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3.
Medicine (Baltimore) ; 99(50): e23535, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327302

RESUMO

BACKGROUND: Nasal septal suturing is a commonly used alternative treatment to nasal packing after septoplasty. Besides alleviating postoperative discomfort, extensive studies have shown that nasal septal suturing is more effective than nasal packing. However, its clinical benefits remain controversial. METHODS: We will perform a systematic review of nasal packings effect-related outcome in comparison to nasal septum suture among septoplasty patients by searching 8 databases, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). All eligible studies will be screened against the inclusion and exclusion criteria. Two independent reviewers will extract the data. Moreover, Review Manage 5.3 will be used for quality assessment and data analysis. Then, the random effects model or fixed effects model will be applied according to the heterogeneity. In conformity with the GRADE criteria, the merits of the evidence and recommended strength will be assessed. RESULTS: This protocol will guide subsequent systematic reviews and meta-analyses. The differences in efficacy between nasal septal suturing and nasal packing after septoplasty will be evaluated in terms of efficiency, adverse reaction, comfort degree, and other factors. CONCLUSION: This proposed study will explore the possibility of adopting nasal septal suturing as an alternative to nasal packing after septoplasty. OSF REGISTRATION NUMBER:: doi: 10.17605/OSF.IO/WF3GX.


Assuntos
Técnicas Hemostáticas , Septo Nasal/cirurgia , Técnicas de Sutura , Epistaxe/etiologia , Epistaxe/terapia , Humanos , Hemorragia Pós-Operatória/prevenção & controle , Hemorragia Pós-Operatória/terapia , Suturas
4.
Zhonghua Yi Xue Za Zhi ; 100(47): 3784-3787, 2020 Dec 22.
Artigo em Chinês | MEDLINE | ID: mdl-33379843

RESUMO

Objective: To investigate the effect of laparoscopic modified with two different sutures on the cesarean incision diverticulum repair. Methods: From July 2018 to July 2019, 35 patients with refertility requirements who were confirmed the diagnosis of caesarean incision diverticulum by hysteroscopy combined with ultrasound, and the muscle layer thickness at the top of diverticulum was less than 3 mm, received modified laparoscopic combined with hysteroscopic surgery in department of gynecological minimally invasive center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Ten patients with history of secondary repair and multiple pelvic operations were excluded. The remaining 25 patients were divided into group A (n=8): underwent laparoscopic "folding suture" , preserving the integrity of the diverticulum of the cesarean incision; Group B (n=17): underwent laparoscopic incision and complete excision of the scar of the diverticulum. The operation time, bleeding volume, postoperative exhaust time, improvement of symptoms and the thickness of muscle layer were compared between the two groups. Results: All patients underwent surgery without complications. 25 patients were followed up one month, three months and half a year after operation, and followed up by telephone for 6-18 months. The operation time of group A and B was (56±12) min, (72±15) min, and the bleeding volume was (40±9) ml and (66±10) ml respectively. The cure rate was 87.5% and 58.8% respectively, the differences were statistically significant (t=6.778, 4.057, χ(2)=5.651, P<0.05). But the postoperative exhaust time was (16±6) h, (18±7) h, and the effective rate was 100.0% and 94.1% respectively, with no significant difference(t=1.967, χ(2)=0.725, P>0.05). Conclusion: Two different suture repair methods under laparoscope are safe and effective for the treatment of diverticulum in cesarean section incision. Among them, the laparoscopic "folding suture" method has a short operation time and preserves the integrity of the myometrium. It is worth popularizing for the elderly patients who has an urgent need for fertility.


Assuntos
Cesárea , Laparoscopia , Idoso , Cicatriz/cirurgia , Feminino , Humanos , Histeroscopia , Gravidez , Suturas , Resultado do Tratamento
5.
Plast Reconstr Surg ; 146(6): 777e-789e, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33234974

RESUMO

BACKGROUND: Deep dermal suturing is critical for scar quality outcomes. The authors evaluated a new, fast medical device for dermal suturing, with the hypothesis of noninferiority with regard to clinical scar and cost-effectiveness. METHODS: A prospective, patient-blind, randomized, multicenter noninferiority study in 26 French hospitals was conducted. Patients were randomized 1:1 to suturing with conventional thread or a semiautomatic stapler. The Patient Scar Assessment Scale was rated at 3 months for primary endpoint effectiveness. Secondary endpoints were cost-effectiveness of the two suturing methods, prevalence of complications, suturing/operating time, Observer Scar Assessment Scale and Patient Scar Assessment Scale score, scar aesthetic quality 18 months after surgery, and occupational exposure to blood during surgery. RESULTS: Six hundred sixty-four patients were enrolled, 660 were randomized, and 649 constituted the full analysis (stapler arm, n = 324; needle arm, n = 325). Primary endpoint Patient Scar Assessment Scale score in the stapler arm was not inferior to that in the needle arm at 3 months or after 18 months. The mean operating time was 180 minutes in the stapler arm and 179 minutes in the needle arm (p = not significant). The mean suturing time was significantly lower in the stapler arm (p < 0.001). There were seven occupational exposures to blood in the needle arm and one in the stapler arm. The two arms did not differ significantly in terms of complications (p = 0.41). The additional cost of using the device was &OV0556;51.57 for the complete-case population. CONCLUSION: Wound healing outcome was no worse than with conventional suturing using a semiautomatic stapler and associated with less occupational exposure to blood. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.


Assuntos
Cicatriz/prevenção & controle , Procedimentos Cirúrgicos Dermatológicos/métodos , Grampeamento Cirúrgico/métodos , Suturas/efeitos adversos , Adolescente , Adulto , Idoso , Cicatriz/diagnóstico , Cicatriz/etiologia , Análise Custo-Benefício , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Procedimentos Cirúrgicos Dermatológicos/economia , Procedimentos Cirúrgicos Dermatológicos/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Índice de Gravidade de Doença , Método Simples-Cego , Pele/patologia , Grampeadores Cirúrgicos/economia , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/economia , Grampeamento Cirúrgico/instrumentação , Resultado do Tratamento , Cicatrização , Adulto Jovem
6.
BMC Surg ; 20(1): 268, 2020 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-33143708

RESUMO

BACKGROUND: Wound healing and scar quality after trauma are subject to impairment through excessive wound healing, chronic wound or even surgical site infections. Optimizing the process of scar formation and skin healing is crucial in virtually all fields of medicine. In this regard, we tested the possible usage and advantages of titanium coated suture material. METHODS: We performed a prospective observational cohort study including 30 patients who underwent soft tissue reconstruction. One half of the donor flap site was sutured with titanium coated suture material, while the other half was closed with non-coated sutures. Scar quality of the donor flap site was assessed by photographs and POSAS scores on days 2-5, 14, 42, 72 and 180 postoperatively. RESULTS: No difference between the titanium coated sutures and non-coated sutures was seen in the POSAS assessment, neither for the patient scale at 14, 42, 72 and 180 days, nor for the observer scale on the same dates. Comorbidities like diabetes, chronic renal failure and smoking as well as the BMI of each patient affected the wound healing process to an equal degree on both sides of the suture. CONCLUSIONS: No difference between the titanium coated and non-titanium-coated suture material was seen in the POSAS assessment in regard to scar quality and wound healing. The titanium-coated suture material can be considered to be equally as effective and safe in all qualities as the non-titanium-coated suture material, even in patients with comorbidities. Clinical trial register This study is registered at the German Clinical Trials Register (DRKS) under the registration number DRKS00021767. ( https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021767 ).


Assuntos
Cicatriz , Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos , Suturas , Titânio , Adulto , Idoso , Idoso de 80 Anos ou mais , Cicatriz/diagnóstico , Cicatriz/fisiopatologia , Materiais Revestidos Biocompatíveis , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pele/lesões , Pele/fisiopatologia , Técnicas de Sutura , Sítio Doador de Transplante , Cicatrização/fisiologia
7.
BMC Surg ; 20(1): 264, 2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33129303

RESUMO

BACKGROUND: It is rare that drains cannot be removed after surgery, however, this situation cannot be completely avoided, and is also hard to deal with. The main reason for a tethered drain is inadvertent suture fixation. At present, no effective way was published or widely accepted to locate the tethered drain. METHODS: Three cases of orthopedic trauma patients experienced unsuccessful removal of the drain after surgery. The ultrasound was used to locate the sutured site of the drain. Based on the sliding sign and vanishing point which can be detected by the ultrasound, the sutured site of the drain can be clearly identified. Finally, the suture was loosened through a small incision, and the drain was completely removed. RESULTS: The surgical procedure was very successful in all patients. The tethered drain was quickly and completely removed through a small incision with locating by ultrasound. Intravenous antibiotics were administered within 24 h after surgery, and no wound or deep infections occurred. CONCLUSIONS: Ultrasound can be used to locate a tethered drain based on the sliding sign. This method can simplify the release procedure and achieve fast removal of the drain. Furthermore, it will help lower the risk of a retained drain and soft tissue complications.


Assuntos
Remoção de Dispositivo , Drenagem , Corpos Estranhos/diagnóstico por imagem , Procedimentos Ortopédicos/efeitos adversos , Técnicas de Sutura/efeitos adversos , Ultrassonografia , Adulto , Animais , Remoção de Dispositivo/métodos , Drenagem/instrumentação , Feminino , Corpos Estranhos/etiologia , Corpos Estranhos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Procedimentos Ortopédicos/métodos , Suturas/efeitos adversos , Suínos
8.
Am J Vet Res ; 81(12): 985-991, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33251840

RESUMO

OBJECTIVE: To determine whether jejunal serosal patches could securely seal large, open defects in duodenal segments harvested from canine cadavers and to compare intraluminal pressures at which leakage first occurred and maximal intraluminal pressures for repaired duodenal segments between 2 suture patterns. SAMPLE: Duodenal and jejunal segments from 9 canine cadavers. PROCEDURES: 20 constructs were created through repair of large, open duodenal defects with circumferential suturing of an intact jejunal segment (jejunal serosal patch). Constructs were randomly assigned to have the serosal patch anastomosed to the duodenal segment by a simple continuous or simple interrupted suture pattern. The pressure at which the first leakage was observed and the maximum pressure obtained during testing were recorded and compared between suture patterns. RESULTS: Initial leakage pressure was significantly higher with the simple interrupted pattern (mean ± SD, 68.89 ± 5.62 mm Hg), compared with the simple continuous pattern (59.8 ± 20.03 mm Hg). Maximum intraluminal pressures did not significantly differ between the simple interrupted (91 ± 8.27 mm Hg) and simple continuous patterns (90.7 ± 16.91 mm Hg). All constructs, regardless of suture pattern, withstood supraphysiologic pressures. CONCLUSIONS AND CLINICAL RELEVANCE: Jejunal serosal patches adequately sealed large, open duodenal defects and prevented leakage in these constructs. Constructs with simple continuous or simple interrupted suture patterns withstood physiologic and supraphysiologic intraluminal pressures, although constructs with a simple interrupted suture pattern initially leaked at higher pressures. (Am J Vet Res 2020;81:985-991).


Assuntos
Doenças do Cão , Suturas , Animais , Cadáver , Cães , Jejuno/cirurgia , Pressão , Técnicas de Sutura/veterinária
9.
Kyobu Geka ; 73(11): 950-953, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130722

RESUMO

A 33-year-old man presenting with fever, fatigue, and delirium was diagnosed with infectious endocarditis(IE). He had already undergone surgery for IE twice;initial valve repair 4 years ago and mitral valve replacement(MVR) 1 year later. He has refractory atopic dermatitis, which was considered to be the cause of his repeated IE. Initially, antibiotics were administered but the infection was not controlled. Therefore, we decided to perform the 3rd surgery. MVR was performed, and using bovine pericardium, we covered valve cuff and suture felts to separete these parts from blood stream. Postoperative echocardiography showed good prosthetic valve motion without transvalvular regurgitation or paravalvular leak. He was discharged on the 39th postoperative day and has been doing well for 2 years since.


Assuntos
Endocardite , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral , Adulto , Animais , Bovinos , Endocardite/cirurgia , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Pericárdio , Suturas
10.
Zhonghua Yan Ke Za Zhi ; 56(11): 853-858, 2020 Nov 11.
Artigo em Chinês | MEDLINE | ID: mdl-33152844

RESUMO

Objective: To investigate the long-term clinical efficacy and safety of the bilateral superior oblique tendon suture spacer in treatment of A-pattern strabismus with superior oblique overaction (SOOA). Methods: Retrospective case series study. Twenty-one A-pattern strabismus patients who received the quantitative bilateral superior oblique tendon suture spacer with a complete follow-up from January 2009 to August 2017 were enrolled. Among these patients, 19 were exotropic and 2 were esotropic, including 11 males and 10 females, aged (14±9) years. Patients with unilateral superior oblique overaction, Broun syndrome or Helveston syndrome were excluded. The A-pattern strabismus, objective torsion, function of the superior oblique muscle and binocular vision were examined pre-and post-operatively. Paired t-test was used for normal distribution data, Wilcoxon rank-sum test was used for non-normal distribution data, Spearman rank correlation test and simple linear regression were used to analyze the correlation between the two variables. Results: The follow-up was 12 to 109 months (mean, 26±17 months). Twenty patients showed good alignment in the primary position with a deviation angle less than 10 prism diopter (PD), and 1 patient with esotropia had an angle greater than 15 PD. All the patients had no A pattern after surgery. The average pre-and post-operative A-patterns were (23.81±9.47) PD and (0.90±3.59) PD (t=11.29, P<0.01), respectively, and the average corrected A pattern was (23.52±9.68) PD.The average pre-and post-operative torsion was 3.18°±3.26° and -4.81°±4.13° (t=8.87, P<0.01), espectively, and the average corrected torsion was 7.95°±3.88°. No patient complained of torsional diplopia after surgery. The average amount of pre-and post-operative SOOA was 3.0 (2.0) and 0.0 (1.0) in 42 eyes (Z=-5.78, P<0.01), respectively. Suture extension of the superior oblique tendon was related with the pre-operative SOOA (r=0.47, P<0.01), but was not related with the pre-operative torsion (r=0.02, P=0.88). The linear regression results was suture extension=2.71× the grade of pre-operative SOOA (t=27.93, P<0.01). Conclusions: The bilateral superior oblique tendon suture spacer can improve the A-pattern, objective torsion and SOOA, with no torsional diplopia or V pattern after the long-term follow-up. It is a safe and effective superior oblique muscle weakening procedure. (Chin J Ophthalmol, 2020, 56: 853-858).


Assuntos
Músculos Oculomotores , Estrabismo , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos , Estrabismo/cirurgia , Suturas , Tendões/cirurgia , Resultado do Tratamento , Visão Binocular , Adulto Jovem
11.
Acta Ortop Mex ; 34(2): 87-90, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33244907

RESUMO

INTRODUCTION: The rotator cuff tears are a very frequent condition. The rotator cuff repair is a procedure often perform by the orthopedic surgeon. There are multiple techniques and suture configurations for this type of repairs. The double row configuration is one of the most used and consider very effective for mid-size and large size rotator cuff tears. The parachute configuration for this repair is a novel technique that may be useful for mid-size and large size tears, for this repair two medial double row anchors are used and one knotless lateral anchor. Our porpoise was to compare biomechanical performance and footprint coverage of a conventional suture-bridge double-row rotator cuff repair configuration versus a double-row-parachute. METHODS: This paper shows the biomechanical behavior on a cadaver model of the parachute configuration, and also compares this conformation with a double row in a suture-bridge fashion. Our hipothesis was that the Parachute configurations biomechanical performance is equivalent to the suture-bridging double-row technique. RESULTS: The parachute configuration advantages show the advantage of using less anchors, which will decrease the surgical time and also the risks of using multiple hardware in the humeral head.


Assuntos
Lesões do Manguito Rotador , Fenômenos Biomecânicos , Humanos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Técnicas de Sutura , Suturas
12.
Medicine (Baltimore) ; 99(48): e19831, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33235053

RESUMO

Sutures are used for the approximation of incised flaps, assistance in primary healing, and hemorrhage control. In oral and periodontal surgery, the appropriate selection of suture material is vital for favorable healing.The aim of the present in-vitro experiment was to evaluate the tensile strengths of 4 different types of suture materials (silk, polygalactine 910, polypropylene, chromic catgut) by simulating potential short-term intraoral exposure to various beverages (saliva, Arabic coffee, tea, cola).A total of 280 suture specimens were prepared, out of which 10 specimens from each group were selected for pre-immersion testing. Remaining suture specimens were immersed in 4 different thermostatically controlled media (1 control [artificial saliva], 3 tests [Cola drink, Arabic coffee, Tea]). Tensile strength was measured at pre-immersion, 3, 7, and 14 days using a universal tensile testing machine. The maximum load required to break the suture material was recorded in Newton.At day 3, tea caused significant reduction in tensile strength of silk and cola caused significant reduction in tensile strengths of polygalactine 910 and chromic catgut. Whereas, at day 7, silk and polypropylene retained their tensile strengths better than others.The authors recommend precaution in the use of these beverages in the first postoperative week, to avoid adverse effect on the mechanical strength of sutures. When exposure to these beverages are anticipated, it is better to use polypropylene sutures that resists rapid fall in tensile strengths in the early postoperative period.


Assuntos
Bebidas , Saliva , Suturas , Odontologia , Humanos , Técnicas In Vitro , Procedimentos Cirúrgicos Bucais , Resistência à Tração
14.
J Cataract Refract Surg ; 46(11): 1578-1579, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33149078
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1238-1242, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063486

RESUMO

Objective: To investigate the effectiveness of arthroscopic all-inside combined with outside-in "suture loop" repair for meniscus bucket-handle tear (BHT). Methods: Between August 2016 and May 2019, 44 case of meniscus BHT were treated with arthroscopic all-inside combined outside-in "suture loop". There were 29 males and 15 females with an average age of 26.6 years (range, 18-42 years). The causes of injury included sports injury in 31 cases, falling injury in 7 cases, and sprain in 6 cases. There were 32 cases of medial meniscus posterior horn tears and 12 cases of lateral meniscus posterior horn tears. The disease duration ranged from 6 weeks to 3 months. Thirty-three cases were complicated with anterior cruciate ligament rupture. All patients had normal lower limb alignment. The preoperative Lysholm score was 42.1±9.1. According to the evaluation criteria of MRI and Barrett et al., the healing of meniscus was evaluated, and the effectiveness was evaluated by Lysholm score. Results: All the 44 patients were followed up 8-36 months with an average of 16.8 months. At last follow-up, according to the evaluation criteria of Barrett et al., 39 cases were clinically healed, 5 cases were not healed, the clinical healing rate was 88.6%; according to MRI evaluation, 32 cases were completely healed, 7 cases were partially healed, and 5 cases were not healed, the total healing rate was 88.6%, and the complete healing rate was 72.7%. Lysholm score was 87.8±4.8, which was significantly different from that before operation ( t=31.060, P=0.000). Conclusion: Arthroscopic all-inside combined with outside-in "suture loop" repair is a reliable and effective method for the meniscus BHT, which can obtain good joint function.


Assuntos
Traumatismos do Joelho , Lesões do Menisco Tibial , Adolescente , Adulto , Artroscopia , Feminino , Humanos , Masculino , Suturas , Lesões do Menisco Tibial/cirurgia , Resultado do Tratamento , Adulto Jovem
16.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1243-1247, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063487

RESUMO

Objective: To investigate the effectiveness of non-absorbable suture cerclage combined with patella claw fixation for the treatment of inferior patella fractures. Methods: Between September 2016 and January 2019, 22 patients with inferior patella fractures were treated. There were 12 males and 10 females, with a mean age of 49.1 years (range, 32-67 years). The causes of injury were traffic accident in 8 cases, falling in 12 cases, and other causes in 2 cases. The interval from injury to operation was 3-7 days (mean, 4.4 days). For the operation, 3 or 4 longitudinal tunnels were drilled backward from the surface of the proximal fracture fragment with Kirschner wires; under the guidance of lumbar puncture needles and steel wires, non-absorbable suture passed through the tunnels and encircled the inferior fracture fragment, then tighten to achieve a satisfactory reduction of the fracture; finally, the patella claw was used to strengthen the fixation. During the follow-up, complications were observed, maximum motion range of the knee joint was measured, X-ray examination was performed and fracture healing time was recorded. The knee function was evaluated according to Böstman scores. Results: All the 22 patients were followed up 12-36 months (mean, 19.4 months). No infection, joint stiffness, bone nonunion, loss of reduction, or displacement of internal fixation occurred. All fractures were clinically healed, and the bone healing time was 2-3 months (mean, 2.6 months). At last follow-up, the maxium motion range of knee joint was 130°-135°, with an average of 132.6°. The Böstman score of the affected knee was 28-30 (mean, 29.2). All cases were graded as excellent results. Conclusion: Non-absorbable suture cerclage combined with patella claw fixation for inferior patella fractures has the advantages of simple operation, reliable fixation, and few complications, and the clinical results are satisfactory.


Assuntos
Fraturas Ósseas , Patela , Adulto , Idoso , Fios Ortopédicos , Feminino , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Patela/cirurgia , Suturas , Resultado do Tratamento
17.
Khirurgiia (Mosk) ; (9): 20-27, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33029998

RESUMO

OBJECTIVE: To develop original technologies that simplify and increase an effectiveness of stomach resection in case of «difficult¼ duodenal ulcers. MATERIAL AND METHODS: Healing of gastroduodenostomy was experimentally observed under tension of anastomosed segments. In the first group (12), gastric resection was performed in a volume of 2/3 without tension of the anastomosed sections using a two-row suture. In the second group (12), stomach resection was accompanied by modeling of tension of the anastomosed sections under a pressure equal to 2.5-3.6 N (245-350 g). In the third group (12), gastric resection was performed in the same fashion as in the second group, but gastroduodenostomy was sutured using a single-row everted seams and hypotraction serous-muscular sutures. The results of Billroth-I gastrectomy using traditional (n=86) (classic double-row Lambert-Albert suture) and developed technologies (n=112) were analyzed in patients with complicated gastric and duodenal ulcers. RESULTS: The obvious advantages of the developed technologies have been experimentally proved for gastric resection under tension of anastomosed sections. There was no inconsistency of gastroduodenostomy, whereas traditional two-row suture was followed by this complication in 58,3% of cases. A favorable course was based on the relatively low inhibition of tissue blood supply in regenerating structures that was manifested by significantly less redox potential. Reduced lipid peroxidation and phospholipase activity in tissue structures along the suture line was also recorded. We obtained the positive clinical results of this approach in patients with complicated course of duodenal ulcer. Billroth-I gastrectomy was performed in all patients. Gastroduodenostomy failure was absent. Overall postoperative morbidity was 6,3%. In case of double-row anastomosis, suture failure occurred in 9,3% of cases, incidence of complications - 57,0%. This procedure was performed for gastric ulcer as a rule. CONCLUSION: The developed technologies greatly simplify resection of stomach and duodenum in the most difficult atypical conditions and ensure physiological Billroth-I surgery. The obvious benefit of this technology is simplified resection per se that makes it accessible to novice surgeons.


Assuntos
Gastroenterostomia , Estômago/cirurgia , Úlcera Duodenal , Gastrectomia , Humanos , Suturas
18.
Am J Vet Res ; 81(9): 714-719, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33112169

RESUMO

OBJECTIVE: To evaluate the effect of suture caliber on the tensile strength of tenorrhaphies performed with a locking-loop technique in cadaveric canine tendons. SAMPLE: 60 superficial digital flexor tendons (SDFTs) from 30 cadaveric adult dogs. PROCEDURES: Transverse tenotomy was performed, and SDFTs were repaired with a locking-loop technique and polypropylene suture of 5 randomly assigned calibers: size-0, 2-0, 3-0, 4-0, or 5-0 (n = 12 SDFTs/suture caliber). Tendon constructs were tested to failure. Yield, peak, and failure forces and causes of failure were compared between groups. RESULTS: Mean ± SD failure force for the constructs was significantly greater with large-caliber suture (size-0: 73.5 ± 3.1 N; size 2-0: 54.4 ± 7.1 N; size 3-0: 28.7 ± 4.9 N; size 4-0: 18.7 ± 3.4 N; and size 5-0: 8.8 ± 2.8 N). The likelihood of construct failure by suture pullout through the tendon substance increased with large-caliber suture (size-0: 12/12), whereas the likelihood of construct failure by suture breakage increased with small-caliber suture (2-0: 10/12; 3-0, 4-0, and 5-0: 12/12 each). CONCLUSIONS AND CLINICAL RELEVANCE: Large-caliber suture had greater tensile strength for tenorrhaphies performed with a locking-loop technique in cadaveric canine tendons. Prior to the use of large-caliber suture in patients requiring tenorrhaphy, however, in vivo studies are required to confirm the results obtained here.


Assuntos
Doenças do Cão , Traumatismos dos Tendões , Animais , Fenômenos Biomecânicos , Cadáver , Cães , Técnicas de Sutura/veterinária , Suturas/veterinária , Traumatismos dos Tendões/cirurgia , Traumatismos dos Tendões/veterinária , Tendões/cirurgia , Resistência à Tração
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5049-5052, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019121

RESUMO

Suture ligation of vascular tissues is slow and skill intensive. Ultrasonic (US) and radiofrequency (RF) devices enable more rapid vascular tissue ligation to maintain hemostasis, than sutures and mechanical clips, which leave foreign objects in the body and require exchange of instruments. However, US and RF devices are limited by excessive collateral thermal damage to adjacent tissues, and high jaw temperatures that require a long time to cool. A novel alternative method using infrared (IR) laser energy is being developed for more rapid and precise sealing of vessels. This study describes design, modeling, and initial testing of several optical beam shaping geometries for integration into the standard jaws of a laparoscopic device. The objective was to transform the circular laser beam into a linear beam, for uniform, cross-irradiation and sealing of blood vessels. Cylindrical mirrors organized in a staircase geometry provided the best spatial beam profile.Clinical Relevance-This study explored several optical designs for potential integration into the standard jaws of a laparoscopic vessel sealing device, transforming a circular laser beam into a linear beam for sealing of vascular structures.


Assuntos
Laparoscopia , Lasers , Ligadura , Instrumentos Cirúrgicos , Suturas
20.
Unfallchirurg ; 123(11): 879-889, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33048209

RESUMO

Injuries of the sternoclavicular joint (SCJ) are rare accounting for 3% of all injuries to the shoulder girdle and are often overlooked. The SCJ is surrounded by tight ligamentous structures, thus substantial energy with corresponding force vectors is needed to cause dislocation. Causative are mostly high-energy traumas. Anterior dislocation is most common but in rare cases potentially life-threatening posterior dislocation occurs, which requires immediate reduction. The established gold standard is 3D reconstruction in contrast-enhanced computed tomography (CT) for depiction of neurovascular structures. Low-grade instability can initially be treated conservatively. For unsuccessful attempts at reduction, high-grade instability and chronic instability various surgical techniques are established. Next to retentive augmentation with suture materials, in acute cases with chronic instability biological tendon augmentation is preferred. In cases of posttraumatic instability arthritis SCJ resection with or without additive biological augmentation can be carried out. Various study groups have shown good to very good midterm outcome.


Assuntos
Luxações Articulares , Procedimentos Cirúrgicos Reconstrutivos , Articulação Esternoclavicular , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Articulação Esternoclavicular/diagnóstico por imagem , Articulação Esternoclavicular/lesões , Articulação Esternoclavicular/cirurgia , Suturas , Tendões
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