Suspension Sutures Research Articles

Clinical and radiography results of mini-plate fixation compared to suture suspensory fixation in cervical laminoplasty: A five-year follow-up study

ObjectivesLamina closure is the most common reason for failure of unilateral open-door laminoplasty. Mini-plate fixation was designed to solve such problem. We assessed the clinical outcomes and radiography results of mini-plate fixation by comparing it with suture suspension fixation. Patients and methodsThis prospective study enrolled 57 patients with multi-segment cervical spondylotic myelopathy between January 2008 and March 2010. Thirty-four patients underwent laminoplasty with mini-plate fixation (mini-plate group) whereas 23 patients underwent laminoplasty with suture suspension fixation (suture group). The neurological function was measured with the Japanese Orthopedic Association (JOA) score. Cervical range of motion (ROM), C2–7 angle, and the spinal canal expansive parameters (anteroposterior diameter, Pavlov's ratio, cross-sectional area, and open angles) were evaluated. ResultsThe mean follow-up time was 64 (60–82) months. There were no significant differences in preoperative JOA scores (p=0.191), postoperative JOA scores (p=0.700), preoperative cervical ROM (p=0.315) and preoperative C2–7 angle (p=0.074) between the two groups. Both groups had significant postoperative JOA improvement (p<0.05). The mini-plate group had larger cervical ROM (p=0.041) and C2–7 angle (p=0.040) than the suture group at the final follow-up. Both groups showed significant improvement in the spinal canal expansive parameters immediately after the surgery. In the suture group, the parameters, such as anteroposterior diameter, Pavlov's ratio, cross-sectional area, and open angles, decreased along with time, mainly within the first 6 months following the operation. In the mini-plate group, these parameters remained unchanged. The spinal canal expansive parameters between the 2 groups were not significantly different immediately following the operation, but were significantly different at the final follow-up (p<0.05). Three patients in the suture group displayed neurological deterioration due to lamina reclosure. ConclusionsLaminoplasty by mini-plate fixation preserved more cervical ROM and better cervical alignment, maintained cervical spine canal expansive stability and effectively avoided lamina reclosure for a long-term follow-up.

Suture Suspension Arthroplasty for Thumb Carpometacarpal Arthritis Reconstruction: Long-term Outcome: Level 4 Evidence

A simple reconstructive method for treating advanced arthritis of the thumb carpometacarpal (CMC) joint with suture suspension arthroplasty (SSA) is a reliable, low morbidity procedure, providing a simpler alternative with similar long-term outcomes, compared to trapeziectomy procedures, with or without ligament reconstruction. SSA technique for thumb CMC arthritis reconstruction consists of trapeziectomy via a single volar incision and a four-strand intra-articular suture (0 gauge non-absorbable) suspension sling, creating a “hammock” between the distal-most insertions of the abductor pollicis longus and the flexor carpi radialis. This construct is pulled firmly, tethering the base of the thumb towards the base of the index metacarpal, correcting the subluxation deformity and maintaining arthroplasty space. All procedures were performed by the senior author, averaging 22 minutes operative time, followed by 14 days of post-operative immobilization, then short opponens splinting for four weeks and rehabilitation protocol (1DelSignore J.L. Accardi K.Z. Suture suspension arthroplasty technique for basal joint arthritis reconstruction.Tech Hand Upper Extrem Surg. 2009; 13: 166-172Crossref PubMed Scopus (29) Google Scholar), progressing to unrestricted use by 12 weeks. Long-term evaluation of 117 thumbs (average 89.4 months) with strength measurement and QuickDASH questionnaire, were analyzed with a paired t test. Final Xrays were obtained. 117 out of 153 thumbs in 110 patients (76% recall) were available for long-term follow up averaging 89.4 months (80-104 months). 96 patients were female, 21 male. Statistically significant (P < 0.05) improvement in pain relief, patient satisfaction, grip, key and tip pinch strength, and functional improvement was noted in the majority of patients. Average QuickDASH score (0.3) at final follow up indicated good to excellent satisfaction and functional use in the majority of patients. Xray evidence of subsidence averaged 30% (0-90%). One patient (0.8%) required revision surgery. Flexor carpi radialis rupture occurred in 7 (6%) thumbs after a sudden stress activity around 4-6 weeks post op, requiring no additional treatment. •Suture suspension arthroplasty for thumb CMC arthritis reconstruction is a simple, reliable method. Patient advantages include lower morbidity as a result of a single incision without tendon sacrificing, and avoidance of potential complications related to multiple incisions, tendon harvesting, drill hole formation, hardware implantation, pin fixation, or prolonged immobilization. Most patients are able to resume normal, unrestricted use at 12 weeks post-operative.•This method is cost-effective, utilizing less operative time, and does not require additional cost of implants or anchors.•Long-term results of suture suspension arthroplasty show similar outcomes as described with other methods of trapeziectomy, with or without ligament reconstruction (2Vermeulen G.M. Slijper H. Feitz R. Hovius S.E. Moojen T.M. Selles R.W. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review.J Hand Surg Am. 2011; 36: 157-169Abstract Full Text Full Text PDF PubMed Scopus (265) Google Scholar), resulting in a very high degree of patient satisfaction, with a simple, minimally invasive, and cost-effective option.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Power-Assisted Liposuction Mammaplasty (PALM): A New Technique for Breast Reduction.

Resection and reshaping of the parenchyma are common procedures to produce a natural breast shape in reduction mammaplasty and mastopexy. The challenges of these practices include maintaining sensitivity of the nipple-areola complex (NAC), achieving upper-pole fullness, and preserving an adequate blood supply for patients with massive breast ptosis. The authors describe their experience with power-assisted liposuction mammaplasty (PALM), a novel technique for breast reduction. One hundred fifty consecutive women (300 breasts) who underwent PALM were evaluated in a prospective study. Minimizing skin undermining and glandular resection ensured maximal blood supply to the breast. A lateral pedicle was created to preserve NAC sensitivity. The transposed gland was contained within a large pocket made in the upper-inner quadrant. Glandular suspension sutures from the dermis to the chest wall stabilized the breast and recreated the inframammary fold. The mean distance from the nipple to the sternal notch was 36 cm, the mean NAC elevation was 16 cm, the mean lipoaspirate volume per breast was 650 cc, and the mean glandular resection mass per breast was 240 g. Complications included wound infection (6 of 300 breasts, 2%), wound dehiscence (3 breasts, 1%), and seroma (9 breasts, 3%). Partial areolar necrosis occurred in 2 of 150 patients (1.3%), and 9 patients (6%) underwent revisional surgery. PALM is a safe and reliable option for breast reduction and is indicated for patients with massive breast ptosis. LEVEL OF EVIDENCE 4: Therapeutic.

Risk factors for ureteral occlusion during transvaginal uterosacral ligament suspension.

To determine any risk factors associated with ureteral occlusion during transvaginal uterosacral ligament suspension (USLS). A retrospective query to identify patients that underwent transvaginal USLS at a teaching hospital from 2008 to 2013 was performed. Patients in which ureteral occlusion was identified by cystoscopy were identified (cases), and compared with those without occlusion (controls). Medical records were reviewed for data abstraction. Variables compared between cases and controls included demographics, medical history/examination, concomitant procedures, number of suspension sutures placed, estimated blood loss and length of hospital stay. Univariate analyses were performed to identify potential risk factors for ureteral occlusion, followed by multivariate regression analysis to estimate odds ratios for identified predictors. A total of 144 USLS procedures were performed. Thirteen cases of ureteral occlusion were identified (9%). Baseline prolapse stage, body mass index, parity, previous hysterectomy or pelvic surgery of the groups were similar (all P > 0.05). Univariate analysis identified age (P = 0.04), concomitant anterior colporrhaphy (P = 0.01), and use of a suture-capturing device for suture placement (P = 0.04) as significant factors. On multivariate logistic regression analysis, concomitant anterior colporrhaphy increased ureteral occlusion risk (OR 10.5, 95%CI 2.37-74.99, P = 0.001), while use of a suture-capturing device decreased it (OR 0.1, 95%CI 0-0.41, P = 0.01). The mean number of suspension sutures placed per side was similar in the two groups (2.6 [range 2-4] for cases and 2.4 [range 1-4] for controls, P = 0.15). During transvaginal USLS, performance of a concomitant anterior colporrhaphy increased the risk of ureteral occlusion, while the use of a suture-capturing device for suspension suture placement was associated with decreased risk.

Alar Suspension Sutures in the Management of Nasal Valve Collapse.

This study assesses the efficacy of alar suspension sutures in the management of nasal valve collapse causing nasal obstruction. These sutures are inserted between the vestibular skin and lateral crura and hitched to the periosteum of the medial inferior orbital margin; this is a variation of the alar (change everywhere) suspension suture technique. A retrospective review of patients who underwent alar suspension suture insertion between January 2009 and December 2010 in the management of nasal obstruction was undertaken. Symptoms of nasal obstruction were assessed using the Visual Analogue Scale (VAS) and peak inspiratory flow rate (PIFR). This was measured preprocedure and repeated at 3, 6, and 12 months postoperatively. A total of 35 patients were identified, and 26 were included in the study; 90% of patients were satisfied with the outcome of surgery, supported by improvement in the VAS and PIFR scores. The mean difference in VAS preprocedure and postprocedure was 4.97 (P value = 0.00), and the average improvement in PIFR was 25.5 L/min (P value = 0.00). Our study shows a significant improvement in patient's symptoms following insertion of alar suspension sutures. It is, therefore, a reliable, safe, and effective technique in treating nasal obstruction secondary to nasal valve collapse.

Single-Incision Laparoscopic Splenectomy Using the Suture Suspension Technique for Splenomegaly in Children with Hereditary Spherocytosis.

With increasing laparoscopic surgery experience and improved new vessel-sealing equipment, single-incision laparoscopic surgery (SILS) for splenectomy has emerged as an alternative to multiport laparoscopy, but the application of SILS for splenomegaly is still challenging due to technical difficulties. The aim of this study was to describe the suture suspension technique contributing to SILS for hereditary spherocytosis (HS). A retrospective review was conducted to evaluate all SILS for splenomegaly performed by a single surgeon. On preoperative ultrasonography, the spleen size index ranged from 0.67 to 0.82. An umbilical incision was used for the placement of a multichannel single port. To provide excellent exposure of the splenic hilum, a needle with a 1-0 suture was percutaneously introduced from the left hypochondriac region and then penetrated out the anterior chest wall for suspending the enlarged spleen. Dissection was facilitated by the use of a 5-mm curved reusable grasper and a 5-mm Harmonic(®) scalpel (Ethicon Endo-Surgery, Cincinnati, OH), and the splenic vessels were ligated with 5-mm Weck(®) Hem-o-lok(®) clips (Teleflex(®), Morrisville, NC). The resected spleen was placed in an endosurgical bag, morcellated, and removed from the abdomen via the umbilical incision. Nine children underwent SILS during the study period without conversion to open procedures or requiring additional ports. The suture suspension technique was successfully used and markedly improved the exposure of the splenic hilum. The operative time was 122.6 ± 31.2 minutes, and the extracted spleen weight was 562 ± 74.5 g (range, 420-1260 g). No intraoperative or postoperative complications were recorded. The umbilical incision healed well with a satisfactory cosmetic effect. Our outcome shows the suture suspension enables safe and feasible usage of SILS for the management of splenomegaly in children with HS. More experience is needed to assess advantages and disadvantages compared with the standard laparoscopic approach.

Warthin's Tumor of the Parotid Enlarged by a Facelift Suture.

Warthin's Tumor of the Parotid Enlarged by a Facelift Suture.

Surgical anatomy relevant to the transpalpebral subperiosteal elevation of the midface.

The surgical anatomy of the midface relevant to its subperiosteal elevation and repositioning is assessed. The aim of this study is to give more details on the anatomy relevant to the midface lift. Twenty hemifacial dissections were performed. The location of the zygomatic branches of the facial nerve (ZBFN) and the terminal branches of the infraorbital nerve (ION) were dissected. The location of the masseteric and zygomatic ligaments and the elevation of midface following their release were documented. On average, there were 3 branches of the facial nerve innervating the zygomatic major muscle and 1.8 branches entering the muscle superior to the caudal origin of the zygomaticomaxillary (ZM) suture. The most superior ZBFN was found to lie at an average of 6.2 ± 1.6 mm cranial to ZM suture and 1.4 ± 0.4 mm superficial to the bone. The most inferior branch was at a mean of 4.8 ± 3.3 mm inferior to ZM suture. On average the ION had 5.2 branches that traveled for 10.2 mm above the periosteum before they passed into a superficial plane. Division of the zygomatico-masseteric retaining ligaments allowed for elevation of the midface by 4.8 ± 1.0 mm medially and 5.5 ± .9 mm laterally. Branches of the ZBFN and ION lie in close proximity to the subperiosteal plane in the midface. These branches are at risk for damage during release of the upper zygomatic ligaments and placement of the periosteal suspension sutures during midface elevation procedures.

The suspension (Frost) suture: experience and applications.

The Frost suture is a well-known surgical technique for providing upward tension on the lower lid to prevent or correct ectropion after surgical interventions in the periorbital area. Despite its relatively common use, comprehensive information on executing this technique is not readily available. To review eyelid anatomy, indications, and proper technique for performing the Frost suture, as well as potential complications. A review of the literature on Frost sutures was performed. Cadaveric dissection was performed to demonstrate placement of the Frost suture. The Frost suture is a useful method to reduce the risk of ectropion after surgery near the lower eyelid. Downward pull on the lid can occur with normal wound contracture even if ectropion is not present with the initial repair, reinforcing the need for preventive measures. Potential complications of this technique include superficial skin erosion of the upper lid, corneal abrasion, and blockage of the field of vision while the suture is in place.

Lower recurrence rate with full-thickness mesh fixation in incisional hernia repair.

To share the lower recurrence rate achieved during long-term follow-up by repairing incisional hernias (IHs) with full-thickness fixation of onlay mesh. We retrospectively analyzed 196 IH cases operated on by the same surgeon between 2002 and 2013. After exclusions (unrelated death, lack of follow-up), 154 cases were included. Abdominal examination findings, recurrence dates (if accessible), and imaging results were obtained from computer records and evaluated. Intraoperatively, all hernial sac adhesions were separated to reveal the anterior abdominal wall, and full-thickness suspension sutures were placed 6-8 cm lateral to the fascial edge at 2-cm intervals, excluding the peritoneum. The primary fasciae were closed, suspension sutures were passed through the mesh holes, and the mesh was fixed as an onlay, leaving no space between the fasciae. In total, 154 subjects with IHs were analyzed: 107 (69.5%) females and 47 (30.5%) males. The mean patient age was 52.60 years [standard deviation (SD) 11.24 years], and the mean fascial defect diameter was 77 cm(2). The average operation time was 128 min (SD 42.5 min), and the average patient follow-up time was 54 months (SD 22.8 months). Eight (5.2%) patients developed recurrences after full-thickness mesh fixation, and ten subjects (6.5%) had persistent pain in the operative area for longer than 3 months. Full-thickness mesh fixation mechanically supports the fascia, especially in the early postoperative period, and enables homogeneous fibrous healing in a wide area, preventing mesh migration; we believe that these attributes are crucial in reducing the IH recurrence rate.

Proximity of Uterosacral Ligament Suspension Sutures and Sacral Nerve Roots to Pelvic Anatomic Landmarks

Proximity of Uterosacral Ligament Suspension Sutures and Sacral Nerve Roots to Pelvic Anatomic Landmarks

Erratum to: Prevention of Lower Eyelid Ectropion Using Nonincisional Suspension Sutures after Blepharoplasty

Erratum to: Prevention of Lower Eyelid Ectropion Using Nonincisional Suspension Sutures after Blepharoplasty

Erratum to: Prevention of Lower Eyelid Ectropion Using Nonincisional Suspension Sutures after Blepharoplasty

Erratum to: Prevention of Lower Eyelid Ectropion Using Nonincisional Suspension Sutures after Blepharoplasty

A comparison of single-port laparoscopic cholecystectomy and an alternative technique without a suspension suture

Many surgeons face difficulties during single-incision laparoscopic cholecystectomy (SILC) surgery and are forced to use an additional port. We compared the results of a technique that we developed with SILC. Fifty-four patients who were diagnosed with chronic cholelithiasis were prospectively randomized and divided into two groups. An additional 5-mm port (MCAP: with an additional port using a multi-channel device through the umbilicus) was placed in the subxiphoid area instead of a transabdominal suspension suture in one group of patients. The other group was operated on with the SILC technique. The demographic and surgical data of the patients were compared. The MCAP technique shortened the surgery duration by more than half (MCAP: 35.0±12.3, SILC: 79.1±27.7 min) (p<0.05). No difference was found between the two methods in terms of estimated blood loss, length of hospitalization, postoperative day 1 and 7 visual analog scale scores, need for analgesia in the postoperative period, and rate of changing to another technique due to inadequacy of the surgical technique. MCAP is as safe as SILC for cholecystectomy and is easier for the surgeon to perform.

Triangular With Ala Nasi (TAN) II Repair of Unilateral Cleft Lips With Severe Nasal Deformity

With our previous technique called triangular with ala nasi (TAN) repair, we combined the superiorities of these 2 popular techniques by approaching the skin, as in Tennison-Randall, and the muscle and nose, as in Millard. Although good results have been obtained in most patients, cleft lip nose (CLN) deformity could not entirely be corrected particularly in serious cleft patients. Therefore, we revised the technique, called the TAN II repair, by adding some nasal maneuvers including the bivectoral suspension sutures, alar buckling resection, and alar web resection. Forty-two consecutive patients (26 male and 16 female) with unilateral cleft lips were operated on using the TAN II technique in the last 5 years. The mean age at repair was 11.95 months (range, 3 to 120). The postoperative outcomes were assessed subjectively by Williams test and objectively by Lindsay-Farkas method. The mean follow-up time was 16.3 months. No early complication involving hematoma, infection, wound dehiscence, or partial or total flap loss was encountered. The recoveries of 92.42% and 88.89% on average, when compared with the noncleft side, were obtained postoperatively. With these modifications, the TAN II technique was able to correct the severe unilateral CLN deformities. We obtained good to excellent outcomes in late postoperative follow-up by means of a long-term suspension effect.

Ten-year follow up after laparoscopic suture rectopexy for full-thickness rectal prolapse

Studies have shown that recurrence rates of full-thickness rectal prolapse (FTRP) 5 years after surgery can quadruple at 10 years. This study aimed to evaluate the impact of laparoscopic suture rectopexy for FTRP on recurrence rates and functional outcome at a median follow up of 10 years. Prospectively collected data for patients who underwent laparoscopic suture rectopexy for FTRP between 1993 and 2006 were analysed. Laparoscopic rectopexy consisted of circumferential mobilization of the rectum down to the levator followed by suture suspension to promontory. Patients with preexisting constipation or who were unfit for general anaesthesia were not included. Incontinence, quality of life and constipation were assessed by validated scores. Recurrence-free curves were generated using the Kaplan-Meier method. One hundred and seventy-nine patients with a median age of 62 (15-93) years including 174 women and five men underwent laparoscopic suture rectopexy. There was no mortality. The 30-day complication rate was 4% (partial transection of the left ureter, pneumonia, urinary tract infection, urinary retention, superficial surgical site infection). Data on 172 patients (96%) were available at follow up. There were 10 recurrences of FTRP at 5-year follow up giving a crude recurrence rate of 6%. The actuarial 10-year recurrence rate was 20% (95% CI, 10.8-20.1). Follow-up continence (P < 0.0001) and quality of life were better than preoperatively: lifestyle (P < 0.001), coping (P < 0.001), self-perception (P < 0.005), embarrassment (P < 0.06). Constipation was unchanged. Laparoscopic suture rectopexy led to few complications, a recurrence rate of 20%, improved continence and quality of life with no worsening of constipation at 10 years.

Technical Pearls in Rhinoplasty

Program Description: Four experienced rhinoplasty surgeons divulge their 3 techniques that prove useful in almost every case. Every component of rhinoplasty will be covered systematically with tips being offered on the straight dorsum, functional middle vault, and the refined tip. Videos or step-by-step photographs will enable attendees to quickly grasp how and when to use these maneuvers to consistently improve their patient outcomes. Topics to be covered include grafts in rhinoplasty made easy, management of the lateral crus, ultrasonic sculpting of the dorsum, suture fixation techniques revisited, and critical closing steps. Educational Objectives: (1) Employ suture techniques such as medial crural fixation stitch and upper lateral cartilage suspension sutures to maintain tip projection and middle vault competency, respectively. (2) Select cartilage grafts that camouflage defects, reinforce projection, and maintain the nasal airway. (3) Choose appropriate tip refinement techniques to consistently improve patient outcomes.

Pilot laparoscopic ileal cannulation in pigs

Zhang, S. X., Wang, H. B., Zhang, H., Liu, H. F., Zhou, Z. F., Zhang, J. T. and Gao, L. 2014. Pilot laparoscopic ileal cannulation in pigs. Can. J. Anim. Sci. 94: 371–377. Pilot laparoscopic ileal cannulation was performed in eight anesthetized pigs (40.5±1.9 kg) positioned in dorsal recumbency using three portals in the abdomen. The T-shaped ileal cannulation site was located 15 cm anterior to the ileocecal valve on the antimesenteric section of the ileum. A transabdominal suspension suture was placed approximately 3 cm caudal to the ileal cannulation site. A purse-string suture was placed first around the insertion site, and a stab incision was made in the middle of the purse-string suture. The T-shaped cannula was inserted into the ileal lumen through the stab incision, and the purse-string suture was tightened. The T-shaped ileal cannula was pulled out of the abdominal cavity through the exit wound located 3–5 cm lateral and 10–12 cm caudal to the right or left side of the umbilicus. The transabdominal suspension suture was then removed. The T-shaped cannula was secured to the skin with a finger-trap suture. Surgical time and complications were recorded. Repeat laparoscopy was performed 35 d later. No major intraoperative or postoperative complications were encountered. The ileal contents were collected easily. On repeat laparoscopy, firm adhesion between the ileum and the abdominal wall was observed in all pigs, and there was no evidence of digesta leakage or consequential peritonitis.

Mitek Bone-anchored Static Suture Suspension of the Oral Commissure

Mitek Bone-anchored Static Suture Suspension of the Oral Commissure

English

Single-incision laparoscopic surgery (SILS) is a recent advance that has taken the surgical community by storm. Single-incision laparoscopic cholecystectomy (SILC) is perhaps the most common SILS procedure used to treat patients with gallstone disease. There are three approaches to SILC: (a) one that uses special, purpose-made access devices or ports for introducing the laparoscope and instruments which are usually, but not always, roticulating ones; (b) passing three 5-mm trocars side-by-side through the fascia after exposing a wide area via a single umbilical incision; and (c) using two trocars at the umbilicus along with suspension sutures to retract the gallbladder. This article provides a detailed, step-by-step description of a technique of SILC using standard laparoscopic instruments. AIM: To evaluate the feasibility, advantages and shortcomings of Single Incision Laparoscopic Cholecystectomy using standard laproscopic instruments. METHOD: We attempted SILC in 50 patients between August 2011 and May 2012 and completed it successfully in 45 (unpublished data). The procedures were performed for elective indications (N=50). CONCLUSION: We have presented a technique of SILC using standard laparoscopic instruments that emulates all the steps of a safe multi-port cholecystectomy. We found that the technique has a relatively short learning curve and is reproducible. Preliminary studies show that SILC carries certain benefits over MLC. However, SILC should be considered a technique under evolution and further larger studies are required before it can be accepted as a replacement to Multi port Laparoscopic Cholecystectomy.