The Loop 'n' Tack Knot: Biomechanical Analysis of a Novel Suture Technique for Proximal Biceps Tenodesis.

BACKGROUND: Secure tendon grasping is critical to the success of any tenodesis procedure. Several techniques currently used for tendon grasping can result in longitudinal splitting of the tendon, causing construct failure and failure of the tenodesis. PURPOSE: To compare the Loop 'n' Tack knot as a tendon-grasping technique with other common suture techniques. We investigated the biomechanical strength and mode of failure. STUDY DESIGN: Controlled laboratory study. METHODS: Eleven matched pairs of proximal biceps were harvested from fresh-frozen cadaveric shoulders. One tendon from each pair was stitched using 1 of 4 different techniques. The suture techniques evaluated included the Loop 'n' Tack with 2 different types of high-strength nonabsorbable suture, a double half-racking stitch, and a Krakow stitch. Samples were cyclically loaded between 5 and 20 N for 100 cycles, followed by a pull to failure at 33 mm/s. RESULTS: The Loop 'n' Tack techniques were equivalent to the double half-racking and Krakow techniques for load to ultimate failure (P = .817 and P = .984, respectively). The double half-racking technique was the stiffest construct, which was significantly greater than the second-stiffest group, the Loop 'n' Tack method with both FiberLink suture (P = .012) and SutureTape (P = .002), which had greater stiffness than the Krakow group (P < .001). The most common failure mode for the Loop 'n' Tack stitch was suture breakage compared with the Krakow and double half-racking methods, where the most common mode of failure was suture pullout from the tendon (P < .001). CONCLUSION: Biomechanical testing found that the Loop 'n' Tack techniques had similar ultimate load to failure values when compared with the double half-racking and Krakow methods. Mode-of-failure analysis showed that the Loop 'n' Tack construct typically failed by suture breakage, whereas the other techniques failed by suture pullout. CLINICAL RELEVANCE: The Loop 'n' Tack technique allows for secure grasping of tissue without the need for externalization of the tendon. This technique may be beneficial in compromised or poor-quality tissue without reducing overall pullout strength when compared with a standard half-racking or Krakow stitch.

Sarcopenia and sarcopenic obesity in patients with complex abdominal wall hernias.

BACKGROUND: Chronic muscle wasting, or sarcopenia, has been associated with poor-health outcomes after major surgical procedures. Here, we explore the utility of CT-generated determinations of sarcopenia as markers of risk in patients undergoing evaluation for complex ventral hernia repair. METHODS: In 148 successive patients being evaluated for complex ventral hernia repair, CT scans were analyzed retrospectively for attributes of the hernia and indices of core-muscle mass, correlating them with preoperative clinical/laboratory profiles and outcomes in 82 patients who had undergone surgery. RESULTS: Prevalence of sarcopenia, and sarcopenia corrected for obesity, was 26% and 20% respectively. Sarcopenia was associated with age, some laboratory indicators, and increased hospital length of stay but not with a higher likelihood of surgical site occurrence. CONCLUSIONS: Obesity may obscure the value of sarcopenia as a marker of metabolic disturbance and postoperative outcome. Image-based measurements of core-muscle mass should be used with caution as predictors of risk in similar surgical populations.

Measuring Surgical Site Infections in Children: Comparing Clinical, Electronic, and Administrative Data.

BACKGROUND: Surgical site infections (SSIs) are an important end point and measure of quality of care. Surgical site infections can be identified using clinical registries, electronic surveillance, and administrative claims data. This study compared measurements of SSIs using these 3 different methods and estimated their implication for health care costs. STUDY DESIGN: Data were obtained from 5,476 surgical patients treated at a single academic children's hospital (January 1, 2010 through August 31, 2014). Surgical site infections within 30 days were identified using a clinical registry in the NSQIP Pediatric, an electronic surveillance method (Nosocomial Infection Marker; MedMined), and billing claims. Infection rates, diagnostic characteristics, and attributable costs were estimated for each of the 3 measures of SSI. RESULTS: Surgical site infections were observed in 2.24% of patients per NSQIP Pediatric definitions, 0.99% of patients per the Nosocomial Infection Marker, and 2.34% per billing claims definitions. Using NSQIP Pediatric as the clinical reference, Nosocomial Infection Marker had a sensitivity of 31.7% and positive predictive value of 72.2%, and billing claims had a sensitivity of 48.0% and positive predictive value of 46.1% for detection of an SSI. Nosocomial Infection Marker and billing claims overestimated the costs of SSIs by 108% and 41%, respectively. CONCLUSIONS: There is poor correlation among SSIs measured using electronic surveillance, administrative claims, and clinically derived measures of SSI in the pediatric surgical population. Although these measures might be more convenient, clinically derived data, such as NSQIP Pediatric, may provide a more appropriate quality metric to estimate the postoperative burden of SSIs in children.

Prevalence of systemic inflammation and micronutrient imbalance in patients with complex abdominal hernias.

OBJECTIVE: To determine the prevalence of low-grade inflammation, micronutrient imbalances and associated clinical profiles in patients being evaluated for complex abdominal hernia repair. METHODS: Review of 127 consecutive adult patients for evaluation of complex ventral hernias from January 2012 to March 2013. Records were analyzed to determine the prevalence and correlations of clinical risk factors, attributes of hernias identified by computerized tomography, and laboratory indices of metabolism, inflammation and micronutrient imbalances. RESULTS: Strong correlations (p < 0.001) were established for body mass index (BMI) with volume of hernia content and C-reactive protein (CRP) level. CRP levels correlated strongly with red cell distribution width and inversely with zinc (p < 0.01). Evidence of micronutrient imbalance (abnormal zinc or red cell distribution width [RDW]) was observed in 48%. CONCLUSIONS: In this comorbidity-rich population with known variability in surgical outcomes, the prevalence of chronic inflammation and micronutrient deficiency are high enough to warrant systemic preoperative evaluation given their possible effect on wound healing and convalescence. Simple repletion is unlikely to improve outcomes without attention to the biological stresses that are associated with micronutrient imbalance.