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224 results for

Horizontal Mattress Suture

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161. Laparoscopic Pelvic Lymph Node Dissection (Follow-up)

perforation can be minimized by limiting the use of electrocautery in the area of the intestine that needs mobilization in order to expose the pelvic lymph nodes. A short burst of electrical energy is sufficient to create a full-thickness injury to the bowel. In addition, abrasions that occur during mobilization of the colon should be covered using horizontal mattress sutures placed laparoscopically. [ ] By carefully identifying the obturator nerve (located in the posterior aspect of the dissection

2014 eMedicine.com

162. Nephrectomy, Partial (Treatment)

are approximated manually. With the assistant approximating the edges of the parenchymal defect as depicted in image #5 above, close the defect over a Surgicel/Gelfoam roll to aid in parenchymal pressure and hemostasis. Two strips of Gelfoam wrapped in Surgicel can be used to bolster the renal capsule along the edges of the defect to reduce the risk of tearing. Lay the 2 strips along the length of the defect on each side. Pass several 2-0 polyglycolic acid horizontal mattress sutures through the renal capsule (...) , closure of the parenchyma with horizontal sutures over the length of the defect with fat or Oxycel or closure with Gelfoam and Surgicel bolsters) have been successfully used. These methods depend on the strength of the renal capsule. Use of Gore-Tex allows for even distribution of tension along the length of the closure. Small bleeding vessels are easily tamponaded. Gore-Tex also allows the surgeon to tie the sutures with the desired tension without risking tear of the kidney capsule, especially when

2014 eMedicine.com

163. Ectropion (Treatment)

at the gray line with either sharp Westcott scissors or a 15 blade. (The author does not find it necessary to split the lid.) The meibomian orifices of the lateral strip are trimmed away. The lateral conjunctiva is scraped to avoid epithelial inclusion cysts. To secure the lateral strip of tarsus to the periosteum, 2 sutures (or a single horizontal mattress suture) can be placed about 4 mm posterior to the lateral orbital rim at the Whitnall tubercle (at or above the level of the inferior pupil). Suitable (...) . [ ] Next: Surgical Care The correct surgical treatment of ectropion depends on the etiology. [ ] Horizontal lid laxity is often seen with ectropion and usually can be corrected with a lateral tarsal strip procedure. Mild-to-moderate cases of medial ectropion may respond to a medial conjunctival spindle procedure. Tarsal ectropion requires reinsertion of the lower lid retractors. Augmentation of the anterior lamellae (along with excision of any cicatrix) is required for cicatricial ectropion. The use

2014 eMedicine.com

164. Nasal Reconstruction (Treatment)

include proper flap design, wide undermining to minimize wound-closure tension, meticulous hemostasis, delicate handling of tissue, and strict preservation of a highly vascular muscular flap base. Surgical attention should be directed toward the delicate handling of tissue and properly everting buried sutures, because incision lines on the nasal tip and alae are more visible than incision lines placed elsewhere on less sebaceous skin. Any flap should be carefully sized in both the horizontal dimension (...) not have any identifiable relaxed skin tension lines; therefore, closures in this area should be oriented vertically to prevent alar asymmetry. As with all linear closures on the nose, the tissue should be undermined at the level of the perichondrium. The wound is approximated by using buried vertical mattress sutures following meticulous hemostasis. Particular attention is paid to wound-edge eversion on the sebaceous areas of the nose, because surgical scars tend to invert in thickly skinned areas

2014 eMedicine.com

165. Nail Surgery (Treatment)

, trimmed, and reattached to the nail bed and the LNFs by using horizontally placed mattress sutures. Stitches are removed in 10 days, when the nail is firmly adherent to the nail bed. Anesthesia is usually not required, but, when indicated, a digital block may be performed. Repair of simple lacerations Superficial lacerations that are limited to the nail plate and involve less than 3 mm of the nail bed usually heal independent of surgical repair as the injured nail grows out. [ , ] Larger lacerations (...) original anatomical site. Hemostasis is achieved with electrocoagulation, Monsel solution, or aluminum chloride solution. The wound may be allowed to heal by secondary intention. Alternatively, the wound may be closed by passing sutures through the nail plate and the LNF. When dressing the wound, the lateral nail groove is packed with iodoform or petroleum jelly gauze. A nonadherent dressing (eg, Telfa) is applied, followed by the placement of a bulky dressing or cling that is secured with elastic tape

2014 eMedicine.com

166. 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

167. 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

168. 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

169. Nasal Reconstruction (Diagnosis)

include proper flap design, wide undermining to minimize wound-closure tension, meticulous hemostasis, delicate handling of tissue, and strict preservation of a highly vascular muscular flap base. Surgical attention should be directed toward the delicate handling of tissue and properly everting buried sutures, because incision lines on the nasal tip and alae are more visible than incision lines placed elsewhere on less sebaceous skin. Any flap should be carefully sized in both the horizontal dimension (...) not have any identifiable relaxed skin tension lines; therefore, closures in this area should be oriented vertically to prevent alar asymmetry. As with all linear closures on the nose, the tissue should be undermined at the level of the perichondrium. The wound is approximated by using buried vertical mattress sutures following meticulous hemostasis. Particular attention is paid to wound-edge eversion on the sebaceous areas of the nose, because surgical scars tend to invert in thickly skinned areas

2014 eMedicine.com

170. Superior Labrum Lesions (Diagnosis)

Med . 2005 Apr. 33(4):507-14. . Silberberg JM, Moya-Angeler J, Martín E, Leyes M, Forriol F. Vertical Versus Horizontal Suture Configuration for the Repair of Isolated Type II SLAP Lesion Through a Single Anterior Portal: A Randomized Controlled Trial. Arthroscopy . 2011 Dec. 27(12):1605-13. . Coleman SH, Cohen DB, Drakos MC, et al. Arthroscopic repair of type II superior labral anterior posterior lesions with and without acromioplasty: a clinical analysis of 50 patients. Am J Sports Med . 2007 (...) of a type II superior labrum anterior posterior (SLAP) lesion. Arthroscopic placement of a suture anchor in the superior glenoid. Arthroscopic suture placement for superior labrum anterior posterior (SLAP) lesion repair. Arthroscopic appearance of a superior labrum anterior posterior (SLAP) lesion after repair with a suture anchor. Simple mattress suture configuration with a single anchor. (Arthroscopy. 2007 Feb;23(2):135-40.) of 8 Tables Contributor Information and Disclosures Author Riley J Williams

2014 eMedicine.com

171. Scar Revision (Diagnosis)

traumatized during closure may develop wound dehiscence or undergo skin-edge necrosis, thus leaving unsightly scars. Likewise, wounds that are unevenly or improperly repaired, become infected, or undergo foreign body reactions to sutures more frequently yield poor cosmetic results. Traumatic wounds traditionally yield poorer eventual scars. Common etiologies of widened or dehisced scars include wounds closed under tension, repairs not formed parallel to relaxed skin tension lines (RSTLs), or wounds (...) realignment of the cutaneous landmarks may be performed on scars that are appropriately oriented in RSTLs. Z-plasty can be used to realign scars within RSTLs or correct any step-off deformity at the vermilion border. Scars crossing horizontally over the mentum generally follow RSTLs and therefore are best treated with a running W-plasty (see image below). Laterally based and more obliquely directed scars are good candidates for Z-plasty because the primary objective here is to redirect the scar

2014 eMedicine.com

172. Laparoscopic Pelvic Lymph Node Dissection (Diagnosis)

perforation can be minimized by limiting the use of electrocautery in the area of the intestine that needs mobilization in order to expose the pelvic lymph nodes. A short burst of electrical energy is sufficient to create a full-thickness injury to the bowel. In addition, abrasions that occur during mobilization of the colon should be covered using horizontal mattress sutures placed laparoscopically. [ ] By carefully identifying the obturator nerve (located in the posterior aspect of the dissection

2014 eMedicine.com

173. 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

174. 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

175. 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

176. 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

177. 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

178. Traumatic Triceps Tendon Avulsion in a Dog: Magnetic Resonance Imaging and Surgical Management Evaluation Full Text available with Trip Pro

Traumatic Triceps Tendon Avulsion in a Dog: Magnetic Resonance Imaging and Surgical Management Evaluation We report here the clinical presentation, magnetic resonance imaging (MRI) findings and successful surgical management associated with triceps tendon avulsion in a dog. A definitive diagnosis of triceps tendon avulsion was made based on MRI with evidence of displacement of the triceps tendon. Surgical correction of triceps tendon avulsion was performed with two horizontal mattress sutures

2013 The Journal of Veterinary Medical Science

179. Corner Stitch

-buried Horizontal Mattress Suture II. Indications: Skin flap closure (no vascular compromise) Y-shaped corners (90 degree angle) X-shaped III. Advantages Does not compromise blood supply to tip of corner IV. Technique: Y-shaped lesion Background Use non- Draw line perpendicular from corner tip (forms Y) Four landmark sites (2 on each side of the wound) Point 1 along left base of Y (6-8 mm from corner) Point 2 at left upper arm of Y (4 mm from corner) Point 3 at right upper arm of Y (4 mm from corner

2015 FP Notebook

180. Wound Repair

to identify the bleeding vessel) Clamp the bleeding end and apply ligature ( ) Figure of eight (or horizontal mattress) Indicated for vessel that has retracted within tissue and cannot be clamped Imagine a square box around the bleeding source Each corner of the exposed square represents an entry or exit of the figure of eight Tying the figure of eight compresses the tissue around the bleeding source XVI. Protocol: Wound Repair Specific injury approaches See See See Indicated if repair must be done (...) bid Granulation and Contraction risk without suturing XII. Protocol: Local Anesthesia Prepare skin with antiseptic prior to injection Betadine is not affective until it dries (hence hibiclens is often preferred) Avoid hibiclens near eyes (irritation) and inside ear canal (ototoxic) See for pearls to decrease patient discomfort Consider topical anesthetics, especially in children (e.g. ) is safe in areas previously contraindicated (fingers, toes, ears, nose) caution in Digits (even ): 1:100,000

2015 FP Notebook

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