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PubMed2003

Gross growth and regrowth of sutures: reflections on some personal research.

A series of experiments was performed on young monkeys, rabbits, and turtles to study gross sutural growth of bones. Radiopaque implants in conjunction with serial, direct gross, and indirect radiographic measurements were employed. Differences in growth were observed in the monkey among five facial sutures and also the same suture at different times. Growth was greatest at the zygomaticotemporal suture and least at the premaxillomaxillary suture. In the rabbit, the nasal bone side of the frontonasal suture grew about twice as fast as the frontal bone side. In the turtle shell, the midsagittal suture grew faster than the transverse suture. In all of the animals, the rate of sutural growth decreased with an increase in age. No gross regional growth disturbance was noted after resection of the frontonasal, midpalatine, or transpalatine sutures. The frontonasal suture reformed presumably because of the underlying nasomucoperiosteum, as in a cranial suture, presumably because of the underlying dura. After extirpation of the midpalatine suture with the formation of a complete cleft and despite no underlying membrane, a new suture reformed in an eccentric position in a number of instances. Bone growth at sutures is secondary or compensatory to some other factors.

Aging↗
PubMed2002

Deep suturing technique for penetrating keratoplasty.

PURPOSE: To evaluate the effect of a new suturing technique on postkeratoplasty visual rehabilitation time and refractive error. METHODS: Penetrating keratoplasty was performed on 17 eyes with keratoconus using a modified suturing technique. A donor button 8.0 mm in diameter was sutured into a 7.75-mm recipient bed with both deep and superficial sutures. The deep sutures consisted of either a single 16-bite 10-0 nylon running suture (n = 7) or eight interrupted 10-0 nylon cross-stitches (n = 10). These sutures were passed into the mid-stroma of the donor cornea and exited through the donor endothelium, then passed through the endothelium of the recipient cornea and exited from its mid-stroma. Thereby all parts of the deep sutures remained below the corneal surface. To further secure the surgical wound, in each case a running 16-bite 10-0 nylon superficial suture was also placed. Care was taken to maintain the bites of the superficial suture above the level of the deep sutures. The superficial suture was removed 3 months after surgery. Vision and refraction were recorded 1 day and 1 month postoperatively and 1 and 3 months after suture removal. A paired Student test was used to verify the significance of changes in visual acuity and refraction recorded at different examination times. RESULTS: As early as 1 month after surgery, spectacle best-corrected visual acuity 20/40 or more and refractive astigmatism less than 4 diopters (D) were recorded in each eye and maintained with two exceptions at the later examination times. In two patients, postoperative astigmatism increased from 4.5 to 5 D after suture removal. CONCLUSIONS: Deep suturing allowed quick visual rehabilitation while minimizing postkeratoplasty astigmatism in the patients with keratoconus operated on in this series.

Adult↗
PubMed2000

Growth restriction of cranial sutures in the fetal lamb causes deformational changes, not craniosynostosis.

Newborns with in utero cranial vault molding can present with severe forms of plagiocephaly. Intrauterine constraint has been proposed as one cause for craniosynostosis. The purpose of this experiment was to investigate whether rigid plate fixation across a fetal cranial suture, representing a severe form of growth restriction in utero, would lead to cranial suture fusion in a fetal lamb model. Six fetal lambs at 85 to 95 days gestation (term = 145 days) underwent laparotomy, hysterotomy, fetal coronal scalp incision, and miniplate screw fixation across the right coronal suture in utero. Two unoperated twins and four unoperated age-matched lambs were used as controls (n = 12). Animals were killed at both 4 and 8 weeks postoperatively. Fetal head analysis consisted of gross examination, photography, basilar and lateral radiographs, and three-dimensional computed tomographic scans. Cranial suture analysis consisted of imaging by computed tomographic scan (axial and sagittal cuts) and histology of experimentally plated coronal sutures, contralateral nonplated coronal sutures and twin control coronal sutures. Gross examination, radiographs, and three-dimensional computed tomographic analysis of heads with cranial suture plating showed ipsilateral forehead flattening, contralateral forehead bossing, superiorly displaced ipsilateral orbital rim, anterolateral projection of ipsilateral malar eminence, and anterior position of the ipsilateral ear point compared with the contralateral side of the same animal and normal controls. There was no change in nasal root, chin point, or predentition occlusal plane. Although analysis of the plated coronal sutures by computed tomographic scans showed diminished width or even stenosis, the histology revealed narrowed but patent experimental coronal sutures at 4 and 8 weeks. Contralateral, nonplated coronal sutures were not only patent, but widened compared with normal control sutures. This finding may have represented compensatory changes in the contralateral coronal suture caused by growth restriction at the plated suture. These data demonstrate that intrauterine growth restriction across a cranial suture caused by compression plate fixation resulted in deformational skull changes, not craniosynostosis. In addition, these data strongly support a role for in utero positional molding secondary to growth restriction in the maternal pelvis as a cause for nonsynostotic plagiocephaly seen in newborns.

Animals↗
PubMed1998

Dexon and nylon-sutured wound reaction in conjunctival flap after trabeculectomy combined with or without topical application of mitomycin-C.

In this study, rabbits were used to evaluate the sutured wound reaction with Dexon or nylon in the conjunctival flap 1, 4, 7, 14 and 28 days after trabeculectomy surgery with or without the use of mitomycin-C. Four major treated groups were used to compare their wound healing reaction; group 1--nylon-suture and non-mitomycin treatment; group 2--nylon-suture and mitomycin treatment; group 3--Dexon-suture and non-mitomycin treatment; group 4--Dexon-suture and mitomycin treatment. One day after surgery, the number of polymorphs was the greatest most in the nylon-sutured and non-mitomycin treated tissues (86 +/- 2). Four days after surgery, the number of polymorphs was the greatest most in Dexon-sutured and non-mitomycin treated tissues (109 +/- 87). The number of fibroblasts was the greatest most in nylon-sutured and non-mitomycin treated tissues (111 +/- 23). Seven days after surgery, the number of polymorphs was the greatest most in Dexon-sutured and mitomycin treated tissues (32 +/- 12). The number of fibroblasts was the greatest most in nylon-sutured and non-mitomycin treated tissues (126 +/- 15). Fourteen days after surgery, the number of fibroblasts was the greatest most in Dexon-sutured and non-mitomycin tissues (43 +/- 10). The number of goblet cells was the greatest most in nylon-sutured and non-mitomycin treated tissues (4 +/- 2). Twenty-eight days after surgery, the number of fibroblasts was the greatest most in Dexon-sutured and mitomycin treated tissues (40 +/- 15). The number of goblet cells was the greatest most in nylon-sutured and non-mitomycin treated tissues (4 +/- 2). Our conclusions are as follows: 1). The concentration of mitomycin in conjunctival wound edge should be maintained at as low a level as possible because the mitomycin will delay the wound healing process; 2). Nylon material is better than Dexon for conjunctival wound suture because nylon could induce a great quantity of fibroblasts before Dexon did.

Administration, Topical↗
PubMed1999

Long-term results of single continuous suture adjustment to reduce penetrating keratoplasty astigmatism.

PURPOSE: To evaluate the long-term effect of single continuous corneal suture adjustment on reducing penetrating keratoplasty astigmatism after suture removal. METHODS: Patients were identified from the original study of single continuous penetrating keratoplasty suture adjustment to reduce corneal astigmatism who were followed for more than a year after suture removal. A matching unadjusted control group was selected in the same way from those patients in the original study undergoing penetrating keratoplasty during the 2 years before the development of suture adjustment. The corneal astigmatism was compared before adjustment (study group) or <3 months after surgery (control group), >4 months after suture adjustment, and >12 months after suture removal in both groups. RESULTS: A study group of 54 patients with suture adjustment and a control group of 45 patients without suture adjustment were identified. Before suture adjustment, the study group had an average keratometric astigmatism of 6.44 diopters (standard deviation [SD] = 2.51, range = 0.38-12.25), and the control group had 6.38 diopters (SD = 3.29, range = 2.75-16.00, p = 0.536). Compared to that in the unadjusted control group, the average penetrating keratoplasty astigmatism in the suture-adjusted group was reduced by 44.6% (2.36 diopters) 4.5 months after surgery and before suture removal (p = 0.0002) and by 25.4% (1.19 diopters) at least 12 months after suture removal (p = 0.011). CONCLUSION: Postoperative adjustment of a single continuous corneal suture significantly reduces penetrating keratoplasty astigmatism after suture removal.

Adolescent↗
PubMed2006

Triple-loaded single-anchor stitch configurations: an analysis of cyclically loaded suture-tendon interface security.

PURPOSE: This study evaluated the strength and suture-tendon interface security of different suture configurations from triple-suture-loaded anchors. METHODS: A juvenile bovine infraspinatus tendon was detached and repaired by use of 4 different suture combinations from 2 suture anchors: 3 simple sutures in each anchor (ThreeVo anchor; Linvatec, Largo, FL); 2 peripheral simple stitches and 1 central horizontal mattress suture passed deeper into the tendon, creating a larger footprint (bigfoot-print anchor); 2 peripheral simple stitches with 1 central horizontal mattress stitch passed through the same holes as the simple sutures (stitch-of-Burns); and 2 simple stitches (TwoVo anchor; Linvatec). The constructs were cyclically loaded between 10 N and 180 N for 3,500 cycles and then destructively tested. The number of cycles required to create a 5-mm gap and a 10-mm gap and the ultimate load to failure and failure mode were recorded. RESULTS: The ThreeVo anchor was strongest and most resistant to cyclic loading (P < .01). The TwoVo anchor was least resistant to cyclic loading. The stitch-of-Burns anchor was more resistant to cyclic loading than both the bigfoot-print anchor and the TwoVo anchor (P < .03). The ThreeVo, stitch-of-Burns, and TwoVo anchors were stronger than the bigfoot-print anchor (P < .05). CONCLUSIONS: Three simple sutures in an anchor hold better than two simple sutures. Three simple sutures provide superior suture-tendon security than combinations of one mattress and two simple stitches subjected to cyclic loading. A central mattress stitch placed more medially than two peripheral simple stitches (bigfoot-print anchor) configured to enlarge the tendon-suture footprint was not as resistant to cyclic loading or destructive testing as three simple stitches (ThreeVo anchor). CLINICAL RELEVANCE: Placing a central mattress stitch more medially than 2 peripheral simple stitches to enlarge the tendon-suture footprint was not as resistant to cyclic loading or destructive testing as 3 simple stitches.

Animals↗
PubMed1993

A comparison of a new polypropylene suture with Prolene.

The purpose of this paper is to examine the performance of the newly available monofilament polypropylene suture (Surgipro) manufactured by U.S. Surgical and compare it with commercial Prolene sutures for determining the merit of this new suture. Two different sizes of Surgipro sutures were used. They were 4/0 and 0 sizes and were tested in terms of their fundamental properties: level of crystallinity, melting temperature, fiber morphology, and mechanical properties including knot strength and knot security. The effect of three different sterilization methods on the mechanical and fundamental properties of the new polypropylene (PP) sutures was also examined. In general, the new Surgipro sutures performed as good as Prolene sutures in terms of mechanical properties; but there were some differences in fundamental properties between these two types of PP sutures, particularly in finer size PP sutures. The major differences were in interior fiber morphology, level of crystallinity, and melting temperature. Surgipro suture fibers showed homogeneous interior morphology, while Prolene fibers exhibited two distinctive fiber morphologies. These two types of PP suture fibers also responded differently to the three sterilization methods tested. Surgipro sutures are less affected by different sterilization methods than the same size Prolene control. Except for the Co 60 gamma sterilization, Surgipro suture fibers did not exhibit statistically significant differences in tensile breaking strength between sterilized and control. Ethylene oxide and autoclave sterilized Prolene suture fibers, however, showed statistically (p less than 0.05) consistently lower tensile breaking strength than their unsterilized controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Crystallization↗
PubMed1991

A comparison of absorbable suture and argon laser welding for lateral repair of arteries.

Conventional vascular anastomoses between autogenous vessels are performed with nonabsorbable sutures. Recently, use of absorbable sutures and laser-assisted vascular anastomoses has been advocated because of their improved healing characteristics. This study compared arterial repairs with the argon laser, absorbable suture, and nonabsorbable suture for technical characteristics including additional suture and overall success rates, burst strength, and cost. Absorbable and nonabsorbable suture closures were comparable with respect to technique, but laser-assisted vascular anastomosis was technically more demanding and required almost twice as much time for completion. The argon laser successfully closed only 58.6% of the arteriotomies, and 90% of the closures required additional sutures for complete hemostasis. All sutured arteriotomies were successfully completed by use of either absorbable or nonabsorbable suture. Burst strength was similar for all groups, but was uniformly greater than 300 mm Hg for sutured repairs, whereas two of five laser-assisted closures burst below 300 mm Hg. Finally, costs for purchasing ($35,000) and operating ($300/hr.) an argon laser make laser-assisted vascular anastomosis much more expensive than sutured repair. These data suggest argon laser-assisted vascular anastomoses are more technically demanding, less successful, and more expensive than conventional sutured anastomoses when evaluated in large caliber arteries in a canine model. Absorbable suture, however, is comparable to conventional nonabsorbable sutured arterial repairs in expense, handling characteristics, and success rates with the added advantage of eliminating permanent foreign body in the arterial wall when it is absorbed.

Absorption↗
PubMed1999

Bias in clinical trials: the importance of suture technique.

OBJECTIVE: To study the effect on suture technique of introducing a new suture material. DESIGN: Prospective clinical study. SETTING: County hospital, Sweden. SUBJECTS: 224 patients included during the first 10 months of a clinical study that had been designed to compare two suture materials. INTERVENTIONS: Wounds were sutured by a continuous technique. The suture length: wound length ratio was recorded together with details of patients and operations. MAIN OUTCOME MEASURES: The incidence of incisional hernia after 12 months. RESULTS: The mean suture length: wound length ratio was 3.6 (95% confidence interval (CI) 3.4 to 3.9) in wounds closed with the introduced new material and 3.2 (2.9 to 3.4) with the familiar material (p<0.01). With the new material a higher proportion of wounds were sutured at a ratio of 4 or more. Incisional hernias developed in 6% (3 of 50) of wounds sutured with a suture length : wound length ratio of 4 or more and in 22% (26 of 119) if it was less (p = 0.01). The rate of incisional hernia was lower in wounds sutured with the new suture material. CONCLUSION: During the first 10 months of a clinical trial the introduction of a new suture material caused a potential systematic error. The suture technique was more meticulous with the new material and this may have affected the rate of incisional hernia. The suture technique should therefore be monitored in such studies in the future.

Aged↗
PubMed2004

Experimental efficacy study of coated VICRYL plus antibacterial suture in guinea pigs challenged with Staphylococcus aureus.

BACKGROUND: This study evaluated the ability of coated polyglactin 910 suture with triclosan (Coated VICRYL Plus Antibacterial) suture to inhibit the colonization of bacteria on the suture after direct in vivo inoculation challenge with Staphylococcus aureus utilizing a guinea pig model. METHODS: One control suture (4-5 cm) and one test suture (4-5 cm) were implanted subcutaneously in the dorsal-lateral regions (control on the left side, test on the right side, approximately 5 cm apart) in 16 female Hartley guinea pigs (300-400 g) via a 20-gauge catheter. Each implantation site was challenged directly with 2.1 x 10(4) colony forming units (cfu) of Staphylococcus aureus through the indwelling catheter. The test material was coated polyglactin 910 suture with triclosan (2-0, dyed), and the control material was coated polyglactin 910 suture (2-0, undyed). At 48 h, suture articles were explanted and a bacterial enumeration assay was performed. RESULTS: There was a significant difference (p < 0.05) in the number of bacteria recovered between the study groups at 48 h post-implantation. The mean recovery for test sutures was 559 cfu, and the mean recovery for control sutures was 16,831 cfu. Coated polyglactin 910 suture with triclosan provided a 30.5-fold (96.7%) reduction in the number of recovered bacteria compared to standard coated polyglactin 910 suture. CONCLUSIONS: This study demonstrates that coated polyglactin 910 suture with triclosan inhibits bacterial colonization of suture after direct in vivo challenge with S. aureus in a guinea pig model.

Animals↗
PubMed2006

Comparison of complication rates and postoperative astigmatism between nylon and mersilene sutures for corneal transplants in patients with Fuchs endothelial dystrophy.

PURPOSE: The purpose of this study is to evaluate corneal astigmatism and suture-related complications for transplants sutured with nylon and transplants sutured with Mersilene in primary corneal transplants for Fuchs endothelial dystrophy. METHODS: A retrospective, observational, and comparative study between transplants sutured with either nylon 10-0 or 11-0 (n = 108) or Mersilene 11-0 (n = 58) was done. One hundred sixty-six eyes of 140 patients who received a primary penetrating keratoplasty for Fuchs endothelial dystrophy between 1995 and 2001 at the Rotterdam Eye Hospital in Netherlands were included. RESULTS: Overall, transplant survival did not differ between groups (log-rank test; P = 0.24). During the first 2 years after transplantation, significantly lower astigmatism was seen in transplants sutured with nylon (P = 0.03). Transplants sutured with Mersilene had a significantly higher risk of surgical intervention to correct astigmatism or wound dehiscence after transplantation (hazard ratio, 2.83; 95% confidence interval, 1.34-6.01). Time to first infiltrate, metaplasia (marked scarring along the sutures), or cheesewiring was significantly less in the Mersilene group (P < 0.01). There was a tendency toward a higher risk of complications associated with loose or broken sutures in the nylon group (hazard ratio, 2.00; 95% confidence interval, 0.57-6.98), which was more pronounced after 2 years. CONCLUSIONS: During the first years after corneal transplant surgery, Mersilene sutures are associated with a higher risk of complications and more interventions to correct suture-related problems. However, after 2 years, the grafts seem to be able to retain Mersilene sutures with less risk of suture-related complications as compared with grafts with retained nylon sutures. These favorable long-term effects of Mersilene sutures may outweigh its short-term disadvantage in patients with Fuchs endothelial dystrophy.

Aged↗
PubMed2001

Nonresorbable versus resorbable sutures in oral implant surgery: a prospective clinical study.

BACKGROUND: Regarding the Brånemark implant system, nonresorbable sutures have been advocated for reapproximation of the flaps. Fast-absorbable sutures are frequently used in oral surgery, which is convenient for both the patient and the surgeon. It would be advantageous if fast-absorbable sutures are suitable in implant surgery as well. PURPOSE: The purpose of this study was to compare irradiated polyglactin 910 (Vicryl Rapide, Ethicon GmbH, Norderstedt, Germany) suture with a nonresorbable polyfilament suture (Supramid, Schwarz, Resorba GmbH, Nürnberg, Germany) used in oral implant surgery. MATERIALS AND METHODS: The study comprised 101 edentulous patients (52 females, 49 males) who were provided with 350 Brånemark implants. They were randomized to receive either Vicryl Rapide suture (n = 61) or 3-0 Supramid suture (n = 40). The patients were evaluated after 10 days and at the time of abutment surgery. Any wound complications and implant losses were recorded. RESULTS: The implant failure rate at abutment surgery was low (1.2%), and no difference was seen between the two suture groups. A higher incidence of complications (mainly wound dehiscence) was found in the absorbable suture group, especially when a continuous suture was used. CONCLUSIONS: The results of this study indicate that it is possible to use irradiated polyglactin 910 sutures in oral implant surgery without affecting the rate of early implant failure. However, it is recommended to add interrupted "security sutures" if a continuous suture technique is used in combination with fast-absorption suture material.

Absorbable Implants↗
PubMed1996

Effects of diode laser welding with dye-enhanced glue on tensile strength of sutures commonly used in urology.

BACKGROUND AND OBJECTIVE: Tissue welding using laser-activated protein solders may soon become an alternative to sutured tissue approximation. In most cases, approximating sutures are used both to align tissue edges and provide added tensile strength. Collateral thermal injury, however, may cause disruption of tissue alignment and weaken the tensile strength of sutures. The objective of this study was to evaluate the effect of laser welding on the tensile strength of suture materials used in urologic surgery. STUDY DESIGN/MATERIAL AND METHODS: Eleven types of sutures were exposed to diode laser energy (power density = 15.9 W/cm2) for 10, 30, and 60 seconds. Each suture was compared with and without the addition of dye-enhanced albumin-based solder. After exposure, each suture material was strained (2"/min) until ultimate breakage on a tensometer and compared to untreated sutures using ANOVA. RESULTS: The strength of undyed sutures were not significantly affected; however, violet and green-dyed sutures were in general weakened by laser exposure in the presence of dye-enhanced glue. Laser activation of the smallest caliber, dyed sutures (7-0) in the presence of glue caused the most significant loss of tensile strength of all sutures tested. CONCLUSION: These results indicate that the thermal effects of laser welding using our technique decrease the tensile strength of dyed sutures. A thermally resistant suture material (undyed or clear) may prevent disruption of wounds closed by laser welding techniques.

Adhesives↗
PubMed1999

Craniofacial sutures: morphology, growth, and in vivo masticatory strains.

The growth and morphology of craniofacial sutures are thought to reflect their functional environment. However, little is known about in vivo sutural mechanics. The present study investigates the strains experienced by the internasal, nasofrontal, and anterior interfrontal sutures during masticatory activity in 4-6-month-old miniature swine (Sus scrofa). Measurements of the bony/fibrous arrangements and growth rates of these sutures were then examined in the context of their mechanical environment. Large tensile strains were measured in the interfrontal suture (1,036 microepsilon +/- 400 SD), whereas the posterior internasal suture was under moderate compression (-440 microepsilon +/- 238) and the nasofrontal suture experienced large compression (-1,583 microepsilon +/- 506). Sutural interdigitation was associated with compressive strain. The collagen fibers of the internasal and interfrontal sutures were clearly arranged to resist compression and tension, respectively, whereas those of the nasofrontal suture could not be readily characterized as either compression or tension resisting. The average linear rate of growth over a 1-week period at the nasofrontal suture (133.8 micrometer, +/- 50.9 S.D) was significantly greater than that of both the internasal and interfrontal sutures (39.2 micrometer +/- 11.4 and 65. 5 micrometer +/- 14.0, respectively). Histological observations suggest that the nasofrontal suture contains chondroid tissue, which may explain the unexpected combination of high compressive loading and rapid growth in this suture.

Animals↗
PubMed1989

Endocranial suture closure in rhesus macaques (Macaca mulatta).

Endocasts from skulls of 330 rhesus monkeys (Macaca mulatta) of known age are scored for closure of nine bilateral and three unilateral sutures or segments of sutures. A variety of tests reveals a strong relationship between age and stages of suture closure, although increasingly broad confidence intervals prevent sutures from being very useful for precisely aging older macaques. The order in which endosutures begin to close, as well as that in which closure is finally achieved, is determined for macaques, and these sequences compared to those for endosutures of humans (Todd and Lyon, 1924). The basilar suture is the earliest to close, while the masto-occipital and rostral and caudal squamosal sutures achieve closure quite late in both species. On the other hand, humans and macaques differ in their schedules for the sphenofrontal suture and in the initiation of closure for the rostral portion of the squamosal suture. Two sutures close significantly sooner on the right than on the left side (the rostral squamosal and masto-occipital) and asymmetry favoring closure of the right lateral lambdoid suture also approaches significance at the 0.05 level. No sutures close significantly sooner on the left side. It is suggested that macaque sutures may close from the inside out, that endosutures are more sensitive than ectosutures for detecting sequences in which cranial sutures begin to close, and that directional asymmetries in suture closure of macaques may be related to minor asymmetries in brain/skull shape (petalias).

Age Determination by Skeleton↗
PubMed2006

Fusion patterns of craniofacial sutures in rhesus monkey skulls of known age and sex from Cayo Santiago.

Bones of the face and cranial vault meet at sutural boundaries. These sutures are of great importance for craniofacial growth. Although the effects that the sutures have on modulating craniofacial strains have been investigated, how sutural fusion influences primate craniofacial biomechanics and adaptation are less considered. Confounding this problem is the lack of any systematic data on patterns of craniofacial sutural fusion from animals of known age and sex. This study examined the status of 28 sutures in Macaca mulatta skulls from a collection of animals of known age and sex from Cayo Santiago, Puerto Rico. Survival analysis showed that most animals died before all sutures fused. There was high variation in the age at which individual sutures or sutural sections were fused in M. mulatta, and significant differences in the amount of sutural fusion among regions and between males and females. Intensive fusion of sutures took place between ages 5 and 15. Sutures in the facial area tended to be less fused than in the cranial vault. Between adolescence and adulthood, males tended to have more sutural fusion than females, especially in the facial area. These differences might be biomechanical adaptations during ontogeny to craniofacial sexual dimorphism. These findings enrich our understanding of variation in sutural morphology in rhesus monkeys. Comparative information across primate species is essential for understanding the biomechanics of craniofacial form throughout primate evolution.

Adaptation, Physiological↗
PubMed2002

Transforming growth factor-beta 3(Tgf-beta3) in a collagen gel delays fusion of the rat posterior interfrontal suture in vivo.

Postnatal expansion of the intramembranous bones of the craniofacial skeleton occurs as bone growth at sutures. Loss of the bone growth site occurs when the suture fails to form, or when the newly formed sutures become ossified, resulting in premature obliteration. Previous experiments demonstrated that removal of dura mater from fetal rat coronal sutures, or neutralizing transforming growth factor-beta 2 (Tgf-beta2) activity using antibodies resulted in premature obliteration of the suture in vitro. Conversely, addition of Tgf-beta3 to coronal sutures in vitro rescued them from osseous obliteration. To examine whether Tgf-beta3 rescues sutures from obliteration in vivo, a collagen gel was used as a vehicle to deliver Tgf-beta3 to the normally fusing rat posterior interfrontal (IF) suture. Surgery was done on postnatal day 9 (P9) rats, in which collagen gels containing 0, 3, or 30 ng Tgf-beta3 were placed above the IF suture, underneath the periosteum for 2 weeks. By P24, 75-100% of animals in control unoperated, sham-operated, and collagen gel-only groups had fused IF sutures. In contrast, 40% of sutures exposed to 3 ng Tgf-beta3 remained open, while sutures exposed to 30 ng Tgf-beta were similar to controls. By immunohistochemistry, sutures rescued from obliteration by Tgf-beta3 had the same Tgf-beta receptor type II (Tbetar-II) distribution as controls. However, Tgf-beta3-treated sutures had altered Tgf-beta2 and Tbetar-I distribution compared to controls.

Animals↗
PubMed2005

New meniscus repair by an all-inside knot suture technique.

The indications for the all-inside knot suture technique include tears in the red-red zone or red-white zone in the meniscus, and a horizontal tear, a vertical tear, and a peripheral tear. First, find an appropriate place for a suture insertion site with a Kateran needle or a spinal needle. Make sure it exits beyond the tear in the meniscus. Once the insertion site is chosen, a suture is passed into and through the joint. The suture is slowly pulled back. You should be able to feel the tip of the suture come out of the joint capsule. If you want to make a vertical suture to suture the tear, move the suture vertically apex. Then insert the suture back into the joint through the capsule. Make sure the suture stays inside the joint. Find and grab the suture with a punch inserted from the clear cannula. Pull the suture out of the joint through the clear cannula with the punch. Tighten the knot with a knot pusher. Then confirm the stability of the sutured site with the probe. Our all-inside knot suture technique can be performed arthroscopically, allowing reliable repair of the torn meniscus.

Anterior Cruciate Ligament↗