Scientifi c Basis for the Selection of Vascular Closure Techniques

Abstract

If this educational program heightens the surgeon's, resident's, and student's interest in the biology of vascular wound closure and infection, the long years occupied in our search for improved methods of wound management would more than fulfill our expectations. As with any master surgeon, he/she must understand the tools of his/her profession. This linkage between a surgeon and surgical equipment is a closed kinematic chain in which the surgeon's power is converted into finely coordinated movements that result in vascular wound closure with the least possible scar and without infection. The description of wound repair of blood vessels will be confined to arterial surgery in which the surgeon attempts to establish a new non-wettable intima and to reestablish a strong elastic muscular media. Repair of vessel wall wounds is encountered in arteriotomy for vascular access as well as in artery-to-artery anastomoses. In both circumstances, wound repair is primarily at the suture line. The surgical needles of Syneture™ are produced from stainless steel alloys, which have excellent resistance to corrosion. A new high-nickel stainless steel, SURGALLOY ™, has been used recently by Syneture™ to manufacture surgical needles. We prefer a polybutester monofilament suture whose surface is coated with an absorbable polymer. This absorbable coating of the VASCUFIL™ monofilament sutures markedly reduces its drag forces in vascular tissue. The surgeon can practice using these sutures in femoral arteriotomies in animals.