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.
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.
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 evaluate the feasibil ity and effectiveness of suture ligation combined with super-wet tumescent technique to replace embolization before surgical resection of peri pheral arteriovenous malformations (AVMs) of the head and neck. MethodsBetween July 2007 and November 2010, 9 patients with peri pheral AVMs of the head and neck were treated, including 4 males and 5 females with a median age of 21 years (range, 8 months to 55 years). The causes were congenital malformation in 6 cases, trauma in 2 cases, and unknown origin in 1 case. The lesions were located at the frontotemporal region in 2 patients, cheek in 2 patients, occi pitocervical region in 2 patients, temporoparietal region in 1 patient, upper lip in 1 patient, and lower lip in 1 patient. The size of the AVMs lesions ranged from 2.2 cm×1.2 cm to 13.0 cm×10.0 cm. Of 9 cases, 8 were classified as Schobinger gradeⅡand 1 as gradeⅢ. The AVMs involved 2 to 7 main nutrient arteries, with a diameter range of 1.7-3.1 mm. At one-stage operation, AVMs was removed and direct suture, skin graft or flaps were used for repair in 6 cases; the skin was expanded at one-stage operation, and then AVMs removal and repair were performed at twostage operation in 3 cases. Before resection of AVMs, No.7 silk suture was used to l igate the main nutrient vessels, and then annular interrupted suture of soft tissue was performed with the silk sutures around the lesions, at least two rings. Tumescent anesthetic solution was injected into lesions, and super wet end-point achieved. ResultsPartial incision dehiscence occurred in 1 patient; the flaps and grafting skin survived, and primary healing of incision was obtained in the other patients. The mean operation time was 136 minutes (range, 42-367 minutes). The mean intraoperative blood loss was 268 mL (range, 15-1 000 mL). Only 1 patient received 3 units of blood transfusion. All patients were followed up for 4.2 years on average (range, 2 years to 6 years and 6 months); there was no recurrence case. The self-assessment cosmetic results were excellent or good in 5 cases and fair in 4 cases. ConclusionIntensive suture ligation followed by super-wet tumescent techniques might partially substitute preoperative embolization to facil itate surgical resection of peri pheral AVMs of the head and neck, due to simple operation and less bleeding.
ObjectiveTo evaluate and compare the effectiveness of double Endobutton technique and suture anchor combined Endobutton plate in the treatment of Tossy type Ⅲ acromioclavicular joint dislocation. MethodsBetween May 2010 and March 2014, a retrospective study was preformed on 56 patients with Tossy type Ⅲ acromioclavicular joint dislocation. The coracoclavicular ligament was reconstructed with double Endobutton technique in 31 cases (Endobutton group), and with suture anchor combined Endobutton plate in 25 cases (Anchor group). There was no significant difference in age, gender, injury causes, injury side, associated injury, medical comorbidities, and disease duration between 2 groups (P>0.05). The operation time, medical device expenses, postoperative complications, preoperative and postoperative Constant-Murley scores, and postoperative Karlsson grading of the injured shoulder were compared between 2 groups. ResultsThe average operation time in Endobutton group was significantly greater than that in Anchor group (t=4.285, P=0.000); there was no significant difference in the medical device expenses between 2 groups (t=1.555, P=0.126). Primary healing of incision was obtained in all patients of 2 groups; no early complications of infection and skin necrosis occurred. All patients were followed up 15.6 months on average (range, 11-35 months). During follow-up, some loss of reduction and ectopic ossification in the coracoclavicular gap were observed in 1 case and 6 cases of Endobutton group, respectively. No recurrence of acromioclavicular joint dislocation, implant fixation loosening and broken, and secondary fractures occurred in the other patients. There was significant difference in the incidence of postoperative complications between 2 groups (P=0.013). Constant-Murley scores of the injured shoulder significantly increased at 9 months after operation when compared with preoperative values in 2 groups (P<0.05), but no significant difference was observed between 2 groups (P>0.05). At last follow-up, there was no significant difference in Karlsson grading between 2 groups (Z=-0.628, P=0.530). ConclusionBoth double Endobutton technique and suture anchor combined Endobutton plate have good effectiveness in the treatment of Tossy type Ⅲ acromioclavicular joint dislocation. But the latter is associated with easier operation, less operation time, and less complications.
ObjectiveTo investigate the effectiveness of a suture bridge technique for quadriceps tendon rupture repair in uraemic patients. MethodsBetween March 2010 and September 2012, 10 uraemic patients (14 sides) with quadriceps tendon rupture were treated with the suture bridge technique. Of them, 8 were male and 2 were female, aged from 30 to 62 years (mean, 54.2 years). The duration of uremia was 3-11 years (mean, 5.5 years);the duration of quadriceps tendon rupture was 5 days to 2 months (median, 12 days). Six cases had a trauma history, and one case had diabetes. The left side was involved in 2 cases, the right side in 4 cases, and both sides in 4 cases. The active range of motion (ROM) of the knees was (115.0±8.3)°in flexion, and (72.5±21.2)°in extension. Lysholm score was 19.5±16.3. X-ray films showed downward shifting of patella. MRI revealed discontinuity between distal quadriceps tendon and upper pole of patella. ResultsThe operation time was 30-50 minutes (mean, 40.3 minutes). Primary healing of incision was obtained in all patients without complications. All patients were followed up 12-25 months (mean, 16.3 months). There was no re-rupture of quadriceps tendon or loosening of internal fixation during follow-up. At last follow-up, the active ROM of the knees was (121.0±7.9)°in flexion, showing no significant difference when compared with preoperative one (t=-2.075, P=0.058); the active ROM was (8.2±6.1)°in extension, showing significant difference when compared with preoperative one (t=11.702, P=0.000). Lysholm score was 84.6±12.4, showing significant difference when compared with preoperative score (t=-16.226, P=0.000). According to the American Knee Society score (KSS), the results were excellent in 4 sides, good in 9 sides, and fair in 1 side, and the total excellent and good rate was 92.9%. At last follow-up, the active ROM of the knee, Lysholm score, and KSS score were significantly better in young patients (<45 years) than in elder patients (≥45 years), and in patients receiving early operation (<2 weeks) than in patients receiving late operation (≥2 weeks) (P<0.05). ConclusionFor fewer traumas and early functional exercise after operation, the suture bridge technique benefits functional restoration of knee joint in uraemic patients. Operation chance and age seem to be important factors to the results. Early operation should be considered when quadriceps tendon ruptured.
ObjectiveTo summarize the surgical accidents and postoperative complications of the treatment of recurrent shoulder dislocation by suture button fixation and bone occlusion, and to provide clinical reference.MethodsThe clinical data of 16 patients with recurrent shoulder dislocation treated with modified arthroscopic Latarjet suture button fixation and bone occlusion between July 2017 and April 2023 were retrospectively analyzed. Among them, 15 were male and 1 was female. The age ranged from 16 to 45 years, with an average of 26 years. Admission examination showed the range of motion of shoulder joint was normal; the shoulder joint fear test was positive; En-face CT scan measured 10%-20% of the glenoid defects, averaging 13.4%; and MRI examination revealed bone Bankart injury. The disease duration ranged from 2 to 20 years, with an average of 7.1 years. The shoulder joint was dislocated 8- 45 times, with an average of 17.4 times, and the shoulder joint was unstable. The occurrence of surgical accidents and postoperative complications as well as corresponding measures and outcomes were recorded. Results All the incisions healed by first intention without any complications such as incision infection or vascular injury. All 16 cases were followed up for an average of 3.6 years (range, 1-7 years), and no shoulder redislocation occurred. Four types of intraoperative surgical accidents and two types of postoperative complications occurred in the early stage of implementation of the technique. Intraoperative surgical accidents included 1 case of difficulty in passing subscapular muscle through coracotomy with large size, which was treated with exchange rod or finger through subscapular muscle split; 2 cases of coracoidal process fracture, of which 1 case was treated conservatively, and the other case was sutured to the base of tendon and fixed through tunnel; 1 case of glenoid fracture occurred in the glenoid tunnel, which was fixed with knot-free anchors; the posterior loop plate fixation was abnormal in 2 cases, of which 1 case was re-fixed and the other case was renovated. Postoperative complications included coracoid bone mass displacement in 1 case, conservative biceps rehabilitation was given to avoid premature external rotation; 1 case of radial nerve injury of healthy upper limb and musculocutaneous nerve injury of affected side was given oral medication and physiotherapy. The above conditions recovered well after corresponding treatment. ConclusionSuture button fixation with bone occlusion is a safe method for the treatment of recurrent shoulder dislocation. Careful operation should be performed during coracoid interception and glenoid tunnel drilling, especially in the fixation process.
OBJECTIVE To investigate the effect of meniscus suture on meniscus healing which included healing time and healing pattern. METHODS Fourty healthy rabbits were adopted in this study. The model of meniscus injury was made by a longitudinal incision at the medial meniscus of the left knee. The rabbits were divided into two groups, the experimental group was treated by meniscus suture and the control group was unsutured. After operation, the meniscus samples were collected periodically and observed by gross, light and electronic microscope to analysis the meniscus healing. RESULTS The injured meniscus was healed gradually and completely at the sixth week in the experimental groups. More fibroblasts and less fibrocartilage cells could be observed in the healed meniscus. Oppositely, there was no meniscus healing in the control group and the edge of injured meniscus was sealed by epithelioid cells. CONCLUSION The meniscus suture can accelerate the healing process of meniscus injury. Besides, early suture make the injured meniscus correctly positioned to ensure the normal healing process.
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.