Trigger Finger Release: Are Sutures Requiring Removal Necessary?

Purpose

There is no consensus regarding optimal closure for trigger finger release (TFR) surgery. The purpose of this study was to compare the number of postoperative visits and complications following TFR closure with nonabsorbable sutures versus those following TFR closure with absorbable sutures and skin glue. The hypothesis was that wound closure with absorbable sutures and glue will result in fewer postoperative visits, while having similar complication rates as that with nonabsorbable sutures.

Methods

A retrospective review identified all patients undergoing open TFR over a 3-year period performed by two hand surgery fellowship-trained hand surgeons who adhered to an identical surgical protocol except for incisional closure. Patients were divided into two groups: a control group with nonabsorbable 4-0 monofilament sutures requiring removal ("suture" group) and a study group with buried absorbable 4-0 monofilament sutures not requiring removal as well as skin glue ("glue" group). The data collected included age, sex, number of postoperative visits, wound complications, infections, antibiotic use, prescribed hand therapy, hospital admission, and reoperation.

Results

A total of 305 open TFR surgeries in 278 patients were included in the study, with 155 digits in the "suture" group and 150 in the "glue" group. Both groups were similar in age and sex. The "suture" group had significantly more total postoperative visits (185 vs 42, respectively, P < .001) and postoperative visits within the first 2 weeks (155 vs 10, respectively, P < .001) than the "glue" group. Additional postoperative visits beyond 2 weeks of surgery were similar between the two groups. Three (1.9%) patients in the "suture" group and two (1.3%) patients in the "glue" group developed a superficial surgical site infection within 30 days after surgery. Neither had deep infections requiring hospitalization or reoperation. Both groups required similar rates of postoperative hand therapy.

Conclusions

Absorbable sutures afford fewer postoperative visits while having a similar complication rate as nonabsorbable sutures requiring removal.

Type of study/level of evidence

Therapeutic IV.

Postoperative Visual Outcome: Sling procedure with prolene sutures in children with simple congenital ptosis

Objective:

To assess the visual outcome after sling procedure using prolene sutures in children with simple congenital ptosis.

Methods:

A descriptive case series study was performed in the Department of Ophthalmology of Jinnah Post Graduate Medical Centre, for a duration of six months in which 20 patients aged 3-10 years were selected with either unilateral or bilateral congenital ptosis. They were thoroughly examined and visual acuity and degree of ptosis were measured pre-operatively. Frontalis sling surgery was performed using prolene sutures on all patients after which their visual acuity and degree of ptosis were measured once again after three months post-operatively. Data were analyzed using SPSS version 20.0. For qualitative variables, frequency and percentages were calculated. Mean and Standard deviation was commutated for the quantitative variable.

Results:

The mean age of the patients was 8.15±1.75. 11 (55%) male and 9 (45%) female participants were included in the study. Visual acuity improved in all the patients with all the patients attaining a visual acuity of 6/6 (n=12, 60%), 6/9 (n=7, 35%), and 6/12 (n=1, 5%). The degree of ptosis post-operatively was not found in any patient either.

Conclusion:

Sling procedure helped in eliminating ptosis and improved visual acuity in patients with simple congenital ptosis.

Surgical wounds in reduction mammoplasty: a comparison of Monocryl and Prolene sutures on scars

OBJECTIVE

The type of suture material affects the quality of scars. The aim of this study was to find the superior suture material for reduction mammoplasty between Prolene and Monocryl based on the comparison of scars.

METHOD

A prospective observational study was conducted at a university-based hospital in Mashhad, Iran between October 2015 and September 2017. Monocryl and Prolene suture materials, used for closing the outermost layer in mammoplasty, were compared. Patients' incision scars were assessed objectively according to the Patient and Observer Scar Assessment (POSAS) criteria. The relevant CONSORT guideline was used for reporting this study.

RESULTS

Seventy-eight women with a mean age of 36.8±9.5 years were entered into the study. The frequency of wound healing in both groups was 97.4% 1 month after surgery and by the third visit, 3 months after surgery, only one patient had a stretched scar. Moreover, wound inflammation in the first two visits was less frequent in the Prolene group that healed completely 3 months after surgery (after excluding the one patient with wide scar inflammation). The frequency of itching of the wound in the Monocryl group was 24.4%, 11.5% and 12.8% in the three follow-up visits, respectively, and the values for the Prolene group were 24.4%, 9.0% and 6.4%, respectively. No significant difference was seen between the two groups in terms of wound healing, inflammation and itching (p>0.05). Overall, 94.8% of patients were satisfied with the surgery.

CONCLUSIONS

Our study revealed that there was no significant difference between Monocryl and Prolene. Hence, either of the two suture materials can be used for wound closure in reduction mammoplasty.

Retromuscular mesh and hernial sac technique in the reconstruction of 139 cases of large median incisional hernias: one institution's experience

PURPOSE

Incisional hernia is the most common complication of laparotomy. Postoperative parietal defects tend to relapse, even after the most optimal surgical methods. The aim of this study was to present the effectiveness of an adapted retromuscular technique with prolene mesh and a hernial sac, in patients with large incisional median hernias. The reported results were obtained by our team after more than 15 years of experience.

METHODS

This retrospective study included 139 consecutive cases of large median incisional hernias operated on using a retromuscular mesh and hernial sac technique. The cross-sectional diameter of incisional hernias was larger than 10 cm, being classified in the W₃ group, according to the European Hernia Society classification.

RESULTS

The study included 83 females (59.71%) and 56 males (40.29%) with a median age of 62.4 ± 16.6 years and an average body mass index of 32.4 ± 7.6 kg. The hernia was supraumbilically located in 54 cases, subumbilically in 61 cases, and supra- and subumbilically in 24 cases. Postoperative complications were recorded in eight cases (5.75%): one case with a hematoma in the right abdominal muscle sheath; five cases with supra-aponeurotic seromas; two cases with skin necrosis and one with a mesh infection. Recurrence occurred in seven cases (5.03%): four cases in the first 2 years postoperatively and three cases in the third year after surgery.

CONCLUSIONS

The retromuscular technique with prolene mesh and a hernial sac is an effective method of restoring the integrity of the abdominal wall in large median incisional hernias with low rates of morbidity and recurrence.

Prevention of incisional hernia using different suture materials for closing the abdominal wall: a comparison of PDS, Vicryl and Prolene in a rat model

Purpose

An incisional hernia occurs frequently after a midline incision with an incidence of 12.8%. The choice in suture material used for abdominal wall closure is not straightforward and the conflicting literature focuses on clinical outcomes. This study compares a non-absorbable, slow-absorbable and fast-absorbable suture in a rat model, focusing on histological outcomes predicting better fascia healing.

Methods

33 male Wistar rats, divided over three groups, each received two separate 1 cm incisions closed with either Prolene 4/0, PDS 4/0 or Vicryl 4/0. At 7 days and 21 days, one of the incisions was explanted. Tissue was semi-quantitatively scored regarding inflammatory cells and collagen fibres present. Using qPCR macrophage polarisation, fibroblast activity and vascularisation were evaluated. Data were analysed by Kruskal–Wallis test with Mann–Whitney U post hoc test. A p value of 0.017 was considered significant after Bonferroni correction.

Results

All animals recovered without complications and completed the 21 days of follow-up. The Vicryl group showed a higher presence of macrophages after 21 days in comparison with Prolene (p = 0.003) and PDS (p = 0.006) and more foreign body giant cells compared to Prolene at 7 days (p = 0.010) and PDS at 21 days (p < 0.001). qPCR showed 2.5-fold higher expression of clec10A in PDS compared to Prolene after 7 days (p = 0.007).

Conclusions

The results of this study carefully support the use of PDS suture, compared to Prolene and Vicryl, in abdominal wall closure based on a favourable macrophage response. The heterogeneity and variability in the data might be explained by the spectrum of the macrophage subtype paradigm.

Electronic supplementary material

The online version of this article (10.1007/s10029-019-01941-9) contains supplementary material, which is available to authorized users.

An experimental research in mice on the "soft tissue reaction to 3 different mesh implants: Titanium silk, Parietene Progrip and Prolene"

Purpose

To analyze the soft tissue reaction of 'Titanium Silk' mesh implant in comparison with 'Parietene Progrip' and 'Prolene' mesh implants for the reinforcement and augmentation of soft tissues to improve the results of static correction in Facial Paralysis and other defects of Maxillofacial region.

Materials and methods

Under standard laboratory conditions, 89 mice were divided into 4 groups: a control group of 5 mice; first group of 28 mice with Titanium mesh implant, second group of 28 mice with semi-resorbable 'Parietene Progrip' implant and third group of 28 mice with 'Prolene' implant. Under inhalational anesthesia with ethyl ether at days 7, 14, 30 and 60, seven mice from each experimental group underwent Gross and histological analysis of the mesh structures for the following characteristics: Macrophage Infiltration, Multinucleated Macrophages, Meshwork around the implant fibers, Connective tissue proliferation, Angiogenesis and Fibroblasts.

Results

Histological analysis revealed a significantly less pronounced inflammatory response to Titanium mesh implant resulting in the formation of a more delicate connective tissue network around the mesh elements.

Conclusion

The experiment clearly demonstrated the cellular and tissue responses to different implantable mesh materials at various times of its integration. It revealed that the titanium mesh is the most bio-inert alloplastic material suitable for reinforcement of soft tissue augmentation and to prioritize it's use in static correction of facial paralysis and other defects of the maxillofacial region. A postoperative timeframe of 30 days is considered appropriate for the adequate formation of connective tissue around the mesh elements.

Polypropylene in Endoscopic Dacryocystorhinostomy: A Novel Stent

Endoscopic dacryocystorhinostomy (DCR) is usually done in cases of lacrimal apparatus obstruction. The common causes of failure are that of obstruction in the common canaliculus and closure of the rhinostomy site. To overcome these problems we use stents. Stents most commonly used are that of silicon which are expensive and not readily available. As an alternative, polypropylene (Prolene; Ethicon) is used as a stent which is cheaper and readily available. This study is done to evaluate the clinical efficacy and results of stenting with polypropylene suture material in endoscopic dacryocystorhinostomy. Fifty one endoscopic DCR operations were performed between July 2013 to December 2014. After creating an aperture in the medial wall of the lacrimal sac, 3/0 prolene was inserted from lower punctum to neo ostium. The prolene was left in the lacrimal sac for 3 weeks. The patients were followed up for 3 months. In our study, most of the patients belonged to the age group of 41-60 years (47%). There was female preponderance as 64.7% were females. 47 patients (92.2%) showed very good results. Two patients (3.9%) developed granuloma for which revision surgery was done. We lost 2 patients during follow up. This modification enables an easy, safe, effective and low-cost form of DCR. Prolene is cheaper and readily available. It might be used successfully in endoscopic dacryocystorhinostomy and is promising alternative to silicone stent intubations, especially in settings with limited resources.

Characterization of the Foreign Body Response to Common Surgical Biomaterials in a Murine Model

BACKGROUND

Implanted biomaterials are subject to a significant reaction from the host, known as the foreign body response (FBR). We quantified the FBR to five materials following subcutaneous implantation in mice.

MATERIALS AND METHODS

Polyvinyl alcohol (PVA) and silicone sheets are considered highly biocompatible biomaterials and were cut into 8mm-diameter disks. Expanded PTFE (ePTFE)and polypropylene are also widely used biocompatible biomaterials and were cut into 2cm-long cylinders. Cotton was selected as a negative control material that would invoke an intense FBR, was cut into disks and implanted. The implants were inserted subcutaneously into female C57BL/6 mice. On post-implantation days 14, 30, 60, 90 and 180, implants were retrieved. Cellularity was assessed with DAPI stain, collagen with Masson's trichrome stain. mast cells with toluidine-blue, macrophages with F4/80 immunohistochemical-stain, and capsular thickness and foreign body giant cells with hematoxylin & eosin.

RESULTS

DAPI revealed a significantly increased cellularity in both PVA andsilicone, and ePTFE had the lowest cell density. Silicone showed the lowest cellularity at d14 and d90 whereas ePTFE showed the lowest cellularity at days 30, 60, and 180. Masson's trichrome staining demonstrated no apparent difference in collagen. Toluidine blue showed no differences in mast cells. There were, however, fewer macrophages associated with ePTFE. On d14, PVA had highest number of macrophages, whereas polypropylene had the highest number at all time points after d14. Giant cells increased earlier and gradually decreased later. On d90, PVA exhibited a significantly increased number of giant cells compared to polypropylene and silicone. Silicone consistently formed the thinnest capsule throughout all time points. On d14, cotton had formed the thickest capsule. On d30 polypropylenehas formed thickest capsule and on days 60, 90 and 180, PVA had formed thickest capsule.

CONCLUSION

These data reveal differences in capsule thickness and cellular response in an implant-related manor, indicating that fibrotic reactions to biomaterials are implant specific and should be carefully considered when performing studies on fibrosis when biomaterials are being used.

A Comparison of Two Monofilament Suture Materials for Repair of Partial Flexor Tendon Lacerations: A Controlled In-vitro Study

BACKGROUND

Surgical repair is advocated for flexor tendon lacerations deeper than 70%. Repair can be undertaken with different suturing techniques and using different materials. Different materials used for tendon repair will have a different gliding resistance (GR) at the joint. Previous studies have compared strength of repair and gliding resistance for various braided suture materials and for 100% laceration of flexor tendons. We directly compare the GR of two monofilament sutures when used for a peripheral running suture repair of partially lacerated tendons.

METHODS

Sixteen flexor tendons and A2 pulleys were harvested from Turkey feet. They were prepared, partially lacerated to 50% depth, and then repaired with a core suture (modified Kessler technique with 4-0 Ethibond) as well as an additional superficial running suture of either 6-0 Prolene or Nylon (half randomised to each). Gliding resistance was measured for all tendons before and after repair, at different flexion angles (40 and 60 degrees) and for different loads (2N and 4N).

RESULTS

After surgical repair, gliding resistance was increased for all tendons (P < 0.01). The tendons repaired with Prolene had a higher mean gliding resistance than those repaired with Nylon (P = 0.02). Increased flexion angle and load amplified the gliding resistance (both P < 0.01).

CONCLUSIONS

6-0 Nylon was associated with a lower gliding resistance than 6-0 Prolene but the minor differences bare unknown clinical significance.

Prolene Canalostenting in Deep Sclerectomy: A Pilot Study

PURPOSE

To study the effect of implantation of a 5/0 prolene suture segment inside Schlemm's canal as an adjunct to deep sclerectomy.

MATERIALS AND METHODS

This was a prospective, interventional case series of nine eyes of six patients with open angle glaucoma. Patients underwent deep sclerectomy with insertion of a segment of 5/0 prolene into Schlemm's canal at the filtration site without suturing. The main outcome measures were: Intraocular pressure (IOP), postoperative interventions, and complications. Ultrasound biomicroscopy of the filtration area as well as the prolene suture was performed at 6 months postoperatively.

RESULTS

Patients were followed for a mean of 8.1 ± 4.5 months. Mean IOP decreased statistically significant from 19 ± 4.2 mmHg preoperatively to 12 mmHg at 15 months postoperatively (P < 0.0001). The number of glaucoma medications was reduced from 3.7 ± 0.7 preoperatively to 0 postoperatively. No postoperative complications were noted. IOP remained in the low teens in all patients out to the last postoperative visit. Yttrium-aluminum-garnet laser goniopuncture was not required in any case.

CONCLUSION

Implantation of a 5/0 prolene suture in Schlemm's canal during deep sclerectomy was a safe, cost-effective adjunct to maintain the patency of the intrascleral space and Schlemm's canal thus controlling IOP for 6 months postoperatively.