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The Journal of Hand Surgery, European... Nov 2023We assessed the influence of different directions of suture strands using the double Tsuge repair on the resistance to gap formation and mode of failure. In total, 25...
We assessed the influence of different directions of suture strands using the double Tsuge repair on the resistance to gap formation and mode of failure. In total, 25 porcine flexor digitorum profundus tendons were split into two groups. One group was repaired using a conventional double Tsuge suture created by two bands of looped suture placed longitudinally parallel (parallel method), and the other group was repaired using a new technique comprising two bands of looped suture placed in a crossed fashion in the anterior and posterior half of the tendon (cruciate method). The repaired tendons were subjected to linear, non-cyclic load-to-failure tensile testing. The cruciate method had a significantly higher mean load at a 2-mm gap tensile load (29.7 N [SD, 8.3]) than the parallel method (21.6 N [SD, 4.9]) and failed significantly more often due to suture pull-out. The direction of a core suture and its location within the tendon affect both gap resistance and the mode of failure of repair when using the double Tsuge suture technique, with a cruciate configuration achieving a greater gap resistance than a parallel one.
Topics: Animals; Swine; Tendon Injuries; Tensile Strength; Biomechanical Phenomena; Tendons; Sutures; Suture Techniques
PubMed: 37416995
DOI: 10.1177/17531934231186011 -
Arthroscopy : the Journal of... Mar 2024The success of rotator cuff repair is often measured by patient-reported outcomes or structural healing on magnetic resonance imaging. Ideally, we can achieve both a...
The success of rotator cuff repair is often measured by patient-reported outcomes or structural healing on magnetic resonance imaging. Ideally, we can achieve both a satisfied patient and a healed tendon. Various technical modifications and stitch patterns have been presented in an effort to achieve the perfect rotator cuff repair. It appears the independently popular suture bridge technique and Mason-Allen stitch may do their best work when combined together. First, double-row repair "anchors down" the tendon to its footprint, and suture bridge adds to this concept with double-row compressive interlinking suture. Second, the Mason-Allen stitch, combining a horizontal stich and a simple stitch that passes around the horizontal, leverages the rip-stop concept where an "anchor suture" is included as a suture is passed around friable tendon like steel rebar rods strengthening concrete. In the midst of many factors out of the surgeon's control during the healing process, we are compelled to listen when a change in our technique might actually make a difference.
Topics: Humans; Rotator Cuff; Shoulder; Rotator Cuff Injuries; Arthroscopy; Sutures; Suture Techniques; Suture Anchors; Biomechanical Phenomena
PubMed: 38219092
DOI: 10.1016/j.arthro.2023.10.038 -
American Journal of Veterinary Research Jul 2023To determine whether axial twisting within an ending loop negatively impacts maximum load to failure and failure mode of suture knots.
OBJECTIVE
To determine whether axial twisting within an ending loop negatively impacts maximum load to failure and failure mode of suture knots.
SAMPLES
525 knots (15 samples each of 7 different suture types/sizes tested in 5 knot-twist configurations each).
PROCEDURES
Each suture type (polydioxanone [PDO], Monoderm [polyglecaprone 25], and Nylon) and size (1, 0, 2-0, 3-0) were used to create a starting square knot, and each of the following ending square knot configurations: 0 twists, 1 twist, 4 twists, and 10 twists. Each suture was tested for failure using a universal testing machine (Instron, Instron Corp) with a 100 kg load cell at a speed of 100 mm/min. Each suture and knot was evaluated for a mode of failure using gross evaluation of the knots and video footage recorded during testing. Maximum load at failure (P-value set at .005) and failure mode (p-value set at 0.003) were recorded for each group.
RESULTS
Maximum load at failure was decreased in knots tied within ending loops containing more twists for some types and sizes of the suture. With 4 twists, 0-PDO, 1 PDO, and 2-0 Nylon was more likely to fail at the knot than knots with 0 twists. All sutures containing 10 twists, except 3-0 Monoderm, were more likely to fail at the knot than knots with 0 twists.
CLINICAL RELEVANCE
The number of twists within the ending loop may not increase the risk of failure at the knot; however, it can decrease the maximum load to failure at a knot, particularly as the suture size increases.
Topics: Animals; Nylons; Suture Techniques; Materials Testing; Sutures; Records; Tensile Strength; Arthroscopy
PubMed: 37142233
DOI: 10.2460/ajvr.23.01.0003 -
Hand Clinics Nov 2023The use of staple technology in the upper extremity has continued to evolve with the development of shape-memory alloys (SMAs) such as Nitinol that display superelastic... (Review)
Review
The use of staple technology in the upper extremity has continued to evolve with the development of shape-memory alloys (SMAs) such as Nitinol that display superelastic properties that can be exploited for persistent compression. Clinical and biomechanical studies support the use of SMA staples for upper extremity fracture fixation and joint arthrodesis. To optimize biomechanical strength and clinical outcomes, it is recommended to place two staples, if possible, at the site of interest as well as to trough the staples to prevent hardware prominence.
Topics: Humans; Fractures, Bone; Sutures; Arthrodesis; Fracture Fixation
PubMed: 37827603
DOI: 10.1016/j.hcl.2023.05.010 -
Hand Surgery & Rehabilitation Oct 2023Sheep Achilles tendons are used as an effective preclinical model of flexor tendon repair in plastic surgery, due to their biomechanical properties, which are similar to...
OBJECTIVES
Sheep Achilles tendons are used as an effective preclinical model of flexor tendon repair in plastic surgery, due to their biomechanical properties, which are similar to humans. The aim of this study was to examine the efficacy and biomechanical outcomes of suture materials and tendon repair techniques in flexor tendon repair.
MATERIAL AND METHODS
72 sheep tendons were obtained for a total of 12 different scenarios. Tendons were repaired using 4 different suture types and 3 different suture techniques. After repair, the tendons were fixed at both ends and subjected to biomechanical tests. Ultimate Failure Load (UFL) and 2-mm Gap Load (GL) per scenario were compared statistically within and between groups.
RESULTS
UFL and GL of all sutures were significantly different between the modified Kessler, Bunnell and Krackow techniques (P < 0.05), and between Monosorb, Ti-Cron and V-loc sutures (P < 0.05). UFL and GL according to repair technique were not significantly different for the Propilen suture (P > 0.05).
CONCLUSION
When UFL and GL were considered together, our findings indicate that optimal strength scenarios were for the modified Kessler technique using Monosorb or V-loc sutures.
Topics: Humans; Animals; Sheep; Biomechanical Phenomena; Tensile Strength; Achilles Tendon; Plastic Surgery Procedures; Sutures; Suture Techniques
PubMed: 37453716
DOI: 10.1016/j.hansur.2023.06.010 -
Plastic and Reconstructive Surgery Nov 2023Wound dehiscence, with an estimated occurrence rate greater than 4% in plastic surgery, is generally underreported, and can be an indicator of increased mortality and...
SUMMARY
Wound dehiscence, with an estimated occurrence rate greater than 4% in plastic surgery, is generally underreported, and can be an indicator of increased mortality and remission rates. The authors developed the lasso suture as a stronger alternative to the current standard patterns. The lasso suture takes less time to perform than the standard high-tension wound repair method. The authors dissected caprine skin specimens to create full-thickness wounds for suture repair using simple interrupted, vertical mattress, horizontal mattress, and deep dermal with running intradermal (DDR) sutures ( n = 10) and lasso sutures ( n = 9). They then conducted uniaxial failure testing to quantify the suture rupture stresses and strains. They also measured the suture operating time with medical students and residents (PGY or MS programs) performing wound repair (10-cm wide, 2-cm deep, 2-0 polydioxanone sutures) on soft-fixed human cadaver skin. The lasso stitch had a greater first-suture rupture stress compared with all other patterns ( P < 0.001): 2.46 ± 0.27 MPa for lasso versus 0.69 ± 0.14 MPa for simple interrupted, 0.68 ± 0.13 MPa for vertical mattress, 0.50 ± 0.10 MPa for horizontal mattress, and 1.17 ± 0.28 MPa for DDR sutures. Performing the lasso suture was 28% faster than performing standard DDR (264 ± 21 versus 349 ± 25 seconds; P = 0.027). In summary, the authors showed that the lasso has superior mechanical properties compared with the studied traditional sutures, and that the new technique can be performed more quickly than the current standard (DDR stitch) for high-tension wounds. Future animal and in-clinic studies will be helpful to confirm the authors' findings in this proof-of-concept study.
CLINICAL RELEVANCE STATEMENT
The authors propose the lasso suture, a new suturing method with improved tensile performance compared with traditional techniques and a faster operative time than the deep dermal stitch typically used for high-tension wounds in reconstructive surgery to prevent wound dehiscence.
Topics: Humans; Animals; Goats; Skin; Plastic Surgery Procedures; Dermatologic Surgical Procedures; Sutures; Suture Techniques
PubMed: 36912934
DOI: 10.1097/PRS.0000000000010391 -
The American Journal of Cardiology Dec 2023Suture-mediated closure device and Figure-of-Eight suture are commonly used to achieve hemostasis after use of large bore venous access. Although both methods of closure... (Randomized Controlled Trial)
Randomized Controlled Trial
Suture-mediated closure device and Figure-of-Eight suture are commonly used to achieve hemostasis after use of large bore venous access. Although both methods of closure are commonly used in clinical practice, a head-to-head comparison in a controlled setting has not been performed. Patients presenting to a single center for elective left atrial appendage occlusion or transcatheter edge-to-edge mitral valve repair were randomized to large bore venous closure using the Perclose ProGlide suture-based closure or a Figure-of-Eight suture closure. The patients were followed for 1 month after the procedure. Primary outcome, a composite of access site large ecchymosis, hematoma, infection, pain, need for unscheduled venous ultrasound and need for transfusion, was compared between the 2 arms. A total of 40 patients were randomized in a 1:1 fashion to the 2 venous closure strategies. Baseline characteristics were similar between the 2 groups. Perclose ProGlide arm required use of more devices for hemostasis (1.5 ± 0.5 vs 1 ± 0 respectively, p <0.0001), and there was a significant difference in the cost of closure device ($367.00 ± 122.00 vs $1.00 ± 0 respectively, p <0.001). At 1 month post-procedure, the primary outcome occurred in 4 patients (20%) in the Perclose arm and 7 (35%) patients in the Figure-of-Eight arm, a difference that was not statistically significant (p = 0.48). Time to hemostasis between Figure-of-Eight and Perclose arms did not reach statistical significance (2.5 ± 2.1 vs 3.7 ± 2.3, p = 0.09). In conclusion, both Perclose ProGlide suture-based device and Figure-of-Eight closure are equally feasible and safe for patients who underwent large bore venous access. Figure-of-Eight-based closure is more cost effective.
Topics: Humans; Femoral Artery; Hemostasis; Hemostasis, Surgical; Hemostatic Techniques; Suture Techniques; Sutures; Treatment Outcome; Vascular Closure Devices; Vascular Surgical Procedures
PubMed: 37863115
DOI: 10.1016/j.amjcard.2023.09.105 -
Urology Dec 2023To report the impact of resection base inner layer renorrhaphy suture type on renal artery pseudoaneurysm (RAP) rate following robotic-assisted partial nephrectomy...
OBJECTIVE
To report the impact of resection base inner layer renorrhaphy suture type on renal artery pseudoaneurysm (RAP) rate following robotic-assisted partial nephrectomy (RAPN).
METHODS
Five hundred and sixty-three consecutive RAPNs performed by a single surgeon were retrospectively reviewed. Patients were classified into 3 categories: (1) No base suture, (2) monofilament barbed suture (2-0 V-Loc 180 absorbable suture, Medtronic, Minneapolis, MN), (3) polyglactin 910 (2-0 Vicryl coated suture, Ethicon Inc, Cincinnati, OH). In a secondary analysis, we evaluated suturing (Vicryl and V-Loc) vs no base suture. All patients had outer cortical renorrhaphy performed with 0-Vicryl suture utilizing the standard sliding clip technique.
RESULTS
One hundred ten patients (19.5%) had V-Loc suturing, 255 patients (45.3%) had Vicryl suturing, and 198 patients (35.2%) had no base suture. Patients had a median age of 62.8years (interquartile range: 53.5-69.7) and median RENAL score was 8 (6-9). Median mass size from preoperative imaging was 3.0 cm (2.5-4.0) for V-Loc, 3.3 cm (2.5-4.2) for Vicryl, and 2.0 cm (1.8-3.0) for no base suture (P < .001). Overall, 21 patients (3.7%) developed a symptomatic postoperative RAP. The rate of RAP was 3.6% (4/110) for V-Loc, 3.9% (10/255) for 2-0 Vicryl, and 3.5% (7/198) for no base suture (P = 1.00). Similarly, the rate of RAP was 3.5% (7/198) for no base suture and 3.8% (14/365) for base suture (P = 1.00).
CONCLUSION
Utilization of base suture and type of base suture used during RAPN was not predictive of postoperative RAP development.
Topics: Humans; Middle Aged; Renal Artery; Robotic Surgical Procedures; Aneurysm, False; Polyglactin 910; Retrospective Studies; Nephrectomy; Sutures; Suture Techniques
PubMed: 37673406
DOI: 10.1016/j.urology.2023.06.040 -
Retina (Philadelphia, Pa.) Dec 2023The aim of this study was to evaluate the accessibility and potential value of intraoperative optical coherence tomography (iOCT) during scleral suture intraocular lens...
PURPOSE
The aim of this study was to evaluate the accessibility and potential value of intraoperative optical coherence tomography (iOCT) during scleral suture intraocular lens (IOL) fixation.
METHODS
This was a prospective cohort study in the Department of Ophthalmology, Eye and ENT Hospital, Fudan University, China. Seven eyes with insufficient capsular support and undergoing two-point scleral suture IOL fixation were included. The potential value of iOCT was evaluated, as well as the safety and efficacy of the surgery.
RESULTS
Seven eyes were included. With a tailor-made iOCT, the structure of the anterior segment could be clearly visualized during the surgery. Intraoperatively, iOCT helped locate the proper place for fixation and access the position of the IOL. After an average 4.43-month follow-up, the spherical equivalent changed significantly ( P < 0.001), but the intraocular pressure, best-corrected visual acuity, and endothelial cell density remained unchanged ( P > 0.05). The IOL was well-centered with a horizontal and a vertical tilt of 0.74 ± 0.60° and 1.13 ± 0.65°, and decentration of 0.28 ± 0.12 mm and 0.30 ± 0.13 mm. The estimated IOL-induced astigmatism was -0.11 diopters (D) ± 0.46 D.
CONCLUSION
Real-time high-resolution images of the anterior segment acquired by the iOCT helped the surgeon to achieve satisfactory results in scleral suture IOL fixation.
Topics: Humans; Lens Implantation, Intraocular; Tomography, Optical Coherence; Prospective Studies; Lenses, Intraocular; Sclera; Sutures; Suture Techniques; Retrospective Studies
PubMed: 36996452
DOI: 10.1097/IAE.0000000000003799 -
Graefe's Archive For Clinical and... Apr 2024The purpose of this study is to determine the incidence of suture-related complications, their risk factors, and effects on the clinical outcomes after deep anterior...
PURPOSE
The purpose of this study is to determine the incidence of suture-related complications, their risk factors, and effects on the clinical outcomes after deep anterior lamellar keratoplasty (DALK) for keratoconus.
METHODS
In this retrospective, comparative, interventional study, the records of consecutive patients with keratoconus who underwent DALK were reviewed for suture-related complications. Univariate analyses were used to identify risk factors for suture complications. We compared groups with and without suture-related complications to evaluate the effects of these complications on clinical outcomes after DALK.
RESULTS
Of the 633 DALKs, 438 eyes (69.2%) developed suture complications including loose sutures (32.7%), spontaneous suture rupture (30%), sterile suture abscesses (22.8%), suture tract vascularization (16.4%), suture erosion (10.3%), and suture cheese wiring (6.8%). Vernal keratoconjunctivitis increased the incidence of sterile suture infiltration, premature suture loosening, and suture tract vascularization. Loose suture was observed more commonly in larger graft size, while spontaneous suture rupture was associated with late suture removal. There was no statistically significant difference in postoperative outcomes including visual acuity, refraction, graft rejection, and failure in eyes with and without suture complications. However, suture-related complications were directly associated with sight-threatening ocular morbidities, including graft rejection (39 eyes), ulcer (1 eye), and failure (2 eyes).
CONCLUSION
Suture-related complications frequently occurred after DALK for keratoconus. Ocular surface inflammation, large grafts, and late suture removal increased the risk of suture-related complications. While these complications had no negative impact on clinical outcomes in the majority of cases, some of them led to sight-threatening morbidity, underlining the importance of early diagnosis and treatment.
Topics: Humans; Keratoconus; Keratoplasty, Penetrating; Corneal Transplantation; Retrospective Studies; Refraction, Ocular; Sutures; Treatment Outcome; Postoperative Complications; Follow-Up Studies
PubMed: 37930442
DOI: 10.1007/s00417-023-06298-5