Modified compression sutures for treatment of asymptomatic uterine arteriovenous malformation in a low-resource setting: A case report.

INTRODUCTION AND IMPORTANCE: Uterine arteriovenous malformation (UAVM) can be present at birth or acquired later, often after trauma like cesarean delivery. It can cause severe vaginal bleeding but may have no symptoms. What makes our case special, other than being a rare condition, is the surgical technique used. CASE PRESENTATION: A 24-year-old woman came in with abdominal pain at 38 weeks pregnant. She had a cesarean delivery 13 months before. She had an uncomplicated repeat cesarean but bled heavily after from uterine atony. A 5 × 7 cm asymptomatic uterine AVM was found incidentally in the right uterine horn. After the transfusion, B-Lynch sutures were used to treat the atony and AVM. The patient recovered well after the sutures. Follow-up ultrasound showed the AVM got much smaller and no more bleeding. CLINICAL DISCUSSION: While conventional approaches advocate hysterectomy or uterine artery embolization (UAE), our case, situated in a low-income setting, necessitated innovative strategies. With embolization unavailable, and surgery carrying inherent risks, the B-lynch Procedure emerged as a pragmatic choice. CONCLUSION: Uterine AVM with no symptoms can happen after cesarean delivery. In low-resource settings, modified compression sutures can effectively treat heavy bleeding after delivery and shrink AVM size, avoiding hysterectomy.

Hamstring Anterior Cruciate Ligament Autograft Contributes to a Delayed Symptomatic Cyclops Lesion: A Case Report.

Cyclops lesions are characterized as fibroid nodules with granulation tissue that looks similar to a cyclops eye during arthroscopy. These are rare postoperative complications following anterior cruciate ligament reconstruction (ACLR), presenting typically within six months of their reconstruction. This case report presents a 21-year-old male, three years following hamstring autograft ACLR, with a symptomatic cyclops lesion. Contrary to the reported literature, this delayed presentation showed a painful flexion contracture of the knee and intraoperative findings consistent with a cyclops lesion. The treatment consisted of surgical debridement and notchplasty with subsequent posterior medial and lateral meniscal horn repairs. This case report presents a lesson to indicate that cyclops lesions can occur in a delayed setting following ACLR and to show a technique for successful surgical management of the lesion.

A modified pancreaticojejunostomy anastomotic technique using double U-sutures for laparoscopic pancreaticoduodenectomy.

Although recent advances in laparoscopic technology have popularized laparoscopic pancreatoduodenectomy (LPD), laparoscopic pancreaticojejunostomy anastomosis (PJA) still presents a major technical challenge. From February 2021 to January 2023, 42 patients underwent LPD with modified double U-suture PJA. Data on the demographic characteristics and clinical results of these patients were investigated. The median operation time was 316 min (249-596 min). The median PJA time was 32 min (25-40 min). The median intraoperative blood loss was 150 mL (50-500 mL). The median postoperative stay was 12 days (7-30 days). Complications occurred in 10 (23.8%) patients, including two cases (4.8%) of delayed gastric emptying and nine cases (21.4%) of postoperative pancreatic fistula (POPF). One patient presented delayed gastric emptying and POPF. Eight patients (19.0%) experienced biochemical leakage, and one patient (2.4%) had grade B POPF. Laparoscopic double U-suture PJA is a feasible and safe technique for performing LPD.

A rare case of fundal intramural ectopic pregnancy associated with previous B-Lynch sutures.

BACKGROUND: Intramural ectopic pregnancy is a rare form of ectopic pregnancy that occurs within the myometrium. It is challenging to diagnose it early because of its nonspecific clinical presentation, and there is no consensus or guideline on the optimal management among gynecologists. CASE PRESENTATION: We report a case of a 34-year-old woman who developed fundal intramural ectopic pregnancy after a previous caesarean section with B-Lynch suture. The B-Lynch suture was performed at 38 weeks of gestation for postpartum hemorrhage caused by refractory uterine atony about 8 years ago. Since then, the patient had oligomenorrhea. The diagnosis of intramural ectopic pregnancy was not confirmed by magnetic resonance imaging or ultrasound. An exploratory laparoscopy and hysteroscopy was performed to remove the gestational sac without significant bleeding. The surgery was successful and the patient recovered well. The patient was advised to monitor her ß-HCG levels regularly until they returned to normal, and a follow-up pelvic ultrasound showed no complications. However, she has not been able to conceive or have an ectopic pregnancy so far. CONCLUSIONS: This case illustrates the difficulty of diagnosing intramural ectopic pregnancy, especially when it is associated with previous uterine surgery and B-Lynch suture. It also demonstrates the feasibility and safety of laparoscopic surgery for treating complete IUP, especially when the gestational sac is located close to the uterine serosa. However, the risk of uterine rupture and hemorrhage should be considered, and the patient should be informed of the possible complications and alternatives. Gynecologists should be familiar with various management strategies and customize the treatment plan according to the patient's clinical situation and preferences.

Biodegradable suture development-based albumin composites for tissue engineering applications.

Recent advancements in the field of biomedical engineering have underscored the pivotal role of biodegradable materials in addressing the challenges associated with tissue regeneration therapies. The spectrum of biodegradable materials presently encompasses ceramics, polymers, metals, and composites, each offering distinct advantages for the replacement or repair of compromised human tissues. Despite their utility, these biomaterials are not devoid of limitations, with issues such as suboptimal tissue integration, potential cytotoxicity, and mechanical mismatch (stress shielding) emerging as significant concerns. To mitigate these drawbacks, our research collective has embarked on the development of protein-based composite materials, showcasing enhanced biodegradability and biocompatibility. This study is dedicated to the elaboration and characterization of an innovative suture fabricated from human serum albumin through an extrusion methodology. Employing a suite of analytical techniques-namely tensile testing, scanning electron microscopy (SEM), and thermal gravimetric analysis (TGA)-we endeavored to elucidate the physicochemical attributes of the engineered suture. Additionally, the investigation extends to assessing the influence of integrating biodegradable organic modifiers on the suture's mechanical performance. Preliminary tensile testing has delineated the mechanical profile of the Filament Suture (FS), delineating tensile strengths spanning 1.3 to 9.616 MPa and elongation at break percentages ranging from 11.5 to 146.64%. These findings illuminate the mechanical versatility of the suture, hinting at its applicability across a broad spectrum of medical interventions. Subsequent analyses via SEM and TGA are anticipated to further delineate the suture's morphological features and thermal resilience, thereby enriching our comprehension of its overall performance characteristics. Moreover, the investigation delves into the ramifications of incorporating biodegradable organic constituents on the suture's mechanical integrity. Collectively, the study not only sheds light on the mechanical and thermal dynamics of a novel suture material derived from human serum albumin but also explores the prospective enhancements afforded by the amalgamation of biodegradable organic compounds, thereby broadening the horizon for future biomedical applications.

Establishment of an Animal Model of Dog Bite Injuries.

Nowadays dog bite is becoming a world public health problem. Therefore, the study aimed to develop a dog bite animal model that is helpful to solve these problems. In this study, the skull of an adult dog was scanned. The three-dimensional model of the dog maxillofacial bones and dentition was built by MIMICS. Next, the model was printed with Co-Cr alloy by using selective laser sintering technology to develop the dog bite simulation pliers. Then, to simulate dog bite to most, the maximum bite force of the pliers was measured and actions contained in dog bite process was analyzed. Afterwards, according to action analysis results, rabbits were bitten by the prepared instrument in actions that simulate dog's bite. Finally, the reproducibility and controllability of this animal model of dog bite injuries was validated in an in vivo study. The results showed a reliable animal model of dog bite injuries has been developed in this study. The sites and severities of the injuries could be adjusted as the operator wishes and the animal model of dog bite injuries was highly repeatable. This study also indicates the feasibility of using digital technology in establishing animal bite models.

Comparison of Different Suturing Techniques in Post-Extraction Socket Healing.

Background: The process of post-extraction socket healing is critical for ensuring proper tissue repair and minimizing complications in dental practice. Suturing techniques play a pivotal role in this process, influencing wound closure, hemostasis, and overall healing. Materials and Methods: This prospective clinical trial involved 80 participants who required single-tooth extractions. Patients were randomly assigned to four groups, each receiving a distinct suturing technique: simple interrupted sutures, horizontal mattress sutures, vertical mattress sutures, and continuous sutures. Standardized assessments, including clinical examination and cone-beam computed tomography (CBCT) scans, were performed at baseline, 1 week, and 4 weeks post-extraction. Wound dehiscence, soft tissue healing, and bone preservation were evaluated. Results: At 1-week post-extraction, the continuous suture group exhibited the lowest rate of wound dehiscence (5%) compared to other groups (simple interrupted, 15%; horizontal mattress, 10%; vertical mattress, 12%). Soft tissue healing scores at 4 weeks were significantly higher in the continuous suture group (8.7 ± 0.5) than in the other groups (simple interrupted, 7.2 ± 0.8; horizontal mattress, 7.8 ± 0.7; vertical mattress, 7.5 ± 0.6). CBCT analysis revealed superior bone preservation in the continuous suture group (98% remaining bone volume) compared to the other groups (simple interrupted, 92%; horizontal mattress, 95%; vertical mattress, 94%). Conclusion: This study demonstrates that the continuous suturing technique offers advantages in post-extraction socket healing, including reduced wound dehiscence, improved soft tissue healing, and better bone preservation.

Intraperitoneal Onlay Mesh (IPOM Plus) Repair Versus Extended-View Totally Extraperitoneal Rives-Stoppa (eTEP-RS) Repair in Primary Ventral Hernias: Experience With 50 Cases in a Tertiary Care Hospital.

Background Primary ventral hernias are abnormal protrusions of abdominal viscera through the areas of weakness in the fascia of the abdominal wall. The aim of this study was to compare the benefits and complications, and the overall outcome in the Extended-View Totally Extraperitoneal Rives-Stoppa (eTEP-RS) repair versus Intraperitoneal Onlay Mesh (IPOM Plus) repair in the management of primary ventral hernias. Methods After obtaining institutional ethical committee clearance, this prospective comparative study between IPOM Plus and eTEP-RS was conducted in a tertiary care hospital from December 2020 to January 2022. A total of 50 patients presenting with primary ventral hernias were included in the study, of whom 25 underwent IPOM Plus and 25 underwent eTEP-RS repairs. Group selection was done by simple randomization using the lottery method. Patients more than 18 years of age with primary ventral hernias presenting with a hernial defect width less than 6 cm, consenting to the study, were included in the study. Patients who did not fulfill the inclusion criteria, strangulated/obstructed hernias, recurrent/incisional hernias, connective tissue disorders, skin infections, enterocutaneous fistulas, pregnancy, morbid obesity, and parastomal hernias were exclusion factors. Results The mean intraoperative duration in the eTEP-RS group (192.3 ± 16.20 min) was significantly higher than in the IPOM Plus group (102.6 ± 16.78min, p=0.001). The mean duration of hospital stay in the IPOM Plus group (5.9 ± 2.19 days) was longer than in the eTEP-RS group (4.6 ± 3.17 days, p=0.02). The mean postoperative pain scores, from the Visual Analogue Scale (VAS), on days 1, 7, and 90 were 3.2 ± 1.11, 2.64 ± 1.11, and 1.68 ± 1.46 in the IPOM Plus group and 1.84 ± 0.688, 0.76 ± 0.66 and 0.08 ± 0.40 in the eTEP-RS group, respectively (p=0.001). Conclusion Despite being a technically easy procedure requiring less intraoperative time, IPOM Plus had several disadvantages, such as increased postoperative pain, longer duration of hospital stays, higher chances of wound site seromas, and higher rates of postoperative paralytic ileus. On the other hand, eTEP-RS was a more challenging procedure requiring more intraoperative time; however, it had several advantages: less postoperative pain, less duration of hospital stay, early recovery, and fewer chances of seromas and paralytic ileus. However, more robust data is required to compare and validate the differences between both procedures' short- and long-term outcomes.

Stable fixation using absorbable sutures in craniofacial surgery in patients over 24 months of age-a retrospective study.

PURPOSE: In craniofacial surgery, the stable fixation of transposed bone segments is crucial in order to ensure good long-term results. The use of absorbable material in fixation avoids the need for a second surgery, which would otherwise be required to remove osteosynthesis material. The authors of the present manuscript have already demonstrated that absorbable sutures ensure the stable fixation of bone segments in patients up to 24 months of age. However, it has thus far remained unclear whether stable fixation is possible in older patients by using only absorbable sutures due to the slower bone remodelling and prolonged healing time in this cohort. METHOD: For the present study, osteosynthesis was performed in 50 patients ranging from 25.7 to 192.1 months of age (mean, 61.4 ± 21.7 months) using solely absorbable sutures (PDS II®, Ethicon, Germany). Post-operative stability and possible restrictions-such as foreign body reactions-were evaluated within clinical and radiological routine follow-ups. RESULTS: All children demonstrated clinically and radiologically stable osteosynthesis both directly post-operatively and in follow-ups. No significant foreign body reaction could be seen. CONCLUSION: The present study demonstrates-for the first time-that absorbable sutures with a longer absorption period are also very well suited for the fixation of bone segments in patients over 24 months of age. The sole use of absorbable sutures in children over 24 months of age is a safe procedure with nearly no foreign body reactions. The procedure enables stable and highly cost-effective osteosynthesis without altering the osteotomy design.

Comparison of Different Suture Techniques on Nasal Soft Tissue Envelope to Prevent Supratip Deformity: A Histologic Study.

BACKGROUND: Studies have described various surgical maneuvers in rhinoplasty to limit thickening from excessive scarring in the supratip region. This study aimed to compare the effectiveness of three maneuvers-a simple suture, a U suture, and bolster dressing-used to avoid supratip deformity in a rabbit model. METHODS: Thirty-two male New Zealand white rabbits were included. The animals were divided into four groups, and dissection was performed in the supra-perichondrial plane up to the supratip region through an open rhinoplasty incision. After dissection, the following approaches were applied to the supratip region: Group 1, simple approximation suture; Group 2, U suture; Group 3, bolster dressing; and Group 4 (control group), no suture. All animals were sacrificed after 12 weeks. Histological analysis was performed. RESULTS: In Group 4, scar thickness was significantly greater than in the other groups (p < 0.05). Group 3 had greater scar thickness than Group 2 (p < 0.05). The ratio of scar thickness to skin thickness was higher in Group 4 compared with the other groups (p < 0.05). Finally, there was no difference in the ratio of scar thickness to skin thickness between Groups 1, 2, and 3 (p > 0.05). CONCLUSIONS: In this study, it was concluded that surgical methods using sutures in the supratip region reduced scar thickness in a rabbit model, and these surgical methods had similar levels of effectiveness. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nasal Dorsum Rotation-Transposition Flap Associated with Guitar-String Sutures: One-Stage Reconstruction of Large Defects on the Nose.

(1) Background: The preferred reconstructive option for closing small- or medium-sized defects of the distal half of the nose is the use of local flaps. The dorsal nasal (Rieger) flap is suitable for closing medium-sized defects at this location, especially when they are medially located, and are wider rather than tall. We describe a rotation-transposition dorsal nasal flap reconstruction for large nasal defects. The novelty of this design includes the addition of a small transposition lobe to the rotation flap, enabling the acquisition of tissue from either the lateral sidewall or the nasolabial sulcus, facilitating closure with guitar-string sutures. (2) Methods: We conducted a retrospective chart review of all the patients with large defects (>20 mm) of the nose who underwent nasal dorsum rotation-transposition flap repair between January 2019 and November 2022 at a single academic center. (3) Results: Fourteen patients (eight males, six females; ages 47-83, mean age 60 years) with defects (range: 20.00-35.00 mm) on the dorsum and nasal tip were recruited. Follow-up duration ranged from 12 months to 3 years, with all cases showing good or excellent oncologic and cosmetic results. (4) Conclusions: The rotation-transposition dorsal nasal flap was demonstrated to be a reproducible one-stage technique for large defects of the dorsum and nasal tip, with minimal risk of aesthetic or functional complications. Guitar-string sutures allowed the reduction of the defect size, facilitating a smaller flap design.

Left Ventricular Pseudoaneurysm Following Penetrating Chest Trauma: A Case Report.

Post-traumatic ventricular pseudoaneurysms are a rare complication of chest trauma that necessitate surgical correction. In this case report, we describe a 22-year-old male patient presenting with a left ventricular pseudoaneurysm 45 days following primary surgical repair of a penetrating left ventricular injury with a background of stabbing chest trauma. The pseudoaneurysm was successfully surgically treated at our hospital after a thorough evaluation despite the vague clinical presentation at the time of referral. The patient fully recovered afterward and his case enriched our understanding of this life-threatening yet rare complication.

Sling for the sling: a new technique for long-term correction of severe congenital ptosis.

INTRODUCTION: Severe congenital ptosis poses a complex challenge for oculoplastic surgeons, requiring meticulous surgical intervention to restore eyelid function and improve aesthetic outcomes mainly by using frontalis sling approach. A crucial issue in frontalis sling surgeries is the sustainability of effect. PURPOSE: This retrospective study reports the outcomes of two surgical techniques for treating severe congenital ptosis in the paediatric age group: Silicon rods ptosis sling and a novel technique involving the use of Silicon rods with green braided polyester (Ethibond) sutures to secure the rods in place "sling for the sling". METHODS: The medical records of children who underwent frontalis suspension were reviewed in a retrospective fashion. We identified two groups; the first group (20 patients: 35 eyelids) had the traditional frontalis suspension surgery using silicone suspension set, the second group (14 patients: 25 eyelids) was operated using the new "sling for sling" technique. We used the postoperative marginal reflex distance-1 (MRD-1) as the primary outcome measure while the frequency of both wound related complications and recurrence were considered as secondary outcome measures. Post operative data were collected and compared after 1 month, 6 months, 12 months, and 18 months. RESULTS: Preliminary results indicate promising outcomes for both techniques, with significant improvement in eyelid elevation observed in both groups. However, the novel technique using Silicon rods with Ethibond sutures demonstrated enhanced sustainability, leading to a more durable outcome with significantly less recurrence. CONCLUSION: This study highlights the potential benefits of the novel technique in treating severe congenital ptosis and introduces an innovative approach to Silicone rods fixation to achieve a long-term corrective effect.

Four-Layer Wound Closure Technique with Barbed Sutures for Inframammary Fold in Mastopexy Augmentation.

BACKGROUND: The inframammary fold (IMF) is an important landmark in breast aesthetic surgery. In augmentation mastopexy procedures, secure and accurate placement of the IMF is essential to aesthetic outcomes and to allow the new IMF to heal in the correct position without displacement. The authors present a simple and efficient four-layer wound closure technique using barbed sutures for closure of the repositioned IMF in augmentation mastopexy procedures. This method was previously described by the first author for reset of the IMF in breast augmentation surgery and has been adapted to the longer IMF incision in augmentation mastopexy procedures. METHODS: A retrospective review was undertaken of 335 patients who underwent bilateral breast augmentation mastopexy procedures with a Wise pattern technique at a single unit. The newly reset IMF was closed using barbed sutures and a four-layer closure technique. RESULTS: There were no cases of complications related to wound healing or wound dehiscence. One patient required explantation for an infected implant. CONCLUSION: The four-layer wound closure technique with barbed sutures provides a quick and efficient method for accurate closure of the newly reset IMF, with positive outcomes related to wound healing. Secure and accurate placement of the inframammary fold is crucial in augmentation mastopexy procedures. The use of a four-layer wound closure technique with barbed sutures provides an efficient method for accurate closure of the newly reset inframammary fold. This method was previously described by the first author for reset of the IMF in breast augmentation surgery and has been adapted to the longer IMF incision in augmentation mastopexy procedures. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparative study of two techniques of laparoscopic burch colposuspension using sutures versus mesh in women with genuine stress urinary incontinence.

Background: To compare the effectiveness and safety of laparoscopic colposuspension using sutures (LCS) versus mesh and staples (LCM) in the treatment of female stress urinary incontinence. Methods: This randomized study was conducted over a total of 80 women with genuine stress urinary incontinence between January 2020 and April 2022. Women were randomly assigned to the LCS group (n = 40) or the LCM group (n = 40). They underwent objective evaluations, including a standardized stress test, a 24-hour pad test, and a frequency-volume chart. Subjective assessments were made using a quality-of-life questionnaire. Results: The LCS group exhibited superior outcomes in PAD test improvement (from 147 [31-304] to 3 [0-300] at 1 year, p < 0.001), stress test scores (from 82 [11-153] to 1 [0-124] at 1 year, p < 0.001), and mean micturated volume (increase from 294 ± 65 to 321 ± 57 at 1 year, p = 0.037) compared to the LCM group. Urodynamic findings revealed a higher Maximum Urethral Closure Pressure in the LCS group (33.1 ± 6.9) versus the LCM group (28.3 ± 6.4, p = 0.002). Quality of life improvements were significantly better in the LCS group across various domains. However, the LCM group benefitted from shorter surgery duration, hospital stays, and bladder drainage duration. Conclusion: LCS demonstrates significant advantages over LCM in treating female stress urinary incontinence, particularly in cure rates and quality of life improvements. Despite the operational benefits of LCM in terms of reduced surgery and recovery times, LCS offers superior therapeutic outcomes.

Braided silk sutures coated with photoreduced silver nanoparticles for eradicating Staphylococcus aureus and Streptococcus mutans infections.

BACKGROUND: Infections resulting from surgical procedures and wound closures continue to pose significant challenges in healthcare settings. To address this issue, the investigators have developed antibacterial non-resorbable braided silk sutures using in situ deposited silver nanoparticles (AgNPs) and investigated their efficacy in eradicating Staphylococcus aureus and Streptococcus mutans infections. METHODS: The braided silk sutures were modified through a simple and efficient in situ photoreduction method, resulting in the uniform distribution of AgNPs along the suture surface. The synthesized AgNPs were characterized using scanning electron microscopy (SEM), dynamic light scattering analysis (DLS) and Fourier Transform Infrared Spectroscopy analysis (FTIR) confirming their successful integration onto the silk sutures. The antibacterial activity of the nanoparticle coated sutures were compared and evaluated with non-coated braided silk sutures through in vitro assays against both S. aureus and S. mutans. RESULTS: The surface and cross-sectional analysis of the treated sutures revealed a uniform and homogeneous distribution of silver particles achieved through the photoreduction of silver solution. This observation confirms the successful coating of silver nanoparticles (AgNPs) on the sutures. The antimicrobial studies conducted, demonstrated significant reductions in bacterial colonies when exposed to the silver nanoparticle-coated sutures. Notably, the width of the inhibition zone surrounding the coated sutures remained consistently wide and stable for duration up to 7 days. This sustained and robust inhibitory effect against gram-positive bacteria, specifically S. aureus and S. mutans, serves as strong evidence of the antibacterial efficacy of the coated sutures. CONCLUSION: The coating of silk sutures with AgNPs provided a significant and effective antibacterial capacity to the surgical sutures, with this activity being sustained for a period of 7 days. This suggests that AgNPs-in situ photoreduction deposited sutures have the potential to effectively manage S. aureus and S. mutans infections.

Knotless suture in revision total joint arthroplasty: a prospective randomized controlled trial.

INTRODUCTION: The use of barbed sutures for wound closure in primary total joint arthroplasty (TJA) has been shown to be effective and safe. However, their effectiveness and safety in revision TJA procedures has not been thoroughly studied. This study aims to evaluate the efficacy and safety of using barbed suture closure in revision TJA setting. METHODS: A total of 80 patients undergoing revision TJA between September 2020 and November 2022 were included in this randomized controlled trial study. Following informed consent, patients were computer-randomized to the treatment arm (barbed suture wound closure) or to the control arm (conventional wound closure). Closure duration, closure rate, number of sutures used and wound related outcomes including complication rates and Patient and Observer Scar Assessment Scale (POSAS) score were compared between groups. RESULTS: The use of barbed sutures decreased closure time by 6 min (30.1 vs. 36.1 min, P = 0.008) with a higher wound closure rate (6.5 vs. 5.5 mm/minute, P = 0.013). Additionally, the number of sutures used for wound closure in the barbed group was significantly lower than in the control group (6.2 vs. 10.1, respectively, P < 0.001). There were no significant differences in the rate of postoperative wound complications (P = 0.556) or patient and observer POSAS scores (P = 0.211, P = 297, respectively) between the two groups at 3-month follow-up. CONCLUSION: Closure of revision TJA surgical wound utilizing barbed sutures reduced closure time and the number of needles handled by operative staff, with no significant increase in intra- or post-operative complications rate when compared to traditional closure technique. LEVEL OF EVIDENCE: I.

Peripheral arterial catheter securement and catheter survival in the pediatric intensive care unit.

BACKGROUND: Peripheral arterial catheters (PACs), and their associated complications, are common in the pediatric intensive care unit (PICU). Accidental catheter displacement and non-functional PACs are the most common complications, and this may be related to inadequate catheter securement. There is mixed guidance on the best way to secure PACs to prevent complications. The authors hypothesized that sutures would not be associated with a decreased risk of malfunction or accidental removal. METHODS: This was a single center retrospective cohort study at a quaternary-care PICU. PICU patients with a peripheral arterial catheter placed in the PICU from 7/2020 to 1/2023 were included. The primary outcome was unplanned PAC removal. A univariate and multivariate Cox proportional hazards regression analysis was performed, using patient weight, sedation, paralytic, and role of the proceduralist as covariates. The secondary outcome was survival probability. A log-rank test was used to compare survival curves. RESULTS: Of 761 PACs that met inclusion criteria in 437 unique patients, 599 were sutured (78.7%) and 162 were un-sutured (21.3%). In 257 cases (33.8%), the PAC had an unplanned removal. Among all PACs, the median duration of PAC placement was 5.3 days (IQR 2.1-10.5 days). There was an unplanned removal rate of 42.2% (68) in the un-sutured group and 31.4% (188) in the sutured group (p < 0.001). In multivariable analysis, sutured PACs were also associated with a lower rate of unplanned removal (hazard ratio, 0.59; 95% CI, 0.44-0.78). Use of continuous sedation was also associated with an increased risk of unplanned removal of PACs (hazard ratio, 1.54; 95% CI, 1.10-2.16). There was a 50% survival probability at 13.3 days for un-sutured PACs and 23.7 days for sutured PACs. CONCLUSIONS: Suturing is associated with fewer unplanned removals and longer catheter survival, compared to un-sutured PACs in pediatric patients.

The Effectiveness of Cyanoacrylates versus Sutures for Mesh Fixation after Lichtenstein Repair (SCyMeLi STUDY) A Systematic Review and Meta-Analyze of Randomized Controlled Trials.

Background: Chronic postoperative inguinal pain (CPIP) is still the most frequent complication after open Lichtenstein repair and any strategy to reduce its incidence and implications is a step forward to better outcomes. Between the means of mesh fixation atraumatic glue fixation has been explored as such possibility. A meta-analysis of randomized controlled trials comparing the performance of cyanoacrylate glue versus sutures fixation was conducted. Methods: the meta-analysis was conducted according to the PRISMA guidelines. Randomized controlled trials (RCTs) published between January 2000 and December 2021 were searched for in MEDLINE, PubMed, Web of Science, and Google Scholars. The quality of RCTs and the potential risk of bias were assessed using MINORS criteria and the Cochrane risk of bias tool. Results: of 269 papers the meta-analysis was performed on 19 RCTs including 3578 patients. In the glue fixation group, the operation was shorter (mean pooled difference 6 minutes; SE = 0.47; 95% CI = - 6.77 - - 4.92; t test = -12.36; p 0.0001) and immediate postoperative pain was lower (2.37% vs 13.3%OR - 0.158; 95% CI = 0.064 0.386; p = 0.0001). There was no difference in terms of chronic pain, recurrence rate and wound events. Conclusion: glue fixation of mesh in elective Lichtenstein repair of inguinal hernia seems to be a valid choice for a painful and safe procedure without increasing risk of recurrence.

Prospective, multi-centric, international, single-arm, cohort study to assess a synthetic polyamide suture material in oral surgery to close the mucosa - MUCODA study.

OBJECTIVES: The aim was to collect different clinical parameters systematically and proactively regarding safety, effectiveness, and performance of a nylon monofilament suture under routine clinical practice for oral surgery. METHODS: The study design was prospective, bicentric, international, single-armed, and observational. A non-absorbable suture was applied to close the mucosa after different dental surgical interventions. Main objective was the incidence of combined postoperative complications until suture removal. The 95 % Confidence Interval (Agresti-Coull method) was used to prove the non-inferiority with a pre-specified upper margin of 21.9 %. Secondary variables were intraoperative suture handling, patient pain and satisfaction, wound healing, aesthetic appearance, and bacterial contamination. RESULTS: 105 patients were enrolled. Complication rate was low (1.9 %), 2 swellings occurred. Pain was present for 1.61 days ± 1.42 after various dental interventions with an average pain level of 20.98 ± 22.60 (VAS). Patients with impacted third molar extraction showed the longest pain duration (6 days) combined with the highest mean pain level of 35.33 ± 30.45 (VAS). Intraoperative suture handling was very good to excellent. Suture removal was done after an average duration of 7.56 ± 2.09 days. Patient's satisfaction was high, and an excellent wound healing was reported by the dentists. Aesthetic appearance only performed in implant patients was rated by oral surgeons with an average of 96.19 ± 3.79 points [min. 80 - max. 100] at 5 months postoperatively. Thread bacterial analysis showed that F. nucleatum was the most present species. CONCLUSIONS: Our findings indicate that the non-absorbable, nylon-based monofilament suture used is safe and quite suitable for oral mucosal closure after various dental surgical interventions such as tooth extraction, implant placement and impacted third molar extraction. CLINICAL SIGNIFICANCE: This study showed the safe use of a non-absorbable, nylon-based monofilament suture for different oral surgical interventions under daily routine clinical practice.