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At least 163 records · Page 9Linked to original sources

[Advantages of reabsorbable intradermal sutures in general surgery. Experience on 201 sutures].

Surgical wound suture is often considered of minor importance compared to the whole surgical operation. The aesthetical result of a wound suture is still hardly considered in general surgical practice compared to other "traditional" wound sutures. The Authors carried a prospective study an 201 intradermal absorbable sutures in clean general surgery. The results clearly show that with a limited increase of the mean operation time of 90 seconds, for a 10 cm suture, there are such positive clinical, and aesthetical results that it is advisable to use routinely this type of suture in elective clean surgery.

Absorption↗

Trigonocephaly in rabbits with familial interfrontal suture synostosis: the multiple effects of premature single-suture fusion.

Previous studies from our laboratory have characterized the craniofacial morphology and growth patterns of an inbred strain of rabbits with autosomal dominant coronal suture synostosis. A number of rabbit perinates from this colony have been collected sporadically over a 5-year period with premature interfrontal suture synostosis. The present study describes the very early onset of craniofacial dysmorphology of these rabbits and compares them to similar-aged normal control rabbits. A total of 40 perinatal New Zealand White rabbits were used in the present study. Twenty-one comprised the sample with interfrontal suture synostosis and ranged in age from 27 to 38 days postconception (term = 31 days) with a mean age of 33.53 days (+/-2.84 days). Nineteen rabbits served as age-matched, normal controls (mean age = 33.05 days +/-2.79 days). Lateral and dorsoventral radiographs were collected from each rabbit. The radiographs were traced, computer digitized, and 12 craniofacial measurements, angles, and indices were obtained. Mean measures were compared using an unpaired Student's t-test. All synostosed rabbits were stillborn or died shortly after birth. Grossly, these rabbits exhibited extreme frontal bossing, trigonocephaly with sagittal keeling, and midfacial shortening. No somatic anomalies were noted. Radiographically, rabbits with interfrontal suture synostosis had significantly (P < 0.05) narrower bifrontal widths, shorter cranial vault lengths, kyphotic cranial base angles, and different cranial vault indices (shapes) compared to controls. Results reveal severe and early pathological and compensatory cranial vault changes associated with premature interfrontal suture synostosis in this rabbit model. The 100% mortality rate noted in this condition may be related to the inheritance of a lethal genetic mutation or to neural compression from reduced intracranial volume. Results are discussed in light of current pathogenic hypotheses for human infants with premature metopic suture synostosis.

Animals↗

[Manual suture versus/or mechanical suture from the Austrian viewpoint].

A general inquiry was made at surgical units and university clinics in Austria about the anastomosis techniques used between 1980 to 1985. The result was that in 90.3% the suture was made by hand and in 9.7% by machine. The first mentioned was performed as double row inverting suture by 66% of our surgeons, and only in 30% as an all-layer suture. The stapler-technique was mostly preferred for the oesophago-jejunostomy and the high and lower resection of the rectum. A leakage of the suture line was observed in 3.9% after sewing by hand and in 6.3% after stapling. The total lethality finally was 1.4% for hand made suture and 1.8% for apparative suture.

Austria↗

Early local stoma complications in relation to the applied suture material: comparison between monofilament and multifilament sutures.

The frequency and character of early complications following creation of enterostomies, and their relation to the applied suture material, were studied in 50 consecutive patients. The stomas were matured by mucocutaneous eversion and were fixated with Maxon (Davis & Geck, Pearl River, NY) 4-0 and Vicryl (Ethicon, Inc., Somerville, NJ) 3-0 sutures. Half of the stoma circumference was sutured with one suture type, and vice versa. Three patients died within 10 days. Of the remaining 47 patients, 34 (72 percent) had one or more complications diagnosed. Four (9 percent) suffered major complications (one total stoma loosening and three partial stoma necroses), and 30 (64 percent) had mucocutaneous affections only. There was no statistically significant correlation between enterostomy type or surgical procedure and complications, whereas the incidence of mucocutaneous complications was significantly higher following fixation with Vicryl as compared with Maxon sutures. The cause of this difference is uncertain; however, the physical configuration of the sutures, Maxon being monofile vs. Vicryl being braided, seems important. Whether the chemical structure is significant as well remains undetermined at present.

Adult↗

Do absorbable mesh sutures cause less chronic pain than nonabsorbable sutures after Lichtenstein inguinal herniorraphy?

Chronic inguinal pain occurs in 20-30% of patients after hernia surgery. A prospective randomized study of 162 patients was undertaken to determine whether absorbable sutures cause less pain than continuous polypropylene fixation of the mesh in the Lichtenstein operation. All patients were operated on under local anesthesia by the same senior surgeon. One-half of the meshes were fixed with continuous 2-0 Dexon II sutures and one-half with continuous 2-0 Prolene sutures. The incidence of pain and recurrence was investigated after a mean follow-up of 2 years. Patient characteristics and operative outcome were similar in the two groups and statistically nonsignificant in both. The rate of significant wound hematomas (n = 3), infections (n = 1), and recurrences (n = 2) were low and not related to the type of sutures. In both study groups 24-26% of the patients felt some pain in follow-up, but over 90% were very satisfied with the operation. The absorbable suture material does not appear to cause less neuropathic pain after Lichtenstein operation than nonabsorbable sutures.

Female↗

Elastic behaviour of sutured calf pericardium: influence of the suture threads.

The purpose of this study was to assess the elastic behaviour of calf pericardium used in the construction of cardiac bioprosthesis valve leaflets, sutured with different types of commercially available sutures: silk, Gore-Tex, Surgilene and nylon. Thirty-two samples (four series of eight samples each) were subjected to tensile strength testing to breakage. The breaking stress (MPa) ranged between 4.89 MPa for samples sutured with Gore-Tex and 5.22 MPa for those sewn with nylon. Three samples from each series were subjected to a stepwise stress test, involving increasing levels of stress followed by return to zero, to define the elastic limit (the cut-off point beyond which strain is no longer reversible). Analysis of the results provided the mathematical functions that govern the elastic behaviour (stress/strain) within the elastic range for each type of sutured sample. The series sutured with Surgilene presented the highest mean value (1.649 MPa). Finally, a statistical study was carried out to determine which series showed the greatest probability of having the least interaction between the thread and the pericardium. Allowing an interval of +/- 10%, Gore-Tex showed the best probability in this respect. However, real fatigue testing is necessary to definitively determine which is the best suture to use.

Animals↗

Suture-mediated closure of the femoral access site after cardiac catheterization: results of the suture to ambulate aNd discharge (STAND I and STAND II) trials.

Despite advances in other aspects of cardiac catheterization, manual or mechanical compression followed by 4 to 8 hours of bed rest remains the mainstay of postprocedural femoral access site management. Suture-mediated closure may prove to be an effective alternative, offering earlier sheath removal and ambulation, and potentially a reduction in hemorrhagic complications. The Suture To Ambulate aNd Discharge trial (STAND I) evaluated the 6Fr Techstar device in 200 patients undergoing diagnostic procedures, with successful hemostasis achieved in 99% of patients (94% with suture closure only) in a median of 13 minutes, and 1% major complications. STAND II randomized 515 patients undergoing diagnostic or interventional procedures to use of the 8Fr or 10Fr Prostar-Plus device versus traditional compression. Successful suture-mediated hemostasis was achieved in 97.6% of patients (91.2% by the device alone) compared with 98.9% of patients with compression (p = NS). Major complication rates were 2.4% and 1.1%, and met the Blackwelder's test for equivalency (p <0.05). Median time to hemostasis (19 vs 243 minutes, p <0.01) and time to ambulation (3.9 vs 14.8 hours, p <0.01) were significantly shorter for suture-mediated closure. Suture-mediated closure of the arterial puncture site thus affords reliable immediate hemostasis and shortens the time to ambulation without significantly increasing the risk of local complications.

Cardiac Catheterization↗

Experimental study on facial nerve suturing--comparison between epineural and perineural sutures.

A comparison was made between epineural and perineural sutures using the orbicular is oculi branches of facial nerves of 30 cats. Nerve regeneration was slightly reduced with perineural suture without a tube compared with epineural suture with a tube, epineural suture without a tube and perineural suture with a tube, which showed similar results. A good regeneration was observed when approximation was made without tension at both cut ends of the perineurium. When the corresponding funiculus cannot be identified, epineural suture is considered sufficient.

Anastomosis, Surgical↗

Cyclic loading of rotator cuff repairs: A comparison of bioabsorbable tacks with metal suture anchors and transosseous sutures.

PURPOSE: The purposes of the study were (1) to compare rotator cuff repair strengths after cyclic loading of 2 bioabsorbable nonsuture-based tack-type anchors, transosseous sutures, and a metal suture-based anchor, and (2) to correlate bone mineral density with mode of failure and cycles to failure. We hypothesized that specimens with a lower bone density would fail through bone at a lower number of cycles independent of the method of cuff fixation. TYPE OF STUDY: Ex vivo biomechanical study. METHODS: Standardized full-thickness rotator cuff defects were created in 30 fresh-frozen cadaveric shoulders that were randomized to 1 of 4 repair groups: transosseous sutures; Mitek Super suture anchors (Mitek Surgical Products, Westwood, MA); smooth bioabsorbable 8-mm Suretacs (Acufex, Smith & Nephew Endoscopy, Mansfield, MA); or spiked bioabsorbable 8-mm Suretacs (Acufex). All repairs were cyclically loaded from 10 to 180 N; the numbers of cycles to 50% (gap, 5 mm) and 100% (gap, 10 mm) failure were recorded. RESULTS: In comparing the repair groups, we found only 1 significant difference: the number of cycles to 100% failure was significantly higher (P <.05) for the smooth bioabsorbable tack than for the transosseous suture group. There were no statistically significant (P </=.05) differences in bone mineral densities with regard to each specimen's mode of failure. CONCLUSIONS: Our results suggested that immediate postoperative fixation provided by bioabsorbable tacks was similar to that provided by Mitek anchors and more stable than that provided by transosseous sutures. Therefore, the immediate postoperative biomechanical strength of bioabsorbable tacks seems comparatively adequate for fixation of selected small rotator cuff tears. However, additional evaluation in an animal model to examine degradation characteristics and sustained strength of repair is recommended before clinical use.

Absorbable Implants↗

[Percutaneous transfemoral implantation of a new, flexible thoracic aorta endoprosthesis using a percutaneous suture system for vascular suture--initial experiences].

PURPOSE: To evaluate the transfemoral placement of a new, flexible stent-graft into the thoracic aorta and the suture-mediated closure of the femoral access. PATIENTS AND METHODS: Five patients were treated endovascularly with a stent-graft for an aneurysm (n = 3) or acute dissection (n = 2) of the thoracic aorta via a femoral 24 F sheath. The femoral access site was closed with two suture-mediated closure devices after placement of the stent-graft. RESULTS: The aneurysm or the false lumen was excluded from perfusion by the placement of the stent-graft in all patients. Hemostasis at the femoral access site was successful in all patients with the percutaneous suture device. A minor stenosis of the femoral artery was found angiographically in four patients after suture-mediated closure. Besides a reversible renal failure due to the medically induced hypotension for the treatment of an acutely ruptured aneurysm, no complications resulted from the stent-graft placement or the percutaneous suture. CONCLUSION: The percutaneous transfemoral placement of stent-grafts in the thoracic aorta using a suture-mediated closure of the access site is technically feasible. Long-term results of the technique have to be awaited.

Aged↗

Biomechanical comparison of the FasT-Fix meniscal repair suture system with vertical mattress sutures and meniscus arrows.

BACKGROUND: A meniscal repair technique that combines the strength of vertical mattress sutures and the decreased tissue morbidity of an all-inside technique would be advantageous. HYPOTHESIS: The FasT-Fix Meniscal Repair Suture System will provide load at failure, stiffness, and displacement equivalent to that of vertical mattress sutures and superior to that of Meniscus Arrows. STUDY DESIGN: In vitro biomechanical study. METHODS: After repair of a 2-cm vertical longitudinal medial meniscal lesion, three groups of six human cadaveric knees were biomechanically tested in a random order on a servohydraulic device, and three groups of five specimens underwent cyclic loading. RESULTS: Specimens repaired with Meniscus Arrows had reduced load at failure, stiffness, and displacement, but there were no differences between the FasT-Fix and vertical mattress suture methods. During cyclic loading, specimens repaired with two Meniscus Arrows failed before test completion, whereas specimens repaired with two vertical mattress sutures (6.0 +/- 3.7 mm) or with two FasT-Fix implants (5.1 +/- 1.4 mm) maintained fixation with comparable displacements. CONCLUSIONS: The FasT-Fix provided load at failure, stiffness, and displacement comparable with that of vertical mattress sutures. CLINICAL RELEVANCE: The results suggest that the FasT-Fix may be preferable to Meniscus Arrows for meniscal repair with minimal associated tissue morbidity.

Analysis of Variance↗

Comparison of tunnel suture and suture anchor methods as a function of time in a sheep model.

There is little quantitative information available on the required healing time after a rotator cuff surgery. This study evaluated two surgical procedures by comparing the healing strength as a function of time of the tendon in a bone trough using a sheep model. The two surgical procedures compared were bioabsorbable suture anchors and bone tunnel suture technique. The infraspinatus tendon was split in half and procedure (suture anchor/tunnel suture) locations were randomly allocated to the proximal or distal half of the tendon at the healing time points of 0, 3, 6, 9, and 12 weeks with n = 6 at t = 0 and n = 8 in all other groups. At each time point, the surgical (right) and normal (left) shoulders were harvested and stored in a -30 degrees C freezer until testing. Biomechanical testing was performed using a MTS 809 Axial/Torsional Servohydraulic System. Special cryo-grips designed and built to test the infraspinatus tendon-bone interface in anatomical alignment were used. All samples were preloaded with 5 Newtons, and then force was measured during a crosshead displacement of 50 cm/min until failure. Force and displacement data were recorded to calculate load to failure and stiffness of the bone-tendon construct. There was only significant difference (95% CI) in mean tensile force at week 0, with the bone tunnel suture technique tensile force greater than the suture anchor method tensile force (p = 0.0261). There was no significant difference between stiffness means at any of the survival times.

Animals↗

A comparative study of gut suture, human amnion collagen, bovine skin collagen and Vicryl suture implants in rats.

This study compares the persistence and histological characteristics of gut suture with those of human amnion collagen, bovine collagen, and Vicryl suture implants in rats. Gut suture and human amnion collagen more resembled living tissue than did bovine collagen and were characterized by their cellularity and the presence of numerous capillaries. The Vicryl suture implants were quickly absorbed. Picrosirius polarization revealed the synthesis of host collagen by rat fibroblasts which immigrated into the gut suture and human amnion collagen implants. The authors suggest the potential of gut suture as a soft tissue substitute to improve linear skin contour deficits.

Absorbable Implants↗

The ramp mattress suture: a new suturing technique combined with a surgical procedure to obtain papillae between implants in the buccal area.

This article has been written to show the opportunity and eventually the predictability to obtain new papillae between implants and a better esthetic result by the use of a new suturing technique. After raising a full-thickness flap from the palatal to the vestibular side, it can be stabilized in such a position using a new suturing technique (ramp mattress suture) to apply pressure and tearing forces on the flap in an apicocoronal direction at the vestibular site and an opposite traction in a coronoapical direction at the palatal site. The ramp mattress suture seems to be capable of pulling the flap in an apicocoronal direction in the vestibular site, as well as in a coronoapical direction in the palatal site. Thanks to such a mattress suture, it will be possible to obtain a more coronal gingival margin. After an adequate healing period of approximately 5 weeks, a vestibular scalloped gingivectomy is performed around the vestibular surface of the abutment to create either a scalloped gingival margin or interproximal papillae only in the vestibular area, forming a gingival ramp in a palatovestibular direction to reasonably reduce the residual increased vestibular depth and optimize the esthetic result. Eight patients, for a total of 56 papillae, were treated with this new suturing technique. The esthetic results satisfied both clinician and patient expectations.

Adult↗

Treatment of chronic complete rupture of achilles tendon in three dogs with locking loop suture and own suture technique.

The present case report describes three heavy dogs, Caucasian Shepherd breed, with chronic complete traumatic rupture of Achilles tendon, which was repaired with two types of sutures. Surgical treatment involved shortening the Achilles tendon, and using a locking loop suture technique and own suture technique with four buttons. Additionally, positional screw and cast supported the sutures. Twelve months postoperatively no discomfort and lameness were observed on clinical examination. This paper shows that treatment of chronic complete rupture of Achilles tendon with locking loop suture and own suture technique gives good results.

Achilles Tendon↗

Absorbable suture materials for vascular anastomoses. Tensile strength and axial pressure studies using polyglycolic acid sutures.

This study attempted to evaluate how vascular healing itself is sufficient enough to provide adequate strength to autogenous vein grafts in small arteries without the use of nonabsorbable sutures. The absorbable suture, Dexon, was used in small canine femoral vein graft anastomoses over a two-month trial period with nonabsorbable Prolene as a control. Tensile strength and resistance to axial leak were measured. Results show that Dexon had 93 per cent of the tensile strength of Prolene immediately; 76 per cent at 14 days, 111 per cent at 21 days, and 110 per cent at 30 days, and 124 per cent at 60 days as an average for all suture lines. The per cent mean resistance to leakage that Dexon had compared to Prolene for all suture lines was 102 per cent at seven days, 97 per cent at 14 days, 107 per cent at 21 days, and 97 per cent at 30 days. There is no evidence of aneurysms, suture line disruptions, dilations, or infections of any anastomoses. Our ultimate conclusion is that the integrity of small autogenous vein graft is dependent on healing rather than on the permanent strength of the suture material and that Dexon maintains vascular integrity long enough to permit this healing to occur.

Absorption↗

[Technic of rectum anastomoses in rectum resection. A controlled study: instrumental suture versus hand suture].

Stapler and manual sutures in rectal end-to-end anastomoses were compared in a controlled trial. The following results were obtained: For the analysis the cases naturally separated into three groups, A (manual suture), B (planned stapler suture) and WD ("withdrawn" cases, from both groups, in which continence could be maintained only with a stapler suture). The distribution of the WD cases in dependence on localization and sex varied significantly from groups A and B, while A and B remained comparable, in spite of the WD cases. The analysis of the date showed no, or only slight, clinical differences. In a comparison of the two stapler groups B and WD, significantly more suture dehiscences, colocutaneous fistulae and post-operative disturbances in bladder function were found in group WD. As a general conclusion we can state that: In comparable anastomosis localizations it is possible to achieve almost the same clinical results with both suture techniques. With a circular stapler it is, however, technically possible to perform rectum resections in cases in which this was not previously possible, particularly in men with a narrow pelvis and a stale pelvic floor. To what extent this still is an advantage after the local recurrences are taken into consideration remains to be seen.

Clinical Trials as Topic↗

[Microsurgical nerve and blood vessel sutures with resorbable suture material].

An experimental study of the behavior of the absorbable suture Polyglactin 910 (Vicryl) 0,2 metric in the tissue was performed. Microsurgical sutures of nerves and vessels (sciatic nerve and carotid artery) were performed and compared with a non-absorbable suture (Ethilon). The micromorphological studies included a period of 12 weeks after surgery. The absorbable suture showed equal mechanical qualities, with the advantage that the suture material and the tissue reaction disappeared after the 10th week, while the poor visualization of the absorbable suture under the operating microscope was a disadvantage.

Animals↗