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PubMed1982

Ultrasound evaluation of sutures following cervical cerclage for incompetent cervix uteri.

This prospective study was designed to determine whether it is possible to visualize cerclage suture material by ultrasound and to evaluate the clinical usefulness of ultrasound examination after cervical cerclage during pregnancy. Ultrasound examinations demonstrated suture material in all patients in this study. The 5-mm-wide Mersiline tape suture, used in the Shirodkar procedure, was easier to visualize by ultrasound than the no. 2 nylon suture used in the McDonald procedure. Ultrasound examination can be helpful in evaluating the location and effectiveness of the sutures and in detecting protrusion of the membranes beyond the sutures before it is clinically apparent. The sonographic demonstration of the relationship of the protruding membranes to the level of the sutures can be valuable in patient management.

Adult↗

PubMed1976

[Preliminary clinical experience with antibacterial surgical sutures].

Surgical sutures made of Letilan-Lavsan and polyvinyl alcohol fibers with morphocycline and neomycin and filamentous Letilan were applied in 802 patients in the past 4 years. These sutures display considerable antibacterial properties. The antibacterial effect of Letilan-Lavsan sutures is reduced during the healing because of formation of fibrous capsules, the fibers themselves not being deprived of their antibacterial properties for a long period. The Letilan fibers undergo gradual fragmentation and degradation. The antibacterial properties of polyvinyl alcohol fibers added with morphocycline and neomycin are retained for 2 months in the body tissues. The antibacterial Letilan-Lavsan sutures and filamentous Letilan sutures can be sterilized by autoclaving, applying hydrogen peroxide--formic acid mixture, gamma irradiation and ethylene oxide. The unsterilized antibacterial sutures can be used as cutaneous sutures in surgical procedures.

Adolescent↗

PubMed2005

Handling characteristics of poly(L-lactide-co-epsilon-caprolactone) monofilament suture.

A monofilament suture made of poly(L-lactide-co-epsilon-caprolactone) was examined by several mechanical tests to evaluate handling characteristics for tight tying. Six types of other monofilament sutures were also examined for comparisons. Two of these were nonabsorbable, while the others were absorbable sutures. Sutures consisting of glicolide were strongest among all the sutures examined. On the other hand, PROLENE and P(LA/CL) sutures showed high knot-pull strength despite low straight pull strength. Untying performance was evaluated by viscoelasticity, bending plasticity and tying test. A good correlation between tan delta and bending plasticity index was observed and the poly(L-lactide-co-epsilon-caprolactone) suture exhibited high tan delta, high bending plasticity and good resistance against untying.

Absorbable Implants↗

PubMed2005

Do absorbable sutures exacerbate presternal scarring?

We investigated cosmetic outcomes of the midline sternotomy incision. A randomized clinical trial was conducted in 60 patients who underwent surgery through a midline sternotomy incision. Patients were divided into groups A (n=30) and B (n=30). In addition, the incision line was also divided into 2 regions (upper and lower halves) in each group. In group A, the upper half of the skin was closed with absorbable 4-0 braided polyglycolic acid sutures (Sentesorb, Boz; Ankara, Turkey), and the lower half was closed with 4-0 nonabsorbable monofilamentous polypropylene suture (Monoplene, Boz), and vice versa in group B. Scar width and height were measured and photographed at the 6th postoperative month. In both groups, the lower part of the incision showed inferior cosmetic results, regardless of the suture material (P <0. 05). On the other hand, the upper part of the incision in group A (the area of absorbable polyglycolic acid sutures) was significantly more hypertrophic. We conclude that monofilament nylon sutures diminish the risk of hypertrophic scarring, in comparison with absorbable sutures. In the lower half of the sternotomy scar, increased tension and relative mobility of the skin over the xiphoid process lead to inferior cosmetic results, regardless of the suture material used.

Absorbable Implants↗

PubMed1991

[Experimental in vitro studies of the stability of tendon sutures].

In early mobilization tendon sutures must perform a sufficient stability. For the examination of a suture under tension tendons of cows with 4 to 6 mm diameter were taken as specimen. They were divided and then sutured with the techniques of Kirchmayr, of Lange and of Dychno-Bunnell. We used the resorbable Polydioxanon-Suture (PDS) and the non-resorbable Polypropylene-Suture (PPS) in 3-0, 4-0 and 5-0 of cross diameter (USP). Breaking-strength, elongation of the suture, the absorbed strength until a gap is developing and the extent of the gaps at their maximum were measured. The results recommend the suture techniques of Dychno-Bunnell and of Lange with 4-0 and 5-0 PDS as sufficient stable for early mobilization.

Animals↗

PubMed1991

Vaginal cuff closure at abdominal hysterectomy: comparing sutures with absorbable staples.

To compare two methods of vaginal cuff closure during abdominal hysterectomy, 60 patients were randomized to one of two cuff-closure methods. The vaginal cuff was closed with three interrupted 0-Dexon sutures in 30 and with absorbable staples in 30. Both groups were similar with respect to age, gravidity, parity, preoperative indication, hemoglobin, and hematocrit. The operative technique and quantity of irrigation used was standardized. Operative blood loss was calculated by the weight method and an unactivated, medium flat Jackson-Pratt drain was left in place for collecting postoperative cuff cultures at 24 and 48 hours. The mean operative times in the suture group (97.4 minutes) and staple group (93.4 minutes) were not significantly different (P greater than .05). Cuff-closure time was more rapid (P = .0001) in the staple group (5.8 minutes) than in the suture group (9.3 minutes). Intraoperative cultures were positive in eight of 30 suture patients (26.7%) and eight of 30 staple patients (26.7%). Postoperative cultures at either 24 or 48 hours were positive in four women (13.3%) in the suture group and six (20%) in the staple group. Febrile morbidity occurred in six (20%) in each group. Three staple and two suture subjects developed a vaginal cuff abscess or hematoma, one of whom was readmitted to the hospital for intravenous antibiotics and draining of the vaginal cuff abscess. The presence of a positive vaginal cuff culture did not predict clinical outcome. Based on these observations and the increased cost of the stapling device, we conclude that there is no significant clinical advantage of surgical staples over traditional sutures for vaginal cuff closure at abdominal hysterectomy.

Adult↗

PubMed1990

[Duration of wound healing and tissue resistance as important criteria for selecting suture materials in colon surgery].

The modern absorbable suture materials are well introduced in colonic surgery. Surgeon's intension is to reduce foreign body reactions by using small sized sutures and will be limited by the suture holding capacity of the tissue. Suture holding capacity of the human colon is about 9 +/- 2 N. Wound healing of colon anastomoses normally lasts 10 to 12 days. The braided absorbable suture materials Dexon, Dexon plus and Vicryl (size 3-0 USP) have a knot breaking strength of about 10 N after 12 days implantation in the human colon, the monofilament absorbable sutures PDS and Maxon have about 20 N resting strength after implantation. These results document that the size 3-0 USP (2-metric) should be the lowest limit for the braided absorbable suture materials used in colonic surgery.

Colon↗

PubMed1985

[Suture technics for the abdominal wall after midline laparotomy].

During the last 10 years 268 laparotomies by a midline incision were performed. A high incidence of seromas, fistulas caused by suturing material and wound ruptures were observed. After finding only a small number of publications in the veterinary medicine about wound healing disturbances an analysis of the human medical literature was done. This induced the change of our surgical procedure and suturing technique: The midline incision and surgical management during the laparotomies in 14 horses suffering from colic were performed by a minimized trauma. The abdominal wall was closed layer by layer in the following manner: peritoneum by a running suture of catgut metric 5, linea alba by Sultan single sutures of polyglycolic acid material metric 5 (12 cases) or of polydioxanone metric 4 (2 cases), subcutaneous layer by a running suture of polyglycolic acid material metric 4, skin by single sutures of monofilamentous synthetic material metric 2. Thus, no complications in wound healing were observed in these 14 horses. Therefore, we recommend to prove the described surgical and suturing procedure by a larger number of horses undergoing a laparotomy by a midline incision.

Animals↗

PubMed1980

Evaluation of 10-0 polyglycolic acid and polyglactin suture in rabbit limbal wounds.

Sutures of 10-0 polyglycolic acid (Dexon) or polyglactin (Vicryl) were used to close limbal incision in rabbits. When seven Dexon or Vicryl sutures were used alone wound disruption occurred in eight of twelve eyes. Sutures disappeared at 4-5 weeks. When three 10-0 nylon sutures were alternated with four 10-0 absorbable sutures, wound integrity was greatly improved. The handling properties of these sutures were excellent and inflammatory reactions were minimal. The 10-0 Dexon and Vicryl did not appear to differ in their properties, but they were insufficient for lasting would closure when used alone. It is suggested that these sutures not be used as the sole closure for limbal wounds.

Animals↗

PubMed1976

Tissue strength of structures involved in musculo-aponeurotic layer sutures in laparotomy incisions.

Tissue strength to breaking point against the pulling forces of a suture was investigated in the musculo-aponeurotic layer of the six laparotomy incisions most commonly used in surgery, namely 1) mid-line incision, 2) paramedial incision, 3) pararectal incision, 4) transverse incision, 5) right oblique subcostal incision, and 6) McBurney's incision. When the suture length was 5 mm and the interval between sutures 10 mm, the mean tissue holding power was 1.9 kp for peritoneum and transversalis fascia together; 5.6 and 3.2 kp for longitudinal incisions through andinary sutures; and 22.9 kp for linea alba with sutures placed lateral to the transition between linea alba and rectus sheath. In comparison with these longitudinal incisions the tissue-holding power in corresponding tissues in transverse incisions was greater (c. 40% greater in the linea alba and anterior rectus sheath and c. 60% greater in the posterior rectus sheath). When regard was paid to the total closure strength of the musculo-aponeurotic layer, e.g. in paramedian incisions the sum of the figures for the anterior and posterior rectal sheaths, the paramedian incision was found to give the weakest closure, followed by the only slightly stronger pararectal incision. The strongest closure was obtained with the midline incision through the linea alba when the sutures were placed laterally to the transition between the linea alba and the rectus sheath. The values for holding power recorded for the musculo-aponeurotic layer may provide a rational basis for the choice of thread dimension and knot type in order to create a suture loop that will be at least as strong as the tissue.

Adult↗

PubMed1993

Releasable suture technique for trabeculectomy.

We studied the effect of the releasable suture technique on immediate postoperative intraocular pressure (IOP). Nine eyes of nine patients with glaucoma had trabeculectomy with a releasable suture. In the six eyes that did not receive antimitotics, the suture was released by the fifth postoperative day; in the others suture release was delayed up to the fourteenth day. Of the nine patients, one had an acceptable postoperative IOP and did not need suture release; in another the suture broke and could not be released. In the remaining seven patients, the difference between the pre-release and post-release IOP was statistically significant (p < 0.001). The complications of this technique include failed suture release, subconjunctival hematoma and a distinctive "windshield wiper" keratopathy.

Corneal Diseases↗

PubMed1993

Temporary sutured tube-tarsorrhaphy: reversible eyelid closure technique.

Temporary closure of the eyelids is frequently recommended for ocular surface disorders in which reepithelialization of the cornea is problematic, as well as for acute Bell's palsy. We describe an easily performed technique of temporary tarsorrhaphy using plastic tubes sutured externally to the upper and lower eyelids, with eyelid closure accomplished by tightening a loop of suture passed through the two tubes. Corneal epithelial defects in 11 of 13 patients in whom we used this technique resolved satisfactorily without complications. In the remaining two, the polypropylene sutures eroded through the eyelids between 5 and 6 weeks after surgery. The sutured tubes loosened and the loosened sutures had to be replaced. In one patient, the overly long end of a suture rotated between the apposed eyelids, inducing a corneal abrasion, but no permanent damage to the eye. We conclude that the sutured tube-tarsorrhaphy provides excellent short-term closure of the eyelids, while allowing simple, painless opening for examining the globe. The risks of inflammation and infection associated with previously described techniques are minimized.

Corneal Diseases↗

PubMed1998

[History of healing; wound suturing].

The history of wound suturing reflects that of surgery itself. In wound treatment, which encloses the technique of suturing as well as suturing materials, wound suturing plays a prominent role. In ancient India, Egypt and the Greek and Roman societies wound treatments as well as suturing techniques and instruments were developed that strongly resemble those in our days. Catgut and silk are known since antiquity. Hardly any progress is noted up to the nineteenth century. The debate on closed or open wound treatment has never stopped. The improvement of catgut by Lister started in 1860. In the 19th century prototypes of mechanical suturing instruments (staplers) were developed. They were introduced into clinical practice in the early decades of the 20th century. The greatest progress in wound suturing started after World War II with the introduction of advanced semiautomatic stapler machinery and with the manufacture of synthetic non-resorbable and resorbable fibres. They have revolutionized surgery and were instrumental in developing new fields (microsurgery).

History, 16th Century↗

PubMed2001

A prospective comparison of octyl cyanoacrylate tissue adhesive (dermabond) and suture for the closure of excisional wounds in children and adolescents.

BACKGROUND: Recent studies suggest that the use of octyl cyanoacrylate tissue adhesive for closure of both traumatic lacerations and incisional surgical wounds results in a cosmetic outcome comparable to that achieved with conventional sutures. To date, no studies have looked at the use of tissue adhesive for higher-tension wounds, such as those created during cutaneous excisional procedures. OBJECTIVE: To compare the tissue adhesive octyl cyanoacrylate with standard suture for the closure of excisional wounds in children and adolescents. DESIGN: A prospective comparison with blinded assessment of cosmetic outcome. Twenty-eight wounds were closed with monofilament suture and 24 were closed with tissue adhesive. At approximately 2 months, photographs of the incisions were evaluated by 2 dermatologists blinded to the method of skin closure. SUBJECTS: Forty-two consecutive patients undergoing excisional dermatologic procedures at Children's Hospital, San Diego, Calif. These 42 patients had a total of 52 wounds that were evaluated. MAIN OUTCOME MEASURES: The cosmetic appearance of the wounds at 2 months, based on 2 validated wound scales: the Hollander Wound Evaluation Scale and a visual analog scale. RESULTS: There were no differences in early complications between the groups. The suture group scored higher on the visual analog scale (63.3 mm for suture vs 47.8 mm for tissue adhesive), and this difference was statistically significant (P =.02). The suture group also had a higher median score on the Hollander Wound Evaluation Scale, but this difference was not statistically significant (P =.09). CONCLUSION: The cosmetic outcome of cutaneous excisional surgery wounds closed with standard suturing was found to be superior to that of wounds closed with octyl cyanoacrylate.

Adolescent↗

PubMed1978

Evaluation of through-and-through corneal sutures.

Sutures placed at the level of Descemet's membrane were compared with sutures placed through and through the full corneal thickness in 42 rabbit corneas using cataract and corneal wounds. The rabbits were killed, and sutures were removed at various postoperative periods up to four weeks. Evaluation of the wounds demonstrated that although the through-and-through technique provided good wound closure in the immediate postoperative period, the technique produced more damage to Descemet's membrane and to the endothelial cells, both at the time of suturing and at the time of suture removal, and tended to produce greater retrocorneal membrane formation. In addition, the through-and-through suturing technique was technically more difficult. In this study performed in rabbits, the one advantage of the through-and-through suture, ie, immediate posterior wound closure, was outweighed by its many disadvantages.

Animals↗

PubMed2004

Optimal angle between instrument shaft and handle for laparoscopic bowel suturing.

OBJECTIVE: To determine the optimal angle between the handle and instrument shaft for endoscopic suturing. DESIGN: A rocker handle needle driver was used to investigate the 0 degrees, 40 degrees, and 80 degrees handle-to-shaft angles. The standard task entailed closure of a 50-mm enterotomy in a nonliving porcine small-bowel model. Fifty enterotomies were performed with each angle in a random sequence. SETTING: Research laboratory in the Surgical Skills Unit at Ninewells Hospital. PARTICIPANTS: Ten surgeons with previous experience in laparoscopic surgery. MAIN OUTCOME MEASURES: The execution time (in minutes), leakage pressure (in centimeters of water), and suture error placement score (deviations of the entry and exit points <3 mm or >5 mm from the enterotomy edge or between sutures). RESULTS: The 40 degrees handle-to-shaft angle had a higher mean (SD) leakage pressure of 43.8 (20.0) cm H2O compared with the 80 degrees and 0 degrees angles (31.1 [21.0] and 26.3 [19.0] cm H2O, respectively) (P<.001). In addition, the 40 degrees angle had a lower mean (SD) suture error placement score of 13.6 (7.6), compared with the 80 degrees and 0 degrees angles (19.4 [9.4] and 21.1 [8.5], respectively) (P<.001). No significant difference was found in the execution time between the different angles (P =.20). CONCLUSION: The best quality of laparoscopic bowel suturing, in terms of the accuracy of suture placement and the integrity of the suture line closure, was obtained with a 40 degrees handle-to-shaft angle.

Analysis of Variance↗

PubMed1988

Response of the intermaxillary suture cartilage to alterations in masticatory function.

Like the condylar cartilage of the mandible, the cartilage at the intermaxillary suture in the rat is secondary in origin and persists well into adulthood. While the condylar cartilage is generally considered to be responsive to changes in its local biomechanical environment, little is known of the response of the intermaxillary suture cartilage to similar stimuli. In order to study the effect of changes in occlusal loads on intermaxillary suture cartilage metabolism, male weanling Sprague-Dawley rats were divided into four groups: soft diet (to discourage molar mastication), incisor clipped (to discourage incision), incisor clipped/soft diet (both treatments), and control (untreated). At 39 days of age, the intermaxillary suture opposite the first molars was removed and compared to control tissue by using histological, histochemical, and biochemical analyses. Alcian blue-stained coronal sections demonstrated moderate decreases in staining intensity and decreased chondrocyte hypertrophy in the soft diet and incisor-clipped groups. However, sutures in the incisor-clipped/soft diet group showed a considerably reduced extent of cartilage and greatly diminished cartilage hypertrophy. [35S]-sulfate incorporation (dpm/micrograms DNA) into acid-insoluble proteoglycans was significantly reduced (P less than or equal to .01) in all three experimental groups compared to controls. [35S] incorporation was further reduced in the incisor-clipped/soft diet group relative to both of the other experimental groups. Staining for alkaline phosphatase activity showed decreased intensity in the experimental groups and was almost absent in the incisor-clipped/soft diet group. These data demonstrate the plasticity of the intermaxillary suture cartilage and provide circumstantial evidence that the observed changes in cartilage morphology and metabolism may be attributable to alterations in the local biomechanical environment of the suture.

Alkaline Phosphatase↗

PubMed1988

Techniques for better suturing.

Suturing techniques enhancing the accuracy of suture placement and reducing the forces on the tissue being sutured were evaluated in six surgeons, each with 6 years' surgical experience. The accuracy was assessed by the distance between the actual and designated needle exit sites. Force was expressed in terms of the torque on the needle holder using a maximum of the torques (max. F), maximum derivative (dF/dt) and integral (IF). The effects of four factors (suturing techniques) on suturing were evaluated: (1) placement of the needle holder on the needle; (2) inclining the tissue at needle entrance, as is commonly done by elevating with forceps (unnoted role of the forceps); (3) adjustment of the needle's exit during suture placement, as is unknowingly employed in practice, and (4) variation between individual surgeons. All these factors affected the accuracy and force of suturing. Gripping the needle closer to the tip strongly reduced the max. F, dF/dt, and IF per time, as did inclining the tissue. Adjustment of exit improved accuracy, but has the potential for causing avoidable tissue injuries. Differences between surgeons suggest the necessity of addressing fundamental surgical techniques and formally incorporating them into the training programme.

Biomechanical Phenomena↗