Search

Background: Tension band wire fixation (TBW) is a well-described method for treating displaced olecranon fractures. Further surgery is often needed due to wound breakdown or prominent hardware. An all-suture technique has recently been described as an alternative to TBW but radiographic and clinical outcome are not well established. The aim of this single-center retrospective cohort study was to evaluate outcome after treatment with all-suture technique for simple displaced olecranon fractures., Methods: A retrospective review of olecranon fractures in patients (> 18 years) treated for displaced olecranon fractures with tension band suture fixation (TBSF) between February and August 2019 was performed in our facility. Primary outcome was revision surgery, which was assessed four years after surgery. Clinical and radiographical follow-up was performed at two weeks, six weeks, three months and six months to assess union rate, fracture displacement, range of motion (ROM), Quick-DASH and Oxford Elbow Score., Results: A total of 24 patients were included. Median age was 64 years [IQR:39-73], 9 patients were male and median ASA score was 2 [IQR:1-2]. 15 fractures were Mayo type 2 A and 9 type 2B with minor comminution. At four-year follow-up, three patients had died. None of the remaining 21 patients had undergone revision surgery. At six months, the median Quick-DASH and Oxford Elbow Score were 2.3 [IQR:0-4.5] and 47 [IQR:46-48], respectively. Median elbow extension and flexion deficits were 0° [IQR:0-2.25] and 0° [IQR:0-0], respectively. Radiographic union was achieved in all patients. In two cases radiographic loss of reduction and malunion was observed but both patients were asymptomatic and had no functional deficits. One patient refractured the elbow due to a second trauma and was reoperated., Conclusions: TBSF is a promising technique for Mayo type 2 A and 2B fractures with minor comminution. There were no revision surgeries within the first four years. We found good functional outcomes and a high union rate., (© 2024. The Author(s).)

Wound closure is an integral part of every spinal procedure. Effective and secure wound closure is paramount in the prevention of infection, wound dehiscence and the preservation of cosmesis. Barbed suture technologies such as STRATAFIX™ Symmetric have been studied and are used in a variety of specialties, including obstetrics and orthopedic surgery, but is underutilized in neurosurgery. This study aims to assess the time and rate of closure using STRATAFIX™ Symmetric technology for fascial closure and compare this method to the more traditionally used method of fascial closure using braided absorbable sutures below the epidermis. 20 patients were recruited for the study. 10 patients underwent fascial approximation with braided absorbable sutures and definitive fascial closure with STRATAFIX™ Symmetric. In the control group, fascial closure was completed entirely with interrupted braided absorbable stitches. Patients assigned to STRATAFIX™ Symmetric group had shorter mean time for fascial closure, faster rate of average fascial closure, and lower number of total sutures used. The use of barbed suture technology such as STRATAFIX™ Symmetric may reduce the time to closure in thoracolumbar spine surgery without increasing the risk of adverse events. This pilot study forms the framework for a larger randomized, controlled trial appropriately powered for such an analysis., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Tension-free hernia repair is the gold standard for groin hernia repair. However, the optimal surgical treatment for incarcerated or strangulated groin hernia in elderly populations is controversial. The aim of this study is to compare the clinical efficacy of mesh repair and suture repair in the treatment of incarcerated or strangulated groin hernia in elderly patients. Patients ≥ 65 years who underwent urgent surgical repair for incarcerated or strangulated groin hernia from January 2012 to June 2022 were included. Patients' demographic data and postoperative outcomes were retrospectively analyzed. Patients with limited life expectancy were screened from the elderly population for subgroup analysis. A total of 103 patients (median age: 84 years old, range 65-96; mean follow-up time: 36.8 ± 24.8 months) were included, involving 42 cases in the suture repair group and 61 cases in the mesh repair group. Suture repair and mesh repair had similar lengths of ICU and hospital stay, and rates of small bowel resection, chronic pain, surgical site infection, and surgical-related death. However, suture repair had a significantly higher recurrence rate than mesh repair (7% vs. 2%, P = 0.04). In our subgroup analysis, for patients with limited life expectancy (41 patients; median age: 88 years old, range: 80-96), suture repair had no statistical difference in postoperative outcomes compared with mesh repair. Mesh repair is suitable for elderly patients with acutely incarcerated or strangulated groin hernias. However, for elderly patients with limited life expectancy, suture repair and mesh repair showed similar clinical outcomes., (© 2024. Italian Society of Surgery (SIC).)

Objective: Multiple techniques are available for closing skin defects, such as skin grafts, flaps and tissue expansion. The tissue extender MID SEW (MID, France) was developed to achieve dermatotraction or suture reinforcement. The aim of this study was to evaluate the effectiveness and safety of this innovative silicone extender for large surgical wounds., Method: A single-centre retrospective and observational study on an unselected consecutive cohort of patients treated with a tissue extender was conducted. Indications, initial and final wound surfaces, and adverse events (AEs) were retrieved from electronic medical records. The main outcome measure was the time to complete wound closure., Results: We identified 50 patients from July 2017 to December 2018. Patients underwent cutaneous tumour-wide excision (n=44), or pilonidal disease surgical treatment (n=6). The average initial wound area was 53.3±42.4cm 2 . Healing was complete, without secondary dehiscence, within the first seven days after device withdrawal for 41 patients (82%). At least one AE was experienced by eight patients (16%) during the study period: five inflammation; five wound dehiscence; two skin necrosis; and one pain., Conclusion: This case series suggests that the tissue extender may be effective and safe in its dermatotraction and suture reinforcement indications in the treatment of large wounds after wide excision of skin cancer or treatment of pilonidal disease., Declaration of Interest: This work was supported in part by the Hospices Civils de Lyon, France and in part by the University Claude Bernard Lyon 1, France. OB co-owns the patent on the MID SEW system. The authors have no other conflicts of interest to declare.

The development of novel robotic devices specifically designed for open microsurgery leads to increasing applications in reconstructive procedures. While initial studies revealed improved precision and surgical ergonomics upon robotic assistance, surgical time was consistently observed to be increased. This study compares two robotic suturing techniques using the Symani Surgical System and RoboticScope in a preclinical setting, to further leverage the benefits of novel robotic devices in microsurgery. Six experienced microsurgeons performed three microvascular anastomoses with a "steady-thread" suturing technique and a "switch-thread" technique on 1.0-mm-diameter artificial silicone vessels. Time for anastomosis and participant's satisfaction with the techniques and robotic setup were recorded. Anastomosis quality and microsurgical skills were assessed using the Anastomosis Lapse Index and Structured Assessment of Microsurgery Skills. Lastly, technical error messages and thread ruptures were quantified. Knot tying was significantly faster and evaluated significantly better by participants using the steady-thread technique (4.11 ± 0.85 vs. 6.40 ± 1.83 min per anastomosis). Moreover, microsurgical skills were rated significantly better using this technique, while both techniques consistently led to high levels of anastomosis quality (2.61 ± 1.21 vs. 3.0 ± 1.29 errors per anastomosis). In contrast, the switch-thread technique was associated with more technical error messages in total (14 vs. 12) and twice as many unintended thread ruptures per anastomosis (1.0 ± 0.88 vs. 0.5 ± 0.69). This study provides evidence for the enhanced performance of a steady-thread suturing technique, which is suggested to be applied upon robot-assisted microsurgical procedures for optimized efficiency., (© 2024. The Author(s).)

Background: Free gingival graft is commonly used to augment the keratinized mucosa and vestibular depth around dental implants. The proper suturing technique is fundamental to achieve a successful result following free gingival graft. However, there are limited studies that focus on the details of the suturing methods to optimize graft adaptation. The purpose of this technical note is to describe a new suturing technique for optimal approximation and stabilization of free gingival graft around dental implants., Case Presentation: Here, we present a 53-year-old Persian female with peri-implantitis and lack of keratinized mucosa around mandibular implants who was a candidate for free gingival graft. A new suturing technique, double vertical interrupted suture, was conducted in the interimplant areas. In addition, the suspensory cross-mattress sutures were added to ensure the adaptation of the graft over the implants. The proposed suturing technique is useful for soft tissue augmentation around multiple implants with concave or uneven recipient bed., Conclusion: The present article describes a novel suturing technique for good adaptation and fixation of free gingival graft around dental implants., (© 2024. The Author(s).)

Introduction: Fast gut cutaneous sutures have become more prominent due to their low tissue reactivity, rapid absorption, and elimination of suture removal visits. It is not known how fast gut sutures compare to other closure modalities., Methods: A comprehensive literature review was conducted to identify randomized controlled trials comparing fast gut sutures to alternative closure methods during dermatologic surgery. Data collected included patient and physician assessed cosmetic outcome as well as standardized complication rates., Results: Six studies were included in final analysis and reported on 208 patients. Fast gut sutures were associated with lower physician opinions of final scar when compared to polypropylene sutures (SMD 0.438; 95% CI 0.082 to 0.794). No differences existed between physician opinion of fast gut sutures and cyanoacrylate tissue adhesive (SMD - 0.024; 95% CI - 0.605 to 0.556). Complications with fast gut suture placement were rare, and included infection, dehiscence, and hematomas. Fast gut sutures were less likely to experience wound dehiscence than tissue adhesive (p = 0.01)., Conclusion: If no contraindications to polypropylene sutures exist, they may provide superior cosmetic outcomes compared to fast gut sutures. Further research is required to better quantify cosmetic outcomes and optimal use of fast gut sutures., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: Conflicts of interest David R. Carr, MD is an investigator for Regeneron. All other authors have no conflicts of interest to declare.

Purpose: Although tendon lacerations are common, there is currently no consensus on choice of suture. Easy and fast sutures that impart enough strength to allow mobilization are needed. This study compared the ex vivo biomechanical strength (force required to create a 2 mm tendon gap) of a novel suture (ST-knot) with that of a conventional suture (double Kessler)., Materials and Methods: Forty fresh deep flexor tendons from porcine forelimbs were used. Both repaired tendon ends were mounted on standard traction jaws of an axial traction machine at an initial distance of 40 mm for all tendons. A high-definition camera was used to determine the force forming a 2 mm gap. Ten tendons in group 1 (ST-knot) and 10 in group 2 (double Kessler) were prepared with PDS 4.0 (single thread for Kessler, double thread for ST-knot). Tendons in groups 3 (ST-knot) and 4 (double Kessler) were repaired with PDS 1.0 using the same principle., Results: There was no significant difference in the force required to form a 2 mm tendon gap between groups 1 and 2, and this trend was identical when using a stronger thread in groups 3 and 4. The maximum force before rupture, mode of repair failure, stress and stiffness were also comparable, with no significant differences between groups 1 and 2, or between groups 3 and 4., Conclusions: The ST-knot showed comparable results to the double-Kessler knot, whichever the thread used. Because it involves fewer steps than conventional techniques and is easy to perform, the ST-knot may offer a therapeutic solution, particularly in complex trauma with multiple tendon injury., (Copyright © 2024 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

The most challenging and time-consuming step in the free gingival graft (FGG) for keratinized mucosa augmentation is the compression suture anchoring the FGG to the periosteum. This article proposed a novel "microscrew with tie-down sutures" technique to anchor the FGG to the recipient site without the traditional trans-periosteum suture. This patient's keratinized mucosa width (KMW) around the healing abutments of teeth #29 and #30 was less than 1 mm. After an apically positioned flap (AFP) was prepared, 2 microscrews were placed at the buccal plate of the alveolar ridge bone, which is the coronal margin of the AFP. Then, the sutures winded between the microscrews and the healing abutments to anchor the FGG. In conclusion, the "microscrew with tie-down sutures" technique offers a feasible and straightforward alternative for the trans-periosteum compression suture, mainly when the periosteum is fragile, thin, or injured.

Background: The inside-out repair technique is the gold standard for treatment of meniscal tears, while some soft tissues can be hung as the sutures are tied outside the capsule. The purpose was to clarify the association between the suture site and knot location in the arthroscopic inside-out technique., Methods: Inside-out meniscal suture was arthroscopically performed on medial and lateral menisci in twenty-three cadaveric knees, on the assumption that longitudinal tear existed. A retractor was inserted above the semi-membranous tendon and anterior to the gastrocnemius for the medial side, while the retractor was placed in the anterior space of the gastrocnemius for the lateral side. After identifying three segments (anterior, middle and posterior segments), eight sutures were inserted into the following eight areas in each knee: anterior (M1, L1) and posterior (M2, L2) areas of the middle segment, and anterior (M3, L3) and posterior (M4, L4) areas of the posterior segment. Twelve knees underwent meniscal repair on femoral side and eleven passed sutures on the tibial side, while knots were tied outside of the joint. Attentive dissection was performed to assess the relation between knot locations and the principal structures around the knee joint., Results: In medial meniscal suture, most sutures for the middle portion (M1, 2) bound medial collateral ligament (MCL), while a few cases included the semi-membranous tendon for the M4 area. In lateral meniscal suture, sutures for the L1 area tied some fibers of lateral collateral ligament (LCL) in high frequency, while popliteal muscles/tendons were tied over at the L3 area., Conclusions: Most suture knots were located on MCL or capsule in medial meniscus suture, while more than half sutures passed through LCL or popliteal tendon/muscle in lateral meniscus suture. An assistant should retract LCL under direct observation and the surgeon must confirm the direction of needle for lateral meniscal repair., Competing Interests: Declarations of competing interest The authors declare no conflicts of interest., (Copyright © 2022 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Objectives: Surgical site infections (SSI) are common causes of postoperative morbidity at cesarean delivery (CD). The objective of this study was to compare the risk of SSI and other wound complications associated with different suture materials for subcuticular skin closure at CD., Data Sources: We searched Cochrane Library, MEDLINE, Embase, and Clinicaltrials.gov from inception to June 3, 2021, and limited our search to English, peer-reviewed, randomized controlled trials and cohort studies., Study Selection: Of 1541 titles identified, 4 studies met the selection criteria and were included. Studies were included if the population was pregnant individuals undergoing transverse incision primary or repeat, elective or emergent CD with subcuticular skin closure, and if outcomes related to SSI, wound seroma, hematoma, or dehiscence were reported. We completed the assessment using Covidence review management software., Data Extraction and Synthesis: Two authors independently reviewed studies and assessed the risk of bias using the Cochrane 'Risk of bias' tool for randomized trials (RoB 2.0) and the Cochrane Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tools for cohort studies. We compared SSI risk and secondary outcomes of hematoma, seroma, and dehiscence between skin closure with monofilament (poliglecaprone 25 or polypropylene) versus multifilament (polyglactin 910) sutures using a fixed-effects meta-analysis. Statistical heterogeneity was estimated using the I 2 statistic. Monofilament sutures were associated with a reduced risk of SSI (RR = 0.71, 95% CI 0.52-0.98, I 2  = 0%) compared to multifilament sutures. There was no difference in the risk of secondary outcomes., Conclusion: Monofilament suture for subcuticular skin closure at CD was associated with decreased risk of SSI compared to multifilament suture., (Copyright © 2023 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

Technique: The CHN•WU wound suture technique uses barbed sutures. The needle is inserted from the basal part of the superficial fascia at the left edge of the wound and passed through half of the reticular dermis to reach a point (1A) approximately 0.5-2 cm away from the wound edge. Occlusion is achieved at 1A at the level of the reticular dermis, and if done correctly, a shallow concavity will appear at the occlusion point on the skin. The needle is then walked along the natural curvature until it reaches the center of the wound and then moved out from the junction between the dermis and subcutaneous tissue. On the other side of the incision, the needle is inserted into the contralateral position at the junction between the dermis and subcutaneous tissue and moved along its natural curvature to achieve occlusion at the mirror site of 1A in the reticular dermis. This process is repeated until the entire wound is closed. In the end, two stitches should be applied in the opposite direction. The left barbed suture is cut and thrown., Results: This technique does not break through the epidermis, has high suture efficiency and satisfactory cosmetic appearance, disperses mechanical tension, and maintains wound tensile strength., Conclusion: This technique was especially effective in closing high-tension wounds in the chest and extremities where the blood supply to both sides of the wound was not affected after suturing, and wound closure could be performed quickly and efficiently in one stage., (Copyright © 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Published by Elsevier B.V. All rights reserved.)

Competing Interests: Conflicts of interest None disclosed.

Microvascular anastomosis is a standard procedure in neurosurgery that is applied to various lesions, such as those of ischemic disease and moyamoya disease. The depth of an anastomosis can be superficial or deep. At deeper sites, the procedure becomes challenging, as the operative field is usually narrow. Among the anastomotic approaches, suturing is the most challenging in a limited and deeper field. Additionally, since the suturing device is inevitably long, the delicate procedure becomes challenging. To overcome this technical difficulty and suture more efficiently, even in a narrow and deep field, the authors developed a needle holder, the REVOLD-HS, that allows rotational motion without moving the holder. This new needle holder is uniaxial and allows the forceps at the tip to be manipulated by operating the rotor in the hand. There is a mechanism for opening, closing, and rotating the holder via the surgeon's finger without moving the holder. Based on suture experiments in simulated blood vessels while using the holder, some situations may necessitate the use of this needle holder. This novel smart device may assist in deep vascular anastomosis in microsurgery, suturing of the carotid artery in carotid endarterectomy, and dural repair in endoscopic surgery.

Purpose: Leap Motion Controller is a device that can capture hand gestures and reproduce these as data comprising several parametric elements. We analyzed surgical suture motion using this device and investigated the optical methodology for clinical applications., Methods: We recruited medical students and residents (novice group) and vascular surgeons (specialist group). The operators applied sutures once on a prosthetic graft, and the captured motion was analyzed., Results: Ten novices, who each received procedural instruction for at least 2 h, and 10 specialists were recruited. The hand gesture consisted of four elements (roll, pitch, yaw, and wrist angle). Since "roll" was the only element in this simple suture movement that showed some difference between the two groups, we analyzed three parameters: (1) the suturing time, (2) the difference in the degree between two piercing points, and (3) slope of the roll. We found that the specialist group demonstrated significantly shorter suturing times and a larger degree of the slope., Conclusion: Leap Motion Controller analysis with the roll revealed that the novices could use the roll motion after only 2 h of instruction; however, the suturing speed and smoothness were secondary to those of the specialists.

It is essential to be aware of the anatomy and biomechanics of the acetabular labrum in order to understand why it should be conserved. Vascularization comes from the capsule and also from the bone. The joint side contains numerous nerve endings, which explains why labral lesions are painful. It is involved in joint stabilization by maintaining a negative pressure inside the joint able to resist distraction. It acts as a seal. There are two main suture techniques: trans- and peri-labral. Translabral suture is better suited to a wide and solid labrum free of degenerative lesions. Both techniques should be known, and may be associated. Results are comparable. It is essential to manage the underlying pathology responsible for the labral lesion. Joint degeneration is associated with poor prognosis. It needs to be recognized and discussed with the patient, to avoid unrealistic expectations., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

The objective of this study was to estimate the time to removal of a suture from the palmar surface of a dark-skinned adult hand. A descriptive and analytical study included a cohort of 146 patients, 57% male, with a mean age of 37 ± 14 years, covering a period of 10 years. The mean time to removal of sutures on the palmar surface of the dark-skinned adult hands was 21 ± 2 days. Complete epithelialization of the suture path was the clinical indication for the ideal day for removal. After removal, closure was total in 90% of cases (132 hands) and partial in 9% (14 hands). The day of suture removal was significantly (p = 0.006) related to wound healing (complete closure). Eighty-five percent of patients without complete wound closure at suture removal had history of use of skin-lightening products. Tobacco use significantly lengthened time to suture removal (p < 0.001). There was a correlation between patient age and time to suture removal. On multivariate analysis, three factors were predictive of suture removal later than day 21: being a manual worker (44% of patients) (p 0.006), suture location in a palmar fold area (<0.001) and the age of patient, the 41-50 years (p = 0.001) and >50 years (p < 0.001)., (Copyright © 2021. Published by Elsevier Masson SAS.)

Background: The success of surgical repairs rely on the effectiveness and integrity of the surgical knots used to secure the repair. The purpose of this study is to examine and compare the performance of the Nice knot, the modified Nice knot, and a commonly used combination of surgeons' and square knots with respect to cyclic loading and load-to-failure usiflueng a high-strength suture composed of ultra-high molecular weight polyethylene in the hands of experienced surgeons., Methods: Two experienced surgeons threw 3 different knot types 9 times, consisting of the Nice knot, modified Nice knot, and a surgeon's knot utilizing Ultrabraid #2 sutures. Each knot was subject to cyclic loading and load to failure testing., Findings: Both surgeons had similar displacement data for the surgeon's knot, while the identity of the surgeon impacted displacement for the Nice knot (p = 0.03) and the modified Nice knot (p = 0.0002). The load to failure for the modified Nice knot (p < 0.001) and the Nice knot (p = 0.001) were significantly impacted by the surgeon tying the knot, while the surgeon's knot was not. Specimens failed where the sutures passed through the loop at the "base" of the knot., Interpretations: The strength and integrity of complex surgical knots are variable between surgeons. While the proposed Modified Nice Knot has a theoretical advantage because the half hitches reinforce the primary knot, in load to failure testing both the Modified Nice Knot and the Nice Knot failed where the suture passed through the loop in the primary knot., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Sutures are ubiquitous medical devices for wound closures in human and veterinary medicine, and suture techniques are frequently evaluated by comparing tensile strengths in ex vivo studies. Direct and nondestructive measurement of tensile force present in sutured biological skin tissue is a key challenge in biomechanical fields because of the unique and complex properties of each sutured skin specimen and the lack of compliant sensors capable of monitoring large levels of strain. The authors have recently proposed a soft elastomeric capacitor (SEC) sensor that consists of a highly compliant and scalable strain gauge capable of transducing geometric variations into a measurable change in capacitance. In this study, corrugated SECs are used to experimentally characterize the inherent biomechanical properties of canine skin specimens. In particular, an SEC corrugated with a re-entrant hexagonal honeycomb pattern is studied to monitor strain and stresses for three specific suture patterns: simple interrupted, cruciate, and intradermal patterns. Stress is estimated using constitutive models based on the Fractional Zener and the Kelvin-Voigt models, parametrized using a particle swarm algorithm from experimental data and results from a validated finite element model. Results are benchmarked against findings from the literature and show that SECs are valuable for clinical evaluation of tensile force in biological skins. It was found that both the ranking of suture pattern performance and the sutured skin's Young's modulus using the proposed approach agreed with data reported in the literature and that the estimated stress at the suture level closely matched that of an approximate finite element model.

Background: Interrupted and continuous suturing are 2 common techniques for microvascular anastomosis in cerebrovascular surgery. One of the technical complexities of interrupted suturing includes the risk of losing the needle in between interrupted sutures during knot tying, which may result in unnecessary movements and wasted time., Objective: To report a new needle parking technique for microvascular anastomosis that addresses a needle control problem during interrupted suturing., Methods: The needle parking technique involves puncturing both vessel walls at the site of the next provisional suture and leaving the needle parked in place while the knots at the first suture are being made. The thread is then cut, the needle is pulled through, and the process is repeated. Illustrative cases in which the needle parking technique was used are presented. We also compared time of anastomosis completion between the conventional interrupted, needle parking interrupted, and continuous suturing techniques during an in vitro study on standardized artificial vessels., Results: This technique is being used successfully by the senior author for various cerebrovascular bypass surgeries. The in vitro study demonstrated that the needle parking technique can be significantly faster than the conventional interrupted suturing technique and may be as fast as continuous suturing., Conclusion: Needle parking technique is a modification of conventional interrupted suturing and solves the problem of losing the needle during knot tying. This technique is simple, prevents unnecessary movements, and may result in a faster anastomosis time., (© Congress of Neurological Surgeons 2021.)

Objective: To determine the functional outcomes after a novel method of H-loop knotless double-row technique in patients with rotator cuff tears., Method: From June 2020 to September 2020, a total of six patients (five women, one man) with arthroscopic rotator cuff repair using the H-loop knotless double-row technique were enrolled in our study. The average age is 54 years (range: 50-61 years). The preoperative and final follow-up clinical outcome were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS), University of California Los Angeles (UCLA) score, and Constant-Murley score. The active shoulder range of motion (ROM) was also collected preoperatively and postoperatively at the final follow-up (forward flexion and abduction). Accordingly, intraoperative and postoperative complications were observed as well., Result: There were six patients that underwent arthroscopic rotator cuff repair using the H-loop knotless double-row technique. The average follow-up period was 7.52 ± 0.70 months. The VAS, UCLA, ASES, and Constant-Murley scores improved from 5 ± 2.45, 15.67 ± 3.44, 47.67 ± 17.41 and 49.17 ± 8.98 preoperatively, to 0.83 ± 0.75, 36.27 ± 3.83, 91.67 ± 10.76 and 85.83 ± 4.31 at the final follow-up, with statistical significances of P = 0.009, P < 0.001, P = 0.006, and P = 0.001, respectively. Meanwhile, the active shoulder ROM (forward flexion and abduction) improved from 135.00 ± 46.80 and 125 ± 56.48 preoperatively, to 173.67 ± 4.13 and 172 ± 3.27 at final follow-up, respectively (P = 0.082, P = 0.088). During the follow-up, there were no postoperative complications such as wound-site infection, nerve or vessel damage, subcutaneous hematoma, and suture anchor problems., Conclusion: With the benefit of reducing the possibility of strangulation and blood supply affection for the rotator cuff, The H-loop knotless double row technique may be an alternative method to significantly improve subjective functional outcomes and increase the healing rate of medium-sized rotator cuff tears with degeneration issues and poor tissue quality., (© 2021 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)

The closure of port-sites wounds, as the ultimate step of surgical laparoscopic procedures, can be allowed by threads, staples, surgical glue or adhesive sutures. We describe a simple and easy skin suturing technique which saves time and provides significant surgical ergonomics., Competing Interests: Declarations of Competing Interest The authors declare no conflict of interest., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

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.

The objective of this study was to assess the efficacy of knotless barbed sutures in intraoral wound closure for maxillofacial trauma in comparison with conventional (vicryl) sutures. This was a randomised controlled clinical trial involving 40 patients with isolated mandibular angle fractures who required intraoral incisions for open reduction and internal fixation (ORIF). The sample was randomised into the study group (20 patients) and control group (20 patients). Following fracture fixation by a standardised surgical protocol, the wound closure was done with bidirectional knotless barbed suture and vicryl for the study and control groups, respectively. The wounds were closed in layers (periosteum and mucosa). All operations were performed by a single surgeon. Outcome parameters measured were intraoperative wound closure time and wound healing using 'Landry's wound healing index' on the first, third, and seventh postoperative days. Statistically significant difference in suturing time was noted between the study and control group (p value <0.001). The study group demonstrated a mean (SD) suturing time of 9.46 (2.01) minutes, compared with the 17.61 (2.57) minutes in the control group. Wound healing was found to be better and statistically significant in the study group than the control group (p value<0.001). Knotless barbed suture is a promising alternative to vicryl for intraoral wound closure., (Copyright © 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Colorectal anastomosis is the one at higher risk of complication in alimentary tract surgery. Several techniques have been used to intraoperatively check a colorectal anastomosis, without reaching a clear consensus. The aim of the present study is to evaluate the addition of intraoperative flexible endoscopy to indocyanine green fluorescence in detecting colorectal anastomotic defects in a consecutive series of patients. This was a pilot study conducted over a 15-month period. Patients were scheduled for an elective laparoscopic left colectomy or anterior resection with a planned stapled colorectal anastomosis. Pre-, intra- and postoperative data were collected. Intraoperative endoscopy was routinely performed and the anastomotic defects were classified. A suture reinforcement of the defect encountered was immediately performed either laparoscopically or transanally. The primary endpoint of the study was the rate of postoperative complications. Fitfty-two patients were enrolled. At intraoperative endoscopy, 12 anastomotic defects were detected and corrected with immediate suture reinforcement. Defects were classified as two leaks, two mucosal crash, one simultaneous leak and crash, one mucosal edema and six active bleedings. None of these patients developed any postoperative complication. Moreover, there was no postoperative bleeding complication in the entire cohort. The three patients developing a postoperative leak requiring anastomosis takedown were at high risk due to general status and cancer characteristics. Even though more data and a comparative group are needed, the results of this pilot study are very promising regarding the role of intraoperative endoscopy and suture reinforcement of a colorectal anastomotic defect.

Background and Purpose: It is generally believed that a tight square knot or a surgeon's knot cannot be easily loosened. The objectives of this study were to explore a magic-trick-based rapid unlocking technique for tying a surgical knot, which allows restoration of the bi-directional movement of an unmovable locked knot., Material and Methods: The suture knots used included 2- and 3-throw square knots and surgeon's knots with different suture materials. The loops of four knots of various materials were tightened using the unlocking technique under simulated bone friction coefficient conditions, and the loops were observed for complete fastening of the humeral specimens. The drag forces of knot sliding (DFKS) used for different materials and different knot configurations were measured using a digital force gauge. Statistical analysis of the differences in DFKS between different knot configurations with different suture materials was performed., Main Findings: Excellent loop tightening effects could be achieved for the arbitrary combination of nine sutures and four knots using this technique. The DFKS of the various knot configurations, with the same material, were as follows: 2 = 1 = 1 > 1 = 1 = 1 > 2 = 1 > 1 = 1, the DFKS of different sizes followed the order 0 silk > 2-0 silk > 3-0 silk; 0 Vicryl Plus > 2-0 Vicryl Plus > 3-0 Vicryl Plus. The DFKS for all sutures was less than 0.5 kgf., Conclusion: The rapid knot unlocking (RKU) technique can unlock any one of the double-stranded types of traceless knot. The suture loop tension can be adjusted at will. Bi-directional movement of the fast knot and the re-locking of sliding knot are solved., (Copyright © 2019 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Background: Although tonsillectomies carry a low-risk for adverse events, postoperative hemorrhage has been reported as the most common complication., Aim: To compare the rates of postoperative secondary hemorrhage for tonsillectomy with or without double-layer suture., Material and Methods: This is a retrospective study of 5087 patients who underwent coblation tonsillectomy with or without suture from 2006 to 2016. All cases had been followed up 3 weeks and severe secondary hemorrhage cases requiring operation were analyzed., Results: The severe secondary hemorrhage rate was statistically higher in group without suture (1.96%) as compared with the group with suture (1.08%). The surgery time (36.55 ± 7.45) was longer in patients with suture as compared to patients without suture (31.50 ± 6.23). In the age between 18 and 49 years group, the higher secondary hemorrhage rate (2.44%) was found in patients without suture. The rate of postoperative hemorrhage (0.96%) was significantly higher in patients without suture as compared with patients with suture (0.36%) on postoperative 5th day., Conclusions: The risk of severe secondary hemorrhage is reduced in coblation tonsillectomy with suture. The rate of secondary hemorrhage is lower in patients with suture in 18 to 49 years old group and on the 5th day after surgery., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: To 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., Methods: From 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., Results: There 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., Conclusions: This 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.

Competing Interests: Disclosure Dr G.A. Dumanian is the inventor and has financial interest in Advanced Suture Inc. and Mesh Suture Inc. He could potentially benefit from changes to established methods to close the abdominal wall, including the use of mesh suture. Neither of the authors has any additional financial disclosures.

Background and Objectives: To explore whether Rose Bengal-induced photochemical crosslinking (RB-PCL) can be a replacement for sutures in conjunctival autograft bonding, we compared the safety, operating time, postoperative ocular signs, and inflammatory responses of RB-PCL versus nylon suturing for sealing conjunctival autografts in rabbits., Study Design/materials and Methods: Thirty-six New Zealand White rabbits underwent limbal conjunctival autografting using either sutures or RB-PCL to attach conjunctival autografts to the bare sclera. Animals were randomized to one of two groups (18 per group): the suture group or RB-PCL group. Photochemical crosslinking with a wavelength of 532 nm green light with an illumination intensity of 0.6 W/cm 2 for 250 seconds (150 J/cm 2 ) or suturing was performed followed by light examination at 3, 7, 28 days after surgery to evaluate the healing condition. Rabbits in each group were euthanized on day 3 (n = 6), 7 (n = 6), or 28 (n = 6) postoperatively, and the graft tissues from the surgical site were processed to evaluate inflammatory response by assessing protein levels of tumor necrosis factor α (TNF-α), and interleukin 6 (IL-6) as well as histological examination. Cell viability was evaluated by counting both total and dead cells on hematoxylin and eosin (H&E) stained tissue samples from both groups at 3 and 7 days after surgery. The surgery procedure time was recorded and the graft surface temperatures were measured before and after illumination., Results: Photochemical crosslinking effectively secured the limbal conjunctival autograft over an ocular conjunctival defect with no significant difference from the suture group. The time required for this light activated bonding method was ~550 seconds in comparison with the suture method of half hour. The differences of measured temperature on the graft surface before and after RB-PCL treatment were 2.98 ± 0.11°C. The induction of IL-6 and TNF-α protein was remarkably reduced in the RB-PCL group compared with the suture group at 3 and 7 days after surgery. Histology revealed less infiltrated neutrophils were observed in the RB-PCL group than in the suture group at 3 and 7 days postoperatively. Furthermore, the RB-PCL group showed a better healing process with less eye discharge and mild conjunctival congestion. No significant difference in percent dead cells was observed between RB-PCL and suture groups at 3 and 7 days after surgery., Conclusions: RB-PCL is a promising alternative for bonding the conjunctival autograft with shorter operation time, less inflammation and better healing outcomes compared to conventional suture. Thermal damage and phototoxicity were not observed using the RB-PCL method in bonding conjunctival grafts. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc., (© 2019 Wiley Periodicals, Inc.)

Partial nephrectomy has become the preferred treatment option for small renal masses. In particular, minimally invasive partial nephrectomy (MIPN) using laparoscopic or robotic approaches has shown decreased blood loss, shorter hospital stay, and faster return to normal activity compared to open surgery. However, MIPN still carries risk of postoperative complications including hemorrhage and urine leakage. Closure of the renal remnant, often called renorrhaphy, is a critical step to avoid these complications. The purpose of the study was to provide quantitative data on suture properties during partial nephrectomy. Multiple suture techniques have been proposed for renal closure during robotic-assisted partial nephrectomy. There is no consensus for preferred closure technique and this decision is at the discretion of the surgeon. Simulated partial nephrectomies were performed on porcine kidneys. Renorrhaphy was completed with barbed suture using a simple running, interrupted sliding-clip, or horizontal mattress technique. Suture tension was obtained prior to tissue failure with force sensors measuring in newtons (N). The interrupted sliding-clip and horizontal mattress techniques performed similarly with median force values of 11.06 N and 12.20 N, respectively. The simple running technique performed with a median force of 3.62 N. ANOVA proved statistical significance. Interrupted sliding-clip and horizontal mattress sutures exert similar forces prior to tissue failure during renorrhaphy. Both techniques were able to achieve forces great enough to overcome the hydrostatic pressure of perfused renal tissue. Simple running sutures failed at significantly lower forces. When closing renal defects after partial nephrectomy, sliding-clip and horizontal mattress should be utilized over simple running sutures.

Purpose: The small bites surgical technique supported by the STITCH trial has been touted as a strategy for preventing early laparotomy dehiscence through greater force distribution at the suture-tissue interface. However, this hernia prevention strategy requires an alteration in the standard closure technique that has not been widely adopted in the USA. This study seeks to determine whether incorporating a mid-weight polypropylene mesh material into a hollow-bore surgical suture material will effectively increase the force distribution at the suture-tissue interface and potentially help prevent early laparotomy dehiscence in an ex vivo model., Methods: A cyclic stress ball-burst model was used to compare suturable mesh (0 DuraMesh™) to conventional suture. After midline laparotomy, 28 porcine abdominal wall specimens were closed with either 0 DuraMesh™ or #1 polydioxanone double-loop suture. A custom 3D-printed ball-burst test apparatus was used to fatigue the repair on a MTS Bionix Load Frame. The tissue was repetitively stressed at a physiological force of 15-120 N cycled at a rate of 0.25 Hz for a total of 1000 repetitions, followed by a load to failure, and the maximal force was recorded., Results: The mean maximal force at suture pull-through was significantly higher (p < 0.0095) in the 0 DuraMesh suture group (mean: 850.1 N) compared to the 1 PDS group (mean: 714.7 N)., Conclusion: This ex vivo study suggests that using rational suture design to improve force distribution at the suture-tissue interface may be a viable strategy for preventing the suture pull-through that drives incisional hernia.

Background: The aim of this study is to assess the causes and rates of re-operation in olecranon fractures in adults treated with transosseous suture., Methods: We prospectively recruited 29 patients who were treated with this technique between 2010 and 2018. The type of suture used, tourniquet time and surgical time were analyzed for each one. X-rays were taken after 2 weeks, 6 weeks and 6 months, recording complications, causes, rates of re-operation and the final clinical condition., Results: Median time for ischemia and surgery were 51 (95% CI:48;62) and 45 (95% CI:42;55) minutes respectively. The radiologic studies showed diastasis of the posterior cortex in the X-rays taken after 2 weeks and after 6 weeks in 7 (24,1%) cases. Of these cases, two (6,8%) were no longer followed-up after 6 months. There was only one case of aseptic non-union. Among these cases, two patients (6.8%) required surgical debridement due to acute soft tissue infection. No complication had any clinical impact, maintaining all patients full range of motion and no pain. Osteosynthesis removal was not necessary in any case., Conclusion: Transosseous suture with high strength thread is a valid alternative for treating Mayo IIA olecranon fractures in adult patients, decreasing re-operation rates for implant removal. There may be, in a moderate percentage of cases, radiologic diastasis of the posterior cortex at the fracture site, without causing pain nor limiting mobility LEVEL OF EVIDENCE: III., Competing Interests: Declaration of Competing Interest All authors disclose no financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work. Examples of potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding., (Copyright © 2020. Published by Elsevier Ltd.)

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.

Background: To close elliptical excisions, surgeons commonly use the rule of halves which involves initially closing of the middle portion of the wound, followed by closure of the remaining halves. Understanding the forces required for suturing such wounds can aid excisional surgery planning to decrease complications and improve wound healing., Methods: Following full thickness excision for removal of skin cancers, back wounds with 3:1 ratio of length-to-width were closed using the rule of halves. The force required to bring the wound edges into contact at the middle portion of the wound was measured, followed by the two bisected halves., Findings: The average force to close the center of the wounds averaged 3.7 N and was six times larger than that of the bisected halves. The forces to close the bisected halves were consistently small, and essentially negligible (<0.5 N) for ~50% of the cases., Interpretation: When planning excisional surgery to avoid complications such as tearing the dermis (cheese wiring), the use of special wound closure techniques (high tension and/or pully sutures, skin support or suture retention devices, etc.) should focus on the center suture only when using the rule of halves, as the remaining sutures require very low forces., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to determine the effect of low-pressure and pulsed lavage irrigation on suture knot security., Methods: Ninety-tied suture loops were measured for baseline circumference and then subjected to no irrigation, bulb syringe irrigation, or pulsed lavage irrigation. The sutures were placed under a load and then measured for final circumference. A larger circumference difference indicated poorer knot security., Results: There was a statistically significant difference in the knot security between all three groups ( p < 0.001). Pulsed lavage resulted in the greatest circumference increase (0.52 ± 0.19 mm), followed by bulb syringe (0.24 ± 0.18 mm), and lastly no irrigation (0.08 ± 0.00 mm). None of the groups had any catastrophic failures. No knots met the predetermined criteria for knot failure., Conclusion: Pulsed lavage irrigation resulted in a statistically significant decrease in suture knot security as compared to bulb syringe irrigation and no irrigation. None of the groups met the currently accepted criteria for clinical suture failure, which has a relatively arbitrary value. While the available literature does not discuss increases in loop circumference for specific orthopedic applications, this small difference suggests that pulse lavage is unlikely to have a clinically significant impact on the suture integrity for most orthopedic procedures.

Currently, Achilles tendon rupture repair is surgically addressed with an open or minimally invasive approach using a heavy, nonabsorbable suture in a locking stitch configuration. However, these sutures have low stiffness and a propensity to stretch, which can result in gapping at the repair site. Our study compares a new multifilament stainless steel cable-crimp repair method to a standard Krackow repair using multistrand, ultra-high molecular weight polyethylene polyester sutures. Eight matched pairs of cadavers were randomly assigned for Achilles tendon repair using either Krackow technique with polyethylene polyester sutures or the multifilament stainless steel cable-crimp technique. Each repair was cyclically loaded from 10 to 50 N for 100 loading cycles, followed by a linear increase in load until complete failure of the repair. During cyclic loading, 4 of the 8 Krackow polyethylene polyester suture repairs failed, whereas none of the multifilament stainless steel cable crimp repairs failed. Load to failure was greater for the multifilament stainless steel cable crimp repairs (321.03 ± 118.71 N) than for the Krackow polyethylene polyester suture repairs (132.47 ± 103.39 N, p = .0078). The ultimate tensile strength of the multifilament stainless steel cable crimp repairs was also greater than that of the Krackow polyethylene polyester suture repairs (485.69 ± 47.93 N vs 378.71 ± 107.23 N, respectively, p = .12). The mode of failure was by suture breakage at the crimp for all cable-crimp repairs and by suture breakage at the knot, within the tendon, or suture pullout for the polyethylene polyester suture repairs. The multifilament stainless steel cable crimp construct may be a better alternative for Achilles tendon rupture repairs., (Copyright © 2019 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Despite preventive methods and careful surgical technique, surgical site infection and incisional hernias are of main concern after the closure of surgical incisions and keep haunting abdominal wall wound healing. The aim of this study is to find how surgical expertise level modifies biomechanical properties of sutures commonly used in abdominal wall fascial closure (polypropylene, polyglactin 910, polydioxanone)., Materials and Methods: Surgery residents with different experience levels performed abdominal wall fascial closure in swine models with the previously mentioned suture materials. A standardized technique was used. Sutures were removed, and a tensile stress test was performed on the removed sutures. A total of 81 abdominal fascial closures were achieved. Time, extension, maximum tensile force (F tmax ), and maximum stress were measured and analyzed., Results: The results of the polydioxanone stress test present a trend in three variables: extension, tensile force, and stress. The trend shows higher medians in the expert group and lower medians in the novice group. While using polypropylene sutures, medians in the expert group are the highest; however, a trend is not observed. Polyglactin 910 sutures have nonspecific behavior among the different experience groups and variables. Polypropylene is the material with the lowest F tmax tested and fails at 42.64 (IQR 40.98-44.89) N. Regarding the elastic properties of the material, polyglactin demonstrates the least extension of all sutures tested, with a 14 (IQR 13.33-14.83) mm extension. This study demonstrates that polydioxanone has a superior F tmax compared with polypropylene and has a superior extension at failure properties compared with polyglactin, confirming that polydioxanone could be the suture of choice used for abdominal wall fascial closure., Conclusions: Study results do not show statistically significant differences regarding the impact of the experience level of different general surgery residents in the biomechanical properties of sutures used in abdominal wall fascial closure., (Copyright © 2019 Elsevier Inc. All rights reserved.)

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).

Background and Aims: Migration of duodenal covered self-expandable metallic stents (C-SEMS) is the main cause of stent dysfunction in patients with malignant gastric outlet obstruction. However, the ideal method to prevent migration has not been clarified. We aimed to evaluate the feasibility and safety of duodenal C-SEMS fixation in this experimental study., Methods: We used the over-the-scope clip (OTSC), suture, and clip methods to fix duodenal C-SEMS and evaluated the gripping force of each device and invasion depth based on pathological findings., Results: The OTSC and suturing systems had a significantly higher mean gripping force compared with the clipping system (OTSC vs. clip: 13.2 vs. 1.0 Newtons [N], P < 0.001; suture vs. clip: 8.5 vs. 1.0 N, P < 0.001). OTSC compression was stronger compared with suturing (OTSC vs. suture: 13.2 vs. 8.5 N, P = 0.006). The submucosal layer, but not the muscle layer, was compressed more widely and deeply by OTSC compared with clips based on pathological findings by hematoxylin and eosin staining., Conclusion: Both OTSC and suturing methods used for duodenal C-SEMS fixation were feasible compared with the clipping method. The pathological evaluation of invasion depth indicated that OTSC may be safe even for preventive use. This study suggested that these methods can be applied clinically for duodenal C-SEMS fixation.

Background: Immediate hemostasis following removal of sheaths is essential to prevent access site complications after atrial fibrillation (AF) ablation. Despite various precautions to achieve complete hemostasis in a safe and effective manner, no standard approach is present yet., Objective: We aimed to compare the efficacy and safety of standard vs modified figure-of-eight (sFoE vs mFoE) suture for immediate venous hemostasis after cryoballoon (CB) AF ablation., Methods: A total of 150 patients who underwent CB catheter ablation were sequentially allocated to either sFoE (n = 75) or mFoE (n = 75) suture to achieve immediate venous hemostasis at right femoral access site after 15 Fr sheath removal. A "three-way stopcock" was used in the mFoE group rather than tying the knot as in a sFoE group. Demographics, clinical and procedural data, and access site complications were recorded., Results: Immediate haemostasis was achieved in all patients (n = 75) with mFoE suture as compared to 90.7% (n = 68) of sFoE suture group (P < .001). Light manual pressure of ≤1 min was required in five patients (6.7%) due to looseness and conventional manual compression because of the snapped silk suture during knotting was required in two patients (2.6%) in the sFoE group. Time to hemostasis was shorter in the mFoE group (P < .001), but time to ambulation and time to discharge were similar in both groups (P > .05). Although no minor or major access site complication has occurred in the mFoE group, in-hospital rebleeding (n = 2, 2.7%) and early local access site infection (n = 2, 2.7%) were observed in the sFoE group., Conclusion: The mFoE suture using three-way stopcock is an available, effective, maybe safe, and time- and cost-saving alternative technique to achieve immediate hemostasis after removal of 15 Fr right femoral venous sheath in patients undergoing cryoablation., (© 2019 Wiley Periodicals, Inc.)

Despite the important relationship between renorrhaphy and functional outcomes of partial nephrectomy, the urological guidelines do not provide recommendations about the optimal renorrhaphy technique. We carried out the first pooled literature analysis of the impact of suture technique on ultimate renal function after partial nephrectomy. Three studies comparing interrupted versus running suture including data on glomerular filtration rate (GFR) were included, for a total of 124 versus 269 patients. No significant differences were found between pre- and postoperative GFR in either patients who received an interrupted suture (weighted mean difference, -4.88ml/min, 95% confidence interval [CI] -11.38; 1.63, p=0.14) or those who received a running suture (-3.42ml/min, 95% CI -9.96; 3.12, p=0.31). Three studies comparing single- versus double-layer renorrhaphy included data on GFR (321 vs 199 patients). A benefit in functional outcomes favored single-layer technique (-3.19ml/min, 95% CI -8.09; 1.70, p=0.2 vs -6.07ml/min, 95% CI -10.75; -1.39, p=0.01). In conclusion, our quantitative synthesis suggests a renal functional benefit of the single-layer closure during partial nephrectomy. PATIENT SUMMARY: The available studies on renal functional data included in the present review suggest that "less is more" for renorrhaphy after partial nephrectomy. The single-layer renorrhaphy technique showed advantages in renal functional outcomes compared with the double-layer technique., (Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

The quantity of the preserved parenchyma after partial nephrectomy is the result of interplay among various factors: the unmodifiable preoperative quality of the renal parenchyma and some technical modifiable aspects. Among the modifiable factors able to influence the quantity, the suture technique has gained paramount importance. Indeed, nowadays there is a consensus suggesting that one of the main predictors of the ultimate renal function is the minimal parenchymal volume loss: this is the sum of the healthy parenchyma excised with the tumour and the portion of the parenchyma devascularised by the renorrhaphy. The historical aim of a good suture was to avoid bleeding and urine leakage. A modern suture after partial nephrectomy should minimise the ischaemic effect on the renal parenchyma whenever possible. This has to be carried out with precision and based on the vascular anatomy of the kidney. PATIENT SUMMARY: In this report, we tried to describe the best practice for the suturing of renal parenchyma after conservative surgical treatment for small renal tumours. Indeed, the suture after the resection of a renal mass should minimise the ischaemic effect on the renal tissue whenever possible, maximising the functional outcomes., (Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.)