Home About us Contact
|
Home About us Contact | ||
|
|
||
Suture Line (suture + line)
Selected AbstractsFundus rotation gastroplasty: rationale, technique and results,DISEASES OF THE ESOPHAGUS, Issue 2 2002W. Uhl SUMMARY. Anastomotic leakage is the main factor (up to 30%) for postoperative morbidity and mortality after esophageal resection. Compromised anastomotic perfusion after dissection of supplying vessels for gastric tube formation and tension on the suture line are the two main reasons for anastomotic insufficiency. To prevent anastomotic leakage, a new technique for gastric tube formation after esophageal resection has been developed and introduced into surgical practice: the fundus rotation gastroplasty (FRG). The following paper summarizes rationale, technique and early results of this new technique. It is shown that the FRG is a safe and effective technique for esophageal reconstruction and offers important advantages over conventional gastroplasties: (i) the improved perfusion of the oral part of the tube; (ii) the gain of tube length allowing for a safer performance of even pharyngeal anastomosis as shown by the low insufficiency rate of 9%; and (iii) the increase of remaining gastric reservoir supporting physiologic stomach and gut function. Therefore, the FRG seems to be an alternative and safe method for esophageal reconstruction, especially for high anastomotic locations. [source] A new interpretation of the female genitalia in Macrocyclops albidus (Copepoda, Cyclopidae)ACTA ZOOLOGICA, Issue 1 2003D. Defaye Abstract The female genital structures of Macrocyclops albidus (Cyclopidae, Eucyclopinae) were studied using light and electron microscopy. The results confirm that the exterior genital area shows only a copulatory pore, located anteromedially on the ventral face of the genital double-somite, and paired gonopores (not directly visible), situated laterally under the P6 plates. An internal seminal receptacle, composed of several parts, is connected to the gonopores by ventro-lateral cuticular extensions or seminal ducts. The lateral site of communication shows a complex set of connections between the seminal receptacle and the oviducts (via the egg-laying ducts). The structure until now designated as ,transverse ducts', visible by transparency on the ventral face, is in fact constituted of internal cuticular thickenings resulting of the fusion of the 6th thoracic somite and the 1st abdominal somite forming the genital double-somite and appearing externally as a part of the suture line; the term ,suture cord' is proposed to designate it. The functioning of the system is explained. [source] Prevention of wound complications following salvage laryngectomy using free vascularized tissueHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2007FRCS(C), Kevin Fung MD Abstract Background. Total laryngectomy following radiation therapy or concurrent chemoradiation therapy is associated with unacceptably high complication rates because of wound healing difficulties. With an ever increasing reliance on organ preservation protocols as primary treatment for advanced laryngeal cancer, the surgeon must develop techniques to minimize postoperative complications in salvage laryngectomy surgery. We have developed an approach using free tissue transfer in an effort to improve tissue vascularity, reinforce the pharyngeal suture line, and minimize complications in this difficult patient population. The purpose of this study was to outline our technique and determine the effectiveness of this new approach. Methods. We conducted a retrospective review of a prospective cohort and compared it with a historical group (surgical patients of Radiation Therapy Oncology Group (RTOG)-91-11 trial). Eligibility criteria for this study included patients undergoing salvage total laryngectomy following failed attempts at organ preservation with either high-dose radiotherapy or concurrent chemo/radiation therapy regimen. Patients were excluded if the surgical defect required a skin paddle for pharyngeal closure. The prospective cohort consisted of 14 consecutive patients (10 males, 4 females; mean age, 58 years) who underwent free tissue reinforcement of the pharyngeal suture line following total laryngectomy. The historical comparison group consisted of 27 patients in the concomitant chemoradiotherapy arm of the RTOG-91-11 trial who met the same eligibility criteria (26 males, 1 female; mean age, 57 years) but did not undergo free tissue transfer or other form of suture line reinforcement. Minimum follow-up in both groups was 12 months. Results. The overall pharyngocutaneous fistula rate was similar between groups,4/14 (29%) in the flap group, compared with 8/27 (30%) in the RTOG-91-11 group. There were no major wound complications in the flap group, compared with 4 (4/27, 14.8%) in the RTOG-91-11 group. There were no major fistulas in the flap group, compared with 3/27 (11.1%) in the RTOG-91-11 group. The rate of pharyngeal stricture requiring dilation was 6/14 (42%) in the flap group, compared with 7/27 (25.9%) in the RTOG-91-11 group. In our patients, the rate of tracheoesophageal speech was 14/14 (100%), and complete oral intake was achieved in 13/14 (93%) patients. Voice-Related Quality of Life Measure (V-RQOL) and Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) scores suggest that speech and swallowing functions are reasonable following free flap reinforcement. Conclusions. Free vascularized tissue reinforcement of primary pharyngeal closure in salvage laryngectomy following failed organ preservation is effective in preventing major wound complications but did not reduce the overall fistula rate. Fistulas that developed following this technique were relatively small, did not result in exposed major vessels, and were effectively treated with outpatient wound care rather than readmission to the hospital or return to operating room. Speech and swallowing results following this technique were comparable to those following total laryngectomy alone. © 2007 Wiley Periodicals, Inc. Head Neck 2007 [source] Clinical, urodynamic and endoscopic characteristics of the Stanford pouch ileal neobladder constructed with absorbable staplesINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2000M Cemil Uygur Abstract Purpose The clinical, urodynamic and endoscopic aspects of the Stanford pouch ileal neobladder formed with absorbable staples were investigated. Methods A Stanford pouch ileal neobladder was formed using absorbable staples after radical cystoprostatectomy in 30 male patients with the diagnosis of muscle invasive carcinoma of the bladder between 1995 and 1998. The mean age of the patients was 62 (range 41,70) years. Patients were followed with arterial blood gas, serum biochemistry, pouch cystography, urodynamic tests and endoscopy. Results Five (16.7%) patients had early postoperative complications and three were related to the neobladder. One year postoperatively, low grade (I, II) vesicoureteral reflux was present in five (16.7%) cases. The mean preoperative and 6 months postoperative serum creatinine levels were 1.07 ± 0.3 mg/dL and 1.2 ± 0.4 mg/dL, respectively, but the difference was not statistically significant (P = 0.1). Six months postoperatively the mean serum chloride level was 109 ± 4.5 (range 100,113) mmol/L and the mean arterial blood pH was 7.37 ± 0.2 (range 7.3,7.4). Two (6.7%) patients required oral alkaline supplementation because of high chloride levels. All the patients except one were continent throughout the day after 1 year. However, nocturnal enuresis was present in 25 (83.3%) cases. The pouch capacity was increased gradually up to 12 months postoperatively and the mean pouch capacity 12 months postoperatively was 460 ± 95.8 mL. Micturition occurred spontaneously in most patients while some needed abdominal straining. None of the patients had a residual urine of more than 60 mL. The mean maximum flow rate 6 months postoperatively was 9.8 (range 5.4,15.0) mL/s. After 6 months the stapled edge was noticed as a nodular line. One year postoperatively only a white scar could be observed at the suture line. Conclusion The Stanford pouch ileal neobladder constructed using absorbable staples was able to provide a good capacity,low pressure reservoir with a low rate of complications. [source] Resistance to tearing of calf and ostrich pericardium: Influence of the type of suture material and the direction of the suture lineJOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 2 2004José María García Páez Abstract The tearing of the valve leaflet of a cardiac bioprosthesis can cause early failure of this device, which is employed to replace a diseased native valve. This report involves the study of the behavior of 312 tissue samples (152 of calf pericardium and 160 of ostrich pericardium) treated with glutaraldehyde and subsequently subjected to tear testing. The samples were cut in the two principal directions: longitudinally, or root to apex, and transversely. They included a series of control samples that were left unsutured, and the remaining samples were repaired with the use of two different suture techniques: a running suture in the direction of the load and a telescoping suture perpendicular to the load. Four commercially available suture materials were employed: Pronova®, nylon, Gore-Tex®, or silk. The unsutured control samples of both types of pericardium exhibited a similar anisotropic behavior in the tear test. The mean resistance to tearing of the calf pericardium was 24.29 kN m in samples cut longitudinally and 34.78 kN m in those cut transversely (p = .03); the values were 28.08 kN m and 37.12 kN m (p = .002), respectively, in ostrich pericardium. The series repaired with the telescoping suture always exhibited greater resistance to tearing, with values that ranged between 44.34 and 64.27 kN for the samples of calf pericardium and from 41.65 to 47.65 kN for those obtained from ostrich. These assays confirm the anisotropic behavior of calf and ostrich pericardium treated with glutaraldehyde when subjected to tear testing, as well as the loss of this behavior in ostrich pericardium after suturing. Suturing techniques, such as the telescoping model, that provide a greater resistance to tearing should be studied for use in the design of the valve leaflets of cardiac bioprostheses made of biological materials. © 2004 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 69B: 125,134, 2004 [source] The "Button Inside" Technique for the Aortic Root Replacement: A Modified Button TechniqueJOURNAL OF CARDIAC SURGERY, Issue 4 2006Carlo Canosa M.D. Anastomosis of the coronary buttons is performed from the inside of the composite valve graft previously including the coronary buttons in the composite valve graft. Reduced tension is present between coronary arteries and the composite valve graft once the heart is beating and the systemic pressure is increasing. In this way coronary buttons are reinforced directly by the composite aortic wall graft prosthesis. The coronary ostia are perfused with lower tension at the site of the coronary anastomoses. No bleeding from the suture line of the coronary buttons occurs using this new surgical approach. [source] Eigenshape analysis of ammonoid suturesLETHAIA, Issue 2 2010TAKAO UBUKATA Ubukata, T., Tanabe, K., Shigeta, Y., Maeda, H. & Mapes, R.H. 2009: Eigenshape analysis of ammonoid sutures. Lethaia, Vol. 43, pp. 266,277. A morphometric method based on eigenshape analysis is proposed for characterizing the morphospace of widely varied ammonoid suture shapes. The analysis requires initially the placement of a suture line in an x,y coordinate system, with the ventral and umbilical extremes located on the x -axis. Series of x- and y -coordinates along the suture line are used as descriptors. The coordinate data are summarized into the two largest principal components using eigenshape analysis. A total of 115 species belonging to six ammonoid orders, spanning from the Devonian to the Cretaceous, was utilized in the present analysis. The analysis, using y -coordinate data, revealed differences in morphological variation in suture shape among taxa within the Mesozoic ammonitids: the Lytoceratina and Ammonitina were characterized by small negative values of the first eigenshape scores, whereas the Phylloceratina (the sister group of the Lytoceratina plus Ammonitina), as well as the Triassic ceratitids and Palaeozoic ammonoids, have a wide range of the first eigenshape scores. The pattern of data obtained from many different ammonoid species, as plotted on eigenshape axes in the morphospace constructed based on y -coordinate data, reveals a plesiomorphic aspect of suture shape in some phylloceratine species with respect to other ammonitids. ,Ammonoids, eigenshape analysis, morphometrics, suture line. [source] The intrinsic transit time of free microvascular flaps: Clinical and prognostic implicationsMICROSURGERY, Issue 2 2010Charlotte Holm M.D., Ph.D. Background: Microscope-integrated indocyanine green near-infrared videoangiography (ICGA) is a new method for the intraoperative assessment of vascular flow through microvascular anastomoses. The intrinsic transit time (ITT) describes the time period from the dye appears at the arterial anastomosis (t1) till it reaches the suture line of the venous anastomosis (t2). As the transit time reflects blood flow velocity within the flap, prolonged ITT might correlate with low blood flow and a higher rate of postoperative thrombosis. We performed a clinical trial evaluating the association between intraoperative free flap transit time and early anastomotic complications in elective microsurgery. Methods: One hundred consecutive patients undergoing elective microsurgical procedures underwent intraoperative ICG angiography (ICGA). In patients with anastomotic patency, angiograms were retrospectively reviewed and the intrinsic transit time was calculated. Postoperative outcome was registered and compared with the ITT. End points included early reexploration surgery and flap loss within the first 24 hours after surgery. Results: Fourteen patients were excluded from the study due to technical anastomotic failure. The overall flap failure rate was 6% (5/86); the incidence of early re-exploration surgery was 10% (9/86). With a median of 31 seconds patients with an uneventful postoperative course showed significantly shorter ITTs than patients with flap loss or early postoperative reexploration (median: >120 seconds). An optimal cut-off value of ITT > 50 seconds was determined to be strongestly associated with a significantly increased risk of at least one positive end point. Conclusions: This study demonstrates a significant predictive value of the intrinsic flap transit time for the development of flap compromise and early re-exploration surgery. © 2009 Wiley-Liss, Inc. Microsurgery, 2010. [source] Mechanism of Atrial Flutter Occurring Late After Orthotopic Heart Transplantation with Atrio-atrial AnastomosisPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2005JOSEPH E. MARINE Objective: We sought to better define the electrophysiologic mechanism of atrial flutter in patients after heart transplantation. Background: Atrial flutter is a recognized problem in the postcardiac transplant population. The electrophysiologic basis of atrial flutter in this patient population is not completely understood. Methods: Six patients with cardiac allografts and symptoms related to recurrent atrial flutter underwent diagnostic electrophysiologic study with electroanatomic mapping and radiofrequency catheter ablation. Comparison was made with a control nontransplant population of 11 patients with typical counterclockwise right atrial flutter. Results: In each case, mapping showed typical counterclockwise activation of the donor-derived portion of the right atrium, with concealed entrainment shown upon pacing in the cavotricuspid isthmus (CTI). The anastomotic suture line of the atrio-atrial anastomosis formed the posterior barrier of the reentrant circuit. Ablation of the electrically active, donor-derived portion of the CTI was sufficient to terminate atrial flutter and render it noninducible. Comparison with the control population showed that the electrically active portion of the CTI was significantly shorter in patients with transplant-associated flutter and that ablation was accomplished with the same or fewer radiofrequency lesions. Conclusions: Atrial flutter in cardiac transplant recipients is a form of typical counterclockwise, isthmus-dependent flutter in which the atrio-atrial anastomotic suture line forms the posterior barrier of the reentrant circuit. Ablation in the donor-derived portion of the CTI is sufficient to create bidirectional conduction block and eliminate this arrhythmia. Ablation or surgical division of the donor CTI at the time of transplantation could prevent this arrhythmia. [source] Conformation of the Equine Skull: A Morphometric StudyANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 4 2006K. E. Evans Summary There is a lack of an established method for quantifying equine skull morphology. This study proposes a method that is valid for use on both live and deceased horses. A total of nine head measurements (skull length, cranial length, nasal length, ratio of cranial:nasal length, cranial width, zygomatic width, mandibular depth, nasal profile area, cranial profile area) and six indices (skull index, cranial index, nasal index, mandibular index, nasal profile index, cranial profile index) were recorded from 30 horses from a variety of breeds whilst the soft tissues of the head were intact. A line was drawn level with the palpable notches caudal to the caudal lacrimal process of each orbit to estimate the suture line of the nasal and frontal bones and distinguish between the neurocranium and splanchnocranium. There were positive correlations between many of the head measurements. This method also illustrated significant differences in the skull morphology of three breeds (Arabians, thoroughbreds and standardbreds). [source] The conservative treatment of pediatric mandibular fracture with prefabricated surgical splint: a case reportDENTAL TRAUMATOLOGY, Issue 4 2007Ceyda Kocabay Abstract,,, The use of rigid fixation in children is controversial and may cause growth retardation along cranial suture lines. Intermaxillary fixation for mandibular fractures should be used cautiously as bony ankylosis in the temporomandibular joint (TMJ) and trismus may develop. The high osteogenic potential of the pediatric mandible allows non-surgical management to be successful in younger patients with conservative approaches. In this case, successful conservative treatment of mandibular fracture of a 3-year-old patient is presented. [source] Perioperative Results of the Aortic Root Replacement in Strict Graft Inclusion TechniqueJOURNAL OF CARDIAC SURGERY, Issue 5 2008Niyazi Cebi M.D. Therefore, the strict graft inclusion technique has been developed to avoid major complications. We present the early results after aortic root replacement in strict graft inclusion technique. Materials and Methods: The strict graft inclusion technique was performed in 28 patients between April 2001 and June 2006 in St-Johannes-Hospital-Dortmund, Dortmund, Germany. There were nine female and 19 male patients. The mean age was 57.78 ± 12.01 years (28 to 77 years). A type A aortic dissection and an ascending aortic aneurysm with aortic valve lesion were the indication to operation in patients. Results: There were no early mortality and postoperative rethoracotomy. The mean postoperative bleeding over mediastinal drains was 565 ± 310 mL. (100,2250 mL). In exception of the patients with preoperative double thrombocyte aggregation inhibitors therapy and postoperative consumption coagulopathy, the mean postoperative bleeding over mediastinal drain was 443.04 ± 171.59 mL (100,1100) in the first 24 hours, the transfusion rate was minimal, mean 0.39 ± 0.64 packed red blood cells (RBC) (0,4) and mean 0.14 ± 0.27 packed fresh frozen plasma (FFP) (0,4), whereas only in 18 patients (78.26%) out of 23 patients was a transfusion not necessary. The intraoperative and postoperative requirement for substitution of erythrocyte concentrate was mean 1 ± 1.28 packed RBC (0,5) and FFP concentrate was mean 1.21 ± 1.90 packed FFP (0,12). Conclusions: The strict graft inclusion technique for aortic root replacement represents a safe and feasible method to avoid bleeding from coronary ostial anastomoses, from aortic annular suture lines, and annular leak. [source] The role of suture complexity in diminishing strain and stress in ammonoid phragmoconesLETHAIA, Issue 1 2008FABIO VITTORIO DE BLASIO Several hypotheses have been put forward to explain the sinuosity and complexity of suture lines in Ammonoidea. At present, the two principal opponent views maintain either that high complexity was a requisite to reinforce the shell in response to hydrostatic pressure, or that complexity augmented the attachment area for muscles. By using finite element calculations and analytical estimates of simplified ammonoid shell geometries, it is shown that complex suture lines reduced dramatically the strain and the stress in the phragmocone. The calculations lend support to the hypothesis that high sinuosity is an evolutionary response to external pressure. Additionally, it is found that without complex septa, the inward deformation of an ammonoid with thin shell would cause it to shrink in response to pressure and to lose buoyancy by a non-negligible amount. [source] | |||||||||||||