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A new suturing instrument that allows easy placement of sutures in deep inaccessible sites is described. The instrument has been used successfully for pelvic and perineal procedures, and is an invaluable asset to the urologist for urethrovesical anastomoses in radical prostatectomies.
Four groups of cataract patients having phacoemulsification with a scleral tunnel incision were studied. Three groups had incision lengths of 5.0, 6.0, and 6.5 mm closed with a single horizontal suture. The fourth group of patients had 5.0 mm incisions without suture closure. We found no statistical difference between these groups in the vector astigmatic changes over a four week period and subsequently over a 6.9 +/- 3.7 week period. The patients in all groups returned to their preoperative astigmatic values within one to two weeks within the statistical significance achieved in this study.
This experiment investigates the holding property of polyglycolic acid suture in repair of divided dog sciatic nerves and the influence of absorption of this synthetic material on regeneration. The conclusion is that PGA maintains its tensile strength sufficently long to allow both physical union and good regeneration of the divided nerve. The suture absorption does not influence regeneration.
Sprague-Dawley rats anesthetized with isoflurane, underwent MCA occlusion by intraluminal 3-0 suture insertion, either 22 mm (n = 8) or 18 mm (n = 6) beyond the CCA bifurcation or were sham-operated as controls (n = 3) for autoradiographic analysis of cerebral blood flow. Infarct volume was measured 24 hours after the onset of ischemia (22 mm, n = 11; 18 mm, n = 10); neurological examinations were performed at 6 and 24 hours. Cerebral blood flow in the MCA distribution was significantly lower in the 22 mm suture insertion group than in the 18 mm group (p < 0.05). The total infarct volume was significantly larger (197 +/- 15 versus 135 +/- 19 mm3, p < 0.05) and the coefficient of variance was significantly smaller (23.8% versus 43.9%, p < 0.05) in the 22 mm group. Border zone regions of medial caudoputamen and dorsolateral cortex were often spared in the 18 mm group but never in the 22 mm group. The neurological deficit was more severe in the 22 mm group at 24 hours (p < 0.05), but not at 6 hours. The greater blood flow reduction and the less variable histological damage in dorsolateral cortex (a watershed area between the middle and anterior cerebral arteries) and the greater histological damage in medial caudate in the 22 mm group further characterizes this focal ischemia model for two potential applications: 22 mm insertion for studies requiring extensive and reproducible infarcts; 18 mm insertion for studies requiring less severe and more variable lesions after permanent MCA occlusion.
OBJECTIVE: To determine if transcostal thoracotomy closure resulted in less pain than circumcostal closure. STUDY DESIGN: Experimental cadaver and prospective clinical study. ANIMALS: Two canine cadavers and 13 adult, 22-29 kg dogs. METHODS: Phase 1: In 2 cadavers, 4 suture passage techniques were evaluated to determine the incidence of nerve entrapment in circumcostal intercostal thoracotomy closure. Phase 2: Pain after circumcostal closure (7 dogs) or transcostal closure (6 dogs) of a 4th intercostal space thoracotomy was evaluated by use of pain threshold scores, fentanyl administration rates, heart and respiratory rates, and numerical ratings for behavior. Arterial blood gas analyses were obtained 4 hours postoperatively. Transcostal closure was accomplished by drilling 5-6 small holes in the 5th rib and passing sutures through the holes and around the 4th rib to achieve closure. Pain threshold scores (PTS) were measured by an observer unaware of closure assignment, at 2, 4, 12, and 24 hours after closure by applying slowly increasing pressure to the incision line using a load cell. Rates of fentanyl administration were adjusted based on subjective impressions of dog comfort by a second observer unaware of closure assignment. RESULTS: A 70-100% incidence of nerve entrapment was found for all circumcostal techniques. PTS was higher (P=.045) and fentanyl infusion rates were lower (P=.001) for the transcostal group at 2, 4, 12, and 24 hour postoperatively compared with the circumcostal group. CONCLUSION: There is a high incidence of nerve entrapment using circumcostal closure techniques. A transcostal technique appears to be associated with less pain during the first 24 hours postoperatively. CLINICAL RELEVANCE: Based on lower pain scores, transcostal thoracotomy closure may be preferable to circumcostal closure techniques.
Knots form the weakest sections in suture materials. The addition of forces in the knot caused by bend and tension exceed the strength of the suture material and lead to rupture in the knot. Furthermore the most pronounced tissue reactions occur in the surrounding of knots because of their relatively large surface as compared to the linear filament. With a higher knot holding capacity a secure fixation can be achieved with less knots. As a reduced number of knots leads to a smaller surface a reduced tissue reaction can be expected. Because of high rigidity and a low coefficient of friction synthetic monofilaments achieve only a low knot holding capacity. To improve the knot holding capacity a usually large number of knots is being used. With increasing surface of exogenous materials the extent of foreign-body reactions increases, e.g. formation of granuloma. Results of in-vitro experiments are reported that were conducted to identify the smallest secure knot in polypropylene filaments of various diameters.
This study compared the cross-sectional area and volume occupied by suture material at the repair site in three common methods of flexor tendon repair. A total of 51 human cadaveric tendons were studied. Zone II flexor digitorum profundus tendon lacerations were created and then repaired using the techniques described by Kessler, Tajima, and Savage. Quantitative cross-sectional area and volumetric measurements of suture material within each repair site were determined using a digital image analysis system. The Tajima repair occupied 27% of the tendon area at the repair site, while the Savage and Kessler repairs occupied 18% and 2%, respectively.
The study aimed to evaluate the healing of intraoral surgical wounds sutured with alpha-cyanoacrylate and silk in clinical and histological terms. Forty-four patients were checked 7 and 14 days after surgery. An incisional biopsy was made at the level of the discharge cut and histological tests were performed on the fragment. On the basis of the results, the authors affirm that in some areas (upper eighths), alpha-cyanoacrylate plays a useful role and simplifies the suture technique. On the contrary, this material was not sufficiently reliable in areas subject to excessive traction (lower eighths).
This article introduces a technique of tendon repair using large-gauge dacron core sutures placed by a suture-assist device. Tensile strengths of the repair on preserved human tendons averaged 44.1 Newtons, compared with 29.8 Newtons for repairs with a modified Kessler technique. The technique shows promise as an alternative method for flexor tendon repair.
The arthroscopic wounds of 100 Caucasian patients were either sutured or simply bandaged on a random basis. The patients were reviewed after 2 and 12 weeks to ascertain the outcome of the two techniques. Suturing an arthroscopic wound resulted in an increased incidence of hematomas and superficial abscesses. A sutureless technique probably favors early hematoma draining, thus removing a potential cause of infection.
In the field of infertility, surgeons choose their sutures according some criteria: handling, absence of side effects and toxicity for the tissues, adequate sterilization, availability in adequate calibers with needles suitable for the structures of Fallopian tube, vas deferens and epididymis. Today, it seems that Polyglactine 910 (treated and gained Vicryl*) is perfectly adapted to all the anatomical situations and can be selected as the "unique" suture for sterility surgery (calibers 7 X 0 or 8 X 0). Our opinion is based on: Experimental findings coming from a personal work concerning 60 anastomosis on the uterine horn of the female rate. Critical analysis of previous experimentations done by other authors. The results of our personal practice in more of 1.400 salpingoplasties and 150 operations in the seminal genital ductus.
Two postvagotomy patients with upper gastrointestinal bleeding, which appeared several months after operation, are reported. Endoscopy showed the pyloroplasty suture line to be ulcerated and bleeding, with a few strands of silk protruding from edematous mucosa. The history of suture line ulceration and the contribution of endoscopy to its diagnosis and treatment are reviewed.
We have conducted a controlled trial to compare skin closure using conventional interrupted sutures with a combination of subcuticular suture and sterile Micropore tape in 169 patients undergoing appendicectomy, inguinal herniorrhaphy, or saphenofemoral ligation. We have found that the combination technique consistently gives a better cosmetic result and that the tape acts well as a dressing, is convenient, and is well tolerated by patients.
A universal suture device (USD) able to make simultaneous two-line and cross-shaped circular clips stitches on various tube-shaped organs (vessels, intestines, esophagus, stomach, ets), creating end-to-end and end-to-side anastomosis with the external cuff is proposed. The results of experimental trials of USD and its clinical use in anastomosing main vessels were published before (8, 9, 11, 12). In this article the results of experiments with the use of USD in intestinal and esophageal sutures in 35 dogs are analysed. There were 4 series of experiments with 45 anastomoses (31 intestinal and 14 esophageal anastomoses). The anastomosed segments of the intestines and esophagus healed at the level of the lower side of the cuff. The cuff completely resumes its shape in 2.5-5 months, and the clips come off by month 7-8 after the surgery. The mucous layer of the esophagus straightened by the 2-3d month, while adventitial-muscular layer does not straigheten at all, and the clips from it could be found till the 10th month after the surgery. There were no cases of anastomotic incompetence.
PURPOSE: The metal ring pin stapler was initially developed for microvascular surgery and there has been little experience of their use in larger vessels. We determined if the titanium ring pin coupling system could be safely and rapidly applied for arterial reconstruction in clinical renal transplantation. MATERIALS AND METHODS: The donor renal artery was end-to-end anastomosed to the internal iliac artery with titanium ring pin staplers in 36 patients. Anastomotic, clamp and total operative time and vascular problems were compared with those in the control group of sutured anastomosis in 39 transplant recipients. RESULTS: The completion of mechanical anastomosis required half the time of suture anastomosis. Mean clamp time was 17.8 minutes in the nonsuture group and 28.1 minutes in the control group. There was no significant difference in total operative time between the 2 groups. A small anastomotic line leak was noted in each group, which was temporary and self-limited. There were no postoperative anastomotic failures, postoperative bleeding episodes or need to revise the anastomosis (100% patency rate) in the 2 groups. Of the patients 61 were followed for 2 to 5 years. Transplant renal artery stenosis was observed in 1 patient in the nonsuture group but 3 in the control group. CONCLUSIONS: The anastomotic technique with the ring pin system is safe and simple, permitting an expeditious and everting anastomosis with a smooth intima-to-intima junction. Application of this technique may decrease warm ischemia time and the incidence of anastomotic artery stenosis, thus, improving outcomes.
This study reports our treatment of divided flexor pollicis longus (FPL) tendons by primary repair from 1999 to 2002. Forty-eight FPL repairs were performed using two Kessler two-strand repairs with a cross-linked Silfverskiold circumferential suture. All were rehabilitated by early active mobilization. Excellent or good results were observed in 73/77% of cases (White/Buck-Gramcko assessments, respectively). No patients (0%) ruptured their repair as a result of early active mobilization. Two patients (4%) developed post-operative infections with wound and tendon dehiscence. This combination of repairs addresses the problem of rupture of FPL during early mobilization which we experienced in previous studies. Its problems and alternatives are discussed.
In the experiments on puppies the authors studied the possibility for the use of ophthalmologic tendinous threads as a suture material for interintestinal anastomoses after intestinal resection. Ophthalmologic tendinous thread was used in a neonate with atresia of the small bowel. Six months' follow-up revealed a good result.
Simple end-to-end anastomoses were performed in the common carotid and femoral arteries and in the jugular and femoral veins of dogs. In other dogs, lateral sutures (running) consisting of absorbable material made from polyglycolic acid were inserted. No occlusions, aneurysms, or infections occurred in the arteries. Without heparin, the patency rate after up to 234 days was 98%. In veins, the observation period was 60 days and a patency rate of 83% was found. All vessels were studied by angiography and by light and electron microscopy. Additionally, an original method of hemodynamic assessment was used (Turbulence Index). The alternating effect of morphological variations in the vessel wall and the degree of blood flow disturbance was evident.