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Background: The inframammary fold (IMF) is an important landmark in breast aesthetic surgery. In augmentation mastopexy procedures, secure and accurate placement of the IMF is essential to aesthetic outcomes and to allow the new IMF to heal in the correct position without displacement. The authors present a simple and efficient four-layer wound closure technique using barbed sutures for closure of the repositioned IMF in augmentation mastopexy procedures. This method was previously described by the first author for reset of the IMF in breast augmentation surgery and has been adapted to the longer IMF incision in augmentation mastopexy procedures., Methods: A retrospective review was undertaken of 335 patients who underwent bilateral breast augmentation mastopexy procedures with a Wise pattern technique at a single unit. The newly reset IMF was closed using barbed sutures and a four-layer closure technique., Results: There were no cases of complications related to wound healing or wound dehiscence. One patient required explantation for an infected implant., Conclusion: The four-layer wound closure technique with barbed sutures provides a quick and efficient method for accurate closure of the newly reset IMF, with positive outcomes related to wound healing. Secure and accurate placement of the inframammary fold is crucial in augmentation mastopexy procedures. The use of a four-layer wound closure technique with barbed sutures provides an efficient method for accurate closure of the newly reset inframammary fold. This method was previously described by the first author for reset of the IMF in breast augmentation surgery and has been adapted to the longer IMF incision in augmentation mastopexy procedures., Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Cardiothoracic surgery demands technical excellence to achieve a successful outcome, and the loading and passing of a needle through tissue atraumatically is a fundamental skill that must be mastered. From how to hold the needle driver to loading the needle and following the curve through the tissue, there are pearls and pitfalls for each step. In this video tutorial, an experienced cardiac surgeon who has trained residents and fellows for more than 30 years demonstrates the basic concepts and techniques of passing the needle through tissue., (© The Author 2023. Published by MMCTS on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background: Multiple flexor tendon repair techniques have been developed over the last years. Despite all this, there is no standard technique that has proven to be superior to others, leading to great variability in the use of techniques in surgical practice. We describe a novel tendon repair technique and compare its biomechanical characteristics with 2 conventional techniques. Methods: Comparative experimental biomechanical study in ex vivo animal models. In all, 66 deep flexor tendons of the pig's front legs were taken and it's repair was performed by 1 of 3 techniques (helical 6-strand cruciate tendon repair, Adelaide tendon repair, or modified Kessler). These repairs were subjected to biomechanical study, measuring, and registering the ultimate tensile strength, load to 2-mm gap force, and stiffness. Results : The helical 6-strand cruciate tenorrhaphy compared with the Adelaide and modified Kessler techniques carries statistically significant greater ultimate tensile strength before failure (65.5, 46, and 36 N, respectively, P < .001). It also required a greater load to 2-mm gap force and is less stiff, allowing greater strain before failure. This technique does not generate significant changes in the dimensions of the tendons compared to the others, and there was no significant difference in the strength of repair between surgeons. Conclusions : The helical 6-strand cruciate tenorrhaphy is a novel technique, useful for the repair of flexor tendons in the hand that holds up the necessary forces to initiate early mobilization in the postoperative period and has better biomechanical properties than 2 standard techniques.

Background: The use of sutures remains the first choice for wound closure. However, incorrect use of a suture technique can lead to impaired healing. Many techniques are described for high-tension wounds, but not much is known about their mechanical properties. Complications of excessive tension include dehiscence, infection, and ischemic necrosis and could be prevented. This study aimed to compare forces in five techniques (single, horizontal mattress, vertical mattress, pulley, and modified pulley suture) in a standardized wound tension model., Materials and Methods: A standardized neoprene wound model was developed on the ForceTRAP system (MediShield B.V., Delft, The Netherlands) to mimic a 5 Newton (N) wound. Five different suture techniques were each repeated 10 times by a student, resident dermatology, and dermsurgeon. The pulling force of the suture's first throw was measured with the Hook-in-Force sensor (Technical University Delft, The Netherlands). Changes in wound tension were measured by the ForceTRAP system. The ForceTRAP is a platform measuring forces from 0 to 20 N in three dimensions with an accuracy of 0.1 N. The Hook-in-Force is a force sensor measuring 0-15 N with an accuracy of 0.5 N. Maximum and mean forces were calculated for each suture technique and operator., Results: Mean maximum pulling force: 5.69 N (standard deviation [SD], 0.88) single, 7.25 N (SD, 1.33) vertical mattress, 8.11 N (SD, 1.00) horizontal mattress, 3.46 N (SD, 0.61) pulley, and 4.52 N (SD, 0.67) modified pulley suture. The mean force increase on the skin (substitute) ranged between 0.80 N (pulley) and 0.96 N (vertical mattress)., Conclusions: The pulley suture requires less pulling force compared with other techniques. The mechanical properties of sutures should be taken in consideration when choosing a technique to close wounds., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the feasibility and safety of purse string suture with Harmonious Clips and Olympus endoloop in single channel endoscopy for large gastric antrum mucosa defect. Methods: A total of 33 patients who underwent ESD of gastric antrum in single channel endoscopy at the First people's Hospital of Wujiang District from January 2015 to April 2018 were retrospectively analyzed. Everyone had one lesion, and the diameters were all more than 3 cm. After the resection and hemostasis, purse string suture with Harmonious Clips and Olympus endoloop or no suture in study group ( n =16) and the control group ( n =17). The degree of abdominal pain, postoperative gastrointestinal decompression time, incidence of delayed hemorrhage, postoperative hospital stay and the healing rate were observed and compared. Results: All patients successfully completed resection, no perforation occurred, and all the lesions were resected completely in one time. All patients in the study group were sutured successfully. The abdominal pain score on the first day after operation was (2.7±0.7) in the study group, and (3.6±0.8) in the control group( t =3.686, P =0.001). The mean time of postoperative gastrointestinal decompression was (1.6±0.5) days in the study group, while (2.4±0.7) days in the control group( t =3.675, P =0.001). No delayed bleeding occurred in the study group, while 5 cases in the control group had delayed bleeding. The rate of delayed hemorrhage was 29.4% in control group, 4 cases successfully achieved hemostasis through endoscopy therapy, 1 case was given surgical intervention after ineffective endoscopic hemostasis( P =0.044). The average postoperative hospital stay were (6.2±1.1) days and (5.9±2.0) days respectively ( t =0.423, P =0.675). Two months after the operation, the two groups of patients reviewed the gastroscopy, the results showed that, all wounds in the study group were healed completely, the healing rate was 100%. There were 6 cases of incomplete wound healing in the control group, the healing rate was 64.7%( P =0.018). No recurrence was found after 6 months of operation through reviewing gastroscopy. Conclution: It indicates good feasibility and efficacy about the purse string suture with Harmonious Clip and Olympus endoloop in single channel endoscopy for large gastric antrum mucosa defect. It is safe and reliable, worth of being generalized.

Background: Synthetic sutures such as Fiberwire used in flexor tendon repairs have high tensile strength. Proper application allows early mobilisation, decreasing morbidity from repair rupture and adhesions while preserving range of motion. Suture stiffness can cause poorer knot holding, contributing to gapping, peritendinous adhesions or rupture. Previous studies recommended more throws in knots tied on Fiberwire to prevent knot slippage. These larger knots are voluminous and prominent. In tendon repairs they can cause "catching", increase friction and work of flexion. Other studies advocated certain complicated knots as being more secure. We evaluated several knots and their biomechanical properties with the aim of finding a compact knot with less potential for slippage to maximise strength potential of flexor tendon repairs using Fiberwire., Methods: A series of different knots tied on Fiberwire 4-0 sutures were pulled to failure on a mechanical tester. Mean tensile strengths, knot volumes and tensile strength to knot volume ratios were compared., Results: Tensile strengths and knot volume increased with more throws and loops. Four variations of the square knot (the 4=4=1, 2=2=2=2, 1=1=1=1=1, 2=1=1=1=1 knots) had tensile strengths greater than 35N. The specialised anti-slip knot had highest tensile strength and suture volume but lower strength-to-volume ratio., Conclusions: The anti-slip knot had highest tensile strength but it also had the highest volume. The greater strength of repair may not translate into improved clinical outcome. The 1=1=1=1=1 knot has superior knot strength-to-volume ratio with good knot strength adequate for early active mobilisation in flexor tendon repairs.

Background: Prevailing tension‐reducing suture methods have a spectrum of issues. This study presents a straightforward yet highly efficacious suture technique known as the Split‐level Folding, Step‐type Tension‐relieving Suture technique, which could play a pivotal role in preempting incisional scarring. Aims: To introduce Split‐level Folding, Step‐type Tension‐relieving Suture technique and assess its effect on scar minimization. Methods: A retrospective analysis of 64 patients who underwent treatment utilizing the proposed suturing methodology. Assessment parameters included the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS), scar width, complications, and all evaluated at 6‐ and 12‐month postoperatively. Results: At 12‐month follow‐up, the POSAS and VSS scores in the normal suture group (32.58 ± 5.43, 3.58 ± 1.39) were considerably higher than the step‐type suture group (29.75 ± 3.56, p = 0.0007; 2.78 ± 1.17, p = 0.0006). Moreover, the step‐type suture group showcased a significantly narrower average incision scar width (1.62 ± 0.36) than the normal suture group (1.87 ± 0.42, p = 0.0004). This novel tension‐relieving suture technique that effectively circumvents the occurrence of persistent localized eversion and other complications often associated with traditional tension‐relieving sutures. Conclusions: The Split‐level Folding, Step‐type Tension‐relieving Suture technique emerges as a highly promising option for averting incisional scarring. This suture method works well for incisions on the chest, back, and extremities, resulting in significantly better long‐term outcomes. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to compare time efficiency and complication rates between smooth monofilament suture (SMS) and barbed suture (BS) using the three-layer continuous incisional closure pattern after ovariohysterectomy in a high-quality high-volume spay/neuter clinic. The study was designed as a randomized controlled trial enrolling 71 adult female dogs. Dogs were randomly assigned to SMS or BS treatments. The effect of closure with BS or SMS on closure time was tested through multilevel, multivariable linear regression in a generalized linear mixed model. Body condition score, weight, and pre-closure incision length were tested as covariates. Surgeon was included in the model as a random effect. Preclosure incision length (p = 0.01) and method (p = 0.0001) were associated with closure time. Adjusting for pre-closure incision length, the average time for closure with SMS was 6.5 min (range 3.70-10.31 min), and the average time for closure with BS was 4.91 min (range 3.05-8.05 min). Accounting for the closure method, the closure time increased by 39 s for each additional centimeter of incision length. BS was more efficient than SMS when performing the three-layer continuous suture pattern. No short-term telemedicineassessed complications were noted with either treatment method. BS can improve efficiency in surgical closures, especially considering large volumes of animals, and appears to have a similar short-term, telemedicine-assessed complication rate when compared to SMS. [ABSTRACT FROM AUTHOR]

Osteochondral or, even more rarely, purely chondral fractures of the lateral femoral condyle following patella dislocation in adolescents are relatively infrequent. Various fixation methods are described in the literature, ranging from traditional screws to bioabsorbable constructs or the use of anchors. Each method possesses its own advantages and limitations. Here, we present a case involving a 13-year-old boy with a large purely chondral fracture of the lateral femoral condyle after patella dislocation, initially overlooked. We introduce a cost-effective suture-bridge technique for the fixation of this fracture, which eliminates the need for a second operation and has yielded favorable outcomes. It is important to know that fractures of this type can be easily overlooked, necessitating a high index of suspicion and the utilization of advanced imaging techniques to prevent potential long-term catastrophic outcomes for the knee joint. [ABSTRACT FROM AUTHOR]

As vessel diameter decreases, reperfusion after anastomosis becomes more difficult. When a blood vessel is sutured, its inner diameter becomes narrower owing to the thickness of the suture material and the number of sutures. To minimize this, we attempted replantation using a 2-point suture technique. We reviewed cases of arterial anastomosis in vessels with a diameter of less than 0.3 mm during replantation performed over a four-year period. In all cases, close observation was followed by absolute bed rest. If reperfusion was not achieved, a tie-over dressing was applied, and hyperbaric oxygen therapy was administered in the form of a composite graft. Of the 21 replantation cases, 19 were considered successful. Furthermore, the 2-point suture technique was performed in 12 cases, of which 11 survived. When three or four sutures were performed in nine patients, eight of these cases survived. Composite graft conversion was found in three cases in which the 2-point suture technique was used, and two of these cases survived. The survival rate was high in cases where 2-point sutures were used, and there were few cases of conversion to a composite graft. Reducing the number of sutures aids in optimizing reperfusion. [ABSTRACT FROM AUTHOR]

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Pharyngocutaneous fistula is one of the most common and serious complications associated with total laryngectomy. Numerous studies tried to evaluate causative and predisposing factors associated with this complication, but data are considerably variable and there is still no international consensus. Incidence rate varies considerably between studies, with reported rates from 3% to 65%. This 4K video presents our T‐shaped four‐step technique (FST) for closing the pharyngeal mucosa after total laryngectomy in a step‐by‐step manner. All sutures were performed by braided absorbable 3/0 26 mm 1/2c (Vicryl plus 3.0; Ethicon, Somerville, NJ, USA). Recordings were performed using a Karl Storz 4K 3D VITOM® exoscope (Karl Storz SE & Co. KG, Tuttlingen, Germany). We have been described this technique through a high‐definition video, showing each step, and tips from the authors. Our T‐shaped pharyngoplasty closure technique can be divided into four steps: 1. "Key Stitches"; 2. "Area Refinement Stitches"; 3. "Modified Connell Suture"; 4. "Modified Purse String Suture." Our T‐shaped FST closure technique proved to be an effective and reproducible method, which we feel could be the preferred choice for primary pharyngoplasty closure. [ABSTRACT FROM AUTHOR]

Wound closing is critical to the completion of any surgical operation. An imperfect closure causes edge isolation, creating a possible route for bacterial contamination, which can lead to infection and scarring. While tissue adhesives and staples are now used as substitutes, surgical sutures remain the gold standard for a safe wound. The aim of this survey is to assess dental students' knowledge on the variety of suturing techniques. A comprehensive online survey of 100 dental students with simple questions about different types of sutures was performed. Each student was asked to complete a questionnaire of 20 questions. This study saw a total of 100 students take part in it. It was found that 58% of the participants opted for interrupted suturing technique and the rest 42% opted for simple continuous technique. It was found that 23% of the participants were not aware of the simple loop suturing technique and the rest 77% were aware of this suturing technique. Thus from the above results and discussion, we will conclude that almost all of the members are fairly privy to the distinctive suturing strategies; however; intensive expertise is required. [ABSTRACT FROM AUTHOR]

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

Objectives: To describe this technique for the treatment of caudal septal dislocation and to evaluate the effectiveness of this technique in terms of correction of cosmetic deformity and relief of nasal obstruction. Materials and Methods: This was a descriptive case series study performed at the ENT department of Services Institute of Medical Sciences (SIMS), Services Hospital, Jail Road, Lahore. 30 Cases of mild to moderate degree of septal caudal dislocation were selected and operated on. The septum was fixed by sutures to the anterior nasal spine. The columellar pocket was made and the septum was sutured in the pocket by two sutures at upper and lower levels to increase the stability of the corrected septum. Results: We performed this suturing technique on 30 septoplasty cases for 3 years from Jan-2016 to Jan-2019. Among them 12 (40%) were male and 18 (60%) were female. The total follow-up period ranged between 3 to 6 months. Anterior rhinoscopy showed no persistence of deviation or dislocation in 25 patients. 5 cases had a mild deviation of the septum on the non-operated side. Conclusion: Two-level septocolomellar suture technique is very effective, easy to learn & perform, and shows long-term reliability in the correction of caudal septal dislocation. This is effective in improving cosmesis and nasal airflow. [ABSTRACT FROM AUTHOR]

The procedure involved an ab-externo scleral fixation technique using a double-armed 10-0 polypropylene suture with straight needles that require no scleral flaps. The IOLs are sutured to the sclera, the free suture ends are tied to the suture loops, and they are buried together under the sclera. Forty eyes of 37 patients were included. Postoperative complications are IOL capture in five eyes (12.5%), a significant IOL tilt in one eye (2.5%), recurrent UGH (uveitis-glaucoma-hyphema) syndrome in two eyes (5%), glaucoma in three eyes (7.5%), suture exposure in two eyes (5%) and IOL drop due to haptic breakage in one eye (2.5%). The technique can be effectively used for the refixation of dislocated hydrophobic acrylic IOLs by temporary haptic externalization through a corneal incision and for the treatment of aphakia with or without penetrating keratoplasty. Surgeons should be aware of the possibility of UGH syndrome due to IOL capture, especially in young eyes. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The wide variety of suture material used in colporrhaphy shows a lack of consensus on the optimal choice. The evidence guiding the choice of suture material is scant. The aim of this study was to investigate the effects of rapid versus slowly absorbable suture on risk of recurrence after native tissue anterior colporrhaphy. Methods: This longitudinal cohort study was performed secondary to a previously published study on pelvic organ prolapse recurrence after the Manchester-Fothergill procedure versus vaginal hysterectomy. Data were collected from four Danish databases and corresponding electronic medical records. In this study, women having had anterior colporrhaphy performed were included. Suture materials were divided in three groups: rapid absorbable multifilament suture (RAMuS), rapid absorbable monofilament suture (RAMoS) and slowly absorbable monofilament suture (SAMoS). The main outcome was recurrence of prolapse in the anterior compartment. Results: A total of 462 women were included in this study. No significant difference in recurrence was found among the three suture groups. However, a non-significant tendency towards a higher risk of recurrence in the RAMoS group [HR 2.14 (0.75–6.10) p = 0.16] compared to the RAMuS group was observed. Conclusion: In this study, the use of rapid absorbable multifilament suture compared to slowly absorbable monofilament suture does not seem to lead to a higher risk of recurrence after anterior colporrhaphy. [ABSTRACT FROM AUTHOR]

A Marwari mare was presented with third-degree perineal laceration and surgically corrected by single stage spiral suture technique. Before surgery, intra-uterine lavage was performed using sterile normal saline containing Povidone iodine solution to control uterine infections. Surgical repair of third degree rectovestibular laceration was undertaken by single stage spiral suture technique, with lateral dissection continued extensively until the two flaps were created and brought to the midline without any tension. Suturing was carried out from inside to outside in spiral fashion and vulvar skin was approximated by horizontal mattress. The obtained results indicate that mares with third degree perineal laceration (rectovestibular lacerations) could be managed by single stage spiral suture technique without any complication with preoperative intra-uterine lavage. [ABSTRACT FROM AUTHOR]

Flap surgery is done to access the tooth and the surrounding periodontium for better visualisation and instrumentation. Various types of suturing techniques and materials have been used in periodontal surgery. The aim of the study was to evaluate the various suture techniques and materials used and their influence on postoperative healing after flap surgery. This retrospective study included patients who underwent flap surgery from June 2019 to March 2020 in a dental hospital. Variables such as age, gender, suture technique and materials used for the flap surgery were extracted from the digital case records. Post operative healing was evaluated using a healing index. Data was tabulated and was statistically subjected to IBM SPSS version 20.0 using One way ANOVA by Bayesian method. Out of 695 patients who underwent flap surgery, 406 were males (58.4%) and 289 were females (41.6%) with an age range of 20-70 years. The most preferred suture technique in periodontal flap surgery was direct loop technique (38.1%). There was a significant association between the suturing technique used and healing.(p<0.05). The most preferred suture material in flap surgery was silk [98%]. There was no significant association between suture material and healing (p>0.05). In the present study, the most preferred suture technique used in the periodontal flap surgery was direct loop and the material used was silk. Suture techniques had a significant influence on healing after the periodontal flap surgery favoring direct loop and mattress sutures. [ABSTRACT FROM AUTHOR]

Abstract Background There are various suture techniques used during laparoscopic gastrostomy to secure the stomach to the anterior abdominal wall. However, it remains unclear whether temporary fixation or subcutaneous absorbable sutures predispose pediatric patients to fewer postoperative complications. Our goal was to determine if a particular suture technique resulted in an increased risk for the development of postoperative complications. Materials and methods A retrospective cohort analysis was performed for patients less than 18 y of age who underwent laparoscopic gastrostomy at a tertiary Children's Hospital between 2012 and 2016. Children were grouped according to suture techniques for laparoscopic gastrostomy placement: temporary sutures or subcutaneous absorbable sutures. Postoperative outcomes at 30 d were defined as major complications (tube dislodgement, unplanned reoperation, readmission) and minor complications (stitch abscess, surgical site infection, emergency department visit). The chi squared test was used to determine if an association existed between the suture techniques and 30 d postoperative complications. Results We identified 682 pediatric patients who underwent laparoscopic gastrostomy. There were 301 (44%) patients with subcutaneous sutures placed and 381 (56%) with temporary sutures placed. The overall rate of major and minor complications was 8.3% and 22%, respectively. We observed a significant difference in the occurrence of major postoperative complications between the subcutaneous and temporary suture techniques (11% versus 6.3%, P = 0.029). There was no significant difference in the development of minor complications between subcutaneous and temporary suture techniques. Conclusions Children who receive subcutaneous sutures during laparoscopic gastrostomy are at an increased risk for developing a major postoperative complication. [ABSTRACT FROM AUTHOR]

Background: Synthetic sutures such as Fiberwire used in flexor tendon repairs have high tensile strength. Proper application allows early mobilisation, decreasing morbidity from repair rupture and adhesions while preserving range of motion. Suture stiffness can cause poorer knot holding, contributing to gapping, peritendinous adhesions or rupture. Previous studies recommended more throws in knots tied on Fiberwire to prevent knot slippage. These larger knots are voluminous and prominent. In tendon repairs they can cause 'catching', increase friction and work of flexion. Other studies advocated certain complicated knots as being more secure. We evaluated several knots and their biomechanical properties with the aim of finding a compact knot with less potential for slippage to maximise strength potential of flexor tendon repairs using Fiberwire. Methods: A series of different knots tied on Fiberwire 4-0 sutures were pulled to failure on a mechanical tester. Mean tensile strengths, knot volumes and tensile strength to knot volume ratios were compared. Results: Tensile strengths and knot volume increased with more throws and loops. Four variations of the square knot (the 4=4=1, 2=2=2=2, 1=1=1=1=1, 2=1=1=1=1 knots) had tensile strengths greater than 35N. The specialised anti-slip knot had highest tensile strength and suture volume but lower strength-to-volume ratio. Conclusions: The anti-slip knot had highest tensile strength but it also had the highest volume. The greater strength of repair may not translate into improved clinical outcome. The 1=1=1=1=1 knot has superior knot strength-to-volume ratio with good knot strength adequate for early active mobilisation in flexor tendon repairs. [ABSTRACT FROM AUTHOR]

The aim of our study was to investigate the efficiacy of the suturation technique after completing the tonsillectomy procedure for posttonsillectomy pain control in adult patients. August 2010-February 2011, 44 adult patients, ages ranged from 16 to 41 years old who underwent tonsillectomy at Elaziğ Training and Research Hospital Otorhinolaryngology Clinic were included to the study. After tonsillectomy procedure, anterior and posterior tonsillar archs were sutured each other and so, the area of tonsillectomy lodges which covered with mucosa were increased. Twenty two patients who applied posttonsillectomy suturation were used as study group and remnant 22 patients who did not applied posttonsillectomy suturation were used as control group. The visual analogue score (VAS) was used to evaluate the postoperative pain degree (0 no pain, 10 worst pain). ANOVA test (two ways classification with repeated measures) was used for statistical analysis of VAS values. P < 0.05 was accepted as statistically significant. The effect of time (each post-operative day) on VAS values was significant. The mean VAS values between study and control group on post-operative day 1st, 3rd, 7th, and 10th were statistically significant ( P < 0.05). The severity of posttonsillectomy pain was less in study group patients than control group patients. The suturation of anterior and posterior tonsillar archs after tonsillectomy procedure was found effective to alleviate the posttonsillectomy pain in adult patients. [ABSTRACT FROM AUTHOR]

Exact knowledge of the topographical anatomy of the arterial vascular system is the basis for all access routes. This article describes the most important assess routes in the neck and torso regions and gives an overview of the basic principles of the surgical technique with respect to suture material, suture technique, anastomotic technique and the atraumatic preparation of the anastomosis region. The article makes no claims to completeness because this would overstretch the limits but refers in particular to the references listed. [ABSTRACT FROM AUTHOR]

Although minimally invasive approaches to the abdominal cavity are becoming increasingly more important, open surgical techniques are still of essential interest and must be mastered by general and visceral surgeons. The choice of the particular approach depends on the specificity and location of the scheduled procedure. The following article is intended to give an overview on the current literature as well as experiences in the field of open surgical approaches to the abdominal cavity. [ABSTRACT FROM AUTHOR]

Background: In nephron-sparing surgery, the closure of the renal remnant is one of the major critical steps in preventing possible complications. Several suture techniques can be used for this purpose. The type of suture used depends on the discretion of the surgeon and not on validated experimental data. Methods: In an experimental setting, the renal remnant of a standardized defect in 20 porcine kidneys (with and without an intact renal capsule) was reconstructed using three different suture techniques (simple, vertical, and horizontal mattress suture). The maximum tensile force before the suture tears through the renal remnant was recorded. Results: The horizontal mattress suture attains the highest maximum tensile force by far. The values of the simple and vertical mattress sutures are surpassed, with a respective increase of 140 and 83% if the capsule is intact and 172 and 109% if the capsule is not intact. If an intact renal capsule is present, the maximum tensile force in each suture technique increases 43-63%. Conclusions: The data suggest that of all tested suture techniques, the horizontal mattress suture provides the best adaptation strength before the suture tears through the renal parenchyma/capsule. Furthermore, it is recommended that the kidney capsule be included in the reconstructive suture because this significantly contributes to the safety of the procedure. [ABSTRACT FROM AUTHOR]

Background: Through an experimental biomechanical study on rabbits, tendon reinsertion by means of trans-osseous suture on a spongy bone bed and suture anchor were evaluated comparatively at different phases of healing. Methods: Twenty-four New Zealand White rabbits were used: 2 as pilots, 4 as the control group, and 18 as the experimental group. These 18 animals underwent sectioning and reinsertion of the Achilles tendon bilaterally, using the technique of trans-osseous suture on 1 side and suture anchor on the other. All the pelvic limbs that underwent the procedure were then immobilized for 3 weeks. The experimental group was divided into 3 groups that were sacrificed, respectively, 3, 6, and 12 weeks later. The tendon-bone complex was subjected to biomechanical tests to evaluate the parameters of maximum strength, stiffness, and yield strength. Results: There was no statistically significant difference between the suture anchor group and the trans-osseous suture group, in relation to yield strength (3 weeks, P = .222; 6 weeks, P = .465; and 12 weeks, P = .200) or maximum strength (3 weeks, P = .222; 6 weeks, P = .076; and 12 weeks, P = .078). In relation to stiffness, the suture anchor group showed a statistically significant difference only at 3 weeks of healing (P = .032) over the trans-osseous suture group. Conclusion: The technique of suturing with an anchor was shown to be similar to the technique of trans-osseous suture for the studied parameters. [ABSTRACT FROM AUTHOR]

Clinical outcomes after intrasynovial flexor tendon repair have been substantially improved over the past 2 decades through advances in tendon suture techniques and postoperative rehabilitation methods. Nevertheless, complications such as repair site elongation (i.e., gap formation) and rupture continue to occur frequently. Experimental studies have shown that repair site strength fails to increase in the first 3 weeks after tendon suture. After 3 weeks, the strength and rigidity of the repair site improve significantly, a process that continues for several months. Formation of a repair site gap during the early rehabilitation period has been shown to considerably delay the accrual of repair site strength over time. Thus, it is of prime importance that the method of tendon suture achieves and maintains a stiff and strong repair site during the early healing interval by maintaining close approximation of the tendon stumps and by stimulating, where possible, the intrinsic repair response. In this review, we describe recent efforts to enhance the integrity of the immature repair site. We focus on 2 major areas of advancement: surgical technique modifications and manipulation of the biologic and biochemical environment. [Copyright &y& Elsevier]

Background: Postfixation loosening within the Krackow stitch-tendon construct may be associated with gap formation in patellar tendon repair. Hypothesis: Pretensioning the Krackow stitch-tendon construct decreases postfixation gap formation in transpatellar patellar tendon repair. Study Design: Controlled laboratory study. Methods: Patellar tendon rupture was simulated in 8 pairs of cadaveric knees. Standard manual traction was used in all specimens to remove Krackow stitch slack. In the experimental group, specimens were pretensioned with a simulated active concentric quadriceps contraction with cycling of the knee 10 times from 90° to 5° of flexion. All specimens were then cycled at 0.25 Hz from 90° to 5° for 1000 cycles until failure, which was defined as 3 or 5 mm of gap formation. Results: A 3-mm gap occurred at 1 cycle (mean, 3.5 mm) and 35 cycles (4.0 mm) in the control and experimental groups, respectively. Gapping of 5 mm occurred at 35 (5.9 mm) and 100 cycles (5.0 mm) in the control and experimental specimens, respectively. Gap formation was smaller in the experimental group through 100 cycles (P < .05). Conclusion: Gapping was lower with pretensioning in the early cycling stages. However, significant gapping occurred in both groups with repetitive concentric active loading ranging from 90° to 5° of flexion. Clinical Relevance: Tightening of the Krackow stitch as done in this study does not result in a clinically important decrease in gapping. This observation may be generalizable to other applications of the Krackow stitch. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is no conclusive evidence which size of suture stitches and suture distance should be used to prevent burst abdomen and incisional hernia. Methods: Thirty-eight porcine abdominal walls were removed immediately after death and divided into 2 groups: A and B (N = 19 each). Two suturing methods using double-loop polydioxanone were tested in 14-cm midline incisions: group A consisted of large stitches (1 cm) with a large suture distance (1 cm), and group B consisted of small stitches (.5 cm) with a small suture distance (.5 cm). Results: The geometric mean tensile force in group B was significantly higher than in group A (787 N vs 534 N; P = .006). Conclusions: Small stitches with small suture distances achieve higher tensile forces than large stitches with large suture distances. Therefore, small stitches may be useful to prevent the development of a burst abdomen or an incisional hernia after midline incisions. [Copyright &y& Elsevier]

Purpose: Numerous flexor tendon repairs have been described. The ideal core flexor tendon repair optimizes strength characteristics while minimizing factors felt to contribute to adhesion formation. The present study compares ultimate tensile strength, gap strength, and surgical time in the Lahey repair, a new 4-strand flexor tendon repair, to 2 previously described techniques. Methods: The flexor digitorum profundus tendons of 30 porcine forelimbs were repaired in situ using 1 of 3 flexor tendon repair techniques. The techniques compared included the 4-strand Kessler repair, the cruciate repair, and the experimental Lahey repair (4-strand Kessler with cruciate modification). Biomechanical testing was conducted in order to obtain initial gap strength and ultimate tensile strength. Results: Although not significantly different from the 4-strand Kessler, the ultimate tensile strength of the Lahey repair was significantly greater than that of the cruciate repair. Conclusions: The Lahey flexor tendon repair has significantly greater ultimate tensile strength than the cruciate repair. These findings suggest that the Lahey repair can be considered a biomechanically favorable 4-strand technique for the repair of flexor tendon lacerations. [Copyright &y& Elsevier]

One aim of the surgical treatment of acute Achilles tendon ruptures is to obtain a maximum primary stability of the sutured tendon. Therefore, we investigated the primary stability of sutured human Achilles tendons depending on different applied techniques. The strength of 60 repaired cadaveric human Achilles tendons was tested depending on either the suture technique (Bunnell or Kessler), the suture material (PDS-thread or PDS-cord) or an additional plantaris tendon augmentation (PDS-thread with or without augmentation). Following anatomic reconstruction the repaired specimens were loaded to failure. The use of Bunnell's technique resulted in a stronger primary suture stability compared to Kessler's technique. Sutures carried out with a PDS-thread were of lower strength than those accomplished with a PDS-cord (Bunnell: thread 139 N ± 29.8; cord 291 N ± 55.2/Kessler: thread 137 N ± 37.3; cord 180 N ± 41.1). Sutures performed according to Bunnell's technique with a PDS-thread and an additional autologous plantaris tendon augmentation reached the highest primary stability (326 N ± 124.9). The findings identify the Achilles tendon suture with a PDS-cord according to Bunnell's technique as a mechanically strong method. A plantaris tendon augmentation in addition to a PDS-thread can even add more stability to the Achilles tendon suture. [ABSTRACT FROM AUTHOR]

The objective was to make a cost analysis of incisional hernia repair by suture repair or prosthetic mesh repair. The study included 44 patients who underwent hernia repair between 1991 and 2000. The rate of recurrent incisional hernia after more than 1 year with associated costs was registered. In 1996, the technique of incisional hernia repair was changed from suture repair to mesh repair. With a mesh repair, zero out of 19 patients presented with a recurrence at follow-up, and with suture repair, five out of 13 had a recurrence (P<0.01). The duration of anaesthetic and operation was longer, but stay in the surgical ward, and sick leave was shorter for patients with a mesh repair than for those with a suture repair. For working patients, costs in the operating theatre were 4,095 Swedish kronor (SEK) higher with a mesh repair, and the costs for surgical ward, sick leave, and examination were 10,129 SEK lower than with a suture repair. Thus, with a mesh repair, the total costs were 6,034 SEK lower than with a suture repair. For retired patients, the total costs with a mesh repair were 1,898 SEK lower than with a suture repair. We conclude that in this setting, mesh repair of incisional hernias produced lower costs than suture repair. [ABSTRACT FROM AUTHOR]

Objective: To study the tensile strength of tracheal anastomoses. Design: Experimental study. Setting: University medical school laboratory, Germany. Animals: 15 sheep. Interventions: Tracheal anastomoses with three different suturing techniques: a continuous suture and interrupted sutures with either a monofilament or a polyfilament material. Anastomoses were tested to breaking after being in place for 1, 2, 4, 8 or 24 weeks. Results: After one week, with all three materials, the trachea broke at the anastomosis. In animals that survived longer, the trachea broke further away from the anastomosis. There was no significant difference between the mean values of the breaking force for continuous sutures and single interrupted sutures (p = 0.9). Conclusion: The suturing technique (continuous or interrupted) has less relevance for the tensile strength of the anastomosis than in vitro experiments suggest. [ABSTRACT FROM AUTHOR]

A suture length to wound length ratio (SLWL ratio) of 4:1 for laparotomy closure has proven in clinical studies to reduce incisional hernia incidence. The effect of different SLWL ratios on the mechanical qualities of the healing incision has not been examined experimentally. In 50 rats, the musculo-fascial layer of median laparotomies was closed with polypropylene sutures using SLWL ratios of 8:1, 4:1, 2:1 and 1.7:1. Single and running sutures, different tissue bites and different suture tensions were applied. Five rats served as controls. After 14 days, the horizontal strength of the incision was tested in a digitised tensiometer. The SLWL ratio, suture tension and suture technique proved to have significant influences on the mechanical strength of the incision. Running sutures and especially closures with a ratio of between 4:1 and 8:1 proved significantly stronger than wounds closed with single sutures. When small tissue bites were applied, the positive influence of running sutures was equalised in the early phase of wound healing. High suture tension led to significantly weaker scars independent of the applied suture technique. In accordance with clinical data, it could be proven experimentally that running closure of midline laparotomies with a SLWL ratio above 4:1 avoiding high suture tension exerts a significantly positive effect on the mechanical strength of the incision. Further studies are needed to allow measurement and better control of suture tension. [ABSTRACT FROM AUTHOR]

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

Abstract: Many suture anchors hold 2 sutures per anchor. Occasionally during a procedure, 1 of these sutures may be inadvertently pulled out of the anchor eyelet. We describe the technique of rethreading a deployed suture anchor in the event that 1 of the sutures is inadvertently unloaded from the anchor eyelet. We have evaluated its effectiveness in vivo. The basic steps of the “suture-weave” technique are as follows. If 1 strand remains threaded through the anchor eyelet, it is tensioned so that there is 1 long end and 1 short end. The free suture is threaded into the eye of a graft preparation needle and this needle is then used to pierce the braids of the long end of the threaded suture. The free suture is interwoven through the braids of the threaded suture. The short end of the threaded suture is then pulled while visualizing the anchor eyelet arthroscopically. The free suture passes through the eyelet as the intersection of the 2 woven sutures traverses the eyelet. During this process, 3 suture strands are traversing the eyelet. Finally, the intersecting suture limbs are pulled free from each other such that there are 2 separate suture strands that slide independently and pass through the anchor eyelet once again. This procedure has been successfully used in vivo without complications. It is important to note that this procedure will only work in an anchor eyelet that will allow for the passage of 3 suture strands. [Copyright &y& Elsevier]