[Lateral sliding flaps: a modified surgical technic].
Explore the source record for details and available documents.
Atrophy↗
SEARCH · Search PubMed
Results for “SUTURE TECHNICS”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
[Operating room assistance: an innovative practice].
Professional practice changes in the operating room have led to the development of a new role for nurses--as surgical assistants. Essentially, the surgical assistant nurse helps ensure the patient's safety while providing technical and clinical assistance to the surgeon in such areas as exposing and manipulating tissues, suturing fascia and using various specialized instruments. The surgical assistant nurse function is being implemented through a pilot project at the Institut de cardiologie de Montréal. Developed by representatives of the nursing and surgical departments there, the project was approved by the Collège des médecins du Québec in April 1995 and subsequently by the institute's council of physicians, dentists and pharmacists. It has also gained recognition from the Ordre des infirmières et infirmiers du Québec (OIIQ). The pilot project incorporated a 186-hour training program, which was delivered from May to September 1995 according to three distinct learning modules: maintenance of a safe environment for the patient, clinical assistance and technical assistance. A tutorial approach to learning included individual and team work, simulation exercises, technical courses, lab work and practical training in the operating room. At the end of the training program, two surgical assistant nurses began practising in their new role. An evaluation of the project will be performed in September 1996.
Curriculum↗
A tarsal strip-periosteal flap technique for lateral canthal fixation.
Lateral canthal fixation is widely used. This article sought to determine if a periosteal flap used routinely in conjunction with a tarsal strip provides lasting lateral canthal fixation. This consecutive clinical series from two ambulatory surgery centers followed 79 patients who underwent 141 lateral canthal fixation procedures. Outcome was measured by the position of the lateral canthus. Correct positioning of the lateral canthus was achieved in 78 of 79 patients representing 139 of 141 procedures (98%). The failed case was a patient with floppy eyelid syndrome in whom the sutures tore through the tarsal strips. The tarsal strip-periosteal flap technique is a successful, technically direct method of lateral canthal fixation. It is promoted as an enhancement of the tarsal strip technique, and is especially helpful in patients with prominent eyes.
Aged↗
Technical considerations in knot construction, part III. Knot asymmetry.
Lactomer and the Polyglactin 910 are coated synthetic braided absorbable sutures commonly used for dermal wound closure. Biomechanical performance tests demonstrated superior performance characteristics of the Lactomer sutures. Using narrow diameter sutures, the Lactomer sutures exhibited superior knot holding forces over the Polyglactin 910 sutures. Moreover, knot security could be reliably achieved with asymmetric and symmetric knots using the Lactomer sutures.
Biomechanical Phenomena↗
[Three-dimensional reconstructions using spiral computerized tomography in the study of craniostenosis. Preliminary experience and technical considerations].
INTRODUCTION: Craniostenosis is a complex association of syndromes and isolated diseases characterized by premature closure of cranial sutures. Three-dimensional (3D) Computed Tomography (CT) reconstructions have been widely used for years in the preoperative assessment and postoperative follow-up of craniostenosis, because of their effectiveness and diagnostic accuracy. Our study concerns the acquisition and reconstruction techniques of spiral CT images. This technique provides optimal diagnostic results allowing reduction of the radiation dose to the patient and of the sedation time. MATERIAL AND METHODS: May, 1995, to September, 1996, twelve patients with abnormal cranial growth or suspected craniostenosis underwent spiral CT examinations, with 3D reconstructions. Fourteen examinations were performed, including two postoperative investigations. Our diagnostic protocol consisted of images with 3 mm slice thickness, 3 mm slice interval, 2 s scan time, with 180 mAs, 120 kV. The images were reconstructed at 1 mm intervals. RESULTS: According to the literature, this technique is safe enough relative to the dose to the patient (12.2 mSv) and permits to obtain good quality 3D reconstructions and adequate images of the brain and liquor spaces. Simple sedation was sufficient in all cases, using pentobarbital, 2-3 mg/kg. CONCLUSIONS: The Authors emphasize the diagnostic effectiveness and accuracy of spiral CT with 3D reconstruction in the study of craniostenosis, which also permits imaging of the brain and liquor spaces with minimal loss of information.
Age Factors↗
Use of an intuitive telemanipulator system for remote trauma surgery: an experimental study.
BACKGROUND: Death from battlefield trauma occurs rapidly. Potentially salvageable casualties generally exsanguinate from truncal hemorrhage before operative intervention is possible. An intuitive telemanipulator system that would allow distant surgeons to remotely treat injured patients could improve the outcome from severe injuries. STUDY DESIGN: We evaluated a prototype, four-degree-of-freedom, telesurgery system that provides a surgeon with a stereoscopic video display of a remote operative field. Using dexterous robotic manipulators, surgical instruments at the remote site can be precisely controlled, enabling operative procedures to be performed remotely. Surgeons (n = 3) used the telesurgery system to perform organ excision, hemorrhage control, suturing, and knot tying on anesthetized swine. The ability to complete tasks, times required, technical quality, and subjective impressions were recorded. RESULTS: Surgeons using the telesurgery system were able to close gastrotomies remotely, although times required were 2.7 times as long as those performed by conventional techniques (451 +/- 83 versus 1,235 +/- 165 seconds, p < 0.002). Cholecystectomies, hemorrhage control from liver lacerations, and enterotomy closures were successfully completed in all attempts. Force feedback and stereoscopic video display were important for achieving intuitive performance with the telesurgery system, although tasks were completed adequately in the absence of these sensory cues. CONCLUSIONS: We demonstrated the feasibility of performing standard surgical procedures remotely, with the operating surgeon linked to the distant field only by electronic cabling. Complex manipulations were possible, although the times required were much longer. The capabilities of the system used would not support resuscitative surgery. Telesurgery is unlikely to play a role in early trauma management, but may be a unique research tool for acquiring basic knowledge of operative surgery.
Abdominal Injuries↗
Development of an objective structured assessment of technical skills for obstetric and gynecology residents.
OBJECTIVE: To develop an objective structured assessment for evaluating surgical skills of obstetrics and gynecology residents and to evaluate the reliability and validity of the assessment. METHODS: A seven-station, objective, structured assessment of technical skills was administered to 24 residents. The test included laparoscopic procedures (port placement, salpingostomy, suturing, vessel ligation) and open abdominal procedures (hypogastric ligation, repair of enterotomy, salpingo-oophorectomy.) All surgical tasks were done on pigs. Residents were timed and assessed at each station using three methods of scoring, a task-specific checklist, global rating scale, and pass-fail grade. RESULTS: Assessment of construct validity (the ability of the test to discriminate among residency levels) found significant differences on the checklist and the global rating scale by residency level. Reliability indices calculated with Cronbach's alpha were 0.89 for the global rating scale and 0.89-0.95 for the individual skills checklists. Interrater reliability was 0.87 for the global rating scale and 0.78-0.98 for the checklists. CONCLUSION: Objective, structured assessment of technical skills can assess residents' surgical skills with high reliability and validity. These assessments have possible application for identifying residents who need additional training and might provide a mechanism to ensure competence of surgical skills.
Adult↗
[Time, technic and results of replacement operations in irreparable radial nerve damage].
In cases with poor motor regeneration following radial nerve damage the Perthes method of tendon transfer is recommended. At the same operation a secondary nerve suture should be performed. The flexor carpi ulnaris tendons is used as the motor for the extensor digitorum communis and extensor pollicis longus, the palmaris longus tendon for the abductor pollicis longus. Attention is focused on some technical details including the mobilisation of the motor muscles, the direction of pull, the tension of the motor and the position in which fingers and wrist should be held during suture.
Adult↗
Laparoscopic management of complications following laparoscopic cholecystectomy.
Laparoscopic cholecystectomy has rapidly become the treatment of choice for symptomatic cholelithiasis. Although published morbidity and mortality rates compare favourably with open cholecystectomy, bile duct injuries occur far more frequently and technical complications unique to the laparoscopic approach account for a significant number of postoperative deaths. The majority of these complications are dealt with by laparotomy. Two technical complications encountered in a series of 170 patients undergoing laparoscopic cholecystectomy and their subsequent management are presented. One patient suffered a diathermy injury to the common hepatic duct and postoperative bile leak. This was managed successfully by repeat laparoscopy and peritoneal lavage combined with endoscopic retrograde cholangiopancreatography (ERCP) and stenting of the hepatic duct. Another patient sustained a perforated duodenum complicated by peritonitis, subcutaneous wound infection and generalized sepsis. The perforation was repaired at a second laparoscopy using intracorporeal suturing and Tissucol. It is demonstrated that it is possible to deal with some of the technical complications of laparoscopic cholecystectomy with a combination of minimally invasive techniques, sparing the patient from the additional risk of laparotomy.
Adult↗
Quantification of motion characteristics and forces applied to tissues during suturing.
BACKGROUND: The quantification of movement processes describes how a movement is generated. These process measures have been shown to be effective sources of feedback to facilitate motor learning and can thus be applied to teach fundamental technical skills in surgery. The aim of this study was to determine, through detailed analyses, whether specific process measures of hand motions and forces imposed on tissues during suturing were sensitive to (1) practice and (2) levels of surgical expertise. METHODS: Six junior surgical residents (PGY-1) and 7 faculty surgeons were required to perform 20 simulated sutures on an artificial artery model, during which time the performers' hand movements were tracked by electromagnetic markers and the quantity of force they applied was measured by a force platform holding the arterial suturing models. The amount of wrist rotation and peak hand velocity produced during the suturing movement, peak and average forces applied to the tissue, the temporal difference between force and wrist rotation onsets, and the total suturing time were evaluated. RESULTS: Surgeons showed greater wrist rotation, higher average forces, shorter force-rotation initiation times, and shorter suturing times than did junior residents. Only the amount of wrist rotation and the time elapsed between force and wrist rotation onsets improved with practice for the junior group. CONCLUSIONS: Although all 4 variables measured can be used to distinguish between expert and novice performances, only the process measures (wrist rotation and force-rotation initiation time) changed as a result of practice for the junior residents. Thus, these measures can be used to facilitate skills learning by serving as a source of detailed structured feedback to trainees.
Clinical Competence↗
[When should peripheral nerves be grafted? (author's transl)].
In the presence of peripheral nerve damage, the only acceptable procedure is suture without tension, carried out under excellent conditions of fascicular approximation. In the case of loss of substance, immediate or secondary suture should never be performed. In the experience of "S.O.S. Main" secondary suture has led to the most disastrous results. Nerve graft, as an emergency, is legitimate in the case or reimplantations, in view of the high degree of technical competence of the teams, and the experience acquired. Deffered nerve graft is envisaged at about the end of the second month:--either in the absence of suture,--or in the absence of recovery. When there is any doubt, further examination at the 4 th or 5 th month ensures that treatment is not delayed too long. At all events, examinations must be repeated every two months in order to study nerve regrowth and to determine the need for possible though difficult reoperation if it stops.
Humans↗
Influence of non-penetrating glaucoma surgery on aqueous outflow facility in isolated porcine eyes.
PURPOSE: To investigate, in vitro, the influence of non-penetrating glaucoma surgery (NPGS) and the influence of tightly suturing the superficial scleral flap on the aqueous outflow facility of isolated porcine eyes. MATERIALS AND METHODS: The anterior chambers of 12 enucleated porcine cadaver eyes were cannulated and perfused. NPGS was performed by the same surgeon. The overall ocular aqueous outflow facilities were assessed before and after the surgical interventions of NPGS, as well as after scleral flap closure. RESULTS: The mean (SD) aqueous outflow facility, which was 0.164 (0.014) microl/min/mm Hg before surgery, increased significantly after NPGS to 1.584 (0.217) microl/min/mm Hg, p<0.001. When the superficial flap was closed, the aqueous outflow facility significantly decreased (0.754 (0.107) microl/min/mm Hg, p<0.001) but remained significantly higher than preoperatively (p<0.01). After suturing the superficial flap, the overall resistance increased to 1.625 (0.210) microl/min/mm Hg. The difference in the resistance to outflow before and after flap closure was 0.848 (0.169) microl/min/mm Hg. CONCLUSION: After NPGS suturing the scleral flap can modulate aqueous outflow resistance. The experimental set up described might provide an efficient model for the technical training of glaucoma surgeries.
Animals↗
Initial clinical experience with a biofragmentable ring for sutureless bowel anastomosis.
Twenty-seven patients have had bowel anastomoses with a biofragmentable ring for sutureless bowel anastomosis. There were no complications associated with the anastomotic technique. One patient developed an ischemic stricture on the proximal side of the anastomosis due to compromised circulation. There was no leakage. Technical factors regarding the BAR anastomosis are described. A properly placed purse-string suture is of primary importance. Advantages appear to be a more rapid and easy anastomosis with better healing.
Aged↗
Partial-thickness articular surface supraspinatus tears: a new transtendon suture technique.
The standard technique for repairing partial-thickness tears of the supraspinatus tendon includes completion of the lesion to a full-thickness tear. Partial articular-side supraspinatus tendon avulsions (PASTA) form a subgroup deserving special consideration. We present a transtendon suture technique that is able to preserve the intact tendon fibers and to achieve firm attachment of the tendon to the humeral footprint using 1 double-loaded bone anchor. The surgical technique is described in detail, and pitfalls and complications are noted. The clinical results of the first 22 consecutive patients are reported, showing an increase in the UCLA score from 17.1 to 31.2 points and a patient satisfaction rate of 91%.
Adult↗
Repair of chest wall defects with prosthetic material.
This report summarizes our experience during a four-year period with the repair of 8 thoracic cage and 3 diaphragmatic defects requiring reinforcement with prosthetic material. Defects as large as the entire left hemidiaphragm or the right anterior chest wall including ribs two through six from the midsternum to the midaxillary line were adequately repaired. The technical approach utilized to obtain a secure, nonmobile thoracic cage involved the placement of sutures through drill holes or around ribs, rather than through the periosteum or pericostal soft tissues. Successful diaphragmatic repair was dependent on proper anchoring of the medial border of the prosthesis, placing sutures in the pericardium as necessary. Skin coverage for thoracic cage defects was achieved with widely undermined and advanced local tissue or previously delayed pedicle flaps. All patients had good evidence of chest wall stabilization after operation, and all were removed from mechanical ventilation within three days. One patient died of myocardial infarction twenty days after operation, and a second patient died later of metastatic disease. On the basis of our experience, we conclude that the range of chest wall lesions that can be surgically corrected or palliated is increased by the use of prosthetics implanted with techniques described here.
Adult↗
Allograft aortic valve implantation: techniques for all types of aortic valve and root pathology.
The geometry and degree of symmetry of the diseased aortic root and valve dictate the technical method of implantation of the allograft aortic valve. Five methods are available that are suitable for the full range of aortic root disease: the small aortic root with a valve annulus diameter less than 21 mm, the common aortic valve lesions (valve annulus diameter, 21 to 29 mm), the aneurysmal noncoronary sinus, the moderately large annulus (valve annulus diameter greater than 30 mm), and the aneurysmal aortic root and dilated annulus. Implantation methods include the subcoronary technique, miniroot inclusion technique, and aortic root replacement. Technical variations such as valve inversion during implantation, valve rotation, and continuous or interrupted suture methods are important in certain techniques. The allograft aortic valve is a versatile device that can be used in the surgical management of the full range of aortic valve and aortic root pathology.
Aortic Valve↗
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↗
Morphogenesis and clinicopathologic characteristics of recurrent carotid disease.
The histopathologic characteristics of primary plaques and recurrent carotid disease were studied in 32 patients. These data were related to symptoms, recurrence interval (6 to 176 months), arteriographic anatomy, and in situ operative findings. A striking predilection was noted for recurrent lesions to be located in the internal carotid artery near the origin, but still within the confines, of the original endarterectomy site and suture line. Although recurrence was frequently associated with a long primary arteriotomy, evidence of technical faults or periarterial fibrosis was rare. Early recurrent lesions (recurrence interval less than 36 months, n = 13) had significantly more smooth muscle cells and proteoglycans (p less than 0.001) than late recurrent lesions (recurrence interval greater than 36 months, n = 19). As previously reported, features of atherosclerosis (abundant collagen, calcium deposits, and foam cells) were more pronounced in late recurrences (p less than 0.001). However, the histopathologic differentiation between early and late recurrent carotid disease was indistinct. A continuum was noted whereby characteristics of late recurrent lesions increased in proportion to recurrence interval. All recurrent lesions were easily distinguished from primary plaques in that recurrences had a less orderly arrangement of all elements and lacked the classic topographic features of advanced atherosclerosis. An important feature that differentiated primary and recurrent lesions was the presence of surface and intraplaque thrombus in 90% of recurrent lesions (p less than 0.001). In early recurrent disease, luminal surface thrombus was striking; this was frequently platelet-rich and showed organization devoid of neovascularity. Intraplaque thrombus was more common in late recurrent disease, consisted almost entirely of fibrin, and was often contiguous with luminal surface thrombus. No discernible relationships were noted between thrombus associated with recurrent lesions and the presence or absence of symptoms, treatment with antiplatelet agents, and hypertension. This finding suggests that thrombus was a continuous and intrinsic component of recurrent disease rather than a secondary, complicating feature. Recurrent carotid disease is a progressive lesion that stems from ongoing thrombogenesis occurring at the endarterectomy site. Organized thrombus and smooth muscle cell proliferation comprise the bulk of the lesion, which undergoes atherosclerotic change with time.
Aged↗