The use of imbricated sutures in radioactive plaque brachytherapy surgery

Abstract

This paper describes a new technique to suture the radioactive plaque to sclera. The radioactive plaque is conventionally sutured to the sclera using 5/0 nylon sutures. The imbricated suture technique involves using a 1/0 silk or 2/0 mersilene suture imbricated with the 5/0 nylon suture when the nylon suture is tied and cut. The imbricated suture technique allows easy identification of the plaque at removal and provides a surface that separates the 5/0 nylon from the surface of the eyelet platform, making suture cutting easier and safer. The radiation exposure times ranged from 9.1 minutes to 14 minutes (mean: 10.8 minutes) during plaque insertion and from 2.8 to 3.3 minutes (mean: 3.0 minutes) during plaque removal with the imbricated suture technique. This technique may decrease radiation exposure time and may prevent inadvertent scleral damage.

Keywords: Collaborative Ocular Melanoma Study; Iodine-125; Ruthenium-106; choroidal melanoma; ciliary body melanoma; plaque placement; plaque radiotherapy; plaque removal; radiation exposure; retinoblastoma.

Figure 1.

A) The 1/0 silk suture is imbricated with the 5/0 nylon suture at the time of plaque placement. B) After the 1/0 silk suture has been imbricated, the 5/0 nylon is tied and cut. C) The imbricated 1/0 silk suture is tied about 1 cm above the scleral surface D) The imbricated 1/0 silk suture is then cut. E) Plaque removal: After the conjunctiva is opened the imbricated sutures are easily found under the conjunctiva and followed back to the plaque.