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1.
Obstet Gynecol ; 141(2): 268-283, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36649334

RESUMO

OBJECTIVE: To explore how permanent compared with absorbable suture affects anatomic success in native tissue vaginal suspension (uterosacral ligament suspension and sacrospinous ligament suspension) and sacrocolpopexy with mesh. DATA SOURCES: MEDLINE, EMBASE, and ClinicalTrials.gov were searched through March 29, 2022. METHODS OF STUDY SELECTION: Our population included women undergoing apical prolapse surgery (uterosacral ligament suspension and sacrospinous ligament suspension and abdominal sacrocolpopexy). Our intervention was permanent suture for apical prolapse surgery, and our comparator was absorbable suture. We determined a single anatomic success proportion per study. Adverse events collected included suture and mesh exposure, surgery for suture and mesh complication, dyspareunia, and granulation tissue. Abstracts were doubly screened, full-text articles were doubly screened, and accepted articles were doubly extracted. Quality of studies was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. In single-arm studies using either permanent or absorbable suture, random effects meta-analyses of pooled proportions were used to assess anatomic success. In comparative studies investigating both suture types, random effects meta-analyses of pooled risk ratios were used. TABULATION, INTEGRATION, AND RESULTS: Of 4,658 abstracts screened, 398 full-text articles were assessed and 63 studies were included (24 vaginal suspension [13 uterosacral ligament suspension and 11 sacrospinous ligament suspension] and 39 sacrocolpopexy). At 2-year follow-up, there was no difference in permanent compared with absorbable suture in uterosacral ligament suspension and sacrospinous ligament suspension (proportional anatomic success rate 88% [95% CI 0.81-0.93] vs 88% [95% CI 0.82-0.92]). Similarly, at 18-month follow-up, there was no difference in permanent compared with absorbable suture in sacrocolpopexy (proportional anatomic success rate 92% [95% CI 0.88-0.95] vs 96% [95% CI 0.92-0.99]). On meta-analysis, there was no difference in relative risk (RR) of success for permanent compared with absorbable suture for uterosacral ligament suspension and sacrospinous ligament suspension (RR 1.11, 95% CI 0.93-1.33) or sacrocolpopexy (RR 1.00, 95% CI0.98-1.03). CONCLUSION: Success rates were similarly high for absorbable and permanent suture after uterosacral ligament suspension, sacrospinous ligament suspension, and sacrocolpopexy, with medium-term follow-up. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021265848.


Assuntos
Prolapso de Órgão Pélvico , Prolapso Uterino , Feminino , Humanos , Útero/cirurgia , Prolapso Uterino/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Ligamentos/cirurgia , Suturas/efeitos adversos , Resultado do Tratamento
2.
Indian J Ophthalmol ; 71(1): 281-286, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36588252

RESUMO

This article reports a novel surgical technique of partial-thickness compression sutures without descemetopexy with air or gas for the management of acute hydrops in keratoconus. Two patients presented with localized corneal edema with a Descemet membrane (DM) tear in the left eye. Tomography of the right eye revealed localized steepening with increased maximum keratometry and decreased central pachymetry. They were diagnosed with keratoconus in the right eye and acute corneal hydrops (ACH) in the left eye. Compression sutures were passed through the stroma without touching the DM. The anterior chamber was not entered at all at any point during the surgery. Resolution of edema was noted intraoperatively itself. Further resolution of edema was noted from the first postoperative day which markedly reduced within the first week. A corneal scar with no edema was seen at six weeks. In both the patients, vision at presentation was counting fingers close to face which improved to 20/60 and 20/50, respectively, at the last visit.


Assuntos
Edema da Córnea , Ceratocone , Humanos , Ceratocone/complicações , Ceratocone/diagnóstico , Ceratocone/cirurgia , Lâmina Limitante Posterior/cirurgia , Doença Aguda , Edema , Edema da Córnea/diagnóstico , Edema da Córnea/etiologia , Edema da Córnea/cirurgia , Suturas
3.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 67(1): 56-61, Ene-Feb. 2023.
Artigo em Inglês | IBECS | ID: ibc-214355

RESUMO

Background and objective: The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous Achilles tendon repair with absorbable sutures. Material and methods: Prospective cohort study including 52 patients treated for Achilles tendon ruptures (January 2016 to March 2019). Inclusion criteria: ≥18 years of age, non-insertional Achilles tendon ruptures. Diagnosis based on clinical criteria, confirmed by ultrasonography. Assessment using Visual Analogue Scale (VAS), Achilles Tendon Rupture Score (ATRS) and ultrasound. Re-rupture rate and postoperative complications were collected. Results: VAS scoring (SD) at 1, 3, 6 and 12 months follow-up (FU) were 2.63 (0.83), 1.79 (1.25), 0.69 (1.09) and 0.08 (0.39), respectively. Mean (SD) ATRS score was 92.45 points at 6 months (6.27) and 94.04 points at 12 months FU (4.59). Three re-ruptures (5.77%) occurred with a mean time between surgery and re-rupture of 108.75 days (SD 28.4), all of them within 4-month FU. No ruptures at the time to return to sports activity. Thirteen complications (25%) (3 re-ruptures, 1 superficial wound infection and 9 transitory sural nerve injuries). Conclusions: Percutaneous Achilles tendon repair with absorbable sutures in patients with acute Achilles tendon ruptures has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, these would be avoided with conservative treatment. Conservative treatment associated with an early weight-bearing rehabilitation protocol should be considered a viable option for patients with Achilles tendon ruptures, specially in cooperative young patients.(AU)


Antecedentes y objetivo: El propósito es evaluar los resultados clínicos y complicaciones de la reparación percutánea del tendón de Aquiles con suturas reabsorbibles. Material y métodos: Estudio de cohorte prospectivo incluyendo 52 pacientes tratados por rotura del tendón de Aquiles (enero 2016-marzo 2019). Criterios de inclusión: ≥18 años de edad, roturas no insercionales del tendón de Aquiles. Diagnóstico clínico y confirmado por ecografía. Evaluación mediante Escala Analógica Visual (EVA), puntuación de rotura del tendón de Aquiles (ATRS) y ecografía. Recopilación de tasas de re-rotura y complicaciones postoperatorias. Resultados: Puntuación EVA (DE) al mes, 3, 6 y 12 meses de seguimiento: 2,63 (0,83), 1,79 (1,25), 0,69 (1,09) y 0,08 (0,39). Media (DE) de la puntuación ATRS: 92,45 puntos a los 6 meses (6,27) y 94,04 puntos a los 12 meses (4,59). 3 re-roturas (5,77%) con tiempo medio entre cirugía y re-rotura de 108,75 días (DE 28,4), todas durante los 4 meses de seguimiento. No roturas a la reincorporación a la actividad deportiva. 13 complicaciones (25%) (3 re-roturas, 1 infección de herida superficial y 9 lesiones transitorias del nervio sural). Conclusiones: La reparación percutánea del tendón de Aquiles con suturas reabsorbibles en pacientes con rotura aguda del tendón de Aquiles muestra buenos resultados funcionales; con alta incidencia de complicaciones. La mayoría de complicaciones fueron síntomas transitorios del nervio sural, que se evitarían en pacientes tratados conservadoramente. Asociado a un protocolo temprano de rehabilitación con carga, debe considerarse una opción, especialmente en pacientes jóvenes cooperadores.(AU)


Assuntos
Humanos , Masculino , Feminino , Tendão do Calcâneo , Suturas , Tratamento Conservador , Nervo Sural , Estudos Prospectivos , Estudos de Coortes
4.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 67(1): T56-T61, Ene-Feb. 2023. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-214356

RESUMO

Antecedentes y objetivo: El propósito es evaluar los resultados clínicos y complicaciones de la reparación percutánea del tendón de Aquiles con suturas reabsorbibles. Material y métodos: Estudio de cohorte prospectivo incluyendo 52 pacientes tratados por rotura del tendón de Aquiles (enero 2016-marzo 2019). Criterios de inclusión: ≥18 años de edad, roturas no insercionales del tendón de Aquiles. Diagnóstico clínico y confirmado por ecografía. Evaluación mediante Escala Analógica Visual (EVA), puntuación de rotura del tendón de Aquiles (ATRS) y ecografía. Recopilación de tasas de re-rotura y complicaciones postoperatorias. Resultados: Puntuación EVA (DE) al mes, 3, 6 y 12 meses de seguimiento: 2,63 (0,83), 1,79 (1,25), 0,69 (1,09) y 0,08 (0,39). Media (DE) de la puntuación ATRS: 92,45 puntos a los 6 meses (6,27) y 94,04 puntos a los 12 meses (4,59). 3 re-roturas (5,77%) con tiempo medio entre cirugía y re-rotura de 108,75 días (DE 28,4), todas durante los 4 meses de seguimiento. No roturas a la reincorporación a la actividad deportiva. 13 complicaciones (25%) (3 re-roturas, 1 infección de herida superficial y 9 lesiones transitorias del nervio sural). Conclusiones: La reparación percutánea del tendón de Aquiles con suturas reabsorbibles en pacientes con rotura aguda del tendón de Aquiles muestra buenos resultados funcionales; con alta incidencia de complicaciones. La mayoría de complicaciones fueron síntomas transitorios del nervio sural, que se evitarían en pacientes tratados conservadoramente. Asociado a un protocolo temprano de rehabilitación con carga, debe considerarse una opción, especialmente en pacientes jóvenes cooperadores.(AU)


Background and objective: The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous Achilles tendon repair with absorbable sutures. Material and methods: Prospective cohort study including 52 patients treated for Achilles tendon ruptures (January 2016 to March 2019). Inclusion criteria: ≥18 years of age, non-insertional Achilles tendon ruptures. Diagnosis based on clinical criteria, confirmed by ultrasonography. Assessment using Visual Analogue Scale (VAS), Achilles Tendon Rupture Score (ATRS) and ultrasound. Re-rupture rate and postoperative complications were collected. Results: VAS scoring (SD) at 1, 3, 6 and 12 months follow-up (FU) were 2.63 (0.83), 1.79 (1.25), 0.69 (1.09) and 0.08 (0.39), respectively. Mean (SD) ATRS score was 92.45 points at 6 months (6.27) and 94.04 points at 12 months FU (4.59). Three re-ruptures (5.77%) occurred with a mean time between surgery and re-rupture of 108.75 days (SD 28.4), all of them within 4-month FU. No ruptures at the time to return to sports activity. Thirteen complications (25%) (3 re-ruptures, 1 superficial wound infection and 9 transitory sural nerve injuries). Conclusions: Percutaneous Achilles tendon repair with absorbable sutures in patients with acute Achilles tendon ruptures has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, these would be avoided with conservative treatment. Conservative treatment associated with an early weight-bearing rehabilitation protocol should be considered a viable option for patients with Achilles tendon ruptures, specially in cooperative young patients.(AU)


Assuntos
Humanos , Masculino , Feminino , Tendão do Calcâneo , Suturas , Tratamento Conservador , Nervo Sural , Estudos Prospectivos , Estudos de Coortes
5.
Jt Dis Relat Surg ; 34(1): 42-49, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36700262

RESUMO

OBJECTIVES: In this meta-analysis, we aimed to compare the differences in surgical site infection (SSI) between triclosan-coated and uncoated sutures after hip and knee arthroplasty. MATERIALS AND METHODS: We searched PubMed, Embase, and Cochrane databases for randomized-controlled studies (RCTs) comparing triclosan-coated sutures with uncoated sutures for the prevention of SSIs after hip and knee arthroplasty. Literature screening and data curation were performed according to inclusion and exclusion criteria and the risk of bias was assessed for included research using Cochrane Handbook criteria. RESULTS: Three RCTs with a total of 2,689 cases were finally included, including 1,296 cases in the triclosan-coated suture group and 1,393 cases in the control group. The overall incidence of SSI was lower in the group with triclosan antimicrobial sutures (1.9%) than in the uncoated suture group (2.5%), but the difference was statistically significant (odds ratio=0.76, 95% confidence interval: [0.45-1.27], p=0.30). The differences in the results of the incidence of superficial SSI and deep SSI were not statistically significant (p>0.05). CONCLUSION: The application of triclosan antimicrobial sutures did not reduce the incidence of SSI after hip and knee arthroplasty compared to the controls, and it needs further high-quality RCT studies to be improved.


Assuntos
Anti-Infecciosos Locais , Anti-Infecciosos , Triclosan , Humanos , Triclosan/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Suturas/efeitos adversos
6.
In Vivo ; 37(1): 124-131, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36593052

RESUMO

BACKGROUND/AIM: Anterior tension band injuries are usually the result of high impact hyperextension trauma. Current surgical treatment includes anterior cervical discectomy and fusion bearing the risk of soft tissue irritation, degeneration of adjacent cervical segments, implant failure or iatrogenic spondylodesis. This study examined the biomechanical properties of tape suture constructs reenforcing ligamental stability for the treatment of Association of Osteosynthesis (AO) type B3 injuries compared to anterior fusion. MATERIALS AND METHODS: After creation of an AO type B3 injury in synthetic cervical segments (C5/6, Sawbone®), seven segments were treated with anterior fusion and seven with a tape suture construct, similar to the SpeedBridge™ (Arthrex®). Biomechanical testing was performed, simulating extension, flexion, lateral bending, and rotation. Dislocation (°) and corresponding force (N) were measured and compared. RESULTS: Anterior fusion displayed a mean range of extension, lateral bending, and rotation of 3.60° (SD 1.87°), 2.28° (SD 1.55°), and 2.81° (SD 0.78°), respectively. The tape suture showed a mean range of extension, lateral bending, and rotation of 4.24° (SD 0.81°) (p=0.146), 5.44° (SD 1.56°) (p=0.013), and 5.29° (SD 1.44°) (p<0.01), respectively. No specimen suffered from implant failure. CONCLUSION: The tape suture construct provides sufficient biomechanical stability for the treatment of AO type B3 injuries compared to anterior fusion. Regarding cervical extension, whose limitation is crucial for ligamental healing, the tape suture shows no significant inferiority. Yet, the tape suture approaches physiological mobility in the planes not affected by the injury. Consequently, the tape suture is a promising alternative preventing an iatrogenic spondylodesis.


Assuntos
Vértebras Cervicais , Discotomia , Humanos , Fenômenos Biomecânicos , Vértebras Cervicais/cirurgia , Suturas , Doença Iatrogênica
7.
BMC Ophthalmol ; 23(1): 30, 2023 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-36690980

RESUMO

BACKGROUND: Techniques used to suture the rectus muscle to the implant can influence the implant-related complications which is still a major problem following retinoblastoma enucleation. The goals of this work were to report the efficacy among patients with retinoblastoma who underwent enucleation followed by porous implant placement with the rectus muscles sutured with 5-0 polyester suture. METHODS: This was a retrospective study of consecutive patients with retinoblastoma who underwent primary enucleation and porous implant placement with the rectus muscles tagged and sutured to the implant with polyester 5-0 suture. All the patients were followed up for a minimum of 2 years. The main outcome measure was implant exposure. The secondary efficacy measures were other implant-related complications. RESULTS: Between May 2016 and December 2018, a total of 120 patients (120 eyes) underwent primary enucleation and porous implant placement were included. Postoperatively, 10/120 (8.3%) eyes developed exposure or conjunctival granuloma. Exposure was the most common postoperative complication (7/10, 70.0%). There were no cases of implant extrusion, migration, or infection. CONCLUSIONS: Polyester 5-0 sutures are successful in patients with retinoblastoma who underwent enucleation followed by porous implant placement. Complications are minimal. Polyester 5-0 sutures were not associated with unacceptable complications in this pediatric population.


Assuntos
Implantes Orbitários , Neoplasias da Retina , Retinoblastoma , Humanos , Criança , Retinoblastoma/cirurgia , Estudos Retrospectivos , Porosidade , Enucleação Ocular , Complicações Pós-Operatórias/cirurgia , Implantação de Prótese , Poliésteres , Neoplasias da Retina/cirurgia , Suturas
8.
J Mech Behav Biomed Mater ; 138: 105658, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36610283

RESUMO

This work reports the first in vitro study on the in-situ biodegradation behaviour and the evolution of fixation strength of Zn-Cu alloy wires in a simulated sternum closure environment. Zn-Cu wires were used to reapproximate the partial bisected sternum models, and their fixation effect was compared with traditional surgical grade 316 L stainless steel (SS) wires in terms of fixation rigidity, critical load, first/ultimate failure characteristics. The metal sutures were then immersed in Hank's balanced salt solution for 12 weeks immersion period, and their corrosion behaviours assessed. Zn-Cu wires showed similar fixation rigidity at 70.89 ± 6.97 N/mm as SS, but the critical load, first failure and ultimate failure characteristics were inferior to SS. The key challenges that limited the fixation effect of the Zn-Cu wires were poor mechanical strength, short elastic region, and strain softening behaviours, which resulted in poor load-bearing capabilities and reduced the knot security of the sutures. The in-situ biodegradation of the Zn-Cu suture was accompanied by the early onset of localised corrosion within the twisted knot and the section located next to the incision line. Crevice corrosion and strain-induced corrosion were the dominant mechanisms in the observed localised corrosion. The localised corrosion on the Zn-Cu sutures did not lead to a significant shift in fixation rigidity, critical load and the first failure characteristics. The findings suggest that the Zn-based biodegradable metallic wires could be a promising sternum closure suture material once the limitations in mechanical characteristics are addressed.


Assuntos
Esterno , Técnicas de Sutura , Esterno/cirurgia , Fios Ortopédicos , Suturas , Aço Inoxidável , Ligas/farmacologia , Corrosão , Zinco , Teste de Materiais
9.
J Orthop Surg Res ; 18(1): 15, 2023 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-36604674

RESUMO

BACKGROUND: Trans-calcaneal suture technique is an economical and effective method for repairing Achilles tendon sleeve avulsion. Whether cancellous bone fixation upon this technique could accelerate tendon-to-bone healing is unknown. The purpose of this study is to compare the effect of cortical versus cancellous bone fixation on tendon-bone healing with a novel rat trans-calcaneal suture model. METHODS: Trans-calcaneal suture treatment was carried out on the right hindlimb in male Sprague-Dawley rats (N = 80). They were randomly divided into the cortical group (Achilles fixed to the calcaneal cortical bone, n = 40) and the cancellous group (Achilles fixed to the calcaneal cancellous bone, n = 40). Gait analysis and immunohistochemistry were performed 1, 4, 7, and 14 days after the operation. Gross observation, biomechanical analysis, micro-CT, and histological analysis were performed 4 and 8 weeks after surgery. Independent-samples t tests were used for comparison between groups. RESULTS: At 1, 4, and 7 days, the swing time of the affected limb in the cancellous group decreased, while the duty cycle, the maximum contact area, the print area, and the mean intensity increased significantly. The cross-sectional area of the tendon-bone junction in the cancellous group was smaller, and the failure load and stiffness were higher 4 weeks after the operation. The cancellous group showed more proportion of new bone and a relatively well-organized and dense connective tissue interface with better fibrocartilage-like tissue at 4 weeks after the operation. The ratio of ED2 + macrophages in the cancellous group was significantly higher than in the cortical group on 1, 4, 7, and 14 days. There were no significant differences in gait at 2 weeks, in appearance, biomechanics, new bone formation, and histology at 8 weeks after surgery between the two groups. CONCLUSION: In the new rat trans-calcaneal suture model, cancellous fixation can accelerate tendon-to-bone healing in the early stage, which perhaps is related to the abundant bone marrow tissue in the cancellous bone that modulates the inflammatory processes.


Assuntos
Tendão do Calcâneo , Traumatismos dos Tendões , Animais , Masculino , Ratos , Tendão do Calcâneo/cirurgia , Fenômenos Biomecânicos , Osso Esponjoso/cirurgia , Ratos Sprague-Dawley , Técnicas de Sutura , Suturas , Traumatismos dos Tendões/cirurgia , Cicatrização
11.
BMC Surg ; 23(1): 9, 2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36639756

RESUMO

BACKGROUND: Subcuticular suture has proven to reduce superficial incisional SSI (si-SSI) in clean surgery. However, question remains regarding clean-contaminated procedures. The aim of this study is to assess if subcuticular suture is superior to staples in reducing si-SSI incidence in elective HBP surgery. METHODS: Single-centre, open-label, parallel, pragmatic randomized clinical trial conducted at a referral tertiary Hospital between January 2020 and April 2022. Patients eligible for elective HBP surgery were randomly assigned (1:1) to subcuticular suture or surgical staples wound closure using a minimisation method based on previously confirmed risk factors. The primary endpoint was the incidence of si-SSI. Considered secondary endpoints were major postoperative morbidity in both groups, additional wound complications, median hospital length of stay and need for re-hospitalisation. RESULTS: Of the 379 patients, 346 patients were randomly assigned to receive skin closure with staples (n = 173) or subcuticular suture (n = 173). After further exclusion of 11 participants, 167 and 168 patients, respectively in the control and the experimental group received their allocated intervention. For the primary endpoint, no significant differences in si-SSI rate were found: 17 (9.82%) staples group vs. 8 (4.62%) in subcuticular suture group (p = 0.062). Subset analysis confirmed absence of significant differences. As for secondary endpoints, overall wound complications did not differ significantly between two procedures: 19 (10.98%) vs. 10 (6.35%) (p = 0.127). There were no treatment related adverse events. However, occurrence of si-SSI contributed to major postoperative morbidity in both groups (p < 0.001 and p = 0.018) and to a substantially prolonged postoperative hospitalization (p = 0.015). CONCLUSIONS: Subcuticular suture might offer a relative benefit for skin closure reducing incidence of si-SSI after elective HBP surgery, although this was found not to be clinically relevant. Yet, this should not be interpreted as equivalence among both treatments. Therefore, wound closure strategy should not be based only on these grounds. TRIAL REGISTRATION NUMBER: ISRCTN Registry number ISRCTN37315612 (registration date: 14/01/2020).


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Técnicas de Sutura , Humanos , Técnicas de Sutura/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Grampeamento Cirúrgico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/etiologia , Suturas/efeitos adversos
12.
BMC Ophthalmol ; 23(1): 20, 2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36635644

RESUMO

PURPOSE: To report a novel surgical approach for the scleral fixation of the Rayner 620 H intraocular lens (IOL) with Gore-Tex suture and its outcomes at 6 months postoperatively. METHODS: 19 consecutive patients who underwent novel surgical approach for the scleral fixation of Rayner 620 H IOL with Gore-Tex suture at Peking Union Medical College Hospital between June 2020 and June 2021 were included. Data on best-corrected visual acuity (BCVA), spherical equivalent, total astigmatism/axis, short-term and long-term complications, and corresponding management with a follow-up of 6 months were collected. RESULTS: Nineteen patients (11 men and 8 women) with a mean age of 62.7 ± 10.6 years were included. The median BCVA improved significantly from 0.90 ± 0.90 (Snellen 20/160) preoperatively to 0.20 ± 0.30 (Snellen 20/32) at postoperative 6 months follow-up (P < 0.001). The stratification of the accuracy of refractive outcomes was 53% of patients within ± 0.5 D and 84% of patients within ± 1.0 D of the refractive target. Corneal edema (n = 3, 16%) and increased intraocular pressure (IOP) (n = 4, 11%) were short-term complications. Long-term complications included increased IOP (n = 1, 5%), and macular edema (n = 1, 5%). CONCLUSION: The novel surgical approach for scleral fixation of the Rayner 620 H IOL with Gore-Tex suture is a reasonable option for patients who need secondary IOL placement without adequate capsular support.


Assuntos
Lentes Intraoculares , Politetrafluoretileno , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Implante de Lente Intraocular , Suturas , Esclera/cirurgia , Técnicas de Sutura , Complicações Pós-Operatórias/cirurgia
13.
BMC Surg ; 23(1): 1, 2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36600246

RESUMO

OBJECTIVE: To investigate the effect of laparoscopic purse-string sutures in adult complicated appendicitis treatment. METHODS: The data of 568 adult cases of complicated appendicitis treated by laparoscopic appendectomy at the Hefei Second People's Hospital, Anhui Province, China, from September 2018 to September 2021 were analysed retrospectively. The patients were divided into two groups: 295 cases in the laparoscopic purse-string suture treatment group (observation group) and 273 cases in the simple Hem-o-lok® clamp treatment group (control group). The baseline data collected included age, gender, preoperative body temperature, leukocyte count and percentage of neutrophils and the surgery time. The postoperative data collected included antibiotic treatment duration, drainage tube placement time and the incidence of complications. RESULTS: There were no significant differences in the baseline data of the two groups, including age, gender, preoperative body temperature, leukocyte count and neutrophil percentage (all P > 0.05). Compared with the control group, the postoperative hospital length of stay, duration of antibiotic treatment, the recovery time of peripheral white blood cell and neutrophil counts and the incidence of postoperative complications in the observation group were significantly decreased (P < 0.05). CONCLUSION: Purse-string sutures can effectively reduce the incidence of postoperative complications after a laparoscopic appendectomy for adult acute complicated appendicitis. There was faster postoperative recovery when patients' appendiceal stumps were treated with laparoscopic purse-string sutures.


Assuntos
Apendicite , Laparoscopia , Humanos , Adulto , Apendicite/cirurgia , Técnicas de Sutura/efeitos adversos , Estudos Retrospectivos , Apendicectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Laparoscopia/efeitos adversos , Suturas/efeitos adversos , Tempo de Internação
14.
BMC Surg ; 23(1): 20, 2023 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-36703127

RESUMO

BACKGROUND: The recently developed endoscopic full-thickness resection technique requires reliable closure. The main closure methods are the purse-string suture (PSS) technique and over-the-scope clip (OTSC) technique; however, basic data on the closure strength of each technique are lacking. This study was performed to compare the closure strengths of these two methods in an ex vivo porcine model. METHODS: In the traction test, a virtual 5-cm full-thickness closure line was closed by the following six methods three times each: conventional hemoclips, mucosal PSS, seromuscular PSS, mucosal OTSC, seromuscular OTSC, and surgical suture. The primary endpoint was the tension at the starting point of dehiscence, measured in Newtons (N) by an automatic traction machine. In the leak test, a 15-mm gastric full-thickness defect was closed by PSS or OTSC six times each, and the closed stomach was then pressurized in a water container. The primary endpoint was the leak pressure when air bubbles appeared. The secondary endpoints were the procedure time and presence of complete inverted closure. RESULTS: The mean tension was 2.16, 3.68, 5.15, 18.30, 19.30, and 62.40 N for conventional hemoclips, mucosal PSS, seromuscular PSS, mucosal OTSC, seromuscular OTSC, and surgical suture, respectively. Complete inverted closure was observed for seromuscular PSS, seromuscular OTSC, and surgical suture. The mean leak pressure was 13.7 and 24.8 mmHg in the PSS and OTSC group, respectively (P < 0.01). The mean procedure time was 541 and 169 s in the PSS and OTSC group, respectively (P < 0.01). Complete inverted closure was observed in OTSC alone. CONCLUSION: The OTSC, which allows complete inverted closure, showed greater closure strength than PSS. Considering the size limitation suitable for single OTSC, a therapeutic strategy for closing the larger size is further warranted.


Assuntos
Estômago , Tração , Suínos , Animais , Estômago/cirurgia , Endoscopia , Suturas , Técnicas de Sutura
15.
Anticancer Res ; 43(1): 59-61, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36585160

RESUMO

BACKGROUND/AIM: In the modern minimally invasive era, diagnostic and therapeutic endoscopic interventions are one of the most emerging fields. For the new operational techniques, it is a major aim to develop reliable instruments, such as suturing devices for flexible endoscopes. The aim of this study was to assess the feasibility of a safe and reproducible suturing technique with an endoluminal suturing device. MATERIALS AND METHODS: The evaluation of the technique was performed in twenty explanted special prepared porcine stomachs. Three different techniques were compared, single stitches, figure-of-eight, or Z-pattern and running sutures in terms of suturing time and bursting pressure. After verification of the reliability of the method, a 3 cm long full thickness incision on the stomach was closed with the endoscopic suturing device in four surviving animals. RESULTS: In our ex vivo studies, we have shown that the figure of 8 or Z- technique is the most optimal for stomach closure without considerable time-cost, thus this technique was chosen as the standard method for the in vivo study. The endoscopic stomach wall suturing was successful in all four cases, the postoperative period was uneventful and ended on the tenth postoperative day with autopsy. CONCLUSION: With the applied suturing device, the endoscopic suturing of the stomach is safe and reproducible, thus a human application may also be justified.


Assuntos
Gastroscopia , Estômago , Animais , Suínos , Humanos , Gastroscopia/métodos , Reprodutibilidade dos Testes , Estômago/cirurgia , Técnicas de Sutura , Suturas , Modelos Teóricos
16.
J Surg Res ; 281: 228-237, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36208563

RESUMO

INTRODUCTION: Basic suturing is a skill expected from graduating medical students. A proposed concept to increase suturing competency is to integrate art by mixing cross-stitching with suturing. We hypothesize that students trained with "cross-suturing" would improve suturing performance. METHODS: We performed a randomized controlled trial of preclinical medical students using an art-based cross-stitching method intervention compared with conventional suturing. Both groups were provided with an introductory suturing video. Assessment of simple interrupted suturing were conducted preintervention and postintervention, and at 2-wk follow-up with a video review by blinded expert raters using the American College of Surgeons basic suturing and knot tying performance rating tool. Students completed a self-assessment of proficiency, confidence, and anxiety. Statistical analysis was performed using unpaired t-tests. RESULTS: A total of 16 preclinical medical students participated. Self-assessment and objective suturing performance were comparable in the preintervention measurements. The intervention group showed significant improvement compared to the control group with median (interquartile range) self-assessment scores 9 (8.5-9) compared with 6.5 (6-7.5) (P < 0.01) and objective performance scores of 25.25 (22.75-27) compared with 16.5 (14.5-18.5) (P < 0.01). The intervention group showed retained skills at the 2-wk follow up with no differences in self-assessment or objective suturing scores immediately postintervention compared with two-wk follow-up with self-assessment scores of 9 (8.5-9) versus 9 (8-9) at 2 wk (P = 0.16) and objective performance score of 25.25 (22.75-27) versus 24.75 (23.5-26.5) at 2 wk (P = 0.29). CONCLUSIONS: The cross-suturing intervention improved suturing skills in this cohort. This low-cost approach to medical student surgical education should be explored on a larger scale.


Assuntos
Competência Clínica , Estudantes de Medicina , Humanos , Suturas , Autoavaliação (Psicologia) , Técnicas de Sutura/educação
17.
J Gynecol Obstet Hum Reprod ; 52(2): 102518, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36526236

RESUMO

OBJECTIVE: To describe a new technique for performing an isthmic retroperitoneal cerclage via vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES). DESIGN: Stepwise explanation of the surgical technique using original video footage. This study was exempted from requiring hospital IRB. SETTING: Department of Obstetrics and Gynaecology, Imelda Hospital, Belgium. INTERVENTION: A circumferential vaginal incision is made around the cervix after infiltration of the tissue with local anaesthetic and adrenaline. The bladder is deflected from the cervix up to the level of the isthmus but the peritoneum is not opened. The rectum is deflected from the cervix up to the level of the isthmus but the peritoneum is not opened. A Gelpoint vPath (9.5 cm) (Applied Medical, Rancho Santa Margarita) is used as a vNOTES port. The inner ring of the Alexis is inserted into the retroperitoneal dissection space around the cervix, covering the bladder anteriorly and the rectum posteriorly. An insufflation stabilization bag (ISB) is connected to the Gelseal cap to minimize pressure fluctuations within the confines of the retroperitoneal operative space. The paracervical space is opened just inferior to the uterine artery. A paracervical tunnel is made from the anterior to the posterior retroperitoneal space just lateral to the cervix and just inferior to the uterine artery. This procedure is performed bilaterally. A vessel loop is inserted from anterior to posterior through the paracervical tunnel on each side of the cervix. The Gelseal cap is removed and an Ethibond-2 suture is tied to the vessel loop. The Gelseal cap is placed again. By pulling on the vessel loop, it is replaced by the Ethibond suture. The Ethibond suture is now tied endoscopically to complete the cerclage; alternatively the suture could be tied vaginally without endoscopic instruments to the surgeon's preference. The vNOTES port is removed and the vaginal mucosa is sutured to the cervix again using a resorbable suture. DISCUSSION: Abdominal cerclage is the preferred approach to treat patients with refractory cervical insufficiency [1]. Over the last 20 years this technique increasingly gets performed laparoscopically with similar success rates [2]. The new transvaginal approach demonstrated in this video article may help reduce the invasivess even more by avoiding abdominal incisions and opening the peritoneum, while still benefiting from the vNOTES endoscopic visualization and minimally invasive instruments [3]. The cerclage is placed permanently at the level of the isthmus, similar to an abdominal cerclage. It is placed more cranially than a McDonald or Shirodkar cerclage and leaves no non-resorbable sutures in the vagina [4]. It can be an alternative to a conventional transvaginal cervicoisthmic cerclage [5,6] in patients with a narrow vagina and without uterine descensus. Following the guidelines of the IDEAL collaboration we present this technique to be peer reviewed in its early developmental phase before starting further studies [7]. CONCLUSION: This is a first feasibility and technique description report on performing a retroperitoneal isthmic cervical via vNOTES. This technique should be considered new, not to be performed on pregnant patients or outside of clinical trials, and only in carefully counselled patients.


Assuntos
Cirurgia Endoscópica por Orifício Natural , Vagina , Gravidez , Feminino , Humanos , Espaço Retroperitoneal/cirurgia , Vagina/cirurgia , Suturas , Peritônio , Cirurgia Endoscópica por Orifício Natural/métodos
18.
Foot Ankle Int ; 44(1): 54-61, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36537750

RESUMO

BACKGROUND: The quality of reduction of the distal tibiofibular joint (DTFJ) has a major impact on the outcome. Novel suture-button systems as well as intraoperative 3D imaging can be applied to increase the quality of DTFJ reduction intraoperatively. The individual effect of either remains unknown. The aim of this study was to investigate the value of intraoperative 3D imaging on the quality of reduction of the DTFJ when using a suture-button system. METHODS: Retrospective, radiographic study including adult patients who underwent surgical stabilization of the syndesmosis with a suture-button system for acute, unilateral, unstable syndesmotic injuries with postoperative bilateral CT imaging. The use of an intraoperative 3D scan was the individual surgeon's choice. Assessed was whether the intraoperative 3D imaging had an influence on the postoperative quality of DTFJ reduction and revision rates. These findings were put in perspective to the correction potential of the suture-button system. RESULTS: A total of 147 patients were included; 76 of these received an intraoperative 3D imaging. Neither the rate of formal malreduction (17% vs 17%) nor the postoperative revision rate (4% vs 3%) differed significantly between patients with or without intraoperative 3D imaging. Intraoperative 3D imaging revealed a false-negative rate of 14%. The intrinsic correction potential of the suture-button system reduced the number of formally malreduced DTFJs in both groups by 51%. CONCLUSION: The additional value of intraoperative 3D imaging to assess the quality of DTFJ reduction in our series did not improve syndesmotic reduction when using a flexible suture-button system. LEVEL OF EVIDENCE: Level III, retrospective comparative cohort study.


Assuntos
Articulação do Tornozelo , Fixação Interna de Fraturas , Adulto , Humanos , Fixação Interna de Fraturas/métodos , Estudos de Coortes , Estudos Retrospectivos , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Imageamento Tridimensional , Parafusos Ósseos , Técnicas de Sutura , Suturas
19.
J Forensic Leg Med ; 93: 102466, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36538863

RESUMO

Post autopsy reconstruction (PAR) plays a vital role in the external appearance of dead bodies while handing over to grieving family members. Autopsy surgeons should not only be restricted to autopsy findings/techniques but should also give importance to PAR. Autopsy incision includes various conventional incisions like I, Y, and Modified Y-shaped. The most commonly used incision is I -shaped in most of the autopsy because it is easy for quick suturing but it produces a poor cosmetic appearance because suturing produces visible suture over the front of the neck and chest of a corpse and improper suturing in the skin flaps leads to gapping causes leakage of body fluids at the suture site. More often that leads to avoidable, unnecessary emotional distress for grieving family members. That creates a negative image of forensic practice in society and sometimes with administrative complaints. The authors conducted an observation based study on the medicolegal autopsy that included ten cases that involved "Stethoscope" and various conventional incisions and explored suturing techniques and body packing methods. The study observed that the proposed "Stethoscope" incision was feasible, less time-consuming for suturing, had an excellent cosmetic effect, and was cost-effective. The suturing technique revealed that invisible sutures leads to good cosmetic outcomes but is more time-consuming and costly. The body packing method showed the excellent result of no leakage of body fluid from the suture site. The authors proposed a "Stethoscope" method of incision that can be practiced and adopted for a better cosmetic appearance and humanitarian aspect for grieving relatives. The body packing method renders the body non-hazardous to the public and attendants while handling and transporting. The authors highlight the importance and sensitization of autopsy surgeon/mortuary staff to restructure the corpse with the best cosmetic appearance for the Dignified Management of the Dead and Humanitarian Forensics.


Assuntos
Transporte Intracorporal de Contrabando , Humanos , Autopsia , Suturas , Cadáver , Técnicas de Sutura
20.
Vet Med Sci ; 9(1): 76-81, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36519212

RESUMO

BACKGROUND: In this study, we compared two different techniques currently used for open canine ovariectomy: traditional method utilising absorbable suture and vessel sealing device (ENSEAL® Ethicon Endo-Surgery, Cincinnati, OH). OBJECTIVES: The aim of this study was to compare the surgical times, intraoperative nociceptive response and the frequency of intraoperative complications in the canine ovariectomy procedure using these two techniques. METHODS: Forty bitches were randomly divided into two groups. The Control Group (C) will use a classic open surgery approach using ligatures with absorbable suture and ovarian resection with a scalpel blade. In the Group E, resection of ovarian structures was performed with ENSEAL® tissue sealer device. For each dog the surgical times, the intraoperative nociceptive response (measuring heart rate, respiratory rate and non-invasive blood pressure) and the intraoperative complications were measured to compare the effectiveness of the two techniques. RESULTS: The results of this study showed that the procedures performed using ENSEAL® were faster than the traditional techniques using surgical suture. Instead, the results regarding the nociception and the safety of the two procedures are similar. CONCLUSIONS: The present study shows that the use of ENSEAL® significantly shortened the surgical time. Meanwhile, its use was found to be similarly safe and efficient in terms of intra-operative nociception, as the classical techniques with absorbable suture. Canine ovariectomy using ENSEAL® device is more practical and faster than the traditional technique; the routine use of this device is considered a useful alternative for the canine neutering.


Assuntos
Doenças do Cão , Nociceptividade , Feminino , Cães , Animais , Duração da Cirurgia , Ovariectomia/veterinária , Complicações Intraoperatórias/veterinária , Suturas/veterinária
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