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Patellar fractures represent approximately 1% of all fractures and the pattern is influenced by the quality of the bone and the energy of the trauma. Transverse fractures are associated with extensor mechanism failure and interruption of joint congruence. Patellar fractures are generally fixed using tension band principles, through K-wires and metal cerclage. The tension band was conceived to transform the considerable tensile force applied to the patella into a compressive one to obtain a stable fixation. The use of metal implants might be associated with a significant discomfort, mostly related to the irritating action of K-wires and cerclage on the surrounding soft tissues, often leading to the need for implant removal. Therefore, we introduced an original technique for fix patellar fractures by using only a non-adsorbable braided polyblend suture. Postoperative care included progressive range of motion recovery using an articulated knee brace and a specific protocol. The suture-only tension band technique seems to be a useful technique in terms of complications and reoperation rate while allowing secure and early mobilization. [ABSTRACT FROM AUTHOR]

Background: The management of the surgical wound of partially impacted mandibular third molar surgery has a great impact on recovery as well as on food impact retention. The present study used clinical parameters and health-related quality of life (HRQL) to compare outcomes of cyanoacrylate application versus traditional suture of third molar impaction surgery. Methods: This was a retrospective observational study of subjects scheduled for outpatient third molar surgery. Each participant signed an informed consent agreement. Inclusion criteria were as follows: presence of at least one partially impacted mandibular third molar, confirmed with a preoperative panoramic radiograph. Exclusion criteria were the following: smoking, diagnosed diabetes mellitus. Between June 2020 and September 2023, a total of 78 patients of mean age 31.14 years old (range 21–40 years, standard deviation 9.14), were included in this study—38 patients were male, 40 patients were female. A group of patients received traditional silk suture (G1 = 41 patients), while the second group (G2 = 37 patients) received hemostasis performed with fibrin sponge and, after complete soaking of the sponge, the application of cyanoacrylate gel on the blood clot and suture with one 2/0 stitch in order for recovery for secondary closure. The following parameters were measured: HRQL, average pain (AP), maximum pain (MP), complication score (CS), facial swelling (FS), and erythema. Results: For HRQL parameters, oral disability was found to be significantly higher in G1 while AP was significantly higher in G2 (p < 0.05). AP was higher in G2 (p = 0.0098), as well as MP (p = 0.001). No differences were found with regards to CS (p = 0.0759). FS and erythema were higher in G1 (p < 0.0001 for facial swelling, and p = 0.0001 for erythema). Conclusions: on the basis of this study, the use of cyanoacrylate after mandibular third molar surgery appears to be useful in order to reduce postoperative oral disability, facial swelling, and erythema after tooth extraction, with increased average and medium pain: clinicians may consider its use in selected cases. [ABSTRACT FROM AUTHOR]

Complications that can occur in the postoperative period of impacted lower third molar extraction are factors that have an impact on the daily routine of patients. This study aimed to evaluate the efficacy of polybutester and polypropylene sutures on postoperative complications after impacted lower third molar surgery. Two different suture materials were used in the 35 patients with bilateral impacted lower third molars included in the study: polybutester sutures in group 1 and polypropylene sutures in group 2. Measurements were taken to evaluate swelling and trismus before surgery and on the 2nd and 7th days after surgery, and pain was evaluated using a visual analogue scale (VAS), which patients were asked to complete after surgery. Wound healing, suture-related injury and suture-related discomfort in patients were also evaluated. The pain and suture-related discomfort felt on the side where the polybutester suture was used was less on the second postoperative day than on the side where the polypropylene suture was used. These results support the use of polybutester sutures in impacted third molar surgery. [ABSTRACT FROM AUTHOR]

Featured Application: This study provides data and rationales to aid researchers in the selection of surrogate models for in vitro assessments of surgically repaired meniscal roots. The results are potentially applicable in experimental in vitro investigations aimed at evaluating the performance of surgical repair both in existing approaches and emerging techniques. It could also be of interest for studies seeking to adjust material models of the meniscal tissue around the suture area for incorporation into computational models. Meniscal root repair is not routinely recommended for patients over 75 years old, yet surrogate age-unrestricted human or porcine models are used for its evaluation. This study assesses the suitability of older human or porcine meniscus models for in vitro testing of the sutured meniscal horn. Three groups of menisci underwent a load-to-failure test with continuous monitoring of the traction force and deformation around the suture: human < 75 years, human ≥ 75 years, and porcine. Both surrogate models were compared to the younger group. The porcine group exhibited a 172.1%-higher traction force before tearing (p < 0.001) and a 174.1%-higher ultimate force (p < 0.001), without there being differences between the human groups. At tissue level, the older group had a 28.7%-lower cut-out stress (p = 0.012) and the porcine group had a 57.2%-higher stress (p < 0.001). Regarding elasticity at the sutured area, a 48.1%-greater deformation rate was observed in the older group (p < 0.001), without difference for the porcine group. In conclusion, neither the porcine nor the older human model demonstrated a clear advantage as a surrogate model for young human sutured meniscal horns. The older human meniscus is preferable for resistance at the specimen level, while the porcine model better represents deformation in the sutured zone. [ABSTRACT FROM AUTHOR]

Surgical site infections (SSIs) may result from surgical procedures requiring a secondary administration of drugs at site or systemically in treating the infection. Drug-eluting sutures containing antimicrobial agents symbolise a latent strategy that precludes a secondary drug administration. It also offers the possibility of delivering a myriad of therapeutic agents to a localised wound site to effect analgesia, anti-inflammation, or the deployment of proteins useful for wound healing. Further, the use of biodegradable drug-eluting sutures eliminates the need for implanting foreign material into the wound, which needs to be removed after healing. In this review, we expound on recent trends in the manufacture of drug-eluting sutures with a focus on the hot-melt extrusion (HME) technique. HME provides a solvent-free, continuous one-step manufacturing conduit for drug-eluting sutures, hence, there is no drying step, which can be detrimental to the drug or suture threads and, thus, environmentally friendly. There is the possibility of combining the technology with additive manufacturing platforms to generate personalised drug-loaded implantable devices through prototyping and scalability. The review also highlights key material requirements for fabricating drug-eluting sutures by HME, as well as quality attributes. Finally, a preview of emerging drug-eluting sutures and advocacy for harmonisation of quality assurance by regulatory authorities that permits quality evaluation of novelty sutures is presented. [ABSTRACT FROM AUTHOR]

The hardest anatomical components of many animals are connected at thin seams known as sutures, which allow for growth and compliance required for respiration and movement and serve as a defense mechanism by absorbing energy during impacts. We take a bio-inspired approach and parameterize suture geometries to utilize geometric connections, rather than new engineering materials, to absorb high-impact loads. This study builds upon our work that investigated the effects of the dovetail suture contact angle, tangent length, and tab radius on the stiffness and toughness of an archway structure using finite element analysis. We explore how increasing the archway segmentation affects the mechanical response of the overall structure and investigate the effects of displacement when induced between sutures. First, when keeping displacement along a suture but increasing the number of archway pieces from two to four, we observed that stiffness and toughness were reduced substantially, although the overall trends stayed the same. Second, when the displacement was induced along an archway edge rather than upon a suture (in a three-piece archway), we observed that archway stiffness and toughness were much less sensitive to the changes in the suture parameters, but unlike the archway indented along the suture line, they tended to lose stiffness and toughness as the tangent length increased. This study is a step forward in the development of bio-inspired impact-resistant helmets. [ABSTRACT FROM AUTHOR]

Background: This study evaluated tissue adhesives in comparison to sutures for treating facial lacerations in children. Methods: We retrospectively analyzed data from September 2017 to August 2022 involving pediatric facial lacerations managed with either tissue adhesives or sutures. Results: Among 50 children, 20 received tissue adhesives, and 30 received sutures. Both methods showed comparable outcomes in terms of wound complications such as dehiscence (adjusted odds ratio = 1.56, 95% CI = 0.08–31.25) and infection (adjusted odds ratio = 2.17, 95% CI = 0.08–58.80). The cosmetic outcomes, assessed using the Hollander Wound Evaluation Score, were also consistent between groups (adjusted beta = −0.55, 95% CI = −1.15–0.05). Notably, those treated with tissue adhesives reported greater satisfaction (adjusted beta = 1.13, 95% CI = 0.63 −1.63) and experienced significantly less pain (adjusted beta = −3.03, 95% CI = −4.15–−1.90). Conclusions: Both techniques displayed similar rates of infection, dehiscence, and cosmetic outcomes. However, tissue adhesives were associated with increased patient comfort, especially in terms of reduced pain and greater satisfaction. [ABSTRACT FROM AUTHOR]

Background: The treatment of transversal maxillary deficiency usually aims at skeletal expansion. The treatment option highly depends on the maturation stage of the midpalatal suture (MPS), which may vary between individuals at the same chronological age. Therefore, the individual determination of the MPS maturation is crucial. Aims: Our aim was to investigate the applicability of fractal analysis for the quantitative evaluation of MPS maturation. Methods: Nine experienced orthodontists were asked to evaluate the MPS maturation on 51 cone beam computed tomography (CBCT) scans according to the Angelieri classification method. Intra- and inter-examiner reliability was measured using Cohen's Kappa coefficient. The stages were agreed upon according to the results of the examiners with the highest strength of agreement. Fractal analysis was then performed on the CBCTs and the correlation between the fractal dimension values and maturation stages was then evaluated. Optimal fractal dimension cut-off values were determined using a receiver operating characteristic curve. Results: The cut-off point was found at 1.073, at which the use of fractal dimension for predicting MPS maturation showed 100% sensitivity, 93.7% specificity, 9.5% false positive, 0% false negative rate. Conclusion: Our results provided further evidence that fractal analysis is a reliable tool to determine MPS maturation stage. [ABSTRACT FROM AUTHOR]

Background: Mandibular third molar (M3M) removal and management of postoperative complications represent a common matter of interest in oral and maxillofacial surgery. This potential quantitative study assessed the ability of two types of surgical sutures, Silk and polytetrafluoroethylene polymer (PTFE), to carry aerobic and anaerobic bacteria on wounds after mandibular third molar surgery, with a collection of the stitches at the suture removal and study in the laboratory on the basis of colony-forming units. Methods: This prospective quantitative study sampled a total of 10 consecutive healthy patients for mandibular third molar surgery at the Oral Surgery School, Dentistry and Dental Prosthodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy. The mean age of the patients was 31 years (range 25–40 years), seven patients were male and three patients were female. Inclusion criteria were: presence of a partially impacted mandibular third molar. Exclusion criteria were: smoking and diabetes mellitus. Extraction of the mandibular third molar was performed under local anesthesia: after the third molar surgery, two sutures were applied on the surgical site distally to the second mandibular molar: one single 3/0 silk stitch; one single 3/0 PTFE stitch. No sutures were applied on the release incision. Sutures were removed after 7 days and were immediately conserved and sent to the laboratory to be rated on the basis of colony-forming units (CFUs). CFUs were evaluated and reported on GraphPad Prism and transformed into its base 10 logarithm. Data were analyzed with a non-parametric Wilcoxon test, and p-values < 0.05 were evaluated as statistically significant. Results: All the patients attended the suture removal date, and all the sutures were present in the site. None of the surgical sites presented dehiscence. No stitch loss was reported, and no patient reported mouth washing or tooth brushing in the surgery site. All interventions were uneventful and no major complications were reported after M3M surgery. Bacterial retention resulted as statistically greater in silk sutures rather than PTFE sutures, both in Brain Heart Infusion samples (p = 0.003) and Wilkins-Chalgren anaerobe samples (p = 0.002). Conclusions: We found the PTFE suture to be superior to the silk suture in a reduction in the bacterial biofilm in both aerobic and anaerobic evaluations after M3M surgery. [ABSTRACT FROM AUTHOR]

Background: Postpartum hemorrhage is the leading cause of maternal mortality in emerging countries. This study aims to evaluate the effectiveness and safety of uterine artery embolization (UAE) using suture fragment (FairEmbo concept) in a swine model. Methods: Seven female swine uteri were embolized. The left uterine artery was embolized with 1 cm fragments of absorbable suture (Optime® 0), and with gelatin sponge torpedoes for the contralateral side for comparison. The embolization effectiveness and the time for arterial recanalization with digital subtraction angiography (DSA) controls at D0, D7, and M1, were evaluated. Follow-up protocol also included clinical monitoring and macroscopical analyses at M1. A Mann–Whitney test (significance at P 0.05) was used for statistics. Results: A technical success was obtained for the seven arteries on each side, with no off-target embolization. The procedure time (10 min versus 3.7 min) and number of fragments (13.8 versus 5.7) required for complete occlusion were significantly greater in the FairEmbo group. All arteries were repermeabilized at M1. No necrosis was macroscopically visible at harvest at M1. Conclusion: This experimental study suggests that UAE with SBM FairEmbo method is feasible, safe, and effective in comparison with gelatin sponge procedure. [ABSTRACT FROM AUTHOR]

Background: The choice of whether to perform a palatal disjunction in constricted maxilla has traditionally been decided based on the age of the patients, although there are gradually increasing references to the fact that this is not a determining factor. The main goal of this study was to evaluate the frequency of the different stages of midpalatal suture maturation in a sample of young adults between 15 and 30 years of age. Other objectives also included analyzing the possible correlation the maturation stages could maintain with sex and age groups. Methods: 142 Cone Beam Computed Tomography (CBCT) scans of young adults were performed. The images were divided into four age groups based on age ranges of 15–18, 19–22, 23–26, and 27–30 years. Each group consisted of 26, 41, 39, and 36 patients, respectively, which were classified using Angelieri's method. In addition, sex and age groups were considered as variables, and the possible correlation of the prevalence of each one, according to age and sex, was studied. Results: the sample was classified into 4.9% stage B; 52.1% stage C; 27.5% stage D; and 15.5% stage E. In addition, no statistically significant correlation between sex and the maturation stages was found, but more advanced stages did appear to be related to the chronological age of the subjects. Conclusions: The frequency of maturational stages where the suture is shown to be consolidated did not appear to be as high as expected; therefore, the idea of rejecting transverse plane treatment in a conventional manner in an out-of-growth patient should be discarded. [ABSTRACT FROM AUTHOR]

(1) Background: Three antimicrobial absorbable sutures have different triclosan (TS) loads, triclosan release kinetics and hydrolysis times. This in vitro study aims to analyse and compare their antimicrobial pharmacodynamics. (2) Methods: Time-kill assays were performed with eight triclosan-susceptible microorganisms common in surgical site infections (SSIs) and a segment of each TS. Microbial concentrations were measured at T0, T4, T8 and T24 h. Similar non-triclosan sutures (NTS) were used as controls. Microbial concentrations were plotted and analysed with panel analysis. They were predicted over time with a double-exponential model and four parameters fitted to each TS × microorganism combination. (3) Results: The microbial concentration was associated with the triclosan presence, timeslot and microorganism. It was not associated with the suture material. All combinations shared a common pattern with an early steep concentration reduction from baseline to 4–8 h, followed by a concentration up to a 24-h plateau in most cases with a mild concentration increase. (4) Conclusions: Microorganisms seem to be predominantly killed by contact or near-contact killing with the suture rather than the triclosan concentration in the culture medium. No significant in vitro antimicrobial pharmacodynamic difference between the three TS is identified. Triclosan can reduce the suture microbial colonisation and SSI risk. [ABSTRACT FROM AUTHOR]

Suturing is an essential skill in dentistry and not one easily acquired. The COVID-19 pandemic prompted a change to the use of Thiel cadavers and online resources with the aim of improving skill acquisition using the best model available. This study investigated the utility of the Thiel cadaver for teaching suturing skills and the potential impact of the lockdown. Fifty-seven year 4 students attended a teaching session. Student views on this teaching were explored via a questionnaire survey and qualitative data collected from a focus group. Data were analysed using an inductive approach. The response rate was 53% (30 students) for the questionnaire with 9 students participating in the focus group. Independent feedback was provided by two members of the teaching staff. Online video resources were very well received by the students with 97% agreeing that it was useful preparation. Ninety percent (90%) thought that the cadaveric model was suitable for this teaching and realistic. Positive emergent themes from the focus group centred on the use of the cadaveric model and the positive and relaxed teaching and learning environment. Staff perceived this model as superior to previously used models. There were no reported negative pandemic impacts and the cadaver model was well received. [ABSTRACT FROM AUTHOR]

Background: Sutures play a pivotal role in promoting healing in any surgical procedure. However, the versatile nature of the oral environment entails additional properties in the suture materials to assure uneventful healing. A surgeon needs to understand these delicate intricacies in the immediate postoperative phase and needs some kind of algorithm in the selection of sutures that suits the different surgical scenarios. Therefore, a study was designed to observe the effect of four different types of mouthwash, viz. Avohex, Aloedent, Parodontax and Betadine, on the mechanical properties of Vicryl (polyglactin 910), PTFE (polytetrafluoroethylene), Prolene (polypropylene) and Mersilk. Methods: A total of 288 suture samples were divided in four equal groups (72 = each group) and used for the experiments. Tensile load, tensile strength as well as percentage elongation of the suture materials were evaluated in the various stated media at 3rd, 7th, 10th and 14th days, which were compared with the controls. The results were analyzed statistically and inferences were drawn. Results: Mersilk in (Avohex, Parodontax and Betadine) solutions showed a statistically significant decrease in tensile load over time. All the sutures had the highest tensile strength in Parodontax and had the lowest in Betadine solution. Vicryl and PTFE presented significant percentage elongation over time as compared to Prolene and Mersilk. Conclusion: The author has given certain recommendations but also states that there is no standard rule for the use of a particular suture material in all clinical situations. However, the selection of the suture material should be based on the type of surgery and preferences of the surgeon. [ABSTRACT FROM AUTHOR]

Many animals have protective anatomical structures that allow for growth and flexibility; these structures contain thin seams called sutures that help the structure to absorb impacts. In this study, we parameterized the stiffness and toughness of a curved archway structure based on three geometric properties of a suture through finite element, quasi-static, three-point bending simulations. Each archway consisted of two symmetric pieces linked by a dovetail suture tab design. The three parameters included suture tab radii (1-5 mm), tangent lengths (0-20 mm), and contact angles (0-40°). In the simulations, a steel indenter was displaced 6.5 mm to induce progressive tab disengagement. Sutures with large contact angles and large tangent lengths generally led to stiffer and tougher structures. Sutures with a small tab radius exhibited the most sensitivity to the input parameters, and the smallest tab radius led to the stiffest and toughest archways. Results suggested that it was a combination of the largest number of tab repeats with the largest possible contact surface area that improved the mechanical response of the archway. The study revealed several suture geometries that hold significant promise, which can aid in the development of hemispherical 3D structures for dynamic impact applications. [ABSTRACT FROM AUTHOR]

Background and Objectives: The landmark for neurosurgical approaches to access brain lesion is the pterion. The aim of the present study is to classify and examine the prevalence of all types of pterion variations and perform morphometric measurements from previously defined anthropological landmarks. Materials and methods: One-hundred and twenty-four Thai dried skulls were investigated. Classification and morphometric measurement of the pterion was performed. Machine learning models were also used to interpret the morphometric findings with respect to sex and age estimation. Results: Spheno-parietal type was the most common type (62.1%), followed by epipteric (11.7%), fronto-temporal (5.2%) and stellate (1.2%). Complete synostosis of the pterion suture was present in 18.5% and was only present in males. While most morphometric measurements were similar between males and females, the distances from the pterion center to the mastoid process and to the external occipital protuberance were longer in males. Random forest algorithm could predict sex with 80.7% accuracy (root mean square error = 0.38) when the pterion morphometric data were provided. Correlational analysis indicated that the distances from the pterion center to the anterior aspect of the frontozygomatic suture and to the zygomatic angle were positively correlated with age, which may serve as basis for age estimation in the future. Conclusions: Further studies are needed to explore the use of machine learning in anatomical studies and morphometry-based sex and age estimation. Thorough understanding of the anatomy of the pterion is clinically useful when planning pterional craniotomy, particularly when the position of the pterion may change with age. [ABSTRACT FROM AUTHOR]

Surgical site infection (SSI) is a frequent complication of surgical procedures. The aim of this study was to analyze the clinical evidence for SSI prevention with triclosan-coated sutures (TCS) in abdominal surgery and to investigate the economic impact of TCS in this type of procedure compared with conventional absorbable sutures (CS). A literature review was carried out to identify meta-analyses that were published between 1990 and 2019 that assessed the use of TCS in abdominal surgery. A budget impact analysis was performed from an Italian hospital perspective based on the most recently published evidence to simulate the financial impact of TCS in a general surgery unit. Uncertainty was explored through scenario analysis, as well as deterministic and probabilistic sensitivity analyses. Nine meta-analyses and two additional randomized clinical trials were retrieved. All meta-analyses described a reduction (range 19%–44%) in the risk of SSI when TCS were used. The use of TCS was associated with an overall annual net saving for the general surgery unit of €14,785 and a reduction of 3.2 SSIs compared with CS. Sensitivity analyses resulted in a positive annual saving associated with TCS in 98% of scenarios. TCS are a valuable, cost-saving SSI prevention strategy. TCS additional costs would be offset by the reduction in SSIs. [ABSTRACT FROM AUTHOR]

To prepare the ESA (European Space Agency) spaceflight project "Wound healing and Sutures in Unloading Conditions", we studied mechanisms of apoptosis in wound healing models based on ex vivo skin tissue cultures, kept for 10 days alive in serum-free DMEM/F12 medium supplemented with bovine serum albumin, hydrocortisone, insulin, ascorbic acid and antibiotics at 32 °C. The overall goal is to test: (i) the viability of tissue specimens; (ii) the gene expression of activators and inhibitors of apoptosis and extracellular matrix components in wound and suture models; and (iii) to design analytical protocols for future tissue specimens after post-spaceflight download. Hematoxylin-Eosin and Elastica-van-Gieson staining showed a normal skin histology with no signs of necrosis in controls and showed a normal wound suture. TdT-mediated dUTP-biotin nick end labeling for detecting DNA fragmentation revealed no significant apoptosis. No activation of caspase-3 protein was detectable. FASL, FADD, CASP3, CASP8, CASP10, BAX, BCL2, CYC1, APAF1, LAMA3 and SPP1 mRNAs were not altered in epidermis and dermis samples with and without a wound compared to 0 day samples (specimens investigated directly post-surgery). BIRC5, CASP9, and FN1 mRNAs were downregulated in epidermis/dermis samples with and/or without a wound compared to 0 day samples. BIRC2, BIRC3 were upregulated in 10 day wound samples compared to 0 day samples in epidermis/dermis. RELA/FAS mRNAs were elevated in 10 day wound and no wound samples compared to 0 day samples in dermis. In conclusion, we demonstrate that it is possible to maintain live skin tissue cultures for 10 days. The viability analysis showed no significant signs of cell death in wound and suture models. The gene expression analysis demonstrated the interplay of activators and inhibitors of apoptosis and extracellular matrix components, thereby describing important features in ex vivo sutured wound healing models. Collectively, the performed methods defining analytical protocols proved to be applicable for post-flight analyzes of tissue specimens after sample return. [ABSTRACT FROM AUTHOR]

Surgical site infections (SSIs) are one of the most common nosocomial infections, which can result in serious complications after surgical interventions. Foreign materials such as implants or surgical sutures are optimal surfaces for the adherence of bacteria and subsequent colonization and biofilm formation. Due to a significant increase in antibiotic-resistant bacterial strains, naturally occurring agents exhibiting antibacterial properties have great potential in prophylactic therapies. The aim of this study was to develop a coating for surgical sutures consisting of the antibacterial substance totarol, a naturally occurring diterpenoid isolated from Podocarpus totara in combination with poly(lactide-co-glycolide acid) (PLGA) as a biodegradable drug delivery system. Hence, non-absorbable monofilament and multifilament sutures were coated with solutions containing different amounts and ratios of totarol and PLGA, resulting in a smooth, crystalline coating. Using an agar diffusion test (ADT), it became evident that the PLGA/totarol-coated sutures inhibited the growth of Staphylococcus aureus over a period of 15 days. A 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay showed that the coated sutures were not cytotoxic to murine fibroblasts. Overall, the data indicates that our innovative, biodegradable suture coating has the potential to reduce the risk of SSIs and postoperative biofilm-formation on suture material without adverse effects on tissue [ABSTRACT FROM AUTHOR]

The present case report aimed to investigate immediate histologic changes in midpalatal suture in humans following rapid maxillary expansion compared to control. Three patients (mean age 8.3 - 0.9 years) were enrolled in the case report and underwent midpalatal suture biopsy. Two patients underwent treatment before biopsy. The third patient did not show transversal maxillary deficiency and was enrolled as a control. Biopsy samples of midpalatal suture at 7 (subject 1) and 30 days (subject 2) after maxillary expansion as well as of one control (subject 3) were collected and processed for histology. In the control (subject 3) inter-digitations at the palatal suture gap were observed. At 7 days (subject 1) mature bone with small marrow spaces and trabecular bone with the peculiar storiform appearance inside the soft tissue and collagen fibers running parallel only in the central part were present. At 30 days (subject 2), a greater number of newly-formed bone trabeculae with a perpendicular orientation to the long axis of the suture could be seen. At 30 days the fibrous component of bone tissue was less represented compared to the sample at 7 days. Data from the preliminary histological results showed that bone formation was observed in the gap after rapid maxillary expansion, although the healing process was still ongoing. [ABSTRACT FROM AUTHOR]

Effective suturing remains key to achieving successful outcomes in corneal surgery, especially anterior lamellar keratoplasty and full thickness transplantation. Limitations in the technique may result in complications such as wound leak, infection, or high astigmatism post corneal graft. By using a systematic approach, this study reviews articles and conducts content analysis based on update 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria). The aim of this paper is to summarize the state of the art of corneal suturing techniques for every type of corneal transplant and patient age and also their outcomes regarding astigmatism and complications. Future developments for corneal transplantation will be also discussed. This is important because especially the young surgeon must have knowledge of the implications of every suture performed in order to achieve consistent and predictable post-operative outcomes and also be aware of all the possible complications. [ABSTRACT FROM AUTHOR]

Background and Objectives: The landmark for neurosurgical approaches to access brain lesion is the pterion. The aim of the present study is to classify and examine the prevalence of all types of pterion variations and perform morphometric measurements from previously defined anthropological landmarks. Materials and methods: One-hundred and twenty-four Thai dried skulls were investigated. Classification and morphometric measurement of the pterion was performed. Machine learning models were also used to interpret the morphometric findings with respect to sex and age estimation. Results: Spheno-parietal type was the most common type (62.1%), followed by epipteric (11.7%), fronto-temporal (5.2%) and stellate (1.2%). Complete synostosis of the pterion suture was present in 18.5% and was only present in males. While most morphometric measurements were similar between males and females, the distances from the pterion center to the mastoid process and to the external occipital protuberance were longer in males. Random forest algorithm could predict sex with 80.7% accuracy (root mean square error = 0.38) when the pterion morphometric data were provided. Correlational analysis indicated that the distances from the pterion center to the anterior aspect of the frontozygomatic suture and to the zygomatic angle were positively correlated with age, which may serve as basis for age estimation in the future. Conclusions: Further studies are needed to explore the use of machine learning in anatomical studies and morphometry-based sex and age estimation. Thorough understanding of the anatomy of the pterion is clinically useful when planning pterional craniotomy, particularly when the position of the pterion may change with age.

Cyanoacrylate tissue adhesive is proposed to promote soft tissue healing in oral surgery and minimize complications (pain, inflammation, and bleeding) associated with wound healing by secondary intention. The objective was to compare cyanoacrylate tissue adhesive (test group) with suture (control group) in terms of postoperative complications, operative time, and wound healing in the palatal donor area after harvesting a de-epithelialized gingival graft. A randomized controlled clinical trial was performed in 24 patients randomly assigned to one of two study groups. Data were gathered on wound bleeding, operative time, postoperative pain, inflammation, hyperesthesia, necrosis, and donor area healing time. Operative time was almost 50% shorter in the tissue adhesive cyanoacrylate group, a significant between-group difference ( p = 0.003). Spontaneous bleeding in the donor area during the first 24 h was observed in 11.1% of the tissue adhesive cyanoacrylate group versus 88.9% of the suture group-a significant difference. No significant between-group difference was observed in postoperative pain, inflammation, or degree of healing over time. There were no cases of hyperesthesia or wound necrosis. Utilization of tissue adhesive cyanoacrylate rather than suture in palatal de-epithelialized gingival graft harvesting reduces postoperative bleeding during the first 24 h, as well as the operative time.

Background: The objective of the arthroscopic treatment in tibial spine avulsion fractures (TSAF) is to achieve firm reduction and strong internal fixation while still having the patient undergo a minimally invasive procedure. Material and methods: The study was performed on 12 young patients with avulsion fracture of the anterior tibial spine. All 12 patients had type 3 Modified Meyers and McKeever fractures. The injury mechanism was direct anterior to posterior trauma in full leg length hyperextension with sport trauma reported in all cases. The physical examination revealed decreased range of motion, extension deficit, and pain during walking. Radiology, MRI, and CT pathologic findings described complete fracture of the anterior tibial spine with no clear signs of callus formation at the time of examination. All patients underwent arthroscopic suture surgical treatment. The Tegner, the Lysholm, and the International Knee Documentation Committee (IKDC) scores were used to evaluate subjective outcomes at three and six months after the surgery. Radiographs were used to assess callus formation and healing status of the fracture. Results: The mean IKDC score was 33.4 ± 23.3 (p = 0.032) preoperatively and 84.2 ± 14.3 at final follow-up (p = 0.0032, CI = 95%). The mean Tegner score improved from 3.8 ± 1.1 pre-operatively to 6.7 ± 2.2 at six months follow-up (p = 0.0231, CI = 95%). The Lysholm score differed significantly at baseline compared to final follow-up (53.7 ± 17.3 vs. 87.7 ± 9.9; p = 0.0066, CI = 95%). In all cases (n = 12), the radiographs taken after six months revealed the healing of the fracture in the anatomic position without secondary displacement. No functional knee instability was detected at the end of the study. Conclusions: The study provides preliminary promising results regarding fracture healing, knee stability, and functional subjective scores. Patient selection was a major factor of success prediction for this technique. [ABSTRACT FROM AUTHOR]

Suture biomaterials are critical in wound repair by providing support to the healing of different tissues including vascular surgery, hemostasis, and plastic surgery. Important properties of a suture material include physical properties, handling characteristics, and biological response for successful performance. However, bacteria can bind to sutures and become a source of infection. For this reason, there is a need for new biomaterials for suture with antifouling properties. Here we report two types of cellulose fibers from coconut (Cocos nucifera) and sisal (Agave sisalana), which were purified with a chemical method, characterized, and tested in vitro and in vivo. According to SEM images, the cellulose fiber from coconut has a porous surface, and sisal has a uniform structure without internal spaces. It was found that the cellulose fiber from sisal has mechanical properties closer to silk fiber biomaterial using Ultimate Tensile Strength. When evaluating the cellulose fibers biodegradability, the cellulose from coconut showed a rapid weight loss compared to sisal. The antifouling test was negative, which demonstrated that neither possesses intrinsic microbicidal activity. Yet, a weak biofilm was formed on sisal cellulose fibers suggesting it possesses antifouling properties compared to cellulose from coconut. In vivo experiments using healthy mice demonstrated that the scarring and mechanical connection was like silk for both cellulose fibers. Overall, our results showed the potential use of cellulose fibers from vegetal for surgical sutures due to excellent mechanical properties, rapid degradation, and no bacterial adhesion. [ABSTRACT FROM AUTHOR]

The aim of this study was to prepare chitosan (CS) filaments incorporated with N-acetyl-D-Glucosamine (GlcNAc), using the wet spinning method, in order to combine the GlcNAc pharmacological properties with the CS biological properties for use as absorbable suture materials. The filaments were characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), uniaxial tensile testing, in vitro biodegradation, and through in vitro drug release and cytotoxicity studies. It was observed that the addition of GlcNAc did not alter the morphology of the filaments. The CS and CS/GlcNAc filaments presented diameters 145 µm and 148 µm, respectively, and the surfaces were homogeneous. Although the mechanical resistance of the chitosan filaments decreased with the incorporation of the GlcNAc drug, this property was greater than the mean values indicated in the U.S. Pharmacopeia (1.7 N) for suture number 6-0 (filament diameter of 100–149 μm). The biodegradation of the CS filaments was accelerated by the addition of GlcNAc. After 35 days, the CS/GlcNAc filaments degradability was at its total, and for the CS filaments it was acquired in 49 days. The in vitro kinetic of the release process was of the zero-order and Hopfenberg models, controlled by both diffusion and erosion process. The in vitro cytotoxicity data of the CS and CS/GlcNAc filaments toward L929 cells showed that these filaments are nontoxic to these cells. Thus, the GlcNAc-loaded CS filaments might be promising as absorbable suture materials. In addition, this medical device may be able to enhance healing processes, relieve pain, and minimize infection at the surgery site due the prolonged release of GlcNAc. [ABSTRACT FROM AUTHOR]

Chitin (CT) is a good material to prepare surgical sutures due to its conspicuous biological characteristics. However, the poor mechanical strength of pure CT sutures limits its application. In order to improve its strength, a composite monofilament absorbable suture was prepared in this study using graphene oxide and chitin (GO-CT) using a green method. FT-IR spectra showed that GO-CT contained the characteristic functional groups of GO and CT, indicating that a GO-CT suture was successfully obtained. With the addition of a small amount of GO (1.6wt% solution) in chitin, the breaking tensile strength, knot strength, and knot-pull strength of the GO-CT suture were significantly improved compared to the CT suture. The biocompatibility of the GO-CT suture in vitro was checked by tetrazolium-based colorimetric assays and no cytotoxicity to L929 cells was found. In vivo, the subcutaneous implantation of GO-CT sutures in the dorsal skin of rats found no abnormalities by hematoxylin-eosin staining. Furthermore, there were no significant changes in the gene expression of the inflammatory mediators, interleukin 1β (IL-1β), tumor necrosis factor-α, IL-6, IL-17A, interferon-γ, or IL-10; however, the expression of transforming growth factor β was significantly increased in the first week. In summary, GO-CT sutures may have potential as a suture material in the clinic. [ABSTRACT FROM AUTHOR]