Search

Purpose: To describe and evaluate the modified suture technique using PDS II for capsule closure in Total knee arthroplasty. Methods: One hundred-five patients with end-stage osteoarthritis of the knee received Total knee arthroplasty (TKA) in our department. The arthrotomy wounds were closed randomly utilizing either modified suture (the MS group, 53 patients) or traditional suture (the TS group, 52 patients) techniques. The time of suturing, rupture of the suture, water tightness, wound seepage and the days of hospitalization were recorded and compared between the two groups. Complications such as infection and rejection of the wound were also assessed. Results: Records indicated significantly shorter time of suturing for the capsule in the MS group (4.6 ± 0.6 min) than in the TS group (16.8 ± 1.1 min, P < 0.001). The mean time of hospitalization was also significantly shorter in the MS group (7.8 + 1.8d) than in the TS group (13.1 + 2.7d, P < 0.001).There were 51 cases in MS group and 42 cases in TS group showed good tightness, the rate of tightness in the MS group (51/53) was significantly higher than in the TS group (42/52, P = 0.015).The rate of postoperative wound seepage in the MS group (3/53) was significantly lower than in the TS group (11/52, P = 0.023). The rate of rupture of the suture in the MS group (0/53) showed no significantly difference compared with the TS group (3/52, P = 0.118). There were no complications such as infection and rejection occurred in both groups. Conclusion: The modified suture technique using PDS II appears to be a promising option for the capsule closure in TKA because it was associated with shorter surgical time, better water tightness, fewer wound see-page, shorter of hospitalization and relatively fewer complications. [ABSTRACT FROM AUTHOR]

Objective: To provide clinicians with reliable recommendations for the selection of appropriate suturing techniques for surgical management of common musculoskeletal soft tissue injuries. Methods: A systematic search of PubMed, Springer, Web Science, Vip Database, China National Knowledge, and Wanfang Data for in vitro biomechanical studies on suture techniques in the surgical treatment of musculoskeletal soft tissue injuries covering relevant studies from April 2009 to April 2024 was performed. A generalized classification was made based on the characteristics of the techniques, and recommendations for the selection of suture techniques were made according to the GRADE concept. Results: The search strategy returned 1015 articles, of which 66 were included. These studies presented moderate and high levels of evidence-based evidence and provided varying recommendations for the choice of suturing techniques in the treatment of three common musculoskeletal soft tissue injuries. Categorizing suturing techniques according to their structural principles further increases the reliability of opinions. Conclusion: The ideal suture technique must be a compromise between the complexity and strength of the repair, which is a great challenge for clinicians. This review can provide an objective and reliable clinical guide for making suture technique choices for common musculoskeletal soft tissue repair. [ABSTRACT FROM AUTHOR]

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Objective To provide clinicians with reliable recommendations for the selection of appropriate suturing techniques for surgical management of common musculoskeletal soft tissue injuries. Methods A systematic search of PubMed, Springer, Web Science, Vip Database, China National Knowledge, and Wanfang Data for in vitro biomechanical studies on suture techniques in the surgical treatment of musculoskeletal soft tissue injuries covering relevant studies from April 2009 to April 2024 was performed. A generalized classification was made based on the characteristics of the techniques, and recommendations for the selection of suture techniques were made according to the GRADE concept. Results The search strategy returned 1015 articles, of which 66 were included. These studies presented moderate and high levels of evidence-based evidence and provided varying recommendations for the choice of suturing techniques in the treatment of three common musculoskeletal soft tissue injuries. Categorizing suturing techniques according to their structural principles further increases the reliability of opinions. Conclusion The ideal suture technique must be a compromise between the complexity and strength of the repair, which is a great challenge for clinicians. This review can provide an objective and reliable clinical guide for making suture technique choices for common musculoskeletal soft tissue repair.

Abstract Background Recently, natural tissue repair has become popular in the treatment of pelvic organ prolapsed. In this study, we compared patients who underwent cystocele repair with the rug-weaving plication technique, a natural tissue repair method implemented since 2022 for anterior prolapse, with those treated using conventional colporrhaphy. Methods We retrospectively reviewed the data of 65 patients who underwent anterior vaginal wall repair with the rug-weaving plication technique (n = 33, Group 1) or conventional colporrhaphy (n = 32, Group 2). We recorded the patients’ clinicodemographic and surgical data. At the 6-month postoperative follow-up, we assessed patients’ complaints, degree of prolapse (using the simplified Pelvic Organ Prolapse Quantification system), and pelvic floor muscle strength (using the Modified Oxford Score). Anterior vaginal wall thickness was measured using transvaginal ultrasonography. We compared clinicodemographic and surgical data and postoperative outcomes between the two groups. Results The two groups were comparable in terms of age (p = 0.326), number of pregnancies (p = 0.307), number of parities (p = 0.555), preoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p = 0.380), preoperative apical prolapse simplified Pelvic Organ Prolapse Quantification grade (p = 0.518), postoperative Modified Oxford Score (p = 0.857), operation time (p = 0.809), postoperative haemoglobin (p = 0.674), and amount of bleeding (p = 0.951). Compared with Group 2, Group 1 had significantly higher postoperative anterior vaginal wall thickness (p

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. [ABSTRACT FROM AUTHOR]

Background: Periorbital aging is characterized by dermatochalasis, lateral hooding and malformation of multiple eyelid creases. Rejuvenation of periorbital region is of great concern in aging Asians, especially for the females. However, the conventional subbrow blepharoplasty was indicated for mild or moderate skin laxity. For severe laxity, double-eyelid incision is necessarily to be involved. This study aims to improve the severe upper eyelid dermatochalasis through an extended subbrow single-incision approach with desirable outcomes. Methods: Patients underwent this surgical method from October 2020 to April 2022 were retrospectively reviewed. The redundant skin and orbicularis oculi muscle were excised through a spindle-like subbrow incision delicately designed in the sitting position. Surgical outcomes were evaluated by heights of designed line from the palpebral margin to the pupil center (HPPC), medial cornea (HPMC), and lateral canthus (HPLC) at different follow-ups. The overall satisfaction score of cosmetic outcomes was assessed by an independent surgeon and patients themselves based on the evaluation of: subbrow scar, eyelid symmetry, lateral hooding lifting, visual block improvement and brow shape. Results: A total of 75 cases were reviewed, including 3 men and 72 women. The preoperative HPPC, HPMC, and HPLC were 4.27 ± 0.40, 4.72 ± 0.45 and 3.41 ± 0.35 mm. The values were postoperatively improved to 7.01 ± 0.46, 6.57 ± 0.34 and 5.69 ± 0.26 mm, respectively, presenting significantly different (p < 0.05). The mean surgeon satisfaction scores were 3.6 ± 0.6 (range, 2.0–4.0), and patient satisfaction scores were 3.5 ± 0.6 (range, 2.0–4.0). No hypertrophic scar, sunken upper eyelids or other complications was found. Conclusions: The modified subbrow blepharoplasty method is an effective and safe alternative for correcting severe upper eyelid skin laxity, which can achieve both good cosmetic outcomes and functional improvement. Level of Evidence IV: 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. [ABSTRACT FROM AUTHOR]

In total shoulder arthroplasty, the subscapularis tendon is routinely mobilized, by tenotomy, peel, or lesser tuberosity osteotomy, to visualize the joint and allow proper implant positioning. Careful mobilization of the subscapularis is undertaken to achieve an anatomic tension-free repair. This cadaveric study tests the biomechanical differences of 2 repair techniques of the subscapularis peel (SP) compared to the classically described technique. We hypothesize that adaptation of this SP technique using a custom-designed polyether-ether-ketone (PEEK) barrel in the bicipital groove may further stabilize suture repair of the subscapularis. Twenty paired cadaveric shoulder specimens underwent SP and repair via transosseous suture fixation. The PEEK barrel used was a laboratory prototype designed for the study (Catalyst OrthoScience, Naples, FL, USA). Five specimens were repaired using a traditional Mason-Allen suture; their paired shoulders were repaired using the PEEK barrel and a Mason-Allen suture. Five specimens were repaired using the Krackow suture; their paired shoulders were repaired using the PEEK barrel and a Krackow suture. Mechanical testing was performed using a uni-axial materials testing system with primary outcome of gap displacement and secondary outcomes of maximum load to failure and method of failure. The Krackow repair method with and without PEEK augmentation was significantly stiffer than the Mason-Allen repair method with and without PEEK augmentation (P <.001 across all groups). Adding augmentation changed the strength of the Mason-Allen repair without achieving statistical significance (P =.0925). Intergroup differences in cyclic displacement were not statistically significant. The Krackow repair methods had higher mean maximal load at failure than the Mason-Allen repairs of 534 ± 108 N and 266 ± 98 N, respectively (P <.001). Maximum load at 5 mm displacement was significantly different across groups (P =.004). Methods of failure in the Mason-Allen technique groups included knot and tendon failure, and in the Krackow technique groups included suture failure and lesser tuberosity fracture. Repairing the subscapularis with a Krackow suture is significantly stronger than a Mason-Allen repair in stiffness as well as load to failure. The results reported here compare a Krackow suture with a more common Mason-Allen suture configuration, and demonstrate the application of PEEK augmentation to subscapularis repair techniques. This study can guide surgeon selection of an ideal subscapularis repair technique for stemmed or stemless total shoulder arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Recently, natural tissue repair has become popular in the treatment of pelvic organ prolapsed. In this study, we compared patients who underwent cystocele repair with the rug-weaving plication technique, a natural tissue repair method implemented since 2022 for anterior prolapse, with those treated using conventional colporrhaphy. Methods: We retrospectively reviewed the data of 65 patients who underwent anterior vaginal wall repair with the rug-weaving plication technique (n = 33, Group 1) or conventional colporrhaphy (n = 32, Group 2). We recorded the patients' clinicodemographic and surgical data. At the 6-month postoperative follow-up, we assessed patients' complaints, degree of prolapse (using the simplified Pelvic Organ Prolapse Quantification system), and pelvic floor muscle strength (using the Modified Oxford Score). Anterior vaginal wall thickness was measured using transvaginal ultrasonography. We compared clinicodemographic and surgical data and postoperative outcomes between the two groups. Results: The two groups were comparable in terms of age (p = 0.326), number of pregnancies (p = 0.307), number of parities (p = 0.555), preoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p = 0.380), preoperative apical prolapse simplified Pelvic Organ Prolapse Quantification grade (p = 0.518), postoperative Modified Oxford Score (p = 0.857), operation time (p = 0.809), postoperative haemoglobin (p = 0.674), and amount of bleeding (p = 0.951). Compared with Group 2, Group 1 had significantly higher postoperative anterior vaginal wall thickness (p < 0.001) and significantly lower postoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p < 0.001). Conclusions: The rug-weaving plication technique may offer a viable alternative for cystocele repair without mesh, using natural tissue and potentially reducing mesh-related complications and recurrence rates. Clinical trial number: NCT06410469 (03/05/2024). [ABSTRACT FROM AUTHOR]

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

Background: 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]

Purpose: Reconstructive periodontal surgery, which has received more and more interest in modern periodontology, can help save severely compromised teeth and solve aesthetic problems caused by the destruction of periodontal tissues in periodontal diseases. Unfortunately, there is few literatures reviewing the use of suspensory suture techniques in reconstructive periodontal surgeries. Methods: An electronic search of the PubMed and Web of Science was performed. Full-text articles were obtained from the records after screening in the title and abstracts. Results: Effective suture is of central importance to a successful treatment outcome of periodontal surgeries, especially incremental soft or hard tissue surgeries. Limitations in suture techniques may negatively affect the intimate contact of the affected tissues, wound closure and stabilization, and successful wound healing. Suitable anchors can be selected to help achieve this objective. Suspensory sutures may be more precise suture techniques, due to the use of relatively immobile anchors. Conclusion: This review aims to provide key points of successful wound healing and summarize the current state of the suspensory suture techniques for reconstructive periodontal surgeries in daily practice, including their treatment application, detailed steps, advantages, and disadvantages. [ABSTRACT FROM AUTHOR]

Abstract Background There is ambiguity in the literature regarding the continuous suture technique (CST) for aortic valve replacement (AVR). At our center, there has been a gradual shift towards CST over the interrupted pledgeted technique (IPT). This study aims at comparing outcomes for both techniques. Methods We performed a retrospective analysis of a single-center study of patients undergoing AVR between January 2011 and July 2020. Patients were divided into two groups: Continuous suture technique and interrupted pledget-reinforced sutures. The pre-operative and In-hospital clinical characteristics and echocardiographic hemodynamics (i.e. transvalvular gradients and paravalvular leakage) were compared between CST and IPT. Results We compared 791 patients with CST to 568 patients with IPT (median age: 73 and 74 years, respectively, p = 0.02). In CST there were 35% concomitant procedure vs. 31% in IPT (p = 0.16). Early mortality was 3.2% in CST versus 4.8% in IPT (p = 0.15), and a second cross-clamp due to a paravalvular-leak in 0.5% vs. 1.2%, respectively (p = 0.22). The CST was not associated with new-onset conduction-blocks mandating pacemaker implants(OR 1.07, 95% CI 0.54–2.14; P = 0.85). The postoperative gradients on echocardiography were lower in CST compared to IPT, especially in smaller annuli (peak gradients: 15.7mmHg vs. 20.5mmHg, in valve size

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]

Background: To determine 1‐year postoperative recurrence rates, postoperative pain and complication rates of transanal open haemorrhoidopexy applied also in grade IV haemorrhoids. Methods: Single‐centre retrospective observational study without control group. The primary outcome was recurrence rate after 1 year postoperatively. Secondary outcomes were length of postoperative pain, use of opiates and postoperative complications. The recurrence rate was assessed with the Sodergren haemorrhoid symptom severity score questionnaire. For information on the early postoperative period, a retrospective chart review based on the routine 3‐month clinical follow‐up was done. Results: 135 consecutive patients with haemorrhoids Goligher grades II–IV were operated with transanal open haemorrhoidopexy. 88 patients (65%) consented to participate in the study when approached later via mail. 23% of patients had haemorrhoids Goligher grade IV. 15 patients (17%) needed a second transanal open haemorrhoidopexy for residual haemorrhoidal prolapse. The recurrence rate of prolapsing haemorrhoids was 15% (13 patients) 1 year postoperatively. 21% of patients reported no postoperative pain, 54% described pain for a duration of up to 1 week and 22% for up to 2 weeks. Two patients reported a longer duration of pain of 3 and 4 weeks, respectively. No complications grade Clavien‐Dindo III or higher were detected. Conclusion: The results of our study indicate that transanal open haemorrhoidopexy has a recurrence rate comparable to traditional haemorrhoidectomy including grade IV haemorrhoids and is associated with less pain and tissue damage. A randomized controlled trial may provide further support for the routine application of this method, but may pose challenges. [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]

Background: This study aimed to compare the outcomes of mitral valve replacement (MVR) using the intermittent simple suture technique versus the horizontal matrix suture technique with pledgeted in terms of paravalvular leakage and infective endocarditis. Methods: A retrospective analysis was conducted on 422 patients who underwent MVR between 2019 and 2023. Patients were divided into two groups based on the suture technique used: group B (simple suture technique) and group P (horizontal matrix suture technique with pledgeted). Propensity score matching was performed to balance the groups, resulting in 62 case pairs for comparative analysis. Results: There were no intraoperative mortalities, and the duration of cardiopulmonary bypass and cross-clamp time did not significantly differ between the two groups. No significant differences were observed in terms of total hospitalization time, early mortality, cerebrovascular events, and arrhythmias. Postoperative echocardiography revealed minimal paravalvular leakage in both groups, with non-serious leakage observed in 4 patients in group B and 2 patients in group P. The incidence of infective endocarditis was 1 in group B and 2 in group P. Hemolysis indicators showed higher mean values in the simple suture technique group, although not statistically significant. Conclusions: The study findings suggest that there is no significant difference in the incidence of paravalvular leak and infective endocarditis between the intermittent simple suture technique and the horizontal matrix suture technique with pledgeted. Both techniques can be safely employed in MVR.

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. Pre-closure 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 telemedicine-assessed 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.

Purpose: Refixation of acute anterior cruciate ligament (ACL) tears represents an increasingly popular treatment option. Systematic evaluations of various suture technique parameters are still pending. We therefore aimed to evaluate the mechanical pull‐out outcomes of various suture methods for optimization of ACL refixation. Methods: Sixty fresh knees from mature domestic pigs were dissected and the femoral attachment of the ACL was peeled off. The 60 knees were divided in 10 groups and sutured as follows: (A) one suture (1, 2, 4 and 6 passes), (B) two sutures (2, 4 and 6 passes each; sutures knotted together as a loop) and (C) two sutures (2, 4 and 6 passes each, sutures knotted separately). The pull‐out test was conducted using a validated electrodynamic testing machine. First occurrence of failure, maximum pull‐out load and stiffness were measured. Suture failure was defined as pull‐out of the ACL. Results: Two‐point fixation, using two sutures, with at least two passes, showed the most favourable biomechanical stability. The maximum pull‐out load was significantly higher with two sutures (529.5 N) used compared to one (310.4 N), p < 0.001. No significant differences were found for maximum pull‐out loads between two‐point fixation versus one‐point fixation but stiffness was significantly higher with two‐point fixation (107.4 N/mm vs. 79.4 N/mm, p < 0.001). More passes resulted in higher maximum pull‐out loads. Conclusion: The results suggest using two independent sutures, refixed separately and at least two suture passes, is appropriate for ACL refixation. More suture passes provide additional strength but are technically challenging to achieve during surgery. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

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

Abstract Background Mechanical forces have an important role in the initiation and progression of orthopedic surgical incisions complications. To avoid incision complications with the reduction of dermal tension, surgeons may choose a buried continuous suture technique other than the traditional interrupted vertical mattress suture. Absorbable barbed sutures are widely used in orthopedics due to their convenience and reducing wound tension. The aim of this research is to compare and explain the advantages of running subcuticular suturing technique with absorbable barbed sutures for orthopedic surgical incisions closure. Methods Finite element models of layered skin and two different suture techniques, running subcuticular suture and intradermal buried vertical mattress suture, ware constructed. The mechanical property difference between standard sutures and barbed sutures was modelled using different contact friction coefficient. Pulling the skin wound was simulated, and the sutures’ pressure on the skin tissue was determined. Results Compared with traditional smooth sutures, the barbed sutures effectively increased the contact force for subepidermal layers, which led the less force variation between different layers. The results also suggested that subcuticular suture caused less stress concentration compared with intradermal buried vertical mattress suture. Conclusions In conclusion, our study indicated that running subcuticular suturing technique with absorbable barbed sutures for orthopedic surgical incisions closure results in more uniform stress distribution in the dermis. We recommend this combination as the preferred method of skin closure in orthopedic surgery unless contraindicated.

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

Abstract Purpose Refixation of acute anterior cruciate ligament (ACL) tears represents an increasingly popular treatment option. Systematic evaluations of various suture technique parameters are still pending. We therefore aimed to evaluate the mechanical pull‐out outcomes of various suture methods for optimization of ACL refixation. Methods Sixty fresh knees from mature domestic pigs were dissected and the femoral attachment of the ACL was peeled off. The 60 knees were divided in 10 groups and sutured as follows: (A) one suture (1, 2, 4 and 6 passes), (B) two sutures (2, 4 and 6 passes each; sutures knotted together as a loop) and (C) two sutures (2, 4 and 6 passes each, sutures knotted separately). The pull‐out test was conducted using a validated electrodynamic testing machine. First occurrence of failure, maximum pull‐out load and stiffness were measured. Suture failure was defined as pull‐out of the ACL. Results Two‐point fixation, using two sutures, with at least two passes, showed the most favourable biomechanical stability. The maximum pull‐out load was significantly higher with two sutures (529.5 N) used compared to one (310.4 N), p

Objective: This study aimed to compare the outcomes of mitral valve replacement (MVR) using the intermittent simple suture technique versus the horizontal matrix suture technique with pledgeted in terms of paravalvular leakage and infective endocarditis. Materials and Method: A retrospective analysis was conducted on 422 patients who underwent MVR between 2019 and 2023. Patients were divided into two groups based on the suture technique used: group B (simple suture technique) and group P (horizontal matrix suture technique with pledgeted). Propensity score matching was performed to balance the groups, resulting in 62 case pairs for comparative analysis. Results: There were no intraoperative mortalities, and the duration of cardiopulmonary bypass and cross-clamp time did not significantly differ between the two groups. No significant differences were observed in terms of total hospitalization time, early mortality, cerebrovascular events and arrhythmias. Postoperative echocardiography revealed minimal paravalvular leakage in both groups with non-serious leakage observed in four patients in group B and two patients in group P. The incidence of infective endocarditis was one in group B and two in group P. Hemolysis indicators showed higher mean values in the simple suture technique group although not statistically significant. Conclusion: The study findings suggest that there is no significant difference in the incidence of paravalvular leak and infective endocarditis between the intermittent simple suture technique and the horizontal matrix suture technique with pledgeted. Both techniques can be safely employed in MVR. [ABSTRACT FROM AUTHOR]

Objective: The acquisition of surgical skills requires motor learning. A special form of this is intermanual transfer by transferring motor skills from the nondominant hand (NDH) to the dominant hand (DH). The purpose of this study was to determine the learning gains that can be achieved for the DH by training with the DH, the NDH, and by non-surgical alternative training (AT). Methods: 124 preclinical (n=62) and clinical (n=62) dental students completed surgical knot tying and suturing technique training with the DH, with the NDH, and an AT in a controlled randomized trial. Results: A statistically significant learning gain in knot tying and suture technique with the DH was evident only after training with the DH when compared to training with the NDH (p<0.001 and p=0.004, respectively) and an AT (p=0.001 and p=0.010, respectively). Of those students who achieved a learning gain ≥4 OSATS points, 46.4% (n=32) benefited in their knot tying technique with the DH from training with the DH, 29.0% (n=20) from training with the NDH, and 24.6% (n=17) from an AT while 45.7% (n=32) benefited in their suturing technique with the DH from training with the DH, 31.4% (n=22) from training with the NDH, and 22, 9% (n=16) from an AT. Conclusions: Training with the DH enabled significantly better learning gains in the surgical knot tying and suturing techniques with the DH. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy and weight of sellar floor repair techniques such as different dura suture, bone reconstruction, and pedicled nasoseptal flap (PNSF) on the skull base reconstruction of medium and high flow cerebrospinal fluid leakage during endonasal endoscopic pituitary adenoma surgery. Methods collected the data of Grade 2-3 cerebrospinal fluid leakage (Kelly grade) during endonasal endoscopic pituitary adenoma resection in our hospital from January 2015 to April 2021. Multiple reconstruction techniques such as dura suture, bone reconstruction and PNSF, and related factors such as age, sex, body mass index (BMI), diabetes, tumor size and diameter of diaphragmatic defect were recorded and introduced to multivariate regression to analyze the effects of the above factors on the duration of postoperative cerebrospinal fluid rhinorrhea and bed rest time, with a special focus on the weight priority of dura suture, bone reconstruction, and PNSF. Results A total of 281 patients were included, with the average age of (47±12.6) years. males accounting for 52.6%. There were 93 cases of PNSF, 268 cases of bone reconstruction, 109 cases of dura anchor suture, 50 cases of patch suture, and 122 cases without suture. The results of multivariate analysis indicated that the application of PNSF, bone reconstruction, and dura suture significantly reduced postoperative rhinorrhea time [reduced by 18.524, 35.876, and 16.983/19.791 (anchor suture/patch suture) hours, respectively; all P<0.001] and bed time [reduced by 16.797, 58.233, and 18.063/ 21.604 (anchor suture/patch suture) hours. respectively; all P<0.001], and there was no significant difference between anchor suture and patch suture. The weight of the standardized coefficient in reducing postoperative rhinorrhea time was dura suture> PNSF> bone reconstruction [Standard 8=0.211/0.207 (anchor suture/patch suture)>0.200 0.165]. The weight of reducing bed time was bone reconstruction >dura suture > PNSF [Standard B=0.239 0.206/0.210 (anchor suture/patch suture) >0.164]. After stabilizing the learning curve in 25-30 cases. the average time for bone reconstruction was (3.9±0.4) minutes. After stabilizing learning curve in 30-40 cases, the dura suture technique took an average of (3.7±0.3) minutes per stitch, (3.7±1.0) stitches per case, and (13.6± 2.7) minutes of total time consumption per case. Conclusion Dural anchoring and patching suture can both effectively shorten the duration of cerebrospinal fluid rhinorrhea and bed rest time. Bone reconstruction significantly improves the stability of reconstruction, especially in prompting patients' early disengagement of bed rest. Moreover, the learning curves of the above two methods are economical and reasonable, and their weight is close to or even exceeds that of PNSF. Therefore, they can be an effective supplement or even substitute for PNSF. [ABSTRACT FROM AUTHOR]

Primary closure of suborbital skin defects can cause tension along the closure resulting in ectropion. The bicycle wheel analogy is a simple yet effective guide to aid in reducing tension vectors resulting in ectropion.

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

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]

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Transumbilical laparoendoscopic single-site surgery (TU-LESS) is a new and evolving surgical method suitable for gynecological diseases, because of its minimal invasion and good cosmetic results. However, since the incision required for this procedure is longer than that for traditional laparoscopy, it may be associated with a higher incidence of postoperative incision complications, such as umbilical hernia, infection, hematoma, and poor wound healing. Moreover, the patient may be left with a misshapen umbilicus because intensive surgery is performed through a single umbilical incision. To minimize the incisional complications and meet patients' cosmetic expectations, we designed a novel suturing technique, named "Zheng's anchor suture technique". This video demonstrates the specific steps and shows photographs of patients' umbilici that were sutured by this technique, taken after recovery from various operations. [ABSTRACT FROM AUTHOR]

All-inside cruciate ligament reconstruction is an emerging technique for treating anterior cruciate ligament and posterior cruciate ligament injuries. The all-inside technique uses a 4-stranded graft made of a single tendon that wraps around itself. Four strands of the graft must be immobilized to form a closed loop, and the free ends of the graft must be attached using a suture technique. There is currently no "optimal" or "standard" suture technique for attaching the free ends of grafts. Twenty porcine flexor tendons retrieved from hind limbs were prepared for quadrupled-strand grafts using four different methods:1. using the whipstitch technique and a new suture technique with a side-to-side graft configuration (w-s graft, new S S graft), 2. using the Krackow suture technique and Kessler suture technique with an end-to-end graft configuration (Krackow graft, Kessler graft). Followed by tensile testing (including preconditioning). Among the tested techniques, the quadrupled-strand grafts formed with the new suture technique performed best in terms of ultimate failure load (931.03 ± 20.53 N) and stiffness (236.85 ± 9.73 mm), with a statistically significant difference between side-to-side grafts and end-to-end grafts in terms of ultimate failure load in both groups. The new side-to-side graft (5.30 min) showed the shortest graft preparation time. There is no doubt that the new suture technique described here has higher tensile and breaking forces than other four-strand suture techniques and is superior to other technologies in terms of preparation time, and side-to-side grafts performed better biomechanically than the end-to-end graft configuration. • The first study compared the suture techniques for connecting the free ends of four-stranded grafts. • This new suture technique offers superior mechanical properties and shorter operating times. • A safer and more maneuverable suture technique deserves to be recognized. [ABSTRACT FROM AUTHOR]

Abstract Background Hepaticojejunostomy is commonly performed in hepato-bilio-pancreatic surgery, particularly during pancreaticoduodenectomy. The purpose of this study is to evaluate the safety and efficiency of two commonly applied suture techniques (the interrupted versus the continuous suture technique) in patients undergoing a hepaticojejunostomy during pancreatoduodenectomy. Methods The HEKTIK trial is a multicenter, randomized controlled, patient-blinded surgical explorative trial with two parallel study groups. An adaptive sample size design was chosen: First, 100 patients scheduled for surgery including a hepaticojejunostomy will be randomized 1:1 either to the interrupted suture technique or the continuous suture technique after informed consent. Based on this data, needed sample size will be adjusted. The primary endpoint will be the occurrence of anastomotic leakage of hepaticojejunostomy, defined as bilirubin concentration in the drain fluid at least 3 times the serum bilirubin concentration on or after postoperative day 3 or as the need for radiologic or operative intervention resulting from biliary collections or bile peritonitis (according to the definition of ISGLS). Further perioperative parameters like other morbidities as well as duration and costs of the hepaticojejunostomy will be analyzed as secondary outcomes. Discussion Until now there are no randomized controlled comparative data of these two suture techniques for hepaticojejunostomy. The HEKTIK trial will investigate the yet unanswered question of whether the interrupted suture or the continuous suture technique has advantages performing a hepaticojejunostomy during pancreatoduodenectomy. Trial registration German Clinical Trials Register DRKS00024395 . Registered on 01 February 2021.

Roux-en-Y hepaticojejunostomy is an important component of robotic biliary reconstruction surgery. High-quality hepaticojejunostomy is inseparable from a number of key factors.These factors include the incision of bile duct stump, the handling of the bowel, anastomosis method selection, and selection of anastomotic threads, etc. More attention should be paid to the improvement of biliary reconstruction techniques in the direction of refinement and homogeneity.

Background: In this study, we aimed to evaluate the long-term results of suture and graft techniques used to increase tip projection and rotation in Open Technique Septorhinoplasty. Methods: In this study, the data of 89 patients who underwent Open Technique Septorhinoplasty were analysed retrospectively. The patients were divided into groups 1,2,3,4 and 5 according to the suture and graft techniques used. Preoperative and postoperative photographs of all patients included in the study at the 1st, 3rd, 6th, 12th, 36th and 60th months were analyzed. To measure and compare these techniques, tip projection and rotation losses were measured on all photographs using a computer program called Imagej. Results: A statistically significant increase was found between the preoperative mean Nasolabial Angle (NLA), Type Angle (TA), Byrd-Hobar Method (BHM) and Nasofacial Angle (NFsA) measurement values and the measurement values at 36th months postoperatively in Groups 1 and 4 (p < 0.05). In Group 2, a statistically significant increase was found between preoperative mean NLA, TA and BHM measurement values and postoperative 36th month measurement values (p < 0.05). In group 1 only, there was a statistically significant difference between the preoperative mean TA, BHM, Simons Method (SM), Goode Method (GM) and Powell-Modified Baum Method (PMBM) measurement values and the postoperative measurement values at 60th months (p < 0.05). Conclusions: Our results showed that suture techniques were more effective on projection and rotation than graft techniques in the long term. [ABSTRACT FROM AUTHOR]

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]

Copyright of Journal für Ästhetische Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Open wounds are usually closed with suture. However, young patients often do not cooperate and prevent proper suture placement. Young patients are often terrified of mild pain and wholly uncooperative, which is why we introduce this timesaving, less painful, more aesthetic technique of placing and removing stitches. 104 patients with facial lacerations aged 5 to 15 years were treated at a single center from May 2019 to March 2021. Patients were randomly assigned equally to a simple interrupted suture group (the SI group) or a continuous locking with Steri‐Strip group (the CS group). Suture times, times for stitch removal, pain scores at stitch removal and mature scar scores were evaluated. Suture and stitch removal times were significantly shorter, and pain scores at stitch removal and observer scar assessment scale scores were lower in the CS group. Patient scar assessment scale score was non‐significantly lower in the SI group. This study shows that the novel continuous locking with the Steri‐Strip technique is easier and quicker to perform, causes less pain when removing stitches, provides better aesthetic results than the simple interrupted suture technique and suggests the continuous locking with Steri‐Strip technique would be very useful for uncooperative young patients. [ABSTRACT FROM AUTHOR]

Substantial nerve lesions almost always lead to persistent functional deficits, even with ideal treatment. Nerve lesions commonly occur in young patients, are often part of complex injuries, and are repeatedly diagnosed and treated with delay. Functional outcome crucially depends on early and adequate treatment. The aim of surgical treatment is a precise and tension-free microsurgical restoration of nerve continuity in a vital and healthy tissue environment. Adequate microsurgical treatment with differentiated postoperative treatment can result in an excellent clinical outcome, even after a delayed diagnosis., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: A. Ayache, M.F. Langer, A. Cavalcanti Kußmaul und F. Unglaub geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Abstract Background The aim of this study was to compare the outcomes of modified Bakay technique (MT) to standard colpotomy (ST) and cuff closure in total laparoscopic hysterectomy (TLH). Methods This two-centre, randomized-controlled study included a total of 160 patients who were scheduled for TLH for benign diseases (ClinicalTrials.gov Identifier is NCT05080114 and the first posted date was 15/10/2021). The patients were allocated into two groups by a computer-based randomization programme as ST group and MT group. Total operative time, cuff closure time, length of hospital stay, intra- and postoperative complications according to the Clavien-Dindo classification, pre- and postoperative vaginal length, and patient satisfaction according to the Patient Global Impression of Improvement (PGI-I) questionnaire were assessed. Results Seventy-seven patients in the ST group and 80 patients in the MT group underwent TLH. The total operative time was significantly shorter in the MT compared to the ST (55.5 vs. 59 min, respectively; p = 0.001). The median total operative time for colpotomy, extraction of uterus, and vaginal cuff closure steps was 9 (range 6–12 in MT vs. 6 to 11 in ST) min in both groups. The median hospital stay was 2 (range 1–4) days in both groups. Intraoperative blood loss was not significantly different between the groups (90 mL in ST vs. 80 mL in MT; p = 0.456). The mean uterine weight for the ST group and MT group was comparable (258.6 ± 88.6 g vs. 232.9 ± 102.5 g, respectively; p = 0.107). The preoperative vaginal length was not significantly different between the groups (p = 0.502). The median postoperative vaginal length was significantly higher in the MT group compared to the ST group on Day 90 (8 cm vs. 7,5 cm, respectively; p = 0.001). The PGI-I questionnaire score on Day 90 postoperatively was 2 (range 1–5) in both groups (p = 0.636). The complication rates were similar between the groups (p = 0.230). Conclusion The MT can be safely performed in most of the cases requiring TLH with the advantages of vaginal cuff closure before the alteration of pelvic anatomy, support to primary healing of the vaginal cuff, and routine concomitant apical support.

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 Introduction Postpartum hemorrhage is a serious complication of childbirth and is still the leading cause of maternal death worldwide. Lower uterine segment hemorrhage during cesarean section is an important cause of postpartum hemorrhage. Our objective is to expore the efficacy and safety of King’s combined uterine suture for hemostasis during cesarean section. Methods We examined 48 cases: 16 cases of pernicious placenta previa (including one case of twins), 11 cases of central placenta previa (including one case of twins), 18 cases of uterine scarring (including two cases of twins), as well as one case of twin pregnancy, two cases of breech presentation, and one case of pulmonary hypertension. The “King’s combined uterine suture” method for hemostasis was used in patients with lower uterine segment hemorrhage during cesarean section. Results The results showed that all patients had successful hemostasis during surgery, and there were no cases of hysterectomy. Conclusion We have concluded that King’s combined uterine suture is a fast and safe hemostasis method for cesarean section that can effectively reduce blood loss and restore the normal shape of the lower uterine segment. Furthermore, this suture method can reduce postpartum hemorrhage and hysterectomy rate, as well as improve maternal prognosis.

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

Objective: Uvulopalatopharyngoplasty (UPPP) is performed as a surgical treatment at the oropharyngeal level for obstructive sleep apnea, but there are problems with variations in treatment effects and postoperative complications. Therefore, to improve those, we have devised and put into practice the so-called CWICKs, which is a modified version of barbed reposition pharyngoplasty as a surgical method. We outline the procedure of CWICKs and report the treatment results in comparison with the conventional UPPP.Methods: CWICKs are surgeries that use resorbable wound closure devices to pull the posterior palatal arch outward and elevate it anteriorly and superiorly to maintain an open upper airway during sleep at the soft palate level. We compared the therapeutic effects of 46 patients evaluated by polysomnography before and after surgery among CWICKs performed in our department between January 2015 and December 2019 and 91 patients who underwent UPPP in our department between January 2000 and December 2008.Results: In 46 patients who underwent CWICKs, significant improvement was observed before and after surgery using the apnea hypopnea index (AHI), obstructive apnea index (OAI), ration of each sleep stage, and SpO2 level > 90%. The improvement rate of AHI was 68.4%, and the surgical success rate was 58.7%. Postoperative patient satisfaction was also good, and significant improvement in subjective sleepiness (Epworth Sleepiness Scale) and subjective sleep quality (Pittsburgh Sleep Quality Index) was observed before and after surgery. No postoperative complications such as dysphagia or scar stenosis were observed in any of the patients in the CWICKs group. Compared with the 91 cases of UPPP, which is the conventional method, there was no significant difference in the improvement rate of AHI (p = 0.199), but the improvement rate of OAI had significantly improved (p = 0.013). Regarding the postoperative sleep stage, In the CWICKs group, a significant decrease in stage 1 and a significant increase in stage 2, stage 3, and stage rapid eye movement were observed, whereas in the UPPP group, no significant improvement in stage 3 was observed. Multivariate analysis of surgical success did not show an association with surgical methods (CWICKs or UPPP). On the other hand, an association was shown with age (<45), palatine tonsil size (≥3 / 5), high MPH (≥14 mm), and OAI rate (> 1/3).Conclusion: The treatment outcome of CWICKs was equal to or better than that of the conventional UPPP. Future follow-up is required for long-term prognosis, but no serious postoperative complications, such as dysphagia or scar stenosis, have been observed. CWICKs are considered to be minimally invasive, simple, and effective surgical procedures with few complications. [ABSTRACT FROM AUTHOR]