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PubMed2005

Evaluation of adhesion formation, mesh fixation strength, and hydroxyproline content after intraabdominal placement of polytetrafluoroethylene mesh secured using titanium spiral tacks, nitinol anchors, and polypropylene suture or polyglactin 910 suture.

BACKGROUND: The purpose of this study is to evaluate fixation methods for polytetrafluoroethylene (ePTFE) mesh with an in vivo model of laparoscopic ventral hernia repair. METHODS: In 40 New Zealand white rabbits, a 4 x 4-cm ePTFE mesh (n = 80, two per animal) was attached to an intact peritoneum with polyglactin 910 (PG 910) (n = 20) or polypropylene (PP) (n = 20) suture, titanium spiral tacks (TS) (n = 20), or nitinol anchors (NA) (n = 20). Mesh was harvested at 8 and 16 weeks for fixation strength testing, adhesion assessment, and collagen (hydroxyproline) content. Fixation strength on day 0 was determined with mesh attached to harvested abdominal wall. Statistical significance was determined as p < 0.05. RESULTS: There was no difference in fixation strength between PP (39.1 N) and PG 910 (40.0 N) sutures at time zero. At week 8, PP (25.7 N) was significantly stronger (p < 0.05) than PG 910 (11.4 N) suture, but not at week 16. The fixation strength of TS and NA (day 0, 15.4 vs 7.4 N; week 8, 17.5 vs 15.3 N; week 16, 19.1 vs 13.8 N) was not significantly different. Fixation with PP suture was significantly (p < 0.05) stronger than that with TS and NA at day 0 (39.1, 15.4, and 7.4 N, respectively) but not at weeks 8 or 16. The fixation strength of suture decreased significantly (p < 0.05) from day 0 to week 16 (PP: day 0 = 39.1 N, week 8 = 25.7 N, week 16 = 21.4 N; PG 910: day 0 = 40.0 N, week 8 = 11.4 N, week 16 = 12.8 N). The fixation strength of NA and TS did not change significantly (NA: day 0 = 7.4 N, week 8 = 15.3 N, week 16 = 13.8 N; TS: week 0 = 15.4 N, week 8 = 17.5 N, week 16 = 19.1 N). There were no differences in adhesion area based on fixation device used; however, there were more (p < 0.05) mesh samples using NA with adhesions compared to TS and adhesion tenacity was greater (p < 0.05) compared to that of TS, PP, and PG. Hydroxyproline content at weeks 8 and 16 was similar for all fixation devices. CONCLUSIONS: The initial fixation strength for nonabsorbable suture is significantly greater than that of the metallic fixation devices, but after 8 weeks there is no difference. Laparoscopic ventral hernia repair without transabdominal suture fixation may be predisposed to acute failure. The metallic devices have similar fixation strength, although the incidence of adhesions and tenacity of adhesions appear to be greater with the nitinol anchors. Since these devices have similar fixation strengths and most likely provide adequate supplementation to transabdominal sutures for mesh fixation after laparoscopic ventral hernia repair, their use should be based on other factors, such as their propensity for adhesions, ease of application, and cost.

Alloys↗
PubMed1995

Monocryl suture, a new ultra-pliable absorbable monofilament suture.

Synthetic absorbable sutures are available as braided constructions or as monofilaments. Braided absorbable sutures are made either from 90:10 poly(glycolide-co-L(-)-lactide), sold by Ethicon, Inc. under the trade name Vicryl, or from polyglycolide, as sold, for instance, by Davis and Geck under the trade name Dexon. There are, however, some concerns with braided sutures that relate to tissue drag and the trauma this may cause, as well as the possible potentiation of infection through the interstices of the braid structure. Absorbable monofilaments, such as the monofilament sutures derived from p-dioxanone homopolymer (PDS II, an Ethicon, Inc. product), or a copolymer of trimethylene carbonate and glycolide (Maxon, a Davis and Geck product), eliminate many of these concerns, but generally monofilaments do not handle as well as braids. This paper describes the research leading to the introduction of Monocryl (poliglecaprone 25) monofilament sutures, based on segmented block copolymers of epsilon-caprolactone and glycolide. Monocryl sutures will be shown to display excellent handling properties, minimal resistance during passage through tissue and excellent tensile properties. These sutures provide an in vivo breaking strength retention of approximately 20-30% after 2 weeks, considered by many to be the critical wound healing period. Absorption data on these sutures are presented; absorption is complete between the 91st and 119th days of implantation, with slight or minimal tissue reaction.

Absorption↗
PubMed2006

Suture anchors are superior to transglenoid sutures in arthroscopic shoulder stabilization.

PURPOSE: We retrospectively compared 2 groups of high-demand patients with post-traumatic anterior shoulder instability to determine whether arthroscopic stabilization was superior with transglenoid suture or suture anchors. METHODS: In a retrospective comparative study we investigated the results of 246 high-demand patients, with post-traumatic anterior shoulder instability, who underwent arthroscopic capsulolabral reconstruction: 165 (mean age, 27.5 years; mean follow-up, 80 months) were evaluated after treatment with transglenoid sutures, and 81 (mean age, 26.6 years; mean follow-up, 27 months) were treated with suture anchors in a consecutive period. We compared both techniques with regard to recurrence rate, postoperative complications, range of motion, sport activity, work, and patient satisfaction. RESULTS: In the anchor group recurrent dislocation after surgery occurred in 7 patients (8.7%), all within 18 months postoperatively. This finding was significantly (P = .009) better than that in the transglenoid group, in which recurrent postoperative dislocation occurred in 57 patients (34%), in a period of 0 to 115 months after surgery. Postoperative complications were seen in 4 of 81 patients in the suture anchor group, whereas a significantly (P = .01) higher rate was found in the transglenoid suture group, with 36 complications in 35 of 165 patients. CONCLUSIONS: The data presented in this study suggest that the modern suture anchor technique results in a better outcome after shoulder stabilization, with fewer complications and lower recurrence rates, than the transglenoid repair. We conclude that the suture anchor technique should be a preferred method for arthroscopic shoulder stabilization surgery. LEVEL OF EVIDENCE: Level III, retrospective, comparative therapeutic study.

Adolescent↗
PubMed2004

[Tracheal anastomosis: monofilament absorbable suture versus monofilament non-absorbable suture. Experimental study in rats].

OBJECTIVES: When tracheal stenosis is symptomatic, the treatment may consist of surgical resection and anastomosis. A multifilament absorbable suture is usually used. The aim of this experimental work on rats was to study the benefits of using a monofilament absorbable suture with high initial resistance. MATERIAL AND METHODS: We compared Ethilon, a nylon monofilament non-absorbable suture (MNA), with Monocryl, a polyglecaprone 25 (P25) monofilament absorbable suture (MA). The sutures were used for tracheal anastomosis on 16 rats. P25 has a high initial strength but its intra-tissular disappearance is fast. Animals were killed at 1, 2 and 3 months. Anastomoses were studied by optical microscopy and histological analysis. RESULTS: At 3 months no disunity or stenosis was seen with the MA. With the MNA, a modification of the tracheal transverse section and a stenosis were observed. The histological examination showed an initial important inflammatory cell reaction with the MA and at 3 months, a surgery-free like tracheal aspect. At 3 months the rats with MNA had a persistent foreign body cell reaction. CONCLUSION: Good results obtained by using P25 could be due to high initial resistance of the suture protecting the anastomosis. The semi-fast absorption of the suture avoided persistent inflammatory cell reaction. Confirmation of these results by working on larger animals and tracheal anastomosis under tension could allow the use of this suture on human beings, in this instance.

Adsorption↗
PubMed1999

Surgical facial wounds: simple interrupted percutaneous suture versus running intradermal suture.

The purpose of this study is to compare the esthetics of scars resulting from small surgical facial wounds sutured either with simple interrupted percutaneous suture (SIPS) or with running intradermal suture (RIS). 93 small (0.6-1.9 cm) benign, facial new growths, mostly (86%) intradermal nevi were surgically removed. Forty-seven surgical wounds were sutured with SIPS and 46 with RIS. All surgical procedures were performed by the same dermatologic surgeon. For comparison, lesions were grouped in five facial areas. Other variables such as the age of the patient and type and size of lesions were similar in both groups. Evaluation of each scar was made blindly by two independent observers and by the patients. Judged by independent observers 90 days after surgery, excellent (45 %) to good (45%) results were obtained in similar proportion with either SIPS or RIS suturing in 90% of the patients. In the patients' self evaluation, excellent (85%) to good (14%) results were obtained in 99% of the cases. Suture marks and tracks present 30 days after surgery in 28% of scars sutured with SIPS disappeared 90 days after surgery. The esthetic results obtained by suturing small surgical facial wounds with SIPS or RIS were similarly good to excellent when observed 90 days after surgery. There was no advantage in using RIS over SIPS in the type of wounds described.

Adolescent↗
PubMed2000

The mechanical properties of locking and grasping suture loop configurations in four-strand core suture techniques.

We have compared the effect of locking and grasping suture loop configurations in four-strand core suture techniques for tendon repair. Forty canine flexor digitorum profundus tendons were repaired with one of four suture techniques (the grasping cruciate, the double-modified grasping Kessler, the locking cruciate and the double-modified locking Kessler) and tested to failure in a tensile testing machine. The mode of failure in all the locking suture specimens was breakage of the sutures in the locking loops or at suture knots. The sutures did not pull out of the tendon, as was seen in the grasping suture specimens. The greatest tensile strength was found with the double-modified locking Kessler technique which incorporated eight rectangular locking loop configurations.

Animals↗
PubMed1995

A randomized study comparing suture with non-suture cold-knife conization.

OBJECTIVE: To compare the short-term outcome of cold-knife conization between suture and non-suture (with Monsel's solution pack) methods. METHODS: Between February, 1990 and March, 1992, 142 patients underwent cold-knife conization were randomly allocated into 2 groups. The hemostasis was done by suture in one group and by Monsel's solution pack without suture in the other group. The patients' and cone specimens' characteristics as well as short-term outcome were recorded and compared using Chi-square test, Fisher exact test and t-test where appropriate. RESULTS: The patients' characteristics, cone size, and histologic diagnosis of both groups were comparable. The non-suture group had shorter operative time (10.69 +/- 7.86 vs. 20.04 +/- 6.99 minutes) and lesser late hemorrhage (2.9 vs. 15.9%) than the suture group (p < 0.05). There was no statistical difference in the operative blood loss. CONCLUSION: The non-suture method of conization should replace the traditional suture method.

Adult↗
PubMed1984

Computerized tomography of cranial sutures. Part 1: Comparison of suture anatomy in children and adults.

Knowledge of normal suture anatomy and development is vital in order to understand abnormal suture development and to be able to distinguish sutures radiographically from normal anatomical structures and possible skull fractures. The anatomy of the sutures and synchondroses of 150 normal pediatric and adult patients was studied using high-resolution computerized tomography scanning. Sutures of both the calvaria and skull base were most accurately identified in axial and coronal high-resolution thin-section scans when bone window algorithms were used. Developmental changes of the sutures and synchodroses , the inner and outer tables, and the diploic space were all well delineated. Vault sutures could be identified routinely in children, but their presence in adults varied considerably. With increasing age, parasutural sclerosis developed and sutures were more closely apposed.

Adolescent↗
PubMed1985

[Stapler suture or single button suture? A controlled clinical study on the comparison of both skin closure methods].

In a controlled randomized clinical trial, skin closure with a skin-stapling technique was compared with interrupted sutures on 50 patients (26 sutured and 24 stapled). The two groups were similar in all important respects. The clinical side of the study was to compare 1) the cosmetic results, 2) the time taken to close the skin, and 3) advantages and disadvantages of the two techniques by a questionnaire completed by the clinical staff. The study suggested a cosmetic advantage for the stapling when the results at 6th postop. week were compared. The only significant difference was in cross hatching (22 out of 26 sutured wounds but none of the 24 stapled) which was predominantly visible in sutured wounds. A clear difference was found in operating time. Skin closure with interrupted sutures took 310s, compared with 122s for stapling (alpha = 0,001). Similarly time required to remove the closure material was less with the staples than with sutures. Staples are more expensive than sutures. However the advantage of the staples over the suture in avoiding cross hatching is significant as well as time saving.

Abdomen↗
PubMed1981

Facial nerve sutures: epineural vs. perineural sutures.

The orbicularis oculi branch of the facial nerve was transected in two groups of 15 cats. Following section of the nerve, a specimen was removed for histological studies; then, using microscopic techniques the epineurium was sutured (nylon 10:0) in the first group, and the perineurium in the second. They were then followed for 100 days. Results rely on clinical (complete closure of the eye), electrophysiological (summation potentials), and histological (fiber count) evaluations. Judging from the relative density and diameters of the fibers, epineural sutures result in better regeneration than perineural sutures. With the tremendous importance of the absence of tension on the suture line in mind, it seems that the technique of choice for monofascicular nerves, as in the pyramidal and tympanic segments of the facial nerve, is epineural suture. Despite the slight advantage of epineural suture over perineural suture as evidenced by histological evaluation, there was no clinical difference. The distal fascicular distribution of facial nerve fibers and their spatial distribution make perineural (fascicular) sutures the method of choice when anastomosis becomes necessary in the vertical portion and in the portion distal to the stylomastoid foramen.

Animals↗
PubMed2007

Stress distribution in the supraspinatus tendon after tendon repair: suture anchors versus transosseous suture fixation.

BACKGROUND: The stress concentration at the site of supraspinatus tendon repair, either by suture anchor fixation or by transosseous suture fixation, has not been fully clarified. HYPOTHESIS: Suture anchor fixation showed higher stress concentrations in the tendon than did transosseous suture fixation. STUDY DESIGN: Controlled laboratory study. METHODS: Three finite element models were developed based on a previously published model of normal supraspinatus tendon (0 degrees abduction). Single-row fixation, double-row fixation, and transosseous suture fixation were simulated. A tensile force was applied to the proximal end of the supraspinatus tendon to simulate its contraction force. RESULTS: In the single-row model, the stress appeared from the site of the anchor and extended into the proximal tendon. The highest stress concentration was observed on the bursal surface of the tendon. The double-row model showed a similar pattern to the single-row model except that the stress concentration was observed only around the medial anchor. In the transosseous model, the stress appeared from the attachment site to a bony trough, which extended proximally into the tendon substance. No significant stress concentration was observed inside the tendon. CONCLUSION: Both single-row and double-row fixations showed higher stress concentration inside the tendon than did transosseous suture fixation. CLINICAL RELEVANCE: A high stress concentration might be a cause of the rerupture often observed after arthroscopic cuff repair using suture anchors.

Adaptation, Physiological↗
PubMed2004

Resistance to tearing of calf and ostrich pericardium: Influence of the type of suture material and the direction of the suture line.

The tearing of the valve leaflet of a cardiac bioprosthesis can cause early failure of this device, which is employed to replace a diseased native valve. This report involves the study of the behavior of 312 tissue samples (152 of calf pericardium and 160 of ostrich pericardium) treated with glutaraldehyde and subsequently subjected to tear testing. The samples were cut in the two principal directions: longitudinally, or root to apex, and transversely. They included a series of control samples that were left unsutured, and the remaining samples were repaired with the use of two different suture techniques: a running suture in the direction of the load and a telescoping suture perpendicular to the load. Four commercially available suture materials were employed: Pronova, nylon, Gore-Tex, or silk. The unsutured control samples of both types of pericardium exhibited a similar anisotropic behavior in the tear test. The mean resistance to tearing of the calf pericardium was 24.29 kN m in samples cut longitudinally and 34.78 kN m in those cut transversely (p =.03); the values were 28.08 kN m and 37.12 kN m (p =.002), respectively, in ostrich pericardium. The series repaired with the telescoping suture always exhibited greater resistance to tearing, with values that ranged between 44.34 and 64.27 kN for the samples of calf pericardium and from 41.65 to 47.65 kN for those obtained from ostrich. These assays confirm the anisotropic behavior of calf and ostrich pericardium treated with glutaraldehyde when subjected to tear testing, as well as the loss of this behavior in ostrich pericardium after suturing. Suturing techniques, such as the telescoping model, that provide a greater resistance to tearing should be studied for use in the design of the valve leaflets of cardiac bioprostheses made of biological materials.

Animals↗
PubMed2006

Subretinal suture misdirection during 360 degrees suture trabeculotomy.

PURPOSE: To report a new complication of 360 degrees suture trabeculotomy attributable to subretinal suture misdirection. DESIGN: Observational case report. METHODS: Retrospective chart review. RESULTS: A 5-month-old female with bilateral congenital glaucoma underwent uncomplicated 360 degrees suture trabeculotomy in the right eye. In the left eye, a scleral flap was created and dissection to Schlemm's canal was achieved. A 6-0 Prolene suture was passed into Schlemm's canal long enough for 360 degrees of treatment, did not come out the opening, and was retracted. The procedure was completed with a trabeculotome. One month later, an unusual white tract was noted subretinally in the left eye. There was no overlying retinal break or detachment. The tract presumably was caused by the misdirected Prolene suture exiting Schlemm's canal prematurely and being directed posteriorly. CONCLUSIONS: Suture misdirection subretinally during cannulation of Schlemm's canal should be considered a possible complication of 360 degrees suture trabeculotomy.

Catheterization↗
PubMed2002

Simplified arthroscopic suture passing using a suture loop.

Arthroscopic procedures for shoulder pathology are becoming more popular. Passing braided nonabsorbable suture for repair of intra-articular tissue can be technically difficult because advancing this suture through tissue is a 2-step process. The use of a suture loop with Spectrum suture hooks (Linvatec, Largo, FL) simplifies braided suture passing, and eliminates the use of expensive suture shuttles. This technique simplifies the use of nonabsorbable suture in arthroscopic shoulder procedures.

Arthroscopy↗
PubMed2005

Uterine compression suture without hysterotomy--why a non-absorbable suture should be avoided.

We describe 2 cases of uterine compression suture without hysterotomy, only described once in the literature previously (Hayman et al. 2002). We consider in detail the suture material used for this technique and show photos of the compression suture at laparoscopy 4 weeks after insertion to demonstrate why it is inappropriate to use a non-absorbable suture. Modified compression sutures are being used increasingly and a wide variety of suture materials are being chosen, including vicryl, PDS and nylon (verbal communications). We feel it important to report our findings so that others can avoid the use of non or slowly absorbable sutures.

Adult↗
PubMedDate not supplied

Clinical evaluation of random skin flaps based on the subdermal plexus secured with sutures or sutures and cyanoacrylate adhesive for reconstructive surgery in dogs.

OBJECTIVE: To evaluate the use of subdermal plexus skin flaps for closing defects after excision of cutaneous and subcutaneous tumors in dogs and to compare outcome of flaps secured with sutures and those secured with butyl-cyanoacrylate and intermittent sutures. STUDY DESIGN: Clinical study. ANIMALS: Fifteen dogs. METHODS: After excision of cutaneous or subcutaneous tumors the skin defect was reconstructed by random flaps based on the subdermal plexus. Flap skin edges were apposed with simple interrupted 4-0 monofilament nylon sutures (group 1; 5 dogs) or nylon sutures alternated with butyl-cyanoacrylate adhesive (group 2; 10 dogs). Flaps were evaluated every 48 hours when bandages were changed, until complete healing. RESULTS: Random flaps based on the subdermal plexus were effectively used to close wound defects; mean flap survival was 89%. Partial flap necrosis occurred in 4 dogs. Wound margins apposed with butyl-cyanoacrylate had thinner and more esthetic scars than sutured margins. CONCLUSION: Random flaps based on the subdermal plexus proved to be versatile for covering limb wounds after excision of cutaneous or subcutaneous tumors. Mean survival rate was comparable to that reported for axial pattern flaps. Butyl-cyanoacrylate adhesive was easy to apply, allowed accurate margin apposition with good cosmetic outcome and reduced sutures needed. CLINICAL RELEVANCE: Cyanoacrylate adhesive should be considered in lieu of suture closure to secure random skin flaps based on the subdermal plexus in dogs.

Animals↗
PubMed2005

Sutures as longitudinal guides for the repair of nerve defects--influence of suture numbers and reconstruction of nerve bifurcations.

PURPOSE: We investigated whether sutures could guide regeneration across bifurcated nerve defects and how the number of sutures influenced regeneration. METHODS: Bilateral ten mm defects in the rat sciatic nerve were bridged by either two or six laps of longitudinal (8/0 polyglactin) sutures. Bilateral ten mm defects including the bifurcation of tibial and peroneal nerves were bridged by two laps to the tibial and four laps to the peroneal nerve on one side and vice versa on the other. Evaluation of tetanic force, weights of the gastrocnemius and caudal tibial muscles and morphometry of the nerves were performed at twelve weeks. RESULTS: Simple defects bridged by six laps yielded a significantly greater number of myelinated axons compared to two laps. In the bifurcated defects a well defined two branched nerve structure was formed in all cases between the sciatic nerve and its peroneal and tibial branches. However, in the bifurcated model the tibial nerve attracted more axons than the peroneal irrespective of the number of suture laps. CONCLUSIONS: There is no simple correlation between the number of sutures and the number of regenerating axons but two suture laps may be insufficient for the repair of a rat sciatic nerve. Sutures supported reconstruction of new fascicles across bifurcated nerve defects.

Animals↗
PubMed1978

[Prolene and vicryl as synthetic sutures for intradermal suture technics].

It could be shown that beside the non-absorbable synthetic suture material (Polypropylene) for the subcuticular continuous skin suture absorbable synthetic suture material (Polyglactin 910) is suitable for the buried subcuticular skin suture to obtain good esthetic scars in plastic surgery. Experiences with Polyglactin 910 in over 300 patients are presented. In no case wound healing was disturbed as a result of the suture material. Further application will give more information about the usefulness of the absorbable synthetic suture material Polyglactin 910 for the buried subcuticular skin suture.

Breast↗