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1.
Med Educ Online ; 27(1): 2023937, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34994685

RESUMO

OBJECTIVE: Onsite clinical skills learning is interrupted during the SARS-CoV-2 pandemic. This study aimed to compare the effectiveness of verbal versus written feedback in virtual suturing skills learning. DESIGN: Participants were randomly divided into two groups, one with verbal feedback and written feedback on the other. Each was instructed to perform a simple interrupted suture which was assessed both before (pre-test) and after (post-test) feedback was given. Both groups were given the same duration of time to learn from the feedback they received. SETTING: Students undergoing clinical rotation in Department of Surgery at School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia. PARTICIPANTS: The eligibility of the participants are students who enrolled on virtual learning in the surgery rotation and have consented to the research and those who own basic surgical equipment at home. A total of 199 participants were enrolled, with 17 (8.55%) participants dropping out. RESULTS: Out of 182 participants, 66 (36.3%) were males and 116 (63.7%) were females. The group receiving verbal intervention showed a significant difference both in suturing skills checklist (Pre-test [M = 4.11, SD = 0.61] and post-test [M = 4.73, SD = 0.37]; t(85) = -10.63, p = 0.000) and Global Rating Scale (GRS) assessment (pre-test [M = 3.83, SD = 1.06] and post-test [M = 4.56, SD = 0.64]; t(86) = -8.10, p = 0.000). In the same way, the group receiving written intervention also showed a significant mean pre-test and pos-test difference in both assessment tools (Checklist assessment [Z = -7.93, p = 0.000]; GRS assessment pre-test [M = 3.42, SD = 0.73] and post-test [M = 4.20, SD = 0.83]; t(105) = -9.62, p = 0.000). Both verbal and written feedback had a large effect (effect size >0.8). CONCLUSIONS: Both verbal and written feedback provide a significant result in improving suturing skills in a virtual learning setting which may provide a solution to online clinical skills training.


Assuntos
COVID-19 , SARS-CoV-2 , Competência Clínica , Retroalimentação , Feminino , Humanos , Masculino , Técnicas de Sutura , Suturas
2.
Colloids Surf B Biointerfaces ; 209(Pt 1): 112214, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34801978

RESUMO

Biodegradable and absorbable sutures have been widely used in surgical procedures. However, for the repair of ligament and tendon injures, the biodegradable suture cannot provide sufficient mechanical support to close the wound for a long period of time which is important to completely heal the tissue. Herein, we develop a simple method that makes a surface coating to prolong the degradation of the suture in vivo. Polylactic acid (PLLA) and Polycaprolactone (PCL) were successfully coated to a commercial degradable polydioxanone (PDO) suture in this study, which was confirmed by Fourier transform infrared spectra (FTIR). Scanning electron microscopy (SEM) was used to observe the smooth surface of the coated sutures. Moreover, live/dead assay of human fibroblasts after co-culturing with the modified/unmodified sutures showed fairly good cellular activity. In vivo study demonstrates the degradation properties of sutures were significantly changed after the surface coating. The raw suture exhibited the fastest degradation in 12 weeks, showing significantly decline in mechanical strength. Interestingly, the PCL-coated suture was able to maintain more than 20% of its original tensile strength after 12 weeks' implantation. In addition, in vivo results of PCL-coated sutures also showed less inflammatory cell infiltration and less surface inflammation. These findings indicate the one step suture-coating method could be feasibly for the development of clinical equipment.


Assuntos
Técnicas de Sutura , Suturas , Humanos , Tendões/cirurgia , Resistência à Tração
3.
J Fr Ophtalmol ; 45(1): 13-19, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34949500

RESUMO

PURPOSE: To compare the use of Yamane flanged intrascleral haptic fixation and scleral suture fixation (SSF) techniques in combination with pars plana vitrectomy (PPV) for treatment of posterior lens dislocations. METHODS: Patients who underwent PPV and scleral fixated IOL implantation due to subluxation/luxation of the crystalline lens/intraocular lens (IOL) were included in this retrospective study. The Yamane group included patients who underwent Yamane flanged intrascleral haptic fixation technique, while the SSF group consisted of patients who underwent conventional SSF. All patients underwent comprehensive ophthalmologic examinations preoperatively and postoperatively. Intraoperative and postoperative complications were recorded. RESULTS: The Yamane group comprised of 39 eyes of 39 patients, and the SSF group included 35 eyes of 35 patients. Postoperative complications included hyphema (Yamane group: 2/39 (5.1%); SSF group: 0/35 (0%)) IOL decentration (Yamane group: 5/39 (12.8%); SSF group: 0/35 (0%)), corneal edema (Yamane group: 4/39 (10.2%); SSF group: 0/35 (0%)) cystoid macular edema (CME) (Yamane group: 1/39 (2.5%); SSF group: 3/35 (8.5%)) and retinal detachment (Yamane group: 1/39 (2.5%); SSF group: 1/35 (28.5%). The mean surgery time was significantly lower in the Yamane group compared with the SSF group (P<0.001). No cases of hypotony, conjunctival erosion, haptic exposure or endophthalmitis were encountered throughout follow-up. CONCLUSION: SSF remains a safe and effective technique for management of posterior lens dislocations. The Yamane intrascleral IOL fixation technique is an effective alternative to conventional SSF, which has a relatively steep learning curve. Postoperative complications, including IOL tilt and decentration, may be experienced in the initial cases.


Assuntos
Cristalino , Lentes Intraoculares , Humanos , Implante de Lente Intraocular/efeitos adversos , Lentes Intraoculares/efeitos adversos , Estudos Retrospectivos , Esclera/cirurgia , Técnicas de Sutura , Suturas , Acuidade Visual
4.
Indian J Ophthalmol ; 70(1): 131-137, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34937224

RESUMO

Purpose: To compare functional outcomes and complication rates of two scleral fixated intraocular lens implantation (SFIOL) techniques. Methods: In this retrospective study, there were 30 eyes of 30 patients who underwent SFIOL implantation for dislocation of the IOL or crystalline lens. Group 1 (n = 17) comprised patients who received scleral-fixated polymethylmethacrylate (PMMA) IOL implantation through a self-sealing sclerocorneal tunnel with the suture burial technique, and group 2 (n = 13) comprised patients who received scleral-fixated foldable acrylic IOL implantation with a cartridge using a self-sealing clear corneal incision (CCI) with knotless Z-suture technique between 2014 and 2019. Surgical outcomes concerning safety, efficiency, visual function, induced astigmatism with vector analysis, and complications were compared. Results: The indications were dislocated crystalline lens (n = 5/30), dislocated IOL (n = 17/30), and dropped nucleus (n = 8/30). The mean follow-up time was 50.65 ± 14.02 months in group 1 and 15.69 ± 3.71 months in group 2 (P < 0.001). The postoperative visual acuity improvement was statistically significant in both groups (P < 0.001). Surgically induced astigmatism was significantly higher in group 1 (2.68 ± 1.04 D) compared with group 2 (1.6 ± 1.0 D) at month 12 (P = 0.001). Postoperative complications included suture exposure (n = 1 in group 1) and cystoid macular edema (n = 1 in group 1; n = 1 in group 2). Conclusion: Both SFIOL techniques are safe and effective in the absence of adequate capsular support. However, the knotless Z-suture technique appears to be superior to the suture burial technique with regard to suture exposure-related complications. In addition, self-sealing CCI appears to be superior to self-sealing sclerocorneal tunnel with regard to surgically induced astigmatism.


Assuntos
Implante de Lente Intraocular , Lentes Intraoculares , Humanos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Esclera/cirurgia , Técnicas de Sutura , Suturas
5.
Dis Colon Rectum ; 65(1): 108-116, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34538832

RESUMO

BACKGROUND: Fecal management systems have become ubiquitous in hospitalized patients with fecal incontinence or severe diarrhea, especially in the setting of perianal wounds. Although fecal management system use has been shown to be safe and effective in initial series, case reports of rectal ulceration and severe bleeding have been reported, with a relative paucity of clinical safety data in the literature. OBJECTIVE: The purpose of this study was to determine the rate of rectal complications attributable to fecal management systems, as well as to characterize possible risk factors and appropriate management strategies for such complications. DESIGN: This was a retrospective cohort study. SETTINGS: The study was conducted at a large academic medical center. PATIENTS: All medical and surgical patients who underwent fecal management system placement from December 2014 to March 2017 were included. MAIN OUTCOME MEASURES: We measured any rectal complication associated with fecal management system use, defined as any rectal injury identified after fecal management system use confirmed by lower endoscopy. RESULTS: A total of 629 patients were captured, with a median duration of fecal management system use of 4 days. Overall, 8 patients (1.3%) experienced a rectal injury associated with fecal management system use. All of the patients who experienced a rectal complication had severe underlying comorbidities, including 2 patients on dialysis, 1 patient with cirrhosis, and 3 patients with a recent history of emergent cardiac surgery. In 3 patients the bleeding resolved spontaneously, whereas the remaining 5 patients required intervention: transanal suture ligation (n = 2), endoscopic clip placement (n = 1), rectal packing (n = 1), and proctectomy in 1 patient with a history of pelvic radiotherapy. LIMITATIONS: The study was limited by its retrospective design and single institution. CONCLUSIONS: This is the largest study to date evaluating rectal complications from fecal management system use. Although rectal injury rates are low, they can lead to serious morbidity. Advanced age, severe comorbidities, pelvic radiotherapy, and anticoagulation status or coagulopathy are important factors to consider before fecal management system placement. See Video Abstract at http://links.lww.com/DCR/B698. INCIDENCIA Y CARACTERIZACIN DE LAS COMPLICACIONES RECTALES DE LOS SISTEMAS DE MANEJO FECAL: ANTECEDENTES:Los sistemas de manejo fecal se han vuelto omnipresentes en pacientes hospitalizados con incontinencia fecal o diarrea severa, especialmente en el contexto de heridas perianales. Aunque se ha demostrado que el uso del sistema de tratamiento fecal es seguro y eficaz en la serie inicial, se han notificado casos de ulceración rectal y hemorragia grave, con una relativa escasez de datos de seguridad clínica en la literatura.OBJETIVO:Determinar la tasa de complicaciones rectales atribuibles a los sistemas de manejo fecal. Caracterizar los posibles factores de riesgo y las estrategias de manejo adecuadas para tales complicaciones.DISEÑO:Estudio de cohorte retrospectivo.ENTORNO CLINICO:Centro médico académico de mayor volumen.PACIENTES:Todos los pacientes médicos y quirúrgicos que se sometieron a la colocación del sistema de manejo fecal desde diciembre de 2014 hasta marzo de 2017.PRINCIPALES MEDIDAS DE VALORACION:Cualquier complicación rectal asociada con el uso del sistema de manejo fecal, definida como cualquier lesión rectal identificada después del uso del sistema de manejo fecal confirmada por endoscopia baja.RESULTADOS:Se identificaron un total de 629 pacientes, con una duración media del uso del sistema de manejo fecal de 4,0 días. En general, 8 (1,3%) pacientes desarrollaron una lesión rectal asociada con el uso del sistema de manejo fecal. Todos los pacientes que mostraron una complicación rectal tenían comorbilidades subyacentes graves, incluidos dos pacientes en diálisis, un paciente con cirrosis y tres pacientes con antecedentes recientes de cirugía cardíaca emergente. En tres pacientes el sangrado se resolvió espontáneamente, mientras que los cinco pacientes restantes requirieron intervención: ligadura de sutura transanal (2), colocación de clip endoscópico (1), taponamiento rectal (1) y proctectomía en un paciente con antecedentes de radioterapia pélvica.LIMITACIONES:Diseño retrospectivo, institución única.CONCLUSIONES:Este es el estudio más grande hasta la fecha que evalúa las complicaciones rectales del uso del sistema de manejo fecal. Si bien las tasas de lesión rectal son bajas, pueden provocar una morbilidad grave. La edad avanzada, las comorbilidades graves, la radioterapia pélvica y el estado de anticoagulación o coagulopatía son factores importantes a considerar antes de la colocación del sistema de manejo fecal. Consulte Video Resumen en http://links.lww.com/DCR/B698.


Assuntos
Incontinência Fecal/terapia , Fissura Anal/diagnóstico , Hemorragia/diagnóstico , Doenças Retais/patologia , Reto/lesões , Idoso , Comorbidade/tendências , Gerenciamento Clínico , Endoscopia do Sistema Digestório/métodos , Incontinência Fecal/epidemiologia , Feminino , Fissura Anal/epidemiologia , Fissura Anal/cirurgia , Hemorragia/epidemiologia , Hemorragia/cirurgia , Humanos , Incidência , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Pelve/patologia , Pelve/efeitos da radiação , Protectomia/métodos , Doenças Retais/cirurgia , Reto/diagnóstico por imagem , Reto/patologia , Estudos Retrospectivos , Fatores de Risco , Segurança , Suturas , Cirurgia Endoscópica Transanal/métodos
6.
Dis Colon Rectum ; 65(1): e5-e13, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34882636

RESUMO

INTRODUCTION: Ileocolic resection for Crohn's disease traditionally does not include a high ligation of the ileocolic pedicle, and most commonly is performed with a stapled side-to-side ileocolic anastomosis. The mesentery has recently been implicated in the pathophysiology of Crohn's disease. Two techniques have been developed and are associated with reduced postoperative recurrence: the Kono-S anastomosis that excludes diseased mesentery and extended mesenteric excision that resects diseased mesentery. We aimed to assess the technical feasibility and safety of a novel combination of techniques: mesenteric excision and exclusion. TECHNIQUES: This initial report is a single-center descriptive study of consecutive adults who underwent mesenteric excision and exclusion for primary or recurrent ileocolic Crohn's disease from September 2020 to June 2021. Medication exposure and endoscopic balloon dilation before surgery were recorded. Phenotype was classified using the Montreal Classification. Thirty-day outcomes were reported. A video of the mesenteric excision and exclusion including the Kono-S anastomosis is presented. RESULTS: Twenty-two patients with ileocolic Crohn's disease underwent mesenteric excision and exclusion: 100% had strictures, 59% had fistulas, 81% were on biologics, and 27% had previous ileocolic resection(s). Seventy-two percent underwent laparoscopic procedures, a mesenteric defect was closed in 86%, omental flaps were fashioned in 77%, and 3 patients were diverted. Median operative time was 175 minutes. Median postoperative stay was 4 days. At 30 days, there were 2 readmissions for reintervention: 1 seton placement and 1 percutaneous drainage of a sterile collection. There were no cases of intra-abdominal sepsis or anastomotic leak. CONCLUSIONS: Mesenteric excision and exclusion represents an innovative, progressive, and promising approach that appears to be highly feasible and safe. Further study is warranted to determine if mesenteric excision and exclusion is associated with reduced postoperative recurrence of ileocolic Crohn's disease.


Assuntos
Anastomose Cirúrgica/métodos , Terapia Combinada/efeitos adversos , Doença de Crohn/cirurgia , Mesentério/cirurgia , Adulto , Produtos Biológicos/uso terapêutico , Colo/cirurgia , Constrição Patológica/epidemiologia , Doença de Crohn/fisiopatologia , Estudos de Viabilidade , Feminino , Fístula/epidemiologia , Humanos , Íleo/cirurgia , Laparoscopia/estatística & dados numéricos , Masculino , Mesentério/patologia , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Recidiva , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Segurança , Suturas/efeitos adversos
7.
J Craniofac Surg ; 33(1): 112-116, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34967518

RESUMO

ABSTRACT: The Craniofacial Collaboration UK (CC-UK) has been established across the 4 highly specialized craniofacial centers in the UK since 2015. This joint collective aims to address the current limitations within developmental craniofacial research, using robust clinical data from a homogenous sample of children. This paper presents the third wave of findings from the CC-UK, with consideration to developmental and behavioral parent-report measures. Whilst previous data for sagittal synostosis have been presented, this article summarizes the analysis of these outcomes for children with metopic synostosis (MS) at 3 years who have undergone primary corrective surgery. Results highlight similar patterns to that of earlier CC-UK work, with the majority of children falling within 1 standard deviation of the population normative means across all measures. However, statistically significant difficulties were found between group means for children with MS on various developmental and behavioral domains. Prosocial skills and peer difficulties were reported as the greatest areas of behavioral concern for parents, with prosocial skills found to be below the level expected for their chronological age. In order to further understand the developmental trajectory of children with MS, longitudinal examination of individual diagnostic and specific age groups with single-suture craniosynostosis is crucial. The continuation of the CC-UK provides an opportunity to attain this goal.


Assuntos
Craniossinostoses , Pré-Escolar , Suturas Cranianas , Craniossinostoses/cirurgia , Ossos Faciais , Humanos , Lactente , Suturas , Reino Unido
8.
Ann Anat ; 239: 151811, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34384857

RESUMO

BACKGROUND: Metopic suture lies between the halves of the growing frontal bone and usually closes in early infancy. If the metopic suture fails to close it persists in adulthood and could be considered an anterior continuation of the sagittal suture (SS). This study aimed to investigate if the metopic suture persistence is related to any significant deviations from the normal SS maturation. We also aimed to elaborate linear regression models for age-at-death prediction of the metopic crania and to compare their accuracy with the models developed on the control ones. METHODS: The SS was investigated in a total of 122 dry adult contemporary male crania of known age-at-death divided in a metopic series (n = 34) and a control one (n = 88). The crania were scanned and high-resolution volumetric images were generated using an industrial µCT system. The SS closure degree was assessed on cross-sectional tomograms using a scale of grades. Both series were compared and linear regression models for age-at-death prediction were elaborated. RESULTS: The comparison between both series showed that the degree of SS closure differs significantly in all SS sections and bone layers and it is considerably lower in the metopic series. The elaborated linear regression models showed that the error in the age-at-death prediction of the metopic crania is almost two times bigger than that in the control. CONCLUSIONS: The SS closure in metopic crania is significantly delayed compared to the control, which means that it is entirely unreliable and misleading as an indicator for age-at-death prediction.


Assuntos
Suturas Cranianas , Osso Frontal , Adulto , Suturas Cranianas/diagnóstico por imagem , Estudos Transversais , Técnicas Histológicas , Humanos , Masculino , Suturas
9.
Zhonghua Nan Ke Xue ; 27(4): 324-329, 2021 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-34914215

RESUMO

Objective: To observe the clinical effect of single-suture versus that of double-suture knot in positioning the cutting plane in circumcision with a stapler. METHODS: We randomly assigned 120 patients with redundant prepuce or phimosis into three groups of an equal number to receive traditional circumcision without suture knot (group 1), circumcision with single-suture knot (group 2), and circumcision with double-suture knot (group 3) for positioning of the cutting plane. We recorded and compared the operation time, intraoperative blood loss, the rates of frenulum sewing, non-frenulum sewing, poor frenulum sewing and surgical conversion, intraoperative anxiety of the doctors, postoperative ecchymosis, and satisfaction with the retained ventral and dorsal prepuce and postoperative penile appearance among the three groups. RESULTS: There were statistically significant differences among the three groups in the surgery time, intraoperative blood loss, the rates of frenulum sewing, non-frenulum sewing, poor frenulum sewing and surgical conversion, intraoperative anxiety of the doctors, and satisfaction with the retained ventral and dorsal prepuce and postoperative penile appearance, (P < 0.05), but not in postoperative ecchymosis (P = 0.849). The rate of satisfaction with the retained dorsal prepuce was remarkably higher in group 3 than in group 2 (P = 0.003), and the intraoperative anxiety rate of the doctors was lower in the former than in the latter group (P = 0.003). CONCLUSIONS: Both single- and double-suture knots for positioning the cutting plane in circumcision with a stapler can help reduce the operation time, intraoperative blood loss, the rates of frenulum sewing, non-frenulum sewing, poor frenulum sewing and surgical conversion, intraoperative anxiety of the doctors, and satisfaction with the retained ventral and dorsal prepuce and postoperative penile appearance, and double-suture knot positioning has an even higher application value in decreasing the intraoperative anxiety of the doctors and increasing the satisfaction with the retained dorsal prepuce.


Assuntos
Circuncisão Masculina , Fimose , Prepúcio do Pênis , Humanos , Masculino , Fimose/cirurgia , Período Pós-Operatório , Suturas
10.
PLoS One ; 16(12): e0261187, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34928969

RESUMO

The impact of surgical correction of cranial cruciate ligament rupture (CCLR) on 3D kinematics has not been thoroughly evaluated in dogs. The success of current techniques remains limited, as illustrated by suboptimal weightbearing and progression of osteoarthritis. The inability to restore the stifle's 3D kinematics might be a key element in understanding these suboptimal outcomes. The objective of this study was to evaluate the impact of lateral suture stabilization (LSS) on the 3D kinematics of the canine stifle joint. We hypothesized that LSS would not restore 3D kinematics in our model. Ten cadaveric pelvic limbs collected from large dogs (25-40 kg) were tested using a previously validated apparatus that simulates gait. Three experimental conditions were compared: (a) intact stifle; (b) unstable stifle following cranial cruciate ligament transection (CCLt) and (c) CCLt stabilized by LSS. Three-dimensional kinematics were collected through 5 loading cycles simulating the stance phase of gait and curves were analyzed using a Wilcoxon signed-rank test. LSS restored baseline kinematics for the entire stance phase for cranial and lateromedial translation, flexion, and abduction. It restored distraction over 90% of the stance phase. Internal rotation was limited, but not restored. This in vitro study had limitations, as it used a simplified model of stifle motion and weight-bearing. The results of this study report that LSS can restore physiologic 3D kinematics largely comparable to those of healthy stifles. Suboptimal outcome in patients following CCLR stabilization by LSS may therefore result from causes other than immediate postoperative abnormal 3D kinematics.


Assuntos
Lesões do Ligamento Cruzado Anterior/fisiopatologia , Ligamento Cruzado Anterior/fisiopatologia , Articulação do Joelho/fisiopatologia , Joelho de Quadrúpedes/fisiopatologia , Suturas/veterinária , Animais , Fenômenos Biomecânicos , Cães
11.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 56(12): 1270-1276, 2021 Dec 07.
Artigo em Chinês | MEDLINE | ID: mdl-34963214

RESUMO

Objective: To explore the efficacy of relocation and expansion pharyngoplasty by suspension sutures in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: Seventy-three patients(including 60 males and 13 females) with OSAHS admitted to the department of otorhinolaryngology of our hospital in recent two years were retrospectively analyzed. All the patients had velopharyngeal obstructionevaluated by electronic endoscopic Müller test and were divided into control group (34 cases) and observation group (39 cases). The patients in the control group were performed modified uvulopalatopharyngoplasty, while those in the observation group were performed relocation and expansion pharyngoplasty by suspension sutures.The scores of ESS, AHI and LSaO2 before and after treatment were collected and compared. Results: The total effective rate of the observation group was 94.87%, which was significantly higher than 79.41% of the control group. The AHI was lower and LSaO2 value was higher (χ2=-1. 896,-1. 968,P<0.05)in the observation group. The sleeping symptoms and quality of life of the two groups were significantly improved. The ESS score of the observation group was decreased more significantly than that of the control group after treatment, and the difference was statistically significant (χ2=-1.451,P<0.05). The incidence of foreign body sensation in pharynx of the observation group (89.74%) was higher than that of the control group (55.88%), and the postoperative bleeding and postoperative recurrence rate (0.00%, 2.56%) was lower than that of the control group (8.82%, 14.70%)with statistical significance (χ2=4.738,4.249,4.119,P<0.05).The incidence of transient nasopharyngeal reflux in both groups was low and statistically insignificant (χ2=0.629,P>0.05). Conclusions: Preoperative strict screening of indications plays an important role in the selection of palatopharyngeal surgery methods and curative effect. Relocation and expansion pharyngoplasty by suspension sutures can improve the clinical efficacy of OSAHS with better safety and less recurrence.


Assuntos
Faringe , Apneia Obstrutiva do Sono , Feminino , Humanos , Masculino , Palato Mole/cirurgia , Faringe/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Apneia Obstrutiva do Sono/cirurgia , Suturas
12.
Zhonghua Nan Ke Xue ; 27(8): 729-732, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34914246

RESUMO

Objective: To compare the clinical effects of disposable titanium nail circumcision stapler (TNCS), one-off circumcision stapler (Shang Ring) and disposable double-handle circumcision suture device (DHCSD) in the treatment of redundant prepuce and phimosis. METHODS: We reviewed the clinical data on 150 cases of redundant prepuce or phimosis treated with the TNCS (n = 50), DHCSD (n = 50) or Shang Ring (n = 50) from September 2018 to July 2020. We compared the operation time, intraoperative blood loss, wound healing time, Visual Analogue Scale (VAS) scores during and at 1 hour and 7 days after operation, postoperative complications and the patients' satisfaction with postoperative penile appearance among the three groups. RESULTS: The operation time was significantly longer (P < 0.05) but the wound healing time remarkably shorter (P < 0.05) in the TNCS and DHCSD groups than in the Shang Ring group. The intraoperative blood loss was markedly less in the TNCS and Shang Ring groups than in the DHCSD group (P < 0.05). No statistically significant difference was observed in the patients' satisfaction with postoperative penile appearance among the three groups (P > 0.05). The VAS scores during and at 1 hour and 7 days after operation and the incidence rate of postoperative complications were significantly higher in the Shang Ring and DHCSD groups than in the TNCS group (P < 0.05). CONCLUSIONS: The disposable titanium nail circumcision stapler is superior to disposable double-handle circumcision suture device and Shang Ring in the treatment of redundant prepuce and phimosis and deserves clinical promotion and application.?


Assuntos
Circuncisão Masculina , Fimose , Humanos , Masculino , Pênis/cirurgia , Fimose/cirurgia , Complicações Pós-Operatórias/epidemiologia , Suturas
13.
BMC Ophthalmol ; 21(1): 410, 2021 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-34837992

RESUMO

BACKGROUND: Modified sutureless and glue-free method is an effective and novel surgical approach for pterygium. We aim to evaluate optical quality in pterygium treated with the new method and investigate the clinical application of the Optical Quality Analysis System (OQAS) and Anterior segment optical coherence tomography (AS-OCT) to evaluate the pterygium surgery. METHODS: A total of 52 eyes of 52 patients with pterygium were randomly divided into 2 groups. After surgical excision, the bare sclera was placed with a tight fit limbal conjunctival autograft fixed via the modified sutureless and glue-free method in group 1 (26 eyes) and conventional sutures in group 2 (26 eyes). Objective scattering index (OSI), modulation transfer function (MTF) and Strehl ratio (SR) were measured using OQAS in both groups during the perioperative period. Pterygium diameter was measured on AS-OCT. Ocular surface disease index (OSDI) questionnaire also was used. RESULTS: The group 1 had significantly lower mean OSI, higher mean MTF, and higher mean SR at 1 month and 3 months after surgery (p < 0.05). The group 1 had significantly lower mean OSDI at 1 month (p < 0.05), while was similar to group 2 at 3 months (p > 0.05). Pterygium diameter positively correlated with OSI (r = 0.528, p < 0.001), while it negatively correlated with MTF (r = - 0.501, p < 0.001) and SR (r = - 0.174, p = 0.217) before operation. CONCLUSIONS: The modified sutureless and glue-free method might be more advantageous in improving the optical quality during early postoperative recovery times and pterygium diameter affected optical quality. OQAS can be reliably used to evaluate postoperative outcomes.


Assuntos
Pterígio , Túnica Conjuntiva/cirurgia , Adesivo Tecidual de Fibrina , Seguimentos , Humanos , Pterígio/cirurgia , Técnicas de Sutura , Suturas , Transplante Autólogo
14.
J Hand Surg Asian Pac Vol ; 26(4): 728-733, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34789097

RESUMO

Thumb carpometacarpal joint osteoarthritis is a common condition that is treated nonsurgically. When conservative treatments fail, surgery is considered. Recently, suture button suspensionplasty has attracted attention and yielded good clinical results. We have developed a novel suture button suspensionplasty procedure called "cross-coupling suture button suspensionplasty" (CC-SBS) using a pair of suture button devices after a complete trapeziectomy. This retrospective study aimed to report the short-term clinical results of patients who underwent CC-SBS at our institution. We evaluated 10 hands of 10 patients (9 women and 1 man; average age, 67 years) who were refractory to conservative treatment and underwent CC-SBS at our institution between 2015 and 2017. We evaluated the preoperative Eaton stage and postoperative trapezial space height immediately after surgery and at the final visit; measured the trapezial space height, range of motion of the palmar and radial abduction of the carpometacarpal joint at the final visit; measured the preoperative and postoperative pinch strength; and recorded postoperative complications. The mean trapezial space height was 6.5 mm, and the mean radial and palmar abductions were 47° and 45°, respectively, at the final visit. The average pinch strength improved to 3.8 kg at the final visit compared to that pre-operation. In one case, a second metacarpal fracture occurred 2 weeks post-surgery, but no other complications were reported. Conclusion: CC-SBS showed short-term clinical outcomes similar to those of ligament reconstruction and tendon interposition and demonstrated faster overall recovery. Our procedure does not need a donor tendon for suspension and is technically simple and less invasive than ligament reconstruction tendon interposition. Thus, stronger initial fixation is obtained by using two suture button devices, and rehabilitation can be started from an early stage. We believe that this procedure is a good surgical option for carpometacarpal joint osteoarthritis.


Assuntos
Articulações Carpometacarpais , Osteoartrite , Idoso , Articulações Carpometacarpais/diagnóstico por imagem , Articulações Carpometacarpais/cirurgia , Feminino , Humanos , Masculino , Osteoartrite/diagnóstico por imagem , Osteoartrite/cirurgia , Estudos Retrospectivos , Suturas , Polegar/cirurgia
15.
J Hand Surg Asian Pac Vol ; 26(4): 611-617, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34789102

RESUMO

Background: The asymmetric technique for flexor tendon repairs has various advantages but further improvement is possible by using a suitable suture material. In this study, we compare the biomechanical performance of asymmetric repairs using 3 suture materials: Supramid Extra II 4-0, Tendo-Loop 4-0, and FiberLoop 4-0. Methods: We divided 30 porcine flexor tendons into 3 arms. Each arm of tendons were repaired by using 1 of the 3 proposed suture materials. Each repaired tendon was tested by using a mechanical tester. Ultimate tensile strength (UTS), load to 2 mm gap force, failure mechanism and stiffness of the tendons were investigated. Results: FiberLoop® achieved the highest UTS (90.4 ± 17.9 N), followed by Tendo-Loop (85.3 ± 10.3 N). The difference was no statistically significant. The UTS of repairs using Supramid® was significantly lower (64.0 ± 8.4 N). For load to 2 mm gap force, FiberLoop® achieved 20.7 ± 4.8 N while Tendo-Loop® had 20.5 ± 4.2 N. The difference was also no statistically significant. The repairs using Supramid® had a significantly lower load to 2 mm gap force of 14.2 ± 2.7 N. The stiffness of asymmetric repairs using FiberLoop® and Tendo-Loop® was 5.64 ± 1.7 N/mm and 5.63 ± 0.7 N/mm. The difference was also no statistically significant. The repairs using Supramid® had a significantly lower stiffness of 4.15 ± 1.0 N/mm. Failure mechanisms for the repaired specimens were reported as such: Supramid had 100% suture rupture; Tendo-Loop had 90% suture rupture and 10% suture pullout; FiberLoop had 20% suture rupture and 80% suture pullout. Conclusions: The asymmetric repair configuration is able to produce superior biomechanical performance by using Tendo-Loop® or FiberLoop®. Improvement of the asymmetric technique by using Tendo-Loop® or FiberLoop® could potentially contribute to better surgical outcomes of flexor tendon repair.


Assuntos
Técnicas de Sutura , Traumatismos dos Tendões , Animais , Fenômenos Biomecânicos , Suturas , Suínos , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia
16.
J Hand Surg Asian Pac Vol ; 26(4): 563-570, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34789116

RESUMO

Background: Olecranon fractures are common in motorcycle accidents, falls, or in direct elbow injury. In cases of transverse olecranon fracture, surgery is frequently required in adults. The aim of this study is to compare the biomechanical durability of suture anchor fixation in olecranon fractures to conventional tension band wiring technique in saw bones. Methods: 12 plastic saw bones were divided into 3 groups: tension band wiring fixation, modified Cha-Batman method, and a modified simple suture method using a suture anchor. After fixation, cyclic load tests were conducted for 1,000 cycles, at 5 Hz with a force of 10 N to 250 N. After cycling loading, the extent of displacement was measured using a non-contact coordinate measuring instrument, and statistical analysis performed. Results: The average displacement was significantly smaller in the modified Cha-Bateman method (1.4 mm) than in the tension band wiring method (3.8 mm, p = 0.007) and the modified simple suture method using suture anchor (3.3 mm, p = 0.012). There was no significant difference in displacement between tension band wiring fixation and the modified simple suture method (p = 0.564). Conclusions: This study provides a biomechanical basis for the hypothesis that the suture anchor technique in weak bone model could obtain results comparable to those of conventional tension band wiring. In particular, the modified Cha-Bateman method, showed stronger biomechanical properties than the tension band wiring method and modified simple suture method using a suture anchor. The current study could also provide pilot data that can be used in future experiments.


Assuntos
Olécrano , Fraturas da Ulna , Adulto , Fixação Interna de Fraturas , Humanos , Olécrano/cirurgia , Âncoras de Sutura , Suturas
17.
Int J Comput Assist Radiol Surg ; 16(12): 2107-2117, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34748152

RESUMO

PURPOSE: Mitral valve repair is a complex minimally invasive surgery of the heart valve. In this context, suture detection from endoscopic images is a highly relevant task that provides quantitative information to analyse suturing patterns, assess prosthetic configurations and produce augmented reality visualisations. Facial or anatomical landmark detection tasks typically contain a fixed number of landmarks, and use regression or fixed heatmap-based approaches to localize the landmarks. However in endoscopy, there are a varying number of sutures in every image, and the sutures may occur at any location in the annulus, as they are not semantically unique. METHOD: In this work, we formulate the suture detection task as a multi-instance deep heatmap regression problem, to identify entry and exit points of sutures. We extend our previous work, and introduce the novel use of a 2D Gaussian layer followed by a differentiable 2D spatial Soft-Argmax layer to function as a local non-maximum suppression. RESULTS: We present extensive experiments with multiple heatmap distribution functions and two variants of the proposed model. In the intra-operative domain, Variant 1 showed a mean [Formula: see text] of [Formula: see text] over the baseline. Similarly, in the simulator domain, Variant 1 showed a mean [Formula: see text] of [Formula: see text] over the baseline. CONCLUSION: The proposed model shows an improvement over the baseline in the intra-operative and the simulator domains. The data is made publicly available within the scope of the MICCAI AdaptOR2021 Challenge https://adaptor2021.github.io/ , and the code at https://github.com/Cardio-AI/suture-detection-pytorch/ .


Assuntos
Procedimentos Cirúrgicos Cardíacos , Suturas , Endoscopia , Humanos
20.
Arthroscopy ; 37(11): 3344-3346, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34740409

RESUMO

Bone-patellar tendon-bone autograft for anterior cruciate ligament (ACL) reconstruction has the most data to support its use. However, there may still be room for improvement, and younger age, insufficient rehabilitation, altered neuromuscular patterns, and precocious return to play can increase risk of graft failure. High strength suture augmentation of soft-tissue repair or reconstruction has gained traction in a variety of applications for the knee, including medial collateral and posteromedial corner, lateral collateral ligament, posterior cruciate ligament, and ACL. For ACL reconstruction, the technique consists of using either suture or suture tape fixed at the femoral and tibial ACL footprints to allow for independent tensioning to back up the separately tensioned ACL reconstruction. The static augment serves as a load-sharing device, allowing the graft to see more strain during earlier levels of graft strain, until graft elongation occurs to a critical level whereby the augment will experience more strain than the graft. Hence, the "seat belt" analogy. This is distinct from static augmentation, where the high strength suture is fixed to the graft. Static augmentation (without tensioning separately from the graft) results in a load-sharing device and increased stiffness, but potential stress shielding compared with the "seat belt." If suture tape augmentation improves patient outcome, it is a worthwhile to "click it."


Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Humanos , Cintos de Segurança , Suturas
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