Fijación con sutura de alta resistencia para fracturas de metacarpianos / High-strength suture fixation in metacarpal fractures

Introducción: Las fracturas de metacarpianos son comunes en la práctica traumatológica. El cirujano dispone de diferentes opciones cuando decide implementar un tratamiento quirúrgico, como fijación percutánea con agujas de Kirschner, reducción abierta y fijación interna con placas y tornillos, tornillos interfragmentarios y tornillos endomedulares, entre otras. materiales y métodos: Se trató a 19 pacientes con fracturas diafisarias oblicuas largas o espiroideas del 2.° al 5.° metacarpiano mediante la reducción abierta y fijación interna con suturas de alta resistencia. El tiempo promedio de seguimiento fue de 20 meses. Se utilizaron radiografías y escalas funcionales para documentar los resultados obtenidos. Resultados: La fractura consolidó en todos los pacientes quienes retornaron a sus actividades en un promedio de 2.3 meses. Un paciente perdió la reducción inicial por no respetar las indicaciones médicas, pero la fractura consolidó sin necesidad de una nueva intervención. Conclusión: El método propuesto proporcionó una reducción anatómica, una fijación estable libre de metal y buenos resultados funcionales. Nivel de Evidencia: IV

Introduction: Metacarpal fractures are highly prevalent in traumatology. When a surgeon determines that surgical treatment is required, numerous techniques are available, including K-wire fixation, open reduction and internal fixation with plates and screws, interfragmentary screws, and intramedullary screws, among others. Materials and methods: This study included 19 patients with long oblique or spiral shaft fractures of the second to fifth metacarpals, who were treated with open reduction and high-strength suture internal fixation. The average follow-up period was 20 months. Radiographs and functional scales were used to document clinical outcomes. Results: Fracture consolidation was achieved in all patients, and they were able to resume their previous activities after an average of 2.3 months. One patient lost the initial reduction due to a failure to comply with medical instructions but achieved fracture consolidation without the need for additional procedures. Conclusion: The technique described herein provided a strong metal-free fixation with good clinical outcomes at a low cost. Level of Evidence: IV

Asociación de errores y eventos adversos intraoperatorios con complicaciones postoperatorias en curso de ampliación de cirugía laparoscópica avanzada y bariátrica / Association of intraoperative errors and adverse events with postoperative complications in fellowship of advanced laparascopy and bariatric surgery

Errores y eventos adversos intraoperatorios son mediciones importantes para el análisis de las habilidades del cirujano y consecuencias postoperatorios; sin embargo la clasificación y relación entre ellos no ha sido revisada ni integradas antes en un mismo grupo de estudio, aún con dos instrumentos de reciente validación disponibles como las escalas G e n e ri c E rro r Ra ti n g To o l (GERT) y C l a s s- I n t raObjetivo: Analizar la relación de errores con eventos adversos intraoperatorios y complicaciones postoperatorias Métodos: Estudio observacional, longitudinal, prospectivo y analítico. Se usaron las escalas GERT, ClassIntra y Clavien-Dindo para la clasificación de datos. Se aplicaron análisis descriptivo, gráfico y de significación con comparación de proporciones y porcentual para 3 o más grupos basado en el método Q-CoChrane con 95% de confianza y análisis jerárquico multivariado con 95% de confianza. Resultados: 30 pacientes operados por cirujanos del curso de ampliación de Laparoscopia Avanzada y Cirugía Bariátrica. 449 errores (30 no técnicos y 385 técnicos). 92 eventos: 86 grado I (93.47%) y 6 grado II (6.52%). 16 complicaciones postoperatorias en 11 pacientes (36,6%): 9 grado I (56.25%), 2 grado IIIA (12.5%), 5 grado IIIB (31.25%). A niveles medios de errores GERT sumados con la aparición de eventos adversos aumenta la posibilidad de complicaciones. Conclusión: Se demostró la asociación entre errores y eventos adversos intraoperatorios con resultados postoperatorio(AU)

Intraoperative errors and adverse events have been important metrics for the analysis of surgeon skills and postoperative outcomes; however, the classification and relationship between them has not been reviewed or integrated before in the same study group, even with two recently validated instruments available such as the Generic Error Rating Tool (GERT) and Class-Intra scales. Objective: To analyze the relationship of errors with intraoperative adverse events and postoperative complications Methods: Observational, longitudinal, prospective and analytical study. The GERT, ClassIntra and Clavien-Dindo scales were used for data classification. Descriptive, graphic and significance analysis were applied with comparison of proportions and percentage for 3 or more groups based on the Q-CoChrane method with 95% confidence and multivariate hierarchical analysis with 95% confidence. Results: 30 patients operated on by Advanced Laparoscopy and Bariatric Surgery fellows. 449 errors (30 non-technical and 385 technical). 92 events: 86 grade I (93.47%) and 6 grade II (6.52%). 16 postoperative complications in 11 patients (36.6%): 9 grade I (56.25%), 2 grade IIIA (12.5%), 5 grade IIIB (31.25%). At medium levels of GERT errors added to the appearance of adverse events, the possibility of complications increases. Conclusion: The association between intraoperative errors and adverse events with postoperative results was demonstrated(AU)

Laceração de canalículo lacrimal em centro de referência do centro-oeste paulista / Lacrimal canaliculus laceration in a reference center in the Center-West of the state of São Paulo

RESUMO Objetivo: Descrever as características clínico-epidemiológicas, técnicas cirúrgicas e resultado do tratamento das lacerações canaliculares operadas em nosso serviço. Métodos: Estudo retrospectivo, realizado de janeiro de 2012 a junho de 2020, considerando-se as lesões de canalículo lacrimal operadas em um serviço de referência. Dados demográficos, características das lesões, detalhes das cirurgias e resultado do tratamento foram obtidos de prontuários eletrônicos e analisados estatisticamente. Resultados: Foram incluídos 26 portadores de lesões canaliculares, com idade entre 2 e 71 anos, sendo 73,1% homens. A lesão acometia o canalículo superior em 53,9%; 80,8% pacientes procuraram pelo serviço nas primeiras 24 horas, e 46,2% tiveram a cirurgia realizada entre 24 e 72 horas após o traumatismo. Todos os pacientes tiveram intubação mono ou bicanalicular, e o tempo transcorrido entre a cirurgia e a retirada do silicone, variou de zero a 183 dias. Após a cirurgia, 21 pacientes (80,8%; p<0,05) não apresentaram complicações, 2 (7,7%) evoluíram com obstrução canalicular, 2 (7,7%) com granuloma e 1 (3,8%) com ectrópio de ponto lacrimal. Conclusão: As lesões de canalículo encontradas em nossa prática são mais comuns em crianças ou homens jovens, acometem mais o canalículo superior e as nossas condutas levam a sucesso no tratamento na maior parte dos casos. As grandes controvérsias no assunto persistem, como o tipo e o tempo de permanência do tubo de silicone na via lacrimal. Somente estudos com grandes amostras podem consolidar esses conceitos.

ABSTRACT Objective: To describe the clinical and epidemiological characteristics, surgical techniques, and results of the canalicular laceration treatment at our service. Methods: A retrospective study was carried out from January 2012 to June 2020, considering canalicular injuries operated at a reference center. Demographic data, lesion characteristics, surgical details, and treatment outcomes were obtained from electronic medical records and were statistically analyzed. Results: Twenty-six cases of people with canalicular lesions aged between 2 to 71 years old were included, of whom 73.1% were men. The superior canaliculus was affected in 53.9%; 80.8% of patients searched for care within the first 24 hours, and 46.2% had the surgery performed between 24-72 hours after trauma. All patients had mono or bicanalicular intubation and the time elapsed between surgery and silicone removal ranged from 0 to 183 days. After surgery, 21 patients (80.8%, p<0.05) did not present any complications, two (7.7%) evolved with canalicular obstruction, two (7.7%) with granuloma, and one (3.8 %) with lacrimal puncta ectropion. Conclusion: In our practice, canalicular injuries are more common in children or young men, affecting mainly the superior canaliculus, and treatment success using our approach can be achieved in most of the cases. However, great controversies remain on the subject, such as type of intubation and when to remove the silicone tube from the lacrimal pathway. Larger series are required to consolidate controversial concepts.

Results of the use of human platelet-rich fibrin membrane applied on colorrhaphy in nourished and malnourished rats

Purpose: To evaluate the effects of platelet-rich fibrin (PRF) on the healing of intestinal sutures in rats. Methods: Forty rats were distributed into four groups. Two groups were treated with a standard diet and considered nourished (I and II). Two other groups were treated with cornmeal and considered malnourished (III and IV). All animals underwent cecotomy and cecorrhaphy. Groups II and IV had sutures overlapped with human PRF membrane. The following parameters were evaluated: animal weight, death, rupture site, rupture pressure, collagen, and reticulin dosage in the suture line. Results: The use of PRF did not influence deaths, rupture pressure or rupture location. For malnourished animals, a significant difference was observed in relation to the rupture site, corresponding to the suture line (p = 0.038) and reticulin dosage (p = 0.040), when PRF was used. There was no difference in relation to burst pressures. Conclusions: The use of PRF did not influence intestinal healing in nourished rats. In the group of malnourished animals, its use favored healing.

Quiste meniscal posterior a la sutura meniscal con monofilamento de polipropileno / Meniscal cyst after polypropylene monofilament suture

Introducción: la función del tejido meniscal es fundamental en la transmisión y distribución de cargas de la rodilla. En casos de lesión meniscal, la sutura es el tratamiento quirúrgico de elección, y pueden utilizarse diferentes materiales para realizarla. El objetivo del trabajo es analizar la aparición de quistes meniscales sintomáticos con el uso de sutura no reabsorbible del tipo monofilamento de polipropileno en un grupo de pacientes con lesiones en asa de balde y evaluar el material de sutura como causal de quiste.Materiales y métodos: se realizó un estudio retrospectivo de un grupo de pacientes con lesiones en asa de balde suturadas con material no reabsorbible del tipo monofilamento de polipropileno (MP) y sutura de alta resistencia de polietileno de ultra alto peso molecular UHMWPE (SAR) y se analizó la presencia de quiste meniscal sintomático como complicación. Los criterios de inclusión para este estudio fueron pacientes con lesiones en asa de balde a los cuales se les realizó sutura meniscal con técnicas combinadas con material de tipo no reabsorbible. Se excluyeron pacientes con lesiones que no fueran con patrón en asa de balde o a los cuales se les hizo sutura meniscal todo-adentro únicamente.Resultados: un total de veinticinco pacientes, quince de sexo masculino y diez de sexo femenino. La edad media del grupo evaluado fue de 27.8 años. El 72% fue suturado con sutura de alta resistencia (SAR) mientras que a un 28% se les realizó sutura con monofilamento de polipropileno (MP). El 92% de las lesiones se presentaron en el menisco interno. Se observaron tres pacientes con quistes meniscales sintomáticos asociados a la sutura MP, los cuales fueron tratados quirúrgicamente con buena evolución. Conclusión: identificamos en nuestra serie que la aparición de quistes sintomáticos se relaciona estrechamente con el uso de monofilamento de polipropileno (MP). Consideramos la utilización de hilos no reabsorbibles de alta resistencia (polietileno de ultra alto peso molecular UHMWPE) como la primera opción para realizar las suturas meniscales por la baja tasa de complicación y los buenos resultados. Nivel de Evidencia: IV

Introduction: The function of the meniscal tissue is fundamental in the transmission and distribution of knee loads. In cases of meniscal injury, suturing is the surgical treatment of choice, and different materials can be used to perform it. The aim of the work is to analyze the appearance of symptomatic meniscal cysts with the use of non-absorbable polypropylene monofilament suture in a group of patients with bucket handle injuries and to evaluate the suture material as a cause of the cyst. Materials and methods: a retrospective study was carried out on a group of patients with bucket-handle injuries sutured with non-absorbable polypropylene monofilament (MP) material and high-strength ultra-high molecular weight UHMWPE polyethylene (SAR) suture and the presence of a symptomatic meniscal cyst as a complication was analyzed. The inclusion criteria for this study were patients with bucket-handle injuries in whom meniscal suture was performed with combined techniques with non-resorbable material. Patients with injuries other than a bucket-handle pattern or who underwent all-in meniscal suturing only were excluded.Results: a total of twenty-five patients, fifteen males and ten females. The average age of the evaluated group was 27.8 years. 72% were sutured with high resistance suture (SAR) while 28% were sutured with polypropylene monofilament (MP). 92% of the injuries occurred in the medial meniscus. Three patients were observed with symptomatic meniscal cysts associated with the MP suture, which were treated surgically with good outcomes. Conclusion: we identified in our series that the appearance of symptomatic cysts is closely related to the use of polypropylene monofilament (MP). We consider the use of high-strength non-absorbable threads (ultra-high molecular weight polyethylene UHMWPE) as the first option to perform meniscal sutures due to the low complication rate and good results. Level of Evidence: IV

Validity of the Maturation Stage Method in the Individual Assessment of Midpalatal Suture Ossification Before Maxillary Expansion: A Systematic Review / Validez del Método de la Etapa de Maduración en la Evaluación Individual de la Osificación de la Sutura Palatina Mediana Previo a la Expansión Maxilar: Una Revisión Sistemática

In 2013, midpalatal suture maturation stage assessment was proposed for the evaluation of patients before performing maxillary expansion. In this study, we aimed to analyze the association between the midpalatal suture maturation stages assessed by CBCT, according to the method described by Angelieri et al., and other objective methods used to assess skeletal maturation or bone fusion. A computerized database search was conducted using PubMed, Cochrane Library, SciELO, LILACS, Web of Science, and Scopus, without language restriction. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. Authors were contacted when necessary, and reference lists of the included studies were screened. Search terms included midpalatal suture, maturation, correlation, diagnostic performance, classification, evaluation, assessment, and relationship. Quality assessment was performed using the Observational Cohort and Cross-Sectional Studies tool developed by the National Heart, Lung, and Blood Institute. Eleven studies met the inclusion criteria. Of all the studies included, 81.9% had fair qualit y and 18.1% good quality, respectively. Eight out of eleven studies assessed the correlation between the midpalatal suture maturation method and the skeletal maturity evaluated by CVM method (Spearman's correlation coefficient: 0.244-0.908). Two out of eleven studies evaluated the correlation between midpalatal suture maturation method and the skeletal maturity assessed by HWM method (Spearman's correlation coefficient: 0.904-0.905) Even though midpalatal suture maturation stage assessment needs an exhaustive training and calibration process, it is a valid method to evaluate skeletal maturation or bone fusion. From a clinical perspective, for patients at CS4, CS5 and CS6, an assessment of the midpalatal suture on CBCT is indicated. A similar assessment should be done in patients at SMI 7-9.

En 2013, se propuso un nuevo método para la evaluación del estadio de maduración de la sutura palatina mediana para la evaluación de los pacientes antes de realizar la expansión maxilar. En este estudio, nuestro objetivo fue analizar la asociación entre las etapas de maduración de la sutura palatina mediana evaluada en CBCT, según el método descrito por Angelieri et al., y otros métodos objetivos utilizados para evaluar la maduración esquelética o la fusión ósea. Se realizó una búsqueda en las bases de datos PubMed, Cochrane Library, SciELO, LILACS, Web of Science y Scopus, sin restricción de idioma. Se buscó literatura no publicada en ClinicalTrials.gov, el Registro Nacional de Investigación y la base de datos Pro-Quest Dissertation Abstracts and Thesis. Se estableció contacto con los autores cuando fue necesario y se revisaron las listas de referencias de los estudios incluidos. Los términos de búsqueda incluyeron sutura palatina mediana, maduración, correlación, rendimiento diagnóstico, clasificación, evaluación, valoración y relación. La evaluación de la calidad se realizó mediante la herramienta de Estudios transversales y de cohortes observacionales desarrollada por el Instituto Nacional del Corazón, los Pulmones y la Sangre. Once estudios cumplieron con los criterios de inclusión. Del total de estudios incluidos, el 81.9% tuvo calidad regular y el 18.1% calidad buena, respectivamente. Ocho de once estudios evaluaron la correlación entre el método de maduración de la sutura palatina mediana y la madurez esquelética evaluada por el método CVM (coeficiente de correlación de Spearman: 0.244-0.908). Dos de once estudios evaluaron la correlación entre el método de maduración de la sutura palatina mediana y la madurez esquelética evaluada por el método HWM (coeficiente de correlación de Spearman: 0.904-0.905). Aunque la evaluación del estado de maduración de la sutura palatina mediana necesita un proceso exhaustivo de entrenamiento y calibración, es un método válido para evaluar la maduración esquelética o la fusión ósea. Desde una perspectiva clínica, para pacientes en CS4, CS5 y CS6, está indicada una evaluación de la sutura palatina mediana en CBCT. Se debe realizar una evaluación similar en pacientes con SMI 7-9.

Rotura aguda del tendón de Aquiles tratadas quirúrgicamente con Técnica de Mínimo Abordaje. Resultados clínicos y funcionales a un año de seguimiento / Acute rupture of the Achilles tendon surgically treated with the Minimal Approach Technique. Clinical and functional results at one year of follow-up

Se deben tener consideraciones especiales cuando se realizan reparaciones quirúrgicas del tendón de Aquiles. Su anatomía e irrigación particular plantean desafíos únicos para el manejo, y tener comprensión profunda de estas características es crucial para escoger el tratamiento adecuado y lograr resultados exitosos. El objetivo de este trabajo es analizar la eficiencia de la reparación quirúrgica de la rotura aguda del tendón de Aquiles con técnica de Dresden, entre el 2015 y el 2021. Se realizó un estudio de tipo analítico, observacional, longitudinal y prospectiva. El análisis del aspecto estadístico fue a través de estadística descriptiva y asociación de las variables. Se incluyeron 34 pacientes con un promedio de 42 años, la mayoría de sexo masculino. Al aplicar las escalas VISA-A se obtuvo un promedio de 12 puntos, 67,5 puntos a los 6 meses y 80,5 puntos a los 12 meses. En la encuesta SF-12 a los 6 meses se obtuvo un promedio de 68,5 puntos y 80 puntos a los 12 meses; un paciente presentó rechazo de la sutura y 6 afirmaron algún grado de edema residual aun al año de la cirugía. La reparación quirúrgica con técnica de Dresden mejora la funcionabilidad del tendón de malos resultados a regulares y buenos resultados al año de seguimiento. El 68% de la población estudiada afirmó que se encuentran satisfechos con la cirugía(AU)

Special considerations must be made when performing surgical repairs of the Achilles tendon. Its particular anatomy and blood supply pose unique management challenges, and a thorough understanding of these characteristics is crucial to choosing the right treatment and achieving successful results. The objective of this work is to analyze the efficiency of the surgical repair of the acute rupture of the Achilles tendon with the Dresden technique, between 2015 and 2021. An analytical, observational, longitudinal and prospective study was carried out. The analysis of the statistical aspect was through descriptive statistics and association of the variables. 34 patients with an average age of 42 years were included, most of them male. When applying the VISA-A scales, an average of 12 points was obtained, 67,5 points at 6 months and 80,5 points at 12 months. In the SF-12 survey at 6 months an average of 68,5 points and 80 points at 12 months were obtained; One patient presented rejection of the suture and 6 reported some degree of residual edema even one year after surgery. Surgical repair with the Dresden technique improves the functionality of the tendon from poor to regular results and good results after a year of follow-up. 68% of the population studied stated that they are satisfied with the surgery(AU)

Sutura de B-Lynch profiláctica: eficacia en la prevención de la hemorragia posparto en pacientes de alto riesgo / Prophylactic B-Lynch suture: efficacy in preventing postpartum hemorrhage in high-risk patients

Objetivo: Evaluar la eficacia de la sutura de B-Lynch profiláctica en la prevención de la hemorragia posparto en pacientes con alto riesgo para atonía uterina, del Servicio de Sala de Partos de la Maternidad Concepción Palacios. Métodos: Estudio prospectivo, comparativo y longitudinal, que incluyó 30 pacientes con factores de riesgo para atonía uterina, distribuidas aleatoriamente en dos grupos: con y sin sutura compresiva de B-Lynch. Se realizó seguimiento ecosonográfico, clínico y paraclínico a las 12 y 24 horas del posoperatorio. Se consideró un contraste estadísticamente significativo si p < 0,05. Resultados: La reducción de hemoglobina en pacientes con sutura compresiva fue 0,5 ± 0,4 g/dl y de hematocrito fue 1,4 ± 1,1 %; en el grupo control fue 1,6 ± 1,6 g/dl y 4 ± 4,7 %, respectivamente (p = 0,014/p = 0,058). El sangrado a las 12 y 24 horas fue escaso en 73,3 % y 93,3 % de las pacientes con sutura compresiva y moderado o abundante en 100 % y 93,4 % del grupo control (p = 0,000). La reducción del tamaño del útero fue mayor en el grupo experimental que en el grupo control (p = 0,000); 33,4 % de las pacientes con sutura de B-Lynch y 93,4 % sin sutura, tuvieron dolor grave o insoportable a las 12 horas (p = 0,007) y a las 24 horas no hubo casos con dolor grave o insoportable en el primer grupo, pero en el segundo la frecuencia fue de 60 %. Conclusiones: La sutura de B-Lynch profiláctica es eficaz para la prevención de la hemorragia posparto por atonía uterina(AU)

Objective: To evaluate the effectiveness of prophylactic B-Lynch suture in the prevention of postpartum bleeding in patients at high risk for uterine atony, from the Concepción Palaces Maternity Delivery Room Service. Methods: Prospective, comparative and longitudinal study, which included 30 patients with risk factors for uterine atonia, randomly distributed in two groups: with and without B-Lynch compression suture. Echosonographic, clinical and paraclinical follow-up was performed at 12 and 24 hours after the postoperative period. A statistically significant contrast was considered if p < 0.05. Results: Haemoglobin reduction in patients with compressive suture was 0.5 ± 0.4 g/dl and hematocrit was 1.4 ± 1.1%; in the control group it was 1.6 ± 1.6 g/dl and 4 ± 4.7%, respectively (p-0.014/p-0.058). Bleeding at 12 and 24 hours was scarce in 73.3% and 93.3% of patients with compressive and moderate sutures or abundant in 100% and 93.4% of the control group (p-0.000). The reduction in the size of the uterus was greater in the experimental group than in the control group (p-0.000); 33.4% of patients with B-Lynch sutures and 93.4% without sutures had severe or unbearable pain at 12 hours (p-0.007) and at 24 hours there were no cases with severe or unbearable pain in the first group but in the second the frequency was 60%. Conclusions: Prophylactic B-Lynch suture is effective for preventing postpartum uterine atonia hemorrhage(AU)

Manejo quirúrgico conservador de la hemorragia posparto mediante sutura compresiva uterina (Técnica de Hayman). Reporte de caso / Conservative surgical management of postpartum hemorrhage by uterine compressive suture (Hayman technique). Case report

La hemorragia posparto es una de las complicaciones más frecuentes en obstetricia, siendo la segunda causa de mortalidad materna a nivel mundial. La atonía uterina es su principal causa. Instaurada la hemorragia, el tiempo y el manejo de la misma dependerá de la experticia del obstetra. Inicialmente el tratamiento se enfoca en el uso de fármacos uterotónicos, pero al no existir una respuesta adecuada se puede optar por un manejo quirúrgico conservador. Las suturas compresivas uterinas son consideradas una buena opción de tratamiento. Una técnica quirúrgica efectiva y sencilla es la descrita por Hayman, una herramienta valiosa para el control de la hemorragia posparto. Se presenta el caso de una paciente de 17 años, con embarazo de 37 semanas y diagnóstico de preeclampsia grave, quien presenta desprendimiento prematuro de placenta y atonía uterina posterior, a quien se le realizó sutura compresiva uterina por técnica de Hayman, con evolución satisfactoria(AU)

Postpartum hemorrhage is one of the most frequent complications in obstetrics, being the second cause of maternal mortality worldwide. Uterine atony is its main cause. Once the hemorrhage is established, the time and management of it will depend on the expertise of the obstetrician. Initially, treatment focuses on the use of uterotonic drugs, but in the absence of an adequate response, conservative surgical management may be chosen. Compressive uterine sutures are considered a good treatment option. An effective and simple surgical technique is described by Hayman, a valuable tool for the control of postpartum hemorrhage. We present the case of a 17-year-old patient, 37 weeks pregnant and diagnosed with severe preeclampsia, who presents placental abruption and posterior uterine atony, who underwent uterine compressive suture by Hayman technique, with satisfactory evolution(AU)

Endoscopic hand-suturing combined with titanium clips for rectal defects closure after endoscopic submucosal dissection: a pilot study / 中华肿瘤杂志

Objective: To explore the feasibility of endoscopic hand-suturing (EHS) for rectal defects closure after endoscopic submucosal dissection (ESD), and the clinical practicability of EHS combined with titanium clips. Methods: This is a prospective study performed by two experienced endoscopists from the Cancer Hospital, Chinese Academy of Medical Sciences who had received EHS training in sixporcine gastric ESD defects in vivo before the study. From December 2022 to February 2022, 20 patients with rectal mucosal lesions or submucosal diseases underwent ESD. Then EHS combined with titanium clips was adopted to close the rectal ESD defects. Specifically, we first sutured the defects as much as possible through EHS, then use titanium clips to fix the tail of the suture, and finally use additional titanium clips to close the residual parts of the defects that cannot be sutured. The main observational indicators were complete closure of the wound and delayed bleeding within one month after surgery. Results: In the 20 rectal cases, the size of defects ranged from 2.2 to 3.6 cm, with a median of 2.7 cm. All cases achieved complete closure without delayed bleeding, of which 12 (60.0%) were completely sutured with EHS and 8 (40.0%) required additional titanium clips to achieve complete closure after suturing. Conclusion: EHS technique is feasible and safe for rectum. EHS combined with titanium clips can also effectively close the rectal ESD defects, prevent postoperative delayed bleeding, and may be easier to be implemented in clinical practice.

Endoscopic hand-suturing combined with titanium clips for rectal defects closure after endoscopic submucosal dissection: a pilot study / 中华肿瘤杂志

Objective: To explore the feasibility of endoscopic hand-suturing (EHS) for rectal defects closure after endoscopic submucosal dissection (ESD), and the clinical practicability of EHS combined with titanium clips. Methods: This is a prospective study performed by two experienced endoscopists from the Cancer Hospital, Chinese Academy of Medical Sciences who had received EHS training in sixporcine gastric ESD defects in vivo before the study. From December 2022 to February 2022, 20 patients with rectal mucosal lesions or submucosal diseases underwent ESD. Then EHS combined with titanium clips was adopted to close the rectal ESD defects. Specifically, we first sutured the defects as much as possible through EHS, then use titanium clips to fix the tail of the suture, and finally use additional titanium clips to close the residual parts of the defects that cannot be sutured. The main observational indicators were complete closure of the wound and delayed bleeding within one month after surgery. Results: In the 20 rectal cases, the size of defects ranged from 2.2 to 3.6 cm, with a median of 2.7 cm. All cases achieved complete closure without delayed bleeding, of which 12 (60.0%) were completely sutured with EHS and 8 (40.0%) required additional titanium clips to achieve complete closure after suturing. Conclusion: EHS technique is feasible and safe for rectum. EHS combined with titanium clips can also effectively close the rectal ESD defects, prevent postoperative delayed bleeding, and may be easier to be implemented in clinical practice.

Risk Analysis and Study of Post-marketing Adverse Events for Absorbable Sutures / 中国医疗器械杂志

Objective To investigate, analyze, and evaluate the risk data associated with the clinical use of absorbable sutures by retrieving and summarizing information from the databases of the US FDA and CNKI, as well as the adverse event reports related to absorbable sutures from January 2019 to October 2022 within Zhejiang province. The adverse event reports are obtained from both incident locations and monitoring organizations affiliated with the registrant. The aim is to identify the main risk factors associated with the clinical use of absorbable sutures. The key risk factors are potential product quality defects, product design and material selection, clinical selection and application, and postoperative recovery care including patient's self-care. Risk control strategies are further proposed to reduce or minimize the risk of adverse events caused by this product.

Complications in repairing acute closed Achilles tendon rupture with micro-incision percutaneous Achilles tendon suture system / 中国骨伤

OBJECTIVE@#To analyze the causes, management and prevention of complications after micro-incision percutaneous repair of acute Achilles tendon rupture.@*METHODS@#A retrospective study indentyfied 279 patients with acute Achilles tendon rupture who underwent a mini-invasive procedure using the micro-incision percutaneous Achilles tendon suture system(MIPAS) from August 2008 to November 2019, including 269 males and 10 female;96 cases on the right side and 183 cases on the left side;aged from 18 to 64 years old with an average of (36.9±11.4 )years old. Surgery was performed 0.5 to 7 days with an average of(2.7±0.9 )days after injury. The incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis, Achilles tendon adhesion, local pain, and ankle stiffness within 18 months after surgery were recorded, as well as the corresponding management and outcome, the causes and prevention measures were analyzed.@*RESULTS@#No superficial or deep infection was found in all patients, symptomatic Achilles tendon adhesion and ankle stiffness were not observed, delayed suture foreign-body reactions occurred in 2 cases (0.7%), re-rupture in 5 cases (1.8%), sural nerve injury in 3 cases (1.1%), 21 cases(7.5%) with skin invagination at puncture site, 2 cases (0.7%) with symptomatic vein thrombosis, and 45 cases (16.1%) of transient posterior medial malleolus pain. After individualized treatment, the function was good. American Orthopeadic Foot & Ankle Sciety(AOFAS) score was 93 to 100 with an average of(98.9±5.4) scores.@*CONCLUSION@#Despite the occurrence of unique complications with MIPAS, it shows low functionally-related complications rates, such as incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis and ankle stiffness.

Double-pulley combined with suture bridge technique for fixation of comminuted fractures of distal patella pole / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of double pulley combined with suture bridge in the treatment of comminuted fracture of the lower pole of the patella.@*METHODS@#From January 2018 to June 2020, 15 patients with comminuted fracture of the lower pole of the patella were treated with double pulley and suture bridge technology, including 9 males and 6 females, aged 28 to 68 years old with an average of (42.4±9.6) years old. All patients had obvious knee joint pain and limited movement after injury. All knee joints were examined by X-ray and CT, which confirmed that they were all comminuted fractures at the lower level of the patella. After operation, X-ray films of the knee joint were taken regularly to understand the fracture healing, the Insall Salvati index was measure, the range of motion of the joint was recorded, and the function of the knee joint was evaluateed by the Bostman scoring system.@*RESULTS@#All the 15 patients were followed up for 7 to 24 months with an average of (11.4±4.2) months, and there was no obvious anterior knee pain. At the last follow-up, the knee joint range of motion of the affected limb was 105° to 140° with an average of (128.5±12.8) °, and the Insall Salvati index was 0.79 to 1.12 with an average of (0.92±0.18). The X-ray film showed that the patella was bone healing, and no anchor fell off, broken, or displaced fracture block was found. Bostman patellar fracture function score was 27.85±2.06, 13 cases were excellent, 2 cases were good.@*CONCLUSION@#Double pulley technique combined with suture bridge technique is reliable for reduction and fixation of comminuted fracture of the lower pole of patella, and patients can start functional exercise early after operation.

Clinical study on a novel minimally invasive Achilles tendon suture instrument for treating fresh closed Achilles tendon rupture / 中国修复重建外科杂志

OBJECTIVE@#To assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture.@*METHODS@#A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity ( P>0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.@*RESULTS@#The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group ( P<0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups ( P>0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant ( P<0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group ( P<0.05).@*CONCLUSION@#In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.

Treatment of tibial insertion avulsion fracture of anterior cruciate ligament involving anterior root of lateral meniscus with multi-point fixation with anchor and suture / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of arthroscopic multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of anterior cruciate ligament (ACL) involving the anterior root of lateral meniscus (LM).@*METHODS@#A retrospective analysis was conducted on the clinical data of 28 patients with tibial insertion avulsion fracture of ACL involving the anterior root of LM who were treated with arthroscopic multi-point fixation with anchor and suture between October 2017 and January 2023. There were 12 males and 16 females with the mean age of 26 years (range, 13-57 years). There were 20 cases of sports injury and 8 cases of traffic accident injury. In 2 cases of old fracture, the time from injury to operation was 45 days and 90 days, respectively; in 26 cases of fresh fracture, the time from injury to operation was 3-20 days (mean, 6.7 days). According to the Meyers-McKeever classification, there were 4 cases of type Ⅱ, 11 cases of type Ⅲ, and 13 cases of type Ⅳ. The preoperative Lysholm knee function score was 42.1±9.0, the International Knee Documentation Committee (IKDC) score was 40.0±7.3, and the Tegner score was 0.7±0.7.@*RESULTS@#All operations were successfully completed, and the incisions healed by first intention. All the 28 patients were followed up 5-60 months (mean, 20.4 months). During the follow-up, there was nocomplication such as infection, vascular or nerve injury, loosening or breakage of internal fixator, or stiffness of knee joint. Postoperative X-ray films showed satisfactory fracture reduction and firm fixation. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 10.3 weeks). At last follow-up, Lachman test and anterior drawer test were negative. At last follow-up, Lysholm knee function score was 92.4±5.5, IKDC score was 91.6±4.4, and Tegner score was 5.2±1.1, which significantly improved when compared with preoperative scores ( t=-22.899, P<0.001; t=-29.870, P<0.001; t=-19.979, P<0.001).@*CONCLUSION@#Multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of ACL involving the anterior root of LM can not only fix the LM, but also effectively reduce and fix the avulsion fracture, which can obtain good effectiveness.

Early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge / 中国修复重建外科杂志

OBJECTIVE@#To investigate the early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge.@*METHODS@#The clinical data of 38 patients with supraspinatus tendon tears who met the selection criteria between September 2020 and July 2022 were retrospectively analyzed, and all of them were treated with arthroscopic double-pulley suture-bridge technique. There were 15 males and 23 females, aged from 43 to 77 years, with an average of 61.5 years. There were 15 cases of left shoulder and 23 cases of right shoulder. Seven cases had a history of trauma, and the other 31 cases had no obvious inducement. The main clinical symptoms of the patient were pain in lifting the shoulder joint and hug resistance test (+). The time from onset of symptoms to admission ranged from 6 to 19 months, with an average of 10.3 months. Flexion, abduction, and external rotation of the shoulder were recorded before operation and at 3 and 12 months after operation. Pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, and American Society of Shoulder and Elbow Surgeons (ASES) score before operation and at 12 months after operation. Tendon healing, tendon continuity, and tension were evaluated by MRI at 3-6 months after operation, and patient's satisfaction was evaluated at last follow-up.@*RESULTS@#All the incisions healed by first intention, and there was no complication such as incision infection or nerve injury. All patients were followed up 12-34 months, with an average of 23.3 months. VAS score, UCLA shoulder score, and ASES score at 12 months after operation were significantly better than those before operation ( P<0.05). The external rotation range of shoulder joint significantly improved at 3 and 12 months after operation ( P<0.05), and it further improved at 12 months after operation when compared with 3 months after operation ( P<0.05). There was no significant difference in the range of flexion and abduction at 3 months after operation when compared with those before operation ( P>0.05), but the range of flexion and abduction at 12 months after operation significantly improved when compared with those before operation and at 3 months after operation ( P<0.05). MRI reexamination was performed in 28 patients at 3-6 months after operation. Among them, 25 patients had intact supraspinatus tendon structure, good tension, and tendon healing, and 3 patients had type 1 retear. The remaining 10 patients refused to undergo MRI reexamination because of the satisfactory effectiveness. At last follow-up, 29 patients (76.3%) were very satisfied with the results, 6 (15.7%) were satisfied, and 3 (7.8%) were not satisfied.@*CONCLUSION@#Arthroscopic double-pulley suture-bridge technique can achieve the effect of suture bridge operation, reduce the cost of operation and the risk of type 2 retear, and the early effectiveness is satisfactory, but the shoulder joint movement is limited within 3 months after operation.

Effectiveness of arthroscopic "hybrid" suture for delaminated rotator cuff tear: A prospective randomized controlled study / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of "hybrid" suture with en masse combined with double-layer repair under arthroscopy in repair of delaminated rotator cuff tear by comparison with en masse suture.@*METHODS@#Fifty-six patients with delaminated rotator cuff tears met selection criteria between June 2020 and January 2022 were included in the study. Patients were divided into two groups ( n=28) using a random number method. The patients in trial group underwent arthroscopic "hybrid" suture with the combination en masse and double-layer suture. The patients in control group underwent en masse suture under arthroscopy. There was no significant difference between the two groups ( P>0.05) in terms of gender, age, rotator cuff tear side, tear size, cause of injury, disease duration, and preoperative American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, visual analogue scale (VAS) score, and shoulder range of motion (forward flexion and lateral external rotation). The operation time, the difference of ASES score, UCLA score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) between pre- and post-operation were recorded and compared between the two groups ( P>0.05). The rotator cuff healing was examined by MRI and evaluated based on the classification criteria of rotator cuff healing proposed by Sugaya et al.@*RESULTS@#Three cases (1 case in the trial group and 2 cases in the control group) were excluded from the study due to loss of follow-up. Twenty-seven cases in the trial group and 26 cases in the control group were included in the final study analysis. All operations of the two groups were completed successfully. There was no significant difference in the operation time between groups ( P>0.05). The follow-up time was 10-12 months (mean, 10.9 months) in the trial group and 10-13 months (mean, 11.4 months) in the control group. All incisions healed by first intention. No surgery-related complications occurred. The UCLA score, ASES score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) of both groups at 9 months after operation were significantly superior to those before operation ( P<0.05). The difference of UCLA score, ASES score, and VAS score between before and after operation in the trial group were significantly better than those in the control group ( P<0.05). There was no significant differences between the two groups in the difference of shoulder range of motion (forward flexion and lateral lateral rotation) ( P>0.05). At 9 months after operation, according to the classification criteria of rotator cuff healing proposed by Sugaya et al, MRI showed that the rotator cuff healing of the trial group was significantly better than that of the control group ( P<0.05).@*CONCLUSION@#Compared with en masse suture, arthroscopic "hybrid" suture for the repair of delaminated rotator cuff tear has advantages in relieving pain and improving shoulder joint function, and the rotator cuff healing is better.

Effectiveness of fascial tissue flaps and skin flaps with layered sutures for repair of wounds after excision of sacrococcygeal pilonidal sinus / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus.@*METHODS@#Between March 2019 and August 2022, 9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females with an average age of 29.4 years (range, 17-53 years). The disease duration ranged from 1 to 36 months, with a median of 6 months. There were 7 cases with obesity and dense hair, 3 cases with infection, and 2 cases with positive bacterial culture of sinus secretion. The wound area after excision ranged from 3 cm×3 cm to 8 cm×4 cm, with a depth of 3-5 cm, reaching the perianal or caudal bone; there were 2 cases with perianal abscess formation and 1 case with caudal bone inflammatory edema. Enlarged resection was performed during operation, and the fascial tissue flap and skin flap were designed and excised at both left and right sides of the buttock, ranging from 3.0 cm×1.5 cm to 8.0 cm×2.0 cm. A cross drainage tube was placed at the bottom of the wound, and the fascial tissue flap and skin flap were advanced and sutured in three layers, namely, 8-string sutures in the fascial layer, barbed wire reduction sutures in the dermis, and interrupted skin sutures.@*RESULTS@#All 9 patients were followed up 3-36 months, with an average of 12 months. All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred. There was no recurrence of sinus tracts, the shape of gluteal sulcus was satisfactory, both sides of buttocks were symmetrical, local incision scar was concealed, and the shape disruption was minimal.@*CONCLUSION@#Fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus can effectively fill the cavity and reduce the incidence of poor incision healing, with the advantages of small trauma and simple operation.

Clinical application of Fastpass Scorpion suture passer for arthroscopic Bankart repair / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness and advantages of using Fastpass Scorpion suture passer to stitch the inferior capsulolabral complex in arthroscopic Bankart repair compared with traditional arthroscopic suture shuttle.@*METHODS@#The clinical data of 41 patients with Bankart lesion, who met the selection criteria and were admitted between August 2019 and October 2021, was retrospectively analyzed. Under arthroscopy, the inferior capsulolabral complex was stitched with Fastpass Scorpion suture passer in 27 patients (FS group) and with arthroscopic suture shuttle in 14 patients (ASS group). There was no significant difference between the two groups ( P>0.05) in gender, age, injured side, frequency of shoulder dislocation, time from first dislocation to operation, and preoperative Rowe score of shoulder. Taking successful suture and pull-tightening as the criteria for completion of repair, the number of patients that were repaired at 5∶00 to 6∶00 (<6:00) and 6∶00 to 7∶00 positions of the glenoid in the two groups was compared. The operation time, and the difference of Rowe shoulder score betwee pre- and post-operation, the occurrence of shoulder joint dislocation, the results of apprehension test, and the constituent ratio of recovery to the pre-injury movement level between the two groups at 1 year after operation.@*RESULTS@#Both groups completed the repair at 5∶00 to 6∶00 (<6∶00), and the constituent ratio of patients completed at 6∶00 to 7∶00 was significantly greater in the FS group than in the ASS group ( P<0.05). The operation time was significantly shorter in the FS group than in the ASS group ( P<0.05). All incisions in the two groups healed by first intention. All patients were followed up 12-36 months (mean, 19.1 months). No anchor displacement or neurovascular injury occurred during follow-up. Rowe score of shoulder in the two groups significantly improved at 1 year after operation than preoperative scores ( P<0.05), and there was no significant difference in the difference of Rowe shoulder score between pre- and post-operation between the two groups ( P>0.05). At 1 year after operation, no re-dislocation occurred, and there was no significant difference in the apprehension test and the constituent ratio of recovery to the pre-injury movement level between the two groups ( P>0.05).@*CONCLUSION@#Compared with the arthroscopic suture shuttle, using Fastpass Scorpion suture passer to stitch the inferior capsulolabral complex in arthroscopic Bankart repair is more convenient, saves operation time, and has good effectiveness.