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PubMed1994

Arthroscopic suture fixation of displaced tibial eminence fractures.

The purpose of this article is to describe a technique for arthroscopic reduction and suture fixation of avulsion fractures of the tibial eminence involving the anterior cruciate ligament (ACL). Six patients (five type III, one type II) with tibial eminence fractures underwent arthroscopic evaluation when closed reduction after aspiration failed to yield an anatomic reduction. The study population was composed of five males and one female. Average age was 24 years (range 16-36). One fracture (type II) was easily reduced after manipulating the interposed anterior horn of the lateral meniscus. In five patients the fragment was stabilized with multiple sutures. The technique involved arthroscopic placement of multiple sutures of 2-0 polydioxanone suture (PDS) into the base of the ACL pulled through a tibia drill hole and tied onto a 4.5-mm screw post. Patients were placed in a standard postoperative ACL protocol. All fractures demonstrated radiographic healing by 8 weeks, and no patients had subjective complaints of instability at 1 year. All patients obtained full extension intraoperatively, and only one patient lost 2 degrees of terminal extension at latest follow-up. Arthroscopic reduction and suture fixation of avulsion fractures of the tibial eminence restores the length of the ACL, provides stable fixation promoting early motion with minimal morbidity, and does not require a second operation for metal removal.

Adolescent↗
PubMed1996

New Tuohy needle technique for triangular fibrocartilage complex repair: preliminary studies.

The treatment of injuries to the triangular fibrocartilage complex (TFCC) has evolved from closed casting through open excision to arthroscopic repair. The authors present the preliminary results of arthroscopic repair of peripheral (Palmer type IB) TFCC tears using a Tuohy needle. Results in 17 patients treated with this technique were obtained retrospectively through chart review and telephone interview. Average age of the patients was 33 years (range, 16 to 54 years). Conservative treatment averaged 9 months (range, 2 to 26 months). The repairs were performed with one or two horizontal mattress sutures of 2-0 polydioxanone. Follow-up ranged from 4 to 13 months (average, 8 months). Sixteen patients were satisfied or very satisfied with the result; 1 was not satisfied. No complications occurred. We believe this Tuohy needle technique is practical and cost-effective for the arthroscopic management of peripheral TFCC tears.

Adolescent↗
PubMed1996

Early and moderate long-term results of a new surgical technique for repair of aortic coarctation.

OBJECTIVE: From June 1987 to September 1995, 53 patients underwent a new technique of coarctation repair. This technique consists of complete mobilization of the left subclavian artery so that it can be pulled down as far as possible. METHOD: After all the necessary clamping, the anterior wall of the aorta is incised longitudinally beginning on the anterior wall of the left subclavian artery and extending distally to the descending aorta 1-2 cm past the coarctation. The left subclavian artery is pulled down so that the proximal end of the incision can reach the distal end. Then, this longitudinal incision is sutured transversely with 5/0 or 6/0 polydioxanone and continuous technique, enlarging the coarctation site and also preserving the blood flow to the left upper limb. The ages of the patients ranged from 16 days to 20 years (mean 3.7 years). Thirty patients were younger than 1 year old. One patient (1.9%) died postoperatively due to persistent pulmonary hypertension. RESULTS: There was no pressure gradient perioperatively through the coarctation site after the repair. The mean follow-up was 34.4 +/- 27.5 months (range 1-99 months). All patients but one were in class I effort capacity (NYHA). Doppler echocardiographic studies were performed in 45 patients postoperatively. There was no restenosis or aneurysm formation at the coarctation site and the mean pressure gradients were between 19.8 +/- 16.2 mmHg. CONCLUSION: The authors experience indicates that this technique could be a good alternative to the subclavian flap aortoplasty because of the preservation of blood flow to the left arm.

Adolescent↗
PubMed1997

Surgical relief of tracheobronchial obstruction in infants and children.

OBJECTIVE: Congenital tracheobronchial obstruction (TBO) presents a complex problem both in terms of diverse aetiology, presence of associated anomalies and the operative strategy to be adopted. We report a single centre experience in managing this difficult problem. METHODS: Twenty-four infants and children with TBO referred to our unit over a 12-year period are reviewed. Aetiology of TBO included vascular rings (n = 9), anomalous innominate artery (n = 6), congenital tracheal stenosis (n = 5), segmental bronchial stenosis (n = 2) and pulmonary artery compression of the main bronchi (n = 2). Seven patients had concurrent cardiac anomalies. Stridor was the commonest presenting symptom (67%). Mean delay from onset of symptoms to referral was 19 months. One patient died preoperatively due to acute airway obstruction. Mean age at operation was 33.1 +/- 42 months (range 4 days-156 months) and 11 children were under 1 year at the time of surgery. In cases of TBO secondary to vascular rings, division of the ring resulted in relief of symptoms in seven cases, with two requiring further surgery for resultant tracheomalacia. Four of the five patients having tracheal resection were operated on with the use of cardiopulmonary bypass; three of these patients had concurrent correction of cardiac lesions, with two survivors. Tracheobronchial anastomoses were carried out using continuous polydioxanone (PDS). Patients with anomalous innominate arteries required aortopexy in five and innominate artery suspension in one, while those with pulmonary artery compression of the main bronchi had correction of their intracardiac defects (n = 2). RESULTS: Hospital mortality was 8.7% and there has been one late death due to Eisenmenger syndrome secondary to pulmonary regurgitation, atrial septal defect (ASD) and patent ductus arteriosus (PDA). On follow-up (mean 40 +/- 31 months), 19 patients are alive and symptom free. There have been no anastomotic strictures following tracheobronchial resection. The single most important predictor of mortality was the presence of associated cardiac anomalies. CONCLUSIONS: TBO can be managed effectively by a single operation in both infants and children without a detrimental effect on tracheal growth. We advocate consideration of concurrent repair of the tracheal and cardiac lesions. Cardiopulmonary bypass (CPB) allows this concurrent correction of cardiac lesions and also facilitates tracheal resection.

Adolescent↗
PubMed1996

Laparoscopic Management of Intentional and Unintentional Cystotomies

We evaluated the outcome of laparoscopic closure of intentional or unintentional bladder openings during operative laparoscopy. The unintentional cystotomies occurred in six women during ancillary suprapubic cannula insertion (1), sharp dissection of the bladder from the uterus in preparation for hysterectomy (2), development of the space of Retzius for bladder neck suspension (1), myomectomy (1), and resection of an ovarian remnant (1). In the remaining 13 women, bladder entry was required for treatment of endometriosis (3), and full-thickness partial cystectomy was necessary for deeply infiltrative endometriosis (7) or embedded ovarian remnants (2), or to repair a vesicovaginal fistula (2). The bladder defect was repaired laparoscopically in one layer using interrupted absorbable polyglycolic acid suture (17) or polydioxanone suture (2), followed by 7 to 14 days of transurethral drainage. The repair of the defects took approximately 5 to 30 minutes. Major complications were limited to one woman who developed a vesicovaginal fistula that required additional surgery. Minor complications were mild incisional erythema (1), urinary incontinence (1), and bladder spasms (1). In follow-up of 6 to 48 months, all patients had good outcomes. In selected women, certain bladder injuries can be repaired safely and effectively during operative laparoscopy.

Journal Article↗
PubMed2000

Saphenous vein harvesting by 'stripping' technique and 'W'-shaped patch covering after plaque incision in treatment of Peyronie's disease.

Harvesting of the saphenous vein tract by means of leg stripping is proposed in the treatment of Peyronie's disease. The technique of W-shaped saphenous vein after plaque incision to correct severe penile deformity associated with Peyronie's disease is described. Graft material was obtained from the lower saphenous vein by means of distal 'leg short stripping' technique. The size and number of tunical incisions depended on the size of the plaque. A 15 cm venous segment is generally sufficient to cover the defect. The venous segment used was W-shaped, assembled with 6/0 polydioxanone (PDS) uninterrupted sutures and then sutured to the albuginea defect. In our preliminary series of eight patients, penile shortening and erectile dysfunction is absent. Complete correction of penile deformity was achieved in seven patients (87.5%). One patient had minimal residual curvature (<20 degrees ) which did not result in difficulty with intromission. Saphenous harvesting by the stripping technique is not an invasive procedure and is quick and simple to perform. The W-shaped assembling technique is safe because the piece of saphena is kept intact and may be suited properly to the albuginea defect.

Humans↗
PubMed1998

Prospective randomized controlled trial to compare skin staples and polypropylene for securing the mesh in inguinal hernia repair.

BACKGROUND: The Lichtenstein tension-free repair has become the standard method for repairing inguinal hernia in many surgical units. This study compared two methods of mesh fixation. METHODS: Fifty men undergoing unilateral primary Lichtenstein inguinal hernia repair under general anaesthesia were randomized into two groups. In the control group polypropylene mesh was secured with 2/0 polypropylene sutures and the skin closed with subcuticular 3/0 polydioxanone. In the study group polypropylene mesh was secured with skin staples and the skin was closed with staples from the same staple gun. Duration of the operation was recorded. Early follow-up was achieved by patient review at 6 weeks and postal questionnaire at 12 weeks. RESULTS: The operation was significantly shorter when staples were used (median 20 min 0 s versus 29 min 30 s, P < 0.001). There was no significant difference in the incidence of postoperative complications or pain score. The study group reported earlier return to normal activity (4 weeks 0 days versus 6 weeks 2 days, P < 0.01) although there was no difference in the time taken to return to work or driving. CONCLUSION: The use of skin staples to secure mesh in the Lichtenstein inguinal hernia repair significantly reduced the duration of the operation and was as effective as conventional mesh fixation with polypropylene in the short term.

Adolescent↗
PubMed2001

Retroperitoneoscopic dismembered pyeloplasty for pelvi-ureteric junction obstruction in infants and children.

OBJECTIVE: To report our initial experience of endoscopic dismembered pyeloplasty through a retroperitoneal approach in infants and children with pelvi-ureteric junction (PUJ) obstruction. PATIENTS AND METHODS: Thirteen infants and children with PUJ obstruction underwent retroperitoneoscopic dismembered pyeloplasty (mean age at operation 2.7 years, range 0.25-10). Nine patients presented with complications secondary to PUJ obstruction, including urinary tract infection, pyonephrosis and increasing hydronephrosis with impairment in renal function. The other four patients had recurrent loin pain secondary to intermittent PUJ obstruction. The patient was placed in semi-prone (for left-sided) or a semilateral position (for right-sided PUJ obstruction). The retroperitoneal space was entered via a 1-cm incision over the mid-axillary line and further developed using a glove balloon. Video-retroperitoneoscopy was undertaken using a 5-mm laparoscope. Dismembered pyeloplasty was carried out with the pelvi-ureteric anastomosis fashioned using fine polydioxanone sutures over a double-pigtail ureteric stent. RESULTS: The retroperitoneoscopic dismembered pyeloplasty was successful in 12 patients, while one with previous percutaneous nephrostomy drainage for pyonephrosis required open conversion because of difficulties in developing the retroperitoneal space. The mean (range) operative duration was 143 (103-235) min. All patients had a rapid and uneventful recovery. The drainage was satisfactory in all 12 patients on a follow-up scan. CONCLUSIONS: Retroperitoneoscopic dismembered pyeloplasty is effective and safe in infants and young children giving a good early outcome, although the long-term results await further studies.

Anastomosis, Surgical↗
PubMed2002

Histopathological evaluation of the urethra after the Snodgrass operation: an experimental study in rabbits.

OBJECTIVE: To investigate the histopathological outcome of the incised urethral plate after tubularized incised-plate urethroplasty (the Snodgrass procedure to repair hypospadias) in a hypospadiac rabbit model, as it can produce meatal and neourethral strictures, and healing with scarring. MATERIALS AND METHODS: The study comprised 10 male New Zealand White rabbits (2.2-2.4 kg); under general anaesthesia the ventral urethra was completely excised 1 cm from the meatus proximally and a model of hypospadias formed. A full-thickness incision was then made in the distal dorsal urethra and the two sides of the incision marked by Indian ink tattooing. After placing a feeding tube (5 F) as a urethral catheter, both urethral wings were sutured ventrally by a 7/0 polydioxanone running suture, and the penile skin approximated by 5/0 chromic catgut. At 21 days and 3 months after surgery the penises were harvested, assessed histopathologically, and compared with those from control untreated rabbits of the same age and weight. RESULTS: In the study group the incised area of the dorsal urethra was re-epithelialized; the regional tissue and vascularity were normal. CONCLUSION: In this rabbit model the dorsal urethral incisions healed with no scar tissue; only the ventral suture lines had minimal fibrosis and inflammatory reaction.

Animals↗
PubMed2000

Double butterfly suture for high tension: a broadly anchored, horizontal, buried interrupted suture.

BACKGROUND: The excision of skin lesions such as tumors, nevi, and scars frequently results in tension on surgical wound margins. This tension is commonly counteracted surgically with buried, intracutaneous, interrupted sutures of absorbable material which are anchored vertically in the corium. METHOD: The horizontal, buried, intracutaneous butterfly suture has been described elsewhere. It is firmly anchored in the corium, everts wound margins, and adapts them nearly as broadly as two vertical sutures. It can also be laid as a double butterfly suture, as described here, and then has the shape of an "8." This double butterfly suture is equivalent to three vertical sutures because of its broad base in the corium. Moreover, it can cope with much greater tension because of its "pulley" effect. A single double butterfly suture usually suffices for small defects, particularly when the wound edges are cut obliquely with a longer rim of epidermis. MATERIALS: We have laid the traditional butterfly suture in more than 35,000 skin lesion excisions since 1985 and the double butterfly suture alone or as a supplement in more than 10,000 sutures since 1992. We use 2-0 to 6-0 polydioxanone for these procedures, since it has proven in trials to be the best-absorbed suture material. RESULTS: In most cases, the resulting scars were narrow and smooth in spite of high tension. Results were unsatisfactory in only 6.2% of procedures. CONCLUSION: The double butterfly suture described here has the advantages of withstanding tension better while everting wound margins and requiring fewer stitches for wound closure. However, it is important that the suture knot be deeply anchored beneath the corium.

Dermatologic Surgical Procedures↗
PubMed2002

The double-loop technique for meniscal suture.

The authors describe a modified method for arthroscopic meniscal repair in which polydioxanone sutures are placed in the torn meniscus using needles and nylon loops. Conventional methods require the use of expensive instruments, which are not always available. However, our method is fast and simple. This technique also simplifies inserting multiple sutures to achieve adequate stability of the torn meniscus.

Arthroscopy↗
PubMed2006

The severely deviated septum--the way I solve the problem.

Surgical correction of severely deviated or "saddle" noses poses specific problems that are often difficult to resolve because of the complexity of the deformities, particularly those of the septum. Four steps are necessary: (1) the deformations must be skeletonized and visualized by a perfect extramucosal dissection and maxillary-premaxillary approaches; (2) the septum must be mobilized by resection of the osteocartilaginous chondrovomerine callus, after which it is possible to carry out the septum as long as the mucosa is not torn; (3) the angulations must be corrected carrying out discontinuous cartilaginous incisions; and (4) the structures must be stiffened. Polydioxanone (PDS) struts provide a neat solution to the issue of the reconstruction of a plane and sufficiently stiff septum.

Adolescent↗
PubMed1996

[Orbital floor reconstruction with autologous periosteum transplant].

BACKGROUND: Various implants (silicon, teflon, titanium, polydioxanone, etc.) and transplants (dura, nasal septum, wall of the maxillary sinus) are used to stabilize the fractured orbital floor. Some of these methods have disadvantages with respect to hygiene, infection, or rejection. METHOD: In four patients, the fractured orbital floor was stabilized with autologous periosteum from the mastoidal region. RESULTS: This graft is easy to obtain; the procedure is sterile, gives good cosmetic results, and is cost effective. CONCLUSIONS: Autografts are regarded as the material of choice in reconstructive surgery. For the reconstruction of the orbital floor, we suggest the use of a free periosteal flap from the mastoidal region. The risk of infection by virus or prion is excluded, rejection is unlikely, and the method is cost effective.

Fracture Healing↗
PubMed1992

Treatment of ruptures of the symphysis and iliosacral joint in pediatric patients.

The three osseous parts of the human pelvis form a continuous structure because of the symphysis and both iliosacral joints that-owing to their mobility-make possible a shock-absorption of vertical forces. The goal in the treatment of ruptures of the symphysis and/or of the sacroiliac joints is the restoration of functioning joints. Especially in the adolescent, a stiffening of these joints has to be avoided. Therefore, we treat ruptures of the pelvic joints with an overbridging banding that preserves the function of shock absorption. Due to utilisation of a banding, made up of polydioxanone, another operation to remove internal fixation material is not necessary. Rupture of the symphysis or iliosacral joint in the pediatric patient is very rare. Only three among the 67 patients whom we operated on because of a rupture of the symphysis or iliosacral joints between 1984 and 1990 were children. These were an eleven-year-old girl and a nine-year-old boy, who had suffered a rupture of the symphysis, and an eight-year-old boy with a disrupted iliosacral joint. In these children a banding with PDS suture was performed. At a follow-up examination, the children were free from pain and did not feel restricted in their daily routine or their physical activities.

Child↗
PubMed2000

Bioartificial nerve graft for bridging extended nerve defects in rat sciatic nerve based on resorbable guiding filaments.

A long defect (15 mm) in rat sciatic nerve was repaired with a bioartificial nerve graft composed of a silicone tube and seven synthetic filaments of five types (polyamide, catgut, polydioxanone, and two types of polyglactin, normal and quickly-absorbed) inserted longitudinally into the tube. In all cases in which filaments were used a regenerating bridge was obtained in the tube after three months in contrast to empty silicone tubes, in which no structure was observed. There was a 6%-46% recovery of isometric muscle contractility of the anterior tibial and gastrocnemius muscles with positive pinch reflex test in most cases. Myelinated axons were seen in the regenerating tissue between the filaments but not directly in contact with them, and there were varying numbers of macrophages close to the filaments. Silicone tubes with filaments, regardless of type of filament, induced nerve tissue to regenerate and resulted in functional recovery through a 15 mm nerve gap not achieved with empty tubes. Nerve promoting factors may be applied to the filaments and the model is a valuable tool for further development of artificial nerve grafts.

Animals↗
PubMed2002

Effect of argon-beam coagulation on the integrity of suture material.

PURPOSE: To evaluate the effect of argon-beam coagulator (ABC) energy on suture materials. MATERIALS AND METHODS: Six absorbable and nonabsorbable suture materials (polyglactin, chromic catgut, polydioxanone, silk, poliglecaprone, and Gore-Tex) were placed under tension and exposed to ABC energy to determine breaking times. Subsequently, all suture materials were exposed to limited ABC energy, and tensiometry was used to determine decreases in breaking strengths. RESULTS: Among the suture materials tested, Gore-Tex was the most resistant to ABC energy. Although absorbable suture materials were less resistant than nonabsorbable suture materials, 2-0 polyglactin manifested the greatest resiliance to deterioration with ABC energy exposure. CONCLUSIONS: The ABC has differential effects on suture materials. Larger-gauge suture materials are more resistant to ABC than smaller materials. Similarly, nonabsorbable sutures are generally more resilient to ABC energy than absorbable materials. Among the suture materials evaluated in our in vitro model, 2-0 Gore-Tex was best suited for vascular ligation, and 2-0 polyglactin is optimal for renal collecting system closure if ABC is anticipated as an adjunct for hemostasis.

Absorbable Implants↗
PubMedDate not supplied

Ureteral pseudodiverticulum associated with absorbable suture clips after laparoscopic pyeloplasty: case report.

A 48 year-old woman with pyelonephritis was found to have bilateral ureteropelvic junction (UPJ) obstruction and a nonfunctioning right kidney. She initially underwent a laparoscopic left nondismembered pyeloplasty using absorbable polydioxanone Lapra-Ty suture clips (Ethicon Endosurgery, Cincinnati, OH) to secure the anastomosis. An antegrade endopyelotomy was later necessitated. Both procedures were complicated by postoperative bacteruria and funguria. She then underwent a laparoscopic dismembered pyeloplasty, again utilizing Lapra-Ty suture clips to secure the anastomosis. Postoperatively, her course was complicated by anastomotic extravasation, bacteriuria, and funguria. Subsequently, an antegrade nephrostogram revealed a 2.5-cm diverticulum just distal to the UPJ, which contained numerous 2- to 4-mm filling defects. Nephroscopic exploration of the pseudodiverticulum revealed numerous Lapra-Ty clips, which were basket extracted. The pseudodiverticulum was fulgurated with a holmium laser. She eventually had restricturing with recurrence of the pseudodiverticulum and was treated successfully by open ureterocalicostomy.

Anastomosis, Surgical↗
PubMed2006

Intra-abdominal adhesions after open and laparoscopic cholecystectomy: an experimental model.

PURPOSE: To evaluate the incidence of intra-abdominal adherences after open and laparoscopic cholecystectomy, on the basis of an experimental study in pigs. MATERIALS AND METHODS: A total of 40 female pigs, mean weight 25 kg, underwent open cholecystectomy by right subcostal laparotomy (group A, n = 22) or laparoscopic cholecystectomy using a Storz laparoscope (group B, n = 18). After surgery, the abdominal wall was closed with polydioxanone suture and staples (group A) or with staples only (group B). One month later, the pigs underwent medial laparotomy to assess whether intra-abdominal adherences had developed. Incidences were compared between groups by the chi-square test with Yates correction. RESULTS: Five pigs in group A and one pig in group B died within 24 hours of surgery, leaving 17 pigs in each group. Mean operative time was similar for both groups (24.7 minutes in group A, 25.3 minutes in group B). In group A, 16 pigs (94%) developed intra-abdominal adherences, in all cases multiple; in group B, only 9 pigs (53%) developed adherences, and in 8 of these pigs only a single adherence was present (P < 0.03). CONCLUSIONS: The results of this study indicate that the incidence of intra-abdominal adherences is statistical lower after laparoscopic cholecystectomy than after open cholecystectomy.

Animals↗