comparative study of two suture configurations in zone II flexor tendon repair in adults

Although the increase in the number of core sutures during flexor tendon repair increases the tensile strength of the repair, both increased handling at the time of repair and increased bulk at the repair site have been hypothesized as affecting clinical outcomes by increasing gliding resistance. The purpose of our study was to assess whether increasing the number of core sutures from two strands to four strands in zone II flexor tendon repair could improve the clinical results. A total of 42 patients with 60 flexor tendon lacerations in zone II were enrolled in this study. The injured tendon randomly underwent surgical repair by using one of the 2-strand or 4-strand modified Strickland techniques. Postoperative rehabilitation was the active extension-rubber band flexion method of Kleinert in all patients. The average duration of follow up was 8 months. The mean total active motion was 155.16° in 2-strand group [excluding two ruptures] and 154.33° in 4-strand group [P > 0.05]. Using Strickland's original score, this corresponds to excellent result in 83.3% and 86.6% of patients in 2-strand group and 4-strand group, respectively. Statistically, there was no significant difference between the clinical outcomes obtained in these groups. Concerning the tendon rupture after the repair, all of the ruptures [2 cases] occurred in the 2-strand group [P > 0.05]. We concluded that both suture strength and gliding resistance have influence on the result of flexor tendon repair in zone II, and increasing the number of core sutures and the resulting suture strength may be negatively affected by increase in gliding resistance

comparative study of sutured versus stapled gastrointestinal anastomosis

A prospective study was carried out at Surgical Unit IV, Liaquat Medical College Hospital, Jamshoro to compare hand sutured with stapled anastomosis from April 1994 to March 1998. Of the total 91 patients in the study, 58 were hand sutured while 33 underwent stapler anastomosis. Patients were divided into seven categories according to the type of anastomosis viz. oesophagogastric [9 sutured, 13 stapled], small intestinal [22 sutured, one stapled], ilcocolic [12 sutured, 3 stapled], colonic [8 sutured, 14 stapled], colorectal [3 sutured, 6 stapled], ileoanal [2 sutured, 3 stapled], and coloanal [2 sutured, 3 stapled]. The occurrence of anastomotic leak was 13.79% in sutured and 9.09% in stapled group whereas stricture formation was 3.72% in sutured and 12.12% in stapled anastomosis. The incidence of wound infection was 1.34% in sutured and 6.6% in stapled group, while reactionary haemorrhage was 3.72% in sutured and 6.6% in stapled anastomosis. The mortality was 10.39% in sutured and 9.09% in stapled group. It was concluded that in stapler anastomosis a lot of time is saved, hospital stay is short, and morbidity and mortality is decreased

Use of subcuticular absorble sutres in paediatric cases of complicated appendicitis

Modern surgical practice and use of appropriate antimicrobial therapy have rendered earlier methods of wound care in complicated appendicitis unnecessary. We performed primary wound closure with absorbable subcuticular stitches in 51 children with complicated appendicitis. The wound healed nicely in all patients except three who developed infection that was easily managed by simple drainage and did not lead to any major complication. The use of subcuticular absorbable stitches obviates the necessity of traumatic daily dressing changes, leaves an excellent scar and decreases hospital stay and cost

Surgical workshop avoiding operative wound sepsis by a new subcutaneous suturing technique

Postoperative wound infection adds considerably to the morbidity and mortality of patients and increases the length of hospitalization and medical costs [Green and Wenzel, 1977]. Bacterial contamination of the operative wound may be exogenous or endogenous and usually is confined to the subcutaneous tissues. Despite every effort to maintain asepsis, we can not guarantee against microscopical contamination [Pollock, 1985]. It is crucial, therefore that the presence of sutures in the subcutaneous layer particularly when there has been contamination following open viscus surgery will predispose to wound complications such as suture abscesses, granulomas and sinuses [Carlos, 1983]. Moreover bacterial migration along braided sutures, reactivity of some absorbable sutures and strangulating effect of tight sutures add to the risk of wound sepsis [Staffer et al., 1986]. Together with subcuticular suture for skin closure, the author has for a number of years adopted a new technique for subcutaneous tissue approximation that allows sound wound healing with minimal scarring and almost avoiding wound sepsis

two surgports technique for the easy laparoscopic cholecystectomy, the application of the trans-parietal proline suture technique [TPPS]

48 cases were studied fulfilling the following criteria: Collapsible fundus when elevated, no omental adhesions, evident structures in the hepatoduodenal ligament. The technique is only using the xiphisternal and mid clavicular trocars. The technique enabled successfully to remove the GB without the need for additional trocars. No encroachment upon the exposure, the safety of the technique, biliary duct injury, leaking or bleeding episodes occurred in this series. The described technique proved to be an efficient alternative to the three ports technique. A further development of the use of TPPS would be the production of a detachable jaw part of an instrument which can be applied to different parts of any organs and to apply many TPPS in different directions to this instrument will definitely contribute to achieve a less invasive technique and help laparoscopic maneuvers

Implante de lente intra-ocular de câmara posterior com fixaçäo escleral / Implantation of posterior chamber intraocular lens with scleral fixation

O autor descreve uma técnica simplificada para implantaçäo de lente intra-ocular de câmara posterior com fixaçäo escleral em olhos sem suporte capsular. A cirurgia foi realizada em 11 olhos afácicos e em 4 outros com rupturas extensas da cápsula posterior durante a execuçäo da extraçäo extracapsular da catarata. Em 10 dos 11 olhos afácicos (91%), a acuidade visual corrigida permanecu inalterada. Em todos os olhos com implantaçäo primária, a acuidade visual foi igual ou melhor que 20/25. A exceçäo de um olho que desenvolveu edema macular cistóide, näo se observaram outras complicaçöes importantes

Evaluation of using single-layer continuous suturing technique in gastro-jejunostomy

Thirty-six patients were included in this study. All of them were subjected to gastrojejunostomy as a drainage operation in combination with trunkal vagotomy as a line of treatment for duodenal peptic ulcer. An absorbable suturing material [3/0 polydioxanone] was used to construct the gastrojejunal anastomoses. The single-layer continuous suturing technique was used involving all coats with care, not to invert much tissue in the anastomotic line. No single case of anastomotic leak was observed in the 36 patients. The single-layer continuous suturing technique is proved to be reliable in creation of integrated gastrojejunal anastomosis. Such technique is advised to be used in gastrojejunostomy because it is reliable, more economic and still safe with the increased risk of bleeding from the anastomotic line and shortens the operation time

Comparación entre polybutester y polipropileno en sutura de aponeurosis y piel en cirugía abdominal / Polybutester and polypropilene comparation in skin aponeurosis suture in abdominal surgery

El polybutester es un material de sutura, no absorbible, sintético, monofilamento, que se ha comparado con el polipropileno, para la sutura de la aponeurosis y piel, empleando en 92 pacientes en intervenciones quirúrgicas abdominales, de diferentes etiologías, tanto electivas como de emergencia. Se comprobó que el polybutester posee mejor manejabilidad, debido a su elasticidad, flexibilidad, más blando que permite hacer un nudo fácil y seguro, por lo que constituye una alternativa a elegir en cirugía general

A importância do fechamento do peritônio nas laparotomias: estudo experimental / The importance of peritoneal closure in laparotomies: experimental study

Realizou-se estudo experimental em ratos com a finalidade de se determinar qual técnica de fechamento da parede abdominal - um plano, excluindo o peritônio, ou dois planos, incluindo o peritônio - confere maior segurança à ferida operatória. Utilizou-se sutura contínua com Vicryl R 4-0, e as feridas foram testadas mecanicamente pelo tensímetro de Monsanto n0 5§ e 15§ dias, de pós-operatório. Os resultados mostraram näo haver diferença entre as duas técnicas: ambas apresentam aderências similares com os órgäos intra-peritoniais