Chromic Catgut Research Articles

A randomized comparison of glycerol‐impregnated chromic catgut with untreated chromic catgut for the repair of perineal trauma

Summary. Glycerol‐impregnated chromic catgut and untreated chromic catgut were compared in a randomized controlled trial involving 737 consecutive women who required repair of perineal trauma following spontaneous vaginal delivery. Medical staff preference was equally divided between the two materials. More untreated chromic catgut sutures required removal both by 10 days and by 3 months postpartum. Women whose perineal trauma was repaired with glycerol‐impregnated chromic catgut were 10% more likely to have perineal pain at 10 days and 33% more likely to suffer from dyspareunia in the 3 months following delivery. The high rates of maternal morbidity associated with glycerol‐impregnated chromic catgut appear to preclude its use for perineal repair.

A randomized comparison of glycerol‐impregnated chromic catgut with untreated chromic catgut for the repair of perineal trauma

Glycerol-impregnated chromic catgut and untreated chromic catgut were compared in a randomized controlled trial involving 737 consecutive women who required repair of perineal trauma following spontaneous vaginal delivery. Medical staff preference was equally divided between the two materials. More untreated chromic catgut sutures required removal both by 10 days and by 3 months postpartum. Women whose perineal trauma was repaired with glycerol-impregnated chromic catgut were 10% more likely to have perineal pain at 10 days and 33% more likely to suffer from dyspareunia in the 3 months following delivery. The high rates of maternal morbidity associated with glycerol-impregnated chromic catgut appear to preclude its use for perineal repair.

Atraumatic Partial Nephrectomy

The aim of the described method of partial nephrectomy is to minimize injury to the kidney, if possible without causing unnecessary loss of blood, and without interrupting the arterial or venous blood flow during surgery. Use of a pedicle clamp, compressing forceps for the renal parenchyma or hypothermia is superfluous. Following pre- and intraoperative estimation of the dimensions of the area of the renal parenchyma to be removed, virtual hemostasis is achieved by applying a continuous U-shaped suture distal to the portion of the kidney to be resected, using an atraumatic chromic catgut suture. Total hemostasis in the area to be excised is attained with the aid of a second U-shaped suture, running parallel to the first but entering on the opposite renal margin. Following excision, the raw surfaces are then reapproximated by means of a continuous suture and thus sealed. To conclude the operation a temporary nephrostomy is inserted. The immediate and later follow-up results and the advantages and potential complications of the new technique are described in 112 consecutive patients presenting for treatment during a period of 12 years.

Surgical Repair of the Kidney After Blunt Lesions of Intermediate Degree Using A Vicryl Mesh: An Experimental Study

Twelve experimentally induced blunt renal lesions in pigs were treated either with an alloplastic renal capsule made of semi-elastic Vicryl mesh or with homologous pig fibrin adhesive or with through-and-through chromic catgut sutures as controls. The Vicryl mesh capsule was made by the Ethnor Company (Paris, France) to our specifications. The postoperative isotope nephrograms, which were repeated until the Vicryl had been fully resorbed, showed good renal function in every case. However, when compared to the controls, the kidneys which had been repaired with Vicryl mesh contained considerably less scar tissue at the site of parenchymal rupture and showed neither perirenal fibrosis nor atrophy of the parenchyma in the vicinity of the capsule. Our preliminary results seem to confirm that simple and rapid surgical treatment of moderately severe blunt renal lesions is possible using the alloplastic Vicryl mesh capsule. The method may also be suitable for reconstruction of the parenchyma following multiple nephrotomies, such as for removal of staghorn calculus, and experimental investigations are under way to clarify this point.

Rectovaginal Fistula

The purpose of this paper is to present the author's experience in managing rectovaginal fistulas from January 1970 to December 1980. They reviewed a consecutive series of 22 patients and looked for specific symptoms, signs, endoscopic and radiological examinations, operative procedures, operative findings, and the results of therapy and follow-up. The average age of the patients at the time of diagnosis was 47.3 years, with a range from 18–75 years. Table 1 presents the specific symptoms and signs at the time of admission. The chief compaint of most patients was the passage of feces and/or flatus per vagina. The patients were divided into two groups (postirradiation fistulas and nonirradiation fistulas), which are summarized in Table 2. Five of the patients underwent no operative procedure, either because they refused surgery or were poor risks, or because the primary cancer had not been controlled. In the follow-up period, none of these patients was recorded as having the fistula healed. All five died within 3 months to 2 years. The causes of death were carcinoma of the cervix, carcinoma of the rectum, and carcinoma of the urinary bladder. Three fistulas were repaired by means of a transvaginal approach. The fistula tract was dissected and excised. The fistula edge was inverted with interrupted 3–0 chromic catgut sutures. The perirectal fascia was used as a second layer to place over the initial layer, and the vaginal mucosa was closed in a third layer with 3–0 chromic catgut sutures. There was one failure in this group. The patient developed several recurrences, and a temporary colostomy was performed. The fistula finally healed after the fifth attempt at repair. These fistulas were located at the vaginal vault following episiotomy.

A simple method of arthrodesis of the first metatarsophalangeal joint.

Eighty-seven feet have been reviewed after arthrodesis of the first metatarsophalangeal joint stabilised by chromic catgut. Radiological union was present in 90% of patients at the mean review time of six years. Twenty-four patients had significant metatarsalgia before operation and only two failed to improve afterwards. Excellent or good subjective results were reported in 94% of patients at review. Chromic catgut is advocated as a simple and effective method of stabilising an arthrodesis of the first metatarsophalangeal joint.

Experimental and clinical use of the YAG laser in the management of pulmonary neoplasms.

Animal experiments were performed with evaluation of the use of the neodymium-YAG (yttrium-aluminum-garnet) laser in the trachea, bronchi, and pulmonary parenchyma. Histologic evaluation of incisions into the lung was assessed by multiple sections over a 5-week period and comparisons were made of incisions closed with chronic catgut or coagulated with electric cautery or by the laser. These studies indicated that the laser is more effective in controlling parenchymal bleeding and air leaks than either the cautery or chromic catgut and produces less local tissue reaction. The Nd-YAG laser has been used clinically to treat patients with inoperable obstructing and bleeding carcinomas of the trachea and main bronchi to open the involved airway and to restore pulmonary function. Fifteen patients have had 26 treatments using the Nd-YAG laser. Total laser time was limited to 15 minutes with 0.5-second pulses of 50 to 80 watts being delivered via the fiberoptic and straight bronchoscope as indicated. It is extremely effective in controlling hemoptysis from recurrent endobronchial lesions, and obstructing lesions in the trachea and main stem bronchus can be treated quite successfully with excellent palliation. It is apparent that continued clinical use of the Nd-YAG laser as palliative therapy for bleeding and obstructing tumors of the tracheobronchial tree is indicated and expanded use at the time of thoracotomy to control lung parenchymal bleeding and air leaks should be considered in the future.

Effects of physical configuration and chemical structure of suture materials on bacterial adhesion: A possible link to wound infection

The purpose of this study was to examine the effects of physical configuration and the chemical nature of suture materials on the preferential adherence of bacteria. Ten suture materials of 2-0 (chromic catgut, Dexon, Vicryl, PDS, Mersilene, Tycron, Ethibond, Surgilon, Ethilon, and Prolene) were used. The bacterial strains tested were Staph. aureus and E. coli. The level of bacterial adherence was determined quantitatively by radiolabelled cells and qualitatively by scanning electron microscopy. It was found that the amount of adhered bacteria depended on the type of suture material, the type of bacteria, and the duration of contact. In the group of absorbable sutures, the new PDS sutures exhibited the smallest affinity toward the adherence of both E. coli and Staph. aureus. Dexon sutures had the highest affinity toward these two bacteria. With nonabsorbable sutures, the physical configuration of the sutures contributed more to their ability to attract bacteria than the surface finish. The bacterial adherence on suture materials was also time dependent. Scanning electron microscope morphologic observation also indicated that Staph. aureus adhered on the suture surface in clusters whereas E. coli tended to adhere individually.

Management of bronchopleural fistula following pneumonectomy.

Bronchopleural fistula developed in 28 (12.5%) of 225 pneumonectomies performed for pulmonary carcinoma of non-small cell types during a 10-year period. The incidence of fistula apparently decreased significantly when chromic catgut was replaced by Dexon for closure of the bronchial stump. The fistula presented as an emergency in nine cases and was subacute in 19. The overall mortality from bronchopleural fistula was 28.6%. Conservative treatment, i.e. bronchoscopic application of silver nitrate to destroy the epithelium in the bronchial stump and induce granulation, achieved closure of fistula in all the surviving patients. In the seven patients with sterile pleural cavity the pleura was not drained. The results justified our principle of conservative management when a bronchopleural fistula does not present as an emergency. In emergency situations, however, or if the pleural fluid is purulent, pleural drainage should be instituted.

Ureteral reaction to suture material

Dog ureters were anastomosed end to end using either chromic catgut, polyglycolic acid (PGA), polyglaetin-910, or polypropylene sutures. Analysis of luminal diameters, fibrosis, scar vascularity, and inflammatory reaction four and seven months later indicated that in ureters of the uninfected dog the best results were obtained with polyglycolic acid. Ureters anastomosed with catgut gave results that were slightly less acceptable.

Experience with pyeloureterostomy in renal transplantation.

Pyeloureterostomy was used as the preferred method of urinary tract reconstruction in 260 of 371 consecutive renal allograft procedures performed between September 1967 and December 1980. Initially chromic catgut suture was used for the anastomosis in 96 patients with ten complications developing (10.4%). Because of the high incidence of anastomotic leakage (8.3%) with chromic catgut suture, the next 101 pyeloureterostomies were constructed using 7-0 Tevdek. Although urinary leakage occurred in only five of these patients (4.9%), late stone formation occurred along the suture material in three patients (2.9%), influencing the conversion to 7-0 Prolene for this anastomosis. With this suture material, only two complications have occurred in 63 subsequent pyeloureterostomies (3.1%), neither related to the anastomosis. In comparison, eight complications developed in 111 patients who underwent reconstruction with the Politano-Leadbetter method of ureteroneocystostomy (7.2%). The currently recommended method for pyeloureterostomy, as described, when combined with meticulous attention to technical details has made pyeloureterostomy a safe and effective method of urinary tract reconstruction in renal transplant recipients, with morbidity indistinguishable from that of ureteroneocystostomy.

A New Method for Induction of Fibrous Renal Artery Stenosis in the Pig Designed for the Study of Percutaneous Balloon Catheter Dilatation

An open surgical method for the creation of experimental renal artery stenosis by ligation with chromic catgut is described. Microscopic examinations at different intervals demonstrated the development of fibrosis throughout the arterial wall. These stenoses seem to provide a suitable model for the study of the effects of balloon catheter dilatation. Previously reported techniques for experimental artery stenosis induction are briefly reviewed.

The biologic response to standard suture materials in the skin of fetal rabbits

It is thought that wound healing and reaction of tissue to suture materials in the newborn or preterm infant may resemble that of the fetus. Wound healing in fetal experimental animals has been described, but to date no study of reaction to suture material in fetal animals has been performed. Operations on 60 pregnant, New Zealand white rabbits were performed. Hysterotomies were performed, and a variety of sutures were simply placed in the skin in Group I. In Group II, a small skin incision was made, and the wound was closed with the various sutures. The suture materials studied were: silk, Prolene, Ethibond, chromic catgut, and Vicryl. The animals were sacrificed 2 to 5 days postoperatively, and histology and grading of the tissue reaction was carried out. Grading was based on: (1) reactive cellular density, and (2) cellular response dimension. The reaction observed in all fetuses was: (1) mild to moderate by our criteria, (2) identical with or without a wound, and (3) present 2 days after implantation and did not seem to change significantly thereafter. This study demonstrates a similar host-tissue response of the rabbit fetus to a variety of suture materials and suggests that any decision on the choice of suture material in the fetus and possibly the preterm and newborn infant should be based on properties of the suture other than the host-tissue response that the suture produces.

Experimental fibrous renal artery stenosis dilated by balloon catheter. Long-term results.

Fibrous renal artery stenosis was induced by subtotal ligation with chromic catgut. Six weeks following unilateral ligation, transluminal balloon dilatation was performed in 8 pigs. Angiography was performed 8 to 10 weeks after dilatation, and at post-mortem 20 weeks after dilatation. Intra-arterial blood pressure and renal venous renin activity were measured before and at the repeat examination after dilatation and the morphologic changes in the arterial wall were evaluated at microscopy. Restenosis developed in 2 renal arteries, while successful dilatation was achieved in 6 cases.

Assessing Ureteral Wound Healing by Pressure Flow Technique

Bilateral ureteral anastomoses were performed on dogs with either chromic catgut, polyglycolic acid (PGA), polyglactin 910 or polypropylene suture. The infusion pressure technique of Whitaker was employed at 4 and 7 months after operation to assess ureteral function. The pressure flow data indicated that ureteral function was best when PGA sutures were used to accomplish the anastomosis. The results of this study suggest that the infusion pressure technique is useful in evaluating ureteral wound healing.

Fracture of the head of the radius with a tear or avulsion of the triceps tendon. A new syndrome?

A tear or avulsion ofthe triceps tendon is very rare, but the combined injury offracture ofthe radial head and avulsion or tear ofthe triceps tendon is even rarer still. The purpose ofthis article is to describe a series of 16 patients with this combined injury and to call into question the rarity of this combination. In an earlier article (Levy, Fishel and Stern i978) we described six patients with avulsion of the triceps tendon, four of whom also had a fracture of the radial head. Since then we have treated 1 2 more patients with this combined injury. To the best of our knowledge this is the first and the largest series describing this combination. In our article we suggested that an awareness of the hazard of a fall on the outstretched arm with fracture of the radial head ought to increase the frequency of the diagnosis of avulsion or tear of the triceps which can result from such an accident. CLINICAL MATERIAL Since 1973 16 patients have been treated (Table I) for the combined injury. All but one had a fracture of the radial head; the one exception (Case 4) had a fracture of the capitulum of the humerus. Twelve patients had avulsion and a tear of the triceps tendon, and four patients had a tear only. Clinical findings. These showed relatively little variation. In most of the patients we could prove that the mechanism of injury was a fall on the outstretched arm; in no patient was there a direct injury to the elbow. The symptoms and signs of the fractured radial head understandably dominated the clinical picture, the pain and tenderness being localised to the region of the radial head. Every patient had painful limitation of movement and diffuse swelling, but a palpably painful gap in the tendon was not consistently present. In all patients with avulsion of the tendon, the lateral radiograph of the elbow revealed an avulsed fragment of olecranon lying posterior to the distal end ofthe humerus (Figs 1 and 2). Treatment. In three patients without avuision of the triceps tendon we made a clinical diagnosis of a partial tear, and therefore we did not operate. The remaining 13 patients were operated on. In the i2 patients with avulsion (even of a very small olecranon fragment) we found that there was a complete or almost complete tear of the triceps tendon, and this was sutured with chromic catgut or Dexon sutures passed through holes drilled in the olecranon (Tarsney 1 972 ; Pantazopoulos et al. 1 975 ; Levy et al. 1 978). Additional sutures were inserted medially and laterally between tendon and muscle along the course of the tear caused by the avulsed fragment. In the fourth patient without avulsion (Case 2) we also found an almost complete rupture ofthe tendon. In five patients we had to excise the radial head, and in two we performed an open reduction. After operation the patients remained in a cast for three weeks with the elbow immobilised at an angle approximately 45 to 50 degrees short of full extension. Thereafter, physiotherapy was continued for four to six

Experience of the Cohen method for ureteral reimplantation in complicated cases.

Thirty-seven infants and children (41 ureters), a majority with complicating factors (low age, neurogenic bladder, duplication, reoperative surgery), were treated with ureteral reimplantation according to Cohen. The results were good in 90% of the cases. Minor deviations from the original technique, i. e. Dexon instead of chromic catgut as suturing material, catheter splinting of ureter in only 40% and short length of submucosal tunnel in some cases, did not seem to have a negative influence on the results. The method, which is easy and safe to perform, is recommended, particularly in complicated cases.

Dilatation of Experimental Renal Artery Stenosis by Balloon Catheter

An experimental model has been developed in the pig in order to evaluate the effect of percutaneous transluminal angioplasty on fibrous renal artery stenosis. Stenoses were induced by bilateral subtotal ligation with chromic catgut. Six weeks following ligation unilateral transluminal dilatation was performed in 9 pigs using Grüntzig balloon catheters. In only one case a serious complication occurred with rupture of the renal artery. Seven pigs with dilated stenoses were re-examined by angiography 8 to 10 weeks after dilatation. In 6 cases the stenoses were practically completely eliminated while in one cases a re-stenosis developed. Microscopy of the dilated arteries revealed several small and large ruptures of th internal elastic membrane.

Katarakt ve Şaşılık Cerrahisinde Yeni Absorbe Olabilen Sentetik Sütürler

New synthetic absorbable dexon and vicryl stures were used in 20 cataract and 20 strabismus operations in our clinic, and they were compared with chromic catgut and virgin silk for side effects and the results. It was found that if selected cataract operation tecnique was performed and in strabismus surgery these new su¬tures have some advantages to virgin silk and chromic catgut.

Repeat torsion of “fixed” testis

Four cases of torsion of the spermatic cord are reported following previous fixation for the same condition. In all cases the initial fixation was by absorbable chromic catgut suture, and at the subsequent operation for repeat torsion the testes were found to be freely mobile. The use of nonabsorbable suture material (2–0 silk) is recommended for testis fixation in cases of torsion.