The Effect of Absorbable and Non-Absorbable Sutures on Nasal Width Following Cinch Sutures in Orthognathic Surgery

Background: Non-absorbable materials (nylon) are always used in cinch sutures to maintain nasal width and to improve harmonious facial symmetry in orthognathic surgery. However, a few drawbacks of nylon materials have been clinically reported following orthognathic surgery, such as nasal irritation and exposure of the sutures. An absorbable material (PDS) has been proposed in cinch sutures, not only to avoid the complications of nylon but also to stabilize the nasal width for a long-term follow-up. Methods: Fifty-seven patients with Angle’s malocclusion classification III receiving orthognathic surgery were enrolled in this study. A non-absorbable material (nylon) and an absorbable material (PDS) were utilized for the cinch sutures. Pre-operative (T1) and post-operative six-month (T2) craniofacial 3D images were collected for all patients to measure the alar curvature (Ac) width and the alar base (Al) width. A significance level of p < 0.05 was applied in the statistical analysis. Results: With the approval of IRB, cinch suturing was performed with nylon in 29 patients and with PDS in 28 patients. Pre-operative Ac and Al distances showed no significant difference between these two groups. There were also no significant differences between the suture materials in the peri-operative change in nasal width, including Ac (nylon: 1.999 ± 1.40; PDS: 1.484 ± 0.97; p = 0.112) and Al (nylon: 1.861 ± 1.66; PDS: 1.115 ± 0.92; p = 0.056). Conclusions: For cinch sutures in orthognathic surgery, PDS can maintain the peri-operative nasal width similarly to nylon; additionally, it can be absorbed in a timely manner without the drawbacks of non-absorbable materials.

BETWEEN PROLENE®, ULTRAPRO® AND BARD SOFT® MESHES WHICH PRESENTS THE BEST PERFORMANCE IN THE REPAIR OF THE ABDOMINAL WALL?

ABSTRACT Background: In the definition of the mesh to be used to correct hernias, porosity, amount of absorbable material and polypropylene should be considered in the different stages of healing process. Aim: To evaluate the inflammatory reaction in the use of macro and microporous meshes of high and low weight in the repair of defects in the abdominal wall of rats. Methods: Ninety Wistar rats (Rattus norvegicus albinus) were used. The animals were submitted to similar surgical procedures, with lesion of the ventral abdominal wall, maintaining the integrity of the parietal peritoneum and correction using the studied meshes (Prolene®, Ultrapro® and Bard Soft®). Euthanasia was performed at 30, 60 and 120 days after surgery. The abdominal wall segments were submitted to histological analysis using H&E, Masson’s trichrome, immunohistochemistry, picrosirius red and tensiometric evaluation. Results: On the 120th day, the tensiometric analysis was superior with Ultrapro® macroporous mesh. The inflammatory process score showed a significant prevalence of subacute process at the beginning and at the end of the study. Microporous meshes showed block encapsulation and in macroporous predominance of filamentous encapsulation. Conclusion: The Ultrapro® mesh showed better performance than the others in healing process of the abdominal wall.

Harmonic scalpel versus traditional ligation in axillary dissection for breast cancer: a retrospective multivariate analysis

Introduction: The aim of this pilot retrospective study is to evaluate the complication rate in patients after axillary dissection comparing preparation with harmonic scalpel vs traditional ligation technique, and to analyse risk factors for complications occurrence. Methods: 144 patients with 148 axillary dissections operated in a single centre between January 2014 and 2019 were included into the study. Axillary dissection was performed using harmonic scalpel in 73 and absorbable ligations in 70 cases. Results: Seroma formation was observed in 41 patients (56.2%) in the harmonic scalpel group and in 21 patients (30.0%) in the ligations group (p=0.003). The mean period from the surgery to drain removal was 4.0 days in the harmonic scalpel group and 3.0 days in the ligations group (p<0.001). The mean amount of the drained fluid after mastectomy was 300.9 ml in the harmonic scalpel group and 168.7 ml in the ligations group (p=0.005); after breast conserving surgery, it was 241.9 ml and 107.4 ml, respectively (p =0.023). Conclusion: In comparison with traditional ligations with absorbable material, axillary dissection using harmonic scalpel significantly increases the risk of postoperative seroma formation, prolongs the time from the surgery to drain removal, and increases the amount of drained fluid.ut any suspicion of nodal involvement, hemithyroidectomy is considered to be a sufficient procedure or the method of choice, respectively.

Liver Regeneration and Recanalization Time Course following Repeated Reversible Portal Vein Embolization in Swine

<b><i>Introduction:</i></b> Portal vein embolization (PVE) is an accepted technique to preoperatively increase the volume of the future remnant liver before major hepatectomy. A permanent material is usually preferred since its superiority to induce liver hypertrophy over absorbable material has been demonstrated. Nevertheless, the use of an absorbable material generates a reversible PVE (RPVE) capable of inducing significant liver hypertrophy. In small animal models, the possibility to proceed to a repeated RPVE (RRPVE) has shown to boost liver hypertrophy further. The aim of this preliminary study was to assess the feasibility and the tolerance of RRPVE in a large animal model, in comparison with permanent PVE (PPVE) and single RPVE. <b><i>Methods:</i></b> Six swine (2 per group) were assigned either to single RPVE group (using powdered gelatin sponge), RRPVE group (2 RPVEs separated by 14 days) or PPVE group (using N-butyl-cyanoacrylate). The feasibility and tolerance of the procedures were evaluated using portography, liver function tests and histological analysis. Evolution of liver volumes was assessed with volumetric imaging by computed tomography. <b><i>Results:</i></b> Embolization of portal branches corresponding to 75% of total liver volume was performed successfully in all animals. Procedures were well tolerated, inducing moderate changes in portal pressure and transient aminotransferase increase. None of the animals developed portal vein thrombosis. After RPVE, complete recanalization occurred at day 11. RRPVE showed a trend for higher hypertrophy, the non-embolized liver to total liver ratio reaching 5.2 ± 1.0% in the RPVE group, 6.8 ± 0.1% in the RRPVE group and 5.0 ± 0.3% in the PPVE group. <b><i>Discussion/Conclusion:</i></b> In this preliminary comparative study, RRPVE was as feasible and as well tolerated as the other procedures, and resulted in higher liver hypertrophy.

TENSIOMETRIC ANALYSIS OF MESHES USED IN ABDOMINAL VENTRAL WALL DEFECTS IN RATS

ABSTRACT Background: Among the various strategies to avoid exaggerated foreign body reaction in the treatment of hernias is the limitation of the amount of polypropylene or the use of absorbable material. Aim: To evaluate the healing of defects in the abdominal wall of rats, comparing microporous polypropylene, macroporous polypropylene and polypropylene/polyglecaprone at the 30º, 60º and 120º postoperative day. Methods: Wistar rats were submitted to defect production in the ventral abdominal wall, with integrity of the parietal peritoneum. Prolene®, Ultrapro® and Bard Soft® meshes were used in the correction of the defect. Nine subgroups of 10 animals were submitted to euthanasia at 30th, 60th and 120th postoperative day. Fragments of the abdominal wall of the animals were submitted to tensiometric analysis. Results: The tensiometry at the 30th postoperative day showed greater resistance of the tissues with Bard Soft® (macroporous mesh) in relation to the tissues with Prolene® (microporous mesh). On the 60th postoperative day Bard Soft® maintained the superior resistance to the tissues comparing to Prolene Mesh®. On the 120th postoperative day the tissues repaired with Ultrapro® (macroporous mesh) proved to be more resistant than the ones by Prolene® (microporous mesh) and Bard Soft® (macroporous mesh). Conclusion: The tissues repaired with macroporous meshes showed greater resistance than with microporous meshes at all stages, and at 120 days postoperative Ultrapro® performed better than the others.