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At least 19 recordsLinked to original sources
PubMed1996

Influence of suture technique and suture material selection on the mechanics of end-to-end and end-to-side anastomoses.

Experiments were performed in dogs to evaluate the mechanics of 26 end-to-end and 42 end-to-side artery-vein graft anastomoses constructed with continuous polypropylene sutures (Surgilene; Davis & Geck, Division of American Cyanamid Co., Danbury, Conn.), continuous polybutester sutures (Novafil; Davis & Geck), and interrupted stitches with either suture material. After construction, the grafts and adjoining arteries were excised, mounted in vitro at in situ length, filled with a dilute barium sulfate suspension, and pressurized in 25 mm Hg steps up to 200 mm Hg. Radiographs were obtained at each pressure. The computed cross-sectional areas of the anastomoses were compared with those of the native arteries at corresponding pressures. Results showed that for the end-to-end anastomoses at 100 mm Hg the cross-sectional areas of the continuous Surgilene anastomoses were 70% of the native artery cross-sectional areas, the cross-sectional areas of the continuous Novafil anastomoses were 90% of the native artery cross-sectional areas, and the cross-sectional areas of the interrupted anastomoses were 107% of the native artery cross-sectional areas (p < 0.05). At physiologic pressures, there were no differences in compliance among the three types of anastomosis. These data suggest that when constructing an end-to-end anastomosis in a small vessel, one should use an interrupted suture line or possibly continuous polybutester suture. Forty-two end-to-side anastomoses demonstrated no differences in cross-sectional areas or compliance for the three suture techniques. This suggests that, unlike with end-to-end anastomoses, when constructing an end-to-side anastomosis in patients any of the three suture techniques may be acceptable.

Anastomosis, Surgical↗
PubMedDate not supplied

Keratometric results during the first year after keratoplasty: adjustable single running suture technique versus double running suture technique.

BACKGROUND AND OBJECTIVE: To compare the 3-month and 1-year postoperative keratometric results in a retrospective sequential series of corneal grafts performed with either a double running suture technique or an adjustable single running suture technique. MATERIALS AND METHODS: Keratometry values obtained 3 months and 1 year after penetrating keratoplasty, when sutures were still present, were compared between 31 grafts with double running sutures and 27 grafts with single running sutures, 15 of which had been adjusted postoperatively. RESULTS: No significant difference in mean keratometry between the 2 groups was found either 3 months or 12 months after keratoplasty. Mean keratometric astigmatism was significantly less in the single running group at both 3 months (2.2 +/- 1.9 vs 4.5 +/- 2.8, mean +/- SD, P <0.001) and 12 months (3.0 +/- 2.2 vs 4.2 +/- 2.1, P = 0.03). Within groups, there was no significant change from 3 months to 12 months in either mean keratometry or keratometric astigmatism. CONCLUSION: The single running suture technique, with postoperative adjustments, produced less keratometric astigmatism during the first postoperative year, when sutures were still in place.

Astigmatism↗
PubMed1997

Load to failure of common meniscal repair techniques: effects of suture technique and suture material.

Success of meniscal repair with early or immediate motion depends on the ability of the suture fixation to withstand the loads applied. Vertical and horizontal mattress suture techniques were tested using 2-0 Ethibond, and 0-PDS and 1-PDS sutures (Ethicon, Somerville, NJ). Mulberry knot technique was tested with 0-PDS and 1-PDS sutures. Twenty menisci (60 sutures) were tested for each suture material. Sutures were placed 3 to 4 mm from the peripheral edge of the meniscus with double barreled cannulas for vertical and horizontal mattress techniques or a spinal needle for the mulberry knot technique, reproducing clinical techniques of meniscal repair. Mechanical testing of suture fixation was performed to failure at a rate of 10 mm/min on a MTS material testing system (MTS Systems Corp, Minneapolis, MN). Suture pullouts were reported as the load displacement to failure from the inner fragment only, because clinical failure would ensue should a suture pull through the inner fragment of a tear. Vertical mattress technique with 1-PDS suture had significantly greater load to failure than any other combination (P < .05). Analysis of variance showed that the vertical mattress technique had statistically superior pullout strength (P < .0001) compared with the horizontal mattress and mulberry knot techniques, which were statistically similar. There were significant differences (P < .0001) between suture types, with 1-PDS proving best compared with 0-PDS, which was stronger than 2-0 Ethibond. Selection of suture material had the greatest impact on vertical mattress load to failure and was not important to the strength of the other techniques.

Analysis of Variance↗
PubMed1983

Separation of sutured tendon ends when different suture techniques and different suture materials are used. An experimental study in rabbits.

Calcaneal tendons in rabbits were divided and then sutured with varying suture techniques and suture materials. The separation of the tendon ends after suturing was registered with an X-ray technique--the tendon ends being identified by thin steel wires. Independently of the suture techniques and the suture materials a biphasic separation of the tendon ends was registered. The first separation took place during the first 4-5 days while the second separation began after 20-24 days. A small initial separation seems to indicate that the tendon suture used is adequate. The initial separation can therefore be used to evaluate a suturing technique and how the result is influenced by the suture material used. In the present study we could show that steel wire was ideal for a Bunnell suture. Prolene and Ethiflex cannot be recommended. A suture technique with a single short loop gave good results with all suture materials. Dexon ligatures placed around the tendon ends according to Schink in order to prevent the strands of the suture from cutting the tissue, did not reduce the initial separation. When a complex suture technique, like a Bunnell suture, is used the physical properties of the suture material influence the result. With a simple suture technique, a single short loop, good results can be achieved with every suture material.

Animals↗
PubMed1988

Evaluation of dural closure techniques. Suture methods, fibrin adhesive sealant, and cyanoacrylate polymer.

A study was undertaken to investigate the relative strengths of dural repair using standard suture techniques, suture supplemented with tissue adhesive, and tissue adhesive alone. The efficacy of two tissues adhesives, fibrin adhesive sealant and cyanoacrylate polymer, as adjunctive or the sole means of effecting dural closure, was studied. In vitro analysis of repair techniques was accomplished using fresh human cadaveric dura. Uniform 4 mm defects were created, repaired using various techniques, and then subjected to pressurization testing. Defects repaired with suture alone leaked at pressurization levels within the physiologic range, while those supplemented with tissue adhesives failed at higher pressurization levels. In vitro testing, accomplished in white New Zealand rabbits, supported this conclusion. Histologic sections obtained from dura treated with fibrin adhesive sealant demonstrated minimal inflammatory response, while those sections obtained at the site of dural repair augmented with cyanoacrylate polymer featured significant inflammatory responses, including dural thinning, gliosis, and cortical necrosis. Results indicate that a new substance, fibrin adhesive sealant, appears to have application as an adjunctive means of effecting dural closure.

Animals↗
PubMed2003

Prospective randomised trial comparing traditional suture technique with the dynamic sliding loop suture technique in the closure of skin lacerations.

OBJECTIVE: The aim of this study was to compare the cosmetic appearance and related complications of selected skin lacerations closed by traditional suture technique with that of the dynamic sliding loop suture technique. DESIGN: Prospective, randomised clinical trial. SETTING: A district general hospital. PARTICIPANTS: Thirty seven eligible patients aged between 16 and 60 years with skin lacerations (no deeper than superficial fascia) to the limbs, trunk, and neck (excluding face and scalp) and with no associated neurovascular or tendon injuries were recruited into the trial. The exclusion criteria used included immunocompromised patients (diabetics, malignancy, renal failure, corticosteroid treatment), primary dermatological conditions (psoriasis, eczema), keloid prone or susceptible patients, and wounds judged unsuitable for primary closure. INTERVENTION: Skin lacerations were randomly allocated to have closure by either the traditional method or by use of the dynamic sliding loop suture method. The trial had ethical approval of the hospital ethics committee and all participants were fully informed of the trial both verbally and by an information leaflet. Written informed consent was obtained before starting the study. MAIN OUTCOME MEASURE: The cosmetic appearance of photographs of wounds immediately after suture removal and at three months were assessed by a general surgeon and an orthopaedic surgeon blinded to the technique used. The 10 point visual analogue cosmesis scale was used for scoring the appearance of the wounds. SECONDARY OUTCOME MEASURE: The presence of wound closure related complications such as infection, dehiscence, suture slippage, wound edge submergence, skin edge necrosis, and haematoma formation were noted and recorded on follow up visits. RESULTS: A total of 37 patients participated in the trial over a period of 18 months. Seventeen patients underwent suture by the traditional technique and 20 by the dynamic sliding loop suture technique. Four patients (all from the traditional group) were lost to follow up and not included in the study. Most wounds healed uneventfully although there was one case of wound infection in each group. Four patients had ligature slippage (three from the dynamic suture and one from the traditional group). Two patients had evidence of skin edge necrosis both from the traditional technique group. A comparison of the healed wounds by two independent assessors blinded to the technique used showed no statistically significant difference observed between the two types of intervention (Wilcoxon matched paired test p>0.05) immediately after suture removal or at three months. Although there was no statistically demonstrable difference, the comparative paired absolute visual analogue scores seemed to consistently show higher values for the sliding loop technique. CONCLUSION: The cosmetic appearance of wounds sutured using the dynamic sliding loop suture technique in this study were not statistically shown to be superior to those sutured using the traditional suture technique although absolute visual analogue scores consistently showed higher values for the sliding loop technique. The significance of this is unclear and may warrant a much larger trial to see if it is a trend that a larger population of participants can help to support or refute with regard to the superiority of this new technique.

Adolescent↗
PubMed2006

An in vivo comparison of the modified Mason-Allen suture technique versus an inclined horizontal mattress suture technique with regard to tendon-to-bone healing: a biomechanical and histologic study in sheep.

The purpose of this study is to examine long-term tendon-to-bone healing, by use of a sheep animal model, after rotator cuff repairs performed with 2 different suture techniques: an inclined horizontal mattress suture pattern placed with special arthroscopic instrumentation (HMS) and the modified Mason-Allen pattern (MMA). After a pre hoc power analysis, 18 skeletally mature sheep were randomly assigned to either the HMS or MMA repair technique, with contralateral limbs used for the control group. At 26 weeks, the animals were euthanized. Six sheep from each group underwent biomechanical testing. Load-to-failure and stiffness results indicated no statistically significant difference between the 2 groups. Avulsion of the tuberosity was the primary mode of failure for both groups. In the remaining 6 sheep, histologic evaluation demonstrated that, regardless of treatment, the tendon appeared completely healed in the bony trough. Because the long-term biomechanical and histologic properties of healed tendons repaired with an HMA technique are equal to those obtained with an MMA technique, the inclined horizontal mattress suture may be appropriate for arthroscopic rotator cuff repair. Short-term studies are necessary to determine whether these findings are true early after tendon repair, when failure may be most common.

Animals↗
PubMedDate not supplied

Early active mobilization for flexor tendons repaired using the double loop locking suture technique.

Current suture techniques limit the postoperative management for flexor tendons. A double loop locking suture (DOLLS) technique has been described that provides sufficient in vitro strength (average 4,400 g) for early active mobilization of the flexor tendon. This paper details four cases in which the flexor digitorum profundus (FDP) tendons were repaired using the DOLLS technique. Early active mobilization was initiated 3 to 7 days postoperatively. Results were classified according to Strickland's formula. Two patients achieved excellent results, one a good result, and one a fair result. One rupture of a flexor digitorum superficialis (FDS) tendon, which had been repaired with a modified Kessler technique, occurred. Although this FDS tendon ruptured, the FDP tendon, which had been repaired with the DOLLS technique, remained intact. With the use of a protective splint, early active mobilization of tendons repaired by the DOLLS technique appears to be an effective method for postoperative management.

Adult↗
PubMed1993

The pop-out, pull-through suture technique.

New suturing techniques have continually been developed through the years out of a need to provide a more pleasing scar, provide an easier method, or to enhance patient comfort and satisfaction. This article details the pop-out, pull-through suture.

Cicatrix↗
PubMed1993

Aortic valve replacement using a continuous suture technique.

The continuous suture technique has been proposed as an alternate method for aortic valve replacement (AVR). Advantages include a decreased ischemic and bypass time. Despite reports of a low incidence of perivalvular leak, wide use of the continuous suture technique has not been adopted. This report reviews our experience with the continuous suture technique. From January 1984 through November 1991, 181 consecutive patients underwent AVR using the continuous suture technique. The mean age was 61 years (range 6 to 88 years). Diagnoses included pure aortic stenosis (AS) in 41%, aortic insufficiency (AI) in 31%, and a combination of AS and AI in 28%. Fifty-six patients underwent isolated AVR and 125 underwent AVR combined with other procedures. The overall early mortality was 5.5%. Early mortality for isolated AVR was 0% (0/56) and was 8.0% (10/125) for those undergoing concomitant procedures. Late mortality was 4.7% in a mean follow-up of 30 months (range 1 to 86 months). The incidence of perivalvular leak was 2.3% (4/171 operative survivors). Perivalvular leak was mild in two, and moderate in two; none required reoperation. Perivalvular leak developed only in patients whose suture line was not reinforced with glutaraldehyde treated pericardium. The continuous suture technique is a quick and effective method for AVR and results in a low incidence of perivalvular leak.

Adolescent↗
PubMed2005

Novel approach to aortic cannulation suturing: tangential suture technique.

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

Adolescent↗
PubMed2001

Sternal wound infections in patients undergoing open heart surgery: randomized study comparing intracutaneous and transcutaneous suture techniques.

BACKGROUND: Intracutaneous suture technique has been our standard method for closing sternal wounds in cardiac surgery, mainly for cosmetic reasons. However, an increased rate of postoperative infections has been reported in cosmetic surgery with this method compared with the percutanous or transcutaneous closure technique. A comparison of these two techniques in cardiac surgery is presented. METHODS: In a randomized study, 300 patients were selected to intracutaneous suture (n = 150) or percutanous suture (n = 150). The endpoints were superficial and deep sternal wound infections within 6 weeks postoperatively. RESULTS: The total infection rate was lower in the percutanous group compared with the intracutaneous group (3% versus 8%) (p = 0.007). The superficial infection rate was lower in the percutaneous group (2.3% versus 6.7%) (p = 0.01), whereas there was no statistically significant difference in the deep infection rate between the groups. CONCLUSIONS: The percutaneous suture technique reduces the incidence of superficial wound infections, but not the deep infection rate in open heart surgery. There was no difference in the cosmetic results on a visual scale, assessed by the patients.

Adolescent↗
PubMed1977

[The position of gastrointestinal suture technique. Advances through mechanical suture methods (author's transl)].

At the present time various materials and methods of manually suturing the gastrointestinal tract are used in parallel. While these methods satisfy basic standards, there is scarcely any detectable difference in the results. Further development in manual suturing with reference to security from failure and reduction of the expenditure of time is unforeseeable. Adhesive methods cannot achieve any importance in the gastrointestinal tract. Presently only the fully mechanical suture methods described at the end of the sixties show promise of possible future development in the gastrointestinal tract. They are suitable for as much as 80% of plastic gastrointestinal operations, but still need statistical comparison of results.

Digestive System Surgical Procedures↗
PubMed1992

A review of sutures and suturing techniques.

The ideal suture is strong, handles easily, and forms secure knots. It causes minimal tissue inflammation and does not promote infection. It stretches and accommodates wound edema. Although no single suture possesses all of these features, proper selection of sutures helps achieve better results in skin surgery. Proper suturing technique is essential for obtaining good cosmetic results and avoiding scarring and poor wound healing. Techniques that must be mastered include good eversion of skin edges, avoiding suture marks, maintaining uniform tensile strength along the skin edges, and precise approximation along skin edges.

Humans↗
PubMed1989

[New technical and methodologic developments in surgery: mechanical suture technique].

Mechanical suture is possible by linear, circular and so-called anastomotic devices. Linear staplers work with metal clips and polyglactin, while circular-stapler-anastomoses function with metal clips and the Murphy principle. Compared to hand suturing staplers have not only the advantage of saving time but they also provide for a simple closure of the duodenal stump, the bronchus and the safe anastomosis of the rectum and the esophagus. The clipless compression-anastomosis seems to have a promising future. Its advantages include the absence of a foreign body, larger diameter of the anastomosis and no risk of postoperative haemorrhage. Our results with staplers (1987-1988) prove their superiority: there were only three insufficiencies among 140 circular anastomoses of the esophagus and the rectum. No complications occurred in 153 applications of linear staplers on the bowel and the lung.

Anastomosis, Surgical↗
PubMed1997

Venous microanastomosis with the Unilink system, sleeve, and suture techniques: a comparative study in the rat.

Multiple microvascular anastomotic techniques have been described with varying rates of success. This experimental study presents the results of a comparison of three types of venous microanastomotic techniques: the Unilink system, the sleeve technique, and the suture technique. Twenty male Sprague-Dawley rats, 40 femoral veins, were used for this study. In vivo observation and microvasculography demonstrated that patency rates between the Unilink system and suture techniques were comparable (p > 0.05) and were significantly superior to the sleeve anastomosis (p < 0.05). The anastomotic time for the sleeve technique was significantly shorter than for the suture technique (p < 0.001). Compared with suture and sleeve anastomoses, the anastomotic time employing the Unilink system was significantly the shortest (p < 0.001). The Unilink system proved to be the fastest method with the highest patency rate. These results suggest that the use of the Unilink system is superior with regard to anastomotic time and patency rate, when compared to suture and sleeve techniques for venous microanastomosis.

Anastomosis, Surgical↗
PubMed1990

A comparison between interrupted and continuous suturing techniques in keratoplasty.

A comparison between continuous and interrupted techniques of suturing in penetrating keratoplasties was made using autologous grafts in rabbits. Wound strength was determined using both a tensiometer and blow-out pressure measurements. Histologic examination of the wounds was also carried out, and clinical observations were made of the behavior of vascular growth through the wound in prevascularized corneas to further characterize the suturing techniques and the healing process. We found no difference in blow-out pressures between the two groups, but a significant increase in healing in the interrupted suture group, as measured by the tensiometer, was observed. Other differences were noted in the clinical course and histology, including a greater ease of vessels traversing the wound and more inflammatory cells in the wound area with interrupted sutures.

Animals↗