Arthroscopic acetabular labrum suture.

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

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

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

Técnica de Karydakis modificada para el tratamiento del sinus pilonidal gigante / Modified Karydakis procedure for giant pilonidal sinus

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

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

A Simulator for Measuring Forces During Surgical Knots.

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

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

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

The accordion suture technique: A modified rhinoplasty spreader flap.

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

[Bronchus sutures failure in lung cancer surgery].

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

[Laparoscopic treatment of perforated ulcers].

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

Suturing principles for the dentoalveolar surgeon.

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

Análisis del comportamiento de tres configuraciones distintas de sutura de las tuberosidades en las fracturas del húmero proximal tratadas mediante hemiartroplastias / Analysis of behavior of three different configurations for suturing tuberosities in humerus fractures treated by proximal hemiarthroplasty

Objetivo: Evaluar experimentalmente la distancia entre los fragmentos sobre especímenes cadavéricos en las fracturas proximales de húmero con cuatro partes. Material y metodología: El estudio se realizó sobre 5 húmeros sintéticos que reproducían una fractura proximal en 4 partes. Con un sistema de fijación un robot reprodujo los movimientos de rehabilitación de la articulación glenohumeral. Las configuraciones de sutura (Ethibond®) fueron estándar, de Boileau y una sutura que aprovechaba el vector de fuerza de los tendones que componen el manguito rotador. El robot efectuaba una abducción de 100º con rotación interna de 45º y 45º de rotación externa. Todas estas pruebas se realizaran 6 veces con 60 repeticiones cada una. El desplazamiento de los fragmentos provocado por los movimientos de simulación durante la rehabilitación. Se midió el desplazamiento que producido entre las tuberosidades y con la diáfisis. Resultados: La disminución del desplazamiento entre los fragmentos de la técnica de banda de tensión es hasta tres veces menor que la estándar y dos veces menor que la de Boileau para la reconstrucción sin lesión del manguito. En aquellos casos que el manguito rotador estaba lesionado se mantuvo dicha diferencia. Conclusión: es posible mejorar las suturas actualmente utilizadas para la fijación de los fragmentos óseos en fracturas proximales de húmero tratadas con hemiartroplastias, utilizando los vectores de fuerza como guía para la dirección de las bandas de tensión (AU)

Objective: To evaluate experimentally the distance between fragments in cadaveric specimens in proximal fractures of the humerus in four parts. Material and Methods: The study was conducted in 5 synthetic humeruses that reproduced a proximal fracture in 4 parts. With a fixation system, the robot reproduced the movements for rehabilitation of the glenohumeral joint. The suture configurations (Ethibond®) were standard, Boileau and a suture taking advantage of the strength vector of the tendons forming the rotator cuff. The robot performed an abduction of 100º with an internal rotation of 45º and external rotation. All these tests were performed 6 times with 60 repetitions each. Displacement of the fragments caused by the simulation movements during rehabilitation The displacement produced was measured between the tuberosities and with the diaphysis. Results: Decreased displacement between the fragments with the band pressure technique was up to three times less than standard and two times less than Boileau for reconstruction without damage to the cuff. In cases in which the rotator cuff was damaged, this difference was maintained. Conclusion: It is possible to improve the sutures currently used for fixing bone fragments in proximal humerus fractures treated with hemiarthroplasties, using strength vectors as guide for the direction of the tension bands (AU)

Suturing: an update for the general dental practitioner.

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

Suturing for optimal soft-tissue management.

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

How reliable is intracorporeal laparoscopic knot tying?

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

Sutura meniscal artroscópica asociada a la cirugía de reconstrucción del ligamento cruzado anterior / Arthroscopic meniscal suture associated with reconstruction surgery of the anterior cruciate ligament

Revisamos 7 casos de rotura meniscal asociada a inestabilidad crónica anterior de rodilla por rotura del ligamento cruzado anterior con cuatro años después de la cirugía. Todos los casos fueron tratados, durante el mismo procedimiento quirúrgico, procediendo en primer lugar a efectuar la reparación meniscal y seguidamente a la ligamentoplastia mediante autoinjerto antólogo HTH. Debido a los buenos resultados obtenidos, consideramos que la sutura meniscal, siempre que ésta sea posible, debería ser un gesto quirúrgico añadido, en el transcurso de la cirugía de reconstrucción del ligamento cruzado anterior

We review 7 cases of meniscal ruptured associated with chronic anterior instability of the knee due to rupture of the ACL with two years evolution after surgery. In all the cases, and by means of arthroscopic techniques, we have proceeded to carry out, at the same time, the repair both of the damaged meniscus with meniscal suture and the reconstruction of the ACL by means of autologous ligamentoplasty with Bone-Tendon-bone. Due to the good results obtained, we consider that meniscal suture, whenever possible, should be an added surgical gesture, in the reconstruction surgery process of anterior cruciate ligament

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

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

Sutura discal temporomandibular: Técnica cerrada (artroscopia) / Temporomandibular disc suture: Closed technique (arthroscopy)

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