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PubMed2006

Prospective randomized trial comparing the effect of early suturing of tracheostomy sites on postoperative patient swallowing and rehabilitation.

PURPOSE: This study was designed to evaluate the effect of tracheostomy site suturing after decannulation on swallowing rehabilitation, the incidence of postoperative complications, the length of hospital stay, and overall cost saving in patients undergoing major head and neck cancer resections. DESIGN: Prospective, randomized, blinded, controlled clinical trial. METHODS: Seventy-five patients undergoing major head and neck cancer resections were block randomized to have their tracheostomy site sutured or not sutured at the time of decannulation. Two blinded speech-language pathologists conducted bedside swallowing assessments immediately after decannulation. Patients resumed oral feedings if they passed; otherwise, the assessment was repeated daily until they were able to resume oral feedings or required a G-tube. OUTCOME MEASURES: We monitored (1) time intervals during the admission from surgery to discharge, (2) the rate of aspiration, (3) complications, and (4) cost savings. RESULTS: Significant differences were seen in the mean time from decannulation and commencement of swallowing (suture arm, 0.58 days; nonsuture arm, 2.7 days; p = .013). There was also a significant difference seen for the time interval from decannulation to discharge from hospital (suture arm, 5.5 days; nonsuture arm, 8.3 days; p = .045) and for overall duration of hospital stay (suture arm, 14.6 days; nonsuture arm, 19.3 days; p = .025). The cost saving per patient in the suture group averaged $11 609, which translates to a yearly saving of 742 976 dollars. CONCLUSION: The suturing of the tracheostomy site in head and neck cancer patients after decannulation is a safe, effective, cost-saving manoeuvre that speeds the return of the patient's normal swallowing, promoting earlier discharge from the hospital.

Adult↗

PubMed1995

Pancreatojejunal sutural insufficiency occurring after pancreatoduodenectomy and countermeasures.

Pancreatojejunal sutural insufficiency occurring after pancreatoduodenectomy and countermeasures are discussed. In the Department of Surgery at Kurume University School of Medicine, 318 patients underwent pancreatoduodenectomies. The present study includes 15 of these patients, all of whom had pancreatojejunal sutural insufficiency. The frequency of sutural insufficiency was 4.7%. Five patients had bile duct cancer, 5 had cancer of the papilla of Vater, 2 had a carcinoma of the pancreatic head, 1 each had gallbladder cancer, chronic pancreatitis, and papillitis. Six (40%) of the 15 patients died during hospitalization. The presence or absence of sutural insufficiency was confirmed mainly by radiography and determining the properties and amylase levels of the drainage fluid. There was no significant difference due to the method of anastomosis. End-to-side anastomosis had a rate of 5 (5.9%) of 85 patients, while end-to-end had 10 (4.3%) of 233 patients. The sutural insufficiency was manifested as a major leakage in 6 patients and a minor leakage in 9. The degree of lymph node dissection was D0 in 6.1%, D1 in 1.4%, D2 in 4.8% and D3 in 10.8%, with a high incidence of sutural insufficiency in D3 patients. The pancreatic duct diameter was smaller than 4 mm in 10, 5-7 mm in 4 and over 8 mm in 1 patient. The intraoperative pancreatic findings were a soft pancreas in 8, slightly hard in 3, and hard in 4 patients. Fibrosis of the pancreas was normal to slight in 11 and moderate in 4 patients. Drainage by relaparotomy was performed in 4 of the 6 patients with major leakages to control sutural insufficiency, and the other 2 underwent continuous aspiration with an intraperitoneal drain inserted during the operation. The 9 patients with minor leakage underwent conservative treatment including continuous aspiration via an intraperitoneal drain inserted during surgery, fasting, intravenous hyperalimentation, and antibiotic administration. All of the patients with major leakage died from an associated occurrence of hepatic insufficiency, renal insufficiency, intraperitoneal hemorrhage or diffuse peritonitis during hospitalization. However, 8 of the 9 patients with minor leakage had some healing, and the 1 remaining patient developed a pancreatic fistula. The frequency of pancreatojejunal sutural insufficiency was high in patients with minimal pancreatic fibrosis, with soft pancreatic tissue without dilatation of the pancreatic duct, and with relatively good pancreatic function.

Anastomosis, Surgical↗

PubMed1986

Use of polydioxanone absorbable monofilament sutures in orthopedic surgery.

The safety and efficacy of polydioxanone absorbable monofilament sutures was documented in 57 orthopedic surgery patients (32, dyed sutures; 25, undyed sutures), 55 of whom were followed for at least 42 days postoperatively. The other two patients were lost to follow up prior to 42 days. The final clinical outcome was excellent in all completed study subjects. No suture-related adverse effects were reported. Both dyed and undyed sutures were consistently better than surgical gut with respect to pliability, strength, ease of passage, ease of tying, fraying, knot security, and overall handling. Intraoperative visibility of dyed polydioxanone sutures was consistently superior to that of surgical gut. The visibility of undyed sutures was rated better than surgical gut in 16 cases, equal in 8, and worse in 1. Both the overall handling of the polydioxanone monofilament sutures and performance as it affected wound healing were significantly superior to those of surgical gut.

Adolescent↗

PubMedDate not supplied

Purse-string sutures for hyperopia following radial keratotomy.

BACKGROUND: Five years ago, we presented 19 procedures employing two intrastromal purse-string sutures to treat hyperopic shift following radial keratotomy. Thirty-four additional procedures and longer follow-up are now presented detailing the task of rehabilitating these eyes. METHODS: Fifty-three eyes of 53 radial keratotomy patients who were unhappy with their uncorrected vision and who were dissatisfied with contact lens or spectacle correction underwent double corneal intrastromal purse-string suturing and were subsequently followed for at least 1 year. There were seven eyes with primary overcorrection and 46 eyes with progressive hyperopic shift. Spherical equivalent refraction before purse-string sutures ranged from +0.50 to +6.25 D (mean, +2.60 D, SD +/- 1.26 D). Prior to purse-string suturing, uncorrected visual acuity ranged from 20/30 to 20/400 with 21 eyes (45.3%) 20/100 or worse. RESULTS: The follow-up after suturing averaged 3.6 years (range, 1 to 10 yr). All patients had follow-up of at least 1 year. The steepening in average keratometric power was 2.94 +/- 1.72 D (range, 1.06 to 6.68 D). The sherical equivalent refraction after suturing averaged -0.15 +/- 1.17 D (range, +3.75 to -2.50 D). Uncorrected visual acuity after suturing was 20/40 or better in 38 eyes (72%) and 20/50 to 20/100 in 15 eyes (28%). The number of eyes with a spherical equivalent refraction of +/- 0.50 D with 0.50 D or less refractive astigmatism was 15 (26% of eyes). There were 34 eyes (66%) with +/- 1.00 D with 1.00 D or less of refractive astigmatism, and 42 eyes (78%) with +/- 2.00 D with 2.00 D or less refractive astigmatism. Most of the spread was on the myopic side, as intended. There were no significant intraoperative or postoperative complications. Fifteen eyes gained two or more lines of best spectacle-corrected visual acuity and no eyes lost one line. CONCLUSION: Double intrastromal purse-string suturing produces steepening of the central cornea and reduces hyperopia after radial keratotomy.

Adult↗

PubMed1998

[Experimental study of fibrin glue adhesion with epineurial anchor suture to repair peripheral nerves].

To prove and improve the technique of fibrin glue adhesion repair peripheral nerve, 20 male rats were chosen. All the rats was randomly divided into two groups: Suture group (n = 10) and glue adhesion group (n = 10). Left sciatic nerves of the rats were cut with knife and repaired by suture or adhesion methods separately according to their groups. When adhesive method being used, the epineurial was fixed with a suture method similar to anchor suture for preventing suture line broken. Immediatly after the repair and 8 weeks after the surgery, the histologic and electrophysiologic changes of the repaired nerve were observed. The result showed: The axonal copation was soon improved in glue adhesion group. At the eighth week, nerve fiber alignment of the adhesion group was more regular than that of the suture group. Moreover, there were great improvement of axon cross rate and the recovery rate of sectional area of nerve fiber at the distal end in glue adhesion group (P < 0.05, P < 0.01). It was concluded that glue adhesion was prior to suture in repair of peripheral nerve, and anchor suture could improve the technique of glue adhesion method.

Animals↗

PubMed1997

[Craniofacial growth changes following premature closure of the bilateral coronal sutures in rabbits].

The study was designed to examine the amount and the direction of craniofacial growth changes following bilateral coronal sutures (BCS) closure in young rabbits. At 2 weeks of age, the BCS were fused by the application of enamel adhesive. These animals and a control group also received amalgam implants on the frontonasal, coronal, and lambdoid sutures to monitor suture growth. At 4 or 8 weeks after suture fusion, separate groups of animals underwent release of fused sutures. Immobilization of BCS resulted in growth cessation of the coronal suture. The normal sutures underwent very rapid growth from 2 to 8 weeks of age. BCS release at 8 weeks after fusion resulted in growth restriction. Significant compensatory growth was also noted in the frontal and the lambdoid sutures from 2 to 8 weeks. Nasal bone length was increased significantly. Vault length and craniofacial length were reduced. The results of the present study give experimental documentation to emphasize that surgical correction of craniosynostosis should be performed at a young age to achieve better functional and cosmetic results.

Animals↗

PubMed1975

Sutures and iris wound-healing in the baboon.

This paper reports an experimental study of iris wound-healing and the response of iris tissue in baboons to different suture materials following a planned surgical incision. The wound was sutured with 8-0 virgin silk, 22 mum Ethilon or 7-0 chromacised catgut, or left unsutured. The iris produces a minimal inflammatory response to aseptic trauma characterised by round cell infiltration, clump cell proliferation, pigment cell proliferation from the posterior epithelial surface and proliferation of non-pigmented ciliary epithelium (knots). This response is associated with microscopic hemorrhages in the iris. There does not appear to be any fibrous union of wound edges, instead the wound surfaces become lined with a layer of pigmented cells, probably from the posterior epithelium. Sutures play the dual role of accurately apposing the wound edges and, because there is no fibrous union of iris tissue, of keeping them in apposition. Therefore, they must remain in situ permanently. Catgut is poorly tolerated by the iris and is eventually absorbed. For these two reasons it is unsuitable. Ethilon is the least reactive and virgin silk only slightly more reactive. Both of these are suitable for iris suture. The suture material at present available is not entirely satisfactory. Finer suture material is required to reduce even more the iris response to sutures. Needles, even those supplied with Ethilon or virgin silk, are too large and clumsy. The answer to this problem probably lies in strengthening and sharpening the suture material ends so that they can act as needles.

Animals↗

PubMed2001

Percutaneous suture closure for management of large French size arterial puncture in aortic valvuloplasty.

Percutaneous aortic valvuloplasty produces acute hemodynamic and clinical improvement in patients with aortic stenosis who are poor candidates for surgical valve replacement. The benefits of this procedure are mitigated by the high restenosis rates and 1--2 year mortality, in addition to significant vascular complications associated with the large arterial puncture necessary for retrograde arterial approaches. We describe the use of suture closure techniques to reduce the vascular morbidity associated with this procedure. We reviewed 31 consecutive patients who underwent percutaneous aortic valvuloplasty and suture closure with the Perclose device between April 1998 and September 2000. After diagnostic catheterization using 6--8 French (Fr) sheaths, an 8 or 10 Fr Perclose device was preloaded into the artery and the untied sutures left in place. A 12.5 or 14 Fr sheath was passed over the wire, through the sutures. The sutures were tied at the conclusion of the procedure, in conjunction with sheath removal. Twenty-seven out of 31 patients (87%) had successful suture closure of the arteriotomy and did not require prolonged bed rest, manual compression or a compression device. There were 4 failures of percutaneous suture closure, requiring conventional manual compression and bed rest for hemostasis. No patient required surgical repair of the arteriotomy, nor were there any limb complications. Compared to 39 consecutive prior patients who had their arterial puncture managed with manual compression, length of stay was shorter (2.2 days versus 5.3 days) and fewer patients received blood transfusions (0% versus 29%). Preloaded suture closure of the arterial puncture is a useful technique for achieving hemostasis after removal of the large sheaths used for percutaneous valvuloplasty, and reduces the post-procedure patient discomfort and prolonged bed rest associated with this procedure.

Aged↗

PubMedDate not supplied

A novel suture technique in stellate corneal lacerations.

A novel suture technique for regular stellate corneal lacerations, called a star-shaped suture is described. The suturing begins from inside any of the wound lips in a clockwise direction. Suture placement proceeds in a counterclockwise direction by the adjacent wound limb, while the suture passes are all in clockwise direction. Finally, a star-shaped suture is achieved with the knot self-buried in the corneal stroma at the initial entry site. This is a continuous suture, of which tractional forces direct to the center of the wound providing good apical apposition for stellate lacerations. This suture technique can be an alternative for the reconstruction of stellate corneal lacerations.

Corneal Injuries↗

PubMedDate not supplied

The effect of repeated ethylene oxide sterilization on the mechanical strength of synthetic absorbable sutures.

The purpose of this study was to determine the effect of repeated ethylene oxide sterilization using a standard clinical protocol on sutures, a type of medical device labeled for single use and reported to be reprocessed for use after being opened but not used. Four types of commonly used synthetic absorbable sutures were subjected to 1 and 2 ethylene oxide resterilization cycles. Knot tensile strength was determined for new sutures and for sutures that had been subjected to 1 and 2 ethylene oxide resterilization cycles. As has been found with other types of single-use devices, no general conclusions can be made for absorbable sutures. The strengths of different types of sutures increased, decreased, or stayed the same after repeated sterilization. In addition, the inner packages of some sutures were not intact after reprocessing, possibly exposing the sutures to increased humidity, which can produce degradation leading to loss of strength both immediately and after additional shelf aging and degraded performance after clinical use.

Ethylene Oxide↗

PubMed2003

Quantification of incidental needle and suture contamination during strabismus surgery.

PURPOSE: To quantify the level of bacterial contamination of needles and sutures immediately after use in strabismus surgery. METHODS: Strabismus surgery was performed on 56 eyes from 31 pediatric strabismus surgical cases. Preoperative site preparation included instillation of 5% povidone-iodine in the conjunctival fornices in all cases. A total of 124 needles and 127 sutures were cultured immediately after final scleral passage. RESULTS: Seventeen of the 31 cases (54.8%) produced at least one positive specimen. Nineteen per cent of the needles and 25.2% of the sutures were culture positive. The bulk of positive specimens (96.7% of needles, 91.3% of sutures) produced 3 or less colony forming units, corresponding to 7 or less total viable organisms per needle or sutures in accordance with the dilution scheme. Coagulase-negative staphylococci overwhelmingly predominated. CONCLUSIONS: Needles and sutures used in strabismus surgery can become contaminated during surgery despite preoperative povidone-iodine preparation. The number of viable bacterial contaminants is usually below the level known to consistently produce experimental endophthalmitis. However, a few needles and sutures carried a high contaminant load, suggesting the possibility that contaminated needles and sutures could potentially cause postoperative intraocular infection.

Adolescent↗

PubMed2003

[The effect of insulin-like growth factor 1 on the fusion of cranial suture].

OBJECTIVE: To evaluate the effect of insulin-like growth factor 1 for the bone induction and the regulation for the fusion of the sagittal cranial sutures. METHODS: The cells, derived from cranial sutures in the newborn SD rats and the sagittal suture from the mice, were cultured with a serum-free medium and treated with and without insulin-like growth factor 1. The osteoblast phetotypes (osteocalcin, alkaline, osteoponcin and type-1 collagen) were measured with the RT-PCR and ELISA, and the explanted sagittal sutures were then evaluated under light microscopy. RESULTS: The cells, treated with the insulin-like growth factor 1, significantly produced more osteocalcin, alkaline, osteoponcin and type-1 collagen than those without insulin-like growth factor 1. The fusion of the sagittal suture explants will delay till to 30 days when it was not treated with IGF1. However, in the group with IGF1 the fusion was observed to start in 8 days, and a small amount of the sagittal suture fusion was found at the 20th day while a large amount was at the 30th day. CONCLUSION: The IGF1 has a direct effect on the fusion of cranial suture due to enhancing bone induction of cranial suture cell.

Animals↗

PubMedDate not supplied

Intracorporeal suturing and knot tying broadens the clinical applicability of laparoscopy.

OBJECTIVE: As surgeons become more experienced with basic laparoscopic procedures like cholecystectomy, they are able to expand this approach to less common operations. However, without laparoscopic suturing skills, like those obtained with Nissen fundoplication, many operations cannot be completed laparoscopically. We present a series of 10 patients with less common surgical illnesses who were successfully treated with minimal access techniques and intracorporeal suturing. METHODS: Over a 6-month period at 2 medical centers, 10 patients underwent operations with laparoscopic intracorporeal suturing and knot tying. Diagnoses included bowel obstruction due to gallstone ileus (n=1), perforated uterus from an intrauterine device (n=1), urinary bladder diverticulum (n=1), bleeding Meckel's diverticulum (n=3), and perforated duodenal ulcer (n=4). RESULTS: Each patient was treated with standard surgical interventions performed entirely laparoscopically with intracorporeal suturing. No morbidity or mortality occurred in any patient due to the operation. CONCLUSIONS: Although each of these operations has been previously reported, as a series, they point out the importance of mastering laparoscopic suturing. Although devices are commercially available to facilitate certain suturing scenarios, we encourage residents and fellows to sew manually. We believe that none of these operations could have been completed as effectively by using a suture device. The ability to suture laparoscopically markedly broadens the number of clinical scenarios in which minimal access techniques can be used.

Adult↗

PubMedDate not supplied

Bacterial adherence to cotton and silk sutures.

BACKGROUND: Silk and cotton sutures are the most commonly used materials for skin closure, the choice being largely based on tradition. We undertook this study to compare the bacterial adherence in vitro to these two materials because it is well known that the physicochemical characteristics of a suture material influence its ability to attract bacteria and consequently promote wound infection. METHODS: We determined the bacterial adherence in vitro to cotton and silk for Staphylococcus aureus and Escherichia coli, common organisms found in postoperative infection at our institute, using three inoculum strengths. The sutures were incubated with the organisms and bacterial counts per suture material calculated after 20, 60, 120 and 180 hours of incubation. The bacterial counts for the sutures were then compared at these intervals. RESULTS: The bacterial adherence for both organisms at all time intervals was significantly greater to silk than to cotton, except at 60 hours for Staphylococcus aureus. The bacterial count for each suture material appeared to be an intrinsic property of the suture and did not vary with the concentration of the bacteria in the initial inoculum. The cost of an equivalent thickness of silk is 50 times that of cotton. CONCLUSION: We suggest that cotton should be the preferred suture for skin closure because bacterial adherence to it is lower and it is much cheaper than silk.

Bacterial Adhesion↗

PubMedDate not supplied

[Clinical experience in using a metallic suture in eye microsurgery].

The use of a metallic suture in eye microsurgery is described in the paper. The metallic suture made from a 0.05-0.05 mm vanadic stainless steel wire (corresponding to 8:0) was applied in 1202 cataract extractions, penetrating injuries, antiglaucomatous surgeries and in removal of pterygium at the medical-and-sanitary facility of steel works in the town of Bokaro (India). The observation period ranged, on the average, from 3 months to 3 years. There were no complications during the procedure of applying the suture. However, it caused a minor response in the ocular tissues during the early postoperative period. Small bullae were observed in the corneal surface near the suture in 7 cases (0.58%), which disappeared spontaneously in 3-4 days. Irritations inflicted by the suture ends were registered in 2.58% of cases (31 patients). The mean postoperative astigmatism was, 3 months after surgery, 1.65 diopters. The sutures were removed in 132 cases (10.98%), including in 16 patients with irritation, and in 116 patients for the purpose of correcting a high astigmatism. The share of patients with a visual acuity of 0.5 and higher was, in one week, 43.59% and went up, one month later, to 78.20%. The suture was well tolerated by patients, it was quickly covered by the corneal epithelium, there was no rejection and it can be easily manufactured. The suture is sterilized by routine techniques without need for any extra treatment before use; it is a reactive, biologically inactive, efficient, convenient and causes minimal operative and postoperative complications.

Adolescent↗

PubMedDate not supplied

No-suture aphakic epikeratoplasty.

BACKGROUND: Use of sutures with aphakic epikeratoplasty is time-consuming during surgery and can create significant hazards for the patient. Thus, a surgical technique for aphakic epikeratoplasty without sutures was developed. METHODS: The conventional procedure was modified to use an oversized lenticule tucked evenly in an expanded lamellar pocket with no anchoring sutures. The technique was performed on one eye of 27 consecutive patients over a 9-month period. RESULTS: After a mean follow up of 14 months, results showed refractive and visual parameters comparable to a sutured technique. A 100% success rate at surgery was obtained using the oversized 9-millimeter lenticule. Five eyes (19.2%) developed a partial lenticule edge dislocation postoperatively. Three of the edge dislocations were reposited at the slit lamp without suturing. One lenticule, manufactured undersize, required primary suturing, leaving 24 of 26 (92.3%) patients healed without sutures. Postoperative spectacle-corrected acuity for the group either improved by one or more Snellen lines or remained unchanged. Two patients had reduced vision: one due to unrelated retinal changes and one due to vernal catarhh resulting in a persistent epithelial defect with subsequent epithelial haze. CONCLUSIONS: A sutureless technique can accomplish visual rehabilitation comparable to the conventional procedure. While the technique is not without complication, significant benefits to the patient include reduced morbidity, eliminating hazards of postoperative suture management, and a simplified surgical procedure.

Adolescent↗

PubMed2005

Adverse events of sutures: possible interactions of biomaterials?

Absorbable sutures are in use for more than 30 years. Tissue reactions which might be associated with suture material have rarely been reported in the past. After a long period without complications caused by suture material we observed 12 cases of unexpected tissue reactions after clean operations. Our patients 3-8 weeks after uneventful elective clean operations (varicose vein, hernia, benign soft tissue tumor) had unexpected tissue reactions (inflammation, granuloma, extrusion, fistula, abscess) in the vicinity of Vicryl, suture material (8 cases with Vicryl, 4 cases with Vicryl plus. After removal of the suture material and the granulomatous tissue wounds healed without any further disturbance. These tissue reactions have been observed in patients with subcuticular sutures as well as in patients with deeper located vein ligatures. It is well known that next to patient-associated and surgeon-related factors biomaterials might have an impact on postoperative inflammatory process and healing. We use Vicryl, suture material for ambulatory surgery since 1999 and did not see complications for a long period up to now. 11 of the patients were observed within several weeks in summer 2005, whereas only one patient has been observed in the year 2004. All 11 patients observed in 2005 had a combination of Vicryl/ Vicryl plus suture material in deep/subcutaneous and Dermabond glue for skin closure. We do not know the cause for this change. For clarification evaluation of the tissue reactions of these biomaterials including possible interactions or combined reactions should be done.

Adult↗

PubMed2006

The use of percutaneous suture-mediated closure for the management of 14 French femoral venous access.

BACKGROUND: Little has been reported regarding the utility or outcomes of femoral venous vascular closure using arterial suture closure devices. We describe results using a pre-closure approach with a 6 French (Fr) Perclose Closer S device in patients who underwent antegrade aortic valvuloplasty using 14 Fr percutaneous femoral venous access catheters. METHODS: Forty-five patients underwent antegrade aortic valvuloplasty and suture-mediated closure with a 6 Fr Perclose device. A 6 Fr Closer S suture device was preloaded into the femoral vein after 6 Fr sheath access, prior to insertion of a 14 Fr venous sheath. Upon completion of the procedure, the 14 Fr femoral venous sheath was removed through the existing sutures. RESULTS: Of 45 patients (mean age 82.4 years; 17 males), immediate hemostasis was achieved with percutaneous suture closure in 43 (95.6%). Only 2 failures occurred which were subsequently successfully treated with manual compression. No late access site bleeding occurred from sutured sites. In all other patients, hemostasis using a 6 Fr Perclose suture-mediated device was successful and immediate. There was no need for transfusion, no clinical venous thrombosis, and no infections occurred at the access site. Two hospital deaths were documented from causes unrelated to suture-mediated closure. CONCLUSIONS: In conjunction with 14-Fr size percutaneous sheaths during antegrade aortic valvuloplasty, percutaneous suturemediated closure is a highly effective method for achieving hemostasis. This has simplified postprocedural management in terms of early mobilization and diminished late access site bleeding.

Aged↗