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PubMed1994

[Comparison of surgical techniques and various suture materials for correction of aortic isthmus stenosis].

UNLABELLED: Clinical examination and Doppler ultrasound were performed in 31 children after repair of coarctation of the aorta. Median postoperative follow-up period was 4.5 years. The aim of our study was a comparison of different operation techniques and suture materials. In 16 infants subclavian flap repair had been performed using polydioxanone absorbable sutures (PDS) in 8 cases and polypropylene (Prolene) sutures in the other 8 cases. Resection and end-to-end repair had been carried out in 8 infants using PDS and in 7 using Prolene sutures. Doppler-echocardiographically derived gradients across the reconstructed aorta were significantly lower in infants operated with the subclavian flap technique (p < 0.05). The length of the arm on the side of the subclavian flap operation was shorter (median 1.2 cm), but there were no signs of ischaemic complications. Using PDS sutures the aortic arch and the aortic isthmus were each morphologically significantly wider in both operation techniques. Noninvasive two-dimensional echocardiography demonstrated good anatomical repair and no anastomotic aneurysm formation after aortic repair using polydioxanone. CONCLUSION: Regarding the doppler-echocardiographically derived gradients in the anastomotic region this intermediate follow-up study reveals better results using the subclavian flap technique; absorbable polydioxanone sutures favour normal growth of the anastomotic site without vascular complications.

Anastomosis, Surgical↗
PubMed1996

A prospective study of adult inguinal hernia repairs using absorbable sutures.

A prospective study was conducted over a 5-year period to determine whether inguinal hernia repair could be safely performed with absorbable suture material (polydioxanone) with reference to recurrence rates, wound pain, haematoma formation and wound infection. Analysis is available for 111 operations involving 111 patients. Mean follow-up was 36 (range 21-66) months, with 81 procedures monitored for more than 2 years. Two-layered hernia repair was used in all cases with polydioxanone as the chosen suture material. Mean post-operative stay was 2.1 days, with no hospital wound infections and three haematomas. Review identified 1 wound infection. There have been two recurrences. Preliminary results suggest that hernia repair with absorbable suture materials is comparable to traditional non-absorbable repair in terms of recurrence and associated wound complications. The additional benefit is the absence of foreign material in the wound region following degradation of the absorbable material. This does not appear to compromise the integrity of the hernia repair. Mesh repairs are increasingly preferred to Shouldice-style repairs in elective inguinal hernias. However, we believe that polydioxanone should be the suture material of choice in obstructed or strangulated hernia. A larger study is required to verify this, as well as a longer follow-up period. The use of absorbable material warrants further investigation.

Female↗
PubMed1988

Inflammatory synovial fluid and absorbable suture strength.

The effect of inflammatory synovial fluid upon several absorbable sutures commonly used for meniscus repair was studied by implanting lengths of these sutures into unstable, arthritic rabbit knees and, after varying lengths of time (1-6 weeks), testing their breaking strength. Both polyglactin-910 (Vicryl) and polyglycolic-acid (Dexon) sutures retained only minimal breaking strength 3 weeks after implantation. Chromic gut sutures demonstrated a steady reduction in breaking strength until they retained only 6% of their original strength at 5 weeks and none at 6 weeks. Polydioxanone (PDS) sutures began to lose breaking strength at 2 weeks and retained only 40% of their original strength 5 weeks after implantation. The rate of loss in polydioxanone breaking strength was faster in inflammatory synovial fluid than previously reported in the normal synovial joint. Braided polyester sutures (Mersiline) showed no loss of breaking strength over the duration of this test. While the choice of suture is only one variable influencing the outcome of a meniscus repair, this study demonstrates that only polydioxanone and green braided polyester sutures retain any strength 6 weeks after implantation (the time of immobilization commonly recommended for meniscal repairs). Complete meniscal healing can require several months. In the absence of compelling evidence to the contrary, the use of nonabsorbable suture materials for meniscal repair seems the most appropriate choice.

Absorption↗
PubMedDate not supplied

In vitro loss of tensile strength and elasticity of five absorbable suture materials in sterile and infected canine urine.

The loss of breaking strength and elasticity of five absorbable suture materials (polydioxanone [PDS-II], polyglycolic acid [PGA], polyglactin 910 [PG-910], polyglyconate [GTMC], and chromic gut) after in vitro incubation in sterile, Escherichia coli- and Proteus mirabilis-inoculated canine urine was studied. Biomechanical testing, in a controlled environment, was performed during the 28-day study period. Polydioxanone and chromic gut retained greater than 90% of their original strengths after 28 days of incubation in sterile urine and 87% of original strengths in E. coli-inoculated urine. Polyglyconate retained 24% and 18% of original strength, respectively, after incubation in sterile and E. coli-inoculated urine for 28 days. Polyglycolic acid and PG-910 retained less than 30% of original strength in sterile urine and only 7% in E. coli-inoculated urine after 21 days of incubation. In P. mirabilis-inoculated urine, loss of tensile strength and elongation was significant for all suture materials. Polyglycolic acid and PG-910 lost all strength after 24 hours of incubation. Polydioxanone lost all strength after 7 days of incubation, whereas GTMC retained 19% at day 7. Chromic gut retained 78% at day 7 and 16% after 21 days of incubation, however, the absence of normal phagocytic destruction of chromic gut in this in vitro study may have artificially elevated these values. In sterile urine with chemically modified pH, loss of strength and elongation was greater in alkaline urine than in neutral or acidic urine for all types of suture materials.

Animals↗
PubMedDate not supplied

Evaluation of a vessel-sealing device for small intestinal resection and anastomosis in normal horses.

OBJECTIVES: To compare arterial bursting pressure after vessel closure using a vessel-sealing device (LigaSure Atlas Laparoscopic Sealer/Divider Instrument; Valleylab, Boulder, CO), a ligate-and-divide stapling device (LDS), and 2-0 polydioxanone suture. To evaluate the LigaSure Atlas as a method for ligation of the mesenteric vasculature during small intestinal resection in normal horses. STUDY DESIGN: Experimental study. ANIMALS: Part A: jejunal segments from 19 horses. Part B: 6 horses, aged 1 to 18 years, weighing 330 to 509 kg. METHODS: Part A: Jejunal segments with mesenteric vessels were collected from 19 horses. After closure by 1 of 3 methods (LigaSure Atlas, LDS, 2-0 polydioxanone) arteries were cannulated, and bursting pressure was measured by incrementally increasing intraluminal pressure until failure. Part B: Six horses had jejunal resection and anastomosis using a vessel-sealing device (LigaSure Atlas) to provide hemostasis of the mesenteric vasculature. Horses were monitored clinically for 4 weeks. RESULTS: Part A: Mean +/- SEM bursting pressure after 2-0 polydioxanone ligation (1,014.50 +/- 279.05 mm Hg) was significantly greater than mean bursting pressure after LigaSure (554.25 +/- 228.79 mm Hg), which was significantly greater than the mean bursting pressure after LDS (373.25 +/- 183.69). Part B: No major operative or postoperative hemorrhage occurred after application of the LigaSure Atlas for sealing and transecting mesenteric vasculature during small intestinal resection in normal horses. CONCLUSIONS: The LigaSure Atlas appears to be a safe method for hemostasis of the mesenteric vasculature during small intestinal resection in normal horses. CLINICAL RELEVANCE: Benefits of the LigaSure Atlas vessel-sealing device include reduced time required to provide hemostasis, acceptable arterial bursting pressure, no remaining foreign material, and no risk for ligature slippage. In our experience, use of the LigaSure Atlas during small intestinal resection and anastomosis in horses is safe for ligation of vessels less than or equal to 7-mm diameter.

Anastomosis, Surgical↗
PubMedDate not supplied

Tensile fixation strengths of absorbable meniscal repair devices as a function of hydrolysis time. An in vitro experimental study.

To determine the effect of hydrolysis time on the fixation strength of absorbable meniscal repair devices, adult bovine menisci were repaired with five devices and a suture. The ultimate tensile strength of the repair was then tested in six specimens immediately or after 6, 12, or 24 weeks of incubation at 37 degrees C in a saline solution containing antibiotics, antimycotics, and protease inhibitors. Immediately after implantation the Bionx Meniscus Arrow had a significantly higher failure strength (57.7 +/- 13.8 N) than the Linvatec BioStinger (35.1 +/- 6.7 N), the Innovasive Clearfix screw (34.9 +/- 13 N), the Surgical Dynamics S-D-sorb staple (9.4 +/- 4.6 N), and the Mitek Meniscal Repair System (polydioxanone) (27.2 +/- 6.0 N). However, there was no significant difference between the Bionx Meniscus Arrow and a 2-0 polydioxanone vertical suture (51.6 +/- 2.7 N). The polydioxanone-based implants demonstrated a significant decrease in failure strength at 12 and 24 weeks. Similarly, the Surgical Dynamics S-D-sorb staple lost all fixation strength by 24 weeks. The remaining devices showed no significant loss of failure strength over the 24-week period, suggesting that 24 weeks of hydrolysis does not adversely affect the ultimate holding power of poly L-lactide-based meniscal fixation devices.

Absorbable Implants↗
PubMed1989

Wound sepsis following Ramstedt pyloromyotomy.

Wound sepsis is common following pyloromyotomy in children and in a retrospective study of 178 cases the incidence of wound infection was 21 (11.8 per cent). On preliminary analysis, three variables were associated with wound sepsis: age, duration of projectile vomiting and surgical technique. Only surgical technique was found to be statistically significant on sequential multivariate analysis. Mass closure with polydioxanone was associated with a 1 per cent (one of 70) wound sepsis rate. Wound sepsis after pyloromyotomy is dependent on technique, and mass closure with polydioxanone is recommended. The routine use of tension sutures should be abandoned.

Female↗
PubMed1990

Tissue reactivity and degradation patterns of absorbable vascular ligating clips implanted in peritoneum and rectus fascia.

Absorbable vascular ligating clips are finding increasing use in intraabdominal surgery. We report the results of a light and scanning electron microscope investigation of the tissue reactivity and clip degradation patterns of two such materials, Absolok (polydioxanone) and Lactomer (copolymer of glycolic and lactic acid), implanted in the fascia and peritoneum of rabbits for intervals of 2 to 70 days. Cellular response to the clips, defined as the number of inflammatory cells/10(4) microns 2, was maximum at day 4 postimplantation, then gradually declined as the duration of implantation increased. This pattern, seen with both types of clips, was similar to that seen with polydioxanone (PDS) suture, but significantly greater than that associated with polypropylene (Prolene) suture. Although cellular response to the clips was greater in peritoneum than in fascia, especially on two occasions associated with adhesion formation, this was not statistically significant. Based on our morphological observations, the signs of clip degradation which were indicated by the appearance of surface crazing and cracks occurred earlier in peritoneum than in fascia.

Abdomen↗
PubMed2006

Biomechanical differences resulting from the combination of suture materials and repair techniques.

BACKGROUND: Many suture materials and repair techniques have been applied in clinical tendon surgery. However, no recommendation is available concerning the choice of suture materials and repair techniques except in a few experimental studies. The purpose of the current study is to show the biomechanical difference resulting from the combination of suture materials and repair techniques. METHODS: The gastrocnemius tendons of 24-week-old cattle (diameter 14-16x9-11 mm) were repaired with application of a single locking, multiple locking, single grasping, or multiple grasping technique using a USP2 suture thread of either braided polyblend polyethylene, polyester, polydioxanone, or nylon. Therefore, a total of 16 combinations were made, with eight specimens for each combination. The specimen was set in an Instron tensiometer to measure the gap length after repetitive tensile loading 500 times (10-100 N). RESULTS: The single locking technique using braided polyblend polyethylene provided the smallest gap (4.5+/-0.5 mm). Other techniques using the same material resulted in a large gap (10.0-11.8 mm). The polyester provided a relatively smaller gap length, irrespective of the repair technique (7.4-8.8 mm). Polydioxanone and nylon tended to result in a large gap (9.3-12.3 mm and 8.4-10.6 mm, respectively). CONCLUSIONS: Mechanical properties of each tendon suture depended on the particular combination of suture materials and repair techniques. The combination of braided polyblend polyethylene and single locking technique provided the highest antigap strength.

Animals↗
PubMed2004

The effect of number of throws on knot security with nonidentical sliding knots.

OBJECTIVE: The study was undertaken to test the integrity of nonidentical sliding knots made with 3 throws compared with those made with 6 throws with monofilament and braided absorbable suture. STUDY DESIGN: The 3 throw nonidentical sliding knot was compared with the 6 throw nonidentical sliding knot in 4 different suture groups. The groups were 0-0 polydioxanone, 2-0 polydioxanone, 0-0 polyglactin 910, and 2-0 polyglactin 910. Knots were tested to failure with a tensiometer. The proportion of 3 throw knots becoming untied was compared with the 6 throw knot within each group. Ultimate load required to break tied knots within each suture group was also evaluated. RESULTS: The 3 throw knots had very high rates of knot failure and untied significantly more often than the 6 throw knots. CONCLUSION: The 6 throw nonidentical sliding knot demonstrates superior knot integrity compared with the 3 throw knot with both monofilament and braided absorbable suture.

Female↗
PubMed2004

Effect of human pancreatic juice and bile on the tensile strength of suture materials.

BACKGROUND: Several suture materials are used for pancreatojejunal anastomosis. In this study, we tested the durability of these suture materials in human pancreatic juice and bile. METHODS: Plain and chromic catgut, polyglactin 910, polyglycolic acid, polydioxanone, polypropylene, and silk sutures were incubated in pancreatic juice and bile that was collected from patients. Fifteen samples of each type of suture material were placed in human juices for 1, 3, and 7 days. Tensile strengths were measured with a tensionmeter. RESULTS: Plain and chromic catgut disintegrated in pancreatic juice and pancreatic juice plus bile mixture. Polyglycolic acid and polyglactin 910 suture materials were vulnerable to pancreatic juice within 7 days. Polydioxanone retained most of its initial strength in pancreatic juice and bile. Polypropylene and silk retained 84% and 92% of their initial strength, respectively. CONCLUSIONS: We found that polidioxanone was the strongest suture material in pancreatic juice.

Anastomosis, Surgical↗
PubMed1982

Vascular anastomoses in growing vessels: the use of absorbable sutures.

Primary end-to-end infrarenal aortic anastomoses were performed in 36 piglets using two synthetic absorbable suture materials: polydioxanone and coated polyglactin. Animals were killed at 1, 4, and 11 weeks and 6 months following operation. Each aorta was removed, burst-tested to 300 mm Hg, radiographed, and examined histologically. All anastomoses were patent, and no burst-test failures occurred. Stenosis occurred in 14 of 17 animals at 1 and 4 weeks, respectively. One of 5 animals exhibited stenosis at 11 weeks, and none of the 14 animals had stenosis 6 months postoperatively. Histological examination revealed fibrosis replacing areas of disrupted elastica at 6 months in both suture groups. This study suggests that absorbable suture material, in particular polydioxanone, because of its excellent handling characteristics and prolonged tensile strength retention, will be useful for the repair of vascular and cardiac anomalies where growth of the suture line is required.

Absorption↗
PubMed1998

Growth of the subclavian artery and the anastomosis in Blalock-Taussig shunt: absorbable versus nonabsorbable suture.

BACKGROUND: We evaluated the growth of Blalock-Taussig shunts placed with absorbable suture by cineangiographic findings and long-term results and compared them with those in an earlier group of patients in whom we used nonabsorbable suture. METHODS: Eighty-one patients had postoperative cineangiography 1 year or more after a Blalock-Taussig shunt procedure. From September 1985 to December 1994, 40 patients (group I) underwent a Blalock-Taussig shunt procedure with the use of absorbable polydioxanone suture, and from January 1980 to August 1989, 41 (group II) underwent the same operation with nonabsorbable polypropylene suture. Cineangiograms were reviewed to assess shunt patency and growth of the subclavian arteries and the subclavian artery-pulmonary artery anastomoses. RESULTS: At the Blalock-Taussig shunt operation, mean outer diameters of the subclavian artery and the anastomosis in group I were 3.8 +/- 0.1 mm and 4.1 +/- 0.1 mm, respectively and 3.9 +/- 0.1 mm and 4.0 +/- 0.1 mm in group II. The mean inner diameters of the subclavian artery and the anastomosis measured in postoperative cineangiograms were 7.9 +/- 0.5 mm and 4.6 +/- 0.2 mm, respectively in group I and 6.6 +/- 0.4 mm and 3.1 +/- 0.2 mm in group II. The diameters of both the subclavian artery (p < 0.05) and the anastomosis (p < 0.001) were significantly greater in group I than in group II. Five years after operation, 71.1% +/- 7.4% of patients in group I and 54.8% +/- 8.0% in group II had good palliation. CONCLUSIONS: The use of absorbable polydioxanone suture has an advantage in terms of growth of the diameters of the subclavian artery and the anastomosis in a Blalock-Taussig shunt and may improve the long-term results after this shunt operation in infancy.

Absorption↗
PubMed1996

Stricture incidence related to suture material in hypospadias surgery.

PURPOSE: To report the complication rates after hypospadias surgery, with stratification according to the type of suture used for the urethral anastomosis (rapid/intermediate absorbable v prolonged absorbable.) MATERIAL AND METHODS: During a 7-year period (1986 to 1992), 117 boys aged 5 to 124 months (mean, 14) underwent surgical correction of hypospadias. The urethral anastomoses were performed with chromic sutures before 1987 (n = 15), with polydioxanone (PDS) between 1987 and 1990 (n = 46), and with polyglycolic acid (PgA) after 1990 (n = 56). The patients were separated into two groups: those whose operations were performed before 1987 and after 1990 (using chromic or PgA sutures), and those whose surgery occurred in the intervening 3 years (using PDS). A successful result was defined as good cosmesis without urethral stricture or urethrocutaneous fistula on long-term follow up (mean follow-up period, 15.9 months). RESULTS: Of the cases that had PgA or chromic sutures, 76.1% were corrected in a single operation, as opposed to 50.9% when PDS was used (P = .002). In the chromic/PgA group, 6.8% had strictures, compared with 23.6% of the PDS group (P < .02). This contrast was most evident in cases with pedicled tube flaps; strictures occurred in 43.8% of the PDS group but in only 9.5% of the chromic/ PgA group (P < .02). There was no significant difference in the incidence of postoperative fistulas between the two groups. In some patients, the PDS sutures remained present in the urethra, without absorption, up to 7 months after the initial repair. CONCLUSION: Sutures with rapid or intermediate absorption rates provide the best results for hypospadias surgery. The extreme delay in in vivo absorption of polydioxanone should preclude its use as an interrupted suture in small-caliber urethral anastomoses.

Absorption↗
PubMed1997

Comparison of effects of suture materials on wound healing in a rabbit pyeloplasty model.

OBJECTIVES: To compare the effects of chromic catgut, polyglactic acid, polydioxanone (PDS), and polytrimethylene carbonate suture on urothelial healing in a rabbit model simulating pyeloplasty. METHODS: Pyeloureterotomies were performed on 8-week-old rabbits [12 rabbits (24 renal units) and 3 control rabbits] and closed with interrupted 7-0 sutures. At 10 days, 5 weeks, and 12 weeks postoperatively, we assessed the upper tracts by examining microscopic sections of the renal pelvis and upper ureter. Acute and chronic inflammation, foreign body reaction, and fibrosis/scar formation were assessed blindly and scored from 0 to 4. RESULTS: Histologic evidence of acute and chronic inflammation and foreign body reaction was most severe at 10 days and 5 weeks in pyeloureterotomies closed with chromic catgut. There was mild inflammation in those closed with polyglactic acid at 10 days, but it was minimal in those closed with polyglactic acid, PDS, and polytrimethylene carbonate at 5 and 12 weeks. Reabsorption of polyglactic acid was complete by 5 weeks, but was incomplete with the other three sutures at that time. By 12 weeks, there was persistent suture in 50% of the renal units closed with polydioxanone and in 100% of those closed with polytrimethylene carbonate. No animal developed a renal calculus. CONCLUSIONS: Because of the mild inflammatory response and rapid tissue reabsorption of polyglactic acid in this animal model, this suture appears to be the best suture for pyeloplasty.

Animals↗
PubMed1988

Substitution of the wall of the trachea by absorbable synthetic material.

Synthetic, absorbable tissue proved to supply a valuable "interim support" for an orderly reconstruction of the wall of the trachea during the first three months following surgery. This is in general the result of experiments in which the use of implanted Polyglactin 910 as a substitute material for the tracheal wall of rats and rabbits was tested. Additionally the possibilities for satisfactory stabilization of the tracheal wall by means of Polydioxanon, another synthetic substance, which is absorbed more slowly, were investigated. The experiments were performed in a total of 30 rats and 70 rabbits. Initial attempts to substitute the entire circumference of the tracheal wall in the area of the neck by synthetics resulted in excessive difficulties post-surgically. Frequently substantial stenoses, obstructing respiration, developed. Consequently, patches of substitute material, covering more than half of the circumference of the trachea, were applied. The periods of survival of the animals ranged from one to 23 weeks. Following autopsy and macroscopical inspection, selected specimens were examined histologically by means of light microscopes and scanning electron microscopes. Evaluation of the samples showed progressive lining of the inner surface of the prosthetic patches with connective tissue and subsequent covering with squamous cell epithelium. On the average, approximately six weeks after surgery, ciliated columnar epithelium resembling normal respiratory mucosa developed. Gradually the synthetic fabric was replaced by dense connective tissue, which finally contained newly generated hyaline cartilage also. The very slow rate of dissolution of the polydioxanone material provided sufficient time for the formation of a new, stratified wall of the trachea, maintaining sufficient clearance in the tracheal lumen.

Animals↗
PubMed1993

[Resorbable implant materials in retinal detachment surgery. Initial animal experiment studies].

In detachment surgery after a mechanically stabile chorioretinal scar is at present full scleral indentation no longer mandatory. Following these considerations absorbable scleral implants have been developed and tested in an animal model. Cylindrical pieces of absorbable composite-material with a diameter of 5 mm were sutured as radial scleral explants in 18 rabbits. The composite material consisted of a polyglactin-polydioxanon ratio 7:1. The absorption time for polyglactin is 60 days, for polydioxanon 180 days. The explants produced initially in ultrasonographically measured buckle height between 3.2 and 4.0 mm. The clinical and ultrasonographical follow up study demonstrated a continuous decrease of buckle height. Two weeks after implantation there was a medium height of 2.0 mm after five weeks a medium elevation of 0.5 mm was found. Histopathological examinations showed incidence of a slight resorptive inflammation in the area of the buckle which was not evident after 12 weeks. No scleral infiltration or scleral thinning was found. The promising results have justified controlled clinical trials with the absorbable material which might allow to combine the advantages of silicone sponge explants (precise localization) with those of scleral buckles by inflatible balloons (reversibility).

Absorption↗
PubMed1997

The effect of suturing technique and material on complication rate following hypospadias repair.

Ninety-seven children with distal hypospadias were treated surgically using perimeatal-based flap urethroplasty (Mathieu procedure) in a two and a half years period. A review of the medical records revealed two distinct groups of patients according to the suturing type and suture material. In the first group of 36 patients (group I), neourethra was constructed using 6/0 polyglactine (Vicryl) in a single layer, full-thickness, uninterrupted fashion. Skin flaps were approximated using interrupted simple 5/0 polyglactine (Vicryl) sutures. In the second group of 61 patients (group II), 7/0 polydioxanone (PDS) was used in the urethral anastomosis performed in a subcuticular, uninterrupted fashion. The skin flaps were closed using interrupted simple 5/0 rapidly absorbable polyglactine (Rapid Vicryl) sutures. Patients were followed-up from 6 to 12 months. Urethral or meatal stenosis was not observed in any patient. There was no infectious complication. Urethrocutaneous fistula rate was significantly higher in group I (16.6%) compared to group II (4.9%) (p < 0.01). Complication rate following hypospadias repair can be reduced by the use of a subcutaneous suture technique utilizing polydioxanone suture material in urethroplasties.

Adolescent↗