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[The position of gastrointestinal suture technique. Advances through mechanical suture methods (author's transl)].

At the present time various materials and methods of manually suturing the gastrointestinal tract are used in parallel. While these methods satisfy basic standards, there is scarcely any detectable difference in the results. Further development in manual suturing with reference to security from failure and reduction of the expenditure of time is unforeseeable. Adhesive methods cannot achieve any importance in the gastrointestinal tract. Presently only the fully mechanical suture methods described at the end of the sixties show promise of possible future development in the gastrointestinal tract. They are suitable for as much as 80% of plastic gastrointestinal operations, but still need statistical comparison of results.

Digestive System Surgical Procedures

Suturing techniques for Dermatologic Surgery.

Various suture techniques that are commonly used in dermatologic surgery are discussed and illustrated. They are applicable to operations as simple as closure of elliptical excisions and as complex as cosmetic surgery.

Dermatologic Surgical Procedures

Correction of the over-projecting nasal tip by the suture technique.

A simple method can be used for correctingan excessively projecting nasal tip. The technique involves suturing the anterior part of the medial crura of the alar cartilages to the posterior part of thecaudal end of the septal cartilage through a transfixion incision using permanent suture material. This technique is not applicable in cases where the integrity of the caudal end of the septum is compromised. Application of this procedure may, at times, result in an undesirable widening of the alae. In such cases, full-thickness resection of the alar bases is necessary. This method of nasal tip reduction has been used in 14 cases of rhinoplasty with a follow-up period of seven to 28 months. The results generally have been satisfactory, with few complications.

Adolescent

Modified continuous suture technique for mitral valve replacement.

A modified continuous suture technique for mitral valve replacement is described which retains desirable features of the less expedient interrupted suture technique. An initial experience with this technique in more than 300 patients has encouraged its continued use.

Heart Valve Prosthesis

[Suture technique for perforating keratoplasty (author's transl)].

The usual suture techniques in connection with perforating keratoplasty and the pulling direction of the threads are described. Especially unfavorable are the verticle factors with relation to the radial and diagonal continuous suture, which necessarily lead to a gaping of the inner and outer wound fissure. The double continuous diagonal suture (cross-stitch suture) seems to come closest to the goal of attaining as uniform a sealing of the wound fissure as possible with as small an amount of suture material as possible. This suture technique is therefore recommended for perforating keratoplasty.

Cornea

Peripheral nerve repairs by the funicular suture technique.

Sixty-one peripheral nerve repairs in 48 patients sutured by the funicular suture technique were followed up for a minimum of 2 years after operation, the average follow-up period being 48 months. Useful recovery was obtained in 100 per cent of cases with radial and musculocutaneous nerve repairs. Seventy-five per cent of cases with median, 82 per cent with ulnar and 88 per cent with digital nerve lesions attained "useful" grade recovery. In the lower extremity, the motor recovery was excellent, whereas the sensory recovery was poor. In two out of three cases where cable grafting was performed between important funiculi the result obtained was excellent. To obtain satisfactory neurological recovery, the funicular suture, technique using the surgical microscope is the method of choice for primary and secondary nerve suture and cable grafting.

Adolescent

The effects of suturing technique and vessel size on patency after microarterial repair.

According to most of the literature, sutures for microarterial repair must include the intima to prevent an "intimal flap" and occlusion of the anastomosis. Some authors have said that vessel diameter affects patency rate. This study was designed to evaluate these two statements. The femoral arteries (about 1.0 mm in diameter), the epigastric arteries (about 0.5 mm), and the central ear arteries (about 0.5 mm) of rabbits were studied. Alternate arteries were repaired using conventional suturing techniques or sutures which included the adventitia and media but excluded the intima. The patency rate in the 1 mm or 0.5 mm vessels was not affected by inclusion or exclusion of the intima from the microarterial repair. The patency rate for conventionally repaired arteries 1 mm in diameter was significantly higher than that for 0.5 mm arteries.

Abdominal Muscles

Suturing technique in facial soft tissue injuries.

This article has presented suturing techniques and instrumentation and suggestions that we have found to be helpful in the management of facial soft tissue injuries. The reader is encouraged to practice suture and knot tying techniques on fresh pigfeet, which are readily accessible and inexpensive and approximate the characteristics of human skin.

Debridement

[Water-tight closure of spinal dura with a new clot suture technique (author's transl)].

A new clot-suturing Technique (using high-concentration fibrinogen solutions) for water-tight closure of the dura is reported. Six dogs underwent laminectomy of the thoracic spine with medial longitudinal incision in the chordal dura. After the dural split had been sealed with natural tissue adhesive and closure of the wound in layers, the animals were sacrificed at intervals of 1 to 21 days postoperatively and the chordal segments involved were removed and histologically examined. Early fibrinolysis of the clot was prevented by adding a natural proteinase inhibitor and factor XIII concentrate to the clotting substances. Histological analysis showed that healing was almost complete after 2 weeks, with delicate connective tissue overgrowing the dural split. After complete reabsorption of fibrin, the originally abundant absorbent granulation tissue had largely disappeared. Among the satisfactory results of fibrin suturing are optimum healing tendency in the fibrin-sutured region, absence of tissue irritation and neurotoxicity, which are known attributes of the synthetic alkl-cyano-acrylate tissue adhesives.

Aminocaproates

[Comparative investigations in closing nephrotomies with conventional suturing technique and dura ribbons (author's transl)].

On 13 rabbits total longitudinal nephrotomies were performed on both kidneys. On the right side the margins of the parenchyma were sutured together with figure eight sutures. On the left, the nephrotomies were closed by tying ribbons of human dura around the kidney. Excretory urograms after 4-8 months showed no differences on both sides. On histological examination there was no difference of the scars. After roentgenological and histological criteria there are no advantages by closing kidney wounds with dura ribbons versus conventional suturing technique.

Animals

Comparison of fascicular, interfascicular and epineural suture techniques in the repair of simple nerve lacerations.

Simple lacerations of dog anterior tibial nerves were repaired utilizing fascicular interfascicular, and epineural suture techniques. Two months following repair, the involved regions of the nerve were removed and stained with hematoxylin and eosin, Weil, Bielschowsky, and Masson trichrome stains. An independent, unbiased observer rated proximal and distal myelin, connective tissue responses, and proximal to distal axon counts. The proportion of proximal to distal axons revealed no significant difference between fascicular (77%) and epineural (67%) neurorrhaphy, but showed a significant beneficial effect of fascicular suture to the interfascicular (52%) repair (significance at less than 0.02). Masson stain revealed dense connective tissue responses, but the axon counts were adversely affected only when the separate fascicles showed internal disruption by connective tissue. In general, distal myelinization was mildly superior with the fascicular neurorrhaphy technique. It appears that in simple lacerations in nerves which are repaired via direct end-to-end suture, there is no significant advantages to fascicular over epineural repair; however, there is a definite deleterious effect of interfascicular neurorrhaphy. The theoretical and technical implications of these findings are discussed.

Animals

Suturing technique for extraocular muscle surgery.

A method for suturing extraocular muscles is presented which provides a safe, anatomically perfect means of reattaching extraocular muscles after recession, resection, or after disinsertion at retinal surgery.

Humans

A double running suture technique for keratoplasty: earlier visual rehabilitation.

The technique of using two continuous sutures of different caliber and relative tightness, running in the same direction, is described for penetrating keratoplasties. The primary purpose of the technique is to allow visual correction earlier in the postoperative period. In addition, graft slippage with override and posterior wound gape, both occurring at suture removal with resultant functional loss, have been eliminated.

Cornea