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PubMed2006

The strength of suture configurations in arthroscopic rotator cuff repair.

PURPOSE: This study evaluated the strength of different suture configurations with the use of a recently introduced arthroscopic suture passer (ExpressSew; Surgical Solutions, Valencia, CA). METHODS: The ultimate tensile strength and mode of failure of each suture configuration were repeatedly tested on a validated porcine rotator cuff tendon model, with the use of standard suture material (No. 2 FiberWire [Arthrex, Naples, FL]) passed with ExpressSew and tested on a Hounsfield digital tensiometer type H20K-W (Tinius Olsen, Hersham, PA). RESULTS: The strongest construct was 2 mattress sutures (mean, 169 N; standard deviation, 56.1 N); this was followed in strength by a single modified Kessler suture (mean, 161 N; standard deviation, 16.9 N), 4 simple sutures (mean, 155 N; standard deviation, 27.3 N), and finally, a single Mason-Allen suture (mean, 140 N; standard deviation, 28.6 N). CONCLUSIONS: Study results show little difference in strength for varying complexities of suture configurations. In simple terms, no demonstrable difference was seen in the strength of construct, whether the surgeon used 4 simple sutures, 2 mattress sutures, or 1 grasping suture. CLINICAL RELEVANCE: This study allows the surgeon to justify use of the simplest configuration of suture passage that works in his hands, for the purpose of attaining a reliable and repeatable repair of the rotator cuff through arthroscopic methods.

Animals↗
PubMed1998

Combined interrupted and continuous versus single continuous adjustable suturing in penetrating keratoplasty: a prospective, randomized study of induced astigmatism during the first postoperative year.

OBJECTIVE: To compare postoperative astigmatism induced by two different suturing techniques in penetrating keratoplasty (PKP). DESIGN: A monocenter, prospective, randomized clinical trial with a longitudinal 1-year follow-up. PARTICIPANTS: A total of 95 eyes undergoing PKP were randomized into 2 groups. Of these, 51 eyes were allocated to the combined interrupted and continuous suturing group (ICS) and 44 eyes to the single continuous adjustable suturing (SCAS) group. INTERVENTION: In the ICS group, suturing was with a combination of 12 interrupted 10-0 nylon and 1 continuous 11-0 nylon sutures. Eyes in the SCAS group had been sutured with a single running 24-bite 10-0 nylon. Selective suture removal started no earlier than 10 weeks after surgery; suture adjustment could start as soon as possible after surgery. MAIN OUTCOME MEASURES: Astigmatism was measured by topography, keratometry, and refraction at 3-, 6-, 9-, and 12-month postoperative intervals. RESULTS: The difference in mean time of suture manipulation between groups was significant (P = 0.0001), with the SCAS starting earlier. A significant decrease in astigmatism occurred by either interrupted suture removal (6.69 +/- 3.11 diopter [D] before to 4.76 +/- 2.99 D after, P = 0.0002) or suture adjustment (7.18 +/- 3.12 D before to 4.46 +/- 3.24 D after, P = 0.0001). However, the net astigmatic reduction in the SCAS group was not significantly greater (P = 0.250) than in the ICS group. Vector change was 7.40 +/- 4.17 D and 6.28 +/- 4.14 D for SCAS and ICS, respectively (P = 0.13). At no interval (3, 6, 9, or 12 months) was there significant difference in astigmatism between the two groups. Refractive astigmatism (cyl, D) at 1 year was 2.66 +/- 1.70 for the ICS and 3.12 +/- 2.62 for the SCAS, but there was no significant treatment effect (P = 0.945). Furthermore, 66% of the ICS eyes and 58% of the SCAS eyes (P = 0.295) were within the astigmatic target of the study (<3.5 D). CONCLUSIONS: Postkeratoplasty astigmatism can be decreased similarly with either adjustment of a single running suture or selective removal of interrupted sutures. No advantage of the SCAS over ICS in terms of fewer manipulations or less astigmatism was seen as suggested previously.

Adult↗
PubMed1987

Absorbable polydioxanone suture for venous anastomoses: experimental studies using venography and transluminal angioscopy.

Because of their increased tendency to stenosis and spasm and thrombosis, results after venous anastomoses are often unsatisfactory. Nonabsorbable sutures and a continuous suture technique have been suggested to have a negative effect on the compliance of vascular anastomoses. Eighty venous anastomoses were performed with either an interrupted or continuous suture technique, using polypropylene or polydioxanone (PDS) sutures, according to a randomised experimental model. The anastomoses were divided in four groups: (1) Nonabsorbable suture material, continuous suture technique; (2) Nonabsorbable suture material, interrupted suture technique; (3) Absorbable suture material, continuous suture technique; and (4) Absorbable suture material, interrupted suture technique. The morphology of the anastomoses was controlled by venography directly after closure of the wound and at weekly intervals for 2 months and monthly intervals thereafter until 2 years had passed. In 10 cases venography was followed by transluminal angioscopy in the early postoperative period and after 1, 2, 4, 8 and 12 weeks. In the first 2 months moderate and high degree stenoses were found in all 4 groups by venography. After 8 weeks there was a significant decrease in the incidence of stenosis in all groups with the exception of the group, in which continuous nonabsorbable suture had been used. Using angioscopy a marked swelling of the intima at the site of the anastomoses could be detected in the early postoperative period in all experimental groups. After 2 months no significant narrowing could be identified in groups 2, 3 and 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed2005

Evaluation of a novel modified suture material designed to facilitate intracorporeal knot tying during laparoscopic surgery.

BACKGROUND AND PURPOSE: Laparoscopic intracorporeal knot tying in minimally invasive surgery is an advanced skill. Mastering this skill is an arduous process with a long learning curve. While recent advances in instrumentation have allowed easier suturing and tying, until now, no attempts have been made to modify the suture material in order to facilitate this process. We present an evaluation of a novel modified suture material designed to allow inexperienced surgical residents to tie intracorporeal knots laparoscopically using conventional laparoscopic needle drivers. SUBJECTS AND METHODS: Surgical residents with no prior experience in laparoscopic surgery were invited to take part in this investigation. Each of the 14 participants was given a 10-minute demonstration of laparoscopic intracorporeal knot tying and then allowed a mentored practice session of 10 minutes. In the first trial, they were then randomized to tie a laparoscopic knot with either a standard or a modified dry suture. Time and accuracy scores were recorded. They then performed the same task with the other type of suture. On the second trial, wet standard and modified sutures were used, and the order of the sutures used in the first trial was reversed. RESULTS: The average time taken to tie an intracorporeal knot laparoscopically was significantly less when the modified suture was used in both dry and wet conditions (162.71 +/- 10.79 seconds v 270.86 +/- 22.76 seconds; P = 0.0039, and 123.29 +/- 4.70 seconds v 247.57 +/- 23.17 seconds; P = 0.0032, respectively). No significant difference in accuracy scores was noted with the two sutures. CONCLUSIONS: Our modified suture design allowed inexperienced surgical residents to perform intracorporeal laparoscopic knot tying on average faster than the standard suture did. The concept of modifying suture design to facilitate laparoscopic suturing and knot tying deserves further investigation and development.

Clinical Competence↗
PubMed1975

Effect of suture materials on healing skin wounds.

A systematic comparison has been made of six suture materials used as subcuticular closure of abdominal incisions in dogs. The effect on wound healing was measured by mechanical, biochemical, and histologic methods. No difference was demonstrated in wound breading strength among wounds closed with different suture materials up to 28 days postoperatively. At 70 days, wounds sutured with nonabsorbable sutures were weaker than those closed with absorbable sutures, but this difference probably was due to a much higher incidence of infection in wounds closed with nonabsorbable sutures. It was our observation that monofilament sutures were superior to multifilament sutures with regard to the incidence of wound infection. By five days, the rate of collagen synthesis in wounds was increased over that of normal skin and remained elevated throughout the 120 day observation period. Suture material had no effect on collagen synthesis. The rate of noncollagenous protein synthesis in the wound was not altered throughout the entire observation period and did not differ from that measured in normal skin. Catgut, both plain and chromic, produced only a mild cellular reaction in dogs after 21 days as contrasted with the intense inflammatory reaction reported by others in rats and rabbits. We observed neither plain nor chromic catgut was absorbed rapidly in dogs; intact sutures were frequently observed at 120 days. Polyglactin, a synthetic absorbable suture, produced a moderate tissue reaction and uniformly disappeared between the twenty-eighth and seventieth days. Silk and Mersilene showed the highest rate of wound infection and the most intense and prolonged tissue reaction. Prolene, a monofilament suture, produced only a mild to moderate tissue reaction. These results taken in conjunction with those of other investigators suggest a marked species difference in the reaction to suture materials, particularly catgut, and suggest caution in transferring these observations to human beings.

Animals↗
PubMed2001

A new suture for hair transplantation: poliglecaprone 25.

BACKGROUND: The most common type of donor closure in hair transplantation is with nonabsorbable, running sutures, usually of nylon or polypropylene. This is accomplished with or without buried absorbable sutures. Another popular method of closure is with stainless steel staples. Each of these methods has benefits and limitations with respect to healing, comfort, and convenience for the patient. OBJECTIVE: The purpose of this study is to describe the use of poliglecaprone 25, a synthetic, absorbable, monofilament suture in hair transplantation surgery, to detail the suturing techniques needed to maximize the benefit of this suture, and to compare this material and suturing technique to a well-established form of closure, that of metal staples in a bilaterally controlled fashion. METHODS: Poliglecaprone 25 is a synthetic, absorbable monofilament suture of low tissue reactivity. It was compared to closure with metal staples in a bilateral controlled study. One side of the donor area was closed with poliglecaprone 25 sutures using a running cutaneous stitch and the other side was closed with stainless steel staples. Patients were evaluated with regard to healing, postoperative discomfort, resultant surgical scar, and closure material preference. RESULTS: Of the 22 patients studied, the following postoperative complaints were noted on the staples side: tenderness (12), itching (4), swelling (2), and scabbing (1). This compared to only one complaint of itching and one complaint of swelling on the poliglecaprone 25 side. Two patients had postoperative complaints of visibility of staples showing through their hair. Objective measurements revealed a wider scar overall on the staples side in six patients and wider scar on the suture side in two patients. The average scar width on the staples side measured 1.78 mm compared to 1.42 mm on the suture side. Fourteen of the 22 patients preferred poliglecaprone 25 for future procedures, 1 preferred metal staples, and 7 had no preference. Most patients stated that postoperative discomfort from the staples and the inconvenience and occasional pain associated with their removal was responsible for their decision. CONCLUSION: Poliglecaprone 25 is a strong synthetic, absorbable, monofilament suture with low tissue reactivity that can be used in hair transplantation to close the donor wound with a single, running cutaneous stitch. This suture can provide a donor closure that ensures hemostasis, has little risk of infection, and is comfortable for the patient. If specific surgical techniques are followed, this suture can provide a donor closure that ensures hemostasis has little risk of complications, is both comfortable and convenient for the patient postoperatively and results in a fine surgical scar.

Absorption↗
PubMed1993

Amount of suture material needed for continuous or interrupted wound closure: an experimental study.

OBJECTIVE: To design an experimental model by which it would be possible to measure exactly the total amount of suture material required for interrupted and continuous closure of the abdominal fascia. DESIGN: Laboratory study. MATERIAL: 160 Patches of 1 mm thick synthetic material (silicone) 25 x 8 cm in which a midline incision had been made and sutured with absorbable sutures, either braided polyglycolic acid or monofilament polyglyconate, using a standard knot under standard tension. MAIN OUTCOME MEASURES: Length of suture material used when sutures placed either 2 or 1.5 cm from the cut edge and with 1 or 1.5 cm left between sutures. Each series of measurements was made 10 times. RESULTS: When the distance from the cut edge, the distance between sutures, and the suture material were standardised continuous suturing used less material than interrupted. Slightly less polyglycolic acid was needed than polyglyconate. More suture material (9-15%) was required for continuous sutures 1 cm apart compared with interrupted sutures 1.5 apart, when both were inserted 1.5 cm from the cut edge, but the difference was smaller when polyglyconate was used than when polyglycolic acid was used. CONCLUSION: The differences in lengths of suture material required do not outweigh the mechanical advantages of continuous closure of the fascia.

Abdominal Muscles↗
PubMed1987

Restricted growth at the frontonasal suture: alterations in craniofacial growth in rabbits.

Apposition of bone at the sutural margin is generally thought to be a compensatory adjustment to growing soft-tissue organs such as the brain or eyes within the skull. The frontonasal suture which is located at the interface between the cranial and facial skeletons is a site of extremely active growth in the young rabbit. Recently, we showed that premature closure of a cranial suture, the coronal suture, can alter the growth not only at the adjacent frontonasal suture but also of the basicranium and midface. This study examines the effects of restricted growth at the frontonasal suture on both growth at adjacent cranial sutures and linear growth of the basicranium and midface. Thirty newborn New Zealand White rabbits were subdivided into experimental and sham-treated groups of equal size and distribution for sex and birth weight. At 9 days of age, the frontonasal suture of each experimental animal was immobilized by bilateral application of methyl-cyanoacrylate adhesive across the frontonasal suture. Growth and morphometric changes were monitored by radiocephalometric methods through 120 days of age by bilateral implantation of radiopague markers on each side of frontonasal, coronal, and anterior lambdoid sutures. Results indicate that restricted growth at the frontonasal suture results not only in a significant shortening of the midface but also in significant decreases in growth at the coronal and internasal sutures. Growth at the interfrontal and sagittal sutures is increased. Furthermore, growth at the anterior portion of the nasal bones is significantly increased, thereby offsetting a portion of the decreased nasal bone length resulting from frontonasal restriction.

Animals↗
PubMed2004

Cranial sutures and bones: growth and fusion in relation to masticatory strain.

Cranial bones and sutures are mechanically loaded during mastication. Their response to masticatory strain, however, is largely unknown, especially in the context of age change. Using strain gages, this study investigated masticatory strain in the posterior interfrontal and the anterior interparietal sutures and their adjacent bones in 3- and 7-month-old miniature swine (Sus scrofa). Double-fluorochrome labeling of these animals and an additional 5-month group was used to reveal suture and bone growth as well as features of suture morphology and fusion. With increasing age, the posterior interfrontal suture strain decreased in magnitude and changed in pattern from pure compression to both compression and tension, whereas the interparietal suture remained in tension and the magnitude increased unless the suture was fused. Morphologically, the posterior interfrontal suture was highly interdigitated at 3 months and then lost interdigitation ectocranially in older pigs, whereas the anterior interparietal suture remained butt-ended. Mineralization apposition rate (MAR) decreased with age in both sutures and was unrelated to strain. Bone mineralization was most vigorous on the ectocranial surface of the frontal and the parietal bones. Unlike the sutures, with age bone strain remained constant while bone MARs significantly increased and were correlated with bone thickness. Fusion had occurred in the interparietal suture of some pigs. In all cases fusion was ectocranial rather than endocranial. Fusion appeared to be associated with increased suture strain and enhanced bone growth on the ectocranial surface. Collectively, these results indicate that age is an important factor for strain and growth of the cranium. .

Age Factors↗
PubMed2006

Role of the osteoclast in cranial suture waveform patterning.

This study investigates the role of bone resorption in defining interdigitations characteristic of cranial suture waveform. Male mice from the CD-1 (ICR) background were analyzed at six age groups (n = 5 mice per group) in order to study the ontogenetic changes of osteoclast counts using tartrate-resistant acid phosphatase-stained histological sections of sagittal sutures. Additionally, the complexity of suture lines were measured ectocranially from the same age groups (n = 5 per group) using image capture and fractal geometry (ruler dimension method). The results suggest that osteoclast resorption is a contributor to suture patterning. Specifically, osteoclasts show the greatest activity along concave suture regions at 42 and 84 days (Kruskal-Wallis test statistic = 14.9; P < or = 0.01). This coincides with significant increases incrementally in suture complexity as measured with fractal dimension at 42 and 84 days of age (ANOVA F-statistic = 19.84; P < or = 0.001). In congruence with these data, mice given osteoclast-depleting injections of alendronate show a decrease in sagittal suture complexity. Data from this experiment indicate a positive relationship between suture complexity and osteoclast count (P < 0.01; r = 76%). Increases in suture complexity and osteoclast activity occur after peak rates of cranial width growth and coincide with weaning and the transition to a hard chow diet. These data demonstrate osteoclasts along the bone margin of the cranial suture and also indicate that sutures attain their complex shape at the same age when osteoclast number is highest along concave suture margins, underscoring the role of osteoclasts in generating the suture waveform pattern.

Acid Phosphatase↗
PubMed2001

The pH dependence of monofilament sutures on hydrolytic degradation.

Hydrolytic degradation of two nonabsorbable sutures, four absorbable sutures, and a new type of absorbable suture was studied in buffered media of various pHs at 37 degrees C. The pH levels fixed in this study were 1.0, 7.4, 8.5, and 10.5. Physical measurements were made on the retention of tensile strength and melting temperature of the sutures after hydrolysis for 12 weeks. Sutures containing glycolic acid as a comonomer exhibited enhanced degradation in alkaline media, similar to polyglycolide multifilament sutures. Poly-p-dioxanone (PDS II) suture lost strength to a significant extent at pH 1.0, suggesting that care should be taken when this suture is used for closing tissues in contact with acidic media, such as the stomach. In marked contrast, the degradation of lactide-epsilon-caprolactone copolymer [P(LA/CL)] suture was not sensitive to the pH of media. The surface morphology of hydrolyzed sutures varied, depending on the pH of media. Particularly, moon-crater-shaped impressions were observed on glycolide-epsilon-caprolactone copolymer (MONOCRYL) and glycolide-trimethylene carbonate-dioxanone copolymer (BIOSYN) sutures. Among the nonabsorbable sutures, nylon (ETHILON) exhibited the fastest loss of strength in acidic buffer solution, and polypropylene (PROLENE) suture retained most of its initial strength at all pHs studied.

Absorption↗
PubMed1992

Sutural complexity in artificially deformed human (Homo sapiens) crania.

The pattern of complexity of cranial sutures is highly variable both among and within species. Intentional cranial vault deformation in human populations provides a controlled natural experiment by which we were able to quantify aspects of sutural complexity and examine the relationship between sutural patterns and mechanical loading. Measures of sutural complexity (interdigitation, number, and size of sutural bones) were quantified from digitized tracings of 13 sutures and compared among three groups of crania (n = 70) from pre-European contact Peru. These groups represent sample populations deformed in 1) anteroposterior (AP) and 2) circumferential (C) directions and 3) an undeformed population. Intergroup comparisons show few differences in degree or asymmetry of sutural interdigitation. In the few comparisons which show differences, the C group is always more interdigitated than the other two while the AP group has more sutural bones. The sutures surrounding the temporal bone (sphenotemporal, occipitotemporal, and temporoparietal) most frequently show significant differences among groups. These differences are related to the more extreme binding of C type deformation and are consistent with hypothesized increases in tension at coronally oriented sutures in this group. The larger number of sutural bones in the AP group is consistent with the general broadening of the cranium in this group and with experimental evidence indicating the development of ossicles in areas of tension. We suggest that so few changes in sutural complexity occurred either because the magnitude of the growth vectors, unlike their direction, is not substantially altered or because mechanisms other than sutural growth modification are responsible for producing the altered vault shapes. In addition, the presence of fontanelles in the infant skulls during binding and the static nature of the binding may have contributed to the similarity in complexity among groups.

Adult↗
PubMed2003

Coronary occlusion using bi-directionally stretched elastic sutures during off-pump coronary artery bypass grafting.

OBJECTIVE: Off-pump coronary artery bypass grafting may be partly invasive, particularly to the coronary endothelium that is snared. Efficacy of a simple technique to occlude a coronary artery with elastic sutures bi-directionally stretched just beneath the artery was evaluated. METHODS: Test subjects were eighteen adult mongrel dogs weighing 20-30 kg. After systemic heparinization (150 U/kg), the mid-left anterior descending artery (mid-LAD) was exposed with a stabilizer applied and snared using non-elastic sutures (n = 6) or elastic sutures (n = 6), or occluded with elastic sutures bi-directionally stretched (n = 6). The left internal thoracic artery (LITA) was anastomosed to the mid-LAD with humidified gas insufflation. After completion of the anastomosis, the mid-LAD was observed endoscopically through the LITA. The coronary endothelium was also observed by a scanning electron microscope (SEM) after perfusion fixation. RESULTS: Bleeding at the anastomotic site with the coronary artery occluded by bi-directionally stretched elastic sutures was observed. However, all anastomoses were done successfully with the aid of humidified gas insufflation. Coronary endoscope showed that the lumens snared with non-elastic sutures were collapsed with folds and often with clots. Coronary arteries snared with elastic sutures appeared similar to the arteries snared with non-elastic sutures endoscopically, but with less clots. In the case of coronary occlusion with bi-directionally stretched elastic sutures, the lumens were occluded in a flattened linear fashion without clots. SEM showed endothelial injuries with blood cells deposited when non-elastic sutures were used. When elastic sutures were used for snaring, endothelial injuries were ameliorated with less blood cells deposited, which were further decreased when elastic sutures were bi-directionally stretched. CONCLUSION: The coronary artery can be effectively occluded by bi-directionally stretched elastic sutures with minimal endothelial damage.

Animals↗
PubMed1993

Changes in keratometric astigmatism after suture removal more than one year after penetrating keratoplasty.

BACKGROUND/PURPOSE: Selective removal of interrupted sutures and adjustment of a running suture can minimize astigmatism after penetrating keratoplasty, but the long-term effects of early suture manipulations remain largely unknown. The authors tested the hypothesis that the cornea becomes "fixed" more than 1 year after keratoplasty so that desirable refractive results will remain when all sutures are eventually removed. METHODS: The authors reviewed retrospectively the changes in astigmatism that occurred when all remaining sutures were removed from 162 eyes 1 to 6 years after penetrating keratoplasty. Single-running sutures were used in 130 eyes, double-running sutures in 20 eyes, and a combination of interrupted and running sutures in 12 eyes. RESULTS: Removal of single-running sutures caused an average decrease in astigmatism of 0.52 diopters (D) from 6.10 +/- 4.41 D to 5.57 +/- 3.14 D. However, the astigmatism in 62% of eyes changed 2 or more D (range, 11.94 to -17.87 D), and the range changed more than 20 degrees in 55% of eyes. The average vectorial change was 6.5 +/- 4.3 D (range, 0.59 to 19.8 D). There was no decrease in the amount of astigmatic change with increasing time between surgery and suture removal. Graft size and diagnosis had no effect on the amount of astigmatic change. Astigmatic errors became stable, with less than 1 D of change between successive examinations within 6 months after suture removal. Similar results were obtained for eyes with double-running and interrupted-running sutures. CONCLUSIONS: Corneal astigmatism may change unpredictably and by large amounts when all remaining sutures are removed 1 to 6 years after penetrating keratoplasty.

Astigmatism↗
PubMed1998

Rapid palatal expansion. Part 2: Dentoskeletal changes in cats with patent versus synostosed midpalatal suture.

Intercanine expansion (C-C) following rapid palatal expansion is made up of sutural displacement (Sd-Sd), tooth tip (Tt-Tt), tooth displacement (Td-Td), and alveolar process tipping and bending (At+b-At+b). The involvement of these four components was studied on 10 rapid palatal expansion treated and two control cats during an active phase (25 days), a retention phase (60 days), and a relapse phase (60 days). The midpalatal suture was analyzed for linear measurements, radiopaque versus radiolucent zones and optical density from occlusal radiographs. Nine treated cats exhibited sutural split and one treated cat showed no split as a result of synostosis of the suture. The contribution of the four constituents [(Sd-Sd):(Tt-Tt):(Td-Td):(At+b-At+b)] to the C-C expansion changed from active to relapse phase from [45%:15%:25%:15%] to [50%:25%:25%:0%] in the animals with sutural split and from [0%:40%:60%:0%] to [0%:0%:100%:0%] in the cat without sutural split, implying the major role of sutural displacement in patent suture, and tooth displacement in synostosed suture. The latter indicates the potential buccal corticalis fenestration, dehiscence or perforation in synostosed suture undergoing RPE. In patent suture (animals with sutural split), optical density increased during rapid palatal expansion (soft tissue build-up) and decreased during retention (remineralization) and relapse phases (medial convergence of the palatal processes). In the animal without sutural split, a continuous decrease in the optical density (predetermined ossification) was found. The progressive six-fold surge in coefficient of variation of C-C expansion during the relapse phase indicates limitation in predicting rapid palatal expansion stability. Clinically, the use of serial occlusal radiographs during rapid palatal expansion is recommended to evaluate patency and extent of retention period.

Animals↗
PubMed2001

Animal model to compare the effects of suture technique on cross-sectional compliance on end-to-side anastomoses.

OBJECTIVE: An animal model has been developed to compare the effects of suture technique on the luminal dimensions and compliance of end-to-side vascular anastomoses. METHODS: Carotid and internal mammalian arteries (IMAs) were exposed in three pigs (90 kg). IMAs were sectioned distally to perform end-to-side anastomoses on carotid arteries. One anastomosis was performed with 7/0 polypropylene running suture. The other was performed with the automated suture delivery device (Perclose/Abbott Labs Inc.) that makes a 7/0 polypropylene interrupted suture. Four piezoelectric crystals were sutured on toe, heel and both lateral sides of each anastomosis to measure anastomotic axes. Anastomotic cross-sectional area (CSAA) was calculated with: CSAA = pi x mM/4 where m and M are the minor and major axes of the elliptical anastomosis. Cross-sectional anastomotic compliance (CSAC) was calculated as CSAC=Delta CSAA/Delta P where Delta P is the mean pulse pressure and Delta CSAA is the mean CSAA during cardiac cycle. RESULTS: We collected a total of 1200000 pressure-length data per animal. For running suture we had a mean systolic CSAA of 26.94+/-0.4 mm(2) and a mean CSAA in diastole of 26.30+/-0.5 mm(2) (mean Delta CSAA was 0.64 mm(2)). CSAC for running suture was 4.5 x 10(-6)m(2)/kPa. For interrupted suture we had a mean CSAA in systole of 21.98+/-0.2 mm(2) and a mean CSAA in diastole of 17.38+/-0.3 mm(2) (mean Delta CSAA was 4.6+/-0.1 mm(2)). CSAC for interrupted suture was 11 x 10(-6) m(2)/kPa. CONCLUSIONS: This model, even with some limitations, can be a reliable source of information improving the outcome of vascular anastomoses. The study demonstrates that suture technique has a substantial effect on cross-sectional anastomotic compliance of end-to-side anastomoses. Interrupted suture may maximise the anastomotic lumen and provides a considerably higher CSAC than continuous suture, that reduces flow turbulence, shear stress and intimal hyperplasia. The Heartflo anastomosis device is a reliable instrument that facilitates performance of interrupted suture anastomoses.

Anastomosis, Surgical↗
PubMed1998

A prospective controlled study of a 10/0 absorbable polyglactin suture for corneal incision phacoemulsification.

PURPOSE: To evaluate the performance of a 10/0 monofilament absorbable polyglactin suture for temporal 5.2 mm corneal incision phacoemulsification. METHODS: A prospective randomised controlled study of 49 patients undergoing phacoemulsification with a sutured temporal 5.2 mm corneal section was conducted to compare the refractive results and complications of a 10/0 monofilament absorbable polyglactin suture with 10/0 nylon. RESULTS: Thirty-eight patients completed the study. There was no significant difference in induced astigmatism between the two groups. All absorbable sutures were intact at 1 week. Six weeks post-operatively the absorbable suture was still intact in 1 (6%) patient, present but broken in 4 (24%) and completely absent in 12 (70%) patients. All polyglactin sutures had been completely absorbed by 12 weeks. Absorption of the polyglactin sutures was associated with mild localised corneal haze in 3(18%) cases (p = 0.055). One of the 18 patients (6%) in the polyglactin suture group presented with iris prolapse associated with knot failure 1 week post-operatively. There was no significant difference in foreign body symptoms between the two groups. CONCLUSIONS: 10/0 polyglactin sutures maintain adequate tensile strength during the immediate post-operative period for small incision surgery and are associated with minimal induction of astigmatism. Their subsequent absorption obviates the need for routine suture removal. Suture absorption is well tolerated although in some cases a mild degree of local tissue reaction raises concern about possible mechanisms of absorption. The risk of knot failure may be reduced by an alternative suture tying technique. 10/0 monofilament polyglactin is an attractive option when a suture is required during small incision cataract surgery.

Absorption↗
PubMed1999

Analysis of TGF-beta production by fusing and nonfusing mouse cranial sutures in vitro.

The role of transforming growth factor beta (TGF-beta) in the regulation of cranial suture fusion has been studied by various qualitative techniques such as in situ hybridization and immunohistochemistry. Although the relative expression of TGF-beta isoforms has been assessed in these studies, increased expression of TGF-beta has not been demonstrated in a quantitative fashion. Therefore, the purpose of this study was to quantify TGF-beta production by fusing (posterofrontal [PF]) and nonfusing (sagittal) mouse sutures using two different quantitative TGF-beta assays. The PF and sagittal sutures of 25-day-old mice were harvested and cultured separately in vitro. Culture media conditioned for 48 hours were collected after 3, 6, 9, 12, 15, 18, 21, 24, 27, and 30 days of culture, and total TGF-beta production was assessed using a TGF-beta bioassay. For a quantitative TGF-beta1 immunoassay, media conditioned for 48 hours were collected after 3, 5, 7, 9, 14, 22, and 28 days of culture. The TGF-beta bioassay revealed large amounts of total TGF-beta activity in both PF and sagittal sutures during the first week of culture, with decreasing amounts thereafter. Absolute TGF-beta activity in conditioned media collected from PF sutures at several early time points was higher than those obtained from sagittal sutures; however, these differences were not statistically significant. The results of the TGF-beta1 immunoassay (enzyme-linked immunosorbent assay) were similar to the bioassay in that the highest TGF-beta1 levels were noted during the first week of culture period and decreased thereafter. Analysis of variance of these samples, however, revealed significantly more TGF-beta1 protein in samples collected from the PF suture compared with the sagittal suture on days 3 and 5 of culture (p < 0.05). TGF-beta1 levels in the conditioned media obtained from PF sutures remained elevated compared with the sagittal suture on days 7 and 9; however, these differences were not statistically significant. Increased production of TGF-beta in the conditioned media of fusing PF sutures is the first such quantitative demonstration of growth factor upregulation during suture fusion and supports the hypothesis that TGF-beta expression may be important in cranial suture fusion.

Animals↗