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PubMed1996

Comparison of anastomotic suturing techniques in the rat trachea.

BACKGROUND: Tracheal resection is the preferred treatment for primary tracheal tumors. Anastomotic tension can be a problem, even when various tension-relieving release maneuvers are employed. Excessive tension can cause anastomotic sutures to pull through the tracheal tissue, with resultant early tracheal anastomotic dehiscence. To test the hypothesis that interrupted horizontal mattress sutures would withstand the forces of tension better than interrupted simple sutures, an experimental study of rat tracheal anastomoses was done. METHODS: Twenty rats were killed and their tracheas excised. The tracheas were divided in the mid portion and end to end anastomoses were done using interrupted 7-0 polypropylene sutures. Ten tracheas had anastomoses done with interrupted simple sutures, and 10 had interrupted horizontal mattress suturing. RESULTS: Anastomotic breaking strength was 2.30 +/- 0.57 N for the interrupted simple sutured anastomoses and 2.15 +/- 0.48 N for the interrupted horizontal mattress group (P = 0.54). The difference was not significant. CONCLUSIONS: In this animal study, interrupted simple and horizontal mattress suturing withstood the disruptive forces of anastomotic tension equally well.

Anastomosis, Surgical↗
PubMed2003

Brief communication: age and fractal dimensions of human sagittal and coronal sutures.

The fractal dimensions of human sagittal and coronal sutures were calculated on 31 complete skulls from the Terry Collection. The aim was to investigate whether the fractal dimension, relying on the whole sutural length, might yield a better description of age-related changes in sutural morphology, as opposed to other methods of quantification, which generally rely on more arbitrary scoring systems. However, the fractal dimension did not yield better age correlations than other previously described methods. At best, the results reflected the general observation that young adults below age 40 years display an age-related development, but that it is impossible to arrive at any precise age determinations for older adults. It seems that for some individuals, suture obliteration simply does not take place, even at an advanced age, whereas for others, suture obliteration progresses rapidly. Until a better understanding of sutural biology is reached, this will render cranial sutures only marginally useful in age determination. This does not mean, however, that investigations should not be made to elucidate more unbiased methods of sutural morphology quantification.

Adult↗
PubMed1987

Relationships between growth at the sutures of the rabbit calvarium.

The present study was designed to elucidate the relationships between growth increments at the cranial vault sutures in rabbits. Thirteen male New Zealand white rabbits were followed regularly from age 31 to 142 days using a roentgen stereophotogrammetric system. Spherical tantalum markers were implanted into the nasal, frontal, and parietal bones, and implant stability was checked at each stereo examination. Problems with instability were encountered only in the nasal bones. Registered growth rates conformed to our previous investigations. High correlations were observed between the following areas; the coronal suture to the frontonasal suture, the first principal component of the neurocranial suture group to the frontonasal suture, and the principal component of the craniofacial suture group to the coronal suture. Remaining relationships demonstrated dispersion to various extents. The findings indicate that there seems to exist a basic mutual dependence between neural and facial skeletal growth, as well as complex covariations between the various sutures of the rabbit calvarium.

Animals↗
PubMed1992

Colonic anastomosis using the biofragmentable anastomotic ring and manual suture: a prospective, randomized study.

One hundred and fifty consecutive patients undergoing colonic surgery were randomized into two groups: 71 underwent hand-suture with a two-layer anastomosis of resorbable suture material (3/0 Dexon) and 79 were fitted with the biofragmentable anastomotic ring (Valtrac-BAR). Five patients, two treated using the BAR and three by suturing, developed anastomotic leakage which required a Hartmann-type reoperation. This was successful in four; one patient in the suture group died after reoperation. One patient who underwent suture had an early anastomotic stricture with fatal sequelae. Three other patients (one in the BAR group and two in the suture group) died after operation from other causes. Thus the mortality rate was 6 per cent in the suture group and 1 per cent in the BAR group. During follow-up, one patient in each group underwent reoperation for anastomotic stricture. Recovery of the gastrointestinal tract was similar in the two groups regarding duration of nasogastric drainage, intravenous fluid therapy and ileus. There was no difference between the groups in duration of hospital stay. The BAR seems to be a safe and reliable alternative to conventional suture anastomosis in colonic surgery.

Aged↗
PubMed1994

Prospective randomized trial of Ivalon sponge versus sutured rectopexy for full-thickness rectal prolapse.

Ivalon sponge rectopexy is a safe reliable procedure in the management of rectal prolapse. Sutured rectopexy is simpler and avoids the use of foreign material. Sutured rectopexy is mandatory if synchronous resection is to be considered. Sixty-three patients (62 women) with full-thickness rectal prolapse were entered into a prospective randomized trial of Ivalon sponge rectopexy (31 patients) versus sutured rectopexy (32). Twenty patients (32 per cent) had coexistent incontinence (ten in each group). The operation was performed in the standard manner with a sutured rectangle of sponge or sutures alone placed along the length of the sacrum. Postoperative morbidity occurred in nine patients (14 per cent) of whom three underwent a sutured procedure and six Ivalon rectopexy: wound infection in three, chest infection in two, urinary tract infection in two and thromboembolism in two. There were no deaths within 30 days. At a median follow-up of 47 months prolapse had recurred in two patients (3 per cent), one in each group, 14 (22 per cent) suffered from incontinence (of whom five had undergone a sutured procedure), while 25 (40 per cent) had developed constipation (of whom 15 had received Ivalon rectopexy). The medium-term results of rectopexy by suture alone are equivalent to those obtained following the conventional Ivalon procedure. These data suggest that Ivalon rectopexy could now be abandoned.

Adult↗
PubMed2006

Twist1 dimer selection regulates cranial suture patterning and fusion.

Saethre-Chotzen syndrome is associated with haploinsufficiency of the basic-helix-loop-helix (bHLH) transcription factor TWIST1 and is characterized by premature closure of the cranial sutures, termed craniosynostosis; however, the mechanisms underlying this defect are unclear. Twist1 has been shown to play both positive and negative roles in mesenchymal specification and differentiation, and here we show that the activity of Twist1 is dependent on its dimer partner. Twist1 forms both homodimers (T/T) and heterodimers with E2A E proteins (T/E) and the relative level of Twist1 to the HLH inhibitor Id proteins determines which dimer forms. On the basis of the expression patterns of Twist1 and Id1 within the cranial sutures, we hypothesized that Twist1 forms homodimers in the osteogenic fronts and T/E heterodimers in the mid-sutures. In support of this hypothesis, we have found that genes regulated by T/T homodimers, such as FGFR2 and periostin, are expressed in the osteogenic fronts, whereas genes regulated by T/E heterodimers, such as thrombospondin-1, are expressed in the mid-sutures. The ratio between these dimers is altered in the sutures of Twist1+/- mice, favoring an increase in homodimers and an expansion of the osteogenic fronts. Of interest, the T/T to T/E ratio is greater in the coronal versus the sagittal suture, and this finding may contribute to making the coronal suture more susceptible to fusion due to TWIST haploinsufficiency. Importantly, we were able to inhibit suture fusion in Twist1+/- mice by modulating the balance between these dimers toward T/E formation, by either increasing the expression of E2A E12 or by decreasing Id expression. Therefore, we have identified dimer partner selection as an important mediator of Twist1 function and provide a mechanistic understanding of craniosynostosis due to TWIST haploinsufficiency.

Animals↗
PubMed1983

The effect of gamma irradiation on the enzymatic degradation of polyglycolic acid absorbable sutures.

The purpose of the study was to examine the effect of gamma irradiation on the enzymatic as well as the in vivo degradation of polyglycolic acid sutures. The sutures of size 2-0 were irradiated at dosage levels of 0-20 mrad. The three enzymes chosen for this study were esterase, alpha-chymotrypsin, and trypsin. The irradiated sutures were both immersed in the enzyme solutions; their corresponding buffer controls, and implanted in inbred black-and-white hooded hister rats (Liverpool strain). The degradation of PGA sutures was determined mechanically. Among the three enzymes studied, esterase showed the highest enzymatic effect on the degradation of the unirradiated and irradiated PGA sutures. Trypsin's effect on PGA sutures was not observed until 20 mrad. The findings of trypsin demonstrated the hypothesis that synthetic high molecular weight polymers, which are initially resistant to enzymatic degradation, could become prone to enzymatic attack after altering their physical and chemical structures. Implanted PGA sutures maintained a similar or slightly higher mean tensile breaking strength in in vivo degradation compared to in vitro degradation (0.1M tris buffer of pH = 7.5); these degradation profiles suggest that PGA does not display similar behavior in in vivo and in vitro degradations. The magnitude of dissimilarity depends on the radiation dosage and on the duration of degradation, and is speculated to be attributable to the specific action of enzymes with respect to the configuration and chemical structure of the PGA sutures.

Biodegradation, Environmental↗
PubMed1991

In vivo strain in cranial sutures: the zygomatic arch.

Although cranial sutures presumably play a role in absorbing and/or transmitting loads applied to the skull, loading patterns on facial sutures are poorly understood. The zygomatic arch provides a comparatively isolated mechanical part of the skull containing a single suture, the zygomatico-squamosal. In pigs the zygomatico-squamosal suture has a short vertical segment located within the postorbital process and a longer horizontal segment which extends posteriorly. In anesthetized pigs single-element high-elongation strain gages were bonded over both segments of the suture. Strain was recorded during stimulation of the masseter muscles and while the lightly anesthetized animals masticated food pellets. The predominant strain patterns differed in the two segments of the suture. During mastication compressive strains predominated in the vertical segment, but tensile strains predominated in the horizontal segment. The same patterns were also produced by stimulation of the ipsilateral masseter muscle. Contraction of the contralateral masseter reversed the strain pattern, but strain levels were low and during mastication such reversals occurred only transiently. The two segments of the suture have contrasting morphologies. The vertical segment has broad, interdigitating contacts with fibers arranged in a compression-resisting orientation. The horizontal segment has a simple tongue and groove structure with fibers arranged to resist tension. Thus, the structure of the suture reflects the predominant strain pattern.

Animals↗
PubMed1995

Study on microvascular anastomosis of arteries with absorbable polyglyconate suture.

A synthetic, monofilament, slowly absorbing suture material, polyglyconate suture was tested to determine its suitability for use in microarterial anastomoses under ordinary tension and under undue tension. Microvascular repair of 34 rat femoral arteries averaging 0.63 mm in diameter using 8-0 polyglyconate suture on an atraumatic needle gave an immediate patency rate of 100% and a late patency rate of 94.1% after 1 to 24 weeks. Microanastomoses of 30 rabbit femoral arteries averaging 1.43 mm in diameter using 8-0 polyglyconate suture on an atraumatic needle gave an immediate patency rate of 100% and a late patency rate of 96.7% when a vessel segment of 3 to 7 mm was resected. Morphological studies included light microscopy and scanning electron microscopy. The results showed that polyglyconate suture retains tensile strength for an adequate period to allow vascular healing and causes a less pronounced tissue response than nonabsorbable nylon suture. Complete absorption of the suture material was followed by a complete regeneration of the vessel wall. These results demonstrated that absorbable polyglyconate suture might be suitable for microvascular anastomosis of arteries under ordinary tension and under tension to a certain degree.

Anastomosis, Surgical↗
PubMed1994

Mechanical comparison of 10 suture materials before and after in vivo incubation.

The material properties of ten 2-O suture materials were evaluated tensiometrically at time = 0 and again after 6 weeks incubation in rats. All suture material was incubated and tested without knots. Specialized machinery was used with a custom securing apparatus to pull suture material apart at constant speed. Stress-strain curves were derived, and from these strength, toughness, strain at rupture, and elastic modulus were determined. Sutures tested included Vicryl [poly(glycolide-lactide)], Dexon (polyglycolic acid), Ethibond (polyester), silk, plain gut, chromic gut, Maxon (polyglyconate), PDS (polydioxanone), nylon, and Prolene (polypropylene). Elastic modulus was greatest for braided, least for monofilament, and intermediate for gut sutures, regardless of chemical composition (ANOVA, P = 0.0001). Strength, strain, and toughness decreased in all of the sutures over time in vivo with the exception of braided polyester (Ethibond), which remained stable. Silk demonstrated the least strength and toughness while PDS and Maxon were the strongest and toughest at time = 0. Vicryl, Dexon, and gut sutures were absorbed to the point that they could not be tested after 6 weeks in vivo. Performance tables are provided for all sutures.

Animals↗
PubMed1991

Vascular anastomoses with absorbable suture material: an experimental study.

A synthetic, monofilament, absorbable suture material, polytrimethylene carbonate, was tested to determine its suitability for use in arterial anastomoses. The material studied is a copolymer made of trimethylene carbonate and polyglycolic acid, with a retention time in the tissue of up to six months. In an experimental group of 12 mongrel dogs, using simple end-to-end anastomoses, aortic and femoral patch grafts of bovine heterograft material and iliofemoral bypass implants of 5 mm of expanded polytetrafluoroethylene prostheses were performed and arteriographically and histologically documented. Direct intraindividual comparisons were made with the absorbable (polytrimethylene carbonate) and nonabsorbable (polypropylene, expanded polytetrafluoroethylene suture) materials, a total of 108 anastomoses. No suture material-related complications such as ruptures or suture line aneurysms occurred. Polytrimethylene carbonate sutures led to less inflammation and scar tissue formation than polypropylene sutures. Complete absorption of the suture material by hydrolytic decomposition was followed by an almost complete regeneration in all layers of the vessel wall. Regeneration of the connective tissue structures of the media was noted. Initial associated reactions in the intima eventually disappeared. Both suture materials were equivalent histologically in the early months of the study, but after 10 month follow-up differences were observed, especially in the structure of the media, apart from the fact that polytrimethylene carbonate is absorbed completely after four to seven months.

Anastomosis, Surgical↗
PubMed1989

Suturing techniques of individual surgeons--differences in accuracy and mechanics.

The suturing techniques of fifteen surgeons with similar surgical experience were evaluated with respect to pinpoint accuracy and the force produced while suturing. Subjects were randomly selected from a group of surgeons whose surgical experience ranged from five to six years. Accuracy was determined by the deviated distance between the needle exit and the designated exit. Force was expressed as torques (F) loaded on a needle holder, and included the derivatives (dF/dt) and integrals (IF). Suturing times (T) were also measured. Ten attempts at suturing were allowed, using each of the following two methods: 1) allowing adjustment by wavering the needle to improve accuracy, and 2) suturing without wavering the needle. The differences in technique, on an individual basis, were highly significant. The accuracy and the mechanics, including the maximum F, maximum dF/dt, IF, IF/T, and T, all had a p-value of less than 0.0001. The surgeons' ranks according to these variables were also concordant, the Kendall's coefficients of concordance (W) being 0.60 (p = 0.002) for suturing done without wavering and 0.56 (p = 0.005) for that done with wavering. It was concluded that the surgeons' skill in suturing techniques differed significantly among individuals and that the surgeons' ranks according to the variables were also concordant. Thus, formal training in suturing techniques should be established as part of the training of all surgeons.

Clinical Competence↗
PubMed1998

High-resolution sonography of the abnormal cranial suture.

OBJECTIVE: The purpose of this investigation is to elucidate the sonographic features of abnormal major cranial sutures. MATERIALS AND METHODS: Eight excised synostosed suture specimens were evaluated. The high-resolution sonographic appearance was correlated with the histological section, plain radiographs, CT and MRI. Diastatic and molded sutures were also evaluated with sonography and compared with the normal cranial suture appearance. RESULTS: Synostosed sutures demonstrated one or more of the following features: (a) loss of echo-poor fibrous gap between bony plates (five sagittal and coronal synostoses); (b) irregular thickened inner sutural margin (three lambdoid synostoses); (c) loss of bevelled edge (one lambdoid synostosis); (d) asymmetric anterior fontanelle (one coronal synostosis). Cranial molding results in an overlap of echogenic bony plates. Sutural width (the distance between bony plates) is increased in cases of elevated intracranial pressure. CONCLUSION: Sonography is an inexpensive, radiation-free modality which can confirm synostosis versus molding versus an underlying intracranial lesion as a cause of plagiocephaly. The high-resolution sonographic images also provide a relatively easy means to assess sutural width and may provide information in regard to increased intracranial pressure.

Cranial Sutures↗
PubMed1998

[Risks of 360 degree suture trabeculotomy].

BACKGROUND: In 1995, Beck and Lynch reported a method to perform a 360 degrees trabeculotomy by prolene suture introduced into Schlemm's canal. Because this type of surgery has proved to have perils and can lead to extreme hypotony, even a small series of cases must be reported. PATIENTS: Suture trabeculotomy was planned in five eyes of four patients, 5 and 7 months old and 6 and 51 years old, with primary congenital glaucoma, but completed in only two eyes. RESULTS: In one child, suture trabeculotomy could be accomplished easily in both eyes. In the first eye a 360 degrees-tomy was performed, in the second eye only a 180 degrees-tomy was done. Both eyes remained extremely hypotonic (4 mm Hg). In one eye Schlemm's canal could not be disrupted by the suture; in another eye, Schlemm's canal could be probed only for a short distance, and in one eye the suture went the wrong way. CONCLUSIONS: Because a suture trabeculotomy can be transformed into a normal trabeculotomy any time, the main problems of the 360 degrees-suture trabeculotomy are not the possible technical difficulties, but that a successful suture trabeculotomy is followed by extreme hypotony.

Child↗
PubMed2003

Cost analysis of incisional hernia repair by suture or mesh.

The objective was to make a cost analysis of incisional hernia repair by suture repair or prosthetic mesh repair. The study included 44 patients who underwent hernia repair between 1991 and 2000. The rate of recurrent incisional hernia after more than 1 year with associated costs was registered. In 1996, the technique of incisional hernia repair was changed from suture repair to mesh repair. With a mesh repair, zero out of 19 patients presented with a recurrence at follow-up, and with suture repair, five out of 13 had a recurrence (P<0.01). The duration of anaesthetic and operation was longer, but stay in the surgical ward, and sick leave was shorter for patients with a mesh repair than for those with a suture repair. For working patients, costs in the operating theatre were 4,095 Swedish kronor (SEK) higher with a mesh repair, and the costs for surgical ward, sick leave, and examination were 10,129 SEK lower than with a suture repair. Thus, with a mesh repair, the total costs were 6,034 SEK lower than with a suture repair. For retired patients, the total costs with a mesh repair were 1,898 SEK lower than with a suture repair. We conclude that in this setting, mesh repair of incisional hernias produced lower costs than suture repair.

Adult↗
PubMedDate not supplied

Glucose metabolism in the visual structures of rat monocularly deprived by eyelid suture after postnatal eye opening.

PURPOSE: To determine the changes in the visual centers of rats following monocular visual deprivation after postnatal eyelid opening (PEO). METHODS: Monocular eyelid suture was performed on rats on days 1, 3, 5, 7, 14, and 28 after PEO, and the glucose metabolism was measured 1, 2, 5, and 7 days after the eyelid suture. Ex vivo autoradiography with (14)C- or (18)F-labeled 2-deoxy-D-glucose was carried out. Effects of monocular enucleation or dark rearing were also determined. RESULTS: Monocular eyelid suture did not decrease the glucose metabolism in any contralateral visual structures on day 1 after visual deprivation in the PEO1 or PEO3 lid-sutured rats. However, there was a decrease on day 1 after the eyelid suture in PEO7 and older rats. Similarly, monocular enucleation on PEO1 did not reduce the glucose metabolism in the visual cortex (VC), but enucleation on PEO7 and thereafter did. Eyelid suture on PEO8 following dark rearing until PEO7 did not reduce the glucose metabolism 1 day after suture, but reduced it at 7 days after suture. CONCLUSIONS: Glucose metabolism was altered by visual deprivation on PEO7 and thereafter. Five days of visual experience after PEO were required for initiation of visual function in the rat visual system.

Animals↗
PubMed1979

Broken nylon iris fixation sutures.

Broken nylon iris sutures, used to fixate the Worst suture lens, occurred in 41 of a series of 215 eyes, a remarkably high frequency. The estimated average time to break was 27.8 months. Over three fourths of the borken sutures were discovered incidentally on a return visit. Complications related to the broken suture occurred in 21 eyes. The characteristic complication was corneal epithelial edema caused by intermittent touch of the endothelium by the broken suture; spontaneous lens dislocation was infrequent. Light and scanning electron microscopy revealed that biodegradation caused the suture break. Broken iris sutures can be avoided by fixation of the lens with a nonbiodegradable suture.

Biodegradation, Environmental↗
PubMed1983

Prolene sutures are not a significant factor in anastomotic false aneurysms.

Anastomotic false aneurysms have been a significant complication in vascular surgery, and the sutures used have been a major cause. Monofilament sutures have been indicated as contributing to the formation of false aneurysm. However, most of the monofilament sutures operative in the formation of false aneurysms have been made of polyethylene. Polypropylene, although significantly different from polyethylene, has been associated and possibly confused with it. Very few anastomotic aneurysms have resulted from breakage of polypropylene sutures. In this series of 2,400 vascular anastomoses in which polypropylene sutures were used, there were 10 false aneurysms; however, only one resulted from suture failure. In that patient, two Dacron grafts were anastomosed with 5-0 polypropylene suture. Polypropylene is a satisfactory and safe suture material for vascular anastomoses. It does not fragment or break easily when properly handled, and therefore is not a principal cause of false aneurysms.

Aneurysm↗