Gynaecological surgery and therapeutics
Helen Bickerstaff, Louise C Kenny in Gynaecology, 2017
Surgical suture materials are essential elements for surgical practice, necessary for tying off vascular pedicles, closing the vaginal vault at hysterectomy and repairing abdominal and vaginal incisions. The ideal suture material is one that allows secure knot tying without slippage, provokes little tissue reaction, does not increase the risk of infection, retains enough tensile strength until the healing process has laid down enough collagen and connective tissue to restore integrity of the tissues and can be wholly reabsorbed by the body. Such a material does not exist! The choice of suture for any particular purpose will depend on which of the above characteristics are considered most important. Broadly, sutures can be characterized by two properties: monofilament versus multifilament, and absorbable versus non-absorbable (Table 17.2).
Vaginal Approach to Fixation of Vaginal Apex
Linda Cardozo, Staskin David in Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
Apex viA A circumscribing incision At the Apex [50]. They hAve recently published on the long-term pAtient sAtisfAction using this technique And A supplementAl video in the Article thAt better describe their technique [77,78]. The Anterior sAcrospinous vAult suspension hAs been described, where the ligAment is ApproAched through An Anterior vAginAl incision; Goldberg et Al. hAd shown thAt with this technique, there wAs A slight increAse of the vAginAl length, with A decreAse in the recurrence of the Anterior vAginAl wAll prolApse [79]. The choice of the suture used remAins controversiAl; some AdvocAte the use of AbsorbAble sutures [11,12,21,50,80], And others use delAyed AbsorbAble or permAnent sutures [13,49,50,52,68,81,82] to Allow AdequAte time for fibrosis And scArring between the sAcrospinous ligAment And the vAginAl Apex. When AbsorbAble sutures Are used, they Are pAssed
Abdominal wall, hernia and umbilicus
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Defects up to 2 cm in diameter may be sutured primarily with minimal tension, although, the larger the defect, the more tension and the more likely it is that mesh reinforcement will be beneficial. The classic repair was described by Mayo. A transverse incision is made and the hernia sac dissected, opened and its content reduced. Any non-viable tissue is removed, sometimes involving bowel resection. The peritoneum is closed. The defect in the anterior rectus sheath is extended laterally on both sides and elevated to create an upper and lower flap. The lower flap is then inserted beneath the upper flap and sutured to it, with the upper flap being brought downwards over it so that the tissue is two layered (double breasted). Non-absorbable sutures are used. There is often a large subcutaneous space. A suction drain is placed to reduce the risk of seroma and haematoma. The skin is closed but stretched or redundant skin may need to be excised (apronectomy) to achieve a better cosmetic result. Today, with modern suture materials, surgeons simply close the anterior sheath in a single layer.
Analysis of study designs and primary outcome measures in clinical trials of investigational suture materials
Published in Expert Review of Medical Devices, 2022
Nahathai Dukaew, Wannachai Sakuludomkan, Mingkwan Na Takuathung, Dumnoensun Pruksakorn, Winita Punyodom, Nut Koonrungsesomboon
A surgical suture is one of the most common medical devices used to sew body tissues together and stitch a wound closed during surgical procedures [1]. It typically provides the mechanical support necessary to maintain wound closure, control bleeding, and minimize the risk of infection until the wound is healed [2]. Alternatively, suture materials can also be used for other medical purposes, such as repairing damaged tissue, facial thread lifting [3], mesh fixation [4], and organ fixation [5]. Since no single suture material is suitable for all types of surgical procedures, there is a wide range of suture materials currently being used in clinical practice [6]. Suture materials can be categorized based on their origin (e.g. natural or synthetic), absorbability (e.g. absorbable or non-absorbable), structural configuration (e.g. monofilament or multifilament), or certain additional advanced techniques (e.g. antibacterial-coated or knotless barbed) [7–9]. Although an ever-increasing array of suture materials are now available, surgeons are still in need of novel ones with regard to the types and complexity of surgical procedures currently being performed [10]. For any novel (investigational) suture materials, clinical trials are a prerequisite prior to a market approval application.
Does Suture Material Affect Uterine Scar Healing After Cesarean Section? Results from a Randomized Controlled Trial
Published in Journal of Investigative Surgery, 2019
Alper Başbuğ, Ozan Doğan, Aşkı Ellibeş Kaya, Çiğdem Pulatoğlu, Mete Çağlar
Sutures are an essential part of any major surgery, serving to hold opposing tissues together and accelerate the healing process, resulting in decreased scarring of the affected areas.11,12 In the past, gold, silver, iron, and steel wires, dried animal gut, silk, and plant fibers (e.g., linen, cotton) have been used as suture materials,13 though nowadays, obstetricians typically prefer synthetic absorbent sutures for CS. Many authors have investigated possible risk factors related to cesarean scar defect (CSD), particularly those related to uterine closure, number of cesarean births, uterine position, and labor before cesarean delivery14; however, studies examining the role of the suture material in formation of cesarean scar defects are limited. Here, we sought to evaluate the effects of different synthetic absorbable suture materials on cesarean scar defect formation.
Canaloplasty with Suprachoroidal Drainage in Patients with Pseudoexfoliation Glaucoma – Four Years Results
Published in Current Eye Research, 2021
Anna-Maria Seuthe, Peter Szurman, Kai Januschowski
The detailed surgical technique of canaloplasty with suprachoroidal drainage has been described recently.17 In brief, under general or parabulbar anesthesia the sclera is liberated from conjunctiva and Tenons, and a superficial rectangular scleral flap of half-scleral thickness, 4 × 4.5 mm in size, is created. Underneath this first flap, a second one, seized 3.5 × 4 mm, is prepared consisting of the remaining sclera. This step creates an access to suprachoroidal space. The deep flap is then lifted and prepared in limbal direction until the scleral spur is reached. Here, the two structures have to be carefully separated from each other. Directly beyond the scleral spur lies Schlemm’s canal, and with this preparation technique it can be quickly located. Figure 1 shows the intraoperative setting after separating the deep scleral flap from scleral spur. After unroofing Schlemm’s canal, the ostia are viscodilated with hyaluronic acid and the microcatheter is inserted. After 360° probing a 10–0 prolene suture is tied to the end of the catheter before the catheter is then pulled backwards through Schlemm’s canal, simultaneously injecting hyaluronic acid for viscodilation. The suture is then knotted under tension. Hyaluronic acid is injected into suprachoroidal space and the deep scleral flap is cut off at its base. Finally, the superficial flap is firmly sutured to achieve water-tightness in order to prevent the development of a filtering bleb. Postoperative regimen comprises three days of topical low dose steroids as well as topical antibiotics (moxifloxacin) for two weeks.
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