Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure

BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient information between the two groups,including the interval between the first surgery and the stoma closure[132(105,184)d vs 134(109,181)d,P=0.63],gender ratio(0.64 vs 0.69,P=0.44),age[62(52,68)years vs 60(52,68)years,P=0.33],preoperative body mass index(BMI)[23.83(21.60,25.95)kg/m²vs 23.12(20.94,25.06)kg/m²,P=0.17].The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group[(n=2/135,1.4%)vs(n=10/135,7.4%),P<0.05],and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group[5(4,7)d vs 7(6,8)d,P<0.05].Additionally,the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group[4840(4330,5138)yuan vs 4980(4726,5221)yuan,P>0.05],but there was no significant difference in the total hospitalization cost between the two groups.CONCLUSION In stoma closure surgery,the improved gunsight technique can reduce the incision infection rate,shorten the postoperative hospital stay,reduce wound tension,and provide better wound cosmetic effects compared to traditional interrupted suture.

Prospective Interventional Study to Quantify Barbed Suture Exposure at Vaginal Vault and Assess Post-Operative Risk

Background: The use of barbed suture in laparoscopic surgery is increasing ever since 2008. Published reports of use of unidirectional barbed suture for vaginal vault closure following total laparoscopic hysterectomy (TLH), indicates it is safe. Despite of this many reports of adhesions and bowel obstruction are reported. This complication was never assessed in relation to amount of suture exposure at vaginal vault. We thought of quantifying the barbed suture exposure at vaginal vault and assess the risk of post-operative complications. Objective: The objective was to quantify the exposure of barbed suture at vaginal vault by adopting a uniform technique of vault suturing and assessing postoperative risk related to adhesions at vaginal vault. Method: In 30 patients who underwent TLH, a uniform new technique of vaginal vault closure using barbed suture was used and the portion of suture exposed at vaginal vault was quantified. The patients were followed up for a period of 6 months to assess post-operative risk of adhesions at vault and sequalae. Result: Mean length of suture exposed was 2.64 ± 1.65 mm only. Suture exposure at vaginal vault was seen in 23 (76.67%) out of 30 patients. The suture was exposed on average at 1.57 ± 1.20 places at vaginal vault. Conclusion and Recommendations: The study with an accepted relative error of 5% quantifies barbed suture exposure at vaginal vault. We had adopted a uniform new method of vaginal vault suturing to study and to quantify barbed suture exposure. It was observed that very minimal portion of suture was exposed at vaginal vault. It was exposed at only a couple of places at vaginal vault. Thus, decreasing suture exposure at vaginal vault will reduce its exposure related risk.

The Optimal Suture Technique for Mitral Valve Replacement in an <i>Ex Vivo</i>Animal Model

Objective: This study compared and evaluated three suture methods in order to find the method with the best durability for mitral valve replacement. The methods evaluated are horizontal mattress suture with subanular pledgets, horizontal mattress suture with supraanular pledgets and continuous running suture. Methods: Thirty hearts were explanted from newly terminated pigs. The hearts were randomized in the three groups. After an atriotomy, the mitral valve was cut out, and a patch was sutured into its place. An air pump model was connected to a balloon which was placed in the left ventricle through aorta and continuously filled with air to a maximum of 300 mmHg. The peak pressure at rupture was noted. If no rupture occurred before reaching 300 mmHg, the suture was found competent. Results: Two out of ten hearts in the continuous running suture-group had myocardial rupture within a pressure of 300 mmHg. In the remaining eight hearts there were no ruptures within 300 mmHg. In the two groups sutured with horizontal mattress with pledgets placed either subanular or supraanular, no rupture of myocardium occurred. When comparing continuous running suture with the horizontal mattress with subanular pledgets or the horizontal mattress with supraanular pledgets, the 1-sided Fishers’ exact was 0.237. At 5% significance level, there was no difference between the three suture methods. Conclusion: There was no statistically significant difference between the durability of the three suture methods, though rupture was only evident in the continuous running suture line. Since it is the surgeon’s choice to select the optimal suture technique, our study should be a reminder for the surgeon to reflect on the suturing factors that have an influence on successful mitral valve replacement.

Safety and feasibility of modified duct-to-mucosa pancreaticojejunostomy during pancreatoduodenectomy: A retrospective cohort study

BACKGROUND Pancreatoduodenectomy(PD)is the most effective surgical procedure to remove a pancreatic tumor,but the prevalent postoperative complications,including postoperative pancreatic fistula(POPF),can be life-threatening.Thus far,there is no consensus about the prevention of POPF.AIM To determine possible prognostic factors and investigate the clinical effects of modified duct-to-mucosa pancreaticojejunostomy(PJ)on POPF development.METHODS We retrospectively collected and analyzed the data of 215 patients who under-went PD between January 2017 and February 2022 in our surgery center.The risk factors for POPF were analyzed by univariate analysis and multivariate logistic regression analysis.Then,we stratified patients by anastomotic technique(end-to-side invagination PJ vs modified duct-to-mucosa PJ)to conduct a comparative study.RESULTS A total of 108 patients received traditional end-to-side invagination PJ,and 107 received modified duct-to-mucosa PJ.Overall,58.6%of patients had various complications,and 0.9%of patients died after PD.Univariate and multivariate logistic regression analyses showed that anastomotic approaches,main pancreatic duct(MPD)diameter and pancreatic texture were significantly associated with the incidence of POPF.Additionally,the POPF incidence and operation time in patients receiving modified duct-to-mucosa PJ were 11.2%and 283.4 min,respectively,which were significantly lower than those in patients receiving traditional end-to-side invagination PJ(27.8%and 333.2 minutes).CONCLUSION Anastomotic approach,MPD diameter and pancreatic texture are major risk factors for POPF development.Compared with traditional end-to-side invagination PJ,modified duct-to-mucosa PJ is a simpler and more efficient technique that results in a lower incidence of POPF.Further studies are needed to validate our findings and explore the clinical applicability of our technique for laparoscopic and robotic PD.

Looped,Broad,and Deep Buried Suturing Technique for Wound Closure

This study explores the clinical application of the circular wide and deep(looped,broad,and deep buried,LBD)suture technique for scar resection and examines its clinical effectiveness for scar treatment.From June 2017 to March 2019,a total of 68 patients with scars were sutured using LBD technique,and recovery was achieved 24 months postoperatively.In all 68 patients,postoperative scars were slightly evident in two cases of cervical scar,one case of leg scar,and one case of chest scar.In addition,the remaining 62 patients were completely satisfied with the outcome.The LBD suturing technique could provide sustained and stable tension-reducing effects postoperatively and significantly improve scar formation in patients.This method is most applicable to incisions with tension.Therefore,it should be more widely used for clinical scar treatment.

Treatment of Keloids in A Child with Surgery Alone:Clinical Application of the LBD Suturing Technique

Keloids are fibroproliferative disorders that can result from cutaneous injuries to the reticular dermis.Recurrence rates as high as 100%have been reported following surgical excision alone.Consequently,a variety of post-surgical techniques have been employed to prevent keloid recurrence,including the use of radiation.Although numerous studies have shown that post-excisional X-rays,electron beams,lasers,and brachytherapy can reduce the rate of keloid recurrence,numerous inconsistencies,including a wide range of definitions for keloid recurrence,render it difficult to compare the outcomes.The treatment of severe keloids in children is much more challenging,and there have been few previous reports.It is generally believed that children with keloids should be treated with nonsurgical treatment such as hormone injections and radiotherapy.For severe keloids,these methods require a long treatment period,and their efficacy is not ideal.Moreover,the side effects of the treatment can affect children’s health.If keloid scars are not effectively treated,they will often seriously affect the physical and mental health of children.The purpose of this review is to discuss case studies of children with severe keloids who were only treated with surgery and their postoperative recovery.In this case,the deep-embedded circular mattress suture technique(LBD,the looped,broad,and deep buried suturing technique)was used in the scar resection.After 18 months of follow-up,the surgical scar was evaluated using the Vancouver Scar Scale(VSS).The scar was stable and did not recur.The child was satisfied.This case shows that it is completely feasible to treat severe keloids with surgery alone,as long as the tension is reduced during the operation to prevent surgical scar hyperplasia.

Using Zhang’s supertension-relieving suture technique with slowly-absorbable barbed sutures in the management of pathological scars:a multicenter retrospective study

Background:An ideal tension-relieving suture should be efficient for>3 months to retrieve normal tensile strength.Most preexisting suturing techniques provided tension elimination followed by relapse and scar proliferation due to absorption and cut-through of the sutures.This study introduces a simple but effective suture technique developed by a senior author(ZYX)to solve this problem.Methods:A total of 120 patients with pathological scar(PS)had intervention treatment with the proposed suturing strategy at three centers from January 2018 to January 2021.A slowly absorbable 2-0 barbed suturewas used for subcutaneous tension relieving with a set-back from the wound edge and a horizontal interval between proposed inserting points of 1 cm.The Patient and Observer Scar Assessment Scale(POSAS),scar width,perfusion and eversion of the wound edge were evaluated at 3-,6-and 12-month follow-up.The time needed to place the tension-relieving suture was recorded and relapse was monitored for 18 months postoperatively.Results:In total,76 trunks,32 extremities and 12 cervical PS were included,with an average subcutaneous tension-relieving suture time of 5 min.The Patient and Observer Scar Assessment Scale(POSAS)score decreased from 84.70±7.06 preoperatively to 28.83±3.09,26.14±1.92 and 24.71±2.00 at 3,6 and 12 months postoperatively,respectively(p<0.0001).The scar widths were 0.17±0.08,0.25±0.09 and 0.33±0.10 cm,respectively,with perfusion significantly decreased from 213.64±14.97 to 112.23±8.18 at 6 months(p<0.0001).The wound edge flattened out during the first 3 months in most cases with only two scar relapses.Conclusions:Zhang’s suture technique provides a rapid and long-lasting tension-relieving effect with ideal scar appearances and lower relapse rates in the surgical management of PS.

Mallet finger deformities treated by buried purse-string suture

Objective： To investigate the efficacy of buried purse-string suture in the treatment of mallet finger deformities. Methods： From February 2009 to February 2010, 12 patients with closed non-fracture mallet fingers were treated by buried purse-string suture. The rupture tendons were sutured by purse-string suture with an atraumatic needle, and the knots were buried under subcutaneous tissue. External fixator was used at the extension position of the finger every night within three weeks after operation. Results： All patients were followed up for 6-12 months, mean 7 months. According to the Patel＇s evaluation criteria, 2 cases （17%） obtained excellent results, 7 good （58%）, 2 fair （17%） and 1 poor （8%）. The overall rate of the cases with excellent and good outcomes was 75%. Conclusion： Buried purse-string suture is an easy and effective way to treat mallet finger deformities, with no serious postoperative complications or no need for reoperation.

Application of purse-string suture for management of duodenal stump in radical gastrectomy

Background Gastric cancer （GC） is the second leading cause currently the only possible curative approach. Duodenal stump gastrectomy, and optimal treatment is still lacking. of cancer mortality worldwide, and surgical resection is leakage is the most serious complication after radical Methods We retrospectively reviewed 2034 cases of total or subtotal gastrectomy for GC from January 1995 to December 2009, including 465 cases of duodenal stump closure using purse-string suture （group A）, 835 cases of duodenal stump treated with linear cutting stapler and seromuscular layer suture （group B）, and 734 cases of duodenal stump closure using full-thickness and seromuscular layer suture （group C）. We evaluated the surgical cost, operative time for duodenal stump closure, short-term postoperative complications, perioperative blood loss, and postoperative recovery.

How we do it:the Running-X suture technique

There are a myriad of suture techniques available to close incisions of the brow and forehead,each with their own advantages and disadvantages.The ideal suture technique would provide excellent cosmetic results,offer expedient wound closure,optimize skin eversion and wound edge apposition,and provide excellent cosmetic results.The authors describe a new suture technique,the Running-X suture,a running horizontal mattress suture that has successfully been used by the senior author for many years to re-approximate surgical wounds of the brow and forehead in an expeditious and aesthetic manner.

Rhinoplasty in Chinese： management of lower dorsum and bulbous nasal tip

Background Bulbous nasal tips and lower dorsa are common facial features in Chinese people, and surgery to reshape these is frequently requested. The use of silicone implants in rhinoplasty has been widely used in China for many years, but is not suitable for patients seeking Caucasian tip shapes. The creation of an excessively high tip supported only by a silicone implant inevitably leads to implant extrusion. Although many rhinoplasty techniques have been used in Caucasian patients, there is currently no suitable method for Chinese patients, whose anatomy differs from that of Caucasians. The present study was aimed to investigate the clinical outcome of a novel method of rhinoplasty in Chinese people. Methods Eighty patients underwent rhinoplasty using our method between 2002 and 2006. We classified the patients into three types, according to the distance between tip defining points, and used different techniques accordingly. Furthermore, an innovative cartilage carving method and a tip fibro-fatty tissue flap were designed and combined with traditional techniques, such as insertion of silicone implant, cartilage grafts, suture techniques and cephalic trimming to reshape the nasal contours. The followup period was 10-60 months （average, 21 months）. Results Remarkable modifications in nasal contours were achieved. No complications developed in any of the 80 patients. Seventy-eight patients were satisfied with the results. The outcomes remained unchanged over time. Conclusion Our method is effective and suitable for the treatment of Chinese patients with lower dorsa and bulbous nasal tips.

A novel method of defective vascular reconstruction using 2-octyl-cyanoacrylate and homemade prosthetic component

Background Currently,adhesive technique is popular in vascular repair but not widely used for defective vessels.This study aimed to determine the feasibility and effectiveness of repairing defective vessels with 2-octyl-cyanoacrylate and a homemade prosthetic component.Methods Homemade prosthetic component consisting of expanded polytetrofluoroethylene （ePTFE）,terylene film,and homemade soluble hollow stent mixed with adhesive can replace autologous graft and suture in repairing defective vessels,can fix vessels better using the stent without occlusive bleeding.Forty male mongrel dogs were used,20 for biomechanical tests and 20 for animal experiments.In the biomechanical test,dogs were randomly divided into two groups （n=10 each）,one group repaired on the two sides of the carotid arteries with 2-octyl-cyanoacrylate and homemade component and another group repaired with suture and ePTFE.Of the 40 specimens,10 were used for adhesive and 10 for suture specimens for tension strength test,whereas the remaining specimens were used for bursting pressure test.In animal experiments,dogs were also divided into adhesive and suture groups （n=10）,only of the left carotid artery.Recording the operational time,bleeding or not.Vessels were tested using color Doppler ultrasound,the inner diameter was measured,and the degree of stenosis at 8 weeks was evaluated digital subtraction angiography （DSA） were also performed.Specimens were then analyzed histologically.Results In the adhesive and suture groups,the specimens could afford atension strength of （23.80±1.51） N versus （24.60±1.08） N （P ＞0.05）,the bursting pressure was （52.03±.2.43） kPa versus （50.04±3.51） kPa （P ＞0.05）,and the mean time of anastomosis was （15.20±0.55） minutes versus （25.97±0.58） minutes （P ＜0.05）.One dog in the adhesive group was bleeding from the suture.One dog from each group presented with thrombosis at 1 week.After measuring using ultrasound,the stenosis degree of all dogs were no more than 30％ except the two thromboses.DSA and histological observation showed no obvious difference between the two groups.Conclusion Defective vascular anastomosis with 2-octyl-cyanoacrylate and our homemade prosthetic component is feasible,effective,timesaving,and easy to master.

Vocal cord mucosal flap for the treatment of acquired anterior laryngeal web

Background Anterior glottic web is one type of laryngeal stenosis.Previous surgical methods had some drawbacks,such as large surgical trauma,long postoperative recovery time,and multiple-stage surgery.This study aimed to explore better treatment to repair anterior glottis web.Methods We performed vocal cord mucosal flap procedure on 32 patients with anterior laryngeal webs.All subjects received vocal cord scar releasing and vocal cord mucosal flap repair and suture under general anesthesia with selfretaining laryngoscope.Results All 32 patients completed surgery in one stage,without postoperative laryngeal edema,difficulty in breathing,or other complications.After the surgery,the anterior commissure of vocal cords recovered to a decent triangle shape in 28 patients; however,in four patients there were 2 to 3 mm adhesion residuals on the anterior ends of the vocal cords,accompanied by scar appearance of bilateral vocal cords.The GRB score,voice handicap index scores,and maximum phonation time score significantly improved in all patients after the surgery.There was no evidence of recurrent laryngeal webbing in the 6-rnonth follow-up.Conclusion Vocal cords mucosal flap repair surgery has the advantages of less trauma,quick recovery,and significant improvement of the voice in the treatment of laryngeal webs.