• Archives of Plastic Surgery
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• 제37권5호
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• pp.650-658
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• 2010

Purpose: In the case of repair for far distal parts of FDP (Flexor digitorum profundus) division, the method of either pull-out suture or fixation of tendon to the distal phalanx is preferred. In this paper, the results of a modified loop suture technique used for the complete division of FDP from both zone 1a and distal parts of zone 1b in Moiemen classification are presented. Methods: From July 2006 to July 2009, the modified loop suture technique was used for the 10 cases of FDP in complete division from zone 1a and distal parts of zone 1b, especially where insertion sites were less than 1 cm apart from a tendon of a stump. In a suture technique, a loop is applied to each distal and proximal parts of tendon respectively. Core suture of 2-strand and epitendinous suture are done with PDS 4-0. Out of 10 patients, the study was done on 6 patients who were available for the followup. The average age of the patients was 49.1 years (in the range from 26 to 67). 5 males and 1 female patients were involved in this study. There were 3 cases with zone 1a and distal parts of zone 1b. The average distance to the distal tendon end was 0.6 cm. There were 5 cases underwent microsurgical repair where both artery and nerve divided. One case of only tendon displacement was presented. The dorsal protective splint was kept for 5 weeks on average. The results of the following tests were measured: active & passive range of motion, grip strength test, key pinch and pulp pinch test. Results: The follow-up period on average was 11 months, in the range from 2 to 20 months. There was no case of re-rupture, but tenolysis was performed in 1 cases. In all 6 cases, the average active range of motion of distal interphalangeal joint was 50.8 degree. The grip strength (ipsilateral/contralateral) was measured as 88.7% and the pulp pinch test was 79.2% as those of contralateral side. Flexion contracture was presented in 2 cases (15 degree on average) and there was no quadrigia effect found. Conclusion: Despite short length of tendon from the insertion site in FDS rupture in zone 1a and distal parts of zone 1b, sufficient functional recovery could be expected with the tendon to tendon repair using the modified loop suture technique.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.496-498
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• 2010

Purpose: Lacerations requiring formal wound closure compose a significant number of all childhood injuries presenting to the emergency department. The problem with conventional suture technique are that suture removal is quite cumbersome, especially in children. Unwanted soft tissue damage can result in the process of suture removal, which calls for sedation, stressful for both medical personnel and child. The purpose of this study is to introduce the convenient suture technique for pediatric facial lacerations. Methods: Children under the age of four, presenting to the emergency department with facial lacerations were enrolled in the study. From March 2008 to June 2009, 63 patients (41 males and 22 females) with an average age of 1.4 years were treated with our convenient suture technique using utilized a loop suspended above a double, flat tie. Clean, tension free wounds were treated with our technique, wounds with significant skin defect and concomitant fractures were excluded. Results: The Patients were followed-up in 1, 3 and 5 days postoperatively. On the third hospital visit, suture removal was done by simply cutting the loop suspended above the wound margin and gently pulling the thread with forceps. There were no significant differences in the rates of infection and dehiscence compared with conventional suture technique. Conclusion: The use of our technique was to be simple with similar operative time compared with conventional suture technique. Removal of suture materials were easy without unwanted injuries to the surrounding tissue which resulted in less discomfort for the patient and greater parental satisfaction, minimized the complications. It can be considered as a viable alternative in the repair of pediatric facial lacerations.

• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.22-27
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• 1999

While the conventional end-to-end anastomotic technique is accepted as 'the golden standard' for microvascular anastomosis, it is time-consuming and tedious. In an effort to offer faster and safer ways of performing microvascular anastomoses, numerous anastomotic techniques have been proposed, but further refinements in microvascular techniques are still necessary. A 'continuous suture with interrupted knot' technique was devised for faster and safer anastomosis. It has been successfully used in microanastomoses of both artery and vein for free tissue transfer. It is a combination of the interrupted suturing technique and the continuous suturing technique. First, a continuous suture is made with the size of loop decreasing in order, and then the sutures are tied individually from the first loop to the last one as in the conventional interrupted suturing technique. It was applied clinically to fourteen patients over the past ten months and found to be a highly efficient technique that satisfied our needs. This 'continuous suture with interrupted knot' technique has several advantages over other techniques : The operative time is reduced comparing conventional interrupted suture technique. By delaying the tie and with the vessel walls kept separated, the risk of through-stitch can be reduced. Tying all the sutures at one time not only speed up the procedures, but also reduced the surgeon's fatigue. In addition, it has no problem of anastomotic stenosis which is a disadvantage of continuous suture technique. This technique proved to be faster and safer, and has patency equal to that of the conventional end-to-end anastomosis. It is of great help to the surgeon in reducing operative time, especially in clinical situations when many anastomoses are required, or lengthy grafting procedures are undertaken.

• 대한정형외과스포츠의학회지
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• 제1권2호
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• pp.118-123
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• 2002

목적: 저자들은반월상연골후내각부에사용되던기존의inside-out 의수술수기를변형하여수직봉합이가능하면서충분한고정력을얻을수있는수술수기를보고하는바이다. 수술수기: 관절경을전외측도달법으로위치시키고봉합용갈고리를전내측도달법으로위치시켜봉합용갈고리를돌려서내측반월상연골후내각부에파열된부분의내측의대퇴골쪽표면에서경골쪽표면으로통과시킨다. 갈고리내로PDS $\#0$을통과시킨후봉합용갈고리를빼내고전내측도달법입구로PDS$\#0$의양끝을뽑아낸다. 전내측도달법입구에관절경을위치시킨후전외측도달법입구로Zone specific cannula를통과시켜반월상연골파열면의경골면에위치시키고저자가고안한Looped Needle을통과시킨 후 경골면의PDS $\#0$을Looped Needle의loop 사이를통과시킨후관절밖으로빼낸다.대퇴골면의PDS $\#0$도같은방법으로관절밖으로빼낸다. 2개의PDS 봉합사가나온입구근처에약1cm가량의incision 을넣고PDS 봉합사사이에연부조직이끼지않음을확인하고결찰을시행한다. 고찰: 변형된inside-out 봉합술은기존의inside-out 봉합술에비해수술시간의지연이있을수있으나, 수직봉합을할수있고견고한고정력을얻을수있으며해부학적인정복으로파열부위의접촉면을증가시켜후내각반월상연골의파열을봉합하는우수한방법으로판단되어보고하는바이다.

• Clinics in Shoulder and Elbow
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• 제25권3호
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• pp.224-229
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• 2022

Background: Most acromioclavicular joint (ACJ) injuries are caused by direct trauma to the shoulders, and various methods and techniques are used to treat them; however, none of the options can be considered the gold standard. This study examines the horizontal stability of the ACJ after a complete dislocation was repaired using one of two Ethibond suture techniques, the loop technique and the two holes in the clavicle technique. Methods: In this single-blind, randomized clinical trial, 104 patients diagnosed with complete ACJ dislocation type V were treated using Ethibond sutures with either the loop technique or the two holes in the clavicle technique. Horizontal changes in the ACJ were radiographically assessed in the lateral axial view, and shoulder function was evaluated by the Constant (CS) and Taft (TS) scores at intervals of 3, 6, and 12 months after surgery. Results: The horizontal stability of the ACJ was better with the two-hole technique than the loop technique at all measurement times. CS and TS changes showed a significant upward trend over time with both techniques. The mean CS and TS at the final visit were 95.2 and 11.6 with the loop technique and 94.0 and 11.9 with the two-hole technique, respectively. The incidence of superficial infections caused by the subcutaneous pins was the same in the two groups. Conclusions: Due to the improved ACJ stability with the two-hole technique, it appears to be a more suitable option than the loop technique for AC joint reduction.

• 대한관절경학회지
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• 제3권2호
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• pp.109-114
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• 1999

목 적 : 내측 반월상 연골후각의 후방 경골 부착부위의 절단 파열은 흔하지 않고 기존의 수기로는 봉합이 어렵다. 이에 저자들은 내측 반월상 연골의 후방 경골 부착부위의 절단 파열의 임상 양상 및 pullout suture를 통한 새로운 봉합술을 소개하고자 한다. 대상 및 방법 : 년 9월부터 1999년 7월까지 9명의 환자에서 후방 경골 부착부위의 절단 파열을 경험 하였다. 평균 나이는 59.3세로 38세에서 70세까지의 분포였다. 전예에서 자기공명영상과 임상양상으로 진단하였고, 슬관절경을 통해서 확진과 치료를 하였다. 1예에서 2차적 관절경을 시행하여 봉합 된 반월상 연골의 치유여부를 확인하였다. 임상 양상 : 대개 중년이후의 나이에서 호발하며, 특별한 외상의 과거력이 없다. 슬관절 후면의 통증을 호소하였으나, 그 위치가 불명확한 특징이 있었다. 경도내지 중등도의 슬관절의 종창을 호소하였으며, 특징적으로 슬관절을 굴곡 시킬수록 심해지는 술관절 후면의 통증으로 완전한 굴곡의 장애가 있었다. 단순 방사선 사진에서 퇴행성 변화는 없거나, 나이에 비해서 미미한 양상이었다. 술 전 자기 공명영상이 진단에 있어서 매우 중요한 역할을 하며, 특히 관상면에서 반월상 연골의 후각이 후방 경골 부착부위에서 분리되어 있는 형태를 보인다. 수술 수기 : 4개의 표준 portal 로 도달하여 후각부의 절단파열을 확인하고, 변연절제술로 시야를 확보하고 후각의 후방 부착부위의 연골하골을 노출 시킨다. 전내측 또는 후내측 도달법으로 절단단율 PDS 로 봉합한다. PDS 봉합사를 전내측 도달법으로 밖으로 꺼내 놓는다. 경골 내측 근위부에 종절개를 가한 후에 ACL tibla guide를 이용하여 경골 내측 근위부에서 후각의 후방 경골부착부위까지 골 터널을 만든다. 강선 루프를 경골 터널을 통하여 삽입하여서 전내측 도달법으로 빼내고, PDS 봉합사를 사이에 끼워서 다시 경골 터널을 통해 아래쪽으로 당겨서 끌어낸다. PDS 봉합사를 경골 내측 근위부에 post-tie 방법으로 고정한다. 결 론 : 내측 반월상연골 후각의 후방 경골부착부위의 절단피열은 임상적으로 흔하지 않고 보고도 드물다. 임상 양상과 자기공명영상이 진단에 있어서 중요한 역할을 한다. 관절경적 pullout 봉합이 이런 형태의 파열에 대한 치료로서 유용할 수 있을 것으로 사료된다.

• Journal of Chest Surgery
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• 제34권8호
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• pp.651-652
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• 2001

비디오흉강경을 이용한 일차성 기흉의 수술은 흉강경, 내시경용감자 그리고 자동봉합기를 위한 3개의 삽입구를 필요로 하였다. 그러나 기흉의 경우에 따라서는 내시경루프를 잘 이용할 경우 2개의 삽입구만으로도 수술이 가능하여 술후 통증 및 흉터의 최소화에도 이바지 할 수 있을 것이다.

• 대한관절경학회지
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• 제7권1호
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• pp.96-99
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• 2003

관절경술의 발달과 반월상 연골판의 기능적 중요성이 강조됨에 따라 반월상 연골판 봉합술은 나날이 발전 되어왔다. 그러나 종래의 기법들은 특별한 기구뿐 아니라 신경, 혈관, 연부조직의 손상을 방지하기 위하여 과다한 피부 절개가 필요하거나, 봉합사 매듭이 관절면에 존재하므로 잠재적인 연골손상의 위험성을 가지고 있었다. 이에 저자들은 spinal needle과 nylon loop를 이용한 변형된 outside-in 기법을 소개하고자 하며, 변형된 outside-in 기법은 안정적이고 간단한 봉합이 가능하면서도 별 도의 피부절개가 필요 없는 장점을 가지고 있다.

• Archives of Plastic Surgery
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• 제40권3호
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• pp.259-262
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• 2013

After skin grafting, to prevent hematoma or seroma collection at the graft site, a tie-over dressing has been commonly used. However, although the conventional tie-over dressing by suture is a useful method for securing a graft site, refixation is difficult when repeated tie-over dressing is needed. Therefore, we recommend a redoable tie-over dressing technique with multiple loops threads and connecting silk threads. After the raw surface of each of our cases was covered with a skin graft, multiple loop silk thread attached with nylon at the skin graft margin. We applied the ointment gauze and wet cotton/fluffy gauze over the skin graft, then fixed the dressing by connecting cross-counter multiple loop thread with connecting silk threads. When we opened the tie-over dressing by cutting the connecting silk threads, we repeated the tie-over dressing with the same method. The skin graft was taken successfully without hematoma or seroma collection or any other complications. In conclusion, we report a novel tie-over dressing enabling simple fixation of the dressing to maintain proper tension for wounds that require repetitive fixation. Further, with this reliable method, the skin grafts were well taken.

• 대한족부족관절학회지
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• 제23권4호
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• pp.216-219
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• 2019

In clinical practice, recurrent Achilles ruptures have been noted to occurr at the original ruptured site. However, reports of new developed fresh rupture of the Achilles tendon in other sites are is extremely rare. Our report is about one uncommon case of a traumatic calcaneal tuberosity avulsion fracture following augmented repair, which was performed using the Krackow locking loop technique. We performed open reduction and intra-osseous fixation using a suture anchor. This procedure was done through the primary longitudinal incision for the calcaneal avulsion fracture fragment. After 6 months of follow-up, our patient has achieved a complete functional recovery and he can normally perform daily and work-related tasks without pain.