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PubMed1993

[Pre- and postoperative corneal topography after combined single suture and running suture in ECCE. An analysis using the video keratoscope].

In a prospective study with 45 patients undergoing extracapsular cataract extraction (ECCE) with implantation of posterior chamber lens, curvature measurements of the cornea by means of computerized videokeratoscope were taken postoperatively. Analysis of the corneal shape on color-coded topographic maps of astigmatism showed an hourglass-shaped formation in all patients with a main axis in the sense of general astigmatism. Within a 3-mm zone (optical zone) the steepest meridian in all eyes was 96.1 +/- 13.3 degrees with an astigmatism of +4.4 +/- 2.1 D (1st postoperative day). Postoperatively we found that 35.6% of the patients examined had irregular astigmatism that could not be corroborated by the readings from the Javal ophthalmometer. An irregular astigmatism, corneal topographic analysis reveals regions peripheral to the center with a peak corneal refractive power of +43.8 +/- 1.4 D. In contrast to the conventional methods (for example, Javal ophthalmometer, autokeratometer), computerized videokeratoscope analysis provides additional and useful information on the corneal topography after intraocular operations.

Aged↗
PubMed2006

Syneture stainless STEEL suture. A collective review of its performance in surgical wound closure.

Syneture (division of U.S. Surgical, division of Tyco Healthcare, Norwalk, Connecticut, USA) STEEL sutures are monofilament stainless steel sutures composed of 316L stainless steel conforming to ASTM Standard F138 grade 2 (" Stainless steel bar and wire for surgical implant"). STEEL sutures meet all requirements established by the United States Pharmacopeia (USP) for nonabsorbable surgical sutures. Steel sutures are for use in abdominal wound closure, intestinal anastomosis, hernia repair, sternal closure, and skin closure. They are attached to the following types of surgical needles: Roto-Grip Needles and SCC Needle. The sutures and needles are packaged in a Mylar/Tyvek outer envelope. The purposes of this clinical review are two fold. First, we will report the performance of the Syneture STEEL suture product in the largest studies of suture performance ever reported in the literature. In addition, we will provide comprehensive information from the surgical literature that highlights the unique benefits of stainless steel sutures for the following wound closure techniques: sternal fixation, abdominal wound repair, inguinal hernia repair, and skin wound closure. Consorta Inc. (Rolling Meadows, Illinois), a leading healthcare resource management group purchasing organization, and Syneture, jointly with a clinician task force, designed a reproducible surgical evaluation program for needles and sutures in a large cooperative of healthcare systems. Because of the subjective nature of the more commonly used suture selection techniques, a nonexperimental observational study approach was designed to replace perception of performance characteristics with actual clinical experience. In a report involving 19 Consorta shareholder hospitals, they discussed the preliminary part (Phase I) of a large nonexperimental observational study of the clinical performance of surgical needles and sutures. Performance characteristics of the sutures and needles produced by Syneture that were evaluated in 3407 surgical procedures included packaging/ease of opening, needle strength and sharpness, tissue drag, knot security, tensile strength, clinically acceptable determinations, and clinically unacceptable determinations. In this preliminary study, the surgeons concluded that the needles and sutures were clinically acceptable in 98.1% of the evaluations. Armed with this favorable experience, we wanted to expand this observational study to an entirely new group of shareholder hospitals that had a larger number of participating hospitals (Phase I, 19 hospitals; Phase II, 42 hospitals). This more than doubling of hospital observational base dramatically increased the number of patients and performance evaluations. In the Phase II expanded program involving 42 hospitals, the number of patients (8939) and the number of evaluations (25,545) were more than twofold the preliminary study. In the phase I multicentric evaluation of Syneture surgical sutures, the performance of 9266 sutures was evaluated. Of these performance evaluations, 130 evaluations focused on Syneture STEEL sutures. The surgeons were especially pleased by the performance of this suture product, with 129 Syneture STEEL products being judged as clinically acceptable in their performance. Only one Syneture STEEL suture was judged to be unacceptable in its performance, resulting in a 99.2% acceptability rating. In the expanded phase II evaluation of Syneture suture products, the performance evaluation involved 25,545 surgical suture evaluations. The performance of Syneture STEEL sutures was judged in 215 cases. Of these product performance evaluations, 207 were judged to be clinically acceptable in their performance (96.3%). It is important to emphasize that the phase I and phase II observational studies evaluated the performance of other sutures besides monofilament steel sutures. These comprehensive suture and needle performance evaluations included the following additional sutures: Plain Gut, Mild Chromic Gut, Chromic Gut, DEXON II, DEXON S, MAXON, BIOSYN, SOFSILK, SURGILON, BRALON, MONOSOF, DERMALON, SURGIDAC, POLY-SORB, TI.CRON, SURGIPRO, SURGIPRO II, NOVAFIL, VASCUFIL, and FLEXON. Finally, we provide a collective review of the literature that shows the reliable performance of monofilament stainless steel sutures in the following wound closure techniques: sternal fixation, abdominal wound closure, inguinal hernia repair, and skin wound closure.

Humans↗
PubMed2004

CAPROSYN*, another major advance in synthetic monofilament absorbable suture.

CAPROSYN* suture is the latest innovation in monofilament synthetic suture. This suture is prepared from POLYGLYTONE*6211, a synthetic polyester composed of glycolide, caprolactone, trimethylene carbonate, and lactide. The purpose of this study was to compare the biomechanical performance of CAPROSYN* suture to that of CHROMIC GUT suture. The biomechanical performance studies included quantitative measurements of wound security, strength loss, mass loss, potentiation of infection, tissue drag, knot security, knot rundown, as well as suture stiffness. Both CAPROSYN* and CHROMIC GUT sutures provided comparable resistance to wound disruption. Prior to implantation, suture loops of CAPROSYN* had a significantly greater mean breaking strength than suture loops of CHROMIC GUT. Three weeks after implantation of these absorbable suture loops, the sutures had no appreciable strength. The rate of loss of suture mass of these two sutures was similar. As expected, CHROMIC GUT sutures potentiated significantly more infection than did the CAPROSYN* sutures. The handling properties of the CAPROSYN* sutures were far superior to those of the CHROMIC GUT sutures. The smooth surface of the CAPROSYN* sutures encountered lower drag forces than did the CHROMIC GUT sutures. Furthermore, it was much easier to reposition the CAPROSYN* knotted sutures than the knotted CHROMIC GUT sutures. In the case of CHROMIC GUT sutures, it was not possible to reposition a two-throw granny knot. These biomechanical performance studies demonstrated the superior performance of synthetic CAPROSYN* sutures compared to CHROMIC GUT sutures and provide compelling evidence of why CAPROSYN* sutures are an excellent alternative to CHROMIC GUT sutures.

Absorbable Implants↗
PubMed2005

Rotator cuff repair: an ex vivo analysis of suture anchor repair techniques on initial load to failure.

PURPOSE: To determine the best combination of anchors and suture techniques for repairing torn rotator cuff tendons. TYPE OF STUDY: Ex vivo biomechanical investigation. METHODS: Sixty fresh-frozen sheep infraspinatus tendons were repaired using 6 different repair techniques: transosseous sutures with 2 sutures and mattress stitches; 2 suture anchors with 1 suture per anchor using either simple stitches, mattress stitches, or modified Kessler stitches; 2 suture anchors with 2 sutures per anchor using simple stitches; or 5 suture anchors with 1 suture per anchor and a mattress stitch pattern. RESULTS: No difference was identified between transosseous sutures (mean +/- SD, 147 +/- 68 N) and suture anchors (140 +/- 36 N) when 2 mattress stitches were used. The weakest construct with suture anchors was when the tendon was grasped with 2 suture anchors with 1 suture per anchor and a simple stitch pattern (72 +/- 25 N). Repair strength increased 2-fold with 2 suture anchors single loaded and a mattress stitch configuration (140 +/- 36 N; P = .026), 3-fold with 2 suture anchors single loaded and a modified Kessler stitch pattern (204 +/- 32 N; P < .001), and 3-fold with 2 suture anchors double loaded and a simple stitch suture pattern (212 +/- 39 N; P < .001). The highest tensile load was observed with 5 suture anchors in a double-row configuration, single loaded, that grasped the tendon with mattress stitches (336 +/- 59 N; P < .001). CONCLUSIONS: This study shows that in an ovine model, initial rotator cuff repair strength can be enhanced by increasing the number of suture anchors used in the repair and by using anchors that are double loaded with suture and suture configurations that pass more frequently through the tendon. CLINICAL RELEVANCE: The clinical relevance of this ex vivo investigation is that the initial load to failure of a rotator cuff repair may be increased by increasing the number of suture anchors, the number of sutures per anchor, or using suture patterns that grab more adjacent tendon fibers.

Animals↗
PubMed2004

Microfocal CT: a method for evaluating murine cranial sutures in situ.

INTRODUCTION: The murine model is a well-established surrogate for studying human cranial suture biology. In mice, all sutures with the exception of the posterior frontal (PF) suture remain patent throughout life. Histology is regarded as the gold standard for analyzing sutures. On this basis, PF suture fusion begins on day of life 25 and is complete by day 45. Cranial suture histology, however, requires sacrifice of the animal to obtain tissue for analysis. As a result, knowledge of the kinetics of cranial suture fusion is based on a patchwork analysis of many sutures from many different animals. The behavior of a single suture through time is unknown. Our goal is to develop a noninvasive means to repeatedly image mouse cranial sutures in vivo. As a first step, the present study was performed to evaluate microfocal computer tomography (micro-CT) technology for the use of capturing images of a mouse cranium in situ. METHODS: The micro-CT system consists of a microfocal X-ray source and a large format CCD camera optically coupled to a high-resolution X-ray image intensifier, digitally linked to a computer. The PF and sagittal sutures lie in continuity along the midline of the skull. Holes were drilled in the calvaria on both sides of the PF and sagittal sutures of a 45-day-old euthanized mouse. A micro-CT scan of this animal was performed and hundreds of cross-sectional images were generated for the cranium. These images were used to reconstruct three-dimensional volumetric images of the entire cranium. Comparisons were made between (1). the gross specimen and the three dimensional reconstructions; (2). two-dimensional coronal images obtained by micro-CT and those obtained by histology. RESULTS: Analysis of PF and sagittal sutures demonstrated the following: (1). The drilled holes were accurately rendered by micro-CT, when compared to both the gross specimen and the histology. (2). The sagittal suture was found to be patent by both micro-CT and histology. (3). The PF suture is fused by histology, but unexpectedly, the PF suture appears incompletely fused by micro-CT. By micro-CT, however, the anterior and endocranial regions appear more extensively fused than the remainder of the PF suture, a finding consistent with published histologic analysis. CONCLUSIONS: We successfully imaged 45-day-old mouse cranial sutures in situ using micro-CT technology. Precise correlation between histologic sections and radiologic images is difficult, but convincing similarities exist between the gross specimen and images from micro-CT and histology. PF suture fusion in a 45-day-old animal appears different by micro-CT than by histology. One possible explanation for this apparent discrepancy is that suture fusion in histology is determined based on the appearance of bone morphology and not tissue density, as the specimens are necessarily decalcified to section the bone. Micro-CT, on the other hand, distinguishes tissues on the basis of density. Newly forming bone may require bone matrix formation prior to complete calcification; PF suture in 45-day-old mice may be morphologically complete but incompletely ossified. Studies correlating histologic and micro-CT assessment of suture development are underway. Micro-CT appears to be a promising method for noninvasive imaging of mouse cranial suture.

Animals↗
PubMed2000

Running suturing: the ideal length facilitates this task.

BACKGROUND AND PURPOSE: Laparoscopic intracorporeal suturing is difficult, a complex task involving several integrated skills such as needle handling, suturing, and knotting. Running suturing is even more complex in the closed environment secondary to the angles of the suture lines, the tension maintained on the suture line, and the need to secure the ends, including tying a knot from the tail of the suture to the loop of the preceding stitch. We have hypothesized that the ideal suture length facilitates this process, and this study was specifically designed to determine the ideal suture length for an intracorporeal running suture. MATERIALS AND METHODS: Latex phantoms were incised for 1 or 2 cm, and each was marked with black points to indicate suture entrance and exit sites. These marks were placed 2 mm from the incision, starting 2 mm proximally and ending 2 mm distally. Suture lengths could then be varied in direct proportion to the length of the incision, keeping all of these points as constants. The ratios of suture length:incision length were 9:1, 10:1, and 11:1. One surgeon performed all of the running suturing utilizing dry 3-0 coated polyglactin with a tapered SH needle. The times needed to create running suture lines were recorded (seconds), the number of ideal entrance and exit points tabulated, and the number of technical errors (missed movements resulting in prolonged suturing) recorded. RESULTS: The lengths of both the incision and the suture affect the ability to perform laparoscopic intracorporeal running suturing. As the incision increased, the suture:incision ratio of 9:1 resulted in the most efficient results (quickest suturing and fewest errors). In smaller suture lines (1 cm), the ratios 10:1 and 11:1 appeared better. CONCLUSIONS: A suture:incision ratio of 9:1 is best for longer suture lines and 10:1 is better for short suture lines.

Evaluation Studies as Topic↗
PubMed2003

Nasal capsular cartilage is required for rat transpalatal suture morphogenesis.

In the cranial vault, suture morphogenesis occurs when the growing cranial bones approximate and overlap or abut one another. Patency of developing sutures is regulated by the underlying dura mater. Once cranial sutures form, bone growth proceeds from the sutures in response to growth signals from the rapidly expanding neurocranium. Facial sutures do not develop in contact with the dura mater. It was therefore hypothesized that facial suture morphogenesis and bone growth from facial sutures are regulated by tissues with an equivalent role to the dura mater. The present study was designed to test this hypothesis by characterizing the morphology and growth factor expression in developing transpalatal (TP) sutures and their surrounding tissues, and then assessing the role of the overlying nasal capsular (NC) cartilages in maintaining suture patency. TP sutures develop as overlapping sutures, similar to cranial coronal sutures, and expression of Tgf-betas in TP sutures was similar to their distribution in cranial coronal sutures. To establish whether NC cartilages play a role in regulating TP suture morphogenesis, fetal rat TP sutures were cultured with associated attached NC cartilages or with NC cartilages removed. Sutures cultured for upward of 5 days with intact NC cartilages remained patent and maintained their cellular and fibrous components. However, in the absence of NC cartilages, the cellular nature of the sutures was not maintained and they became progressively acellular, with bony bridging across the suture. This finding is similar to that for cranial vault sutures cultured in the absence of dura mater, indicating that NC cartilages play an equivalent role to dura mater in maintaining the patency of developing sutures. These studies indicate that tissue interactions likely regulate morphogenesis of all cranial and facial sutures.

Animals↗
PubMed1993

Sutural biology and the correlates of craniosynostosis.

The purpose of this paper is to provide a new perspective on craniosynostosis by correlating what is known about sutural biology with the events of craniosynostosis per se. A number of key points emerge from this analysis: 1) Sutural initiation may take place by overlapping, which results in beveled sutures, or by end-to-end approximation, which produces nonbeveled, end-to-end sutures. All end-to-end sutures occur in the midline (e.g., sagittal and metopic) probably because embryonic biomechanical forces on either side of the initiating suture tend to be equal in magnitude. A correlate appears to be that only synostosed sutures of the midline have pronounced bony ridging. 2) Long-term histologic observations of the sutural life cycle call into question the number of layers within sutures. The structure varies not only in different sutures, but also within the same suture over time. 3) Few, if any, of the many elegant experimental research studies in the field of sutural biology have increased our understanding of craniosynostosis per se. An understanding of the pathogenesis of craniosynostosis requires a genetic animal model with primary craniosynostosis and molecular techniques to understand the gene defect. This may allow insight into pathogenetic mechanisms involved in primary craniosynostosis. It may prove to be quite heterogeneous at the basic level. 4) The relationship between suture closure, cessation of growth, and functional demands across sutures poses questions about various biological relationships. Two conclusions are provocative. First, cessation of growth does not necessarily, or always lead to fusion of sutures. Second, although patent sutures aid in the growth process, some growth can take place after suture closure. 5) In an affected suture, craniosynostosis usually begins at a single point and then spreads along the suture. This has been shown by serial sectioning and calls into question results of studies in which the affected sutures are only histologically sampled. 6) Craniosynostosis is etiologically and pathogenetically heterogeneous. Known human causes are reviewed. Is craniosynostosis simply normal suture closure commencing too early?(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1996

Chronic loading of polypropylene sutures: implications for breakage after carotid endarterectomy.

This study compared the breaking force of acutely and chronically loaded 6-O and 5-O polypropylene sutures. It also examined the effect of graded injuries on those sutures. Studies were performed on 134 6-O and 5-O polypropylene sutures subjected to acute loads, 312 6-O and 5-O sutures subjected to chronic loads, and 377 6-O sutures subjected to quantitative "pinches" with DeBakey forceps to produce graded injuries before chronic loading. The lowest acute breaking force for 6-O polypropylene was 192 g. This occurred in 1.3% of acutely loaded sutures. The single lowest chronic breaking force for 6-O sutures was between 150 and 175 g, occurring in 5% of chronically loaded sutures. Thus, chronically loaded sutures are more likely to break than are acutely loaded ones. All of the chronically loaded sutures broke within the first 48 hr of loading, resembling the time of breakage in patients. The lowest chronic breaking force for 5-O sutures was 300 g, 71% greater than the 175 g for 6-O sutures. Graded pinches of 6-O sutures with DeBakey forceps increased the risk of breakage with chronic loads even more. All of the above data were related to the forces imposed upon a suture when it is used to close a carotid arteriotomy. Safety ratios were lower for chronically loaded 6-O sutures than for acutely loaded 6-O sutures or for chronically loaded 5-O sutures. When used to close a carotid arteriotomy, 6-O polypropylene has an acceptable safety ratio with respect to acute loads, but this is markedly reduced with chronic loading, producing a small but finite risk of breakage. The safety ratio may be reduced to dangerously low levels if the suture is handled improperly. Use of 5-O sutures would greatly increase the safety ratio of the suture line, both acutely and chronically, when polypropylene is used to close a carotid arteriotomy.

Carotid Arteries↗