Prospective randomized trial comparing absorbable and non-absorbable sutures in open carpal tunnel release

A prospective randomized trial was undertaken to compare the influence of absorbable and non-absorbable sutures on pillar pain, scar tenderness, extent of wound inflammation and overall outcome of the surgery following open carpal tunnel release. Forty hands in 33 patients (mean age, 51 years; range, 31-74 years) were randomized into group A (absorbable sutures) or group B (non-absorbable sutures). Clinical assessment was done at 2, 6 and 12 weeks follow-up. The outcome of surgery in terms of improvement of severity of symptoms and functional status of patients was assessed using a self-administered Boston Questionnaire. There was no significant difference between the two groups for any of our outcome measures at the final follow-up.     

关节镜下不可吸收缝线结合Endbutton钢板固定治疗儿童胫骨髁间棘骨折

目的探讨关节镜下不可吸收缝线结合Endbutton钢板固定治疗儿童胫骨髁间棘骨折的手术方法和疗效。方法对13例儿童胫骨髁间棘骨折患者行关节镜下复位,用不可吸收缝线结合Endbutton钢板对骨折块行内固定。结果 13例均获随访,时间14-23个月。无切口感染、关节强直等并发症发生。X线片显示13例均达解剖复位,术后膝关节Lachman征和抽屉试验均为阴性。伤膝关节活动度与健侧一致,关节稳定。结论关节镜下不可吸收线结合Endbutton钢板固定儿童胫骨髁间棘骨折是一种安全、有效的术式。     

Comparison of two trocar-guided trans-vaginal mesh systems for repair of pelvic organ prolapse: a retrospective cohort study

Introduction and hypothesis

The aim of this study was to compare failure and complication rates in patients who underwent a trocar-guided vaginal mesh repair with either a non-absorbable or a partially absorbable mesh.

Methods

Retrospective analysis of prospectively collected data from consecutive women undergoing either non-absorbable or partially absorbable mesh for symptomatic stage 2 prolapse or higher were evaluated at 12 months. Outcome measures included objective and subjective failure rates, patient’s satisfaction, complications and perioperative outcomes.

Results

Five hundred and sixty-nine women (347 with non-absorbable mesh, 222 with partially absorbable mesh) were included. Failure rates were similar in the two groups; the re-operation rate in the untreated compartments was higher in the non-absorbable mesh group compared with the partially absorbable mesh group (5 % vs 1 %). Mesh exposure rate in the non-absorbable mesh group was 12 % and in the partially absorbable mesh group it was 5 %. Other complication and patient satisfaction rates were similar.

Conclusions

Non-absorbable and partially absorbable mesh demonstrated similar outcome rates at 12 months. The risk of reoperation was lower for partially absorbable mesh. The mesh exposure rate was significantly lower for the partially absorbable mesh group compared with the non-absorbable mesh group.     

Comparison of zones 1 to 4 flexor tendon repairs using absorbable and unabsorbable four-strand core sutures

Absorbable sutures behave favourably in vitro and in an animal model. We report the outcome of flexor tendon injuries in a series of 272 consecutive patients treated over 45 months with a mean follow-up of 4 (range 3-12) months. Five hundred and seventy-six tendons were repaired in 416 digits. The patients were not randomised and all repairs were performed using a Strickland four-strand core technique. In 191 (73%) patients an absorbable core suture was used (Group 1) and in 81 (27%) a non-absorbable material was used (Group 2). There were six ruptures (2%) in Group 1 and two (2%) in Group 2. Using the original Strickland criteria, there were 72% excellent/good and 28% fair/poor results in the absorbable core suture group, and 73% and 27%, respectively, in the non-absorbable core suture group. This study suggests that appropriate absorbable core sutures can be used safely for flexor tendon repair.     

Influence of suture material and surgical technique on risk of reoperation after non-mesh open hernia repair

BACKGROUND: Although mesh techniques are used with increasing frequency, sutured repair still has a place in groin hernia surgery. Studies relating suture material to recurrence rate have yielded conflicting results. The aim of the present study was to analyse the influence of suture material and sutured non-mesh technique on the risk of reoperation in open groin hernia repair using data from the Swedish Hernia Register. METHODS: The relative risk of reoperation after sutured repair using non-absorbable, late absorbable and early absorbable sutures was compared in multivariate analyses, taking into account known confounding factors. RESULTS: Between 1992 and 2000, 46,745 hernia repairs were recorded in the Swedish Hernia Register. Of these, 18,057 repairs were performed with open non-mesh methods and were included in the analysis. Using non-absorbable suture as reference, the relative risk of reoperation after repair with early absorbable suture and late absorbable suture was 1.50 (95 per cent confidence interval (c.i.) 1.22 to 1.83) and 1.03 (95 per cent c.i. 0.83 to 1.28) respectively. Using the Shouldice repair as reference, other sutured repairs were associated with a significantly higher relative risk of reoperation (1.22, 95 per cent c.i. 1.03 to 1.44). CONCLUSION: A non-absorbable or a late absorbable suture is recommended for open non-mesh groin hernia repair. The Shouldice technique was found to be superior to other open methods.     

Experimental study of suture materials placed in the renal parenchyma

Absorbable and non-absorbable suture materials in the renal parenchyma were examined in comparative studies performed on 12 mongrel dogs. Quantitative and qualitative histological studies showed that Dexon was preferable to other absorbable suture materials as opposed to traditional catgut, while Supramide and Polyester had certain advantages over other non-absorbable materials.     

A randomised, multi-centre, prospective, observer and patient blind study to evaluate a non-absorbable polypropylene mesh vs. a partly absorbable mesh in incisional hernia repair

Background

The implantation of a polymer mesh is considered as the standard treatment for incisional hernia. It leads to lower recurrence rates compared to suture techniques without mesh implantation; however, there are also some drawbacks to mesh repair. The operation is more complex and peri-operative infectious complications are increased. Yet it is not clear to what extent a mesh implantation influences quality of life or leads to chronic pain or discomfort. The influence of the material, textile structure and size of the mesh remain unclear. The aim of this study was to evaluate if a non-absorbable, large pore-sized, lightweight polypropylene (PP) mesh leads to a better health outcome compared to a partly absorbable mesh.

Methods/design

In this randomised, double-blinded study, 80 patients with incisional hernia after a median laparotomy received in sublay technique either a non-absorbable mesh (Optilene? Mesh Elastic) or a partly absorbable mesh (Ultrapro? Mesh). Primary endpoint was the physical health score from the SF-36 questionnaire 21?days post-operatively. Secondary variables were patients' daily activity score, pain score, wound assessment and post-surgical complications until 6?months post-operatively.

Results

SF-36, daily activity and pain scores were similar in both groups after 21?days and 6?months, respectively. No hernia recurrence was observed during the observation period. Post-operative complication rates also showed no difference between the groups.

Conclusion

The implantation of a non-absorbable, large pore-sized, lightweight PP mesh for incisional hernia leads to similar patient-related outcome parameters, recurrence and complication rates as a partly absorbable mesh.     

Arthroscopic reduction and suture fixation of displaced tibial intercondylar eminence fractures in adults

Introduction Tibial intercondylar eminence fractures are uncommon. In a review of the literature, most authors agreed that conservative treatment was suggested for non-displaced fractures. Displaced fractures were considered an indication for surgery.Materials and methods Between April 2000 and November 2001, five adult displaced tibial eminence fractures were treated by arthroscopic reduction and non-absorbable suture fixation. Postoperatively, the knee was immobilized in a hinged knee brace locked in full extension with non-weight bearing for 4 weeks. Range of motion and quadriceps-strengthening exercises were started 4 weeks later. Partial weight-bearing was allowed in the following 4 weeks.Results The average follow-up was 24.6 months (range 18–36 months). Subjectively, there was no instability or residual pain in the knee. The patients were able to resume their normal activities. Objectively, the average Lysholm Score was 95.6 (range 93–98). The average knee range of motion was 2° to 135° (range 0°–140°). All patients had a negative Lachmans test and no pivot shift phenomenon. All fractures showed good union according to radiological evaluation.Conclusion Arthroscopy-assisted screw fixation is more stable, and it allows early exercise. However, the fragment must be large enough to be fixed with a screw. Comminuted or small fragments present limitations for screw fixation techniques. We used the non-absorbable intraligmentous suture to pull down the fragment regardless of small size or comminuted status. The technique is simple and provided secure fixation without damage to the ACL insertion. A second operation is not required to remove the hardware.     

Mesh repair for postoperative wound dehiscence in the presence of infection: is absorbable mesh safer than non-absorbable mesh?

Objective In patients with postoperative wound dehiscence in the presence of infection, extensive visceral oedema often necessitates mechanical containment of bowel. Prosthetic mesh is often used for this purpose. The aim of the present study was to assess the safety of the use of non-absorbable and absorbable meshes for this purpose. Method All patients that had undergone mesh repair of abdominal wound dehiscence between January 1988 and January 1998 in the presence of intra-abdominal infection were included in a retrospective cohort study. All surviving patients had physical follow-up in February 2001. Result Eighteen patients were included in the study. Meshes consisted of polyglactin (n = 6), polypropylene (n = 8), polyester (n = 1), or a combination of a polypropylene mesh with a polyglactin mesh on the visceral side (n = 3). All patients developed complications, consisting mainly of mesh infection (77%), intra-abdominal abscess (17%), enterocutaneous fistula (17%), or mesh migration through the bowel (11%). Mesh removal was necessary in eight patients (44%). Within four months postoperatively, six patients (33%) had died because of progressive abdominal sepsis. The incidence of progressive abdominal sepsis was significantly higher in the group with absorbable polyglactin mesh than in the group with nonabsorbable mesh (67 vs. 11%, p = 0.02) After a mean follow-up of 49 months, 63% of the surviving patients had developed incisional hernia. Absorbable meshes did not yield better outcomes than nonabsorbable meshes in terms of complications and mortality rate. Conclusion Synthetic graft placement in the presence of intra-abdominal infection has a high risk of complications, regardless of whether absorbable (polyglactin) or non-absorbable mesh material (polypropylene or polyester) is used, and should be avoided if possible.     

Clinical use of a new absorbable suture material in general surgery]

Results with a new, completely absorbable synthetic suture material made of polyglycolic acid (Dexon) in abdominal and anorectal surgery are reported. It is considered that this material can usefully be employed in the place of known absorbable materials and, under certain conditions, non-absorbable materials. No complications due to inflammation and mucosa ulceration following transparietal migration of stitches in the sero-serous or seromuscular layer of the intestine were noted. The results obtained when stitches were left in situ in 37 intradermal sutures, on the other hand, were not so satisfactory and some scars were judged cosmetically poor after 6 months. These results are felt to be caused by Dexon's long absorption time. In cases of this kind, therefore, it should only be used in the form of removable, single stitches.     

Absorbable versus nonabsorbable graft: outcome of bone anchored male sling for post-radical prostatectomy incontinence

PURPOSE: We determined the outcome of the bone anchored male sling procedure for stress urinary incontinence in men regarding the graft material used. MATERIALS AND METHODS: A total of 39 men with post-radical prostatectomy incontinence received a perineal bone anchored male sling. Patients with previous salvage external beam radiotherapy and high serum prostate specific antigen, incontinence due to neurogenic or posttraumatic etiology, or previous benign prostatectomy were excluded. Urodynamic evaluation was performed preoperatively. The number of pads daily used by patients was recorded preoperatively and during postoperative visits. To compress the urethra 2 types of materials were used. Absorbable biomaterials were used in the first 12 patients and nonabsorbable material was used in the following 27. RESULTS: Mean patient age +/- SD was 67.3 years (range 50 to 79). The mean duration between radical prostatectomy and male sling surgery was 57.9 +/- 40.4 months (range 5 to 135). The procedure was successful in 26 patients (96.2%) in the nonabsorbable group and in 1 (8.3%) in the absorbable group at a mean followup of 18.9 and 28.8 months, respectively. CONCLUSIONS: The absorbable sling materials that were used for the bone anchored male sling demonstrated disintegration of the material. Autolysis of these absorbable materials removed active compression forces on the urethra after a short period. Nonabsorbable graft is associated with the best outcome following the perineal bone anchored male sling procedure.     

Meta-analysis of techniques for closure of midline abdominal incisions

BACKGROUND: Various randomized studies have evaluated techniques of abdominal fascia closure but controversy remains, leaving surgeons uncertain about the optimal method of preventing incisional hernia. METHOD: Medline and Embase databases were searched. All trials with a follow-up of at least 1 year that randomized patients with midline laparotomies to closure of the fascia by different suture techniques and/or suture materials were subjected to meta-analysis. Primary outcome was incisional hernia; secondary outcomes were wound dehiscence, wound infection, wound pain and suture sinus formation. RESULTS: Fifteen studies were identified with a total of 6566 patients. Closure by continuous rapidly absorbable suture was followed by significantly more incisional hernias than closure by continuous slowly absorbable suture (P < 0.009) or non-absorbable suture (P = 0.001). No difference in incisional hernia incidence was found between slowly absorbable and non-absorbable sutures (P = 0.75), but more wound pain (P < 0.005) and more suture sinuses (P = 0.02) occurred after the use of non-absorbable suture. Similar outcomes were observed with continuous and interrupted sutures, but continuous sutures took less time to insert. CONCLUSION: To reduce the incidence of incisional hernia without increasing wound pain or suture sinus frequency, slowly absorbable continuous sutures appear to be the optimal method of fascial closure.     

四种固定材料在肋骨骨折内固定中的临床应用及比较

目的比较钢丝、可吸收髓内钉、记忆合金环抱器、条形钢板四种肋骨内固定材料在肋骨骨折内固定中的差异。方法近4年来我科共实施肋骨骨折内固定术83例,其中钢丝固定者11例,可吸收髓内钉固定者34例,记忆合金环抱器固定者25例,条形钢板固定者13例。比较四种固定方式在手术费用,手术时间,胸廓畸形矫正程度,断端复位情况,牢固程度及疼痛程度方面的差异。结果钢丝肋骨固定术操作简单,手术时间短,手术费用低廉,断端复位情况及牢固程度较差,且不可吸收。可吸收髓内钉肋骨固定手术费用较高,断端复位情况及牢固程度较差,但可吸收。记忆合金环抱器操作复杂,手术时间长,费用较高,断端复位情况及牢固程度好。条形钢板手术操作简单,断端复位情况及牢固程度可,术后无肋间神经卡痛现象,但不可吸收,放射线下表现明显。结论四种材料的肋骨固定各有其优缺点,临床上应结合固定材料的特点,病情以及患者经济能力综合考虑应用。     

腹壁正中切口关闭缝合的荟萃分析

目的 以相关的文献资料,对腹壁正中切口缝合关闭技术的安全性和疗效进行荟萃分析.方法 查询MedLine和Embase数据库中1981至2009年有关腹壁正中切口关闭缝合的文献,要求为具有1年以上随访、采用不同缝合技术和(或)不同缝线材料进行腹壁正中切口关腹的随机对照研究.分析指标包括切口疝、伤口裂开、伤口感染、缝线窦道形成等.结果 共纳入文献13篇,共计6263例患者.与连续缝合相比,间断缝合切口疝发生率明显增加(OR=0.80,95%CI:0.66～1.00;P=0.05),两种缝合方式在切口裂开、切口感染和窦道形成方面无显著差异.与连续不吸收缝线缝合相比,采用连续快吸收缝线的切口疝发生率显著增加(8.3%比15.8%,P＜0.05);而连续不吸收缝线缝合的窦道形成发生率更高(5.6%比1.0%,P＜0.05).与连续慢吸收缝线缝合相比,连续快吸收缝线缝合切口疝发生率更高(10.0%比15.8%,P＜0.05);与间断快吸收缝线缝合相比,使用间断不吸收缝线缝合窦道形成发生率更高(0比8.8%,P＜0.05);连续慢吸收缝线缝合与连续不吸收缝线缝合相比,两者切口疝、切口感染、切口裂开发生率等差异无统计学意义,而连续不吸收缝线缝合窦道形成发生率会明显增加(OR=0.47,95%CI:0.24～0.92;P＜0.05).连续缝合时,缝线长度与切口长度比值(SL/WL)＜4∶1与≥4∶1相比,切口裂开、切口感染差异无统计学意义;但SL/WL＜4:l时切口疝发生率会明显增加(P＜0.05).结论 腹壁正中切口缝合关闭以连续全层(SL/WL为≥4∶1)慢吸收缝线关腹为宜,适宜的关腹技术和材料,可以明显减少切口裂开、切口感染和切口疝的发生.     

Anterolateral incision in total knee arthroplasty: is there a role for a longer incision in this day-and-age of minimal invasive surgery?

Study design  Prospective randomised study on the early clinical outcome of anterior midline versus anterolateral incision for total knee arthroplasty (TKA). Purpose  To assess the early clinical outcome of anterior midline versus anterolateral incision for TKA in terms of wound dehiscence, time for wound healing, lateral flap numbness and knee range of movements. Method  A total of 40 consecutive patients randomly received either anterior midline (midline group; 20 patients, 25 TKAs) or anterolateral skin incision (anterolateral group; 20 patients, 24 TKAs) followed by anteromedial arthrotomy. Postoperatively, the patients were assessed for wound dehiscence, time for wound healing, lateral flap numbness and range of movements. Results  Midline group demonstrated more wound dehiscence, longer healing time and lateral flap numbness compared to anterolateral group. Although the incision was shorter in midline group(P < 0.0001), better flexion was achieved in anterolateral (P < 0.0001). Conclusion  Anterolateral incision may be superior in terms of wound healing, lateral flap numbness and knee range of movements and may be a good alternative to the routine anterior midline incision especially in patients who want to kneel, for religious reasons, in the early postoperative period.     

异体肌腱两种方式重建膝内侧副韧带陈旧损伤

目的探讨异体肌腱解剖重建治疗膝内侧副韧带陈旧性损伤的临床效果。方法 2007年3月至2012年2月,收治64例膝内侧副韧带陈旧性损伤患者。男44例,女20例;年龄20~46岁,平均36岁。所有病例外翻试验在膝关节伸直0°及屈膝30°位均呈阳性。双膝伸直位外翻应力位X线片示:双膝内侧关节间隙差3~5 mm 8例,5~10mm 52例,大于10 mm 4例。MRI示内侧副韧带均有损伤的影像学表现,T2相上可见高信号。受伤至入院时间为3~12个月,平均5.8个月。将患者按损伤程度平均分为两组,其中甲组32例患者采用异体半腱肌腱仅重建内侧副韧带浅层前纵束结构,乙组32例患者采用异体半腱肌腱解剖重建浅层及后斜韧带,均采用可吸收挤压螺钉固定。结果术后切口除1例外均Ⅰ期愈合,64例均获随防,随访时间12~58个月,平均30个月。末次随访时根据改良LysholmScale评分标准,甲组优16例,良10例,可6例,优良率为81.25%,乙组优20例,良11例,可1例,优良率为96.88%,均较术前明显改善,两组比较乙组优于甲组,差异有统计学意义。结论使用异体肌腱解剖膝关节内侧副韧带陈旧损伤,重建全面可靠,易于操作,较单纯重建浅层结构临床效果良好。     

Ipsilateral fracture dislocations of the hip and knee joints with contralateral open fracture of the leg: a rare case and its management principles

This paper discussed the injury mechanism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture.A 32-year-old man presented with ipsilateral fracture-dislocations of the left hip (Pipkin's type IV) and knee (Moore II) joints and contralateral open fracture of the leg bones after a car accident. After emergency resuscitative measures, the hip joint was reduced and Pipkin's fracture was fixed using Ganz approach with lag screws; knee joint was reduced closely and tibial plateau fracture was stabilized with lateral buttress plate and a transarticular spanning fixator. The open fracture on the other leg was de-brided and fixed with an external fixator. There was no instability in both joints after fixation when he was examined under anesthesia. The fractures united after 3 months and the patient had no residual instability of hip and knee. There was no clinical or radiological evidence of osteonecrosis in the hip joint after 6 months. At one-year follow-up, he had satisfactory functional outcome with almost normal range of motion at both joints.Ipsilateral hip and knee dislocations are rare injuries and more caution is needed for early diagnosis. A timely appropriate intervention can provide good functional outcome to the patient in this situation.     

Laparoscopic inguinal herniorrhaphy in children--experiences in a primary medical care center

AIM: Children undergoing laparoscopic herniorrhaphy may benefit from a minimally invasive access and the possible exploration of the contralateral groin. In this prospective feasibility study, the experiences and results after introduction of this method in a tertiary referral medical center are reported. METHODS: 50 laparoscopic herniorrhaphies were performed in 44 children (32 boys and 12 girls, range: 17 months-11 years) with open inner inguinal rings between January 2001 and March 2007. In 6 children (13.6 %) an additional contralateral open inner inguinal ring was detected. Laparoscopic access was obtained with a 5-mm laparoscope which was inserted transumbilically and two 2-mm needle holders were inserted through the inferolateral abdominal wall. The open inner inguinal rings were closed in 8 children using a resorbable Z-suture and in 36 children using a monofilamentous non-absorbable suture. Follow-up examinations included records of intra- and postoperative complications, recurrence rate and economic aspects. RESULTS: No intra- or perioperative complications occurred. Median operation time was 19 minutes. 43 / 44 operations were carried on an outpatient basis. Average material costs were about 20 Euro without any difference from the open access. During 36 months the follow-up rate was 91 %. Two children who had previously received an absorbable suture suffered from a recurring groin hernia within the first 6 months. CONCLUSION: Laparoscopic herniorrhaphy in children represents a safe and effective surgical method that can be recommended for tertiary referral medical centers with training facilities and experience in minimally invasive surgery.     

Comparison of polydioxanone (PDS) and polypropylene (Prolene) for Shouldice repair of primary inguinal hernias: a prospective randomised trial.

OBJECTIVE: To compare the recurrence rates after Shouldice operation for primary inguinal hernias, using non-absorbable polypropylene or absorbable polydioxanone suture material. DESIGN: Randomised, controlled trial. SETTING: Teaching hospital, Germany. SUBJECTS: 220 male patients who had 233 elective Shouldice repairs of primary inguinal hernias, 201 of whom were followed up. INTERVENTION: Standard Shouldice procedure with 2/0 polypropylene (Prolene, n = 98) or 2/0 polydioxanone (PDS, n = 103). MAIN OUTCOME MEASURES: Recurrence rates after a minimum follow-up of 24 months (range 24-48, mean 31). RESULTS: Numbers of early complications were similar in the two groups; there were 2 wound infections in each. A total of 193 patients with 201 repairs had a documented follow-up (86%). There were 6 recurrences in the PDS group and 5 in the Prolene group, giving a total recurrence rate of 5%. This difference was not significant (Fisher's exact test, p = 1.0). CONCLUSION: Recurrence rates in both groups were higher than expected, but there was no difference between the two groups.     

关节镜下半月板损伤修复的治疗方法

目的探讨关节镜下半月板损伤缝合修复术的治疗方法和效果。方法1998年6月~2003年5月,收治110例膝半月板损伤患者。其中男78例,女32例。年龄14~66岁,平均27.5岁。半月板滑膜缘纵裂93例,横裂12例,潜行撕裂5例。半月板损伤部位侧缘损伤78例,近前角部损伤23例,近后角部损伤9例。术前Lysholm评分为57±12分。均在关节镜下应用可吸收缝线缝合修复损伤的半月板,其中2针91例,4针13例,6针4例,8针2例。术后行康复训练及随访观察效果。结果术后关节无血肿、伤口期愈合。全部获随访12~67个月,平均26个月。3例患者劳累后出现膝关节胀痛,1例半月板损伤症状再出现,再手术探查见半月板缝合处未完全愈合,行半月板部分切除,术后痊愈。其余患者症状消失,关节功能良好。术后Lysholm评分为92±7分。结论关节镜下半月板损伤缝合修复术安全、可靠、操作简便。缝线吸收后,避免对半月板的制约,使愈合的半月板更好地发挥其生理和生物力学功能。