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1.
Zhonghua Yan Ke Za Zhi ; 58(9): 688-692, 2022 Sep 11.
Artigo em Chinês | MEDLINE | ID: mdl-36069089

RESUMO

Objective: To observe the restriction effect of silicone oil retention sutures and their protective effect on the corneal endothelium. Methods: Retrospective case series study. The clinical data of 6 patients (6 eyes) with lens-iris damage after severe ocular trauma were collected from March 2017 to November 2021 in Beijing Tongren Hospital. Their was combined retinal injury in each eye, so silicone oil retention sutures and silicone oil filling were performed. The silicone oil position was observed by slit lamp and ultrasound biomicroscopy. The corneal endothelium was examined by specular microscopy during the follow-up. Results: All patients were male, with an average age of 47 years (range, 26 to 73 years). The diseased eyes included 2 left eyes and 4 right eyes. Five eyes had ocular rupture, and 1 eye had ocular contusion. The follow-up time ranged from 5 months to 51 months, with an average of 18.5 months. In all 6 eyes, the silicone oil was completely located in the posterior segment and never touched the corneal endothelium. Four eyes maintained healthy and had a clear cornea during the follow-up, while 2 eyes developed band keratopathy at the 11 month and 16 month separately during follow-up, 1 of which was found to suffer corneal decompensation at the last follow-up (51 month). Both band keratopathy and corneal decompensation were caused by severe anterior segment trauma and were not related to the silicone oil contact with the cornea. There were no complaints about occlusion or glare due to silicone oil retention sutures. All patients did not need to keep the prone position postoperatively. Silicone oil emulsification occurred in 1 eye and ocular hypertension occurred in this eye after silicone oil emulsification. Conclusion: Silicone oil retention sutures can effectively prevent silicone oil from migrating to the anterior chamber or contacting the corneal endothelium.


Assuntos
Distrofias Hereditárias da Córnea , Descolamento Retiniano , Distrofias Hereditárias da Córnea/cirurgia , Endotélio Corneano , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Óleos de Silicone/efeitos adversos , Suturas/efeitos adversos , Vitrectomia
2.
Zhonghua Yan Ke Za Zhi ; 58(9): 693-700, 2022 Sep 11.
Artigo em Chinês | MEDLINE | ID: mdl-36069090

RESUMO

Objective: To evaluate the efficacy and safety of superior rectus transposition (SRT) with/without augmented suture and vertical rectus transposition (VRT) for the treatment of strabismus caused by complete abducens nerve palsy. Methods: This was a retrospective cohort study. Forty-two patients (42 eyes) with complete abducens nerve palsy underwent strabismic surgeries from January 2015 to November 2020 in Tianjin Eye Hospital. According to the different procedures, the patients were divided into three groups: SRT group (16 cases, SRT with medial rectus recession), superior rectus transposition with augmented suture (SRTA) group (13 cases, SRT with Buckley suture and medial rectus recession) and VRT group (13 cases). The preoperative and postoperative (1, 6 and 12 months) data including deviations, ocular motility, binocular vision and surgical complications among three groups were analyzed and compared. χ2 test was used for comparison of count data among three groups. The measurement data were compared among three groups by the repeated measures ANOVA. LSD-t test was used for within-group comparison and between-group comparison. Results: There was no difference in sex ratio, age and course of disease among the groups (all P>0.05). The horizontal deviations of the three groups at 1, 6 and 12 months after surgeries was lower than that before surgeries, and the difference was statistically significant (all P<0.001). The horizontal deviations of the SRT group, SRTA group and VRT group at 12 months after surgeries were (+0.8±5.8), (+0.8±4.5), (+1.2±2.5) prism diopters (PD), respectively, lower than that of the preoperative (+82.8±17.2), (+77.7±26.1), (+71.5±18.6) PD. However, there was no significant difference among different postoperative follow-up timepoints (all P>0.05). There was no difference in horizontal deviations before surgeries and at 1, 6 and 12 months after surgeries among three groups (P>0.05). There were significant differences in the scales of abduction motility among preoperative, postoperative 1, 6 and 12 months measurements for three group (all P<0.001). The scales of abduction before surgeries in the SRT group, SRTA group, and VRT group were (-4.4±0.5), (-4.4±0.5), (-4.5±0.5) scale and at 12 months after surgeries were (-2.3±0.7), (-2.2±0.5), (-2.1±0.6) scale respectively. But there was no change among different postoperative follow-up timepoints (all P>0.05). Preoperative and postoperative 1-, 6-and 12-month abduction motility was similar among three groups (P>0.05). There were significant differences in the scales of adduction limitation among preoperative, postoperative 1-, 6-and 12-months measurements for three group (all P<0.05). But there was no change among different postoperative follow-up timepoints (all P>0.05). There were significant differences between the SRT group [(-0.9±0.6), (-0.8±0.6) scale] and the SRTA groups [(-1.5±0.5), (-1.4±0.5) scale] (t=-2.62, -2.52) and between the SRTA group and the VRT group [(-0.8±0.8), (-0.6±0.7) scale] (t=2.62, 3.01) at 6 and 12 months after surgeries (all P<0.05). The outcomes of binocular vision at postoperative 12 months were similar among three groups (P>0.05). No patient had torsional diplopia and anterior segment ischemia. Only 2 patients from the SRTA group had hypotropia of 4 to 5 PD in the primary position associated with supraduction limitation. Conclusions: SRT with/without augmented suture and VRT are effective and safe procedures for the treatment of strabismus caused by complete abducens nerve palsy. They could correct deviations, improve abduction motility and restore binocular vision, with stable outcomes and a small risk of vertical and torsional diplopia.


Assuntos
Doenças do Nervo Abducente , Esotropia , Estrabismo , Doenças do Nervo Abducente/complicações , Doenças do Nervo Abducente/cirurgia , Diplopia/cirurgia , Esotropia/cirurgia , Humanos , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estudos Retrospectivos , Suturas/efeitos adversos , Visão Binocular/fisiologia
3.
Am J Otolaryngol ; 43(5): 103597, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35987100

RESUMO

BACKGROUND: The complication of brachial plexus injury (BPI) after surgical suture of chylous fistula caused by neck dissection is extremely rare. For the first time, we investigated the treatment and prevention strategy of BPI caused by surgical suture of neck dissection induced chylous fistula. METHODS: Forty-two patients undergoing surgical suture of neck dissection induced chylous fistula were identified between January 2015 to March 2022 at a single tertiary academic center. All patients were divided into two groups, medial anterior scalene muscle (MASM) group (24 patients) and lateral anterior scalene muscle (LASM) group (18 patients), according to the location of fistula regarding scalene muscle described in the surgical records. The incidence of BPI between the two groups after surgical suture was summarized and compared. RESULTS: There was significant difference in the incidence of different degrees of BPI between the two groups. In the MASM group, the incidence of BPI was 0 % (0/24), while in the LASM group, 6 cases suffered different degrees of BPI immediately after operation and the incidence of BPI was 33.3 % (6/18) (p < 0.05). The neurological function of all BPI cases recovered within 1-3 months after the suture was removed in time. CONCLUSION: The incidence of BPI in patients of LASM group was significantly higher than that of MASM group. When suturing this kind of fistula, the depth of the needle should be properly controlled to avoid BPI. In case of BPI, the suture should be removed as soon as possible to promote the recovery of neurological function.


Assuntos
Plexo Braquial , Quilo , Fístula , Plexo Braquial/lesões , Fístula/epidemiologia , Fístula/etiologia , Fístula/prevenção & controle , Humanos , Esvaziamento Cervical/efeitos adversos , Suturas/efeitos adversos
4.
Br J Surg ; 109(10): 943-950, 2022 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-35979802

RESUMO

BACKGROUND: Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS: A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS: Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION: The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER: ISRCTN25616490 (http://www.controlled-trials.com).


After bowel cancer surgery, bulges known as hernias can occur at the site of the scar. Many patients find this uncomfortable and embarrassing. These hernias can also need further operations, sometimes as an emergency. This trial aimed to find out whether one way of closing the scars was better than another at stopping hernias developing. A total of 802 patients from 28 different hospitals in the UK joined the trial. The patients all had bowel cancer, and at the end of the operation had either a method known as the Hughes closure to close the incision or the method that the surgeon normally used. There was no difference between the two types of closure. The trial has shown that the chance of getting a hernia after a bowel cancer operation is still much higher than surgeons or patients would like.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais , Neoplasias Colorretais , Hérnia Incisional , Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Neoplasias Colorretais/complicações , Humanos , Hérnia Incisional/epidemiologia , Hérnia Incisional/etiologia , Hérnia Incisional/prevenção & controle , Nylons , Método Simples-Cego , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversos
5.
Eur J Obstet Gynecol Reprod Biol ; 277: 27-31, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35987075

RESUMO

INTRODUCTION: Postpartum hemorrhage (PPH) is mostly caused by uterine atony and is the leading cause of maternal death. Hysterectomy may be necessary in severe cases, but uterine compressive sutures are an uterine-sparing alternative. In 2005, Alcides Pereira proposed a technique with serial superficial stiches around the uterus. To date, there were no further reports on its clinical use. OBJECTIVE: To evaluate a tertiary center's experience with Alcides-Pereira's compressive uterine sutures for severe PPH due to uterine atony, reviewing its efficacy, morbidity, and impact on reproductive outcomes. STUDY DESIGN: An 11-year retrospective cohort study of Alcides-Pereira's sutures for PPH at a single tertiary hospital. Demographic and obstetric data were collected. Details of subsequent pregnancies and fertility plans were collected through a telephonic interview. Comparison between women in which the sutures were effective and ineffective to prevent hysterectomy was made. RESULTS: Alcides-Pereira's sutures were applied in 23 patients with PPH due to uterine atony. The technique was successful in controlling the hemorrhage and avoiding hysterectomy in 20 patients (87%). When successful, the sutures avoided the need for any blood therapy in 55% (RR 0.45, 95% CI 0.28-0.73) of patients, intensive care unit admission in 80% (RR 0.2, 95% CI 0.08-0.48) and significantly shortened the length of hospital stay. All patients with preserved uterus resumed their usual menstrual pattern. One had a subsequent term vaginal delivery; one had three first trimester miscarriages. All other patients did not try to conceive. CONCLUSION: Alcides-Pereira's sutures are a feasible, uterine-sparing technique, providing an effective and safe option for PPH.


Assuntos
Hemorragia Pós-Parto , Inércia Uterina , Compostos Clorados , Feminino , Humanos , Óxidos , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/prevenção & controle , Hemorragia Pós-Parto/cirurgia , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversos , Inércia Uterina/cirurgia , Útero/cirurgia
6.
Nepal J Ophthalmol ; 14(27): 72-81, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35996906

RESUMO

INTRODUCTION: This study aims to evaluate outcomes and complications of temporary suture tarsorrhaphy (TST) in cases of impending corneal ulcer perforation. MATERIALS AND METHODS: Case records of patients who underwent temporary suture tarsorrhaphy at Mechi Eye Hospital during a period of 18 months were retrospectively evaluated. All the smear positive fungal keratitis with more than 5mm infiltration involving central and/or paracentral cornea with impending corneal perforation were included. Demographic and clinical profile including - visual acuity, indication for temporary suture tarsorrhaphy, duration of signs and symptoms were noted. The outcomes were evaluated after 1 month and 3 months post tarsorrhaphy, in relation with time to epithelial healing, anatomical success rate, best corrected visual acuity, complications associated with non-healing corneal ulcer, number of temporary suture tarsorrhaphy needed and complications of TST. RESULTS: The study included 119 cases of smear positive fungal keratitis with mean age of 51.34 + 15.56 years. In this study, 56.30% of the patients developed epithelial healing at 2 - 4 weeks with mean duration of 23.24 + 12.09 days of temporary suture tarsorrhaphy. Out of 119 patients, the corneal ulcer healed in 84 patients (70.6%), whereas 35 (29.4%) did not heal. Among those with non-healing ulcers, 15 patients (12.6%) had to undergo evisceration. The anatomical success rate was 87.39% which was statistically significant (P = 0.001). Regarding visual outcome, in 62 patients (52.10%) BCVA improved by 2 or more lines, which was statistically significant (P<0.05) resulting in a functional success of 26.89%. CONCLUSION: This study concludes that temporary suture tarsorrhaphy could be a useful option for management of corneal ulcers with impending perforation in eye centers with limited resources settings and high disease burden with good anatomical and functional outcome.


Assuntos
Perfuração da Córnea , Úlcera da Córnea , Infecções Oculares Fúngicas , Adulto , Idoso , Perfuração da Córnea/diagnóstico , Perfuração da Córnea/etiologia , Perfuração da Córnea/cirurgia , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/etiologia , Úlcera da Córnea/cirurgia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/cirurgia , Pálpebras/cirurgia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Suturas/efeitos adversos , Úlcera
7.
Cir Cir ; 90(S1): 115-120, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35944113

RESUMO

OBJECTIVE: Staple line bleeding control (SLBC) after laparoscopic sleeve gastrectomy (LSG) is a serious problem. Cauterization alone is generally not preferred because of concerns about weakening the staple line. The aim of this study was to compare the suturing and monopolar cauterization methods for SLBC in LSG. METHODS: 212 patients were divided into two groups as cautery and suture groups. Demographic characteristics, intraoperative, and post-operative results were analyzed. RESULTS: Post-operative complications were seen in seven patients, four of them staple line bleeding (three patients were in the cautery group and one patient was in the suture group), and three of them leakage (all patients were in the suture group) from the staple line. There was no significant difference between the groups in terms of staple line bleeding (p = 0.35), staple line leakage (p = 0.09), blood loss (p = 0.12), intraoperative complications (p = 0.16), post-operative hemoglobin decrease (p = 0.63), and length of hospital stay (p = 0.35), but the operation time was longer in the suture group. CONCLUSION: This is the first study in literature comparing monopolar cauterization with another technique. Monopolar cauterization can be used for SLBC in LSG. It is a safe and efficient method as well as inexpensive.


OBJETIVO: El control del sangrado de la línea de grapas (SLBC) después de la gastrectomía en manga laparoscópica(LSG) es un problema grave. Generalmente, no se prefiere la cauterización sola debido a preocupaciones sobre el debilitamiento de la línea de grapas. El objetivo de este estudio fue comparar los métodos de sutura y cauterización monopolar para SLBC en LSG. MÉTODOS: 212 pacientes fueron divididos en 2 grupos de cauterización y sutura. Se analizaron las características demográficas, los resultados intraoperatorios y posoperatorios. RESULTADOS: Se observaron complicaciones posoperatorias en siete pacientes, cuatro de ellos sangrado en la línea de grapas (tres pacientes estaban en el grupo de cauterización, un paciente en el grupo de sutura) y tres de ellos fuga (todos los pacientes estaban en el grupo de sutura) del línea de grapas. No hubo diferencia significativa entre los grupos en términos de sangrado de la línea de grapas (p = 0.35), fuga dela línea de grapas (p = 0.09), pérdida de sangre (p = 0.12), complicaciones intraoperatorias (p = 0.16), disminución de hemoglobina postoperatoria (p = 0.63), duración dela estancia hospitalaria (p = 0.35), pero el tiempo de operación fue mayor en el grupo de sutura. CONCLUSIÓN: Este es el primer estudio que compara la cauterización monopolar con otra técnica. La cauterización monopolar se puede utilizar para SLBC en LSG. Es un método seguro, eficaz y económico.


Assuntos
Laparoscopia , Obesidade Mórbida , Cauterização , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Hemorragia/etiologia , Humanos , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Grampeamento Cirúrgico/métodos , Suturas/efeitos adversos , Resultado do Tratamento
8.
JBJS Case Connect ; 12(3)2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-36040073

RESUMO

CASE: A 17-year-old male patient suffered a radial lateral meniscus tear and underwent an arthroscopic all-inside suture repair. After 7 months, the patient experienced catching. Magnetic resonance imaging and computed tomography revealed an intra-articular loose body without calcification, which was removed surgically. The excised specimen was histopathologically confirmed to be a necrotic meniscus fragment with a suture knot. In addition, cartilage damage because of suspected impingement by a residual suture knot was observed. After removing the loose body and knot, the patient's symptoms were relieved, and he returned to sports. CONCLUSION: Suture knot-related complications should be considered while performing meniscal repairs.


Assuntos
Traumatismos do Joelho , Menisco , Lesões do Menisco Tibial , Adolescente , Artroscopia/efeitos adversos , Artroscopia/métodos , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Masculino , Menisco/cirurgia , Técnicas de Sutura , Suturas/efeitos adversos , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/etiologia , Lesões do Menisco Tibial/cirurgia
9.
Obstet Gynecol ; 140(2): 293-303, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35852281

RESUMO

OBJECTIVE: Absorbable suture is the preferred method of cesarean skin closure compared with metal staples, because it decreases wound complications. Two recently published trials in patients with obesity contradict this evidence. The goal of this meta-analysis was to assess whether suture remains the recommended method of cesarean skin closure, regardless of obesity status. DATA SOURCES: MEDLINE through OVID, PubMed, Cochrane Database, and ClinicalTrials.gov were searched from inception until September 24, 2021. METHOD OF STUDY SELECTION: Published randomized controlled trials (RCTs) comparing subcuticular absorbable suture with nonabsorbable metal staples for cesarean skin closure were included. Non-RCTs, RCTs that did not compare staples with suture, and ongoing trials were excluded. Fourteen studies met inclusion criteria. TABULATION, INTEGRATION AND RESULTS: Data were individually abstracted and entered into RevMan. Fixed and random effects models were used. The Cochrane risk-of-bias tool was used to assess each study. The primary outcome, a sensitivity analysis of wound complications (excluding studies at high risk of bias), showed a significant decrease in wound complications when the cesarean skin incision was closed with suture compared with staples (10 studies; 71/1,497 vs 194/1,465; risk ratio [RR] 0.47, 95% CI 0.25-0.87). When all studies were analyzed, there remained a significant decrease in wound complications when the skin was closed with suture (14 studies; 121/1,780 vs 242/1,750; RR 0.59, 95% CI 0.36-0.97). Of the individual wound complications, wound separation was significantly decreased with suture closure compared with staples (11 studies; 55/1,319 vs 129/1,273; RR 0.43, 95% CI 0.32-0.58). In patients with obesity, there remained a significant decrease in wound complications with suture closure of the skin incision compared with staples (five studies; 34/507 vs 67/522; RR 0.51, 95% CI 0.34-0.75). CONCLUSION: Closure of the cesarean skin incision with suture decreased composite wound complications by 50% as compared with closure with staples; a significant decrease persisted regardless of obesity status. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021270378.


Assuntos
Infecção da Ferida Cirúrgica , Técnicas de Sutura , Cesárea/efeitos adversos , Feminino , Humanos , Obesidade/complicações , Gravidez , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversos
10.
ANZ J Surg ; 92(9): 2143-2148, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35903966

RESUMO

INTRODUCTION: Hepatobiliary and pancreatic surgery is frequently complicated by surgical site infections (SSI) with significant postoperative morbidity and mortality rates contributing to the economic burden on healthcare. Advancements in operative techniques to prevent SSI are gaining traction in clinical practice. This study compares the effectiveness of the 'loop and drain technique (LDT)', a combination method utilizing a continuous subcutaneous vessel loop and subcuticular suture for surgical wound closure in patients undergoing upper gastrointestinal surgery at a Metropolitan Hospital in Sydney. METHODS: A retrospective review of patients who underwent an upper gastrointestinal procedure was conducted at Bankstown-Lidcombe hospital between 2017 and 2019. There were 77 patients in the LDT group and 123 patients included in the control group. The primary outcome assessed was the rate of SSI. Secondary outcomes included length of stay (LOS) and drainage of surgical site infections. RESULT: Two hundred adult patients were treated for an upper gastrointestinal procedure. The most common operation was a Whipple procedure (35.0%). The rate of SSI was 12.5% with all these patients receiving intravenous antibiotics. The LDT cohort had a significantly lower rate of SSI compared to their counterparts (3.9% vs. 17.9%, P = 0.004). CONCLUSION: The LDT method is associated with a decreased incidence of SSI and should be considered as a cost-effective operative technique to improve patient outcomes after upper gastrointestinal surgery.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Infecção da Ferida Cirúrgica , Adulto , Antibacterianos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Drenagem/efeitos adversos , Humanos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Suturas/efeitos adversos
11.
Taiwan J Obstet Gynecol ; 61(4): 703-707, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35779926

RESUMO

OBJECTIVE: Symptomatic Uterine arteriovenous malformation (AVM) can result in sudden and massive vaginal bleeding that can be life-threatening. We report a new fertility-preserving treatment modality for disastrous bleeding caused by acquired uterine AVM: Combination laparoscopic ligation of uterine arteries and AVM suture. CASE REPORT: A 39-year-old female received Dilatation and Curettage due to missed abortion. However, she experienced heavy vaginal bleeding after surgery. Uterine arteriovenous malformation (AVM) was diagnosed by color Doppler ultrasonography, hysteroscopy, and angiography. She was successfully treated using laparoscopy bilateral uterine arteries ligation followed by application of uterine AVM suture with absorbable barbed wound closure device. After the laparoscopic surgery, vaginal bleeding stopped immediately. Complete regression of the AVM lesion on sonography was noted 8 months after laparoscopic surgery. Besides, this patient had normal menstruation after the operation. CONCLUSION: This case report describes for the first time a successful combination of bilateral uterine artery ligation and AVM suture to treat a patient with uterine arteriovenous malformation. We demonstrated the efficacy and safety of this fertility preserving method.


Assuntos
Malformações Arteriovenosas , Laparoscopia , Adulto , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/cirurgia , Feminino , Fertilidade , Humanos , Laparoscopia/efeitos adversos , Gravidez , Suturas/efeitos adversos , Artéria Uterina/anormalidades , Hemorragia Uterina/etiologia , Hemorragia Uterina/cirurgia
12.
Afr J Paediatr Surg ; 19(3): 137-143, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35775513

RESUMO

Background: A technique that offers the best chance of an optimal result is most appropriate to be employed for wound closure. Aims: We set out to compare the cosmetic outcome, and wound complication rates associated with clean paediatric groin wounds closed using Steri-Strip™ or subcuticular suturing. Settings and Design: A prospective randomised study. Subjects and Methods: Children of African descent with unilateral and bilateral clean groin wounds were randomised into subcuticular suture skin closure and Steri-Strip™ groups and followed up postoperatively. Cosmetic assessment and outcome were scored based on parents' satisfaction using the visual analogue scale (VAS) and a single Plastic Surgeon assessed pictures of the scars using the Hollander Wound Evaluation Scale (HWES). Statistical analysis was used SPSS version 18. Results: Seventy-five wounds were assessed, (n = 35, Steri-Strips™) and (n = 40, suturing). Closure with Steri-Strips resulted in scars with comparable cosmesis as those with subcuticular suturing. Wound complications were also similar. There was no statistically significant difference between mean VAS scores on the 5th day (P = 0.320), 2nd week (P = 0.080), 4th week (P = 0.070) and 8th week (P = 0.080). The HWES scores were also comparable at those times. Conclusions: We conclude that skin closure of clean paediatric groin wounds with SteriStrips™ gives comparative cosmetic outcomes with subcuticular suturing.


Assuntos
Cicatriz , Adesivos Teciduais , Criança , Cicatriz/etiologia , Virilha/cirurgia , Humanos , Estudos Prospectivos , Suturas/efeitos adversos
13.
Jt Dis Relat Surg ; 33(2): 359-366, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35852195

RESUMO

OBJECTIVES: The purpose of this study was to evaluate the clinical and radiologic outcomes of unstable distal clavicle fractures in patients who underwent indirect fracture fixation by performing augmentation with nonabsorbable sutures. PATIENTS AND METHODS: In this descriptive observational study, 16 patients (11 males, 5 females; mean age: 34.8±12.1 years; range, 18 to 67 years) who underwent indirect fracture fixation using nonabsorbable sutures for Neer type IIB distal clavicle fractures between January 2014 and September 2019 were retrospectively reviewed. Clinical outcomes were evaluated using the Constant-Murley score and Visual Analog Scale. RESULTS: Complete union was achieved in all patients, and mean union time was 45.3± 8.4 (range, 30 to 68) days. There were no patients with loss of reduction, infection, or requirement for additional surgery. CONCLUSION: The coracoclavicular fixation method, which was applied using nonabsorbent sutures in a limited number of Neer type IIB clavicle fractures, provides a suitable and stable fixation comparable to classical techniques.


Assuntos
Clavícula , Fraturas Ósseas , Adolescente , Adulto , Idoso , Placas Ósseas , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Feminino , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Técnicas de Sutura , Suturas/efeitos adversos , Resultado do Tratamento , Adulto Jovem
14.
BMJ Case Rep ; 15(7)2022 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-35798499

RESUMO

A woman in her early 30s in the 11 2/7 week of pregnancy was admitted with severe abdominal pain and emesis. One year prior, the patient had undergone hysteroscopic adhesiolysis to treat Asherman syndrome resulting from a prior pregnancy. Examination of the patient revealed a haemoperitoneum and an intact intrauterine pregnancy. Laparoscopic adhesiolysis and haemostasis was performed and the patient was transferred to the intensive care unit. Subsequent examination due to persistent abdominal pain revealed an occult iatrogenic perforation of the uterus and placenta percreta with spontaneous uterine rupture. Although treatment for placenta percreta has generally been hysterectomy, in this case, the rupture and perforation sites were resected, representing successful fertility preserving management for this oft-overlooked pregnancy complication.


Assuntos
Placenta Acreta , Ruptura Uterina , Dor Abdominal/etiologia , Feminino , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Humanos , Histerectomia/efeitos adversos , Placenta Acreta/diagnóstico , Placenta Acreta/cirurgia , Gravidez , Primeiro Trimestre da Gravidez , Ruptura Espontânea/cirurgia , Suturas/efeitos adversos , Artéria Uterina , Ruptura Uterina/diagnóstico , Ruptura Uterina/etiologia , Ruptura Uterina/cirurgia , Útero/cirurgia
15.
J Gynecol Obstet Hum Reprod ; 51(8): 102420, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35688324

RESUMO

AIM: Cesarean section (CS) in obese women poses many surgical, anesthetic, and logistical challenges. This systematic review and meta-analysis aimed to compare the outcomes between staples versus subcuticular suture for cesarean skin closure in obese women undergoing CS. METHODS: PubMed, EMBASE and CENTRAL databases were searched for relevant articles using the keywords cesarean section, cesarean delivery, staple, suture, closure and obese. Randomized controlled trials (RCTs), prospective and retrospective studies comparing between staples and subcuticular suture for wound closure in obese women (BMI ≧ 30 kg/m2) were eligible for inclusion. Outcomes were composite wound complication, wound separation, infection and wound appearance satisfaction. RESULTS: Four studies (two RCTs, one retrospective, one post hoc analysis of an RCT) met the inclusion criteria, with a total of 2,038 obese women undergoing CS, of whom 984 had wound closure by staples and 1,054 had wound closure by subcuticular suture. Pooled analysis did not show significant differences on the risk for composite wound complication, infection, wound appearance satisfaction score or wound separation between staples and sutures. CONCLUSIONS: In obese women receiving CS, it appears there are no significant differences in wound complication, infection, satisfaction scores or wound separation between staples and subcuticular suture. These findings may help optimize risk stratification for obese CS patients. A larger study size meta-analysis is needed to confirm the findings.


Assuntos
Cesárea , Obesidade , Técnicas de Sutura , Cesárea/efeitos adversos , Feminino , Humanos , Obesidade/complicações , Obesidade/cirurgia , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecção da Ferida Cirúrgica/epidemiologia , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversos
16.
J Am Coll Surg ; 234(6): 1147-1159, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35703813

RESUMO

BACKGROUND: Previous randomized trials have assessed the effectiveness of triclosan-coated sutures in fascia closure after midline laparotomy in preventing surgical site infections (SSIs); however, available evidence remain inconclusive. We aimed to evaluate the effectiveness of triclosan-coated sutures in abdominal fascia closure to prevent postoperative SSIs. STUDY DESIGN: This study was a multicenter prospective trial conducted within 24 Japanese secondary and tertiary care centers and a propensity score (PS)-matched analysis. Patients 20 years of age or older who underwent elective surgery for colorectal cancer (CRC) were included. Between July 2016 and July 2019, 2,207 patients were prospectively enrolled into the triclosan-coated sutures or uncoated sutures groups. The per-protocol population comprised 2,195 patients. The PS matching was performed for 1,579 patients: 926 patients in the coated group and 653 patients in the uncoated group. The abdominal fascia after midline laparotomy was closed with triclosan-coated or uncoated sutures depending on group. The primary endpoint was the incidence of an SSI. Secondary endpoints were length of hospital stay and surgical complication rates. RESULTS: The recorded SSI rates were 4.2% in the triclosan-coated group and 6.74% in the uncoated suture group (p = 0.028). There were no serious adverse events in the groups. The final logistic regression model showed that several variables affected the occurrence of SSI. Our meta-analysis included six phase-III trials, and our study evaluated 4,797 patients. The results show a significant superiority of triclosan-coated sutures over uncoated suture material. CONCLUSION: Triclosan-coated sutures reduce the incidence of SSI after elective CRC surgery.


Assuntos
Parede Abdominal , Anti-Infecciosos Locais , Cirurgia Colorretal , Laparoscopia , Triclosan , Humanos , Laparoscopia/efeitos adversos , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Suturas/efeitos adversos , Triclosan/uso terapêutico
17.
Plast Reconstr Surg ; 150(2): 435e-438e, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35674641

RESUMO

SUMMARY: Following neurosurgical repair of spinal dysraphism defects, soft-tissue reconstruction is often required to obtain robust coverage of the dura. Layered closure utilizing local muscle and muscle fascia has proven reliable for this purpose, but it often results in significant dead space necessitating closed suction drainage. Progressive-tension sutures have been reported as an alternative to drains for prevention of fluid collection in several other procedures. In this study, the use of progressive-tension sutures for eliminating subcutaneous dead space and obtaining tension-free skin closure was prospectively evaluated in pediatric patients undergoing soft-tissue reconstruction for congenital spinal anomalies. Primary outcomes of interest included wound breakdown, seroma, hematoma, and cerebrospinal fluid leak. Patients were excluded if a lumbar, submuscular, or subcutaneous drain was placed during the index procedure. Over a 3-year period, 45 patients underwent muscle flap reconstruction for coverage of dural defects. The primary diagnoses were myelomeningocele (10 patients), lipomyelomeningocele (eight patients), myelocystocele (three patients), tethered cord release (15 patients), meningocele (three patients), spinal tumor (two patients), and hardware exposure following spinal instrumentation (three patients). During the follow-up period, three patients (6.7 percent) had postoperative wound complications. One patient had superficial dehiscence, one had cerebrospinal fluid leak requiring operative revision, and one had a surgical site infection necessitating operative drainage. No patients developed hematomas, seromas, cerebrospinal fluid fistulae, or wound breakdown requiring operative revision. The use of progressive-tension sutures is an effective method for eliminating subcutaneous dead space in pediatric soft-tissue reconstruction and eliminates the need for drain placement. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Seroma , Suturas , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Vazamento de Líquido Cefalorraquidiano/cirurgia , Criança , Drenagem/métodos , Hematoma , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Seroma/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Suturas/efeitos adversos
18.
PLoS One ; 17(6): e0270337, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35771895

RESUMO

OBJECTIVE: To compare the effect of skin closure materials on skin closure during cesarean delivery. METHODS: We searched EMBASE、PubMed、Scopus、Cochrane CENTRAL for randomized controlled trials (RCTs) on the use of closure materials for skin closing effect during cesarean delivery. The outcomes were time to skin closure of dermal and epidermal layer, skin separation rate and wound complications(wound infection, hematoma,seroma, reclosure, readmission) reported as an odds ratio (OR) and surface under the cumulative ranking curve analysis (SUCRA) score. RESULTS: Twenty -six RCTs met the inclusion criteria. In the network meta-analysis (NMA) for time to skin closure of dermal and epidermal layer, pooled network OR values indicated that staple (network SMD, -337.50; 95% CrI: -416.99 to -263.18) was superior to absorbable suture. In the Skin separation NMA, pooled network OR values indicated that the absorbable suture (network OR, 0.37; 95% CrI: 0.19 to 0.70) were superior to staple. In the wound complications NMA, pooled network OR values indicated that the no interventions were superior to staple. CONCLUSION: In conclusion, our network meta-analysis showed that the risk of skin separation with absorbable suture after cesarean delivery was reduced compared with staple, and does not increase the risk of wound complications, but the wound closure time would slightly prolonged.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais , Técnicas de Sutura , Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Cesárea/efeitos adversos , Feminino , Humanos , Metanálise em Rede , Gravidez , Infecção da Ferida Cirúrgica/etiologia , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversos
19.
Am J Sports Med ; 50(9): 2357-2366, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35666109

RESUMO

BACKGROUND: Secondary meniscectomy rates after repair of longitudinal tears of the posterior horn of the medial meniscus (PHMM) performed concomitantly with anterior cruciate ligament reconstruction (ACLR) are reported to be as high as 25% with an all inside repair technique. Posteromedial portal suture hook repair is an emerging technique; however, it is unknown whether it confers a significantly reduced secondary meniscectomy rate compared with the current gold standard. PURPOSE/HYPOTHESIS: The primary objective of this study was to compare the secondary meniscectomy rates of suture hook repair and all inside repair for longitudinal tears of the PHMM performed concomitant to ACLR. The secondary outcome was to determine the risk factors associated with the failure of the repair. It was hypothesized that repair with an all inside device would be associated with higher secondary meniscectomy rates when compared with suture hook repair and that concomitant anterolateral ligament reconstruction (ALLR) would confer improved meniscal repair survivorship. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients with longitudinal tears of the PHMM who underwent meniscal repair during primary ACLR between January 2011 and December 2015 at our institution were eligible for the study. Patients undergoing suture hook repair were propensity matched in a 1:1 ratio to patients who underwent all inside repair. At the end of the study period, secondary meniscectomy rates were determined. RESULTS: The study population comprised 237 matched pairs. The mean follow up was 97.7 ± 17.3 months. Patients who underwent an all inside repair had a >2-fold higher failure rate compared with patients who underwent suture hook repair through a posteromedial portal (31.2% vs 15.6%; P = .0003). Patients in the suture hook repair group undergoing additional ALLR demonstrated a >3-fold higher meniscal repair survival rate compared with all other subgroups (P = .0014). This association was not seen in the all inside repair group. The only statistically significant risk factor for meniscal repair failure was the suture repair technique (hazard ratio, 2.133 [95% CI, 1.383-3.292]; P = .0008). CONCLUSION: Suture hook repair through a posteromedial portal is associated with a significantly lower secondary meniscectomy rate when compared with the all inside meniscal repair of longitudinal tears of the PHMM performed at the time of ACLR. Furthermore, patients in the suture hook repair group who underwent an additional ALLR had a significantly better meniscal repair survivorship compared with all other subgroups.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Lesões do Menisco Tibial , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Estudos de Coortes , Humanos , Análise por Pareamento , Meniscos Tibiais/cirurgia , Suturas/efeitos adversos , Lesões do Menisco Tibial/complicações
20.
J Cardiothorac Surg ; 17(1): 159, 2022 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-35717232

RESUMO

BACKGROUND: Aortic valve stenosis is the most frequent cardiac valve pathology in the western world. Surgical aortic valve replacement is the gold standard for the treatment of significant degenerative aortic valve diseases. CASE PRESENTATION: This case report highlights an unexpected abnormal iatrogenic shortening of the aorto-mitral continuity and its deformity, during traditional AVR using sutured stented aortic prosthesis as the first choice, which caused significant mitral valve regurgitation. The suture-less prosthesis was a rescue choice to restore the geometry and eliminate the deformation of the aorto-mitral continuity. CONCLUSIONS: Aortic valve replacement using suture-less prosthesis could be a valuable optional choice for lowering the risk of deformation of the aortic annulus and aorto-mitral continuity. It might provide better outcomes in combined procedures.


Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Suturas/efeitos adversos , Resultado do Tratamento
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