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PubMedDate not supplied

[Comparative study of the suture of pancreatic stump with absorbable and unabsorbable threads in rats].

The safety of suture and healing of pancreas after surgery with absorbable and unabsorbable suture was studied. One hundred and twenty female rats was underwent a segmentar pancreatic resection. The pancreatic suture was performed with catgut in Group I (n = 48), polygalactin in Group II (n = 48) and silk in Group III (n = 24). The animals were sacrificed at 5th, 10th, 20th and 30th days after surgery and analized at macroscopy: inflammatory signs, fistula, abscess and suture bearing in tissue. Microscopic findings were: suture bearing in tissue, inflammatory aspects against suture, necrosis, edema, neovascular modifications, fibrosis and the collagen's type. After comparing the results with Wilcoxon's two sample test, we concluded that pancreatic healing was not modified with differents sutures, and then pancreatic absorbable or unabsorbable suture was safe.

Animals↗

PubMedDate not supplied

Mersilene sutures for corneal surgery.

We studied the complications resulting from using running Mersilene suture in 14 patients who underwent penetrating keratoplasty for keratoconus. 11-0 Mersilene running suture and 12 interrupted 10-0 nylon stitches were used in each procedure and the patients were followed for 22 to 48 months. None of the Mersilene sutures broke, but four were removed in two patients: in one, due to astigmatism or loosening of the suture as a result of sterile ulceration, and in the other, due to herpetic keratitis. Marked scarring manifested along the loops of the sutures in 11 of the Mersilene sutures. Despite these problems, we conclude that the use of Mersilene sutures, alone or combined with nylon sutures, in penetrating keratoplasty is sufficiently advantageous to warrant further study.

Adolescent↗

PubMed1977

A study of polybutilate lubricated polyester sutures.

In the 49 patients in whom polybutilate coated polyester sutures were used, no adverse side-effects, such as increased redness, tenderness, pain or edema of the wounds, were noted. Primary healing was achieved in each patient. There were no suture related complications encountered during the early or late follow-up examinations. Polybutilate coated polyester sutures were found to be easy to work with. They were strong, pliable and handled and tied with ease. They had no tendency to twist, tangle or adhere to gloves or instruments. Tissue passage through skin, fascia, arteries, veins and Dacron vascular grafts was better than it was with uncoated polyester sutures and as good as with Teflon coated sutures. No unusual drag, pull or catching of the sutures was encountered. Over-all, the polybutilate coated polyester suture is thought to be a safe, reliable and an easy to use material for a wide variety of surgical procedures for which a strong nonabsorbable suture is indicated.

Adolescent↗

PubMed1995

Lateral hemostatic sutures in cold knife conization of the cervix. What do they accomplish?

OBJECTIVE: The purpose of cold knife conization is to ligate the descending cervical branch of the uterine artery and thus to decrease bleeding. The aim of this study was to investigate the actual frequency of ligation. STUDY DESIGN: Two lateral sutures were placed in the cervix at the 3 and 9 o'clock positions in 97 patients (194 sutures) as part of vaginal hysterectomy. The position of each suture was determined during evaluation of the surgical specimen. RESULTS: Because the specimens from 10 patients contained only single sutures, only 184 sutures were actually evaluated. Upon microscopic examination, 50 of the 184 (27%) appeared to contain no artery. Of the remaining 134 sutures, 95 (71%) enclosed an artery, and 9 (7%) lay within a 10 x field of a branch. Only 30 sutures (22%) missed the artery entirely. Thus, in the 73% of cases where an artery of significant size could be identified, the artery lay within a lateral stitch 71% of the time. CONCLUSION: If the descending cervical branch of the uterine artery supplies most of the blood to the cervix, advance placement of lateral sutures would be expected to reduce blood loss during conization.

Arteries↗

PubMed1996

Suture technique and wound healing in midline laparotomy incisions.

OBJECTIVE: To study the influence of suture technique on healing of midline laparotomy wounds. DESIGN: Prospective clinical study. SETTING: County hospital, Sweden. SUBJECTS: 467 patients who underwent midline laparotomy between September 1991 and June 1993. INTERVENTIONS: Wounds were sutured by a continuous technique. The suture length: wound length ratio, the stitch length, and the interval between stitches were recorded together with the body mass index and operative variables. MAIN OUTCOME MEASURES: Incidence of postoperative wound infection and of incisional hernia at 12 months. RESULTS: Wound infection developed in 25 of 150 (17%) wounds if the stitch length was 5 cm or more and in 21 of 307 (7%) if it was shorter than 5 cm (p < 0.01). Overweight patients were sutured with a longer stitch and there was a high rate of infection among these patients: 20/253 (14%) compared with 30/211 (8%) (p < 0.05). In a multivariate analysis stitch length 5 cm or more and degree of wound contamination were independent risk factors for wound infection. Incisional hernias developed in 42 of 368 patients (11%). In a multivariate analysis suture length: wound length ratio less than 4, overweight, and wound infection were independent risk factors. CONCLUSION: Suture technique affects both early and late wound complications. The rate of incisional hernia is lower if the suture length: wound length ratio is 4 or more. However, a high ratio should not be achieved by suturing with a stitch length of 5 cm or more as this is associated with an increase in the rate of wound infection.

Body Mass Index↗

PubMed1997

Comparison of fibrin glue, laser weld, and mechanical suturing device for the laparoscopic closure of ureterotomy in a porcine model.

PURPOSE: We evaluated fibrin glue, laser welding, and a mechanical suturing device (Endo-Stitch) as alternatives to standard laparoscopic suturing with a free needle. METHODS: In 14 pigs, 22 linear proximal ureterotomies were closed laparoscopically with one of 4 different methods: fibrin glue, laser welding, Endo-Stitch suture placement (4-0 polyglactin), and free-needle suture placement (4-0 polyglactin). The ureterotomy was left open in 6 ureters. Acute leakage was tested by instillation of methylene blue. After 12 weeks, the ureters were assessed with radiography, ex-vivo pressure-flow studies, bursting pressures, and histology. RESULTS: All alternative closure techniques were more rapid than free-needle suturing, and less frequently allowed acute leakage. Closure with fibrin glue yielded significantly higher flow rates than control, whereas the other closure techniques yielded flow rates similar to that of unclosed ureters. All alternative closure methods demonstrated histological evidence of healing that were superior to free-needle suturing. In multifactorial analysis, leakage at the ureterotomy site was the factor most significantly associated with subsequent poor ex-vivo flow characteristics. CONCLUSIONS: All of the alternative laparoscopic ureteral closure methods compared favorably with standard free-needle suturing. Fibrin glue produced better radiographic findings, flow characteristics, and histology, suggesting that it currently has the most promise as an alternative or adjunct to laparoscopic suturing. Development of alternative laparoscopic techniques is ongoing, however, and thus the current state-of-the-art techniques used in this study may well be supplanted by other technologies in the future.

Animals↗

PubMed1998

Breaking strength and diameter of absorbable sutures after in vivo exposure in the rat.

Although absorbable sutures are commonly used in clinical practice, the rate of decay of strength in various tissues has not been studied. The purpose of this study was to assess breaking strength (BS) and diameter of monofilament (chromic gut, polydiaxanone, Maxon, Monocryl) and multifilament (Vicryl, Dexon, Polysorb) absorbable sutures implanted in various sites and measured at specific time intervals. A 15 cm length of 4-0 suture from a single lot of each material was implanted in the pleural space, rectus abdominus muscle, subcutaneous tissue, intravascular space, peritoneal cavity, and stomach lumen in the rat. A precipitous decrease in BS was noted in all multifilament sutures after 7 days, and in chromic gut and Monocryl sutures after 1 day. Polydiaxanone and Maxon sutures maintained the highest BS over the 28-day period, 71 per cent and 59 per cent of their initial BS, respectively. Suture diameter remained essentially unchanged except for chromic gut and the multifilament sutures which exhibited increased diameter. This increase was attributed to inflammatory tissue infiltration.

Animals↗

PubMedDate not supplied

[Comparative study of cicatrization with suture technics in 1 or 2 layers in small intestine anastomosis in adverse conditions. Experimental work in dogs].

Some experimental procedures have shown in intestinal anastomosis advantages in the use of suture on only one plane as compared to the classical suture on two planes. However, these experiments, performed in healthy dogs, raised doubts about its safety when used under adverse clinical conditions. The objective of this work is, therefore, to compare in dogs submitted to immunosupressive drugs (azotioprine and corticoid) the two techniques of suture in the presence of peritonitis and intestinal ischemia. The comparative study of the healing in the sutures performed under such conditions shows the advantages in the use of suture on only one plane. In the dogs examined on the fourth and fifteenth day after surgery, the superiority of the suture on one plane compared to that on two planes is evident, both in the macroscopic and microscopic aspects. The suture in one plane shows a better coadaptation of the borders, without increasing the thickness of the wall at the level of the anastomosis, less exudative inflammatory reaction, quicker and greater fibroblastic proliferation, less inflammatory reaction to the suture material, and less vascular alteration at the healing level.

Animals↗

PubMed1976

Age changes in the human frontozygomatic suture from 20 to 95 years.

The frontozygomatic suture of human cadaver material was examined by a combination of histologic, radiographic, and gross tecniques to determine the aging changes in the suture and the approximate age at which sutural fusion occurs. The sample consisted of sixty-One specimens of human beings ranging in age from 20 to 95 years. Observations were made on specimens at age intervals of 5 years. Since the frontozygomatic suture is bilateral, one suture from each specimens was used for radiographic and gross examination for synostosis, and the opposite side was subjected to histologic analysis. The findings of this study have lead to the following conclusions: 1. The human frontozygomatic suture undergoes synostosis during the eigth decade of life, but does not completely fuse by the age of 95 years. 2. Synostosis is a progressive process which commences as small areas of bony union that occur initially within the internal portion of the suture and then progresses to the orbital perisosteal surface. Bony union is not found at or near the facial periosteal surface. 3. The bony surfaces of the frontozygomatic suture become increasingly irregular with advancing age as a result of the formation of projections or interifitations=

Adult↗

PubMed2000

Suture biology: Lessons from molecular genetics of craniosynostosis syndromes.

Sutures are critical growth sites in the developing craniofacial skeleton, and equally importantly, they are the target tissues for certain orthodontic therapeutic modalities. For these reasons, suture biology has long been an area of significant interest in orthodontics. In fact, much of our knowledge on sutures, such as structure, ontogeny, growth and development, pathology, and tissue response to biomechanical forces, is based on investigations conducted by orthodontic researchers in the 1950-1970s. Despite their significant impact in the establishment of the current paradigm in suture biology, these earlier studies have not provided much information on the molecular and cellular mechanisms of suture development. Only in the last 5 or 6 years, identification of genes involved in genetic disorders of premature suture closure (syndromes of craniosynostosis) has uncovered the first clues to some key molecules and their specific roles in this process. The list, which is expected to get longer, includes fibroblast growth factor receptors (FGFRs), MSX2, and TWIST. FGFRs belong to a family of cell membrane receptor kinases and bind to their principal ligands, fibroblast growth factors (FGFs). Upon binding to FGFs, FGFRs transduce intracellular signaling cascades and ultimately modify cellular behavior, such as cell proliferation and differentiation. MSX2 and TWIST are transcription factors that bind to regulatory regions of target effector genes and determine their expression. In addition to the above-mentioned molecules, recent tissue recombination and biochemical studies have added FGFs and transforming growth factors to the list of key molecules in suture biogenesis. The purpose of this article is not to reiterate the earlier classical studies, which have been extensively reviewed by others, but to present the new and exciting developments in the field of suture research at the genetic and cellular levels. These new perspectives and what lies ahead as future challenges in this field are discussed.

Journal Article↗

PubMed1975

The effect of heavy orthopedic forces on the sutures of the facial bones.

The effect of heavy continuous orthopedic forces was studied in three Saimiri Sciureus (squirrel) monkeys. Two additional monkeys served as controls. The maxillary sutures were investigated microscopically. In addition, the bone markers (tetracycline, Procion Red H-8 BS) served for quantitative evaluation under ultraviolet light. After two weeks slight remodeling activity could be observed. After one month a tremendous activity was found in the sutures. The width of the sutures was two to three times enlarged. The regular tissue pattern of the sutures had changed to a mixture of precollagen and collagen fibers running in all directions with plenty of active cells. In the ultraviolet light there is a take up of markers at the sutural margins. After three months of treatment though, the sutures showed a similar pattern. The three zones of the sutures began to form again; osteoblasts were attached to the sutural margins and reorganization was relatively complete.

Animals↗

PubMed1994

Internal calvarial bone distraction in rabbits with experimental coronal suture immobilization.

Correction of craniosynostosis involves removal of the coronal suture to allow for expansion of the developing brain and normal craniofacial growth. Frequently, however, the site reossifies, restricts growth, and requires additional surgery. The present study was designed to assess the effects of an internal, subperiosteal calvarial distractor on suturectomy site patency and compensatory craniofacial growth changes in an experimental rabbit model of coronal suture synostosis. In the present study, 43 1 1/2-week-old rabbits were used. Amalgam markers were placed across the frontonasal, coronal, and anterior lambdoidal sutures in all animals. Twenty-nine rabbits underwent bilateral coronal suture immobilization using methyl methacrylate. Fourteen rabbits were left untreated and served as sham controls. At 6 weeks of age, the immobilized rabbits were divided into three groups: (1) immobilized (controls), (2) suturectomy, and (3) suturectomy and distraction. The distractors were activated percutaneously at an average of 0.6 mm/week for 5 weeks (3 mm total). Lateral head radiographs were taken at 1 1/2, 6, 12, and 18 weeks of age. Results revealed that, by 6 weeks of age, animals with coronal suture immobilization exhibited significantly (p < 0.01) reduced growth across the coronal suture, resulting in shorter and inferiorly rotated cranial vaults compared with sham controls. By 12 weeks of age, rabbits with distraction returned to normal (sham control) coronal suture marker separation, whereas rabbits with immobilized sutures and suturectomy only showed significantly reduced marker distances. Rabbits with distraction also exhibited greater anterior cranial base lengths compared with the other experimental groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2004

Quantitative transcriptional analysis of fusing and nonfusing cranial suture complexes in mice.

Previous studies have documented the differences in expression of various genes associated with the process of osteogenesis in fusing and nonfusing cranial sutures, including growth factors, growth factor receptors, and extracellular matrix molecules. Most of these studies were performed in rats, and although the biology regulating cranial suture fusion in mice and rats is presumed to be similar, studies are needed to verify these expression patterns as mice become increasingly utilized for scientific inquiry into the molecular biology of suture fusion and patency. The purpose of this study was to determine the differences in expression of several genes known to be critical to osteoblast biology. Posterior frontal and sagittal suture complexes (including the associated dura mater, suture mesenchyme, and osteogenic fronts) were isolated from 5-, 15-, 25-, 35-, and 45-day-old male CD-1 mice (n = 8 per age; n = 40 total). Total cellular RNA was extracted and converted to cDNA. Quantitative real-time reverse transcriptase polymerase chain reaction was then performed for the following genes: transforming growth factor beta1 and beta3, fibroblast growth factor receptor 1, Runx2,Osteopontin, and Osteocalcin. Expression of all genes examined was increased significantly in the posterior frontal suture as compared with the sagittal suture. Peak expression for all genes was observed on day 25. These data demonstrate that the expression of osteogenic growth factors, growth factor receptors, transcription factors, and extracellular matrix molecules is increased in the fusing posterior frontal suture in mice.

Animals↗

PubMed2002

Sutural loosening and skeletal flexibility during growth: determination of drop-like shapes in sea urchins.

The shape of sea urchins may be determined mechanically by patterns of force analogous to those that determine the shape of a water droplet. This mechanical analogy implies skeletal flexibility at the time of growth. Although comprised of many rigid calcite plates, sutural collagenous ligaments could confer such flexibility if the sutures between plates loosened and acted as joints at the time of growth. We present experimental evidence of such flexibility associated with weight gain and growth. Over 13-, 4-, and 2-week periods, fed urchins (Strongylocentrotus droebachiensis) gained weight and developed looser sutures than unfed urchins that maintained or lost weight. Further, skeletons of fed urchins force-relaxed more than did those of unfed urchins and urchins with loose sutures force-relaxed more than those with tight sutures. Urchins (Strongylocentrotus franciscanus) fed for two and a half weeks, gained weight, also had looser skeletons and deposited calcite at sutural margins, whereas unfed ones did not. In field populations of S. droebachiensis the percentage having loose sutures varied with urchin diameter and reflected their size-specific growth rate. The association between feeding, weight gain, calcite deposition, force relaxation and sutural looseness supports the hypothesis that urchins deform flexibly while growing, thus determining their drop-like shapes.

Animals↗

PubMed2003

Fibroblast growth factors lead to increased Msx2 expression and fusion in calvarial sutures.

Craniosynostosis, the premature fusion of the skull bones at the sutures, represents a disruption to the coordinated growth and development of the expanding brain and calvarial vault and is the second most common birth defect that affects the craniofacial complex. Mutations in the human homeobox-containing gene, Msx2, have been shown to cause Boston type craniosynostosis, and we have shown that overexpression of Msx2 leads to craniosynostosis in mice. Activating mutations in fibroblast growth factor (FGF) receptors are thought to cause craniosynostosis in Crouzon, Apert, Jackson-Weiss, Beare-Stevenson, and Muenke syndromes. To mimic activated signaling by mutated FGF receptors, we used heparin acrylic beads to deliver FGF ligands to mouse calvaria and demonstrated increased Msx2, Runx2, Bsp, and Osteocalcin gene expression, decreased cell proliferation, and suture obliteration and fusion. FGF2 elicited the greatest increase in Msx2 expression, and FGF1 was most likely to cause suture obliteration and fusion. Of the three sutures studied, the coronal suture exhibited the greatest increase in Msx2 expression and was the most likely to undergo obliteration and fusion. These results are intriguing because the coronal suture is the most commonly affected suture in syndromic craniosynostosis. These results suggest that Msx2 is a downstream target of FGF receptor signaling and that increased FGF signaling leads to osteogenic differentiation by sutural mesenchyme in mouse calvaria. These results are consistent with the hypotheses that increased Msx2 expression and activated signaling by mutated FGF receptors lead to craniosynostosis.

Animals↗

PubMed1976

Layer closure of laparotomy wounds with absorbable and non-absorbable suture materials.

Opinions vary regarding the best suture material for abdominal wound closure. Some surgeons favour non-absorbable sutures while others use absorbable materials, but there is little objective clinical information regarding the relative merits of the different suture materials. In a randomized prospective clinical trial the synthetic absorbable polyglactin and polyglycolic acid sutures were compared with the non-absorbable polypropylene suture in the closure of 161 laparotomy wounds. A layered closure technique was used in all cases. The total incidence of wound dehiscence and herniation was 8-1 per cent, and there was no significant difference between polylycolic acid (9-6 per cent), polyglactin (5-8 per cent) and polypropylene (8-8 per cent). Dehiscence and herniation were significantly more common in wounds closed by surgeons in training. It was concluded that none of the suture materials provided satisfactory freedom from wound complications. It is possible that these sutures may prove satisfactory with an alternative technique of abdominal wound closure, but this should be the subject of further clinical studies.

Abdomen↗

PubMedDate not supplied

Face lift, Part 4: Use of superficial musculoaponeurotic system suspending sutures.

We describe nonabsorbable sutures running from one or more sites in the superficial musculoaponeurotic system (SMAS), to other sites at a distance, or to fixed sites beyond or deep to SMAS for the purpose of pulling on or suspending the distal selected SMAS sites or changing contours between the suture ends. Our reasons for abandoning some sutures and continuing with others are stated. In face lifting, we still often employ sutures running from the anterior part of the platysma and SMAS back to the sternocleidomastoid fascia. These sutures help prevent platysma "cording" and are useful in the restoration and preservation of a more youthful profile in the neck. Examples and controls are demonstrated. These sutures and the long-term results of their use have never been shown before. Problems encountered in using suspending sutures are described.

Face↗

PubMed1980

Microvascular anastomosis with absorbable and nonabsorbable sutures--a comparative study in rats.

Polyglycolic acid, polypropylene, and nylon sutures were used to anastomose the aortas of 40 rats. Comparative studies of the healing process at the suture sites were performed. The long-term observations, by means of light and scanning electron microscopy, revealed that the regeneration of endothelium was more rapid and the endothelium had a smoother surface in the aortas that received the polyglycolic acid sutures than in the aortas receiving polypropylene or nylon sutures because the polyglycolic acid sutures were absorbed after 6 weeks. It was concluded that polyglycolic acid suture material may be more desirable than nonabsorbable suture material in microvascular anastomoses.

Anastomosis, Surgical↗