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PubMed2005

Cyclic testing of pullout sutures and micro-mitek suture anchors in flexor digitorum profundus tendon distal fixation.

PURPOSE: Little data exist comparing the strength of traditional methods of fixation in a flexor digitorum profundus tendon with the use of a suture anchor. In vitro cyclic testing simulating a passive mobilization protocol was used to compare the repair of a flexor digitorum profundus tendon using a single micro-Mitek anchor (Mitek, Westwood, MA) or a modified Bunnell 2-strand pullout technique using a monofilament or a braided polyester suture. METHODS: Twenty-four fresh-frozen cadaveric fingers were divided randomly into 4 repair groups (n = 6 each): a micro-Mitek with a 3-0 braided polyester suture or a 3-0 monofilament suture, or a modified Bunnell technique with a 3-0 braided polyester suture or a 3-0 monofilament suture. After repair the specimens were loaded cyclically from 2 to 15 N at 5 N/s, for a total of 500 cycles. Gap formation at the tendon-bone interface was assessed every 100 cycles. Samples were tested to failure at the completion of 500 cycles. RESULTS: No specimens failed catastrophically during cyclic testing. A significantly greater gap formed using the monofilament sutures compared with the braided polyester sutures with both repair techniques. Load to failure in the modified Bunnell technique was superior to the micro-Mitek with both suture types. The modified Bunnell technique using a braided polyester suture was superior to the monofilament suture whereas the suture type did not alter the properties of the micro-Mitek repair. CONCLUSIONS: Significant gap formation with the use of a monofilament suture may be of concern. The use of a braided polyester suture when removal of the pullout suture is required as in the Bunnell technique also needs to be considered.

Aged↗
PubMed2002

Strength retention properties of self-reinforced poly L-lactide (SR-PLLA) sutures compared with polyglyconate (Maxon) and polydioxanone (PDS) sutures. An in vitro study.

Recent developments in manufacturing techniques have led to the development of strong bioabsorbable materials such as self-reinforced poly L-lactide (SR-PLLA) sutures. The aim of the study was to investigate the mechanical properties of SR-PLLA sutures in comparison with polyglyconate (Maxon) and polydioxanone (PDS) sutures in vitro. Sutures made of SR-PLLA (0.3, 0.5 and 0.7 mm diameter), Maxon (0.3 and 0.5 mm diameter) and PDS (0.3 and 0.5 mm diameter) were studied by immersion in phosphate-buffered distilled water (pH 7.4) at 37 degrees C for 40 weeks. The breaking force of straight sutures and suture knots was measured. Tensile strength and percentage elongation were calculated. Means, standard deviations, differences between means, and confidence intervals for differences between means were evaluated. SR-PLLA, PDS and Maxon sutures of 0.3 and 0.5 mm diameter were of comparable initial tensile strength. Initial knot tensile strength values were lower than those of their counterpart straight sutures. Maxon sutures had lost their tensile strength by 12 weeks; PDS sutures by 20 weeks. SR-PLLA sutures of 0.3 mm diameter had a strength of 161.6 MPa and those of 0.5 mm diameter had a strength of 134 MPa at 40 weeks. The highest percentage elongation of straight sutures (62.8% and 62%) was exhibited by PDS; the lowest by SR-PLLA (35.6% and 35%). In loop tests, PDS showed the highest percentage elongation (43.7% and 58.1%) and SR-PLLA had the lowest values (19.7% and 33%). SR-PLLA sutures had the most prolonged strength retention in vitro, but the lowest elongation (elasticity). Compared with straight sutures, knots had lower tensile strength and elongation values. SR-PLLA sutures can be applied to the closure of wounds that need prolonged support, such as bone.

Absorbable Implants↗
PubMed1999

[Tissue response in circum-maxillary sutures after transverse palated suture expansion].

OBJECTIVE: This study was carried out to investigate the histological reactions of midfacial sutures induced by transverse palatal suture expansion. METHODS: Nine mongrel dogs of 8-week old were used in the study. Six of them were used as experimental group as described in a previous paper. The additional three served as controls. In the experimental dogs, a NiTi-shape memory alloy (NiTi-SMA) arch wire was used to expand the transverse palatal suture. Tetracycline was injected intramuscularly (50 mg/kg) three days before operation and at the time of sacrifice. Tissue reactions of premaxillo-maxillary suture, transverse palatal suture, zygomatico-maxillary suture, zygomatico-temporal suture and fronto-maxillary suture were observed in undecalcified tetracycline labeled sections and decalcified histological sections. RESULTS: The sutures in normal young dogs showed active bone formation. With the increase of age, the cellular components of the suture decreased. A great amount of new bone apposition was found in the bony front of expanded transverse palatal suture of the experimental dogs. Degenerative changes were found in premaxillo-maxillary suture at the expanded side while the contralateral showed active osteogenesis. Other sutures manifested both bone apposition and deposition due to the irregular interdigitations. CONCLUSION: After expansion, a great amount of new bone formed in the transverse palatal suture and thus the hard palate was lengthened. All the circum-maxillary sutures reacted in different patterns.

Animals↗
PubMed1987

Reduced anastomotic bleeding using new sutures with a needle-suture diameter ratio of one.

Reduction of blood loss from a vascular anastomosis, especially when one is using a polytetrafluoroethylene (PTFE) graft, is of great interest; even when a technically perfect anastomosis has been performed, there can still be significant and often bothersome bleeding from the needle holes. Currently, sutures have a needle-to-suture ratio of 2:1 or 3:1. Two new sutures, one made of PTFE and the other of polypropylene, were designed to have a needle-to-suture diameter ratio of 1:1. Theoretically, this allows the suture to completely fill the graft needle hole and control bleeding. These sutures were evaluated in a heparin-treated canine in vivo model to measure graft needle-hole bleeding. The materials were also tested by an independent laboratory to compare the basic physical characteristics. Twenty centimeters of 6 mm PTFE graft was interposed in an end-to-end fashion to the infrarenal canine aorta. The graft was then transected at its midpoint and a series of end-to-end, graft-to-graft anastomoses were performed with alternate experimental and control sutures. The experimental PTFE suture bled a mean of 12.46 ml per anastomosis. The experimental polypropylene bled 4.32 ml per anastomosis, while a control suture of polypropelene with a needle-to-suture ratio of 1.94 (5-0 prolene with a C-1 needle), produced a mean blood loss of 33.35 ml per anastomosis. These data are based on a total of 82 anastomoses. The results were analyzed with a two-tailed paired t test. As the data indicate, both experimental sutures allowed significantly less bleeding than the controls (p = .05). The testing of physical properties of the suture included diameter, tensile strength, needle pull-off strength, and elongation percent and were performed by an independent laboratory. These findings are included along with subjective evaluations of the sutures' handling qualities. We believe that sutures produced with needle-to-suture ratios of 1:1 greatly reduce graft needle-hole bleeding and will be a useful addition to the vascular surgeon's armamentarium.

Animals↗
PubMed1998

Effect of cranial suture autotransplantation from metopic to coronal suture.

The aim of this study was to determine the outcome of autotransplanting part of the metopic suture to a defect in the coronal suture in a pig model and to explore further the concept of functioning and nonfunctioning recipient sites. The authors harvested 15-mm x 10-mm bone grafts, incorporating a part of the metopic suture, in 10 Yorkshire pigs under general anesthesia. The authors immediately autotransplanted the grafts to a surgically created defect along the line of the coronal suture. Both donor and graft were either covered with pericranium or left bare. Radiopaque titanium markers were inserted to assess growth 1) of the transplanted suture; 2) across both coronal sutures; and 3) across the metopic suture. Serial radiographs were taken immediately after surgery and at 3-week intervals. The pigs were then killed at 21 weeks. The cranium was harvested, and blocks of donor site and graft were taken, incorporating the embedded titanium markers. Histologic analysis confirmed graft take in all pigs. All grafts continued to function as active cranial sutures with no growth disturbance compared with the contralateral coronal suture (P = 0.953). There was also regeneration of the donor defect, as confirmed by histologic analysis, with no growth disturbance across the metopic suture (P = 0.972). Pericranium did not alter graft take or subsequent growth (P = 0.964). However, pericranium resulted in a much smaller defect (P = 0.045). These results show that after autotransplanting a cranial suture to replace another cranial suture, the graft continues to grow and function as a cranial suture to meet the functional demands of the new recipient site. Pericranium has a significant effect on calvarial regeneration but does not affect cranial suture autotransplantation.

Animals↗
PubMed1992

Wound closure and suturing patterns: a vector analysis of suture tension.

When the vectors of force required to close the ideal surgical wound are analysed, it is apparent that suture tension varies with the pattern of suture. For a given closing force, perpendicular interrupted sutures have the least tension. Symmetrical continuous sutures require greater suture tension, and this increases the more the suture is aligned with the direction of the wound. Asymmetrical (perpendicular/diagonal) continuous suturing requires more tension than interrupted sutures but this never exceeds 200%. Symmetrical suturing has slightly less tension than asymmetrical suturing when the spacing is about equal to the width of the suture. However, as the spacing ratio increases to greater than 2, the tension in the symmetrical suture rises very sharply. At a length:width ratio of 4, the symmetrical suture tension is about 70% greater than the same asymmetrical suturing.

Humans↗
PubMed1999

Increased IGF-I and IGF-II mRNA and IGF-I peptide in fusing rat cranial sutures suggest evidence for a paracrine role of insulin-like growth factors in suture fusion.

Premature cranial suture fusion, or craniosynostosis, can result in gross aberrations of craniofacial growth. The biology underlying cranial suture fusion remains poorly understood. Previous studies of the Sprague-Dawley rat posterior frontal suture, which fuses at between 12 and 20 days, have suggested that the regional dura mater beneath the cranial suture directs the overlying suture's fusion. To address the dura-suture paracrine signaling that results in osteogenic differentiation and suture fusion, the authors investigated the possible role of insulin-like growth factors (IGF) I and II. The authors studied the temporal and spatial patterns of the expression of IGF-I and IGF-II mRNA and IGF-I peptide and osteocalcin (bone morphogenetic protein-4) protein in fusing posterior frontal rat sutures, and they compared them with patent coronal (control) sutures. Ten Sprague-Dawley rats were studied at the following time points: 16, 18, and 20 days of gestation and 2, 5, 10, 15, 20, 30, 50, and 80 days after birth (n = 110). Posterior frontal and coronal (patent, control) sutures were analyzed for IGF-I and IGF-II mRNA expression by in situ hybridization by using 35S-labeled IGF-I and IGF-II antisense riboprobes. Levels of IGF-I and IGF-II mRNA were quantified by counting the number of autoradiograph signals per cell. IGF-I and osteocalcin immunoreactivity were identified by avidin-biotin peroxidase immunohistochemistry. IGF-I and IGF-II mRNA were expressed in dural cells beneath fusing sutures, and the relative mRNA abundance increased between 2 and 10 days before initiation of fusion. Subsequently, IGF-I and IGF-II mRNA were detected in the suture connective tissue cells at 15 and 20 days during the time of active fusion. In contrast, within large osteoblasts of the osteogenic front, the expression of IGF-I and IGF-II mRNA was minimal. However, IGF-I peptide and osteocalcin protein were intensely immunoreactive within these osteoblasts at 15 days (during the period of suture fusion). These data suggest that the dura-suture interaction may be signaled in a paracrine fashion by dura-derived growth factors, such as IGF-I and IGF-II. These peptides, in turn, stimulate nearby osteoblasts to produce bone-promoting growth factors, such as osteocalcin.

Animals↗
PubMedDate not supplied

[Surgical treatment of carcinoma of the esophagus: automatic suture versus manual suture].

The authors have reviewed the anastomosis and sutures utilized for the surgical treatment of 38 patients with carcinoma of the esophagus and cardia. They have compared results following the stapled anastomosis and sutures with those following hand sutured procedures (30 anastomosis and 13 sutures) performed by the same group of surgeons. The stapled anastomosis were performed utilizing a new circular stapling device and gastric and jejunal stapled sutures, utilizing Nakayama's clamp. When anastomosis and sutures were performed by hand suturing, standard techniques were utilized. Patients were grouped in three categories: Group I if the gastric or jejunal sutures or the esophagogastric or esophagojejunal anastomosis were hand sutured; Group II wherein both stapled and hand sutures were performed; Group III when the esophageal anastomosis and related sutures were all performed by stapling devices. Different factors with possible adverse effect on suture healing were also studied. The incidence of suture related complications ranged between 4,2 and 29,1% for Group I; 1,8 and 19,2% for Group II; 0 and 16,2% for Group III. The 60-day operative mortality rate was 23% for Group I (8,4-50,9%), 17,64% for Group II (6,4-25,9%) and 0% (0-28,3%) for Group III. It is felt that better results were obtained with stapled sutures.

Esophageal Neoplasms↗
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↗
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↗
PubMed2006

Buried tension sutures: force-tension comparisons of pulley, double butterfly, mattress, and simple interrupted suture patterns.

OBJECTIVES: To compare suture patterns (simple interrupted, modified pulley, horizontal mattress, double butterfly) by use of a novel in vitro model that quantifies force required for closure against tension. STUDY DESIGN: In vitro study. SAMPLE POPULATION: Suture constructs. METHODS: An in vitro suturing frame was constructed with extension springs to provide a standard resistance against movement of 2 panels of loops toward each other. Four different suture patterns were applied to the frame in randomized trials. The frame was affixed to a tensiometer that measured the force required for each suture pattern to close a fixed distance (3.81 cm) at a constant rate (5.08 cm/min) against the tension (0.6 kg/cm) of the extension springs. The closure distance and tension were selected subjectively to mimic tension encountered clinically during wound reconstruction oncologic surgical procedures. RESULTS: The modified pulley suture required the least force to close, followed by the double butterfly, simple interrupted, and horizontal mattress patterns. CONCLUSIONS: The modified pulley suture and double butterfly suture patterns require less force to close a given distance under tension than either simple interrupted or horizontal mattress suture patterns. CLINICAL RELEVANCE: Application of tension relieving suture techniques for fascia, subcutaneous, and buried-knot subdermal suturing should be considered to facilitate direct closure of wounds under tension. Modified pulley and double butterfly suture patterns offer some mechanical advantage by requiring less force to achieve closure compared with other suture patterns that might be used in reconstructive surgery.

Animals↗
PubMed1993

The surgeon's technical skill in suturing: an analysis of the actual suture tracks.

Ideal suturing was defined as advancing a needle along its curvature (needle circle) to minimize tissue trauma, while placing the suture with its intended span and tissue bite in the expected place. Actual suture tracks were analyzed to find the keys to produce such suturing. Correspondence of those tracks to the ideal track was then determined by the span, the initial needle angle (IA) into the tissue, and the center of the needle circle. Eight surgeons with 4-7 years of experience produced 22 ideal sutures in two types of tissue simulants: The entrance and exit points of the needle were level in flat suturing, while the entrance point was slanted 45 degrees for slant saturing. The correspondence was better with slant suturing than flat suturing (P < 0.01). The IA in flat suturing was 49.0 +/- 2.0 (mean +/- SE) degrees versus 33.0 for ideal suturing (P < 0.01), while that in slant suturing was 35.5 +/- 1.9 (P: ns). In conclusion, the IA was the key to good results, and was optimized in slant suturing, which was instinctively utilized in practice by using forceps. The forceps avoided a derangement of suturing stemming from the configuration of the needle employed and from the range of motion of the surgeon's arm (human engineering), while satisfying the surgeons inclination to take a large IA.

Clinical Competence↗
PubMedDate not supplied

The TOTS (temporary outside traction suture): a new technique to allow easy suture placement and improve capsular shift in arthroscopic bankart repair.

We describe a new technique to allow easy placement of anterior sutures and to improve the proximal capsular shift in arthroscopic anterior stabilization of the shoulder, which we call the temporary outside traction suture (TOTS). Two standard portals are used: posterior and anterosuperior. Using a curved suture hook, both the capsule and the labrum are perforated at approximately the 5-o'clock position, and a monofilament suture is passed through the tissues. The suture is first retrieved through the anterior canula and then placed outside the canula. After labrum detachment and glenoid preparation, 1 or 2 further inferior sutures can be placed before the first suture is retrieved inside the canula and used. The technique of the TOTS has many advantages. (1) It allows easy placement of the first suture before the anterior capsule and labrum have been released. This makes this step much more difficult due to the lack of tension in the anterior tissues and anterior subluxation of the humeral head. (2) It allows the surgeon to choose, with accuracy, the amount of capsule taken, according to the severity of the capsular lesions and the degree of capsular laxity. It can also allow anatomic recreation of the anterior band of the inferior glenohumeral ligament (IGHL). (3) By placing tension on the suture, it avoids damaging the anterior capsule and labrum with the shaver and burr while preparing the scapula neck and can aid with haemostasis. (4) Tension on the suture also allows one to easily place 1 or 2 further sutures in a lower position. (5) It avoids entangling the sutures in the canula. (6) It allows one to perform a capsular shift of approximately 10 to 15 mm when the traction suture is retrieved and implanted with an anchor in the 3- or even 2-o'clock position.

Arthroscopy↗
PubMed2000

Double butterfly suture for high tension: a broadly anchored, horizontal, buried interrupted suture.

BACKGROUND: The excision of skin lesions such as tumors, nevi, and scars frequently results in tension on surgical wound margins. This tension is commonly counteracted surgically with buried, intracutaneous, interrupted sutures of absorbable material which are anchored vertically in the corium. METHOD: The horizontal, buried, intracutaneous butterfly suture has been described elsewhere. It is firmly anchored in the corium, everts wound margins, and adapts them nearly as broadly as two vertical sutures. It can also be laid as a double butterfly suture, as described here, and then has the shape of an "8." This double butterfly suture is equivalent to three vertical sutures because of its broad base in the corium. Moreover, it can cope with much greater tension because of its "pulley" effect. A single double butterfly suture usually suffices for small defects, particularly when the wound edges are cut obliquely with a longer rim of epidermis. MATERIALS: We have laid the traditional butterfly suture in more than 35,000 skin lesion excisions since 1985 and the double butterfly suture alone or as a supplement in more than 10,000 sutures since 1992. We use 2-0 to 6-0 polydioxanone for these procedures, since it has proven in trials to be the best-absorbed suture material. RESULTS: In most cases, the resulting scars were narrow and smooth in spite of high tension. Results were unsatisfactory in only 6.2% of procedures. CONCLUSION: The double butterfly suture described here has the advantages of withstanding tension better while everting wound margins and requiring fewer stitches for wound closure. However, it is important that the suture knot be deeply anchored beneath the corium.

Dermatologic Surgical Procedures↗
PubMed1996

Studies in cranial suture biology: part II. Role of the dura in cranial suture fusion.

The biology underlying normal and premature cranial suture fusion remains unknown. The purpose of this study was to investigate the role of the dura mater in cranial suture fusion. In the Sprague Dawley rat model, the posterior frontal cranial suture fuses between 10 and 20 days of postnatal life. The effect of separating the posterior frontal cranial suture from its underlying dura mater with an intervening silastic sheet was studied. Sixty rat pups, age 8 days, were divided into four groups of 15. Group A served as unoperated controls. Group B, the experimental group, underwent craniotomy, dural elevation, and insertion of a silicone sheet between the posterior frontal cranial suture and the underlying dura. Two operative sham groups were included. Group C underwent craniotomy and dural deflection only. Group D underwent craniotomy alone without dural deflection. The rats were sacrificed at 15, 22, and 30 days of age. The results showed that the unoperated animals (group A) demonstrated normal initiation of suture fusion at 15 days and complete fusion by 22 days. Group B animals, with silicone sheet barriers placed, showed persistent patency of sutures at 22 days. Initiation of suture fusion was delayed until 30 days. Sham group C, animals with craniotomy and dural deflection, showed that initiation of fusion was delayed until 22 days with complete fusion by 30 days of age. Sham group D, craniotomy alone, had the same normal temporal sequence of suture fusion as the unoperated control group A. These data indicate that normal cranial suture fusion is delayed when the suture-dural interaction is interrupted by a surgically place barrier or by simple dural deflection. Furthermore, interaction between the dura and the overlying suture appears to direct suture fusion.

Animals↗
PubMed2006

New sutures and suture anchors in sports medicine.

Arthroscopic surgery requires appropriate surgical implants for effective fixation of tendons and ligaments to bone. Biodegradable suture anchors are being used with increasing frequency for various procedures in sports medicine. As companions to these biodegradable suture anchors, new sutures have been developed which possess greater strength and different material properties from the conventional braided polyester suture. Biodegradable polymers currently found in sutures and suture anchors include poly-L-lactic acid, poly-D, L lactic acid, polydioxanone, polyglycolic acid and their copolymers. Suture anchors are now available preloaded with a choice of conventional braided polyester sutures or some version of ultrahigh molecular weight polyethylene ("super") sutures. Most new suture anchors come with 2 sutures. The manner in which these sutures are attached to the anchor varies and may consist of 2 separate eyelets or 2 slots either parallel to one another or at different angles to one another. Some anchors have a very large single eyelet that allows for 2 or more sutures.

Arthroscopy↗
PubMed2004

In vitro murine posterior frontal suture fate is age-dependent: implications for cranial suture biology.

In CD-1 mice, the posterior frontal suture (analogous to the human metopic suture) fuses while all other cranial sutures remain patent. In an in vitro organ culture model, the authors previously demonstrated that posterior frontal sutures explanted immediately before the onset of suture fusion (at 25 days old) mimic in vivo physiologic fusion. In the first portion of this study, the authors defined how early in development the posterior frontal suture fuses in their tension-free, serum-free organ culture system by serially analyzing posterior frontal suture fusion from calvariae explanted at different stages of postnatal development. Their results revealed a divergence of suture fate leading to abnormal patency or physiologic fusion between the first and second weeks of life, respectively, despite viability and continued growth of the calvarial explants in vitro. From these data, the authors postulated that the gene expression patterns present in the suture complex at the time of explant may determine whether the posterior frontal suture fuses or remains patent in organ culture. Therefore, to elucidate potentially important differences in gene expression within this "window of opportunity," they performed a cDNA microarray analysis on 5-day-old and 15-day-old posterior frontal and sagittal whole suture complexes corresponding to the age ranges for unsuccessful (1 to 7 days old) and successful (14 to 21 days old) in vitro posterior frontal suture fusion. Overall, their microarray results reveal interesting differential expression patterns of candidate genes in different categories, including angiogenic cytokines and mechanosensitive genes potentially important in cranial suture biology.

Age Factors↗
PubMed2003

Prospective randomised trial comparing traditional suture technique with the dynamic sliding loop suture technique in the closure of skin lacerations.

OBJECTIVE: The aim of this study was to compare the cosmetic appearance and related complications of selected skin lacerations closed by traditional suture technique with that of the dynamic sliding loop suture technique. DESIGN: Prospective, randomised clinical trial. SETTING: A district general hospital. PARTICIPANTS: Thirty seven eligible patients aged between 16 and 60 years with skin lacerations (no deeper than superficial fascia) to the limbs, trunk, and neck (excluding face and scalp) and with no associated neurovascular or tendon injuries were recruited into the trial. The exclusion criteria used included immunocompromised patients (diabetics, malignancy, renal failure, corticosteroid treatment), primary dermatological conditions (psoriasis, eczema), keloid prone or susceptible patients, and wounds judged unsuitable for primary closure. INTERVENTION: Skin lacerations were randomly allocated to have closure by either the traditional method or by use of the dynamic sliding loop suture method. The trial had ethical approval of the hospital ethics committee and all participants were fully informed of the trial both verbally and by an information leaflet. Written informed consent was obtained before starting the study. MAIN OUTCOME MEASURE: The cosmetic appearance of photographs of wounds immediately after suture removal and at three months were assessed by a general surgeon and an orthopaedic surgeon blinded to the technique used. The 10 point visual analogue cosmesis scale was used for scoring the appearance of the wounds. SECONDARY OUTCOME MEASURE: The presence of wound closure related complications such as infection, dehiscence, suture slippage, wound edge submergence, skin edge necrosis, and haematoma formation were noted and recorded on follow up visits. RESULTS: A total of 37 patients participated in the trial over a period of 18 months. Seventeen patients underwent suture by the traditional technique and 20 by the dynamic sliding loop suture technique. Four patients (all from the traditional group) were lost to follow up and not included in the study. Most wounds healed uneventfully although there was one case of wound infection in each group. Four patients had ligature slippage (three from the dynamic suture and one from the traditional group). Two patients had evidence of skin edge necrosis both from the traditional technique group. A comparison of the healed wounds by two independent assessors blinded to the technique used showed no statistically significant difference observed between the two types of intervention (Wilcoxon matched paired test p>0.05) immediately after suture removal or at three months. Although there was no statistically demonstrable difference, the comparative paired absolute visual analogue scores seemed to consistently show higher values for the sliding loop technique. CONCLUSION: The cosmetic appearance of wounds sutured using the dynamic sliding loop suture technique in this study were not statistically shown to be superior to those sutured using the traditional suture technique although absolute visual analogue scores consistently showed higher values for the sliding loop technique. The significance of this is unclear and may warrant a much larger trial to see if it is a trend that a larger population of participants can help to support or refute with regard to the superiority of this new technique.

Adolescent↗