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This study is aimed to investigate the types of knot failure (untying or breaking) and the tension required to break different suture diameters. A total of 150 knots were fabricated using polyamide sutures with diameters of 6/0, 7/0, and 8/0. The studied knots were either squared or slipped with different numbers of throws (2, 3, 4, 5, and 6), and the following data were recorded: type of failure (untied or broken), number of throws, the tension required to untie or break each knot, slippage, and elongation of the knot. The knots were created in a standardized way with a device and weights, then subjected to a controlled tension. The knots that became untied were: 1=1, 1×1, 2=1, and 2×1, whereas the remaining knots broke. Notably, at least three throws were required to prevent untying, but separately, as in 1=1=1 or 1×1×1. The mean tension needed to break the knots in 6/0, 7/0, and 8/0 sutures were 3.1, 1.3, and 0.6 N, respectively (P < .05), and they were independent of the knot type. The results from this study demonstrate that the knots with geometries of 2=2/2×2 and 1=1=1/1×1×1 were secure, and having additional throws does not increase their security. Further, tensile strength reduces with decreased suture size. [ABSTRACT FROM AUTHOR]

Purpose: To present a sling suture technique used to stabilize a collagen membrane against the lateral bone window to improve bone substitute stability inside the sinus cavity. Materials and Methods: Maxillary sinus floor augmentation was performed on 17 patients (8 women and 9 men; mean age 58.2 years) using a lateral approach with the sling suture technique to maintain a collagen membrane against the lateral bone window. Postoperative CBCT images were captured at 6-month follow-up of each patient to monitor the bone graft stability at the level of the lateral antrostomy. Clinical postoperative pain and swelling were assessed via visual analog scale (VAS) questionnaire, measured from level 1 (low) to level 5 (acceptable) to level 10 (high) at 1 week postoperative. Results: No bone substitute displacement was observed in any clinical cases on the CBCT images at 6 months postoperative. The pain and swelling levels observed 1 week postoperatively were significantly low (mean ± SD; 1.6 ± 1.0 and 2.1 ± 0.9, respectively). Conclusions: The use of the sling suture technique to maintain a barrier membrane at the level of the lateral bone window in cases of maxillary sinus floor augmentation using a lateral approach is a predictable protocol to prevent bone substitute displacement outside the sinus cavity. [ABSTRACT FROM AUTHOR]

The aim of this report is to describe a new sling suturing method with papillary anchorage that is clinically applicable within the available conventional root-coverage tunneling procedures. Although caution is advised to not increase excessive tension on the fragile papilla tips, as they provide coronal and palatal suspension, the tension used with this method ascertains a firm and stable connection for the entire buccogingival graft complex into the horizontal and vertical dimensions of both single and multiple recession defects. This technical note describes the "trapezoidal sling suture" technique, which allows fixation and stabilization for the graft and flap around both natural teeth and implants. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of sinus membrane stabilization (via suturing) and dental implant placement on the endo-sinus bone formation in lateral sinus elevations performed without grafting. Materials and Methods: Maxillary sinus elevation surgery using the lateral approach was performed bilaterally on 30 New Zealand white rabbits. The maxillary sinus areas were divided into control and test groups. In the control group, a titanium screw was placed after sinus membrane elevation; in the test group, the sinus membrane was sutured to the lateral walls, and a titanium screw was placed in the center of the alveolar crest. The subjects were sacrificed at 4 and 8 weeks. Then samples were collected, and a microcomputed tomography (micro-CT) analysis was performed. In addition, the volume of newly formed bone, percentage of osseointegration, sinus volume, residual bone height, and implant protrusion length were measured using micro-CT analysis. Results: The sinus volume, volume of newly formed bone, and percentage of osseointegration in the test group were significantly higher than in the control group at 4 weeks (P = .01, P = .04, P = .02, respectively). While the volume of newly formed bone was 17.1 ± 3.08 mm3 in the control group, it was 26.9 ± 14.26 mm3 in the test group at 4 weeks. The volume of newly formed bone significantly decreased from 26.9 ± 14.26 mm3 to 17 ± 3.66 mm3 at 8 weeks (P = .02). No significant difference in residual bone height was found at 4 and 8 weeks (P = .07). No significant difference in implant protrusion length was found between the control and test groups (P = .18). Protrusion length and new bone formation in the sinus showed a negative relationship (P = .01). Conclusions: Suturing the sinus membrane to the lateral sinus wall is an effective approach for increasing osseointegration, bone volume, and sinus volume in the short term. A slow-absorbing suture material can be used to maintain sinus and bone volumes in the long term. [ABSTRACT FROM AUTHOR]

Background: Selective suture removal has been demonstrated to be effective in reducing post-keratoplasty astigmatism, while the remaining sutures are left in place. Existing studies typically focus on outcomes immediately after selective suture removal, without delving into the final suture-out keratometric astigmatism. Objectives: To examine the impact of selective suture removal on corneal graft astigmatism following keratoplasty in keratoconus and identify potential factors associated with the changes in graft astigmatism after suture removal. Design: Retrospective, comparative interventional case series. Methods: The study included 118 consecutive eyes of 118 cases that underwent corneal transplantation for keratoconus and had a keratometric astigmatism of ⩾4 D. One or two interrupted sutures corresponding to the steep meridian were removed per session. Patients were re-evaluated at 1 to 2-month intervals, repeating the procedure until achieving a keratometric astigmatism of <4.0 D or no interrupted sutures remained in the steep meridian. Results: The mean recipient age was 28.4 ± 8.4 years. A total of 234 selective suture removals were performed, with a mean of 2.0 ± 1.1 removals per eye. Pre-suture removal keratometric astigmatism significantly decreased from 6.3 ± 2.0 D to 3.91 ± 2.23 D after the completion of selective suture removal (p < 0.001). This value was significantly increased to 5.45 ± 2.93 D after all suture removal (p < 0.001). Higher pre-suture removal astigmatism and deep anterior lamellar keratoplasty were associated with a more favorable response to selective suture removal. Conclusion: Selective suture removal effectively modifies graft curvature to reduce post-keratoplasty astigmatism in keratoconus patients. However, its efficacy markedly diminishes after all sutures are removed. This procedure is particularly effective in patients with higher pre-suture removal astigmatism and those undergoing deep anterior lamellar keratoplasty. Plain language summary Selective suture removal after keratoplasty Selective suture removal has been demonstrated to be effective in reducing post-keratoplasty astigmatism, while the remaining sutures are left in place. Existing studies typically focus on outcomes immediately after selective suture removal, without delving into the final suture-out keratometric astigmatism. The efficacy of selective suture removal markedly diminishes after all sutures are removed. Higher pre-suture removal astigmatism and deep anterior lamellar keratoplasty predict more favorable response to selective suture removal. [ABSTRACT FROM AUTHOR]

Introduction: The inability to sense force applied to tissue is suggested as a limitation to robotic-assisted surgery (RAS). This pre-clinical study evaluated the impact of a novel force feedback (FFB) technology, integrated on a next-generation robotic system that allows surgeons to sense forces exerted at the instrument tips, on suturing performance by novice surgeons during RAS. Methods: Twenty-nine novice surgeons (< 50 RAS cases in the last 5 years) were randomized into two groups with (n = 15) or without (n = 14) FFB sensing. Participants performed interrupted stitches on ex vivo porcine bladder and running stitches on porcine aorta (Fig. 1A) over four runs. Average forces applied, number of errors, time for exercise completion, and Robotic Anastomosis Competence Evaluation (RACE) technical skill ratings were compared using a three-way mixed-model ANOVA and applicable post hoc tests. Results: FFB sensing significantly lowered the mean force applied (bladder, 1.71 N vs 2.40 N, p < 0.006; aorta, 1.80 N vs 2.53 N, p < 0.006), average number of errors (bladder, 0.59 vs 1.76, p < 0.001; aorta, 0.38 vs 1.14, p < 0.001), and the time to completion (bladder, 659 s vs 781 s, p = 0.002; aorta, 460 s vs 570 s, p = 0.001) (Fig. 1C). The FFB group applied less tissue trauma with a higher RACE skill score (3.75 vs 3.03, p = 0.012). Conclusion: This study showed that novice surgeons using FFB-enabled instruments completed suturing tasks using less force, with fewer errors, taking less time, and less tissue trauma during RAS. Future studies are required to better understand the impact of FFB technology on surgical performance and potential patient benefits. [ABSTRACT FROM AUTHOR]

BACKGROUND: Surgeons face numerous choices in selecting sutures for skin closure, with potential adverse effects such as tissue tearing. OBJECTIVE: To investigate the influence of needle design and suture gauge on tissue tearing during suturing procedures. MATERIALS AND METHODS: The authors tested the tear-through force in Newtons for 3 needle types and 3 suture gauges using an artificial skin model and a professional-grade tensiometer. Suture material was secured into the skin model, and force was applied to the suture at a constant rate, resulting in tearing. Force–displacement and force–time curves were generated. Evaluation included conventional cutting (PC-3), reverse cutting (PS-3), and taper point (BB) needles with a 5-0 polypropylene suture. In addition, nylon sutures with a reverse cutting needle (PS-2) were tested at 3 suture gauges (5-0, 4-0, 3-0). RESULTS: The mean tear-through forces for PC-3, PS-3, and BB were 3.26 N, 3.75 N, and 4.07 N, respectively. For the 5-0, 4-0, and 3-0 nylon sutures, the mean tear-through forces were 3.44 N, 3.81 N, and 4.04 N, respectively. Statistical analysis revealed a significant impact of suture gauge size (p <.001) and needle geometry (p <.001) on tear-through force. CONCLUSION: Larger suture diameter and taper needles minimize tissue tearing. [ABSTRACT FROM AUTHOR]

Purpose: The primary objective of this study was to investigate the possible role and assess the potential relationship of speculum use during phacoemulsification surgery in the occurrence of blepharoptosis. Methods: Our study is a prospective observational design to analyze patients who underwent phacoemulsification surgery under topical anesthesia between October 2017 and May 2018 at a tertiary eye hospital in South India. All patients had their Margin Reflex Distance 1 (MRD1), levator palpebrae superioris (LPS) function, and lid crease distance (LCD) measured before and after surgery on day one, one month, three months, and six months to evaluate the extent of ptosis at each time point that was recorded clinically and photographic documentation for accurate evaluation. Results: Out of the 221 patients who participated in the study, a total of 250 eyes were examined. On postoperative day one, 34 patients (15.8% with a rigid speculum and 11.4% with a non-rigid speculum) developed ptosis. At the one-month follow-up, ptosis persisted in four patients, with one patient having undergone surgery using a rigid speculum and the rest of three patients with a non-rigid speculum. However, further follow-ups at three and six months revealed a complete resolution of ptosis in all cases, indicating that the ptosis was transient and resolved spontaneously. Conclusion: Speculum use cannot be considered as the sole causative factor for postoperative ptosis, as a multitude of other modifiable factors, such as superior rectus bridle suturing, anesthetic approach, prolonged patching, and duration of surgery, may have an additive effect alongside speculum used in the development of postoperative ptosis. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to conduct an updated survey of American Society for Surgery of the Hand (ASSH) membership to evaluate current preferences for surgical management of thumb CMC arthritis. Past surveys have demonstrated LRTI to be the most preferred surgical technique. We hypothesised that current surgical preferences for thumb CMC arthritis have changed over the last several years due to rising popularity of high-strength suture implants. Methods: A 22-question survey inquired about the preferences for the surgical management of basal joint arthritis and was sent to the ASSH membership. Descriptive statistics were calculated on all survey questions. Chi-squared analysis was used to compare differences in thumb CMC arthroplasty preferences across respondents. Results: A total of 1,499 responses were available for analysis, yielding a response rate of 29.9%. For surgical management of basal joint arthritis in the primary setting, the largest percentage of respondents preferred open trapeziectomy with suture suspension arthroplasty (39.2%); amongst them, over half (56%) used a high-strength suture implant. This was followed by open trapeziectomy with LRTI (38.3%). In the revision setting, most respondents preferred open trapeziectomy with suture suspension arthroplasty (53.5%), followed by LRTI (24.6%). In determining the choice of procedure, respondents felt some form of metacarpal suspension and implant cost to be more important factors than ligament reconstruction and interposition. A higher proportion of international members (16.2%) utilised implant arthroplasty than US/Canadian members (1.1%; p < 0.01). Conclusions: Past surveys have demonstrated LRTI to be the most preferred surgical technique. The current survey demonstrates open trapeziectomy and suture suspension arthroplasty, especially using high-strength suture implants, gaining popularity amongst surgeons, while open trapeziectomy and LRTI decreasing in preference. Suture suspension arthroplasty is now the preferred surgical technique in both the primary and revision setting. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Injuries to the ulnar collateral ligament (UCL), have become increasingly prevalent among overhead-throwing athletes, especially baseball pitchers. From 2011 to 2023, UCL injuries were the most common injury in Major League Baseball (MLB). Contributing factors include high pitching velocity, fatigue, overuse, and year-round pitching. Research indicates that 25% of MLB pitchers and 14% of Minor League pitchers have undergone UCL surgery, with these numbers steadily rising. After traditional UCL reconstruction, 83% of athletes return to the same or higher levels of play. While the success rate for UCL surgery is high, revision surgeries are becoming more frequent, with mixed outcomes. This underscores the need for improved surgical techniques and rehabilitation strategies. The hybrid UCL reconstruction technique presents a reliable and effective solution for treating UCL injuries, combining the benefits of autogenous grafting with internal brace augmentation. Current research, however, lacks focus on the surgical technique and rehabilitation following UCL hybrid surgery. Achieving successful outcomes with this procedure relies on a collaborative approach, from surgery to rehabilitation with adherence to the rehabilitation protocol and throwing program. Full recovery typically requires 12-14 months, depending on the athlete's level of play. With over 400 successful surgeries to date, this technique has proven to enhance stability and facilitate recovery, particularly in elite-level throwing athletes. The purpose of this paper is to describe this new surgical technique and its associated rehabilitation programs, emphasizing the importance of rehabilitation under the guidance of a rehabilitation professional experienced with overhead athletes. Level of Evidence: 5 [ABSTRACT FROM AUTHOR]

This study aims to assess the therapeutic efficacy of a modified arthroscopy discopexy suturing technique in combination with an anterior disc repositioning splint (ARS) for the treatment of early phase anterior disc displacement without reduction (ADDwoR) patients. During 2021–2022, early phase ADDwoR cases were included and underwent modified arthroscopy discopexy suturing surgery and ARS therapy after surgery. Pre- and post-surgical evaluation parameters include the visual analogue scale (VAS) for pain, maximum mouth opening (MMO), and disc-condyle relationship on MRI. Patients were followed up for a period of 6 months after surgery. Statistical significance was considered when p < 0.05. A total of 31 unilateral early phase ADDwoR cases were included, with an average age of 26.97. The VAS scores of pain decreased from 4.87 to 1.61, while MMO increased from 23.13 mm to 39.35 mm(p < 0.05). MRI evaluations at 1 month and 6 months post-surgical revealed a disc reduction rate of 93.55% and 90.32%, respectively. The modified arthroscopy discopexy suturing technique combined with ARS therapy after surgery proves to be an effective, minimally invasive and simplified approach for the treatment of early phase ADDwoR patients. [ABSTRACT FROM AUTHOR]

In laparoscopy, the absence of ergonomics in the instruments affects the performance and efficiency of the surgeon, increasing the likelihood of developing musculoskeletal injuries. This article presents the development of a laparoscopic needle holder with an ergonomic handle and the experience in its use with surgeons in the intracorporeal suturing task. The handle of the laparoscopic needle holder consists of a semi-spherical piece that easily adapts to the palm of the surgeon's hand and improves the posture and ergonomics of the wrist, allowing the direct transmission of rotational movements around the longitudinal axis of the instrument towards the tip. Moreover, a spring-loaded mechanism allows the tip of the tool to be opened and closed in a normally closed configuration, with enough pressure to hold different surgical needles. Twenty-two pediatric surgery surgeons and residents, without upper extremity musculoskeletal disorders, participated in this study. Each participant performed the intracorporeal suturing task using two laparoscopic needle holders (conventional and with ergonomic handle) in a laparoscopic simulator. Motion data from both instruments were captured and the performance was assessed by means of 16 motion analysis parameters (MAPs). The performance of the residents improved markedly using the laparoscopic needle holder with ergonomic handle, obtaining statistically significant differences in 10 MAPs evaluated. The comparison of the results of each instrument showed that this ergonomic laparoscopic needle holder stood out over the conventional tool, improving psychomotor skills and the ability to control the angular position and rotational movements of the instrument on its own axis, indispensable for intracorporeal suturing. The innovative design of the laparoscopic needle holder with ergonomic handle allows for better transfer of rotational movements from the surgeon's hand directly with the longitudinal axis to the tip, reducing extreme wrist positions and excessive effort to open and close the tip of the instrument during intracorporeal suturing. [ABSTRACT FROM AUTHOR]

Background: The anterior vaginal wall is frequently affected by prolapse, which is frequently treated with anterior colporrhaphy. However, this repair has a high recurrence rate, and no standardized approach exists. Our study aimed to compare two suture techniques concerning postoperative outcomes. Methods: This randomized, single-center trial involved patients with symptomatic pelvic organ prolapse, assigned to either continuous or interrupted stitches during anterior repair. The primary outcome was subjective symptom improvement, assessed by the German pelvic floor questionnaire 6–12 months post-surgery. Secondary outcomes included anatomical results and surgery-related adverse events per Clavien–Dindo classification (CDC). A total of 42 patients were analyzed to achieve 80% study power. Results: No significant differences were found in the pelvic floor scores between the two groups, but both groups showed significant improvements in prolapse and all other domains assessed by the questionnaire. None of the patients reported a recurrence of symptoms or required re-treatment during the follow-up visits. In patients with continuous stitches, significantly more CDC 2 and fewer CDC 1 events were noticed. The baseline prolapse stage, prolapse domain scores, age, and the stitching technique did not significantly influence the treatment success. Conclusions: We were able to demonstrate that both suture techniques are comparable and effective in improving subjective symptoms after anterior colporrhaphy, with no significant difference in outcomes between the two methods. The choice of stitching technique did not impact the recurrence of symptoms or the need for reoperation. [ABSTRACT FROM AUTHOR]

Background: Superficial temporal artery (STA)-middle cerebral artery (MCA) side-to-side microvascular anastomosis can achieve the same clinical effects as traditional STA-MCA end-to-side anastomosis in extracranial-intracranial revascularization surgery, furthermore, STA-MCA side-to-side anastomosis has the lower risk of postoperative cerebral hyperperfusion syndrome (CHS) and the potential to recruit all scalp arteries as the donor sources via self-regulation. Therefore, STA-MCA side-to-side microvascular anastomosis seems to be a revascularization strategy superior to traditional STA-MCA end-to-side anastomosis. In this study, we presented seven cases in which a STA-MCA side-to-side microvascular anastomosis was performed with a 4–5 mm long arteriotomy using the in-situ intraluminal suturing technique. Methods: Superficial temporal artery (STA)-middle cerebral artery (MCA) side-to-side anastomosis was performed in seven patients using the in-situ intraluminal suturing technique. Results: The diameters of the recipient MCA and the donor STA were approximately 0.94 mm (range 0.8–1.4 mm) and 1.65 mm (range 1.4–2.0 mm), respectively, and the length of the arteriotomy was approximately 4.71 mm (range 4–5 mm). The MCA was temporarily occluded in approximately 25.00 min (range 20–29 min). 100% patency rates of the STA-MCA microvascular anastomosis were achieved in all patients. No obvious CHS was recorded. Intraoperative Indocyanine green videoangiography (ICG-VA) and postoperative digital subtraction angiography (DSA) demonstrated three different blood flow distribution patterns after the STA-MCA side-to-side anastomosis, the donor MCA received not only antegrade blood flow from the proximal preanastomotic STA but also retrograde blood flow from the distal postanastomotic STA in one case; the donor MCA received all the antegrade blood from the proximal STA without retrograde blood flow from the distal STA in two case; whereas, the recipient MCA territories received only partial antegrade blood flow from the proximal preanastomotic STA. Conclusions: STA-MCA side-to-side microvascular anastomosis with a 4–5 mm long arteriotomy using the in situ intraluminal suturing technique is a safe and effective revascularization surgery, and the anastomosis can serve as a shunt for blood flow self-regulation. [ABSTRACT FROM AUTHOR]

Background: Total laparoscopic hysterectomy (TLH) is nowadays the standard to treat benign and malignant disease occurring in the uterus, but the number of robotic-assisted surgeries is increasing worldwide. To facilitate the handling of sutures in a bi- and tri-dimensional plane, a new type of suture material has been developed, named barbed sutures, which are in use in different indications. In comparison to conventional suture materials, the barbs anchor the suture in the tissue, provide tissue approximation and prevent slippage without the need for knot tying. Several meta-analyses and systematic reviews have shown that they are safe and efficient. The current study investigates the clinical outcome of a novel unidirectional mid-term absorbable barbed suture which differs in its configuration from other barbed sutures. The collected data will be prospectively compared to the results of a competitor's unidirectional mid-term absorbable barbed suture and retrospectively to the findings reported for conventional sutures after hysterectomy in the literature. Methods: An international, randomised, multicentric, single-blinded design was chosen. A total of 132 patients will be included receiving randomly either the novel unidirectional barbed suture versus the competitor unidirectional barbed suture in a 3:1 ratio. Both suture materials will be applied to close the vaginal cuff after laparoscopic hysterectomy and the time for suturing is the primary endpoint. As secondary objectives, the following parameters will be collected and compared in both suture groups: intraoperative handling of the suture material, quality of life using the Female Sexual Function Index (FSFI), patient satisfaction, pain, and complications occurring in the short-term and long-term follow-up. For each patient, the study lasts 6 months after surgery. Discussion: This study will assess the clinical performance of a novel unidirectional mid-term absorbable barbed suture material for the first time in gynaecology surgery and, to our knowledge, it will be the second largest RCT performed so far in total laparoscopic hysterectomy using unidirectional mid-term absorbable barbed suture materials. Trial registration: The study was prospectively registered before the enrolment of the first patient. Registration was performed under www.clinicaltrials.gov, NCT 06024109. Registered on 15 August, 2023. [ABSTRACT FROM AUTHOR]

Introduction: Pharyngocutaneous fistula (PCF) is the most common complication following total laryngectomy (TL). The factors contributing to its occurrence are still a matter of debate. The impact of suture type has been relatively underexplored. This study aimed to analyze the risk factors associated with PCF and understand how the type of suture influences PCF characteristics. Materials and Methods: An observational study encompassing all TL procedures was performed between 2005 and 2022 at a secondary care hospital. Sociodemographic and clinical variables widely studied in the literature to identify PCF risk factors were considered. Additionally, the characteristics of fistulas were examined to assess the influence of the suture type. Results: Seventy TL cases were included. The incidence of PCF was 56.0%. Identified risk factors for PCF included pharyngeal closure type (p=0.001) (RR=13.09), nutritional support type (p=0.001) (RR=13.54), the need for reintervention due to postoperative bleeding (p=0.001) (RR=1.13), and the need for blood transfusion after surgery (p=0.015) (RR=1.20). Regarding the suture type, Modified Connell Suture (MCS) was associated with a later onset of fistula (p=0.014), shorter hospital stay (p=0.001), and early initiation of oral feeding (p=0.009). Conclusion: PCF occurrence is associated with nasogastric tube use, Lambert closure, postoperative bleeding, and reintervention for bleeding after TL. Moreover, MCS sutures are linked to a shorter hospital stays and early initiation of oral feeding. [ABSTRACT FROM AUTHOR]

OBJECTIVE To compare the stability, ultimate strength, and isometry of 4 prosthetic ligament repairs for canine tarsal medial collateral ligament injury. METHODS 24 cadaveric canine distal hind limbs with induced medial tarsal instability were randomly divided into 4 groups. Simulated medial shearing injury of the collateral and medial malleolus were repaired using 1 of 4 isometric suture techniques: bone tunnels with nylon suture (TN), ultrahigh-molecular-weight polyethylene (UHMWPE) suture (TU), tibial bone anchor with nylon suture (AN), or talar bone anchor with UHMWPE suture (AU). Each repair was evaluated for medial stability before and after cyclic range of motion. 3 of 4 repair configurations allowed string potentiometer isometry data collection during cyclic range of motion. Each construct was subsequently tested to failure; the strength and failure mode were recorded. RESULTS All repair groups showed statistically increased laxity compared to intact ligament. There was no difference in joint laxity between repair techniques. Cyclic range-of-motion testing did not increase joint laxity at any tested joint angle. Strength to failure was no different between repair groups. Isometry was achieved in the TU and TN groups. CONCLUSIONS All 4 techniques improved medial stability compared to that medial collateral ligament injury; however, no technique returned stability to the tarsal of the intact ligament. All 4 techniques maintained stability after range-of-motion testing. Isometric placement of the prosthetic suture was achievable. The constructs did not provide sufficient resistance to physiologic valgus stress. CLINICAL RELEVANCE Isometric placement of a prosthetic ligament is possible; secondary stabilization appears necessary to support the repair postoperatively. [ABSTRACT FROM AUTHOR]

Introduction: This study evaluated patient-reported outcome measures and reinjury rates in higher-risk adolescents and young adults aged 14–25 years old following Anterior Cruciate Ligament reconstruction using autograft with suture tape augmentation (SA ACLR). Materials and methods: We performed a retrospective case series of patients aged 14–25 who underwent SA ACLR by a single surgeon between 2016 and 2020. After a minimum of 2 years of follow-up, data was collected on reinjury and patient reported outcome measures, including Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale (MARS), Single Assessment Numeric Evaluation (SANE), and Visual Analog Pain Scale (VAPS). Results: 27 patients were identified. 4 were lost to follow-up, and 23 met inclusion criteria (11 male, 12 female). Average age was 20, and average follow-up was 2.5 years. Failure rate was 8.7%, with two patients requiring revision ACL reconstruction. One patient required two additional meniscal operations with intraoperative findings demonstrating maintenance of an intact ACL. Postoperative patient-reported outcomes measures (PROMs) were obtained for the patients who did not require additional surgery (n = 20), and preoperative PROMs were available for 16 of these patients. Postoperatively, patients reported a mean VAPS of 0.74 ± 1.27, MARS of 8.05 ± 5.58, and SANE of 83.05 ± 16.47. Mean KOOS was 86.92 ± 11.77 with subscores Pain of 86.94 ± 12.94, Symptoms of 82.16 ± 14.96, ADL of 95.81 ± 8.10, Sport of 75.61 ± 21.52, and QOL of 70.64 ± 22.04. Paired t-tests demonstrated significant improvements in VAPS, SANE, and KOOS outcomes following surgery. Patients were significantly less active postoperatively as reported by the MARS. A multivariable regression analysis showed that increased age predicted poorer postoperative KOOS Pain outcomes, and female sex predicted inferior KOOS Pain and Sport outcomes. Conclusion: SA ACLR is a safe and effective surgical technique in the high failure risk young adult demographic, with a low reinjury rate and acceptable KOOS scores. Patients were active with minimal pain at minimum two years of follow-up. Female sex was a risk factor for poorer outcomes in this population. [ABSTRACT FROM AUTHOR]

BACKGROUND: The optimal surgical management of penetrating carotid artery injuries (PCAIs) remains controversial. This study aimed to examine the association between operative techniques for PCAI and the incidence of stroke. STUDY DESIGN: This retrospective cohort study used the American College of Surgeons TQIP (2016 to 2021) database. We included patients (age 16 years or older) with severe penetrating injuries to the common or internal carotid arteries (CCA/ICA) who underwent one of the following operative procedures: primary suture repair, ligation, and arterial reconstruction with a graft. Multivariate logistic regression analysis with cluster-adjusted-robust SEs was performed to estimate the adjusted odds ratio (AOR) for postoperative stroke stratified by the initial Glasgow Coma Scale (GCS). RESULTS: A total of 492 patients were included (329 underwent primary suture repair, 82 underwent ligation, and 81 underwent arterial reconstruction with a graft). The median age was 31 years (interquartile range 24 to 43) and median GCS on arrival was 11 (interquartile range 3 to 15). On multivariate analysis after adjusting for potential confounders, ligation of CCA/ICA was significantly associated with increased odds of stroke in patients with initial GCS =9 (AOR: 4.40, 95% CI 1.16 to 16.58, p = 0.029), whereas there was no significant association in patients with GCS <9 (AOR 0.77, 95% CI 0.28 to 2.11, p = 0.37). No significant association was identified between arterial reconstruction with a graft and stroke, irrespective of the initial GCS. CONCLUSIONS: The study findings suggest that the preoperative level of consciousness may help in planning operative strategies for PCAI. In patients with an initial GCS =9, definitive repair of the CCA/ICA, including arterial reconstruction with a graft, should be pursued instead of ligation. [ABSTRACT FROM AUTHOR]

Background: It is still unknown if the double–femoral tunnel technique (Arciero [ARC]) provides better stability as compared with the single–femoral tunnel technique (modified Larson [LAR]) in posterolateral corner reconstruction. The ideal angle of fixation of the popliteofibular strand in ARC is also unknown. Hypotheses: The ARC provides greater external rotation (ER) stability than the LAR (hypothesis 1); there is no difference in varus rotation (VR) stability between LAR and ARC (hypothesis 2); and femoral fixation of the popliteofibular strand at 60° during the ARC leads to greater ER stability than fixation at 30° or 90° of knee flexion (hypothesis 3). Study Design: Controlled laboratory study. Methods: Eight fresh-frozen human knees were tested in a knee test bench in 4 states: native, posterolateral deficiency, LAR, and ARC. With the ARC, the popliteofibular strand was fixed at 30°, 60°, and 90° (ARC30, ARC60, ARC90). The order of testing (LAR/ARC) was randomized. A tibial ER and VR torque of 5 N·m was applied at 0°, 30°, 60°, and 90°. Rotation degrees were captured using an ultrasound-based analysis system. Wilcoxon signed rank tests were used to assess statistical significance between paired groups in different states. Results: The ARC and LAR significantly improved VR and ER stability at all flexion angles in comparison with posterolateral deficiency (P <.05). At 60° and 90°, ARC30 showed significantly greater ER stability in comparison with the LAR (mean ± SD; ARC30 vs LAR at 60°, 21.2°± 5.1° vs 15.4°± 5.6° [ P <.05]; ARC30 vs LAR at 90°, 23.7°± 5.6° vs 16.8°± 6.3° [ P <.05]). At 90°, the LAR showed significantly greater VR instability in comparison with the native state (3.5°± 1.5° vs 2.5°± 1.0°; P =.012), and ARC30 was not significantly different from the native state with respect to VR (2.9°± 1.5° vs 2.5°± 1.0°; P =.327). No significant differences in ER and VR were found among ARC30, ARC60, and ARC90 at any flexion angle (P ≥.05). Conclusion: The ARC technique provided greater tibial ER stability in comparison with the LAR at higher flexion angles (hypothesis 1 accepted). There were no differences between LAR and ARC in restoring VR stability, except at 90° (hypothesis 2 partly accepted). Different femoral flexion angles for fixation of the popliteofibular strand during the ARC did not show any significant differences in relation to knee stability (hypothesis 3 rejected). Clinical Relevance: Posterolateral corner reconstruction using the ARC technique provides greater ER stability at higher flexion angles than the modified LAR technique. [ABSTRACT FROM AUTHOR]

Introduction: The number of applications for cardiothoracic surgery has been steadily dropping over the past decades. We aim to assess whether a 1-day cardiothoracic surgical skills conference could increase interest into the speciality. Methods: Participants included in the study had to be medical students or junior doctors. Out of 57 delegates that attended the conference, 52 were enrolled in the study, and completed the pre-conference and post-conference questionnaires. Three introductory lectures were delivered by consultants in cardiothoracic surgery or cardiology in the morning, followed by three practical surgical workshops. We assessed demographics, confidence in and knowledge of procedures, and the change in participants' interest in the speciality pre- and post-conference. This study was conducted at St George's University of London. Results: The interest to pursue a career in cardiothoracic surgery increased by 23% post-conference (p =.035). Confidence and knowledge in all procedures taught improved significantly after the conference (p <.05), with the highest increase seen in anastomosis of vessels (p <.0001). Preclinical students made up 57.7% of participants, majority of whom had not seen more than three surgical procedures. Conclusion: Our conference has shown to increase interest in cardiothoracic surgery and improve exposure to surgical skills, especially to those in early years of medical school. The surgical workshops improved student confidence and knowledge in procedures used within the field and the use of animal tissue improved participant experience. Further research is needed at other medical schools to assess whether a change in surgical skills teaching should be made to medical school curriculums. [ABSTRACT FROM AUTHOR]

Background Thorough validation of novel microsurgical techniques is deemed essential before their integration into clinical practice. To achieve proper validation, the design of randomized controlled trials (RCTs) should be undertaken, accompanied by the execution of comprehensive statistical analyses, including confounder adjustment and power analysis. This systematic review aims to provide an encompassing overview of the validation methodologies employed in microsurgical studies, with a specific focus on innovative vessel anastomosis techniques. Methods A literature search was conducted in PubMed for articles describing the validation of novel microsurgical vessel anastomosis techniques in animal or human subjects. Results The literature search yielded 6,658 articles. A total of 6,564 articles were excluded based on title and abstract. Ninety-four articles were assessed for full-text eligibility. Forty-eight articles were included in this systematic review. Out of 30 comparative studies, 9 studies validated novel modified interrupted suture techniques, 6 studies modified continuous techniques, 6 studies modified sleeve anastomosis techniques, 1 study a modified vesselotomy technique, 7 studies sutureless techniques, and 1 study a modified lymphaticovenular anastomosis technique. Twenty-eight studies contained animals (n = 1,998). Fifteen animal studies were RCTs. Two studies contained human/cadaveric subjects (n = 29). Statistical power analysis and confounder adjustment were performed in one animal study. Out of 18 noncomparative studies, 5 studies validated novel modified interrupted suture techniques, 1 study a modified continuous technique, 2 studies modified sleeve anastomosis techniques, 4 studies modified vesselotomy techniques, 4 studies sutureless techniques, and 2 studies modified lymphaticovenular anastomosis techniques. Ten studies contained animal subjects (n = 320), with two RCTs. Eight studies contained human subjects (n = 173). Statistical power analysis and confounder adjustment were performed in none of the animal or human studies. Conclusion The current methods of microsurgical technique validation should be reconsidered due to poor study design. Statistical analysis including confounder adjustment and power analysis should be performed as a standard method of novel technique validation. [ABSTRACT FROM AUTHOR]

Septoplasty is among the most frequently performed procedures in the field of otorhinolaryngology. Adhesion is known to be the most common complication occurring after septoplasty. Post-surgical insertion of silicone splints is a widely used measure for the prevention of postoperative complications. Recently, we encountered a case where the silicone splint was dislocated and further displaced to the level of the upper esophageal sphincter. Although it was safely removed using fiberoptic gastroendoscopy, delayed removal could have induced other serious sequelae. Since no similar cases have been previously reported, we believe that this may be a very rare complication induced by a loose absorbable suture. Therefore, we suggest that otorhinolaryngologists should pay attention to the fixation of a silicone splint with sutures under appropriate tension to prevent the dislocation of the silicone splint and its subsequent sequelae. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy is one of the most common surgical procedures. Several techniques of ligating the cystic duct have been compared in randomized trials, but data on comparative effectiveness are missing. Our aim was to systematically review the literature and, if appropriate, synthesize the available evidence. Methods: A systematic search of PubMed, Scopus, Ovid, and Cochrane Library was conducted to identify randomized studies comparing different ligation techniques of the cystic duct in laparoscopic cholecystectomy. Network meta-analysis synthesized evidence from all available techniques. Techniques compared were metal (MC), absorbable (AC), or polymer clips (PC), suture ligation (SL), and ultrasonic shears (US). Results: Twenty-three randomized studies with 2851 patients were included in our study. A well-connected network was formed for bile leak and a star-shaped network for operative time, with MC as the common comparator. No difference was found when SL, AC, US, or PC were compared for bile leak. Operative time was statistically significantly reduced when US were compared to MC (mean difference [MD] = −14.32 [−19.37, −9.28]), SL MD = −20.16 (−10.84, −29.47), and AC MD = −18.32 (−1.25, −35.39). The remaining techniques had similar operative times. PC had the highest probability of being the best technique P = 41.8, and SL had the highest probability P = 46.1 of being the second best for bile leak. US had a 98.1% chance of being the best technique for operative time. Conclusions: Given that all techniques demonstrate similar efficacy, the decision should be based on cost, familiarity with the technique, and environmental factors. [ABSTRACT FROM AUTHOR]

The use of RDV in SAVR is associated with risk of conduction abnormality requiring PPM implantation, when compared to conventional bioprosthetic valves. We aimed to evaluate the outcome after selective placement of annular compression sutures during surgical aortic valve replacement (SAVR) using Intuity rapid deployment valve (RDV). This is a retrospective study of prospectively enrolled patients receiving SAVR using Intuity RDV. Selective placement of commissural compression suture was assessed for all patients based on their annular morphology. Outcomes including operative mortality, rate of pacemaker rate, paravalvular leak and change in trans -valvular pressure gradient were analyzed. 56 consecutive patients underwent SAVR with the INTUITY RDV at our institution from January 2020 to November 2021. The Mean age of our cohort was 69.9 ± 10.6 years with a EuroSCORE II of 3.4 ± 2.4%. 28.6% (16/56) of patients had notable conduction abnormalities pre-operatively, which included atrial fibrillation and left/right bundle branch block. Compression sutures were selectively applied in 19/56 (33.9%) patients. Of which, 13 were bicuspid aortic valve. Post-operatively, we observed no conduction abnormality requiring PPM implantation. In addition, only 3 of the 56 (5.4%) had any degree of paravalvular leak on post-operative echocardiography (all ≤ mild). The mean reduction in trans -valvular gradient was 29.9 mmHg and the mean pressure gradient at 1 month and 1 year follow-up were 9.3 ± 3.6 mmHg and 10.2 ± 4.1 mmHg, respectively. Selective placement of compression suture helps to avoid unnecessary oversizing, which may reduce the risk of paravalvular leak and post-operative PPM implantation. [ABSTRACT FROM AUTHOR]

Background: Quadriceps tendon ruptures occur infrequently in the general population. Biomechanical data suggest advantages with the use of suture anchor fixation for major tendon repair. Clinical studies of quadriceps tendon repair have been limited to small case series. Purpose: To evaluate clinical failure following primary quadriceps tendon repair with transosseous tunnel or suture anchor repair. Study Design: Cohort study; Level of evidence, 3. Methods: The Military Health System Data Repository was queried to identify all adult patients who underwent primary quadriceps tendon repair in the Military Health System between 2014 and 2018. Patients were excluded if they had incomplete records, polytrauma, open injury, prior ipsilateral total knee arthroplasty did not undergo quadriceps tendon repair, or underwent revision repair. Follow-up was obtained by manual chart review of both orthopaedic and nonorthopaedic records, recording any evidence of ongoing knee issues. Univariate analysis was performed to determine associations between potential risk factors and repair failure. Multicollinearity was assessed between potential risk factors, and candidate variables were included in multivariate logistic regression models to determine independent risk factors for repair failure. Results: Following application of inclusion/exclusion criteria, 245 knees in 234 patients were included. Mean age of the cohort was 52 years. Patients were predominantly male (223/234; 95%) and military retirees (143/234; 61%). Transosseous tunnel repair was the most frequently employed surgical technique (147/245; 60%), followed by suture anchor repair (78/245; 32%). Repair failure requiring revision surgery occurred in 11% of knees (27/245). Surgical-site infection following index surgery was associated with eventual rerupture (P =.02). There was no difference in failure rate between transosseous tunnel repair and suture anchor repair (12.2% vs 9.0%; P =.51). Among knees undergoing suture anchor repair, no difference in failure was found between knot-tying and knotless suture anchor fixation (P =.73). Conclusion: We observed no difference in failure of primary quadriceps tendon repair between transosseous tunnel and suture anchor repair types or between the 2 main suture anchor implant subtypes (knotless vs knot-tying anchors). A greater than previously reported rerupture rate was observed, indicating the need for continued investigation into optimal surgical techniques. [ABSTRACT FROM AUTHOR]

Background: Hip abductor tendon tears have been identified as a common cause of greater trochanteric pain syndrome. While abductor tendon tears are often managed surgically, the optimal tendon attachment technique remains controversial. Purpose: To compare the outcomes of hip abductor tendon repair between the suture anchor (SA) and transosseous suture (TS) techniques. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed in June 2023 in Embase, PubMed, and Web of Science databases. Studies reporting pre- and postoperative clinical outcomes of hip abductor repairs using SA or TS fixation with a minimum follow-up of 12 months were included in our analysis. From 608 studies initially identified, 21 studies (14 SA and 7 TS) with a total of 680 patients met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist guided the reporting and data abstraction, and the quality of the studies was assessed using the methodological index for non-randomized studies checklist. The results were presented as a narrative summary using descriptive statistics such as ranges and agreement statistics. Results: Significant pre- to postoperative improvement in pain scores and functional outcomes were reported on all included studies. The mean improvement on the Harris Hip Score/modified Harris Hip Score was 32.5 (95% CI, 28.4-36.7) for the SA technique versus 21.9 (95% CI, 6.7-37.0) for the TS technique, while mean improvement in pain according to the visual analog scale was 5.1 ± 2.3 for SA and 4.8 ± 2.2 for TS (P =.9). There was a trend toward statistical significance regarding retear rates, with higher rates for SA (6.7% ± 7.6%) versus TS (1.3% ± 4.7%) (t [13.9] = 2.0; P =.06). Conclusion: We observed no significant difference between SA and TS regarding improvements in patient-reported hip outcome and pain scores. However, SA trended toward a higher retear rate. Future research should propose a classification scheme that considers tear size and morphology, the extent of associated muscle degeneration, and the distance of tendon retraction to provide more context for the understanding of expected functional outcomes. [ABSTRACT FROM AUTHOR]

A 64-year-old woman suffered a traumatic rupture of the inferior rectus muscle, with the distal segment unrecoverable. An inferior oblique muscle transposition, augmented with a posterior fixation suture, was performed. This modification may have contributed to the surgical outcome. [J Pediatr Ophthalmol Strabismus. 2025;62(1):e14–e17.] [ABSTRACT FROM AUTHOR]

Objective: To provide clinicians with reliable recommendations for the selection of appropriate suturing techniques for surgical management of common musculoskeletal soft tissue injuries. Methods: A systematic search of PubMed, Springer, Web Science, Vip Database, China National Knowledge, and Wanfang Data for in vitro biomechanical studies on suture techniques in the surgical treatment of musculoskeletal soft tissue injuries covering relevant studies from April 2009 to April 2024 was performed. A generalized classification was made based on the characteristics of the techniques, and recommendations for the selection of suture techniques were made according to the GRADE concept. Results: The search strategy returned 1015 articles, of which 66 were included. These studies presented moderate and high levels of evidence-based evidence and provided varying recommendations for the choice of suturing techniques in the treatment of three common musculoskeletal soft tissue injuries. Categorizing suturing techniques according to their structural principles further increases the reliability of opinions. Conclusion: The ideal suture technique must be a compromise between the complexity and strength of the repair, which is a great challenge for clinicians. This review can provide an objective and reliable clinical guide for making suture technique choices for common musculoskeletal soft tissue repair. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence This study aims to illustrate the assessment and treatment strategies of acute and chronic deltoid ligament injuries, providing a treatment algorithm for each scenario.A retrospective review was conducted on 39 patients, who had either an acute deltoid ligament injury or suffered chronic deltoid ligament insufficiency. All patients were operated on between January 2016 and December 2022. The cases represent a range of different clinical scenarios, including acute trauma, chronic insufficiency or instability situations. Clinical and imaging evaluation, surgical techniques and clinical outcomes are presented.The mean follow‐up time was 21.3 months (±4.5). Acute trauma represented 18 (46%) of the ankles, while 21 (54%) had chronic instability. Treatment options were tailored according to the aetiology, patient characteristics, injury pattern and associated lesions. In 11 of the 18 acute deltoid ruptures (64%), repair was performed using suture anchors, while the remaining 7 cases were treated with direct suture. In chronic deltoid insufficiency, re‐tensioning with suture anchor was performed in 14 (67%) ankles, suture imbrication in 5 (24%) and reconstruction in 6 (9%). The most common associated injuries were syndesmotic injuries (n = 12, 56%) and osteochondral lesions (n = 13, 36%). The complication rate was 18% (n = 7), the majority related to persistent stiffness (n = 4, 10%).The decision on when and how to repair the deltoid ligament should be guided by the characteristics of the injury and the individual patient. The current treatment rationale may serve as a working basis for evaluating and treating these ankles.Level IV. [ABSTRACT FROM AUTHOR]

Background: Patellar fractures present challenges in treatment, with traditional methods often leading to complications such as loss of reduction and implant failure. This study aimed to compare a novel suture fixation technique with the traditional tension band method using finite element analysis. Methods: CT images of a healthy 35-year-old male were used to construct 3D patellar models. Two fixation methods were modeled: the novel suture technique using polyester sutures and traditional tension band fixation with Kirschner wires and cerclage wires. Finite element analysis was conducted to compare stress and pressure distribution under varying force angles. Results: The novel suture fixation method demonstrated superior stress dispersion and more uniform pressure distribution compared to the traditional tension band technique. Stress concentration was notably reduced, indicating potential for enhanced fracture stability and healing. Tensile testing confirmed the mechanical properties of the sutures, further validating the proposed method. Conclusions: Finite element analysis revealed that the novel suture technique for patellar fractures provides better stress and pressure distribution compared to traditional methods. This approach offers promise for improved fracture stability and reduced complications. Clinical validation and long-term follow-up studies are warranted to confirm these findings and assess patient-specific outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The aim of our study was to assess the outcome of Gore-Tex sutures in minimally invasive scleral fixation of subluxated posterior chamber intraocular lenses (PCIOLs) and to demonstrate a method for validating the lens position. Methods: Retrospective study of patients who underwent lasso in-the-bag scleral fixation of a subluxated PCIOL using the snare technique with Gore-Tex suture from 2019 to 2021 in a single tertiary medical center. Functional outcome was analyzed by clinical assessment, and anatomical outcome, by ultrasound biomicroscopy (UBM). Results: A total of 18 eyes were included. The mean duration of follow-up was 140 days (range 23–659), and the median time from PCIOL implantation to fixation was 8.5 years (IQR 6.25–10.75). All patients had ocular comorbidities, mainly glaucoma (n = 6) and pseudoexfoliation syndrome (n = 5). Best corrected visual acuity improved from a median of 6/30 (0.7 logMAR) to a median of 6/12 (0.35 logMAR) (p = 0.06); postoperative astigmatism measured 0.91 ± 2.19 diopters. UBM demonstrated well-balanced PCIOL fixation with no difference between the horizontal and vertical tilt measurements (p = 0.84; p = 0.94; p = 0.62; p = 0.085). The fixated PCIOL showed <10% decentration with reference to the visual axis. There was a high negative correlation between BCVA improvement and residual lens tilt (r = −0.76, p = 0.037). Postoperative complications included transient ocular hypertension (n = 3), corneal decompensation with subsequent keratoplasty (n = 3), temporary hypotony (n = 2), cystoid macular edema (n = 1), suture exposure (n = 1), and endophthalmitis (n = 1). Conclusions: Subluxated PCIOLs are amenable to treatment with minimally invasive fixation using Gore-Tex suture with good anatomic outcomes. UBM image analysis may serve as a valuable method for assessing PCIOL position following scleral fixation. [ABSTRACT FROM AUTHOR]

During any operative procedure incisions are made to reach the surgical site. Incisions are usually closed with the suture that can be continuous or interrupted type. Continuous sutures are usually inserted underneath the skin on the other hand interrupted sutures can involve the full skin thickness. Post surgery impaired wound healing can lead to poor cosmetic results as well as the post-surgical complications. The objective of this study was to compare the closure of wound with simple interrupted non-absorbable suture versus an absorbable subcuticular suture in terms of cosmesis, post-operative complications. It was a longitudinal cross sectional study with prospective follow up was conducted at one of the super speciality hospitals of the Raipur to compare the outcomes of both suturing technique among surgical patients. The patients with various surgical indications were included in the study and were followed up till 3 months after the surgery. The patients were divided in the two groups: In first group skin closure was done through the interrupted suture and in another group skin closure was done with the subcuticular continuous suture. Outcomes were compared with appropriate statistical test. p-value less than 0.05 was considered as statistically significant. Total 150 patients were included in the study, 73 and 77 sutured in interrupted and continuous manner. On comparison of both the technique there was no statistically significant difference was observed in post operative complications among both the group. Although, continuous suture had better cosmesis and less pain as compared to the interrupted suture. This study suggests that while both interrupted and continuous suturing techniques are effective for surgical wound closure, continuous sutures offer advantages in terms of improved cosmetic outcomes and reduced pain over time. No significant difference in postoperative complications was observed between the two methods. Continuous suturing may therefore be preferable for enhanced cosmesis and patient comfort in clean surgical wound closures. [ABSTRACT FROM AUTHOR]

Background: This study aimed to elucidate the safety and intra-articular elution profiles of vancomycin and gentamicin bone cement in patients undergoing primary total knee arthroplasty (TKA), with a focus on serum safety thresholds and therapeutic efficacy. Methods: Consecutive patients who underwent unilateral primary TKA were prospectively enrolled. The implants were fixed using gentamicin-impregnated bone cement, and after arthrotomy closure, 1000 mg of vancomycin suspended in 25 mL of normal saline was directly injected into the joint. Peripheral venous blood and drain fluid samples were collected 2, 8, and 24 h postoperatively. The serum and intra-articular concentrations of vancomycin and gentamicin were analyzed using liquid chromatography-tandem mass spectrometry within 24 h. Results: Clinical data reflecting renal and liver function were recorded preoperatively, and at 24 and 72 h postoperatively. A total of 100 patients were included. At 2, 8, and 24 h postoperatively, the serum vancomycin concentration was 7.0 ± 2.0, 5.7 ± 1.8, and 3.6 ± 1.4 µg/mL, respectively, while the intra-articular concentration was 468.5 (interquartile range [IQR] 286.0 to 774.8), 139.5 (IQR 52.0 to 295.3), and 34.4 (IQR 22.2 to 56.8) µg/mL, respectively; 33.2 (IQR 19.5 to 80.5) mg vancomycin was lost in drainage fluid at 24 h postoperatively. For gentamicin, the overall intra-articular concentration was 70.4 (IQR 35.4 to 109.2), 33.8 (IQR 17.8 to 73.9), and 21.1 (IQR 12.2 to 36.0) µg/mL at 2, 8, and 24 h postoperatively, respectively, with an undetectable serum concentration. No cases of acute renal injury, liver injury, ototoxicity, or anaphylaxis were observed. Conclusions: Intra-articular injection of 1000 mg vancomycin after arthrotomy closure combined with gentamicin-impregnated bone cement provided a therapeutic intra-articular concentration while avoiding systemic toxicity over the initial 24 h after primary TKA. Therefore, intra-articular vancomycin administration may offer a safer alternative to intravenous antibiotics, reducing systemic toxicity; however, further large-scale studies are necessary. Trial registration: ClinicalTrials. Gov (registration number: NCT05338021). [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions Level of Evidence This study aims to perform a systematic review to determine whether ultra‐high molecular weight polyethylene (UHMWPE) tapes have superior biomechanical properties compared to conventional sutures in posterior meniscal root tear (PMRT) repairs, and whether this translates into superior clinical outcomes.The Cochrane Controlled Register of Trials, PubMed and Embase were used to perform a systematic review using the following search terms: (meniscus OR meniscal) AND (root OR posterior horn) AND (suture OR tape OR wire OR cord). Data pertaining to certain biomechanical properties (load to failure, stiffness, displacement during cyclical loading and at failure), meniscal healing and patient‐reported outcome measures (PROMs) were extracted.Seven biomechanical and two clinical studies were included. There were 232 knees for biomechanical testing: 81 with UHMWPE tapes and 151 with conventional sutures (133 with UHMWPE sutures and 18 with Ethibond [Ethicon]). Testing set‐up was similar across studies, but there were differences in repair techniques, including suture configuration, location and method of fixation. In general, the consensus was that tapes had a higher load to failure and stiffness, with similar displacement at failure to that of UHMWPE sutures. A similar trend was also observed when tapes were compared to Ethibond, except for FiberTape (Arthrex). This particular UHMWPE tape showed greater displacement during cyclical loading, resulting from knot slippage. Clinically, there were 73 patients, 41 with UHMWPE tapes and 32 with either UHMWPE sutures (n = 18) or braided polyester sutures (n = 14). Tapes led to greater meniscal healing 1 year postoperatively, with PROMs similar across groups.UHMWPE tapes generally demonstrated superior biomechanical properties compared to conventional sutures in PMRT repairs with a simple stitch configuration. However, further biomechanical studies are required to determine the extent to which tapes contribute to the repaired construct, especially with more complex repair configurations, as the existing evidence displayed a notable amount of methodological heterogeneity.Level IV systematic review of level IV evidence. [ABSTRACT FROM AUTHOR]

One-anastomosis gastric bypass is an accepted bariatric procedure performed worldwide. Perforation of the gastrojejunal anastomosis ulcer is a rare and rather serious complication for which there is no well-defined treatment. Suturing of perforation with omentopexy is the most common treatment. Bile diversion from the anastomotic ulcer may be additionally required in some cases. [ABSTRACT FROM AUTHOR]

Laparoscopic sleeve gastrectomy can be associated with significant morbidity. Dehiscence of the staple line and gastric leak are some of the severest complications. The aim of this study was to compare three different methods of gastric suture in terms of staple line strength and leak volume/pressure of the sleeved stomach. The resected stomachs of 20 patients subjected to laparoscopic sleeve gastrectomy were evaluated for bursting volume/pressure after extraction from the abdomen. The specimens were categorized into three groups according to the staples that were used. The staple line of each specimen was divided into three groups: group A, standard green cartridge stapler [stapler closure 4.0 mm] and standard blue cartridge [stapler closure 3.5 mm] for antrum and body/fundus, respectively, with interrupted suture over the intersection of stapler suture line for reinforcement [n=10]; group B, standard green and blue loads but without reinforcement [n=4]; and group C, Tri-Stapler® mechanical [stapler closing 3.0–3.5–4.0 mm] devices without reinforcement [n=6]. Leak volume/pressure was determined by injection of methylene blue solution into the lumen of the resected stomach and by recording the pressure at which the leakage occurred. Intragastric pressure and volume of first leak and location of leak were recorded. Twenty sleeved gastrectomy specimens were included. The leak pressure was significantly higher [34.0 SD 20.7 mm Hg] in group C. The volume of the resected stomach was also greater in group C [1083.3 SD 343 cc]. Leaks were observed indistinctly in the antrum body or fundus of the stomach. We found higher burst pressure and volume in stomachs resected with Tri-Stapler®. It could be a safer device for performing sleeve gastrectomy. [ABSTRACT FROM AUTHOR]

Background: Endoscopic‐assisted breast surgery (EABS) provides better cosmetic outcomes for breast cancer patients with small incisions in an inconspicuous area. However, an extended incision and heavy assistant retraction are usually required for an adequate exposure for conventional axillary lymph node dissection (ALND). Therefore, we propose an innovative single‐port three‐dimensional endoscopic‐assisted ALND (S‐P 3D E‐ALND) to facilitate better visualization, and report its preliminary outcomes herein. Methods: The surgical technique of the S‐P 3D E‐ALND, using either monopolar Endo Hook, LigaSure, or Sonicision, is described. A total of 11 breast cancer patients who received the S‐P 3D E‐ALND in a single institution from January 2023 to September 2023 were enrolled. The preliminary results of the S‐P 3D E‐ALND, including perioperative parameters, complication, and short‐term oncological outcomes, were retrospectively analyzed. Results: Endoscopic breast and axillary procedures were conducted via a single axillary incision. The primary success rate of the S‐P 3D E‐ALND was 100% without a conversion to open surgery. The median operative time for the S‐P 3D E‐ALND was 39 (IQR = 28, 49) minutes. Average blood loss during E‐ALND was 3 (IQR = 3, 5) mL. The median number of harvested LN was 10 (IQR = 8, 11) LNs. During the median follow‐up time of 7 months, there was no complication, lymphedema, shoulder stiffness, or chronic arm numbness found. None of the patients reported locoregional recurrence, distant metastasis, or mortality. Conclusion: The S‐P 3D E‐ALND can serve as an alternative approach for ALND in breast cancer patients undergoing EABS, as our findings indicate it results in only minor complications. [ABSTRACT FROM AUTHOR]

Dog ear deformities in wound closure can lead to cosmetic concerns and discomfort for patients, particularly when there is unequal wound length, resulting in lying half cone-type dog ears. Managing these deformities involves aligning the longer side with the shorter side without extending the wound. The Songket suture technique, implemented in a two-stage process, has shown effectiveness in addressing this issue, especially in patients undergoing modified radical mastectomy with a crescent incision that we have presented. [ABSTRACT FROM AUTHOR]

Nowadays, endoscopic submucosal dissection (ESD) is commonly performed for the removal of large gastrointestinal lesions. Endoscopic mucosal defect closure after ESD is vital to avoid adverse events. In recent years, many innovative instruments have emerged and proved to be beneficial. In this paper, we conducted a thorough literature review and summarized the closure methods for large‐size post‐ESD mucosal defects over decades. We separated these methods into five categories based on the operational principle: "side closure" method, "ring closure" method, "layered closure" method, "hand suturing closure" method, and "specially designed device closure" method. Side closure with clips assisted by instruments such as threads or loops is applicable for each segment of the gastrointestinal tract to prevent postoperative bleeding. If the defect tension is too large to close with the traditional side closure methods, zigzag closure and ring closure could be applied to gather the bilateral defect edges together and achieve continuous closure. In the stomach and rectum with a high risk of submucosal dead space between the submucosa and muscular layers, side closure methods with muscle layer grasping clip or layered closure methods could enable the involvement of the deep submucosa and muscle layers. The ring closure method and specially designed devices including over‐the‐scope clip, Overstitch, and X‐tack could resolve perforation effectively. Individual closure method requires endoscope reinsertion or sophisticated operation, which may be limited by the deep location and the narrow lumen, respectively. Although specially designed devices are expected to offer promising prospectives, the cost‐effectiveness remains to be a problem. [ABSTRACT FROM AUTHOR]

Background: To develop and maintain suturing skills, clinical exposure is important. When clinical exposure cannot be guaranteed, an adequate training schedule for suturing skills is required. This study evaluates the effect of continuous training, 'reflection before practice' and self-assessment on basic open suturing skills. Methods: Medical students performed four basic suturing tasks on a simulation set up before ('pre-test') and after their surgical rotation ('after-test'). Participants were divided in three groups; the 'clinical exposure group' (n = 44) had clinical exposure during their rotation only, the 'continuous training group' (n = 16) completed a suturing interval training during their rotation and the 'self-assessment group' (n = 16) also completed a suturing interval training, but with the use of reflection before practice and self-assessment. Parameters measured by a tracking system during the suturing tasks and a calculated 'composite score' were compared between groups and test-moments. Results: A significantly better composite score was found at the after-test compared to the pre-test for all groups for all basic suturing tasks (0.001 ≤ p ≤ 0.049). The self-assessment group scored better at the pre-test than the other two groups for all tasks, except for 'knot tying by hand' (0.004 ≤ p ≤ 0.063). However, this group did not score better at the after-test for all tasks, compared to the other two groups. This resulted in a smaller delta of time ('transcutaneous suture', p = 0.013), distance ('Donati suture' and 'intracutaneous suture', 0.005 ≤ p ≤ 0.009) or composite score (all tasks, except for knot tying by hand, 0.007 ≤ p ≤ 0.061) in the self-assessment group. Conclusion: Reflection before practice and self-assessment during continuous training of basic open suturing tasks, may improve surgical skills at the start of the learning curve. [ABSTRACT FROM AUTHOR]

Purpose: When the intermediate or collicular fascicle of the medial collateral ligament (MCL) is injured, the diagnosis of posttraumatic medial ankle instability (MAI) is supported. The aim of this study was to describe an arthroscopic all‐inside MCL repair after posttraumatic MAI secondary to an isolated injury of the MCL deep fascicle with a knotless suture anchor technique. Methods: Seven patients (seven men, median age: 23 [19–28] years) with posttraumatic MAI were treated by arthroscopic means after failing nonoperative management. The median follow‐up was 34 (13–75) months. The MCL was repaired with an arthroscopic all‐inside technique. Results: A tear affecting the deep and intermediate or collicular fascicle of the MCL was observed in all cases. In addition, five patients were diagnosed with an isolated fibular anterior talofibular ligament (ATFL) detachment, and in two patients, both the ATFL and calcaneofibular ligament were involved. All patients reported subjective improvement after the arthroscopic ligament repair. The median American Orthopedic Foot and Ankle Society score increased from 68 (range: 64–70) preoperatively to 100 (range: 90–100) at final follow‐up. Conclusion: Posttraumatic MAI can be successfully treated by an arthroscopic all‐inside repair of the MCL. The presence of an MCL tear affecting the tibiotalar ligament fibres attached to the area of the anterior colliculus should be considered a sign of posttraumatic MAI. This partial deltoid injury at the level of the intermediate or collicular fascicle will conduct to a dynamic MAI. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Three adult specimens of the rare lower Oxfordian ammonite species Protophites insociale (Bukowski) are described from two sections of southern Poland, Ogrodzieniec and Zalas. Based on their globular phragmocone, geniculate body chamber, suture line, looped ribs, and age, they have been included in the Pachyceratidae. In the present study Protophites (microconch) and Tornquistes (macroconch) are considered as a sexual dimorphic pair. [ABSTRACT FROM AUTHOR]

• Laparoscopic cerclage is a safe and effective alternative for cervical insufficiency when vaginal cerclage is not an option. • We present the surgical technique for a laparoscopic cerclage, utilizing a port-site closure device, in two distinct clinical scenarios. This video-article describes a laparoscopic cervico-isthmic cerclage technique for managing cervical insufficiency in both pregnant and non-pregnant patients, utilizing a port-site closure device for precise suture placement. Two cases—one non-pregnant and one at 12 weeks gestation—underwent the procedure, with details on trocar placement, dissection, and suture passage documented. Both surgeries were completed successfully, with minimal blood loss and no complications. The use of the port-site closure device allowed for precise suture placement near the uterine vessels, contributing to favorable postoperative outcomes. This laparoscopic approach offers a minimally invasive alternative to the open technique in specialized centers. [ABSTRACT FROM AUTHOR]

Background: Manual objective assessment of skill and errors in minimally invasive surgery have been validated with correlation to surgical expertise and patient outcomes. However, assessment and error annotation can be subjective and are time-consuming processes, often precluding their use. Recent years have seen the development of artificial intelligence models to work towards automating the process to allow reduction of errors and truly objective assessment. This study aimed to validate surgical skill rating and error annotations in suturing gestures to inform the development and evaluation of AI models. Methods: SAR-RARP50 open data set was blindly, independently annotated at the gesture level in Robotic-Assisted Radical Prostatectomy (RARP) suturing. Manual objective assessment tools and error annotation methodology, Objective Clinical Human Reliability Analysis (OCHRA), were used as ground truth to train and test vision-based deep learning methods to estimate skill and errors. Analysis included descriptive statistics plus tool validity and reliability. Results: Fifty-four RARP videos (266 min) were analysed. Strong/excellent inter-rater reliability (range r = 0.70–0.89, p < 0.001) and very strong correlation (r = 0.92, p < 0.001) between objective assessment tools was demonstrated. Skill estimation of OSATS and M-GEARS had a Spearman's Correlation Coefficient 0.37 and 0.36, respectively, with normalised mean absolute error representing a prediction error of 17.92% (inverted "accuracy" 82.08%) and 20.6% (inverted "accuracy" 79.4%) respectively. The best performing models in error prediction achieved mean absolute precision of 37.14%, area under the curve 65.10% and Macro-F1 58.97%. Conclusions: This is the first study to employ detailed error detection methodology and deep learning models within real robotic surgical video. This benchmark evaluation of AI models sets a foundation and promising approach for future advancements in automated technical skill assessment. [ABSTRACT FROM AUTHOR]

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]