• Journal of Chest Surgery
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• v.57 no.1
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• pp.92-95
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• 2024

Complete resection of an apicoposterior mediastinal mass is essential due to the mass effect, which exerts pressure on adjacent organs. Recently, the use of minimally invasive surgery has had many advantages. In this report, we describe a case in which a large apicoposterior mediastinal hypervascular mass was managed using a purse-string suture technique during robotic-assisted thoracoscopic surgery (RATS). The patient, a 77-year-old woman, was diagnosed with a 6.2-cm apicoposterior mediastinal hypervascular solid mass originating from the branches of the right subclavian artery. The patient underwent RATS for treatment. To obtain an adequate view of the apex of the thoracic cavity, a needle aspiration was performed, followed by the application of a purse-string suture technique. This was done to reduce the size of the tumor and to prevent catastrophic events such as seeding or spillage of the cystic mass. The mass was histopathologically diagnosed as a schwannoma. The patient was discharged on the first postoperative day without experiencing any complications.

• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.2
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• pp.69-77
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• 2011

Purpose: This study was retrospectively performed to compare the clinical outcomes of modified Brostrom procedures using the single suture anchor and the double suture anchor for chronic lateral ankle instability. Materials and Methods: Thirty-seven patients were followed up for more than 1 year after the modified Brostrom procedures using suture anchor. Single surgeon treated seventeen cases with single suture anchor and 20 cases with double suture anchor. The clinical evaluation was performed according to the Karlsson scale and Sefton grading system. Radiologic measurement of the talar tilt and anterior talar translation was performed through anterior and varus stress radiographs using Telos device. Results: The Karlsson scale had improved significantly from preoperative average of 45.2 points to 89.4 points in single suture anchor group, and from 46.4 points to 90.5 points in double suture anchor group. According to the Sefton grading system, 15 cases (88.2%) in single suture anchor group and 18 cases (90%) in double suture anchor group achieved satisfactory results. The talar tilt angle and anterior talar translation had improved significantly from preoperative average of $13.6^{\circ}$ and 8.6 mm to $5.4^{\circ}$ and 4.1 mm in single suture anchor group, from $14.1^{\circ}$ and 8.4mm to $3.9^{\circ}$ and 4 mm in double suture anchor group. Double suture anchor technique was significantly superior in postoperative talar tilt. Conclusion: Single and double suture anchor techniques produced similar clinical and functional outcomes except for talar tilt, which was significantly superior in double suture anchor group. Both modified Brostrom procedures using the single and double suture anchor appear to be effective treatment methods for chronic lateral ankle instability. Further evaluation of clinical outcomes and biomechanical studies in athletes are needed.

• Journal of Chest Surgery
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• v.29 no.5
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• pp.504-509
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• 1996

When a valve prosthesis is to be implanted in the aortic position, simple interrupted suture, figure-of- eight suture, or horizontal mattress suture technique is used as a suture method. However, the suture techniques may be unacceptable for aortic valve replacement in patients with friable annulus caused by some lesions, such as endocarditis and degenerative change. We used an alternative technique for the aortic vlave replacement in 4 patients with valve endocarditis, ) patients with degenerative valvular lesion, and 1 with rheumatic valvular disease. Mattress sutures through the annulus were placed with pledgets on the ventricular side of the annulus, whi h resulted in implantation of the prosthesis at a supra-annular level. Mechanical valves of 21 mm or larger were implanted in the supra-annular position in all patients and there was no impeded motion of leaflets during the follow-up period of mean 13.3 mouths. The transvalvular pressure gradient was less than 6 mm Hg in 3 patients and 20 to 40 mm Hg in 5 patients. The supra-annular implantation of mechanical aortic valve using a vertical mattress suture technique may be a useful alternative method of aortic valve replacement for the selected patients with friable or destroyed aortic annulus.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.3
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• pp.241-249
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• 2007

An augmentation of the maxillary sinus floor facilitates placement of dental implants in the posterior atrophic maxilla. However, a maxillary sinus augmentation has potential complications that can lead to early failure and loss of the bone graft. One specific complication is sinus membrane perforation. Especially, large perforations may cause loss of the graft materials into the sinus and infection, so, early failure of the sinus lift. Attempts at managing sinus membrane perforations are difficult because of the limited access to them and friability of the thin Schneiderian membrane. Repair of sinus membrane perforations intraoperatively may be performed using a variety of techniques and materials, including sutures, collagen membranes, fibrin glue. Inspite of various repair technique, as has been reported extensively in the literature, large perforations represent an absolute contraindication to the continuation of surgery. But, we obtained clinically favorable results in cases that show repair of the perforated sinus membrane with a micro-suture technique by 4X Loupe ($Surgitel^{(R)}$ Loupe, General Scientific Corporation) in large perforation. The objective of this presentation is to report of several cases of repair of the perforated sinus membrane with micro-suture technique using 7.0 or 8.0 suture materials, to make a brief review of the literature about various technique managing perforated sinus membrane.

• Journal of Chest Surgery
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• v.46 no.4
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• pp.249-255
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• 2013

Background: The continuous suture (CS) technique has several advantages as a method for simple, fast, and secure aortic valve replacement (AVR). We used a simple CS technique without the use of a pledget for AVR and evaluated the surgical outcomes. Materials and Methods: Between October 2007 and 2012, 123 patients with aortic valve disease underwent AVR alone (n=28) or with other concomitant cardiac procedures (n=95), such as mitral, tricuspid, or aortic surgery. The patients were divided into two groups: the interrupted suture (IS) group (n=47), in which the conventional IS technique was used, and the CS group (n=76), in which the simple CS technique was used. Results: There were two hospital deaths (1.6%), which were not related to the suture technique. There were no significant differences in cardiopulmonary bypass time or aortic cross-clamp time between the two groups for AVR alone or AVR with concomitant cardiac procedures. In the IS group, two patients had prosthetic endocarditis and one patient experienced significant perivalvular leak. These patients underwent reoperations. In the CS group, there were no complications related to the surgery. Postoperatively, the two groups had similar aortic valve gradients. Conclusion: The simple CS method is useful and secure for AVR in patients with aortic valve disease, and it may minimize surgical complications, as neither pledgets nor braided sutures are used.

• Archives of Craniofacial Surgery
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• v.22 no.4
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• pp.183-192
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• 2021

Background: The purse-string suture (PSS) is a simple and rapid wound closure method that results in minimal scarring. It has been used to treat circular or oval skin defects caused by tumor excision or trauma. However, due to obscurity, it is not widely used, especially for the head and neck. This study aimed to modify the PSS to obtain predictable and acceptable results. Methods: A total of 45 sites in 39 patients with various types of skin and soft tissue defects in the head and neck were treated with PSS. We used PDS II (2-0 to 5-0), which is an absorbable suture. Minimal dissection of the subcutaneous layer was performed. The suture knot was hidden by placing it in the dissection layer. Depending on the characteristics of the skin and soft tissue defects, additional surgical interventions such as side-to-side advancement sutures, double PSS, or split-thickness skin graft were applied. Results: All wounds healed completely without any serious complications. Large defects up to 45 mm in diameter were successfully reconstructed using only PSS. Postoperative radiating folds were almost flattened after approximately 1-2 months. Conclusion: PSS is simple, rapid, and relatively free from surgical design. Owing to the circumferential advancement of the surrounding tissue, PSS always results in a smaller scar than the initial lesion and less distortion of the body structures around the wound in the completely healed defect. If the operator can predict the process of healing and immediate radiating folds, PSS could be a favorable option for round skin defects in the head and neck.

• Clinics in Shoulder and Elbow
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• v.26 no.3
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• pp.276-286
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• 2023

Background: The transosseous anchorless repair (ToR) technique was recently introduced to avoid suture anchor-related problems. While favorable outcomes of the ToR technique have been reported, no previous studies on peri-implant cyst formation with the ToR technique exist. Therefore, this study compared the clinical outcomes and prevalence of peri-implant cyst formation between the ToR technique and the conventional transosseous equivalent technique using suture anchors (SA). Methods: Cases with arthroscopic rotator cuff repair (ARCR) between 2016 and 2018 treated with the double-row suture bridge technique were retrospectively reviewed. Patients were divided into ToR and SA groups. To compare clinical outcomes, 19 ToR and 57 SA cases without intraoperative implant failure were selected using propensity score matching (PSM). While intraoperative implant failure rate was analyzed before PSM, retear rate, peri-implant cyst formation rate, and functional outcomes were compared after PSM. Results: The intraoperative implant failure rate (ToR, 8% vs. SA, 15.3%) and retear rate (ToR, 5.3% vs. SA, 19.3%) did not differ between the two groups (all P>0.05). However, peri-implant cysts were not observed in the ToR group, while they were observed in 16.7% of the SA group (P=0.008). Postoperative functional outcomes were not significantly different between the two groups (all P>0.05). Conclusions: The ToR technique produced comparable clinical outcomes to conventional techniques. Considering the prospect of potential additional surgeries, the absence of peri-implant cyst formation might be an advantage of ToR. Furthermore, ToR might reduce the medical costs related to suture anchors and, thereby, could be a useful option for ARCR. Level of evidence: III.

• Journal of Trauma and Injury
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• v.19 no.2
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• pp.121-125
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• 2006

Purpose: There is ongoing demand to deliver better procedural training to medical students in the emergency department. Thus, we studied the efficacy of a cadaver-based training model for teaching simple suture techniques to medical students. Methods: We investigated ten fourth-year medical students, who were rounding and being trained in the Emergency Department of Chungnam National University Hospital. They were educated with slides about a simple suture technique for 30 minutes to evaluate the efficacy of the cadaver-based training model. We prospectively measured their skill by administering a test on the cadaver-based simple suture technique in 3cm sized linar wound separately to each of them. Results: A total of ten fourth-year medical students completed the investigation. The tension, the direction of suture, the degree of cleanness, the number of sutures, the adequacy of the cutting thread length, and the suturing time in the first attempt were compared with those in the second one. The second results were compared with those in the third one, and the third results were compared with those in the fourth one. All the results had statistical significance. Conclusion: These findings support the value of the cadaver-based simple suture technique training model as a medical student teaching model. The cadaver-based simple suture technique teaching model is a good way of teaching several medical skills to medical students.

• Journal of the Korean Arthroscopy Society
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• v.3 no.2
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• pp.132-137
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• 1999

Displaced tibial spine fractures need the anatomical reduction of the displaced bone fragment to achieve normal range of motion and anterior stability of the knee joint. The purpose of this paper is to describe details of arthroscopic technique using suture hook and pull-out PDS and to evaluate the clinical results. We report 7 cases who underwent arthroscopic reduction and internal fixation using suture hook and pull-out PDS. All cases had fresh fractures generated within 3 weeks. The follow up period was at average 16.6 months. The fracture union was achieved at average 7.4 weeks. Knee exercise was started 2 weeks after the operation. One of the patients, who had combined injury of posterior cruciate ligament and lateral meniscus, showed limitation of knee movement. But he was underwent the arthroscopic fibrolysis at one year later, he returned to normal range of motion. Arthroscopic treatment of displaced tibial spine fracture using suture hook and pull-out PDS showed good results including rigid fixation and early mobilization. Therefore it is thought to be one of the effective operative techniques in treatment of the tibial spine fractures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.5
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• pp.349-357
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• 2003

Several microvascular anastomotic techniques have been described with methodical effectiveness, patency rates, healing state of microscopic findings. This experimental study presents the comparison of three types of arterial microvascular anastomotic techniques: end-to-end(ETE) anastomosis, end-in-end(EIE) anastomosis, and continuous technique. Sixty male Sprague-Dawley rats, 60 femoral arteries were used for this study. Twenty rats per each technique were used and sacrificed at post-operation 1 day, 3 days, a week, 2 weeks for scanning electromicroscopic findings. The patency was monitored by miniDoppler throughout total experimental periods. The anastomotic time on each method was measured to compare the technical effectiveness. The final results were as follows: 1. The anastomotic time for the end-in-end technique was significantly shorter than another techniques. The average time for each technique was measured as 15 minutes on EIE technique, 20 minutes on continuous technique and 25 minutes on ETE technique. 2. The patency rate for the end-in-end technique at 2 weeks also was superior to another techniques. The patency rate for each technique was demonstrated as 90 % on EIE technique, 85 % on ETE technique and 80 % on continuous technique. 3. The scanning electromicroscopic findings on healing condition of vessel endothelium during the observation period showed that the end results of EIE technique, ETE technique and continuous technique in sequence were good. The end-in-end technique proved to be the superior with regard to anastomotic time and patency rate when compared to end-to-end technuqe, so EIE techniqe might be well available for the case of large discrepancy of vessel size. The patency rate, microscopic healing findings in continuous technique were seen as the lowest level among the three anastomotic techniques, therefore the application of continuous technique was recommended only on the inevitable case.