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Advances in Hip Arthroscopy
Published in K. Mohan Iyer, Hip Joint in Adults: Advances and Developments, 2018
Most of the vascular supply to the labrum comes from the capsular contribution [29]; the articular surface of the labrum has decreased vascularity and has limited synovial covering. The labrum is thinner in the anterior inferior section and is thicker and slightly rounded posteriorly. During repair the labral tear is identified and the margins defined. A motorised shaver is then used to debride and remove the torn portion of the labrum. A high-speed burr is used to decorticate the acetabular rim. This provides a bleeding surface for the graft to heal. The labrum is repaired by using a bioabsorbable suture anchor, which is placed on the rim of the acetabulum between the labrum and the capsule. Once the anchor is placed, the suture material is passed through the split in the labrum in a vertical mattress suture technique. The suture is tied down by using standard arthroscopic knot-tying techniques or knotless methods. For an intrasubstance split in the labrum, a bioabsorbable suture is passed around the split by using a suture lasso or similar suture-passing instrument. The suture is tied, thus reapproximating the split labral tissue. It is vital that the associated pathology be dealt with, to minimise recurrence and improve outcome. In cases where a significant portion of the labrum is deficient or removed, the labrum can be reconstructed with rectus auto graft, ITB and hamstrings auto or allograft.
Automated suturing: sharp wound recognition and planning with surgical robot
Published in Advanced Robotics, 2023
Hermes F. Vargas, Victor Muñoz, Andrés Vivas
Several authors have proposed their viewpoints on this matter. For example, Kudur [17] suggests that the distance to the wound edge should be 1–3 mm for a vertical mattress pad suture, 5–10 mm for a horizontal mattress pad suture, and an average distance of 4 mm for a simple mattress pad suture. Jain [18], on the other hand, suggests using the rule that the distance to the edge should be equal to the depth of the wound (x mm) and the distance between stitches of 2x mm, but this rule does not apply for wounds deeper than 10 mm. Robinson [19] proposes a general distance of 3–5 mm, while Bolognia [12] suggests a distance of 3–4 mm from the edge. For deep wounds, Giele [20] suggests a needle entry or exit distance of 5 mm, while Bennett [21] indicates that for wounds on the trunk and extremities, this distance can be between 2 and 2.5 mm.