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PubMed1995

Intracranial pressure in single-suture craniosynostosis.

The indications for surgical correction of craniosynostosis in which there is involvement of only one of the cranial vault sutures have traditionally been based upon the cosmetic merits of the deformity alone. Whilst it is now appreciated that intracranial hypertension is commonly associated with the more complex forms of craniosynostosis, this aspect has not previously been addressed in detail among cases of single-suture craniosynostosis. This retrospective study reports our experience of overnight subdural intracranial pressure monitoring in 74 children with premature closure of a single cranial suture. A single coronal suture was involved in 37 patients, the sagittal suture in 25 and the metopic suture in 12. Intracranial pressure was raised in 13 (17%), borderline in 28 (38%) and normal in 33 (45%). Elevated intracranial pressure was seen more commonly where a midline suture was involved (sagittal or metopic) than when a single coronal suture was fused. We conclude that intracranial hypertension occurs in a significant proportion of children with single-suture craniosynostosis and suggest that this factor should be borne in mind during the initial assessment of these children so as to enable timely intervention where required and appropriate counselling of parents.

Child↗
PubMedDate not supplied

Morphological change of the nasopremaxillary suture in growing "toothless" osteopetrotic (op/op) mice.

Osteopetrotic (op/op) mice are known to commonly show a failure of tooth eruption. It is also well understood that masticatory function is highly associated with the craniofacial morphology of the growing mouse; however, the effects on sutural growth have not been studied. The present study was conducted to examine, in detail, the morphological and histological changes of the nasopremaxillary suture in these mutant mice and to assess a role of mechanical stress from mastication in the sutural growth. The width of the nasopremaxillary suture was measured on the section for the superior (P1), middle (P2), and inferior (P3) levels. The width of the nasopremaxillary suture for the P1 level in the normal mice fed a solid diet was significantly smaller in 30-day-old mice than in 15-day-old mice, whereas the width for the level P3 was significantly greater in the 30-day-old mice than in the 15-day-old mice. These changes in the sutural space were more prominent in the normal mice fed a solid diet than in the normal mice fed a granular diet. The sutural widths for all the levels became smaller in the 30-day-old op/op mice than in the 10-day-old op/op mice. The endocranial area of the nasopremaxillary suture showed synostosis in 30-day-old op/op mice. In both the normal and op/op mice, the number of tartrate-resistant acid phosphatase (TRAP)-positive cells was greatest at the age of 15 days. Moreover, the TRAP-positive cell number was smaller in the op/op mice than in the normal mice for all the experimental stages. Since, in general, mastication begins in mice after tooth eruption, i.e. from 15 to 30 days after birth, the present findings suggest that failure of tooth eruption and the reduced masticatory function restrict sutural modification.

Animals↗
PubMed1977

USE OF A NEW POLYBUTILATE-COATED POLYESTER SUTURE IN CARDIOVASCULAR SURGERY.

Polybutilate coated polyester (Dacron) sutures were evaluated in a variety of cardiovascular procedures performed on 117 patients. The age range was from 6 months to 88 years, and long-term follow-up was available in 100 patients. The most frequently sutured tissues were those of the aorta, atrium, fascia and pericardium. Suture sizes ranged from 1-0 through 5-0, the most common being 3-0. There were no suture related complications, and the performance was found to be superior to non-coated polyester sutures and other forms of coated sutures. Favorable characteristics were: 1) ease of passage through tissue, especially through prosthetic materials; 2) ease of tying, 3) increased knot security; and 4) better handling characteristics in general. Because of the firm bonding of polybutilate with the polyester suture, flaking (minute amounts of the coating which become dislodged) and suture drag characteristics of other coated polyester sutures were not experienced.

Journal Article↗
PubMed1991

Craniofacial suture stenosis: morphologic effects.

Craniofacial anomalies, such as Apert's and Crouzon's syndromes, are presumed to be related to premature growth arrest of cranial base growth sites. However, premature growth arrest at cranial vault sutures in animals appears to play a causative role in the development of cranial deformities characteristic of single-suture, or simple, craniosynostosis in humans. To study the possible causative role of cranial vault and other (interface) suture stenoses on the development of craniofacial deformity, a vault suture and an interface suture between the cranial vault and facial skeleton were simultaneously immobilized. Thirty-one New Zealand White rabbits at 9 days of age underwent implantation of dental amalgam growth markers adjacent to cranial vault and facial sutures. In the experimental group (n = 15), methylcyanoacrylate adhesive was applied over the coronal (vault) and frontonasal (interface suture between vault and facial skeleton) sutures to immobilize them. The remaining 16 animals served as sham-treated controls. All animals underwent serial radiographic cephalometry to document growth effects in the cranial vault, cranial base, and facial skeleton. Application of adhesive resulted in statistically significant (p less than 0.05) reduction in growth at the coronal and frontonasal sutures. This was accompanied by an overall significant reduction in neurocranial vault length during the first 30 days of development.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2001

Comparison of strength properties of poly-L/D-lactide (PLDLA) 96/4 and polyglyconate (Maxon) sutures: in vitro, in the subcutis, and in the achilles tendon of rabbits.

Achilles tendon rupture is a common injury. Absorbable sutures are not commonly used because of their limited strength properties. Recently, sutures with prolonged strength retention properties have been developed. The aim of the study is to test the mechanical properties of recently developed poly-L/D-lactide (PLDLA) sutures in comparison with polyglyconate (Maxon) sutures. PLDLA (0.2 mm thick) and Maxon (4.0) sutures were studied in vitro by immersion in a buffered saline solution (pH 7.4). Tensile strength tests were done on sutures retrieved after 1-26 weeks. In vivo, they were implanted in the subcutis of 32 rabbits. Tensile strength tests were done on sutures retrieved after 1-6 weeks. The sutures were also used to repair the Achilles tendon in rabbits. Maximum force before breaking and percentage elongation of tendons were determined. Although PLDLA had a lower initial tensile strength than Maxon, PLDLA showed more prolonged tensile strength retention than Maxon. Tendons repaired with PLDLA, however, had a lower strength than Maxon-repaired tendons at six weeks (insignificant difference). PLDLA has more prolonged tensile strength properties compared with Maxon. Thus, PLDLA offers an alternative to Maxon in repair of the Achilles tendon.

Absorbable Implants↗
PubMed1993

Monofilament versus multifilament absorbable sutures for abdominal closure.

This study compares monofilament continuous absorbable sutures with multifilament interrupted absorbable sutures for abdominal closure. Before closure of an abdominal incision, 988 patients were randomized to receive either a monofilament polyglyconate (Maxon) or a multifilament polyglactin 910 (Vicryl) suture. At 1 year after operation, 684 patients (69 per cent) were examined for the presence of incisional hernia, sinus and other wound-healing problems; 179 (18 per cent) had died and 125 (13 per cent) did not attend for follow-up. Incisional hernia occurred in 8 per cent of patients receiving monofilament continuous sutures compared with 6 per cent of those having multifilament interrupted closure (P not significant). Wound dehiscence occurred in 1 per cent of both groups. The mean time for suturing was 7.1 min for monofilament continuous and 8.7 min for multifilament interrupted sutures (P < 0.001). It is concluded that closure of an abdominal incision can be effected by a monofilament continuous absorbable suture more quickly than by multifilament interrupted absorbable sutures without an increased risk of wound dehiscence or incisional hernia.

Abdominal Muscles↗
PubMed2005

Bacterial colonization on different suture materials--a potential risk for intraoral dentoalveolar surgery.

In this in vivo and in vitro study on resorbable (Monocryl and nonresorbable (Deknalon) monofilament sutures used in intraoral dentoalveolar surgery the bacterial colonization was compared. For the in vivo study the sutures were applied in 11 patients during dental surgery. Eight days postoperative the sutures were removed and the adhered bacteria were isolated and identified by biochemistry, morphology, antibiotic susceptibility, and gas chromatography. The colonization was studied by scanning electron microscopy. Aerobic and anaerobic bacteria were isolated in nearly equal colony-forming units (cfu) on each suture. In comparison with Monocryl about 15% more aerobic and anaerobic strains were isolated on Deknalon. Regarding the pathogens only, about three times more anaerobic strains were isolated on both sutures in total. Additionally, more pathogens were found on Deknalon than on Monocryl (aerobic >40%, anaerobic >25%). The variety of bacteria correspond with purulent infections, not with normal oral flora. Intraindividual comparisons of cfu showed differences in dependence of the patient as described for subgingivale plaques. For the in vitro study the sutures were incubated with Streptococcus intermedius and Prevotella intermedia for 0.5 h. Scanning electron microscopy was performed to examine qualitatively the level of bacterial adherence. After 0.5 h the bacteria adhered very well. The colonization rate of Streptococcus intermedius on both sutures was similar. Coccoid bacteria within biofilms were seen. The growth of Prevotella intermedia was much better on Deknalon than on Monocryl. The risk of bacteremia at the time of suture removal is discussed.

Bacteria↗
PubMed1992

Mersilene (polyester), a new suture for penetrating keratoplasty.

Mersilene (polyester monofilament) seems to be suitable for penetrating keratoplasty because it is strong, shows no degradation by ultraviolet light, is insoluble, so that it can be left in situ, and offers the possibility of regulating postoperative astigmatism by suture adjustment. In 12 patients penetrating keratoplasty was performed with the combined interrupted/running suturing technique, using eight interrupted nylon 10-0 sutures and one running Mersilene 11-0 suture. The results were compared with those of 25 patients in whom eight interrupted nylon 10-0 sutures and one running nylon 11-0 suture were used. Six months after penetrating keratoplasty, no differences could be found between the two groups in keratometric astigmatism, visual acuity or slitlamp findings. In three patients postoperative adjustment of the running Mersilene suture reduced astigmatism by 50, 90 and 100% respectively. In an animal study the behaviour of Mersilene in the cornea was evaluated by slitlamp examination, histology and electron-microscopy. The tissue response to Mersilene was minimal. Considering the resemblance to nylon in clinical findings, minimal tissue response, lack of biodegradation and possibility of regulating postoperative astigmatism by suture adjustment, Mersilene seems to be a suitable material for penetrating keratoplasty.

Animals↗
PubMed1996

An experimental study of tensile strength of six different suture techniques.

Tests were carried out on the strength of six different suture techniques used to join polyester lace ends, for example, in interscapulo-scapulocostal scapulopexy. The following sutures were used: four 5-cm rows of a continuous suture, four 2.5-cm rows of a continuous suture, two 5-cm rows of a continuous suture, 4 or 8 interrupted sutures, and 4 U-sutures. The laces were tested in tension, and load and elongation recorded. The strongest techniques involved a suture of four 5-cm rows of continuous thread (average maximum load at point of failure 1484 N). This was higher than the maximum load at failure of the point of attachment to the scapula.

Analysis of Variance↗
PubMed1983

Intestinal suturing. Review of the experimental foundations for traditional doctrines.

The doctrines of intestinal suturing have been handed down from the 19th century. It has been widely accepted that intestinal wounds heal most reliably when an inverting suture line is constructed. The serosal surfaces of the bowel should be apposed by sutures, anchored in the submucosa, forming an inverting suture line. The wound should be kept free of hematoma, necrotic tissue, or infection. Intestinal wounds heal with a pattern similar to that of wounds in other tissues. During the lag period of repair, the wound is cleansed of debris. Excessive tissue injury, foreign body, or infection incite inflammation, prolonging this period of wound healing. Cellular elements proliferate during the phase of fibroplasia. Collagen within the wound assumes its mature form only during the prolonged phase of maturation. The return of wound integrity can be quantified by measuring its tensile strength, bursting strength, or collagen content. Such measurements have shown that, during the lag period, sutures provide almost the entire strength of the wound. During the phase of fibroplasia, new collagen adds to the suture line integrity. The contribution of new collagen to wound strength soon overtakes that of sutures. It is only during the first week of wound healing, the lag period, that surgical technique plays a significant role in ensuring intestinal wound integrity. Surgical techniques developed during the 19th century provide secure closure of intestinal wounds during the lag period of wound healing. After the onset of the period of fibroplasia, newly formed collagen replaces sutures in ensuring wound integrity.

Animals↗
PubMed1999

A comparison of sutures for adjustable strabismus surgery.

BACKGROUND: The adjustable suture technique after strabismus surgery may be more easily performed if the sutures offered minimal resistance during the procedure as desired by the surgeon. METHODS: In a rabbit model, 3 different types of 6-0 absorbable sutures-Biosorb-C (polyglycolic acid with polycaprolate coating, Alcon Surgical), coated Vicryl (polyglactin 910 coated with polyglactin 370 and calcium stearate, Ethicon), and Dexon-"S" (polyglycolic acid, Davis and Geck)-were advanced through scleral tunnels when attached and not attached to extraocular muscles. Resistance was measured with a precise strain gauge accurate to 0.1 g with an intrinsic microprocessor. RESULTS: For unattached advancements, Biosorb-C offered significantly less resistance than Vicryl at 6 and 24 hours after operation (P < .02), whereas Dexon-"S" offered less resistance than Vicryl only at 24 hours (P = .001). At 6 hours, Biosorb-C sutures were marginally more slipperythan Dexon-"S" (P= .07). For sutures attached to extraocular muscles at 6 hours after surgery, the 3 sutures offered similar resistance. By 24 hours after the initial procedure, Vicryl presented significantly more resistance than either Biosorb-C or Dexon-"S" (P< .01 for both). For all comparisons of 6 versus 24 hours after surgery, the only significant increase in resistance were Vicryl sutures attached to muscles (P= .02). CONCLUSIONS: These data support the use of Biosorb-C and Dexon-"S" for the adjustable suture technique whether adjusted at 6 or 24 hours after the initial procedure, although Biosorb-C may be slightly easier to adjust at 6 hours. If Vicryl is used, it would be easier to adjust the muscle 6 hours after surgery rather than after 24 hours.

Animals↗
PubMed1996

Do Mersilene sutures need to be removed after cataract surgery?

A major disadvantage of nylon sutures is the need to remove them post-operatively to prevent suture fracture and irritation. Mersilene (polyester) sutures do not hydrolyse or disintegrate and are in theory superior to nylon. Fifty-two consecutive patients were examined an average of 3 years after uncomplicated extracapsular cataract extraction with corneal sections sutured with interrupted 11/0 polyester. It was found that 29% had suture-related problems and required, or had previously undergone, suture removal for reasons other than high astigmatism. The most common problem was a loose stitch with adherent mucus and corneal vascularisation (17% of patients at review). Sixty-six per cent of patients with loose sutures reported discomfort. We would not advocate prophylactic removal, but patients with polyester sutures should be advised to return if they become symptomatic.

Astigmatism↗
PubMed1993

Microvascular anastomoses in growing vessels: a long-term evaluation of nonabsorbable suture materials.

Diametric growth at the anastomotic site, following microvascular anastomoses in pediatric patients, remains a problem, when nonabsorbable suture material is used. This study investigated the long-term effects of femoral artery anastomoses with nonabsorbable sutures in 20 growing rats with a mean weight of 101 g. The right femoral artery was anastomosed with 10-0 polypropylene monofilament suture and the left with identical nylon suture, using 5 to 6 interrupted sutures for each end-to-end anastomosis. At a 6-month harvest, the mean body weight had increased by 729 percent and the diameter of the femoral artery by 240 percent. The patency rate at the anastomotic sites was 97.5 percent and the complication rate was 10 percent, including one occlusion and three aneurysm formations at the sites. Angiography, diameter measurement, and histology demonstrated no stenosis or thrombus formation in all animals. Histology also showed normal vessel lumen size and well-organized re-endothelialization, without intimal hyperplasia at the anastomosis sites. With an interrupted suture technique, nonabsorbable sutures do not compromise growth at the anastomosis site or long-term patency of the anastomosed vessels. This study indicates that interrupted nonabsorbable suture materials are able to create excellent long-term results in microvascular anastomoses in rapidly growing hosts.

Anastomosis, Surgical↗
PubMed2000

Negative side-effects of retention sutures for abdominal wound closure. A prospective randomised study.

OBJECTIVE: To assess the effect of retention sutures on the postoperative course of patients after major abdominal operations. DESIGN: Prospective, randomised study. SETTING: Teaching hospital, Germany. SUBJECTS: 95 patients who were at increased risk of wound failure after major abdominal operations. INTERVENTION: Conventional mass closure either with (n = 44) or without (n = 51) reinforcement by wire retention sutures. MAIN OUTCOME MEASURES: Pain intensity on postoperative days 3, 6, 9, and 12, patients' acceptance, retention-suture-related morbidity, general morbidity. RESULTS: Postoperative pain was overall more severe with retention sutures. On day 6, 31/49 control patients but only 13/41 patients with retention sutures were pain-free (p = 0.003, 95% CI 0.12 to 0.51). Twelve of 44 patients with retention sutures developed local complications of the sutures, and 21 of the 44 had to have them removed prematurely, in most cases because of intolerable pain. CONCLUSIONS: Retention sutures used to close abdominal wounds cause inconvenience, pain, and specific morbidity.

Abdominal Muscles↗
PubMed2005

Comparison of holding strength of suture anchors for hepatic and renal parenchyma.

BACKGROUND AND PURPOSE: Various laparoscopic devices have been described for suture anchoring during solidorgan parenchymal closure. Application of these devices expedites the closure of parenchymal defects and minimizes ischemia time. We compared different technologies as suture anchors for parenchymal closure. MATERIALS AND METHODS: A tensometer was used to determine the amount of tension necessary to dislodge each of five different clips from Vicryl suture alone or against two different substrates (fresh pig kidney and liver) with and without an intervening pledget. The clips investigated were the Lapra-Ty (Ethicon), Endoclip II (US Surgical), small Horizon Ligating Clips (Weck), Hem-o-lok Medium Polymer Clips (Week), and a novel Suture-clip (Applied Medical). ANOVA and two-sided Fisher's exact test provided statistical analysis. RESULTS: The force required to dislodge the Lapra-Ty clip from bare suture for both 0 and 1 Vicryl (7.0 N) was approximately fourfold the force required to dislodge the Endoclips or the 5-mm or 10-mm Hem-o-lok clips (p<0.01). When clips were applied to suture running through renal or liver parenchyma, the novel Suture-clip required the greatest tension to dislodge (P<0.01), followed by the Horizon and Lapra-Ty clips. There were no statistically significant differences in the tension required to dislodge a given clip from the two parenchymal substrates or in the presence or absence of a pledget. CONCLUSIONS: In our experimental model, the Suture-clip, Lapra-Ty, and Horizon clips required significantly greater tension to dislodge than the Hem-o-lok and Endoclip clips. The addition of a pledget did not improve tension resistance.

Animals↗
PubMed1986

Novafil. A dynamic suture for wound closure.

Abdominal wound dehiscence was quantitatively studied in a rat model. Polybutester suture is a new monofilament nonabsorbable suture that has unique stress-strain properties that are potentially beneficial for abdominal wound closure. The abdominal volume at the moment of wound dehiscence was correlated with the extensibility of the suture material used for closure. Interrupted sutures of polybutester cut through the tissues at a mean abdominal volume of 212 +/- 3 ml. This volume was significantly (p less than or equal to 0.005) greater than the mean volumes reached with nylon (197 +/- 3 ml) or polyglycolic acid (187 +/- 4 ml). Closure of abdomens with continuous polybutester suture resulted in a mean rupture volume of 218 +/- 3 ml, which was significantly (p less than or equal to 0.005) greater than that achieved with the same suture employed as simple interrupted sutures (212 +/- 4 ml). The influence of width of tissue bite, suture size, and needle configuration was also evaluated.

Abdominal Muscles↗
PubMed2003

Polytetrafluoroethylene versus polypropylene sutures for Essed-Schroeder tunical plication.

PURPOSE: Essed-Schroeder plication is an established operative technique to correct congenital and acquired penile deviation. However, a third of all patients complain about discomfort from the suture material used. We prospectively evaluated patient satisfaction and quality of life after modified Essed-Schroeder plication by comparing 2 suture materials. MATERIALS AND METHODS: Between 1998 and 2001, 88 patients underwent surgical correction of penile deviation at our hospital. Mean patient age was 40 years (range 18 to 71) and mean followup was 30 months. Preoperatively penile curvature was greater than 20 degrees in all patients. A standardized questionnaire was sent to all patients. A total of 55 patients, including 30 with Peyronie's disease (PD) and 25 with congenital penile deviation (CPD), were available for evaluation and had complete followup. RESULTS: In 25 of these patients (12 with PD and 13 with CPD) nonabsorbable polypropylene (PP) sutures were used for plication, whereas in the other 30 (18 with PD and 12 with CPD) nonabsorbable polytetrafluoroethylene (PT) sutures were used. In the PP group 22 of the 25 patients (88%) could notice the sutures (11 with PD and 11 with CPD), 10 had discomfort (6 with PD and 4 with CPD) and 3 had pain during penile erection (2 with PD and 1 with CPD). In the PT group 15 of the 30 patients (50%) could notice the sutures (10 with PD and 5 with CPD), 3 had discomfort (1 with PD and 2 with CPD) and 1 with PD had painful erections. Three patients had recurrent deviation, of whom 2 and 1 underwent plication with PP and PT, respectively. CONCLUSIONS: These results indicate the PT is the more superior suture material with regard to postoperative patient discomfort after Essed-Schroeder correction of penile deviation. Nonabsorbable PT sutures do not impair the efficacy of the modified Essed-Schroeder plication technique and the success rate is not related to the underlying pathological condition.

Adolescent↗
PubMed2006

Evaluation of a novel technique for wound closure using a barbed suture.

BACKGROUND: Suture knots present several disadvantages in wound closure, because they are tedious to tie and place ischemic demands on tissue. Bulky knots may be a nidus for infection, and they may extrude through skin weeks after surgery. Needle manipulations during knot-tying predispose the surgeon to glove perforation. A barbed suture was developed that is self-anchoring, requiring no knots or slack management for wound closure. The elimination of knot tying may have advantages over conventional wound closure methods. METHODS: This prospective, randomized, controlled trial was designed to show that the use of barbed suture in dermal closure of the Pfannenstiel incision during nonemergent cesarean delivery surgery produces scar cosmesis at 5 weeks that is no worse than that observed with conventional closure using 3-0 polydioxanone suture. Cosmesis was assessed by review of postoperative photographs by a blinded, independent plastic surgeon using the modified Hollander cosmesis score. Secondary endpoints included infection, dehiscence, pain, closure time, and other adverse events. RESULTS: The study enrolled 195 patients, of whom 188 were eligible for analysis. Cosmesis scores did not significantly differ between the barbed suture group and the control group. Rates of infection, dehiscence, and other adverse events did not significantly differ between the two groups. Closure time and pain scores were comparable between the groups. CONCLUSIONS: The barbed suture represents an innovative option for wound closure. With a cosmesis and safety profile that is similar to that of conventional suture technique, it avoids the drawbacks inherent to suture knots.

Adolescent↗