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Tissue Engineering. Part A Mar 2024Many surgical tendon repairs fail despite advances in surgical materials and techniques. Tendon repair failure can be partially attributed to the tendon's poor intrinsic...
Many surgical tendon repairs fail despite advances in surgical materials and techniques. Tendon repair failure can be partially attributed to the tendon's poor intrinsic healing capacity and the repurposing of sutures from other clinical applications. Electrospun materials show promise as a biological scaffold to support endogenous tendon repair, but their relatively low tensile strength has limited their clinical translation. It is hypothesized that combining electrospun fibers with a material with increased tensile strength may improve the suture's mechanical properties while retaining biophysical cues necessary to encourage cell-mediated repair. This article describes the production of a hybrid electrospun-extruded suture with a sheath of submicron electrospun fibers and a core of melt-extruded fibers. The porosity and tensile strength of this hybrid suture is compared with an electrospun-only braided suture and clinically used sutures Vicryl and polydioxanone (PDS). Bioactivity is assessed by measuring the adsorbed serum proteins on electrospun and melt-extruded filaments using mass spectrometry. Human hamstring tendon fibroblast attachment and proliferation were quantified and compared between the hybrid and control sutures. Combining an electrospun sheath with melt-extruded cores created a hybrid braid with increased tensile strength (70.1 ± 0.3N) compared with an electrospun only suture (12.9 ± 1 N, < 0.0001). The hybrid suture had a similar force at break to clinical sutures, but lower stiffness and stress. The Young's modulus was 772.6 ± 32 MPa for the hybrid suture, 1693.0 ± 69 MPa for PDS, and 3838.0 ± 132 MPa for Vicryl, < 0.0001. Hybrid sutures had lower overall porosity than electrospun-only sutures (40 ± 4% and 60 ± 7%, respectively, = 0.0018) but had a significantly larger overall porosity and average pore diameter compared with surgical sutures. There were similar clusters of adsorbed proteins on electrospun and melt-extruded filaments, which were distinct from PDS. Tendon fibroblast attachment and cell proliferation on hybrid and electrospun sutures were significantly higher than on clinical sutures. This study demonstrated that a bioactive suture with increased tensile strength and lower stiffness could be produced by adding a core of 10 μm melt-extruded fibers to a sheath of electrospun fibers. In contrast to currently used sutures, the hybrid sutures promoted a bioactive response: serum proteins adsorbed, and fibroblasts attached, survived, grew along the sutures, and adopted appropriate morphologies.
Topics: Humans; Polydioxanone; Polyglactin 910; Suture Techniques; Tendons; Sutures; Tensile Strength; Blood Proteins
PubMed: 38126344
DOI: 10.1089/ten.TEA.2023.0273 -
Current Reviews in Musculoskeletal... Jun 2024Anterior shoulder instability is associated with concomitant injury to several stabilizing structures of the shoulder, including glenoid bone loss. While instability is... (Review)
Review
PURPOSE OF REVIEW
Anterior shoulder instability is associated with concomitant injury to several stabilizing structures of the shoulder, including glenoid bone loss. While instability is most common in young athletes and patients with predisposing conditions of hyperlaxity, recurrent shoulder instability can occur throughout various age ranges and may lead to longer term effects including pain and shoulder arthritis. Glenoid bone loss exceeding certain thresholds is generally treated by glenoid reconstruction via bone block augmentation to adequately stabilize the glenohumeral joint. These procedures increase the width of the articular surface on which the humeral head can translate before dislocation and, based on the procedure performed, provide a sling effect via the conjoined tendon, and increase tension to support the anterior capsule. The purpose of this review is to summarize the available literature regarding bone block fixation techniques.
RECENT DEVELOPMENTS
Various fixation techniques have been utilized to secure bone block transfers. Though screw fixation has traditionally been used for bone block fixation, suture buttons, suture anchors, and all-suture techniques have been utilized in attempts to avoid complications associated with the use of screws. Biomechanical studies report variable force-resistance, displacement, and mode of failure when comparing screw to suture button-based fixation of glenoid bone blocks. Clinical and radiographic studies have shown these novel suture-based techniques to be comparable, and in some cases advantageous, to traditional screw fixation techniques. While screw fixation has long been the standard of care in glenoid bone block procedures, it is associated with high complication rates, leading surgeons to endeavor toward new fixation techniques. In available biomechanical studies, screw fixation has consistently demonstrated high maximal load-to-failure and displacement with cyclic loading. Studies have reported similar clinical and radiographic outcomes in both screw and suture-based fixation methods, with evidence of reduced bone resorption with suture fixation. While suture button fixation is associated with a higher rate of recurrent instability, overall complication rates are low. Future research should address biomechanical shortcomings of suture-based fixation techniques and continue to assess long-term follow-up of patients treated with each fixation method.
PubMed: 38587597
DOI: 10.1007/s12178-024-09895-x -
International Dental Journal Feb 2024The aim of this scoping review was to explore and synthesise the current evidence on the antimicrobial activity of antibacterial suture materials used in oral surgery. (Review)
Review
OBJECTIVE
The aim of this scoping review was to explore and synthesise the current evidence on the antimicrobial activity of antibacterial suture materials used in oral surgery.
METHODS
The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. A bibliographic search was carried out in the PubMed and Scopus databases to retrieve all human clinical studies that investigated the antimicrobial efficacy of antibacterial-coated sutures used in oral surgery. Included studies were screened and extracted independently by 2 examiners. Data were tabulated and qualitatively described.
RESULTS
The search initially returned 150 articles and resulted in 5 included studies after the duplicates' removal and the full-text screening. Selected studies were published from 2014 to 2019. Three studies (60%) were randomised clinical trials, whilst the remaining studies did not report information on randomisation. The antimicrobial agents for coated sutures included triclosan and chlorhexidine. In almost all the studies, antibacterial-coated sutures exhibited lower bacterial retention compared to those without coating.
CONCLUSIONS
Within limitations, the antimicrobial-coated sutures employed in oral surgery exhibited good results in terms of their microbicidal activity when compared with sutures that were not coated. Considering the high variability and confounding factors identified in the included studies, more high-quality research is needed to confirm these results. Antimicrobial-coated sutures could represent a promising and clinically valid strategy to reduce microbial colonisation in oral surgery. The reduced bacterial adherence is likely to improve the clinical success of the surgical procedures. Yet, the cost-benefit ratio of antimicrobial-coated sutures should be assessed in larger clinical trials to confirm their efficacy over conventional noncoated sutures.
PubMed: 38429145
DOI: 10.1016/j.identj.2024.01.029 -
International Journal of Surgery Case... Sep 2023Isolated duodenal perforation secondary to trauma is a rare abdominal surgical condition, with a questionable surgical approach depending on the case.
INTRODUCTION
Isolated duodenal perforation secondary to trauma is a rare abdominal surgical condition, with a questionable surgical approach depending on the case.
PRESENTATION OF CASE
This is a case report of a 27-year-old male patient who presented with a free perforation in the posterior wall of the third portion of the duodenal frame and secondary retropneumoperitoneum without injuring any contiguous organ, after a medium-impact blunt abdominal trauma during a soccer game.
DISCUSSION
A laparotomy was performed, followed by duodenorraphy with Connell-Mayo suture and Lambert suture using vascular prolene in two planes. A nasogastric tube was placed up to the jejunum, and a Jackson-Pratt drain was placed in close to the duodenum next to the sutures. During hospitalization was found a positive bacterial culture of the peritoneal fluid hence received antibiotics, without complication.
CONCLUSION
It is essential to make a timely diagnosis with its respective individualized surgical approach and it must be managed as an emergency surgical procedure.
PubMed: 37647753
DOI: 10.1016/j.ijscr.2023.108615 -
Archives of Gynecology and Obstetrics Apr 2024One of the most challenging tasks in laparoscopic gynecological surgeries is suturing. Knotless barbed sutures are intended to enable faster suturing and hemostasis. We... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
One of the most challenging tasks in laparoscopic gynecological surgeries is suturing. Knotless barbed sutures are intended to enable faster suturing and hemostasis. We carried out a meta-analysis to compare the efficacy and safety of V-Loc barbed sutures (VBS) with conventional sutures (CS) in gynecological surgeries.
METHODS
We systematically searched PubMed and EMBASE for studies published between 2010 and September 2021 comparing VBS to CS for OB/GYN procedures. All comparative studies were included. Primary analysis and subgroup analyses for the different surgery and suturing types were performed. Primary outcomes were operation time and suture time; secondary outcomes included post-operative complications, surgical site infections, estimated blood loss, length of stay, granulation tissue formation, and surgical difficulty. Results were calculated as weighted mean difference (WMD) or risk ratio (RR) and 95% confidence intervals (CI) with a random effects model, and a sensitivity analysis for study quality, study size, and outlier results was performed. PROSPERO registration: CRD42022363187.
RESULTS
In total, 25 studies involving 4452 women undergoing hysterectomy, myomectomy, or excision of endometrioma. VBS were associated with a reduction in operation time (WMD - 17.08 min; 95% CI - 21.57, - 12.59), suture time (WMD - 5.39 min; 95% CI - 7.06, - 3.71), surgical site infection (RR 0.26; 95% CI 0.09, 0.78), estimated blood loss (WMD - 44.91 ml; 95% CI - 66.01, - 23.81), granulation tissue formation (RR 0.48; 95% CI 0.25, 0.89), and surgical difficulty (WMD - 1.98 VAS score; 95% CI - 2.83, - 1.13). No difference between VBS and CS was found regarding total postoperative complications or length of stay. Many of the outcomes showed high heterogeneity, likely due to the inclusion of different surgery types and comparators. Most results were shown to be robust in the sensitivity analysis except for the reduction in granulation tissue formation.
CONCLUSION
This meta-analysis indicates that V-Loc barbed sutures are safe and effective in gynecological surgeries as they reduce operation time, suture time, blood loss, infections, and surgical difficulty without increasing post-operative complications or length of stay compared to conventional sutures.
Topics: Humans; Female; Gynecologic Surgical Procedures; Suture Techniques; Hysterectomy; Uterine Myomectomy; Sutures; Surgical Wound Infection
PubMed: 38127141
DOI: 10.1007/s00404-023-07291-3 -
Journal of Clinical Medicine Sep 2023Surgical knots are sequences of half-knots (H) or half-hitches (S), defined by their number of throws, by an opposite or similar rotation compared with the previous one,... (Review)
Review
Laparoscopic Surgery: A Systematic Review of Loop and Knot Security, Varying with the Suture and Sequences, Throws, Rotation and Destabilization of Half-Knots or Half-Hitches.
Surgical knots are sequences of half-knots (H) or half-hitches (S), defined by their number of throws, by an opposite or similar rotation compared with the previous one, and for half-hitches whether they are sliding (s) or blocking (b). Opposite rotation results in (more secure) symmetric (s) knots, similar rotation in asymmetric (a) knots, and changing the active and passive ends has the same effect as changing the rotation. Loop security is the force to keep tissue together after a first half-knot or sliding half-hitches. With polyfilament sutures, H2, H3, SSs, and SSsSsSs have a loop security of 10, 18, 28, and 48 Newton (N), respectively. With monofilament sutures, they are only 7, 16, 18, and 25 N. Since many knots can reorganize, the definition of knot security as the force at which the knot opens or the suture breaks should be replaced by the clinically more relevant percentage of clinically dangerous and insecure knots. Secure knots with polyfilament sutures require a minimum of four or five throws, but the risk of destabilization is high. With monofilament sutures, only two symmetric+4 asymmetric blocking half-hitches are secure. In conclusion, in gynecology and in open and laparoscopic surgery, half-hitch sequences are recommended because they are mandatory for monofilament sutures, adding flexibility for loop security with less risk of destabilization.
PubMed: 37834810
DOI: 10.3390/jcm12196166 -
Asian Journal of Surgery Sep 2023The CHN•WU wound suture technique uses barbed sutures. The needle is inserted from the basal part of the superficial fascia at the left edge of the wound and passed...
TECHNIQUE
The CHN•WU wound suture technique uses barbed sutures. The needle is inserted from the basal part of the superficial fascia at the left edge of the wound and passed through half of the reticular dermis to reach a point (1A) approximately 0.5-2 cm away from the wound edge. Occlusion is achieved at 1A at the level of the reticular dermis, and if done correctly, a shallow concavity will appear at the occlusion point on the skin. The needle is then walked along the natural curvature until it reaches the center of the wound and then moved out from the junction between the dermis and subcutaneous tissue. On the other side of the incision, the needle is inserted into the contralateral position at the junction between the dermis and subcutaneous tissue and moved along its natural curvature to achieve occlusion at the mirror site of 1A in the reticular dermis. This process is repeated until the entire wound is closed. In the end, two stitches should be applied in the opposite direction. The left barbed suture is cut and thrown.
RESULTS
This technique does not break through the epidermis, has high suture efficiency and satisfactory cosmetic appearance, disperses mechanical tension, and maintains wound tensile strength.
CONCLUSION
This technique was especially effective in closing high-tension wounds in the chest and extremities where the blood supply to both sides of the wound was not affected after suturing, and wound closure could be performed quickly and efficiently in one stage.
Topics: Humans; Suture Techniques; Neurosurgical Procedures; Sutures; Skin; Subcutaneous Tissue
PubMed: 37308388
DOI: 10.1016/j.asjsur.2023.05.114 -
European Journal of Orthopaedic Surgery... Dec 2023Patellar tendon ruptures (PTR) occur predominantly in middle-aged patients following indirect trauma. The aim of this study was to quantify the short-term results using...
PURPOSE
Patellar tendon ruptures (PTR) occur predominantly in middle-aged patients following indirect trauma. The aim of this study was to quantify the short-term results using a suture tape augmentation technique for the repair of PTR.
METHODS
All consecutive patients with acute (< 6 weeks) PTR who underwent suture tape augmentation between 03/2014 and 11/2019 at a single institution with a minimum follow-up of 12 months were retrospectively evaluated. Outcome measures included Visual Analog Scale (VAS) for pain, Tegner Activity Scale (TAS) and return to sport rates, Lysholm score, International Knee Documentation Committee subjective knee form (IKDC) as well as Knee Injury and Osteoarthritis Outcome Score (KOOS). Additionally, a standardized clinical examination and an isometric strength evaluation of knee extension and flexion were performed. It was hypothesized that high return to sport rates and good functional outcome would be observed and that the majority of patients would not present with a severe (> 20%) knee extension strength deficit when compared to the contralateral side.
RESULTS
A total of 7 patients (mean age 37.0 ± SD 13.5 years; 6 male/1 female) were available for final assessment at a median follow-up of 17.0 (25-75% IQR 16.0-77.0) months. Three injuries occurred during ball sports, two injuries occurred during winter sports, and one injury each occurred during a motorcycling and skateboarding accident. The average time between trauma and surgery was 4.7 ± 2.6 days. At follow-up, patients reported little pain (VAS: 0 [0-0.4]). Return to sport was possible for all patients 8.9 ± 4.0 months postoperatively at a high level (TAS: 7.0 [6.0-7.0]). Five patients (71.4%) returned to the preinjury level of play, and 2 (28.6%) did not return to the preinjury level of play. Patient-reported outcome measures were moderate to good (Lysholm score: 80.4 ± 14.5; IKDC: 84.2 ± 10.6; KOOS subscales: pain 95.6 ± 6.0, symptoms 81.1 [64.9-89.1], activities of daily living 98.5 [94.1-100], sport and recreation function 82.9 ± 14.1 and knee-related quality of life 75.9 ± 16.3). All patients were very satisfied (57.1%) or satisfied (42.9%) with the postoperative result. No postoperative complications were reported. Strength measurements revealed a severe knee extension deficit in 3 patients (42.9%), but no significant deficit of isometric knee extension or flexion strength in comparison with the contralateral side was observed overall (p > 0.05).
CONCLUSION
Suture tape augmentation in acute PTR repair leads to good functional outcome without major complications. Although a severe knee extension strength deficit may occur in some patients postoperatively, an excellent return to sports rate and high patient satisfaction can be expected nonetheless.
LEVEL OF EVIDENCE
Retrospective cohort study; III.
Topics: Middle Aged; Humans; Male; Female; Adult; Patellar Ligament; Retrospective Studies; Activities of Daily Living; Quality of Life; Knee Joint; Knee Injuries; Tendon Injuries; Pain; Sutures; Anterior Cruciate Ligament Injuries; Treatment Outcome; Return to Sport
PubMed: 37233797
DOI: 10.1007/s00590-023-03572-4 -
Materials (Basel, Switzerland) Nov 2023Surgical site infections (SSIs) may result from surgical procedures requiring a secondary administration of drugs at site or systemically in treating the infection.... (Review)
Review
Surgical site infections (SSIs) may result from surgical procedures requiring a secondary administration of drugs at site or systemically in treating the infection. Drug-eluting sutures containing antimicrobial agents symbolise a latent strategy that precludes a secondary drug administration. It also offers the possibility of delivering a myriad of therapeutic agents to a localised wound site to effect analgesia, anti-inflammation, or the deployment of proteins useful for wound healing. Further, the use of biodegradable drug-eluting sutures eliminates the need for implanting foreign material into the wound, which needs to be removed after healing. In this review, we expound on recent trends in the manufacture of drug-eluting sutures with a focus on the hot-melt extrusion (HME) technique. HME provides a solvent-free, continuous one-step manufacturing conduit for drug-eluting sutures, hence, there is no drying step, which can be detrimental to the drug or suture threads and, thus, environmentally friendly. There is the possibility of combining the technology with additive manufacturing platforms to generate personalised drug-loaded implantable devices through prototyping and scalability. The review also highlights key material requirements for fabricating drug-eluting sutures by HME, as well as quality attributes. Finally, a preview of emerging drug-eluting sutures and advocacy for harmonisation of quality assurance by regulatory authorities that permits quality evaluation of novelty sutures is presented.
PubMed: 38005174
DOI: 10.3390/ma16227245 -
Acta Ortopedica Brasileira 2023Currently, the market offers a wide variety of suture threads, made of materials with different structural and chemical properties. Among many other characteristics,...
UNLABELLED
Currently, the market offers a wide variety of suture threads, made of materials with different structural and chemical properties. Among many other characteristics, they vary in origin, absorption or degradation, and structure. From this variety, the clinical doubt arises as to which material provides the patient with the best healing quality.
OBJECTIVE
This study aims to comparatively evaluate two different types of suture threads-Monocryl (polyglycaprone 25) and Ethilon (nylon)-regarding their ability to aid in tissue regeneration by a histological and immunohistochemical analysis of the skin of rats sutured with the aforementioned materials.
METHODS
This basic experimental study used 12 adult Wistar rats, randomly divided into three groups with four animals each and subjected to four longitudinal incisions under anesthesia. Each group corresponded to a postsurgical evaluation date (one, seven, and 14 days).
RESULTS
At 14 postoperative days, the studied groups had no histological difference. However, the use of nylon thread showed greater evidence of earlier fibrotic union.
CONCLUSION
This study found no histological difference in healing 14 days after surgery among the techniques and the types of suture threads.
PubMed: 37547237
DOI: 10.1590/1413-785220233104e266635