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219 results for

Horizontal Mattress Suture

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141. Tube Thoracostomy

. For securing sutures, two separate through-and-through, simple, interrupted stitches on each side of the chest tube are recommended. This technique ensures tight closure of the skin incision and prevents routine patient movements from dislodging the chest tube. Each stitch should be tightly tied to the skin, then wrapped tightly around the chest tube several times to cause slight indentation, and then tied again. Sealing suture: A central vertical mattress stitch with ends left long and knotted together (...) source and tubing Sterile gloves Preparatory solution Sterile drapes Surgical marker Lidocaine 1% with epinephrine Syringes, 10-20 mL (2) Needle, 25 gauge (ga), 5/8 in Needle, 23 ga, 1.5 in; or 27 ga, 1.5 in; for instilling local anesthesia Blade, No. 10, on a handle Large and medium Kelly clamps Large curved Mayo scissors Large straight suture scissors Silk or nylon suture, 0 or 1-0 Needle driver Vaseline gauze Gauze squares, 4 x 4 in (10) Sterile adhesive tape, 4 in wide Chest tube of appropriate

2014 eMedicine.com

142. Extensor Tendon Repair

to TIII extensor tendon repairs. J Hand Surg Am . 2012 May. 37(5):933-7. . Dy CJ, Rosenblatt L, Lee SK. Current methods and biomechanics of extensor tendon repairs. Hand Clin . 2013 May. 29(2):261-8. . Altobelli GG, Conneely S, Haufler C, Walsh M, Ruchelsman DE. Outcomes of digital zone IV and V and thumb zone TI to TIV extensor tendon repairs using a running interlocking horizontal mattress technique. J Hand Surg Am . 2013 Jun. 38(6):1079-83. . Feuvrier D, Loisel F, Pauchot J, Obert L. Emergency (...) , then irrigate and debride the wound, approximating the skin loosely with interrupted sutures, and place the hand in a volar resting extension splint. [ ] Ideally, lesions proximal to zone 6 should be treated in an OR; such injuries tend to require significant exposure of the tissues for appropriate reapproximation of the tendon. [ ] Previous Next: Contraindications Extensor tendon repair should not be attempted in the ED or acute care setting in any of the following circumstances: Unavailability

2014 eMedicine.com

143. Emergency Bedside Thoracotomy

mattress sutures, horizontal mattress sutures, or continuous running sutures. Nonabsorbable sutures, such as polypropylene or nylon, and even staple guns may be used. [ ] The coronary arteries must not be compromised during repair; this is usually accomplished with mattress sutures. Cardiac exsanguination may be temporized by placing a Foley catheter inside the wound, inflating the catheter balloon, and then withdrawing the catheter to occlude the defect. Clamp the catheter to prevent exsanguination (...) shears or saw (eg, Gigli) To control hemorrhage and repair injury See the list below: Tissue/tooth forceps Satinsky vascular clamps (large and small) Long and short needle holders (eg, Hegar) Nonabsorbable sutures (silk), 2-0 or larger, on large round-body needle Cardiovascular Ethibond sutures, 3-0 Teflon pledgets plus polypropylene or large braided sutures Suture scissors Aortic clamp instrument Kelly clamp Skin stapler High-volume suction device Laparotomy packs Tonsil clamps Foley catheter, 20F

2014 eMedicine.com

144. Ebstein Malformation: Surgical Perspective (Follow-up)

, closure of the atrial septal defect, and right atrial reduction. [ ] The Danielson repair is depicted in the image below. Surgical repair of Ebstein anomaly as described by Danielson. (A) The right atrium is incised and reduced, and the atrial septal defect is closed with a patch. The arrow identifies the large anterior leaflet. (B) Mattress sutures with felt pledgets are used to pull the tricuspid annulus and valve together in a horizontal plane, obliterating the atrialized right ventricle. (C (...) into the right ventricle outflow tract (insert). Mattress sutures with pledgets are placed in a vertical plane to plicate the atrialized portion of the right ventricle (top right). The anterior leaflet is reattached at the level of the true annulus with a continuous running suture (bottom left). An annuloplasty ring is inserted to reinforce the repair (bottom right). This repair creates a bileaflet valve with the relocated posterior leaflet and septal leaflet serving as one leaflet to coapt with the anterior

2014 eMedicine Pediatrics

145. Atrioventricular Septal Defect: Surgical Perspective (Treatment)

and IBL. Place interrupted horizontal mattress sutures through the crest of the VSD patch and then the SBL and IBL (see the image below). Two-patch technique. Interrupted horizontal mattress sutures are placed through the crest of the ventricular septal defect (VSD) patch and the inferior and superior bridging leaflets, dividing the common atrioventricular (AV) valve into right and left components. Pass these same sutures through the edge of the autologous pericardial patch for the closure of the ASD (...) . A patch of polytetrafluoroethylene (Gore-Tex) is fashioned and secured along the crest of the ventricular septal defect. Two-patch technique. Interrupted horizontal mattress sutures are placed through the crest of the ventricular septal defect (VSD) patch and the inferior and superior bridging leaflets, dividing the common atrioventricular (AV) valve into right and left components. Two-patch technique. The pericardial patch is secured to the crest of the prosthetic ventricular septum with the superior

2014 eMedicine Pediatrics

146. Atrioventricular Septal Defect: Surgical Perspective (Overview)

are identified and marked with fine polypropylene sutures. Two-patch technique. A patch of polytetrafluoroethylene (Gore-Tex) is fashioned and secured along the crest of the ventricular septal defect. Two-patch technique. Interrupted horizontal mattress sutures are placed through the crest of the ventricular septal defect (VSD) patch and the inferior and superior bridging leaflets, dividing the common atrioventricular (AV) valve into right and left components. Two-patch technique. The pericardial patch (...) . The LV outflow tract is elongated and horizontally oriented. According to Studer et al and Piccoli et al, although frequently narrow, the LV outflow tract causes obstruction in only 4-7% of individuals with AVSDs. [ , ] Ventricular balance Both left and right AV valves may equally share the common AV valve orifice. This arrangement is termed a balanced defect. Occasionally, the orifice may favor the right AV valve (right dominance) or the left AV valve (left dominance). In marked right dominance

2014 eMedicine Pediatrics

147. Ebstein Malformation: Surgical Perspective (Treatment)

, closure of the atrial septal defect, and right atrial reduction. [ ] The Danielson repair is depicted in the image below. Surgical repair of Ebstein anomaly as described by Danielson. (A) The right atrium is incised and reduced, and the atrial septal defect is closed with a patch. The arrow identifies the large anterior leaflet. (B) Mattress sutures with felt pledgets are used to pull the tricuspid annulus and valve together in a horizontal plane, obliterating the atrialized right ventricle. (C (...) into the right ventricle outflow tract (insert). Mattress sutures with pledgets are placed in a vertical plane to plicate the atrialized portion of the right ventricle (top right). The anterior leaflet is reattached at the level of the true annulus with a continuous running suture (bottom left). An annuloplasty ring is inserted to reinforce the repair (bottom right). This repair creates a bileaflet valve with the relocated posterior leaflet and septal leaflet serving as one leaflet to coapt with the anterior

2014 eMedicine Pediatrics

148. Atrioventricular Septal Defect: Surgical Perspective (Follow-up)

and IBL. Place interrupted horizontal mattress sutures through the crest of the VSD patch and then the SBL and IBL (see the image below). Two-patch technique. Interrupted horizontal mattress sutures are placed through the crest of the ventricular septal defect (VSD) patch and the inferior and superior bridging leaflets, dividing the common atrioventricular (AV) valve into right and left components. Pass these same sutures through the edge of the autologous pericardial patch for the closure of the ASD (...) . A patch of polytetrafluoroethylene (Gore-Tex) is fashioned and secured along the crest of the ventricular septal defect. Two-patch technique. Interrupted horizontal mattress sutures are placed through the crest of the ventricular septal defect (VSD) patch and the inferior and superior bridging leaflets, dividing the common atrioventricular (AV) valve into right and left components. Two-patch technique. The pericardial patch is secured to the crest of the prosthetic ventricular septum with the superior

2014 eMedicine Pediatrics

149. Atrioventricular Septal Defect: Surgical Perspective (Diagnosis)

are identified and marked with fine polypropylene sutures. Two-patch technique. A patch of polytetrafluoroethylene (Gore-Tex) is fashioned and secured along the crest of the ventricular septal defect. Two-patch technique. Interrupted horizontal mattress sutures are placed through the crest of the ventricular septal defect (VSD) patch and the inferior and superior bridging leaflets, dividing the common atrioventricular (AV) valve into right and left components. Two-patch technique. The pericardial patch (...) . The LV outflow tract is elongated and horizontally oriented. According to Studer et al and Piccoli et al, although frequently narrow, the LV outflow tract causes obstruction in only 4-7% of individuals with AVSDs. [ , ] Ventricular balance Both left and right AV valves may equally share the common AV valve orifice. This arrangement is termed a balanced defect. Occasionally, the orifice may favor the right AV valve (right dominance) or the left AV valve (left dominance). In marked right dominance

2014 eMedicine Pediatrics

150. Posterior Glenohumeral Instability (Treatment)

described the reverse Bankart procedure in two patients, using drill holes placed through the glenoid rim to the medial bone and then securing the capsular flap with mattress sutures. [ ] In both of the cases described, the patient regained normal function. Reverse Putti-Platt repair The reverse Putti-Platt procedure was originally described by Severin, [ ] who shortened the infraspinatus only, and DePalma, [ ] who shortened the infraspinatus and the teres minor together. A subsequent report (...) the deltoid in line with its fibers, followed by dissection of the infraspinatus/teres minor interval. A horizontal incision is then made in the capsule to expose the joint. A Fukuda retractor is inserted to retract the humeral head and expose the posterior glenoid rim. Suture anchors are inserted into the glenoid rim. The sutures are used to perform the capsulorrhaphy and are then tied. Completion of the procedure demonstrates significant reduction of the posterior capsular redundancy. Posterior

2014 eMedicine Surgery

151. Flexor Tendon Lacerations (Treatment)

MGH suture Indianapolis four-strand suture An eight-strand cross-locked cruciate repair using 4-0 caliber double-stranded suture has also been described. [ ] Peripheral tendon (epitendinous) suture techniques are as follows: Simple running suture [ ] Running lock loop suture (Lin) Cross-stitch epitendinous repair technique (Silfverskiold) Halsted continuous horizontal mattress suture (Wade) Horizontal mattress intrafiber suture (Mashadi and Amis) A dorsal splint is recommended to keep the wrist (...) The Indianapolis protocol is indicated for patients with four-strand Tajima and horizontal mattress repair with an additional peripheral epitendinous suture. Patients should be motivated and understanding. Digits should have minimal or moderate edema and minimal wound complications. Two splints are used, the traditional dorsal-blocking splint—with the wrist at 20-30° of flexion, MCP joints in 50° of flexion, and IP joints in neutral—and the Strickland tenodesis splint. The latter allows full wrist flexion

2014 eMedicine Surgery

152. Lisfranc Fracture Dislocation (Treatment)

and the Lisfranc screw. Because no real tissue layers are present at this level of the foot, wound closure can be accomplished with an absorbable suture to close joint capsules and a nonabsorbable suture in using a vertical or horizontal mattress technique to close the skin. Plate fixation The approach and initial fracture reduction for plate fixation are similar to those for screw fixation. Once the reduction has been achieved, the dorsal plate can be applied. Typically, this procedure is used for comminuted (...) that bioabsorbable screws are safe and that they eliminate the need for screw removal. Larger studies with long-term follow-up are needed to determine the true efficacy. [ ] Suture button fixation Several papers have addressed the use of suture button fixation in Lisfranc injuries with the hope of allowing some physiologic motion and to avoid putting screws across the articular cartilage of the first cuneiform and the second MT. Ahmed et al [ ] did a cadaveric study that showed more displacement with suture

2014 eMedicine Surgery

153. Diaphragmatic Hernias, Acquired (Treatment)

with monofilament permanent sutures. Small lacerations may be repaired by using interrupted, horizontal mattress, or figure-eight stitches; larger lacerations may be repaired with continuous or double-layered closures. Absorbable sutures are associated with a high rate of recurrence. [ ] There is some limited evidence to suggest that the use of biologic mesh in traumatic diaphragmatic repair may be feasible, at least in chronic cases. [ ] Laparoscopic abdominal exploration in the setting of trauma has become

2014 eMedicine Surgery

154. Epilepsy Surgery (Treatment)

the skin with a foreign body in place is difficult, and CSF leaks are not uncommon. Because of this, the dressing is changed as often as needed. Some authors suggest placing a cable-retaining suture in the scalp, [ , ] both to attempt to secure the electrode and to decrease CSF leakage. The lead author has not found this to be helpful in decreasing CSF leakage, and all electrode companies manufacture quick-release connectors designed to break apart easily if tugged. Patients are monitored (...) is determined based on data gathered during the preoperative evaluation; usually, a large craniotomy is performed to accommodate up to an 8 × 8-cm grid. Prophylactic antibiotics and dexamethasone are routinely administered. Mannitol is not used unless necessary, because the putative space created by a fluid shift could adversely contribute to hematoma formation after closure. Once placed, the grid is sutured to the dura to prevent motion. Often, 1 or more strip electrodes are added to sample adjacent areas

2014 eMedicine Surgery

155. Triangular Fibrocartilage Complex Injuries (Overview)

with double three-dimensional mattress suturing technique. Tech Hand Up Extrem Surg . 2004 Jun. 8 (2):116-23. . Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res . 1984 Jul-Aug. 26-35. . Adams BD. Partial excision of the triangular fibrocartilage complex articular disk: a biomechanical study. J Hand Surg Am . 1993 Mar. 18 (2):334-40. . Tang JB, Ryu J, Kish V. The triangular fibrocartilage complex: an important component of the pulley for the ulnar wrist extensor. J (...) that the percentage of axial force transmitted through the ulna decreases by sequential removal of the horizontal portion of the TFCC. [ ] This percentage decrease is accentuated with more positive ulnar variance. In a cadaver study, Adams demonstrated that no significant kinematic or structural changes resulted from an excision that did not violate the peripheral 2 mm of the disk and that constituted less than two thirds of the disk area. [ ] TFCC tears are associated with a positive ulnar variance. Ulnar

2014 eMedicine Surgery

156. Nailbed Injuries (Follow-up)

as a stent and held in position by 5-0 or smaller nylon sutures placed by one or a combination of the techniques below: Distally through the hyponychium and the nail. Through the nail and proximal to the nail fold. [ ] Through a half-buried horizontal mattress suture placed down proximal to the nail fold into proximal nail then back out the nail fold. Through the paronychia and nail bilaterally. As a dorsal figure-of-eight suture [ ] - A suture is placed transversely just distal to the hyponychium (...) as it is removed. Care must again be taken to avoid further damage to the underlying nailbed or overlying nail fold. Once the nail is sufficiently separated from the nailbed, it is gently removed by applying firm and steady distal traction using a hemostat. Lacerations to the nailbed should be repaired using 6-0 or smaller absorbable sutures. Minimal to no debridement should be performed because aggressive debridement may cause undue tension on the repair and results in scarring. When repairing avulsed nails

2014 eMedicine Emergency Medicine

157. Ebstein Malformation: Surgical Perspective (Overview)

demonstrates cardiomegaly, with evidence of severe right atrial enlargement. Surgical repair of Ebstein anomaly as described by Danielson. (A) The right atrium is incised and reduced, and the atrial septal defect is closed with a patch. The arrow identifies the large anterior leaflet. (B) Mattress sutures with felt pledgets are used to pull the tricuspid annulus and valve together in a horizontal plane, obliterating the atrialized right ventricle. (C) Sutures are tied after all have been inserted (...) . The arrow identifies the septal leaflet. (D) A posterior annuloplasty is used to narrow the orifice of the tricuspid annulus. (E) Completed repair, resulting in a competent tricuspid valve. Surgical repair of Ebstein anomaly as described by Carpentier. The anterior and posterior leaflets are detached from the tricuspid annulus. In type D lesions, fenestrations are used to create interchordal spaces for the passage of blood into the right ventricle outflow tract (insert). Mattress sutures with pledgets

2014 eMedicine Pediatrics

158. Ebstein Malformation: Surgical Perspective (Diagnosis)

demonstrates cardiomegaly, with evidence of severe right atrial enlargement. Surgical repair of Ebstein anomaly as described by Danielson. (A) The right atrium is incised and reduced, and the atrial septal defect is closed with a patch. The arrow identifies the large anterior leaflet. (B) Mattress sutures with felt pledgets are used to pull the tricuspid annulus and valve together in a horizontal plane, obliterating the atrialized right ventricle. (C) Sutures are tied after all have been inserted (...) . The arrow identifies the septal leaflet. (D) A posterior annuloplasty is used to narrow the orifice of the tricuspid annulus. (E) Completed repair, resulting in a competent tricuspid valve. Surgical repair of Ebstein anomaly as described by Carpentier. The anterior and posterior leaflets are detached from the tricuspid annulus. In type D lesions, fenestrations are used to create interchordal spaces for the passage of blood into the right ventricle outflow tract (insert). Mattress sutures with pledgets

2014 eMedicine Pediatrics

159. Upper Gastrointestinal Bleeding: Surgical Perspective (Treatment)

is a horizontal mattress placed to control hemorrhage from the transverse pancreatic branch of the gastroduodenal artery. Failure to place this third stitch may result in recurrent bleeding that requires another emergent laparotomy of the abdomen. Vagotomy with antrectomy is reserved for patients whose conditions have failed to respond to more conservative attempts at surgical intervention and for those with aggressive and recurrent duodenal ulcer diathesis, such as gastric outlet obstruction. When performing (...) vagotomy 10 5 0.1 Truncal vagotomy and drainage 7 20-30 < 1 Truncal vagotomy and antrectomy Billroth I or Billroth II 1 30-50 0-5 Truncal vagotomy and antrectomy Roux-en-Y 5-10 50-60 0-5 The 3 most common operations performed for a bleeding duodenal ulcer are as follows [ ] : Truncal vagotomy and pyloroplasty with suture ligation of the bleeding ulcer Truncal vagotomy and antrectomy with resection or suture ligation of the bleeding ulcer Proximal (highly selective) gastric vagotomy with duodenostomy

2014 eMedicine Surgery

160. Triangular Fibrocartilage Complex Injuries (Treatment)

to the dorsal radioulnar (DRU) ligament. Reflect the DRU ligament and the periosteum over the lunate fossa. Place horizontal mattress sutures in the TFCC through drill holes placed in the dorsoulnar aspect of the distal radius. Wrist arthroscopy Indications for wrist arthroscopy include acute unstable tears, acute tears that fail to respond to conservative management, and chronic tears for which conservative management fails. [ , , , ] General arthroscopic principles are as follows: Debride to a stable (...) in the triangular fibrocartilage of the wrist joint. J Anat . 1978 Jun. 126 (Pt 2):367-84. . Nakamura T, Nakao Y, Ikegami H, Sato K, Takayama S. Open repair of the ulnar disruption of the triangular fibrocartilage complex with double three-dimensional mattress suturing technique. Tech Hand Up Extrem Surg . 2004 Jun. 8 (2):116-23. . Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res . 1984 Jul-Aug. 26-35. . Adams BD. Partial excision of the triangular fibrocartilage complex

2014 eMedicine Surgery

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