Cheesewiring

Cheesewiring, or the cheesewire effect, is a term used in medicine to depict the phenomenon wherein cells or the intercellular matrix are dissected or extruded. This occurs due to a material being pressed through a taut element or the tension of a taut element pulling through tissue. Commonly observed in surgical contexts, the effect can both be an intentional technique or a potential complication.

Medical Contexts

Cheesewiring can denote the process where suture material cuts or tears through viscera during suture anastomosis under tension.

Complications

The cheesewire effect can be a consequence of a negative outcome post a procedure. Instances include:

• Tumor growth permeating the apertures of a bowel stent meant for unblocking an obstructed bowel.
• Sutures upholding a transplanted cornea.
• Sutures extracting from a tendon during the treatment of tendon rupture.

Postoperative indications of the cheesewire effect manifest when swelling begins at wound margins. If the suture is observed to have relocated slightly towards the insertion point, it implies the occurrence of cheesewiring. A distinguishing “Y” shaped scar is a hallmark sign. Consequences encompass tissue damage and prolonged recovery for the patient.

Cheesewiring is notably frequent in cornea surgeries due to the eye's delicate tissue. For instance, cheesewiring of the puncta during intubation can arise from myriad causes, such as excessive tension or the formation of scar tissue around the tubing.

Technique for Removal

Cheesewiring, whether intentional or not, can be rectified. The suture's removal involves making a minor incision atop the suture ends, followed by careful extraction using removal suture forceps. Removal can, however, present complications like tissue scarring, ocular hypotony, and hypheama.

Mitigating Cheesewiring Suture Drag

Surgeons can adopt measures to diminish the likelihood of cheesewiring. Considerations involve needle and suture specifications, suture placement, and the inclusion of coating materials to lessen tissue drag. For instance, a tight suture can induce necrosis, especially coupled with considerable edema.

Intentional Usage

Cheesewiring can be deliberately employed in certain surgical procedures. For instance:

• Treating fistulas by placing a suture allowing it to sever the fistula over time.
• In a trabeculectomy, cheesewiring assists in rescuing a failing bleb by mechanically disintegrating the subscleral flap.
• Facilitating endovascular aortic repair by employing the cheesewire technique for fenestrating an intimal flap, alleviating malperfusion in aortic dissection.

See also

• Surgical suture
• List of medical topics
• Cheese knife
• Ligature (medicine)

References

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