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PubMed2002

Prospective randomized evaluation of surgical resident proficiency with laparoscopic suturing after course instruction.

BACKGROUND: Laparoscopic suturing is required to develop competency in advanced laparoscopy. METHODS: Manuals detailing laparoscopic suturing were give to 17 Surgery residents. One week later they performed a suture on a training model. Time (s), accuracy (mm), and knot strength (lb) were recorded. The residents were blindly randomized to intervention (n = 9) and control (n = 8) groups. The intervention residents attended a 60-min course with lecture, video, and individual proctoring. Two weeks later they performed a stitch with standard laparoscopic instruments and a stitch with a suturing assist device. Statistical analysis included a Wilcoxon rank-sum test. RESULTS: The intervention residents decreased their suturing time from the first to the second stitich (732.4-257.6s), the control and residents decreased their time from 500.2 s to 421.8 s. The time required to perform the second stitch showed no significant difference between the two groups (p = 0.46), but the difference in reduced time between the first and second stitch was significant (p = 0.001). Using the suturing assist device for the third suture, the intervention and control groups both decreased their times significantly. The control residents performed almost as quickly as the intervention residents with the suturing; device (p = 0.11). Accuracy and knot strength were not different in any test. CONCLUSIONS: Residents can improve suturing skill with a short didactic course and individual proctoring. A suturing assist device decreases time required by inexperienced surgeons to device perform an intracorporeal tie.

Audiovisual Aids↗
PubMed1984

Effects of physical configuration and chemical structure of suture materials on bacterial adhesion. A possible link to wound infection.

The purpose of this study was to examine the effects of physical configuration and the chemical nature of suture materials on the preferential adherence of bacteria. Ten suture materials of 2-0 (chromic catgut, Dexon, Vicryl, PDS, Mersilene, Tycron, Ethibond, Surgilon, Ethilon, and Prolene) were used. The bacterial strains tested were Staph. aureus and E. coli. The level of bacterial adherence was determined quantitatively by radiolabelled cells and qualitatively by scanning electron microscopy. It was found that the amount of adhered bacteria depended on the type of suture material, the type of bacteria, and the duration of contact. In the group of absorbable sutures, the new PDS sutures exhibited the smallest affinity toward the adherence of both E. coli and Staph. aureus. Dexon sutures had the highest affinity toward these two bacteria. With nonabsorbable sutures, the physical configuration of the sutures contributed more to their ability to attract bacteria than the surface finish. The bacterial adherence on suture materials was also time dependent. Scanning electron microscope morphologic observation also indicated that Staph. aureus adhered on the suture surface in clusters whereas E. coli tended to adhere individually.

Absorption↗
PubMed1987

Mechanical performance of monofilament synthetic absorbable sutures.

The purpose of this study was to evaluate the mechanical performance of two new synthetic monofilament absorbable sutures. The polydioxanone sutures is prepared by polymerizing and extruding the monomer, paradioxanone, in the presence of a suitable catalyst. The other suture is a modified polyglycolic acid suture, made by reacting trimethylene carbonate and glycolide. The knot configuration (1 = 1 = 1, 1 x 1 x 1, and 2 = 1 = 1) required for knot security was identical for the two synthetic monofilament sutures. The mean knot breaking strengths for the polydioxanone and modified polyglycolic acid sutures did not differ significantly. The surfaces of these sutures exhibited a low coefficient of friction which was slightly increased by hydration. The most distinctive difference between the handling characteristics of these two sutures was their flexural rigidity. The stiffness of the polydioxanone suture was 60 percent greater than that of the modified polyglycolic acid suture.

Polydioxanone↗
PubMed1995

Laser tissue welding in genitourinary reconstructive surgery: assessment of optimal suture materials.

OBJECTIVES: Laser tissue welding in genitourinary reconstructive surgery has been shown in animal models to decrease operative time, improve healing, and decrease postoperative fistula formation when compared with conventional suture controls. Although the absence of suture material is the ultimate goal, this has not been shown to be practical with current technology for larger repairs. Therefore, suture-assisted laser tissue welding will likely be performed. This study sought to determine the optimal suture to be used during laser welding. METHODS: The integrity of various organic and synthetic sutures exposed to laser irradiation were analyzed. Sutures studied included gut, clear Vicryl, clear polydioxanone suture (PDS), and violet PDS. Sutures were irradiated with a potassium titanyl phosphate (KTP)-532 laser or an 808-nm diode laser with and without the addition of a light-absorbing chromophore (fluorescein or indocyanine green, respectively). A remote temperature-sensing device obtained real-time surface temperatures during lasing. The average temperature, time, and total energy at break point were recorded. RESULTS: Overall, gut suture achieved significantly higher temperatures and withstood higher average energy delivery at break point with both the KTP-532 and the 808-nm diode lasers compared with all other groups (P < 0.05). Both chromophore-treated groups had higher average temperatures at break point combined with lower average energy. The break-point temperature for all groups other than gut occurred at 91 degrees C or less. The optimal temperature range for tissue welding appears to be between 60 degrees and 80 degrees C. CONCLUSIONS: Gut suture offers the greatest margin of error for KTP and 808-nm diode laser welding with or without the use of a chromophore.

Evaluation Studies as Topic↗
PubMed1992

The effect of inflammatory synovial fluid on the breaking strength of new "long lasting" absorbable sutures.

The effect of inflammatory synovial fluid upon several absorbable sutures potentially useful for arthroscopic procedures, e.g., meniscus repair and shoulder stabilization, was studied by implanting lengths of these sutures into unstable, arthritic rabbit knees and testing their breaking strength after varying time periods (up to 18 weeks). Polyglyconate (Maxon) sutures retained no significant strength at 6 weeks. Polydioxanone (PDS) sutures began to lose breaking strength at 3 weeks, retained only 40% of their original strength 6 weeks after implantation, and had no measurable strength at 9 weeks. Polycaprolactone (LTS) sutures showed a slow reduction in strength and retained approximately 90% of their original breaking strength after 18 weeks of implantation. Green braided polyester (Mersiline) sutures showed no loss of breaking strength over the testing period. Measurements of inherent viscosity were made to give an indirect indication of the decline in molecular weight of these sutures. These data paralleled the breaking strength decline in every case. The surgeon selecting an absorbable suture must consider the length of time the suture will hold the target tissue. This information should be helpful to surgeons considering an absorbable suture for procedures such as meniscus repair and shoulder stabilization.

Absorption↗
PubMed1995

Failure strengths of different meniscal suturing techniques.

The aim of this study was to measure the failure strengths of three arthroscopic meniscal suturing methods. The techniques investigated were a single horizontal loop, a double vertical loop, and a single vertical loop. Eleven human, lateral menisci obtained at autopsy were cut with a scalpel to simulate peripheral longitudinal tears. The menisci were then repaired with one suture at a time, using each of the three methods in turn. The two parts of the meniscus were then pulled apart using a computer-controlled materials testing machine until failure occurred, either by the suture itself failing or by the suture pulling out because of tearing of the meniscus. The horizontal sutures had a mean failure strength of 29.3 N, whereas the double vertical loop failed at 63.2 N and the single vertical loop at 67.3 N. The horizontal loop sutures and the double vertical loop sutures all failed by pulling out of the meniscus. The single vertical loop sutures failed by rupture of the suture itself. This study showed the superior mechanical characteristics of the single vertical loop suturing system over the other techniques tested. Owing to the more consistent failure strength, decreased costs, and shorter surgical time over the double vertical loop system, the single vertical loop technique is recommended for arthroscopic meniscal repair.

Aged↗
PubMed2004

In vivo comparison of a metal versus a biodegradable suture anchor.

PURPOSE: This protocol compares an absorbable polylactic acid (PLA) anchor to a similarly sized metallic anchor, comparing the load to failure of the suture anchor construct in vivo in a goat model. TYPE OF STUDY: Basic science. METHODS: Thirty-nine goats underwent bilateral implantation of suture anchors at the intra-articular origin of the long digital extensor tendon at the knee (stifle). Each goat randomly received an absorbable anchor in one knee and a metallic anchor in the other. At 0, 6, and 12 weeks after implantation, the suture attached to the implanted anchor was pulled to failure on a materials testing machine, annotating the load at failure and location of failure of the suture anchor construct. RESULTS: At each time period tested, no difference was found in failure load between metal and PLA suture anchor constructs, nor was there degradation in strength over time of implantation of either anchor. Most failures occurred by suture breakage, and the force required for suture breakage did not differ between anchors. Three absorbable PLA anchors failed, one (1 of 13, 7.7%) at 6 weeks, and 2 (15.4%) at 12 weeks. PLA anchor failure occurred when the suture loop eyelet pulled out of the anchor's PLA body. CONCLUSIONS: The absorbable PLA suture anchor construct, tested in an in vivo, intra-articular model, had similar strength over a 12-week period of implantation with a comparable metal anchor construct. These absorbable anchors offer a reasonable alternative to metal anchors, with comparable strength and function and advantages unique to an absorbable anchor. CLINICAL RELEVANCE: This study provides the reader with an evaluation of the in vivo function and holding strength over time of implantation of an absorbable suture anchor in comparison with a metal anchor.

Absorbable Implants↗
PubMed2005

Pullout strength of knotless suture anchors.

PURPOSE: Suture anchors are used consistently for repairs of soft tissues, especially around the glenohumeral joint. These anchors can be used either arthroscopically or in an open procedure to anatomically restore the labrum and capsular tissues to the glenoid after avulsion injuries (Bankart lesion). The purpose of this study was to analyze the pullout strength of a new knotless suture anchor (Mitek Knotless Suture Anchor; Mitek, Norwood, MA) compared with 2 commercially available suture anchors that require knots to be tied (Mitek Panalok 3.5-mm Anchor and Mitek GII Quick Anchor). TYPE OF STUDY: Randomized cadaveric study. METHODS: Three groups of 10 anchors were tested on 15 fresh-frozen cadaveric glenoids. Two anchors were affixed to the anterior glenoid in subchondral bone, 1 each from 2 groups. In this way, the variance of bone density among groups was minimized. The anchors requiring knots were fixed to the glenoid and tied to a ring using a Duncan knot with 3 half-hitches alternating posts. The Knotless Anchor was looped through the ring and anchored into the glenoid as described by the manufacturer. All constructs were then tested for tensile strength on an Instron machine (Canton, MA) using a crosshead speed of 200 mm/min. Ultimate failure was defined as complete failure of the construct (either suture breakage or anchor pullout). Data were then analyzed for statistical significance using analysis of variance analysis among the 3 groups, and a 2-tailed t test for statistical significance among groups. RESULTS: The average failure under tensile load for the GII, Panalok, and Knotless Anchors were 471.5 N, 432.8 N, and 650.0 N, respectively. Statistical analysis showed a statistical difference between the Knotless Anchor and the GII and Panalok sutures ( P = .02). Two-tailed t tests between the Knotless Anchor and the GII or Panalok Anchors were also significant (P = .02 and P = .02, respectively). Observations included a large standard deviation within groups. This is thought to result from the variation in bone density because markedly lower tensile loads were recorded for those anchors that pulled out from the bone before suture failure. CONCLUSIONS: The Knotless Suture Anchor is a statistically stronger construct with respect to tensile loads. It appears to be a viable option for any type of soft-tissue repair around the glenoid. CLINICAL RELEVANCE: Because the knot in suture repair is consistently the weakest point in the construct and because of the difficulty in tying knots arthroscopically, the Knotless Suture Anchor appears to be a stronger and easier method for both arthroscopic and open Bankart repair, with or without capsular shift.

Cadaver↗
PubMed2006

ISOCAN method and device for arthroscopic suture management.

ISOCAN refers to a method and device that functionally isolates sutures within the working cannula during arthroscopic rotator cuff repair, allowing passage of instruments through the same cannula through an instrument-passing quadrant. As sutures are passed, tension and orientation are maintained with each limb by parking each limb into a suture-holding slot. Suture tension prevents loops from forming and functionally isolates each limb. Attention to detail as the sutures are passed, keeping track of the cuff limb and the lateral limb, and parking them in sequence, prevents tangles. The instrument-passing quadrant is kept clear by parking sutures in only 3 of the 4 quadrants around the ISOCAN. Advantages extend beyond suture management and include the ability of an ISOCAN ring to hold reduction tension on the cuff edge, spreading the reduction force over multiple points of fixation, allowing individual suture pairs to be tied down without tension. This enhances knot security and loop security. The technique is especially helpful in arthroscopic rotator cuff repair but can be used wherever arthroscopic suture management is needed, including arthroscopic Bankart repairs and SLAP lesion repairs. A do-it-yourself ISOCAN may be constructed intraoperatively using an 8.25-mm Arthrex clear screw in cannula with a no-spray stopper (Arthrex, Naples, FL). Radial cuts can be made in the no-spray stopper to serve as ISOCAN suture parking slots. A metal ISOCAN ring prototype has been adapted to press-fit over this same cannula and has been used to great advantage in over 100 arthroscopic rotator cuff repairs by the author.

Arthroscopy↗
PubMed2006

The Krackow stitch: a biomechanical evaluation of changing the number of loops versus the number of sutures.

PURPOSE: The purpose of this study was to biomechanically evaluate several configurations of the Krackow stitch and determine which configuration provided the best fixation with regard to load to failure and elongation. TYPE OF STUDY: Biomechanical study. METHODS: Thirty fresh-frozen porcine Achilles tendons were randomly assigned into 6 groups. For 3 of the groups, 1 suture was used (No. 5 Ethibond; Ethicon, Somerville, NJ) with 2, 4, or 6 Krackow locking loops. For the other 3 groups, 2 sutures (interlocking and at 90 degrees) with 2, 4, or 6 Krackow locking loops were used. Data were evaluated using analysis of variance. RESULTS: There were no statistical differences in peak load to failure and elongation among any of the 1-suture techniques regardless of the number of locking loops (2, 290 N; 4, 302 N; and 6, 298 N; standard deviation, 25.2, 9.0, and 28.6, respectively). Similarly, there were no statistical differences among any of the 2-suture techniques regardless of the number of locking loops (2, 534 N; 4, 492 N; and 6, 505 N; standard deviation, 42.0, 65.4, and 76.3, respectively). There was, however, a significant difference (P < .05) in peak load to failure between the 1-suture and the 2-suture groups. The mechanism of failure was suture rupture in all cases. CONCLUSIONS: Load to failure did increase with the addition of a second interlocking suture placed at 90 degrees to the first. CLINICAL RELEVANCE: Tendon fixation with gap formation or suture rupture is at risk of failure. This study identifies that increasing the number of sutures is more important than increasing the number of locking loops.

Animals↗
PubMed2006

Load transmission in the nasofrontal suture of the pig, Sus scrofa.

The nasofrontal suture links the nasal complex with the braincase and is subject to compressive strain during mastication and (theoretically) tensile strain during growth of nasal soft tissues. The suture's ability to transmit compressive and tensile loads therefore affects both cranioskeletal stress distribution and growth. This study investigated the in vitro viscoelastic and failure properties of the nasofrontal suture in the pig, Sus scrofa. Suture specimens from two ages were tested in compression and tension and at fast and slow rates. In additional specimens, strain gauges were applied to the suture and nasal bone for strain measurement during testing. Relaxation testing demonstrated higher elastic moduli in tension than compression, regardless of test rate or pig age. In contrast, maximum elastic moduli from failure tests, as well as peak stresses, were significantly higher in compression than in tension. Sutures from older pigs tended to have higher elastic moduli and peak stresses, significantly so for tensile relaxation moduli. Strain gauge results showed that deformation at the suture was much greater than that of the nasal bone. These data demonstrate the viscoelasticity and deformability of the nasofrontal sutural ligament. The suture achieved maximal resistance to tensile deformation at low loads, corresponding with the low tensile loads likely to occur during growth of nasal soft tissues. In contrast, the maximal stiffness in compression at high loads indicates that the suture functions with a substantial safety factor during mastication.

Animals↗
PubMed2004

Locking repairs for obliquely cut tendons: Effects of suture purchase and directions of locking circles.

PURPOSE: Oblique cuts in tendons weaken conventional repairs but locking sutures improve the repair strength of the tendon. In this study we assessed how suture purchase and direction (or type) of locking sutures affect the repair strength. METHODS: Ninety-three fresh pig flexor tendons were transected obliquely (45 degrees to the long axis of the tendon) and repaired with either a locking Kessler repair (with perpendicular or horizontal locking circles) or a locking cruciate method (with oblique locking or perpendicular locking circles). The suture purchase in the short side of the tendon stump with a perpendicular locking Kessler repair ranged from 0.3 to 1.2 cm. The gap formation and ultimate strength were measured to compare the biomechanical performance for each repair. RESULTS: The repair strength increased significantly as the suture purchase increased from 0.3 to 1.0 cm in oblique tendon lacerations, with a suture span of 1.0 cm being the strongest. The strength decreased significantly when the span was 1.2 cm. The repairs with horizontal locking sutures were significantly weaker than those with perpendicular locking sutures. The locking cruciate repair with the perpendicular locking circles had strength identical to that of the cruciate with oblique locking circles. CONCLUSIONS: Both suture purchase and the direction of locking circles affect the repair strength remarkably. For locking repairs the suture purchase of 1.0 cm in an obliquely cut tendon produced the highest strength; the repairs with a purchase less than 0.4 cm had significantly reduced strength. The strength of the repairs with locking circles perpendicular to the long axis of the tendon was significantly greater than that of the repairs with locking circles parallel to the long axis of the tendon.

Animals↗
PubMed2005

Core suture purchase affects strength of tendon repairs.

PURPOSE: It generally is considered that a certain distance should be maintained between the site of the tendon-suture junction and the laceration level of the tendon. In this study we assessed how the length of core suture purchase may affect the repair strength of transversely cut tendons using a 2-strand modified Kessler method and a 4-strand circle-locking method. METHODS: Seventy-four fresh pig flexor tendons were transected. Fifty-eight tendons were divided into 4 groups and repaired with a 2-strand grasping repair technique with the core suture purchase in the tendon stump ranging from 0.4 to 1.2 cm. Sixteen tendons were repaired with a 4-strand circle-locking tendon-suture repair technique. The core suture purchase of these tendons was 0.4 and 1.0 cm, respectively. The tendons were subjected to a linear, noncyclic, load-to-failure test in a tensile testing machine. The forces measured for initial gap formation, 2-mm gap formation, and ultimate strength were recorded for each repair. RESULTS: The resistance to gap formation and ultimate strength of 2-strand grasping technique repairs increased significantly as the suture purchase increased from 0.4 to 0.7, 1.0, and 1.2 cm although strength remained constant from 0.7 to 1.2 cm. The strength of 4-strand circle-locking repairs with a suture purchase of 1.0 cm was statistically greater than that of the repairs with a suture purchase of 0.4 cm. CONCLUSIONS: For both the 2-strand grasping and 4-strand circle-locking repair methods, the length of core suture purchase significantly influences the resistance to 2-mm gap formation and the ultimate strength of repairs in transversely lacerated flexor tendons. We determined that the optimal length of purchase is between 0.7 and 1.0 cm and that increased length of purchase from 0.7 to 1.2 cm does not increase the strength of the repair. Core suture purchase length of 0.4 cm or less results in significantly weaker repairs.

Animals↗
PubMed2001

Suture support: is it advantageous?

Sutures have been used to facilitate and enhance wound closure and healing throughout the course of medical history. Suturing is still the most common method of wound closure, but in some surgical situations suture support can improve clinical outcomes. Sutures provide mechanical support to a wound and help create the optimal environment for wound healing. However, suturing can give rise to such complications as bleeding from suture holes and air and fluid leakage. In the last 25 years, fibrin sealants have been used increasingly in the clinical setting to assist in the sealing of surgical wounds and to give additional mechanical support to a range of wounds during the early phases of wound healing. The use of fibrin sealants in addition to sutures has a direct effect on hemostasis and blood loss. Fibrin sealants also reduce the volume of fluid drained and air leakage postoperatively in head, neck, and thoracic surgery, in some cases resulting in a reduced length of hospital stay. The use of fibrin sealant as suture support can also reduce the number of sutures and the length of operations for intricate or complex procedures. The aim of this article is to provide an overview of how fibrin sealants acting as an adjunct to sutures affect surgical outcomes.

Animals↗
PubMed2003

Effect of suture size and carotid clip application upon blood flow and infarct volume after permanent and temporary middle cerebral artery occlusion in mice.

Problems with the intraluminal suture method for induction of focal cerebral ischemia in genetically altered mice include occurrence of subarachnoid hemorrhage (SAH) and variability of infarct volume. We hypothesized that use of 5-0 curved or 6-0 straight suture for carotid cannulation might decrease SAH and that the application of a microvascular clip to the common carotid artery (CCA) might decrease variability of infarct volume. The purpose of this study is to evaluate and explain the results of these technical modifications. Strain related differences in vascular anatomy were evaluated. Male C57BL/6 mice were divided into two groups for permanent and temporary middle cerebral artery occlusion (MCAO). Results of 5-0 curved suture and 6-0 straight suture insertion with and without CCA clip application were examined. Cerebral perfusion was monitored by laser-Doppler flowmetry and infarct volume was measured. After permanent MCAO, larger and more consistent infarct volumes resulted using CCA clip application with a 6-0 but not with a 5-0 suture. After temporary MCAO, the SAH rate was 12.5% with a 5-0 curved suture and 11.1% with a 6-0 straight suture. A 40% rate was observed in a pilot study with 5-0 straight suture. Infarct volume after temporary MCAO with a CCA clip was significantly larger and variability of infarct volume was smaller than without the CCA clip using 5-0 curved and 6-0 straight suture. In summary, SAH is less frequent using a 5-0 curved or 6-0 straight suture. Infarct volume is enlarged by application of a CCA clip (249).

Animals↗
PubMed1999

Comparison of absorbable and nonabsorbable sutures for microsurgical vasovasostomy in rats.

OBJECTIVES: At least 12% of initially patent vasovasostomies (VVs) shut down. Currently, only nonabsorbable sutures are used for VV. A synthetic, slowly absorbing, monofilament polyglactin suture has been developed that retains tensile strength for up to 6 months. We performed a prospective controlled randomized study comparing absorbable and nonabsorbable sutures for rat VVs. METHODS: Bilateral microsurgical VV was performed in three groups of 36 Wistar male rats, with 10-0 nylon, 10-0 polypropylene, and 10-0 polyglactin sutures. Twelve control rats underwent sham operations. Three rats in each group were killed at 2, 6, 12, and 24 weeks. The abdominal end of the vas deferens was transected and the intraluminal fluid examined microscopically for presence of sperm. The segment of the vas deferens containing the anastomosis was excised. Fluid from the testicular end was examined for sperm to confirm spermatogenesis. Patency was confirmed by an antegrade indigo carmine vasogram of the anastomotic segment. Segments were randomly sent for histologic or tensile strength evaluation. RESULTS: The mean tensile strength of the anastomoses performed with nylon was slightly higher than in polypropylene and polyglactin sutures, although the difference was not statistically significant. Polyglactin consistently maintained tensile strength throughout 6 months without significant fluctuations. The mean patency rate in the polyglactin group was 96%, in nylon 81%, and in polypropylene 61%. Although polyglactin had a consistently higher patency rate compared with nonabsorbable sutures, the difference was not statistically significant (P = 0.11) but indicated a strong trend. The occurrence of microscopic sperm granuloma, muscle layer injuries, intimal fibrosis, and adventitial fibrosis of the vas deferens was not significantly different between suture types. CONCLUSIONS: The three suture materials appear equivalent with respect to overall tensile strength of anastomosis; with histologic evaluation, the trend was toward better patency with polyglactin. Polyglactin 10-0 microsurgical suture is a viable alternative to nonabsorbable sutures in microsurgical VVs, although further studies are indicated to assess long-term results.

Animals↗
PubMed1997

Analysis of videokeratography after penetrating keratoplasty: topographic characteristics and effects of removing running sutures.

OBJECTIVE: Previous studies have shown that removal of running sutures after penetrating keratoplasty causes unpredictable changes in astigmatism. The current study was conducted to investigate whether computer-assisted videokeratography is beneficial for predicting visual outcomes after running sutures are removed. DESIGN: The design was that of a prospective clinical study. PARTICIPANTS: The authors prospectively studied 29 consecutive eyes undergoing a 10-0 nylon running suture removal after penetrating keratoplasty. INTERVENTIONS: Videokeratography was performed before, 1 week, 1 month, and 3 months after removal of sutures. MAIN OUTCOME MEASURES: Changes in refractive and topographic astigmatism after suture removal were measured. Topographic patterns and their quantitative descriptors also were analyzed. RESULTS: An asymmetric bowtie was the most common videokeratography pattern both before and after suture removal. After suture removal, the incidence of peripheral corneal steepening increased significantly (2 vs. 21 eyes, P < 0.0001), and that of focal flattening of the midperipheral cornea decreased (13 vs. 5 eyes, P = 0.046). The mean topographic astigmatism, surface regularity index, and corrected visual acuity were improved significantly by suture removal in eyes that had localized flattening but not in eyes without this finding. Eyes having either skewed axis in astigmatism or topographic astigmatism of more than 9 diopters also showed significant decreases in astigmatism. CONCLUSIONS: Suture removal after keratoplasty is advantageous for both reducing astigmatism and normalizing topography, especially in eyes that have localized flattening of the midperipheral cornea. Predictability of visual outcomes of a running suture removal in postkeratoplasty eyes may be improved by the use of videokeratography.

Adolescent↗
PubMed1982

Experimental investigations into the clinical significance of bone growth at viscerocranial sutures.

The development of a viscerocranial suture under physiological conditions was investigated in a total of 37 pigs and the effects of various traumas on expected sutural bone growth were observed. Different operations were carried out on one side only in the vicinity of the zygomaticotemporal suture in 18-25 day old piglets. The animals were sacrificed six months after the operation. The skulls of some of the animals were macerated and subjected to macroscopic and radiological investigation. Both zygomatic arches were removed from each of the remaining animals and used for the production of undecalcified microtome and ground sections. Intravital fluorochrome labelling was used to determine the asymmetric growth at this suture; this is interpreted as being the formation of new bone following passive expansion of the sutural region. After injury or transplantation of the periosteum and after the healing of a narrow bone defect or fracture we observed either a continuous suture from the outset or the formation of a new fissure after osseous regeneration. Similar findings were also made after the transplantation of compact rib fragments into a sutural defect without subsequent bridging of the defect. Only after the transplantation of autologous pieces of cancellous rib into an osseous defect in the sutural region was sutural ossification, accompanied by distinct deformation of the skull observed. As a clinical consequence of this it may be presumed that trauma or operation in the region of a suture has a considerable effect on the growth of the visceral cranium only if it results in premature synostosis.

Animals↗