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\"Introduces the reader to what stitches are, why they might need them, and how to care for them\"-- Provided by publisher.

Both mesh and suture repair are used for the treatment of umbilical hernias, but for smaller umbilical hernias (diameter 1–4 cm) there is little evidence whether mesh repair would be beneficial. In this study we aimed to investigate whether use of a mesh was better in reducing recurrence compared with suture repair for smaller umbilical hernias. We did a randomised, double-blind, controlled multicentre trial in 12 hospitals (nine in the Netherlands, two in Germany, and one in Italy). Eligible participants were adults aged at least 18 years with a primary umbilical hernia of diameter 1–4 cm, and were randomly assigned (1:1) intraoperatively to either suture repair or mesh repair. In the first 3 years of the inclusion period, blocked randomisation (of non-specified size) was achieved by an envelope randomisation system; after this time computer-generated randomisation was introduced. Patients, investigators, and analysts were masked to the allocated treatment, and participants were stratified by hernia size (1–2 cm and >2–4 cm). At study initiation, all surgeons were invited to training sessions to ensure they used the same standardised techniques for suture repair or mesh repair. Patients underwent physical examinations at 2 weeks, and 3, 12, and 24–30 months after the operation. The primary outcome was the rate of recurrences of the umbilical hernia after 24 months assessed in the modified intention-to-treat population by physical examination and, in case of any doubt, abdominal ultrasound. This trial is registered with ClinicalTrials.gov, number NCT00789230. Between June 21, 2006, and April 16, 2014, we randomly assigned 300 patients, 150 to mesh repair and 150 to suture repair. The median follow-up was 25·1 months (IQR 15·5–33·4). After a maximum follow-up of 30 months, there were fewer recurrences in the mesh group than in the suture group (six [4%] in 146 patients vs 17 [12%] in 138 patients; 2-year actuarial estimates of recurrence 3·6% [95% CI 1·4–9·4] vs 11·4% (6·8–18·9); p=0·01, hazard ratio 0·31, 95% CI 0·12–0·80, corresponding to a number needed to treat of 12·8). The most common postoperative complications were seroma (one [<1%] in the suture group vs five [3%] in the mesh group), haematoma (two [1%] vs three [2%]), and wound infection (one [<1%] vs three [2%]). There were no anaesthetic complications or postoperative deaths. This is the first study showing high level evidence for mesh repair in patients with small hernias of diameter 1–4 cm. Hence we suggest mesh repair should be used for operations on all patients with an umbilical hernia of this size. Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.

Objectives: Full-thickness transtendinous supraspinatus tears involve a large portion of the tendon that remains attached to the footprint that often leaves insufficient medial tissue for tension free footprint restoration with traditional suture anchor repair. The aim of this study was to compare outcomes and failure rates for arthroscopic side-to-side suture repair for transtendinous tears to traditional double-row repair for more common tendon avulsions. We hypothesized poorer objective and subjective outcomes as well as higher retear rates for side-to-side suture repair. Methods: This was a retrospective cohort study of 18 consecutive patients with full-thickness transtendinous supraspinatus tears repaired with arthroscopic side-to-side sutures (Group 1) compared to 36 matched controls with classic tendon avulsion from the footprint repaired with double-row knotless transosseous equivalent (TOE) repairs (Group 2). All procedures were performed by a single surgeon with a minimum of 2 years follow-up. Demographics and prospectively collected patient reported outcomes (PROs) were collected including postoperative active range of motion (AROM), American Shoulder and Elbow Surgeons (ASES) score, Visual analog scale (VAS) for pain, and Subjective Shoulder Value (SSV). Failure defined as a symptomatic re-tear diagnosed on magnetic resonance imaging (MRI) or need for revision surgery was also determined. Preoperative tear size and Goutallier stage were recorded from MRIs. Results: There were no significant differences between Group 1 and Group 2 regarding mean follow-up (49 months vs. 52.4 months, p = 0.640) and age (68.7 ± 6.8 vs. 67.1 ± 9.6, p = 0.550). With respect to clinical outcomes and PROs, there were no differences in postoperative VAS for pain score (1 ± 1.54 vs 1.5 ± 2.1, p = 0.537), SSV score (92.2 ± 9.1 vs 87.1 ± 10.9, p = 0.086), or ASES score (90.8 ± 9.9 vs 83.1 ± 23.9, p = 0.377). No differences were identified for postoperative AROM forward flexion (153 ± 14 vs 156 ± 16, p= 0.194), external rotation (53 ± 6 vs 51 ± 9, p= 0.498) and internal rotation score (6.4 ± 1.8 vs 7.2 ± 1.2, p=0.244). There was no statistically significant difference in failure rates between cohorts (11.1% vs. 2.7%, p = 0.255). Regarding preoperative tear characteristics, fatty infiltration of the supraspinatus (1.2 ± 1 vs 1.5 ± 0.7, p= 0.307) and anteroposterior tear size were similar (21.3 ± 9.3 vs 24 ± 8, p = 0.322), although lower grades of fatty infiltration in the infraspinatus was present in Group 1 (0.3 ± 0.6 vs 1.1 ± 0.7, p < 0.001). Conclusions: Arthroscopic side-to-side suture repair for supraspinatus tears yields excellent outcomes with low failure rates comparable to tendon-to-bone double suture anchor repair for typical avulsion type tears. Retention of the large tendon stump on the greater tuberosity with side-to-side repair also allows restoration of anatomy without undue tension in this uncommon scenario.

Background Effective wound closure is critical to minimizing wound complications and withstanding the forces associated with early knee motion after TKA. Barbed sutures allow for knotless fixation, have been used successfully in other specialties, and may provide for more even distribution of tension along the length of the incision; however, data regarding unidirectional barbed sutures from randomized trials have raised important concerns about their use. Bidirectional barbed sutures offer a potential alternative, but have not been studied extensively in orthopaedic surgery. Questions/purposes Using a prospective, randomized, within-patient controlled study design I compared wound closure performed with bidirectional barbed sutures in one knee of bilateral TKAs performed under the same anesthetic with those performed with standard sutures in the other knee to determine whether the barbed suture was associated with (1) faster closure times; (2) fewer intraoperative suture issues, such as needle sticks or suture breakage, and fewer postoperative wound complications; (3) no detrimental effect on clinical outcomes, including knee ROM and Knee Society scores; and (4) lower total operative cost, considering suture material cost and operating room time savings. Methods Between 2011 and 2012, 50 consecutive patients meeting prespecified inclusion criteria with simultaneous bilateral TKAs had deep and superficial closures performed using interrupted and running standard sutures in one randomly assigned knee, and running knotless bidirectional barbed sutures in the other knee. The barbed suture is US FDA-approved for soft tissue approximation wherever absorbable sutures are appropriate. Intraoperative suture issues and the number of sutures used were recorded at the time of wound closure. Suture cost was compared between the standard and barbed sutures and measured against the operative time cost, as estimated per minute saved. Patients were followed postoperatively at 2, 6, and 12 weeks, and 1 year. Outcomes assessed included detailed operative and tourniquet time, knee ROM, Knee Society scores, postoperative complications, use of antibiotics, and any subsequent surgical interventions. These outcomes were assessed at each visit except for Knee Society scores which were collected at the 12-week and 1-year evaluations. All patients completed followups up to the final evaluation at 1 year. Results Mean wound closure time was 4.7 minutes less using barbed sutures (SD, ± 2.8; 95% CI, −5.5 to −3.7; p < 0.001), average 16.1 (SD, ± 2.2) versus 11.4 (SD, ± 2.2) minutes for the standard versus barbed suture types, respectively. Overall tourniquet time was not different at 78.7 minutes (SD, ± 11.1 minutes) versus 74.9 minutes (SD, ± 10.1 minutes), respectively (p > 0.1). There were no intraoperative clinical issues, such as provider or patient injury, using either suture. There were no needle disengagements or suture breakages with barbed-suture closure; five episodes of premature disengagement of the suture from the needle and three suture breakages were observed with standard closures (p < 0.005). There were no postoperative wound dehiscences or disruptions of the arthrotomy closure with either closure technique. Final ROM was not different with the numbers available (barbed-suture group mean, 126.7° ± 6.9° SD vs standard-suture group mean, 125.6° ± 7.0° SD; p = 0.4, 95% CI, −3.77 to 1.73) between patient groups at 1 year. There were no differences with the numbers available in 1-year Knee Society knee scores (barbed mean, 92.8 ± 6.69 SD vs standard mean, 93.3 ± 6.2 SD; p = 0.6, 95% CI, −1.97 to 3.36). Considering suture material cost against time savings in operating room time, there was a cost savings of mean USD 175 per case when using barbed suture. Conclusions In this randomized controlled trial, I found knotless bidirectional barbed suture to be more efficient in terms of closure time and lower in direct operative cost than conventional suture material, while showing no difference in terms of Knee Society knee scores, ROM, or wound appearance with the numbers available. Future studies with larger numbers will be needed to compare overall costs of care and to detect uncommon complications that might arise, although none were observed in this small series. Level of Evidence Level I, therapeutic study.

Purpose Mastering intracorporeal suturing is challenging in the evolution from conventional to laparoscopic bariatric surgery. Among various techniques competing for superiority in overcoming this hurdle, we focus on exploring the potential of barbed sutures through a meta-analysis that compares outcomes to those of conventional non-barbed sutures in bariatric surgery. Materials and Methods We conducted a comprehensive search on PubMed, Scopus, and Embase to identify studies comparing barbed sutures with non-barbed sutures in bariatric surgeries, focusing on outcomes such as operative time, suturing time, postoperative complications, and hospital stay. The statistical analysis was carried out using RStudio version 4.3.2. Heterogeneity was assessed using the Cochrane Q test and I 2 statistics. Results Incorporating data from 11 studies involving a total of 27,442 patients, including 3,516 in the barbed suture group across various bariatric surgeries, our analysis demonstrates a significant reduction in suturing time (mean difference -4.87; 95% CI -8.43 to -1.30; p  < 0.01; I 2  = 99%) associated with the use of barbed sutures. Specifically, in Roux-en-Y gastric bypass, we observed a significant decrease in operative time (mean difference -12.11; 95% CI -19.27 to -4.95; p  < 0.01; I 2  = 93%). Subgroup analyses and leave-one-out analyses consistently supported these findings. Furthermore, we found that the mean body mass index did not significantly predict the mean difference in operative time outcome. No significant differences emerged in hospital stay or postoperative complications, including leak, bleeding, stenosis, and bowel obstruction ( p  > 0.05). Conclusion Our study findings address barbed sutures as a potential alternative for laparoscopic intracorporeal suturing in bariatric surgery. Graphical Abstract

Objective Timely and complete surgical wound healing substantially affects the patient’s performance and satisfaction with surgery outcomes. Sutures and staples are two common wound closure methods in total knee arthroplasty; however, their role in reducing the rate of surgical wound infections and dehiscence in diabetic patients is unclear. Therefore, this study was conducted to investigate the rate of infection and post-closure dehiscence in wounds closed with either nylon sutures or skin staples in diabetic patients undergoing total knee arthroplasty (TKA). Methods This is a single-blind randomized clinical trial including 70 diabetic mellitus patients undergoing TKA. Patients were selected using a restricted random sampling method and haphazardly assigned to study groups using the permuted block randomization technique, including the suture-closed ( n  = 35) and staple-closed ( n  = 35) groups. The follow-up was 2 to 8 weeks after the surgery, evaluation of wound infection and dehiscence was performed. Results The present study showed that there was no significant correlation between wound infection rate (P-value = 0.254) and wound dehiscence (P-value = 0.324) with the method of wound closure (i.e., sutures or staples). However, surgical wound dehiscence revealed a significant correlation with body mass index (BMI) (P-value = 0.044), Glycosylated hemoglobin (HbA1c) (P-Value = 0.001), and fasting blood glucose (FBS) (P-Value = 0.012) in diabetic mellitus patients. Conclusion The use of the staple technique compared to suture had no difference in the rate of wound opening and infection, but from a clinical point of view, the prevalence of wound opening after TKA in patients with the suture method was higher than that of staples. Further research is needed to confirm these findings and the long-term efficacy of each method. Clinical trial registration The present study was registered at the Iranian Registry of Clinical Trails (No. IRCT20230928059543N1, Trial Id:74754, approved on 12/01/2024, https://irct.behdasht.gov.ir/user/trial/74754/view ) and conducted according to Consolidated Standards of Reporting Trials (CONSORT) guidelines.

Sutures separate the flat bones of the skull and enable coordinated growth of the brain and overlying cranium. The coronal suture is most commonly fused in monogenic craniosynostosis, yet the unique aspects of its development remain incompletely understood. To uncover the cellular diversity within the murine embryonic coronal suture, we generated single-cell transcriptomes and performed extensive expression validation. We find distinct pre-osteoblast signatures between the bone fronts and periosteum, a ligament-like population above the suture that persists into adulthood, and a chondrogenic-like population in the dura mater underlying the suture. Lineage tracing reveals an embryonic Six2 + osteoprogenitor population that contributes to the postnatal suture mesenchyme, with these progenitors being preferentially affected in a Twist1 +/−; Tcf12 +/− mouse model of Saethre-Chotzen Syndrome. This single-cell atlas provides a resource for understanding the development of the coronal suture and the mechanisms for its loss in craniosynostosis. The development of the coronal suture remains incompletely understood. Here the authors perform scRNA-seq and expression validation to uncover the cellular diversity within the murine embryonic coronal suture, thus revealing possible mechanisms for its loss in craniosynostosis.

Background To evaluate the clinical efficacy and safety of Monofix ® -PDO compared to V-Loc™ for tumor bed suturing during robotic-assisted laparoscopic partial nephrectomy (RAPN). Methods A randomized, controlled, multicenter, single-blinded trial was conducted across four tertiary institutions. Patients with T1-2 stage renal masses scheduled for RAPN were enrolled. The exclusion criteria included patients not deemed in need of bed suturing, those with a history of prior chemotherapy or immunotherapy, and those with severe systemic diseases or high bleeding tendencies. A total of 174 patients participated and were subjected to permuted block randomization (T1a vs. others), resulting in 88 patients in the V-Loc™ group and 86 in the Monofix ® -PDO group. The primary outcome was the resection bed suture time. The secondary outcomes were total suture use time, warm ischemia time, console time (for efficacy), estimated blood loss, hemoglobin change, and 90-day treatment-related adverse events (for safety). All patients were scheduled for follow-up visits for up to three months postoperatively. Results The primary outcome, resection bed suture time, did not significantly differ between the V-Loc™ and Monofix ® -PDO groups (4.8 ± 2.6 vs. 4.5 ± 2.6 min, p  = 0.531). Secondary outcomes, including total suture used time (5.3 ± 2.8 vs. 4.8 ± 2.6 min, p  = 0.289) and warm ischemic time (15.6 ± 5.5 vs. 15.4 ± 5.4 min, p  = 0.834), were comparable between the two groups. In terms of safety outcomes, changes in serum hemoglobin levels did not show significant differences on postoperative days 1, 3, and 14 ( P  = 0.537, 0.353, and 0.840, respectively). No device-related adverse events were observed during the 90-day follow-up period in either group. Conclusions Monofix ® -PDO demonstrated non-inferior to V-Loc in terms of both safety and efficacy in patients undergoing RAPN. This trial is registered on cris.nih.go.kr as KCT0006809 (Registration date: 02/19/2021).