scholarly journals Differences of tensile strength in knot tying technique between orthopaedic surgical instructors and trainees

2020 ◽  
Author(s):  
Kengo Harato ◽  
Mitsuru Yagi ◽  
Kazuya Kaneda ◽  
Yu Iwama ◽  
Akihiko Masuda ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Wound Dehiscence ◽  
Wound Complications ◽  
Polished Surface ◽  
Knot Tying ◽  
Fisher Exact Probability Test ◽  
Exact Probability ◽  
Custom Made ◽  
Actual Trial ◽  
Knot Tying Technique

Abstract Background: Knot tying technique is an extremely important basic skill for all surgeons. Clinically, knot slippage or suture breakage will lead to wound complications. Although some previous studies described the knot-tying technique of medical students or trainees, little information had been reported on the knot-tying technique of instructors. The objective of the preset study was to assess surgeons’ manual knot tying techniques and to investigate the differences of tensile strength in knot tying technique between surgical instructors and trainees. Methods: A total of 48 orthopaedic surgeons (postgraduate year: PGY 2-18) participated. Surgeons were requested to tie surgical knots manually using same suture material. They were divided into two groups based on each career; instructors and trainees.　Although 4 open conventional knots with 4 throws were chosen and done with self-selected methods, knot tying practice to have the appropriate square knots was done as education only for trainees before the actual trial. The knots were placed over a 30 cm long custom made smooth polished surface with 2 cylindrical rods. All knots were tested for tensile strength using a tensiometer. The surgical loops were loaded until the knot slipped or the suture broke. The tensile strength of each individual knot was defined as the force (N) required to result in knot failure. Simultaneously, knot failure was evaluated based on knot slippage or suture rupture. In terms of tensile strength or knot failure, statistical comparison was performed between groups using two-tailed Mann-Whitney U test or Fisher exact probability test, respectively. Results: Twenty-four instructors (PGY6- PGY18) and 24 trainees (PGY2-PGY5) were enrolled. Tensile strength was significantly greater in trainees (83.0 ± 27.7N) than in instructors (49.9 ± 34.4N, P=0.0246). The ratio of slippage was significantly larger in instructors than in trainees (P<0.001). Knot slippage (31.8 ± 17.7N) was significantly worse than suture rupture (89.9 ± 22.2N, P<0.001) in tensile strength. Conclusions: Mean tensile strength of knots done by trainees after practice was judged to be greater than that done by instructors in the present study. Clinically, knot slippage can lead to wound dehiscence, compared to suture rupture.

scholarly journals Differences of tensile strength in knot tying technique between orthopaedic surgical instructors and trainees

2021 ◽  
Author(s):  
Kengo Harato ◽  
Mitsuru Yagi ◽  
Kazuya Kaneda ◽  
Yu Iwama ◽  
Akihiko Masuda ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Wound Dehiscence ◽  
Wound Complications ◽  
Polished Surface ◽  
Knot Tying ◽  
Fisher Exact Probability Test ◽  
Exact Probability ◽  
Custom Made ◽  
Actual Trial ◽  
Knot Tying Technique

Abstract Background: Knot tying technique is an extremely important basic skill for all surgeons. Clinically, knot slippage or suture breakage will lead to wound complications. Although some previous studies described the knot-tying technique of medical students or trainees, little information had been reported on the knot-tying technique of instructors. The objective of the preset study was to assess surgeons’ manual knot tying techniques and to investigate the differences of tensile strength in knot tying technique between surgical instructors and trainees.Methods: A total of 48 orthopaedic surgeons (postgraduate year: PGY 2-18) participated. Surgeons were requested to tie surgical knots manually using same suture material. They were divided into two groups based on each career; instructors and trainees.　Although 4 open conventional knots with 4 throws were chosen and done with self-selected methods, knot tying practice to have the appropriate square knots was done as education only for trainees before the actual trial. The knots were placed over a 30 cm long custom made smooth polished surface with 2 cylindrical rods. All knots were tested for tensile strength using a tensiometer. The surgical loops were loaded until the knot slipped or the suture broke. The tensile strength of each individual knot was defined as the force (N) required to result in knot failure. Simultaneously, knot failure was evaluated based on knot slippage or suture rupture. In terms of tensile strength or knot failure, statistical comparison was performed between groups using two-tailed Mann-Whitney U test or Fisher exact probability test, respectively.Results: Twenty-four instructors (PGY6- PGY18) and 24 trainees (PGY2-PGY5) were enrolled. Tensile strength was significantly greater in trainees (83.0 ± 27.7N) than in instructors (49.9 ± 34.4N, P=0.0246). The ratio of slippage was significantly larger in instructors than in trainees (P<0.001). Knot slippage (31.8 ± 17.7N) was significantly worse than suture rupture (89.9 ± 22.2N, P<0.001) in tensile strength.Conclusions: Mean tensile strength of knots done by trainees after practice was judged to be greater than that done by instructors in the present study. Clinically, knot slippage can lead to wound dehiscence, compared to suture rupture.

scholarly journals Differences of tensile strength in knot tying technique between orthopaedic surgical instructors and trainees

2020 ◽  
Author(s):  
Kengo Harato ◽  
Mitsuru Yagi ◽  
Kazuya Kaneda ◽  
Yu Iwama ◽  
Akihiko Masuda ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Wound Dehiscence ◽  
Wound Complications ◽  
Polished Surface ◽  
Knot Tying ◽  
Fisher Exact Probability Test ◽  
Exact Probability ◽  
Custom Made ◽  
Actual Trial ◽  
Knot Tying Technique

Abstract Background: Knot tying technique is an extremely important basic skill for all surgeons. Clinically, knot slippage or suture breakage will lead to wound complications. Although some previous studies described the knot-tying technique of medical students or trainees, little information had been reported on the knot-tying technique of instructors. The objective of the preset study was to assess surgeons’ manual knot tying techniques and to investigate the differences of tensile strength in knot tying technique between surgical instructors and trainees.Methods: A total of 48 orthopaedic surgeons (postgraduate year: PGY 2-18) participated. Surgeons were requested to tie surgical knots using same suture material. They were divided into two groups based on each career; instructors and trainees. Although 4 knots with 4 throws were chosen and done with self-selected methods, knot tying practice was done as education only for trainees before the actual trial. The knots were placed over a 30 cm long custom made smooth polished surface with 2 cylindrical rods. All knots were tested for tensile strength using a tensiometer. The surgical loops were loaded until the knot slipped or the suture broke. The tensile strength of each individual knot was defined as the force (N) required to result in knot failure. Simultaneously, knot failure was evaluated based on knot slippage or suture rupture. In terms of tensile strength or knot failure, statistical comparison was performed between groups using two-tailed Mann-Whitney U test or Fisher exact probability test, respectively.Results: Twenty-four instructors (PGY6- PGY18) and 24 trainees (PGY2-PGY5) were enrolled. Tensile strength was significantly greater in trainees (83.0 ± 27.7N) than in instructors (49.9 ± 34.4N, P=0.0246). The ratio of slippage was significantly larger in instructors than in trainees (P<0.001). Knot slippage (31.8 ± 17.7N) was significantly worse than suture rupture (89.9 ± 22.2N, P<0.001) in tensile strength.Conclusions: Mean tensile strength of knots done by trainees after practice was judged to be greater than that done by instructors in the present study. Clinically, knot slippage can lead to wound dehiscence, compared to suture rupture.

scholarly journals Differences of tensile strength in knot tying technique between orthopaedic surgical instructors and trainees

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kengo Harato ◽  
Mitsuru Yagi ◽  
Kazuya Kaneda ◽  
Yu Iwama ◽  
Akihiko Masuda ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Wound Dehiscence ◽  
Wound Complications ◽  
Polished Surface ◽  
Knot Tying ◽  
Fisher Exact Probability Test ◽  
Exact Probability ◽  
Custom Made ◽  
Actual Trial ◽  
Knot Tying Technique

Abstract Background Knot tying technique is an extremely important basic skill for all surgeons. Clinically, knot slippage or suture breakage will lead to wound complications. Although some previous studies described the knot-tying technique of medical students or trainees, little information had been reported on the knot-tying technique of instructors. The objective of the preset study was to assess surgeons’ manual knot tying techniques and to investigate the differences of tensile strength in knot tying technique between surgical instructors and trainees. Methods A total of 48 orthopaedic surgeons (postgraduate year: PGY 2–18) participated. Surgeons were requested to tie surgical knots manually using same suture material. They were divided into two groups based on each career; instructors and trainees. Although four open conventional knots with four throws were chosen and done with self-selected methods, knot tying practice to have the appropriate square knots was done as education only for trainees before the actual trial. The knots were placed over a 30 cm long custom made smooth polished surface with two cylindrical rods. All knots were tested for tensile strength using a tensiometer. The surgical loops were loaded until the knot slipped or the suture broke. The tensile strength of each individual knot was defined as the force (N) required to result in knot failure. Simultaneously, knot failure was evaluated based on knot slippage or suture rupture. In terms of tensile strength or knot failure, statistical comparison was performed between groups using two-tailed Mann–Whitney U test or Fisher exact probability test, respectively. Results Twenty-four instructors (PGY6–PGY18) and 24 trainees (PGY2–PGY5) were enrolled. Tensile strength was significantly greater in trainees (83.0 ± 27.7 N) than in instructors (49.9 ± 34.4 N, P = 0.0246). The ratio of slippage was significantly larger in instructors than in trainees (P < 0.001). Knot slippage (31.8 ± 17.7 N) was significantly worse than suture rupture (89.9 ± 22.2 N, P < 0.001) in tensile strength. Conclusions Mean tensile strength of knots done by trainees after practice was judged to be greater than that done by instructors in the present study. Clinically, knot slippage can lead to wound dehiscence, compared to suture rupture.

scholarly journals Differences of tensile strength in knot tying technique between orthopaedic surgical instructors and trainees

2020 ◽  
Author(s):  
Kengo Harato ◽  
Mitsuru Yagi ◽  
Kazuya Kaneda ◽  
Yu Iwama ◽  
Akihiko Masuda ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Wound Dehiscence ◽  
Wound Complications ◽  
Polished Surface ◽  
Knot Tying ◽  
Fisher Exact Probability Test ◽  
Exact Probability ◽  
Custom Made ◽  
Actual Trial ◽  
Knot Tying Technique

Abstract Background: Knot tying technique is an extremely important basic skill for all surgeons. Clinically, knot slippage or suture breakage will lead to wound complications. Although some previous studies described the knot-tying technique of medical students or trainees, little information had been reported on the knot-tying technique of instructors. The objective of the preset study was to assess surgeons’ manual knot tying techniques and to investigate the differences of tensile strength in knot tying technique between surgical instructors and trainees.Methods: A total of 48 orthopaedic surgeons (postgraduate year: PGY 2-18) participated. Surgeons were requested to tie surgical knots manually using same suture material. They were divided into two groups based on each career; instructors and trainees. Although 4 open conventional knots with 4 throws were chosen and done with self-selected methods, knot tying practice to have the appropriate square knots was done as education only for trainees before the actual trial. The knots were placed over a 30 cm long custom made smooth polished surface with 2 cylindrical rods. All knots were tested for tensile strength using a tensiometer. The surgical loops were loaded until the knot slipped or the suture broke. The tensile strength of each individual knot was defined as the force (N) required to result in knot failure. Simultaneously, knot failure was evaluated based on knot slippage or suture rupture. In terms of tensile strength or knot failure, statistical comparison was performed between groups using two-tailed Mann-Whitney U test or Fisher exact probability test, respectively.Results: Twenty-four instructors (PGY6- PGY18) and 24 trainees (PGY2-PGY5) were enrolled. Tensile strength was significantly greater in trainees (83.0 ± 27.7N) than in instructors (49.9 ± 34.4N, P=0.0246). The ratio of slippage was significantly larger in instructors than in trainees (P<0.001). Knot slippage (31.8 ± 17.7N) was significantly worse than suture rupture (89.9 ± 22.2N, P<0.001) in tensile strength.Conclusions: Mean tensile strength of knots done by trainees after practice was judged to be greater than that done by instructors in the present study. Clinically, knot slippage can lead to wound dehiscence, compared to suture rupture.

Treatment of Pediatric Sternotomy Wound Complications: A Minimally Invasive Approach

2021 ◽  
Author(s):  
Taehee Jo ◽  
Joon Hur ◽  
Eun Key Kim
Keyword(s):  
Negative Pressure Wound Therapy ◽  
Wound Dehiscence ◽  
Surgical Debridement ◽  
Wound Complications ◽  
Approximation Technique ◽  
Invasive Approach ◽  
Nonsurgical Management ◽  
Single Use ◽  
Sternal Wound Infections ◽  
Deep Sternal Wound Infections

Abstract Background Pediatric sternal wound complications (SWCs) include sterile wound dehiscence (SWD) and superficial/deep sternal wound infections (SSWI/DSWI), and are generally managed by repetitive debridement and surgical wound approximation. Here, we report a novel nonsurgical management strategy of pediatric sternotomy wound complications, using serial noninvasive wound approximation technique combined with single-use negative pressure wound therapy (PICO) device. Methods Nine children with SWCs were managed by serial approximation with adhesive skin tapes and serial PICO device application. Thorough surgical debridement or surgical approximations were not performed. Results Three patients were clinically diagnosed as SWD, two patients as SSWI, and four patients as DSWI. None of the wounds demonstrated apparent mediastinitis or bone destructions. PICO device was applied at 16.1 days (range: 6–26 days) postoperatively, together with serial wound approximation by skin tapes. The average duration of PICO use was 16.9 days (range: 11–29 days) and the wound approximation was achieved in all patients. None of the patients underwent aggressive surgical debridement or invasive surgical approximation by sutures. Conclusion We report our successful management of selected pediatric SWCs, using serial noninvasive wound approximation technique combined with PICO device.

scholarly journals Profile vs Tubular Plate in Unimalleolar or Bimalleolar Fractures: is There a Real Difference in Wound complications?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0015
Author(s):  
Paolo Ceccarini ◽  
Rosario Petruccelli ◽  
Michele Bisaccia ◽  
Giuseppe Rinonapoli ◽  
Auro Caraffa
Keyword(s):  
Wound Dehiscence ◽  
Deep Infection ◽  
Ankle Fractures ◽  
Bone Union ◽  
Wound Complications ◽  
Fisher Exact Test ◽  
Superficial Infection ◽  
Operative Care ◽  
Group B

Category: Ankle; Trauma Introduction/Purpose: The aim of our study is to compare two types of plates, one third tubular plate and LCP distal fibula plate, evaluating the clinical outcome and the skin complications associated with their use. Methods: We collected the data of 122 consecutive unimalleolar or bimalleolar fractures treated by internal fixation for a closed, displaced distal closed fibular fracture. Exclusion criteria were: 1) open ankle fractures,2) trimalleolar fractures, 3) previous ankle fractures 4) severe venous insufficiency, 5) ankleosteoarthritis previous to surgery, 6) associated ankle dislocation. After this selection, 93 patients were included in our study and assigned in two groups, based on using of different implant: in group A48 patients were treated with one-third tubular and in group B 45 patients were treated with LCP distalfibula plate. There were no significant differences in the baseline characteristics. Patients received the same surgical procedure and the same post-operative care, then they were radiologically evaluated at1-3-12 months and clinical examination was made at 24 (range 15-36) months using AOFAS clinical rating system. All data were evaluated using chi-square test. Results: At the final 24-month follow-up a comparison between the two groups showed no statistical significant differences in reduction accuracy and bone union ratio at radiological examination. The wound complications rate of the overall study group was 7.6%. There were no statistical differences in the rate of wound complications between the two groups. There were no differences between both group in percentage of hardware removal at follow-up (overall 5.4%). In the group A occurred 1 deep infection, 2 superficial infection, no wound dehiscence; in group B occured 1 deep infection, 1 superficial infection and 2 wound dehiscence. There were no statistical differences in the rate of wound complications between the two groups (p=0.70; Fisher exact test). Conclusion: Our study has shown no difference in radiographic bone union rate, no significant differences in terms of clinical outcomes, in time of bone reduction and wound complication rate between the LCP distalfibula plate and conventional one-third tubular plate. RCT or metanalasys are in this case useful to improve scientific evidence and give more information for the correct surgical treatment of ankle fractures.

Primary or Redo Posterior Sagittal Anorectoplasty without a Stoma: To Feed or Not to Feed?

2017 ◽  
Vol 29 (02) ◽  
pp. 150-152 ◽  
Author(s):  
Clare Skerrit ◽  
Alexander Dingemans ◽  
Victoria Lane ◽  
Alejandra Sanchez ◽  
Laura Weaver ◽  
...  
Keyword(s):  
Breast Milk ◽  
Wound Dehiscence ◽  
Anorectal Malformations ◽  
Wound Complication ◽  
Wound Complications ◽  
Age At Surgery ◽  
Significant Difference ◽  
Male Patients ◽  
The Mean ◽  
Picc Line

Introduction Repair of anorectal malformations (ARMs), primarily or with a reoperation, may be performed in certain circumstances without a diverting stoma. Postoperatively, the passage of bulky stool can cause wound dehiscence and anastomotic disruption. To avoid this, some surgeons keep patients NPO (nothing by mouth) for a prolonged period. Here, we report the results of a change to our routine from NPO for 7 days to clear fluids or breast milk. Materials and Methods After primary or redo ARM surgery, patients given clear liquids were compared to those who were kept strictly NPO. Age, indication for surgery, incision type, use of a peripherally inserted central catheter (PICC) line, and wound complications were recorded. Results There were 52 patients, including 15 primary and 37 redo cases. Group 1 comprised 11 female and 15 male patients. The mean age at surgery was 4.9 years (standard deviation [SD]: 2.3). There were 8 primary cases and 18 redo cases. Twelve (46.6%) received a PICC line. The average start of clear liquids was on day 5.3 (SD: 2.2) after examination of the wound, and the diet advanced as tolerated. The first stool passage was recorded on average on day 2.3 (SD: 1.3). Four minor wound complications and no major wound complications occurred.Group 2 comprised 14 females and 12 male patients. The mean age at surgery was 3.5 (SD: 2.4) years. There were 7 primary and 19 redo cases. One (3.8%) patient required a PICC line. A clear liquid diet was started within 24 hours after surgery. A regular diet was started on average on day 5.8 (SD: 1.3). The first stool passage was recorded on an average of day 1.6 (SD: 0.9). Three minor wound complications occurred; however, there was no significant difference between the two groups (SD: 0.71). One major wound complication occurred. However, there was no significant difference in major wound complications between the groups (SD: 0.33). Conclusion No increase in wound problems was noted in children receiving clear liquids or breast milk compared with the strict NPO group, and PICC line use was reduced. We believe this change in practice simplifies postoperative care without increasing the risk of wound complications.

scholarly journals The Preparation of Breastfeeding Lowers the Incidence of Nipple Blisters of Postpartum Mother in Sub-district Health Centers Gandusari Kec. Gandusari Kab. Blitar

2016 ◽  
Vol 3 (3) ◽  
pp. 242-246
Author(s):  
Maria Ulfa
Keyword(s):  
Breast Feeding ◽  
Health Centers ◽  
Control Group ◽  
Fisher Exact Probability Test ◽  
District Health ◽  
Exact Probability ◽  
Control Group Design ◽  
Group Design ◽  
Independent Variable ◽  
Feeding Techniques

Breastmilk has advantages and privilages as a source of nutrients compared to other nutrientsources. However, the breastfeeding process often fail. The main cause of the failure is a problem in thebreast. One of them are blisters on the nipples. Nipple blisters dominantly caused by breast feedingpreparationespecially on breast feeding techniques and breastcare. The purpose of this study was todetermine how is the preparation of breastfeeding lowers the incidence of nipple blisters of postpartummother in Sub-district Health CentersGandusari Kec.GandusariKab. Blitar. Methods: with posttestonly control group design. The population in this study was 50 postpartum mother in Health Centers.Thesample was 16 respondents by using purposive sampling. The independent variable was the preparationof breastfeeding, the dependent variable was the sore nipple blisters. The instrument used SOP.Result: the statistical Fisher Exact Probability Test showed p=0,003 (a=0,05). It could be concludedthat the preparation of brestfeeding could reduce the incidence of nipple blisters postpartum mother inSub-district Health Centers Gandusari. By this research, it was expected the respondents to activelyask, observing carefully about breasfeeding preparation especially breaastfeeding techniques andtreatments given. So, breastfeeding in infants couldbe succeed. As for the profession of midwifery resultsof this study could be used as the input in motivating postpartum mother, so that it could perform theappropriate techniques of breastfeeding and breastcareto avoid nipple blisters.

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