Braided Suture Research Articles

Modified Z-plasty of the patellar tendon for patella baja and flexion deficits

Lengthening of the patellar tendon to normalize patellar height and improve knee flexion deficits. Flexion deficits in combination with patella baja (Caton index < 0.6). Infection. Arthroscopy of the knee and resection of adhesions in suprapatellar pouch and additional intraarticular adhesions. Approximately 15 cm long incision from tibial tuberosity up to the patella. Exposition of the patellar tendon. Longitudinal incision in the middle from the tibial tuberosity towards the proximal patella. Division of the tendon into two strands. Detachment of the lateral tendon strand with periosteum from the bone of the patella and detachment of the medial strand with periosteum from the bone of the tibial tuberosity. Resection of fibrotic adhesions within Hoffa's fad pad and detachment of the longitudinal retinacula. Lengthening of the patella tendon of maximal 2.5 cm. Refixation of the medial strand to the upper part of the tibial tuberosity and the lateral strand to the distal patella pole with asoft anchor. Drilling of small transverse bone tunnels in the patella and tibial tuberosity for application of aMcLaughlin cerclage for augmentation of the z‑plasty with athick braided suture cord. Six weeks partial weight bearing with 10 kg within astraight leg brace. Free passive range of motion. Previously published results show that the Z‑plasty technique presented here on the patellar tendon can normalize the Caton index and improve mobility and clinical scores.

Silver-Treated Sutures for the Prevention of Biofilm-Associated Surgical Site Infections.

The huge concerns associated with biofilm-related infections in surgical procedures, along with the antibiotic resistance demonstrated by an increasing number of bacteria, have highlighted the need for alternative and effective prevention approaches. The aim of this research was to develop novel antimicrobial coatings on surgical sutures for the prevention of surgical site infections through nanotechnology-based methods. The results demonstrated that although very low amounts of silver precursor were adopted for the treatments, the silver coating was effective against Staphylococcus aureus and antibiotic-resistant Pseudomonas aeruginosa in reducing the potential risk of infection. Nanostructured silver coatings were deposited onto the surface of polyglactin 910 absorbable braided sutures through a technology based on a photo-assisted chemical reaction. The materials were characterized in order to verify the efficacy of the coating in preventing biofilm formation and in reducing the bacterial colonization of the device. As a broad-spectrum antimicrobial agent, silver represents an important option for the prevention and management of surgical site infections. The silver deposition technology adopted in this work provides an interesting strategy for preventing biofilm formation on medical devices such as surgical sutures.

Attaching artificial Achilles and tibialis cranialis tendons to bone using suture anchors in a rabbit model: assessment of outcomes.

The purpose of this study was to investigate the timing and mode of failure of metallic screw-type suture anchors used to attach artificial tendons to bone in an in vivo New Zealand White rabbit model. Metal suture anchors with braided composite sutures of varying sizes (United States Pharmacopeia (USP) size 1, 2, or 5) were used to secure artificial tendons replacing both the Achilles and tibialis cranialis tendons in 12 female New Zealand White rabbits. Artificial tendons were implanted either at the time of (immediate replacement, n=8), or four/five weeks after (delayed replacement, n=4) resection of the biological tendon. Hindlimb radiographs of the rabbits were obtained immediately after surgery and approximately every other week until the study endpoint (16 weeks post-surgery). All suture anchors used for the tibialis cranialis artificial tendons remained secure and did not fail during the study. The suture anchor used to attach the Achilles artificial tendon to the calcaneus bone failed in nine of 12 rabbits. In all cases of suture anchor failure, the suture broke away from the knot, while the metallic screw remained securely embedded in the bone. Based on radiographic analysis, the mean estimated failure timepoint was 5.3 ±2.3 weeks post-surgery, with a range of 2-10 weeks. Statistical analyses (Mann-Whitney U test and Fisher's exact test) revealed no significant effect of tendon implantation timing or suture size on either the timing or frequency of suture anchor failure. For the suture anchors used to attach artificial tendons in this study, suture anchor failure was most likely due to suture wear or cutting against the eyelet of the anchor screw. Future studies are needed to test the effect of suture-eyelet interaction on suture strength under different loading conditions.

Impact of Suture Materials on Surgical Site Infection in Oral Oncological Surgery With Free-Flap Reconstruction: Analysis Using Propensity Scores.

The impact of suture materials on surgical site infections (SSIs) has been well documented in various surgical fields; however, it has not been thoroughly examined in oral oncological surgery with free-flap reconstruction. This study aimed to evaluate the incidence of oral SSIs associated with the use of monofilament and braided sutures for flap fixation. A retrospective chart review of patients who underwent oral oncological resection with free-flap reconstruction was conducted between May 2020 and April 2024. Either monofilament (4-0 PDS® II or Monodiox®) or braided (3-0 Vicryl®) suture was used for flap suturing. The primary outcome was the incidence of oral SSIs, defined according to the guidelines of the United States Centers for Disease Control and Prevention. Multivariable logistic regression and inverse probability of treatment weighting based on propensity scores were used to estimate the risk differences. Of 209 eligible patients, 58 experienced oral SSIs, resulting in an incidence of 27.8%. Monofilament sutures were used in 174 patients and braided sutures in 35. The incidence of oral SSIs was higher in the braided suture group (42.9%) than in the monofilament suture group (24.7%). Analysis using propensity scores revealed a significantly higher risk of oral SSIs associated with braided sutures than with monofilament sutures, with a 18.5% risk difference (95% confidence interval, 2.1%-34.9%; P = 0.027). Braided sutures may pose an increased risk of SSIs in oral oncological surgeries with free-flap reconstructions. Monofilament sutures are recommended for reconstructions, especially of the floor of the mouth.

Suture tapes show superior biomechanical properties and greater meniscal healing compared to conventional sutures in posterior meniscal root tear repairs: A systematic review.

This study aims to perform a systematic review to determine whether ultra-high molecular weight polyethylene (UHMWPE) tapes have superior biomechanical properties compared to conventional sutures in posterior meniscal root tear (PMRT) repairs, and whether this translates into superior clinical outcomes. The Cochrane Controlled Register of Trials, PubMed and Embase were used to perform a systematic review using the following search terms: (meniscus OR meniscal) AND (root OR posterior horn) AND (suture OR tape OR wire OR cord). Data pertaining to certain biomechanical properties (load to failure, stiffness, displacement during cyclical loading and at failure), meniscal healing and patient-reported outcome measures (PROMs) were extracted. Seven biomechanical and two clinical studies were included. There were 232 knees for biomechanical testing: 81 with UHMWPE tapes and 151 with conventional sutures (133 with UHMWPE sutures and 18 with Ethibond [Ethicon]). Testing set-up was similar across studies, but there were differences in repair techniques, including suture configuration, location and method of fixation. In general, the consensus was that tapes had a higher load to failure and stiffness, with similar displacement at failure to that of UHMWPE sutures. A similar trend was also observed when tapes were compared to Ethibond, except for FiberTape (Arthrex). This particular UHMWPE tape showed greater displacement during cyclical loading, resulting from knot slippage. Clinically, there were 73 patients, 41 with UHMWPE tapes and 32 with either UHMWPE sutures (n = 18) or braided polyester sutures (n = 14). Tapes led to greater meniscal healing 1 year postoperatively, with PROMs similar across groups. UHMWPE tapes generally demonstrated superior biomechanical properties compared to conventional sutures in PMRT repairs with a simple stitch configuration. However, further biomechanical studies are required to determine the extent to which tapes contribute to the repaired construct, especially with more complex repair configurations, as the existing evidence displayed a notable amount of methodological heterogeneity. Level IV systematic review of level IV evidence.

Overview of Achilles Tendon Injury Treatment

Achilles tendon rupture is a prevalent injury, particularly among middle-aged individuals who participate in high-demand athletics. This article reviews the anatomy, risk factors, diagnosis, and current treatment strategies for Achilles tendon rupture, with a focus on surgical and non-surgical approaches. The traditional open repair technique is still a widespread surgical approach that uses a large incision to reconnect the tendon directly. However, complications and infections may occur, so percutaneous or mini-open techniques can be changed depending on the patient's condition. Various suture techniques, such as Bunnell, Modified Kessler, and Tsuge, have been evaluated in clinical settings, with braided polyester sutures demonstrating superior biomechanical performance over monofilament polydioxanone sutures. Despite the effectiveness of surgical intervention, non-surgical treatment remains an option for specific patient populations, though it is associated with a slightly higher re-rupture rate. Postoperative rehabilitation is crucial for restoring function, with early weight-bearing and mechanical stimulation playing key roles in successful recovery.

We Reduced the Incidence of Postoperative Complications in Neonatal Ostomy Patients by Using Simple Devices.

Background: Complications frequently occur after neonatal enterostomy. Enterostomy formation is a common outcome following an emergency neonatal laparotomy. This study investigated whether the incidence of complications after enterostomy could be decreased with a drainage device (composed of foreskin cerclage staple, a condom, and a 0-Mersilk braided nonabsorbable suture) fixed in the proximal ostomy bowel tube to improve proximal enterostomy in newborns. Methods: This study was a retrospective case note review of the incidence of emergency neonatal enterostomy incidence over a 3-year period (2/2016-2/2019) at the authors' center. A single surgeon conducted all surgeries. The incidence of intraoperative and postoperative complications was compared between modified and traditional surgery groups. Results: All 47 surgeries were successfully completed (32 boys and 15 girls; sex ratio: 2.13:1). The mean (±SD) birth weight, gestational period, and daily age were 2.64 ± 0.81 kg 35.62 ± 3.76 weeks and 3.49 ± 5.61 days, respectively. The patients were divided into modified surgery groups (20 cases) and traditional surgery groups (27 cases). The modified surgery group had significantly lower rates of total complications, unplanned reoperations, wound-related complications, and stoma-related complications than the traditional group (p <0.05). Conclusions: The preliminary observations suggested that the simple drainage device was a safe and effective operation device that reduced the risk of stoma-related complications.

Тип шовного матеріалу при цервікальному серкляжі: загублена частина пазла в лікуванні істміко-цервікальної недостатності

Every year, preterm birth (PTB) causes more than million deaths worldwide. Cervical insufficiency (CI) is a significant risk factor for PTB. Progesterone and cervical cerclage (CC) are used to manage such patients. In this study, the authors analyzed the effect of the type of suture material used for cerclage on the inflammatory status of the birth canal and pregnancy outcomes. The aim of our study is to evaluate the effect of using braided and monofilament sutures on the results of microscopic and microbiological examination and the level of IL-6 and IL-8 in cervical-vaginal fluid (CVF). Materials and methods. During 2021-2024, a prospective cohort study was conducted, which analyzed 51 patients with singleton pregnancy who underwent CC. The braided suture (BS) group included 27 patients, and the monofilament suture (MS) group included 24 patients. Participants were examined twice during the study: 3 weeks after suturing and at suture removal time. Results. The microscopy results (12 vs. 4 patients) and bacteriological examination (15 vs. 6 patients) in the BS group were significantly worse. IL-6 level in the BS group was significantly higher at the time of suture removal than at the beginning (59.67±29.95 vs. 76.6±22.29). The increase of IL-6 levels in the BS group was 2.1, and in the MS group - 1.49. The type of suture material can affect the delivery timing (34.2±2.7 weeks in BS group versus 32.9±3.1 in MS group). Conclusions. The data indicate that CC using BS is associated with vaginal dysbiosis – increase in the frequency of 3-4 grade smear and abnormal levels of opportunistic microflora, CVF IL-6 levels, and with an increased incidence of PTB. The research was carried out in accordance with Helsinki Declaration principles. The study protocol was approved by participating institution’s Local Ethics Committee. The informed consent of the patients was obtained for conducting the studies. Authors declare no conflict of interest.

Foreign body suture granuloma in canthal surgery: association with suture type

ABSTRACT Purpose Foreign body suture reaction (“suture granuloma”) is a complication faced by all surgeons. The purpose of this study was to examine the incidence and risk factors of suture granulomas in canthal surgery. Methods An IRB-approved retrospective review of medical records identified patients who had canthal surgery. Statistical analysis was performed on multiple data points to determine associations with granuloma formation. Summary statistics were reported as a mean and standard deviation for continuous variables, and as frequencies or proportions for categorical variables. Effect estimates were reported as odds ratios. A p-value of less than .05 was deemed statistically significant. Results A total of 758 procedures were included. Seven commonly used suture materials were encountered including uncoated polyester, polyester coated with polytetramethylene adipate (PTMA), nylon, polydioxanone, polyester coated with polytetrafluoroethylene (PTFE), polypropylene, and polyglactin 910. Eighteen total granulomas were observed (2.4%). Fifteen granulomas were associated with uncoated polyester, two with polyester coated with PTFE, and one with polypropylene. The odds of developing a suture granuloma with uncoated polyester were 25.4 times as likely as polyglactin 910 (p = .04). The odds of developing a suture granuloma with a non-absorbable, braided suture were 23.2 times as likely as absorbable, braided suture (p = .04). There was no significant association identified between the other collected variables. Conclusions Foreign body suture granulomas occur at a low rate following canthal surgery and can be largely avoided through careful selection of resorbable or monofilament sutures.

Superior suspensory complex of the shoulder reconstruction for acute and chronic acromioclavicular joint dislocations: the Queensland Unit for Advanced Shoulder Research 3-tunnel technique

BackgroundManagement of acromioclavicular joint (ACJ) injuries have wide variety of classification systems, surgical indications and operative techniques. Our study describes the QUASR (Queensland Unit for Advanced Shoulder Research) 3-Tunnel Technique with LARS (Ligament Augmentation and Reconstruction System; Surgical Implants and Devices, Arc sur Tille, France) artificial ligament to reconstruct the superior shoulder suspensory complex (SSSC) in acute, chronic and revision ACJ dislocations and lateral clavicle fractures. MethodsOur prospective cohort series of patients undergoing the QUASR 3-Tunnel Technique using LARS artificial ligament. This technique reconstructs the SSSC using two 4mm clavicle tunnels, one acromion tunnel, and is arthroscopically assisted to pass the artificial ligament under the coracoid. The ligament is secured with braided composite sutures and no interference screw is used. Pre and postoperative functional outcome scores were compared in patients with minimum 12-months follow-up. ResultsOf 26 patients in this series, 7 (27%) were operated within 4 weeks of injury, two (8%) were revision cases, and six (23%) were lateral clavicle fractures. Mean time to surgery was 14 weeks (2-650). Mean postoperative scores with associated 95% CI were Specific Acromioclavicular Score 87.38 (CI 75.38, 99.37), American Shoulder and Elbow Surgeons score 94.60 (87.85, 101.35), Constant 79.47 (71.87, 87.07), Simple Shoulder Test 85.44 (72.34, 98.54) and Visual Analogue Score 0.50 (-0.15, 1.15). There were two infections and one atraumatic loss of reduction, however there were no tunnel fractures. ConclusionThe QUASR 3-Tunnel Technique with LARS artificial ligament is a safe and efficient technique for both acute and chronic acromioclavicular joint reconstruction, lateral clavicle fractures with coracoclavicular ligament disruption and complex revision cases with favorable outcomes at mid-term follow-up.

The Use of a Suture Bridge Technique for Arthroscopic Rotator Cuff Repair in Patients Under 40 Years of Age Resulted in Successful Tendon Healing, Pain Relief, Improved Shoulder Function, and High Patient Satisfaction at a Minimum of 5-Year Follow-Up

PurposeThe purpose of this study was to evaluate the long-term clinical and imaging outcomes after arthroscopic repair of rotator cuff tear (RCT) using a suture bridge technique in patients under 40 years of age. MethodA consecutive series of patients who were treated arthroscopically for RCT by a single surgeon between 2016 and 2018 were retrospectively identified. Both full thickness tears and partial tears were included. Arthroscopic cuff repair employed a knotless double-row suture bridge technique, utilizing braided suture tapes. To assess clinical outcomes, we employed the Constant score, the American Shoulder and Elbow Surgeons score (ASES), a strength score, and a visual analog scale (VAS). Tendon healing was evaluated at 12 months using the Sugaya MRI classification. ResultsA total of 63 patients were included in the study. The mean age at the time of the surgery was 33.6 years (range, 21 to 40) and minimum follow up duration was 5 years. Thirty-nine patients reported occasional sports, eight were professional athletes, while sixteen reported no sportive activity prior to first symptoms. Mean follow-up duration was 66.8 months (range, 62.4 to 88.6 months). A significant improvement was observed in both the Constant score and ASES score. The mean Constant score increased significantly from 39.8 (range, 29 to 52) points to 88.9 (range, 34 to 100) points postoperatively (p < 0.001). Similarly, the ASES score improved significantly from 41.8 (range, 30 to 64) to 90.2 (range, 35 to 100, p < 0.001). Anterior flexion mean improved from 86° (range: 60° to 110°) to 137° (range, 90° to 180°, p < 0.001). Pain significantly decreased after the surgery, VAS descending from 6.3 (range, 3 to 10) to 1.3 (range, 0 to 9) postoperatively. The overall rate of return to previous activities in the cohort was 84% at an average of 10.1 months (range, 6 to 12 months) after surgery. Among the included patients, 85% engaging in occasional sports activities and 67% of elite athletes similarly returned to their pre-injury sports levels after 9.8 (range, 6 to 12) months and 10.7 months (range, 6 to 12) respectively. Two patients (3%) experienced cuff re-rupture, and tendon non-healing (Sugaya stage 3 and stage 4) was observed in five (7%) patients. At the final follow-up, 95% of patients were very satisfied or satisfied with their functional results. ConclusionThe use of a suture bridge technique in arthroscopic RCT repair for patients under 40 years of age resulted in excellent long-term outcomes, including successful tendon healing, pain relief, improved shoulder function, and high patient satisfaction.

Refixation of aposterior medial root lesion in combination with centralization by ameniscotibial suture

Refixation of aposterior root lesion of the medial meniscus via atibial drill tunnel and prevention of extrusion using ameniscotibial suture (centralization). Posterior root lesion of the medial meniscus. Grade4 cartilage damage in the corresponding compartment, uncorrected varus or valgus deformities, symptomatic instabilities, extensive degenerative tears apart from the root region. Knee arthroscopy via the high anterolateral standard portal. Diagnostic arthroscopy to check indication. Locate the insertion zone on the tibial plateau and local debridement until the bone of the tibial plateau is visible. Insertion of atargeting device and drilling of atargeting wire into the center of the insertion zone in the area of the intercondylar eminence. Overdrill the target wire with a4.5 mm drill. Reinforcement of the medial meniscus posterior horn with braided suture material. The reinforcing thread is inserted into the bone tunnel via an eyelet wire with athread loop. Optional additional centralization with incision in the middle part of the meniscus. Reinforcement of the meniscus base with braided suture material using the "outside in" technique and fixation of the inner meniscus base at the edge of the tibial plateau using atransosseous extraction suture or asuture anchor. Six weeks nonweight-bearing (0kg), then gradually increased load. Range of motion: 4weeks E/F 0-0-60°, 2weeks 0-0-90°, optionally use of avalgus brace (varus of < 5°). In root lesions of the medial meniscus, transosseous refixation significantly improves knee function (Lysholm, Hospital for Special Surgery, International Knee Documentation Committee, visual analog scale for pain, Tegner, and Knee Injury and Osteoarthritis Outcome scores) and reduces osteoarthritis progression. However, atransosseous suture alone could not significantly reduce postoperative extrusion. However, previous studies have shown that additional centralization can significantly reduce extrusion.

Prospective analysis of STRATAFIX™ symmetric PDS plus suture for fascial closure in spinal surgery: a pilot study

Wound closure is an integral part of every spinal procedure. Effective and secure wound closure is paramount in the prevention of infection, wound dehiscence and the preservation of cosmesis. Barbed suture technologies such as STRATAFIX™ Symmetric have been studied and are used in a variety of specialties, including obstetrics and orthopedic surgery, but is underutilized in neurosurgery. This study aims to assess the time and rate of closure using STRATAFIX™ Symmetric technology for fascial closure and compare this method to the more traditionally used method of fascial closure using braided absorbable sutures below the epidermis. 20 patients were recruited for the study. 10 patients underwent fascial approximation with braided absorbable sutures and definitive fascial closure with STRATAFIX™ Symmetric. In the control group, fascial closure was completed entirely with interrupted braided absorbable stitches. Patients assigned to STRATAFIX™ Symmetric group had shorter mean time for fascial closure, faster rate of average fascial closure, and lower number of total sutures used. The use of barbed suture technology such as STRATAFIX™ Symmetric may reduce the time to closure in thoracolumbar spine surgery without increasing the risk of adverse events. This pilot study forms the framework for a larger randomized, controlled trial appropriately powered for such an analysis.

Trans-Abdominal Pre-Peritoneal (TAPP) Approach for Anatomical Repair of Direct Inguinal Hernia in Children: Could it Be the New Standardized Approach?

BackgroundThe incidence of direct inguinal hernia in the pediatric population is relatively low and is usually discovered intraoperatively, rendering it unfamiliar to most pediatric surgeons. The traditional approach involves directly addressing the peritoneal defect, which includes dissecting the sac and repairing the peritoneum, reinforced with the umbilical ligament. In this paper, we present our experience with a novel approach to anatomical repair utilizing a non-mesh transabdominal preperitoneal (TAPP) approach. MethodsThis a retrospective case series of direct inguinal hernia that were operated laparoscopically using the novel approach of repair from January 2018 to January 2024. Data were analyzed for demographics, presentation, type of defect, operative time, complications, and recurrence. The new approach utilizes the pre-peritoneal approach to delineate the exact facial defect then, primary anatomical repair is established using 2/0 non-absorbable braided sutures. Finally, closure of the peritoneum was performed using running 4/0 absorbable sutures.This is a retrospective case series of direct inguinal hernias that were operated on laparoscopically using the novel repair approach from January 2018 to January 2024. Data were analyzed for demographics, presentation, type of defect, operative time, complications, and recurrence. The new approach employs the pre-peritoneal approach to accurately delineate the fascial defect, followed by primary anatomical repair using 2/0 non-absorbable braided sutures. Finally, the peritoneum is closed using running 4/0 absorbable sutures. ResultsData from nine cases were included. Six cases were on right side, and three cases were on left side. Patients were predominantly boys (8 boys and 1 girl). The mean age at operation was 25.1 months (range:11 month to 5 years). Four patients had previous indirect inguinal hernia repair on the same side. The mean operative time was 34 ± 9 min. No intraoperative complications occurred. The median follow up period was 24 months with no recurrence was detected in any of the cases. ConclusionThe non-mesh TAPP approach offers excellent exposure of the fascial structures, facilitating accurate identification and repair of the defect. Despite being technically demanding, it allows for the establishment of a robust anatomical repair. No recurrences occurred in the study group; however, a longer follow up and a larger sample are needed to provide more reliable evaluation. Level of EvidenceIII.

Assessment of formalin preserved and fresh frozen quadriceps tendon graft-suture constructs for load to failure testing: a biomechanical cadaveric study.

Fresh-frozen specimen availability and cost may be a barrier for initiation of biomechanical studies where soft tissue is used in a construct with other medical devices. The impact of soft tissue preservation method on the outcomes of biomechanical studies in the specific case of graft-suture constructs is relatively unexplored. This study aimed to observe peak loads and failure modes in biomechanical testing of fresh-frozen (FF) versus formalin embalmed (FE) quadriceps tendon (QT) graft-suture constructs for soft tissue fixation in ACLR and assess suitability of FE QT graft constructs for load-to-fail testing. Twenty QT grafts were harvested from human cadaver specimens. Ten grafts came from fresh-frozen donors and 10 from embalmed donors. All grafts were prepared with the modified Prusik knot using a braided composite suture and subjected to tensile loading. Comparisons between the biomechanical properties of the graft-suture constructs were made with unpaired t tests with α = 0.05. FE and FF constructs displayed similar peak loads and failure modes. FF constructs had greater elongation after pre-tensioning than FE (7.3 vs. 5.5mm, p = 0.02) and greater elongation after cyclic loading than FE constructs (17.5 vs. 10.5mm, p = 0.01). Hysteresis was greater for FF constructs at the 50th, 100th, 150th, and 200th cycle (p = 0.02, p = 0.07, p < 0.001, p = 0.004, respectively). FE constructs were stiffer than fresh-frozen (103 vs. 84N/mm, p < 0.001). FE constructs were significantly stiffer but displayed similar peak load and failure mode to FF which was reflective of the strength of the suture material. FE grafts can offer an alternative to FF grafts in graft-suture constructs for biomechanical studies where load at failure and knot security and strength is of main interest.

Meticulous Closure of Mesenteric Defects Effectively Reduces the Incidence of Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass.

Internal hernia (IH) after Roux-Y gastric bypass (RYGB) can lead to extended small bowel ischemia if it not recognized and treated promptly. The aim of this study is to show whether improvement in mesenteric defect (MD) closure reduces the incidence of IH. Retrospective analysis of prospectively collected data from our database including all patients who underwent laparoscopic RYGB between 1999 and 2015. The usual technique was a retrocolic/retrogastric RYGB. We divided patients in four groups according to the closure technique for MD and compared incidences of IH between groups. All patients had at least 8years of follow-up. A total of 1927 patients (1497 females/460 males, mean age of 41.5 ± 11years) were operated. A retrocolic/retrogastric RYGB was performed in 1747 (90.7%) and an antecolic RYGB in 180 patients. Mean duration of follow-up was 15 (8-24) years. 111 patients (5.8%) developed IH, the majority through the jejunojejunostomy (JJ, 3.7%) and Petersen (1.7%) defects. With improvement of closure technique, the incidence decreased over time, from 12.9% in the group with separate sutures to 1.05% in the most recent group with running non-absorbable sutures and an additional purse-string at the JJ defect (p < 0.0001). Meticulous closure of MD during RYGB is a very important step that significantly reduces the IH risk after RYGB, even with a retrocolic/retrogastric anatomy. Using running non absorbable braided sutures and an additional purse-string suture at the JJ is the most effective technique, but a small IH risk persists. A high index of suspicion remains necessary in patients who present with acute abdominal pain after RYGB.

A comparison of Mersilene tape versus braided suture in transvaginal cervical cerclage: A retrospective case-control study.

Previous studies have indicated that there is an association between cervical cerclage and type of suture material. However, it is still unclear which suture material can provide the greatest benefit to patients who have undergone cerclage. This study investigated the effect of two different suture materials (Mersilene tape vs braided suture) used for transvaginal cervical cerclage placement on maternal outcomes of women with cervical insufficiency. In this retrospective case-control study, 170 women who underwent history-, ultrasound-, or physical examination-indicated transvaginal cervical cerclage were categorized according to suture materials used for cerclage: a total of 96 received Mersilene tape and 74 received braided suture. Study participants received a transvaginal cervical cerclage before 28 weeks and were followed up until delivery to assess pregnancy and neonatal outcomes. The primary outcome was gestational age at delivery. Secondary outcomes included preterm premature rupture of membranes (PPROM), premature rupture of membranes (PROM), chorioamnionitis, neonatal survival rate, and neonatal morbidity. Out of 170 eligible women, 74 (43.5%) received braided suture while 96 (56.5%) received Mersilene tape. Baseline characteristics were similar between the two groups. The group that received braided suture had a lower incidence of gestational age at delivery <37 weeks (29.2% vs 54.2%, P = 0.046), PPROM (9.5% vs 21.9%, P = 0.029) and PROM (17.6% vs 32.3%, P = 0.028) compared to the group that received Mersilene tape. However, there were no significant differences between the two groups in average gestational age at delivery, the rate of gestational age at delivery <24, <28, <32, and < 34 weeks, chorioamnionitis, and neonatal survival rate, as well as neonatal morbidity. Compared to Mersilene tape, the utilization of braided suture has been significantly associated with a reduction in the incidence of gestational age at delivery <37 weeks, as well as a decreased risk of PPROM and PROM. However, the use of braided sutures did not result in discernible differences in the rates of chorioamnionitis or adverse neonatal outcomes.

Suture Characteristics after Exposure to Amniotic Fluid from an in vitro Model of Fetal Surgery

Introduction: Suture tensile properties have only been tested in extrauterine environments. Amniotic fluid (AF) is a complex milieu of enzymes and inflammatory factors. This study tested the mechanical properties of sutures with a variety of inherent properties, after exposure to AF from patients with conditions prompting fetal intervention. Methods: AF was obtained from 3 patients with twin-twin transfusion syndrome (TTTS), and 3 patients with neural tube defects. Six types of 2-0 sutures were placed on 1.2 N of tension to mimic placement in vivo, and incubated in AF at 37°C (98.6°F). These included ethylene terephthalate (Ethibond), glycomer 631 (V-Loc), poliglecaprone 25 (Monocryl), poly-4-hydroxybutyrate (Monomax), polydioxanone (PDS), and polyglactin 910 (Vicryl). Failure load, stress, strain, and initial modulus were tested after 24 h of incubation and after 4 weeks, and compared with control (unincubated) sutures using t tests, Kruskal-Wallis tests, and stress-strain curves. Results: Poliglecaprone 25 and polyglactin 910 dissolve more quickly in AF compared to outside the uterus, disintegrating at 4 weeks. Ethylene terephthalate and PDS experienced little change across 4 weeks of incubation. Glycomer 631 and poly-4-hydroxybutyrate exhibited interesting behavior in AF: glycomer 631 became more deformable at 24 h but later regained toughness by 4 weeks, while poly-4-hydroxybutyrate became tougher and in some cases stronger with time in AF. As a class, braided sutures act more like rigid materials, and monofilaments act like deformable plastics. Conclusion: These findings along with other suture characteristics such as ease of handling and availability may inform fetal intervention teams as they optimize procedures in a relatively new surgical field.

Transmission of Genetic Material and Malignant Cells of Cutaneous Origin via Surgical Sutures.

Seeding of skin cancer cells following diagnostic or therapeutic surgical procedures can occur and might cause local recurrences. As current preferred therapy for skin malignancy is surgical excision, seeding of tumour cells by manipulating malignant tissue or suturing can be another factor leading to recurrences. To evaluate whether genetic material and malignant cells adhere to standard suture materials. This prospective study included patients who underwent excision of skin lesions. Monofilament and braided sutures were examined. Sutures were passed through the observed tumour or healthy skin margins and were examined for DNA material and cells by cytological analysis, cell culture and characterization, and DNA analysis. Twenty-two patients and 148 sutures were included. DNA quantification showed DNA material on all sutures, with no significant difference between braided and monofilament sutures. Cytological analysis showed that all slides prepared from cell blocks contained normal squamous and atypical cells. Cell culture and characterization showed viable cells adhering to the sutures under direct light microscopy. Cell cultures showed rapid proliferation of epithelial cells from squamous cell carcinoma specimens. Suture materials carry DNA material and cells, including malignant cells of cutaneous origin and may seed them at distant sites.

Biomechanical Characteristics of All-Suture Meniscal Repair Devices Compared With PEEK-Anchored Devices and Inside-Out Suture for Meniscal Repair: A Porcine Study.

Recently, all-suture, all-inside meniscal repair devices-including devices containing flat sutures or tapes-have been introduced. Similar to those in suture anchors, these modifications may have different performance characteristics than conventional sutures and polyether ether ketone (PEEK)-anchored devices. To compare the biomechanical characteristics of all-suture meniscal repair devices with those of a conventional PEEK-anchored device and an inside-out meniscal suture construct. Controlled laboratory study. A total of 48 adult porcine menisci with simulated bucket-handle tears were included. Single-device repairs were performed with the SuperBall Meniscal Repair System, FiberStitch, and FAST-FIX 360 with 2 PEEK anchors, and a vertical mattress inside-out suture repair was performed using a Ti-Cron No. 2-0 braided polyethylene terephthalate suture. All specimens were preloaded (10 N) and cycled 200 times (between 10 and 50 N). Specimens surviving cyclic loading were then destructively tested. Endpoints included maximum failure load, stiffness, cyclic displacement, and failure mode. The goal was 12 successful tests in each group. Metrics between groups were compared using analysis of variance with post hoc tests to control for multiple comparisons. The SuperBall (108.9 N) was significantly stronger than the FAST-FIX 360 (67.3 N) and Ti-Cron (75.2 N), and the FiberStitch (102.8 N) was significantly stronger than the FAST-FIX 360 (P≤ .01 for all). Cyclic stiffness increased during cyclic loading for all constructs (P < .001). The Ti-Cron was significantly stiffer than the SuperBall during 5 to 200 cycles (P < .001). Cyclic displacement significantly increased in all constructs during cycling (P < .001) but did not differ between devices. Failure mode varied by device: the Ti-Cron repairs failed because of suture breakage, the SuperBall and FAST-FIX 360 failed at the anchor, and the FiberStitch showed both failure modes. The all-suture, all-inside meniscal repair devices demonstrated superior strength to the PEEK-anchored device and the classic inside-out suture meniscal repair but no statistically significant difference in cyclic displacement.