Elastic Suture Research Articles

The 6:1 short stitch SL-WL-ratio: short term closure results of transverse and midline incisions in elective and emergency operations

AimTo analyze laparotomy closure quality (suture/wound length ratio; SL/WL) and short term complications (surgical site occurrence; SSO) of conventional midline and transverse abdominal incisions in elective and emergency laparotomies with a longterm, absorbent, elastic suture material.MethodProspective, monocentric, non-randomized, controlled cohort study on short stitches with a longterm resorbable, elastic suture (poly-4-hydroxybutyrate, [p-4OHB]) aiming at a 6:1 SL/WL-ratio in midline and transverse, primary and secondary laparotomies for elective and emergency surgeries.ResultsWe included 351 patients (♂: 208; ♀: 143) with midline (n = 194), transverse (n = 103), and a combined midline/transverse L-shaped (n = 54) incisions. There was no quality difference in short stitches between elective (n = 296) and emergency (n = 55) operations. Average SL/WL-ratio was significantly higher for midline than transverse incisions (6.62 ± 2.5 vs 4.3 ± 1.51, p < 0.001). Results in the first 150 patients showed a reduced SL/WL-ratio to the following 200 suture closures (SL/WL-ratio: 5.64 ± 2.5 vs 6.1 ± 2.3; p < 0.001). SL/WL-ratio varied insignificantly among the six surgeons participating while results were steadily improving over time.Clinically, superficial surgical site infections (SSI, CDC-A1/2) were encountered in 8%, while 4,3% were related to intraabdominal complications (CDC-A3). An abdominal wall dehiscence (AWD) occurred in 22/351 patients (6,3%)—twice as common in emergency than elective surgery (12,7 vs 5,1%)—necessitating an abdominal revision in 86,3% of cases.ConclusionWe could show that a short stitch 6:1 SL/WL-ratio with a 2–0 single, ultra-long term, absorbent, elastic suture material can be performed in only 43% of cases (85% > 4:1 SL/WL-ratio), significantly better in midline than transverse incisions. Transverse incisions should preferably be closed in two layers to achieve a sufficient SL/WL-ratio equivalent to the median incision.Clinical Trials.gov IdentifierNCT01938222.

6:1 Suture or Wound length ratio with the short stitch technique – a reality check on practicability and short term outcome

Aim: To analyze laparotomy closure of conventional midline and transverse abdominal incisions in elective and emergency laparotomies with a longterm, absorbent, elastic suture material. Method: Prospective, single centre, non randomised, controlled cohort study on short stitches with a longterm resorbable, elastic suture (material: poly-4-hydroxybutyrate) aiming at a 6:1 suture to wound (SL/WL) length ratio in midline and transverse, primary &amp; secondary laparotomies for elective &amp; emergency surgery. Results: We included 351 patients (♂: 208; ♀: 143), midline (n=194), transverse (n=103) and a combined midline/transverse L-shaped (n=54) incisions. There was no stitch performance quality difference between elective (n=296) and emergency (n=55) operations, while results in the first 150 patients showed a significantly reduced SL/WL-ratio to the following 200 suture closures (SL/WLratio: 5.64±2.5 vs 6.1±2.3, p&lt;0.001). Average SL/WL-ratio in general was better for midline than transverse incision sutures (6.62±2.5 vs 4.3±1.51, p&lt;0.001). SL/WL-ratio varied among the 6 surgeons participating, although results steadily improved and eventually approximated each other. Conclusions: We could show that a 6:1 SL/WL-ratio with a 2-0 single, ultra-long term, absorbent, elastic suture material can be significantly performed better in midline than transverse incisions. Transverse incisions should preferably be closed in 2 layers in order to achieve a sufficient SL/WL-ratio equivalent to the median incision. While on an individual level, results varied between surgeons, quality will improve and eventually approximate.

Effects of the short stitch technique for midline abdominal closure on incisional hernia (ESTOIH): randomized clinical trial.

Incisional hernia remains a frequent problem after midline laparotomy. This study compared a short stitch to standard loop closure using an ultra-long-term absorbent elastic suture material. A prospective, multicentre, parallel-group, double-blind, randomized, controlled superiority trial was designed for the elective setting. Adult patients were randomly assigned by computer-generated sequence to fascial closure using a short stitch (5 to 8 mm every 5 mm, USP 2-0, single thread HR 26 mm needle) or long stitch technique (10 mm every 10 mm, USP 1, double loop, HR 48 mm needle) with a poly-4-hydroxybutyrate-based suture material (Monomax®). Incisional hernia assessed by ultrasound 1 year after surgery was the primary outcome. The trial randomized 425 patients to short (n = 215) or long stitch technique (n = 210) of whom 414 (97.4 per cent) completed 1 year of follow-up. In the short stitch group, the fascia was closed with more stitches (46 (12 s.d.) versus 25 (7 s.d.); P < 0.001) and higher suture-to-wound length ratio (5.3 (2.2 s.d.) versus 4.0 (1.3 s.d.); P < 0.001). At 1 year, seven of 210 (3.3 per cent) patients in the short and 13 of 204 (6.4 per cent) patients in the long stitch group developed incisional hernia (odds ratio 1.97, 95 per cent confidence interval 0.77 to 5.05; P = 0.173). The 1-year incisional hernia development was relatively low with clinical but not statistical difference between short and long stitches. Registration number: NCT01965249 (http://www.clinicaltrials.gov).

Concomitant use of elastic suture associated with vacuum dressing in the closure of large soft tissue losses

Concomitant use of elastic suture associated with vacuum dressing in the closure of large soft tissue losses

Effects of the short-stitch technique for midline abdominal closure: short-term results from the randomised-controlled ESTOIH trial

PurposeThe short-stitch technique for midline laparotomy closure has been shown to reduce hernia rates, but long stitches remain the standard of care and the effect of the short-stitch technique on short-term results is not well known. The aim of this study was to compare the two techniques, using an ultra-long-term absorbable elastic suture material.MethodsFollowing elective midline laparotomy, 425 patients in 9 centres were randomised to receive wound closure using the short-stitch (USP 2-0 single thread, n = 215) or long-stitch (USP 1 double loop, n = 210) technique with a poly-4-hydroxybutyrate-based suture material (Monomax®). Here, we report short-term surgical outcomes.ResultsAt 30 (+10) days postoperatively, 3 (1.40%) of 215 patients in the short-stitch group and 10 (4.76%) of 210 patients in the long-stitch group had developed burst abdomen [OR 0.2830 (0.0768–1.0433), p = 0.0513]. Ruptured suture, seroma and hematoma and other wound healing disorders occurred in small numbers without differences between groups. In a planned Cox proportional hazard model for burst abdomen, the short-stitch group had a significantly lower risk [HR 0.1783 (0.0379–0.6617), p = 0.0115].ConclusionsAlthough this trial revealed no significant difference in short-term results between the short-stitch and long-stitch techniques for closure of midline laparotomy, a trend towards a lower rate of burst abdomen in the short-stitch group suggests a possible advantage of the short-stitch technique.Trial registryNCT01965249, registered October 18, 2013.

Abstract 13904: Ex vivo Biomechanical Analysis of Elastic Artificial Chordae Implantation for Beating-heart Transapical Mitral Valve Repair

Introduction: Beating-heart transapical mitral valve repair represents a significant advancement in the minimally invasive treatment of mitral regurgitation. However, current techniques require increased artificial chordae length and altered anchoring position, which may increase the stresses on the suture. We hypothesized that artificial chordae manufactured with increased elasticity will dampen sharp increases in force, thus theoretically increasing durability. Methods: Porcine mitral valves (n=3) were mounted in a heart simulator and isolated mitral regurgitation was induced by cutting posterior primary chordae. Each valve was first repaired with standard CV-5 polytetrafluoroethylene (PTFE) suture affixed to a 3D-printed anchor with an embedded high-resolution Fiber Bragg Grating sensor to measure forces (Fig A). The repair was then repeated with an elastic suture manufactured using a biocompatible silicone and designed with a cross-sectional area of 0.56mm 2 , a geometry calculated to result in a desired 10-15% strain at relevant forces (Fig B). Results: Both materials allowed for successful repairs: mitral leakage volume was reduced from 28.29±4.83ml to 1.26±0.99ml ( p =0.009) with PTFE suture, and to 1.78±0.88ml ( p =0.008) with the elastic suture, with no significant difference between the repairs. Normalized force tracings (Fig C, standard deviation is shaded) revealed that the elastic suture resulted in a significantly lower peak systolic force when compared to PTFE suture (0.23±0.04N vs 0.32±0.03N, p =0.007). Conclusions: Artificial chordae with increased elasticity compared to traditional PTFE suture can dampen sharp peaks in force, thus offering a promising advancement in improving transapical repair durability. This proposal has the potential to apply to open-heart artificial chordae implantation as well. Future work to optimize suture material and manufacturability will help translate this development into clinical use.

Application of modified tracking components in CyberKnife treatment of thoracic and abdominal tumors

Objective To improve synchrony tracking components of CyberKnife (tracking vest and tracking markers) and to analyze the clinical application value of the improved tracking components in CyberKnife treatment of thoracic and abdominal tumors. Methods The tracking apron was made of knitted four-side elastic spandex cloth and suture design of Velcro, which was used to stick the tracking markers on the chest and abdomen of patients. The tracking markers added a 2 cm thick light foam block to the bottom of the original markers, and then the hook face of the Velcro was fixed to the bottom of the light foam. The improved trace component (the improved component) and the original component (the vendor component) were applied to the lung tracking treatment model, and the manufacturer components were included in the reference group. Adoption of improved components into the observation group; 20 different types of respiratory waveforms were simulated and applied to the same mold plan. After treatment, the coverage rate, mean standard deviation, maximum standard deviation and the slope of XYZ-axis vs. R correlation graph were recorded. The relevant parameters of Synchrony model and wearable time of two components were compared, and the application significances of the improved tracking component in the breathing tracking process of the CyberKnife were evaluated. Results The maximum slope [median(interquartile range)] of XYZ-axis vs. R related graph in the reference group was 0.73 (3.89), 0.27 (0.49) and 0.34 (1.02), respectively. The maximum slope of XYZ-axis vs. R related graph in the observation group was 0.70 (2.78), 0.31 (0.30) and 0.36 (0.75), respectively. There was no statistically significant difference in the slope of XYZ-axis vs. R between the reference group and the observation group (all P > 0.05). There was no significant difference in the average standard error and maximum standard error between the reference group and the observation group [(1.7±0.4) mm vs. (1.7±0.5) mm, t=-0.382, P= 0.710; (2.0±0.6) mm vs. (1.7±0.5) mm, t=-0.877, P= 0.401], and the difference of the model coverage rate between the two groups was statistically significant [(48±18)% vs. (60±22)%, t= 2.762, P= 0.042]. The setup time of tracking components in the observation group was less than that in the reference group, and the difference was statistically significant [(44±24) s vs. (81±15) s, t=-4.310, P= 0.001]. Conclusions The improved tracking components are comparable to the manufacturer tracking components in the standard error of the Synchrony model. The improved components shorten the wear time and appropriately improve the coverage of the Synchrony model. Key words: Thoracic neoplasms; Abdominal neoplasms; CyberKnife; Stereotactic body radiation therapy; Standard error; Synchrony model

Measurement of Three-Dimensional Force Applied to Elastic Suture Training Pads for Laparoscopic Suturing.

Laparoscopic surgery requires highly trained skills to manipulate the laparoscopic instruments. The effectiveness and efficiency of manipulation training are expected to increase by quantitatively evaluating how a series of trainee's manipulations are different from those conducted by skilled surgeons and providing feedback. However, such detailed feed- back is not available because adequate measurement systems have not been proposed to measure the precise forces applied to suture training pads without disturbing the delicate manipulations. Therefore, we proposed a sensorized suture training pad satisfying the above requirements. Three surgical residents participated in an experiment to measure time sequences of three-dimensional forces applied to the pad when executing a transfixion suture. As a result, the differences in manipulation patterns among the residents were found by dividing the transfixion operation based on the sequential force data and recorded videos.

A coupled physical-computational methodology for the investigation of short fall related infant head impact injury

Head injury in childhood is the most common cause of death or permanent disability from injury. However, insufficient understanding exists of the response of a child’s head to injurious loading scenarios to establish cause and effect relationships to assist forensic and safetly investigations. Largely as a result of a lack of availability of paediatric clinical and Post-Mortem-Human-Surrogate (PMHS) experimental data, a new approach to infant head injury experimentation has been developed. A coupled-methodology, combining a physical infant head surrogate, producing “real world” global, regional and localised impact response data and a computational Finite-Element (FE-head) model was created and validated against available PMHS and physical model global impact response data. Experimental impact simulations were performed to investigate regional and localised injury vulnerability. Different regions of the head produced accelerations significantly greater than those calculated using the currently available method of measuring the global, whole head response. The majority of material strain was produced within the relatively elastic suture and fontanelle regions, rather than the skull bones. A subsequent parametric analysis was conducted to provide a correlation between fall height and areas of maximum-stress-response and fracture-risk-probability. The FE-head was further applied to investigating fracture risk, simulating injurious PMHS impacts and a good qualitative match was observed. The FE-head shows significant potential for the study of infant head injury and is anticipated to be a motivating tool for the improvement of head injury understanding across a range of potentially injurious head loading scenarios.

Comprehensive and innovative techniques for laparoscopic choledocholithotomy: A surgical guide to successfully accomplish this advanced manipulation.

Surgeries for benign diseases of the extrahepatic bile duct (EHBD) are classified as lithotomy (i.e., choledocholithotomy) or diversion (i.e., choledochojejunostomy). Because of technical challenges, laparoscopic approaches for these surgeries have not gained worldwide popularity. The right upper quadrant of the abdomen is advantageous for laparoscopic procedures, and laparoscopic choledochojejunostomy is safe and feasible. Herein, we summarize tips and pitfalls in the actual procedures of choledocholithotomy. Laparoscopic choledocholithotomy with primary closure of the transductal incision and transcystic C-tube drainage has excellent clinical outcomes; however, emergent biliary drainage without endoscopic sphincterotomy and preoperative removal of anesthetic risk factors are required. Elastic suture should never be ligated directly on the cystic duct. Interrupted suture placement is the first choice for hemostasis near the EHBD. To prevent progressive laceration of the EHBD, full-layer interrupted sutures are placed at the upper and lower edges of the transductal incision. Cholangioscopy has only two-way operation; using dedicated forceps to atraumatically grasp the cholangioscope is important for smart maneuvering. The duration of intraoperative stone clearance accounts for most of the operative time. Moreover, dedicated forceps are an important instrument for atraumatic grasping of the cholangioscope. Damage to the cholangioscope requires expensive repair. Laparoscopic approach for choledocholithotomy involves technical difficulties. I hope this document with the visual explanation and literature review will be informative for skillful surgeons.

Evaluation of a Monofile, Ultra-Long Absorbable Suture with High Elasticity for Abdominal Wall Closure Under Daily Clinical Routine MULTIMAC a Prospective Observational Study

Recent meta-analyses have shown that the application of a monofile, late-absorbable suture using a continuous suture technique with a suture-to-wound length ratio of at least 4:1 is the method of choice for the closure of midline laparotomies. Monomax, a new ultra-long term absorbable, high elastic monofilament suture, was approved in 2009 and its safety and efficacy were proven in a selected patient population under controlled conditions for elective midline abdominal wall closure (ISSAAC Study). The present multi-centric, international, prospective observational study is aimed at evaluating the performance of Monomax suture for transverse and midline abdominal wall closure in daily clinical practice even in high risk patients. A total of 200 patients undergoing a primary elective laparotomy using either a midline or transverse incision were examined regarding the frequency of short-term complications (e.g. reoperation due to burst abdomen, wound infection, wound healing disorders), until discharge and 1 month after surgery. Postoperative length of hospital stay was also reported. Frequency of reoperation due to burst abdomen was 2.5% and a wound infection rate of 3.5% was reported up to day of discharge. Seven patients developed a wound healing disorder (3.5%). Average length of postoperative hospital stay was 10.3 days. Our results indicate that the ultra-long term absorbable, elastic monofilament suture is safe and efficient for transverse and midline abdominal wall closure performed under daily clinical routine even in high risk patients.

Elastic suture: a treatment option for extensive skin loss

Elastic suture: a treatment option for extensive skin loss

Elastic suture thread

Elastic suture thread

Extensive mammary wound treatment in ewe using a rubber elastic suture technique combined with aloe gel

Extensive wounds may not be able to heal by primary intention, due to the lack of tissue. Moreover, treatment of these wounds by secondary intention is more difficult in production animals, due to the high investment requirement and long recovery time. Therefore, new approaches that favor short-term recovery are desirable. This study reports the application of an elastic suture technique for the treatment of an extensive mammary wound. This technique was applied in a lactating ewe with gangrenous mastitis, resulting in extensive tissue necrosis and loss of mammary tissue. Extension of the wound made complete coaptation of the wound edges impossible. Elastic sutures were chosen as they allow a constant and moderate tension that gradually induces approximation of the skin edges. The wound showed a significant decrease in extension before removal of the stitches, demonstrating the successful application of this technique in wound closure surgery. The elastic suture is presented as a new management option for extensive wounds in the field of veterinary medicine.

Elastic suture as an alternative for the initial wound care in the emergency room

Elastic suture as an alternative for the initial wound care in the emergency room

Laparotomy closure using an elastic suture: a promising approach.

Midline laparotomy wound failure like burst abdomen remains one of the major complications after abdominal surgery. The use of sutures with a closer resemblance to abdominal wall physiology, like elastic threads, could decrease the risk of these complications occurring. Thus, we evaluated the possibility of using a new elastic thread composed of thermoplastic polyurethane (TPU) as a suture for the closure of midline laparotomies compared to conventionally used polypropylene (PP) in a rabbit model. The elastic TPU thread was processed and tensile tests were performed. Twenty female chinchilla rabbits underwent midline laparotomy. They were randomized to a TPU and a PP group depending on the suture used for fascia closure. After 7 or 21 days, the abdominal walls were assessed macroscopically for wound healing complications and were explanted for histopathological investigation. Tensile tests showed a mean elastic elongation of 55.5% and a sufficient material strength of the TPU thread. In animal experiments, there was no difference between the groups at 7 days; however, the TPU suture showed significantly less CD68 positive cells (p < 0.001) and a higher collagen I/III ratio (p = 0.011) than PP did after 21 days. The amount of apoptotic cells was significantly elevated in the TPU group (p = 0.007) after 21 days. No differences were found concerning granuloma size and number of Ki67-positive cells. The newly developed TPU thread shows promising tensile characteristics. Midline laparotomy closure is feasible and safe in a rabbit model. Immunohistochemistry indicates similar biocompatibility and wound healing after implantation compared to PP after 21 days. To confirm these findings and to proof long-term capability further studies need to be conducted.

Elastic suture: An alternative for extensive skin loss

The treatment of complex wounds in soft tissues remains a major challenge for plastic surgeons. In this context, skin detachments, slow expansion, and presuture and elastic suture methods use the basic principles of skin biomechanics to correct various skin defects that are the result of various causes such as car accidents, tissue necrosis, resection of skin lesions, and scar formation, which would otherwise require grafts, flaps, or spreaders. ABSTRACT The treatment of complex wounds in soft tissues remains a major challenge for plastic surgeons. Several reconstruction methods have been used for this purpose, including the use of grafts, flaps, and spreaders. This study aimed to improve the technique of elastic suture by using the biomechanical properties of the skin and in which the open wound areas are closed without the need for detachment and often under local anesthesia, in two surgical stages, and without causing further sequelae. The contribution to the improvement of the technique is based on the use of a polypropylene mesh (Marlex) fixed to wound edges, allowing the elastic traction to be homogeneously distributed throughout the tissue, thus avoiding ischemic necrosis of the wound edges.

Closure of large wound with rubber elastic circular strips - case report

added in the application of subcutaneous and superficial fascia, in order to avoid additional suffering the edge of the skin, which could worsen the condition of the wound to this technique. This modification improved the aesthetic appearance and location prevented the formation of the lateral wound scars. The objective of this report is to present a new technique for closure of extensive surgical wounds through elastic suture, using circular elastic rubber bands.

Comparison of elastic versus rigid suture material for peripheral sutures in tendon repair

BackgroundFor secure tendon repair, while core suture materials have been previously investigated, the optimum material for peripheral sutures remains unclear. MethodsTransected bovine gastrocnemius tendons were repaired by 2-strand side-locking loop technique using no.2 braided polyblend polyethylene thread for the core suture. Then, 8-strand peripheral cross-stitches were added using either 2–0 rigid sutures (braided polyblend polyethylene) or USP 2-0-sized elastic sutures (nylon). The holding area of each peripheral suture was set at either 3×1mm (shallow holding) or 6×2mm (deep holding). Therefore, 4 groups were compared (the shallow-rigid, deep-rigid, shallow-elastic, and deep-elastic groups). The gap formation, ultimate tensile strength, and suture migration state were measured after 500 cyclic loadings (from 10 to 200N). MethodsThe shallow-rigid group had inferior outcomes compared to the other groups. Although the deep-rigid group had the smallest gap and highest ultimate strength, all peripheral sutures had failure prior to core suture rupture. The two elastic groups showed no significant differences, irrespective of the size of the holding area. Suture migration did not occur in the two elastic groups until the ultimate strength was reached and the core suture ruptured. InterpretationDepending on the suturing method, rigid suture material may not be appropriate for peripheral sutures, when accompanying rigid core suture material. If peripheral sutures can be made with accurate deep holding, rigid suture material will provide favorable outcome. However, in other cases, elastic suture material is considered best for supporting a rigid core suture, as elasticity is another important factor for peripheral sutures.

New Elastic Suture Materialによる血管吻合の評価

New Elastic Suture Materialによる血管吻合の評価