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At least 451 records · Page 25Linked to original sources
PubMed1999

Comparison of a continuous suture pattern with a simple interrupted pattern for enteric closure in dogs and cats: 83 cases (1991-1997).

OBJECTIVE: To describe and compare a simple continuous suture pattern with a simple interrupted pattern for enterotomy closure or end-to-end intestinal anastomosis. DESIGN: Retrospective study. ANIMALS: 58 dogs and 25 cats that underwent enterotomy or intestinal resection and anastomosis. PROCEDURE: Signalment, surgical procedure, suture pattern, suture material, confirmation of dehiscence, and follow-up were reviewed. Groups were compared by procedure (anastomosis or enterotomy) and by suture pattern. RESULTS: 57 animals underwent continuous closure; 26 had interrupted closure. Only polydioxanone or polypropylene suture materials were used. Overall, 81 (98%) animals had no signs of intestinal dehiscence and survived > 2 weeks. Two animals had confirmed dehiscence after foreign body removal, 1 of 57 (2%) after continuous closure, and 1 of 26 (4%) after interrupted closure. CLINICAL IMPLICATIONS: The simple continuous closure pattern is an acceptable alternative to simple interrupted closure for small intestinal anastomosis or enterotomy closure.

Anastomosis, Surgical↗
PubMed1999

[The study of anastomoses performed with the utilization of synthetic absorbable sutures in the surgery of the stomach and intestines].

Intestinal and gastro-intestinal anastomoses, performed using synthetic absorbable suture materials, foreign-dexon, vicryl and polydioxanon and native-oktselon, were studied up in experiment. The oktselon thread do not cede to foreign threads in quality and has advantages over them in some features. It is possible to regulate the terms of a firmness loss and resorption changing the threads oxidation degree during their manufacturing. In tissues, sutured using oktselon thread, the processes of reparative regeneration are passing in maximally favourite conditions.

Animals↗
PubMedDate not supplied

Segmental gastrectomy for early cancer in the mid-stomach.

BACKGROUND/AIMS: We modified the surgical procedure for segmental gastrectomy, which is normally used for peptic ulcers, to treat early gastric cancer of the mid-stomach. In this paper, we describe the surgical technique and its results. METHODOLOGY: The location of the tumor was confirmed by intra-operative endoscopic examination. An area 2 cm proximal and distal to the tumor was marked with sutures. Firstly, the lymph nodes were dissected from around the perigastric and along the left gastric and common hepatic arteries. Then, a segmental gastrectomy was performed. The greater omentum, omental sac, and vagal nerve, including the hepatic, pyloric and celiac rami, were left intact. An end-to-end gastrogastrostomy was performed using Gambee's sutures and 4-0 monofilament polydioxanone. Gastric drainage was not necessary. RESULTS: We performed segmental gastrectomies on 30 patients. Tumors less than 1 cm in diameter were found in 4 patients; 1.1-2 cm in 14, 2.1-5 cm in 11, and a tumor exceeding 5.1 cm in one patient. The cancer was confined to the mucosa in 23 patients; in the other 7, it had penetrated the submucosa. No lymph node metastases were found but 2 patients had microscopic invasion or permeation of the lymphatic vessels. One patient required post-operative balloon dilation of the pyloric sphincter for delayed gastric emptying. The remaining patients had no post-operative complications. To date, 29 patients, excluding one who died in a traffic accident, have survived disease-free for a mean of 30 months (range: 7-51). Their body weight and dietary volume returned to pre-operative levels within 12 months of surgery. CONCLUSIONS: Patients who underwent segmental gastrectomy have had a reasonably good quality of life in the post-operative follow-up to date.

Adult↗
PubMed1999

Buccal fat pad pedicle flap for midface augmentation.

Midface aging is characterized by soft-tissue ptosis with loss of cheek projection. Subperiosteal midface lifts may reposition the soft-tissue mounds and improve the tear trough, but may not fill the lateral cheeks in patients with significant jowls or poor bony support. Correction with alloplastic implants is helpful, but may not be accepted by many patients. During subperiosteal midface lifts, the author often excises Bichat's fat pad to decrease the jowl and to diminish face fullness. He has modified this approach and used a vascularized Bichat's fat flap to aid lateral cheek projection while still improving lower face fullness and the jowl. For the last 4 years, close to 150 patients undergoing subperiosteal midface lifts have had vascularized Bichat's fat pad flaps. The jowls were marked preoperatively. All patients had complete cheek undermining either through a buccal sulcus incision or through a crow's-foot incision, or through a muscle-sparing limited lower blepharoplasty incision. Bichat's fat pad is identified in its pocket medial to the masseter tendon. Mobilization of Bichat's fat pad is done by blunt dissection, preserving its thin fascial envelope. The "hernial saclike" pocket, excluding Stensen's duct and the buccal branches of the facial nerve, is identified and protected. Suspension is accomplished by fixation with 3-0 polydioxanone sutures either to the temporalis fascia (via the temporal incisions), to the arcus marginalis, or to the suborbicularis oculi fat pad. Fixation technique is dependent on where the fat pad is needed and the surgeon's preference. Fat pad repositioning is accomplished with a minor learning curve. The most common problems are tearing of the fat pad during fixation and temporary numbness of the long buccal nerve. Attention to leaving the capsule intact and gentle handling is essential to fixation. Nevertheless, in some patients with poor-quality fat pads, fixation is extremely difficult. Four-year results have been excellent. Further studies with magnetic resonance imaging of postoperative patients are necessary to assess longevity. Bichat's fat pad provides autologous vascularized tissue for midface fill. Placement may be lateral for cheek augmentation or medial for deep nasolabial folds. Jowl improvement also occurs with the removal of Bichat's fat pad from its pocket.

Adipose Tissue↗
PubMed2000

Chordee repair utilizing a novel technique ensuring neurovascular bundle preservation.

Penile chordee, with and without hypospadias, is amenable to surgical correction. The Nesbit technique of dorsal plication of the ventral tunica albuginea is effective in correcting most cases of corporal disproportion. A hazard with this approach is the potential inclusion of the dorsal neurovascular bundle, with resultant erectile and sensory dysfunction. We developed a simple technique using the Freer elevator to isolate the neurovascular bundle prior to plication. This ensures that no injury occurs to the neurovascular bundle during plication. Since 1994, 37 boys with chordee have been repaired using this approach. Their ages at the time of operation ranged from 5 months to 28 years (mean 9 months). Following standard degloving of the penis, an incision through Buck's fascia is made lateral and parallel to the neurovascular bundle at the maximum level of the chordee. A similar incision is carried out on the contralateral side. A 4-mm-wide Freer elevator is positioned under Buck's fascia while hugging the tunica albuginea. The Freer elevator slides across the midline to the contralateral side, separating Buck's fascia and underlying layers from the tunica albuginea. Following isolation of the bundle, each corporal body is plicated by creating a longitudinal incision through the tunica albuginea, which then is closed transversely with a 5-0 polydioxanone suture. Buck's fascia subsequently is closed with an absorbable suture following confirmation of chordee correction. No complications have been encountered during a mean follow-up of 21 months (range 5-51 months). No patients have required reoperation for persistent chordee. We developed a technique that elevates the neurovascular bundle prior to plication, thereby ensuring no injury to this structure. We have successfully used this modified Nesbit technique since 1994 and have had no complications. Utilization of the Freer elevator adds an estimated 5 minutes to chordee correction compared to a standard plication lateral to the neurovascular bundles. Although long-term follow-up needs to be performed to confirm any erectile or sensory advantage, this approach should be considered whenever plication is to be performed.

Adolescent↗
PubMed2000

[Tissue engineering for therapy of osteochondral cartilage lesions].

Cartilage defects still represent an unsolved problem in joint surgery. The intrinsic healing capacity of cartilage is insufficient and at best leads to reparative tissue like fibrous cartilage or cartilage like tissue regardless of the therapy applied. Cell culture techniques and generation of tissue specific matrix tread new paths to treat traumatic cartilage lesions. This technology referred to as tissue engineering allows for formation of constructs consisting of chondrocytes capable of production of cartilage specific matrix in combination with three-dimensional cell carriers. Polymers such as polylactid, co-polymers like polydioxanon with polyglactin and lyophilized dura have been used successfully to create such constructs with chondrocytes of different animal species. Cartilage specific compounds can be detected by histological and immunohistochemical techniques. To apply these constructs in humans, the distinguishing characteristics and problems of cell culture with human chondrocytes have to be considered. A further improvement of the artificially created tissue is conceivable using growth factors even including genetic manipulation of the applied cells.

Animals↗
PubMed2000

Transcaruncular approach for reconstruction of medial orbital wall fracture.

Medial orbital wall fractures can cause horizontal diplopia and enophthalmos. Therefore, reconstruction of displaced medial wall fractures should be considered. We used a transcaruncular approach in five male patients to reconstruct the medial orbital wall after acute injuries and also as a secondary procedure for enophthalmos correction. Four of these patients had a concomitant orbital floor fracture. The incision was made in the caruncule and extended in the conjunctiva superior and inferior into the fornices for 10-12 mm. The tissue was bluntly dissected in an anteroposterior direction. The periosteum was incised dorsal of the posterior lacrimal crest and after elevation of the periosteum, the fractured orbital wall was visible. Transplants up to a height of 2 cm could be inserted for reconstruction of the medial orbital wall. In the cases of acute trauma, the medial wall was reconstructed using a resorbable polydioxanone plate. Cortical bone was used for the reconstruction of late enophthalmos. No postoperative complications were found. The transcaruncular approach gave a rapid entry to the fractured medial orbital wall without a visible scar.

Adult↗
PubMed2003

A biomechanical comparison of suture constructs used for coracoclavicular fixation.

There is no consensus regarding surgical treatment for severely dislocated acromioclavicular joints. Although many treatments are suture-based, the suture materials and resulting suture-bone constructs have been subjected to limited systematic evaluation. This study identifies the strongest and least deforming suture construct among those commonly used for such repairs. Each suture-based repair was tested on a simulated clavicle and coracoid process with the skeletal components distracted until the suture failed to obtain tensile strength. Additional groups of sutures were subjected to cyclic loading to determine resistance to deformation. Panacryl braid had significantly greater tensile strength than all other constructs: Polydioxanone (PDS) braid, Mersilene tape, and Ethibond #5. Deformation after cyclic loading of Panacryl braid, PDS braid, and two strands of Mersilene tape was significantly less than that of the other constructs. A bioabsorbable suture loop, such as Panacryl, can act as a temporary internal splint, maintaining acromioclavicular joint reduction long enough for ligamentous healing during rehabilitation, and can avoid complications associated with permanent fixation materials. Panacryl braid deserves serious consideration for coracoclavicular fixation because of its strength, resistance to deformation, and bioabsorbable properties.

Absorbable Implants↗
PubMed2004

Extracranial sinonasal tract meningioma: a case report.

Extracranial meningioma is an unusual tumor, mainly found in the head and neck area. Before surgical removal and histopathological examination, this diagnosis is rarely considered. We report a case of an extracranial meningioma located in the frontal sinuses of a 65-year-old-woman. Symptomatology included trouble of vision due to bilateral exophtalmos and mild headaches. Bilateral exophtalmos was secondary to the development of huge frontal mucoceles. These mucoceles grew slowly due to the frontal recesses blockage by the extracranial meningioma. External approach was performed with removal of the mucocele walls and of the extracranial meningioma itself. The frontal recesses were blocked with synthetic cement, and orbital roofs were reconstructed with a polydioxanon-sheet (PDS). Frontal sinuses were excluded and filled with bone bank grafts. A review of the literature on extracranial meningioma and a discussion about the surgical management of this case are proposed in this paper.

Aged↗
PubMedDate not supplied

Laparoscopic "Dome-down" cholecystectomy with the LCS-5 Harmonic scalpel.

OBJECTIVE: Misidentification of ductal anatomy and electrocautery injuries are complications associated with laparoscopic cholecystectomy (LC). Dome-down LC creates a 360-degree view of the gallbladder-cystic duct junction, reducing the risk for anatomy misidentification. In addition, ultrasonic instrumentation eliminates the risk for electrocautery injuries. This study assessed the feasibility and safety of dome-down LC combined with ultrasound technology. METHODS: Patients with noncancerous gallbladder disease were enrolled consecutively. Gallbladders were classified by clarity (Class I to IV) of anatomy and pathology (acute, chronic, or acalculous). The gallbladder was dissected from the gallbladder bed using a dome-down technique, and the cystic artery was coagulated and transected with the LCS-5 Harmonic scalpel (Ethicon Endo-Surgery Inc., Cincinnati, Ohio). The cystic duct was ligated with 2-polydioxanone Endoloops size 2-0 and sharply divided, leaving one Endoloop on the cystic duct stump. RESULTS: LC was successfully completed in 105 patients (mean age, 44 years; range, 18 to 91 years) in whom the anatomy was classified as Class I in 30 (29%) patients, Class II in 42 (38%), Class III in 25 (24%), and Class IV in 8 (8%). Gallbladder dissection time ranged from 8 to 42 minutes (mean, 18 min). The operating room time ranged from 32 to 128 minutes (mean, 55 min). Two gallbladder perforations occurred, but no complications were associated with the extrahepatic biliary tree, viscera, or major blood vessels. Elective conversion occurred in 8 (7.6%) patients due to poor visualization of anatomy because of inflammation and adhesions. Patient blood loss was minimal in all cases. No postoperative complications were observed after a 6-month follow-up. CONCLUSION: Dome-down laparoscopic cholecystectomy with the LCS-5 Harmonic scalpel decreases the potential for misidentification of ductal anatomy, has minimal complications, and eliminates electrocautery risks. Conversion is related to poor visualization of anatomy due to inflammation and adhesions.

Adolescent↗
PubMedDate not supplied

Incisional hernia following hand-assisted laparoscopic surgery for renal cell cancer.

OBJECTIVES: For renal cell cancer, the hand-assisted laparoscopic approach provides several advantages while maintaining equal advantages with regards to patient recovery. We offer our experience with laparoscopic hand-assisted radical nephrectomy and the incidence of ventral wall hernia. METHODS: Between February 1999 and July 2002, we performed 50 laparoscopic hand-assisted radical nephrectomies. A midline or a muscle splitting right lower quadrant incision was used depending on the side of the tumor. Hand-port incisions were all between 7 cm and 8 cm and closed with #1 polydioxanone sulfate suture in a running fashion. Three (6%) patients developed hand-port incisional hernias. All hernias occurred in midline hand-port sites. The average body weight of those who developed an incisional hernia was 137 kg. Although the cause of incisional hernia is multifactorial, we believe that obesity plays a significant role. The technical limitations involved in closing a short, deep ventral incision combined with the earlier return to activity of laparoscopy patients put this patient population at significant risk. CONCLUSION: We now perform an interrupted closure with nonabsorbable suture for the hand-assist incision and limited activity for 4 weeks to 6 weeks post procedure in high-risk patients. We have had no further wound hernias since adopting these changes.

Carcinoma, Renal Cell↗
PubMed2006

Ventral laparoscopic abomasopexy on adult cows.

Displacement of the abomasum is frequently diagnosed by veterinarians in bovine practice and numerous surgical techniques have been developed to treat and prevent this condition. Complications secondary to those techniques are related to their degree of invasiveness and the development of postoperative wound infections. The objectives of this study were to describe a safe and reliable abomasopexy technique by laparoscopy and to assess postoperative adhesion formation. A ventral laparoscopic abomasopexy was performed on 10 adult dry cows. The abomasum was fixed with 4 simple interrupted sutures using USP 2 polydioxanone suture material. No major complications were encountered during the surgery. Abomasal adhesions were visually evaluated by laparoscopy 3 mo postoperatively. This technique proved to be simple and safe, and it provided adequate abomasum fixation in healthy dry cows. It could be used to surgically correct left displaced abomasum.

Abomasum↗
PubMed2006

[Tendon holding capacities of the suture materials used in repairing Achilles tendon rupture].

OBJECTIVES: We evaluated tendon holding capacities of suture materials that are commonly used in repair of Achilles tendon ruptures. METHODS: Achilles tendons of 60 sheep were removed by incisions 2-cm proximal to the calcaneal insertion and 1-cm distal to the musculotendinous junction. The tendons were randomly divided into six groups and sutures were placed with the Kessler technique at the distal end of the tendons using one of the following suture materials: 2 polydioxanone (PDS), 1 PDS, 2 Vicryl, 1 Vicryl, 2 Ethibond, and 1 Prolene. The distal end of the suture material was left free. Each specimen was mounted in an Instron machine, with the tendon being placed proximally and the suture material distally. The system was loaded with a displacement rate of 20 mm/min. RESULTS: Failure of all the specimens was due to pull-out of the suture material through the tendon. There were no failures due to suture breakage. The highest and the lowest tendon holding capacities were found with 2 PDS and 2 Ethibond sutures, respectively. CONCLUSION: Following Achilles tendon repair, the healing period, in particular the first three weeks, is precarious for pull-out of the suture material through the tendon. Thus, tendon holding capacity of the suture material is an important factor for the strength of the repair. Among the tested suture materials, 2 PDS was found to have the highest tendon holding capacity.

Achilles Tendon↗
PubMed1991

Effect of tissue adhesives and suture patterns on experimentally induced teat lacerations in lactating dairy cattle.

Tissue adhesives and suture materials were evaluated for repair of experimentally induced teat lacerations in 6 lactating dairy cows. Group-1 teat lacerations were not closed and served as nonsutured controls. Group-2 lacerations were closed in three layers (mucosa, submucosa, and skin) by use of 3-0 polydioxanone. Group-3 lacerations were closed by use of N-butyl cyanoacrylate monomer tissue adhesive. Group-4 lacerations were closed by use of a combination of sutures and tissue adhesive. All cows were milked by machine. Healing was observed for 28 days, then cows were slaughtered, and teats were recovered for further study. Evaluation revealed failure of healing of all layers with formation of large fistulas in 3 of 4 nonsutured control teats in group 1. All 6 teat lacerations in groups 2 and 3 healed satisfactorily with no fistulas. Five of 6 teats in group 4 had partial healing of skin and mucosa with no fistulas, and 1 teat failed to heal and developed a small fistula. Data indicated that closure of experimentally induced teat lacerations with three layers of fine absorbable suture or closure with tissue adhesive alone gave good results and satisfactory healing of all layers. However, when sutures and tissue adhesive were used together, foreign body reaction was marked, and the skin and submucosa healed only partially. Sutures appeared to entrap the tissue adhesive, resulting in a foreign body reaction.

Animals↗
PubMed1990

[Side effects of adhesion prevention by fibrinolytic drugs--in vitro studies of resorbable suture material and fibrin glue].

Surgical threads of a variety of resorbable suture materials (Cat plain and Chrom Cat, Serag Wiessner, Polyglactin 910 and Polydioxanon, Ethicon and polyglycolic acid, Dexon) were incubated up to 7 days at 37 degrees C in Varidase-containing media (Lederle Cyanamid, 1000 IU/ml in 0.9% NaCl or citrated human plasma). Thereafter the knot-breaking strength remained within 90.0 and 108.2% of the respective control threads (incubation in Varidase-free media, n = 7, n.s.). The dose-dependent lysis of fibrin glue by Varidase is effectively inhibited by small amounts of aprotinin (15 KIU/ml as compared with 1000-3000 KIU/ml in routine application). The inhibitor is bound to the matrix and not readily eluted.

Abdomen↗
PubMed1991

A new clinch knot.

A new slip knot is introduced. It can be used as the beginning knot of a running suture and for ligation of pedicles where accessibility is limited. When used at the beginning of a running suture to close abdominal-wall fascia, the knot can be safely used with monofilament material such as polydioxanone. It locks readily, it takes less time to tie than numerous square knots, and it is not as bulky as other knots. The clinch knot has been found to be especially useful for securing pedicles in relatively inaccessible places such as the infundibulopelvic ligament when performing oophorectomy at the time of vaginal hysterectomy. During endoscopic surgery, the knot has been used as an alternative to the Endoloop and as the preferred knot to secure the Endo-knot.

Gynecology↗
PubMed1991

Subcuticular Prolene or PDS for skin closure?

One hundred patients undergoing abdominal surgery were randomly allocated to have their skin wound closed by either polypropylene (Prolene) or polydioxanone (PDS) by the subcuticular method. Ninety-one patients completed the study and were assessed at discharge and again 3 months later for wound complications and cosmetic result. No statistically significant differences were found between the two sutures; overall wound infection rate was 5.5% and cosmetic result was equally acceptable for the two suture materials. This study indicates that an absorbable subcuticular suture may be safely used in all classes of wound.

Abdomen↗
PubMed1990

[Surgical treatment of bullous emphysema using Gore-Tex sheet].

Surgical treatment for bullous emphysema using Gore-Tex sheet and mechanical stapler is reported. The techniques were followed in a Juetnner's report: Small cut is made at the center of a 10 cm square of a Gore-Tex sheet, through which the area of bullous lung planned for resection is tented out with a lung forceps. A stapling instrument charged with a 4.8 mm clips is placed over the sheet around the suture line, and closed over both sheet and lung parenchyma. The excess sheet is removed after resection of the bullous lung. Five cases of bullous emphysema with a history of pneumothorax were successfully treated by the above method. Air leakage disappeared on the first postoperative day at latest. We assume Gore-Tex sheet, although a non-absorbable material, is in use as well as polydioxanone ribbon for prevention of air leakage in surgical cases of bullous emphysema.

Adult↗