An in vitro study to determine the effectiveness of a patellar ligament/fascia lata graft and new tibial suture anchor points for extracapsular stabilization of the cranial cruciate ligament-deficient stifle in the dog

OBJECTIVE: (1) To determine whether an extracapsular patellar ligament/fascia lata graft would provide stability in the cranial cruciate ligament (CrCL)-deficient stifle comparable with that of the intact stifle. (2) To determine if different tibial anchor points would enhance stability of the CrCLdeficient stifle when compared with the standard fabellar-tibial suture (FTS) placement. STUDY DESIGN: Experimental. ANIMALS: Twenty-eight canine cadaver hind limbs. METHODS: Stifles were mounted in a jig and tested between loads of -65 and 80 N. After testing the intact CrCL, 4 stabilization techniques were tested after CrCL transection: lateral graft technique (LGT) and 3 FTS with different tibial anchor points. RESULTS: There were no significant differences in displacement between the LGT and standard FTS, between the LGT and the intact CrCL, or between the FTS and the intact CrCL, in either the Securos or the Screw-washer experiments. Stiffness of the intact CrCL was significantly greater than that of any stabilization technique and the cut CrCL. The standard FTS showed the least displacement of all suture stabilization techniques. Differences in stiffness were not significant between the suture stabilization techniques. CONCLUSIONS: Securely anchored, the LGT results in a reduction in drawer motion similar to that of the intact CrCL and the standard FTS. Altering the tibial anchor point for the FTS does not improve stiffness or enhance stabilization of the CrCL-deficient stifle. CLINICAL RELEVANCE: The LGT could be used for the treatment of CrCL ruptures in the dog. A clinical study is recommended.

Rectus versus linea alba: a biomechanical study

The comparative differences in pullout suture strength between rectus muscle and sheath and linea alba were studied in cadaveric models. A suture simulating the rectus repair procedure and one using just linea alba were used. Forces were measured on a tensiometer. Mean rectus force was found to account for over 59 percent variability. Both force uniformly decrease towards the symphysis pubis. This suggests that the rectus, when used for incisional hernia repair, may contributed significantly to wound strength. Additionally, our findings may help to elucidate the observance that incisional hernias are commonly subumbilical and occur mostly in females.(AU)

A comparison of the use of plain catgut, skin tapes and polyglactin sutures for skin closure: a propsective clinical trial

A prospective clinical trial was carried out to compare the effect, on wound healing, of the use of polyglactin, plain catgut sutures, or skin tapes, in the closure of 190 groin crease incisions in children. The final outcome variable analysed was uneventful healing, defined as the absence of wound erythema, four successive observation periods, up to 11 months post-operatively. Wounds closed with polyglactin (P=<0.5). This association diminished over subsequent observation periods. Skin tapes were cheapest of the skin edges. Patient age (P=<0.01 to <0.05) and sex (P<0.01) also exercised an effect on wound outcome, particularly at the final observation point. The reason for this was not determined. The results of this trial favour the use of polyglactin sutures over plain catgut and skin tapes in the closure of groin crease incisions in the population studied (AU)

Clinical and cost effectiveness of prophylactic parenteral penicillin in the care of simple wounds undergoing suture repair

Physicians working in casualty and outpatient departments where adverse conditions prevail often prescribe antibiotic prophylaxis routinely at the time of suture repair of simple wounds. To evaluate this practice, we performed a randomized, controlled study of parenteral chemoprophylaxis of simple wounds undergoing suture repair. Uncomplicated wounds were randomized to either treatment with a combination of benzathine penicillin (2.4 million units) and procaine penicillin (2.0 million units) intramuscularly, or a control group. At the time of suture removal, seven days later, all wounds were reviewed for signs of infection. Of 320 patients enrolled in the study, 173 (54.1 percent) returned for review. Among treated wounds, 75 of 81 (92.6 percent) were healing, compared to 79 of 92 (85.9 percent) controls (p=0.24). A significantly higher rate of healing was observed when wounds repaired nine or more hours after injury and involving the arms, legs, or trunk were treated (22 of 23, 95.7 percent) compared to those in whom prophylaxis was omitted (20 of 30, 66.7 percent) (p=0.03). Wounds involving the head, and wounds repaired within nine hours after injury had a high rate of healing (>90 percent), whether prophylaxed or not. Based on a 30 percent higher healing rate for the patients who benefitted from treatment (arm, leg, trunk wounds repaired after nine or more hours), the drug cost of implementing prophylaxis for this group alone was more than five times that of an expectant, non-prophylactic strategy. These results serve to remind practitioners of the possibility that a clinically effective mode of therapy may not necessarily be cost-effective in the delivery of health care.(AU)

The Natural history of vertical abdominal parietal closure: a prospective study of Prolene (PPL) versus Dexon (PGA) - [abstract]

Synthetic absorbable sutures are commonly used for abdominal wall closure following laparotomy, but the long-term outcome of such wound closure is uncertain. To determine the natural history, 200 consecutive patients were randomized to closure of vertical laparotomy wounds with continuous simple sutures of No 1 PPL (nonabsorbable) -95 wounds, or Smead sutures of No 1 PGA (absorbable) -105 wounds. Two patients from each group were withdrawn because of death or reoperation within the first week. The remainder were followed postoperatively for wound complications and were examined at 1, 3, 6, and 12 months, and at 2 and 5 years for incisional hernias. Wounds were midline in 194 patients and were lower abdominal in 52. The treatment groups were evenly matched. The mean rate of fascial closure was 41 sec/cm with PPL wounds and 49 sec/cm with PGA. Wound infections (WI) occured in 20 PPL and 12 PGA wounds, and ileus and respiratory complications were equal in the groups. The single wound dehiscence (0.52 percent) was due to slippage of a PPL knot. Analysis by the life table method showed a 12 percent wound failure rate at 5 years for PPL compared with 21 percent for PGA. Among 93 wounds closed with PPL, 2 hernias developed within the first year, and 2 over the next four years. But of 103 wounds closed with PGA, 1 developed a hernia in the first year, and 10 did so in the next 4 years (P = 0.01). In each group only 2 hernias occured in patients who had had wound infections. The findings show that PPL and PGA both allow rapid and secure closure of midline laparotomy incisions; but PGA is associated with an unacceptable rate of late herniation (AU)

Clinical and cost-effectiveness of prophylactic penicillin in the care of simple wounds undergoing suture repair - abstract

Many physicians working in Casualty and Outpatient Departments, where adverse conditions prevail, routinely prescribe antibiotic prophylaxis at the time of suture repair of simple wounds. In departments and hospitals with a busy practice in wound care, this custom may make considerable demands on limited pharmacy resources. We therefore performed a randomized, controlled study of parenteral chemoprophylaxis of simple wounds undergoing suture repair. Patients whose wounds spared neurovascular structures, tendon, and bone were randomized to either treatment with a combination of benzathine penicillin (2.4 million units) intramuscularly, or a control group. At the time of suture removal, seven days later, all wounds were reviewed for signs of infection. Of 320 patients enrolled in the study, 173 (54.1 percent) returned for review. Seventy-five of 81 (93 percent) treated wounds were healing, compared to 79 of 91 (86 percent) controls (p>0.2). A significantly higher rate of healing was observed, with prophylaxis, for wounds which were repaired 9 or more hours after injury and involved the arms, legs, or trunk (treated - 22 of 23, 96 percent; p>0,05 prophylaxis omitted - 20 of 30, 67 percent; p<0.05). Wounds involving the head, and wounds repaired within nine hours after injury had a high rate of healing (>90 percent), whether or not prophylaxis was given. Based on a 30 percent higher healing rate for the categories of patient who benefited from treatment (arm, leg, trunk wounds repaired after nine or more hours), it was calculated that the drug cost of implementing prophylaxis for this group alone was more than five times that of an expected, non-prophylactic strategy (J$33.94 vs J$6.55). These results serve to remind practitioners of the possibility that a clinically effective mode of therapy may not necessarily be cost-effective in the delivery of health care (AU)

Results of inguinal hernia repair using a nylon darn

281 inguinal hernias were repaired by a nylon darn method and 249 examined between one and ten years after operation. There were five failures, including three reoccurrences. There were four imperfections, none of which required re-operation. Combining this series with the original one of Leacock & Rowley, a total of 729 hernias were repaired by this method. 597 were followed up, with a failure rate of 2.15 percent. (AU)