Evaluation of In Vivo Properties of Velosorb™ Fast Versus Vicryl™ Rapide in a Functional Rabbit Model of Intradermic Suture and Episiotomy

Objective: Fast-absorbing polyglactin 910 is commonly used to suture skin and vaginal incisions. In vitro studies have shown similar tensile strength properties between Velosorb? Fast and Vicryl? Rapide (Al-Qattan MM. J Hand Surg Br Eur. 2005;30(1):90–91). This randomized study compared Velosorb? Fast (Covidien) with Vicryl? Rapide (Ethicon) in a rabbit model of intradermic suture and episiotomy. Materials and Methods: This randomized prospective study was performed on 20 New Zealand rabbits, in which we realized a mediolateral perineo-vaginal incision and two vertical skin incisions of about 8 cm on the abdominal wall. The sutures were randomized between Velosorb? Fast (Covidien) and Vicryl? Rapide (Ethicon), and each rabbit was treated with the same suture on both vaginal incision and left abdominal incision, while the right abdominal incision was closed with an alternate suture. A macroscopic examination was performed on days 5 and 11. On day 11, animals were sacrificed for histological (Badylak quantitative score) and electron microscopic examinations. Differences were considered significant at p < .05. Results: All of the rabbits survived and were included in the final results. Fifty-one sutures were visible by histologic analysis (27 in the Velosorb? Fast group and 24 in the Vicryl? Rapide group). The power of the study was ≥80%. There was no significant difference between the two groups based on the total histologic Badylak score analysis or the Badylak sub-score analysis. Conclusions: Velosorb? Fast seems to be as efficient as Vicryl? Rapide for use in perineal and skin closure.     

Influence of differences in the hardness and calcium content of diets on the growth of craniofacial bone in rats

Objective:To examine the effects of a soft diet and a low-calcium diet on the craniofacial growth and bone architectures of the maxilla and mandible.Materials and Methods:Male rats (n  =  20, 3 weeks old) were divided into four groups. Ten rats were given a normal-calcium diet, and the other rats were given a low-calcium diet. Each group was then divided into two subgroups, which were fed a hard or a soft diet. After 4 weeks, craniofacial growth and architecture in maxillary and mandibular bone were analyzed using cephalometry, micro-computed tomography, and histopathology.Results:The low-calcium diet had no effect on serum calcium levels. The low-calcium diet had the greatest effect on craniofacial bone growth, while the soft diet affected the growth of several bone sites that are attached to the masseter muscle. A low-calcium diet resulted in the deterioration of the connectivity of the trabeculae in the furcation region of the maxillary and mandibular first molar, while a soft diet resulted in the diffuse disappearance of trabeculae in the central part of the furcation regions. In the midpalatal suture, a low-calcium diet resulted in inhibition of cartilaginous ossification, although the midpalatal suture had a normal cartilaginous structure. A soft diet resulted in narrower cartilage cell layers in the midpalatal suture.Conclusions:We demonstrated that a low-calcium diet and a soft diet resulted in a deterioration of bone structures in both the maxilla and in the mandible; however, the mechanisms underlying these effects differed between diets.     

B-Lynch缝合术治疗8例剖宫产后出血体会

目的探讨B-Lynch缝合术治疗剖宫产后出血的效果。方法对8例剖宫产后出血患者采用B-Lynch缝合术治疗,回顾性分析患者的病历资料。结果 8例患者均经B-Lynch缝合术成功止血,无1例因血液循环不良或再出血手术或子宫切除。子宫复旧、月经复潮时间无异常。结论剖宫产后子宫收缩乏力性出血药物治疗无效时,B-Lynch缝合术操作简单易行,止血效果可靠,尤其适合在基层医院开展。     

Barbed Sutures and Tendon Repair—a Review

Introduction

Traumatic tendon lacerations are a common problem encountered by hand surgeons worldwide. Although the use of barbed suture to repair tendon lacerations has gained theoretical popularity in recent years, there is little information available regarding the safety, efficacy, longevity, or complications encountered when used in tenorraphy. In this study, we review the available literature on the use of barbed suture in tendon repair.

Methods

Studies conducted between 1980 and 2014 were identified using several databases, including EMBASE, SCOPUS, MEDLINE, and Web of Science. Keywords used to search for appropriate studies included the following: barbed, v loc, quill, tendon, tendon injuries, suture, tenorraphy, injury, and laceration, in various combinations.

Results

Our initial literature search identified 47 articles, and 8 were deemed appropriate for review after applying our exclusion criteria. The data from each of the articles is reviewed for the following major categories:

1. Maximum load to failure
2. Mode of failure
3. Load to 2-mm gap
4. Change in cross-sectional area
5. Type of repair

Conclusions

Barbed suture tenorraphy has a myriad of theoretical advantages, supported by varying ex vivo studies, as compared to traditional techniques. However, due to the non-uniformity in current studies and the lack of available data in a live model, we are unable to argue for or against barbed suture tenorraphy. We believe our review provides the most in-depth analysis of barbed suture tenorraphy to date, illuminates the potential advantages of using barbed sutures, and highlights the need for further investigation into this technique.     

膝关节镜下中心成形联合边缘稳定术治疗外侧盘状半月板损伤

目的探讨关节镜下中心成形联合边缘稳定术治疗外侧盘状半月板损伤的疗效。方法收集自2009-01—2013-08诊治的盘状半月板损伤68例(72膝),经MRI和关节镜下确诊后,随机分成2组。A组给予保留边缘6~8 mm成形联合半月板稳定术,进行体部、肌腱裂口周围垂直缝合固定,前、后角经胫骨骨道固定;B组行盘状半月板全切或次全切除术。观察2组术后3、6、12膝关节功能Lysholm评分,术后12个月MRI半月板板台比。结果 A组34例获得随访,B组34例获得随访,随访时间平均12.3(12~14)个月。患者术后关节活动度恢复满意,关节交锁及弹响症状消失,无再撕裂或因症状复发需要二次手术者。2组术后3、6个月Lysholm评分差异无统计学意义(t=1.826,P=0.077;t=0.442,P=0.661);术后12个月A组Lysholm评分较B组高,差异有统计学意义(t=3.718,P=0.001)。A组术后12个月MRI半月板板台比为(9.2±2.6)%,B组为(5.0±2.7)%,A组残存半月板板台比较B组高,差异有统计学意义(t=3.475,P=0.001);但比同侧正常的(12.3%)低。结论对于不稳定盘状软骨损伤,在半月板成形的基础上,给予周边缝合固定及前后角重建固定,能最大程度地保留外侧半月板周缘并保持其稳定性,具有良好的短期疗效。     

Surgical suture assembled with polymeric drug-delivery sheet for sustained,local pain relief

Surgical suture is a strand of biocompatible material designed for wound closure, and therefore can be a medical device potentially suitable for local drug delivery to treat pain at the surgical site. However, the preparation methods previously introduced for drug-delivery sutures adversely influenced the mechanical strength of the suture itself – strength that is essential for successful wound closure. Thus, it is not easy to control drug delivery with sutures, and the drug-delivery surgical sutures available for clinical use are now limited to anti-infection roles. Here, we demonstrate a surgical suture enabled to provide controlled delivery of a pain-relief drug and, more importantly, we demonstrate how it can be fabricated to maintain the mechanical strength of the suture itself. For this purpose, we separately prepare a drug-delivery sheet composed of a biocompatible polymer and a pain-relief drug, which is then physically assembled with a type of surgical suture that is already in clinical use. In this way, the drug release profiles can be tailored for the period of therapeutic need by modifying only the drug-loaded polymer sheet without adversely influencing the mechanical strength of the suture. The drug-delivery sutures in this work can effectively relieve the pain at the surgical site in a sustained manner during the period of wound healing, while showing biocompatibility and mechanical properties comparable to those of the original surgical suture in clinical use.     

Bending and abrasion fatigue of common suture materials used in arthroscopic and open orthopedic surgery

In orthopedic surgery, the reattachment of tendon to bone requires suture materials that have stable and durable properties to allow time for healing at the tendon–bone interface. The suture, not rigidly restrained within the anchor eyelet, is free to move during surgery and potentially after surgery with limb motion. During such movement, the suture is subjected to bending and frictional forces that can lead to fatigue‐induced failure. We investigated some common contemporary commercial number‐two‐grade suture materials and evaluated their resistance to bending abrasion fatigue and the consequent failure. Sutures were oscillated over a stainless steel wire at low frequency under load. Number of abrasion cycles to failure, changes in suture morphology, and fatigue‐failure method was recorded for each material. Suture structure had a significant effect on abrasion resistance, with braided sutures containing large numbers of fine high tenacity core filaments performing15–20 times better than other braided suture structures. Ultra high molecular weight polyethylene (UHMWPE) core filaments resisted bending abrasion failure better than other core materials due to the load spreading and abrasion resistance of these filaments. Sutures with UHMWPE cores also had high resistance to tensile failure. Limited correlation was observed between tensile strength and abrasion resistance. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:132–138, 2012