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PubMed1976

Suture granulomas simulating tumors: a preventable postgastrectomy complication.

Suture granulomas can occur after gastric surgery with nonabsorbable suture material. They are usually an asymptomatic, incidental finding on post-surgical x-ray studies, but have to be recognized because their radiological appearance may mimic gastric neoplasms and therefore may lead to unnecessary reoperations. Four cases of suture granulomas are presented, their diagnostic criteria outlined, and a plea is made for the use of a new completely absorbable suture material which could eliminate the occurrence of suture granulomas as well as the other known complications related to nonabsorable sutures, such as suture-line ulcers, abscesses, and adhesions.

Aged↗

PubMed1995

The deadman theory of suture anchors: observations along a south Texas fence line.

Suture anchors are being increasingly reported as a means of fixation of torn rotator cuff tendons to bone. The author has developed a mechanical model for the suture anchor-rotator cuff construct based on an analogy to the deadman system used to stabilize a corner fence post. Using this model, one can demonstrate a mechanically favorable angle of insertion of the suture anchor (theta 1) such that the anchor's pullout strength is increased at low angles of theta 1. In addition, the angle that the suture makes with the direction of pull of the rotator cuff (theta 2) has a direct effect on tension in the suture. A low angle of theta 2 minimizes the total tension in the suture, thereby minimizing the chance of suture breakage.

Biomechanical Phenomena↗

PubMed2004

The use of a polyglactin suture in the lateral tarsal strip procedure.

PURPOSE: To evaluate the rate of recurrence of horizontal laxity or lid malposition and suture-related complications associated with the use of an absorbable suture in the lateral tarsal strip procedure. DESIGN: Prospective, interventional, consecutive case series. METHODS: A prospective study. SETTING: Institutional. PATIENT POPULATION: One hundred patients with horizontal lid laxity associated with ectropion or entropion. Patients with paralytic ectropion or ocular prostheses were excluded. INTERVENTION: One hundred and five lateral tarsal strip procedures were performed using a 6-0 polyglactin suture. These were combined with full-thickness skin grafts (34), internal (55) or external (23) retractor plications, and inverting sutures (4) as required to correct the lid malposition. MAIN OUTCOME MEASURES: Recurrence of horizontal laxity or lid malposition and suture related complications were the main outcome measures. Suture related wound infection was diagnosed clinically by the presence of pus associated with wound breakdown. RESULTS: One patient failed to reach 3-month follow-up and was excluded. There was one recurrence of horizontal laxity after a mean follow-up period of 9.1 months. Four patients developed lateral canthal wound infections, compared with none at the other operative sites. The 95% confidence intervals for infections in the tarsal strip procedure were 1.1% to 9.6%, which were significantly greater than zero (P < .0001), the infection rate for the other procedures. CONCLUSION: A 6-0 absorbable suture may be used for the lateral tarsal strip and does not lead to a recurrence of horizontal laxity. It does not appear to reduce the wound infection rate associated with this procedure.

Aged↗

PubMed2006

Comparison and performance characteristics of 3 different knots when tied with 2 suture materials used for shoulder arthroscopy.

PURPOSE: To compare the performance of a standard suture material with that of a new material across several arthroscopic knot configurations. METHODS: Three knots were evaluated (Duncan loop, Weston, and San Diego knots) with the use of 2 suture materials (No. 2 Ethibond [Ethicon, Somerville, NJ] and No. 2 Force Fiber [Stryker Endoscopy, San Jose, CA]). Ten samples were tested for each knot and suture configuration. Samples were pretensioned to 10 N and were mechanically loaded from 10 to 45 N for 1,000 cycles. The number of cycles to 3 mm of loop elongation was recorded as "early" slippage. Intact knots with no evidence of early slippage were then subjected to a load-to-failure test so that the ultimate failure strength of the knot/material could be determined. RESULTS: Force Fiber knots required a statistically greater number of cycles to reach 3 mm of slippage compared with Ethibond knots (P < .0001). A single Force Fiber knot experienced 3 mm of displacement during cyclic loading; all others survived to 1,000 cycles. One third of all Ethibond knots were displaced to 3 mm during cyclic loading. For Ethibond sutures, no significant differences in ultimate failure strength were observed between knots (average, 143 N across knot types). For Force Fiber sutures, the San Diego knot (279 +/- 41 N) was statistically similar in ultimate failure strength to the Weston knot (254 +/- 41 N), but it was significantly stronger than the Duncan knot (224 +/- 70 N) (P < .03). CONCLUSIONS: The higher failure loads associated with Force Fiber may allow the surgeon to increase suture tension during knot tying, thereby creating a tighter knot. Loop elongation with Force Fiber occurred at loads that were greater than the typical breakage load for No. 2 Ethibond. Force Fiber is a new material that may be useful for various arthroscopic procedures. CLINICAL RELEVANCE: Force Fiber provided increased biomechanical stability compared with Ethibond regardless of knot type. The cost benefit of using very strong yet very stiff sutures must be clinically evaluated.

Arthroscopy↗

PubMed1999

A technique for suturing peripapillary radioactive plaques.

PURPOSE: To describe a technique for suturing radioactive plaques positioned posteriorly and adjacent to the optic nerve. METHODS: Posterior and juxtapapillary notched radioactive iodine-125 plaques were sutured using four 5/0 nylon sutures. Two sutures were placed in the sclera at the anterior border of the plaque position and passed through the eyelets at the anterior edge of the plaque. Two sutures were attached to the posterior eyelets and brought to either side of the optic nerve, under the rectus muscles, to be sutured to sclera anterior to the insertion of the recti muscles. The position of the plaques was documented intraoperatively using sterile B-scan ultrasonography. RESULTS: Plaques positioned and sutured using this technique were found by ultrasonography to be tight up against the sclera and optic nerve.

Brachytherapy↗

PubMed2003

Use of adhesive surgical tape with the absorbable continuous subcuticular suture.

BACKGROUND: The absorbable continuous subcuticular suture is frequently used to close surgical incisions where the aim is healing by primary intention. A form of adhesive surgical tape is commonly also placed over the wound but this combination closure seems to have its development based on anecdotal, rather than experimental evidence. The present study reviews the scientific literature on the development of sutureless wound closure and presents the current evidence for the use of combination wound closure. METHODS: Review was undertaken of the medical literature using the PubMed Internet database and cross-referencing major -articles on the subject. The following combinations of key words were searched: skin closure, wound closure, suture technique, sutureless, adhesive tape, op-site, staples, subcuticular suture, complication, infection and scars. RESULTS: Taped closure alone has advantages of lower wound infection rates and greater wound tensile strength, but disadvantages of epidermal reaction, skin edge inversion, doubtful safety and time required for meticulous surgical technique. The use of the continuous absorbable subcuticular suture allows accurate skin edge approximation, which increases the safety margin. The combination closure has a slightly superior cosmetic result to sutureless techniques but no study has been performed to compare the results of combination subcuticular suture and tape, with tape or subcuticular suture alone. CONCLUSIONS: There is no evidence in the scientific literature to justify or support the practice of closing a surgical wound with both subcuticular suture and adhesive surgical tape.

Adhesives↗

PubMed2001

Comparison of three closure methods and two absorbable suture materials for closure of jejunal enterotomy incisions in healthy dogs.

The macroscopic and histological appearance of jejunal antimesenteric incisions approximated with two different absorbable suture materials (monofilament versus multifilament) and three closure techniques (appositional single layer, crushing single layer, and double layer) were compared in healthy dogs at 14 or 28 days, postoperatively. No significant differences between the two suture materials were observed for most of the macroscopic or histological variables. However, the monofilament suture material caused significantly more fibrous tissue reaction in the muscular layer of the jejunum than did the multifilament suture material. Of the three enterotomy closure techniques used in this study, the appositional single-layer method proved to be the best. The double-layer closure method caused a significant decrease in the incisional circumference, the relative circumference, and volume of the jejunum, and a significant increase in jejunal wall thickness. Our findings suggest that canine jejunal enterotomy incisions can be closed using an appositional suture pattern with relatively rapidly absorbable monofilament suture material. The use of double-layer suture patterns for closure of jejunal enterotomy incisions should be avoided because the size of the intestinal lumen may be reduced.

Absorption↗

PubMed2006

Construct validity of the chicken model in the simulation of laparoscopic radical prostatectomy suture.

BACKGROUND AND PURPOSE: For a simulation to be valid, it has to be close to reality, correlate with the performance in a real case, and be able to discriminate between individuals with different degrees of experience. We explored the construct validity (ability to discriminate between experienced and inexperienced subjects) of a simulation for the urethrovesical anastomosis during laparoscopic radical prostatectomy (LRP). MATERIALS AND METHODS: Dead chickens were used. After partial emptying of the corporal cavity, an 18F catheter was placed through the esophagus to the stomach. In the Pelvic Trainer, a laparoscopic section of the esophago-glandular-stomach junction and a suture between the two edges were performed in the same fashion as for a urethrovesical suture in LRP. Five subjects with different levels of experience in laparoscopy, ranging from nil to more than 250 LRPs, tested two types of suture. One-way ANOVA was used to detect differences in suturing time among the operators. A multiple comparison test was used to detect specific differences between operators. RESULTS: Although suturing time had a strong negative correlation with the operator's experience, significant statistical differences in suturing time were found only between the least experienced operator and the other ones. Qualitative differences in the suture were found among operators. CONCLUSION: This simulation correlates well with the laparoscopic (LRP) subject's experience. It can discriminate between inexperienced and experienced subjects, exhibiting moderate construct validity, but failed to reflect the different levels of experience among the most experienced subjects.

Animals↗

PubMed2001

Involutional entropion repair with fornix sutures and lateral tarsal strip procedure.

PURPOSE: To evaluate the long-terrm effectiveness of fornix suture placement combined with a lateral tarsal strip procedure in correcting involutional entropion. Published reports regarding various surgical techniques and results are reviewed. METHODS: This retrospective study reviewed 119 patients with involutional lower eyelid entropion who underwent surgical repair between January 1987 and May 1999 at the Bascom Palmer Eye Institute. Exclusion criteria included follow-up duration of less than 6 months, previous lower eyelid blepharoplasty, previous conjunctival surgery other than chalazion removal, or cicatricial entropion. The three surgical subsets were (1) combined lateral tarsal strip and fornix sutures: (2) fornix sutures alone; and (3) lateral tarsal strip procedure alone. The chart review was complemented by a telephone questionnaire to assess the long-term clinical outcome, complications, and patient satisfaction. RESULTS: One hundred fifty-two eyelids in 119 patients were included. One hundred twenty-five eyelids had combined surgery (lateral tarsal strip with fornix sutures), 9 eyelids had only fornix suture repair, and 18 eyelids had repair with only the lateral tarsal strip procedure. The recurrence rate in these three surgical subsets was 1.6%, 33%, and 22%, respectively, with average follow-up of 36 months. One case of incisional cellulitis was encountered. Postoperative ectropion was not seen in the group having the combined lateral tarsal strip and fornix suture procedure. CONCLUSIONS: Suture advancement of the lower eyelid retractors in conjunction with a lateral tarsal strip procedure is a simple, quick, physiologic, and effective approach in achieving long-lasting correction for involutional entropion.

Aged↗

PubMed2001

Suture materials and other factors associated with tissue reactivity, infection, and wound dehiscence among plastic surgery outpatients.

The most common complications in plastic surgery are tissue reactivity, infections, and wound dehiscence. In the literature, there are only a few studies with sample sizes large enough and methods of statistical analysis appropriate for evaluating the role of suture materials in inducing such complications. In the 1000 plastic surgery outpatients in this study, the association of different suture materials, individual patient characteristics, surgeon skill, and wound site and length with postoperative wound complications (i.e., tissue reactivity, infection rate, and wound dehiscence) were investigated. No substantial differences were found between the different suture materials and suturing techniques. A moderate increase in the risk of tissue reactivity for silk and polyglactin 910 and a protective effect of thinner internal sutures were observed. In multivariate analysis, such differences were not statistically significant. Male sex [odds ratio (OR), 1.7; 95 percent confidence interval (CI), 1.06 to 2.72] and older age (OR, 2.34; 95 percent CI, 1.36 to 4.05) were found to be the most important risk factors for tissue reactivity and infection rate (male sex: OR, 5.1; 95 percent CI, 1.7 to 15.9; older age: OR, 5.6; 95 percent CI, 1.9 to 16), whereas younger age was associated with an increased risk of dehiscence (OR, 3.06; 95 percent CI, 1.41 to 6.65). Wounds on the lower limbs showed a lower risk of tissue reactivity and wounds on the back a higher risk of dehiscence. Wound length was associated with the risk of tissue reactivity in one-layer sutures (OR, 2.92; 95 percent CI, 1.51 to 5.65). An increased risk of both tissue reactivity (OR, 1.53; 95 percent CI, 1.03 to 2.27) and dehiscence (OR, 2.44; 95 percent CI, 1.1 to 5.43) was observed for operations performed by less-experienced surgeons. Rather than factors related to suture materials and different surgical techniques, and with the exception of surgeon experience, general characteristics of the patients (i.e., sex and age) and of the wounds (i.e., length and site) seemed to be primarily responsible for local wound complications.

Absorbable Implants↗

PubMed2004

A new wound closure achieving and maintaining device using serial tightening of loop suture and its clinical applications in 15 consecutive patients for up to 102 days.

A device that can both achieve and maintain wound closure by serial tightening of a loop suture was developed. The device consists of 3 components: a hollow plastic cylinder with a 1-way locking mechanism, a flat plastic strip passing though the cylinder, and a plastic cushion between the cylinder and the skin. The body of the device is composed of a soft cylinder and a hard strip. This difference in flexibility enables the device to absorb impacts of positional changes and daily activities, while the device preserves tension of loop suture and wound closure ().(Figure is included in full-text article.)After debridement or excision of a lesion, the passage of 0-1 nylon suture is designed. The nylon suture is threaded through the deep dermis across the wound. Both ends of the suture are then tied to make a loop, which is secured to 2 holes at one end of a plastic strip. The plastic strip, which holds the loop suture, is pulled away from the skin gradually through a hollow plastic cylinder to approximate wound margins ().(Figure is included in full-text article.)From January 2003 to August 2003, the device was applied 21 times in 15 consecutive patients. A mean stretching of 42.0 mm was performed for defects with a mean shortest dimension of 24.5 mm (from 2 mm to 60 mm). All 21 wounds were closed primarily (21/21 = 100%), and the closure was maintained successfully for 18 wounds (18/21 = 85.7%) in 13 patients (13/15 = 86.7%). The device was left in situ for as long as 102 days (average application time of 34.5 days). Three wound dehiscences (3/21 = 14.3%) occurred in 2 diabetic foot patients, which were cured by skin grafting. In 2 sacral pressure ulcer patients, minimal skin lacerations were caused by the loop sutures at the skin entrance site but without true wound dehiscence. These lacerations healed with minimal debridement and routine wound dressing within 2 weeks. This instrument was devised to overcome the limitations of previous skin stretching methods. It has wider indications and shows better compliances. In particular, because of its longer period of application, the device does not only stretch the skin to achieve wound closure, but also helps maintain it during wound healing.

Debridement↗

PubMed2006

Suturing after childbirth--a randomised controlled study testing a new monofilament material.

The aim of this study was to assess if a monofilament suture material (Biosyn) compared with a commonly used multifilament suture (Dexon II) would cause fewer problems and lower levels of discomfort and pain after suturing lacerations and episiotomies following vaginal delivery. Women (1139) who required suturing by a midwife were allocated for repair with either the multifilament polyglycolic acid suture (Dexon II) or with a new monofilament of glycomer 631 (Biosyn). The outcome assessment involved inspection of the sutured area and measuring levels of discomfort and pain with a Visual Analogue Scale (VAS). At follow up after 8-12 weeks, more women in the monofilament group reported problems with the sutured area.

Dioxanes↗

PubMed1981

Nylon sutures for wound closure in cataract operation.

In this series of patients the use of nylon sutures in wound closure produced wounds which were watertight, secure but astigmatic. The complications which occurred from premature suture absorption were averted and suture removal was not necessary. Less postoperative astigmatism was produced with postplaced running sutures than with interrupted ones and suture knot erosion was avoided by turning suture knots into suture tracks.

Astigmatism↗

PubMedDate not supplied

A comparison of ultrasonic suture welding and traditional knot tying.

The slippage of knots and the technical challenge of tying them securely are potential impediments to certain arthroscopic procedures. Ultrasonic energy delivered at 70 kHz can be used to weld No. 2 polypropylene suture. This method was compared with a traditional knot (surgeon's knot with four alternating half hitches) tied with an open technique to determine whether welding of sutures is comparable, in mechanical properties, to hand-tied knots. Both loops were fashioned around a 0.25-inch mandrel and then tested. The load to reach 3-mm elongation (point of likely biologic failure of a repair) was significantly greater for welded sutures than for knots. The elongation at ultimate failure was significantly less for welded sutures than for knots. The number of cycles to failure and the creep after initial displacement were similar for both welded and knotted suture loops. The ultimate load to failure was significantly greater for the knotted than for the welded suture. The welding of suture for the repair of musculoskeletal soft tissue presents an attractive alternative to traditional knot tying, particularly for arthroscopic applications.

Equipment Failure Analysis↗

PubMedDate not supplied

Pull-out strength and stiffness of meniscal repair using absorbable arrows or Ti-Cron vertical and horizontal loop sutures.

We tested pull-out strength and linear stiffness of meniscal repair using bioabsorbable arrows and vertical and horizontal loop sutures in fresh-frozen bovine lateral menisci. In phase I, menisci repaired either with 2-0 Ti-Cron vertical or horizontal loop suture, or 10-, 13-, or 16-mm Meniscus Arrows were loaded to failure at 12.5 mm/sec. In phase II, we examined the number of barbs engaged and angle of insertion using 10- and 13-mm arrows. Pull-out strengths of both suture repair groups were significantly higher than those of the arrow groups. Vertical loop sutures were significantly stiffer than horizontal sutures and 10-mm arrows. In phase II, the mean ultimate load to failure for the 10-mm arrows was 35.1 N, significantly stronger than in phase I (18.5 N); however, stiffness remained low (7.9 N/mm). Five arrows in the 13-mm group were inserted parallel to the tibial surface and showed no significant difference from phase I. Five arrows were inserted at more than a 30 degrees angle. This group was significantly weaker than in phase I. Single vertical loop suture showed the highest overall pull-out strength. Although weaker than sutures, arrows should provide sufficient stability for meniscal healing. The number of barbs engaged and angle of insertion are critical.

Absorbable Implants↗

PubMed1988

Suture extrusion in small arteries and veins.

One longitudinally orientated microsuture was implanted in the femoral artery and vein of 40 rats and harvested at 4 different time intervals (2, 8, 12, 18 weeks). The tissue section containing the most luminal portion of suture loop was chosen and submitted for analysis. Two parameters, one estimating the suture location in the vessel wall relative to the internal elastic lamina (IEL) and a second, estimating the magnitude of the intimal response at the suture site were addressed. Average suture location changed significantly over time. The suture tended to be exteriorized or extruded from its once luminal location within the intima to a position located within the adventitia. Veins exhibited a greater incidence of suture extrusion than arteries. The maximum magnitude of the intimal cellular response occurred in the 2 week time interval. Significant decreases (p less than 0.05) in the thickness of the intima was observed in each subsequent time interval for both arteries and veins. The results of this experiment indicate that the cellular response and reparative processes occurring in small arteries and veins modifies the luminal papillary projection and extrudes nylon suture material.

Animals↗

PubMed2001

A growth and differentiation factor-5 (GDF-5)-coated suture stimulates tendon healing in an Achilles tendon model in rats.

Growth and differentiation factor-5 (GDF-5) is essential for normal skeletal development and induces tendon-and ligament-like structures at ectopic sites. Therefore, we investigated the influence of a GDF-5-coated suture on the healing Achilles tendon in rats. The right Achilles tendon in 80 rats was transected and sutured with an absorbable polyglactin suture. Animals were randomized to an uncoated-suture control and a GDF-5-coated suture group. At 1, 2, 4 and 8 weeks after surgery the repair tissue was evaluated biomechanically and histologically. Biomechanical testing revealed significantly thicker tendons, which were stiffer at 1, 2, and 4 weeks, in the experimental group than in the control group. The maximum tensile strength was significantly increased at 2 weeks after surgery. Histologically we found cartilage-like cell nests 4 weeks after tendon repair, which were positive for type II collagen. In conclusion, local growth factor delivery by a coated suture material showed a promising beneficial effect on tendon repair. The appearance of cartilage-like structures may demonstrate the chondroinductive capacity of GDF-5, which in these circumstances, however, might be overcome by modifications of the GDF-5 dose and/or the suture material.

Achilles Tendon↗

PubMed1982

Relaxation sutures for the oesophageal end-to-end anastomosis.

Intrathoracic end-to-end anastomoses were made in 4 series of piglets with 10 animals in each. In one series (S) the anastomoses were made with interrupted 6/0 silk sutures. In another series (MR) interrupted 10/0 supramid sutures were used after standardized resection. In a third series (F) 6/0 silk sutures were utilized and the oesophageal ends fastened to fascia perivertebralis with traction sutures. In a fourth series (RF) the anastomoses were made with silk 6/0 suture material after standardized resection and including traction sutures. The results were evaluated with standardized X-ray examination with calculation of anastomotic index, histological examination and macrophotography. Statistical analysis of the anastomotic index showed a significant difference between the F and S series. The anastomoses in the F series had healed with less stricture formation. No significant differences were observed between the MR and S series, the RF and S series, and the MR and RF series. Our results encourage us to recommend traction sutures in contriving an intrathoracic end-to-end oesophageal anastomosis.

Animals↗