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Modified Continuous Mucosal Connell Suture for the Pharyngeal Closure After Total Laryngectomy: Zipper Suture.

Haksever M, Akduman D, Aslan S, Solmaz F, Ozmen S - Clin Exp Otorhinolaryngol (2015)

Bottom Line: The surgical suture techniques are not studied so much.This technique is a simple modification of continuous mucosal Connell suture.We named it as zipper suture.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Bursa Sevket Yilmaz Training and Research Hospital, Bursa, Turkey.

ABSTRACT

Objectives: Pharyngocutaneous fistula is a serious complication after total laryngectomy, and there are some risk factors stated in the literature. The surgical suture techniques are not studied so much. The aim of this study is to evaluate the effectiveness of 'modified continuous mucosal Connell suture' on the incidence of pharyngocutaneous fistula after total laryngectomy.

Methods: This is a retrospective case series study based at a tertiary center with 31 patients who underwent total laryngectomy between July 2011 and December 2013. Pharyngocutaneous fistula formation after total laryngectomy was evaluated with the patients who underwent modified continuous mucosal Connell suture for pharyngeal repair.

Results: Pharyngocutaneous fistula was observed in only one patient (3.2%) who had a history of previous radiotherapy, and it was spontaneously healed within 6 days by conservative treatment.

Conclusion: We defined a new suture technique for the pharyngeal repair after total laryngectomy. This technique is a simple modification of continuous mucosal Connell suture. We named it as zipper suture. It is effective in the prevention of pharyngocutaneous fistula for pharyngeal reconstruction after total laryngectomy.

No MeSH data available.


Related in: MedlinePlus

Semi closed pharyngeal defect. Note that oblige position of porteque and needle. Assistant keeps the vicryl in tension to provide inversion of mucosa and not to permit relaxation. (A) Zipper suture on synthetic material. (B) Note that the spontaneous inversion of the edges.
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Figure 3: Semi closed pharyngeal defect. Note that oblige position of porteque and needle. Assistant keeps the vicryl in tension to provide inversion of mucosa and not to permit relaxation. (A) Zipper suture on synthetic material. (B) Note that the spontaneous inversion of the edges.

Mentions: Continuous modified Connell technique (zipper suture) was a simple modification type of continuous Connell suture [6]. The suture material used in all cases was 3/0 vicryl with a round needle. Two points (a and b on one side, a1 and b1 on the corresponding side, Fig. 2B) were determined at the wound edges near (-0.5 mm) and a little distant (-1 mm) to the suture line. These points were not on the same line vertically and horizontally (Fig. 2B). To achieve that, the acceptable distance (shown by χ in Fig. 2B) should be adjusted between every consecutive needle insertion point in horizontal and vertical plane. These points were simply adjusted by the curve of needle in the oblique fashion, with the sense of proportion. Firstly, the needle was inserted from extra mucosal site to the mucosal side at the lateral point, then it was took off from the mucosal side to the extra mucosal side at the medial point in the oblique plane with a single maneuver, while the mucosal edge was gently pinched and lifted with the fine forceps (Fig. 3). We mentioned this sewing pattern as 'far outside in and near inside out' as demonstrated in Fig. 4. Before and after every stitch, the free end of completed suture should be secured in tension by another surgeon to provide spontaneous inversion of the mucosa (Fig. 5). The pharyngeal defect was sutured horizontally with only one-piece of vicryl. When T type closure was required a second vicryl lsuture has been used for the vertical portion (Fig. 6). After the completion of suturing, the free end of vicry lwas knotted tightly to the end of defect to prevent the relaxation. Then, it was supported by second or third layers with single sutures in a manner that does not interrupt the blood supply.


Modified Continuous Mucosal Connell Suture for the Pharyngeal Closure After Total Laryngectomy: Zipper Suture.

Haksever M, Akduman D, Aslan S, Solmaz F, Ozmen S - Clin Exp Otorhinolaryngol (2015)

Semi closed pharyngeal defect. Note that oblige position of porteque and needle. Assistant keeps the vicryl in tension to provide inversion of mucosa and not to permit relaxation. (A) Zipper suture on synthetic material. (B) Note that the spontaneous inversion of the edges.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553361&req=5

Figure 3: Semi closed pharyngeal defect. Note that oblige position of porteque and needle. Assistant keeps the vicryl in tension to provide inversion of mucosa and not to permit relaxation. (A) Zipper suture on synthetic material. (B) Note that the spontaneous inversion of the edges.
Mentions: Continuous modified Connell technique (zipper suture) was a simple modification type of continuous Connell suture [6]. The suture material used in all cases was 3/0 vicryl with a round needle. Two points (a and b on one side, a1 and b1 on the corresponding side, Fig. 2B) were determined at the wound edges near (-0.5 mm) and a little distant (-1 mm) to the suture line. These points were not on the same line vertically and horizontally (Fig. 2B). To achieve that, the acceptable distance (shown by χ in Fig. 2B) should be adjusted between every consecutive needle insertion point in horizontal and vertical plane. These points were simply adjusted by the curve of needle in the oblique fashion, with the sense of proportion. Firstly, the needle was inserted from extra mucosal site to the mucosal side at the lateral point, then it was took off from the mucosal side to the extra mucosal side at the medial point in the oblique plane with a single maneuver, while the mucosal edge was gently pinched and lifted with the fine forceps (Fig. 3). We mentioned this sewing pattern as 'far outside in and near inside out' as demonstrated in Fig. 4. Before and after every stitch, the free end of completed suture should be secured in tension by another surgeon to provide spontaneous inversion of the mucosa (Fig. 5). The pharyngeal defect was sutured horizontally with only one-piece of vicryl. When T type closure was required a second vicryl lsuture has been used for the vertical portion (Fig. 6). After the completion of suturing, the free end of vicry lwas knotted tightly to the end of defect to prevent the relaxation. Then, it was supported by second or third layers with single sutures in a manner that does not interrupt the blood supply.

Bottom Line: The surgical suture techniques are not studied so much.This technique is a simple modification of continuous mucosal Connell suture.We named it as zipper suture.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Bursa Sevket Yilmaz Training and Research Hospital, Bursa, Turkey.

ABSTRACT

Objectives: Pharyngocutaneous fistula is a serious complication after total laryngectomy, and there are some risk factors stated in the literature. The surgical suture techniques are not studied so much. The aim of this study is to evaluate the effectiveness of 'modified continuous mucosal Connell suture' on the incidence of pharyngocutaneous fistula after total laryngectomy.

Methods: This is a retrospective case series study based at a tertiary center with 31 patients who underwent total laryngectomy between July 2011 and December 2013. Pharyngocutaneous fistula formation after total laryngectomy was evaluated with the patients who underwent modified continuous mucosal Connell suture for pharyngeal repair.

Results: Pharyngocutaneous fistula was observed in only one patient (3.2%) who had a history of previous radiotherapy, and it was spontaneously healed within 6 days by conservative treatment.

Conclusion: We defined a new suture technique for the pharyngeal repair after total laryngectomy. This technique is a simple modification of continuous mucosal Connell suture. We named it as zipper suture. It is effective in the prevention of pharyngocutaneous fistula for pharyngeal reconstruction after total laryngectomy.

No MeSH data available.


Related in: MedlinePlus