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PubMed1981

Bacterial adherence to surgical sutures. A possible factor in suture induced infection.

Surgical sutures are known to potentiate the development of wound infection. The purpose of this study was to investigate whether the capability of bacteria to adhere to various types of sutures has a significant effect on their ability to cause infections. Bacterial adherence to sutures was quantitatively measured using radiolabeled bacteria. In vitro adherence assays revealed remarkable variations in the affinity of bacteria to the various sutures: nylon bound the least bacteria while bacterial adherence to braided sutures (silk, Ti-cron, Dexon) was five to eight folds higher. The degree of infection obtained in mice in the presence of different sutures nicely correlated with their adherence properties. The different removal rate of adherent bacteria (glutaraldehyde-fixed) from various sutures by the tissue factors in mice supports the hypothesis that bacterial adherence to suture materials plays a significant role in the induction of surgical infection. Our observation points out at the need for careful suture selection in contaminated wounds. The adherence properties of sutures should be considered in any future surgical suture design.

Animals↗
PubMed1984

Computerized tomography of cranial sutures. Part 2: Abnormalities of sutures and skull deformity in craniosynostosis.

Preoperative computerized tomographic (CT) scans of 24 children who had surgery for either single or multiple craniosynostoses were compared with skull radiographs and operative and pathological findings. In addition to providing accurate imaging of calvarial and skull base deformities secondary to premature suture closure, high-resolution CT with bone definition algorithms supplied valuable detail of anatomical changes at the abnormally developed suture. The CT findings varied with the location of the suture. Thickened bony ridges predominated at the sagittal suture, focal bone thickening and erosions were more likely to be found at the metopic suture, and parasutural sclerosis was the prevalent finding on one side of the lambdoid suture. No evidence of the suture could be detected in the majority of patients with complete coronal craniosynostosis. Radiographs of the skull were shown to be a relatively insensitive means of imaging the zone of limited fusion, especially the lambdoid suture. An excellent correlation was found between the CT scan and the operative and pathological findings. There was histological evidence of progressive suture fusion in virtually all patients. An asymmetrically narrowed lucent zone with parasutural sclerosis or bony ridges seen on CT scans correlated well with fibrous union of the suture found on histological examination. The authors conclude that high-definition CT used in conjunction with bone windows and thin and coronal slices for the evaluation of sagittal sutures is a useful imaging method for the evaluation of craniosynostosis.

Cranial Sutures↗
PubMed1990

[Meniscal sutures combined with the reconstruction of the anterior cruciate ligament. Comparative results between sutures of chronic and recent lesions: 102 cases].

The authors report the results of 102 meniscal sutures (53 lateral meniscus and 49 medial meniscus) done on 85 persons (86 knees) with laxity of the knee (54 acute laxities and 32 chronic laxities). All the sutures were done by posterior arthrotomy, while reconstruction of anterior cruciate ligament. Among the operations done on anterior cruciate ligaments, we find 45 reconstructions using MacIntosh procedure, 37 CHO method and 3 reconstructions using Lemaire procedure. 78 per cent of the sutures of the recent injuries were placed in a post-operative plaster cast, on the other hand, none of the chronic injuries was splinted. All the knees (except 1) were followed up within an interval of time of 1 year minimum to 4 years maximum. 3 sutures of fresh medial meniscus tear were reoperated on and one suture of old tear was reoperated. None of the lateral meniscus sutures, old or new was reoperated. 27 "objective" controls were done: 5 by arthrography, 4 by arthroscopy and 18 by magnetic resonance imaging (M.R.I.). Of the 18 controlled sutures by M.R.I., 13 (that is, 76, 5 per cent) presented a high signal as if they had a "wound" or persistent injury, this was found within a context of knees without any symptoms. Therefore the sutures of medial meniscus associated with laxity heal very well. It would be even better if they were in the chronic laxity stage (1 did not succeed out of the 22) than in the acute laxity stage (3 failures out of 27). The sutures of lateral meniscus healed very well in the chronic and in the old laxity stages (total success in both stages). The M.R.I controls for the 18 meniscus sutures presented the problem of the sutured meniscus future.

Adolescent↗
PubMed2000

The effect of knot location, suture material, and suture size on the gliding resistance of flexor tendons.

The effect of knot location, suture material, and suture size on gliding resistance between the pulley and flexor tendon was investigated in a canine model. Different suture materials [monofilament nylon (Ethilon), braided polyester suture coated with silicone (Ticron) and uncoated braided polyester suture (Mersilene)] and suture sizes (4-0, 5-0) were tested. A knot was made on either the volar surface, on one lateral side, or on both lateral sides of canine hind-paw tendons, and gliding resistance was measured. In addition, the frictional coefficient between three suture materials (4-0 nylon, 4-0 Ticron, 4-0 Mersilene) and a nylon rod were measured. The gliding resistance of the tendon with knots on both sides was highest, while tendons with one lateral knot had the lowest resistance (p < 0.01). The gliding resistance of 4-0 suture size was higher than that of 5-0 size (p < 0.0001). The coefficient of friction of nylon was lower than that of braided polyester suture (Ticron or Mersilene) (p < 0.001). The placement of knots and choice of suture material affect gliding resistance after tendon repair, and may, therefore, have an effect on the result of tendon repair.

Animals↗
PubMed1977

Suture technic and suture-holding capacity. A model study and a theoretical analysis.

The suture-holding capacity (SHC) of six representative surgical suture materials was analyzed. The single loop, the far-and-near, and the near-and-near suture technics were used in the study. The SHC was found to depend on: (1) the coefficient of friction between the suture strand and the tissue; (2) the distensibility of tied and untied fiber; (3) the holding capacity of the knot used; and (4) the strength of the untied strand. Knot-holding capacity (KHC) was of the greatest importance when the single loop technic was used and when the friction between the suture strand and the tissue was low. When the near-and-near or the far-and-near technic was used, the SHC was influenced little by the strength of the knot, especially when the coefficient of friction between strand and tissue was high. The near-and-near suture technic produced the strongest sutures for all materials except Dexon, for which the far-and-near technic produced the strongest sutures. With a correct suture and tying technic, one can optimally use the strength of the suture material and one can use thin strands.

Humans↗
PubMed2000

Influence of suture material and suture technique on collagen fibril diameters in midline laparotomies.

BACKGROUND: Although laparotomy closure is associated with a cumulative 15% failure rate, the effect of different suture techniques and materials on the ultrastructural composition of the healing incision has not been investigated. METHOD: in 40 Wistar rats the collagen fibril diameters and the regenerative tissue were compared using electron microscopy 14 and 28 days after midline laparotomy. Wounds were closed with single and running sutures using either polypropylene or polyglactin 910. RESULTS: Closure with polypropylene led to significantly larger mean fibril diameters than closure with polyglactin. Regardless of time and suture material, running closure resulted in significantly smaller mean collagen fibril diameters than single sutures. Four weeks after laparotomy, inflammatory reactions, disorganization of collagen and irregularities of the vascular architecture were found after closure with absorbable suture material but not after closure with nonabsorbable material. CONCLUSION: Suture material and suture method significantly influence the ultrastructural composition of the healing incision. Persisting mechanical irritation around the suture threads after single sutures and severe persisting inflammatory reactions after the use of absorbable suture material are important influencing factors.

Animals↗
PubMed2004

Initial fixation strength of flexible all-inside meniscus suture anchors in comparison to conventional suture technique and rigid anchors: biomechanical evaluation of new meniscus refixation systems.

BACKGROUND: The newest generation of meniscus repair devices is designed to combine the benefits of the all-inside technique with the biomechanical properties of sutures. HYPOTHESIS: New flexible all-inside suture anchors have better fixation strength than rigid anchors, but there is no difference when compared to conventional horizontal and vertical mattress sutures. STUDY DESIGN: Controlled laboratory study. METHODS: In fresh-frozen bovine menisci, initial fixation strength, stiffness, and failure mode of different meniscus fixation techniques (FastT-Fix, RapidLoc, Meniscus Arrow, horizontal and vertical 2.0 Ethibond sutures) were evaluated in a computer-based materials testing machine at a rate of 12.5 mm/sec. RESULTS: The vertical and horizontal FastT-Fix suture anchors were the strongest devices with regard to pullout strength, with no significant difference compared to the vertical 2-0 Ethibond sutures. Horizontal sutures, Meniscus Arrow, and RapidLoc had significantly lower pullout strength. Vertical and horizontal FastT-Fix suture anchors showed significantly higher stiffness than the other devices. CONCLUSIONS: Biomechanical properties of flexible all-inside meniscus anchors (FastT-Fix) are comparable to conventional vertical suture techniques. Characteristics of the flexible RapidLoc are comparable to rigid anchors (Meniscus Arrow). CLINICAL RELEVANCE: From the biomechanical point of view, flexible all-inside meniscus refixation devices are an alternative to conventional suture techniques and rigid meniscus anchors.

Animals↗
PubMed1992

Influence of the distance between interrupted sutures and the tension of sutures on the healing of experimental colonic anastomoses.

Certain technical factors determine the success of the creation of intestinal anastomoses. The influence of the distance between interrupted sutures and the suture tension on wound healing was investigated in an experimental study using a specially designed suture model. The combination of a long suture distance (group A, 2.5 mm) and a short suture distance (group B, 1.5 mm) with three different suture tensions, i.e., (1) no tension; (2) moderate tension; and (3) high tension, resulted in six different techniques. Tension was created by means of a spring balance. The anastomoses were examined macroscopically, histologically by microangiography, and by bursting pressure. Apposition of the bowel wall between the interrupted sutures was inappropriate due to prolapse of the mucosa in 7.9% of the patients in group A but did not occur in groups B2 and B3. The leakage rate was 4.6% in group A and 1.3% in group B. Early healing of the mucosa was noted in group B2. Bursting pressure was significantly higher on day 2 and 4 in groups B2 and B3. The results demonstrate the influence of suture technique on the wound healing of intestinal anastomoses. The best healing pattern was achieved by a small distance between the sutures and a moderate suture tension.

Anastomosis, Surgical↗
PubMed2003

Sutures and suture anchors: update 2003.

PURPOSE: The purpose of this study was to evaluate recently introduced sutures and suture anchors for single-pull load-to-failure strength and failure mode. TYPE OF STUDY: Experimental laboratory biomechanical study. METHODS: Using an established protocol in fresh porcine femurs, anchors were tested in diaphyseal cortex, metaphyseal cortex, and cancellous troughs after threading them with either steel sutures or strong synthetic material to reduce the likelihood of suture breakage as a mode of failure. An Instron machine (Instron, Canton, MA) applied tensile loads parallel to the axis of insertion at a rate of 12.5 mm/second until failure, and mean anchor failure strengths were calculated. Mode of failure was recorded (anchor pullout, suture eyelet cutout, or wire breakage). Anchors tested included the RotorloC (Smith & Nephew Endoscopy, Andover, MA), TwinFix Ti 3.5, TwinFix Ti 5.0, and TwinFix AB (Smith & Nephew Endoscopy), Super Revo and UltraSorb (Linvatec, Largo, FL), Duet (Bionx Implants, Blue Bell, PA), AlloAnchor RC (Regeneration Technologies, Alachua, FL), Opus Magnum anchor (Opus Medical, San Juan Capistrano, CA), and the BioCorkscrew 5.0 and BioCorkscrew 6.5 (Arthrex, Naples, FL). Sutures tested were No.2 and No. 5 Ethibond (Ethicon, Somerville, NJ), No. 2 Panacryl (Mitek, a division of Ethicon, Somerville, NJ), and Nos. 2, 5, and 2-0 Fiberwire (Arthrex, Naples, FL). RESULTS: The sutures all broke in the midpoint of their tested strand away from the grips. The No. 2 Ethibond failed at a mean of 21 lb (92 N); No. 5 Ethibond failed at a mean of 44 lb (193 N); No. 2, No. 5, and No. 2-0 Fiberwire at means of 44 lb (188 N), 112 lb (483N), and 19 lb (82 N), respectively; and No. 2 Panacryl at a mean of 22 lb (99 N). The suture anchors all failed at levels higher than the associated sutures. CONCLUSIONS: Screw anchors showed higher load to failure values than nonscrew designs, and the new biodegradable anchors showed failure loads lower than the anchors. All anchors were stronger than the suture for which they are designed.

Animals↗
PubMed2006

Posterior-wall-first continuous suturing combined with conventional interrupted suturing for microvascular anastomosis.

Vascular anastomosis with conventional interrupted suturing is often difficult to perform when the vascular clamp is not reversed, because of a narrow operative field or a short vascular pedicle. A posterior-wall-first continuous suture technique combined with the standard interrupted suture technique is one method of solving this problem. The authors conducted a comparative study of posterior-wall-first continuous suturing combined with standard interrupted suturing and conventional interrupted suturing in rat vessels. There was no statistically significant difference in patency rates or suturing times. Electron microscopy demonstrated no significant difference in recoverability of the intima. The posterior-wall-first continuous suture technique combined with the standard interrupted suture technique is a useful alternative to the conventional interrupted suture technique.

Anastomosis, Surgical↗
PubMedDate not supplied

Treatment of acromioclavicular joint separation: suture or suture anchors?

This investigation compared the stability of 2 methods of fixation for acromioclavicular (AC) joint separations. A complete AC joint separation was simulated in 6 matched pairs of fresh-frozen human cadaveric shoulders. One specimen from each pair was repaired with two No. 5 nonabsorbable braided sutures passed around the base of the coracoid and the other with 2 suture anchors preloaded with the same suture material placed into the base of the coracoid process. The specimens were cyclically loaded for 10(4) cycles to simulate our early postoperative rehabilitation protocol for coracoclavicular repairs. Before cycling, the repairs had a mean superior laxity of 1.68 +/- 0.44 mm for the sutures alone and 1.23 +/- 0.31 mm for the suture anchors. After 10(4) cycles, the laxity was 1.32 +/- 0.59 mm and 1.33 +/- 0.94 mm, respectively. These differences were not statistically significant (P =.2). This study demonstrated that similar stability can be achieved for coracoclavicular fixation with suture anchors or with sutures placed around the base of the coracoid for the treatment of AC joint separations. The clinical relevance includes the following: (1) the potentially diminished risk of neurovascular injury with the use of suture anchors compared with the passage of sutures around the base of the coracoid and (2) the potentially reduced surgical time associated with the use of suture anchors.

Acromioclavicular Joint↗
PubMed1996

Identification of IGF-I in the calvarial suture of young rats: histochemical analysis of the cranial sagittal sutures in a hyperthyroid rat model.

Premature closure of cranial sutures has been known as one of the complications of juvenile or congenital hyperthyroidism. Thyroid hormone is an anabolic agent for bone formation in the early stages of childhood development. In children, excess thyroid hormone acts as an acceleration factor for the skeletal bone, whereas in adult hyperthyroidism, it causes bone mineral loss due to the high turnover rate of bone formation and consequently bone resorption. In addition, there are numerous literature descriptions concerning the interactions among bone metabolism, hormones, and growth factors, among which insulin-like growth factor I (IGF-I) is the most abundantly found growth factor in osteoblasts and in bone models in vivo. We therefore investigated whether or not the cranial sutures show accelerated closure and how the local growth factors or cytokines participate and function in local bone metabolism after administration of exogenous excess thyroid hormone in a rat model. A total of 60 female Wistar rats, aged 10 days, were divided into two groups, the triiodothyronine (T3)-treated group (n = 30, T3 0.1 microgram/gm of body weight per day) and the control group (n = 30, saline vehicle only), and were maintained and subsequently sacrificed at 15, 30, and 60 days. The parameters of cranial width derived from the morphologic measurements of the skull indicated that the lambda-asterion distance at 30 days and the pterion-bregma distance at 60 days in the T3-treated group were significantly decreased compared with those of the control group. Furthermore, the fluorescent histologic findings showed fluorescent labeling with no interruption along the suture edges, suggesting continuous bone formation, and displayed narrowing of the suture gap of the sagittal suture in the T3-treated group. Tartrate resistant acid phosphatase staining showed very little osteoclastic activity in the sagittal suture, especially in the T3-treated group. The intensity of immunohistochemical staining of IGF-I was markedly increased in the suture margins of the T3-treated group. There were no significant differences observed either in the skull base measurements or in the histologic and histochemical findings of the skull base or the coronal suture between the groups. More significantly, excess administration of thyroid hormone enhanced the cranial sagittal suture closure; therefore, it was proposed that local IGF-I plays an important role in sagittal sutural bone formation.

Alkaline Phosphatase↗
PubMed1999

Regional differentiation of rat cranial suture-derived dural cells is dependent on association with fusing and patent cranial sutures.

A significant body of literature supports a role for the dura mater underlying cranial sutures in the regulation of sutural fate. These studies have implicated regional differentiation of the dura mater based on association with fusing and patent rat cranial sutures. The purpose of these experiments was to isolate and characterize dural cells associated with fusing (posterior frontal) and patent (sagittal) rat cranial sutures. Six-day-old rats were killed, and the dura mater underlying the posterior frontal and sagittal sutures was harvested. Dural cells were briefly trypsinized and allowed to reach confluence. Two litters (10 animals per litter) were used for each set of experiments. Cells were harvested after the first and fifth passages for analysis of vimentin and desmoplakin expression (characteristic of human meningeal cells), cellular proliferation, density at confluence (a measure of cellular contact inhibition), and alkaline phosphatase production. In addition, bone nodule formation and collagen I production were analyzed in first passage cells. The results indicate that suture-derived dural cells can be established and that these cells coexpress vimentin and desmoplakin. In addition, it is demonstrated that first-passage sagittal suture-derived dural cells proliferate significantly faster and have decreased cellular contact inhibition than posterior frontal suture-derived cells (p < 0.01). Finally, it is shown that suture-derived dural cells have osteoblast-like properties, including alkaline phosphatase production, collagen I expression, and bone nodule formation in vitro. The possible mechanisms by which regional differentiation of suture-derived dural cells occur are discussed.

Alkaline Phosphatase↗
PubMed2005

Novel approach to aortic cannulation suturing: tangential suture technique.

BACKGROUND: Pursestring suture for ascending aortic cannulation in open heart surgery that requires cardiopulmonary bypass may cause serious events, especially in patients who have a thin or calcific aorta. We introduce a novel suturing method, called the 'tangential suture technique', and submit our clinical experience. METHODS: Adult patients undergoing cardiopulmonary bypass were included in this study. Patients in whom the tangential suture technique was applied (Group A; n = 146) were compared with patients in whom the classic pursestring technique was applied (Group B; n = 152). RESULTS: The age (38 +/- 11 years vs 36 +/- 10 years), sex (males 65.1% vs 62.5%) and operation types were similar in both groups. Although the difference was not significant (P > 0.05), subadventitial haematoma occurred more frequently in Group B (13 patients; 8.6%) than in Group A (3 patients; 2.1%). However, none in Group A required opening the adventitia. No aortic dissection was observed in peri- or postoperative periods in either group. In Group B, seven (4.6%) patients required repair by suture after tying of pursestring sutures following decannulation because of bleeding, while none was required in Group A (P = 0.0156). CONCLUSIONS: Tangential suture technique allows the needle to take a longer segment from the media layer while decreasing the likelihood of entering the lumen. Because the tract of the suture almost perfectly fits to the needle curve, tissue injury is less, even on fragile aortas, and this ensures more stable closure of the hole when the suture is tied following decannulation. By considering both its theoretical advantages and our clinical experience, we believe tangential suture technique should be preferred to the classic method.

Adolescent↗
PubMed1988

[Resorbable suture material in the human skin: tissue reaction and modified suture technic].

Two-stage excision of skin tumors provided an opportunity for histological evaluation of implanted PDS or Vicryl suture material. Our findings showed a weak or absent tissue response to PDS sutures that was detectable for up to 100 days and a moderately pronounced tissue response to Vicryl that, in rare cases, was evident for up to 80 days. The tissue response to both materials depended on the depth of the implanted suture material. A persistent inflammatory reaction was provoked particularly by Vicryl, a polyfilament suture, when it was embedded near the skin surface. Contact between parts of the suture and the skin surface, which is encouraged by the wick effect of the Vicryl suture, frequently led to suture infection. To avoid infections it is important to place the knot of the stich below the dermis, since the suture ends of the knot decrease the surface-suture distance. A more-or-less horizontal, butterfly-shaped interrupted suture that extends upward is recommended to ensure secure placement of the knot at the lower border of the corium.

Foreign-Body Reaction↗
PubMed1993

[A perspective study on blood flow of the gastrointestinal anastomosis with special reference to the influence on blood flow at the anastomotic region by the suture material and it's size and the suturing interval].

To investigate the change of blood flow of the gastrointestinal anastomotic site by the material of the suture, the size of suture, the suture interval, blood flow, microangiography and histology of the anastomosis including tissue reaction were examined. Results are as follows. 1. When the colonic anastomosis was devascularized, the anastomotic blood flow was significantly lower and the avascular area in microangiography was significantly larger in the case of the silk and the 2mm suturing interval group compared to those of the polyglycolic acid (PGA) and the 4mm group. Concerning the size, the 4-0 group and the 6-0 group did not show any difference. 2. The necrotic change of the tissue surrounded by the suture was observed in 42.9% in the 4mm interval group and in 75.0% in the 2mm group. 3. The areas of the extension of tissue reaction to the suture were wider in the silk group than those of the PGA group. In conclusion, blood circulation of the anastomosis is affected by the material of the suture as well as by the suture interval, and under an insufficient blood flow, the use of the suture with lesser tissue reaction is preferable, and the suture interval should be kept at 4mm.

Anastomosis, Surgical↗
PubMed1995

[Study of subcuticular suture skill for perineotomy and catgut-suture reaction].

The post perineotomy complications such as catgut-suture-reaction, incision infection, and laceration are very common in the hospital. The purpose of this study was to find a better suture skill. The subcuticular suture skill was studied in this study. The relationship between suture skill and catgut suture reaction was analysed. 200 women had vaginal delivery with perineotomy subcuticular suture who were hospitalized during 3 to 10 in 1994 were compared with 399 women with perineotomy routine suture skill who were hospitalized during the same period in 1992 and 1993. The result indicated that the incidence of cat gut suture reaction and secondary suture in the research group were 9%, 7.5% lower than that in control group (P < 0.01). The average time of hospitalization was 5.3 days shorter (P < 0.025). These implicate the future study on perioneotomy suture skill.

Catgut↗
PubMed1998

Absorbable PDS-II suture and nonabsorbable polypropylene suture in aortic anastomoses in growing piglets.

The long-term outcome of vascular anastomoses in children can be compromised by stenosis when the growth of the anastomosis does not match that of the vessels. This can be influenced by the suture material. We evaluated the suitability of the new generation of polydioxanone (PDS-II), an absorbable synthetic monofilament suture, in vascular surgery, in terms of permitting normal growth of aortic anastomoses. Ten piglets underwent primary end-to-end anastomosis of the thoracic aorta, five with PDS-II suture and five with conventional polypropylene (Prolene) suture. Six months after surgery, an aortogram was obtained for each animal. The piglets were then killed and the aortas were sent for pathologic examination. Complete absorption of suture material with slight dilatation of the anastomoses was found in all five pigs in the PDS-II suture group. We also found thrombus formation in one pig in this group. Mild stenosis of the anastomotic site was noted in all five pigs in the polypropylene suture group, but no intraluminal thrombus formation was seen. The degree of dilatation or stenosis within each group was not significantly different when intraluminal diameters were compared at three distinct sites in the reconstructed aorta (p > 0.05). The differences in vascular growth between the two groups were also not significant (p > 0.05). Histologic examination revealed less tissue reaction in the PDS-II suture group than in the polypropylene suture group. Thus, PDS-II seems to be a suitable suture material for anastomoses as far as vascular growth is concerned, but the possibility of aneurysm formation secondary to dilatation of the anastomotic site should be kept in mind.

Anastomosis, Surgical↗