Permanent Suture Research Articles

Stensen Duct Rupture (Sialocele) and Other Complications of the Aptos Thread Technique

The Aptos thread technique is a mode of uplifting the flabby soft tissue of the aging face. Permanent suture material made of polypropylene monofilament with dents is used in this technique. This procedure is gaining popularity throughout the world. According to the literature, several hundred Aptos procedures have been performed, and no major complications have been reported yet. Two adult women presented shortly after the Aptos thread insertion. They sustained devastating results. A close study was performed to understand and learn the potential complications. The authors present two major complications, a rare case of Stensen's duct laceration and a case of chronic inflammation mandating surgical treatment. Describing complications may teach plastic surgeons more about this method and how to avoid similar devastating side effects in the future.

Complications After Laparoscopic Burch With Hernia Mesh and Surgical Tacks

The Burch retropubic urethropexy for the repair of stress urinary incontinence can be performed laparoscopically. Advances in laparoscopic technique have led some surgeons to perform this procedure with hernia mesh and surgical tacks. A postmenopausal woman presented with complaints of lower abdominal pain, dyspareunia, dysuria, and urinary urgency and frequency after a laparoscopic Burch and paravaginal repair. Bimanual examination revealed tenderness over the pelvic floor muscles and anterior vaginal wall. Exploratory laparotomy revealed dense fibrous adhesions in the space of Retzius along with mesh, permanent suture, and 13 helical tacks. Laparoscopic procedures that use hernia mesh fastened with surgical tacks should not be used in the vagina or surrounding structures.

Lateral Crus Pull-up

Collapse of the nasal vestibule during inspiration is a frequently encountered symptom, often caused by weak or medially displaced lateral crura in the lower lateral cartilages. Numerous techniques are available for lateralizing and strengthening the lateral crura using cartilage grafts or suture techniques. In most cases, they involve an external rhinoplasty approach or additional incisions. An elegant endonasal method for widening and strengthening the lateral component of the nasal valve area is described herein. The basis of the procedure is a permanent submucosal spanning suture between the piriform aperture and the distal part of the lower lateral cartilage. The effect of this technique is 2-fold. First, it provides superolateral rotation of the lateral crura, increasing the cross-sectional area, and second, the spanning suture provides additional support for the lateral wall of the nasal vestibule.

Alar Expansion and Reinforcement

To describe the new technique of alar expansion and reinforcement as a comprehensive approach to the surgical management of nasal valve collapse. Alar expansion and reinforcement expands the narrow nasal valve and reinforces the floppy nasal sidewall. Forty-one patients underwent rhinoplastic surgery for nasal valve collapse between May 1, 2002, and April 30, 2005, using an external rhinoplasty approach; of these, 32 responded to our postoperative questionnaire. Twenty-four patients (75%) underwent primary surgery and 8 (25%) had undergone previous rhinoplasty. All patients had permanent adjustable expansion sutures. Twelve patients (38%) had an excessively floppy nasal sidewall that required a high-density porous polyethylene alar batten implant to anchor the expansion sutures. Patients underwent clinical review from 6 months to 3 years after surgery, and a telephone survey was used to evaluate their functional and cosmetic satisfaction rates. Thirty patients (94%) experienced good improvement in their nasal airway. The improvement in nasal airway patency was statistically significant (P<.001). Two patients (6%) reported no improvement. There were no complications. Cosmetic outcome was satisfactory in all 8 patients who also requested cosmetic improvement. Of the 24 patients who had surgery for nasal obstruction only, 10 (42%) rated their cosmetic appearance as better, with the remaining 14 (58%) indicating that they did not identify any significant change in their nasal appearance. Alar expansion and reinforcement is a safe, reliable, and effective technique to manage nasal valve collapse.

Biomechanical properties of the superficial fascial system

Surgical repair of the superficial fascial system (SFS) has been claimed to both increase wound strength and enhance surgical outcome through anchoring of deeper tissues. The authors assessed the biomechanical properties of the SFS to determine whether repair of the SFS layer improved early and long-term postoperative wound strength. Four complementary studies were conducted to study the dermis and SFS junctional architecture and connective tissue content: gross dissection using a dehydrating agent (Pen-Fix; Richard-Allan Scientific, Kalamazoo, MI), a histologic study with hemotoxylin and eosin staining, soft tissue radiography, and immunofluorescence staining. Freshly excised human abdominal and lower back/buttock tissues underwent a midline incision, followed by repair using dermal sutures only (DRM), dermal sutures plus SFS sutures (DRM/SFS) or repair of the SFS only (SFS). Fresh swine abdominal tissues were similarly excised and repaired. Biomechanical tests were undertaken to compare the ex vivo human and swine tissues. Three types of closure-dermal sutures only (DRM), dermal sutures plus permanent 0-braided nylon suture in the SFS (DRM/SFS/N), and dermal sutures plus absorbable 0-vicryl suture in the SFS (DRM/SFS/V) were also tested in an in vivo swine model. Immunofluorescence studies showed collagen and elastin content and ratios to be comparable in the dermis and SFS. In ex vivo studies of human abdominal and back tissues, cyclic creep did not vary significantly among the different types of repair. DRM/SFS repair had a significantly higher failure load than dermal repair alone in both human abdominal and back tissues. In the in vivo swine study, normal tissue had a significantly higher failure load than all repair groups. The wounds where SFS had been repaired in addition to dermis exhibited an increased tensile strength and, among these, the wounds closed with SFS repair with a nonabsorbable suture exhibited greater tensile strength compared to absorbable suture repair. However, no statistically significant difference was noted, due to the small sample size. We have determined, using an ex vivo model, that repair of the SFS layer in addition to dermis repair significantly increases the initial biomechanical strength of wound repair. This has the potential to decrease early wound dehiscence. In our in vivo model, the use of a nonabsorbable suture to approximate the SFS demonstrated a trend toward increased long-term wound strength. We believe our studies provide scientific data documenting that SFS is a key contributory strength layer in the early postoperative period, and is likely to be a strength layer even in the later stages of wound healing.

Arthroscopic Bankart Repair Using Permanent Sutures and Interval Closure: A Comparison with Earlier Techniques (SS-03)

Arthroscopic instability surgery has traditionally shown higher rates of recurrent instability than open instability repair. Many surgeons have felt that recent advances in arthroscopic technique such as use of permanent sutures and interval closure have corrected these deficiencies such that open and arthroscopic repair are now similar. No prior studies exist that compare the recurrence rates of these newer techniques with more traditional instability repair. Fifty patients with arthroscopic Bankart repairs were retrospectively reviewed prior to 2000 repaired with PDS suture and metal suture anchors without interval closure. In 2000, the author changed to using permanent sutures with routine interval closure; 42 patients were evaluated using this technique change with minimum two year follow-up. Patient selection and technique otherwise remained identical. There were 12 dislocations in the early group (24%) with 10 reoperations (20%). This decreased to 3 dislocations (7.1%) and 2 reoperations (4.9%) (p<0.03). Survivorship statistics showed that even with longer follow-up the difference between the groups remains statistically significant. Use of permanent sutures and interval closure decreased the recurrence rate for arthroscopic Bankart repair, without increasing complication rates.

Composite Anterolateral Thigh???Fascia Lata Flap: A Good Alternative to Radial Forearm???Palmaris Longus Flap for Total Lower Lip Reconstruction

Major defects of the lower lip are challenging to the reconstructive surgeon. The major goals in treating total lower lip defects are reconstruction of the external skin and mucosal lining and maintenance of oral competence and sphincter function. The authors describe reconstruction of total lower lip and larger full-thickness defects including the cheek and commissure by means of a composite anterolateral thigh-fascia lata free flap. The flap was harvested with 5-cm fascial extensions at the superior and inferior margins. The flap was folded over the fascia lata to restore the intraoral lining and cover the external skin defect. Fascia lata extensions were divided longitudinally into two fascial strips at both margins of the flap. Two strips were tunneled through the orbicularis muscle in the upper lip and sutured to each other and to the orbicularis muscle. The remaining two strips were anchored to the zygomatic bone periosteum by permanent sutures. This procedure was used in 11 patients. In all cases, disease was advanced squamosus cell carcinoma. The patients' ages ranged from 37 to 72 years. Nine patients had cancer of the lower lip and two patients had a buccal cancer involving the lip. The entire lower lip, bilateral modiolus, and part of the cheek were resected in all patients, and mandibulectomy was performed in three patients. Flap survival was 100 percent. One patient died 10 days after the operation because of cardiopulmonary arrest. At the end of the 1-year follow-up period, all patients had good oral continence at rest and had achieved sufficient oral competence when eating. Eight patients were able to resume a regular diet and two patients could eat a soft diet. This flap is a good choice for reconstruction of the extensive head and neck defects. We think that anterolateral thigh-fascia lata composite flap has maximum reconstructive capacity and minimal donor-site morbidity. This flap has many advantages over the radial forearm flap and should replace to the composite radial forearm palmaris longus tendon flap when total lower lip reconstruction is concerned.

Comparison of Ischemic Lesion Evolution in Embolic Versus Mechanical Middle Cerebral Artery Occlusion in Sprague Dawley Rats Using Diffusion and Perfusion Imaging

Differences among models in the temporal evolution of ischemia after middle cerebral artery occlusion (MCAO) in rats may considerably influence the results of experimental stroke research. Using diffusion and perfusion imaging, we compared the spatiotemporal evolution of ischemia in Sprague Dawley rats after permanent suture MCAO (sMCAO; n=8) and embolic MCAO (eMCAO; n=8). Serial measurements of quantitative cerebral blood flow (CBF) and the apparent diffusion coefficient (ADC) were performed up to 180 minutes after MCAO. ADC and CBF values within 5 different brain regions were analyzed. ADC and CBF lesion volumes were calculated by using previously established viability thresholds and correlated with infarct volume defined by 2,3,5-triphenyltetrazolium chloride staining 24 hours after MCAO. Compared with sMCAO animals, the threshold-derived CBF lesion volume was significantly larger in eMCAO at all time points (P<0.01), remained relatively constant over time, and was highly correlated with the 2,3,5-triphenyltetrazolium chloride-defined infarct size. The ADC lesion volume did not differ between models at any time point. A diffusion/perfusion mismatch was present significantly longer in eMCAO animals (P<0.05), and these rats demonstrated larger absolute mismatch volumes that were statistically significant at 30, 60, and 90 minutes (P<0.05). In both models, CBF and ADC declines were highly correlated. This study demonstrated substantial differences in acute ischemic lesion evolution between the eMCAO and sMCAO models.

Peritoneal Closure at Primary Cesarean Delivery and Adhesions

Objective: To evaluate the effect of parietal peritoneal closure at cesarean delivery on adhesion formation. Methods: A prospective cohort study of women undergoing first repeat cesarean delivery was designed. All surgeons were asked immediately after surgery to score the severity and location of adhesions. Patient records were then abstracted to assess prior surgical technique, including parietal peritoneal closure, other attributes of first surgery, and patient characteristics. Exclusion criteria included adhesions, other surgery, or use of permanent suture at the first cesarean, unavailable first postoperative note and course, wound infection or breakdown following first surgery, intervening pelvic surgery, insulin-dependent diabetes mellitus, and steroid-dependent disease. The X 2 test and multivariable logistic regression were used for statistical comparison and analysis. A total of 128 patients was required to have 80% power to detect a 50% reduction in adhesions when the parietal peritoneum was left open. Results: One hundred seventy-three patients were enrolled. Prior parietal peritoneal closure was associated with significantly fewer dense and filmy adhesions (52% versus 73%, P =.006) and significantly fewer dense adhesions (30% versus 45%, P =.043). When controlling for potential confounding variables, including prior infection, visceral peritoneal closure, rectus muscle closure, payor status, ethnicity, maternal age, gestational diabetes, and labor, parietal peritoneal closure at primary cesarean delivery was 5-fold protective against all adhesions (odds ratio 0.20, 95% confidence interval 0.08-0.49), and 3-fold protective against dense adhesions (odds ratio 0.32, 95% confidence interval 0.13-0.79). Omental-fascial adhesions were decreased most consistently. Conclusion: Parietal peritoneal closure at primary cesarean delivery was associated with significantly fewer dense and filmy adhesions. The practice of nonclosure of the parietal peritoneum at cesarean delivery should be questioned.

Complications From Transvaginal Pubovaginal Slings Using Bone Anchor Fixation

Objectives: To evaluate the history and management of complications from transvaginally placed pubovaginal slings using bone anchor fixation. Methods: During a 3-year period, 10 patients were referred to us for complications related to transvaginally placed pubovaginal slings using bone anchor fixation. Results: The patient age ranged from 42 to 73 years. All women had a vaginally introduced bone anchor sling for stress urinary incontinence. The presenting symptoms after surgery included fever, pain, and difficulty ambulating in 1; pain and/or vaginal dyspareunia with discharge in 5: pain or dyspareunia alone in 2; and vaginal discharge alone in 2 patients. Two patients ultimately developed bone lesions on radiologic studies consistent with osteomyelitis. Six patients developed sinus drainage tracts associated with granulation tissue from at least one bone anchor that was unresponsive to outpatient management. One of the patients with pain alone had a permanent suture extending into the bladder neck. Nine patients underwent surgery, of whom five had resolution of their presenting complaint. Four of these patients were continent at last follow-up. Conclusions: Transvaginally placed pubovaginal slings using bone anchors can be associated with serious complications that may be intractable to common therapies. This knowledge may enable practitioners who use this technique to better counsel their patients regarding these significant complications.

Advances in the diagnosis and treatment of ptosis

The surgical correction of blepharoptosis, both congenital and acquired, has been intensively examined and reported on for many years. This paper reviews recent publications on basic science, evaluation, technique modifications, and innovative materials in the care of ptosis patients. The frontalis suspension technique is a commonly performed surgical correction of congenital blepharoptosis, used widely in the repair of ptosis with poor levator function. The repair typically includes using either tissue such as autologous or banked fascia lata or permanent suture material. The procedure involves connecting the motor unit (frontalis muscle) and the upper eyelid. Authors have recently reintroduced the technique of a dynamic frontalis muscle flap tunneled into the eyelid that directly attaches to the tarsal plate.Patients presenting with symptomatic blepharoptosis due to disinsertion or thinning of the levator aponeurosis require surgical repair. Multiple groups have tended toward a minimally invasive approach directed specifically at the levator aponeurotic defect. Proposed advantages of a small eyelid incision (8-13 mm) include less local anesthetic and tissue distortion, less ecchymosis and edema, decreased operative times, a shortened recovery period, and improved surgical results. Surgical correction of congenital blepharoptosis may be performed with autologous fascia lata, cadaveric allograft, or permanent suture material. The use of a frontalis muscle advancement flap is elegantly designed; however, its role in clinical practice remains to be defined. Advancement of the levator aponeurosis for senile blepharoptosis may be preformed via a minimally invasive small incision approach. Patients benefit with decreased operative time, edema, ecchymosis, and recovery times.

Temporary Assisting Suspension Suture Technique for Successful Microvascular Anastomosis of Extremely Small and Thin Walled Vessels for Mice Transplantation Surgery

Dissection and microsurgical anastomosis in small and thin-walled vessels is challenging. Temporary assisting suspension suture technique was developed to overcome those difficulties in establishing successful composite tissue allotransplantation in mice. The operations were performed in 12- to 16-week-old Balb/c mice weighing 25 to 30 grams as both donor and recipient animals. Extended vascularized groin cutaneous flaps based on the superficial epigastric vessels were used. A total of 10 groin cutaneous flaps were transplanted. Three temporary assisting suspension sutures of 11-0 nylon were placed at the 12-, 4-, and 8-o'clock positions to donor and recipient artery and vein before the anastomosis. This technique allowed atraumatic dissection of delicate and thin vessels, prevented vessel wall collapse, and facilitated adequate exposure of the lumen during placement of the permanent microvascular sutures. Thus, the microvascular anastomosis was performed in an unusual manner. The temporary assisting suspension sutures were removed just before the permanent suture was tied down. The mean operation time was 1 hour and 45 minutes with an ischemia time of 1 hour. Ninety-percent success in immediate and late-term patency rates was achieved, which was confirmed by transplant survival. This technique was proven to be useful for microvascular anastomosis in thin-walled vessels and is recommended.

Arthroscopic Stabilization of the Acute, First-Time Shoulder Dislocation

Arthroscopic management for shoulder instability has gained wider acceptance among both patients and orthopedic surgeons during the past 15 years. Advances in surgical instrumentation allow the surgeon to perform essentially the same repair, whether accomplished through the arthroscope or via a deltopectoral incision. An acute, initial traumatic anterior shoulder dislocation sustained by a young adult provides the optimal situation to repair both the pathologic Bankart lesion and minimize the development of secondary joint pathology that comes with recurrent instability. The author’s preferred arthroscopic technique using nonmetallic anchors and permanent sutures is described. This technique stresses the low morbidity of the approach and the reestablishment of the anatomic repair of the Bankart lesion and any concomitant pathology noted at arthroscopy.

176: Transvaginal Repair of Anterior Compartment Defect Using Porcine Dermal Graft Fixation to the Arcus Tendinous Fascia Pelvis

176: Transvaginal Repair of Anterior Compartment Defect Using Porcine Dermal Graft Fixation to the Arcus Tendinous Fascia Pelvis

178: Laparoscopic Site-Specific Repair of Pelvic Floor Defects

To study the efficacy of laparoscopic management of significant utero vaginal prolapse and post-hysterectomy vault prolapse (POP). Retrospective analysis of 105 cases of pelvic organ prolapse done over the three years. Tertiary care referral centre for advanced laparoscopic surgery. Thirty-five cases of post hysterectomy vault prolapse and other 70 cases were various grades of prolapse. Site specific repair employing permanent sutures was done. Endopelvic fascia along with levator ani muscles form the main support of the pelvic organs. Cullen Richardson pointed out that prolapse was not caused by stretching of the supports of the pelvic organs but by breaks in the endopelvic fascia. These breaks usually occurred at the attachment of endo pelvic fascia to arcus tendines white line. These defects can be readily identified and repaired judiciously using the laparoscopic route. Non-absorbable suture materials are used to approximate the torn rectovaginal septum. Interrupted suture are placed from arcus tendinus ligament to recto vaginal septum. Stitches are passed through utero sacral ligament then anteriorly through pubocervical fascia, then posteriorly through the RV septum and then back to uterosacral ligament. Thus fixation of vagina or vaginal vault to the proximal ends of utero sacral ligaments at level of pericervical ring is carried out. Vault prolapse after hysterectomy and prolapse with intact uterus were managed by this technique. All these cases have been followed for three years and found to have satisfactory anatomical and functional correction. Laparoscopic approach to pelvic organ prolapse ensures good surgical out come as pelvic support anatomy is clearly identified with the magnification offered by operating laparoscopy.

Optimising Results from Minimal Access Cranial Suspension Lifting (MACS-Lift)

Between November 1999 and February 2005, 450 minimal access cranial suspension (MACS) lifts were performed. Starting with the idea of suspension for sagging soft tissues using permanent purse-string sutures, a new comprehensive approach to facial rejuvenation was developed in which the vertical vector appeared to be essential. The neck is corrected by extended submental liposuction and strong vertical traction on the lateral part of the platysma by means of a first vertical purse-string suture. The volume of the jowls and the cheeks is repositioned in a cranial direction with a second, slightly oblique purse-string suture. The descent of the midface is corrected by suspending the malar fat pad in a nearly vertical direction. In 23 cases (5.1%), the result in the neck was unsatisfactory, and additional work had to be done secondarily, or in later cases, primarily. The problem that appeared was unsatisfactory correction of platysmal bands (resolved with an additional anterior cervicoplasty) or vertical skin folds that appeared in the infralobular region (corrected with an additional posterior cervicoplasty). This article describes two ancillary procedures that, although not frequently necessary, can optimise the result of MACS lifting.

Peritoneal Closure at Primary Cesarean Delivery and Adhesions

To evaluate the effect of parietal peritoneal closure at cesarean delivery on adhesion formation. A prospective cohort study of women undergoing first repeat cesarean delivery was designed. All surgeons were asked immediately after surgery to score the severity and location of adhesions. Patient records were then abstracted to assess prior surgical technique, including parietal peritoneal closure, other attributes of first surgery, and patient characteristics. Exclusion criteria included adhesions, other surgery, or use of permanent suture at the first cesarean, unavailable first postoperative note and course, wound infection or breakdown following first surgery, intervening pelvic surgery, insulin-dependent diabetes mellitus, and steroid-dependent disease. The chi2 test and multivariable logistic regression were used for statistical comparison and analysis. A total of 128 patients was required to have 80% power to detect a 50% reduction in adhesions when the parietal peritoneum was left open. One hundred seventy-three patients were enrolled. Prior parietal peritoneal closure was associated with significantly fewer dense and filmy adhesions (52% versus 73%, P = .006) and significantly fewer dense adhesions (30% versus 45%, P = .043). When controlling for potential confounding variables, including prior infection, visceral peritoneal closure, rectus muscle closure, payor status, ethnicity, maternal age, gestational diabetes, and labor, parietal peritoneal closure at primary cesarean delivery was 5-fold protective against all adhesions (odds ratio 0.20, 95% confidence interval 0.08-0.49), and 3-fold protective against dense adhesions (odds ratio 0.32, 95% confidence interval 0.13-0.79). Omental-fascial adhesions were decreased most consistently. Parietal peritoneal closure at primary cesarean delivery was associated with significantly fewer dense and filmy adhesions. The practice of nonclosure of the parietal peritoneum at cesarean delivery should be questioned.

Differences in Ischemic Lesion Evolution in Different Rat Strains Using Diffusion and Perfusion Imaging

Interstrain differences in the temporal evolution of ischemia after middle cerebral artery occlusion (MCAO) in rats may considerably influence the results of experimental stroke research. We investigated, in 2 commonly used rat strains (Sprague-Dawley [SD] and Wistar-Kyoto [WK]), the spatiotemporal evolution of ischemia after permanent suture MCAO using diffusion and perfusion imaging. Serial measurements of quantitative cerebral blood flow (CBF) and apparent diffusion coefficient (ADC) were performed up to 210 min after MCAO. Lesion volumes were calculated by using previously established viability thresholds and correlated with infarct volume defined by 2,3,5-triphenyltetrazolium chloride staining 24 hours after MCAO. While the ADC-derived lesion volume increased rapidly during the first 120 min after MCAO and essentially stopped growing after 3 hours in SD rats, ADC lesion in WK rats increased progressively during the entire 210-min period and was significantly smaller at all time points (P<0.05). The abnormal perfusion volume correlated highly with the TTC-defined infarct size in both groups. In WK rats, the abnormal perfusion volume was significantly larger than the abnormal diffusion volume up to 90 min after MCAO (P<0.001), whereas the diffusion/perfusion mismatch was significant (P<0.001) only at 45 min in SD rats. ADC-CBF scatterplots analysis revealed a slower and less robust ADC decline over time in WK rats in pixels with severe (<20% of normal) and moderate (21 to 40% of normal) CBF reduction. This study demonstrated substantial differences in acute ischemic lesion evolution between SD and WK rats. These interstrain variations must be taken into account when assessing new therapeutic approaches on ischemic lesion evolution in the rat MCAO model.

Rotator Interval Closure After Arthroscopic Capsulolabral Repair: A Technical Variation

Abstract Rotator interval tear is one of the lesions identified in patients with glenohumeral instability. We present our technique for arthroscopic interval capsule repair. After having performed Bankart reconstruction, we pull the anterosuperior cannula back some millimeters and introduce a Penetrator suture retriever forceps (Arthrex, Naples, FL) through the upper interval capsule into the joint. Then we also remove some millimeters of the anterior cannula and introduce a suture passer (Spectrum; Linvatec, Largo, FL) loaded with a monofilament suture through the lower interval capsule. The suture is pushed into the joint and, using the Penetrator suture retriever forceps, we retrieve it out of the joint. This suture is replaced if desired by a permanent braided suture. Next, a suture passer (Arthrex) advances the end of the suture from the anterosuperior portal into the joint. The suture is retrieved out of the joint from the anterior cannula with a crochet hook. We tie the suture down the anterior cannula to close the anterior capsule. Because we use cannulas, we can use a sliding knot. The degree of tightening can be observed directly under arthroscopic view but the knot is outside of the capsule. We believe that this method is easy, effective, and reproducible.

Suture erosion and wound dehiscence with permanent versus absorbable suture in reconstructive posterior vaginal surgery

This study was undertaken to determine the incidence of wound disruption after reconstructive posterior vaginal surgery with braided permanent versus absorbable suture. A retrospective cohort study of women undergoing posterior vaginal surgery. Outcomes included suture erosion, wound dehiscence, and additional surgical procedures. Ninety-nine procedures were performed with permanent sutures, followed by 111 with absorbable sutures. There were no differences in demographics or comorbidities between patient groups. Suture erosion/wound dehiscence occurred in 31.3% of the permanent suture group versus 9% of the absorbable suture group (P = .003, odds ratio [OR] = 7.5, 95% CI 2-28). The need for additional surgical intervention was 16.1% among permanent suture group versus no patients with absorbable suture. Performing a concomitant anal sphincteroplasty with permanent sutures significantly increased the incidence of suture erosion (P = .003, OR = 4.7, 95%CI 1.7-13.3). Permanent sutures increase the incidence in wound disruption and the need for additional surgical intervention in posterior colporrhaphy and anal sphincteroplasty.