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PubMedDate not supplied

The use of percutaneous sutures for graft fixation in rhinoplasty.

We reviewed our 10-year experience using percutaneous suturing to secure cartilage grafts in rhinoplasty. A total of 382 patients having up to 4 percutaneous sutures per surgery were analyzed. Cases using this suture technique included lower lateral onlay grafts, dorsal onlay grafts, tip grafts, and intact conchal cartilage grafts to repair nasal valve collapse. Sutures are ideally placed in a horizontal mattress fashion beginning at the skin surface, continuing into the nasal cavity, and then out through the skin. Sutures are strategically placed to secure the graft and at times stent open the nasal valve. The suture is tied loosely over the skin taking in to consideration the anticipated edema formation. There is no need to use a bolster technique. Sutures are removed at the second postoperative visit. Long-term follow-up reveals precise graft placement. There are in most instances no visible suture marks and our results achieve over 95% patient satisfaction. Percutaneous suture placement is a simple technique that allows precise graft placement and fixation without resultant scarring. It coapts the skin and soft tissues to the grafted nasal skeleton and prevents fluid accumulation, hematoma formation, and graft migration. We believe that it aids in decrease long-term tissue edema and excessive fibrosis, therefore promoting quicker healing. Our patients are both functionally and cosmetically pleased.

Cartilage↗
PubMed1990

The efficacy of absorbable suture for microvascular anastomoses.

Although microvascular anastomoses are routinely performed with nonabsorbable sutures, a foreign body reaction can be stimulated that acts as a nidus for inflammation, infection, and possible thrombosis. Absorbable sutures should be able to diminish this reaction. There are sparse data describing the use of absorbable sutures for both arterial and venous anastomoses. This investigation compares standard microvascular anastomotic technique using nonabsorbable 10-0 sutures (nylon) with absorbable 10-0 sutures (polyglactin 910), using a previously reported tubed superficial epigastric flap model in rats. Patency rates and histologic responses are compared at intervals of 3 days and 1, 2, 8 and 12 weeks postoperatively. Arterial and venous patency rates were similar for both materials (overall nonabsorbable, 85.9%; overall absorbable, 84.4%). A somewhat increased inflammatory response was noted in the arterial absorbable group at 1 week and in both the venous and arterial nonabsorbable groups at 8 and 12 weeks postoperatively. The later finding most probably represents the continued presence of the nylon sutures. The incidence of intraluminal thrombosis was greater for nonabsorbable suture, occurring in two arterial and four venous anastomoses, compared with only one absorbable suture venous anastomosis. We conclude that nonabsorbable suture is as efficacious as standard absorbable material in both arterial and venous microanastomoses with the potential benefit of diminished foreign body reaction.

Absorption↗
PubMed1998

Manual vs robotically assisted laparoscopic surgery in the performance of basic manipulation and suturing tasks.

OBJECTIVE: To compare the surgical performance of manual and robotically assisted laparoscopic instruments on basic maneuvers and intracorporeal suturing in inanimate models. DESIGN: A set of laparoscopic tasks was used to evaluate basic endoscopic movements and intracorporeal suturing: positioning a cylinder on a Peg-Board, dropping beads into receptacles, running a 25-cm rope, and capping a hypodermic needle. Intracorporeal knot tying and running a suture through predetermined points were evaluated separately. The sutures used for these tasks were 2-0 and 4-0 silk and 6-0 and 7-0 polypropylene. PARTICIPANTS: Twenty surgeons completed the set of laparoscopic tasks manually and then with a robotically assisted system. None had used the robotic system before. MAIN OUTCOME MEASURES: Time required to complete the tasks and the precision in performing them. RESULTS: The robotic system accurately reproduced the movements of the surgeons and filtered their hand tremors efficiently. In the basic tasks, operative times were significantly longer for the robotic system (P<.001). In the suturing tasks, operative times were longer with the use of the robotic system for sutures sizes 2-0 and 4-0 (P<.001). However, time differences were not significant for suture sizes 6-0 and 7-0 (P> or =.07). Precision measurements were similar for all tasks using the manual instruments and the robotically assisted system. No significant differences were found between the performance of advanced laparoscopic surgeons and laparoscopic fellows. CONCLUSIONS: Laparoscopic maneuvering and suturing is faster and just as precise when performed manually as when performed with the prototype robotic system. These differences in speed are inversely proportional to the size of the suture. Future generations of the robotic system may eliminate these differences.

Equipment Design↗
PubMed2000

Elimination of stick-slip of elastomeric sutures by radiofrequency glow discharge deposited coatings.

Fine elastomeric sutures intended for cardiovascular surgery can exhibit "stick-slip" behavior as they are pulled through tissue; the resulting oscillatory force can damage delicate tissue or cause sutures to snap. To eliminate this undesirable effect, sutures were surface-modified using a radiofrequency glow discharge in a vapor of either hexamethyldisiloxane or hexamethyldisilazane, to produce a thin polymeric coating on the suture. The same coatings were also deposited onto aluminized tape to facilitate their characterization by measurement of air/water contact angles and by X-ray photoelectron spectroscopy. Coatings from both monomers were found to be very hydrophobic. The hexamethyldisiloxane glow discharge coatings underwent negligible oxidation when stored in air, and thus remained stable over a shelf-life period akin to what may be required of sutures. The hexamethyldisilazane glow discharge coatings, in contrast, incorporated substantial amounts of oxygen over a 3-month period. The coatings did not measurably alter the tensile properties of the sutures. The frictional properties of coated sutures were assessed by measuring the dynamic friction between the suture and ovine myocardium. Both coatings were effective in removing the inherent stick-slip behavior of polybutester sutures in this model. The coatings remained intact after several passes and proved to be robust and efficacious under various strain regimes.

Animals↗
PubMed1986

Effect of steel wire sutures on the incidence of chemically induced rodent colonic tumours.

An experiment is presented which shows that colonic primary tumours cluster around a previously constructed anastomosis and that the choice of suture materials (but not the technique of their insertion) can influence this. In a rodent model where dimethylhydrazine was administered 2 months after surgery, anastomotic tumours were most often seen when wire sutures--as used in the staples of anastomotic stapling guns--had been employed (10 out of 16 large bowel tumours were anastomotic as compared with 2 of 12 in a silk sutured group, P = 0.019). An explanation may be that wire sutures persist much longer than silk (in the experiment, 10 months after insertion, 4 per cent of silk sutures were still present, 15 per cent of wire, P less than 0.01). This was translated into a greater degree of scarring at the anastomosis, being most severe in the presence of persisting sutures. Of the 12 anastomotic tumours found in both groups, 7 (58 per cent) were in the minority (17-26 per cent) who had persisting sutures and the remaining 5 in the 47 who had none. Techniques of suturing (needle always passed from the serosa in; needle from mucosa out--the latter in such a way that mucosal cells could be displaced into the bowel wall where it was supposed that they might be more susceptible to subsequent carcinogenesis) did not affect tumour yield. We suggest that non-absorbable sutures, and especially stainless steel wire, should not be used when constructing an anastomosis after large bowel cancer surgery.

1,2-Dimethylhydrazine↗
PubMed1994

Closure of midline laparotomy incisions with polydioxanone and nylon: the importance of suture technique.

The healing of midline laparotomy incisions closed with a continuous suture of nylon or second-generation polydioxanone was evaluated in a randomized clinical trial. The effect of suture technique, reflected in the suture length to wound length ratio, was also assessed. All patients who underwent abdominal surgery through a midline incision were included except those with incisional hernia after previous midline operation. Wound dehiscence occurred in five (0.6 per cent) of 813 patients and wound infection in 73 (9.0 per cent). These rates were similar for both suture materials, as were those for the development of suture sinus and prolonged postoperative wound pain. Incisional hernia 12 months after surgery was found in 49 (15.1 per cent) of 325 wounds sutured with polydioxanone and in 50 (15.7 per cent) of 318 closed with nylon (P = 0.91). There was a significant correlation between the hernia rate and the suture to wound length ratio for both materials (P < 0.001). These results indicate that suture of midline laparotomy wounds is as safe with polydioxanone as it is with nylon. Incisional hernia is associated more with suture technique than with the material used.

Female↗
PubMed1993

Biomechanical performance of new vascular sutures and needles for use in polytetrafluoroethylene grafts.

Two new cardiovascular monofilament sutures attached to taper point needles have been developed for use in expanded polytetrafluoroethylene (PTFE) grafts. One monofilament suture made of PTFE has a microporous structure that allows it to be channel swaged to a needle that closely approximates its suture diameter. The other suture is a monofilament polypropylene suture that has been extruded to produce a tapered swage end, which was significantly smaller than that of the remainder of the suture in order to be channel swaged to smaller diameter needles. On the basis of comprehensive biomechanical performances, the performance of the new needle suture products with needle/suture diameter ratios approaching 1:1 was superior to needle suture products with 2:1 needle/suture diameter ratios for use in PTFE vascular grafts, regardless of the suture material.

Blood Vessel Prosthesis↗
PubMed1984

Penetration of Staphylococcus aureus into sutured wounds.

An animal model was developed to study whether Staphylococcus aureus could penetrate a sutured wound. Six days after bacteria were applied to sutured incisions, viable organisms could be recovered from the depths of the wounds in the majority of cases. Specifically, bacteria could be recovered in 23 of 24 wounds when they were applied 1 day after suturing, in 17 of 24 wounds when they were applied 4 days after suturing, and in 13 of 24 when applied 7 days after suturing. When Steri-strips were used to close the wounds, bacteria could not be recovered from any of 24 wounds when bacteria were applied 4 or 7 days after wound closure. When bacteria were applied 5 min after sutures had been placed but without incision, bacteria could be recovered in three of 12 cases and in two of 12 cases when they were applied 7 days after suturing. These results demonstrate that bacteria can penetrate sutured wounds. The sutures themselves probably contributed to this phenomenon.

Animals↗
PubMed1993

Comparison of 10-0 polypropylene and 10-0 nylon sutures in rat arterial anastomosis.

The selection of suture materials is an important factor in further improving the results of microsurgical operations. In this study, two kinds of nonabsorbable suture materials, 10-0 polypropylene and 10-0 nylon monofilament, were compared in end-to-end anastomosis of 66 femoral arteries of adult rats. Both suture types were of identical size (70 microns needle/28 microns suture) and each artery received eight sutures. The vessels were harvested at various intervals from 2 hr to 180 days postoperatively and were evaluated by pathology, radiology, and tensile strength test. The results show that both sutures are capable of achieving excellent long-term patency (100%) of anastomosed sites. Polypropylene suture was equivalent to nylon in mechanical integrity of the anastomosis sites but was superior in handling, knotting, and biocompatibility. These physical and biological properties of polypropylene sutures may offer the benefits of diminished early and late complications at anastomosis sites and reduced operation time. Enhancement of contrast against surrounding tissue may make polypropylene a superior alternative to nylon sutures for microsurgical use.

Anastomosis, Surgical↗
PubMed2006

Metopic suture in fetuses with Apert syndrome at 22-27 weeks of gestation.

OBJECTIVES: To examine the possible association of skull deformity and the development of the cranial sutures in fetuses with Apert syndrome. METHODS: Three-dimensional (3D) ultrasound was used to examine the metopic and coronal sutures in seven fetuses with Apert syndrome at 22-27 weeks of gestation. The gap between the frontal bones in the transverse plane of the head at the level of the cavum septi pellucidi was measured and compared to findings in 120 anatomically normal fetuses undergoing routine ultrasound examination at 16-32 weeks. RESULTS: In the normal group, the gap between the frontal bones in the metopic suture at the level of the cavum septi pellucidi, decreased significantly with gestation from a mean of 2.2 mm (5th and 95th centiles: 1.5 mm and 2.9 mm) at 16 weeks to 0.9 mm (5th and 95th centiles: 0.3 mm and 1.6 mm) at 32 weeks. In the seven cases with Apert syndrome, two-dimensional ultrasound examination demonstrated the characteristic features of frontal bossing, depressed nasal bridge and bilateral syndactyly. On 3D examination there was complete closure of the coronal suture and a wide gap in the metopic suture (15-23 mm). CONCLUSION: In normal fetuses, cranial bones are believed to grow in response to the centrifugal pressure from the expanding brain and proximity of the dura to the suture is critical in maintaining its patency. In Apert syndrome, the frontal bossing may be a mere consequence of a genetically predetermined premature closure of the coronal suture. Alternatively, there is a genetically predetermined deformation of the brain, which in turn, through differential stretch of the dura in the temporal and frontal regions, causes premature closure of the coronal suture and impaired closure of the metopic suture.

Acrocephalosyndactylia↗
PubMed2000

Laparoscopic suturing evaluation among surgical residents.

BACKGROUND: Laparoscopic suturing is an integral part of advanced laparoscopic surgery training. The objective of this study was to evaluate the performance and preference of surgical residents performing intracorporeal and extracorporeal knot-tying techniques using conventional and Endo Stitch instruments. The residents were also evaluated on their suturing techniques using conventional instruments, the Endo Stitch, and the Suture Assistant. METHODS: Using an inanimate laparoscopic trainer model, 39 residents were evaluated as they performed laparoscopic knot tying exercises. Endpoints of the study were execution time and subjective preference of surgical residents with respect to the type of instrument used for knot tying. Forty-three residents were evaluated as they performed laparoscopic suturing exercises with three different types of suturing instruments using the same endpoints. RESULTS: The intracorporeal technique was the preferred (89%) method of knot tying among surgical residents. The time for completion of laparoscopic suturing was significantly (P < 0.05) shorter with the Endo Stitch (114 +/- 64 s) than with the conventional instrument (206 +/- 107 s) or the Suture Assistant (151 +/- 70 s). Residents preferred the use of the Endo Stitch in all three categories for suturing, knot tying, and handling. CONCLUSION: The Endo Stitch enhanced laparoscopic skills and was the preferred instrument for laparoscopic knot tying and suturing among surgical residents.

Humans↗
PubMed1976

Comparative study of circumferential nerve suture using the operating microscope. Electrophysiological and histological control.

The aim of this work is to try to compare the results of different methods of circumferential small nerve suture according to the degree of magnification and type of microsurgical technique. Four techniques were studied in forty Wistar rats. 1. Microsurgical suture with the Set technique. Magnification 25, accurate suture. 2. Microsurgical suture with simple end to end approximation. Magnification 25, accurate suture. 3. Same technique, but delayed suture. 4. Suture with a simple end to end approximation. Magnification 4. Four stitches for reapproximation. After four months the sutured nerves have been studied both electrophysiologically and histologically. The results show clearly that the so-called set technique associated with an accurate circumferential suture with eight stitches under high magnification gives by far the best results, the regeneration rate of the nerve being higher than 80%. The results in groups 3 and 4 are definitely less good. The simple bringing together of both stumps under low magnification with only four stitches (group 4) gives the worst results with only 20% of regeneration.

Animals↗
PubMed1986

[Telethermographic studies of the wound suture in animal experiments].

It is known from clinical practice that the healing of wounds is influenced by the type of wound suture applied. In general, the scar resulting from an intracutaneous suture looks better than that produced by an uninterrupted suture or by knotted suture. With respect to the appearance of the scar, the intracutaneous suture is normally superior to other wound sutures. As suggested by the results of our investigations, this may be due to an undisturbed microcirculation within the wound. Thermovision shows that a local temperature increase appears sooner in a wound closed by intracutaneous suture, whereas the temperature increases more slowly in case of uninterrupted or knotted suture. We suppose that the alterations of microcirculation in a wound closed by one of the latter types of wound suture can be considered as disturbance in blood circulation which may be followed by healing disturbances and proliferations of connective tissue.

Animals↗
PubMed2004

Cranial suture simulator for ultrasound diagnosis of craniosynostosis.

BACKGROUND: In evaluating the effectiveness of ultrasound as a screening tool for craniosynostosis it was discovered that sonologists and sonographers needed more experience scanning and visualizing cranial sutures on ultrasound. OBJECTIVE: To create an ultrasound simulator to train radiologists and technologists to locate and recognize patent and fused cranial sutures in children. MATERIALS AND METHODS: The hypoechoic appearance of patent sutures was simulated by cutting lines into life-sized plastic doll heads and filling them with a commercial hypoechogenic material. Fused hyperechoic sutures were simulated by not cutting into the hard plastic region of a suture. The simulator's teaching value was evaluated on three radiology residents and three fellows. Subjects performed pre-training scans on unknown simulators, received feedback and an opportunity to scan a training simulator, and then performed post-training scans on random unknown simulators. Accuracy was recorded as percentage of correctly demonstrated sutures. RESULTS: The suture simulator reproduces the sonographic appearance of patent and fused cranial sutures. Accuracy of acquisition, interpretation, and overall diagnosis increased from 64 to 91%, 79 to 91%, 61 to 97%, respectively, between pre and post training scans. CONCLUSION: An ultrasound simulator can reproduce the appearance of patent and fused cranial sutures in children and can be used to train radiologists and technologists in the performance of a screening protocol.

Cranial Sutures↗
PubMed2003

Unicoronal suture autotransplantation in the rabbit.

INTRODUCTION: Our hypothesis was that a neurocranial suture autograft will, when shielded from dura, grow and be incorporated into the calvarium. METHODS: Growth was monitored by marker separation in three isohistogenic groups of rabbits, between postnatal days 9 and 90. In order to simulate increased neurocapsular expansion force, the left-sided coronal suture of a group of 20 rabbits was immobilised with a resorbable suture on gestational day 25. The other group of 10 rabbits was sham-operated. On postnatal day 9, 10 of the experimental rabbits underwent transplantation of the suture contralateral to the defect resulting from extirpation of the immobilised suture. The transplant was shielded from dural influence by a platinum foil. RESULTS: The growth of the immobilised coronal sutures was severely impaired, and also that of the contralateral unicoronal sutures to a lesser extent. A significant catch-up of growth occurred in the transplanted unicoronal sutures. Overgrowth occurred at the donor sites. CONCLUSION: The results allow us to consider suture transplantation combined with endosteal dura stripping in craniosynostosis surgery.

Animals↗
PubMed2004

Laparoscopic incisional hernia repair in a porcine model: what do transfixion sutures add?

BACKGROUND: The aim of this study was to evaluate the need for transfixion sutures during laparoscopic ventral hernia repair with mesh. METHODS: Incisional hernias were created in 14 Yucatan mini-pigs. Animals were randomized to undergo laparoscopic hernia repair either with spiral tacks alone (Tacks) or with tacks and 4 Prolene transfixion sutures (Sutured) using Composix E/X mesh (Davol Inc.). At 4 weeks, exploratory laparoscopy was performed to assess the repair and score adhesions. The abdominal wall was harvested for tensile strength analysis and histologic evaluation. Continuous variables were compared using a two-tailed nonpaired t-test. Results are presented as mean +/- standard deviation. RESULTS: The mean hernia size was 8.5 +/- 0.5 cm by 5.5 +/- 0.7 cm, with no difference between groups. The operative time was significantly longer ( p = 0.006) for the Sutured group (62.1 +/- 16.8 min) than for the Tacks group (32.3 +/- 7.0 min). The number of tacks per repair was equivalent between groups. At necropsy, the mesh in all cases was well incorporated, reperitonealized, and without evidence of migration. No hernias recurred. However, the Sutured group had a significantly ( p < or = 0.05) higher adhesion score (5.4 +/- 3.3) than the Tacks group (2.0 +/- 2.7). The tensile strength of the repair zone was no different between groups (Sutured 4.8 +/- 1.5 N/cm, Tacks 3.8 +/- 1.4 N/cm). On histologic examination, the ratio of inflammatory cells to fibroblasts was similar between groups (Sutured 0.2 +/- 0.6, Tacks 0.2 +/- 0.3). Only 82% of tacks in each group penetrated the fascia, and the depth of tack penetration was similar between groups (Sutured 3.7 +/- 0.3 mm, Tacks 3.9 +/- 0.4 mm). CONCLUSIONS: In a porcine model, the use of transfixion sutures was associated with longer operative times and more adhesions, without improvement in tensile strength or mesh incorporation. A human clinical trial is needed to determine the optimal method of securing abdominal wall mesh.

Abdominal Wall↗
PubMed2004

Bimodal assessment of laparoscopic suturing skills: construct and concurrent validity.

BACKGROUND: The assessment of technical skills should provide objective feedback and judge suitability of progress during training. The aim of this study was to validate two objective assessment techniques for laparoscopic suturing and demonstrate a correlation between them. METHODS: Six experts, seven surgeons skilled in laparoscopic suturing, and 13 with no laparoscopic suturing skills were asked to place two or three intracorporeal sutures on a synthetic suture pad. The latter group was given video-based instructions prior to the execution of the sutures. Ergonomic conditions were standardized for all subjects. The procedures were recorded on videotape and two blinded observers rated the first suture of each subject on a 29-point checklist. A motion analysis system, Imperial College Surgical Assessment Device, was used to assess psychomotor skills. RESULTS: There was a significant difference in the time taken (p = 0.000) and total path length (p = 0.000) per suture across the groups. There were also a significant difference in the total checklist score (p = 0.000) and its individual categories. The was a strong correlation between the total path length and the total checklist score (coefficient, 0.78; p < 0.001). CONCLUSIONS: A combination of the motion analysis system and the checklist would make the process of formative feedback during the learning of intracorporeal suturing objective and comprehensive.

Clinical Competence↗
PubMed1988

The effect of suture removal on postkeratoplasty astigmatism.

I followed up for a minimum of six months 439 eyes that had undergone corneal transplantation using a suturing technique consisting of eight interrupted 10-0 and a single, continuous, 16-bite 11-0 nylon suture. All sutures were removed from 188 eyes an average of 20 months after surgery. After suture removal, 64 corneas had an increase of astigmatism greater than 0.5 diopter, 79 eyes showed a decrease in astigmatism greater than 0.5 diopter, and 42 corneas had no change in astigmatism. The mean astigmatism before suture removal was 3.7 diopters, and the mean astigmatism after suture removal was 3.5 diopters. There was no apparent difference in postkeratoplasty astigmatism with donor corneal diameters 0.25 to 0.75 mm greater in diameter than the recipient diameters, or with different host diseases. The longer the sutures were left in place after surgery, the smaller the quantitative change in astigmatism after suture removal. The complications of this technique were no different from other currently used suture techniques.

Astigmatism↗