Tracheoarterial fistula as a complication of prolonged tracheostomy

The article presents a clinical case of a rare and severe complication of prolonged tracheostomy in the form of fistula formation between tracheal lumen and brachiocephalic artery and the development of massive bleeding from it. The patient’s treatment was urgent and successful. Operative intervention was performed with subsequent allografting of brachiocephalic trunk (vascular prosthesis Vascutek 8 mm was used) and the anastomosis was created using a continuous suture technique. The patient was discharged home in a satisfactory condition on the 17th post-operative day.

Evaluation of three methods of suture for skin closure in total knee arthroplasty: a randomized trial

Background There are several studies comparing techniques and different materials, yet the results are not unanimous. We compared three methods of skin closure in total knee arthroplasty (TKA), including suture with single stitches and unabsorbable MonoNylon®, as well as continuous subcuticular suture with Monocryl® or barbed Stratafix® absorbable suture. Methods A prospective, randomized study was conducted with 63 patients undergoing TKA between March 2016 and December 2016. Patients were divided into three groups: traditional suture MonoNylon® (n 22), subcuticular continuous suture with Monocryl® (n 20), and another barbed with Stratafix® (n 21). The closure time, length of wire used, pain intensity, possible complications, and cosmeses were evaluated. Results Subcuticular continuous suture using Monocryl® was superior to traditional suture using MonoNylon® as less thread was used (p 0.01) and a better cosmetic effect was achieved (p < 0.01), which was equal to Stratafix® aspects analyzed (p > 0.05). Complications were observed mostly in patients who used Stratafix®. Conclusions This study concluded that the subcuticular suture with absorbable monofilament Monocryl® proved to be advantageous compared to the others because it presented results equal to the barbed Stratafix®, however with fewer complications. Furthermore, Monocryl® was shown to be equal or superior to traditional MonoNylon® suture regarding in relation pain intensity, aesthetic result, and effective cost. Trial registration WHO ICTRP identifier RBR78dh5d. Retrospectively registered: 07/29/2020.

Management of canine urolithiasis by cystotomy in a two-year old Lhasa Apso bitch

Canine urolithiasis is a common urinary tract disease requiring a rapid definitive diagnosis for immediate surgical and/or non-surgical therapy. The calculi may be microscopic or macroscopic, and when detected, the condition should be treated, either surgically or conservatively. This paper presents a surgical management of urolithiasis in a two-year old Lhasa apso bitch. The dog was haematuric for two weeks and had been on ceftriaxone and diclofenac for the period. Urolithiasis was confirmed following ultrasonography. The dog was pre-medicated with 0.02 mg/kg atropine sulphate and 2 mg/kg xylazine, while anaesthesia was induced and maintained with 10 mg/kg of 5% ketamine. Following aseptic patient preparation, the peritoneal cavity was accessed via a caudal ventral midline incision. The bladder was incised and the uroliths were evacuated via a cystotomy incision. Retrograde flushing of the urethra was performed to propel uroliths into the bladder for removal. The urinary bladder was closed with polyglycolic acid in Lambert suture pattern. The peritoneum and muscles were sutured using catgut in simple continuous suture. The skin was closed with silk using horizontal mattress suture pattern. The dog recovered uneventfully from the surgery and the wound healed after two weeks, at which time the skin suture was removed Keywords: Bladder, calculi, cystotomy, urolith, urolithiasis.

Comparison of two end-to-end continuous sutures for intestinal anastomoses in dogs.

Background: Single-layer appositional closures are preferred to inverting or everting patterns, as submucosal apposition has been shown to promote primary healing of the intestinal wall, whereas inverted or everted closures require second-intention healing and can increase the risk of luminal stenosis or anastomosis site leakage. There are different suture patterns available, but relatively few studies comparing these aspects have been published.The aim of this study was to compare two suture techniques for end-to-end anastomosis of the canine intestine (jejunum and colon): handsewn intestinal anastomosis by appositional simple continuous suture and inverting Cushing suture. The objectives of this study were to investigate 1.) whether the type of suture influences the specific effort to which the anastomosis site is submitted to, 2.) whether the anastomosis technique influences the diameter of the intestinal lumen and 3.) survival and complication rates in canine clinical cases undergoing end-to-end anastomoses. Results: The equilibrium angle for implanting the sutures in an anastomosis is 35°, aspect completely fulfilled by the simple continuous suture. The efforts to which sutures are submitted to in anastomoses are minimal for the Cushing suture. The difference in size of the anastomoses’ lumen between simple continuous suture and the Cushing suture are minimal, without being statistically relevant. The differences between the lumen of the anastomoses performed using PDS and those performed using PGA are not statistically relevant. The retrospective analysis of the outcome for 676 dogs (clinical cases) that underwent intestinal resection and anastomosis reveals that the dehiscence rate was 1.48%, out of which 1.18% following simple continuous anastomoses, and 0.3% following Cushing anastomoses. Narrowing of the intestinal lumen due to anastomotic healing was not registered.Conclusions: Use of the Cushing suture should be considered for performing an end-to-end intestinal anastomosis, although more studies are required to determine if there are any clinically significant differences between the sutures investigated in this study.

BARBED SUTURE FOR LAPAROTOMY CLOUSURE IN URGENCY PROCEDURES. RETROSPECTIVE ANALYSIS

INTRODUCTION Urgency surgeries are often performed in a stressful setting, out of hours and with critical patient involved. In this context, laparotomy closure can sometimes be deficient. Suture recommended by European Hernia Society is slowly absorbable monofilament continuous suture with a “small bites” technique. Barbed sutures appear as an alternative to conventional suture, frequently used in laparoscopic procedures due to its’ intrinsic maintenance of traction. The aim of this study is to describe the results in terms of short and mid-term rate of incisional hernia after urgency midline laparotomy, according to the suture utilized. MATERIAL AND METHODS A single-center retrospective cohort study was performed including patients with urgency midline laparotomy during 2018. Group A was represented by patients with slowly absorbable monofilament continuous suture. Group B included patients with barbed suture laparotomy closure. Main variables were hernia rates one month and one year after surgery, diagnosed by physical exploration and/or imaging. RESULTS A total of 68 of patients (36 on group A; 32 Group B) were included. On Group A, 13.9% (5) patients presented incisional hernia on the month follow-up, whereas none did on Group B. After a year, Group A only had 1 new case, but 12.5% of patients did herniate on group B; with no significantly relation with obesity neither underlying neoplasm. CONCLUSIONS Midline laparotomy closure must be performed within quality standards, as “small bites” technique with the ratio at least 4/1. Barbed suture appears as a promising closure option, especially in emergency procedures, but needs further study.