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PubMed2001

Influence of the selection of the suture material on the mechanical behavior of a biomaterial to be employed in the construction of implants. Part 1: Calf pericardium.

A hydraulic stress simulator was employed to study the mechanical behavior of the calf pericardium used in the construction of cardiac valve leaflets. One hundred eighty pairs of tissue samples were subjected to tensile testing to rupture. One of the two samples from each of 144 pairs (four series of 36 pairs each) was sutured with commercially available threads made of nylon, silk, Prolene or Gore-Tex, while the other sample in each of these pairs was left unsewn. The remaining 36 pairs were employed as controls in which neither of the two samples was subjected to suturing. The sutured tissue samples showed a significant decrease in tensile strength at rupture (range: 11.81 to 26.04 MPa) when compared with unsutured samples (range: 39.38 to 87.96 MPa; p < 0.01). The application of morphological and mechanical selection criteria to maximize the homogeneity of the samples provided excellent fit with respect to the stress/strain curves. This method made it possible to carry out a predictive study of the mechanical behavior of a sutured sample, based on that observed in the corresponding unsutured fragment. The interaction of the different suture materials with the pericardial tissue was also assessed by comparing the mechanical behavior of the sutured samples with that of the control samples. At stresses of less than 0.8 MPa, samples sewn with Gore-Tex were found to show the least difference with respect to the controls, indicating that this material presented the lowest degree of interaction with the pericardium. In conclusion, the degree of the loss of resistance to tearing of the sutured samples is of no value in the selection of the optimal suture material. The selection process applied makes it possible to predict the mechanical behavior in response to suturing of a given unsewn tissue specimen by determining that of its sutured mate. The similarity between the findings in samples sewn with Gore-Tex and in the unsutured controls indicates a lesser degree of interaction between the suture material and the pericardium employed in the construction of cardiac valve leaflets.

Animals↗
PubMed2006

Frequency of use of suturing and repair techniques preferred by dermatologic surgeons.

BACKGROUND: There are many closure techniques and suture types available to cutaneous surgeons. Evidence-based data are not available regarding the frequency of use of these techniques by experienced practitioners. OBJECTIVE: To quantify, by anatomic site, the frequency of use of common closure techniques and suture types by cutaneous surgeons. METHOD: A prospective survey of the members of the Association of Academic Dermatologic Surgeons that used length-calibrated visual-analog scales to elicit the frequency of use of specific suture techniques. RESULTS: A response rate of 60% (61/101) indicated reliability of the received data. Epidermal layers were closed most often, in descending order, by simple interrupted sutures (38-50%), simple running sutures (37-42%), and vertical mattress sutures (3-8%), with subcuticular sutures used more often on the trunk and extremities (28%). The most commonly used superficial sutures were nylon (51%) and polypropylene (44%), and the most common absorbable suture was polyglactin 910 (73%). Bilayered closures, undermining, and electrocoagulation were used, on average, in 90% or more sutured repairs. The median diameters (defined as longest extent along any axis) of most final wound defects were 1.1 to 2.0 cm (56%) or 2.1 to 3.0 cm (37%). Fifty-four percent of wounds were repaired by primary closure, 20% with local flaps, and 10% with skin grafting, with the remaining 15% left to heal by second intent (10%) or referred for repair (5%). Experience-related differences were detected in defect size and closure technique: defects less than 2 cm in diameter were seen by less experienced surgeons, and defects greater than 2 cm by more experienced surgeons (Wilcoxon's rank-sum test: p=.02). But more experienced surgeons were less likely to use bilayered closures (r=-0.28, p=.036) and undermining (r=-0.28, p=.035). CONCLUSIONS: There is widespread consensus among cutaneous surgeons regarding optimal suture selection and closure technique by anatomic location. More experienced surgeons tend to repair larger defects but, possibly because of their increased confidence and skill, rely on less complicated repairs.

Dermatology↗
PubMed2000

Response of zygomaticomaxillary suture to experimental malocclusion in rats.

The purpose of this study was to examine the response of the zygomaticomaxillary suture (ZMS) to experimental malocclusion in rats. Thirty-two male Wistar rats were divided into two groups. Malocclusion was produced in the experimental group (n = 20) by gluing a wire, 1 mm in diameter, on the upper left first molar. Duration of the procedure was 20 min. In the control group (n = 12), rats were forced to open their mouths for the same time as in the experimental group. Histomorphological changes of the ZMS were examined at intervals of 1, 2, 4 and 8 weeks. The specimens were stained with hematoxylin-eosin and Mallory's azan. The suture in the control group showed a regular functional arrangement of component fibers, and osteoblasts lined the periphery of new bone at the inner half of the suture. On the untreated side in the experimental group, osteoclasts were most abundant after 2 weeks. Histomorphometric quantification of the sutural width revealed that, at the inner half of the suture, the width of the sutural space on the treated side in the experimental group was greater than that in the control group after 4 weeks (p < 0.05). The argyrophilic nucleolar organizer region (AgNOR) technique was used to investigate the transcriptional activity of fibroblasts in the suture. At the inner half of the suture, the number of AgNORs on the untreated side in the experimental group was greater than that on the treated side and that in the control group after 2 weeks (p < 0.05). Around the tip of the suture and at the outer half of the suture, there was no appreciable difference in the AgNOR number between the experimental and control groups. It was concluded that unilateral changes in occlusion had different effects on the treated and untreated sides of the ZMS. Moreover, the inner and outer halves of the suture showed different histological changes in response to experimental malocclusion.

Animals↗
PubMed1994

Behavior of different suture materials in the urinary bladder of the rabbit with special reference to wound healing, epithelization and crystallization.

Five urinary bladder incisions were performed in 16 rabbits and the defects closed by plain catgut 4-0, chromic catgut 4-0, polypropylene 4-0, polyglactin 910 4-0 and polyglactin 910 8-0 in the form of an all-layer suture, thereby obtaining a total of 80 suture sites. The running sutures in 8 animals were reviewed by light microscopy after 1, 2, 7 and 15 weeks, and in 8 additional animals after 3 days, 1, 2, 7 and 15 weeks by scanning electron microscopy. Moreover, we analyzed and compared the autopsy findings on gross inspection, the urinary sediments and urinary cultures of the individual animals. Scanning electron-microscopic evaluations showed that epithelization of the intraluminal suture portions can be accomplished after 3 days already. Reduced suture strength and rapid absorption of the suture material prevent later postoperative incrustations. Light-microscopic inspection of the segments of the bladder wall bearing this suture material suggests that a minor inflammatory tissue response around the suture material--with polyglactin 910 8-0 in particular--is more likely to enhance regeneration of the tunica muscularis and to prevent formation of cysts than seen with a long-standing highly inflammatory tissue response around the suture site of catgut threads. In the animal experiment, the polyglactin 910 suture has shown sufficient firmness and proved to be superior to any other suture material as regards the reaction to foreign bodies and inclination to incrustation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

A knotless suture anchor. Design, function, and biomechanical testing.

The development of a unique Knotless suture anchor for soft tissue repair to bone is described. This device allows for soft tissue repair to bone using a suture anchor without the need for knot tying. This provides a particular advantage for arthroscopic repairs, where knot tying can be difficult. The Knotless suture anchor has a short loop of suture secured to the tail end of the anchor. A channel located at the tip of the anchor functions to capture the loop of suture after it has been passed through the soft tissue. The soft tissue is tensioned as the anchor is inserted into bone to the appropriate depth. Biomechanical testing demonstrated increased suture strength in the Knotless suture anchor compared with standard suture anchors. This is because of the doubled-suture configuration that is created with the Knotless suture anchor loop. To the author's knowledge, this paper describes the first knotless suture anchor. A secure, low-profile repair can be created without knot tying.

Animals↗
PubMed2004

Suturing technique and the integrity of dural closures: an in vitro study.

OBJECTIVE: The watertight closure of the dura mater is fundamental to intracranial procedures in neurosurgery. Nevertheless, for any given operator and type of suture, it is still not certain which suturing technique affords the most watertight dural closure. We have developed a laboratory model that allows us to compare the pressures at which dural closures leak when different suturing techniques are used. METHODS: Human cadaveric dura was secured to a glass cylinder filled with colored saline. By application of force to a bag of saline attached to the cylinder, the pressure at which sutured dural incisions leak can be recorded. Using this method, we have compared the closure of 2-cm dural incisions with 3-0 silk using the following techniques (10 per group): 1) interrupted simple, 2) running simple, 3) running locked, and 4) interrupted vertical mattress. We have also compared the closure of 1- x 3-cm dural windows with cadaveric dura and 3-0 silk using the same suturing techniques (10 per group). RESULTS: The pressure at which 2-cm linear dural incisions leaked was significantly higher when they were closed with the interrupted simple suturing technique (P < 0.05). There was no significant difference among the different suturing techniques when they were used to close a 1- x 3-cm dural window with a duraplasty. Overall, the pressures at which sutured linear dural incisions leaked were higher than the pressures at which sutured dural windows closed with duraplasties leaked. CONCLUSION: In the experimental model described, an interrupted simple suturing technique affords the most watertight dural closure for linear incisions, whereas no suturing technique proved advantageous for the closure of a duraplasty.

Cadaver↗
PubMed2003

An expanded surgical suture and needle evaluation and selection program by a healthcare resource management group purchasing organization.

The purpose of this report is to describe an expanded suture and needle clinical evaluation program jointly designed by hospital representatives of Consorta, Inc. (Rolling Meadows, Illinois), a leading healthcare resource management and group purchasing organization, and United States Surgical/Davis & Geck Sutures (Division of United States Surgical, Norwalk, Connecticut). In this expanded evaluation program, 42 Consorta shareholder hospitals enrolled 1913 surgeons to participate in Phase II of this non-experimental observational study of the clinical performance of surgical needles and sutures. Performance characteristics of the sutures and needles produced by USS/DG that were evaluated in 25,545 surgical procedures included packaging/ease of opening, needle strength and sharpness, tissue drag, knot security, tensile strength, clinically acceptable determinations, and clinically unacceptable determinations. In these 30-day studies, the surgeons found that the needles and sutures were clinically acceptable in 98.1% of the evaluations. The general, cardiothoracic, and orthopedic surgeons who performed 61.2% of the product evaluations reported that the suture and needle products were clinically acceptable in 98.2% of the evaluations. Nearly half (49.2%) of the evaluations involved the POLYSORB* braided synthetic sutures that received a clinically acceptable rating in 98.2% of the evaluation. The silk suture (SOFSILK*), followed by the monofilament nylon suture (MONOSOF*), were the next most frequently used sutures. The SOFSILK* was found to be clinically acceptable in 99.2% of the evaluations, while MONOSOF* was noted to be clinically acceptable in 98.7% of the evaluations. Surgical needles made by USS/DG Sutures also had a high rating of clinical acceptability (97.9%).

Evaluation Studies as Topic↗
PubMed1993

Thermal gradients in the eyes of lid-sutured chicks.

Thermal gradients were measured from the cornea to the posterior pole in the eyes of 11 chicks, six of which had the lids of one eye sutured three weeks previously. A comparison was made between eyes that were chronically closed by lid-suture (while still sutured shut) and two types of control eyes: (a) treated controls, which were the non-sutured, contralateral eyes of the lid-sutured chicks and (b) untreated controls, which were the eyes of a different group of chicks in which neither eye had been sutured. The results indicated that transient closing of the eyes of normal, untreated chicks (untreated controls) elevated the ocular temperature by about 1.5 degrees C at the cornea; the extent of thermal elevation diminished as the thermoprobe was advanced towards the posterior pole. In contrast, when the transiently closed eyes in untreated control chicks were compared with the chronically closed eyes of the lid-sutured chicks, the lid-sutured eyes were cooler by 2 degrees - 2.5 degrees. When the sutured lids were opened, however, the eyes were isothermal with the untreated control eyes. Moreover, the eyes of lid-sutured chicks were isothermal with their contralateral, non-sutured, control eyes (treated control), whether in the opened or closed state. A comparison of the untreated control eyes and the treated control eyes revealed no differences (except at the cornea) when the eyes were opened; but when the eyes were closed, the treated control eyes were 2 degrees - 3 degrees cooler than the untreated control eyes.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

Reformation of the sagittal suture following surgery for isolated sagittal craniosynostosis.

OBJECT: Data from animal studies have shown that in experimentally induced craniosynostosis, removal of the involved calvaria results in the formation of new calvaria with time, and sutures redevelop in their normal anatomical positions. However, the pattern of suture reformation following surgery in humans with craniosynostosis remains ill-defined. The aim of this study was to determine the pattern of postoperative suture reformation in children who have undergone surgery for isolated sagittal synostosis and assess possible factors related to suture reformation. METHODS: Records were retrospectively reviewed for 42 consecutive infants who had surgery for isolated sagittal synostosis between 1987 and 2000 and for whom postoperative skull radiographs were available. The radiographs were evaluated for sagittal suture morphology and patency of the coronal and lambdoid sutures. Surgery involved at a minimum 1) a vertex craniectomy, characterized by removal of the sagittal suture and a 1.5- to 2.5-cm piece of adjacent parietal bone with the attached pericranium bilaterally, and 2) parietal osteotomies and/or craniectomies. The median age at surgery was 3.9 months (range 1.9-7.6 months). The mean duration of follow up was 32.2 months (range 6-144 months). The sagittal suture had reformed in only seven (16.7%) of the children at follow up. In the other 35 (83.3%), the craniectomized bone defects had reossified without any part of the sagittal suture being visible on the radiographs. CONCLUSIONS: There is a very low incidence of suture reformation in children after surgery for isolated sagittal craniosynostosis. Genetic predisposition, inclusion of undiagnosed syndromic patients, and current operative techniques may be some of the factors responsible for the low incidence of suture reformation seen in this series.

Cranial Sutures↗
PubMed1998

Oral tissue reactions to suture materials.

Tissue reactions to natural and synthetic braided and monofilament suture materials in gingiva and oral mucosa were studied. A total of 138 sutures made of four commonly used materials were placed in the edentulous ridges and vestibular mucosa of eight beagle dogs. Biopsy specimens including the suture loop and surrounding tissues were obtained after 3, 7, and 14 days and processed for histologic analysis. The inflammatory reaction was more rapid and intense than the reaction that has been reported after suture placement in skin. Bacterial invasion of the suture track was a common sequela regardless of the material used, but it was particularly prominent for silk. The formation of a perisutural epithelial sleeve was well under way at 3 days and in some instances included the entire suture track within 7 days. Connective tissue reactions consisted of several well-defined, concentric perisutural zones. At 14 days, these zones were partly replaced by granulation tissue surrounded by a fibrous capsule. The synthetic monofilament suture elicited a mild inflammatory tissue response. The results showed that sutures placed in gingiva and oral mucosa produce a prolonged tissue response that is most likely a result of the continual influx of microbial contamination along the suture channel, which may be a lesser problem when sutures are placed in other surgical compartments. The results indicate that chromic gut sutures are rapidly and unpredictably absorbed when used in an environment characterized by moisture and infectious potential.

Animals↗
PubMed2001

Knotless suture anchor: arthroscopic bankart repair without tying knots.

Arthroscopic Bankart repair done using suture anchors most closely mimics open repair techniques. The challenge with the arthroscopic technique is tying consistent, good quality arthroscopic knots. A unique knotless suture anchor and method of use for arthroscopic Bankart repair is described. The Knotless Suture Anchor has a short loop of suture secured to the tail end of the anchor. A channel is located at the tip of the anchor that functions to capture the loop of suture after it has been passed through the ligament. The ligament is tensioned as the anchor is inserted into bone to the appropriate depth. Mechanical testing showed increased suture strength in the Knotless Suture Anchor compared with standard suture anchors. This is attributable to the doubled suture configuration that is created with the Knotless Suture Anchor loop. To the author's knowledge, the current study describes the first knotless suture anchor. A secure, low-profile repair can be created without arthroscopic knot tying.

Arthroscopy↗
PubMed2000

Application of mechanical and manual sutures enclosing the bronchus.

The mechanical suture was introduced into thoracic surgical procedures by Amonosow and Androsow, Soviet surgeons, in the late 50s. The aim of the paper is to compare the incidence of bronchopleural fistulae that develop after the mechanical suture has been applied in bronchus surgery with the corresponding figures for traditional manual sutures. In the period of January 1997-March 1999 a series of 524 anatomical lung parenchyma resections was performed at the Department of Thoracic Surgery, Medical Academy of Gdańsk. In 460 cases (87.8%) the indication for the procedure came from primary lung carcinoma, and in 64 cases (12.2%) from tuberculosis, hamartoma, arteriovenous fistula, inflammatory lesions, asperpilloma, and metastases to the lungs. Depending on the way the bronchus was surgically closed the patients were subgrouped as follows: group I comprised 209 subjects (40.6%) whose bronchus was closed with a mechanical TA Premium Auto Suture, and group II that embraced 306 subjects (59.4%) whose bronchus was closed with a manual PDS 3/0 or Maxon 3/0 suture. The bronchopleural fistula developed in 11 cases of which 5/216 (2.3%) had the bronchus stump closed with a mechanical suture, and 6/308 (2.0%) cases had it closed with a manual suture. Of 11 cases of bronchopleural fistula 10 cases were noted after pneumonectomy. After the right side pneumonectomy, one fistula was discovered following the application of mechanical suture and six fistulas were found when the manual suture was used. After the left side pneumonectomy, no fistulae were discovered when the manual suture was used, and 3 those found were exclusively present when the mechanical suture was applied.

Adult↗
PubMed2004

Erosion of a B-Lynch suture through the uterine wall: a case report.

BACKGROUND: The B-Lynch uterine suture brace has been used for the surgical treatment of postpartum hemorrhage. To date, no complications of this procedure have been reported. We describe B-Lynch suture erosion through the uterine wall identified at a 6-week postpartum visit. CASE: A 19-year-old primigravida underwent a primary low transverse cesarean section at term for arrest of descent. The surgery was complicated by postpartum hemorrhage secondary to uterine atony unresponsive to medical management. The patient underwent successful placement of a B-Lynch suture using delayed, absorbable suture for control of the hemorrhage and had an uneventful postoperative course. At her 6-week postpartum examination, she was found to have the suture protruding from the uterine cervical os. The suture was removed in its entirety without difficulty. Follow-up sonohysterography at 6 months identified a small defect in the anterior wall of the lower uterine segment, corresponding to the probable site of suture erosion. CONCLUSION: Erosion of suture through the uterine wall can be a complication of the B-Lynch uterine suture brace. Delayed, absorbable suture is less desirable than absorbable suture for this procedure due to the risk of erosion through the uterine wall.

Adult↗
PubMed1981

The relative importance of Vicryl and Prolene sutures to the strength of healing abdominal wounds.

Based on animal experiments the importance of the sutures for the strength of the healing transversal abdominal wall incision was analyzed. As experimental animals rabbits were used, as suture material Prolene and Vicryl, and the wounds were tested using an Alvetron materials testing machine 3, 6, 10, 15, 28, and 56 days postoperatively. The strength of the wounds with suture intact and suture cut was compared. By measurement of the energy absorption the suture in the transversal incisions have lost their importance between the 15th and the 28th day. The investigation further showed that if Vicryl suture was used instead of Prolene of the same USP size, the sutures did not contribute to the strength of the rectus wounds on the 15th day. The results from the present investigation together with the results from clinical investigations are discussed in relation to the incidence of wound rupture and incisional hernias after use of absorbably suture materials. It is concluded that Vicryl and Dexon sutures of suitable USP size can secure the wound until the time when the suture is superfluous. In the conditions with reduced rate of wound healing, however, it could be risky to apply suture materials which cannot secure the wound after the elapse of 3 weeks.

Abdominal Muscles↗
PubMed1980

[A comparative study on early and late results following transcutaneous and intracutaneous suture in mediolateral episiotomy (author's transl)].

The techniques of postoperative treatment of mediolateral episiotomy by means of transcutaneous knotted suture and intracutaneous suture, are subjected to a comparative study. The non-resorptive suturing material Supramid of "O" gauge thickness was used in this study. There can be no doubt that patients' complaints following episiotomy were definitely less when using the intracutaneous suturing technique than with transcutaneous knotted sutures. After removal of the suturing material on the 6th. post-partial day there is a very definite reduction of complaints both with the knotted suture and the continuous intracutaneous suture. Late results 3 months post partum reveal a positive advantage of the intracutaneous suture with regard to the cosmetic aspect only. The advantages of intracutaneous suture compared with transcutaneous knotted suture following mediolateral episiotomy, therefore, are mainly represented by early relief of subjective complaints and improvement of objective pathological findings.

Episiotomy↗
PubMedDate not supplied

Refractive stability after cataract extraction using a 6.5-millimeter scleral pocket incision with horizontal or radial sutures.

BACKGROUND: Radial suturing of 6.5-millimeter scleral tunnel incisions following cataract surgery can create significant with-the-rule astigmatism in the immediate postoperative period. Because of the significant visual distortion and slow visual recovery seen with radial suturing, this study was undertaken to compare two other suturing techniques which induce lesser amounts of with-the-rule astigmatism in the immediate postoperative period. METHODS: The refractive behavior of eyes closed with loose radial sutures and with horizontal sutures was compared to the behavior of eyes closed with the more traditional "tight" radial sutures following phacoemulsification surgery. RESULTS: Eyes sutured with loosely tied radial sutures demonstrated minimal with-the-rule cylinder immediately following surgery (1.25 D) and showed a more rapid stabilization of astigmatism than did the eyes tied with tight radial sutures, 2 months versus up to 6 months. However, the eyes tied with horizontal sutures, which showed no induced with-the-rule astigmatism at the time of surgery, showed even more rapid stabilization between 5 days and 1 month from the time of surgery. CONCLUSION: To get the most rapid visual rehabilitation following cataract surgery, a wound closure which generates no induced with-the-rule cylinder such as horizontal sutures would be required.

Astigmatism↗
PubMed1994

[Sutures in surgery of the colon].

The use of different suture technique in the surgery of colon in the Surgical Clinic KBC Zvezdara Belgrade, was subjected to the retrospective study. The 2 years period of statistical study was performed in 1992/93. The early postoperative results of 143 patients were analysed and divided in four different groups: In the first group are the patients operated by mechanical device technique (12 patients, 8%), the second group of patients are those operated by the double row suture technique (38 patients 26%) the third one are the patients operated by one raw suture technique (37 patients, 25%)) and the fourth one in which the patients were operated by Gambee technique of suture (56 patients, 39%). In all four groups of patients three most important parameters of the postoperative evolution of the reconstructive operations in the surgery of the colon were analysed: anastomotic leakage, leptic temperature over 38 C, and evident wound infection. The best results have been registered in the group operated by mechanical device, without any anastomotic leak, septic state or evident wound infection. Good results have been obtained using the Gambee suture technique with evident anastomotic leakage in 4 patients (7,8%). The worst results were found using the double row suture where we registered 13,5% dehiscencics and in 27% of patients septic fever over 38 C. Based on our experience on the small group of patients we could find the following conclusions: a mechanical suture is the best in the surgery of colon b. in the field of manual suture we prefer the one-row extramucosal suture, c. Gambee suture is a transitional one between one row and double row suture and it presents everywhere good results except in low and extralow anastomosis.

Anastomosis, Surgical↗
PubMed2005

Sox9 neural crest determinant gene controls patterning and closure of the posterior frontal cranial suture.

Cranial suture development involves a complex interaction of genes and tissues derived from neural crest cells (NCC) and paraxial mesoderm. In mice, the posterior frontal (PF) suture closes during the first month of life while other sutures remain patent throughout the life of the animal. Given the unique NCC origin of PF suture complex (analogous to metopic suture in humans), we performed quantitative real-time PCR and immunohistochemistry to study the expression pattern of the NCC determinant gene Sox9 and select markers of extracellular matrix. Our results indicated a unique up-regulated expression of Sox9, a regulator of chondrogenesis, during initiation of PF suture closure, along with the expression of specific cartilage markers (Type II Collagen and Type X Collagen), as well as cartilage tissue formation in the PF suture. This process was followed by expression of bone markers (Type I Collagen and Osteocalcin), suggesting endochondral ossification. Moreover, we studied the effect of haploinsufficiency of the NCC determinant gene Sox9 in the NCC derived PF suture complex. A decrease in dosage of Sox9 by haploinsufficiency in NCC-derived tissues resulted in delayed PF suture closure. These results demonstrate a unique development of the PF suture complex and the role of Sox9 as an important contributor to timely and proper closure of the PF suture through endochondral ossification.

Animals↗