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Inflammatory bowel disease
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Aimee G. Kim, Samir K. Gadepalli, James D. Geiger
For mobilization of the omentum off the transverse colon, a pair of 5 mm ultrasonic scissors is helpful, after which the omentum is reflected cephalad. Care is taken to identify and staple or ligate the middle colic vessel. Once the colon and mesentery are fully mobilized, the low transverse suprapubic (Pfannenstiel) incision is made. Alternatively, the Pfannenstiel incision can be made at the beginning and a gel-port placed to be used for a fifth port during the colon mobilization. A wound protector is placed in the Pfannenstiel incision to aid with gentle retraction and visualization. The operating surgeon pulls the terminal ileum (TI) out through the incision and transects the TI approximately 1 cm from the ileocecal valve with an Endo GIA stapler (Medtronic, Minneapolis, MN, USA). The entire colon is then eviscerated from the abdomen to the level of the sigmoid colon, and the dissection is carried distally along the sigmoid and rectum, taking care to stay just on the wall of the colon. Just above the peritoneal reflection, the rectum is transected with a blue load of the Endo GIA stapler. The colon specimen is sent to pathology. Prolene sutures may be placed at the rectal stump for ease of identification in subsequent surgery. At this point, the ileum is brought up to an end ileostomy.
Direct Myocardial Revascularization Sequential Grafting Techniques
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
We use the continuous suture technique for both the coronary and the aortic anastomoses. Fine suture material (7/0 Prolene®) and delicate instruments are a requirement for optimal results. Optical magnification is recommended for all surgeons doing this kind of work. Most satisfactory graft sites have a 2-mm internal diameter. A vessel 1.5 mm in diameter, if it is soft and thin-walled, can be a very satisfactory graft site; if it is 1 mm or smaller it will probably not produce a worthwhile graft in most cases.17–18
Blepharoplasty
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Post-operative care Post-operatively the patient is prescribed a topical antibiotic ointment to the eyes three times a day for 2 weeks and Lacri-Lube® ointment 2 hourly to the eyes for 48 hours and at bedtime. The Lacri-Lube® ointment is then changed to a preservative-free topical lubricant gel to be used 2 hourly during the day and Lacri-Lube® is continued at bedtime until any post-operative chemosis has resolved. Post-operative steroid drops are unnecessary. The patient is instructed to sleep with the head of the bed elevated for 2 weeks and to avoid lifting any heavy weights for 2 weeks. Clean cool packs are gently applied to the eyelid intermittently for 48 hours. The patient should be reviewed in clinic within 5 days when the Prolene sutures are removed, and again within 4–6 weeks. The conjunctival sutures should drop out spontaneously within 2 weeks. Massage to the lower eyelid/cheek junction for 3 minutes three times per day can be commenced using Lacri-Lube® ointment as soon as the Prolene sutures have been removed. This is continued for 2–3 weeks.
Atypical mycobacterium infection following upper eyelid Müller’s muscle-conjunctival resection – case report
Published in Orbit, 2023
Julia T. W. Lam, Stacey C. Lam, Tracy Y. T. Kwok, Hunter K. L. Yuen
A 61-year-old lady presented with left upper lid swelling and nodular mass after bilateral MMCR surgery for aponeurotic ptosis. She has an underlying disease of systemic lupus erythematosus (SLE) and chronic hepatitis B infection. Prior to ptosis surgery, she had bilateral cataract operation done 14 years ago and right eye Fuch’s dystrophy with Descemet stripping automated endothelial keratoplasty done 3 years ago. Standard MMCR was done under local anesthesia with lidocaine and adrenaline, 3-O silk traction suture, lid eversion with Desmarres retractor, resection of 10 mm conjunctival-muller-muscle complex, and 6-O prolene (synthetic, monofilament, nonabsorbable polypropylene) suture externalized onto the skin. Surgery was uneventful and lid height was corrected. Topical steroid and antibiotic drops were prescribed for 2 weeks, and the 6-O prolene sutures were removed 2 weeks after surgery.
Long-term Surgical Outcomes in Patients of Centurion Syndrome: A Mystic Etiology of Epiphora in Young
Published in Seminars in Ophthalmology, 2023
Manpreet Singh, Manpreet Kaur, Aditi Mehta, Manjula Sharma, Pankaj Gupta
All patients (n = 44 eyes) underwent the desired surgical procedure, i.e., the release of anterior limb of the medial canthal tendon. The anterior limb of MCT was exposed via the described skin incision and excised near its anterior insertion in all eyes. A gentle soft-tissue dissection was performed in the surrounding area to release the MCT. This was to ensure adequate medial eyelid-globe apposition and placement of lacrimal punctum in the tear-film lake. The skin suturing was performed using 5–0 prolene in a transverse manner or direction to provide a sufficient amount of skin to adjust for postoperative wound contracture, causing possible recurrence of symptoms. An additional inferior single snip punctoplasty with punctum dilatation was done in 6 eyes having punctum stenosis. None of them required lacrimal stents. Additionally, trans-conjunctival lower eyelid retractor plication was required in 4 eyes having punctum ectropion.
The Effect of Absorbable and Non-absorbable Scleral Suture on Strabismus Surgery in the Rabbits
Published in Current Eye Research, 2020
Dong-Hoon Shin, Won Yeol Ryu, Jae Ho Jung
There were several limitations in the current study. First, this study was based on experimental data obtained from rabbit sclera, which consists of cross-linked and interwoven fibrous bands which consist of considerable variations in fibril diameter and spread in different directions. However, the direction of collagen always parallel to the sclera surface and there is no difference apparent between the proteoglycan-collagen organization in human and rabbit sclera.11,12 Therefore, experiments on the sclera of rabbits can be appropriate and significant, in view of the fact that the conclusions can be applied to the human sclera.11 Furthermore, 6–0 and 7–0 needles were used in the current study. Different needle sizes may create dissimilar scleral passages and induce different degrees of tissue responses. Additionally, Prolene® suture material was the non-absorbable suture material used in the current study due to the unavailability of Mersilene® (ethylene terephthalate), in South Korea. Although Mersilene® is a different type of non-absorbable suture material, compared to Prolene®, no significant difference in tissue responses was perceived on a literature review.13,14 Further research in the field of strabismus surgery, regarding the effects of different types of suture materials on the sclera and peri-scleral tissues, is a necessity in the current scenario.