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1.
BMJ Case Rep ; 14(7)2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34266822

RESUMO

Rotator cuff injuries present rarely in paediatric patients due to the tendon strength at this age. There are reports of ruptures caused by either irritation of the lateral clavicle or acromioclavicular (AC) joint in fractures or after usage of hook plates. In this case report, we present a patient with an acute complete supraspinatus rupture caused by a suture anchor tip from a previously performed AC joint stabilisation. After the diagnosis of a new complete supraspinatus, the causative prominent suture anchor was removed, and the tendon subsequently repaired. This case highlights the close anatomic relation of the AC joint and the rotator cuff, which is imperative to adequately address in injuries to this anatomical location.


Assuntos
Lesões do Manguito Rotador , Traumatismos dos Tendões , Artroscopia/efeitos adversos , Criança , Humanos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/cirurgia , Âncoras de Sutura , Técnicas de Sutura , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia
2.
Indian J Ophthalmol ; 69(7): 1945-1947, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34146063

RESUMO

In a developing country like India, both availability and affordability of medical care are obstacles, leading to delay in seeking timely treatment. To reduce the cost incurred to the patients for strabismus surgery, we used half of a 6-0 polyglactin suture for performing common muscle weakening and strengthening procedures: a fixed and hang back recessions with plication and resection. We cut the 45-cm-long double-armed 6-0 polyglactin sutures in two halves, and with a modified approach, used one-half in each of two patients planned for monocular two horizontal muscles surgeries: fixed recession-plication and hang back recession-resection. By devising an intuitive manner of threading a single armed 22.5 cm suture we successfully carried out horizontal extraocular muscle surgeries on each of two patients of exotropia. We believe in the long run, this will reduce the cost to individual patients and sponsoring groups, and suggest that strabismus surgeons consider adopting this option.


Assuntos
Músculos Oculomotores , Estrabismo , Humanos , Índia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia , Técnicas de Sutura , Suturas
3.
Ann Plast Surg ; 86(6S Suppl 5): S498-S502, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34100806

RESUMO

BACKGROUND: After many years of debate, underlay and sublay placement of mesh slowly emerged as the standard of care in abdominal wall reconstruction because of lower hernia recurrence rates. However, onlay has the advantages of being faster, less invasive, and technically easier compared with underlay and sublay. Therefore, if a similar recurrence could be achieved, then onlay should be a consideration. In this study, we present a new onlay method using multipoint progressive tension suture fixation. METHODS: This was a retrospective chart review of patients who underwent abdominal wall reconstruction from 2012 to 2019. Inclusion criteria included onlay mesh placement and at least 1 year of follow-up. The core principles of the surgical technique are establishing myofascial continuity by component separation and reinforcing the repair with onlay mesh that is fixated with multipoint progressive tension sutures. RESULTS: The number of patients after exclusions was 59, and the average body mass index was 32.52 ± 6.44 kg/m2. More than half (62.7%) of patients had a history of hypertension, 95% had at least 1 prior abdominal/pelvic surgery, and 61% had at least 1 prior hernia repair. Postoperative complications included 20.3% of patients requiring drainage of a fluid collection in the clinic setting, and 29.3% of patients requiring return to the operating room for any reason (including superficial wound debridement). The average defect size was 231.88 ± 195.86 cm2, the mean follow-up was 3.11 ± 1.83 years, and the recurrence rate was 5.1%. CONCLUSIONS: We report a hernia recurrence rate of 5.1% in a high-risk population with complex defects at a mean of 3.1 years of follow-up using onlay mesh fixated with multipoint progressive tension sutures. This recurrence rate is similar to that reported for both underlay and sublay techniques. However, the onlay approach is technically easier, faster, and less invasive compared with underlay and sublay techniques, which may translate into wider reproducibility, lower costs, and improved patient safety.


Assuntos
Parede Abdominal , Produtos Biológicos , Hérnia Ventral , Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia , Humanos , Recidiva , Reprodutibilidade dos Testes , Estudos Retrospectivos , Telas Cirúrgicas , Técnicas de Sutura , Suturas , Resultado do Tratamento
4.
Rev. cuba. cir ; 60(2): e1075, tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1280217

RESUMO

Introducción: La dehiscencia de la línea de sutura es una de las complicaciones más frecuentes en la cirugía intestinal. Objetivo: Diseñar una escala predictiva para estimar de forma individual la probabilidad de dehiscencia de la línea de sutura intestinal. Métodos: Se realizó un estudio, analítico, de cohorte con recogida retrospectiva de datos en el sexenio 2014-2019 en el hospital "Celia Sánchez Manduley". La muestra fue de 437 pacientes y se usó la variable dependiente: dehiscencia de la línea de sutura intestinal y variables independientes: edad, sexo, comorbilidad, hemoglobina, hipoalbuminemia, neoplasia de colon, riesgo anestésico, entre otras. Resultados: En el análisis multivariado se obtuvo un modelo ajustado con las variables: edad mayor de 70 años (p = 0,002), hipoalbuminemia (p = 0,014), anastomosis enterocólica (p = 0,018), cirugía urgente (p = 0,001) e íleo paralítico prolongado (p < 0,001). La escala predictiva fue derivada del modelo estadístico ajustado y clasificado en 3 grupos de riesgo la probabilidad de dehiscencia de la línea de sutura intestinal: bajo (menor de 2 puntos), moderado (entre 3 y 5 puntos) y elevado (mayor de 6 puntos). Presentó una sensibilidad de 89,6 por ciento, especificidad de 89,1 por ciento, porciento predictivo global de 89,2 por ciento, valor predictivo positivo de 66,1 por ciento y valor predictivo negativo de 97,2 por ciento. Tuvo una excelente calibración y un elevado poder discriminativo. Conclusión: Se obtuvo una escala predictiva para estimar de forma individual la probabilidad de dehiscencia de la línea de sutura intestinal(AU)


ABSTRACT Introduction: The suture line dehiscence is one of the most frequent complications in intestinal surgery. Objective: To design a predictive scale for estimating individual probability of suture line dehiscence. Methods: An analytical cohort study, which involved retrospective data collection, was carried out, in the six-year period of 2014-2019, at Celia Sánchez Manduley Hospital. The sample consisted of 437 patients. Dehiscence of the intestinal suture line was used as a dependent variable, while age, sex, comorbidity, hemoglobin, hypoalbuminemia, colon neoplasia, anesthetic risk, among others, were used as independent variables. Results: Through multivariate analysis, an adjusted model was obtained, with the following results for the variables: age over 70 years (P=0.002), hypoalbuminemia (P=0.014), enterocolic anastomosis (P=0.018), urgent surgery (P=0.001), and ileus prolonged paralytic (P < 0.001). The predictive scale was derived from the adjusted statistical model and, based on the probability of dehiscence of the intestinal suture line, classified into three risk groups: low (less than two points), moderate (between 3-5 points) and high (more than six points). It presented a sensitivity of 89.6 percent, a specificity of 89.1 percent, a global predictive percentage of 89.2 percent, a positive predictive value of 66.1 percent, and a negative predictive value of 97.2 percent. It had an excellent calibration and a high discriminative power. Conclusion: A predictive scale was obtained for estimating the individual probability of dehiscence of the intestinal suture line(AU)


Assuntos
Humanos , Deiscência da Ferida Operatória/complicações , Pseudo-Obstrução Intestinal/terapia , Valor Preditivo dos Testes , Técnicas de Sutura/efeitos adversos , Coleta de Dados , Estudos Retrospectivos , Estudos de Coortes
5.
J Cardiothorac Surg ; 16(1): 163, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099017

RESUMO

BACKGROUND: CORKNOT® facilitates a reduction in cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and operative time, but reported to be associated with other complications. We aim to quantify the incidence of valvular complications related to CORKNOT® and determine the feasibility of its use between different valvular surgeries. METHODS: Patients who underwent heart valve repair or replacement surgery via the use of automated titanium suture fasteners (CORKNOT®) in a tertiary care hospital were included in the study. This single-centre retrospective study was conducted on 132 patients between January 2016 and June 2018. RESULTS: In our study, the overall mean operative time was 320.0 ± 97.0 min, mean CPB time was 171.4 ± 76.0 min and the calculated mean ACC time was 105.9 ± 54.0 min. Fifty-eight patients (43.9%) underwent minimally invasive valve replacement or repair surgery and 66 patients (50.0%) underwent concomitant procedures. A total of 157 valves were operated on, with 112 (84.8%) single valve surgeries, 15 (11.4%) double valve surgeries and 5 (3.8%) triple valve surgeries. After reviewed by the cardiologist blinded towards the study, we report trivial and/or mild paravalvular leak (PVL) in immediate post-operative echocardiography was found in 1 (1.01%) patients. There were no reported cases of valvular thrombosis, leaflet perforation, device dislodgement or embolization, moderate and/or severe PVL during hospitalization and follow-up echocardiography within 1 year. Single mitral valve and aortic surgeries had comparable incidences of post surgical complications. CONCLUSION: We conclude the feasibility of CORKNOT® utilisation in mitral and aortic valve surgeries. Additionally, incidence of CORKNOT® related complications in heart valve repair or replacement surgery is less usual in our setting than previously reported. These results motivate the use of CORKNOT® as a valid alternative with complete commitment.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Valvas Cardíacas/lesões , Complicações Intraoperatórias/etiologia , Complicações Pós-Operatórias/etiologia , Ruptura/etiologia , Técnicas de Sutura/efeitos adversos , Adulto , Idoso , Estudos de Viabilidade , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Valvas Cardíacas/cirurgia , Humanos , Incidência , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Ruptura/diagnóstico , Ruptura/epidemiologia , Técnicas de Sutura/instrumentação , Titânio , Resultado do Tratamento
6.
Ann Plast Surg ; 87(1): 12-15, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34133363

RESUMO

OBJECTIVE: A majority of patients with senile entropion have a lower eyelid pouch. This study aimed to explore a modified method to correct the entropion and enhance ophthalmic cosmetology. PATIENTS AND METHODS: Patients with senile entropion and lower eyelid pouches, who underwent anterior fascia of tarsus tightening combined with lower eyelid pouch plastic surgery from 2018 to 2019, were enrolled in the study. The data on operation time, postoperative effect, degree of eyelid swelling after surgery, patient satisfaction, and recurrence rate were recorded. RESULTS: The lower eyelid entropion was well corrected in all of the 46 patients after the surgery, and the lower eyelid pouch and saggy skin were satisfactorily repaired. After 1-year follow-up, no recurrence of lower eyelid eversion and ectropion was observed. The shape of the orbital areas was natural in all the patients, the incision scar was hidden, and the patient achieved a high degree of satisfaction. CONCLUSIONS: In patients with senile entropion and lower eyelid pouch, anterior tarsal fascia tightening combined with lower eyelid blepharoplasty could not only increase the cure rate and reduce the recurrence rate but also achieve good appearance and improve patient satisfaction.


Assuntos
Blefaroplastia , Entrópio , Tornozelo , Entrópio/cirurgia , Pálpebras/cirurgia , Fáscia , Seguimentos , Humanos , Técnicas de Sutura
7.
Zhongguo Gu Shang ; 34(6): 504-7, 2021 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-34180166

RESUMO

OBJECTIVE: To observe and compare the clinical outcomes between arthroscopic modified Mason-Allen repair and suture-bridge repair for medium-size rotator cuff tears. METHODS: From January 2017 to January 2018, 22 patients with medium-size rotator cuff tears underwent arthroscopic modified Mason-Allen repair. There were 9 males and 13 females with an average age of (57.14±10.26) years. From February 2018 to January 2019, 20 patients with medium-size rotator cuff tears underwent arthroscopic suture-bridge repair. There were 6 males and 14 females with an average age of (57.75±7.57) years. The preoperative and postoperative clinical function was assessed by American Shoulder and Elbow Surgeons (ASES) and Constant score system. The healing status of repaired rotator cuff was assessed using MRI. RESULTS: All patients were followed up, and the duration ranged from 24 to 33 months, with a mean of (26.38±2.29) months. In modified Mason-Allen group, AS###ES score and Constant score increased from (45.22±7.58) and (58.72±9.26) preoperatively to (96.89±3.49) and (93.18± 3.20) postoperatively. In suture-bridge group, ASES score and Constant score increased from(47.33±7.50) and (60.05±11.76) scores to (97.58±3.43) and (93.85±3.15). There were no significant differences in ASES score and Constant score between the two groups before and after operation. There were no significant differences in rotator cuff healing between the two groups. CONCLUSION: Both arthroscopic modified Mason-Allen and suture-bridge repair for treatment of medium-size rotator cuff tears could obtain good clinical outcomes, and there were no significant differences in clinical outcomes between the two techniques.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Idoso , Artroscopia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Técnicas de Sutura , Suturas , Resultado do Tratamento
8.
Zhongguo Gu Shang ; 34(6): 544-9, 2021 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-34180175

RESUMO

OBJECTIVE: To compare and analyze the mechanical differences between single-row suture anchor fixation for repairing rotator cuff injuries and double-row suture bridges for repairing rotator cuff injuries from a biomechanical perspective. METHODS: The CT scan data of healthy adult shoulder joint were imported into Mimics, Geomagics and Hypermesh to carry out reverse reconstruction of two repair models, material assignment and mesh division, and the tearing of supraspinatus muscle was designed. After treatments, the load and boundary conditions were applied to the shoulder joint in ABAQUS software. The shoulder joint was fixed with four working conditions including flexion 15 °, flexion 30 °, internal rotation 15 ° and internal rotation 30 ° after anchor fixationand repair. The stress changes of the upper rotator cuff muscle and the anchor with thread were compared under these four conditions. RESULTS: Under the two flexion conditions, the stress of the supraspinatus in the double row suture bridge fixation model was 8.3% and 12% less than that in the single-row suture anchor fixation, respectively. Under the two internal rotation conditions, the stress of supraspinatus in the double row suture bridge fixation model was 47% and 48% less than that in the single row fixation repair model, respectively. CONCLUSION: The "load sharing" effect between the two rows of four anchors makes the stress distribution more dispersed, increases the contact area between the supraspinatus muscle and the humerus, reduces the stress of the anchor, avoids the serious stress concentration phenomenon, and explains the advantages of the fixation method of the double row suture bridge from the biomechanical angle.


Assuntos
Lesões do Manguito Rotador , Adulto , Fenômenos Biomecânicos , Cadáver , Humanos , Lesões do Manguito Rotador/cirurgia , Âncoras de Sutura , Técnicas de Sutura , Suturas
9.
Medicine (Baltimore) ; 100(23): e26282, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115029

RESUMO

ABSTRACT: Open reduction and pre-contoured locking plate fixation is a popular treatment option for displaced midshaft clavicle fracture. Lag screw and cerclage are 2 main intraoperative techniques to reduce and fix fragments. However, both lag screw and metallic cerclage have disadvantages. The doubled-suture Nice knot has been reported in many areas of orthopedic surgery for its effectiveness. This study aims to compare the outcomes of comminuted mid-shaft clavicle fractures reduced by Nice knots vs traditional techniques (lag screw or/and metallic cerclage) when bridged with pre-contoured locking plates.We retrospectively reviewed 101 patients (65 females and 36 males) diagnosed with midshaft clavicle fractures with at least one wedge fragment reduced by either Nice knots or traditional methods and bridged with pre-contoured locking plates between December 2016 and April 2019. Operation time, functional outcomes, pain, patient satisfaction, fracture healing, and complications were assessed at a follow-up of 12 to 40 months.The mean age of all the patients was 50.8 years. There were 52 and 49 patients in the Nice knot group and traditional group respectively, and no differences between 2 groups were found in general patient characteristics, fracture type, follow up and injury-to-surgery duration. The Nice knot group had significant less operation time (P < .01) than the traditional group (mean and standard deviation [SD], 78.6 ±â€Š19.0 compared with 94.4 ±â€Š29.9 minutes, respectively). For healing time, functional score, pain, satisfaction and complications, there were no significant differences between groups, despite the Nice knot group had slightly better results.Both Nice knots and traditional methods treated for comminuted Robinson type 2B clavicle fractures were effective and safe. And the Nice knots seemed to be superior with significant less operation time.


Assuntos
Clavícula , Fixação Interna de Fraturas , Fraturas Ósseas , Redução Aberta , Técnicas de Sutura , Suturas , Placas Ósseas , Parafusos Ósseos , Clavícula/diagnóstico por imagem , Clavícula/lesões , Clavícula/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Fraturas Cominutivas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Redução Aberta/efeitos adversos , Redução Aberta/instrumentação , Redução Aberta/métodos , Duração da Cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Recuperação de Função Fisiológica
10.
Acta Cir Bras ; 36(5): e360502, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34133504

RESUMO

PURPOSE: To evaluate the use of barbed sutures over the surgical time, the leukogram, the tissue thickness in which the sutures were employed (ultrasonography), the costs, and the possible complications in bitches with pyometra submitted to ovariohysterectomy (OH). METHODS: Convectional 2.0 polyglyconate suture was used in the control group (CG n = 10) and 2.0 barbed polyglyconate suture in the barbed group (BG n = 10) to perform celiorrhaphy (simple continuous pattern) and subcutaneous closure (continuous intradermal pattern). Data were assessed using paired (leukogram between 24 and 48 h within the same group) and unpaired (leukogram, surgical time, tissue thickness, and costs) Student's t-test. The Fisher exact test was used to assess the occurrence of seroma between groups (p < 0.05). Results are shown as mean ± standard error of mean. RESULTS: The time spent to perform the celiorrhaphy (195.30 ± 17.37 s vs. 204 ± 16.00 s), subcutaneous closure (174.0 ± 15.86 s vs. 198.0 ± 15.62 s), and the total surgical time (24.30 ± 1.44 min vs. 23.00 ± 1.30 min) did not differ between BG and CG, respectively (p > 0.05). Leukogram at 48 h post-surgery did not differ between groups (p = 0.20). No differences were observed in the subcutaneous and the abdominal wall thickness (cm) assessed by ultrasonography at 48 h in BG (0.31 ± 0.04, 0.80 ± 0.05) and CG (0.34 ± 0.03, 0.72 ± 0.06), respectively. Similarly, 15 days post-surgery the same structures did not differ between BG (0.26 ± 0.02, 0.74 ± 0.08) and CG (0.26 ± 0.03, 0.64 ± 0.05) (p > 0.05). In one bitch from each group, a mild seroma was observed on one side of the surgical wound 48 h after surgery (p = 1.00). The procedures in which barbed sutures were used had an average additional cost of R$ 200.00 ± 11.66 (p < 0.0001). CONCLUSIONS: Barbed suture has proven to be efficient and safe for abdominal and subcutaneous closure. However, considering its current high cost in addition thatthe surgical time of bitches with pyometra undergone OH was not reduced, no advantages were observed with theuse of barbed sutures for this type of surgery.


Assuntos
Parede Abdominal , Piometra , Parede Abdominal/cirurgia , Feminino , Humanos , Duração da Cirurgia , Técnicas de Sutura , Suturas
11.
Cesk Slov Oftalmol ; 77(2): 73-78, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33985336

RESUMO

BACKGROUND: Ectropion and entropion are eyelid malpositions associated with a number of unpleasant symptoms. One of several surgical methods that can correct these problems is referred to as the lateral tarsal strip technique. In this paper, we evaluate the postoperative results and quality of this technique. We also examine the complications associated with this surgical method. METHODS: The study took place from April 2018 to April 2020 at the Military University Hospital in Prague. The operation was performed by two surgeons. The study included 43 eyes of 33 patients (17 women and 16 men), average age was 79 years. Before the operation, 23 eyes were affected by ectropion and 20 eyes affected by entropion, 35 of the 43 were cases of involutional origin. The study does not include patients who underwent other surgical techniques. RESULTS: There were no perioperative or postoperative complications in the entropion surgery group. Successful correction was achieved, and adverse symptoms disappeared in 91.3% of cases. Correct position of the eyelid was not achieved in two cases. For patients with ectropion, surgical correction was successful in 95% of cases. Ectropion persisted after surgery only in one patient. CONCLUSION:   The lateral tarsal strip technique is a safe, reliable and highly effective surgical technique. Correction of eyelid malposition was achieved in more than 90% of cases. The vast majority of patients were satisfied and reported relief from preoperative symptoms.


Assuntos
Ectrópio , Entrópio , Idoso , Ectrópio/cirurgia , Entrópio/cirurgia , Pálpebras/cirurgia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Técnicas de Sutura
12.
BMC Med Educ ; 21(1): 250, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933058

RESUMO

BACKGROUND: Acquisition of Basic Surgical Skills (BSS) are essential for medical students. The objective was to determine it's fidelity impact. METHODS: Using four suturing models (SM) (pigskin, sponge, commercial pad, and orange), SM-quality and student-SM interaction were evaluated. After a 1-h class, participants were divided into groups and randomly assigned exercises in SM in 15-min intervals. The experiment included completing three individual simple stitches and a 3-stitch continuous suture in each SM. RESULTS: Eighty-two medical students participated. Suturing quality was better in pigskin and sponge, which were also the preferred models (p < 0.001). Significant differences in quality between the insertion and exit point, and firmness of knots (p < 0.05) in both simple and continuous sutures, as well as between length and distance in continuous ones (p < 0.001) were identified. CONCLUSIONS: Acquisition and quality of BSS are influenced by the intrinsic characteristics of SM. An adequate degree of resistance, consistency, and elasticity are necessary.


Assuntos
Estudantes de Medicina , Técnicas de Sutura , Competência Clínica , Humanos , Percepção , Suturas
13.
Vet Surg ; 50(5): 1147-1156, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33942332

RESUMO

OBJECTIVE: To evaluate the effect of accessory tendon graft (ATG) augmentation as an adjunct to a core locking-loop (LL) and epitendinous suture (ES) repair in a gastrocnemius tendon (GT) model. STUDY DESIGN: Randomized, ex vivo, biomechanical. POPULATION: Twenty-two canine GT musculotendinous constructs. METHODS: GT repair constructs were randomly divided into two groups (n = 10/group). After transection, paired GT were repaired with LL + ES alone or with concurrent ATG augmentation. Yield, peak and failure loads, tensile loads required to create 1 and 3 mm gapping, and failure modes were evaluated. Four GT were used as intact controls for validation of testing methodology. ATG constructs were compared to LL + ES and control specimens. RESULTS: Yield (p < .0001), peak (p = .0001) and failure loads (p = .0003) were greater when ATG was used for repair. Greater force was required to cause 1 mm (p = .0001) and 3 mm (p = .0002) gap formation in the ATG group, however, the frequency of gap formation did not differ between groups. All repaired constructs failed exclusively by suture pull-through. CONCLUSION: Autologous ATG augmentation as an adjunct to primary GT repair increased yield, peak and failure forces by approximately 1.6×, 1.9×, 1.8× respectively and required 2.1× greater force to cause 1 and 3 mm formation respectively compared to LL + ES repairs alone. CLINICAL SIGNIFICANCE: ATG augmentation should be considered as an autologous method to support and strengthen the primary GT repair. These results justify studies to determine the effect of ATG on clinical function following graft harvest in dogs.


Assuntos
Doenças do Cão/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/veterinária , Traumatismos dos Tendões/veterinária , Animais , Fenômenos Biomecânicos , Cadáver , Cães , Membro Posterior , Músculo Esquelético/cirurgia , Procedimentos Ortopédicos/veterinária , Técnicas de Sutura/veterinária , Suturas/veterinária , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia , Resistência à Tração , Transplante Autólogo/veterinária
14.
Vet Surg ; 50(5): 1128-1136, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33959989

RESUMO

OBJECTIVE: To determine the effect of a novel barbed suture pattern (NBSP) compared to a three-loop-pulley (3LP) with and without epitendinous suture (ES) augmentation on the biomechanical strength and gap formation of repaired canine tendons. STUDY DESIGN: Ex vivo, cadaveric, randomized, experimental study. SAMPLE POPULATION: Forty, adult superficial digital flexor tendons (SDFT). METHODS: SDFT were randomly assigned to one of four groups (n = 10/group). Sharp tenotomy was performed and repaired with 3LP, NBSP, 3LP + ES, and NBSP + ES. Constructs were tested to failure while evaluating yield, peak, and failure loads, loads at 1 and 3 mm gap formation, and failure mode. RESULTS: Constructs augmented with ES sustained 80% greater yield (p < .001), peak (p < .001), and failure (p < .001) loads, with no difference between 3LP + ES and NBSP + ES constructs regarding peak (p = .614), and failure forces (p = .865). Loads resulting in 1 and 3 mm gap formation were greater when constructs were augmented with an ES (p ≤ .003). Failure mode differed between groups (p < .001), occurring predominantly due to suture pull-through in 3LP and NBSP groups compared to tissue failure distant to the repair site in ES augmented constructs. CONCLUSION: Tendons repaired with the NBSP used in this study resisted similar forces as those repaired with 3LP. Augmentation with an ES improved the biomechanical properties of repaired constructs, including resistance to gap formation. CLINICAL RELEVANCE: The NBSP repair tested here may be advantageous over monofilament suture repair as it uses a similar-sized barbed core suture but eliminates the requirement for knot tying.


Assuntos
Doenças do Cão/cirurgia , Técnicas de Sutura/veterinária , Traumatismos dos Tendões/veterinária , Tendões/cirurgia , Animais , Fenômenos Biomecânicos , Cadáver , Cães , Membro Anterior , Procedimentos Cirúrgicos Reconstrutivos/veterinária , Suturas , Traumatismos dos Tendões/cirurgia , Tenotomia/veterinária , Resistência à Tração
15.
Vet Surg ; 50(5): 1137-1146, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33982804

RESUMO

OBJECTIVE: To compare biomechanical characteristics of three-loop pulley (3LP) pattern versus Bunnell technique (BT) using polydioxanone (PDS) suture; to determine the influence of polyester tape (PT) versus PDS on the BT for equine superficial digital flexor tendon (SDFT) tenorrhaphy; to compare BT with PT versus 3LP with PDS. STUDY DESIGN: Ex vivo biomechanical study. SAMPLE POPULATION: Forty equine forelimb SDFT. METHODS: Two experiments were performed: (1) 10 SDFT pairs were repaired with 3LP or BT using PDS; (2) 10 SDFT pairs were repaired with PDS or PT using BT. Load at failure, mode of failure, load at 2 mm gap, and gap at failure were obtained using a material testing machine. RESULTS: In experiment 1, 3LP + PDS1 had higher loads at failure (p < .001) and at 2 mm gap (p < .001), and smaller gap at failure than BT + PDS1 (p = .024). In experiment 2, BT + PT2 had higher loads at failure (p < .001) and at 2 mm gap (p = .001), and larger gap at failure (p = .004) than the BT + PDS2 . 3LP + PDS1 and BT + PT2 mostly failed by suture/implant pull-through while BT + PDS failed by suture breakage. BT + PT2 had greater load (p = .035) and gap at failure (p < .001) than 3LP + PDS1, with no difference in load at 2 mm gap (p = .14). CONCLUSION: The use of BT may be justified over 3LP if combined with PT. However, the larger size of the PT required stab incisions in the tendon for placement and was subjectively more difficult to place than PDS. CLINICAL SIGNIFICANCE: The BT + PT, although the strongest among the tested repairs, would only be able to withstand 12%-24% of the load encountered by the SDFT at walk.


Assuntos
Doenças dos Cavalos/cirurgia , Técnicas de Sutura/veterinária , Suturas/veterinária , Traumatismos dos Tendões/veterinária , Tendões/cirurgia , Animais , Fenômenos Biomecânicos , Cadáver , Feminino , Membro Anterior , Cavalos , Masculino , Teste de Materiais/veterinária , Procedimentos Ortopédicos/veterinária , Polidioxanona , Poliésteres , Traumatismos dos Tendões/cirurgia , Resistência à Tração
16.
Vet Surg ; 50(5): 1157-1163, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34028059

RESUMO

OBJECTIVE: To describe the treatment of persistent right aortic arch (PRAA) in dogs with combined ligamentum arteriosum (LA) transection and esophageal diverticulum resection. ANIMALS: Three client owned dogs. STUDY DESIGN: Short case series. METHODS: Medical records were reviewed for clinical signs, diagnostic procedures, surgical treatment, post-operative therapies including medications and feeding regime, outcomes, and follow-up imaging. RESULTS: Esophageal resection was performed using a thoracoabdominal (TA) stapler with suture overlay. All dogs recovered well from surgery and did not experience any peri- or post-operative complications. The last follow-up was performed between 64 and 1004 days post-operatively. In all cases, regurgitation resolved and did not recur in any dogs. No dogs required medical therapy or dietary modifications. In two cases, follow-up imaging was performed that revealed marked improvement of esophageal dilation. CONCLUSION: Resection of esophageal diverticulum secondary to PRAA utilizing a TA stapler with suture overlay was technically feasible and did not seem associated with early or late complications.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/veterinária , Divertículo Esofágico/veterinária , Doenças do Cão/cirurgia , Anel Vascular/veterinária , Animais , Doenças da Aorta/complicações , Doenças da Aorta/cirurgia , Divertículo Esofágico/etiologia , Divertículo Esofágico/cirurgia , Cães , Feminino , Ligadura/métodos , Ligadura/veterinária , Masculino , Técnicas de Sutura/veterinária , Anel Vascular/complicações , Anel Vascular/cirurgia
17.
Cardiovasc Intervent Radiol ; 44(8): 1273-1278, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33948699

RESUMO

PURPOSE: To describe and study the utility of vascular suture-mediated closure systems for large bore arterial access during challenging implantation of liver intra-arterial catheters taking as a reference the conventional procedure involving patients without challenging anatomy. MATERIALS AND METHODS: Between January 2017 and January 2019, 61 consecutive patients underwent 65 intra-arterial catheter IAC implantations for colorectal cancer. Twenty-three procedures (35%) considered by the operators with challenging coeliac trunk angulations were treated using a vascular suture technique where a 6-F introducer was used, the other patients were treated with a conventional 4F access technique. Clinical and radiological characteristics of patients, technical success (implantation of catheters allowing safe infusion of chemotherapy) and complications (Common Terminology Criteria for Adverse Events, CTCAE 5.0) were recorded. RESULTS: Mean coeliac trunk angulations were 36.3° (± 14.3) for the vascular closure group and 49.6° (± 17.1) for the conventional group. Technical success of the procedures was 100% for the vascular closure group and 80% in the conventional group (p < .05). Four patients with technical failure in the conventional group had a successful IAC implantation on the second attempt using the vascular closure technique. The use of a suture-mediated closure system for large bore arterial access allowed more frequent positioning of the distal tip into the gastro duodenal artery (GDA) (p = .01). No major complication occurred. CONCLUSION: The use of a large bore arterial access combined with a suture-mediated closure system may be useful for challenging IAC implantation without major complications.


Assuntos
Cateterismo Periférico/métodos , Cateteres de Demora , Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Técnicas de Sutura/instrumentação , Feminino , Humanos , Fígado/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
BMC Surg ; 21(1): 227, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933041

RESUMO

BACKGROUND: Preperitoneal herniation is a rare complication after transabdominal preperitoneal patch plasty (TAPP) and may be caused by inadequate peritoneal closure. We herein report two cases of postoperative small bowel obstruction due to preperitoneal herniation through a disrupted peritoneum. CASE PRESENTATION: Two men in their 70s were admitted to our center because of small bowel obstruction after TAPP. After examinations and unsuccessful conservative treatment, emergency laparoscopic exploration was performed. Preperitoneal herniation through the disrupted peritoneum was found. The herniated small bowel was reduced and the peritoneum was properly reclosed. The patients recovered and were discharged with normal bowel function. CONCLUSIONS: Inadequate peritoneal closure may cause preperitoneal herniation and lead to postoperative small bowel obstruction and even death. Hernia surgeons can avoid this complication by improving their suture technique and paying attention to the procedure details.


Assuntos
Hérnia Inguinal , Obstrução Intestinal , Laparoscopia , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Masculino , Peritônio/cirurgia , Telas Cirúrgicas , Técnicas de Sutura
19.
World J Surg Oncol ; 19(1): 148, 2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980267

RESUMO

BACKGROUND: The aim of this study was to compare conventional suture with prolonged timing of drainage with quilting suture on the formation of seroma at pectoral area after mastectomy (ME) with sentinel lymph node biopsy (SLN) or axillary lymph node dissection (ALND) for breast cancer. METHODS: Three hundred and eighty-eight consecutive breast cancer patients were retrospectively analyzed and categorized into three groups. Patients in group 1 were with quilting suture, group 2 with conventional suture and 13-15 days drainage in situ, and group 3 with conventional suture and 20-22 days drainage. The primary outcome was the incidence of grades 2 and 3 seroma at anterior pectoral area within 1 month postoperatively. Cox regression was used for analysis. RESULTS: The incidence of grades 2 and 3 seroma was comparable among groups (9.5% vs. 7.9% vs. 5.3%, p = 0.437), as well as late grades 2 and 3 seroma among groups (4.3% vs. 2.9% vs. 1.5%, p = 0.412). Old age, high body mass index, and hypertension were independent risk factors for grades 2 and 3 seroma. CONCLUSIONS: Prolonged timing of drainage to 13-15 days in conventional suture was long enough to decrease the incidence of grades 2 and 3 seroma as lower as that in quilting suture group at pectoral area within 1 month after mastectomy.


Assuntos
Neoplasias da Mama , Seroma , Neoplasias da Mama/cirurgia , Drenagem , Humanos , Excisão de Linfonodo/efeitos adversos , Mastectomia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Estudos Retrospectivos , Seroma/etiologia , Seroma/prevenção & controle , Retalhos Cirúrgicos , Técnicas de Sutura , Suturas
20.
Surg Clin North Am ; 101(3): 511-524, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34048770

RESUMO

This article discusses and illustrates a variety of accepted techniques of esophagogastric anastomosis during an esophagectomy. The performance of an anastomotic technique can be surgeon specific, although it is of great benefit for the esophageal surgeon to be facile and adept in multiple techniques, as occasionally the clinical situation may be better suited for a particular technique. Regardless of the method of creating the esophagogastric anastomosis, the goal is to create a viable, tension-free and nonobstructive anastomosis with adequate margins.


Assuntos
Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Esôfago/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estômago/cirurgia , Anastomose Cirúrgica , Humanos , Técnicas de Sutura
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