.004). Fracture displacement was not different between the LPCC and the CH groups (p=0.544). The CH group and the LPCC group showed a significant higher stiffness compared to the HP group (p<0.001 and p=0.003, respectively). The CH group showed a significant higher ultimate load to failure compared with the HP group (429 vs. 172 N; p=0.005), and showed a tendency towards higher ultimate load to failure when compared with the LPCC group (429 vs. 258 N; p=0.071). ConclusionThe CC stand-alone Cow-Hitch suture reconstruction and the locking plate with CC reconstruction showed higher fixation strength compared with the hook plate for simulated Neer type V distal clavicle fractures. There was a tendency of higher ultimate load to failure with the Cow-Hitch technique compared with the lateral locking plate with CC suture reconstruction, and given the potential advantages of less soft tissue stripping, metal-free fixation, low costs, and simple surgical technique, clinical application of the all-suture CC reconstruction using the Cow-Hitch for Neer type V distal clavicle fractures appears warranted.

Ultrasound-guided scalp nerve block in anesthesia of children receiving cranial suture reconstruction

ObjectiveAnalgesia is very important for children with craniosynostosis who are undergoing cranial suture reconstruction. This study investigated the effectiveness and safety of an analgesic technique based on scalp nerve block combined with general anesthesia versus general anesthesia alone.MethodsThis was a single-center, prospective, randomized, controlled study. A total of 60 children aged 6-24 months who underwent cranial suture reconstruction were randomly divided into two groups: Group A (general anesthesia combined with scalp nerve block) and Group N (general anesthesia). The hemodynamics were recorded preoperatively, at 5 min after incision and at 1, 6 and 12 h after surgery; the pain was scored at 1, 6 and 12 h after surgery, and blood glucose was detected at 1 h after surgery.ResultsThe mean arterial pressure and heart rate at 5 min after incision and 1 h after surgery in Group N were higher than those in Group A; the blood glucose and FLACC score in Group N were higher than those in Group A; and the number of postoperative analgesic pump presses were also significantly increased in Group N.ConclusionPreoperative scalp nerve block can reduce hemodynamic fluctuation and postoperative pain in children undergoing cranial suture reconstruction for craniosynostosis. Thus, it can be safely and effectively applied in the anesthesia of these children.

Use of the forgotten joint score (FJS)-12 to evaluate knee awareness after quadriceps tendon reconstruction

BackgroundQuadriceps tendon rupture (QTR) is a severe injury of the knee extensor apparatus. The study aims to validate the use of forgotten joint score (FJS-12) for functional outcome assessing after surgical treatment of QTR.MethodsFifty-seven patients who underwent surgery for QTR with transosseous suture reconstruction in a single orthopaedic surgery and traumatology center between 2015 and 2020 were eligible for enrolment in this retrospective case series. The demographic data and other pre-operative details such as age, gender, comorbidities and medication use also were extracted from the medical records. Patient reported outcome measures (PROMs) were gathered in the form of Western Ontario and McMaster Universities Arthritis Index Score (WOMAC), Tegner Activity Score (TAS), Lysholm Score and FJS-12 at a mean follow-up time of 49.84 months ± 20.64 months. The FJS-12 was validated by correlation with WOMAC, TAS and Lysholm Score.ResultsThe mean age of all patients were 69.2 ± 13.6 years with 51 (89.5%) males and 6 (10.5%) females. The mean time from injury to surgery was 3.39 ± 5.46 days. All patients reported satisfactory functional outcomes after surgery on FJS-12, WOMAC and Lysholm scores, except the TAS, which decreased slightly from pre-operative level. There was a high negative correlation between WOMAC and FJS-12, but moderate positive correlations between FJS-12 and TAS and Lysholm scores. The Cronbach’s alpha value was 0.96 for 12 items in FJS-12.ConclusionThis study has found that FJS-12 is a reliable and easy to assess tool for functional outcomes after QTR reconstruction. It has shown moderate to strong correlation with other commonly used outcome measures (WOMAC, TAS and Lysholm).

The Floating Clavicle: Surgical Technique for Management of an Ipsilateral Acromioclavicular and Sternoclavicular Joint Dislocation

Bipolar “floating” clavicle injuries are infrequent upper-extremity injuries that occur secondary to a high-energy trauma, which can cause dislocation at the sternoclavicular (SC) and acromioclavicular joints. Given the rarity of this injury, there is not a consensus regarding clinical management. Although anterior dislocations can be managed nonoperatively, posterior dislocations may pose a threat to chest-wall structures and typically are managed surgically. Here, we present our preferred technique for concomitant management of a locked posterior SC joint dislocation with associated grade 3 acromioclavicular joint dislocation. Reconstruction of both ends of the clavicle was performed in this case, using a figure-of-8 gracilis allograft and nonabsorbable suture reconstruction for the SC joint, and an anatomic acromioclavicular joint and coracoclavicular ligament reconstruction with semitendinosus allograft and nonabsorbable suture.

Novel Dynamic Screw-Suture Stabilization System for Syndesmotic Repair Provides Better Anteroposterior Translation and Axial Tibiofibular Joint Stability: A Human Cadaveric Study

Category: Ankle; Basic Sciences/Biologics; Trauma Introduction/Purpose: The quest for optimal treatment of acute distal tibiofibular syndesmotic disruptions is still in full progress. Using suture-button repair devices is one of the dynamic stabilization options, however, they may not be always appropriate for stabilization of length-unstable syndesmotic injuries. Recently, a novel screw-suture repair system was developed to address such issues. The aim of this study was to investigate its performance in comparison to a suture-button stabilization of unstable syndesmotic injuries. Methods: Eight pairs of human cadaveric lower legs were CT scanned under 700 N single-leg axial loading in five foot positions - neutral, 15° external/internal rotation and 20° dorsi-/plantarflexion - in 3 different states: (1) pre-injured (intact); (2) injured, characterized by complete syndesmosis and deltoid ligaments cuts simulating pronation-eversion injury types III and IV as well as supination-eversion injury type IV according to Lauge-Hansen; (3) reconstructed, using a screw-suture (FIBULINK, Group 1) or a suture-button (TightRope, Group 2) implants for syndesmotic stabilization, placed 20 mm proximal to the tibia plafond/joint surface. Following, all specimens were: (1) biomechanically tested over 5000 cycles under combined 1400 N axial and +-15° torsional loading; (2) rescanned. Clear space (diastasis), anterior tibiofibular distance, talar dome angle and fibular shortening were measured radiologically from CT scans. Anteroposterior, axial, mediolateral and torsional movements at the distal tibiofibular joint level were evaluated biomechanically via motion tracking. Results: In each group clear space increased significantly after injury (p &lt;= 0.004) and became significantly smaller in reconstructed compared with both pre-injured and injured states (p &lt;= 0.041). In addition, after reconstruction it was significantly smaller in Group 1 compared to Group 2 (p &lt; 0.001). Anteroposterior (AP) and axial movements were significantly smaller in Group 1 compared with Group 2 (p &lt; 0.001, Figure). No further significant differences were identified/detected between the groups (p &gt;= 0.113). Conclusion: Although both implant systems demonstrate ability for stabilization of unstable syndesmotic injuries, the screw- suture reconstruction provides better anteroposterior translation and axial stability of the tibiofibular joint and maintains it over time under dynamic loading. Therefore, it could be considered as a valid option for treatment of syndesmotic disruptions.

Treating AC joint dislocation in pediatric population

Acromioclavicular joint dislocation accounts for approximately 9% of shoulder girdle injuries. These injuries are classified into type I–VI injuries on the basis of the radiographic findings using the Rockwood criteria. Most surgical procedures involving the AC joint primarily involve fixation of the joint and reconstruction of the CC ligament. In children the Ac joint dislocations should not be treated with hook plates or any other rigid plate fixations. Operative intervention is recommended for complete acromioclavicular joint dislocation to restore AC stability, but the best operative technique is still controversial.Patient and Methods: Young patients less than 14 yrs. are considered for this study with more than type 3 dislocation, here suture is used mostly ethibond to reconstruct the Ac joint dislocation .In this study patient were treated with figure of 8 suture reconstruction of Joint .Results: Out of 10 patients 9 patients follow-up for 6months were satisfactory reduction and maintenance of joint reduction, 1 patient got minimal displacement post-Surgery, No superficial infections found during the follow-up. Functional and radiological outcomes were good in 9 patients with mallet grade 5 and one case had grade 4 outcome.Conclusion: Ac joint reconstruction with Ethibond has proved more suitable in both functional outcome along with no need of resurvey or removal.

Real-Time Suture Reconstruction in Rat Skin Stretching Experiments With Multiocular Stereo Vision Measurement System

To investigate the effects of skin stretching stress on tissue expansion and its mechanotransduction mechanism, an animal model of skin stretching was established in our previous work. However, the distribution of stress in the skin cannot be precisely determined in real-time, which leads to an imprecise correlation analysis between stress distribution and protein levels of mechanosensitive molecules. To address this problem, a real-time suture reconstruction method with a multi-ocular stereo vision measurement system was developed in this study. The shape of the suture passing through the rat’s skin can be measured in real-time, and the distribution of skin stress can be precisely determined. The key to real-time suture reconstruction is suture-matching in multi-ocular images, therefore a suture-matching method based on the nearest-neighbor rule and region growing was proposed. First, color markers were fixed on the suture nodes and the frame, secondly, pixels in the frame region are sampled, and the frame inner region is segmented by the nearest neighbor rule. Furthermore, the pixels within the color markers in the region were selected as the seed points for growth, and the markers were segmented using a edge and color integrated detection method. Finally, the markers on the frame were fitted to form a reference line, and the distance between each marker on the suture and the reference line was calculated as the matching feature to realize image matching of nodes in the stereo camera. The three-dimensional coordinates of the nodes were calculated based on region growth, and the sutures were reconstructed using a B-spline curve. The experimental results confirmed the feasibility and high robustness of the proposed method, which ensured accurate three-dimensional reconstruction of the suture.

Robotic left upper lobectomy after immunotherapy with suture reconstruction and reinforcement of the left upper lobe bronchus

Robotic left upper lobectomy after immunotherapy with suture reconstruction and reinforcement of the left upper lobe bronchus

Meniscal Suture Influence on Driving Ability 6 Weeks after Anterior Cruciate Ligament Reconstruction with Hamstring Autograft.

The purpose of this study was to determine if driving ability 6 weeks after anterior cruciate ligament (ACL) reconstruction is affected by the addition of a meniscal suture. It was also hypothesized that no differences in the driving performance would be found between right or left knee surgery subgroups. A total of 82 people participated in this prospective cohort study: 36 healthy controls, 26 patients undergoing isolated ACL (iACL) reconstruction with hamstring autograft, and 20 patients undergoing ACL and meniscal suture (ACL-MS) reconstruction. ACL-MS group followed a weight-bearing and movement restriction protocol during the first 2 postoperative weeks, whereas patients undergoing iACL could start range-of-motion exercises and full weight-bearing ambulation on the first postoperative day. A driving simulator that reproduced real-life driving conditions was used to evaluate driving ability. The software analyzed multiple driving and braking variables. Driving performance in the sixth postoperative week was compared with that of a healthy control group. Subgroup analysis considering additional procedures (iACL, ACL-MS) and the side of the operated knee (right, left) was also performed. No statistically significant differences were found in the demographic characteristics nor in the driving performance (collisions, p = 0.897; sidewalk invasions, p = 0.749; pedestrian impact, p = 0.983) between iACL, ACL-MS, and control groups. No statistically significant differences were found in right-left subgroup analysis. The results of the present study show that patients in their sixth postoperative week after right or left ACL reconstruction showed similar driving performance as compared with a healthy control group, regardless of associating or not a meniscal suture, suggesting it is safe to resume driving 6 weeks after the mentioned surgeries.

Clinical outcomes of a combined osteoligamentous reconstruction technique of Neer Type IIB distal clavicle fractures

PurposeTo evaluate outcomes for a combined osteoligamentous reconstruction technique for Neer Type IIB clavicle fractures. MethodsPatients with Neer Type IIB clavicle fractures treated with combined clavicular locking plate and coracoclavicular ligament suture reconstruction were identified. Demographics, clinical outcomes, and radiographic outcomes were collected. ResultsTwenty-four patients with mean 13 months of follow-up were included. Bony union and normal radiographic coracoclavicular relationship were achieved in 23 (96%) patients. The mean UCLA Shoulder score was 33.3. Three (13%) complications occurred. DiscussionThe combined osteoligamentous reconstruction approach as described is a successful option for treating Neer Type IIB clavicle fractures.

Clinical Analysis of the Effects of Cranial Suture Reconstruction and Frontal Frame Retraction in the Operation of Premature Closure of the Sagittal Suture in Infants.

To compare and analyze the effects of cranial suture reconstruction and frontal frame retraction for surgical treatment of premature closure of the sagittal suture. Infants with premature closure of the sagittal suture were included in this study. All infants underwent preoperative skull model reconstruction using imaging techniques and 3D printing. The infants were then allocated to either the experiment group, where the frontal frame retraction was used to guide the surgical treatment of cranial stenosis, or the control group, where traditional cranial suture reconstruction was performed. All interventions were performed by the same operator. The surgical effects of the two groups were compared. Overall, 28 infants were enrolled in this study, with 15 infants in the experimental group and 13 in the control group. In the one-year post-operative follow-up visit, the cephalic index of scaphoid malformation was 78.3 ± 1.4 in the experimental group and 69.0 ± 4.2 in the control group. The difference between the two groups was statistically significant. Frontal frame retraction surgery can guide the surgical procedure for cranial stenosis, significantly improve the treatment outcome in children with premature closure of the sagittal suture, and improve the form of the head aesthetically in children, and the effect is better than traditional operation; therefore, the technique is worth popularizing in the clinic.

Clinical Analysis of the Effects of Frontal Bone Reconstruction and Cranial Suture Reconstruction in the Operation of Simple Premature Closure of Frontal Suture in Infants.

To compare, and to analyze the effects of cranial suture reconstruction and frontal bone reconstruction in the operation of premature closure of the sagittal suture in infants. A total of 35 infants with simple premature closure of frontal suture were divided into the experimental group (n=18) and the control group (n=17). In the experimental group, the skull model was reconstructed by imaging examination and three-dimensional (3D) printing technique before operation, and the frontal bone reconstruction was used to guide the surgical treatment of cranial stenosis. In the control group, the skull model was reconstructed by imaging examination and 3D printing technique before operation, and the cranial suture reconstruction was performed by the same operator. The surgical effects of the two groups were compared. During the 12-month follow-up after operation, the interfrontal angles of scaphoid malformation were 153.67 ± 12.77 and 128.67 ± 7.90 in the experimental and control groups, respectively. The difference between the two groups was statistically significant. Frontal bone reconstruction surgery can guide the operation of cranial stenosis, significantly improve the surgical treatment effect of infants with frontal suture, and esthetically enhance the head type of infants. Moreover, its effect is better than that of traditional operation, which is worth given significant attention in clinical settings.

Clinical Analysis of the Effects of Cranial Suture Reconstruction and Frontal Frame Band Transfer in the Operation of Premature Closure of Coronal Suture in Infants.

To compare, and to analyze the effects of fronto-orbital band anterior displacement in the operation of premature closure of coronal suture in infants. A total of 31 infants with premature closure of coronal suture were randomly divided into two groups; experimental group (n=16) and control group (n=15). In the experimental group, the skull model was reconstructed by an imaging examination and three-dimensional (3D) printing technique before the operation, and the fronto-orbital band was anteriorly displaced during the operation to guide the surgical treatment of craniosynostosis. In the control group, the skull model was reconstructed by an imaging examination and 3D printing technique before the operation, and the fronto-orbital band was not anteriorly displaced during the operation by the same operator. The surgical effects of the two groups were compared. During the 12-month follow up after the operation, the cephalic index of short head deformity in the experimental group was 80.7 ± 1.1, while that in the control group was 89.3 ± 4.5. There was a significant difference between the two groups. Fronto-orbital band anterior displacement may guide the operation of craniosynostosis and significantly improve the effectiveness of surgical treatment of children with premature closure of coronal suture, which is worth popularizing in the clinical management of cases.

Treatment analysis of craniosynostosis combined with Chiari malformation in children

Objective To explore the surgical method and outcome of craniosynostosis combined with Chiari malformation in children. Methods A retrospective analysis was conducted on the clinical data of 16 children with craniosynostosis combined with Chiari malformation who were admitted to Department of Neurosurgery, Children′s Hospital of Nanjing Medical University from April to December 2017. All cases were retrospectively analyzed and their imaging results were analyzed. Of the 16 children without hydrocephalus, 12 underwent craniofacial reconstruction of cranial suture or craniofacial reconstruction, of which 1 case underwent posterior fossa reconstruction and suboccipital decompression at 7 months post operation. In 4 children with combined hydrocephalus, 3 underwent routine right ventricle-peritoneal shunting and cranial reconstruction, of which 1 case was treated with posterior fossa reconstruction and suboccipital decompression at 5 months post operation. The other 1 case was Pfeiffer syndrome and underwent right ventricle-peritoneal shunting plus posterior fossa reconstruction as well as suboccipital decompression. At 3, 6 and 12 months post operation, all patients were followed up at the outpatient clinic and underwent the reexamination of head MRI for assessment of brain tissue development, ventricle changes and cerebellum tonsil herniation. Results All 16 children underwent operation successfully without any surgical complications. Revealed by the postoperative skull CT, all the children′s cranial cavity volume was enlarged, and the cranial malformation was improved. The follow-up time of 16 children was (12.1±2.0) months (10-18 months). The review of head MRI showed that brain tissue developed well and the position of the cerebellar tonsils did not decline further. All children were free of neurological deficits, and parents were satisfied with the improvement in the appearance of their skulls and faces. Conclusions The combination of craniosynostosis with Chiari malformation should be fully evaluated before surgery and appropriate individualized treatment program should be selected according to specific conditions. One-stage craniofacial surgery seems an effective treatment method. Key words: Craniosynostosis; Arnold-Chiari malformation; Child; Treatment outcome

Laparoscopic Pancreaticoduodenectomy with Major Vein Resection: Single Institutional Experience

Pancreatic cancer is a common tumor of the digestive system with high malignancy, and the incidence is increasing annually. Approximately 40% of pancreatic cancer patients have a locally advanced disease at the first diagnosis. The safety and feasibility of laparoscopic pancreaticoduodenectomy (LPD) has been established in recent years. Pancreatic cancer with major vein involvement, once considered an absolute contraindication of surgical treatment, is now also a potential candidate for LPD. This study aims to describe the detailed surgical procedures (standard procedure and retrocolonic approach in LPD) and provide the short-term outcomes of patients receiving this challenging operation. From August 2016 to November 2017, among 137 patients undergoing LPD at our center, 8 patients received LPD with major vein resection and reconstruction. The patients’ general data, intraoperative parameters, postoperative morbidity, pathological outcomes, and specific information related to SMV/PV resection and reconstruction were extracted and analyzed. The median age of all patients was 53 (range 49–67) years. The median body mass index (kg/m2) and American Society of Anesthesiologists score were 22.7 (range 18.9–30.2) and 2 (range 2–3), respectively. One patient received tangential resection and primary suture reconstruction, 5 patients underwent segmental resection and end-to-end anastomoses, and 2 patients had a segmental resection and prosthetic vein interposition graft. The median duration of operation and total SMV/PV clamping time were 570 (range 440–640) min and 45 (range 30–60) min, respectively. The median intraoperative estimated blood loss was 630 (range 100–1500) ml. Postoperative pathological outcomes revealed pancreatic ductal adenocarcinoma in 7 patients and chronic pancreatitis in 1 patient. Negative margin was obtained in 6 of 7 patients suffering from pancreatic cancer. One positive margin was found due to local cancer infiltration at the retroperitoneal margin. Median lymph node harvest was 13 (range 6–20), and lymph node metastasis was confirmed in 3 patients. No severe complications after LPD were detected. No 30-day or in-hospital mortality occurred. To date, all patients involved in this study were alive without evidence of tumor recurrence except one patient undergoing R1 resection. LPD with major vein resection and reconstruction is safe and feasible in high-volume tertiary centers. Substantial experience in laparoscopic operations and advanced skills of intracorporal vascular suture in open surgeries should be obtained before attempting LPD with major vein resection. A standard LPD procedure and retrocolonic approach should be adopted appropriately according to the results of preoperative imaging studies.

Management of Urethral Lesions and Urethrovaginal Fistula Formation Following Placement of a Tension-Free Suburethral Sling: Evaluation From a University Continence and Pelvic Floor Centre.

Introduction The complication of tape erosion in the urethra following placement of a retropubic (TVT) or transobturator (TOT) tension-free suburethral vaginal sling or an accidental iatrogenic transurethral tape position can result in the formation of a urethrovaginal or vesicovaginal fistula. The objective of the investigation is the evaluation of the management of such rare complications. Patients and Methods Retrospective analysis of 14 patients who were treated for a urethral lesion or urethrovaginal fistula formation status post TVT/TOT placement between June 2011 and February 2018 in the Tübingen University Department of Gynaecology. Results As surgical therapy, 57.1% (n = 8) cases underwent vaginal fistula closure using a Martius flap of the labium majus and in 21.4% (n = 3) using a vaginal rotation skin flap. In 21.4% (n = 3), exclusively vaginal suture reconstruction of the urethra following excision of the tape running transurethrally or tape erosion was performed. 50% (n = 7) of the patients had lasting continence postoperatively without any further need for therapy. In 28.6% (n = 4), there was ongoing stress urinary incontinence, in 21.4% (n = 3) mixed urinary incontinence. Six of the 7 patients with persistent incontinence underwent new placement of a tension-free suburethral retropubic sling (TVT) an average of 8.8 months (5 – 13 months) postoperatively which was uncomplicated in all patients and achieved satisfactory continence. The 3 patients with mixed urinary incontinence and persistent urgency components additionally received anticholinergic medication. During the time period investigated, there were no long-term complications, in particular no recurrent fistulas. Conclusion The rare but relevant complications of a urethral erosion, transurethral tape position or urethrovaginal fistula formation status post TVT/TOT placement can be successfully managed via vaginal surgery. Persistent postoperative urinary incontinence with the need for a two-phase repeat TVT placement following sufficient wound healing must be preoperatively clarified.

Cadaveric Biomechanical Analysis of 3 Lateral Ulnar Collateral Ligament Reconstructions.

To biomechanically assess the angular stability provided by 3 techniques for reconstruction of the lateral ulnar collateral ligament. Eight cadaveric elbows were tested with the lateral collateral ligament complex intact, disrupted from the origin at the lateral epicondyle, and reconstructed with 3 different techniques using ulnar bone tunnels: a suture "lasso" or palmaris longus tendon "lasso" both docked with a metal button at the origin, and a doubled-over palmaris longus tendon docked with metal buttons at both the origin and ulnar insertion. Elbows were tested with a physiologic elbow simulator, and varus angular position was quantified with an optical tracking system. Statistical analysis was performed using a repeated measures analysis of variance test to determine whether significance existed, and a Tukey post hoc analysis to compare statistical difference between native, disrupted, and repair states. There was a statistically significant difference between all repairs and the disrupted state (P < 0.05). The varus angulation after the repairs showed that the suture reconstruction was closest to the native case. The tendon reconstructions were similar to each other but less similar to the native elbow. Quantitatively, the suture reconstruction was within an average of 0.86 degrees of the native elbow throughout range of motion. A suture reconstruction was most similar to a native elbow, but both tendon reconstructions significantly improved angular stability under varus gravitational loads.

Sciatic Nerve Regeneration in Wistar Albino Rats Evaluated by in vivo Conductivity and in vitro 1H NMR Relaxometry

Abstract Objective: The aim of this study was to evaluate and quantify functional and structural nerve regeneration after reconstruction using either direct suture or silicon graft. Methods: Thirty-two adult Wistar Albino rats were divided in two equal groups. The left sciatic nerve was cross-sectioned and reconstructed using either direct suture (DS group) or a silicone graft (SG group). At 4, 6, 8 and 10 weeks two rats were randomly chosen from each group for in vivo measurement of nerve electric conductivity and subsequently sacrificed together with other two rats from the same group for in vitro 1H NMR relaxometry measurements. The T2 distributions were assigned to 1H located in different pools corresponding to the nerve structure. Results: In the injured nerve we observed a significant increase in the stimulation threshold and a decrease in conduction velocity when compared with the healthy nerve in both groups. Whereas the conduction velocity increased progressively from 4 to 10 weeks in the DS group, the opposite evolution was observed in the SG group. In both groups, the first two peaks corresponding to water bound to collagen and epineurium had smaller transverse relaxation times in the injured nerves, while there was no change in the peaks corresponding to perineurium and free water between healthy and injured nerves. Conclusions: Significant differences were observed between direct suture and nerve graft reconstructions from both a functional and structural point of view. In the case of direct suture reconstruction, the nerve was functionally healed at 10 weeks after injury.

Bleeding and blood transfusion during different craniotomies in children with craniostenosis

Objective To conclude the situation of bleeding and blood transfusion during different craniotomy in children with craniostenosis, in order to improve the quality of surgery cooperation and reduce the occurrence of related complications. Methods The study retrospectively analyzed the bleeding and blood transfusion situation during the operation and the occurrence of related complications for 24 children with craniostenosis. The participants received either cranial suture reconstruction or cranial cavity remodeling. Results Cranial cavityremodeling resulted in a higher amount of bleeding and transfusion compared with suture of skull, as well as increased complications of blood transfusion(P<0.05). Conclusions The observation of the vital signs and nursing care during operation should be paid more attention to in order to ensure the safety of the surgery and reduce the related complications for craniostenosis children. Key words: Craniostenosis; Cranial suture reconstruction; Cranial cavity remodeling; Bleeding; Blood transfusion

Inframammary Fold Reconstruction: A Biomechanical Analysis.

Background:Inframammary fold reconstruction has scarcely been evaluated in literature. No biomechanical analyses have been performed comparing different reconstructive methods. This evaluation compares the gold-standard suture reconstruction with an intrarib anchor system (Micro BioComposite SutureTak, Arthrex).Methods:Three analysis groups were compared including 8 Sawbone blocks, 22 embalmed cadaver, and 27 regular cadaver specimens (N = 57). Transient mechanical analysis was performed at 5 N/s using an Instron 5565 test frame.Results:Ultimate load favored the anchor system (compared with the gold-standard suture) by a factor of 9.8 (P < 0.0001) for the regular cadaver group and a factor of 1.7 (P < 0.038) for the embalmed cadaver group. A similar statistically significant benefit was shown for stiffness and load at 2-mm displacement.Conclusions:This analysis showed an anchor system to be the biomechanically superior fixation method in terms of ultimate load, fixation stiffness, and displacement at failure when compared with the gold-standard suture method in inframammary fold reconstruction. Because of superior stability in every aspect, an anchor system may be considered for inframammary fold reconstruction.