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PubMed1990

Suture material in bladder surgery: a comparison of polydioxanone, polyglactin, and chromic catgut.

A comparison of polydioxanone, polyglactin, and chromic catgut suture was performed in 120 rat bladders studying propensity for infection, degree of inflammation, calculogenic potential, changes in urine pH, and suture absorption. None of the sutures predisposed to infection and there was wide variability but no correlation in urine pH. Although initially the polydioxanone incited a greater inflammatory response, by six months all three sutures were similar. The absorption of polydioxanone was slower than chromic catgut suture, but similar to the absorption of polyglactin. There was no significant difference in calculogenic potential between the suture materials tested over a six-month period. Based on this study in rats, polydioxanone suture would appear to be equal to catgut and polyglactin suture in bladder surgery.

Animals↗

PubMed1987

N-[4-(5-nitro-2-furyl)-2-thiazolyl] formamide-induced bladder cancer in mice: augmentation by sutures through the bladder wall.

The augmenting effect of chronic inflammation on bladder cancer was studied in female Swiss mice treated with N-[4-(5-nitro-2-furyl)-2-thiazolyl] formamide (FANFT), 0.15% by weight of diet for 20 weeks. To produce chronic inflammation one silk suture and one catgut suture were placed through the bladder wall of 63 mice to receive FANFT and 18 to receive normal diet. In remaining mice (no. = 62) the bladder was simply touched without suture insertion. Thirty-two animals treated with FANFT and 33 treated with FANFT + sutures also received supplements to their drinking water throughout the experiment of the sulfhydryl-reducing agent N-acetylcysteine (500 mg./kg. body weight/day). Seven weeks following FANFT treatment, bladder cancers developed in 12% of mice with sutures and FANFT and in 19% of those with sutures, FANFT, and N-acetylcysteine. No cancers developed in mice receiving FANFT alone or FANFT with N-acetylcysteine and none in mice treated with sutures only. Placement of silk sutures through the bladder wall of mice augments FANFT-induced bladder cancer. N-acetylcysteine at these doses does not influence the incidence.

Acetylcysteine↗

PubMed1997

An in-line suturing device to simplify sacrospinous vaginal vault suspension.

A disposable suturing instrument is used in our surgical method for sacrospinous vault suspension to facilitate suture placement and retrieval. The pararectal space is dissected and the suturing device is placed just medial to the lateral third of the sacrospinous ligament-coccygeus muscle complex. Depression of the device's firing button advances a standard needle in a controlled circular path through the sacrospinous ligament-coccygeus muscle complex. The needle is retrieved with a straight-needle holder at a consistent location, 3 mm from the shaft of the instrument. A second suture is placed 0.5-1 cm medial to the first suture. If the holding strength for either suture is considered inadequate, the device is reloaded with the same suture and subsequent bites are taken. The procedure is completed using standard methods. In ten women treated for vaginal vault eversion, lateral dissection was completed in less than 10 minutes, and passage of two sutures through the sacrospinous ligament was accomplished in less than 2 minutes. There were no complications. One patient described mild buttock pain that resolved in 1 week. At 4-6 months' follow-up, vaginal examination with maximal straining demonstrated direct apposition of the vaginal wall to the sacrospinous ligament.

Female↗

PubMed2002

Continuous versus interrupted perineal repair with standard or rapidly absorbed sutures after spontaneous vaginal birth: a randomised controlled trial.

BACKGROUND: Trauma to the perineum is a serious and frequent problem after childbirth, with about 350000 women each year in the UK needing sutures for perineal injury after spontaneous vaginal delivery, and many millions more worldwide. We compared the continuous technique of perineal repair with the interrupted method, and the more rapidly absorbed polyglactin 910 suture material with the standard polyglactin 910 material. METHODS: 1542 women who had a spontaneous vaginal delivery with a second-degree perineal tear or episiotomy were randomly allocated to either the continuous (n=771) or interrupted (771) suturing method, and to either the more rapidly absorbed polyglactin 910 suture material (772) or standard polyglactin 910 material (770). Primary outcomes were pain 10 days after delivery and superficial dyspareunia 3 months postpartum. Analysis was by intention to treat. FINDINGS: At day 10, three women had dropped out of the study. Significantly fewer women reported pain at 10 days with the continuous technique than with the interrupted method (204/770 [26.5%] vs 338/769 [44.0%], odds ratio 0.47, 95% CI 0.38-0.58, p<0.0001). Occurrence of pain did not differ significantly between groups assigned the more rapidly absorbed material or standard material (256/769 [33.3%] vs 286/770 [37.1%], 0.84, 0.68-1.04, p=0.10). Women reported no difference in superficial dyspareunia at 3 months for the continuous vs the interrupted method (98/581 [16.9%] vs 102/593 [17.2%], 0.98, 0.72-1.33, p=0.88) or the more rapidly absorbed versus standard material (105/586 [17.9%] vs 95/588 [16.2%], 1.13, 0.84-1.54, p=0.42). Suture removal was done less with the more rapidly absorbed material than with standard suture material (22/769 [3%] vs 98/770 [13%], p<0.0001), and with the continuous versus interrupted method (24/770 [3%] vs 96/769 [12%], p<0.0001). INTERPRETATION: A simple and widely practicable continuous repair technique can prevent one woman in six from having pain at 10 days. Also, the more rapidly absorbed polyglactin 910 material obviates need for suture removal up to 3 months postpartum for one in ten women sutured.

Adult↗

PubMed1985

Selective suture removal can reduce postkeratoplasty astigmatism.

Two hundred four consecutive eyes underwent penetrating keratoplasty by a single surgeon using eight interrupted 10-0 monofilament nylon sutures in the cardinal position combined with a continuous 11-0, 16-bite monofilament nylon suture technique. The interrupted 10-0 monofilament nylon sutures were selectively removed postkeratoplasty based on central keratometry readings and corneal topography. Sutures were removed in 56 eyes in Group I as early as six to eight weeks after surgery and in 148 eyes in Group II as early as three weeks after surgery. The mean astigmatism for all groups decreased from 7.5 diopters in the first postoperative month to 2.6 diopters 14 to 16 months after surgery. Sutures were completely removed in 75 eyes in this study between 2 and 46 months after surgery without producing significant changes in corneal curvature. The complications associated with this suturing technique were no different from those associated with other suturing techniques. The selective removal of interrupted sutures postkeratoplasty can improve the recovery of vision after corneal transplantation without subjecting the eyes to increased risks.

Aphakia↗

PubMed1990

An adjustable single running suture technique to reduce postkeratoplasty astigmatism. A preliminary report.

The authors compared postkeratoplasty astigmatism over a 4-month period after surgery in a randomized, prospective study of two groups of patients (total N = 18) who received two different suture techniques. The test group N = 8) had a single running suture with postoperative suture adjustment; on the basis of computer-assisted topographic analysis, the suture was tightened in the flatter meridian and loosened in the steeper meridian in the first month after surgery. The control group (N = 10) had a standard double running suture procedure with no postoperative adjustment; the single running 10-0 nylon suture was removed 3 months after surgery. Four months after penetrating keratoplasty, mean (+/- standard deviation) astigmatism in the test group was 1.7 +/- 0.7 diopters (D), and all patients had less than 2.6 D of astigmatism. In the control group, mean astigmatism was significantly higher (5.4 +/- 2.4 D; range, 0.7-9.0 D; P less than 0.01). The results suggest that postkeratoplasty astigmatism can be reduced with the single running suture technique accompanied by postoperative suture adjustment.

Astigmatism↗

PubMed1999

Intraocular lens tilt and decentration, anterior chamber depth, and refractive error after trans-scleral suture fixation surgery.

OBJECTIVES: To compare the extent of intraocular lens (IOL) tilt and decentration, as well as the anterior chamber depth after trans-scleral suture IOL fixation after either secondary out-of-the-bag or primary in-the-bag IOL implantation. DESIGN: Retrospective, comparative, nonrandomized, interventional study. PARTICIPANTS: Fifty-two eyes that underwent scleral suture fixation were compared with 51 eyes that underwent secondary out-of-the-bag implantation and 50 eyes that underwent in-the-bag implantation. INTERVENTION: One-piece polymethyl methacrylate IOL implantation by three different techniques. MAIN OUTCOME MEASURES: The tilt angle and decentration length of the IOL, as well as the anterior chamber depth, were measured by the Scheimpflug videophotography system. The spherical equivalent error from the predicted value was also examined. RESULTS: The mean tilt angle in the scleral suture fixation group was significantly greater than that in either the out-of-the-bag or the in-the-bag implantation group (P<0.0001). The mean decentration length was also largest in the suture group, followed by the out-of-the-bag group and the in-the-bag group (P<0.0001). The anterior chamber depth in the suture group and the out-of-the-bag group was significantly smaller than that in the in-the-bag group (P<0.0001). The spherical equivalent error in the suture group and the out-of-the-bag group was also greater than that in the in-the-bag group (P<0.0001). CONCLUSIONS: The extent of both tilt and decentration after scleral suture fixation was greater than that observed after either out-of-the-bag or in-the-bag implantation. The anterior chamber depth with the sutured or out-of-the-bag fixated IOL was shallower than that with the in-the-bag fixated IOL, which resulted in a significant myopic shift.

Adolescent↗

PubMed1996

Tensile strength of cross-stitch epitenon suture.

Using a computerized tensiometer, the mechanical properties of two types of repair in the canine flexor digitorum superficialis tendon were examined. The slope and ultimate tensile strength of a cross-stitch epitenon suture were compared to those of a simple over-and-over running epitenon suture. Both epitenon sutures were combined with a modified Kessler core suture. Suture material was 6/0 monofilament nylon for the epitenon suture, and 4/0 braided polyester for core suture. Average relative values of individual ultimate tensile strength for the cross-stitch group was 245% compared to that for the running suture group. There was no discrepancy in slope between the two groups.

Achilles Tendon↗

PubMed1998

Evaluation of the platysma interlocking suture sling for rhytidectomy.

PURPOSE: The purpose of this study was to evaluate the complication rate and the clinical results of the platysma interlocking suture sling for rhytidectomy patients. PATIENTS AND METHODS: In the first part of this study, the charts and photographs of 29 patients who underwent rhytidectomy with the platysma interlocking suture sling were reviewed for complications. The parameters included infection, rupture of the sutures, extrusion of the sutures, prolonged tightness around the neck, and nerve injury. In the second part, the patients' neck deformities were classified into three types: mild (type 1), moderate (type 2), and severe (type 3). The changes in the preoperative and postoperative cervicomental angles were compared between the patients who underwent rhytidectomies with the platysma interlocking suture sling (group 1) and those patients who underwent rhytidectomies only (group 2). RESULTS: The complication rate was found to be minimal. Only one case of prolonged tightness around the neck was noted; there was no other complication. All of the patients, regardless of neck classifications, benefited from rhytidectomy, whether or not the platysma interlocking suture sling was used. However, when comparisons were made between group 1 and group 2 patients in their specific neck deformity categories, it was found that the patients with the severe (type 3) neck deformity benefited most when the platysma interlocking suture sling was used in conjunction with the rhytidectomy procedure. CONCLUSION: The platysma interlocking suture sling has a low morbidity rate and is helpful in reconstruction of patients with the type 3 neck deformity.

Adipose Tissue↗

PubMed2003

Femoral endarteritis associated with percutaneous suture closure: new technology, challenging complications.

OBJECTIVE: Use of percutaneous suture closure devices after catheter-based interventions is increasing. We recently have seen several severe femoral arterial wall infections after use of such devices. The purpose of this study was to examine the incidence, comorbid associations, and management of femoral arterial infections associated with percutaneous suture closure devices. METHODS: We retrospectively reviewed all infectious complications that occurred after 2223 consecutive cardiac catheterization procedures performed over 12 months in a university-affiliated community teaching hospital. Outcome variables included demographics, procedural details, infection, type of arterial reconstruction required, mortality, and limb loss. RESULTS: During this study, 822 patients received percutaneous suture devices. Infection developed in 6 patients (0.7%). The incidence of diabetes in the population undergoing percutaneous suture closure was 219 of 822 patients (26.6%). Three comorbid conditions, noted in multiple patients with infectious complications, included diabetes mellitus, obesity, and placement of a percutaneous suture closure device within the past 6 months. Invasive femoral endarteritis developed in 4 patients. Gram-positive cocci predominated in 4 patients. In 1 patient with polymicrobial infection catastrophic complications developed, including multiple anastomotic ruptures and hemorrhage. A new method of repair that incorporated double-thickness everted saphenous vein was used in 2 patients, and safe arterial closure was achieved. There was 1 late fatality on postoperative day 36. Limb salvage was achieved in all patients. CONCLUSIONS: Femoral endarteritis complicating percutaneous suture closure is a challenging new problem for vascular surgeons and can result in catastrophic complications. Customary techniques that use saphenous vein patch or interposition grafting are not adequate in all circumstances. Successful outcome requires operative exploration in patients with suspected infection. Removal of the percutaneous suture closure device and debridement to normal arterial wall is recommended in all patients with suspected femoral endarteritis, based on positive intraoperative Gram stains or abnormal appearance of the adjacent femoral artery. Early success with an autologous bolstered repair is reported. Caution is advised when considering the use of a percutaneous suture closure device in patients with comorbid conditions including diabetes, obesity, and previously implanted devices.

Arteritis↗

PubMed1997

Effect of nylon suture diameter on induced astigmatism after phacoemulsification.

PURPOSE: To prospectively compare the clinical results of 10-0 and 9-0 monofilament nylon sutures after phacoemulsification with poly(methyl methacrylate) intraocular lens implantation through a 4.0 mm cruciate incision. SETTING: Department of Ophthalmology, Ramón y Cajal Hospital, Madrid, Spain. METHODS: One hundred eyes with cataract were randomly assigned to have surgery using a 10-0 or a 9-0 nylon suture. Except for suture diameter, identical surgical methods were used in every case. Data on uncorrected visual acuity, keratometry and postoperative astigmatism were analyzed up to 12 months after surgery. RESULTS: Both groups had similar uncorrected visual acuity. Mean postoperative corneal astigmatism was against the rule in the 10-0 nylon suture group and with the rule in the 9-0 nylon suture group. Significant differences were found between groups (P < .05). CONCLUSION: Both suture diameters offered satisfactory clinical results. Patients with preoperative with-the-rule astigmatism might benefit from 10-0 nylon sutures and those with preoperative against-the-rule astigmatism, from 9-0 nylon sutures.

Aged↗

PubMed1998

Age-related changes on bone regeneration in midpalatal suture during maxillary expansion in the rat.

The purpose of the present study was to investigate age-related changes in bone regeneration during expansion of a midpalatal suture in rats. When the midpalatal suture was expanded for 7 days in rats of four different ages (6, 15, 24, and 52 weeks), it was found to have significantly widened in all groups by the analysis of a histomorphometric method. The expansion-induced widening of the suture was similar in 6, 15, and 24-week-old rats but was significantly less in 52-week-old rats. When the newly mineralized bone area and the osteoid area along the suture in all groups were quantified, newly mineralized bone area in all expansion groups significantly increased compared with corresponding controls, but expansion-induced newly mineralized bone area decreased in an age-dependent manner. Osteoid area also significantly increased by expansion, but expansion-induced osteoid area unexpectedly increased with age up to the 24-week-old rats. In the expansion-induced total bone area (expansion-induced newly mineralized bone area plus osteoid area), there was no significant difference among 6, 15, and 24-week-old rats, but it was markedly decreased in 52-week-old rats. Alkaline phosphatase activity in the suture strongly increased in all expansion groups, whereas increase in the rate of alkaline phosphatase activity clearly was less in 24 and 52-week-old rats. These results suggested that the difficulty of rapid-palatal expansion in 52-week-old rats and age-related decrease in bone regeneration after expansion of the suture within 24-week-old rats may be caused by decrease in mineralization of the bone matrix. Therefore, midpalatal suture can expand even in the cases exceeding the pubertal growth period, but more time may be necessary for mineralized bone to regenerate in the suture.

Age Factors↗

PubMed2006

Histological and histomorphometric study of growth-related changes of cranial sutures in the animal model.

INTRODUCTION: During the early development, numerous histological and morphometric changes occur in the cranial sutures the exact knowledge of which is of fundamental significance for understanding clinically relevant cranial anomalies. In this paper a histological and histomorphometric longitudinal study of the coronal, sagittal and lambdoid sutures in the rat is reported in relation to age. MATERIAL AND METHODS: Forty-eight male Wistar rats (Rattus norvegicus Berkenhout) were raised under standard conditions. Eight animals each were sacrificed at defined time points (10, 14, 28, 42, 70, 98 days post partum) for specimen preparation. Histological preparations of the sagittal, coronal and lambdoid sutures were produced and examined morphologically and histomorphometrically (suture width, height, and area). RESULTS: Histologically, three phases of sutural growth with characteristic structural features were found. Histomorphometry reveals a quasi linear increase in height from the 30th to the 98th day post partum. Suture width remained relatively constant in the area of dura mater and periosteum. CONCLUSION: The sutures of the test animals studied had a similar growth behaviour primarily consisting of an increase in height with almost constant width. The three-phases of development could be demonstrated histologically in all sutures.

Animals↗

PubMed2000

Three-dimensional finite element analysis of skin suture. Part 1: spindle model and S-shaped modified model.

Suturing of postoperative wounds in skin unfortunately leads to extrusion of the skin, resulting in so-called "dog ear". We performed three-dimensional finite element method (FEM) analyses to investigate how suture methods affect the height of the extrusion. Three models were prepared: (1) conventional suture method Sp; (2) S-shaped modified suture model Si-1, in which one side of the curves is introverted; and (3) another S-shaped suture model Si-2, in which both sides of the curves are introverted. The results of FEM analysis agreed well with the figure and location of the extrusions in clinical suture surgery and the height of the extrusion was mimicked visually in three dimensions. The height of the extrusion peak of the S-shaped modified suture method Si-1 was decreased by 40% in comparison with the conventional suture method Sp.

Dermatologic Surgical Procedures↗

PubMed2003

A randomized comparison of a percutaneous suture device versus manual compression for femoral artery hemostasis after PTCA.

BACKGROUND: The prolonged bed rest following femoral sheath removal after PTCA is a source of discomfort for the patient. We designed a randomized study to evaluate the efficacy and safety of an arterial suture device developed to percutaneously close the vascular access site after PTCA, allowing immediate sheath removal and early ambulation, compared to manual compression. METHODS: After successful PTCA, patients were randomized to manual compression or immediate femoral percutaneous closure. Exclusion criteria were arteritis, age > 80 years and > 3 previous femoral punctures on the same side. The two-needle device was used for the 6F sheath removal and the four-needle device for the 8F sheath. Ambulation was allowed 4 hours after the arterial suture. RESULTS: One hundred and sixty-seven patients (59 +/- 10 years, 81% males) were randomized to suture device (n = 91) or to manual compression (n = 76). The two groups were similar in terms of age, sex, size of sheath, number of patients with stent implantation (62 vs 61%), procedural anticoagulation. Procedural duration was 8 +/- 6 minutes with percutaneous suture versus 25 +/- 11 minutes with manual compression (P < 0.0001). Procedural success with percutaneous suture was 93% whereas six technical failures were treated with prolonged manual compression. Nonsurgical hematoma occurred in five patients (5%) with the suture device and in two (3%) with manual compression with no need for blood transfusion (P = NS). Uneventful blood oozing occurred in 11 patients (12%) with percutaneous suture and in only 2 (3%) with manual compression (P < 0.06). The tolerance of the hemostasis procedure and the length of post-procedure hospital stay (40 +/- 32 hours) were similar in the two groups. CONCLUSION: Percutaneous suture of the femoral artery, allows immediate closure of femoral puncture sites after PTCA, without increasing the incidence of vascular complications. The use of this device should allow earlier discharge and subsequent cost savings.

Aged↗

PubMed1996

Long-term follow-up of a single continuous adjustable suture in penetrating keratoplasty.

Penetrating keratoplasty was performed on 30 patients using a single adjustable continuous 10/0 nylon suture. Seventeen patients had astigmatism of 4.00 dioptre cylinders (DC) or more and were adjusted. The latest adjustment was at 32 weeks. Following adjustment there was a significant reduction in median post-keratoplasty astigmatism from 6.00 DC to 2.50 DC (p < 0.001). Thirteen patients, with astigmatism of 4.00 DC or less, were not adjusted. Median astigmatism for the non-adjusted group was 3.00 DC and for the entire group was 2.88 DC. Long-term refraction and suture status were monitored with time. Mean follow-up was 112 weeks (range 53-170 weeks). Over the study period the entire group showed significant 'long-term astigmatic drift' (LTAD), from 2.88 DC to 3.25 DC (median drift, 1.25 DC; range, 0.00-5.50 DC) (p < 0.001). Suture adjustment and suture removal showed no significant effect on LTAD. With suture removal between 32 and 84 weeks median LTAD was 1.50 DC. For suture removal after 84 weeks, median LTAD was also 1.50 DC, but the range of LTAD was 1.50 DC, compared with a larger range of 5.00 DC in the earlier suture removal group. The technique of single continuous adjustable sutures for penetrating keratoplasty is safe, effective in reducing astigmatism, but may need modification to further enhance long-term refractive stability.

Adolescent↗

PubMed1999

Suspension sutures aid facial reconstruction.

BACKGROUND: Suspension, pexing or tacking sutures, which have a long history of use in facial cosmetic surgery, have only recently begun use in reconstruction. OBJECTIVE: In this study, the suspension suture was used to fix the closure line at the junction of cosmetic units, to prevent distortion of free margins secondary to wound contraction, eg, ectropion or eclabium, to prevent tenting across concavities, and to prevent scar spreading of wounds closed under tension. The acute complications and long-term effectiveness of this suturing technique in achieving the 4 desired results were evaluated. METHODS: During a 10-year period, 136 cases of surgical defects of the face created by the removal of nonmelanoma skin cancer by Mohs micrographic surgery were repaired using absorbable suspension sutures. The wounds were evaluated initially for acute complications of hemorrhage, infection, dehiscence, and necrosis; and later over 3 years for chronic sequela of hypertrophic scar, spread scar, contraction deformities such as distortion of free margins, and pigmentary changes. RESULTS: Suspension sutures were used in 60 cases of primary layered closure and 76 flaps of the face. Suspension sutures allowed primary closure of defects that would have required flaps in 72% of the cases and prevented distortion of free margins. There were more acute and long-term complications related to excess tension with primary closure than with flaps. Suspension sutures fixed the closure line at the junction of cosmetic units, prevented tenting across concavities, and both features were maintained over the duration of the study. CONCLUSION: Suspension sutures aided in obtaining linear closures, prevented distortion of free margins, prevented tenting across concavities, and fixed the closure line at the junction of cosmetic units; however, they did not prevent spread scars.

Face↗

PubMed2003

Mechanical testing of absorbable suture anchors.

PURPOSE: Absorbable suture anchors offer great advantages but are made of mechanically weak material. The weakest link in the fixation of soft tissue to bone may therefore be the anchor itself. In this study, several commercially available anchors were mechanically tested in vitro. TYPE OF STUDY: Biomechanical bench study. METHODS: Twelve absorbable suture anchor models were implanted into an artificial test bone according to the recommended technique. Testing temperature was 37 degrees C +/- 1 degrees C. The anchors were loaded with an Instron testing machine with the suture material (USP No. 2, Ethibond, Ethicon, Somerville, NJ) in line with the anchor axis, with and without previous abrasion of the suture at the eyelet. Tensile load at failure and failure mode were recorded. To test creep behavior, a permanent load of 100 N was applied to the anchors, and time to failure was recorded. Suture anchor weight and crystallinity were analyzed. RESULTS: Mean failure load on tensile testing using a cross-head speed of 60 mm/min ranged from 124 to 244 N. Failure modes were eyelet failure in 5 cases, suture failure in 6 cases, and anchor pullout in 1 case. In creep testing, eyelet failure occurred in 8 anchor models after a mean duration of 0.5 to 99 hours; 3 anchor models remained intact after 300 hours, and 1 anchor model failed by pullout of the test sample. Crystallinity ranged from 0% (amorphous) to 57.2%; anchor weight ranged from 0.036 to 0.161 g. Mechanical properties did not correlate with crystallinity but with anchor weight. Abrasion of the suture material at the eyelet had little effect on failure load. CONCLUSIONS: At 37 degrees C, structural failure (breaking) of absorbable suture anchors may occur if loaded to the mechanical limit. Absorbable anchors are particularly sensitive to static, long-term loading.

Absorbable Implants↗