Biomechanical and histological comparison of two suture configurations for soft tissue grafts: speedtrap™ versus krackow stitch.

To compare 2 different graft preparation techniques to determine biomechanical strength and resultant tissue trauma evaluated by histology. Twelve common flexors of the finger's tendons were prepared with either tubulization (SpeedTrap™) or transtendon stiches (Orthocord™). The stiffness, resistance and energy at maximum load were tested for biomechanical assessment in both groups. After load testing, Samples were stained with hematoxylin and eosin (HE) to evaluate histological damage. We observe that the time to prepare tendons with SpeedTrap™ was 8.3 times faster (1:25 min) than traditional ones (15:02 min). In all cases, the mean values for SpeedTrap™ were higher in terms of strength, stiffness and energy at maximum load than for traditional suture but without significant difference (p > 0.05). The Krackow stitch produces greater structural damage to the collagen fibers while SpeedTrap™ maintains better organized arrangement of the fibers after tubulization preparation. With the results obtained, we can conclude that the tubulization technique allows faster graft preparation with less structural damage to the manipulated tissue without altering the biomechanical resistance provided by the transtendon suture technique.

Does cyanoacrylate have the best postoperative outcomes after third molar extractions when compared to conventional sutures? A systematic review and meta-analysis.

Purpose: Tissue synthesis is extremely important for the attenuation of postoperative discomforts, as it keeps the tissues coapted, accelerates the healing process, and reduces the bleeding period of the surgical wound. Thus, this study aimed to systematically review the results of clinical trials that compared the use of cyanoacrylate with conventional sutures after third molars extraction. Materials and methods: Searches were conducted on MEDLINE (via PubMed), Cochrane Central Registry of Controlled Trials (CENTRAL), Virtual Health Library (VHL), and Web of Science. Articles published up to February 20, 2022, were included. No restrictions were imposed on data or language of publication. Results: A total of 8 studies (5 randomized controlled trials and 3 non-randomized comparative clinical studies) were included in this review and five studies were included in the meta-analysis, comprising 440 patients. The use of cyanoacrylate promoted better results in pain reduction in the first postoperative day when compared to the use of conventional suture (SMD: -1.01; 95%CI -1.90 to -0.12). Cyanoacrylate group promoted significant but borderline edema reduction compared to conventional sutures in the 7th postoperative day (SMD: -0.24, 95%CI -0.46 to -0.01, I2 = 0 %). For the trismus outcome, in all periods evaluated no differences were found between the groups. Conclusion: Although promising results, there is no high-quality evidence to suggest the use of cyanoacrylate was better than conventional sutures.

Internal suspension sutures in tip rhinoplasty.

BACKGROUND: Achieving an aesthetically pleasant tip rotation is paramount in rhinoplasty, and these results should be long-lasting. However, even powerful structural techniques such as septal extension grafts can lose rotation over time, as most support depends on the attachment of the graft to the septal cartilage. METHODS: We describe a simple suture technique to strengthen tip support in rhinoplasty, by suspending it to the cartilaginous dorsum, providing additional support to the tip against forces, such as gravity, scar contraction and muscle tension. CONCLUSIONS: Combining traditional techniques with suspension sutures can improve intraoperative results and could enhance long-term tip stability.

[Results of all-inside arthroscopic meniscal sutures, mid-term review]. / Resultado de suturas meniscales por técnica artroscópica ''todo adentro'', revisión a mediano plazo.

INTRODUCTION: all-in meniscal suture devices have evolved and simplified meniscal repair. In this study we will formulate the following research questions: what is the rate of survival and failure? What are the risk factors associated with failure? And what are the functional results after meniscal repair surgery? MATERIAL AND METHODS: ambispective study from 2001 to 2021 of patients with repairable meniscal injury with all-in meniscal suture devices. The survival and failure ratio were obtained with the Kaplan-Meier test, the risk factors associated with meniscal suture failure were assessed with the logistic regression test, and the pre- and post-surgical functional results were estimated with the test. t-Student. RESULTS: in 20 years of follow-up of 316 menisci repaired with all-in meniscal sutures, a survival rate of 95.9% was obtained. The absence of injury to the anterior horn of the meniscus was shown to be a protective factor [OR = 0.12], together with not practicing impact sports [OR = 0.2]. Post-surgery IKDC and Tegner-Lysholm results were shown to be very good to excellent (p < 0.0001). CONCLUSION: all-in meniscal suture devices are and will continue to be front-line weapons in the repair of meniscal tears. In 20 years of follow-up, a lower failure rate was evidenced, associated with excellent functional results.

INTRODUCCIÓN: los dispositivos de suturas meniscal todo adentro han evolucionado y simplificado la reparación meniscal. En este estudio formulamos las siguientes preguntas de investigación: ¿cuál es la tasa de supervivencia y falla?, ¿cuáles son los factores de riesgo asociado a falla? y ¿cuáles son los resultados funcionales posterior a la cirugía de reparación meniscal? MATERIAL Y MÉTODOS: estudio ambispectivo desde el 2001 al 2021 de pacientes con lesión meniscal reparable con dispositivos meniscales de sutura todo adentro. La razón de supervivencia y falla se obtuvo con el test de Kaplan-Meier, los factores de riesgo asociado con falla de la sutura meniscal se valoraron con el test de regresión logística y los resultados funcionales pre y postquirúrgicos fueron estimados con la prueba t-Student. RESULTADOS: en 20 años de seguimiento de 316 menisco reparados con suturas meniscal todo adentro se obtuvo que la razón de supervivencia de 95.9%. La ausencia de lesión del cuerno anterior del menisco se mostró como un factor protector [OR = 0.12], junto a la no práctica de deportes de impacto [OR = 0.2]. Se mostraron resultados del IKDC y Tegner-Lysholm posterior a la cirugía de muy buenos a excelentes (p < 0.0001). CONCLUSIÓN: los dispositivos de sutura de meniscal todo adentro son y seguirán siendo armas de primera línea en la reparación de las roturas meniscales. En 20 años de seguimiento se evidenció una menor tasa de falla, asociados con excelentes resultados funcionales.

Modelo alternativo para o treinamento de técnicas de microssuturas em "patch" de pericárdio bovino / Alternative model for training microsuture techniques in bovine pericardium patches

Introdução: As técnicas microcirúrgicas caracterizam-se pela aplicação de manobras e suturas em estruturas milimétricas com o auxílio de lentes de aumento. São técnicas complexas, utilizadas em diversas especialidades médicas, que demandam grande habilidade e treinamento antes da aplicação em humanos. O objetivo é desenvolver um modelo de baixo custo e alta fidelidade, para o treinamento de técnicas de microcirurgia, utilizando um fragmento de patch de pericárdio bovino. Método: São utilizados para a confecção deste modelo segmentos remanescentes de uma placa de pericárdio bovino, previamente utilizado em reparos vasculares. O material é recortado em duas partes simétricas e suas extremidades fixadas aos campos cirúrgicos, com auxílio de clamps. A borda superior de cada uma das partes é, então, suturada à borda inferior com fio de Prolene 8-0, de maneira que cada uma forme uma estrutura tubular. Posteriormente, as extremidades tubulares livres passam pela dissecção da camada adventícia e são suturadas entre si, mimetizando uma anastomose vascular término-terminal. Resultados: Com o modelo, simulam-se os mesmos inconvenientes/ dificuldades presentes nas suturas vasculares humanas, como a delaminação de camadas, excesso da camada adventícia e risco de sutura inadvertida da parede posterior, provando sua utilidade na aquisição de habilidades microcirúrgicas básicas, sem necessidade de manipulação de tecidos humanos ou animais. A prática neste modelo pode ocorrer dentro do próprio centro cirúrgico e emprega materiais que seriam descartados. Conclusão: A utilização do pericárdio bovino para confecção de suturas milimétricas mimetiza o tecido vascular humano e é um procedimento de baixo custo, que possibilita o treinamento de habilidades microcirúrgicas.

Introduction: Microsurgical techniques are characterized by the application of maneuvers and sutures to millimetric structures with the aid of magnifying lenses. These are complex techniques, used in various medical specialties, which require great skill and training before applying them to humans. The objective is to develop a lowcost and high-fidelity model for training microsurgery techniques using a fragment of bovine pericardium patch. Method: Remaining segments of a bovine pericardium plate, previously used in vascular repairs, are used to create this model. The material is cut into two symmetrical parts, and its ends are fixed to the surgical drapes with the aid of clamps. The upper edge of each part is then sutured to the lower edge with 8-0 Prolene thread so that each one forms a tubular structure. Subsequently, the free tubular ends undergo dissection of the adventitial layer and are sutured together, mimicking an end-to-end vascular anastomosis. Results: With the model, the same inconveniences/ difficulties present in human vascular sutures are simulated, such as delamination of layers, excess of the adventitial layer, and risk of inadvertent suturing of the posterior wall, proving its usefulness in the acquisition of basic microsurgical skills, without need to manipulate human or animal tissues. Practice in this model can take place within the surgical center itself and uses materials that would otherwise be discarded. Conclusion: The use of bovine pericardium to create millimetric sutures mimics human vascular tissue and is a low-cost procedure that allows the training of microsurgical skills.

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.

COMPARATIVE EVALUATION OF SKIN SUTURE IN RATS WITH POLYGLYCAPRONE 25 AND NYLON.

Currently, the market offers a wide variety of suture threads, made of materials with different structural and chemical properties. Among many other characteristics, they vary in origin, absorption or degradation, and structure. From this variety, the clinical doubt arises as to which material provides the patient with the best healing quality. Objective: This study aims to comparatively evaluate two different types of suture threads-Monocryl® (polyglycaprone 25) and Ethilon® (nylon)-regarding their ability to aid in tissue regeneration by a histological and immunohistochemical analysis of the skin of rats sutured with the aforementioned materials. Methods: This basic experimental study used 12 adult Wistar rats, randomly divided into three groups with four animals each and subjected to four longitudinal incisions under anesthesia. Each group corresponded to a postsurgical evaluation date (one, seven, and 14 days). Results: At 14 postoperative days, the studied groups had no histological difference. However, the use of nylon thread showed greater evidence of earlier fibrotic union. Conclusion: This study found no histological difference in healing 14 days after surgery among the techniques and the types of suture threads. Level of Evidence II, Therapeutic Studies.

Atualmente, encontra-se disponível no mercado uma grande variedade de fios de sutura, compostos de materiais com diferentes propriedades estruturais e químicas, que variam quanto à origem, absorção ou degradação e estrutura, entre outras características. A partir dessa disponibilidade, emerge a dúvida clínica quanto ao material que propicia a melhor qualidade de cicatrização ao paciente. Objetivo: Avaliar comparativamente dois tipos de fios - Monocryl® (poliglicaprone 25) e Ethilon® (nylon) - quanto à sua capacidade de auxílio na regeneração tecidual, por meio da análise histológica e imuno-histoquímica da pele de ratos submetidos a suturas com esses materiais. Métodos: Neste estudo básico experimental, foram utilizados 12 ratos adultos da linhagem Wistar, randomicamente divididos em três grupos com quatros animais cada, que foram submetidos a quatro incisões longitudinais sob anestesia. Cada grupo correspondeu a uma data de avaliação pós-cirúrgica (1, 7 e 14 dias). Resultados: Passados 14 dias após a operação, não houve diferença histológica em relação aos grupos estudados. No entanto, o uso de fio de nylon apresentou evidência de união fibrótica mais precoce. Conclusão: Não há diferença histológica de cicatrização após 14 dias pós-operatórios entre as técnicas e os tipos de fio de sutura. Nível de Evidência II, Estudos Terapêuticos.

Persistência da sutura metópica em crânios secos adultos do Nordeste brasileiro: análise antropológica forense / Persistence of metopic suture in adult dry skulls from Northeast Brazil: a forensic anthropological analysis / Persistencia de la sutura metópica en cráneos secos adultos del Nordeste de Brasil: análisis antropológico forense

A sutura metópica forma-se aproximadamente no primeiro trimestre da vida intrauterina entre os dois centros de ossificação que irão formar o osso frontal. Há controvérsias na literatura em relação ao momento em que essa sutura oblitera, mas se sabe que ocorre antes dos dez anos de idade; entretanto, essa sutura pode não obliterar e persistir ao longo da vida do indivíduo. Este trabalho objetivou relatar a persistência da sutura metópica em crânios secos de esqueletos humanos adultos pertencentes ao Centro de Estudos em Antropologia Forense da Faculdade de Odontologia da Universidade de Pernambuco (CEAF/FOP/UPE), com a finalidade de demonstrar a importância para a perícia antropológica forense. Dentre os 426 examinados, foram identificados dez crânios (2,4%) com a presença de sutura metópica completa, sendo 5 do sexo masculino e 5 do feminino, compreendendo uma faixa etária de 29 a 86 anos. A persistência da metópica possui relevância forense, afinal as variações anatômicas são vistas como estruturas que não são consequência de uma patologia e que diferem do encontrado na população geral, tornando o indivíduo que as possui ainda mais único. Dessa forma, essa variação anatômica pode atuar como auxiliar no processo de identificação humana na perícia antropológica forense... (AU)

The metopic suture forms approximately in the first trimester of intrauterine life between the two ossification centers that will form the frontal bone. There are controversies in the literature as to when this suture obliterates, but it is known to occur before the age of ten; however, this suture may not obliterate and persist throughout the individual's life. This work aimed to report the persistence of the metopic suture in dried skulls of adult human skeletons belonging to the Center for Studies in Forensic Anthropology of the School of Dentistry of the University of Pernambuco (CEAF/FOP/UPE) in order to demonstrate its importance for forensic anthropology. Among the 426 skeletons examined, ten skulls (2.4%) with complete metopic sutures were identified, five male and five female, ranging in age from 29 to 86 years. The persistence of metopic sutures has forensic relevance, after all, anatomical variations are seen as structures that are not a consequence of pathology and that differs from what is found in the general population, making the individual who has them even more unique. Thus, this anatomical variation can act as an aid in the process of human identification in forensic anthropology... (AU)

La sutura metópica se forma aproximadamente en el primer trimestre de vida intrauterina entre los dos centros de osificación que formarán el hueso frontal. Existen controversias en la literatura sobre el momento en que se oblitera esta sutura, pero se sabe que ocurre antes de los diez años; sin embargo, esta sutura puede no obliterarse y persistir durante toda la vida del individuo. Este estudio tuvo como objetivo informar sobre la persistencia de la sutura metópica en cráneos desecados de esqueletos humanos adultos pertenecientes al Centro de Estudos em Antropologia Forense de la Faculdade de Odontologia da Universidade de Pernambuco (CEAF/FOP/UPE), con el fin de demostrar su importancia para la antropología forense. Entre los 426 esqueletos examinados, se identificaron diez cráneos (2,4%) con presencia de sutura metópica completa, 5 masculinos y 5 femeninos, con edades entre 29 y 86 años. La persistencia de la sutura metópica tiene relevancia forense, después de todo las variaciones anatómicas son vistas como estructuras que no son consecuencia de una patología y que difieren de lo que se encuentra en la población general, haciendo aún más único al individuo que las presenta. Así pues, esta variación anatómica puede servir de ayuda en el proceso de identificación humana en antropología forense... (AU)

Resultado de suturas meniscales por técnica artroscópica "todo adentro", revisión a mediano plazo / Results of all-inside arthroscopic meniscal sutures, mid-term review

Resumen: Introducción: los dispositivos de suturas meniscal todo adentro han evolucionado y simplificado la reparación meniscal. En este estudio formulamos las siguientes preguntas de investigación: ¿cuál es la tasa de supervivencia y falla?, ¿cuáles son los factores de riesgo asociado a falla? y ¿cuáles son los resultados funcionales posterior a la cirugía de reparación meniscal? Material y métodos: estudio ambispectivo desde el 2001 al 2021 de pacientes con lesión meniscal reparable con dispositivos meniscales de sutura todo adentro. La razón de supervivencia y falla se obtuvo con el test de Kaplan-Meier, los factores de riesgo asociado con falla de la sutura meniscal se valoraron con el test de regresión logística y los resultados funcionales pre y postquirúrgicos fueron estimados con la prueba t-Student. Resultados: en 20 años de seguimiento de 316 menisco reparados con suturas meniscal todo adentro se obtuvo que la razón de supervivencia de 95.9%. La ausencia de lesión del cuerno anterior del menisco se mostró como un factor protector [OR = 0.12], junto a la no práctica de deportes de impacto [OR = 0.2]. Se mostraron resultados del IKDC y Tegner-Lysholm posterior a la cirugía de muy buenos a excelentes (p < 0.0001). Conclusión: los dispositivos de sutura de meniscal todo adentro son y seguirán siendo armas de primera línea en la reparación de las roturas meniscales. En 20 años de seguimiento se evidenció una menor tasa de falla, asociados con excelentes resultados funcionales.

Abstract: Introduction: all-in meniscal suture devices have evolved and simplified meniscal repair. In this study we will formulate the following research questions: what is the rate of survival and failure? What are the risk factors associated with failure? And what are the functional results after meniscal repair surgery? Material and methods: ambispective study from 2001 to 2021 of patients with repairable meniscal injury with all-in meniscal suture devices. The survival and failure ratio were obtained with the Kaplan-Meier test, the risk factors associated with meniscal suture failure were assessed with the logistic regression test, and the pre- and post-surgical functional results were estimated with the test. t-Student. Results: in 20 years of follow-up of 316 menisci repaired with all-in meniscal sutures, a survival rate of 95.9% was obtained. The absence of injury to the anterior horn of the meniscus was shown to be a protective factor [OR = 0.12], together with not practicing impact sports [OR = 0.2]. Post-surgery IKDC and Tegner-Lysholm results were shown to be very good to excellent (p < 0.0001). Conclusion: all-in meniscal suture devices are and will continue to be front-line weapons in the repair of meniscal tears. In 20 years of follow-up, a lower failure rate was evidenced, associated with excellent functional results.

Proposal for the Modification of the Method to Evaluate the Midpalatal Suture Maturation Status / Proposta de Modificação do Método para Avaliação do Status da Sutura Palatina Mediana

The objective of present research was to propose a new definition for the midpalatal suture (MPS) maturational stages through reevaluation of intermediate stages B, C and D. The sample was composed by 158 cone-beam computed tomography (CBCT) of individuals between 11 and 20 years of age (±15.4 years, 86 females and 71 males), divided into two groups: 74 individuals aged 11-15 years and 84 individuals aged 16-20 years. The CBCT scans were applied to evaluate midpalatal suture maturation status and comprised stages previously classified as B (29), C (92) and D (37). Each axial image was subdivided into six parts in the anteroposterior direction, and each portion was classified according to MPS maturational evaluation methodology. New definitions of stages were proposed. The reliability of the method was tested by two examiners and the intra- and inter-examiner concordances were defined for each evaluation through weighted kappa coefficients and 95% confidence intervals. The chi-square test was used to compare the groups. In all statistical tests, a significance level of 5% was adopted. Two new maturational stages were defined: sub-stage C- and sub-stage C+, with prevalence of 12% and 8.9%, respectively, in 11 to 20-year-olds. The redefinition and validation of the maturational stages of MPS, considering the sub-stages C- and C+, may allow to elucidate the difference in the prognosis of Rapid Maxillary Expansion among individuals aged 11 to 20 years. This data should be confirmed through a clinical study.(AU)

O objetivo da presente pesquisa foi propor uma nova definição para os estágios maturacionais da sutura palatina média (MPS) por meio da reavaliação dos estágios intermediários B, C e D. A amostra foi composta por 158 tomografias computadorizadas de feixe cônico (TCFC) de indivíduos entre 11 e 20 anos de idade (±15,4 anos, 86 do sexo feminino e 71 do sexo masculino), divididos em dois grupos: 74 indivíduos de 11 a 15 anos e 84 indivíduos de 16 a 20 anos. Os exames de TCFC foram aplicados para avaliar o estado de maturação da sutura palatina média e compreenderam os estágios previamente classificados como B (29), C (92) e D (37). Cada imagem axial foi subdividida em seis partes no sentido anteroposterior, e cada porção foi classificada de acordo com a metodologia de avaliação maturacional MPS. Novas definições de estágios foram propostas. A confiabilidade do método foi testada por dois examinadores e as concordâncias intra e interexaminadores foram definidas para cada avaliação por meio de coeficientes kappa ponderados e intervalos de confiança de 95%. O teste do qui-quadrado foi utilizado para comparar os grupos. Em todos os testes estatísticos adotou-se o nível de significância de 5%. Dois novos estágios maturacionais foram definidos: subestágio C- e subestágio C+, com prevalência de 12% e 8,9%, respectivamente, em jovens de 11 a 20 anos. A redefinição e validação dos estágios maturacionais da MPS, considerando os subestágios C- e C+, podem permitir elucidar a diferença no prognóstico da Expansão Rápida da Maxila entre indivíduos de 11 a 20 anos. Esses dados devem ser confirmados por meio de um estudo clínico.(AU)

Use of surgical glue versus suture to repair perineal tears: a randomised controlled trial.

BACKGROUND: Surgical glue has been used in several body tissues, including perineal repair, and can benefit women. OBJECTIVES: To evaluate the effectiveness of n-butyl-2-cyanoacrylate surgical glue compared to the polyglactin 910 suture in repairing first- and second-degree perineal tears and episiotomy in vaginal births. DESIGN: A parallel randomised controlled open trial. SETTING: Birth centre in Itapecerica da Serra, São Paulo, Brazil. PARTICIPANTS AND METHODS: The participants were 140 postpartum women allocated into four groups: two experimental groups repaired with surgical glue (n = 35 women with a first-degree tear; n = 35 women with a second-degree tear or episiotomy); two control groups sutured with thread (n = 35 women with a first-degree tear; n = 35 women with a second-degree tear or episiotomy). The outcomes were perineal pain and the healing process. Data collection was conducted in six stages: (1) up to 2 h after perineal repair; (2) from 12 to 24 h postpartum; (3) from 36 to 48 h; (4) from 10 to 20 days; (5) from 50 to 70 days; and (6) from 6 to 8 months. ANOVA, Student's t, Monte Carlo, x-square and Wald tests were used for the statistical analysis. RESULTS: One hundred forty women participated in the first three stages, 110 in stage 4, 122 in stage 5, and 54 in stage 6. The women treated with surgical glue had less perineal pain (p ≤ 0.001). There was no difference in the healing process, but the CG obtained a better result in the coaptation item (p ≤ 0.001). CONCLUSIONS: Perineal repair with surgical glue has low pain intensity and results in a healing process similar to suture threads. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (UTN code: U1111-1184-2507; RBR-2q5wy8o); date of registration 01/25/2018; www.ensaiosclinicos.gov.br/rg/RBR-2q5wy8/.

Method of closing fasciotomies by progressive tissue traction / Método de fechamento de fasciotomias por tração tecidual progressiva

High-energy trauma has increased significantly in the last decade, mostly in the lower limbs, in many cases requiring fasciotomy due to the subsequent compartment syndrome. In this context, its closure often leads to a delay in the patient's comprehensive treatment and the return to their activities and may lead to local infection, in addition to generating high costs. There are many options for the plastic surgeon to try to bring the edges together and reconstruct the extremities, such as flaps, grafts, vacuum dressings, and elastic sutures, in addition to expansion devices, sometimes with a combination of the above.

O trauma de grande energia vem aumentando de maneira expressiva na última década, em boa parte de membros inferiores, necessitando, em muitos casos, de fasciotomia devido à síndrome compartimental subsequente. Neste contexto muitas vezes seu fechamento acaba por levar a um retardo no tratamento integral do paciente, do retorno a suas atividades e podendo levar a infecção local, além de gerar altos custos. Há muitas opções ao cirurgião plástico para a tentativa de aproximação de bordos e reconstrução das extremidades, como retalhos, enxertos, curativo a vácuo e sutura elástica, além de dispositivos de expansão, sendo, às vezes, com combinação das anteriores. O método de fechamento apresentado através do alongamento progressivo da pele com fio de Kirschnner representa uma forma de baixo custo e facilmente reproduzível para lidar com este tipo de ferida.

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)

Polydioxanone Bioactive Sutures-Acetyl Hexapeptide-8 (Argireline): An Intelligent System for Controlled Release in Facial Harmonization.

Introduction: We propose a new facial lifting protocol using polydioxanone (PDO) threads embedded in acetyl hexapeptide-8 (Argireline [Arg]). We assume that Arg reinforces the effects of PDO threads, as it is a mimetic of botulinum toxin. Because the PDO suture is hydrolyzable, this assumption is analyzed by instrumental analysis. Objective: To demonstrate the capacity of the PDO suture as a system for the controlled release of acetyl hexapeptide-8 to apply in deep wrinkles of the upper third. Materials and Methods: Three segments of 1-cm long 21G PDO threads immersed in 1 mL of Arg. PDO threads were observed under an optical, electron microscope at 24, 48, and 72 h later. They were also weighed before and after being soaked in Arg, and employing ultraviolet (UV)-visible spectroscopy, the release rate of Arg from the PDO suture was measured. Finally, was insert the thread PDO-Arg following a protocol designed especially for deep static wrinkles in the upper third. Results: The electronic weighing revealed that the PDO thread enjoys capillarity by the peptide, doubling its weight every 24 h. UV spectra revealed that PDO thread is a well-controlled release system for Arg, allowing its sustained release for 1 h. Optical and electronic photomicrographs confirm the swelling of the PDO thread by absorbing Arg by its capillarity, but this hydrophilicity does not lead to its premature physical degradation. Conclusions: The PDO thread system with Arg is an intelligent bioactive system useful in facial harmonization. It recommend conduct clinical trial to verify his superior lifting effect.

Comparative evaluation of skin suture in rats with polyglycaprone 25 and nylon / Avaliação comparativa da sutura de pele com poliglicaprone 25 e nylon em ratos

ABSTRACT Currently, the market offers a wide variety of suture threads, made of materials with different structural and chemical properties. Among many other characteristics, they vary in origin, absorption or degradation, and structure. From this variety, the clinical doubt arises as to which material provides the patient with the best healing quality. Objective: This study aims to comparatively evaluate two different types of suture threads-Monocryl® (polyglycaprone 25) and Ethilon® (nylon)-regarding their ability to aid in tissue regeneration by a histological and immunohistochemical analysis of the skin of rats sutured with the aforementioned materials. Methods: This basic experimental study used 12 adult Wistar rats, randomly divided into three groups with four animals each and subjected to four longitudinal incisions under anesthesia. Each group corresponded to a postsurgical evaluation date (one, seven, and 14 days). Results: At 14 postoperative days, the studied groups had no histological difference. However, the use of nylon thread showed greater evidence of earlier fibrotic union. Conclusion: This study found no histological difference in healing 14 days after surgery among the techniques and the types of suture threads. Level of Evidence II, Therapeutic Studies.

RESUMO Atualmente, encontra-se disponível no mercado uma grande variedade de fios de sutura, compostos de materiais com diferentes propriedades estruturais e químicas, que variam quanto à origem, absorção ou degradação e estrutura, entre outras características. A partir dessa disponibilidade, emerge a dúvida clínica quanto ao material que propicia a melhor qualidade de cicatrização ao paciente. Objetivo: Avaliar comparativamente dois tipos de fios - Monocryl ® (poliglicaprone 25) e Ethilon ® (nylon) - quanto à sua capacidade de auxílio na regeneração tecidual, por meio da análise histológica e imuno-histoquímica da pele de ratos submetidos a suturas com esses materiais. Métodos: Neste estudo básico experimental, foram utilizados 12 ratos adultos da linhagem Wistar, randomicamente divididos em três grupos com quatros animais cada, que foram submetidos a quatro incisões longitudinais sob anestesia. Cada grupo correspondeu a uma data de avaliação pós-cirúrgica (1, 7 e 14 dias). Resultados: Passados 14 dias após a operação, não houve diferença histológica em relação aos grupos estudados. No entanto, o uso de fio de nylon apresentou evidência de união fibrótica mais precoce. Conclusão: Não há diferença histológica de cicatrização após 14 dias pós-operatórios entre as técnicas e os tipos de fio de sutura. Nível de Evidência II, Estudos Terapêuticos.

Resultados del taller para residentes de ginecoobstetricia en reparación de episiotomías y desgarros obstétricos / Results of workshop for obstetrics and gynecology residents on episiotomy and injury obstetric tear repair

Resumen OBJETIVO: Evaluar los conocimientos, satisfacción y nivel de confianza de los médicos residentes de Ginecología y Obstetricia luego de haber participado en un taller de simulación de reparación de episiotomías y desgarros perineales severos. MATERIALES Y MÉTODOS: Estudio observacional y transversal efectuado en residentes de la especialidad de Ginecología y Obstetricia en junio del 2022. Se aplicaron cuestionarios de conocimientos antes y después del taller, una encuesta de satisfacción y nivel de confianza, así como una lista de cotejo para valorar el desempeño en la ejecución de la técnica de reparación de episiotomías y desgarros. Se utilizó estadística descriptiva y prueba de t pareada para la comparación antes y después de las muestras relacionadas. Se consideró significancia estadística una p < 0.05. RESULTADOS: Se incluyeron 37 médicos residentes de todos los grados académicos. La media de la evaluación preprueba fue de 14.89 ± 0.54 puntos y 15.81 ± 0.41 puntos en la posprueba (p = 0.233). Durante la práctica de reparación de la episiotomía, 34 de los 37 residentes reconocieron estructuras anatómicas y todos seleccionaron adecuadamente el material de sutura. En el taller de desgarros perineales 25 de 37 reconocieron las estructuras anatómicas y todos, menos uno, seleccionaron adecuadamente el material. CONCLUSIONES: El taller con modelos animales de simulación tiene un alto grado de satisfacción y nivel de confianza; sin embargo, en este estudio no se observó mejoría en los conocimientos. Este efecto positivo en los médicos en vías de especialización permite identificar, de manera oportuna, las lesiones del esfínter anal, llevar a cabo una correcta reparación y, en consecuencia, disminuir la incidencia de disfunciones asociadas con el traumatismo obstétrico perineal.

Abstract OBJECTIVE: To assess the knowledge, satisfaction and level of confidence of Gynaecology and Obstetrics residents after participating in a simulation workshop on episiotomy and severe perineal tear repair. MATERIALS AND METHODS: Observational and cross-sectional study carried out in residents of the speciality of Gynaecology and Obstetrics in June 2022. Knowledge questionnaires were administered before and after the workshop, a satisfaction and confidence level survey, as well as a checklist to assess the post-workshop episiotomy and tear repair technique. Descriptive statistics and paired t-test were used for pre- and post-test comparison. A p < 0.05 was considered statistically significant. RESULTS: Thirty-seven resident physicians of all academic grades were included. The mean pre-test assessment was 14.89 ± 0.54 points and 15.81 ± 0.41 points at post-test, p = 0.233. During episiotomy repair practice, 34 of the 37 residents recognized anatomical structures and all selected suture material appropriately. In the perineal tears workshop 25 of 37 recognized anatomical structures and all but one selected material appropriately. CONCLUSIONS: The workshop with simulation animal models has a high satisfaction and confidence level; however, no improvement in knowledge was observed in this study. This positive effect on trainee doctors allows early identification of anal sphincter injuries, correct repair and consequently a decrease in the incidence of dysfunction associated with perineal obstetric trauma.

Recent Methods Used for Analysis of Midpalatal Suture Closure Before Maxillary Expansion in Humans: A Systematic Review

The evaluation of the maturation of the midpalatal suture is highly important before making the clinical decision on whether to correct a transverse discrepancy in a conventional or surgical way. For this purpose, there are methods such as hand and wrist analysis, evaluation of maturation of the cervical vertebrae, and evaluation by means of occlusal radiographs. The main objective of this systematic review is to identify in the current literature the use of new methods and technologies to evaluate the maturation of the midpalatal suture before performing maxillary expansion. A bibliographic search was carried out using PubMed, Cochrane Library, SciELO, LILACS, Web of Science and Scopus using the terms midpalatal suture, cranial sutures, palate, maturation, interdigitation, ossification, maxillary expansion, evaluatio n, assessment and assess. The 119 articles were obtained, of which only 7 meet the selection criteria, which describe qualitative, quantitative and semiquantitative evaluation methods. During the last few years, due to advances in technology and science, various promising methods and techniques have been proposed for the evaluation of median palatal suture maturation. The quality of the available evidence is not enough to support the use of any one of these methods on their own. We recommend that clinicians use multiple diagnostic methods for an objective assessment of the maturation of the midpalatal suture, to guide them in their clinical decisions.

La evaluación de la maduración de la sutura palatina mediana es de suma importancia antes de tomar la decisión clínica sobre si corregir una discrepancia transversal de forma convencional o quirúrgica. Para ello existen métodos como el análisis de la mano y la muñeca, la evaluación de la maduración de las vértebras cervicales y la evaluación mediante radiografías oclusales. El objetivo principal de esta revisión sistemática es identificar en la literatura actual el uso de nuevos métodos y tecnologías para evaluar la maduración de la sutura palatina mediana antes de realizar la expansión maxilar. Se realizó una búsqueda bibliográfica en PubMed, Cochrane Library, SciELO, LILACS, Web of Science y Scopus, utilizando los términos "midpalatal suture", "cranial sutures", "palate, maturation", "interdigitation", "ossification", "maxillary expansion", "evaluation",y "assessment". Se obtuvieron 119 artículos, de los cuales solo 7 cumplieron con los criterios de selección. Estos, describen métodos de evaluación cualitativos, cuantitativos y semicuantitativos. Durante los últimos años, debido a los avances tecnológicos y científicos, se han propuesto varios métodos y técnicas prometedoras para la evaluación de la maduración de la sutura palatina media. La calidad de la evidencia disponible no es suficiente para apoyar el uso de alguno de estos métodos por sí solo. Recomendamos que los profesionales utilicen una combinación de métodos de diagnóstico, que permitan una evaluación objetiva de la maduración de la sutura palatina mediana y ayuden a guiarlos en sus decisiones clínicas.

Uso concomitante de sutura elástica associada ao curativo a vácuo no fechamento de grandes perdas de partes moles / Concomitant use of elastic suture associated with vacuum dressing in the closure of large soft tissue losses

O tratamento das feridas complexas com grande perda de partes moles é um desafio para a cirurgia plástica, principalmente quando a ferida encontra-se infectada. Várias opções são consideradas para o tratamento, como sutura, enxertos, retalhos, expansores. Devido à complexidade dos casos, frequente associação de morbidades, necessidade de intervenções multidisciplinar e longos internamentos, os custos do tratamento são frequentemente elevados. Este trabalho vem demonstrar a técnica de sutura elástica empregada em um caso clínico, utilizando tração contínua da pele em associação ao curativo a vácuo, que possibilitou reabilitação do paciente sem a necessidade de intervenções mais agressivas para o fechamento da ferida traumática extensa.

Treating complex wounds with great loss of soft tissues is a challenge for plastic surgery, especially when the wound is infected. Several options are considered for treatment, such as sutures, grafts, flaps, and expanders. Due to the complexity of the cases, the frequent association of morbidities, the need for multidisciplinary interventions, and long hospital stays, treatment costs are often high. This work demonstrates the elastic suture technique used in a clinical case, using continuous skin traction in association with a vacuum dressing, which enabled patient rehabilitation without the need for more aggressive interventions to close the extensive traumatic wound.

Midpalatal Suture Maturation Method for the Assessment of Maturation before Maxillary Expansion: A Systematic Review.

Assessment of midpalatal suture maturation is crucial before deciding which type of maxillary expansion technique will be performed to treat transverse discrepancies. In 2013, Angelieri et al. proposed a new method to evaluate midpalatal maturation using cone-beam computed tomography. The aim of this study was to systematically identify, evaluate, and provide a synthesis of the existing literature about this new method and to rigorously assess the methodological quality of these articles. A bibliographic search was carried out using PubMed, Cochrane Library, SciELO, LILACS, Web of Science, and Scopus using the terms midpalatal suture, cranial sutures, palate, maturation, interdigitation, ossification, maxillary expansion, evaluation, assessment, and assess. Quality assessment was performed using the Observational Cohort and Cross-Sectional Studies tool developed by the National Heart, Lung, and Blood Institute. Hence, 56 articles were obtained, of which only 10 met the selection criteria. We could not include any of the data into an analysis because of the large variation of the data collected and high methodological heterogeneity found among studies. Of all the studies included, 10% had poor quality, 70% fair, and 20% good quality, respectively. Even though age and sex play a role in midpalatal suture obliteration, there is a poor correlation between these variables. Thus, every patient should be assessed individually before choosing the best protocol for maxillary expansion. The midpalatal suture maturation method has the potential to be used for diagnostic purposes, but clinicians should be cautious of routinely using it because an extensive training and calibration program should be performed prior.

Use of non-surgical aesthetic refinement after orthognathic surgery: Case studies.

Orthognathic surgery has an undeniable functional effect, but the aesthetic result must not be disregarded, especially since many patients visit the surgeon precisely because of an aesthetic complaint and ignore the practical benefits. The aim of this paper is to discuss about an ideal treatment that combines this functional improvement with facial aesthetics and improves it after the operation. In order to predict which aesthetic deficits may occur, a facial analysis is essential. As precise as the virtual planning may be, there is still no exact predictability of soft tissue behavior. Some non-surgical procedures can help the surgeon achieve a result that better meets the patients' expectations. Imaging exams, photographs, facial analyzes, and patient complaints are essential to assess the possibility of any postoperative refinement. The entire surgical planning is discussed with the patient; the possibility of refinement must be part of the treatment plan. The surgeon's focus is on the functional correction of the dentofacial deformity, but the aesthetic outcome is essential for the patient. The results of this study suggest that refinement should be part of the treatment plan.