Rotator cuff repair with a novel mesh suture: An ex vivo assessment of mechanical properties

Surgical repair is a common treatment for rotator cuff tear; however, the retear rate is high. A high degree of suture repair strength is important to ensure rotator cuff integrity for healing. The purpose of this study was to compare the mechanical performance of rotator cuffs repaired with a mesh suture versus traditional polydioxanone suture II and FiberWire sutures in a canine in vitro model. Seventy‐two canine shoulders were harvested. An infraspinatus tendon tear was created in each shoulder. Two suture techniques—simple interrupted sutures and two‐row suture bridge—were used to reconnect the infraspinatus tendon to the greater tuberosity, using three different suture types: Mesh suture, polydioxanone suture II, or FiberWire. Shoulders were loaded to failure under displacement control at a rate of 20 mm/min. Failure load was compared between suture types and techniques. Ultimate failure load was significantly higher in the specimens repaired with mesh suture than with polydioxanone suture II or FiberWire, regardless of suture technique. There was no significant difference in stiffness among the six groups, with the exception that FiberWire repairs were stiffer than polydioxanone suture II repairs with the simple interrupted technique. All specimens failed by suture pull‐out from the tendon. Based on our biomechanical findings, rotator cuff repair with the mesh suture might provide superior initial strength against failure compared with the traditional polydioxanone suture II or FiberWire sutures. Use of the mesh suture may provide increased initial fixation strength and decrease gap formation, which could result in improved healing and lower re‐tear rates following rotator cuff repair. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:987–992, 2018.

     

Comparison of Patient Satisfaction and Practitioner Satisfaction with Wound Appearance after Traumatic Wound Repair

Introduction : Existing cosmetic scales for wounds are based only on practitioners' evaluations. They have not been validated using the patient's assessment.
Objective : To validate a previously developed wound cosmesis scale by determining the relationship between patient and practitioner assessments of cosmetic outcome following traumatic wound repair. Methods : A convenience sample of patients with lacerations repaired in an ED were evaluated at the time of suture removal. Practitioners assigned 0 or 1 point each for the presence or absence of a step-off of borders; contour irregularities; margin separation; edge inversion; excessive distortion; and overall appearance. A total cosmetic score was calculated by adding the categories above. As previously defined, a score of 6 was considered optimal; < s6 was considered "suboptimal." Patients, blinded to the physician score, assessed their degrees of satisfaction with the cosmetic outcome of the wounds using a 100-mm visual analog scale (VAS). Because VAS scores were not normally distributed, practitioner scores were compared with patient satisfaction scores using a Mann-Whitney U test.
Results : 125 patients were enrolled, of whom 64% were male; the median age was 19.5 years (interquartile range = 8–33 years). Wounds were located predominantly on the face, scalp, or neck (47%) and upper extremity (35%), and had a median length of 2 cm. The 86 lacerations given optimal practitioner scores had a median patient satisfaction score of 97 mm; the 39 "suboptimal" lacerations had a median patient satisfaction score of 87 mm (p = 0.0006).
Conclusion : Lacerations that practitioners ponsidered to have optimal cosmetic appearances at the time of suture removal received higher patient satisfaction scores than did lacerations considered to be suboptimal. This provides a measure of validity to this 6-item categorical cosmetic scale.     

复合式小梁切除术在难治性青光眼的应用

目的 :探讨复合式小梁切除术在难治性青光眼的临床效果。方法 :对 36例 4 2眼的难治性青光眼 ,在表面麻醉加球结膜下麻醉后采用小梁切除术、丝裂霉素和可松解缝线的缝合等一系列方法进行治疗 ,术后对视力、视野、前房、眼压、滤过泡形态进行观察 ,总结分析疗效。结果 :36例 4 2眼术后都经半年以上的随访 ,术前平均眼压 (32 6± 4 9)mmHg,术后 (14 9± 3 0 )mmHg,下降率为 5 4 3% ,手术前后有非常显著性差异 (P <0 0 1)。其中 33例 39眼术后未用降压药 ,眼压控制在 8～2 1mmHg之间 ,2例 2眼局部用一种抗青光眼眼药水 ,眼压控制在 2 1mmHg以下 ,一例近绝对期青光眼 ,术后眼压未能控制在2 1mmHg以下 ,因患者无明显不适未作进一步处理。术后视力无改变的 32例 38眼 ,1例 1眼因眼底出血 ,经治疗视力不稳定 ,3例 3眼因原有的晶体混浊加重而引起视力下降 ,4 2眼中Ⅰ型滤过泡 2 9眼 ,Ⅱ型滤过泡 12眼 ,Ⅲ型滤过泡 1眼 ,功能性滤过泡占 97 6 %。结论 :复合式小梁切除术 ,术式简单、安全、效果好、易掌握 ,是难治性青光眼一种理想的手术方式。     

无缝线翼状胬肉切除术

目的通过翼状胬肉切除手术中运用丝裂霉素C,免除结膜缝线。方法以胬肉颈部切断,倒向"撕除"胬肉头,切除胬肉体部,0.02%丝裂霉素C留置巩膜床3min,不缝合球结膜。结果该法与常规丝裂霉素C运用的缝线手术复发率结果类似。结论该法较缝线法手术简洁,创伤小、速度快,消除了医源性巩膜穿孔的可能。不需要拆线,患者术后不适感少。     

心脏瓣膜置换的缝合技术

心脏瓣膜置换有多年的历史，瓣膜的缝合方法也有多种类型，然而，现有的间断缝合和连续缝合均有一定的缺陷，新型的瓣膜手术缝线可以充分吸取现有缝合方法的优点，而除去其缺点，是比较理想的缝线。     

Anatomical modifications of the mid palatal suture during ageing: a radiographic study

In transverse maxillary deficiencies it is important to know if the mid palatal suture is obliterated or not, to decide which treatment to perform (orthodontic expansion or surgical disjunction of the suture). The maxillary sutures obliteration has been used in forensic medicine in estimating adult age at death. In order to determine the proportion of mid palatal suture obliteration in the elderly in man, we examined 100 consecutive CT scans of the palate. This study has shown that the age of mid palatal total obliteration was variable. The obliteration begins in the anterior and in the superior part of the palate. The inferior part of the junction between the palatal processes is the last part of the suture to be obliterated.     

精细缝合与局部皮瓣在面部外伤修复中的应用

目的 探讨精细缝合与局部皮瓣在修复面部外伤中的疗效,总结分析其应用效果.方法 面部外伤患者80例,分为观察组(40例)与对照组(40例),观察组采用精细缝合与局部皮瓣方式进行修复,对照组以传统缝合方式修复,分析两组患者伤口愈后瘢痕情况及患者满意度的区别.结果 术后3个月随诊患者满意度评分,观察组(89.21 ±5.45)分,对照组(64.84 ± 7.36)分,观察组明显高于对照组(t=16.830,P<0.05),观察组和对照组瘢痕宽度[(0.68 ±0.47)vs(1.96 ±0.31)mm]、瘢痕评分[(0.72 ±0.63)vs(1.85 ±0.78)分]比较,差异有统计学意义(P<0.05).结论 对面部外伤采用精细缝合或应用局部皮瓣修复,能够有效减轻瘢痕形成,满足患者的美容要求.     

单向免打结倒刺缝线双层连续缝合在后腹腔镜肾部分切除术中的应用

目的探讨双层连续免打结缝合,单层连续免打结缝合与单层间断缝合在肾部分切除术中的应用。方法 2011年1月-2015年1月93例肾肿瘤患者接受后腹腔镜下肾部分切除术治疗。所有手术均为同一术者完成。术中依据手术创面缝合方法分为3组。单层间断组22例,采用单层间断8字缝合,肿瘤床同时填塞止血纱布卷。单层连续组28例,采用单层可吸收缝线免打结连续缝合,应用Hem-o-loc替代打结。双层连续组共43例,为双层免打结可吸收单向倒刺缝线连续缝合。比较3组患者手术时间、围手术期结果和围手术期并发症等情况差异。结果 93例患者无中转开放,5例术中转为根治性手术。3组除肿瘤大小有差别外,性别、年龄和部位无差别。单层间断组,单层连续组,双层连续组手术时间分别为(94.00±19.00)min vs(85.00±14.00)min vs(75.00±10.00)min(P0.05),术中平均出血量分别为(131.00±57.00)ml vs(96.00±34.00)ml vs(76.00±22.00)ml(P0.05)。平均肾热缺血时间3组分别为(27.30±4.90)min vs(22.60±4.20)min vs(19.90±3.80)min(P0.05)。3组术后肠道恢复时间和术后出院时间差异无统计学意义。单层间断组、单层连续组和双层连续组术中转根治术分别为3、1和1例。术后尿瘘分别为3、1和0例。术后血肿形成分别为3、1和1例。均给予保守治疗后治愈出院。结论免打结可吸收倒刺缝线双层连续缝合可减少后腹腔镜肾部分切除术中热缺血时间,减少术中术后并发症发生。     

三点肛垫悬吊联合消痔灵注射治疗痔疗效观察

目的探讨应用肛垫悬吊联合消痔灵注射治疗痔的可行性和安全性。方法在齿线上4cm，直肠左侧、右上、右下，用可吸收线“Z”形缝合悬吊肛垫并在黏膜下注射消痔灵。治疗痔50例，其中混合痔32例，内痔18例。观察术后便血，痔核脱垂等症状发生率及并发症。结果50例总治愈率96％，总好转率100％，无效为0；其中混合痔治愈率93．7％，好转率100％，内痔治愈率100％。结论肛垫悬吊联合消痔灵注射是治疗痔的一种有效方法，具有手术简单、安全，疗效确切，术后并发症少，恢复工作快，费用低廉等优点。