Search PubMed⌕ Search

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.

At least 1,747 records · Page 97Linked to original sources
PubMedDate not supplied

Mitral valve replacement in patients after aortic valve replacement.

BACKGROUND: Mitral valve replacement in patients who previously had undergone aortic valve replacement is a technical challenge. The rigid aortic prosthesis limits visualization of the anterior mitral annulus and placement of sutures. METHODS: Reoperative mitral valve replacement was performed in five patients after aortic valve replacement. Two patients underwent resternotomy to allow verification of normal aortic prosthetic valve function. Anterolateral right thoracotomy was used for reentry in the remaining three patients. Exposure of the anterior mitral annulus was accomplished by initial traction on the intact anterior leaflet, with resection of this leaflet only after placement of sutures. RESULTS: All patients survived the surgical procedure and are well 2 to 30 months after operation. In one patient it was impossible to open one cusp of the mitral prosthesis, nor was it possible to rotate the valve. The valve was reimplanted, but sutures were tied only after testing for full free cusp motion. CONCLUSIONS: When appropriate, right thoracotomy incision offers excellent exposure of the mitral valve with minimal dissection. Placement of sutures along the anterior portion of the annulus is facilitated by traction downwards on the anterior leaflet. Full range of motion of the prosthetic cusps should be verified before tying the sutures.

Aged↗
PubMed2003

A case of successfully treated inferior vena cava injury.

The inferior vena cava (IVC) is the most frequently injured retroperitoneal vascular structure. Despite the improvements in preoperative care and operation techniques, mortality rates for inferior vena cava injuries are still high due to delayed or inadequate volume recussitation, difficulty of diagnosis and technical problems in repair. A 1.5-cm sized wound at the IVC was primarly repaired by suturing. Because of appropriate and successful perioperative blood and fluid resuscitation, the patient was able to survive. We report a case of successfully treated IVC injury caused by a gunshot.

Abdominal Injuries↗
PubMed1999

Technical adjuncts in beating heart surgery comparison of MIDCAB to off-pump sternotomy: a meta-analysis.

OBJECTIVES: The technical aspects of minimal invasive surgery are discussed, together with a comparison of off-pump MIDCAB with off-pump sternotomy, with special respect to outcomes of death, infarct and anastomoses. METHODS: Technical aspects of beating heart surgery are described under the headings: Trauma; Access; Stabilisation; Ischaemia; Haemostasis; Suturing; and Circulatory support. Data from papers and meetings on minimal invasive surgery were collated to September 1998 and correlated with the unit of origin. Percentage figures were back calculated to provide an actual number from which a new data base was obtained relevant to the reporting incidence. For statistical analysis a Chi squared test with Yates correction was used. RESULTS: Sixty-three centres reported 3304 cases of MIDCAB surgery (M) and 21 centres reported over 3060 cases of off-pump surgery through a sternotomy (S). There was no difference in early or late death rates between the two groups (1.6% M:2.2% S). There was a higher infarct rate with MIDCAB (2.9% M: 1.45% S; P < 0.03). The occlusion and stenosis rates for MIDCAB were 3.9 and 6.6% whilst for sternotomy off-pump they were 4.9 and 1.4%. The stenosis difference was significant at the P < 0.001 level. A combined occlusion and stenosis rate showed a higher incidence with MIDCAB (10.5%), than sternotomy 6.4% (P < 0.08). Four major series showed comparative data before and after stabiliser usage in MIDCABs. The stenosis rate was significantly reduced with stabilisation from 9.6 to 3.7% (P < 0.002) as was the combined occlusion and stenosis rate from 16 to 5.0% (P < 0.0001). In the total series there was no significant difference in length of stay (4.6 days), incidence of atrial fibrillation (9%), or between conversion to sternotomy(MIDCAB group) or to bypass (sternotomy group) (5%) between the two groups (M and S). Grafting the right coronary artery by MIDCAB produced worse results than for the left anterior descending artery (LAD). CONCLUSIONS: There is an important failure rate with beating heart surgery; stabilisers reduce this risk and are essential tools in both MIDCAB and beating heart surgery and encourages the further use of minimally invasive approaches.

Coronary Angiography↗
PubMed1989

[Use of diverse prosthetic materials in preparation of sequential bypasses in combined lesions of the aorto-iliac-femoral axis].

A series regarding three years of surgery is analysed with regard to the preparation of four sequential by-passes out of 23 aorto-bifemoral revascularisations. Indications and the eminently technical aspects are discussed, the latter consisting of the adoption of two types of different prostheses sutured one to the other, such as the Dacron and the PTFE prostheses, which proved to be very compatible and long-lasting. The results were excellent as is testified by the follow-up.

Aorta, Abdominal↗
PubMedDate not supplied

A new technique of microlympho-venous anastomoses. Experimental study.

This experimental study in dogs presents a new technique of microlympho-venous anastomosis to improve long-term patency rates and clinical results in lymphedema therapy. Technical points, such as an oval window on the wall of the vein and a few sutures piercing only two lymphatic layers, adventitia and media, outside the lumen for successful results are emphasized. Three methods for assessment of patency of anastomoses were used: (1) observation with operating microscope of dye transit across the anastomotic site; (2) lymphography, and (3) histopathologic examination. Of 23 dogs, five were used to perfect the technique, three died after operation, while the remaining 15 were divided into three groups of five dogs each. In the first group which were explored one month after surgery, all anastomoses were patent (100% patency). In the second group, explored three months after surgery, one anastomosis was obstructed and four were patent (80% patency). In the third group, explored six months after surgery, one anastomosis was obstructed and four were patent (80% patency). The results obtained with this technique and the occurrence of a similar physiological lympho-venous anastomosis suggest that end-to-side anastomosis may be the technique of choice.

Anastomosis, Surgical↗
PubMed1988

A simplified technique for transplantation of the canine liver.

A method of orthotopic transplantation in the dog is described. It uses cuffs for the portal and lower vena caval anastomoses and a single shunt from the portal vein to the external jugular vein. The upper caval anastomosis is sutured in conventional fashion. The technique is simple and reliable producing consistent good results and minimises technical causes for failure. It is of particular value in preservation studies and has been extensively applied in this laboratory for such studies.

Animals↗
PubMedDate not supplied

An improved model for rat liver transplantation including arterial reconstruction and simplified microvascular suture techniques.

For experimental liver transplantation in the rat, the models that have been used most frequently do not include reconstruction of the arterial blood supply to the liver. In these procedures, specially developed cuff anastomoses rather than the conventional microvascular suture technique are used almost exclusively in the recipient operation, so that the anhepatic time is minimized. In this study the technical details of an improved rat model for orthotopic liver transplantation are described. During the donor operation in this experimental method, the liver is prepared with an arterial pedicle that includes the abdominal segment of the aorta, permitting perfusion in situ of the portal vein as well as the hepatic artery. The transplantation of the excised donor organ into the recipient site is carried out with simplified microvascular suture techniques and includes reconstruction of the arterial supply to the liver. Anastomosis of the bile duct is accomplished by choledocho-choledochostomy with a splint technique and supplemental suturing. For the entire procedure, magnifying glasses with 2- to 2.5-fold magnification are sufficient. When this technique has been mastered, the average duration of the anhepatic phase is about 20 min, well below the critical 30-min limit for survival of the experimental animals. As proficiency increased, the perioperative mortality was reduced to 9.2% (n = 130). With the combination of portal and arterial in situ flushing during the donor operation and the rearterialization of the transplant during the recipient operation, the clinical conditions can be approximated more closely than is possible when the transplanted rat liver is supplied only by the portal vein. Use of microvascular suture techniques, without cuff anastomoses, reduces the need for ex situ handling of the donor organ.

Anastomosis, Surgical↗
PubMed1999

Mesh-and-glue technique to prevent leakage of cerebrospinal fluid after implantation of expanded polytetrafluoroethylene dura substitute--technical note.

Expanded polytetrafluoroethylene (ePTFE) can be used as a dura substitute but is associated with leakage of cerebrospinal fluid (CSF) through the suture line. Fibrin glue alone may not prevent this problem. This new method for sealing the suture line in ePTFE membrane uses an absorbable polyglycoic acid mesh soaked with fibrinogen fluid placed on the suture line. Thrombin fluid is then slowly applied to the wet mesh, forming a large fibrin membrane reinforced by the mesh over the suture line. Only one of 33 patients in whom this technique was used had CSF leakage, whereas 12 of 59 patients in whom a dural defect was closed with ePTFE alone showed postoperative subcutaneous CSF collection (p < 0.05). Our clinical experiences clearly show the efficacy of the mesh-and-glue technique to prevent CSF leakage after artificial dural substitution. Mesh and glue can provide an adequate repair for small dural defect. The mesh-and-glue technique may also be used for arachnoid sealing in spinal surgery.

Biodegradation, Environmental↗
PubMed1993

[Material and technical stipulations for synthetic augmentation materials].

Generally used notion of "augmentation" does not present the protective effect of the ligament which has been sutured or reconstructed by the autogenic implant. "Protection" seems to be more proper notion presenting better the fulfilled function. Cruciate ligament, sutured or reconstructed by the autogenic implant from the 1/3 of the patellar ligament, is submitted to time specified healing and rebuilding processes, lasting over 1 year. Synthetic implants application creates undoubtedly protection of mentioned above rebuilding processes from functional overloading. Implants made from the resorbable materials don't fulfill the protective role for such a long period of time. That's why the non-resorbable materials implants application becomes indispensable. We keep using the polyester woven prosthesis (TREVIRA HOCHFEST) with 200 mu mesh. This kind of ligament can be strictly connected, by means of the real augmentation, with the structure it protects and can be fixed in the bones from both distal and proximal end. It is possible also to fix it following the "over the top" method in the proximal portion. For the reconstruction of ligaments with the augmentation there is a need for the synthetic prosthesis with extensibility similar to the normal cruciate ligament extensibility. In the protective plastic operation following the "over the top" method relatively stiff implants should be applied to obtain the protective "stress shield". That's why our company's offer of the cruciate ligaments implants Trevira is so varied. We use implants of 1 mm thick and of various widths: for the ligaments prosthesis--8 mm, for the so called protective plastics--5 mm and for the augmentation--3 mm of width.

Anterior Cruciate Ligament↗
PubMed1995

Rehbein's anterior resection in Hirschsprung's disease, using a circular stapler.

The results of 30 patients with Hirschsprung's disease, operated by Rehbein's anterior resection, have been evaluated. In 26 children the anastomosis was constructed with a circular stapler (Ethicon Proximate ILS) and in 4 it was handsutured. When a stapler was used, technical problems in 4, with a defect in the rings of bowel after firing the instrument, necessitated reinforcing sutures. The level of the anastomosis was significantly lower in the children in which a stapler was used. Eight children were operated by dorsal myectomy (DRM) prior to and 4 after anterior resection. The children with DRM prior to anterior resection had a significantly lower requirement for postoperative dilations. Early postoperative complications included 3.3% mortality, 6.7% enterocolitis, 3.3% anastomotic insufficiency, 3.3% early ileus and 10.0% wound infection. Three patients (10.0%) were operated for postoperative anastomotic stricture, one requiring anastomotic revision and two requiring DRM. At follow-up two children (7.4%) reported constipation with regular requirement for enemas and two (7.4%) reported daily encopresis. Twenty-three patients had 1-5 bowel movements per day and 4 patients had more than 5. In our experience the use of a circular stapler makes it possible to perform a lower anastomosis. We believe that this technique gives a wider and more elastic anastomosis and is technically less difficult to handle than a handsutured anastomosis.

Anastomosis, Surgical↗
PubMed1991

Liver transplantation in children.

Although liver transplantation is now accepted as the ideal therapy for end-stage liver disease, relatively few centers have gained a large experience in children, and good results have been elusive. Technical difficulty and a high incidence of graft failure are among the obstacles to success. At the University of California at Los Angeles, 39% of our liver transplants are in the patients who are younger than 18 years. We have analyzed our experience with 103 patients to emphasize factors important to a favorable outcome with the procedure. One hundred twenty-three transplants were performed in 103 children (mean age, 5.2 years; 48% younger than 3 years). No reduced-size grafts were used. Scrupulous attention to technical details of the vascular reconstruction, including frequent use of the supraceliac aorta of the recipient and interrupted suture techniques, ensured construction of sound hepatic artery and portal vein anastomoses at the first operation. Preoperative exchange transfusions were used if the prothrombin time was prolonged beyond 7 seconds, resulting in an average blood loss of only 3.3 volumes. Cyclosporine dosage was maintained in the high therapeutic range for the first 4 weeks, and anti-T-cell antibody (OKT3) was used for rejection (38%). Amphotericin prophylaxis was used for biliary atresia patients with multiple previous operations. Eighty-two of one hundred three patients (80%) are alive. There were no intraoperative deaths. Actuarial survival rates at 6 months, 1 year, and 5 years are 80%, 79%, and 77%, respectively. Survival of patients who underwent transplantation at age less than 1 year is 65% versus 85% at age more than 1 year (p = 0.08). Retransplantation was performed in 19 patients (18%), with a survival rate of 58%. Hepatic artery thrombosis, the most frequent technical complication, occurred in only 16 patients (13%). Survival rates of ABO identical-match versus nonidentical-match grafts were 96% and 60%, respectively (p = 0.02). Graft survival was only 47% if more than one steroid cycle was needed, compared to 75% survival with OKT3 treatment. Despite impairment of renal function (glomerular filtration rate [GFR] less than 80 cc/kg/min) in 54% of patients and hypertension requiring therapy in 27%, 90% of the children demonstrated enhancement of growth, development, and functional status. The following conclusions were made. (1) Pediatric liver transplantation is the treatment of choice for all types of end-stage liver disease and should be considered early. (2) Factors that enhance survival include technical precision, aggressive retransplantation, antifungal chemoprophylaxis and therapy, and judicious immunosuppression with use of OKT3 for rejection.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

The use of an absorbable mesh wrap in the management of major liver injuries.

Uncontrollable hemorrhage remains the predominant cause of death in patients with complex liver injuries. In view of the recently reported success in control of hemorrhage from and salvage of the injured spleen and kidney with an absorbable mesh wrap, we have begun to use a similar technique in the management of major hepatic parenchymal injuries, as an alternative to suture hepatorrhaphy, lobar resection, and perihepatic packing. The technique of mesh-wrap hepatorrhaphy is described in detail. Our initial experience with four cases is reported, demonstrating the unique features of the mesh and the technical ease with which it can be applied. Advantages over conventional techniques are discussed. These include avoidance of reoperation for removal of perihepatic packing, avoidance of hepatic necrosis after wide suture hepatorrhaphy, and avoidance of the morbidity associated with lobar resections.

Accidents, Traffic↗
PubMed1983

Technical advances in the Senning operation.

Since March 1978, 59 patients with transposition of the great arteries (TGA) ranging in age from 2 months to 6 years have undergone the Senning operation. Forty-six patients (77.9%) had transposition with intact ventricular septum, 8 of them with patent ductus arteriosus; 8 patients (13.5%) had TGA with ventricular septal defect (VSD), 3 of them with previously performed banding; 4 patients (6.7%) had TGA with VSD and pulmonary stenosis (PS), and one (1.6%) had TGA with PS. Prior to correction, 38 cases had undergone a Rashkind septotomy and 15 had had a previous Blalock-Hanlon septectomy. During this time we have introduced some technical modifications of the original Senning operation: (A) right atrial incision, (B) large left atrial wall window, (C) infrasinal suture of the left atrial flap, (D) avoidance of damage to the hypothetical anterior atrioventricular conduction bundle, and recently, in 12 patients, we have used (E) an inverted left atrial appendage as an interatrial flap. There were 9 hospital deaths (15.2%) caused by low cardiac output (4 cases), severe hypoxemia and low cardiac output (4 cases) and one patient with pulmonary venous drainage obstruction died following reoperation. Two patients developed neurological complications that disappeared without sequela. Another complication was a right chylothorax (4 patients), which improved without the necessity of surgical repair. Eighteen patients developed a junctional rhythm for a period over 24 hours. We think that the technical modifications which we present here, partially contribute to improving the Senning operation.

Cardiac Output, Low↗
PubMed1988

A century's worth of arterial sutures.

In light of the advanced state of vascular surgery today, it is hard to realize that the technique of vascular suturing is barely 100 years old. Even more remarkable is the skill with which the early surgeons applied almost all of the techniques we use today. Eck's experiments in the laboratory with portal vein-to-vena caval anastomoses were followed by pessimistic predictions concerning the future of arterial sutures. Jassinowsky had just performed the first successful arterial suture when he did a clinical arterial repair and, within 15 years, Carrel had developed nearly all the technical maneuvers which we use today. Knowledge of Carrel's work spread rapidly, and practical application of his work was reflected in the development of vascular replacements, such as venous grafting, the bypass technique used for vein grafts before World War I. There was, however, a lag in further developments until the end of the forties when dos Santos and Kunlin revived old methods and opened the way for further arterial surgical advances. These early developments are well-documented, but the reasons for delaying the acceptance of their applications remain a matter for speculation.

Arteries↗
PubMed1982

Avoidance of surgical right bundle branch block in ventricular septal defect.

Right bundle branch block (RBBB) has been the most frequent conduction disturbance in postoperative patients with a large ventricular septal defect. It has long been considered as an insignificant postoperative sequela. However, recent documentation of its possible deleterious effects on cardiac performance led us to modify the standard technique in an attempt to avoid the postoperative RBBB. In addition to approaching the defect through the right atriotomy, special care was taken for suture placement at the inferior margin and the antero-inferior corner of the defect of defect of perimembranous type. With this technical modification, the frequency of surgical RBBB in patients with a large perimembranous defect has decreased from 31.3 to 8.3 per cent.

Bundle-Branch Block↗
PubMed2003

Facilitated endoscopic beating heart coronary artery bypass grafting using a magnetic coupling device.

BACKGROUND: Suturing of a coronary anastomosis in totally endoscopic coronary artery bypass grafting on the beating heart is technically demanding. The potential benefits of the endoscopic Magnetic Vascular Positioner device (Ventrica, Inc, Fremont, Calif) to facilitate construction of a coronary anastomosis in a closed chest environment were evaluated. METHODS: Totally endoscopic coronary artery bypass grafting on the beating heart was performed in 8 foxhound-beagle inbred dogs with the da Vinci telemanipulation system (Intuitive Surgical, Mountain View, Calif). A prototype of the endoscopic Magnetic Vascular Positioner device was used to facilitate construction of the coronary anastomosis. One pair of magnets was inserted in the internal thoracic artery and left anterior descending artery using robotic instruments to guide and place the endoscopic delivery platform. All animals underwent angiography; gross inspection of the anastomotic site was performed after excision of the hearts. RESULTS: The procedure was accomplished in all animals in 169 minutes (155-190 minutes). Dissection of the left anterior descending coronary artery (6.5 minutes; 1-20 minutes), positioning of the stabilizer (8.5 minutes; 7-16 minutes), placement of occlusion tapes (6 minutes, 3-10 minutes), and arteriotomy 5.5 minutes (3-30 minutes) was achieved without problems. By use of the Magnetic Vascular Positioner device, the anastomosis at the graft site was performed with the graft still in situ. Except for 1 premature deployment, all other deployments were easily accomplished in 3 minutes (1-28 minutes). The following adverse events were encountered: bleeding from the right ventricle caused by occlusion tape (1), anastomotic leakage on reperfusion requiring repair stitches (2), and anastomotic occlusion as a result of thrombus (1). All except 1 animal with a patent graft and anastomosis survived the procedure. The overall patency was 7 of 8. DISCUSSION: The combination of robotic technology allowing for dexterous manipulation in a closed chest environment and a simple yet effective and timesaving technique for anastomotic coupling may facilitate beating heart totally endoscopic coronary artery bypass grafting.

Anastomosis, Surgical↗
PubMed2000

Reduction of lower palpebral bulge by plicating attenuated orbital septa: a technical modification in cosmetic blepharoplasty.

Bulging of the lower eyelid is regarded as a sign of aging. "Herniation" of the periorbital fat pads is traditionally regarded as the factor responsible for the change. Excision of fat pads, therefore, has been the mainstay of treatment in reducing the palpebral bulge in cosmetic blepharoplasty. The surgical excision of"excess" and "herniated" fat pads, however, causes problems such as lid ecchymosis, chemosis, lid contour irregularity, ectropion, and retrobulbar hematoma formation. The author proposes that the loss of fat pad support caused by the attenuation of the orbital septa, not herniation of the excess fat pads, is the major factor responsible for the bulge. The author further proposes that the functional integrity of the orbital septum can be restored by plicating the attenuated orbital septa with 5-0 absorbable sutures. This technique of invaginating the protruded fat pad was performed in 138 individuals (276 lower eyelids). The operation was technically simple, and the approach was "tissue friendly." The results obtained, with the exception of a mild degree of puffiness encountered soon after the surgery, were satisfactory. Morbidity was minimal.

Adult↗
PubMedDate not supplied

[The effect of various surgical technics on neuroma development using the neodymium laser].

The development of neuroma after surgery of peripheral nerves is an unsolved problem. Conventional methods like suture after cutting by seizure or bipolar coagulation cannot control it until today. Contradict results are reported since different types of laser were introduced in surgery. In an animal experimental study on rats the Neodym Yag laser is superior to conventional methods described above. After severance and reanastomosis of the sciatic nerve by laser in none of these cases a development of neuroma could be observed until three months of surviving.

Animals↗