Arthroscopic acetabular labrum suture.

It is essential to be aware of the anatomy and biomechanics of the acetabular labrum in order to understand why it should be conserved. Vascularization comes from the capsule and also from the bone. The joint side contains numerous nerve endings, which explains why labral lesions are painful. It is involved in joint stabilization by maintaining a negative pressure inside the joint able to resist distraction. It acts as a seal. There are two main suture techniques: trans- and peri-labral. Translabral suture is better suited to a wide and solid labrum free of degenerative lesions. Both techniques should be known, and may be associated. Results are comparable. It is essential to manage the underlying pathology responsible for the labral lesion. Joint degeneration is associated with poor prognosis. It needs to be recognized and discussed with the patient, to avoid unrealistic expectations.

[Comparative analysis of laparotomy closure techniques]. / Sravnitel'nyi analiz sposobov ushivaniia laparotomnoi rany.

AIM: To assess experimentally different laparotomy closure techniques. MATERIAL AND METHODS: Experimental research on laboratory animals was performed. Laboratory animals underwent laparotomy followed by aponeurosis suturing by using of interrupted, continuous suture and continuous suture with an arrangement of stitches at different levels. Tensometric and histological examination of tissue specimens together with sutures was made in 7, 14, 60 days after surgery. RESULTS: Correlation of laparotomy closure technique with values of durability, elasticity and wound process course was obtained. CONCLUSION: Continuous suture after laparotomy promotes the formation of more mature granulation tissue and more solid scar with low elasticity compared with interrupted sutures.

A multicenter study comparing surgical outcomes and ultrasonographic evaluation of scarring after laparoscopic myomectomy with conventional versus barbed sutures.

OBJECTIVE: To compare clinical outcomes after laparoscopic myomectomy using traditional interrupted sutures (TIS) versus continuous barbed suture (CBS) for treatment of symptomatic uterine myomas. METHODS: In a multicenter retrospective study, data were obtained for women with uterine myomas who underwent laparoscopic myomectomy at three centers between January 1, 2009 and January 31, 2015. Suturing of the uterine wall had been performed initially using TIS; CBS were used from January 31, 2012. RESULTS: Overall, laparoscopic myomectomy was performed using CBS for 360 women and using TIS for another 360. The mean operative time was 52±19min using CBS and 67±21min using TIS groups (P=0.001). The mean blood loss was 135±35mL in the CBS group and 215±55mL in the TIS group (P=0.006). The mean decrease in hemoglobin was 1.2±0.2g/L in the CBS group and 1.2±0.2g/L in the TIS group (P=0.072). CONCLUSION: Laparoscopic myomectomy using CBS is a suitable alternative to TIS in the treatment of uterine myomas for women with up to three tumors.

A Simulator for Measuring Forces During Surgical Knots.

In this study new metrics were developed for assessing the performance of surgical knots. By adding sensors to a knot tying simulator we were able to measure the forces used while performing this basic and essential skill. Data were collected for both superficial tying and deep tying of square knots using the one hand and two hands techniques. Participants used significantly more force when tying a deep knot compared to a superficial knot (3.79N and 1.6N respectively). Different patterns for upward and downward forces were identified and showed that although most of the time upward forces are used (72% of the time), the downward forces are just as large. These data can be crucial for improving the safeness of knot tying. Combing these metrics with known metrics based on knot tensiometry and motion data may help provide feedback and objective assessment of knot tying skills.

A Novel Platform for Assessment of Surgical Suturing Skill: Preliminary Results.

In this work, we describe a novel platform for quantifying surgical suturing skill. Forces and user movements are recorded using sensors during suturing maneuvers performed on a suture patch. Preliminary results from a pilot experiment suggest that force data could be used for objective assessment of suturing skill.

The accordion suture technique: A modified rhinoplasty spreader flap.

In rhinoplasties, a spreader flap is a widely used alternative to dorsal reconstruction with spreader grafts; however, it has a limited ability to provide sufficient nasal dorsal width. The upper lateral cartilage (ULC) thickness is four times thinner than a spreader graft. This report presents an accordion suture technique for the ULC that involves simple sutures which fix each ULC (3 times folded) to the septum. We performed this technique in 64 primary rhinoplasties, and the patients were followed up for approximately 18 months. The patients completed a questionnaire 12 months postoperatively, and reported marked satisfaction with the aesthetics and function. Furthermore, rhinomanometric analysis showed that nasal airway resistance (NAR) decreased significantly in the postoperative period.

[Bronchus sutures failure in lung cancer surgery].

Main methods of bronchus suturing after lung resection are presented in the article. The safest methods of bronchus closure are manual and mechanical suturing with use of UB apparatus. Use of UO or TL-TLH apparatus with longitudinal orientation of tantalic brackets significantly increases the frequent of bronchus suture failure. It is determined by deterioration of bronchus blood supply and poor trophic healing of bronchus wound.

[Laparoscopic treatment of perforated ulcers].

It was done comparative analysis the results of different treatment options using of laparoscopic treatment of 331 patients with perforated ulcers. It was defined that postoperative complications frequency is increased to 1.6% in case of perforated ulcers suturing with diameter to 0.7 cm. This indication is increased to 7.1% in case of perforated ulcers suturing and plugging by greater omentum with holes diameter to 1.0 cm. The complications are absent in case of perforated ulcer excision with subsequent vagotomy and pyloroplasty.

Suturing principles for the dentoalveolar surgeon.

Dentists should be aware of the characteristics of suture material, and the technique used should provide effectiveness and ease. Dentists who routinely perform dentoalveolar surgery should have at least 1 type of absorbable and 1 type of nonabsorbable suture readily available within their operatory supply. This article focuses on the physical properties of suture materials and their tissue reactivity, and it reviews various suturing techniques used in contemporary dentoalveolar surgery. Familiarity with the concepts presented in this article, and continuous practice of the surgical skills presented, enhances surgical acumen and allows for improved healing, increased postoperative comfort, and successful surgery.

Suturing: an update for the general dental practitioner.

UNLABELLED: Sutures are routinely used to achieve haemostasis and to approximate soft tissues after extractions, periodontal procedures, implant surgery and soft tissue biopsies. This paper provides the general dental practitioner with the knowledge and understanding of sutures to select the most appropriate for use. Common suturing techniques are also discussed. CLINICAL RELEVANCE: Suturing is an important aspect of dental practice, the selection of an appropriate suture and technique is integral to obtaining an optimal outcome.

Suturing for optimal soft-tissue management.

Establishing nontension primary wound closure of various soft tissue flaps is paramount for optimal postsurgical wound healing. Surgical procedures that require clinical flap manipulation, such as those used with traditional periodontal therapy, periodontal plastic cosmetic surgery, hard and soft tissue regeneration, and the excision of pathologic tissue, also require excellence in execution. Also paramount to clinical success is a thorough understanding of the various techniques of surgery, suturing, and the materials currently available to ensure the desired clinical results. This article will discuss the rationale of specific suturing techniques and suture materials to help the clinician obtain optimal wound closure.

How reliable is intracorporeal laparoscopic knot tying?

BACKGROUND: Are knots tied laparoscopically as reliable as those tied in open surgery? The aim of our study was to try to answer this question. MATERIALS AND METHODS: Using a standardized technique, one senior laparoscopic surgeon tied 3 suture materials using 3 methods of knotting: hand, instrument, and laparoscopic (in a simulator). The tension in the knots was measured using a tension gauge at the time of knotting and 5 minutes later. The surgeon was blinded to the value. The experiment was repeated 4 times. The 36 sutures were then analyzed using a materials-testing machine. The force achieved prior to breakage, the extension, and the breaking points were recorded. The scientist performing the analysis was blinded as to the method of tying and tensions produced. RESULTS: There were no significant differences in tension at 5 minutes between suture materials or method of knot tying. The mean extension achieved prior to breakage for 33 sutures was 29.71 mm with a force of 16.09 N. In 3 sutures the knot slipped completely while tension was being increased, thus no measure of breakage force could be obtained. These 3 sutures were monofilament and tied laparoscopically. CONCLUSION: There were no significant changes in suture tension after 5 minutes regardless of material or method of knot tying. Three of the 12 knots tied laparoscopically came undone under strain testing. All 3 knots were monofilament suture. This may have important implications when choosing suture material. Further studies are planned to expand the analysis of different knotting techniques with different suture materials.

Knot security in laparoscopic surgery. A comparative study with conventional knots.

BACKGROUND: Few comparative studies have evaluated conventional and laparoscopic knots. The objective of this study was to evaluate laparoscopic knot reliability and identify which type of knot is most secure. METHODS: Seven types of knots were compared; each one was conventionally tied with four and six throws and similarly by laparoscopy. Dinsmore nomenclature for knots was used. A tension meter was used to evaluate knot reliability, using the loop method, and percentage of failure by slipping and tensile strength was calculated for each group. RESULTS: When S=S=S=S and S=S=S=S=S=S geometry are excluded, there was no difference between laparoscopic and conventional knot. A significant difference between four- and six-throw knots was shown. Excluding S=S=S=S=S=S geometry, all knots in the conventional six-throw group were secure. Intracorporeal 2X1X1X1X1 and 1X1X1X1X1X1 and extracorporeal SXS#SXS#SXS six-throw laparoscopic group knots were secure. CONCLUSIONS: Laparoscopic knots are as secure as conventional knots. All knots must be made with six throws because security is maximized.

Sutura convencional e assistida pela cola de fibrina em aorta e cava de ratos wistar-EPM1: alteraçöes hemidinâmicas e histológicas / Conventional suture used the fibrin glue in a vascular suture the male adult WISTAR1: histological and hemodynamic alterations

No período de novembro de 1999 a dezembro de 2000, utilizamos 120 ratos machos adultos da linhagem WISTAR-EPM1, cuja média de peso corpóreo era de 355 gramas, com a finalidade de compararmos os resultados da sutura convencional com os da realizada utilizando-se a cola de fibrina como coadjuvante. Esses animais foram divididos em 6 subgrupos de 20 (4 grupos e 2 controles), sendo que, em 2 grupos, a sutura foi realizada em aorta e nos outros 2 grupos em cava inferior. Seccionamos a parede anterior do vaso estudado, sendo que nos grupos em que foi realizada a sutura convencional utilizamos 4 pontos de prolene 10-0 e no grupo em que se aplicou a cola de fibrina foram dados 2 pontos. Comparamos, no 15º dia pós-operatório, os parâmetros hemodinâmicos, obtidos por meio do mapeamento dúplex, e as alteraçoes histológicas da parede vascular. Observamos que nos grupos em que nao se utilizou a cola de fibrina como coadjuvante da sutura vascular ocorreram as maiores alteraçoes histológicas da parede vascular caracterizadas pela desorganizaçao tissular com perda da aposiçao de camadas, pela presença de hemorragia no local da sutura, pela destruiçao de fibras de colágeno e fibras elásticas e pela presença de processo inflamatório, representado pela reaçao do tipo corpo estranho. Nesses mesmos grupos ocorreram as maiores alteraçoes hemodinâmicas, caracterizadas pelo aumento do pico de velocidade sistólico e pelo aumento do pico de velocidade diastólica. Concluímos ser o mapeamento dúplex um método de grande importância na caracterizaçao da perviedade de uma sutura vascular, devendo ser utilizado rotineiramente no pós-operatório, principalmente quando realizadas em vasos de pequeno calibre. Concluímos, ainda, que o número de pontos dados em uma sutura de um vaso de pequeno calibre influi...(au)

Revisäo da técnica das suturas mecânicas do aparelho digestivo / Review of mechanic suture in gastrointestinal system

Os autores fazem um estudo a respeito das técnicas de sutura mecânica no aparelho digestivo desde o seu surgimento até os dias atuais. Apresentam aspectos históricos da sutura mecânica bem como os tipos de aparelhos utilizados para as suturas de aparelho digestivo. São feitos comentários das desvantagens, bem como de suas complicações

Determining flexor-tendon repair techniques via soft computing.

An SC-based multi-objective decision-making method for determining the optimal flexor-tendon repair technique from experimental and clinical survey data, and with variable circumstances, was presented. Results were compared with those from the Taguchi method. Using the Taguchi method results in the need to perform ad-hoc decisions when the outcomes for individual objectives are contradictory to a particular preference or circumstance, whereas the SC-based multi-objective technique provides a rigorous straightforward computational process in which changing preferences and importance of differing objectives are easily accommodated. Also, adding more objectives is straightforward and easily accomplished. The use of fuzzy-set representations of information categories provides insight into their performance throughout the range of their universe of discourse. The ability of the technique to provide a "best" medical decision given a particular physician, hospital, patient, situation, and other criteria was also demonstrated.

A biomechanical study of Tang's multiple locking techniques for flexor tendon repair.

This study was designed to biomechanically compare Tang's multiple looped locking techniques with various suture techniques for flexor tendon repair in the hand. Fifty flexor digitorum profondus tendons taken from pig toes were used as models; The tendons were transected in the middle part of zone 2 defined as the area beneath bifurcation of the flexor digitorum superficialis tendons, and were repaired by five different suture methods: (1) modified Kessler, (2) Tsuge's suture, (3) double Kessler, (4) modified Kessler plus Tsuge, and (5) Tang's suture. The repaired tendons were placed in an Instron tensile testing machine to determine the tensile properties of the repair. 2 mm gap formation force and ultimate tensile strength were measured during the test. Maximal work to failure were calculated according to area under the load-displacement curve of the test. 2 mm gap formation force was 21.5 N for the Kessler, 20.6 N for the Tsuge, 31.6 N for double Kessler, 30.9 N for the Kessler plus Tsuge and 41.4 N for the Tang. Ultimate tensile strength was 23.5 N for the Kessler, 22.9 N for the Tsuge, 34.5 N for the Kessler plus Tsuge and 45.6 N for the Tang. Statistically, Tang's suture had the greatest gap formation force, ultimate strength and energy for failure among the five techniques (p < 0.01 or p < 0.001). Gap formation force, ultimate strength and energy to failure for double Kessler or the Kessler plus Tsuge were significantly greater than those for the Kessler or the Tsuge (p < 0.05 or < 0.01). The tendons repaired by Tang's method tolerated a significantly higher tensile load (133 to 198% of the other techniques) than the other methods. Among the methods tested, Tang's multiple looped locking suture provides sufficient gap resistance and tensile strength that may be able to withstand early active mobilization after primary flexor tendon repair.