Suture Group Research Articles

Cosmetic Outcome of Wound Closure between Steri-Strips (3M™ Steri-Strip) and Simple Interrupted Nylon 6-0 Sutures in Out-Patient Cervical Lymph Node Excision: A Randomized Controlled Trial

Objective: To compare the aesthetic outcome of cervical lymph node excision skin closure between Steri-Strips closure and simple interrupted sutures using Nylon 6-0. Materials and Methods: The present study was a single-blinded randomized controlled trial of forty patients with cervical lymph node excision. They were randomized into two groups of twenty. The first group was allocated to close the skin by simple interrupted sutures with Nylon 6-0, the other group received the Steri-Strips for skin closure. Complications were observed at the first and second week. The aesthetic outcomes for skin closure were evaluated at 12 weeks postoperatively using the predetermined Sakka’s cosmetic assessment criteria and scoring system. Results: There was no statistically significant difference between the two groups in terms of gender, age, length of surgical wound, and pathology. The Steri-Strips group showed significantly lower Sakka’s aesthetic score compared to the 6-0 Nylon sutures group (6.25±0.85 and 7.75 ±1.33, p<0.001). There was no significant difference in aesthetic outcomes between genders. Moreover, the operative time of the Steri-Strips group was significantly less than that of the 6-0 Nylon sutures group (2.2±0.41 and 4.75±0.44 minutes, p<0.001). Conclusion: Skin closure with Steri-Strips gave better aesthetic outcomes compared to the 6-0 Nylon sutures (p<0.001). However, the aesthetic outcomes were assessed by physicians, so the patients’satisfaction could not be assessed. Keywords: Lymph node biopsy; Hypertrophic scar; Keloid; Cosmetic outcome; Steri-strip

Sutures versus clips for skin closure following caesarean section: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials.

To evaluate comparative outcomes of skin closure with clips and sutures after caesarean section (CS). We conducted a systematic search of electronic information sources and bibliographic reference lists. Wound infection, wound separation, haematoma, seroma, re-admission, closure time, length of hospital stay, patient scar assessment scale (PSAS) and the observer scar assessment scale (OSAS) were the evaluated outcome parameters. We identified 16 randomised controlled trials reporting a total of 4926 patients who had skin closure with sutures (n = 2724) or clips (n = 2202) following CS. Use of clips was associated with a significantly higher rate of wound separation (risk ratio (RR): 2.33, P = 0.004) and longer length of hospital stay (mean difference (MD): 1.21, P = 0.03) but shorter closure time (MD: 5.35, P = 0.00001) when compared to sutures group. There was no significant difference between the two groups in the risk of wound infection (RR: 1.12, P = 0.75), haematoma formation (RR: 2.46, P = 0.23), seroma (RR: 1.17, P = 0.73), re-admission rate (RR: 1.28, P = 0.73), PSAS (MD: 0.44, P = 0.73) and OSAS (MD: 0.32, P = 0.55). Trial sequential analysis showed the meta-analysis was conclusive for wound infection, wound separation and closure time; however, it was inconclusive for length of hospital stay, PSAS and OSAS due to risk of type 2 error. This meta-analysis of best available evidence (level 1) demonstrated that although skin closure with subcuticular sutures is more time-consuming than clips, it is associated with a significantly lower risk of wound separation and shorter length of hospital stay.

Comparison of double-strand braided polyester sutures tension band (Nice knot) with cable tension band in transverse patellar fractures

BackgroundThe tension band technique is the most common method for internal fixation of transverse patellar fractures. Titanium cable and high-strength sutures have been successfully applied in this treatment; however, few studies have compared the Nice knot technique using sutures with the standard cable technique. Whether the suture technique (Nice knot) provides preferable results compared with those of the cable technique is unclear. MethodsForty patients with transverse patellar fractures participated in this study. Twenty patients underwent sutures tension band fixation (Nice knot), and the others were managed with cable tension bands. All patients were followed up at 1, 3, 6, and 12 months. Pain was measured by VAS scores, flexion and extension of the knee were measured in degrees by goniometry, and knee function was evaluated using the Böstman clinical grading scale. ResultsThe two groups had equal distributions in age, gender, injured side, and fracture classification. The mean operation time in the suture group was shorter (55.75±9.77 minutes versus 64.25±9.63 minutes). The VAS score was comparable in the two groups at the 1-month, 3-month, and 6-month follow-ups; however, the score was lower at 12 months postoperatively in the suture group (P=0.037). No significant difference was found in flexion, extension, Böstman score, or fracture healing time in either group (P>0.05). Postoperative complications were higher in the cable group (9 versus 2) (P = 0.031) but were mostly related to symptomatic soft tissue irritation. ConclusionThe suture tension band technique using braided polyester nonabsorbable sutures tied with Nice knot was as effective as the cable tension band technique for transverse patellar fracture management. However, more convenient operations, less cost and fewer complications were found in suture fixation (Nice knot).

Comparison of decentration, tilt and lenticular astigmatism of ıntraocular lens between sutured and sutureless scleral fixation techniques

To evaluate at six months the intraocular lens (IOL) decentration, tilt and lenticular astigmatism between foldable sutured and sutureless scleral fixation IOLs compared to conventional phacoemulsification surgery. We retrospectively reviewed records for 22 eyes with sutureless scleral fixation, 16 eyes with sutured scleral fixation and 23 eyes with conventional phacoemulsification. IOL decentration and angle of IOL tilt were compared on Scheimpflug images 6 months after surgery. Lenticular astigmatism is described as the difference between refractive and net corneal astigmatism. The angle of tilt in both meridians was significantly lower in the sutureless group than in the sutured group (P=0.008 horizontally and P=0.002 vertically). IOL decentration did not show a significant difference between the three groups in either horizontal or vertical meridians (P˃0.05). Lenticular astigmatism was significantly lower in the sutureless and control groups than in the sutured group (P=0.003 and P<0.001). In addition to being relatively quick and easy to perform, the sutureless scleral fixation technique showed superior results in terms of IOL tilt and lenticular astigmatism at the six-month follow-up compared to the sutured technique.

Is Placing Prophylactic Dural Tenting Sutures a Dogma?

In this study, we investigated if and when dural tenting sutures are necessary during craniotomy. Results from 437 patients 18-91 years of age (average, 43.5 years) who underwent supratentorial craniotomy between 2014 and 2019 were evaluated. The patients were categorized into 1 of 3 groups: patients who had at least 3 prophylactic dural tenting sutures placed before opening of the dura (group 1); patients who had at least 3 dural tenting sutures placed after surgery was completed, during closure (group 2); or patients who had no dural tenting sutures (group 3 [control]). All such sutures in groups 1 and 2 were placed in the circumference of the craniotomy and dural junction. No central dural tenting sutures were placed in any of the patients. Among the 437 patients, 344 underwent surgery for the first time and 93 were undergoing a second surgery. Cranial computed tomography imaging was performed for each patient 1 hour, 3 days, and 1 month after surgery. In group 1, 3 patients had a cerebral cortex contusion and 2 patients had acute subdural hematoma after the sutures were placed. In groups 2 and 3, none of the patients had a cerebral cortex contusion or acute subdural hematoma. Fewer complications were observed when duraltenting sutures were placed during postsurgical closure. Placing dural tenting sutures is an important technique for ensuring hemostasis. However, when not needed, they seem to cause inadvertent complications. As our results suggest, knowing when and where to use them is equally important.

Comparative Analysis of Safety and Feasibility of Suture Versus Sutureless Pediatric Cataract Surgery.

To compare the safety, feasibility, and outcomes of clear corneal cataract surgery with or without sutures in children (2 to 8 years old) with congenital or developmental cataracts. One hundred seventy consecutive eligible eyes with pediatric cataracts were randomized into treatment groups depending on closure of clear corneal incisions: suture group and sutureless hydroclosure group (sutureless group). Patients were evaluated on days 1, 7, 30, and 90 postoperatively, with an emphasis on wound leakage from incisions and complications. Wound leakage from any corneal incisions was not observed in both groups. Shallow anterior chamber on the first postoperative day was observed in 2 and 3 eyes in the suture and sutureless groups, respectively (P = .48). Hypotony was not observed in any patients. Intraocular pressure measurements were comparable on follow-up visits (P > .05). Mean cylindrical error was significantly greater (P = .03) in the suture group than the sutureless group (1.01 and 0.74 diopters, respectively) after 1 month. One patient developed endophthalmitis after suture removal in the suture group. Sutureless hydroclosure of incisions is not inferior compared to suturing in pediatric cataracts. This avoids suture-related complications while reducing the astigmatic error and is thus potentially less amblyogenic. However, sutures must be used whenever the incision architecture is compromised. [J Pediatr Ophthalmol Strabismus. 2021;58(4):246-253.].

Comparison of efficacy of conjunctival autografts using sutures and fibrin glue in patients undergoing pterygium excision surgery

Background: Pterygium is a wing-shaped ocular surface lesion traditionally described as an encroachment of bulbar conjunctiva onto the cornea. Hence; the present study was undertaken for comparing the efficacy of conjunctival autografts using sutures and fibrin glue in patients undergoing pterygium excision surgery. Materials & Methods: 40 patients presenting with the pterygia of various types were enrolled. Patients were divided into 2 groups with 20 patients in each group, for applying sutures and fibrin glue to one group each. Each eye of the patient was considered as one case. Screening of the patient by brief history and general physical examination was done. Diffuse torch light examination for details of the pterygium and to rule out any other gross ocular pathology. Follow-up was done and postoperative findings were compared. Results: Mean duration of surgery of the suture group and the glue group were 31.5 minutes and 18.4 minutes respectively. Significant results were obtained while comparing the mean duration of surgery. Patient discomfort was significantly less in the glue group in comparison to the suture group. Conclusion: From the above results, the authors concluded that the use of fibrin glue to attach the free conjunctival autograft in pterygium surgery produces shorter operating time and less post-operative discomfort as compared to sutures.

Comparing the closure of hepatocaval ligament using stapler or suturing in liver surgery

HCL is localized on the posterior and lateral side of the retrohepatic IVC, above the right adrenal vein. Bleeding due to retro-hepatic cava injury could sometimes occur during the dissection and closure of hepatocaval ligament (HCL). We aim to determine closing methods of HCL in terms of cost, ease of application and safety. The study population included 90 recipient hepatectomy patients who had cadaveric and live-donor liver transplantation at Organ Transplant Center of Acıbadem Hospital between 2017 and 2019. The patients were divided into two groups. The first group contained 40 patients who were closed with 25 mm EndoTA 30 stapler. The second group contained 50 patients who were closed by continuous double-layer suturing with propylene 5/0. In the group closed by endovascular stapler, reinforcement suturing was performed in eight patients (20%) using 5/0 propylene suture due to mild blood leakage in the closing line. In two patients (5%), on the other hand, the staple device could not be used due to the fact that HCL was very close to the right hepatic vein and the distance between the liver and the v. cava was short. There were no perioperative and postoperative HCL-associated liver and V. cava bleeding complications in both groups. However, the cost was significantly higher in the stapler group than in the suturing group. The present study is the first to compare the stapler or suturing techniques for closing HCL in the receiver hepatectomy of liver transplantation. The results indicated that the closure with suturing was more.

English

BACKGROUND Pterygium removal is prone for recurrence. Use of conjunctival autografting is considered the most suitable approach that can lower the recurrence. Traditionally, the conjunctival autograft (CAG) is attached to the sclera by suturing. Recently fibrin glue has been used as an alternative to suturing. Advantages being shortened operating time, improved postoperative comfort and absence of suture related complications. Fibrin glue (Baxter TISSEEL kit) is a biological tissue which has a fibrinogen component and a thrombin component prepared by processing plasma. On activation of human fibrinogen by thrombin it imitates the final stage of the coagulation cascade and acts as a tissue adhesive. Fibrin glue is absorbable, relatively easy to use and can be kept at room temperature or in a refrigerator. We wanted to compare the postoperative outcomes in patients undergoing pterygium surgery with conjunctival autografting using fibrin glue (fibrin glue group) in comparison to suturing with 10 - 0 nylon (suture group). METHODS This was a prospective study carried out at M.R. Medical College, Kalaburgi, in the Department of Ophthalmology. Patients with pterygium were enrolled into the study after taking informed and written consent. Clinical grading of pterygium was done as Grade 1 - &lt; 2 mm onto cornea, Grade 2 – 2 to 4 mm onto the cornea, Grade 3 - &gt; 4 mm onto the cornea. 100 subjects were randomly divided into 2 groups of 50 patients each undergoing pterygium surgery between Nov 2018 and Oct 2019. Group 1: Conjunctival autograft with 10 0 nylon suture. Group 2: Conjunctival autograft with fibrin glue. A post-operative comfort scale was used to assess pain, foreign body sensation and lacrimation. These patients were followed up on postoperative day 1, one week, 1 month for postoperative signs and symptoms and 6 months for any recurrence of pterygium. RESULTS Patients in the fibrin glue group experienced significantly less pain, foreign body sensation and lacrimation on day-one, 1 week and at 1 month after surgery, compared to those in the suture group. Other complications like graft oedema, graft retraction, corneal scarring, sub graft haemorrhage were noted in both the groups. At the end of 6 months follow up, no recurrence was noticed in both the groups. CONCLUSIONS The use of fibrin glue for attaching autografts in pterygium surgery is an effective method with global autograft success, less post-operative discomfort like pain, foreign body sensation, lacrimation and less chance of recurrence. KEYWORDS Pterygium, Conjunctival Autograft, Suture, Fibrin Glue

Sutureless Glue Free Versus Sutured Limbal Conjunctival Autografts in Primary Pterygium Surgery.

Surgical excision is the definitive treatment for pterygium. Following excision, conjunctival autograft is usually preferred. Various methods for grafting with sutures, glue or autologous serum from the recipient bed are in use. The objective of this study was to compare surgical outcomes of sutureless glue free conjunctival autograft with sutured (vicryl 8-0) conjunctival autograft in primary pterygium excision. A prospective randomized interventional study was carried out in 100 eyes with primary pterygium. They were divided into two groups for conjunctival graft adhesion; sutureless glue free (group 1; n=50 eyes) and sutured with absorbable (vicryl 8-0) suture (group 2; n=50 eyes). Time taken for surgery, complications, postoperative symptoms and overall satisfaction score were noted. The patients were followed up on day 1, day 14 and 6 weeks after surgery. Recurrence was noted till 1 year after surgery. The mean age was 46.76 ± 11.97 years (group 1) and 47.24±12.76 years (group 2). Group 1 had shorter duration of surgery (p<0.001), less postoperative complaints (p<0.001) and better patient satisfaction (p<0.001) than group 2. Postoperative complications and gain in visual acuity in both the groups were not clinically significant. Recurrence was not significant in both groups until 1 year of follow up. Pterygium surgery with sutureless glue free conjunctival autograft had fewer postoperative complaints and better patient satisfaction than pterygium surgery with sutured conjunctival autograft. The postoperative complications, recurrence were comparable to conventional sutured technique.

Whether sutures reduce the graft laceration caused by interference screw in anterior cruciate ligament reconstruction? A biomechanical study in vitro

BackgroundInterference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction. However, previous studies had reported that the insertion of interference screws significantly caused graft laceration. The purposes of this study were to (1) quantitatively evaluate the graft laceration from one single insertion of PEEK interference screws; and (2) determine whether different types of sutures reduced the graft laceration after one single insertion of interference screws in ACL reconstruction.MethodsThe in-vitro ACL reconstruction model was created using porcine tibias and bovine extensor digitorum tendons of bovine hind limbs. The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra-high molecular weight polyethylene (UHMWPE) sutures. Poly-ether-ether-ketone (PEEK) interference screws were used for tibial fixation. This study was divided into five groups (n = 10 in each group): the non-fixed group, the non-sutured group, the absorbable suture group, the Ethibond suture group and the UHMWPE suture group. Biomechanical tests were performed using the mode of pull-to-failure loading tests at 10 mm/min. Tensile stiffness (newtons per millimeter), energy absorbed to failure (in joules) and ultimate load (newtons) were recorded for analysis.ResultsAll prepared tendons and bone specimens showed similar characteristics (length, weight, and pre-tension of the tendons, tibial bone mineral density) among all groups (P > 0.05). The biomechanical tests demonstrated that PEEK interference screws significantly caused the graft laceration (P < 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction (P > 0.05).ConclusionsOur biomechanical study suggested that the ultimate failure load of grafts was reduced of approximately 25 % after one single insertion of a PEEK interference screw in ACL reconstruction. Suturing the ends of the grafts using different sutures (absorbable, Ethibond and UHMWPE sutures) did not decrease the graft laceration caused by interference screws.

The Effect of TISSEELTM on Confined Bowel Perforation: An Experimental Study

Objective: During the last decades, surgeons of several specialties presenting different levels of expertise in colon handling have been involved in laparoscopic procedures. The aim of the present experimental study was to investigate the feasibility of TISSEEL^TM versus the conventional suture placement technique on confined bowel lesions in rats. Methods: Twenty-four Sprague-Dawley rats underwent confined bowel perforation and were divided into three groups: the SUTURE group (sutures were used), the SUTURE + TISSEEL^TM group (sutures and TISSEEL^TM were utilized), and the TISSEEL^TM group (only TISSEEL^TM was used). Blinded histopathologic analysis followed animal sacrifice. Results: The median weight of the rats was 526 ± 50 g. A single animal had hematochezia on the first postoperative day. Cessation of bleeding at the perforation margin was indicated intraoperatively after TISSEEL^TM application. Animals in the TISSEEL^TM group presented less intraperitoneal adhesions and lower hemorrhagic infiltration compared to animals of the two other groups. In addition, animals in the TISSEEL^TM group showed thrombus formation at the bowel perforation site compared to animals of the two other groups (p = 0.042). Histopathologic analysis demonstrated reduced inflammatory reaction (p = 0.003), diminished fibrosis (p = 0.001), and better tissue regeneration (p = 0.000) in the TISSEEL^TM group compared to the other two groups. Conclusion: Application of TISSEEL^TM at the perforation site was associated with increased regeneration of the intestinal wall and less inflammatory and fibrotic reaction compared to suture placement. However, more experimental and clinical studies should be conducted before implementation in humans.

The use of staples for external ventricular drain catheter fixation: A single-institution experience

BackgroundSutures are conventionally used for external ventricular drain (EVD) catheter fixation, but staples are an appealing alternative as they are quicker and easier to learn. We report our institutional experience with EVD fixation techniques and the patterns of catheter fixation. MethodsWe conducted a retrospective review of all aneurysmal subarachnoid hemorrhage (aSAH) patients treated in a single US center between 2007 and 2017. ResultsOut of 307 patients, 217 patients (62.2% female, mean age 59.5 years) met inclusion criteria harboring 268 EVDs. Two main configurations were used for EVD catheter fixation; spiral-shaped EVDs in 139 (51.9%) cases and arciform (C-shaped) EVDs in 129 (48.1%) of the cases. 220 (82.1%) were secured with staples and 48 (17.9%) with sutures. The most common complication was obstruction (n = 43, 16.2%), followed by infections (n = 18, 6.8%). Catheter dislodgements occurred in 16 (5.9%) catheters and 61 (22.8%) required repositioning/replacement. EVD dislodgement rates did not differ between the staples and sutures group, or between the spiral and C-shaped EVDs (p = 0.5 and 0.93, respectively). No cases of catheter perforation by the staples were encountered in our cohort. ConclusionStaples and sutures are equally valid and acceptable methods for EVD fixation with similar dislodgement rates. Scarce data exist in the literature regarding dislodgements, and further studies are needed to address its incidence and the best preventive strategies.

Fibrin Sealant for Prevention of Bile Leakage After Laparoscopic Common Bile Duct Incision: Outcome of a Randomized Controlled Trial.

Background: There are several methods used to extract common bile duct (CBD) stones encountered during cholecystectomy. Intraoperative cholangiotomy, cholangioscopy, and laparoscopic CBD exploration (LCBDE) are techniques that allow removal of stones from the CBD during the index procedure. However, bile leakage following CBD exploration is a common problem. The aim of this study was to assess whether fibrin sealant applied to the duct incision is safe. Methods: Patients planned for laparoscopic gallstone surgery at the Department of Surgery, Enköping Hospital, were included in the study. In cases where perioperative cholangiography showed CBD stones, LCBDE was performed through a longitudinal incision in the CBD. Randomization between closure of the incision with polyglactin sutures or with fibrin sealant was performed. After all the stones had been removed and the incision closed according to the allocation, an abdominal drain was placed close to the incision. A T tube was placed in the CBD or a straight tube into cystic duct for eventual postoperative cholangiogram. The patient and the surgeon assessing the postoperative course were blinded to the randomized allocation. Results: Altogether 51 patients were included from December 2012 to July 2016. Mean operative time was 188 minutes in the fibrin sealant group and 214 minutes in the suture group (P = .159). There was no significant difference between groups in bile flow in the abdominal drainage tube or in the CBD drain during the three first postoperative days. The time to removal of the abdominal drain did not differ significantly between groups. Conclusion: Although the present study lacks the statistical power to prove a benefit from fibrin sealant, it indicates that closure of the incision may be an option to reduce the risk for leakage. Further studies are required to confirm this. The study was retrospectively registered on clinicaltrials.gov September 5, 2015 (NCT02545153).

PSU6 Cost-Eectiveness Analysis of the Application of Porcine-Derived Fibrin Sealant for the Treatment of IntraOperative Cerebrospinal Fluid Leak in China

Cerebrospinal fluid leak (CSFL) after craniotomy may incur serious sequelae, such as meningitis and hematoma. A porcine-derived fibrin sealant (FS) has been introduced and used in conjunction with sutures for dural closure at hospitals in China. This study aimed to evaluate the cost-effectiveness of using FS for the treatment of intraoperative CSFL. A decision tree was constructed in R 3.6.3 to assess the cost-effectiveness of using FS with sutures compared to sutures alone for treatment of intra-operative CSFL from the perspective of the Chinese healthcare system. Efficacy and safety information were extracted from a randomized, single-blinded clinical trial comparing the two interventions (NCT03110783). Costs were obtained through the analysis of real-world databases of provincial procurement costs. All costs were converted to USD based on the published exchange rate on 12/23/2020 (6.5400 RMB to 1 USD). The effectiveness of the interventions was measured both as the success rate of CSFL treatment and as the reduction of postoperative complications. The CSFL treatment success rate was higher in patients using FS with sutures than using sutures alone (97.8% vs. 49.2%). Postoperative complication rates were lower for the group with FS (9.5% vs. 14.5%). Higher costs for using FS ($248.5 vs. $7.7) were offset by savings from higher treatment success rate and lower post-operative complication rates. The FS group saved $375.0 in additional CSFL repairs compared to the sutures group ($18.1 vs. $393.0), and $66.7 in treatment for complications ($131.9 vs. $198.6). Total costs per patient were lower by $200.8 in the FS plus suture group ($398.5 vs. $599.3). The cost effectiveness analysis demonstrated that using FS with sutures could provide improved clinical outcomes at reduced costs. FS used in combination with sutures was the dominant strategy vs sutures alone for the treatment of intra-operative CSFL.

A Single-Center Randomized Prospective Study Investigating the Efficacy of Various Wound Closure Devices in Reducing Postoperative Wound Complications

BackgroundSutures and staples are the mainstay wound closure techniques in total joint arthroplasty. Newer techniques such as zipper devices and novel skin adhesives have emerged because of their potential to decrease operative time and possibly minimize complications. The aim of this study is to compare these newer techniques against conventional sutures with respect to wound complications, closure time, and costs. MethodsA single-center randomized control trial was conducted on 160 patients (52 zipper, 55 suture, 53 mesh) who underwent primary total hip or knee arthroplasty between February 2017 and May 2018. Patients were divided into 3 closure groups: zipper device, monofilament suture plus adhesive, and monofilament plus polyester mesh with adhesive. The primary endpoint was closure time (superficial skin layer). Secondarily we collected perioperative complication rates, including infection, persistent (14-day) wound drainage, 90-day readmission, and emergency room visit rates as well as compared material costs. ResultsThere were no differences in baseline characteristics between groups for age, body mass index, and American Society of Anesthesiologists classification. There was a trend toward decreased time to closure for the suture group. There were no significant differences between groups for our secondary endpoint, complications. ConclusionsOur study shows that the suture group trended toward shorter closure time but suggests that each of the closure methods after total joint arthroplasty has equivalent complication rates. With small differences in closure time and no significant differences in complications, the decision to use one wound closure device or technique over another should be driven by institutional costs and provider familiarity.

A comparative study of postoperative chronic pain after tension free inguinal hernia repair using absorbable versus non-absorbable sutures for mesh fixation

Background: Inguinal hernias are very commonly encountered by surgeons throughout the world. Chronic groin pain may be caused by nerve injury either during dissection or retraction, or nerve entrapment due to post-operative fibrosis, or mesh related fibrosis, or lastly sutures used to fix the mesh. The mesh can be secured by non-absorbable sutures or absorbable sutures. Material and methods: This is a prospective, descriptive, single centre and randomized study was conducted in the Department of General Surgery, N.C Medical College and Hospital over a period of 1 year. All patients of 21-80 years old, who were admitted for elective inguinal hernia repair, were included for the study. Patients with bilateral, recurrent, irreducible or incarcerated hernia and patients with co morbid conditions that might interfere with pain assessment (e.g. impaired cognitive function, limited mobility, daily use of pain medicine); and patients who had undergone surgery in the groin area were excluded from the study. Results: Out of 180 patients 90 were having right inguinal hernia, 56 patients with left inguinal hernia and 34 patients were having bilateral inguinal hernia. we analyzed post- operative pain using VAS score on alternate basis till 10th post-operative day. In Group A, mesh fixation was done by non-absorbable suture material polypropylene (n=90) and Group B, mesh fixation was done by monofilament absorbable suture material poliglecaprone (n=90). On post-operative day 1 the mean VAS score in group A was 6.12±1.03, while that in group B was 5.01±0.93, on day 10, the mean VAS score in group A was 2.41±0.56, while that in group B was 1.62±0.46, with a p value of 0.039 which is statistically significant. Overall, Group B experienced less pain compared to group A. Mean VAS score at 1st month in group A was 1.93±0.62 and in group B was 1.52±0.34 and at 2nd month it was 1.31±0.54 in group A and 1.03±0.26 in group B. Conclusion: Patients with absorbable suture for mesh fixation has less groin pain as compared to nonabsorbable suture in hernia repair during 6 months follow up period.

Reduction of Anastomotic Time Through the Use of Cyanoacrylate in Microvascular Procedures.

Background: Ever since the description of the first microvascular anastomosis, numerous alternative methods have been described to the classical approach. Tissue adhesive has shown promising result in previous studies and can be a fast and efficient alternative which still requires more studies to allow its clinical implementation. Methods: A randomized comparative experimental study was conducted on rats' femoral arteries and an end-to-end anastomosis was performed in order to compare 2 anastomosis techniques. In one group, a simple interrupted suture was utilized, whereas in the second group a combination between fewer sutures and tissue adhesive was used. The anastomotic time, total operative time, blood flow velocity before, immediately after and 48 hours after the procedure, as well as an independent grading of the anastomosis immediately after the procedure were performed. Magnetic resonance imaging (MRI) was performed in order to assess the degree of stenosis. After euthanasia, histology and scanning electron microscopy (SEM) were performed on the vessels in order to assess possible complications. Results: A total of 24 anastomoses were performed, of which 12 with a classic technique and 12 with an adhesive technique. All the anastomoses were patent with a significant reduction of anastomotic and total operative time. The grading of the anastomoses showed better results in the classic suture group. The blood flow velocities were not statistically significant between the 2 groups. On MRI there was one stenotic anastomosis, whereas histology and SEM showed more complications on the adhesive group. Conclusion: Anastomotic times were significantly lower with a non-significant trend toward more thrombotic complications in the adhesive group. Further improvement of the glue properties and refinement of the technique will likely make it a viable alternative to interrupted suturing in the future.

Biomechanical study on different high-strength sutures and suture site for repairing posterior root tear of the medial meniscus

To compare biomechanical characteristic of different high-strength sutures and suture sites for repairing posterior root tear of the medial meniscus with modified Mason-Allen technique. Forty-eight specimen of medial meniscus of knee joint from fresh porcine (female, aged from 5 to 9 months with an average of 7 months) were chosen and established experimental model. The samples were divided into red zone fixation group and red-white zone fixation group according to suture sites, 24 in each group; and then were randomly divided into 3 subgroups which 8 in each group, and fixed with Ethibond suture, Ultrabraid suture and FiberWire suture, respectively. Biomechanical tests were performedon universal electromagnetic and mechanical testing machine. Each specimen was underwent 1 000 cyclic tests on the first time, then pull out test until failure. The maximum failure load, yield load, stiffness and displacement were analyzed. All specimen were successfully completed biomechanical tests. The failure mode of Ethibond group was caused by suture fracture; 6 cases of Ultrabraid suture group was caused by suture fracture which belong to red zone fixation group, 10 cases were caused by suture pull out, which 2 cases belong to red zone fixation group, 8 cases belong to red-white zone fixation group;8 cases of FiberWire group was caused by suture pull-out. Biomechanical test showed that:(1)In terms of suture strength, comparison of the maximum failure load, yield load and stiffness showed that Ethibond suture group <Ultrabraid suture group <FiberWire suture group, and had statistical differences among groups (P<0.05);comparison of cyclic displacement at 100, 500 and 1 000 cycles showed that Ethibond suturegroup>Ultrabraid suture group >FiberWire suture group, and had statistical differences among groups (P<0.05);the results showed the suture strength in Ethibond was the best, Ultrabraid suture took the second place, and FiberWire suture was the worst. (2)As for different suture sites, comparison of the maximum failure load, yield load and stiffness showed that red zone fixation group >red-white region fixation group, and had statistical difference between two groups(P< 0.05);comparison of cyclic displacement at 100, 500 and 1 000 cycles showed that red zone fixation group <red-white zone fixation group, and had statistical difference between two groups (P<0.05);the results showed that suture strength in red zone fixation group was better than that of red white zone fixation group. Mason-Allen suture could effectively fix posterior root tear of the medial meniscus and meet needs of early partial weight bearing after surgery. Suturing with Fiberwire in red zone is stronger and better for the meniscus healing and rehabilitation.

Outcomes following emergency fixation of torted and non-torted testes

Scrotal exploration is a frequently performed emergency procedure in children. It is a subject of debate as to whether and how a non-torted testis should be fixed, with a wide variation in practice across the UK. This study aims to ascertain whether the method of testicular fixation (if any) impacts on patient outcomes. A review of all emergency scrotal explorations performed in children under the age of 18 between 2008 and 2018 in a tertiary Paediatric Surgery unit was undertaken. Patients were categorised by initial fixation method, chi squared analysis was used to compare complication and reoperation rates. 522 boys were taken to theatre, 424 had a unilateral procedure and 98 had bilateral; after 35 orchidectomies, 585 testes were left in situ. The most frequent diagnosis at operation was torted testicular appendage (n=278, 53%), followed by testicular torsion (n=79, 15%). The number of testes by category of fixation were: 72 no documented fixation, 130 dartos pouch only, 34 absorbable sutures, 346 non-absorbable sutures and 3 unspecified sutures. There was no difference in the reattendance rate between groups after outliers were removed (p=0.72). Thirty-seven patients experienced complications, most commonly ongoing pain. Nine patients required an ipsilateral reoperation, 25 underwent a contralateral operation at a later date. The complication rate appeared to be higher in the no fixation group compared to the dartos (p=0.02) and sutured groups (p=0.048). Testes in the no fixation group had a higher reoperation rate compared to the sutured group (p=0.002). The present study is a detailed analysis of a wide variety of emergency testicular fixation methods in a large cohort, including the routine fixation of non-torted testes. Whilst there appears to be a benefit to using sutured or dartos fixation, this merits cautious interpretation. It is likely that influences on complications and reoperations are multifactorial and cannot be attributed solely to the method of testicular fixation. Adoption of a standardised approach to emergency fixation of testes within or across institutions may be a potential avenue for future studies.