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Khamvongsa P, Gotluru C, Stavros S, Borges J, Bonnice S. Horizontal mattress uterine closure compared to single layered lock suture in cesarean section - A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100234. [PMID: 37701631 PMCID: PMC10493498 DOI: 10.1016/j.eurox.2023.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/27/2023] [Accepted: 09/02/2023] [Indexed: 09/14/2023] Open
Abstract
Objective The objective of this study is to compare the outcomes of standard cesarean section uterine closure, single-layered running lock sutures, versus using primary horizontal mattress sutures (the K uterine closure technique). Method This study used a retrospective cohort chart review of patients undergoing elective primary and repeat cesarean section between January 2016 and August 2020 at a South Florida hospital. From 613 included patients, 176 received the K uterine closure technique completed by a triple board-certified physician. Remaining 437 patients received single-layered lock uterine closure completed by other physicians in the same hospital. Clinical, demographic, and post-operative outcomes were collected using patients' operative, post-operative, and progress notes. Results Using the data gathered, the experimental group demonstrated a greater difference between pre- and post-cesarean section hemoglobin (p < 0.027) and hematocrit (p < 0.014) compared to single-layered lock closure methods. There was a significantly lower estimated blood loss (p < 0.001), however, there was no significant difference in the average quantitative blood loss (p < 0.374). There was also a significant reduction in the length of total and postoperative hospital stay (p < 0.001), but the total operation time was significantly increased (p < 0.016). No significant difference was found in the percentage of patients using opioids as pain management during hospital stay (p < 0.431). There was no need for blood transfusion nor an increase in infectious morbidity using this method. Conclusions Using the K uterine closure technique for post-cesarean section uterine closure was a reasonable alternative for closure of hysterotomy. It led to decreased duration of hospital stay and no significant difference in quantitative blood loss. The greater difference in hemoglobin and hematocrit for the K uterine closure technique group could be explained due to the significantly greater total operation time. Although the single-layered running lock suture closure is what has been more historically performed by obstetricians for cesarean sections, this data supports the viability and efficacy of the K uterine closure technique as an equally safe, non-inferior alternative. The value of this technique for uterine closure can be confirmed with future prospective studies and potential research in reduction of uterine scar defects. Synopsis Primary horizontal mattress closure at cesarean section provides a safe alternative to single-layered lock closure and may reduce blood loss, hospital stay, and opioid use.
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Affiliation(s)
- Peter Khamvongsa
- Obstetrics and Gynecology Department, Baptist Health System, Miami, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Chitra Gotluru
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA
- University of California Davis, Obstetrics and Gynecology, Sacramento, CA, USA
| | - Sarah Stavros
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Jordana Borges
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Sabrina Bonnice
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
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Chen A, Garvey SR, Adebagbo O, Park J, Rahmani B, Chu L, Cauley RP. Novel use of interosseous absorbable mattress sutures for secondary sternal fixation: A case series. J Plast Reconstr Aesthet Surg 2023; 87:387-389. [PMID: 37939642 DOI: 10.1016/j.bjps.2023.10.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/15/2023] [Indexed: 11/10/2023]
Abstract
There is currently no consensus on the treatment of median sternotomy patients presenting secondarily with deep sternal wound infection or symptomatic sternal nonunion. We have developed a novel approach to sternal bone fixation when concerns for open wounds or microbial colonization preclude the use of permanent hardware placement: (1) sternal closure with absorbable interosseous monocortical horizontal mattress sutures followed by (2) multilayered soft tissue closure with pectoralis major advancement or turnover flaps. Benefits of this technique include: closure of retrosternal dead-space, tension offloading of the soft tissue closure, repair of transverse sternal fractures, and preservation of internal mammary artery (IMA) perforators for potential pectoralis turnover flaps. In our early experience, this technique has been successful at promoting functional sternal union - even in secondary closure of high-risk patients contraindicated for permanent hardware placement.
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Affiliation(s)
- Amy Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Shannon R Garvey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Oluwaseun Adebagbo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - John Park
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Benjamin Rahmani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Louis Chu
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ryan P Cauley
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Kim JH, Koo BK, Ku KH, Kim MS. No difference in biomechanical properties of simple, horizontal mattress, and double row repair in Bankart repair: a systematic review and meta-analysis of biomechanical studies. BMC Musculoskelet Disord 2023; 24:765. [PMID: 37759194 PMCID: PMC10536762 DOI: 10.1186/s12891-023-06864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Arthroscopic Bankart repair is the most common procedure in patients with anterior shoulder instability. Various repair techniques using suture anchors have been used to improve the strength of fixation and surgical outcomes in arthroscopic Bankart surgery. However, evidence regarding which method is superior is lacking. This systematic review and meta-analysis study was designed to compare the biomechanical results of simple versus horizontal mattress versus double-row mattress for Bankart repair. METHODS A systematic search of the MEDLINE, Embase, and Cochrane Library databases was performed to identify comparative biomechanical studies comparing the simple, horizontal mattress, and double-row techniques commonly used in Bankart repair for anterior shoulder instability. Biomechanical results included the ultimate load to failure, stiffness, cyclic displacement, and mode of failure after the ultimate load. The methodological quality was assessed based on the Quality Appraisal for Cadaveric Studies (QUACS) scale for biomechanical studies. RESULTS Six biomechanical studies comprising 125 human cadavers were included in this systematic review. In biomechanical studies comparing simple and horizontal mattress repair and biomechanical studies comparing simple and double-row repair, there were no significant differences in the ultimate load to failure, stiffness, or cyclic displacement between the repair methods. The median QUACS scale was 11.5 with a range from 10 to 12, indicating a low risk of bias. CONCLUSION There was no biomechanically significant difference between the simple, horizontal mattress, and double-row methods in Bankart repair. Clinical evidence such as prospective randomized controlled trials should be conducted to evaluate clinical outcomes according to the various repair methods. LEVEL OF EVIDENCE Systematic review, Therapeutic level IV.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Korea
| | - Bon-Ki Koo
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Korea
| | - Ki Hyeok Ku
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Korea
| | - Myung Seo Kim
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Korea.
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Connaughton AJ, Kluczynski MA, Marzo JM. Simple versus horizontal mattress suture configuration in bankart repair. J Orthop 2021; 23:225-226. [PMID: 33642819 DOI: 10.1016/j.jor.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/31/2021] [Indexed: 11/25/2022] Open
Abstract
The purpose of this article was to compare the anatomy and biomechanics of different suture repair configurations for arthroscopic Bankart lesion repair. The horizontal mattress technique improves the restoration of labral height and decreases capsular strain in comparison to simple suture repairs. Further research examining the clinical outcomes of horizontal mattress suture technique is required for comparison with simple suture arthroscopic Bankart repairs.
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Affiliation(s)
- Alexander J Connaughton
- Jacobs School of Medicine and Biomedical Sciences, Department of Orthopaedics and Sports Medicine, University at Buffalo, Room 7156, 955 Main St., Buffalo, NY, 14214, USA
| | - Melissa A Kluczynski
- Jacobs School of Medicine and Biomedical Sciences, Department of Orthopaedics and Sports Medicine, University at Buffalo, Room 7156, 955 Main St., Buffalo, NY, 14214, USA
| | - John M Marzo
- Jacobs School of Medicine and Biomedical Sciences, Department of Orthopaedics and Sports Medicine, University at Buffalo, Room 7156, 955 Main St., Buffalo, NY, 14214, USA
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Yang HJ, Yoon K, Jin H, Song HS. Clinical outcome of arthroscopic SLAP repair: conventional vertical knot versus knotless horizontal mattress sutures. Knee Surg Sports Traumatol Arthrosc 2016; 24:464-9. [PMID: 25427975 DOI: 10.1007/s00167-014-3449-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 11/17/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Arthroscopic repair of type II superior labrum anterior to posterior (SLAP) tears yields variable results. In this study, the clinical outcomes of arthroscopic knotless horizontal mattress repair were compared to those of conventional vertical knot repair. METHODS Forty-six patients treated arthroscopically for isolated SLAP lesions were assessed. Forty-one of those patients underwent follow-up evaluations for a minimum of 2 years: 21 received vertical knot (group 1), while 20 received horizontal mattress (group 2). In group 1, an anchor was inserted at the superior glenoid. After relaying the sutures, knotting over the labral tissue was performed. In group 2, two strands were passed through the labrum and fixed into the glenoid with a bioabsorbable knotless anchor. Functional scores were evaluated preoperatively and at the final follow-up assessment. A visual analogue scale (VAS) for pain and range of motion (ROM) were assessed preoperatively, 2 months postoperatively and at the last follow-up visit. RESULTS There were no significant differences in functional scores between groups (n.s.). However, external rotation at the side, internal rotation at abduction and total ROM were better in group 2 at the last follow-up visit. At 2 months postoperatively, the VAS for pain and ROM of internal rotation at abduction were better in group 2. CONCLUSION At the final assessment, there were no significant differences in functional scores between the two groups. However, external rotation at the side, internal rotation at abduction and total ROM were better in group 2. LEVEL OF EVIDENCE Case-control study, Level III.
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Abstract
OBJECTIVE To evaluate the horizontal mattress technique in microvascular anastomosis for size-mismatched vessels. METHODS The present study involved cadaveric simulation using size-mismatched (1.5:1) Thiel-embalmed cadaveric arteries. The authors performed horizontal mattress anastomoses using 9-0 nylon suture and recorded the procedure. Vessel patency was evaluated by saline infusion. Vessels were cut open and photographed; histological slides were prepared and stained with hematoxylin and eosin. RESULTS Four anastomoses were performed. Vessels were found to be patent in all cases, with grade 0 leaks. Intima-on-intima apposition with no intraluminal exposure of muscularis nor adventitia were observed. CONCLUSION The present cadaveric study supports the technical feasibility of using horizontal mattress sutures in size-mismatched end-toend anastomoses.
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Affiliation(s)
| | - Sami P Moubayed
- Otolaryngology-Head and Neck Surgery Service, Notre-Dame Hospital, University of Montréal Hospital Center (CHUM)
| | - Eugene Daniels
- Department of Anatomy, McGill University, Montreal, Quebec
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Odobescu A, Moubayed SP, Harris PG, Bou-Merhi J, Daniels E, Danino MA. A new microsurgical research model using Thiel-embalmed arteries and comparison of two suture techniques. J Plast Reconstr Aesthet Surg 2013; 67:389-95. [PMID: 24507964 DOI: 10.1016/j.bjps.2013.12.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 12/20/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the utility of the Thiel arterial model in microsurgical research, we compared interrupted horizontal mattress (HM) sutures to simple interrupted (SI) sutures in human vessels. METHODS A microsurgical set-up using an operating microscope and Thiel-embalmed arteries was used to practice ten SI and HM anastomoses. Vessel patency, leak and stricture were evaluated using angiography, and vessel wall architecture was evaluated using light microscopy and scanning electron microscopy (SEM). The technique speed was also assessed. RESULTS We have successfully evaluated all outcomes. All anastomoses were patent. The stricture rate was higher with HM than with SI (60% vs. 35% surface area reduction). Three minor leaks occurred with HM sutures versus one with SI sutures. Edges were evenly everted without any intimal flaps with HM compared to SI. The anastomoses were performed faster using HM than SI sutures (7:58 min vs. 12:41 min, respectively). CONCLUSION This is the first study to evaluate the feasibility of a Thiel-embalmed artery model for research purposes. The HM microvascular suture is a promising technique that requires further in vivo validation.
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Affiliation(s)
- Andrei Odobescu
- Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Sami P Moubayed
- Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Patrick G Harris
- Plastic and Reconstructive Surgery Service, Department of Surgery, Notre-Dame Hospital, University of Montréal Hospital Center (CHUM), Montreal, QC, Canada
| | - Joseph Bou-Merhi
- Plastic and Reconstructive Surgery Service, Department of Surgery, Notre-Dame Hospital, University of Montréal Hospital Center (CHUM), Montreal, QC, Canada
| | - Eugene Daniels
- Department of Anatomy and Cell Biology, McGill University, Montreal, QC, Canada
| | - Michel Alain Danino
- Plastic and Reconstructive Surgery Service, Department of Surgery, Notre-Dame Hospital, University of Montréal Hospital Center (CHUM), Montreal, QC, Canada.
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