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PubMed2006

In vivo cranial suture function and suture morphology in the extant fish Polypterus: implications for inferring skull function in living and fossil fish.

This study describes the mechanical role that cranial sutures play in fish during feeding. The long-term goal of our work is to establish relationships between suture form and function, so that functional inferences can be made from suture morphology in fossil taxa. To this end, strain gauges were surgically implanted across selected sutures in the skull roof of four individuals of Polypterus endlicherii. After surgery, bone and suture strains during feeding were recorded along with high-speed video of the feeding events. Each trial was designated as a suction feeding or biting on prey trial, and neurocranial elevation, hyoid position and gape were quantified to aid in interpreting the strain data. The strains due to suction feeding are different from those observed during biting. Suction feeding results in a fairly stereotyped strain pattern, with the interfrontal and frontoparietal sutures experiencing tension, while the interparietal suture is compressed. Biting causes much more variable strain patterns. However, both suction and biting result in compression in the back of the skull, and tension between the frontals. Peak strains, and the time at which they occur in the feeding cycle, were compared between suction and biting. In general, peak suture strains are higher during suction than during biting, but not all of these differences are significant. Peak suture and bone strains occur at or near maximum gape during both suction and biting, suggesting that these strains are caused by muscle contraction involved in mouth opening and closing. Micro-computed tomography (microCT) scans of the experimental specimens indicate that the interfrontal and frontoparietal sutures, typically loaded in tension, are less interdigitated in cross section than the interparietal suture, which experiences compression. This is consistent with published correlations of suture form and function in mammals, where interdigitated sutures indicate compression and lack of interdigitation is associated with tension.

Animals↗
PubMed2005

Suture strength and angle of load application in a suture anchor eyelet.

PURPOSE: To assess the effect of suture material, anchor orientation, and anchor eyelet design on the static loading properties of suture anchors. TYPE OF STUDY: Biomechanical bench study. METHODS: Two metallic suture anchors, Mitek GII (Mitek, Westwood, MA) and Corkscrew (Arthrex, Naples, FL) and a bioabsorbable anchor (Biocorkscrew; Arthrex) were tested with single strand of No. 2 Ethibond (Ethicon, Norderstedt, Germany) or No. 2 FiberWire (Arthrex) suture. Suture pull angle was varied through 0 degrees, 45 degrees, and 90 degrees with the anchor rotation angle in either a sagittal or coronal plane. Constructs were tested to failure using an MTS 858 Bionix testing machine (Material Testing Systems, Eden Prairie, MN). Peak loads, stiffness, energy to peak load, and failure modes were determined for all samples. RESULTS: FiberWire showed superior static mechanical properties when compared with single-strand Ethibond over all testing conditions (P < .05). Suture pull angle had a significant effect on load to failure with both metallic anchors but not on the bioabsorbable anchor (P < .05). CONCLUSIONS: Suture pull angle and anchor rotation angle play an important role in the failure load of suture when placed in an eyelet. The polyaxial nature of the Biocorkscrew eyelet allows for increased degrees of freedom but introduces failure of the suture eyelet as a new failure mode. CLINICAL RELEVANCE: The loading direction and placement of the suture anchor plays a role in the performance of the suture anchor-suture complex.

Absorbable Implants↗
PubMed2004

Flap and suture manipulation after trabeculectomy with adjustable sutures: titration of flow and intraocular pressure in guarded filtration surgery.

PURPOSE: To describe the intraocular pressure (IOP) changes resulting from scleral flap suture and scleral flap manipulation in an experimental model of conventional guarded filtration surgery. DESIGN: Experimental study. METHODS: Trabeculectomy operations were performed with adjustable sutures on 5 donor human eyes connected to a constant flow infusion and a real-time IOP monitoring system. Three different manipulations: posterior lip massage, suture adjustment using special forceps, and suture release, were tested on the completed operation site. MAIN OUTCOME MEASURES: The success in lowering IOP to the target range of 7 to 15 mm Hg within 5 interventions, the time to reach equilibrium IOP, and the frequency of undesired outcomes. RESULTS: Posterior lip massage, suture release, and suture adjustment lowered the IOP after stabilization to the target range in less than 5 interventions in 9%, 14%, and 100% respectively (P < 0.001). The median time for IOP to stabilize at the new level after each intervention after correction for the flow rates used was 36.3 minutes for massage, 8.5 minutes for releasable sutures, and 3.7 minutes for adjustment of sutures (P < 0.001). CONCLUSIONS: These results suggest that suture adjustment may be superior to both posterior lip massage and releasable sutures for managing IOP in the early phase following glaucoma surgery. Following clinical interventions that result in loss of anterior chamber volume, IOP checks should be made at least 40 minutes post-intervention or at a later time afterwards if there is a clinical risk of low aqueous production. Manipulation of the scleral flap and associated sutures may only lower the IOP for minutes to hours if the suture tension is not decreased.

Equipment Design↗
PubMed1991

[Growth of the aortic anastomosis in puppies--comparison of monofilament suture materials, whether absorbable or nonabsorbable, and of suture techniques, whether continuous or interrupted].

This study compared the growth of vascular anastomoses performed with either polypropylene or polydioxanone sutures and with either continuous running suture or interrupted suture technique. Primary end-to-end anastomoses of the infrarenal aorta were performed in 38 puppies. Nineteen were performed with 5-0 polypropylene sutures; in ten all sutures were placed in continuous fashion, and in nine in interrupted fashion. The other nineteen were performed with 5-0 polydioxanone sutures; in ten the sutures were placed in continuous fashion, and in nine in interrupted fashion. The animals were subjected to the repeated aortograms at 2, 4, 8 weeks, 6 months and 1 year following operation. Each abdominal aorta was subjected to burst test, and pathological examination. All anastomoses were patent and tolerated burst-test (300 mmHg). Neither aneurysm nor dilatation of anastomotic site was observed. Anastomotic area was significantly smaller and more stenotic in the continuous polypropylene suture group than in other three groups at 8 weeks, 6 months and 1 year following operation. There was no significant difference among these three groups. No suture materials were observed in the polydioxanone suture groups after 6 months following operation. This study suggests that polydioxanone suture will be useful for the repair of cardiovascular anomalies where growth of the suture line is required.

Absorption↗
PubMed1992

[Quantifying suture tension of corneal sutures with the suture forceps with strain gauge strips].

To achieve uniform tensions on corneal stiches a modified tying forceps was developed. This forceps provides the possibility to measure the tension which is put to a nylon thread (10-0) by means of surface mounted strain gauges detecting the forceps jaws' bending. The results are registered and displayed electronically. To obtain a preselected tension, a limit value switch and a tare unit is used. A first series of registrations showed reproduceable values and confirmed a linear correlation between forceps jaw bending and traction force. A prototype and possibilities of technical improvement are demonstrated.

Corneal Transplantation↗
PubMed2005

Suture erosion and wound dehiscence with permanent versus absorbable suture in reconstructive posterior vaginal surgery.

OBJECTIVE: This study was undertaken to determine the incidence of wound disruption after reconstructive posterior vaginal surgery with braided permanent versus absorbable suture. STUDY DESIGN: A retrospective cohort study of women undergoing posterior vaginal surgery. Outcomes included suture erosion, wound dehiscence, and additional surgical procedures. RESULTS: Ninety-nine procedures were performed with permanent sutures, followed by 111 with absorbable sutures. There were no differences in demographics or comorbidities between patient groups. Suture erosion/wound dehiscence occurred in 31.3% of the permanent suture group versus 9% of the absorbable suture group (P = .003, odds ratio [OR] = 7.5, 95% CI 2-28). The need for additional surgical intervention was 16.1% among permanent suture group versus no patients with absorbable suture. Performing a concomitant anal sphincteroplasty with permanent sutures significantly increased the incidence of suture erosion (P = .003, OR = 4.7, 95%CI 1.7-13.3). CONCLUSION: Permanent sutures increase the incidence in wound disruption and the need for additional surgical intervention in posterior colporrhaphy and anal sphincteroplasty.

Absorption↗
PubMed2006

Bacterial adherence to surgical sutures: can antibacterial-coated sutures reduce the risk of microbial contamination?

BACKGROUND: Surgical site infections are associated with severe morbidity and mortality. The role of surgical sutures in the etiology of surgical site infection has been the objective of discussion for decades. This study used a standardized in vitro microbiologic model to assess bacterial adherence and the antibacterial activity of a triclosan-coated polyglactin 910 (braided) suture against selected Gram-positive and Gram-negative clinical isolates that may infect surgical wounds. STUDY DESIGN: Standardized cultures (2.0 log(10) colony forming units/mL and 5.0 log(10) colony forming units/mL of three clinical strains, Staphyllococcus aureus (methicillin-resistant S aureus [MRSA]), S epidermidis (biofilm-positive) and Escherichia coli (extended-spectrum beta-lactamase [ESBL]-producer) were inoculated to triclosan-coated and noncoated polyglactin 910 sutures to evaluate comparative adherence of bacterial isolates to the antibacterial coated and noncoated surgical sutures; to assess the impact of serum proteins (bovine serum albumin) on antibacterial activity of triclosan-coated suture; and to document the duration of antibacterial activity of the triclosan-coated material. Selected suture samples were prepared for scanning electron microscopy to demonstrate bacterial adherence. RESULTS: Substantial (p < 0.01) reductions in both Gram-positive and Gram-negative bacterial adherence were observed on triclosan-coated sutures compared with noncoated material. Pretreatment of surgical sutures with 20% BSA did not diminish antibacterial activity of the triclosan-coated braided device compared with noncoated suture (p < 0.01), and antibacterial activity was documented to persist for at least 96 hours compared with controls (p < 0.01). CONCLUSIONS: The in vitro model demonstrated a considerable reduction (p < 0.01) in Gram-positive and Gram-negative bacterial adherence to a triclosan-coated braided suture, which was associated with decreased microbial viability (p < 0.001). Because bacterial contamination of suture material within a surgical wound may increase the virulence of a surgical site infection, treating the suture with triclosan provides an effective strategy for reducing perioperative surgical morbidity.

Anti-Infective Agents, Local↗
PubMed2001

Effect of suture locking and suture caliber on fatigue strength of flexor tendon repairs.

The objectives of this cadaveric study were 2-fold: to determine the effect of different locking configurations on the cyclical fatigue strength of flexor tendon repairs and to assess the differences between each repair when a 3-0 or 4-0 suture is used. One hundred twenty flexor digitorum profundus tendons were cut and repaired using nonlocked, simple locked, and cross-stitch locked variations of 2- and 4-strand flexor tendon repairs. Using an incremental cyclical loading protocol we performed 10 trials of each repair with both 3-0 and 4-0 sutures and analyzed the number of Newton-cycles to failure using a 3-way ANOVA. The use of a 3-0 suture led to a 2- to 3-fold increase in fatigue strength in all repairs tested and the fatigue strength of the 4-strand repairs was significantly greater than the 2-strand repairs. All repairs performed with 4-0 suture failed by suture rupture. Of the 3-0 suture repairs, the three 2-strand repairs and the 4-strand cross-stitch locked repair failed by suture rupture. In contrast, 6 of 10 of the 4-strand simple locked and nonlocked repairs failed by suture pullout. There was no significant difference in fatigue strength between the 2 locked and the nonlocked 2-strand repairs using either 3-0 or 4-0 suture. There also was no significant difference in holding capacity or fatigue strength between the simple locked or nonlocked 4-strand repairs. However, the 4-strand cross-stitch locked repair with a 3-0 suture had significantly improved fatigue strength and holding capacity compared with the other repairs tested. Based on the consistently inferior biomechanical performance of 4-0 suture, we recommend that 3-0 suture be considered for 2- or 4-strand tendon repairs when early active motion is planned. The orientation of the transverse and longitudinal components of simple locked repairs did not significantly influence their holding capacity or fatigue strength. The cross-stitch type of locked repair provides better holding capacity and fatigue strength compared with simple locked or nonlocked 4-stranded flexor tendon repairs.

Analysis of Variance↗
PubMed2003

Keratometric astigmatism after suture removal in penetrating keratoplasty: double running versus single running suture techniques.

BACKGROUND AND OBJECTIVE: To compare astigmatism after suture removal in a retrospective sequential series of patients who had penetrating keratoplasty with either a double running suture technique or an adjustable single running suture technique. During the first year postkeratoplasty, when sutures were in place, the latter technique had produced less astigmatism. MATERIALS AND METHODS: Keratometry and keratometric astigmatism were measured before and after suture removal. We compared these variables in 30 grafts with the double running suture technique to the same variables in 24 grafts with the single running suture technique. RESULTS: The final portion of the double running suture was removed 408 +/- 177 (mean +/- SD) days after keratoplasty, whereas the single running suture was removed 611 +/- 224 days after keratoplasty (P<0.001). After suture removal, there was no difference between the double running and single running groups in either mean keratometry [46.5 +/- 1.8 diopters (D) versus 45.6 +/- 2.0 D, P=0.09, minimum detectable difference (MDD)=1.5D] or mean astigmatism (4.6 +/- 2.7 D versus 5.2 +/- 3.2D, P=0.72, MDD=2.3). CONCLUSION: In this consecutive series of corneal transplants performed by one surgeon, the results suggest no difference in astigmatism between the two suturing techniques after all sutures have been removed.

Astigmatism↗
PubMed1985

Effect of suture material and construction on frictional properties of sutures.

The results overwhelmingly support the view that the coefficient of friction is not a material constant of the sutures but a function of several variables, including applied tension, suture construction and suture material. The coefficient of friction decreased with an increase in applied tension with the rate of change depending upon the suture material. Prolene and Ethilon had the highest frictional values among all sutures at low tension, but dropped to a position of lowest values at high tension. On an average, braided sutures gave higher frictional values than did the monofilament sutures. Sutures with special surface coatings (silicone or Teflon) generally gave lower values than did the sutures without any such coatings. Similar results were reported in other studies on coated materials. The differences in frictional profiles are governed by the differences in the viscoelastic nature of the suture materials. The unusual traces produced by Prolene were considered as being due to its high degree of stretch and elasticity. Others similarly found that Prolene behaved peculiarly due to a high degree of stretch. Finally, coefficient of friction is an important property of suture materials as it is expected to have a direct bearing on the security of knots. A careful study of this parameter under a variety of clinical conditions is essential to gain an understanding of the behavior of surgical knots in clinical practice. The present study gives detailed information on the frictional behavior of various types of surgical suture materials.

Sutures↗
PubMed1993

[An experimental study on absorbable and non-absorbable suture materials in aortic anastomoses: influence of the growth to suture lines and anastomotic sites].

Ent-to-end anastomoses of the abdominal aorta in dogs and growing pigs were performed with absorbable sutures and non-absorbable sutures. Comparison studies between the two suture materials were done with respect to mechanical properties, angiographic findings, and macroscopic and microscopic examinations. In macroscopic examinations, animals with non-absorbable suture materials developed thickening at the site of the anastomosis and showed protrusion of the suture materials into the intraluminal space of the aorta with growing pigs. However, those findings were not observed in the animals with absorbable suture materials. In histological examinations, prolonged inflammatory reaction around the anastomotic site was observed in the non-absorbable suture group, but excellent healing without any inflammatory reaction was a constant finding in the absorbable suture group. Animals with the absorbable suture materials showed good mechanical properties evaluating the compliance and tensile strength, compared to that of animals with the non-absorbable suture materials. Growth of a aortic anastomosis after application of absorbable suture material seems to be possible without any complication and can be recommended as adequate suture materials for application in young growing humans.

Anastomosis, Surgical↗
PubMed2004

[The "Clothesline Phenomenon" after Cerclage with Arruga's Suture - Is Cutting of the Suture Necessary?].

BACKGROUND: Several early and late complications have been described since the introduction of cerclage surgery using a supramid suture. Due to cutting of the supramid suture through scleral tissue the supramid suture may appear at the fundus. Long-term results of scleral penetration and crossing the bulbus by the supramid suture, which is then only covered by the retina ("clothesline phenomenon"), could not be described so far. We report on a patient 20 years after cerclage surgery with Arruga's suture. CASE REPORT: A now 63-year old female patient with high myopia (D - 14.0 OU) suffering from complete retinal detachment had had ophthalmic surgery using Arruga's encircling suture with additional horizontal buckling at her left eye in 1983. Postoperative visual acuity was 10/20. The retina was attached. In 2002 phakoemulsification with posterior chamber lens implantation due to cataracta corticalis was done externally. In 2003 a complete scleral and chorioidal penetration and appearance of the Arruga's suture behind the retina occurred extending from 4 over 6 to 8 o'clock position with a visual acuity of 20/25. The patient did not agree with the cutting of the suture at any time. CONCLUSIONS: The "clothesline phenomenon" is a very rare late complication after encircling surgery using an Arruga suture by retinal detachment. Suture cutting is suggested because of a possible risk of retinal detachment. As shown in our case report, stable retinal attachment after Arruga's suturing is possible.

Female↗
PubMed1993

Intracutaneous butterfly suture with absorbable synthetic suture material. Technique, tissue reactions, and results.

BACKGROUND: Tension on surgical wound edges is often an obstacle to proper closure and good cosmetic results in dermatologic surgery. OBJECTIVE: A buried, butterfly-shaped, interrupted suture has been developed to remedy this. The suture is anchored very broadly in the corium, the knot is below the corium. The butterfly suture can be supplemented by a temporary running suture or by close-set, superficially placed interrupted sutures. METHODS: This technique was studied in a follow-up of 876 operations, with histologic study of 60 scars resulting from the suture. In particular, the specific advantages and disadvantages of two synthetic suture materials were compared: monofilament (polydioxanon) and polyfilament (polyglactin 910). RESULTS: Polydioxanon sutures were found to be clinically superior. It was important, however, that the suture knot be deeply anchored and that the surgeon be experienced. CONCLUSION: Cosmetic results of 18,000 procedures with this suture over a period of 6 years were found to be clearly better than those of surgery with conventional sutures.

Absorption↗
PubMed2006

An in vitro comparison of two suture intervals using braided absorbable loop suture in the equine linea alba.

OBJECTIVE: To compare bursting strength and failure modes of ventral median abdominal incisions closed with loop suture in a simple continuous pattern using two different suture-bite intervals. STUDY DESIGN: In vitro experiment. SAMPLE POPULATION: Equine cadavers (n=14; weighing >318 kg; postmortem interval <2 hours). METHODS: A template was used to make a 25 cm incision with suture interval and bite size of either 1.0 cm x 1.5 cm or 1.5 cm x 1.5 cm. A 200 L polyurethane bladder was inserted within the abdomen and insufflated to create abdominal wall tension. Celiotomies were closed with a #2 braided lactomer 9-1 continuous pattern with a loop suture. Deviation from the linea, closure time (minutes), total suture length (cm), suture length to wound ratio (SL:WL), bursting pressure (mm Hg), and failure modes (fascial or suture) were compared between groups using a Mann-Whitney U test. Significance was set at P<.05. RESULTS: No significant differences were identified between closing time, total suture length used, SL:WL, bursting pressure, or failure mode. Fascial failure was the main failure mode for both techniques; suture failure occurred rarely and knot failure did not occur. CONCLUSION: Based on the overall bursting pressure and failure mode, #2 braided lactomer loop suture placed in a continuous pattern should provide sufficient security for closure of the equine linea alba during recovery and the immediate postoperative period. CLINICAL RELEVANCE: Although there were no significant differences in the 2 patterns evaluated, the 1.5 cm x 1.5 cm pattern may have potential advantages for closure time, less total suture remaining in the wound, and strength.

Abdominal Muscles↗
PubMed1985

Comparison of suture materials and suture patterns for inverting intestinal anastomosis of the jejunum in the horse.

In 7 horses, 4 anastomoses were done in the small intestine in each, using the combinations of synthetic absorbable monofilament and multifilament suture materials with continuous- and interrupted-suture patterns in the serosubmucosal layer of a 2-layer inverting-suture technique. Horses were evaluated 30 days after the operation for adhesion formation, lumen diameter, evidence of chronic obstruction, and suture tract inflammation at the anastomosis. Postoperative obstruction occurred in 5 of the 7 horses, and 6 horses survived. One horse was euthanatized on postoperative day 6 after 48 hours of ileus and obstruction; necropsy revealed a partial intussusception involving the anastomosis done with continuous multifilament-suture material. Two other horses that became obstructed between postoperative days 3 and 5 had protracted ileus and gastric reflux up to 48 hours' duration, but survived. Horses that had obstruction after the 6th postoperative day recovered within 4 hours of onset. The continuous inverting-suture pattern in the serosubmucosal layer resulted in significantly (P less than 0.05) fewer adhesions than did the interrupted pattern, and suture material had no effect on adhesion formation. There was no significant difference in the percentage of reduction of lumen diameter between the variations of the 2-layer technique, and there was no evidence of chronic obstruction related to any of the anastomoses. Suture tract inflammation was moderate in the anastomoses, using continuous-multifilament suture, with neutrophils being the predominant cell type. The anastomoses with continuous-monofilament suture had mild inflammation with focal accumulations of neutrophils. Minimal inflammation was associated with both types of suture in the interrupted pattern.

Animals↗
PubMed1998

A rabbit model of human familial, nonsyndromic unicoronal suture synostosis. I. Synostotic onset, pathology, and sutural growth patterns.

Poswillo has stated, "The more severe anomalies of the calvaria, such as plagiocephaly, Crouzon [syndrome], and Apert syndrome still defy explanation, in the absence of an appropriate animal system to study" (p. 207). This two-part study reviews data from a recently developed colony of New Zealand white rabbits with familial, nonsyndromic unilateral coronal suture synostosis. Part 1 presents pathological findings and compensatory sutural growth data from 109 normal rabbits and 82 craniosynostotic rabbits from this colony. Synostotic foci, onset, and progression were described in the calvariae from 102 staged (fetal days 21, 25, 27, 33; term = 30 days) fetuses (39 normal, 63 synostosed). Calvarial suture growth patterns from 10 to 126 days of age were assessed from serial radiographs obtained from 89 rabbits (70 normal rabbits and 19 rabbits with unicoronal suture synostosis) with amalgam bone marker implants. Perinatal results revealed that by fetal day 25 the synostotic focal point in synostotic rabbits consistently originated from the endocortical surface of the calvaria in the middle of the coronal suture at a presumed high-tension, interdigitating zone. Histological analysis revealed hyperostotic osteogenic fronts on the affected side compared with the unaffected side. Postnatal sutural growth data revealed a predictable pattern of plagiocephaly (contralateral coronal sutures growing more than ipsilateral sutures and ipsilateral frontonasal and anterior lambdoidal sutures growing more than contralateral sutures), which resulted in early cranial vault deformities and a double "S" shape torquing towards the affected side. The advantages and disadvantages of these rabbits as a model for human familial, nonsyndromic unicoronal suture synostosis are discussed, especially in light of recent cytokine and genetic findings from human craniosynostotic studies.

Animals↗