Impact of Needle Design and Suture Gauge on Tissue Tearing During Skin Suturing: A Comparative Analysis.

Surgeons face numerous choices in selecting sutures for skin closure, with potential adverse effects such as tissue tearing. To investigate the influence of needle design and suture gauge on tissue tearing during suturing procedures. The authors tested the tear-through force in Newtons for 3 needle types and 3 suture gauges using an artificial skin model and a professional-grade tensiometer. Suture material was secured into the skin model, and force was applied to the suture at a constant rate, resulting in tearing. Force-displacement and force-time curves were generated. Evaluation included conventional cutting (PC-3), reverse cutting (PS-3), and taper point (BB) needles with a 5-0 polypropylene suture. In addition, nylon sutures with a reverse cutting needle (PS-2) were tested at 3 suture gauges (5-0, 4-0, 3-0). The mean tear-through forces for PC-3, PS-3, and BB were 3.26 N, 3.75 N, and 4.07 N, respectively. For the 5-0, 4-0, and 3-0 nylon sutures, the mean tear-through forces were 3.44 N, 3.81 N, and 4.04 N, respectively. Statistical analysis revealed a significant impact of suture gauge size ( p < .001) and needle geometry ( p < .001) on tear-through force. Larger suture diameter and taper needles minimize tissue tearing.

Potter CT ，Maloney ME ，Riopelle AM ，Fudem GM ，Schanbacher CF ... -  《-》

Comparative Analysis of Taper Point and Reverse Cutting Needles on Skin Puncture Force.

Maloney ME ，Potter CT ，Chun BD ，Montilla RD ，Schanbacher CF ... -  《-》

Repair of Acute Grade-3 Combined Posterolateral Corner Avulsion Injuries Using a Transosseous Krackow Suture Pull-Through Technique.

For complete disruption of the posterolateral corner (PLC) structures, operative treatment is most commonly advocated, as nonoperative treatment has higher rates of persistent lateral laxity and posttraumatic arthritis1-5. Some studies have shown that acute direct repair results in revision rates upwards of 37% to 40% compared with 6% to 9% for initial reconstruction3,6. In a recent study assessing the outcomes of acute repair of PLC avulsion injuries with 2 to 7 years of follow-up, patients with adequate tissue were shown to have a much lower failure rate than previously documented7. In the present video article, we demonstrate a transosseous Krackow pull-through technique for repair of acute avulsion-type PLC multiligamentous knee injuries with no midsubstance injury. An incision is made along the lateral aspect of the knee from the epicondyle to the fibular shaft. The soft-tissue avulsion injury is identified and tagged with suture. Locking Krackow sutures are placed into the injured structures without separating the soft-tissue sleeve avulsion. With fibular avulsions, fibular and tibial transosseous tunnels are drilled with 2 Beath pins through the fibular head and tibia, exiting through the anteromedial tibial cortex. Lateral collateral ligament (LCL) and anterior biceps sutures are passed through the anterior tunnel, and popliteofibular ligament (PFL) and posterior biceps sutures are passed through the posterior tunnel. A small incision is made over the anteromedial tibial cortex in order to tie the sutures over the same metallic button. In fibular head avulsion fractures, high-strength suture placed through the fibular neck can provide additional compression. For proximal PLC injuries, the iliotibial band is incised at the lateral epicondyle, and the proximal attachment sites of the LCL and popliteus are localized. Krackow locking sutures are placed within the LCL and popliteus tendon. Transosseous tunnels are drilled with Beath pins through the native attachment sites of the LCL and popliteus on the lateral condyle and are directed anteriorly to avoid convergence with a potential anterior cruciate ligament (ACL) femoral tunnel. Sutures are pulled through the femoral attachment sites and tied over the same metallic button. For acute PLC injuries, nonoperative treatment is not endorsed for the majority of cases. Surgical options include direct repair, repair with augmentation, or reconstruction. The transosseous Krackow pull-through technique allows for an enhanced and secure soft-tissue repair while avoiding suture anchor pull-out from the metaphyseal fibular head bone, which can also be compromised by cortical avulsion fractures. This procedure avoids the cost of an allograft and the donor-site morbidity of an autograft that are associated with a reconstruction. For patients with midsubstance tears, chronic injuries, and/or inadequate tissue quality, reconstructions or augmentations are more appropriate. According to Moran et al., this technique can result in a similar failure rate (10.7%) to initial reconstruction and a far lower failure rate than seen in other PLC repair techniques8. The present technique has a comparatively more reliable fixation method, as the suture is secured to dense tibial cortical bone, avoiding the suture anchor dislodgement that can occur with solely fibular fixation8. This is advantageous when the fibular bone is fragile or fractured. Suture pull-out may be further prevented with multiple locking Krackow sutures. At a mean follow-up of 2 years (range, 3 to 90 months), Moran et al. reported a failure rate of 10.7%, which was significantly lower than the failure rate of 38% reported in a 2016 systematic review of PLC repairs8,9. On clinical examination, the procedure yielded a significant decrease in lateral compartment opening, from 9 mm preoperatively to 0 mm postoperatively8. For distal PLC injuries, perform a peroneal neurolysis to identify and decompress the peroneal nerve.Carefully evaluate the soft tissue proximal to the avulsed portion to determine if any midsubstance tearing is present. PLC = posterolateral cornerLCL = lateral collateral ligamentPFL = popliteofibular ligamentACL = anterior cruciate ligamentALL = anterolateral ligamentMRI = magnetic resonance imagingAM = anteromedialPCL = posterior cruciate ligamentFU = follow-upPROM = patient-reported outcome measureTDWB = touch-down weight-bearing.

Park N ，Medvecky H ，Moran J ，Medvecky MJ ... -  《-》

A Novel Custom Bent 27-Gauge Needle-Guided Suture Snare Technique for Scleral Fixation of Posterior Chamber Intraocular Lenses.

To describe a custom bent 27-gauge needle-guided suture snare technique for scleral fixation of posterior chamber intraocular lenses (PCIOL). An 8-0 polypropylene suture was threaded into the lumen of a custom bent 27-gauge needle, and the needle tip was advanced into the eye from the intraocular lens (IOL) fixation point. The suture was threaded through the posterior limbal incision inside the IOL haptic loop and pulled out. The needle tip was advanced into the eye again, going around the IOL haptic loop through the same limbal incision. The suture was threaded in again, and the needle was withdrawn from the eye, completing fixation of the IOL haptic loop. The suture knot was buried in the stroma of the sclera. The technique was performed in 10 eyes of 10 patients, with a preoperative logarithm of the minimum resolution angle-corrected visual acuity of 0.73 ± 0.55 (Snellen 20/107), improvement of 0.24 ± 0.27 (Snellen 20/35) at the final follow-up visit, and a mean postoperative PCIOL tilt of 2.78 ± 1.32°. There were no cases of pupillary capture or suture-related complications during follow-up. The curved needle-guided suture snare technique provides a simple minimally invasive method of scleral suture fixation of PCIOL.

Chen C ，Shao Y ，Zhong H ，Qin C ，Liu Z ，Sun W ，Li M ... -  《-》

Comparison of surgical wound infection and dehiscence following the use of two methods of nylon sutures and skin staples in staples in diabetic mellitus patients undergoing total knee arthroplasty surgery: a randomized clinical trial study.

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). 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. 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. 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. 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.

Rahbari H ，Ahmadi M ，Doreh MA ，Mahmoudi S ，Ghaemmaghami P ，Fereidouni A ... -  《-》