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BMC Surgery Oct 2023Based on the current trend of increasing incidence of choledocholithiasis, it is of great significance to explore the closure method of the common bile duct during...
BACKGROUND
Based on the current trend of increasing incidence of choledocholithiasis, it is of great significance to explore the closure method of the common bile duct during laparoscopic choledocholithotomy.
METHODS
Backtracking full-thickness continuous everting suture was selected for primary closure of the common bile duct suture, while traditional T-tube drainage was selected for the control group. Propensity score matching (PSM) was used to reduce baseline differences between the two groups.
RESULT
The intraoperative blood loss, operation time, postoperative recovery speed, postoperative bleeding, postoperative pancreatitis, recurrence rate of bile duct stones, and hospitalization time in the primary closure group were all less than those in the T-tube drainage group.
CONCLUSION
Under certain conditions, backtracking full-thickness continuous everting suture could benefit patients with choledocholithiasis compared with traditional T-tube drainage.
Topics: Humans; Choledocholithiasis; Length of Stay; Common Bile Duct; Drainage; Laparoscopy; Sutures; Postoperative Complications; Retrospective Studies
PubMed: 37848861
DOI: 10.1186/s12893-023-02222-0 -
Children (Basel, Switzerland) Dec 2023Congenital diaphragmatic hernia (CDH) repair can be challenging, particularly when a larger defect is present. Barbed sutures prevent the suture from slipping back after...
BACKGROUND
Congenital diaphragmatic hernia (CDH) repair can be challenging, particularly when a larger defect is present. Barbed sutures prevent the suture from slipping back after approximation of the tissues. Although introduced almost 2 decades ago, barbed sutures have not been widely used for CDH repair. We report our initial experience and pitfalls.
METHODS
All patients presenting with CDH from 2021 onward underwent repair using barbed sutures. Demographics, operative parameters, complications, and outcomes were prospectively recorded.
RESULTS
A total of 13 patients underwent CDH repair during the study interval (median age 6 days, range 3 days to 5.75 years). Median operative time was 89 min (range 46 to 288 min). Five thoracoscopic and eight open procedures were performed. Severe pulmonary hypertension and ECMO (extracorporeal membrane oxygenation) were considered contraindications for thoracoscopic repair. The included patients were compared to a historic controlled group performed without barbed sutures. The barbed suture facilitated easy and quick closure of the defects in most cases and obviated the need for knot tying. One patient in the thoracoscopic group had a patch placed due to high tension after the barbed sutures tore the diaphragm. At a median follow-up time of 15 months (range 2 to 34 months), one patient had died, and one patient with complete diaphragmatic agenesis was home-ventilated. There were no recurrences. Median operative time trended lower (89 min) than in the historic control group repaired without barbed sutures (119 min, < 0.06) after eliminating outliers with large, complex patch repairs.
CONCLUSIONS
Barbed sutures simplify congenital diaphragmatic hernia repair regardless of whether a minimal-invasive or open approach is performed. Patch repair is not a contraindication for using barbed sutures. The resulting potential time savings make them particularly useful in patients with cardiac or other severe co-morbidities in which shorter operative times are essential. In cases with high tension, though, the barbs may tear through and produce a "saw" effect on the tissue with subsequent damage.
PubMed: 38255349
DOI: 10.3390/children11010035 -
Medicina Oral, Patologia Oral Y Cirugia... Sep 2023The purpose of this study is to explore whether decreasing the number of sutures can improve the quality of life after inferior third molar extraction. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The purpose of this study is to explore whether decreasing the number of sutures can improve the quality of life after inferior third molar extraction.
MATERIAL AND METHODS
This study used a three-arm randomized design that included 90 individuals. Patients were randomized and divided into three groups-the airtight suture group (traditional), the buccal drainage group, and the no-suture group. Postoperative measurements, including treatment time, visual analog scale, questionnaire on postoperative patient quality of life, and details about trismus, swelling, dry socket, and other postoperative complications were obtained twice and the mean values were recorded. To verify the normal distribution of the data, the Shapiro-Wilk test was performed. The statistical differences were evaluated using the one-way ANOVA and the Kruskal-Wallis test with Bonferroni post-hoc correction.
RESULTS
The buccal drainage group showed a significant decrease in postoperative pain and better speech ability than the no-suture group on the 3st day, with a mean of 1.3 and 0.7 (P < 0.05). The airtight suture group also showed similar eating and speech ability, which was better than the no-suture group, with a mean of 0.6 and 0.7 (P < 0.05). However, no significant improvements were noted on the 1st and 7th days. The surgical treatment time, postoperative social isolation, sleep impairment, physical appearance, trismus, and swelling showed no statistical difference between the three groups at all measured times (P > 0.05).
CONCLUSIONS
Based on the above findings, the triangular flap without a buccal suture may be superior to the traditional group and no-suture group in less pain, and better postoperative patient satisfaction in the first 3 days and may be a simple and viable option in clinical practice.
Topics: Humans; Molar, Third; Trismus; Quality of Life; Tooth, Impacted; Dry Socket; Tooth Extraction; Pain, Postoperative; Edema; Mandible
PubMed: 37330952
DOI: 10.4317/medoral.25859 -
Journal of Indian Society of... 2023When it comes to surgical site infection (SSI), it has been shown that two-thirds of wound infections starts around the incision line and the number is even greater in...
BACKGROUND
When it comes to surgical site infection (SSI), it has been shown that two-thirds of wound infections starts around the incision line and the number is even greater in the presence of sutures. Therefore, a number of compounds have been used to coat the suture materials which tend to decrease the SSI some of which include ciprofloxacin, , and chlorhexidine.
OBJECTIVE
The objective of this study was to assess the antibacterial properties of neem oil-coated sutures in anaerobic culture media when compared to triclosan-coated sutures and uncoated sutures.
MATERIALS AND METHODS
The phosphate-buffered saline solution containing the plaque samples of the patients was transferred evenly onto the sterile agar media. Equal segments of 100% neem oil coated (Group 1), 50% neem oil coated (Group 2), triclosan-coated (Group 3), and uncoated (Group 4) sutures were placed on the agar plate. These were then incubated at 37°C for 24 h. The inhibition zone was calculated in mm by measuring of the zone of inhibition (ZOI) in terms of length, breadth, and area.
RESULTS
The results were calculated following the incubation. The mean length for 100% neem oil-coated suture was 2.61 mm ± 0.2 and for 50% neem oil-coated suture was 2.49 mm ± 0.24. The mean breadth for 100% neem oil-coated suture was 1.5 mm ± 0.41 and for 50% neem oil-coated suture the mean was 0.95 mm ± 0.58. The mean area for 100% neem oil-coated suture was 77 mm ± 32.9 and for 50% neem oil-coated suture was 16.8 mm ± 11.14. Triclosan and uncoated sutures did not show any ZOI.
CONCLUSION
The 100% neem oil-coated sutures had the largest length, breadth, and area of ZOI in the anaerobic culture media, followed by 50% neem oil-coated sutures. Triclosan-coated and uncoated sutures did not show any ZOI. Therefore, neem oil-coated suture can be used in the overall healing and prevention of postoperative discomfort after oral surgical procedures.
PubMed: 37781326
DOI: 10.4103/jisp.jisp_475_22 -
Plastic and Reconstructive Surgery.... Oct 2023Defects of the central ear after skin cancer removal remain a common problem for the reconstructive surgeon. The experience with a one-stage, postauricular, skin-island...
BACKGROUND
Defects of the central ear after skin cancer removal remain a common problem for the reconstructive surgeon. The experience with a one-stage, postauricular, skin-island flap passed through the cartilage to reconstruct ear defects is reported.
METHODS
Patients with an intact ear helix and an anterior full-thickness defect (cartilage defects included) were reconstructed with a skin-island flap based on posterior subcutaneous tissue deep to the flap base. The flap was passed through a generous aperture created in the ear cartilage. The skin at the base was incised superficially after the flap was passed through the cartilage to create a skin-island and avoid burial of epithelium. The flap periphery and postauricular harvest site were sutured with absorbable chromic sutures.
RESULTS
Twenty-two patients (six women, 16 men) with ear defects underwent single-stage reconstruction over a 9-year period. The defects reconstructed measured in diameter from 2 cm to 4.5 cm. Six patients required a second skin flap from the preauricular area to close ear canal defects. The pull-through flap added structural support, and prevented ear distortion. No flap necrosis occurred. Venous congestion was common and self-limiting. No epithelial cysts developed.
CONCLUSIONS
A one-stage postauricular skin-island flap can reliably reconstruct anterior ear defects without distorting shape or position of the ear. Care is needed to provide a generous aperture through the ear cartilage to accommodate the flap. Healing proceeds predictably, and minimal complications are associated with this posteriorly-based, pass-through, skin-island flap in ear reconstruction.
PubMed: 37842079
DOI: 10.1097/GOX.0000000000005338 -
ACS Biomaterials Science & Engineering Aug 2023Coronary artery disease affects millions worldwide. Bypass surgery remains the gold standard; however, autologous tissue is not always available. Hence, the need for an...
Coronary artery disease affects millions worldwide. Bypass surgery remains the gold standard; however, autologous tissue is not always available. Hence, the need for an off-the-shelf graft to treat these patients remains extremely high. Using melt spinning, we describe here the fabrication of tubular scaffolds composed of microfibers aligned in the circumferential orientation mimicking the organized extracellular matrix in the tunica media of arteries. By variation of the translational extruder speed, the angle between fibers ranged from 0 to ∼30°. Scaffolds with the highest angle showed the best performance in a three-point bending test. These constructs could be bent up to 160% strain without kinking or breakage. Furthermore, when liquid was passed through the scaffolds, no leakage was observed. Suturing of native arteries was successful. Mesenchymal stromal cells were seeded on the scaffolds and differentiated into vascular smooth muscle-like cells (vSMCs) by reduction of serum and addition of transforming growth factor beta 1 and ascorbic acid. The scaffolds with a higher angle between fibers showed increased expression of vSMC markers alpha smooth muscle actin, calponin, and smooth muscle protein 22-alpha, whereas a decrease in collagen 1 expression was observed, indicating a positive contractile phenotype. Endothelial cells were seeded on the repopulated scaffolds and formed a tightly packed monolayer on the luminal side. Our study shows a one-step fabrication for ECM-mimicking scaffolds with good handleability, leak-free property, and suturability; the excellent biocompatibility allowed the growth of a bilayered construct. Future work will explore the possibility of using these scaffolds as vascular conduits in settings.
Topics: Tissue Engineering; Tissue Scaffolds; Endothelial Cells; Extracellular Matrix; Cell Differentiation
PubMed: 37490420
DOI: 10.1021/acsbiomaterials.3c00535 -
BMC Surgery Dec 2023To determine the clinical efficacy of rotator cuff suture and arthroscopic 360° capsular release in patients with rotator cuff tendinopathy to improve the...
BACKGROUND
To determine the clinical efficacy of rotator cuff suture and arthroscopic 360° capsular release in patients with rotator cuff tendinopathy to improve the Constant-Murley and Visual Analogue Scale (VAS) scores, and shoulder flexion.
METHODS
Fifty-one patients with full-thickness rotator cuff tears and limited shoulder movement who were admitted to our hospital from October 2017 to October 2020 were selected; all patients were treated with arthroscopic rotator cuff suture and 360° capsular release. The Constant-Murley score, VAS score, and shoulder flexion angle were used to evaluate shoulder joint function before and during follow-up. Rotator cuff healing was assessed by MRI with the Sugaya classification.
RESULTS
After treatment, the Constant-Murley score (58.98 ± 9.84) was significantly improved compared with pre-treatment (29.33 ± 9.71), the VAS score (1.23 ± 0.87) was significantly lower than pre-treatment (7.54 ± 1.22), and the shoulder flexion angle (142.67 ± 8.59°) was significantly improved compared with pre-treatment (51.50 ± 2.10°); the difference was statistically significant (P < 0.05).
CONCLUSIONS
Arthroscopic rotator cuff suture and simultaneous 360° capsular release have a significant effect on the treatment of rotator cuff tear with limited shoulder movement.
Topics: Humans; Rotator Cuff; Rotator Cuff Injuries; Shoulder; Joint Capsule Release; Shoulder Joint; Arthroscopy; Treatment Outcome; Range of Motion, Articular; Sutures
PubMed: 38093270
DOI: 10.1186/s12893-023-02157-6 -
Acta Cirurgica Brasileira 2023To introduce a new low-cost simulation model for training basic surgical skills.
PURPOSE
To introduce a new low-cost simulation model for training basic surgical skills.
METHODS
The training model was made from a mixture of 20 g of acetic silicone with 11 g of maize starch. Validation consisted of serial training sessions, evaluating the mean pre- and post-training time and the mean final score according to the global rating scale.
RESULTS
A decrease in the time required to perform the sutures was observed, comparing the average post and pre-training time of each training day, with a significant correlation between the order of training and the time for performing the simulation.
CONCLUSIONS
The presented model proved to be capable of simulating the basic suture training skills. It is easy to make, has low cost, and can be easily reproduced in educational institutions.
Topics: Computer Simulation; Clinical Competence; Sutures; Simulation Training
PubMed: 37851786
DOI: 10.1590/acb384223 -
BMC Cancer Jul 2023Seroma is the most common complication following breast cancer surgery, with reported incidence up to 90%. Seroma causes patient discomfort, is associated with surgical... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Seroma is the most common complication following breast cancer surgery, with reported incidence up to 90%. Seroma causes patient discomfort, is associated with surgical site infections (SSI), often requires treatment and increases healthcare consumption. The quilting suture technique, in which the skin flaps are sutured to the pectoralis muscle, leads to a significant reduction of seroma with a decrease in the number of aspirations and surgical site infections. However, implementation is lagging due to unknown side effects, increase in operation time and cost effectiveness. Main objective of this study is to assess the impact of large scale implementation of the quilting suture technique in patients undergoing mastectomy and/or axillary lymph node dissection (ALND).
METHODS
The QUILT study is a stepped wedge design study performed among nine teaching hospitals in the Netherlands. The study consists of nine steps, with each step one hospital will implement the quilting suture technique. Allocation of the order of implementation will be randomization-based. Primary outcome is 'textbook outcome', i.e.no wound complications, no re-admission, re-operation or unscheduled visit to the outpatient clinic and no increased use of postoperative analgesics. A total of 113 patients is required based on a sample size calculation. Secondary outcomes are shoulder function, cosmetic outcome, satisfaction with thoracic wall and health care consumption. Follow-up lasts for 6 months.
DISCUSSION
This will be one of the first multicentre prospective studies in which quilting without postoperative wound drain is compared with conventional wound closure. We hypothesize that quilting is a simple technique to increase textbook outcome, enhance patient comfort and reduce health care consumption.
Topics: Humans; Female; Mastectomy; Breast Neoplasms; Surgical Wound Infection; Seroma; Prospective Studies; Drainage; Sutures; Postoperative Complications
PubMed: 37460983
DOI: 10.1186/s12885-023-11154-0 -
International Journal of Impotence... Nov 2023For patients with large calcified tunical plaque or severe corporal fibrosis which are likely to have a pronounced and persistent residual curvature which may not be... (Review)
Review
For patients with large calcified tunical plaque or severe corporal fibrosis which are likely to have a pronounced and persistent residual curvature which may not be correct by penile prosthesis implantation alone, other adjunctive manoeuvres such as penile plication and/or plaque incision with grafting may be necessary. The sequence between penile plication and penile prosthesis implantation is largely dependent on several factors such as the severity of penile curvature, the presence of (calcified) tunical plaque(s) and whether aggressive corporal dilation and subsequent penile remodelling with an inflated implant can straighten any residual penis curvature. The advantages of pre-placement of penile plication sutures prior to penile prosthesis implantation are the avoidance of inadvertent damage to the underlying penile prosthesis implant, the ability to adjust the tension on the rows of the plication sutures based on residual curvature with the device fully inflated, and potentially minimising the duration of surgery. In contrast, penile prosthesis implantation followed by penile plication to correct residual curvature, this sequence of surgery may negate the need for penile plications if penile remodelling is effective, or the residual curvature is less than 15 degrees where postoperative manual remodelling may continue to improve the penile cosmesis. When performed by expert surgeons and adhering to safe surgical principles, there is no doubt that patients will be satisfied with the outcomes and highly appreciative of the final penile cosmesis and the ensuing optimal outcomes.
Topics: Male; Humans; Penile Implantation; Penile Induration; Penile Prosthesis; Penis; Sutures
PubMed: 37864087
DOI: 10.1038/s41443-023-00774-6