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.
Objective To compare the efficacy of incision healing by abdominal wall closure measure without suturing subcutaneous fat layer and the traditional abdominal wall closure measure. Methods Four hundreds patients underwent operation of abdominal median incision and abdominal paramedian incision from Sep. 2010 to Sep. 2012 in our department were randomly assigned to observation group （n=199） and control group （n=201）. The patients in obser- vation group underwent abdominal wall closure measure without suturing subcutaneous fat layer， and those of control group were subjected to abdominal wall closure by traditional layer suture technique. Comparison of efficacy of incision healing in the 2 groups was performed. Results The incidences of fat liquefication 〔1 （0.5%） vs.18 （9.0%）〕， incision swelling 〔3 （1.5%） vs.16 （8.0%）〕， incision induration 〔1 （0.5%） vs.15 （7.5%）〕， and dehiscence of wound 〔0 （0） vs.9 （4.5%）〕 in observation group were significantly lower than those of control group （P＜0.01）， but there was no significant difference in incidence of subcutaneous hematoma 〔2 （1.0%） vs.0 （0）， P＞0.05〕. The rate of primary healing in obser-vation group was significantly higher than those of control group 〔199 （100%） vs.186 （92.5%）， P＜0.01〕. Duration of abdominal closure 〔（13.0±1.6） min vs.（18.0±2.2） min〕 and postoperative hospital stay 〔（7.7±1.3） days vs.（9.6±1.9） days〕 were all shorter than those of control group （P＜0.01）. Conclusion The abdominal wall closure measure without suturing subcutaneous fat layer is obviously more effective to the traditional layer suture technique， which is a suture way worthy to spread.
Objective To establish chronic hindlimb ischemia model with suture-occluded method in rats， and then compare the effects of chronic hindlimb ischemia model with acute ischemia model. Methods Models of chronic hindlimb ischemia were established by using suture-occluded femoral artery method. The laser Doppler blood flow analysis and angiography were performed on day 7， 14， 28， 42， and 49 after operation， and then the rats were sacrificed after angiography， respectively， the quadriceps and gastrocnemius of contralateral and ipsilateral （surgical side） were gotten， which were tested by HE staining and α-actin immunohistochemistry staining， and then calculate arteriolar density. Results There were no lameness and limb necrosis after operation in chronic hindlimb ischemia models. Laser Doppler analysis found that chronic hindlimb ischemia models were still maintained in ischemia state on day 49 after operation compared with acute ischemic models. The resluts of HE staining showed no acute necrosis and muscle fibrosis in chronic hindlimb ischemia model group. Chronic hindlimb ischemia models after operation did not appear obvious lameness and limb necrosis. The arteriolar density of quadriceps femoris on day 7 after operation in chronic hindlimb ischemia models were less than that in acute hindlimb ischemia models （0.015 2 vs. 0.036 4）. Conclusions Compared with the commonly used acute ischemic models， the duration of arterial limb ischemia in chronic hindlimb ischemia rats， which were established by suture-occluded method， is longer and less likely to be affected by the compensatory mechanisms. So suture-occluded method can provide a new animal hindlimb ischemia model for further study of ischemia angiogenesis mechanism and treatment of severe lower extremity ischemia.
Objective To analyze the short-term effectiveness of repairing musculus extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) tendon using suture anchor after debridement of extensor tendon insertion for recalcitrant lateral epicondylitis. Methods Between March 2009 and May 2011, 10 patients (10 elbows) with recalcitrant lateral epicondylitis received repair of the ECRB and EDC tendon to the lateral epicondyle using a single suture anchor after debridement of extensor tendon insertion. There were 6 males and 4 females with an average age of 45.4 years (range, 36-57 years). The dominant elbow was involved in 8 patients and nondominant elbow in 2 patients; there were 4 manual workers and 6 ordinary workers. The disease duration ranged from 8 to 24 months (mean, 12.3 months). All patients had epicondylus lateralis humeri pain, local swelling and tenderness, and positive Mill sign. The average elbow range of motion (ROM) was 11.3°(range, 0-30°) in extension and was 132.5°(range, 120-145°) in flexion. Preoperative MRI showed external humeral epicondylitis in all patients. ResultsPrimary wound healing was obtained in all patients without complications of infection, leakage of joint fluid, and stiffness of elbow. Ten patients were followed up 4 to 23 months with an average of 12 months (more than 12 months in 7 cases). The time to return to work was (3.75 ± 0.95) months for manual workers and was (2.91 ± 0.20) months for ordinary workers, showing no significant difference (t=1.715, P=0.180). Compared with preoperation, the mean visual analogue scale (VAS) score significantly decreased (P lt; 0.05), and Mayo score and the grip strength of dominant and nondominant significantly increased (P lt; 0.05), but no significant difference was found when compared with non-surgical side at last follow-up (P gt; 0.05). At last follow-up, the average ROM was —1.5° (range, 0-—10°) in extension and was 150.5°(range, 140-160°) in flexion. ConclusionTo suture anchor for repairing the ECRB and EDC after debridement is a satisfactory procedure to treat recalcitrant lateral epicondylitis. It can effectively prevent loss of the forearm extensor strength, relieve the pain, recover the grip strength, and obtain good results.
Objective To investigate the methods and effectiveness of surgical treatment for posteromedial corner (PMC) injury combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) ruptures. Methods Between February 2009 and February 2012, 15 patients (15 knees) with PMC injury combined with ACL and PCL ruptures underwent PMC repair with suture anchor and ACL and PCL reconstruction. There were 7 males and 8 females with an average age of 39 years (range, 15-59 years). The causes of injury were traffic accident injury in 6 cases, sport injury in 7 cases, and sprain injury in 2 cases. The disease duration was 3-15 days with an average of 7 days. All patients presented positive results of anterior drawer test, posterior drawer test and valgus stress test, and dysfunction of knee joint. Of 15 cases, 3 had ACL and PCL ruptures, 5 had ACL rupture, 3 had ACL injury at the attachment point of the condyles crest, and 4 had PCL rupture; 9 had PMC tear at the femur insertion, 5 had PMC tear at the tibia insertion, and 1 had PMC tear in the body area. Results All incisions healed by first intention with no complication of infection or stiffness of knee. All cases were followed up 18.4 months on average (range, 10-36 months). At last follow-up, 14 cases had normal knee flexion and extension ranges, but 1 case had 10° limitation of the knee extension. Except 1 case which had weakly positive valgus stress test, the other patients showed negative results of anterior drawer test, posterior drawer test, and valgus stress test. Based on the improved Lysholm classification standard, the results were excellent in 8 cases, good in 5 cases, and fair in 2 cases; the excellent and good rate was 86.7%. Conclusion Early repair of the PMC and reasonable reconstruction of cruciate ligament can effectively restore the knee stability for patients with PMC injury combined with ACL and PCL ruptures.
Objective To introduce the arthroscopic technique of figure-of-eight suture fixation for tibial eminence fracture, and to report its clinical results. Methods From January 1998 to June 2001, 21 cases of tibial eminence fracture were treated arthroscopically with figure-of-eight suture fixation technique. Active rehabilitation began one week after operation. The patients were followed up 6-24 months. The reduction and union of fracture, knee laxity, range ofmotion, and total knee function were evaluated. Results All fracture healed without displacement six weeks after operation. Three months postoperatively, no knee laxity or instability was detected in all patients; full range of motion of the affected knee returned in all patients when compared with the normal side. Six months postoperatively, the Lysholm knee score was 93.4±2.7. Conclusion Arthroscopic treatment of tibial eminence fracture with figure-of-eight suture fixation technique is reliable for fracture reduction , fixation and early mobilization. Arthroscopy is conducive to diagnoses and treatment of associated knee arthropathy, reduces the morbidity associated with arthrotomy, and restores knee function to the greatest extent when combined with figure-of-eight suture fixationtechniques.
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.
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.