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Sample records for all-inside suture technique

  1. All-inside arthroscopic suturing technique for meniscal ruptures.

    PubMed

    Darabos, Nikica; Dovzak-Bajs, Ivana; Bilić, Vide; Darabos, Anela; Popović, Iva; Cengić, Tomislav

    2012-03-01

    The most frequent indication for surgical treatment of the knee is lesion of the meniscus. The "all inside" arthroscopic technique with bioresorptive material for meniscus lesion is becoming the most popular treatment. This prospective study included 10 patients with posterior meniscal horn lesion operatively treated at Sports Traumatology Department. The "all inside" technique was performed by intra-articular application of bioresorptive pins-Darts sticks or Meniscus Viper and bioresorptive string. Patients were followed up for 2-6 months postoperatively and graded according to the IKDC 2000 scale. All surgical treatments showed satisfactory results. Young patients with acute longitudinal peripheral lesion-posterior horn lesions, in the red-red or red-white meniscal zone, 1-2 centimeters long are most appropriate for this type of treatment. In these patients, this technique proved to be superior and free from the risk of neurovascular damage. For better authentication of this conclusion, additional prospective randomized studies should be performed.

  2. The Optimal Placement of Sutures in All-inside Repair of Meniscocapsular Separation

    PubMed Central

    Tiftikci, Uğur; Serbest, Sancar

    2016-01-01

    Background: The aim of this study was to show the effects on the meniscus of repair applied from the femoral, the femoral-tibial and the tibial surfaces. Methods: In the treatment of meniscocapsular separation, although the accepted gold standard technique in the past was the inside-out suture technique, the current treatment method is all-inside repair methods. The all-inside techniques include the hook method and applications with a meniscus suture device. The hook method is difficult with a steep learning curve. In meniscus repair applied with the all-inside meniscus devices, the application of the suture can change the anatomic structure and position of the meniscus. Results: The suturing method applied from the tibial section of the meniscus does not disrupt the anatomic position of the meniscus in meniscocapsular separation. Thus, the optimum conditions are provided for restoration of the functions of the meniscus. Conclusion: The optimal repair in meniscocapsular separations can be considered to be that made with sutures from the tibial section of the meniscus. This technique may be helpful in obtaining better clinical results. PMID:27347236

  3. A Biomechanical Comparison of All-Inside Meniscus Repair Techniques

    PubMed Central

    Chang, Jen-Huei; Shen, Hsain-Chung; Huang, Guo-Shu; Pan, Ru-Yu; Wu, Chi-Fang; Lee, Chian-Her; Chen, Qian

    2010-01-01

    Background The aim of this study was to assess the biomechanical characteristics of six all-inside meniscal single suture repair techniques using a porcine model. Materials and Methods Peripheral longitudinal tears were created in freshly isolated porcine menisci. Tears were repaired using the single vertical technique with six different repair complexes including those involving sutures (#2 FiberWire, #2 Ethibone, flexible anchors (Fast-Fix, RapidLoc), and rigid anchors (Meniscal-Dart, BioStinger). Displacement, ultimate failure strength, stiffness, and site of failure were measured using a Materials Testing System machine. An initial 2 N preload was applied, followed by loading between 5 and 20 N for 300 cycles. Failure strength was determined lastly by increasing tension at a rate of 5 mm/min until failure. Results Failure strength was highest in the #2 FiberWire group (175.6 N). This was significantly higher than in all other groups (P <0.05). The second highest failure load was evident in the #2 Ethibone group (113.8 N). This was significantly higher than in all other groups bar the #2 FiberWire group (P <0.05). Stiffness was also significantly higher in the #2 FiberWire group compared with all other groups (8.5 N/mm, P < 0.05). There were no between-group differences in displacement. When grouped by repair technique, failure load was significantly higher, and displacement was significantly lower, in suture compared with both flexible and rigid anchor repaired menisci (P < 0.01 for all comparisons). Although stiffness was also higher in the suture group, there were no significant between-group differences detected. Conclusions Suture techniques exhibited biomechanical superiority over biodegradable flexible and rigid anchor devices for meniscus repair. PMID:19328497

  4. All-Inside Posterior Cruciate Ligament Reconstruction: GraftLink Technique

    PubMed Central

    Prince, Matthew R.; Stuart, Michael J.; King, Alexander H.; Sousa, Paul L.; Levy, Bruce A.

    2015-01-01

    Posterior cruciate ligament (PCL) injuries account for nearly 20% of knee ligament injuries. PCL injuries can occur in isolation or, more commonly, in the setting of multiligamentous knee injuries. Isolated PCL disruptions are commonly treated nonoperatively; however, symptomatic grade III injuries, as well as PCL injuries found in multiligamentous injuries, are frequently treated surgically. Several reconstructive techniques exist for the treatment of PCL deficiency without a clear optimal approach. We describe our preferred operative technique to reconstruct the PCL using an all-inside arthroscopic approach with a quadrupled tibialis anterior or peroneus longus allograft with both tibial and femoral suspensory fixation. PMID:26900564

  5. All-Inside Posterior Cruciate Ligament Reconstruction: GraftLink Technique.

    PubMed

    Prince, Matthew R; Stuart, Michael J; King, Alexander H; Sousa, Paul L; Levy, Bruce A

    2015-10-01

    Posterior cruciate ligament (PCL) injuries account for nearly 20% of knee ligament injuries. PCL injuries can occur in isolation or, more commonly, in the setting of multiligamentous knee injuries. Isolated PCL disruptions are commonly treated nonoperatively; however, symptomatic grade III injuries, as well as PCL injuries found in multiligamentous injuries, are frequently treated surgically. Several reconstructive techniques exist for the treatment of PCL deficiency without a clear optimal approach. We describe our preferred operative technique to reconstruct the PCL using an all-inside arthroscopic approach with a quadrupled tibialis anterior or peroneus longus allograft with both tibial and femoral suspensory fixation. PMID:26900564

  6. New Complication Associated With All-Inside Meniscal Repair Device

    PubMed Central

    Warth, Lucian C.; Bollier, Matthew J.; Hoffman, Douglas F.; Cummins, Justin S.; Hall, Mederic M.

    2016-01-01

    Background: The importance of meniscal preservation has become widely accepted, and meniscal repair techniques have evolved over recent years. With new techniques come new complications, which are critical to recognize. Purpose: To describe a new complication of foreign body reaction from a nonabsorbable suture anchor associated with improper placement of the all-inside meniscal device. Study Design: Case series; Level of evidence, 4. Methods: This study was a retrospective review of 3 patients who developed pain associated with a foreign body reaction from a misplaced all-inside meniscal device. Results: All patients had a delayed diagnosis (6 months to 8 years) and negative magnetic resonance imaging (MRI). Diagnostic ultrasound identified the misplaced suture with foreign body reaction and was used to guide a diagnostic injection of local anesthetic prior to surgical intervention. Intraoperative ultrasound guidance was utilized to precisely localize and excise the suture material and associated reactive tissue. Conclusion: Foreign body reaction from a misplaced all-inside meniscal device is a previously unreported complication. Diagnosis is challenging as MRI and arthroscopy can be unrevealing. Diagnostic ultrasound was able to identify the foreign body reaction, confirm the diagnosis by facilitating diagnostic local anesthetic injection, and guide surgical excision. Sonographic evaluation should be considered in patients presenting with ongoing knee pain after all-inside meniscus repair. PMID:27635413

  7. New Complication Associated With All-Inside Meniscal Repair Device

    PubMed Central

    Warth, Lucian C.; Bollier, Matthew J.; Hoffman, Douglas F.; Cummins, Justin S.; Hall, Mederic M.

    2016-01-01

    Background: The importance of meniscal preservation has become widely accepted, and meniscal repair techniques have evolved over recent years. With new techniques come new complications, which are critical to recognize. Purpose: To describe a new complication of foreign body reaction from a nonabsorbable suture anchor associated with improper placement of the all-inside meniscal device. Study Design: Case series; Level of evidence, 4. Methods: This study was a retrospective review of 3 patients who developed pain associated with a foreign body reaction from a misplaced all-inside meniscal device. Results: All patients had a delayed diagnosis (6 months to 8 years) and negative magnetic resonance imaging (MRI). Diagnostic ultrasound identified the misplaced suture with foreign body reaction and was used to guide a diagnostic injection of local anesthetic prior to surgical intervention. Intraoperative ultrasound guidance was utilized to precisely localize and excise the suture material and associated reactive tissue. Conclusion: Foreign body reaction from a misplaced all-inside meniscal device is a previously unreported complication. Diagnosis is challenging as MRI and arthroscopy can be unrevealing. Diagnostic ultrasound was able to identify the foreign body reaction, confirm the diagnosis by facilitating diagnostic local anesthetic injection, and guide surgical excision. Sonographic evaluation should be considered in patients presenting with ongoing knee pain after all-inside meniscus repair.

  8. Fourier technique for studying ammonoid sutures

    SciTech Connect

    Gildner, R.F.; Ackerly, S.C.

    1985-01-01

    Suture patterns have long been recognized as being of primary importance in the study of ammonoids. The authors have developed a technique to use Fourier analysis to study these structures by using a simple transformation: x-y data of a digitized suture are transformed to angle of slope versus position along the suture's length. A Fast Fourier Transform applied to the data produces a power spectrum (amplitude versus wave number) providing a precise and accurate measure of suture shape. The authors have applied this technique to the analysis of ontogenetic change in suture morphology. In goniatitic, ceratitic and preadult ammonitic patterns most of the change is exhibited in the amplitudes of the lowest ten wave numbers. Their Fourier coefficients clearly show trends not readily apparent by visual inspection. The more complex ammonitic patterns are reflected in increased amplitudes of higher wave numbers (a broader peak of the power spectrum) and their analysis is necessarily more complex. The Fourier approach presents the opportunity to quantitatively measure and describe the tempo and mode of evolution in the Ammonoidea. Potential applications of the new technique, as well as limitations, are discussed with special attention to investigations of ammonoid ontogeny and phylogeny.

  9. Techniques and applications of adjustable sutures.

    PubMed

    Fells, P

    1987-02-01

    The 'rediscovery' of adjustable sutures some 10 years ago has given the ophthalmic surgeon much more confidence in his ability to correct strabismus. Three methods of use are described: during surgery under general anaesthesia with adjustment during the operation using the 'springback' test to centralise the eye; during surgery under general anaesthesia and subsequent adjustment under local anaesthesia using the patient's subjective responses to obtain optimal positioning; and performance of the operation and adjustment under topical local anaesthesia in one procedure. Full details are given of each technique and the indications for their application to particular problems are discussed. PMID:3297111

  10. All-inside anterior cruciate ligament reconstruction.

    PubMed

    Blackman, Andrew J; Stuart, Michael J

    2014-10-01

    All-inside anterior cruciate ligament (ACL) reconstruction has undergone a series of modifications over the past 20 years. Current techniques offer the advantages of improved cosmesis, less postoperative pain, decreased bone removal, and gracilis preservation. Few all-inside ACL reconstruction outcome studies are available; therefore, additional research is necessary to compare the results to conventional techniques. The purpose of this article is to review the evolution of all-inside ACL reconstruction, the advantages and disadvantages, our preferred technique, and clinical experience to date.

  11. Structural grafts and suture techniques in functional and aesthetic rhinoplasty

    PubMed Central

    Gassner, Holger G.

    2011-01-01

    Rhinoplasty has undergone important changes. With the advent of the open structure approach, requirements for structural grafting and direct manipulation of the cartilaginous skeleton through suture techniques have increased substantially. The present review analyzes the current literature on frequently referenced structural grafts and suture techniques. Individual techniques are described and their utility is discussed in light of available studies and data. PMID:22073105

  12. Suture Bridge Fixation Technique for Posterior Cruciate Ligament Avulsion Fracture.

    PubMed

    Lee, Kwang Won; Yang, Dae Suk; Lee, Gyu Sang; Choy, Won Sik

    2015-12-01

    We presented a surgical technique including a suture bridge technique with relatively small incision for the reduction and fixation of posterior ligament avulsion fractures. A suture anchor was used to hold the avulsed fragment and a knotless anchor was used to continuously compress the bony fragment into the fracture site, thereby maintaining reduction during healing.

  13. Interdomal Suture through a Nondelivery Endonasal Approach: A New Technique

    PubMed Central

    Leibou, Lior

    2016-01-01

    Background: The use of interdomal sutures for tip refinement is common in open rhinoplasty and in endonasal rhinoplasty using a delivery technique, but there is paucity of reports in the literature regarding the use of interdomal suturing techniques when the nondelivery endonasal approach is chosen. Objective: The authors describe a technique designed to refine the nasal tip with an interdomal suture placed through a nondelivery endonasal approach. Methods: In this study, the authors retrospectively review the cases of 45 patients who underwent endonasal rhinoplasty with the authors’ interdomal suturing technique between the years 2011 and 2013. The average age of the patients was 25.3 years. Intercrural sutures (PDS 4.0 straight needle, Cincinnati, Ohio) were placed as mattress-like suture in the tip region, with the knot buried between both alar cartilages. The suture is tightened progressively according to the tip definition and narrowing sought. Results: The patients were followed for 12 months. All of the patients demonstrated a significant reduction in lobule and tip widths. This series had only 1 complication of tip asymmetry that was revised 1 year after the initial operation. There were no cases of infection, allergic reaction, or extrusion of the suture. Conclusions: Despite the lack of a large volume of patients, our study confirms that this technique is indeed an attractive and highly predictable option for achieving adequate tip refinement and definition when using a nondelivery endonasal rhinoplasty. PMID:27622086

  14. Interdomal Suture through a Nondelivery Endonasal Approach: A New Technique

    PubMed Central

    Leibou, Lior

    2016-01-01

    Background: The use of interdomal sutures for tip refinement is common in open rhinoplasty and in endonasal rhinoplasty using a delivery technique, but there is paucity of reports in the literature regarding the use of interdomal suturing techniques when the nondelivery endonasal approach is chosen. Objective: The authors describe a technique designed to refine the nasal tip with an interdomal suture placed through a nondelivery endonasal approach. Methods: In this study, the authors retrospectively review the cases of 45 patients who underwent endonasal rhinoplasty with the authors’ interdomal suturing technique between the years 2011 and 2013. The average age of the patients was 25.3 years. Intercrural sutures (PDS 4.0 straight needle, Cincinnati, Ohio) were placed as mattress-like suture in the tip region, with the knot buried between both alar cartilages. The suture is tightened progressively according to the tip definition and narrowing sought. Results: The patients were followed for 12 months. All of the patients demonstrated a significant reduction in lobule and tip widths. This series had only 1 complication of tip asymmetry that was revised 1 year after the initial operation. There were no cases of infection, allergic reaction, or extrusion of the suture. Conclusions: Despite the lack of a large volume of patients, our study confirms that this technique is indeed an attractive and highly predictable option for achieving adequate tip refinement and definition when using a nondelivery endonasal rhinoplasty.

  15. Optimal Suturing Technique and Number of Sutures for Surgical Implantation of Acoustic Transmitters in Juvenile Salmonids

    SciTech Connect

    Deters, Katherine A.; Brown, Richard S.; Boyd, James W.; Eppard, M. B.; Seaburg, Adam

    2012-01-02

    The size reduction of acoustic transmitters has led to a reduction in the length of incision needed to implant a transmitter. Smaller suture knot profiles and fewer sutures may be adequate for closing an incision used to surgically implant an acoustic microtransmitter. As a result, faster surgery times and reduced tissue trauma could lead to increased survival and decreased infection for implanted fish. The objective of this study was to assess the effects of five suturing techniques on mortality, tag and suture retention, incision openness, ulceration, and redness in juvenile Chinook salmon Oncorhynchus tshawytscha implanted with acoustic microtransmitters. Suturing was performed by three surgeons, and study fish were held at two water temperatures (12°C and 17°C). Mortality was low and tag retention was high for all treatments on all examination days (7, 14, 21, and 28 days post-surgery). Because there was surgeon variation in suture retention among treatments, further analyses included only the one surgeon who received feedback training in all suturing techniques. Incision openness and tissue redness did not differ among treatments. The only difference observed among treatments was in tissue ulceration. Incisions closed with a horizontal mattress pattern had more ulceration than other treatments among fish held for 28 days at 17°C. Results from this study suggest that one simple interrupted 1 × 1 × 1 × 1 suture is adequate for closing incisions on fish under most circumstances. However, in dynamic environments, two simple interrupted 1 × 1 × 1 × 1 sutures should provide adequate incision closure. Reducing bias in survival and behavior tagging studies is important when making comparisons to the migrating salmon population. Therefore, by minimizing the effects of tagging on juvenile salmon (reduced tissue trauma and reduced surgery time), researchers can more accurately estimate survival and behavior.

  16. Anatomic All-Inside Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autograft.

    PubMed

    Crall, Timothy S; Gilmer, Brian B

    2015-12-01

    All-inside anterior cruciate ligament reconstruction has recently gained popularity, in part because of its bone-sparing socket preparation and reported lower pain levels after surgery. However, because this technique uses suture loops and cortical suspension buttons for graft fixation, it has mostly been limited to looped graft constructs (e.g., hamstring autograft, peroneus longus allograft). Quadriceps tendon autograft offers several advantages in anterior cruciate ligament reconstruction but, until recently, has not been compatible with suture-loop and cortical suspensory fixation. We describe a technique that allows a relatively short (<75 mm) quadriceps tendon autograft (without bone block) to be used with established all-inside anatomic techniques. PMID:27284521

  17. Modified Margin Convergence: Over-Under Lacing Suture Technique

    PubMed Central

    Métais, Pierre; Lanzone, Roberto; Lim, Chauncey Kester; Albino, Paolo; Carbone, Stefano

    2015-01-01

    The principle of margin convergence can be applied to rotator cuff repair to enhance the security of fixation by decreasing the mechanical strain at the margins of the tear. We describe a suture technique, over-under lacing, that reproduces the same margin convergence, with equal tissue tension across the entire surface area of the cuff. A consecutive series of patients affected by massive U-shaped rotator cuff tears were treated by this repair technique. Preoperative diagnosis, tear assessment, and grading of fatty infiltration of the cuff muscles were based on arthro–computed tomography evaluation. The technique passes 2 sutures from the medial to lateral margin of the tear, with a knotless suture anchor for tendon-to-bone fixation. The proposed technique seems to reduce tensile strain on the repaired tendon, can reconstruct the rotator cuff cable, and can attain the balanced pull of the tendon in a medial-to-lateral fashion. The over-under lacing suture technique is both simple and reproducible. This technique may achieve the goals of margin convergence with satisfactory preliminary clinical results for patients with massive rotator cuff tears. PMID:26697304

  18. Total laparoscopic hysterectomy via suture and ligation technique

    PubMed Central

    Kang, Hye Won; Lee, Ji Won; Kim, Ho Yeon; Kim, Bo Wook

    2016-01-01

    Objective The term 'total laparoscopic hysterectomy (TLH) with classical suture method' refers to a surgical procedure performed using only sutures and ligations with intracorporeal or extracorporeal ties, without using any laser or electronic cauterization devices during laparoscopic surgery as in total abdominal hysterectomy. However, the method is not as widely used as electric coagulation equipment for TLH because further advances in technology and surgical technique are required and operative time can take longer. In the current study, we evaluated the benefits of the classical suture method for TLH. Methods This study retrospectively reviewed patients who received TLH using the classical suture method from August 2005 to April 2014. The patients' baseline characteristics were analyzed, including age, parity, cause of operation, medical and surgical history. Surgical outcomes analyzed included the weight of the uterus, operative time, complications, changes in hemoglobin level, blood transfusion requirements, and postoperative hospital stay. Results Of 746 patients who underwent TLH with the classical suture method, mean operation time was 96.9 minutes. Mean average decline in hemoglobin was 1.6 g/dL and transfusion rate was 6.2%. Urinary tract injuries were reported in 8 patients. Urinary tract injuries comprised 6 cases of bladder injury and 3 cases of ureter injury. There were no cases of vaginal stump infection, hematoma, bowel injury or abdominal wound complication. All cases involving complications occurred before 2010. Conclusion The classical suture method for TLH presents tolerable levels of complications and blood loss. Advanced surgical skill is expected to decrease operation time and complications. PMID:26866034

  19. Iris mattress suture: a technique for sectoral iris defect repair.

    PubMed

    Tsao, Sean W; Holz, Huck A

    2015-03-01

    Achieving a cosmetic and functional outcome from iris defect repair is a surgical challenge. We describe an adaptation of techniques to address a case of 2.5 clock hours of sectoral iris tissue defect. Our method combines Siepser's modified closed-chamber sliding knot technique with the placement of a double-armed iris mattress suture to approximate iris tissue to the scleral wall and thereby create a pseudo-iris root. This technique reduces glare and achieves a cosmetic outcome for the patient.

  20. Half-bow sliding knot: modified suture technique for scleral fixation using the corneoscleral pocket.

    PubMed

    Chee, Soon-Phaik

    2011-09-01

    A modified suture technique for precise knot placement in the Hoffman corneoscleral pocket technique of scleral fixation is described. Both loops of the polypropylene suture passing from the intraocular device through the sclera and conjunctiva are retrieved from the pocket. A loop of suture is pulled through 3 suture throws made using the second suture loop, forming a half bow. Centration of the intraocular lens (IOL)-capsular bag is checked. If the suture tension is too tight, the surgeon can easily undo the knot of the half-bow knot by pulling it free and can then retie the sliding knot. When the IOL-capsular bag is centered, the suture loop is cut and the free end removed. The second suture end is retrieved from the pocket, and knot tying is completed without further adjustment to the tension. Posterior pressure on the intraocular device centers it and settles the knot within the sclera at the fixation point.

  1. Description of a novel technique for suture ligation of the renal vessels during robotic nephrectomy.

    PubMed

    Patel, Manish N; Laungani, Rajesh; Shrivastava, Alok; Bhandari, Akshay; Spencer Krane, L; Menon, Mani; Rogers, Craig G

    2009-03-01

    Minimally invasive techniques are frequently used for surgical treatment of suspected malignant renal masses. We previously reported on our experience with robotic nephrectomy and the feasibility of performing suture ligation of the renal vessels using robotic needle drivers. We describe a novel technique for suture ligation of the renal vessels during robotic nephrectomy utilizing the robotic hook and a suture with loops at each end. Our technique for suture ligation of the renal vessels recapitulates the open technique without the need for exchanging the robotic working instruments for robotic needle drivers and without the need for endovascular staplers. PMID:27628449

  2. Healing of the goat anterior cruciate ligament after a new suture repair technique and bioscaffold treatment.

    PubMed

    Nguyen, D Tan; Geel, Jurre; Schulze, Martin; Raschke, Michael J; Woo, Savio L-Y; van Dijk, C Niek; Blankevoort, Leendert

    2013-10-01

    Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining conditions can be improved by introducing a new suturing technique and by using small intestinal submucosa (SIS) as a bioscaffold. It is hypothesized that the suturing technique keep the torn ends together and that SIS enhance and promote the healing of the ACL. The goat was used as the study model. In the Suture group, the left ACL was transected and suture repaired with a new locking suture repair technique (n=5) allowing approximation and fixation under tension. The Suture-SIS group underwent the same procedure with the addition of SIS (n=5). The right ACL served as control. After 12 weeks of healing, anterior-posterior translation and in situ force of the healing ACL were measured, followed by the measurement of the cross-sectional area and structural stiffness. Routine histology was performed on tissue samples. Gross morphology showed that the healing ACL was continuous with collagenous tissue in both groups. The cross-sectional area of the Suture and the Suture-SIS group was 35% and 50% of the intact control, respectively. The anterior-posterior translations at different flexion angles were statistically not different between the Suture group and the Suture-SIS group. Only the in situ force at 30° in the Suture-SIS group was higher than in the Suture group. Tensile tests showed that the stiffness for the Suture group was not different from the Suture-SIS group (31.1±8.1 N/mm vs. 41.9±18.0 N/mm [p>0.05]). Histology showed longitudinally aligned collagen fibers from origo to insertion. More fibroblasts were present in the healing tissue than in the control intact tissue. The study demonstrated the proof of concept of ACL repair in a goat model with a new suture

  3. Sequential lift and suture technique for post-LASIK corneal striae.

    PubMed

    Mackool, Richard J; Monsanto, Vivian R

    2003-04-01

    We describe a surgical technique to manage persistent corneal striae after laser in situ keratomileusis (LASIK). The sequential lift and suture technique reduces the time required for LASIK, eliminates the need to fixate the flap with forceps during suturing, and increases the accuracy of suture placement. The results in 10 eyes (9 patients) showed complete resolution of striae with improvement in subjective symptoms (glare and blurred vision) and best corrected visual acuity.

  4. Modified technique of stapled esophagojejunostomy without a purse-string suture.

    PubMed

    Seshadri, Ramakrishnan Ayloor; Thammaiah, Siddappa K; Vaidhyalingam, Venktesh

    2011-09-01

    Placement of a purse-string suture during a stapled esophagojejunostomy following total gastrectomy is a technically demanding and time consuming procedure. Improper placement of the purse-string suture can lead to anastamotic breakdown with its associated complications. We describe a technique of stapled esophagojejunostomy without using a purse-string suture. We used this technique in 35 patients including 4 patients who underwent an extended total gastrectomy. We encountered a difficulty only in one patient due to malfunction of the stapler. None of the patients had an anastamotic leak. The modified technique of stapled esophagojejunostomy without a purse-string suture makes the procedure more easy, safe and simple.

  5. Strength of the suture in the epitenon and within the tendon fibres: development of stronger peripheral suture technique.

    PubMed

    Mashadi, Z B; Amis, A A

    1992-04-01

    In tendon repair, the peripheral stitches are usually placed in the epitenon, but it has not yet been defined whether the grasping strength of the sutures in the epitenon and within the tendon fibres are different. The first stage of this work investigated this difference and found that peripheral stitches within cadaveric tendon fibres were 83% stronger than those in the epitenon layer. A new peripheral stitch, based on this finding, has been designed. Mechanical tests of a range of peripheral suture types in vitro found that the new technique gave a resistance to gap formation twice that of the peripheral stitches commonly in use at present and a rupture strength more than three times, while still avoiding eversion problems. PMID:1534111

  6. A Medial Meniscal Root Pullout Repair With the Use of a Tibial Tunnel Suturing Technique.

    PubMed

    Apivatgaroon, Adinun; Chernchujit, Bancha

    2016-06-01

    A meniscal root tear is one of the common knee injuries that can lead to degenerative changes in the knee joint. Meniscal root repairs can restore proper biomechanics of the knee joint. We have developed a suturing technique that uses a tibial tunnel for a pullout suture medial meniscal root repair. This is a straightforward technique that helps to promote simple suturing of the medial meniscal root, avoid iatrogenic injuries to the articular cartilage, and produce an additional working portal during a meniscal root repair. PMID:27656383

  7. Outcome of repair of chronic tear of the pectoralis major using corkscrew suture anchors by box suture sliding technique

    PubMed Central

    Joshi, Deepak; Jain, Jitesh Kumar; Chaudhary, Deepak; Singh, Utkarsh; Jain, Vineet; Lal, Ajay

    2016-01-01

    AIM To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique. METHODS In this retrospective study, we reviewed the results of pectoralis major repair in 11 chronic cases (> 6 wk) done between September 2011 and December 2014 at our institute. In all cases repair was done by same surgeon using corkscrew suture anchors and box suture sliding technique. At 6 mo, after surgery magnetic resonance imaging was done to see the integrity of the repair. Functional evaluation was done using Penn and ASES scores. Pre and postoperative Isokinetic strength was measured. RESULTS Average follow-up was 48.27 ± 21.0 mo. The Wilcoxon signed rank test was used to evaluate the outcome scores. The average ASES score increased from an average of 54.63 ± 13.0 preoperatively to 95.09 ± 2.60 after surgery at their last follow-up. The average Penn score also increased from 5.72 ± 0.78, 2.81 ± 1.32 and 45.81 ± 1.72 to 9.36 ± 0.80, 8.27 ± 0.90 and 59 ± 1.34 for pain, satisfaction and function respectively. Follow up magnetic resonance imaging (MRI) (at 6 mo) showed continuity and the bulk of pectoralis major muscle in all cases. Average isokinetic strength deficiency in horizontal adduction at 60° was 13.63% ± 6.93% and at 120° was 10.18% ± 4.93% and in flexion at 60° was 10.72% ± 5.08% and at 120° was 6.63% + 3.74%. Results showed that both ASES and Penn score improved significantly (2 tailed P value = 0.0036). CONCLUSION We could conclude from this series that pectoralis major repair even in chronic cases using 5.5 mm corkscrew anchors give excellent functional and cosmetic results. In chronic cases the repairable length of the tendon is not available and sliding suture technique allows for fixation of worn out tendomuscular junction to bone without letting cutting through the muscle. PMID:27795949

  8. Closure of round cutaneous defects progressively with the purse string suture technique

    PubMed Central

    Küçükdurmaz, Fatih; Agir, Ismail; Gümüstas, Seyitali; Kivilcim, Hakan; Tetik, Cihangir

    2015-01-01

    Introduction There are many closure techniques available to cutaneous surgeons. One of them is the purse-string suture which is used to provide complete or partial closure of round skin defects. In our animal study; we closed skin defects with using subcuticular purse string suture technique by progressively cinching wound and we aim to more rapidly healing according to secondary healing. Methods After anaesthetize, we created a 4 cm diameter circular full thickness skin defect on dorsal area of rats. In group 1, subcuticular purse string suture was applied by using a nonabsorbable and monofilament suture and a sliding arthroscopic knot was applied to both ends. Arthroscopic suture was shift 1 cm forward every day. In group 2 skin defect was leaved open and daily dressing was made and in both group defect diameters were measured every day and noted. Results The skin defects were closed totally after 15 days in group 1 but in group 2 defects were reduced but still had a mean 1,5-cm diameter sircular defect. Conclusion Closing large circular wound with purse string suture and gradual tightening decreases the healing time and expand the skin tissue without using any tissue expander. PMID:26600915

  9. Hamstring graft fixation in MPFL reconstruction at the patella using a transosseous suture technique.

    PubMed

    Siebold, Rainer; Chikale, Shivanand; Sartory, Nico; Hariri, Nawid; Feil, Sven; Pässler, Hans H

    2010-11-01

    Controversy still exists about fixation methods of a hamstring graft to the patella in case of medial patellofemoral ligament (MPFL) reconstruction. This article presents a surgical technique of hamstring tendon graft fixation to the anatomical MPFL insertion on the patella using transosseous sutures. A superficial bony sulcus is created at the anatomical MPFL insertion site on the medial patellar rim with a bur. A looped hamstring tendon graft is fixed to this superficial sulcus by a pair of nonresorbable transosseous sutures passed across the patella. The retinaculum is sutured on top of the hamstring tendon graft at the level of the patella for additional fixation. The technique avoids bone tunnels as well as hardware at the patella. It reduces the risk of intraoperative or postoperative patella fracture or implant-related complications. The stable transosseous fixation technique allows for early rehabilitation.

  10. Tram-Track Suture Technique for Pupillary Capture of a Scleral Fixated Intraocular Lens

    PubMed Central

    Kim, Sung In; Kim, Kiseok

    2016-01-01

    Purpose To report a new technique using tram-track suture for pupillary capture of a scleral fixated posterior chamber intraocular lens (PC-IOL) to reposition the tilted IOL. Methods In this prospective interventional case series, we describe a tram-track suture for pupillary capture of a scleral fixated PC-IOL. A long straight needle with double-armed 10-0 polypropylene is passed behind the iris and just above the optic portion (tilted forward) of the IOL. The other straight needle with double-armed 10-0 polypropylene is passed just below the optic portion (tilted backward) of the IOL. After the IOL is repositioned properly, the polypropylene sutures are gently pulled and tied. Results Four eyes of 4 patients underwent tram-track suture for pupillary capture of a scleral fixated PC-IOL. No intra- or postoperative complications were noted, and no pupillary captures were detected during the follow-up period. Conclusions The tram-track suture technique provides good centration and stability of a PC-IOL. This technique is an easy and effective way to reposition pupillary capture of an IOL. Further, it is also minimally invasive as it maintains a closed system. PMID:27462257

  11. An All-Inside Repair for Full Radial Posterior Lateral Meniscus Tears.

    PubMed

    Soejima, Takashi; Tabuchi, Kousuke; Noguchi, Kouji; Inoue, Takashi; Katouda, Michihiro; Murakami, Hidetaka; Horibe, Shuji

    2016-02-01

    There is controversy about the treatment for unstable full radial posterior lateral meniscus tears, particularly that involving the posterior root. Some surgeons have advocated repairing these types of meniscus tears using various techniques, but their methods are somewhat technical. We developed the technique for an all-inside repair for full radial posterior lateral meniscus tears using the Meniscal Viper (Arthrex, Naples, FL). A doubled thread is passed through 1 edge of the radial tear by the Meniscal Viper and is kept in place without tying the knot. The Meniscal Viper is used again to set a new thread, repeating the same procedure to another edge of the tear. At this step, 2 doubled threads are passed through each stump of the tear, and both a loop end and 2 free ends of each thread are located outside of the joint. Then, 2 doubled threads pass the third thread into its own loop, pulling it out. Finally, the third thread becomes the mattress suture over the radial tear site and is fastened by sliding knot techniques. This procedure makes it easy to strictly, smoothly, and less invasively shorten the gap by drawing each stump of the meniscus in the direction of the circumference.

  12. Novel Suture Anchor Technique with Continuous Locking Stitch for Collateral Ligament Repair.

    PubMed

    Tokunaga, Susumu; Abe, Yoshihiro

    2016-06-01

    Collateral ligaments are difficult to repair due to large amount of fraying in detached ligaments and attenuated stumps that may not provide enough strength after the repair. Although strong locking sutures are used to repair the ligament with proper tension, these damages can cause pull-out failure or relaxation of the repaired ligaments even from undersized load that may extend postoperative splinting or casting time. Furthermore, current suture techniques can repair varus or valgus instability of the elbow and radial or ulnar instability of the fingers, but these techniques do not offer rotatory stability of these areas. We have developed a novel suture anchor technique that has overcome this problem of current suture techniques, and this can be used to correct rotatory instability in the elbow and fingers. We used this procedure in seven cases with injury of collateral ligament in the elbow and eight cases with detached collateral ligaments of finger joint. No patient experienced rerupture or any kind of residual instability. We believe that the proposed method can produce much stronger repair and may shorten the postoperative immobilization period.

  13. The “excluding” suture technique for surgical closure of ventricular septal defects: A retrospective study comparing the standard technique

    PubMed Central

    Varghese, Roy; Saheed, Sanni; Ravi, Amrutha K; Sherrif, Ejaz Ahmed; Agarwal, Ravi; Kothandam, Sivakumar

    2016-01-01

    Background: Conventional methods of closure of ventricular septal defects involve placement of sutures 4-5 mm from the posterior inferior margin. This study compares the conventional method with an alternative technique wherein sutures are placed along the edge of the defect thereby “excluding” the conduction system and the tensor apparatus of the tricuspid valve from the suture line. Materials and Methods: Between January 2013 and January 2016, 409 consecutive patients were retrospectively reviewed and divided into two matched groups. Group A (n = 174) underwent closure using the alternative technique and Group B (n = 235) with the conventional technique. Patients with isolated ventricular septal defects (VSDs) (n = 136) were separately analyzed as were infants within this subset. Results: Immediate postoperative results were similar with no statistically significant differences in either group in terms of incidence of residual defects or postoperative tricuspid regurgitation. There was however a significantly increased incidence of post operative complete heart block (CHB) among patients in the conventional group (P = 0.02). Incidence of temporary heart block that reverted to sinus rhythm was also more in the conventional method group (Group B) (P = 0.03) as was right bundle branch block (P ≤ 0.05) in all the subsets of patients analyzed. Conclusion: Surgical closure of VSDs can be accomplished by placing sutures along the margins or away with comparable results. The incidence of CHB, however, seems to be less when the “excluding” technique is employed.

  14. The “excluding” suture technique for surgical closure of ventricular septal defects: A retrospective study comparing the standard technique

    PubMed Central

    Varghese, Roy; Saheed, Sanni; Ravi, Amrutha K; Sherrif, Ejaz Ahmed; Agarwal, Ravi; Kothandam, Sivakumar

    2016-01-01

    Background: Conventional methods of closure of ventricular septal defects involve placement of sutures 4-5 mm from the posterior inferior margin. This study compares the conventional method with an alternative technique wherein sutures are placed along the edge of the defect thereby “excluding” the conduction system and the tensor apparatus of the tricuspid valve from the suture line. Materials and Methods: Between January 2013 and January 2016, 409 consecutive patients were retrospectively reviewed and divided into two matched groups. Group A (n = 174) underwent closure using the alternative technique and Group B (n = 235) with the conventional technique. Patients with isolated ventricular septal defects (VSDs) (n = 136) were separately analyzed as were infants within this subset. Results: Immediate postoperative results were similar with no statistically significant differences in either group in terms of incidence of residual defects or postoperative tricuspid regurgitation. There was however a significantly increased incidence of post operative complete heart block (CHB) among patients in the conventional group (P = 0.02). Incidence of temporary heart block that reverted to sinus rhythm was also more in the conventional method group (Group B) (P = 0.03) as was right bundle branch block (P ≤ 0.05) in all the subsets of patients analyzed. Conclusion: Surgical closure of VSDs can be accomplished by placing sutures along the margins or away with comparable results. The incidence of CHB, however, seems to be less when the “excluding” technique is employed. PMID:27625520

  15. Traumatic lumbar hernia repair: a laparoscopic technique for mesh fixation with an iliac crest suture anchor.

    PubMed

    Links, D J R; Berney, C R

    2011-12-01

    Traumatic lumbar hernia (TLH) is a rare presentation. Traditionally, these have been repaired via an open approach. Recurrence can be a problem due to the often limited tissue available for mesh fixation at the inferior aspect of the hernia defect. We report the successful use of bone suture anchors placed in the iliac crest during transperitoneal laparoscopy for mesh fixation to repair a recurrent TLH. This technique may be particularly useful after previous failed attempts at open TLH repair.

  16. Clinical and Radiological Evaluation after Arthroscopic Rotator Cuff Repair Using Suture Bridge Technique

    PubMed Central

    Lee, Kwang Won; Bae, Kyoung Wan; Choy, Won Sik

    2013-01-01

    Background We retrospectively assessed the clinical outcomes and investigated risk factors influencing retear after arthroscopic suture bridge repair technique for rotator cuff tear through clinical assessment and magnetic resonance arthrography (MRA). Methods Between January 2008 and April 2011, sixty-two cases of full-thickness rotator cuff tear were treated with arthroscopic suture bridge repair technique and follow-up MRA were performed. The mean age was 56.1 years, and mean follow-up period was 27.4 months. Clinical and functional outcomes were assessed using range of motion, Korean shoulder score, Constant score, and UCLA score. Radiological outcome was evaluated with preoperative and follow-up MRA. Potential predictive factors that influenced cuff retear, such as age, gender, geometric patterns of tear, size of cuff tear, acromioplasty, fatty degeneration, atrophy of cuff muscle, retraction of supraspinatus, involved muscles of cuff and osteolysis around the suture anchor were evaluated. Results Thirty cases (48.4%) revealed retear on MRA. In univariable analysis, retear was significantly more frequent in over 60 years age group (62.5%) than under 60 years age group (39.5%; p = 0.043), and also in medium to large-sized tear than small-sized tear (p = 0.003). There was significant difference in geometric pattern of tear (p = 0.015). In multivariable analysis, only age (p = 0.036) and size of tear (p = 0.030) revealed a significant difference. The mean active range of motion for forward flexion, abduction, external rotation at the side and internal rotation at the side were significantly improved at follow-up (p < 0.05). The mean Korean shoulder score, Constant score, and UCLA score increased significantly at follow-up (p < 0.01). The range of motion, Korean shoulder score, Constant score, and UCLA score did not differ significantly between the groups with retear and intact repairs (p > 0.05). The locations of retear were insertion site in 10 cases (33.3%) and

  17. The effect of core suture flexor tendon repair techniques on gliding resistance during static cycle motion and load to failure: a human cadaver study

    PubMed Central

    Moriya, T.; Larson, M. C.; Zhao, C.; An, K.-N.; Amadio, P. C.

    2011-01-01

    The purpose of this study was to describe a modification of the Massachusetts General Hospital (MMGH) tendon repair and to compare it with three other suture techniques. Twenty human flexor digitorum profundus (FDP) tendons were randomly assigned to the modified Pennington (MP) suture and the MMGH suture. These were compared to the modified Kessler (MK) and Massachusetts General Hospital (MGH) sutures, using data from a previous study. All tendons were repaired with a similar epitendinous stitch and core sutures of 4-0 FiberWire. There was no significant difference in the normalized gliding resistance within the two-strand or four-strand core repair groups. The MP suture had significantly higher 2 mm gap force and ultimate load to failure than the MK suture. The MMGH suture had significantly higher 2 mm gap force and maximum failure ultimate load than the MGH suture. All repairs failed by knot unravelling. PMID:21987278

  18. Alternate Sequential Suture Tightening: A Novel Technique for Uncontrolled Postpartum Hemorrhage

    PubMed Central

    Ghosh, Sharda Brata; Mala, Y. M.

    2015-01-01

    Objective. The most commonly described technique of modified B-Lynch suture may not be suitable for all the patients presenting with flabby, atonic uterus. Study Design. A retrospective analysis of twelve patients with uncontrolled postpartum haemorrhage, who underwent this procedure from March 2007 to September 2012, was conducted. In this novel technique, sutures are passed in the lower uterine segment and are tightened alternately to control uterine bleeding. Results. Average duration of the procedure was 4 minutes (range 2–7 minutes). Average blood loss was 1625 mL (range 1300–1900 mL). Eleven patients (91.66%) were seen to have a successful outcome with only this technique. No patient required hysterectomy and one patient (8.33%) required additional bilateral internal iliac artery ligation. All the patients had a minimum follow-up of 2 yrs and none of them reported any infertility problems. Conclusion. This technique is simple, quick, and effective. There was no adverse effect on the fertility potential for the observed 2 years; however, a long-term follow-up is required to comment on its actual rate. This technique cannot replace the standard modified B-Lynch technique for uncontrolled postpartum haemorrhage but can be used for unresponsive, flabby, and atonic uterus. PMID:25873974

  19. Four-Strand Core Suture Improves Flexor Tendon Repair Compared to Two-Strand Technique in a Rabbit Model

    PubMed Central

    Beyersdoerfer, Sascha Tobias; Vollmar, Brigitte; Mittlmeier, Thomas; Gierer, Philip

    2016-01-01

    Introduction. This study was designed to investigate the influence of the amount of suture material on the formation of peritendinous adhesions of intrasynovial flexor tendon repairs. Materials and Methods. In 14 rabbits, the flexor tendons of the third and the fourth digit of the right hind leg were cut and repaired using a 2- or 4-strand core suture technique. The repaired tendons were harvested after three and eight weeks. The range of motion of the affected toes was measured and the tendons were processed histologically. The distance between the transected tendon ends, the changes in the peritendinous space, and cellular and extracellular inflammatory reaction were quantified by different staining. Results. A 4-strand core suture resulted in significantly less gap formation. The 2-strand core suture showed a tendency to less adhesion formation. Doubling of the intratendinous suture material was accompanied by an initial increase in leukocyte infiltration and showed a greater amount of formation of myofibroblasts. From the third to the eighth week after flexor tendon repair, both the cellular and the extracellular inflammation decreased significantly. Conclusion. A 4-strand core suture repair leads to a significantly better tendon healing process with less diastasis between the sutured tendon ends despite initially pronounced inflammatory response. PMID:27446949

  20. Effects of two alar base suture techniques suture techniques on nasolabial changes after bimaxillary orthognathic surgery in Taiwanese patients with class III malocclusions.

    PubMed

    Chen, C Y-H; Lin, C C-H; Ko, E W-C

    2015-07-01

    A randomized controlled trial was designed to assess the effectiveness of two alar base cinch techniques on the changes in nasolabial morphology after bimaxillary orthognathic surgery. Sixty patients requiring a Le Fort I osteotomy to correct skeletal discrepancies were selected randomly to receive either conventional or modified alar base cinching during the intraoral wound closure procedure. Conventional cinching passed through nasalis muscle and anterior nasal spine. Modified cinching also passed through dermis tissue to increase the anchorage. Postoperative hard and soft tissue changes were evaluated using cone beam computed tomography and three-dimensional stereophotogrammetry at predefined time points. Forty-eight patients with a skeletal class III malocclusion were included. In the conventional group, there was an increase of 0.31 ± 1.31 mm in nasal width and an increase of 0.97 ± 1.60mm in columellar length. In the modified group, there was an increase of 0.81 ± 1.87 mm in the cutaneous height of the upper lip and a decrease of 0.76 ± 1.56 mm in lower prolabial width. Patients with an initial narrow nasal width, alar base width, and less vertical nostril show were more susceptible to a greater degree of change after surgery. Both alar base suture techniques are effective at controlling nasolabial form changes resulting from class III dual-jaw orthognathic surgery.

  1. A safety technique for Mitek anchor suture rupture: a useful trick.

    PubMed

    Othman, Diaa; Le Cocq, Heather; Majumder, Sanjib

    2011-09-01

    We propose that the simple method of passing an extra suture through the Mitek anchor eyelet before bony insertion provides a safety net against failure of the preloaded suture and gives extra strength to the core repair.

  2. A Novel Surgical Pre-suturing Technique for the Management of Ankyloglossia

    PubMed Central

    Khairnar, Mayur; Pawar, Babita; Khairnar, Darshana

    2014-01-01

    Ankyloglossia or “tongue-tie” is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using presuturing technique in which different sets of sutures are given on lingual frenum before severing it. This results in reduced opening of the wound, minimal bleeding, pain and discomfort. Two male patients with severe ankyloglossia had been managed with this technique and after 2 years of follow-up of these cases showed satisfactory protrusive and lateral movement of the tongue with minimal scarring and discomfort. PMID:25598942

  3. Efficacy of Achilles Suture Bridge Technique for Insertional Achilles Tendinosis in an Obese and Athletic Patient.

    PubMed

    Mineta, Kazuaki; Suzue, Naoto; Matsuura, Tetsuya; Sairyo, Koichi

    2016-01-01

    Here, we report the efficacy of the suture bridge technique for treating insertional Achilles tendinosis in an obese and athletic patient. A 48-year-old man presented to our department with a 6-month history of left posterior heel pain. The patient was an athlete (triathlon) and appeared obese (height: 197 cm, body weight: 120 kg, body mass index: 30.9). A diagnosis of insertional Achilles tendinosis was made. Because 6 months of conservative treatments had failed, we performed open resection of the calcaneal exostosis and Haglund's deformity along with debridement of the degenerative tissue of the tendon. Wide detachment of the insertion of the Achilles tendon was necessary, and reattachment of the tendon was performed using the Arthrex SpeedBridge(TM) system (Arthrex, Inc., Naples, FL). Six weeks postoperatively, this patient was allowed to walk with full weight bearing. Twelve weeks after surgery, this patient started jogging with neither pain nor evidence of Achilles tendon rupture. The suture bridge technique was effective for the reconstruction of the Achilles tendon in an obese and athletic patient. J. Med. Invest. 63: 310-314, August, 2016.

  4. Scleral Suture-Fixation Technique for One-Piece Acrylic Intraocular Lens

    PubMed Central

    Leung, Ella H.; Mohsenin, Amir; Smiddy, William E.

    2016-01-01

    Purpose To describe a previously published scleral-fixation technique to secure one-piece acrylic intraocular lenses (IOLs) to the sclera. Methods Retrospective, consecutive, non-comparative case series. Patients 16 eyes of 15 patients Results All patients who underwent scleral-fixation of one-piece acrylic IOLs using the loop method from 2014 to 2016 were included. The mean follow-up was 8.1 months. The dislocated one-piece acrylic IOL was repositioned in 8 eyes, a primary implantation was performed in 5 eyes, and the IOL was exchanged in 3 eyes. All IOLs remained well-centered postoperatively. The vision improved from an initial best corrected visual acuity of 0.97 ± 0.74 logMAR (Snellen equivalent ≈20/190) to 0.47 ± 0.49 logMAR (≈20/60, P=0.031) at the last follow-up. The post-operative complications were self-limited. Conclusions The previously reported scleral suture-fixation technique can be readily applied to one-piece acrylic IOLs. PMID:17278543

  5. Comparison of Semi-Invasive "Internal Splinting" and Open Suturing Techniques in Achilles Tendon Rupture Surgery.

    PubMed

    Sarman, Hakan; Muezzinoglu, Umit Sefa; Memisoglu, Kaya; Aydin, Adem; Atmaca, Halil; Baran, Tuncay; Odabas Ozgur, Bahar; Ozgur, Turgay; Kantar, Cengizhan

    2016-01-01

    The goal of the present study was to evaluate the semi-invasive "internal splinting" (SIIS) method for repair of Achilles tendon rupture relative to open repair with Krakow sutures. Efficacy was evaluated based on the clinical and functional outcomes, postoperative magnetic resonance imaging measurements, isokinetic results, and surgical complication rates. Functional measurements included the Thermann and American Orthopaedic Foot and Ankle Society (AOFAS) ankle scores, bilateral ankle dorsiflexion, and plantar flexion measurements. Magnetic resonance imaging was used to compare the bilateral length and thickness of each Achilles tendon. The isokinetic outcomes were evaluated using a Biodex System 3 dynamometer. Of the 45 patients meeting the inclusion criteria, 24 were treated by SIIS and 21 by the open Krackow suture technique. The mean follow-up time for all patients was 43.7 (range 6 to 116) months. In the SIIS group, patients returned to normal daily activities after 7.2 (range 6 to 8) weeks compared with 14.3 (range 12 to 15) weeks in the open surgery group. The AOFAS ankle scores were 93.5 (range 82 to 100) points in the open repair group and 96.2 (range 86 to 100) points in the SIIS group. The Thermann scores were 80.4 (range 53 to 91) points for the open repair group and 87.9 (range 81 to 100) points for the SIIS method. The mean Achilles length on the operated side measured using magnetic resonance imaging was 175.06 (range 110 to 224) mm and 177.76 (range 149 to 214) mm for the open surgery and SIIS groups, respectively. Sensory impairment in the territory of the sural nerve was identified in 1 patient immediately after SIIS surgery, although this defect had completely resolved within 12 months. SIIS yielded better outcomes relative to the open surgery group according to the isokinetic measurements. Taken together, these data indicate the SIIS method for Achilles tendon ruptures performed better in terms of both functional and objective outcomes

  6. Sutural distraction osteogenesis (SDO) versus osteotomy distraction osteogenesis (ODO) for midfacial advancement: a new technique and primary clinical report.

    PubMed

    Liu, Chunming; Hou, Min; Liang, Limin; Huang, Xuming; Zhang, Tong; Zhang, Haizhong; Ma, Xiao; Song, Ruyao

    2005-07-01

    A new technique of osteotomy distraction osteogenesis (ODO) and sutural distraction osteogenesis (SDO) by the use of bone-borne traction hooks is presented. The technique of osteotomy plus distraction osteogenesis is suitable for adult patients. The technique of sutural distraction osteogenesis is suitable for young patients, ages 6 through 12 years. The distraction system consists of a face-bow, orthodontic elastics, and bone-borne traction hooks. The bone-borne traction hooks are made of titanium, with two traction hooks running laterally or downwardly. When a Le Fort III osteotomy is needed, bone-borne traction hooks are inserted through the nostrils into a bone hole drilled at the lateral-inferior pyriform aperture. When no osteotomy is needed, only the bone-borne traction hooks are placed. Heavy elastics were used in the technique of osteotomy distraction osteogenesis for Le Fort III osteotomy adult patients, whereas light forces and thus light elastics were used for younger patients. Three adult patients and four children were treated by osteotomy distraction and sutural distraction, respectively. All seven patients with midfacial hypoplasia established a harmonious facial profile and normal occlusal relationships. Radiographic examination showed balanced advancement of the midfacial skeleton. It is suggested that the treatment of midfacial hypoplasia in children by the technique of sutural distraction osteogenesis is to be preferred because of its simplicity and relative noninvasiveness. Thus, the authors suggest that midfacial hypoplasia should be treated at a younger age by this technique, potentially eliminating the need for a Le Fort III osteotomy at an older age.

  7. Association between Fellowship Training, Surgical Volume, and Laparoscopic Suturing Techniques among Members of the American Association of Gynecologic Laparoscopists

    PubMed Central

    Scott, Lauren; Miladinovic, Branko; Imudia, Anthony N.; Hart, Stuart

    2016-01-01

    Study Objective. To compare surgical volume and techniques including laparoscopic suturing among members of the American Association of Gynecologic Laparoscopists (AAGL) according to fellowship training status. Design. A web-based survey was designed using Qualtrics and sent to AAGL members. Results. Minimally invasive gynecologic surgery (FMIGS) trained surgeons were more likely to perform more than 8 major conventional laparoscopic cases per month (63% versus 38%, P < 0.001, OR [95% CI] = 2.78 [1.54–5.06]) and were more likely to perform laparoscopic suturing during these cases (32% versus 16%, P < 0.004, OR [95% CI] = 2.44 [1.25–4.71]). The non-fellowship trained (NFT) surgeons in private practice were less likely to perform over 8 conventional laparoscopic cases (34% versus 51%, P = 0.03, OR [95% CI] = 0.50 [0.25–0.99]) and laparoscopic suturing during these cases (13% versus 27%, P = 0.01, OR [95% CI] = 0.39 [0.17–0.92]) compared to NFT surgeons in academic practice. Conclusion. The surgical volume and utilization of laparoscopic suturing of FMIGS trained surgeons are significantly increased compared to NFT surgeons. Academic practice setting had a positive impact on surgical volume of NFT surgeons but not on FMIGS trained surgeons. PMID:26885389

  8. A Barbed Suture Repair For Flexor Tendons: A Novel Technique With No Exposed Barbs

    PubMed Central

    Sugrue, Conor; Chan, Jeffrey C.; Delgado, Luis; Zeugolis, Dimitrios; Carroll, Seam M.; Kelly, Jack L.

    2014-01-01

    Background: Barbed suture technology has shown promise in flexor tendon repairs, as there is an even distribution of load and the need for a knot is eliminated. We propose that a quick and simple, novel, barbed technique without any exposed barbs on the tendon surface has comparable strength and a smaller cross-sectional area at the repair site than traditional methods of repair. Methods: Forty porcine flexor tendons were randomized to polybutester 4-strand barbed repair or to 4-strand Adelaide monofilament repair. The cross-sectional area was measured before and after repair. Biomechanical testing was carried out and 2-mm gap formation force, ultimate strength of repair, and method of failure were recorded. Results: The mean ultimate strength of the barbed repairs was 54.51 ± 17.9 while that of the Adelaide repairs was 53.17 ± 16.35. The mean 2-mm gap formation force for the barbed group was 44.71 ± 17.86 whereas that of the Adelaide group was 20.25 ± 4.99. The postrepair percentage change in cross-sectional area at the repair site for the Adelaide group and barbed group was 12.0 ± 2.3 and 4.6 ± 2.8, respectively. Conclusions: We demonstrated that a 4-strand knotless, barbed method attained comparable strength to that of the traditional Adelaide repair technique. The barbed method had a significantly reduced cross-sectional area at the repair site compared with the Adelaide group. The 2-mm gap formation force was less in the barbed group than the Adelaide group. Barbed repairs show promise for tendon repairs; this simple method warrants further study in an animal model. PMID:25426354

  9. Laparoscopic inguinal hernia repair in children using the percutaneous internal ring suturing technique – own experience

    PubMed Central

    Patkowski, Dariusz

    2014-01-01

    Introduction Percutaneous internal ring suturing (PIRS) is a method of laparoscopic herniorrhaphy, i.e. percutaneous closure of the internal inguinal ring under the control of a telescope placed in the umbilicus. Aim To evaluate the usefulness of the PIRS technique. Material and methods Fifty-five children (39 girls and 16 boys) underwent surgery using this method in our institution between 2008 and 2010. Results In 10 cases the presence of an open inguinal canal on the opposite side was also noted during surgery, and umbilical hernia was recognized in 2 patients. In 5 cases it was necessary to convert to the open surgery because of the inability to continue the laparoscopic procedure. In 1 case, male pseudohermaphroditism was diagnosed during surgery. Recurrent inguinal hernia required a conventional method of surgery in 1 child. Other children did not exhibit the characteristics of hernia recurrence. The inguinal canals were followed up with postoperative ultrasound examination in 29 children. In 23 children, the ultrasound examination showed no dilatation of the inguinal canal. In the other 6 children dilatation of the inguinal canal or the presence of fluid within the inguinal canal was observed during ultrasound. In 6 children symptoms such as swelling and soreness around the inguinal canal developed within 3 to 6 months after surgery. Conclusions Inguinal hernia surgery using the PIRS procedure is an alternative, effective, minimally invasive method of surgery. Visualization of the peritoneal cavity allows for detection of other abnormalities, as well as for performing other procedures during the same session (such as closing the contralateral inguinal canal or umbilical hernia surgery). PMID:24729810

  10. Systematic Review and Meta-Analysis of Surgical Zipper Technique versus Intracutaneous Sutures for the Closing of Surgical Incision

    PubMed Central

    Chen, Dezhi; Song, Jian; Zhao, Yong; Zheng, Xun; Yu, Aixi

    2016-01-01

    Background It is controversial whether surgical zipper technique (SZT), a non-invasive method of surgical wound closure, achieves a better outcome of incision healing than intracutaneous sutures (IS) in the surgery. This meta-analysis was performed to systematically analyze whether surgical zipper is superior to suture material for the incision closure. Methods Databases and reference lists were searched for randomized controlled trials (RCTs) comparing SZT with IS for the incision closure. Results Four RCTs with 678 patients were identified and analyzed. Compared with IS, SZT achieved similar incidence of postoperative complications, less time for incision closure, less cost of both surgeons’ time and operating room time, no need for removing sutures and more comfort for the patients. Besides, SZT achieved perfect aesthetic results in various types of incisions with the exception of those with substantial curvatures, those with secretions, in obese patients or those under high tension. Conclusion The non-invasive zipper technique may be a more attractive option of incision closure in a wide spectrum of surgical areas. PMID:27611083

  11. Modified technique of pancreaticogastrostomy for soft pancreas with two continuous hemstitch sutures: a single-center prospective study.

    PubMed

    Zhu, Feng; Wang, Min; Wang, Xin; Tian, Rui; Shi, Chengjian; Xu, Meng; Shen, Ming; Han, Juan; Luo, Ninanian; Qin, Renyi

    2013-07-01

    Postoperative pancreatic fistula (POPF) remains a persistent problem after pancreaticoduodenectomy (PD), especially in the presence of a soft, nonfibrotic pancreas. To reduce the risk of POPF, pancreaticogastrostomy (PG) is an optional reconstruction technique for surgeons after PD. This study presents a new technique of PG for a soft, nonfibrotic pancreas with double-binding continuous hemstitch sutures and evaluates its safety and reliability. From January 2011 to June 2012, 92 cases of patients with periampullary malignancy with a soft pancreas underwent this technique. A modified technique of PG was performed with two continuous hemstitch sutures placed in the mucosal and seromuscular layers of the posterior gastric wall, respectively. Then the morbidity and mortality was calculated. This technique was applied in 92 patients after PD all with soft pancreas. The median time for the anastomosis was 12 min (range, 8-24). Operative mortality was zero, and morbidity was 16.3 % (n = 15), including hemorrhage (n = 2), biliary fistula (n = 2), pulmonary infection (n = 1), delayed gastric emptying (DGE; n = 5, 5.4 %), abdominal abscess (n = 3, one caused by PF), and POPF (n = 2, 2.2 %). Two patients developed a pancreatic fistula (one type A and one type B) classified according to the International Study Group on Pancreatic Fistula. The described technique is a simple and safe reconstruction procedure after PD, especially for patients with a soft and fragile pancreas.

  12. Prosthetic mesh "slim-cigarette like" for laparoscopic repair of ventral hernias: a new technique without transabdominal fixation sutures.

    PubMed

    Canton, S A; Merigliano, S; Pasquali, C

    2016-06-01

    Prosthetic mesh rolled up and fixed with stitches like a slim cigarette ("slim-mesh") for laparoscopic ventral hernia (VH) repair is an new technique which allows an easy intraperitoneally introduction, distension and circumferential fixation of a prosthetic mesh without transabdominal fixation sutures even for meshes larger than 16 cm up to 30 cm for the "slim-mesh" repair of wide ventral hernias. We report the technique of laparoscopic repair of VH with "slim-mesh". This technique enables an easy intra-peritoneally introduction of the mesh through the trocar because it reduces consistently its size, it allows a rapid intra-abdominal handling of the mesh and a fast and easy fixation for VH repair. The average time of surgery with "slim-mesh" for treatment of all 28 VH was 97 min ranging from 57 to 160 min. The average time for the repair of the 24 VH smaller than 10 cm was 91 and 135 min for the four VH larger than 10-22 cm. This new surgical technique leads to a reduction of surgical risks avoiding the use of transfascial sutures with the associated complications. This new surgical procedure in our experience is fast, safe, simple and also easily reproducible by surgeons in laparoscopic training. This technique may be used in wide VH (larger than 10-22 cm) that generally require open surgery.

  13. Facilitating endoscopic submucosal dissection: the suture-pulley method significantly improves procedure time and minimizes technical difficulty compared with conventional technique: an ex vivo study (with video)

    PubMed Central

    Aihara, Hiroyuki; Kumar, Nitin; Ryou, Marvin; Abidi, Wasif; Ryan, Michele B.; Thompson, Christopher C.

    2015-01-01

    Background The lack of countertraction in endoscopic submucosal dissection (ESD) results in increased technical demand and procedure time. Although the suture-pulley method for countertraction has been reported, its effectiveness compared with the traditional ESD technique remains unclear. Objective To objectively analyze efficacy of countertraction using the suture-pulley method for ESD. Design Prospective ex vivo animal study. Setting Animal laboratory. Interventions Twenty simulated gastric lesions were created in porcine stomachs by using a standard circular template 30 mm in diameter. In the control arm (n = 10), ESD was performed by using the standard technique. In the suture-pulley arm (N = 10), a circumferential incision was made, and an endoscopic suturing device was used to place the suture pulley. Main Outcome Measurements The primary outcome of this study was total procedure time. Results The median total procedure time with the suture-pulley method was significantly shorter than the traditional ESD technique (median, 25% to 75%, interquartile range [IQR]: 531 seconds [474.3–549.3 seconds] vs 845 seconds [656.3–1547.5 seconds], P < .001). The median time (IQR) for suture-pulley placement was 160.5 seconds (150.0–168.8 seconds). Although there was a significantly longer procedure time for proximal versus middle/lower stomach lesions with traditional ESD (median, 1601 seconds; IQR, 1547.5–1708.8 seconds vs median, 663 seconds; IQR, 627.5–681.8 seconds; P =.01), there was no significant difference in procedure time for lesions of various locations when using the suture-pulley method. Compared with traditional ESD, the suture-pulley method was less demanding in all categories evaluated by the NASA Task Load Index. Limitations Ex vivo study. Conclusions The suture-pulley method facilitates direct visualization of the submucosal layer during ESD and significantly reduces procedure time and technical difficulty. In addition, the benefit of the suture

  14. Arthroscopic Technique for Treatment of Combined Pathology Associated With Femoroacetabular Impingement Syndrome Using Traction Sutures and a Minimal Capsulotomy

    PubMed Central

    Thakral, Rishi; Ochiai, Derek

    2014-01-01

    The use of hip arthroscopy is gaining popularity for diagnostic and therapeutic purposes. With our increasing understanding of hip biomechanics and pathophysiology, our techniques for treatment are evolving as well. The main aim is to preserve the joint and prolong the degenerative process associated with femoroacetabular impingement (FAI). In general, combined pathology is encountered when a diagnosis of FAI is established. In our experience, we have seen large number of patients with a combination of cam and pincer lesions with or without associated labral tears. It is optimal to address all symptomatic pathology with one surgical intervention. The described technique shows the feasibility of dealing with the hip FAI pathology by using traction sutures on the capsule through a 2-portal technique. PMID:25264515

  15. Effect of the suture technique on postoperative pain, swelling and trismus after removal of lower third molars: A randomized clinical trial

    PubMed Central

    Gómez-Santos, Laila; Sánchez-Torres, Alba; Herráez-Vilas, José-María

    2015-01-01

    Background To evaluate the intensity of pain, swelling and trismus after the removal of impacted lower third molars comparing two different suture techniques of the triangular flap: the complete suture of the distal incision and relieving incision and the partial suture with only one suture knot for closure of the corner of the flap and the closure of the distal incision, without suturing the relieving incision. Material and Methods A prospective, randomized, crossover clinical trial was conducted in 40 patients aged from 18 to 45 years who underwent surgical extraction of impacted lower third molars at the Department of Oral Surgery in the Odontological Hospital of the University of Barcelona during the year 2011. Patients were randomly divided in 2 groups. Two different techniques (hermetical closure and partial closure of the wound) were performed separated by a one month washout period in each patient. Postoperative pain, swelling and trismus were evaluated prior to the surgical procedure and also at 2 and 7 days post operatively. Results No statistically significant differences were observed for pain (p<0.06), trismus (p<0.71) and swelling (p<0.05) between the test and the control group. However, the values of the three parameters related to the test group were lower than those for the control group. Conclusions Partial closure of the flap without suturing the relieving incision after surgical extraction of lower third molars reduces operating time and it does not produce any postoperative complications compared with complete closure of the wound. Key words: Third molar, surgical flaps, suture techniques, postoperative pain, swelling, trismus. PMID:25662551

  16. Arthroscopic All-Inside Posterior Cruciate Ligament Reconstruction: Overcoming the "Killer Turn".

    PubMed

    Vasdev, Attique; Rajgopal, Ashok; Gupta, Himanshu; Dahiya, Vivek; Tyagi, Vipin Chand

    2016-06-01

    One of the most challenging arthroscopic surgical procedures is posterior cruciate ligament (PCL) reconstruction. PCL injuries account for 20% of all knee ligament-related injuries. These may be isolated or occur as part of poly-ligament injuries. With the possibility of PCL reconstruction with the all-inside technique, there has been a surge in interest in treating PCL injuries. With the PCL being one of the strongest ligaments in the body and a primary restraint to posterior translation of the tibia, the need for PCL reconstruction is being more and more recognized. Surgeons often find it difficult to negotiate the so-called killer turn while attempting arthroscopic PCL reconstruction. We describe the use of the GraftLink graft construct through the posteromedial portal in 7 patients (6 male and 1 female patient) with isolated PCL injuries, which we believe not only allows us to perform the all-inside PCL reconstruction but also does away with the difficulty of the killer turn encountered while performing the arthroscopic PCL reconstruction.

  17. Pulmonary arterioplasty using video-assisted thoracic surgery mechanical suture technique

    PubMed Central

    Xu, Xin; Huang, Jun; Yin, Weiqiang; Zhang, Xin; Chen, Hanzhang; Mo, Lili

    2016-01-01

    Lung cancer invading pulmonary trunk is a locally advanced condition, which may indicate poor prognosis. Surgical resection of the lesion can significantly improve survival for some patients. Lobectomy/Pneumonectomy with pulmonary arterioplasty via thoracotomy were generally accepted and used in the past. As the rapid development of minimally invasive techniques and devices, pulmonary arterioplasty is feasible via video-assisted thoracic surgery (VATS). However, few studies have reported the VATS surgical techniques. In this study, we reported the techniques of pulmonary arterioplasty via VATS. PMID:27076961

  18. Anterior Medial Meniscal Root Tears: A Novel Arthroscopic All Inside Repair

    PubMed Central

    Osti, L.; Del Buono, A.; Maffulli, N.

    2015-01-01

    Background Management of tears of the anterior and posterior roots of the meniscus is still controversial. We wish to propose a simple technique of suture anchor to repair tears of the anterior root of the medial meniscus. Methods Twelve patients, active males, underwent arthroscopic repair of the anterior meniscal horn between 2009 and 2011. All were assessed postoperatively at an average follow-up of 1 year after the index operation. Results At the last appointment, the average Lysholm scores was improved from a pre-operative average value of 48±17 to a postoperative value of 91±7 (P<0.001); five patients (45.3%) were scored as excellent (≥95), and 7 (54.6%) as good (85–94). At the last appointment, 8 of 9 active patients practiced sport at the same preoperative level, 1 (8.5%) had changed to lower level of activity. No technique related complications were evident. PMID:26535186

  19. Knee Extensor Mechanism Repairs: Standard Suture Repair and Novel Augmentation Technique.

    PubMed

    Meyer, Zachary; Ricci, William M

    2016-08-01

    Patellar and quadriceps tendon ruptures are relatively common injuries. Rupture of the knee extensor mechanism may occur because of a forceful eccentric contraction of the quadriceps against a resisted flexed knee, though atraumatic cases have also been described. Patients at higher than normal risk for knee extensor mechanism rupture include those with systemic co-morbidities, fluoroquinolone use, and chronic tendinopathy. Early operative treatment and mobilization of acute extensor mechanism ruptures has proven effective, and numerous techniques have been described. A 46-year-old male on anastrozole therapy simultaneously ruptured his left patellar and right quadriceps tendons during a deadlift attempt. Diagnosis was by history and physical examination. Repair of both injuries was performed 5 days after injury. Described within and shown in the accompanying video is a standard technique for primary repair using Krackow stitches through the ruptured tendon that are passed through patellar bone tunnels and tied over a bone bridge. The finer points of this technique are emphasized. Also included is a technique to augment the standard repair with a figure-of-8 stitch passed through additional oblique patellar bone tunnels. The mechanical advantage of the adjuvant figure-of-8 stitch provides additional compression, which nicely reapproximates the tendon edges. PMID:27441933

  20. The Results of All-Inside Meniscus Repair Using the Viper Repair System Simultaneously with Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kang, Hong Je; Kim, Kwang Mee; Cho, Hang Hwan; Espinosa, Johnsel C.

    2015-01-01

    Background Meniscus tears are commonly associated with anterior cruciate ligament (ACL) ruptures. It is essential to repair meniscal tears as much as possible to prevent early osteoarthritis and to gain additional stability in the knee joint. We evaluated the results of arthroscopic all-inside repair using the Meniscal Viper Repair System (Arthrex) on meniscus tears simultaneously with ACL reconstruction. Methods Nineteen out of 22 patients who were treated with arthroscopic all-inside repair using the Meniscal Viper Repair System for meniscus tear associated with ACL rupture were evaluated. ACL reconstructions were performed at the same period. The mean follow-up period was 16.5 months (range, 12 to 24 months). The clinical results of the meniscus repair were evaluated by symptoms (such as catching or locking), tenderness, effusion, range of motion limitation, and the McMurray test. Clinical success was defined by negative results in all five categories. The Hospital for Special Surgery (HSS) score was evaluated. Objective results were evaluated with secondary look arthroscopy or magnetic resonance imaging (MRI). The MRI results were categorized as completely repaired, incompletely repaired, and failure by Henning's classification. The results of second-look arthroscopy were evaluated with the criteria of meniscal healing. Results The clinical success rate was 95.4% and the HSS scores were 93.9 ± 5.4 at the final follow-up. According to Henning's classification, 15 out of 18 cases showed complete healing (83.3%) and two cases (11.1%) showed incomplete healing. Seventeen out of 18 cases that underwent second-look arthroscopy showed complete healing (94.4%) according to the criteria of meniscal healing. Only one case showed failure and the failure was due to a re-rupture at the sutured area. Complications of ACL reconstruction or meniscus repair were not present. Conclusions The results demonstrate that arthroscopic all-inside repair using the Meniscal Viper Repair

  1. Suture anchor versus suture through tunnel fixation for quadriceps tendon rupture: a biomechanical study.

    PubMed

    Lighthart, William A; Cohen, David A; Levine, Richard G; Parks, Brent G; Boucher, Henry R

    2008-05-01

    This biomechanical study compared suture anchors versus transosseous sutures for repair of quadriceps tendon ruptures using a force of 150 N at a frequency of 0.5 Hz. No significant difference in displacement was found between the 2 techniques with initial loading or with load or no load after 1000 cycles. Displacement after 1000 cycles for suture anchors and bone tunnels was 4.65 and 4.50 mm, respectively. These findings suggest a possible role for suture anchors in repairing quadriceps tendon ruptures. Suture anchors are relatively expensive but require less dissection over the patella and do not involve suture placement about the patella tendon.

  2. The effects of multiple-strand suture techniques on the tensile properties of repair of the flexor digitorum profundus tendon to bone.

    PubMed

    Silva, M J; Hollstien, S B; Fayazi, A H; Adler, P; Gelberman, R H; Boyer, M I

    1998-10-01

    We examined the effects of multiple-strand suture techniques on the tensile properties of flexor digitorum profundus tendon-to-bone repairs in a human cadaver finger model. Forty-four fingers were obtained from the cadavera of fifteen donors who had been an average of seventy-four years old (range, fifty-four to eighty-nine years old) at the time of death. Four or eight-strand proximal grasping sutures were secured to the distal phalanx of each finger with use of either a suture anchor or a dorsally placed button. There were four subgroups of eleven fingers each. We found that repairs performed with use of a dorsally placed button had greater yield force, ultimate force, and rigidity than those performed with use of an anchor and that repairs performed with eight strands had greater ultimate force than those performed with four strands. These differences were significant (p < 0.05). We could detect no differences among the four types of repairs with regard to the amount of relative tendon-bone elongation at twenty newtons of force. The repairs performed with eight strands and a dorsally placed button had an average yield force (and 95 per cent confidence interval) of 50.0 +/- 14.1 newtons, an average ultimate force of 68.5 +/- 14.6 newtons, an average rigidity of 744 +/- 327 newton/(millimeter/millimeter), and an average tendon-bone elongation of 3.4 +/- 0.7 millimeters at twenty newtons of force. Multiple-comparison testing showed that the eight-strand repairs performed with a dorsally placed button had greater ultimate force than the other three types of repairs as well as greater yield force and rigidity than the four and eight-strand repairs performed with a suture anchor.

  3. Craniosynostosis of the lambdoid suture.

    PubMed

    Rhodes, Jennifer L; Tye, Gary W; Fearon, Jeffrey A

    2014-08-01

    Craniosynostosis affecting the lambdoid suture is uncommon. The definition of lambdoid craniosynostosis solely applies to those cases demonstrating true suture obliteration, similar to other forms of craniosynostosis. In patients presenting with posterior plagiocephaly, true lambdoid craniosynostosis must be differentiated from the much more common positional molding. It can occur in a unilateral form, a bilateral form, or as part of a complex craniosynostosis. In children with craniofacial syndromes, synostosis of the lambdoid suture most often is seen within the context of a pansynostotic picture. Chiari malformations are commonly seen in multisutural and syndromic types of craniosynostosis that affect the lambdoid sutures. Posterior cranial vault remodeling is recommended to provide adequate intracranial volume to allow for brain growth and to normalize the skull shape. Although many techniques have been described for the correction of lambdoid synostosis, optimal outcomes may result from those techniques based on the concept of occipital advancement.

  4. Craniosynostosis of the Lambdoid Suture

    PubMed Central

    Rhodes, Jennifer L.; Tye, Gary W.; Fearon, Jeffrey A.

    2014-01-01

    Craniosynostosis affecting the lambdoid suture is uncommon. The definition of lambdoid craniosynostosis solely applies to those cases demonstrating true suture obliteration, similar to other forms of craniosynostosis. In patients presenting with posterior plagiocephaly, true lambdoid craniosynostosis must be differentiated from the much more common positional molding. It can occur in a unilateral form, a bilateral form, or as part of a complex craniosynostosis. In children with craniofacial syndromes, synostosis of the lambdoid suture most often is seen within the context of a pansynostotic picture. Chiari malformations are commonly seen in multisutural and syndromic types of craniosynostosis that affect the lambdoid sutures. Posterior cranial vault remodeling is recommended to provide adequate intracranial volume to allow for brain growth and to normalize the skull shape. Although many techniques have been described for the correction of lambdoid synostosis, optimal outcomes may result from those techniques based on the concept of occipital advancement. PMID:25210507

  5. Craniosynostosis of the lambdoid suture.

    PubMed

    Rhodes, Jennifer L; Tye, Gary W; Fearon, Jeffrey A

    2014-08-01

    Craniosynostosis affecting the lambdoid suture is uncommon. The definition of lambdoid craniosynostosis solely applies to those cases demonstrating true suture obliteration, similar to other forms of craniosynostosis. In patients presenting with posterior plagiocephaly, true lambdoid craniosynostosis must be differentiated from the much more common positional molding. It can occur in a unilateral form, a bilateral form, or as part of a complex craniosynostosis. In children with craniofacial syndromes, synostosis of the lambdoid suture most often is seen within the context of a pansynostotic picture. Chiari malformations are commonly seen in multisutural and syndromic types of craniosynostosis that affect the lambdoid sutures. Posterior cranial vault remodeling is recommended to provide adequate intracranial volume to allow for brain growth and to normalize the skull shape. Although many techniques have been described for the correction of lambdoid synostosis, optimal outcomes may result from those techniques based on the concept of occipital advancement. PMID:25210507

  6. Direct closure of round skin defects: a four-step technique with multiple subcutaneous and cutaneous "figure-of-8" sutures alleviating dog-ears.

    PubMed

    Tilleman, Tamara Raveh

    2004-12-01

    Excisional biopsies of rounded lesions are performed daily by surgeons. The objective of this article is to establish a surgical technique for direct closure of circular and elliptical defects without the need for additional excision of dog-ears. A four-step technique based on multiple cutaneous and subcutaneous "figure-of-8" sutures is presented. When correctly placed, these sutures can equally distribute the excess tissue along the scar and alleviate dog-ears. The results of the 65 presented cases show that this technique yields short scars and saves healthy skin. A significant reduction of the length-to-width ratio and the arc-to-scar length ratio is obtained. Direct closure of a circular or elliptical defect without stipulating a 3:1 length-to-width ratio is feasible. Among the advantages of the technique are that no excessive healthy tissue is removed and that the scar length is reduced. The long-term outcome is a scar that is thin, linear, flat, and concealed in the body structure. PMID:15577346

  7. An Inexpensive Suture Practice Board

    PubMed Central

    Kasdan, Morton L.; Wilhelmi, Bradon J.

    2015-01-01

    Objective: We provide a design for an effective suture practice board for surgical instruction that is both easily assembled and repaired. Methods: This model's design is achieved through inexpensive materials that do not compromise adequate simulation through repetitive use. We used a wooden board, synthetic microfiber cloth, and metal plates and screws to create the suture board. Two pieces of synthetic microfiber cloth, folded along the long axis, were attached to the outer edges of the wooden board using an electric screwdriver, with the metal plates and screws to secure the attachment. Results: Upon completion of construction, we have a board sufficient for instructing various suturing techniques. Conclusions: Our suture board design provides an effective practice material that is an improvement in cost, as well as reusability compared with other models. Our board has the advantage over animal tissues, such as chicken's or pigs’ feet, because it is not perishable and maintains its durability over extended periods of time. This model is advantageous compared with other commercially available synthetic models because the materials are cheaper and more easily replaced. Our suture board model provides sufficient simulation to enhance the user's skills across various suturing techniques in a manner that is cost-effective in production and maintenance. PMID:26693271

  8. Inverting bilateral figure-of-eight suture of the rectus sheath after burst abdomen with destruction of the linea alba: a new technique.

    PubMed

    Dietz, U A; Debus, E-S; Thiede, A; Kuhfuss, I

    2007-01-01

    The authors report a new technique for secondary abdominal closure after burst abdomen as illustrated by the case of a patient who developed a perforated sigmoid diverticulitis following septic polyarthritis. Sigmoid resection was followed on the sixth day postoperative by a burst abdomen. Upon abdominal revision the burst abdomen was found to be caused by necrotic destruction of the linea alba. Abdominal wall closure was achieved using the novel technique of inverting bilateral interrupted figure-of-eight suture of the anterior and posterior rectus sheaths in combination with relieving lateral incisions and mesh implantation in the sublay technique. It remains for future studies to show whether this technique can reduce the high incisional hernia rate following secondary abdominal wall closure.

  9. Modified arthroscopic suture fixation of displaced tibial eminence fractures using a suture loop transporter.

    PubMed

    Yip, D K; Wong, J W; Chien, E P; Chan, C F

    2001-01-01

    Current arthroscopic suture fixation techniques of tibial eminence fractures are time consuming and the number of anchor sutures that can be placed is limited by the cumbersome and repetitive numerous needle threading steps. This occurs at 2 stages: first, when placing anchoring sutures through the avulsed anterior cruciate ligament stump with a suture punch, and second, when there is a need to traverse the tibial bone canal with the suture ends. We describe a modification that reduces the reliance on conventional rigid instruments and instead uses a loop transporter made from readily available suture material. The suture loop transporter being malleable reduces the necessary width of the tibial bone canal to be made and has a further advantage of minimizing the bone loss during the reaming of the bone tunnel. The subsequent potential for a stress fracture at these tunnel sites is also substantially reduced. Our technique is more user friendly, more accurate, and quicker to perform.

  10. BIOMECHANICS AND HISTOLOGICAL ANALYSIS IN RABBIT FLEXOR TENDONS REPAIRED USING THREE SUTURE TECHNIQUES (FOUR AND SIX STRANDS) WITH EARLY ACTIVE MOBILIZATION

    PubMed Central

    Severo, Antônio Lourenço; Arenhart, Rodrigo; Silveira, Daniela; Ávila, Aluísio Otávio Vargas; Berral, Francisco José; Lemos, Marcelo Barreto; Piluski, Paulo César Faiad; Lech, Osvandré Luís Canfield; Fukushima, Walter Yoshinori

    2015-01-01

    Objective: Analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. Methods: The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand breed (Oryctolagus cuniculus) were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). For the flexor tendons of the hind paws, sterile and driven techniques were used in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). Results: In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6- strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands) (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15th day and in 66.7% on the 30th day, making the biological tissue stronger and more resistant (p=0.095). Conclusion: This study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques

  11. Mesh Sutured Repairs of Abdominal Wall Defects

    PubMed Central

    Lanier, Steven T.; Jordan, Sumanas W.; Miller, Kyle R.; Ali, Nada A.; Stock, Stuart R.

    2016-01-01

    Background: A new closure technique is introduced, which uses strips of macroporous polypropylene mesh as a suture for closure of abdominal wall defects due to failures of standard sutures and difficulties with planar meshes. Methods: Strips of macroporous polypropylene mesh of 2 cm width were passed through the abdominal wall and tied as simple interrupted sutures. The surgical technique and surgical outcomes are presented. Results: One hundred and seven patients underwent a mesh sutured abdominal wall closure. Seventy-six patients had preoperative hernias, and the mean hernia width by CT scan for those with scans was 9.1 cm. Forty-nine surgical fields were clean-contaminated, contaminated, or dirty. Five patients had infections within the first 30 days. Only one knot was removed as an office procedure. Mean follow-up at 234 days revealed 4 recurrent hernias. Conclusions: Mesh sutured repairs reliably appose tissue under tension using concepts of force distribution and resistance to suture pull-through. The technique reduces the amount of foreign material required in comparison to sheet meshes, and avoids the shortcomings of monofilament sutures. Mesh sutured closures seem to be tolerant of bacterial contamination with low hernia recurrence rates and have replaced our routine use of mesh sheets and bioprosthetic grafts. PMID:27757361

  12. Repair of quadriceps tendon ruptures using suture anchors.

    PubMed

    Richards, David P; Barber, F Alan

    2002-01-01

    The repair of ruptured quadriceps tendon is commonly performed by weaving sutures through the ruptured tendon and then attaching the tendon to the bone by passing these sutures through tunnels in the superior patella. This technical note is the first report we are aware of in the English language literature of a technique that uses suture anchors to attach the tendon to bone.

  13. Horizontal running mattress suture modified with intermittent simple loops.

    PubMed

    Chacon, Anna H; Shiman, Michael I; Strozier, Narissa; Zaiac, Martin N

    2013-01-01

    Using the combination of a horizontal running mattress suture with intermittent loops achieves both good eversion with the horizontal running mattress plus the ease of removal of the simple loops. This combination technique also avoids the characteristic railroad track marks that result from prolonged non-absorbable suture retention. The unique feature of our technique is the incorporation of one simple running suture after every two runs of the horizontal running mattress suture. To demonstrate its utility, we used the suturing technique on several patients and analyzed the cosmetic outcome with post-operative photographs in comparison to other suturing techniques. In summary, the combination of running horizontal mattress suture with simple intermittent loops demonstrates functional and cosmetic benefits that can be readily taught, comprehended, and employed, leading to desirable aesthetic results and wound edge eversion.

  14. Treatment of Suture-related Complications of Buried-suture Double-eyelid Blepharoplasty in Asians

    PubMed Central

    2016-01-01

    Background: Double-eyelid blepharoplasty is a popular aesthetic surgery in Asians. However, the buried suture technique is associated with complications related to implantation of the suture thread. The present study was performed to identify optimal surgical suture removal techniques in Japanese patients with suture-related complications after buried suture double-eyelid blepharoplasty. Methods: This retrospective study included 210 upper eyelids of 116 consecutive Japanese patients who had undergone buried suture double-eyelid blepharoplasty at other clinics. All patients underwent suture removal surgery at the author's institution for treatment of suture-related complications. Although 12 patients (10.3%) underwent suture removal surgery alone, 104 (89.7%) underwent secondary double-eyelid blepharoplasty. The outcomes of 3 techniques were evaluated: the small skin incision method, the full skin incision method, and the conjunctival method. Results: The small skin incision method was performed in 46 patients, the full skin incision method in 63, and the conjunctival method in 7. The success rate of the full skin incision method was significantly higher than that of the small skin incision method (4.8% vs 37.0%, respectively; p < 0.0001). Patients with an uncomfortable pulling sensation exhibited a linear scar or depressive deformity without inflammation of the tarsal plate and impingement on the subconjunctival capillary vessels of the tarsal plate or a depressive deformity of the levator muscle. Patients with corneal irritation exhibited chronic inflammation of the conjunctival surface of the tarsal plate. Conclusions: Suture-related complications of buried suture double-eyelid blepharoplasty in Asians must be treated with suture removal surgery. The full skin incision method is more reliable than the small incision method for such patients.

  15. Treatment of Suture-related Complications of Buried-suture Double-eyelid Blepharoplasty in Asians

    PubMed Central

    2016-01-01

    Background: Double-eyelid blepharoplasty is a popular aesthetic surgery in Asians. However, the buried suture technique is associated with complications related to implantation of the suture thread. The present study was performed to identify optimal surgical suture removal techniques in Japanese patients with suture-related complications after buried suture double-eyelid blepharoplasty. Methods: This retrospective study included 210 upper eyelids of 116 consecutive Japanese patients who had undergone buried suture double-eyelid blepharoplasty at other clinics. All patients underwent suture removal surgery at the author's institution for treatment of suture-related complications. Although 12 patients (10.3%) underwent suture removal surgery alone, 104 (89.7%) underwent secondary double-eyelid blepharoplasty. The outcomes of 3 techniques were evaluated: the small skin incision method, the full skin incision method, and the conjunctival method. Results: The small skin incision method was performed in 46 patients, the full skin incision method in 63, and the conjunctival method in 7. The success rate of the full skin incision method was significantly higher than that of the small skin incision method (4.8% vs 37.0%, respectively; p < 0.0001). Patients with an uncomfortable pulling sensation exhibited a linear scar or depressive deformity without inflammation of the tarsal plate and impingement on the subconjunctival capillary vessels of the tarsal plate or a depressive deformity of the levator muscle. Patients with corneal irritation exhibited chronic inflammation of the conjunctival surface of the tarsal plate. Conclusions: Suture-related complications of buried suture double-eyelid blepharoplasty in Asians must be treated with suture removal surgery. The full skin incision method is more reliable than the small incision method for such patients. PMID:27622107

  16. Isolating Suture Slippage During Cadaveric Testing of Knotless Anchors.

    PubMed

    Klinge, Stephen A; Vopat, Bryan G; Paller, David; Avery, Anthony L; Koruprolu, Sarath; Fadale, Paul D

    2015-07-01

    We evaluated a testing method designed to isolate and analyze the effectiveness of different suture-retention mechanisms in knotless suture anchors used for rotator cuff repairs. Six knotless PushLock implants (Arthrex) with a suture-retention mechanism dependent on a press-fit of suture between the anchor's outer diameter and surrounding bone were compared with 6 ReelX STT devices (Stryker) reliant on an intrinsic suture-locking mechanism. Suture slippage beyond minimal clinical failure thresholds, as well as ultimate failure load, were determined with a novel testing fixture that isolated suture slippage. Suture slippage was isolated from anchor-bone disengagement. Each PushLock exhibited suture slippage of more than 3 mm, and each ReelX exhibited slippage of less than 3 mm. The PushLock implants also exhibited significantly (P < .05) more interval and maximum slippage; 5 of these 6 implants failed via complete suture slippage before dynamic testing could be completed. All ReelX devices survived dynamic testing and ultimately failed via suture breakage. This novel axial load biomechanical testing technique isolated suture slippage in 2 uniquely designed knotless anchors. The press-fit PushLock implant was prone to slippage failure, whereas the ReelX device with its internal suture-locking mechanism exhibited minimal slippage. PMID:26161766

  17. Resection of the sidewall of superior vena cava using video-assisted thoracic surgery mechanical suture technique

    PubMed Central

    Xu, Xin; Qiu, Yuan; Pan, Hui; Mo, Lili; Chen, Hanzhang

    2016-01-01

    Lung cancer invading the superior vena cava (SVC) is a locally advanced condition, for which poor prognosis is expected with conservative treatment alone. Surgical resection of the lesion can rapidly relieve the symptoms and significantly improve survival for some patients. Replacement, repair and partial resection of SVC via thoracotomy were generally accepted and used in the past. As the rapid development of minimally invasive techniques and devices, partial resection and repair of SVC are feasible via video-assisted thoracic surgery (VATS). However, few studies have reported the VATS surgical techniques. In this study, we reported the crucial techniques of partial resection of SVC via VATS. PMID:27076960

  18. Shear lag sutures: Improved suture repair through the use of adhesives.

    PubMed

    Linderman, Stephen W; Kormpakis, Ioannis; Gelberman, Richard H; Birman, Victor; Wegst, Ulrike G K; Genin, Guy M; Thomopoulos, Stavros

    2015-09-01

    Suture materials and surgical knot tying techniques have improved dramatically since their first use over five millennia ago. However, the approach remains limited by the ability of the suture to transfer load to tissue at suture anchor points. Here, we predict that adhesive-coated sutures can improve mechanical load transfer beyond the range of performance of existing suture methods, thereby strengthening repairs and decreasing the risk of failure. The mechanical properties of suitable adhesives were identified using a shear lag model. Examination of the design space for an optimal adhesive demonstrated requirements for strong adhesion and low stiffness to maximize the strength of the adhesive-coated suture repair construct. To experimentally assess the model, we evaluated single strands of sutures coated with highly flexible cyanoacrylates (Loctite 4903 and 4902), cyanoacrylate (Loctite QuickTite Instant Adhesive Gel), rubber cement, rubber/gasket adhesive (1300 Scotch-Weld Neoprene High Performance Rubber & Gasket Adhesive), an albumin-glutaraldehyde adhesive (BioGlue), or poly(dopamine). As a clinically relevant proof-of-concept, cyanoacrylate-coated sutures were then used to perform a clinically relevant flexor digitorum tendon repair in cadaver tissue. The repair performed with adhesive-coated suture had significantly higher strength compared to the standard repair without adhesive. Notably, cyanoacrylate provides strong adhesion with high stiffness and brittle behavior, and is therefore not an ideal adhesive for enhancing suture repair. Nevertheless, the improvement in repair properties in a clinically relevant setting, even using a non-ideal adhesive, demonstrates the potential for the proposed approach to improve outcomes for treatments requiring suture fixation. Further study is necessary to develop a strongly adherent, compliant adhesive within the optimal design space described by the model. PMID:26022966

  19. Shear lag sutures: Improved suture repair through the use of adhesives

    PubMed Central

    Linderman, Stephen W.; Kormpakis, Ioannis; Gelberman, Richard H.; Birman, Victor; Wegst, Ulrike G. K.; Genin, Guy M.; Thomopoulos, Stavros

    2015-01-01

    Suture materials and surgical knot tying techniques have improved dramatically since their first use over five millennia ago. However, the approach remains limited by the ability of the suture to transfer load to tissue at suture anchor points. Here, we predict that adhesive-coated sutures can improve mechanical load transfer beyond the range of performance of existing suture methods, thereby strengthening repairs and decreasing the risk of failure. The mechanical properties of suitable adhesives were identified using a shear lag model. Examination of the design space for an optimal adhesive demonstrated requirements for strong adhesion and low stiffness to maximize the strength of the adhesive-coated suture repair construct. To experimentally assess the model, we evaluated single strands of sutures coated with highly flexible cyanoacrylates (Loctite 4903 and 4902), cyanoacrylate (Loctite QuickTite Instant Adhesive Gel), rubber cement, rubber/gasket adhesive (1300 Scotch-Weld Neoprene High Performance Rubber & Gasket Adhesive), an albumin-glutaraldehyde adhesive (BioGlue), or poly(dopamine). As a clinically relevant proof-of-concept, cyanoacrylate-coated sutures were then used to perform a clinically relevant flexor digitorum tendon repair in cadaver tissue. The repair performed with adhesive-coated suture had significantly higher strength compared to the standard repair without adhesive. Notably, cyanoacrylate provides strong adhesion with high stiffness and brittle behavior, and is therefore not an ideal adhesive for enhancing suture repair. Nevertheless, the improvement in repair properties in a clinically relevant setting, even using a non-ideal adhesive, demonstrates the potential for the proposed approach to improve outcomes for treatments requiring suture fixation. Further study is necessary to develop a strongly adherent, compliant adhesive within the optimal design space described by the model. PMID:26022966

  20. Pediatric Coronal Suture Fiber Alignment and the Effect of Interdigitation on Coronal Suture Mechanical Properties.

    PubMed

    Adamski, Kelly Nicole; Loyd, Andre Matthew; Samost, Albert; Myers, Barry; Nightingale, Roger; Smith, Kathleen; 'Dale' Bass, Cameron R

    2015-09-01

    The morphological and mechanical properties of the pediatric skull are important in understanding pediatric head injury biomechanics. Although previous studies have analyzed the morphology of cranial sutures, none has done so in pediatric specimens nor have previous studies related the morphology to mechanical properties of human sutures. This study quantified the geometry of pediatric cranial sutures and investigated its correlation with the suture mechanical properties. First, the suture fiber alignment was quantified using histological analysis for four ages-neonate, 9 months-old, 11 months-old, and 18 months-old. For the morphometric investigation of the suture interdigitation, suture samples from a 6-year-old were scanned using micro-CT and the level of interdigitation was measured using two techniques. The first technique, the sinuosity index, was calculated by dividing the suture path along the surface of the skull by the suture distance from beginning to end. The second technique, the surface area interdigitation index, was calculated by measuring the surface area of the bone interface outlining the suture and dividing it by the cross-sectional area of the bone. The mechanical properties were obtained using methods reported in Davis et al.6. The results of the histological analysis showed a significant increase in fiber alignment in older specimen; where random fiber alignment has an average angle deviation of 45°, neonatal suture fibers have an average deviation of 32.2° and the 18-month-old fibers had an average deviation of 16.2° (p < 0.0001). For the suture index measurements, only the sinuosity was positively correlated with the ultimate strain (R (2) = 0.62, Bonferroni corrected p = 0.011) but no other measurements showed a significant relationship, including the amount of interdigitation and elastic modulus. Our results demonstrate that there is a distinct developmental progression of the suture fiber alignment at a young age, but the

  1. Recycling Suture Limbs from Knotless Suture Anchors for Arthroscopic Shoulder Stabilization

    PubMed Central

    Johnson, Timothy S.; DiPompeo, Christine M.; Ismaeli, Zahra C.; Porter, Polly A.; Nicholson, Shannon L.; Johnson, David C.

    2014-01-01

    Recurrent shoulder instability often leads to labral abnormality that requires surgical intervention that may require fixation with suture anchors. The proposed surgical technique allows the surgeon to achieve 2 points of fixation around the labrum and/or capsule with a single suture secured to the glenoid with a knotless anchor. Instead of cutting and discarding the residual suture limbs after anchor insertion, this technique uses the residual suture limbs of the knotless anchor for a second suture pass. This technique (1) creates a more cost- and time-efficient surgical procedure than using multiple single-loaded anchors or double-loaded anchors, (2) decreases the known risk of glenoid fracture from the stress riser at the implant tips of multi-anchor repairs by reducing the number of anchors required for stabilization, (3) decreases the surgical time compared with the use of double-loaded anchors through simpler suture management and less knot tying, (4) allows for the secure reapproximation of the labrum to the glenoid while offering a convenient option for capsulorrhaphy without the need to insert another anchor, and (5) yields more points of soft-tissue fixation with fewer anchors drilled into the glenoid. PMID:25126504

  2. 7. Perineal suturing.

    PubMed

    Blease, Megan; Taylor, Kerry

    2016-04-01

    Preceptorship is the 15th series of 'Midwifery basics' targeted at practising midwives. The aim of these articles is to provide information to raise awareness of the impact of the work of midwives on women's experience, and encourage midwives to seek further information through a series of activities relating to the topic. During the transition from student midwife, the newly qualified practitioner (NQM) is required to obtain experience of perineal suturing. With exposure varying from student to student and inconsistency in teaching methods between hospital trusts, the NQM can be left feeling apprehensive and unsupported to learn this skill. Suturing is a major and sometimes traumatic event for childbearing women, whose experience can vary greatly, depending upon many factors, including environment, skill of those suturing, effective analgesia and waiting times. In this penultimate article of the series, Megan Blease and Kerry Taylor address the current issues and provide learning hints and tips for NQMs learning and practising the skill. PMID:27172679

  3. Cataract Section Across Temporary Stainless-Steel Sutures

    PubMed Central

    MacDonald, R. Keith

    1965-01-01

    The purpose of the technique described was to combine the advantages of a cleanedged Graefe-knife incision with those of safety and near-perfect apposition offered by preplaced sutures: a preliminary to cataract extraction. Uncuttable preplaced 2-mm. stainless steel sutures were finally replaced after completion of the incision by attached braided silk for closure purposes. PMID:14291461

  4. The application of barbed sutures in body contouring surgery.

    PubMed

    Shermak, Michele A

    2013-09-01

    Even with the evolution of primary surgical techniques in body contouring, wound closure remains primarily traditional and has not advanced beyond the techniques followed in past decades. Streamlining wound closure would be the next advance for body contouring surgery. Absorbable barbed sutures offer a potential solution, and they are the subject of this review investigating the applications of absorbable barbed sutures in body contouring surgery. Barbed sutures hold tension as closure proceeds, theoretically decreasing the time required for wound closure, approximating dead space, and obliterating subcutaneous knots that may result in palpable, painful granulomas. Review of the literature reveals some evidence of time savings (in some cases significant and, in some, not); however, the literature also shows some wound complications from the use of barbed sutures, including infections and extrusions. Barbed sutures have not yet been conventionally embraced, and the technology will certainly continue to evolve in order to make the devices more desirable for plastic surgeons.

  5. Evaluation of Sternal Closure with Absorbable Polydioxanone Sutures in Children

    PubMed Central

    Bigdelian, Hamid; Sedighi, Mohsen

    2014-01-01

    Introduction: Sternal dehiscence, sternal wound infection and mediastinitis are troublesome complications following median sternotomy which are major causes of morbidity and mortality of patients. Synthetic polydioxanone absorbable suture seems effective in prevention of these complications in children undergoing open heart surgery. Methods: During 2 years period, 620 patients who underwent median sternotomy were studied. The efficacy of absorbable polydioxanone suture was tested on patients using figure-of-eight suture technique. The patients’ age ranged from newborn to 15 years old. All surgical interventions were performed according to a standard protocol. Results: No sternal sutures were broken during the sternal closure and no case of mediastinitis was seen. Two patients experienced sternal dehiscence (0.32%). Follow-up period of patients were established between 1 to 132 months after open heart surgery. Conclusion: Sternal closure with the polydioxanone suture in combination with figure-of-eight technique is a safe and suitable method in children with good clinical results. PMID:24753834

  6. The use of suture anchors to repair the ruptured quadriceps tendon.

    PubMed

    Bushnell, Brandon D; Whitener, George B; Rubright, James H; Creighton, R Alexander; Logel, Kevin J; Wood, Mark L

    2007-07-01

    Quadriceps tendon rupture is an incapacitating injury that usually requires surgical repair. Traditional repair methods involve transpatellar suture tunnels, but recent reports have introduced the idea of using suture anchors to repair the ruptured tendon. We present 5 cases of our technique of using suture anchors to repair the ruptured quadriceps tendon.

  7. Transcutaneous lower blepharoplasty, painless suture removal.

    PubMed

    De Vita, Roy; Buccheri, Ernesto Maria

    2013-01-01

    Despite being referred to as one of the more challenging procedures in plastic surgery, lower blepharoplasty is one of the most commonly requested and performed aesthetic procedures.Our experience, from February 2007 to March 2012, is based on 214 transcutaneous lower blepharoplasty procedures in which the skin flap was sutured by means of the epidermal-dermal U stitch, a new, simple, and reliable method. Patients were followed up for a mean period ranging from 7 to 70 months. To our knowledge, the literature proposes a single-stitch closure or continuous suture in transcutaneous lower blepharoplasty using nylon or silk 4-5-0 to close the skin incision (1-3-5). According to our experience before 2007 based on patients' reports, single-stitch subciliary suture removal is a source of stress for the patient that causes anxiety, discomfort, and pain.Thus, in February 2007, following transepithelial lower blepharoplasty, we started using a new, simple way to suture the subciliary skin flap adopting the epidermal-dermal U nylon 5-0 stitch to avoid any discomfort and drastically reduce the level of anxiety and pain at the time of suture removal. According to our experience, the healing of the wound does not require any subsequent scar revision resulting from healing defects or pathological scar tissue; the complication rate in our series is in keeping with that reported by other authors in the literature.In conclusion, our experience indicates that the suture technique we describe is an easily reproducible, rapid, discomfort-free, and painless means of removing stitches. PMID:24036781

  8. [Mechanical anastomosis without purse-string suture in esophageal surgery].

    PubMed

    Liboni, A; Zamboni, P; Occhioni, G; Masia, S; Passerò, G; Trignano, M

    1990-03-01

    A new surgical procedure for oesophago-enterostomy using staplers without purse-string suture is described. This technique is possible only using the CEEAP stapler, thanks to its new technical features.

  9. Nanomechanical properties of facial sutures and sutural mineralization front.

    PubMed

    Radhakrishnan, P; Mao, J J

    2004-06-01

    The mechanical properties of craniofacial sutures have rarely been investigated. Three facial sutures-the pre-maxillomaxillary (PMS), the nasofrontal (NFS), and the zygomaticotemporal (ZTS)-and their corresponding sutural mineralization fronts in 8 young New Zealand White rabbits were subjected to nano-indentation with atomic force microscopy as a test of the hypothesis that they have different mechanical properties. The average elastic modulus of the PMS was 1.46 +/- 0.24 MPa (mean +/- SD), significantly higher than both the ZTS (1.20 +/- 0.20) and NFS (1.16 +/- 0.18). The average elastic moduli of sutural mineralization fronts 30 micro m away were significantly higher than their corresponding sutures and had the same distribution pattern: the PMS (2.07 +/- 0.24 MPa) significantly higher than both the ZTS (1.56 +/- 0.29) and NFS (1.71 +/- 0.22). Analysis of these data suggests that facial sutures and their immediately adjacent sutural mineralization fronts have different capacities for mechanical deformation. The elastic properties of sutures and sutural mineralization fronts are potentially useful for improving our understanding of their roles in development.

  10. Anatomic Hip Capsular Reconstruction With Separate Suture Anchors.

    PubMed

    Cuéllar, Ricardo; Cuéllar, Asier; Sánchez, Alberto; Cuéllar, Adrián

    2016-06-01

    The number of reports on the use of capsule suturing techniques during hip arthroscopy has increased in the last few years because of the important function played by the iliofemoral ligament (IFL). This study describes an arthroscopic technique whereby the hip capsule is opened by a limited vertical dissection of both the capsule itself and the IFL from their footprint on the acetabular rim, and the capsulolabral junction and the IFL's deep fibers are released. After the intra-articular procedure, the capsule is closed through 2 to 4 side-to-side sutures in the vertical arm of the capsulotomy and 1 to 2 suture anchors with sutures are passed through either side of the capsular confluence. This technique prevents a full transverse section of the IFL and allows complete capsular closure through reconstruction of the capsular footprint. PMID:27656393

  11. Bundles of Spider Silk, Braided into Sutures, Resist Basic Cyclic Tests: Potential Use for Flexor Tendon Repair

    PubMed Central

    Hennecke, Kathleen; Redeker, Joern; Kuhbier, Joern W.; Strauss, Sarah; Allmeling, Christina; Kasper, Cornelia; Reimers, Kerstin; Vogt, Peter M.

    2013-01-01

    Repair success for injuries to the flexor tendon in the hand is often limited by the in vivo behaviour of the suture used for repair. Common problems associated with the choice of suture material include increased risk of infection, foreign body reactions, and inappropriate mechanical responses, particularly decreases in mechanical properties over time. Improved suture materials are therefore needed. As high-performance materials with excellent tensile strength, spider silk fibres are an extremely promising candidate for use in surgical sutures. However, the mechanical behaviour of sutures comprised of individual silk fibres braided together has not been thoroughly investigated. In the present study, we characterise the maximum tensile strength, stress, strain, elastic modulus, and fatigue response of silk sutures produced using different braiding methods to investigate the influence of braiding on the tensile properties of the sutures. The mechanical properties of conventional surgical sutures are also characterised to assess whether silk offers any advantages over conventional suture materials. The results demonstrate that braiding single spider silk fibres together produces strong sutures with excellent fatigue behaviour; the braided silk sutures exhibited tensile strengths comparable to those of conventional sutures and no loss of strength over 1000 fatigue cycles. In addition, the braiding technique had a significant influence on the tensile properties of the braided silk sutures. These results suggest that braided spider silk could be suitable for use as sutures in flexor tendon repair, providing similar tensile behaviour and improved fatigue properties compared with conventional suture materials. PMID:23613793

  12. Terrane suturing, Mindoro, Philippines

    SciTech Connect

    Wynne, D.B.; McCabe, R.; Mazzullo, J.; Malicse, A.

    1985-01-01

    A middle to late Miocene suture zone (SZ) on Mindoro Island separates the older North Palawan Continental terrane (NPCT) (west) from the younger Central Philippine Arc Terrane (CPAT) (east). The SZ consists of mafic and ultramafic rocks and amphibolites thrust westward against slaty meta-sediments (NPCT). East of the SZ lies the East Mindoro Basin (EMB), separated from the SZ by the East Mindoro Fault Zone (EMFZ). Locally, topography and geology suggest normal motion on the EMFZ. However, in central Mindoro, topographic expression of the EMFZ is very diffuse and geologic map patterns are complex. Lithotectonic units and sequences are sometimes repeated and motion appears to have been multiphase. In the eastern central SZ, westerly thrust CPAT ( ) crystalline rocks are overlain by lower Pliocene shelfal limestone. This limestone contains both serpentinite pebbles and metamorphic, polcrystalline quartz grains near its base, thus constraining thrusting and terrane suturing to pre-Pliocene. 100 km NNW, at the town of Puerto Galera, the same relations are observed, although thrusting appears to have been SSW there. 100 km WNW of Puerto Galera, a northeast-dipping ophiolite on Ambil Island lies several km NE of slaty metasediments (NPCT ) on Luband Island. The authors suggest that these three ultramafic exposures represent western CPAT Basement, thrust westward against portions of the advancing NPCT.

  13. The double loop mattress suture

    PubMed Central

    Biddlestone, John; Samuel, Madan; Creagh, Terry; Ahmad, Tariq

    2014-01-01

    An interrupted stitch type with favorable tissue characteristics will reduce local wound complications. We describe a novel high-strength, low-tension repair for the interrupted closure of skin, cartilage, and muscle, the double loop mattress stitch, and compare it experimentally with other interrupted closure methods. The performance of the double loop mattress technique in porcine cartilage and skeletal muscle is compared with the simple, mattress, and loop mattress interrupted sutures in both a novel porcine loading chamber and mechanical model. Wound apposition is assessed by electron microscopy. The performance of the double loop mattress in vivo was confirmed using a series of 805 pediatric laparotomies/laparoscopies. The double loop mattress suture is 3.5 times stronger than the loop mattress in muscle and 1.6 times stronger in cartilage (p ≤ 0.001). Additionally, the double loop mattress reduces tissue tension by 66% compared with just 53% for the loop mattress (p ≤ 0.001). Wound gapping is equal, and wound eversion appears significantly improved (p ≤ 0.001) compared with the loop mattress in vitro. In vivo, the double loop mattress performs as well as the loop mattress and significantly better than the mattress stitch in assessments of wound eversion and dehiscence. There were no episodes of stitch extrusion in our series of patients. The mechanical advantage of its intrinsic pulley arrangement gives the double loop mattress its favorable properties. Wound dehiscence is reduced because this stitch type is stronger and exerts less tension on the tissue than the mattress stitch. We advocate the use of this novel stitch wherever a high-strength, low-tension repair is required. These properties will enhance wound repair, and its application will be useful to surgeons of all disciplines. PMID:24698436

  14. Barbed sutures in body surgery.

    PubMed

    Moya, Alexander P

    2013-09-01

    Wound-closing technology continues to evolve with the advent of barbed sutures, which appear to address some of the limitations of traditional sutures (numerous knots and time-consuming insertion, among other things). Advantages of knotless suture devices, specifically in body contouring, have been discussed in the literature over the past decade, with a recent increase over the past several years due to the US Food and Drug Administration (FDA) approval of unidirectional V-Loc (Covidien, Mansfield, Massachusetts) and bidirectional Quill (Angiotech Pharmaceuticals, Inc, Vancouver, British Columbia, Canada) barbed sutures for soft tissue approximation. A thorough review of the existing literature and evaluation of the author's personal experience are presented in this article. As with any new surgical device, a learning curve is present that needs to be overcome to realize the full benefits of utilizing barbed sutures in body surgery while minimizing their complications.

  15. [Suture protection of acute ruptured anterior cruciate ligament by the Pet-band (Trevira extra strong). Indications, technique results of a five-year study].

    PubMed

    Letsch, R; Stürmer, K M; Kock, H J; Schmit-Neuerburg, K P

    1993-10-01

    In a prospective clinical study 56 acute tears of the anterior cruciate ligament (ACL) were treated between 1986 and 1991 by reinsertion and protection of the suture by means of a PET ligament (Trevira hochfest). The patients concerned were 31 men and 23 women (1 man and 1 woman had both knees operated on), with an average age of 39.7 years; 28 left and 28 right knees were affected. In 19 cases the ACL tear occurred in isolation, while in 37 concomitant intraarticular lesions were present. Nine patients had suffered multiple injury, and 3 had additional fractures distant from the knee. Haemarthrosis was encountered in 34 cases, and a clear effusion in 3 cases. The main causes of ACL rupture were sports injuries (n = 32), followed by traffic accidents (n = 14), activities of daily life (n = 6), and work accidents (n = 4). The preoperative diagnosis of ACL rupture was made correctly in 54 cases. After injury, 37 knees were operated on within the first 2 weeks, and 19 between the 3 and the 8 week. After arthroscopic repair of the concomitant lesions the alloplastic ligament was implanted isometrically by arthrotomy or miniarthrotomy through two bone tunnels and fixed to the bone with staples. Postoperative treatment included immediate continuous passive motion (CPM) and early weight-bearing with the protection of a brace. The patients were followed up at yearly intervals. At the last follow up, 6 years after the beginning of the study, 50 patients were examined clinically and radiologically, and the mean follow-up interval in these 50 was 40.2 months (12-79 months).(ABSTRACT TRUNCATED AT 250 WORDS)

  16. A comparison of ultrasonic suture welding and traditional knot tying.

    PubMed

    Richmond, J C

    2001-01-01

    The slippage of knots and the technical challenge of tying them securely are potential impediments to certain arthroscopic procedures. Ultrasonic energy delivered at 70 kHz can be used to weld No. 2 polypropylene suture. This method was compared with a traditional knot (surgeon's knot with four alternating half hitches) tied with an open technique to determine whether welding of sutures is comparable, in mechanical properties, to hand-tied knots. Both loops were fashioned around a 0.25-inch mandrel and then tested. The load to reach 3-mm elongation (point of likely biologic failure of a repair) was significantly greater for welded sutures than for knots. The elongation at ultimate failure was significantly less for welded sutures than for knots. The number of cycles to failure and the creep after initial displacement were similar for both welded and knotted suture loops. The ultimate load to failure was significantly greater for the knotted than for the welded suture. The welding of suture for the repair of musculoskeletal soft tissue presents an attractive alternative to traditional knot tying, particularly for arthroscopic applications.

  17. A century's worth of arterial sutures.

    PubMed

    Barker, W F

    1988-01-01

    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. PMID:3067741

  18. Cranial sutures work collectively to distribute strain throughout the reptile skull

    PubMed Central

    Curtis, Neil; Jones, M. E. H.; Evans, S. E.; O'Higgins, P.; Fagan, M. J.

    2013-01-01

    The skull is composed of many bones that come together at sutures. These sutures are important sites of growth, and as growth ceases some become fused while others remain patent. Their mechanical behaviour and how they interact with changing form and loadings to ensure balanced craniofacial development is still poorly understood. Early suture fusion often leads to disfiguring syndromes, thus is it imperative that we understand the function of sutures more clearly. By applying advanced engineering modelling techniques, we reveal for the first time that patent sutures generate a more widely distributed, high level of strain throughout the reptile skull. Without patent sutures, large regions of the skull are only subjected to infrequent low-level strains that could weaken the bone and result in abnormal development. Sutures are therefore not only sites of bone growth, but could also be essential for the modulation of strains necessary for normal growth and development in reptiles. PMID:23804444

  19. INTRASYNOVIAL FLEXOR TENDON REPAIR: A BIOMECHANICAL STUDY OF VARIATIONS IN SUTURE APPLICATION IN HUMAN CADAVERA

    PubMed Central

    Nelson, GN; Potter, R; Ntouvali, E; Silva, MJ; Boyer, MI; Gelberman, RH; Thomopoulos, S

    2013-01-01

    To improve the functional outcomes of intrasynovial tendon suture, prior experiments evaluated individual technical modifications used in the repair process. Few studies, however, have assessed the combinatorial effects of those suture modifications in an integrated biomechanical manner, including a sample size sufficient to make definitive observations on repair technique. 256 flexor tendon repairs were performed in cadavera, and biomechanical properties were determined. The effects of five factors for flexor tendon repair were tested: core suture caliber (4-0 or 3-0), number of sutures crossing the repair site (4- or 8-strand), core suture purchase (0.75 cm or 1.2 cm), peripheral suture caliber (6-0 or 5-0), and peripheral suture purchase (superficial or 2 mm). Significant factors affecting the properties of the repair were the number of core suture strands and the peripheral suture purchase. The least significant factors were core suture purchase and peripheral suture caliber. The choice of core suture caliber affected the properties of repair marginally. Based on these results, we recommend that surgeons continue to focus on multi-strand repair methods, as the properties of 8-strand repairs were far better than those of 4-strand repairs. To resist gap formation and enhance repair strength, a peripheral suture with 2mm purchase is also recommended. Finally, since core suture caliber affected some biomechanical properties, including the failure mode, a 3-0 suture could be considered, provided that future in vivo studies can confirm that gliding properties are not adversely influenced. PMID:22457145

  20. Current applications of endoscopic suturing

    PubMed Central

    Stavropoulos, Stavros N; Modayil, Rani; Friedel, David

    2015-01-01

    Endoscopic suturing had previously been considered an experimental procedure only performed in a few centers and often by surgeons. Now, however, endoscopic suturing has evolved sufficiently to be easily implemented during procedures and is more commonly used by gastroenterologists. We have employed the Apollo OverStitch suturing device in a variety of ways including closure of perforations, closure of full thickness defects in the gastrointestinal wall created during endoscopic full thickness resection, closure of mucosotomies during peroral endoscopic myotomy, stent fixation, fistula closure, post endoscopic submucosal dissection, endoscopic mucosal resection and Natural Orifice Transluminal Endoscopic Surgery defect closures, post-bariatric surgery gastrojejunal anastomosis revision and primary sleeve gastroplasty. PMID:26191342

  1. Effect of suture material on postoperative astigmatism.

    PubMed

    Gimbel, H V; Raanan, M G; DeLuca, M

    1992-01-01

    Two hundred patients were enrolled in a randomized, prospective clinical trial comparing the use of 10-0 nylon, 10-0 polypropylene (Prolene), 11-0 polyester (Mersilene), and 10-0 polyethylene (Novafil) suture materials on the amount and decay curves of surgically induced astigmatism following intraocular lens (IOL) surgery. Patients with Mersilene and nylon sutures had the highest amounts of induced with-the-rule (WTR) cylinder (significantly more than Prolene) at one day after surgery. However, the WTR cylinder decayed rapidly for nylon during the first three months but more slowly for Mersilene because of its lack of stretchability. The Prolene group had the lowest level of induced WTR cylinder at one day, but against-the-rule (ATR) drift occurred, leaving cases with ATR astigmatism by a year. The nylon group had the second highest amount of induced WTR cylinder at one day, which had decayed to ATR cylinder by five months. Between one and two years postoperatively, the nylon group experienced a significant ATR shift. The amount of early induced WTR cylinder seemed to be related to the knot-tying technique and tissue gripping characteristics, whereas the shape of the decay curve was related to the material characteristics of the suture. PMID:1531234

  2. Biomechanics of craniofacial sutures: orthopedic implications.

    PubMed

    Mao, Jeremy J; Wang, Xin; Kopher, Ross A

    2003-04-01

    Sutures are soft connective tissue articulations between craniofacial bones. Suture mechanics deals with patterns of mechanical stress experienced in sutures resulting from natural activities such as mastication and exogenous forces such as orthopedic loading. Patterns of sutural mechanical stress can be delineated readily as sutural strain using strain gages attached over the suture. In mastication, complex sutural strain patterns have been elucidated in a few species. Mechanical stresses are not transmitted in the skull as a continuing gradient, for different sutures are capable of redefining a propagating mechanical force as predominately tensile or compressive strain. Exogenous mechanical forces with engineering waveforms such as static and sine wave at different frequencies induce corresponding waveforms and rates of sutural strain, providing the basis for applying novel mechanical stimuli to engineer sutural growth. The available data on suture mechanics converge to a hypothetical theme that mechanical forces regulate sutural growth by inducing sutural mechanical strain. Various orthopedic therapies, including headgear, facemask, and functional appliances may induce sutural strain, leading to modification of otherwise natural suture growth.

  3. Suture Forces in Undersized Mitral Annuloplasty: Novel Device and Measurements

    PubMed Central

    Siefert, Andrew; Pierce, Eric; Lee, Madonna; Jensen, Morten; Aoki, Chikashi; Takebayashi, Satoshi; Gorman, Robert; Gorman, Joseph; Yoganathan, Ajit

    2014-01-01

    Purpose: Demonstrate the first use of a novel technology for quantifying suture forces on annuloplasty rings to better understand the mechanisms of ring dehiscence. Description: Force transducers were developed, attached to a size 24 Physio™ ring, and implanted in the mitral annulus of an ovine animal. Ring suture forces were measured after implantation and for cardiac cycles reaching peak left ventricular pressures (LVP) of 100, 125, and 150 mmHg. Evaluation: After implanting the undersized ring to the flaccid annulus, the mean suture force was 2.0±0.6 N. During cyclic contraction, anterior ring suture forces were greater than posterior ring suture forces at peak LVPs of 100 mmHg (4.9±2.0 N vs. 2.1±1.1 N), 125 mmHg (5.4±2.3 N vs. 2.3±1.2 N), and 150 mmHg (5.7±2.4 N vs. 2.4±1.1 N). The largest force was 7.4 N at 150 mmHg. Conclusions: Preliminary results demonstrate trends in annuloplasty suture forces and their variation with location and LVP. Future studies will significantly contribute to clinical knowledge by elucidating the mechanisms of ring dehiscence while improving annuloplasty ring design and surgical repair techniques. PMID:24996707

  4. A reusable suture anchor for arthroscopy psychomotor skills training.

    PubMed

    Tillett, Edward D; Rogers, Rainie; Nyland, John

    2003-03-01

    For residents to adequately develop the early arthroscopy psychomotor skills required to better learn how to manage the improvisational situations they will encounter during actual patient cases, they need to experience sufficient practice repetitions within a contextually relevant environment. Unfortunately, the cost of suture anchors can be a practice repetition-limiting factor in learning arthroscopic knot-tying techniques. We describe a technique for creating inexpensive reusable suture anchors and provide an example of their application to repair the anterior glenoid labrum during an arthroscopy psychomotor skills laboratory training session.

  5. Suture anchor repair of quadriceps tendon rupture after total knee arthroplasty.

    PubMed

    Kim, Tae Won B; Kamath, Atul F; Israelite, Craig L

    2011-08-01

    Disruption of the extensor mechanism after total knee arthroplasty (TKA) is a devastating complication, usually requiring surgical repair. Although suture anchor fixation is well described for repair of the ruptured native knee quadriceps tendon, no study has discussed the use of suture anchors in quadriceps repair after TKA. We present an illustrative case of successful suture anchor fixation of the quadriceps mechanism after TKA. The procedure has been performed in a total of 3 patients. A surgical technique and brief review of the literature follows. Suture anchor fixation of the quadriceps tendon is a viable option in the setting of rupture after TKA.

  6. Bacterial colonization of percutaneous sutures.

    PubMed

    Gristina, A G; Price, J L; Hobgood, C D; Webb, L X; Costerton, J W

    1985-07-01

    The direct electron microscopic examination of 15 sutures and 15 staples removed from 10 healed surgical wounds showed, on the intradermal portions, consistent colonization by bacteria growing in adherent biofilms. This clearly demonstrable bacterial colonization of biomaterials within the wound tract had not resulted in infection or perceptible inflammation in any of the wounds. These bacterial cells were of several morphotypes, including gram-positive cocci, and all specimens yielded cultures of the autochthonous (native) skin bacterium, Staphylococcus epidermidis. The bacteria within the wound tracts were enveloped by extracellular material that appeared on scanning electron microscopy to be a condensed amorphous residue and on transmission electron microscopy to be a fibrous extracellular matrix. We suggest that this mode of growth, in which the colonizing bacteria are enveloped in a copious exopolysaccharide glycocalix, protects the bacteria from host defense factors and accounts for their persistence on the suture surfaces until they are removed with the sutures.

  7. Selective laser vaporization of polypropylene sutures and mesh

    NASA Astrophysics Data System (ADS)

    Burks, David; Rosenbury, Sarah B.; Kennelly, Michael J.; Fried, Nathaniel M.

    2012-02-01

    Complications from polypropylene mesh after surgery for female stress urinary incontinence (SUI) may require tedious surgical revision and removal of mesh materials with risk of damage to healthy adjacent tissue. This study explores selective laser vaporization of polypropylene suture/mesh materials commonly used in SUI. A compact, 7 Watt, 647-nm, red diode laser was operated with a radiant exposure of 81 J/cm2, pulse duration of 100 ms, and 1.0-mm-diameter laser spot. The 647-nm wavelength was selected because its absorption by water, hemoglobin, and other major tissue chromophores is low, while polypropylene absorption is high. Laser vaporization of ~200-μm-diameter polypropylene suture/mesh strands, in contact with fresh urinary tissue samples, ex vivo, was performed. Non-contact temperature mapping of the suture/mesh samples with a thermal camera was also conducted. Photoselective vaporization of polypropylene suture and mesh using a single laser pulse was achieved with peak temperatures of 180 and 232 °C, respectively. In control (safety) studies, direct laser irradiation of tissue alone resulted in only a 1 °C temperature increase. Selective laser vaporization of polypropylene suture/mesh materials is feasible without significant thermal damage to tissue. This technique may be useful for SUI procedures requiring surgical revision.

  8. Force-Induced Craniosynostosis in the Murine Sagittal Suture

    PubMed Central

    Oppenheimer, Adam J.; Rhee, Samuel T.; Goldstein, Steven A.; Buchman, Steven R.

    2010-01-01

    BACKGROUND The etiology of non-syndromic craniosynostosis remains elusive. While compressive forces have been implicated in premature suture fusion, conclusive evidence of force-induced craniosynostosis is lacking. The purpose of this study was to determine if cyclical loading of the murine calvarium could induce suture fusion. METHODS Calvarial coupons from post-natal day 21, B6CBA wild-type mice (n = 18) were harvested and cultured. A custom appliance capable of delivering controlled, cyclical, compressive loads was applied perpendicular to the sagittal suture within the coupon in vitro. Nine coupons were subjected to 0.3g of force for 30 minutes each day for a total of 14 days. A control group of nine coupons was clamped in the appliance without loading. Analysis of suture phenotype was performed using alkaline phosphatase and H&E staining techniques, as well as in situ hybridization analysis using Bone Sialoprotein (BSP). RESULTS Control group sagittal sutures—which normally remain patent in mice—showed their customary histological appearance. In contradistinction, sagittal sutures subjected to cyclic loading showed histological evidence of premature fusion (craniosynostosis). In addition, alkaline phosphatase activity and BSP expression was observed to be increased in the experimental group when compared to matched controls. CONCLUSIONS An in vitro model of forced-induced craniosynostosis has been devised. Premature fusion of the murine sagittal suture was induced with the application of controlled, cyclical, compressive loads. These results implicate abnormal forces in the development of non-syndromic craniosynostosis, which supports our global hypothesis that epigenetic phenomena have a crucial role in the pathogenesis of craniosynostosis. PMID:19952640

  9. Ultrastructure, Histochemistry, and Mineralization Patterns in the Ecdysial Suture of the Blue Crab, Callinectes sapidus

    NASA Astrophysics Data System (ADS)

    Priester, Carolina; Dillaman, Richard M.; Gay, D. Mark

    2005-12-01

    The ecdysial suture is the region of the arthropod exoskeleton that splits to allow the animal to emerge during ecdysis. We examined the morphology and composition of the intermolt and premolt suture of the blue crab using light microscopy and scanning electron microscopy. The suture could not be identified by routine histological techniques; however 3 of 22 fluorescein isothiocyanate-labeled lectins tested (Lens culinaris agglutinin, Vicia faba agglutinin, and Pisum sativum agglutinin) differentiated the suture, binding more intensely to the suture exocuticle and less intensely to the suture endocuticle. Back-scattered electron (BSE) and secondary electron observations of fracture surfaces of intermolt cuticle showed less mineralized regions in the wedge-shaped suture as did BSE analysis of premolt and intermolt resin-embedded cuticle. The prism regions of the suture exocuticle were not calcified. X-ray microanalysis of both the endocuticle and exocuticle demonstrated that the suture was less calcified than the surrounding cuticle with significantly lower magnesium and phosphorus concentrations, potentially making its mineral more soluble. The presence or absence of a glycoprotein in the organic matrix, the extent and composition of the mineral deposited, and the thickness of the cuticle all likely contribute to the suture being removed by molting fluid, thereby ensuring successful ecdysis.

  10. A transducer for measuring force on surgical sutures

    PubMed Central

    Witte, Thomas H.; Cheetham, Jonathan; Rawlinson, Jeremy J.; Soderholm, L. Vince; Ducharme, Norm G.

    2010-01-01

    The objective of this study was to validate, both in vitro and in an ex vivo model, a technique for the measurement of forces exerted on surgical sutures. For this purpose, a stainless steel E-type buckle force transducer was designed and constructed. A strain gauge was mounted on the central beam of the transducer to measure transducer deformation. The transducer was tested and calibrated on a single strand of surgical suture during cyclic loading. Further validation was performed using a previously published cadaveric model of laryngoplasty in the horse. Linear regression of transducer output with actual force during calibration tests resulted in mean R2 values of 1.00, 0.99, and 0.99 for rising slope, falling slope, and overall slope, respectively. The R2 was not less than 0.96 across an average of 75 cycles per test. The difference between rising slope and falling slope was 4%. Over 45 846 samples, the predicted force from transducer output showed a mean error of 4%. In vitro validation produced an adjusted R2 of 0.99 when the force on the suture was regressed against translaryngeal pressure in a mixed-effects model. E-type buckle force transducers showed a highly linear output over a physiological force range when applied to surgical suture in vitro and in an ex vivo model of laryngoplasty. With appropriate calibration and short-term in vivo implantation, these transducers may advance our knowledge of the mechanisms of success and failure of techniques, such as laryngoplasty, that use structural suture implants. PMID:21197230

  11. Accuracy of Suture Passage During Arthroscopic Remplissage—What Anatomic Landmarks Can Improve It?

    PubMed Central

    Garcia, Grant H.; Degen, Ryan M.; Liu, Joseph N.; Kahlenberg, Cynthia A.; Dines, Joshua S.

    2016-01-01

    Background: Recent data suggest that inaccurate suture passage during remplissage may contribute to a loss of external rotation, with the potential to cause posterior shoulder pain because of the proximity to the musculotendinous junction. Purpose: To evaluate the accuracy of suture passage during remplissage and identify surface landmarks to improve accuracy. Study Design: Descriptive laboratory study. Methods: Arthroscopic remplissage was performed on 6 cadaveric shoulder specimens. Two single-loaded suture anchors were used for each remplissage. After suture passage, position was recorded in reference to the posterolateral acromion (PLA), with entry perpendicular to the humeral surface. After these measurements, the location of posterior cuff penetration was identified by careful surgical dissection. Results: Twenty-four sutures were passed in 6 specimens: 6 sutures (25.0%) were correctly passed through the infraspinatus tendon, 12 (50%) were through the infraspinatus muscle or musculotendinous junction (MTJ), and 6 (25%) were through the teres minor. Suture passage through the infraspinatus were on average 25 ± 5.4 mm inferior to the PLA, while sutures passing through the teres minor were on average 35.8 ± 5.7 mm inferior to the PLA. There was an odds ratio of 25 (95% CI, 2.1-298.3; P < .001) that the suture would be through the infraspinatus if the passes were less than 3 cm inferior to the PLA. Sutures passing through muscle and the MTJ were significantly more medial than those passing through tendon, measuring on average 8.1 ± 5.1 mm lateral to the PLA compared with 14.5 ± 5.5 mm (P < .02). If suture passes were greater than 1 cm lateral to the PLA, it was significantly more likely to be in tendon (P = .013). Conclusion: We found remplissage suture passage was inaccurate, with only 25% of sutures penetrating the infraspinatus tendon. Passing sutures 1 cm lateral and within 3 cm inferior of the PLA improves the odds of successful infraspinatus tenodesis

  12. Accuracy of Suture Passage During Arthroscopic Remplissage—What Anatomic Landmarks Can Improve It?

    PubMed Central

    Garcia, Grant H.; Degen, Ryan M.; Liu, Joseph N.; Kahlenberg, Cynthia A.; Dines, Joshua S.

    2016-01-01

    Background: Recent data suggest that inaccurate suture passage during remplissage may contribute to a loss of external rotation, with the potential to cause posterior shoulder pain because of the proximity to the musculotendinous junction. Purpose: To evaluate the accuracy of suture passage during remplissage and identify surface landmarks to improve accuracy. Study Design: Descriptive laboratory study. Methods: Arthroscopic remplissage was performed on 6 cadaveric shoulder specimens. Two single-loaded suture anchors were used for each remplissage. After suture passage, position was recorded in reference to the posterolateral acromion (PLA), with entry perpendicular to the humeral surface. After these measurements, the location of posterior cuff penetration was identified by careful surgical dissection. Results: Twenty-four sutures were passed in 6 specimens: 6 sutures (25.0%) were correctly passed through the infraspinatus tendon, 12 (50%) were through the infraspinatus muscle or musculotendinous junction (MTJ), and 6 (25%) were through the teres minor. Suture passage through the infraspinatus were on average 25 ± 5.4 mm inferior to the PLA, while sutures passing through the teres minor were on average 35.8 ± 5.7 mm inferior to the PLA. There was an odds ratio of 25 (95% CI, 2.1-298.3; P < .001) that the suture would be through the infraspinatus if the passes were less than 3 cm inferior to the PLA. Sutures passing through muscle and the MTJ were significantly more medial than those passing through tendon, measuring on average 8.1 ± 5.1 mm lateral to the PLA compared with 14.5 ± 5.5 mm (P < .02). If suture passes were greater than 1 cm lateral to the PLA, it was significantly more likely to be in tendon (P = .013). Conclusion: We found remplissage suture passage was inaccurate, with only 25% of sutures penetrating the infraspinatus tendon. Passing sutures 1 cm lateral and within 3 cm inferior of the PLA improves the odds of successful infraspinatus tenodesis

  13. Mesenchymal stem cell-coated sutures enhance collagen depositions in sutured tissues.

    PubMed

    Casado, Javier G; Blazquez, Rebeca; Jorge, Inmaculada; Alvarez, Veronica; Gomez-Mauricio, Guadalupe; Ortega-Muñoz, Mariano; Vazquez, Jesus; Sanchez-Margallo, Francisco M

    2014-01-01

    Sutures are commonly used for surgical procedures and new sutures are being developed to improve wound healing. In the past decade, it has been extensively shown that mesenchymal stem cells (MSCs) have a wound healing potential. To benefit the overall wound healing process, we aimed to analyze the usage of pretreated sutures for improving the implantation of MSCs in the tissues. Our results firstly showed that suture pretreatments with gelatin, poly-L-lysine, and NaOH improved the adhesive strength of MSCs to sutures. These cells remained surrounding the sutured tissue and no significant phenotypic changes were found in those cells cultured onto pretreated sutures. In vivo experiments showed that the implantation of MSCs by suturing increases the collagen content in the sutured tissue. Moreover, proteomics analysis of secreted proteins showed that collagen alpha-1(I) chain was the most abundant collagen found. To our knowledge, this is the first report that aimed to improve the implantation of MSCs in tissue by suture pretreatments. Moreover, in vivo experiments suggest that MSC-coated sutures may enhance wound healing and tissue remodeling through the release of different collagen types being applicable for those patients that tend to have difficulty healing.

  14. Combined suture and clipping for the reconstruction of a ruptured blister-like aneurysm.

    PubMed

    Kantelhardt, Sven R; Archavlis, Eleftherios; Giese, Alf

    2016-10-01

    Blister-like aneurysms of the internal carotid artery (ICA) present a severe therapeutical challenge. While several reconstructive techniques are in use in case of acute rupture sacrifice of the parent vessel may be required. We present a combined technique of micro-sutures and clip application to repair the parent vessel in an intraoperatively ruptured blister-like aneurysm. Following temporary trapping of an intraoperatively ruptured 7-mm blister-like aneurysm four 8-0 nylon sutures were applied to adapt the vessel walls and support the branches of subsequently applied mini-clips. The combination of micro-sutures and mini-clips might be a valuable alternative to direct clipping or suturing in some cases with intraoperative rupture of blister-like aneurysms. PMID:27514829

  15. Combined suture and clipping for the reconstruction of a ruptured blister-like aneurysm.

    PubMed

    Kantelhardt, Sven R; Archavlis, Eleftherios; Giese, Alf

    2016-10-01

    Blister-like aneurysms of the internal carotid artery (ICA) present a severe therapeutical challenge. While several reconstructive techniques are in use in case of acute rupture sacrifice of the parent vessel may be required. We present a combined technique of micro-sutures and clip application to repair the parent vessel in an intraoperatively ruptured blister-like aneurysm. Following temporary trapping of an intraoperatively ruptured 7-mm blister-like aneurysm four 8-0 nylon sutures were applied to adapt the vessel walls and support the branches of subsequently applied mini-clips. The combination of micro-sutures and mini-clips might be a valuable alternative to direct clipping or suturing in some cases with intraoperative rupture of blister-like aneurysms.

  16. Barbed versus conventional 2-layer continuous running sutures for laparoscopic vaginal cuff closure.

    PubMed

    Kim, Jin Hwi; Byun, Seung Won; Song, Jae Yeon; Kim, Yeon Hee; Lee, Hee Joong; Park, Tae Chul; Lee, Keun Ho; Hur, Soo Young; Park, Jong Sup; Lee, Sung Jong

    2016-09-01

    We compared results using unidirectional barbed sutures and conventional sutures for vaginal cuff closure during total laparoscopic hysterectomy (TLH).The electronic medical records and surgical videos of 170 patients who underwent TLH between January 2013 and March 2015 at Uijeong-bu St. Mary's Hospital of Catholic University of Korea were reviewed. Vaginal cuffs were closed using the 2-layer continuous running technique with unidirectional barbed sutures (V-Loc; Covidien, Mansfield, MA) in 64 patients and with polycolic acid Vicryl; Ethicon, Somerville, NJ sutures in 106 patients. Procedure time, clinical characteristics, and postoperative complications were compared between the 2 study groups. There were no differences in clinical characteristics (age, body mass index, and demographic data) between groups. The mean suturing time was significantly reduced in the barbed group (7.2 vs 12.2 minutes; P < 0.001), although the mean number of stitches was greater than in the Vicryl group (14.1 vs 12.3, P < 0.001). Perioperative complications, including episodes of vaginal bleeding, vaginal cuff cellulitis, and postoperative fever, did not differ between groups. There were no instances of vaginal cuff dehiscence in either group. Unidirectional barbed sutures can be used safely to reduce procedure time and surgical difficulty relative to conventional sutures in laparoscopic vaginal cuff closure. PMID:27684850

  17. Postoperative washing of sutured wounds.

    PubMed

    Harrison, Conrad; Wade, Cian; Gore, Sinclair

    2016-11-01

    A best evidence topic was written according to the structured protocol. The three part question addressed was: [In patients undergoing closure of surgical wounds with sutures] does [keeping the wound dry for the first 48 h after closure] [reduce the incidence of surgical site infections (SSIs)]? 4 relevant papers were culled from the literature and appraised. The authors, date, country, population, study type, main outcomes, key results and study weaknesses were tabulated. Current NICE guidelines recommend cleaning surgical wounds with sterile saline only for the first 48 h following skin closure. We found no evidence that washing wounds with tap water during this period increases the incidence of SSIs compared to keeping them dry. Further randomised controlled trials will enable the construction of conclusive systematic reviews and meta-analyses. PMID:27668079

  18. [Low colorectal anastomosis: a comparison of manual and mechanical sutures].

    PubMed

    Del Gaudio, A; Boschi, L; Petrin, C; Berardi, M; Accorsi, D

    1993-01-01

    Sixty-three carcinomas of the lower third of the rectum operated of anterior resection with low colorectal or coloanal anastomosis are presented. Handsewn anastomoses were performed in 33 patients, while staplers were used in 30 cases. The average distance of the tumor from the anal verge is 10.8 cm. in hand sutured anastomoses and 7.8 cm. in stapled ones. Dehiscences, stenosis and temporary incontinence are observed more frequently after stapled anastomosis, while the incidence of neoplastic recurrences is higher in sutured anastomosis; hospital stay and mortality are similar in the two series. Our results and literature review show that both techniques are comparable though maintaining their own specific identity and precise indication.

  19. [100 cases of bronchial mechanical sutures].

    PubMed

    Paolini, A; Lepore, M; Riccardelli, F; Canuti, W; Caminiti, A; Mucci, M; Ruggieri, M

    1990-03-01

    The Authors report their experience with stapler model T.A. 30 in lung resections; 100 stapled sutures were carried out in the IV Surgical Department of the University "La Sapienza" of Rome, during the period 1980-88. The use of stapler with two rows of staples allows a secure closure of the bronchial stump. Moreover, it prevents granulomas caused by suture material. The bronchopleural fistulas, serious complications of manual suturing, did not occur. Finally, this method is simpler and rapidly feasible in comparison with classic ones.

  20. Division and repair of the sphincteric mechanism at the gastric outlet in emergency operations for bleeding peptic ulcer. A new technique for use in combination with suture ligation of the bleeding point and highly selective vagotomy.

    PubMed Central

    Johnston, D

    1977-01-01

    In three of 26 patients who were treated by highly selective vagotomy (HSV) plus suture of the bleeding point for massive hemorrhage from peptic ulceration, access to the ulcer could not be obtained by means of a duodenotomy or gastrotomy which spared the pylorus. Instead, a wide gastroduodenotomy was performed, the artery in the base of the ulcer underrun and HSV performed. The gastroduodenotomy incision was closed longitudinally, rather than as a pyloroplasty. In this way, the integrity of the antral mill and of the pyloric sphincter was restored. The patients were followed up for six months, one year and three years respectively, and were found to be in good health, without clinical or radiological evidence of gastric retention or of recurrent ulceration. Thus the sphincteric mechanism at the exit of the stomach can, like the anal sphincter, be divided and subsequently repaired with good restoration of function. Images Fig. 1. Fig. 2. Fig. 3. PMID:341823

  1. Endoscopic removal of intravesical polypropylene suture with plasmakinetic resection after abdominal hysterectomy

    PubMed Central

    Küçükdurmaz, Faruk; Can, Selman; Barut, Osman

    2014-01-01

    INTRODUCTION Intravesical foreign substances such as mesh or suture are among the rare reasons of recurrent urinary tract infections. Anti-incontinence and prolapsus procedures are associated with mesh/suture extrusion into the bladder, however, this complication is uncommon with abdominal hysterectomy. PRESENTATION OF CASE A 61-year-old female, obese patient admitted to our clinic with recurrent urinary tract infections and voiding symptoms which were worsened after abdominal hysterectomy. Radiological evaluation revealed an intravesical foreign material within the bladder. The cytoscopy was performed and a polypropylene suture which was inserted from dome, passed through the base and exited from the dome of bladder during abdominal hysterectomy. Transurethral plasmakinetic resection of superficial layer of urothelium between suture entrance and exit sites was performed and suture was removed from the bladder. DISCUSSION Urogynecological procedures are associated with the increased risk of urethral or ureteral injury, intravesical mesh or suture erosion and fistulae formation. Many different techniques including open, laparoscopic and transvaginal approaches were described for the removal of intravesical mesh/suture extrusion in the literature. Transurethral approach with its minimally invasive and safe nature was used to remove suture in this patient. This technique with the use of plasmakinetic energy has the advantage of decreased risk of bleeding and urothelial injury when compared to monopolar cautery. It also avoids the need for open or extensive surgery which may have a high rate of complications. CONCLUSION Transurethral resection is the treatment of choice for the removal of intravesical foreign substances. Use of plasmakinetic energy will decrease the risk of complications and avoid the need for open interventions. PMID:25437667

  2. 21 CFR 882.4650 - Neurosurgical suture needle.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Neurosurgical suture needle. 882.4650 Section 882...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4650 Neurosurgical suture needle. (a) Identification. A neurosurgical suture needle is a needle used in suturing during...

  3. 21 CFR 882.4650 - Neurosurgical suture needle.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Neurosurgical suture needle. 882.4650 Section 882...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4650 Neurosurgical suture needle. (a) Identification. A neurosurgical suture needle is a needle used in suturing during...

  4. 21 CFR 882.4650 - Neurosurgical suture needle.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Neurosurgical suture needle. 882.4650 Section 882...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4650 Neurosurgical suture needle. (a) Identification. A neurosurgical suture needle is a needle used in suturing during...

  5. 21 CFR 882.4650 - Neurosurgical suture needle.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Neurosurgical suture needle. 882.4650 Section 882...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4650 Neurosurgical suture needle. (a) Identification. A neurosurgical suture needle is a needle used in suturing during...

  6. 21 CFR 882.4650 - Neurosurgical suture needle.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Neurosurgical suture needle. 882.4650 Section 882...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4650 Neurosurgical suture needle. (a) Identification. A neurosurgical suture needle is a needle used in suturing during...

  7. Laceration - sutures or staples - at home

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000498.htm Laceration - sutures or staples - at home To use the ... features on this page, please enable JavaScript. A laceration is a cut that goes all the way ...

  8. Multilayer deformation planarization by substrate pit suturing.

    PubMed

    Chai, Yingjie; Zhu, Meiping; Xing, Huanbin; Wang, Hu; Cui, Yun; Shao, Jianda

    2016-08-01

    In the pursuit of 1064 nm high-power laser resistance dielectric coatings in the nanosecond region, a group of HfO2/SiO2 high reflectors with and without suture layers were prepared on prearranged fused silica substrates with femtosecond laser pits. Surface morphology, global coating stress, and high-resolution cross sections were characterized to determine the effects of substrate pit suturing. Laser-induced damage resistance was investigated for samples with and without suture layers. Our results indicate considerable stability in terms of the nanosecond 1064 nm laser-induced damage threshold for samples having a suture layer, due to decreased electronic field (e-field) deformation with simultaneous elimination of internal cracks. In addition, a suture layer formed by plasma ion-assisted deposition could effectively improve global mechanical stress of the coatings. By effectively reducing the multilayer deformation using a suture layer, electron-beam high-reflective coatings, whose laser-induced damage resistance was not influenced by the substrate pit, can be prepared. PMID:27472579

  9. Functional implications of squamosal suture size in paranthropus boisei.

    PubMed

    Dzialo, Christine; Wood, Sarah A; Berthaume, Michael; Smith, Amanda; Dumont, Elizabeth R; Benazzi, Stefano; Weber, Gerhard W; Strait, David S; Grosse, Ian R

    2014-02-01

    It has been hypothesized that the extensively overlapping temporal and parietal bones of the squamosal sutures in Paranthropus boisei are adaptations for withstanding loads associated with feeding. Finite element analysis (FEA) was used to investigate the biomechanical effects of suture size (i.e., the area of overlap between the temporal and parietal bones) on stress, strain energy, and strain ratio in the squamosal sutures of Pan troglodytes and P. boisei (specimen OH 5) during biting. Finite element models (FEMs) of OH 5 and a P. troglodytes cranium were constructed from CT scans. These models contain sutures that approximate the actual suture sizes preserved in both crania. The FEM of Pan was then modified to create two additional FEMs with squamosal sutures that are 50% smaller and 25% larger than those in the original model. Comparisons among the models test the effect of suture size on the structural integrity of the squamosal suture as the temporal squama and parietal bone move relative to each other during simulated premolar biting. Results indicate that with increasing suture size there is a decreased risk of suture failure, and that maximum stress values in the OH 5 suture were favorable compared to values in the Pan model with the normal suture size. Strain ratios suggest that shear is an important strain regime in the squamosal suture. This study is consistent with the hypothesis that larger sutures help reduce the likelihood of suture failure under high biting loads. PMID:24242913

  10. Investigation of the best suture pattern to close a stuffed Christmas turkey.

    PubMed

    Verwilghen, D; Busoni, V; van Galen, G; Wilke, M

    Instructions on how to debone and stuff a turkey are available, but what is the best way to close it up? A randomised trial involving 15 turkeys was performed in order to evaluate skin disruption scores and cosmetic outcomes following the use of different suture patterns. Turkeys were deboned, stuffed and cooked according to guidelines of the US Department of Agriculture Food Safety and Inspection Services. After stuffing, they were randomly assigned to one of five closure groups: simple continuous Lembert; simple continuous Cushing; simple continuous Utrecht; simple continuous; or staples. Turkeys were cooked at 180 °C for two hours ensuring core temperature reached 75 °C. Suture line integrity was evaluated after removal of the sutures and the cosmetic aspect was graded. Before cooking, the Utrecht pattern and skin staples offered the best cosmetic result. After removal of the sutures, the skin remained intact only in the stapled group. All other suture patterns disrupted the skin after removal of the sutures, rendering the turkey less cosmetically appealing for serving. Closure of a stuffed turkey was best performed using skin staples to achieve the best cosmetic results. Using this technique you will be able to impress family and friends at a Christmas dinner, and finally show them your surgical skills.

  11. The history and evolution of sutures in pelvic surgery

    PubMed Central

    Muffly, Tyler M; Tizzano, Anthony P; Walters, Mark D

    2011-01-01

    Summary The purpose of the study is to review the history and innovations of sutures used in pelvic surgery. Based on a review of the literature using electronic- and hand-searched databases we identified appropriate articles and gynaecology surgical textbooks regarding suture for wound closure. The first documented uses of suture are explored and then the article focuses on the use of knotted materials in pelvic surgery. The development of suture of natural materials is followed chronologically until the present time where synthetic suture is implanted during countless surgeries every day. This millennial history of suture contains an appreciation of the early work of Susruta, Celsus, Paré and Lister, including a survey of some significant developments of suture methods over the last 100 years. Most surgeons know little about the history and science of sutures. A retrospective view of suture is critical to the appreciation of the current work and development of this common tool. PMID:21357979

  12. The cell biology of suturing tendons.

    PubMed

    Wong, J K F; Alyouha, S; Kadler, K E; Ferguson, M W J; McGrouther, D A

    2010-07-01

    Trauma by suturing tendon form areas devoid of cells termed "acellular zones" in the matrix. This study aimed to characterise the cellular insult of suturing and acellular zone formation in mouse tendon. Acellular zone formation was evaluated using single grasping sutures placed using flexor tendons with time lapse cell viability imaging for a period of 12h. Both tension and injury were required to induce cell death and cell movement in the formation of the acellular zone. DNA fragmentation studies and transmission electron microscopy indicated that cells necrosed. Parallel in vivo studies showed that cell-to-cell contacts were disrupted following grasping by the suture in tensioned tendon. Without tension, cell death was lessened and cell-to-cell contacts remained intact. Quantitative immunohistochemistry and 3D cellular profile mapping of wound healing markers over a one year time course showed that acellular zones arise rapidly and showed no evidence of healing whilst the wound healing response occurred in the surrounding tissues. The acellular zones were also evident in a standard modified "Kessler" clinical repair. In conclusion, the suture repair of injured tendons produces acellular zones, which may potentially cause early tendon failure. PMID:20600895

  13. Clinical Results of Meniscal Repair Using Submeniscal Horizontal Sutures

    PubMed Central

    Navali, Amir Mohammad; Aslani, Hossein

    2015-01-01

    Background: Parts of the implants placed over the meniscus during meniscal repair can wear down the cartilage in the contact zones and cause chronic synovitis. Placing horizontal sutures under the meniscus may overcome this potential hazard. The purpose of this prospective study was to evaluate the midterm results of arthroscopic meniscal repair using submeniscally placed out-in horizontal sutures. Methods: One hundred and three meniscal repairs with submeniscal horizontal out-in technique in 103 patients were performed between 2009 and 2012. Our indications for meniscal repair were all longitudinal tear in red-red and red-white zone with acceptable tissue quality. Clinical evaluation included the Tegner and Lysholm knee scores and clinical success was defined as absence of joint-line tenderness, locking, swelling, and a negative McMurray test. Results: The average follow-up was 19 months (range, 14 to 40 months). The time interval from injury to meniscal repair ranged from 2 days to 390 days (median, 96 days). At the end of follow-up, the clinical success rate was 86.5%. Fourteen of 103 repaired menisci (13.5%) were considered failures according to Barrett’s criteria. The mean Lysholm score significantly improved from 39.6 preoperatively to 84.5 postoperatively (P<0.001). Eighty five patients (82.5%) had an excellent or good result according to Lysholm knee score. Tegner activity score improved significantly (P<0.01) from an average of 3.4 (range, 2-6) preoperatively to 5.9 (range, 5-8) postoperatively. Statistical analysis showed that age, simultaneous anterior cruciate ligament reconstruction, chronicity of injury did not affect the clinical outcome. Conclusion: Our results showed that acceptable midterm results are expected from submeniscal horizontal out-in repair technique. This technique is cheap, safe and has the advantage of avoiding chondral abrasion caused by solid implants and suture materials placed over the meniscus. PMID:26213701

  14. Endoscopic navigation for minimally invasive suturing.

    PubMed

    Wengert, Christian; Bossard, Lukas; Häberling, Armin; Baur, Charles; Székely, Gábor; Cattin, Philippe C

    2007-01-01

    Manipulating small objects such as needles, screws or plates inside the human body during minimally invasive surgery can be very difficult for less experienced surgeons, due to the loss of 3D depth perception. This paper presents an approach for tracking a suturing needle using a standard endoscope. The resulting pose information of the needle is then used to generate artificial 3D cues on the 2D screen to optimally support surgeons during tissue suturing. Additionally, if an external tracking device is provided to report the endoscope's position, the suturing needle can be tracked in a hybrid fashion with sub-millimeter accuracy. Finally, a visual navigation aid can be incorporated, if a 3D surface is intraoperatively reconstructed from video or registered from preoperative imaging. PMID:18044620

  15. Endoscopic navigation for minimally invasive suturing.

    PubMed

    Wengert, Christian; Bossard, Lukas; Häberling, Armin; Baur, Charles; Székely, Gábor; Cattin, Philippe C

    2007-01-01

    Manipulating small objects such as needles, screws or plates inside the human body during minimally invasive surgery can be very difficult for less experienced surgeons, due to the loss of 3D depth perception. This paper presents an approach for tracking a suturing needle using a standard endoscope. The resulting pose information of the needle is then used to generate artificial 3D cues on the 2D screen to optimally support surgeons during tissue suturing. Additionally, if an external tracking device is provided to report the endoscope's position, the suturing needle can be tracked in a hybrid fashion with sub-millimeter accuracy. Finally, a visual navigation aid can be incorporated, if a 3D surface is intraoperatively reconstructed from video or registered from preoperative imaging.

  16. Prolene monofilament suture in Boston Keratoprosthesis surgery

    PubMed Central

    Kyrillos,, Ralph; Harissi-Dagher, Mona

    2011-01-01

    Summary Toxic reaction to nylon following uncomplicated cataract surgery and vitrectomy has been documented in the literature. We report the case of an aniridic patient with a known adverse reaction to nylon in whom Prolene suture was used in Boston Keratoprosthesis type 1 (KPro) surgery. During follow-up the cornea was checked for signs of inflammation and toxic reaction; at last follow-up (18 months) the patient showed no signs of complications due to Prolene. Our study suggests that Prolene suture may be used as an alternative to nylon in Boston KPro surgery in patients with a history of nylon toxicity. PMID:23362386

  17. Popliteomeniscal Fascicle Tear: Diagnosis and Operative Technique

    PubMed Central

    Shin, Hong-Kwan; Lee, Hee-Sung; Lee, Young-Kuk; Bae, Ki-Cheor; Cho, Chul-Hyun; Lee, Kyung-Jae

    2012-01-01

    The occurrence and the consistency of the popliteomeniscal fascicle between the popliteus tendon and the lateral meniscus have been the subject of debate. It is difficult to diagnose and treat popliteomeniscal fascicle tears. Furthermore, popliteomeniscal fascicle tears are difficult to identify with arthroscopy. This article describes the diagnostic factors for popliteomeniscal fascicle tears and the safe, effective operative techniques that can be used for their treatment. We suggest that popliteomeniscal fascicle tears are diagnosed when the following 3 conditions are confirmed: (1) existence of mechanical symptoms such as pain, locking, and giving way in the lateral compartment of the knee; (2) identification of hypermobility of the lateral meniscus through arthroscopic probing; and (3) occurrence of an osteochondral lesion in the posterior area of the lateral femoral condyle. In the case of popliteomeniscal fascicle tears, the tear area can be repaired with a suture hook and polydioxanone with an all-inside technique. If the joint space is narrowing because of soft-tissue tightness, it can be repaired with a zone-specific cannula through an inside-out technique. PMID:23766962

  18. Suture needles in Oral Surgery: Alterations depending on the type and number of sutures

    PubMed Central

    Barranco-Piedra, Sebastian; Rodríguez-Caballero, Angela; Serrera-Figallo, María-Angeles; Segura-Egea, Juan-José; Gutiérrez-Pérez, José-Luis

    2012-01-01

    This study examined whether the number and type of sutures used in oral surgery influence two ad hoc variables (incision plane and displaced area), which are two variables related to whether the suture needle is suitable for the task. Seventy-five TB-15 needles were studied, which were used to suture between zero and three mucosa and/subperiosteal sutures, producing 15 groups with 5 needles in each one. The incision plane and displaced area were measured for each group, which are two variables related to how the needle has worn and altered. Statistical treatment was conducted using the Kruskal-Wallis H test to compare multiple values and the Mann-Whitney U test to compare pairs. A multi-stage regression model was applied with the aim of predicting the changes in the dependent variables based on the number and type of sutures performed. The incision plane ranged from 126.67 to 346.24μm among the different groups. The displaced area was measured as being between 14 524.83μm² and 128 311.91μm². The best predictive model for the incision plane obtained a coefficient of determination (R2) of 0.149, while it reached 0.249 for the displaced area. Subperiosteal sutures held more weighting among the variables studied. Mucosal sutures did not seem to greatly affect needle wear. Observations reported in this paper indicate that the needle should be changed after having performed two subperiosteal sutures, given the wear and change to the incision plane that is produced, which causes the needle’s cutting ability to reduce. Key words: Needles, sutures, material testing, oral surgery, third molar, scanning electron microscope. PMID:22157669

  19. Use of Barbed Sutures in Laparoscopic Gastrointestinal Single-Layer Sutures

    PubMed Central

    Kaji, Masahide; Kinoshita, Jun; Shimizu, Koichi

    2016-01-01

    Background and Objectives: Laparoscopic anastomotic methods are not commonly used because of the cumbersome laparoscopic intracorporeal sutures and tying involved. The barbed suture is one of the various devices developed to simplify the placement of intracorporeal sutures. However, barbed sutures are not commonly used during reconstruction after radical gastrectomy in cancer patients or for single-layer entire-thickness running suturing for intestinal anastomoses. We describe the procedure for using barbed sutures and report on the short-term surgical outcomes. Methods: Between August 2012 and March 2014, 15-cm-long barbed sutures (V-Loc 180; Covidien, Mansfield, MA, USA) were used for laparoscopic intestinal anastomoses, including intestinal hole closure for esophagojejunal and gastrojejunal anastomoses after mechanical anastomoses and gastric wall closure after partial resection. Results: In total, 38 patients underwent 40 laparoscopic anastomoses (esophagojejunostomies, 26; gastrojejunostomies, 7; and simple closure of gastric defect, 7); no cases required conversion to open surgery. Two cases exhibited positive air leak test results during surgery (1 case of esophagojejunostomy and 1 case of simple closure of gastric defect). Two cases of intestinal obstruction were noted; of those, one patient with postoperative intestinal paresis (grade II) was managed conservatively, and the other underwent repeat laparoscopic surgery (grade IIIb) for internal herniation unrelated to V-Loc use. No postoperative complications at the anastomosis site and no surgery-related deaths were noted. Conclusion: Single-layer entire-thickness running suturing with the V-Loc 180 barbed suture after stapled side-to-side intestinal anastomosis was found to be safe and feasible in the reported cases. PMID:27493467

  20. Ab-interno scleral suture loop fixation with cow-hitch knot in posterior chamber intraocular lens decentration

    PubMed Central

    Can, Ertuğrul; Koçak, Nurullah; Yücel, Özlem Eşki; Gül, Adem; Öztürk, Hilal Eser; Sayın, Osman

    2016-01-01

    Aim of Study: To describe a simplified ab-interno cow-hitch suture fixation technique for repositioning decentered posterior chamber intraocular lens (PC IOL). Materials and Methods: Two cases are presented with the surgical correction of decentered and subluxated IOL. Ab-interno scleral suture fixation technique with hitch-cow knot in the eye was performed with a ciliary sulcus guide instrument and 1 year follow-up was completed. Results: Both of the patients had well centered lenses postoperatively. Corrected distant and near visual acuities of the patients were improved. There was no significant postoperative complication. In the follow-up period of 1 year, no evidence of suture erosion was found. Conclusions: Ab-interno scleral suture loop fixation with hitch-cow knot in the eye was effective in repositioning decentered or subluxated PC IOLs with excellent postoperative centered lenses and visual outcomes. PMID:27050346

  1. Suture Line Response of End-to-Side Anastomosis: A Stress Concentration Methodology.

    PubMed

    Roussis, P C; Giannakopoulos, A E; Charalambous, H P

    2015-03-01

    End-to-side vascular anastomosis has a considerable complexity regarding the suturing of the juncture line between the artery and the graft. The present study proposes a stress-concentration methodology for the prediction of the stress distribution at the juncture line, aiming to provide generic expressions describing the response of an end-to-side anastomosis. The proposed methodology is based on general results obtained from the analysis of pipe connections, a topic that has been investigated in recent years in the field of offshore structural engineering. A key aspect for implementing the stress-concentration-factor approach is the recognition that the axial load due to pressure and flow dynamics exerted along the graft axis controls the "hot spots" on the juncture line, which in turn affects the mechanical response of the sutures. Several parameters, identified to influence the suture line response, are introduced in closed-form expressions for the suture line response calculations. The obtained results compare favorably with finite element results published in the literature. The proposed model predicts analytically the suture line response of end-to-side anastomosis, while capturing the influence of and interdependence among the problem parameters. Lower values of the graft radius, the distance between sequential stitches, and the intersecting angle between the artery and the graft are some of the key parameters that reduce the suture line response. The findings of this study are broad in scope and potentially applicable to improving the end-to-side anastomosis technique through improved functionality of the sutures and optimal selection of materials and anastomosis angle.

  2. Suture Line Response of End-to-Side Anastomosis: A Stress Concentration Methodology.

    PubMed

    Roussis, P C; Giannakopoulos, A E; Charalambous, H P

    2015-03-01

    End-to-side vascular anastomosis has a considerable complexity regarding the suturing of the juncture line between the artery and the graft. The present study proposes a stress-concentration methodology for the prediction of the stress distribution at the juncture line, aiming to provide generic expressions describing the response of an end-to-side anastomosis. The proposed methodology is based on general results obtained from the analysis of pipe connections, a topic that has been investigated in recent years in the field of offshore structural engineering. A key aspect for implementing the stress-concentration-factor approach is the recognition that the axial load due to pressure and flow dynamics exerted along the graft axis controls the "hot spots" on the juncture line, which in turn affects the mechanical response of the sutures. Several parameters, identified to influence the suture line response, are introduced in closed-form expressions for the suture line response calculations. The obtained results compare favorably with finite element results published in the literature. The proposed model predicts analytically the suture line response of end-to-side anastomosis, while capturing the influence of and interdependence among the problem parameters. Lower values of the graft radius, the distance between sequential stitches, and the intersecting angle between the artery and the graft are some of the key parameters that reduce the suture line response. The findings of this study are broad in scope and potentially applicable to improving the end-to-side anastomosis technique through improved functionality of the sutures and optimal selection of materials and anastomosis angle. PMID:26577101

  3. Advances in Suture Material for Obstetric and Gynecologic Surgery

    PubMed Central

    Greenberg, James A; Clark, Rachel M

    2009-01-01

    Despite millennia of experience with wound closure biomaterials, no study or surgeon has yet identified the perfect suture for all situations. Tissue characteristics, tensile strength, reactivity, absorption rates, and handling properties should be taken into account when selecting a wound closure suture. This review discusses the wound healing process and the biomechanical properties of currently available suture materials to better understand how to choose suture material in obstetrics and gynecology. PMID:19826572

  4. Bone cement improves suture anchor fixation.

    PubMed

    Giori, Nicholas J; Sohn, David H; Mirza, Faisal M; Lindsey, Derek P; Lee, Arthur T

    2006-10-01

    Suture anchor fixation failure can occur if the anchor pulls out of bone. We hypothesized that suture anchor fixation can be augmented with polymethylmethacrylate cement, and that polymethylmethacrylate can be used to improve fixation in a stripped anchor hole. Six matched cadaveric proximal humeri were used. On one side, suture anchors were placed and loaded to failure using a ramped cyclic loading protocol. The stripped anchor holes then were injected with approximately 1 cc polymethylmethacrylate, and anchors were replaced and tested again. In the contralateral humerus, polymethylmethacrylate was injected into anchor holes before anchor placement and testing. In unstripped anchors, polymethylmethacrylate increased the number of cycles to failure by 34% and failure load by 71% compared with anchors not augmented with polymethylmethacrylate. Polymethylmethacrylate haugmentation of stripped anchors increased the cycles to failure by 31% and failure load by 111% compared with unstripped uncemented anchors. No difference was found in cycles to failure or failure load between cemented stripped anchors and cemented unstripped anchors. Polymethylmethacrylate can be used to augment fixation, reducing the risk of anchor pull-out failure, regardless whether the suture anchor hole is stripped or unstripped. PMID:16702922

  5. 21 CFR 870.3460 - Endovascular Suturing System.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Endovascular Suturing System. 870.3460 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3460 Endovascular Suturing System. (a) Identification. An endovascular suturing system is a medical device intended to...

  6. 21 CFR 870.3460 - Endovascular Suturing System.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Endovascular Suturing System. 870.3460 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3460 Endovascular Suturing System. (a) Identification. An endovascular suturing system is a medical device intended to...

  7. Biomechanical Dynamics of Cranial Sutures during Simulated Impulsive Loading

    PubMed Central

    Zhang, Z. Q.; Yang, J. L.

    2015-01-01

    Background. Cranial sutures are deformable joints between the bones of the skull, bridged by collagen fibres. They function to hold the bones of the skull together while allowing for mechanical stress transmission and deformation. Objective. The aim of this study is to investigate how cranial suture morphology, suture material property, and the arrangement of sutural collagen fibres influence the dynamic responses of the suture and surrounding bone under impulsive loads. Methods. An idealized bone-suture-bone complex was analyzed using a two-dimensional finite element model. A uniform impulsive loading was applied to the complex. Outcome variables of von Mises stress and strain energy were evaluated to characterize the sutures' biomechanical behavior. Results. Parametric studies revealed that the suture strain energy and the patterns of Mises stress in both the suture and surrounding bone were strongly dependent on the suture morphologies. Conclusions. It was concluded that the higher order hierarchical suture morphology, lower suture elastic modulus, and the better collagen fiber orientation must benefit the stress attenuation and energy absorption. PMID:27019589

  8. Single suture customized loop for large iridodialysis repair

    PubMed Central

    Omar Yousif, Mohamed

    2016-01-01

    Managing large iridodialysis that may occur during phacoemulsification is challenging. I describe how a procedure to reposit a prolapsed iris while the anterior chamber is markedly inflated by a current of infusion fluid may inadvertently lead to large iridodialysis, and discuss how to avoid such a complication. I describe a fast and efficient technique for managing large iridodialysis both immediately, once it occurs, or as a secondary maneuver. My technique involved fixing the iris periphery back to its root at the anterior chamber angle using 10-0 polypropylene suture with two straight needles introduced directly through the cornea at distant points, and an insulin syringe as a guide track to a point 1.5 mm from the limbus at the base of a triangular scleral flap that was designed to be centered on the area of iridodialysis. I confirmed the simplicity, efficacy, and safety of my technique through a 1-year follow-up period. PMID:27729765

  9. Modified arthroscopic suture fixation of a displaced tibial eminence fracture.

    PubMed

    Lehman, Ronald A; Murphy, Kevin P; Machen, M Shaun; Kuklo, Timothy R

    2003-02-01

    This study describes a new arthroscopic method using a whip-stitch technique for treating a displaced type III tibial eminence fracture. A 12-year-old girl who sustained a displaced type III tibial eminence fracture was treated with arthroscopic fixation using the Arthrosew disposable suture device (Surgical Dynamics, Norwalk, CT) to place a whip stitch into the anterior cruciate ligament (ACL). The Arthrex ACL guide (Arthrex, Naples, FL) was used to reduce the avulsed tibial spine fragment. Sutures were then passed through the tibial tunnel and secured over a bony bridge with the knee in 20 degrees of flexion. At 9 months, the patient has a full range of motion with normal Lachman and anterior drawer testing, and she has returned to competitive basketball. Radiographs show complete fracture healing. KT-1000 and isokinetic testing at 9-month follow-up show only minimal side-to-side differences. The Arthrosew device provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation within the substance of the ACL, thus obviating arthrotomy and hardware placement. This technique also restores the proper length and tension to the ACL, and provides a simplified, reproducible method of treatment for this injury.

  10. Successful treatment of recurrent rectal prolapse using three Thiersch sutures in children.

    PubMed

    Chauhan, Kashif; Gan, Richard Wei Chern; Singh, Shailinder

    2015-01-01

    Many techniques are described to manage recurrent rectal prolapse in children, including repeated Thiersch stitch, phenol injections, Delorme and Altemeier procedures, and rectopexy. We describe a case of successful treatment of rectal prolapse by placing three Thiersch sutures circumferentially along the anal canal--a simple and novel modification of a well-known procedure. An 8-year-old boy with full-thickness rectal prolapse was treated with laxatives to no avail. He was subsequently treated with phenol-in-almond-oil injection and insertion of a 1/0PDS Thiersch suture. The effects were temporary with recurrence 3 months later. A further phenol-in-almond-oil injection was given and a 1/0PDS Thiersch suture placed, and the patient was discharged on laxatives. Recurrence occurred again at 3 months. This was treated with three circumferential Thiersch sutures along the anal canal--one Prolene 2/0 and two 1/0PDS. There has been no recurrence at follow-up. Placement of three sequential Thiersch sutures along the rectum is effective in treating recurrent rectal prolapse and a good alternative to major rectopexy. PMID:26607187

  11. SR and LR Union Suture for the Treatment of Myopic Strabismus Fixus: Is Scleral Fixation Necessary?

    PubMed Central

    Lam, Carol P. S.; Yam, Jason C. S.; Lau, Flora H. S.; Fan, Dorothy S. P.; Wong, C. Y.; Yu, Christopher B. O.; Lau, Winnie W. Y.

    2015-01-01

    Purpose. To evaluate and compare the effectiveness of scleral fixation SR and LR union suture and nonscleral fixation union suture for the treatment of myopic strabismus fixus. Methods. Retrospective review of 32 eyes of 22 patients with myopic strabismus fixus who had undergone union suture of superior rectus (SR) and lateral rectus (LR) with or without scleral fixation, and follow-up longer than 6 months at Hong Kong Eye Hospital from 2006 to 2013. Surgical techniques and outcomes in terms of ocular alignment are analyzed. Results. There is significant overall improvement both in postoperative angle of esodeviation (P < 0.01) and postoperative range of movement (P = 0.042). Comparing between the sclera fixation group (11 eyes) versus nonscleral fixation group (21 eyes), the postoperative horizontal deviation, the postoperative vertical deviation, successful outcome, and the change in horizontal deviation were not significantly different (P > 0.05). Conclusions. Union suture of SR and LR is an effective procedure in correcting myopic strabismus fixus. Fixation of the union suture to the sclera does not improve surgical outcome. PMID:25954751

  12. Achilles tendon suture deteriorates tendon capillary blood flow with sustained tissue oxygen saturation – an animal study

    PubMed Central

    Kraemer, Robert; Lorenzen, Johan; Rotter, Robert; Vogt, Peter M; Knobloch, Karsten

    2009-01-01

    Background Treatment of ruptured Achilles tendons currently constitutes of conservative early functional treatment or surgical treatment either by open or minimal invasive techniques. We hypothesize that an experimental Achilles tendon suture in an animal model significantly deteriorates Achilles tendon microcirculation immediately following suturing. Methods Fifteen Achilles tendons of eight male Wistar rats (275–325 g) were included. After preparation of the Achilles tendon with a medial paratendinous approach, Achilles tendon microcirculation was assessed using combined Laser-Doppler and spectrophotometry (Oxygen-to-see) regarding: - tendinous capillary blood flow [arbitrary units AU] - tendinous tissue oxygen saturation [%] - tendinous venous filling pressure [rAU] The main body of the Achilles tendon was measured in the center of the suture with 50 Hz. 10 minutes after Achilles tendon suture (6-0 Prolene), a second assessment of microcirculatory parameters was performed. Results Achilles tendon capillary blood flow decreased by 57% following the suture (70 ± 30 AU vs. 31 ± 16 AU; p < 0.001). Tendinous tissue oxygen saturation remained at the same level before and after suture (78 ± 17% vs. 77 ± 22%; p = 0.904). Tendinous venous filling pressure increased by 33% (54 ± 16 AU vs. 72 ± 20 AU; p = 0.019) after suture. Conclusion Achilles tendon suture in anaesthetised rats causes an acute loss of capillary perfusion and increases postcapillary venous filling pressures indicating venous stasis. The primary hypothesis of this study was confirmed. In contrast, tendinous tissue oxygen saturation remains unchanged excluding acute intratendinous hypoxia within the first 10 minutes after suture. Further changes of oxygen saturation remain unclear. Furthermore, it remains to be determined to what extent reduced capillary blood flow as well as increased postcapillary stasis might influence tendon healing from a microcirculatory point of view in this animal setting

  13. All-Suture Transosseous Repair for Rotator Cuff Tear Fixation Using Medial Calcar Fixation

    PubMed Central

    Aramberri-Gutiérrez, Mikel; Martínez-Menduiña, Amaia; Valencia-Mora, María; Boyle, Simon

    2015-01-01

    We describe an all-suture transosseous repair technique used in the management of rotator cuff tears by means of an all-suture anchor secured on the intra-articular side of the humeral calcar. The technique uses an anterior cruciate ligament guide to ensure accurate positioning of the tunnels, avoiding the articular cartilage and minimizing risk to the neurovascular structures. The distal end of the guide is inserted through a rotator interval portal and passed down to the axillary pouch. The proximal end of the guide is approximated to the greater tuberosity at the cuff footprint, and a complete transosseous tunnel is created with a 2.4-mm drill. An all-suture implant is inserted through this tunnel down to the calcar, and its deployment is visualized under arthroscopy. Gentle traction is applied to the anchor, resulting in a 4-mm concertina of the suture anchor that rests opposed to the medial cortex. The major advantage of this technique is the fixation strength gained from the biomechanically superior cortical bone of the calcar. Furthermore, this method permits greater preservation of bone surface area at the level of the footprint for a larger tendon-to-bone healing surface. This technique also provides an excellent alternative in revision situations. PMID:26052495

  14. Arthroscopic 4-Point Suture Fixation of Anterior Cruciate Ligament Tibial Avulsion Fractures

    PubMed Central

    Boutsiadis, Achilleas; Karataglis, Dimitrios; Agathangelidis, Filon; Ditsios, Konstantinos; Papadopoulos, Pericles

    2014-01-01

    Tibial eminence avulsion fractures are rare injuries occurring mainly in adolescents and young adults. When necessary, regardless of patient age, anatomic reduction and stable internal fixation are mandatory for fracture healing and accurate restoration of normal knee biomechanics. Various arthroscopically assisted fixation methods with sutures, anchors, wires, or screws have been described but can be technically demanding, thus elongating operative times. The purpose of this article is to present a technical variation of arthroscopic suture fixation of anterior cruciate ligament avulsion fractures. Using thoracic drain needles over 2.4-mm anterior cruciate ligament tibial guidewires, we recommend the safe and easy creation of four 2.9-mm tibial tunnels at different angles and at specific points. This technique uses thoracic drain needles as suture passage cannulas and offers 4-point fixation stability, avoiding potential complications of bony bridge fracture and tunnel connection. PMID:25685674

  15. Endocaval suture of aortocaval fistula.

    PubMed

    Illuminati, G; Calió, F G; Bertagni, A; Caratozzolo, M; Vietri, F

    1997-05-01

    A case of aortocaval fistula complicating a ruptured infrarenal aortic aneurysm is reported. As the length of the defect and the thickness of the aortic wall made repair from within the aorta unsafe, the defect was repaired from within the vena cava. The details of the technique are reported. It can be a useful alternative to inferior vena cava ligation, when standard repair of aortocaval fistulae from within the aorta is risky or difficult to attempt.

  16. Transfascial suture in laparoscopic ventral hernia repair; friend or foe?

    PubMed

    Sahu, Diwakar; Das, Somak; Wani, Majid Rasool; Reddy, Prasanna Kumar

    2015-01-01

    'Suture hernia' is fairly a new and rare type of ventral hernia. It occurs at the site of transfascial suture, following laparoscopic ventral hernia repair (LVHR). Employment of transfascial sutures in LVHR is still debatable in contrast to tackers. Prevention of mesh migration and significant post-operative pain are the pros and cons with the use of transfascial sutures, respectively. We report an unusual case of suture hernia or transfascial hernia, which can further intensify this dispute, but at the same time will provide insight for future consensus. PMID:25883460

  17. ASSESSMENT OF MECHANICAL AND MANUAL SUTURE IN THE SURGICAL TREATMENT OF THE PHARYNGOESOPHAGEAL DIVERTICULUM

    PubMed Central

    de AQUINO, José Luis Braga; CHAGAS, José Francisco Salles; SAID, Marcelo Manzano; PASCOAL, Maria Beatriz Nogueira; BRANDI-FILHO, Luis Antonio; PEREIRA, Douglas Alexandre Rizzanti; FRUET, Fernanda

    2015-01-01

    Background: The occurrence of the pharyngoesophageal, or Zenker diverticulum is not frequent in the national scenario, and the technique of the diverticulectomy with cricomyotomy in medium and great dimension diverticula is still the most indicated. Because the resection of the diverticulum requires the suture of the pharynx, dehiscence can occur, thereafter delaying swallowing. Hence, the idea is to accomplish this surgical procedure, comparing the manual and mechanical suture, in order to evaluate the real benefit of the mechanical technique. Aim: To evaluate the results of the pharyngoesophageal diverticulectomy with cricomyotomy using manual and mechanical suture with regard to local and systemic complications. Method: Fifty-seven patients with pharyngoesophageal diverticula diagnosed through high digestive endoscopy and pharyngeal esophagogram were studied. The applied surgical technique was diverticulectomy with myotomy of the cricopharyngeal muscle, done in 24 patients (42.2%) the mechanical suture (group A) with the mechanical linear suture device and in 33 (57.8%) a manual closure of the pharynx (group B). Results: In the postoperative period, one patient of group A (4.1%) presented fistula caused by dehiscence of the pharyngeal suture, and three of group B (15.1%) presented the same complication, with a good outcome using a conservative treatment. In the same group, three patients (9.0%) presented stenosis of the suture of the pharynx, with good outcome and with endoscopic dilatations, and no patient from group A presented such complication. Lung infection was present in five patients, being two (8.3%) of group A and three (9.0%) on B, having good outcomes after specific treatment. In the late review, done with 43 patients (94.4%) of group A and 22 (88.0%) on B, the patients declared to be pleased with the surgical procedure, because they were able to regain normal swallowing. Conclusion: The diverticulectomy with myotomy and pharyngeal closure using

  18. Ectocranial suture fusion in primates: pattern and phylogeny.

    PubMed

    Cray, James; Cooper, Gregory M; Mooney, Mark P; Siegel, Michael I

    2014-03-01

    Patterns of ectocranial suture fusion among Primates are subject to species-specific variation. In this study, we used Guttman Scaling to compare modal progression of ectocranial suture fusion among Hominidae (Homo, Pan, Gorilla, and Pongo), Hylobates, and Cercopithecidae (Macaca and Papio) groups. Our hypothesis is that suture fusion patterns should reflect their evolutionary relationship. For the lateral-anterior suture sites there appear to be three major patterns of fusion, one shared by Homo-Pan-Gorilla, anterior to posterior; one shared by Pongo and Hylobates, superior to inferior; and one shared by Cercopithecidae, posterior to anterior. For the vault suture pattern, the Hominidae groups reflect the known phylogeny. The data for Hylobates and Cercopithecidae groups is less clear. The vault suture site termination pattern of Papio is similar to that reported for Gorilla and Pongo. Thus, it may be that some suture sites are under larger genetic influence for patterns of fusion, while others are influenced by environmental/biomechanic influences.

  19. Effect of suture material on platelet deposition onto prosthetic material

    SciTech Connect

    Connolly, R.; McEnroe, C.S.; Li, S.; Coleman, J.; Callow, A.D.

    1988-07-01

    Previous studies have demonstrated the importance of employing prosthetic material with minimal thrombogenicity. However, the role of different suture materials in early thrombotic events on prosthetic materials has not been examined. Experiments were designed to analyze the effects of suture on platelet graft interaction using an in vivo baboon hemocompatability screen. Indium labeled, autologous platelet deposition was determined on expanded polytetrafluoroethylene (ePTFE) containing suture lines of polypropylene (Prolene), polybutester (Novafil), and ePTFE (Gore-Tex). A significant increase in platelet deposition was noted not only at the suture line, but proximal and distal to it as well. The results were different for each of the sutures employed and suggest that the suture line may influence early platelet deposition in the perianastomotic region, not only at the suture line, but proximally and distally as well.

  20. [Dissertations 25 years after date 26. Maxillary sutural surfaces].

    PubMed

    Remmelink, H J

    2011-06-01

    In the case of growing children with a deviation in the size or position of the upper jaw orthopaedic devices are often used to direct the growth at the level of the sutures. In the PhD thesis 'The postnatal development of the human maxillary sutural surfaces', published in 1985, the orientation and macroscopic morphology of the sutural surfaces of the maxilla in children's skulls were described. The existence of premaxillomaxillary and pterygomaxillary sutures could not be demonstrated. It was observed that the maxillary sutural surfaces were mainly sagittally oriented. Some sutural surfaces became increasingly rough with age, while the majority of the surfaces remained smooth. It was concluded that advice concerning the determination of the direction of orthopaedic forces in relation to the orientation of the sutures needed revision. Subsequent systematic reviews have reported that so far little is known about the long-term stability of orthopaedic effects in orthodontics. PMID:21761798

  1. Craniofacial Sutures: Morphology, Growth, and In Vivo Masticatory Strains

    PubMed Central

    RAFFERTY, KATHERINE L.; HERRING, SUSAN W.

    2010-01-01

    The growth and morphology of craniofacial sutures are thought to reflect their functional environment. However, little is known about in vivo sutural mechanics. The present study investigates the strains experienced by the internasal, nasofrontal, and anterior interfrontal sutures during masticatory activity in 4–6-month-old miniature swine (Sus scrofa). Measurements of the bony/fibrous arrangements and growth rates of these sutures were then examined in the context of their mechanical environment. Large tensile strains were measured in the interfrontal suture (1,036 με ± 400 SD), whereas the posterior internasal suture was under moderate compression (−440 με ± 238) and the nasofrontal suture experienced large compression (−1,583 με ± 506). Sutural interdigitation was associated with compressive strain. The collagen fibers of the internasal and interfrontal sutures were clearly arranged to resist compression and tension, respectively, whereas those of the nasofrontal suture could not be readily characterized as either compression or tension resisting. The average linear rate of growth over a 1-week period at the nasofrontal suture (133.8 μm, ± 50.9 S.D) was significantly greater than that of both the internasal and interfrontal sutures (39.2 μm ± 11.4 and 65.5 μm ± 14.0, respectively). Histological observations suggest that the nasofrontal suture contains chondroid tissue, which may explain the unexpected combination of high compressive loading and rapid growth in this suture. PMID:10521876

  2. Skin tension related to tension reduction sutures.

    PubMed

    Hwang, Kun; Kim, Han Joon; Kim, Kyung Yong; Han, Seung Ho; Hwang, Se Jin

    2015-01-01

    The aim of this study was to compare the skin tension of several fascial/subcutaneous tensile reduction sutures. Six upper limbs and 8 lower limbs of 4 fresh cadavers were used. At the deltoid area (10 cm below the palpable acromion) and lateral thigh (midpoint from the palpable greater trochanter to the lateral border of the patella), and within a 3 × 6-cm fusiform area of skin, subcutaneous tissue defects were created. At the midpoint of the defect, a no. 5 silk suture was passed through the dermis at a 5-mm margin of the defect, and the defect was approximated. The initial tension to approximate the margins was measured using a tensiometer.The tension needed to approximate skin without any tension reduction suture (S) was 6.5 ± 4.6 N (Newton). The tensions needed to approximate superficial fascia (SF) and deep fascia (DF) were 7.8 ± 3.4 N and 10.3 ± 5.1 N, respectively. The tension needed to approximate the skin after approximating the SF was 4.1 ± 3.4 N. The tension needed to approximate the skin after approximating the DF was 4.9 ± 4.0 N. The tension reduction effect of approximating the SF was 38.8 ± 16.4% (2.4 ± 1.5 N, P = 0.000 [ANOVA, Scheffé]). The tension reduction effect of approximating the DF was 25.2% ± 21.9% (1.5 ± 1.4 N, P = 0.001 [ANOVA, Scheffé]). The reason for this is thought to be that the SF is located closely to the skin unlike the DF. The results of this study might be a basis for tension reduction sutures.

  3. Cranial suture biology of the Aleutian Island inhabitants.

    PubMed

    Cray, James; Mooney, Mark P; Siegel, Michael I

    2011-04-01

    Research on cranial suture biology suggests there is biological and taxonomic information to be garnered from the heritable pattern of suture synostosis. Suture synostosis along with brain growth patterns, diet, and biomechanical forces influence phenotypic variability in cranial vault morphology. This study was designed to determine the pattern of ectocranial suture synostosis in skeletal populations from the Aleutian Islands. We address the hypothesis that ectocranial suture synostosis pattern will differ according to cranial vault shape. Ales Hrdlicka identified two phenotypes in remains excavated from the Aleutian Island. The Paleo-Aleutians, exhibiting a dolichocranic phenotype with little prognathism linked to artifacts distinguished from later inhabitants, Aleutians, who exhibited a brachycranic phenotype with a greater amount of prognathism. A total of 212 crania representing Paleo-Aleuts and Aleutian as defined by Hrdlicka were investigated for suture synostosis pattern following standard methodologies. Comparisons were performed using Guttmann analyses. Results revealed similar suture fusion patterns for the Paleo-Aleut and Aleutian, a strong anterior to posterior pattern of suture fusion for the lateral-anterior suture sites, and a pattern of early termination at the sagittal suture sites for the vault. These patterns were found to differ from that reported in the literature. Because these two populations with distinct cranial shapes exhibit similar patterns of suture synostosis it appears pattern is independent of cranial shape in these populations of Homo sapiens. These findings suggest that suture fusion patterns may be population dependent and that a standardized methodology, using suture fusion to determine age-at-death, may not be applicable to all populations.

  4. Fiber from ramie plant (Boehmeria nivea): A novel suture biomaterial.

    PubMed

    Kandimalla, Raghuram; Kalita, Sanjeeb; Choudhury, Bhaswati; Devi, Dipali; Kalita, Dhaneswar; Kalita, Kasturi; Dash, Suvakanta; Kotoky, Jibon

    2016-05-01

    The quest for developing an ideal suture material prompted our interest to develop a novel suture with advantageous characters to market available ones. From natural origin only silk, cotton and linen fibers are presently available in market as non-absorbable suture biomaterials. In this study, we have developed a novel, cost-effective, and biocompatible suture biomaterial from ramie plant, Boehmeria nivea fiber. Field emission scanning electron microscopy (FE-SEM), energy-dispersive X-ray spectroscopy (EDX), attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) and thermo gravimetric analysis (TGA) results revealed the physicochemical properties of raw and degummed ramie fiber, where the former one showed desirable characteristics for suture preparation. The braided multifilament ramie suture prepared from degummed fiber exhibited excellent tensile strength. The suture found to be biocompatible towards human erythrocytes and nontoxic to mammalian cells. The fabricated ramie suture exhibited significant antibacterial activity against Escherichia coli, Bacillus subtilis and Staphylococcus aureus; which can be attributed to the inherent bacteriostatic ability of ramie plant fiber. In vivo wound closure efficacy was evaluated in adult male wister rats by suturing the superficial wound incisions. Within seven days of surgery the wound got completely healed leaving no rash and scar. The role of the ramie suture in complete wound healing was supported by the reduced levels of serum inflammatory mediators. Histopathology studies confirmed the wound healing ability of ramie suture, as rapid synthesis of collagen, connective tissue and other skin adnexal structures were observed within seven days of surgery. Tensile properties, biocompatibility and wound closure efficacy of the ramie suture were comparable with market available BMSF suture. The outcome of this study can drive tremendous possibility for the utilization of ramie plant fiber for

  5. Knotless anchors with sutures external to the anchor body may be at risk for suture cutting through osteopenic bone

    PubMed Central

    Ono, Y.; Woodmass, J. M.; Nelson, A. A.; Boorman, R. S.; Thornton, G. M.

    2016-01-01

    Objectives This study evaluated the mechanical performance, under low-load cyclic loading, of two different knotless suture anchor designs: sutures completely internal to the anchor body (SpeedScrew) and sutures external to the anchor body and adjacent to bone (MultiFIX P). Methods Using standard suture loops pulled in-line with the rotator cuff (approximately 60°), anchors were tested in cadaveric bone and foam blocks representing normal to osteopenic bone. Mechanical testing included preloading to 10 N and cyclic loading for 500 cycles from 10 N to 60 N at 60 mm/min. The parameters evaluated were initial displacement, cyclic displacement and number of cycles and load at 3 mm displacement relative to preload. Video recording throughout testing documented the predominant source of suture displacement and the distance of ‘suture cutting through bone’. Results In cadaveric bone and foam blocks, MultiFIX P anchors had significantly greater initial displacement, and lower number of cycles and lower load at 3 mm displacement than SpeedScrew anchors. Video analysis revealed ‘suture cutting through bone’ as the predominant source of suture displacement in cadaveric bone (qualitative) and greater ‘suture cutting through bone’ comparing MultiFIX P with SpeedScrew anchors in foam blocks (quantitative). The greater suture displacement in MultiFIX P anchors was predominantly from suture cutting through bone, which was enhanced in an osteopenic bone model. Conclusions Anchors with sutures external to the anchor body are at risk for suture cutting through bone since the suture eyelet is at the distal tip of the implant and the suture directly abrades against the bone edge during cyclic loading. Suture cutting through bone may be a significant source of fixation failure, particularly in osteopenic bone. Cite this article: Y. Ono, J. M. Woodmass, A. A. Nelson, R. S. Boorman, G. M. Thornton, I. K. Y. Lo. Knotless anchors with sutures external to the anchor body may be

  6. A novel method for endoscopic perforation management by using abdominal exploration and full-thickness sutured closure

    PubMed Central

    Kumar, Nitin; Thompson, Christopher C.

    2016-01-01

    Background Perforation of the GI tract during endoscopy can result in significant morbidity and mortality. Early recognition and immediate management of endoscopic perforation are essential to optimize outcome. Larger perforations, defects with complex geometry, and those complicated by leakage of luminal contents have traditionally required surgical management. Objective To assess the feasibility of a new method for managing complex perforations that incorporates abdominal exploration and endoscopic sutured closure. Design Case series. Setting Tertiary care center. Patients Two patients with large, complicated perforations and peritoneal contamination. Interventions Endoscopic exploration of abdomen with angiocatheter placement under direct visualization, management of leaked luminal contents, and full-thickness sutured defect closure. Results Endoscopic abdominal exploration through the perforation site allowed safe placement of an angiocatheter for management of pneumoperitoneum, inspection for injury that may warrant surgical management, and removal of leaked luminal contents. Endoscopic sutured closure allowed safe and robust perforation management. Repair of gastrojejunal anastomotic perforation required 2 sutures and 63 minutes. Repair of gastric perforation required 4 sutures and 48 minutes. Patients had successful endoscopic defect closure confirmed by an upper GI series and were discharged 1 day later. Limitations Report of a new method in 2 patients performed at tertiary care center. Conclusions We demonstrate successful management of complex perforations with peritoneal contamination by incorporating endoscopic exploration and sutured closure with standard treatment measures. Traditional practice would have directed these patients to surgical management, which introduces additional morbidity and cost. A means for safe and broad implementation of these techniques should be evaluated. PMID:24721517

  7. A Randomized Study Comparing Skin Staples with Subcuticular Sutures for Wound Closure at Caesarean Section in Black-Skinned Women

    PubMed Central

    Abdus-Salam, Rukiyat Adeola; Bello, Folasade Adenike; Olayemi, Oladapo

    2014-01-01

    This study aimed to compare patients' satisfaction and outcome of caesarean section wound closure by skin staples and subcuticular suture at discharge and 6 weeks of postoperation. It was a randomized controlled trial of pregnant women scheduled for caesarean section at the University College Hospital, Ibadan, Nigeria, allocating them to wound closure by skin staples or subcuticular suture. Pain was assessed using the box numeric pain scale. Scar assessments were by patient, research nurse, and independent observers using the visual analogue scale, modified patient observer scar assessment scale, and patient satisfaction scale. Operation time (minutes) was significantly shorter in the staple group, 40.26 (±16.53) compared to 47.55 (±14.55) in the suture group (P = 0.025). Skin closure time (seconds) was significantly less in the staple group, 118.62 (±69.68) versus 388.70 (±170.40) in the suture group (P ≤ 0.001). There was no difference in pain experienced, wound assessment by the participants, and patients' satisfaction. Participants in the staple group scored higher on both scar assessment scales by the nurse (P = 0.044). Cost comparison analysis showed that staple use costs significantly more than suture use (P < 0.001). The perceived benefit of subcuticular suture over skin staples was not observed and participants were satisfied with both wound closure techniques. PMID:27437457

  8. A Percutaneous Knotless Technique for SLAP Repair.

    PubMed

    Tennent, Duncan; Pearse, Eyiyemi

    2016-02-01

    We describe a percutaneous technique for repair of type II SLAP lesions. Through the Neviaser portal, a spinal needle is used to pass a FiberStick suture (Arthrex, Naples, FL) through the labrum to create 2 mattress sutures that are secured with PushLock anchors (Arthrex). This technique is simple, reproducible, and knotless and requires no cannulas. At the end of the procedure, minimal suture material remains in the joint.

  9. Mechanics of cranial sutures during simulated cyclic loading.

    PubMed

    Jasinoski, S C; Reddy, B D

    2012-07-26

    Previous computational and experimental analyses revealed that cranial sutures, fibrous joints between the bones, can reduce the strain experienced by the surrounding skull bones during mastication. This damping effect reflects the importance of including sutures in finite element (FE) analyses of the skull. Using the FE method, the behaviour of three suture morphologies of increasing complexity (butt-ended, moderate interdigitated, and complex interdigitated) during static loading was recently investigated, and the sutures were assumed to have linear elastic properties. In the current study, viscoelastic properties, derived from published experimental results of the nasofrontal suture of young pigs (Sus scrofa), are applied to the three idealised bone-suture models. The effects of suture viscoelasticity on the stress, strain, and strain energy in the models were computed for three different frequencies (corresponding to periods of 1, 10, and 100s) and compared to the results of a static, linear elastic analysis. The range of applied frequencies broadly represents different physiological activities, with the highest frequency simulating mastication and the lowest frequency simulating growth and pressure of the surrounding tissues. Comparing across all three suture morphologies, strain energy and strain in the suture decreased with the increase in suture complexity. For each suture model, the magnitude of strain decreased with an increase in frequency, and the magnitudes were similar for both the elastic and 1s frequency analyses. In addition, a viscous response is less apparent in the higher frequency analyses, indicating that viscous properties are less important to the behaviour of the suture during those analyses. The FE results suggest that implementation of viscoelastic properties may not be necessary for computational studies of skull behaviour during masticatory loading but instead might be more relevant for studies examining lower frequency physiological

  10. [The system of designation of surgical suture materials].

    PubMed

    Adamian, A A; Vinokurova, T I; Novikova, O A; Gavriliuk, N N; Sergeev, V P

    1990-12-01

    The authors suggest a unified system of designation of type--sizes of surgical suture materials of various nature and structure, which removes the existing discrepancy between the numbering of foreign and Soviet threads as well as of Soviet threads produced by different enterprises of the country. Introduction of the new system of metric sizes of the suture threads will allow surgeons to be properly orientated in the choice of the necessary suture material and make easier the work of services engaged in the development and realization of surgical suture materials. PMID:2079825

  11. Visual Measurement of Suture Strain for Robotic Surgery

    PubMed Central

    Martell, John; Elmer, Thomas; Gopalsami, Nachappa; Park, Young Soo

    2011-01-01

    Minimally invasive surgical procedures offer advantages of smaller incisions, decreased hospital length of stay, and rapid postoperative recovery to the patient. Surgical robots improve access and visualization intraoperatively and have expanded the indications for minimally invasive procedures. A limitation of the DaVinci surgical robot is a lack of sensory feedback to the operative surgeon. Experienced robotic surgeons use visual interpretation of tissue and suture deformation as a surrogate for tactile feedback. A difficulty encountered during robotic surgery is maintaining adequate suture tension while tying knots or following a running anastomotic suture. Displaying suture strain in real time has potential to decrease the learning curve and improve the performance and safety of robotic surgical procedures. Conventional strain measurement methods involve installation of complex sensors on the robotic instruments. This paper presents a noninvasive video processing-based method to determine strain in surgical sutures. The method accurately calculates strain in suture by processing video from the existing surgical camera, making implementation uncomplicated. The video analysis method was developed and validated using video of suture strain standards on a servohydraulic testing system. The video-based suture strain algorithm is shown capable of measuring suture strains of 0.2% with subpixel resolution and proven reliability under various conditions. PMID:21436874

  12. Heterochrony and patterns of cranial suture closure in hystricognath rodents

    PubMed Central

    Wilson, Laura A B; Sánchez-Villagra, Marcelo R

    2009-01-01

    Sutures, joints that allow one bone to articulate with another through intervening fibrous connective tissue, serve as major sites of bone expansion during postnatal craniofacial growth in the vertebrate skull and represent an aspect of cranial ontogeny which may exhibit functional and phylogenetic correlates. Suture evolution among hystricognath rodents, an ecologically diverse group represented here by 26 species, is examined using sequence heterochrony methods, i.e. event pairing and parsimov. Although minor nuances in suture closure sequence exist between species, the overall sequence was found to be conserved both across the hystricognath group and, to an increasing degree, within selected clades. At species level, suture closure pattern exhibited a significant positive correlation with patterns previously reported for hominoids. Patterns for most clades revealed the first sutures to close are those contacting the exoccipital, interparietal, and palatine bones. Heterochronic shifts were found along 19 of 35 branches within the hystricognath phylogeny. The number of shifts per node ranged from one to seven events and, overall, involved 21 of 34 suture sites. The topology generated by parsimony analyses of the event pair matrix yielded only one grouping that was congruent with the evolutionary relationships, compiled from morphological and molecular studies, taken as framework. Sutures contacting the exoccipital displayed the highest levels of most complete closure across all species. Level of suture closure is negatively correlated with cranial length (P < 0.05). Differing life history and locomotory strategies are coupled in part with differing suture closure patterns among several species. PMID:19245501

  13. Cyclic loading comparison of Bio-SutureTak-#2 FiberWire and Bio Mini-Revo-#2 Hi-Fi suture anchor-sutures in cadaveric scapulae.

    PubMed

    Sparks, Brad S; Nyland, John; Nawab, Akbar; Blackburn, Ethan; Krupp, Ryan; Burden, Robert

    2008-03-01

    This study compared tap-in Bio-SutureTak suture anchor-#2 FiberWire suture (Group 1) and screw-in Bio Mini-Revo suture anchor-#2 Hi-Fi suture (Group 2) fixation in the glenoid region of interest for Bankart repair, in addition to evaluation of isolated suture loop biomechanical properties under progressive incremental cyclic loads. With knowledge of glenoid apparent bone mineral density (BMD), implant preparation and fit characteristics, and following application of a light manual tensile load, the primary investigator scored each specimen for perceived within group biomechanical test performance using a 0-10 point modified visual analog scale. After scoring, 12 paired constructs were placed in a servo hydraulic device clamp, preloaded to 25 N, and cycled between 25 and 50 Hz with a 25 N load increase every 25 cycles. Group 2 withstood greater load (104.1 +/- 56 vs. 70 +/- 36.9 N, P = 0.04) and displaced more at failure (13 +/- 4.5 vs. 8.6 +/- 3.3 mm, P = 0.04). All Group 1 specimens failed prior to reaching 150 N, whereas 25% of Group 2 specimens (n = 3) failed at 200 N. All specimens failed by anchor pullout except for three Group 2 specimens that failed by eyelet breakage at 200 N. Isolated suture testing revealed that Group 1 sutures displaced less at each cyclic load (P = 0.028) and withstood greater failure loads (P = 0.028) than that of Group 2 sutures. Group 2 constructs displayed moderately strong relationships between perceived within group biomechanical test performance and ultimate load (r (2) = 0.55) and displacement at failure (r (2) = 0.67). Group 1 did not display significant relationships. Similar biomechanical performance between 50 and 125 N, greater load at failure, and superior biomechanical test prediction accuracy suggest that the screw-in type Bio Mini-Revo suture anchor-#2 Hi-Fi suture combination may be preferred for Bankart lesion repair in low apparent BMD glenoid processes. The #2 Hi-Fi suture, however, allowed significantly greater

  14. Evolution of Complexity in Paleozoic Ammonoid Sutures.

    PubMed

    Saunders; Work; Nikolaeva

    1999-10-22

    The septal sutures of 588 genera of Paleozoic ammonoids showed a 1600 percent increase in mean complexity over 140 million years. Within 475 ancestor/descendant pairs, descendants were more than twice as likely to be more complex than their ancestors. Twelve subclades (373 genera) averaged 34 percent increased complexity. These patterns are compatible with an active or driven system of long-term bias for increased complexity. Mass extinctions acted in opposition to this long-term trend, tending to eliminate more-complex forms and resetting the trend with each extinction event.

  15. Propagation of tears in pericardium from young bulls: influence of the suture.

    PubMed

    Páez, José María García; Jorge-Herrero, Eduardo; Claramunt, Rafael; Millán, Isabel; Rocha, Aurora; Martínez, Belén; Cordón, Angeles; Ros, Antonio

    2010-03-01

    The tearing of the collagen fibers of biological materials utilized in implants or bioprostheses is an important, and sometimes early cause of the failure of these devices. We studied the force necessary to propagate a tear in a biomaterial, pericardium from young bulls, and the influence of the suture. An Elmendorf pendulum capable of measuring the force necessary to tear a given length of tissue was employed. We analyzed 112 trials (70%) that proved valid after achieving the homogeneity of the samples according to their thickness, thus making the results comparable. Mean forces ranging between 19.87 and 150 N were required to propagate tears measuring from 0.25 to 2.0 cm. In the samples with a 1-cm-long suture, sewn using an edge-to-edge technique, the propagation of the tear required a mean force of 15.75 N when the suture was made of nylon and 28.73 N when Prolene was utilized. When these results were compared with the mean recorded in an unsutured control series (56.76 N), the loss of resistance was significant in both sutured series (P = 0.000 and P = 0.011, respectively). Finally, the equation that relates the force (y) with the length of the tear made in unsutured tissue (x) was also obtained: y = 58.14 + 9.62x(2) (R(2) = 0.924). The force necessary to produce a microtear, thus estimated, can be utilized as a parameter for comparison.

  16. Tendoscopic Double-Row Suture Bridge Peroneal Retinaculum Repair for Recurrent Dislocation of Peroneal Tendons in the Ankle.

    PubMed

    Nishimura, Akinobu; Nakazora, Shigeto; Ito, Naoya; Fukuda, Aki; Kato, Ko; Sudo, Akihiro

    2016-06-01

    Traumatic dislocation of peroneal tendons in the ankle is an uncommon lesion that mainly affects young adults. Unfortunately, most cases lead to recurrent dislocation of the peroneal tendons of the ankle (RPTD). Therefore, most cases need operative treatment. One of the most common operative procedures is superior peroneal retinaculum (SPR) repair. Recently, surgery for RPTD has been achieved with less invasive arthroscopic procedures. In this article, tendoscopic surgery for RPTD using a double-row suture bridge technique is introduced. This technique consists of debridement of the lateral aspect of the fibula under an intrasheath pseudo-cavity, suture anchor insertion into the fibular ridge, and reattachment of the SPR to the fibula using a knotless anchor screwed into the lateral aspect of the fibula. This technique mimics the double-row suture bridge technique for rotator cuff tear repair. The double-row suture bridge technique requires more surgical steps than the single-row technique, but it provides a wider bone-SPR contact surface and tighter fixation than the single-row technique. This procedure is an attractive option because it is less invasive and has achieved results similar to open procedures. PMID:27656359

  17. Does UV disinfection compromise sutures? An evaluation of tissue response and suture retention in salmon surgically implanted with transmitters

    SciTech Connect

    Walker, Ricardo W.; Brown, Richard S.; Deters, Katherine A.; Eppard, M. B.; Cooke, Steven J.

    2013-10-01

    Ultraviolet radiation (UVR) can be used as a tool to disinfect surgery tools used for implanting transmitters into fish. However, the use of UVR could possibly degrade monofilament suture material used to close surgical incisions. This research examined the effect of UVR on monofilament sutures to determine if they were compromised and negatively influenced tag and suture retention, incision openness, or tissue reaction. Eighty juvenile Chinook salmon Oncorhynchus tshawytscha were surgically implanted with an acoustic transmitter and a passive integrated transponder. The incision was closed with a single stitch of either a suture exposed to 20 doses of UV radiation (5 minute duration per dose) or a new, sterile suture. Fish were then held for 28 d and examined under a microscope at day 7, 14, 21 and 28 for incision openness, ulceration, redness, and the presence of water mold. There was no significant difference between treatments for incision openness, redness, ulceration or the presence of water mold on any examination day. On day 28 post-surgery, there were no lost sutures; however, 2 fish lost their transmitters (one from each treatment). The results of this study do not show any differences in negative influences such as tissue response, suture retention or tag retention between a new sterile suture and a suture disinfected with UVR.

  18. New suture materials for midline laparotomy closure: an experimental study

    PubMed Central

    2014-01-01

    Background Midline laparotomy closure carries a significant risk of incisional hernia. This study examines the behavior of two new suture materials, an elastic material, polyurethane (PUe), and a barbed polydioxanone (PDXb) suture thread in a rabbit model of midline incision closure. Methods Three 2-cm midline incisions were made in 68 New Zealand White rabbits. The incisions were closed by running suture using four 3/0 threads: polypropylene (PP) (Surgipro®, Covidien), PUe (Assuplus®, Assut Europe), PDX (Assufil®, Assut Europe) or PDXb (Filbloc®, Assut Europe). Animals in each suture group were euthanized 3 weeks and 6 months after surgery. Histological sections of the tissue-embedded sutures were subjected to morphological, collagen expression, macrophage response and uniaxial tensiometry studies. Results No signs of wound dehiscence or complications were observed. At 3 weeks, all sutures were surrounded by connective tissue composed mainly of collagen III. PUe showed greater collagen I expression than the other sutures. All sutures elicited a macrophage response that diminished from 3 weeks to 6 months (p < 0.001). This response was similar for the non-reabsorbable sutures (PP and PUe) yet PDXb showed a significantly greater response than the other reabsorbable suture (PDX) at 3 weeks (p < 0.01). At this early time point, the tensile strength of PUe was similar to that of control intact tissue (p > 0.05). Conclusion Three weeks after surgery, PUe revealed more collagen I deposition than the remaining materials and this translated to a similar biomechanical behavior to linea alba, that could avoid the appearance of short term dehiscences and thus reduce the incidence of incisional hernia. PDXb provides no additional advantages in their behavior regarding PDX suture. PMID:25231161

  19. Suture welding for arthroscopic repair of peripheral triangular fibrocartilage complex tears.

    PubMed

    Badia, Alejandro; Khanchandani, Prakash

    2007-03-01

    This report presents a method of arthroscopic repair of the peripheral triangular fibrocartilage tears by using ultrasonic suture welding technique, thus avoiding the need for traditional suture knots. This technique eliminates the potential causes of ulnar-sided wrist discomfort especially during the postoperative period. Twenty-three patients (9 women and 14 men; mean age, 35 years; range, 18-52 years) were operated during a 1-year period in 2001 for Palmer grade 1B triangular fibrocartilage complex tear and followed up for 17 months. At the final follow-up, the average wrist arc of motion was as follows: extension, 65 degrees; flexion, 56 degrees; supination, 80 degrees; pronation, 78 degrees; radial deviation, 12 degrees; and ulnar deviation, 25 degrees. Grip strength measured with a dynamometer (Jamar) averaged 81% of the contralateral side at the final evaluation (range, 53%-105%).

  20. 21 CFR 878.4930 - Suture retention device.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Suture retention device. 878.4930 Section 878.4930 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4930 Suture retention...

  1. 21 CFR 878.4495 - Stainless steel suture.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Stainless steel suture. 878.4495 Section 878.4495 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4495 Stainless steel suture....

  2. 21 CFR 878.4495 - Stainless steel suture.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Stainless steel suture. 878.4495 Section 878.4495 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4495 Stainless steel suture....

  3. 21 CFR 878.4930 - Suture retention device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Suture retention device. 878.4930 Section 878.4930 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4930 Suture retention...

  4. 21 CFR 878.4495 - Stainless steel suture.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Stainless steel suture. 878.4495 Section 878.4495 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4495 Stainless steel suture....

  5. 21 CFR 878.4930 - Suture retention device.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Suture retention device. 878.4930 Section 878.4930 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4930 Suture retention...

  6. 21 CFR 878.4495 - Stainless steel suture.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Stainless steel suture. 878.4495 Section 878.4495 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4495 Stainless steel suture....

  7. 21 CFR 878.4930 - Suture retention device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Suture retention device. 878.4930 Section 878.4930 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4930 Suture retention...

  8. 21 CFR 878.4930 - Suture retention device.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Suture retention device. 878.4930 Section 878.4930 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4930 Suture retention...

  9. 21 CFR 878.4495 - Stainless steel suture.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Stainless steel suture. 878.4495 Section 878.4495 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4495 Stainless steel suture....

  10. [Costs and benefits of mechanical sutures in esophageal surgery].

    PubMed

    Peracchia, A; Bardini, R

    1990-03-01

    The cost/benefit ratio of mechanical sutures is a controversial issue. Aim of this work was to compare the cost of esophago-visceral anastomoses performed with staplers versus the cost of conventional anastomoses. Not only the cost of the material, but also the economical impact of the hospital stay and operative complications was evaluated. Results show a statistically significant decrease of morbidity in patients treated with mechanical sutures (3.7% vs 18.8%, p = 0.0001). The overall cost of a single mechanical suture was markedly lower than that of a single manual suture (934.000 vs 2,209.000 Italian lira). We conclude that a significant decrease of hospital cost can be expected using mechanical sutures. It has to be noted, however, that in order to achieve such results, an adequate surgical training with staplers is mandatory.

  11. No-mesh Inguinal Hernia Repair with Continuous Absorbable Sutures: A Dream or Reality? (A Study of 229 Patients)

    PubMed Central

    Desarda, Mohan P.

    2008-01-01

    Background/Aim The author has published results from two series based on his new technique of inguinal hernia repair. Interrupted sutures with a nonabsorbable material were used for repairs in both theses series. The author now describes the results of repairs done with continuous absorbable sutures. Materials and Methods This is a prospective study of 229 patients having 256 hernias operated from December 2003 to December 2006. An undetached strip of the external oblique aponeurosis was sutured between the inguinal ligament and the muscle arch to form the new posterior wall. Continuous sutures were taken with absorbable suture material (Monofilament Polydioxanone Violet). Data of hospital stay, complications, ambulation, recurrences, and pain were recorded. Follow-up was done until June 2007. Results A total of 224 (97.8%) patients were ambulatory within 6-8 h (mean: 6.42 h) and they attained free ambulation within 18-24 h (mean: 19.26 h). A total of 222 (96.4%) patients returned to work within 6-14 days (mean: 8.62 days) and 209 (91.26%) patients had one-night stays in the hospital. A total of 216 (94.3%) patients had mild pain for 2 days. There were four minor complications, but no recurrence or incidence of chronic groin pain. Patients were followed up for a mean period of 24.28 months (range: 6-42 months). Conclusions The results of this study correlate well with the author's previous publications. Continuous suturing saves operative time and one packet of suture material. The dream of every surgeon to give recurrence-free inguinal hernia repair without leaving any foreign body inside the patient may well become a reality in future. PMID:19568520

  12. Quadriceps tendon rupture: a biomechanical comparison of transosseous equivalent double-row suture anchor versus transosseous tunnel repair.

    PubMed

    Hart, Nathan D; Wallace, Matthew K; Scovell, J Field; Krupp, Ryan J; Cook, Chad; Wyland, Douglas J

    2012-09-01

    Quadriceps rupture off the patella is traditionally repaired by a transosseous tunnel technique, although a single-row suture anchor repair has recently been described. This study biomechanically tested a new transosseous equivalent (TE) double-row suture anchor technique compared with the transosseous repair for quadriceps repair. After simulated quadriceps-patella avulsion in 10 matched cadaveric knees, repairs were completed by either a three tunnel transosseous (TT = 5) or a TE suture anchor (TE = 5) technique. Double-row repairs were done using two 5.5 Bio-Corkscrew FT (fully threaded) (Arthrex, Inc., Naples, FL, USA) and two 3.5 Bio-PushLock anchors (Arthrex, Inc., Naples, FL, USA) with all 10 repairs done with #2 FiberWire suture (Arthrex, Inc., Naples, FL). Cyclic testing from 50 to 250 N for 250 cycles and pull to failure load (1 mm/s) were undertaken. Gap formation and ultimate tensile load (N) were recorded and stiffness data (N/mm) were calculated. Statistical analysis was performed using a Mann-Whitney U test and survival characteristics examined with Kaplan-Meier test. No significant difference was found between the TE and TT groups in stiffness (TE = 134 +/- 15 N/mm, TT = 132 +/- 26 N/mm, p = 0.28). The TE group had significantly less ultimate tensile load (N) compared with the TT group (TE = 447 +/- 86 N, TT = 591 +/- 84 N, p = 0.04), with all failures occurring at the suture eyelets. Although both quadriceps repairs were sufficiently strong, the transosseous repairs were stronger than the TE suture anchor repairs. The repair stiffness and gap formation were similar between the groups.

  13. Mesenteric suture granuloma caused by retained fragments of suture material in a girl who had a laparotomy 12 years previously.

    PubMed

    Jung, Eunyoung; Park, Woo-Hyun; Choi, Soon-Ok

    2013-01-01

    The authors report a case of a mesenteric suture granuloma in a 12 year-old-girl who had a small bowel resection for a complicated intussusception at the age of 5 months. At later exploration a whitish round tumor located on the anti-mesenteric side of the intestine was found. Several small intestinal loops also abutted on the tumor. Pathologic examination showed fibrosis and a granuloma containing linear colored braided suture material with multinucleated giant cell. As mesenteric suture granulomas have a complex appearance and mimic a soft tissue tumor during imaging, it is important for a surgeon to know about this condition and to consider the history of previous surgery when evaluating the images of patients presenting with an abdominal or pelvic mass. Suture granulomas separate from previous suture sites have not been described in the literature.

  14. Sutures in the Altaids: Implications for Continental Suturing and Growth (Invited)

    NASA Astrophysics Data System (ADS)

    Xiao, W.

    2013-12-01

    Ophiolites and melanges are remnants of vanished oceans in orogenic belts; therefore they are very important for defining sutures. However, as illustrated in the Altaids ophiolitic fragments can be formed at different tectonic settings. Some ophiolites in the Altaids may be substrate of oceanic island arcs or accreted fragments, such as those in Kazakhstan and East Junggar. Others are mainly melanges and mostly occur as blocks or slices in accretionary prisms, such as those in the southern Chinese Altay and southern Tianshan. Ages of ophiolites and melanges should be used to constrain the existence time of ancient oceans, which predate the accretionary process after their emplacement. These ophiolitic fragments or melanges do not necessarily represent real sutures. Ages of some ophiolitic fragments and melanges in Central Asia such as those in the Tianshan predate accretion/collision event and the incorporation of these ophiolitic fragments into accretionary complexes may reflect merely different phases of accretion instead of closure of a major ocean. Major oceans or real sutures can only be recognized by paleogeographical separation of typical faunas and/or floras as many orogenic systems contain archipelagos with second-hand ocean basins, a tectonic scenario similar to the present-day SE Asia. Paleomagnetic data and tectonic analysis enable us to conduct palinspastic reconstructions and can help define real sutures, such as the one in the Southern Tianshan as a main cryptic plane separating the Tarim craton to the south and the accretionary collages to the north from the late Paleozoic to the early Triassic. During most of the Paleozoic time, the Siberia Craton was distributed in the northwest and the Tarim Craton was in the southeast, while the Kazakhstan arc chain was in the west. The active margin of the Siberia Craton had wide accretionary complexes and accreted intra-oceanic arcs and terranes, the Kazakhstan arc chain was characterized by multiple

  15. The Role of Thyroid Eye Disease and Other Factors in the Overcorrection of Hypotropia Following Unilateral Adjustable Suture Recession of the Inferior Rectus (An American Ophthalmological Society Thesis)

    PubMed Central

    Kerr, Natalie C.

    2011-01-01

    Purpose Overcorrection of hypotropia subsequent to adjustable suture surgery following inferior rectus recession is undesirable, often resulting in persistent diplopia and reoperation. I hypothesized that overcorrection shift after suture adjustment may be unique to thyroid eye disease, and the use of a nonabsorbable suture may reduce the occurrence of overcorrection. Methods A retrospective chart review of adult patients who had undergone eye muscle surgery with an adjustable suture technique was performed. Overcorrection shifts that occurred between the time of suture adjustment and 2 months postoperatively were examined. Descriptive statistics, linear regression, Anderson-Darling tests, generalized Pareto distributions, odds ratios, and Fisher tests were performed for two overcorrection shift thresholds (>2 and >5 prism diopters [PD]). Results Seventy-seven patients were found: 34 had thyroid eye disease and inferior rectus recession, 30 had no thyroid eye disease and inferior rectus recession, and 13 patients had thyroid eye disease and medial rectus recession. Eighteen cases exceeded the 2 PD threshold, and 12 exceeded the 5 PD threshold. Statistical analyses indicated that overcorrection was associated with thyroid eye disease (P=6.7E-06), inferior rectus surgery (P=6.7E-06), and absorbable sutures (>2 PD: OR=3.7, 95% CI=0.4–35.0, P=0.19; and >5 PD: OR=6.0, 95% CI=1.1–33.5, P=0.041). Conclusions After unilateral muscle recession for hypotropia, overcorrection shifts are associated with thyroid eye disease, surgery of the inferior rectus, and use of absorbable sutures. Surgeons performing unilateral inferior rectus recession on adjustable suture in the setting of thyroid eye disease should consider using a nonabsorbable suture to reduce the incidence of postoperative overcorrection. PMID:22253487

  16. Interlocking circumareolar suture with undyed polyamide thread: a personal experience.

    PubMed

    Salgarello, Marzia; Visconti, Giuseppe; Barone-Adesi, Liliana

    2013-10-01

    In plastic breast surgery, the interlocking areolar suture has gained wide popularity since its introduction in 2007 by Hammond and colleagues. The interlocking circumareolar suture plays its role in the setting of circumareolar excisions to achieve a durable areola shaping and to prevent scar widening/hypertrophy and areola spreading/distortion. This study retrospectively reviewed 49 breasts that underwent interlocking suture after July 2011 for both aesthetic and reconstructive indications. For the suturing, 3-0 undyed polyamide thread with a straight cutting needle (Dafilon; B. Braun Melsungen AG, Melsungen, Germany) was used. This suture material was preferred to Gore-Tex reported by Hammond and colleagues because it is undyed without any microporous configuration, more wieldy, and less expensive. All 49 breasts showed good results in terms of areola shaping and diameter control as well as good scar quality during a mean follow-up period of 12 months (range 2-18 months) (Fig. 2). No infection, suture extrusion, skin fistula, or granuloma were experienced. The suture was not visible at all, and the patients did not report its palpability. However, at careful examination, the thread resulted slightly palpable.

  17. Arthroscopic coracoclavicular ligament reconstruction using biologic and suture fixation.

    PubMed

    Pennington, William T; Hergan, David J; Bartz, Brian A

    2007-07-01

    Presented in this report is a modified arthroscopic approach to acromioclavicular joint reconstruction via suture and allograft fixation. An arthroscopic approach is used to expose the base of the coracoid by use of electrocautery. After an open distal clavicle excision is performed, clavicular and coracoid tunnels are created under arthroscopic visualization as previously described by Wolf and Pennington. The myotendinous end of a semitendinosus allograft is sutured to a Spider plate (Kinetikos Medical, San Diego, CA). The tendinous end of the graft is prepared with a running baseball stitch. A Nitinol wire with a loop end (Arthrex, Naples, FL) is used to pass 2 free FiberTape sutures (Arthrex) and the leading sutures from the tendinous end of the graft through the clavicular and coracoid tunnels, exiting out the anterior portal. One of the FiberTape sutures is retrieved with a grasper and passed over the anterior aspect of the distal clavicle. The second FiberTape suture and the allograft are passed over the distal end of the resected clavicle. While the acromioclavicular joint is held reduced, the FiberTape sutures are tied to the plate and the allograft is tensioned medially until the plate is embedded against the superior surface of the clavicle. The tendinous end of the graft is secured to the superior surface of the clavicle with a Bio-tenodesis screw (Arthrex) medial to the clavicular tunnel.

  18. In vivo comparison of THC:YAG laser welding to sutured closure of biliary tissue.

    PubMed

    Oz, M C; Popp, H W; Treat, M R; Bass, L S; Popilskis, S

    1991-05-01

    Percutaneous endoscopic approaches to cholelithiasis are an alternative to extracorporeal shockwave lithotripsy which offer advantages of fewer restrictions on stone size and type as well as avoidance of fragmented stone passage complications. Endoscopic techniques would be facilitated by methods of welding gallbladder tissues. The technical constraints imposed by the endoscopic approach favor nonsuture methods of fusing gallbladder tissues. To evaluate a laser method for fusing biliary tissue, we have compared the healing response of laser-welded versus polyglycolic acid suture-closed incisions in canine gallbladder tissue in vivo. The laser used was a thulium-holmium-chromium:YAG laser producing 200-microsecond, 300-millijoule pulses at 2.15 microns. Serial sacrifice of dogs that underwent laser or suture closure of incisions made in the fundus of the gallbladder revealed that all repairs healed without evidence of leakage or infection. Laser-welded cholecystotomy sites had complete fibrous healing of the wound by two weeks postoperatively and reepithelialization by three weeks after operation. Suture-closed wounds were still without complete epithelization four weeks after the procedure. Laser welding may be a useful technique in endoscopic biliary surgery.

  19. Microvascular anastomoses in irradiated vessels: A comparison between the Unilink system and sutures

    SciTech Connect

    Ragnarsson, R.; Berggren, A.; Klintenberg, C.; Ostrup, L. )

    1990-03-01

    A new mechanical device (the Unilink system) was compared to conventional suture anastomoses in irradiated microvessels. Twenty rabbits received a single radiation dose of 20 Gy from a 7-MeV electron source through an anterior neck field. One and 6 months following irradiation, the carotid arteries and facial veins were divided and anastomosed on one side with the Unilink system and on the other side with suture technique. At sacrifice 4 weeks postoperatively, all vessels were evaluated for patency and histologic changes associated with radiation and anastomotic trauma. Histology disclosed severe radiation changes. Also, intimal hyperplasia was consistently found at the anastomotic sites in the arteries, while it was totally absent in the venous anastomoses. Occlusive thrombosis was found in two arteries, one anastomosed with the Unilink system and one sutured. Two other arteries, one from each group, had subtotal occlusions at the anastomotic site. No occlusions occurred in any of the venous anastomoses. The overall patency in this study was 97.5 percent, with no difference between the two techniques.

  20. Healing of colonic anastomoses: comparative experimental study of glued, manually sutured, and stapled anastomoses

    SciTech Connect

    Jansson, O.K.; Zilling, T.L.; Walther, B.S. )

    1991-07-01

    In 10 pigs a nonsutured, glued colonic anastomosis was constructed with a modified stapling device without staples and compared with an EEA-stapled anastomosis and a one-layer-sutured anastomosis concerning radiologic appearance, breaking strength, circulation, and collagen concentration. 141Ce-labeled microspheres were used for measurements of the anastomotic blood flow before the animals were sacrificed on the 4th postoperative day. The breaking strength was recorded and an anastomotic index calculated. No leakage was found. The anastomotic width did not differ between the groups, but the interindividual variation was more prominent in the sutured group. The handsewn and stapled anastomoses were stronger than the glued anastomosis (P = 0.0009 and 0.0054, respectively). There was an increase in the anastomotic circulation in all of the anastomoses, but no differences were seen between groups. The collagen concentration was independent of the technique used.

  1. New and emerging uses of barbed suture technology in plastic surgery.

    PubMed

    Rosen, Allen D

    2013-09-01

    Barbed sutures first received US Food and Drug Administration approval for soft tissue approximation in 2005 and early adopters readily embraced this device to develop new techniques. It has become apparent that the advantages are more than just "skin deep." Superficial and deep fascia, cartilage, tendon, joint capsule, and fibrous periprosthetic capsules can also be manipulated. Barbed sutures have revolutionized our approach to facial rejuvenation and body contouring by enhancing our ability to quilt and powerfully lift tissue. The elimination of surgical drains and shorter surgical times has made this a true boon for plastic surgeons as well as many other surgical specialists. This article summarizes some of the current and evolving applications of this exciting new tool.

  2. Spatial motion constraints for robot assisted suturing using virtual fixtures.

    PubMed

    Kapoor, Ankur; Li, Ming; Taylor, Russell H

    2005-01-01

    We address the problem of the stitching task in endoscopic surgery using a circular needle under robotic assistance. Our main focus is to present an algorithm for suturing using guidance virtual fixtures (VF) that assist the surgeon to move towards a desired goal. A weighted multi-objective, constraint optimization framework is used to compute the joint motions required for the tasks. We show that with the help of VF, suturing can be performed at awkward angles without multiple trials, thus avoiding damage to tissue. In this preliminary study we show the feasibility of our approach and demonstrate the promise of cooperative assistance in complex tasks such as suturing.

  3. The Paleotethys suture in Central Iran

    NASA Astrophysics Data System (ADS)

    Bagheri, S.; Stampfli, G. M.

    2003-04-01

    The Triassic rocks of the Nakhlak area have been used to justify the hypothesis of the rotation of the Central-East Iranian microplate, mainly based on paleomagnetic data. Davoudzadeh and his coworkers (1981) pointed out the existing contrast between the Nakhlakh succession and the time-equivalent lithostratigraphic units exposed in the surrounding regions and compared them with the Triassic rocks of the Aghdarband area on the southern edge of the Turan plate. We recently gathered evidences that this part of central Iran effectively belongs to the Northern Iranian Paleo-Tethys suture zone and related Variscan terrains of the Turan plate. This is the case for the northwestern part of central Iran, where the Anarak-Khur belt (Anarak schists and their thick Cretaceous-Paleocene sedimentary cover) presents all the elements of an orogenic zone such as dismembered ophiolites and silisiclastics, calcareous and volcanic cover which has been deformed and metamorphosed. This belt is separated to the northwest from the Alborz microcontinent by the Great Kavir fault and Cretaceous ophiolite mélanges. To the southeast it is bounded by the Biabanak fault and serpentinites and the Biabanak block, part of the central-east Iranian plate. The later zone is formed by Proterozoic metamorphic basement and marine sedimentary cover, nearly continuous from the Ordovician to the Triassic, at the uppermost part upper Triassic-lower Jurassic bauxites and silisiclastics are observed. Excepted the Ordovician angular unconformities and the boundary between lower Jurassic and younger layers, this sequence displays no significant main unconformities and can be attributed to the Cimmerian super-terrain. Thus, this sequences represents the classical evolution of the southern Paleo-Tethys passive margin, as found in the Alborz microcontinent or the Band-e Bayan zone of Afghanistan and is the witness of large scale duplication of the Paleo-Tethys suture zone through major Alpine strike-slip faults

  4. A multiphase transitioning peptide hydrogel for suturing ultrasmall vessels

    NASA Astrophysics Data System (ADS)

    Smith, Daniel J.; Brat, Gabriel A.; Medina, Scott H.; Tong, Dedi; Huang, Yong; Grahammer, Johanna; Furtmüller, Georg J.; Oh, Byoung Chol; Nagy-Smith, Katelyn J.; Walczak, Piotr; Brandacher, Gerald; Schneider, Joel P.

    2016-01-01

    Many surgeries are complicated by the need to anastomose, or reconnect, micrometre-scale vessels. Although suturing remains the gold standard for anastomosing vessels, it is difficult to place sutures correctly through collapsed lumen, making the procedure prone to failure. Here, we report a multiphase transitioning peptide hydrogel that can be injected into the lumen of vessels to facilitate suturing. The peptide, which contains a photocaged glutamic acid, forms a solid-like gel in a syringe and can be shear-thin delivered to the lumen of collapsed vessels (where it distends the vessel) and the space between two vessels (where it is used to approximate the vessel ends). Suturing is performed directly through the gel. Light is used to initiate the final gel-sol phase transition that disrupts the hydrogel network, allowing the gel to be removed and blood flow to resume. This gel adds a new tool to the armamentarium for micro- and supermicrosurgical procedures.

  5. A multiphase transitioning peptide hydrogel for suturing ultrasmall vessels.

    PubMed

    Smith, Daniel J; Brat, Gabriel A; Medina, Scott H; Tong, Dedi; Huang, Yong; Grahammer, Johanna; Furtmüller, Georg J; Oh, Byoung Chol; Nagy-Smith, Katelyn J; Walczak, Piotr; Brandacher, Gerald; Schneider, Joel P

    2016-01-01

    Many surgeries are complicated by the need to anastomose, or reconnect, micrometre-scale vessels. Although suturing remains the gold standard for anastomosing vessels, it is difficult to place sutures correctly through collapsed lumen, making the procedure prone to failure. Here, we report a multiphase transitioning peptide hydrogel that can be injected into the lumen of vessels to facilitate suturing. The peptide, which contains a photocaged glutamic acid, forms a solid-like gel in a syringe and can be shear-thin delivered to the lumen of collapsed vessels (where it distends the vessel) and the space between two vessels (where it is used to approximate the vessel ends). Suturing is performed directly through the gel. Light is used to initiate the final gel-sol phase transition that disrupts the hydrogel network, allowing the gel to be removed and blood flow to resume. This gel adds a new tool to the armamentarium for micro- and supermicrosurgical procedures. PMID:26524396

  6. Brief communication: Ectocranial suture closure in Pongo: pattern and phylogeny.

    PubMed

    Cray, James; Cooper, Gregory M; Mooney, Mark P; Siegel, Michael I

    2010-11-01

    Ectocranial suture fusion patterns have been shown to contain biological and phylogenetic information. Previously the patterns of Homo, Pan, and Gorilla have been described. These data reflect the phylogenetic relationships among these species. In this study, we applied similar methodology to Pongo to determine the suture synostosis progression of this genus, and to allow comparison to previously reported data on other large-bodied hominoids. We hypothesized these data would strengthen the argument that suture synostosis patterns reflect the phylogeny of primate taxa. Results indicate that the synostosis of vault sutures in Pongo is similar to that reported for Gorilla (excluding Pan and Homo). However, the lateral-anterior pattern of fusion, in which there is a strong superior to inferior pattern, for Pongo is unique among these species, reflecting its phylogenetic distinctness among great ape taxa.

  7. Anatomic and Biomechanical Comparison of Traditional Bankart Repair With Bone Tunnels and Bankart Repair Utilizing Suture Anchors

    PubMed Central

    Judson, Christopher H.; Charette, Ryan; Cavanaugh, Zachary; Shea, Kevin P.

    2016-01-01

    Background: Traditional Bankart repair using bone tunnels has a reported failure rate between 0% and 5% in long-term studies. Arthroscopic Bankart repair using suture anchors has become more popular; however, reported failure rates have been cited between 4% and 18%. There have been no satisfactory explanations for the differences in these outcomes. Hypothesis: Bone tunnels will provide increased coverage of the native labral footprint and demonstrate greater load to failure and stiffness and decreased cyclic displacement in biomechanical testing. Study Design: Controlled laboratory study. Methods: Twenty-two fresh-frozen cadaveric shoulders were used. For footprint analysis, the labral footprint area was marked and measured using a Microscribe technique in 6 specimens. A 3-suture anchor repair was performed, and the area of the uncovered footprint was measured. This was repeated with traditional bone tunnel repair. For the biomechanical analysis, 8 paired specimens were randomly assigned to bone tunnel or suture anchor repair with the contralateral specimen assigned to the other technique. Each specimen underwent cyclic loading (5-25 N, 1 Hz, 100 cycles) and load to failure (15 mm/min). Displacement was measured using a digitized video recording system. Results: Bankart repair with bone tunnels provided significantly more coverage of the native labral footprint than repair with suture anchors (100% vs 27%, P < .001). Repair with bone tunnels (21.9 ± 8.7 N/mm) showed significantly greater stiffness than suture anchor repair (17.1 ± 3.5 N/mm, P = .032). Mean load to failure and gap formation after cyclic loading were not statistically different between bone tunnel (259 ± 76.8 N, 0.209 ± 0.064 mm) and suture anchor repairs (221.5 ± 59.0 N [P = .071], 0.161 ± 0.51 mm [P = .100]). Conclusion: Bankart repair with bone tunnels completely covered the footprint anatomy while suture anchor repair covered less than 30% of the native footprint. Repair using bone tunnels

  8. [Skull fracture or accessory suture in a child?].

    PubMed

    Burkhard, Katrin; Lange, Lena M; Plenzig, Stefanie; Verhoff, Marcel A; Kölzer, Sarah C

    2016-01-01

    Differentiation between accessory sutures and fractures in the skull of an infant can be difficult. Apart from the regular sutures there is a multitude of variations that may be mistaken for a fracture line. Such variations include for instance the intraparietal suture between the two ossification centers of the parietal bone or the mendosal suture between the supraoccipital and interparietal bone of the occipital squama. The presented case refers to an approximately 20-month-old female child. During autopsy, a discontinuity in the right paramedian posterior cranial fossa parallel to the internal occipital crest with connection to the foramen magnum was observed. The macroscopic findings suggested a fracture line because of its course. However, neither a hemorrhage in the soft tissue nor callus formation was discernible. The discontinuity was preserved with the adjacent parts of the occipital bone for further histological examination. In the report of a cranial CT, which was carried out five days before the child's death, an accessory suture paramedially in the right posterior cranial fossa was described. When the clinical CT records were re-evaluated, a similar discontinuity at the corresponding position on the other side was detected, though of noticeably shorter length. Additionally, the preserved occipital bone fragment including the discontinuity was histologically processed. In the radiological literature, precise (radiological) criteria for differential diagnosis are indicated. A zigzag pattern with sclerotic borders and a bilateral and fairly symmetric occurrence indicate a suture, whereas a sharp lucency with non-sclerotic edges and a unilateral occurrence indicate a fracture. Taking all the findings into account, the depicted discontinuity was regarded as an accessory suture. This case demonstrates that differentiation between a fracture and an accessory suture may be difficult in the autopsy of a child and underlines the importance of a postmortem CT

  9. Experimental evaluation of horse hair as a nonabsorbable monofilament suture

    PubMed Central

    Yedke, Swati R.; Raut, Subhash Y.; Jangde, C. R.

    2013-01-01

    Background: Success of surgery depends on wound closure and healing. Ancients had coated many suture materials from plant and animal origin. As the quest for natural nonabsorbable, monofilament surgical suture continues, horsehair has been taken for study, which is mentioned in ancient literature. Objectives: Aim of the study was to evaluate detail mechanical and biophysical properties of horsehair. Materials and Methods: Physical properties, that are diameter, straight pull and knot pull tensile strength, bioburden, sterility tests were performed. Visual and histological wound healing parameters were studied in experimental Wistar rat incision wound model. Two experimental wounds about 5 cm long were created on each side of dorsal midline. Each animal received two sutures-Horsehair 4-0 and Ethilon 4-0. The sutured areas were grossly examined on 3rd and 7th days for visual observations like congestion, edema, infection, wound disruption, and impression of suture material on healed wound and then subjected for histological study. Results: Revealed that horsehair has got diameter of 0.19 mm which complies with the 4-0 size USP standard. Straight pull tensile strength was found 0.5851 ± 0.122 kg and knot pull tensile strength was 0.3998 ± 0.078 kg, which complies with the standards of United State Pharmacopia for class II nonabsorbable suture materials. In vivo study revealed that there was no evidence of edema, congestion, and discharge in both the groups. Wounds healed with minimum impressions of suture material with minimum scar mark. Mean histological scoring shows very mild tissue reaction. Conclusion: Horsehair has got properties of standard suture material except low tensile strength and hence can be used in reconstructive, plastic surgeries, and ophthalmic surgeries. PMID:24459386

  10. External Dacryocystorhinostomy with and Without Suturing the Posterior Mucosal Flaps

    PubMed Central

    Kaçaniku, Gazmend; Begolli, Ilir

    2014-01-01

    ABSTRACT Purpose: To evaluate the outcome of the external dacryocystorhinostomy with and without suturing the posterior mucosal flaps. Methods: This study included 106 patients with lacrimal drainage system disorders who underwent the external dacryocystorhinostomy. Fifty four patients (Group A) underwent external dacryocystorhinostomy with suturing anterior and posterior flaps of the lacrimal sac and nasal mucosa, and the results obtained were compared with those of another series of 52 patients (Group B) where dacryocystorhinostomy was performed with suturing only the anterior flaps, whereas posterior mucosal flaps were excised. Results: The success rate was evaluated by lacrimal patency to irrigation and relief of epiphora. Patency achieved in groups A and B was 94.4% and 96.2%, respectively. There was no statistically significant difference in success rate between the groups. Conclusion: Our study suggests that external dacryocystorhinostomy with suturing anterior and posterior flaps have no advantage over dacryocystorhinostomy with suturing only anterior flaps. Anastomosis by suturing only anterior flaps and excision of the posterior flaps is easier to perform and may improve the success rate of external dacryocystorhinostomy. PMID:24783915

  11. No-drain DIEP Flap Donor-site Closure Using Barbed Progressive Tension Sutures

    PubMed Central

    Nagarkar, Purushottam; Lakhiani, Chrisovalantis; Cheng, Angela; Lee, Michael; Teotia, Sumeet

    2016-01-01

    Background: The use of progressive tension sutures has been shown to be comparable to the use of abdominal drains in abdominoplasty. However, the use of barbed progressive tension sutures (B-PTSs) in deep inferior epigastric artery perforator (DIEP) flap donor-site closure has not been investigated. Methods: A retrospective chart review was performed on patients with DIEP flap reconstruction in a 3-year period at 2 institutions by 2 surgeons. Patients were compared by method of DIEP donor-site closure. Group 1 had barbed running progressive tension sutures without drain placement. Group 2 had interrupted progressive tension closure with abdominal drain placement (PTS-AD). Group 3 had closure with only abdominal drain placement (AD). Data collected included demographics, perioperative data, and postoperative outcomes. Results: Seventy-five patients underwent DIEP reconstruction (25 B-PTS, 25 PTS-AD, and 25 AD). Patient characteristics—age, body mass index, comorbidities, smoking status, and chemotherapy—were not significantly different between groups. Rate of seroma was 1.3% (B-PTS = 0%, PTS-AD = 4%, AD = 0%), wound dehiscence 16% (B-PTS = 8%, PTS-AD = 16%, AD = 24%), and umbilical necrosis 5.3% (B-PTS = 0%, PTS-AD = 0%, AD = 16%). No hematomas were observed in any patients. No statistically significant difference was found between complication rates across groups. Conclusions: Use of B-PTSs for abdominal closure after DIEP flap harvest can obviate the need for abdominal drains. Complication rates following this technique are not significantly different from closure using progressive tension suture and abdominal drain placement. This practice can prevent the use of abdominal drains, which can promote patient mobility, increase independence upon discharge, and contribute to patient satisfaction. PMID:27200234

  12. THE ROLE OF FIBRIN GLUE AND SUTURE ON THE FIXATION OF ULTRA FROZEN PRESERVED MENISCUS TRANSPLANTATION IN RABBITS

    PubMed Central

    Reckers, Leandro José; Fagundes, Djalma José; Pozo Raymundo, José Luiz; Granata Júnior, Geraldo Sérgio de Mello; Moreira, Márcia Bento; Paiva, Vanessa Carla; Negrini Fagundes, Anna Luiza; Cohen, Moises

    2015-01-01

    Objective: To evaluate the ability of fibrin adhesive in promoting the meniscus fixation within two, four and eight weeks compared to the conventional soft-tissue suture technique. Materials and Methods: 36 right medial menisci of rabbits preserved at negative 73° Celsius for 30 days were transplanted to animals of the same sample and fixed with soft-tissue suture or fibrin glue. After 2, 4 or 8 weeks, the appearance of the menisci and the quality of fixation were macroscopically checked and evaluated by a scoring system. The findings were subjected to the statistical study of variance analysis (p ≤ 0.05%). Results: The deep-frozen meniscus preservation maintained the integrity of the meniscus transplant, and, macroscopically, there was no significant reduction of the length of the meniscus in all post-transplant periods (p = 0.015). The menisci fixed with fibrin showed slight changes in color and surface roughness. There were no signs of rejection or infection in both groups. Suture fixation scoring was superior (p = 0.015) in all periods (80% of total fixation) as compared to the setting promoted by fibrin (20% of total fixation). Conclusion: The homologous transplantation of the meniscus of rabbits experienced various degrees of integration to the knee according to the fixation method; the surgical soft tissues suturing technique was shown to be superior in the evaluation of scores compared to the fixation with fibrin adhesive. PMID:27004186

  13. Rehabilitation of long-standing facial nerve paralysis with percutaneous suture-based slings.

    PubMed

    Alam, Daniel

    2007-01-01

    Long-standing facial paralysis creates significant functional and aesthetic problems for patients affected by this deficit. Traditional approaches to correct this problem have involved aggressive open procedures such as unilateral face-lifts and sling procedures using fascia and implantable materials. Unfortunately, our results with these techniques over the last 5 years have been suboptimal. The traditional face-lift techniques did not address the nasolabial fold to our satisfaction, and suture-based techniques alone, while offering excellent short-term results, failed to provide a long-term solution. This led to the development of a novel percutaneous technique combining the minimally invasive approach of suture-based lifts with the long-term efficacy of Gore-Tex-based slings. We report our results with this technique for static facial suspension in patients with long-standing facial nerve paralysis and our surgical outcomes in 13 patients. The procedure offers re-creation of the nasolabial crease and suspension of the oral commissure to its normal anatomic relationships. The recovery time is minimal, and the operation is performed as a short outpatient procedure. Long-term 2-year follow-up has shown effective preservation of the surgical results.

  14. Disposable circumcision suture device: clinical effect and patient satisfaction.

    PubMed

    Lv, Bo-Dong; Zhang, Shi-Geng; Zhu, Xuan-Wen; Zhang, Jie; Chen, Gang; Chen, Min-Fu; Shen, Hong-Liang; Pei, Zai-Jun; Chen, Zhao-Dian

    2014-01-01

    In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the benefits of a new disposable circumcision suture device (DCSD). A total of 942 patients were equally divided into three groups (conventional circumcision, Shang ring and disposable suture device group). Patients in the DCSD group were anesthetized with compound 5% lidocaine cream, the others with a 2% lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were significantly lower in the Shang ring and suture device groups compared to the conventional group (P < 0.001). Intra-operative pain was less in the suture device group compared with the other two groups (P < 0.001); whereas post-operative pain was higher in the conventional group compared to the other two groups (P < 0.001). Patients in the suture device (80.57%) and Shang ring (73.57%) groups were more satisfied with penile appearances compared with the conventional circumcision group (20.06%, P < 0.05). Patients in suture device group also healed markedly faster than the conventional group (P < 0.01). The overall satisfaction rate was better in the suture device group (78.66%) compared with the conventional (47.13%) and Shang ring (50.00%) groups (P < 0.05). The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances. PMID:24759586

  15. Laparoscopic ureteral reimplantation: a simplified dome advancement technique.

    PubMed

    Lima, Guilherme C; Rais-Bahrami, Soroush; Link, Richard E; Kavoussi, Louis R

    2005-12-01

    Laparoscopic Boari flap reimplantation has been used to treat long distal ureteral strictures. This technique requires extensive bladder mobilization and complex intracorporeal suturing. This demonstrates a novel laparoscopic bladder dome advancement approach for ureteral reimplantation. This technique obviates the need for bladder pedicle dissection and simplifies the required suturing.

  16. The effect of saliva and oral intake on the tensile properties of sutures: an experimental study.

    PubMed

    Ferguson, Robert E H; Schuler, Kevin; Thornton, Brian P; Vasconez, Henry C; Rinker, Brian

    2007-03-01

    The plastic surgeon often operates in the oral cavity. Little or no information exists regarding the effect of saliva and oral intake upon the tensile properties of suture. Polyglactin 910 (Vicryl) and chromic gut were studied. Five sutures of each type were subjected to saline, saliva, milk, or soy milk over different durations of exposure. Suture breaking strength was tested. A 4-way interaction between suture type, size, liquid, and time was significant (P = 0.0046). Sutures soaked in saliva were significantly weaker. No significant difference was observed between sutures soaked in milk or soy. Saliva appears to enhance degradation rates in both sutures. Suture selection in the oral cavity should be predicated upon the demands of the repair and surgeon's preference. Postoperative feeding instructions should limit tension across mucosal repairs, but the selection of formula should be based upon nutritional requirements and preferences of the child rather than concern over suture degradation.

  17. Recognizing surgeon's actions during suture operations from video sequences

    NASA Astrophysics Data System (ADS)

    Li, Ye; Ohya, Jun; Chiba, Toshio; Xu, Rong; Yamashita, Hiromasa

    2014-03-01

    Because of the shortage of nurses in the world, the realization of a robotic nurse that can support surgeries autonomously is very important. More specifically, the robotic nurse should be able to autonomously recognize different situations of surgeries so that the robotic nurse can pass necessary surgical tools to the medical doctors in a timely manner. This paper proposes and explores methods that can classify suture and tying actions during suture operations from the video sequence that observes the surgery scene that includes the surgeon's hands. First, the proposed method uses skin pixel detection and foreground extraction to detect the hand area. Then, interest points are randomly chosen from the hand area so that their 3D SIFT descriptors are computed. A word vocabulary is built by applying hierarchical K-means to these descriptors, and the words' frequency histogram, which corresponds to the feature space, is computed. Finally, to classify the actions, either SVM (Support Vector Machine), Nearest Neighbor rule (NN) for the feature space or a method that combines "sliding window" with NN is performed. We collect 53 suture videos and 53 tying videos to build the training set and to test the proposed method experimentally. It turns out that the NN gives higher than 90% accuracies, which are better recognition than SVM. Negative actions, which are different from either suture or tying action, are recognized with quite good accuracies, while "Sliding window" did not show significant improvements for suture and tying and cannot recognize negative actions.

  18. Quantitative evaluation of midpalatal suture maturation via fractal analysis

    PubMed Central

    Kwak, Kyoung Ho; Kim, Yong-Il; Kim, Yong-Deok

    2016-01-01

    Objective The purpose of this study was to determine whether the results of fractal analysis can be used as criteria for midpalatal suture maturation evaluation. Methods The study included 131 subjects aged over 18 years of age (range 18.1–53.4 years) who underwent cone-beam computed tomography. Skeletonized images of the midpalatal suture were obtained via image processing software and used to calculate fractal dimensions. Correlations between maturation stage and fractal dimensions were calculated using Spearman's correlation coefficient. Optimal fractal dimension cut-off values were determined using a receiver operating characteristic curve. Results The distribution of maturation stages of the midpalatal suture according to the cervical vertebrae maturation index was highly variable, and there was a strong negative correlation between maturation stage and fractal dimension (−0.623, p < 0.001). Fractal dimension was a statistically significant indicator of dichotomous results with regard to maturation stage (area under curve = 0.794, p < 0.001). A test in which fractal dimension was used to predict the resulting variable that splits maturation stages into ABC and D or E yielded an optimal fractal dimension cut-off value of 1.0235. Conclusions There was a strong negative correlation between fractal dimension and midpalatal suture maturation. Fractal analysis is an objective quantitative method, and therefore we suggest that it may be useful for the evaluation of midpalatal suture maturation. PMID:27668195

  19. Quantitative evaluation of midpalatal suture maturation via fractal analysis

    PubMed Central

    Kwak, Kyoung Ho; Kim, Yong-Il; Kim, Yong-Deok

    2016-01-01

    Objective The purpose of this study was to determine whether the results of fractal analysis can be used as criteria for midpalatal suture maturation evaluation. Methods The study included 131 subjects aged over 18 years of age (range 18.1–53.4 years) who underwent cone-beam computed tomography. Skeletonized images of the midpalatal suture were obtained via image processing software and used to calculate fractal dimensions. Correlations between maturation stage and fractal dimensions were calculated using Spearman's correlation coefficient. Optimal fractal dimension cut-off values were determined using a receiver operating characteristic curve. Results The distribution of maturation stages of the midpalatal suture according to the cervical vertebrae maturation index was highly variable, and there was a strong negative correlation between maturation stage and fractal dimension (−0.623, p < 0.001). Fractal dimension was a statistically significant indicator of dichotomous results with regard to maturation stage (area under curve = 0.794, p < 0.001). A test in which fractal dimension was used to predict the resulting variable that splits maturation stages into ABC and D or E yielded an optimal fractal dimension cut-off value of 1.0235. Conclusions There was a strong negative correlation between fractal dimension and midpalatal suture maturation. Fractal analysis is an objective quantitative method, and therefore we suggest that it may be useful for the evaluation of midpalatal suture maturation.

  20. Material properties of common suture materials in orthopaedic surgery.

    PubMed

    Najibi, S; Banglmeier, R; Matta, Jm; Tannast, M

    2010-01-01

    Suture materials in orthopaedic surgery are used for closure of wounds, repair of fascia, muscles, tendons, ligaments, joint capsules, and cerclage or tension band of certain fractures. The purpose of this study was to compare the biomechanical properties of eleven commonly used sutures in orthopaedic surgery. Three types of braided non-absorbable and one type of braided absorbable suture material with different calibers (n=77) underwent biomechanical testing for maximum load to failure, strain, and stiffness. All samples were tied by one surgeon with a single SMC (Seoul Medical Center) knot and three square knots. The maximum load to failure and strain were highest for #5 FiberWire and lowest for #0 Ethibond Excel (p<0.001). The stiffness was highest for #5 FiberWire and lowest for #2-0 Vicryl (p<0.001). In all samples, the failure of the suture material occurred at the knot There was no slippage of the knot in any of the samples tested. This data will assist the orthopaedic surgeon in selection and application of appropriate suture materials and calibers to specific tasks. PMID:21045977

  1. MATERIAL PROPERTIES OF COMMON SUTURE MATERIALS IN ORTHOPAEDIC SURGERY

    PubMed Central

    Najibi, S; Banglmeier, R; Matta, JM; Tannast, M

    2010-01-01

    Suture materials in orthopaedic surgery are used for closure of wounds, repair of fascia, muscles, tendons, ligaments, joint capsules, and cerclage or tension band of certain fractures. The purpose of this study was to compare the biomechanical properties of eleven commonly used sutures in orthopaedic surgery. Three types of braided non-absorbable and one type of braided absorbable suture material with different calibers (n=77) underwent biomechanical testing for maximum load to failure, strain, and stiffness. All samples were tied by one surgeon with a single SMC (Seoul Medical Center) knot and three square knots. The maximum load to failure and strain were highest for #5 FiberWire and lowest for #0 Ethibond Excel (p<0.001). The stiffness was highest for #5 FiberWire and lowest for #2-0 Vicryl (p<0.001). In all samples, the failure of the suture material occurred at the knot There was no slippage of the knot in any of the samples tested. This data will assist the orthopaedic surgeon in selection and application of appropriate suture materials and calibers to specific tasks. PMID:21045977

  2. Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair

    PubMed Central

    Islam, Anowarul; Bohl, Michael S.; Tsai, Andrew G; Younesi, Mousa; Gillespie, Robert; Akkus, Ozan

    2015-01-01

    Background Currently, there are no well-established suture protocols to attach fully load-bearing scaffolds which span tendon defects between bone and muscle for repair of critical sized tendon tears. Methods to attach load-bearing tissue repair scaffolds could enable functional repair of tendon injuries. Methods Sixteen rabbit shoulders were dissected (New Zealand white rabbits, 1 yr. old, female) to isolate the humeral-infraspinatus muscle complex. A unique suture technique was developed to allow for a 5 mm segmental defect in infraspinatus tendon to be replaced with a mechanically strong bioscaffold woven from pure collagen threads. The suturing pattern resulted in a fully load-bearing scaffold. The tensile stiffness and strength of scaffold repair was compared with intact infraspinatus and regular direct repair. Findings The failure load and displacement at failure of the scaffold repair group were 59.9 N (Standard Deviation, SD = 10.7) and 10.3 mm (SD = 2.9), respectively and matched those obtained by direct repair group which were 57.5 N (SD = 15.3) and 8.6 mm (SD = 1.5), (p > 0.05). Failure load, displacement at failure and stiffness of both of the repair groups were half of the intact infraspinatus shoulder group. Interpretation With the developed suture technique, scaffolds repair showed similar failure load, displacement at failure and stiffness to the direct repair. This novel suturing pattern and the mechanical robustness of the scaffold at time zero indicates that the proposed model is mechanically viable for future in vivo studies which has a higher potential to translate into clinical uses. PMID:26009492

  3. Gliding Resistance and Strength of a Braided Polyester/Monofilament Polyethylene Composite (FiberWire®) Suture in Human Flexor Digitorum Profundus Tendon Repair: An In-Vitro Biomechanical Study

    PubMed Central

    Silva, Jose M.; Zhao, Chunfeng; An, Kai-Nan; Zobitz, Mark E.; Amadio, Peter C.

    2009-01-01

    Purpose While the strength of a tendon repair is clearly important, the friction of the repair is also a relevant consideration. The purpose of this study was to characterize the frictional coefficient, gliding resistance and breaking strength of suture materials and a suture construct commonly used for flexor tendon repair. Methods We measured the friction coefficients of 3-0 braided nylon enclosed in a smooth nylon outer shell (Supramid, S. Jackson, Alexandria, VA), 3-0 braided polyester coated with polybutilate (Ethibond, Ethicon, Somerville, NJ), and a 3-0 braided polyester/monofilament polyethylene composite (FiberWire, Arthrex, Naples, FL) sutures. We also measured the gliding resistance, linear breaking strength and resistance to gapping of zone 2 modified Pennington tendon repairs with the two lowest friction sutures in 20 human cadaveric flexor digitorum profundus (FDP) tendons. Results The braided polyester/monofilament polyethylene composite had a significantly lower friction coefficient (0.054) than either the coated polyester (0.076) or nylon (0.130) sutures (p<0.001). The gliding resistances of the repaired tendons with braided/monofilament polyethylene composite suture and coated, braided polyester were similar (p> 0.05). The strength of the two repairs, force to produce a 2mm gap, and resistance to gap formation than coated, braided polyester repairs were also not significantly different. Conclusion Braided polyester composite is a low friction suture material. However, when this suture was used for tendon repair with a locking suture technique, it did not show a significant effect on the gliding resistance and repair strength compared with the same repair using coated polyester suture. PMID:19121735

  4. Use of a bidirectional barbed suture in robot-assisted sacrocolpopexy.

    PubMed

    Ghomi, Ali; Askari, Reza

    2010-08-01

    Abdominal sacrocolpopexy is an effective and durable surgical procedure that is conventionally reserved for management of vaginal vault prolapse. With the availability of robotic technology in recent years, sacrocolpopexy has become more commonly performed in a minimally invasive fashion. Peritoneal closure can be a tedious and time-consuming step in robot-assisted sacrocolpopexy. We describe a novel technique utilizing a bidirectional barbed suture to re-approximate the peritoneum in robot-assisted sacrocolpopexy, making the procedure more time-efficient. PMID:27628772

  5. Is the Kapuskasing structure the site of a cryptic suture

    NASA Technical Reports Server (NTRS)

    Burke, K.

    1983-01-01

    The demonstration that the Kapuskasing structure involves substantial thrusting of deep continental crustal rocks over shallower continental rocks calls into question an earlier suggestion (by Wilson) that the Circum-Ungaua suture zone continued through the Kapuskasing to join the Penokean fold belt (implying that the Kapuskasing marked the site of what has since come to be called a cryptic suture). Problems are discussed which arose in attempting to reconcile Wilson's idea with data from more recent studies: whether the Kapuskasing and the Thompson belt both mark sutures of about 1700 Ma age; why there is no age difference across the Kapuskasing if it does mark the site of continental collision, and why there is no offset of Superior subprovinces across the Kapuskasing.

  6. Influence of metopic suture fusion associated with sagittal synostosis.

    PubMed

    Domeshek, Leahthan F; Das, Rajesh R; Van Aalst, John A; Mukundan, Srinivasan; Marcus, Jeffrey R

    2011-01-01

    Some patients with sagittal synostosis present with a fused metopic suture. We hypothesize that premature metopic suture fusion consistently and identifiably alters form associated with sagittal synostosis. We previously validated three-dimensional vector analysis as a tool for the study of cranial morphology and used it herein to distinguish between dysmorphologies of isolated sagittal synostosis (ISS) and combined sagittal-metopic synostosis (CSM). Preoperative computed tomographic scans for patients with ISS and CSM were compared with matched normative counterparts. Premature metopic suture fusion was defined by established radiographic criteria. Color-coded point clouds were created for each scan, with color gradient based on patient deviation from normal across the dysmorphic skull. Standard deviation data were evaluated in 7 cranial regions and compared between ISS and CSM. Mean ISS and CSM point clouds were evaluated. Using three-dimensional vector analysis, standard anthropometric data/indices were determined and compared between the 2 groups. Differences in ISS and CSM regional deviations and index measurements were not statistically significant. Mean ISS and CSM representations depicted similar overall morphology. Using accepted criteria for identification of metopic synostosis in CSM, only subtle differences appear between the 2 populations on average. Expected morphologic changes associated with metopic synostosis are present in only a small number of patients with CSM, arguing against our hypothesis, and calling into question the criteria used to identify premature metopic suture fusion. Normal metopic suture fusion occurs for a continuum of time. Our findings suggest that the normal continuum may begin earlier than the literature suggests. In the setting of sagittal synostosis, the influence of metopic suture fusion and treatment is best determined by individual morphologic analysis.

  7. Gingival response to silk, cotton, and nylon suture materials.

    PubMed

    Castelli, W A; Nasjleti, C E; Caffesse, R E; Diaz-Perez, R

    1978-02-01

    Silk, cotton, and nylon suture materials were implanted in the tunica propria of the gingiva in seven adult rhesus monkeys. The histologie study of twenty-four biopsy specimens indicated that there was neither an increase in the vascular permeability nor a leukocytic margination and migration into the tissues adjacent to the suture materials. However, there was a variable histiocytic reaction, with multinucleated cell formation. This reaction was quite intense with cotton, less intense with silk, and practically absent with nylon. The greater cellular response to cotton was probably due to its more active capacity for modifying the internal biologic medium of the gingvia.

  8. Familial idiopathic hypertrophic osteoarthropathy and cranial suture defects in children

    SciTech Connect

    Reginato, A.J.; Schiapachasse, V.; Guerrero, R.

    1982-05-01

    Three children with idiopathic hypertrophic osteoarthropathy and cranial suture defects are reported. The syndrome was recognized after birth and in the two oldest siblings, the cranial defects and subperiosteal bone formation resolved almost completely by age 4 and 6 years. The joint swelling and clubbing persisted and mild bone reabsorption of the distal phalanges became apparent at an older age. Two siblings and both parents had normal bone X-rays and no clubbing. This study confirms the association of cranial sutural defects and familial idopathic hypertrophic osteoarthropathy.

  9. Medial transposition of split lateral rectus augmented with fixation sutures in cases of complete third nerve palsy.

    PubMed

    Saxena, Rohit; Sharma, Medha; Singh, Digvijay; Dhiman, Rebika; Sharma, Pradeep

    2016-05-01

    Surgical management of complete third nerve paralysis is a challenge. While several techniques have been described over the years, they result in less than satisfactory outcomes with residual deviations in primary gaze or postoperative drifts. One of the described techniques for management of oculomotor palsy has been medial transposition of the lateral rectus muscle which provides a good surgical alternative but often can result in undercorrection. We describe a modification of the existing technique of medial transposition of the split lateral rectus by force augmentation through the use of equatorial fixation sutures resulting in an improved outcome in primary gaze alignment. The modified technique involves splitting of the lateral rectus into two halves followed by transposing the superior half from below the superior oblique and superior rectus and inferior half from below the inferior oblique and inferior rectus to attach them at the superior and inferior edge of the medial rectus insertion, respectively. This is followed by placing non-absorbable sutures to fix each split belly of the transposed muscles to the sclera at the equator adjacent to the medial rectus such that the split muscles lie nearly parallel to the medial rectus till the equator before reflecting away. These sutures augment the force of the transposed muscles by redirecting the force vectors in the direction of action of the medial rectus. Satisfactory postoperative primary gaze alignment was achieved in three cases of complete third nerve paralysis.

  10. The Effect of Suture Preloading on the Force to Failure and Gap Formation After Flexor Tendon Repair

    PubMed Central

    Vanhees, Matthias; Thoreson, Andrew R.; Larson, Dirk R.; Amadio, Peter C.; An, Kai-Nan; Zhao, Chunfeng

    2014-01-01

    Purpose Gap formation is a common and severe complication after flexor tendon repair that can affect the outcome and prolong tendon healing. The purpose of this study was to investigate the effect that a pretensional force applied to the suture during tendon repair has on the repair strength and force that causes gap formation. Methods We used a total of 48 flexor digitorum profundus tendons from 12 human cadaver hands. We employed a core tendon suture, using the modified Pennington technique, and a running suture for flexor tendon repair. Before tying the knots of the core suture, we preloaded the sutures in each tendon end 0, 5, 10, or 15 N for 10 seconds to compare the effect of loading magnitude on repaired tendon peak force to failure and force causing gap formation. Results The force to form a gap of 2 mm in the 15-N preload group was significantly increased compared with the 0-N and 5-N preload groups. At the 3-mm gap formation, the force of all preload groups was significantly higher than the nonpreload group. The peak force with a preload of 10 N and 15 N was significantly higher than 0-N preload. Conclusions These findings suggest that pretensioning with 10 to 15 N at the suture–tendon interface before tying the knot has a beneficial effect on both the tendon gap formation and the peak force to failure. Clinical relevance When the surgeons perform tendon repair, pretensioning at the suture–tendon conjunction will increase the repair strength. PMID:23261189

  11. Complexity of suture zones:Example from the Yarlung Zangbo Suture Zone , southern Tibet. (Invited)

    NASA Astrophysics Data System (ADS)

    Hebert, R.; Guilmette, C.

    2013-12-01

    Decade-long investigation of the Yarlung Zangbo Suture Zone (YZSZ), southern Tibet, has revealed it's high complexity in terms of structure, geochronology and metamorphic and igneous histories. For instance, YZSZ comprises Late Devonian to mid-Miocene rocks, metamorphic intensities vary from high-grade to very-low grade and deformation styles range from ductile to brittle. Late Devonian rocks (363.7 × 1.7 Ma) are alkalic gabbros resulting from activity of a plume active within the Paleo-Tethys basin. Two ophiolite sub-groups are recognized. Sub-group 1 is Mid- to Late Jurassic (150-177 Ma) in age and ill-defined because only few sequences have been found and studied so far. IThis sub-group is probably derived from the destruction of a marginal basin comprising intra-oceanic arc and fore-arc settings. Spontang and Zedong sequences are good examples of this sub-group. Sub-group 2 is Lower Cretaceous (120-130 Ma) and represents the destruction of a marginal basin comprising an arc-back-arc system. These ophiolites are spatially associated with ophiolitic mélanges and flysch respectively representing the reworking of the Cretaceous ophiolites and Indian continental margin and the Neo-Tethyan ocean floor although such affinities need clarification. Most ophiolitic sequences belong to sub-group 2 such as Xiugubagu, Saga, Xigaze. Amphibolite and garnet amphibolite blocks (123-130 Ma) found within the ophiolitic mélange share similar geochemical attributes with sub-group 2 ophiolites. Their protoliths were probably generated within back-arc spreading center and metamorphosed in a subduction zone at depth around 50 km. Some radiometric ages suggest events at 80 Ma and 90 old represent the entry of Indian continental margin into the intra-oceanic subduction zone and/or obduction of ophiolites. However these ages seem to be very rare throughout the whole suture zone and are therefore considered as resulting from local metamorphic events. Some alkaline igneous rocks (131

  12. Suture material in bladder surgery: a comparison of polydioxanone, polyglactin, and chromic catgut.

    PubMed

    Stewart, D W; Buffington, P J; Wacksman, J

    1990-06-01

    A comparison of polydioxanone, polyglactin, and chromic catgut suture was performed in 120 rat bladders studying propensity for infection, degree of inflammation, calculogenic potential, changes in urine pH, and suture absorption. None of the sutures predisposed to infection and there was wide variability but no correlation in urine pH. Although initially the polydioxanone incited a greater inflammatory response, by six months all three sutures were similar. The absorption of polydioxanone was slower than chromic catgut suture, but similar to the absorption of polyglactin. There was no significant difference in calculogenic potential between the suture materials tested over a six-month period. Based on this study in rats, polydioxanone suture would appear to be equal to catgut and polyglactin suture in bladder surgery.

  13. An Update on the Use of Barbed Suture in Minimally Invasive Gynecological Surgery (MIGS).

    PubMed

    Kondrup, James Dana; Anderson, Frances R

    2016-04-01

    The use of barbed suture has enabled general and minimally invasive gynecological surgery (MIGS) surgeons to close surgical wounds more efficiently with minimal complications. This article reviews developments in barbed (knotless) sutures and related devices.

  14. ENDOSCOPIC FULL THICKNESS BIOPSY OF THE GASTRIC WALL WITH DEFECT CLOSURE USING AN ENDOSCOPIC SUTURING DEVICE: SURVIVAL PORCINE STUDY

    PubMed Central

    Rajan, E; Gostout, CJ; Bonin, E Aimore; Moran, EA; Locke, GR; Szarka, LA; Talley, NJ; Deters, JL; Miller, CA; Knipschield, MA; Lurken, MS; Stoltz, GJ; Bernard, CE; Grover, M; Farrugia, G

    2013-01-01

    Background The pathogenesis of several common gastric motility diseases and functional gastrointestinal disorders remains essentially unexplained. Gastric wall biopsies that include the muscularis propria to evaluate the enteric nervous system, interstitial cells of Cajal and immune cells can provide important insights to our understanding of the etiology of these disorders. Objectives To determine 1. Technical feasibility, reproducibility and safety of performing a full thickness gastric biopsy (FTGB) using a submucosal endoscopy with mucosal flap (SEMF) technique; 2. Technical feasibility, reproducibility and safety of tissue closure using an endoscopic suturing device; 3. Ability to identify myenteric ganglia in resected specimens; 4. Long-term safety. Design Single center, pre-clinical survival study. Setting Animal research laboratory – Developmental Endoscopy Unit. Subjects Twelve domestic pigs. Interventions Animals underwent a SEMF procedure with gastric muscularis propria resection. The resultant offset mucosal entry site was closed using an endoscopic suturing device. Animals were survived for 2 weeks. Main Outcome Measurements 1. Technical feasibility, reproducibility and safety of the procedure 2. Clinical course of the animals 3. Histological and immunochemical evaluation of the resected specimen to determine if myenteric ganglia were present in the sample. Results FTGB was achieved using the SEMF technique in all 12 animals. The offset mucosal entry site was successfully closed using the suturing device in all animals. Mean resected tissue size was 11 mm. Mean total procedure time was 61 mins with 2–4 interrupted sutures placed per animal. Histology showed musclaris propria and serosa confirming full thickness resections in all animals. Myenteric ganglia were visualized in 11/12 animals. The clinical course was uneventful. Repeat endoscopy and necropsy at 2 weeks showed absence of ulceration at either the mucosal entry sites or overlying the more

  15. [The resistance to infection of digestive sutures. Experimental study (author's transl)].

    PubMed

    Bellamy, J; Brunschvicg, O; Fékété, F; Lortat-Jacob, J L

    1977-01-01

    The authors study the effects of severe sepsis due to pathogenic gems in large quantity an healing of the suture of the ileum in the rabbit. Contamination of the suture did not lead to any breakdown of the suture whatever the germ. These experimental facts, compared with the data in the literature suggest that the peritoneal serosa ensures efficacious anti-infectious defence, permitting healing of intra-peritoneal digestive sutures in spite of the septic nature of the intestinal contents. PMID:885933

  16. Angiogenesis and osteogenesis in an orthopedically expanded suture

    NASA Technical Reports Server (NTRS)

    Chang, H. N.; Garetto, L. P.; Potter, R. H.; Katona, T. R.; Lee, C. H.; Roberts, W. E.

    1997-01-01

    The purpose of this study was to examine the angiogenic and the subsequent osteogenic responses during a 96-hour time-course after sutural expansion. Fifty rats were divided into: (1) a control group that received only angiogenic induction through injection of 5 ng/gm recombinant human endothelial cell growth factor (rhECGF); (2) an experimental group that received orthopedic expansion and rhECGF; (3) a sham group that received expansion and sodium chloride (NaCl) injection; and (4) a baseline group that received no expansion or injection. All rats were injected with 3H-thymidine (1.0 microCi/gm) 1 hour before death to label the DNA of S-phase cells. Demineralized sections (4 microm thick) were stained with hematoxylin and eosin. Angiogenesis and cell migration were analyzed with a previously established cell kinetics model. Analysis of variance was used to test the hypothesis that enhancement of angiogenesis stimulates reestablishment of osteogenic capability. Blood vessel number, area, and endothelial cell-labeled index significantly increased in experimental groups, but no difference was found between control and baseline groups. Labeled-pericyte index and activated pericyte numbers in the experimental group were also higher than in the sham groups. These results show that supplemental rhECGF enhances angiogenesis in expanded sutures but not in nonexpanded sutures. Data also suggest that pericytes are the source of osteoblasts in an orthopedically expanded suture.

  17. Comparison of Subcuticular Suture Materials in Cesarean Skin Closure

    PubMed Central

    Hasdemir, Pınar Solmaz; Guvenal, Tevfik; Ozcakir, Hasan Tayfun; Koyuncu, Faik Mumtaz; Dinc Horasan, Gonul; Erkan, Mustafa; Oruc Koltan, Semra

    2015-01-01

    Aim. Comparison of the rate of wound complications, pain, and patient satisfaction based on used subcuticular suture material. Methods. A total of 250 consecutive women undergoing primary and repeat cesarean section with low transverse incision were prospectively included. The primary outcome was wound complication rate including infection, dehiscence, hematoma, and hypertrophic scar formation within a 6-week period after operation. Secondary outcomes were skin closure time, the need for use of additional analgesic agent, pain score on numeric rating scale, cosmetic score, and patient scar satisfaction scale. Results. Absorbable polyglactin was used in 108 patients and nonabsorbable polypropylene was used in 142 patients. Wound complication rates were similar in primary and repeat cesarean groups based on the type of suture material. Skin closure time is longer in nonabsorbable suture material group in both primary and repeat cesarean groups. There was no difference between groups in terms of postoperative pain, need for additional analgesic use, late phase pain, and itching at the scar. Although the cosmetic results tended to be better in the nonabsorbable group in primary surgery patients, there was no significant difference in the visual satisfaction of the patients. Conclusions. Absorbable and nonabsorbable suture materials are comparable in cesarean section operation skin closure. PMID:26413566

  18. 21 CFR 878.4830 - Absorbable surgical gut suture.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Absorbable surgical gut suture. 878.4830 Section 878.4830 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4830...

  19. 21 CFR 878.5030 - Natural nonabsorbable silk surgical suture.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Natural nonabsorbable silk surgical suture. 878.5030 Section 878.5030 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...

  20. 21 CFR 878.5010 - Nonabsorbable polypropylene surgical suture.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nonabsorbable polypropylene surgical suture. 878.5010 Section 878.5010 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...

  1. 21 CFR 878.5030 - Natural nonabsorbable silk surgical suture.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Natural nonabsorbable silk surgical suture. 878.5030 Section 878.5030 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...

  2. 21 CFR 878.5030 - Natural nonabsorbable silk surgical suture.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Natural nonabsorbable silk surgical suture. 878.5030 Section 878.5030 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...

  3. 21 CFR 878.4830 - Absorbable surgical gut suture.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Absorbable surgical gut suture. 878.4830 Section 878.4830 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4830...

  4. 21 CFR 878.4830 - Absorbable surgical gut suture.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Absorbable surgical gut suture. 878.4830 Section 878.4830 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4830...

  5. 21 CFR 878.5010 - Nonabsorbable polypropylene surgical suture.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nonabsorbable polypropylene surgical suture. 878.5010 Section 878.5010 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...

  6. 21 CFR 878.5020 - Nonabsorbable polyamide surgical suture.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nonabsorbable polyamide surgical suture. 878.5020 Section 878.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.5020...

  7. 21 CFR 878.5030 - Natural nonabsorbable silk surgical suture.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Natural nonabsorbable silk surgical suture. 878.5030 Section 878.5030 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...

  8. 21 CFR 878.5030 - Natural nonabsorbable silk surgical suture.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Natural nonabsorbable silk surgical suture. 878.5030 Section 878.5030 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...

  9. 21 CFR 878.4830 - Absorbable surgical gut suture.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Absorbable surgical gut suture. 878.4830 Section 878.4830 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4830...

  10. 21 CFR 878.4830 - Absorbable surgical gut suture.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Absorbable surgical gut suture. 878.4830 Section 878.4830 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4830...

  11. 21 CFR 878.5020 - Nonabsorbable polyamide surgical suture.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nonabsorbable polyamide surgical suture. 878.5020 Section 878.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.5020...

  12. 21 CFR 878.5020 - Nonabsorbable polyamide surgical suture.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nonabsorbable polyamide surgical suture. 878.5020 Section 878.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES..., sterile, flexible thread prepared from long-chain aliphatic polymers Nylon 6 and Nylon 6,6 and...

  13. 21 CFR 878.5010 - Nonabsorbable polypropylene surgical suture.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nonabsorbable polypropylene surgical suture. 878.5010 Section 878.5010 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... a monofilament, nonabsorbable, sterile, flexible thread prepared from long-chain polyolefin...

  14. 21 CFR 878.5010 - Nonabsorbable polypropylene surgical suture.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonabsorbable polypropylene surgical suture. 878.5010 Section 878.5010 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... a monofilament, nonabsorbable, sterile, flexible thread prepared from long-chain polyolefin...

  15. 21 CFR 878.5010 - Nonabsorbable polypropylene surgical suture.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nonabsorbable polypropylene surgical suture. 878.5010 Section 878.5010 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... a monofilament, nonabsorbable, sterile, flexible thread prepared from long-chain polyolefin...

  16. 21 CFR 878.5020 - Nonabsorbable polyamide surgical suture.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nonabsorbable polyamide surgical suture. 878.5020 Section 878.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES..., sterile, flexible thread prepared from long-chain aliphatic polymers Nylon 6 and Nylon 6,6 and...

  17. 21 CFR 878.5020 - Nonabsorbable polyamide surgical suture.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonabsorbable polyamide surgical suture. 878.5020 Section 878.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES..., sterile, flexible thread prepared from long-chain aliphatic polymers Nylon 6 and Nylon 6,6 and...

  18. Scanning electron microscope and micro-CT evaluation of cranial sutures in health and disease.

    PubMed

    Anderson, Peter J; Netherway, David J; David, David J; Self, Peter

    2006-09-01

    Current knowledge of suture biology has been ascertained as a result of morphological studies of normal cranial sutures (and rarely those undergoing craniosynostosis). These were initially undertaken often using histological investigations, or more recently using CT scans, as investigative tools, but have often used animal models. However, recent technological advances have provided the potential to refine our understanding of the ultrastructure by the use of new advanced scanning technology, which offers the possibility of more detailed resolution. Our aim was to undertake detailed scans of normal, fusing and fused sutures from patients with craniosynosotosis affecting different sutures, to study the detailed structure at different stages of the fusion process using a modern micro-CT scanner and a microanalytical scanning electron microscope. We wished to include in our study all the human sutures because previous studies have mostly been undertaken using the sagittal suture. Ten sutures from seven patients have revealed a complex ultra-structural arrangement. The different patterns of bone ridging seen on the ectocranial and endocranial surfaces of the fused sagittal suture were not repeated on closer inspection of either fused coronal or lambdoid sutures. Elemental analysis confirmed that the amount of calcium increased and the amount of carbon decreased as sampled areas moved away from the suture margin. We conclude that scanning allowed detailed assessment and revealed the complex arrangement of the structure of the human cranial sutures and those undergoing the process of craniosynostosis, with some differences in final structure depending on the affected suture.

  19. Effects of Citalopram on Sutural and Calvarial Cell Processes

    PubMed Central

    Durham, Emily; Jen, Serena; Wang, Lin; Nasworthy, Joseph; Elsalanty, Mohammed; Weinberg, Seth; Yu, Jack; Cray, James

    2015-01-01

    The use of selective serotonin reuptake inhibitors (SSRIs) for the treatment of depression during pregnancy is suggested to increase the incidence of craniofacial abnormalities including craniosynostosis. Little is known about this mechanism, however based on previous data we propose a mechanism that affects cell cycle. Excessive proliferation, and reduction in apoptosis may lead to hyperplasia within the suture that may allow for differentiation, bony infiltration, and fusion. Here we utilized in vivo and in vitro analysis to investigate this proposed phenomenon. For in vivo analysis we used C57BL–6 wild-type breeders treated with a clinical dose of citalopram during the third trimester of pregnancy to produce litters exposed to the SSRI citalopram in utero. At post-natal day 15 sutures were harvested from resulting pups and subjected to histomorphometric analysis for proliferation (PCNA) and apoptosis (TUNEL). For in vitro studies, we used mouse calvarial pre-osteoblast cells (MC3T3-E1) to assess proliferation (MTS), apoptosis (Caspase 3/7-activity), and gene expression after exposure to titrated doses of citalopram. In vivo analysis for PCNA suggested segregation of effect by location, with the sagittal suture, showing a statistically significant increase in proliferative response. The coronal suture was not similarly affected, however there was a decrease in apoptotic activity at the dural edge as compared to the periosteal edge. No differences in apoptosis by suture or area due to SSRI exposure were observed. In vitro results suggest citalopram exposure increased proliferation and proliferative gene expression, and decreased apoptosis of the MC3T3-E1 cells. Decreased apoptosis was not confirmed in vivo however, an increase in proliferation without a concomitant increase in apoptosis is still defined as hyperplasia. Thus prenatal SSRI exposure may exert a negative effect on post-natal growth through a hyperplasia effect at the cranial growth sites perhaps

  20. Evaluation of opening pattern and bone neoformation at median palatal suture area in patients submitted to surgically assisted rapid maxillary expansion (SARME) through cone beam computed tomography

    PubMed Central

    SALGUEIRO, Daniel Gomes; RODRIGUES, Vitor Hugo Leite de Oliveira; TIEGHI, Victor; de MENEZES, Carolina Carmo; GONÇALES, Eduardo Sanches; FERREIRA, Osny

    2015-01-01

    Surgically assisted rapid maxillary expansion (SARME) is the treatment of choice to adult patients even with severe transversal maxillary discrepancies. However, the adequate retention period to achieve the bone remodeling, thus assuring treatment stability, is controversial. Objective To evaluate the opening pattern and bone neoformation process at the midpalatal suture in patients submitted to surgically assisted (SARME) through cone beam computed tomography (CBCT). Material and Methods Fourteen patients were submitted to SARME through subtotal Le Fort I osteotomy. Both the opening pattern and the mean bone density at midpalatal suture area to evaluate bone formation were assessed pre- and post-operatively (15, 60 and 180 days) through CBCT. Results Type I opening pattern (from anterior to posterior nasal spine) occurred in 12 subjects while type II opening pattern (from anterior nasal spine to transverse palatine suture) occurred in 2 individuals. The 180-day postoperative mean (PO 180) of bone density value was 49.9% of the preoperative mean (Pre) value. Conclusions The opening pattern of midpalatal suture is more related to patients’ age (23.9 years in type I and 33.5 years in type II) and surgical technique. It was not possible to observe complete bone formation at midpalatal suture area at the ending of the retention period studied (180 days). PMID:26398512

  1. Evaluation of opening pattern and bone neoformation at median palatal suture area in patients submitted to surgically assisted rapid maxillary expansion (SARME) through cone beam computed tomography.

    PubMed

    Salgueiro, Daniel Gomes; Rodrigues, Vitor Hugo Leite de Oliveira; Tieghi Neto, Victor; Menezes, Carolina Carmo de; Gonçales, Eduardo Sanches; Ferreira Júnior, Osny

    2015-01-01

    Surgically assisted rapid maxillary expansion (SARME) is the treatment of choice to adult patients even with severe transversal maxillary discrepancies. However, the adequate retention period to achieve the bone remodeling, thus assuring treatment stability, is controversial.Objective To evaluate the opening pattern and bone neoformation process at the midpalatal suture in patients submitted to surgically assisted (SARME) through cone beam computed tomography (CBCT).Material and Methods Fourteen patients were submitted to SARME through subtotal Le Fort I osteotomy. Both the opening pattern and the mean bone density at midpalatal suture area to evaluate bone formation were assessed pre- and post-operatively (15, 60 and 180 days) through CBCT.Results Type I opening pattern (from anterior to posterior nasal spine) occurred in 12 subjects while type II opening pattern (from anterior nasal spine to transverse palatine suture) occurred in 2 individuals. The 180-day postoperative mean (PO 180) of bone density value was 49.9% of the preoperative mean (Pre) value.Conclusions The opening pattern of midpalatal suture is more related to patients' age (23.9 years in type I and 33.5 years in type II) and surgical technique. It was not possible to observe complete bone formation at midpalatal suture area at the ending of the retention period studied (180 days).

  2. A Randomized Controlled Trial Comparing Suture-Fixation Mucopexy and Doppler-Guided Hemorrhoidal Artery Ligation in Patients with Grade III Hemorrhoids

    PubMed Central

    Zhai, Min; Zhang, Yong-An; Wang, Zhen-Yi; Sun, Jian-Hua; Wen, Jie; Zhang, Qi; Li, Jin-De; Wu, Yi-Zheng; Zhou, Feng; Xu, Hui-Lei

    2016-01-01

    Background. We aimed to evaluate the effectiveness of a suture-fixation mucopexy procedure by comparing with Doppler-guided hemorrhoidal artery ligation (DGHAL) in the management of patients with grade III hemorrhoids. Methods. This was a randomized controlled trial. One hundred patients with grade III hemorrhoids were randomly assigned to receive suture-fixation mucopexy (n = 50) or DGHAL (n = 50). Outcome assessments were performed at 2 weeks, 12 months, and 24 months. Assessments included resolution of clinical symptoms, postoperative complications, duration of hospitalization, and total costs. Results. At 2 weeks, one (2%) patient in suture-fixation group and four (8%) patients in DGHAL group had persistent prolapsing hemorrhoids. Postoperative bleeding was observed in two patients (4%) in suture-fixation group and one patient in DGHAL group. There was no significant difference in short-term recurrence between groups. Postoperative complications and duration of hospitalization were comparable between the two groups. Rates of recurrence of prolapse or bleeding at 12 months did not differ between groups. However, recurrence of prolapse at 24 months was significantly more common in DGHAL group (19.0% versus 2.3%, p = 0.030). Conclusions. Compared with DGHAL, the suture-fixation mucopexy technique had comparable short-term outcomes and favorable long-term outcomes. PMID:27066071

  3. Neuroma-in-continuity of the median nerve managed by nerve expansion and direct suture with vein conduit.

    PubMed

    Jeudy, J; Raimbeau, G; Rabarin, F; Fouque, P A; Saint-Cast, Y; Césari, B; Bigorre, N

    2014-06-01

    Autologous nerve grafting is the current standard for bridging large gaps in major sensory and motor nerves. It allows both function and pain improvement with predictable results. Clinical observations of nerve elongation caused by tumours have prompted experimental animal studies of induced gradual elongation of the nerve stump proximal to the gap. This technique allows direct suturing of the two nerve ends to bridge the gap. Here, we describe a case of neuroma-in-continuity of the median nerve managed by resection and direct suture after nerve elongation with a tissue expander. We are not aware of similar reported cases. Secondary repair 3 years after the initial injury improved the pain and hypersensitivity and restored a modest degree of protective sensory function (grade S1).

  4. Timing of ectocranial suture activity in Gorilla gorilla as related to cranial volume and dental eruption.

    PubMed

    Cray, James; Cooper, Gregory M; Mooney, Mark P; Siegel, Michael I

    2011-05-01

    Research has shown that Pan and Homo have similar ectocranial suture synostosis patterns and a similar suture ontogeny (relative timing of suture fusion during the species ontogeny). This ontogeny includes patency during and after neurocranial expansion with a delayed bony response associated with adaptation to biomechanical forces generated by mastication. Here we investigate these relationships for Gorilla by examining the association among ectocranial suture morphology, cranial volume (as a proxy for neurocranial expansion) and dental development (as a proxy for the length of time that it has been masticating hard foods and exerting such strains on the cranial vault) in a large sample of Gorilla gorilla skulls. Two-hundred and fifty-five Gorilla gorilla skulls were examined for ectocranial suture closure status, cranial volume and dental eruption. Regression models were calculated for cranial volumes by suture activity, and Kendall's tau (a non-parametric measure of association) was calculated for dental eruption status by suture activity. Results suggest that, as reported for Pan and Homo, neurocranial expansion precedes suture synostosis activity. Here, Gorilla was shown to have a strong relationship between dental development and suture activity (synostosis). These data are suggestive of suture fusion extending further into ontogeny than brain expansion, similar to Homo and Pan. This finding allows for the possibility that masticatory forces influence ectocranial suture morphology.

  5. Assessment of the role of sutures in a lizard skull: a computer modelling study

    PubMed Central

    Moazen, Mehran; Curtis, Neil; O'Higgins, Paul; Jones, Marc E.H; Evans, Susan E; Fagan, Michael J

    2008-01-01

    Sutures form an integral part of the functioning skull, but their role has long been debated among vertebrate morphologists and palaeontologists. Furthermore, the relationship between typical skull sutures, and those involved in cranial kinesis, is poorly understood. In a series of computational modelling studies, complex loading conditions obtained through multibody dynamics analysis were imposed on a finite element model of the skull of Uromastyx hardwickii, an akinetic herbivorous lizard. A finite element analysis (FEA) of a skull with no sutures revealed higher patterns of strain in regions where cranial sutures are located in the skull. From these findings, FEAs were performed on skulls with sutures (individual and groups of sutures) to investigate their role and function more thoroughly. Our results showed that individual sutures relieved strain locally, but only at the expense of elevated strain in other regions of the skull. These findings provide an insight into the behaviour of sutures and show how they are adapted to work together to distribute strain around the skull. Premature fusion of one suture could therefore lead to increased abnormal loading on other regions of the skull causing irregular bone growth and deformities. This detailed investigation also revealed that the frontal–parietal suture of the Uromastyx skull played a substantial role in relieving strain compared with the other sutures. This raises questions about the original role of mesokinesis in squamate evolution. PMID:18765341

  6. Assessment of the role of sutures in a lizard skull: a computer modelling study.

    PubMed

    Moazen, Mehran; Curtis, Neil; O'Higgins, Paul; Jones, Marc E H; Evans, Susan E; Fagan, Michael J

    2009-01-01

    Sutures form an integral part of the functioning skull, but their role has long been debated among vertebrate morphologists and palaeontologists. Furthermore, the relationship between typical skull sutures, and those involved in cranial kinesis, is poorly understood. In a series of computational modelling studies, complex loading conditions obtained through multibody dynamics analysis were imposed on a finite element model of the skull of Uromastyx hardwickii, an akinetic herbivorous lizard. A finite element analysis (FEA) of a skull with no sutures revealed higher patterns of strain in regions where cranial sutures are located in the skull. From these findings, FEAs were performed on skulls with sutures (individual and groups of sutures) to investigate their role and function more thoroughly. Our results showed that individual sutures relieved strain locally, but only at the expense of elevated strain in other regions of the skull. These findings provide an insight into the behaviour of sutures and show how they are adapted to work together to distribute strain around the skull. Premature fusion of one suture could therefore lead to increased abnormal loading on other regions of the skull causing irregular bone growth and deformities. This detailed investigation also revealed that the frontal-parietal suture of the Uromastyx skull played a substantial role in relieving strain compared with the other sutures. This raises questions about the original role of mesokinesis in squamate evolution.

  7. Preliminary report: Laser welding and fibrinogen soldering are superior to sutured cholecyctostomy closure in a canine model

    NASA Astrophysics Data System (ADS)

    Oz, Mehmet C.; Treat, Michael R.; Libutti, Steven K.; Popp, Howard W.; Bass, Lawrence S.; Popilskis, Sulli

    1990-06-01

    Percutaneous endoscopic techniques for biliary surgery would be facilitated by methods of welding biliary tissue. To further investigate laser methods for fusing biliary tissue, we compared the time 0 bursting strength of two variations of near-infrared laser closure against polyglycolic acid suture controls. These time 0 studies were performed with a gallium-aluminum-arsenide semiconductor diode laser with a major ,iavelength output of 808 -F 1 nm and an energy density of 4.8 J/cm'. Using the 808 nm laser and indocyanine green dye to enhance laser energy uptake, closure of gallbladder incisions was accomplished with and without addition of fibrinogen to the target site prior to laser exposure. Without fibrinogen, the laser welds burst at 77 mm Hg, while fibrinogen soldering yielded a bursting pressure of 194 mm Hg. Sutured welds leaked at 215 mm Hg. Survival studies were performed with a mid-infrared 2.15 micron thulium-holmium--chromium:YAG laser producing 200 microsecond 300 millijoule pulses at 3 Hz (peak power .75 megawatts/sq cm, fluence 150 joules per square centimeter). The healing of midinfrared and polyglycolic suture closures of gallbladder incisions were compared at 1,2,3, and 4 weeks. All closures healed without evidence of leakage or infection. Laser welded cholecystostomy sites were completely ingrown with fibrous tissue by 2 weeks post- operatively and re-epithelialized by 3 weeks after operation. Suture closed wounds were still without complete epithelization 4 weeks after the procedure. Laser welding, particularly with fibrinogen reinforcement, may be a useful technique in future developments in percutaneous endoscopic biliary surgery.

  8. Running barbed suture quilting reduces abdominal drainage in perforator-based breast reconstruction.

    PubMed

    Liang, D G; Dusseldorp, J R; van Schalkwyk, C; Hariswamy, S; Wood, S; Rose, V; Moradi, P

    2016-01-01

    Prolonged abdominal drainage after perforator-based breast reconstruction is a common problem that can result in seroma formation, patient morbidity, and increased duration of hospital stay. Abdominal quilting with progressive tension sutures has been effective in reducing abdominal drainage in abdominoplasty patients prompting a change of practice in our unit. We studied consecutive unilateral mastectomy patients undergoing breast reconstruction with a deep inferior epigastric artery perforator (DIEP) flap. The initial 27 patients underwent breast reconstruction without any form of abdominal flap plication. The subsequent 26 patients underwent an identical DIEP flap raise procedure after which the abdominal flap was progressively tensioned using a running barbed suture quilting technique. All patients had closed suction drains inserted bilaterally until daily drain output was <40 ml in 2 consecutive days. Primary outcome measures were total volume of abdominal drainage and length of hospital stay. Independent statistical analyses were performed using Welch's t-test. There were no demographic differences between the two groups. A statistically significant decrease in the mean total abdominal drainage was found after quilting (238 ml vs. 528 ml; p = 0.0005). Patients in the quilting group also showed a reduction in mean duration of hospital stay. Quilting of the abdominal flap helps to reduce abdominal drainage not only in abdominoplasty patients but also in patients undergoing breast reconstruction with DIEP flap. PMID:26601878

  9. Torn discoid lateral meniscus treated using partial central meniscectomy and suture of the peripheral tear.

    PubMed

    Adachi, Nobuo; Ochi, Mitsuo; Uchio, Yuji; Kuriwaka, Masakazu; Shinomiya, Rikuo

    2004-05-01

    We present the cases of 5 patients with a torn discoid lateral meniscus treated using partial central meniscectomy in conjunction with the suture repair of the tear. The patients were 4 boys and 1 girl with a mean age of 15.4 years (range, 11 to 17). Preoperatively, all patients complained of knee pain during daily or sports activities. At the final follow-up evaluation, more than 2 years later, 4 patients' conditions were graded as excellent and 1 patient's condition was graded as fair according to Ikeuchi's grading scale. The average Lysholm score improved from 83.4 points (range, 70-90) to 95.8 points (range, 89-100) postoperatively. In the 3 patients who underwent second-look arthroscopy, complete healing was seen in 2 patients. One patient had severe degenerative changes in the meniscus; the repaired site was not united and required an additional partial meniscectomy along the tear. We believe that with the current advancement in arthroscopic meniscal repair techniques, a partial central meniscectomy in conjunction with the suture repair of the peripheral tear can be effective treatment for patients with a torn complete or incomplete discoid meniscus.

  10. Modification of the Bankart reconstruction using a suture anchor.

    PubMed

    Traina, S M; Holtgrewe, J L; King, S

    1998-01-01

    A prospective study was done to determine the effectiveness of a suture anchor in doing a Modified Bankart Reconstruction on the traumatic unidirectional Bankart lesion shoulder. From 1989 to 1991, 26 patients encompassing 27 shoulders with recurrent instability had modified Bankart reconstructions. A minimum 18-month follow-up was obtained by examination of 24 patients with telephone interviews done on two patients. The average follow-up was 23.6 months. A 93.1% good-to-excellent result was obtained using the Bankart rating scale. There were no failures or complications. The surgeon involved in the study thought the suture anchor facilitated the attachment of the avulsed capsulolabral complex in doing the Bankart procedure.

  11. [Peculiarities of tissue reactions during resorption of biodegradable suture materials].

    PubMed

    Kuznetsova, I V; Maĭborodin, I V; Shevela, A I; Barannik, M I; Manaev, A A; Brombin, A I; Maĭborodina, V I

    2013-01-01

    The reaction of the surrounding tissues to the implantation of biodegradable suture materials (plain catgut threads, DemeTECH polyglactin 910, Surgilactin--polyglactin 910) into the subcutaneous adipose tissue of rats, was studied using light microscopy 1, 2, 6 and 12 months after grafting. It was shown that the tissue reactions to implantation of different biodegradable suture materials followed the general pattern characteristic of wound healing and foreign body reaction. By the first month of observation, in all the animal groups, the stage of traumatic perifocal inflammation was replaced by a proliferative phase with the new growth of the blood vessels and connective tissue. In all the animal groups, there was a trend to reduction of productive inflammation activity from the 1st month till the 12th month. By the 12th month the total degeneration of the material with full recovery of structure of surrounding tissues (restitution) was recorded only after the implantation of polyglactin 910 (DemeTECH).

  12. Local tissue reaction to implantation of biodegradable suture materials.

    PubMed

    Kuznetsova, I V; Maiborodin, I V; Shevela, A I; Barannik, M I; Manaev, A A; Brombin, A I; Maiborodina, V I

    2014-07-01

    Morphological changes in tissues adjacent to the implant were studied 1, 2, 6, and 12 months after implantation of biodegradable suture materials (catgut thread, DemeTECH polyfilament thread, and Surgilactin monofilament thread) into subcutaneous fat of rats. Tissue reaction to implantation of different suture materials developed as usual in response to a wound process and to a foreign body. By the end of month 1. the stage of traumatic perifocal inflammation was replaced in all groups by the proliferative phase with formation of new vessels and connective tissue. A trend to reduction of the productive inflammation activity from month 1 to month 12 was noted. Complete degeneration of the material after 12 months with complete recovery of the histoarchitecture of the adjacent tissues (restitution) was detected only after implantation of DemeTECH polyfilament thread.

  13. Biomechanics of the rostrum and the role of facial sutures.

    PubMed

    Rafferty, Katherine L; Herring, Susan W; Marshall, Christopher D

    2003-07-01

    The rostrum is a large diameter, thin-walled tubular structure that receives loads from the teeth. The rostrum can be conceptualized both as a rigid structure and as an assemblage of several bones that interface at sutures. Using miniature pigs, we measured in vivo strains in rostral bones and sutures to gain a better understanding of how the rostrum behaves biomechanically. Strains in the premaxillary and nasal bones were low but the adjacent maxillary-premaxillary, internasal, and intermaxillary suture strains were larger by an order of magnitude. While this finding emphasizes the composite nature of the rostrum, we also found evidence in the maxillary and nasal bones for rigid structural behavior. Namely, maxillary strain is consistent with a short beam model under shear deformation from molar loading. Strain in the nasal bones is only partially supported by a long beam model; rather, a complex pattern of dorsal bending of the rostrum from incisor contact and lateral compression is suggested. Torsion of the maxilla is ruled out due to the bilateral occlusion of pigs and the similar working and balancing side strains, although it may be important in mammals with a unilateral bite. Torsional loading does appear important in the premaxillae, which demonstrate working and balancing side changes in strain orientation. These differences are attributed to asymmetrical incisor contact occurring at the end of the power stroke.

  14. Self-directed practice schedule enhances learning of suturing skills

    PubMed Central

    Safir, Oleg; Williams, Camille K.; Dubrowski, Adam; Backstein, David; Carnahan, Heather

    2013-01-01

    Background Most preoperative surgical training programs experience challenges with the availability of expert surgeons to teach trainees. Some research suggests that trainees may benefit from being allowed to actively shape their learning environments, which could alleviate some of the time and resource pressures in surgical training. The purpose of this study was to investigate the effects of self-directed or prescribed practice schedules (random or blocked) on learning suturing skills. Methods Participants watched an instructional video for simple interrupted, vertical mattress and horizontal mattress suturing then completed a pretest to assess baseline skills. Participants were assigned to 1 of 4 practice groups: self-directed practice schedule, prescribed blocked practice schedule, prescribed random practice schedule or matched to the self-directed group (control). Practice of the skill was followed by a delayed (1 h) posttest. Improvement from pretest to posttest was determined based on differences in performance time and expert-based assessments. Results Analyses revealed a significant effect of group for difference in performance time of the simple interrupted suture. Random practice did not show the expected advantage for skill learning, but there was an advantage of self-directed practice. Conclusion Self-directed practice schedules may be desirable for optimal learning of simple technical skills, even when expert instruction is available. Instructors must also take into account the interaction between task difficulty and conditions of practice to develop ideal training environments. PMID:24284153

  15. Terranes and suture zones in east central Alaska

    NASA Astrophysics Data System (ADS)

    Churkin, M., Jr.; Foster, H. L.; Chapman, R. M.; Weber, F. R.

    1982-05-01

    East central Alaska, with its 17 terranes, forms a part of the mosaic of allochthonous terranes that join the North American and Siberian plates. These terranes range from continental and continental margin, such as the Tatonduk with its thick well-bedded succession of marine shelf rocks, to seamount, arc, and ocean floor terranes. The Yukon crystalline terrane, the largest described here, is a composite of at least four subterranes juxtaposed across the Tintina fault with the Tatonduk terrane, a northwestern extension of the North American plate in Alaska. Inboard of the Yukon crystalline terrane are packets of closely appressed microterranes separated from the Tatonduk and other terranes belonging to North America by major suture zones. These microterranes lie between North America and the mosaic of accretionary terranes that form the more southerly part of Alaska. The most obviously allochthonous microterranes within the suture zones are the Woodchopper Canyon, an Early Devonian basaltic seamount, and the White Mountains, an Ordovician volcanic arc terrane capped by Silurian and Devonian carbonate bank deposits. The nearest counterpart of these terranes is the Alexander terrane in southeastern Alaska. The Tintina fault of Mesozoic and Cenozoic age, like the Denali fault, primarily follows old suture zones that separate terranes. Strike slip faulting developed after collision in places where further convergence was oblique to the terrane margins. Where terranes met head-on, their leading edges lie along a multiple set of high-angle faults that outline microterranes in accretion zones.

  16. Stress and strain analysis on the anastomosis site sutured with either epineurial or perineurial sutures after simulation of sciatic nerve injury☆

    PubMed Central

    Liu, Guangyao; Zhang, Qiao; Jin, Yan; Gao, Zhongli

    2012-01-01

    The magnitude of tensile stress and tensile strain at an anastomosis site under physiological stress is an important factor for the success of anastomosis following suturing in peripheral nerve injury treatment. Sciatic nerves from fresh adult cadavers were used to create models of sciatic nerve injury. The denervated specimens underwent epineurial and perineurial suturing. The elastic modulus (40.96 ± 2.59 MPa) and Poisson ratio (0.37 ± 0.02) of the normal sciatic nerve were measured by strain electrical measurement. A resistance strain gauge was pasted on the front, back, left, and right of the edge of the anastomosis site after suturing. Strain electrical measurement results showed that the stress and strain values of the sciatic nerve following perineurial suturing were lower than those following epineurial suturing. Scanning electron microscopy revealed that the sciatic nerve fibers were disordered following epineurial compared with perineurial suturing. These results indicate that the effect of perineurial suturing in sciatic nerve injury repair is better than that of epineurial suturing. PMID:25538753

  17. Biomechanical comparison of the four-strand cruciate and Strickland techniques in animal tendons

    PubMed Central

    Iamaguchi, Raquel Bernardelli; Villani, William; Rezende, Marcelo Rosa; Wei, Teng Hsiang; Cho, Alvaro B; dos Santos, Gustavo Bispo; Mattar, Rames

    2013-01-01

    OBJECTIVE: The objective of this study was to compare two four-strand techniques: the traditional Strickland and cruciate techniques. METHODS: Thirty-eight Achilles tendons were removed from 19 rabbits and were assigned to two groups based on suture technique (Group 1, Strickland suture; Group 2, cruciate repair). The sutured tendons were subjected to constant progressive distraction using a universal testing machine (Kratos®). Based on data from the instrument, which were synchronized with the visualized gap at the suture site and at the time of suture rupture, the following data were obtained: maximum load to rupture, maximum deformation or gap, time elapsed until failure, and stiffness. RESULTS: In the statistical analysis, the data were parametric and unpaired, and by Kolmogorov-Smirnov test, the sample distribution was normal. By Student's t-test, there was no significant difference in any of the data: the cruciate repair sutures had slightly better mean stiffness, and the Strickland sutures had longer time-elapsed suture ruptures and higher average maximum deformation. CONCLUSIONS: The cruciate and Strickland techniques for flexor tendon sutures have similar mechanical characteristics in vitro. PMID:24473513

  18. Medial patello-femoral ligament (MPFL) reconstruction using suture anchors fixation: preliminary results

    PubMed Central

    Calanna, Filippo; Pulici, Luca; Carimati, Giulia; Quaglia, Alessandro; Volpi, Piero

    2016-01-01

    Summary Purpose several surgical techniques have been described for the MPFL reconstruction, using many femoral and patellar fixation techniques and different grafts (autograft, allograft, synthetic). The goal of our study is to evaluate the safety and efficacy of MPFL reconstruction using Juggerknot™ (BIOMET, Warsaw, Indiana) suture anchors fixation with a clinical evaluation pre/post surgery of our patients with objective patellofemoral (PF) instability. Methods from January 2013 to March 2015, 19 patients underwent isolated MPFL reconstruction using Juggerknot™ (BIOMET, Warsaw, Indiana) suture anchors fixation. All patients were operated by the same surgeon using the same technique. Patients were evaluated by the same operator during pre surgery phase and at least at 6 months of follow up, using clinical evaluation (apprehension sign, patellar glide test, ROM) and 4 different scores (Tegner, Vas, Lysholm, Kujala). The possible complications and dislocation following surgery were investigated. Results no patellar dislocation and complications were found at follow up. A clinical evaluation improvement was recorded at follow up: all patients achieved a full range of knee motion; apprehension sign from 89% positivity (17 cases) decreased up to 11% (2 cases); glide test from 100% (19 cases) positivity decreased up to 0% (0 cases). Median VAS score decreased significantly (p<0.05) from a median pre-operative value of 8 (min:5 max:10) to 2 (min:0 max:7). Mean Kujala score improved significantly (p<0.05) from 65.23 ± 18.64 pre-operatively to 94.69 ± 6.40. Mean Lysholm score improved significantly (p<0.05) from 64.30 ± 19.29 pre-operatively to 94.72 ± 4.02. Mean Tegner score decreased from 6.15 ± 1.06 pre-operatively to 5.69 ± 0.85. Conclusions in this preliminary study, a clinical assessment of patients undergoing surgery with the Juggerknot ™ (BIOMET, Warsaw, Indiana) suture anchor fixation in MPFL reconstruction, has shown promising results, revealing easy

  19. Laparoscopic Transcystic Choledochotomy with Primary Suture for Choledocholith

    PubMed Central

    Zhu, Andong; Zhang, Zhibo

    2015-01-01

    Background and Objectives: To investigate the possibility of extracting common bile duct (CBD) stones by laparoscopically inserting choledochoscope through the natural orifice of the cystic duct and a mini-incision on the CBD, and the safety of laparoscopic primary double-layer suture of the cystic duct and CBD. Methods: Laparoscopic transcystic choledochotomy and extraction of stones with primary suture was performed on 194 patients with gallbladder and CBD stones from October 1, 2009, through April 30, 2012. The cystic duct was left at a diameter of 1 to 1.5 cm after removal of the gallbladder. The duct was longitudinally cut at its ventral side to the confluence with the CBD, and the anterior wall of the CBD was also cut longitudinally. A choledochoscope was then inserted via the enlarged opening, and the stones were extracted from the CBD. Finally, the CBD and cystic duct were closed by continuous mucous layer suture and seromuscular Lembert suture, respectively. The cystic duct was ligated close to the CBD and an abdominal drainage tube was placed. Results: All surgical procedures were successfully performed. The caliber at the confluence between the cystic duct and the CBD was 0.3 to 0.8 cm (SD 0.4 ± 0.1 cm), and the mini-incision of the CBD was 0.1 to 1.1 cm (SD 0.3 ± 0.2 cm). Abdominal drainage lasted 3 to 5 days. Magnetic resonance cholangiopancreatography (MRCP) in 55 patients showed no abnormal change in the CBD diameter. Two patients had bile leakage. Another patient had intermittent abdominal pain and jaundice 5 to 7 days postoperatively, and the retained stones spontaneously passed. The postoperative hospital stay was 6 to 13 days (SD 8 ± 2.1 days). Observation of 176 patients (90%) lasting 1 to 30 months (SD 11 ± 8 months) showed no recurrent stones or stricture of the CBD. Conclusion: The surgical procedure of laparoscopic transcystic choledochotomy and extraction of stones with primary suture is feasible and safe. PMID:25848193

  20. Effects of increased muscle mass on mouse sagittal suture morphology and mechanics.

    PubMed

    Byron, Craig D; Borke, James; Yu, Jack; Pashley, David; Wingard, Christopher J; Hamrick, Mark

    2004-07-01

    The purpose of this study is to test predicted form-function relationships between cranial suture complexity and masticatory muscle mass and biomechanics in a mouse model. Specifically, to test the hypothesis that increased masticatory muscle mass increases sagittal suture complexity, we measured the fractal dimension (FD), temporalis mass, and temporalis bite force in myostatin-deficient (GDF8(-/-)) mice and wild-type CD-1 mice (all male, 6 months old). Myostatin is a negative regulator of muscle mass, and myostatin-deficient mice show a marked increase in muscle mass compared to normal mice. We predicted that increased sagittal suture complexity would decrease suture stiffness. The data presented here demonstrate that increased suture complexity (measured as FD) was observed in a hypermuscular mouse model (GDF8(-/-)) with significantly increased temporalis muscle mass and bite forces. Hypermuscular mice were also found to possess suture connective tissue that was less stiff (i.e., underwent more displacement before failure occurred) when loaded in tension. By decreasing stiffness, suture complexity apparently helps to dissipate mechanical loads within the cranium that are related to chewing. These results suggest that cranial suture connective tissue locally adapts to functional demands of the biomechanical suture environment. As such, cranial sutures provide a novel model for studies in connective tissue mechanotransduction.

  1. New technical procedure involving Achilles tendon rupture treatment through transcutaneous suture.

    PubMed

    TarniŢă, DănuŢ Nicolae; TarniŢă, Daniela; Grecu, Dan Cristian; Calafeteanu, Dan Marian; Căpitănescu, Bogdan

    2016-01-01

    The Achilles tendon is the widest tendon of the human body. Achilles tendon belongs to the extrasynovial tendons group and this allows it a faster recovery, thanks to local hematoma from the peritenon, necessary for the scarification. We concluded that in Achilles tendon rupture treatment it is essential to maintain the tendon covering skin integrity, the peritendinous integrity, to maintain the local hematoma formed during and after tendon rupture, reattaching the ruptured tendon heads and maintain them in this position by suturing them and by relaxing the sural triceps muscle. The percutaneous suture requires five pairs of mirror micro-incisions (5 mm) on one side and the other of the tendon. It is necessary for one of the pairs to be placed to the rupture level. With a surgical needle, we arm the proximal and distal heads of the tendon by different threads. By traction and muscular relaxation, we bring in contact the two ruptured heads and then we knot together the arming threads. The inferior member was cast immobilized in relaxing position for the sural triceps muscle for a 45 days period. Using this technique, we have operated 15 cases in our Clinic. In all the cases, we obtained a healing by first intention of the tegument micro-incisions. After the cast immobilization suppression, during 30 days the patients were in a recovery program. At the end of this program, they have recovered completely the dorsal and plantar flexion and the walking. In four months after the surgery, the esthetic of the area is completely restored, this technique being the only surgical technique that realizes this recovery.

  2. Comparison of a superficial suturing device with a full-thickness suturing device for transoral outlet reduction (with videos)

    PubMed Central

    Kumar, Nitin; Thompson, Christopher C.

    2016-01-01

    Background Larger gastrojejunal (GJ) anastomosis aperture is one independent predictor for weight regain after Roux-en-Y gastric bypass. Transoral outlet reduction (TORe) has proven safe and effective for treatment of weight regain by using a superficial-thickness (ST) suturing device. Full-thickness (FT) suturing devices are now available, potentially providing more effective results. Objective To compare effectiveness of superficial-thickness with full-thickness TORe. Design Matched cohort study: patients were matched sequentially by GJ anastomosis aperture, body mass index, and age. Setting Tertiary-care center. Patients A total of 59 consecutive patients undergoing full-thickness TORe were matched with 59 patients undergoing superficial-thickness TORe. All had GJ anastomosis apertures >20 mm. Intervention Transoral outlet reduction. Main Outcome Measurements Weight loss and rate of adverse events. Results Post-TORe GJ anastomosis apertures were similar between groups (ST 6.9 ± 0.2 mm vs FT 7.1 ± 0.3 mm). Weight loss was greater at 6 months in the FT group (10.6 ± 1.8 kg in FT vs 4.4 ± 0.8 kg in ST; P < .01) and at 1 year (8.6 ± 2.5 kg in FT vs 2.9 ± 1.0 kg in ST; P < .01). Excess weight loss was greater in the FT group at 6 months (20.4 ± 3.3% in FT vs 8.1 ± 2.5% in ST; P < .01) and at 1 year (18.9 ± 5.4% in FT vs 9.1 ± 2.3% in ST; P = .03). Limitations This was a single-center, retrospective, cohort study. Conclusion There is level 1b evidence for effectiveness of TORe by using a superficial mucosal suturing device. This matched cohort study compared TORe by using the same ST suturing device with TORe by using a newer, FT suturing device and the same operative methods. FT TORe resulted in significantly more weight loss than ST TORe at 6 months and at 1 year. Full-thickness TORe is a significant improvement over ST TORe for endoscopic therapy of weight regain in patients with dilated GJ anastomosis. PMID:24721521

  3. Orientation of late Precambrian sutures in the Arabian-Nubian shield

    NASA Technical Reports Server (NTRS)

    Stern, Robert J.; Nielsen, Kent C.; Best, Eric; Sultan, Mohamed; Arvidson, Raymond E.

    1990-01-01

    Recent tectonic models have resulted in conflicting descriptions of how the late Precambrian sutures of the Arabian-Nubian shield extend into northeast Africa. The Hamisana shear zone in northeastern Sudan is critical to this discussion because it truncates and disrupts two sutures, the Allaqi-Heiani and the Onib-Sol Hamed. Analysis of field structural data, Thematic Mapper imagery, and Rb-Sr and U-Pb geochronology suggests that the Allaqi-Heiani suture is the western extension of the Onib-Sol Hamed suture and that both make up the exposed parts of a far-traveled, polydeformed ophiolitic nappe complex. Subsequent deformation localized in the Hamisana shear zone disrupted this nappe and displaced the suture between 660 and 550 Ma during regional deformation associated with the Najd fault system. These results indicate that at least one suture extends westward into the interior of northern Africa.

  4. A Chronic, Nonhealing Wound of the Finger Caused by Polypropylene Suture Material.

    PubMed

    Sung, Kun-Yong; Lee, Sang-Yeul

    2015-07-01

    Chronic wounds usually result from poor peripheral circulation, neuropathy, pressure, radiation, or infection. Such common types of chronic wounds are easily diagnosed and managed with traditional wound care techniques. In contrast, chronic nonhealing wounds caused by cancerous skin lesions, mycobacterial infections, and foreign-body reactions that are refractory to traditional wound therapy present a particular diagnostic challenge, resulting in erroneous or delayed diagnosis. Therefore, an unusual presentation of a chronic wound should be taken into account when establishing differential diagnosis. In an effort to enhance recognition of chronic wounds caused by foreign-body reactions and facilitate their proper management, the authors report a case of a chronic nonhealing wound on the dorsum of a finger that was associated with the use of polypropylene suture and lasted for 3 years. PMID:26214386

  5. [Morphological changes of tissues in formation of a welding suture on the large intestine].

    PubMed

    Bondar', G V; Basheev, V Kh; Borota, A V; Miroshnichenko, E Iu; Koshik, E A

    2011-01-01

    Abdominoanal resection with descending of left colon on perineum, leaving additional part of a descended intestine, was performed. For the hemorrhage arrest the welding sutures were put on intestinal wall. According to morphological investigations data, a damage of intestinal wall in the zone of a welding suture application is a reversible one, it spreads from the electrode branch on 2-3 mm. The presence of undamaged structures witnesses the presence of an active regeneration process in tissues around the welding suture.

  6. A new, removable, sliding noose for adjustable-suture strabismus surgery.

    PubMed

    Deschler, Emily K; Irsch, Kristina; Guyton, Kristina L; Guyton, David L

    2013-10-01

    We describe a new removable sliding polyglactin 910 suture noose for postoperative suture adjustment following extraocular muscle surgery. No excess suture material remains after adjustment has been completed, helping to reduce discomfort, inflammation, and scarring. We have used this noose with the cul-de-sac conjunctival incision in approximately 360 patients over a period of 18 months. This report details how to fashion, use, and remove the noose.

  7. Gene Expression Changes Between Patent and Fused Cranial Sutures in a Nonsyndromic Craniosynostosis Population

    PubMed Central

    Rhodes, Jennifer L.; Vega, Rafael A.; Ridder, Thomas; Shiang, Rita

    2015-01-01

    Objective: Craniosynostosis is a premature fusion of 1 or more cranial sutures. It may occur with additional morphological abnormalities (syndromic) or in isolation. Studies suggest that dysregulation of normal cell proliferation, differentiation, and migration has a role in isolated or nonsyndromic craniosynostosis but the molecular mechanisms remain unknown. The aim of this research is to identify genes differentially expressed in prematurely fused human suture compared to patent suture in nonsyndromic craniosynostosis. Methods: Bone fragments from synostosed and patent sutures of 7 infants with nonsyndromic craniosynostosis were collected during surgical release of fused sutures. RNA was isolated from the fragments (7 patent and 7 fused) and global gene expression profiled using the Illumina WGE-DASL assay and HumanRef 8.0 Beadchip. Results: Comparison of mRNA expression in fused and patent suture identified 68 genes significantly differentially expressed and having fold changes ≤ −2.0 and ≥ 2.0 with a false discovery rate adjusted P value at .10 and 136 with adjusted P value of 0.15. SFRP2 (secreted frizzled-related protein 2) demonstrated the largest decrease in fused sutures. Analysis including only sagittal fused sutures revealed a set of 35 overlapping genes that may be involved in suture patency over all suture types. SPHKAP (sphingosine kinase type 1-interacting protein), a modulator of TGFβ signaling, was significant in the sagittal subset. Conclusion: Differentially expressed genes were identified in fused suture relative to patent in a nonsyndromic craniosynostosis population. SFRP2 is likely important in suture patency. Genes having significant roles in osteoblastogenesis as negative regulators of canonical Wnt pathway were significantly downregulated. PMID:25987937

  8. Clinical Outcomes After Suture Anchor Repair of Recalcitrant Medial Epicondylitis.

    PubMed

    Grawe, Brian M; Fabricant, Peter D; Chin, Christopher S; Allen, Answorth A; DePalma, Brian J; Dines, David M; Altchek, David W; Dines, Joshua S

    2016-01-01

    This study evaluated clinical and patient-reported outcomes and return to sport after surgical treatment of medial epicondylitis with suture anchor fixation. Consecutive patients were evaluated after undergoing debridement and suture anchor repair of the flexor-pronator mass for the treatment of medial epicondylitis. Demographic variables, a short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, Oxford Elbow Score (OES), and 10-point pain and satisfaction scales were collected. Ability and time to return to sport after surgery were evaluated, and the relationship between predictor variables and both elbow function and return to sport was investigated. Median age at the time of surgery was 55 years (range, 29-65 years), with median follow-up of 40 months (range, 12-67 months). Median QuickDASH score and OES at final follow-up were 2.3 (range, 0-38.6) and 45 (range, 22-48), respectively. Most patients returned to premorbid sporting activities at a median of 4.5 months (range, 2.5-12 months), whereas 4 patients (14%) reported significant limitations at final follow-up. Older age at the time of surgery was predictive of better QuickDASH score and OES (P=.05 and P=.02, respectively). Patients who underwent surgery after a shorter duration of symptoms had better outcomes, but the difference did not reach statistical significance (QuickDASH, P=.09; OES, P=.10). Surgical treatment of recalcitrant medial epicondylitis with suture anchor fixation offers good pain relief and patient satisfaction, with little residual disability. Older age at the time of surgery predicts a better outcome.

  9. Evaluating the Effectiveness of the Lateral Intercrural Suture to Decrease the Interdomal Distance to Improve the Definition of the Nasal Tip in Primary Rhinoplasty

    PubMed Central

    Soares, Caio Márcio Correia; Mocelin, Marcos; Pasinato, Rogerio; Berger, Cezar Augusto Sarraf; Grocoske, Francisco Luiz Busato; Issa, Maria Julia Abrão

    2014-01-01

    Introduction Several surgical techniques emphasizing sutures on the lower lateral cartilage have been studied by surgeons as instruments to improve nasal tip remodeling. It is already known that the domal divergence angle and its definition angle can be modified by lateral intercrural suture (LIS). Techniques for measuring these structures are not yet standardized. Objectives Assess the efficacy of LIS using polydioxanone 4–0 absorbable thread by interdomal distance and systematize the LIS technique to improve nasal tip definition. Materials and Methods This prospective study measured and analyzed interdomal distances measured preoperatively and perioperatively compared with 3- and 6-month postoperative measurements. Results LIS was efficient on reducing interdomal distances. Conclusion LIS is statistically safe and efficient and has low morbidity when utilized in patients with mild to moderate deformities, because it reduces the domal divergence angle, effectively sustaining the nasal tip. PMID:25992073

  10. Effects of suture position on left ventricular fluid mechanics under mitral valve edge-to-edge repair.

    PubMed

    Du, Dongxing; Jiang, Song; Wang, Ze; Hu, Yingying; He, Zhaoming

    2014-01-01

    Mitral valve (MV) edge-to-edge repair (ETER) is a surgical procedure for the correction of mitral valve regurgitation by suturing the free edge of the leaflets. The leaflets are often sutured at three different positions: central, lateral and commissural portions. To study the effects of position of suture on left ventricular (LV) fluid mechanics under mitral valve ETER, a parametric model of MV-LV system during diastole was developed. The distribution and development of vortex and atrio-ventricular pressure under different suture position were investigated. Results show that the MV sutured at central and lateral in ETER creates two vortex rings around two jets, compared with single vortex ring around one jet of the MV sutured at commissure. Smaller total orifices lead to a higher pressure difference across the atrio-ventricular leaflets in diastole. The central suture generates smaller wall shear stresses than the lateral suture, while the commissural suture generated the minimum wall shear stresses in ETER.

  11. Patterns and implications of extensive heterochrony in carnivoran cranial suture closure.

    PubMed

    Goswami, A; Foley, L; Weisbecker, V

    2013-06-01

    Heterochronic changes in the rate or timing of development underpin many evolutionary transformations. In particular, the onset and rate of bone development have been the focus of many studies across large clades. In contrast, the termination of bone growth, as estimated by suture closure, has been studied far less frequently, although a few recent studies have shown this to represent a variable, although poorly understood, aspect of developmental evolution. Here, we examine suture closure patterns across 25 species of carnivoran mammals, ranging from social-insectivores to hypercarnivores, to assess variation in suture closure across taxa, identify heterochronic shifts in a phylogenetic framework and elucidate the relationship between suture closure timing and ecology. Our results show that heterochronic shifts in suture closure are widespread across Carnivora, with several shifts identified for most major clades. Carnivorans differ from patterns identified for other mammalian clades in showing high variability of palatal suture closure, no correlation between size and level of suture closure, and little phylogenetic signal outside of musteloids. Results further suggest a strong influence of feeding ecology on suture closure pattern. Most of the species with high numbers of heterochronic shifts, such as the walrus and the aardwolf, feed on invertebrates, and these taxa also showed high frequency of closure of the mandibular symphysis, a state that is relatively rare among mammals. Overall, caniforms displayed more heterochronic shifts than feliforms, suggesting that evolutionary changes in suture closure may reflect the lower diversity of cranial morphology in feliforms. PMID:23530892

  12. Electrospun Polymeric Core-sheath Yarns as Drug Eluting Surgical Sutures.

    PubMed

    Padmakumar, Smrithi; Joseph, John; Neppalli, Madhuri Harsha; Mathew, Sumi Elizabeth; Nair, Shantikumar V; Shankarappa, Sahadev A; Menon, Deepthy

    2016-03-23

    Drug-coated sutures are widely used as delivery depots for antibiotics and anti-inflammatory drugs at surgical wound sites. Although drug-laden coating provides good localized drug concentration, variable loading efficiency and release kinetics limits its use. Alternatively, drug incorporation within suture matrices is hampered by the harsh fabrication conditions required for suture-strength enhancement. To circumvent these limitations, we fabricated mechanically robust electrospun core-sheath yarns as sutures, with a central poly-l-lactic acid core, and a drug-eluting poly-lactic-co-glycolic acid sheath. The electrospun sheath was incorporated with aceclofenac or insulin to demonstrate versatility of the suture in loading both chemical and biological class of drugs. Aceclofenac and insulin incorporated sutures exhibited 15% and 4% loading, and release for 10 and 7 days, respectively. Aceclofenac sutures demonstrated reduced epidermal hyperplasia and cellularity in skin-inflammation animal model, while insulin loaded sutures showed enhanced cellular migration in wound healing assay. In conclusion, we demonstrate an innovative strategy of producing mechanically strong, prolonged drug-release sutures loaded with different classes of drugs. PMID:26936629

  13. Differential spatial regulation of BMP molecules is associated with single-suture craniosynostosis.

    PubMed

    Whitton, Alaina; Hyzy, Sharon L; Britt, Chelsea; Williams, Joseph K; Boyan, Barbara D; Olivares-Navarrete, Rene

    2016-07-01

    OBJECTIVE The aim of this study was to examine messenger RNA (mRNA) levels of bone morphogenetic protein (BMP) ligands, receptors, and soluble inhibitors in cells isolated from single-suture synostoses from fused coronal, metopic, sagittal, and lambdoid sutures. METHODS Cells were isolated from bone collected from patients undergoing craniotomies at Children's Healthcare of Atlanta. Real-time polymerase chain reaction was used to examine mRNA levels in cells isolated from fused sutures or patent sutures in comparison with levels in normal bone from the same patient. RESULTS Cells isolated from fused sutures in cases of sagittal and coronal synostosis highly expressed BMP2, while cells isolated from fused metopic or lambdoid synostosis expressed high BMP4. Noggin, a BMP inhibitor, was lower in fused sutures and had high expression in patent sutures. CONCLUSIONS These results suggest that BMPs and inhibitors play a significant role in the regulation of suture fusion as well in the maintenance of patency in the normal suture. PMID:27035551

  14. Patterns and implications of extensive heterochrony in carnivoran cranial suture closure

    PubMed Central

    Goswami, A; Foley, L; Weisbecker, V

    2013-01-01

    Heterochronic changes in the rate or timing of development underpin many evolutionary transformations. In particular, the onset and rate of bone development have been the focus of many studies across large clades. In contrast, the termination of bone growth, as estimated by suture closure, has been studied far less frequently, although a few recent studies have shown this to represent a variable, although poorly understood, aspect of developmental evolution. Here, we examine suture closure patterns across 25 species of carnivoran mammals, ranging from social-insectivores to hypercarnivores, to assess variation in suture closure across taxa, identify heterochronic shifts in a phylogenetic framework and elucidate the relationship between suture closure timing and ecology. Our results show that heterochronic shifts in suture closure are widespread across Carnivora, with several shifts identified for most major clades. Carnivorans differ from patterns identified for other mammalian clades in showing high variability of palatal suture closure, no correlation between size and level of suture closure, and little phylogenetic signal outside of musteloids. Results further suggest a strong influence of feeding ecology on suture closure pattern. Most of the species with high numbers of heterochronic shifts, such as the walrus and the aardwolf, feed on invertebrates, and these taxa also showed high frequency of closure of the mandibular symphysis, a state that is relatively rare among mammals. Overall, caniforms displayed more heterochronic shifts than feliforms, suggesting that evolutionary changes in suture closure may reflect the lower diversity of cranial morphology in feliforms. PMID:23530892

  15. Timing of ectocranial suture activity in Pan troglodytes as related to cranial volume and dental eruption.

    PubMed

    Cray, James; Mooney, Mark P; Siegel, Michael I

    2010-08-01

    Research has shown that Pan and Homo have similar ectocranial suture synostosis patterns possibly because of their phylogenetic relationship. However, unlike human data, it is unclear if the ontogeny of suture activity for Pan exhibits a relationship with the expanding neurocranium or the masticatory apparatus. These relationships were assessed by examining the associations between ectocranial suture status and morphology and cranial volume (as a proxy for neurocranial expansion) and dental development (as an indicator of adulthood and proxy for masticatory influence) in a large sample of Pan troglodytes skulls. One hundred and fifty-five P. troglodytes dry skulls were examined, and data were collected on ectocranial suture closure status, cranial volume, and dental eruption status. Regression models were calculated for suture status by cranial volumes, and Kendall's tau (a nonparametric measure of association) was calculated for suture status by dental eruption status. Results suggest that suture synostosis activity in P. troglodytes exhibits a period of stasis after neurocranial expansion cessation and does not have a strong relationship with brain development (r(2) ranged from 0.09 to 0.28), as similarly seen in Homo. Instead, suture synostosis has a stronger relationship with dental development (tau ranged from 0.59 to 0.72), where most osseous activity occurs after full adult dental eruption. This suggests that masticatory forces may influence both ectocranial suture morphology and synostosis more than brain expansion does in Pan, as also similarly noted in Homo.

  16. Recent advances in biodegradable metals for medical sutures: a critical review.

    PubMed

    Seitz, Jan-Marten; Durisin, Martin; Goldman, Jeremy; Drelich, Jaroslaw W

    2015-09-16

    Sutures that biodegrade and dissolve over a period of several weeks are in great demand to stitch wounds and surgical incisions. These new materials are receiving increased acceptance across surgical procedures whenever permanent sutures and long-term care are not needed. Unfortunately, both inflammatory responses and adverse local tissue reactions in the close-to-stitching environment are often reported for biodegradable polymeric sutures currently used by the medical community. While bioabsorbable metals are predominantly investigated and tested for vascular stent or osteosynthesis applications, they also appear to possess adequate bio-compatibility, mechanical properties, and corrosion stability to replace biodegradable polymeric sutures. In this Review, biodegradable alloys made of iron, magnesium, and zinc are critically evaluated as potential materials for the manufacturing of soft and hard tissue sutures. In the case of soft tissue closing and stitching, these metals have to compete against currently available degradable polymers. In the case of hard tissue closing and stitching, biodegradable sternal wires could replace the permanent sutures made of stainless steel or titanium alloys. This Review discusses the specific materials and degradation properties required by all suture materials, summarizes current suture testing protocols and provides a well-grounded direction for the potential future development of biodegradable metal based sutures.

  17. Elimination of stick-slip of elastomeric sutures by radiofrequency glow discharge deposited coatings.

    PubMed

    Griesser, H J; Chatelier, R C; Martin, C; Vasic, Z R; Gengenbach, T R; Jessup, G

    2000-01-01

    Fine elastomeric sutures intended for cardiovascular surgery can exhibit "stick-slip" behavior as they are pulled through tissue; the resulting oscillatory force can damage delicate tissue or cause sutures to snap. To eliminate this undesirable effect, sutures were surface-modified using a radiofrequency glow discharge in a vapor of either hexamethyldisiloxane or hexamethyldisilazane, to produce a thin polymeric coating on the suture. The same coatings were also deposited onto aluminized tape to facilitate their characterization by measurement of air/water contact angles and by X-ray photoelectron spectroscopy. Coatings from both monomers were found to be very hydrophobic. The hexamethyldisiloxane glow discharge coatings underwent negligible oxidation when stored in air, and thus remained stable over a shelf-life period akin to what may be required of sutures. The hexamethyldisilazane glow discharge coatings, in contrast, incorporated substantial amounts of oxygen over a 3-month period. The coatings did not measurably alter the tensile properties of the sutures. The frictional properties of coated sutures were assessed by measuring the dynamic friction between the suture and ovine myocardium. Both coatings were effective in removing the inherent stick-slip behavior of polybutester sutures in this model. The coatings remained intact after several passes and proved to be robust and efficacious under various strain regimes. PMID:10813763

  18. Barbed Suture as a Treatment Approach in Complex Degloving Injuries.

    PubMed

    Boudreault, David Jean-Guy; Lance, Sam H; Garcia, Jesus A

    2016-05-01

    In the late 19th century, French physician Morel-Lavallée was challenged with a group of patients who sustained similar patterns of degloving injuries, which today carry his eponym. In 1853, he reported a series of cases as well as proposed strategies for the management of these complex degloving injuries. Treatment strategies have not varied significantly over the years, and these lesions continue to plague surgeons today with failure rates in excess of 50%. We present 2 case series using barbed suture in the management of these complex injuries. PMID:26954732

  19. Revascularization alone or combined with suture annuloplasty for ischemic mitral regurgitation. Evaluation by color Doppler echocardiography.

    PubMed Central

    Czer, L S; Maurer, G; Bolger, A F; DeRobertis, M; Chaux, A; Matloff, J M

    1996-01-01

    To determine the effectiveness of revascularization alone or combined with mitral valve repair for ischemic mitral regurgitation, we performed color Doppler echocardiography intraoperatively before and after cardiopulmonary bypass in 49 patients (mean age, 70 +/- 9 years) with concomitant mitral regurgitation and coronary artery disease (triple vessel or left main in 88%; prior infarction in 90%). After revascularization alone (n = 25), the mitral annulus diameter (2.88 +/- 0.44 cm vs 2.88 +/- 0.44 cm), leaflet-to-annulus ratio (1.44 +/- 0.30 vs 1.44 +/- 0.29), and mitral regurgitation grade (1.7 +/- 0.9 vs 1.8 +/- 0.7) remained unchanged (p = NS, postpump vs prepump); mitral regurgitation decreased by 2 grades in only 1 patient (4%). After combined revascularization and mitral valve suture annuloplasty (Kay-Zubiate; n = 24), the annulus diameter decreased (to 2.57 +/- 0.45 cm from 3.11 +/- 0.43 cm), the leaflet-to-annulus ratio increased (to 1.46 +/- 0.25 from 1.20 +/- 0.21), and the mitral regurgitation grade decreased significantly (to 0.9 +/- 0.9 from 2.8 +/- 1.0) (p < 0.01); mitral regurgitation decreased by 2 grades or more (successful repair) in 75%. The origin of the jet correlated with the site of prior infarction (p < 0.05), being inferior in cases of posterior or inferior infarction (67%), and central or broad in cases of combined anterior and inferior infarction (70%). Despite a slightly higher 30-day mortality in the repair group (p = 0.10), there was no significant difference in survival between the 2 surgical groups at 5 years or 8 years. Therefore, in this study of patients with mitral regurgitation and coronary artery disease, reduction in regurgitation grade with revascularization alone was infrequent. Concomitant suture annuloplasty significantly reduced regurgitation by reestablishing a more normal relationship between the leaflet and annulus sizes. The failure rate after suture annuloplasty was 25%; alternative repair techniques such as ring

  20. Suture of a stab wound of the heart.

    PubMed

    Ellis, Harold

    2015-01-01

    Over many centuries, from the early writings of Galen, 'the father of Medicine', wounds of the heart were considered fatal and outside the remit of surgery. With the advent of anaesthesia, (ether was introduced by William Morton in 1846) and of antiseptic surgery, (Joseph Lister's first publication was in 1867), there was an explosion in the surgery of the abdominal cavity, the chest, the skull and the limbs, yet the heart was considered by the surgical fraternity to be the 'no-go' area of the body. Theodor Billroth, Professor of Surgery in Vienna and himself a pioneer of modern surgery, (he performed the first successful partial gastrectomy for carcinoma of the stomach in 1881), wrote "the surgeon who would attempt to suture a wound of the heart should lose the respect of his colleagues". In London, Stephen Paget, in 1896, wrote: "No new method and no new discovery can overcome the natural difficulties that attend a wound of the heart. It is true that suture has been vaguely proposed as a possible procedure and has been done in animals but I cannot find that it has ever been attempted in practice". (In fact, the heart is an amazingly tough and efficient pump that goes on working, year after year, without ever stopping for a service!). PMID:26309960

  1. Suture of new and old peripheral meniscus tears.

    PubMed

    Hamberg, P; Gillquist, J; Lysholm, J

    1983-02-01

    A prospective study of repaired vertical peripheral tears of the meniscus in fifty patients (nine women and forty-one men) was carried out from January 1977 to June 1980. All tears were confirmed preoperatively by arthroscopy. Forty-three medial and seven lateral menisci were repaired. Fifteen tears were treated within two weeks and thirty-five were operated on as long as seven years after injury. Only eight patients had a meniscal tear that was not accompanied by injuries of either the anterior cruciate ligament or the collateral ligaments, or both. At a mean follow-up of eighteen months (range, six to thirty-nine months), forty-two patients (84 per cent) had clinically apparent healing of the sutured meniscal tear. Repeat arthroscopy was done in twenty-seven (64 per cent) of these patients, four to twenty-nine months (mean, twelve months) after the operation. The arthroscopy proved that all of these repaired tears had healed. Eight patients had a second tear after the initial repair: four were reruptures at the sutured area and four were new ruptures in another area of the meniscus and were associated with fresh trauma. All of these patients subsequently had an arthroscopic meniscectomy.

  2. Stapler suture of the pharynx after total laryngectomy.

    PubMed

    Dedivitis, R A; Aires, F T; Pfuetzenreiter, E G; Castro, M A F; Guimarães, A V

    2014-04-01

    The use of a stapler for pharyngeal closure during total laryngectomy was first described in 1971. It provides rapid watertight closure without surgical field contamination. The objective of our study was to compare the incidence of pharyngocutaneous fistula after total laryngectomy with manual and mechanical closures of the pharynx. This was a non-randomised, prospective clinical study conducted at two tertiary medical centres from 1996 to 2011 including consecutive patients with laryngeal tumours who underwent total laryngectomy. We compared the incidence of pharyngocutaneous fistula between two groups of patients: in 20 patients, 75 mm linear stapler closure was applied, whereas in 67 patients a manual suture was used. Clinical data were compared between groups. The groups were statistically similar in terms of gender, age, diabetes mellitus, smoking and alcohol consumption and tumour site. The group of patients who underwent stapler-assisted pharyngeal closure had a higher number of patients with previous tracheotomy (p < 0.001) and previous chemoradiation (p < 0.001). The incidence of pharyngocutaneous fistula was 30% in the mechanical closure group and 20.9% in the manual suture group (p = 0.42). In conclusion the use of the stapler does not increase the rate of fistulae.

  3. Antibacterial Surgical Silk Sutures Using a High-Performance Slow-Release Carrier Coating System.

    PubMed

    Chen, Xiaojie; Hou, Dandan; Wang, Lu; Zhang, Qian; Zou, Jiahan; Sun, Gang

    2015-10-14

    Sutures are a vital part for surgical operation, and suture-associated surgical site infections are an important issue of postoperative care. Antibacterial sutures have been proved to reduce challenging complications caused by bacterial infections. In recent decades, triclosan-free sutures have been on their way to commercialization. Alternative antibacterial substances are becoming relevant to processing surgical suture materials. Most of the antibacterial substances are loaded directly on sutures by dipping or coating methods. The aim of this study was to optimize novel antibacterial braided silk sutures based on levofloxacin hydrochloride and poly(ε-caprolactone) by two different processing sequences, to achieve suture materials with slow-release antibacterial efficacy and ideal physical and handling properties. Silk strands were processed into sutures on a circular braiding machine, and antibacterial treatment was introduced alternatively before or after braiding by two-dipping-two-rolling method (M1 group and M2 group). The antibacterial activity and durability against Staphylococcus aureus and Escherichia coli were tested. Drug release profiles were measured in phosphate buffer with different pH values, and release kinetics model was built to analyze the sustained drug release mechanism between the interface of biomaterials and the in vitro aqueous environment. Knot-pull tensile strength, thread-to-thread friction, and bending stiffness were determined to evaluate physical and handling properties of sutures. All coated sutures showed continuous antibacterial efficacy and slow drug release features for more than 5 days. Besides, treated sutures fulfilled U.S. Pharmacopoeia required knot-pull tensile strength. The thread-to-thread friction and bending stiffness for the M1 group changed slightly when compared with those of uncoated ones. However, physical and handling characteristics of the M2 group tend to approach those of monofilament ones. The novel suture

  4. Antibacterial Surgical Silk Sutures Using a High-Performance Slow-Release Carrier Coating System.

    PubMed

    Chen, Xiaojie; Hou, Dandan; Wang, Lu; Zhang, Qian; Zou, Jiahan; Sun, Gang

    2015-10-14

    Sutures are a vital part for surgical operation, and suture-associated surgical site infections are an important issue of postoperative care. Antibacterial sutures have been proved to reduce challenging complications caused by bacterial infections. In recent decades, triclosan-free sutures have been on their way to commercialization. Alternative antibacterial substances are becoming relevant to processing surgical suture materials. Most of the antibacterial substances are loaded directly on sutures by dipping or coating methods. The aim of this study was to optimize novel antibacterial braided silk sutures based on levofloxacin hydrochloride and poly(ε-caprolactone) by two different processing sequences, to achieve suture materials with slow-release antibacterial efficacy and ideal physical and handling properties. Silk strands were processed into sutures on a circular braiding machine, and antibacterial treatment was introduced alternatively before or after braiding by two-dipping-two-rolling method (M1 group and M2 group). The antibacterial activity and durability against Staphylococcus aureus and Escherichia coli were tested. Drug release profiles were measured in phosphate buffer with different pH values, and release kinetics model was built to analyze the sustained drug release mechanism between the interface of biomaterials and the in vitro aqueous environment. Knot-pull tensile strength, thread-to-thread friction, and bending stiffness were determined to evaluate physical and handling properties of sutures. All coated sutures showed continuous antibacterial efficacy and slow drug release features for more than 5 days. Besides, treated sutures fulfilled U.S. Pharmacopoeia required knot-pull tensile strength. The thread-to-thread friction and bending stiffness for the M1 group changed slightly when compared with those of uncoated ones. However, physical and handling characteristics of the M2 group tend to approach those of monofilament ones. The novel suture

  5. New insights into the relationship between suture closure and craniofacial dysmorphology in sagittal nonsyndromic craniosynostosis

    PubMed Central

    Heuzé, Yann; Boyadjiev, Simeon A; Marsh, Jeffrey L; Kane, Alex A; Cherkez, Elijah; Boggan, James E; Richtsmeier, Joan T

    2010-01-01

    Premature closure of the sagittal suture occurs as an isolated (nonsyndromic) birth defect or as a syndromic anomaly in combination with other congenital dysmorphologies. The genetic causes of sagittal nonsyndromic craniosynostosis (NSC) remain unknown. Although variation of the dysmorphic (scaphocephaly) skull shape of sagittal NSC cases has been acknowledged, this variation has not been quantitatively studied three-dimensionally (3D). We have analyzed the computed tomography skull images of 43 infants (aged 0.9–9 months) with sagittal NSC using anatomical landmarks and semilandmarks to quantify and characterize the within-sample phenotypic variation. Suture closure patterns were defined by dividing the sagittal suture into three sections (anterior, central, posterior) and coding each section as ‘closed’ or ‘fused’. Principal components analysis of the Procrustes shape coordinates representing the skull shape of 43 cases of NSC did not separate individuals by sex, chronological age, or dental stages of the deciduous maxillary first molar. However, analysis of suture closure pattern allowed separation of these data. The central section of the sagittal suture appears to be the first to fuse. Then, at least two different developmental paths towards complete fusion of the sagittal suture exist; either the anterior section or the posterior section is the second to fuse. Results indicate that according to the sequence of sagittal suture closure patterns, different craniofacial complex shapes are observed. The relationship between craniofacial shape and suture closure indicates not only which suture fused prematurely (in our case the sagittal suture), but also the pattern of the suture closure. Whether these patterns indicate differences in etiology cannot be determined with our data and requires analysis of longitudinal data, most appropriately of animal models where prenatal conditions can be monitored. PMID:20572900

  6. Revisiting the Variscan transpressional tectonics in the Southwestern Iberian suture

    NASA Astrophysics Data System (ADS)

    Pérez Cáceres, Irene; Martínez Poyatos, David; Simancas, José Fernando; Azor, Antonio

    2014-05-01

    The boundary between the Ossa-Morena Zone (OMZ) and the South Portuguese Zone (SPZ) in southwest Iberia is a Variscan collisional suture with transpressive left-lateral kinematics, contrasting with the dextral component that characterizes most of the Variscan convergence in other regions of the Orogen. Recent work including new structural and radiometric data has improved our knowledge on the geometry and timing of deformations affecting the OMZ/SPZ suture, which can be summarized as follows: Closure of the Rheic Ocean in Late Devonian time is attested by high-pressure and ophiolitic thin allochthonous units emplaced on the southern border of the OMZ. The kinematic interpretation of early stretching lineations and tectonic fabrics indicate that these units were emplaced in a tectonic regime of oblique left-lateral convergence. Transient transtension in Early Carboniferous time gave way to a narrow aisle of newly-formed oceanic-like crust just over the foregoing Rheic Ocean suture, accompanied by mafic magmatism intruded/extruded at both continental sides. Radiometric dating has yielded the same age of around 340 Ma for the oceanic-like mafic protholiths and their granulite/amphibolite facies tectonic fabric, thus indicating the very ephemeral life of the oceanic-like strip. Oblique convergence was resumed immediately after transtension, first causing northward obduction of the oceanic-like unit and north-verging folding in metasedimentary units of the southern border of the suture. Later on, a south-vergent regional fold was developed synchronous with left-lateral granulite-amphibolite facies shearing. Finally, shear deformation gave way to a low pitch stretching lineation, thrusting the OMZ over SPZ, concentrated on the southern limb of this regional fold and constituting a complex ductile 2-3 km-thick shear band evolving from amphibolite to greenschist facies, developing: (i) high-temperature greenschists at the southern border of the mafic oceanic-like unit

  7. Effect of a Disposable Automated Suturing Device on Cost and Operating Room Time in Benign Total Laparoscopic Hysterectomy Procedures

    PubMed Central

    Hashemi, Lobat; Sobolewski, Craig J.

    2013-01-01

    Background and Objectives: To determine the effect of a disposable automated laparoscopic suturing device, the Endo Stitch (ES) (Covidien, Mansfield, MA, USA), on hospital cost and surgical time in patients undergoing a benign total laparoscopic hysterectomy procedure compared with the use of the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) or traditional laparoscopic suturing technique. Methods: The Premier Perspective Database (Premier, Charlotte, NC, USA) was used to identify all inpatient hospital discharges with the primary procedure of a total laparoscopic hysterectomy (International Classification of Diseases, Ninth Revision, Clinical Modification code 68.41) for benign conditions between January 1, 2009, and June 30, 2011. Patients were further categorized into 3 groups: (1) those for whom the ES was used during the laparoscopic hysterectomy procedure, (2) those for whom robotic assistance (RA) was used, and (3) those for whom neither ES nor RA (NER) was used. Multivariate analysis was performed to examine the association among the ES, RA, and NER groups with respect to hospital cost, length of stay, and surgery time. The multivariate analysis controlled for the patient's age, race, severity of illness, and comorbid conditions, as well as hospital characteristics, such as bed size, region, and teaching status. Results: A total of 9308 patients undergoing an inpatient total laparoscopic hysterectomy procedure between January 1, 2009, and June 30, 2011, were eligible for the study. The ES was used in 974 of the patients (10%), RA was used in 3971 (43%), and neither technique was used in 4363 (47%). After adjusting for confounding variables, the mean hospital cost was $1769 (P = .0332) lower, with a 42-minute (P < .001) surgery time savings, for the ES group compared with the RA group. The mean hospitalization cost for the ES group was also $634 (P < .0879) less expensive, with a 21-minute (P = .0131) surgery time savings, compared with

  8. The Importance of Craniofacial Sutures in Biomechanical Finite Element Models of the Domestic Pig

    PubMed Central

    Bright, Jen A.

    2012-01-01

    Craniofacial sutures are a ubiquitous feature of the vertebrate skull. Previous experimental work has shown that bone strain magnitudes and orientations often vary when moving from one bone to another, across a craniofacial suture. This has led to the hypothesis that craniofacial sutures act to modify the strain environment of the skull, possibly as a mode of dissipating high stresses generated during feeding or impact. This study tests the hypothesis that the introduction of craniofacial sutures into finite element (FE) models of a modern domestic pig skull would improve model accuracy compared to a model without sutures. This allowed the mechanical effects of sutures to be assessed in isolation from other confounding variables. These models were also validated against strain gauge data collected from the same specimen ex vivo. The experimental strain data showed notable strain differences between adjacent bones, but this effect was generally not observed in either model. It was found that the inclusion of sutures in finite element models affected strain magnitudes, ratios, orientations and contour patterns, yet contrary to expectations, this did not improve the fit of the model to the experimental data, but resulted in a model that was less accurate. It is demonstrated that the presence or absence of sutures alone is not responsible for the inaccuracies in model strain, and is suggested that variations in local bone material properties, which were not accounted for by the FE models, could instead be responsible for the pattern of results. PMID:22363727

  9. Interactive Virtual Suturing Simulations: Enhancement of Student Learning in Veterinary Medicine

    ERIC Educational Resources Information Center

    Staton, Amy J.; Boyd, Christine B.

    2013-01-01

    This capstone addresses an instructional gap in the Morehead State University Veterinary Technology Program and in other similar programs around the globe. Students do not retain the knowledge needed to proficiently complete suture patterns nor do students receive sufficient instructional time during the year to master each suture pattern that is…

  10. 77 FR 8117 - Medical Devices; Cardiovascular Devices; Classification of the Endovascular Suturing System

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-14

    ... HUMAN SERVICES Food and Drug Administration 21 CFR Part 870 Medical Devices; Cardiovascular Devices; Classification of the Endovascular Suturing System AGENCY: Food and Drug Administration, HHS. ACTION: Final rule. SUMMARY: The Food and Drug Administration (FDA) is classifying the endovascular suturing system into...

  11. Arthroscopic repair of peripheral triangular fibrocartilage complex tears with suture welding: a technical report.

    PubMed

    Badia, Alejandro; Jiménez, Alexis

    2006-10-01

    This report presents a method of arthroscopic repair of the peripheral triangular fibrocartilage complex tears that replaces traditional suture knots with ultrasonic welding of sutures. This will help eliminate potential causes of ulnar-sided wrist discomfort during the postoperative period.

  12. A novel suture retention test for scaffold strength characterization in ophthalmology.

    PubMed

    Küng, Florian; Schubert, Dirk W; Stafiej, Piotr; Kruse, Friedrich E; Fuchsluger, Thomas A

    2016-12-01

    Sutures are a common way to attach scaffolds in patients. For tubular cardiac scaffolds, the 'suture retention strength' is commonly used to evaluate the resistance of a scaffold against the pull-out of a suture. In order to make this quantity accessible for ophthalmological scaffolds the test procedure has been modified in a novel way. Polycaprolactone (PCL) films of different thicknesses and an amniotic membrane (AM) were used for the experiments. Circular samples with a radius of 7mm were taken and a suture was passed through each sample and tied to a loop. The sample was clamped in a tensile tester and a bolt was passed through the loop. The suture was then pulled with a constant deformation rate until pull-out occurred. The suture retention strength, the deformation at the suture retention strength, and the deformation at rupture were determined for each sample. The presented modified suture retention test allows to measure the relevant parameters of samples on the scale of ophthalmological scaffolds in a reproducible way. A comparison between the first data on PCL and AM has been made. PMID:27612789

  13. Evaluation of five different suture materials in the skin of the earthworm (Lumbricus terrestris).

    PubMed

    Salgado, Melissa A; Lewbart, Gregory A; Christian, Larry S; Griffith, Emily H; Law, Jerry McHugh

    2014-01-01

    The purpose of this study was to determine which suture material is the most appropriate for dermal closure of terrestrial annelids. This paper describes the tissue reactions of the earthworm, Lumbricus terrestris, to five different types of suture materials in order to determine which suture material is the most appropriate for dermal closure. Silk, monofilament nylon, polydiaxonone, polyglactin 910, and chromic gut were studied. There was mild to moderate tissue reaction to all five suture materials. In all of the biopsies wound-healing reaction consisted of aggregates of blastemal cells which appeared in various stages of dedifferentiation from the body wall. Inflammatory cells infiltrated the wound sites, reminiscent of the typical foreign body reaction in vertebrates. The results indicate polyglactin 910 would be the best suture material with regards to tissue security and reaction scores. Chromic gut occupies the next position but there were problems with suture security over time. This appears to be the first suture material performance study on a terrestrial invertebrate. The earthworm, Lumbricus terrestris, was chosen for its wide availability, size, and the extensive species knowledge base. The earthworm may prove to be a good surgical/suture model for economically important invertebrates such as mollusks, tunicates, and insect larval stages. PMID:25143875

  14. Mechanical Properties of Cranial Bones and Sutures in 1–2-Year-Old Infants

    PubMed Central

    Wang, Jiawen; Zou, Donghua; Li, Zhengdong; Huang, Ping; Li, Dongri; Shao, Yu; Wang, Huijun; Chen, Yijiu

    2014-01-01

    Background The mechanical properties of 1–2-year-old pediatric cranial bones and sutures and their influential factors were studied to better understand how the pediatric calvarium reacts to loading. Material/Methods Cranial bone and suture specimens were extracted from seven fresh-frozen human infant cadavers (1.5±0.5 years old). Eight specimens were obtained from each subject: two frontal bones, two parietal bones, two sagittal suture samples, and two coronal suture samples. The specimens were tested in a three-point bend setup at 1.5 mm/s. The mechanical properties, such as ultimate stress, elastic modulus, and ultimate strain, were calculated for each specimen. Results The ultimate stress and elastic modulus of the frontal bone were higher than those of the parietal bone (P<0.05). No differences were found between the coronal and sagittal sutures in ultimate stress, elastic modulus, or ultimate strain (P>0.05). The ultimate stress and elastic modulus of the frontal and parietal bones were higher than those of the sagittal and coronal sutures (P<0.05), whereas the opposite ultimate strain findings were revealed (P<0.05). Conclusions There was no significant difference in ultimate stress, elastic modulus, or ultimate strain between the sagittal and coronal sutures. However, there were significant differences in ultimate stress, elastic modulus, and ultimate strain between the frontal and parietal bones as well as between the cranial bones and sutures. PMID:25279966

  15. Bacterial colonization on different suture materials--a potential risk for intraoral dentoalveolar surgery.

    PubMed

    Otten, J-E; Wiedmann-Al-Ahmad, M; Jahnke, H; Pelz, K

    2005-07-01

    In this in vivo and in vitro study on resorbable (Monocryl and nonresorbable (Deknalon) monofilament sutures used in intraoral dentoalveolar surgery the bacterial colonization was compared. For the in vivo study the sutures were applied in 11 patients during dental surgery. Eight days postoperative the sutures were removed and the adhered bacteria were isolated and identified by biochemistry, morphology, antibiotic susceptibility, and gas chromatography. The colonization was studied by scanning electron microscopy. Aerobic and anaerobic bacteria were isolated in nearly equal colony-forming units (cfu) on each suture. In comparison with Monocryl about 15% more aerobic and anaerobic strains were isolated on Deknalon. Regarding the pathogens only, about three times more anaerobic strains were isolated on both sutures in total. Additionally, more pathogens were found on Deknalon than on Monocryl (aerobic >40%, anaerobic >25%). The variety of bacteria correspond with purulent infections, not with normal oral flora. Intraindividual comparisons of cfu showed differences in dependence of the patient as described for subgingivale plaques. For the in vitro study the sutures were incubated with Streptococcus intermedius and Prevotella intermedia for 0.5 h. Scanning electron microscopy was performed to examine qualitatively the level of bacterial adherence. After 0.5 h the bacteria adhered very well. The colonization rate of Streptococcus intermedius on both sutures was similar. Coccoid bacteria within biofilms were seen. The growth of Prevotella intermedia was much better on Deknalon than on Monocryl. The risk of bacteremia at the time of suture removal is discussed.

  16. A mathematical model for mechanotransduction at the early steps of suture formation

    PubMed Central

    Khonsari, R. H.; Olivier, J.; Vigneaux, P.; Sanchez, S.; Tafforeau, P.; Ahlberg, P. E.; Di Rocco, F.; Bresch, D.; Corre, P.; Ohazama, A.; Sharpe, P. T.; Calvez, V.

    2013-01-01

    Growth and patterning of craniofacial sutures is subjected to the effects of mechanical stress. Mechanotransduction processes occurring at the margins of the sutures are not precisely understood. Here, we propose a simple theoretical model based on the orientation of collagen fibres within the suture in response to local stress. We demonstrate that fibre alignment generates an instability leading to the emergence of interdigitations. We confirm the appearance of this instability both analytically and numerically. To support our model, we use histology and synchrotron X-ray microtomography and reveal the fine structure of fibres within the sutural mesenchyme and their insertion into the bone. Furthermore, using a mouse model with impaired mechanotransduction, we show that the architecture of sutures is disturbed when forces are not interpreted properly. Finally, by studying the structure of sutures in the mouse, the rat, an actinopterygian (Polypterus bichir) and a placoderm (Compagopiscis croucheri), we show that bone deposition patterns during dermal bone growth are conserved within jawed vertebrates. In total, these results support the role of mechanical constraints in the growth and patterning of craniofacial sutures, a process that was probably effective at the emergence of gnathostomes, and provide new directions for the understanding of normal and pathological suture fusion. PMID:23516237

  17. Responses of intramembranous bone and sutures upon in vivo cyclic tensile and compressive loading.

    PubMed

    Peptan, Alexandra I; Lopez, Aurora; Kopher, Ross A; Mao, Jeremy J

    2008-02-01

    Cranial vault and facial sutures interpose between mineralized bones of the skull, and may function analogously to appendicular and cranial base growth plates. However, unlike growth plates that are composed of chondrocyte lineage, cranial and facial sutures possess heterogeneous cell lineages such as mesenchymal cells, fibroblasts, and osteoblasts, in addition to vascular-derived cells. Despite recently intensified effort, the biological responses of intramembranous bone and sutures to mechanical loading are not well understood. This study was designed to investigate whether brief doses of tensile or compressive forces induce modeling and growth responses of intramembranous bone and sutures. In different groups of growing rabbits in vivo, cyclic tensile or compressive forces at 1 N and 8 Hz were applied to the maxilla for 20 min/day over 12 consecutive days. Computerized histomorphometric analyses revealed that the average sutural widths of both the premaxillomaxillary suture (PMS) and nasofrontal suture (NFS) loaded in either tension or compression were significantly higher than age- and sex-matched sham controls (P<0.01). The average cell densities of tension- or compression-loaded PMS and NFS were significantly higher than sham controls (P<0.01). The average osteoblast occupied sutural bone surface loaded under tension was significantly higher than that of sham control (P<0.05). Interestingly, tensile loading significantly reduced the average osteoclast surface, in comparison to sham control (P<0.05). For the NFS, tensile loading significantly increased the average osteoblast occupied sutural bone surface, in comparison with that of sham control (P<0.05). Also for the NFS suture, compression significantly reduced the average sutural osteoclast surface in comparison with sham control (P<0.05). Taken together, the present data suggest that high-frequency cyclic forces in either tension or compression induce modeling and growth changes in cranial sutures. Due to

  18. Complications and pregnancy outcome following uterine compression suture for postpartum haemorrhage: a single centre experience.

    PubMed

    Liu, S; Mathur, M; Tagore, S

    2014-07-01

    In the treatment of postpartum haemorrhage from uterine atony, uterine compression sutures, such as the B-Lynch suture and its modifications have a role with the advantage of preservation of the uterus for fertility. There is however, a risk that apposition of the anterior and posterior walls of the uterus will impede drainage of lochia, resulting in undesirable complications. We undertook a five-year retrospective study of all women who underwent uterine compression sutures at the KK Women's and Children's Hospital, between 2008 and 2012. In total, 23 women had uterine compression sutures during the study period, of which, nineteen women managed to conserve their uterus. Our complication rate was 25%, which included persistent vaginal discharge, pyometra and endometritis. There were three conceptions, with two successful pregnancies. Our study shows uterine compression suture to be a safe and effective alternative to avoid hysterectomy with preservation of fertility at the time of major postpartum haemorrhage. The outcome of subsequent pregnancies is reassuring.

  19. Effects of myrrh on the strength of suture materials: an in vitro study.

    PubMed

    Alshehri, Mohammed A; Baskaradoss, Jagan Kumar; Geevarghese, Amrita; Ramakrishnaiah, Ravikumar; Tatakis, Dimitris N

    2015-01-01

    The present in vitro study sought to determine the effects of myrrh-containing solutions on common suture materials used in periodontal surgery. Three commonly used suture materials (silk, polyglactin 910, polytetrafluoroethylene) were immersed in four thermostatically controlled experimental media to simulate daily oral rinsing activity, namely -artificial saliva, normal saline solution with 0.2% Commiphora myrrh, full-concentration (100%) Commiphora myrrh oil, and a myrrh-containing commercial mouthwash. Tensile strength was measured at the end of each day using an Instron tensile testing machine. Silk sutures were susceptible to tensile strength loss when exposed to 0.2% myrrh solution once daily for 5 days. Myrrh-containing commercial mouthwash had no effect on tensile strength, but all three suture materials lost tensile strength when exposed to 100% myrrh oil. For patients that routinely use myrrh mouthwashes postoperatively, findings of this study suggested that silk sutures might not be the optimal material choice. PMID:25736257

  20. Small bowel obstruction from barbed suture following laparoscopic myomectomy—A case report

    PubMed Central

    Lee, Eric Tat Choi; Wong, Felix Wu Shun

    2015-01-01

    Myomectomy is commonly performed for symptomatic fibroids in women who wish to conserve fertility. Laparoscopic myomectomy provides advantages as a minimally invasive procedure. To facilitate the closure of the uterine wound after enucleation of the fibroid, barbed sutures have been introduced as they can shorten the operative time and reduce the amount of bleeding. However, the use of barbed suture is not without risk. There were a few reports on the risks of barbed sutures in the literature. We report herein a case of acute abdomen because of small bowel entrapment and obstruction following the use of barbed suture in laparoscopic myomectomy. Surgeons using barbed suture in myomectomy should be vigilant on the possibility of this bowel complication whenever adverse clinical situation arises as the outcome could be serious if the condition was left unchecked. PMID:26454501

  1. Celastrol nanoparticles inhibit corneal neovascularization induced by suturing in rats

    PubMed Central

    Li, Zhanrong; Yao, Lin; Li, Jingguo; Zhang, Wenxin; Wu, Xianghua; Liu, Yi; Lin, Miaoli; Su, Wenru; Li, Yongping; Liang, Dan

    2012-01-01

    Purpose Celastrol, a traditional Chinese medicine, is widely used in anti-inflammation and anti-angiogenesis research. However, the poor water solubility of celastrol restricts its further application. This paper aims to study the effect of celastrol nanoparticles (CNPs) on corneal neovascularization (CNV) and determine the possible mechanism. Methods To improve the hydrophilicity of celastrol, celastrol-loaded poly(ethylene glycol)-block-poly(ɛ-caprolactone) nanopolymeric micelles were developed. The characterization of CNPs was measured by dynamic light scattering and transmission electron microscopy analysis. Celastrol loading content and release were assessed by ultraviolet-visible analysis and high performance liquid chromatography, respectively. In vitro, human umbilical vein endothelial cell proliferation and capillary-like tube formation were assayed. In vivo, suture-induced CNV was chosen to evaluate the effect of CNPs on CNV in rats. Immunohistochemistry for CD68 assessed the macrophage infiltration of the cornea on day 6 after surgery. Real-time quantitative reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay were used to evaluate the messenger ribonucleic acid and protein levels, respectively, of vascular endothelial growth factor, matrix metalloproteinase 9, and monocyte chemoattractant protein 1 in the cornea. Results The mean diameter of CNPs with spherical shape was 48 nm. The celastrol loading content was 7.36%. The release behavior of CNPs in buffered solution (pH 7.4) showed a typical two-phase release profile. CNPs inhibited the proliferation of human umbilical vein endothelial cells in a dose-independent manner and suppressed the capillary structure formation. After treatment with CNPs, the length and area of CNV reduced from 1.16 ± 0.18 mm to 0.49 ± 0.12 mm and from 7.71 ± 0.94 mm2 to 2.29 ± 0.61 mm2, respectively. Macrophage infiltration decreased significantly in the CNP-treated corneas. CNPs reduced

  2. Three-dimensional densitometric analysis of maxillary sutural changes induced by rapid maxillary expansion

    PubMed Central

    Lione, R; Franchi, L; Fanucci, E; Laganà, G; Cozza, P

    2013-01-01

    Objective: This prospective study evaluated the density of the midpalatal and transverse sutures as assessed by low-dose CT before rapid maxillary expansion (T0), at the end of active expansion (T1) and after a retention period of 6 months (T2). Methods: The study sample comprised 17 pre-pubertal subjects (mean age 11.2 years) with constricted maxillary arches. Total amount of expansion was 7 mm in all subjects. Multislice low-dose CT scans were taken at T0, T1 and T2. On the axial CT scanned images six regions of interest (ROIs) were placed along the midpalatal and transverse sutures and two in maxillary and palatal bony areas. Density was measured in Hounsfield units. Mann–Whitney U test and Friedman analysis of variance with post hoc tests were used (p < 0.05). Results: The three ROIs in the midpalatal suture showed a significant decrease in density from T0 to T1, a significant increase from T1 to T2 and a lack of statistically significant differences from T0 to T2. Both ROIs located in the transverse suture showed a significant decrease in density from T0 to T1, followed by a non-significant increase in density from T1 to T2. Conclusions: At the end of the active phase of expansion a significant reduction in density along the midpalatal and transverse sutures was observed in all subjects. The sutural density of the midpalatal suture at T2 indicated reorganization of the midpalatal suture while the density along the transverse suture increased without reaching the pre-treatment values, possibly due to different morphology between midpalatal and transverse sutures. PMID:22996394

  3. Microbiology of Explanted Suture Segments from Infected and Noninfected Surgical Patients

    PubMed Central

    Krepel, Candace J.; Marks, Richard M.; Rossi, Peter J.; Sanger, James; Goldblatt, Matthew; Graham, Mary Beth; Rothenburger, Stephen; Collier, John; Seabrook, Gary R.

    2013-01-01

    Sutures under selective host/environmental factors can potentiate postoperative surgical site infection (SSI). The present investigation characterized microbial recovery and biofilm formation from explanted absorbable (AB) and nonabsorbable (NAB) sutures from infected and noninfected sites. AB and NAB sutures were harvested from noninfected (70.9%) and infected (29.1%) sites in 158 patients. At explantation, devices were sonicated and processed for qualitative/quantitative bacteriology; selective sutures were processed for scanning electron microscopy (SEM). Bacteria were recovered from 85 (53.8%) explanted sites; 39 sites were noninfected, and 46 were infected. Suture recovery ranged from 11.1 to 574.6 days postinsertion. A significant difference in mean microbial recovery between noninfected (1.2 isolates) and infected (2.7 isolates) devices (P < 0.05) was noted. Staphylococcus epidermidis, Staphylococcus aureus, coagulase-negative staphylococci (CNS), Peptostreptococcus spp., Bacteroides fragilis, Escherichia coli, Enterococcus spp., Pseudomonas aeruginosa, and Serratia spp. were recovered from infected devices, while commensal skin flora was recovered from noninfected devices. No significant difference in quantitative microbial recovery between infected monofilament and multifilament sutures was noted. Biofilm was present in 100% and 66.6% of infected and noninfected devices, respectively (P < 0.042). We conclude that both monofilament and braided sutures provide a hospitable surface for microbial adherence: (i) a significant difference in microbial recovery from infected and noninfected sutures was noted, (ii) infected sutures harbored a mixed flora, including multidrug-resistant health care-associated pathogens, and (iii) a significant difference in the presence or absence of a biofilm in infected versus noninfected explanted devices was noted. Further studies to document the benefit of focused risk reduction strategies to minimize suture contamination and

  4. HOSPITALIZATION TIME AFTER OPEN APPENDECTOMY BY THREE DIFFERENT SURGICAL TECHNIQUES

    PubMed Central

    XIMENES, Agláia Moreira Garcia; MELLO, Fernando Salvo Torres; de LIMA-JÚNIOR, Zailton Bezerra; FERREIRA, Cícero Faustino; CAVALCANTI, Amanda Dantas Ferreira; DIAS-FILHO, Adalberto Vieira

    2014-01-01

    Background The choice of surgical technique to approach the appendicular stump depends mostly on skill and personal preference of the surgeon or on the protocol used in the service, and the influence of this choice in hospitalization time is not evaluated. Aim To evaluate the relation between surgical technique and postoperative hospitalization time in patients presenting with acute appendicitis. Methods Retrospective analysis of 180 patients who underwent open appendectomy. These where divided into three groups according to surgical technique: conventional appendectomy (simple ligation of the stump), tobacco pouch suture and Parker-Kerr suture. Data where crossed with hospitalization time (until three days, from four to six days and over seven days). Results A hundred and eighty patients with age from 15 to 85 years where included. From these, 95 underwent conventional technique, had an average hospitalization time of 3,9 days and seven had complications (surgical site infection, seroma, suture dehiscence and evisceration). In 67 patients, tobacco pouch suture was chosen and had average hospitalization time of 3,7 days and two complications (infection and seroma). In 18 Parker-Kerr suture was made, with average hospitalization time of 2,6 days, with no complication. Contingency coefficient between the variables hospitalization time and technique was 0,255 and Cramér's V was 0,186. Conclusion There was tendency to larger hospitalization time and larger number of complications in conventional appendectomy, whereas in patients where Parker-Kerr suture was performed, hospitalization time was significantly smaller. PMID:25184769

  5. Virtual reality thread simulation for laparoscopic suturing training.

    PubMed

    Figueras Sola, Pablo J; Rodriguez Bescós, Samuel; Lamata, Pablo; Pagador, J Blas; Sánchez-Margallo, Francisco M; Gómez, Enrique J

    2006-01-01

    The level of realism in virtual reality trainers might not be proportional to its didactic value. As an example, three exercises to train suturing skills are proposed in this article. They use a discrete thread model with a simple but good enough behaviour, and constitute a training means for three laparoscopic skills: (1) Accurate grasping, which trains grasping a precise point in the thread. (2) Coordinated Pulling, which trains tightening the thread co-ordinately and in different space orientations; and (3) Knotting, which allow the surgeon to practice this manoeuvre. These three exercises, found interesting among experts in surgical training, are now being validated in MIS workshops at the Minimally Invasive Surgery Centre of Cáceres (Spain).

  6. Arthroscopic-Assisted Management of Unstable Distal-Third Clavicle Fractures: Conoid Ligament Reconstruction and Fracture Cerclage With Sutures

    PubMed Central

    Cisneros, Luis Natera; Reiriz, Juan Sarasquete

    2015-01-01

    Surgical treatment is usually indicated for the management of Neer type IIB fractures of the distal third of the clavicle. These unstable injuries have shown a rate of nonunion that oscillates around 30% to 45% when managed conservatively, and surgical strategies often require a second operation for implant removal. We describe an arthroscopic-assisted technique for the treatment of Neer type IIB unstable distal-third clavicle fractures that overcomes the issues related to open surgery, metal hardware, and implant irritation. This technique increases the load to failure of the construct by means of adding a synthetic conoid ligament reconstruction with a nonrigid suspension device, and it allows the diagnosis and treatment of associated glenohumeral injuries. Our technique incorporates a fracture interfragmentary fixation with sutures, thus avoiding a second operation for implant removal. PMID:26870642

  7. Enhanced Zone II Flexor Tendon Repair through a New Half Hitch Loop Suture Configuration

    PubMed Central

    Thomopoulos, Stavros; Gelberman, Richard H.

    2016-01-01

    This study evaluated the impact of a new half hitch loop suture configuration on flexor tendon repair mechanics. Cadaver canine flexor digitorum profundus tendons were repaired with 4- or 8-strands, 4–0 or 3–0 suture, with and without half hitch loops. An additional group underwent repair with half hitch loops but without the terminal knot. Half hitch loops improved the strength of 8-strand repairs by 21% when 4–0, and 33% when 3–0 suture was used, and caused a shift in failure mode from suture pullout to suture breakage. 8-strand repairs with half hitch loops but without a terminal knot produced equivalent mechanical properties to those without half hitch loops but with a terminal knot. 4-strand repairs were limited by the strength of the suture in all groups and, as a result, the presence of half hitch loops did not alter the mechanical properties. Overall, half hitch loops improved repair mechanics, allowing failure strength to reach the full capability of suture strength. Improving the mechanical properties of flexor tendon repair with half hitch loops has the potential to reduce the postoperative risk of gap formation and catastrophic rupture in the early postoperative period. PMID:27101409

  8. Development of silver nano-coatings on silk sutures as a novel approach against surgical infections.

    PubMed

    De Simone, S; Gallo, A L; Paladini, F; Sannino, A; Pollini, M

    2014-09-01

    The infections give rise to a range of clinical problems and prolong hospitalization with increased healthcare costs. Moreover, persistent infections exasperate the problem of antibiotic resistance. The aim of this study was the development of effective and low-cost antibacterial silver coatings on surgical sutures by adopting an innovative photochemical deposition process to prevent early contamination of surgical wounds. The silver deposition technology adopted in this work is an innovative process based on the in situ photoreduction of a silver solution. The samples were dipped in the silver solution and then exposed to UV radiation in order to induce the synthesis of silver clusters on the surface of the suture. The homogeneous distribution of silver particles on the surface and on the cross-section of the treated sutures was demonstrated. All the antibacterial studies clearly demonstrated that the use of novel silver treated sutures could represent clinical advantages in terms of the prevention of surgical infections against bacterial colonization. The silver coating deposited on the sutures demonstrated no cytotoxic effect on a selected cell population. The results obtained suggested that the antibacterial silver-coated sutures developed in this work could represent an interesting alternative to conventional sutures, with evident advantages in terms of prevention of the surgical infections and on the health costs. In addiction, very low concentrations of silver significantly inhibited the microbial load, without affecting the cell viability. PMID:24997984

  9. The role of graft materials in suture augmentation for tendon repairs and reattachment.

    PubMed

    Kummer, Frederick J; Iesaka, Kazuho

    2005-08-01

    Various biomaterials have been used to augment sutures for the repair and reattachment of tendons. This study examined four different graft materials in a simple and reproducible model using chicken Achilles tendons to determine the strength and mechanism of suture reinforcement of tendon repairs. The graft materials tested were Gore-Tex(R) Soft Tissue Patch, Graftjacket, bovine pericardium, and an experimental graft material from Xylos Corporation. Testing was performed in shear to simulate forces on a torn tendon repair and pull-off to simulate those on a tendon reattachment to bone. Compared to unaugmented suture, grafts increased suture fixation strength from 10% to 60% in shear and from 0% to 36% in pull-off with the bovine pericardium graft, providing significant improvement in both tests. In no cases (even unaugmented) did the suture pull directly through the tendon, but instead sliced along it, demonstrating that the interface between the suture and the tendon determines fixation strength. Grafts function by increasing the area, friction, and nature of this interface, not by acting as a barrier for suture pull-through. PMID:15981174

  10. FGFR2c-mediated ERK-MAPK activity regulates coronal suture development.

    PubMed

    Pfaff, Miles J; Xue, Ke; Li, Li; Horowitz, Mark C; Steinbacher, Derek M; Eswarakumar, Jacob V P

    2016-07-15

    Fibroblast growth factor receptor 2 (FGFR2) signaling is critical for proper craniofacial development. A gain-of-function mutation in the 2c splice variant of the receptor's gene is associated with Crouzon syndrome, which is characterized by craniosynostosis, the premature fusion of one or more of the cranial vault sutures, leading to craniofacial maldevelopment. Insight into the molecular mechanism of craniosynostosis has identified the ERK-MAPK signaling cascade as a critical regulator of suture patency. The aim of this study is to investigate the role of FGFR2c-induced ERK-MAPK activation in the regulation of coronal suture development. Loss-of-function and gain-of-function Fgfr2c mutant mice have overlapping phenotypes, including coronal synostosis and craniofacial dysmorphia. In vivo analysis of coronal sutures in loss-of-function and gain-of-function models demonstrated fundamentally different pathogenesis underlying coronal suture synostosis. Calvarial osteoblasts from gain-of-function mice demonstrated enhanced osteoblastic function and maturation with concomitant increase in ERK-MAPK activation. In vitro inhibition with the ERK protein inhibitor U0126 mitigated ERK protein activation levels with a concomitant reduction in alkaline phosphatase activity. This study identifies FGFR2c-mediated ERK-MAPK signaling as a key mediator of craniofacial growth and coronal suture development. Furthermore, our results solve the apparent paradox between loss-of-function and gain-of-function FGFR2c mutants with respect to coronal suture synostosis. PMID:27034231

  11. Vessel sealing versus suture ligation for canine ovarian pedicle haemostasis: a randomised clinical trial.

    PubMed

    Schwarzkopf, I; Van Goethem, B; Vandekerckhove, P M; de Rooster, H

    2015-01-31

    Vessel sealing (VS) is well established in laparoscopic ovariectomy (OVE) in dogs. The objectives of this study were to evaluate the efficacy of ovarian pedicle haemostasis by VS using a commercially available VS tool in open OVE and compare it with suture ligation (SL). A prospective, randomised clinical trial including 20 female dogs was designed. Open OVE was performed via a standard mid-line celiotomy by a single surgeon using a standardised protocol. At random, the right ovarian pedicle was sealed (VS) or ligated (SL) whereas the left pedicle was treated by the alternative technique. Surgical times for procedural stages and intra-operative complications were recorded and statistically evaluated. Total surgical time was 29.28±11.13 minutes (range 12.50-62.13 minutes) and time from identification to removal of the ovary was significantly less when sealing (VS 2.22±0.58 minutes) than when ligating (SL 4.10±1.13 minutes P=0.0001). Intra-operative complications were rare for both techniques (failure of the electrode of the VS device (n=3); ovarian pedicle haemorrhage due to ligature slippage (n=1)). The results of the current study indicate that ovarian pedicle haemostasis achieved by VS is significantly faster than by placement of ligatures without appearing to compromise safety.

  12. New Method of Age Estimation from Maxillary Sutures Closure in a Thai Population.

    PubMed

    Sinthubua, A; Theera-Umpon, N; Auephanwiriyakul, S; Ruengdit, S; Das, S; Mahakkanukrauh, P

    2016-01-01

    Age estimation is one of the major components of forensic identification. Cranial suture closure has long been used as indicator for age estimation. Maxillary sutures have been less studied for estimation of age at death because they vary in their timing of closure with age. The purpose of this study was to estimate age by examining 190 Thai skulls with age ranging between 15-93 years from Forensic Osteology Research Center, Faculty of Medicine, and Chiang Mai University. Four parts of maxillary suture (incisive, anterior, transverse, and posterior sutures) were investigated the suture obliteration of each suture by computerizing from photograph. The suture were measured by pixel counting.The prediction model which based on the support vector machine (SVM) for regression or support vector regression (SVR) was utilized for data analysis. The results showed high correlation (R2 = 0.9086) between the predicted age and actual age. Plot between actual age group and predicted age in seven groups also revealed high correlation (R2 = 0.9434). These can be implied that we are able to use this SVR model to predict age at death using maxillary suture information.The interesting issue is to further apply this model in more cases to ensure the generalization of the finding. This study is the first attempt to estimate age at death using a new method based on novel analysis which considers a characteristic of relationship between maxillary suture closures with age that are not in linear form. The present study may contribute as a basis knowledge and method for further study of age estimation in archaeological and forensic anthropological contexts, especially when only skull or base of skull are found. PMID:27212570

  13. A miniature tension sensor to measure surgical suture tension of deformable musculoskeletal tissues during joint motion.

    PubMed

    Kiriyama, Yoshimori; Matsumoto, Hideo; Toyama, Yoshiaki; Nagura, Takeo

    2014-02-01

    The aim of this study was to develop a new suture tension sensor for musculoskeletal soft tissue that shows deformation or movements. The suture tension sensor was 10 mm in size, which was small enough to avoid conflicting with the adjacent sensor. Furthermore, the sensor had good linearity up to a tension of 50 N, which is equivalent to the breaking strength of a size 1 absorbable suture defined by the United States Pharmacopeia. The design and mechanism were analyzed using a finite element model prior to developing the actual sensor. Based on the analysis, adequate material was selected, and the output linearity was confirmed and compared with the simulated result. To evaluate practical application, the incision of the skin and capsule were sutured during simulated total knee arthroplasty. When conventional surgery and minimally invasive surgery were performed, suture tensions were compared. In minimally invasive surgery, the distal portion of the knee was dissected, and the proximal portion of the knee was dissected additionally in conventional surgery. In the skin suturing, the maximum tension was 4.4 N, and this tension was independent of the sensor location. In contrast, the sensor suturing the capsule in the distal portion had a tension of 4.4 N in minimally invasive surgery, while the proximal sensor had a tension of 44 N in conventional surgery. The suture tensions increased nonlinearly and were dependent on the knee flexion angle. Furthermore, the tension changes showed hysteresis. This miniature tension sensor may help establish the optimal suturing method with adequate tension to ensure wound healing and early recovery.

  14. Triclosan-coated sutures and sternal wound infections: a prospective randomized clinical trial.

    PubMed

    Steingrimsson, S; Thimour-Bergström, L; Roman-Emanuel, C; Scherstén, H; Friberg, Ö; Gudbjartsson, T; Jeppsson, A

    2015-12-01

    Surgical site infection is a common complication following cardiac surgery. Triclosan-coated sutures have been shown to reduce the rate of infections in various surgical wounds, including wounds after vein harvesting in coronary artery bypass grafting patients. Our purpose was to compare the rate of infections in sternotomy wounds closed with triclosan-coated or conventional sutures. A total of 357 patients that underwent coronary artery bypass grafting were included in a prospective randomized double-blind single-center study. The patients were randomized to closure of the sternal wound with either triclosan-coated sutures (Vicryl Plus and Monocryl Plus, Ethicon, Inc., Somerville, NJ, USA) (n = 179) or identical sutures without triclosan (n = 178). Patients were followed up after 30 days (clinical visit) and 60 days (telephone interview). The primary endpoint was the prevalence of sternal wound infection according to the Centers for Disease Control and Prevention (CDC) criteria. The demographics in both groups were comparable, including age, gender, body mass index, and rate of diabetes and smoking. Sternal wound infection was diagnosed in 43 patients; 23 (12.8%) sutured with triclosan-coated sutures compared to 20 (11.2%) sutured without triclosan (p = 0.640). Most infections were superficial (n = 36, 10.1%), while 7 (2.0%) were deep sternal wound infections. There were 16 positive cultures in the triclosan group and 17 in the non-coated suture group (p = 0.842). The most commonly identified main pathogens were Staphylococcus aureus (45.4%) and coagulase-negative staphylococci (36.4%). Skin closure with triclosan-coated sutures did not reduce the rate of sternal wound infection after coronary artery bypass grafting. (clinicaltrials.gov: NCT01212315).

  15. Inhibiting the effect of 90Sr-90Y ophthalmic applicators on rat corneal neovascularization induced by sutures

    PubMed Central

    Zhou, Hong-Yan; Wang, Shuang; Zhang, Hong; Wang, Ling; Zhang, Wen-Song

    2016-01-01

    AIM To investigate a practical technique used to inhibit corneal angiogenesis with a 90Sr-90Y ophthalmic applicator. METHODS A 90Sr-90Y ophthalmic applicator was detected with a radioactive nuclide application treatment healthy protection standard. The applicator used was produced through medical dosimetry research; it had a concave applicator add measured the applicator temperature, serviceable humidity range, applicator appearance status, applicator radiation homogeneity, radioautography, and radiological safety of the original applicator surface. A vessel model was established using newborn rats, with sutures around the corneal limbus. Corneal neovascularization (CNV) were observed with a slit lamp. The new vessel length and response area were measured. RESULTS Low-dose radiation can inhibit CNV after corneal sutures. The absorbed dose of the applicator (0.046 Gy/s) was safe for the treatment of it. The lengths of new vessels and the areas of new vessels were lower than the new born vessel rat group (P<0.01). CONCLUSION The optimal radiation dose emitting from the applicator can be safe and potentially used in humans.

  16. Inhibiting the effect of 90Sr-90Y ophthalmic applicators on rat corneal neovascularization induced by sutures

    PubMed Central

    Zhou, Hong-Yan; Wang, Shuang; Zhang, Hong; Wang, Ling; Zhang, Wen-Song

    2016-01-01

    AIM To investigate a practical technique used to inhibit corneal angiogenesis with a 90Sr-90Y ophthalmic applicator. METHODS A 90Sr-90Y ophthalmic applicator was detected with a radioactive nuclide application treatment healthy protection standard. The applicator used was produced through medical dosimetry research; it had a concave applicator add measured the applicator temperature, serviceable humidity range, applicator appearance status, applicator radiation homogeneity, radioautography, and radiological safety of the original applicator surface. A vessel model was established using newborn rats, with sutures around the corneal limbus. Corneal neovascularization (CNV) were observed with a slit lamp. The new vessel length and response area were measured. RESULTS Low-dose radiation can inhibit CNV after corneal sutures. The absorbed dose of the applicator (0.046 Gy/s) was safe for the treatment of it. The lengths of new vessels and the areas of new vessels were lower than the new born vessel rat group (P<0.01). CONCLUSION The optimal radiation dose emitting from the applicator can be safe and potentially used in humans. PMID:27672586

  17. Primary repair of an incomplete unilateral cleft lip: avoiding an elongated lip and achieving a straight suture line.

    PubMed

    Nakajima, T; Yoshimura, Y; Yoneda, K; Nakanishi, Y

    1998-10-01

    The methods designed for the repair of a complete cleft lip should not be used to repair an incomplete cleft lip. This results too often in the postoperative drooping of the white lip on the affected side because in most incomplete cleft lips there is more tissue on the cleft side than in complete cleft lip. We present and discuss the refinements we made in our original technique for complete cleft lip in order to adapt it to incomplete cleft lip repair. The skin design at the white skin roll follows Cronin's method with an incision perpendicular to the vermilion border. The suture that pulls the edges of the angular incisions together pushes on the white skin roll caudally. This ensures that the peak of the Cupid's bow on the cleft side does not droop postoperatively. It also ensures that it does not take on an acute angle and that the vermilion border will be a continuous line without a break. We do not create a triangular flap at the vermilion border, but we raise a triangular flap at the alar base on the cleft side and advance it to the bottom of the columella. This creates the nostril sill and corrects the flared alar base. The resulting suture line is completely straight and runs along the philtral column. In this way, the postoperative elongation of the white lip on the cleft side can be prevented.

  18. Novel retrograde puncture method to establish preperitoneal space for laparoscopic direct inguinal hernia repair with internal ring suturing

    PubMed Central

    Jiang, H.; Ma, R.; Zhang, X.

    2016-01-01

    The aim of this study was to explore the clinical efficacy of a novel retrograde puncture approach to establish a preperitoneal space for laparoscopic direct inguinal hernia repair with inguinal ring suturing. Forty-two patients who underwent laparoscopic inguinal hernia repair with retrograde puncture for preperitoneal space establishment as well as inguinal ring suturing between August 2013 and March 2014 at our hospital were enrolled. Preperitoneal space was successfully established in all patients, with a mean establishment time of 6 min. Laparoscopic repairs were successful in all patients, with a mean surgical time of 26±15.1 min. Mean postoperative hospitalization duration was 3.0±0.7 days. Two patients suffered from postoperative local hematomas, which were relieved after puncturing and drainage. Four patients had short-term local pain. There were no cases of chronic pain. Patients were followed up for 6 months to 1 year, and no recurrence was observed. Our results demonstrate that preperitoneal space established by the retrograde puncture technique can be successfully used in adult laparoscopic hernioplasty to avoid intraoperative mesh fixation, and thus reduce medical costs. PMID:27191609

  19. Glottal configuration, acoustic, and aerodynamic changes induced by variation in suture direction in arytenoid adduction procedures.

    PubMed

    Inagi, Katsuhide; Connor, Nadine P; Suzuki, Tatsutoshi; Ford, Charles N; Bless, Diane M; Nakajima, Masami

    2002-10-01

    Arytenoid adduction is a phonosurgical procedure in which the arytenoid cartilages are approximated to reduce posterior glottal gap size and improve voice. Voice outcomes following arytenoid adduction are not always optimal. The goal of this study was to systematically vary suture direction and force of pull on the arytenoid cartilages in a human excised laryngeal model to determine the optimal combination of factors for reducing glottal gap and improving voice. Several factors demonstrated significant effects. Changes in suture direction and force of pull affected glottal configuration in both the horizontal and vertical planes. Increased force of pull on the muscular process resulted in increased adduction of the vocal process for all suture directions. Changes in suture direction and force of pull also affected acoustic and aerodynamic measures of induced voice. Therefore, voice outcomes can be optimized with arytenoid adduction if the vocal fold plane is accurately adjusted.

  20. Bilateral squamosal suture synostosis: A rare form of isolated craniosynostosis in Crouzon syndrome.

    PubMed

    Tandon, Yasmeen K; Rubin, Michael; Kahlifa, Mohamed; Doumit, Gaby; Naffaa, Lena

    2014-07-28

    Craniosynostosis is a pathologic condition which is characterized by the premature fusion of cranial sutures. It may occur alone or in association with other anomalies making up various syndromes. Crouzon syndrome is the most common craniosynostosis syndrome. Bicoronal sutures fusion is most commonly involved in Crouzon syndrome. There have only been a handful of cases of squamosal suture synostosis described in the surgery literature with the few ones described in Crouzon syndrome associated with other types of craniosynostosis. To the best of our knowledge, we are presenting the first case of isolated bilateral squamosal suture synostosis in a patient with Crouzon syndrome in a radiology journal with emphasis on its radiological appearance. PMID:25071892

  1. Stem cells of the suture mesenchyme in craniofacial bone development, repair and regeneration

    PubMed Central

    Maruyama, Takamitsu; Jeong, Jaeim; Sheu, Tzong-Jen; Hsu, Wei

    2016-01-01

    The suture mesenchyme serves as a growth centre for calvarial morphogenesis and has been postulated to act as the niche for skeletal stem cells. Aberrant gene regulation causes suture dysmorphogenesis resulting in craniosynostosis, one of the most common craniofacial deformities. Owing to various limitations, especially the lack of suture stem cell isolation, reconstruction of large craniofacial bone defects remains highly challenging. Here we provide the first evidence for an Axin2-expressing stem cell population with long-term self-renewing, clonal expanding and differentiating abilities during calvarial development and homeostastic maintenance. These cells, which reside in the suture midline, contribute directly to injury repair and skeletal regeneration in a cell autonomous fashion. Our findings demonstrate their true identity as skeletal stem cells with innate capacities to replace the damaged skeleton in cell-based therapy, and permit further elucidation of the stem cell-mediated craniofacial skeletogenesis, leading to revealing the complex nature of congenital disease and regenerative medicine. PMID:26830436

  2. The suture provides a niche for mesenchymal stem cells of craniofacial bones

    PubMed Central

    Zhao, Hu; Feng, Jifan; Ho, Thach-Vu; Grimes, Weston; Urata, Mark; Chai, Yang

    2015-01-01

    Bone tissue undergoes constant turnover supported by stem cells. Recent studies showed that perivascular mesenchymal stem cells (MSCs) contribute to the turnover of long bones. Craniofacial bones are flat bones derived from a different embryonic origin than the long bones. The identity and regulating niche for craniofacial bone MSCs remain unknown. Here, we identify Gli1+ cells within the suture mesenchyme as the major MSC population for craniofacial bones. They are not associated with vasculature, give rise to all craniofacial bones in the adult and are activated during injury repair. Gli1+ cells are typical MSCs in vitro. Ablation of Gli1+ cells leads to craniosynostosis and arrest of skull growth, indicating these cells are an indispensible stem cell population. Twist1+/− mice with craniosynostosis show reduced Gli1+ MSCs in sutures, suggesting that craniosynostosis may result from diminished suture stem cells. Our study indicates that craniofacial sutures provide a unique niche for MSCs for craniofacial bone homeostasis and repair. PMID:25799059

  3. Cutaneous fistula from the gastric remnant resulting from a chronic suture-associated biofilm infection.

    PubMed

    Kathju, Sandeep; Lasko, Leslie-Ann; Nistico, Laura; Colella, Joseph J; Stoodley, Paul

    2010-02-01

    A 53-year-old woman developed three chronic draining sinuses after Roux-en-Y gastric bypass; these persisted for almost 1 year despite antibiotics and local wound care. At approximately 1 year post-operatively, the drainage from the most superior sinus increased significantly and assumed a greenish hue, prompting concerns for gastrocutaneous fistula despite negative radiologic evaluation. At surgery, the patient was found to have a retained permanent multifilament suture at the base of each sinus, with associated inflammatory and fibrous tissue and a "slimy" matrix. Confocal laser scanning microscopy of both the explanted sutures and investing soft tissue revealed extensive bacterial biofilm formation. Also at surgery, a frank fistulous track was noted communicating the most superior suture/sinus to the gastric remnant, necessitating laparotomy and remnant gastrectomy in addition to removal of the foreign bodies (sutures) and concomitant panniculectomy. The patient has subsequently been free of complaint or finding for over 3 years.

  4. Local tissue reactions after nerve repair with ethyl-cyanoacrylate compared with epineural sutures.

    PubMed

    Landegren, Thomas; Risling, Mårten; Persson, Jonas K E

    2007-01-01

    Anastomosis of a nerve with cyanoacrylate following a lesion has previously been shown to indicate morphological and functional recovery to an extent comparable to that of conventional epineural sutures. In this study we examined the local tissue reactions after transection and repair of rat sciatic nerve, and compared sutures with a synthetic ethyl-cyanoacrylate adhesive. Many ED-1-immunoreactive macrophages were found accumulating on either side of the repair site whereas neurofilament labelling was less pronounced distal to the repair site seven days after reparation with cyanoacrylate compared with sutures. After six months, when reinnervation was completed, the difference in ED-1-immunoreactivity was still present but to a less extent. These results indicate that ethyl-cyanoacrylate seems to induce an increased inflammatory reaction, which may lead to accelerated Wallerian degeneration, and could therefore have benefits over conventional sutures for reconstruction of peripheral nerves.

  5. Deformation and sedimentation along a developing terrane suture: Eastern Sunda forearc, Indonesia

    SciTech Connect

    Reed, D.L.; Silver, E.A.; Prasetyo, H.; Meyer, A.W.

    1986-12-01

    The collision of the eastern Sunda arc with northwest Australia has resulted in the development of a suture between the Sumba ridge and Sawu-Timor terranes along a zone of intraforearc convergence. The developing suture varies from the low-angle Sawu thrust, with attendant mud diapirs in the Sumba basin, to high-angle reverse faults near a basement high of the underthrust Sumba ridge terrane. Bottom currents, associated with the flow of Pacific Ocean deep water into the Indian Ocean, have eroded the terranes and subsequently deposited the detritus in an assemblage of contourites along the suture. This study reveals the high structural variability of a terrane suture and the oceanographic influence on the deposition of overlap assemblages.

  6. Material properties of human infant skull and suture at high rates.

    PubMed

    Coats, Brittany; Margulies, Susan S

    2006-08-01

    Clinicians are often faced with the challenging task of distinguishing between accidental and inflicted pediatric head trauma. There is currently a disparity in the anecdotal case study literature as to what kinds of injuries can occur in children from low height falls. There is also a paucity of material property data for pediatric skull and suture at rates similar to those expected in low height falls. We tested human infant (<1 year old) cranial bone and suture from 23 calveria in three-point bending and tension, respectively, at rates ranging from 1.2-2.8 m/sec. Donor age was found to have the largest influence on the elastic modulus and ultimate stress of cranial bone, with an increase in age increasing both material properties. In adults, cranial bone and suture have similar properties and the adult calveria deforms very little prior to fracture. In contrast, pediatric cranial bone is 35 times stiffer than pediatric cranial suture. In addition, pediatric cranial suture deforms 30 times more before failure than pediatric cranial bone and 243 times more than adult cranial bone. The large strains in the pediatric bone and suture result in a skullcase that can undergo dramatic shape changes before fracture, potentially causing substantial deformation in the brain. The sizeable difference between pediatric bone and suture material properties also underscores the crucial role that sutures play in the unique response of the pediatric head to impact in low height falls. These data provide necessary information to enhance our understanding of mechanisms of head injury in young children.

  7. [Iris suture fixation of posterior-chamber elastic intraocular lens in ligament apparatus laxity].

    PubMed

    Pashtaev, N P; Bat'kov, E N; Zotov, V V

    2010-01-01

    An original MIOL-23 multifocal elastic intraocular lens (IOL) was used to operate 5 eyes with acquired lens dislocation and traumatic cataract. By making self-sealing tunnel incision, ILO was implanted into the capsular sac and sutured to the iris. MIOL-23 implantation caused an increase in mean visual acuity. The IOL took up a correct position. Elastic IOL implantation with iris suture fixation is an efficient and safe mode of additional ILO support. PMID:20645577

  8. A single centre comparative study of laparoscopic mesh rectopexy versus suture rectopexy

    PubMed Central

    Sahoo, Manash Ranjan; Thimmegowda, Anil Kumar; Gowda, Manoj S

    2014-01-01

    AIM: The aim of our study is to compare the results of laparoscopic mesh vs. suture rectopexy. MATERIALS AND METHODS: In this retrospective study, 70 patients including both male and female of age ranging between 20 years and 65 years (mean 42.5 yrs) were subjected to laparoscopic rectopexy during the period between March 2007 and June 2012, of which 38 patients underwent laparoscopic mesh rectopexy and 32 patients laparoscopic suture rectopexy. These patients were followed up for a mean period of 12 months assessing first bowel movement, hospital stay, duration of surgery, faecal incontinence, constipation, recurrence and morbidity. RESULTS: Duration of surgery was 100.8 ± 12.4 minutes in laparoscopic suture rectopexy and 120 ± 10.8 min in laparoscopic mesh rectopexy. Postoperatively, the mean time for the first bowel movement was 38 hrs and 40 hrs, respectively, for suture and mesh rectopexy. Mean hospital stay was five (range: 4-7) days. There was no significant postoperative complication except for one port site infection in mesh rectopexy group. Patients who had varying degree of incontinence preoperatively showed improvement after surgery. Eleven out of 18 (61.1%) patients who underwent laparoscopic suture rectopexy as compared to nine of 19 (47.3%) patients who underwent laparoscopic mesh rectopexy improved as regards constipation after surgery. CONCLUSION: There were no significant difference in both groups who underwent surgery except for patients undergoing suture rectopexy had better symptomatic improvement of continence and constipation. Also, cost of mesh used in laparoscopic mesh rectopexy is absent in lap suture rectopexy group. To conclude that laparoscopic suture rectopexy is a safe and feasible procedure and have comparable results as regards operative time, morbidity, bowel function, cost and recurrence or even slightly better results than mesh rectopexy. PMID:24501504

  9. Identification and dynamics of a cryptic suture zone in tropical rainforest

    PubMed Central

    Moritz, C.; Hoskin, C.J.; MacKenzie, J.B.; Phillips, B.L.; Tonione, M.; Silva, N.; VanDerWal, J.; Williams, S.E.; Graham, C.H.

    2009-01-01

    Suture zones, shared regions of secondary contact between long-isolated lineages, are natural laboratories for studying divergence and speciation. For tropical rainforest, the existence of suture zones and their significance for speciation has been controversial. Using comparative phylogeographic evidence, we locate a morphologically cryptic suture zone in the Australian Wet Tropics rainforest. Fourteen out of 18 contacts involve morphologically cryptic phylogeographic lineages, with mtDNA sequence divergences ranging from 2 to 15 per cent. Contact zones are significantly clustered in a suture zone located between two major Quaternary refugia. Within this area, there is a trend for secondary contacts to occur in regions with low environmental suitability relative to both adjacent refugia and, by inference, the parental lineages. The extent and form of reproductive isolation among interacting lineages varies across species, ranging from random admixture to speciation, in one case via reinforcement. Comparative phylogeographic studies, combined with environmental analysis at a fine-scale and across varying climates, can generate new insights into suture zone formation and to diversification processes in species-rich tropical rainforests. As arenas for evolutionary experimentation, suture zones merit special attention for conservation. PMID:19203915

  10. Cranial Suture Closure in Domestic Dog Breeds and Its Relationships to Skull Morphology.

    PubMed

    Geiger, Madeleine; Haussman, Sinah

    2016-04-01

    Bulldog-type brachycephalic domestic dog breeds are characterized by a relatively short and broad skull with a dorsally rotated rostrum (airorhynchy). Not much is known about the association between a bulldog-type skull conformation and peculiar patterns of suture and synchondrosis closure in domestic dogs. In this study, we aim to explore breed-specific patterns of cranial suture and synchondrosis closure in relation to the prebasial angle (proxy for airorhynchy and thus bulldog-type skull conformation) in domestic dogs. For this purpose, we coded closure of 18 sutures and synchondroses in 26 wolves, that is, the wild ancestor of all domestic dogs, and 134 domestic dogs comprising 11 breeds. Comparisons of the relative amount of closing and closed sutures and synchondroses (closure scores) in adult individuals showed that bulldog-type breeds have significantly higher closure scores than non-bulldog-type breeds and that domestic dogs have significantly higher closure scores than the wolf. We further found that the prebasial angle is significantly positively correlated with the amount of closure of the basispheno-presphenoid synchondrosis and sutures of the nose (premaxillo-nasal and maxillo-nasal) and the palate (premaxillo-maxillary and interpalatine). Our results show that there is a correlation between patterns of suture and synchondrosis closure and skull shape in domestic dogs, although the causal relationships remain elusive. PMID:26995336

  11. Asymmetric six-strand core sutures enhance tendon fatigue strength and the optimal asymmetry.

    PubMed

    Kozono, N; Okada, T; Takeuchi, N; Hanada, M; Shimoto, T; Iwamoto, Y

    2016-10-01

    Under cyclic loading, we recorded the fatigue strength of a six-strand tendon repair with different symmetry in the lengths of suture purchase in two stumps of 120 dental rolls and in 30 porcine tendons. First, the strengths of the repairs with 1, 2, 3, 4 and 5 mm asymmetry were screened using the dental rolls. The asymmetric core suture repairs were then made with a Kessler repair of equal suture purchase (10 mm) in two tendon stumps, and shifting two other Kessler repairs by 1, 3 or 5 mm, respectively, along the longitudinal axis of the tendon in relation to the first (symmetric) Kessler repair. The core repairs with 3 mm or more asymmetry in suture purchases in two tendon ends showed significantly greater fatigue strength and significantly smaller gaps compared with 1 mm asymmetry in core suture repair. Our results support that asymmetric placement of core sutures in two tendon ends favour resisting gapping at the repair site and 3 mm or more asymmetry is needed to produce such beneficial effects.

  12. The Development of the Calvarial Bones and Sutures and the Pathophysiology of Craniosynostosis.

    PubMed

    Ishii, Mamoru; Sun, Jingjing; Ting, Man-Chun; Maxson, Robert E

    2015-01-01

    The skull vault is a complex, exquisitely patterned structure that plays a variety of key roles in vertebrate life, ranging from the acquisition of food to the support of the sense organs for hearing, smell, sight, and taste. During its development, it must meet the dual challenges of protecting the brain and accommodating its growth. The bones and sutures of the skull vault are derived from cranial neural crest and head mesoderm. The frontal and parietal bones develop from osteogenic rudiments in the supraorbital ridge. The coronal suture develops from a group of Shh-responsive cells in the head mesoderm that are collocated, with the osteogenic precursors, in the supraorbital ridge. The osteogenic rudiments and the prospective coronal suture expand apically by cell migration. A number of congenital disorders affect the skull vault. Prominent among these is craniosynostosis, the fusion of the bones at the sutures. Analysis of the pathophysiology underling craniosynostosis has identified a variety of cellular mechanisms, mediated by a range of signaling pathways and effector transcription factors. These cellular mechanisms include loss of boundary integrity, altered sutural cell specification in embryos, and loss of a suture stem cell population in adults. Future work making use of genome-wide transcriptomic approaches will address the deep structure of regulatory interactions and cellular processes that unify these seemingly diverse mechanisms. PMID:26589924

  13. Fusion Patterns in the Skulls of Modern Archosaurs Reveal That Sutures Are Ambiguous Maturity Indicators for the Dinosauria.

    PubMed

    Bailleul, Alida M; Scannella, John B; Horner, John R; Evans, David C

    2016-01-01

    The sutures of the skulls of vertebrates are generally open early in life and slowly close as maturity is attained. The assumption that all vertebrates follow this pattern of progressive sutural closure has been used to assess maturity in the fossil remains of non-avian dinosaurs. Here, we test this assumption in two members of the Extant Phylogenetic Bracket of the Dinosauria, the emu, Dromaius novaehollandiae and the American alligator, Alligator mississippiensis, by investigating the sequence and timing of sutural fusion in their skulls. As expected, almost all the sutures in the emu skull progressively close (i.e., they get narrower) and then obliterate during ontogeny. However, in the American alligator, only two sutures out of 36 obliterate completely and they do so during embryonic development. Surprisingly, as maturity progresses, many sutures of alligators become wider in large individuals compared to younger, smaller individuals. Histological and histomorphometric analyses on two sutures and one synchondrosis in an ontogenetic series of American alligator confirmed our morphological observations. This pattern of sutural widening might reflect feeding biomechanics and dietary changes through ontogeny. Our findings show that progressive sutural closure is not always observed in extant archosaurs, and therefore suggest that cranial sutural fusion is an ambiguous proxy for assessing maturity in non-avian dinosaurs. PMID:26862766

  14. Fusion Patterns in the Skulls of Modern Archosaurs Reveal That Sutures Are Ambiguous Maturity Indicators for the Dinosauria

    PubMed Central

    Bailleul, Alida M.; Scannella, John B.; Horner, John R.; Evans, David C.

    2016-01-01

    The sutures of the skulls of vertebrates are generally open early in life and slowly close as maturity is attained. The assumption that all vertebrates follow this pattern of progressive sutural closure has been used to assess maturity in the fossil remains of non-avian dinosaurs. Here, we test this assumption in two members of the Extant Phylogenetic Bracket of the Dinosauria, the emu, Dromaius novaehollandiae and the American alligator, Alligator mississippiensis, by investigating the sequence and timing of sutural fusion in their skulls. As expected, almost all the sutures in the emu skull progressively close (i.e., they get narrower) and then obliterate during ontogeny. However, in the American alligator, only two sutures out of 36 obliterate completely and they do so during embryonic development. Surprisingly, as maturity progresses, many sutures of alligators become wider in large individuals compared to younger, smaller individuals. Histological and histomorphometric analyses on two sutures and one synchondrosis in an ontogenetic series of American alligator confirmed our morphological observations. This pattern of sutural widening might reflect feeding biomechanics and dietary changes through ontogeny. Our findings show that progressive sutural closure is not always observed in extant archosaurs, and therefore suggest that cranial sutural fusion is an ambiguous proxy for assessing maturity in non-avian dinosaurs. PMID:26862766

  15. Efficacy of Single-Suture Incision Closures in Tagged Juvenile Chinook Salmon Exposed to Simulated Turbine Passage

    SciTech Connect

    Boyd, James W.; Deters, Katherine A.; Brown, Richard S.; Eppard, M. B.

    2011-09-01

    Reductions in the size of acoustic transmitters implanted in migrating juvenile salmonids have resulted in the use of a shorter incision-one that may warrant only a single suture for closure. However, it is not known whether a single suture will sufficiently hold the incision closed when fish are decompressed and when outward pressure is placed on the surgical site during turbine passage through hydroelectric dams. The objective of this study was to evaluate the effectiveness of single-suture incision closures on five response variables in juvenile Chinook salmon Oncorhynchus tshawytscha that were subjected to simulated turbine passage. An acoustic transmitter (0.43 g in air) and a passive integrated transponder tag (0.10 g in air) were implanted in each fish; the 6-mm incisions were closed with either one suture or two sutures. After exposure to simulated turbine passage, none of the fish exhibited expulsion of transmitters. In addition, the percentage of fish with suture tearing, incision tearing, or mortal injury did not differ between treatments. Expulsion of viscera through the incision was higher among fish that received one suture (12%) than among fish that received two sutures (1%). The higher incidence of visceral expulsion through single-suture incisions warrants concern. Consequently, for cases in which tagged juvenile salmonidsmay be exposed to turbine passage, we do not recommend the use of one suture to close 6-mm incisions associated with acoustic transmitter implantation.

  16. Performance Assessment of Suture Type, Water Temperature, and Surgeon Skill in Juvenile Chinook Salmon Surgically Implanted with Acoustic Transmitters

    SciTech Connect

    Deters, Katherine A.; Brown, Richard S.; Carter, Kathleen M.; Boyd, James W.; Eppard, M. B.; Seaburg, Adam

    2010-05-01

    This study assessed performance of seven suture types in subyearling Chinook salmon Oncorhynchus tshawytscha implanted with acoustic microtransmitters. Nonabsorbable (Ethilon) and absorbable (Monocryl) monofilament and nonabsorbable (Nurolon, silk) and absorbable (Vicryl, Vicryl Plus, Vicryl Rapide) braided sutures were used to close incisions in Chinook salmon. Monocryl exhibited greater suture retention than all other suture types 7 d after surgery. Both monofilament suture types were retained better than all braided suture types at 14 d. Incision openness and tag retention did not differ among suture types. Wound inflammation was similar for Ethilon, Monocryl, and Nurolon at 7 d. Wound ulceration was lower for Ethilon, Monocryl, and Nurolon than for all other suture types at 14 d post-surgery. Fish held in 12°C water had more desirable post-surgery healing characteristics (i.e., higher suture and tag retention and lower incision openness, wound inflammation, and ulceration) at 7 and 14 d after surgery than those held in 17°C water. The effect of surgeon was a significant predictor for all response variables at 7 d. This result emphasizes the importance of including surgeon as a variable in telemetry study analyses when multiple surgeons are used. Monocryl performed better with regard to post-surgery healing characteristics in the study fish. The overall results support the conclusion that Monocryl is the best suture material to close incisions created during surgical implantation of acoustic microtransmitters in subyearling Chinook salmon.

  17. A New Method for Revision of Encapsulated Blebs after Trabeculectomy: Combination of Standard Bleb Needling with Transconjunctival Scleral Flap Sutures Prevents Early Postoperative Hypotony

    PubMed Central

    Laspas, Panagiotis; Culmann, Philipp David; Grus, Franz Hermann; Prokosch-Willing, Verena; Poplawksi, Alicia; Pfeiffer, Norbert; Hoffmann, Esther Maria

    2016-01-01

    Purpose A simple needling procedure is the standard method for restoring the function of an encapsulated bleb after trabeculectomy. However, postoperative hypotony represents a possible hazard. This study describes a new surgical approach for treating encapsulated blebs with reduced risk of early postoperative hypotony: bleb needling combined with transconjunctival sutures tightening the scleral flap directly. Methods The study included two groups of 23 patients with failing bleb following trabeculectomy: “Group 1” underwent simple needling revision of the filtering bleb and served as a control group, while “Group 2” received needling revision with additional transconjunctival scleral flap sutures, if intraoperatively the intraocular pressure was estimated to be very low. Intraocular pressure (IOP), postoperative management and complications were analyzed over a follow-up period of 4 weeks postoperatively. Results were compared using t-test or Mann-Whitney U-tests. Results Adverse effects occurred with a higher frequency after sole needling of the bleb (5 cases of choroidal effusion and 1 case of choroidal hemorrhage) than after the combined method with additional scleral sutures (1 case of choroidal effusion). The IOP on the first postoperative day was significantly lower in group 1, with 9.43 ± 9.01 mm Hg vs. 16.43 ± 8.35 mm Hg in group 2 (P = 0.01). Ten patients with ocular hypotony (IOD of 5 mmHg or lower) were found in group 1 and only two in group 2. One week and one month after surgery the intraocular pressure was similar in both groups (P>0.05). Conclusions This new needling technique with additional transconjunctival scleral flap sutures appears to reduce postoperative hypotony, and may thus protect from further complications, such as subchoroidal hemorrhage. PMID:27314495

  18. Mesoproterozoic suturing of Archean crustal blocks in western peninsular India: Implications for India-Madagascar correlations

    NASA Astrophysics Data System (ADS)

    Ishwar-Kumar, C.; Santosh, M.; Wilde, S. A.; Tsunogae, T.; Itaya, T.; Windley, B. F.; Sajeev, K.

    2016-10-01

    The Kumta and Mercara suture zones welding together Archean crustal blocks in western peninsular India offer critical insights into Precambrian continental juxtapositions and the crustal evolution of eastern Gondwana. Here we present the results from an integrated study of the structure, geology, petrology, mineral chemistry, metamorphic P-T conditions, zircon U-Pb ages and Lu-Hf isotopes of metasedimentary rocks from the two sutures. The dominant rocks in the Kumta suture are greenschist- to amphibolite-facies quartz-phengite schist, garnet-biotite schist, chlorite schist, fuchsite schist and marble. The textural relations, mineral chemistry and thermodynamic modelling of garnet-biotite schist from the Kumta suture indicate peak metamorphic P-T conditions of ca. 11 kbar at 790 °C, with detrital SHRIMP U-Pb zircon ages ranging from 3420 to 2547 Ma, εHf (t) values from - 9.2 to 5.6, and TDMc model ages from 3747 to 2792 Ma. The K-Ar age of phengite from quartz-phengite schist is ca. 1326 Ma and that of biotite from garnet-biotite schist is ca. 1385 Ma, which are interpreted to broadly constrain the timing of metamorphism related to the suturing event. The Mercara suture contains amphibolite- to granulite-facies mylonitic quartzo-feldspathic gneiss, garnet-kyanite-sillimanite gneiss, garnet-biotite-kyanite-gedrite-cordierite gneiss, garnet-biotite-hornblende gneiss, calc-silicate granulite and metagabbro. The textural relations, mineral chemistry and thermodynamic modelling of garnet-biotite-kyanite-gedrite-cordierite gneiss from the Mercara suture indicate peak metamorphic P-T conditions of ca. 13 kbar at 825 °C, followed by isothermal decompression and cooling. For pelitic gneisses from the Mercara suture, LA-ICP-MS U-Pb zircon ages vary from 3249 to 3045 Ma, εHf (t) values range from - 18.9 to 4.2, and TDMc model ages vary from 4094 to 3314 Ma. The lower intercept age of detrital zircons in the pelitic gneisses from the Mercara suture ranges from 1464 to 1106

  19. A pilot study evaluating laparoscopic closure of the nephrosplenic space using an endoscopic suturing device in standing horses.

    PubMed

    Bracamonte, José L; Duke-Novakovski, Tanya

    2016-06-01

    This study evaluated the use of an articulating automated suturing device for laparoscopic closure of the nephrosplenic space in standing horses. Closure of the nephrosplenic space was performed in 4 horses using an automated suturing device. Second-look laparoscopy was performed at 5 weeks. A smooth fibrous adhesion formed between the spleen, the perirenal fascia, and the nephrosplenic ligament in 3 of the 4 horses in which the nephrosplenic space was closed using the automated suturing device. In 1 horse, closure of the nephrosplenic space was not possible due to constant breakage of the endoscopic needle. Intra-operative complications encountered with the automated suturing device were tearing of the perirenal fascia, nephrosplenic ligament, and dorsal splenic capsule along with breakage of the needle. The automated suturing device used in this study for laparoscopic closure of the nephrosplenic space resulted in longer surgery times, suffered instrument failures and delivered inadequate suture.

  20. Acrylic polymer-grafted polypropylene sutures for covalent immobilization or reversible adsorption of vancomycin.

    PubMed

    García-Vargas, M; González-Chomón, C; Magariños, B; Concheiro, A; Alvarez-Lorenzo, C; Bucio, E

    2014-01-30

    Glycidyl methacrylate (GMA) and acrylic acid (AAc) were separately grafted onto polypropylene (PP) monofilament sutures by means of pre-irradiation using a (60)Co γ-source, with the purpose of loading vancomycin via (i) covalent immobilization through the glycidyl groups of GMA and (ii) ionic interaction with AAc moieties. The effect of absorbed radiation dose, monomer concentration, temperature and reaction time on the grafting degree was evaluated in detail. GMA grafting ranged from 25% to 800% while the grafting yield of AAc onto PP could be tuned between 9% and 454%, at doses from 5 to 50 kGy and a dose rate 13.7 kGy/h. Grafting of GMA or AAc decreased the decomposition temperature and made the sutures swellable to a certain extent. GMA grafting led to a continuous, smooth and thick coating, which was suitable for immobilization of up to 1.9 μg vancomycin per gram. The immobilized vancomycin enabled a reduction in the Staphylococcus aureus CFU adhered to the suture surface. On the other hand, dried AAc-functionalized sutures exhibited a rough and cracked surface which was responsible for a minor increase in the coefficient of friction. PP-g-AAc sutures exhibited pH-dependent swelling and remarkably high capability to host vancomycin (up to 109.9 mg/g), particularly those with an intermediate degree of grafting. Some AAc-functionalized sutures were shown able to inhibit bacterial growth after successive challenges with fresh lawns. Therefore, tuning the yield of grafting of GMA or AAc may enable the preparation of drug-suture combination products that retain or release, respectively, antimicrobial agents.

  1. Knotless single-row rotator cuff repair: a comparative biomechanical study of 2 knotless suture anchors.

    PubMed

    Efird, Chad; Traub, Shaun; Baldini, Todd; Rioux-Forker, Dana; Spalazzi, Jeffrey P; Davisson, Twana; Hawkins, Monica; McCarty, Eric

    2013-08-01

    The purpose of this study was to compare the gap formation during cyclic loading, maximum repair strength, and failure mode of single-row full-thickness supraspinatus repairs performed using 2 knotless suture anchors with differing internal suture-retention mechanisms in a human cadaver model. Nine matched pairs of cadaver shoulders were used. Full-thickness tears were induced by detaching the supraspinatus tendon from the greater tuberosity. Single-row repairs were performed with either type I (Opus Magnum PI; ArthroCare, Austin, Texas) or type II (ReelX STT; Stryker, Mahwah, New Jersey) knotless suture anchors. The repaired tendon was cycled from 10 to 90 N for 500 cycles, followed by load to failure. Gap formation was measured at 5, 100, 200, 300, 400, and 500 cycles with a video digitizing system. Anchor type or location (anterior or posterior) had no effect on gap formation during cyclic loading regardless of position (anterior, P=.385; posterior, P=.389). Maximum load to failure was significantly greater (P=.018) for repairs performed with type II anchors (288±62 N) compared with type I anchors (179±39 N). Primary failure modes were anchor pullout and tendon tearing for type II anchors and suture slippage through the anchor for type I anchors. The internal ratcheting suture-retention mechanism of type II anchors may have helped this anchor outperform the suture-cinching mechanism of type I anchors by supporting significantly higher loads before failure and minimizing suture slippage, potentially leading to stronger repairs clinically. PMID:23937749

  2. VEGF-releasing suture material for enhancement of vascularization: development, in vitro and in vivo study.

    PubMed

    Bigalke, Christian; Luderer, Frank; Wulf, Katharina; Storm, Thilo; Löbler, Marian; Arbeiter, Daniela; Rau, Bettina M; Nizze, Horst; Vollmar, Brigitte; Schmitz, Klaus-Peter; Klar, Ernst; Sternberg, Katrin

    2014-12-01

    As it has been demonstrated that bioactive substances can be delivered locally using coated surgical suture materials, the authors developed a vascular endothelial growth factor (VEGF)-releasing suture material that should promote vascularization and potentially wound healing. In this context, the study focused on the characterization of the developed suture material and the verification of its biological activity, as well as establishing a coating process that allows reproducible and stable coating of a commercially available polydioxanone suture material with poly(l-lactide) (PLLA) and 0.1μg and 1.0μg VEGF. The in vitro VEGF release kinetics was studied using a Sandwich ELISA. The biological activity of the released VEGF was investigated in vitro using human umbilical vein endothelial cells. The potential of the VEGF-releasing suture material was also studied in vivo 5days after implantation in the hind limb of Wistar rats, when the histological findings were analyzed. The essential results, enhanced cell viability in vitro as well as significantly increased vascularization in vivo, were achieved using PLLA/1.0μg VEGF-coated suture material. Furthermore, ELISA measurements revealed a high reproducibility of the VEGF release behavior. Based on the results achieved regarding the dose-effect relationship of VEGF, the stability during its processing and the release behavior, it can be predicted that a bioactive suture material would be successful in later in vivo studies. Therefore, this knowledge could be the basis for future studies, where bioactive substances with different modes of action are combined for targeted, overall enhancement of wound healing.

  3. [Technique of the urethral anastomosis in orthotopic neo-bladder following robot-assisted radical cystectomy (RARC)].

    PubMed

    Horstmann, M; Kurz, M; Padevit, C; Horton, K; John, H

    2013-03-01

    The urethral anastomosis in extracorporeally constructed orthotopic neo-bladder following robot-assisted radical cystectomy (RARC) remains a challenge. In principle either pre-posi-tioned single sutures or robotic continuous suture techniques can be applied. In the literature the different techniques are most often not described in detail. In the present work one example for each technique is given and the advantages and disadvantages of both methods are discussed.

  4. Use of Transalveolar Sutures in Conjunction With Grafting to Preserve Vestibular Depth and Augment Gingival Thickness Around Mandibular Implants.

    PubMed

    Deeb, George R; Deeb, Janina Golob; Kain, Nicholas J; Wilson, Graham H; Laskin, Daniel M

    2016-05-01

    Preservation or reconstruction of the soft tissues around dental implants is an essential component of implant dentistry. Increased width and thickness of the keratinized tissue surrounding dental implants has been recognized as an important factor associated with long-term implant success. When extractions and ridge reduction are performed concurrently with implant placement, maintaining vestibular depth also is of utmost importance. A previous report described a technique for applying bone-anchoring sutures to preserve keratinized tissue and vestibular depth around implants. The present report describes a variation of the procedure for the simultaneous correction of situations in which the existing keratinized tissue is thin and narrow and preserving and apically positioning it might not provide an appropriate gingival cuff. PMID:26745993

  5. Internal morphology of the nonsyndromic prematurely fused sagittal suture in the human skull--A preliminary micro-CT study.

    PubMed

    Nowaczewska, W; Ziółkowski, G; Dybała, B

    2015-10-01

    Although nonsyndromic craniosynostosis (NSC) of the sagittal suture is a well-known type of craniosynostosis, little is currently known about the internal morphology of this prematurely fused suture in modern humans. Recently, micro-computed tomography (micro-CT) has been applied as a new tool for the quantitative evaluation of cranial suture morphology. However, so far there are only a small number of reports concerning studies of the internal morphology of prematurely fused sagittal suture in humans using micro-CT. The primary aim of this study was to examine the internal morphology of a completely obliterated sagittal suture in NSC. Two modern human skulls were used in this study: a skull of a child (aged 10 ± 2.5 years) displaying NSC of the sagittal suture and a skull of an adult showing non-prematurely completely obliterated sagittal suture. Quantitative variables of the sagittal sutures were assessed using method proposed by the authors. Porosity, and relative thickness of three bone layers in two examined skulls (inner cortical, diploë and outer cortical) were analysed using micro-CT in three equal sections of the sagittal suture. In the case of the prematurely fused suture, there were statistically significant differences mainly in the mean values of the porosity, thickness and relative thickness of the diploë between the anterior part and the two other parts (central and posterior) of this suture. Significant differences were also observed in some of the analysed variables between the sections of the sagittal suture of the skull with NSC and the normal skull. PMID:26122169

  6. Antibacterial suture vs silk for the surgical removal of impacted lower third molars. A randomized clinical study

    PubMed Central

    Sala-Pérez, Sergi; López-Ramírez, Marta; Quinteros-Borgarello, Milva; Valmaseda-Castellón, Eduardo

    2016-01-01

    Background The aim of this study was to evaluate the clinical and microbiological impact of an antibacterial suture (Monocryl® Plus) in the surgical removal of I3M. Material and Methods A “split-mouth”, prospective pilot clinical study was designed involving 20 patients programmed for the surgical removal of I3M. Each side was randomly sutured with Monocryl® Plus or silk suture and removed for microbiological study 72 hours and 7 days after surgery. Presence of SSI, wound bleeding and the degree of discomfort associated with each type of suture material (scored by means of a visual analog scale) were evaluated. The level of contamination of each material was observed under the scanning electron microscope. Results Wound bleeding upon suture removing was slightly greater after 72 hours and 7 days with black silk suture, though the differences were not statistically significant (p=0.752 and p=0.113, respectively). Patient discomfort was very similar with both types of suture material (p=0.861). Only one case of SSI was recorded with black silk suture after 72 hours. Microbiologically, the antibacterial suture showed a lesser presence of microorganisms (p<0.001, at 72h and p=0.033 at 7th day, respectively). The most common bacterial species included grampositive cocci (Streptococcus viridans group, Neisseria spp., Coagulasenegative Staphylococcus and Peptostreptococcus), gramnegative cocci (Veillonella), grampositive Bacilli (Lactobacillus), and gramnegative Bacilli (Prevotella). Conclusions The greatest antibacterial effect of Monocryl Plus suture was observed after 72 hours. According to most authors, there is no doubt that this antibacterial suture can provide little safety in the control of SSI. Key words:Antibacterial suture, monocryl® plus, vicryl® plus, third molar surgery, postoperative infection, surgical site infection (SSI). PMID:26615503

  7. Three-dimensional echo-guided suture of atrial septal defect with Maniceps in an experimental model.

    PubMed

    Orihashi, Kazumasa; Takahashi, Shinya; Ozawa, Masamichi; Herlambang, Bagus; Takasaki, Taiichi; Sato, Katsutoshi; Kurosaki, Tatsuya; Imai, Katsuhiko; Sueda, Taijiro

    2010-09-01

    Toward the establishment of suture closure procedures for atrial septal defect or patent foramen ovale under guidance of three-dimensional (3D) echocardiography but without use of cardiopulmonary bypass (off-pump surgery), an experimental study was conducted using a laparoscopic suture instrument, Maniceps. First, the panel setting of the 3D echo system which was optimal for precisely visualizing the surgical instruments on the image display with the least time delay was determined. The optimal setting was: 1) harmonic imaging, 2) no smoothing, 3) low scanning line density, and 4) a scanning range around 55 degrees. Using an ex vivo model of atrial septal defect, 3D echo-guided surgical procedures were attempted in three steps. First, grasping of the edge of the defect with a forceps was attempted. It was feasible in every direction. Reverberation artifact occasionally disturbed imaging of the defect edge. Second, transfixion suture of the facing edges was attempted. Guided by 3D echo, serial sutures were feasible, but interlocking of the thread was a pitfall. Third, continuous suture of the defect was attempted under 3D echo guidance. Following the initial suture bite on one side, continuous suture could be performed under echo guidance. Deformity of the Maniceps needle after repeated sutures was a limitation. In conclusion, suture closure of the defect under 3D echo guidance using the Maniceps system is feasible in an ex vivo ASD model as visualization is optimized by panel setting for guiding surgical procedures.

  8. Biomechanical Comparison of Parallel and Crossed Suture Repair for Longitudinal Meniscus Tears

    PubMed Central

    Milchteim, Charles; Branch, Eric A.; Maughon, Ty; Hughey, Jay; Anz, Adam W.

    2016-01-01

    Background: Longitudinal meniscus tears are commonly encountered in clinical practice. Meniscus repair devices have been previously tested and presented; however, prior studies have not evaluated repair construct designs head to head. This study compared a new-generation meniscus repair device, SpeedCinch, with a similar established device, Fast-Fix 360, and a parallel repair construct to a crossed construct. Both devices utilize self-adjusting No. 2-0 ultra–high molecular weight polyethylene (UHMWPE) and 2 polyether ether ketone (PEEK) anchors. Hypothesis: Crossed suture repair constructs have higher failure loads and stiffness compared with simple parallel constructs. The newer repair device would exhibit similar performance to an established device. Study Design: Controlled laboratory study. Methods: Sutures were placed in an open fashion into the body and posterior horn regions of the medial and lateral menisci in 16 cadaveric knees. Evaluation of 2 repair devices and 2 repair constructs created 4 groups: 2 parallel vertical sutures created with the Fast-Fix 360 (2PFF), 2 crossed vertical sutures created with the Fast-Fix 360 (2XFF), 2 parallel vertical sutures created with the SpeedCinch (2PSC), and 2 crossed vertical sutures created with the SpeedCinch (2XSC). After open placement of the repair construct, each meniscus was explanted and tested to failure on a uniaxial material testing machine. All data were checked for normality of distribution, and 1-way analysis of variance by ranks was chosen to evaluate for statistical significance of maximum failure load and stiffness between groups. Statistical significance was defined as P < .05. Results: The mean maximum failure loads ± 95% CI (range) were 89.6 ± 16.3 N (125.7-47.8 N) (2PFF), 72.1 ± 11.7 N (103.4-47.6 N) (2XFF), 71.9 ± 15.5 N (109.4-41.3 N) (2PSC), and 79.5 ± 25.4 N (119.1-30.9 N) (2XSC). Interconstruct comparison revealed no statistical difference between all 4 constructs regarding maximum

  9. Upper Mantle Structure Around the Trans-European Suture Zone

    NASA Astrophysics Data System (ADS)

    Janutyte, Ilma; Majdanski, Mariusz; Voss, Peter H.; Kozlovskaya, Elena

    2014-05-01

    The Trans-European Suture Zone (TESZ) is the transition between old Proterozoic lithosphere in Northern and Eastern Europe and the younger Phanerozoic lithosphere in Central and Western Europe. The presented study is a part of the PASSEQ 2006-2008 project which is linked to the TOR project realized during 1996-1997. The PASSEQ and the TOR projects aimed to study the lithosphere and asthenosphere structure around the TESZ, but the latter was focused on the northwestern part of the TESZ between Sweden and Denmark - Germany, while the PASSEQ project was focused on the TESZ mainly beneath Poland. During the PASSEQ project 139 short-period and 49 broadband temporary seismic stations were deployed along the transect stretching from Germany throughout Czech Republic and Poland to Lithuania. The array recorded continuous seismic data from May, 2006 to June, 2008. In our study we used data of all available PASSEQ seismic stations and seismic stations of the national seismological networks of the participating countries and compiled a data set of teleseismic P-wave arrivals. The full data set consists of 8308 manually picked arrivals. Due to limited computational power we used the data of the highest quality only, i.e. 6008 picks. The non-linear teleseismic tomography algorithm TELINV was used to obtain the model of P-wave velocity perturbations in the upper mantle around the TESZ. We recovered the upper mantle structure from 70 km down to 350 km in the study area. The results show ±6.5 % P-wave velocity variations compared to the IASP91 velocity model. We found higher velocities beneath the old East European Craton (EEC) east of the TESZ and lower ones beneath the younger Western Europe west of the TESZ. The thickest litosphere was found beneath the EEC (Lithuania) where the higher velocities continue to about 300 km or even more. To the west of the TESZ under the Variscides the average depth of the lithosphere-asthenosphere boundary (LAB) is about 100 km. The TESZ appears

  10. [In vitro studies of the mechanical load capability of resorbable monofilament suture materials].

    PubMed

    Bremer, Felicia; Gellrich, Nils-Claudius; Stiesch, Meike

    2009-01-01

    In a vast spectrum of wound closures there is an indication for resorbable suture materials. For surgeons detailed knowledge of the physicochemical properties is important in order to find the right suture for each indication. For this purpose, various new monofilament polymers were employed. The objective of the present study was to investigate the effects of hydrolysis and gamma-irradiation on the linear strength. The final analysis of all tested suture materials concluded that gamma-irradiation had no effects on linear strength. However, the analysis showed significant discrepancies between individual polymers with regard to loss of tensile strength associated with hydrolysis. Polydioxanone- and caprolactone-lactid-based resorbable suture materials both displayed adequate tensile strength after a five-week period of hydrolysis. In comparison the triblock-copolymer is subject to rapid degradation. Polydioxanone- and caprolactone-lactid-based resorbable suture materials are indicated for use in tissues which require mechanical support over a longer period. Monosyn is more suitable for short-term wound support. PMID:19852206

  11. Clinical Outcome and Wound Healing following Carpal Tunnel Decompression: A Comparison of Two Common Suture Materials

    PubMed Central

    MacFarlane, Robert J.; Donnelly, Thomas D.; Morapudi, Syam; Waseem, Mohammad

    2014-01-01

    Introduction. Debate exists amongst surgeons regarding the ideal suture material for skin closure in carpal tunnel decompression (CTD). This study compares wound related complications, patient satisfaction, and functional outcome following open carpal tunnel decompression in patients undergoing wound closure with either of two common absorbable and nonabsorbable suture types. Materials and Methods. 53 patients underwent CTD with either 4/0 polypropylene (ProleneTM, n = 28) or 4/0 polyglactin (Vicryl RapideTM, n = 25) for skin closure. QuickDASH, VAS satisfaction scores, and Southampton wound scores were assessed preoperatively and at 2 and 6 weeks postoperatively. Results. At 6 weeks the mean QuickDASH scores postoperatively were 18.54 and 17.70 for absorbable and nonabsorbable sutures, respectively, (P = 0.86). The mean VAS scores were 0.61 and 0.42 (P = 0.91), respectively. All patients achieved a Southampton wound score of 0 by 6 weeks except one, who achieved 1C in the nonabsorbable group, equivalent to mild erythema. There were no complications in either group. Conclusion. Both suture types are safe and effective materials for CTD, and we recommend surgeons to choose according to personal preference, handling properties, and resources available for suture removal. PMID:25165693

  12. Creep rupture behavior of polypropylene suture material and its applications as a time-release mechanism

    SciTech Connect

    Kusy, R.P.; Whitley, J.Q.

    1983-05-01

    The controlled failure of polypropylene (PP) sutures is studied via creep rupture tests. From plots of log time (tB) vs. stress (sigma), linear relationships are generated over the failure times of 1-1000 h. Results show that as a function of stress, the time dependence varies with irradiation dose (15, 20, 25, and 50 Mrad), irradiation atmosphere (air and vacuum), suture diameter (7-0, 6-0, 5-0, and 4-0), and test temperature (26 and 37 degrees C). For a given stress, the time to failure is least for the greatest dose in the presence of air and at the highest temperature. When suture loops are wrapped around a small wire sheave, however, failure occurs in the largest suture as much as two decades sooner than the smallest suture studied. Within the limitations stated herein, they are independent of test method, loop diameter, aging, and humidity. Consequently, after irradiation in vacuum and postirradiation heat treatment, the processed material may be stored at room temperature for at least 1 month. Such materials are advocated when the time release of a dental or medical device is required, for example, in the self-activating cleft palate appliance.

  13. Arthroscopic technique for patch augmentation of rotator cuff repairs.

    PubMed

    Labbé, Marc R

    2006-10-01

    The patient is placed in the lateral position, and an arthroscopic cuff repair is performed according to standard techniques. The line of repair is usually in the shape of a "T" or an "L." The repair is viewed through the lateral portal, with fluid inflow through the scope. Mattress sutures are placed in the anterior and posterior portions of the cuff, with respect to the line of repair, just medial to the most medial point of the tear. The sutures are placed in accordance with margin convergence suture passing methods. Next, 2 double-stranded suture anchors are placed into the lateral aspect of the greater tuberosity, which can be used to secure the anterior and posterior portions of the rotator cuff as well as the patch. The cuff sutures are tied first; then, the patch is addressed. The graft is sized by placement of a ruled probe or similar device into the subacromial space. The length of each side of the "rectangle" is measured to obtain the dimensions of the patch. The patch is then cut to fit the measurements. If the patch material is elastic, a slightly smaller than measured graft is cut to provide tension on the repair. The arthroscope is then moved to the posterior portal, and a large (8 mm) cannula, with a dam, is placed into the lateral portal. All sutures are brought out of the lateral cannula, and corresponding ends of each suture are held together in a clamp. The sutures are placed in their respective orientations once outside the cannula (e.g., anterior-medial, anterior-lateral), covering all 4 quadrants. Care is taken to ensure that the sutures have no twists and are not wrapped around one another. The sutures are passed through the graft, in mattress fashion, with a free needle, in their respective corners and clamped again. The graft is then grasped with a small locking grasper on its medial edge and is passed through the cannula into the subacromial space. The clamps holding the sutures are then gently pulled to remove the slack. A smaller (5 mm

  14. Simultaneous bilateral quadriceps tendon rupture in a patient on chronic haemodialysis. (Short-term results of treatment with transpatellar sutures augmented with a quadriceps tendon flap).

    PubMed

    Kayali, Cemil; Agus, Haluk; Turgut, Ali; Taskiran, Can

    2008-01-01

    Quadriceps tendon ruptures are rare orthopaedic injuries. Although they are generally seen after the age of 50, they may occur in younger patients with certain underlying conditions, including chronic haemodialysis. Several repair techniques have been proposed but the choice of the best method is still a matter of controversy. This paper presents the case of a renal failure patient with 10 years' history of haemodialysis treatment suffering from bilateral quadriceps tendon rupture. The treatment was with transpatellar sutures augmented with a reverse quadriceps tendon flap. His short-term clinical and radiological results are satisfactory.

  15. Allergy to Prolene Sutures in a Dural Graft for Chiari Decompression

    PubMed Central

    Cajigas, Iahn; Burks, S. Shelby; Gernsback, Joanna; Fine, Lauren; Moshiree, Baharak; Levi, Allan D.

    2015-01-01

    Allergy to Prolene suture is exceedingly rare with only 5 cases reported in the literature. There have been no such cases associated with neurosurgical procedures. Diagnosis is nearly always delayed in spite of persistent symptomatology. A 27-year-old girl with suspected Ehlers-Danlos, connective tissue disorder, underwent posterior fossa decompression for Chiari Type 1 malformation. One year later, the patient presented with urticarial rash from the neck to chest. Cerebrospinal fluid and blood testing, magnetic resonance imaging, and intraoperative exploration did not suggest allergic reaction. Eventually skin testing proved specific Prolene allergy. After suture material was removed, the patient no longer complained of pruritus or rash. This single case highlights the important entity of allergic reaction to suture material, namely, Prolene, which can present in a delayed basis. Symptomatology can be vague but has typical allergic characteristics. Multidisciplinary approach is helpful with confirmatory skin testing as a vital part of the workup. PMID:26798347

  16. Allergy to Prolene Sutures in a Dural Graft for Chiari Decompression.

    PubMed

    Cajigas, Iahn; Burks, S Shelby; Gernsback, Joanna; Fine, Lauren; Moshiree, Baharak; Levi, Allan D

    2015-01-01

    Allergy to Prolene suture is exceedingly rare with only 5 cases reported in the literature. There have been no such cases associated with neurosurgical procedures. Diagnosis is nearly always delayed in spite of persistent symptomatology. A 27-year-old girl with suspected Ehlers-Danlos, connective tissue disorder, underwent posterior fossa decompression for Chiari Type 1 malformation. One year later, the patient presented with urticarial rash from the neck to chest. Cerebrospinal fluid and blood testing, magnetic resonance imaging, and intraoperative exploration did not suggest allergic reaction. Eventually skin testing proved specific Prolene allergy. After suture material was removed, the patient no longer complained of pruritus or rash. This single case highlights the important entity of allergic reaction to suture material, namely, Prolene, which can present in a delayed basis. Symptomatology can be vague but has typical allergic characteristics. Multidisciplinary approach is helpful with confirmatory skin testing as a vital part of the workup. PMID:26798347

  17. Entrapment of Common Peroneal Nerve by Surgical Suture following Distal Biceps Femoris Tendon Repair

    PubMed Central

    Nakazora, Shigeto; Kato, Ko

    2016-01-01

    We describe entrapment of the common peroneal nerve by a suture after surgical repair of the distal biceps femoris tendon. Complete rupture of the distal biceps femoris tendon of a 16-year-old male athlete was surgically repaired. Postoperative common peroneal nerve palsy was evident, but conservative treatment did not cause any neurological improvement. Reexploration revealed that the common peroneal nerve was entrapped by the surgical suture. Complete removal of the suture and external neurolysis significantly improved the palsy. The common peroneal nerve is prone to damage as a result of its close proximity to the biceps femoris tendon and it should be identified during surgical repair of a ruptured distal biceps femoris tendon. PMID:27703826

  18. Prevalence of biofilms on surgical suture segments in wounds of dogs, cats, and horses.

    PubMed

    König, L; Klopfleisch, R; Kershaw, O; Gruber, A D

    2015-03-01

    The formation of biofilms on surgical implants is thought to play a major role in chronic infection and wound-healing disorders and has been rarely described in veterinary medicine. Due to poor and unreliable results from bacterial culturing, histology may be an economic tool for the detection of biofilms. In this study, the prevalence of biofilms on surgical suture materials and swabs with chronic wound-healing complications in dogs, cats, and horses was assessed by histologic examination using hematoxylin and eosin, Gram, and Giemsa stains, as well as periodic acid-Schiff reaction. Of the 91 tissue samples with intralesional suture material or swab residues associated with inflammation, only 2 contained bacterial colonies arranged in an extracellular polymeric matrix consistent with a biofilm. The results of this study suggest that biofilms on suture material may occur in veterinary medicine.

  19. Performance Assessment of Suture Type in Juvenile Chinook Salmon Surgically Implanted with Acoustic Transmitters

    SciTech Connect

    Deters, Katherine A.; Brown, Richard S.; Carter, Kathleen M.; Boyd, James W.

    2009-02-27

    The objective of this study was to determine the best overall suture material to close incisions from the surgical implantation of Juvenile Salmon Acoustic Telemetry System (JSATS) acoustic microtransmitters in subyearling Chinook salmon Oncorhynchus tshawytscha. The effects of seven suture materials, four surgeons, and two water temperatures on suture retention, incision openness, tag retention, tissue inflammation, and tissue ulceration were quantified. The laboratory study, conducted by researchers at the Pacific Northwest National Laboratory, supports a larger effort under way for the U.S. Army Corps of Engineers, Portland District, aimed at determining the suitability of acoustic telemetry for estimating short- and longer-term (30-60 days) juvenile-salmonid survival at Columbia and Snake River dams and through the lower Columbia River.

  20. Novel high efficient coatings for anti-microbial surgical sutures using chlorhexidine in fatty acid slow-release carrier systems.

    PubMed

    Obermeier, Andreas; Schneider, Jochen; Wehner, Steffen; Matl, Florian Dominik; Schieker, Matthias; von Eisenhart-Rothe, Rüdiger; Stemberger, Axel; Burgkart, Rainer

    2014-01-01

    Sutures can cause challenging surgical site infections, due to capillary effects resulting in bacteria permeating wounds. Anti-microbial sutures may avoid these complications by inhibiting bacterial pathogens. Recently, first triclosan-resistances were reported and therefore alternative substances are becoming clinically relevant. As triclosan alternative chlorhexidine, the "gold standard" in oral antiseptics was used. The aim of the study was to optimize novel slow release chlorhexidine coatings based on fatty acids in surgical sutures, to reach a high anti-microbial efficacy and simultaneously high biocompatibility. Sutures were coated with chlorhexidine laurate and chlorhexidine palmitate solutions leading to 11, 22 or 33 µg/cm drug concentration per length. Drug release profiles were determined in aqueous elutions. Antibacterial efficacy against Staphylococcus aureus was assessed in agar diffusion tests. Biocompatibility was evaluated via established cytotoxicity assay (WST-1). A commercially triclosan-containing suture (Vicryl Plus), was used as anti-microbial reference. All coated sutures fulfilled European Pharmacopoeia required tensile strength and proved continuous slow drug release over 96 hours without complete wash out of the coated drug. High anti-microbial efficacy for up to 5 days was observed. Regarding biocompatibility, sutures using 11 µg/cm drug content displayed acceptable cytotoxic levels according to ISO 10993-5. The highest potential for human application were shown by the 11 µg/cm chlorhexidine coated sutures with palmitic acid. These novel coated sutures might be alternatives to already established anti-microbial sutures such as Vicryl Plus in case of triclosan-resistance. Chlorhexidine is already an established oral antiseptic, safety and efficacy should be proven for clinical applications in anti-microbial sutures. PMID:24983633

  1. Surgical Staples Compared With Subcuticular Suture for Skin Closure After Cesarean Delivery: A Randomized Controlled Trial

    PubMed Central

    Figueroa, Dana; Jauk, Victoria Chapman; Szychowski, Jeff M.; Garner, Rachel; Biggio, Joseph R.; Andrews, William W.; Hauth, John; Tita, Alan T. N.

    2013-01-01

    Objective To compare the risk of cesarean wound disruption or infection after closure with surgical staples compared with subcuticular suture. Methods Women with viable pregnancies at 24 weeks of gestation or greater undergoing scheduled or unscheduled cesarean delivery were randomized to wound closure with surgical staples or absorbable suture. Staples were removed at postoperative days 3-4 for low transverse incisions and days 7-10 for vertical incisions. Standardized wound evaluations were performed at discharge (days 3-4) and 4-6 weeks post-operatively. The primary outcome was a composite of wound disruption or infection within 4-6 weeks. Secondary outcomes included operative time, highest pain score on analog scale, cosmesis score and patient scar satisfaction score. Analyses were by intent-to-treat. Results Of 398 patients, 198 were randomized to staples and 200 to suture (but four received staples). Baseline characteristics including body mass index, prior cesarean, labor, and type of skin incision were similar by group. The primary outcome incidence at hospital discharge was 7.1% for staples and 0.5% for suture; P <0.001 (RR 14.1; 95% CI 1.9-106). Of 350 (87.9%) with follow up at 4-6 weeks, the cumulative risk of the primary outcome at 4-6 weeks was 14.5% for staples and 5.9% for suture; P=0.008 (RR 2.5; 95% CI 1.2-5.0). Operative time, pain scores at 72-96 hours and at 6 weeks, cosmesis score, and patient satisfaction score did not differ by group. Conclusion Staples closure compared with suture is associated with significantly increased composite wound morbidity after cesarean delivery. PMID:23262925

  2. Self-tapping ability of carbon fibre reinforced polyetheretherketone suture anchors.

    PubMed

    Feerick, Emer M; Wilson, Joanne; Jarman-Smith, Marcus; Ó'Brádaigh, Conchur M; McGarry, J Patrick

    2014-10-01

    An experimental and computational investigation of the self-tapping ability of carbon fibre reinforced polyetheretherketone (CFR-PEEK) has been conducted. Six CFR-PEEK suture anchor designs were investigated using PEEK-OPTIMA® Reinforced, a medical grade of CFR-PEEK. Experimental tests were conducted to investigate the maximum axial force and torque required for self-taping insertion of each anchor design. Additional experimental tests were conducted for some anchor designs using pilot holes. Computational simulations were conducted to determine the maximum stress in each anchor design at various stages of insertion. Simulations also were performed to investigate the effect of wall thickness in the anchor head. The maximum axial force required to insert a self-tapping CFR-PEEK suture anchor did not exceed 150 N for any anchor design. The maximum torque required to insert a self-tapping CFR-PEEK suture anchor did not exceed 0.8 Nm. Computational simulations reveal significant stress concentrations in the region of the anchor tip, demonstrating that a re-design of the tip geometry should be performed to avoid fracture during self-tapping, as observed in the experimental component of this study. This study demonstrates the ability of PEEK-OPTIMA Reinforced suture anchors to self-tap polyurethane foam bone analogue. This provides motivation to further investigate the self-tapping ability of CFR-PEEK suture anchors in animal/cadaveric bone. An optimised design for CFR-PEEK suture anchors offers the advantages of radiolucency, and mechanical properties similar to bone with the ability to self-tap. This may have positive implications for reducing surgery times and the associated costs with the procedure.

  3. Functional Effects of Delivering Human Mesenchymal Stem Cell-Seeded Biological Sutures to an Infarcted Heart.

    PubMed

    Hansen, Katrina J; Favreau, John T; Guyette, Jacques P; Tao, Ze-Wei; Coffin, Spencer T; Cunha-Gavidia, Anny; D'Amore, Brian; Perreault, Luke R; Fitzpatrick, John P; DeMartino, Angelica; Gaudette, Glenn R

    2016-01-01

    Stem cell therapy has the potential to improve cardiac function after myocardial infarction (MI); however, existing methods to deliver cells to the myocardium, including intramyocardial injection, suffer from low engraftment rates. In this study, we used a rat model of acute MI to assess the effects of human mesenchymal stem cell (hMSC)-seeded fibrin biological sutures on cardiac function at 1 week after implant. Biological sutures were seeded with quantum dot (Qdot)-loaded hMSCs for 24 h before implantation. At 1 week postinfarct, the heart was imaged to assess mechanical function in the infarct region. Regional parameters assessed were regional stroke work (RSW) and systolic area of contraction (SAC) and global parameters derived from the pressure waveform. MI (n = 6) significantly decreased RSW (0.026 ± 0.011) and SAC (0.022 ± 0.015) when compared with sham operation (RSW: 0.141 ± 0.009; SAC: 0.166 ± 0.005, n = 6) (p < 0.05). The delivery of unseeded biological sutures to the infarcted hearts did not change regional mechanical function compared with the infarcted hearts (RSW: 0.032 ± 0.004, SAC: 0.037 ± 0.008, n = 6). The delivery of hMSC-seeded sutures exerted a trend toward increase of regional mechanical function compared with the infarcted heart (RSW: 0.057 ± 0.011; SAC: 0.051 ± 0.014, n = 6). Global function showed no significant differences between any group (p > 0.05); however, there was a trend toward improved function with the addition of either unseeded or seeded biological suture. Histology demonstrated that Qdot-loaded hMSCs remained present in the infarcted myocardium after 1 week. Analysis of serial sections of Masson's trichrome staining revealed that the greatest infarct size was in the infarct group (7.0% ± 2.2%), where unseeded (3.8% ± 0.6%) and hMSC-seeded (3.7% ± 0.8%) suture groups maintained similar infarct sizes. Furthermore, the remaining suture area was

  4. Functional Effects of Delivering Human Mesenchymal Stem Cell-Seeded Biological Sutures to an Infarcted Heart

    PubMed Central

    Hansen, Katrina J.; Favreau, John T.; Guyette, Jacques P.; Tao, Ze-Wei; Coffin, Spencer T.; Cunha-Gavidia, Anny; D'Amore, Brian; Perreault, Luke R.; Fitzpatrick, John P.; DeMartino, Angelica; Gaudette, Glenn R.

    2016-01-01

    Abstract Stem cell therapy has the potential to improve cardiac function after myocardial infarction (MI); however, existing methods to deliver cells to the myocardium, including intramyocardial injection, suffer from low engraftment rates. In this study, we used a rat model of acute MI to assess the effects of human mesenchymal stem cell (hMSC)-seeded fibrin biological sutures on cardiac function at 1 week after implant. Biological sutures were seeded with quantum dot (Qdot)-loaded hMSCs for 24 h before implantation. At 1 week postinfarct, the heart was imaged to assess mechanical function in the infarct region. Regional parameters assessed were regional stroke work (RSW) and systolic area of contraction (SAC) and global parameters derived from the pressure waveform. MI (n = 6) significantly decreased RSW (0.026 ± 0.011) and SAC (0.022 ± 0.015) when compared with sham operation (RSW: 0.141 ± 0.009; SAC: 0.166 ± 0.005, n = 6) (p < 0.05). The delivery of unseeded biological sutures to the infarcted hearts did not change regional mechanical function compared with the infarcted hearts (RSW: 0.032 ± 0.004, SAC: 0.037 ± 0.008, n = 6). The delivery of hMSC-seeded sutures exerted a trend toward increase of regional mechanical function compared with the infarcted heart (RSW: 0.057 ± 0.011; SAC: 0.051 ± 0.014, n = 6). Global function showed no significant differences between any group (p > 0.05); however, there was a trend toward improved function with the addition of either unseeded or seeded biological suture. Histology demonstrated that Qdot-loaded hMSCs remained present in the infarcted myocardium after 1 week. Analysis of serial sections of Masson's trichrome staining revealed that the greatest infarct size was in the infarct group (7.0% ± 2.2%), where unseeded (3.8% ± 0.6%) and hMSC-seeded (3.7% ± 0.8%) suture groups maintained similar infarct sizes. Furthermore, the remaining suture area

  5. Non-absorbable suture granuloma mimicking a retroperitoneal metastatic implant in a patient with sigmoid neoplasm.

    PubMed

    Martínez-Martínez, Alberto; García-Espinosa, Jade

    2016-09-01

    The development of a foreign body granuloma from non-absorbable suture is a relatively uncommon condition, exceptional in the retroperitoneum of patients operated on for colorectal surgery. We report the case of a patient with a history of sigmoid neoplasm showing a retroperitoneal nodule on CT and high activity on PET, mimicking a tumor implant. Pathology found a foreign body granuloma. Foreign body granuloma from suture is a condition that may look identical to tumor relapse or metastatic disease on CT and PET scans, thus requiring pathology confirmation. PMID:27615018

  6. Functional Effects of Delivering Human Mesenchymal Stem Cell-Seeded Biological Sutures to an Infarcted Heart

    PubMed Central

    Hansen, Katrina J.; Favreau, John T.; Guyette, Jacques P.; Tao, Ze-Wei; Coffin, Spencer T.; Cunha-Gavidia, Anny; D'Amore, Brian; Perreault, Luke R.; Fitzpatrick, John P.; DeMartino, Angelica; Gaudette, Glenn R.

    2016-01-01

    Abstract Stem cell therapy has the potential to improve cardiac function after myocardial infarction (MI); however, existing methods to deliver cells to the myocardium, including intramyocardial injection, suffer from low engraftment rates. In this study, we used a rat model of acute MI to assess the effects of human mesenchymal stem cell (hMSC)-seeded fibrin biological sutures on cardiac function at 1 week after implant. Biological sutures were seeded with quantum dot (Qdot)-loaded hMSCs for 24 h before implantation. At 1 week postinfarct, the heart was imaged to assess mechanical function in the infarct region. Regional parameters assessed were regional stroke work (RSW) and systolic area of contraction (SAC) and global parameters derived from the pressure waveform. MI (n = 6) significantly decreased RSW (0.026 ± 0.011) and SAC (0.022 ± 0.015) when compared with sham operation (RSW: 0.141 ± 0.009; SAC: 0.166 ± 0.005, n = 6) (p < 0.05). The delivery of unseeded biological sutures to the infarcted hearts did not change regional mechanical function compared with the infarcted hearts (RSW: 0.032 ± 0.004, SAC: 0.037 ± 0.008, n = 6). The delivery of hMSC-seeded sutures exerted a trend toward increase of regional mechanical function compared with the infarcted heart (RSW: 0.057 ± 0.011; SAC: 0.051 ± 0.014, n = 6). Global function showed no significant differences between any group (p > 0.05); however, there was a trend toward improved function with the addition of either unseeded or seeded biological suture. Histology demonstrated that Qdot-loaded hMSCs remained present in the infarcted myocardium after 1 week. Analysis of serial sections of Masson's trichrome staining revealed that the greatest infarct size was in the infarct group (7.0% ± 2.2%), where unseeded (3.8% ± 0.6%) and hMSC-seeded (3.7% ± 0.8%) suture groups maintained similar infarct sizes. Furthermore, the remaining suture area

  7. Preventing Cauliflower Ear with a Modified Tie-Through Technique.

    ERIC Educational Resources Information Center

    Dimeff, Robert J.; Hough, David O.

    1989-01-01

    Describes a quick, simple tie-through suture technique (in which a collodion packing is secured to the auricle with two buttons) for preventing cauliflower ear following external ear trauma in wrestlers and boxers. The technique ensures constant compression; multiple treatments for fluid reaccumulation are rarely necessary. (SM)

  8. Tissue reaction and surface morphology of absorbable sutures after in vivo exposure.

    PubMed

    Andrade, Miguel G S; Weissman, Ruben; Reis, Sílvia R A

    2006-10-01

    Tissue reaction to suture materials depends mainly on how the polymer they are composed of interacts with the tissues. There are few in vivo studies evaluating the suture material modifications resulting from its interaction with tissues. This paper aimed to study rat subcutaneous tissue reaction to irradiated polyglactin 910, polydioxanone, poliglecaprone 25 and chromic gut and its correlation with the ultra-structural alterations the materials undergo. The histological alterations were studied on the 1st, 2nd, 3rd, 7th and 14th day after suture implantations. In these periods, the materials were removed from the tissues and their surfaces were analyzed by scanning electron microscopy. Irradiated polyglactin 910 stimulated the formation of multinucleated giant cells and its filaments underwent cleavage and dissolution. In potydioxanone, a few inflammatory cells and scar fibrosis was observed, and triangular cracks appeared on its surface. Around the poliglecaprone 25, a diffused infiltration of a few mononuclear cells and fibrosis was recorded and formation of craters was observed on its surface. Chromic gut induced necrosis and granulation tissue and underwent dissolution in the tissues during the studied periods. In this study, it was observed that suture materials induced differentiated tissue reactions and morphologic surface changes, suggesting that indications should be individualized. PMID:16977393

  9. Significantly Reducing Post-Tonsillectomy Haemorrhage Requiring Surgery by Suturing the Faucial Pillars: A Retrospective Analysis

    PubMed Central

    Senska, Götz; Schröder, Hilal; Pütter, Carolin; Dost, Philipp

    2012-01-01

    Background The tonsillectomy is one of the most frequently performed surgical procedures. Given the comparatively frequent postsurgical bleeding associated with this procedure, particular attention has been paid to reduction of the postoperative bleeding rate. In 2006, we introduced routine suturing of the faucial pillars at our clinic to reduce postoperative haemorrhage. Methods Two groups from the years 2003–2005 (n = 1000) and 2007–2009 (n = 1000) have been compared. We included all patients who had an elective tonsillectomy due to a benign, non-acute inflammatory tonsil illness. In the years 2007–2009, we additionally sutured the faucial pillars after completing haemostasis. For primary haemostasis we used suture ligation and bipolar diathermy. Results The rate of bleeding requiring second surgery for haemostasis was 3.6% in 2003–2005 but only 2.0% in 2007–2009 (absolute risk reduction 1.6% (95% CI 0.22%–2.45%, p = 0.04)). The median surgery time—including adenoidectomy and paracentesis surgery—increased from 25 to 31 minutes (p<0.01). Conclusions We have been able to substantiate that suturing of the faucial pillars nearly halves the rate of postoperative haemorrhage. Surgery takes 8 minutes longer on average. Bleeding occurs later, mostly after 24 h. The limitations of this study relate to its retrospective character and all the potential biases related to observational studies. PMID:23118902

  10. Effects of force magnitude on a sutural model: a quantitative approach

    SciTech Connect

    Southard, K.A.; Forbes, D.P.

    1988-06-01

    In an effort to quantify the biologic effects of an orthodontic tensile force, the rat interpremaxillary suture was investigated as a model for the periodontal ligament and expanded in vivo with a helical spring across the maxillary incisors. Three levels of force were used: light (50 to 75 g), medium (150 to 175 g), and heavy (250 to 300 g). Thymidine labeling and histologic studies after 12 hours and 1, 2, and 4 days of force delivery are described (n = 48 rats), as are biochemical studies after 2 and 4 days including a 6-hour organ culture (n = 32). The percentage of labeled cells increased significantly in all force groups at 1 day, followed by a rapid decline at 2 days, to a value at 4 days not significantly different from the controls. Biochemical studies showed significant increases in proline incorporation and alkaline phosphatase activity after 2 days of heavy force application. Histologic examinations showed obvious tissue changes beginning by day 1 and involving increases in suture width, vascularity, size and number of cells, amount of osteoid production, and changes in suture morphology. The experimental system was convenient, inflammation-free, and appeared to be reliable as evidenced by characteristic, synchronous tissue and autoradiographic changes in all experimental sutures through 4 days.

  11. IMMEDIATE AND LATE EFFECT OF SUTURES IN EXTRASYNOVIAL TENDONS: BIOMECHANICAL STUDY IN RATS

    PubMed Central

    Sardenberg, Trajano; Muller, Sérgio Swain; Garms, Luciana Zauhy; Miduati, Francini Belluci

    2015-01-01

    Objective: The aim of this study was to evaluate the effects on the mechanical properties of rats’ calcaneus tendons, of repair arrangements using suture material in the absence of any healing process. Method: Twelve male Wistar rats were used. They were subjected to placement of a modified Kessler suture stitch in the calcaneus tendon. The sacrifices were performed immediately after and six weeks after the operation. The mechanical properties studied were maximum load, tension in the maximum load and module of elasticity. The contralateral tendon was used as a control. Results: The statistical analysis showed that for the times studied, the values for mechanical properties did not present any significant differences. In relation to the control, i.e. the contralateral tendon without a suture, the results demonstrated that, six weeks after the operation, the values for the modulus of elasticity were lower, whereas there were no significant variations in maximum load or tension at maximum load. Conclusion: Placement of suture material on an extrasynovial tendon without lesions decreased the modulus of elasticity, but it did not interfere with the maximum load or tension at maximum load, six weeks after the operation. PMID:27047823

  12. Evaluation of four suture materials for surgical incision closure in Siberian sturgeon

    USGS Publications Warehouse

    Boone, S. Shaun; Hernandez, Sonia M.; Camus, Alvin C.; Peterson, Douglas C.; Jennings, Cecil A.; Shelton, James L.; Divers, Stephen J.

    2015-01-01

    The visual and microscopic tissue reactions to the absorbable monofilament Monocryl, absorbable monofilament triclosan-coated Monocryl-Plus, absorbable multifilament Vicryl, and nonabsorbable monofilament Prolene were evaluated for their use of surgical closure in Siberian Sturgeon Acipenser baerii. Postoperative assessments were conducted at 1, 2, 8, 12, and 26 and 55 weeks to visually evaluate the surgical incision for suture retention, incision healing, erythema, and swelling. Incisions were also assessed microscopically at 1, 2, and 8 weeks for necrosis, inflammation, hemorrhage, and fibroplasia. The results indicated that incisions closed with either Vicryl or Prolene suture materials were more likely to exhibit more erythema or incomplete healing compared with those closed with Monocryl or Monocryl-Plus. The surgical implantation of a transmitter in the coelomic cavity did not significantly affect the response variables among the four suture materials. Monocryl or Monocryl-Plus were equally effective and superior to other suture materials used for closing surgical incisions in Siberian Sturgeon or closely related species of sturgeon. Furthermore, Monocryl or Monocryl-Plus may decrease the risk of transmitter expulsion through the incision, as surgical wounds appear to heal faster and exhibit less erythema compared with those closed with Vicryl.

  13. A Wireless Sensor for Real-Time Monitoring of Tensile Force on Sutured Wound Sites.

    PubMed

    DeRouin, Andrew; Pacella, Nina; Zhao, Chunfeng; An, Kai-Nan; Ong, Keat Ghee

    2016-08-01

    A new wireless sensor was designed, fabricated, and applied for in situ monitoring of tensile force at a wound site. The sensor was comprised of a thin strip of magnetoelastic material with its two ends connected to suture threads for securing the sensor across a wound repair site. Since the sensor was remotely interrogated by applying an ac magnetic field and capturing the resulting magnetic field, it did not require direct wire connections to an external device or internal battery for long-term use. Due to its magnetoelastic property, the application of a tensile force changed the magnetic permeability of the sensor, altering the amplitude of the measured magnetic field. This study presents two sensor designs: one for high and one for low-force ranges. A sensor was fabricated by directly adhering the magnetoelastic strip to the suture. This sensor showed good sensitivity at low force, but its response saturated at about 1.5 N. To monitor high tensile force, the magnetoelastic strip was attached to a metal strip for load sharing. The suture thread was attached to the both ends of the metal strip so only a fraction of the applied force was directed to the sensor, allowing it to exhibit good sensitivity even at 44.5 N. The sensor was applied to two ex vivo models: a sutured section of porcine skin and a whitetail deer Achilles tendon. The results demonstrate the potential for in vivo force monitoring at a wound repair site. PMID:26340766

  14. 21 CFR 878.4494 - Absorbable poly(hydroxybutyrate) surgical suture produced by recombinant DNA technology.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... produced by recombinant DNA technology. 878.4494 Section 878.4494 Food and Drugs FOOD AND DRUG... recombinant DNA technology. (a) Identification. An absorbable poly(hydroxybutyrate) surgical suture is an... deoxyribonucleic acid (DNA) technology. The device is intended for use in general soft tissue approximation...

  15. 21 CFR 878.4494 - Absorbable poly(hydroxybutyrate) surgical suture produced by recombinant DNA technology.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... produced by recombinant DNA technology. 878.4494 Section 878.4494 Food and Drugs FOOD AND DRUG... recombinant DNA technology. (a) Identification. An absorbable poly(hydroxybutyrate) surgical suture is an... deoxyribonucleic acid (DNA) technology. The device is intended for use in general soft tissue approximation...

  16. 21 CFR 878.4494 - Absorbable poly(hydroxybutyrate) surgical suture produced by recombinant DNA technology.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... produced by recombinant DNA technology. 878.4494 Section 878.4494 Food and Drugs FOOD AND DRUG... recombinant DNA technology. (a) Identification. An absorbable poly(hydroxybutyrate) surgical suture is an... deoxyribonucleic acid (DNA) technology. The device is intended for use in general soft tissue approximation...

  17. 21 CFR 878.4494 - Absorbable poly(hydroxybutyrate) surgical suture produced by recombinant DNA technology.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... produced by recombinant DNA technology. 878.4494 Section 878.4494 Food and Drugs FOOD AND DRUG... recombinant DNA technology. (a) Identification. An absorbable poly(hydroxybutyrate) surgical suture is an... deoxyribonucleic acid (DNA) technology. The device is intended for use in general soft tissue approximation...

  18. 21 CFR 878.4494 - Absorbable poly(hydroxybutyrate) surgical suture produced by recombinant DNA technology.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... produced by recombinant DNA technology. 878.4494 Section 878.4494 Food and Drugs FOOD AND DRUG... recombinant DNA technology. (a) Identification. An absorbable poly(hydroxybutyrate) surgical suture is an... deoxyribonucleic acid (DNA) technology. The device is intended for use in general soft tissue approximation...

  19. Crustal-scale duplexing beneath the Yarlung Zangbo suture in the western Himalaya

    NASA Astrophysics Data System (ADS)

    Gao, Rui; Lu, Zhanwu; Klemperer, Simon L.; Wang, Haiyan; Dong, Shuwen; Li, Wenhui; Li, Hongqiang

    2016-07-01

    The fate of the Indian plate during continental collision with Asian terranes, and the proportion of the Indian crust that is underthrust or subducted beneath Tibet as opposed to transferred to the upper (Himalayan) plate, are much debated. The active geometry of low-angle underthrusting or subduction of the Indian plate beneath the Lesser and Greater Himalayan thrust sheets is well known from seismic imaging. Previously, only lower-resolution images of the Main Himalayan Thrust have been obtained beneath the Yarlung Zangbo suture that separates Indian and Asian rocks at the surface. It remains controversial whether the orogenic wedge between the Main Himalayan Thrust and the Yarlung Zangbo suture, formed of Indian crust transferred to the upper plate, is evolving by thrust-faulting in a critical-taper wedge or by southward extrusion of a ductile channel flow. Here we present a seismic reflection profile across the western Himalaya at 81.5° E, and show that the Main Himalayan Thrust dips ~20° to ~60 km depth beneath the Yarlung Zangbo suture, approaching a continuous Moho reflection at ~70-75 km depth. The Indian crust being transported northwards beyond the Yarlung Zangbo suture is no more than ~15 km thick, reduced from its original ~40 km thickness by transfer of material from the lower plate to the upper plate through crustal-scale duplexing.

  20. 21 CFR 878.4493 - Absorbable poly(glycolide/l-lactide) surgical suture.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Absorbable poly(glycolide/l-lactide) surgical suture. 878.4493 Section 878.4493 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...

  1. 21 CFR 878.5000 - Nonabsorbable poly(ethylene terephthalate) surgical suture.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nonabsorbable poly(ethylene terephthalate) surgical suture. 878.5000 Section 878.5000 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES...

  2. 21 CFR 878.4493 - Absorbable poly(glycolide/l-lactide) surgical suture.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Absorbable poly(glycolide/l-lactide) surgical suture. 878.4493 Section 878.4493 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...

  3. 21 CFR 878.4493 - Absorbable poly(glycolide/l-lactide) surgical suture.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Absorbable poly(glycolide/l-lactide) surgical suture. 878.4493 Section 878.4493 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...

  4. 21 CFR 878.4493 - Absorbable poly(glycolide/l-lactide) surgical suture.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Absorbable poly(glycolide/l-lactide) surgical suture. 878.4493 Section 878.4493 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...

  5. 21 CFR 878.5000 - Nonabsorbable poly(ethylene terephthalate) surgical suture.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nonabsorbable poly(ethylene terephthalate) surgical suture. 878.5000 Section 878.5000 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES...

  6. 21 CFR 878.4493 - Absorbable poly(glycolide/l-lactide) surgical suture.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Absorbable poly(glycolide/l-lactide) surgical suture. 878.4493 Section 878.4493 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices §...

  7. Transpressive suture and flower structure: the Tomar-Badajoz-Cordoba shear zone, SW Iberia

    NASA Astrophysics Data System (ADS)

    Marti Linares, D.; Palomeras, I.; Perez-Estaun, A.; Carbonell, R.; Simancas, F.; Ayarza, P.; Tejero, R.; Martín-Parra, L.; Matas, J.; Lodeiro, F.; Mansilla, L.

    2009-12-01

    The Tomar-Badajoz-Córdoba shear Zone (TBCSZ) is a major structural element located in SW-Iberia. This is considered a suture that separates the Central Iberian Zone (CIZ) in NE and Ossa Morena Zone (OMZ) in SW. It is at least 380km in length and 10 to 20km width. It is a left lateral transpressive flower structure. The strike-slip displacement decays from SE to NW. Its axial zone includes a high grade metamorphic rock unit known as the Central Unit (CU) containing eclogites, and also suture lithotypes as ophiolites. It has been interpreted as a Variscan suture or a reworked Cadomian suture in intraplate regime during the Variscan cycle. This important structure has been imaged by 2 deep seismic reflection transects, the IBERSEIS in 2003 and more recently by ALCUDIA. The good quality of the seismic data sets constrains the internal architecture of this transpressional zone imaging a crustal scale flower structure. The structure features a north dipping wedge limited by two bands of reflectors that reach the middle crust (5 s). Beneath that and slightly to the north a wedge of relatively high amplitude reflectivity dips to the south into the mantle for 10-15 km. This structure is most probably the seismic signature of a complex structure result of deformation associated to a strike slip fault.

  8. A Wireless Sensor for Real-Time Monitoring of Tensile Force on Sutured Wound Sites.

    PubMed

    DeRouin, Andrew; Pacella, Nina; Zhao, Chunfeng; An, Kai-Nan; Ong, Keat Ghee

    2016-08-01

    A new wireless sensor was designed, fabricated, and applied for in situ monitoring of tensile force at a wound site. The sensor was comprised of a thin strip of magnetoelastic material with its two ends connected to suture threads for securing the sensor across a wound repair site. Since the sensor was remotely interrogated by applying an ac magnetic field and capturing the resulting magnetic field, it did not require direct wire connections to an external device or internal battery for long-term use. Due to its magnetoelastic property, the application of a tensile force changed the magnetic permeability of the sensor, altering the amplitude of the measured magnetic field. This study presents two sensor designs: one for high and one for low-force ranges. A sensor was fabricated by directly adhering the magnetoelastic strip to the suture. This sensor showed good sensitivity at low force, but its response saturated at about 1.5 N. To monitor high tensile force, the magnetoelastic strip was attached to a metal strip for load sharing. The suture thread was attached to the both ends of the metal strip so only a fraction of the applied force was directed to the sensor, allowing it to exhibit good sensitivity even at 44.5 N. The sensor was applied to two ex vivo models: a sutured section of porcine skin and a whitetail deer Achilles tendon. The results demonstrate the potential for in vivo force monitoring at a wound repair site.

  9. ERCP-induced duodenal perforation successfully treated with endoscopic purse-string suture: a case report.

    PubMed

    Li, Quanpeng; Ji, Jie; Wang, Fei; Ge, Xianxiu; Nie, Junjie; Xu, Boming; Zhang, Xiuhua; Jiang, Guobing; Miao, Lin

    2015-07-10

    Duodenal perforation is one of the most serious complications of endoscopic retrograde cholangiopancreatography (ERCP) and is difficult to manage. Recently, endoscopic purse-string suture, using endoloops with endoclips, is a relatively new technology and has provided good clinical results. However, the study and use of endoscopic purse-string suture on duodenal perforation is less and its feasibility and safety are unknown. Here, we report a case of ERCP-induced duodenal perforation successfully treated with endoscopic purse-string suture. During ERCP, fluoroscopy revealed abnormal perinephric gas shadowing after breaking and extracting the stones with a stone-removal basket. Then duodenal endoscopy showed an approximately 2.0 cm × 1.5 cm perforation on the lateral duodenal wall, with visible retroperitoneal loose connective tissue. Titanium clips were used to attempt closure of the perforation but failed because of the long diameter of the injury. Therefore, an endoscopic purse-string suture, using endoloops with endoclips, was employed with an Olympus double-lumen endoscope. The perforation was successfully closed. At the 2-month follow-up visit, the patient had no complaints or symptoms. Our case once again proved its feasibility and safety and provided a new perspective for surgeons.

  10. 21 CFR 878.5000 - Nonabsorbable poly(ethylene terephthalate) surgical suture.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nonabsorbable poly(ethylene terephthalate) surgical suture. 878.5000 Section 878.5000 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... thread prepared from fibers of high molecular weight, long-chain, linear polyesters having...

  11. 21 CFR 878.5000 - Nonabsorbable poly(ethylene terephthalate) surgical suture.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonabsorbable poly(ethylene terephthalate) surgical suture. 878.5000 Section 878.5000 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... thread prepared from fibers of high molecular weight, long-chain, linear polyesters having...

  12. 21 CFR 878.5000 - Nonabsorbable poly(ethylene terephthalate) surgical suture.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nonabsorbable poly(ethylene terephthalate) surgical suture. 878.5000 Section 878.5000 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... thread prepared from fibers of high molecular weight, long-chain, linear polyesters having...

  13. Percutaneous Retrieval of a Central Venous Catheter Sutured to the Wall of the Right Atrium

    SciTech Connect

    Neuerburg, Joerg-M.; Guenther, Rolf W.; Chalabi, Khaled; Hunter, David

    1999-01-15

    A transjugular central venous catheter was inadvertently sutured to the wall of the right atrium in a 63-year-old female during coronary bypass surgery. Using two nitinol Goose Neck snares via a transfemoral and a transjugular approach the catheter was severed into two pieces and retrieved percutaneously.

  14. Hereditary premature closure of a coronal suture in the Abraham Lincoln family.

    PubMed

    Fishman, Ronald S

    2013-10-01

    The most easily recognized facial features of unilateral premature closure of a coronal suture in the skull are an upward arching of the superior orbital rim and a smaller face on the involved side. Photographs indicate that at least 9 individuals over 5 generations of the Abraham Lincoln family showed this anomaly.

  15. How to overcome severed sutures of the tibial bone peg in anterior cruciate ligament reconstruction.

    PubMed

    Yip, Daniel K H; Wong, Jimmy W K; Chien, Eric P

    2002-03-01

    We report a case of severed sutures of the tibial bone peg during anterior cruciate ligament reconstruction. The graft retracted proximally in the bone tunnel. We describe a simple and aesthetically acceptable method to salvage this rare complication by use of a small arthrotomy through the defect in the remaining patellar tendon.

  16. Closure of traumatic wounds without cleaning and suturing

    PubMed Central

    Maharaj, D; Sharma, D; Ramdass, M; Naraynsingh, V

    2002-01-01

    Background: In less than ideal situations wounds have to be closed without extensive cleaning using sterile adhesive strips (Steristrips). This prospective analyses the efficiency of this technique and compares it to the more conventional approach. Methods: Altogether 147 lacerations were closed with sterile strips with no wound cleaning. Patients were subsequently followed up for a minimum of three months. Results: The sepsis rate in compliant patients was 1.4% with a total complication rate of 2.7%. Conclusion: This technique, while contradicting the "sacred tenets" of wound closure, is a cheap, quick, and effective alternative to routine closure of traumatic wounds in a casualty department. PMID:12151570

  17. Halstedian technique revisited. Innovations in teaching surgical skills.

    PubMed

    Barnes, R W; Lang, N P; Whiteside, M F

    1989-07-01

    This paper reviews the laboratory models used to teach fundamental surgical skills in our general surgery residency. The laboratory modules allow supervision and self-instruction, practice, and videotape monitoring of the following techniques: skin incision, suturing, knot tying, hemostasis, vascular anastomosis, and intestinal anastomosis. Pigs' feet simulate human skin for exercises in skin incision, lesion excision, suturing, and basic plastic surgical techniques. Latex tubing and penrose drains allow experience in suturing, knot tying, and hemostasis. Polytetrafluoroethylene vascular prostheses permit quantification of the precision of needle passage and suturing by measurement of leakage of water through a vascular anastomosis. Reconstituted, lyophilized, irradiated bovine arteries and ileum provide models of biologic tissue for creating handsewn vascular anastomoses and sutured or stapled gastrointestinal anastomoses. A headlamp videocamera allows unobstructive recording of the resident's technical performance and provides subsequent visual feedback for self-improvement when compared to reference instructional videotapes. We feel that these innovations may enhance surgical dexterity of residents without the need for animal sacrifice. Our goal is to foreshorten the learning curve for basic surgical skills and improve performance in the clinical operating room.

  18. Successful repair of recurrent rectovaginal fistula by stratified suture using transanal endoscopic microsurgery

    PubMed Central

    Chen, Weijie; Chen, Xin; Lin, Guole; Qiu, Huizhong

    2016-01-01

    Abstract Background: Rectovaginal fistulas (RVFs) are abnormal connections between the rectum and vagina. Although many surgical approaches to correct them have been attempted, management of RVFs still remains a challenge, especially for recurrent RVFs. Methods: In the present study, we report a case in a 22-year-old female with a chief complaint of obvious passages of flatus or stool through the vagina for 10 years. She had suffered a vaginal trauma from a violent accident 10 years prior, and gradually noticed the uncontrollable passage of gas or feces from the vagina 2 weeks later. The patient underwent a transvaginal direct repair surgery at local hospital 9 years ago, but the symptoms recurred 1 month after the surgery. After 2-years monitoring, the patient underwent another transvaginal repair surgery (fistulectomy followed by direct suture) at another hospital, but the fistula recurred again. We initially performed a temporary protective transversostomy upon admission. After 8-months of observation, a methylene blue test was conducted and the diagnosis of recurrent RVF was confirmed. Subsequently, we performed a successful repair by stratified suture using transanal endoscopic microsurgery (TEM). The scar tissue on the posterior wall of the vagina and the anterior wall of the rectum were meticulously excised until the margin of the excisional line showed healthy tissue. In addition, the fistulous tract was completely removed. The edges of the fistula on the posterior wall of the vagina were closed by simple continuous suturing, and the rectal anterior wall was sutured in the same manner. Results: During a 1-year follow-up period, the fistulae were not recurrent and no complication such as incontinences or rectal bleeding were found. The latest Wexner score was 3. Conclusion: We present a case of successful treatment with stratified suture using TEM throughout the procedure. We strongly recommend this efficient and minimally invasive procedure for recurrent

  19. Laparoscopic Suturing Skills Acquisition: A Comparison Between Laparoscopy-Exposed and Laparoscopy-Naive Surgeons

    PubMed Central

    Tamang, Tseten; Misra, Mahesh C.; Prakash, Pradeep; Rajan, Karthik; Bhattacharjee, Hemanga K.; Kumar, Subodh; Goswami, Amit

    2012-01-01

    Background: Laparoscopic suturing is a difficult skill to master but can be acquired with extensive training outside the operating room. This study was done with the primary aim of assessing whether prior exposure to laparoscopic surgery helped trainees in acquiring laparoscopic suturing skills more quickly than trainees with no prior exposure to laparoscopic surgery. Materials and Methods: Twenty laparoscopy-exposed and 20 laparoscopy-naïve surgeons performed 5 laparoscopic gastrojejunostomies each on a phantom porcine model. The performance was evaluated for operation time, overall anastomotic score (calculated by adding scores of anastomotic leak, size of the anastomosis, suture placement, and mucosal approximation), and the level of difficulty. The performance at the beginning of training (baseline) was compared to the performance at the end of training. Results: All participants showed statistically significant improvement in operation time, overall anastomotic score, and difficulty level. Laparoscopy-exposed surgeons had a significantly better operation time than laparoscopy-naïve surgeons at the beginning of training; however, the difference became insignificant by the end of training. The difference in overall anastomotic score was not significant between laparoscopy-exposed and naïve-surgeons. Laparoscopy-exposed surgeons showed significant improvements in anastomotic leak rate and size of the anastomosis, whereas laparoscopy naïve surgeons showed improvements in all the parameters, although these were not significant statistically. Conclusion: Training improves the laparoscopic suturing skills of laparoscopy-exposed as well as laparoscopy-naïve surgeons. Prior experience in laparoscopic surgery does not seem to influence the acquisition of laparoscopic suturing skills as laparoscopic-naïve surgeons manage to catch up with the skills of the laparoscopy-exposed surgeons. PMID:23484575

  20. Mesozoic ophiolites, sutures, and arge-scale tectonic movements in Afghanistan

    NASA Astrophysics Data System (ADS)

    Tapponnier, Paul; Mattauer, Maurice; Proust, François; Cassaigneau, Christian

    1981-02-01

    The tectonic history of Afghanistan appears to be the result of successive accretion of fragments of Gondwana to the active margin of Laurasia since the end of the Paleozoic. The margin, in Afghanistan, lies along the present Herat and Panjshir faults, south of Hindu Kush, swings around the central Pamirs and can presumably be traced along the present western Altyn Tagh and Kunlun faults in Tibet. North of this boundary, Paleozoic rocks have been deformed in the Upper Paleozoic, whereas south of it, there is no trace of the Hercynian orogeny. The first collision of Gondwanian fragments with Laurasia probably occurred in the early Mesozoic along the Hindu Kush and Kunlun. To the south, ophiolites along the Panjao and Pangong-Nu Chiang sutures (respectively in central Afghanistan and central Tibet) testify for another suturing event in the Upper Jurassic or Lower Cretaceous. The Indus-Tsangpo suture between India and Tibet corresponds, in eastern Afghanistan, to two ophiolite subbelts, near Kabul and Khost. Both ophiolite complexes have been emplaced between Maestrichtian and Lower Eocene by choking of two northward-dipping subduction zones. After complete contact between the Indian and Asian continents was achieved, presumably in the end of Eocene, the penetration of India into Asia caused large-scale intra-continental shortening. A large part of the shortening was accommodated by strike-slip faulting along Mesozoic and more ancient sutures. Central Afghanistan, in particular, was extruded to the west along the Herat suture by the protrusion of the Pamir wedge. It subsequently collided with the Lut block.

  1. Acromioclavicular joint reconstruction using a tendon graft: a biomechanical study comparing a novel “sutured throughout” tendon graft to a standard tendon graft

    PubMed Central

    Naziri, Qais; Williams, Nadine; Hayes, Westley; Kapadia, Bhaveen H.; Chatterjee, Dipal; Urban, William P.

    2016-01-01

    Background: With a recurrence rate of over 30%, techniques that offer stronger acromioclavicular (AC) joint reconstruction through increased graft strength may provide longevity. The purpose of our study was to determine the biomechanical strength of a novel tendon graft sutured throughout compared to a native tendon graft in Grade 3 anatomical AC joint reconstruction. Methods: For this in vitro experiment, nine paired (n = 18) embalmed cadaveric AC joints of three males and six females (age 86 years, range 51–94 years) were harvested. Anatomic repair with fresh bovine Achilles tendon grafts without bone block was simulated. Specimens were divided into two groups; with group 1 using grafts with ultra-high molecular-weight polyethylene (UHMWPE) suture ran throughout the entire length. In group 2, reconstruction with only native allografts was performed. The distal scapula and humerus were casted in epoxy compound and mounted on the mechanical testing machine. Tensile tests were performed using a mechanical testing machine at the rate of 50 mm/min. Maximum load and displacement to failure were collected. Results: The average load to failure was significantly higher for group 1 compared to group 2, with mean values of 437.5 N ± 160.7 N and 94.4 N ± 43.6 N, (p = 0.001). The average displacement to failure was not significantly different, with 29.7 mm ± 10.6 mm in group 1 and 25 mm ± 9.1 mm in group 2 (p = 0.25). Conclusion: We conclude that a UHMWPE suture reinforced graft can provide a 3.6 times stronger AC joint reconstruction compared to a native graft. PMID:27163106

  2. LigLAP: Encirclement and Ligation of Vessels in Laparoscopic Surgery: A Double-Layer Suture Sealing Approach.

    PubMed

    Yousefian, Reza; Jones, Paul; Kia, Michael A; Zadeh, Mehrdad Hosseini

    2015-12-01

    This article proposes a potential automatic ligation (LigLAP) method to occlude vessels and ducts in several laparoscopic surgical procedures. Currently, stapling devices are widely used for this purpose. However, there are some complications associated with stapling devices, including biliary leak and tissue damage. In this article, we examine the feasibility of an alternative method that uses a double-layer suture to encircle and occlude a vessel. A heating element melts the outer layer of the suture at the cross-point of the suture to create a seal. Several electromechanical mechanisms have been proposed to carry out this ligation process. In addition, some parts have been prototyped for experimental verification and visualization. Several double-layered sutures have been created, and their tensile strength and sealing capabilities have been measured. Moreover, a simple leakage experiment has been performed to verify experimentally the idea of using the double-layer suture. The results show that the new suture and the thermal sealing method provide the required strength to occlude balloons filled with water. Although the results suggest that the proposed method and the double-layer suture may be used in surgical ligation processes, much more rigorous testing of leakage is required. PMID:25918125

  3. The red-eared slider turtle carapace under fatigue loading: The effect of rib-suture arrangement.

    PubMed

    Achrai, Ben; Daniel Wagner, H

    2015-08-01

    Biological structures consisting of strong boney elements interconnected by compliant but tough collagenous sutures are abundantly found in skulls and shells of, among others, armadillos, alligators, turtles and more. In the turtle shell, a unique arrangement of alternating rigid (rib) and flexible (suture) elements gives rise to superior mechanical performance when subjected to low and high strain-rate loadings. However, the resistance to repeated load cycling - fatigue - of the turtle shell has yet to be examined. Such repeated loading could approximately simulate the consecutive high-stress bending loads exerted during (a predator) biting or clawing. In the present study flexural high-stress cyclic loads were applied to rib and suture specimens, taken from the top dorsal part of the red-eared slider turtle shell, termed carapace. Subsequently, to obtain a more complete and integrated fatigue behavior of the carapace, specimens containing a complex alternating rib-suture-rib-suture-rib configuration were tested as well. Although the sutures were found to be the least resistant to repeated loads, a synergistic effect was observed for the complex specimens, displaying improved fatigue durability compared to the individual (suture or even rib) constituents. This study may assist in the design of future high-stress fatigue-resistant materials incorporating complex assemblies of rigid and flexible elements. PMID:26042699

  4. Inhibition of secondary cartilage of the intermaxillary suture in Sprague-Dawley rats following the enucleation of maxillary molars

    SciTech Connect

    Forbes, D.P.; Al-Bareedi, S.

    1986-01-01

    A single craniofacial suture can undergo several morphologic transformations during its development. From 3 to 7 weeks of age, the intermaxillary suture of the rat is synchondrotic in character, featuring secondary cartilage; at later times, this suture is syndesmotic in character, featuring a fibrous tissue interface. Since intermittent mechanical stimulation has been reported to initiate secondary cartilage formation, a study was done to determine if the functioning dentition were responsible for secondary cartilage formation in the intermaxillary suture of the rat. Twenty-two female Sprague-Dawley rats were used. At 3 weeks of age, prior to eruption, the maxillary molars were enucleated from nine animals. Body weights were recorded weekly. Animals were sacrificed weekly from 4 to 7 weeks of age. One hour prior to sacrifice, each rat was injected with (/sup 35/S)sulfate at a dosage of 2 microCi/g body weight. The tissues were evaluated by light microscopy and autoradiography. In the experimental group, the midpalatal suture did not undergo the normal synchondrotic transformation. Instead, this suture remained fibrous with negligible metachromatic staining. In the control animals, the peak period of (/sup 35/S)sulfate incorporation was 4 weeks of age and was five times greater than in the experimental group. The primary stimulus for the initiation of secondary cartilage formation in the midpalatal suture of the rat was molar function. Also, functioning molars were found to be important in the maintenance of the palatal bone.

  5. The red-eared slider turtle carapace under fatigue loading: The effect of rib-suture arrangement.

    PubMed

    Achrai, Ben; Daniel Wagner, H

    2015-08-01

    Biological structures consisting of strong boney elements interconnected by compliant but tough collagenous sutures are abundantly found in skulls and shells of, among others, armadillos, alligators, turtles and more. In the turtle shell, a unique arrangement of alternating rigid (rib) and flexible (suture) elements gives rise to superior mechanical performance when subjected to low and high strain-rate loadings. However, the resistance to repeated load cycling - fatigue - of the turtle shell has yet to be examined. Such repeated loading could approximately simulate the consecutive high-stress bending loads exerted during (a predator) biting or clawing. In the present study flexural high-stress cyclic loads were applied to rib and suture specimens, taken from the top dorsal part of the red-eared slider turtle shell, termed carapace. Subsequently, to obtain a more complete and integrated fatigue behavior of the carapace, specimens containing a complex alternating rib-suture-rib-suture-rib configuration were tested as well. Although the sutures were found to be the least resistant to repeated loads, a synergistic effect was observed for the complex specimens, displaying improved fatigue durability compared to the individual (suture or even rib) constituents. This study may assist in the design of future high-stress fatigue-resistant materials incorporating complex assemblies of rigid and flexible elements.

  6. The European Academy laparoscopic “Suturing Training and Testing’’ (SUTT) significantly improves surgeons’ performance

    PubMed Central

    Sleiman, Z.; Tanos, V.; Van Belle, Y.; Carvalho, J.L.; Campo, R.

    2015-01-01

    The efficiency of suturing training and testing (SUTT) model by laparoscopy was evaluated, measuring the suturingskill acquisition of trainee gynecologists at the beginning and at the end of a teaching course. During a workshop organized by the European Academy of Gynecological Surgery (EAGS), 25 participants with three different experience levels in laparoscopy (minor, intermediate and major) performed the 4 exercises of the SUTT model (Ex 1: both hands stitching and continuous suturing, Ex 2: right hand stitching and intracorporeal knotting, Ex 3: left hand stitching and intracorporeal knotting, Ex 4: dominant hand stitching, tissue approximation and intracorporeal knotting). The time needed to perform the exercises is recorded for each trainee and group and statistical analysis used to note the differences. Overall, all trainees achieved significant improvement in suturing time (p < 0.005) as measured before and after completion of the training. Similar significantly improved suturing time differences (p < 0.005) were noted among the groups of trainees with different laparoscopic experience. In conclusion a short well-guided training course, using the SUTT model, improves significantly surgeon’s laparoscopic suturing ability, independently of the level of experience in laparoscopic surgery. Key words: Endoscopy, laparoscopic suturing, psychomotor skills, surgery, teaching, training suturing model. PMID:26977264

  7. LigLAP: Encirclement and Ligation of Vessels in Laparoscopic Surgery: A Double-Layer Suture Sealing Approach.

    PubMed

    Yousefian, Reza; Jones, Paul; Kia, Michael A; Zadeh, Mehrdad Hosseini

    2015-12-01

    This article proposes a potential automatic ligation (LigLAP) method to occlude vessels and ducts in several laparoscopic surgical procedures. Currently, stapling devices are widely used for this purpose. However, there are some complications associated with stapling devices, including biliary leak and tissue damage. In this article, we examine the feasibility of an alternative method that uses a double-layer suture to encircle and occlude a vessel. A heating element melts the outer layer of the suture at the cross-point of the suture to create a seal. Several electromechanical mechanisms have been proposed to carry out this ligation process. In addition, some parts have been prototyped for experimental verification and visualization. Several double-layered sutures have been created, and their tensile strength and sealing capabilities have been measured. Moreover, a simple leakage experiment has been performed to verify experimentally the idea of using the double-layer suture. The results show that the new suture and the thermal sealing method provide the required strength to occlude balloons filled with water. Although the results suggest that the proposed method and the double-layer suture may be used in surgical ligation processes, much more rigorous testing of leakage is required.

  8. [Endoscopically controlled optimization of trans-scleral suture fixation of posterior chamber lenses in the ciliary sulcus].

    PubMed

    Althaus, C; Sundmacher, R

    1993-08-01

    Two technical difficulties have to be overcome in transscleral suture fixation of posterior chamber intraocular lenses (PCL) in the ciliary sulcus: first, exact needle penetration through the sulcus, and second, exact positioning of the PCL haptics in the sulcus. Incongruence of the two may lead to long-term complications by compression or even strangulation of ciliary processes. Intraocular endoscopy was used intraoperatively to visualize the site of needle penetration and the final location of the haptics in patients. It turned out that with our previously described standard techniques the precision was far less than anticipated. Thus, new technical ways had to be sought to improve the precision of positioning. In secondary implantation without perforating keratoplasty we achieved the best results when the needle was passed ab externo before opening the eye and before anterior vitrectomy, taking advantage of a precisely prepared sclerocorneal zone. Passing the needle ab externo in an already hypotonic eyeball gives much less precise results. In combination with perforating keratoplasty with an open-sky approach, needle penetration ab interno is reliable. Correct positioning of the PCL haptics is at least as difficult as correct needle penetration, a fact which up to now has mostly been ignored. In 33 consecutively operated eyes the technique of implantation and PCL design was varied under endoscopical control.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. The utilization of a suture bridge construct for tibiofibular instability during transtibial amputation without distal bridge synostosis creation.

    PubMed

    Lewandowski, Louis R; Tintle, Scott M; D'Alleyrand, Jean-Claude G; Potter, Benjamin K

    2013-10-01

    Symptomatic distal tibiofibular instability is a known complication of trauma-related transtibial amputations. Overt proximal tibiofibular dislocations, which are easily recognized on routine radiographs, may occur concurrently with the traumatic injury or amputation. More commonly, however, the proximal tibiofibular joint remains structurally intact in the presence of distal instability due to the loss of the distal syndesmotic structures and damage to the interosseous membrane, resulting in fibular angulation and distal tibiofibular diastasis. Some authors have espoused treating this instability with the creation of a distal tibiofibular bridge synostosis (the so-called Ertl procedure or modifications there of) to prevent potentially painful discordant motion and to minimize the prominence of the residual distal fibula. Recent studies, however, have suggested an increase in complication and reoperation rates in transtibial amputations that received a bridge synostosis compared with standard transtibial amputations. Additionally, although there are several described techniques for bridge synostosis creation, most are dependent on having sufficient remaining fibula to construct the bone bridge without unnecessary shortening of the tibia; however, sufficient residual fibula is not always available after traumatic and trauma-related amputations. We propose a technique utilizing a suture bridge to restore tibiofibular stability when performing transtibial amputations in patients with proximal tibiofibular dislocations or distal diastasis, avoiding the potential need for a distal bridge synostosis.

  10. Endoscopic Suturing and Knot Tying: Theory Into Practice

    PubMed Central

    Murphy, Donald L.

    2001-01-01

    Objective To advance modern surgical techniques of endoscopic knot tying, encompassing a new appreciation of knot-tying theory and the application of second-generation, purpose-designed instruments. Summary Background Data During open surgery, surgeons automatically create the surgical half-hitch by using either instrument or hand/finger knot-tying methods (figure 4). Each of these methods, which are mirror images of each other, forms the same result, the half-hitch. Two opposing half-hitches are needed to form a square knot. There are many ways for new-generation instruments to create a secure square knot during endoscopic surgery. An overview of the current endoscopic knot-tying methods is presented. Methods The author presents a theoretical analysis of square knot-tying techniques as applied during instrument and hand/finger movements. The application of a mirror-image concept was considered in the analysis of these two contrasting methods. Results There are 12 ways to create a square knot, some of which have previously not been described or needed in open surgery. Some of these methods have particular application in endoscopic surgery. Conclusions A new understanding of knot-tying theory has been developed, with innovative methods being defined for tissue approximation during endoscopic surgery. These ergonomic, efficient, and contrasting methods of knot tying are described using second-generation endoscopic instruments. The new techniques have direct and broad application in many fields of minimally invasive surgery. PMID:11685022

  11. The potential of photoacoustic microscopy as a tool to characterize the in vivo degradation of surgical sutures

    PubMed Central

    Aguirre, Juan; Morales-Dalmau, Jordi; Funk, Lutz; Jara, Francesc; Turon, Pau; Durduran, Turgut

    2014-01-01

    The ex vivo and in vivo imaging, and quantitative characterization of the degradation of surgical sutures (∼500 μm diameter) up to ∼1cm depth is demonstrated using a custom dark-field photo-acoustic microscope (PAM). A practical algorithm is developed to accurately measure the suture diameter during the degradation process. The results from tissue simulating phantoms and mice are compared to ex vivo measurements with an optical microscope demonstrating that PAM has a great deal of potential to characterize the degradation process of surgical sutures. The implications of this work for industrial applications are discussed. PMID:25136508

  12. A New Look at the Lithospheric Structure of the Southern Rocky Mountains and the Cheyenne Belt Suture

    NASA Astrophysics Data System (ADS)

    Rumpfhuber, E.; Keller, G.; Velasco, A. A.

    2008-12-01

    We have used the Southern Rocky Mountains and the Cheyenne belt suture as a test bed for integrating tectonic scale controlled- and passive-source seismic datasets. The CD-ROM 1999 experiment in the western U.S. was an example of a multi-discipline geoscientific experiment, including a 1000 km long controlled-source seismic line that extended from central Wyoming to central New Mexico. In addition, two passive source seismic transacts focusing on the Cheyenne belt and the Jemez lineament were deployed for one year along the controlled-source seismic (CSS) line. For the large-scale refraction/wide-angle reflection seismic dataset, we applied a new picking strategy and forward-modeled and inverted the resulting seismic picks for a 2-D velocity and interface model of the area. Furthermore, we identified and picked the S-wave phases that were present, and established an independent S-wave velocity model, which allowed us to construct the Vp/Vs and Poisson's ratios. We calculated teleseismic receiver functions for the area based on northern passive seismic transect, which targeted the Cheyenne belt. We then applied a slant stacking technique to determine crustal thickness and Vp/Vs ratios, as well as common conversion point (CCP) stacking and migration techniques, which provide us with additional two-dimensional images of the target area. Only the joint interpretation of both the CSS and receiver function results enabled us to undertake a detailed interpretation of the Cheyenne belt area, which constitutes the transition zone between the 2.7 Ga Archean Wyoming craton to the north and the Proterozoic terranes to the south. The crustal structure is distinctively different between these two areas. A strong mid-crustal layer underneath the Wyoming craton was confirmed, which was identified in the earlier Deep Probe seismic experiment. Furthermore, this layer terminates at depth ~100 km north of the Cheyenne belt, which represents the surface expression of the suture. Our

  13. Magnetotelluric survey to locate the Archean/Proterozoic suture zone north of Wells, Nevada

    USGS Publications Warehouse

    Williams, Jackie M.; Rodriguez, Brian D.

    2006-01-01

    It is important to know whether major mining districts in the Northern Nevada Gold Province are underlain by rocks of the Archean Wyoming craton, which are known to contain orogenic gold deposits, or by accreted rocks of the Paleoproterozoic Mojave province. It is also important to know the location and orientation of the Archean/Proterozoic suture zone between these provinces as well as major basement structures within these terranes because they may influence subsequent patterns of sedimentation, deformation, magmatism, and hydrothermal activity. The Archean was the main gold-mineralization period, and Archean lode-gold deposits were formed at mid-crustal depths along major shear zones. The nature of the crystalline basement below the Northern Nevada Gold Province and the location of major faults within it are relevant to Rodinian reconstructions, crustal development, and ore deposit models (e.g., Hofstra and Cline, 2000; Grauch and others, 2003). According to Whitmeyer and Karlstrom (2004), the Archean cratons of the northwestern United States and Canada had stabilized as continental lithosphere by 2.5 Ga, and were rifted and assembled into a large continental mass by 1.8 Ga, to which the 1.73-1.68 Ga Mohave province was accreted by 1.65 Ga. The Archean/Proterozoic suture zone has a west-southwest strike where it is exposed (Reed, 1993) at the eastern Utah and southwestern Wyoming border (Cheyenne Belt) where it is characterized by an up to 7-km-thick mylonite zone (Smithson and Boyd, 1998). In the Great Basin, the strike of the Archean/Proterozoic suture zone is poorly constrained because it is largely concealed below a Neoproterozoic-Paleozoic miogeocline and basin fill. East-west and southwest-northeast strikes for the Archean/Proterozoic suture zone have been inferred based on Sr, Nd, and Pb isotopic compositions of granitoid intrusions (Tosdal and others, 2000). To better constrain the location and strike of the Archean/Proterozoic suture zone below cover

  14. The role of the sutures in biomechanical dynamic simulation of a macaque cranial finite element model: Implications for the evolution of craniofacial form

    PubMed Central

    Wang, Qian; Wood, Sarah A.; Grosse, Ian R.; Ross, Callum F.; Zapata, Uriel; Byron, Craig D.; Wright, Barth W.; Strait, David S.

    2012-01-01

    The global biomechanical impact of cranial sutures on the face and cranium during dynamic conditions is not well understood. It is hypothesized that sutures act as energy absorbers protecting skulls subjected to dynamic loads. This hypothesis predicts that sutures have a significant impact on global patterns of strain and cranial structural stiffness when analyzed using dynamic simulations; and that this global impact is influenced by suture material properties. In a finite element model developed from a juvenile Rhesus macaque cranium, five different sets of suture material properties for the zygomaticotemporal sutures were tested. The static and dynamic analyses produced similar results in terms of strain patterns and reaction forces, indicating that the zygomaticotemporal sutures have limited impact on global skull mechanics regardless of loading design. Contrary to the functional hypothesis tested here, the zygomaticotemporal sutures did not absorb significant amounts of energy during dynamic simulations regardless of loading speed. It is alternatively hypothesized that sutures are mechanically significant only insofar as they are weak points on the cranium that must be shielded from unduly high stresses so as not to disrupt vitally important growth processes. Thus, sutural and overall cranial form in some vertebrates may be optimized to minimize or otherwise modulate sutural stress and strain. PMID:22190334

  15. Suturing-Free Artificial Dura with Dacron Heart Patch in Decompressive Craniectomy and Cranioplasty.

    PubMed

    Wang, Fei; Xue, Yan; Zhao, Si-Shun; Yang, Ting-Jian; Song, Hao-Qing; Liu, Hong

    2015-12-01

    Dacron heart patch has been used in decompressive craniectomy, performing the function of septa, mainly to prevent extra adhesion of temporal muscle and decompressive meningeal adhesion in the second-stage cranioplasty, so as to make the operation easier. Then, we made the following modification technology: (1) We used artificial suturing-free dura participate directly in the duraplasty. (2) Dacron patch is not in need of trimming the side holes and can directly cover the decompression window. From March 2012 to October 2013, we applied the technology of artificial dura with Dacron heart patch in 23 patients; after operation, we found that the initial depressive craniectomy cost less time, due to the tension-reduced suture which was not needed, and in the second-stage cranioplasty, the temporal was easy to remove and had no adhesion with the Dacron patch, so as to reach temporal muscle anatomy preservation, and with no obvious postoperative complication. PMID:27011500

  16. Piezosurgical Suturectomy and Sutural Distraction Osteogenesis for the Treatment of Unilateral Coronal Synostosis

    PubMed Central

    Cui, Jie; Chen, Jianbin; Buffoli, Barbara; Rodella, Luigi Fabrizio; Zou, Jijun; Ji, Yi; Chen, Haini

    2015-01-01

    Summary: Different surgical procedures are used for the treatment of synostosis. Among them, suturectomy and sutural distraction osteogenesis (SDO) are suitable for young infant patients. In this report, we present the case of a young infant patient with a clear synostosis of the left coronal suture, which was treated by piezoelectric suturectomy combined with SDO and 2 internal distractors. One-year follow-up showed good results. Thirty-six months after surgery, normal skull growth and shape were observed by 3D computed tomographic examination. No infection, bleeding, fistula, and other complications were observed. The results suggested that the treatment of unilateral coronal synostosis in young infant patient by piezosurgical suturectomy and SDO is to be preferred because of its simplicity and relatively minimal invasiveness. PMID:26495188

  17. The influence of stenosis degrees and graft suture position on local hemodynamics of coronary bypass

    NASA Astrophysics Data System (ADS)

    Totorean, A. F.; Bernad, S. I.; Susan-Resiga, R. F.

    2016-06-01

    Bypass graft failure is mainly caused by intimal hyperplasia (IH) that occurs at the graft anastomosis after coronary artery bypass grafting (CABG) surgery. It has been shown that local hemodynamics influences the process of IH initiation and progression. A main concern at this type of surgery is to increase the graft patency, respectively to improve the local hemodynamics. This paper analyzes the influence of different degree of stenosis severity and graft suture position on graft patency, taking into consideration the local hemodynamics. Bypass configurations with anastomosis angle of 45° were numerically investigated, with respect to wall shear stress and pressure variation. We can assume that in the conditions of our study, different stenosis degrees and position of the graft suture influence the local blood flow conditions, and, nevertheless, the graft patency.

  18. Symptomatic Bilateral Torn Discoid Medial Meniscus Treated with Saucerization and Suture

    PubMed Central

    2016-01-01

    Discoid meniscus is an anatomical congenital anomaly more often found in the lateral meniscus. A discoid medial meniscus is a very rare anomaly, and even more rare is to diagnose a bilateral discoid medial meniscus although the real prevalence of this situation is unknown because not all the discoid medial menisci are symptomatic and if the contralateral knee is not symptomatic then it is not usually studied. The standard treatment of this kind of pathology is partial meniscectomy. Currently the tendency is to be very conservative so suture and saucerization of a torn discoid meniscus when possible are gaining support. We present the case of a 13-year-old patient who was diagnosed with symptomatic torn bilateral discoid medial meniscus treated by suturing the tear and saucerization. To the best of our knowledge this is the first case reported of bilateral torn discoid medial meniscus treated in this manner in the same patient. PMID:27656305

  19. Suturing property of tough double network hydrogels for bio-repair materials

    NASA Astrophysics Data System (ADS)

    Na, Yang Ho; Oh, Hwa Yeon; Ahn, Young Ju; Han, Youngbae

    2015-02-01

    Cartilage and meniscal lesions have limited potential for spontaneous repair. Consequently, much effort has been made to develop methods for repairing such lesions. Double-network (DN) gels are new candidate-materials for repairing such lesions. They exhibit exceptional mechanical strength and toughness in spite of their high water content. In this study, we prepared highly tough DN hydrogels and investigated the mechanical properties related to clinical implant use. The mechanical properties such as Young's modulus and suture tear-out strength were measured for the artificial replacement. The results suggest that the suture property of DN hydrogels can be adjusted by controlling the crosslinking density and monomer concentration. Finite element method was also applied to these DN hydrogels in order to check whether the fracture strength of the material is enough to meet a medical purpose.

  20. [Ultrasound biomicroscopy for localization of artificial lens haptics after trans-scleral suture fixation].

    PubMed

    Steiner, A; Steinhorst, U H; Steiner, M; Theischen, M; Winter, R

    1997-01-01

    Correct positioning of transscleral haptics for sulcus fixation of IOL haptics may be difficult due to lack of visual control by the surgeon. We determined the haptic sites in eyes which underwent secondary IOL implantation with transscleral suturing using ultrasound biomicroscopy (UBM) (Humphrey Instruments, Inc., San Leandro, CA, USA). Eighteen eyes of 17 patients were included in the study. The follow-up time ranged from 1 to 36 months (mean: 7 months). The positions of 36 IOL-haptics were documented by UBM examination. Twelve haptics (33%) were found in the sulcus, whereas 18 haptics (50%) were located posteriorly to the sulcus. Six haptics (17%) were identified anteriorly to the sulcus. There were no complications resulting from dislocation. In one of the eyes, suture infection occurred requiring surgical revision and antibiotic therapy.

  1. Bacterial biofilm on monofilament suture and porcine xenograft after inguinal herniorrhaphy.

    PubMed

    Kathju, Sandeep; Nistico, Laura; Lasko, Leslie-Ann; Stoodley, Paul

    2010-08-01

    Bacterial biofilms have been implicated in multiple clinical scenarios involving infection of implanted foreign bodies, but have been little studied after hernia repair. We now report a case of revision inguinal herniorrhaphy complicated by chronic pain at the operated site without any external indication of infection. Computed tomographic imaging revealed a contrast-enhancing process in the left groin. Subsequent surgical exploration found an inflammatory focus centered on implanted porcine xenograft material and nonabsorbable monofilament sutures placed at the previous surgery. Confocal microscopic examination of these materials with Live/Dead staining demonstrated abundant viable bacteria in biofilm configuration. The removal of these materials and direct closure of the recurrent hernia defect eliminated the infection and resolved the patient's complaints. These results demonstrate that implanted monofilament suture and xenograft material can provide the substratum for a chronic biofilm infection.

  2. Teflon-buttressed sutures plus pericardium patch repair left ventricular rupture caused by radiofrequency catheter ablation

    PubMed Central

    Cao, Hao; Zhang, Qi; He, Yanzhong; Feng, Xiaodong; Liu, Zhongmin

    2016-01-01

    Abstract Background: Cardiac rupture often occurs after myocardial infarction or chest trauma with a high mortality rate. However, left ventricular rupture caused by radiofrequency catheter ablation (RFCA) is extremely rare. Methods: We describe a case of a 61-year-old male who survived from left ventricular rupture caused by a RFCA procedure for frequent ventricular premature contractions. Surgical exploration with cardiopulmonary bypass (CPB) was performed when the signs of cardiac tamponade developed 7 hours after the ablation surgery. Results: Teflon-buttressed sutures of the tear in the left ventricular posterolateral wall and pericardium patch applied to the contusion region on the wall repaired the rupture safely and effectively. Conclusion: Timely surgical intervention under CPB facilitated the survival of the patient. Teflon-buttressed sutures plus pericardium patch achieved the successful repair of the rupture. PMID:27661047

  3. Mechanical strength of sutured block copolymers films for load bearing medical applications.

    PubMed

    Stasiak, Joanna; Nair, Sukumaran; Moggridge, Geoff D

    2014-01-01

    The mechanical behavior of three styrenic thermoplastic block copolymer elastomers with applied surgical sutures was studied by uniaxial tensile testing. The materials exhibited oriented cylindrical microstructure. Distinct macroscopic deformation mechanisms have been observed upon stretching of samples with vertical and horizontal orientation. Deformation progressed along the axis of the suture in samples with parallel orientation (P), while it in case of normal orientation (N) the whole sample responded to the applied force. Also the analysis of the stress-strain curves showed a significant difference between samples P and N. Greater stress at break was observed for samples P, while samples N showed the capability to tolerate higher strain. The influence of morphology on the tear-out shape has been also observed. The thread made a vertical tear out in samples P while for samples N ripping off the bottom was observed.

  4. Symptomatic Bilateral Torn Discoid Medial Meniscus Treated with Saucerization and Suture

    PubMed Central

    2016-01-01

    Discoid meniscus is an anatomical congenital anomaly more often found in the lateral meniscus. A discoid medial meniscus is a very rare anomaly, and even more rare is to diagnose a bilateral discoid medial meniscus although the real prevalence of this situation is unknown because not all the discoid medial menisci are symptomatic and if the contralateral knee is not symptomatic then it is not usually studied. The standard treatment of this kind of pathology is partial meniscectomy. Currently the tendency is to be very conservative so suture and saucerization of a torn discoid meniscus when possible are gaining support. We present the case of a 13-year-old patient who was diagnosed with symptomatic torn bilateral discoid medial meniscus treated by suturing the tear and saucerization. To the best of our knowledge this is the first case reported of bilateral torn discoid medial meniscus treated in this manner in the same patient.

  5. CXCL12/CXCR4 axis regulates neovascularization and lymphangiogenesis in sutured corneas in mice.

    PubMed

    Du, Ling-Ling; Liu, Ping

    2016-06-01

    The present study aimed to determine the plausible functional role of chemokine (C‑X‑C motif) ligand 12 (CXCL12/chemokine (C‑X‑C motif) receptor 4 (CXCR4) in inflammatory corneal hemangiogenesis and lymphangiogenesis in vivo. Corneal hemangiogenesis and lymphangiogenesis were induced by placing an 11‑0 nylon suture in an intrastromal position. The expression levels of the vascular endothelial growth factor (VEGF) family, CXCL12 and CXCR4 in the corneas were investigated in the corneas using reverse transcription‑quantitative polymerase chain reaction and immunohistochemistry. Corneal hemangiogenic and lymphangiogenic responses were assessed by immunofluorescence using specific antibodies against cluster of differentiation 31 and lymphatic vessel endothelial hyaluronan receptor‑1. Subconjunctival injection of AMD3100 to the sutured corneas was also performed. CXCL12/CXCR4 mRNA and protein expression levels increased markedly in suture‑induced corneal neovascularization (CNV) and decreased with AMD3100 treatment. Hemangiogenesis and lymphangiogenesis were captured in images using immunofluorescence and were shown to be markedly increased with suture placement and reduced with AMD3100 treatment. VEGF‑A/VEGFR‑1 and VEGF‑C/VEGFR‑3 mRNA expression levels were upregulated in the suture placement and control groups, whereas the expression levels of all the factors were downregulated in the AMD3100 treatment group. The results from the present study demonstrated that CXCL12/CXCR4 interactions regulate hemangiogenesis and lymphangiogenesis in suture‑induced CNV. AMD3100 may be a novel therapeutic target for the prevention of blindness. PMID:27121088

  6. A Rare Case of a Lost Suture Needle during Third Molar Surgery

    PubMed Central

    Aktop, Sertac; Gocmen, Gokhan; Özturk, M. Elif; Gonul, Onur; Varol, Altan

    2015-01-01

    The authors report a case that is started with a simple upper third molar's surgical extraction and a broken 3.0 suture needle tip incident occurred. Broken fragment's localization has been detected with 3D cone beam computed tomography (CBCT). Needle tip has been reached with the help of CBCT vision. CBCT's benefits have been discussed on these types of cases and further migration of the needle tip during surgical procedure is reported. PMID:26347829

  7. Suture Button Fixation Treatment of Chronic Lisfranc Injury in Professional Dancers and High-Level Athletes.

    PubMed

    Charlton, Timothy; Boe, Chelsea; Thordarson, David B

    2015-12-01

    Chronic Lisfranc injury is a subtle and severe injury in high-level athletes, including dancers. This patient population is generally intolerant of intra-articular screw fixation and can develop significant post-traumatic arthritis with potentially career ending complications. Flexible fixation with suture-button devices provides potential restoration of physiologic motion at the joint, with appropriate support for healing that may facilitate return to en pointe activities for dancers. We hypothesized that the suture-button device would restore motion at the Lisfranc joint and allow for return to activities in this particular population without the limitations and complications of rigid fixation. We operated on seven dancers and high-level athletes with diagnosed Lisfranc injuries by installing a suture-button device. All patients had failed conservative management after late presentation. They were allowed to return to sport in 6 months, preoperative and postoperative American Orthopaedic Foot and Ankle Score (AOFAS) foot scores were obtained, and patients were followed for a minimum of 15 months. All seven returned to full activities in 6 months, with radiographic evidence of fixation and no complications to date. AOFAS foot scores improved from an average of 65 preoperatively to an average of 97 postoperatively at latest follow-up. It is concluded that flexible fixation with suture-button type device represents a viable alternative to screw fixation or fusion that may allow dancers and athletes to return to previous levels of activity after Lisfranc injury. This case series represents to our knowledge the first application of this device to a unique population that requires flexibility at the Lisfranc joint for performance.

  8. Is the central Piedmont suture a low-angle normal fault

    SciTech Connect

    Dennis, A.J. )

    1991-11-01

    In the crystalline southern Appalachians, the Carolina arc terrane is in fault contact with the Piedmont terrace along a seismically reflective surface dipping toward the hinterland and called the central Piedmont suture. The central Piedmont suture may be interpreted as a thrust, but existing data also support a Silurian-Devonian, normal-slip origin: (1) There are lower grade rocks in the hanging wall than in the footwall. (2) A normal-fault solution allows simultaneous metamorphism of the Piedmont terrane and Carolina terrane, prior to their juxtaposition along the central Piedmont suture. (3) Mineral ages in the Piedmont terrane are older in the west than in the east, consistent with an eastward-progressive unroofing. (4) Along the western edge of the Carolina terrane, a linear belt of Devonian subalkalic to alkalic granitoids and gabbro-norites with low initial {sup 87}Sr/{sup 86}Sr ratios may represent mantle-derived magmas along the axis of rifting that are contemporary with major crustal extension. The westernmost Piedmont terrane includes the Chauga belt. The Chauga belt comprises metavolcanic and metaplutonic units similar in rock type and age to those of the western Carolina terrane. Chauga belt rocks are interpreted to be the westernmost exposures of the Carolina terrane, translated west on the lower plate by extension. The Piedmont and Carolina terranes may thus compose a single lithotectonic element. The Piedmont terrane would represent the basement on which the arc was constructed; the terrane was uplifted during extension along a major low-angle normal fault, recognized today as the central Piedmont suture.

  9. Imaging Ancient Sutures with EarthScope Transportable Array Magnetotelluric Data

    NASA Astrophysics Data System (ADS)

    Egbert, G. D.

    2014-12-01

    Magnetotellurics (MT) provides a powerful geophysical tool for imaging of ancient suture zones, which are frequently marked by elongated zones of very low resistivity. These conductive anomalies, which can extend to great depths and have apparently persisted for several billion years, most likely result from graphite and sulfides deeply emplaced and remobilized, through subduction, accretion and orogenesis. The Earthscope MT transportable array provides a unique broad-scale view of sutures in the continental US. In the northwestern US subvertical conductive features bound all of the major cratonic blocks. These can be identified with the Cheyenne Belt between the Wyoming Craton (WC) and Yavapai Terranes (YT), the Great Falls Tectonic Zone between WC and the Medicine Hat Block (MHB), and the Vulcan Structure of southern Alberta between MHB and the Hearne Craton. In all cases the conductive anomalies extend well into the mantle lithosphere. The more recent MT TA footprint in the north-central US (surrounding the Mid-Continent Rift (MCR)) also reveals conductive signatures of ancient sutures. The most prominent lies south of Lake Superior, just north of the Niagara Fault (NF), and can be associated with the Penokean Orogeny (~1.85 Ga). A second, further south beneath Iowa and western Wisconsin, just south of the Spirit Lake tectonic zone (SLtz), can be identified with YT accretion (~1.75 Ga). Both of these sutures are cleanly cut by the MCR. The break in the anomalies is narrow (comparable to the surface expression of the MCR) indicating that rifting impacts on the entire crustal section were highly localized. The south-dipping NF conductive anomaly extends from surface outcrop to at least the Moho. The SLtz anomaly is north-dipping, extending from mid-crust through the Moho. In both cases there is some evidence for a modestly conductive layer (likely carbon) thrust to mid-lithospheric depths within the overriding terrane.

  10. Perioperative complications associated with intracranial procedures in patients with nonsyndromic single-suture craniosynostosis.

    PubMed

    Tahiri, Youssef; Paliga, James Thomas; Wes, Ari M; Whitaker, Linton A; Bartlett, Scott P; Taylor, Jesse A

    2015-01-01

    Within the diagnosis "craniosynostosis," there is a subset of patients who present with isolated, nonsyndromic, single-suture involvement. This study evaluates perioperative complications in this specific subset of patients over 4 decades at a single institution. To do so, we performed a retrospective review on consecutive patients undergoing correction of single-suture synostosis from May 1977 to January 2013 at a tertiary pediatric craniofacial center. Demographic information, operative details, and perioperative course were collected. Complications were categorized as either major or minor. A χ(2) test and Fisher exact test were used to compare all categorical variables. Continuous variables were analyzed using Wilcoxon rank-sum and Kruskal-Wallis tests.Seven hundred forty-six patients underwent surgical correction of nonsyndromic craniosynostosis. Of these, there were 307 (41.2%) sagittal, 201 (26.9%) metopic, and 238 (31.9%) unicoronal. Thirty-four patients had complications (4.6%). Eight were considered major (1.1%), including one postoperative mortality in a patient with hypoplastic left-sided heart syndrome. Minor complications occurred in 26 patients (3.5%) and included subgaleal hematoma (n = 3), seroma (n = 4), and superficial wound infection (n = 5). Metopic and sagittal suture involvement was significantly associated with a higher complication rate (P = 0.04). A child with isolated single suture synostosis and any comorbidity had a significantly greater risk of any complication (P < 0.001; odds ratio, 3.8) and specifically an increased risk of major complication (P = 0.031; odds ratio, 6.0). Subclassification of patients by time period yielded no statistically significant changes in perioperative morbidity. To conclude, these data allow us to counsel families more accurately with regard to morbidity and mortality and may potentially serve as a benchmark for future quality improvement work.

  11. Paraplegia after thoracotomy for division and suture Patent Ductus Arteriosus (PDA).

    PubMed

    Sayasathid, Jarun; Somboonna, Naraporn; Numchaisiri, Chun

    2006-12-01

    A Thai women, aged 22 years old, came to hospital with Patent Ductus Arteriosis (PDA). Left thoracotomy, with division and suturing PDA, was performed. The second day after operation, she developed paraplegia below umbilical level. The CT-scan detected an extradural hematoma in the spinal cavity from T3-T6. To remove the blood clot, the T spine laminectomy was performed. 6 months after the laminectomy, the patient was able to perform her regular exercise. PMID:17214069

  12. Long-term safety of polypropylene knots under scleral flaps for transsclerally sutured posterior chamber lenses.

    PubMed Central

    Van Meter, W S

    1997-01-01

    PURPOSE: To evaluate the safety of polypropylene knots used in TS-SPCL combined with PK and AV over time. METHOD: A retrospective review of 26 consecutive cases of TS-SPCL by one surgeon (WSVM) with at least 12 months follow-up (mean 26, range 12-62). All patients had a double strand polypropylene knot buried under partial thickness scleral flaps at 2 and 8 o'clock. Knots were rotated into the globe (R) in 10 cases, and could not be buried (N) in 13 cases, and in 3 cases 1 knot was buried. RESULTS: No cases of suture erosion occurred in R or N. One or more polypropylene sutures were visible in 17 patients (8 R, 9 T) at last exam. Twenty-three of 52 knots were rotated into the globe, and 70% of rotated knots were not even visible at the slit lamp at final visit. There was no evidence of conjunctival erosion in any patient. There was no lens dislocation and no endophthalmitis. CONCLUSION: The combination of partial thickness scleral flaps with double strand polypropylene knots reduces the incidence of suture erosion through the conjunctive if knots cannot be rotated into the globe. Images FIGURE 1 FIGURE 2 FIGURE 3 PMID:9440177

  13. Suture materials affect peri-implant bone healing and implant osseointegration.

    PubMed

    Villa, Oscar; Lyngstadaas, Staale P; Monjo, Marta; Satué, Maria; Rønold, Hans J; Petzold, Christiane; Wohlfahrt, Johan C

    2015-09-01

    The aim of this study was to evaluate the effects of the remnants of two suture materials on osseointegration of titanium implants in a rabbit tibial model. Calibrated defects were prepared in the tibia of five Chinchilla rabbits. Filaments of nonresorbable (NR) nylon or resorbable (R) chitosan were placed at the bone to implant interface, whereas control sites had no suture material. After a healing period of 4 weeks, a pull-out test procedure was performed followed by enzymatic analyses of the wound fluid and relative quantification of mRNA levels for bone-related and cytokine markers from the peri-implant bone. A trend toward a reduced pull-out force was observed in the NR group (NR: 23.0 ± 12.8 N; R: 33.9 ± 11.3 N; control: 33.6 ± 24.0 N). Similarly, the bone resorption marker vacuolar type H+-ATPase was increased in the NR group compared with that in the control group (P = 0.041). The R group showed trends for lower alkaline phosphatase activity and osteocalcin expression and higher total protein content and RNA compared with the control group. In this submerged healing model, peri-implant bone healing was marginally affected by the two suture materials tested. However, there was a tendency toward better osseointegration and lower expression of bone resorption markers in the R group compared with the control group.

  14. Using sutures to attach miniature tracking tags to small bats for multimonth movement and behavioral studies.

    PubMed

    Castle, Kevin T; Weller, Theodore J; Cryan, Paul M; Hein, Cris D; Schirmacher, Michael R

    2015-07-01

    Determining the detailed movements of individual animals often requires them to carry tracking devices, but tracking broad-scale movement of small bats (<30 g) has been limited by transmitter technology and long-term attachment methods. This limitation inhibits our understanding of bat dispersal and migration, particularly in the context of emerging conservation issues such as fatalities at wind turbines and diseases. We tested a novel method of attaching lightweight global positioning system (GPS) tags and geolocating data loggers to small bats. We used monofilament, synthetic, absorbable sutures to secure GPS tags and data loggers to the skin of anesthetized big brown bats (Eptesicus fuscus) in Colorado and hoary bats (Lasiurus cinereus) in California. GPS tags and data loggers were sutured to 17 bats in this study. Three tagged bats were recaptured 7 months after initial deployment, with tags still attached; none of these bats showed ill effects from the tag. No severe injuries were apparent upon recapture of 6 additional bats that carried tags up to 26 days after attachment; however, one of the bats exhibited skin chafing. Use of absorbable sutures to affix small tracking devices seems to be a safe, effective method for studying movements of bats over multiple months, although additional testing is warranted. This new attachment method has the potential to quickly advance our understanding of small bats, particularly as more sophisticated miniature tracking devices (e.g., satellite tags) become available.

  15. Using sutures to attach miniature tracking tags to small bats for multimonth movement and behavioral studies

    USGS Publications Warehouse

    Castle, Kevin T.; Weller, Theodore J.; Cryan, Paul M.; Hein, Cris D.; Schirmacher, Michael R.

    2015-01-01

    1. Determining the detailed movements of individual animals often requires them to carry tracking devices, but tracking broad-scale movement of small bats (< 30g) has been limited by transmitter technology and long-term attachment methods. This limitation inhibits our understanding of bat dispersal and migration, particularly in the context of emerging conservation issues like fatalities at wind turbines and diseases. 2. We tested a novel method of attaching lightweight global positioning system (GPS) tags and geolocating data loggers to small bats. We used monofilament, synthetic, absorbable sutures to secure GPS tags and data loggers to the skin of anesthetized big brown bats (Eptesicus fuscus) in Colorado and hoary bats (Lasiurus cinereus) in California. 3. GPS tags and data loggers were sutured to 17 bats in this study. Three tagged bats were recaptured seven months after initial deployment, with tags still attached; none of these bats showed ill effects from the tag. No severe injuries were apparent upon recapture of 6 additional bats that carried tags up to 26 days after attachment, however one of the bats exhibited skin chafing. 4. Use of absorbable sutures to affix small tracking devices seems to be a safe, effective method for studying movements of bats over multiple months, although additional testing is warranted. This new attachment method has the potential to quickly advance our understanding of small bats, particularly as more-sophisticated miniature tracking devices (e.g., satellite tags) become available.

  16. Using sutures to attach miniature tracking tags to small bats for multimonth movement and behavioral studies.

    PubMed

    Castle, Kevin T; Weller, Theodore J; Cryan, Paul M; Hein, Cris D; Schirmacher, Michael R

    2015-07-01

    Determining the detailed movements of individual animals often requires them to carry tracking devices, but tracking broad-scale movement of small bats (<30 g) has been limited by transmitter technology and long-term attachment methods. This limitation inhibits our understanding of bat dispersal and migration, particularly in the context of emerging conservation issues such as fatalities at wind turbines and diseases. We tested a novel method of attaching lightweight global positioning system (GPS) tags and geolocating data loggers to small bats. We used monofilament, synthetic, absorbable sutures to secure GPS tags and data loggers to the skin of anesthetized big brown bats (Eptesicus fuscus) in Colorado and hoary bats (Lasiurus cinereus) in California. GPS tags and data loggers were sutured to 17 bats in this study. Three tagged bats were recaptured 7 months after initial deployment, with tags still attached; none of these bats showed ill effects from the tag. No severe injuries were apparent upon recapture of 6 additional bats that carried tags up to 26 days after attachment; however, one of the bats exhibited skin chafing. Use of absorbable sutures to affix small tracking devices seems to be a safe, effective method for studying movements of bats over multiple months, although additional testing is warranted. This new attachment method has the potential to quickly advance our understanding of small bats, particularly as more sophisticated miniature tracking devices (e.g., satellite tags) become available. PMID:26306181

  17. Smart tissue anastomosis robot (STAR): a vision-guided robotics system for laparoscopic suturing.

    PubMed

    Leonard, Simon; Wu, Kyle L; Kim, Yonjae; Krieger, Axel; Kim, Peter C W

    2014-04-01

    This paper introduces the smart tissue anastomosis robot (STAR). Currently, the STAR is a proof-of-concept for a vision-guided robotic system featuring an actuated laparoscopic suturing tool capable of executing running sutures from image-based commands. The STAR tool is designed around a commercially available laparoscopic suturing tool that is attached to a custom-made motor stage and the STAR supervisory control architecture that enables a surgeon to select and track incisions and the placement of stitches. The STAR supervisory-control interface provides two modes: A manual mode that enables a surgeon to specify the placement of each stitch and an automatic mode that automatically computes equally-spaced stitches based on an incision contour. Our experiments on planar phantoms demonstrate that the STAR in either mode is more accurate, up to four times more consistent and five times faster than surgeons using state-of-the-art robotic surgical system, four times faster than surgeons using manual Endo360(°)®, and nine times faster than surgeons using manual laparoscopic tools. PMID:24658254

  18. Smart tissue anastomosis robot (STAR): a vision-guided robotics system for laparoscopic suturing.

    PubMed

    Leonard, Simon; Wu, Kyle L; Kim, Yonjae; Krieger, Axel; Kim, Peter C W

    2014-04-01

    This paper introduces the smart tissue anastomosis robot (STAR). Currently, the STAR is a proof-of-concept for a vision-guided robotic system featuring an actuated laparoscopic suturing tool capable of executing running sutures from image-based commands. The STAR tool is designed around a commercially available laparoscopic suturing tool that is attached to a custom-made motor stage and the STAR supervisory control architecture that enables a surgeon to select and track incisions and the placement of stitches. The STAR supervisory-control interface provides two modes: A manual mode that enables a surgeon to specify the placement of each stitch and an automatic mode that automatically computes equally-spaced stitches based on an incision contour. Our experiments on planar phantoms demonstrate that the STAR in either mode is more accurate, up to four times more consistent and five times faster than surgeons using state-of-the-art robotic surgical system, four times faster than surgeons using manual Endo360(°)®, and nine times faster than surgeons using manual laparoscopic tools.

  19. Suture materials affect peri-implant bone healing and implant osseointegration.

    PubMed

    Villa, Oscar; Lyngstadaas, Staale P; Monjo, Marta; Satué, Maria; Rønold, Hans J; Petzold, Christiane; Wohlfahrt, Johan C

    2015-09-01

    The aim of this study was to evaluate the effects of the remnants of two suture materials on osseointegration of titanium implants in a rabbit tibial model. Calibrated defects were prepared in the tibia of five Chinchilla rabbits. Filaments of nonresorbable (NR) nylon or resorbable (R) chitosan were placed at the bone to implant interface, whereas control sites had no suture material. After a healing period of 4 weeks, a pull-out test procedure was performed followed by enzymatic analyses of the wound fluid and relative quantification of mRNA levels for bone-related and cytokine markers from the peri-implant bone. A trend toward a reduced pull-out force was observed in the NR group (NR: 23.0 ± 12.8 N; R: 33.9 ± 11.3 N; control: 33.6 ± 24.0 N). Similarly, the bone resorption marker vacuolar type H+-ATPase was increased in the NR group compared with that in the control group (P = 0.041). The R group showed trends for lower alkaline phosphatase activity and osteocalcin expression and higher total protein content and RNA compared with the control group. In this submerged healing model, peri-implant bone healing was marginally affected by the two suture materials tested. However, there was a tendency toward better osseointegration and lower expression of bone resorption markers in the R group compared with the control group. PMID:26369486

  20. Oblique sinistral transpression in the Arabian shield: The timing and kinematics of a Neoproterozoic suture zone

    USGS Publications Warehouse

    Johnson, P.R.; Kattan, F.

    2001-01-01

    The Hulayfah-Ad Dafinah-Ruwah fault zone is a belt of highly strained rocks that extends in a broad curve across the northeastern Arabian shield. It is a subvertical shear zone, 5-30 km wide and over 600 km long, and is interpreted as a zone of oblique sinistral transpression that forms the suture between the Afif terrane and the Asir-Jiddah-Hijaz-Hulayfah superterrane. Available data suggest that the terranes began to converge sometime after 720 Ma, were in active contact at about 680 Ma, and were in place, with suturing complete, by 630 Ma, The fault zone was affected by sinistral horizontal and local vertical shear, and simultaneous flattening and fault-zone-parallel extension. Structures include sinistral sense-of-shear indicators, L-S tectonite, and coaxial stretching lineations and fold axes. The stretching lineations switch from subhorizontal to subvertical along the fault zone indicating significant variation in finite strain consistent with an origin by oblique transpression. The sense of shear on the fault zone suggests sinistral trajectories for the converging terranes, although extrapolating the shear sense of the suture zone to infer far-field motion must be done with caution. The amalgamation model derived from the chronologic and structural data for the fault zone modifies an existing model of terrane amalgamation and clarifies the definitions of two deformational events (the Nabitah orogeny and the Najd fault system) that are widely represented in the Arabian shield. ?? 2001 Elsevier Science B.V.

  1. Inferring the viscous and elastic properties of a suture zone in Larsen C

    NASA Astrophysics Data System (ADS)

    O'Leary, Martin; Kulessa, Bernd; Booth, Adam; Holland, Paul; Jansen, Daniela; King, Ed; Luckman, Adrian; McGrath, Dan; Zwinger, Thomas

    2016-04-01

    After the collapse of its neighbours, Larsen A and B, the Larsen C ice shelf is widely considered at risk of future climate-driven instability. Recent work has shown that the ice shelf is stabilized by soft melange in its suture zones, where adjacent flow units merge. Little is known about the mechanical properties of melange however, so that the quantification of its effect on the stability of Larsen C Ice Shelf has remained challenging. To identify the structural and elastic properties of the Joerg Peninsula suture zone in Larsen C Ice Shelf, we integrate seismic reflection and ground-penetrating radar (GPR) geophysical measurements. GPR transects reveal the presence of a stiff layer of meteoric ice, trapped between the softer melange beneath and the firn layer above. Monte Carlo analysis reveals that the seismic velocity of this melange is noticeably reduced compared to meteoric ice. By applying Hashin-Shtrikman bounds on the elastic moduli of a two-phase mixture of ice and water to the velocities, we are able to derive the elastic properties of the melange. We ascertain, significantly, that the melange is softer than meteoric ice because it contains a substantial volume fraction of water. The meteoric ice layer is buckling due to compressive lateral stresses. We suggest this process is analogous to fold buckling in sedimentary rocks. Using the ice flow model Elmer/Ice we are able to replicate this process, and thereby derive bounds on the rheological properties of the suture zone melange.

  2. Comparison of ultrasonic suture welding and traditional knot tying in a rabbit rotator cuff repair model.

    PubMed

    Nho, Shane J; Cole, Brian J; Mazzocca, Augustus D; Williams, James M; Romeo, Anthony A; Bush-Joseph, Charles A; Bach, Bernard R; Hallab, Nadim J

    2006-01-01

    The purpose of this study is to evaluate ultrasonic suture welding of monofilament suture in an animal model of rotator cuff repair with biomechanical and histologic analyses. We randomly assigned 46 shoulders in 23 rabbits to 1 of 3 treatment groups: sham-operated (n = 15), knotted (n = 15), and welded (n = 16). Supraspinatus defects were surgically created and acutely repaired with suture anchors loaded with either No. 2-0 Ethibond for knotted group or No. 2-0 nylon for welded shoulders. Eighteen weeks postoperatively, all animals were killed, and the shoulders underwent either biomechanical testing or histologic analysis. The maximum stress of the sham-operated group (20.6 N/mm2) was significantly greater than that of both the knotted (10.2 N/mm2) and welded (8.3 N/mm2) groups (P < .05), but no differences were observed between the knotted and welded groups. Although some histologic changes were noted, none was considered to be significant to distinguish either group.

  3. The western Idaho suture zones meets the central Montana trough: A soft indentee model

    SciTech Connect

    Strayer, L.M. . Dept. of Geology and Geophysics)

    1993-04-01

    The western Idaho suture zone is defined by a thin (5--25 km) belt of mylonitic granitoid rocks formed during large-scale, Cretaceous, dextral strike-slip activity. It marks an initial subvertical boundary between accreted oceanic terranes and cratonic North America. Deformation style along the suture zone changes abruptly from transpressions on the southern segment, to west-vergent thrusting on the northern segment, the change occurring near Slate Ck. The northern segment appears to be a structural and metamorphic culmination-the Clearwater culmination-that acts as the mylonitic root-zone of the Rapid River thrust, which splays off to the SW. The northern and southern extents of the Clearwater culmination coincide with the north and south boundaries of the Central Montana Trough (CMT), an east-west trough containing thick packages of Proterozoic through Mesozoic strata. The CMT has been interpreted as an aulacogen, and as such must have extended to the western edge of N. America after Proterozoic rifting. The change in structural style from pure-shear dominated dextral transpression south of Slate Ck. to west-directed thrusting north of Slate Ck. is likely due to the strong rheologic contrast caused by the intersection of the western Idaho suture zone and the CMT. The CMT acts as a soft-indented', focusing the collisional deformation of the Seven Devils/Wallowa terrain eastward into the unusually thick Proterozoic through Mesozoic rocks of the CMT.

  4. Using sutures to attach miniature tracking tags to small bats for multimonth movement and behavioral studies

    PubMed Central

    Castle, Kevin T; Weller, Theodore J; Cryan, Paul M; Hein, Cris D; Schirmacher, Michael R

    2015-01-01

    Determining the detailed movements of individual animals often requires them to carry tracking devices, but tracking broad-scale movement of small bats (<30 g) has been limited by transmitter technology and long-term attachment methods. This limitation inhibits our understanding of bat dispersal and migration, particularly in the context of emerging conservation issues such as fatalities at wind turbines and diseases. We tested a novel method of attaching lightweight global positioning system (GPS) tags and geolocating data loggers to small bats. We used monofilament, synthetic, absorbable sutures to secure GPS tags and data loggers to the skin of anesthetized big brown bats (Eptesicus fuscus) in Colorado and hoary bats (Lasiurus cinereus) in California. GPS tags and data loggers were sutured to 17 bats in this study. Three tagged bats were recaptured 7 months after initial deployment, with tags still attached; none of these bats showed ill effects from the tag. No severe injuries were apparent upon recapture of 6 additional bats that carried tags up to 26 days after attachment; however, one of the bats exhibited skin chafing. Use of absorbable sutures to affix small tracking devices seems to be a safe, effective method for studying movements of bats over multiple months, although additional testing is warranted. This new attachment method has the potential to quickly advance our understanding of small bats, particularly as more sophisticated miniature tracking devices (e.g., satellite tags) become available. PMID:26306181

  5. The structure and effect of suture zones in the Larsen C Ice Shelf, Antarctica

    NASA Astrophysics Data System (ADS)

    McGrath, Daniel; Steffen, Konrad; Holland, Paul R.; Scambos, Ted; Rajaram, Harihar; Abdalati, Waleed; Rignot, Eric

    2014-03-01

    Ice shelf fractures frequently terminate where they encounter suture zones, regions of material heterogeneity that form between meteoric inflows in ice shelves. This heterogeneity can consist of marine ice, meteoric ice with modified rheological properties, or the presence of fractures. Here, we use radar observations on the Larsen C Ice Shelf, Antarctica, to investigate (i) the termination of a 25 km long rift in the Churchill Peninsula suture zone, which was found to contain ~60 m of accreted marine ice, and (ii) the along-flow evolution of a suture zone originating at Cole Peninsula. We determine a steady state field of basal melting/freezing rates and apply it to a flowline model to delineate the along-flow evolution of layers within the ice shelf. The thickening surface wedge of locally accumulated meteoric ice, which likely has limited lateral variation in its mechanical properties, accounts for ~60% of the total ice thickness near the calving front. Thus, we infer that the lower ~40% of the ice column and the material heterogeneities present there are responsible for resisting fracture propagation and thereby delaying tabular calving events, as demonstrated in the >40 year time series leading up to the 2004/2005 calving event for Larsen C. This likely represents a highly sensitive aspect of ice shelf stability, as changes in the oceanic forcing may lead to the loss of this heterogeneity.

  6. Application of lariat lock catch knot suture in the achilles tendon rupture

    PubMed Central

    Wang, Baocang; Feng, Xiaona; Yan, Ming; Wang, Hui; Li, Yong

    2015-01-01

    The aim of this study was to summarize the clinical experience of repairing the Achilles tendon rupture by lariat lock catch knot suture. Between January 2011 and February, 2014, 32 cases of the Achilles tendon rupture were treated by lariat lock catch knot suture. There were 26 males and 6 females, with the average age of 39 years (range 17-53 years), including 13 left knees and 19 right knees. 29 wounds healed by first intention, and 3 cases who were performed local flap transfer due to necrosis of skin were healed by second intention. Thirty-two cases were followed up 10-25 months (13 months on average). No re-rupture of Achilles tendon or deep infection occurred during follow-up period. According to Arner-Lindholm assessment standard, the results were excellent in 19 cases and good in 13 cases, the excellent and good rate was 100%. Lariat lock catch knot suture is a safe and effective method for repairing Achilles tendon. PMID:26770612

  7. Efficacy of silver coated surgical sutures on bacterial contamination, cellular response and wound healing.

    PubMed

    Gallo, Anna Lucia; Paladini, Federica; Romano, Alessandro; Verri, Tiziano; Quattrini, Angelo; Sannino, Alessandro; Pollini, Mauro

    2016-12-01

    The resistance demonstrated by many microorganisms towards conventional antibiotics has stimulated the interest in alternative antimicrobial agents and in novel approaches for prevention of infections. Silver, a natural braod-spectrum antimicrobial agent known since antiquity, has been widely employed in biomedical field due to its recognized antibacterial, antifungal and antiviral properties. In this work, antibacterial silver coatings were deposited on absorbable surgical sutures through the in situ photo-chemical deposition of silver clusters. Scanning electron microscopy (SEM), Energy dispersive X-ray spectroscopy (EDX) and thermo-gravimetric analysis (TGA) were performed in order to investigate the presence and distribution of the silver clusters on the substrate. The amounts of silver deposited and released by the silver treated sutures were calculated through Inductively Coupled Plasma-Mass Spectroscopy (ICP-MS), and the results were related to the biodegradation of the material. The microbiological properties and the potential cytotoxicity of the silver-treated sutures were investigated in relation with hydrolysis experiments, in order to determine the effect of the degradation on antibacterial properties and biocompatibility. PMID:27612783

  8. COMPARATIVE STUDY OF MICROANASTOMOSIS WITH DISTINCT 10-0 NYLON SUTURES IN RATS

    PubMed Central

    Silva, Ricardo Teixeira e; Barros, Thiago Felipe Santos; de Carvalho, José Thomé; Ribeiro, André Araújo; Pires, André Fernandes; Wei, Teng Hsiang

    2016-01-01

    ABSTRACT Objective: The aim of this study is to compare micro-sutures commonly used in our midst. Methods: In this double-blind study, 30 Wistar rats were operated randomly divided into three groups matched according to the suture used (Nylon 10-0, 75micron, brands Microsuture(r), Polysuture(r) and Ethicon(r)). We analyzed the number of surgical nodes required, bleeding, surgical time and histological evaluation. Results: There was no significant difference between the amount of stitches of arterial suture per anastomosis. Surgical time was longer in Microsuture(r) group as compared to Polysuture(r) (p ≤ 0.05). Bleeding in Microsuture(r) group was higher when compared to the others (p <0.01). In the histological analysis, the Microsuture(r) group showed a greater tendency to develop fibrosis and aneurysm in surgical site than the others (p <0.01 and p≤0,05, respectively). Similarly, the Ethicon(r) group showed less tendency to myointimal proliferation than the rest. (p = 0.025). Conclusion: The results confirm the relevance of the choice of surgical thread as an independent determining factor for the success of the procedure, besides serving as a rational subsidy for a better cost-benefit analysis. Level of Evidence I, Experimental Study, Controlled Animal Study. PMID:26997912

  9. Medial Patellofemoral Ligament Reconstruction: Fixation Technique Biomechanics.

    PubMed

    Russo, Franco; Doan, Joshua; Chase, Derek C; Farnsworth, Christine L; Pennock, Andrew T

    2016-05-01

    Introduction The medial patellofemoral ligament (MPFL) is the primary soft-tissue stabilizer of the patella and it is often reconstructed in patients with recurrent patella instability. This biomechanical analysis evaluates the integrity of four methods of MPFL reconstruction subjected to cyclic loading using a porcine model. Methods Four techniques of MPFL reconstruction were analyzed using a 4 mm flexor tendon graft, all with two points of patellar fixation to best recreate the native MPFL anatomy. The four techniques were: (1) interference screw technique, (2) suture anchor technique, (3) converging tunnel technique, and (4) two bone tunnel technique. Maximum load, yield load, and stiffness of the graft fixation/bone complex were analyzed, and statistics were performed with SPSS and significance set at a p-value of < 0.05. Results The converging tunnel technique demonstrated the highest maximum load and yield load, significantly higher than the interference screw or suture anchor groups (p = 0.007). In addition, the converging tunnel technique demonstrated the greatest stiffness with significantly greater stiffness than the two bone tunnel techniques (p = 0.016). Conclusion The combination of strength and stiffness, the avoidance of patella implants, and the creation of a single transosseous tunnel make the converging tunnel technique a desirable technique for MPFL reconstructions. PMID:26190788

  10. Rheological control on the tectonic evolution of a continental suture zone: the Variscan example from NW Iberia (Spain)

    NASA Astrophysics Data System (ADS)

    Díez Fernández, Rubén; Foster, David A.; Gómez Barreiro, Juan; Alonso-García, Montserrat

    2013-07-01

    The Variscan continental suture zone exposed in NW Iberia is examined to uncover the long-lived rheological control exerted by the strata deposited over the external parts of Gondwana on its geodynamic evolution. The suture occurs within a set of allochthonous terranes whose limits were taken as domain boundaries to interpret the Variscan stacking of Paleozoic continental domains and retrodeform the resulting nappe pile. The suture zone formed due to closure of ocean basins located between Gondwana and Laurussia during the Late Paleozoic and consists of relics of oceanic and transitional crust. The suture zone exhibits a tabular to lens shape due to repeated tectonic events dominated by non-coaxial deformation (thrusts and low-angle normal faults). Thrusting and normal faulting also involved the margins of the continents bounding the suture. The structure of the continental blocks, however, is dominated by folds, particularly large nappe folds with pronounced superimposed flattening. The upper part of the basal allochthonous units comprises a rheologically incompetent domain below the suture zone. This domain is typified by the carbonaceous-rich strata, which are probably Ordovician-Silurian sediments based on U-Pb detrital zircon populations. The rheology of this layer determined the location of the first accretionary thrust that initiated the Late Devonian subduction of the Gondwana margin below the suture zone. By favoring fault development, the upper sequence of the basal allochthonous units as a whole influenced the exhumation of deep-seated continental crust, the transference of the suture zone over Gondwana, and the re-equilibration of the resulting overthickened crust.

  11. Flat bones and sutures formation in the human cranial vault during prenatal development and infancy: A computational model.

    PubMed

    Burgos-Flórez, F J; Gavilán-Alfonso, M E; Garzón-Alvarado, D A

    2016-03-21

    The processes of flat bones growth, sutures formation and interdigitation in the human calvaria are controlled by a complex interaction between genetic, biochemical and environmental factors that regulate bone formation and resorption during prenatal development and infancy. Despite previous experimental evidence accounting for the role of the main biochemical factors acting on these processes, the underlying mechanisms controlling them are still unknown. Therefore, we propose a mathematical model of the processes of flat bone and suture formation, taking into account several biological events. First, we model the growth of the flat bones and the formation of sutures and fontanels as a reaction diffusion system between two proteins: TGF-β2 and TGF-β3. The former is expressed by osteoblasts and allows adjacent mesenchymal cells differentiation on the bone fronts of each flat bone. The latter is expressed by mesenchymal cells at the sutures and inhibits their differentiation into osteoblasts at the bone fronts. Suture interdigitation is modelled using a system of reaction diffusion equations that develops spatio-temporal patterns of bone formation and resorption by means of two molecules (Wnt and Sclerostin) which control mesenchymal cells differentiation into osteoblasts at these sites. The results of the computer simulations predict flat bone growth from ossification centers, sutures and fontanels formation as well as bone formation and resorption events along the sutures, giving rise to interdigitated patterns. These stages were modelled and solved by the finite elements method. The simulation results agree with the morphological characteristics of calvarial bones and sutures throughout human prenatal development and infancy.

  12. Performance Assessment of Suture Type, Water Temperature, and Surgeon Skill in Juvenile Chinook Salmon Surgically Implanted with Acoustic Transmitters

    SciTech Connect

    Deters, Katherine A.; Brown, Richard S.; Carter, Kathleen M.; Boyd, James W.; Eppard, M. B.; Seaburg, Adam

    2010-08-01

    Size reductions of acoustic transmitters implanted in migrating juvenile salmonids have resulted in the use of a shorter incision - one that may warrant only one suture for closure. However, it is not known if a single suture will sufficiently hold the incision closed when fish are decompressed and outward pressure is placed on the surgical site during passage of hydroelectric dams. The objectives of this study were to evaluate five response variables in juvenile Chinook salmon subjected to simulated turbine passage. Fish were implanted with an acoustic transmitter (0.43 g in air) and a passive integrated transponder tag (0.10 g in air); incisions (6 mm) were closed with either one or two sutures. Following exposure, no transmitters were expelled. In addition, suture and incision tearing and mortal injury did not differ between treatment and control fish. Viscera expulsion was higher in treatment (12%) than control (1%) fish. The higher incidence of viscera expulsion through single-suture incisions warrants concern. Consequently, the authors do not recommend using one suture to close 6-mm incisions associated with acoustic transmitter implantation when juvenile salmonids may be exposed to turbine passage.

  13. Magnetotelluric survey to locate the Archean-Proterozoic suture zone in the northeastern Great Basin, Nevada, Utah, and Idaho

    USGS Publications Warehouse

    Sampson, Jay A.; Rodriguez, Brian D.

    2013-01-01

    North-central Nevada contains a large amount of gold in linear belts, the origin of which is not fully understood. During July 2008, September 2009, and August 2010, the U.S. Geological Survey, as part of the Assessment Techniques for Concealed Mineral Resources project, collected twenty-three magnetotelluric soundings along two profiles in Box Elder County, Utah; Elko County, Nevada; and Cassia, Minidoka, and Blaine Counties, Idaho. The main twenty-sounding north-south magnetotelluric profile begins south of Wendover, Nev., but north of the Deep Creek Range. It continues north of Wendover and crosses into Utah, with the north profile terminus in the Snake River Plain, Idaho. A short, three-sounding east-west segment crosses the main north-south profile near the northern terminus of the profile. The magnetotelluric data collected in this study will be used to better constrain the location and strike of the concealed suture zone between the Archean crust and the Paleoproterozoic Mojave province. This report releases the magnetotelluric sounding data that was collected. No interpretation of the data is included.

  14. A comparison of single-suture and double-suture incision closures in seaward-migrating juvenile Chinook salmon implanted with acoustic transmitters: implications for research in river basins containing hydropower structures

    SciTech Connect

    Brown, Richard S.; Deters, Katherine A.; Cook, Katrina V.; Eppard, M. B.

    2013-07-15

    Reductions in the size of acoustic transmitters implanted in migrating juvenile salmonids have resulted in the ability to make shorter incisions that may warrant using only a single suture for closure. However, it is not known if one suture will sufficiently hold the incision closed, particularly when outward pressure is placed on the surgical site such as when migrating fish experience pressure changes associated with passage at hydroelectric dams. The objective of this research was to evaluate the effectiveness of single-suture incision closures on juvenile Chinook salmon (Oncorhynchus tshawytscha). Juvenile Chinook salmon were surgically implanted with a 2012 Juvenile Salmon Acoustic Telemetry System (JSATS) transmitter (0.30 g) and a passive integrated transponder tag (0.10 g) and incisions were closed with either one suture or two sutures. Mortality and tag retention were monitored and fish were examined after 7 and 14 days to evaluate tissue responses. In a separate experiment, surgically implanted fish were exposed to simulated turbine passage and then examined for expulsion of transmitters, expulsion of viscera through the incision, and mortal injury. With incisions closed using a single suture, there was no mortality or tag loss and similar or reduced tissue reaction compared to incisions closed with two sutures. Further, surgery time was significantly reduced when one suture was used, which leads to less handling and reduced stress. No tags were expelled during pressure scenarios and expulsion of viscera only occurred in two non-mortally injured fish (5%) with single sutures that were also exposed to very high pressure changes. No viscera expulsion was present in fish exposed to pressure scenarios likely representative of hydroturbine passage at many Columbia River dams (e.g. <2.7 ratio of pressure change; an acclimation pressure of 146.2 absolute kpa and a lowest exposure pressure of ~ 53.3 absolute kpa). Based on these results, we recommend the use of a

  15. Fluids in high- to ultrahigh-temperature metamorphism along collisional sutures: Record from fluid inclusions

    NASA Astrophysics Data System (ADS)

    Tsunogae, Toshiaki; Santosh, M.

    2011-08-01

    Petrographic studies and microthermometric investigations on fluid inclusions associated with high- to ultrahigh-temperature metamorphic rocks in three major Precambrian suture zones on the globe demonstrate the dominant occurrence of CO 2-rich fluids. These rocks form part of hot orogens developed along collisional plate boundaries. The sapphirine-quartz-bearing Mg-Al-rich rock from the Palghat-Cauvery Suture Zone, a trace of the Cambrian Gondwana suture zone in southern India, preserves evidence for a prograde high-pressure event and subsequent peak ultrahigh-temperature metamorphism along a clockwise path, and contains abundant CO 2-rich inclusions in corundum, garnet, and sapphirine. Most of the fluid inclusions are either primary or secondary and preserve low-density CO 2-rich fluids (0.569-0.807 g/cm 3). Similar low-density CO 2-rich fluid inclusions (0.853-0.953 g/cm 3) are also present in pelitic granulites from the Limpopo Complex of southern Africa, a Neoarchean granulite-facies orogen formed by continent-continent collision. In contrast, the garnet-orthopyroxene granulite from Tonagh Island in the Neoarchean Napier Complex in East Antarctica contains very high-density primary (1.095-1.129 g/cm 3) and secondary (0.960-1.179 g/cm 3) carbonic inclusions in garnet and quartz. The calculated isochores for the fluid inclusions from the Palghat-Cauvery Suture Zone and the Limpopo Complex yield significantly lower-pressure estimates than those predicted from peak metamorphic conditions. We interpret this as a result of significant density decrease due to rapid decompression along a clockwise P- T trajectory. In contrast, the estimated isochores for primary inclusions in garnet-orthopyroxene granulites from the Napier Complex are consistent with the peak P- T conditions estimated from mineral phase equilibria for the Tonagh Island rocks, suggesting that most of the fluid inclusions in these rocks did not undergo any marked effect of volume change and density

  16. [Morphological changes of vascular network of the midpalatal suture and palate mucosa after rapid maxillary expansion].

    PubMed

    Hirose, T

    1989-01-01

    Rapid maxillary expansion has been utilized for years in the treatment of transverse maxillomandibular discrepancies. It is important to understand the changes of the vascular network in midpalatal suture following rapid maxillary expansion. The reason is because it is critical to maintain the blood supply and circulation for the osteogenesis and bone remodeling after the expansion. The purpose of this study was to examine the morphological changes in the vascular network of the palate regions following rapid maxillary expansion. A total of 30 dogs were divided into 6 groups of 5 dogs each, of which one group was used as a control. A skeleton type rapid maxillary expansion appliance was utilized in the 5 experimental groups. Transverse expansion was accomplished by activating the appliances 0.4 mm each day for 10 days, achieving a total of 4.0 mm of width increase. The animals were sacrificed and injected with acrylic resin through the maxillary artery at 3, 7, 14, 21 and 28 days. The thin sections were examined with a light microscope and fine vascular corrosion specimens were examined with a scanning electron microscope. The results were as follows: 1. Vascular network in the midpalatal suture. 1) The suture appeared as an interdigitating bony processes separated by a relatively narrow gap. The blood vessels were running in the direction from the posterior to anterior in the control. 2) 3 days after the expansion, the suture had separated. The hemorrhage which accompanied the expansion was not observed, though hyperemia and enlargement of the blood vessels were observed. The stretched blood vessels from the bone walls observed along the stretched fiber bundles were remarkable. A few new blood vessels were observed in various places in the bone walls. 3) 7 and 14 days after the expansion, the number of new blood vessels increased significantly and anastomosed. The tube-shaped new bone formation was observed in parts of the bone walls along the stretched fiber

  17. Mesozoic and Cenozoic tectonics of the eastern and central Alaska Range: Progressive basin development and deformation in a suture zone

    USGS Publications Warehouse

    Ridgway, K.D.; Trop, J.M.; Nokleberg, W.J.; Davidson, C.M.; Eastham, K.R.

    2002-01-01

    Analysis of late Mesozoic and Cenozoic sedimentary basins, metamorphic rocks, and major faults in the eastern and central Alaska Range documents the progressive development of a suture zone that formed as a result of collision of an island-arc assemblage (the Wrangellia composite terrane) with the former North American continental margin. New basin-analysis, structural, and geochronologic data indicate the following stages in the development of the suture zone: (1) Deposition of 3-5 km of Upper Jurassic-Upper Cretaceous marine strata (the Kahiltna assemblage) recorded the initial collision of the island-arc assemblage with the continental margin. The Kahiltna assemblage exposed in the northern Talkeetna Mountains represents a Kimmeridgian-Valanginian backarc basin that was filled by northwestward-flowing submarine-fan systems that were transporting sediment derived from Mesozoic strata of the island-arc assemblage. The Kahiltna assemblage exposed in the southern Alaska Range represents a Valanginian-Cenomanian remnant ocean basin filled by west-southwestward-flowing submarine-fan systems that were transporting sediment derived from Paleozoic continental-margin strata uplifted in the along-strike suture zone. A belt of retrograde metamorphism and a regional anticlinorium developed along the continental margin from 115 to 106 Ma, roughly coeval with the end of widespread deposition in the Kahiltna sedimentary basins. (2) Metamorphism of submarine-fan deposits of the Kahiltna basin, located near the leading edge of the island-arc assemblage, occurred at ca. 74 Ma, as determined from a new U-Pb zircon age for a synkinematic sill. Coeval with metamorphism of deposits of the Kahiltna basin in the southern part of the suture zone was development of a thrust-top basin, the Cantwell basin, in the northern part of the suture zone. Geologic mapping and compositional data suggest that the 4 km of Upper Cretaceous nonmarine and marginal marine sedimentary strata in this basin

  18. Distal Triceps Knotless Anatomic Footprint Repair: A New Technique

    PubMed Central

    Paci, James M.; Clark, Jonathan; Rizzi, Angelo

    2014-01-01

    Distal triceps rupture is a rare injury causing significant disability. Several techniques for treating distal triceps ruptures have been described using bone tunnels or suture anchors. More recent techniques have focused on re-creating the anatomic footprint of the distal triceps tendon. However, the increasing numbers of anchors used increase the risk to the articular surface, and all earlier techniques require knot tying and bulky knots beneath the thin posterior elbow soft-tissue envelope. We describe a technique combining the use of bone tunnels and a single suture anchor to create a knotless anatomic footprint repair of the distal triceps. By using this technique, we are able to create a tension-band construct that self-reinforces the anatomic repair and is very low profile while significantly decreasing risk to the articular surface. PMID:25473618

  19. Effects of suture material and ultrasonic transmitter size on survival, growth, wound healing, and tag expulsion in rainbow trout

    USGS Publications Warehouse

    Ivasauskas, Tomas J.; Bettoli, P.W.; Holt, T.

    2012-01-01

    We examined the effects of suture material (braided silk versus Monocryl) and relative ultrasonic transmitter size on healing, growth, mortality, and tag retention in rainbow trout Oncorhynchus mykiss. In experiment 1, 40 fish (205-281mmtotal length [TL], 106-264 g) were implanted with Sonotronics IBT-96-2 (23??7 mm; weight in air, 4.4 g; weight in water, 2.4 g) or IBT 96-2E (30 ?? 7 mm; weight in air, 4.9 g; weight in water, 2.4 g) ultrasonic telemetry tags. In experiment 2, 20 larger fish (342-405 mm TL; 520-844 g) were implanted with Sonotronics IBT-96-5 ultrasonic tags (36 ?? 11 mm; weight in air, 9.1 g; weight in water, 4.1 g). The tag burdens for all implanted fish ranged from 1.1% to 3.4%, and fish in both studies were held at 10-15??C. At the conclusion of both experiments (65 d after surgery), no mortalities were observed in any of the 60 tagged fish, most incisions were completely healed, and all fish in both experiments grew in length, although tagged fish grew more slowly than control fish in experiment 1. In both experiments, fish sutured with silk expelled tags more frequently than those sutured with Monocryl. Expulsion was observed in 45-50% of the fish sutured with silk and 0-25% of the fish sutured withMonocryl. Tag expulsion was not observed until 25-35 d after surgery. Fish sutured with silk exhibited a more severe inflammatory response 3 weeks after surgery than those sutured with Monocryl. In experiment 1, the rate of expulsion was linked to the severity of inflammation. Although braided silk sutures were applied faster than Moncryl sutures in both experiments, knots tied with either material were equally reliable and fish sutured with Monocryl experienced less inflammation and lower rates of tag expulsion. American Fisheries Society 2012.

  20. Technique of transanal endoscopic microsurgery.

    PubMed

    Buess, G; Kipfmüller, K; Hack, D; Grüssner, R; Heintz, A; Junginger, T

    1988-01-01

    Sessile adenomas are predominantly localized in the rectum and lower sigma. Surgical removal is indicated but often implies an invasive surgical procedure. Using conventional transanal surgical techniques, only the lower rectum can be reached and there are high rates of recurrence. The new technique combines an endoscopic view of the rectum under gas insufflation via a stereoscopic telescope with conventional surgical preparation and suturing. Adenomas can be excised using the mucosectomy technique or full-thickness-excision, whereas carcinomas should be excised using full-thickness excision with a sufficient border of healthy mucosa. In carcinomas of the sacral cavity, we remove the retrorectal fat up to the fascia of Waldeyer, including the regional lymph nodes. Transanal endoscopic microsurgery is the most economical and tissue-saving surgical technique for the removal of rectal adenomas and early rectal carcinomas.

  1. Effects of strontium ranelate on bone formation in the mid-palatal suture after rapid maxillary expansion

    PubMed Central

    Zhao, Shuya; Wang, Xuxia; Li, Na; Chen, Yun; Su, Yuran; Zhang, Jun

    2015-01-01

    Background The aim of this experimental study was to investigate the effects of strontium ranelate on bone regeneration in the mid-palatal suture in response to rapid maxillary expansion (RME). Methods Thirty-six male 6-week-old Wistar rats were randomly divided into three groups, ie, an expansion only (EO) group, an expansion plus strontium ranelate (SE) group, and a control group. An orthodontic appliance was set between the right and left upper molars of rats with an initial expansive force of 0.98 N. Rats in the SE group were administered strontium ranelate (600 mg/kg body weight) and then euthanized in batches on days 4, 7, and 10. Morphological changes in the mid-palatal suture were investigated using micro-computed tomography and hematoxylin and eosin staining after RME. Bone morphogenetic protein-2 expression in the suture was also examined to evaluate bone formation in the mid-palatal suture. Image-Pro Plus software was then used to determine the mean optical density of the immunohistochemical images. Analysis of variance was used for statistical evaluation at the P<0.05 level. Results With expansive force, the mid-palatal suture was expanded, but there was no statistically significant difference (P>0.05) between the SE and EO groups. The bone volume of the suture decreased after RME, but was higher in the SE group than in the EO group on days 7 and 10. Further, expression of bone morphogenetic protein-2 in the SE group was higher than in the other two groups (P<0.05). Conclusion Strontium ranelate may hasten new bone formation in the expanded mid-palatal suture, which may be therapeutically beneficial in prevention of relapse and shortening the retention period after RME. PMID:26056433

  2. Geological Studies of the Salmon River Suture Zone and Adjoining Areas, West-Central Idaho and Eastern Oregon

    USGS Publications Warehouse

    Kuntz, Mel A.; Snee, Lawrence W.

    2007-01-01

    The papers in this volume describe petrologic, structural, and geochemical studies related to geographic areas adjacent to and including the Salmon River suture zone. We therefore start this volume by defining and giving a general description of that suture zone. The western margin of the North American continent was the setting for complex terrane accretion and large-scale terrane translation during Late Cretaceous and Eocene time. In western Idaho, the boundary that separates the Paleozoic-Mesozoic accreted oceanic, island-arc rocks on the west from Precambrian continental metamorphic and sedimentary rocks on the east is called the Salmon River suture zone (SRSZ). Readers will note that the term 'Salmon River suture zone' is used in the title of this volume and in the text of several of the papers and the term 'western Idaho suture zone' is used in several other papers in this volume. Both terms refer to the same geologic feature and reflect historical usage and custom; thus no attempt has been made by the editors to impose or demand a single term by the various authors of this volume. The suture zone is marked by strong lithologic and chemical differences. Rocks adjacent to the suture zone are characterized by high-grade metamorphism and much structural deformation. In addition, the zone was the locus of emplacement of plutons ranging in composition from tonalite to monzogranite during and after the final stages of accretion of the oceanic terrane to the North American continent. The contents of this paper consists of seven chapters.

  3. Outcomes following arthroscopic transosseous equivalent suture bridge double row rotator cuff repair: a prospective study and short-term results

    PubMed Central

    Imam, Mohamed Abdelnabi; Abdelkafy, Ashraf

    2016-01-01

    Background: The transosseous-equivalent cross bridge double row (TESBDR) rotator cuff (RC) repair technique has been developed to optimize healing biology at a repaired RC tendon insertion. It has been shown in the laboratory to improve pressurized contact area and mean foot print pressure when compared with a double row anchor technique. Pressure has been shown to influence healing between tendon and bone, and the tendon compression vector provided by the transosseous-equivalent suture bridges may enhance healing. The purpose was to prospectively evaluate the outcomes of arthroscopic TESBDR RC repair. Methods: Single center prospective case series study. Sixty-nine patients were selected to undergo arthroscopic TESBDR RC repair and were included in the current study. Primary outcome measures included the Oxford Shoulder Score (OSS), the University of California, Los Angeles (UCLA) score, the Constant-Murley (CM) Score and Range of motion (ROM). Secondary outcome measures included a Visual Analogue Scale (VAS) for pain, another VAS for patient satisfaction from the operative procedure, EuroQoL 5-Dimensions Questionnaire (EQ-5D) for quality of life assessment. Results: At 24 months post-operative, average OSS score was 44, average UCLA score was 31, average CM score was 88, average forward flexion was 145°, average internal rotation was 35°, average external rotation was 79°, average abduction was 150°, average EQ-5D score was 0.73, average VAS for pain was 2.3, and average VAS for patient satisfaction was 9.2. Conclusion: Arthroscopic TESBDR RC repair is a procedure with good post-operative functional outcome and low re-tear rate based on a short term follow-up. PMID:27163096

  4. A modified surgical technique for reconstruction of an acute acromioclavicular joint dislocation

    PubMed Central

    Marchie, Anthony; Kumar, Arun; Catre, Melanio

    2009-01-01

    We report a modified surgical technique for reconstruction of coracoclavicular and acromioclavicular ligaments after acute dislocation of acromioclavicular joint using suture anchors. We have repaired 3 consecutive type III acromioclavicular dislocations with good results. This technique is simple and safe and allows anatomical reconstruction of the ligaments in acute dislocations. PMID:20671868

  5. Evaluation of the effect of 4 types of knots on the mechanical properties of 4 types of suture material used in small animal practice.

    PubMed

    Avoine, Xytilis; Lussier, Bertrand; Brailovski, Vladimir; Inaekyan, Karine; Beauchamp, Guy

    2016-04-01

    The influence of the type of material used, knot configuration, and use of an additional throw on the tensile force at failure, the elongation, and the mode of failure of different configurations of linear sutures and knotted suture loops was evaluated in this in-vitro mechanical study. We hypothesized that all types of knots would significantly influence the initial force and elongation of suture materials and would influence the force and elongation at which the knotted loops break, but not their mode of failure. A total of 432 samples of 4 types of size 3-0 suture material (polydioxanone, polyglecaprone 25, polyglactin 910, and nylon), representing 9 configurations, were tested in a tensiometer. The configurations were 1 linear suture without a knot and the following loops: square (SQ) knot; surgeon's (SU) knot; granny (GR) knot; and sliding half-hitch (SHH) knot using either 4 and 5 or 3 and 4 throws, depending on the material. For polydioxanone, SQ and SU knots did not decrease the initial force at failure of the suture. Granny (GR) and SHH knots decreased the tensile force at failure and elongation by premature failure of the loop. For polyglecaprone 25, all knots decreased the initial force at failure of the suture, with SHH being weaker than the other knots. For coated polyglactin 910, all knots decreased the initial force at failure of the suture and slippage increased significantly compared with the other 3 sutures. The use of SQ knots with 3 throws did not result in a safe knot. For nylon, knots did not alter the original mechanics of the suture. In conclusion, all knots and types of suture material do not necessarily have the same effect on the initial tensile force at failure of suture materials. PMID:27127344

  6. The “Labral Bridge”: A Novel Technique for Arthroscopic Anatomic Knotless Bankart Repair

    PubMed Central

    Ostermann, Roman C.; Hofbauer, Marcus; Platzer, Patrick; Moen, Todd C.

    2015-01-01

    Arthroscopic Bankart repair with suture anchors is widely considered a mainstay for surgical treatment of anterior shoulder instability after recurrent anterior shoulder dislocations. Traditionally, the displaced capsulolabral complex is restored and firmly attached to the glenoid by placing multiple suture anchors individually from a 5- to 3-o'clock position. A variety of different techniques using different anchor designs and materials have been described. Knotless anchors are widely used nowadays for shoulder instability repair, providing a fast and secure way of labral fixation with favorable long-term outcomes. However, these techniques result in a concentrated point load of the reduced labrum to the glenoid at each suture anchor. We describe a technique, developed by the first author, using a 1.5-mm LabralTape (Arthrex, Naples, FL) in combination with knotless suture anchors (3.5-mm PEEK [polyether ether ketone] PushLock anchors; Arthrex), for hybrid fixation of the labrum. The LabralTape is used to secure the torn labrum to the glenoid between each suture anchor, thus potentially providing a more even pressure distribution. PMID:26052499

  7. Sulcus vocalis: excision, primary suture and medialization laryngoplasty: personal experience with 44 cases.

    PubMed

    Yılmaz, Taner

    2012-11-01

    This is a prospective, cohort study to present personal experience on excision of sulcus, primary suture of defect and medialization laryngoplasty. An article about this subject is not present in medical literature. Forty-four patients with sulcus vocalis who were operated on by excision, primary suture of epithelial defect and medialization laryngoplasty were included. Pre- and postoperative evaluations included GRBAS, VHI-30, stroboscopy, aerodynamic and acoustic analysis. Grade, roughness and breathiness of GRBAS were significantly better postoperatively (p < 0.05), whereas asthenia and strain were not (p > 0.05). All VHI-30 results decreased significantly after surgery (p < 0.01). Glottal closure and mucosal wave amplitude during stroboscopy improved significantly postoperatively (p < 0.05), whereas symmetry and periodicity did not (p > 0.05). Maximum phonation time, mean airflow rate, mean efficiency and mean pressure of aerodynamic analysis improved significantly after surgery (p < 0.05). However, mean resistance and mean power were not significantly different (p > 0.05). All parameters, except F (0) and soft phonation index during acoustic analysis with /a/, and except F (0), voice turbulence index and soft phonation index during acoustic analysis with constant phrase improved significantly after surgery (p < 0.05). Surgical treatments of sulcus vocalis are not satisfactory enough, yet. Excision of sulcus, primary suture of epithelial defect and medialization laryngoplasty is one of the successful surgical options. Intact vocal ligament at the bottom of sulcus is a good prognostic sign for good postoperative voice result. Success appears to depend on how long, how wide and how deep sulcus is. Good patient selection may increase the percentage of happy patients.

  8. The role of multimodality imaging in percutaneous left atrial appendage suture ligation with the LARIAT device.

    PubMed

    Laura, Diana M; Chinitz, Larry A; Aizer, Anthony; Holmes, Douglas S; Benenstein, Ricardo; Freedberg, Robin S; Kim, Eugene E; Saric, Muhamed

    2014-07-01

    Atrial fibrillation (AF), the most common cardiac arrhythmia, is a significant cause of embolic stroke. Although systemic anticoagulation is the primary strategy for preventing the thromboembolic complications of AF, anticoagulants carry major bleeding risks, and many patients have contraindications to their use. Because thromboembolism typically arises from a clot in the left atrial appendage (LAA), local therapeutic alternatives to systemic anticoagulation involving surgical or percutaneous exclusion of the LAA have been developed. Surgical exclusion of the LAA is typically performed only as an adjunct to other cardiac surgeries, thus limiting the number of eligible patients. Furthermore, surgical exclusion of the LAA is frequently incomplete, and thromboembolism may still occur. Percutaneous LAA exclusion includes two approaches: transseptal delivery of an occlusion device to the LAA and epicardial suture ligation of the LAA, the LARIAT procedure. In the LARIAT procedure, a pretied snare is placed around the epicardial surface of the LAA orifice via pericardial access. Proper snare placement is achieved with epicardial and endocardial magnet-tipped guidewires. The endocardial wire is advanced transvenously to the LAA apex after transseptal puncture. The epicardial wire, introduced into the pericardial space, achieves end-to-end union with the endocardial wire at the LAA apex. The snare is then placed over the LAA, tightened, and sutured. On the basis of early clinical experience, the LARIAT procedure has a high success rate of LAA exclusion with low risk for complications. The authors describe the indispensable role of real-time transesophageal echocardiography in the guidance of LAA epicardial suture ligation with the LARIAT device.

  9. The elusive nature of the Rheic Ocean suture in SW Iberia

    NASA Astrophysics Data System (ADS)

    Pérez-Cáceres, I.; Martínez Poyatos, D.; Simancas, J. F.; Azor, A.

    2015-12-01

    The Rheic Ocean suture resulted from pre-Carboniferous oceanic subduction followed by Late Devonian-Carboniferous Variscan collision. In SW Iberia, this suture has been classically located along the boundary between the Ossa-Morena and South Portuguese Zones based on the presence of three units: (i) a conspicuous metamafic unit (Beja-Acebuches) that crops out along this boundary and has been interpreted as a pre-Carboniferous Rheic Ocean ophiolite; (ii) a low-grade metasedimentary unit with minor mid-ocean ridge basalt-like lithologies (Pulo do Lobo unit), thought to represent a Rheic Ocean subduction-related accretionary prism; and (iii) the allochthonous Cubito-Moura unit that contains high-pressure and ophiolitic-like rocks. We report new structural and geochronological data that allow us to reinterpret the origin and internal structure of the Beja-Acebuches and the Pulo do Lobo units. Thus, both the Beja-Acebuches protoliths and the Pulo do Lobo metabasalts would have been formed in the context of an intracollisional extensional stage that interrupted the Variscan collision at early Carboniferous time, after the Rheic Ocean consumption, and the first continental collision. Later on, collision was resumed in an oblique left-lateral regime that gave way to coeval frontal (folds and thrusts) and lateral (shear zones and strike-slip faults) structures, with variable pressure-temperature conditions and space distribution along time. As a consequence of the superposition of transtension and complex transpression, the Rheic suture in SW Iberia has an obscure nearly cryptic appearance.

  10. Arthroscopic Fixation of Comminuted Glenoid Fractures Using Cannulated Screws and Suture Anchors

    PubMed Central

    Qu, Feng; Yuan, Bangtuo; Qi, Wei; Li, Chunbao; Shen, Xuezhen; Guo, Qi; Zhao, Gang; Wang, Jiangtao; Li, Hongliang; Lu, Xi; Liu, Yujie

    2015-01-01

    Abstract We investigate the feasibility of arthroscopic fixation of comminuted glenoid fractures using cannulated screws and suture anchors. We retrospectively review 11 cases of closed comminuted glenoid fractures treated at our institution from August 2010 to May 2013. The 11 patients, 8 males and 3 females, had a mean age of 41 years (range: 27–55 years). The mechanisms of injury were traffic accidents in 9 cases and falls from height in 2 cases. The mean time from injury to surgery was 12 days (range: 3–28 days). All glenoid fractures were confirmed on x-ray and computed tomography. The major fracture fragments were fixed with cannulated screws and the small fragments were fixed with suture anchors. All surgical wounds healed with primary closure and no complications including infection and neurovascular damage were observed. All 11 patients were followed up for a mean of 21 months (range: 14–29 months). Bone union was achieved in all patients with a mean time of 10 months. At the last follow-up, range of motion of the shoulder joint was significantly improved (P < 0.05). Both ASES scores (41.4 ± 24.9, 87.3 ± 13.8) and Rowe scores (28.2 ± 18.6, 93.2 ± 11.2) were significantly increased after the surgery (P < 0.01), indicating significantly improved function and stability of the shoulder joint. Arthroscopic fixation using cannulated screws and suture anchors is feasible for the treatment of comminuted glenoid fractures. This method is minimally invasive and provides good functional recovery with a lower risk of complications. PMID:26656324

  11. Comparison of laser-assisted fibrinogen-bonded and sutured canine arteriovenous anastomoses.

    PubMed

    Oz, M C; Libutti, S K; Ashton, R C; Lontz, J F; Lemole, G M; Nowygrod, R

    1992-07-01

    The effect of laser-assisted fibrinogen bonding (LAFB) on the development of intimal hyperplasia was studied with stress-strain profiles and histologic evaluation of canine arteriovenous fistulas (AVFs). In 19 animals femoral AVFs were created with an 808 nm diode laser after topical application of fibrinogen mixed with indocyanine green dye; in the contralateral limb a sutured AVF was created. The animals were divided into three groups. Group 1 dogs (n = 6) were killed serially up to 4 weeks after surgery to examine the healing of the anastomoses created with LAFB. Group 2 dogs (n = 6) were killed 1 month after surgery, and the fresh specimens were strained axially to produce a stress-strain profile graph. Group 3 dogs (n = 7) were killed 7 months after surgery, and the AVFs were infused with formalin under pressure and histologically prepared to allow comparison of the ratio of maximum to minimum intimal hypertrophy. Fibrinogen used for LAFB was resorbed during the first month after operation without evidence of foreign body reaction or inflammation. Tensile break force was not significantly different in the laser-bonded group (4.6 +/- 2.4 pounds) and the sutured group (4.3 +/- 1.7 pounds). The modulus (tensile break force per square inch), a measure of elasticity, identified the laser-bonded AVF (149 +/- 44 pounds per square inch) to be less rigid than the sutured AVF (203 +/- 35 pounds per square inch) (p less than 0.05). No significant differences in the degree of intimal hyperplasia were noted in any area of the anastomoses. Use of LAFB neither accelerates nor prevents intimal hyperplasia in a canine AVF model.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Percutaneous repair of iatrogenic subclavian artery injury by suture-mediated closure device

    PubMed Central

    Chivate, Rahul S; Kulkarni, Suyash S; Shetty, Nitin S; Polnaya, Ashwin M; Gala, Kunal B; Patel, Paresh G

    2016-01-01

    Central venous catheterization through internal jugular vein is done routinely in intensive care units. It is generally safe, more so when the procedure is performed under ultrasound guidance. However, there could be inadvertent puncture of other vessels in the neck when the procedure is not performed under real-time sonographic guidance. Closure of this vessel opening can pose a challenge if it is an artery, in a location difficult to compress, and is further complicated by deranged coagulation profile. Here, we discuss the removal of an inadvertently placed catheter from subclavian artery with closure of arteriotomy percutaneously using arterial suture-mediated closure device. PMID:27413277

  13. Percutaneous repair of iatrogenic subclavian artery injury by suture-mediated closure device.

    PubMed

    Chivate, Rahul S; Kulkarni, Suyash S; Shetty, Nitin S; Polnaya, Ashwin M; Gala, Kunal B; Patel, Paresh G

    2016-01-01

    Central venous catheterization through internal jugular vein is done routinely in intensive care units. It is generally safe, more so when the procedure is performed under ultrasound guidance. However, there could be inadvertent puncture of other vessels in the neck when the procedure is not performed under real-time sonographic guidance. Closure of this vessel opening can pose a challenge if it is an artery, in a location difficult to compress, and is further complicated by deranged coagulation profile. Here, we discuss the removal of an inadvertently placed catheter from subclavian artery with closure of arteriotomy percutaneously using arterial suture-mediated closure device. PMID:27413277

  14. Successful Angioplasty of a Superficial Femoral Artery Stenosis Caused by a Suture-Mediated Closure Device

    SciTech Connect

    Gemmete, Joseph J. Dasika, Narasimham; Forauer, Andrew R.; Cho, Kyung; Williams, David M.

    2003-08-15

    We report the successful angioplasty of an acute arterial narrowing after suture-mediated closure (SMC) of a femoral arterial puncture. A 75-year-old woman underwent a cerebral arteriogramvia a right common femoral artery puncture. The arteriotomy site was closed with a SMC device. Four days after placement the patient complained of pain in her right calf after walking. An arteriogram 7 days after SMC showed a severe focal stenosis at the origin of the superficial femoral artery involving the presumed puncture site. The lesion was successfully treated with balloon angioplasty. The patient at 6 months was asymptomatic.

  15. [THE EVOLUTION IN TREATING MENISCAL TEARS--FROM RESECTION TO SUTURING].

    PubMed

    Stahl, Ido; Shapira, Jackob; Peskin, Bezalel; Hous, Nir; Norman, Doron; Falah, Mazen

    2016-05-01

    The meniscus has an important biomechanical role in the normal function of the knee including load bearing, shock absorption and joint stability. Tears of the meniscus are one of the common sports injuries. The knowledge that total meniscectomy causes early development of degenerative changes has raised the prevalence of meniscal tear repair in order to preserve as much as possible of the meniscal tissue. The type of tear (degenerative of traumatic), shape and location have a critical effect on healing ability after suture of the tear and thus will determine the treatment plan.

  16. Mesozoic metamorphism and its tectonic implication along the Solonker suture zone in central Inner Mongolia, China

    NASA Astrophysics Data System (ADS)

    Zhang, Jinrui; Wei, Chunjing; Chu, Hang; Chen, Yaping

    2016-09-01

    The Xing'an-Inner Mongolia Orogenic Belt (XIMOB) exposed in the eastern section of the Central Asian Orogenic Belt (CAOB) is generally thought to have resulted from closure of the Paleo-Asian Ocean. However, disputations still exist on the age and detailed tectonic processes involved in its final amalgamation. The Solonker suture zone in the central Inner Mongolia, once recognized as the major paleo-plate boundary recording the terminal collision of the XIMOB, is characterized by extensive regional low-temperature metamorphism of greenschist to epidote-amphibolite facies with local presence of blueschists, which lacks systematic study. Four metabasite and garnet-mica schist samples were studied for determination of metamorphic P-T evolution using pseudosection and conventional thermobarometry. The two metabasite samples from Wulangou and Daqing Pasture contain actinolite, albite, epidote, chlorite and hornblende (in Daqing Pasture) and are estimated to have peak P-T conditions of 5.2-5.9 kbar/415-450 °C in Wulangou and 7.0-7.9 kbar/470-475 °C in Daqing Pasture. Two garnet-mica schist samples from Shuangjing (or Shuangjing schist) contain garnet porphyroblasts, muscovite, quartz, plagioclase, chlorite with or without potassium feldspar, biotite, and calcite, and are modeled to record prograde P-T vectors respectively of 3.0 kbar/482 °C-3.3 kbar/495 °C and 4.2 kbar/478 °C-4.8 kbar/483 °C, followed by near-isothermal decompression. The zircon U-Pb dating analyses suggest that the metamorphism probably occurred soon afterwards in the Early Mesozoic. The peak P-T conditions for the metabasite and garnet-mica schist samples yield thermal gradients respectively of 18-22 °C/km and 26-33 °C/km, being intermediate and low P/T series, and the metamorphic evolution in these rocks characteristic of clockwise P-T paths may correspond to tectonic thickening and thinning processes. The extensive low-temperature metamorphism of intermediate to low P/T types along the

  17. [THE EVOLUTION IN TREATING MENISCAL TEARS--FROM RESECTION TO SUTURING].

    PubMed

    Stahl, Ido; Shapira, Jackob; Peskin, Bezalel; Hous, Nir; Norman, Doron; Falah, Mazen

    2016-05-01

    The meniscus has an important biomechanical role in the normal function of the knee including load bearing, shock absorption and joint stability. Tears of the meniscus are one of the common sports injuries. The knowledge that total meniscectomy causes early development of degenerative changes has raised the prevalence of meniscal tear repair in order to preserve as much as possible of the meniscal tissue. The type of tear (degenerative of traumatic), shape and location have a critical effect on healing ability after suture of the tear and thus will determine the treatment plan. PMID:27526563

  18. Sutures - ridged

    MedlinePlus

    ... an overlap of the bony plates of the skull in an infant, with or without early closure. Considerations The skull of an infant or young child is made ... bony plates that allow for growth of the skull. The borders where these plates intersect are called ...

  19. Sutures - separated

    MedlinePlus

    The problem may be caused by: Arnold-Chiari malformation Battered child syndrome Bleeding inside the brain (intraventricular hemorrhage) Brain tumor Certain vitamin deficiencies Dandy-Walker malformation Down syndrome Hydrocephalus Infections that are ...

  20. The anatomy of a 'suture zone' in Amazonian butterflies: a coalescent-based test for vicariant geographic divergence and speciation.

    PubMed

    Dasmahapatra, Kanchon K; Lamas, Gerardo; Simpson, Fraser; Mallet, James

    2010-10-01

    Attempts by biogeographers to understand biotic diversification in the Amazon have often employed contemporary species distribution patterns to support particular theories, such as Pleistocene rainforest refugia, rather than to test among alternative hypotheses. Suture zones, narrow regions where multiple contact zones and hybrid zones between taxa cluster, have been seen as evidence for past expansion of whole biotas that have undergone allopatric divergence in vicariant refuges. We used coalescent analysis of mutilocus sequence data to examine population split times in 22 pairs of geminate taxa in ithomiine and heliconiine butterflies. We test a hypothesis of simultaneous divergence across a suture zone in NE Peru. Our results reveal a scattered time course of diversification in this suture zone, rather than a tight cluster of split times. Additionally, we find rapid diversification within some lineages such as Melinaea contrasting with older divergence within lineages such as the Oleriina (Hyposcada and Oleria). These results strongly reject simple vicariance as a cause of the suture zone. At the same time, observed lineage effects are incompatible with a series of geographically coincident vicariant events which should affect all lineages similarly. Our results suggest that Pleistocene climatic forcing cannot readily explain this Peruvian suture zone. Lineage-specific biological traits, such as characteristic distances of gene flow or varying rates of parapatric divergence, may be of greater importance. PMID:20819158