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PubMed1993

Presence of calcium in the vessel walls after end-to-end arterial anastomoses with polydioxanone and polypropylene sutures in growing dogs.

The presence of calcium in the vessel walls after end-to-end arterial anastomoses performed with polydioxanone and polypropylene interrupted sutures was studied in 140 anastomoses in 35 10-week-old German shepherd dogs. Histologic examination with hematoxylin and eosin, van Gieson, and von Kossa staining techniques was performed after the animals were killed 6 months after the operation. Ketamine hydrochloride was used as an anesthetic agent. At the start of the investigation the dogs weighed 14.5 +/- 2.6 kg (mean +/- standard deviation, n = 35), and after 6 months they weighed 45.3 +/- 3.1 kg (mean +/- standard deviation, n = 35). The diameter of the sutured arteries in the first operation was 2.6 +/- 0.5 mm (mean +/- standard deviation, n = 140). With each dog, both brachial and both femoral arteries were used--one artery for each different type of suture. In different dogs, different arteries were used for the same type of suture. The prevalence of calcifications after 6 months was determined from the numeric density of calcifications with standard stereologic techniques. The sutured and sutureless parts taken from longitudinal sections from each artery were studied, and t test values were calculated as follows: In paired samples, statistically significant differences in numerical density of calcifications were seen between sutured and sutureless arterial parts for both materials (sutureless part versus part with polydioxanone sutures, p < 0.001, n = 70; sutureless part versus part sutured with polypropylene sutures, p < 0.01, n = 70); however, in independent samples no statistically significant differences in numerical density of calcifications were seen between the polydioxanone and polypropylene groups for sutured (p > 0.05, n = 70) and sutureless parts (p > 0.05, n = 70).

Anastomosis, Surgical↗
PubMed1995

[A study of the influence of sutures and tension on skin cicatrization in loss of substance in 18 minipigs].

This study concerned the evaluation of wound healing after extensive skin resections in 18 minipigs, sutured with: continuous intradermal Polyglactin 910 suture or Polyamide, an interrupted intradermal sutures using the same resorbable suture material. Three equivalent groups were studied: 0, 3 and 6 cm skin resections were studied after using a dynamometer to record the tension necessary to join the wound margins. Results were evaluated 1 month later by light and electron microscopy, and were statistically correlated by Pearson's test. The wound tension was correlated with skin resection (r = 0.97, p < 10-4). The scar width was exponentially correlated with tension (r = 0.70, p < 10-3); the fibrous and cellular appearances increased with the skin resection. The absence of any significant statistical results prevents any conclusion concerning the superiority of one suture material or suture technique, but the group with no resection led to homogenous results, regardless of the suture technique, or suture material used. 3 and 6 cm resection the groups led to unpredictable and various results. Granulous reactions were observed in 7 out of 12 cases with resorbable suture, and only 1 of the 8 cases with non resorbable suture, but these results are not significant.

Animals↗
PubMed1998

[Suture of the episiotomy wound--comparison of two techniques from clinical and cosmetic aspects].

The use of an episiotomy for vaginal delivery is a controversial topic in modern obstetrics. If one is done, however, correct technique of perineal trauma repair is important. The usual episiotomy has traditionally been closed with interrupted suture. The use of a less reactive material, e.g. polyglycolic acid (Dexon), seem to be suitable for subcutaneous skin closure and beneficial in terms of acute postpartum discomfort and healing. The comparison of healing and patient comfort parameters between interrupted and subcutis polyglycolic acid suture used for episiotomy repair after delivery was done. Patients had follow-up during hospital stay, and two months after delivery a self administered questionnaire was sent to all women who participated, enquiring about perineal pain, resumption of sexual intercourse and cosmetics of suture line. Of 52 patients who had repair with interrupted suture, 21 were lost to follow-up. Of 65 gravidas who had repair with subcutis suture, 23 were lost to follow-up. At the 3rd day postpartum examination, patients with subcutis sutures had significantly better healing. An inflammatory process was present in 2 of 52 patients with interrupted sutures comparable with 1 of 65 in the subcutis group, and a gaping wound in 0 of 52 and 1 of 65, respectively. Recovery of function, measured by resumption of sexual activity by 8 weeks, was demonstrated in 5 of 31 patients with interrupted sutures versus 24 of 42 patients who had subcutis sutures. Episiotomy repair with subcutis polyglycolic acid (Dexon) offers significant advantages over traditional interrupted suture, both in terms of wound healing and resumption of sexual activity.

Adult↗
PubMed1987

Control of corneal astigmatism following cataract extraction by selective suture cutting.

We evaluated the ability of selective suture cutting to reduce postoperative corneal astigmatism in 75 eyes of 68 patients who underwent extracapsular cataract extraction with posterior chamber intraocular lens implantation. Keratometric and refractive measurements were obtained before and at selected intervals (3, 6, 10, 26, and 52 weeks) after surgery. The number of sutures cut during the sixth week after surgery was based on the degree of astigmatism (0.00 to 2.00 diopters (D), no sutures cut; 2.25 to 3.00 D, one suture cut; 3.25 to 4.00 D, two sutures cut; greater than or equal to 4.25 D, three sutures cut). Our analysis demonstrated the following: (1) a spontaneous reduction of 0.5 D in surgically induced astigmatism in eyes without suture cutting, (2) an additional reduction of 1.2 D in postoperative astigmatism for each suture cut, and (3) attainment of 75% to 93% of the total effect of suture cutting within four weeks. The final astigmatism one year after surgery had increased by a mean of 0.9 D, exhibited predominantly with-the-rule properties, and showed no significant difference among the four groups of patients. Vector analysis revealed that only small shifts in the axis of astigmatism occurred after suture cutting. A strong correlation between the keratometric and subjective refractive measurements during all postoperative examinations indicated that corneal astigmatism is primarily responsible for postoperative astigmatism.

Astigmatism↗
PubMed1994

Trabeculectomy with releasable sutures.

OBJECTIVE: To determine whether the use of releasable scleral-flap sutures affects the success rate and the incidence of complications following trabeculectomy. DESIGN: A retrospective chart review of a consecutive series of trabeculectomies. SETTING: A university-based referral practice. PATIENTS: Two hundred fifty-eight consecutive patients (274 eyes) undergoing trabeculectomy because of uncontrolled glaucoma. INTERVENTION: During the first year, 124 patients (128 eyes) underwent trabeculectomies with permanent scleral-flap sutures. During the second year, 134 patients (146 eyes) underwent trabeculectomies with releasable scleral-flap sutures. MAIN OUTCOME MEASURES: Incidence of flat and shallow anterior chamber, incidence of operations to drain choroidal detachment and to re-form anterior chamber, and long-term control of intraocular pressure. RESULTS: In the group with permanent sutures, 42 eyes (32.8%) had clinically detectable shallowing of the anterior chamber in the early postoperative period. In contrast, a shallow anterior chamber was noted in 21 eyes (14.4%) in the group with releasable sutures (P = .0003). Flat anterior chamber, defined as iridocorneal apposition to the pupil margin, occurred in 11 eyes with permanent sutures (8.6%) but in only two eyes (1.4%) with releasable sutures (P = .0078). Surgical intervention to drain suprachoroidal fluid and re-form the anterior chamber was required in eight eyes with permanent sutures (6.2%) but in only one eye with releasable sutures (0.7%) (P = .014). At 1-year follow-up, the two groups were similar in terms of intraocular pressure and the need for ocular hypotensive medications. CONCLUSIONS: Releasable scleral-flap sutures reduce the incidence of shallow and flat anterior chamber after trabeculectomy without compromising long-term control of intraocular pressure.

Aged↗
PubMed1989

Common bile duct healing. Do different absorbable sutures affect stricture formation and tensile strength?

Few basic investigations have addressed the problem of common bile duct strictures. We systematically investigated the healing canine end-to-end choledochal anastomosis and tested the hypothesis that common bile duct anastomoses sutured with monofilament polyglyconate absorbable suture would heal with less stricture formation and greater tensile strength than those sutured with braided polyglactin 910 and chromic catgut sutures. Seventy-six canines, randomized to control vs sutured groups, underwent either mobilization (controls) or transection of the mid-common bile duct and were allowed to heal 5, 10, 15, or 50 days postoperatively before sacrifice. The type of absorbable suture used to construct a common bile duct anastomosis was found to have no major effect on anastomotic strictures nor on anastomotic breaking strength. Polyglyconate suture caused significantly less perianastomotic inflammation than did chromic suture, with polyglactin 910 sutures evoking an intermediate inflammatory response. Surgeons may safely choose sutures for biliary procedures based on the clinical circumstances and personal preference.

Anastomosis, Surgical↗
PubMed2000

The role of superoxide ions in the degradation of synthetic absorbable sutures.

The objective of this study was to examine the effect of superoxide ion-induced degradation on synthetic absorbable biomaterials. Synthetic absorbable sutures were used as the model compounds. Inflammatory cells, particularly leukocytes and macrophages, are able to produce highly reactive oxygen species, such as superoxide (. O(2)(-)), during inflammatory reactions to foreign materials. Superoxide ions may act as oxygen nucleophile agents to attack biomaterials. In this study, the changes in tensile breaking force, thermal properties, and the surface morphology of five commercial (2/0 in size) synthetic absorbable sutures (Dexon, Vicryl, PDS II, Maxon, and Monocryl) as a function of superoxide ion concentration at 25 degrees C for 24 h were studied. Among the five absorbable sutures and over the concentration range of this study, the monofilament Monocryl suture was the most sensitive toward superoxide ion-induced degradation, followed by Maxon, Vicryl, Dexon, and PDS II sutures. The amount of tensile breaking force loss over a 24 h period ranged from as low as 3% to as high as 80%, depending on the type of absorbable sutures, the reaction time, and the superoxide ion concentration. All five absorbable sutures showed significant reductions in both the T(m) and T(g). Unlike the surface morphological changes of absorbable sutures in conventional buffer solutions, the effect of superoxide ion-induced degradation on the surface morphologies of these five absorbable sutures was unique, particularly the moon-crater-shaped impressions of various sizes and depths found in Monocryl and Maxon sutures, which defied the anisotropic characteristics of fibers.

Absorption↗
PubMed1998

Developing a standardized test for the assessment of suturing skill in novice microsurgeons.

Suturing performance was assessed for 13 novice microsurgeons throughout a 4-5 day microsurgical training course. Time to complete a suture (from needle insertion to completion of tie-off) was assessed on a standardized suture task, for two sutures at the beginning and end of each training day. For days 2-4, suturing performance with actual tissue was also assessed at both the beginning and end of each day. An average learning curve for suturing performance on the standardized test was developed and demonstrated huge performance improvement. A consistent and significant relationship existed between trainees' performance on the standardized suturing test and suturing of actual tissue. Thus the standardized test appears both to reflect actual suturing performance and to be sensitive to improvements in suturing skill that result from practice.

Adult↗
PubMed2000

Strain in the braincase and its sutures during function.

The skull is distinguished from other parts of the skeleton by its composite construction. The sutures between bony elements provide for interstitial growth of the cranium, but at the same time they alter the transmission of stress and strain through the skull. Strain gages were bonded to the frontal and parietal bones of miniature pigs and across the interfrontal, interparietal and coronal sutures. Strains were recorded 1) during natural mastication in conjunction with electromyographic activity from the jaw muscles and 2) during stimulation of various cranial muscles in anesthetized animals. Vault sutures exhibited vastly higher strains than did the adjoining bones. Further, bone strain primarily reflected torsion of the braincase set up by asymmetrical muscle contraction; the tensile axis alternated between +45 degrees and -45 degrees depending on which diagonal masseter/temporalis pair was most active. However, suture strains were not related to overall torsion but instead were responses to local muscle actions. Only the coronal suture showed significant strain (tension) during jaw opening; this was caused by the contraction of neck muscles. All sutures showed strain during jaw closing, but polarity depended on the pattern of muscle usage. For example, masseter contraction tensed the coronal suture and the anterior part of the interfrontal suture, whereas the temporalis caused compression in these locations. Peak tensile strains were larger than peak compressive strains. Histology suggested that the skull is bent at the sutures, with the ectocranial surface tensed and the endocranial surface predominantly compressed. Collectively, these results indicate that skulls with patent sutures should be analyzed as complexes of independent parts rather than solid structures.

Animals↗
PubMed2004

Effects of increased muscle mass on mouse sagittal suture morphology and mechanics.

The purpose of this study is to test predicted form-function relationships between cranial suture complexity and masticatory muscle mass and biomechanics in a mouse model. Specifically, to test the hypothesis that increased masticatory muscle mass increases sagittal suture complexity, we measured the fractal dimension (FD), temporalis mass, and temporalis bite force in myostatin-deficient (GDF8(-/-)) mice and wild-type CD-1 mice (all male, 6 months old). Myostatin is a negative regulator of muscle mass, and myostatin-deficient mice show a marked increase in muscle mass compared to normal mice. We predicted that increased sagittal suture complexity would decrease suture stiffness. The data presented here demonstrate that increased suture complexity (measured as FD) was observed in a hypermuscular mouse model (GDF8(-/-)) with significantly increased temporalis muscle mass and bite forces. Hypermuscular mice were also found to possess suture connective tissue that was less stiff (i.e., underwent more displacement before failure occurred) when loaded in tension. By decreasing stiffness, suture complexity apparently helps to dissipate mechanical loads within the cranium that are related to chewing. These results suggest that cranial suture connective tissue locally adapts to functional demands of the biomechanical suture environment. As such, cranial sutures provide a novel model for studies in connective tissue mechanotransduction.

Animals↗
PubMed1992

Plasma surface modification of synthetic absorbable sutures.

The aim of the study was to examine the feasibility of using plasma surface modification technology to alter the hydrolytic degradation rate of commercial synthetic absorbable sutures. Size 2-0 Dexon, Vicryl, PDSII, and Maxon sutures were tested. They were treated by two different surface modification techniques: parylene deposition and plasma gases (Methane, trimethylsilane, and tetrafluoroethene). The thickness of surface treatment ranged from 200 to 1000 A. The treated sutures were subject to in vitro hydrolytic degradation in phosphate buffer of pH = 7.4 at 37 degrees C for up to 120 days. The tensile breaking strength, weight loss, surface wettability, bending stiffness, and surface morphology were evaluated. The results indicated that the concept of plasma surface treatment for altering the hydrolytic degradation of synthetic absorbable sutures was feasible, and the level of improvement depended on the type of sutures, the treatment conditions, and the duration of hydrolysis. Vicryl and PDSII sutures showed overall the best improvement in tensile strength retention among the four commercial sutures. Dexon and Maxon sutures, however, exhibited only marginal improvement. The observed improvement in tensile strength retention appeared to be related to the increasing hydrophobicity of the sutures. The surface treatments did not adversely affect the bending stiffness of the sutures and no visible surface morphological changes were observed. Refinements and optimization of the surface treatment conditions are needed for achieving the maximum advantage of the proposed concept, particularly shielding the harmful effect of uv during plasma treatment.

Biodegradation, Environmental↗
PubMed2003

Composite surgical sutures with bioactive glass coating.

A processing method was developed to coat polyglactin 910 (Vicryl) sutures with bioactive glass powder (45S5 Bioglass). High reproducibility and homogeneity of the coating in terms of microstructure and thickness along the suture length were achieved. Bioglass-coated sutures exhibited a high level of chemical reactivity in simulated body fluid (SBF), indicating their bioactive behavior. This was evident by the prompt formation of hydroxyapatite (HA) crystals on the surface after only 7 days of immersion in SBF. These crystals grew to form a thick HA layer (15 microm thickness) after 3 weeks in SBF. The tensile strength of the sutures was tested before and after immersion in SBF in order to assess the effect of the bioactive glass coating on suture degradation. The tensile strength of composite sutures was lower than that of as-received Vicryl sutures, 385 and 467 MPa, respectively. However, after 28 days of immersion in SBF the residual tensile strengths of coated and uncoated sutures were similar (83 and 88 MPa, respectively), indicating no negative effect of the HA layer formation on the suture strength. The effect of bioactive glass coating on the polymer degradation is discussed. The developed bioactive sutures represent interesting materials for applications in wound healing, fabrication of fibrous three-dimensional scaffolds for tissue engineering, and reinforcement elements for calcium-phosphate temporary implants.

Body Fluids↗
PubMed2003

Impact of poor microsurgical suture technique on tissue perfusion in a rat model.

This study was designed to evaluate the effect of poor suture technique in microsurgical small-vessel anastomosis on tissue microcirculation. Eighteen male Sprague-Dawley rats were divided into three groups of six animals each: sham control group, regular suture group (control), and inverting suture group. In the regular suture group, a standard single-stitch suture technique was used for microsurgical reanastomosis of the transected common iliac artery. In the inverting suture group, a suture technique was applied inverting the vessel wall, thus simulating poor suture technique. After 24 h, intravital microcirculatory measurements were obtained in the cremaster muscle flap. The inverting suture caused a significant drop in capillary perfusion from 6.40 (sham control) and 5.65 (regular suture) to 1.81 capillaries per visual field (P < 0.005). A poor microsurgical anastomosis may result in a significant reduction of peripheral tissue perfusion, although blood flow through the main feeding vessel is maintained.

Anastomosis, Surgical↗
PubMed2005

Microsurgical skills training: a new concept for simulation of vessel-wall suturing.

Initiation of training in basic microsurgical suturing technique usually involves placing sutures on incisions made on latex sheets, and then progressing to a live anastomosis in a rat model. A straight incision resembles a skin incision and does not mechanically simulate vessel wall suturing, and various modifications and innovative prosthetic models continue to be developed to bring the simulation closer to a live anastomosis. We developed two models which closely simulate vessel wall suturing and require the application of similar skills by the trainee. In the first model (the "I" model), the straight 1-cm incision is converted to an I-shaped incision which increases the instability of the edge to be sutured, depending on the length of the horizontal incision, putting greater demand on dexterity in suture placement similar to a vessel. The length (1 cm) of the edge does not constrain the spacing of the sutures and can be used for the beginner. The second model (the "double triangle" model) creates a narrow and unstable edge for placing sutures, and puts greater demand on bimanual coordination and instrument control for training in accuracy of suture placement as well as spacing between sutures. Both these models are cost-effective and simple to construct.

Anastomosis, Surgical↗
PubMed1992

Experimental carcinogenesis at sutured and sutureless colonic anastomoses.

This study explores the role of sutures and the healing colonic wound in experimental carcinogenesis. One hundred sixty rats underwent surgery with colotomy and repair using silk, steel, or Vicryl (Ethicon, Somerville, NJ) sutures or a sutureless technique. Forty rats had a sham procedure. All animals received azoxymethane for 12 weeks at a dose of 10 mg/kg/week. Half the rats commenced carcinogen before surgery, and half commenced it eight weeks after surgery. Animals with anastomotic tumors were found in 46 percent of the sham group (P less than 0.05 cf. sutured), 41 percent of the sutureless group (P less than 0.02 cf. sutured), and 68 percent of the sutured group. The corresponding figures for anastomotic carcinoma were 9 percent (P less than 0.001 cf. sutured), 22 percent, and 38 percent. No significant differences in tumor yield were noted among the different sutures. However, several differences were noted between the two carcinogen models. In those animals that received surgery first, there was a higher incidence of anastomotic tumors (P less than 0.002) and cancers (P less than 0.0001) in the sutured and sutureless groups, and those tumors that occurred in the sutured group were considerably larger than in those that had carcinogen first (15.9 mm cf. 4.9 mm; P less than 0.0001). Overall, all sutures seem to enhance anastomotic tumor formation, and we would suggest that a sutureless anastomosis may diminish this risk.

Anastomosis, Surgical↗
PubMed2000

Incisional hernia after laparotomy: prospective randomized comparison between early-absorbable and late-absorbable suture materials.

Incisional hernia is a serious postoperative complication of laparotomy. Selecting an appropriate suture material may lessen such morbidity. This study undertook a prospective, randomized comparison of early-absorbable polyglactin 910 suture versus late-absorbable polydioxanone loop suture for fascial closure after abdominal surgery. A series of 340 consecutive patients undergoing elective laparotomy were randomized to have fascial closure with either polyglactin 910 suture or polydioxanone loop suture between October 1993 and August 1996. A 2-year follow-up revealed that 23 patients had died, and the overall mortality rate was 6.8% (23/340). Ten (10/340, 2.9%) patients, including seven with polyglactin 910 suture and three with polydioxanone loop suture, developed incisional hernias. The early postoperative evaluation revealed an incidence of wound infection of 4.1% (14/340). The development of incisional hernia was not secondary to postoperative wound infection in this study. Among these 340 patients, 192 had malignant diseases and 148 had nonmalignant ones. Fascial closure with polyglactin 910 suture was associated with more incisional hernias than that with polydioxanone loop suture, with marginal significance for patients in the malignant group (4.7% versus 0%, p = 0.07) but not in the nonmalignant group (2.6% versus 4.2%, p = 0.67). In conclusion, abdominal closure with a late-absorbable polydioxanone loop suture may be beneficial to patients with a malignant disease for preventing incisional hernia.

Abdomen↗
PubMed1999

Loosening of single versus double running sutures in penetrating keratoplasty for keratoconus.

PURPOSE: Purpose of the study was to evaluate single versus double running sutures in penetrating keratoplasty for keratoconus with respect to suture loosening. METHODS: Eighty-eight patients were consecutively operated for keratoconus by the same surgeon with the same surgical technique. For the first 45 patients, a single running 10-0 nylon suture was used. For the remaining 43 patients, double running 10-0 nylon sutures were taken. RESULTS: Suture loosening was observed significantly (P<0.001; Chi-Square test) more often in the patients with a single running suture (12/45=27%) than in the patients with double running sutures (0/43=0%). CONCLUSIONS: The results indicate that double running sutures in comparison to a single running suture may be helpful in preventing suture loosening in penetrating keratoplasty for keratoconus.

Corneal Transplantation↗
PubMed2005

Expression and mechanical modulation of matrix metalloproteinase-1 and -2 genes in facial and cranial sutures.

Craniofacial sutures create a soft tissue interface between various calvarial and facial bones. Facial and cranial sutures show differences in their surrounding anatomical structures and local mechanical strain environments. Despite previous attempts to identify the expression of matrix metalloproteinase genes (MMPs) in cranial sutures, little is known regarding whether facial and cranial sutures differ in MMP expression. We have investigated the expression of MMP-1 and MMP-2 in the pre-maxillomaxillary suture (PMS; facial suture) and the frontoparietal suture (FPS; cranial suture) in 32-day-old rats with or without the application of cyclic loading. Expression of MMP-1 and MMP-2 was detected by the reverse transcription/polymerase chain reaction technique. At 32 days of postnatal development (n=6), both MMP-1 and MMP-2 were reproducibly expressed in the facial PMS, in comparison with negligible MMP-1 and MMP-2 expression in the cranial FPS. In six age- and sex-matched control rats, cyclic loading at 4 Hz and 1000 mN was applied to the maxilla for two 20-min episodes within a 12-h interval. In some (but not all) cases, cyclic loading induced marked expression of MMP-1 and MMP-2 in the PMS and FPS in comparison with corresponding non-loaded controls. These data confirm our previous finding that short doses of cyclic loading upregulate MMP-2 expression in craniofacial sutures and suggest the possibility that facial and cranial sutures differ in matrix degradation rates during postnatal development.

Animals↗