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Background: Vascularized transplantation models in mice are critical to understand mechanisms that mediate rejection and to develop new therapeutics. Standard abdominal heterotopic heart transplantation techniques employ an end-to-side suture technique and are the workhouse of transplant immunology research laboratories. Recently, cervical heterotopic heart transplantation in mice has emerged as an alternative due to several advantages but is conventionally performed by suture or cuff techniques in an end-to-end fashion. Therefore, we introduce an end-to-side anastomosis technique. Methods: The donor pulmonary artery is end-to-side anastomosed to the recipient right external jugular vein, using a continuous 10–0 nylon suture. Vascular suturing is accomplished inside the vessel on the posterior wall, and then outside the vessel on the anterior wall. Finally, the donor ascending aorta is end-to-side anastomosed to the recipient common carotid artery with an identical suture technique. Results: The median times for the donor heart harvest, recipient preparation, anastomoses of the pulmonary artery to the external jugular vein, and the ascending aorta to the common carotid artery were 12, 10, 12 and 11 minutes, respectively. The survival rate was 100% (n = 20). Conclusions: We provide a detailed description of how to perform end-to-side anastomoses using a suture technique in the mouse cervical heart transplantation model. This procedure reconstitutes coronary blood flow in the heart graft with minimal interruption to recipient anatomy and provides an experimental platform to study transplant immunology.

Background: Incisional herniae (IH) are reported in 5–>20 % of patients undergoing open celiotomy, and can be linked to closure technique. The STITCH randomized trial favors a small bite technique for midline celiotomy closure with a 1-year IH rate of 13 % over larger bites (23 %). Methods: A continuous musculofascial mass closure with absorbable looped #1 PDS suture with 2-cm bite size was used for all open celiotomies. IH frequency and associated clinicopathologic factors were retrospectively analyzed from prospective data in 336 consecutive patients undergoing visceral resections by a single surgeon. Results: The study population included 192 men and 144 women, 81 % of whom had a cancer diagnosis, who underwent hepatobiliary, pancreatic, gastroesophageal, and colorectal resections, or a combination. The majority of patients (84 %) had subcostal incisions, and 10 % received a midline incision. At a median follow-up of 19.5 months, the overall IH rate was 3.3 %. Hernia rates were 2.5 % for subcostal margin, 2.9 % for midline, and 5.5 % for other incisions (p = 0.006). Median time to hernia detection was 492 days. Factors associated with IH were increased weight, abdominal depth/girth, male sex, spleen size, visceral fat, and body height (p ≤ 0.04 for all), but not type of resection, prior operations, underlying diagnosis, weight loss, adjuvant chemotherapy or radiation, incision length or suture to incision ratio. Conclusions: The described technique leads to a low IH rate of

Technique: (1) A four-pointed star-shaped incision was made to separate the skin around the stoma intestine. (2) The stoma intestine was resected, and side-to-side or end-to-side anastomosis was performed to restore the continuity of the intestine. (3) The peritoneum and rectus sheath should be closed using continuous full-thickness sutures. (4) The subcutaneous fat layer and dermis layer should be sutured using purse-string sutures. Two holes should be made in the center of the sutured area. (5) The cross should be sutured intermittently on all four sides using 1–2 stitches. (6) A rubber strip should be placed in the center of the small hole. Results: The presence of a small hole in the center of the incision and the use of a rubber strip for drainage facilitate early fluid drainage. The design of a cross-stitched skin incision helps reduce local tension. Conclusion: The modified cross-suture technique may reduce postoperative incision infections and associated pain, which is a suitable incision treatment method for loop stoma reversal.

The treatment of wide-necked complex intracranial aneurysms is full of challenges. We report a 72-year-old woman with subarachnoid hemorrhage and three intracranial aneurysms. According to the location of the hemorrhage, we chose the left side Pterional approach to clip the left side aneurysms and remove the hematoma. After clipping the left posterior communicating artery aneurysm, we found a small bifurcation aneurysm associated with dysplastic bulging of the nearby wall which together formed a wide-necked complex aneurysm. We used a novel suture combined with clipping technique to treat this complex aneurysm. Indocyanine green arteriography showed intact vascular patency in distal vessels, and the patient has achieved a good prognosis. It may provide a new idea for treating wide-necked complex intracranial aneurysms.

Introduction: Surgeons can reduce incisional hernia formation by adhering to standardized techniques for incisional wound closure. This is often neglected by the time a long operation is to be ended and can lead to the risk of developing an incisional hernia or a wound rupture. To address this issue, a suturing machine (Suture-TOOL) was developed for swift and standardized abdominal closure. The aim was to compare the user safety, speed, and suturing quality between Suture-TOOL and manual Needle-Driver suturing. Method: Fifteen surgeons who were specialists in surgery, urology, and gynaecology as well as surgical trainees were invited. The Suture-TOOL was presented to the surgeons who read the instructions for use before starting the test. Each surgeon closed nine 15 cm-long incisions in a human body model; six with Suture-TOOL and three with the Needle-Driver technique. Gloves were examined for puncture damage. Endpoints were suture-length/wound-length (SL/WL)-ratio, closure time, number of stitches, learning curve, and glove puncture rate. A VAS-evaluation concerning different Suture-Tool user impressions was completed. Results: A SL/WL-ratio ≥4 was 98% for Suture-TOOL versus 69% for Needle-Driver (p

Technique: (1) A four-pointed star-shaped incision was made to separate the skin around the stoma intestine. (2) The stoma intestine was resected, and side-to-side or end-to-side anastomosis was performed to restore the continuity of the intestine. (3) The peritoneum and rectus sheath should be closed using continuous full-thickness sutures. (4) The subcutaneous fat layer and dermis layer should be sutured using purse-string sutures. Two holes should be made in the center of the sutured area. (5) The cross should be sutured intermittently on all four sides using 1-2 stitches. (6) A rubber strip should be placed in the center of the small hole., Results: The presence of a small hole in the center of the incision and the use of a rubber strip for drainage facilitate early fluid drainage. The design of a cross-stitched skin incision helps reduce local tension., Conclusion: The modified cross-suture technique may reduce postoperative incision infections and associated pain, which is a suitable incision treatment method for loop stoma reversal., (Copyright © 2024 Asian Surgical Association and Taiwan Robotic Surgery Association. Published by Elsevier B.V. All rights reserved.)

The technical and ergonomic details of laparoendoscopic single site (LESS) reconstruction have not been reported. In this study, we explored the feasibility and safety of performing advanced LESS upper urinary tract reconstruction with conventional laparoscopic instruments. Methods: Between September 2010 and March 2011, we retrospectively reviewed prospectively collected data from five patients who underwent LESS urinary tract reconstruction. The LESS reconstruction included pyeloureterostomy (N = 1), dismembered pyeloplasty (N = 2), ureteroneocystostomy (N = 1), and ureteroplasty for bifid blind ending ureter (N = 1). The perioperative and postoperative parameters were collected for analysis. The ergonomic principles and techniques are detailed. Results: All reconstructive LESS procedures were completed successfully without open conversion or laparoscopic conversion. Ancillary ports or ancillary instruments were not applied in any of the patients. The mean patient age was 40.4 years. The mean operative time was 213 ± 69 minutes, the estimated blood loss ranged from minimal to 50 mL, and the mean hospital stay was 4.4 ± 4 days. No operation-related complication occurred. Conclusion: Based on our ergonomic principles and suturing/knotting techniques, conventional laparoscopic instruments are feasible and safe for LESS urinary reconstructive procedures.

Background: In East Asians, a common method to ameliorate puffy eyelids is to resect the excess orbital fat and the orbicularis. However, in some patients, a satisfactory improvement cannot be achieved because of the thick submuscular fibroadipose tissue (SMFAT) and minimal orbital fat. The SMFAT lies between the orbicularis and the orbital septum and can also be found in the pretarsal area. It is responsible for puffy eyelids and the slackening of the tissue after removal. In this study, we combined an extended SMFAT resection with the ladder suture technique to correct puffy SMFAT eyelids., Method: A total of 76 patients with a thick SMFAT and minimal orbital fat were recruited. The thick SMFAT, which included the soft tissue near the artificial fold and the pretarsal area soft tissue, was resected. The ladder suture technique was performed by positioning the stitch 1 mm below the orbicularis margin after a skin flap margin puncture. The esthetic effect was evaluated pre-operatively and at 12 months post-operatively., Results: The pre-operative thickness of the SMFAT and full layers of the eyelid were 0.27 ± 0.03 mm and 2.01 ± 0.11 mm, respectively. One year after surgery, the thickness was 0.08 ± 0.02 mm and 1.68 ± 0.14 mm, respectively (p < 0.05). The post-operative upper eyelash lift-up angle and the eyelash exposure length were significantly increased on both sides compared with the pre-surgery (p < 0.05). No patients experienced complications., Conclusion: An extended SMFAT resection combined with the ladder suture technique can effectively correct puffy SMFAT eyelids without complications., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022. Published by Elsevier Ltd.)

Introduction: Anterior sternoclavicular joint dislocation (SCJ) is a relative rare injury, related to high energy trauma. The objective of the present study is to present a novel suture technique for treatment of anterior SCJ traumatic dislocation and to report clinical outcomes from a small case series undergoing this procedure., Patients and Methods: Patients presenting with traumatic anterior SCJ disruption in our institution were eligible to participate. Surgical technique consisted of two bone tunnels drilled in vertical direction from the anterior to the posterior cortex of the manubrium. Analogous to the sternal side of the clavicle, two vertical bone tunnels were drilled from the anterior cortex towards the posterior cortex. A non-absorbable suture was passed though the four holes in a parallel configuration. Then, by pulling the free suture edges the posterior translation of the clavicle was performed. Two additional drill holes, the first in manubrium and the second in clavicle were performed from the anterior cortex to the posterior between the previous bone tunnels. A non-absorbable suture was placed in a simple configuration in order to stabilize the SCJ in the superior-inferior direction. The final follow up was 28.2 months. The mean QuickDASH was used for functional assessment., Results: Seven patients (6 males and 1 female) with average age of 34,8 years were included in the present study. Two patients suffered from concomitant medial clavicle fracture. At final follow-up (none of the patients had experienced any symptoms of instability of SCJ, no side-to-side difference was observed, while the Mean QuickDASH score was 4.85., Conclusion: The reported technique for SCJ reconstruction in traumatic anterior SCJ dislocations with two sutures has theoretical advantages, since it stabilizes the SCJ in the antero-posterior, as well as the supero- inferior direction. Outcomes from this small case series are favorable. However, more research is desirable to compare different techniques and to conclude to the optimal surgical treatment., Competing Interests: Declaration of Competing Interest All authors declare no conflict of interest in relation to the content of this study., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: Polypropylene meshes are one of the most frequently used patches in inguinal hernia repairs. This material was proved to be not completely inert, and may cause inflammatory responses like foreign body reactions. One of the physical results of these inflammatory reactions against the mesh is mesh shrinkage which is responsible for recurrence and pain. In this study, we aimed to investigate the effects of the suture technique on mesh shrinkage., Methods: 36 animals were used for the study. Subjects were divided into 3 groups. In the first group the mesh (onlay) was not fixated by any means. In the second group, mesh was placed on the abdomen wall, after which the mesh was fixated with interrupted suturing. In the third group, continuous suturing was applied after the placement of the mesh. Mesh shrinkage was measured macroscopically, and the mesh site reaction was evaluated microscopically. At the end of the second month, 18 subjects were sacrificed again to conduct the same procedure., Results and Conclusion: When meshes are used for hernia repairs, shrinkage may be observed in meshes placed on fascia. In the first group without mesh fixation, mesh shrinkage was more significant in the second month compared to the first month. The amount of shrinkage of without fixation group was found to significantly differ during the second month from interrupted and continuous suture groups. Even though statistically not significant, fixation of the mesh with interrupted sutures seems to be more advantageous compared to fixation with continuous sutures., (Copyright © 2018. Published by Elsevier Taiwan LLC.)

Background: Surgical wound closure directly influences spinal surgical efficiency and several postoperative complications. The traditional suture technique is time-consuming and associated with greater rates of complications. Bidirectional absorbable barbed sutures seem to compensate for some of the limitations of traditional suture; however, they rarely are reported in spinal surgery. We designed a novel suture technique for use in thoracolumbar spinal surgery., Methods: The data of 189 patients with traumatic thoracolumbar fractures were analyzed between bidirectional barbed suture closure and traditional interrupted suture closure. Data of operative time, wound closure time, length of incision, intraoperative blood loss, complications of wound dehiscence and postoperative hematoma, cost, and neurologic status were collected., Results: No significant differences were observed in the baseline demographics of included patients. Compared with the traditional suturing group, the barbed sutures decreased the mean operative time (P = 0.037), suture time (P < 0.01), and mean suturing time (P < 0.01) significantly, although no statistically significant differences were found in blood loss (P = 0.724) and neurologic functional scores (preoperative: P = 0.901; 3 months after surgery: P = 0.208; final follow-up assessments: P = 0.163), and no statistically significant differences were found in rates of postoperative infection, hematoma, and wound dehiscence., Conclusions: Our findings suggest that the novel knotless barbed suture has comparable strength to traditional sutures, with the advantage of less suturing time. It is an efficient, safe technique, and alternative choice for patients with thoracolumbar fracture after posterior surgery., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: This study aims to provide a helpful guide to perform tissue suturing successfully using suture coding-a method for identification of suture patterns and techniques by giving full information about the method of application of each pattern using numbers and symbols. Suture coding helps construct an infrastructure for surgical suture science. It facilitates the easy understanding and learning of suturing techniques and patterns as well as detects the relationship between the different patterns., Methods: Guide points are fixed on both edges of the wound to act as a guideline to help practice suture pattern techniques. The arrangement is fixed as 1-3-5-7 and a-c-e-g on one side (whether right or left) and as 2-4-6-8 and b-d-f-h on the other side. Needle placement must start from number 1 or letter "a" and continue to follow the code till the end of the stitching. Some rules are created to be adopted for the application of suture coding. A suture trainer containing guide points that simulate the coding process is used to facilitate the learning of the coding method., Results: (120) Is the code of simple interrupted suture pattern; (ab210) is the code of vertical mattress suture pattern, and (013465)²/3 is the code of Cushing suture pattern. (0A1) Is suggested as a surgical suture language that gives the name and type of the suture pattern used to facilitate its identification. All suture patterns known in the world should start with (0), (A), or (1). There is a relationship between 2 or more surgical patterns according to their codes., Conclusions: It can be concluded that every suture pattern has its own code that helps in the identification of its type, structure, and method of application. Combination between numbers and symbols helps in the understanding of suture techniques easily without complication. There are specific relationships that can be identified between different suture patterns. Coding methods facilitate suture patterns learning process., Clinical Relevance: The use of suture coding can be a good approach to the construction of an infrastructure of surgical suture science and the facilitation of the understanding and learning of suture pattern techniques., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)