Monofilament Nylon Suture Research Articles

Comparison of nylon, vicryl, and fibrin glue for nerve grafting in rats

ABSTRACT Objectives For nerve injuries, not amendable to tensionless epineural coaptation of the nerve, autografts are the preferred treatment. Although absorbable sutures are not recommended for nerve repair, there is no evidence that non-absorbable sutures are superior to absorbable sutures. This study aims to assess the effectiveness of non-absorbable monofilament nylon sutures, absorbable monofilament vicryl sutures, and fibrin glue when used for nerve grafting. Methods Lewis rats (N = 32) were subjected to a sciatic nerve transection and randomly assigned to a group: graft with Nylon, graft with Vicryl, graft with Fibrin Glue, or no graft. Motor function, sensory function, and thermal pain were assessed during a 12-week recovery period, and immunohistochemistry was used to assess macrophage response. Results At 12 weeks, the Vicryl and Nylon groups had significantly larger ankle angles at to lift off, which is a measure of motor function, compared to injured controls (p < 0.05). Grafted rats displayed no difference in thermal response but hypersensitivity to mechanical stimuli compared to the uninjured hindlimb. The Nylon, Vicryl, and Fibrin Glue groups all had significantly less atrophy of the gastrocnemius muscle compared to injured controls (p < 0.0001). In the Fibrin Glue group, 3/9 grafts did not incorporate. The Nylon group had significantly less (p = 0.0004) axon growth surrounding the suture holes compared to the Vicryl group. There were no differences in the axon counts, motor neurons, or sensory neurons between all grafted rats. Conclusions These results demonstrate that vicryl sutures work just as well as nylon for nerve recovery after injury and grafting.

Skimmianine Showed Neuroprotection against Cerebral Ischemia/Reperfusion Injury.

The aim of this study was to investigate the antioxidant and anti-inflammatory effects of skimmianine on cerebral ischemia-reperfusion (IR) injury. Twenty-four female Wistar albino rats were randomly divided into three groups: Sham, Ischemia-Reperfusion (IR), and IR + Skimmianine (40 mg/kg Skimmianine). Cerebral ischemia was induced using a monofilament nylon suture to occlude the middle cerebral artery for 60 min. Following 23 h of reperfusion, the animals were sacrificed 14 days later. The effects of skimmianine on brain tissue post-IR injury were examined through biochemical and immunochemical analyses. In silico analysis using the Enrichr platform explored skimmianine's potential biological processes involving IBA-1, IL-6, and NF-κB proteins. In the IR group, MDA levels increased, while SOD and CAT antioxidant enzyme activities decreased. In the IR + Skimmianine group, skimmianine treatment resulted in decreased MDA levels and increased SOD and CAT activities. Significant increases in IBA-1 expression were observed in the IR group, which skimmianine treatment significantly reduced, modulating microglial activation. High levels of IL-6 expression were noted in pyramidal neurons, vascular structures, and neuroglial cells in the IR group; skimmianine treatment reduced IL-6 expression, demonstrating anti-inflammatory effects. Increased NF-κB expression was observed in neurons and blood vessels in the gray and white matter in the IR group; skimmianine treatment reduced NF-κB expression. Gene Ontology results suggest skimmianine impacts immune and inflammatory responses via IBA-1 and IL-6, with potential effects on estrogen mechanisms mediated by NF-κB. Skimmianine may be a potential therapeutic strategy due to its antioxidant and anti-inflammatory effects on cerebral IR injury.

A Modified Model Preparation for Middle Cerebral Artery Occlusion Reperfusion.

The middle cerebral artery occlusion reperfusion (MCAO/R) model is crucial for understanding the pathological mechanisms of stroke and for drug development.However, among the commonly used modeling methods, the Koizumi method often faces scrutiny due to its ligation of the common carotid artery (CCA) and its inability to achieve adequate reperfusion. Similarly, the Longa method has been criticized for disconnecting and ligating the external carotid artery (ECA). This study aims to introduce a modified model preparation method that preserves the integrity of the ECA, involves inserting a monofilament nylon suture through the CCA, repairing the ligated CCA incision, and maintaining reperfusion from the CCA. Reperfusion of blood flow was confirmed using laser speckle flow imaging. Evaluation methods such as the Longa scale, Modified Neurological Severity Score, triphenyltetrazolium chloride (TTC) staining, and immunofluorescence labeling of neurons demonstrated that this approach could induce stable ischemic nerve damage. This modified MCAO/R model protocol is simple and stable, providing valuable guidance for practitioners in the field of cerebral ischemia.

Prospective, multi-centric, international, single-arm, cohort study to assess a synthetic polyamide suture material in oral surgery to close the mucosa - MUCODA study.

ObjectivesThe aim was to collect different clinical parameters systematically and proactively regarding safety, effectiveness, and performance of a nylon monofilament suture under routine clinical practice for oral surgery. MethodsThe study design was prospective, bicentric, international, single-armed, and observational. A non-absorbable suture was applied to close the mucosa after different dental surgical interventions. Main objective was the incidence of combined postoperative complications until suture removal. The 95 % Confidence Interval (Agresti-Coull method) was used to prove the non-inferiority with a pre-specified upper margin of 21.9 %. Secondary variables were intraoperative suture handling, patient pain and satisfaction, wound healing, aesthetic appearance, and bacterial contamination. Results105 patients were enrolled. Complication rate was low (1.9 %), 2 swellings occurred. Pain was present for 1.61 days ± 1.42 after various dental interventions with an average pain level of 20.98 ± 22.60 (VAS). Patients with impacted third molar extraction showed the longest pain duration (6 days) combined with the highest mean pain level of 35.33 ± 30.45 (VAS). Intraoperative suture handling was very good to excellent. Suture removal was done after an average duration of 7.56 ± 2.09 days. Patient's satisfaction was high, and an excellent wound healing was reported by the dentists. Aesthetic appearance only performed in implant patients was rated by oral surgeons with an average of 96.19 ± 3.79 points [min. 80 – max. 100] at 5 months postoperatively. Thread bacterial analysis showed that F. nucleatum was the most present species. ConclusionsOur findings indicate that the non-absorbable, nylon-based monofilament suture used is safe and quite suitable for oral mucosal closure after various dental surgical interventions such as tooth extraction, implant placement and impacted third molar extraction. Clinical significanceThis study showed the safe use of a non-absorbable, nylon-based monofilament suture for different oral surgical interventions under daily routine clinical practice.

Diamond ophthalmic burr-assisted deep anterior lamellar keratoplasty – Case series

This case series presents a simple technique using the diamond ophthalmic burr (DOB) to perform successful deep anterior lamellar keratoplasty (DALK) in cases where the big-bubble technique is unsuitable or intraoperative Descemet membrane perforation occurs. Five patients underwent DOB-assisted DALK, and postoperative outcomes were evaluated, including best-corrected visual acuity, corneal astigmatism, residual host tissue thickness, and postoperative endothelial cell count. Manual corneal lamellar dissection was performed, followed by DOB-assisted pre-Descemet layer polishing and donor graft attachment using 16 (10-0) Monofilament Nylon sutures. The postoperative visual acuity significantly improved. DOB-assisted DALK is a viable alternative.

Cyclic testing of six-strand suture techniques for zone 2 flexor tendon lacerations

BackgroundBiomechanical analysis using cyclic testing for repaired flexor tendons is a clinically relevant method. The aim of this study was to evaluate the tensile properties of two six-strand suture techniques, the triple looped suture and Yoshizu #1 suture techniques using cyclic testing under simulating early active mobilization conditions. MethodsTwenty-five flexor digitorum profundus tendons harvested from fresh frozen human cadaver hands were repaired in zone 2 utilizing one of three repair techniques: the 2-strand modified Kessler (MK) technique as a control, the triple looped suture (TLS) and Yoshizu #1 suture (Y1) techniques. In each suture technique, 4-0 monofilament nylon sutures were used for core sutures and 6-0 monofilament nylon sutures for circumferential running sutures. Cyclic testing was performed using 20 N with 600 cycles at 1 Hz. ResultsFive out of eight specimens in the MK group ruptured during cyclic testing. Thus, this group was excluded from analysis. On the other hand, all tendons in the TLS and Y1 groups tolerated cyclic testing. Average gaps of the TLS and Y1 groups were 0.5 ± 0.8 mm and 1.9 ± 2.2 mm, respectively. All tendons in the TLS group and six out of nine tendons in the Y1 group formed gaps less than 2 mm. Two tendons in the Y1 group formed a gap of 3.8 and 6.6 mm had breakage of peripheral sutures at the first cycle. Mean ultimate tensile force of the TLS and Y1 group measured after cyclic tensing, were 66.2 ± 9.0 N and 65.9 ± 13.1 N, respectively. No statistical difference between the two groups was found in gap and ultimate tensile forces. ConclusionsThis study suggested that the TLS and Y1 techniques have tensile properties to allow early active mobilization. None of tendons repaired with the TLS technique had gaps more than 2 mm.

Evaluation of the treatment of traumatic coxofemoral luxations in dogs using toggle pin technique

This study was performed on 11 dogs diagnosed with traumatic coxofemoral luxation. The direction of the luxations, the operation details, postoperative complications, and radiographic evaluation were recorded during the study. The study utilized the toggle pin technique, which provided open-reduction techniques for the treatment of coxofemoral luxations. Polyester multifilament braided sutures with commercial toggle pins were employed in three cases, whereas toggle pins obtained from Kirschner wire and monofilament nylon suture material were performed in eight patients. Clinical and radiographic monitoring of postoperative lameness, complications, pain, and infection were assessed and recorded for comparison. Postoperative reluxation was observed in two cases in which multifilament braided polyester suture material was performed without other complications. In the cases without reluxation, it was noted that the animals used their limbs comfortably on the 1st postoperative day, and their lameness scores were 0 on the 7th postoperative day. As a result of the findings, the toggle pin technique using monofilament nylon suture could effectively treat coxofemoral luxations in dogs.

Effects of platelet-rich fibrin on skin pedicle graft healing

Objective: Avulsion injuries mostly lead to serious lesions. and those wounds become a challenge to be repaired by surgeons. The aim of the study was to evaluate the effect of autogenic PRF on skin pedicle graft to treat experimental avulsion wounds including clinical and hydroxyproline evaluations. Materials and methods: The experiment was performed on 15 adult female goats, aged between 7-8 months and weighted 18-20 Kg. Surgery was performed under heavy sedation and complete aseptic conditions, 2 skin marks (2×2 cm) were created on both sides of the trunk region of the animal. Two full thickness of the marked skin is cut carefully. A sliding flap (2×6 cm) are harvested parallel to the lines of least tension and are then slid over the adjacent wound which were closed by 2-0 nylon monofilament suture. These wounds are classified into two groups, the first one as the control group and the second group treated with autogenic platelet-rich fibrin. The two groups are represented in each goat. Results: Clinical examination showed the amount of wound exudation in the treated group was a significant increase compared to the control group.

Improving the antithrombogenicity of nylon monofilament for surgical suture by coating a protease from Euphorbia resinifera latex

This study developed a method to improve the antithrombogenicity of a blue nylon monofilament suture (USP 3/0) by coating a plant serine protease purified from Euphorbia resinifera latex (EuRP-61) onto the surface of nylon using a combination of dipping and ultrasonication methods. EuRP-61 was a selected protease because the enzyme had been previously reported to have antithrombotic and anticoagulant activities, high stability and biological safety. Analyses of the fibrinogenolytic and fibrinolytic activities using sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS–PAGE) and microwell plate assays revealed that the proper concentration of protease was 1 mg/ml for each coating of 20 strips of 10-mm nylon. The enzyme-coated nylon was disinfected by ethylene oxide (EO) sterilization. After EO sterilization, the enzyme-coated nylon presented fibrinogenolytic and fibrinolytic activities. Comparing the enzyme-coated and bare nylon, the enzyme-coated nylon prevented the human fibrin clot from adhering to its surface. In contrast, the fibrin clot stuck and was unable to be removed from the surface of the bare nylon. The antithrombogenicity of the protease-coated nylon evaluated in this study suggests its potential application as a surgical suture, especially for vessel anastomosis.

Comparison of three purse-string suture techniques for prevention of anal leakage during surgery

To compare 3 anal purse-string suture techniques for resistance to leakage and to identify the suture technique requiring the fewest tissue bites to create a consistent leak-proof orifice closure. 18 large-breed canine cadavers. 3 purse-string suture techniques (3 bites with 0.5 cm between bites [technique A], 5 bites with 0.5 cm between bites [technique B], and 3 bites with 1.0 cm between bites [technique C]) were evaluated. Each technique involved 2-0 monofilament nylon suture that was placed in the cutaneous tissue around the anus and knotted with 6 square throws. Standardized 2.0-cm-diameter circular templates with the designated bite number and spacing indicated were used for suture placement. Leak-pressure testing was performed, and the pressure at which saline was first observed leaking from the anus was recorded. The median and interquartile (25th to 75th percentile) range (IQR) were compared among 3 techniques. Median leak pressure for technique A (101 mm Hg; IQR, 35 to 131.3 mm Hg) was significantly greater than that for technique C (19 mm Hg; IQR, 14.3 to 25.3 mm Hg). Median pressure did not differ between techniques A and B (50 mm Hg; IQR, 32.5 to 65 mm Hg) or between techniques B and C. Placement of an anal purse-string suture prevented leakage at physiologic colonic and rectal pressures, regardless of technique. Placement of 3 bites 0.5 cm apart (technique A) is recommended because it used the fewest number of bites and had the highest resistance to leakage.

Corneal wounds repair emergencies during COVID‐19: 10/0 absorbable polyglactin sutures as a valuable strategy

AbstractPurposeThe aim of this study is to report the use of Vicryl 10‐0 (polyglactin 910) resorbable monofilament in corneal trauma during COVID‐19 pandemic: structural and functional results, and follow‐up adaptation during health crisis.MethodsDuring the COVID‐19 pandemic, nine patients were selected from the overall population of open or closed globe surgical emergencies (n = 37) in a french University Hospital. Selected patients were eligible for corneal sutures with Vicryl 10‐0, thus replacing the traditional 10‐0 nonabsorbable monofilament nylon suture. Postoperative treatment combined anti‐inflammatory drugs, topical antibiotics and lubricating drops. Outpatient visits were performed at D10, M2, M6 then every six month. Interim visits were performed if needed between D10 and M2 by teleconsultation. Patients received complete examination including different imaging. The main outcome was best corrected visual acuity. Secondary outcomes included average corneal astigmatism and the occurrence of complications.ResultsMean distance and near acuity improved from 0.711 ± 0.805 &amp; 0.556 ± 0.305 logMAR preoperatively to 0.056 ± 0.073 &amp; 0.333 ± 0.100 logMAR postoperatively (p = 0.032 and p = 0.043 respectively). Mean astigmatism decreased from 4.91 ± 4.21 diopters preoperatively to 0.99 ± 0.57 after suture resorption (p = 0.020). There were no serious adverse events or repeated surgery.ConclusionsPolyglactin 910 10‐0 could provide a maximum infectious risk reduction; a shorter topical treatment and antibiotic prophylaxis. The absorbable nature of the sutures simplifies logistics by reducing the number of early outpatient visits before M2. It avoids suture removal, especially for the pediatric population. Interim teleconsultation(s) on demand are interesting to evaluate the need for an additional face‐to‐face consultation. Vicryl 10‐0 sutures are ideally suited to the COVID‐19 pandemic logistical constraints, as a safe and effective alternative to nylon 10‐0 for the management of eligible corneal wounds.

Intraluminal Stent Optimization for the Baerveldt Glaucoma Implant: An Experimental Study.

Our laboratory study determined the approximate suture diameter for use in intraluminal stenting of the Baerveldt glaucoma implant (BGI) to prevent postoperative hypotony. Commercial 3-0 monofilament nylon sutures which are commonly used may vary significantly outside of this diameter. Postoperative hypotony is a complication of surgical treatment of glaucoma using the BGI. One method utilized to prevent early postoperative hypotony is intraluminal stenting of the implant with monofilament sutures. The present study attempted to determine optimal stent diameter in microns for 3-0 monofilament sutures to reduce outflow and thereby reduce the risk of postoperative hypotony using the BGI. A laboratory bench model of the anterior chamber was utilized to measure the outflow rate of balanced salt solution through the BGI at pressures of 20 and 40 mm Hg while utilizing commercially available 3-0 monofilament nylon stents of various diameters. The BGI tube has an inner diameter of 300 µm. In addition, 3-0 nylon sutures were studied for variability by measuring the diameters at 10 equally spaced points along the length of each sample using a digital micrometer. Average experimental flow rates decreased with increasing intraluminal stent diameter and increased with increasing pressure. An intraluminal stent diameter of 250 µm yielded a flow rate of 40 µL/min at a nominal pressure of 20 mm Hg. Diameters of the tested 3-0 monofilament nylon sutures were all within the United States Pharmacopeia diameter range of 200 to 250 µm, but diameters varied significantly depending on the manufacturer. In our laboratory model, the optimal stent diameter to reduce aqueous flow to a level approaching the normal aqueous production is at least 250 µm. Secondarily, commercially available 3-0 monofilament nylon suture materials showed variable diameters within the United States Pharmacopeia diameter range.

Staples Versus Sutures for Skin Closure in Standard Four Port Laparoscopic Cholecystectomy: A Prospective Cohort Study.

IntroductionMany studies have been done comparing sutures versus skin staples in various wounds. To the author's knowledge, there is no study comparing these two in an laparoscopic cholecystectomy (LC) wound. Our study aims at comparing the clinical outcome of skin closure by monofilament nylon suture and stainless-steel skin stapler in standard four-port LC. The results of this study can help in developing guidelines for skin closure in LC.ObjectiveTo compare the clinical outcome of skin closure by monofilament nylon suture and stainless-steel skin stapler in standard four-port LC.MethodsThe study was conducted as a time-bound prospective cohort study on diagnosed patients of cholelithiasis admitted in a single unit of the Department of Surgery at All India Institute of Medical Sciences, Rishikesh, India from February 2018 to February 2019. The standard four-port LC was done by the same surgeon. After the completion of the surgery, port closure was done using absorbable sutures, and skin was closed by either 2.0 monofilament nylon suture (Ethilon, Ethicon, Scotland) or stainless-steel staples (Proximate plus MD, 35W, Ethicon, Scotland). The time taken for skin closure in both the groups was noted using a stopwatch. Each wound was assessed on the post of day (POD) 1 during discharge, on POD 10 during suture/stapler removal, and POD 30 by the operating surgeon for pain, wound infection, scar status using validated scales.Statistical analysis usedThe outcome measures were calculated as mean and standard deviation. Continuous variables were analyzed using a two-tailed student t-test.ResultsOut of 48 suture vs 45 stapler cases the average time for closure is 277.14 seconds in suture vs 77.2 seconds (p = 0.0001) in the stapler group. All other parameters studied were not statistically significant among the two cohorts.ConclusionWe conclude that stapler requires minimum time for closure with no statistically significant difference in wound infection, post-op pain, pain during removal, and scar results are the same in both the groups.

Risk factors for reluxation after toggle rod stabilization for treatment of coxofemoral luxation in 128 dogs.

Evaluate the risk factors for reluxation and outcomes for dogs with a toggle rod construct. Retrospective case series. One hundred twenty-eight client-owned dogs. Medical records from 2007 to 2018 were reviewed for signalment, history, surgery, and outcome for dogs with a coxofemoral luxation repaired with a commercial toggle rod and nylon monofilament suture construct. Univariate and multiple logistics regression analysis were performed to assess risk factors associated with postoperative luxation. Primary veterinarians and owners were contacted for follow-up via telephone or electronic communication. The overall complication rate was 24.2%, and the reluxation rate was 14.8%. There was a decreased risk of reluxation when the cause was traumatic in origin (odds ratio [OR] 0.10) or when the lameness was severe at presentation (OR 0.42). Fifteen of 58 (25.9%) owners contacted completed a follow-up survey. Dogs with nontraumatic, low impact luxations were at a higher risk for reluxation. Dogs of any body condition with a traumatic coxofemoral luxation are at lowest risk for reluxation.

Spontaneous Corneal Perforation

A male patient, 59 years of age, who had undergone a pterygium operation 45 days ago in another center, applied to our clinics for itching and burning complaints. The patient was examined and thinning of the cornea at the perilimbal region and intense hyperemia, inflammation and scarred tissue in the nasal conjunctiva were observed. Additionally, the patient had chronic dacryocystitis. Firstly, an external dacryocystorhinostomy (DSR) operation was applied. Three days after the operation, corneal perforation and iris prolapse occurred. An autograft, including conjunctiva, limbus and neighbouring corneal tissue with lamellar excision from the superior region of the same eye, was taken. With the help of 10/0 monofilament nylon sutures, the autograft was implanted. In the postoperative period, the patient’s cataract, which was present before the operation, progressed. In the postoperative 6th month, a cataract operation was performed. By the postoperative 7th month, the patient’s visual acuity was 0.00 logMAR and the perforation region had recovered completely.

The clinical outcome of three procedures for extraarticular stabilization of cranial cruciate ligament injuries in dogs

The objective of this study was to evaluate the long-term outcomes in dogs with cranial cruciate ligament injury in which the stifle was stabilized with lateral suture stabilization, lateral suture stabilization-modified, or Securos lateral bone anchor tibial suture and monofilament nylon sutures placed at quasi-isometric points of the stifle. It is a retrospective study comprising a sample population of 49 client-owned dogs. Medical records from 2014?2016 were reviewed to identify dogs that had a cranial cruciate ligament rupture in which the stifle was stabilized using one of the aforementioned methods. The overall complication rate was 16.3% and the documented complication rate requiring implant removal was 0%. Owners reported full or acceptable function in 96% of cases. There were no significant statistical differences between the 3 techniques. Stabilization of cranial cruciate ligament-deficient stifles in dogs with lateral suture stabilization, lateral suture stabilization-modified, or Securos lateral bone anchor tibial suture is reliable with acceptable complication rates. The 3 procedures tested may be appropriate in medium-sized nonathletic dogs whose owners have limited budgets.

Coxofemoral Joint Luxation in Dogs Treated with Toggle Rod Stabilization: A Multi-Institutional Retrospective Review with Client Survey.

Coxofemoral luxation is the most common type of joint luxation observed clinically in dogs. This retrospective study determines the complications and outcomes of open reduction and internal fixation of coxofemoral luxations using a toggle rod stabilization in 58 dogs. The purpose of the study was to compare the results with previous studies to ascertain commonalities and differences. A majority of the canine luxations were stabilized using a 4.0 or 3.2 mm commercial toggle rod and either one or two strands of OrthoFiber, FiberWire, or monofilament nylon suture. Postoperative complications developed in 25 of the 58 (43%) dogs, with major complications in 9 cases (15.5%). The most common major complication was reluxation, which occurred in 6 dogs (10%). Five of the 6 cases of reluxation received monofilament suture, although there was not a statistically significant relationship between suture type and reluxation. Owner responses to a questionnaire reported good to excellent results for satisfaction with the procedure in 90% of cases. Results of the present study suggest that toggle rod stabilization remains an effective method for the treatment of coxofemoral joint luxation in dogs.

Intra-arterial transplantation of neural stem cells improve functional recovery after transient ischemic stroke in adult rats

The neural stem cell transplantation has been proposed as alternative therapy to promote functional recovery after various neurological disorders. The aim of this study was to evaluate the effect of intra-arterial transplantation of adult neural stem cells on improving local brain ischemia injuries. In this study, 32 male Wistar rats were used. Ischemia was induced using a middle cerebral artery obstruction with monofilament nylon suture. Neural stem cells were isolated from subventricular zone of the rat brain. 24 hours after local ischemia, the cells were labeled with DiI and transplanted intra-articularly. Evaluation of neurological movement deficits was performed using a neurological deficit score. The transplanted neural stem cells differentiation into neurons and astrocytes was assessed by immunohistochemistry. The results indicated that lesion volumes in the ischemic control, PBS and the treatment groups were 31.5, 29.8 and 14.7 % respectively. Our results also showed that the number of eosinophilic neurons and also neurological impairment in the treatment group was significantly reduced compared to the control and PBS groups. The results suggested that intra-arterial transplantation of neural stem cells 24 hours after ischemia, led to a decrease in the volume of brain ischemic lesion and improved neurological outcomes (Fig. 7, Ref. 23).

Traumatic wound dehiscence after penetrating keratoplasty for keratoconus: about a case

We report a case of a 35-year-old patient, who had undergone optical penetrating keratoplasty (PKP) for bilateral keratoconus in 2012. He was referred to ophthalmic emergency room for a blunt eye injury of the right eye. His visual acuity was reduced to light perception. Slit lamp examination revealed a dehiscence of PKP at 4 o´clock (extending from 2 o´clock to 7 o´clock) with flat anterior chamber, iris prolapse, total hyphema and corneal edema of the corneal graft (A). The posterior segment noted no complications. Suturing of the graft was performed; seven interrupted 10-0 monofilament nylon sutures were applied in the area of wound dehiscence (B). Follow-up was ensured for several months, during which visual acuity rose to 1/10. The scar from transfixing keratoplasty for keratoconus is at a high risk of rupture even with minor trauma. The prognosis for such a trauma is always severe and the post-traumatic course remains less pejorative, especially when there are lesions of the posterior segment.

Asymmetric 6-Strand Flexor Tendon Repair - Biomechanical Analysis Using Barbed Suture.

Background: This study investigates the biomechanical performance of the Asymmetric flexor tendon repair technique using barbed suture. The Asymmetric repair technique using monofilament nylon suture was previously reported to have a higher tensile strength than the modified Lim-Tsai repair technique, but its repair stiffness and load to gap force were significantly lower. There is hence an unmet need to improve this technique and the substitution of nylon suture with barbed sutures may be the solution. Methods: Two groups consisting of 10 porcine tendons each were repaired with the six-strand Asymmetric repair technique using V-Loc® 3-0 and Supramid® 4-0 respectively. The repairs were subjected to a mechanical tester for static testing. The ultimate tensile strength, load to 2 mm gap force, repair stiffness, time taken to complete a repair and failure mechanism of the repairs were recorded and analyzed. Results: All the repairs using V-Loc® 3-0 sutures had significantly higher median values of ultimate tensile strength (64.1 N; 56.9 N), load to 2 mm gap force (39.2 N; 19.7 N), repair stiffness (6.4 N/mm; 4.7 N/mm) and time taken to complete a repair (9.4 mins; 7.7 mins). All the repairs using V-Loc® sutures failed by suture breakage while 80% of repairs using Supramid® sutures failed by suture pullout. Conclusions: The use of the barbed sutures in the Asymmetric repair technique, whilst more time consuming, has shown promising improvement to its biomechanical performance (i.e. better ultimate tensile strength, stiffness and resistance to gap formation).