Erosion of conjunctiva over the suture knot with a leak in an eye with a non-flow restrictive aqueous drainage device

We report a case of conjunctival erosion due to ligature suture knot exposure following Aurolab aqueous drainage device (AADI) implantation. A 48-year-old man, a known case of primary angle-closure glaucoma, had failed trabeculectomy with mitomycin-C and Ahmed glaucoma valve (AGV) in the right eye. The right eye had a large posterior AGV bleb with hypertropia and limitation of extraocular movement on downward gaze and uncontrolled intraocular pressure (IOP). An inferonasal AADI was performed uneventfully. At the 1-month postoperative visit, a small conjunctival erosion was noted over the ligature (6-0 vicryl) suture knot. However, there was no leak. Two weeks later, there was hypotony and a leak was noted at the site of the absorbed ligature. Immediate surgical repair was performed by re-ligature of the AADI tube with 8-0 vicryl and the ligature knot was placed under the scleral patch graft and the conjunctival defect was sutured. Early intervention helped in successfully healing the conjunctival erosion, reversal of the hypotony and well-controlled IOP. Adequate covering of the entire subconjunctival tube including its ligated part by a patch graft may prevent this complication.

Fascia Repair With Vicryl Suture in 636 Urologic Surgeries

Objective: The procedure for closing the fascia after surgery should be quick, easy, and persistent, yet comfortable for the patient. Polydioxanone thread is not widely available in Iran and we use Vicryl kind instead for almost all patients. This study was conducted in two years from January 2018 to January 2020 at Imam Reza and Imam Khomeini Medical Center in Ardabil. Fascia was treated with Vicryl suture of 0 or 1 in a double layer and in continues form for all patients in the Urology Department.Results: 636 patients were evaluated in these two years. The fascia healing was at the site of inguinal, midline Gibson and flank. The fascia relief is bilaterally treated with Vicryl suture and continuously in all urologic surgeries with a very low rate of wound infection and hernia at the place of operation. At the same time, the amount of pain at the place of operation and the formation of sinus sores is very low.

Microbiological Evaluation of the Antibacterial Vicryl Suture in the Mandibular Third Molar Surgery

Background: Selection and application of suture materials, has gained more importance especially with the increasing number of patients seeking oral surgeries. Since lying in a bacterial-filled environment, sutures make the tissue prone to infection. Suture material plays an important role in the reduction of the risk of infection. This study aimed to assess the success rate of an antibacterial suture named Vicryl Plus in preventing bacterial growth in the surgical site of the mandibular third molar. Methods: 27 patients were included in this double-blinded randomized clinical trial study. Surgical Extraction of the mandibular wisdom tooth was done and the incision was managed by randomly using Vicryl Plus and Vicryl sutures. After 7 days, sutures were removed and assessed microbiologically. Predominant species of Streptococcus mutans and Lactobacillus were assessed as well as the total number of colonies on each suture. Results: There was a significant difference between two suture materials in colony number-length ratio of lactobacillus (p-value= 0.031) and total bacterial colonies (p-value=0.016); but not for S. mutans species (p-value=0.201). Conclusion: Antibacterial Vicryl suture can be a useful tool for the reduction in the rate of surgical site infection in high-risk cases and situations.

Surgical outcomes of Ahmed glaucoma valve implantation with plate fixation using vicryl sutures or no plate fixation

Purpose: To summarize the surgical outcomes of Ahmed glaucoma valve (AGV) implantation with plate fixation with vicryl absorbable sutures or no plate suturing. Methods: This study was a retrospective case series that included all glaucoma patients who underwent AGV implantation surgery with vicryl absorbable sutures for plate fixation or without plate fixation by a single surgeon between 2014 and 2019. We reviewed their medical records and retrieved clinical data on intra- and postoperative complications, best-corrected visual acuity, intraocular pressure (IOP), and number of IOP-lowering medications. Results: Twenty out of 29 eyes (29 patients, mean age 61.04 ± 27.1 years, 17 men) underwent AGV implantation without plate fixation and nine had AGV implantation with fixation with vicryl sutures. Complications were observed in 15 cases (51.7%). Nine of these were defined as failure due to the need for removal or repositioning of the AGV or for further surgery for uncontrolled IOP, of which five were no-fixation cases (5/20, 25%) and four were vicryl-fixation cases (4/9, 44.4%). Six of all surgical failures were related to AGV migration (6/9, 66.6%). There were three cases of extrusion and one case of plate migration in the no-fixation group, and two cases of plate migration and one case of extrusion in the vicryl-fixation group. Conclusion: AGV implantation without suture plate fixation or with vicryl suture fixation had a high complication and failure rate, often necessitating reoperation and AGV removal. The high rate of tube-related complications observed after both techniques does not favor either of them. The use of non-absorbable sutures for suturing of the AGV plate is recommended.

A COMPARATIVE STUDY BETWEEN THE INCIDENCE OF WOUND INFECTION AND BURST ABDOMEN BETWEEN DELAYED ABSORBABLE (VICRYL) AND MEDICATED VICRYL (VICRYL PLUS) SUTURE MATERIAL IN PATIENTS UNDERGOING MIDLINE INCISION LAPAROTOMY IN ACUTE ABDOMEN CASES IN THE EMERGENC

Midline laparotomy is frequently done in the emergency setting of any hospital and type of suture material used for the fascial closure of the abdominal wall influences the incidence of the postoperative complications. The aim of this study was to compare the efficacy of the medicated Vicryl (Vicryl plus) suture material with plain Vicryl suture material in patients undergoing midline incision laparotomy in acute abdomen cases based on the postoperative complications. In addition, the effect of various risk factors on burst abdomen and wound infection was also evaluated. Methods: 100 patients who have visited the emergency department of the hospital and underwent midline laparotomy were enrolled in this study. Results: Patients were divided into two groups depending on whether they have an intestinal perforation (group A, n=60) or intestinal obstruction (Group B, n=40). These two groups were further divided into two groups depending on the type of suture material used (plain Vicryl: group A1, B1 and medicated Vicryl: group A2, B2). Both these groups had an equal number of patients. The analysis of the data showed that compared to the non medicated suture material the rate of wound infection is considerably less in the cases of medicated polyglactin suture material. In addition, older age, diabetes, anemia, and malnutrition are the significant risk factor for wound infection (p<0.001s) while Older age, malnutrition, and cough were found to be highly significant risk factors for burst abdomen. Conclusion: The medicated suture material was proved to be more effective in preventing the burst abdomen and postoperative wound infections compared to the plain delayed absorbable Vicryl suture material. Keywords: delayed absorbable Vicryl, medicated Vicryl, burst abdomen, wound infection, a midline laparotomy

Microbial Adherence of three different suture materials in patients undergoing periodontal flap surgery. A clinical & microbiological study

proliferation of microbes to the parts open to the oral cavity. Hence, microbial colonization on various intraoral suture materials from patients undergoing periodontal flap surgery and its impact on healing of gingival tissues was compared. Patients and Methods: During periodontal flap surgery, three different suture materials (silk, polyamide, & vicryl) were used in 25 patients. Eight days postoperatively, the sutures were removed, and adhered micro-organisms were counted by culturing on nutrient agar. Additionally clinical parameters, bleeding on probing and papillary position to assess healing were recorded to baseline, at 2 weeks, 4 weeks, and 6 weeks. Wilcoxon signed ranks test was used for statistical analysis. Results: Mean CFU’s for silk, polyamide and vicryl sutures were 6.239 ±1.476 X 108, 2.425 ± 1.010 X 108, 4.431 ± 1.069 X 108. There was no inter-group statistical difference in the clinical parameters i.e. bleeding on probing, papillary position at all time periods (p>0.05). There was a significant statistical improvement in bleeding on probing in all the three groups from base line (p<0.05). Conclusions: The results of the present study demonstrated that bacteria have different affinity towards different suture materials. Monofilament polyamide suture adhered the least amount of bacteria, followed by multifilament vicryl suture, while silk adhered maximum amount of bacteria. There was no statistically significant difference in the healing of gingival tissues in between all the three groups. Keywords: Monofilament sutures, Multifilament sutures, Colony forming units, Periodontal flap surgery

A Cross-Knotted Suture Basket Technique for Large Nonmagnetic Intraocular Foreign Body Removal

Purpose. To report a novel technique of cross-knotted suture basket and to test its effectiveness in large nonmagnetic intraocular foreign body (IOFB) removal. Methods. A 7/0 Vicryl suture was cut in half and cross-knotted, and four ends were introduced into a 23G needle to form a basket. Pig eyes were used to set up the IOFB model, and the effectiveness of the suture basket in the removal of large nonmagnetic intraocular foreign bodies was tested. Results. Several modifications can be made to adapt to different situations. For the materials (stone, metal, glass, and wood) and shapes (irregular, spherical, and rectangle) of large IOFB tested, the cross-knotted suture basket successfully removed all kinds of IOFBs. Conclusion. The suture basket technique provides an accessible, safe, and effective alternative in large nonmagnetic IOFB removal. It can be adapted and interchangedand also worth’s further clinical investigations.

Extraocular Myoplasty: Surgical Remedy For Intraocular Implant Exposure

Background: Evisceration and nucleation are commonly performed ophthalmic surgeries for painful blind eye, disfiguring blind eye, endophthalmitis etc. After both these surgeries it is important to replace the lost volume in the orbit with implant. Implant is associated with many complications such as major discharge, exposure with discharge and implant exposure. The main surgical management of implant exposures basically primary revision or patch grafting with or without removal of the implant. Case: A 60 years old man presented to ophthalmic OPD with complaint of foreign body sensation and irritation in left eye. There was history of evisceration with silicon ball implant in left eye done one month back for painful blind eye at another hospital. On ophthalmic examination, there was a 3 × 4 mm of implant exposure most probably dueto tight closure. As per records the size of implant was 22mm. The patient was planned for extra-ocular myoplasty with buccal mucosal graft under general anesthesia. Observation: After sterile prepping and draping, 360˚ degrees peritomy was performed and care was taken to dissect between tenons and orbital implant. Medialand lateral recti were isolated and dissected upto 10-12mm from insertion site. Both the recti were secured with 6-0 vicryl suture and were detached from their respective insertions, advanced and approximated over the site of implant exposure. Thus the exposed implant was covered with a vascularized base which was reinforced with amucosal graft harvested from the buccal mucosa and secured with absorbable sutures. After 1 year of follow up patient was asymptomatic. Conclusion: Extraocular myoplasty with buccal mucosal graft is a good surgical remedy for orbital implant exposure implant.

A Case Report of a Buried Needle in an Oculofacial Trauma

We report a case of a 40-year-old East Asian male who presented with multiple facial lacerations and was referred to oculoplastics for periorbital assessment and wound repair. On wound closure, the needle of a 6-0 vicryl suture accidentally detached, and a mobile image intensifier was used which did not detect a foreign body. Surgical closure was done, but upon computed tomography scan of the face, an embedded foreign material was seen. Difficult secondary wound exploration was performed but with the aid of an intraoperative magnetic probe, the 11-mm needle was identified in entirety.