Faringoplastía de reposición con suturas barbadas como tratamiento quirúrgico en pacientes con síndrome de apnea-hipopnea obstructiva del sueño / Barbed sutures reposition pharyngoplasty as surgical treatment in obstructive sleep apnea-hypopnea syndrome

INTRODUCCIÓN: La planificación de cirugías para el manejo del síndrome de apneahipopnea obstructiva del sueño (SAHOS) ha incrementado su precisión desde la introducción de la endoscopía del sueño inducido por fármacos (DISE). OBJETIVO: Evaluar la técnica de faringoplastía de reposición con suturas barbadas (BRP) para el colapso velofaríngeo y/o de paredes laterales orofaríngeas evaluado mediante DISE en pacientes con SAHOS. MATERIAL Y MÉTODO: Ochenta y ocho pacientes fueron evaluados para cirugía mediante antropometría, escala de somnolencia de Epworth (ESS) y poligrafía respiratoria. Veinte y seis de 88 pacientes fueron seleccionados. De los 26, 14 accedieron al tratamiento quirúrgico, el que se seleccionó en base a la DISE. En todos los casos, se realizó BRP. RESULTADOS: A los 3 meses de la cirugía hubo mejoría en 10/14 pacientes (criterios de Sher, disminución del índice de apnea-hipoapnea a <20 o 50% del basal). La ESS bajó en promedio de 12 a 5 puntos (p <0,05). No se reportaron incidentes en el posoperatorio y no han ocurrido eventos adversos. CONCLUSIÓN: La técnica de BRP es una técnica sencilla y útil para la expansión anterior y lateral del paladar blando y orofaringe, con una tasa de éxito similar en esta cohorte a la reportada internacionalmente.

INTRODUCTION: Surgical planning for the management of obstructive sleep apneahypopnea syndrome (OSAHS) has changed since the introduction of drug induced sleep endoscopy (DISE). AIM: To evaluate the technique of barbed sutures reposition pharyngoplasty (BRP) for velopharyngeal collapse and/or oropharyngeal lateral walls after DISE evaluation in OSAHS patients. MATERIAL AND METHOD: 88 patients were evaluated for surgery by anthropometry, Epworth sleepiness scale (ESS) and respiratory polygraphy. 26 of 88 patients were selected. Of the 26, 14 agreed to surgical treatment, which was selected on DISE findings. In all cases, BRP was performed. RESULTS: Three months after surgery there was improvement in 10/14 patients (Sher criteria, apnea-hypopnea index reduction at <20 or 50% of baseline). The ESS improved on average 12 to 5 (p <0.05). No incidents were reported in the post-operative period and no adverse events were reported. CONCLUSION: The BRP technique is a simple and useful technique for the anterior and lateral expansion of the soft palate and oropharynx, with a similar success rate in this cohort to that internationally reported.

A randomized controlled trial of knotless barbed suture stitching deep fascia in posterior lumbar decompression and fusion / 中国组织工程研究

BACKGROUND: Whether knotless barbed suture applied in lumbar posterior fusion can shorten the suturing time and reduce incision complication has not been confirmed in clinical practice. OBJECTIVE: To explore whether knotless barbed suture has advantages in shortening the suturing time and reducing incision complication in lumbar posterior fusion. METHODS: Sixty-two patients with lumbar degenerative disease at Dongzhimen Hospital, Beijing University of Chinese Medicine from January to December 2018 were selected, and all received lumbar posterior fusion. The patients were randomly divided Into trial group (n=33, the deep lumbar fascia was sutured using knotless barbed suture) and control group (n=29, the deep lumbar fascia was sutured using absorbable suture). The incision length, and the suturing time of deep fascia and subcutaneous tissue were compared between two groups. The suture quality was analyzed by leakage test. The Incision healing and complications were observed and recorded. The Visual Analogue Scale scores and Oswestry Dysfunction Index at baseline and 2 and 6 weeks, and 3 months after surgery were detected. The trial was approved by the Ethics Committee of Dongzhimen Hospital, Beijing University of Chinese Medicine (approval No. DZMEC-KY-2018-11). RESULTS AND CONCLUSION: (1) The Incision length and subcutaneous tissue suture time showed no significant difference (P > 0.05). The suture time of deep fascia in the trial group was shorter than that in the control group [(8.0±0.9) vs. (11.6±1.7) minutes, P 0.05). (4) These results Indicate that the knotless barbed suture can reduce suturing time and Incidence of incision complications in posterior lumbar fusion.

Meta-analysis of barbed suture versus traditional suture in primary total knee arthroplasty / 中国组织工程研究

BACKGROUND: A new barb suture has been extensively applied in clinical practice of surgery and has achieved good efficacy. However, its application in total knee arthroplasty is little, and the treatment efficacy remains controversial. OBJECTIVE: To collect the related studies for systematic analysis, so as to provide evidence for the use of barbed suture in total knee arthroplasty. METHODS: PubMed, EMBASE, Cochrane library, CBM, CNKI, Wanfang and VIP databases were retrieved by two researchers independently for the randomized controlled trials on barbed suture and traditional suture applied in total knee arthroplasty published before June 2019. Literature quality was assessed using the randomized controlled trials bias risk assessment tool recommended by the Cochrane manual, and meta-analysis was performed using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) Eight randomized controlled trials were included, involving 1 004 knees. (2) The results showed that barbed suture could significantly shorten the wound closure time [MD=-5.17, 95%CI(-6.26, -4.09), P < 0.000 01] and reduce the total cost of wound closure [SMD=-1.66, 95%CI(-2.58, -0.75), P=0.000 4], and incidence of acupuncture injury [RR=0.14, 95%CI(0.03, 0.78), P=0.02]. (3) There was no significant difference in the postoperative complications [RR=0.96, 95%CI(0.65, 1.42), P=0.85], and suture breakage [RR=4.58, 95%CI(0.16, 128.29), P=0.37], range of motion at postoperative 6 weeks and 3 months [MD=-0.74, 95%CI(-4.19, 2.71), P=0.67]; [MD=-0.30, 95%CI(-2.62, 2.02), P=0.80] or American Knee Society Knee Score at postoperative 6 weeks [MD=-0.22, 95%CI(-3.10, 2.66), P=0.88]. The American Knee Society Knee Score at postoperative 3 months was better in the barbed suture group [MD=-2.04, 95%CI(-3.92, -0.15), P=0.03]. (4) To conclude, barbed suture is a fast, low-cost, safe and effective method in primary total knee arthroplasty, which is worthy of clinical use. More randomized controlled trials and long follow-up are needed to confirm this conclusion.

Application of absorbable barbed suture in closure of epicranial aponeuroisis / 中国医师进修杂志

Objective To clarify the value of absorbable barbed suture in closure of galeal. Methods A total of 101 patients had craniotomy treated in Shengjing Hospital of China Medical University from October 2018 to February 2019 were divided into two groups according to the admission date. In the barbed suture group, 45 patients were sutured with QUILL by continuous stitching. In the control group, 56 patients were sutured with traditional stitchingby intermittent suture. Compare the differences in suture speed, average postoperative hospital stay, incision complication rate, and the average hospital costs of the two groups. Results The suture speed in barbed suture group was (0.330 ± 0.012) cm/min , and was significantly faster than that in control group (0.540 ± 0.016) cm/min;the postoperative average hospitalization days in barbed suture group was (10.91 ± 0.62) d, and was significantly shorter than that in control group (12.73 ± 0.41) d, there were significant differences (P<0.05) . However, the complications and hospital costs in two groups had no significant differences (P>0.05). Conclusions The use of absorbable barbed close epicranial aponeuroisiscan improve suture speed, shorten the postoperative average hospitalization days, which is worthy of promotion.

Effectiveness of a novel remnant-preserving anterior cruciate ligament reconstruction with bidirectional barbed suture / 中国修复重建外科杂志

Objective: To investigate the feasibility and effectiveness of a novel remnant-preserving anterior cruciate ligament (ACL) reconstruction with bidirectional barbed suture. Methods: Between February 2014 and January 2016, 96 patients (96 knees) with ACL injury who met the inclusion criteria were recruited and randomly divided into 2 groups ( n=48). All patients underwent ACL reconstruction with autologous tendon. The tibial remnant was fixed with PDS-Ⅱ suture (control group) and bidirectional barbed suture (trial group). There was no significant difference in age, gender, injury side, the interval from injury to operation, and preoperative knee stability (KT-1000 test), International Knee Documentation Committee (IKDC) score, and Lysholm score ( P>0.05). The knee stability (KT-1000 test), IKDC score, Lysholm score, proprioception, and Cyclops lesion after operation were recorded. Results: All incisions healed by first intention in both groups. Forty-four patients in control group were followed up 26-47 months (mean, 36.6 months), and 45 patients in trial group were followed up 26-48 months (mean, 35.6 months). At last follow-up, the IKDC score, Lysholm score, and KT-1000 test were significantly improved when compared with preoperative ones in both groups ( P0.05). There was no significant difference in proprioception between 2 groups at 1 and 2 years after operation, and between 1 year after operation and 2 years after operation ( P>0.05) in the same group. The incidences of Cyclops lesion at 6 months, 1 year and 2 years after operation were 0, 4.44% (2/45), and 4.44% (2/45) in trial group, and 13.6% (6/44), 13.6% (6/44), 20.5% (9/44) in control group, showing significant differences between 2 groups at 6 months and at 2 years after operation ( P=0.012; P=0.022) and no significant difference at 1 year after operation ( P=0.157). Conclusion: The remnant-preserving ACL reconstruction with bidirectional barbed suture can decrease the incidence of Cyclops lesions. However, this technique can not improve the effectiveness in terms of the clinical function and stability compared with the traditional technique.

Internal Hernia through a Defect in the Broad Ligament of Uterus: Laparoscopic Management Using a Self-Anchoring Barbed Suture

The occurrence of internal hernia through a defect in the broad ligament is a very rare condition, which may cause small bowel obstruction. This is a case of a 50-year-old woman who developed intestinal obstruction induced by internal hernia and who had undergone laparoscopic myomectomy 7 years prior to visiting our emergency room. Abdominopelvic computed tomography showed luminal narrowing of the ileum and dilatation of the pelvic loop of the small bowel at the left side of the uterus. We detected internal hernia through the defect in the broad ligament and managed it successfully by performing a laparoscopic procedure using a barbed suture, V-Loc (Covidien, Mansfield, MA).

Biomechanical Analysis of Resorbable Barbed Suture Tenorrhaphy

PURPOSE: To evaluate the tensile strength and repair-site profile of a technique of resorbable barbed suture tenorrhaphy. METHODS: Forty-eight flexor digitorum profundus tendons were collected from the 8 adult cadavers. In the test group, the tendons were sutured using absorbent 2-0 barb knotless sutures in a 2-strand or 4-strand zig-zag pattern. In the control group, 2-0 Prolene and 3-0 polydioxanone (PDS) were used to suture the tendons using the 2-stand Modified Kessler method and the 4-strand cruciate suture method. Using a tensile force measurement machine, the breaking load (N) and the stiffness (N/mm) were measured. The types of rupture were categorized into suture breaking, knot rupture, and pullout. RESULTS: In the comparative analysis between the absorbent 2-0 Quill (Angiotech Pharmaceuticals, Canada) suture that used the 2-strand core suture and the 3-0 PDS and 2-0 Prolene sutures, the average breaking load for the 2-0 Quill suture was 26.83±7.47 N, and 21.96±6.78 N and 17.20±4.93 N for the 2-0 Prolene and 3-0 PDS sutures. In the comparison using the 4-strand core suture, the average breaking load for the 2-0 Quill suture was 62.50±13.34 N, and 22.35±5.72 N and 18.67±4.27 N for the 2-0 prolene and 3-0 PDS sutures. The most common type of rupture were knot rupture. CONCLUSION: For flexor tendon sutures using the absorbent barb sutures, compared to the conventional 2-0 Prolene or 3-0 PDS sutures, absorbent barbed sutures have a higher tensile strength.

Safety and efficiency of unidirectional barbed suture for laparoscopic partial nephrectomy / 国际外科学杂志

Objective To evaluate whether the unidirectional barbed suture is safety and efficiency enough for laparoscopic partial nephrectomy.Method From March 2013 to March 2014,27 patients with renal mass have been involved into this study and divided into 2 groups wsing a lottery.Group A used Coated Vicryl in renorrhaphy after LPN,and group B used unidirectional barbed suture.All patients underwent LPN preformed by single group of surgeons.Perioperative and postoperative indicators were compared in two groups.Result It is identical in age,BMI,tumor size,R.E.N.A.L nephrometry scoring system between 2 groups.However,using barbed suture has significantly shortened in warm ischemia time (WIT).The postoperative indicators,such as blood loss,hospital stay and surgery complication has no significantly difference in two groups.Conclusion The unidirectional barbed suture is safety and efficiency using in LPN which can shorten WIT significantly.

Feasibility of Use of a Barbed Suture (V-Loc 180) for Quilting the Donor Site in Latissimus Dorsi Myocutaneous Flap Breast Reconstruction

BACKGROUND: Latissimus dorsi (LD) myocutaneous flap is a popular method of breast reconstruction which can be associated with high incidence of seroma formation. Quilting sutures at the harvest site are used to reduce this. Barbed sutures are self anchoring sutures which avoid multiple knotting and can be useful in quilting. METHODS: A retrospective analysis of prospectively maintained database of patients who underwent LD flap breast reconstruction between January 2009 and January 2011 was carried out. Seroma formation at the harvest site, wound related complications, inpatient stay and duration of surgery were analysed and a comparison was made between two groups where quilting was done with barbed (V-Loc) suture and conventional polydioxanone (PDS) II sutures. RESULTS: Fifty-seven patients were included of which 33 had quilting by V-Loc sutures and in 24 patients PDS II suture was used. Median age in the PDS group was 55 years (interquartile range [IQR)], 45 to 61 years) which was comparable to the V-Loc group (53 years [IQR, 48 to 59 years]; P-value 0.948). Sixteen patients (28%) had significant seroma formation and 5 (9%) patients developed superficial wound dehiscence. Incidences of seroma or wound complications were comparable (P-value 0.378 and 1.00, respectively). Secondary outcomes such as total duration of surgery, total inpatient stay, total amount of drain at the donor site were also similar in two groups. CONCLUSIONS: Use of barbed sutures for quilting the donor site in LD flap reconstruction is a feasible option and the associated seroma formation and wound complications are comparable with conventional sutures.

Comparative study of self-retaining suture versus traditional absorbable suture in laparoscopic partial nephrectomy / 中华泌尿外科杂志

Objective To evaluate the safety and efficacy of QUILLTM self-retaining suture (QUILLTMSRS) in laparoscopie partial nephrectomy.Methods Sixty-three patients (39 males,24 females) with renal tumor accepted laparoscopic partial nephrectomy in Peking Union Medical Hospital from February 2012 to January 2013.The ages ranged from 38 to 75 years.The tumor sizes varied from 1.5 cm to 4.5 cm.According to the device of renorrhaphy,they were divided into 2 groups.Vicryl suture was used for renorrhaphy in 32 patients (Group 1),and QUILLTMSRS was used in 31 patients (Group 2).Renorrhaphy was performed in two layers for both groups,with a closure of deep vessels and the collecting system with 4-0 absorbable suture,followed by a running closure of the renal parenchyma and renal capsule.Demographical and perioperative parameters including age,body mass index,tumor size,R.E.N.A.L score,estimated blood loss,warm ischemic time,length of hospital stay were recorded and compared between the 2 groups.Results Renorrhaphy was successfully performed in all the 63 cases without conversion to open procedure or nephrectomy.The estimated blood loss and length of postoperative hospital stay were not significantly different between the 2 groups (P＞0.05).But warm ischemic time was significantly shorter in QUILLTM SRS group than that in Vicryl group (22.2 vs 26.7 min,P＜0.001).Conclusions QUILLTMSRS could be safe and effective for renorrhaphy in laparoscopic partial nephrectomy.It could make laparoscopic renorrhaphy easier and reduce warm ischemic time significantly.

The role of self-retaining suture in retroperitoneal laparoscopic partial nephrectomy for complicated renal tumor / 中华泌尿外科杂志

Objective To evaluate the efficacy of self-retaining suture (QuillTM SRS) in retroperitoneal laparoscopic partial nephrectomy for complicated renal tumor by assessing perioperative parameters.Methods Between 2010 and 2012,78 cases of complicated renal tumor (R.E.N.A.L score ≥ 7) treated by retroperitoneal laparoscopic partial nephrectomy (LPN) with two layers continuous knotless barbed suture (QuillTM SRS group) (n=30) or traditional absorbable vicyl suture (non-SRS group) (n=48) were retrospectively analyzed.In QuillTM SRS group,2-0 Quill SRS was used to suture the deep wound bed,and the second outcr layer renorrhaphy was performed with a 1-0 Quill SRS by the same way.In non-SRS group,the inner layer was sutured using a 15cm in length 2-0 monicryl suture by the same method mentioned above.A second outer layer was sutured with 1-0 vicryl suture across the wound.Cases were matched for R.E.N.A.L score.Comparison was made in term of operation time,preoperative parameter and perioperative complications between SRS group and non-SRS group.Results Renorrhaphy was successfully performed in all cases except 1 case converting to open surgery in non-SRS group.Mean warm ischemia time in SRS group was shorter than non-SRS group (18 vs 25 min,P =0.021).The proportion of bleeding requiring intervention in the non-SRS group (7/48,14.5％) was 4.3-fold higher than that of the SRS group (1/30,3.3％),but the differernce is not significant (P＞0.05).There were no significant differences between two groups in postoperative creatinine changes.Limitations of this study include the absence of randomization and the relative small sample size.Conclusions SRS can be safely used for complicated renal tumor during LPN,and SRS can significantly reduce the WIT and may also reduce bleeding during the operation.