Innovative design and experimental study of electromagnetic ejection endoscopic suture device / 国际生物医学工程杂志

Objective:To design a novel electromagnetic ejection device for endoscopic suturing to achieve continuous deployment of suture nails.Methods:An electromagnetic ejection device and its accompanying suture nail structure were designed and a prototype was fabricated based on electromagnetic ejection principles. A finite element model of the electromagnetic ejection device was constructed to study the effects of armature-coil center distance and different driving voltages on suture nail ejection speed. An experimental platform for testing electromagnetic ejection velocity was constructed, and a high-speed camera was used to detect the ejection velocity. A platform for the suture embedding experiment was built to measure the effects of different voltages on the inserting speed of suture into the gastric wall tissue. A platform for a suture extraction force experiment was built to evaluate the extraction force of sutures embedded in tissues under different driving voltages.Results:A suture nail structure and electromagnetic ejection device were designed, and a prototype was fabricated. The ejection velocity increased and then decreased with the increase of the armature-coil center distance, and the maximum ejection velocity was 15.81 m/s at the center distance of 18 mm. At this distance, the voltage was linearly related to the ejection velocity, and the experimental values of the staple basically coincided with the simulated values. When the driving voltage was in the range of 150 to 180 V, the suture nails could successfully insert in the tissues, and the 180 V voltage group had a greater insertion depth. The extraction force of the suture nails at 120, 150, 180, and 210 V voltages were (0.49 ± 0.19), (1.14 ± 0.19), (1.23 ± 0.15), and (1.85 ± 0.31) N, respectively.Conclusions:A novel electromagnetic ejection device for endoscopic suturing is proposed that is capable of continuous firing of suture nails. This device provides a new long-distance driving method for intelligent, minimally invasive surgical instruments.

Efficacy and safety assessment of polyglycolic acid and hydroxypropyl methylcellulose for postoperative suturing in a distal pancreatectomy model / 西安交通大学学报(医学版)

【Objective】 To explore the effectiveness and safety of polyglycolic acid (PGA) and hydroxypropyl methylcellulose (HPMC) composite materials in distal pancreatectomy postoperative suturing. 【Methods】 We selected 36 healthy adult beagles and divided them randomly into observation group and control group, with 18 distal pancreatectomy surgeries in each group. The observation group used PGA+HPMC composite materials for incision reinforcement while the control group used NEOVEIL for incision reinforcement. 3 days before surgery, 3 days after surgery, and before dissection, blood routine tests were performed on each group of experimental dogs. Observation periods of 2-week, 4-week and 8-week were set, and six animals at each observation point were evaluated for histological examination of heart, liver, spleen, lung, and kidney tissues, hard tissue slice pathological diagnosis, and safety evaluation. 【Results】 There was no significant difference between the observation group and the control group in the preoperative blood routine test. Repeated measures ANOVA results showed differences in the mean values of white blood cell count (WBC) ( F=14.875, P=0.001), mean corpuscular hemoglobin concentration (MCHC) (F=5.049,P=0.009), neutrophil percentage (Neu%) (F=4.794, P=0.011), red blood cell count (RBC) (F=6.591, P=0.002), hemoglobin (HGB) (F=8.154, P=0.001), hematocrit (HCT) (F=5.281, P=0.007), platelet count (PLT) (F=6.560, P=0.014), red blood cell distribution width coefficient of variation (RDW-CV) (F=33.950, P=0.039), or lymphocyte percentage (Lym%) (F=3.299, P=0.043) at different time points. However, the observation group and the control group did not differ, and the interaction between time and group had no significant effect on the above indicators, suggesting that both groups of dogs had inflammatory response or surgical stress. For the 8-week postoperative hard tissue pathological section score, there was no significant difference between the observation group and the control group in the inflammation and necrosis related score, fibrosis, repair or other related scores and total score (P>0.05). In the dissection at 8 weeks after surgery, no obvious damage to the heart, liver, spleen, lung, kidney, or other organs was found in both groups, nor was there any residual suture material, pancreatic fistula, or pancreatitis, indicating that the suture materials in both groups had been completely absorbed and metabolized, and the incision healed well without causing adverse effects on the visceral organs. 【Conclusion】 PGA and HPMC are effective and safe postoperative suture materials, with good biodegradability, biocompatibility, suture strength, and wound healing quality. They can be comparable to traditional absorbable reinforcement materials in distal pancreatectomy postoperative suturing, thus providing scientific basis for their clinical application.

The methods of anastomosis in totally laparoscopic total gastrectomy esophagojejunostomy-the collision and fusion of hand suturing and stapled anastomosis / 中华消化外科杂志

Totally laparoscopic total gastrectomy is the most comlex procedure in gastric surgery, which involves the entire stomach removal, lymph node dissection and digestive tract recons-truction through minimally invasive techniques, among which laparoscopic esophagojejunostomy is a technological difficulty. Currently, three types of anastomoses are widely used, including stapled anastomosis with circular staplers or linear staplers, and hand suturing, but which is the best and safe anastomosis remains controversial. Based on team experience, the authors review the progress of esophagojejunostomy on stapled anastomosis or hand suturing, promote that how to select an appropriate esophagojejunostomy according to surgeon′s individual technical capabilities, operating habits and patient conditions, strive to achieve the precise and minimally invasive effect with the least trauma for patients.

Endoscopic hand-suturing combined with titanium clips for rectal defects closure after endoscopic submucosal dissection: a pilot study / 中华肿瘤杂志

Objective: To explore the feasibility of endoscopic hand-suturing (EHS) for rectal defects closure after endoscopic submucosal dissection (ESD), and the clinical practicability of EHS combined with titanium clips. Methods: This is a prospective study performed by two experienced endoscopists from the Cancer Hospital, Chinese Academy of Medical Sciences who had received EHS training in sixporcine gastric ESD defects in vivo before the study. From December 2022 to February 2022, 20 patients with rectal mucosal lesions or submucosal diseases underwent ESD. Then EHS combined with titanium clips was adopted to close the rectal ESD defects. Specifically, we first sutured the defects as much as possible through EHS, then use titanium clips to fix the tail of the suture, and finally use additional titanium clips to close the residual parts of the defects that cannot be sutured. The main observational indicators were complete closure of the wound and delayed bleeding within one month after surgery. Results: In the 20 rectal cases, the size of defects ranged from 2.2 to 3.6 cm, with a median of 2.7 cm. All cases achieved complete closure without delayed bleeding, of which 12 (60.0%) were completely sutured with EHS and 8 (40.0%) required additional titanium clips to achieve complete closure after suturing. Conclusion: EHS technique is feasible and safe for rectum. EHS combined with titanium clips can also effectively close the rectal ESD defects, prevent postoperative delayed bleeding, and may be easier to be implemented in clinical practice.

Endoscopic hand-suturing combined with titanium clips for rectal defects closure after endoscopic submucosal dissection: a pilot study / 中华肿瘤杂志

Objective: To explore the feasibility of endoscopic hand-suturing (EHS) for rectal defects closure after endoscopic submucosal dissection (ESD), and the clinical practicability of EHS combined with titanium clips. Methods: This is a prospective study performed by two experienced endoscopists from the Cancer Hospital, Chinese Academy of Medical Sciences who had received EHS training in sixporcine gastric ESD defects in vivo before the study. From December 2022 to February 2022, 20 patients with rectal mucosal lesions or submucosal diseases underwent ESD. Then EHS combined with titanium clips was adopted to close the rectal ESD defects. Specifically, we first sutured the defects as much as possible through EHS, then use titanium clips to fix the tail of the suture, and finally use additional titanium clips to close the residual parts of the defects that cannot be sutured. The main observational indicators were complete closure of the wound and delayed bleeding within one month after surgery. Results: In the 20 rectal cases, the size of defects ranged from 2.2 to 3.6 cm, with a median of 2.7 cm. All cases achieved complete closure without delayed bleeding, of which 12 (60.0%) were completely sutured with EHS and 8 (40.0%) required additional titanium clips to achieve complete closure after suturing. Conclusion: EHS technique is feasible and safe for rectum. EHS combined with titanium clips can also effectively close the rectal ESD defects, prevent postoperative delayed bleeding, and may be easier to be implemented in clinical practice.

Incidence of re-surgery after manual small-incision cataract surgery at a tertiary eye-care center in South India

Purpose: To study the incidence of re-surgery after manual small-incision cataract surgery (MSICS) at a tertiary eye-care center in South India and to compare the re-surgery rate between trainees and experts. Methods: A retrospective study was conducted at a tertiary eye-care center in Andhra Pradesh state of South India, which included 19,515 patients who underwent MSICS between 2012 and 2022 with 369 eyes of 369 patients who underwent re-surgery within 1 week of primary surgery. Factors included demographic data, type of re-surgery, that is, wound re-suturing, IOL repositioning, cortical wash, as well as anterior chamber (AC) wash. Results: 19,515 eyes from the year 2012�22 were analyzed. Most of the patients undergoing re-surgery belonged to the age group of 61� years (40.3%). Wound re-suturing was the more frequently performed re-surgery (47.6%). Wound re-suturing rates were comparable between the trainees and experts, whereas IOL repositioning, cortical wash, and AC wash were higher in the cases performed by trainees though statistically not significant. Conclusion: Careful pre-operative assessment, training under supervision, and other measures can be taken to reduce the re-surgery rates. Timely diagnosis and early treatment can give better outcomes and prevent devastating complications like endophthalmitis

Reverse graft suturing to avoid Descemet’s membrane detachment of glycerol-preserved donor cornea used for therapeutic penetrating keratoplasty during COVID-19 to overcome the tissue shortage – A novel surgical technique

To overcome tissue shortage during pandemic, we switched to 100% glycerol preservation of the donor cornea, which is economical and provides longer duration of storage than the short and intermediate storage mediums we normally use like McCAREY Kaufman (MK) or cornisol. During our initial few cases of therapeutic penetrating keratoplasty using glycerol preserved donor cornea, we faced spontaneous Descemet’s detachments resistant to air tamponade. We tried reverse graft suturing and successfully reinforced Descemet’s attachment along with air tamponade, in one of the cases after multiple failed air injections. In the subsequent two cases of infective keratitis needing therapeutic penetrating Keratoplasty, we took eight reverse sutures in between the eight cardinals, to anchor the Descemet’s membrane of the graft. Both the grafts showed attached Descemet’s and maintained good graft clarity. The reverse corneal suturing technique has not been described to the best of our knowledge and hope this helps our corneal fraternity.

Effect of sequential suture and adhesion on craniomaxillofacial skin contusion and laceration / 中华医学美学美容杂志

Objective:To investigate the effect of sequential suture and adhesion on craniomaxillofacial skin contusion and laceration.Methods:A total of 189 patients with craniomaxillofacial skin contusion and laceration (CMFSCL) were randomly divided into three groups: 66 cases in SSA group, 63 cases in CS group and 60 cases in TS group. Operation time, visual analogue scale (VAS), Vancouver scar scale (VSS) and adverse reactions incidence were compared and analyzed between the three groups. Effect and satisfactory scale were evaluated.Results:Operation time in SSA group (10.67±1.26) min was significantly less than that in CS (18.91±1.38) min and TS group (17.96±1.43) min ( P<0.05). VAS in SSA group 24 h post-operation (3.11±1.01) was significantly lower than that in CS and TS group ( P<0.05). VSS in SSA group 6 months post-operation (1.18±0.21) was significantly lower than that in CS (3.78±1.01) ( P<0.05) and TS group (5.98±1.06) ( P<0.01). Total effective rate of SSA group (96.5%) was significantly higher than that in CS (85.7%) ( P<0.05) and TS group (56.1%) ( P<0.01); total effective rate in CS group was significantly higher than that in TS group ( P<0.05). Infection and dehiscence rates in SSA group were lower than those in CS and TS group ( P<0.01). Satisfactory rate of SSA group (99%) was significantly higher than that of CS (89.1%) and TS group (71.3%) ( P<0.05); the satisfactory rate of CS group was significantly higher than that of TS group ( P<0.05). Conclusions:Sequential suture and adhesion technique is simple and effective for craniomaxillofacial skin contusion and laceration, which is worthy of clinical promotion.

Reconstituição cirúrgica do períneo após o parto: um estudo qualitativo de uma prática pedagógica / Surgical reconstitution of the perineum after delivery: a qualitative study of a pedagogical practice

Resumo Descreve-se uma atividade pedagógica com estudantes do Mestrado e Pós-Licenciatura em Enfermagem de Saúde Materna e Obstetrícia, aplicando princípios da prática simulada na realização da sutura perineal após o parto. Este procedimento causa muita insegurança e gera grande ansiedade nos estudantes, quando iniciam estágio em bloco de partos. Os objetivos deste artigo são desenvolver competências psicomotoras nos estudantes para a reconstituição cirúrgica perineal; aumentar a autoconfiança dos estudantes para o procedimento. Metodologia qualitativa, com 2 momentos de recolha de dados aplicados a dois cursos. Questionário com perguntas abertas, sessão de "focus group" e filmagem. Análise de conteúdo das respostas às perguntas abertas e verbatim do "focus group". Como Resultados destaca-se uma estreita relação entre a simulação e o desenvolvimento de competências. Os estudantes salientaram a importância da atividade pedagógica na aquisição de competências de sutura, reforço da autoconfiança e na diminuição da ansiedade inicial. O uso da investigação qualitativa permitiu identificar o impacto da prática simulada no desenvolvimento de competências dos estudantes, identificar aspetos a aperfeiçoar na metodologia, contribuindo para a melhoria das práticas pedagógicas.

Abstract A pedagogical activity with Master's Degree and Postgraduate students in Maternal Health and Obstetrics Nursing is described, applying principles of simulated practice in perineal suturing after delivery. This procedure causes a lot of insecurity and generates great anxiety in the students, when they start the internship in a delivery room. Objectives: to develop the psychomotor skills in students for perineal surgical reconstruction; increase students' self-confidence to perform the procedure. Methodology: qualitative, with 2 moments of data collection applied to two courses. Questionnaire with open questions, focus group session and filming. Content analysis of the answers to the questions and verbatim of the focus group. Results: a close relationship was observed between simulation and skills development. Conclusion: the students emphasized the importance of the pedagogical activity in the acquisition of suturing skills, improving their self-confidence and reducing the initial anxiety. The use of the qualitative research allowed identifying the impact of the simulated practice on the development of the students' skills and to identify aspects to be improved, contributing to the progress of pedagogical practices.

Rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models using magnetic compression anastomosis technique / 器官移植

Objective To explore the feasibility of rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models using magnetic compression anastomosis (MCA) technique. Methods Twelve healthy adult crossbred dogs were evenly divided into the MCA and hand suturing (HS) groups according to the anastomosis method between abdominal aorta and artificial blood vessels. The intraoperative duration of abdominal aorta occlusion, intraoperative condition of anastomotic stoma and postoperative imaging examination of anastomotic stoma were compared between two groups. Results The intraoperative duration of abdominal aorta occlusion in the MCA group was significantly shorter than that in the HS group [(5.2±2.3) min vs. (24.4±4.3) min, P < 0.001]. No anastomotic leakage of blood or anastomotic stenosis occurred in the MCA group during the operation. Intraoperative anastomotic leakage of blood occurred in all of the 6 dogs in the HS group. Among them, 1 dog died of excessive blood loss, and 2 dogs experienced mild anastomotic stenosis due to repeated repair. Postoperative color Doppler ultrasound and angiography showed smooth blood flow at the anastomotic stoma without stenosis or thrombosis in the MCA group. In the HS group, 4 dogs presented with anastomotic stenosis on angiography at postoperative 4 weeks. Conclusions MCA technique may achieve rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models, which reduces the incidence of anastomotic complications and accelerates postoperative recovery.

Estimation of time utilized in suturing of oral flaps post-surgical wisdom teeth removal using Negus knot pusher instrument (a comparative study) / Estimativa do tempo utilizado na sutura de retalhos orais após exodontia de terceiros molares utilizando o instrumental Empurrador de nó Negus: um estudo comparativo

Objective: Wisdom teeth were the most common teeth affected among the rest of the teeth, these teeth need accurate evaluation and diagnosis, surgical removal of impacted wisdom needs time for incision, bone removal and suture, so the use of any instrument helps to reduce this time is essential. The objectives of this study were to estimate the time needed for the suture of oral flaps post-surgical removal of the lower wisdom teeth by using Negus knot pusher and compare it with the time used for stitching in conventional manual holding single stitching. Material and Methods: Data had been collected from thirty patients through history, clinical examination and radiographic assessment, followed by classical surgical removal performed on the same principles for all patients, at the suture level patients divided arbitrarily into two groups, control group 15 patients and 15 patients Negus pusher group, using Negus knot pusher, which is usually used to hold the stitch and stop bleeding post tonsillectomy operations by ligation, time elapsed for suturing with knot tying is calculated for both groups. Results: Among the 30 patients incorporated in the clinical study, control group mean was (1 minutes and 11 seconds and 70 milliseconds) while for the pusher group was (1 minutes and 32 seconds and 57 milliseconds), the comparison by means of T-test was not significant with the (0.424) value. Conclusion: the Negus pusher instrument can be used for the knotting stiches post wisdom teeth removal as an auxiliary tool and the time can be shortened by the use of a modified handling technique and more satisfaction for patients. (AU)

Objetivo: Os terceiros molares são os dentes mais afetados entre o resto dos dentes e necessitam de avaliação e diagnóstico precisos. A exodontia desses elementos impactados requer tempo para incisão, remoção óssea e sutura, portanto, é essencial o uso de instrumentos que ajudem a reduzir o tempo de procedimento. Os objetivos do presente estudo foram estimar o tempo necessário para a sutura de retalhos orais após a exodontia de terceiros molares inferiores utilizando o instrumental Empurrador de nó Negus (Negus Knot pusher) e compará-lo com o tempo necessário para a realização de sutura única convencional. Material e Métodos: Os dados foram coletados de 30 pacientes através da história, exame clínico e avaliação radiográfica, seguidos pela remoção cirúrgica clássica realizada através do mesmo princípio para todos os pacientes. Considerando o nível da sutura, os pacientes foram divididos arbitrariamente em dois grupos, grupo controle (n=15) e grupo Empurrador de nó Negus (n=15), o qual é geralmente utilizado para segurar o ponto e estancar o sangramento após cirurgia de tonsilectomia por ligadura. O tempo decorrido para sutura foi calculado para ambos os grupos. Resultados: Entre os 30 pacientes incluídos no estudo, a média do grupo controle foi de 1 minuto e 11 segundos e 70 milissegundos, enquanto para o grupo Empurrador de nó Negus foi de 1 minuto e 32 segundos e 57 milissegundos. A comparação intergrupo por meio do teste T não foi estatisticamente significativa (p=0,424). Conclusão: O instrumental Empurrador de nó Negus pode ser usado para sutura após a extração de terceiros molares como ferramenta auxiliar e o tempo pode ser reduzido pelo uso de uma técnica de manuseio modificada. Ademais, pode estar associado a maior satisfação dos pacientes. (AU)

Absorbable versus Non-Absorbable Sutures in Paediatric Facial Trauma - A Cosmetic Assessment

Paediatric age group is most vulnerable to trauma. Children often suffer facial injuries. Though many topical skin adhesives and strips are available in the market which have given excellent cosmetic results, deeper injuries especially along the lines of high tension need suturing both with buried and skin sutures. Different variety of sutures are available in the market which are used as per the choice of the surgeon. Children are more apprehensive when it comes to suture removal. So use of absorbable sutures in place of non-absorbable sutures in skin can save the children from this fear factor. MethodsA prospective study was done in the department of plastic surgery from May 2012 to Dec. 2013 with an objective of studying the outcome of plain catgut suture as skin sutures versus non-absorbable skin suture Nylon in facial trauma in the paediatric age group. Chromic catgut was used as buried suture in both groups. All the patients presenting in emergency department with facial trauma with age 10 years or less were included in the study. Skin sutures, where needed removal, were removed on 5th post-operative day followed by follow up on 7th post-operative day, 3rd month and 8th month during which cosmetic assessment of scar was done. 25 patients who presented first in emergency and fulfilled the study criteria were sutured with 5 - 0 chromic catgut buried sutures and skin suture used was 6 - 0 Nylon and this group was labelled group A. Next 25 patients who presented in emergency for suturing were sutured with 5 - 0 chromic catgut as buried and plain catgut as skin suture. This group was labelled as Group B. Cosmetic outcome was assessed on 7th post-operative day, 3rd month and 8th month by using Beusang E cosmetic scar assessment scale based on two parameters which included colour and texture of scar.1 Statistical analysis was done with continuous variables expressed as Mean ± S.D. and categorical variables were expressed as count (percentage). Chi-square was used to compare the categorical variables between groups or Fisher exact test was used. ResultsOn 7th post-operative day follow up, out of 50 patients, 25 patients (50 %) in whom nylon was used as skin suture, 4 patients (16 %) had mismatch of colour. All scars were smooth in texture. In rest 25 patients (50 %) in whom plain catgut was used as a skin suture, 1 (4 %) patient had mismatch of the colour. None of the patients had frank pus in both groups & hypertrophic scar was seen in one patient. On 3rd month follow up, Group A patients with nylon as skin suture, 1 (4 %) patient showed hypertrophic scar whereas in Group B (8 %) patients had hypertrophic scar. On 8th month follow up, both group A & B had colour mismatch of 12% with firm texture of scar in 8% patients. ConclusionsThere is no long-term differences in cosmetic outcomes and complication rates between absorbable catgut suture and commonly used nylon sutures in the repair of facial trauma in paediatric age groups. So, absorbable sutures are acceptable alternative to non-absorbable suture especially in paediatric age group, keeping in mind their apprehensive nature and fear of suture removal.

Polydioxanone as Buried Suture in Facial Trauma - A Prospective Study.

Irrespective of cause of injury, facial scars are always considered as a stigma causing both mental and social disgrace to the victim. The principle aim of any suturing is to produce aesthetically pleasing scar. Besides surgical skills, the choice of suture material also plays a very important role in getting a good scar. Though suture material used for suturing is mostly Nylon everywhere, it’s the buried sutures which obliterate the dead space and reduce wound tension which make the real difference in the appearance of scar. Sutures of different types are today available & the operating surgeon uses the best suture material for the patient in a given circumstance based on his personal experience, scientific observations, & manufacturer’s advice.1 METHODSThis is a prospective study conducted in the department of plastic surgery at Christian Medical College, Ludhiana from May 2012 to April 2013. The study included all the patients of facial trauma registered during that period of one year. Demographic profile was noted along with the cause of trauma. A well-informed consent was taken. In our study skin approximation was done by either 5-0 or 6-0 Nylon suture. Buried suture used in all was Polydioxanone (PDS) 5-0. Skin sutures were removed on 5th POD. Beusang Clinical Scar assessment scale2 was used in the study to assess scar appearance. Patients were followed every month for 5 months after removal of skin sutures. The parameters noted included, colour, contour, matte/shine, and texture of scar. Photographic record of the patients was maintained. Statistical analysis was done using McNemar test. RESULTSOut of the 40 patients in our study, road traffic accidents constituted 85 percent of facial trauma, rest included fall on floor. M:F ratio was 3:1. With Polydioxanone as buried suture, 35 patients (87.5%) had normal texture, 30 patients (75%) had Matte appearance of the scar, 20 patients (50%) had no distortion of scar, 25 patients (62.5%) had perfect match of colour with hypertrophic scar noticed in 4 patients (0.1%). CONCLUSIONSPolydioxanone as buried suture gave aesthetically pleasing scar which improved in appearance during the follow up periods. There was significant statistical improvement in scar appearance starting from 5th day of suture removal to assessment at 5 months. No discharge from the wound site was noted in any of the patients. Hypertrophic scars noticed were later treated with steroid injection

Comparative study of delayed primary closure by shoelace technique versus conventional secondary suturing method in closure of fasciotomy wounds, done for spreading cellulitis with compartment syndrome

Background: Fasciotomy is a standard treatment for acute compartment syndrome. Historically, fasciotomy incisions were usually left open till oedema settles down. In literature, there is a wide range of wound closure techniques published, but none of them is deemed to be the best. In this study, focus is laid on whether delayed primary closure (DPC) by shoelace technique, is as effective as conventional secondary suturing, in closure of fasciotomy wounds, done for spreading cellulitis.Methods: All those patients who met below mentioned inclusion criteria and underwent fasciotomy, were allocated into 2 groups (A and B) where Group A consists of 30 patients undergoing conventional secondary suturing, whereas Group B consists of 30 patients undergoing DPC by shoelace technique for closure of fasciotomy wounds. Parameters such as duration of hospital stay, time taken for complete wound closure, local wound complications, hospital expenses, anaesthesia related complications between the two groups were compared.Results: Patients who underwent DPC for fasciotomy wound closure achieved wound closure ~7 days earlier with 5 days lesser hospital stay than that of those who underwent conventional secondary suturing. Average health care cost of Group B was significantly lower compared to Group A, but there was no statistically significant difference in incidence of wound infections between the two groups.Conclusions: DPC by shoelace technique, takes less time for wound closure and hence the need for nursing care and hospital stay is significantly reduced in comparison to the conventional secondary suturing method.

Post-operative bleeding in tonsillectomy versus tonsillectomy with fossa closure in a tertiary military hospital: A cohort study

Objective@#To determine the incidence of post-operative bleeding among patients who underwent tonsillectomy alone versus tonsillectomy with fossa closure at the Victoriano Luna Medical Center from January 2015 to December 2017. @*Methods@#Design: Retrospective Cohort Study. Setting: Tertiary Military Hospital. Patients: Medical records of 83 patients that underwent tonsillectomy under the Department of Otorhinolaryngology – Head and Neck Surgery between January 2015 to December 2017 were retrospectively reviewed for data regarding sex, age, tonsillectomy with or without fossa closure and post-operative bleeding. Cases of tonsillectomy alone versus tonsillectomy with fossa closure were compared (particularly with respect to post-operative bleeding), tabulated and statistically analyzed using risk ratio and t-test.@*Results@#There were 57 cases of tonsillectomy alone versus 26 cases of tonsillectomy with fossa closure. The incidence of bleeding in all cases of tonsillectomy whether tonsillectomy alone or with fossa closure was 4.8%. The incidence of bleeding was higher in cases of tonsillectomy with fossa closure at 11.5% (versus 1.8% in tonsillectomy alone). Post-operative bleeding was 0.1 times more likely to occur in patients who underwent tonsillectomy alone than those who underwent tonsillectomy with fossa closure but there was no statistically significant difference in the risk of post-operative bleeding between the two. @*Conclusion@#Although the incidence of bleeding was higher in cases of tonsillectomy with fossa closure, our results suggest that there is no statistically significant difference in risk for postoperative bleeding between tonsillectomy alone or tonsillectomy with fossa closure.

Modified mattress sutures vs running sutures in uterine closure: which is better?

Background: Conventional closure of uterus has been known to bear risk of scar dehiscence and scar rupture in subsequent pregnancies and thus, a study was conducted to compare the outcome of uterine closure with modified mattress manner and running manner and to establish a better method of uterine closure during caesarean section. Objective was to compare the conventional single layer running sutures and single layer modified mattress sutures for closure of uterus in caesarean section and find out which method is superior.Methods: This prospective interventional study was carried out in Dhiraj Hospital, a tertiary care hospital in Vadodara. 60 pregnant women in the study criteria were equally divided randomly into 2 groups. Uterine closure was done in single layered sutures, one by running sutures and other group by modified mattress sutures.Results: Uterine scar thickness on 8th day and 6 months post-operatively was significantly more in single layered suturing by modified mattress suture compared to running suture (p <0.05).Conclusions: Uterine closure by single layered modified mattress suture is better in comparison to conventional single layer running suture.

Evolving a System of Classification for Scalp Defects and Methods of Reconstruction

Background: Scalp wound closure requires good understanding of scalp anatomy, knowledge of a algorithm for reconstruction ofscalp defects, good planning, adequate debridement, proper execution and proper post-operative care. Aim and objective: Theaim of the study was to use a simple algorithm to reconstruct scalp defects of various sizes and to study the efficacy of thealgorithm in reconstruction of scalp defects. Materials and Methods: All patients with scalp defect who presented to theDepartment of Burns Plastic and Reconstructive surgery at Kilpauk government medical college were studied. Reconstructionof scalp defect was planned based on the algorithm. All patients were followed up for a period of 1 year post operatively.Results: The scalp defects were reconstructed based on the algorithm. Smaller defects were managed with primary closureand SSG. Larger size defects and defects without periosteum were given local or distant flap. All patients recovered well withlesser rate of complications. Conclusion: Reconstruction of scalp defect is made easy with the use of the algorithm for choiceof treatment based on the defect size.

A detailed description and 16-year validation of a new suturing method for stabilizing connective tissue grafts at recipient sites for root coverage and gingival augmentation

Background: Which are the different ways of stabilizing connective tissue grafts (CTGs) for root coverage and gingival augmentation by means of placement of sutures? There are various defined and undefined ways of stabilizing CTGs depending on experience and personal preferences. Most of the techniques profess use of absorbable sutures in separate interrupted fashion (sutures at the corners of the graft wherever possible). Aim: This paper describes a new suturing method, “the lingually-tied horizontal mattress contouring suture,” for stabilization of CTGs with or without epithelialized collar at the recipient site, for use with papilla retention and sparing techniques to treat marginal tissue recessions. Methods and Material: The suturing technique is described in detail. It can be indicated for good number of root coverage cases, with additional objectives of gingival augmentation, specifically developed for papilla sparing and papillary buccal de-epithelialization recipient site preparations. Results: Over a period of last 16 years this suturing technique showed promising results in terms of graft stabilization and survival. The main advantage of this technique lies in the use of cost-effective nonabsorbable sutures that usually retain some amount of tension on the soft tissues longer. Conclusion: The primary objective of the suturing technique, per se, is to stabilize the CTG firmly along the contours of the root surface and to expedite a very close adaptation to the interdental soft tissues as well. The secondary objective of the article or publication is to disseminate the knowledge acquired through long periods of performance and observation for the benefit of the periodontal community as whole. Further validation is advocated.

Finite element analysis of cornea deformation and curvature change during the keratoplasty suturing process

Keratoplasty, which is cornea transplant surgery, is one of the treatment methods for patients with turbidity or keratitis. Recently, keratoplasty using a surgical robot was studied to increase precision. In this study, the effect of surgical factors on the deformation and curvature of the cornea were analyzed in order to improve the accuracy of keratoplasty and derive the optimal surgical factors using finite element method (FEM). Suturing tension and depth were selected as surgical factors. An FEM model, a constitutive equation, and boundary conditions were determined using experiments and reference data. Suturing tension significantly impacted deformation and curvature change, and suturing depth affected the position of the thread-cornea contact point. Both factors have a significant impact on a focal point in the retina and the patient's visual acuity after keratoplasty.

Omental Patching and Purse-String Endosuture Closure after Endoscopic Full-Thickness Resection in Patients with Gastric Gastrointestinal Stromal Tumors

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, primarily arising from the stomach. With the widespread utilization of and technical advancements in endoscopy, gastric GISTs are being increasingly detected at an early stage, enabling complete endoscopic resection. Endoscopic full-thickness resection (EFTR) is an advanced technique that has been recognized as a treatment tool for neoplasms in the digestive tract in selected patients. Although a number of methods are available, closing large iatrogenic defects after EFTR can be a concern in clinical practice. If this potential problem is appropriately solved, patients with gastric GISTs would be suitable candidates for resection utilizing this technique. To our knowledge, this is the first study to propose omental patching and purse-string endosuture closure following EFTR as a feasible endoscopic option in patients with gastric GISTs.