Search

INTRODUCTION: Adjunctive suture augmentation of patellar plate fixation has yet to be investigated. Our biomechanical study sought to evaluate whether suture augmentation improves dorsal patellar locking plate fixation. Our hypothesis was that suture augmentation would improve fixation of this construct. METHODS: A transverse patella fracture in six matched cadaveric pairs was stabilized using a patellar locking plate with or without suture augmentation. Specimens were tested at 60° knee flexion with load placed through quadriceps. Cyclic loading followed by load to failure was done. Stiffness, deformation at peak, and nonrecoverable deformation were calculated. RESULTS: During cyclic loading, suture augmentation demonstrated a higher average stiffness throughout all loads. At the final cycle, deformation was markedly higher without suture augmentation. Average load to failure was higher with suture augmentation. Maximum load to failure occurred at 2500 N in both groups. CONCLUSION: Suture augmentation in a transverse patellar fracture model improved dorsal plate fixation, leading to less fracture displacement at the final load. Although suture augmentation demonstrated higher stiffness and lower deformation, these trends were not statistically significant. In both groups, plate fixation sustained very high loads, which reflects the fixation strength of the dorsal locking plate and screw construct in this fracture model.

Purpose: To evaluate and compare continuous suture (CS) and interrupted suture (IS) techniques applied in excision and primary anastomosis (EPA) urethroplasty in terms of surgical success and complication rates. Methods: A retrospective evaluation was conducted on patients with bulbar urethral strictures measuring ≤ 2.5 cm who underwent EPA between April 2020 and December 2022. Patients with a history of urethral reconstruction, multiple strictures, a history of pelvic radiotherapy, a diagnosis of Lichen sclerosis, a history of surgery due to congenital penile curvature or Peyronie's disease, and a follow-up period of less than 12 months were excluded. The patients were divided into two groups according to the suture technique used (CS or IS), and the groups were compared for demographic and perioperative data. Results: A total of 97 patients (CS n = 52, IS n = 55) were included in the sample. The mean age of the entire patient group was calculated to be 56.2 years and the mean stricture length was 19.3 mm. Operation time and postoperative catheter time were shorter in the CS group (94.7 ± 7.3 vs. 117.2 ± 5.7 min and 9.9 ± 1.6 vs. 15.8 ± 1.9 min, p < 0.001, respectively). The groups were similar regarding anatomical success, stress urinary incontinence, penile numbness, curvature, and postoperative infection (p > 0.05). Conclusion: No significant difference was observed in terms of success or complications between the CS and IS techniques employed during EPA urethroplasty. However, in addition to reducing the operation time, the CS technique offers the advantage of safely removing the urethral catheter earlier. [ABSTRACT FROM AUTHOR]

Introduction: Pharyngocutaneous fistula (PCF) is the most common complication following total laryngectomy (TL). The factors contributing to its occurrence are still a matter of debate. The impact of suture type has been relatively underexplored. This study aimed to analyze the risk factors associated with PCF and understand how the type of suture influences PCF characteristics. Materials and Methods: An observational study encompassing all TL procedures was performed between 2005 and 2022 at a secondary care hospital. Sociodemographic and clinical variables widely studied in the literature to identify PCF risk factors were considered. Additionally, the characteristics of fistulas were examined to assess the influence of the suture type. Results: Seventy TL cases were included. The incidence of PCF was 56.0%. Identified risk factors for PCF included pharyngeal closure type (p=0.001) (RR=13.09), nutritional support type (p=0.001) (RR=13.54), the need for reintervention due to postoperative bleeding (p=0.001) (RR=1.13), and the need for blood transfusion after surgery (p=0.015) (RR=1.20). Regarding the suture type, Modified Connell Suture (MCS) was associated with a later onset of fistula (p=0.014), shorter hospital stay (p=0.001), and early initiation of oral feeding (p=0.009). Conclusion: PCF occurrence is associated with nasogastric tube use, Lambert closure, postoperative bleeding, and reintervention for bleeding after TL. Moreover, MCS sutures are linked to a shorter hospital stays and early initiation of oral feeding. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to use a mathematical approach to understand the exact location and spacing of microvascular anastomosis, and investigate the effectiveness of a practice model using chicken legs and partial meat from chicken wings. Methods: The suture techniques used for microvascular anastomosis were analyzed mathematically. In addition, chickens of various sizes were dissected to measure the size of blood vessels and compared with the size of blood vessels found in partial meat. Results: When using eight- or nine-point sutures, the positions and intervals were different. Larger chickens had larger blood vessels. In the partial meat samples, the average size of the blood vessels was 0.8 mm for the radial artery, 0.45 mm for the ulnar artery, and 1.3 mm for the tibial artery. Conclusion: It is important to understand the location and spacing of sutures through a mathematical analysis of microvascular anastomosis, which enables suturing techniques to be improved. The practice model using chicken legs and partial meat from chicken wings was found to be useful for beginners. [ABSTRACT FROM AUTHOR]

Abstract Objective The objective of this study is to assess and compare the clinical efficacy of “Figure-8” banding and double-row anchor suture-bridge fixation techniques in the arthroscopic management of tibial intercondylar eminence avulsion fractures. Method A retrospective analysis was conducted on the medical records of 42 patients who underwent arthroscopic surgery for tibial intercondylar eminence fractures at our institution from June 2017 to June 2022. This cohort included 20 cases treated with “Figure-8” banding and 22 cases managed using double-row anchor suture-bridge fixation. Comparative assessments were made regarding operative duration, duration of fracture consolidation, postoperative knee joint range of motion, joint stability as assessed by the Lachman test, Lysholm score, and International Knee Documentation Committee (IKDC) functional score for both treatment groups. Results The mean follow-up duration was 13.8 months. The analysis indicated that the double-row anchor suture-bridge group had a significantly longer operative duration compared to the “Figure-8” banding group (p 0.05). By the one-year postoperative mark, joint stability outcomes were comparable between the two treatment groups (p > 0.05). Conclusion Both “Figure-8” banding and double-row anchor suture-bridge fixation techniques in the arthroscopic management of tibial intercondylar eminence avulsion fractures can achieve precise reduction and stable fixation. In addition, the figure-8 suture group has the characteristics of shorter surgery time and less cost. Notably, early postoperative knee function appears to be superior with double-row anchor suture-bridge fixation compared to “Figure-8” banding.

Background/aim: Cesarean section (CS) is a widely performed operation worldwide but data about uterine closure are lacking. We aimed to evaluate scar niches and compare single-layer and double-layer uterine closure at 6 months following CS. Materials and methods: This prospective randomized trial assessed 56 women undergoing single- or double-layer uterine closure. None of the patients had previous uterine surgery and all CS cases were elective. Transvaginal ultrasound was performed 6 months after CS to assess the uterine scars by measuring the width, depth, and length of the scar niche and residual myometrial thickness. An experienced sonographer was blinded to the uterine closure technique and the ultrasounds were conducted by practitioners unaware of the technique in the postoperative follow-up appointments. Results: Twenty-eight women were assigned to the single-layer closure group (Group 1) and 28 were assigned to the double-layer closure group (Group 2). The demographic and clinical characteristics of patients and the width, depth and diameter of the niche were similar between the groups, as was residual myometrial thickness. There was no difference in uterine scar volume under the incision between the two groups. The duration of surgery was approximately 5 min longer (p = 0.048) and hemoglobin decrease was about 0.5 g/dL less (p = 0.039) in the double-layer group compared to the single-layer group. Postmenstrual spotting rates were similar between the groups. Group 1 had two and Group 2 had one spontaneous pregnancy within 6 months after CS. Conclusion: The single- and double-layer closure techniques do not produce different impacts on CS niche features at 6 months after delivery. Ultrasound might be an important noninvasive diagnostic tool for understanding CS scar remodeling. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effectiveness of a new suturing technique called Dragonfly for the closure of temporary tracheotomies. This technique involves placing two sutures during the tracheotomy procedure and leaving them loose and unknotted until the day of skin closure. Methods: Retrospective case control study. Monocentric study at a department of Otolaryngology and head and neck surgery at a tertiary centre in Italy. A total of 50 patients who underwent temporary tracheotomy between January 2017 and December 2021. Patients were divided into two groups based on the trachea closure method: traditional closure with sutures placed during the skin closure procedure (Group A) and the Dragonfly technique (Group B). The incidence of tracheal stenosis by Computed Tomography (CT), granulation tissue formation, bleeding, procedure duration, patient discomfort were evaluated. Results: The incidence of tracheal complications and tracheal stenosis was reduced in Group B (6%) compared to Group A (24%). Procedure times (3 min vs. 6 min) durations was significantly shorter. No patients had symptoms of tracheal stenosis at the end of the procedures. Conclusion: The Dragonfly suturing technique is effective and safe for tracheotomy closure, reducing the incidence of tracheal stenosis and shortening hospitalization duration compared to the traditional method. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to assess and compare the clinical efficacy of “Figure-8” banding and double-row anchor suture-bridge fixation techniques in the arthroscopic management of tibial intercondylar eminence avulsion fractures. Method: A retrospective analysis was conducted on the medical records of 42 patients who underwent arthroscopic surgery for tibial intercondylar eminence fractures at our institution from June 2017 to June 2022. This cohort included 20 cases treated with “Figure-8” banding and 22 cases managed using double-row anchor suture-bridge fixation. Comparative assessments were made regarding operative duration, duration of fracture consolidation, postoperative knee joint range of motion, joint stability as assessed by the Lachman test, Lysholm score, and International Knee Documentation Committee (IKDC) functional score for both treatment groups. Results: The mean follow-up duration was 13.8 months. The analysis indicated that the double-row anchor suture-bridge group had a significantly longer operative duration compared to the “Figure-8” banding group (p < 0.05). Postoperative computed tomography (CT) scans confirmed successful reduction in both groups, with fracture consolidation achieved within an average of three months. Both groups showed significant improvements in postoperative knee range of motion, joint stability, and functional scores compared to preoperative measurements (p < 0.05). During the initial two-month post-surgery, the double-row anchor suture-bridge group demonstrated superior knee joint range of motion and functional scores compared to the “Figure-8” banding group (p < 0.05); however, these differences were not statistically significant beyond three months post-surgery (p > 0.05). By the one-year postoperative mark, joint stability outcomes were comparable between the two treatment groups (p > 0.05). Conclusion: Both “Figure-8” banding and double-row anchor suture-bridge fixation techniques in the arthroscopic management of tibial intercondylar eminence avulsion fractures can achieve precise reduction and stable fixation. In addition, the figure-8 suture group has the characteristics of shorter surgery time and less cost. Notably, early postoperative knee function appears to be superior with double-row anchor suture-bridge fixation compared to “Figure-8” banding. [ABSTRACT FROM AUTHOR]

Controversy remains regarding the optimal technique and suture type for wound closure after carpal tunnel surgery. Adult patients undergoing open carpal tunnel release were prospectively randomized to receive either interrupted, buried Monocryl sutures or traditional nylon horizontal mattress sutures for their wound closures. At the 2-week and 6-week postoperative visits, Patient and Observer Scar Assessment Scale questionnaires were completed. At 2 weeks, patients and observers had a significantly better opinion of incisions closed with Monocryl. By 6 weeks, neither patients nor observers found a difference between suture types in any category. Scars of wounds closed with Monocryl did not change appreciably in appearance between 2 and 6 weeks. However, patients and observers noted significant improvement in scar appearance in the nylon group over time. Monocryl suture represents an effective method for carpal tunnel closure that leads to improved patient- and observer-reported outcome scores in the early postoperative period compared with nylon.Level of evidence: II.

Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.

Aim: To determine the tensile load capacity (TLC) and the tearing characteristics for interrupted and vertical mattress sutures with different insertion points from the wound margin, and the effect of the bite size when using vertical mattress sutures. Materials and Methods: A total of 120 gingiva and lining mucosa samples obtained from pig jaws were divided into groups according to the suturing technique (interrupted and vertical mattress sutures), distance of the insertion points from the wound margin (margin, 1, 3, and 5 mm) and bite size (1, 3, and 5 mm). The TLC of the suture and the tearing characteristics were evaluated using a tensile tester device. Results: The TLC was significantly higher for vertical mattress sutures than for interrupted sutures regardless of the distance of the insertion points from the wound margin (intergroup p <.001). This distance significantly influenced the TLC for vertical mattress sutures (p <.05) but not for interrupted sutures (p >.05). Testing the tearing characteristics revealed that no tissue tearing occurred in groups when the insertion points were more than 3 mm from the wound margin. Conclusion: The TLC is higher for vertical mattress sutures than for interrupted sutures, and it increases when the insertion points are farther from the wound margin. [ABSTRACT FROM AUTHOR]

(1) Introduction: Tendinous mallet finger is a frequent deformity that occurs after an extensor tendon injury during sports or daily life activities. Despite the existence of numerous non-operative and operative techniques to address this deformity, there is a controversy on its optimal management. In this study, we aimed to present a direct tendon suture technique using the distal interphalangeal (DIP) joint open approach for treating tendinous mallet finger injury. (2) Methods: Between 2019 and 2021, 19 patients with closed non-fracture tendinous mallet fingers underwent the direct tendon and paratenon repair technique. After skin incision, we opened the paratenon with lazy S shape incision and found the ruptured proximal and distal tendon ends. We reapproximated the tendons using a simple interrupted suture with Prolene #6/0. After that, we meticulously performed paratenon repair using PDS #6/0 for preventing readherence. Temporary trans-articular Kirschner wire fixation was used for 4 weeks. (3) Results: All patients were followed-up for 3–8 months (mean: 4.8 months). The mean final extension lag was 6.5 degrees, and the overall rate of cases with excellent and good outcomes using Crawford's criteria was 85%. (4) Conclusions: In conclusion, this surgical approach could be a reliable alternative for the treatment of tendinous mallet finger injuries. [ABSTRACT FROM AUTHOR]

Objective: To compare the frequency of anastomotic leakage in interrupted versus continuous, single layer extramucosal anastomotic techniques in jejunum. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Multan Pakistan, from Feb 2020 to Feb 2021. Methodology: Patients aged 15-60 years, from the indoor surgical department of the hospital who required jejunal anastomosis were selected. Patients were categorized as Group-A (interrupted single layer extra mucosal anastomosis) or Group-B (continuous single layer extra mucosal anastomosis). Results: The mean age was 43±9.5 years in Group-A and 41.6±10.1 years in Group-B. Eighteen patients (56.3%) in Group-A and 21(65.6%) in Group-B were male while 14 patients (43.67%) in Group-A and 11(34.4%) in Group-B were females. Frequency of anastomotic leakage was recorded as one patient (3.13%) in Group-A and 3(9.38%) in Group-B while rest of the patients in both groups had no anastomotic leakage (p=0.302). Chi square test was applied, which showed statisticaly insignificant difference between the two groups (p=0.32) Conclusion: Comparatively higher frequency of anastomotic leakage was recorded in patients treated with continuous as compared to interrupted suturing but the results were statisticaly insignificant. [ABSTRACT FROM AUTHOR]

Purpose: Pharyngocutaneous fistula (PCF) is a possible complication following total laryngectomy (TL), with a mean incidence of 17%. We intended to investigate the effect of pharyngeal closure type during TL on the prevention of PCF. Methods: We retrospectively reviewed patients that underwent TL with a horizontal pharyngeal closure over a 10-year period. The frequency of PCF clinically, dysphagia, total oral diet, postoperative dilatation of the neopharynx and voice problems were tabulated. Results: Seventy-seven subjects underwent TL due to laryngeal tumor without pharyngeal extension. Of them, 45 underwent a salvage TL. PCF occurred in 1/77 subjects. The rest of the subjects (76/77) did not develop a PCF, neither in the early nor in the late postoperative phase. All subjects (15/77) that underwent implantation of a voice prosthesis were satisfied with their voice. No subject complained about dysphagia. Every subject achieved total oral diet. Conclusion: The horizontal pharyngeal closure is a safe pharyngeal closure technique during TL, reduces PCF rates (< 2%), results in excellent voice rehabilitation and swallowing function, and can also be used during salvage TL instead of a major pectoral flap. This type of closure should be used only in selected patients with laryngeal disease without pharyngeal extension. [ABSTRACT FROM AUTHOR]

Background/Aim. Laparoscopic ventral hernia surgery, including intraperitoneal onlay mesh (IPOM), is as effective and safe as open surgery, with a lower recurrence rate. Some surgeons advocate laparoscopic primary fascial closure (PFC) with intraperitoneal mesh placement to reduce recurrence rates. The aim of this study was to compare the treatment outcome between two laparoscopic techniques: the PFC technique and mesh placement without suture closure (IPOM technique) for defects under 4 cm in patients with ventral hernias. Methods. The study sample was comprised of 50 patients who underwent laparoscopic ventral hernia surgery from January 1, 2018, until December 31, 2020. Half of the patients underwent only the IPOM technique (group of patients without the suture), while in others, this was preceded by the closure of the hernial ring (group of patients with the suture). All hernias were midline and all defects were under 4 cm. The studied groups were homogeneous according to gender and age. Comorbidities, complications, and postoperative comfort were monitored. Results. The most common (76%) hernias were primary, and the most common comorbidity was arterial hypertension (28%). One (2%) patient had intraoperative bleeding, and the most common postoperative complication was pain in 7 (14%) patients. After a threeyear follow-up, there were 10 (20%) patients with complications -- one hernia recurred, while 9 (18%) patients died. There was no difference in the types of occurrence of hernias, comorbidities, and intraoperative complications. The distribution of postoperative complications differed significantly (p = 0.007) between the groups. Pain was statistically significantly more prevalent in patients with sutures. During the first three months postoperatively, significantly more patients with sutures had chronic pain (χ² = 8.140; p = 0.004). Conclusion. We recommend the application of the PFC technique in selected ventral hernia repair cases, although it can lead to more frequent postoperative pain (which, fortunately, is easily treated). [ABSTRACT FROM AUTHOR]

The worldwide accepted repair for indirect inguinal hernia in children is high ligation of the hernia sac with open herniotomy. However, laparoscopic pediatric inguinal hernia repair (IHR) has been gaining popularity in the last two decades. An experimental study was conducted to investigate the effects of different intraperitoneal IHR suture techniques on the collagen formation at the hernia sac neck. Present study was conducted on thirty-five male adult (3–6 months old) Wistar-Albino rats (260–300 g). Intraperitoneal IHR with different hernia sac neck suturing techniques (purse string suture only, transfixation suture only and purse string suture plus transfixation suture) were performed through median laparotomy using open operative techniques. Non-absorbable 2/0 braided polyester suture with 16 mm 1/2 curved round needle (Ti-cron, Covidien, MN) was used as suture material. The highest collagen thickness around the suture was detected in intraperitoneal IHR with purse-string plus transfixation suture group. The collagen thickness of the intraperitoneal IHR with purse string suture only and IHR with tranfixation suture only groups were not statistically significantly different. The collagen thickness of the intraperitoneal IHR with purse string suture plus transfixation suture group was statistically significantly higher compared with the intraperitoneal IHR with purse string suture only and intraperitoneal IHR with transfixation suture only groups. The combined usage of purse string suture and transfixation suture during laparoscopic intraperitoneal inguinal hernia repair further stimulates mesothelial fibrosis at the hernia sac neck compared with mesothelial fibrosis induced by purse string suture only or transfixation suture only. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose: This study investigated the hypothesis of early dehiscence of hysterorrhaphy as the initial stage of post-cesarean uterine scar defects, examining the possible influence of barbed suture in this process. Methods: This longitudinal, prospective, double-blind study included 54 pregnant women with no history of cesarean section, randomized into two suture groups: #0 polyglactin or #1 barbed PDS threads. Sutures were continuous, unlocked, involved the entire myometrium in a single layer, and included the endometrium. Tridimensional transvaginal ultrasonography was performed on the second day postpartum to investigate scar dehiscence and measure its maximal width. Results: The groups had 29 and 25 participants, respectively. Ages: 18–37 (mean 25.80 ± standard error of the mean 0.69) years old. Groups were homogeneous for labor duration, cervical thickness, edge-to-os distance, retroversion, amniotic sac rupture, and additional hemostatic sutures required. Uterine retroversion accounted for 7.4% of cases. Dehiscence was observed in 68.5% (3.98 ± 0.57 mm). The only factor correlating (positively) with dehiscence width was myometrial thickness, whether proximal or distal. Conclusions: Suture type had no influence on early dehiscence, which occurred at the same rate as published niche formation rates. Tridimensional ultrasound proved effective for evaluating dehiscence.

ABSTRACT Purpose: This study aimed to introduce and evaluate two new microvascular anastomosis techniques compared to the conventional method in a rat renal transplant model. Methods: Using a Fisher-to-Lewis rat kidney transplantation model, the renal artery anastomosis was performed using the interrupted (I) suture technique, Y-shaped continuous (Y) suture technique, and anterior-interrupted and posterior-continuous (I-C) suture technique. The rats were then divided into three groups: I group, Y group, and I-C group. Parameters such as arterial anastomosis time, warm ischemia time, seven-day survival rate of the rats, and vessel histopathology were assessed. Results: The mean arterial anastomosis time, blood leakage scores, and warm ischemia time were significantly reduced in groups Y and I-C compared to group I. Moreover, the seven-day survival rate was significantly higher in the I-C group compared to the other two groups. Arterial histopathology demonstrated vessel wall recovery without damage in all three groups, suggesting the safety of both Y and I-C techniques. Conclusions: The anterior-interrupted and posterior-continuous suture method is particularly beneficial for small artery reconstruction in organ transplantation.

Undermining is thought to improve wound outcomes; however, randomized controlled data regarding its efficacy are lacking in humans. The objective of this randomized clinical trial was to determine whether undermining low to moderate tension wounds improves scar cosmesis compared to wound closure without undermining. Fifty-four patients, 18 years or older, undergoing primary linear closure of a cutaneous defect with predicted postoperative closure length of ≥ 3 cm on any anatomic site were screened. Four patients were excluded, 50 patients were enrolled, and 48 patients were seen in follow-up. Wounds were divided in half and one side was randomized to receive either no undermining or 2 cm of undermining. The other side received the unselected intervention. Three months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS). A total of 50 patients [mean (SD) age, 67.6 (11.5) years; 31 (64.6%) male; 48 (100%) white] were enrolled in the study. The mean (SD) sum of the POSAS observer component scores was 12.0 (6.05) for the undermined side and 11.1 (4.68) for the non-undermined side (P = .60). No statistically significant difference was found in the mean (SD) sum of the patient component for the POSAS score between the undermined side [15.9 (9.07)] and the non-undermined side [13.33 (6.20)] at 3 months. For wounds under low to moderate perceived tension, no statistically significant differences in scar outcome or total complications were noted between undermined wound halves and non-undermined halves.Trail Registry: Clinical trials.gov Identifier NCT02289859. https://clinicaltrials.gov/ct2/show/NCT02289859 .

N/a.

Introduction: The synthesis of tensioned skin wounds is an area that has been the subject of studies for the development of suturing techniques that are capable of performing the primary closure of these wounds with tension relief, ensuring adequate healing, and avoiding complications such as dehiscence, edema, bleeding, and infection. Method: This research was a pilot study, being the first presentation of the Rectified Pulley Suture technique for the synthesis of tensioned skin wounds through prospective, double-blind monitoring of a series of cases of 8 patients randomly admitted to the surgical center of a high-complexity hospital in a medium-sized city. Results: Rectified Pulley Suture is a versatile technique suitable for dealing with tensioned skin wounds, since intraoperatively it was able to close, by first intention, lesions measuring up to 6.5 centimeters and in different tensioned regions without the need for the use of more extensive techniques. complex, such as flaps, grafts, Z-plasty, and secondary intention closure. Furthermore, post-operatively, there was a reduction in POSAS scores, indicating a satisfactory healing process for both observers and the patient. It is also essential to mention that the most feared outcome in the follow-up of patients with tension wounds undergoing primary closure - dehiscence - was completely avoided. Conclusion: The technique is simple, reliable, safe, and reproducible, with a short learning curve, so the Rectified Pulley Suture can be considered a new tool to be integrated into the surgical arsenal.

Complete resection of an apicoposterior mediastinal mass is essential due to the mass effect, which exerts pressure on adjacent organs. Recently, the use of minimally invasive surgery has had many advantages. In this report, we describe a case in which a large apicoposterior mediastinal hypervascular mass was managed using a purse-string suture technique during robotic-assisted thoracoscopic surgery (RATS). The patient, a 77-yearold woman, was diagnosed with a 6.2-cm apicoposterior mediastinal hypervascular solid mass originating from the branches of the right subclavian artery. The patient underwent RATS for treatment. To obtain an adequate view of the apex of the thoracic cavity, a needle aspiration was performed, followed by the application of a purse-string suture technique. This was done to reduce the size of the tumor and to prevent catastrophic events such as seeding or spillage of the cystic mass. The mass was histopathologically diagnosed as a schwannoma. The patient was discharged on the first postoperative day without experiencing any complications.

Abstract Objective To evaluate the performance of residents in gynecology and obstetrics before and after practicing laparoscopic sutures, to establish when the training shows the best results, in addition to comparing whether being in different years of residency influences this progression. Methods A prospective cohort study involving 32 medical residents evaluated with a pretest to establish their previous knowledge in laparoscopic suture. This test consisted of knotting two wires, one made of polypropylene and the other of polyglactin, with a blocking sequence of five semi-knots. We set a 30-minute limit to complete the task. Then, the residents held four training meetings, focusing on suture, Gladiator rule, knot, and symmetries, in addition to executing blocking sequences. A second test to establish progress was performed. Results Regarding the time spent to make the stiches using polyglactin wire, a statistically significant time improvement (p< 0.01) was observed, with a 10.67-minute pretraining median (mean 12.24 minutes) and a 2.53-minute posttraining median (mean 3.25 minutes). Regarding the stitches with polypropylene wire, a statistically significant time improvement (p< 0.05) was also observed, with a 9.38-minute pretraining median (mean 15.43 minutes) and a 3.65-minute posttraining median (mean 4.54 minutes). A total of 64.2% of the residents had been able to make the knot with polypropylene previously. One hundred percent were able to complete the task in the posttest. Conclusion Model training using the Gladiator rule for laparoscopic suture improves the knotting time with statistically similar performance, regardless of the year of residency, after systematic training.

Background Surgical scars subjected to excessive tension tend to widen and become hypertrophic due to strong mechanical stretching forces. In this study, we evaluated the clinical outcomes of combined intraoperative and postoperative long-term tension reduction techniques for the revision of scars subjected to excessive tension. Methods In total, 64 cases (62 patients) underwent scar revision and were followed for 6 months or more. The long-term tension reduction technique included intraoperative subcutaneous fascial and deep dermal closure using nonabsorbable nylon sutures and postoperative long-term skin taping for 3 to 8 months. The final scars were objectively evaluated using our Linear Scar Evaluation Scale (LiSES, 0-10 scale), which consisted of five categories: width, height, color, texture, and overall appearance. Results All 64 cases healed successfully, without early postoperative complications such as infection or dehiscence. The follow-up period ranged from 6 months to 6 years. The LiSES scores ranged from 5 to 10 (mean: 8.2). Fifty-one cases (79.6%) received a score of 8 to 10, which was assessed as “very good” by the evaluator. Two cases with a score of 5 (3%) showed partial hypertrophic scars at the last follow-up visit. All patients were highly satisfied with their final outcomes, including the two patients who experienced partial hypertrophic scars. Conclusions A combination of intraoperative and postoperative long-term tension reduction techniques can achieve the goal of long-term dermal support and satisfactory aesthetic outcomes for scar revision in areas subjected to excessive tension.

Background and Objective: Appendectomy is one of the most common surgical procedures with various clinical complications affecting wound healing. The type of skin closure is a critical surgical stage to prevent infection and dermal scarring. Therefore, administration of proper skin suturing can lead to complete wound healing and reduction of appendectomy-associated complications. In this regard, the present study was designed to compare the quality of the wound healing process and related complications in Simple Semi-Plastic (SSP) and Continuous Sub-Cuticular (CSC) dermal suturing procedures. Materials and Methods: This triple-blind clinical trial study was conducted on 73 appendectomy patients randomly categorized as the cases with SSP (n=38) and CSC (n=35) suturing procedures. Demographic data, wound-associated characteristics (e.g., width of scar, color, odor, patency, necrotic tissue, wound warmth, granulation and epithelialization tissues, volume and color of wound secretion, and color of wound-surrounded tissues) were totally assessed using a pre-designed checklist. Visual Analogue Scale (VAS) index was also used for assessing level of pain. All the collected data were applied on 2nd, 10th, and 30th days post-surgery. The obtained data was analyzed in SPSS software (version 23). Results: According to the results of the present research, no significant differences were detected in the terms of demographic characteristics, wound-associated complications, healing-related factors, and changes of wound-surrounding tissues between the SSP and CSC groups (P>0.05). The width of scar was significantly higher on the 2nd and the 10th days after suturing in SSP group than CSC group (P

Objective Multilevel or revisional posterior spinal surgery is prone to infection and delayed wound healing, related with the wound closure time and suture strength. Knotless barbed suture is an innovative self-locking, multianchor suture. This study aims to evaluate the safety and efficacy of the knotless barbed suture and self-adhering mesh with polymeric glue in multilevel or revisional posterior spinal surgery. Methods This is a single-center retrospective matched cohort study. Patients were divided into 2 groups based on the wound closure method: barbed suture group with novel wound closure, and conventional suture group with conventional wound closure, 1:1 matched by the level of surgery and sex, resulting in 120 subjects each. Total operation time and wound closure time were measured intraoperatively, and perioperative clinical outcome parameters including postoperative wound complication were investigated for the first 3 months postoperatively. The distribution of continuous variables was assessed for normality by Shapiro-Wilk test, then parametric or nonparametric tests were applied accordingly (paired t-test or Wilcoxon signed-rank test). Results Wound closure time was significantly shorter with the novel barbed suture than with conventional suture in all subgroups divided by the level of spinal surgery: 3–5, 6–9, ≥ 10 levels (p < 0.001). The 2 groups showed no significant differences in surgical complications (p = 1.000). Specially, total operation time and wound-closing time were significantly shorter in revisional subgroup. Conclusion Absorbable knotless barbed suture and self-adhering mesh with polymeric glue can shorten spinal wound closure time with noninferiority in complications for multilevel or revisional spinal surgery.

Introduction: Uterine compressive sutures are conservative measures applied in cases of severe postpartum hemorrhage unresponsive to uterotonics. Pereira’s suture was introduced in 2005 and consists of two longitudinal and three transverse non-transfixes sutures. Previous studies reported favorable results, highlighting its benefits and value. The aim of this study was to assess the efficacy, complications, and impact on fertility and future pregnancies of Pereira’s suture applied in cases of uterine atony and postpartum hemorrhage. Methods: An observational retrospective study was performed by consulting the medical records of women treated with Pereira’s compressive sutures in a tertiary center between January 2013 and December 2022. We registered demographic data, pregnancy outcomes, short-term complications, and outcomes of subsequent pregnancies. Results: A total of 50 women were treated with Pereira’s suture. The overall success rate was 96% and no hysterectomies were performed. Women who had sutures performed during an intra-cesarean section had better outcomes than those who had an after-cesarean section. Complications were reported in 12% (n = 6) of women, with the most frequent being pelvic infection (n = 3) and abdominal pain (n = 3). Regarding fertility, all women desiring a future pregnancy (n = 5) were able to conceive, resulting in three live births. Conclusion: Pereira’s suture is a type of suture that provides numerous advantages and should be considered when first-line medical treatment fails. When applied at an early stage, the sutures may prevent maternal morbidity. The Alcides Pereira’s suture is a safe technique and appears to preserve fertility.

PurposeTo assess safety and efficacy outcomes of sutured custom silicone artificial iris and intraocular lens implantation combined with penetrating keratoplasty (triple procedure).MethodsProspective consecutive surgical case series of patients who underwent the triple procedure between 2010 and 2019 at Stein Eye Institute, UCLA, followed up for 1 year minimum. Safety outcomes were changes from preoperative to last follow-up in corrected distance visual acuity (CDVA), endothelial cell count, intraocular pressure (IOP), and postoperative complications. Efficacy outcomes included changes in subjective glare (none to severe), cosmetic appearance (worse to very much improved), and visual function as assessed by the Visual Function Questionnaire-25 at 1-year follow-up.ResultsAmong 82 eyes implanted with an artificial iris, 14 eyes (17.1%) underwent the triple procedure. The median follow-up was 18.1 months (range 12.0-54.9 months). The median CDVA improved from 2.0 log of minimum angle of resolution (logMAR) (range 0.9-2.3 logMAR) to 0.7 logMAR (range 0.2-2.6 logMAR) (P = 0.02). Average endothelial cell count decreased 57.6% (P < 0.01). Six eyes (42.9%) experienced IOP elevations, 13 eyes (92.3%) developed iritis, and 11 eyes (78.6%) underwent secondary surgery. Graft rejection or secondary graft failure occurred in 7 eyes each (50.0%). Cosmesis improved in 12 eyes (85.7%; P < 0.01). The Visual Function Questionnaire-25 score improved from 72 to 77 (P < 0.01). Glare symptoms did not change significantly.ConclusionsThe triple procedure was effective at improving CDVA, cosmesis, and quality of life; however, it was associated with frequent postoperative complications, of which iritis, IOP elevation, and secondary graft failure were the most common.

Abstract Objective To evaluate the postoperative functional and radiographic outcomes of the shoulder of patients submitted to transosseous suturing of a greater tuberosity fracture (GTF) through an anterolateral route and the influence of the glenohumeral dislocation on these outcomes. Methods We conducted a retrospective study and functional assessment using the Constant-Murley score. The distance between the greater tuberosity and the joint surface of the proximal humerus (in true anteroposterior radiographs) after the union was calculated. We used the Fisher exact test for the categorical independent variables, and the Student t or Mann-Whitney test for the non-categorical variables. Results In total, 26 patients met the inclusion criteria, and 38% of the sample presented an association between glenohumeral dislocation and GTF. The mean Constant-Murley score was of 82.5 + 8.02 points. The presence of an associated dislocation did not alter the functional outcome. The mean distance between the greater tuberosity of the humerus and the joint surface of the humeral head after the union was of 9 + 4.3 mm below the articular line of the humeral head. The dislocation led to a lower level of reduction, but this did not influence the Constant-Murley score. Conclusion The cases of GTF submitted to surgical treatment with transosseous sutures had good functional outcomes. The presence of dislocation made the anatomical reduction of the greater tuberosity difficult. However, it did not influence the Constant-Murley score.

Breast augmentation mastopexy is a common procedure in cosmetic plastic surgery. Augmentation mastopexy has proven to be a relatively safe operation, but surgeons should be aware of and able to cope with disastrous complications such as soft tissue necrosis and nipple loss. The most important consideration in breast reconstruction is the recovery of breast shape and symmetry, as well as the maintenance of the shape of the nipple-areolar complex without any complications. We experienced a case of sequential breast and nipple-areolar complex reconstruction, in which the purse-string suture technique was used to repair medium-sized circular defects accompanied by nipple loss in the central area of both breasts and to preserve the shape of both breast mounds. Modified CV flaps were performed for left nipple reconstruction, and the Elsahy method and the purse-string suture technique were used to reconstruct the right nipple. Tattooing was performed on both breasts for areolar reconstruction. Through sequential reconstruction, the patient achieved satisfactory aesthetic results. In medium-sized, round defects on the central breast accompanied by nipple loss, the pursestring technique is a simple and effective reconstructive option that enables maintenance of the breast mound shape without requiring additional incision or distortion of surrounding structures.

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]

Introduction Transanal Endoscopic Microsurgery (TEM) is a minimally invasive method for management of different proctologic conditions. Despite widespread use of this method, it is not used widely in Iran. This report is about to describe the application of TEM in managing different proctologic conditions in a tertiary colorectal referral center in Iran regarding methods and complications.

Introduction: Microsurgical techniques are characterized by the application of maneuvers and sutures to millimetric structures with the aid of magnifying lenses. These are complex techniques, used in various medical specialties, which require great skill and training before applying them to humans. The objective is to develop a low-cost and high-fidelity model for training microsurgery techniques using a fragment of bovine pericardium patch. Method: Remaining segments of a bovine pericardium plate, previously used in vascular repairs, are used to create this model. The material is cut into two symmetrical parts, and its ends are fixed to the surgical drapes with the aid of clamps. The upper edge of each part is then sutured to the lower edge with 8-0 Prolene thread so that each one forms a tubular structure. Subsequently, the free tubular ends undergo dissection of the adventitial layer and are sutured together, mimicking an end-to-end vascular anastomosis. Results: With the model, the same inconveniences/difficulties present in human vascular sutures are simulated, such as delamination of layers, excess of the adventitial layer, and risk of inadvertent suturing of the posterior wall, proving its usefulness in the acquisition of basic microsurgical skills, without need to manipulate human or animal tissues. Practice in this model can take place within the surgical center itself and uses materials that would otherwise be discarded. Conclusion: The use of bovine pericardium to create millimetric sutures mimics human vascular tissue and is a low-cost procedure that allows the training of microsurgical skills.

Background: Complete closure of mucosal defects after colorectal endoscopic submucosal dissection (ESD)/piecemeal endoscopic mucosal resection (p-EMR) procedures reduces postoperative adverse events, but the complete closure rate of the traditional method using only hemostatic clips is not satisfactory. Therefore, we invented a continuous suture technique using a barbed suture and clips to increase the complete closure rate of colorectal mucosal defects. Methods: Patients with a single large (≥ 2 cm) colorectal lesion were recruited. After completion of the ESD/p-EMR procedures, they were randomly allocated to the treatment group or control group. The mucosal defects of the treatment group were closed using barbed suture and clips, while the control group was closed using only clips. Results: From January 18, 2022 to April 13, 2022, a total of 62 patients with colorectal lesions were enrolled, with 31 patients in each group. Complete closure was achieved in 29 patients (93.5%) in the treatment group and 18 patients (58.1%) in the control group (P = 0.001). The median closure time was 13 min in the treatment group and 19 min in the control group (P < 0.001). The median closure speed was 6.4 cm2/10 min in the treatment group and 3.5 cm2/10 min in the control group (P = 0.008). Conclusions: This study provided a clinically feasible continuous suture technique that was safe and effective for the complete closure of colorectal mucosal defects after endoscopic resection. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course. Background: Recent developments in surgical suture material include the use of sutures with unidirectional barbs that facilitate laparoscopic suturing thanks to self-anchoring and tension-keeping properties. Complications deriving from the use of barbed sutures have been previously reported. In this report we present the case of a patient with gastric outlet obstruction by the free end of a V-Loc™ barbed suture (Medtronic, Dublin, Ireland) following Roux-en-Y gastric resection. Case Report: In February 2023, a 77-year-old man who underwent laparoscopic subtotal gastrectomy for cancer followed by Roux-en-Y reconstruction developed symptoms of gastric outlet obstruction a few days after discharge. The patient was readmitted to the hospital due to vomiting 4 days after being discharged after an uneventful postoperative course. Imaging confirmed the presence of an occlusion at the level of the jejunojejunal anastomosis, with a noticeable change in caliber. During laparoscopy, a loop of bowel was entrapped around the tail of the barbed suture used to close the common enterotomy of jejunojejunal anastomosis. Following laparoscopic division of the anchoring suture, the bowel regained its normal caliber. Conclusions: Although complications from the use of unidirectional barbed surgical sutures are rare, this report highlights bowel obstruction as a recognized postoperative complication. The preferred treatment is laparoscopic division of the suture's tail. To prevent complications related to barbed sutures, it is essential to ensure that all barbs of the suture are properly unfolded. [ABSTRACT FROM AUTHOR]

Objective: Microvascular anastomosis, particularly side-to-side (STS) bypass, is a complex surgical procedure. While several suture techniques exist, none of them is superior to the others. We assessed the association between various STS bypass techniques and vessel twisting using chicken wing training models. Methods: Three suture techniques were compared over an anterior wall suture procedure. The unidirectional continuous suture (UCS) group used a downward "right-to-left" continuous suture. The reverse continuous suture (RCS) group used a downward "left-to-right" continuous suture. The interrupted suture (IS) group used the standard interrupted suture. The number of samples in each of the three groups was 30 (n=90). We compared the incidence of vessel twisting and rotation angles across groups. Results: Vessel twisting occurred in 96.7%, 56.7%, and 0% of the cases in the UCS, IS, and RCS groups, respectively. The incidence of vessel twisting differed significantly in all 3 groups (p<0.001), with an apparent trend (p=0.002). The mean rotation angles were 201°±90.6°, 102°±107.6°, and 0° in the UCS, IS, and RCS groups, respectively, which were significantly different (p<0.001). On excluding cases without twisting, the rotation angles of twisted vessels in the UCS and IS groups were 207.9°±83.7° and 180°±77.9°, respectively, which yielded a significant difference between these groups (p<0.001). Conclusions: We found that the incidence and trend of vessel twisting differed significantly across suture techniques. The RCS technique may aid in preventing vessel twisting in the STS bypass procedure. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the application of an intraoral banana peel suturing model in helping students to acquire intraoral surgical techniques. Methods: This is a self‐control study conducted from January 2021 to March 2021. An intraoral banana peel suturing model was implemented to provide oral suture experience for undergraduates majoring in stomatology. The sutures students placed in the model were photographed and evaluated blindly by a professional team using an established scoring system. Training scores were recorded before (training 1) and after 2 months of training (training 2). Linear regression was used to examine factors related to the scores. Suturing training was conducted in the School and Hospital of Stomatology at Peking University. A total of eighty‐two students in Peking University School and Hospital of Stomatology were in their fourth pre‐clinical year and followed a workshop on surgical sutures according to the curriculum. All students who should take this course were included, and the response rate was 100%. Results: The mean training 2 score (23.04 ± 3.83) was higher than the mean training 1 score (13.94 ± 3.15). The training 1 score was not significantly correlated with any of the students' general characteristics. The training 2 score was correlated with the training 1 score and the cumulative duration of practice outside of class. Conclusion: The intraoral banana peel suturing model can be used for suture training, and dental students' suture ability was improved after using the banana peel for suture practice. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing 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.)

PurposeTo study the feasibility and efficacy of a new remote wet lab for microsurgical education using a corneal suturing task.SettingDepartment of Ophthalmology, University of California San Francisco, San Francisco, California, USA.DesignProspective randomized controlled study.MethodsTen ophthalmology residents were stratified by postgraduate year and randomized to perform a corneal suturing task consisting of placing the 4 cardinal sutures for a penetrating keratoplasty in porcine eyes with or without remote ophthalmology attending feedback. Subsequently, both groups repeated the same task without remote feedback to test whether initial remote feedback affected subsequent performance. Finally, the group without feedback was crossed over to repeat the same corneal suturing task with remote feedback. The effectiveness of the remote wet lab was assessed subjectively by survey and objectively by grading each suture pass.ResultsResident-reported comfort with corneal suturing improved significantly after the remote wet lab for all residents. Residents and attendings rated the remote wet lab as equally or more effective compared with previous in-person wet labs and overall effective in corneal suturing. Attendings rated the remote wet lab as effective in multiple domains of microsurgical education using a modified microsurgical global rating scale. Objective corneal suturing performance was similar for both groups.ConclusionsThe remote wet lab was feasible and effective for training ophthalmology residents in corneal suturing. This represents a new social distancing compliant platform for microsurgical education during the COVID-19 pandemic.

Mixed opinions exist regarding cosmetic outcomes of 5-0 fast absorbing plain (FG) gut relative to nonabsorbable suture material, such as 5-0 polypropylene (PP). High quality randomized trials comparing these two suture materials are lacking. To determine whether the use of PP during layered repair of linear cutaneous surgery wounds improves scar cosmesis compared to wound closure with FG. A randomized, split wound, comparative effectiveness trial was undertaken. Patients were evaluated 3 months after the intervention by two blinded physicians using the validated patient observer scar assessment scale (POSAS). Patient assessments were also captured using the same instrument as well as scar width and complications. The mean sum of the six components of the POSAS was 10.26 vs 12.74 for PP and FG, respectively, significantly (p

BACKGROUND:The basic perineural catheter design has changed minimally since inception, with the catheter introduced through or over a straight needle. The U.S. Food and Drug Administration recently cleared a novel perineural catheter design comprising a catheter attached to the back of a suture-shaped needle that is inserted, advanced along the arc of its curvature pulling the catheter past the target nerve, and then exited through the skin in a second location. The authors hypothesized that analgesia would be noninferior using the new versus traditional catheter design in the first two days after painful foot/ankle surgery with a primary outcome of average pain measured with the Numeric Rating Scale. METHODS:Subjects undergoing painful foot or ankle surgery with a continuous supraparaneural popliteal-sciatic nerve block 5 cm proximal to the bifurcation were randomized to either a suture-type or through-the-needle catheter and subsequent 3-day 0.2% ropivacaine infusion (basal 6 ml/h, bolus 4 ml, lockout 30 min). Subjects received daily follow-up for the first four days after surgery, including assessment for evidence of malfunction or dislodgement of the catheters. RESULTS:During the first two postoperative days the mean ± SD average pain scores were lower in subjects with the suture-catheter (n = 35) compared with the through-the-needle (n = 35) group (2.7 ± 2.4 vs. 3.4 ± 2.4) and found to be statistically noninferior (95% CI, -1.9 to 0.6; P < 0.001). No suture-style catheter was completely dislodged (0%), whereas the tips of three (9%) traditional catheters were found outside of the skin before purposeful removal on postoperative day 3 (P = 0.239). CONCLUSIONS:Suture-type perineural catheters provided noninferior analgesia compared with traditional catheters for continuous popliteal-sciatic blocks after painful foot and ankle surgery. The new catheter design appears to be a viable alternative to traditional designs used for the past seven decades.

Treating complex wounds with great loss of soft tissues is a challenge for plastic surgery, especially when the wound is infected. Several options are considered for treatment, such as sutures, grafts, flaps, and expanders. Due to the complexity of the cases, the frequent association of morbidities, the need for multidisciplinary interventions, and long hospital stays, treatment costs are often high. This work demonstrates the elastic suture technique used in a clinical case, using continuous skin traction in association with a vacuum dressing, which enabled patient rehabilitation without the need for more aggressive interventions to close the extensive traumatic wound.

Background: Although surgical suturing is one of the most important basic skills, many medical school graduates do not acquire sufficient knowledge of it due to its lack of integration into the curriculum or a shortage of tutors. E-learning approaches attempt to address this issue but still rely on the involvement of tutors. Furthermore, the learning experience and visual-spatial ability appear to play a critical role in surgical skill acquisition. Virtual reality head-mounted displays (HMDs) could address this, but the benefits of immersive and stereoscopic learning of surgical suturing techniques are still unclear. Material and methods: In this multi-arm randomized controlled trial, 150 novices participated. Three teaching modalities were compared: an e-learning course (monoscopic), an HMD-based course (stereoscopic, immersive), both self-directed and a tutor-led course with feedback. Suturing performance was recorded by video camera both before and after course participation (>26 h of video material) and assessed in a blinded fashion using the Objective Structured Assessment of Technical Skills (OSATS) Global Rating Score (GRS). Furthermore, the optical flow of the videos was determined using an algorithm. The number of sutures performed was counted, the visual-spatial ability was measured with the Mental Rotation Test (MRT), and courses were assessed with questionnaires. Results: Students' self-assessment in the HMD-based course was comparable to that of the tutor-led course and significantly better than in the e-learning course (P= 0.003). Course suitability was rated best for the tutor-led course (x =4.8), followed by the HMD-based (x = 3.6) and e-learning (x =2.5) courses. The median ΔGRS between courses was comparable (P=0.15) at 12.4 (95% CI 10.0-12.7) for the e-learning course, 14.1 (95% CI 13.0-15.0) for the HMD-based course, and 12.7 (95% CI 10.3-14.2) for the tutor-led course. However, the ΔGRS was significantly correlated with the number of sutures performed during the training session (P =0.002), but not with visual-spatial ability (P= 0.615). Optical flow (R²=0.15, P<0.001) and the number of sutures performed (R²= 0.73, P<0.001) can be used as additional measures to GRS. Conclusion: The use of HMDs with stereoscopic and immersive video provides advantages in the learning experience and should be preferred over a traditional web application for e-learning. Contrary to expectations, feedback is not necessary for novices to achieve a sufficient level in suturing; only the number of surgical sutures performed during training is a good determinant of competence improvement. Nevertheless, feedback still enhances the learning experience. Therefore, automated assessment as an alternative feedback approach could further improve self-directed learning modalities. As a next step, the data from this study could be used to develop such automated AI-based assessments. [ABSTRACT FROM AUTHOR]

Foundation: an ideal technique has not been established yet to allow laparotomic closure to guarantee the reduction of complications. Objective: to compare the results of abdominal wall closure using internal subtotal points and total points in patients operated on for colorectal cancer. Methods: a descriptive, prospective and cross-sectional study was carried out at the Dr. Enrique Cabrera General Teaching Hospital, from 2019 to 2021, with 80 patients operated on for colorectal cancer. The Chi-square test, Fisher's exact test and the Mann-Whitney U test, among others, were used. Results: the tumor was located in the sigmoid colon in 35% of patients with total suture closure; and in 31.7% of the group with closure by subtotal points. Surgery was urgent in 80% of the group with total stitch closure; and elective in 75% of the closing cases with subtotal points. The incision was median supra and infraumbilical in 70% of the patients in the group with total suture closure; and xiphopubic in 66.7% of those at closure with subtotal points. There were medians of 3 ± 2 and 1 ± 0 complications for closure with total stitches and closure with subtotal stitches, respectively. Median hospital stay was longer in the total stitch closure group (8 ± 6 days). Conclusions: in the patients where internal subtotal sutures were applied for abdominal wall closure, the results were better than in the group where total sutures were used. [ABSTRACT FROM AUTHOR]

Purpose: Shoulder function limitation duration after a full-thickness rotator cuff tendon (RCT) tear may influence post-repair healing and outcomes. A suture anchor was developed to improve footprint repair fixation and healing through biological fluid delivery and scaffold augmentation. The primary multicenter study objective was to evaluate RCT repair failure rate based on 6-month MRI examination, and device survival at 1-year follow-up. The secondary objective was to compare the clinical outcomes of subjects with shorter- and longer-term shoulder function limitation duration. Methods: Seventy-one subjects (46 men) with moderate-to-large RCT tears (1.5–4 cm), at a median 61 years of age (range = 40–76), participated in this study. Pre-repair RCT tear location/size and 6-month healing status were confirmed by an independent radiologist. Subjects with shorter- (Group 1: 17.8 ± 21 days, n = 37) and longer-term (Group 2: 185.4 ± 89 days, n = 34) shoulder function limitation durations were also compared over 1 year for active mobility, strength, American Shoulder and Elbow Surgeon's Shoulder Score (ASES score), Veterans RAND 12 Item Health Survey (VR-12), and visual analog scale (VAS) pain and instability scores. Results: Three of the 52 subjects [5.8%] who underwent 6-month MRI experienced a re-tear at the original RCT footprint repair site. By the 1-year follow-up, overall anchor survival was 97%. Although Group 2 displayed lower ASES and VR-12 scores pre-repair (ASES = 40.1 ± 17 vs. 47.9 ± 17; VR-12 physical health (PH) = 37.2 ± 9 vs. 41.4 ± 8) (p ≤ 0.048), at 3-month post-RCT repair (ASES = 61.3 ± 19 vs. 71.3 ± 20; VR-12 PH = 40.8 ± 8 vs. 46.8 ± 9) (p ≤ 0.038), and at 6-month post-RCT repair (ASES = 77.4 ± 18 vs. 87.8 ± 13; VR-12 PH = 48.9 ± 11 vs. 54.0 ± 9) (p ≤ 0.045), by 1-year post-RCT repair, groups did not differ (n.s.). Between-groups VR-12 mental health score differences were not evident at any time period (n.s.). Shoulder pain and instability VAS scores also did not differ (n.s.), displaying comparable improvement between groups from pre-RCT repair to 1-year post-RCT repair. Groups had comparable active shoulder mobility and strength recovery at each follow-up (n.s.). Conclusion: At 6-month post-RCT repair, only 3/52 of patients [5.8%] had a footprint re-tear, and at 1-year follow-up, overall anchor survival was 97%. Use of this scaffold anchor was associated with excellent early clinical outcomes regardless of shoulder function impairment duration. Level of evidence: II. [ABSTRACT FROM AUTHOR]

We conducted a single-blind, prospective, randomized, 3-arm controlled trial to compare the efficacy of interactive and noninteractive video-based with instructor-led teaching in acquiring and retaining basic surgical skills. Participants were pretested after providing written instruction using a simulator. After the pretest, students were randomized to three groups: noninteractive video-based instruction (NIVBI), instructor-led teaching with concurrent feedback, and interactive video-based instruction (IVBI). An immediate post-test and a retention test were performed 1 mo after the practice session's end to assess the efficacy of practice conditions. Two experts blinded to the experimental condition evaluated performance using expert-based assessment. Data were analyzed using SPSS. There were no differences in expert-based assessments between groups at the pretest. All three groups showed significant improvements in expert-based scores between the pretests and post-tests as well as between pretests and retention tests (P < 0.0001). Instructor-led teaching and IVBI were equally effective initially for teaching this skill to naive medical students and showed better performance than NIVBI (P < 0.0001 each). At retention, IVBI displayed superior performance compared to NIVBI and the instructor-led group (P < 0.0001 each). Our result showed that video-based instruction could be as effective as instructor-led teaching in acquiring basic surgical skills. These findings support the idea that with thoughtful incorporation into technical skill curricula, video-based instruction may efficiently use faculty time and serve as a helpful adjunct for basic surgical skills training. [ABSTRACT FROM AUTHOR]