Braided Polyester Research Articles

Active mobilisation following single cross grasp four-strand flexor tenorrhaphy (Adelaide repair)

This paper presents our initial experience using a single cross grasp, four-strand repair with an active mobilization regimen in a general trauma hospital setting. Variably experienced members of the trauma service of a large general hospital used a four-strand single cross grasp tenorrhaphy technique for acute repair of 73 zone one and two flexor digitorum profundus tendon lacerations in 53 patients. Postoperatively, all patients commenced an active mobilization program within 12 hours of the surgical repair. With a minimum 3 months post-repair follow-up of 89% of the repaired flexor digitorum profundus tendons, 71% of fingers achieved a good or excellent outcome. There were three (4.6%) flexor digitorum profundus ruptures post surgery. A four-strand single cross grasp repair using 3-0 braided polyester suture and active post-repair mobilization can achieve satisfactory outcomes in the general trauma service setting; however, patient compliance remains a problem.

Clinical Outcome Measures Following Suture Anchor Repair for Traumatic Rupture of the Distal Triceps Tendon (SS-53)

Introduction Rupture of the triceps tendon is an uncommon injury with few published reports of surgical repairs. These publications include case reports and small series, which assess elbow strength and motion, but fail to report any commonly used or validated elbow outcome measures for the patients. These reports all utilize braided polyester sutures through bone tunnels in the olecranon for the reattachment of the distal triceps tendon. While recent publications have described the surgical technique and biomechanical properties of distal triceps tendon repair using suture anchors, there are no published outcomes using this technique. The purpose of this study is to report the clinical outcomes following suture anchor repair of the ruptured triceps tendon with high strength sutures. An extensive literature review failed to identify any other report which evaluated the clinical results using validated elbow outcome measures or to report the clinical results following distal triceps suture anchor repair. Methods A consecutive series of traumatic distal triceps tendon ruptures from a single institution between 2006 and 2010 was reviewed. All cases were surgically repaired using suture anchors and high strength sutures. The patients were evaluated postoperatively using the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure, the Oxford Elbow Score, the American Shoulder and Elbow Surgeons (ASES) elbow assessment form, and the Mayo Elbow Performance index. Results A total of five male patients with at least six months follow-up underwent suture anchor repair for traumatic rupture of the distal triceps tendon. Of the five distal triceps tendon tears, three involved the dominant arm and two involved the non-dominant arm. The average patient age was 46.8 years (range, 35 to 54) and the average follow-up was 27.4 months (range 6 to 49 months). Postoperatively, the mean DASH score was 2.2 (from 0-100, lower score indicates less disability and better function), the mean ASES elbow score was 99.2 (from 0-100, higher score indicates better outcome), the mean Mayo Elbow Performance Index was 95.8 (from 0-100, higher score indicates better outcome), the mean Oxford Elbow Pain Score was 98.8 (from 0-100, higher score indicates less pain and better outcome), the mean Oxford Elbow Function Score was 100 (from 0-100, higher score indicates better function), and the mean Oxford Elbow Social Score was 96.2 (from 0-100, higher score indicates better outcome). Conclusion Distal triceps tendon ruptures can be successfully repaired using high strength sutures in suture anchors instead of conventional sutures in bone tunnels. This technique results in minimal pain and excellent elbow function based on validated clinical outcome measures.

Biomechanical Testing of Meniscal Repair Techniques in Human Cadaveric Menisci (SS-30)

<h3>Introduction</h3> The established gold standard for meniscal repair has been a braided polyester suture inside-out repair. Recent technological advances have expanded the surgical options for repair of a torn meniscus, especially the development of all-inside meniscal repair devices using ultra high-molecular weight polyethylene (UHMWPE) containing suture. Modified versions of the first generation of UHMWPE suture repair devices have been recently released. The hypothesis was that recent modifications in the first generation UHMWPE suture devices have resulted in improved repair characteristics. The purpose of this study was to compare the biomechanical properties of these newly-released, modified meniscal repair devices to the traditional braided polyester suture and UHMWPE containing suture repair in human cadaveric menisci. <h3>Methods</h3> Vertical longitudinal tears were made 3 millimeters from the periphery in fresh-frozen adult human menisci to simulate a bucket-handle meniscus tear. Each tear was then repaired a single repair technique. Group 1 menisci were repaired using a vertical suture of No. 2-0 Ethibond (Ethicon, Somerville, NJ). Group 2 menisci were repaired using a vertical suture of No. 2-0 Orthocord (DePuy-Mitek, Raynham, MA). Group 3 menisci were repaired using a single OmniSpan device with No. 2-0 Orthocord suture (DePuy-Mitek) in a vertical mattress configuration. Group 4 menisci were repaired using a single MarXmen device with MaxBraid suture (Biomet Sports Medicine, Warsaw, IN) in a vertical mattress configuration. Group 5 menisci were repaired using a single Meniscal Cinch device with No. 2-0 FiberWire suture (Arthrex, Naples, FL). Group 6 menisci were repaired using a Linvatec Sequent prototype device with No. 0 Hi-Fi suture in a "V" suture configuration. Using a mechanical testing machine, all samples were preloaded at 5N and cycled 200 times between 5 and 50 N. Those specimens that survived were destructively tested at 5 mm/min. Endpoints included maximum load, cycles to failure, and failure mode. <h3>Results</h3> The following mean failure loads were determined: Ethibond suture (73 N); Orthocord suture (88 N); OmniSpan (88 N); MarXmen (54 N); Meniscal Cinch (71 N); Sequent prototype device (64 N). The mean number of cycles completed were calculated for the Ethibond suture (140 cycles), Orthocord suture (160 cycles), OmniSpan (121 cycles), MarXmen (37 cycles), Meniscal Cinch (140 cycles), and the Sequent prototype device (110 cycles). When compared to the Ethibond suture repair, the Orthocord suture, OmniSpan, Meniscal Cinch, and Sequent device repairs did not exhibit a statistically significant difference. However, the Ethibond suture repair was superior to the MarXmen with regards to both load to failure (p=0.03) and cycles completed (p=0.01). <h3>Conclusion</h3> The biomechanical properties of meniscal repairs using the OmniSpan, Meniscal Cinch, and Sequent all-inside meniscal repair devices are equivalent to traditional suture repair techniques. However, the MarXmen meniscal repair device demonstrated significantly lower failure loads and survived less cyclic loading in the human cadaver meniscus.

Optimum suture material for locking technique in tendon repair: Effects of suture friction in mobilization

BackgroundThe 2-strand side-locking loop technique allows secure locking formation easily, yielding maximum tensile force. However, not all suture materials are suitable for this technique. MethodsThe bovine gastrocnemius tendons were transected and repaired end-to-end by the side-locking loop technique using USP2 braided polyblend, braided polyester, monofilament nylon, braided nylon, or monofilament absorbable polydioxanone sutures. A repetitive loading protocol from 10N to 100N was used, and the loading was repeated 10,000 times. In ruptured samples during the repetitive loading test, the number of loading was recorded. In samples which did not rupture, the ultimate tensile strength was measured after repetitive loading. After testing, ruptured sutures were examined microscopically. For comparison of ultimate tensile strength before and after repetitive loading, we performed a one-time loading test on samples which did not undergo the repetitive loading. FindingsWith monofilament nylon, braided nylon, or monofilament absorbable polydioxanone, suture rupture occurred during repetitive loading. In contrast, no suture rupture occurred with braided polyblend or braided polyester. Microscopic observation showed abrasion of the surface in braided polyester, though the friction effects were not seen with braided polyblend. The mean ultimate tensile strength before and after repetitive loading was 395N and 399N, respectively, for braided polyblend. For braided polyester, they were 208N and 174N, respectively. InterpretationBraided polyblend suture material has an excellent resistivity to friction and is suitable for the side-locking loop technique.

Influence of Locking Stitch Size in a Four-Strand Cross-Locked Cruciate Flexor Tendon Repair

The 4-strand cross-locked cruciate technique (Adelaide technique) for repairing flexor tendons in zone II is a favorable method in terms of strength and simplicity. The purpose of this study was to investigate the effects of varying the cross-lock stitch size in this repair technique. Outcomes measured were load to failure and gap formation. We harvested 22 deep flexor tendons from adult pig forelimbs and randomly allocated them into 2 groups. After cutting the tendons at a standard point, we performed a 4-strand cross-locked cruciate repair using 3-0 braided polyester with either 2-mm cross-locks (n = 11) or 4-mm cross-locks (n = 11). All repairs were completed with a simple running peripheral suture using 6-0 polypropylene. Repaired tendons were loaded to failure and the mechanism of failure, load to failure, stiffness, and load to 2-mm gap formation were determined. All repairs failed by suture breakage; we noted no suture pullout. There was no difference in load to failure (71.7-71.1 N; p = .89) or stiffness (4.1-4.6 N/mm; p = .23) between the 2-mm cross-lock and the 4-mm cross-lock groups. There was a trend toward higher resistance to 2-mm gap formation with the 4-mm cross-locks (55-62.2 N; p = .07). Four-strand cross-locked cruciate repairs with cross-lock sizes of 2 and 4 mm provide high tensile strength and are resistant to pullout. Repairs with 4-mm cross-locks tend to provide a more central load distribution and better gapping resistance than repairs with 2-mm cross-locks.

A comparative study between two different suture materials in oral implantology

The prospective study compares, in split-mouth design, the use of two different suture materials, silk vs. Teflon-coated, multi-filament braided polyester threads suture. Ten edentulous or partially edentulous patients were surgically treated for implant installation. Each side was sutured with either, randomly selected one or the other suture material. Seven days postsurgically, the sutures were removed and three knots per patient and side were collected for microbiological testing. Additionally, a piece of each suture thread was analysed before clinical use to test its susceptibility for bacterial adherence. To evaluate the patient's subjective opinion, a questionnaire based on Visual Analogue Scale had to be filled out by all included patients 1 week after the intervention. The results showed a more pronounced plaque accumulation for silk sutures but there was not a statistical difference. The intraoperative handling of the silk sutures was less comfortable and the patient comfort was worse than Teflon-coated polyester suture. The bacterial adherence on Teflon-coated polyester suture was slightly inferior than silk suture although it did not show the expected differences.

Nickel–titanium wire as a flexor tendon suture material: an ex vivo study

Nickel-titanium shape memory alloy (NiTi) is a new suture material that is easy to handle, is strong, and biocompatible. The purpose of this study was to evaluate the material properties and biomechanical behaviour of 150 microm and 200 microm NiTi wires in flexor tendon repair. Braided polyester (4-0 Ethibond) was used as control. Fifty fresh-frozen porcine flexor tendons were repaired using the Pennington modification of the Kessler repair or a double Kessler technique. NiTi wires were stiffer and reached higher tensile strength compared to braided polyester suture. Repairs with 200 microm NiTi wire had a higher yield force, ultimate force and better resistance to gapping than 4-0 braided polyester repairs. Repairs made with 200 microm NiTi wire achieved higher stiffness and ultimate force than repairs made with 150 microm NiTi wire.

Strength of Braided Polyblend Polyethylene Sutures versus Braided Polyester Sutures in Achilles Tendon Repair

Various techniques may be used to repair Achilles tendon ruptures; however, we contend that using the strongest suture with the least amount of suture material is ideal. To compare the strength of 2-0 FiberLoop (Arthrex Inc, Naples, Florida) and #2 Ethibond (Ethicon Inc, Somerville, New Jersey) suture materials in Achilles tendon repairs, 12 Achilles tendons were harvested from cadavers aged 18 to 62 years (median age, 42 years). The tendons were transected and repaired using a modified Krackow suture technique. All of the right limbs were repaired with 2-0 FiberLoop, and the contralateral side was repaired with #2 Ethibond. The specimens were mounted to a materials testing system, and the repairs were pulled to failure in an anatomical direction. The mean +/- SD yield loads of 2-0 FiberLoop and #2 Ethibond were 233 +/- 48 N and 134 +/- 34 N, respectively (P = .002). The mean +/- SD ultimate load of 2-0 FiberLoop was 282 +/- 58 N, and that of #2 Ethibond was 135 +/- 33 N (P < .001). The cross-sectional area of one pass of 2-0 FiberLoop was calculated to be 0.21 mm(2), and one pass of #2 Ethibond was 0.28 mm(2). The smaller-caliber 2-0 FiberLoop was significantly stronger than #2 Ethibond. This study suggests that there is no advantage to using the traditional larger suture material for Achilles tendon repairs; however, further clinical testing is needed to determine the optimal repair technique.

Interference Fit: A Novel Method for Strong Knotless Arthroscopic Fixation of Sutures to Bone

Background The present study examined the strength of fixation of a knotless anchor system that relies on trapping the suture between an interference fit screw and its bone tunnel, a method familiar to orthopaedic surgeons during anterior cruciate ligament reconstruction. Type of study In vitro biomechanical single-pull load to failure study of fixation achieved by interference fit screws in porcine bone. A standard suture anchor with eyelet was used as a control. Methods A single-pull to failure test was carried out on a Hounsfield H20K digital tensiometer (Tinius Olsen, Hersham, PA, USA). Two suture materials were compared [braided polyester (Ethibond; Ethicon Ltd, Edinburgh, UK) and a new suture (Fibrewire; Arthrex Inc., Naples, FL, USA) that has a high molecular weight polyethylene core]. Two interference fit screws were compared: one metal and the other plastic (PEEK; Parkus Medical, Sturgeon Bay, WI, USA). Results The average values were between 262 N and 584 N. The average failure value for a standard anchor was 206 N. Clinical Relevance Interference fit fixation provides an elegant strong knotless method for securing multiple sutures to a single point.

A Biomechanical Assessment of Repair Versus Nonrepair of Sheep Flexor Tendons Lacerated to 75 Percent

The benefit of repairing a 75% partial flexor tendon laceration remains controversial. The purpose of this study was to assess the degree of gap formation with and without repair when the 75% lacerated tendon is subjected to cyclic loading. Repair with only a peripheral suture was compared to that using a core and peripheral repair technique. Sixteen deep flexor tendons from sheep hind limbs were lacerated to 75% of the tendon diameter. The cut tendons were loaded for 100 cycles from 3 N up to 30 N and then back to 3 N, at a rate of 0.2 Hz. Gap formation was measured at 0 and 100 cycles. Tendons were then randomized into 2 repair groups of 8 each: group 1 was repaired with only a simple, running peripheral suture (6-0 polypropylene monofilament), whereas group 2 was repaired with a modified Kessler core suture (4-0 silicone-coated braided polyester) plus a peripheral suture (6-0 polypropylene monofilament). Repaired tendons were tested for 500 cycles, and the gap was measured at 0, 100, and 500 cycles. After cycling, gap was measured at 100 N load, and the peak loads were determined on static failure testing. The 75% partially lacerated tendons had >2 mm gap at 100 cycles. This gap was significantly reduced by peripheral or peripheral plus core repairs (p < .001). There was no difference in gap formation between tendons with peripheral repair only and those with both peripheral and core repairs. Gap formation in repaired tendons remained <or=1 mm at 500 cycles. After cycling, neither gap formation at 100 N load or the peak loads on failure testing differed between the 2 repair groups. There is a large gap when an unrepaired 75% partial laceration is cyclically loaded. This gap is significantly reduced with a peripheral repair whether or not a core suture is used.

Suture complications in a teaching institution among patients undergoing uterosacral ligament suspension with permanent braided suture

Introduction and hypothesisOur study aimed to identify the rate of suture complications over a 5-year period using braided permanent suture for uterosacral ligament suspension (USLS) surgery.MethodsWe reviewed the medical records of patients who underwent vaginal uterosacral ligament suspensions using braided polyester suture. Outcome measures included rate and timing of suture complications, patient symptoms post-operatively, efficacy of treatment modalities and surgical success.ResultsEighty-three patients had undergone USLS with braided, polyester suture over the study period that met inclusion criteria. Thirty-seven patients (44.6%) had suture-related complications post-operatively with a mean follow-up of 10.4 months. When only silver nitrate was applied, 16.7% improved, and when the suture was cut in clinic, 77.8% resolved.ConclusionsPermanent polyester braided suture for suspension of vaginal vault may lead to an unacceptably high suture erosion rate, cutting the suture in clinic results in the highest resolution.

Initial load-to-failure and failure analysis in single- and double-row repair techniques for rotator cuff repair

AimThis experimental study aimed to compare the load-to-failure rate and stiffness of single- versus double-row suture techniques for repairing rotator cuff lesions using two different suture materials. Additionally, the mode of failure of each repair was evaluated.MethodIn 32 sheep shoulders, a standardized tear of the infraspinatus tendon was created. Then, n = 8 specimen were randomized to four repair methods: (1) Double-row Anchor Ethibond® coupled with polyester sutures, USP No. 2; (2) Double-Row Anchor HiFi® with polyblend polyethylene sutures, USP No. 2; (3) Single-Row Anchor Ethibond® coupled with braided polyester sutures, USP No. 2; and (4) Single-Row Anchor HiFi® with braided polyblend polyethylene sutures, USP No. 2. Arthroscopic Mason–Allen stitches were placed (single-row) and combined with medial horizontal mattress stitches (double-row). All specimens were loaded to failure at a constant displacement rate on a material testing machine.ResultsGroup 4 showed lowest load-to-failure result with 155.7 ± 31.1 N compared to group 1 (293.4 ± 16.1 N) and group 2 (397.7 ± 7.4 N) (P < 0.001). Stiffness was highest in group 2 (162 ± 7.3 N/mm) and lowest in group 4 (84.4 ± 19.9 mm) (P < 0.001). In group 4, the main cause of failure was due to the suture cutting through the tendon (n = 6), a failure case observed in only n = 1 specimen in group 2 (P < 0.001).ConclusionsA double-row technique combined with arthroscopic Mason-Allen/horizontal mattress stitches provides high initial failure strength and may minimize the risk of the polyethylene sutures cutting through the tendon in rotator cuff repair when a single load force is used.

Effect of Partial Versus Complete Circumferential Repair on Flexor Tendon Strength in Cadavers

This study investigated the strength of epitendinous repairs covering the palmar half of the tendon circumference only. Two hundred porcine tendons were harvested from pig feet and separated into 2 equal groups. Group 1 tendons were sutured with a 2-strand core repair and group 2 tendons were sutured with a 4-strand core repair. Each group was then divided into 5 equal subgroups (n=20). Four of the subgroups were sutured with 1 of the following epitendinous repairs: 50% simple running (50SR), complete simple running (100SR), 50% Silfverskiold (50SK), or complete Silfverskiold (100SK). One sub-group (0C) had no epitendinous repair. The core suture material was 3-0 braided polyester (Tricon; Tyco Healthcare, Dominican Republic), and the circumferential suture material was 6-0 polypropylene (Prolene, Sumerville, NJ). The tendons were mechanically strained to failure, and force data were recorded. The 50SR and 50SK repairs significantly increased the force at 1-mm and 2-mm gap formation of both core repairs. The 50SR and 50SK repairs increased the ultimate force at failure of both core repairs by approximately 20%. Both 50% circumferential (50C) repairs increased repair strength at the points of initial gap formation more than at the point of ultimate force. The 50C repairs were approximately 50% as strong as the 100% circumferential (100C) repairs at 1-mm and 2-mm gap formation and approximately 70% as strong at the ultimate force of failure. The 50C repairs increased the tensile strength of 2-strand and 4-strand tendon repairs in vitro. The prevention of early gapping was more significant than the increase of strength at failure.

675: Mersilene versus Ethibond suture efficacy and cerclage

Two common choices of suture material for McDonald cerclage are Mersilene and Ethibond. Both are made of braided polyester; however, Ethibond is uniformly coated with polybutylate. The lack of uniform coating may allow for increased microbial invasion of the Mersilene suture, and theoretically an increased risk for infection leading to preterm birth. We sought to evaluate the risk of preterm birth between women who received a cerclage with Mersilene versus Ethibond.

Long-term results of posterior suturing with postauricular fascial flap otoplasty

Posterior suturing with postauricular fascial flap otoplasty has previously been shown to be associated with a significantly reduced rate of complications and better aesthetic outcome when compared with the anterior scoring and posterior suturing techniques. This study evaluates the long-term results of this technique. A retrospective casenote analysis of all paediatric patients who underwent otoplasty within a four-year period were retrieved. Sixty patients (112 ears) met the inclusion criteria (mean age 8.5 years; range 4 to 14). The perpendicular distance from the mastoid to the helical rim at the Frankfort line was recorded preoperatively and immediately postoperatively. Patients were invited to a follow up clinic where further measurements were taken by two observers. Photographs were evaluated by an independent blinded observer. The clinical recurrence rate was 4.5%. Thirty patients (57 ears) attended the follow-up clinic (mean 3.9 years since surgery). Mean loss of medialisation was 0.7 mm (6.2%), with loss of medialisation of > or =1 mm seen in 26 ears (46%), and improvement in medialisation of > or =1 mm in 15 ears (26%). Mean visual analogue scores for overall appearance and symmetry were higher at follow-up than at six weeks postoperatively. There was no relationship between measurements or visual analogue scores and duration since surgery. In conclusion posterior suturing with braided polyester permanent sutures covered with a postauricular fascial flap results in longevity of postoperative appearance and symmetry with low clinical recurrence rates and with excellent patient and parent satisfaction.

The optimum length of the Silfverskiold circumferential cross stitch

Three groups of six porcine deep flexor tendons were repaired with a locking loop modified Kessler core suture using 4-0 braided polyester. Silfverskiöld repairs were performed using 6-0 monofilament nylon taking bites 2, 4 and 6 mm from the cut end of the tendon. The repairs were tested to failure and record made of bulking, mode of failure, force to produce a 3 mm gap and the ultimate strength. Data were analysed using one-way ANOVA, with analysis of mode of failure using the Chi-squared test. The 4 mm repairs were significantly stronger than the 2 mm for all parameters but there was no difference between the 4 mm and 6 mm repairs. We feel that optimal repair strength is provided using bites 4 mm from the cut tendon ends. Taking bites further from the cut end has no significant benefits and carries the theoretical risk of increasing the work of flexion.

Biomechanical Testing of New Meniscal Repair Techniques Containing Ultra High–Molecular Weight Polyethylene Suture

To evaluate the biomechanical characteristics of current meniscal repair techniques containing ultra high-molecular weight polyethylene (UHMWPE) suture with and without cyclic loading. Vertical longitudinal cuts made in porcine menisci were secured with a single repair device. Noncycled and cycled (500 cycles) biomechanical tests were performed on the following groups: group 1, No. 2-0 Mersilene vertical suture (Ethicon, Somerville, NJ); group 2, No. 2-0 Orthocord vertical suture (DePuy Mitek, Westwood, MA); group 3, No. 0 Ultrabraid vertical suture (Smith & Nephew Endoscopy, Andover, MA); group 4, No. 2-0 FiberWire vertical suture (Arthrex, Naples, FL); group 5, vertically oriented mattress suture by use of an Ultra FasT-Fix device (Smith & Nephew Endoscopy) with No. 0 Ultrabraid; group 6, vertically oriented mattress suture by use of a RapidLoc A2 device (DePuy Mitek) with No. 2-0 Orthocord suture; group 7, vertically oriented stitch by use of a MaxFire device with MaxBraid PE suture (Biomet Sports Medicine, Warsaw, IN); and group 8, an obliquely oriented stitch of No. 0 UHMWPE suture inserted by use of a CrossFix device (Cayenne Medical, Scottsdale, AZ). Endpoints were failure loads, failure modes, stiffness, and cyclic displacement. Mean single-pull loads were calculated for Ultra FasT-Fix (121 N), FiberWire (110 N), MaxFire (130 N), Mersilene (84 N), Orthocord (124 N), RapidLoc A2 (86 N), CrossFix (77 N), and Ultrabraid (109 N). After 500 cyclic loads, the Orthocord (222 N) repair was stronger than the others: Ultra FasT-Fix (110 N), FiberWire (117 N), MaxFire (132 N), Mersilene (89 N), RapidLoc A2 (108 N), CrossFix (95 N), and Ultrabraid (126 N) (P < .05). Ultrabraid suture showed significantly more elongation over 500 cycles than the other repairs (P < .05). The principal failure mode associated with the single destructive pull (suture breakage) changed to pulling through the meniscus after cyclic loading for most devices. Knot slippage or device failure was seldom observed as the failure mode with these techniques. Self-adjusting, UHMWPE suture-containing meniscal repair devices (Ultra FasT-Fix, RapidLoc A2, and MaxFire) were comparable to the isolated UHMWPE-containing suture repairs on single-failure load testing. UHMWPE-containing suture repairs are stronger than braided polyester suture repairs, but pure UHMWPE suture (Ultrabraid) elongated more during cycling. Orthocord suture is significantly stronger than the other meniscal repair techniques after cyclic loading (P < .05). Meniscal repair techniques using UHMWPE containing sutures provide greater strength than earlier generations of meniscal repair techniques.

Wound Complications Following the Use of FiberWire in Lower-Extremity Traumatic Amputations

With the development of new arthroscopic approaches over the last decade, one innovation that has facilitated this trend has been the introduction of high-tensile-strength sutures. These nonabsorbable sutures allow for the reliable and secure fixation of soft tissues, such as the glenoid labrum and rotator cuff, to bone by means of anchors1,2. Similarly, these sutures have gained great acceptance in open procedures, such as tendon repairs and suture fixation of fracture fragments3. FiberWire (Arthrex, Naples, Florida) is one of the first members of this family of sutures. Currently, it is one of the most commonly used high-tensile-strength sutures in orthopaedic surgery. FiberWire is composed of an ultra-high molecular weight polyethylene multifilament core surrounded by a braided polyester jacket4. A silicone coating has been added to the surface of the polyester jacket to improve the handling and knot-tying characteristics of the suture. Ticron (Tyco, Waltham, Massachusetts) is the only other high-tensile-strength suture sold in the United States that has an outer silicone coating. The remaining high-tensile-strength sutures all employ proprietary blends of polyethylene and polyester without the use of a silicone coating. Over a two and a half-year period, we performed or revised 193 lower-extremity amputations at our institution in our treatment of injured soldiers. Because of its strength and the excellent documented clinical experience with FiberWire, we used it to suture the myodesis in 178 (92%) of the 193 transtibial and transfemoral amputations. Recently, five patients with similar-appearing draining sinuses through previously well-healed incisions presented during follow-up visits for the lower-extremity amputations. In all five patients, FiberWire had been used to secure the myodesis. This clustering of similar complications suggested a common cause. Thus, a quality assurance review was initiated. The purpose of this case series is to present the results of …

Evaluation of soft tissue reactions to three nonabsorbable suture materials in a rabbit model

We evaluated the inflammatory reactions induced by three commonly used nonabsorbable suture materials in a rabbit model. Three suture materials were tested: braided polyester suture (Ethibond), braided blend of polyester and polyethylene suture (FiberWire), and monofilament polypropylene suture (Polypropylene). Thirty-six rabbits were randomly allocated to three suture groups, equal in number. Each suture type was placed bilaterally in the quadriceps muscle, patellar tendon, knee joint capsule, and Achilles tendon. Six animals in each group were sacrificed in the third and sixth weeks. The inflammation induced by each suture was assessed using light microscopy and the width of the inflammation zone (WIZ) was measured. Ethibond was found to cause the most severe reaction in the muscle and tendon in the third week; in the sixth week, however, it showed the lowest inflammatory reaction in all tissue types. Reaction to Propylene was moderate in the third week, whereas it caused the largest WIZ in all tissue types in the sixth week, such that the eventual size of the WIZ induced by Propylene (6.6 + or - 2.1 mm) was significantly greater than that of Ethibond (1.6 + or - 0.9 mm) in muscle specimens (p<0.05). Except for the largest WIZ seen in joint capsule specimens in the third week, inflammatory reactions associated with FiberWire were low or moderate in all tissue specimens throughout the study. FiberWire was associated with some necrotic areas in two muscle and one tendon specimens. The extent of inflammatory reaction to nonabsorbable suture materials depends on the type of suture material, tissue type, and the duration of postoperative time.

Cyclic Load and Failure Behavior of Arthroscopic Knots and High Strength Sutures

To compare the biomechanical performance of several different sutures by evaluating knot security and load to failure strength using different arthroscopic knots. Eight different No. 2 sutures (Ethibond [Ethicon, Somerville, NJ], FiberWire [Arthrex, Naples, FL], Orthocord [DePuy-Mitek, Norwood, MA], Hi-Fi [ConMed Linvatec, Largo, FL], Ultrabraid [Smith & Nephew, Andover, MA], ForceFiber [Stryker Endoscopy, San Jose, CA], MagnumWire [ArthroCare, Sunnyvale, CA], and MaxBraid PE [Arthrotek, Warsaw, IN]) were tied arthroscopically into standardized loops using 6 different knots (Weston, Tennessee slider, Duncan, SMC, Revo, and San Diego knot) 10 times each. The suture loops were pretensioned to 10N, cycled between 10N and 45N for 1,000 cycles, and loaded to failure. The failure load for each suture, each knot, and slippage trend during cyclic loading was recorded. The Revo and SMC knots (group A) were stronger than the Tennessee and San Diego knots (group B), which were stronger than the Weston knot, which was stronger than the Duncan loop (P < .05). This pattern also coincided with the loads at which these knots slipped. Evaluating the sutures showed that Ethibond had lower failure loads than all other sutures and FiberWire showed statistically higher loads (P < .05). Duncan loops (97.5%) and Weston knots (86.3%) slipped more than other knots (P < .001), while the SMC and Revo knots slipped least. Ethibond sutures were least likely to slip. The Duncan loop and Weston knot were more likely to slip than all other knots, and caution should be exercised when tying them with high-strength sutures. The Revo, Tennessee slider, San Diego, and SMC knots were least likely to slip (P < .001). While stronger than braided polyester sutures, newer sutures containing ultra-high molecular weight polyethylene have a greater tendency to slip. Backing up knots with 4 reversed half hitches with switched posts does not guarantee knot security.