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The Journal of Hand Surgery Feb 2022Sutures are used ubiquitously in surgery and are the most implanted materials in hand surgery. However, surgical training does not routinely include formal education on... (Review)
Review
Sutures are used ubiquitously in surgery and are the most implanted materials in hand surgery. However, surgical training does not routinely include formal education on stitching materials or needles. Rather, suture familiarity is passed down by common use throughout training. We focus on a brief history and evolution of suture materials and suture needles, their material and mechanical properties, hand surgery-specific applications, other methods of skin closure (staples, skin glue, and adhesive strips), a cost analysis, and advances in musculoskeletal suturing, with a look toward the future. Equipped with a fundamental knowledge of suture needles and suture materials, hand surgeons will be better prepared to select the most appropriate, situation-specific tools.
Topics: Humans; Needles; Surgeons; Suture Techniques; Sutures
PubMed: 34839964
DOI: 10.1016/j.jhsa.2021.09.019 -
Calcified Tissue International Mar 2022Trans-sutural distraction osteogenesis has been proposed as an alternative technique of craniofacial remodelling surgery for craniosynostosis correction. Many studies... (Review)
Review
Trans-sutural distraction osteogenesis has been proposed as an alternative technique of craniofacial remodelling surgery for craniosynostosis correction. Many studies have defined the contribution of a series of biological events to distraction osteogenesis, such as changes in gene expression, changes in suture cell behaviour and changes in suture collagen fibre characteristics. However, few studies have elucidated the systematic molecular and cellular mechanisms of trans-sutural distraction osteogenesis, and no study has highlighted the contribution of cell-cell or cell-matrix interactions with respect to the whole expansion process to date. Therefore, it is difficult to translate largely primary mechanistic insights into clinical applications and optimize the clinical outcome of trans-sutural distraction osteogenesis. In this review, we carefully summarize in detail the literature related to the effects of mechanical stretching on osteoblasts, endothelial cells, fibroblasts, immune cells (macrophages and T cells), mesenchymal stem cells and collagen fibres in sutures during the distraction osteogenesis process. We also briefly review the contribution of cell-cell or cell-matrix interactions to bone regeneration at the osteogenic suture front from a comprehensive viewpoint.
Topics: Collagen; Cranial Sutures; Endothelial Cells; Osteogenesis; Osteogenesis, Distraction; Sutures
PubMed: 34802070
DOI: 10.1007/s00223-021-00927-z -
Injury Dec 2023The biomechanical assessment of tendon repair is essential for the evaluation of different tendon suturing techniques. The shoelace suture technique with absorbable... (Review)
Review
BACKGROUND
The biomechanical assessment of tendon repair is essential for the evaluation of different tendon suturing techniques. The shoelace suture technique with absorbable Vicryl® is a modified technique of Achilles tendon repair that may have biomechanical advantages depending on the number of threads used and the direction of the suture.
PURPOSE
To evaluate the creep under constant pre-load, the stiffness, the maximum strength, and the failure mode for three different configurations of the shoelace suture in a bovine tendon biomechanical model.
STUDY DESIGN
Controlled Laboratory Study.
METHODS
36 bovine Achilles tendon specimens were acquired and divided into three test groups of 12 Achilles tendons each. A model of the calcaneal tendon rupture was created through a transverse cut with a scalpel, performed 5 centimeters proximal to the calcaneal bone insertion. Group 1 was repaired using the simple shoelace technique with just one suture. Group 2 was repaired using the shoelace technique with three sutures individually sutured from distal to proximal at the site of rupture. Group 3 was repaired using the shoelace technique with three sutures individually sutured from proximal to distal at the site of rupture.
RESULTS
System creep after constant pre-load was 5.9 ± 2.5 mm, 3.0 ± 0.4 mm and 2.9 ± 0.4 mm for groups 1, 2 and 3, respectively. The system's stiffness was 23.2 ± 2.8 N/mm, 30.3 ± 1.1 N/mm and 29.8 ± 2.3 N/mm for groups 1, 2 and 3, respectively. In the final load-to-failure test, the ultimate load force (ULF) was 158.2 ± 27.5 N, 346.5 ± 47.6 N and 358.1 ± 41.6 N for groups 1, 2 and 3, respectively. There was statistical significance in the comparative tests between groups 1-2 and 1-3 in terms of means of creep, system stiffness and maximum system strength. No statistically significant difference was found between groups 2 and 3 when analyzing creep, system stiffness and ULF. Suture breakage was the prevalent mode of failure for all tested groups.
CONCLUSION
The shoelace with three sutures significantly reduced creep in the preloading phase and increased the stiffness and ultimate load force. The biomechanical results demonstrate better overall mechanical performance of the technique than the simple shoelace technique. The better mechanical performance indicates that the shoelace with three sutures could result in early postoperative rehabilitation.
CLINICAL RELEVANCE
This study indicates that the shoelace suture technique with three sutures is biomechanically strong and stiff, being a possible therapeutic option to be used.
Topics: Humans; Animals; Cattle; Achilles Tendon; Biomechanical Phenomena; Tendon Injuries; Plastic Surgery Procedures; Suture Techniques; Sutures; Rupture
PubMed: 37890290
DOI: 10.1016/j.injury.2023.111134 -
Nederlands Tijdschrift Voor... Jun 2024This article highlights the importance of proper suturing of mucosa, gingiva, and skin after surgical procedures and trauma. Several factors play a role in promoting... (Review)
Review
This article highlights the importance of proper suturing of mucosa, gingiva, and skin after surgical procedures and trauma. Several factors play a role in promoting good healing, including optimal tension on the sutured wound, adequate blood flow, and careful selection of suture materials. The selected suture material depends on various factors, such as type of tissue, location of the wound, and healing time. Different suture techniques are discussed, including interrupted sutures, continuous sutures, horizontal and vertical mattress sutures, each with their own specific applications and benefits. Skillfulness in suture techniques and appropriate material selection contribute to effective wound healing and optimal outcomes.
Topics: Humans; Suture Techniques; Oral Surgical Procedures; Sutures; Wound Healing; Gingiva; Mouth Mucosa
PubMed: 38860657
DOI: 10.5177/ntvt.2024.06.23090 -
Archives of Gynecology and Obstetrics Sep 2015Total laparoscopic or robotic hysterectomy represents one of the most performed gynecological procedures nowadays. Minimally invasive procedures seem to increase the... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Total laparoscopic or robotic hysterectomy represents one of the most performed gynecological procedures nowadays. Minimally invasive procedures seem to increase the risk of vaginal cuff dehiscence (VCD). Barbed suture is a new class of suture introduced to aid surgeons during laparoscopic suturing, with the aim to reduce operative time, blood loss, and vaginal dehiscence.
METHODS
We identified all articles that report a series of laparoscopic or robotic-assisted hysterectomy using barbed suture compared to conventional suture for vaginal cuff closure. The main outcome measures were vaginal cuff suturing time, vaginal bleeding, and vaginal dehiscence with or without small bowel evisceration. Suturing time was meta-analyzed as the standardized mean difference, which is the difference in means of two arms divided by pooled standard deviation with 95 % confidence intervals. For vaginal bleeding and dehiscence risk difference were calculated for each study and then meta-analyzed. Fixed models were considered if heterogeneity was low (I (2) < 50 %), otherwise random models were preferred.
RESULTS
We show that minor bleeding (RD = 0, 95 % CI 0.03-0.03; p value = 0.907) and VCD (RD = -0.01, 95 % CI 0.02-0.00; p value = 0.119) are comparable in minimally invasive hysterectomy with or without the use of barbed suture. The major bleeding (RD = -0.03; 95 % CI 0.05-0.00; p value = 0.047) appears borderline significant, but the difference between the two types of sutures is not high and the upper limit of 95 % IC is equal to 0 so they were considered comparable. Instead, meta-analysis on vaginal cuff suturing time demonstrates that suturing time is reduced with the use of barbed suture (SMD = -0.96, 95 % CI 1.26-0.70; p value <0.001).
CONCLUSIONS
Barbed suture is safe and well tolerated as traditional sutures and is associated with reduced operative time of laparoscopic vaginal vault closure.
Topics: Blood Loss, Surgical; Colpotomy; Female; Humans; Hysterectomy; Laparoscopy; Minimally Invasive Surgical Procedures; Operative Time; Pregnancy; Robotics; Suture Techniques; Sutures; Treatment Outcome; Uterine Hemorrhage; Vagina
PubMed: 25700658
DOI: 10.1007/s00404-015-3653-x -
Journal of Minimally Invasive Gynecology Jul 2022To compare perioperative outcomes between knotless barbed sutures (KBSs) and conventional smooth sutures for uterine incision closure at cesarean section. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare perioperative outcomes between knotless barbed sutures (KBSs) and conventional smooth sutures for uterine incision closure at cesarean section.
DATA SOURCES
MEDLINE, EMBASE, Web of Sciences, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched from the inception of the study to March 2021 without language restriction. The search terms were as follows: ["Stratafix" OR "Quill" OR "V-Loc" OR "Barbs" OR "barbed"] AND ["Cesarean" OR "Caesarean"] AND ["Suturing" OR "Suture" OR "Closure" OR "Repair"]. Moreover, these terms were combined to complete the search.
METHODS OF STUDY SELECTION
Retrospective and randomized peer-reviewed studies comparing the use of KBSs and conventional sutures for uterine incision closure at cesarean section were included. The studies' quality was assessed by the Cochrane risk-of-bias tool. The primary outcome was the time of uterine incision closure in seconds. The secondary outcomes included total operating time (minutes), use of additional hemostatic sutures, rates of blood transfusion, and postoperative complications.
TABULATION, INTEGRATION, AND RESULTS
Of 20 reports identified, 4 representing 3332 women (1473 with KBSs and 1859 with conventional sutures) were eligible. All studies were judged to be at low risk of bias. The uterine incision closure time was significantly lower in the KBS group (mean difference, -110.58; 95% confidence interval [CI], -127.37 to -93.79; p = .001). Furthermore, the rate of use of additional hemostatic sutures was significantly lower in the KBS group (odds ratio, 0.14; 95% CI, 0.07-0.26; p = .001). Total operative time, rates of blood transfusion, febrile morbidity, and length of postoperative stay were comparable. The incidence of postoperative ileus was significantly lower in the KBS group (odds ratio, 0.31; 95% CI, 0.11-0.89; p = .029).
CONCLUSION
The use of KBSs for uterine incision closure was associated with decreased hysterotomy closure time and less frequent need for the placement of additional hemostatic sutures. Other perioperative outcomes were not affected, although the risk of postoperative ileus was reduced.
Topics: Cesarean Section; Female; Hemostatics; Humans; Hysterotomy; Ileus; Postoperative Complications; Pregnancy; Retrospective Studies; Suture Techniques; Sutures
PubMed: 35533955
DOI: 10.1016/j.jmig.2022.05.001 -
American Family Physician Dec 1991The ideal suture is strong, handles easily and forms secure knots. It causes minimal tissue inflammation and does not promote infection. It stretches, accommodates wound... (Comparative Study)
Comparative Study Review
The ideal suture is strong, handles easily and forms secure knots. It causes minimal tissue inflammation and does not promote infection. It stretches, accommodates wound edema and recoils to its original length with wound contraction. Ideally, it is also inexpensive. Although no single suture material possesses all of these features, proper selection of sutures helps achieve better results in skin surgery. Among the absorbable sutures are catgut and treated catgut (both are used infrequently) and the synthetic sutures, which are designed for good tensile strength, easy handling and low tissue reactivity. Nonabsorbable sutures include silk (now infrequently used) and several synthetic materials designed for elasticity, easy handling, good knot security and minimal tissue irritation.
Topics: Absorption; Animals; Dermatologic Surgical Procedures; Elasticity; Humans; Plastics; Polyesters; Polymers; Sutures; Tensile Strength
PubMed: 1746393
DOI: No ID Found -
Journal of Plastic, Reconstructive &... Mar 2022In buried suture methods, the levator aponeurosis is fixed to the subcutaneous tissue in the pretarsal region using a suture. However, loosening of the suture occurs...
BACKGROUND
In buried suture methods, the levator aponeurosis is fixed to the subcutaneous tissue in the pretarsal region using a suture. However, loosening of the suture occurs frequently and causes regression or disappearance of the double-eyelid folds. To avoid potential loosening of the suture after surgery, we modified the horizontal suture technique commonly used in buried suture double-eyelid blepharoplasty.
METHODS
In our procedure, the levator aponeurosis was sutured horizontally, and then the subcutaneous tissue in the pretarsal region was sutured vertically by the same suture. After the two ends of the suture were tied, three tissue layers, namely, the levator aponeurosis, pretarsal fascia, and orbicularis oculi muscle, were fixed together in the pretarsal region.
RESULTS
A total of 873 Asian patients underwent double-eyelid blepharoplasty during the past 8 years. No loss of the double-eyelid folds occurred in 563 patients who were followed up for more than six months, and 531 patients, accounting for 94% of the sample, were satisfied with the postoperative results.
CONCLUSION
Since the suture was perpendicular to both the levator aponeurosis and the pretarsal orbicularis oculi muscle, pulling on the suture fixation site during blinking was effectively reduced. As a result, regression or disappearance of the double-eyelid folds due to loosening of the suture along the orientation of the muscle fibers was avoided, and the long-term stability of the double-eyelid folds was ensured.
Topics: Ankle; Blepharoplasty; Eyelids; Humans; Suture Techniques; Sutures
PubMed: 34896040
DOI: 10.1016/j.bjps.2021.11.012 -
Journal of the American Academy of... Apr 2024
Topics: Humans; Suture Techniques; Treatment Outcome; Sutures; Surgical Wound Infection
PubMed: 37224969
DOI: 10.1016/j.jaad.2023.05.032 -
Anatomical Record (Hoboken, N.J. : 2007) Dec 2021Cranial sutures join the many bones of the skull. They are therefore points of weakness and consequently subjected to the many mechanical stresses affecting the cranium....
Cranial sutures join the many bones of the skull. They are therefore points of weakness and consequently subjected to the many mechanical stresses affecting the cranium. However, the way in which this impacts their morphological complexity remains unclear. We examine the intrinsic and extrinsic mechanisms of human sagittal sutures by quantifying the morphology from 107 individuals from archaeological populations spanning the Mesolithic to Middle ages, using standardized two-dimensional photographs. Results show that the most important factor determining sutural complexity appears to be the position along the cranial vault from the junction with the coronal suture at its anterior-most point to the junction with the lambdoid suture at its posterior-most point. Conversely, factors such as age and lifeways show few trends in complexity, the most significant of which is a lower complexity in the sutures of Mesolithic individuals who consumed a tougher diet. The simple technique used in this study therefore allowed us to identify that, taken together, structural aspects play a more important role in defining the complexity of the human sagittal suture than extrinsic factors such as the mechanical forces imposed on the cranium by individuals' diet.
Topics: Archaeology; Cranial Sutures; Head; Humans; Skull; Sutures
PubMed: 33773064
DOI: 10.1002/ar.24627