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Background: Traditional microvascular anastomosis can be timeconsuming, which raises the risk of thrombosis. Damage to the endothelium during the process triggers a repair mechanism that involves platelet aggregation, smooth muscle cell proliferation, and thickening of the endothelium. Microvascular anastomosis plays a vital role in free flap transfers and replantation surgeries. Although standard suturing remains the preferred technique, it presents challenges due to its technical difficulty, extended duration, and potential for vessel wall trauma. Fibrin glue, derived from a combination of autologous cryoprecipitate and thrombin, was originally introduced for peripheral nerve repair in humans. The success of these early uses led to its expanded application in areas such as wound closure, skin grafting, and osteotomy healing. This study aims to evaluate the effectiveness of fibrin adhesive in addressing these challenges within the context of microvascular anastomosis. Methods: This experimental study included 22 male Sprague-Dawley albino rats, the rats were divided into two groups Group (1): Experimental group, we used 4 core sutures with 9/0 polypropylene placed 90 degrees from each other and 0.1 ml of fibrin glue at site of anastomosis. Group (2): As a control group we used the standard repair technique of the transected artery by 5-8 primary sutures with 9/0 polypropylene. Results: The use of fibrin adhesive significantly decreased both the number of sutures required and the time needed to complete the anastomosis. The immediate and long-term patency rates were not adversely affected by the application of fibrin glue. Histological analysis of the anastomosed vessels revealed no significant differences between the two techniques. Conclusions: In conclusion, the application of fibrin adhesive did not produce any adverse effects in microvascular anastomosis. The authors advocate for using fibrin adhesive in clinical settings, particularly in more complex cases where multiple microvascular anastomoses are necessary. [ABSTRACT FROM AUTHOR]

Background: The multiple-U technique is a new method for microvascular anastomosis that allows for easy and stable intima-to-intima contact, which is crucial for a successful procedure. The present work aimed to compare the Multiple-U technique and the simple interrupted suture technique regarding patency, time needed for anastomosis, duration of bleeding after declamping, and blood leakage. Methods: In an experimental study, forty adult male albino rats with an average weight of 200-350 gm were subjected to femoral artery anastomosis and were split into two equal groups (n = 20): simple interrupted suture in one group and multiple-U technique in another group. The milking test was done to assess the patency of the repaired vessel after an anastomosis. Anastomosis time, anastomotic leakage, bleeding time, and vessel diameter were assessed. Results: Regarding anastomotic leakage, the Multiple-U technique leakage (6-18 ml) was less than the leakage of the Simple Interrupted Suture technique (7.5-24 ml). Regarding vessel diameter after anastomosis, there was a significant decrease in vessel diameter in the simple interrupted suture technique (1.7 - 1.9 mm) when compared with the multiple U technique (1.9 - 2.17 mm) (p = 0.017). Our results showed non-significant differences between the two techniques regarding patency rate and anastomosis time. Conclusion: The multiple-U technique significantly decreased bleeding time and vessel diameter after anastomosis. Therefore, our recommendation is to use the multiple-U technique, particularly in digital replantation and in cases with a high risk of vessel occlusion. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this retrospective patient chart review was to analyze the clinical data of 52 patients with benign parotid tumors who underwent modified buried vertical mattress sutures and to assess the postoperative complication rate and patient scarring. Methods: A total of 52 patients with benign parotid tumors underwent total parotidectomy and modified buried vertical mattress suture. Variables included general characteristics (age, gender, tumor diameter, and pathologic type), surgical indicators (suture time, wound healing time, operative time, hospital stay, bleeding volume, and drainage volume), complication rates, and Sunnybrook facial neurological function score, visual scar scale (VSS) score and patient and observer scar assessment scale (POSAS) score. Results: Most tumors were less than 3 cm in diameter, with pleomorphic adenomas being the most common. Suture time was 14.83 ± 1.61 min, operative time was 58.90 ± 15.76 min and hospital stay were 5.12 ± 0.96 days. Postoperatively, salivary fistulae developed in one patient, Frey's syndrome in two patients, temporary facial paralysis in six patients and temporary numbness in the incision area in six patients. At 6 months postoperatively, 86.5% of patients had a Sunnybrook score of more than 80, and VSS scores and POSAS scores were between one and two. Conclusion: The postoperative complication rate was 30.8%, and the scarring in the facial incision area was mild and close to normal skin at 3 years postoperatively. [ABSTRACT FROM AUTHOR]

Background/Objectives: Robotic-assisted surgery has revolutionised modern medicine, enabling greater precision and control, particularly in microsurgical procedures. This systematic review evaluates the current state of robotic-assisted surgery across various specialties, focusing on four major robotic systems: Symani, Da Vinci, ZEUS, and MUSA. Methods: The review systematically analyses the effectiveness of these systems in performing vascular, lymphatic, and nervous anastomoses, comparing key metrics such as procedure time, success rates, and learning curves against manual techniques. It includes 48 studies, highlighting the technological capabilities and limitations of these systems in direct comparisons. Results: Results indicate that while robotic procedures often take longer than manual methods, significant improvements in efficiency are observed as surgeons gain experience. Conclusions: Overall, this study provides insights into the future potential of robotic-assisted surgery and highlights areas that require further research. It ultimately aims to promote the application of robotic systems in cranial neurosurgery, with a particular focus on advancing neurovascular techniques, such as microsuturing for bypass procedures. [ABSTRACT FROM AUTHOR]

Background: There is concern that physiologic knee hyperextension may be associated with inferior outcomes after anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) autografts. Purpose: To assess whether there is an association between contralateral passive preoperative knee hyperextension (≤−5°) and postoperative anterior knee laxity, subjective knee function, or revision surgery after ACLR using HT autografts. Study Design: Cohort study; Level of evidence, 3. Methods: Patients without concomitant ligament injuries who underwent primary ACLR using an HT autograft at Capio Artro Clinic, Stockholm, Sweden, between January 1, 2005, and December 31, 2018, were identified. The cohort was dichotomized into the hyperextension group (≤−5°) and the no hyperextension group (>–5°) depending on preoperative contralateral passive knee extension degree. Anterior knee laxity (KT-1000 arthrometer; 134 N) was assessed preoperatively and at 6 months postoperatively. The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1, 2, and 5 years postoperatively. Patients who underwent revision ACLR at any institution in Sweden within 5 years of the primary surgery were identified in the Swedish National Knee Ligament Registry. Results: A total of 6104 patients (53.5% male) for whom knee range of motion measurements were available were identified (hyperextension group [≤−5°]: 2350 [38.5%]; mean extension, −6.1°± 2.3° [range, −20° to −5°]; no hyperextension group [>−5°]: 3754 [61.5%]; mean extension, 0°± 1.4° [range, −4° to 15°]). There were no intergroup differences in anterior knee laxity preoperatively (hyperextension group, 3.6 ± 2.8 mm; no hyperextension group, 3.7 ± 2.7 mm; P =.24) or postoperatively (hyperextension group, 1.8 ± 2.3 mm; no hyperextension group, 1.8 ± 2.2 mm; P =.41). The only significant but nonclinically relevant intergroup differences were seen in the KOOS Symptoms subscale at the 1-year follow-up (hyperextension group, 81.4 ± 16.0; no hyperextension group, 80.3 ± 16.5; P =.03) and in the Sport and Recreation subscale at the 5-year follow-up (hyperextension group, 73.0 ± 25.6; no hyperextension group, 75.7 ± 24.3; P =.02). No other significant intergroup differences were noted preoperatively or at 1, 2, or 5 years postoperatively in any of the KOOS subscales. The overall revision ACLR rate at ≤5 years after the primary surgery was 4.9% (302 of 6104 patients). The hazard for revision ACLR in the no hyperextension group (4.5%; 170 of 3754 patients) was not significantly different from that in the hyperextension group (5.6%; 132 of 2350 patients) (hazard ratio, 0.89; 95% CI, 0.71 to −1.12; P =.34). A subsequent subanalysis showed that the hazard of revision ACLR in patients with no hyperextension was not significantly different from that of patients with ≤−10° of extension (5.8%; 27 of 467 patients) (hazard ratio, 0.91; 95% CI, 0.61 to 1.36; P =.65). Conclusion: Preoperative passive contralateral knee hyperextension (≤−5°) was not associated with postoperative anterior knee laxity, subjective knee function, or revision surgery ≤5 years after ACLR using HT autografts. Therefore, the presence of knee hyperextension alone should not be considered a contraindication per se for the use of HT autografts in ACLR. [ABSTRACT FROM AUTHOR]

Introduction: We describe a tissue-based repair technique for primary ventral hernia. We use the anterior rectus sheath as a flap from across the opposite side to cover and strengthen the suture repair in patients with small primary ventral hernia. Patients and Methods: Patients with primary ventral hernias of 1 to 3 cm defect width were included in this series. We created a rectangle-shaped anterior rectus sheath flap (ARS). The ARS flap was rotated medially to cover the closed hernia defect. The patients operated with this technique were evaluated for postoperative pain, surgical site infection, seroma, hematoma, skin necrosis, hospital stay, readmissions, chronic pain, and recurrence. Results: We studied eight patients (six men and two women), seven of whom had an umbilical hernia and one epigastric hernia. Two patients had chronic liver disease with ascites and infected hernia. One was an obstructed hernia. The mean defect width was 2.1 cm (range 1.2 to 2.5), and the mean operative time was 40 min (range 30–50 min). The mean pain score on a scale of 1 to 10 on postoperative day one was 2 (range 1–3). The median follow-up period was 14 months (range 12–47). In the postoperative period, none of the patients had surgical site infection, seroma, hematoma, skin necrosis, readmission, chronic pain, or recurrence. Conclusion: The anterior rectus sheath flap repair gives strength to the simple suture closure in patients with small primary ventral hernia. It is suitable for repair when the mesh is not desired. However, further studies are needed to throw more light on this promising technique. [ABSTRACT FROM AUTHOR]

Aesthetic genital surgeries are on the rise globally. Labia minora reduction, the most common aesthetic genital surgery, can be done either by the edge resection or by the wedge resection techniques. The edge resection technique trims the edge of the labia minora and leads to unnatural results as it does not maintain the color gradation that is naturally present on the inner surface of the labia minora or the minor irregularities that are naturally present in the labia besides posing problems like scar pain at edges during intercourse and chances of overresection. Wedge resection has the advantage of retaining the color gradation and the minor natural irregularities on the edge of the labia minora and is considered to be a better technique than the edge resection technique. However, the classical central wedge reduction technique suffers from a deformity in long term in the form of a visible notch at margins of the labia minora at the site of suturing. The author suggests a modification of this technique to overcome this problem to give better natural long-term results. [ABSTRACT FROM AUTHOR]

Purpose: The resection of lymph nodes/neck dissection is a typical part of the surgical treatment of head and neck malignancies. The aim of this study was to compare subcutaneous closure using single knotted, braided suture (VicrylTM, standard arm) with continuous self-locking, monofilament barbed suture (V-LocTM, experimental arm). Methods: Neck Lock was a randomized clinical trial at a single tertiary referral center. It was conducted from 2016 till 2022 with a follow-up period of 3 months. Assessment of safety and aesthetic outcome was double-blinded. 68 patients were randomized after application of exclusion criteria. Subcutaneous wound closure was performed in an intrapatient randomized fashion for suture technique. The primary endpoint was the duration of subcutaneous sutures. Wound healing and scar formation were recorded at multiple postoperative intervals as secondary endpoints. Results: The median age was 61 years, 89.7% were male. 92.6% suffered from a squamous cell carcinoma. There was a significant difference in median subcutaneous suture time (p = 0.024) between the experimental (6:11 ± 2:30 min) and standard (7:01 ± 2.42 min) arms. There was no significant difference in safety when assessing adverse events (AEs). At least one AE occurred in 14.7% vs. 5.9%, for barbed and smooth sutures respectively (p = 0.16). Conclusion: For neck dissection of head and neck malignancies, subcutaneous wound closure with self-locking sutures offers significant time savings over the single knot technique with similar safety and aesthetic results. Trial registration information: The trial was registered with WHO acknowledged primary registry "German Clinical Trials Register" under the ID DRKS00025831 (https://drks.de/search/de/trial/DRKS00025831). [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to use a mathematical approach to understand the exact location and spacing of microvascular anastomosis, and investigate the effectiveness of a practice model using chicken legs and partial meat from chicken wings. Methods: The suture techniques used for microvascular anastomosis were analyzed mathematically. In addition, chickens of various sizes were dissected to measure the size of blood vessels and compared with the size of blood vessels found in partial meat. Results: When using eight- or nine-point sutures, the positions and intervals were different. Larger chickens had larger blood vessels. In the partial meat samples, the average size of the blood vessels was 0.8 mm for the radial artery, 0.45 mm for the ulnar artery, and 1.3 mm for the tibial artery. Conclusion: It is important to understand the location and spacing of sutures through a mathematical analysis of microvascular anastomosis, which enables suturing techniques to be improved. The practice model using chicken legs and partial meat from chicken wings was found to be useful for beginners. [ABSTRACT FROM AUTHOR]

Purpose: This study presents the outcomes of a modified loop-locking suture technique for repairing complete flexor digitorum profundus (FDP) tendon divisions at the terminal level. Traditional methods, such as pullout sutures or tendon fixation, are commonly used; however, this paper explores the reliability of the loop-locking suture technique. Methods: From June 2011 to January 2024, the modified loop-locking suture technique was performed in 21 cases of FDP tendon division in which the distal stump was less than 1 cm in length. Core and epitendinous sutures were made using polydioxanone 4-0 and poliglecaprone 25 4-0. The study focused on 13 patients aged 24 to 68 years, with an average tendon stump length of 0.61 cm. Ten cases necessitated microsurgical repair involving both arterial and nerve repair. A dorsal protective splint was used for an average of 5 weeks. The outcomes measured included active and passive range of motion, grip strength, and key and pulp pinch. Results: The mean follow-up period was 12 months. No re-ruptures occurred, although two cases required tenolysis. The average active range of motion at the distal interphalangeal joint was 61.5°. Grip strength and pulp pinch averaged 95.3% and 86.8%, respectively, compared to the contralateral side. Flexion contracture was observed in three cases, with no quadriga effect. Conclusion: The modified loop-locking suture technique provides sufficient functional recovery for FDP tendon divisions in Zone 1a and distal Zone 1b, even with a short tendon stump. [ABSTRACT FROM AUTHOR]

Laparoscopic techniques are being widely applied for peritoneal dialysis (PD) catheter (PDC) placement. The suture passer is a novel fixation tool that aims to reduce catheter migration. We compared the clinical value of the suture passer combined with two-hole laparoscopic PDC placement to open surgical placement by evaluating preoperative and postoperative conditions, as well as the onset of complications in both groups. A retrospective study was conducted including 169 patients who underwent PDC placement surgery from January 2021 to May 2023. Based on the method employed, patients were divided into two groups: the suture passer combined with a two-hole laparoscopy group (SLG) and the open surgical group (SG). Comprehensive patient information, including general data, preoperative and postoperative indicators, peritoneal function after surgery, and the incidence rate of complications, were collected and analyzed. The SLG showed a statistically significant decrease in operative time, intraoperative blood loss, and 6-month postoperative drift rate compared to the SG (p < 0.05). No statistically significant differences were observed between the two groups in terms of sex, age, primary disease, hospitalization time, hospitalization costs, preoperative and postoperative examination indicators, peritonitis, and omental wrapping. Suture passer combined with two-hole laparoscopic PDC placement, characterized by simplicity and facilitating secure catheter fixation, was deemed safe and effective for patients undergoing PD. It reduces the catheter migration rate and improved surgical comfort. Overall, this technique demonstrates favorable outcomes in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the cost and efficiency of suture‐mediated percutaneous closure (SMC) compared to manual compression (MC) after atrial fibrillation (AF) ablation. SMC has been demonstrated to be efficacious in reducing hemostasis and bedrest times after AF ablation. To date, randomized data comparing the direct and indirect cost between the two techniques have not been described. Methods: We conducted a 1:1 randomized trial comparing SMC to MC following AF ablation. The primary endpoints have been previously published. However, secondary endpoints pertinent to indirect cost including complication rates, hospital utilization (i.e., delays in discharge, additional patient encounters, nursing utilization), pain, patient reported outcomes, as well as the direct costs of care associated with AF ablation were collected. We also performed secondary analysis of the primary endpoint to evaluate for a learning curve, and subgroups analysis comparing efficacy across different numbers of access sites and compared to those in the MC group with a figure‐of‐eight suture (Fo8), that could potentially have impacted the relative efficiency of the procedure. Results: A total of 107 patients were randomized and included: 53 in the SMC group and 54 in MC. A learning curve was observed in the SMC group between the first and second half of the study group (p = 0.037), with no such difference in the MC group. After accounting for the number of access sites, time to hemostasis remained shorter in the SMC Group (p = 0.002). Compared to those in the Fo8 arm (n = 37), the time to hemostasis remained shorter in the SMC group (p = 0.001). Among those planned for same‐day discharge, there were more delays in the MC group (31.5% vs. 11.3%, p = 0.0144). Rates of major and minor complications were similar between SMC and MC groups at discharge (p = 0.243) and 30 days (p = 1.00), as were nursing utilization, self‐reported pain, and overall patient reported outcomes. The overall cost of care related to the procedure was similar between the MC and SMC groups ($56 533.65 [$45 699.47, $66 987.64] vs. $57 050.44 [$47 251.40, $66 426.34], p = 0.601). Conclusion: SMC has been shown to decrease time to hemostasis and ambulation and facilitate earlier same‐day discharge after AF ablation without an increase in direct or indirect costs. [ABSTRACT FROM AUTHOR]

This article discusses the care of normally healing surgical wounds, together with key potential wound complications of surgical wound dehiscence (SWD) and surgical site infection (SSI). It also provides a brief overview of how fistulas and sinuses develop and how to manage these complex wounds. Indeed, timely intervention and appropriate care of surgical wounds and any complications which may arise is vital to ensure optimal outcomes and prevent long-term issues. [ABSTRACT FROM AUTHOR]

Pain after trapeziectomy is a vexing problem, most commonly due to scaphometacarpal impingement. A number of treatment strategies have been described and are examined in this systematic review. In total, 27 studies describing revision surgery for unsatisfactory results after trapeziectomy were included. Results after soft tissue or synthetic suspensionplasties, arthrodesis procedures, implant arthroplasty and costochondral autografting were included. Most studies were heterogeneous in terms of patient selection and procedure performed, and the level of evidence and methodological quality were uniformly low. Autologous suspensionplasty procedures are the best studied and most rigorously reported techniques, with modest improvements in pain widely reported. Newer techniques using synthetic suture button suspension are encouraging with the benefit of earlier mobilization but require further study. Due to high incidences of complication and revision, the literature does not support the use of implant arthroplasty after trapeziectomy. Arthrodesis appears to be a reasonable last resort when attempts at suspension have failed. [ABSTRACT FROM AUTHOR]

Purpose: Recently, a new dynamic high-strength suture (DC) was introduced, also available in tape form (DT), featuring a salt-infused silicone core attracting water in a fluid environment to preserve tissue approximation. The aims of this study were to (1) assess the influence of securing throw number on knot security of two double-stranded knot configurations (Cow-hitch and Nice-knot) tied with either dynamic (DC and DT) or conventional (FW and ST) high-strength sutures and tapes, and (2) compare the ultimate force and knot slippage of the novel dynamic versus conventional sutures and tapes when used with their minimal number of needed securing throws. Methods: Seven specimens of each FW, ST, DC and DT were considered for tying with Cow-hitch or Nice-knots. The base of these Cow-hitch and Nice-knots was secured with surgeons' knots using 1–3 alternating throws. Tensile tests were conducted under physiologic conditions to evaluate knot slippage, ultimate force at rupture, and minimum number of throws ensuring 100% knot security. Results: For both Cow-hitch and Nice-knots, 100% security was achieved with 2 securing throws for DC, DT, ST, and with 3 securing throws for FW. With these minimum numbers of securing throws, ultimate force was significantly higher for Nice-knots versus Cow-hitch tied with DT (p = 0.001) and slippage was significantly less with Nice-knots versus Cow-hitch tied with DC (p = 0.019). Conclusions: The minimum number of securing throws required to achieve 100% security was 2 with DC, DT and ST for both Cow-hitch and Nice-knots configurations, in contrast to FW where 3 securing throws were needed. With these minimum numbers of securing throws, Nice-knots were associated with significantly higher ultimate forces when using DT and lower slippage with DC versus Cow-hitch knots. [ABSTRACT FROM AUTHOR]

The article discusses the challenges of oral rehabilitation with dental implants in the maxillary region due to bone resorption and sinus pneumatization. It explores the use of injectable porcine collagenated bone for crestal sinus lift procedures with and without immediate implant placement. The study aims to analyze radiological changes in the vertical dimensions of the maxillary sinus after using heterologous xenograft material. The research demonstrates successful outcomes in bone regeneration and implant stability, highlighting the potential of xenograft materials as alternatives to autologous bone grafts in sinus augmentation procedures. [Extracted from the article]

Background: Creating a model for acute liver failure in animal models is essential for research on liver regeneration and cancer. Current surgical techniques allow for a maximum of 80% partial hepatectomy in rats, with low survival rates due to poor inflow control. The common resection technique involves ligation at the liver lobe neck, causing peri-operative blood loss and postoperative blood loss. Methods: A 90% partial hepatectomy was performed on 5 rats using a bile duct-saving portal ligation technique, involving two hilum dissections for bile duct preservation. The first dissection controlled the blood supply to the median and left lateral lobes, and the second to the right inferior and superior lobes. Before closing, all rats were given 5 mL of 10% dextrose intraperitoneally and had access to ClearH2O DietGel Recovery and 20% dextrose. Weight and behavior were closely monitored for seven days post-operatively. Results: This method resulted in 100% survival, with a 3.1% increase in liver mass and 12.3% increase in liver-to-body mass ratio. Conclusions: This technique is the first bile duct-saving portal ligation for rodent models of acute liver failure, with long-term survival and complete hepatic regeneration. Our procedure offers a viable 90% hepatectomy model for research with improved survival and regeneration outcomes. [ABSTRACT FROM AUTHOR]

Background Bipolar vessel-sealing devices (BVSD) have been used for muscle transection in canine limb amputations; however, a retrospective study of their use, and particularly the short-term complications, has not yet been reported. Objectives To describe the use of a BVSD as the main method for muscle transection in canine limb amputations and to report the incidence of short-term incisional complications following these surgeries. Animals and procedure Medical records of dogs undergoing limb amputations using a BVSD from January 2017 to December 2018 were reviewed for demographics, preoperative findings, intraoperative complications, and short-term outcomes. Exclusion criteria included surgery and anesthesia time not recorded, or short-term postoperative follow-up data not available for review. Complications noted in the medical record up to the time of suture removal were included in the review. Results A total of 27 cases met selection criteria, including amputations of 17 forelimbs and 10 pelvic limbs. There were no intraoperative complications noted. Median duration between surgery and suture removal was 13 d (range: 4 to 23 d). Seroma formation occurred in 1 case (3.7%), whereas convalescent surgical-site infections were identified in 3 cases (11%). All complications were documented in dogs weighing > 27 kg. Conclusion Use of a BVSD as the main method of muscle transection in canine limb amputations is a safe and feasible alternative to more traditional methods of limb amputation. Surgical-site infection and seroma formation were the only documented complications in the present study. The complication rate was similar to rates described previously; therefore, using a BVSD for muscle transection seems a viable alternative to traditional methods of limb amputation. Clinical relevance Given similar incisional complication rates when compared to more traditional methods of muscle transection, a BVSD may be considered for an alternative method of muscle transection in canine limb amputations. [ABSTRACT FROM AUTHOR]

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Background: Several types of suture anchors, which differ in their working principles, are available for fixation of ligamentous structures in knee surgery. How the choice of a suture anchor type influences the biomechanical stability of ligament fixation is largely unknown. Purpose: To compare the biomechanical properties of different suture anchor designs regarding primary stability for tendon fixation and repair in medial collateral ligament (MCL) surgery. Study Design: Controlled laboratory study. Methods: The primary stability of MCL fixation was assessed in a porcine model utilizing 1 of 3 suture anchor types: a 5.5-mm titanium suture anchor (TSA), a 2.8-mm all-suture anchor (ASA), or a 5.5-mm polyether ether ketone knotless suture anchor (KLSA). Primary stability was assessed using a uniaxial material testing machine. Cyclic loading at 50 N and 100 N was applied for 500 cycles each, followed by a load-to-failure test. Results: After 500 cycles at 50 N, the KLSA (2.4 ± 0.3 mm) showed significantly (P <.05) reduced elongation in comparison to the TSA (4.0 ± 0.9 mm) and ASA (3.6 ± 0.7 mm), and after 500 cycles at 100 N, the KLSA (6.5 ± 1.4 mm) again showed significantly (P <.05) reduced elongation in comparison to the TSA (11.0 ± 2.2 mm) and ASA (12.0 ± 3.6 mm). However, the KLSA (213 ± 27 N) showed a significantly (P <.05) inferior ultimate failure load in comparison to the TSA (300 ± 20 N) and ASA (348 ± 23 N). In comparison to the TSA (113.0 ± 11.0 N/mm) and ASA (113.6 ± 14.4 N/mm), the KLSA (150.7 ± 11.6 N/mm) displayed the highest stiffness (P <.05). No significant differences were observed regarding yield load. Conclusion: KLSAs displayed significantly reduced elongation, at the cost of a reduced ultimate failure load, in comparison to TSAs and ASAs. Clinical Relevance: Surgeons should be aware that differences exist between different suture anchor types regarding their biomechanical stability. KLSAs may be favorable for fixation of peripheral ligaments in knee surgery. [ABSTRACT FROM AUTHOR]

The purpose of this study was to quantify the buccal bone thickness, area, and perimeter following guided bone regeneration (GBR) using stabilizing periosteal sutures. The loss in hard tissue volume may impair proper implant placement. GBR has been used to regenerate the lost alveolar ridge prior to or at the same time as dental implant placement. The most important factor for GBR success is graft stability. The periosteal mattress suture (PMS) stabilizing technique is an alternative to pins and screws to stabilize bone grafting material and has the advantage of not requiring the removal of the fixing devices. CBCT scan was acquired before and 6 months after surgery from six patients who underwent GBR with the PMS stabilizing technique. Images were analyzed for buccal bone thickness, area, and perimeter. The mean change in buccal bone thickness was 3.42 ± 1.31 mm and proved statistically significant (P = .005). The mean change in bone crest area also proved statistically significant (P = .001). No significant difference was found in bone perimeter (P = .12). The PMS technique delivered optimal results without clinical complications. This study shows the potential of this technique as an alternative to pins or screws for graft stabilization in the esthetic zone. [ABSTRACT FROM AUTHOR]

This study evaluated the clinical efficacy of the coronally advanced lingual flap (CALF) technique in terms of the extent of lingual and buccal flap advancement, the maintenance of primary wound closure, and safety in comparison to buccal flap advancement alone during horizontal ridge augmentation in the posterior mandible. A total of 14 patients were randomly allocated to two different groups: buccal flap advancement without the CALF technique (control), referred to as the NO-CALF group, and buccal flap advancement with the CALF technique (test), referred to as the CALF group. Wound healing was monitored weekly for the first 4 weeks, then at 2, 4, 6, and 9 months postoperatively for any sod tissue dehiscence (titanium mesh [TM] exposure) along the incision line. The extent of lingual and buccal flap advancement was measured, and any intraoperative and postoperative CALF-related complications were reported. The difference between groups was statistically significant (P < .0001) in terms of (1) TM exposure: 83.3% of cases in the NO-CALF group showed early Class П exposures, whereas the CALF group showed no exposure; (2) mean lingual flap advancement: 3.9 ± 1.1 mm and 14.4 ± 3.8 mm for the NO-CALF and CALF groups, respectively; and (3) mean buccal flap advancement: 15.8 ± 2.1 mm and 10.5 ± 1.4 mm for the NO-CALF and CALF groups, respectively. There were no reported complications related to the CALF technique. Tension-free primary wound closure was facilitated and maintained during the healing period by applying the CALF technique, which is a reliable technique to safely advance the lingual flap coronally. [ABSTRACT FROM AUTHOR]

Orthognathic surgery affects both function and aesthetics. An important aesthetic complication is the nasal alteration that can result from Le Fort I osteotomy. A common method for countering this complication is the alar base cinch suture technique. Although the method for this suture has been standardized, the results vary and are inconsistent; further improvements are therefore required. The objective of this study was to review the literature data on the alar base cinch suture technique and associated results. In this review, the PubMed, Ovid, and Ichushi-Web electronic databases were searched using logical combinations of keywords related to the perinasal musculature and alar base cinch suture technique. Following screening of the results, 42 publications were included. The review findings prompted several conclusions. The anatomy of the myrtiformis muscle and depressor septi nasalis may differ between ethnicities, and it is essential to take certain factors related to ethnicity into account when implementing the alar base cinch suture technique. It is also important to consider factors such as the patient's aesthetic preferences. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of split-thickness labial eversion periosteoplasty (EPP) for soft tissue closure in horizontal ridge augmentation of posterior mandibular regions using a bone shell onlay grafting technique. Materials and Methods: Sixteen patients (12 female and 4 male; mean age: 46.2 ± 8.7 years) with 18 horizontal bone defects in posterior mandibular regions were included for lateral onlay bone grafting using the bone shell technique. After lateral bone augmentation, the EPP was used for soft tissue closure and was prospectively followed up for wound healing efficacy using a modified scoring index. The scoring index included dichotomous (yes: 0 / no: 1) evaluation of the following items: (1) bleeding on palpation or spontaneously, (2) tissue color difference, (3) presence of hematoma, (4) presence of granulation tissue, (5) incomplete incision margin closure, (6) dehiscence with visible augmentation material, (7) presence of exudation, and (8) presence of suppuration. In addition, a visual analog scale (VAS) was used to quantify and record the amount of pain and swelling (0 = no pain/swelling and 5 = severe pain/swelling); VAS scores of 0, 1, and 2 were rated as 1 in the dichotomous scoring index, and VAS scores of 3, 4, and 5 were rated as 0. A summarized wound healing score consisting of all 10 items was assessed at days 2, 7, and 14 and at months 1 and 4 postoperatively, including a comparison of the follow-up evaluations. Results: The summarized healing score increased significantly (P < .01) between day 2 (score: 6.6 ± 1.1) and day 7 (score: 8.9 ± 1.0) but showed little difference between day 14 (score: 9.6 ± 0.6) and the 1- and 4-month follow-ups (score: 10.0 ± 0). There was no wound dehiscence and no incomplete incision margin adaptation. For the individual parameters evaluated, bleeding on palpation, hematoma, and exudation were the most frequent side effects at day 2 at 50%, 100%, and 22.2%, respectively, and at day 7 at 16.7%, 55.6%, and 22.2%, respectively. The average pain score and the swelling/edema score were initially 4.0 ± 0 and 3.0 ± 0.77 on day 2, with a significant decrease (P < .001) by day 7 (pain: 2.0 ± 0; edema/swelling: 2.0 ± 0.59) and day 14 (pain: 1.0 ± 0.42; edema/swelling: 2.0 ± 0.79) and complete absence (score: 0) at months 1 and 4. Conclusions: Labial split-thickness EPP facilitates flap advancement and enables tight soft tissue coverage in large horizontal posterior mandibular bone augmentations as a result of offset double-layer wound closure. Although this procedure is shown to be surgically demanding, the postoperative complication rate may be reduced significantly. [ABSTRACT FROM AUTHOR]

Introduction. Inguinal ectopic testis is a rare complication after inguinal hernia repair. In modern literature, there are few articles devoted to this problem.Objective. To study the testicular elevation mechanisms after inguinal hernia surgery in children and methods to treat this complication.Materials & methods. A cross-sectional retrospective analysis of medical records of male children who underwent inguinal plasty between January 2018 and December 2023 was performed at the Chelyabinsk Regional Children's Clinical Hospital. Those who underwent subsequent orchopexy for ipsilateral cryptorchidism were identified. Cryptorchidisms that were misdiagnosed were excluded.Results. A total of 1140 boys with inguinal hernias were treated, of which 978 (86%) were operated on laparoscopically using the PIRS technique, and 162 (14%) underwent open hernia repair. In nine (0.7%) children, an ectopic testicle in the groin was detected after surgery. During orchiopexy, extensive adhesions and scars in the inguinal canal were found only in two cases after open plastic surgery. The processus vaginalis remained intact after laparoscopic repair and partially after open hernia repair.Conclusion. Ectopic testicles in patients undergoing inguinal hernia repair can be successfully treated with orchiopexy performed through the inguinal approach.

Suturing is an integral part of surgery. Specialized instrumentation facilitates manual needle handling to support laparoscopic suturing tasks, e.g. uterine closure, in minimally invasive surgery. Current solutions for robotassisted laparoscopy lack the possibility to integrate these instruments, making them suitable only for conventional laparoscopic surgery. This paper introduces a novel end effector design actuating a conventional suturing instrument. The end effector is integrated into the DLR MiroSurge system to facilitate telemanipulated suturing. The mechanical properties of the end effector are characterized and its feasibility for use in robot-assisted laparoscopy is demonstrated.

Objective: To investigate the efficacy of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicular fractures with coracoclavicular ligament injuries. Methods: A retrospective analysis was performed on 43 patients who sustained distal clavicular fractures along with injuries to the coracoclavicular ligament. These patients were treated between January 2017 and December 2023. The fractures were classified according to the fixation method: high-strength Nice knot suture fixation (experimental group, n = 23) and acromioclavicular Kirschner wire fixation (control group, n = 20). The basic information of the two groups of patients, including age, gender, cause of injury, fracture classification, hospitalization duration, fracture healing time and complications, was collected and analyzed. The increase rate of coracoclavicular space on the affected side was collected and analyzed. The pain level of the affected shoulder was assessed using the visual analog scale (VAS). The shoulder joint function was assessed using the American Shoulder and Elbow Surgeons (ASES) scores and Constant-Murley scores before and after surgery. Results: No significant differences were observed in the general demographic data, including age, gender, injury etiology, Craig classification, and hospitalization duration between the two groups (p > 0.05). Both groups were followed for a period ranging from 12 to 33 months, with an average follow-up of 20.53 ± 5.16 months. The bone healing time in the experimental group was significantly shorter than in the control group (12.82 ± 1.12 weeks vs. 17.25 ± 1.71 weeks, p < 0.05). At the final follow-up, The increase rate of coracoclavicular space was (9.25 ± 2.53) % in the experimental group and (8.10 ± 2.53) % in the control group, which was not significantly different (p > 0.05). Both groups demonstrated significant improvements in VAS scores, Constant-Murley scores, and ASES scores post-operatively compared to pre-operative values (p < 0.05). One month after surgery, the Constant-Murley and ASES scores were significantly superior in the experimental group compared to the control group (p < 0.05). However, no statistical difference was observed three months post-surgery or during the final follow-up (p > 0.05). The control group reported one case of infection related to the Kirschner wire and one case of Kirschner wire displacement postoperatively. Conversely, no significant complications were reported in the experimental group. Conclusion: In the management of distal clavicle fractures accompanied by coracoclavicular ligament injuries, particularly oblique fractures or those with butterfly-shaped fragments, the application of a high-strength Nice knot suture in conjunction with Endobutton plate fixation can effectively stabilize the fracture site. This approach not only mitigates complications associated with Kirschner wire fixation but also enhances fracture healing, leading to favorable postoperative outcomes. [ABSTRACT FROM AUTHOR]

Background and Objectives: Evisceration and incisional hernia (IH) represent a significant morbidity following open or laparoscopic colorectal surgery where midline laparotomy or extraction incision (EI) are performed. We executed a systematic review to evaluate primary mesh closure of laparotomy or EI in colorectal resections of benign or malignant conditions. Methods: A comprehensive literature search was performed using PubMed, Science Direct, Cochrane, and Google Scholar databases for studies comparing prophylactic mesh to traditional suture techniques in closing laparotomy in open approach or EI when minimally invasive surgery was adopted in colorectal procedures, regardless of the diagnosis. Both IH and evisceration were identified as primary outcomes. Secondary outcomes included surgical site infections (SSI), postoperative seroma, and length of hospital stay (LOS). Results: Six studies were included in our analysis with a total population of 1398 patients, of whom 411 patients had prophylactic mesh augmentation when closing laparotomy or EI, and 987 underwent suture closure. The mesh closure group had a significantly lower risk of developing IH compared to the conventional closure group (OR 0.23, p = 0.00001). This result was significantly consistent in subgroup analysis of open laparotomy or EI of laparoscopic surgery subgroups. There was no statistically notable difference in evisceration incidence (OR 0.51, p = 0.25). Secondary endpoints did not significantly differ between both groups in terms of SSI (OR 1.20, p = 0.54), postoperative seroma (OR 1.80, p = 0.13), and LOS (MD −0.54, p = 0.63). Conclusions: primary mesh reinforcement of laparotomy or EI closure in colorectal resections lessens IH occurrence. No safety concerns were identified; however, further high-quality research may provide more solid conclusions. [ABSTRACT FROM AUTHOR]

Skin flap transplantation is the most commonly used method to repair tissue defect and cover the wound. In clinic, finite element method is often used to design the pre-operation scheme of flap suture. However, the material parameters of skin flap are uncertain due to experimental errors and differences in body parts. How to consider the influence of material parameter uncertainty on the mechanical response of flap suture in the finite element modeling is an urgent problem to be solved at present. Therefore, the influence of material parameter uncertainty propagation in skin flap suture simulation was studied, Firstly, the geometric model of clinical patient's hand wound was constructed by using reverse modeling technology, the patient's three-dimensional wound was unfolded into a flat surface by using curved surface expansion method, yielding a preliminary design contour for the patient's transplant flap. Based on the acquired patient wound geometry model, the finite element model of flap suture with different fiber orientations and different sizes was constructed in Abaqus, and the uncertainty propagation analysis method based on Monte Carlo simulation combined with surrogate model technology was further used to analyze the stress response of flap suture considering the uncertainty of material parameters. Results showed that the overall stress value was relatively lower when the average fiber orientation was 45°. which could be used as the optimal direction for the flap excision. when the preliminary design contour of the flap was scaled down within 90%, the stress value after flap suturing remained within a safe range. [ABSTRACT FROM AUTHOR]

Background: The management of anterior colliculus fractures in combination with deltoid ligament injuries is a topic of debate, and there is a need to improve surgical outcomes. The purpose of the present study was to describe the application of a modified double-row suture bridge technique and evaluate its early clinical outcomes in the management of anterior colliculus fracture combined with deltoid ligament injury. Methods: From 2020 to 2022, 12 patients with anterior colliculus fracture combined with deltoid ligament injury were treated using a modified double-row suture bridge technique. For clinical outcome evaluation, objective data are presented through clinical examination findings; radiographic assessments, including X-rays and computed tomography (CT); and follow-up analysis utilizing American Orthopaedic Foot & Ankle Society ankle‒hindfoot (AOFAS) scores, Olerud Molander Ankle Scores (OMAS), and visual analogue scale (VAS) scores. Preoperative and follow-up scores were compared with Student's t test. (p <.05). Results: The mean age of the patients was 52.67 ± 9.42 years (range: 39–74). The mean duration of follow-up was 14.42 ± 1.51 months (range: 12–17). At the final follow-up, the mean AOFAS score (P < 0.001) improved to 91.50 ± 2.65 points (range: 87–96), the mean OMAS (P < 0.001) improved to 77.08 ± 3.97 points (range: 70–85), and the mean VAS score (P < 0.001) improved to 0.25 ± 0.45 points (range: 0–1). Nine patients achieved excellent outcomes, and three achieved good outcomes according to the AOFAS score. Follow-up imaging evaluation indicated satisfactory alignment of the fracture and complete healing. Clinical examination suggested good mobility of the ankle. At the last follow-up, ankle dorsiflexion mobility was 14–18 degrees, plantar flexion mobility was 42–45 degrees, inversion mobility was 27–32 degrees, and eversion mobility was 22–25 degrees. Conclusions: The modified double-row suture bridge technique is effective for achieving anatomic reduction of anterior colliculus fractures, and the technique also provides substantial benefit to the injured deltoid ligament. With this technique, the clinical outcomes can be significant and encouraging, indicating a new stage in its application and development. [ABSTRACT FROM AUTHOR]

Background: Ureteral spatulation, the first ureteral suture, and double-J stenting may be challenging and time-consuming in laparoscopic pyeloplasty, especially in small children. We aimed to present our comparative results of the extracorporeal ureteral spatulation, suturing, and stenting (EUSSS) technique in mini-laparoscopic pyeloplasty (MLP) and the conventional intracorporeal technique in prepubertal children. Methods: The data of 46 prepubertal pediatric patients (< 12 years) who underwent laparoscopic pyeloplasty by a single surgeon between January 2021 and October 2023 were retrospectively reviewed. The patients were divided into two groups: who underwent EUSSS-MLP (Group-1, n = 26) and who underwent conventional intracorporeal pyeloplasty (Group-2, n = 20). Results: The mean age of all patients was 5.3 years (4.8 ± 2.8 years in Group-1 and 6.0 ± 2.1 years in Group-2 p = 0.126). The mean duration of ureteral preparation plus double-J stenting was 5.7 ± 1.6 min in Group-1 and 19.2 ± 4.1 min in Group-2 (p < 0.0001). The mean duration of surgery was statistically significantly higher in Group-2 (p = 0.034). There was no significant difference in terms of postoperative complications (p = 0.482). Laparoscopic pyeloplasty was successful in 42 (91.3%) patients, with no statistically significant difference between the two groups (Group-1: 24 (92.3%), Group-2:18 (90%), p = 0.783). Conclusion: Extracorporeal ureteral preparation and double-J stenting can be safely and effectively preferred in MLP for prepubertal children. [ABSTRACT FROM AUTHOR]

Introduction: Magnesium Sulphate (MgSO4) is commonly used in human medicine for the management of perioperative pain in different types of procedures. However, in veterinary medicine, the use of MgSO4 has not been evaluated for its analgesic efficacy in dogs, which has generated conflicts of opinion in this area of veterinary anesthesiology. The aim of this study was to evaluate the perioperative analgesic efficacy of MgSO4 in combination with Ketamine in dogs undergoing Tibial Plateau Leveling Osteotomy (TPLO). Our hypothesis is that MgSO4 plus ketamine have a synergistic action in the management of intra-and postoperative pain. Methods: Twenty adult mixed breed dogs with average age 5.9 ± 2.6 years and weight 27.8 ± 9.2 kg were included in this prospective, clinical, randomized study. Dogs were randomly assigned to two groups. The MK group received ketamine (0.5 mg/kg as starting bolus followed by continuous infusion rate at 1 mg/kg/h). At the end of the ketamine bolus, MgSO4 (50 mg/kg over 15 min) was administered by the same route, followed by a constant rate infusion (CRI) at 15 mg/kg/h, IV. K group received a bolus of ketamine followed by a CRI at the same dosage described in MK group. Main cardiorespiratory parameters were recorded 10 min before the start of surgery (BASE), after the ketamine bolus (T1) and the MgSO4 bolus (T2), during the skin incision (SKIN), the osteotomy (OSTEOTOMY) and skin suturing (SUTURE). In the postoperative period, the short form of Glasgow Composite Pain scale (SF-CMPS) was used to assess pain at 30, 60, 120, and 180 min after extubation (Post30, Post60, Post120, and Post180, respectively). The main blood electrolytes (Mg2+, Ca2+, Na+, K+) were analyzed at BASE, T2, OSTEOTOMY, SUTURE and T3 (one hour after stopping MgSO4 infusion). Number of rescue analgesia and administration times were recorded both in the intra-and postoperative period. Results: In K group 7 out of 10 dogs required intraoperatory rescue analgesia compared to MK group (3/10). Furthermore, mean arterial pressure (MAP) and heart rate (HR) were significantly higher at OSTEOTOMY compared to BASE time in both groups. In the postoperative period, at T120, ICMPS-SF score was higher in K group than MK group. Conclusion: The administration of MgSO4 could guarantee better analgesia in the perioperative period in dogs undergoing TPLO, performing a synergistic action with ketamine. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions Currently, there are various surgical options for the treatment of lateral ankle sprains, and deciding which surgical option to use is a question worth considering. Furthermore, there is a relative scarcity of mechanical research comparing suture anchor repair (SAR) and suture tape augmentation (STA) internal brace for the repair of the anterior talofibular ligament (ATFL). Therefore, this study aimed to compare the efficacy of arthroscopically all‐inside ATFL SAR and STA for reconstruction to treat lateral ankle sprains through biomechanical testing.Eighteen fresh‐frozen cadaver ankles were used for the study and divided into one of three groups: (1) intact ATFL group, (2) arthroscopically reconstructed with suture tape augmentation internal brace of the ATFL (STA group), and (3) arthroscopically repaired ATFL with suture anchors (SAR group). We used custom fixtures to test the specimens for loading to ultimate failure and stiffness.The mean load to failure of the STA group (311.20 ± 52.56 N) was significantly higher than that of the intact ATFL group (157.37 ± 63.87 N; p = 0.0016) and the SAR group (165.27 ± 66.81 N; p = 0.0025). The mean stiffness of the STA group (30.10 ± 5.10 N/mm) was significantly higher than that of the intact ATFL (14.17 ± 6.35 N/mm; p = 0.0012) and the SAR group (15.15 ± 6.89 N/mm; p = 0.0021). The suture anchor repair withstood failure loads and stiffness similar to the intact ATFL.In terms of failure load and stiffness, the reconstructive outcome of ATFL reconstruction with STA is markedly superior to that of SAR reconstruction of the ATFL and the intact ATFL. Additionally, the novel technique of the SAR was a reliable technique that offered biomechanical properties similar to intact ATFL. [ABSTRACT FROM AUTHOR]

This article provides an overview of the wound healing process, outlining the four distinct phases of the healing cascade: haemostasis, inflammation, proliferation, and maturation. The different types of closure method are described and, specifically, the various types of surgical suture that can be used for wound closure, as well as the strengths and limitations of each. The article explains aspects of patient care that need to be considered such as obtaining informed consent, and the importance of nurses maintaining appropriate clinical skills. It concludes with a step-by-step outline of best practice on how to remove sutures. [ABSTRACT FROM AUTHOR]

Background: Managing recurrent pterygium combined with symblepharon presents significant challenges in ophthalmology. Clinicians aim to reconstruct the ocular surface, alleviate eye movement restrictions, and minimize recurrence risks. Objective: Evaluation of efficacy and safety of continuous blanket sutures (CBS) for fixation of large autologous conjunctival grafts in patients with severe recurrent pterygium with symblepharon. Methods: Retrospective, observational case series. Thirty-nine patients (40 eyes) were included, all with severe recurrent pterygium with symblepharon. During surgery, CBS was employed to affix large autologous conjunctival grafts to the exposed sclera, aiming to restore the ocular surface to smoothness as much as possible. All patients were followed up for more than one year. Main outcome measures include the rate of recurrence, improvement of eye movement, and intraoperative and postoperative complications. Results: Nearly all patients exhibited a smooth ocular surface and largely restored physiological structures during the follow-up period. There were no graft loss or contraction cases until the last follow-up, with only three eyes experiencing a pterygium recurrence (recurrence rate 7.5%, 3/40). Preoperative eye movement limitations improved significantly from 2.10 ± 0.71 (range 1–3) to 0.33 ± 0.53 (range 0–2; p < 0.001) post-surgery. Other postoperative complications included varying degrees of corneal scarring and a single instance of conjunctival granulomatous hyperplasia (1 eye, 2.5%). Conclusion: When addressing severe recurrent pterygium with Symblepharon, using CBS to secure large autologous conjunctival grafts during surgery can achieve favorable postoperative outcomes. This surgical method is safe and feasible and effectively rebuilds a smooth ocular surface, improves the appearance of the ocular surface, and reduces the recurrence rate of pterygium after excision. [ABSTRACT FROM AUTHOR]

Background: Deep inferior epigastric perforator (DIEP) flap breast reconstruction is an increasingly popular technique, but controversy exists regarding the optimal use of closed suction drains (CSD) at the abdominal donor site. This narrative review synthesizes current evidence on CSD application, criteria for placement/removal, and complications in DIEP flap procedures. Alternative techniques and implications for postoperative care are also discussed. Methods: A systematic search was conducted in August 2024 across several databases to identify English language studies related to CSD use in DIEP flap breast reconstruction. Inclusion criteria consisted of original research on aspects such as CSD volume criteria, timing, complications, alternatives like progressive tension sutures, and impact on showering and patient outcomes. References from relevant papers were hand-searched. Results: The review found a lack of consensus on CSD protocols, with drainage volume triggering removal varying widely from 5 mL to 80 mL daily. While CSD may reduce seroma/hematoma formation, earlier removal (≤3 days) did not increase complications and shortened hospital stay. Progressive tension sutures show promise as an alternative, with evidence of comparable or reduced complications and improved recovery versus CSD. The safety of early showering with drains remains unclear. Conclusions: Although CSD aims to minimize postoperative complications, more rigorous randomized trials are needed to establish evidence-based practices for the timing of removal and demonstrate the efficacy of emerging drain-free techniques on patient-centered outcomes. Standardized criteria could reduce practice variability. Further research should also explore the long-term impact of drainage strategies on aesthetic and functional results. [ABSTRACT FROM AUTHOR]

Flexor tendon injury is a common hand trauma that requires surgical repair. The objective was to compare the repaired strength and gliding resistance with a varied number of repair strands and of square knots using a two‐strand‐overhand locking (TSOL) knot. First, isolated suture loops with different number of suture strands and number of closing knots were compared in mechanical strength and failure mode. Then, 90 flexor digitorum profundus (FDP) tendons from turkey digits were used for the tendon repair experiment. Both phases followed a similar 3 × 3 matrix comparing the knot type including TSOL+1SK (square knot), TSOL+2SK, and TSOL+3 SK and repair techniques including two‐, four‐, and six‐strand repairs techniques respectively. The repaired tendons were tested for tendon resistance against pulley (friction), maximum force, force at 2 mm displacement, stiffness, and failure mode. Increasing the number of strands and closing square knots increases the tensile strength and stiffness of flexor tendon repairs and isolated suture loops without a significant effect on tendon friction. An increase in the number of square knots have shown increased strength only in Pennington repair, which correlated with the increased number of knot unraveling, a weak knot failure model. Our data demonstrated that increasing the number of strands is effective for improving the overall strength of tendon repair. When a two‐strand repair is chosen, increasing knot number can improve repair strength. However, the number of knots appears not affecting repair strength in six‐strand repair technique. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate long‐term outcomes of patients treated with posterior medial meniscal root tear (PMMRT) repair through assessment of functional outcome scores and to identify patient surgical and magnetic resonance imaging (MRI) characteristics associated with improved outcomes. Methods: This was a single‐centre, retrospective study evaluating patients who had undergone a PMMR repair using a transtibial suture pullout technique with two locking cinch sutures. This was performed as a follow‐up to previously published 2‐year and 5‐year outcome studies, using the same cohort. All patients from the prior short‐term and midterm studies were invited to participate. Patient‐reported outcome (PROs) scores, including the International Knee Documentation Committee (IKDC) and Lysholm scores, were collected. Previously collected demographic data were updated based on review of the electronic medical record. Patient outcomes were assessed preoperatively, as well as at 2‐year, 5‐year and 8‐year postoperatively. MRI outcome measurements were assessed at 2‐year and 5‐year follow‐ups. All statistical analysis was performed using SPSS version 26. Results: Seventeen patients of the original 18 patients (94.4%) were included in the final analysis. Additionally, three patients who had additional ipsilateral surgery were excluded from the analysis of PROs. The IKDC score significantly increased from 44.7 ± 11.6 at preoperative baseline to 71.2 ± 21.3 at 8‐year post‐operation (p = 0.001). There were no significant differences in IKDC score between 2‐year and 8‐year follow‐ups (p = n.s.) or 5‐year and 8‐year follow‐ups (p = n.s.). The Lysholm score significantly increased from 49.6 ± 7.3 at preoperative baseline to 76.4 ± 17.2 at 8‐year follow‐up (p < 0.001). There was no significant difference in Lysholm scores between 2‐year and 8‐year follow‐ups (p = n.s.) or 5‐year and 8‐year follow‐ups (p = n.s.). A linear regression analysis found that 5‐year IKDC scores were significantly correlated with 8‐year IKDC scores (β = 0.681, p = 0.038). At 8‐year follow‐up, four (23.5%) patients required additional procedures on their operative knee (one total knee arthroplasty conversion). Conclusion: Patients treated with repair of PMMRT had maintenance of clinical outcome improvements at long‐term follow‐up despite worsening MRI outcomes at short‐term and medium‐term follow‐ups. While a high proportion of patients required additional procedures on their operative knee at 8‐year follow‐up, few of these patient's additional procedures were related to failure of their primary surgery. Providers and patients may expect durable clinical outcomes following the repair of PMMRT, irrespective of radiographic appearance. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: According to previous biomechanical studies, the success of meniscus root repair depends on the suture–meniscus interface and optimisation of this procedure seems to be critical. A progressive, reliable and adjustable knot has numerous advantages in meniscal repair since the surgeon can adapt and meticulously tune the final strength of the fixation. We hypothesised that a single passage of one tape at two different points of the posterior meniscal root with a modified Nice knot configuration may allow similar or superior fixation for root repair compared to the cinch stitch suture technique. Methods: Posterior root repair of medial and lateral meniscus was performed on 26 porcine knees. In group (A), two simple cinch stitches were applied, and in group (B), a modified Nice knot was used in a crossmatch configuration. For both groups, two passages through the meniscus with a 2‐mm braided tape were used, and a single transosseous tibial tunnel technique was performed and tested in pull‐out conditions. Results: The modified Nice knot showed an improved biomechanical performance considering the maximum failure load for both the medial (600.7 ± 77.5 N) and lateral (686.1 ± 83.5 N) (p = 0.006) posterior root fixation when compared to a double cinch stitch (558.0 ± 123.9 N) and (629.0 ± 110.2 N) (p = 0.178) for medial and lateral fixation, respectively. The maximum stiffness was also higher for the modified Nice knot configuration for both medial (17.1 ± 1.5 vs. 13.3 ± 1.6 N/mm) and lateral meniscus (20.0 ± 2.6 vs. 13.8 ± 2.3 N/mm), being this difference statistically significative (p = 0.001). Conclusions: The modified Nice knot allowed better adaptation in the pull‐out tests and presented higher fixation strength, stiffness and reproducibility, with lower standard deviation, being at the same time economically advantageous, since only one tape is needed. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate and compare the clinical and radiological outcomes of three different patellar fixation techniques on medial patellofemoral ligament reconstruction (MPFLR) in the treatment of patellar dislocation (PD). Methods: Between 2015 and 2020, 130 patients with recurrent PD who underwent surgical reconstruction were eligible for this retrospective study: 48 patients were treated with the semi‐tunnel bone bridge fixation technique (Group A), 42 patients were treated with the suture anchor fixation technique (Group B) and 40 patients were treated with the transpatellar tunnel fixation technique (Group C). Clinical outcomes included functional outcomes (Kujala, Lysholm and International Knee Documentation Committee scores), activity levels (Tegner activity score and return to sports), physical examinations, patellar re‐dislocation rate and complications. Radiological outcomes included patellar congruence angle, patellar tilt angle, lateral patellar translation and lateral patellar angle. Results: All clinical and radiological outcomes improved significantly in all groups, without any significant difference among these three groups. At the final follow‐up, no re‐dislocation occurred, and all groups achieved a successful return to sports. However, the semi‐tunnel bone bridge and suture anchor fixation techniques showed statistically higher Tegner activity scores (p = 0.004) and shorter time from surgery to return to sports (p = 0.007) than the transpatellar tunnel fixation technique. Conclusion: The three MPFLR patellar fixation techniques achieved favourable and comparable clinical and radiological outcomes in the treatment of PD. Compared with the transpatellar tunnel fixation technique, the semi‐tunnel bone bridge and suture anchor fixation techniques may be more effective with higher activity levels. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

• High level of agreement on the OASIS classification system. • High level of agreement on immediate management such as the site, choice of suture material, and need for adequate analgesia during the OASIS repair. • Differences in the recommended timing of OASIS repair, involvement of specialists, and use of prophylactic antibiotics. • Considerable variability in post-operative care and follow-up practices. To review and compare existing guidelines on the intrapartum management and postpartum follow-up of obstetric anal sphincter injuries (OASIS) We conducted a systematic review of clinical guidelines related to OASIS management, focusing on intrapartum care and postpartum follow-up. Searches were performed in July 2024 across multiple databases, including PubMed, Embase, and the Cochrane Library. Guidelines published after 2010 in English were included. Nine national guidelines were included. There was a consensus on OASIS classification and immediate management, particularly regarding suture techniques, materials, and the necessity of adequate analgesia. However, notable variations were identified in the timing of repair, specialist involvement, use of prophylactic antibiotics, and post-operative care protocols. Postpartum follow-up practices also varied, especially regarding the role of physiotherapy and the timing of specialist consultations, reflecting inconsistencies in long-term care recommendations. Significant variability existed in the guidelines for the management and follow-up of OASIS, particularly in postpartum care. This study underscored the need for standardized, evidence-based guidelines to ensure consistent and optimal care for women affected by OASIS. [ABSTRACT FROM AUTHOR]

Background/aim: Cesarean section (CS) is a widely performed operation worldwide but data about uterine closure are lacking. We aimed to evaluate scar niches and compare single-layer and double-layer uterine closure at 6 months following CS. Materials and methods: This prospective randomized trial assessed 56 women undergoing single- or double-layer uterine closure. None of the patients had previous uterine surgery and all CS cases were elective. Transvaginal ultrasound was performed 6 months after CS to assess the uterine scars by measuring the width, depth, and length of the scar niche and residual myometrial thickness. An experienced sonographer was blinded to the uterine closure technique and the ultrasounds were conducted by practitioners unaware of the technique in the postoperative follow-up appointments. Results: Twenty-eight women were assigned to the single-layer closure group (Group 1) and 28 were assigned to the double-layer closure group (Group 2). The demographic and clinical characteristics of patients and the width, depth and diameter of the niche were similar between the groups, as was residual myometrial thickness. There was no difference in uterine scar volume under the incision between the two groups. The duration of surgery was approximately 5 min longer (p = 0.048) and hemoglobin decrease was about 0.5 g/dL less (p = 0.039) in the double-layer group compared to the single-layer group. Postmenstrual spotting rates were similar between the groups. Group 1 had two and Group 2 had one spontaneous pregnancy within 6 months after CS. Conclusion: The single- and double-layer closure techniques do not produce different impacts on CS niche features at 6 months after delivery. Ultrasound might be an important noninvasive diagnostic tool for understanding CS scar remodeling. [ABSTRACT FROM AUTHOR]

Lateral meniscus posterior root tears (LMPRTs) are radial tears that occur within 10 mm of the posterior root tibial connection, also known as lateral meniscus posterior root avulsions. A common surgical approach for LMPRT (2) that contributes to positive biomechanical outcomes is independent transtibial pullout repair.(6,7,8) If this treatment is performed on people who need both LMPRT repair and ACL restoration, an extra tibial tunnel is required. The installation of a tibial tunnel increases surgical challenges and lengthens operation time, as well as the danger of iatrogenic damage to the normal architecture of the knee. To circumvent these drawbacks, we have developed a novel technique for intra-tunnel LMPRT repair using a knotless anchor construct at the upper posterior edge of the tibial tunnel. A stab incision is made to create the standard antero lateral portal and after introducing the trochar and the scope, a round of diagnostic arthroscopy is performed and the posterior root of lateral meniscus tear is identified. After creating an anteromedial portal, With help of 1 fiber tape, a loaded bite is taken with the help of a first pass mini device (Smith & Nephew), via the antero medial portal, deep into the posterior root (around 5 mm), using a self winching technique, and reduction of the LMPRT is checked. The position for the anchor entry is visualized in the superior edge of the tibial tunnel along its posterior wall, and the tapes are passed through the knotless anchor extra-articulately outside the AM portal. Thereafter, the anchor is shuttled in through the AM portal and punched in the footprint on the posterior-superior edge of the tibial tunnel with visualization of the reduction of the LMPR to the footprint. This technique offers a simple solution to a complex problem in the form of a simple procedure. This technique is a good choice when a tear of the posterior root of the LM occurs. [ABSTRACT FROM AUTHOR]

Background: The Endoscopic Purse-string Suture (EPSS) technique has gained attention for its potential in closing large defects following gastrointestinal procedures. However, its application in fistula closure is not as widely reported. This study aims to evaluate the safety and efficacy of EPSS and naso-jejunal tube feeding in the closure of duodenal cutaneous fistulas and gastric cutaneous fistulas. Methods: This single-center retrospective study, conducted from September 2020 to September 2023 at Tongji University in Shanghai, China, examined the outcomes of EPPS and nasojejunal feeding for patients with gastric and duodenal cutaneous fistulas (n = 10). Demographic data, fistula characteristics, procedure technique and outcomes were evaluated. Results: In this study, the average size of a fistula opening was 7.9 ± 4.6 mm. The operations took an average of 25.8 ± 5.6 min. Patients typically needed naso-jejunal tube feeding for a median of 14.0 days, with an interquartile range (IQR) of 7.7–19.0 days. The median duration of hospital stay post-operation was 16.5 days, with an IQR of 7.0–25.0 days. Nine patients were successful in their initial fistula closure using the EPSS technique. The other patient underwent a second EPSS and, ultimately, all patients experienced complete healing and fully recovered. There were no major adverse events reported. Conclusions: EPSS and naso-jejunal tube feeding are a safe and effective treatment option for duodenal and gastric cutaneous fistulas. Larger, prospective studies are needed to validate these findings and establish the long-term safety and efficacy of this approach. [ABSTRACT FROM AUTHOR]

Background: Hiatal and paraesophageal hernia (HH/PEH) recurrence is the most common cause of failure after gastroesophageal anti-reflux surgery. Crural reinforcement with mesh has been suggested to address this issue, but its efficacy remains debated. In this study, we aimed to determine the impact of biosynthetic mesh reinforcement compared to suture cruroplasty on anatomic and symptomatic hernia recurrence. Method: Data of patients who underwent robotic HH/PEH repair with suture cruroplasty with or without biosynthetic mesh reinforcement between January 2012 and April 2024 were retrospectively reviewed. Gastroesophageal reflux disease symptoms and anatomic hernia recurrence were assessed at short-term (3 months to 1 year) and longer-term (≥ 1 year) follow-up. Symptomatic hernia recurrence was defined as having both anatomic recurrence and symptoms. Results: Out of the 503 patients in the study, 308 had undergone biosynthetic mesh repair, while 195 had suture-only repair. After the surgery, both groups demonstrated comparable improvements in symptoms. Short-term anatomic hernia recurrence rates were 11.8% and 15.6% for mesh and suture groups, respectively (p = 0.609), while longer-term rates were 24.7% and 44.9% (p = 0.015). The rates of symptomatic hernia recurrence in the same group were 8.8% and 14.6% in the short-term (p = 0.256), and 17.2% and 42.2% in longer-term follow-ups (p = 0.003). In the repair of medium and large-size hernias, mesh reinforcement resulted in a 50.0% relative risk reduction in anatomic hernia recurrences and a 59.2% reduction in symptomatic hernia recurrences at ≥ 1-year follow-up. Conclusion: After more than a year of follow-up, it has been found that using biosynthetic mesh for medium and large hiatal or paraesophageal hernia repair significantly reduces the likelihood of both anatomic and symptomatic recurrence compared to using only suture cruroplasty. These findings strongly support the use of biosynthetic mesh to manage larger hernias. However, further long-term multicenter randomized studies are needed to provide more conclusive evidence. [ABSTRACT FROM AUTHOR]

Background: Percutaneous endoscopic gastrostomy is commonly used for enteral nutritional access, but gastrocutaneous fistulae (GCF) may persist after tube removal, posing clinical challenges. The use of endoscopic closure devices, including over-the-scope clips (OTSC), has shown promise in managing non-healing fistulae, although data in the pediatric population are limited. Methods: A retrospective multicenter study analyzed pediatric patients who underwent GCF closure following gastrostomy tube removal. Data from seven centers across multiple countries were collected, including patient demographics, procedural details, complications, and outcomes. Closure techniques were compared between OTSC and surgical closure. Results: Of 67 pediatric patients included, 21 underwent OTSC closure and 46 had surgical closure. Surgical closure demonstrated a higher success rate (100%) compared to OTSC closure (61.9%, P < 0.001). While procedural duration was shorter for OTSC closure (25 vs. 40 min, P = 0.002), complications, and scar quality were comparable between techniques. A subsequent sub-analysis did not reveal differences based on center experience. Conclusion: OTSC closure is feasible and safe in pediatric patients, but surgical closure remains superior in achieving sustained GCF closure, although OTSC offers benefits, such as shorter procedural duration, potentially reducing the duration of general anesthesia exposure. Non-operative approaches, including OTSC, may be a valuable alternative to surgical closure. [ABSTRACT FROM AUTHOR]

Objectives: Endoscopic hand suturing (EHS) is a novel technique for closing a mucosal defect after endoscopic submucosal dissection (ESD). We investigated the technical feasibility of colorectal EHS using a modified flexible through‐the‐scope needle holder. Methods: This was a prospective multicenter study conducted at two referral centers between June 2022 and April 2023. This study included colorectal neoplasms 20–50 mm in size located in the sigmoid colon or rectum. A modified flexible through‐the‐scope needle holder, with an increased jaw width to facilitate needle grasping, was used for colorectal EHS. The primary end‐points were sustained closure rate on second‐look endoscopy (SLE) performed on postoperative days 3–4 and suturing time for colorectal EHS. Secondary end‐points included complete closure rate and delayed adverse events. Results: We enrolled 20 colorectal neoplasms in 20 patients, including four patients receiving antithrombotic agents. The tumor location was as follows: lower rectum (n = 8), upper rectum (n = 2), rectosigmoid colon (n = 4), and sigmoid colon (n = 6), and the median mucosal defect size was 37 mm (range, 21–65 mm). The complete closure rate was 90% (18/20 [95% confidence interval (CI) 68.3–98.8%]), and the median suturing time was 49 min (range, 23–92 min [95% CI 35–68 min]). Sustained closure rate on SLE was 85% (17/20 [95% CI 62.1–96.8%]). No delayed adverse events were observed. Conclusion: EHS demonstrated a high sustained closure rate. Given the long suturing time and technical difficulty, EHS should be reserved for cases with a high risk of delayed adverse events. [ABSTRACT FROM AUTHOR]

With the alarmingly increasing prevalence of obesity in the Western world, it has become necessary to provide more acceptable treatment options for patients with obesity. Minimally invasive endoscopic techniques are continuously evolving. Currently, metabolic and bariatric endoscopies encompass several different techniques that can offer significant weight loss and improvement in comorbidities with a favorable safety profile. Restrictive bariatric procedures include the use of intragastric balloons and gastric remodeling techniques with different suturing devices. Several studies have demonstrated the efficacy and safety of these techniques that are widely used in clinical practice. Small intestine-targeted metabolic endoscopy is an intriguing and rapidly evolving field of research, although it is not widespread in routine practice. These techniques include duodenal-jejunal bypass liners, duodenal mucosal resurfacing, and incisionless anastomoses. The aim of this review article is to provide a detailed update on the currently available bariatric endoscopy techniques in Western countries. [ABSTRACT FROM AUTHOR]

Background: Injuries to the glenoid labrum have been recognized as a source of joint pain and discomfort, which may be associated with the inflammatory responses that lead to the deterioration of labral tissue. However, it is unclear whether the torn labrum prompts mast cell (MC) activation, resulting in synovial inflammatory responses that lead to labral tissue degeneration. Purpose: To determine the potential influence of activated MC on synovial inflammatory responses and subsequent labral tissue degeneration and shoulder function deterioration in a rat model by monitoring MC behavior and sequential inflammatory responses within the synovial tissue and labral tissue after injury, suture repair, and MC stabilizer administration. Study Design: Controlled laboratory study. Methods: Anteroinferior glenoid labral tears were generated in the right shoulder of rats (n = 20) and repaired using a tunneled suture technique. Synovial tissue inflammatory responses were modulated in some rats with intraperitoneal administration of an MC stabilizer—cromolyn (n = 10). At weeks 1 and 3, MC activation, synovial inflammatory responses, and labral degeneration were histologically evaluated. Simultaneously, gait analysis was performed before and after surgical repair to assess the worsening of the shoulder function after the injury and treatment. Results: Resident MC degranulation after labral injury (50.48% ± 8.23% activated at week 1) contributed to the initiation of synovial tissue inflammatory cell recruitment, inflammatory product release, matrix metalloproteinase-13, and subsequent labral tissue extracellular matrix degeneration. The administration of cromolyn, an MC stabilizer, was found to significantly diminish injury-mediated inflammatory responses (inflammatory cell infiltration and subsequent proinflammatory product secretion) and improve shoulder functional recovery. Conclusion: MC activation is responsible for labral tear–associated synovial inflammation and labral degeneration. The administration of cromolyn can significantly diminish the cascade of inflammatory reactions after labral injury. Clinical Relevance: Our findings support the concept that MC stabilizers may be used as a complementary therapeutic option in the treatment and repair of labral tears. [ABSTRACT FROM AUTHOR]