Releasable Adjustable Suture Technique for Children

Hakim, Ossama M.; El-Hag, Yasser Gaber; Haikal, Mostafa A.

doi:10.1016/j.jaapos.2005.02.015

Cited by 15 publications

(12 citation statements)

References 18 publications

(15 reference statements)

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“…We describe a modification of the existing techniques of adjustable-suture strabismus surgery, [2][3][4][5][6][9][10][11][12][13][14][15][16] which we call the short tag noose adjustable technique. Saunders and O'Neil 11 devised a technique in which postoperative knot tying was required only in patients who underwent adjustment.…”

Section: Commentmentioning

confidence: 99%

“…It is difficult to adjust sutures in children because of the challenge of obtaining the cooperation of a child for postsurgical manipulations. [1][2][3][4][5] Adjustable-suture strabismus surgery requires 2 stages of anesthesia in very young, less cooperative children. 6 Granet et al 7 described a sliding noose technique that allowed for delayed su-ture adjustment.…”

mentioning

confidence: 99%

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Short Tag Noose Technique for Optional and Late Suture Adjustment in Strabismus Surgery

Nihalani

Whitman²,

Salgado³

et al. 2009

Arch Ophthalmol

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Section: Commentmentioning

confidence: 99%

mentioning

confidence: 99%

Short Tag Noose Technique for Optional and Late Suture Adjustment in Strabismus Surgery

Nihalani

Whitman²,

Salgado³

et al. 2009

Arch Ophthalmol

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“…[7] reported a releasable adjustable suture technique on medial rectus recession in fifty infantile esotropia patients, aged 10–94 months. The medial rectus muscle was recessed, reattached to the new sclera site with 2 mm hang back, and was tied.…”

Section: Discussionmentioning

confidence: 99%

“…[456789] However, there was still room for improvement. The aim of this study is to describe and evaluate the application of the pull-string adjustable suture technique in pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

Adjustable suture strabismus surgery in pediatric patients using pull-string technique

Tsai

2017

Taiwan J Ophthalmol

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BACKGROUND/PURPOSE:The concept of adjustable suture has been developed in strabismus surgeries for nearly four decades. This technique is not yet universally embraced by strabismus surgeons, especially in pediatric patients. The aim of this study is to describe and evaluate the application of the adjustable suture with pull-string technique in pediatric patients.METHODS:A retrospective medical record review was conducted for patients aged 18 years and under who received adjustable suture strabismus surgery using short tag sliding noose with pull-string technique. For the analysis, the patients were arbitrarily divided into three age groups: 6 years and younger, between 6 and 12 years, and 12 years and older. Patients were examined at 1 week and 1, 3, and 6 months after surgery.RESULTS:A total of 123 patients were enrolled in this study. The mean age at the time of surgery was 9.4 years, ranging from 0.7 to 18.4 years. Eighteen (14.6%) patients required adjustment and 105 (85.4%) patients did not require adjustment. The average follow-up was 10.2 months (range, 1–48 months). At their final postoperative follow-up, 93 of 123 (75.6%) patients were within 10 prism diopters of orthophoria. The success rates were 77.6% (66/85) in exotropia patients and 71.1% (27/38) in esotropia patients. The success rates were 76.4% (84/110) for those who receive the procedure as primary surgery and 69.2% (9/13) for those who receive the procedure as reoperative surgery. Of the 18 patients who required adjustment, 16 (88.9%) patients were successful. Of the 105 patients who did not require adjustment, 77 (73.3%) patients were successful.CONCLUSION:This study showed that the pull-string technique provided similar success rate compared to those reported in literature in pediatric patients. The pull-string technique is developed to simplify the postoperative adjustments. Many surgeons encounter difficulties to handle the postoperative adjustments, especially when they need to retrieve the buried subconjunctival adjustable sutures. The obstacles are reduced with the aid of pull string. Using the pull-string technique, the surgeon can perform adjustable suture surgeries in any age group with confidence.

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“…Adjustment was performed in the operating room under intravenous propofol sedation or laryngeal mask anesthesia. Hakim et al 44 left the releasable suture in place if the alignment was found to be satisfactory on the first postoperative day, but if adjustment was required, lidocaine hydrochloride 2% jelly was applied to eye for 5 min and adjustment was performed without sedation. Children aged 10 months to 7 years (mean, 2.8 years) were included in their study.…”

Section: Adjustable Sutures In Childrenmentioning

confidence: 99%

Adjustable suture strabismus surgery

Nihalani

Hunter

2011

Eye

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Surgical management of strabismus remains a challenge because surgical success rates, short-term and long-term, are not ideal. Adjustable suture strabismus surgery has been available for decades as a tool to potentially enhance the surgical outcomes. Intellectually, it seems logical that having a second chance to improve the outcome of a strabismus procedure should increase the overall success rate and reduce the reoperation rate. Yet, adjustable suture surgery has not gained universal acceptance, partly because Level 1 evidence of its advantages is lacking, and partly because the learning curve for accurate decision making during suture adjustment may span a decade or more. In this review we describe the indications, techniques, and published results of adjustable suture surgery. We will discuss the option of 'no adjustment' in cases with satisfactory alignment with emphasis on recent advances allowing for delayed adjustment. The use of adjustable sutures in special circumstances will also be reviewed. Consistently improved outcomes in the adjustable arm of nearly all retrospective studies support the advantage of the adjustable option, and strabismus surgeons are advised to become facile in the application of this approach.

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Releasable Adjustable Suture Technique for Children

Cited by 15 publications

References 18 publications

Short Tag Noose Technique for Optional and Late Suture Adjustment in Strabismus Surgery

Short Tag Noose Technique for Optional and Late Suture Adjustment in Strabismus Surgery

Adjustable suture strabismus surgery in pediatric patients using pull-string technique

Adjustable suture strabismus surgery

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