The author routinely performs glenoid neck abrasion and soft tissue debridement with the arthro-scope prior to the open portion of the procedure, but these procedures can be easily performed at the time of arthrotomy as well. Following mobilization of the capsulolabral tissue and aggressive abrasion of the glenoid neck anteriorly and inferiorly, three suture anchors loaded with no. Placement of these suture anchors is critical to reestablishing an anatomically correct labral buttress and proper ligamentous tension.
The suture anchors are placed at the articular margin of the glenoid, and often through the most anterior portion of the articular cartilage. The sutures are then passed through the labrum inferior to the level of the anchor itself, using a horizontal mattress technique.
Tying of the suture effectively shifts the capsulolabral structures superiorly along the articular margin of the glenoid, retensioning these tissues. The subscapularis tendon and underlying capsule are then carefully reapproximated using no. Subcutaneous and skin closure is accomplished in standard fashion. A drain is generally not required. This procedure is routinely performed by the author on an outpatient basis.
Figure 11—1. Open technique for repair of traumatic, recurrent anterior shoulder instability. A Arthroscopic photograph demonstrating a Bankart lesion in a college football player. See Color Plate 11—1A. B Transverse section demonstrating anchor placement at articular edge of glenoid rim.
Retraction of the subscapularis and humeral head allows for excellent access to the anterior glenoid. C Sutures passed through the detached labrum is also shown. D An intraarticular illustration demonstrating the Bankart lesion, with sutures passed inferior to the anchor position on the glenoid. When concern exists over the quality of the tissue, when the patient has no Bankart lesion, or when he has demonstrated an element of multidirectional instability, the subscapularis tendon is released separately from the underlying capsule Fig.
This release is carried out approximately 1 cm medial to the lesser tuberosity with a knife or electrocautery. With the arm externally rotated, the subscapularis is placed under tension and careful release of the subscapularis will allow for identification of the capsule. As one continues through the subscapularis tendon, a change in the orientation and texture of the tissue serves as identification of the underlying capsule.
With careful release of the subscapularis, the capsule can remain intact. Figure 11—2. A Bankart repair carried out through a transverse capsular arthrotomy following overlying release of the subscapularis tendon. B A humeral head retractor allows for visualization of the Bankart lesion.
C Sutures have been passed through the lesion but have not yet been tied. D Following Bankart repair a pants-over-vest capsular plication is carried out by advancing the inferior capsular limb deep to the superior limb. A transverse incision through the midportion of the capsule is then made, extending from the glenoid margin to the insertion of the capsule on the humeral head.
Re-tractors are then placed through this transverse incision and the capsulolabral structures are visualized directly. The Bankart lesion is repaired using three suture anchors placed in a similar fashion to that described when the subscapularis and capsule are released as a unit. However, these sutures are passed outside of the capsule and tied external to it. Following repair of the Bankart lesion, a pants-over-vest closure using no.
The overlying subscapularis tendon is then reapproximated with no. Skin closure carried out in routine fashion. This procedure is carried out on an outpatient basis as well. Finally, when no Bankart lesion is present, a lateral capsulorrhaphy is carried out by simply making a vertical incision along the humeral head after the transverse capsular incision is made Fig.
The inferior flap is shifted superiorly and the superior flap is shifted inferiorly. When a lateral capsular shift is performed, several technical points are important to consider. Release of the capsule inferiorly along the humeral head is necessary to allow for adequate mobilization of the inferior capsular and ligamentous structures.
Release of the capsule inferiorly and around the humeral head is possible with progressive abduction and external rotation of the shoulder. Extreme care must be taken to protect the axillary nerve during release of the capsule. Also, a small cuff of capsular tissue should be retained on the humeral head to allow for suture reapproximation after the capsular shift is performed.
Following release of the capsule in a T-shaped arthrotomy, the position of the arm is important when suturing the capsular flaps down. The position depends at least partly on the necessity for extreme postoperative abduction and external rotation on the part of the patient. Athletes such as football receivers, defensive backs and quarterbacks, as well as baseball pitchers require tremendous abduction and external rotation. The arms of these patients are generally placed in approximately 60 degrees of abduction and 70 degrees of external rotation when the capsular limbs are sutured.
Patients with less demanding requirements for shoulder mobility generally have capsulorrhaphy performed with the arm in approximately 40 degrees of abduction and 45 degrees of external rotation. It is routinely performed by the authors regardless of the technique employed to stabilize the shoulder.
This allows for easier reapproximation after labral repair and makes ligation of the anterior humeral circumflex arteries and veins unnecessary. These arthroscopic suture retrievers are available to most orthopaedic surgeons. They are used in the depths of the arthrotomy to aid in the passage of suture limbs. Anterior Instability: Open Repair Technique. Differential Diagnosis 1. Anterior shoulder instability 2.
Posterior shoulder instability 3. Multidirectional shoulder instability Radiologic Findings An anteroposterior AP , axillary view, and scapular Y view of the shoulder failed to demonstrate any obvious abnormalities. Diagnosis Recurrent Anterior Shoulder Instability. Surgical Management The authors prefer to perform arthroscopy on all patients undergoing stabilization procedures for anterior shoulder instability.
Only gold members can continue reading. Log In or Register to continue. You may also need Posterior Instability: Arthroscopic Repair Technique Anterior Instability: Arthroscopic Repair Technique Posterior Instability: Open Repair Technique Rotator Interval Capsular Lesion Acromioclavicular Joint Separations—Chronic 1.
Greater Tuberosity Fracture 6. Glenoid Rim Fractures Multidirectional Instability. The vest-over-pants closure technique for surgical treatment of bovine umbilical hernia  Asami, K. Kitasato Univ. Lookup at Google Scholar. The vest-over-pants closure technique for surgical treatment of bovine umbilical hernia.
We used the vest-over-pants technique to operate on umbilical hernias in 6 Japanese Black cattle, and 2 Holstein cows that had relapsed after repositioning using the horizontal mattress technique. After surgical removal of the hernia sac, the hernia ring was sutured using No.
Follow-up after discharge showed that all the cases recovered, and none relapsed. Four of the operated cattle exceeded kg body weight. Because of the good results obtained, including in relapsed cases and heavy cattle, it is considered that this type of closure is effective in the surgical treatment of umbilical hernia in cattle.
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|China investment in africa by country||Only gold members can continue reading. The vest-over-pants closure technique for surgical treatment of bovine umbilical hernia  Asami, K. Release of the capsule inferiorly along the humeral head is necessary to allow for adequate mobilization of the inferior capsular and ligamentous structures. Robust, thick capsule and ligamentous tissue, in combination with a prominent labrum and Bankart lesion, is stabilized using a slightly different open operative technique than is a shoulder with poorly defined ligamentous structures with a small Bankart lesion or a shoulder without a Bankart lesion. Glenoid Rim Fractures|
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|Pants over vest suture||The three sister vessels that run inferior to the subscapularis are not routinely ligated. Start Page:. The vest-over-pants closure technique for surgical treatment of bovine umbilical hernia  Asami, K. This information is important to the author L. Athletes such as football receivers, defensive backs and quarterbacks, as well as baseball pitchers require tremendous abduction and external rotation. Surgery is then scheduled following completion of the season. The treatment options for this patient are limited.|
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When the suture material is pulled tight, the wound edges evert. All rights reserved. A form of fibrous joint in which two bones formed in membrane are united by a fibrous membrane continuous with the periosteum. Synonym s : sutura [TA], suture joint. To unite two surfaces by sewing. Synonym s : stitch 3. The material silk thread, wire, synthetic material, etc. The process of joining two surfaces or edges together along a line by sewing. The material, such as thread, gut, or wire, that is used in this procedure.
Medicine a. The fine thread or other material used surgically to close a wound or join tissues. Anatomy The line of junction or an immovable joint between two bones, especially of the skull. Biology A seamlike joint or line of articulation, such as the line of dehiscence in a dry fruit or the spiral seam marking the junction of whorls of a gastropod shell. Published by Houghton Mifflin Company. Synonym s : sutura [TA].
The material silk thread, wire, catgut with which two surfaces are kept in apposition. A length of thread-like material used for surgical sewing or the product of surgical sewing. Sutures are made of many materials including catgut, collagen, linen, silk, nylon, polypropylene, polyester, human FASCIA LATA and stainless steel, and are available in a wide range of thicknesses.
Evaluation of the Joint , a trochleoplasty procedure is recommended to deepen the groove. The block recession is my preferred technique because it maximizes articular cartilage contact between the patella and trochlear groove, particularly near the proximal and distal ends of the groove. Soft tissue techniques alter parapatellar soft tissue tension to help maintain the patella in the trochlear groove. In most cases of patellar luxation, perform these techniques as part of the correction, but not as the sole correction, except in cases of traumatic patellar luxation.
Techniques include:. To reduce parapatellar soft tissue laxity in the joint capsule and muscle fascia opposite the direction of luxation, perform a combination of tissue resection and imbrication. I usually reduce soft tissue laxity while closing my arthrotomy, because I perform the arthrotomy on the side of the stifle on which laxity should be reduced lateral for a medial luxation and medial for a lateral luxation.
To perform this technique:. Figure 5. Imbrication of the fascia lata during closure of a lateral arthrotomy. The lateral imbrication technique is used to treat a medial patellar luxation. The suture pattern is a modified Mayo mattress or vest over pants , which accomplishes imbrication by overlapping the cranial and caudal edges of the fascial incision. The first mattress suture is placed before tightening and tying.
The black, numbered arrows demonstrate the sequence and direction of suture bite passage through the fascial tissue A. The first mattress suture is tied and the second mattress suture placed B. Note the fascial overlap after completed fascial imbrication C. Tibial tuberosity transposition is a surgical technique that moves the attachment of the patellar ligament medially or laterally on the proximal tibia to help keep the patella aligned in the trochlear groove.
Figure 6. Tibial tuberosity transposition during correction of medial patellar luxation. The tibial tuberosity is being transposed laterally; proximal is toward the top in all 4 images. An osteotomy has been created caudal to the tibial tuberosity and crest from proximal to distal arrowhead denotes location of tibial tuberosity. The osteotomy angles slightly cranial as it continues distally and ends near the distal extent of the tibial crest.
The cranial distal tibial cortex and associated fascial attachments have been left intact arrow. In this image A , cranial is to the left. The tibial tuberosity has been transposed laterally and secured using a temporary Kirschner wire placed medial to the tuberosity arrow, B. The stifle is put through range of motion, and the position of the patella is assessed before placing permanent Kirschner wires through the tibial tuberosity. The tibial tuberosity has been stabilized in the laterally transposed position using 2 Kirschner wires placed side by side through the tibial tuberosity arrow, C and into the proximal tibial metaphysis; note the slight axial angulation of the Kirschner wires to ensure good purchase in the tibia.
The Kirschner wires are bent proximally and cut off short D. Choosing which of the described surgical techniques to use in a given patient can be difficult. Most patients do not need to have all 4 of the described correction techniques performed in order to achieve appropriate patellar tracking without luxation.
My approach is to:. Obtain craniocaudal and mediolateral projection radiographs of the stifle joint Figure 7 immediately post-operatively and at the 6- and week recheck appointments. The radiographs should be critically evaluated, specifically:. Figure 7. Postoperative craniocaudal A and mediolateral B projection radiographs of a patient treated with a trochlear block recession and tibial tuberosity transposition to correct medial patellar luxation.
I typically do not place a bandage on the hindlimb, although I do cover the skin incision with an adhesive wound dressing, which I leave in place for the first 3 to 5 days after surgery. Patients are typically kept in the hospital overnight and discharged the day after surgery. Postoperative activity is limited to strict crate rest for 8 weeks after surgery.
Postsurgery recheck examinations are performed at 2, 6, and 12 weeks. Patellar luxation can cause clinically significant hindlimb lameness in cats. Patients with persistent lameness attributable to patellar luxation should be considered candidates for surgical therapy. Surgical treatment of patellar luxation is typically a multistep process.
The exact techniques required vary from patient to patient.
as a double-pass pants-over-vest technique. Each varied suturing method has a role and place in reconstructive foot and ankle surgery or trauma repair. vest-over-pants repair Surgery A method used in surgical correction of inguinal hernias, where the fascia above the hernia is brought down over the fascia. Repair with strong absorbable sutures in a vest- over-pant fashion. Source publication. Figure 1. After removal of all the adhesions to the surrounding soft.