Cartilage Curvature Reshaping: A Quantitative Assessment

Background Horizontal mattress suture is frequently performed procedure during Rhinoplasty and Otoplasty to control the curvature of the cartilages. Despite the popularity of mattress technique, there are no quantitative methods to determine the suture effects in cartilage reshaping. Objectives The aim of the present experimental study was to quantify the straightening effect of mattress suture on convexity of ear cartilage in rabbit models. Methods Eleven young adult male New Zealand white rabbits were used in this study. Horizontal mattress suture with spacing 3×6 mm was used in rectangle demarcated on left ear in area with maximum convexity. Preoperative and postoperative photographers were done before and immediately after surgery respectively. The Radius of curvature (ROC), first order deviation (FOD) and second order deviation (SOD) were calculated to quantify net cartilage reshaping, each point changes and homogeneity of new shaped cartilage respectively. Results The means for ROC were 1.112 and 2.169 before and after surgery respectively. ROC as indicator of net overall changing increased statistically significant. The means of FOD as each point slope index was statistically lower after surgery. (0.269 before surgery, 0.135 after surgery) The means for SOD also significantly decreased after surgery. (0.007 before surgery, 0.003 after surgery) The values of SOD remained positive after surgery that indicate changes in curve were homogenous. Conclusions A quantitative measurement method was introduced to directly quantify the controlling effect of suture. This quantifying method seems to be mandatory to compare the effect of horizontal mattress suture with other techniques in cartilage reshaping.

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.

Differences in Failure Mode Between Simple and Mattress Suture Configuration in Arthroscopic Bankart Repairs: A Cadaveric Study

Background: Traumatic anterior shoulder dislocations disrupt the anteroinferior labrum (Bankart lesion), leading to high rates of instability and functional disability, necessitating stabilization. Purpose: To investigate modes and locations of repair failure between simple and horizontal mattress suture configurations after arthroscopic Bankart repair using suture anchors in a cadaveric model. Study Design: Controlled laboratory study. Methods: A total of 48 fresh-frozen human cadaveric shoulders from 48 specimens underwent creation of Bankart lesions from either the 3:00 to 6:00 o’clock position on the right glenoid or the 6:00 to 9:00 o’clock position on the left glenoid. Shoulder laterality between specimens was alternated and randomized to either simple or mattress suture repair configurations. In each shoulder, anchors were placed on the glenoid at the 3:00, 4:30, and 6:00 o’clock positions on the right or 6:00, 7:30, and 9:00 o’clock positions on the left and were secured via standard arthroscopic knot-tying techniques. Specimens were tested in the supine anterior apprehension position using a servohydraulic testing machine that was loaded to failure, simulating a traumatic anterior dislocation. After dislocation, open inspection of specimens was performed, and failure mode and location were documented. Differences in failure mode and location were compared using nominal multivariate generalized estimating equations. Results: Simple suture repairs most frequently failed at the labrum, while mattress suture repair failed at the capsule. Regardless of configuration, repairs failed most commonly at the 3:00 o’clock position on the right shoulder and 9:00 o’clock position on the left shoulder. Compared with mattress suture repairs, simple suture repairs failed at a significantly higher rate at the 6:00 o’clock position. Conclusion: Traumatic anterior shoulder dislocation after arthroscopic Bankart repair in a cadaveric model resulted in simple suture configuration repairs failing most commonly via labral tearing compared with capsular tearing in mattress repairs. Both repair configurations failed predominately at the anterior anchor position, with simple suture repairs failing more commonly at the inferior anchor position. Clinical Relevance: Horizontal mattress suture configurations create a larger area of repair, decreasing the risk of repair failure at the labrum. The extra time required for mattress suture placement at the inferior anchor position is used effectively, resulting in lower biomechanical failure rates.