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1.
J Surg Res ; 282: 101-108, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36265429

RESUMO

INTRODUCTION: Most microsurgical procedures require the surgeon to use tools to grasp and hold fragile objects in the surgical site. Prior research on grasping in surgery has mostly either been in other surgical techniques or used grasping as an auxiliary metric. We focus on microsurgery and investigate what grasping can tell about microsurgical skill and suturing performance. This study lays groundwork for using automatic detection of grasps to evaluate surgical skill. METHODS: Five expert surgeons and six novices completed sutures on a microsurgical training board. Video recordings of the performance were annotated for the number of grasps, while an eye tracker recorded the participants' pupil dilations for cognitive workload assessment. Performance was measured with suturing duration and the University of Western Ontario Microsurgical Skills Assessment instrument (UWOMSA). Differences in skill, suturing performance and cognitive workload were compared with grasping behavior. RESULTS: Novices needed significantly more grasps to complete sutures and failed to grasp more often than the experts. The number of grasps affected the suturing duration more in novices. Decreasing suturing efficiency as measured by UWOMSA instrument was associated with increase in grasps, even when we controlled for overall skill differences. Novices displayed larger pupil dilations when averaged over a sufficiently large sample, and the difference increased after the grasp. CONCLUSIONS: Grasping action during microsurgical procedures can be used as a conceptually simple yet objective proxy in microsurgical performance assessment. If the grasps could be detected automatically, they could be used to aid in computational evaluation of surgical trainees' performance.


Assuntos
Competência Clínica , Cirurgiões , Humanos , Suturas , Microcirurgia , Força da Mão
2.
J Surg Res ; 281: 228-237, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36208563

RESUMO

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


Assuntos
Competência Clínica , Estudantes de Medicina , Humanos , Suturas , Autoavaliação (Psicologia) , Técnicas de Sutura/educação
3.
Ann R Coll Surg Engl ; 104(4): 288-294, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34931536

RESUMO

INTRODUCTION: Motor imagery and mental practice are important for the acquisition and mastery of surgical skills. The success of this technique relies on the use of a well-developed mental script. In this study, we shared how we developed a mental script for basic micro suturing training by using a low-fidelity rubber glove model. METHODS: This study applied the design and development research framework. Five expert surgeons developed a mental script by performing a cognitive walkthrough to repair a vertical opening in a rubber glove model, followed by hierarchical task analysis. A draft script was created, and its face and content validity assessed with a checking-back process. Twenty-eight surgeons used the Mental Imagery Questionnaire (MIQ) to assess the validity of the final script. RESULTS: The process of developing the mental script is detailed. The assessment by the expert panel showed the mental script had good face and content validity. The mean overall MIQ score was 5.2±1.1 (standard deviation), demonstrating the validity of generating mental imagery from the mental script developed in this study for micro suturing in the rubber glove model. CONCLUSION: The methodological approach described in this study is based on a design and development research framework to teach surgical skills. This model is inexpensive and easily accessible, addressing the challenges of reduced opportunities to practise surgical skills. However, although motor skills are important, the surgeon's other non-technical expertise is not addressed with this model. Thus, this model should act as one surgical training approach, but not replace it.


Assuntos
Competência Clínica , Cirurgiões , Humanos , Destreza Motora , Inquéritos e Questionários , Suturas
4.
CRSLS ; 9(4)2022.
Artigo em Inglês | MEDLINE | ID: mdl-36452882

RESUMO

Introduction: A case report of small bowel obstruction related to barbed suture in a postoperative patient of laparoscopic sacrocolpopexy. Case Description: A 61 -year-old female with a body mass index of 27 with vault prolapse underwent laparoscopic sacrocolpopexy. The patient was discharged on postoperative day two. She presented again in the emergency department on the fifth postoperative day with complaints of frequent vomiting episodes with intermittent and colicky pain in the abdomen. Her imaging (computed tomography abdomen/pelvis with oral contrast) suggested distal small bowel mechanical obstruction at midileum with significant free fluid in the peritoneum. Emergency laparoscopic exploration was done. Peroperative V-LocTM 180 suture tail end barbs were found anchored to the mesentery of midileum causing a loop that led to compression and occlusion of distal bowel. The barbed suture tail end was detached from the mesentery and thus relieving the compression. No additional procedure was required for the bowel wall. The excess barbed suture tail end outside the peritoneum was trimmed. The postoperative course was uneventful. Conclusion: Bowel complication is an uncommon but serious issue following the use of barbed sutures. It should be used with utmost caution as none of the preventive measures are completely safe. Further studies need to be done for preventive measures.


Assuntos
Obstrução Intestinal , Laparoscopia , Humanos , Feminino , Pessoa de Meia-Idade , Obstrução Intestinal/diagnóstico por imagem , Suturas/efeitos adversos , Procedimentos Neurocirúrgicos , Mesentério , Doença Aguda , Laparoscopia/efeitos adversos
5.
Hinyokika Kiyo ; 68(11): 355-358, 2022 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-36458399

RESUMO

A 63-year-old woman underwent laparoscopic sacrocolpopexy for pelvic organ prolapse. Four days postoperatively, she underwent an abdominal computed tomography scan because she developed a stomachache, and a strangulated bowel obstruction was suspected. The patient then underwent an emergency laparotomy which revealed strangulation of the small intestine caused by a band formed between the stump of a barbed suture and the mesentery. The strangulation was released by resecting the stump, and intestinal resection was not necessary. Nine days following the re-intervention, the patient was discharged from our hospital. As of four months after the surgery, she has not experienced any recurrence of pelvic organ prolapse or other postoperative complications. We need some ingenuity when using barbed suture in situations where the thread and the intestine come into contact.


Assuntos
Laparoscopia , Prolapso de Órgão Pélvico , Feminino , Humanos , Pessoa de Meia-Idade , Suturas/efeitos adversos , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/etiologia , Hospitais , Laparoscopia/efeitos adversos
6.
BMC Musculoskelet Disord ; 23(1): 1037, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36451236

RESUMO

BACKGROUND: Wire cerclages play a fundamental role in fracture fixation. With an increasing variety of designs being commercially available the question arises which cerclage should be used. This study investigates the biomechanical properties of metallic and non-metallic cerclages and their different application-types. Furthermore, potential influence of muscular interposition between bone and cerclage constructs was tested. METHODS: Samples of the following four different cerclage types were tested on 3D printed models of human humeri as well as on human cadaveric humeri with and without muscular interposition: Titanium Cable Cerclage (CC), Steel Wire Cerclage (SWC), Suture Tape (ST), Suture Tape Cerclage (STC) with both single- (sSTC) and double-loop application (dSTC). A preinstalled self-locking mechanism secured by the provided tensioner in the STCs being the main difference to the STs. Cyclic loading was performed to 1 kN and then linearly to a maximum load of 3 kN. Statistical analysis was performed using either one-way ANOVA and post-hoc Tukey or Kruskal-Wallis and post-hoc Dunn test depending on normalization of data (p < 0.05). RESULTS: Whilst all cerclage options could withstand high loads during failure testing, only within the CC and dSTC group, all samples reached the maximal testing load of 3000 N without any failure. The SWC reached 2977.5 ± 63.6 N, the ST 1970.8 ± 145.9 N, and the sSTC 1617.0 ± 341.6 N on average. Neither muscular interposition nor bone quality showed to have a negative influence on the biomechanical properties of the cerclage constructs, presenting no significant differences. CONCLUSION: All tested cerclage constructs produce reliable stability but differ in their resulting compression forces, in a simplified fracture model. Therefore, non-metallic cerclage alternatives can provide similar stability with less compression and stiffness to metallic cable constructs, but they may offer several advantages and could possibly provide future benefits. Especially, by offering more elasticity without losing overall stability, may offer a biologic benefit. Installing any cerclage constructs should be performed carefully, especially if poor bone quality is present, as the tightening process leads to high forces on the construct.


Assuntos
Fraturas Ósseas , Procedimentos Neurocirúrgicos , Humanos , Suturas , Análise de Variância , Elasticidade , Fraturas Ósseas/cirurgia
7.
Arthroscopy ; 38(12): 3149-3151, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36462780

RESUMO

The debate regarding optimal capsular management during hip arthroscopy has been evolving for over 20 years. Femoroacetabular impingement emerged in the arthroscopic world in the early 2000s. However, the ability to address osseous deformities and decompress and/or reshape them was limited by the hip capsular structures and small capsulotomies. Some surgeons attempted to arthroscopically manage these deformities with limited capsulotomies, with not surprisingly limited success. Others made larger capsular windows (capsulectomies) to more accurately manage these deformities but potentially left some patients with varying degrees of iatrogenic microinstability or macroinstability. Over time, an increasing awareness of post-arthroscopy instability in the form of case reports, case series, and backroom chatter among the hip arthroscopy thought leaders brought the idea of routine capsular closure to the forefront. Biomechanical studies defined the role of the hip capsular ligaments, the deficits created with various capsulotomies during surgery, and the ability to restore stability after capsular repair. Clinical studies revealed better outcomes and lower revision rates after capsular repair for subtle osseous and soft-tissue instability, revision cases, and athletes compared with unrepaired capsulotomies. Various capsular repair constructs (side-to-side repairs, capsular shifts, and various suture configurations and suture materials) have been proposed, without evidence to support a superior technique or suture material. In the end, capsular management is an evolving art that takes into account various patient-specific factors (i.e., individual activity requirements, soft-tissue and osseous parameters, and intraoperative impressions) with the end goal of achieving a stable, impingement-free joint. There might be various capsular management roads to travel, but the destination remains the same.


Assuntos
Impacto Femoroacetabular , Humanos , Impacto Femoroacetabular/cirurgia , Artroscopia , Osso e Ossos , Ligamentos Articulares , Suturas
8.
Eur J Med Res ; 27(1): 270, 2022 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-36463220

RESUMO

BACKGROUND: The surgical treatment of inferior patellar pole fractures can be a challenge, especially in geriatric patients, who are particularly frequently affected by osteoporosis. The objective of this biomechanical study was to compare the performance of suture anchor and transosseous suture fixation in fractures of the inferior patellar pole in context of bone mineral density. METHODS: Twelve fresh-frozen human cadaveric knees received a transverse osteotomy, simulating an AO/OTA 34C1.3 inferior pole fracture of the patella. These fractures were fixated with either suture anchors (SA; Corkscrew® FT 4.5 mm) or transosseous suture (TS; #2 FiberWire®). Cyclic loading tests were performed by pulling the quadriceps tendon against gravity from 90° flexion to almost full extension (5°) for 1000 cycles. Motion and fracture gap displacement were tracked until failure occurred. Subsequently, loading to failure tests followed. Differences between groups were compared using unpaired t-tests, and correlations were calculated with Pearson's correlation coefficient. RESULTS: The suture anchor group showed significantly fewer cycles to failure than the transosseous suture group (SA: 539.0 ± 465.6 cycles, TS: 1000 ± 0 cycles, P = 0.04). Bone mineral density correlated positively with cycles to failure in the suture anchor group (Pearson's r = 0.60, P = 0.02). No differences in fracture gap displacement could be proven after 100 cycles (SA: 4.1 ± 2.6 mm, TS: 6.5 ± 2.6 mm, P = 0.19); 500 cycles (SA: 6.4 ± 6.1 mm, TS: 9.6 ± 3.8 mm, P = 0.39); and 1000 cycles (SA: 4.0 ± 0.4 mm, TS: 11.0 ± 4.5 mm, P = 0.08). Furthermore, the mean destructive load to failure in the suture anchor group was also significantly lower than in the transosseous suture group (SA: 422.4 ± 212.2 N, TS: 825.7 ± 189.3 N, P = 0.04). CONCLUSIONS: Suture anchors may be a viable alternative to transosseous suture in younger patients for clinical advantages, but in osteoporotic bone, the more stable osteosynthesis with transosseous suture continues to prove superior. Therefore, trauma surgeons might consider the use of transosseous suture in elderly patients, especially in those presenting with low bone mineral density values.


Assuntos
Fraturas Ósseas , Osteoporose , Idoso , Humanos , Patela/cirurgia , Âncoras de Sutura , Fraturas Ósseas/cirurgia , Suturas , Osteoporose/cirurgia
9.
BMJ Case Rep ; 15(11)2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36319041

RESUMO

Uterine necrosis is an infrequent event and is most commonly reported as a complication of interventions for postpartum haemorrhage management. Cases of uterine necrosis in pregnancy are rare. The mainstay of treatment for uterine necrosis is hysterectomy, and the data regarding conservative management are limited. A gravida 3, para 2 presented at 33 weeks gestation with ovarian torsion and underwent an exploratory laparotomy with ovarian cystectomy. The surgery was complicated by excess bleeding, which was controlled with the placement of sutures along the uterine body. She had multiple subsequent presentations for severe abdominal pain without clear aetiology. Four weeks after the initial surgery, she underwent caesarean delivery, at which time uterine necrosis was diagnosed. Her uterus was preserved. She received postoperative intravenous antibiotics and was closely observed. She continued to do well 10 months postpartum. In patients with uterine necrosis during pregnancy who are haemodynamically stable, conservative management may be an option.


Assuntos
Laparotomia , Hemorragia Pós-Parto , Gravidez , Feminino , Humanos , Útero/cirurgia , Hemorragia Pós-Parto/cirurgia , Suturas , Necrose/cirurgia
10.
Injury ; 53(12): 4033-4037, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36424688

RESUMO

PURPOSE: Split type of greater tuberosity fracture has variety of surgical treatment options. This study aimed to compare the biomechanics property of additional cuff suture and other fracture fixation techniques. METHODS: Fifteen porcine humeri were categorized into three groups of fixation techniques those were proximal humeral internal locking system (PHILOS) plate with 2 cuff sutures, nonlocking (conventional, 3.5 mm) T-plate with 2 cuff sutures and T-plate with washer that had additional cuff suture (novel technique). Fracture was created by greater tuberosity osteotomy with 50˚ inclination to the line of surgical neck and then fixed with different prescribed techniques. Displacement of fracture site was measured with universal testing machine. The maximum forces to produce 3 mm, 5 mm of displacement and load to failure were recorded. RESULTS: The average loads to reach 3 mm, 5 mm displacement and failure were 30.8 N, 45.4 N and 161 N for nonlocking T-plate; 76.6 N, 99.2 N and 144 N for PHILOS plate; 95.8 N, 120 N and 197 N for novel technique. The differences among three groups were significant in load to displacement at 3 and 5 mm (but not significant in load to failure). For load to reach 3- and 5-mm displacement, PHILOS plate and novel technique were significantly stronger than nonlocking T-plate (P < 0.05). For load to reach 3 and 5 mm displacement, novel technique was stronger than PHILOS plate but not significant (P > 0.05). For load to failure, novel technique was stronger than nonlocking plate and PHILOS plate but not significant (P < 0.05). CONCLUSION: The important factors affecting the strength of fracture fixation are type of plate and numbers of suture augmentation that tie to the plate. Fixation with additional cuff suture showed the superior biomechanics of load to reach 3 mm, 5 mm displacement with better load to failure compared with PHILOS plate and conventional T-plate alone.


Assuntos
Fixação Interna de Fraturas , Fraturas do Ombro , Suínos , Animais , Fixação Interna de Fraturas/métodos , Fraturas do Ombro/cirurgia , Placas Ósseas , Suturas , Úmero/cirurgia
11.
Bull Hosp Jt Dis (2013) ; 80(4): 246-251, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36403953

RESUMO

BACKGROUND: Watertight capsular closure in knee arthro- plasty is desirable in order to achieve a good functional outcome. Barbed knotless sutures are being increasingly used in wound closure following knee arthroplasty. The prior studies have compared barbed sutures with either VICRYL® or Ethibond for closure, while none had compared all the three in a single setting in terms of closure time, needle stick injuries, postoperative complications, and functional outcome. PATIENTS AND METHODS: One hundred and forty-three subjects of unilateral knee arthroplasty were screened for eligibility in the prospective randomized controlled trial. One hundred and twenty patients fulfilled the inclusion criteria and were randomized into three groups to undergo capsular closure with barbed sutures, VICRYL, or Ethibond. RESULTS: The wound closure was fastest with barbed su- tures followed by VICRYL and Ethibond (10.4 ± 4.1; 15.4 ± 4.7; 17.2 ± 3.8 minutes; p < 0.001). There were seven needle stick injuries in the Ethibond group followed by three in the VICRYL group and none in the barbed suture group. The Knee Society Scores and wound related complications were comparable in all the three groups. CONCLUSION: Barbed suture, VICRYL, and Ethibond are equally good in the capsular closure following knee arthro- plasty. The faster wound closure time achieved may not be clinically relevant in the short term.


Assuntos
Artroplastia do Joelho , Ferimentos Penetrantes Produzidos por Agulha , Humanos , Artroplastia do Joelho/efeitos adversos , Estudos Prospectivos , Poliglactina 910 , Técnicas de Sutura/efeitos adversos , Resultado do Tratamento , Suturas
12.
BMJ Open ; 12(11): e059709, 2022 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-36418137

RESUMO

INTRODUCTION: The optimal closure of the abdominal wall after emergency midline laparotomy is still a matter of debate due to lack of evidence. Although closure of the fascia using a continuous, all-layer suture technique with slowly absorbable monofilament material is common, complications like burst abdomen and hernia are frequent. METHODS AND ANALYSIS: This randomised controlled trial with a 1:1 allocation evaluates the efficacy and safety of a continuous suture with or without additional interrupted retention sutures for closure of the abdominal fascia. Patients with an indication for a primary emergency midline laparotomy are eligible to participate in this study and will be randomised intraoperatively via block randomisation. Fascia closure in the intervention group will be done with a standard continuous suture with slowly absorbable monofilament material (MonoMax 1, B. Braun, Tuttlingen, Germany) and additional interrupted retention sutures every 2 cm of the fascia using rapidly absorbable braided material (Vicryl 2, Ethicon, Norderstedt, Germany). In the control group, the fascia is closed only with the standard continuous suture with slowly absorbable monofilament material. Sample size calculations (n=111 per study arm) are based on the available literature. The primary endpoint is the rate of dehiscence of the abdominal fascia (rate of burst abdomen within 30 days or rate of incisional hernia within 12 months). Secondary endpoints are wound infections, quality of life, length of hospital stay, morbidity and mortality. Patients as well as individuals involved in data collection, endpoint assessment, data analysis and quality of life assessment will be blinded. ETHICS AND DISSEMINATION: The study protocol, the patient information and the informed consent form have been approved by the ethics committee of the Ludwig-Maximilians-University, Munich, Germany (reference number: 20-1041). Study findings will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: DRKS00024802. WHO UNIVERSAL TRIAL NUMBER: U1111-1259-1956.


Assuntos
Parede Abdominal , Laparotomia , Humanos , Parede Abdominal/cirurgia , Laparotomia/efeitos adversos , Laparotomia/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Técnicas de Sutura , Suturas
14.
Zhonghua Wei Chang Wai Ke Za Zhi ; 25(11): 1020-1024, 2022 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-36396378

RESUMO

Objective: To explore the value of a two-stitch continuous suture in single- lumen ileostomy. Methods: This was a retrospective cohort study. Data for 98 patients who underwent single-lumen enterostomy were retrospectively collected between 1 January 2021 and 1 May 2022 at Zhujiang Hospital of Southern Medical University. All patients met the indications for prophylactic single-lumen ileostomy. Those older than 80 years of age, with complex underlying diseases, extremely poor systemic conditions who could not tolerate surgery, poor blood supply at the end of the bowel, and severe edema or severe infection at the end of the bowel were excluded. Among the included patients, patients who underwent surgery before 1 October 2021 underwent ileostomy with interrupted suture (control group, n=60), and patients operated on and after 1 October 2021 routinely underwent two-stitch continuous suture ileostomy (two-stitch stoma group, n=38). Two-stitch continuous suture ileostomy is performed as follows: the first continuous suture is used to suture the intestinal seromuscular layer, peritoneum, posterior sheath, and anterior sheath from deep to superficial layers. The bowel wall is then opened. The second continuous suture is used to suture the full thickness of the bowel and the skin. The differences in postoperative ostomy-related complications and operation time were compared between the groups. Results: There were no significant differences in baseline data between the groups (all, P>0.05). The operative time in the two-stitch stoma group was shorter than that of the control group (16.6±2.2 minutes vs. 25.1±2.4 minutes, respectively; t=-17.874;P<0.001). The incidences of mucocutaneous separation, dermatitis, and stoma rebound in the two-stitch stoma group were lower than those of the control group [5.3% (2/38) vs. 31.7% (19/60), χ2=9.633, P=0.002;5.3% (2/38) vs. 28.3% (17/60), χ2=7.923, P=0.005; and 2.6% (1/38) vs. 18.3% (11/60), P=0.026, respectively], while the incidences of parastomal hernia and stoma prolapse, and the postoperative visual analog scale scores in the two groups were similar (all P>0.05). Conclusion: Compared with traditional single-lumen ileostomy, two-stitch continuous suture ileostomy has the advantages of short operation time, simplicity, esthetic appearance of the stoma, and a significant reduction in the postoperative complications associated with ileostomy.


Assuntos
Ileostomia , Estomas Cirúrgicos , Humanos , Ileostomia/efeitos adversos , Estudos Retrospectivos , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversos , Complicações Pós-Operatórias/epidemiologia
15.
Jt Dis Relat Surg ; 33(3): 658-665, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36345195

RESUMO

The stability of distal radioulnar joints is afforded by bony radioulnar articulation and peripheral soft-tissue stabilizers. The primary soft-tissue stabilizers are structures that surround the distal radioulnar joint and are collectively referred to as the triangular fibrocartilaginous complex. Among the stabilizers, the volar and dorsal radioulnar ligaments contribute the most to the stability of distal radioulnar joints. For acute traumatic distal radioulnar joint instability accompanied by purely ligamentous injury, traditional surgical treatments involve the repair or reconstruction of the distal radioulnar ligament; however, these intra-articular procedures are highly invasive and difficult. The extra-articular reconstruction of the secondary stabilizer such as the distal oblique bundle of the interosseous membrane has attracted significant attention in recent years; however, most studies have only conducted cadaveric or laboratory modelbased investigations. In this article, we present three patients who suffered from acute dorsal wrist pain after a trauma event. Radiographic and physical examinations revealed distal radioulnar joint instability. All patients were treated with minimally invasive suture-button suspension augmentation in the direction of distal oblique bundle of the interosseous membrane. The instability was resolved after the surgical procedure, but two patients developed ulnar wrist pain and one patient underwent implant removal. All patients have been continually followed at our outpatient department and exhibited stable wrists, despite mild limitation in the range of motion after the procedure. In conclusion, acute traumatic distal radioulnar joint instability may be sufficiently treated with suture-button suspension for augmentation of the distal oblique bundle; however, some obstacles impede the in vivo adoption of this treatment.


Assuntos
Instabilidade Articular , Fibrocartilagem Triangular , Humanos , Instabilidade Articular/cirurgia , Membrana Interóssea , Fibrocartilagem Triangular/cirurgia , Suturas , Dor
16.
Cells ; 11(22)2022 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-36429014

RESUMO

The midpalatal suture is mainly responsible for the growth and development of the maxillary and resistance to rapid maxillary expansion (RME). It is essential for clinical researchers to explore the intramembrane ossification and to elucidate the underlying mechanism of the maturation and ossification process of the midpalatal suture to help identify the optimum time and force of RME. However, mechanistic studies associated with the midpalatal suture are rare. The aim of this present study is to create an intramembrane osteogenesis model for the midpalatal suture region of mice. Interestingly, we discovered a type of chondrogenic mesenchymal cell expressing Piezo2, which might be related to the detection of mechanical and external stimuli. This result provides a potential molecular and cellular mechanism that explains why the midpalatal suture is not closed until adulthood. We depict a landscape of mesenchymal cells that might play an important role in the intramembrane osteogenesis of the midpalatal suture and provide new perspectives on midpalate suture maturation and ossification, which might lead to further possibilities for clinical operations.


Assuntos
Células-Tronco Mesenquimais , Osteogênese , Animais , Camundongos , Osteogênese/genética , RNA-Seq , Condrogênese/genética , Suturas , Canais Iônicos
17.
Int J Mol Sci ; 23(22)2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36430601

RESUMO

This study is preliminary to an experiment to be performed onboard the International Space Station (ISS) and on Earth to investigate how low gravity influences the healing of sutured human skin and vein wounds. Its objective was to ascertain whether these tissue explants could be maintained to be viable ex vivo for long periods of time, mimicking the experimental conditions onboard the ISS. We developed an automated tissue culture chamber, reproducing and monitoring the physiological tensile forces over time, and a culture medium enriched with serelaxin (60 ng/mL) and (Zn(PipNONO)Cl) (28 ng/mL), known to extend viability of explanted organs for transplantation. The results show that the human skin and vein specimens remained viable for more than 4 weeks, with no substantial signs of damage in their tissues and cells. As a further clue about cell viability, some typical events associated with wound repair were observed in the tissue areas close to the wound, namely remodeling of collagen fibers in the papillary dermis and of elastic fibers in the vein wall, proliferation of keratinocyte stem cells, and expression of the endothelial functional markers eNOS and FGF-2. These findings validate the suitability of this new ex vivo organ culture system for wound healing studies, not only for the scheduled space experiment but also for applications on Earth, such as drug discovery purposes.


Assuntos
Pele , Cicatrização , Humanos , Pele/metabolismo , Suturas , Queratinócitos/fisiologia , Procedimentos Neurocirúrgicos
18.
PLoS One ; 17(11): e0274868, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36445893

RESUMO

OBJECTIVE: To describe the technique of laparoscopic radical prostatectomy in canine cadavers. STUDY DESIGN: Cadaveric study. ANIMALS: 8 canine cadavers. METHODS: Specimens were randomly divided into a 2D or 3D group. The vesicourethral anastomosis (VUA) was performed with 5 mm laparoscopic needle holders. A unidirectional barbed suture was used to complete the VUA with two simple continuous suture patterns. The number of stitches placed, the patency of the anastomosis, and the distance between the VUA and the ureters were recorded. RESULTS: Four dogs were entered into each group. The prostatectomy was completed in each dog following the same technique. VUA were completed with nine stitches (range: 8-10 stitches) for the 2D group and ten stitches (range: 9-11 stitches) for the 3D group (p<0.176). All the stitches were placed full thickness. The VUA was patent in each case. The left ureter was 1.05 cm (range: 0.5 to 1.1cm) from the VUA in the 2D group and 1.8 cm (range: 1.3-1.8 cm) for the 3D group (p< 0.025). The right ureter was 1.5 cm (range: 1 to 2 cm) from the VUA in the 2D group and 1.75 cm (range: 1.3-2 cm) for the 3D group (p< 0.55). CONCLUSION: Laparoscopic radical prostatectomy can be performed with a 2D or a 3D camera in canine cadavers. The 3D camera results in more accurate placement of the sutures since they were placed further away from the left ureter. CLINICAL SIGNIFICANCE: Radical prostatectomy with laparoscopy should be considered for dogs.


Assuntos
Laparoscopia , Ureter , Masculino , Cães , Animais , Prostatectomia , Suturas , Cadáver
19.
Tex Heart Inst J ; 49(6)2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36450144

RESUMO

Minimally invasive aortic valve replacement through a right thoracotomy is frequently performed in patients with aortic valve disease. The Cor-Knot Device (LSI Solutions) is an automated fastener that secures valve sutures. This case report is for a patient who developed postcardiotomy shock during a minimally invasive aortic valve surgery. The patient was found to have an aortic root dissection involving 90% of the aortic root circumference, including bilateral coronary ostia. The autopsy revealed that the aortic damage could be explained by a direct aortic intimal tear from the distal tip of the device shaft. The device was most likely not in perfect apposition to the sewing ring because of the restricted angle and space between the ribs.


Assuntos
Aneurisma Dissecante , Humanos , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/cirurgia , Aorta , Coração , Toracotomia , Suturas
20.
J Orthop Surg (Hong Kong) ; 30(3): 10225536221141477, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36420544

RESUMO

PURPOSE: Because modified Broström procedure provides a restoration of mechanical stability by reinforcing attenuated host tissue, poor quality of remnant ligamentous tissue is considered as a prognostic factor for ligament repair surgery. The purpose of this study was to assess the intermediate-term clinical results after anatomic anterior talofibular ligament repair augmented with suture-tape for chronic lateral ankle instability (CLAI) with poor quality of ligament remnants. METHODS: 64 patients with the insufficient anterior talofibular ligament confirmed by preoperative magnetic resonance image and intraoperative inspection were followed for ≥3 years after the augmented anterior talofibular ligament repair. The clinical outcomes were assessed with the Foot and Ankle Outcome Score, Foot and Ankle Ability Measure. Measurements on stress radiographs were performed to assess the changes of mechanical instability. To identify the changes of functional ankle instability, postural control ability was analysed with single leg stance test. RESULT: Foot and Ankle Outcome Score and Foot and Ankle Ability Measure scores improved from preoperative mean 58.3 and 53.6 points to 90.2 and 88.7 points at final followup, respectively (p < 0.001). Talar tilt angle and anterior talar translation improved from preoperative mean 16.5° and 13.4 mm to 3.2° and 4.4 mm at final followup, respectively (p < .001). Two patients (3.1%) showed a recurrence of instability. Although balance retention time improved from preoperative mean 3.9-6.2 seconds at final followup (p < .001), a significant side-to-side difference was found. CONCLUSION: Anatomic anterior talofibular ligament repair augmented with suture-tape appears to be a useful surgical option for CLAI with poor quality of ligament remnants at intermediate-term followup. Through anatomic repair of attenuated ligaments and suture-tape augmentation, this combined procedure can provide the reliable restoration of mechanical stability and advantages of the anatomic ligament repair. Postural control deficit compared to the uninjured ankle supports a necessity of continuous proprioceptive-oriented rehabilitation.


Assuntos
Instabilidade Articular , Ligamentos Laterais do Tornozelo , Humanos , Tornozelo , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/cirurgia , Ligamentos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Suturas
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