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PubMed1993

[Use of vertical and horizontal traction sutures in eyelid surgery].

BACKGROUND: Patients with lid surgery may benefit from traction sutures. However no detailed descriptions of the techniques exists. We describe our techniques and experiences in patients with cicatricial ectropion and large lid defects. PATIENTS AND METHODS: In 33 patients with severe cicatricial ectropion, the wound was extended with transtarsal traction sutures before skin grafts or sliding flaps were sutured in place. Horizontal traction sutures allowed wound closure in 7 patients with tumors of the medial canthal area or large traumatic lid defects. In all patients monofil 4-0 polypropylene suture material was used. RESULTS: Vertical transtarsal traction sutures and horizontal traction sutures did not cause any irritations of the lids or wound edges. Postoperative overcorrection of the lower lid margin was achieved in all ectropion patients. However, five patients required additional surgery. Three patients were operated for bilateral cicatricial ectropion simultaneously. Postoperative shrinkage of the free skin-graft was more accelerated on the side where the transtarsal traction sutures were first removed. Horizontal traction sutures allowed wound closure in all seven patients who had undergone medial canthal reconstruction and traumatic lid repair. CONCLUSION: Traction sutures with monofil 4-0 polypropylene material can fixate the lid margins and wound edges in the preoperatively desired position. There is evidence that the traction sutures can influence postoperative wound contraction. Our technique of transtarsal traction sutures has several advantages as compared with previously described techniques.

Adolescent↗
PubMed2003

The use of acrylic bone cement for suture anchoring.

Healing of tendon or ligament sutured to bone depends among other parameters on the mechanical stability of the suture fixation in or to the bone. The authors propose a method of anchoring suture material using bone cement as a substitute for conventional suture anchors. Conditions for secure fixation of suture material in bone cement were assessed and the technique of anchoring suture material with acrylic cement in bone was developed. Mechanical testing and microcomputed tomography of the suture-cement-bone compound were done. It was found that the suture always should be knotted before embedding it at least 2 mm deep in the bone cement. The holes drilled into the bone in which the sutures are secured with cement should be at least 3.5 mm in diameter and 10 mm deep; in cortical bone a tapped thread is required. Sutures can be secured safely using cement anchors which provide higher pull-out strength of a factor two to five than conventional metallic suture anchors of comparable size. They also adapt to anatomic situations where conventional anchors cannot be used and are more favorable in osteoporotic bone. Cement anchoring of sutures seems to be a cost-effective and valuable alternative when there is poor bone quality or extraordinarily high mechanical load.

Bone Cements↗
PubMed2005

Failure mode of suture anchors as a function of insertion depth.

BACKGROUND: Surgeons can control not only the angle but also the depth of suture anchor placement during arthroscopic rotator cuff repair, although the tendency may be to place suture anchors on the deep side to avoid damage from prominent anchor eyelets. However, little information is available regarding possible effects of suture anchor depth on construct failure mechanisms. HYPOTHESIS: Anchor depth affects the mode of suture failure with physiologically relevant cyclic loads. STUDY DESIGN: Controlled laboratory study. METHODS: Metallic screw-in suture anchors loaded with No. 2 braided polyester sutures were inserted into the bovine infra-spinatus footprint with the eyelet proud, standard, or deep. Sutures were hand tied to create a closed loop. Constructs were cyclically loaded from 10 to 90 N and, if still intact at 500 cycles, taken to ultimate failure (maximum load). RESULTS: When clinical failure was defined as greater than 3-mm construct elongation, anchors placed with the eyelet deep experienced statistically earlier clinical failure via cutting of the suture through the bone (P < .02). However, anchors placed at this level did not experience catastrophic failure during cyclic loading. The standard and proud anchors experienced 3 mm of elongation at a greater number of cycles, but the suture material degraded at the anchor eyelet, and a majority of these constructs broke during cyclic physiologic loading. At failure testing, the deep anchors had a significantly increased failure load (164 N) compared to standard (133 N) (P < .04) and proud (113 N) anchors (P < .005). CONCLUSION: Varying the depth of suture anchor insertion changes the mechanical properties and mode of failure of suture anchor constructs. CLINICAL RELEVANCE: Surgeons should be aware of the effects of suture anchor depth and abrasive eyelet wear on construct failure during arthroscopic rotator cuff repair.

Animals↗
PubMed1984

Abdominal wound closure. A comparison of polydioxanone, polypropylene, and Teflon-coated braided Dacron sutures.

A midline abdominal wound was made in 135 Harlan Sprague-Dawley rats, and the fascia was then closed by the continuous suture technique with 4-0 absorbable monofilament polydioxanone sutures (n = 45 rats), 4-0 permanent monofilament polypropylene sutures (n = 45 rats), or 4-0 Teflon-coated braided Dacron sutures (n = 45 rats). At 1-, 2-, and 6-month intervals, wound-bursting pressures were determined in 15 animals from each group. At 1 month and at 6 months, there was no significant difference in wound-bursting strength among the three types of sutures. At 2 months, wounds closed with Teflon-coated braided Dacron were significantly stronger than wounds closed with the other types of sutures. In most of the braided Dacron suture animals, the fascia burst in areas other than the abdominal wound, indicating that the wound was stronger at that time than was the surrounding fascia. There is no advantage to that added strength, and braided Dacron sutures have been shown to cause greater tissue reaction than monofilament sutures. Therefore, except in patients with poor wound healing who are highly susceptible to dehiscence and in whom permanent low-tissue-reaction sutures may be beneficial, the authors recommend a running suture technique using absorbable monofilament suture, such as polydioxanone, for the routine closure of clean abdominal wounds.

Abdomen↗
PubMed1986

Suture technique in preventing dehiscence of prosthetic mitral valves.

To evaluate suture techniques for mitral valve replacement, 60 fresh porcine hearts were used to determine suture holding strength. Using four techniques (simple interrupted, figure-of-eight, and horizontal without and with pledgets), the anterior leaflet, the posterior leaflet, and the commissures were sutured. The free ends of the sutures were then attached to a force transducer, and tension was increased until disruption occurred. In the anterior leaflet, horizontal mattress sutures disrupted with significantly less force than the other techniques. Pledgets increased the holding strength of mattress sutures, but figure-of-eight and simple interrupted sutures had greater holding strength than sutures with pledgets, suggesting that the direction of the suture vs that of tissue fibers is critical. Histologic studies confirmed this point. The posterior leaflet exhibited less holding strength than the anterior leaflet for all suture techniques but did not demonstrate a superiority for any specific technique. The posterior leaflet is the problem area for suture disruption from the mitral anulus. We secure mitral prostheses with horizontal mattress sutures with pledgets around the entire anulus, placing them from the atrial side.

Animals↗
PubMed1993

Tissue interactions with underlying dura mater inhibit osseous obliteration of developing cranial sutures.

Cranial sutures play a critical role in calvarial morphogenesis, serving as growth centers during skull development. Both biomechanical tensile forces originating in the cranial base and biochemical factors present in dura mater have been postulated as determinants of suture morphogenesis and patency. A rat transplant model free of the putative biomechanical influence of the dura and cranial base was used to investigate the role of the dura mater in both the initial morphogenesis and maintenance of sutures during skull growth. Day 19 fetal presumptive (F19) and day 1 neonatal differentiated (N1) coronal sutures, including associated frontal and parietal bones, were transplanted with or without underlying dura mater to the center of adult parietal bones. After 1, 2, and 3 weeks, transplanted tissues were examined histologically and histomorphometrically to determine whether sutures formed and whether they were obliterated by ossification in the absence of dura mater. Both F19 and N1 sutures remained patent for 2 weeks either in the presence or the absence of transplant dura mater. However, at 3 weeks, in the absence of transplant dura mater, sutures were obliterated by bone, while in the presence of dura mater sutures resisted ossification, demonstrating an essential requirement for interactions with the transplant dura mater in maintaining functional sutures. Both F19 and N1 transplants showed comparable bone growth (cross-sectional surface area), regardless of the presence of transplant dura mater. These experiments suggest that tissue interactions of a biochemical nature, rather than biomechanical forces generated through the cranial base, are required to maintain the suture as a non-ossified growth center. Furthermore, while the presence of dura mater was essential for maintenance of suture patency, fetal dura mater was not required for initial suture formation.

Animals↗
PubMed2005

Malformations of the axial skeleton in the museum Vrolik: II: craniosynostoses and suture-related conditions.

The Museum Vrolik collection of anatomical specimens in Amsterdam, The Netherlands, comprises over 5,000 specimens of human and animal anatomy, embryology, pathology, and congenital anomalies. Recently, we rediagnosed a subset of the collection comprising dried infantile, juvenile, and adult human skulls with congenital and acquired conditions. On external examination and additional radiography, we found 58 skulls with craniosynostosis (CS) involving one or more sutures and 40 skulls with a presumed suture related condition. Most of these were part of the material collected and described by Louis Bolk (1866-1930). Analysis of his observations suggests that skull deformation because of premature suture closure depends not only on the identity of the sutures involved but also on the timing and progression of their closure and the extent of their involvement. Moreover, premature closure of the sagittal suture after 3-6 years of age appeared to be much more common than expected because it is not accompanied by skull deformation. Many of the skulls with single-suture CS were microcephalic, which may be the cause of the premature synostosis. By contrast, microcephaly may be a resulting phenomenon in multi-suture CS. We noticed that the quotient between height of the cranial vault (vertex-porion distance) and head circumference, multiplied by 100, was 26 or higher only in those CS cases with multi-suture involvement. We therefore consider this parameter, which we named "acrocephalic index", to be an indicator of multi-suture involvement in individual CS cases. In two adult skulls, the skull had a quadrangular shape, which we assumed to be correlated to the presence of an unusually interdigitated open metopic suture. We propose to name this anomaly: tetragonocephaly. Another presumed suture-related condition, bathrocephaly, was found concomitantly with basilar invagination in several cases. We hypothesize that the chronically raised intracranial pressure in these cases caused the still open lambdoidal sutures to distend and the occipital bone to protrude.

Cranial Sutures↗
PubMed2003

Rescue of coronal suture fusion using transforming growth factor-beta 3 (Tgf-beta 3) in rabbits with delayed-onset craniosynostosis.

Craniosynostosis results in cranial deformities and increased intracranial pressure, which pose extensive and recurrent surgical management problems. Developmental studies in rodents have shown that low levels of transforming growth factor-beta 3 (Tgf-beta 3) are associated with normal fusion of the interfrontal (IF) suture, and that Tgf-beta 3 prevents IF suture fusion in a dose-dependent fashion. The present study was designed to test the hypothesis that Tgf-beta 3 can also prevent or "rescue" fusing sutures in a rabbit model with familial craniosynostosis. One hundred coronal sutures from 50 rabbits with delayed-onset, coronal suture synostosis were examined in the present study. The rabbits were divided into five groups of 10 rabbits each: 1) sham controls, 2) bovine serum albumin (BSA, 500 ng) low-dose protein controls, 3) low-dose Tgf-beta 3 (500 ng), 4) high-dose BSA (1,000 ng) controls, and 5) high-dose Tgf-beta 3 (1,000 ng). At 10 days of age, radiopaque amalgam markers were implanted in all of the rabbits on either side of the coronal suture to monitor sutural growth. At 25 days of age, the BSA or Tgf-beta 3 was combined with a slow-absorbing collagen vehicle and injected subperiosteally above the coronal suture. Radiographic results revealed that high-dose Tgf-beta 3 rabbits had significantly greater (P < 0.05) coronal suture marker separation than the other groups. Histomorphometric analysis revealed that high-dose Tgf-beta 3 rabbits also had patent coronal sutures and significantly (P < 0.01) greater sutural widths and areas than the other groups. The results suggest that there is a dose-dependent effect of TGF-beta 3 on suture morphology and area in these rabbits, and that the manipulation of such growth factors may have clinical applications in the treatment of craniosynostosis.

Animals↗
PubMed2006

Cranial suture complexity in white-tailed deer (Odocoileus virginianus).

Neurocranial expansion and mastication are commonly implicated as the two major biomechanical factors affecting suture morphology. In deer the antlers provide an additional source of biomechanical stress acting on the skull. Equivalent stresses are not found in females, who lack antlers. We analyzed the complexity and interdigitation of the interfrontal and coronal sutures that surround the antler-bearing frontal bones of (n = 67) white-tailed deer (Odocoileus virginianus) to 1) evaluate changes in suture morphology throughout ontogeny, and 2) test the hypothesis that male deer have more complex sutures than females. Two methods were used to quantify suture morphology: fractal analysis and length-ratios (actual suture length divided by direct straightline length). Both techniques produced similar results, although the two methods cannot be considered equivalent. Suture complexity increases markedly throughout ontogeny, but appears to level off after animals have reached adulthood. Cranial size in males, but not females, continues to increase in adults. No significant increase in suture complexity with age in the adult cohort was detected. While deer are highly dimorphic in size and the presence of antlers, no significant differences existed between males and females for any measure of suture complexity. No consistent patterns emerged between suture complexity and skull size or antler characteristics. The presence of antlers appears to have a minimal effect on suture complexity in white-tailed deer. Factors that may contribute to the lack of dimorphism in suture complexity are discussed.

Animals↗
PubMed2005

Three-dimensional sonographic description of abnormal metopic suture in second- and third-trimester fetuses.

OBJECTIVE: To describe patterns of abnormal development of the metopic suture in association with fetal malformations during the second and third trimesters of pregnancy. METHODS: This was a cross-sectional study of the frontal bones and metopic suture in 11 fetuses at 17-32 weeks of gestation. Cases were selected because there were obvious abnormalities in the metopic sutures. In each case, a malformation was detected by two-dimensional (2D) ultrasound and the abnormality of the metopic suture was detected and evaluated on three-dimensional (3D) ultrasound, using transparent maximum mode. RESULTS: There were essentially four patterns of abnormality in the metopic suture: firstly, delayed development with a V- or Y-shaped open suture, which is found in normal fetuses at 12-16 weeks; secondly, a U-shaped open suture, presumably due to upward growth of the frontal bones with delayed closure; thirdly, premature closure of the suture, which is normally observed after 32 weeks; fourthly, the presence of additional bone between the frontal bones. Premature closure of the suture or additional bone between the frontal bones was observed in fetuses with holoprosencephaly and abnormalities of the corpus callosum, whereas the V-, Y- and U-shaped metopic sutures were observed in fetuses with facial defects involving the orbits, nasal bones, lip, palate and mandible, in the absence of holoprosencephaly and abnormal corpus callosum. CONCLUSIONS: This preliminary study describes the pattern of possible abnormalities of the metopic suture and should stimulate further investigation to establish the prevalence and evolution of abnormal sutures as well as the incidence and pattern of other associated defects.

Abnormalities, Multiple↗
PubMed2006

[Arthroscopic meniscal suture].

OBJECTIVE: Restoration of the function of the meniscus by suturing a tear to prevent long-term degeneration. INDICATIONS: Unstable longitudinal meniscal tear in the red and red-white zones with an intact central fragment. Dislocated bucket-handle tear near the base in the presence of good-quality tissue. CONTRAINDICATIONS: Lesion of the central meniscal fragment. Meniscal tears in the white, avascular zone. Degenerative meniscal lesions. Complex meniscal lesions. Untreated knee ligament instability. Uncooperative patient. SURGICAL TECHNIQUE: Standard anterior arthroscopy approach. Revitalization of the tear margins and the perimeniscal synovial membrane, trephination of the base of the meniscus to promote healing. Fixation of the tear with a resorbable or nonresorbable suture size 2-0 to 0 USP by means of different suture techniques. "Outside-in technique": the suture is introduced from outside the joint through the base of the meniscus using a cannulated needle and is then pulled back out using a suture loop inserted with another cannulated needle. The U-suture is knotted over the joint capsule through a stab incision. "Inside-out technique": the suture is introduced using a needle through a guide cannula from outside the joint through the meniscus and joint capsule and then brought out of the joint. The U-suture is knotted over the capsule through a short skin incision. "All-inside technique": the suture loop is passed through the meniscal tear and knotted within the joint using a posterior arthroscopy approach. POSTOPERATIVE MANAGEMENT: Full weight bearing without a brace for short tears with one suture. For tears with two sutures, partial weight bearing for 4 weeks without a brace. For large tears with three to four sutures, partial weight bearing up to 20 kp for 6 weeks and restricted knee motion in a brace up to 0/0/60 degrees . RESULTS: The healing rate for knee joints with stable ligaments and an isolated meniscal tear is between 50% and 75%. In cases with simultaneous ACL (anterior cruciate ligament) plasty, the healing rate is > 75%; for unstable knee joints it is < 50%.

Adolescent↗
PubMed2005

Depth of endoscopically placed sutures: an experimental study in a human cadaver model.

BACKGROUND: Endoscopic suturing devices offer interesting access for interventional procedures used on the gastrointestinal tract. For the time being, the main indication is endoluminal suturing at the gastroesophageal junction for the management of gastroesophageal reflux disease. There is some evidence that endoluminal endoscopic suturing offers an alternative to the closure of esophageal fistulas and to the fixation of feeding tubes and stents in the near future. A review of the literature found no anatomic data on wall layers stitched by sutures. The aim of this study was to determine the depth of sutures placed endoscopically in the esophagus of a human cadaver model. METHODS: Altogether, 62 sutures were placed in the esophagi of 10 cadavers (complete exenterative cadaver model) at three different suction levels (0.4, 0.6, and 0.8 bar) using the EndoCinch suturing machine. After preparation of the esophagus from its mediastinal bed, all sutures were fixed in formalin and stained with hematoxylin and eosin for histologic examination. RESULTS: No sutures were placed in the mucosa alone. As observed, 1.6% were placed in the submucosa, 4.8% in the circular muscularis propria, and 56.5% in the longitudinal muscularis propria, with 37% placed transmurally. At a suction level of 0.4 bar (0.6, 0.8 bar), 0% (0%, 1.6%) were placed in the submucosa, 3.2% (0%, 1.6%) in the circular muscularis propria, and 11% (25.8%, 12.9%) in the longitudinal muscularis propria, with 12.9% (6.5%, 17.7%) placed transmurally. CONCLUSIONS: This study reports, for the first time, a systematic examination of the depth of sutures placed endoscopically in the esophagus. Most of the sutures were found in the muscular wall of the esophagus at a suction level of 0.6 bar. Also, transmural placements were seen. Reduction of suction pressure may lead to a decrease in transmural sutures.

Aged↗
PubMed1998

Chronic loading and extension increases the acute breaking strength of polypropylene sutures.

Polypropylene sutures provide satisfactory strength for construction of vascular anastomoses, but occasionally they break. Experimental studies show that they break at reduced forces when they are subjected to chronic loads. Moreover, in patients, sutures are subject to acute loads superimposed on chronic loads. For example, an episode of hypertension applies acute load that is added to the baseline chronic load in a suture that has been used to close an arteriotomy. The purpose of the present study was to examine the breaking force of 6-0 polypropylene sutures subjected to acute loads after they had been loaded with chronic loads. One hundred sixty-five 6-0 polypropylene sutures were subjected to 50-175 g chronic loads in vitro. After 38 days they were subjected to additional increasing acute loads until they broke. Five hundred ninety other sutures were subjected to "injuries" of manipulation before chronic loading. A stray knot was simulated by placing a knot in the center of 90 sutures. Nurse's tugs used to straighten folded sutures in the operating room were simulated by applying brief loads of 75-275 g to 452 other sutures. Intraoperative injuries were simulated in 48 other sutures by pinching them with DeBakey forceps. Surprisingly, chronic loading of polypropylene sutures increased their acute breaking force. It is suggested that this may have resulted from increased orientation of crystals in the core of the filaments. By contrast, disturbing the outer surface of the filament by placing a stray knot, or pinching with forceps decreased acute breaking strength. These data suggest that if polypropylene sutures do not break soon after they have been placed in a patient, they may gain strength over time.

Materials Testing↗
PubMed2005

Age-dependent properties and quasi-static strain in the rat sagittal suture.

We measured the morphology of and performed tensile tests on sagittal sutures from rats of postnatal age 2 to 60 days. Using the properties measured ex vivo and a pressure vessel-based analysis, we estimated the quasi-static strain that had existed in the suture in vivo from 2 to 60 days. Sutural thickness, width, and stiffness per length were notable properties found to be age dependent. Sutural thickness increased 4.5-fold (0.11-0.50mm) between 2 and 60 days. Sutural width increased transiently between 2 and 20 days, peaking around 8 days; at 8 days, mean sutural width was 75% larger than mean sutural width at two days (0.35+/-0.07 (SD) vs. 0.20+/-0.06 mm). Sutural stiffness per length increased 4.4-fold (8.77-38.3N/mm/mm) between 2 and 60 days. The quasi-static sutural strain estimated to exist in vivo averaged 270+/-190 muepsilon between 2 and 60 days and was not age dependent. These findings provide data on the age-dependent sutural properties of infant to mature rats and provide the first estimate of quasi-static sutural strain in vivo in the rat. The findings show that during development the rat sagittal suture, as a structure, changes significantly and is exposed to quasi-static tensile strain in vivo due to intracranial pressure.

Aging↗
PubMed2000

[Posterior corneal curvature after penetrating keratoplasty before and after suture removal].

PURPOSE: After penetrating keratoplasty (PK), peripheral swelling effects, malapposition of the graft in the recipient bed and suture tension may result in a changed ratio of curvature between anterior and posterior corneal surface. The purpose of this pilot study was to assess the posterior corneal curvature after PK with and without sutures and to compare this data to the posterior curvature of normal individuals. PATIENTS AND METHODS: In this cross-sectional study, 44 eyes after PK with a double running 16-bite diagonal antitorque suture in place (mean age 37 +/- 14 years, spherical equivalent (SEQ) -0.1 +/- 3.2 diopters (D)), 36 eyes with "all-sutures-out" (mean age 40 +/- 18 years, SEQ -0.8 +/- 3.5 D), and 464 normal control eyes (mean age 34 +/- 16 years, SEQ -0.3 +/- 2.2 D) were included. Based on Orbscan slit scanning topography analysis the following parameters were assessed: posterior power, posterior astigmatism, and posterior asphericity in various segments. RESULTS: With sutures in place the posterior central power ranged from -7.36 to -4.53 (mean -5.90 +/- 0.62) D, astigmatism ranged from 0.13 to 1.15 (mean 0.42 +/- 0.20) D, and asphericity ranged from 0.20 to 2.97 (mean 1.13 +/- 0.76, 56% oblate). With "all-sutures-out" the central power ranged from -7.56 to -4.93 (mean -6.41 +/- 0.53) D, astigmatism ranged from 0.13 to 1.15 (mean 0.39 +/- 0.19) D, and asphericity ranged from 0.26 to 3.04 (mean 1.25 +/- 0.76, 44% oblate). In the control group the central power ranged from -7.20 to -4.90 (mean -6.01 +/- 0.29) D, astigmatism ranged from 0.01 to 1.04 (mean 0.12 +/- 0.10) D, and asphericity ranged from 0.33 to 3.13 (mean 1.06 +/- 0.37, 47% oblate). Mean negative posterior power in grafts with "all-sutures-out" was significantly greater than in grafts with "all-sutures-in" and normal controls (p < 0.001), but showed no difference between the two latter groups (p = 0.56). Posterior astigmatism did not differ significantly comparing grafts with and without sutures (p = 0.44). However, astigmatism was significantly higher in grafts than in the control group (p < 0.0001). Asphericity did not differ significantly comparing grafts with and without sutures (p = 0.49) or comparing grafts to controls (p > 0.38). CONCLUSIONS: Except for the amount of astigmatism, the posterior corneal curvature of grafts with a double running suture in place does not seem to differ significantly from that of normal corneas. The removal of a double running suture tends to steepen the central posterior curvature. Knowledge about the individual posterior corneal curvature may have a favorable impact on the precision of intraocular lens power calculation for cataract surgery in eyes after PK.

Adult↗
PubMed2001

Comparison and analysis of laparoscopic intracorporeal suturing devices: preliminary results.

BACKGROUND AND PURPOSE: One of the most challenging aspects of laparoscopic surgery is intracorporeal suturing and knot tying. A loss of depth perception and tactile sense and visual obstruction make placing accurate and well-tied knots a difficult and time-consuming task. Two devices conceived to ease the task of suturing and knotting while presumably speeding performance are the Suture Assist (SA; Ethicon Endo-Surgery) and EndoStitch (ES; US Surgical/Tyco). We set out to objectively assess suture placement accuracy and knot speed and strength of these two suturing devices and conventional laparoscopic suturing (CS). MATERIALS AND METHODS: To date, six surgeons with laparoscopic experience were trained on the three suturing techniques. A pelvic trainer was set up with a freshly marked and incised swine renal pelvis and ureter. Each surgeon placed four sutures of 2-0 polyester suture with each technique (repeated on three separate occasions) with five half-hitches for a total of 216 knots. Time, strength, and accuracy were measured for each suture/knot placement. The knot distance was then measured from the marked target using calipers and carefully dissected from the tissue. Each knot was individually tested on a Monsanto Model 10 tensiometer, whereby slippage, strength, and breakage points were determined. RESULTS: The mean times (min:sec) and accuracy (millimeters) were as following: CS 5:08 and 0.457, ES 2:45 and 0.660, and SA 2:40 and 0.508. The difference in time was found to be statistically significant (P < 0.001), while the difference in accuracy was not. Only 182 of 216 knots were able to be included for analysis because of either a small knot lumen or device failure. Device failures necessitating intervention were encountered only with the SA, which had a misfire rate of 9.7% (7 of 72). The mean knot strength was measured at 41.1 N for CS, 57.3 N for SA, and 28.0 for ES. Knot break percentage (breakage) was calculated as 50.8% for CS, 20.7% for ES, and 95% for SA. CONCLUSION: Preliminary results show that each of the laparoscopic suturing devices has distinct advantages over conventional intracorporeal suturing and tying. Decreased times and comparable, if not greater, knot strengths may translate into improved laparoscopic suturing/tying performance for laparoscopic intracorporeal suturing devices.

Equipment Design↗
PubMed2001

The mid-palatal suture in young adults. A radiological-histological investigation.

The aim of the present study was to analyse which histological-histomorphometric findings correspond to a radiologically diagnosed open (group I) or closed mid-palatal suture (group II) on occlusal radiographs. For this purpose, 30 radiological regions of interest (rROI) from specimens obtained from 10 subjects ranging in age from 18 to 38 years were evaluated, and compared with the suture morphology, mean sutural width, and degree of suture closure on stained sections (3/rROI). The results showed that whether or not a radiologically visible suture can be classified as 'open' depends predominantly on the main oronasal suture course in relation to the X-ray path, rather than on factors such as suture width and degree of obliteration. The mean sutural width was 231 microns in group I (n = 10 rROI) and 201 mu in group II (n = 20 rROI). The degree of obliteration in relation to the total oronasal suture length was 0.45 in group I and 1.30 per cent in group II. No significant differences were found between the corresponding parameters of the two groups. The term 'suture obliteration' or 'fusion' should be avoided if a suture is radiologically not visible, since in 11 of the 20 rROI in which the suture was not visible no obliteration was recorded morphometrically.

Adolescent↗
PubMed1986

Something of the nature of gross sutural growth.

A series of experiments was performed on monkeys, rabbits, and turtles to study gross sutural growth of bones. Radiopaque implants in conjunction with serial gross and radiographic measurements were employed. Differences in growth were observed between 5 facial sutures and also the same suture at different times. Growth was greatest at the zygomaticotemporal suture and least at the premaxillomaxillary suture. The nasal bone side of the frontonasal suture grew about twice as fact as the frontal bone side. In the turtle shell the midsagittal suture grew faster than a transverse suture. In all of the animals the rate of sutural growth decreased with increase in age. No gross regional growth disturbance was noted after resection of the frontonasal, midpalatine, or transpalatine sutures. After extirpation of the median palatine suture, it re-formed, in an eccentric position, in a number of instances. We concluded that bone growth that occurred at sutures was secondary or compensatory to some other factor.

Aging↗