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Horizontal Mattress Suture

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161. 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

162. Vertebral Fracture (Treatment)

. For a posterior approach, place the patient in the prone position with either horizontal or flexed positioning at the hips. For a lateral approach, the surgeon can use either the prone position or a modified lateral decubitus position. For the ventral approach, position the patient supine. Ensure that the anesthesiologist has proper intravenous access and access to the extremities and chest for intraoperative monitoring. Exercise the usual precautions of positioning and avoidance of pressure on peripheral (...) thoracolumbar plating system has been used for the treatment of burst fractures. Surgery is performed for neurologic deficits, deformity, progressive kyphosis, and late pain. Ghanayem and Zdeblick reported good success with this form of anterior arthrodesis. Previous Next: Postoperative Details Postoperative care of the surgical incision The incision is usually closed in a layered fashion, and the skin is either stapled or sutured. A dressing is applied and taped in place. Some surgeons keep the dressing

2014 eMedicine Surgery

163. Posterior Glenohumeral Instability (Follow-up)

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

164. Epilepsy Surgery (Follow-up)

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

165. Flexor Tendon Lacerations (Follow-up)

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

166. Diaphragmatic Hernias, Acquired (Follow-up)

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

167. Triangular Fibrocartilage Complex Injuries (Diagnosis)

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

168. Upper Gastrointestinal Bleeding: Surgical Perspective (Follow-up)

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

169. Triangular Fibrocartilage Complex Injuries (Follow-up)

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

170. Vertebral Fracture (Follow-up)

. For a posterior approach, place the patient in the prone position with either horizontal or flexed positioning at the hips. For a lateral approach, the surgeon can use either the prone position or a modified lateral decubitus position. For the ventral approach, position the patient supine. Ensure that the anesthesiologist has proper intravenous access and access to the extremities and chest for intraoperative monitoring. Exercise the usual precautions of positioning and avoidance of pressure on peripheral (...) thoracolumbar plating system has been used for the treatment of burst fractures. Surgery is performed for neurologic deficits, deformity, progressive kyphosis, and late pain. Ghanayem and Zdeblick reported good success with this form of anterior arthrodesis. Previous Next: Postoperative Details Postoperative care of the surgical incision The incision is usually closed in a layered fashion, and the skin is either stapled or sutured. A dressing is applied and taped in place. Some surgeons keep the dressing

2014 eMedicine Surgery

171. Lisfranc Fracture Dislocation (Follow-up)

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

172. Replantation (Follow-up)

tendon is repaired by using horizontal mattress 4-0 polyester sutures. A tendon graft may also be necessary if a sufficient length of tendon is not available. Finally, if extension is deemed expendable, arthrodesis (joint fusion) may be performed. Then, the flexor tendon is repaired with sutures. Arterial repair is performed next. Brisk blood flow from the proximal vessel should be confirmed prior to vascular anastomosis. Restoration of proximal blood flow may require relief of vascular compression

2014 eMedicine Emergency Medicine

173. Nailbed Injuries (Treatment)

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

174. Traumatic Triceps Tendon Avulsion in a Dog: Magnetic Resonance Imaging and Surgical Management Evaluation (Full text)

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 PubMed abstract

175. 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

176. 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

177. Bolsterless management for recurrent auricular hematomata. (Full text)

performed, and then auricular skin was stabilized using through-and-through absorbable horizontal mattress sutures. Patients were seen in follow-up to evaluate for recurrence and assess cosmetic results.Twenty-eight patients were treated for recurrent auricular hematomata using the bolsterless technique. There were no recurrences in follow-up, and cosmetic results were judged to be excellent by both patient and surgeon.Bolsterless management for auricular hematomata using absorbable mattress sutures has

2012 Laryngoscope PubMed abstract

178. Lacerations

at the surface. Eversion is more easily obtained when the hand is fully pronated and the skin is entered with the needle at a 90° angle and angled slightly away from the skin edge. Suture spacing Spacing between sutures is typically equal to the distance from needle entry to wound margin. Sutures should enter and exit at an equal distance from the wound margin. A vertical mattress suture (see figure ) is sometimes used instead of a layered closure, provided skin tension is not marked; it also helps ensure (...) proper edge eversion in loose tissue. A running suture (see figure ) is quicker to place than interrupted sutures and can be used when wound edges are well aligned. Vertical mattress suture The first pass of the needle is the same as a large simple suture, but instead of tying off, another smaller bite is taken back across the wound to end on the starting side. Both ends are pulled up to closely align (approximate) the wound edges. Points A and B must be at the same depth, as must points C and D

2013 Merck Manual (19th Edition)

179. Left Ventricular Pseudo-pseudoaneurysm with Hemopericardium (Full text)

tomography showed pericardial effusion and a 16-mm cavity at the anterolateral wall of the left ventricle. Magnetic resonance imaging suggested either pseudo-pseudoaneurysm or myocardial abscess. We successfully repaired the myocardial defect using a patch made from a vascular graft with pledgeted horizontal mattress sutures under cardiopulmonary bypass.

2011 The Korean journal of thoracic and cardiovascular surgery PubMed abstract

180. Nonappositional repair of iridodialysis. (Abstract)

Nonappositional repair of iridodialysis. We describe a novel "hang-back" surgical approach for repairing an iridodialysis. Instead of repositioning the iris tightly to the sclera, the detached peripheral iris is suspended by a suture inside the normal iris insertion, reducing corectopia and avoiding inadvertent coverage of the trabecular meshwork by peripheral iris. A horizontal mattress suture is placed ab interno via a paracentesis site and tightened to bring the iris periphery to inside

2011 Journal of cataract and refractive surgery

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