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Biomedical Microdevices Aug 2023Cytobrushes are used for low-invasive sample collection and screening in multiple diseases, with a significant impact on early detection, prevention, and diagnosis. This...
Cytobrushes are used for low-invasive sample collection and screening in multiple diseases, with a significant impact on early detection, prevention, and diagnosis. This study focuses on improving the safety of cell brushing in hard-to-reach locations by exploring brush construction from absorbable materials. We investigated the efficacy of loop brushes made of absorbable suture wires of Chirlac, Chirasorb, Monocryl, PDS II, Vicryl Rapid, Glycolon, and Catgut during their operation in conjunction with fine-needle aspiration in an artificial cyst model. PDS II brushes demonstrated the highest efficiency, while Monocryl and Catgut also provided a significant brushing effect. Efficient brushes portrayed higher flexural rigidity than their counterparts, and their efficiency was inversely proportional to their plastic deformation by the needle. Our results open avenues for safer cell biopsies in hard-to-reach locations by utilizing brushes composed of absorbable materials.
Topics: Humans; Cysts; Electric Wiring; Plastics; Sutures
PubMed: 37610663
DOI: 10.1007/s10544-023-00674-y -
Journal of Clinical Medicine May 2024: The aim of this review paper is to summarise surgical options available for repairing iris defects at the iris-lens plane, focusing on suturing techniques,... (Review)
Review
: The aim of this review paper is to summarise surgical options available for repairing iris defects at the iris-lens plane, focusing on suturing techniques, iridodialysis repair, and prosthetic iris devices. : A thorough literature search was conducted using multiple databases, including Medline, PubMed, Web of Science Core Collection, and the Cochrane Library, from inception to February 2024. Relevant studies were screened based on predefined criteria, and primary references cited in selected articles were also reviewed. : Various surgical techniques were identified for iris defect repair. Suturing methods such as interrupted full-thickness sutures and the McCannel technique offer solutions for smaller defects, while iridodialysis repair techniques address detachment of the iris from the ciliary body. Prosthetic iris devices, including iris-lens diaphragm devices, endocapsular capsular tension ring-based devices, and customizable artificial iris implants, provide options for larger defects, each with its own advantages and limitations. : Successful iris reconstruction requires a personalised approach considering factors like defect size, ocular comorbidities, and patient preference. Surgeons must possess a thorough understanding of available techniques and prosthetic devices to achieve optimal outcomes in terms of both visual function and, nonetheless, cosmetic appearance.
PubMed: 38731235
DOI: 10.3390/jcm13092706 -
Bioactive Materials Nov 2023Corneal transplantation is a prevailing treatment to repair injured cornea and restore vision but faces the limitation of donor tissue shortage clinically. In addition,...
Corneal transplantation is a prevailing treatment to repair injured cornea and restore vision but faces the limitation of donor tissue shortage clinically. In addition, suturing-needed transplantation potentially causes postoperative complications. Herein, we design a PEG-Lysozyme injective hydrogel as a suture-free, shape self-adaptive, bioactive implant for corneal stroma defect repair. This implant experiences a sol-gel phase transition via an in situ amidation reaction between 4-arm-PEG-NHS and lysozyme. The physicochemical properties of PEG-Lysozyme can be tuned by the components ratio, which confers the implant mimetic corneal modulus and provides tissue adhesion to endure increased intraocular pressure. In vitro tests prove that the implant is beneficial to Human corneal epithelial cells growth and migration due to the bioactivity of lysozyme. Rabbit lamellar keratoplasty experiment demonstrates that the hydrogel can be filled into defect to form a shape-adaptive implant adhered to native stroma. The implant promotes epithelialization and stroma integrity, recovering the topology of injured cornea to normal. A newly established animal forging behavior test prove a rapid visual restoration of rabbits when use implant in a suture free manner. In general, this work provides a promising preclinical practice by applicating a self-curing, shape self-adaptive and bioactive PEG-Lysozyme implant for suture-free stroma repair.
PubMed: 37456580
DOI: 10.1016/j.bioactmat.2023.05.008 -
Heliyon Sep 2023The primary aim of this study was to explore the relationship between the biophysical structure and function of modern suture materials. Particularly the suture's...
OBJECTIVE
The primary aim of this study was to explore the relationship between the biophysical structure and function of modern suture materials. Particularly the suture's ability to withstand the stressors of surgery and how the material properties affect knot stability. The secondary aim was to investigate the effect that different knots have on the suture material itself. This study builds on previous research assessing suture and knot characteristics but in modern Ultra High Molecular Weight Polyethylene (UHMWPE) materials currently in widespread clinical use in arthroscopic surgery.
METHODS
Three common UHMWPE sutures and one polyester suture were tested in both a dry and wet state using the Geelong, Nicky's, Surgeon's and Tautline knots. Tensile strength of knots was tested vertically at a 60 mm/min strain rate and 45 mm gauge length. Sutures were tied through a cannula around two 8 mm diameter circular bollards. Testing was conducted in a controlled environment temperature and humidity environment (20 ± 2 °C, 65 ± 2%).
RESULTS
No one knot type was optimal over all suture types. Mean tensile strength in both a dry and wet state and a low coefficient of variation (CV) in tensile strength in a wet state were considered as an indication of suitability. With Ethibond sutures this was the Geelong knot (CV:4.2%). With Orthocord sutures both the Geelong and Tautline knots (CV:4.2% and CV:11.9% respectively). With FiberWire sutures the Nickys and Tautline knots (CV:22.6% and CV:22.5% respectively). With ForceFiber sutures all four knots exhibited similar wet tensile strength with high variability showing that all should perform in a similar way .
CONCLUSIONS
This study demonstrates a statistically significant three-way interaction between polyblend suture materials, the knot and the environment. This has implications for knot security using the tested sutures in different environments, as one knot may not behave the same under all conditions.
PubMed: 37809838
DOI: 10.1016/j.heliyon.2023.e19391 -
JBJS Essential Surgical Techniques 2023Flexor-tendon injury is a historically challenging problem for orthopaedic surgeons. Much research has been dedicated to finding solutions that offer balance in terms of...
BACKGROUND
Flexor-tendon injury is a historically challenging problem for orthopaedic surgeons. Much research has been dedicated to finding solutions that offer balance in terms of the strength and ease of the repair versus the rate of complications such as adhesions. The number of core sutures, distance from the tendon edge, and use of an epitendinous stitch have been shown to affect repair strength. A number of configurations have been described for the placement of the suture; however, none has been identified as a clear gold standard. This article will highlight the preferred tendon repair technique of the senior author (R.J.S.), the Strickland repair with a simple running epitendinous stitch. Relevant anatomy, indications, operative technique, and postoperative management will be discussed.
DESCRIPTION
The flexor tendon is typically accessed via extension of the laceration that caused the initial injury. After the neurovascular structures and pulleys are assessed, the tendon is cleaned and prepared for repair. A 3-0 braided nylon suture is utilized for the 4-core strand repair and placed in the Strickland fashion. A 5-0 polypropylene suture is then utilized for the simple running epitendinous stitch.
ALTERNATIVES
Multiple alternative techniques have been described. These vary in the number of core strands, the repair configuration, the suture caliber, and the use of an epitendinous or other suture. Nonoperative treatment is typically reserved for partial flexor-tendon laceration, as complete tendon discontinuity will not heal and requires surgical intervention.
RATIONALE
The 4-core strand configuration has been well established to increase the strength of the repair as compared with 2-core strand configurations, while also being easier to accomplish and with less suture burden than other techniques. The presently described technique has excellent repair strength and can allow for early active range of motion, which is critical to reduce the risk of postoperative adhesions and stiffness.
EXPECTED OUTCOMES
Excellent outcomes have been demonstrated for primary flexor-tendon repair if performed soon after the injury. Delayed repair may lead to adhesions and poor tendon healing. Early postoperative rehabilitation is vital for success. There are advocates for either active or passive protocols. The protocol at our institution is to begin early active place-and-hold therapy at 3 to 5 days postoperatively, which has been shown in the literature to provide improved finger motion as compared with passive-motion therapy. The proximal end of the tendon may need to be retrieved via a separate incision if it is not accessible through the flexor-tendon sheath.The proximal end of the tendon may be held in place with a 25-gauge needle in order to best place sutures into both ends of the tendon.The epitendinous suture is run around the back wall before the core sutures are tied down, in order to prevent the tendon and repair from bunching up and becoming overly bulky.The entire A4 pulley and the distal A2 pulley can be divided for exposure if necessary.Up to 2 cm of the flexor-tendon sheath can be divided.If there are concomitant digital nerve injuries, repair these after the tendon, in order to avoid damaging the more delicate nerve repair while manipulating the tendon for repair.The most common major complications following tendon repair are formation of adhesions and rerupture. FDS = flexor digitorum superficialisFDP = flexor digitorum profundusMCP = metacarpophalangealPIP = proximal interphalangealDIP = distal interphalangeal.
PubMed: 38357470
DOI: 10.2106/JBJS.ST.22.00057 -
Surgery Open Science Sep 2023Surgical suturing is a fundamental skill that all medical and dental students learn during their education. Currently, the grading of students' suture skills in the...
BACKGROUND AND OBJECTIVES
Surgical suturing is a fundamental skill that all medical and dental students learn during their education. Currently, the grading of students' suture skills in the medical faculty during general surgery training is relative, and students do not have the opportunity to learn specific techniques. Recent technological advances, however, have made it possible to classify and measure suture skills using artificial intelligence methods, such as Deep Learning (DL). This work aims to evaluate the success of surgical suture using DL techniques.
METHODS
Six Convolutional Neural Network (CNN) models: VGG16, VGG19, Xception, Inception, MobileNet, and DensNet. We used a dataset of suture images containing two classes: successful and unsuccessful, and applied statistical metrics to compare the precision, recall, and F1 scores of the models.
RESULTS
The results showed that Xception had the highest accuracy at 95 %, followed by MobileNet at 91 %, DensNet at 90 %, Inception at 84 %, VGG16 at 73 %, and VGG19 at 61 %. We also developed a graphical user interface that allows users to evaluate suture images by uploading them or using the camera. The images are then interpreted by the DL models, and the results are displayed on the screen.
CONCLUSIONS
The initial findings suggest that the use of DL techniques can minimize errors due to inexperience and allow physicians to use their time more efficiently by digitizing the process.
PubMed: 37601890
DOI: 10.1016/j.sopen.2023.07.023 -
Journal of Functional Biomaterials Oct 2023The extraction of impacted third molars is a common but potentially complication-prone oral surgical procedure. Wound healing plays a vital role in preventing... (Review)
Review
The extraction of impacted third molars is a common but potentially complication-prone oral surgical procedure. Wound healing plays a vital role in preventing complications. This scoping review aimed to assess the clinical and microbiological aspects of various suture materials and cyanoacrylates. Unlike existing studies, we included more articles and comprehensively compared suture materials. Articles published in languages other than English; duplicate studies; studies deemed irrelevant for the specific research questions, including those analyzing different supplementary treatments or not corresponding to the abstract's content; ex vivo or experimental animal studies; studies lacking approval from an ethics committee; and narrative reviews, systematic reviews, or systematic and meta-analysis reviews were excluded. Thus, only 17 studies, published between 2000 and 2023, were included in the search. Suture techniques varied among surgeons, with debates on primary and secondary closure methods. A comparison of different suture materials and their effects on wound healing, infection rates, and other factors was described. Cyanoacrylate has also been used as an alternative to traditional sutures. Microbiological analysis showed varying bacterial adhesion based on the suture material, with silk sutures retaining more microbes than PTFE sutures. Clinical assessments have revealed differing inflammatory responses that affect wound healing and complications. Cyanoacrylate has emerged as a promising alternative to traditional sutures, owing to its rapid polymerization and early healing. However, the choice of suture material in impacted third molar surgery remains controversial, considering microbiological factors and clinical outcomes. More extensive randomized clinical trials are required to better understand the effect of suture materials on surgical outcomes and potential improvements. This study could enhance the safety and effectiveness of this common oral surgical procedure.
PubMed: 37888194
DOI: 10.3390/jfb14100529 -
World Journal of Gastroenterology Aug 2023Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection...
BACKGROUND
Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors. However, the traditional interrupted suturing technique used in enterostomy closure surgery has several issues, including longer surgical incisions and higher incision tension, which can increase the risk of postoperative complications. To address these issues, scholars have proposed the use of a "gunsight suture" technique. This technique involves using a gunsight incision instead of a traditional linear incision, leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection. Building on this technique, we propose an improved gunsight suture technique. A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture, which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes, thereby reducing the risk of postoperative complications.
AIM
To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.
METHODS
In this study, a retrospective, single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021. The patients were divided into two groups: 135 patients received sutures using the improved gunsight method, while the remaining 135 patients were sutured with the traditional interrupted suture method. We collected data on a variety of parameters, such as operation time, postoperative pain score, body temperature, length of hospital stays, laboratory indicators, incidence of incisional complications, number of wound dressing changes, and hospitalization costs. Non-parametric tests and chi-square tests were utilized for data analysis.
RESULTS
There were no statistically significant differences in general patient information between the two groups, including the interval between the first surgery and the stoma closure [132 (105, 184) d 134 (109, 181) d, = 0.63], gender ratio (0.64 0.69, = 0.44), age [62 (52, 68) years 60 (52, 68) years, = 0.33], preoperative body mass index (BMI) [23.83 (21.60, 25.95) kg/m² 23.12 (20.94, 25.06) kg/m², = 0.17]. The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group [ ( = 2/135, 1.4%) ( = 10/135, 7.4%), < 0.05], and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group [5 (4, 7) d 7 (6, 8) d, < 0.05]. Additionally, the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group [4840 (4330, 5138) yuan 4980 (4726, 5221) yuan, > 0.05], but there was no significant difference in the total hospitalization cost between the two groups.
CONCLUSION
In stoma closure surgery, the improved gunsight technique can reduce the incision infection rate, shorten the postoperative hospital stay, reduce wound tension, and provide better wound cosmetic effects compared to traditional interrupted suture.
Topics: Humans; Retrospective Studies; Enterostomy; Surgical Wound; Surgical Wound Infection; Sutures
PubMed: 37621751
DOI: 10.3748/wjg.v29.i29.4571