RÉSUMÉ
Parastomal hernias are an inevitable consequence of ostomy formation and their repairs remain a challenge to many surgeons. With multiple systems of classification and a multitude of techniques for hernia repair ranging from suture to mesh repair, the literature remains sparse with regards to the optimal method of repair. The authors describe the most commonly adopted techniques, discuss preventative measures, and review the current literature in the context of perioperative outcomes and hernia recurrence.
Sujet(s)
Herniorraphie , Filet chirurgical , Humains , Herniorraphie/méthodes , Herniorraphie/effets indésirables , Hernie incisionnelle/chirurgie , Hernie incisionnelle/étiologie , Hernie incisionnelle/prévention et contrôle , Hernie ventrale/chirurgie , Hernie ventrale/étiologie , Stomies chirurgicales/effets indésirables , Résultat thérapeutique , Récidive , Techniques de sutureRÉSUMÉ
PURPOSE: To compare the outcomes of anterior chamber intraocular lens (AC-IOL) implantation versus the four-flanged scleral fixation technique in eyes with loss of capsular support during routine cataract surgery. METHODS: This was a retrospective cohort study of all patients in whom an IOL was implanted either during or after short-term aphakia due to loss of capsular and sulcus support in a routine cataract surgery with at least 6 months of follow-up time between 2015 and 2023 in a tertiary medical center in Israel. Two different IOL implantation techniques were compared: the implantation of an angle-supported ACIOL and four-flanged scleral fixation. Main outcome measures included postoperative complications such as pseudophakic bullous keratopathy, loss of intraocular pressure control and glaucoma, IOL subluxation, and retinal detachment. RESULTS: Sixty-five eyes of 65 patients were included in the study, 33 eyes in the AC-IOL group and 32 eyes in the flange group. Follow-up time was 29.92 ± 20.02 months in the AC-IOL group and 20.17 ± 15.56 months in the flange group (P = .087). Pseudophakic bullous keratopathy was observed in 10 (30.3%) patients in the AC-IOL group and in 1 (3.1%) patient in the flange group (P = .04). This association remained significant using survival analysis (P = .006). In 4 (12.1%) patients in the AC-IOL group, a glaucoma filtering procedure was performed to control the intraocular pressure compared with none in the flange group (P = .042). CONCLUSIONS: In the setting of loss of capsular support during routine cataract surgery, four-flanged scleral fixation showed an overall lower rate of complications and significantly reduced rate of subsequent surgical interventions. [J Refract Surg. 2024;40(8):e520-e526.].
Sujet(s)
Chambre antérieure du bulbe oculaire , Pose d'implant intraoculaire , Sclère , Acuité visuelle , Humains , Pose d'implant intraoculaire/méthodes , Études rétrospectives , Sclère/chirurgie , Femelle , Mâle , Sujet âgé , Acuité visuelle/physiologie , Adulte d'âge moyen , Chambre antérieure du bulbe oculaire/chirurgie , Complications postopératoires , Techniques de suture , Études de suivi , Pression intraoculaire/physiologie , Lentilles intraoculaires , Extraction de cataracte/méthodes , Phacoémulsification/méthodes , Sujet âgé de 80 ans ou plus , Capsule du cristallin/chirurgie , Pseudophakie/physiopathologieRÉSUMÉ
BACKGROUND: Anastomotic leakage (AL) is the most frequent life-threating complication following colorectal surgery. Several attempts have been made to prevent AL. This prospective, randomized, multicentre trial aimed to evaluate the safety and efficacy of nebulised modified cyanoacrylate in preventing AL after rectal surgery. METHODS: Patients submitted to colorectal surgery for carcinoma of the high-medium rectum across five high-volume centres between June 2021 and January 2023 entered the study and were randomized into group A (anastomotic reinforcement with cyanoacrylate) and group B (no reinforcement) and followed up for 30 days. Anastomotic reinforcement was performed via nebulisation of 1 mL of a modified cyanoacrylate glue. Preoperative features and intraoperative and postoperative results were recorded and compared. The study was registered at ClinicalTrials.gov (ID number NCT03941938). RESULTS: Out of 152 patients, 133 (control group, n = 72; cyanoacrylate group, n = 61) completed the follow-up. ALs were detected in nine patients (12.5%) in the control group (four grade B and five grade C) and in four patients (6.6%), in the cyanoacrylate group (three grade B and one grade C); however, despite this trend, the differences were not statistically significant (p = 0.36). However, Clavien-Dindo complications grade > 2 were significantly higher in the control group (12.5% vs. 3.3%, p = 0.04). No adverse effects related to the glue application were reported. CONCLUSION: The role of modified cyanoacrylate application in AL prevention remains unclear. However its use to seal colorectal anastomoses is safe and could help to reduce severe postoperative complications.
Sujet(s)
Anastomose chirurgicale , Désunion anastomotique , Cyanoacrylates , Rectum , Humains , Désunion anastomotique/prévention et contrôle , Désunion anastomotique/étiologie , Femelle , Mâle , Études prospectives , Sujet âgé , Adulte d'âge moyen , Cyanoacrylates/administration et posologie , Anastomose chirurgicale/effets indésirables , Anastomose chirurgicale/méthodes , Rectum/chirurgie , Adhésifs tissulaires/usage thérapeutique , Techniques de suture , Tumeurs du rectum/chirurgie , Résultat thérapeutiqueSujet(s)
Fistule cutanée , Mucosectomie endoscopique , Fistule gastrique , Gastrostomie , Humains , Fistule gastrique/étiologie , Fistule gastrique/chirurgie , Gastrostomie/méthodes , Gastrostomie/effets indésirables , Fistule cutanée/étiologie , Fistule cutanée/chirurgie , Fistule cutanée/thérapie , Mucosectomie endoscopique/méthodes , Mucosectomie endoscopique/effets indésirables , Ablation de dispositif/méthodes , Mâle , Techniques de suture , Femelle , Sujet âgé , Adulte d'âge moyen , Gastroscopie/méthodesSujet(s)
Cholangiopancréatographie rétrograde endoscopique , Endosonographie , Endoprothèses , Humains , Cholangiopancréatographie rétrograde endoscopique/effets indésirables , Cholangiopancréatographie rétrograde endoscopique/méthodes , Endoprothèses/effets indésirables , Techniques de suture/instrumentation , Techniques de suture/effets indésirables , Mâle , Femelle , Sujet âgé , Échographie interventionnelleRÉSUMÉ
PURPOSE: Mitigating unwanted refractive errors is crucial for surgeons to ensure quality vision after penetrating keratoplasty (PK). The primary objective of the present study is to highlight the importance of microstructural matching of the host and the donor cornea during PK on the distribution of the corneal tissue while suturing. METHODS: For this purpose, the present study undertakes an in-vitro PK model to analyse the effect of suturing and host-donor misalignment on corneal birefringence. Five groups of experiments were performed using five corneoscleral buttons. In each group, N = 16 data points (corresponding to 16 simple interrupted sutures) were assessed before and after PK with five degrees of misalignments, 0°, 30°, 45°, 60° and 90° to detect the variations in corneal birefringence post-PK. The technique of digital photoelasticity is utilized to capture the corneal birefringence experimentally. RESULTS: The local and global features of corneal birefringence provided interesting insights into the nuances of corneal birefringence in PK. Statistical analysis was performed to study the effects of suturing on the birefringence around the suture bites. It was observed that the interaction of the suture tension and structural misalignment between the host and the donor cornea influences the corneal birefringence in PK. Conclusions The zero-degree structural misalignment of the host and the donor tissue is preferable to minimize the topographical irregularities and related astigmatism post-PK. The findings of the present study envisage an additional step of structurally aligning the donor tissue with the host before suturing to minimize topographical irregularities in PK.
Sujet(s)
Collagène , Cornée , Kératoplastie transfixiante , Donneurs de tissus , Kératoplastie transfixiante/méthodes , Cornée/chirurgie , Collagène/composition chimique , Matériaux de suture/effets indésirables , Biréfringence , Humains , Techniques de suture , Topographie cornéenne/méthodesRÉSUMÉ
Several fixation methods have been described to secure the cochlear implant's receiver/stimulator, but the optimal stabilization technique is still being debated. The aim of this study was to compare the conventional technique with suture fixation to the subperiosteal tight pocket technique in terms of revision cochlear implantation rate. A retrospective review was conducted on the medical records of 649 patients who underwent cochlear implantation. The study participants were divided into different groups regarding the applied surgery technique. The relationship between the fixation technique, revision rates, and the cause of revisions related to techniques was investigated. The overall revision rate was 2.9% (19 out of 649). There were 14 (3.5%) and 5 (2%) revision implantations in the subperiosteal tight pocket and conventional technique groups, respectively. The incidence of device failure was 2.5%, and it constituted the primary cause for revision surgery in both groups. Even though patients who had the subperiosteal tight pocket technique had a much higher rate of device failure, the results indicate that there was no significant difference between the groups, as evidenced by a P-value of .12. The conventional and subperiosteal tight pocket techniques can both be safely preferred with low revision rates in patients undergoing cochlear implantation.
Sujet(s)
Implantation cochléaire , Implants cochléaires , Réintervention , Techniques de suture , Humains , Études rétrospectives , Implantation cochléaire/méthodes , Réintervention/méthodes , Réintervention/statistiques et données numériques , Femelle , Mâle , Adulte d'âge moyen , Techniques de suture/instrumentation , Implants cochléaires/effets indésirables , Adulte , Enfant , Sujet âgé , Adolescent , Enfant d'âge préscolaire , Jeune adulte , Défaillance de prothèse , Nourrisson , Résultat thérapeutique , Sujet âgé de 80 ans ou plusRÉSUMÉ
BACKGROUND: A straight silicone stent can be used to treat proximal benign tracheal stenosis in non-surgical candidates. However, stent migration is a common complication when placed at a particular location and can lead to major complications. This case series of laryngotracheal stenosis reports a fixation method for straight silicone stents in the subglottic trachea (Stage 3 of the McCaffrey classification). METHODS: The medical charts of these patients scheduled for straight silicone stent placement with suture fixation between 2014 and 2020 at the CHU UCL Namur Hospital (Belgium) were retrospectively reviewed. The procedure was performed using a rigid bronchoscope. Details of the procedure were obtained from medical records. RESULTS: This case series included six patients (males: 4, females: 2). The median patient age was 59 years. Two suture fixations were placed following previous silicone stent migration episodes, whereas the others were placed proactively to avoid this risk. All fixations were performed by the device Freka® Pexact II ENFIt®, originally developed for gastropexy in endoscopic gastrostomy. The sutures were subcutaneously buried. CONCLUSIONS: During the 6-month follow-up period, complications such as fixation issues and stent migration were reported despite the off-label use of the treatment. The straight silicone stent fixation technique used in this case series was simple and effective for securing the stent in upper benign tracheal stenosis.
Sujet(s)
Laryngosténose , Endoprothèses , Sténose trachéale , Humains , Femelle , Adulte d'âge moyen , Mâle , Sténose trachéale/chirurgie , Laryngosténose/chirurgie , Études rétrospectives , Sujet âgé , Adulte , Techniques de suture , Récidive , Silicone , BronchoscopieRÉSUMÉ
Wound closure is an integral part of every spinal procedure. Effective and secure wound closure is paramount in the prevention of infection, wound dehiscence and the preservation of cosmesis. Barbed suture technologies such as STRATAFIX™ Symmetric have been studied and are used in a variety of specialties, including obstetrics and orthopedic surgery, but is underutilized in neurosurgery. This study aims to assess the time and rate of closure using STRATAFIX™ Symmetric technology for fascial closure and compare this method to the more traditionally used method of fascial closure using braided absorbable sutures below the epidermis. 20 patients were recruited for the study. 10 patients underwent fascial approximation with braided absorbable sutures and definitive fascial closure with STRATAFIX™ Symmetric. In the control group, fascial closure was completed entirely with interrupted braided absorbable stitches. Patients assigned to STRATAFIX™ Symmetric group had shorter mean time for fascial closure, faster rate of average fascial closure, and lower number of total sutures used. The use of barbed suture technology such as STRATAFIX™ Symmetric may reduce the time to closure in thoracolumbar spine surgery without increasing the risk of adverse events. This pilot study forms the framework for a larger randomized, controlled trial appropriately powered for such an analysis.
Sujet(s)
Fasciotomie , Techniques de suture , Matériaux de suture , Humains , Projets pilotes , Femelle , Mâle , Adulte d'âge moyen , Sujet âgé , Fasciotomie/méthodes , Études prospectives , Adulte , Procédures de neurochirurgie/méthodes , Rachis/chirurgie , Résultat thérapeutiqueRÉSUMÉ
BACKGROUND: The purpose of the study was to assess visual outcomes, complications, intraocular lens (IOL) stability, and corneal status after sutured scleral-fixated intraocular lens implantation combined with penetrating keratoplasty (PKP). METHODS: This retrospective single-arm cohort study included patients who underwent PKP and sutured scleral-fixated intraocular lens implantation between 2013 and 2018 at the Dhahran Eye Specialty Hospital. The eyes were examined postoperatively at 1, 3, 6, 12, and 24 months. Corneal status, complications, and IOL status were also evaluated periodically, and the number of eyes with a BCVA of > 20/200 was recorded. RESULTS: Twenty-two eyes from 22 patients were included. The median duration of follow-up was 3 (IQR 1.8; 4.4) years. Reasons for surgery were traumatic globe rupture (six eyes, 27.3%), bullous keratopathy (nine eyes, 40.1%), failed previous graft (five eyes, 22.7%), and corneal scarring (two eyes, 9.1%). Twelve (54.5%) eyes showed a BCVA of > 20/200 (non-blind) at 12 months after surgery and only five (22.7%) before surgery. Twelve months after surgery, 13 patients showed an improvement in BCVA in two lines (59.1%), seven remained the same (31.8%), and 2 deteriorated (9.1%). The indication for surgery (p = 0.2) and the stability of the sutured-scleral fixated IOL (p = 0.8) were not associated with an improvement in BCVA at the final follow-up. The corneal graft remained clear in nine eyes (40.9%) at a median duration of 3 years. The overall average survival period for all corneal grafts was 42.9 months. CONCLUSIONS: The combination of sutured scleral-fixated intraocular lens implants and PKP is an effective intervention for preserving visual acuity in patients with complex cases. However, the risk of graft failure and then need for repeat transplantation should be taken into consideration.
Sujet(s)
Kératoplastie transfixiante , Pose d'implant intraoculaire , Sclère , Techniques de suture , Acuité visuelle , Humains , Kératoplastie transfixiante/méthodes , Femelle , Études rétrospectives , Mâle , Pose d'implant intraoculaire/méthodes , Adulte d'âge moyen , Sclère/chirurgie , Sujet âgé , Adulte , Études de suivi , Maladies de la cornée/chirurgie , Résultat thérapeutique , Lentilles intraoculaires , Complications postopératoiresRÉSUMÉ
PURPOSE: Superficial surgical site infection (SSSI) is a prominent problem in spine surgery. Intracutaneous sutures and staple-assisted closure are two widely used surgical techniques for skin closure. Yet, their comparative impact on wound healing and infection rates is underexplored. Our goal was to address this gap and compare wound healing between these two techniques. METHODS: This study was a multicenter international prospective randomized trial. Patient data were prospectively collected at three large academic centers, patients who underwent non-instrumented lumbar primary spine surgery were included. Patients were intraoperatively randomized to either intracutaneous suture or staple-assisted closure cohorts. The primary endpoint was SSSI within 30 days after surgery according to the wound infection Centers for Disease Control and Prevention (CDC) classification system. RESULTS: Of 207 patients, 110 were randomized to intracutaneous sutures and 97 to staple-assisted closure. Both groups were homogenous with respect to epidemiological as well as surgical parameters. Two patients (one of each group) suffered from an A1 wound infection at the 30-day follow up. Median skin closure time was faster in the staple-assisted closure group (198 s vs. 13 s, p < 0,001). CONCLUSION: This study showed an overall low superficial surgical site infection rate in both patient cohorts in primary non instrumented spine surgery.
Sujet(s)
Vertèbres lombales , Infection de plaie opératoire , Cicatrisation de plaie , Humains , Mâle , Femelle , Adulte d'âge moyen , Cicatrisation de plaie/physiologie , Infection de plaie opératoire/prévention et contrôle , Études prospectives , Sujet âgé , Vertèbres lombales/chirurgie , Adulte , Techniques de suture , Agrafage chirurgical/méthodes , Techniques de fermeture des plaies , Matériaux de sutureRÉSUMÉ
The hinotori™ Surgical Robot System (hinotori™, Medicaroid, Kobe, Japan) is increasingly being utilized primarily in urology and adult surgery; however, data on its application in pediatric surgery are lacking. This preclinical study aimed to evaluate the limitations of this system for accurate suturing in small cavities designed for pediatric and neonatal applications. Two trained operators performed simple ligature sutures (easy task [ET]) and hepaticojejunostomy sutures (difficult task [DT]) within five differently sized boxes, ranging from 5123 to 125 mL. The suture time, number of internal and external instrument/instrument collisions, instrument/box collisions, and suture accuracy were evaluated. The suture accuracy was assessed using the A-Lap Mini endoscopic surgery skill assessment system. As a result, an increase in the number of collisions and extended suturing times were observed in boxes with volumes smaller than 215 mL. Despite these variations, there were no significant differences between the boxes, and all tasks were precisely performed in all boxes (p = 0.10 for the ET and p = 1.00 for the DT). These findings demonstrate the capability of the hinotori™ system to perform precise suturing techniques within tightly confined simulated neonatal cavities as small as 125 mL. To advance the integration of pediatric robotic surgery utilizing the hinotori™ system, additional trials comparing it with conventional laparoscopic and thoracoscopic techniques using pediatric and animal models are necessary to assess its clinical safety and applicability.
Sujet(s)
Interventions chirurgicales robotisées , Techniques de suture , Interventions chirurgicales robotisées/méthodes , Interventions chirurgicales robotisées/instrumentation , Techniques de suture/instrumentation , Humains , Matériaux de sutureRÉSUMÉ
PURPOSE: To assess the clinical efficacy of arthroscopic treatment for posterior cruciate ligament (PCL) tibial avulsion fractures using high-intensity suture binding combined with button plate suspension fixation. METHODS: We retrospectively analyzed clinical data from 32 patients with PCL tibial avulsion fractures treated at our hospital from July 2020 to August 2023. We recorded operation time, intraoperative and postoperative complications, and used imaging to assess fracture reduction and healing. Pain and knee function were evaluated using the Visual Analogue Scale (VAS), range of knee motion, Lysholm score, and International Knee Documentation Committee (IKDC) score. STUDY DESIGN: Case series; Level of evidence, 4. RESULTS: All patients were followed for 6 to 18 months, averaging 13.6 months. All incisions healed successfully without postoperative complications. X-rays taken on the first postoperative day showed satisfactory fracture reduction. Three-month post-surgery imaging confirmed healed fractures and no internal fixation failures. At the final follow-up, knee function was well recovered, with only one patient exhibiting a positive posterior drawer test of degree I. Furthermore, the mean VAS score was 0. 5 (range 0.0 to 1.0), active knee extension was 2. 2° (range 0.0 to 5.0), and active knee flexion was 137.7° (range 130.0 to 145.0). The mean Lysholm score was 91.5(range 89.3 to 94.0), and the IKDC score averaged 83.8 ± 3.7, and these outcomes showed statistically significant improvement from preoperative levels (P < 0.001). CONCLUSIONS: Arthroscopic high-intensity suture binding combined with button plate suspension fixation for PCL tibial avulsion fractures offers several benefits: it is minimally invasive, results in less postoperative pain, enables earlier functional exercise, and provides satisfactory clinical outcomes with fewer complications.
Sujet(s)
Arthroscopie , Plaques orthopédiques , Ostéosynthèse interne , Fractures-avulsions , Ligament croisé postérieur , Fractures du tibia , Humains , Mâle , Adulte , Femelle , Arthroscopie/méthodes , Fractures du tibia/chirurgie , Fractures du tibia/imagerie diagnostique , Études rétrospectives , Ligament croisé postérieur/chirurgie , Ligament croisé postérieur/traumatismes , Adulte d'âge moyen , Résultat thérapeutique , Ostéosynthèse interne/méthodes , Fractures-avulsions/chirurgie , Fractures-avulsions/imagerie diagnostique , Jeune adulte , Techniques de suture , Études de suivi , Amplitude articulaireRÉSUMÉ
This retrospective study aimed to compare the outcomes of modified double-flanged sutureless scleral fixation versus sutured scleral fixation. Medical records of 65 eyes from 65 patients who underwent double-flanged scleral fixation (flange group) or conventional scleral fixation (suture group) between 2021 and 2022 were reviewed. Visual and refractive outcomes, as well as postoperative complications, were compared 1, 2, and 6 months after surgery. We included 31 eyes in the flange group and 34 eyes in the suture group. At 6 months postoperatively, the flange group showed better uncorrected visual acuity (0.251 ± 0.328 vs. 0.418 ± 0.339 logMAR, P = 0.041) and a smaller myopic shift (- 0.74 ± 0.93 vs. - 1.33 ± 1.15 diopter, P = 0.007) compared to the suture group. The flange group did not experience any instances of iris capture, while the suture group had iris capture in 10 eyes (29.4%; P < 0.001). In the flange group, all intraocular lenses remained centered, whereas in the suture group, they were decentered in 8 eyes (23.5%; P = 0.005). The double-flanged technique not only prevented iris capture and decentration of the intraocular lens but also reduced myopic shift by enhancing the stability of the intraocular lens.
Sujet(s)
Sclère , Techniques de suture , Acuité visuelle , Humains , Sclère/chirurgie , Mâle , Femelle , Adulte d'âge moyen , Études rétrospectives , Sujet âgé , Résultat thérapeutique , Matériaux de suture , Pose d'implant intraoculaire/méthodes , Pose d'implant intraoculaire/effets indésirables , Interventions chirurgicales sans suture/méthodes , Adulte , Complications postopératoires/étiologieRÉSUMÉ
Iatrogenic perforation is the most feared adverse event in endoscopy. With the expansion of interventional endoscopy in favor of traditional surgery, it is now more crucial than ever to develop effective defect closure techniques. This has culminated in the dissemination of multiple novel closure technologies, including through-the-scope clips, over-the-scope clips, through-the-scope suturing and over-the-scope suturing devices. In this editorial, we comment on the recent publication by Wang and colleagues discussing the performance of the double-nylon purse-string suture technique in the closure of large (> 3 cm) gastric full-thickness defects. This technique offers a promising, practical and cost-effective approach to closure of large full-thickness defects that can be readily implemented across diverse healthcare settings.
Sujet(s)
Techniques de suture , Matériaux de suture , Humains , Techniques de suture/instrumentation , Maladie iatrogène/prévention et contrôle , Estomac/chirurgie , Résultat thérapeutiqueRÉSUMÉ
Xkin closure is a newly developed medical suture device for lacerations and surgical wounds that can reduce scarring, pain and the risk of infection compared with conventional sutures or staplers. A randomized controlled study was performed to compare the wound healing effects and complications of Xkin closure with stapler closure. Fifty patients who underwent robot-assisted radical prostatectomy for prostate cancer were randomly assigned. Only the wound above the navel, which was extended to take out the prostate was targeted. The wound was examined at 2, 6 and 12 weeks after surgery, and the modified Vancouver Scar Scale (mVSS), scar height and side effects were assessed with a 3D skin analyser. Forty-six patients (23 Xkin, 23 Stapler) were analysed. The mVSS scores, vascularity and pliability were significantly lower in the Xkin group compared with the stapler group at the 12-week follow-up. No significant differences in the maximum peak and depth of the scars were detected between the two groups using 3D photographs at 12 weeks. Xkin is an effective wound closure method for improving scar outcomes. This method is expected to be widely used for surgical wounds and lacerations caused by trauma in daily life.
Sujet(s)
Techniques de suture , Cicatrisation de plaie , Humains , Mâle , Adulte d'âge moyen , Sujet âgé , Techniques de suture/instrumentation , Cicatrice/prévention et contrôle , Cicatrice/étiologie , Ruban chirurgical , Prostatectomie/méthodes , Prostatectomie/effets indésirables , Matériaux de suture , Tumeurs de la prostate/chirurgie , Agrafeuses chirurgicales , Plaie opératoire , Résultat thérapeutiqueRÉSUMÉ
BACKGROUND: The osteonecrosis ratio in valgus impacted fractures of the proximal humerus is low (<10 %), giving osteosynthesis all its meaning. However, the optimal fixation technique remains controversial. After recentering the humeral head, osteosuture is stable enough to allow bone healing in an adequate position as well as a good long-term shoulder functionality. METHODS: Our cohort included 22 patients with a mean age of 65 (28-83). Patients were placed in a beach-chair position. Surgical exposure was done through an anterolateral, transdeltoid approach. Stay sutures were placed on both tuberosities. Elevation of the humeral head was obtained for 9 patients using iliac crest bone graft, for 7 patients using bone substitutes, for 6 without any graft needed. Both tuberosities were approximated and tied together using two horizontal non-absorbable double-threaded sutures. The whole head was also tied to the humeral metaphysis by cerclage wiring using the same suture. Patients were immobilized in a sling for 4 weeks with no passive or active mobilization; then began rehabilitation starting with passive and active-assisted mobilization. Functional outcome was assessed with the Constant score. Radiographic follow-up was used for fracture healing and osteonecrosis signs. RESULTS: All fractures united within the first 3 months. One patient had radiographic signs of osteonecrosis and one had a secondary displaced fracture without osteonecrosis. At an average follow-up of 35 months, the median Constant score was 83.7 % (63-100) in comparison to the uninjured side. DISCUSSION: A preserved posteromedial periosteal hinge in a valgus impacted fracture of the proximal humerus is key to the success of osteosuture. This hinge provides mechanical stability to the humeral head once elevated, as well as blood-supply from the branches of the posterior circumflex humeral artery. Computed Tomography with Three-Dimensional reconstructed images allow for a precise analysis of this hinge as well as the vascularity of the humeral head. Osteosuture being a minimally invasive surgical procedure plays a predominant role in sparing the remaining vascularization of the humeral head. CONCLUSION: Osteosuture in four-part valgus impacted fractures of the proximal humerus is a minimally invasive procedure as well as a reliable technique yielding good long-term results.
Sujet(s)
Ostéosynthèse interne , Consolidation de fracture , Fractures de l'épaule , Techniques de suture , Humains , Mâle , Fractures de l'épaule/chirurgie , Fractures de l'épaule/imagerie diagnostique , Femelle , Adulte d'âge moyen , Sujet âgé , Adulte , Ostéosynthèse interne/méthodes , Résultat thérapeutique , Sujet âgé de 80 ans ou plus , Amplitude articulaire , Ostéonécrose/chirurgie , Ostéonécrose/imagerie diagnostique , Études de suivi , Matériaux de suture , Radiographie , Transplantation osseuse/méthodesRÉSUMÉ
PURPOSE: The purpose of this study was to propose a surgical technique for arthroscopic medial patellofemoral ligament (MPFL) reconstruction with polyethylene suture combined with medial retinaculum plication and to evaluate the efficacy of this surgical technique in the treatment of acute patellar dislocation. METHODS: Clinical data of patients with acute patellar dislocations treated with arthroscopic MPFL reconstruction with polyethylene tape (FiberTape) combined with medial support band compression were analyzed retrospectively from January 2018 to January 2021. The mean age of the patients was 25.15 ± 4.66 years; the mean follow-up time was 27.5 (24-36) months. Clinical evaluation consisted of apprehension test results, patellar extrapolation test results, Lysholm score, Kujala score, and IKDC score, the Patellar lateral shift distance and patellar tilt angle (PTA) measured by CT scan. RESULTS: All patients had no recurrent patellar dislocation or subluxation after surgery, and the apprehension test was negative. In all patients, the Kujala score (36.0 ± 9.9 vs. 98.2 ± 3.1), the IKDC score (48.6 ± 7.0 vs. 90.6 ± 4.4) and the Lysholm score (32.8 ± 10.4 vs. 96.7 ± 3.1) had improved at the 24-month follow up (P < 0.05). In addition, PTA was significantly lower at the 12-month follow-up and 24-giving-month follow-up compared to the preoperative period (P < 0.05, Table 2). The patellar lateral shift distance decreased from 14.94 ± 6.11 mm preoperatively to 3.00 ± 1.40 mm (12-month follow up) and 3.26 ± 1.37 mm (24-month follow up), respectively. CONCLUSION: Arthroscopic MPFL reconstruction with polyethylene suture combined with medial retinaculum plication is a safe and reliable surgical technique for the treatment of acute patellar dislocation in young and middle-aged patients. LEVEL OF EVIDENCE: Level III, Therapeutic Study.
Sujet(s)
Arthroscopie , Luxation patellaire , Polyéthylène , Humains , Luxation patellaire/chirurgie , Luxation patellaire/imagerie diagnostique , Mâle , Femelle , Adulte , Études rétrospectives , Arthroscopie/méthodes , Jeune adulte , Études de suivi , Résultat thérapeutique , Matériaux de suture , Adolescent , Articulation fémoropatellaire/chirurgie , Articulation fémoropatellaire/imagerie diagnostique , Techniques de suture , Adulte d'âge moyen , /méthodes , /instrumentation , Ligaments articulaires/chirurgie , Ligaments articulaires/imagerie diagnostique , Ligaments articulaires/traumatismes , Ligament patellaire/chirurgie , Ligament patellaire/imagerie diagnostiqueRÉSUMÉ
Gastrointestinal luminal defects, including perforations, leaks and fistulae, pose persistent obstacles in endoscopic therapeutic interventions. A variety of endoscopic approaches have been proposed, with through-the-scope clipping (TTSC), over-the-scope clipping (OTSC) and suturing representing the main techniques of tissue apposition. However, the heterogeneity in defect morphology, the technical particularities of different locations in the gastrointestinal (GI) tract and the impact of various parameters on the final outcome, do not allow distinct conclusions and recommendations on the optimal approaches for defect closure, and, thus, current practice is based on endoscopists experience and local availability of devices. This review aims to collect the existing evidence on tissue apposition devices, in order to outline the role of every device on specific indications.