Suture thread: An unusual etiology of tracheal pseudotumor

A 66-year-old man ingested sodium hydroxide in a suicide attempt in June 2018. In emergency room, he presented burning of the tongue and uvula and supraglottic and vocal cords edema. Because of the risk of airway obstruction, the patient underwent endotracheal intubation and started invasive mechanical ventilation. Five days later, a surgical tracheostomy was performed due to a large laryngeal necrosis including extensive epligottis involvement. After prolonged mechanical ventilation through tracheostomy, the patient presented a favorable clinical course allowing ventilator weaning and decannulation 2 months after initial presentation. In February 2019, cervical Computed Tomography (CT) revealed a polypoid lesion occupying 25% of the tracheal lumen, with contrast uptake and suggestive of malignant etiology (Figure 1A-B). The patient was asymptomatic. Rigid bronchoscopy showed that the pseudotumoral tracheal lesion corresponded to granulation tissue around suture thread from the previous tracheostomy, which were successfully removed during the procedure (Figure 1C-E). Pathological examination showed granulation tissue with extensive inflammatory infiltrate and foreign-body giant cell reaction.

Evaluation of Biomechanical Traction of Incisional Gastropexy and Scarification Gastropexy Techniques in Dogs

Background: Gastropexy is used to correct gastric dilation, a disease that usually affects large and giant dogs and leads to death in 23.4 - 43% of patients. This study aimed to evaluate the biomechanical traction of 2 gastropexy techniques, incisional gastropexy and scarified gastropexy, in 10 dog cadavers. Incisional gastropexy comprises a single incision in the abdominal wall and another incision in the stomach wall in the pyloric region followed by simple continuous sutures. The scarification technique creates scarification along the stomach borders of the pexy. Thereby, knowing that both techniques are successful, the biomechanical traction of each technique was compared.Materials, Methods & Results: A total of 10 animals without defined breed weighing from 6.4-43.0 kg were allocated into 2 equal groups (GE [scarified gastropexy] and GI [incisional gastropexy]). Incisional gastropexy was performed with a simple continuous suture pattern in the GI group and scarified gastropexy with an interrupted simple suture pattern was performed in the GE group. Absorbable 2-0 monofilament yarn (polygllecaprone 25) was used for sutures in both groups. Rectangular segments of the gastric antrum were collected from the right abdominal wall and from the bottom of the stomach at the left abdominal wall, which were subjected to a traction test. The scarification technique was easier, faster, and used less surgical sutures than the incisional technique. Both techniques were effective regardless of the site applied, with no significant differences. There was a difference in stretching depending on location.Discussion: The pathogenesis of gastric dilatation volvulus (GDV) is unknown. However, gas accumulation inside the gastric chamber may lead to organ dilation and consequently cause torsion of the cardia region and pyloric antrum, resulting in strangulation of blood vessels and nerves. This torsion could cause stomach ischemia followed by organ necrosis if early emergency care is not provided. In addition, vessel strangulation my lead to a systemic syndrome resulting in shock. The disease presents acute and non-specific clinical signs such as weight loss, vomiting, and abdominal intumescence. Patients with risk factors such as reduced gastric motility, delayed stomach replenishment, lower weight, advanced age, or presence of a foreign body may present with poor prognosis. Once GDV becomes an emergency, surgical correction with the most efficient surgical techniques and procedures is necessary to guarantee patient survival. Based on the results obtained, both the scarified and incisional gastropexy techniques are more efficient than other techniques. In addition, the scarified technique with interrupted simple stitches stood out when compared to the incisional technique with a continuous simple suture pattern as it was faster and used less suture thread. The incisional technique, on the other hand, provides good juxtaposition of the edges of the wounds, avoiding the exposure of muscle tissue, as well as adhesions from other organs. The knowledge of those factors promotes positive effects on the effectiveness of an emergency surgical approach for patients with GDV, since it allows less surgical time, as well as less anesthetic time. Based on the results obtained during the biomechanical traction tests of the study, it was concluded that both scarified gastropexy with interrupted single stitches and incisional gastropexy with a continuous single stitch may be efficient. The scarified technique stood out when compared to the incisional technique as it required less time and used less sutures.

How I Do It: Inferior Turbinectomy: Modified Techniques for Submucosal Resection

Although inferior turbinectomy with submucosal resection effectively reduces the volume of the inferior turbinate, there is room for improvement in surgical procedures. Techniques have been developed to reduce crusting and bleeding while efficiently achieving volume reduction. State-of-the-art procedures pertaining to the local injection site, incision line, exposure of the periosteum, submucosal outfracture of the turbinate bone, trimming of redundant mucosa, and incision line suturing are described. Pre and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores and postoperative inferior turbinate bleeding and crusting were evaluated. For the 18 consecutive patients analyzed, the pre and postoperative NOSE scores were 67.8 ± 14.8 and 16.1 ± 13.0, respectively ( P = .0002). Postoperatively, bleeding was absent, and only minor suture thread crusting was observed in 13 patients. In conclusion, our novel technique improves the effectiveness of surgery as well as the postoperative quality of the inferior turbinate.

A novel suturing technique, based on physical principles

Introduction: In medicine, sutures have been used for thousands of years to close wounds. However, despite the great advances that have been made in technology, little progress has taken place in suturing techniques and most surgeons continue to use the same two classical techniques (continuous suture or interrupted suture). This paper proposes a suturing technique (“double diabolo”) in which a pattern of eight 45-degree angles is formed, in the view that this achieves a notable reduction in the tension exerted (30% at each angle), thereby increasing the overall strength of the suture. Material and Method: In this study, we compare the physical tensions exerted on the suture thread and its entry/exit points, on the one hand by the two techniques most often used – interrupted suture (Type 1) and continuous suture (Type 2) – and on the other, by the proposed “double-diabolo” suture (Type 3). Results: The Type 3 suturing method produced the lowest levels of tension on the thread, almost 65% less than those of Type 1 and 50% less than those of Type 2. The tension on the wound was also considerably lower, with reductions of 33% and 50% in comparison with Types 1 and 2, respectively. Conclusions: The results obtained in this study corroborate our hypothesis that the proposed double-diameter suture method exerts less tension on the thread and on the entry/exit points than conventional techniques. Theoretically it would be recommended for cases in which the suture must withstand significant tension as laparotomy closure

Histological Inflammation in Human Ureter either Healthy or Fitted with Double-Pigtail Stent or a Thin 0.3 F Suture Thread: A Preliminary Study

Background. Ureteral stent intolerance reduces patients’ quality of life. It has been suggested that changes in the shape of stents could decrease discomfort. In previous studies, the innovative pigtail-suture stent (i.e., JFil® or MiniJFil®) with a thin 0.3 F suture thread significantly decreased stent-related symptoms. Fortuitously, a dilation of the ureter containing the sutures was discovered. In addition, no inflammation was seen on the ureter wall around the suture in endoscopy. In this preliminary study, we assessed ureteral inflammation in the human ureter when it was healthy or when fitted with a double-pigtail stent or a thread. Materials and Methods. After consent and inclusion of patients in the protocol, fifteen segments of ureters were collected during cystectomy procedures for bladder tumors. Ureteral inflammation was assessed on the histological section stained with hematoxylin-eosin. Histological grading (cumulative range of 0 to 6) assessing inflammation was performed on the ureter section for mucosa inflammation and inflammation in the muscle layer. Results. A marked ureteral inflammatory reaction was observed in all cases of ureters fitted with a double-pigtail stent with a mean inflammation score of 4.8 ± 0.4. The ureter fitted with the thin suture thread showed inflammation in only one case with a mean inflammation score of 1.8 ± 1.3 p=0.001. Conclusion. Although the study was limited by the small number of patients, it confirmed that the double-pigtail stent induced ureteral inflammation in all cases and the thin 0.3 F suture thread caused less ureteral inflammation than the double-pigtail stent. The concept of material reduction within the urinary tract seems necessary in order to decrease mucosal irritation. The JFil® or the MiniJFil® thread could meet this requirement.

The Role of Bacterial Colonization of the Suture Thread in Early Identification and Targeted Antibiotic Treatment of Surgical Site Infections: A Prospective Cohort Study

Background: The aim of the present study is to investigate the role of the colonization of suture thread to identify patients at risk of developing a surgical site infection (SSI) after clean surgical procedures. Methods: Patients who underwent elective clean surgery procedures at the Surgery Unit of the AOU-University of Campania Luigi Vanvitelli in a 21-month period were prospectively enrolled. For each patient, a synthetic absorbable thread in Lactomer 9-1 was inserted into the surgical site at the end of surgery and microbiologically evaluated after 48 h. Antibiotic prophylaxis was chosen according to international guidelines. Results: A total of 238 patients were enrolled; 208 (87.4%) of them were subjected to clean procedures without the placement of prosthesis, and 30 (12.6%) with prosthesis. Of the 238 patients, 117 (49.2%) underwent an antimicrobial prophylaxis. Overall, 79 (33.2%) patients showed a bacterial colonization of the thread: among the 208 without the implantation of prosthesis, 19 (21.8%) of the 87 with antibiotic prophylaxis and in 58 (47.9%) of the 121 without it; among the 30 patients with the implantation of prosthesis, only two patients showed a colonized thread. The patients with antibiotic prophylaxis developed a colonization of the thread less frequently than those without it (17.9% vs. 47.9%, p < 0.001). SSI was observed in six (2.5%) patients, all of them showing a colonized thread (7.6% vs. 0%, p < 0.001). The bacteria identified in colonized threads were the same as those found in SSIs. Conclusions: Our study presents a new method that is able to precociously assess patients who have undergone clean procedures who may develop SSI, and identify the microorganism involved.