Suture Migration Research Articles

Late Subcutaneous Suture Migration After Caesarean Section

Late Subcutaneous Suture Migration After Caesarean Section

SP10.1 Post operative complications and functional outcome after ventral mesh and suture rectopexy for rectal prolapse: a single centre observational study

Abstract Aims Laparoscopic ventral mesh rectopexy (LVMR) is a technique gaining more recognition for the management of pelvic floor disorders, such as external rectal prolapse (ERP), high grade internal rectal prolapse (IRP) and rectocele. The aim of this study was to evaluate post op complications (early, late and mesh) and functional outcomes after a standardized LVMR. Methods All patients who underwent Rectopexy from February 2008 to April 2021 were included into the study. The patients were evaluated preoperatively, at 3 months and 1 year postoperatively. Surgical complications, mesh complications (mesh detachment, erosion and infection) and functional results in terms of faecal incontinence, recurrence and ODS were analysed. Results 95 patients (88 – LVMR; 7 - suture Rectopexy) who underwent Rectopexy were included in the study with a mean age of 68 and female predominance of 90 patients. 30 patients had external rectal prolapse (ERP), 45 patients had internal rectal prolapse (IRP) or intussusception, 20 patients had both ERP and IRP (Table 3). 53 patients had preoperative MRI scan and 15 patients had preoperative proctogram. (Table 4). 92 patients did not have any early complications. 13 patients had late postoperative complications including recurrent prolapse, stoma formation, suture migration and incisional hernia. Mesh complications were seen in 2 patients with mesh erosion and mesh detachment, both of whom had non-absorbable stitches used. There were no post op deaths documented. During the follow up period, 12 patient developed symptoms of ODS. Conclusion LVMR is a safe and effective treatment for rectal prolapse. Careful patient selection, appropriate preoperative workup, and meticulous surgical technique undoubtedly transforms postoperative outcomes.

Commentary: Scleral penetration or perforation during strabismus surgery.

Commentary: Scleral penetration or perforation during strabismus surgery.

The fate of sutures post rotator cuff repair

Ultrasonographic imaging has been widely used as a diagnostic tool for rotator cuff tears. Several studies have explored the changes in rotator cuff tendon morphology after arthroscopic cuff repair; however, none have addressed the fate of sutures. The aim of this study was to determine (1) if the sutures migrate through the tendon during the postoperative healing period in patients who have had arthroscopic rotator cuff repair; (2) if the sutures do migrate, the time point at which it does; and (3) if the quality of the tendon, in terms of tendon stiffness, modulus of elasticity, bursal thickness, and anatomic footprint, affects suture migration. This was a prospective study involving 21 patients who had primary arthroscopic rotator cuff repair performed by a single surgeon. All patients were assessed at 8 days, 6 weeks, 12 weeks, and 24 weeks postrepair; during each assessment, patients underwent an ultrasonographic examination (using a Siemens ACUSON S3000 ultrasonographic system, following a standardized protocol), where supraspinatus tendon thickness and thickness of tendon tissues below and above the suture were measured. Measurements of anatomic footprint, bursal thickness, tendon stiffness, and modulus of elasticity were obtained to assess tendon quality. Of the 21 participants, 14 (67%) had full-thickness tears and 7 (33%) had partial-thickness tears. Between the 12th- and 24th-week follow-up, 2 patients' tendons were found to be not intact. Within the first 12 weeks of the postrepair healing period, the sutures migrated inferiorly, through to the middle of the tendon at the footprint-articular junction (ie, ratio of tendon tissue thickness below the suture to the total tendon thickness = 0.5) (P = .03). The mean anatomic footprint increased from 8.4 ± 1.6 mm to 9.1 ± 1.2 mm between 8 days and 6 weeks (P = .04); bursal thickness decreased during the 24-week period from 1.5 ± 0.9 mm to 0.7 ± 0.4 mm (P = .005); tendon modulus of elasticity increased from 154 ± 75 kPa to 205 ± 96 kPa between 8 days and 24 weeks (P = .05). This is the first study to investigate suture position and migration post arthroscopic rotator cuff repair. The findings of this study suggest that sutures migrating to the middle of the tendon during the postoperative healing process is a normal phenomenon observed on ultrasonography.

In Vivo Evaluation of a Novel Pigtail Suture Stent

To compare pressure, dilation, and histology in a porcine model after stenting with a pigtail suture stent (PSS)-where the ureteral and bladder component consists of a suture and a double J (DJ) stent. Twelve pigs were studied with a PSS (4.8F/MiniJFil®) and DJ stent (4.8F/RocaJJ Soft) inserted in both sides, except in one where the DJ was not placed to serve as control. Intrapelvic pressure (IPP) and ureteral pressures were recorded. Five pigs were stented for 7 days, and the next 7 for 13-15 days, where a retrograde study was performed after stent removal. Ureteral histology in 4 and 3 pigs stented for 7- and 13-15 days, respectively, were assessed in a blinded manner. In total, 11 renal units were stented with PSS and DJ, respectively. There was a rise in IPP and ureteral pressure after stenting. There were no significant differences in post-stenting pressures between DJ and PSS systems. Ureteral dilation occurred in 100% of DJ and 83% of PSS units. PSS suture migration occurred in 3 of 11. Gross edema at the ureteral orifice was greater with the DJ compared to the PSS (82% vs 18%; p = .003). Histology demonstrated greater inflammation at the ureteral orifice in the DJ group (2.3 vs 1; p = .016) when stented for 13-15 days. There was no difference in IPP after stenting with a PSS compared to a DJ stent. When stented for 13-15 days, the PSS resulted in ureteral dilation, but with less edema and inflammation at the ureteral orifice.

Recombinant mouse periostin ameliorates coronal sutures fusion in Twist1+/\u2212 mice

BackgroundSaethre–Chotzen syndrome is an autosomal dominantly inherited disorder caused by mutations in the twist family basic helix-loop-helix transcription factor 1 (TWIST1) gene. Surgical procedures are frequently required to reduce morphological and functional defects in patients with Saethre–Chotzen syndrome. Therefore, the development of noninvasive procedures to treat Saethre–Chotzen syndrome is critical. We identified that periostin, which is an extracellular matrix protein that plays an important role in both bone and connective tissues, is downregulated in craniosynostosis patients.MethodsWe aimed to verify the effects of different concentrations (0, 50, 100, and 200 μg/l) of recombinant mouse periostin in Twist1+/− mice (a mouse model of Saethre–Chotzen syndrome) coronal suture cells in vitro and in vivo. Cell proliferation, migration, and osteogenic differentiation were observed and detected. Twist1+/− mice were also injected with recombinant mouse periostin to verify the treatment effects.ResultsCell Counting Kit-8 results showed that recombinant mouse periostin inhibited the proliferation of suture-derived cells in a time- and concentration-dependent manner. Cell migration was also suppressed when treated with recombinant mouse periostin. Real-time quantitative PCR and Western blotting results suggested that messenger ribonucleic acid and protein expression of alkaline phosphatase, bone sialoprotein, collagen type I, and osteocalcin were all downregulated after treatment with recombinant mouse periostin. However, the expression of Wnt-3a, Wnt-1, and β-catenin were upregulated. The in vivo results demonstrated that periostin-treated Twist1+/− mice showed patent coronal sutures in comparison with non-treated Twist1+/− mice which have coronal craniosynostosis.ConclusionOur results suggest that recombinant mouse periostin can inhibit coronal suture cell proliferation and migration and suppress osteogenic differentiation of suture-derived cells via Wnt canonical signaling, as well as ameliorate coronal suture fusion in Twist1+/− mice.

Safety and complications of absorbable threads made of poly-L-lactic acid and poly lactide/glycolide: Experience with 148 consecutive patients.

Thread lifting is a minimally invasive procedure for lifting and repositioning tissues. Few articles with absorbable sutures exist in the literature. Furthermore there is no study focusing on complications of absorbable sutures. To describe complications of thread lifting using a totally absorbable suture composed of poly-L-lactic acid affixed with poly lactide/glycolide cones. Data regarding complications were analyzed retrospectively for 148 patients underwent thread lifting between June 2014 and February 2017. A total of 321 pairs of sutures used in the 148 patients studied. Overall 40 (27%) patients had complications regarded as minimal or moderate without permanent sequela. The most common complication was skin dimpling and irregularity (n = 17, 11.4%) followed by ecchymosis (n = 12, 8.1%), suture extrusion (n = 4, 2.7%), and pain (n = 4, 2.7%) Except one patient, dimpling, and irregularity resolved in all patients after 3-7 days spontaneously. Suture migration was observed in 2 (1.35%) patients. Hematoma and infection were seen in 2 patients one for each. The procedure using sutures made of absorbable poly-L-lactic acid and poly lactide/glycolide is a relatively safe procedure without major complications.

Functionally Graded, Bone- and Tendon-Like Polyurethane for Rotator Cuff Repair.

Critical considerations in engineering biomaterials for rotator cuff repair include bone-tendon-like mechanical properties to support physiological loading and biophysicochemical attributes that stabilize the repair site over the long-term. In this study, UV-crosslinkable polyurethane based on quadrol (Q), hexamethylene diisocyante (H), and methacrylic anhydride (M; QHM polymers), which are free of solvent, catalyst, and photoinitiator, is developed. Mechanical characterization studies demonstrate that QHM polymers possesses phototunable bone- and tendon-like tensile and compressive properties (12-74 MPa tensile strength, 0.6-2.7 GPa tensile modulus, 58-121 MPa compressive strength, and 1.5-3.0 GPa compressive modulus), including the capability to withstand 10 000 cycles of physiological tensile loading and reduce stress concentrations via stiffness gradients. Biophysicochemical studies demonstrate that QHM polymers have clinically favorable attributes vital to rotator cuff repair stability, including slow degradation profiles (5-30% mass loss after 8 weeks) with little-to-no cytotoxicity in vitro, exceptional suture retention ex vivo (2.79-3.56-fold less suture migration relative to a clinically available graft), and competent tensile properties (similar ultimate load but higher normalized tensile stiffness relative to a clinically available graft) as well as good biocompatibility for augmenting rat supraspinatus tendon repair in vivo. This work demonstrates functionally graded, bone-tendon-like biomaterials for interfacial tissue engineering.

In Vivo Comparison of “V-Loc 90 Wound Closure Device” With “Vicryl” and “Monocryl” in Regard to Tissue Reaction in a Rabbit Bladder Model

To compare the barbed polyglyconate suture (BPS) with 2 commonly used conventional sutures, this prospective randomized trial was designed. The sutures applied in the urinary collecting system, in terms of long-term histopathologic and macroscopic suture material features. Eight female and 6 male New Zealand rabbits were included in the study. Each animal served as its own control and was subjected to cystotomy. Watertight running cystorrhaphies were performed using 3 different sutures in a randomized fashion, namely Monocryl, Vicryl, and V-Loc 90. Seven animals were sacrificed after the third and 7 after the sixth week. Macroscopic and histopathologic examinations were performed. Tissue reaction, like inflammation and fibrosis, around the sutures were evaluated. Friedman and Wilcoxon signed ranks test was used for the statistical analysis. The BPS demonstrated no adhesion. However, in the six-week group, stone formation was recorded on 4 BPS and 1 Vicryl thread, a difference being statistically significant (P = .039). Additionally, in the third- and in the sixth-week group, 1 (P = .368) and 3 (P = .050) BPS threads migrated, respectively. The histopathologic analysis revealed less inflammation and fibrosis associated with the BPS thread in both the third and the sixth-week groups (P = .010 and P = .002, respectively). The BPS appears to be superior to conventional sutures in terms of local inflammation and fibrosis. However, suture migration and stone formation following collecting system closure could be potential predicaments.

Bladder stone formation on permanent suture material ten years after laparoscopic high uterosacral ligament suspension

The present authors describe an uncommon case of iatrogenic bladder stone formation in a patient who underwent surgery for pelvic organ prolapse. A female patient who underwent high uterosacral ligament suspension ten years ago presented with pyuria and irritable bladder symptoms that did not respond to treatment. She had not experienced any specific urinary symptoms during the previous ten years. Patient evaluation revealed bladder stone formation on the non-absorbable suture material used during the previous operation. Cystoscopy during the previous operation did not find the suture material, and the suture knot that was tied extravesically during the operation was found inside the bladder. These strongly suggest delayed migration and rotation of the'suture knot after surgery rather than direct penetration of the bladder during operation. Delayed suture migration is a long-term complication that clinicians should consider in a patient who suffers from recurrent urinary symptoms after pelvic surgery around the bladder.

Ex vivo biomechanical stability of 5 cricoid-suture constructs for equine laryngoplasty.

To determine the biomechanical properties of 5 suture constructs in the equine cricoid under cyclic loading and load to failure testing. Ex vivo study. Seventy-five equine cadaver larynges. Each larynx was implanted with 1 of 5 cricoid-suture constructs. The standard laryngoplasty, where a suture is passed once through the cricoid, including its caudal edge, was used in 2 constructs: 1 with 5 USP Ethibond (ES) and 1 with 2 mm Fibertape (FS). In the third construct, the 2 mm Fibertape was passed twice through the cricoid including its caudal edge (Double Loop-DL). Constructs 4 and 5 used 2 mm Fibertape in a U-shaped loop passed through the cricoid but excluding its caudal edge. One construct was supported with a metallic button (MB) on the caudo-ventral aspect of the cricoid while the other included only the U-shaped loop (U). Constructs were subjected to cyclic loading and to single cycle to failure. Reduction of the left-to-right arytenoid angle quotient (LRQ), suture migration, and load at failure were compared. LRQ reduction after cyclic loading was lower in MB and U than ES constructs. During cyclic loading, suture migration was reduced in MB, U, and DL compared to ES constructs. Mean load at failure was lower in FS and U than in ES constructs. Loss of abduction after equine laryngoplasty may be reduced and pullout forces increased by applying a MB construct in the cricoid cartilage. In vivo testing is required to verify these results.

The role of transabdominal cervical cerclage techniques in maternity care

Key content The transabdominal cerclage procedure aims to strengthen the cervix by placing a suture at the level of the internal os. The main indications for transabdominal suture are a grossly disrupted cervix, an absent vaginal cervix, and previous failed elective vaginal cerclage. The transabdominal cerclage was first described in 1965 and the laparoscopic modification was first reported in 1998. Published reports suggest very high neonatal survival rates with both approaches. Laparoscopic cerclage has the general advantages of minimal access surgery, such as avoiding a large abdominal incision, short hospital stay and quick recovery. Potential complications include bleeding from uterine vessels and loss of pregnancy for non‐interval procedures. The other reported complications, such as suture migration, rectouterine fistula, uterine rupture and intrauterine growth restriction, are rare. The place of transabdominal cerclage in preventing pregnancy loss and preterm birth remains a subject of debate and there is a need to audit the outcomes. Learning objectives To better understand the role of the cervix in miscarriage. To understand the indications for referral for transabdominal cervical cerclage. To understand the obstetric and neonatal outcomes of women after this procedure. Ethical issues To consider the place of this invasive procedure, with its consequent possible complications, in the management of cervical weakness in women who often have poor reproductive histories. To consider the lack of national and international availability of this potentially valuable procedure. To consider an effective system of assessment of this procedure in a referral context, and the future of this procedure.

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.

Bidirectional Barbed Suture Migration: A Unique Complication After Intracuticular Closure

One of our body-contouring patients recently experienced a complication not reported previously for this type of procedure and closure. After gastric bypass, a 29-year-old woman desired body contouring aimed at the lower trunk and inner thighs. She underwent a 360 body-lift, posterior flap gluteal augmentation, and bilateral vertical thigh-lift. As part of the closure, an intracuticular 2-0 Quill SRS Monoderm (polyglocolide-poly-e-caprolactone copolymer; Angiotech Pharmaceuticals, Vancouver, BC) was used. Approximately 2 weeks postoperatively, the patient experienced isolated cellulitis and wound breakdown on a portion of the left vertical thigh-lift incision, which resolved with antibiotics and topical Silvadene. The patient resumed her exercise routine 6 weeks postoperatively but noted pain and a cordlike structure at the medial aspect of her knee. This was suspected to represent inferior migration of the monoderm intracuticular suture (Fig. 1). The suture was removed with the use of local anesthesia and consisted of approximately 7 cm of unidirectional barbs (Fig. 2). The patient’s symptoms resolved, and she resumed her exercise routine. Bidirectional barbed suture was developed to remedy the disadvantages of traditional suturing techniques using knots. These disadvantages include increased foreign body reaction, ‘‘spitting,’’ increased operating room time, and tissue strangulation [1–8]. Early bidirectional barbed suture was noted to cause visible or palpable threads, skin dimpling, ecchymosis, and even suture migration and extrusion in face-lifts [9–13]. These problems have not been reported for the Quill SRS series. The cause for suture breakage and migration in the reported case may have been due to the resumption of exercise or to the previous episode of cellulitis. Increased inflammatory cells may have led to more rapid degradation of the suture in an isolated location. Because factors contributing to this complication are not entirely avoidable, we present this case as a cautionary note for other surgeons. As new wound closure devices are developed, they must be examined to ensure that their advantage extends to patient outcomes and not merely to time savings or novelty. Although bidirectional suture has the potential to improve operative time and offers a theoretical advantage in wound healing, long-term data are limited. We hope future reports will elucidate the frequency of complications with this product.

Medial versus Lateral Supraspinatus Tendon Properties

Background Rotator cuff repair retear rates range from 25% to 90%, necessitating methods to improve repair strength. Although numerous laboratory studies have compared single-row with double-row fixation properties, little is known regarding regional (ie, medial vs lateral) suture retention properties in intact and torn tendons. Hypothesis A torn supraspinatus tendon will have reduced suture retention properties on the lateral aspect of the tendon compared with the more medial musculotendinous junction. Study Design Controlled laboratory study. Methods Human supraspinatus tendons (torn and intact) were randomly assigned for suture retention mechanical testing, ultrastructural collagen fibril analysis, or histologic testing after suture pullout testing. For biomechanical evaluation, sutures were placed either at the musculotendinous junction (medial) or 10 mm from the free margin (lateral), and tendons were elongated to failure. Collagen fibril assessments were performed using transmission electron microscopy. Results Intact tendons showed no regional differences with respect to suture retention properties. In contrast, among torn tendons, the medial region exhibited significantly higher stiffness and work values relative to the lateral region. For the lateral region, work to 10-mm displacement (1592 ± 261 N-mm) and maximum load (265 ± 44 N) for intact tendons were significantly higher (P < .05) than that of torn tendons (1086 ± 388 N-mm and 177 ± 71 N, respectively). For medial suture placement, maximum load, stiffness, and work of intact and torn tendons were similar (P >. 05). Regression analyses for the intact and torn groups revealed generally low correlations between donor age and the 3 biomechanical indices. For both intact and torn tendons, the mean fibril diameter and area density were greater in the medial region relative to the lateral (P ≤. 05). In the lateral tendon, but not the medial region, torn specimens showed a significantly lower fibril area fraction (48.3% ± 3.8%) than intact specimens (56.7% ± 3.6%, P < .05). Conclusion Superior pullout resistance of medially placed sutures may provide a strain shielding effect for the lateral row after double-row repair. Larger diameter collagen fibrils as well as greater fibril area fraction in the medial supraspinatus tendon may provide greater resistance to suture migration. Clinical Relevance While clinical factors such as musculotendinous integrity warrant strong consideration for surgical decision making, the present ultrastructural and biomechanical results appear to provide a scientific rationale for double-row rotator cuff repair where sutures are placed more medially at the muscle-tendon junction.

A Common Bile Duct Stone formed by Suture Material after Open Cholecystectomy

The use of non-absorbable suture materials for cystic duct ligation after cholecystectomy can expose patients to the risk of recurrent stone formation in the common bile duct (CBD). However, in Korea suture materials have rarely been found to act as a nidus for common bile duct calculus formation. Recently, we experienced a case in which suture material, that had migrated from a previous cholecystectomy site into the CBD, probably served as a nidus for common bile duct stone formation. The stone was confirmed by endoscopic retrograde cholangiopancreatography (ERCP) and removed successfully using a basket. The authors report a case of surgical suture migration and discuss its subsequent role as a stone forming nucleus within the CBD in a patient who underwent open cholecystectomy; and include a review of the literature.

Effect of a new guideline on outcome following third-degree perineal tears: results of a 3-year audit.

The aim of this study was to assess the impact of a new guideline on the outcome of repair of obstetric anal sphincter tears by examining adherence to the guideline and the effect upon the incidence of symptoms of anal incontinence. An audit of third-degree perineal tears was conducted in 1997. A reaudit was completed in 1998 and 1999 after the introduction of a new guideline. The audits were conducted in a tertiary obstetric unit with 5000 deliveries per annum. Over the 3-year period between 1997 and 1999 124 women with a third-degree tear were identified; 14 381 women who had delivered vaginally without third-degree tears were used as controls. The main outcome measure was the number of cases with adherence to the protocol, and the number of patients with ongoing symptoms. Cases were identified from the hospital database, and case notes were reviewed to obtain clinical data. The incidence of third-degree perineal tears was 0.81% over the 3-year period. Following the introduction of a new guideline there was a significant increase in the number of repairs performed in theatre (70% vs 82% vs 97%, P<0.05), using Prolene (64% vs 76% vs 93%, P< 0.05), with adequate anesthesia (70% vs 82% vs 97%, P<0.05). At follow-up there was a transient improvement in defecatory symptoms in the first year of the protocol only (45% vs 32% vs 50%, P<0.01). More patients had complete follow-up data after introduction of the protocol: 66% vs 86% vs 80% ( P<0.001). There were more cases of Prolene suture migration (7% vs 34% vs 16%, P<0.01). We concluded that the introduction of a new guideline was followed by improved performance of appropriate repair. There was no sustained improvement in fecal symptoms at follow-up.

Blepharoptosis surgery complicated by late suture migration

%PURPOSE: To report late suture migration as a complication of blepharoptosis surgery. METHOD: Case reports. RESULTS: After upper eyelid blepharoptosis repair, two eyes of two patients developed unusual foreign body reactions and ulceration in the conjunctiva caused by migration of nonabsorbable suture from the levator aponeurosis to the upper conjunctival fornix. The foreign body caused eyelid edema, papillary changes in the upper tarsal conjunctiva, recurrent blepharoptosis, and a foreign body sensation that started more than 3 months after the surgery and persisted until the suture was removed. The sutures, hidden in edematous conjunctiva of the superior fornix, eluded detection. CONCLUSIONS: Foreign body reaction secondary to suture migration is an uncommon complication of blepharoptosis repair.

Pathological changes of anastomotic false aneurysms.

Anastomotic parts of polyester vascular prostheses implanted in thoracic aortae of 270 dogs were examined. Anastomotic false aneurysms were seen with 3 cases (1.2%), in which disruption did not occur, however, the grafts which have no aneurysm showed the following features, i.e., suture migration, degenerative changes of the host arterial wall sustaining a suture and dissection between the host arterial wall and a prosthesis. From the results of an analysis of the arrangement pattern of smooth muscle cells in neointima, it was clarified that a suture had been subjected to continuous tensile stress. So that, the host arterial wall sustaining a suture is clinched and pulled toward prosthesis by the suture at every pulsation during implantation. These results indicate that the features mentioned above are phenomena of the developing into anastomotic false aneurysms.