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PubMed1988

Bacteremia following intraoral suture removal.

Following dental extractions, prophylactic antibiotic protection of patients at high risk of cardiovalvular infection is usually discontinued before suture removal. To determine whether bacteremia is created upon removal of intraoral sutures, twenty healthy patients who required extractions of at least five erupted teeth and placement of several sutures were selected without regard to sex, age, or race. Blood samples were drawn preoperatively, immediately after the extractions, before suture removal, and immediately following removal of the intraoral silk sutures. The samples were cultured in prereduced and aerobic media suitable for quantitative colony counts. Fourteen of 16 patients yielded positive blood cultures following tooth extractions. One of 20 patients yielded a positive blood culture following suture removal. Even though the incidence of bacteremia following intraoral suture removal is relatively low (5%), this study suggests that intraoral suture removal is not a benign procedure for those persons who are considered high-risk cardiac patients.

Bacteria↗

PubMed1996

Chromic gut suture reduces calcitonin-gene-related peptide and substance P levels in the spinal cord following chronic constriction injury in the rat.

The chronic constriction injury (CCI) is an animal model of an experimental peripheral neuropathy. In this model, a mononeuropathy is produced by loosely ligating the left sciatic nerve of the rat with chromic gut suture (Bennett and Xie 1988). Maves et al. (1993) have proposed that chemical constituents of chromic gut suture influence the behavioral changes of rats with the CCI. Considering their results, we became interested in evaluating whether the type of suture material used to produce the CCI also affected spinal levels of calcitonin-gene-related peptide immunoreactivity (CGRP-ir) and substance P immunoreactivity (SP-ir), peptides that are associated with small primary afferent neurons. Using methods of radioimmunoassay (RIA), we measured levels of CGRP-ir and SP-ir in the dorsal quadrants of approximately the lumbar 4-5 (L4-L5) spinal segments of rats with a CCI induced using polyglactin (Vicryl), plain gut, or chromic gut suture. We observed bilateral decreases in CGRP-ir and SP-ir 60 days after a CCI induced with chromic gut suture, but no changes in peptide levels after a CCI induced with either polyglactin or plain gut suture. These results suggest two possibilities: (1) chromic gut suture, when used to produce the CCI, has more than just a constrictive effect on the sciatic nerve, and/or (2) different suture materials produce changes in CGRP-ir and SP-ir with a differential time-course. Our experiments are unable to distinguish between these two possibilities.

Animals↗

PubMed1988

Sutures and forces: a review.

This review gives a description of the biologic significance of craniofacial sutures with respect to growth and to growth corrections. Sutural growth and its regulation are discussed briefly. Morphogenesis of sutures, sutural morphology, both microscopic and macroscopic, the structure and function of the sutural periosteum and secondary cartilages, and the biochemical composition of sutures are described. Furthermore, in vivo and in vitro experiments, including transplantation experiments, are discussed. The relationship between extrinsic mechanical forces and the resulting tissue responses in sutures is given special attention. The present article describes the state of our knowledge on the interaction between sutures and forces, and indicates problems that need to be investigated.

Animals↗

PubMed2006

The effect of the timing of scleral flap suture release on the safety and long-term success of phacotrabeculectomy.

PURPOSE: To investigate the effect of the timing of the scleral flap suture release on the safety and long-term success of phacotrabeculectomy. DESIGN: Retrospective, nonrandomized chart review. METHODS: We studied 173 eyes of 173 consecutive patients who underwent primary phacotrabeculectomy, with or without intraoperative mitomycin-C, and subsequent scleral flap suture release. RESULTS: Early suture release (<3 weeks) had a lower long-term success rate than late suture release (>3 weeks), with an average follow-up period of 44.8 months. Patients who used mitomycin-C had statistically later suture release than did patients without mitomycin-C. There were nine cases of hypotony, for which independent risk factors were early suture release and the use of mitomycin-C. CONCLUSIONS: Greater long-term success with minimal complications was achieved when scleral flap suture release was performed three weeks after phacotrabeculectomy. Suture release within three weeks after surgery was associated with an increased risk of filtration failure and a higher risk of postoperative complications.

Antibiotics, Antineoplastic↗

PubMed2006

Arthroscopic transosseous suture anchor technique for rotator cuff repairs.

The skin is incised 1 to 2 cm distal to the lateral portal. A transosseous tunnel is created through the greater tuberosity by a sharp penetrator, entering 1.5 to 2 cm distal to the top of the greater tuberosity. The penetrator exits medially, between the tip of the greater tuberosity and the articular surface of the humeral head, in the middle of the footprint. The first anchor, a 5-mm Spiralok (DePuy Mitek, Norwood, MA) is placed at the penetrator's exit site on the footprint. Using a specially designed suture leader, the lateral limb of the suture in the anchor, which passes through the previously created transosseous tunnel, is taken from the anchor and pulled out. The other suture end is passed through the supraspinatus tendon. The second suture, placed superficially in the anchor, is passed from the anchor through the supraspinatus tendon, as a mattress suture. If more anchors are required, the procedure should be repeated. The transosseous suture limb and the suture limb that is passed through the supraspinatus tendon are tied through the lateral portal. The knot tying is then performed with a sliding Delimar knot. The mattress suture, passing through the supraspinatus tendon, is tied through the anterior lateral portal. The knot tying procedure is repeated depending on the number of anchors.

Arthroscopy↗

PubMed2006

Clinical results of arthroscopic bankart repair with knot-tying and knotless suture anchors.

PURPOSE: To compare the results of arthroscopic Bankart repair completed with knot-tying with results of the procedure performed with knotless suture anchors. METHODS: We evaluated 82 patients who underwent arthroscopic Bankart repair. A total of 61 patients were treated with knot-tying suture anchors, and 21 patients were treated with knotless suture anchors during the same period. In all, 75 male and 7 female patients were studied. Mean patient age at the time of operation was 24 years (range, 16 to 42 years), and the mean follow-up period had a duration of 29 months (range, 24 to 41 months' duration). RESULTS: Shoulder scores improved in both groups (P < .05). Postoperative pain, patient satisfaction score, and redislocation rate were significantly different between the 2 groups, with the knot-tying suture anchor group showing better results (P = .007, P = .007, and P = .012, respectively). In the knot-tying suture anchor group, 4.9% (3 patients) experienced redislocation and 1 patient underwent revision surgery. The redislocation rate in the knotless suture anchor group was 23.8% (5 patients), and 4 patients underwent revision surgery. CONCLUSIONS: The knot-tying and knotless suture anchor groups showed improvement in postoperative shoulder scores after arthroscopic Bankart repair. However, results after the knotless technique was performed were unsatisfactory when compared with results in the standard suture anchor group, particularly in terms of redislocation rate. LEVEL OF EVIDENCE: Level III, retrospective comparative therapeutic study.

Adolescent↗

PubMed2005

Nell-1 induced bone formation within the distracted intermaxillary suture.

Maxillary bone deficiencies, such as cleft palate and underdeveloped maxilla that require bone graft or regeneration after orthopedic or surgical expansion, pose a significant biomedical burden. Nell-1 is a secreted molecule that possesses chordin-like domains and induces cranial suture bone growth and osteoblast differentiation. To accelerate bone formation in acutely distracted palatal sutures, rat organ cultures were stimulated with Nell-1 or BMP-7 for 8 days in vitro. We hypothesized that Nell-1 stimulation to the distracted palatal suture would accelerate bone formation. Distracted palates of 4-week-old male rats were maintained in an organ culture system, and tissue was either unstimulated or stimulated with Nell-1 or BMP-7 for 8 days. MicroCT was conducted to quantitate bone formation, while alcian blue staining was conducted for cartilage localization. Immunohistochemistry of Sox9 for chondrocyte proliferation, type X collagen for hypertrophic cartilage in endochondral bone formation, and bone sialoprotein for bone formation was conducted to characterize the cellular mechanism of newly developed tissues. Distracted palates cultured in the presence of Nell-1 or BMP-7 produced statistically significantly (P < 0.05) more bone and cartilage within the intermaxillary suture, relative to unstimulated control samples. While both BMP-7 and Nell-1 induced similar bone formation in the distracted suture, BMP-7 induced both chondrocyte proliferation and differentiation, while Nell-1 accelerated chondrocyte hypertrophy and endochondral bone formation. While both Nell-1 and BMP-7 are effective in forming bone in the distracted palatal suture, they are suggested to have distinctively different mechanisms. The ability of Nell-1 to accelerate bone formation within the palate suture demonstrates the versatility of Nell-1 within the craniofacial complex as well as an exciting advance in palate suture defect healing.

Animals↗

PubMedDate not supplied

Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass.

OBJECTIVES: A precipitating factor for marginal ulcer formation after Roux-en-Y gastric bypass may be the prolonged irritation by foreign material, such as nonabsorbable suture at the gastrojejunostomy. This study examines the incidence of marginal ulcers before and after a change was made from using nonabsorbable suture to using absorbable suture for the inner layer of the anastomosis. METHODS: A total of 3285 laparoscopic Roux-en-Y gastric bypass operations were performed during a 5-year period. The gastrojejunostomy technique was modified in August 2002. Those patients who developed a marginal ulcer postoperatively were identified, and their charts were retrospectively analyzed for the operative technique, patient age, history of previous gastric surgery, presence of preoperative diabetes, coronary artery disease, or peptic ulcer disease, and use of nonsteroidal anti-inflammatory medications or tobacco. RESULTS: The incidence of marginal ulceration after Roux-en-Y gastric bypass decreased significantly from 2.6% (28/1095) with the use of nonabsorbable suture to 1.3% (29/2190) after the change to absorbable suture for the inner layer of the gastrojejunal anastomosis (P < .001). The incidence of visible suture adjacent to the ulcer on endoscopy was also significantly reduced (64.3% vs 3.4%; P < .001). When the results were corrected for length of follow-up, the difference in the incidence of ulcers occurring within 1 year of surgery remained significant between the two groups (P = .002). There were no other significant differences in the factors analyzed. CONCLUSIONS: The use of nonabsorbable sutures for the inner layer of the gastrojejunal anastomosis is associated with an increased incidence of marginal ulcers, and the adoption of absorbable suture material has reduced this incidence.

Adult↗

PubMed2000

Suture closure of femoral arterial puncture sites after coronary angioplasty followed by same-day discharge.

BACKGROUND: The purpose of this study was to determine whether immediate suture closure of 8F femoral arterial puncture sites can facilitate same-day discharge after coronary angioplasty. METHODS AND RESULTS: After coronary angioplasty, 100 patients were randomly assigned to immediate sheath removal with the double-suture Prostar-Plus device or delayed sheath removal with application of a c-clamp. After suture closure, mobilization at 4 hours after sheath removal and discharge 4 hours later were planned. Patients treated with the c-clamp had sheaths removed 4 hours after percutaneous transluminal coronary angioplasty, were mobilized 6 hours later, and discharged the following day. Patients were assessed for groin complications at 8, 24, and 72 hours. Overall, patients who received suture closure were mobilized at 7.1 +/- 5.3 hours and discharged 11. 15 +/- 6.22 hours after sheath removal versus 15.49 +/- 3.9 hours and 21.9 +/- 3.8 hours for patients with the c-clamp (P <.001). Initial failure of the suture device occurred in 5 patients, with 1 requiring surgery for an entrapped device. After the procedure, patients with suture closure more frequently had an ooze of blood (55% vs 24%, P <.001) and a trend to more overt external bleeding (10% vs 2%, P = not significant). Hematomas were reported by 20% of patients in both groups at 72 hours. Overall, patients preferred the suture closure method of sheath removal when assessed by a simple questionnaire. An economic analysis by cost minimization demonstrated potential hospital cost saving. CONCLUSIONS: Suture closure of 8F arterial puncture sites can facilitate early mobilization and same-day discharge and is considered acceptable by more patients compared with application of the c-clamp. There is potential to realize cost savings with a strategy of same-day discharge.

Angioplasty, Balloon, Coronary↗

PubMed1999

Management of arterial puncture site after catheterization procedures: evaluating a suture-mediated closure device.

To overcome the challenge associated with achievement in hemostasis after a catheterization procedure, a suture-based closure device was compared with manual compression in a 600-patient randomized trial. The major study end points included the incidence of vascular complications and the time to ambulation after the procedure. The study included diagnostic or interventional procedures. The suture-mediated closure was performed immediately after the procedure independent of the anticoagulation level, whereas manual compression was performed per hospital protocol with sheath removal relying on normalization of patient's anticoagulation status. A significant reduction in time to achieve hemostasis (7.8 +/- 4.8 vs 19.6 +/- 13.2 minutes, p <0001) and time to ambulation (4.5 +/- 6.5 vs 17.8 +/- 5 hours, p <0001) was associated with use of the suture-mediated closure device. The incidence of vascular complications was similar in the overall population (5.7% for suturing device vs 11.3% for compression) or in the interventional patient subset (8.4% for suturing device vs 9.6% for compression). There was a significant reduction in the incidence of vascular complications in the diagnostic procedure subset (4.4% for suturing device vs 12.1% for compression, p <0.05). Thus, the use of a suture-mediated closure device represents a safe alternative to manual compression. Hemostasis and ambulation can be achieved faster with the suturing device than with manual compression, with a potential reduction in access site complications.

Aged↗

PubMed1987

Relaxing incisions with augmentation sutures for the correction of postkeratoplasty astigmatism.

We performed a prospective study of relaxing incisions with augmentation sutures in 21 patients who were unable to wear spectacles or contact lenses after penetrating keratoplasty because of high astigmatism. The mean preoperative astigmatism was 9.37 diopters (range, 4.50 to 14.50 diopters), and the mean postoperative astigmatism was 3.73 diopters (range, 0.00 to 7.00 diopters). The net decrease in astigmatism was 6.56 diopters (range, 1.00 to 11.00 diopters), which represents a 67% decrease in astigmatism. The mean vector corrected change in astigmatism was 8.40 diopters (86%). These results were compared with those of our previous study of relaxing incisions without sutures. Overall, there was a significantly greater decrease in astigmatism (67% vs 47%, P = .009) when augmentation sutures were placed 90 degrees away from the relaxing incisions. Furthermore, in patients with more than 8.50 diopters of astigmatism, relaxing incisions with sutures yielded a much greater reduction in astigmatism compared with relaxing incisions without sutures (70% with sutures vs 39% without sutures, P = .002). We recommend relaxing incisions with augmentation sutures as the initial surgical procedure in eyes with more than 8.50 diopters of astigmatism.

Astigmatism↗

PubMed1998

Ergonomic evaluation of laparoscopic bowel suturing.

BACKGROUND: Ergonomic assessment of the instrument to needle to tissue relationship on efficiency and accuracy of laparoscopic suturing. METHODS: Video records of nine laparoscopic surgeons were analyzed for five technical variables of laparoscopic suturing. Surgeons undertook closure of 60 mm enterotomy using continuous 3/0 seromuscular atraumatic sutures. Subjects attempted to suture 3 to 5 mm from enterotomy edge and at 3 to 5 mm intervals. Vertical/horizontal deviations from desired entry/exit point of suture, execution time, and failure to complete sutures were recorded. RESULTS: Visualization style used by some was significantly more accurate but slower than the nonvisualization style used by others. Needle insertion angle of 80 degrees to 100 degrees gripping the middle and proximal end of needle and holding the needle >90 degrees to instrument axis significantly improved task accuracy. Insertion angle <80 degrees produced three times the failure rate of 80 degrees to 100 degrees. Surgeon's performance was consistent with either suturing style. CONCLUSIONS: Visualization style was slower but more accurate. Optimum conditions for good suturing include 80 degrees to 100 degrees needle insertion angle; holding angle >90 degrees, and gripping point at middle and proximal third of the shaft of the needle. Task accuracy was surgeon dependent.

Colon↗

PubMed2002

Novel suture device for beating-heart mitral leaflet approximation.

BACKGROUND: This investigation evaluates the potential of using a novel suturing device to achieve mitral valve repair (Alfieri type) on a beating heart without cardiopulmonary bypass. METHODS: Eight healthy adult sheep were anesthetized and the chest was opened via a left thoracotomy. The suture device was directly inserted into the appendage of the left atrium. Suction ports on the distal tip of the device grasped and approximated the mitral leaflets while the heart was beating. Two-dimensional echocardiography and intracardiac pressure monitoring at the tip of the device were utilized to guide the procedure. The device was used to place two single sutures across the two leaflets at the center of the mitral valve. A knot pusher with integrated cutter was used to tie the sutures and cut the suture ends. RESULTS: In all animals, the free margins of the mitral leaflets were successfully grasped and approximated by this device. Echocardiography confirmed successful deployment of the sutures in all cases, with a figure-of-eight appearance of the valve and normal valve hemodynamic function after placement of the sutures. Mid-leaflet approximation was verified at autopsy immediately after the procedure. No tissue damage was observed. CONCLUSIONS: This study demonstrates that mitral valve repair (Alfieri type) can be performed safely and consistently on a beating heart without cardiopulmonary bypass using this new tissue approximation suture device. This technique may be applicable to the treatment of ischemic mitral regurgitation in conjunction with revascularization procedures or to mitral regurgitation in heart failure patients.

Animals↗

PubMed2000

Effects of tensile forces on the expression of type III collagen in rat interparietal suture.

The aim was to investigate the direct contribution of mechanically induced stress to synthesized type III collagen in the interparietal suture. Twenty 4-week-old male rats were used as experimental animals. An activated expansion spring was placed across the interparietal suture. After expansion, the parietal bones including the suture were dissected and immunostained for type I and III collagens. Also, a three-dimensional model of the interparietal suture was developed to analyze stress during expansion. The localization of type III collagen in the suture was dependent upon the duration of expansion. Although the control suture exhibited no or little reactivity for type III collagen, it was observed as early as 15 h of expansion in the cambial layers, and was distributed throughout the suture at 50 h of expansion. The time-dependent distribution of type III collagen was fully consistent with that of tensile stresses calculated by the use of a three-dimensional finite-element model. It was concluded that the increases in tensile stress are associated with the synthesis of type III collagen in the suture.

Animals↗

PubMed1998

Optimal patterns for suturing wounds.

A mathematical model for computing stresses in sutured human skin wounds is presented. The model uses the incremental law of elasticity and elastic constants valid for in vivo orthotropic skin. The model is applied to compute the principal stress and displacements resulting from suturing small elliptical and circular wounds in a large flat sheet of skin, in order to determine the optimal suturing patterns. It is observed that the average stress index for a circular wound sutured toward the center is almost double that of a wound sutured transverse to the diameter. Thus, the latter type of suturing pattern is preferable. Similarly, suturing an elliptical wound transversely produces a lower average stress index than a circular wound of the same area. It is also found that the optimal ratio of semi-major to semi-minor axis of an elliptical wound is near 3 (for abdominal wounds), i.e., this ratio produces the most uniform stresses along the wound edges, where wound healing is slowest. Since high stresses have adverse effects on healing and blood flow, this work, depicting regions of high stresses, may be used along with other biological factors to help predict regions of slower healing in sutured wounds.

Algorithms↗

PubMed1995

Economic comparison of a tissue adhesive and suturing in the repair of pediatric facial lacerations.

OBJECTIVE: To determine, from the societal perspective, the most cost efficient of the three methods commonly used to repair pediatric facial lacerations: nondissolving sutures, dissolving sutures, or a tissue adhesive (Histoacryl blue). DESIGN: Cost-minimization analysis and willingness-to-pay survey. SETTING: Tertiary-care pediatric emergency department. METHODS: All differential costs relevant to equipment utilization, pharmaceutical use, health care worker time, and parental loss of income for follow-up visits were calculated for each method. On the basis of previous research, our model assumes equal cosmetic outcome for the three methods. In addition, a convenience sample of 30 parents were surveyed in the emergency department to rank their preferences and willingness to pay for the three methods of wound closure. RESULTS: The reduction in cost (in Canadian dollars) per patient of switching from the standard nondissolving sutures was $49.60 for switching to tissue adhesive and $37.90 for dissolving sutures. Sensitivity analyses performed on key variables did not significantly alter our conclusions. Of those parents surveyed; 90% (95% confidence interval, 74% to 98%) chose tissue adhesive and 10% (95% confidence interval, 2% to 26%) chose dissolving sutures as their first choice for wound closure. Nondissolving sutures were ranked third by 29 of 30 parents. Parents were willing to pay a median (25th to 75th percentile) of $40 ($25 to $100) for tissue adhesive and $25 ($10 to $56) for dissolving sutures if only nondissolving sutures provided by the health care system (p = 0.1). CONCLUSIONS: Tissue adhesive is the preferred method of closure of pediatric facial lacerations because it results in the most efficient use of resources and is preferred by the majority of parents.

Adolescent↗

PubMed1998

Microsurgical vasovasostomy: the microdot technique of precision suture placement.

PURPOSE: A technique of vasovasostomy that facilitates precision suture placement is presented. MATERIALS AND METHODS: The technique involves mapping of the planned suture exit points with "microdots" placed on the cut ends of the vas deferens with a microtip marking pen. Microdots are placed at 12, 3, 6 and 9 o'clock positions. Four additional dots are placed between each of the previous 4 dots. Exactly 8 mucosal sutures (double armed 10-zero monofilament sutures) are used for each anastomosis. The anastomosis is completed with 8 muscularis sutures (9-zero monofilament) and 6 to 8 sutures (6-zero monofilament) approximating the vasal sheath. RESULTS: In a series of 194 consecutive vasovasostomy procedures using this technique a patency rate of 99.5% was achieved. Pregnancy rates of 54% (crude) and 64% (excluding female factor infertility) were observed for the first 100 subjects of this cohort. CONCLUSIONS: The microdot technique ensures precision suture placement and facilitates the anastomosis of lumens of discrepant diameters by exact mapping of each planned suture. The microdot method separates the planning from the placement. Patency rates using the microdot technique approach 100%.

Anastomosis, Surgical↗

PubMed1991

Fibrin glue vasal anastomosis compared to conventional sutured vasovasostomy in the rat.

Vasectomy reversal has become a frequently performed surgical procedure with best results obtained with the use of the operating microscope and microsurgical technique. The present study was undertaken to evaluate the use of fibrin glue ("Tisseel", Immuno U.S., Inc.) for vasovasostomy and to compare this technique to conventional sutured vasovasostomy. Utilizing 60 male Sprague Dawley rats, a conventional two layered sutured anastomosis of vasovasostomy (30 rats) was compared to a fibrin glue technique of vasal anastomosis (30 rats). The fibrin glue technique was performed with two transmural sutures, was unstented, and utilized the biological glue to seal the anastomosis. The contralateral vas of each animal underwent vasectomy and reapproximation of unligated ends so that the rate of spontaneous recanalization could be accessed. Rats were sacrificed at 24 hours, one week, four weeks, and three months postvasovasostomy. The vasal specimens were evaluated for gross patency, presence and size of sperm granuloma, mean flow rates at varying infusion pressures, tensile strength measurements and histologic studies. Combining the one and three month groups, a similar patency rate was obtained by either technique; 83% (n = 18) for the sutured group, and 90% (n = 21) for the fibrin glue group. The rate of spontaneous recanalization of the contralateral vasa in the one and three month animals was 8% (n = 38). The mean flow rates obtained at high and low infusion pressures were not statistically different for the two techniques. The tensile strength of the glue anastomosis averaged 78% of the tensile strength achieved by the conventional sutured technique. The incidence of sperm granuloma after vasovasostomy was 28% for the fibrin glue group and 61% for the sutured group. Additionally, 67% of granulomas were small (less than 3 mm.) in the glue group, compared to only 36% in the sutured group. Histology revealed similar morphological changes in the area of anastomosis with either technique. Operative time for sutured vasovasostomy averaged 24 minutes, compared to an average of 11 minutes for the glue assisted vasovasostomy. The use of fibrin glue allowed the performance of a sperm tight patent anastomosis that had the advantages of reduced incidence of sperm granuloma formation, reduced operative time, and less microsurgical skill required to perform the anastomosis.

Anastomosis, Surgical↗