Closing the Fornix Based Conjunctival Flap
Dr. Condon, presents several pearls on incisional architecture and suturing technique for achieving a water-tight Fornix based conjunctival flap closure.
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Comments (13)
As Dr. Condon suggested, the J-974 8-0 Vicryl is an excellent substitute. It is very affordable, the needle works just as well as VAS-100, and the 8-0 is very strong. I've been using it exclusively with consistent results.
Has anyone tried Ethicon TG-140-8 on 9-0 vicryl. In same needle class as VAS-100 on Ethicon chart.
Thank you very much DR. Condon. closing conj in trab. was always headach to me I am sure it is headach for every body who care. Sincerity in transferring knowledge rewarded only by God. Thank you Indeed. Sultan K.
Nice video & technique but....Who needs a water tight closure of the conjunctiva??
Garry, thank you for posting this technique. I have been using it for the last three years after you taught it to me with marvelous results. Everyone needs to use this!! I look forward to trying the J-974. Thanks again, Bret
Garry again. I have recently discovered the Ethicon J-974 8-0 vicryl can be an EXCELLENT stand-in for the 9-0 I suggested. The needle is nearly identical and it is indeed the needle that I've found to be the key in the technique.
Try the 8-0 Vicryl on a BV130-5 by Ethicon. (J401) Again, the needle is bulkier, but sturdy enough to withstand the scleral passes while still giving watertight passes thru the conjunctiva. I even use it initially for my clear cornea retraction suture.
Thank you Garry for the information. We now have the suture and it works beautifully though somewhat expensive!!
Info on the needle and suture: The needle I REALLY like for this is the VAS 100-4 from Ethicon. It is readily available on 9-0 nylon but on vicryl ONLY as special order item # D-8760. Nylon version is affordable. Both work fine but I prefer vicryl because I don't need to remove it. Garry
This closure can also be done using an 8-0 Vicryl on a BV needle. The needle is longer and bulkier than the VAS-100 but creates watertight passes through the conjunctiva and is sturdy enough to withstand the scleral passes required in this technique (unlike the BV-100 needle that comes with a 9-0 Vicryl suture) The 8-0 vicryl is "stringier" and braided but still works. The patients also don't seem to mind the bulkier external knots, in fact since the suture is "softer" than 9-0 vicryl or nylon, the knots may cause less foreign body sensation.
Gary,
correction: it was a 9-0 vicryl on the VAS 100-4
I had my hospital look into getting this suture (10-0 vicryl on VAS 100-4). I was told it was very expensive and they would not order it for me. Has anyone else had a similar experience? Anyone know how much per package or per suture? I've tried this closure with a BV needle and the TG 160-4, neither of which is optimal.