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PubMed1986

Effect of renacidin on suture material.

Renacidin solution is used sometimes to irrigate renal units with retained calculi after definitive stone surgery. The effects of this solution on the integrity of suture material utilized to close kidneys have not been determined previously. In an attempt to define the best suture material to use when postoperative renacidin irrigation is contemplated, we studied the effects of this solution on a variety of sutures commonly used in genitourinary surgery.

Benzenesulfonates↗
PubMed1989

A new spacing material for interstitial implantation of radioactive seeds.

Poly-p-dioxanon sutures (PDS) have been common in surgery as an absorbable material for years. After hardening by a particular procedure we use PDS pins as spacer material in interstitial I-125 implantations. The advantages of PDS are the mechanical qualities in contrast to catgut which causes hazards because of its soft consistency. PDS supports the efforts in optimization of seed distribution and dose application in interstitial radiotherapy.

Brachytherapy↗
PubMed2006

Comparison of holding power of metal and absorbable hemostatic clips.

PURPOSE: Metal hemoclips remain in the tissue permanently. Metal clips will interfere with the interpretation of a computed tomography or magnetic resonance imaging scan. Polydixanone polymer clips (Absolak extra clips; Ethicon Endo-Surgery, Cincinnati, OH) are completely absorbable. Absolak extra clips will not interfere with a computed tomography or magnetic resonance imaging scan and will encircle 360 degrees vessels for extra security. The aim of this study was to test the holding strength of the metal hemoclips and Absolak clips and the amount of pressure that will cause slippage of the 2 types of clips. METHODS: The study period was from April 2001 to December 2002 and the study included 74 patients undergoing colectomy. There were 40 men and 34 women. Patient ages ranged from 33 to 86 years (average, 64.5 y). The clips were applied on the dissected vessels of the specimen. Part I of the study was as follows: a rubber band was applied to the protruding part of the clip and a balance weight then was tied onto the rubber band. The weight was increased gradually by 50-g units. The weight that caused slippage of the clip was recorded. Part II of the study was as follows: a correctly sized angiocatheter was inserted individually into the artery and vein and attached to a sphygmomanometer. The intravascular pressure was increased by inflating the balloon of sphygmomanometer and the amount of pressure that caused slippage of the clips was recorded. RESULTS: Part I of the study determined that an artery could hold 406.4 +/- 46.1 g, a vein could hold 247.3 +/- 36.5 g, and both arteries and veins could hold 621.6 +/- 24.9 g without slippage when a single hemoclip was applied. No slippage occurred when an Absolak or double hemoclips were applied to the vessel(s). Part II of the study determined that a hemoclip would slip off of a vein when the pressure was increased to 156.6 +/- 8.4 mm Hg. Double clips would slip off of a vein when the pressure was increased to 257.6 +/- 9.6 mm Hg. No hemoclip slipped off of an artery after application even if the amount of pressure was increased to 300 mm Hg. No Absolak clip slipped off after application to an artery or vein even if the amount of pressure was increased to 300 mm Hg. CONCLUSIONS: Absolak clips can withstand a higher weight than single hemoclips without slipping off of an artery and/or vein. Likewise, Absolak clips can withstand a higher intravascular pressure without slippage than single or double hemoclips when applied to a vein.

Adult↗
PubMed2005

Extramucosal hepaticojejunostomy.

BACKGROUND: The creation of a secure hepaticojejunostomy is an essential skill for any hepatobiliary surgeon. METHODS: We describe a refined technique of sewing the end of the common hepatic duct to the side of the jejunum. The sutures are placed to include all layers of the bowel wall except mucosa. RESULTS: One hundred eighty-five anastomoses were performed over a 6-year period. There were 3 documented leaks, 1 significant anastomotic bleed, and 2 postoperative strictures. There were no deaths. CONCLUSION: This refined technique facilitates accurate placement of sutures by improving vision and results in a well-vascularized watertight connection.

Anastomosis, Surgical↗
PubMed2006

[Subperitoneal inguinal hernioplasty by anterior approach, using a memory-ring patch. Preliminary results].

OBJECTIVE: Incidence of chronic pain is lower following laparoscopic hernioplasty than open surgery, probably due to the location of the patch in the preperitoneal space. But since laparoscopy is more demanding, the rates of complications and recurrences are higher. The aim of this study was to evaluate the results of a procedure consisting of placement of a patch, endowed with some memory of shape, provided by a thin peripheral memory ring, in the preperitoneal space, by inguinal incision, through the hernia orifice, under spinal or local anesthesia. METHODS: The study was carried out in two stages. The first study consisted of evaluating the results of a prosthesis made of a polypropylene mesh endowed with a memory-ring made of a PDS cord (Ethicon SAS, 92787 Issy-les-Moulineaux). The second study evaluated the results of the Polysoft patch manufactured by Bard C degrees (Bard France, 78960 Voisins-le-Bretonneux), according to this concept. RESULTS: The first study involved 129 hernias operated on 126 patients of mean age 60 years (27-84). There were 3 (2.3%) benign complications. With a median follow-up of 24.5 months (12-42), 124 hernias (96%) were evaluated. There were 2 recurrences (1.6%) and 7 cases (5.6%) of chronic pain. The second series involved 150 hernias operated on 139 patients of mean age 60 years (21-94). Four (2.7%) benign complications occurred. The median length of surgery was 36 min (20-60), the median postoperative hospital stay was 1 day (0-5), the median time to return to normal activity was 3 days (0-8) and the median time off work was 18 days (1(30). The patients took paracetamol for 3 days (0-10) and the total units number was 8 (0-28). CONCLUSION: These results suggest that the method, easily reproducible, provides a low rate of complications and recurrences, as well as a low level of postoperative and chronic pain. They are worth being confirmed by a randomised comparison to the laparoscopic and Lichtenstein techniques.

Adult↗
PubMed2006

Sutures and suture anchors--update 2006.

PURPOSE: To evaluate recently introduced sutures and suture anchors for single pull load to failure strength and failure mode. METHODS: Suture anchors were tested in fresh porcine metaphyseal cortex and cancellous troughs with the use of an established protocol. An Instron machine applied tensile loads parallel to the axis of insertion at a rate of 12.5 mm/sec until failure, and mean anchor failure strengths were calculated. The mode of failure (anchor pull-out, suture eyelet cut-out, or suture failure) was recorded. Anchors tested included the BioRaptor 2.9, BioZip, Super Revo, Impact, Allograft cortical anchor, SpiraLok, Herculon, AxyaLoop titanium anchors 3, 5, and 6.5 mm, AxyaLoop bioabsorbable anchors 3, 5, and 6.5, ParaFix titanium anchors 3, 5, and 6.5, ParaSorb BioAnchors 3, 5.5, and 6.5, and Bio-Corkscrew FT. Sutures were also tested through an established protocol for load to failure. Sutures tested consisted of Orthocord, Ultrabraid (White and CoBraid), ForceFiber, Hi-Fi, MagnumWire, and Maxbraid Polyethylene Plus. RESULTS: Mean failure loads were as follows: BioRaptor 238 N, BioZip 366 N, double-loaded Super Revo 486 N, triple-loaded Super Revo 362 N, Impact 202 N, Allograft cortical anchor 240 N, SpiraLok 289 N, Herculon 819 N, AxyaLoop titanium anchors 3.0 (335 N), 5.0 (485 N), and 6.5 mm (465 N), AxyaLoop bioabsorbable anchors 3 (143 N), 5 (395 N), and 6.5 (369 N), ParaFix titanium anchors 3 (335 N), 5 (485 N), and 6.5 (465 N), ParaSorb BioAnchors 3 (143 N), 5.5 (395 N), and 6.5 (369 N), and Bio-Corkscrew FT (260 N). The sutures all broke at the mid point of their tested strands away from the grips. Mean suture strength for No. 2 Orthocord was 92 N; for No. 2 Ultrabraid CoBraid and White, strengths were 265 N and 280 N, respectively; strength for No. 2 Force Fiber was 289 N, for No. 2 Hi-Fi 250 N, for No. 2 MagnumWire 303 N, and for No. 2 Maxbraid Polyethylene Plus 256 N. CONCLUSIONS: Newer suture products showed significant improvements in load to failure values when compared with braided polyester sutures. Higher load to failure values continue to be seen in metal versus biodegradable anchors and in screw-type versus nonscrew designs. CLINICAL RELEVANCE: Surgeons who prefer stronger sutures now have several high-strength suture options from which to choose. Most of the new anchors tested performed very well.

Animals↗
PubMed2005

Repair of an intercalated long bone defect with a synthetic biodegradable bone-inducing implant.

Recombinant human bone morphogenetic protein (rhBMP)-2 in a block copolymer composed of poly-D,L-lactic acid with randomly inserted p-dioxanone and polyethylene glycol (PLA-DX-PEG) as a carrier and porous beta-tricalcium phosphate (beta-TCP) blocks were used to generate a new fully absorbable osteogenic biomaterial. The bone regenerability of the rhBMP-2/PLA-DX-PEG/beta-TCP composite was studied in a critical-sized rabbit bone defect model. In an initial study, a composite of PLA-DX-PEG (250 mg) and beta-TCP (300 mg) loaded with or without rhBMP2 (50 microg) was implanted into a 1.5 cm intercalated bone defect created in a rabbit femur. Defects were assessed by biweekly radiography until 8 weeks postoperatively. The bony union of the defect was recognized only in the BMP-loaded group. To obtain further data on biomechanical and remodeling properties, another BMP-loaded composites group was made and observed up to 24 weeks. All defects were completely repaired without residual traces of implants. Anatomical and mechanical properties of the repaired bone examined by histology, 3-dimensional CT (3D-CT) and mechanical testing were essentially equivalent to the nonoperated-on femur at 24 weeks. These experimental results indicate that fully absorbable rhBMP-2/PLA-DX-PEG/beta-TCP is a promising composite having osteogenicity efficient enough for repairing large bone defects.

Absorbable Implants↗
PubMed2005

Reconstruction of orbital floor fracture with polyglactin 910/polydioxanon patch (ethisorb): a retrospective study.

PURPOSE: We sought to evaluate the effectiveness and the complications related to the use of Ethisorb (resorbable alloplastic material) in the reconstruction of orbital floor fractures. PATIENTS AND METHODS: We retrospectively reviewed the charts of all patients who underwent orbital floor fracture reconstruction with Ethisorb since 2001. We only included patients with a minimum follow-up of 3 months. The following data were recorded for every patient: age, gender, cause of trauma, time from trauma to surgery, signs and symptoms, concomitant ocular injuries, radiographic analysis, pertinent intraoperative findings (including the type of approach), follow-up time, and postoperative complications. RESULTS: Eighty-seven patients were included in the study. Twenty-one patients (24.1%) experienced postoperative complications. Of these, only 3 patients (3.4%) had permanent complications directly related to the Ethisorb membrane (diplopia, enophthalmos). Two of these patients required revision surgery and are discussed in the article. CONCLUSIONS: The results of our study demonstrate the effectiveness of Ethisorb in the repair of small-to-moderate orbital floor fracture defects (up to a maximum size of 2 x 2 cm).

Absorbable Implants↗
PubMed2005

A novel high-resolution magnetic resonance imaging microscopy coil as an alternative to the multislice computed tomography in postoperative imaging of orbital fractures and computer-based volume measurement.

BACKGROUND: Multislice computed tomography (MSCT) has been the modality of choice for postoperative detailed imaging of orbital trauma. Unfortunately, it involves extensive exposition of the lens to radiation, especially when taking multiple readings. Also, it holds beam hardening effects and limited imaging (delineation) of the reconstruction material. Alternative conventional magnetic resonance imaging (MRI) head coils (MRIhc) present reduced differentiation of anatomic structures caused by low signal and artifact appearance. A substantially improved depiction is made possible by a newly introduced MRI microscopy coil (MRImc), used for the first time in this field. PATIENTS AND METHODS: In this prospective study, 32 patients with extended orbital wall fractures (n = 36) were treated surgically using a polydioxanonsulfate (PDS) foil after reconstruction. Postoperatively, imaging was performed using MRImc, conventional MRI, and MSCT to evaluate the different imaging techniques. RESULTS: The position of the PDS foil could precisely be depicted in 29 of 36 fractures by MRImc, whereas by conventional MRI and MSCT the reconstruction material could only be detected in 25 and 24 of 36 fractures, respectively. In contrast to MRIhc, the new microscopy coil allows fast and high resolution imaging and therefore a clear differentiation of eventual postoperative complications (eg, dislocation of the PDS foil with secondary soft tissue entrapment resulting in limitation of ocular movements or enophthalmos). In 13 long lasting symptomatic cases, revision surgery could be avoided because of regular MRImc findings, apart from muscle swelling and hematoma. In 11 cases of inadequate PDS foil position resulting in revision, the mean volume of displaced tissue (VDT) of 0.62 cm3 correlated significantly to an enophthalmos of more than 2 mm. CONCLUSION: In this pilot study, MRImc proved to be highly superior to MRIhc and MSCT in postsurgical orbital imaging, especially for decision making regarding revision surgery.

Adolescent↗
PubMed2006

Creep behavior of commonly used suture materials in abdominal wall surgery.

BACKGROUND: The incidence of incisional hernia after abdominal wall closure is high. Furthermore, recurrence is a significant complication after correction of all abdominal wall hernias. Besides surgeon- and patient-related factors, in this experimental study a third factor, i.e., creep behavior of suture materials, is introduced and evaluated. MATERIALS AND METHODS: Creep measurements were performed on 0 and 2-0 Prolene (Ethicon, Johnson & Johnson Intl., Somerville, NJ) and 1 and 2-0 PDSII (Ethicon, Johnson & Johnson Intl.) sutures. Two different loads were used representing normal intra-abdominal pressure (IAP) and pathological IAP. A mean percentage of elongation was calculated for each type of suture material. Statistical analysis was performed using analysis of variance. RESULTS: All suture materials showed significant (3-51%) creep behavior. Prolene sutures showed more creep than PDSII sutures in both loading conditions. CONCLUSIONS: As significant creep was demonstrated for commonly used suture materials, creep might be a significant influential factor with regard to the etiology of incisional hernias and recurrence after abdominal wall hernia repair.

Abdominal Wall↗
PubMed1986

Urolithiasis on absorbable and non-absorbable suture materials in the rabbit bladder.

Absorbable and non-absorbable suture materials were evaluated for calculi formation and tissue reactivity in the rabbit bladder. Five-O chromic, polydioxinone and polypropylene sutures were used to close cystostomies made in New Zealand white rabbits. Bladders were evaluated at 15, 30, 60 and 90 days. Calculi formed on all sutures tested and the persistence of calculi appeared to be dependent on the longevity of the suture material used. This data suggests that the use of non-absorbable suture material in urologic surgery may contribute to calculus formation.

Animals↗
PubMed1996

Biodegradable pins versus Kirschner wires in hand surgery.

We compared biodegradable pins with standard Kirschner wires in the fixation of fractures, arthrodeses and osteotomies in the hand in a prospective, randomized study. Eleven patients were allocated to the biodegradable pin group and 12 to the Kirschner wire group. Age, gender, operative procedure and postoperative treatment did not differ in the two groups. All patients were evaluated after 6 months. No differences in time to union or complication rates were found, but the number of additional operative procedures in the Kirschner wire group significantly exceeded the number needed in the biodegradable pin group.

Adult↗
PubMed1997

Load to failure of common meniscal repair techniques: effects of suture technique and suture material.

Success of meniscal repair with early or immediate motion depends on the ability of the suture fixation to withstand the loads applied. Vertical and horizontal mattress suture techniques were tested using 2-0 Ethibond, and 0-PDS and 1-PDS sutures (Ethicon, Somerville, NJ). Mulberry knot technique was tested with 0-PDS and 1-PDS sutures. Twenty menisci (60 sutures) were tested for each suture material. Sutures were placed 3 to 4 mm from the peripheral edge of the meniscus with double barreled cannulas for vertical and horizontal mattress techniques or a spinal needle for the mulberry knot technique, reproducing clinical techniques of meniscal repair. Mechanical testing of suture fixation was performed to failure at a rate of 10 mm/min on a MTS material testing system (MTS Systems Corp, Minneapolis, MN). Suture pullouts were reported as the load displacement to failure from the inner fragment only, because clinical failure would ensue should a suture pull through the inner fragment of a tear. Vertical mattress technique with 1-PDS suture had significantly greater load to failure than any other combination (P < .05). Analysis of variance showed that the vertical mattress technique had statistically superior pullout strength (P < .0001) compared with the horizontal mattress and mulberry knot techniques, which were statistically similar. There were significant differences (P < .0001) between suture types, with 1-PDS proving best compared with 0-PDS, which was stronger than 2-0 Ethibond. Selection of suture material had the greatest impact on vertical mattress load to failure and was not important to the strength of the other techniques.

Analysis of Variance↗
PubMed1997

Osteochondritis dissecans of the patella: arthroscopic fixation with bioabsorbable pins.

Osteochondritis dissecans of the patella is a relatively rare condition. Surgical treatment has been recommended for those patients who fail conservative treatment, or who present with mechanical symptoms or loose bodies. In an attempt to preserve the patellofemoral articulation, we describe a new technique to arthroscopically fix osteochondritic lesions of the patella using bioabsorbable pins. This technique avoids the morbidity of a formal arthrotomy as well as the complications associated with metallic hardware.

Arthroscopy↗
PubMed1999

Modified Caspari technique for traumatic anterior shoulder instability: comparison of absorbable sutures versus absorbable plus nonabsorbable sutures.

The efficacy of the Caspari technique using a combination of absorbable and nonabsorbable sutures was compared with that of using only absorbable sutures. Forty-four patients (45 shoulders) underwent our modified Caspari technique for traumatic anterior shoulder instability and were followed-up for 2 to 3 years postoperatively. The average age at operation was 22 years. Among 27 patients treated using all absorbable PDS sutures, 7 patients had recurrent instability (success rate, 74%). Among 18 patients treated using both PDS and nonabsorbable polypropylene sutures, only one showed apprehension after a direct blow to the shoulder sustained by falling from a height (success rate, 94%). The mean stability score according to Rowe's criteria was significantly higher in the combination of absorbable and nonabsorbable group (P = .0412). External rotation increased more slowly in the combination of absorbable and nonabsorbable group than in the absorbable group. The mean limitation of external rotation was 8.4 degrees and 2.7 degrees, respectively (P = .0129). The modified Caspari technique using both absorbable and nonabsorbable sutures achieved excellent stability according to Rowe's criteria and external rotation showed more gradual improvement compared to repair with absorbable sutures alone.

Absorbable Implants↗