Faculty Opinions recommendation of Reversed needle pass clear-corneal or limbal incision suturing technique using the 3-throw (1-1-1) adjustable square knot.

Background: Use of the interrupted coronary anastomosis has largely been abandoned in favor of the more rapid continuous suturing technique. The Coalescent U-CLIP anastomotic device allows the surgeon to create an interrupted distal anastomosis in the same amount of time that it would take to create a continuous anastomosis. This acute bovine study examined the effect of the anastomotic technique on blood flow and vessel wall function. Methods: End-to-side coronary anastomoses were created in an open chest bovine model using the left and right internal thoracic arteries and the left anterior descending coronary artery. All other variables except suturing technique were carefully controlled. In each animal, one anastomosis was completed using a continuous suturing technique and the other was performed in an interrupted fashion using the Coalescent U-CLIP anastomotic device. Volumetric flow curves through each graft were analyzed using key indicators of anastomotic quality, and anastomotic compliance was evaluated using intravascular ultrasound. Luminal castings were created of each vessel to examine the interior surface of each anastomosis for constrictions and deformities. Results: The interrupted anastomoses created with the Coalescent U-CLIP anastomotic device showed significant differences with respect to anastomotic compliance, pulsatility index, peak flow, and percentage of diastolic flow. The cross-sectional area and degree of luminal deformity were also different for the two suturing techniques. Conclusions: In this acute bovine model, interrupted coronary anastomoses demonstrated superior geometric consistency and greater physiologic compliance than did continuously sutured anastomoses. The interrupted anastomosis also caused fewer disturbances to the flow waveform, behaving similarly to a normal vessel wall. The combination of these effects may influence both acute and long-term patency of the coronary bypass grafts.

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641 What Is the Most Reliable Way to Secure A Surgical Drain?

British Journal of Surgery ◽

10.1093/bjs/znab134.157 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

B Hughes ◽

J Stallard ◽

S Jivan

Keyword(s):

Suture Material ◽

Suture Techniques ◽

Robust Method ◽

Suturing Technique ◽

The Moment ◽

Tissue Reactions ◽

Surgical Drain

Abstract Introduction Surgical drains are used by many specialities, we aim to determine the most robust method of securing them by comparing suturing technique, material and fixation angle. Method A Blake’s drain was inserted into a piece of pork belly and secured using a standard ‘three half hitch’ technique with 3.0 Silk, EthilonTM and ProleneTM . For each suture type, drains were sutured in line, at 45 and 90 degrees to the course of the drain. The force needed for the suture to failure was measured and each repeated 3 times. Different suture techniques were then used to determine the strongest fixation. Results With the drain exiting inline the moment of failure was, on average, 1.25kg for silk, 3.5kg for EthilonTM and 4.0kg for ProleneTM. Increasing drain fixation angle required more force for the suture to fail. With EthilonTM and ProleneTM, the suture snapped before the drain slipped. Three half hitches was the strongest technique. Conclusions Suture material, technique and drain fixation angle had an impact on suture strength with ProleneTM outperforming Silk. We advocate using a ‘three half hitch’ technique with 3.0 ProleneTM to secure a surgical drain. It offers superior strength whilst reducing the risk of localised tissue reactions.

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