ObjectiveTo analyze clinical outcomes of sutureless technique for patients undergoing surgical correction of total anomalous pulmonary venous connection (TAPVC).
MethodsBetween July 2007 and December 2013, 132 consecutive TAPVC patients underwent surgical correction in Guangdong Cardiovascular Institute. Those patients with such associated congenital cardiac anomalies as single ventricle and right atrial isomerism were excluded from this study. All the patients underwent biventricular repair. Preoperatively, all the patients received echocardiography, and most patients received CT scan to know the development of pulmonary veins. Preoperative diagnosis was confirmed by intraoperative exploration. According to different surgical techniques, all the patients were divided to a conventional technique group and a sutureless technique group. In the conventional technique group, there were 69 patients including 54 males (78.3%)and 15 females (21.7%)with their median age of 60 (30, 225)days and median body weight of 4.85 (3.50, 6.35)kg. In the sutureless technique group, there were 63 patients including 48 males (76.20%)and 15 females (23.8%)with their median age of 90 (30, 210)days and median body weight of 4.58 (3.72, 6.20)kg. Follow-up was performed till January 1, 2014.
ResultsIn-hospital mortality (4.8% vs. 7.2%, χ2=1.414, P=0.720)and postoperative overall mortality (4.8% vs. 13.0%, χ2=2.733, P=0.098)of the sutureless technique group were both lower than those of the conventional technique group, although there was no statistical difference. Postoperative incidence of pulmonary venous obstruction (PVO)of the sutureless technique group was significantly lower than that of the conventional technique group (1.6% vs. 10.1%, χ2=4.236, P=0.040). Cox proportional-hazards regression showed that conventional technique and preoperative PVO were significant risk factors for postoperative PVO (P=0.023, P=0.016). Conventional technique was not significantly correlated with postoperative mortality (P=0.060).
ConclusionSutureless technique can significantly lower postoperative incidence of PVO for patients with supracardiac TAPVC.
Objective
To analyze the sutureless technique use in the surgical repair for total anomalous pulmonary venous connection in neonates.
Methods
Between September 2002 and December 2015, 71 consecutive neonates with supracardiac or infracardiac type total anomalous pulmonary venous connection who underwent surgical repair in our institute were included in this study. There were 57 males and 14 females at median age of 8 (1, 29) d. And the median body weight was 3.3 (2.1, 4.7) kg. There were 45 patients (63.4%) with supracardiac, 26 patients (36.6%) with infracardiac. Patients were divided into two groups: a conventional technique group (29 patients) and a sutureless technique group (42 patients). To control for potential differences in the characteristics of patients between the sutureless technique group and the conventional technique group, the method of propensity-score matching was used.
Results
Basic characteristics of patients after propensity-score were not different.There were 11 operative deaths (15.5%), 7 late deaths (96.%), total 18 deaths (25.4%). The mortality was 58.6% (17/29) in the conventional technique group, 2.4% (1/42) in the sutureless technique group (P=0.000). Kaplan-Meier survival curve showed a difference in mortality between the two groups (P=0.005). The patients were followed up for 25.5 (1.0-13.0) months.Postoperative anastomotic or pulmonary vein stenosis occurred in 12 patients, 8 of them died at a higher mortality than that of the patients with smooth anastomosis [66.7% (8/12) vs. 16.9% (10/59), P=0.001].
Conclusion
The patients who have postoperative anastomotic or pulmonary vein stenosis have higher mortality. Compared with conventional technique, sutureless technique can dramatically decrease the incidence of postoperative anastomotic or pulmonary vein stenosis and the mortality of surgical repair for total anomalous pulmonary venous connection in neonates.
Objective To introduce the arthroscopic technique of figure-of-eight suture fixation for tibial eminence fracture, and to report its clinical results. Methods From January 1998 to June 2001, 21 cases of tibial eminence fracture were treated arthroscopically with figure-of-eight suture fixation technique. Active rehabilitation began one week after operation. The patients were followed up 6-24 months. The reduction and union of fracture, knee laxity, range ofmotion, and total knee function were evaluated. Results All fracture healed without displacement six weeks after operation. Three months postoperatively, no knee laxity or instability was detected in all patients; full range of motion of the affected knee returned in all patients when compared with the normal side. Six months postoperatively, the Lysholm knee score was 93.4±2.7. Conclusion Arthroscopic treatment of tibial eminence fracture with figure-of-eight suture fixation technique is reliable for fracture reduction , fixation and early mobilization. Arthroscopy is conducive to diagnoses and treatment of associated knee arthropathy, reduces the morbidity associated with arthrotomy, and restores knee function to the greatest extent when combined with figure-of-eight suture fixationtechniques.
Objective
To investigate the methods and effectiveness of surgical treatment for posteromedial corner (PMC) injury combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) ruptures.
Methods
Between February 2009 and February 2012, 15 patients (15 knees) with PMC injury combined with ACL and PCL ruptures underwent PMC repair with suture anchor and ACL and PCL reconstruction. There were 7 males and 8 females with an average age of 39 years (range, 15-59 years). The causes of injury were traffic accident injury in 6 cases, sport injury in 7 cases, and sprain injury in 2 cases. The disease duration was 3-15 days with an average of 7 days. All patients presented positive results of anterior drawer test, posterior drawer test and valgus stress test, and dysfunction of knee joint. Of 15 cases, 3 had ACL and PCL ruptures, 5 had ACL rupture, 3 had ACL injury at the attachment point of the condyles crest, and 4 had PCL rupture; 9 had PMC tear at the femur insertion, 5 had PMC tear at the tibia insertion, and 1 had PMC tear in the body area.
Results
All incisions healed by first intention with no complication of infection or stiffness of knee. All cases were followed up 18.4 months on average (range, 10-36 months). At last follow-up, 14 cases had normal knee flexion and extension ranges, but 1 case had 10° limitation of the knee extension. Except 1 case which had weakly positive valgus stress test, the other patients showed negative results of anterior drawer test, posterior drawer test, and valgus stress test. Based on the improved Lysholm classification standard, the results were excellent in 8 cases, good in 5 cases, and fair in 2 cases; the excellent and good rate was 86.7%.
Conclusion
Early repair of the PMC and reasonable reconstruction of cruciate ligament can effectively restore the knee stability for patients with PMC injury combined with ACL and PCL ruptures.
ObjectiveTo introduce a modified sutureless technique and its surgical results in the treatment of total anomalous pulmonary venous connection (TAPVC).MethodsClinical data of 11 patients with TAPVC who underwent the modified sutureless technique treatment from 2014 to 2019 in our center were retrospectively analyzed, including 4 males and 7 females. The median surgical age was 1.4 (0.3, 27.0) months. The median weight was 4.3 (3.5, 8.5) kg.Six (54.5%) patients were of supracardiac subtype, and five (45.5%) patients were of infracardiac subtype. Five (45.5%) patients had preoperative severe pulmonary hypertension, and three (27.3%) patients had preoperative pulmonary vein obstruction. The surgical results were compared with those of 10 patients treated with conventional surgical technique.ResultsThe median follow-up was 12 (range, 1-65) months. During the follow-up, no death or postoperative pulmonary vein obstruction occurred in the modified sutureless technique group. The perioperative data and relief of re-obstruction were superior in the modified sutureless technique group, but the difference was not statistically significant (P>0.05). The postoperative survival of the the modified sutureless technique group was better than that of the traditional surgery group (P=0.049).ConclusionThe modified sutureless technique which includes partial suture and then incising, and eversion of pulmonary vein incision, is a safe and reliable method for the treatment of TAPVC with satisfactory short-term results.
Objective To compare the efficacy of incision healing by abdominal wall closure measure without suturing subcutaneous fat layer and the traditional abdominal wall closure measure. Methods Four hundreds patients underwent operation of abdominal median incision and abdominal paramedian incision from Sep. 2010 to Sep. 2012 in our department were randomly assigned to observation group （n=199） and control group （n=201）. The patients in obser- vation group underwent abdominal wall closure measure without suturing subcutaneous fat layer， and those of control group were subjected to abdominal wall closure by traditional layer suture technique. Comparison of efficacy of incision healing in the 2 groups was performed. Results The incidences of fat liquefication 〔1 （0.5%） vs.18 （9.0%）〕， incision swelling 〔3 （1.5%） vs.16 （8.0%）〕， incision induration 〔1 （0.5%） vs.15 （7.5%）〕， and dehiscence of wound 〔0 （0） vs.9 （4.5%）〕 in observation group were significantly lower than those of control group （P＜0.01）， but there was no significant difference in incidence of subcutaneous hematoma 〔2 （1.0%） vs.0 （0）， P＞0.05〕. The rate of primary healing in obser-vation group was significantly higher than those of control group 〔199 （100%） vs.186 （92.5%）， P＜0.01〕. Duration of abdominal closure 〔（13.0±1.6） min vs.（18.0±2.2） min〕 and postoperative hospital stay 〔（7.7±1.3） days vs.（9.6±1.9） days〕 were all shorter than those of control group （P＜0.01）. Conclusion The abdominal wall closure measure without suturing subcutaneous fat layer is obviously more effective to the traditional layer suture technique， which is a suture way worthy to spread.
Objective To explore the mechanism of mesenchymal stem cells （MSCs） transplantation for chronic hindlimb ischemia in Lewis rats by using cell tracer technique. Methods MSCs were isolated and cultured by using density gradient centrifugation and adherence method respectively， then labeled by 5-bromo-2-deoxyuridine （BrdU）. Eight chronic hindlimb ischemia models of Lewis rats were prepared by using suture-occluded method and then divided randomly to MSCs transplantation group and control group， each group enrolled 4 rats， accepting MSCs transplantation and saline respectively. Then on 7 days and 14 days after transplantation， clinical observation， determination of blood flow， and angiography were performed on rats of the 2 groups. At the same time points after previous tests， rats of the 2 groups were sacrificed to get quadriceps tissues and gastrocnemius tissues to perform HE staining and BrdU immunohis-tochemistry. Results The 8 rats were all survived on 14 days after transplantation， with no tumor happened and necroses in the transplanted area. On 14 days after transplantation， the blood flow ratio of operated side to un-operated side in the hindlimb （1.773 vs. 1.279） of rats in MSCs transplantation group and control group increased， and the angiography results showed that there were no much increase in ratio of collateral vessels number （0.908 vs. 0.835）. There were no significant change in the quadriceps tissues and gastrocnemius tissues by HE staining. The BrdU positive kernels located in the inter-stitial substance cells and vascular endothelia cells， and divided differently in different parts of hindlimb at different time points， that the ratio of positive cells in gastrocnemius tissue was higher than those of quadriceps tissue on 7 days after transplantation， but lower on 14 days. Conclusions MSCs transplantation can increases the blood perfusion of hindlimb in the early stage of chronic hindlimb ischemia model， and the possible mechanism may be the paracrine effect of MSCs but not the number increase of collateral vessels.
ObjectiveTo investigate the effectiveness of multiple tension reduction suture of in-situ return needle vertical mattress suture and in-situ return needle horizontal mattress suture combination with intradermal intermittent continuous suture (denominated as Zunyi’s Suture Method) on suturing the donor site of the anterolateral thigh flap. MethodsBetween January 2019 and December 2019, 62 patients were treated with anterolateral thigh flaps to repair wounds. There were 46 males and 16 females, aged 9-67 years (mean, 31 years). The size of anterolateral thigh flap ranged from 6 cm×5 cm to 25 cm×7 cm. The donor site of the flap was sutured directly by the Zunyi’s Suture Method. The skin on both sides of the incision was advanced to the middle, and the wound edge was attached and in a state of negative tension. The intradermal suture line was removed at 7 days after operation. The complications and scars at donor site were observed during follow-up. The Vancouver Scar Scale was used to assess the appearance of scars and the width of scars were measured at 6 months after operation.ResultsThe flaps survived smoothly, and the wounds healed by first intention. The incisions at donor sites healed by first intention at 2 to 3 weeks after operation. All patients were followed up 7-16 months, with an average of 10.7 months. There was no ischemic necrosis of the donor site or skin threading. There was pigmentation of the needle back point in the early stage, and the pigmentation completely disappeared after 3 to 6 months without scar hyperplasia. At 6 months after operation, liner scars were achieved in all the patients with an average Vancouver Scar Scale score of 2.5 (range, 1.0-3.5) and an average width of 2.4 mm (range, 0.8-9.1 mm). ConclusionThe suture of the donor site of the anterolateral thigh flap with Zunyi’s Suture Method can effectively reduce the tension on wound edges and scar hyperplasia.
ObjectiveTo evaluate the effectiveness of arthroscopic suture and absorbable screw double fixation for both anterior and posterior cruciate ligament avulsion fractures of tibial insertions.
MethodsBetween June 2006 and September 2013, 8 patients with anterior and posterior cruciate ligament avulsion fractures of the tibial eminence underwent arthroscopic treatment with suture and absorbable screw double fixation. There were 5 males and 3 females, with a mean age of 28.9 years (range, 18-43 years). The causes of injury included traffic accident in 5 cases and falling from height in 3 cases. The time from injury to operation was 3-10 days (mean, 6.2 days). The Lysholm knee score, International Knee Documentation Committee (IKDC) score, and Tegner rating scales were used to evaluated the knee function.
ResultsPrimary healing of incision was obtained, without infection or deep vein thrombosis. The mean follow-up period was 42.4 months (range, 24 to 65 months). At 3 months after operation, X-ray films showed good reduction and healing of fracture. The anterior and posterior drawer tests were negative. The knee range of motion was normal (0-125°), and it recovered to preoperative level in 7 cases. The IKDC score, Tegner score, and Lysholm score were significantly improved to 90.4±5.2, 7.5±1.6, and 89.2±3.5 from preoperative 52.1±3.3, 3.3±1.0, and 51.9±3.5 respectively (t=-38.680, P=0.000; t=-39.520, P=0.000; t=-41.150, P=0.000).
ConclusionA combined injury of anterior and posterior cruciate ligament avulsion fractures of tibial insertions is rare. Arthroscopic treatment with suture and absorbable screw double fixation is a useful technique to restore tibial avulsion injuries with well-documented radiographic healing, good clinical outcomes, and low complication rates.
ObjectiveTo summarize the research progress of suture augmentation (SA) in anterior cruciate ligament (ACL) reconstruction. MethodsA comprehensive review of recent literature about SA in ACL reconstruction at home and abroad was conducted. The efficacy of SA in ACL reconstruction was evaluated by examining the definition, biomechanics, and histological studies of SA, along with its clinical application status in ACL reconstruction. ResultsSA demonstrates significant advantages in enhancing the biomechanical stability of ACL grafts, reducing the risk of re-rupture, and accelerating postoperative recovery. Specifically, SA improves graft stiffness, ultimate failure strength, and cyclic stability, thereby diminishing the risk of early postoperative failure and joint instability. Histologically, it fosters remodeling and tendon-bone integration through early load-sharing mechanisms; however, stress shielding may interfere with natural remodeling processes, warranting further attention. Clinically, SA reduces graft failure rates and the need for revision surgeries, markedly improving knee joint stability and functional recovery in young patients. Nevertheless, its impact on graft maturation and potential complications remains controversial. ConclusionDespite the many advantages of SA in ACL reconstruction, future endeavors should focus on optimizing tensioning techniques, developing bioactive materials, and conducting large-scale randomized controlled trials to further elucidate its clinical value and scope of applicability, providing a more reliable solution for ACL reconstruction.
