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Objectives: Hepatocaval ligament is localized on the posterior and lateral side of the retrohepatic Inferior Vena Cava (IVC) , above the right adrenal vein. Bleeding due to retro-hepatic cava injury could sometimes occur during the dissection and closure of hepatocaval ligament (HCL). We aim to determine closing meth- ods of HCL in terms of cost, ease of application and safety. Methods: The study population included 90 recipient hepatectomy patients who had cadaveric and live-donor liver transplantation at Organ Transplant Center of Acıbadem Hospital between 2017 and 2019. The patients were divided into two groups. The first group contained 40 patients who were closed with 25 mm EndoTA 30 stapler. The second group contained 50 patients who were closed by continuous double- layer suturing with 5/0 propylene. Results: In the group closed by endovascular stapler, reinforcement suturing was performed in eight patients (20%) using 5/0 propylene suture due to mild blood leakage in the closing line. In two patients (5%), on the other hand, the staple device could not be used due to the fact that HCL was very close to the right hepatic vein and the distance between the liver and the vena cava was short. There were no perioperative and postoperative HCL-associated liver and vena cava bleeding complications in both groups. However, the cost was significantly higher in the stapler group than in the suturing group. Conclusions: The present study is the first to compare the stapler or suturing techniques for closing HCL in the receiver hepatectomy of liver transplantation. The results indicated that the closure with suturing was at least as useful and convenient in terms of cost, ease of application and safety.

Introduction Information on the long-term performance of biosynthetic meshes is scarce. This study analyses the performance of biosynthetic mesh (Phasix™) over 24 months. Methods A prospective, international European multi-center trial is described. Adult patients with a Ventral Hernia Working Group (VHWG) grade 3 incisional hernia larger than 10 cm2, scheduled for elective repair, were included. Biosynthetic mesh was placed in sublay position. Short-term outcomes included 3-month surgical site occurrences (SSO), and long-term outcomes comprised hernia recurrence, reoperation, and quality of life assessments until 24 months. Results Eighty-four patients were treated with biosynthetic mesh. Twenty-two patients (26.2%) developed 34 SSOs, of which 32 occurred within 3 months (primary endpoint). Eight patients (11.0%) developed a hernia recurrence. In 13 patients (15.5%), 14 reoperations took place, of which 6 were performed for hernia recurrence (42.9%), 3 for mesh infection (21.4%), and in 7 of which the mesh was explanted (50%). Compared to baseline, quality of life outcomes showed no significant difference after 24 months. Despite theoretical resorption, 10.7% of patients reported presence of mesh sensation in daily life 24 months after surgery. Conclusion After 2 years of follow-up, hernia repair with biosynthetic mesh shows manageable SSO rates and favorable recurrence rates in VHWG grade 3 patients. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report lasting presence of mesh sensation. Results of biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations. Trial registration Registered on clinicaltrials.gov (NCT02720042), March 25, 2016.

Uni-portal video-assisted thoracoscopic approach is currently a popular surgical technique in general thoracic surgery. After operation, a chest tube is usually placed through the incision to drain the effusion and gas from the thoracic cavity. In the conventional method, the retaining stitches should be taken out ten days after removing chest drain. To get better would-healing and avoid unsightly scar, we explored a method of anchoring chest drain and two-layer suture for Uni-portal incision without removing stitches post operation.

Background There are several studies comparing techniques and different materials, yet the results are not unanimous. We compared three methods of skin closure in total knee arthroplasty (TKA), including suture with single stitches and unabsorbable MonoNylon®, as well as continuous subcuticular suture with Monocryl® or barbed Stratafix® absorbable suture. Methods A prospective, randomized study was conducted with 63 patients undergoing TKA between March 2016 and December 2016. Patients were divided into three groups: traditional suture MonoNylon® (n 22), subcuticular continuous suture with Monocryl® (n 20), and another barbed with Stratafix® (n 21). The closure time, length of wire used, pain intensity, possible complications, and cosmeses were evaluated. Results Subcuticular continuous suture using Monocryl® was superior to traditional suture using MonoNylon® as less thread was used (p 0.01) and a better cosmetic effect was achieved (p Stratafix® aspects analyzed (p > 0.05). Complications were observed mostly in patients who used Stratafix®. Conclusions This study concluded that the subcuticular suture with absorbable monofilament Monocryl® proved to be advantageous compared to the others because it presented results equal to the barbed Stratafix®, however with fewer complications. Furthermore, Monocryl® was shown to be equal or superior to traditional MonoNylon® suture regarding in relation pain intensity, aesthetic result, and effective cost. Trial registration WHO ICTRP identifier RBR78dh5d. Retrospectively registered: 07/29/2020.

Objective: Suspicion of early anterior fontanel (AF) closure is a common reason for referral to a pediatric neurosurgeon because of the suspected increased risk of developing craniosynostosis (CS) in spite of the absence of evidence in the literature. The aim of this study was to analyze the association between AF closure and the diagnosis of non-syndromic CS in Brazilian children. Methods: An observational and case-cohort study was conducted to compare the incidence of closed AF between healthy children (group 1) and children diagnosed with non-syndromic CS (group 2) at a pediatric neurosurgery referral center. The accuracies of completely closed AF and diagnosis of CS were assessed. Results: High-resolution three-dimensional reconstruction computed tomography scans were obtained for 140 children aged < 13 months, of whom 62.9% were boys and 37.1% were girls (p < 0.001). The most common types of non-syndromic CS were trigonocephaly (34, 48%) and scaphocephaly (25, 35.7%). Closed fontanel (27, 38.6%) was observed in both groups, and a sensitivity of 36.1%, specificity of 72%, the positive predictive value of 59%, and negative predictive value of 51% were observed in the patients diagnosed with CS when AF closure occurred before the age of 6 months. Conclusion: The results of this comparative study of AF closure and CS diagnosis suggest that early AF closure does not imply a diagnosis of CS. Pediatricians should be aware of the risk of misdiagnosis of CS in cases with a widely open AF in spite of the presence of CS.

Background Interference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction. However, previous studies had reported that the insertion of interference screws significantly caused graft laceration. The purposes of this study were to (1) quantitatively evaluate the graft laceration from one single insertion of PEEK interference screws; and (2) determine whether different types of sutures reduced the graft laceration after one single insertion of interference screws in ACL reconstruction. Methods The in-vitro ACL reconstruction model was created using porcine tibias and bovine extensor digitorum tendons of bovine hind limbs. The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra-high molecular weight polyethylene (UHMWPE) sutures. Poly-ether-ether-ketone (PEEK) interference screws were used for tibial fixation. This study was divided into five groups (n = 10 in each group): the non-fixed group, the non-sutured group, the absorbable suture group, the Ethibond suture group and the UHMWPE suture group. Biomechanical tests were performed using the mode of pull-to-failure loading tests at 10 mm/min. Tensile stiffness (newtons per millimeter), energy absorbed to failure (in joules) and ultimate load (newtons) were recorded for analysis. Results All prepared tendons and bone specimens showed similar characteristics (length, weight, and pre-tension of the tendons, tibial bone mineral density) among all groups (P > 0.05). The biomechanical tests demonstrated that PEEK interference screws significantly caused the graft laceration (P < 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction (P > 0.05). Conclusions Our biomechanical study suggested that the ultimate failure load of grafts was reduced of approximately 25 % after one single insertion of a PEEK interference screw in ACL reconstruction. Suturing the ends of the grafts using different sutures (absorbable, Ethibond and UHMWPE sutures) did not decrease the graft laceration caused by interference screws.

Background Due to improvements in operative techniques and medical equipment, video-assisted thoracoscopic surgery has become a mainstay of thoracic surgery. Nevertheless, in multiport thoracoscopic surgery, there have been no substantial advances related to the improvement of the esthetics of the site of the chest tube kept for postoperative drainage of intrathoracic fluid and decompression of air leak after thoracoscopic surgery. Leakage of fluid and air around the site of the chest tube can be extremely bothersome to patients. Methods From March 2019 to April 2020, we used a modified technique of closing the port site in 67 patients and the traditional method in 51 patients undergoing multiport thoracoscopic surgery due to lung disease or mediastinal disease. We recorded patients’ age, gender, body mass index, surgical method, postoperative drainage time, and postoperative complications.The NRS pain scale was used to score the pain in each patient on the day of extubation.The PSAS and the OSAS were used for the assessment of scars one month after surgery. Results In the modified technique group, only one patient (1.49%) had pleural effusion leakage, compared with five patients (9.80%) in the traditional method group (P Conclusions The modified technique of port site closure is a leak-proof method of fixation of the chest tube after multiport thoracoscopic surgery. Moreover, it is effective and preserves the esthetic appearance of the skin.

BACKGROUND Metopic suture is located anterior to the coronal suture. There are two types: complete and incomplete metopic sutures. Knowledge regarding the metopic sutures in adults is necessary to avoid misinterpretation of radiographs as frontal bone fracture. Knowledge with regard to metopic suture is helpful for anatomists and medico legal experts. This study has been done to find out the incidence of metopic suture, classify the metopic sutures into complete and incomplete type and further classify the incomplete variety based on shape. METHODS This study was conducted on 50 skulls from the Department of Anatomy, Autonomous Government Medical College and Hospital, Ratlam (MP). Skulls with signs of disease and damaged skulls were excluded from the study. RESULTS In the present study, out of 50 dry adult cadaveric skulls, 2 skulls (4 %) showed complete metopism. Incomplete metopic sutures were present in 28 / 50 (56 %) and absent in 20 / 50 (40 %). Out of 28 incomplete metopic sutures, single linear metopic sutures were present in 12 / 28 (42.85 %). Double linear metopic sutures were present in 7 / 28 (25 %). V-shaped metopic sutures were present in 5 / 28 (17.85 %) and U shaped metopic sutures were present in 4 / 28 (14.28 %). CONCLUSIONS Detailed knowledge of the metopic suture is important for neurosurgeons and radiologists in routine practice. Vertical frontal bone fractures may be easily misdiagnosed with persistent metopic sutures. This anatomical knowledge of metopic sutures is very useful for doctors while treating traumatised patients and during surgical intervention including frontal craniotomy. KEYWORDS Suture, Metopism, Frontal Bone, Nasion, Bregma

This study sought to assess patent fossa ovalis (PFO) anatomy by transesophageal echocardiography (TEE) in patients undergoing percutaneous suture-mediated PFO closure to identify predictors of post-procedural residual atrial right-to-left shunt (RLS).Percutaneous suture-mediated PFO closure has been proven to be a safe and effective technique in most PFO patients.From June 2016 to October 2019, 247 consecutive patients underwent percutaneous suture-mediated PFO closure at our institution. Of them, 230 (46 ± 13 years of age, 146 women) had complete and technically evaluable pre-procedural TEE. The following parameters in short-axis view were assessed: presence and grade of spontaneous RLS, PFO length and width, presence of atrial septal aneurysm and its maximal bulge, and presence of an embryonic or fetal remnant (Chiari network or Eustachian valve).At the first follow-up transthoracic echocardiography performed between 3 and 6 months from the closure procedure, a residual RLS ≥2 grade was found in 37 (16%) patients. Grade of pre-procedural spontaneous RLS (hazard ratio: 1.99; 95% confidence interval: 1.14 to 3.48; p = 0.016) shunt and PFO width (hazard ratio: 2.52; 95% confidence interval: 1.85 to 3.43; p 0.001) were both found to be significantly associated with significant residual RLS at multivariable analysis. The presence of atrial septal aneurysm and its maximal bulge and of congenital remnants was not associated with significant residual RLS.Percutaneous suture-mediated PFO closure is feasible in the majority of septal anatomies; however, PFO5 mm in width and spontaneous large RLS are less likely to be closed with 1 stitch only.

Renal transplantation represents the optimal management option for end-stage renal disease. it is associated with favourable outcome. Urolithiasis after renal transplant is an extremely rare condition, with an incidence less than 1% after renal transplantation. We reported six post renal transplant patients who had renal stones. The stones located in the transplanted kidney, its ureter or both. Transplanted kidney and ureteric stones had been reported 2 – 3 years after transplantation, while the urinary bladder calculi reported 8 – 10 years after transplantation, at the site of ureteral implantation to the bladder over the site of sutures and in the absence of any post-transplant complications. A written consent has been signed by the patient to release information for this study. The treatment was individualized for each patient. Interestingly, one patient with asymptomatic post-transplant renal stone needs no intervention “we watched and see” and he passed the stone within shortest follow up period that confirmed by ultrasound examination. Others, underwent extracorporeal wave lithotripsy or percutaneous nephrostomy and antegrade double-J stent insertion.

Although upper blepharoplasty is a common cosmetic surgical intervention, a better scientific understanding of the aesthetic results and the preferred surgical technique to achieve the best aesthetic results is still needed. A systematic search using four search engines (PubMed, Embase, CINAHL, and Cochrane) was performed to identify any study on the aesthetic outcome of a solitary upper blepharoplasty; these were subjected to quality assessment for possible inclusion. Eligible studies were randomized controlled trials, controlled trials, cohort studies, and case series (n >= 10). A total of 4043 studies were assessed, of which 26 were included. Aesthetic outcomes included patient-reported outcome measures, scarring, eyebrow height, tarsal platform show, and panel or expert evaluation. Meta-analysis was not possible. Patients were generally satisfied with the aesthetic result and scar formation after an upper blepharoplasty. The amount of tarsal platform show increases, which positively affects the aesthetics. The eyebrow seems to move down slightly. The surgical technique used (skin only or skin/muscle removal) did not influence patient satisfaction or the physician-assessed aesthetic outcomes. Patients are generally satisfied after an upper blepharoplasty. The optimal design of the skin excision is still a matter of debate, especially when addressing lateral hooding. Further objective research is advised.

BACKGROUND: The method of mesh fixation in Lichtenstein hernia repair may have an impact on the incidence of chronic groin pain (CGP) after surgery. This study aimed to compare fixation of mesh with N-butyl 2-cyanoacrylate and with sutures in open inguinal hernia repair in terms of CGP, postoperative complications, operation time, and hernia recurrence. PATIENTS AND METHODS: Adult patients with unilateral uncomplicated inguinal hernia were randomly assigned to one of two equal groups. Group I underwent mesh fixation with cyanoacrylate glue and Group II underwent mesh fixation with polypropylene sutures. The main outcome measures were pain scores at 1, 6, and 12 months of follow-up, hernia recurrence, postoperative complications, and operation time. RESULTS: Forty patients (39 male) of an average age of 48.2 years were included in the study. Patients in Group I had significantly lower pain scores at 1 week and 6 and 12 months after surgery than Group II. The operation time in Group I was significantly shorter than Group II (51.7 vs. 58.7 min, P = 0.007). No recurrence of hernia was recorded in either group at 12 months. Four patients in Group I experienced complications as compared to two patients in Group II with no significant difference (P = 0.66). CONCLUSIONS: Fixation of mesh in Lichtenstein repair with cyanoacrylate glue conferred significantly lower pain scores in the early postoperative period and at 6 and 12 months of follow-up than the classical suture fixation. No difference in the hernia recurrence and postoperative complication rates between cyanoacrylate and suture mesh fixation groups was observed.

Background The technique used in the repair of a perineal injury resulting from childbirth could avoid discomfort and morbidity during the postpartum period. Recent studies show inconsistent results and support the need for new research with the inclusion of new health parameters not yet studied. Therefore, this study aims to evaluate if the suture technique (continuous or interrupted) has an effect on pain and other postpartum problems, incidence of incontinence (urinary and/or fecal), and the restart of sexual relations. Methods A single-blind randomized clinical trial was conducted in five hospitals in south-east Spain. The participants were primiparous women who had experienced a perineal injury during delivery (second-degree tear or episiotomy). Data was collected on sociodemographic variables, variables associated with pregnancy, labor and delivery, and the postpartum period, and outcomes during the 3 months after delivery: pain, incontinence, and restart of sexual relations. Odds ratios (OR) were calculated by binary logistic regression to assess the influence of the suture type on binary outcomes and t-test used for comparing continuous outcomes. Multivariate analyses (using logistic regression -adjusted (aOR)- and analysis of covariance) were carried out to adjust for unbalanced variables after randomization. Results A total of 70 women were included in the intervention group (continuous suture) and 64 in the reference group (interrupted sutures). A negative association was observed (aOR = 0.39; 95% CI = 0.18–0.86) between a continuous suture and the need for analgesia at 24 h postpartum. Pain experienced by the women at 24 h postpartum was assessed as 4.4 ± 0.3 compared with a score of 3.4 ± 0.3 in the group with continuous sutures (p = 0.011). At 15 days postpartum, women in the intervention group experienced less pain (aOR = 0.38; 95% CI = 0.18–0.80) (p = 0.019). Urinary sphincter incontinence was also evaluated at 15 days, with 4.3% (n = 3) of the women in the intervention group presenting with urinary incontinence compared with 18.8% (n = 12) in the control group (aOR = 0.11; 95% CI = 0.03–0.47) (P = 0.003). Conclusions The women who had a continuous suture repair showed lower levels of pain from delivery to 3 months after delivery and had a lower incidence of urinary incontinence at 15 days postpartum. Trial registration ClinicalTrials.gov NCT03825211 posted January 31, 2019 (retrospectively registered).

International audience; Introduction - The aim of this article was to provide an overview of ultrasound (US) techniques for the investigation of cranial sutures in infants. Material and methods - We first describe a high-resolution sonography technique and its limitations. We then analyze the reliability, effectiveness and role of ultrasonography in routine practice using a PubMed literature review. Results - Ten studies reported excellent correlations between ultrasonography and 3D-CT. Cranial US for the diagnosis of a closed suture had 100% sensitivity in 8 studies and 86-100% specificity before the age of 12 months. Negative findings mean imaging investigation can be stopped. If ultrasonography confirms diagnosis, neurosurgical consultation is required. Thus, 3D-CT can be postponed until appropriate before surgery. Conclusion - Cranial suture ultrasound is an effective and reliable technique for the diagnosis of craniosynostosis. It has many advantages: it is fast and non-irradiating, and no sedation is required. It should be used as first-line imaging in infants below the age of 8-12 months when craniosynostosis is clinically suspected.

Right-sided Bochdalek hernia is a mostly congenital condition of the diaphragm caused by a persistence of the pleuroperitoneal cavity and a rare disease in adults. As it often presents as an emergent situation, urgent diagnostics and surgical intervention are essential to reduce morbidity and mortality rates. Choosing the right surgical approach (abdominal, thoracic, or a combination of both) can be very challenging for clinicians. Here, we report a case of a 40-year-old woman, who presented with severe abdominal pain and tachypnoea. Imaging revealed a right-sided Bochdalek hernia. Emergency laparotomy was performed followed by reduction of hernia content, right-sided hemicolectomy, and side-to-side anastomosis from the ileum to the transverse colon due to intestinal ischemia and intrathoracic bowel perforation. The post-operative course was complicated by a pleural empyema. Therefore, the patient underwent thoracotomy. One year after surgical repair the patient had no recurrence. Here, we discuss feasible approaches for the surgical management of complicated Bochdalek hernias.

Background: Suture hole bleeding is a common complication of vascular graft anastomosis that has potential to prolong vascular procedures, increase costs, and compromise patient outcomes. Objectives: Compare real-world bleeding-related outcomes and costs following vascular anastomosis using PROLENE sutures with HEMO-SEAL technology (HEMO-SEAL sutures) compared with standard PROLENE sutures in patients receiving abdominal aortic aneurysm (AAA) repair in the United States. Methods: AAA repair procedures using hemostats and either HEMO-SEAL sutures or standard PROLENE sutures were identified from 2009 to 2013 using the Premier Healthcare Database. The primary outcome was the number and cost of hemostat units. Secondary outcomes were number and cost of sutures, bleeding complications, and transfusions. Results: A total of 5082 discharges for AAA repairs using hemostats and HEMO-SEAL sutures or standard PROLENE sutures were identified. HEMO-SEAL sutures were used in 79 (1.6%) discharges, standard PROLENE sutures were used in 4946 (97.3%); both sutures (excluded from the analysis) were used in 57 (1.1%). Discharge demographics were similar across suture groups, with the exception of disease severity; the HEMO-SEAL suture group had a higher proportion of minor discharges and a lower proportion of extreme discharges compared with the standard PROLENE suture group. Mean number of hemostat units used per discharge (2.34 vs 3.30; median = 2.0 in both groups; p=0.026) and median hemostat costs per discharge ($111 vs $186; p

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.

Several surgical methods for the treatment of acute Achilles tendon ruptures have been described. Whether open or percutaneous, these methods may be subdivided into two categories: all-soft-tissue procedures or procedures with stabilization of the Achilles tendon directly on the os calcaneum. The former comprise end-to-end suturing of the tendon stumps, the latter include additional stabilization of the sutures on the calcaneus either with bone anchors or by means of trans-osseous sutures. We describe a new, simple, anatomic, trans-osseous suture technique to stabilize the Achilles tendon on the calcaneus.

BackgroundPartial nephrectomy (PN) is the recommended treatment for T1 renal cell carcinoma (RCC). Compared with suture PN, sutureless PN reduces the difficulty and time of operation, but the safety and feasibility have been controversial. This meta-analysis was conducted to compare the function and perioperative outcomes of suture and sutureless PN for T1 RCC.MethodsSystematic literature review was performed up to April 2021 using multiple databases to identify eligible comparative studies. According to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria, identification and selection of the studies were conducted. Meta-analysis was performed for studies comparing suture to sutureless PN for both T1a and T1b RCC. In addition, subgroup analysis was performed on operation time, warm ischemia time, estimated blood loss, and postoperative complications. Sensitivity analysis was used in analysis with high heterogeneity (operation time and estimated blood loss).ResultsEight retrospective studies were included with a total of 1,156 patients; of the 1,156 patients, 499 received sutureless PN and 707 received suture PN. The results showed that sutureless PN had shorter operative time (I2 = 0%, P < 0.001), warm ischemia time (I2 = 97.5%, P < 0.001), and lower clamping rate (I2 = 85.8%, P = 0.003), but estimated blood loss (I2 = 76.6%, P = 0.064) had no difference. In the comparison of perioperative outcomes, there was no significant difference in postoperative complications (I2 = 0%, P = 0.999), positive surgical margins (I2 = 0%, P = 0.356), postoperative estimated glomerular filtration rat (eGFR) (I2 = 0%, P = 0.656), and tumor recurrence (I2 = 0%, P = 0.531).ConclusionsIn T1a RCC with low RENAL score, sutureless PN is a feasible choice, whereas it should not be overestimated in T1b RCC.

Purpose: To compare the performance of nylon sutures to that of polyglactin sutures in pediatric patients undergoing cataract surgery.Setting: University of Campinas (UNICAMP), Campinas, São Paulo, BrazilDesign: A prospective, randomized, partially masked, single-site clinical trial. (https://clinicaltrials.gov/ct2/show/NCT03812640).Methods: A total of 80 eyes from 80 patients who underwent pediatric cataract surgery were randomized into two groups in block sizes of four. Group A consisted of 41 patients whose surgical incisions were sutured with polyglactin 10-0 material. Group B consisted of 39 patients whose surgical incisions were sutured with nylon 10-0 material. The primary outcome was frequency of suture-related complications in each group. Secondary outcomes were the frequency with which suture removal was necessary.Results: The incidence of suture-related complications within 6 months of follow up was 0 out of 41 eyes (0.00%) in the polyglactin group and 17 out of 39 eyes (43.59%) in the nylon control group (p < 0.001). In all of the eyes with suture-related complications, the sutures were promptly removed. The most frequent complications were vascularization near the suture (17.95%) and loose sutures (17.95%). No ocular or systemic study-related adverse events were observed.Conclusions: Polyglactin sutures were found to be safe and effective for pediatric patients undergoing cataract surgery. Their lower rate of complications and reduced likelihood of removal (and the subsequent need for general anesthesia) make their use preferrable to that of nylon sutures. This study represents the first controlled randomized clinical trial to compare nylon sutures to polyglactin sutures in pediatric patients undergoing cataract surgery.Clinical Trial Registration: URL: https://clinicaltrials.gov/ct2/show/, Identifier: NCT03812640.

Objective To determine the extent of acute cartilage injury by using trans-articular sutures. Methods Five different absorbable sutures, monofilament polydioxanone (PDS) and braided polyglactin (Vicryl), were compared on viable human osteochondral explants. An atraumatic needle with 30 cm of thread was advanced through the cartilage with the final thread left in the tissue. A representative 300 μm transversal slice from the cartilage midportion was stained with Live/Dead probes, scanned under the confocal laser microscope, and analyzed for the diameters of (a) central “Black zone” without any cells, representing in situ thread thickness and (b) “Green zone,” including the closest Live cells, representing the maximum injury to the tissue. The exact diameters of suture needles and threads were separately measured under an optical microscope. Results The diameters of the Black (from 144 to 219 µm) and the Green zones (from 282 to 487 µm) varied between the different sutures ( P < 0.001). The Green/Black zone ratio remained relatively constant (from 1.9 to 2.2; P = 0.767). A positive correlation between thread diameters and PDS suturing material, toward the Black and Green zone, was established, but needle diameters did not reveal any influence on the zones. Conclusions The width of acute cartilage injury induced by the trans-articular sutures is about twice the thread thickness inside of the tissue. Less compressible monofilament PDS induced wider tissue injury in comparison to a softer braided Vicryl. Needle diameter did not correlate to the extent of acute cartilage injury.

The surgical sutures commonly used in surgeries have been assessed by characterizing their behavior through tensile tests and determining which one has greater mechanical strength. Tensile tests of two different sutures have been performed. Tests have been performed under controlled conditions. The findings have been highlighted in this article.

Benoît Vogt,1 Ilham Chokri2 1Department of Urology, Polyclinique de Blois, La Chaussée Saint-Victor, 41260, France; 2Laboratory of Anatomocytopathology, Laboratoire Léonard de Vinci, Chambray-lès-Tours, 37170, FranceCorrespondence: Benoît VogtDepartment of Urology. Polyclinique de Blois, 1 rue Robert Debré, La Chaussée Saint-Victor, 41260, FranceTel +33 663220844Fax +33 254906566Email message@benoitvogt.frIntroduction: The Sonic Hedgehog/Gli1 signal is involved in smooth muscle activity. An experiment showed that the double-pigtail stent caused ureteral inflammation and decreased Gli1 expression in smooth muscle cells. The innovative pigtail-suture stent (JFil® or MiniJFil®) with a thin 0.3F suture thread significantly decreased stent-related symptoms. Fortuitously, a dilation of the ureter containing the sutures was discovered, and a previous study confirmed that the sutures caused less ureteral inflammation than the double-pigtail stent. However, the mechanisms involved in the ureteral dilation are still unknown. In this study, we assessed ureteral Gli1 expression in the human ureter when it was un-stunted or when fitted with a double-pigtail stent or a suture thread.Material and Methods: After consent and inclusion of patients in the protocol, nine segments of ureters were collected during cystectomy procedures for bladder cancers. There was no selection or exclusion, and patients with large tumors were included. Gli1 expression was assessed on the histological section to control the reflection of an active hedgehog signal. The expression of Gli1 in smooth muscle cells of the stented ureter was subjectively compared to un-stented ureter.Results: A decrease in the intensity of Gli1 expression of smooth muscle cells was observed in all cases of ureter fitted with a double-pigtail stent. For the un-stunted ureters and the ureters fitted with the thin 0.3F suture thread, Gli1 staining of smooth muscle cells was heterogeneous, and the small number of cases did not allow us to conclude.Conclusion: Apart from the cases of ureters fitted with the double-pigtail stent, Gli1 expression of smooth muscle was heterogeneous. The Shh/Gli1 pathway may not be involved in ureteral dilation by the thread. A broader exploration of molecular mechanisms could make it possible to obtain the mechanisms involved in the dilation of the ureter by the thread.Keywords: Sonic Hedgehog, suture, thread, ureter, ureteral stent, pigtail-suture stent

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.

Objective: The objective of this trial was to identify a superior method for umbilical and epigastric hernia repair in terms of complications. Complications such as an extended operation duration, additional use of painkillers, reoperation, infection, seroma, extended wound care, extended hospitalization, and early recurrencewere reported according to the Clavien-Dindo grading system.Summary Background Data: Over the years mesh repair is proven the gold standard for umbilical and epigastric hernias. The question remains, which mesh should be used?Methods: In this randomized controlled, multicenter trial, all patients >= 18 years with a single, symptomatic, and primary small umbilical or epigastric hernia qualified for inclusion. Flat preperitoneal polypropylene mesh repair was compared with patch repair (PROCEED Ventral Patch) (PVP).Results: A total of 352 patients were randomized; 348 patients received the intervention (n = 177 PVP vs n = 171 mesh). One out of 4 suffered from any kind of complication within 2 years postoperative (27.6%). A significant difference in complications was seen, in favor of polypropylene mesh repair (P = 0.044, 22.1% mesh vs 32.5% PVP). Reoperation was performed in 19 PVP operated patients (10.7%) versus 7 patients with polypropylene mesh repair (4.0%, P = 0.021).No significant differences were seen in recurrences (n = 13, 8.4% PVP vs n = 6, 4.1% mesh, P = 0.127).Conclusions: In small epigastric and small umbilical hernia repair a flat polypropylene mesh repair was associated with a lower complication rate than PVP repair. No differences in recurrence rates were seen. Combining all complications, the preperitoneal positioned flat polypropylene mesh performed better.

Purpose: This study was designed to assess the feasibility and safety of percutaneous axillary access in complex endovascular aortic repair (EVAR) with use of a percutaneous closure device.Materials and Methods: All patients undergoing percutaneous axillary artery access between 2012 and 2017 were included. Left percutaneous axillary access was the sole antegrade aortic approach used. Patient and intervention characteristics were documented. Mortality, procedural success, technical success, peri- and postoperative complications, and repeat interventions were examined. A total of 25 percutaneous axillary access procedures were performed in 23 patients. The mean age of the treated patients was 72.2 years, and 71% were male. Percutaneous axillary access was obtained for a variety of indications (chimney EVAR, thoracoabdominal aortic aneurysm repair, thoracic EVAR, and type B dissections). Vascular access sheath sizes ranged`from 6 F to 12 F.Results: The procedural success rate was 96%. Technical success of vascular closure was 100%. The perioperative access complication rate was 8%: 1 dissection of the axillary artery and 1 stenosis occurred. No hematoma, hemorrhage, or neuropathies were seen. One access-related repeat intervention had to be performed. The 30-d mortality rate was 4%.Conclusions: Direct puncture and percutaneous closure of the axillary artery for complex aortic procedures is safe and feasible.

Introduction: The surgical treatment for Achilles tendon rupture has become very popular in the last years, because of the good outcomes and the low re-rupture rate. Aim: The aim of this study is to compare the results between open surgery and percutaneous ultrasound-assisted surgery. Methods: All patients who underwent an Achilles tendon surgical repair in the last 3 years were included, resulting in a total of 56 patients (40 M and 16 F) with an average age of 53 years. Of these patients, 36 were treated with an open suture, while 20 with a mini invasive ultrasound assisted suture. At a minimum follow-up of one year, patients were evaluated echografically, using both the Achilles Tendon Rupture Total score (ATRS) and the McComis score, and performing the ultrasounds bilaterally to assess both the structure and the diameter of tendons. Results: Both groups of patients showed an average ATRS score >80. The McComis score was 54.18 vs. 56.25 (p>0.05). Plantar flexion and dorsal flexion work were not similar (p>0.05). On average, the calf circumference of the operated side was decreased compared to the healthy side between the groups (p>0.05). The thickness of the operated tendons evaluated with ultrasound measurement compared to the average tendon, (p

Purpose: To evaluate the efficacy of autologous serum in fixing conjunctival autografts of various sizes in different grades and types of pterygium and to determine the largest successfully secured graft size. Methods: This prospective interventional study comprised 151 eyes of 151 patients belonging to age group of 21 to 64 years with different grades and types of primary and recurrent pterygium that underwent excision with inferior conjunctivo - limbal autograft secured with autologous serum. The autografts were measured with calipers and were grouped by size into three categories: Group A, small (5 × 5 mm); Group B, medium (5–7 × 5 mm); and Group C, large (>7 × 5 mm). The adhesive fixation power of autologous serum for the various conjunctival autograft sizes was determined for each group using the following criteria: graft stability, cosmetic appearance and complications in the immediate ( first week) and two-months postoperative follow-up visits. Descriptive statistical analysis was used to calculate the percentage frequency of the variables. Results: The groups A, B, and C included 48%, 22%, and 30% of the autografts, respectively. Overall, 93.34% of the grafts were stable with good cosmetic appearance. However, subconjunctival hemorrhage (36%), graft edema (36%) and graft retraction (13.5%) were the most common complications. The largest successfully fixed graft was 14 × 5 mm in size. Conclusion: Autologous serum is efficient in securing conjunctival autografts of various sizes with minimal complications and satisfactory results, including good cosmesis.

Background The current standard for open and laparoscopic repair of incisional hernia consist of an abdominal wall augmentation by mesh implantation. However, the ideal fixation method of the prothesis material remains under discussion, due to potential complications of conventional fixation methods such as chronic abdominal pain or intestinal obstruction. As the use of adhesive based mesh fixation is an option of growing interest, the aim of this experimental study was to investigate the strength and biocompatibility of two newly developed polyurethane-based adhesives in comparison to a cyanoacrylatic adhesive, which is currently in clinical use. Methods Two experimental polyurethane/urea-based adhesives (Adhesive-A and Adhesive-B) were compared to a conventional cyanoacrylatic adhesive and an untreated control group. Biomechanical testing was carried out using a pull-out test in uniaxial tensile mode, while biocompatibility assessment was performed in a rat model with 40 Sprague-Dawley rats receiving a subcutaneous implanted PVDF mesh fixed by the corresponding adhesive. Histological and immunohistochemical analysis by a Tissue FAXS system examined the tissue integration of the mesh/adhesive combination and characterized the foreign body reaction. Results Biomechanical testing of the mesh/adhesive combinations showed a minimal strength of 15.08 N without a significant difference between the groups. Cellular penetration into the mesh/adhesive interface was significantly improved after application of polyurethane adhesives and Adhesive-A showed a significantly lower migration of CD68 positive cells to the adhesive sites compared to cyanoacrylate after 7 days. Conclusion The developed polyurethane-based adhesives are a promising alternative with sufficient adhesive strength and superior short-term biocompatibility to cyanoacrylate.

Objective To find out the mesh fixation technique that minimises chronic pain in Lichtenstein hernioplasty. Summary background data Mesh fixation may affect chronic pain and recurrence after inguinal hernia surgery, but long-term results of comparative trials are lacking. Methods Lichtenstein hernioplasty was performed under local anaesthesia on 625 patients in day care units. The patients were randomised to receive either a cyanoacrylate glue (n = 216), self-gripping mesh (n = 202) or non-absorbable 3–0 polypropylene sutures (n = 216) for the fixation of mesh. A standardised telephone interview or postal questionnaire was conducted 5 years after the index operation. The patients with complaints suggesting recurrence or chronic pain (visual analogue scale ≥ 3, 0–10) were examined clinically. The rate of occasional pain, chronic severe pain, recurrence, re-operations, daily use of analgesics, overall patient satisfaction and sensation of a foreign object were recorded. Results A total of 82% of patients (n = 514) completed the 5-year audit including 177, 167 and 170 patients in the glue, self-fixation and suture groups, respectively. There were no significant differences in the incidence of pain (7–8%), operated recurrences (2–4%), overall re-operations (4–5%), need for analgesics (1–2%), patient’s satisfaction (93–97%) or in the feeling of a foreign object (11–18%) between the study groups. Conclusion The choice of the mesh or fixation method had no effect on the overall long-term outcome, pain or recurrence of hernia. Less penetrating fixation (glue or self-gripping mesh) is a safe option for the fixation of mesh in Lichtenstein hernia repair.

BACKGROUND Sutures have been used to repair wounds since ancient times. However, the basic suture technique has not significantly changed. In Phase I of our project, we proposed a “double diabolo” suture design, using a theoretical physical study to show that this suture receives 50% less tension than conventional sutures, and so a correspondingly greater force must be applied to break it. AIM To determine whether these theoretical levels of resistance were met by the new type of suture. METHODS An observational study was performed to compare three types of sutures, using a device that exerted force on the suture until the breaking point was reached. The tension produced by this traction was measured. The following variables were considered: Tearing stress on entry/exit points, edge separation stress, and suture break stress. The study sample consisted of 30 sutures with simple interrupted stitches (Group 1), 30 with continuous stitches (Group 2), and 30 with the “double diabolo” design (Group 3). RESULTS The mean degree of force required to reach the breaking point for each of these variables (tearing, separation, and final breaking) was highest in Group 3 (14.56, 18.28, and 21.39 kg), followed by Group 1 (7.36, 10.38, and 12.81 kg) and Group 2 (5.77, 7.7, and 8.71 kg). These differences were statistically significant (P < 0.001) in all cases. CONCLUSION The experimental results show that with the “double diabolo” suture, compared with conventional sutures, greater force must be applied to reach the breaking point (almost twice as much as in the simple interrupted suture and more than double that required for the continuous suture). If these results are confirmed in Phase III (the clinical phase) of our study, we believe the double diabolo technique should be adopted as the standard approach, especially when the suture must withstand significant tension (e.g., laparotomy closure, thoracotomy closure, diaphragm suture, or hernial orifice closure).

Sutures are medical devices used in surgery. They serve as tissues stabilizers in contact with or near to the surgical site without compromising the healing process. They must keep their physical properties for the necessary time, in particular tensile strength. In view of the wide variety of references offered by all specialtys combined, which supply sutures with all materials described, whose use is indicated for all surgical procedures. The objective of this work is to evaluate the tensile strength of absorbable and non-absorbable sutures for a period of 10 to 28 days under conditions simulated by the oral route. 5 sutures materials were tested with a metric diameter of 1.5 and 4.The tensile strength test was used according to the protocol of the European Pharmacopoeia (Eur.Ph.9.5). 5 fragments of each material were measured before and after their immersion in Artificial Saliva (AS). In AS, the Polypropylene suture significantly maintained (p = 5%) its tensile strength compared to that of Polyamide. For absorbable sutures, a loss of more than 70% of their initial strength was marked on the 7th day of immersion. In view of the results obtained, during oral surgical operations, the material of choice is in favor of Propylene.

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 Patella fractures requiring surgery are traditionally treated using metallic implants, which are associated with high re-operation rates, mainly due to implant prominence. To overcome the problem of prominent metallic implants, we present a technique based purely on braided sutures. Methods This technique is described in a step-wise, standardised way based on our findings on six patients treated at our institution. Results This technique can be adapted to all types of patella fractures. The described suture configuration allows maintenance of inter-fragmentary reduction until bony union without symptoms from the suture material. Conclusions We believe that this technique is a safe and promising alternative to traditional metallic fixation methods.

Sutures are applied almost universally at the site of trauma or surgery, making them an ideal platform to modulate the local, postoperative biological response, and improve surgical outcomes. To date, the only globally marketed drug‐eluting sutures are coated with triclosan for antibacterial application in general surgery. Loading drug directly into the suture rather than coating the surface offers the potential to provide drug delivery functionality to microsurgical sutures and achieve sustained drug delivery without increasing suture thickness. However, conventional methods for drug incorporation directly into the suture adversely affect breaking strength. Thus, there are no market offerings for drug‐eluting sutures, drug‐coated, or otherwise, in ophthalmology, where very thin sutures are required. Sutures themselves help facilitate bacterial infection, and antibiotic eye drops are commonly prescribed to prevent infection after ocular surgeries. An antibiotic‐eluting suture may prevent bacterial colonization of sutures and preclude patient compliance issues with eye drops. We report twisting of hundreds of individual drug‐loaded, electrospun nanofibers into a single, ultra‐thin, multifilament suture capable of meeting both size and strength requirements for microsurgical ocular procedures. Nanofiber‐based polycaprolactone sutures demonstrated no loss in strength with loading of 8% levofloxacin, unlike monofilament sutures which lost more than 50% strength. Moreover, nanofiber‐based sutures retained strength with loading of a broad range of drugs, provided antibiotic delivery for 30 days in rat eyes, and prevented ocular infection in a rat model of bacterial keratitis.

Background Microsurgery requires high skills for suturing using fragile threads, often within narrow surgical fields. Precise tension is required for good healing and to avoid the risk of thread breakage. Methods To meet the demands, we developed a novel assist robot utilizing high-precision sensorless haptic technology. The robot adopts a cable-driven mechanism to maintain a distance from the surgical area and enhances compatibility with surgical equipment such as microscopes. The robot performance was verified through an in vitro and in vivo experiments using a rat model. Results The realization of precise tension control was confirmed in both experiments. In particular, in the in vivo experiments, the developed robot succeeded to produce a knot with an accurate tension of 0.66% error. Conclusions The developed robot can realize to control traction force precisely. This technology might open up the window for a full assist robot for microsurgery with haptic feeling. This article is protected by copyright. All rights reserved.

Background: For high–tensile strength sutures, past research has largely focused on mechanical properties or bacterial adherence across various manufacturers. Purpose: This study investigated high-tensile strength sutures with different shapes but otherwise identical composition. The purpose was to evaluate the differences between high–tensile strength suture wire and suture tape relative to bacterial adherence and bacterial retention after washout. Study Design: Controlled laboratory study. Methods: Sutures were implanted in dorsal air pouches of 72 BALB/cJ mice. Experimental pouches were inoculated with Staphylococcus aureus; no bacteria were used in the control conditions. The mice were randomized into 3 groups: group 1 underwent suture extraction 7 days after implantation; group 2 underwent an irrigation procedure, followed by immediate suture extraction on day 7; and group 3 underwent an irrigation procedure on day 7, with delayed suture extraction on day 14 after implantation. The sutures were evaluated using confocal microscopy; electron microscopy; and spectrophotometry, through which optical density, as measured by the amount of scattered light, is directly correlated with the number of bacteria. Histological assessment was performed on the pouches. Results: Optical density (mean ± SD) was significantly higher for FiberTape sutures than for FiberWire sutures, respectively, at the 2-hour time point for all groups (group 1, 0.0550 ± 0.0081 vs 0.0162 ± 0.006 [ P = .0054]; group 2, 0.0225 ± 0.0049 vs 0.0056 ± 0.0006 [ P = .0045]; group 3, 0.055 ± 0.0222 vs 0.0043 ± 0.0005 [ P = .0103]). Additionally, groups 2 and 3 showed statistically significant results at the 4-hour time points (group 2, 0.0384 ± 0.0087 vs 0.0145 ± 0.0042 [ P = .0280]; group 3, 0.0532 ± 0.0159 vs 0.0101 ± 0.0025 [ P = .0058]). The wash fluid also demonstrated significantly greater optical density for the FiberTape than the FiberWire sutures, respectively, at the 2-hour time point for all groups (group 1, 0.1657 ± 0.0319 vs 0.0317 ± 0.008 [ P = .0063]; group 2, 0.0522 ± 0.0156 vs 0.0127 ± 0.0022 [ P = .0219]; group 3, 0.1707 ± 0.0205 vs 0.0191 ± 0.0053 [ P < .0001]). No bacterial growth occurred in the control conditions. Histological assessment revealed only mild inflammation in the control groups as compared with more severe responses in the experimental groups at all time points. Conclusion: FiberTape was associated with increased bacterial adhesion as well as retention as compared with FiberWire in an in vivo murine wound model. Clinical Relevance: This study demonstrates that suture design influences the occurrence of and ability to clear surgical infection and must be considered when selecting high-tensile strength sutures in a clinical setting.

Cranial sutures play critical roles in facilitating postnatal skull development and function. The diversity of function is reflected in the highly variable suture morphology and complexity. Suture complexity has seldom been studied, resulting in little consensus on the most appropriate approach for comparative, quantitative analyses. Here, we provide the first comprehensive comparison of current approaches for quantifying suture morphology, using a wide range of two-dimensional suture outlines across extinct and extant mammals (n= 79). Five complexity metrics (sinuosity index (SI), suture complexity index (SCI), fractal dimension (FD) box counting, FD madogram and a windowed short-time Fourier transform with power spectrum density (PSD) calculation) were compared with each other and with the shape variation in the dataset. Analyses of suture shape demonstrate that the primary axis of variation captured attributes other than complexity, supporting the use of a complexity metric over raw shape data for sutural complexity analyses. Each approach captured different aspects of complexity. PSD successfully discriminates different sutural features, such as looping patterns and interdigitation amplitude and number, while SCI best-captured variation in interdigitation number alone. Therefore, future studies should consider the relevant attributes for their question when selecting a metric for comparative analysis of suture variation, function and evolution.

Background and objectives In high-risk populations, the efficacy of mesh placement in incisional hernia (IH) prevention after elective abdominal surgeries has been supported by many published studies. This meta-analysis aimed at providing comprehensive and updated clinical implications of prophylactic mesh placement (PMP) for the prevention of IH as compared to primary suture closure (PSC). Materials and methods PubMed, Science Direct, Cochrane, and Google Scholar were systematically searched until March 3, 2020, for studies comparing the efficacy of PMP to PSC in abdominal surgeries. The main outcome of interest was the incidence of IH at different follow-up durations. All statistical analyses were carried out using Review Manager version 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) and Stata 11.0 (Stata Corporation LP, College Station, TX). The data were pooled using the random-effects model, and odds ratio (OR) and weighted mean differences (WMD) were calculated with the corresponding 95% confidence interval (CI). Results A total of 3,330 were identified initially and after duplicate removal and exclusion based on title and abstract, 26 studies comprising 3,000 patients, were included. The incidence of IH was significantly reduced for PMP at follow-up periods of one year (OR= 0.16 [0.05, 0.51]; p=0.002; I2=77%), two years (OR= 0.23 [0.12, 0.45]; p

Background Endophthalmitis is a sight-threatening disease characterized by marked progressive inflammation of the vitreous and/or aqueous humors. Limited information is currently available regarding endophthalmitis in the Philippines. This study aimed to provide long-term summary data on endophthalmitis cases seen at the largest tertiary referral hospital in the Philippines. Methods All endophthalmitis cases diagnosed at the Philippine General Hospital from January 1, 2007 to December 31, 2016 were retrieved and classified by etiology. Data pertaining to history, associated risk factors, isolated microorganisms, management, and final visual outcomes for each patient were reviewed. Results A total of 202 cases diagnosed within the audit period were included in the study. These were classified as post-traumatic (55.94%), endogenous (14.36%), acute post-operative (10.40%), keratitis-induced (6.93%), chronic post-operative (5.44%), bleb-associated (3.96%), and suture-associated (2.97%) endophthalmitis. Males comprised 71.29% of the population, while the largest age group affected was 0–10 years (24.75%). The culture-positive rate was 57.89%. The predominant etiology was Gram-positive bacteria (38.18%), followed by Gram-negative bacteria and mixed pathogens (21.82% each), and fungi (18.18%). The most common organisms were Streptococcus, Staphylococcus, Pseudomonas, Aspergillus, and Candida, accounting for 56.45% of isolates. Pars plana vitrectomy was done for 62.87% of patients, intravitreal and other antibiotic therapy in 23.27%, and primary enucleation/evisceration in 10.89%. The final outcomes and best corrected visual acuities were: anophthalmia 11.86%, no light perception/no dazzle 27.84%, light perception 8.76%, hand motions 24.23%, counting fingers 5.15%, 3/200 to 20/50 12.89%, and 20/40 to 20/20 9.28%. Conclusions There was a higher proportion of post-traumatic endophthalmitis cases compared to traditional estimates but consistent with studies from China and Thailand. The majority of these cases involved younger children as well as young to middle-aged males engaged in carpentry and construction work, implying a need for increased public health awareness and strengthening of childcare and workplace safety policies. Our microbiologic profile showed a lower proportion of Gram-positive infections and a higher proportion of mixed pathogen infections compared to other studies. There was also a higher proportion of fungi associated with post-operative and keratitis-induced endophthalmitis. The best outcomes were seen in acute post-operative and bleb-associated endophthalmitis, and the worst outcomes in endogenous and keratitis-induced endophthalmitis. Visual outcomes were poorer compared to other Western and Asian countries, with only 21.7% of patients improving from presentation.

BackgroundTo investigate the clinical efficacy and outcomes of skin stretch suturing with self-locking sliding Nice knots in the treatment of small- or medium-sized wounds.MethodsFrom June 2015 to May 2018, 26 patients with small- or medium-sized wounds were included in the present study. Skin stretch suturing with self-locking slide Nice knots was performed to gradually close the soft-tissue defects in these patients. The time of wound closure and healing was recorded. The color and blood supply of the skin, cutaneous sensation, the stretch of skin, and the hair growth situation of the skin wound were observed and recorded.ResultsThere were 17 males and 9 females with an average age of 30.65 years (range, 15–48 years). The areas of the soft-tissue defects were between 3.2 × 7.1 cm and 8.0 × 15.2 cm. All patients underwent stretch suturing with self-locking slide Nice knots to close the soft-tissue defects. All wounds were successfully closed and healed. The mean time of wound closure was 10.69 days (range, 5–20 days), and the mean time of wound healing was 16.85 days (range, 10–24 days). The cutaneous sensation of skin wound recovered normally, and the color of the skin wounds was the same as that of normal skin at the last follow-up. The hair growth situation of the skin wounds also returned to normal.ConclusionsThis study revealed that Nice knots yielded an accepted clinical result as a new method to close small- or medium-sized wounds that was simple and less minimally invasive, resulted in progressive tension, did not return to previous results, and partially replace flaps or free skin grafts.

Pancreatic trauma is a rare but potentially lethal injury because often it is associated with other abdominal organ or vascular injuries. Usually, it has a late clinical presentation which in turn complicates the management and overall prognosis. Due to the overall low prevalence of pancreatic injuries, there has been a significant lack of consensus among trauma surgeons worldwide on how to appropriately and efficiently diagnose and manage them. The accurate diagnosis of these injuries is difficult due to its anatomical location and the fact that signs of pancreatic damage are usually of delayed presentation. The current surgical trend has been moving towards organ preservation in order to avoid complications secondary to exocrine and endocrine function loss and/or potential implicit post-operative complications including leaks and fistulas. The aim of this paper is to propose a management algorithm of patients with pancreatic injuries via an expert consensus. Most pancreatic injuries can be managed with a combination of hemostatic maneuvers, pancreatic packing, parenchymal wound suturing and closed surgical drainage. Distal pancreatectomies with the inevitable loss of significant amounts of healthy pancreatic tissue must be avoided. General principles of damage control surgery must be applied when necessary followed by definitive surgical management when and only when appropriate physiological stabilization has been achieved. It is our experience that viable un-injured pancreatic tissue should be left alone when possible in all types of pancreatic injuries accompanied by adequate closed surgical drainage with the aim of preserving primary organ function and decreasing short and long term morbidity. Resumen El trauma pancreático es un tipo de trauma poco común potencialmente fatal que está asociado con lesiones de órganos abdominales o vasculares. Usualmente, los signos clínicos son tardíos aumentado el riesgo de complicaciones respecto al manejo y al pronóstico general. Debido a la baja prevalencia de la lesión del trauma, no existe consenso entre los cirujanos alrededor del mundo sobre cómo se debe diagnosticar y tratar adecuadamente este desafío quirúrgico. La precisión en el diagnóstico es difícil por la localización anatómica y las manifestaciones clínicas tardías. El abordaje quirúrgico ha ido cambiando de dirección hacia la preservación del órgano para evitar complicaciones secundarias asociada a la perdida de la función exocrina y endocrina, o de potenciales complicaciones postquirúrgicas incluyendo las dehiscencias y fistulas. El objetivo de este artículo es proponer un algoritmo de manejo del trauma pancreático a través de un consenso de expertos. Las lesiones del páncreas pueden ser manejadas con una combinación de maniobras hemostáticas, empaquetamiento pancreático, sutura de la herida y drenaje quirúrgico cerrado. La pancreatectomía distal con la perdida de tejido vital pancreático debe ser evitadas. Los principios generales de la cirugía de control de daños deben ser aplicados cuando sea necesario para un manejo quirúrgico definitivo cuando y solo cuando la estabilización fisiológica haya sido lograda. En nuestra experiencia, el tejido pancreático sano debe preservarse cuando el trauma se asocia de un manejo mediante un drenaje quirúrgico cerrado con el objetivo de preservar la función primaria del órgano y disminuir a corto y largo tiempo las morbilidades.

International audience; The main objective of this study was to compare the medium-term results of nail bed repair in children using glue (2-octylcyanoacrylate) versus absorbable sutures. The secondary objective was to compare the results of treatment in the emergency room versus the operating room. This retrospective review of 74 fingertip nail bed lacerations (68 children) evaluated the appearance and pain at the last follow-up visit (minimum of 1 year), and the operating time. Mean age was 3.3 years at time of injury (range 10 months-13 years), with a mean follow-up of 2.6 (1-7) years. Thirty-six nail beds were repaired with glue; 38 were sutured. The clinical outcomes in the two groups were similar. The rate of nail dystrophy was 14% (5% major) regardless of the technique. Nail bed repair time was significantly shorter in the glue group (10.2 vs. 20.3min, p

Objective: To create a web application that can evaluate suture performance and assess its quality. Material and Methods: We developed the web application using a few cloud computing systems, servers, database, and computing languages. We used 20 anastomosed graft samples for optimizing the application. The images of the anastomosed grafts were captured two-dimensionally. Five vascular surgeons utilized the application to compute the objective score and rank the score of the anastomoses subjectively. Results: Steps for using the application include uploading a two-dimensional image of sutures, tracing the stitch line manually, and pushing the button to have the score displayed. After using this system for more than 1,000 times without server issues or failures, we confirmed its stability and easy accessibility. The system calculated the score within several seconds. The score of the three factors (bite, pitch, and skewness of angle) ranged from 0.25 to 0.76. The error range of the application was acceptable. The interclass correlation coefficient (ICC (2,1)) of the three factors was 0.92. Conclusion: The quality of the application was acceptable considering the low range of interoperator variations in the scores.

aytac, gunes/0000-0003-4902-2844 WOS:000522643800019 PubMed: 32130480 Purpose To compare five different repair techniques for extensor tendon zone III modified Kessler (MK), double-modified Kessler (DMK), modified Kessler epitendinous (MKE), double-modified Kessler epitendinous (DMKE), and running-interlocking horizontal mattress (RIHM) in terms of shortening, stiffness, gap formation, and ultimate load to failure. Methods A total of 35 human cadaver fingers were randomly assigned to five suture techniques with 7 fingers each and were tested under dynamic and static loading conditions. Results DMK was found to be superior over MK in terms of ultimate load to failure (36 N vs. 24 N, respectively), shortening (1.75 vs. 2.20 mm, respectively) and gap formation. However, these two methods had similar characteristics in terms of stiffness. The addition of epitendinous sutures to the repair methods resulted in approximately 40% increase in ultimate load to failure, whereas epitendinous sutures had no effect on shortening. DMKE was found to be superior over MKE in terms of shortening (1.77 vs. 2.22 mm, respectively). However, these two methods had similar characteristics in terms of mean ultimate load to failure and stiffness. RIHM was found to be superior over the other four methods in terms of ultimate load to failure (89 N), stiffness, and shortening (0.75 mm). Conclusion RIHM was found to be stronger and more durable for extensor tendon zone III than the other techniques in terms of ultimate load to failure and stiffness.

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.

Suturing is an essential procedural skill that medical students are expected to be competent in before they graduate medical school; however, there is often a lack of suturing instruction and practice in undergraduate medicine curriculums. Silicone suturing task trainers created from 3D printed molds can help address this gap in medical education by improving student's manual skills before they perform procedures on real patients upon graduation. Commercially available suture task trainers on the market today lack validation from medical learners; therefore, this study aimed to evaluate the perceived efficacy of a silicone skin suture task trainer created from a 3D printed mold using input from novice medical trainees. A silicone task trainer created by MUN Med 3D was used to teach suturing during two surgery interest group skill development sessions. At the end of the sessions, 38 medical students completed a product evaluation survey that assessed the perceived educational efficacy of the suturing task trainer. Overall, the feedback received from the participants was positive and supported the use of silicone suturing task trainers in undergraduate medicine curriculums.

Objective: Use of cyanoacrylate glue in facial plastic surgery is still controversial due to the absence of long-term follow up showing the results. Aim of our study is comparing the long-term outcomes of N-butyl-cyanoacrylate + Metacryloxysulfolane versus traditional sutures in rhinoplasty. Methods: Prospective comparative study. One hundred forty-two patients affected by ptotic nasal tip were included and randomized in two groups. In group A, the surgeon fixed the graft by using the glue and suture and in group B by using the traditional suture only. The following data were collected and compared by statistical analysis: nasolabial angle before and after surgery, dimensions of the graft, duration time (in minutes) for graft application during the surgery, number of sutures applied to fix the graft, presence of post-surgery negative outcomes. Results: All patients statistically improved their nasolabial angle after surgery (ANOVA: P < .0001) without statistically significant differences between the two groups both at short and long follow-up (χ: P = 1 and P = .9 respectively). A statistically significant difference in graft fixation time ( P < .00001) and number of sutures (t: P < .00001) used was observed between the two groups. No statistically significant difference was observed in prevalence of infection after surgery. Conclusion: N-butyl-cyanoacrylate + Metacryloxysulfolane could be a valid tool to reduce the necessary number of sutures and to reduce the time required for graft fixation graft fixation with consistent results in long-term follow-up.