ADJUSTABLE SUTURES IN STRABISMUS SURGERY: A PERSONAL SERIES OF CASES

A personal series of 77 separate primary adjustable suture procedures performed on 69 patients is analysed. Adjustable suture surgery was performed on patients over ten years of age undergoing rectus muscle surgery, and a few selected younger patients. The ages ranged from 7 to 74 years. A 24-month-old infant who had a two-stage-anaesthesia is included in the series.
Thirty-eight of the 69 patients were reoperations. Of the 77 primary procedures, 48 (62.3%) required postoperative adjustment; 29 (37.7%) were tied down without adjustment.
Sixty-two of the 69 patients (89.8%) achieved a "cure". A further four patients (5.8%) were initially in desired alignment, but deteriorated within the follow-up period. Three of these were successfully reoperated. Of the three primary failures (4.4 %) two were reoperated with one achieving orthophoria.
Apart from alignment failure in the primary procedure, complications were minimal. Current follow-up periods range from one to 24 months.     

Cranial sutures and craniometric points detected on MRI

The main goal of the study was to determine on MRI the cranial sutures, the craniometric points and craniometric measurements, and to correlate these results with classical anthropometric measurements. For this purpose, we reviewed 150 cerebral MRI examinations considered as normal (Caucasian population aged 2049 years). For each examination we individualized 11 craniometric landmarks (Glabella, Bregma, Lambda, Opisthocranion, Opisthion, Basion, Inion, Porion, Infra-orbital, Eurion) and three measurements. Measurements were also calculated independently on 498 dry crania (Microscribe 3-DX digitizer). To validate the MRI procedure, we measured four dry crania by MRI and with compass or digital caliper gauges. Cranial sutures always appeared without signal (black), whatever the MRI sequence used, and they are better visualized with a 5 mm slice thickness (compact bone overlapping). Slice dynamic analysis and multiplanar reformatting allowed the detection of all craniometric points, some of these being more difficult to detect than others (Porion, Infra-orbital). The measurements determined by these points were as follows: VertexBasion height=135.66±6.56 mm; EurionEurion width=141.17±5.19 mm; GlabellaOpisthocranion length=181.94±6.40 mm. On the midline T1-weighted sagittal image, all median craniometric landmarks can be individualized and the GlabellaOpisthocranion length, VertexBasion height and parenchyma indices can be calculated. Craniometric points and measurements between these points can be estimated with a standard cerebral MRI examination, with results that are similar to anthropometric data.     

Repair of lumbar incisional hernia using polypropylene mesh strip sutures – A case report

IntroductionLumbar hernias are considered rare and they constitute less than 1.5% of all abdominal wall hernias.Case reportHere we present a case of a 72-year-old female with a left flank swelling since 2-years diagnosed as a lumbar incisional hernia. This lumbar incisional hernia¹ was repaired successfully using polypropylene mesh strip sutures.²DiscussionMany surgical techniques have been described for repair of LIH. Suture repair, mesh repair and myofascial flaps have been described for lumbar hernias. Repairing a lumbar hernia can be surgically challenging because of its proximity to bony structures, which can limit proper dissection and mesh overlap. We performed defect closure with PMSS. Patient has no recurrence after 2 years of follow up.ConclusionIn our case of left lumbar incisional hernia, defect closure with PMSS was an effective operation. This technique may also be effective in potentially contaminated settings due to reduced implant load. Further studies are required to understand its biomechanics and long-term outcomes.     

New method for quantification of the relative severity and (a)symmetry of isolated metopic synostosis

Trigonocephaly is the result of premature fusion of the metopic suture and its severity can vary widely. However, there is no gold standard for quantification of the severity. This study was performed to quantify severity using the Utrecht Cranial Shape Quantifier (UCSQ) and to assess forehead symmetry. Nineteen preoperative non-syndromic trigonocephaly patients (age ≤1 year) were included for the analysis of severity and symmetry. Severity according to the UCSQ was based on the following combined variables: forehead width and relative skull elongation. The UCSQ was compared to the most established quantification methods. A high correlation was found between the UCSQ and visual score (r = 0.71). Moderate to negligible correlation was found between the UCSQ and frontal angle, binocular distance, inter-ocular distance, and frontal stenosis. Additionally, correlation between the visual score and these established quantification methods was negligible. Assessment of the frontal peak (a)symmetry (ratio of right to left triangle area in the curve) showed a mean right versus left triangle area ratio of 1.4 (range 0.9–2.4). The results suggest that the UCSQ is appropriate for the quantification of severity based on the high correlation with clinical judgement. Furthermore, a larger triangle area right than left was unexpectedly found, indicating forehead asymmetry.     

Impact of fibrin glue versus suture closure on double-headed pterygia in Asian eyes – a 7-year study in a tertiary institution

BackgroundTo compare the recurrence rate and outcomes of double-headed pterygia using fibrin glue versus suture closure of conjunctival autograft.MethodsAll patients with double-headed pterygia who underwent pterygia excision with conjunctival autograft from January 2012 to January 2019 in the National University Hospital of Singapore were included. Patients were divided into 2 groups depending on whether fibrin glue or sutures were used to secure the conjunctival autograft in place. All patients had a minimum of 6 months follow-up.ResultsA total (26 patients) of 22 eyes had fibrin glue, while eight eyes underwent suture closure of their conjunctival autograft. Fibrin glue group had 4.5% recurrence rate, while suture group had 37.5% recurrence rate (p = .021). There is statistically significant improvement for overall visual acuity (p = .009) and cylinder (p = .002). There is also statistically significant improvement for visual acuity in the glue group (p = .026), but not in the suture group. Fibrin glue group had a shorter operation duration time compared to suture group (p < .001).There were no cases of graft dislocation, contraction or limbal stem cell deficiency.ConclusionsLow recurrence rates and good postoperative visual outcomes can be achieved with the split conjunctival autograft technique. Our study suggests that fibrin glue has an additional benefit over the use of sutures in the management of these complex cases.     

不可吸收缝线治疗髂前上棘撕脱性骨折

正2012年7月~2015年10月,我们采用不可吸收缝线治疗11例髂前上棘撕脱骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组11例,均为男性,年龄11~16岁。就诊时可见患者轻度屈髋体位,髂前上棘处肿胀、压痛。受伤至手术时间4 h~5 d。1.2治疗方法全身麻醉下手术。患者仰卧,患肢稍屈髋屈膝外旋位。以髂     

抗菌薇乔缝线在预防胃肠急诊手术切口感染中的应用研究

目的探讨抗菌薇乔缝线在胃肠急诊外科手术切口感染预防中的作用,为减少胃肠急诊手术治疗切口感染提供参考。方法选取2010年1月-2014年1月收治的160例胃肠急诊手术患者作为观察对象,根据住院号随机分为观察组和对照组,每组各80例,观察组采用抗菌薇乔缝线缝合,对照组采用传统丝线缝合,比较影响两组患者切口愈合的危险因素及切口感染率。结果术后3~20d,观察组切口感染2例,感染率2.50%,对照组切口感染9例,感染率11.25%,观察组切口感染率明显低于对照组,差异有统计学意义(P<0.05);Ⅲ类切口的感染率观察组为1.25%、对照组为8.75%,差异有统计学意义(P<0.05),Ⅱ类切口感染率两组比较,差异无统计学意义;患者手术时间>120 min的感染率观察组为1.25%、对照组则为10.00%,差异有统计学意义(P<0.05),<120min时,两组患者切口感染率差异无统计学意义。结论抗菌薇乔缝线与普通缝线相比,可降低手术时间≥120min和Ⅲ类切口胃肠急诊手术患者的切口感染率。