Continuous Nonabsorbable Suture Research Articles

Blefaroplastia: ¿suturar o usar cianocrilato?

Objective To study the safety and surgical time required when using the tissue adhesive 2-ethyl-cyanoacrylate compared with conventional suture in upper lid blepharoplasty. Method A retrospective study was performed on 40 eyes of 20 patients who underwent bilateral upper lid blepharoplasty. In 7 patients, continuous non-absorbable suture (6-0 nylon monofilament Ethilon ®, Ethicon Inc., Somerville, NJ) was used for closure of the incision and in 13 patients 2-ethyl-cyanoacrylate (Epiglue ®, Meyer -Haake, Germany) was used. The variables studied were intraoperative time required to close the incision, the cost of the material used and the incidence of infections and suture dehiscence. Results The average time taken to close the incision was 6.069 minutes with cyanoacrylate and 11.914 minutes with conventional suture ( P < .05). The price of surgical material used was practically similar. No cases of infection or wound dehiscence were found. Conclusion The closure of the incision in upper lid blepharoplasty using 2-ethyl-cyanoacrylate is a safe, effective, and faster, but not less expensive method than conventional suture.

Blepharoplasty: to suture or to use cyanoacrylate?

ObjectiveTo study the safety and surgical time required when using the tissue adhesive 2-ethyl-cyanoacrylate compared with conventional suture in upper lid blepharoplasty. MethodA retrospective study was performed on 40 eyes of 20 patients who underwent bilateral upper lid blepharoplasty. In 7 patients, continuous non-absorbable suture (6-0 nylon monofilament Ethilon®, Ethicon Inc., Somerville, NJ) was used for closure of the incision and in 13 patients 2-ethyl-cyanoacrylate (Epiglue®, Meyer -Haake, Germany) was used. The variables studied were intraoperative time required to close the incision, the cost of the material used and the incidence of infections and suture dehiscence. ResultsThe average time taken to close the incision was 6.069 minutes with cyanoacrylate and 11.914 minutes with conventional suture (P<.05). The price of surgical material used was practically similar. No cases of infection or wound dehiscence were found. ConclusionThe closure of the incision in upper lid blepharoplasty using 2-ethyl-cyanoacrylate is a safe, effective, and faster, but not less expensive method than conventional suture.

Meta-analysis of suture techniques for midline abdominal incisions

To evaluate the safety and efficacy of suture techniques for midline abdominal incisions with systematic review and meta-analysis. The articles about suture techniques for midline abdominal incisions published from year of 1981 to 2009 in MedLine and Embase databases were retrieved. All the trials with a minimal follow-up of one year that randomized patients for midline laparotomy with different suture techniques and/or suture materials were subjected to meta-analysis. The outcomes included incisional hernia, wound dehiscence, wound infection and suture sinus formation. Total of 13 articles were collected in this analysis. Compared with continuous sutures, interrupted sutures had significantly more incisional hernias (OR = 0.80, 95%CI: 0.66 - 1.00;P = 0.05). Continuous rapidly absorbable suture was associated with significantly more incisional hernias than continuous slowly absorbable suture or continuous non-absorbable suture (15.8%, 10.0% and 8.3%, respectively; P < 0.05). More suture sinuses occurred in patients with continuous non-absorbable suture than in those with continuous rapidly absorbable suture (5.6% vs. 1.0%, P < 0.05); And more suture sinuses occurred in patients with interrupted non-absorbable suture than in those with interrupted rapidly absorbable suture (8.8% vs. 0, P < 0.05). Compared with continuous slowly absorbable suture, more suture sinuses occurred in patients with continuous non-absorbable suture (OR = 0.47, 95%CI: 0.24 - 0.92; P < 0.05). Less incisional hernias occurred in patients with a suture length/wound length ratio (SL/WL) of ≥ 4:1 than those with the ratio less than 4:1 (P < 0.05). To reduce the incidence of incisional hernia without increasing wound infection frequency, the ideal suture technique is mass closure using a continuous suture, with an adequate suture length/wound length ratio no less than 4:1, the suture materials should be slowly absorbable.

Ischemic bowel after laparoscopic Roux-en-Y gastric bypass: limited resection based on fluorescein assessment of bowel viability

Small bowel obstruction (SBO) occurs in 1.5–4% of patients after laparoscopic Roux-en-Y gastric bypass (LRYGB) [1–5] and results from internal hernia in 30–50% of cases [1, 6]. Three potential internal hernia defects result from RYGB: the jejunojejunostomy mesenteric defect, Petersen’s defect, and the transverse mesocolon defect [2]. Routine closure of all three defects with continuous nonabsorbable suture has been advocated [7].

Laparoscopic Closure of the Petersen Mesenteric Defect

Small-bowel obstruction secondary to internal hernia is a known postoperative complication of laparoscopic Roux-en-Y gastric bypass (RYGBP). Petersen's defect is the most common site of postoperative internal herniation. The authors describe their technique of closure of the infracolic component of the Petersen's defect using continuous non-absorbable suture material. The method has been used successfully to reduce the incidence of internal herniation after laparoscopic RYGBP.

Choosing the best abdominal closure by meta-analysis

Background: Local custom, rather than evidence-based medicine, dictates how a surgeon closes abdominal wounds. Closures might be more secure if grounded on statistical data. Materials and methods: A meta-analysis of 12,249 patients with abdominal wound closures was made. Infections, hernias, and dehiscences were compared examining continuous versus interrupted closures, continuous (absorbable versus nonabsorbable), interrupted (absorbable versus nonabsorbable), and mass versus layered. Results: Continuous absorbable closures showed more hernias ( P = 0.0007). Dehiscences were significantly more with continuous nonabsorbable suture ( P = 0.01). Interrupted nonabsorbable closures showed a higher incidence of hernias and dehiscences ( P = 0.0002, P = 0.04). Mass closures produced significantly less hernias and dehiscences when compared with layered closures ( P = 0.02, P = 0.0002). Conclusions: Continuous closures with nonabsorbable suture should be used to close most abdominal wounds. However, if infection or distention is anticipated, interrupted absorbable sutures are preferred. Mass closures are superior to layered closures.

Double Skin Technique with Polyglactine or Mixed Mesh in Mastopexy and Breast Reduction

Introduction: The periareolar approach to breast reduction results in a circumareolar scar without vertical and horizontal components. The problems of this technique are widening of the periareolar scar, difficulty in obtaining proper breast shape, and early appearance of breast ptosis. The double skin technique using polyglactine or mixed mesh through a periareolar approach was utilized to see if the problems of the periareolar approach could be reduced. Materials and Methods: Since 1994, 100 patients have had a periareolar approach utilizing the double skin technique with polyglactine or mixed mesh. Age range was 19 to 49 years. There were 44 cases of mastopexy (breast lift) and 66 cases of breast reduction. The double skin technique is a periareolar pexy that utilizes a central large dermo-glandular pedicle, which is lifted (and eventually reduced) up to the desired new position and fixed at the costal margin. A second layer, represented by a large dermal flap, is utilized for the internal lining. A 910 polyglactine mixed mesh harvests the new breast cone to reinforce the new shaped breast. A round-block continuous nonabsorbable suture contributes to pull and distributes the tension of the internal cutaneous lining, while the areolar skin is sutured with a long-term absorbable continuous suture, in a double layer, leaving two independent elements sutured without tension. Conclusions: The experience of the author with the Goes technique includes a large series of patients with mild to medium ptosis and mild to medium hypertrophies. Having performed breast pexy and reductions with other periareolar techniques, experience shows that the present choice exactly fulfills all the requirements of the operation. Shape, projection of the breast, quality of the areolar scar, and long-term results are all improved in comparison with the techniques utilized in the past.

Absorbable polydioxanone suture and results in total anomalous pulmonary venous connection

Despite theoretical advantages of absorbable suture in the growing vascular anastomosis, there has not been a documented advantage over nonabsorbable suture in preventing late anastomotic stenosis in total anomalous pulmonary venous connection (TAPVC). We reviewed our experience from 1982 to 1994 with 65 hospital survivors of total TAPVC repair to examine the influence of suture type on survival and incidence of late pulmonary venous obstruction. From 1982 until 1988, we used continuous nonabsorbable polypropylene suture for the pulmonary venous-left atrial anastomosis in supracardiac, infracardiac, and mixed types of TAPVC: In 1989, we adopted a running absorbable polydioxanone suture technique. Cardiac catheterization and echocardiography were used to evaluate late pulmonary venous obstruction. Late pulmonary venous obstruction occurred in 17% (4/23) of survivors after repair with polypropylene suture compared with 3.2% (1/32) after repair with polydioxanone suture (p < 0.05). There were no instances of late pulmonary venous obstruction in the intracardiac TAPVC group (0/10). All late pulmonary venous obstructions occurred within 16 months after operation. The actuarial 3-year and 5-year freedom from late pulmonary venous obstruction was 100% for intracardiac TAPVC, 96% for the polydioxanone group, and 81% for the polypropylene group. Five patients died late (5/65, 7.7%), 3 in the polypropylene suture group (3/23, 13%) and 2 in the polydioxanone group (2/32, 6%). Continuous absorbable polydioxanone suture for the repair of TAPVC results in a low incidence of late pulmonary venous obstruction and death and appears to offer advantages over a continuous nonabsorbable suture. A continuous nonabsorbable suture may limit growth of a vascular anastomosis, particularly one involving a "low-pressure" anastomosis such as in the repair of TAPVC:

Recent trends in the management of incisional herniation.

There is a high incidence of risk factors for incisional herniation in hospitalized veterans. Almost half the defects appear more than 12 months after celiotomy. "Buttonholing" of the rectus sheath by a sawing motion of the continuous nonabsorbable suture may be responsible for this later herniation. Suturing with synthetic, slowly absorbed monofilament may reduce delayed herniation. The recurrence rate after primary repair was 24.8% (n = 206), and after a second repair the recurrence rate was 41.7% (n = 36). Plastic prostheses, used only in difficult cases (18% of the sample), were associated with a recurrence rate similar to that associated with sutures because of protrusion around the edge. The use of larger and better fixed ("sandwich") polypropylene mesh (Marlex) is indicated. Subxiphoid epigastric hernias following sternotomy do not require prosthetic herniorrhaphy.

Absorbable polydioxanone suture for venous anastomoses: Experimental studies using venography and transluminal angioscopy

Because of their increased tendency to stenosis and spasm and thrombosis, results after venous anastomoses are often unsatisfactory. Nonabsorbable sutures and a continuous suture technique have been suggested to have a negative effect on the compliance of vascular anastomoses. Eighty venous anastomoses were performed with either an interrupted or continuous suture technique, using polypropylene or polydioxanone (PDS) sutures, according to a randomised experimental model. The anastomoses were divided in four groups: (1) Nonabsorbable suture material, continuous suture technique; (2) Nonabsorbable suture material, interrupted suture technique; (3) Absorbable suture material, continuous suture technique; and (4) Absorbable suture material, interrupted suture technique. The morphology of the anastomoses was controlled by venography directly after closure of the wound and at weekly intervals for 2 months and monthly intervals thereafter until 2 years had passed. In 10 cases venography was followed by transluminal angioscopy in the early postoperative period and after 1, 2, 4, 8 and 12 weeks. In the first 2 months moderate and high degree stenoses were found in all 4 groups by venography. After 8 weeks there was a significant decrease in the incidence of stenosis in all groups with the exception of the group, in which continuous nonabsorbable suture had been used. Using angioscopy a marked swelling of the intima at the site of the anastomoses could be detected in the early postoperative period in all experimental groups. After 2 months no significant narrowing could be identified in groups 2, 3 and 4.(ABSTRACT TRUNCATED AT 250 WORDS)

An experimental single layer colonic anastomosis.

THIRTY-THREE rats had end to end colonic anastomoses performed. A single layer anastomosis using a continuous polypropylene (Prolene) suture was compared with a standard two layer technique. Each anastomosis was assessed for local complications, bursting pressure, stenosis and histological appearances. The mortality rate in the single layer group was 5.9% with no deaths in the two layer group. The single layer technique also produced a significantly greater index of stenosis 6 and 10 weeks postoperatively. Single layer anastomoses using a continuous nonabsorbable suture are not recommended for clinical practice.