Polyester 5-0 Suture for Porous Implant Placement After Retinoblastoma Enucleation: Analysis of 120 Sockets

Background: Techniques used to suture the rectus muscle to the implant can influence the implant-related complications which is still a major problem following retinoblastoma enucleation. The goals of this work were to report the efficacy among patients with retinoblastoma who underwent enucleation followed by porous implant placement with the rectus muscles sutured with 5-0 polyester suture.Methods: This was a retrospective study of consecutive patients with retinoblastoma who underwent primary enucleation and porous implant placement with the rectus muscles tagged and sutured to the implant with polyester 5-0 suture. All the patients were followed up for a minimum of 2 years. The main outcome measure was implant exposure. The secondary efficacy measures were other implant-related complications.Results: A total of 120 patients (120 eyes) underwent primary enucleation and porous implant placement were included. Postoperatively, 10/120 (8.3%) eyes developed exposure and conjunctival granuloma. Exposure was the most common postoperative complication (7/10, 70.0%). There were no cases of implant extrusion, migration, or infection.Conclusions:Polyester 5-0 sutures are successful in patients with retinoblastoma who underwent enucleation followed by porous implant placement. Complications are minimal. Polyester 5-0 sutures were not associated with unacceptable complications in this pediatric population.

In vitro evaluation of antibacterial efficacy of vancomycin-loaded suture tapes and cerclage wires

Usage of implants containing antibiotic agents has been a common strategy to prevent implant related infections in orthopedic surgery. Unfortunately, most implants with microbial repellent properties are characterized by accessibility limitations during daily clinical practice. Aim of this in vitro study was to investigate whether suture tapes and cerclage wires, which were treated with vancomycin, show a sustainable antibacterial activity. For this purpose, we used 24 stainless steel wire cerclages and 24 ultra-high molecular weight polyethylene and polyester suture tape test bodies. The test bodies were incubated for 30 min. in 100 mg/ml vancomycin solution or equivalent volumes of 0.9% NaCl. After measuring the initial solution uptake of the test bodies, antibacterial efficacy via agar diffusion test with Staphylococcus aureus and vancomycin elution tests were performed 1, 2, 3, and 6 days after incubation. Vancomycin-loaded tapes as well as vancomycin-loaded cerclage wires demonstrated increased bacterial growth inhibition when compared to NaCl-treated controls. Vancomycin-loaded tapes showed an additional twofold and eightfold increase of bacterial growth inhibition compared to vancomycin-loaded wires at day 1 and 2, respectively. Elution tests at day 1 revealed high levels of vancomycin concentration in vancomycin loaded tapes and wires. Additionally, the concentration in vancomycin loaded tapes was 14-fold higher when compared to vancomycin loaded wires. Incubating suture tapes and cerclage wires in vancomycin solution showed a good short-term antibacterial activity compared to controls. Considering the ease of vancomycin application on suture tapes or wires, our method could represent an attractive therapeutic strategy in biofilm prevention in orthopedic surgery.

Case Report on Sleeve Avulsion of Patella in Young Adult

Introduction: Sleeve avulsion of patella is extremely rare, limited almost to children. However, few cases have been reported in adults. Rarity of this fracture makes the diagnosis and choice of treatment difficult. Inability to raise leg remains important clinical sign for quadriceps mechanism insufficiency. In the absence of standard treatment guidelines pullout sutures through patella provides a secure and stable fixation option. Our case remains the first to be reported ever in English literature in a 23-year-old male with a superior pole avulsion patella being treated with Krakow pullout suture. Case Report: A 23-year-old Indian male was admitted with left knee pain and swelling following fall from bike. He had knee pain, swelling, and inability to bear weight. Active straight leg raising was not possible. On X-ray he had small bony sleeve visible near proximal pole of patella. Magnetic resonance imaging (MRI) was done which showed sleeve avulsion of patella at proximal pole. Under spinal anesthesia fracture was exposed through midline approach. Pullout Krakow sutures were taken through quadriceps tendon and fracture fragments using 3 no Polyester suture. Transosseous tunnels were drilled in patella and tied distally. At 4 months patient had no extension lag with full range of movements. At 14 months follow-up patient is asymptomatic and able to run, squat, sit cross legged, and do his day-to-day activities. Conclusion: Sleeve avulsion of patella in adults is extremely rare with only few cases reported in literature. MRI is not only useful for diagnosis but also for deciding treatment modality. Krackow technique with Polyester suture through quadriceps tendon incorporating fracture fragment passed through patellar transosseous tunnel provides secure fixation with excellent results. Also avoids any future hardware problems in this subcutaneous bone. Keywords: Sleeve avulsion, Krakow suture, pull out technique.

Surgery and Rehabilitation Following Flexor Tendon Zone II Injury Of The Hand: A Literature Review

Background : Flexor tendon injury of the hand is common and it used to end up with poor outcomes. It gives negative effects to patient’s daily life. Successful treatment for these cases is a challenge for surgeons. Before 1967, Injury in Zone II was called as “No Man’s Land”. Flexor tendon repair and rehabilitation have been substantially improved through advances in repair and rehabilitation. Method : We reviewed literatures from PubMed, MEDLINE, Cochrane and Google Scholar. It was researched using the terms flexor tendon zone II injury, flexor tendon zone II repair and flexor tendon zone II rehabilitation. Topics covered included anatomy, suture repair and material, and rehabilitation. Result : There is no significant difference of rupture rates and functional outcomes in the number of core suture. Braided polyester suture is the choice for core suture and monofilament for peripheral suture. There is no significant difference in rehabilitation using early passive motion or early active motion. The preference for post operative treatment is by using short splint without immobilization of the wrist. Discussion : Repair sutures techniques and suture materials have been improved as well as active mobilization rehabilitation protocols including a change of wrist position by modification of splints. Improvement in putting splint from a traditional dorsal blocking splint into splint that not immobilize the wrist. Despite all of these modifications, tendon ruptures have not been eliminated. The definitive answer remains elusive.