A Controlled Trial of Polyglytone 6211 versus Poliglecaprone 25 for Use in Intradermal Suturing in Dogs

The objective of this work was the comparative evaluation of the healing process after employing 4/0 poliglecaprone 25 and 4/0 polyglytone 6211 in a continuous intradermal suture pattern. Ten Beagle dogs were used, in which skin incisions were created surgically and subsequently were sutured by means of continuous intradermal pattern using polyglytone 6211 or poliglecaprone 25 suture. Cosmetic, clinical, and histologic scores were evaluated. The cosmetic appearance of the wounds was blindly evaluated on days 7, 14, 28, 180, 360, 730, and 1095. On the same days, tissue biopsy was performed for histological evaluation. Clinical evaluation was performed initially daily, then weekly, monthly, and finally yearly, till day 1095. The clinical appearance of the intradermal pattern with both sutures was initially very good, deteriorated in the second post-operative month and thereafter improved. The cosmetic, clinical, and histological differences between the two suture materials were minimal and statistically insignificant. Polyglytone 6211 is sufficient for use in intradermal suturing in dogs. However, its earlier absorption compared to poliglecaprone 25 did not have any beneficial effect on cutaneous wound healing and scar appearance in the experimental animals.

How to tie dangerous surgical knots: easily. Can we avoid this?

ObjectiveSecure knots are essential in all areas of surgical, medical and veterinary practice. Our hypothesis was that technique of formation of each layer of a surgical knot was important to its security.DesignEqual numbers of knots were tied, by each of three groups, using three techniques, for each of four suture materials; a standard flat reef knot (FRK), knots tied under tension (TK) and knots laid without appropriate hand crossing (NHCK). Each knot technique was performed reproducibly, and tested by distraction with increasing force, till each material broke or the knot separated completely.SettingTemporary knot tying laboratory.MaterialsThe suture materials were, 2/0 polyglactin 910 (Vicryl), 3/0 polydioxanone, 4/0 poliglecaprone 25 (Monocryl) and 1 nylon (Ethilon).ParticipantsThree groups comprised, a senior surgeon, a resident surgeon and three medical students.Outcome measuresProportion of each knot type that slipped, degree of slippage and length of suture held in loop secured by each knot type.Results20% of FRK tied with all suture materials slipped; all knots tied with the other two techniques, with all materials, slipped, TK (100%) and NHCK (100%). The quantitative degree of slip was significantly less for FRK (mean 6.3%–, 95% CI 2.2% to 10.4%) than for TK (mean 312%, 95% CI 280.0% to 344.0%) and NHCK (mean 113.0%, –95% CI 94.3% to 131.0%).The mean length of suture in loops held within (FRK mean 25.1 mm 95% CI 24.2 to 26.0 mm) was significantly greater than mean lengths held by the other techniques (TK mean 17.0 mm, 95% CI 16.3 to 17.7 mm), (NHCK mean 16.3 mm, 95% CI 15.9 to 16.7 mm). The latter two types of knot may have tightened more than anticipated, in comparison to FRK, with potential undue tissue tension.ConclusionMeticulous technique of knot tying is essential for secure knots, appropriate tissue tension and the security of anastomoses and haemostasis effected.

Cadaveric Evaluation of Load to Failure in Canine Gingiva Apposed With Varied Suture Patterns Using Poliglecaprone 25

The purpose of the study was to determine the effect of suture pattern and repair length on the load to failure in an ex vivo canine gingival model. Healthy mandibular gingiva and mucosa were harvested from fresh cadavers euthanized for purposes unrelated to the study. Samples were randomly assigned by length and pattern. Lingual and buccal free gingival margins were apposed using a simple interrupted (SI), cruciate (XT), simple continuous (SC), or unidirectional knotless continuous barbed suture (SF) closure technique with USP 4-0 poliglecaprone 25i, ii applied over 2 lengths (3 cm and 6 cm). A custom template was used to ensure uniform suture bite application. Surgical time was recorded. Using a soft tissue mechanical testing frame, samples were tensioned to failure. Testing was video recorded and reviewed in conjunction with the tension trace data for tension at initial failure (Tfail) and maximum tension sustained (Tmax). Two factor ANOVA by length and pattern was performed followed by individual one way T-tests. Statistically significant findings were XT-SC-SF patterns were quicker to perform than SI. SF was more likely to fail by suture breakage than tissue tearing, and SF withstood less tension at the 3 cm length than SI-XT-SC. No significant difference was detected in Tmax or Tfail between SI and SC or XT. The study demonstrates that SC and XT are comparable to SI in tension resistance and faster to perform suggesting that SC and XT could replace SI for extraction site closure although further in vivo testing is required.

How to tie dangerous surgical knots - easily. Can we avoid this?

E H Drabble**, S Spanopoulou*, E. Sioka*, E Politaki*, I K Paraskeva*, E Palla*, L Stockley***, D Zacharoulis* (* University of Thessaly, Greece, **Clinical lead BSS course RCS England, Consultant Surgeon, University of Plymouth Hospitals NHS Trust***University of Plymouth, England) (Data statement: 'Technical appendix, statistical code, and dataset available from the Univrersity of Plymouth Data repositry Corresponding author: Eric Drabble, c/o 42 Skylark Rise, Plymouth PL6 7SN, Devon, UK [email protected] +44 7533 186772 Abstract Objective: Secure knots are essential. Previous publications have concentrated on security of different knot types, but could individual technique be important? Determine whether the technique of formation of each layer of a surgical knot is important to the security of the knot formed. Design study: Prospective analysis of technique on knot security Materials and methods: Senior and resident surgeons, and medical students, tied knots with three techniques, using four study materials, 2/0 polyglactin 910 (vicryl), 3/0 polydioxanone (PDS), 4/0 poliglecaprone 25 (monocryl) and 1 nylon (Ethilon); a standard flat reef knot (FRK), knots tied under tension (TK), and knots laid without appropriate hand crossing (NHCK). Each knot technique was performed reproducibly, and security determined by distraction with increasing force, till each material broke, or the knot separated completely. Results: 20% of flat reef knots (FRK) tied with all suture materials slipped; all knots tied with the other two techniques, with all materials, slipped, TK (100%) and NHCK (100%). The quantitative degree of slip, was significantly less for FRK (mean 6.3% 95%CI 2.2-10.4%) than for TK (mean 312% 95%CI 280.0-344.0%) and NHCK (mean 113.0% 95%CI 94.3-131.0%). The mean lengths of suture in loops held within knots, tied under tension (TK mean 17.0mm 95%CI 16.3-17.7mm), and tied without appropriate hand crossing (NHCK mean 16.3mm 95%CI 15.9-16.7mm) were significantly lower than for flat reef knots (FRK mean 25.1mm 95%CI 24.2-26.0mm). The first two types of knot may have tightened more than anticipated, in comparison to flat reef knots, with potential undue tissue tension. Conclusion: Meticulous technique of knot tying, is essential for secure knots, appropriate tissue tension, and the security of anastomoses and haemostasis effected

Ultrasonographic, cosmetic, clinical and histological study of the healing process in the canine skin following surgical incision and closure using various techniques

Σκοπός της διατριβής ήταν η σύγκριση τεχνικών σύγκλισης τραύματος και η αξιολόγησή τους με τη βοήθεια κλινικής, υπερηχοτομογραφικής (50 MHz) και ιστοπαθολογικής εξέτασης, καθώς και η διερεύνηση της χρήσης της υπερηχοτομογραφίας στη διαγνωστική του δέρματος. Οι ακόλουθες τεχνικές χρησιμοποιήθηκαν για τη σύγκλιση τομών 12 εκατοστών στην εξωτερική επιφάνεια των μηρών 10 Beagle: (α) συρραπτικά δέρματος, (β) n-butyl cyanoacrylate κόλλα ιστών, γ. συνεχής ενδοδερμική ραφή με ενταφιασμό κόμπων (ράμμα 4-0 poliglecaprone-25) και (δ) συνεχής ενδοδερμική ραφή με καθήλωση με χρήση κουμπιών (ράμμα polypropylene 4-0). ΄Εγινε αισθητική, κλινική, υπερηχοτομογραφική και ιστολογική αξιολόγηση των τομών, σε τακτά χρονικά διαστήματα έως ένα έτος μετά τη σύγκλιση. Η αισθητική αξιολόγηση έγινε από δύο κριτές. Η κλινική αξιολόγηση περιελάμβανε την βαθμολόγηση του οιδήματος, ερυθήματος, εύρους ουλής, φλεγμονής ή αποστηματοποίησης, εξιδρώματος, κόμεδων, υπερχρωμίας, απώλειας συρραπτικών, διάσπασης τραύματος και σχηματισμού σταυροειδών ουλωδών εντυπωμάτων. Η υπερηχοτομογραφική αξιολόγηση περιελάμβανε μέτρηση της περιοχής επούλωσης σε τέσσερα διαφορετικά σημεία της τομής. Με την ιστολογική αξιολόγηση εκτιμήθηκε τυχόν νέκρωση, έλλειμμα επιδερμίδας, οίδημα, φλεγμονή, παρουσία υλικού συρραφής, ιστική αντίδραση πέριξ του υλικού συρραφής, πάχος επιδερμίδας, εύρος ουλής, παρουσία ινοβλαστών, παραγωγή κολλαγόνου και αγγειογένεση στην περιοχή επούλωσης. Τα συμπεράσματα της έρευνα είναι:Με όλες τις τεχνικές, η αισθητική αξιολόγηση βελτιωνόταν έως τον δεύτερο μήνα, μετά όμως η βελτίωση ήταν ελάχιστηΑπό την 9η μετεγχειρητική ημέρα και μετά, η κόλλα είχε τη χειρότερη αισθητική αξιολόγηση.Η ενδοδερμική ραφή με κουμπιά είχε την καλύτερη αισθητική εικόνα έως τον έκτο μήνα, στη συνέχεια όμως η ενδοδερμική με ενταφιασμό του κόμπου είχε καλύτερη εικόνα.Η ουλή είχε μεγαλύτερο εύρος με την κόλλα, η δε διαφορά ήταν στατιστικώς σημαντική σε σχέση με τις ενδοδερμικές στο τέλος του πειράματος.Η συνολική κλινική αξιολόγηση ήταν συνεχώς καλύτερη με τις ενδοδερμικές, με την ενδοδερμική με ενταφιασμό των κόμπων να υπερτερεί στο τέλος του πειράματος.Η υπερηχοτομογραφία δέρματος μπορεί να χρησιμοποιηθεί για την αξιολόγηση της επούλωσης δέρματος κατά πρώτο σκοπό, καθώς τα υπερηχοτομογραφικά ευρήματα αντικατόπτριζαν με ακρίβεια τα κλινικά και ιστολογικά ευρήματα.Τα ιστολογικά ευρήματα έδειξαν ότι η χρήση κόλλας προκαλεί έντονη πάχυνση της επιδερμίδας τον πρώτο μήνα της επούλωσης, ενώ, παρότι η εφαρμογή κόλλας έγινε με ιδιαίτερη προσοχή, μικρές ποσότητες κόλλας διείσδυσαν στο τραύμα, όπου παρέμειναν μέχρι το τέλος του πειράματος, προκαλώντας μικρές εστίες φλεγμονής.Η συνολική αξιολόγηση των τεχνικών έδειξε ότι οι ενδοδερμικές τεχνικές είχαν την καλύτερη εξέλιξη, με την ενδοδερμική ραφή με ενταφιασμό των κόμπων να υπερέχει, ενώ η χρήση κόλλας είχε την λιγότερο ικανοποιητική εικόνα. Η χρήση συρραπτικών είχε πολύ καλή εξέλιξη, ενώ ταυτόχρονα ήταν η γρηγορότερη και ευκολότερη τεχνική κατά την εφαρμογή, και μπορεί να εφαρμόζεται όταν υπάρχει πίεση χρόνου.

An Improved Method for Temporary Suture Medialisation of the Middle Turbinates following Endoscopic Sinus Surgery

Background. Middle turbinate (MT) lateralisation with adhesion formation (MiTLAF) is a common complication following endoscopic sinus surgery, frequently resulting in surgical failure, persistence of preoperative symptoms, and delayed secondary complications. Packing materials, splints, or spacers reduce the risk of MiTLAF but often result in postoperative nasal obstruction and discomfort, along with reduced access for irrigation. Temporary suture medialisation of the MTs reduces the risk of MiTLAF and prevents the problems encountered with packing, splints, or spacers. However, the techniques described in the literature are technically challenging and often ineffectual. Methods. We describe a method of suture placement that provides a secure temporary MT medialisation, without the technical challenges of traditional techniques, using a 4-0 Monocryl (Poliglecaprone 25, Ethicon, Somerville, NJ, USA) suture on a 19 mm precision point reverse cutting PS-2 curved needle. We review 25 consecutive patients undergoing sinonasal procedures with our new technique and assess for MiTLAF. Results. In our cohort, only one patient experienced MiTLAF which was not clinically significant. Conclusions. Our method is simple, easy to perform, and highly effective and prevents adhesion formation without the need for postoperative splints or packing.

PS01.163: EVALUATION OF A TECHNIQUE OF SINGLE LAYER CONTINUOUS ESOPHAGOGASTRIC ANASTOMOSIS USING POLIGLECAPRONE 25

Background Methods This was a prospective study on patients who underwent esophagectomy for carcinoma oesophagus from May 2016 to August 2017. The patients who expired in immediate post operative period were excluded from study for evaluation of anastomotic leak and those patients who could not be followed up for at least six months were also excluded from study for evaluation of development of post operative stricture. End to side anastomosis was placed on the anterior surface of stomach using two suture lengths of 2–0 polyglecaprone 25. Anastomosis was done in single continuous layer with full thickness bites. At the end the stomach conduit was tucked to prevertebral fascia by a single stitch. During post operative period, Jejunal feeding was started on 2nd post operative day. Ryle's tube was removed on 5th post operative day and clear liquids were started. Gastrograffin study was done only if clinical suspicion of leak was there on day 7. Semisolid puree diet was started on day 7 and neck drain was removed on day 10. Patients were followed up for six months and specifically asked for symptoms of dysphagia.Symptoms of dysphagia were recorded and graded on the basis of Mellow-Pinkas scoring system. Results Mckeowns esophagectomy was performed in 18 patients, transhiatal in 8 patients and Ivor Lewis in 1 patient. Average time taken for anastomosis was 17 min. Anastomotic leak was seen in four patients(14.81%) and all leaks could be managed conservatively. Only two patients(7.40%) presented with dysphagia which required dilatations. The cost of suture used was least as compared to other techniques. Conclusion Anastomotic leak rate of the present technique was found to be comparable to other techniques whereas the post operative stricture formation was significantly less. Poliglecaprone 25 looses all its tensile strength by third week and this may be the reason for low stricture rates. We conclude that Esophagogastic anastomosis with a single layer continuous technique using 2–0 poliglicaprone 25 gives good results having comparable leak rates to other techniques. The rate of anastomotic stricture formation is quite low as compared to other techniques.The anastomosis takes less than seventeen minutes and is quite cost effective. Disclosure All authors have declared no conflicts of interest.

A rare reaction to synthetic mono-filament sutures: a report of two cases

Due to their clinical advantages, synthetic mono-filament sutures are dominantly used for postoperative wound closures. We present two patients who suffered rare skin reactions to either poliglecaprone 25 or glyconate sutures, following breast cancer lumpectomy. This report aims to make perioperative practitioners and clinicians aware of reactions to sutures and possible management options.