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At least 1,135 records · Page 63Linked to original sources
PubMed2005

Catheter occlusion technique to facilitate distal anastomoses using vein grafts.

Several different modes of achieving a bloodless operating field by proximal and distal occlusion of blood vessels have been described. Vascular clamps, vessel loops, intraluminal occluding devices, and tourniquets have been used to control the tibial and pedal vessels but may cause injury or fail to control heavily calcified arteries. We describe an alternative way to control proximal and distal small arteries by using small, umbilical vein, feeding catheters. The catheters are introduced in the proximal and distal arterial lumen and in the vein graft lumen, achieving hemostasis, technically facilitating the suturing, and providing a means for the administration of vasodilator or thrombolytic agents as well as for a completion angiography.

Anastomosis, Surgical↗
PubMed1998

Ergonomic evaluation of laparoscopic bowel suturing.

BACKGROUND: Ergonomic assessment of the instrument to needle to tissue relationship on efficiency and accuracy of laparoscopic suturing. METHODS: Video records of nine laparoscopic surgeons were analyzed for five technical variables of laparoscopic suturing. Surgeons undertook closure of 60 mm enterotomy using continuous 3/0 seromuscular atraumatic sutures. Subjects attempted to suture 3 to 5 mm from enterotomy edge and at 3 to 5 mm intervals. Vertical/horizontal deviations from desired entry/exit point of suture, execution time, and failure to complete sutures were recorded. RESULTS: Visualization style used by some was significantly more accurate but slower than the nonvisualization style used by others. Needle insertion angle of 80 degrees to 100 degrees gripping the middle and proximal end of needle and holding the needle >90 degrees to instrument axis significantly improved task accuracy. Insertion angle <80 degrees produced three times the failure rate of 80 degrees to 100 degrees. Surgeon's performance was consistent with either suturing style. CONCLUSIONS: Visualization style was slower but more accurate. Optimum conditions for good suturing include 80 degrees to 100 degrees needle insertion angle; holding angle >90 degrees, and gripping point at middle and proximal third of the shaft of the needle. Task accuracy was surgeon dependent.

Colon↗
PubMed1991

Effectiveness of trigonoplasty to treat primary vesicoureteral reflux.

Among the surgical procedures to treat vesicoureteral reflux trigonoplasty is a conservative technique that preserves the integrity of the vesicoureteral junction. Since its introduction in 1984 by Gil Vernet it gained only little attention in small series. Between 1986 and 1989 we performed trigonoplasty in 51 children 4 months to 13 years old, of whom 47 had primary vesicoureteral reflux. Our study includes 44 patients who have sufficient followup and 69 refluxing units. Reflux was grade II in 25 units, grade III in 39 and grade IV in 5. Patients were arbitrarily divided into 2 age groups: less than (13) and greater than (31) 3 years old. All children underwent standard preoperative assessment. The operation, with technical modifications (absorbable sutures in all cases and muscular incision added in 12), was performed after failed conservative treatment in all patients except 5 who were operated on at diagnosis. Surgery was successful in 97.7% of the patients and in 92.3% of the children less than 3 years old. The only recurrence was noted on 1 side of a 2-year-old child who had had grade IV bilateral reflux. Considering that reimplantation threatens the integrity of the vesicoureteral junction and endoscopic injections still have unclear side effects, indications for trigonoplasty can be extended to higher grades of reflux if ureteral tapering is not required and a sufficient intramural length of ureter can be obtained.

Adolescent↗
PubMed2003

Tissue engineering of flexor tendons.

Despite technical advances in suture methods and rehabilitation protocols, challenges remain in the field of flexor tendon repair. This article reviews the state-of-the-art research in the tissue engineering of flexor tendons. These early published data will hopefully lay the foundation for molecular methods and materials that can be used to reconstruct tendons to restore normal form and function in the hand.

Humans↗
PubMed2000

Use of a non-penetrating staple device for spinal dural closure.

Closure of the spinal dura by suture can be technically demanding and a watertight closure is rarely achieved. A method of dural closure using non-penetrating staples is described which permits rapid watertight closure of the dura even in confined spaces.

Dura Mater↗
PubMed1991

Effect of rearterialization on short-term graft function in orthotopic rat liver transplantation.

The orthotopic liver transplant model in rats has been very useful for immunological studies. However, differing opinions exist as to whether rearterialization of the graft is necessary for such experiments. Therefore, in this study we evaluated the short-term allograft function when rearterialized was compared to restored venous portal flow only and in situ hepatic artery ligation. The technique of orthotopic liver transplantation in the rat with and without rearterialization of the graft is described in detail. In addition, we evaluated the technical feasibility of sutured vascular anastomosis as compared to the traditional cuff technique. Urea synthesis rate was used as a sensitive marker of integrated liver function, including uptake, synthesis and excretion. Standard liver test of bilirubin, plasma aspergine aminotransferase and alanine aminotransferase were measured. We found no significant differences in the biochemical markers between allografts with portal venous flow only compared to the combination with arterial flow. Autopsy was performed after the biochemical studies at day 14. Histopathological analyses revealed no differences between the two groups of transplanted rats. The patency of sutured anastomoses was in our hands found to be superior to that of the cuff technique, with a success rate of more than 90% in rats with portal venous flow. This rat model in which vascular anastomosis is performed with a running suture technique and without rearterialization seems to be excellent for short-term studies of preservation and liver function after orthotopic liver transplantation.

Anastomosis, Surgical↗
PubMed1999

[Autogenic bone plug to seal burr holes: technical note].

Many neurosurgical procedures can be performed by a single burr hole: neuro-endoscopy, microvascular decompression, stereotactic procedures, chronic subdural haematomas. It is technically difficult to suture and close the dura, located at the bottom of such holes, which can lately lead to CSF leakage. On the other hand, the surgical material used to seal the burr holes can be divided in heterogenic (metal screws, silicon plugs, gelfoam, bone wax, metilmetacrilate, hydroxyapatite), and autogenic (fat, aponeurosis, muscle, and bone dust from trephination). The heterogenic group always brings the possibility of foreign body reaction, which can complicate the procedure lately, ensuing a new surgical procedure to clean up the area. It also favors infection. We present a simple, economic, and biologically compatible "autogenic bone plug" to seal burr holes using the bone dust from the original trephination packed with surgical. The incidence of CSF fistulae on that procedures performed by a single burr hole lowered to almost zero, and foreign body reaction was not observed to present.

Biocompatible Materials↗
PubMedDate not supplied

[Splenic implantation in spleen injuries].

Three patients with splenic autotransplantation are reported. The 3 of them had suffered abdominal trauma and splenectomy was carried out due to splenic rupture. The technic was to suture a 1 cm2 of splenic tissue to the splenic area with 2-0 chromic catgut. The planned goals were accomplished: the viability of the splenic tissue, its growth and the lack of postoperative complications. We believe this is a good surgical procedure the enlarges the surgeon's armamentarium in the management of splenic traumatisms.

Adult↗
PubMed1993

[Tracheobronchial injury: clinical analysis of 17 consecutive cases].

Consecutive 17 tracheobronchial injury caused by blunt chest trauma were reviewed. 14 patients were injured by traffic accidents, 2 by fall from the high, and one by accident during play in the house. 16 were male and one was female. Patient's age range from 4 to 60 years (average 25). Site of tracheobronchial injuries were scattered and there were not found risky area. Several problem to rescue tracheobronchial injuries are discussed. To maintain the ventilation in the patient of carinal injury, it is supposed that jet ventilation may be a possible method. For the infant victims, it is difficult to evaluate the injury using bronchofiberscopy. It is recommended that repair of tracheobronchial injury may be undergone as soon as the general condition becomes enough for anesthesia. On a technical aspect, stay suture should be put at the healthy site because those injuries are larger than expected before operation. For the victims with cerebral injury or shock, respirator is necessary for ventilatory management. In those cases adequate sedation and muscle relaxation should be applied.

Adolescent↗
PubMed2005

The use of suture anchors for sternal nonunion as a new technical approach (Demircin-Dogan technique).

OBJECTIVES: Various comparative studies and techniques have been described for median sternotomy closure in the literature, previously. However, some patients are still under risk of sternal dehiscence, malunion or nonunion due to intrinsic or extrinsic factors after median sternotomy closure. Sternal nonunion described as sternal pain, with clicking, instability, or both for more than 3 months in the absence of infection, is an uncommon complication of midline sternotomy incision. To date, only a few studies have addressed the entity of sternal nonunion and its treatment. MATERIAL AND METHOD: The suture anchor system has been described for the fixation of tendons or ligaments to the bone in the orthopedic, and then in cardiac surgery for closure of sternum. In the present study, we used different methods for correction and reduction of sternal nonunion with the use of suture anchors and it accompanied steel wires as an alternative technique in a male patient after coronary artery bypass grafting. RESULTS: There was no complication due to suture anchors. Sternal stability, reduction, and fixation were achieved successfully. CONCLUSION: Sternal nonunion and dehiscence may be the cause of prolonged hospitalization and increased mortality and morbidity if the patient is not treated surgically. This device may protect the wire from cutting into the sternal bone because the thoracal lateral enforcement may be decreased by the devices when the patient is breathing, and with upper extremity movement. This technique can be used easily, safely, and effectively in the repair of sternal nonunion.

Bone Wires↗
PubMed1990

[Repair of pure mitral insufficiency--experience in 50 patients].

Between February 1982 and March 1987, 50 adults underwent mitral valve repair for pure mitral insufficiency representing 54% of all adults having mitral valve surgery for pure mitral insufficiency. Ages ranged from 20 to 73 years (50.0 +/- 11.6). Anterior leaflet prolapse was present in 11, posterior leaflet prolapse in 26 and annulus dilation in 13. The mitral valve was repaired by quadrangular resection in 21, triangular resection in 2, plication without resection in 4, chordal shortening in 8 and annuloplasty alone in 15. Commissural annuloplasty was performed in addition to leaflet repair or chordal shortening in other 14 patients. The competence of the mitral valve was usually evaluated under beating conditions. 79% of the attempted repairs was considered successful in the posterior leaflet, contrasting to only 37% in the anterior leaflet. Prolapse of the anterior leaflet remains a surgical challenge. There were two early deaths (4%). During the follow up period (Mean 1.9 years, range 0.2-5.2 years), 2 late deaths (4%) were observed, one of them from thromboembolism, before adopting the policy of routinely anti-coagulating these patients during the first few months. 4 patients (9%), early in our experience, required reoperation within 4 months of surgery: two for severe mitral insufficiency and two for severe mechanical hemolysis. At reoperation, residual insufficiency was present in one, valve suture tear due to technical imperfection in two and complete disruption of the valve tissue at the suture line in one. Four additional patients had transient mechanical hemolysis requiring no specific therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1975

[Incompetence of duodenal stump sutures after stomach resection in ulcer disease].

Among 356 gastric resections of the Billroth 11 type performed for ulcerous disease there were 11 cases of suture incompetency of the duodenal stump (3.1%). This complication was mainly caused by technical difficulties arising in operations under complicated anatomical conditions and tactical errors of a surgeon in selection of the technic of the stump suturing. The treatment of the duodenal stump suture incompetency consisted in urgent relaparotomy with a tramponade and drainage at the site of incompetency and application of a complex of conservative measures. During the first days after relaparotomy a drainage is connected into a pump-aspirator. In case of complicated duodenal ulcers resection with the aim of "ulcer exclusion" seems to be rational.

Duodenum↗
PubMed1999

Galea-cranium suture method for prevention of the subcutaneous fluid collection--technical note.

A simple method is described for preventing cerebrospinal fluid (CSF) from collecting in the subcutaneous space following a supratentorial osteoplastic craniotomy. A few pairs of oblique holes through which suture materials may pass are made by drilling in the surface cortex of the bone flap. The galea aponeurotica is sutured to the bone flap by means of these holes. These galea-cranium sutures reduce the subgaleal free space in which pooling of CSF or hematoma may occur.

Cerebrospinal Fluid↗
PubMed1975

Keratoplasty wound separations.

Forty cases of partial or full-thickness corneal wound separtions after penetrating keratoplasty comprised three groups. One group of separations occurred before suture removal, due to technical problems encountered at surgery or increased intraocular pressure, or both. Most separations occurred immediately after suture removal and may be the most preventable. The third group of separations occurred long after suture-removal and may not be associated with obvious trauma. About 50% of all wound separations caused graft failure, but patients with fullthickness wound separations had a worse prognosis for visual acuity recovery. Of those grafts that failed after wound separation and were retransplanted, there is a good chance of visual recovery. In our series, fullthickness wound separations or partial wound gape occurred in about 5.7% of our transplant cases. With delay of suture removal associated with a more adequate clinical means of evaluating wound healing, this number may be decreased.

Adolescent↗