Comparison of 2-octyl cyanoacrylate skin adhesive and interrupted polypropylene sutures for wound closure in total ankle arthroplasty

Background Adhesive skin materials have increasingly been used in orthopedic surgery. We aimed to compare the efficacy and safety of skin adhesive (2-octyl cyanoacrylate and polymer mesh, Dermabond Prineo) and interrupted polypropylene sutures for wound closure in patients undergoing total ankle arthroplasty (TAA). Methods We prospectively enrolled 107 consecutive patients (108 ankles) undergoing TAA and divided them into two groups: skin adhesive group (36 ankles) and suture group (72 ankles). The primary outcome assessment included wound complications and patient satisfaction for wound cosmesis. The secondary outcome assessment included duration of surgery, length of hospital stay, and the Ankle Osteoarthritis Scale (AOS) pain and disability score. Results There was one case of allergic contact dermatitis, three cases of wound dehiscence, and one case of superficial surgical site infection in the skin adhesive group. Among them, one case each with allergic contact dermatitis and wound dehiscence finally progressed to deep surgical site infection. Three cases of wound dehiscence were also reported in the suture group; however, there was no case of surgical site infection. Patient satisfaction for wound cosmesis was significantly higher in the skin adhesive group than in the suture group (p = 0.001). There was no statistically significant difference between the groups in terms of secondary outcomes (p > 0.05). Conclusions Although the use of Dermabond Prineo showed better patient satisfaction for wound cosmesis, it showed significantly high wound complication rates and no other clinical benefits compared to interrupted polypropylene suture in TAA. Our results suggest that awareness of the possibility of wound complications is necessary when Dermabond Prineo is used in TAA.

Repairing Cyclodialysis by Riveting: A Flanged Polypropylene Suture

Cyclodialysis causes intraocular lens (IOL) pupillary capture. It requires surgical repair to prevent this risk of IOL pupillary capture. However, since repairing cyclodialysis is often technically difficult, other methods such as barricading by suturing, pupilloplasty, and pars plana fixation of the IOL were preferred. We applied a double-flanged (riveting) technique for repairing cyclodialysis to prevent IOL pupillary capture following intrascleral fixation of the IOL. Cyclodialysis was surgically repaired by riveting with double-flanged 6-0 polypropylene sutures in 3 cases with no recurrence of pupillary capture during at least 12 months of follow-up. When pupillary capture is related to cyclodialysis, repairing cyclodialysis may help prevent pupillary capture after intrascleral fixation of the IOL. Riveting using a double-flanged 6-0 polypropylene suture could possibly make the procedure simpler and more efficient.

LEFT VENTRICULAR PSEUDOANEURYSM - A COMPLICATION OF ACUTE MYOCARDIAL INFARCTION

Left ventricular pseudoaneurysm is a complication of acute myocardial infarction, especially after involvement of the inferior wall. The signs and symptoms are nonspecific. We report a case of a 69-year-old patient admitted for clinically important dyspnea. Transthoracic echocardiography showed pseudoaneurysm in the apical region, measuring 96x116 mm. Surgical correction was performed, using bovine pericardium and anchoring the ventricular orifice with 3-0 polypropylene sutures. It was not possible to perform coronary artery bypass grafting, as the distal beds of the proposed vessels were calcified. The patient was referred to the intensive care unit and discharged on the 17th postoperative day.

A comparative study of mesh fixation with polypropylene sutures (prolene) versus polyglactin sutures (vicryl) sutures in assessing inguinodynia in open inguinal hernia repair

Background: Inguinal hernia, the most frequently occurring type of hernia globally, Chronic groin pain could be related to nerve mangling while operating. Mesh repair can lead to an inflammatory reaction over a period of time, though it still needs ground work to find out exact cause of pain. So this study aims to compare the effectiveness of polyglactin versus prolene sutures in reducing the post-operative pain in inguinal hernia repair.Methods: A one year hospital prospective study in KLE hospital. A total of 60 adult patients were divided into two groups of 30 each. Mesh fixation with polyglactin sutures was group A (30) and mesh fixation with polypropylene sutures was group B (30) and then post-operative pain, was assessed. Follow-up was for 3 months. Collected data was analyzed using chi–square tests, Mann-Whitney U tests.Results: Our analysis showed that the incidence of postoperative groin pain with mean severity scores of 1.37±0.49 versus 1.43±0.50; 1.40±0.50 versus 1.57±0.73; 1.03±0.61 versus 1.50±0.057; 0.77±0.63 versus 1.30±0.79; at post-operative day 1, 3 in both groups were similar and statistically not significant whereas the 1 week and 3 months follow up in group A and B respectively, were significant (p<0.05).Conclusions: The post-op chronic groin pain is significantly low, hence routine usage of polyglactin sutures to fix a mesh is a safe and effective alternative to polypropylene sutures in Lichtenstein hernia repair.

Intraocular Suture Looping Technique for Flapless Four-Point Refixation of Dislocated Intraocular Lenses

Purpose. To describe a flapless/grooveless technique for four-point refixation of a dislocated intraocular lens (IOL) with four fenestrated haptics. Methods. An intraocular suture looping technique was performed with the assistance of two 27-gauge needles. A looping needle was passed into the eye through paracentesis and was used to loop both fenestrated haptics on the same side with an 8–0 polypropylene thread. A guiding needle was used to guide the looping needle out of the eye at the scleral fixation sites. After looping each pair of fenestrated haptics on nasal/temporal sides with 8–0 polypropylene sutures, the IOL was refixated by definitive knotting. The exterior suture ends were buried into the sclera without the creation of scleral flaps/grooves. Results. The technique was employed in four eyes (three patients). The mean postoperative follow-up period was 13.8 ± 2.2 months. Postoperatively, the IOLs of all the eyes remained well positioned and stable. The postoperative visual acuities of all the eyes were improved. No suture erosion, hypotony, scleral atrophy, chronic inflammation, retinal tears, and/or detachments were observed within the follow-up period. Conclusion. The present technique provides minimal surgical invasion for the transscleral refixation of a dislocated IOL with four fenestrated haptics.

Long-Term Stability of Sutured Scleral Fixation of a Posterior Chamber Intraocular Lens With 10-0 Polypropylene for More Than 30 Years

Purpose: We report the longest follow-up to our knowledge of stable scleral fixation of a posterior chamber intraocular lens (PC IOL) with 10-0 polypropylene sutures. Methods: A retrospective review is presented of a case with more than 30 years’ follow-up after performing sutured scleral fixation with 10-0 polypropylene suture using 2 sutures tied together under a scleral flap. One suture was a cow-hitch looped around the haptic, and the other suture was passed through the sclera to create the scleral fixation. Results: The scleral fixation with 10-0 polypropylene suture knots for both haptics of the PC IOL allowed central optic positioning with excellent vision for more than 30 years without suture breakage. Conclusions: Polypropylene sutures for scleral fixation of PC IOLs remained stable for more than 30 years with central positioning of the PC IOL, without exposure of the fixation suture knots through the conjunctiva, and without suture breakage.

Local inflammatory response to suture material in surgical practice: experimental data

Objective: to study the effect of various types of suture materials, potentially suitable for cardiovascular surgery, on experimental surgical outcomes. Materials and methods. Polypropylene sutures (Prolene 6/0), titanium nickelide (TiNi) sutures (6/0) and absorbable polydioxanone sutures (Monoplus 6/0) were used in the study. Male Wistar rats were used for in vivo studies. The effect of suture materials on abdominal adhesions was studied. In vivo calcification process was examined, and response of blood components in contact with suture materials was also assessed in vitro. Results. There is a negative inflammatory response to suture materials. The severity of this response depended on the type of material used. Polypropylene sutures demonstrated the most severe inflammatory response provoking massive adhesion formation. In addition, large calcium deposits were found both in the suture area and in the thickness of the biomaterial, stitched with prolene and implanted subcutaneously in the rats. Titanium nickelide sutures showed high hemocompatibility and biocompatibility. The Monoplus sutures caused minimal inflammatory response and provoked calcification of the biomaterial to a lesser degree. Conclusion. The suture material could have significant effects on surgical outcomes and could cause postoperative complications.