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We report a case of conjunctival erosion due to ligature suture knot exposure following Aurolab aqueous drainage device (AADI) implantation. A 48-year-old man, a known case of primary angle-closure glaucoma, had failed trabeculectomy with mitomycin-C and Ahmed glaucoma valve (AGV) in the right eye. The right eye had a large posterior AGV bleb with hypertropia and limitation of extraocular movement on downward gaze and uncontrolled intraocular pressure (IOP). An inferonasal AADI was performed uneventfully. At the 1-month postoperative visit, a small conjunctival erosion was noted over the ligature (6-0 vicryl) suture knot. However, there was no leak. Two weeks later, there was hypotony and a leak was noted at the site of the absorbed ligature. Immediate surgical repair was performed by re-ligature of the AADI tube with 8-0 vicryl and the ligature knot was placed under the scleral patch graft and the conjunctival defect was sutured. Early intervention helped in successfully healing the conjunctival erosion, reversal of the hypotony and well-controlled IOP. Adequate covering of the entire subconjunctival tube including its ligated part by a patch graft may prevent this complication.

Background Hymenoplasty is one of the least described vulvovaginal procedures in plastic surgery without any surgical standard that attempts to restore the hymen’s ability to bleed during sexual intercourse on a couple’s wedding night. Objectives The objective of this study was to report outcomes from a Moroccan retrospective study of a series of 529 patients who underwent either a hymenorrhaphy or a hymenoplasty. Methods This was a retrospective study of 529 patients who underwent hymen restoration at a center in Morocco between April 2010 and April 2019. The data were collected according to the requirements of the center through preoperative and postoperative consultations and in-person or phone post-coital interviews. The procedure consisted of suturing the edges of the hymen remnants with Vicryl 5-0, leaving a small opening in the newly reconstructed hymen. Two techniques—hymenal flap hymenoplasty and vaginal flap hymenoplasty—were employed depending on the presence or absence of hymen remnants. Results A total of 529 patients underwent hymen restoration, including 42% hymenorrhaphies, 58% hymenoplasties, 39% hymenal flap hymenoplasty, and 19% vaginal flap hymenoplasty. The mean age of the patients was 32 years. Of the 227 women who underwent a hymenorrhaphy, no failure was reported, and all the patients who had sexual intercourse within 15 days of the procedure experienced vaginal bleeding. Of the 99 hymenoplasties employing vaginal flaps, only 1 failure was reported. Conclusions The techniques utilized in our cohort are safe and the complications are minor with general satisfaction of patients. Level of Evidence: 4

PURPOSE Cerebrospinal fluid leakage (CSFL) is a common complication during spinal surgery. This study aimed to compare dural closure with different suture types, sizes, and techniques, and adhesives to reduce the occurrence of CSFL. MATERIALS AND METHODS Using a pig spine model, the PDS II 4-0, 5-0, 6-0, Vicryl 4-0, 5-0, 6-0, and Prolene 4-0, 5-0, 6-0 sutures were compared by calculating the permeability after suturing. Spraying bioprotein glue was also tried. Next, 120 patients who underwent surgery for intraspinal subdural tumors were enrolled and received 5-0 PDSII, Vicryl, or Prolene for dura repair. RESULTS In the animal model study, Vicryl 5-0 showed a reduced leakage flow rate compared with 5-0 Prolene and 5-0 PDS II. In the clinical study, postoperative drainage in the Vicryl group was smaller than that in the other groups during the first 3 days after surgery (p

Laparoscopic colorectal surgery is a surgical technique as safe as open surgery. Transanal total mesorectal excision (TaTME), which is a new approach in rectum surgery, is the resection of the rectum with the perianal approach with the help of endoscopic instruments. Although there are specially designed tools for this approach, it can also be done with the help of other options. Our patient, who we prepared for the operation with the diagnosis of rectal cancer, was operated with a standard technique using a manually prepared sponge-port during the Coronavirus disease-19 pandemic period. After resection, the specimen was taken out transrectally, coloanal anastomosis was performed with 2/0 vicryl one by one, and the operation was completed with a protective ileostomy. Operation time was 245 minutes. The patient who did not develop postoperative complications was discharged on the 5th day. The wide series results should be followed in order to compare the oncological and clinical results of TaTME with open and standard laparoscopic TME results, which allows to perform the tumor surgical margin macroscopically with the dissection.

Background: Staple line bleeding & leak are the most annoying events of Laparoscopic Sleeve Gastrectomy. Staple line reinforcement (SLR) is considered a weapon to reduce the incidence of such dangerous events. Purpose: Rationale of this study is to compare between non reinforced and reinforced staple line with vicryl sutures during laparoscopic sleeve gastrectomy. Patients and methods: Patients were divided into two groups; group (A); 25 cases; underwent Laparoscopic Sleeve Gastrectomy (LSG) with strength­ening of the stapler line by v-lock suture and group (B); 25 cases; underwent LSG without reinforcement of stapler line. patient follow-up period was 12 months. Results: There were no significant differences between both groups as regard to patient demographic data and hospital stay. Group (A) was performed in longer time; 102 ± 9 vs 74 ± 4 in group (B). frequency of bleeding was more in group (B); 7 patients (28%) than in group (A); one patient (4%). Also frequency of leakage was more group (B); 6 patients (24%) than in group (A); no patients (0%). P-value was for bleeding and leakage; 0.049 & 0.022. Conclusions: Sleeve gastrectomy by laparoscopy is a safe, minimally invasive and easy operative procedure. Adding reinforcement of the whole staple line is easy method to reduce the rate and severity of the postoperative bleeding and leakage to a great extent. Additional cost due to invaginating the whole staple line may be counterbalanced by the reduction in the length of hospital stay.

Introduction: Surgical removal of gall bladder is called cholecystectomy. The most commonly operation done in the case of symptomatic gall stone diseases and other gall bladder related pathologies. Cholecystectomy can be performed using two techniques either ‘open cholecystectomy’ and laparoscopic Cholecystectomy. Methods and material: This was a tertiary hospital based observational study carried in the department of general surgery government medical college srinagar kashmir, over a period of three years from august 2017 to august 2020 including 100 patients who underwent elective laparoscopic cholecystectomy for symptomatic gall bladder stones. In this study we divided patients into two categories where group a which includes first 50 patients who underwent ligation of cystic artery and duct by titanium clipping and group b included those with separate suture ligation of cystic duct and artery. Results: most of these patients were belonging to age group of 19-28 and 29-38 with mean age of 31.3. pre-operative usg was showing mostly stones. the body mass index was mostly between 18.5-24.5. mean operative time in clipping group 41.2 and in suture ligation group was 46.8 and in according to bmi, higher bmi took less operative time in suture ligation 38.1 min than clipping 41.7. One patient (clipping) was having post operative bile leak which was managed by ercp and one patient among 50 developed clip migration. Conclusion: From this study we concluded that suture ligation of cystic duct and artery by either silk or vicryl 2/0 is safe, effective and low cost alternative to clips especially in developing countries.

Summary Prepectoral breast reconstruction has minimized morbidity and dynamic deformities associated with submuscular implant-based breast reconstruction. However, reliance on implant coverage with acellular dermal matrix in immediate implant reconstruction remains limited by high material costs. The authors describe a technique in which anterior implant coverage in prepectoral reconstruction is split into acellular dermal matrix inferolaterally and synthetic, absorbable mesh superiorly. Use of acellular dermal matrix inferiorly provides coverage and reinforces the inframammary fold, whereas the absorbable mesh is trimmed and sutured to the acellular dermal matrix at the appropriate tension to support the implant and relieve pressure on mastectomy flaps. A retrospective review was performed on all consecutive prepectoral one-stage breast reconstructions using this technique at a single institution. Patient demographics, mastectomy and reconstruction characteristics, reconstructive outcomes, and cost of support materials were queried and analyzed. Eleven patients (21 breasts) underwent prepectoral immediate implant reconstruction with Vicryl and acellular dermal matrix anterior coverage. Average mastectomy weight was 775.8 g. Smooth, round cohesive implants were used in all cases and average implant size was 514.5 ml. Overall complication rates were low and included one minor infection (4.8 percent) and one case of minor mastectomy flap and partial nipple necrosis each (4.8 percent). Calculated cost savings of Vicryl and acellular dermal matrix anterior coverage was up to $3415 in unilateral and $6830 in bilateral cases. Prepectoral breast reconstruction using acellular dermal matrix inferiorly and Vicryl mesh superiorly is a safe technique that decreases material costs associated with support materials and allows the surgeon to precisely control the implant pocket and position. Clinical question/level of evidence Therapeutic, IV.

Introduction Open rhinoplasty involving columellar incision has gained popularity since the 1930s. Many surgical incision techniques have been employed to obtain better results in terms of postoperative scarring. This study evaluated and compared the results of absorbable and non-absorbable sutures used in open technique rhinoplasty, assessed scar properties regardless of the techniques used, from the perspectives of patients and surgeons. Objective This study evaluated and compared the results of absorbable and nonabsorbable sutures used in open technique rhinoplasty from the perspectives of patients and surgeons. Material and methods Study population included 70 patients who underwent primary open rhinoplasty between 2013 and 2018. Rhinoplasty Operations were performed in 2 different centers by a total of 2 rhinoplasty surgeons. Both surgeons used suture materials, which can be used for columellar closure, regardless of patients' skin characteristics. Columellar scars were assessed at an outpatient clinic at least 6 months postoperatively. Patients who could not come to the clinic were excluded from the study. Columellar Scars were assessed using the Turkish Patient Observer Scar Assessment Questionnaire. Patients were also asked to complete a Scar Assessment Analysis Questionnaire at the outpatient clinic, and were photographed from the front, basal, and right and left oblique sides. Three surgeons, who were not part of the research team but routinely performed rhinoplasty, completed the Observer Scar Assessment Questionnaire by examining patients in person at the clinic as well as their photographs. Results Observer Scar Assessment Questionnaire results; for the Vicryl group, surgeons ranked pigmentation of the scar as the best criterion (3.34 ± 0.97) and irregularity of the scar as the worst (3.82 ± 1.01). For the Prolene group, surgeons ranked irregularity as the best criterion (3.30 ± 0.97) and stiffness as the worst (3.54 ± 0.94). Although there was no statistically significant result between the two groups in the criteria, the mean scores of the Prolene group were less than the Vicryl group. (3.36 ± 0.46, 3.50 ± 0.65 respectively).Scar Assessment Analysis Questionnaire Results; patients in both the Vicryl and Prolene groups ranked pain as the least important factor (mean 2.9 ± 1.11 and 3.33 ± 1.35, respectively). The Prolene group scored lower than the Vcryl group in terms of overall scarring (3.49 ± 0.72, 3.66 ± 1.37, respectively, P > 0,05). Conclusions Absorbable sutures are a convenient alternative to nonabsorbable sutures. Level iv Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

Aim: To compare the efficacy of simple interrupted and continuous interlocking suturing techniques using 3-0 vicryl (polyglactin) sutures. Method: The study sample included 20 patients (16 males and four females) with maxillofacial trauma requiring ORIF (Open Reduction and Internal Fixation) of maxilla or mandible fractures. They were randomly allocated to two groups (Group A and Group B). Patients in the age group of 20-50 years, requiring ORIF under local anesthesia or general anesthesia through an intraoral approach and incision measuring 4-6 cm were included in the study. Exclusion criteria included patients requiring extra-oral incisions, comminuted fractures with acute illness, infection, pregnancy, immune compromised conditions and patients not willing to participate in the study. Surgical site was closed in single layer using 3-0 vicryl sutures. Intraoperatively, time taken for suturing, wound dehiscence and wound healing were monitored on third, seventh and 30th day post-operatively. Results: In terms of time taken for suturing, dehiscence of wound and wound healing, continuous interlocking sutures showed superior results than that of simple interrupted sutures. Conclusion: Even though simple interrupted suturing is an easy technique, continuous interlocking suturing technique showed superior results. However, surgeons operating maxillofacial trauma may have their own point of view and selection of technique depends on individual preferences.

Introduction: Cleft palate (CP) is a congenital dysmorphosis that results from a failure of the palatal processes of the maxillary buds and nasal septum to merge. The objectives of this study were to determine the frequency of complications of the modified Furlow technique and to evaluate its anatomical and functional outcomes. Materials and Method: This was a retrospective study that took place over a period of 4 years (from January 1st, 2015 to December 31th, 2018) in the Department of Odontostomatology and Maxillofacial Surgery at the National Hospital of Donka (Conakry, Guinea). Data retrieval consisted of records from patients operated on for cleft palate according to Furlow’s modified technique only. The operative technique consisted of marginal incisions of the cleft according to the technique of the double Z-plasty of Furlow. Subsequently, the defect created between the 2 flaps and the anterior edge of the cleft was filled by two fat masses of Bichat sutured to each other with Vicryl 3-0. Four years after surgery, the patients were recalled for an evaluation of the anatomical and functional results. Results: 13 patients underwent surgical loading according to the modified Furlow technique. The average age of the patients was 6.9 years with an age range of 7 months and 17 years. Females were the most affected, with 61.54% of cases and a sex ratio of 0.62. The primary repair rate was 84.61% of cases. Immediate operative follow-up was simple with epithelialization of the flaps in all patients. Four (4) years after the surgeries, 12 patients were reevaluated (92.30%), among them one case (8.33%) of fistula complication was noted. The mobility of the veil and the phonation were good in 85.71% and 60% respectively. Articular disorders with nasonation were found in 2 patients (16.67%). Swallowing was normal in 85.72% of cases. Conclusion: The modified Furlow technique is an important contribution to cleft palate surgery significantly reducing the occurrence of postoperative complications. However, the delay of the surgical operation remains a real obstacle for obtaining a normal phonation.

OBJECTIVE The aim: The study focuses on the morphometric features specification concerning the structural components of the hemomicrocirculatory bed of the perivulnar region of the cecum in rabbits when suturing a wound defect with synthetic polyfilament surgical suture Vicryl. PATIENTS AND METHODS Materials and methods: The research was carried out on rabbits (n = 30: 5 animals made up the control group and 25 animals made up the experimental group) and included surgery based on the method of surgical intervention on the large intestine patented by the authors, which was performed in the conditions of the operating room at the Department of Clinical Anatomy and Operative Surgery. When determining the main morphometric parameters, we took biopsy specimens of the cecum and used paraffin and epoxy resin embedding considering the generally accepted methods. RESULTS Results: The study determined that the implantation of Vicryl surgical suture material in the tissues of the cecum became a trigger for the formation of active inflammatory focus and occurrence of leukocyte infiltrate in the perivulnar region. CONCLUSION Conclusions: Arterioles, as a resistive link, capillaries, as an exchange link and venules, as a capacitive link in the hemomicrocirculatory bed, actively participate in response to the inflammatory process and formation of a connective tissue scar. The process of structural organization of microvessels begins in the formed granulation tissue in the perivulnar region of the cecum starting from the 14th day of the experiment.

Background Laparoscopic procedure has inherent merits of smaller incisions, better cosmesis, less postoperative pain, and earlier recovery. In the current study, we presented our method of purely laparoscopic feeding jejunostomy and compared its results with that of conventional open approach. Methods We retrospectively reviewed our patients from 2012 to 2019 who had received either laparoscopic jejunostomy (LJ, n = 29) or open ones (OJ, n = 94) in Chang Gung Memorial Hospital, Linkou. Peri-operative data and postoperative outcomes were analyzed. Results In the current study, we employed 3-0 Vicryl, instead of V-loc barbed sutures, for laparoscopic jejunostomy. The mean operative duration of LJ group was about 30 min longer than the OJ group (159 ± 57.2 mins vs 128 ± 34.6 mins; P = 0.001). There were no intraoperative complications reported in both groups. The patients in the LJ group suffered significantly less postoperative pain than in the OJ group (mean NRS 2.03 ± 0.9 vs. 2.79 ± 1.2; P = 0.002). The majority of patients in both groups received early enteral nutrition (P = 0.143). Conclusions Our study demonstrated that purely laparoscopic feeding jejunostomy is a safe and feasible procedure with less postoperative pain and excellent postoperative outcome. It also provides surgeons opportunities to enhance intracorporeal suture techniques.

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

Objective: To determine the frequency of reproductive outcomes after abdominal myomectomy in infertile women. Study Design: Case series. Place and Duration of Study: at Combined Military Hospital, Multan Pakistan, from Sep 2015 to Feb 2017. Methodology: This study included 60 women who underwent myomectomy to retain their capabilities of reproduction. Inclusion criteria were infertile women with uterine fibroids. Routine investigation was done to all patients like ultrasound and hysterosalpingogram before and after the procedure. The procedure of abdominal myomectomy was done under general anesthesia. All fibroids were enucleated and large blood vessels were tied. Vicryl no.1 was used to close the uterine defect. All patients were followed up for 3, 6 and 12 months interval and data was collected for conception, spontaneous conception, and conception with assisted reproductive technique, live birth and miscarriage. Results: In this study mean age was 27.33 ± 4.03 years, mean number of fibroid was 1.366 ± 0.48 and mean size of fibroid was 7.06 ± 1.64 cm. Twenty eight (46.7%) women had conceived after myomectomy, in which 92.9% had spontaneous conception and 7.1% by assisted reproductive technique. Conclusion: Abdominal myomectomy should be the standard treatment of infertile women with uterine fibroids if no other underline cause of infertility. Moreover, this study results also showed that younger patients might be benefited more in term of reproductive outcomes after abdominal myomectomy.

Highlights • Hematocolpos remains the main consequence of the transversal septums of vagina. • The management of transversal septum of vagina is essentially based on surgery. • The risk of vaginal stenosis after surgery remains high., Introduction The transverse septum of the vagina or vaginal septum is a rare abnormality of the female genital tract. The most frequently advanced etiology is a defect in the fusion and/or channelling of the urogenital sinus and Mullerian conductors. This structural obstruction can completely obstruct the vagina and thus can cause a haematocolpos associated with cyclic pelvic pain shortly after menarche in adolescent girls. The diagnosis of a vaginal septum is based on a careful clinical gynaecological examination and especially on ultrasound scan via the abdominal or transrectal (see Transperineal) and in more complex cases on MRI. The treatment is surgical and must be carried out as early as possible. Case report We report the management of a case of a 16 year old girl who presented a haematocolpos complicating a complete transverse vaginal septum. The treatment consisted of making a transverse incision in the centre of the transverse septum of the vagina, draining the hematocolpos and visualising the cervix. A circumferential excision of the septum was made and the remaining vaginal edges were then sutured by a simple tarring of the entire circumference with Vicryl 2.0. A sponge soaked in oestrogen cream was placed in her vagina to prevent stenosis and removed the day after the operation. The patient was followed in our department for 2 years without any recurrence of vaginal stenosis or hematocolpos. Conclusion The transverse vaginal septum remains a rare anomaly of the female genital tract, the reasons for its discovery are extremely variable according to its shape and location. Haematocolpos remains the main consequence of these septums. The management is essentially based on surgery while taking into account the risks of postoperative stenosis and the repercussions on the upper genital tract.

The problem of anterior cruciate ligament (ACL) reconstruction of the knee joint remains relevant, despite of significant number of designed surgical techniques for its reconstruction. Repeated ruptures of the restored ACL are recorded in 3–15 % of cases. Objective: to determine the morphological features of the knee joint tissues rearrangement in rabbits after implantation of a polypropylene mesh (PM) into the capsule defect. Methods: the study was performed on 50 rabbits weighing (694 ± 27) g. A capsule defect was formed on the right knee joint between the patellar ligament and the medial collateral ligament. In the experimental group (25 rabbits), the defect was repaired using PM, in the control group (25) — the edges of the defect were tightened and sutured with vicryl. A modified Vanderbilt University scale was used to assess the scarring process. Morphological analysis was performed. Results: no significant clinical differences in the state of the operated knee joint in the postoperative period were found between the groups. In the control group, from the 7th day after the surgery, the formation of dense connective tissue (scar) was observed. In animals of the experimental group, against the background of the formation of connective tissue around the PM, a significant thickening of the capsule and ligaments was observed at the points of contact with it. In 21 days after PM implantation, 51–75 % of its area showed ingrowth of connective tissue, after 45 — 75–100 %. After 2 months after the surgery, the relative area of dense connective tissue in the experiment was (68.12 ± 2.74) % versus (51.68 ± 4.22) % in the control.Conclusions: implantation of PM into the area of the knee joint capsule defect of rabbits between the patellar ligament and the medial collateral led to the formation of a larger volume of dense connective tissue at the final follow-up period (2 months). Ingrowth of connective tissue between cells and fibers of PM promotes the formation of a tight connection with the surrounding tissues, thereby strengthening area of traumatic injury.

This study was aimed to compare the effectiveness of 3-0 knotless barbed suture (polydioxanone) with 4-0 polyglactin 910 (vicryl) in achieving wound closure after impacted mandibular third molar surgery.Patients with bilateral mandibular third molar impaction of similar difficulty index enrolled in the split mouth study. Wound closure was done using 3-0 knotless suture (30 × 30 cm) for the study group and 4-0 polyglactin 910 (vicryl) for the control group following extraction. Samples were allocated on the basis of simple randomization. The clinical outcome parameters that were measured were (1) time taken to achieve wound closure and hemostasis (2) postoperative mouth opening (3) swelling and (4) Pain. Data analysis involved descriptive statistics and paired t-tests (p 0.05). IBM SPSS software (v.20.0) was used.A total of 25 patients participated in the study (14 males and 11 females) with the mean age of 25.6 years. The mean time taken for wound approximation was 2.45 min and 4.1480 min (p-0.026) for the study and control groups respectively. The difference in mouth opening (p-0.015), VAS score(p-0.24), and swelling (p-0.041) were statistically significant on the first post-operative day in the study group than the control group indicating reduction in pain (p 0.0001), swelling (p-0.033) and improvement in mouth opening (p 0.0001) on seventh post-operative day in the study group compared to the control group.Knotless suture is an effective alternative to conventional sutures for intra oral wound closure as it reduces suturing time, facilitates effective wound closure and minimises knot related complications.

Background: The use of continuous sutures are associated with lower short-term pain intensity assessed compared to the interrupted sutures; 2 days after repair and 10 days after repair. Objective: To assess the effects of continuous versus interrupted suturing methods on short and long term postpartum maternal morbidity experienced by primiparous women following repair of episiotomy after vaginal birth. Patients and methods: This comparative study was conducted in the Emergency Unit of Obstetrics and Gynecology at Desouk general Hospital. The study involved 200 primigravid women prepared for vaginal delivery with episiotomy). Results: In the current study, episiotomy repair with continuous sutures was more economic; it required a significantly shorter time and lesser number of Vicryl sutures. Repair of episiotomy wound using continuous suturing technique of the vaginal mucosa and perineal muscles results in a better post-procedural pain recovery. Conclusions: Continuous suturing technique consumed significantly shorter procedure time and less cost owing to fewer vicryl sutures.

Formation of seroma most frequently occurs after mastectomy and axillary surgery. This study is intended at creating data on whether flap fixation has any role in reducing the seroma formation in patients undergoing the modified radical mastectomy. A prospective comparative study was conducted among 61 patients scheduled for modified radical mastectomy from 1st of January 2017 to 31st of December 2017. Patients were divided into two groups. In the flap fixation group (N = 30), the skin flaps were sutured to the pectoral muscle with Vicryl 3–0 sutures, and in the control group (N = 31), the wound was closed in the conventional methods at the edges. Closed suction drain was used in both groups. Flap fixation group showed a significantly lower frequency of seroma formation compared with the control group. In the flap fixation group, the drain was removed earlier compared with the control group. Mean value of the total amount of fluid drained for the study group was significantly lower than that of control. Flap fixation is a surgical technique which appears to reduce the total volume of fluid drained, the development of seroma, and the need for seroma aspirations.

Precis The use of nylon wicks with fenestrations in non-valved aqueous shunt surgery significantly reduces intraocular pressure and glaucoma medication usage in the immediate postoperative period compared to the use of fenestrations alone. Purpose To compare early postoperative intraocular pressure (IOP) and medication usage in patients undergoing implantation of a non-valved aqueous shunt device with fenestrations only or fenestrations with nylon wicks. Methods A retrospective review of all non-valved aqueous shunt insertions completed by one surgeon (LWH) was completed using current procedure terminology. Patients undergoing Baerveldt or ClearPath 350▒mm aqueous shunt insertion with fenestrations only (n=37) or fenestrations with two nylon wicks were identified (n=92). All devices were ligated with 7-0 Vicryl (polyglactin) suture, and either 4 fenestrations or 2 fenestrations and two 9-0 nylon wicks were placed anterior to the ligature. Data regarding visual acuity (VA), IOP, number of glaucoma medications, and complications were collected from the preoperative visit just prior to surgery, postoperative day 1, week 3 (POW3), week 5, and month 2 (POM2). Main outcome measures were VA, IOP, number of glaucoma medications, and complications at all postoperative timepoints. Results There was no difference in logMAR VA between the two groups at any timepoint. At POW3, IOP was significantly lower in the wick group (14.6±7.7 vs. 18.1±8.7▒mmHg, P=0.03). Number of glaucoma medications used was significantly reduced in the wick group at POW3 (0.5±0.9 vs. 1.0±1.2, P=0.02) and POM2 (0.7±1.0 vs. 1.4±1.3, P=0.02). There was no significant increase in the overall rate of complications in the wick group, but there was a higher rate of transient hyphema (28% vs. 8%, P=0.02). Conclusions The use of two nylon wicks with fenestrations in non-valved aqueous shunt device implantation can significantly lower IOP and medication burden while awaiting dissolution of the ligature suture.

Primary spontaneous colporrhexis is rare a condition characterised by rupture of the upper one third of the vaginal wall without extension from uterus or cervix in a parous women with an unscarred uterus. In our case the colporrhexis was also a complete one with rupture of the entire vaginal wall layers. A 31-year old, second gravida was booked in our hospital at 36 wks of gestation. She had no comorbities. She had previous full term normal vaginal delivery of an alive baby weighing 2.75kg. At 39 weeks and 4 days gestation she was admitted for induction of labour as she had borderline liquor. Induction was done with 2 doses of misoprostol 25mcg kept vaginally 4 hrs apart. 2 hours after placing the 2ndmisoprost she had spontaneous rupture of membranes with clear liquor draining PV.With strong uterine contractions. She delivered within 45minutes a live healthy baby of 3kg weight. Placenta was delivered by AMTSL. Bleeding per vagina was within normal limits. During visualization of cervix and vagina prior to closure of episiotomy, omentum was seen coming out of upper part of posterior fornix of vagina. An irregular transverse rent was found and felt behind the cervix. Cervix was intact Uterus had contracted well. There was no excessive bleeding from vagina. Patients vitals were stable. Vagina was immediately packed and patient was shifted to OT after explaining about the unexpected complication and obtaining informed consent from patient and her relatives. Under anaesthesia, Visualisation of cervix and Examination of uterus was done. They were found to be intact. No extension of episiotomy seen. There was a transtransverse tear of 5 cm involving the posterior fornix. The left edge of the tear was found to be extending slightly upwards for about 2 cm. Omentum was seen protruding through the rent. The edges were dilineated, omentum was pushed inside. The delineated edges of the rent were sutured with 1-0 vicryl with intermittent sutures in two layers. Complete hemostasis

proliferation of microbes to the parts open to the oral cavity. Hence, microbial colonization on various intraoral suture materials from patients undergoing periodontal flap surgery and its impact on healing of gingival tissues was compared. Patients and Methods: During periodontal flap surgery, three different suture materials (silk, polyamide, & vicryl) were used in 25 patients. Eight days postoperatively, the sutures were removed, and adhered micro-organisms were counted by culturing on nutrient agar. Additionally clinical parameters, bleeding on probing and papillary position to assess healing were recorded to baseline, at 2 weeks, 4 weeks, and 6 weeks. Wilcoxon signed ranks test was used for statistical analysis. Results: Mean CFU’s for silk, polyamide and vicryl sutures were 6.239 ±1.476 X 108, 2.425 ± 1.010 X 108, 4.431 ± 1.069 X 108. There was no inter-group statistical difference in the clinical parameters i.e. bleeding on probing, papillary position at all time periods (p>0.05). There was a significant statistical improvement in bleeding on probing in all the three groups from base line (p

PURPOSE To describe the off-label use of lyophilized equine pericardium for tectonic enhancement of the sclera in a case of progressive scleromalacia perforans. METHODS An 82-year-old woman with a history of varicella zoster virus sclerokeratitis presented with a progressively expanding scleral thinning at the superonasal quadrant of the anterior sclera of her left eye. The eye was blind because of intractable glaucoma. To avoid perforation of the exposed choroid, a single layer of lyophilized equine pericardium was sutured over the scleral perforation. After performing a conjunctival peritomy in the involved superonasal area, the pericardium was trimmed, fixated on the anterior sclera with 4 Nylon 9 to 0 interrupted sutures, and tucked underneath the conjunctival pocket. The conjunctiva was adapted with 6 Vicryl 8 to 0 interrupted sutures. RESULTS The postoperative course was uneventful. At 12 months after surgery, slit-lamp biomicroscopy showed a stable subconjunctival sheet covering the staphyloma, whereas anterior segment optical coherence tomography demonstrated thickening of the ocular wall, suggesting successful integration of the pericardium. CONCLUSIONS Suturing of equine pericardium over a scleral defect was feasible allowing successful reinforcement of the staphyloma in a case of severe scleromalacia perforans.

Highlights • The travails in the management of complex duodenal injuries is well known among the surgical fraternity. • We here present a salvage technique of primary reinforcement with pedicled rectus abdominis muscle flap (RAMF) for a tenuous post traumatic duodenal perforation (PTDP) of the second part. • The majority of the studies in the literature are on the use RAMF for the repair of duodenal fistulas following failed primary repair of peptic perforations of first part of duodenum. • Reinforcement with RAMF is a useful rescue technique when the omentum is not available and other simpler techniques are not feasible in the primary repair setting., Introduction The conventional techniques for management of complex duodenal injuries are duodenal diverticularisation, pyloric exclusion or triple tube decompression. We here present a salvage technique of primary reinforcement with pedicled rectus abdominis muscle flap (RAMF) for a tenuous post traumatic duodenal perforation (PTDP). The majority of the studies in the literature are on the use RAMF for the secondary repair of peptic duodenal perforations. Presentation of case A 38 year old male presented with an acute abdomen, three days after sustaining a blunt abdominal trauma. The clinical and radiological findings in the abdomen were subtle and not contributory. An emergency laparotomy with a high index of suspicion revealed a large perforation in the anterolateral wall of the second portion of the duodenum with a friable unhealthy wall and shearing of the serosa around the perforation site. The entire omentum was unhealthy, contused with areas of gangrene and omentectomy done. The perforation site was closed using 3.0 vicryl and reinforced with a pedicled right RAMF based on the superior epigastric artery. The patient recovered uneventfully and was discharged. Discussion The addition of conventional diversion techniques to primary duodenorrhaphy is sophisticated, time consuming and adds morbidity. Conclusion RAMF is a good tissue substitute to buttress tenuous duodenal injuries presenting late with inflamed, friable perforation sites and associated tissue loss, where duodenorrhaphy alone may not be successful. RAMF is a valuable salvage technique when the omentum is not available and the local tissue condition negates the effectiveness of other simpler techniques.