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Journal of Materials Chemistry. B Jul 2024Surgical site infection (SSI) caused by pathogenic bacteria leads to delayed wound healing and extended hospitalization. Inappropriate uses of antibiotics have caused a...
Surgical site infection (SSI) caused by pathogenic bacteria leads to delayed wound healing and extended hospitalization. Inappropriate uses of antibiotics have caused a surge in SSI and common antibiotics are proving to be ineffective against SSI. Antimicrobial peptides (AMPs) can be a potential solution to prevent SSI because of their broad spectrum of antimicrobial activities. In this study, naturally sourced AMPs were studied along with microfibers, fabricated by a novel wet-spinning method using sodium alginate and polycaprolactone. Afterward, fibers were functionalized by the catechol groups of dopamine immobilizing nucleophilic AMPs on the surface. Conjugation between PCL and alginate resulted in fibers with smooth surfaces improving their mechanical strength hydrogen bonds. Having an average diameter of 220 μm, the mechanical properties of the fiber complied with USP standards for suture size 3-0. Engineered microfibers were able to hinder the growth of spp., a pathogenic bacterium for at least 60 hours whereas antibiotic ceftazidime failed. When subjected to a linear incisional wound model study, accelerated healing was observed when the wound was closed using the engineered fiber compared to Vicryl. The microfibers promoted faster re-epithelialization compared to Vicryl proving their higher wound healing capacity.
PubMed: 38958038
DOI: 10.1039/d4tb00889h -
Plastic and Reconstructive Surgery.... Jul 2024In prepectoral breast reconstruction, the acellular dermal matrix (ADM) is commonly used to envelop breast implants. Various wrapping methods have been proposed. We...
In prepectoral breast reconstruction, the acellular dermal matrix (ADM) is commonly used to envelop breast implants. Various wrapping methods have been proposed. We present a simple but aesthetic method (ie, the ray method) for wrapping in prepectoral breast reconstruction. Without any complicated design, we folded the four corners of one large ADM and sewed them together to completely envelop the implant. Then, the 6 o'clock corner of the ADM envelope was folded up and sutured to make a pentagonal shape. The other corners of the ADM envelope were quilted to determine the position and movement of the internal implant. Additional sutures were placed on the ADM envelope to separate the implant from the host tissue. The folded 6 o'clock corner was cut to a convex contour and had a diagonal gap to prevent the collection of fluid in the ADM envelope. Finally, the wrapped implant was inserted in the postmastectomy space, and the ADM envelope was spread widely to support soft tissue effectively. This simple design is straightforward for inexperienced surgeons and reduces operation time. The position and movement of the breast implant in the ADM envelope can be easily controlled by using quilted sutures. Subclavian depression and step-off deformities can be minimized by this wide-stretched ADM. By total coverage with a large ADM, the breast implant is separated from the surrounding tissue, and foreign body reactions are reduced. This method is reliable for maximizing the aesthetic advantages of prepectoral direct-to-implant breast reconstruction.
PubMed: 38957719
DOI: 10.1097/GOX.0000000000005835 -
Trauma Case Reports Aug 2024A male in his early 30s was transported to the emergency room after being hit by a vehicle while inebriated and lying in the street. His general condition was stable;...
A male in his early 30s was transported to the emergency room after being hit by a vehicle while inebriated and lying in the street. His general condition was stable; however, he had a perineal laceration that extended to the coccyx. Due to the proximity of the wound margin to the anus, we were concerned regarding the potential contamination and opted not to suture it. Therefore, we refrained from suturing the wound and kept the wound open after irrigation and debridement. Additionally, we performed a transverse colostomy. On day 4, we initiated negative pressure wound therapy for 40 days, during which sufficient wound granulation occurred. The patient was discharged, and the colostomy was closed approximately 4 months after the injury. Our case illustrates the effectiveness of negative pressure wound therapy in managing perineal lacerations.
PubMed: 38957177
DOI: 10.1016/j.tcr.2024.101059 -
Doklady Biological Sciences :... Jul 2024Fragments of two skulls of young cetotheriid baleen whales were described from the Fortep'yanka 2 locality (Russia, Republic of Adygea, Maikop district, Fortep'yanka...
Fragments of two skulls of young cetotheriid baleen whales were described from the Fortep'yanka 2 locality (Russia, Republic of Adygea, Maikop district, Fortep'yanka River valley, Upper Miocene, Upper Sarmatian, Blinovskaya Formation). The finds were attributed to Kurdalagonus maicopicus (Spasskii, 1951) based on the morphology of the posterior (mastoid) process of the petrosal bone, the structure of the posterior edge of the temporal fossa, and the S-like shape of the supraoccipital ridges. The skull proportions and the degree of suture closure made it possible to determine the individual age of the whales within a year. New finds significantly complement the data on the structure of the sutures of the lateral wall of the skull and age-related variability of cranial morphology in representatives of the genus Kurdalagonus.
PubMed: 38955886
DOI: 10.1134/S0012496624701011 -
Techniques in Coloproctology Jul 2024Laser hemorrhoidoplasty has demonstrated significant therapeutic effectiveness. To diminish postoperative bleeding and enhance overall outcomes, we have additionally...
BACKGROUND
Laser hemorrhoidoplasty has demonstrated significant therapeutic effectiveness. To diminish postoperative bleeding and enhance overall outcomes, we have additionally adopted suture ligating the feeding vessels. This study aimed to understand the treatment outcomes and any associated complications.
METHODS
This study comprised patients with symptomatic grade II-III hemorrhoids who underwent laser hemorrhoidoplasty with feeding vessel suture ligation and Milligan-Morgan hemorrhoidectomy between 1 September 2020, and 31 August 2022. Surgical-related details, postoperative pain, discomfort after discharge, hemorrhoid recurrence, and any complications were collected from inpatient records, outpatient follow-ups, and telephone interviews. Initially, we will analyze the distinctions between the laser group and the traditional group, followed by an investigation into complications and satisfaction within the laser surgery subgroup.
RESULTS
The study included 323 patients, with 173 undergoing laser hemorrhoidoplasty (LHP) and 150 undergoing Milligan-Morgan hemorrhoidectomy. Regarding pain assessment, the LHP group exhibited superior performance compared to traditional surgery at postoperative 4 h, before discharge, and during the first and second outpatient visits, with statistically significant differences. Additionally, the LHP group had a lower rate of urinary retention and experienced significantly less pain, with statistically significant differences.
CONCLUSIONS
Laser hemorrhoidoplasty with feeding vessels suture ligation has been shown to reduce postoperative pain and appears to be a promising minimally invasive treatment option for symptomatic grade II and III hemorrhoids.
Topics: Humans; Hemorrhoids; Ligation; Female; Retrospective Studies; Male; Hemorrhoidectomy; Middle Aged; Treatment Outcome; Adult; Pain, Postoperative; Laser Therapy; Suture Techniques; Aged; Recurrence; Postoperative Complications; Patient Satisfaction; Sutures
PubMed: 38955875
DOI: 10.1007/s10151-024-02940-4 -
Plastic and Reconstructive Surgery Feb 2024Suture extrusion has been reported to be the most common complication following cartilage-sparing otoplasty. Several studies have described various designs of...
BACKGROUND
Suture extrusion has been reported to be the most common complication following cartilage-sparing otoplasty. Several studies have described various designs of postauricular flaps to cover the cartilage sutures and reduce the incidence of suture extrusion.
PATIENTS AND METHODS
One hundred consecutive patients with prominent ears were operated between January 2018 and February 2023 using a de-epithelialized postauricular dermofascial flap that is performed as an adjunct to our cartilage-sparing otoplasty technique which is essentially a combined modified Mustardé and Furnas technique. The flap is used to cover the cartilage holding sutures with an extra layer of vascularized tissue to avoid the scar being directly over these sutures.
RESULTS
The median age of patients was 12 (IQR 9-15) years. One out of the 100 patients (1%) developed a postauricular skin infection requiring surgical removal of sutures. Primary suture extrusion did not occur, compared to our earlier study of cartilage-sparing technique without the postauricular flap in which 17 out of 200 patients had suture extrusion (p=0.001). No hematoma occurred that necessitated return to the theatre. Skin necrosis and wound dehiscence did not occur in any case. No patients developed cartilage deformities or relapse requiring surgical correction.
CONCLUSIONS
Combining cartilage-sparing otoplasty using sutures and the described postauricular dermofascial flap is simple to perform and has significantly reduced the complication rate and improved the outcome compared to cartilage-sparing otoplasty alone. We recommend using this flap for both primary and revisional otoplasty.
PubMed: 38954644
DOI: 10.1097/PRS.0000000000011342 -
Updates in Surgery Jul 2024The relatively recent adoption of Endoscopic Sleeve Gastroplasty (ESG) amongst obese patients has gained approval within the surgical community due to its notable...
The relatively recent adoption of Endoscopic Sleeve Gastroplasty (ESG) amongst obese patients has gained approval within the surgical community due to its notable benefits, including significant weight loss, safety, feasibility, repeatability, and potential reversibility. However, despite its promising clinical outcomes and reduced invasiveness, there is still a lack of standardised procedures for performing ESG. Multiple suture patterns and stitching methods have been proposed over time, yet rational tools to quantify and compare their effects on gastric tissues are absent. To address this gap, this study proposed a computational approach. The research involved a case study analyzing three distinct suture patterns (C-shaped, U-shaped and Z-shaped) using a patient-specific computational stomach model generated from magnetic resonance imaging. Simulations mimicked food intake by placing wire features in the intragastric cavity to replicate sutures, followed by applying a linearly increasing internal pressure up to 15 mmHg. The outcomes facilitated comparisons between suture configurations based on pressure-volume behaviours and the distribution of maximum stress on biological tissues, revealing the U-shaped as the more effective in terms of volume reduction, even if with reduced elongation strains and increased tissues stresses, whereas the Z-shaped is responsible of the greatest stomach shortness after ESG. In summary, computational biomechanics methods serve as potent tools in clinical and surgical settings, offering insights into aspects that are challenging to explore in vivo, such as tissue elongation and stress. These methods allow for mechanical comparisons between different configurations, although they might not encompass crucial clinical outcomes.
PubMed: 38954375
DOI: 10.1007/s13304-024-01917-0 -
Pediatric Surgery International Jul 2024To report our experience with laparoscopic repair of anterior congenital diaphragmatic hernia (CDH) using extracorporeal subcutaneous knot tying and to define recurrence...
PURPOSE
To report our experience with laparoscopic repair of anterior congenital diaphragmatic hernia (CDH) using extracorporeal subcutaneous knot tying and to define recurrence risk factors.
METHODS
This retrospective unicentric study included children who underwent laparoscopic repair of anterior CDH without patch, using extracorporeal knot tying of sutures passed through the full thickness of the abdominal wall (2013-2020). A systematic review of the literature with meta-analysis was performed using the MEDLINE database since 2000.
RESULTS
Eight children were included (12 months [1-183]; 10.6 kg [3.6-65]). Among the two patients with Down syndrome, one with previous cardiac surgery had a recurrence at 17 months postoperatively. In our systematic review (26 articles), among the 156 patients included, 10 had a recurrence (none with patch). Recurrence was statistically more frequent in patients with Down syndrome (19.4%) than without (2.5%) (p < 0.0001), and when absorbable sutures were used (50%) instead of non-absorbable sutures (5.3%) (p < 0.0001).
CONCLUSION
Laparoscopic repair of anterior CDH without patch was a safe and efficient surgical approach in our patients. The use of a non-absorbable prosthetic patch should be specifically discussed in anterior CDH associated with Down syndrome and/or in case of previous cardiac surgery to perform a diaphragmatic tension-free closure.
Topics: Humans; Hernias, Diaphragmatic, Congenital; Laparoscopy; Retrospective Studies; Infant; Recurrence; Herniorrhaphy; Male; Female; Child, Preschool; Child; Suture Techniques; Infant, Newborn; Adolescent; Down Syndrome; Risk Factors
PubMed: 38954216
DOI: 10.1007/s00383-024-05739-4 -
Indian Journal of Public Health Apr 2024The medical devices industry plays a critical role in public health and requires attention in research and policy. The COVID-19 pandemic exposed a lack of resilience in...
BACKGROUND
The medical devices industry plays a critical role in public health and requires attention in research and policy. The COVID-19 pandemic exposed a lack of resilience in areas of drugs and vaccines but also in medical products.
OBJECTIVES
The study analyzes India's strengths and weaknesses in the trade of medical devices and identifies specific devices where India can attain self-sufficiency and areas where trade is still beneficial.
MATERIALS AND METHODS
A set of critical products traded during the COVID-19 pandemic were identified from the World Integrated Trade Solution website at the 6-digit Harmonized System code level. A detailed analysis of exports and imports of medical products at disaggregated 8-digit codes was carried out.
RESULTS
During the pandemic, India had a trade surplus in some low-technology-based products such as suture needles, catheters, and cannulae along with X-ray apparatus and electrocardiographs among the medium-tech products. The imports of high-tech devices like in vitro diagnostics almost doubled to meet the surge in demand. The requirement of pulse oximeters, ventilators, and other monitoring devices jumped, and their imports reported an 800% increase from $134 million in 2019-2020 to $1162 million in 2021-2022. Most of India's imports of medical devices come from the top five exporting countries, with the share of the USA and China at 39%-40%.
CONCLUSION
There is a need to expand the manufacturing capacity of surgical instruments, consumables and disposables, apart from some high-tech products. The public health care facilities should procure domestically manufactured medical devices and trade with neighbouring countries to reduce import concentration must be prioritised.
Topics: COVID-19; India; Humans; Equipment and Supplies; Commerce; SARS-CoV-2; Pandemics
PubMed: 38953811
DOI: 10.4103/ijph.ijph_1403_23 -
Operative Neurosurgery (Hagerstown, Md.) Jul 2024The surgical treatment of trigonocephaly has undergone significant evolution, with an increasing use of a minimally invasive technique. The endoscope-assisted metopic...
The surgical treatment of trigonocephaly has undergone significant evolution, with an increasing use of a minimally invasive technique. The endoscope-assisted metopic suturectomy is currently considered a valid surgical option for the correction of metopic craniosynostosis.1-5 In this video-article, we present our surgical technique performed on a 5-month-old patient with type III (Genitori's classification6) trigonocephaly. The computed tomography (CT) scan showed fusion of the metopic suture with bitemporal narrowing and hypotelorism. The patient underwent endoscope-assisted metopic suturectomy, the width of the suturectomy is 1 cm, and an Esmarch sheet was used to protect the dura mater while drilling. Bridging veins are coagulated under endoscopic vision. The suturectomy is considered complete when the nasal cartilages are exposed, deconnecting thus completely the orbits. The postoperative CT scan showed the extent of the suturectomy. The patient did not present any neurological deficit or complications after surgery and was discharged on postoperative day 2. No helmet was used postoperatively. The patient repeated a head CT at age 11 years after head trauma and was seen at consultation. Interestingly, once the bone gap created after the metopic suturectomy reossifies, the frontal sinus develops normally. The long-term result was quite satisfying. The advantages of the mini-invasive technique consist in a smaller surgical scar, lower blood loss, shorter surgical time, and shorter hospital stay with good long-term results. The parents provided written consent for the publication of the patient's picture, the institutional research board approved the submission of this video article. In the video, the tips, tricks, and pitfalls of the technique are discussed.
PubMed: 38953669
DOI: 10.1227/ons.0000000000001247