An Alternative Technique of Intraoperative Identification of Multiple Muscular Ventricular Septal Defects

We propose the passage of a thick black braided silk SUTUPAK silk suture (Ethicon, Somerville, NJ) through the additional muscular ventricular septal defects to facilitate patch closure of the multiple muscular ventricular septal defects.

Investigating the braiding parameters and their effects on the mechanical and frictional properties of silk sutures

In this research work, the simultaneous effects of braided sutures made up of silk filament were studied with respect to parameters such as filament twist (0-6 Twist/inch), braiding angle (28.8°–34.8°) and braid structure (1/1, 1/2 and 2/2) on tensile strength, elongation, bending stiffness and friction were investigated by using response surface methodology. The influence of independent and dependent values has been studied using the categorical central composite design of experiments. The optimum conditions for enhanced handling characteristics of braided silk suture were 3.7 twist /inch of silk filament twist level, at a 28.8°braid angle, and a 1/2 braided structure. The handling characteristics of the suture can be enhanced by choosing suitable braiding parameters.

Suture granuloma with hydronephrosis caused by ileostomy closure after rectal cancer surgery: a case report

Background Suture granuloma with hydronephrosis after abdominal surgery is extremely rare. We herein report a successfully treated case of suture granuloma with hydronephrosis caused by ileostomy closure after rectal cancer surgery. Case presentation A 63-year-old male underwent laparoscopic low anterior resection with covering ileostomy. Two months after primary operation, ileostomy closure was performed with two layered hand-sewn suture (Albert–Lembert method) using absorbable suture. In that operation, marginal blood vessels in the mesentery were ligated with silk suture. The patient had remained in remission with no evidence of tumor recurrence, however, 2 years and 5 months after primary surgery, a contrast-enhanced computed tomography (CT) scan showed a mass-forming lesion on the right external iliac artery (43 × 26 mm) and hydronephrosis. Positron emission tomography/computed tomography (PET/CT) showed a mass-forming lesion without high accumulation, which obstructed the right ureter. Recurrence could not be ruled out due to the rapid appearance of tumor and hydronephrosis in the short-term period. Thus, the patient underwent laparotomy. The tumor located in the mesentery near the anastomosis of ileostomy closure and it was strongly adherent to the retroperitoneum, which obstructed the right ureter. The adhesion between the tumor and ureter was carefully dissected and tumor resection with partial small bowel resection was then performed with preservation of the ureter using ureteral stents. Pathological examination of the tumor revealed fibrous proliferation of foreign body granuloma. In the resected tumor, sutures with foreign giant cells were found. Therefore, we diagnosed the tumor as silk suture granuloma, which was caused by the silk suture used to ligate blood vessels of the mesentery at the ileostomy closure. The patient remained well with no evidence of tumor recurrence as 5 years after the primary operation of rectal cancer. Conclusions Suture granuloma is a rare surgery-related complication in the postoperative surveillance of patients with colorectal cancer. If suture granuloma mimicking local recurrence is a differential diagnosis, it would be important to consider to avoid unnecessary extended resection.

987 Braidlock - The Evolution of a Novel Drain Securing Device

Introduction The use of drains in Oral and Maxillofacial Surgery is widespread and the securing method using a silk suture laddering along the drain in a standard ‘roman sandal’ pattern is well established. Other methods include tie-lock with sutures and adhesive dressings. We describe the use of a braided device (Braidlock®) without using sutures, based on the concept of a Chinese finger trap, to secure the drain onto patients' skin using tissue adhesive. We report the evolutionary changes of Braidlock. Device Evolution Braidlock® is a Class I non-invasive disposable medical device which provides securement of lines, drains and catheters to a patient using tubing from 3.5Fr to 36Fr. The diameter of the Braidlock® expands when the device is compressed, similar to a ‘Chinese finger trap’. A line can then be inserted through the device and into the body. When decompressed, the Braidlock® squeezes the line tightly and securely. The initial Braidlock® device was hook & loop which required suturing to secure onto skin. Integrated adhesive is a recent invention. Advancement With advances in adhesive dressing and ultrasonic wielding between the plastic casing and adhesive pads, Braidlock® drain securing device appears to be a safe medical device that enables successful securement of drains. Braidlock® may represent a cost saving relative to the conventional suture pack for drain securement. Conclusions This new drain securing device offers a cost effective and reliable alternative to the standard suture fixation. This will eliminate the risk of sharps injury and allow shortening of the drain by ward staff with minimal training.

Comparative assessment between bio-adhesive material and silk suture in regard to healing, clinical attachment level and width of keratinized gingiva in gingival recession defects cases

The objective of this study was to compare the silk suture with a cyanoacrylate adhesive to stabilize the free gingival graft in conjunction with Er: YAG laser-assisted recipient site preparation to augment the keratinized tissue in gingival recession cases. This randomized trial comprised of 300 recession defects patients. All the included patients were diagnosed using Miller class I and II gingival recession defects classification. Group I sites were treated with a free gingival graft (FGG) harvested using an Er: YAG laser and further sutured with silk. Group II sites were stabilized with isoamyl 2 cyanoacrylate bio-adhesive material. Clinical parameters, such as gingival recession depth, clinical attachment level, gain in gingival tissue thickness, and width of keratinized gingiva were recorded at baseline, and at third month, sixth month, and 12th month postoperatively. The mean changes in gingival recession from months 3 to 6 and months and 6 to 12 were significant ( p < 0.05) in both groups. However, the improvement in recession depth was better in group II than in group I. The mean change in clinical attachment level did not differ significantly between the groups at the different time intervals. However, values tended to be higher in group II than in group I. The width of the keratinized gingiva tended to be higher from baseline to 3 months, baseline to 6 months, baseline to 12 months, 3 to 6 months, and from 6 to 12 months in group II as compared with group I ( p > 0.05). Cyanoacrylate could be used as a substitute to silk sutures to stabilize FGGs. Cyanoacrylate was easy to apply, consumed less operating time, and was considered equally efficacious for stabilizing FGGs.

Novel Chest Tube Anchoring and Closure Technique with an Aesthetic Scar

Technique: This chest tube anchoring technique differs from other techniques by introducing 2 layered closure to avoid wound healing complications such as hypertrophic or keloid scar and to achieve airtight closure. The first suture to be used is a monofilament synthetic absorbable 4/0 suture – Monocryl (Johnson & Johnson, New Jersey, USA) that is passed as a buried stitch in the dermal layer. The second suture to be used is a monofilament non-absorbable 3/0 suture – Prolene (Johnson & Johnson, New Jersey, USA) that is passed around the chest tube incision in a horizontal mattress manner taking the muscle/fascia and skin layers. The chest tube is then anchored with a 2/0 silk suture with a mesentery. The three suture ends are secured and wrapped around the chest tube with Steri-Strips™ (3M™, Minnesota, USA). Two long dressings are sandwiched together, partially on skin and partially on the tube as dressing anchors. Results: This technique has shown good results with no complications. Routine chest radiograph and physical examination showed no signs of pneumothorax or discharge from the wound nor any wound healing complications. Conclusion: This chest tube anchoring and closure technique is secure and produces an aesthetic pleasing scar that does not require any expensive sutures or special skills.

Intercostal chest drain fixation strength: comparison of techniques and sutures

ObjectiveThe accidental removal of an intercostal chest drain (ICD) is common and may result in serious complications. A number of fixation techniques and suture material are in use, and the selection is often based on personal preferences and equipment availability. This study is designed to determine which of the common techniques provides the strongest ICD fixation.MethodsThis study compared the mechanical strength of eight different ICD fixation techniques (purse string, ‘Roman sandal’, ‘Jo’burg’ (JO) technique, a suture through the tube, one and two passes through a locking plastic tie, tape fixation and a commercial disposable drainage tube holder) and two silk suture sizes using porcine cadavers and a digital push–pull dynamometer to simulate accidental removal of an ICD. A total of 14 different experimental set-ups produced 280 measurements.ResultsSignificant differences in ICD fixation strength were observed. A modified JO technique using a size 1 silk suture was nearly three times stronger than a purse-string fixation using a size 0 silk and 10 times stronger from a commercial, adhesive-based device (180, 70 and 22, respectively).ConclusionIn situations where the mechanical strength of ICD fixation is important, using a size 1 silk and a modified JO technique may provide the strongest fixation.