Conventional Interrupted Suture Research Articles

Water-Tight Knee Arthrotomy Closure: Comparison of a Novel Single Bidirectional Barbed Self-Retaining Running Suture Versus Conventional Interrupted Sutures

Standard medial parapatellar arthrotomies of 10 cadaveric knees were closed with either conventional interrupted absorbable sutures (control group, mean of 19.4 sutures) or a single running knotless bidirectional barbed absorbable suture (experimental group). Water-tightness of the arthrotomy closure was compared by simulating a tense hemarthrosis and measuring arthrotomy leakage over 3 minutes. Mean total leakage was 356 mL and 89 mL in the control and experimental groups, respectively (p = 0.027). Using 8 of the 10 knees (4 closed with control sutures, 4 closed with an experimental suture), a tense hemarthrosis was again created, and iatrogenic suture rupture was performed: a proximal suture was cut at 1 minute; a distal suture was cut at 2 minutes. The impact of suture rupture was compared by measuring total arthrotomy leakage over 3 minutes. Mean total leakage was 601 mL and 174 mL in the control and experimental groups, respectively (p = 0.3). In summary, using a cadaveric model, arthrotomies closed with a single bidirectional barbed running suture were statistically significantly more water-tight than those closed using a standard interrupted technique. The sample size was insufficient to determine whether the two closure techniques differed in leakage volume after suture rupture.

Posterior-Wall-First Continuous Suturing Combined with Conventional Interrupted Suturing for Microvascular Anastomosis

Vascular anastomosis with conventional interrupted suturing is often difficult to perform when the vascular clamp is not reversed, because of a narrow operative field or a short vascular pedicle. A posterior-wall-first continuous suture technique combined with the standard interrupted suture technique is one method of solving this problem. The authors conducted a comparative study of posterior-wall-first continuous suturing combined with standard interrupted suturing and conventional interrupted suturing in rat vessels. There was no statistically significant difference in patency rates or suturing times. Electron microscopy demonstrated no significant difference in recoverability of the intima. The posterior-wall-first continuous suture technique combined with the standard interrupted suture technique is a useful alternative to the conventional interrupted suture technique.

Posterior-Wall-First Continuous Suture Combined with a Standard Interrupted Suture in Microvascular Anastomosis in Rats

Vascular anastomosis with conventional interrupted suture technique is often difficult to perform when the vascular clamp is not reversed because of a narrow operative field or a short vascular pedicle. A posterior–wall–first continuous suture, combined with the standard interrupted suture suturing method, is one of the means to solve this problem, but this method is not reliable. These authors did a comparative study in rats of the posterior–wall–first continuous suture combined with the standard interrupted suture and the conventional interrupted suture technique. The results showed no significant difference in patency rates or suturing times. There was also no significant difference in the recoverability process of the intima revealed from electron microscopic images. The posterior–wall–first continuous suture combined with standard interrupted suture is a useful alternative to the conventional interrupted suture technique.

Continuous-Suture Technique in Aortic Valve Replacement

From April 2000 to April 2003 total 103 patients underwent aortic valve replacement and some concomitant cardiac procedures including mitral valve replacement in our hospital. According to the suture technique used in aortic valve replacement, the patients were divided into two groups: group A, 42 patients, the continuous suture technique with some modifications was used; group B, 61 patients, the conventional interrupted suture technique was used. There were no statistical differences between the two groups in age, sex, bodyweight, valve lesion, concomitant cardiac procedure and early mortality. But there were significant differences ([<0.001 approximately 0.012) in aortic cross-clamp time (AOCT) and cardiopulmonary bypass time (CPBT) between the two groups with less time for the group A patients. During a follow-up from 1 to 35 months, in group B, one patient developed perivalvular leak. The incidence of perivalvular leak was 1.7% (1/59). Three patients developed prosthetic bacterial endocarditis, the incidence of which was 5.0% (3/59). All the patients in group A recovered satisfactorily without suture technique or prosthesis associated complications. The modified technique was introduced and illustrated with diagrams, and the reasons for the advantages of the technique over the conventional interrupted suture technique were discussed.

Vascular Closure Stapler Clips Versus Polypropylene Sutures in End-to-End Anastomoses of Growing Arteries and Veins

Alternatives are still being sought in vascular surgery to avoid the complications caused in growing vessels by the various suture techniques and materials currently in use. A major complication is arrested growth following anastomosis. Opinions differ widely regarding the best approach to this problem, and research is currently underway at our center on the latest generation of clip appliers (vascular closure stapler, or VCS) and their potential application as an alternative to the conventional suture technique in pediatric vascular surgery. This study compared vascular growth and reendothelialization following anastomosis of growing arteries and veins using VCS clips versus the conventional interrupted polypropylene suture technique. Thirty 55-day-old lambs underwent end-to-end anastomosis of the carotid artery and jugular vein. Serial ultrasonography and angiography were carried out over the ensuing 6-month growth period, after which the lambs were euthanized. Gross examination of the anastomosis site was followed by histologic examination involving light microscopy, immunohistochemical techniques, and transmission electron microscopy. Although both VCS clips and polypropylene sutures allowed transverse vessel growth, the clips did not penetrate the intima and thus provided enhanced reendothelialization. The satisfactory results obtained here, as in earlier studies, increasingly point to VCS clips as the method of choice in pediatric vascular surgery.

End-to-end arterial anastomosis with fibrin glue in larger arteries: histology, hydroxyproline concentration and tensile strength study in carotids of rabbits

End-to-end conventional arterial anastomosis is time consuming, requires prolonged clamping times and is associated with focal necrosis, granulocyte infiltration and subsequently, fibrosis and calcification of the arterial wall. Fibrin glue as an alternative for microarterial anastomosis may obviate these lesions, with less adherence to adjacent tissues and better coaptation of the arterial margins. OBJECTIVE: In this study we compared the healing process of conventional to fibrin glue end-to-end anastomosis in larger arteries. METHODS: In 22 rabbits, both carotid arteries were cross sectioned and repaired by end-to-end anastomosis with 4 interrupted sutures and fibrin glue in one side (GI) and with 8 conventional interrupted sutures in the other side (G2). After 3 and 15 days, the animals were randomly allocated for tensile strength, hydroxyproline determination (8 animals), and histologic analysis of the anastomosis (3 animals). Conventional staining procedures (hematoxylin-eosin and Masson methods) and picrosirius red polarization (PSP) technique for collagen type determination were employed. RESULTS: From 3 to 15 days, the tensile strength increased in both groups, from 280.0± 32.6 g to 432.2± 131.2g in Group I and from 221.4± 72.4g to 452.2± 132.0g in Group 2 (p&lt;0.001), with no statistical difference between the groups in each period of the study. The hydroxyproline content, expressed as hydroxyproline /protein ratio, varied from 0.0816 ± 0.0651 to 0.0622 ± 0.0184 in Group l and from 0.0734 ± 0.0577 to 0.0460 ± 0.0271 in Group 2, with no significant difference between periods and groups (p&gt;0.05). Histology showed slight increase of inflammatory and reparative reactions in Group 2. PSP technique demonstrated predominant type I collagen in relation to type III collagen in the anastomosis of both groups, with no significant difference between them. CONCLUSION: Fibrin glue was less harmful to the arterial wall than conventional suture. Even using less sutures in fibrin glue anastomosis, similar tensile strength and healing characteristics were noted in both groups. Completion times for the fibrin glue group was significantly greater than for the conventional anastomosis.

Combined microvascular anastomosis: experimental and clinical experience.

A short operative time and a high successful rate of microvascular anastomosis are the goals of many plastic surgeons. The authors present their experimental and clinical experience in microvascular anastomoses with the use of a combination of continuous suture and interrupted tie. Twenty rats were divided into two groups. The aorta and inferior vena cava were used for microvascular anastomoses. The vessels of 10 rats were repaired with conventional interrupted suture, and the vessels of the other 10 rats were repaired with combined anastomoses. A total of 150 clinical microvascular surgeries during the past 2 years are also presented, all of which were performed using the combined method. Microvascular anastomoses with the combined method were completed faster than when using the conventional interrupted method in experimental studies. Clinically, no direct microvascular anastomosis failed with the use of combined method. Microvascular anastomosis with the use of the combined continuous suture and interrupted tie resulted in satisfactory outcomes. This technique has the advantages of both interrupted and continuous methods, but not their shortcomings.

Jejunoileal atresia: A 27-year experience

Purpose: In this study, the authors review cases of jejunoileal atresia (JIA) to evaluate their surgical treatment strategy. Methods: Eighty-eight neonates who underwent surgical repair for JIA were divided into four groups for the type of lesion: group I, membranous (n = 23), group II, interrupted (n = 49), group III, multiple (n = 9), and group IV, apple-peel (n = 7). Group I patients were treated with membranectomy or bowel resection and anastomosis, group II with resection of the dilated bowel and one anastomosis, group III with two to six multiple anastomoses to preserve bowel length, and group IV with minimal bowel resection and bowel anastomosis. During surgery a uniform protocol was used to minimize bowel resection and to perform an end-to-end single layer anastomosis using either Halsted horizontal mattress or conventional interrupted sutures. Mortality, morbidity, days for functional recovery, and central venous nutrition (CVN) were included in the review. Results: Of 88 patients, three died of causes unrelated to operation for JIA. Nine patients underwent an additional laparotomy for leakage (n = 4) and obstruction (n = 5). Oral feeding was allowed on day 5.4 ± 4.3 and full caloric intake via the enteric route on day 12.5 ± 10.0. Twenty-one patients required CVN for 32.4 ± 19.1 days. None required a long-term treatment for the short bowel syndrome. Conclusion: This study concludes that efforts to preserve bowel length are laudable to avoid the short bowel syndrome and that an end-to-end single layer anastomosis contributes to early recovery of bowel function.

A Modified Method of Continuous Venous Anastomosis in Microsurgery

The continuous suture technique for end-to-end vascular anastomosis is cautioned against because of the risk of vessel constriction. A modified method of continuous suture for end-to-end venous microanastomosis is presented in which vessel constriction does not occur. This technique was compared with the conventional interrupted suture technique in the rat femoral vein, with each rat serving as its own control. Forty-eight Long-Evans rats were used. The mean time taken to complete the anastomosis was 9.8 minutes (range, 8-14 minutes) for the modified continuous technique and 17.7 minutes (range, 14-24 minutes) for the conventional interrupted technique (p < 0.05, independent t-test). In addition, the veins were examined under the microscope for patency and the milk test was performed on each anastomosis 30 minutes postanastomosis, and 1 week and 1 month postoperatively. Two groups of rats were sacrificed, one at 1 week and one at 1 month, and the two different anastomoses were compared using vessel morphometry in 40 rats and corrosion casts in 8 rats. All veins were patent postoperatively, as well as at 1 week and 1 month postoperatively. Vessel morphometry confirmed a similar luminal surface area in all veins examined at 1 week and 1 month. A two-way analysis of variance of vessel morphometry indicated no significant interaction between the methods used and the postoperative time (p = 0.60). The modified continuous technique is twice as quick as the conventional interrupted technique for end-to-end microvenous anastomosis and does not lead to vessel constriction.

Dural closure with laser tissue welding.

This study investigates the use of tissue-soldering techniques to substitute or reinforce traditional suture closure of dural incisions. Fresh human cadaveric dura was incised and subsequently closed by use of three techniques: (1) conventional interrupted suture with 4-0 silk (n = 25), (2) laser solder reinforced suture closure (n = 25), and (3) laser solder closure alone (n = 25). Anastomosis tensile strength and hydrostatic leak pressures were measured. Dural repair was also performed in 15 live Lewis rats. Dural closure was accomplished with 9-0 Prolene sutures (n = 5), laser-reinforced suture closure (n = 5), and laser solder closure alone (n = 5). Histologic examination of the closure immediately after soldering and 2 weeks later was performed. Suture closure alone had the lowest leak pressure, 9.4 +/- 1.7 mm Hg, and an intermediate break point, 13.3 +/- 2.1 Kgf/cm2. Measurements with laser solder alone revealed a mean leak pressure of 26.2 +/- 3.7 mm Hg and a break point of 4.6 +/- 1.4 Kgf/cm2. Solder-reinforced suture closure leak pressure measured 64.0 +/- 6.7 mm Hg and 21.4 +/- 2.4 Kgf/cm2. There was a statistically significant increase in leak pressure and tensile strength in the closures performed with laser weld reinforcement of traditional suture technique (p = 0.0001). Dural closure with laser tissue welding alone provided an immediate leak-free closure, but with poor tensile strength. Histologic examination of welded dura and underlying brain tissue showed no evidence of thermal injury in four of five animals studied. Laser welding may significantly decrease the incidence of cerebrospinal fluid leak after dural closure. In addition, laser tissue welding also makes dural closure possible where space constraints make traditional suture closure difficult.

Dural closure with laser tissue welding

This study investigates the use of tissue-soldering techniques to substitute or reinforce traditional suture closure of dural incisions. Fresh human cadaveric dura was incised and subsequently closed by use of three techniques: (1) conventional interrupted suture with 4-0 silk ( n = 25), (2) laser solder reinforced suture closure ( n = 25), and (3) laser solder closure alone ( n = 25). Anastomosis tensile strength and hydrostatic leak pressures were measured. Dural repair was also performed in 15 live Lewis rats. Dural closure was accomplished with 9-0 Prolene sutures ( n = 5), laser-reinforced suture closure ( n = 5), and laser solder closure alone ( n = 5). Histologic examination of the closure immediately after soldering and 2 weeks later was performed. Suture closure alone had the lowest leak pressure, 9.4 ± 1.7 mm Hg, and an intermediate break point, 13.3 ± 2.1 Kgf/cm 2. Measurements with laser solder alone revealed a mean leak pressure of 26.2 ± 3.7 mm Hg and a break point of 4.6 ± 1.4 Kgf/cm 2. Solder-reinforced suture closure leak pressure measured 64.0 ± 6.7 mm Hg and 21.4 ± 2.4 Kgf/cm 2. There was a statistically significant increase in leak pressure and tensile strength in the closures performed with laser weld reinforcement of traditional suture technique ( p = 0.0001). Dural closure with laser tissue welding alone provided an immediate leak-free closure, but with poor tensile strength. Histologic examination of welded dura and underlying brain tissue showed no evidence of thermal injury in four of five animals studied. Laser welding may significantly decrease the incidence of cerebrospinal fluid leak after dural closure. In addition, laser tissue welding also makes dural closure possible where space constraints make traditional suture closure difficult. (Otolaryngol Head Neck Surg 1996;115:513-8.)

A comparison of CO laser-assisted venous anastomoses and conventional suture techniques: Patency, aneurysm formation, and histologic differences

The expected patency and the potential complications of CO2 laser-welded end-to-end venous anastomoses have not been well established despite increasing clinical interest in the subject. To further study this relatively new technique we used the internal jugular veins (1.0 to 1.4 mm diameter) of 15 New Zealand White rabbits weighing 2.5 to 3.5 kg. On one randomly selected side, a laser-welded end-to-end anastomosis was performed in all animals by placing three equidistant stay sutures followed by welding the vein edges with a CO2 laser (spot size of 0.27 mm, power of 100 mW, and power density of 175 W/cm2). On the contralateral side, the vein was anastomosed with interrupted 10-0 nylon sutures in 10 animals, and in the remaining five animals a continuous 10-0 nylon suture technique was used. All anastomoses were surgically assessed at 30 days after operation. A significantly lower 30-day patency rate (p less than 0.05, Fisher's Exact Test) was found in anastomoses constructed by use of the continuous technique (20%) compared with either interrupted (90%) or the laser-assisted technique (87%). No significant difference was observed in 30-day patency between laser-assisted and conventional interrupted anastomoses. Anastomoses performed with the continuous and the laser-assisted technique required 12.5 +/- 1.3 and 12.9 +/- 3.0 minutes, respectively, whereas those constructed with interrupted technique required 19.1 +/- 4.5 minutes (p less than 0.05, Student-Neuman-Keuls' Test). No evidence of false or true aneurysm was noted in any of the animals. Histologic evaluation of laser-assisted anastomoses demonstrated early full-thickness coagulation necrosis of the wall with reendothelialization by 7 days and complete healing by 30 days after the procedure. Conventional anastomoses showed reendothelialization and minimal necrosis near the sutures at 7 days, but healing was complete by 30 days after the procedure. The patency rate of vein anastomoses performed with the CO2 laser is excellent and superior to the one obtained with continuous sutures, and except for less operating time, the former technique does not appear to offer any significant advantage over the conventional interrupted suture technique for small vein anastomosis in this animal model up to 1 month of follow-up.

A comparison of CO 2 laser-assisted venous anastomoses and conventional suture techniques: Patency, aneurysm formation, and histologic differences

The expected patency and the potential complications of CO 2 laser-welded end-to-end venous anastomoses have not been well established despite increasing clinical interest in the subject. To further study this relatively new technique we used the internal jugular veins (1.0 to 1.4 mm diameter) of 15 New Zealand White rabbits weighing 2.5 to 3.5 kg. On one randomly selected side, a laser-welded end-to-end anastomosis was performed in all animals by placing three equidistant stay sutures followed by welding the vein edges with a CO 2 laser (spot size of 0.27 mm, power of 100 mW, and power density of 175 W/cm 2). On the contralateral side, the vein was anastomosed with interrupted 10-0 nylon sutures in 10 animals, and in the remaining five animals a continuous 10-0 nylon suture technique was used. All anastomoses were surgically assessed at 30 days after operation. A significantly lower 30-day patency rate ( p < 0.05, Fisher's Exact Test) was found in anastomoses constructed by use of the continuous technique (20%) compared with either interrupted (90%) or the laser-assisted technique (87%). No significant difference was observed in 30-day patency between laser-assisted and conventional interrupted anastomoses. Anastomoses performed with the continuous and the laser-assisted technique required 12.5 ± 1.3 and 12.9 ± 3.0 minutes, respectively, whereas those constructed with interrupted technique required 19.1 ± 4.5 minutes ( p < 0.05, Student-Neuman-Keul's Test). No evidence of false or true aneurysm was noted in any of the animals. Histologic evaluation of laser-assisted anastomoses demonstrated early full-thickness coagulation necrosis of the wall with reendothelialization by 7 days and complete healing by 30 days after the procedure. Conventional anastomoses showed reendothelialization and minimal necrosis near the sutures at 7 days, but healing was complete by 30 days after the procedure. The patency rate of vein anastomoses performed with the CO 2 laser is excellent and superior to the one obtained with continuous sutures, and except for less operating time, the former technique does not appear to offer any significant advantage over the conventional interrupted suture technique for small vein anastomosis in this animal model up to 1 month of follow-up.

Konnektor-Technologie: Entwicklung des einfachen Schnelltransfers freier mikrochirurgischer Gewebelappen im Kopf- und Hals-Bereich*

The aim of this research program was to develop vessel connectors to replace the difficult microsurgical suture, which could be implanted quickly, safely and without any special training. Three types of connectors were developed specially for the anatomical features of the head and neck region: miniconnectors, stick connections with vascular prosthesis, and interposition connectors. The development of the model, the biomechanical tests on the in-vitro system comprising a free, muscular, porcine latissimus-dorsi flap, and the in-vivo tests involving implantation of the connectors in vessels of rats, rabbits, dogs and pigs are outlined. The results are compared with those obtained with conventional microsurgical interrupted sutures.--The indications for these three different types of connector are determined by the diameter and quality of the vessels (vein, artery).

レーザー皮膚接合治癒過程の組織学的観察

The sutureless approximation technique using Nd: YAG laser had already been reported before by the authors. This study was conducted to clarify the characteristics of wound healing process using this laser new technique as comparison with a conventional interrupted suture technique. For this purposes, Hematoxylin-Eosin staining and cell-maceration/scanning electron microscope (SEM) method were used to observe the wound on the post operative day 7, 21 and 42. The cell-maceration/SEM method study revealed the signs of earlier reproduction of collagen fibers and smaller wound cleft in the laser suture technique than in the conventional suture technique. These findings seems to be the reason why lower scar formation and faster wound healing are achieved in the laser technique than in the conventional technique.

The stretched scar: the benefit of prolonged dermal support

A study of skin suture following elliptical excision of tattoos from the upper limb shows that when the dermis is supported by a subcuticular non-absorbable suture for 6 months there is (a) a highly significant and numerically considerable (37.5%) reduction of scar stretching over that following conventional interrupted skin suture and (b) a significant reduction of scar width (15.7%) when compared with the same material used as a subcuticular suture for 3 weeks. Subcuticular polyglycolic acid achieved no reduction in scar width at one year when compared with conventional interrupted sutures.

Continuous suture method for microvascular anastomosis: technical note.

A continuous suture technique for microvascular end-to-side anastomosis was tested in an animal model. Twenty-five Wistar rats underwent carotid-to-carotid end-to-side anastomoses using the conventional interrupted suture technique, and another 25 animals underwent similar operations using a continuous suture method. Anastomosis patency, growth, and vessel clamp time during the operation were recorded. The continuous suture technique was found to have equivalent growth and patency figures and to be much faster than the interrupted suture method.

Use of Synthetic Absorbable Sutures for Abdominal and Chest Wound Closure

The advent of synthetic collagen suture (polyglycolic acid and polyglacin 910) has provided a new dimension in surgical suturing. However, surgeons in general have not yet taken full advantage of the potential that this new material offers. Associated evisceration and wound dehiscence rates as well as the incidence rate of wound infection were assessed since these represent standards by which the suture material can be evaluated. In an entire series of 650 cases, there has been one case of wound dehiscence with evisceration. The incidence of infection has been less than 1%, which is comparable to previous experience with interrupted, nonabsorbable sutures. The time required for closure using the new material has been approximately one third of that associated with the use of conventional interrupted closure sutures. This implies a substantial cost reduction for the patient. As a result of this experience, the synthetic absorbable sutures seem to represent the material of choice for routine abdominal or chest wound closure.