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Emily Deschler, Kristina Irsch, Kristina Guyton, David Guyton; Adjustable-suture strabismus surgery: A new, removable, sliding noose. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4711.
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We describe a new removable sliding VicrylTM noose for use in post-operative suture adjustment. This noose slides reliably for adjustment of extraocular muscle surgery and can easily be removed once adjustment has been completed. No excess suture material is left behind, thus reducing discomfort, inflammation, and scarring.
In the laboratory we systematically tested knots with various combinations of turns, wrapping directions, and slip knots to find a knot that was easy to fashion, slid reliably, and released easily. In 2011 we added a third slip knot which effectively prevented inadvertent tightening of the noose during adjustment. If the noose is found to be too tight to slide easily, sliding the noose by grasping the last slipknot loop usually works by loosening the noose slightly.
This knot has served us well, over the last 12 months, in approximately 240 patients, with the only difficulty being when tissue becomes caught in the slip knot loop and prevents release. In that case one of the noose sutures is trimmed flush with the noose knot, and the other suture is pulled forward or backward, usually releasing the noose. Occasionally, when used with tight resections, even this maneuver will not work, and in that case both noose suture ends are trimmed flush with the noose, and the noose knot must be left to resorb.
Our removable sliding VicrylTM noose is easy to fashion, adjust, and remove. After its very first use, we never returned to the cow hitch noose we had used for years. It minimizes the amount of suture material left behind that must be resorbed, and in our hands it has been a welcome aid to adjustable strabismus surgery.
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