Absorbable Suture Research Articles

The Routine Use of Nonabsorbable Sutures in Bilateral Horizontal Rectus Recession

Surgical outcomes of bilateral horizontal rectus recession surgeries performed by a single surgeon using absorbable compared to non-absorbable sutures. The use of non-absorbable sutures in a novel technique reduces overcorrection compared to absorbable sutures use.

Clip migration after minimally-invasive surgical procedures

Introduction. Today absorbable suture material as well as plastic nonabsorbable clips are widely used for surgical haemostasis and stabilisation of sutures during minimally invasive operations, however, they are capable of potential and spontaneous migration into the lower and upper urinary tract.Objective. In this paper, we present clinical cases of clip migration after radical prostatectomy and renal resection.Clinical cases. Clinical cases of spontaneous clip migration after the two most common minimally invasive interventions: kidney resection with subsequent removal of a foreign body after the use of lithokinetic therapy and a case of hemostatic material migration after robot-assisted radical prostatectomy. The literature review is also available.Conclusion. Excessive use of non-absorbable plastic clips around their close contact with the kidney cavity or the bladder wall should be avoided to achieve adequate hemostasis during minimally invasive methods of treating patients.

Local application of gingiva-derived mesenchymal stem cells on experimental periodontitis in rats.

Stem cell-based approaches in regenerative periodontal therapy have been used in different experimental models. In this study, the effect of local application of gingival mesenchymal stem cells (GMSC) in fibroin/chitosan oligosaccharide lactate hydrogel (F/COS) on periodontal regeneration was evaluated using experimental periodontitis model in rats. Mesenchymal stem cells were isolated from the gingiva of rats and characterized. Viability tests and confocal imaging of GMSC in hydrogels were performed. Healthy control without periodontitis (Health; H; n=10), control with periodontitis but no application (Periodontitis; P; n=10), only hydrogel application (F/COS; n=10), and GMSC+F/COS (n=10) four groups were formed for in vivo studies. Experimental periodontitis was created with silk sutures around the maxillary second molars. GMSC labeled with green fluorescent protein (GFP) (250,000 cells/50μL) in F/COS were applied to the defect. Animals were sacrificed at 2nd and 8th weeks and maxillae of the animals were evaluated by micro-computed tomography (micro-CT) and histologically. The presence of GFP-labeled GMSC was confirmed at the end of 8weeks. Micro-CT analysis showed statistically significant new bone formation in the F/COS+GMSC treated group compared with the P group at the end of 8weeks (p<0.05). New bone formation was also observed in the F/COS group, but the statistical analysis revealed that this difference was not significant when compared with the P group (p>0.05). Long junctional epithelium formation was less in the F/COS+GMSC group compared with the P group. Periodontal ligament and connective tissue were well-organized in F/COS+GMSC group. The results showed that local GMSC application in hydrogel contributed to the formation of new periodontal ligament and alveolar bone in rats with experimental periodontitis. Since gingiva is easly accessible tissue, it is promising for autologous cell-based treatments in clinical applications.

Transduodenal Sphincteroplasty: A Visual Case Study

BackgroundSphincter of Oddi dysfunction is a challenging and rare clinical entity resulting in pancreatobiliary pain and stasis of bile and pancreatic juice. This problem was classically treated with surgical therapy, but as classification of the disease has changed and newer methods of endoscopic evaluation and therapy have evolved, operative transduodenal sphincteroplasty is now generally reserved as a final therapeutic option for these patients. In this video and manuscript, we describe our approach to operative transduodenal sphincteroplasty in a patient with type I Sphincter of Oddi dysfunction. MethodsA 50-year-old female with history of Roux-en-Y gastric bypass presented with episodic right-upper-quadrant and epigastric abdominal pain with associated documented elevations in liver chemistries. Preoperative cross-sectional imaging demonstrated dilation of her common bile duct. After multidisciplinary discussion, the decision was made to pursue operative transduodenal sphincteroplasty. ResultsAll key operative steps of the transduodenal sphincteroplasty are demonstrated in the embedded video. Key operative steps include laparotomy, generous Kocher maneuver, and duodenotomy over the ampulla, allowing access for sequential biliary and pancreatic sphincterotomies and sphincteroplasties with absorbable suture. The duodenotomy and abdominal fascia are then closed. Our patient underwent sequential diet advancement and was discharged to home on postoperative day five. At clinic follow-up, pancreatobiliary-type pain had resolved. ConclusionThe embedded video demonstrates a case of operative transduodenal sphincteroplasty, which can provide durable results in appropriate patient populations.

Evaluation of biomechanical properties and biocompatibility: are partially absorbable cords eligible for anterior cruciate ligament reconstruction?

Introduction: Independent augmentation technology based on reinforcing devices has been reported to signifi-cantly reduce the elongation behavior of graft and improve knee stability after anterior cruciate ligament reconstruction (ACLR). Using biodegradable devices could reduce the risk of severe inflammatory reactions due to particle accumulation from foreign bodies. Given the limitations of the mechanical properties of biodegradable materials, partially biodegradable composite devices may offer a compromise strategy. Methods: Three types of partially absorbable core-sheath sutures, including low-absorbable cord (LA-C), medium-absorbable cord (MA-C) and high-absorbable cord (HA-C), were braided using unabsorbable ultra-high molecular weight polyethylene (UHMWPE) yarn and absorbable polydioxanone (PDO) monofil-ament bundle based on the desired configuration. The feasibility of these partially absorbable cords were verified by biomechanical testing, material degradation testing, and cell experiments, all performed in vitro. Results: Reinforcement of an 8mm graft with the cords decreased dynamic elongation by 24%-76%, was positively related to dynamic stiffness, and increased the failure load by 44%-105%, during which LA-C showed maximum enhancement. Human ligament-derived fibroblasts showed good proliferation and vitality on each cord over 2weeks and aligned themselves in the direction of the fibers, especially the UHMWPE portion. Discussion: This study supports the potential of partially degradable UHMWPE/PDO cords, particularly LA-C, for graft protection. Nervertheless, a higher proportion of biodegradable material results in lower stiffness, which may impair the protective and lead to mechanical instability during degradation.

Absorbable vs Nonabsorbable Sutures for Achilles Tendon Repair: A Systematic Review and Meta-analysis.

Nonabsorbable sutures are still the main choice for acute Achilles tendon rupture (AATR) repair due to strength provided. However, the rerupture rates, infection risks, foreign body reaction, and postsurgical recovery differences between absorbable and nonabsorbable suture materials in AATR repair have not been carefully reviewed. A systematic review was done on PubMed, EBSCO, Cochrane Central Register of Controlled Trials, and Embase to find research studies in relation to complications associated with AATR repair using the PRISMA guidelines. The risk of bias from each study included will be assessed using the Cochrane Risk of Bias Tool for randomized study (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) for nonrandomized study. Five studies with a total of 255 patients, 105 in the absorbable suture group and 150 in the nonabsorbable suture group, were included for analysis. Risk of rerupture, infection, and foreign body reaction shown no significant difference between groups, and the mean difference of recovery scores were similar. Existing literature shows that absorbable sutures appear to be associated with similar outcomes to nonabsorbable sutures regarding rates of rerupture, infection, foreign body reaction, and outcomes grading following surgical repair of acute Achilles tendon repair.

Gingival Recession Treatment by Free Graft Fixed with Silk Sutures vs Vicryl Plus

Gingival Recession Treatment by Free Graft Fixed with Silk Sutures vs Vicryl Plus

Operative risk factors for clinically relevant-postoperative pancreatic fistula after pancreaticoduodenectomy: a prospective multicenter cohort study

Background Pancreatic fistula remains the most dangerous complication after pancreatoduodenectomy (PD). This study aimed to identify the operative risk factors for clinically relevant-postoperative pancreatic fistula (CR-POPF) after PD. Methods This prospective multicenter cohort study investigated the association between CR-POPF and operative risk factors in 107 patients who underwent PD at three tertiary centers from August 2017 to July 2022. Results The incidence of CR-POPF was 26.2%. With univariate analysis, soft pancreatic texture, pancreatic duct diameter (≤3 mm), right-sided pancreatic transection, absorbable suture, pancreatico-enteric anastomosis invagination technique, non-stented pancreatic drainage, internal pancreatic drainage, long anastomotic time (&gt;40 min), and R1 resection margin were risk factors for CR-POPF. Multivariate analysis identified four independents risk factors for CR-POPF: (1) soft pancreatic texture (OR 0.219; 95% CI 0.061–0.792; P&lt;0.021), (2) small main pancreatic duct diameter (OR 0.280; 95% CI 0.086–0.910; P&lt;0.034), (3) right-sided pancreatic transection (OR 0.168; 95% CI 0.032–0.881; P&lt;0.035), and (4) non-stented pancreatic drainage (OR 3.771; 95% CI 1.147–12.401; P&lt;0.029). Conclusion The incidence of CR-POPF after PD is reduced significantly by left-sided pancreatic transection and pancreatic drainage. Soft pancreatic texture and small main pancreatic duct diameter are independent risk factors for CR-POPF, and clinically postoperative prophylactic measures should be implemented as soon as possible.

Anterior Ear Reconstruction with the Posterior Pull-through Flap.

Defects of the central ear after skin cancer removal remain a common problem for the reconstructive surgeon. The experience with a one-stage, postauricular, skin-island flap passed through the cartilage to reconstruct ear defects is reported. Patients with an intact ear helix and an anterior full-thickness defect (cartilage defects included) were reconstructed with a skin-island flap based on posterior subcutaneous tissue deep to the flap base. The flap was passed through a generous aperture created in the ear cartilage. The skin at the base was incised superficially after the flap was passed through the cartilage to create a skin-island and avoid burial of epithelium. The flap periphery and postauricular harvest site were sutured with absorbable chromic sutures. Twenty-two patients (six women, 16 men) with ear defects underwent single-stage reconstruction over a 9-year period. The defects reconstructed measured in diameter from 2 cm to 4.5 cm. Six patients required a second skin flap from the preauricular area to close ear canal defects. The pull-through flap added structural support, and prevented ear distortion. No flap necrosis occurred. Venous congestion was common and self-limiting. No epithelial cysts developed. A one-stage postauricular skin-island flap can reliably reconstruct anterior ear defects without distorting shape or position of the ear. Care is needed to provide a generous aperture through the ear cartilage to accommodate the flap. Healing proceeds predictably, and minimal complications are associated with this posteriorly-based, pass-through, skin-island flap in ear reconstruction.

New Releasable Nonabsorbable Polypropylene 8.0 Suturing Technique for Sclerotomy Sealing in 23-Gauge Vitrectomy.

We propose a new releasable 8.0 polypropylene suture for leaking sclerotomies at the end of vitrectomy. Characteristic of this suture is that it can be easily removed the day after surgery at the slit-lamp examination. Patients undergoing 23-gauge pars plana vitrectomy with the need for at least 2 sclerotomy sutures and having a preoperative Ocular Surface Disease Index score <12 were consecutively allocated to sealing with either polyglactin 910 absorbable suture (VY GROUP) or nonabsorbable 8.0 polypropylene releasable suture (PR GROUP). Evaluation of adverse events, Ocular Surface Disease Index score, and conjunctival hyperemia (through the Efron scale) was performed at 1, 7, and 30 days postoperatively. Both methods effectively sealed sclerotomies. PR GROUP showed a significantly lower Ocular Surface Disease Index score and lower degree of conjunctival hyperemia at both 7 and 30 days follow-up. The Ocular Surface Disease Index score decreased significantly after 7 days in PR GROUP while in VY GROUP improved at 30 days postoperatively. PR GROUP showed a lower degree of conjunctival hyperemia both at 7 and 30 days follow-up. Polypropylene 8-0 releasable sutures proved to be effective in 23-gauge pars plana vitrectomy wound sealing while inducing less ocular surface inflammation and patient discomfort compared with the standard polyglactin 910 suture.

Umbilical Granuloma: A case report

After birth, remnants of the umbilical cord should separate spontaneously from the neonate within 1-2 weeks. However, in certain instances, following separation, a small red or pink moist bump forms in a neonate’s umbilical stump known as an umbilical granuloma. Treatment options include the application of silver nitrate, salt application, double-ligature technique, cryosurgery, and surgical excision. We present a 7 week old male with an umbilical granuloma treated with the double ligature technique using an absorbable suture with the disappearance of the lesion at a 1 week follow up visit. The ligature technique is one of several methods used in the treatment of umbilical granuloma. Although non-absorbable silk sutures are commonly used for this technique, absorbable sutures can be used for lesions with a narrow stalk.

Risk Analysis and Study of Post-marketing Adverse Events for Absorbable Sutures

Objective To investigate, analyze, and evaluate the risk data associated with the clinical use of absorbable sutures by retrieving and summarizing information from the databases of the US FDA and CNKI, as well as the adverse event reports related to absorbable sutures from January 2019 to October 2022 within Zhejiang province. The adverse event reports are obtained from both incident locations and monitoring organizations affiliated with the registrant. The aim is to identify the main risk factors associated with the clinical use of absorbable sutures. The key risk factors are potential product quality defects, product design and material selection, clinical selection and application, and postoperative recovery care including patient's self-care. Risk control strategies are further proposed to reduce or minimize the risk of adverse events caused by this product.

Surgical and Clinical Outcomes Associated With the Use of Barbed Sutures and Self-Adhering Mesh System and Polymeric Glue for Wound Closure in Multilevel or Revision Spinal Surgery: A Matched Cohort Comparative Study With Conventional Wound Closure Procedure.

Multilevel or revisional posterior spinal surgery is prone to infection and delayed wound healing, related with the wound closure time and suture strength. Knotless barbed suture is an innovative self-locking, multianchor suture. This study aims to evaluate the safety and efficacy of the knotless barbed suture and self-adhering mesh with polymeric glue in multilevel or revisional posterior spinal surgery. This is a single-center retrospective matched cohort study. Patients were divided into 2 groups based on the wound closure method: barbed suture group with novel wound closure, and conventional suture group with conventional wound closure, 1:1 matched by the level of surgery and sex, resulting in 120 subjects each. Total operation time and wound closure time were measured intraoperatively, and perioperative clinical outcome parameters including postoperative wound complication were investigated for the first 3 months postoperatively. The distribution of continuous variables was assessed for normality by Shapiro-Wilk test, then parametric or nonparametric tests were applied accordingly (paired t-test or Wilcoxon signed-rank test). Wound closure time was significantly shorter with the novel barbed suture than with conventional suture in all subgroups divided by the level of spinal surgery: 3-5, 6-9, ≥ 10 levels (p < 0.001). The 2 groups showed no significant differences in surgical complications (p = 1.000). Specially, total operation time and wound-closing time were significantly shorter in revisional subgroup. Absorbable knotless barbed suture and self-adhering mesh with polymeric glue can shorten spinal wound closure time with noninferiority in complications for multilevel or revisional spinal surgery.

SURGICAL OR CONSERVATIVE MANAGEMENT OF TRACHEOBRONCHIAL INJURY

Background: Surgical intervention is considered as the radical traditional management of acute posttraumatic tracheobronchial lesions.The aim of the current study was to assess the effectiveness of conservative and surgical treatments for managing posttraumatic tracheobronchial injury management Methodology: This is a retrospective study of 27 patients, from January 2009 to December 2015, with posttraumatic tracheobronchial injuries who were managed in King Faisal Medical Complex (trauma hospital) and King Abdul-Aziz specialist hospital (tertiary hospital) in Taif city, Saudi Arabia. Results: Seventeen (63%) cases were treated conservatively, whereas the remaining 10 (37%) cases were treated surgically, the lesion was repaired with interrupted absorbable sutures. Conservative treatment consisted of endotracheal intubation, adequate ventilation with low tidal volumes, chest tube, prevention of pressure peaks as well as retention achieving a continuous control and Bronchoscopy follow-up. The overall survival rate within our series was 92.6% (25 patients). Two patients (7.4%) in our study died (one was treated surgically and the other conservatively) due to associated Polytrauma. Conclusions: In our experience, conservative treatment is a feasible, safe procedure with a mortality rate as low as that of surgical management, and therefore should be considered as an option in the management of tracheobronchial injuries.

Frequency and Outcome of Emergency Oculoplastic Cases with Adaptations in Management during Covid-19 Pandemic

Purpose: To determine whether treating emergency oculoplastic conditions with protective modification have any effect on treatment outcome visiting tertiary oculoplastic service. Study Design: Interventional case series. Place and Duration of Study: Department of Ophthalmology, Lady Reading Hospital, from March to September 2020. Methods: We included all patients operated during pandemic at oculoplastic service. Protective modifications included; use of loupe instead of surgical microscope, avoidance of General Anesthesia, judicial use of cautery, use of absorbable suture and follow up through phone call and minimum visits. Results: A total of 117 patients were eligible with a mean age of 25.399 ± 34.89 years. Majority of the patients were male, 74 (63.2%). The mean follow-up time was 04 months. Satisfactory surgical and functional outcome was seen in 107 (91.5%) patients. There was no statistically significant difference in outcome with reference to gender (p-value of 0.824) and treatment (p-value of 0.168). Similarly, treatment outcome was statistically insignificant (p value 0.342) in different oculoplastic conditions. Unsatisfactory outcome due to various complications was seen in 10 (8.5%) patients at follow up of 01 to 05 months which were then given special treatment at followup. Conclusion: With adopted protocols and modifications in techniques, outcome was acceptable in common emergency oculoplastic conditions. Proper follow up through telemedicine was helpful in picking up the complicated cases for timely intervention to get satisfactory outcome during Covid 19 pandemic.

Influence of pulling direction on knot security: A laboratory research

When tying knots, some surgeons do not pay particular attention to the direction in which they pull to lay down throws. We examine to what extent does pulling direction influence on knot security. A total of 368 residents were instructed to tie knots with from 2 to 7 throws using silk braided suture in 3-0 gauge. The direction in which they pulled to lay down throws was recorded. Only the knots tied either by pulling in alternate directions (Group A) or in constant direction (Group C) from the first throw to the last were involved in statistical analysis. Tensile strength and untying rate of the knots were then measured for comparative analysis. For knots with from 2 to 7 throws, the tensile strength of the ones from Group A was significantly higher than that of the ones from Group C (p<0.05), respectively. For knots with from 5 to 7 throws, the untying rate of the ones from Group A was significantly lower than that of the ones from Group C (p<0.05), respectively. For the unraveled knots with from 2 to 7 throws (except for the ones with 5 throws), the tensile strength of the ones from Group A was significantly higher than that of the ones from Group C (p<0.05), respectively. Pulling in constant direction results in inferior knot security. Surgeons must ascertain the influence of pulling direction on knot security, and try to achieve superior security with fewer throws to ensure patient safety.

Addition of Transfixation Suture to Purse String Suture During Intraperitoneal Inguinal Hernia Repair Increases Peri-Hernia Sac Neck Collagen Formation

BackgroundThe worldwide accepted repair for indirect inguinal hernia in children is high ligation of the hernia sac with open herniotomy. However, laparoscopic pediatric inguinal hernia repair (IHR) has been gaining popularity in the last two decades. An experimental study was conducted to investigate the effects of different intraperitoneal IHR suture techniques on the collagen formation at the hernia sac neck. MethodsPresent study was conducted on thirty-five male adult (3–6 months old) Wistar-Albino rats (260–300 g). Intraperitoneal IHR with different hernia sac neck suturing techniques (purse string suture only, transfixation suture only and purse string suture plus transfixation suture) were performed through median laparotomy using open operative techniques. Non-absorbable 2/0 braided polyester suture with 16 mm 1/2 curved round needle (Ti-cron, Covidien, MN) was used as suture material. ResultsThe highest collagen thickness around the suture was detected in intraperitoneal IHR with purse-string plus transfixation suture group. The collagen thickness of the intraperitoneal IHR with purse string suture only and IHR with tranfixation suture only groups were not statistically significantly different. The collagen thickness of the intraperitoneal IHR with purse string suture plus transfixation suture group was statistically significantly higher compared with the intraperitoneal IHR with purse string suture only and intraperitoneal IHR with transfixation suture only groups. ConclusionsThe combined usage of purse string suture and transfixation suture during laparoscopic intraperitoneal inguinal hernia repair further stimulates mesothelial fibrosis at the hernia sac neck compared with mesothelial fibrosis induced by purse string suture only or transfixation suture only.

Can multiple-degree-of-freedom articulating instruments be effective in pediatric endoscopic surgery? - A prospective trial

BackgroundPediatric endosurgery often requires intracorporeal suturing, including reverse or vertical needle driving, which is difficult using a conventional instrument because of limited degrees of freedom (DOFs). To address this, multiple-DOF (mDOF) articulating instruments (mDOF-AIs) have been developed. We therefore evaluated the usefulness of mDOF-AIs compared with conventional instruments. MethodsARTISENTIALⓇ (LivsMed, Seongnum-si, Republic of Korea) was used as the mDOF-AI. Forty medical students were randomly divided into groups using conventional or mDOF articulating graspers to compare their proficiency with three-dimensional peg transfer. Task completion time and number of errors (dropping a peg) were evaluated. In addition, among pediatric surgeon participants, the number of practice times taken to reach the goal (completion of peg transfer within two minutes and vertical suturing) was measured. After achieving the goal, three vertical sutures of laparoscopic hepaticojejunostomy of the simulator were performed using the conventional and mDOF articulating needle-driver. The task completion time and quality of suturing were then evaluated. ResultsForty medical students were enrolled. The mDOF group showed significantly longer task completion times but significantly fewer errors than the conventional group (0.7 vs. 1.4 times, p = 0.03). Six pediatric surgeons achieved the goal in 42.5 min of practice on average. Using the mDOF articulating needle-driver, laparoscopic hepaticojejunostomy took significantly longer than with the conventional needle-driver (1120 vs. 856 s, p<0.01); however, the suturing quality improved significantly. ConclusionThe quality of basic and advanced endoscopic procedures using mDOF-AIs was higher than that with conventional instruments. mDOF-AIs potentially have safe and accurate performance.

The type of suture material affects transverse aortic constriction-induced heart failure development in mice: a repeated measures correlation analysis.

Transverse-aortic constriction (TAC) operation is a widely used animal model to induce hypertrophy and heart failure through left-ventricular pressure overload. In mice, the cardiac response to TAC exhibits considerable variability influenced by factors such as strain, sub-strain, age, sex and vendor. To investigate the impact of suture material (silk versus prolene) and size (6-0 versus 7-0) on the TAC-induced phenotype, we performed surgeries on male C57BL6/N mice at 9 weeks of age defining the aortic constriction by a 27G needle, thereby employing most frequently used methodological settings. The mice were randomly assigned into four separate groups, 6-0 silk, 7-0 silk, 6-0 prolene and 7-0 prolene (10 mice per group). Echocardiography was conducted before TAC and every 4 weeks thereafter to monitor the development of heart failure. Repeated measures correlation analysis was employed to compare disease progression among the different groups. Our findings reveal a significant influence of the chosen suture material on TAC outcomes. Mice operated with prolene showed increased mortality, slower body weight gain, faster left-ventricular mass increase, and a faster decline in left-ventricular ejection fraction, fractional shortening and aortic pressure gradient compared to silk-operated mice. Moreover, despite non significant, using thinner suture threads (7-0) tended to result in a more severe phenotype compared to thicker threads (6-0) across all tested parameters. Collectively, our results highlight the importance of suture material selection in determining the cardiac phenotype induced by TAC and emphasize the need to consider this factor when comparing data across different research laboratories.

Histological Assessment of the Effects of Derma + Flex®, versus Black Silk Suture on Oral Mucosal Primary Wound Healing in Rabbits

Histological Assessment of the Effects of Derma + Flex®, versus Black Silk Suture on Oral Mucosal Primary Wound Healing in Rabbits