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At least 379 records · Page 21Linked to original sources
PubMed2005

Recent experiences with minimally invasive pectus excavatum repair "Nuss procedure".

OBJECTIVE: To review the new technical modifications and results of 668 patients who have had pectus excavatum repair utilizing the minimally invasive technique. METHODS: A retrospective chart review was conducted of 668 patients undergoing minimally invasive pectus repair from 1987 through July 2004. Since 1997, a standardized treatment pathway was implemented. Preoperative evaluation included computed tomography (CT) scan, pulmonary function tests, and cardiac evaluations with electrocardiogram and echocardiogram. Indications for operation included at least 2 of the following: progression of the deformity, Haller CT index greater than 3.25, mitral valve prolapse, cardiac compression or displacement, pulmonary function studies that indicate restrictive or obstructive airway disease, previous failed open or minimally invasive pectus repair. Technical and design modifications since 1998 have included routine thoracoscopy, the use of an introducer/dissector for creating the substernal tunnel, elevating the sternum, and routine use of a wired lateral stabilizer and polydioxanone suture (PDS) sutures around the bar and underlying rib to prevent bar displacement. The bar is removed as an outpatient procedure in 2 to 4 years. RESULTS: In 668 patients undergoing minimally invasive pectus repairs, single bars were used in 78.1% and double in 21.7%. Lateral stabilizers were applied in 99.8% and were wired for further stability in 71%. Bar shifts before the use of stabilizers were 14.3%, which decreased to 4.6% after stabilizers were placed and 0.8% with a wired stabilizer and PDS sutures. Results were excellent in 78.5%, good in 13.1%, fair in 4.7% and failed in 3.7% after more than 1 year post bar removal. CONCLUSION: The minimally invasive technique has evolved into an effective method of pectus excavatum repair. Modifications of the technique have reduced complications. Long-term results continue to be excellent.

Adolescent↗
PubMed1995

Effects of method of internal fixation of symphyseal disruptions on stability of the pelvic ring.

This study tested different methods of internal fixation of a symphyseal disruption, in comparison with the mechanics of the intact pelvis. Unembalmed cadaveric pelves were tested in simulated bilateral stance in a servohydraulic materials-testing machine. Motion of the superior and inferior pubic symphysis, and at two levels of the posterior sacroiliac complex, was measured using high resolution displacement transducers. The fixations tested were (1) double plating (4.5 mm reconstruction plates), (2) wire loops around two 6.5 mm, fully threaded cancellous screws, and (3) an absorbable suture material (polydioxanone). Each pelvis was first tested intact, recording displacements in response to a cyclic axial load up to a maximum of 500 N applied through the proximal sacrum. The pubic symphysis was then sectioned and the sacrum fractured to produce an unstable pelvis (Tile C-type). Recordings were then repeated, following fixation of the sacral fracture with lag screws and sequential fixation of the symphysis with each of the test methods. The results from eight pelves revealed that internally fixed symphyseal motion was generally greater than intact, regardless of fixation method. The superior symphysis was usually compressed, while there was distraction inferiorly. Wiring resulted in significantly less symphyseal motion than the other methods (P < 0.02), provided four loops were used, reducing the separation inferiorly. There was no significant difference in sacral fracture motion between the three methods. The results indicate that in osteoporotic bone, as used in this study, symphyseal wiring is best able to oppose the tensile loads in the inferior symphysis that are associated with bilateral stance loading. These biomechanical findings must be interpreted within the broader context of surgical management of these complex injuries.

Aged↗
PubMed1995

Laser tissue welding in genitourinary reconstructive surgery: assessment of optimal suture materials.

OBJECTIVES: Laser tissue welding in genitourinary reconstructive surgery has been shown in animal models to decrease operative time, improve healing, and decrease postoperative fistula formation when compared with conventional suture controls. Although the absence of suture material is the ultimate goal, this has not been shown to be practical with current technology for larger repairs. Therefore, suture-assisted laser tissue welding will likely be performed. This study sought to determine the optimal suture to be used during laser welding. METHODS: The integrity of various organic and synthetic sutures exposed to laser irradiation were analyzed. Sutures studied included gut, clear Vicryl, clear polydioxanone suture (PDS), and violet PDS. Sutures were irradiated with a potassium titanyl phosphate (KTP)-532 laser or an 808-nm diode laser with and without the addition of a light-absorbing chromophore (fluorescein or indocyanine green, respectively). A remote temperature-sensing device obtained real-time surface temperatures during lasing. The average temperature, time, and total energy at break point were recorded. RESULTS: Overall, gut suture achieved significantly higher temperatures and withstood higher average energy delivery at break point with both the KTP-532 and the 808-nm diode lasers compared with all other groups (P < 0.05). Both chromophore-treated groups had higher average temperatures at break point combined with lower average energy. The break-point temperature for all groups other than gut occurred at 91 degrees C or less. The optimal temperature range for tissue welding appears to be between 60 degrees and 80 degrees C. CONCLUSIONS: Gut suture offers the greatest margin of error for KTP and 808-nm diode laser welding with or without the use of a chromophore.

Evaluation Studies as Topic↗
PubMed1992

Interactions between osteoclastic cells and biodegradable polymers in vitro.

The use of implants to stabilize fractured diaphyseal bone, to handle difficult bone damage and to perform augmentation or replacement procedures in bone has become a common method in bone surgery. In most cases metal implants were used. Biodegradability of implant materials offers new perspectives. Restoration of the physiological status in the implant site becomes possible. Allergic reaction and second operations to remove the implants can be avoided and transitional aid in wound healing by the use of biomaterials can be achieved. An in-vitro system was established to investigate the interactions between osteoclasts and biomaterials, since it is the osteoclasts which are potentially able to resorb or degrade implants. The cell's resorption capabilities as well as its morphological behavior were documented. Two biodegradable and four nonbiodegradable materials were tested. The non-degradable materials provoked specific cell behaviour patterns but were not resorbed. Fibrin tissue adhesive sealant, however, displayed resorption lacunae mediated by osteoclasts, whereas polydioxanone (PDS) showed no resorption sites but normal cellular morphology when compared to the standard control (cells on hydrophilic coated teflon dishes). Both materials appeared to be well accepted by osteoclasts. This test system was established for the valuation of biodegradable implant materials and can be used to characterize new materials concerning their resorbability and biocompatibility without superposition by other cell systems.

Aluminum Oxide↗
PubMed2006

A simple method of meniscus repair using the arthroscopic outside-in technique.

We describe a simple method of arthroscopic outside-in meniscus repair that is easy to perform using readily available materials. The technique uses a 19-gauge venepuncture needle, a 16-gauge epidural needle, a No. 3 Prolene suture as a lasso loop, and No. 2 polydioxanone (PDS) sutures for meniscus repair. The venepuncture needle is used to puncture the meniscus from outside-in to deliver the Prolene lasso loop suture. The epidural needle is used to deliver one end of the PDS repair suture through the lasso loop. This suture end is captured by tightening the lasso loop, and delivered out of the joint by withdrawing the venepuncture needle. The epidural needle is kept in the joint. A second pass is made with the venepuncture needle at an appropriate site on the meniscus, and the lasso loop delivered. The other free end of the repair suture is threaded through the epidural needle and through the lasso loop. This other repair suture end is similarly captured and delivered out of the joint. The repair is completed by pulling on the free ends of the repair suture to apply it across the meniscus tear site, and secured by tying the suture to the capsule through a small incision.

Arthroscopy↗
PubMed2006

New meniscus repair technique for peripheral tears near the posterior tibial attachment of the posterior horn of the medial meniscus.

We introduce a suture technique to repair a peripheral tear near the posterior tibial attachment of the posterior horn. A suture hook was inserted through the posteromedial portal, and the peripheral capsular rim was penetrated from superior to inferior by the sharp hook. Both relay limbs were brought out through the posteromedial portal. The outer limb of the superior peripheral capsular rim was identified with a hemostat. An 18-gauge spinal needle loaded with a No. 0 polydioxanone suture (PDS) was introduced into the joint from the anteromedial portal; it was passed through the joint space until it penetrated the inner torn meniscus. The PDS suture loaded within the needle was pushed into the joint and picked up through the posteromedial portal. The needle was pulled out of the torn meniscus and readvanced over it while the suture was kept loaded. The other limb of the suture from the tip of the spinal needle was retrieved through the posteromedial portal. The initial PDS suture limb was hooked to the shuttle-relay system; it then was passed through the inner torn meniscus and the peripheral capsular rim. The suture limb exiting from the peripheral capsular rim was used as a post and was joined to the other suture limb to form a sliding knot.

Arthroscopy↗
PubMed2006

Strength of damaged suture: an in vitro study.

PURPOSE: To determine the mechanical properties of damaged suture. METHODS: Undamaged and damaged sutures were tested by a single pull to failure. Sutures were damaged with a razor blade incorporated into a custom-designed jig. Sutures were tested to failure by straight pull and by pulling at 180 degrees through a suture anchor eyelet. The friction of sutures through anchors was also tested. RESULTS: For the straight line pull test, undamaged FiberWire (Arthrex, Naples, FL) had the highest load to failure (LTF) and ultimate tensile strength (UTS) of all sutures tested. Undamaged Orthocord (Mitek, Somerville, NJ) ranked second in both properties. Uncut polydioxanone (PDS) suture (Ethicon, Somerville, NJ) had a higher LTF and a comparable UTS with respect to Tevdek (Deknatel, Mansfield, MA) and Ethibond (Ethicon). For cut sutures, FiberWire and Orthocord had a significantly higher LTF and UTS than the other sutures tested. Suture stiffness was not significantly affected when the suture was cut. For the suture anchor test, FiberWire and Orthocord had the highest LTF, whether undamaged or damaged. When cut, PDS had the greatest loss of LTF and UTS during both tests. CONCLUSIONS: The newer polyethylene core sutures (FiberWire and Orthocord) have superior mechanical properties compared with other sutures. Their superior properties are maintained even when cut. Although uncut PDS had equivalent or superior strength compared with Ethibond and Tevdek, once cut, PDS suture was weakened significantly more compared with all other sutures tested. CLINICAL RELEVANCE: The mechanical properties of damaged suture are important to all surgeons who use suture arthroscopically.

Biomechanical Phenomena↗
PubMed2004

A novel technique using customised templates for the application of fractionated interstitial HDR brachytherapy to the tumour bed in soft-tissue sarcomas located in the extremities.

AIMS: Postoperative interstitial brachytherapy of limbs is challenging, because it is difficult to deliver a conformal dose to the tumour bed. We developed and assessed a new surgical fixation system for positioning guiding tubes in interstitial brachytherapy in order to achieve favourable geometry. MATERIALS AND METHODS: A 28-year-old patient was treated with postoperative interstitial brachytherapy boost followed by external radiotherapy after the 11th recurrence of a desmoid tumour in the forearm. On the basis of preoperative imaging data, customised resorbable templates made of polydioxanone (PDS) were cut to fit in the space left by the resected tumour. These were strategically positioned in the tumour bed during surgery. In order to hold the brachytherapy-guiding tubes parallel for the duration of treatment, they were passed through a series of holes bored into the templates. RESULTS: Fixing the guiding tubes with PDS templates resulted in a fixed geometry, and thus in an optimal dose distribution with only little additional dose optimisation needed by the brachytherapy treatment planning system. An optimised dose to the tumour bed, and a reduction of dose to critical normal tissues, is achievable with this template system for sarcomas located between osseous structures. CONCLUSION: The PDS templates offer a more rigid fixation of the guiding tubes in relation to the surrounding anatomy even after the operation cavity has been closed. A tailored dose distribution can be achieved, thus reducing possible side-effects. Additionally, because of the self-resorbable nature of the material, a re-operation for template removal is not necessary. The potential advantages of this method are being further investigated.

Adult↗
PubMed2026

A modified stomal construction technique to reduce incidence of stomal stenosis in continent catheterizable channels.

BACKGROUND: Antegrade continence enema (ACE) and catheterizable bladder channel (Mitrofanoff) procedures are routinely performed in pediatric urology patients diagnosed with a neurogenic bladder and bowel. Stomal stenosis is a common surgical complication of these procedures, occurring in approximately 10-30% of stomas. Our frustration with this complication prompted us to modify our suturing technique during stomal construction to attempt to decrease the incidence of stomal stenosis. METHODS: We compared the rates of stomal stenosis between patients with neurogenic bladder who underwent the creation of an ACE or Mitrofanoff channel using the historical techniques (prior to April 2018) versus the current technique (from April 2018 to December 2020). Our current technique for stoma creation consists of suturing full thickness bowel to only the dermal layer of the skin using interrupted 5-0 polydioxanone interrupted sutures with the knots buried. Statistics were performed using Fisher's exact t-test, with p-values <0.05 considered significant. RESULTS: There were no significant differences in demographics between patients in the 2 cohorts. Stomal stenosis occurred in 25 of 98 stomas (25.5%) after undergoing either an ACE or Mitrofanoff procedure using the historical techniques, with a median patient follow-up of 122.6 months for ACE cohort and 165.8 for Mitrofanoff cohort. The incidence of stomal stenosis was significantly decreased in the current technique, with one of the 31 stomas (3.2%) experiencing stenosis (p = 0.022), with a median follow-up of 78.4 months for ACE cohort, and 66.5 months for Mitrofanoff cohort. These follow-up durations exceed the upper limits of time-to-stenosis in the historical stomas. Stomas in the current cohort have a minimum follow-up of 4.5 years and a maximum follow-up of 7 years. CONCLUSIONS: Our current suturing technique has significantly reduced the incidence of stomal stenosis in our patients. The technique is straightforward and flexible and can be applied to any stoma placed in any position. Only one of the patients with stomas created with the current suturing technique have developed stomal stenosis, with follow-up exceeding the median time to development of stenosis of our historical cohort.

Humans↗
PubMed2004

Results of dorsal midline plication in children with penile curvature and hypospadias.

OBJECTIVES: To present our initial results using dorsal midline (12-o'clock position) plication in children with penile curvature and hypospadias. METHODS: Twenty-five children with hypospadias and ventral curvature confirmed after artificial erection underwent dorsal midline plication and hypospadias repair. Ventral curvature was corrected by making a 5 to 10-mm-long vertical incision through the tunica albuginea at the dorsal midline and approximating the outer edges of the incision with a monofilament polydioxanone stitch. RESULTS: One plication suture was needed in 15 patients. In 8 patients with mid-shaft hypospadias and 2 with proximal penile hypospadias, two and three sutures were needed, respectively. In none of the patients was division of the urethral plate needed, except for one with proximal hypospadias. No complications were encountered during a mean follow-up of 9 months (range 5 to 34). CONCLUSIONS: We believe that most cases of penile curvature with hypospadias can be corrected using dorsal midline plication of the tunica albuginea. Although long-term follow-up is necessary after puberty to confirm any erectile or sensory advantage, this approach might be considered whenever plication is to be performed.

Child, Preschool↗
PubMed2001

Absorbable pulmonary artery banding in tricuspid atresia.

A child with tricuspid atresia, concordant ventriculoarterial connections, large ventricular septal defect, and elevated pulmonary artery pressure underwent pulmonary artery banding with a polydioxanone ribbon. This procedure was successful in this patient as the ventricular septal defect became restrictive while the banding was fully absorbed after 5 months. This technique could be included in the panel of surgical strategies for patients with single ventricle physiology and potential but insufficient subpulmonary stenosis in early infancy.

Absorbable Implants↗
PubMed1997

Minimally invasive coronary revascularization through parasternal incisions without cardiopulmonary bypass.

BACKGROUND: We report the results of minimally invasive coronary revascularization without cardiopulmonary bypass through miniparasternal incisions. METHODS: This procedure was performed in 40 patients with disease in the left anterior descending, first diagonal, and right coronary arteries. After a 5- to 7-cm left vertical parasternal incision and removal of two costal cartilages, the left internal mammary artery was harvested up to the 2nd rib. The left anterior descending artery was occluded by means of two polydioxanone monofilament sutures. The anastomosis was performed with one 7-0 Prolene suture while the heart was beating. In 4 cases the left internal mammary artery was used as a sequential graft to the left anterior descending artery and the first diagonal artery. In 14 cases the right coronary artery was grafted with the right internal mammary artery through a right parasternal incision. Postoperatively, 95% of the patients underwent angiographic assessment of the anastomoses. RESULTS: We performed 52 anastomoses (34 to the left anterior descending artery, 4 to the first diagonal artery, and 14 to the right coronary artery). The mortality was 0% and the morbidity included postoperative bleeding (5%), acute renal failure (2.5%), atrial fibrillation (2.5%), and wound infection (5%). No patient had ventricular arrhythmias or circulatory problems during or after the operation. Two patients (5%) with right internal mammary artery-to-right coronary artery grafting had graft failure that required a redo operation. CONCLUSIONS: Small vertical parasternal incisions may be an alternative approach for single and multiple coronary revascularization, with a low incidence of intraoperative cardiac complications. The application of this approach to the right coronary artery, however, carries additional technical difficulties, and careful patient selection may be required to achieve optimal results.

Adult↗
PubMed1997

Comparative biomechanical analysis of a new circumferential flexor tendon repair and a modified Kessler repair.

We present the technical details and the results of a biomechanical analysis of a new type of circumferential flexor tendon repair, designed with the more stringent requirements of zone II injuries in mind. Apart from good initial strength we aimed for a design with little bulk at the repair site and good control of the tendon edges. The new repair is achieved using a single, continuous, inverting and locking suture of the periphery of the tendon. The repair was compared with a Kessler core suture of 4/0 polydioxanone, with Tajima and Strickland modifications, to which has been added a simple running circumferential suture (6/0 polypropylene), the repair currently used in our unit. Fresh human cadaver flexor tendons were divided and repaired by one of the two techniques (n = 12 for each technique), using 5/0 polypropylene for the new circumferential suture. A third group of tendons (n = 8) were divided and repaired with a 5/0 multifilament steel circumferential suture. The repaired tendons were tested at longitudinal stress to failure. The first two groups of tendons were tested at two crosshead speeds. Overall, crosshead speed had no effect on ultimate tensile strength (P = 0.5). The 5/0 polypropylene circumferential repair (median 32.29 N) was significantly stronger than the Kessler repair (median 24.03 N) (P = 0.046). The circumferential repair was significantly stronger with steel (median 56.04 N) than with polypropylene (median 32.29 N) (P = 0.007). The size of the repair site, resistance to gap formation and the patterns of failure were analysed on video recordings.

Biomechanical Phenomena↗
PubMed1999

Right sternoclavicular dislocation after traumatic delivery: a case report.

Sternoclavicular (SC) dislocation is an injury that is very rare in the newborn. Thus far there have been no reports describing this in neonates after a traumatic birth injury. This condition can be difficult to differentiate from epiphyseal separation, which occurs more often in older children. For successful treatment, early diagnosis is essential. Timely surgical reposition and fixation with following immobilization is recommended in instances of complete (SC) dislocation. We report a trauma-induced case of SC dislocation in a neonate successfully managed by polydioxanon cord fixation.

Birth Injuries↗
PubMed1987

Tunica wedge excision to correct penile curvature associated with the inflatable penile prosthesis.

We encountered 7 cases of significant penile curvature after placement of an inflatable penile prosthesis. In 3 cases curvature was present preoperatively owing to Peyronie's disease and penile trauma, while in 4 it developed postoperatively owing to improper penile positioning. Curvature was straightened successfully by removal of small elliptical wedges of tunica albuginea of the corpus cavernosum from the convex surface of the curve and closing the defects created with 3-zero polydioxanone sutures. A subjectively gratifying result was achieved in each instance.

Adult↗
PubMedDate not supplied

Enteroplication in cats, using suture of N-butyl cyanoacrylate adhesive.

Enteroplication has been recommended to prevent recurrence of intussusception in dogs and cats. This study investigated the impact of enteroplication on subsequent function of the plicated small intestine as measured by transit time of barium impregnated polyethylene spheres (BIPS) and compared two methods of achieving enteroplication--sutures using polydioxanone and cyanoacrylate tissue adhesive. Twenty-two healthy young cats were used--four controls, nine sutured and nine glued. The mean +/-SD transit times before, one week after and four weeks after enteroplication were respectively 2.0+/-0.80 hours, 1.6+/-0.80 hours, 2.2+/-1.18 hours. There was no significant difference in transit time or in the time to create enteroplication in the two plicated groups. Maintenance of intestinal adhesion was greater for the sutured plications. There was no significant change in internal diameter with either technique. Adverse clinical signs after enteroplication were not severe, however, they were more prevalent in cats which had glued plication. The inflammation associated with the suture was of a greater depth initially but that associated with the adhesive was more widespread and persisted for the four weeks of the experiments. Enteroplication in cats was a relatively benign procedure which did not cause significant alterations in small intestinal function. However, cyanoacrylate tissue adhesive cannot be recommended for this clinical procedure.

Anastomosis, Surgical↗
PubMed2005

[Endoscopically assisted retro-caroncular approach for medial wall fracture of the orbit: preliminary study].

PURPOSE: The purpose of this study was to present our experience of endoscopically assisted retro-caruncular approach of medial wall fracture of orbital bone, notably concerning the accessibility and visibility. METHODS: Five consecutive patients (4 men and 1 woman) with recent fracture (1 to 3 days), underwent medial wall reconstruction with a polydioxanone plate, endoscopically assisted via a retro-caruncular approach. The surgical technique and its results are described. Helpful hints are discussed. RESULTS: The plate did not have to be bent for introduction. Operative time was less than an hour for all patients. All patients were discharged the day after surgery. All experienced a mild degree of postoperative edema-related diplopia. None had persistent or secondary diplopia or enophthalmos at the one and six-month follow-up visits, respectively. Other postoperative complications, such as hematoma, nerve injury, or infection were not observed. All patients were satisfied with the outcome and especially the cosmetic result. DISCUSSION: The retro-caruncular approach with adjunctive endoscopic surgery should be the gold standard for posttraumatic isolated medial wall reconstruction of the orbit.

Adult↗
PubMed1994

Refixation of large chondral fragments on the weight-bearing area of the knee joint: a report of two cases.

In most cases of cartilage avulsion, the chondral fragments are severely damaged, and refixation is therefore impossible. We present two cases with large intact cartilage fragments from the weight-bearing area of the femoral condyle after patellar dislocation. We tried refixation using fibrin sealant (Tisseel-Kit, Immuno AG, Vienna, Austria) and polydioxanone-pins (Bio-fix-Pins, Miracon AB, Helsingborg, Sweden). At second look arthroscopy, we found only one third to one half of the defects healed. Due to these results, the refixation of chondral fragments without attached bone seems to be questionable.

Adolescent↗