Suitability for day surgery of trabeculectomy and phacotrabeculectomy using 10-0 polyglactin suture

Objective: To evaluate the suitability of trabeculectomy or phacotrabeculectomy as a day case procedure with the objective of keeping the post-operative intraocular pressure (IOP) under control, both short-term and long-term, and post-operative complications at a low level. Method: A total of 27 eyes undergoing trabeculectomy with or without phacoemulsification for either primary open angle glaucoma or chronic angle closure glaucoma were chosen. All of them had surgery as day cases under sub-tenon injection. IOP check was done at baseline, day 1, month 1, month 6 and year 1 on 27 eyes. Post-operative complications directly related to aqueous drainage were noted at day 1. Result: Mean, mode and range of IOP at each level were analysed. Mean pre-operative IOP was 23.34 mmHg. Post-operative IOP was lowest on day 1 (mean 10.03 mm) which stabilised to mean IOP of 16.3 mmHg at year 1. At 1 year the success rate (IOP less than 21 mmHg) was 92.3% without any glaucoma medication; however, if IOP control with medication (less in number than before surgery) is taken into account the success rate was 96%. Post-operative complications were few and transient. Conclusion: Graded control of post-operative IOP was possible using 10-0 polyglactin suture. IOP on day 1 was not very low due to adequate suture tension and at the same time good control of IOP longterm (1 year in this study) was possible due to gradual release of suture tension by slow absorption. This is ideally suited for day surgery.     

Evaluation of 10-0 polyglycolic acid and polyglactin suture in rabbit limbal wounds

Sutures of 10-0 polyglycolic acid (Dexon) or polyglactin (Vicryl) were used to close limbal incision in rabbits. When seven Dexon or Vicryl sutures were used alone wound disruption occurred in eight of twelve eyes. Sutures disappeared at 4-5 weeks. When three 10-0 nylon sutures were alternated with four 10-0 absorbable sutures, wound integrity was greatly improved. The handling properties of these sutures were excellent and inflammatory reactions were minimal. The 10-0 Dexon and Vicryl did not appear to differ in their properties, but they were insufficient for lasting would closure when used alone. It is suggested that these sutures not be used as the sole closure for limbal wounds.     

The clinical evaluation of 9-0 and 10-0 monofilament Polyglactin 910 absorbable suture for corneal surgery.

The 9-0 or 10-0 monofilament Polyglactin 910 absorbable (Vicryl) suture was utilized in combination with 10-0 nylon suture for 35 patients undergoing corneal surgery in order to evaluate the clinical usefulness of a very fine absorbable suture material. The maintenance of wound approximation, degree of tissue reaction, and rate of absorption were observed along with any adverse effects. Adequate wound closure was maintained in all cases. Little tissue reaction was present in the cornea although a slightly increased healing time was observed for the corneal epithelium in five cases. Absorption was complete within six weeks. The clinical usefulness appears to be in patients who might avoid an additional general anesthetic for suture removal by using the absorbable 10-0 Vicryl for small corneal lacerations and incisions.     

Suitability of orthopaedic day surgery in Emilia-Romagna

The Emilia-Romagna Regional Authority has encouraged the development of day surgery practice in this healthcare program. This study analyzes the results of the program, with particular attention to the field of orthopaedics, with the aim of defining the type of operations that can be carried out in day surgery. There has been a marked increase in the rate of day surgery operations in all fields of surgery on the whole. However, in orthopaedics, the average rate was lower than the general trend. On the other hand, there has been an increased use of day surgery for some types of operations not included in those indicated by the region. Results of the data analyzed suggest that the use of day surgery for orthopaedics can be extended, and so can the regional indications for operations that can be performed by this method of treatment.     

A comparative evaluation of 9-0 monofilament and 9-0 braid polyglactin 910 in cataract surgery (intracapsular, extracapsular, and phacoemulsification)

This study describes the operative and postoperative performance of 9-0 monofilament and 9-0 braid Polyglactin 910 synthetic absorbable sutures in cataract surgery. The evaluation represents a clinical comparison of the sutures in 150 cataract surgical procedures. In a comparative evaluation each suture provided specific performance advantages: (table: see text). To date, the 9-0 monofilament and 9-0 braid Polyglactin 910 sutures are the smallest useful absorbable sutures developed for cataract surgery. While these sutures seem safe for use with phacoemulsification as sole wound closure materials, we recommend the use of nylon stints for intracapsular and extracapsular procedures until further experience is gained.     

Topographic changes that occur with 10-0 running suture removal following penetrating keratoplasty

Twelve eyes undergoing penetrating keratoplasty with a double-running suture technique had corneal topographical analysis immediately before and one month after 10-0 suture removal. Substantial changes in astigmatism were evident following suture removal. Twenty five percent of eyes showed a decrease of 1 D, 33% of eyes showed a decrease of 3 D, 8.3% of eyes showed an increase of 1 D, 8.3% of eyes showed an increase of 2 D, 16.6% of eyes showed an increase of 3 D, and 8.3% of eyes showed an increase of 4 D of astigmatism following suture removal. The mean corneal astigmatism did not show a significant change from a mean of 5.3 D after suture removal. There was less individual variation of spherical corneal power following suture removal. Thirty three percent of eyes showed a decrease of 1 D, 33% of eyes showed a decrease of 2 D, 8.3% of eyes showed a decrease of 3 D, 18.3% of eyes showed an increase of 1 D, and 6.6% of eyes showed an increase of 2 D of spherical power following suture removal. The surface asymmetry index (SAI), a centrally weighted measure of corneal surface irregularity, decreased significantly (P less than 0.04) from a mean of 1.17 before suture removal to a mean of 0.93 after suture removal. These results suggest that surface irregularity may be decreased following the removal of a single running 10-0 nylon suture following penetrating keratoplasty.     

Shortterm and longterm visual and astigmatic results of an opposing 10-0 nylon double running suture technique for penetrating keratoplasty

BACKGROUND: In ophthalmic surgery, corneal transplantation (penetrating keratoplasty) may be employed when the clarity of the cornea has been significantly compromised by conditions such as scarring, edema, and variable corneal thickness. Irregularities in corneal curvature can occur postoperatively. This astigmatism is of concern, because it can impair visual acuity despite an otherwise good surgical result. Different suturing techniques have been developed to minimize astigmatism. The purpose of this study was to evaluate an opposing 10-0 nylon double running suture technique for penetrating keratoplasty. STUDY DESIGN: A retrospective study was undertaken of 91 records of patients who underwent penetrating keratoplasty performed by one surgeon (RNG). This represents 54.8% of 166 consecutive cases. Every eye with an opposing double running suture and a 1- to 3-month postsuture removal followup was selected and evaluated for best corrected visual acuity and astigmatism, excluding eyes that developed graft failure or corneal ulcer or that had lack of adequate followup. The cases were divided into five groups by preoperative diagnosis: pseudophakic bullous keratopathy (n = 43), aphakic bullous keratopathy (n = 5), keratoconus (n = 17), Fuchs dystrophy (n = 12), and miscellaneous (n = 14). The mean standard followup period was 13.7 months after penetrating keratoplasty. Thirty percent of the eyes had an extensive followup, with a mean of 33 months after penetrating keratoplasty. RESULTS: Eighty-two percent of the patients had a significant improvement of their visual acuity postoperatively, defined by a five-line improvement of best corrected visual acuity or a best corrected visual acuity of 20/40 or better. The mean astigmatic keratometric reading was 3.98 diopters, with a manifest refraction cylinder of 3.42 diopters at the 1- to 3-month postsuture removal visit. This study also shows that there is no statistically significant change in keratometric astigmatism or manifest refraction cylinder from the 1- to 3-month postsuture removal measurements to the more extensive followup of 18 to 66 months after penetrating keratoplasty (p > 0.10). CONCLUSIONS: This suture technique allows for excellent longterm stability of the wound with visual and astigmatic results that are comparable to those of previous studies. The use of the opposing double running suture is a viable alternative to some of the other widely used techniques and may be considered more stable and secure.     

Comparison of 10-0 polypropylene and 10-0 nylon sutures in rat arterial anastomosis

The selection of suture materials is an important factor in further improving the results of microsurgical operations. In this study, two kinds of nonabsorbable suture materials, 10-0 polypropylene and 10-0 nylon monofilament, were compared in end-to-end anastomosis of 66 femoral arteries of adult rats. Both suture types were of identical size (70 μm needle/28 μm suture) and each artery received eight sutures. The vessels were harvested at various intervals from 2 hr to 180 days postoperatively and were evaluated by pathology, radiology, and tensile strength test. The results show that both sutures are capable of achieving excellent long-term patency (100%) of anastomosed sites. Polypropylene suture was equivalent to nylon in mechanical integrity of the anastomosis sites but was superior in handling, knotting, and biocompatibility. These physical and biological properties of polypropylene sutures may offer the benefits of diminished early and late complications at anastomosis sites and reduced operation time. Enhancement of contrast against surrounding tissue may make polypropylene a superior alternative to nylon sutures for microsurgical use. © 1993 Wiley-Liss Inc.     

The in-vitro assessment of a collagen/vicryl (polyglactin) composite film together with candidate suture materials for use in urinary tract surgery

Summary Collagen coated vicryl mesh has been incubated with a series of urine collections from healthy and stoneforming patients. For comparison, collagen film, vicryl mesh, and a number of absorbable and non-absorbable sutures were similarly tested. Incubation in rabbit urine were also included in the study. Deposition of urinary salts, estimated qualitatively by electron microcopy, were observed on the collagen vicryl composite in approximately two thirds of the urines tested including rabbit urine. Those urines from patients with a high calcium excretion in particular caused urinary deposits on the material. Similar results were obtained with collagen film although the latter was not tested in rabbit urine. Considerably less deposits of urinary constituents were found with other absorbable materials such as vicryl mesh, vicryl sutures, and chromic catgut, whereas a higher proportion of concretions were found with the nonabsorbable sutures. The results indicate that urinary salt deposition may be a problem associated with collagen based composite materials after prolonged exposure to urine. It must, however, be emphasised that great care should be exercised when extrapolating any results obtained in-vitro to the in-vivo situation.     

小切口可吸收线张力带克氏针治疗锁骨骨折

目的比较小切口可吸收线张力带克氏针与常规术式在治疗锁骨骨折方面的切口长度及并发症发生率。方法用小切口可吸收线张力带克氏针治疗锁骨骨折26例(实验组),用常规术式(包括单纯克氏针、钢板、钢丝环扎等)治疗38例(对照组),比较两者切口长度及并发症。结果手术切口长度:实验组为(2.52±0.53)cm,对照组为(6.34±1.26)cm(P<0.01)。并发症发生率:实验组11.54%,对照组63.16%(P<0.01)。结论小切口可吸收线张力带克氏针治疗锁骨骨折在切口长度及并发症发生率方面优于常规术式。     

The in vitro assessment of a collagen/vicryl (polyglactin) composite film together with candidate suture materials for use in urinary tract surgery

Summary A Vicryl (Polyglactin)/Collagen composite membrane has been developed for potential use in urinary tract surgery. The compatability of this membrane, together with its two individual components, collagen film and vicryl mesh, has been tested over a three week period in urine obtained from both healthy and from stone forming patients. The rate of degradation as indicated by changes in the mechanical strength was determined at regular intervals. In addition,absorbable suture materials such as plain catgut, chromic catgut, and vicryl were similarly tested; in the latter case, the breaking stress, and actual loss of weight of the material were compared. The whole series of experiments were then repeated in urine obtained from rabbits, the animal chosen for any future in vivo studies.     

The use of human fibrin glue and of the suture in polyglactin 910 in extraintracranial by-pass

At the Division of Neurosurgery of Fatebenefratelli-Oftalmico Hospital in Milano, 12 of the last 22 temporosylvian anastomosis have been performed employing sutures with separate points in mixed materials, partly nylon and partly Polyglactin 910 (reabsorbable) in order to avoid as much as possible the disadvantages of permanent sutures; in the other 10 consecutive cases reducing about 50% the points of suture and employing human fibrin glue as complement of the suture, in order to respect better the arterial wall and to reduce significantly the critical times of the operation (clampage). The Authors compared the clinical and instrumental results of the patients of this series with the ones of a previous series operated with traditional technique and pointed out a better success in the last operations (mixed materials and fibrin glue).     

Complications of 10-0 nylon sutures.

Three cases are presented which document the finding that 10-0 monofilament nylon suture may cut through corneal tissue after a coup or contrecoup injury to a recently operated eye. The authors speculate that a larger gauge suture does not have the tendency to cut through recently operated corneal tissue as easily as 10-0 monifilament nylon. The authors recommend the use of a larger gauge suture in closing corneal incisions in persons whom the surgeon feels are at a greater postoperative traumatic risk.     

Postoperative analgesia and discharge criteria for day surgery

Day surgery has a major role in delivering high-quality care in the modern NHS of today. It has rapidly expanded in recent times. Economic benefits, reduced bed numbers, patient preference and modern minimally invasive surgical techniques are responsible for this. Provision of effective and long-lasting postoperative analgesia coupled with stringent discharge criteria are essential in order to run a successful day-surgery facility. A multi-modal approach to analgesia is most effective, incorporating paracetamol, non-steroidal anti-inflammatory drugs, local anaesthesia and opioids if necessary. In patients with opioid-tolerance, gabapentinoids are useful as alternative analgesics. Dexamethasone, in addition to anti-emetic properties, has analgesic effects in certain procedures. Ketamine and clonidine may have their place as rescue analgesia in recovery or in certain patient groups. Spinal anaesthesia is increasingly a viable option in this setting with the advent of hyperbaric prilocaine. Protocols should be in place to manage analgesia in the recovery room. Discharge from day-surgery should be done in a safe manner with the emphasis on patient quality of care. Discharge scoring systems are available, which can assist staff to assess whether a patient is fit for discharge. These systems do have limitations and local guidelines are encouraged. Designated lead clinicians incorporating anaesthetists, surgeons and nursing staff should work together in the development of local guidelines and the safe running of a day-surgery facility. Patients and their carers, upon discharge, should be issued with a set of procedure-specific written instructions containing useful information and an emergency helpline. Regular audit is mandatory for the effective running of a day-surgery facility.     

Postoperative analgesia and discharge criteria for day surgery

After day surgery, patients are discharged within a relatively short time. A meticulous and safe anaesthetic technique, which enables a good-quality recovery with minimal postoperative morbidity, is required. The provision of adequate analgesia from the time of operation and the following few days is paramount for patient satisfaction. Multimodal analgesia using regular paracetamol and non-steroidal anti-inflammatory drugs, with local anaesthesia where appropriate and weak opioids for breakthrough pain, is ideal. Postoperative nausea and vomiting should be minimized by adequate hydration and avoiding long-acting opioids. Discharge criteria must be robust, although the requirement for oral intake and voiding before discharge in low-risk patients is currently being questioned. Patients must be given adequate verbal and written instructions on pain relief and possible complications before discharge.