Cerclage suture type to prevent pregnancy loss in women requiring a vaginal cervical cerclage: the C-STICH RCT.

Background: Second trimester miscarriage and preterm birth is a significant global problem. Surgical cervical cerclage is performed to prevent pregnancy loss and preterm birth. It utilises either a monofilament or braided suture. It is hypothesised that a braided material becomes colonised with pathogenic bacteria that causes vaginal dysbiosis, infection and cerclage failure. Objectives: The primary objective of the study was to examine the effectiveness of using a monofilament suture material as opposed to a braided suture material on pregnancy loss in women requiring a vaginal cervical cerclage. Design: Superiority open randomised controlled trial. Setting: Seventy-five maternity sites across the UK. Participants: Women experiencing a singleton pregnancy requiring a cervical cerclage. Interventions: Monofilament suture or braided suture. Main outcome measures: The primary outcome was pregnancy loss (miscarriage and perinatal mortality, including any stillbirth or neonatal death in the first week of life). Secondary outcomes included the core outcome set for preterm birth. Methods: Women were randomised on a 1 : 1 basis to monofilament or braided cerclage utilising a bespoke randomisation service with minimisation dependent on the site, indication for cerclage, intention to use progesterone and planned surgical technique. The inclusion criteria were three or more previous mid-trimester losses or preterm births, insertion of a cerclage in a previous pregnancy, a history of a mid-trimester loss or preterm birth with a shortened cervical length in the current pregnancy or in women who clinicians deemed at risk of preterm birth. The exclusion criteria were an emergency or rescue cerclage, age of < 18 years, being unable to give informed consent or the cerclage having to be placed abdominally. The original sample size was calculated based on a relative risk reduction of 41% from a pregnancy loss rate of 19% in the braided group to 11% in the monofilament group with 90% power and alpha at p = 0.05. The independent data monitoring committee noted a lower-than-anticipated pooled event rate within the trial and recommended an increase in sample size to 2050. The outcome data were collected using clinical record forms from the maternal and neonatal medical records and reported to Birmingham Clinical Trials Unit. Results: A total of 2049 women were randomised, after withdrawals and loss to follow-up, data on 1005 women in the monofilament group and 993 women in the braided group were included. The baseline demographics between the groups were similar. There was no evidence of a difference in pregnancy loss rates between the monofilament and braided groups (80/1003 vs. 75/993; adjusted risk ratio: 1.05, 95% confidence interval: 0.79 to 1.40; adjusted risk difference: 0.002, 95% confidence interval: -0.02 to 0.03). Limitations: The trial did not collect long-term paediatric outcomes. There were no safety concerns. Conclusions: There was no evidence of a difference in pregnancy loss between a monofilament suture and a braided suture. Future work: Long-term follow-up of neonates born within the C-STICH (cerclage suture type for an insufficient cervix and its effects on health outcomes) trial. Trial registration: This trial is registered as ISRCTN15373349. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/04/107) and is published in full in Health Technology Assessment; Vol. 28, No. 40. See the NIHR Funding and Awards website for further award information.

Cervical cerclage is an operation performed in pregnancy to prevent miscarriage and preterm birth. A cervical cerclage is sometimes recommended in women who have had babies born prematurely before or who have had previous cervical surgery. A cerclage operation involves a stitch being inserted around the neck of the womb (cervix) to keep it closed during pregnancy and to prevent it opening prematurely. When performing the operation, the doctor can use different types of threads made of different materials. The threads used to perform the operation are called sutures. One suture type is a single strand or monofilament thread, and the other is a multifilament braided thread with lots of thin strands woven together. Some evidence has suggested that using a monofilament suture thread prevented pregnancy loss by preventing infection. Therefore, we performed a randomised controlled trial of the use of monofilament suture thread versus braided suture thread, aiming to reduce pregnancy loss in women who were having a cerclage as part of their routine care. The women consented to take part in the study and were randomly allocated to their cerclage performed with either a monofilament or braided suture thread; there was no other change to their planned pregnancy care. What happened in their pregnancy was recorded from their medical records and analysed. A total of 2049 women agreed to take part in the study and consented to the analysis of their pregnancy and neonatal outcomes. Cerclage suture type for an insufficient cervix and its effects on health outcomes showed that there was no difference in pregnancy loss between the two suture threads. There was decreased maternal sepsis and decreased chorioamnionitis (which is an infection inside the womb during labour) in the women who received a monofilament suture, which needs further investigation. Although more women who had a cerclage using the monofilament thread needed a small operation and an anaesthetic, often between 36 and 37 weeks, to remove the monofilament suture prior to a vaginal birth, there were no differences in the outcomes for their babies.

Evaluating the benefit of progressive tension sutures at the donor site in autologous breast reconstruction - A retrospective comparative cohort study.

BACKGROUND: As seroma formation is a common donor site complication following autologous breast reconstruction, we adapted the surgical protocol by introducing progressive tension sutures (PTS). This study aimed to evaluate the influence of PTS at the donor site in autologous breast reconstruction on seroma formation. Additionally, an exploratory analysis on patient satisfaction and aesthetic outcome was performed. METHODS: This retrospective cohort study analyzed data of 400 patients who received autologous breast reconstruction between 2018 and 2022. Among them, 204 patients received traditional donor site closure, and 188 patients received PTS with or without drain placement. Proportional incidence of seroma was described and multivariable logistic regression was used to assess the risk factors for seroma formation. At the deep inferior epigastric artery perforator donor site, patient satisfaction was further explored by administering the BREAST-Q and the aesthetic outcome was graded by three blinded participants. RESULTS: Overall, 514 breast reconstructions were performed on 400 patients. The incidence of seroma formation was lower in the PTS group compared with that in the traditional closure group. Multivariable analysis showed that patients who received PTS were 40% less likely to develop seroma. Aesthetic outcome was considered more pleasing objectively and subjectively if PTS were performed. Regarding patient satisfaction, no difference was found in the post-operative physical well-being between the two groups. CONCLUSIONS: In this large cohort, we found reduced incidence of seroma when PTS were performed. PTS were also associated with reduced odds of seroma formation and were described to be aesthetically more pleasing. PTS should be considered in autologous breast reconstruction.

"Evaluating wound closure innovations in spinal surgery: impacts on efficiency and patient outcomes".

This study evaluates contemporary wound closure techniques in spinal surgery, focusing on the efficacy of barbed sutures, skin staples, and negative-pressure wound therapy (NPWT), compared to traditional methods. Barbed sutures, like STRATAFIX™ Symmetric, and skin staples demonstrate significant advantages, including reduced wound closure time, lower infection rates, and improved surgical outcomes, particularly in multilevel or revisional procedures. In contrast, plastic surgery closures do not show a substantial reduction in postoperative complications despite being used in more complex cases. NPWT is highlighted as an effective adjunct therapy for managing surgical site infections and reducing the need for hardware removal. The findings suggest that while modern techniques offer clear benefits, traditional methods remain valuable in specific contexts. The review advocates for further research through large-scale, long-term studies and emphasizes the need for personalized wound closure strategies based on individual patient risk factors.

Capsular and fascial closure with barbed sutures reduces blood loss compared to traditional interrupted sutures in total hip arthroplasty.

BACKGROUND: STRATAFIX, a recently introduced barbed suture device, incorporates self-anchoring, knotless sutures with higher tensile strength and enhanced tissue-holding capacity compared to traditional braided absorbable sutures. This study aimed to compare the efficacy of barbed sutures and interrupted sutures in capsular and fascial closure during total hip arthroplasty. METHODS: We retrospectively reviewed the records of patients who underwent total hip arthroplasty between April 2017 and March 2021. Overall, 547 patients were evaluated, comprising 77 men and 470 women (mean age: 64.5 years). Among them, 330 patients were in the interrupted suture (control) group, while 217 were in the barbed suture (BS) group. Data on surgical time, perioperative hemoglobin, length of hospital stay, complications such as transfusions and delayed wound healing, and dislocation rates were collected during the latest outpatient follow-up and compared between the two groups. RESULTS: No differences were observed in intraoperative blood loss between the groups. However, the BS group exhibited significantly longer operative time, as well as significantly lower postoperative blood loss, total blood loss, and postoperative hemoglobin drop compared to the control group. Dislocation was reported in two cases within the control group, whereas no instances were recorded in the BS group. CONCLUSION: The use of barbed sutures demonstrated effectiveness in reducing perioperative blood loss for capsular and fascial closure during total hip arthroplasty.

Perspective: Timely diagnosis and repair of intraoperative thoracic/lumbar cerebrospinal fluid (CSF) leaks.

Background: Our review of 12 articles for this perspective showed the frequency of intraoperative thoracic and/or lumbar CSF fistulas/dural tears (DT) ranged from 2.6% - 8% for primary surgical procedures. Delayed postoperative CSF leak/DT were also diagnosed in 0.83% (17/2052 patients) to 14.3% (2/14 patients) of patients undergoing thoracic and/or lumbar procedures. Further, the rate of recurrent postoperative CSF leaks/DT varied from 13.3% (2/15 patients) to 33.3% (4/12 patients). Methods: Intraoperative, postoperative delayed, and recurrent postoperative traumatic postsurgical thorac CSF leaks/DT can be limited by performing initially sufficient operative decompressions and/or decompressions/fusions (i.e., utilizing adequate open exposures vs. inadequate minimally invasive (MI) approaches). The incidence of CSF leaks/DT can be further reduced by spine surgeons' utilization of operating microscopes, and their avoiding routine attempts at total synovial cyst excision and/or complete resection of hypertrophied/ossified yellow ligament in the presence of significant dural adhesions. Results: Multiple CSF leak/CT repair techniques included; using interrupted, non-resorbable sutures for direct dural repairs (i.e. 7-0 Gore-Tex sutures where the suture is larger than the needle thus plugging needle holes), and adding where needed muscle patch grafts, microfibrillar collagen, the rotation of Multifidus muscle pedicle flaps, fibrin sealants (FS)/fibrin glues (FG), lumbar drains (LD), and/or lumbo-peritoneal (LP) shunts. Conclusion: Intraoperative, postopertive delayed, and/or recurrent postoperative thorac and/or lumbar traumatic surgical CSF leaks can be reduced by choosing to initially perform the appropriately extensive open operative decompressions and/or decompresssions/fusions. It is critical to use an operating microscope, non-resorbable interrupted sutures, and where necessary, muscle patch grafts, microfibrillar collagen, the rotation of Multifidus Muscle Pedicle Flaps, FS/FG, LD, and/or LP shunts.

Removable regulating sutures during trabeculectomy for a safer and more effective intraocular pressure control.

PURPOSE: Comparing the effect of standard trabeculectomy with direct sutures versus trabeculectomy with compression and everting sutures. METHODS: Mono-centric randomized prospective comparative study on 38 glaucomatous eyes undergoing trabeculectomy: 19 with standard fixed sutures (group A) and 19 withremovable regulating sutures (group B). Preoperatively and at day-7, 1-month, 2-months, 3-months and 6-months after surgery, we recorded best-corrected visual acuity (BCVA), intraocular pressure (IOP) and possible complications. Complete, partial success and failure rates were recorded at the end of the study. RESULTS: In group B, we pulled everting sutures with the "horse bridle" technique at the 14th day, and successively removed all sutures between the 14th-30th post-operative day. At month-1, we recorded a significant IOP reduction in both groups (mean reduction of 11.5 mmHg for group A and of 14.4 mmHg for Group B, p = 0.001 and p < 0.0001, respectively). Furthermore, group B showed a significantly lower IOP than group A (-4.2 mmHg, 95% confidence interval [CI] -7.0 to -0.5 mmHg for group B, p = 0.01). At 2, 3 and 6-months, no significant IOP differences were reported between the two groups (all p > 0.05), but failure rate was higher for group A (21%) than for group B (11%). No differences in visual outcomes at any timepoints were noted. CONCLUSIONS: Trabeculectomy with removable regulating sutures showed a good safety profile, comparable to standard trabeculectomy. Moreover, we reported a lower IOP one month postoperatively, suggesting this technique may optimize early management of trabeculectomy.

Comparisons of laparoscopic and robotic pancreaticoduodenectomy using barbed and conventional sutures for pancreaticojejunostomy: a propensity score matching study.

BACKGROUND: There are limited data on the effect of different sutures and surgical approaches on the quality of pancreaticojejunostomy in minimally invasive pancreaticoduodenectomy (MIPD). This study compares the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) between the use of barbed sutures (BSs) and conventional sutures (CSs). METHODS: A retrospective cohort study was conducted on 253 consecutive patients who had undergone MIPD from July 2016 to April 2023. Patients were excluded if conversion to open surgery or open anastomosis was necessary. 220 patients were enrolled and divided into BS (n = 148) and CS (n = 72) groups. After 1:1 propensity score matching (PSM), 67 cases remained in each group. Univariate and multivariate analyses identified factors associated with CR-POPF. Comparisons were also made between laparoscopic (LPD) and robotic (RPD) pancreaticoduodenectomy. RESULTS: After PSM, BSs were associated with significantly lower rates of CR-POPF (7.5 vs. 22.4%, P = 0.015) and severe complications (Clavien-Dindo ≥ III) (7.5vs. 19.4%, P = 0.043). No significant differences were found in operative time, length of postoperative hospital stay, or other major morbidities. Multivariate analyses revealed BMI ≥ 22 kg/m2 (OR = 5.048, 95% CI: 1.256-20.287, P = 0.023) and the use of BSs (OR = 0.196, 95% CI: 0.059-0.653, P = 0.008) as the independent predictors of CR-POPF. There were no significant differences in postoperative outcomes between the LPD and RPD groups, but RPD was associated with significantly shorter operative time (402.8 min vs. 429.4 min, P = 0.015). CONCLUSIONS: In conclusion, using BSs for PJ during MIPD is feasible and has the potential to reduce CR-POPF and severe complications.

Severe conjunctival allergic reaction to polyglactin 910 sutures following strabismus surgery: A case report.

INTRODUCTION AND IMPORTANCE: Polyglactin 910 sutures are commonly used in strabismus surgery due to their favorable handling and absorption qualities. However, their potential to cause allergic reactions is poorly documented in medical literature. This case report emphasizes this rare complication, stressing the importance of promptly recognizing and managing such reactions to ensure optimal patient outcomes. CASE PRESENTATION: An 11-year-old girl with a history of left congenital partial third nerve palsy was treated with 8-0, polyglactin 910 sutures during a strabismus surgery. However, two days postoperatively, she experienced persistent redness, swelling, and pain in her left eye despite antibiotic therapy. After six days, the sutures were removed, resulting in an immediate reduction in symptoms. By the two-month follow-up, the patient fully recovered, with no signs of inflammation or complications. CLINICAL DISCUSSION: This case highlights a rare but crucial allergic reaction to polyglactin 910 sutures used in strabismus surgery. The patient's persistent inflammation, pain, and resistance to antibiotics indicated a localized allergic reaction, rather than an infection. The prompt resolution of symptoms after suture removal supports the diagnosis of suture-related allergic reaction. This case emphasizes the need to consider suture material as a potential cause of postoperative complications, especially when standard treatment fails. CONCLUSION: Healthcare providers should be alert to potential allergic reactions to sutures after strabismus surgery. Timely identification and removal are vital for resolving the symptoms and achieving optimal patient outcomes. This case emphasizes the importance of postoperative care protocols that consider allergies to suture material.

Cleidocranial Dysplasia Presenting With Mixed Dentition in a 28-Year-Old Male: A Case Report.

Cleidocranial dysplasia (CCD) is an inherited development anomaly of the skeletal system that is also classified as an autosomal dominant genetic disorder. This is due to a gene mutation on chromosome 6p21 that encodes core binding factor activity a-1 (CBFA1), a member of runt-related transcription factor 2 (RUNX2) found on the short arm of chromosome 6. CCD is a scarce condition and its occurrence is about one per million births. It primarily affects bones that are derived from both endochondral and intramembranous ossification. It is identified by certain clinical and radiological features including open cranial sutures and open anterior fontanelle, aplastic or hypoplastic clavicles, wormian bones, short stature, deformities of the pelvic bones, and various skeletal changes. Patients usually show class III malocclusion because of mandibular hyperplasia and mid-face hypoplasia. Vertical facial growth is reduced due to hypoplasia of the alveolar bone, and permanent teeth eruptions are failed. We reported a case of CCD in a 28-year-old who was referred to OPD for poor esthetics.

Advances and Techniques in Subcuticular Suturing for Abdominal Wall Closure: A Comprehensive Review.

Subcuticular suturing has emerged as a prominent technique for abdominal wall closure, offering notable benefits in cosmetic outcomes, infection reduction, and patient satisfaction. This comprehensive review delves into the evolution and current state of subcuticular suturing, examining its principles, techniques, and advancements. Traditional methods like continuous and interrupted suturing are compared with modern innovations like barbed sutures and knotless techniques. Clinical outcomes, including healing efficacy, complication rates, and cost-effectiveness, are analyzed to highlight the technique's advantages. The review also explores specific applications in various surgical specialities, presenting case studies and clinical trials to substantiate its effectiveness. Despite certain challenges and limitations, the future of subcuticular suturing appears promising with ongoing research and technological advancements. This review aims to thoroughly understand subcuticular suturing, emphasizing its significance in improving surgical outcomes and patient care in abdominal wall closure.

Jellyfish-Inspired Artificial Spider Silk for Luminous Surgical Sutures.

The development of functional surgical sutures with excellent mechanical properties, good fluorescence, and high cytocompatibility is highly required in the field of medical surgeries. Achieving fibers that simultaneously exhibit high mechanical robustness, good spinnability, and durable fluorescence emission has remained challenging up to now. Taking inspiration from the spinning process of spider silk and the luminescence mechanism of jellyfish, this work reports a luminous artificial spider silk prepared with the aim of balancing the fiber spinnability and mechanical robustness. This is realized by employing highly hydrated segments with aggregation-induced luminescence for enhancing the fiber spinnability and polyhydroxyl segments for increasing the fiber mechanical robustness. Twist insertion during fiber spinning improves the fiber strength, toughness, and fluorescence emission. Furthermore, coating the fiber with an additional polymer layer results in a "sheath-core" architecture with improved mechanical properties and capacity to withstand water. This work provides a new design strategy for performing luminescent and robust surgical sutures.

Comparison of Fibrin Glue With Conventional Suturing in Peripheral Nerve Repairs: A Study of Sensory and Motor Outcomes.

BACKGROUND: Nerve injuries have traditionally been repaired with sutures, and this method is considered the gold standard technique in the management of nerve injuries. However, fibrin glue has recently become a promising tool for repairing nerve injuries and has advantages including ease of usability, atraumatic application technique, and decreased co-optation time of the nerves. This study aims to clinically evaluate the efficacy of nerve repair with fibrin glue compared with the usual suture technique in terms of sensory and motor outcomes. METHODS: A total of 80 patients were included in the study; 50 patients underwent primary nerve repair, and 30 patients underwent Oberlin's repair. These subsets were randomly divided into two groups in which the nerves were repaired with microsutures in one group and fibrin glue in the other group. RESULTS: In the comparison of fibrin glue with microsutures, there were no significant differences between the two groups in the 2-point discrimination (2PD) test, Semmes-Weinstein test, motor function, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores. However, the co-optation times were significantly shorter with fibrin glue than with microsutures. CONCLUSION: Based on our findings, nerve repair with fibrin glue is as effective as microsutures in terms of sensory and motor recovery and has added advantages of ease of usability and shorter repair times. Therefore, fibrin glue may be an effective alternative to sutures in nerve repair.

Postoperative monitoring of ovariohysterectomy carried out with two types of surgical sutures in shelter cats and differences in selected blood parameters between shelter and pet cats.

BACKGROUND: Reduction of inflammation and early detection of complications after surgical procedures are important objectives for proper veterinary practice. This study aimed to evaluate the differences between shelter and pet female cats in selected acute-phase parameters scheduled to ovariohysterectomy. Postoperative monitoring after ovariohysterectomy with the same laboratory parameters was performed in shelter cats, in which two different types of surgical sutures were used for the entire procedure. The experimental group comprised 40 female cats from animal shelters ('shelter cats,' n = 40). These cats were divided into two subgroups: group A (n = 20) operated on with absorbable sutures and group NA (n = 20) operated on with non-absorbable sutures. In addition, the same parameters were evaluated in pet female cats (n = 19). Blood was collected from shelter cats immediately before surgery (term 0), at 24 and 72 h (terms 1 and 3, respectively), and at 7 and 14 days (terms 7 and 14, respectively) after ovariohysterectomy. Blood samples from the pet cat group were collected only once. RESULT: The mean haptoglobin concentration before ovariohysterectomy in pet cats was significantly lower than that in shelter cats. Fibrinogen concentration was significantly lower in pet cats than in cats from group A. Serum albumin, beta-1, beta-2, and gamma-globulin concentrations were significantly higher in the shelter cats than in the pet cats. Subcutaneous tissue thickening at the site of the postoperative wound was observed in five patients cats (25%) in group A, and two (10%) cats in the NA group. CONCLUSION: These results indicate that ovariohysterectomy leads to local and general inflammatory responses. The majority of cats from animal shelters suffered from subclinical inflammation.

Simultaneous Muraine Sutures and Excimer Laser-Assisted Penetrating Keratoplasty for Acute Keratoconus.

Background: Acute keratoconus (acute KC), which affects approximately 1.6-2.8% of keratoconus (KC) patients, is a pathological condition of the cornea characterized by stromal edema due to entry of aqueous humor through a tear in Descemet's membrane. Methods: We present a novel combination of surgical procedures that allows swifter visual recovery in a consecutive, retrospective case series. The new surgical procedure for acute KC consists of a combination of Muraine corneal sutures to smooth the corneal curvature and Excimer laser-assisted penetrating keratoplasty and was performed in six acute KC patients from 2019 to 2022 at the Department of Ophthalmology, University Hospital of Martin-Luther-University Halle-Wittenberg (UMH), Germany. We monitored data on preoperative status, operative details, intraoperative and postoperative complications and visual outcomes were analyzed. Results: The mean age was 41.5 ± 13.5 years (3 OD, 3 OS). Neurodermatitis was present in 3 patients (50%). All patients received significant visual benefits from the procedure. Preoperative BCVA was hand motion (logMAR 3.0) in all patients; postoperatively, BCVA improved significantly logMAR 0.03 ± 0.09 [range: 0.2-0.4; p < 0.001, FUP 20+/-10 months). Visual acuity remained stable throughout the roughly biannual follow-ups. One patient developed endothelial graft rejection after 2 years. During the last examination, all eyes had clear grafts and stable curvatures, K1 and K2 being 42.43 ± 4.17 D and 44.95 ± 4.07 D, respectively, and mean corneal astigmatism was 2.61 ± 1.74 D. The thinnest corneal thickness was 519 ± 31 µm. A graft size of 8.0 × 8.1 mm was the most beneficial. Conclusions: in patients with acute KC and hydrops, a penetrating keratoplasty with Muraine corneal sutures is successful in terms of graft clarity and visual outcome. Combining the procedures allows quicker visual recovery. Patients with a history of neurodermatitis should have preoperative and postoperative dermatologic treatment and close follow-up for possible complications.

Aplasia Cutis Congenita Pathomechanisms Reveal Key Regulators of Skin and Skin Appendage Morphogenesis.

Aplasia cutis congenita (ACC) manifests at birth as a defect of the scalp skin. New findings answer 2 longstanding questions: why ACC forms and why it affects mainly the midline scalp skin. Dominant-negative mutations in the genes KCTD1 or KCTD15 cause ACC owing to loss of function of KCTD1/KCTD15 complexes in cranial neural crest cells (NCCs), which normally form midline cranial suture mesenchymal cells that express keratinocyte growth factors. Loss of KCTD1/KCTD15 function in NCCs impairs the formation of normal midline cranial sutures and, consequently, the overlying skin, resulting in ACC. Moreover, KCTD1/KCTD15 complexes in keratinocytes regulate skin appendage morphogenesis.

Relationship Between Circummaxillary and Intramaxillary Suture Densities and Skeletal Effects of Rapid Maxillary Expansion.

Objective: This retrospective clinical study aimed to evaluate the maturation of intramaxillary and circummaxillary suture systems and cervical vertebral maturation as predictors of the skeletal response achieved by rapid maxillary expansion (RME). Methods: A Digital Imaging and Communication in Medicine dataset of 20 patients (mean age: 15.55 years) prior (T0) and after (T1: 3.5±0.5 months) to RME were retrieved from the archive and analyzed. Bone density values of midpalatal suture (MPS), zygomaticomaxillary suture (ZMS), zygomaticotemporal suture (ZTS), pterygopalatine suture (PPS), and transverse palatine suture (TPS) were measured. The cervical vertebral maturational stages (CVS) were examined. The linear distances between the most lateral points of the piriform apertures were measured as the anterior reference, and the medial margins of the greater palatine foramina on the axial slice were chosen as the posterior reference. The difference at T1-T0 was calculated as the skeletal response to RME at anterior and posterior skeletal references. Spearman's rho rank and Kruskal-Wallis tests were used. Results: Mean density values of ZMS, PPS, ZTS, TPS, MPS-Anterior, and MPS-Posterior were 922.81, 807.44, 753.83, 640.77, 661.13, and 604.59 HU, respectively. Mean linear changes in anterior and posterior skeletal expansion were 2.93±1.78 and 1.93±2.52 mm. There was no significant relationship between maturation indicators and skeletal response. Significant relationships were found between CVS and MPS density and CVS and circummaxillary suture average density (p≤0.05). Conclusion: Sutural density showed significant variations among CVSs. Although there was no correlation between skeletal response and density measurements, sutural density was found to be a promising indicator for future studies.

Antimicrobial-coated sutures versus non-coated sutures in reducing surgical site infection: an updated systematic review and meta-analysis.

BACKGROUND: Antimicrobial-coated sutures are one of the strategies to avoid surgical site infection (SSI) caused by microbial colonization on the surface of surgical sutures. AIM: To investigate the effectiveness of antimicrobial-coated sutures in reducing SSI and develop the latest systematic evaluation evidence for clinical SSI prevention and the use of antimicrobial-coated sutures. METHODS: The databases of MEDLINE, Embase, CINAHL, Cochrane, African Index Medicus, and WHO Global Health were searched from October 10th, 1990 to March 3rd, 2023 with language restricted to English, Spanish, and French. Meta-analysis was used to evaluate the impact of antimicrobial-coated sutures on SSI and whether their effectiveness is influenced by the type of sutures or wounds. Subgroup analyses were conducted based on type of sutures and wounds. Finally, quality of the retrieved evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). FINDINGS: Twenty-six randomized control trials (RCTs) and nine observational studies (OBSs) met the inclusion criteria. Antimicrobial sutures significantly reduced SSI risk (RCTs: odds ratio: 0.74; 95% confidence interval: 0.63-0.87; P = 0.0002; OBSs: OR: 0.61; 95% CI: 0.48-0.76; P < 0.0001). Only subgroup analysis of Polydioxanone Suture (PDS) Plus vs PDS, Vicryl Plus vs Vicryl and mixed wounds revealed consistent results in favour of antimicrobial-coated sutures. According to GRADE, the quality of RCT evidence is moderate, while that of OBS evidence is low. CONCLUSION: Antimicrobial-coated sutures are effective in reducing the risk of postoperative SSI among a large number of surgical patients. However, the available evidence is of moderate/low quality and many studies had conflicts of interest.

Association between skin suture devices and incidence of incisional surgical site infection after gastrointestinal surgery: systematic review and network meta-analysis.

BACKGROUND: Surgical site infections (SSIs) are common complications after abdominal surgery. AIM: To compare which suture devices could reduce the incidence of incisional surgical site infections (SSIs) after gastrointestinal surgery using a systematic review and network meta-analysis. METHODS: The CENTRAL, PubMed, and ICHUSHI-Web databases were searched from January 1st, 2000, to December 31st, 2022, for randomized clinical trials (RCTs) comparing the incidence of incisional SSI after gastrointestinal surgery among patients treated with different surgical suture devices, including non-absorbable sutures, absorbable sutures, skin staplers, and tissue adhesives (last searched in August 23th, 2023). The risk of bias was assessed using the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. To estimate the pooled odds ratios (ORs) for each comparison, a fixed-effect inverse-variance model based on the Mantel-Haenszel approach was employed. FINDINGS: A total of 18 RCTs with 5496 patients were included in this study. The overall SSIs in absorbable sutures were significantly lower than those in skin staplers (OR: 0.77; 95% confidence intervals (CI): 0.63-0.95) and non-absorbable sutures (OR: 0.62; 95% CI: 0.39-0.99), whereas SSIs in absorbable sutures were not significantly different from the SSIs in tissue adhesive. The highest P-score was 0.91 for absorbable sutures. A funnel plot for estimating the heterogeneity of the studies revealed that a publication bias would be minimal (Egger test, P = 0.271). CONCLUSION: This study showed that absorbable sutures reduced incisional SSIs in gastrointestinal surgical operations compared to any other suture devices.

Training in cataract surgery in Spain: analysis of the results of a survey of the European Board of Ophthalmology in a Spanish cohort.

INTRODUCTION: A survey conducted by the European Board of Ophthalmology (EBO) revealed significant differences in the surgical training of the ophthalmology residents in Europe, including a disparity between the sexes and a variation in the experience on cataract surgery (CC) between them. This study is about the Spanish sub-cohort of the survey, and its objective is to present and analyse the peculiarities of ophthalmology training in Spain within the European context, as well as discussing ways to harmonise and improve that training throughout the EU. METHODS: We analyse data of the Spanish participants in the EBO exams, defining subgroups by the Autonomous Communities existing in Spain. RESULTS: 93 of 135 requested participants (68.9%) responded. A 60.2% passed the EBO exam between 2021 and 2022, being mostly women (65.59%) aged 31 years old on average. The 91.4% were right-handed, coming from 13 of the 17 Spanish autonomous communities, although mostly from the Community of Valencia, Madrid and Catalonia. Respectively, 16.1%, 3.2% and 8.7% of the respondents said they have completed 10 or more training sessions on animal eyes, synthetic eyes and through the virtual reality simulator. This training was correlated with greater self-confidence in the management of a posterior capsular tear during surgery (p .025). All respondents manifested to have already performed stages of the CC. The average number of operations reported was 181.6 with regional disparities. A significant difference is observed between the sexes against women (-28.3%, p 0.03). DISCUSSION: Ophthalmologists in Spain, much more than other European countries, have greater opportunities for surgical training, with surgical procedures during the residency, that nearly triples those made by the others. Spanish women refer, like their European colleagues, to be in disadvantage in learning opportunities about cataract surgery. The Simulation Based Medical Education (SBME) allows to respond to the training deficit and complements the training on the patient. Although we demonstrate a significant correlation between the number of procedures carried out and self-confidence to operate simple cases, the SBME would be a complementary tool in self-confidence in front of a complication like capsular rupture. CONCLUSION: Spain massively adopts the model named by us "surgery for all", despite the underrepresentation of women in this area, emphasising a need for cultural change that the SBME could facilitate.

Unexpected massive bleeding during the modified LeFort III advancement surgery for Crouzon syndrome: A case report.

Key Clinical Message: Vigilant monitoring for postoperative complications, including bleeding and dysrhythmia, is crucial in patients with craniosynostosis syndromes like Crouzon syndrome undergoing craniofacial surgery, with a thorough evaluation, including coagulation tests, assisting in diagnosing underlying conditions such as von Willebrand disease subtype 1 to inform appropriate management strategies. Abstract: Crouzon syndrome is a rare genetic disorder affecting craniofacial structures. Its etiology is the premature fusion of cranial sutures. The LeFort III advancement surgery is a commonly used approach to correct malformations related to midface hypoplasia. Complications following surgical treatment of craniosynostosis and craniofacial syndromes can include both intracranial and extracranial problems. Reporting of this syndrome and the surgery complications, in addition to consideration of other differential diagnoses, can help improve the treatment plan and surgery outcomes. The aim of the article is to report a 14-year-old female with Crouzon syndrome who underwent the modified LeFort III osteotomy and developed unexpected massive bleeding during the surgery. Post-surgery, she experienced complications including dysrhythmia, hypothermia, and cyanosis. Treatment included fluid therapy, blood transfusions, and antibiotic therapy for suspected septic shock. Differential diagnosis was disseminated intravascular coagulation but was ruled out. Post-discharge, coagulation tests suggested von Willebrand disease subtype 1 as the diagnosis. Excessive bleeding during surgery for craniosynostosis syndromes is a significant and concerning issue in the surgical management of Crouzon syndrome. For patients with von Willebrand disease who are candidates for elective surgeries, von Willebrand factor concentrates or recombinant von Willebrand factor can be used.