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1.
Proc Natl Acad Sci U S A ; 117(27): 15497-15503, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32576692

RESUMO

Bioadhesives such as tissue adhesives, hemostatic agents, and tissue sealants have potential advantages over sutures and staples for wound closure, hemostasis, and integration of implantable devices onto wet tissues. However, existing bioadhesives display several limitations including slow adhesion formation, weak bonding, low biocompatibility, poor mechanical match with tissues, and/or lack of triggerable benign detachment. Here, we report a bioadhesive that can form instant tough adhesion on various wet dynamic tissues and can be benignly detached from the adhered tissues on demand with a biocompatible triggering solution. The adhesion of the bioadhesive relies on the removal of interfacial water from the tissue surface, followed by physical and covalent cross-linking with the tissue surface. The triggerable detachment of the bioadhesive results from the cleavage of bioadhesive's cross-links with the tissue surface by the triggering solution. After it is adhered to wet tissues, the bioadhesive becomes a tough hydrogel with mechanical compliance and stretchability comparable with those of soft tissues. We validate in vivo biocompatibility of the bioadhesive and the triggering solution in a rat model and demonstrate potential applications of the bioadhesive with triggerable benign detachment in ex vivo porcine models.


Assuntos
Materiais Biocompatíveis/química , Hidrogéis/química , Ferida Cirúrgica/terapia , Adesivos Teciduais/química , Adesividade , Animais , Reagentes para Ligações Cruzadas/química , Modelos Animais de Doenças , Feminino , Teste de Materiais , Ratos , Bicarbonato de Sódio/química , Soluções , Succinimidas/química , Suínos , Técnicas de Fechamento de Ferimentos/instrumentação
2.
Ulus Travma Acil Cerrahi Derg ; 26(3): 384-388, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32436964

RESUMO

BACKGROUND: In this study, we aimed to evaluate the superiority of intracorporeal sutures and Hem-o-lok clips about efficiency, reliability and cost. METHODS: We performed laparoscopic surgery for acute appendicitis in this study. Appendiceal stump was closed by Hem-o-lok clips (Group I) and intracorporeal knotting (Group II) in a randomized manner. Groups were compared for demographic data (age, sex, body mass index, American Society of Anesthesiologists score) operation time, total cost, 2.6.12.24.hours and 7th day pain score. RESULTS: Demographic data, such as age, gender and BMI, were similar between groups (p>0.05). There was no significant difference between the groups concerning peroperative and postoperative complications (p>0.05). No postoperative nausea, vomiting, ileus and intraabdominal abscess were observed in patients. There was no significant difference between the groups about duration of operation, length of hospital stay and cost analysis (p>0.05). There was no significant difference in pain scores of groups. The effect of the operation type on pain scores was not statistically significant (p>0.05). CONCLUSION: This study showed that both intracorporeal knotting and Hem-o-loc clips were effective, reliable and similar cost-effective in laparoscopic appendectomy. The decision should be based on the surgeon's experience.


Assuntos
Apendicectomia , Apêndice/cirurgia , Laparoscopia , Técnicas de Fechamento de Ferimentos , Apendicectomia/efeitos adversos , Apendicectomia/instrumentação , Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Instrumentos Cirúrgicos , Suturas , Técnicas de Fechamento de Ferimentos/efeitos adversos , Técnicas de Fechamento de Ferimentos/instrumentação , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos
3.
Semin Thorac Cardiovasc Surg ; 32(2): 244-252, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31778787

RESUMO

The union rate of wire fixation after median sternotomy remains unsatisfactory. We developed a novel osteoconductive sheet composed of hydrophilized hydroxyapatite and evaluated its osteogenetic effect when interposed between sternal halves in a canine model. Eighteen canines were divided equally into groups based on the hemostatic agent used: osteoconductive sheet (S), none (C), and bone wax (BW). After median sternotomy, the sternal halves were closed by wire fixation. In each group, 3 canines were euthanized at 1 month, while 3 were euthanized at 2 months. Resected sternums were mechanically assessed by the 3-point bending test, radiographically assessed by micro-CT, and pathologically assessed to quantify the osteogenesis between sternal halves. Compared with the BW group, the S group had a greater maximum stress at 1 month (S: 322.9 ± 107.7 N, C: 233.0 ± 62.7 N, BW: 124.9 ± 88.4 N; P = 0.025), and greater maximum shear force at 1 month (S: 1.92 ± 0.67 N/m2; C: 1.23 ± 0.28 N/m2; BW: 0.68 ± 0.41 N/m2; P = 0.025). Micro-CT revealed that the S group had more osteogenesis than the BW group at 1 month (25.7% ± 9.8% vs 6.9% ± 9.2%), and 2 months (34.0% ± 15.1% vs 14.8% ± 9.4%); the respective values in the C group were 17.1% ± 7.2% and 29.7% ± 9.3%. Pathologic examination revealed that the S group had the greatest osteogenetic area at 2 months (S: 38.8% ± 18.8%; C: 24.5% ± 6.9%; BW: 24.7% ± 18.6%). Adjuvant osteoconductive therapy using a cotton-like hydroxyapatite sheet in addition to wire fixation significantly improved sternal healing compared with BW. This new material also showed relatively better outcome than the C group.


Assuntos
Regeneração Óssea/efeitos dos fármacos , Fios Ortopédicos , Hidroxiapatitas/administração & dosagem , Esternotomia , Esterno/cirurgia , Técnicas de Fechamento de Ferimentos/instrumentação , Cicatrização/efeitos dos fármacos , Animais , Cães , Hemostáticos/administração & dosagem , Hidroxiapatitas/toxicidade , Palmitatos/administração & dosagem , Esterno/diagnóstico por imagem , Esterno/patologia , Esterno/fisiopatologia , Fatores de Tempo , Ceras , Técnicas de Fechamento de Ferimentos/efeitos adversos
6.
J Invest Surg ; 33(1): 59-66, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29775392

RESUMO

Background: Bipolar sealing devices are routinely used to seal blood vessels. The aim of the study is to evaluate the feasibility and safety of colonic sealing with the use of the bipolar energy devices in rats as model for experimental appendectomy. Methods: Seventy-five male Wistar rats underwent a cecal resection with four different bipolar sealing devices or a linear stapler. The harvesting procedure was performed immediately or at postoperative day (POD) 7. The sealing front bursting pressure (BP) was measured in both groups. At POD7, the resection line was clinically examined and the hydroxyproline (HDP) levels were determined. Hematoxylin and Eosin (H&E) staining was used for histopathological evaluation of the sealing front as well. Results: There was no mortality and no insufficiency. The BPs between the bipolar sealing devices showed no statistical differences. The early phase of the seal (POD 0) provides a low BP with an 30.8% increase until POD 7. The BPs in the stapler group showed significant better values. The hydroxyproline levels did not differ statistically between the groups. Histopathologically, there were more signs of ischemic necrosis in the stapler group than in the sealing devices groups. Conclusion: The resection and sealing of the cecum as an experimental appendectomy model with the use of bipolar energy devices proved feasible and safe in rats. The different energy devices in this study produce comparable results. To justify clinical practice in humans, several studies on the underlying mechanisms of early stage wound healing are needed.


Assuntos
Apendicectomia/instrumentação , Ceco/cirurgia , Eletrocoagulação/instrumentação , Hemostasia Cirúrgica/instrumentação , Técnicas de Fechamento de Ferimentos/instrumentação , Animais , Apendicectomia/efeitos adversos , Apendicectomia/métodos , Eletrocoagulação/métodos , Estudos de Viabilidade , Hemostasia Cirúrgica/efeitos adversos , Hemostasia Cirúrgica/métodos , Masculino , Modelos Animais , Ratos , Ratos Wistar , Grampeadores Cirúrgicos/efeitos adversos , Técnicas de Fechamento de Ferimentos/efeitos adversos
7.
Asian J Endosc Surg ; 13(1): 83-88, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30688041

RESUMO

INTRODUCTION: Dual-hemostat techniques for port closure have previously been reported, but their safety and efficacy have not been evaluated. Here, we describe the dual-hemostat port closure technique employed at our institution, which uses a customized surgical suture for safe and certain port closure, and we assess the incidence rate of trocar-site hernia (TSH) after laparoscopic cholecystectomy. METHODS: From March 1999 to March 2017 at our institution, 316 patients underwent elective laparoscopic cholecystectomy performed by a single experienced surgeon. We routinely used a dual-hemostat technique with a customized surgical suture to achieve safe and certain port closure. We assessed the incidence rate of TSH after laparoscopic cholecystectomy (defined as a reoperation for a TSH or clinical hernia at the port site) based on follow-up data from patient questionnaires and clinical examinations. RESULTS: After 67 patients were excluded because of death, unknown address, or conversion to open cholecystectomy, 249 eligible patients received questionnaires, of which 173 were returned (response rate, 69.5%). From these responses, TSH was suspected in three patients, but only one underwent reoperation for TSH after laparoscopic cholecystectomy. Thus, the incidence rate of TSH after laparoscopic cholecystectomy was 0.6% (1/173). CONCLUSIONS: Our single-center experience demonstrated that our port closure technique using a dual-hemostat technique with customized surgical suture provides an appropriate option for laparoscopic cholecystectomy, especially given its ease and low incidence of TSH.


Assuntos
Colecistectomia Laparoscópica/instrumentação , Colecistectomia Laparoscópica/métodos , Hérnia Ventral/cirurgia , Hérnia Incisional/cirurgia , Técnicas de Fechamento de Ferimentos/instrumentação , Colecistectomia Laparoscópica/efeitos adversos , Hérnia Ventral/etiologia , Humanos , Hérnia Incisional/etiologia , Instrumentos Cirúrgicos , Suturas
8.
Rev Neurol (Paris) ; 176(1-2): 53-61, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31787326

RESUMO

BACKGROUND: Unlike previous randomized clinical trials (RCTs), recent trials and meta-analyses have shown that transcatheter closure of patent foramen ovale (PFO) reduces stroke recurrence risk in young and middle-aged adults with an otherwise unexplained PFO-associated ischaemic stroke. AIM: To produce an expert consensus on the role of transcatheter PFO closure and antithrombotic drugs for secondary stroke prevention in patients with PFO-associated ischaemic stroke. METHODS: Five neurologists and five cardiologists with extensive experience in the relevant field were nominated by the French Neurovascular Society and the French Society of Cardiology to make recommendations based on evidence from RCTs and meta-analyses. RESULTS: The experts recommend that any decision concerning treatment of patients with PFO-associated ischaemic stroke should be taken after neurological and cardiological evaluation, bringing together the necessary neurovascular, echocardiography and interventional cardiology expertise. Transcatheter PFO closure is recommended in patients fulfilling all the following criteria: age 16-60 years; recent (≤6 months) ischaemic stroke; PFO associated with atrial septal aneurysm (>10mm) or with a right-to-left shunt>20 microbubbles or with a diameter≥2mm; PFO felt to be the most likely cause of stroke after thorough aetiological evaluation by a stroke specialist. Long-term oral anticoagulation may be considered in the event of contraindication to or patient refusal of PFO closure, in the absence of a high bleeding risk. After PFO closure, dual anti-platelet therapy with aspirin (75mg/day) and clopidogrel (75mg/day) is recommended for 3 months, followed by monotherapy with aspirin or clopidogrel for≥5 years. CONCLUSIONS: Although a big step forward that will benefit many patients has been taken with recent trials, many questions remain unanswered. Pending results from further studies, decision-making regarding management of patients with PFO-associated ischaemic stroke should be based on a close coordination between neurologists/stroke specialists and cardiologists.


Assuntos
Isquemia Encefálica/cirurgia , Cateterismo Cardíaco/normas , Procedimentos Endovasculares/normas , Forame Oval Patente/cirurgia , Prevenção Secundária , Acidente Vascular Cerebral/prevenção & controle , Adolescente , Adulto , Isquemia Encefálica/complicações , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Cardiologia/organização & administração , Cardiologia/normas , Consenso , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Prova Pericial , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Neurologia/organização & administração , Neurologia/normas , Recidiva , Prevenção Secundária/métodos , Prevenção Secundária/normas , Sociedades Médicas/normas , Dispositivos de Acesso Vascular/normas , Técnicas de Fechamento de Ferimentos/instrumentação , Técnicas de Fechamento de Ferimentos/normas , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: mdl-31835653

RESUMO

This study aims to evaluate the effectiveness of advanced practice nurses with respect to complex chronic wounds (APN-CCWs) in the care of patients with venous ulcers. A multicentric, quasi-experimental pre-post study was conducted without a control group in the sanitary management areas where the APN-CCW program is being piloted. The intervention consisted of a mass training of clinical nurses from the participating districts on the proper management of injuries and the use of compression therapy. The data were collected through a specifically constructed questionnaire with questions regarding descriptive variables of injuries and their treatment. A total of 643 professionals responded (response rate of 89.1%), attending to a total population of 707,814 inhabitants. An increase in multilayer bandage use by 15.67%, an increase in elastic bandage use by 13.24%, and a significant decrease in the referral of patients to consultation with hospital specialists was achieved, from 21.08% to 12.34%. The number of patients referred to the APNs was 13.25%, which implied a resolution rate of 94.08% of their injuries. In conclusion, the coordination by the APN-CCWs in patients with venous ulcers was effective in improving the continuity of care, in the optimization of resources, and in their care role.


Assuntos
Prática Avançada de Enfermagem , Úlcera Varicosa/enfermagem , Técnicas de Fechamento de Ferimentos/enfermagem , Bandagens , Doença Crônica , Feminino , Humanos , Masculino , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/instrumentação , Cicatrização
10.
J Cardiothorac Surg ; 14(1): 193, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711516

RESUMO

BACKGROUND: For low risk patients undergoing median sternotomies, no midterm follow-up studies involving sternal healing have been conducted. In this study we evaluated sternal healing in low risk patients by chest CT scan and the risk factors associated with poor healing were analyzed. METHODS: Patients who underwent sternal median incision heart surgery from September 2014 to March 2015 were recruited. The clinical information of these patients during hospitalization was collected, and the CT scan data were submitted to the two chief physicians of the Radiology Department for radiographical sternal healing score determination. Based on the method of wound closure, the patients were divided into sternum plate (Plates) and wire groups (Wires). RESULTS: Forty-four patients were recruited. The mean CT examination time was 17.27 ± 2.30 months postoperatively. Twenty-nine (65.9%) patients met the criteria for radiographic sternal healing. Three segments, including the aortopulmonary window, the main pulmonary artery, and the aortic root, had healed less in comparison to the manubrium segment. Compared to patients in whom 6-7 metal wires were used for sternal closure, healing of the lower sternum was worse in patients in whom five wires were used, but the difference in healing was not statistically significant. Univariate analysis of sternal healing showed that patient age was a risk factor for sternal non-healing. When the patient age was > 45 years, the predicted risk of radiographic sternal non-union was 1.833 (95% CI: 1.343-2.503). CONCLUSIONS: At the mid-term follow-up, 65.9% of patients undergoing median sternotomies demonstrated radiographic sternal healing. Age, but not closure device, was a risk factor for sternal non-healing in low risk patients. Use of more wires had a positive impact on sternal healing. TRIAL REGISTRATION: researchregistry4918, registered 28 May 2019, retrospectively registered.


Assuntos
Manúbrio/diagnóstico por imagem , Esternotomia , Técnicas de Fechamento de Ferimentos/instrumentação , Cicatrização , Adulto , Fatores Etários , Idoso , Placas Ósseas , Fios Ortopédicos , Procedimentos Cirúrgicos Cardíacos , Feminino , Seguimentos , Humanos , Masculino , Manúbrio/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Esternotomia/métodos , Tomografia Computadorizada por Raios X
11.
Chirurgia (Bucur) ; 114(5): 668-673, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31689175

RESUMO

Background: The desire for perfect haemostasis has led the medical equipment industry to produce ideal instruments for safe thyroidectomy. Thus, haemostasis and sealing instruments such as the LigaSureTM Small Jaw, ThunderbeatTM Open Fine Jaw and HarmonicTM Focus have been indicated for thyroid surgery. Aim: The purpose of this study is to present the initial results of using these three surgical instruments for performing monobloc thyroidectomy. Material and Methods: We performed a prospective study between January 2014 and July 2019 in which we included all the patients operated by same surgeon using those 3 sealing devices. Thyroidectomies were performed using LigaSureTM Small Jaw (group 1), the ThunderbeatTM Open Fine Jaw (group 2) and HarmonicTM Focus (group 3). The groups were statistically compared in term of duration of surgery and hospitalisation, early postoperative complications as well as voice alteration or acute respiratory failure. Results: No significant differences were observed among groups in terms of patient demographics, pathological diagnoses, postoperative complications, length of hospitalization, and clinical outcomes. Operating time was shorter in group 1. Conclusions: New surgical instruments have beneficial properties, including shortening the operative time, maintaining a clean operating field, and minimising smoke released during the operation.


Assuntos
Hemostasia Cirúrgica/instrumentação , Glândula Tireoide/cirurgia , Tireoidectomia/instrumentação , Tireoidectomia/métodos , Humanos , Estudos Prospectivos , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/instrumentação
12.
IET Nanobiotechnol ; 13(8): 778-785, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31625517

RESUMO

Wound healing is a series of different dynamic and complex phenomena. Many studies have been carried out based on the type and severity of wounds. However, to recover wounds faster there are no suitable drugs available, which are highly stable, less expensive as well as has no side effects. Nanomaterials have been proven to be the most promising agent for faster wound healing among all the other wound healing materials. This review briefly discusses the recent developments of wound healing by nanotechnology, their applicability and advantages. Nanomaterials have unique physicochemical, optical, and biological properties. Some of them can be directly applied for wound healing or some of them can be incorporated into scaffolds to create hydrogel matrix or nanocomposites, which promote wound healing through their antimicrobial, as well as selective anti- and pro-inflammatory, and proangiogenic properties. Owing to their high surface area to volume ratio, nanomaterials have not only been used for drug delivery vectors but also can affect wound healing by influencing collagen deposition and realignment and provide approaches for skin tissue regeneration.


Assuntos
Materiais Biocompatíveis/farmacologia , Nanotecnologia/métodos , Cicatrização/efeitos dos fármacos , Animais , Bandagens , Materiais Biocompatíveis/administração & dosagem , Portadores de Fármacos/síntese química , Portadores de Fármacos/química , Sistemas de Liberação de Medicamentos , Humanos , Hidrogéis/síntese química , Hidrogéis/química , Hidrogéis/uso terapêutico , Nanotecnologia/instrumentação , Nanotecnologia/tendências , Regeneração/efeitos dos fármacos , Pele/efeitos dos fármacos , Pele/fisiopatologia , Fenômenos Fisiológicos da Pele/efeitos dos fármacos , Pele Artificial , Tecidos Suporte/química , Técnicas de Fechamento de Ferimentos/instrumentação
13.
Eur J Obstet Gynecol Reprod Biol ; 243: 21-25, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31654860

RESUMO

OBJECTIVE: To investigate the incidence of 30-day surgical site infection (SSI) rate before and after the introduction of evidence-based "bundled interventions" (BI) in gynaecological malignancy (GM).To evaluate the efficacy of BI in reducing SSI rate and readmission rate due to SSI. METHODS: This prospective interventional study was carried out at a Single University teaching hospital. BIs were implemented in GM laparotomies from March 2016 to June 2018. Baseline SSI rate was determined retrospectively from January 2011 to December 2015. The interventions included patient education, separate closing tray, dressing removal ≤48 h, dismissal with 4% chlorhexidine gluconate and follow up phone call. A 30-day SSI and re-admission rate were assessed. RESULTS: The study included 840 patients, 624 who underwent laparotomy before (PRE) the implementation of BI and 216 after (POST) the implementation. The most common diagnosis was ovarian cancer (OC). There was significant reduction in: overall (p < 0.001) and superficial SSI rates (p < 0.001); OC undergoing surgery without bowel resection (BR) (p < 0.001); and OC with BR (p = 0.003), after implementation of BI. None of the patients had deep organ/space infections or readmissions during the Post-intervention period. The overall compliance for BI was 96.7%. SSI rates significantly decreased in patients aged ≥ 60 years, ASA score ≥ 3, operative time ≥ 240 min, clean contaminated and contaminated surgeries, and prolonged hospital stay (all p < 0.05). CONCLUSION: Implementation of BI was associated with significant reduction of SSI rate in GM. The intervention remained effective in at-risk patients with non-modifiable clinico-pathologic and surgical factors.


Assuntos
Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Pacotes de Assistência ao Paciente/métodos , Assistência Perioperatória/métodos , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Adulto , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos Locais/uso terapêutico , Bandagens , Clorexidina/análogos & derivados , Clorexidina/uso terapêutico , Procedimentos Cirúrgicos de Citorredução , Feminino , Humanos , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Estudos Prospectivos , Estudos Retrospectivos , Telefone , Técnicas de Fechamento de Ferimentos/instrumentação , Adulto Jovem
15.
Arq Bras Cir Dig ; 32(3): e1452, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644672

RESUMO

BACKGROUND: In high-income countries, morbid obesity is a growing health problem that has already reached epidemic proportions. When performing a laparoscopic gastric bypass several operative methods exist. AIM: To describe the institutional experience using a knotless unidirectional barbed suture (V-Loc 180/Covidien, Mansfield, MA) to create a hand-sewn gastrojejunostomy (GJ) and jejunojejunostomy (JJ) during bariatric surgery. METHODS: Evaluation of a case series of 87 morbidly obese patients who underwent laparoscopic gastric bypass with a hand-sewn gastrojejunostomy (GJA) and jejunojejunostomy (JJA) between 01/2015 and 06/2017. The patients were divided into two groups: in group I, GJA und JJA sutures were performed using the knotless unidirectional barbed suture; in group II, GJA and JJA were sutured with resorbable multifilament thread (Vicryl® 3/0 Ethicon, Livingstone, UK). The recorded data on gender, age, BMI, ASA score, operative time, postoperative morbidity, length of hospital stay, and reoperation, were analyzed and compared. RESULTS: All procedures were completed laparoscopically with no mortality. The mean operative time was 123.23 (±30.631) in group I and 127.57 (±42.772) in group II (p<0.05). The postoperative complications did not differ significantly between the two groups. Early complications were observed for two patients (0.9%) in the barbed suture group and for one patient (0.42%) in the multifilament suture group (p<0.05). In group I two patients (0.9%) required reoperation: on the basis of jejunojejunal stenosis in one patient, and local abscess near the gastrojejunostomy, without a leakage, in the other. In group II one patient (0.42%) required reoperation due to stenosis of the GJA. The duration of hospital admission was similar for both groups: 3.36 (±0.743) days in group I vs. 3.38 (±1.058) days in group II (p<0.05). CONCLUSION: The novel anastomotic technique is a safe and effective method and can be applied to gastrojejunal anastomosis and jejunojejunal anastomosis in laparoscopic gastric bypass.


Assuntos
Cirurgia Bariátrica/instrumentação , Segurança de Equipamentos/instrumentação , Obesidade Mórbida/cirurgia , Técnicas de Sutura/instrumentação , Adulto , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Cirurgia Bariátrica/métodos , Feminino , Derivação Gástrica/instrumentação , Derivação Gástrica/métodos , Humanos , Jejunostomia/instrumentação , Jejunostomia/métodos , Jejuno/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Poliglactina 910 , Complicações Pós-Operatórias , Estudos Prospectivos , Estômago/cirurgia , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/instrumentação
17.
Gen Thorac Cardiovasc Surg ; 67(11): 907-916, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31531834

RESUMO

OBJECTIVE: Median sternotomy remains the most common access to perform cardiac surgery procedures. However, the experience of the operating surgeon remains a crucial factor during sternal closure to avoid potential complications related to poor sternal healing, such as mediastinitis. Considering the lack of major randomized controlled trials and the heterogeneity of the current literature, this narrative review aims to summarize the different techniques and approaches to sternal closure with the aim to investigate their reflections into clinical outcomes and to inform the choice on the most effective closure method after median sternotomy. METHODS: A literature search through PubMed, Embase, EBSCO, Cochrane database of systematic reviews, and Web of Science from its inception up to April 2019 using the following search keywords in various combinations: sternal, sternotomy, mediastinitis, deep sternal wound infection, cardiac surgery, closure. RESULTS: Single wire fixation methods, at present, seems the most useful method to perform sternal closure in routine patients, although patients with a fragile sternum might benefit more from a figure-of-eight technique. In high-risk patients (e.g. chronic pulmonary disease, obesity, bilateral internal mammary artery harvesting, diabetes, off-midline sternotomy), rigid plate fixation is currently the most effective method, if available; alternatively, weave techniques could be used. CONCLUSION: The choice among the sternal closure techniques should be mainly inspired and tailored on the patient's characteristics, and correct judgement and experience play a pivotal role. A decisional algorithm has been proposed as an attempt to overcome the absence of specific guidelines and to guide the operative approach. This operative approach might be used also in non-cardiac procedure in which median sternotomy is required, such as in case of thoracic surgery.


Assuntos
Esternotomia , Técnicas de Fechamento de Ferimentos , Placas Ósseas , Fios Ortopédicos , Procedimentos Cirúrgicos Cardíacos , Humanos , Mediastinite/etiologia , Esternotomia/efeitos adversos , Esterno/cirurgia , Técnicas de Fechamento de Ferimentos/instrumentação
18.
Rev. bras. cir. plást ; 34(3): 384-390, jul.-sep. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047160

RESUMO

Introdução: O tratamento de grandes e médias feridas é um desafio para os cirurgiões quando precisam fechálas e, normalmente, são utilizadas técnicas cirúrgicas de enxertias ou retalhos, que podem deixar sequelas e até mesmo mutilações. Ao longo do tempo desenvolveu-se a técnica de "sutura elástica" que promove a cicatrização em curto espaço de tempo com sequelas menores, entretanto o procedimento tem sido realizado com material improvisado. Objetivo: Desenvolver um fio de sutura elástico cirúrgico que possa ser esterilizado e confeccionado nos moldes dos produtos médicos cirúrgicos. Métodos: Revisão das patentes existentes por meio da busca de anterioridade e comparação com o dispositivo do estudo. Pesquisa de materiais com as características necessárias como elasticidade e tensão. Teste destas características em laboratórios especializados. Resultados: O produto desenvolvido é um fio elástico com duplo agulhamento para suturas, com matéria prima de silicone que apresenta elasticidade e resistência a tensão. Conclusão: O fio de sutura elástico, com duplo agulhamento, para feridas de médio e grande porte foi desenvolvido.


Introduction: Closing large and medium wounds is challenging for surgeons and often leads to the use of graft or flap surgical techniques. These procedures can leave sequelae and even mutilations. An "elastic suture" technique was developed to promote wound healing in a short time span with minor sequelae; however, improvised materials have been used in this procedure. Objective: To develop a surgical elastic suture thread that can be manufactured and sterilized following the standards of surgical medical products. Methods: We conducted a patent search, compared the findings with the study device, and researched materials with necessary characteristics such as elasticity and tension. Testing these characteristics in specialized laboratories. Results: The developed device is a double-needled elastic suture made of silicone that presents tensile strength. Conclusion: Here, we developed a double-needled elastic suture for medium and large wounds.


Assuntos
Humanos , História do Século XXI , Cirurgia Plástica , Instrumentos Cirúrgicos , Suturas/normas , Cicatrização , Técnicas de Sutura/instrumentação , Técnicas de Fechamento de Ferimentos , Cirurgia Plástica/instrumentação , Cirurgia Plástica/métodos , Instrumentos Cirúrgicos/normas , Suturas , Cicatrização/ética , Ferimentos e Lesões , Técnicas de Fechamento de Ferimentos/instrumentação
19.
Braz J Cardiovasc Surg ; 34(4): 406-411, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454194

RESUMO

OBJECTIVE: To describe a new technique of sternal closure, modified from the conventional figure-of-eight approach, which can provide a secure closure and prevent sternal complications. METHODS: The modified technique is based on the intercalation of the caudal portion of each steel wire passed along the sternum. This is a retrospective analysis of patients operated with this modified technique at our institution between January 2014 and December 2016. RESULTS: One hundred and forty-three patients underwent sternal closure with the modified technique. In-hospital mortality rate was 1.4% (n=2). No sternal instability was observed at 30 days postoperatively. Two patients developed mediastinitis that required extraction of the wires. CONCLUSION: Short-term results have shown that the modified sternal closure technique can be used safely and effectively, with complications rates being consistent with worldwide experience.


Assuntos
Esterno/cirurgia , Deiscência da Ferida Operatória/prevenção & controle , Técnicas de Sutura/instrumentação , Técnicas de Fechamento de Ferimentos/instrumentação , Adolescente , Adulto , Idoso , Fios Ortopédicos/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Mediastinite/complicações , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Deiscência da Ferida Operatória/etiologia , Técnicas de Sutura/efeitos adversos , Técnicas de Fechamento de Ferimentos/mortalidade , Adulto Jovem
20.
Gastrointest Endosc Clin N Am ; 29(4): 705-719, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31445692

RESUMO

Large and complex colon polyps are frequently referred to surgery for fear of perforation that may need emergency surgery. During the last 15 years, advances in clip and suturing devices allowed us to close perforations and avoid surgery. In addition, we have made substantial progress in our understanding of the lesions at risk for either immediate or delayed perforation. This article focuses on the colonoscopic closure of resection defects and perforations and the prevention and treatment of colon perforations after endoscopic resection.


Assuntos
Colonoscópios , Colonoscopia/efeitos adversos , Neoplasias Colorretais/cirurgia , Perfuração Intestinal/cirurgia , Complicações Intraoperatórias/cirurgia , Idoso , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Prognóstico , Instrumentos Cirúrgicos , Técnicas de Sutura , Técnicas de Fechamento de Ferimentos/instrumentação
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