The purpose of this study was to determine the influence of orthopedic surgeons' tying techniques on knot security using 2-0 and 4-0 monofilament and multifilament nylon sutures. Using an Instron Tensile Tester and a portable tensiometer, knot security was achieved with these sutures using four-throw square knots (1 = 1 = 1 = 1). After didactic and psychomotor skill training, medical students were taught to construct the four-throw square knot using either a two-hand tie or an instrument tie. Using the portable tensiometer, their knot-tying techniques were judged to be superior to those used by orthopedic surgeons. The orthopedic surgeon's faculty technique can easily be corrected by didactic information and psychomotor skill training.

Clinical Competence↗

PubMed1995

First metatarsophalangeal joint arthroplasties in the Commonwealth of Virginia.

This retrospective analysis of arthroplasty of the first metatarsophalangeal joint documents the incidence of surgery as well as the selection of the commercially available implants. During a 1-year period, 1994, arthroplasties were performed in 47 of the 1.7 million subscribers to Trigon Blue Cross Blue Shield of Virginia. Women received the majority of the arthroplasties (83%). Of the 47 cases, the silicone implant was predominantly used (83%). The most common indications for arthroplasty were hallux valgus (30%) and hallux rigidus (28%). Podiatrists performed 79% of the procedures, while orthopedic surgeons performed the remaining 21% of the cases. A prospective study is needed that will assess the long-term performance of the different implants.

Age Distribution↗

PubMed1995

Wound cleansing by irrigation for implant surgery.

Wound irrigation is an adjunct to all implant surgeries involving surgical incisions or arthroplasties. An understanding of the physics of wound irrigation provides a scientific basis for recommending wound irrigation systems for implant surgery. When inserting implants through surgical incisions, a low-pressure irrigation system is recommended for removing blood from the wound surface. In contrast, high-pressure irrigation systems are indicated to cleanse the intramedullary canal before cemented arthroplasty. With the advent of static and dynamic pressure transducers, irrigation systems can now be specifically designed to achieve these goals.

Animals↗

PubMed1995

Evolution of powered surgical instruments.

The history of powered surgical instruments has paralleled their need in surgery, particularly surgery involving hard tissue like bone or teeth. This development was of great importance, as the sophistication of procedures became more demanding, requiring the use of implants. The fields of neurosurgery, orthopaedics, otology, and dentistry have all played key roles in the development of the high-powered surgical instruments that are now used in every surgical and dental subspecialty. Power modalities that include pneumatic and electric sources along with the development of interchangeable accessories have revolutionized the surgical field, making procedures both safer and faster. Many physicians, dentists, and companies continue to contribute to this exciting and rapidly evolving industry.

Electricity↗

PubMed1995

New instruments, bone liners, and tray for finger joint arthroplasty.

Titanium circumferential grommets have been developed for finger joint arthroplasty that fit on the base of the silicone implant stems to protect the flexible hinge from tearing and fracture. To facilitate grommet insertion, new intramedullary bone rasps have been devised with a reverse cutting tooth pattern, an extended shaft for an improved view of the surgical field, and a redesigned cutting head to allow for grommet insertion. Surgical accessibility and ease of recognition have been facilitated by the development of color-coded sizers. All of the instruments necessary for finger joint surgery are available in a molded tray that has also been redesigned with a transparent lid and clearly labeled compartments for accurate determination of instruments and implant sizers.

Equipment Design↗

PubMed1995

An overview of first metatarsophalangeal joint implant arthroplasty.

The metatarsophalangeal joint of the great toe often requires an arthroplasty to correct joint disease and pain. Today, joint replacement systems are combinations of components manufactured to optimize biological ingrowth, mechanical interlock, press fit, and cementing. Three different types of arthroplasties are available to foot surgeons: the double stem hinged silicone implant, the two-component joint mimicking implant, and a hemi-implant available for the phalanx. No comprehensive studies on very large populations have been conducted to accurately evaluate the beneficial long-term effects of these implants. This review article describes the development of the toe arthroplasty, details the commercially available implants, and addresses the advantages and adverse effects of each implant.

Humans↗

PubMed1995

A retrospective analysis of 6,387 cholecystectomies.

This is the largest retrospective analysis of biliary tract surgery ever reported involving 6,378 patients operated on during a three year period, 1990-1992. During this time interval, the frequency of laparoscopic procedures has increased dramatically. The use of laparoscopic procedures was associated with a significant decrease in the total length of hospital stay and total charges as compared to the open procedures. Because of laparoscopic surgery's increased acceptance, we propose that the frequency of laparoscopic surgery of the biliary tract should be used as a quality control measure.

Aged↗

PubMed1994

Evaluation of new absorbable Lactomer subcuticular staple.

The most recent advance in skin sampling is the Auto Suture SQS -20 disposable stapler. It approximates and everts wound edges, placing one synthetic absorbable pin in the dermis each time the instrument handle is activated. Staple wound closure was accomplished four times faster than sutural closure of the dermis. Wounds with staple pin closure exhibit superior resistance to infection than wounds approximated by dermal sutures. Although sutures provide more immediate wound security, as measured by wound breaking strength, than dermal pins, the breaking strength of wounds subjected to either dermal pins or dermal sutures were not significantly different 14 days after wounding.

Equipment Design↗

PubMed1994

New advances in electronic devices for hole detection.

Holes in surgical gloves are considered to be an important source of transmission of pathogens between surgeon and patient. Two new glove hole detectors have been devised to alert the surgeon to the presence of holes. These devices have been evaluated using six powder-free and seven powdered varieties of surgical gloves that were either dry or exposed to hydration. Eight of the 13 surgical gloves hydrated rapidly with water, altering their resistance to the conduction of electricity. Because the Barrier Integrity Monitor¿ only has a hydration monitor, 68 false positives occurred during the evaluation, indicating to the surgeon that he/she should change gloves unnecessarily because the glove had no hole. In contrast, the Surgic Alert Monitor¿ (SAM¿) had a hydration alarm as well as a glove hole detection alarm. During the 104 tests, the SAM¿ device showed no false positives. In the testing of five of the rapidly hydrating types of surgical gloves, the SAM¿ device could not reliably detect holes. On the basis of this study, the SAM¿ device, in conjunction with gloves that resist hydration, appeared to be a reliable hole detection monitor.

Equipment Design↗

PubMed1994

Surgeons', nurses' and bereaved families' attitudes toward dying in the burn centre.

Because death of a patient is one of the most emotionally disruptive events in the health professionals' life as well as the bereaved, it was hypothesized that surgeons' and nurses' attitudes in the burn centre would interfere with their emotional support of the bereaved family. Consequently, we performed a psychometric assessment of the surgeons', nurses' and bereaved families' attitudes about death and dying in the burn centre. A psychometric instrument was developed and validated that assessed 13 surgical directors' of burn centres, 13 burn nurses' and nine bereaved family members' attitudes on death and dying in the burn centre. In the case of the bereaved family member, this instrument was complemented by interviews to ensure that the respondents understood each question. All surgeons and nurses were experienced health professionals working for an average of 12 +/- 8 years and 3 +/- 1 years respectively. The majority of burn surgeons (six) and the burn nurses (seven) found it to be emotionally difficult to support emotionally the bereaved family after the death of the patient. Over half the burn surgeons (seven) and nurses (seven) felt that the process of dealing with the bereaved family was different from that experienced in other hospital settings. The surgeons attributed this difference to the long duration of the patients' illnesses, while the nurses felt that it was due to the traumatic and painful qualities of burn injury. These emotional difficulties experienced by the staff in dealing with the dying patients were associated with a relatively low frequency of contact with the bereaved families after the patients' death.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

Biomechanical performance of a disposable graft stapler with absorbable skin tacs.

A stapler has been specially designed for fixing skin grafts to the underlying wound. The stapler has a loading unit which can be reloaded with cartridges of absorbable tacs. Each tac is made of a polymer which is biocompatible with tissue. The stapler ejects the tac into the graft, reliably securing it to the underlying tissue. The force and work required to eject the tacs were significantly less than that needed to form the metal staples. The most obvious advantage of the tac is that the majority of the tacs spontaneously extrude after the first dressing change. The performance of the disposable graft stapler with absorbable skin tacs has been compared to that of the disposable skin stapler with metal staples.

Biocompatible Materials↗