Black Silk Suture Research Articles

Surgical repair of a vesicovaginal fistula guided by a black braided silk suture line

The purpose of the study was to evaluate the effect of the identification of the margins of a vesicovaginal fistula (VVF) during its repair by passing a black braided silk suture line through the fistula. During the repair of a VVF, a suture line was placed through the fistula. By passing the suture line from the vagina through the fistula tract into the bladder and hence to the outside through the urethral meatus, the circumference of the VVF opening can be easily identified after dissection and excision of the vaginal wall around the fistula opening. There were four VVF patients who underwent a modified Latzko procedure using the thread to guide surgical repair. The operation times and blood loss were 45-90 min and no more than 50 ml, respectively. This trick provides adequate identification of the fistula tract, thus permitting safe and easy fistula repair for a narrow, deep, or atrophic vagina.

A simple way of securing drains

There are several ways of securing suction drains to the skin. Conventionally a suture is used, but there are the disadvantages of possible slippage and cost. The current price of a 2/0 black silk suture is £1.22 (June 2006, Ethicon UK).

Role of Neuregulin-1/ErbB2 Signaling in Endothelium-Cardiomyocyte Cross-talk

Neuregulin-1 (NRG-1), a cardioactive growth factor released from endothelial cells, has been shown to be indispensable for the normal function of the adult heart by binding to ErbB4 receptors on cardiomyocytes. In the present study, we have investigated to what extent ErbB2, the favored co-factor of ErbB4 for heterodimerization, participates in the cardiac effects of endothelium-derived NRG-1. In addition, in view of our previously described anti-adrenergic effects of NRG-1, we have studied which neurohormonal stimuli affect endothelial NRG-1 expression and release and how this may fit into a broader frame of cardiovascular physiology. Immunohistochemical staining of rat heart and aorta showed that NRG-1 expression was restricted to the endocardial endothelium and the cardiac microvascular endothelium (CMVE); by contrast, NRG-1 expression was absent in larger coronary arteries and veins and in aortic endothelium. In rat CMVE in culture, NRG-1 mRNA and protein expression was down-regulated by angiotensin II and phenylephrine and up-regulated by endothelin-1 and mechanical strain. CMVE-derived NRG-1 was shown to phosphorylate cardiomyocyte ErbB2, an event prevented by a 24-h preincubation of myocytes with monoclonal ErbB2 antibodies. Pretreating cardiomyocytes with these inhibitory anti-ErbB2 antibodies significantly attenuated CMVE-induced cardiomyocyte hypertrophy and abolished the protective actions of CMVE against cardiomyocyte apoptosis. Accordingly, ErbB2 signaling participated in the paracrine survival and growth controlling effects of NRG-1 on cardiomyocytes in vitro, explaining the cardiotoxicity of ErbB2 antibodies in patients. Cardiac NRG-1 synthesis occurs in endothelial cells adjacent to cardiac myocytes and is sensitive to factors related to the regulation of blood pressure.

The Use of Temporal Polyethylene Implant After Temporalis Myofascial Flap Transposition: Clinical and Radiographic Results From Its Use in 21 Patients

The use of temporalis myofascial flap (TMF) as a pedicled flap in craniofacial reconstructive surgery is well established. The transposition of temporalis muscle results in a large hollowing of the temporal fossa that leaves the patient with a cosmetic impairment. Reconstruction of this donor site deformity is desirable. One of the established reconstructive techniques is the use of a prefabricated porous high-density polyethylene (HDPE) temporal implant. In order to evaluate results from its use, we retrospectively reviewed a series of 21 consecutive patients. From October 1999 to October 2004, 21 patients (7 men and 14 women) aged 32 to 85 years (mean, 65) had their surgical defects reconstructed with the use of a TMF. The majority of patients (15 of 21) had squamous cell carcinoma of the maxilla or the maxillary sinus. In 17 patients, the reconstructive procedure was performed simultaneously with the oncological resection, whereas in 4, a secondary reconstruction was performed. In 1 patient, bilateral TMFs were used to cover a total maxillectomy defect. Standard surgical approach was used in all patients during TMF elevation. The temporal defect was reconstructed with the use of a prefabricated sterile HDPE implant (Medpor; Porex Surgical Inc, College Park, GA). Fixation of the implant to the recipient infratemporal fossa was performed with black silk sutures (in 2 patients) or titanium miniscrews (in 19 patients). The manufacturer's instructions for the placement of the implant were followed in all cases. One of the 21 operated patients preoperatively received radiotherapy (RT). Of the remaining 20 patients, 5 underwent postoperative RT. Eighteen patients are alive and free from disease. One died during the perioperative period from myocardial infarction and 2 more from locoregional recurrence of their disease, 18 and 27 months postoperatively. In all 21 patients, the placement of the Medpor temporal implant was successful and no immediate or perioperative complications resulting from its use were encountered, giving an overall success implantation rate of 100%. Follow-up ranged from 9 to 70 months (mean, 39). The condition of the implant was evaluated with computed tomography in 18 of the 21 patients as part of the standard postoperative assessment. Radiographic results of the recipient site did not reveal any abnormalities. In 7 patients, the contour of the HDPE implant could be manually palpated, and in 3, it could be seen to protrude subcutaneously. Esthetic results were judged satisfactory from all patients. The hemicoronal skin flap healed uneventfully in all patients and did not cause a visible scar even to bald male patients. The reconstruction of the temporal defect after TMF transposition with the use of a Medpor temporal implant is an easy and safe method. The implant does not seem to cause any tissue reaction, and long-term functional and esthetic results are excellent. When properly used and the relevant manufacturers' instructions are carefully followed, the success rate of the method is extremely high.

Effect of the Wicking Behavior of Multifilament Sutures

The purpose of this study was to compare the wicking propensity of multifilament sutures. Dexon II, Vicryl, and black silk suture (BSS) were dipped in saline or soaked for 48 h, then suspended on a microscope slide. Fluorescein isothiocyanate-dextran (FITC-D) was placed at the suture mid points, and its movement was observed using fluorescence microscopy. The experiment was repeated, replacing the FITC-D with mixture of S. salivarius and saline, incubating the suture specimens in culture medium, and evaluating microbial growth. Dipped sutures showed FITC-D movement in the Dexon II group only. All 48-h soaked sutures demonstrated FITC-D movement with significant (p < 0.005) differences in mean times: BSS 179 +/- 42 s; Vicryl 120 +/- 26 s; and Dexon II 32 +/- 2 s. Dexon II suture demonstrated wicking of S. salivarius, whereas Vicryl and BSS did not (p < 0.05). These results suggest that BSS and Vicryl sutures do not wick as readily as Dexon II does.

Alternative AOAC Sporicidal Test Carrier for Evaluating Peracetic Acid-Based Sterilants (Modification of AOAC Official Method 966.04)

Dacron suture loops were demonstrated to be inert, consistent carriers in the presence of peracetic acid-based sterilants, whereas black silk sutures had a variable preparation process and interacted with peracetic acid. In addition, Dacron suture loops provided comparable spore loading to black silk suture loops and an HCI resistance of > or = 2 min. These results indicate that black silk suture loops are not appropriate carriers for assessing peracetic acid-based sterilants, and Dacron loops are an acceptable alternative. This finding is consistent with the Office of Science and Technology Laboratory (Center for Devices and Radiological Health) study which determined that "polyester suture material is a viable alternative to silk for the AOAC sporicidal test for liquid disinfectants."

Autogenic dental transplants

Am J Orthod Dentofacial Orthop 2002;121:592-3

Use of Dacron as an Alternative Carrier for Evaluating Oxidizing Sterilants in the AOAC Sporicidal Test

The AOAC sporicidal method (966.04) recommends the use of porcelain penicylinders and black waxed silk sutures as carriers for demonstrating the sporicidal activity of sterilants. However, the silk carriers are not suitable for evaluating the sporicidal efficacy of oxidizing agents, and an inert polyester material (Dacron) is recommended as an alternative. Dacron provides an equivalent microbial and physical challenge to silk. Microbiologically, both materials demonstrated similar HCI resistance, which is required by the AOAC test, as well as equivalent spore loading and spore wash-off. Electron microscopy showed that both materials present the same braided microstructure, providing an equivalent physical challenge to the test sterilant. Dacron was more consistent than silk, and did not require extraction prior to spore loading. The extraction method for black waxed silk was variable and incomplete, which may compromise the activity of oxidizing sterilants and add to method variability. Silk was also structurally altered in the presence of oxidizing sterilants and increased sterilant degradation. Dacron did not affect the sterilant and was inert in the presence of oxidizing agents. Dacron sutures are proposed as inert alternatives to silk for evaluating the sporicidal efficacy of oxidizing agents.

Laparoscopic bladder ‘wrap’ technique for repair of vesicoureteric reflux in a porcine model

Purpose : The aim of this study was to determine if vesicoureteric reflux (VUR), can be successfully corrected laparoscopically by a bladder “wrap” technique in a pig model. Methods : In 15 female piglets (mean weight, 22.5 kg) bilateral VUR was created by an open technique (11 grade 3, 2 each of grades 2 and 4). Eight weeks later (range, 4 to 16 weeks) VUR was confirmed by fluoroscopic cystogram, and unilateral laparoscopic correction was performed. The contralateral ureter was used as a control. The bladder was emptied, and a 3F ureteric catheter was inserted on the repair side. Four 11-mm ports were inserted transperitoneally. The ureter was dissected to the ureterovesical junction (UVJ). Commencing at the UVJ, 2 (n = 9) or 3 (n = 6) black silk sutures were placed through the bladder muscle on either side of the ureter creating a bladder wrap around the distal 2 to 4 cm of ureter. At a mean of 16 weeks (range, 4 to 24 weeks) cystograms were repeated. The animals were killed the bladder and ureters underwent histopathology examination. Results : VUR was corrected in 12 animals (80%). There was persistence of VUR in 2 and ureteric obstruction in 1. The wrap was intact in all animals. Conclusions : Laparoscopic correction of VUR by the bladder wrap technique is successful in pigs. Long-term follow-up studies will determine if this will be a satisfactory alternative surgical treatment for correction of VUR in children.

Correlation of histology and acoustic parameters of liver tissue on a microscopic scale

The correlation of several acoustic parameters with histological features was investigated in healthy White New Zealander rabbit liver ( n = 10). Thin sections (10 μm) were studied by means of a light microscope in combination with a digital image processing system. Adjacent thick sections (250μm) were studied by means of a custom-designed acoustic microscope. Markers of black silk suture material, that could be identified both optically and acoustically, enabled the spatial correlation of both imaging modalities. Acoustic images were reconstructed from the velocity of ultrasound, the attenuation at the central frequency (30 MHz), the attenuation spectral slope, the backscatter spectral slope and the backscatter at the central frequency. The measurements comprised the frequency range from 10 to 50 MHz, yielding a resolution of approximately 50 μm. From the thin sections (10μm) the local histological composition was obtained by digital segmentation techniques. The features that were segmented are: the collagen rich fibrous tissue content, the area lumina, the area interstitial spaces, the number density of nuclei and the area parenchymal tissue. Correlation techniques revealed that the main feature responsible for attenuation is collagen. There was a fair correlation between area lumina and attenuation, but this was caused by a high correlation between the collagen that surrounds the lumina, and attenuation. No correlation was found between any histological feature and backscatter parameters or velocity.

Radiation induced grafting of methacrylic acid onto silk for the immobilization of antimicrobial drug for sustained delivery

AbstractMedical grade black braided silk suture and pure mulberry silk twisted yarn were grafted with methacrylic acid (MAA) using 60Co gamma radiation. The effect of various synthesis conditions on the grafting was studied. The addition of methanol in water has a marked effect on the degree of grafting, maximum yield of grafting was obtained in an equivolume mixture of water‐methanol. The percent grafting increased with the increase in the monomer concentration and in total radiation. For a constant total dose, grafting was found to be higher at lower dose rates. The order of the dependence of the rate of grafting on the dose rate was found to be 0.53 and 0.56 for medical grade black braided silk suture samples and mulberry silk twisted yarn samples respectively. The immobilization of an antimicrobial drug, 8‐hydroxy quinoline (8‐HQ) hydrochloride on the grafted pure silk for sustained delivery, its release in vitro and its antimicrobial activity were also studied. The percentage of 8‐HQ immobilized onto various grafted silk samples increased with the increase in the degree of grafting. The release of the drug in distilled water was sustained for 32 days. 8‐HQ was found to be active against both gram‐positive and Gram‐negative bacteria.

Fluid absorbency of retraction cords after soaking in aluminum chloride solution

Soaking retraction cord in an aluminum chloride solution before placing into gingival sulci does not lessen the cord's ability to absorb fluid. Black silk suture is clinically ineffective and should be replaced with a dark, size 0 impregnated retraction cord.

Technique for trouble-free removal of pars plana infusion cannulas.

We describe a simple procedure that facilitates the removal of a pars plana cannula. A 2-cm 4-O black silk suture is passed under the double-throw knot, which secures the infusion cannula. When the ends of the silk suture are pulled, the double-throw knot opens easily, allowing the cannula to be removed.

Isobutyl cyanoacrylate: A clinical and histologic comparison with sutures in closing mucosal incisions in monkeys

Bilateral vertical incisions were made in the maxillary and mandibular labial mucosa of eight young green vervet monkeys. Incisions were closed with either interrupted 4-0 black silk sutures or by the application of isobutyl cyanoacrylate. Mucosal specimens containing the incisions were examined histologically and scored for degree of inflammation at 1, 3, 10, and 20 weeks. The results showed that cyanoacrylate and sutures did not produce similar inflammatory responses.

Modified hartmann procedure in emergency sigmoid colectomy

A new technique has been added to the Hartmann procedure to suture the rectal stump to the presacral fascia using black silk sutures at the time of the initial resection and closure of rectal stump. This will prevent contraction of the rectal stump behind the bladder or vagina deep in the pelvis and makes reanastomosis of the proximal colon to the rectal stump very easy. Also discussed are the advantages of the modified Hartmann procedure in cases of emergency sigmoid colectomy as opposed to the conventional three stage procedure.

Treatment of epiphora owing to flaccid eyelids.

• Flaccid eyelids commonly have a history of gradual onset of epiphora, which is aggravated by cold weather and wind. The natural history starts in middle age; as age increases, flaccidity increases. When the flaccid eyelids are surgically improved by a lateral canthal tendonesis, epiphora is greatly diminished. The surgical technique of tenodesis is accomplished by making an 18-mm skin incision at the lateral canthus. The pretarsal and preseptal portions of the orbicular muscle are mobilized, and the raphe is incised. The lateral canthal tendon is dissected and a 2-0 black silk suture is orthopedically placed so it pulls the tendon into a drilled hole near Whitnall's orbital tubercle. Cautery is applied to the cut ends of the upper and lower mobilized muscle. The pretarsal and preseptal muscles are resected 5 mm. The skin is approximated and the 2-0 suture is tied over a button and left in place for six weeks.

Skin closure with polyglycolic acid (Dexon).

Cosmetically satisfactory scars were achieved in 94.5% of skin crease orchidopexy wounds sutured with subcuticular polyglycolic acid. Of twenty-seven similar wounds closed with interrupted black silk sutures 18.5% developed hypertrophy at the medial end.

An Additional Knot for Stay Sutures in Retinal Detachment Surgery

<h3>To the Editor.</h3> —In retinal detachment surgery, we use an O black silk suture as a stay suture under each of the four rectus muscles. Normally, the surgeon ties a knot at the end of the suture. This makes the suture into somewhat of a loose ring when it is not held tautly. This can cause difficulty when the surgeon handles the suture, especially if he grasps only one arm of it. In this case, the suture will slip or slide and act as a loose ring under the muscle (Fig 1). Because of the slippage, it will be temporarily ineffective for holding the muscle. This situation can be avoided by tying an additional knot in the middle of the suture. This will prevent all slippage when the suture is grasped anywhere distal to the middle knot and will assure that neither of the arms of the suture will slip

Lateral lip sclerectomy.

OVER the past several years, the following sclerectomy operation has been evolved in New Orleans, based on Allen's cyclodialysis modification. 1 After preparation, anesthesia and akinesia, a superior rectus bridle suture is placed and secured. An 8 mm curving flap of conjunctiva and Tenon's is created and folded over the cornea. The limbus is cleaned with a Tooke blade. With a No. 67 Beaver blade, a radial groove is made from the anterior most limit of the limbus and extending posterior for 3 to 4 mm (Figure, A ). One 7-0 black silk suture is passed across the groove, drawn up in the center, and cut. The ends are used to apply traction to gape the groove, which is then deepened down to the choroid (Figure, B ). Cautery is used for hemostasis only if scleral bleeding obscures the groove. Using a cyclodialysis spatula, the sclera is separated from the underlying choroid

Rubber Dam Clamp Ingestion, an Operative Risk: Report of Case

One hazard that has not been stressed sufficiently in connection with the use of the rubber dam in operative dentistry is the danger of a patient’s ingesting or inhaling the rubber dam clamp when he is lying in a supine position. A 6-year-old girl swallowed a clamp; it was recovered successfully after an esophagoscopy was performed. This incident led us to develop a method that would help prevent the problem of inhalation or ingestion of a rubber dam clamp. Dental floss or heavy black silk suture material is ligated to each clamp and is allowed to hang from the patient’s mouth. If a clamp should fall into the pharynx, it can be retrieved by pulling on the ligature. This technique is recommended to all operative dentists, especially to those working with children.