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Scientific Reports Mar 2022Esophageal elongation is one of the methods of long gap esophageal atresia treatment. The aim of the study was to determine the best type of traction suture for...
Esophageal elongation is one of the methods of long gap esophageal atresia treatment. The aim of the study was to determine the best type of traction suture for esophageal lengthening on an animal model. White Pekin Duck's esophagi were used as a model (fresh-frozen and thawed). The esophagus was cut in half, then both ends were sutured together and extended on a tensiometer. Tested sutures involved simple suture, suture aided by a single or double clip, and suture aided by pledget (10 samples each). Constant and 2 methods of intermittent traction were also compared. The histological study showed similarities between duck's and newborn's esophagus. The highest maximal force was achieved with pledget suture (F = 8.59 N ± 1.45 N), then with double clip (F = 5.74 N ± 1.29 N) and the lowest with single suture (F = 3.80 N ± 0.54 N) (p < 0.001). Pledget suture also allowed for the greatest elongation (p < 0.01). Intermittent traction results in better elongation at the same breaking strength as constant traction (p < 0.05) if traction is maintained during breaks. Reinforced sutures (pledget or double clip) should be taken into consideration in internal traction. When performing traction sutures, it is worth step by step carefully tightening the sliding knot in short periods before its final binding.
Topics: Anastomosis, Surgical; Animals; Biomechanical Phenomena; Disease Models, Animal; Esophagus; Suture Techniques; Sutures; Tensile Strength; Traction
PubMed: 35233044
DOI: 10.1038/s41598-022-07348-4 -
The Journal of Surgical Research Nov 2020The use of sutures remains the first choice for wound closure. However, incorrect use of a suture technique can lead to impaired healing. Many techniques are described... (Comparative Study)
Comparative Study
BACKGROUND
The use of sutures remains the first choice for wound closure. However, incorrect use of a suture technique can lead to impaired healing. Many techniques are described for high-tension wounds, but not much is known about their mechanical properties. Complications of excessive tension include dehiscence, infection, and ischemic necrosis and could be prevented. This study aimed to compare forces in five techniques (single, horizontal mattress, vertical mattress, pulley, and modified pulley suture) in a standardized wound tension model.
MATERIALS AND METHODS
A standardized neoprene wound model was developed on the ForceTRAP system (MediShield B.V., Delft, The Netherlands) to mimic a 5 Newton (N) wound. Five different suture techniques were each repeated 10 times by a student, resident dermatology, and dermsurgeon. The pulling force of the suture's first throw was measured with the Hook-in-Force sensor (Technical University Delft, The Netherlands). Changes in wound tension were measured by the ForceTRAP system. The ForceTRAP is a platform measuring forces from 0 to 20 N in three dimensions with an accuracy of 0.1 N. The Hook-in-Force is a force sensor measuring 0-15 N with an accuracy of 0.5 N. Maximum and mean forces were calculated for each suture technique and operator.
RESULTS
Mean maximum pulling force: 5.69 N (standard deviation [SD], 0.88) single, 7.25 N (SD, 1.33) vertical mattress, 8.11 N (SD, 1.00) horizontal mattress, 3.46 N (SD, 0.61) pulley, and 4.52 N (SD, 0.67) modified pulley suture. The mean force increase on the skin (substitute) ranged between 0.80 N (pulley) and 0.96 N (vertical mattress).
CONCLUSIONS
The pulley suture requires less pulling force compared with other techniques. The mechanical properties of sutures should be taken in consideration when choosing a technique to close wounds.
Topics: Dermatologic Surgical Procedures; Materials Testing; Suture Techniques; Sutures; Tensile Strength
PubMed: 32543379
DOI: 10.1016/j.jss.2020.05.033 -
IEEE Transactions on Bio-medical... Apr 2019As robotic surgery has increased in popularity, the lack of haptic feedback has become a growing issue due to the application of excessive forces that may lead to...
As robotic surgery has increased in popularity, the lack of haptic feedback has become a growing issue due to the application of excessive forces that may lead to clinical problems such as intraoperative and postoperative suture breakage. Previous suture breakage warning systems have largely depended on visual and/or auditory feedback modalities, which have been shown to increase cognitive load and reduce operator performance. This work catalogues a new sensing technology and haptic feedback system (HFS) that can reduce instances of suture failure without negatively impacting performance outcomes including knot quality. Suture breakage is common in knot-tying as the pulling motion introduces prominent shear forces. A shear sensor mountable on the da Vinci robotic surgical system's Cadiere grasper detects forces that correlate to the suture's internal tension. HFS then provides vibration feedback to the operator as forces near a particular material's failure load. To validate the system, subjects tightened a total of four knots, two with the Haptic Feedback System (HFS) and two without feedback. The number of suture breakages were recorded and knot fidelity was evaluated by measuring knot slippage. Results showed that instances of suture failure were significantly reduced when HFS was enabled (p = 0.0078). Notably, knots tied with HFS also showed improved quality compared to those tied without feedback (p = 0.010). The results highlight the value of HFS in improving robotic procedure outcomes by reducing instances of suture failures, producing better knots, and reducing the need for corrective measures.
Topics: Equipment Design; Feedback; Humans; Materials Testing; Robotic Surgical Procedures; Suture Techniques; Sutures; Task Performance and Analysis; Tensile Strength
PubMed: 30207946
DOI: 10.1109/TBME.2018.2869417 -
Journal of Orthopaedic Research :... Jan 2013In orthopedic surgery, the reattachment of tendon to bone requires suture materials that have stable and durable properties to allow time for healing at the tendon-bone... (Comparative Study)
Comparative Study
In orthopedic surgery, the reattachment of tendon to bone requires suture materials that have stable and durable properties to allow time for healing at the tendon-bone interface. The suture, not rigidly restrained within the anchor eyelet, is free to move during surgery and potentially after surgery with limb motion. During such movement, the suture is subjected to bending and frictional forces that can lead to fatigue-induced failure. We investigated some common contemporary commercial number-two-grade suture materials and evaluated their resistance to bending abrasion fatigue and the consequent failure. Sutures were oscillated over a stainless steel wire at low frequency under load. Number of abrasion cycles to failure, changes in suture morphology, and fatigue-failure method was recorded for each material. Suture structure had a significant effect on abrasion resistance, with braided sutures containing large numbers of fine high tenacity core filaments performing 15-20 times better than other braided suture structures. Ultra high molecular weight polyethylene (UHMWPE) core filaments resisted bending abrasion failure better than other core materials due to the load spreading and abrasion resistance of these filaments. Sutures with UHMWPE cores also had high resistance to tensile failure. Limited correlation was observed between tensile strength and abrasion resistance.
Topics: Arthroscopy; Bone and Bones; Equipment Failure Analysis; Friction; Humans; Materials Testing; Polydioxanone; Polyethylenes; Sutures; Tendons; Tensile Strength; Weight-Bearing
PubMed: 22777625
DOI: 10.1002/jor.22185 -
Hernia : the Journal of Hernias and... Dec 2022Incisional hernias often follow open abdominal surgery. A small-stitch-small-bite suture might close the incision durably. We analyzed specific details of this closure...
PURPOSE
Incisional hernias often follow open abdominal surgery. A small-stitch-small-bite suture might close the incision durably. We analyzed specific details of this closure technique and assessed their influence on the closure stability.
METHODS
The effects of cyclic loads, simulating coughs were investigated on a bench test. We prepared porcine bellies in the median line and bovine flanks parallel to the muscle fibers with 15 cm long incisions. Then we punched round or rhomboid defects with a diameter of 5-10 cm into the center of the incision. Monomax® 2-0 and Maxon® 1 and 2-0 were used as suture materials. We tested the durability of the closure with pressure impacts of 210 mmHg repeated 425 times. Throughout the experiments, we modified the suturing technique, the surgeon, the tissue tension, the defect size and shape and the suture diameter.
RESULTS
Standardizing the suture technique improved the durability of the closure significantly. Any other variations showed minor influences after standardization. All incisions with round defects up to 7.5 cm width withstood 425 impacts using standardized suturing. Unstandardized sutures failed in all cases. When closing an incision with a 10 cm wide defect, the tissues ruptured frequently next to the suture line. We defined criteria to standardize this suturing technique. For the first time, we developed a suture factor related to the durability of a sutured tissue closure. We integrated the suture factor into the concept of biomechanically durable repairs.
CONCLUSIONS
Suturing the abdominal wall with a standardized suturing technique improves its durability significantly.
Topics: Animals; Cattle; Swine; Herniorrhaphy; Sutures; Incisional Hernia; Abdominal Wall; Suture Techniques; Abdominal Wound Closure Techniques
PubMed: 35997898
DOI: 10.1007/s10029-022-02659-x -
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 -
Turkish Neurosurgery 2023To present a technique for tightening continuous suture loops in microvascular side-to-side anastomosis with a microneedle.
AIM
To present a technique for tightening continuous suture loops in microvascular side-to-side anastomosis with a microneedle.
MATERIAL AND METHODS
The technique for tightening continuous suture loops with a microneedle was presented in side-to-side microvascular anastomosis in chicken thighs arteries and rat common carotid arteries. After all the spiral continuous suture loops were loosely placed, the tip of the microneedle was used to precisely and gently tighten the second suture loop, then microforceps was used to pick this loop up and gently tighten it, while the body of the microneedle was gently applied to create a counterforce on the inner or outer surface of the vessel to help tighten the first loop under appropriate tension and place it in an appropriate position.
RESULTS
With this technique the author described, there is no need to change to any other surgical instruments during anastomosis, and these continuous suture loops in continuous microvascular anastomosis could be effectively tightened with a microneedle. And the technique was successfully applied in side-to-side microvascular anastomosis in chicken thighs arteries and rat common carotid arteries.
CONCLUSION
Microneedle could be safely and effectively used as a microretractor to tighten the continuous suture loops in continuous microvascular anastomosis. The judicious and discreet use of a microneedle as a multifunctional instrument for functions other than suturing could minimize the exchange of instruments and improve operative efficiency.
Topics: Rats; Animals; Suture Techniques; Microsurgery; Anastomosis, Surgical; Sutures; Neurosurgical Procedures; Chickens
PubMed: 36300578
DOI: 10.5137/1019-5149.JTN.37621-22.3 -
The Cochrane Database of Systematic... 2000Approximately 70% of women will experience some degree of perineal trauma following vaginal delivery and will require stitches. This may result in perineal pain and... (Review)
Review
BACKGROUND
Approximately 70% of women will experience some degree of perineal trauma following vaginal delivery and will require stitches. This may result in perineal pain and superficial dyspareunia.
OBJECTIVES
The objective of this review was to assess the effects of absorbable synthetic suture material as compared with catgut on the amount of short and long term pain experienced by mothers following perineal repair.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group trials register.
SELECTION CRITERIA
Randomised trials comparing absorbable synthetic (polyglycolic acid and polyglactin) with plain or chromic catgut suture for perineal repair in mothers after vaginal delivery.
DATA COLLECTION AND ANALYSIS
Trial quality was assessed independently by two reviewers. Data were extracted by one reviewer and checked by the second reviewer.
MAIN RESULTS
Eight trials were included. Compared with catgut, the polyglycolic acid and polyglactin groups were associated with less pain in first three days (odds ratio 0.62, 95% confidence interval 0.54 to 0.71). There was also less need for analgesia (odds ratio 0.63, 95% confidence interval 0.52 to 0.77) and less suture dehiscence (odds ratio 0.45, 95% confidence interval 0.29 to 0.70). There was no significant difference in long term pain (odds ratio 0.81, 95% confidence interval 0.61 to 1.08). Removal of suture material was significantly more common in the polyglycolic acid and polyglactin groups (odds ratio 2.01, 95% confidence interval 1.56 to 2.58). There was no difference in the amount of dyspareunia experienced by women.
REVIEWER'S CONCLUSIONS
Absorbable synthetic suture material (in the form of polyglycolic acid and polyglactin sutures) for perineal repair following childbirth appears to decrease women's experience of short-term pain. The length of time taken for the synthetic material to be absorbed is of concern. A trial addressing the use of polyglactin has recently been completed and this has been included in this updated review.
Topics: Catgut; Delivery, Obstetric; Female; Humans; Perineum; Polyglactin 910; Polyglycolic Acid; Pregnancy; Sutures
PubMed: 10796081
DOI: 10.1002/14651858.CD000006 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... May 2022To provide systematic information for deep understanding and improvement of tension-reducing suture of deep layer skin.
OBJECTIVE
To provide systematic information for deep understanding and improvement of tension-reducing suture of deep layer skin.
METHODS
The related literature over the years was extensively collected and precisely processed to summarize the characteristics and applications of different tension-reducing suture of deep layer skin.
RESULTS
Throughout the development of plastic surgery, tension-reducing suture of deep layer skin mainly includes vertical mattress suture and its modified styles, horizontal mattress suture and its modified styles, and some special types of suture technique, and each one of them has its own characteristics and is suitable for wounds with different tension and shape.
CONCLUSION
Clinically, surgeons need to select appropriate tension-reducing suture techniques according to specific factors such as wound location and tension, so as to fully reduce the tension of the wound, which can achieve good wound healing and prevent the pathological scaring.
Topics: Neurosurgical Procedures; Suture Techniques; Sutures; Wound Healing
PubMed: 35570642
DOI: 10.7507/1002-1892.202201042 -
The Laryngoscope Feb 2019Surgical simulators aimed at mimicking elements of rhinoplasty surgery, specifically those aimed at improving cartilage suturing, are not available. Here, we present a...
OBJECTIVE
Surgical simulators aimed at mimicking elements of rhinoplasty surgery, specifically those aimed at improving cartilage suturing, are not available. Here, we present a surgical simulator for spreader graft placement that uses cartilage rather than synthetic materials and gauge improvement using objective measures for suture placement accuracy, speed, and efficiency of hand motion.
METHODS
Twenty-two otolaryngologists in two groups (residents [10] and experts [12]) were instructed to secure the two spreader graft specimen into position with three mattress sutures on a nose model that used porcine septal cartilage as a proxy for the human counterpart. Hand motion was tracked using an electromagnetic position sensing device. The time required to complete the suture task, total hand displacement, cumulative number of hand motion direction changes, and accuracy of suture insertion were measured. These measurements were compared between the two cohort groups for construct validity. The subjects completed a survey to evaluate realism and value of the model.
RESULTS
The expert group had a lower mean time required to complete the task (P < 0.05), total hand displacement (P < 0.01), and number of hand motion direction changes (P < 0.001). No significant difference was observed between the two groups in suture precision measurement. The subjects agreed on the face validity and usefulness of the trainer.
CONCLUSIONS
Our study suggests that the simulator may be a useful tool to objectively gauge suturing efficiency. Devices such as this may be useful for developing skill with suturing cartilage tissue and potentially be used to assess resident acquisition of surgical skill.
LEVEL OF EVIDENCE
NA Laryngoscope, 129:344-350, 2019.
Topics: Animals; Humans; Nasal Septum; Rhinoplasty; Suture Techniques; Sutures; Swine; Time Factors
PubMed: 30194858
DOI: 10.1002/lary.27326