Suture Thread Research Articles

ThP3.4 - Suture Endoclips coding, a novel technique to improve efficiency and reduce errors In laparoscopic repair of peptic ulcer perforation

Abstract The presentation describes our a novel technique of using Endo clips to tag the sutures during laparoscopic repair of perforated peptic ulcer utilizing Graham omental patch, Methods Four patients presented with perforated peptic ulcer. All treated with Laparoscopically. Supine position with split leg was standard. 5 and10mm thirty-degree scopes were used to facilitate efficient and comprehensive washing, through 11 mm umbilical port and two 5 mm ports. An extra 5mm port was needed on the lateral right Upper Quadrant for drain or liver retractor. We used 5mm endoclips to tag the end of sutures and create a tunnel to pass the patch through it. Each suture end was tagged with either one, two or three clips, in order. The suture ends were held together to create a tunnel, where the omental patch was passed through that tunnel. Corresponding sutures end where identified easily by holding endoclips in order, then removed to allow the two ends to be tied without mixing the sutures. Furthermore, the endoclip tagging prevents suture looping around each other, minimizing wasted time, error and dislodging the stitches during identifying, correcting the looping and picking the corresponding ends. All patients had uneventful recovery, with assuring follow up. Conclusions Our novel technique of suture Coding with endolcips eliminated the confusion between the different suture threads and prevents looping and consequently improved the technique efficiency and prevent mistakes and loose ties

Surgical sealant using free pericardial fat pad with fibrin glue and polyglycolic acid sheets for secondary spontaneous pneumothorax: a novel technique.

We report on the "Triple-FP technique," a novel surgical approach for secondary spontaneous pneumothoraces, which combines a free pericardial fat pad, fibrin glue, and polyglycolic acid sheets. In our experience with 13 patients suffering from secondary spontaneous pneumothoraces, this method effectively prevented postoperative air leaks and re-operations. The technique includes the following steps: (1) harvesting free pericardial fat; (2) suturing around the lung parenchymal defect with the needles and thread left outside the thoracic cavity; (3) ensuring contact between the mediastinal pleural side of the fat and the lung; (4) applying fibrin glue to both the lung and fat before suturing; (5) securing the fat to the lung via the suture thread, reinforced with fibrin glue; and (6) stabilization with polyglycolic acid sheets and additional fibrin glue. This innovative technique is a reliable and effective treatment strategy for secondary spontaneous pneumothoraces, especially for patients with fragile lung tissue.

Evaluating and Comparing the Tensile Strength and Clinical Behavior of Monofilament Polyamide and Multifilament Silk Sutures: A Systematic Review

Objective: This systematic review was carried out with the primary objective of verifying which suture (polyamide or silk) of two non-resorbable suture materials with different structures had better/greater tensile strength/resistance to tension, thereby presenting better mechanical behavior. The secondary objective was to verify which one had better performance. The null hypothesis was that both types of sutures had the same behavior. Methods: This systematic study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The focused clinical question was: “In patients that underwent oral surgery treatment (P), is there significantly higher tensile strength/resistance for silk sutures (I) or for polyamide sutures (C) when comparing the outcomes (O)?”. The bibliographic search was conducted on ScienceDirect, B-On, and PubMed/MedLine between March and May 2023. The following MeSH terms were defined: sutures, breaking strength, tensile strength, oral surgery, and dentistry, which were articulated and combined using Boolean operators. There were restrictions, such as articles published in Portuguese, Spanish, or English between 1 January 2018 and 3 April 2023. The quality assessment involved the use of the Joanna Briggs Institute (JBI) checklist for RCTs and the QUIN tool (Quality Assessment Tool For In Vitro Studies) for in vitro assays. Results: Ten articles were included in this review (eight in vitro studies and two RCTs). For the RCTs, there were moderate and high levels of bias, whereas in the in vitro studies, three were classified as having a high risk of bias and five as moderate risk. The results proved that suture thread with a monofilament polyamide physical structure causes a less inflammatory reaction owing to less bacterial retention and capillarity, while multifilament sutures, such as silk, have superior mechanical characteristics. Regarding hydration, the evidence demonstrated that the preservation and stability of mechanical properties lacked uniformity. Otherwise, hyaluronic acid (HA) presents a promising solution with the same characteristics and antibacterial capabilities. Conclusion: It was possible to reject the null hypothesis that both types of sutures had the same behavior and result. It was proven by the results above that sutures with a monofilament polyamide physical structure cause a less inflammatory reaction owing to less bacterial retention and capillarity. In contrast, multifilament sutures (silk) have superior mechanical characteristics. Regarding hydration using chlorohexidine in surgical sites, the evidence demonstrated in the preservation and stability of mechanical properties lacks uniformity and congruence. However, HA seems to present a promising option with the same characteristics and antibacterial capabilities.

Fibrin Clot–Augmented Meniscal Repair

Background: Failure rate of meniscal repair can reach 25%. Multiple techniques have been used to increase meniscal healing, notably biological augmentation techniques. One of them is fibrin clot–augmented meniscal repair, which will be described in this video. Indications: This technique is indicated mainly for the lesions with a high failure rate. This includes large, horizontal, and radial tears and even for meniscal cysts, especially in a stable knee. This technique can also be used in revision meniscal suture when failure is no longer an option. Surgical Technique: Fibrin clot is prepared from sterile peripheral venous blood from the patient. A plastic syringe is used to stir the blood in a sterile glass container. The fibrin clot is then formed and washed rigorously with saline solution. Rolling the fibrin clot which is fixed to the syringe allows to give the fibrillar aspect of the clot. The formed fibrin clot is now solid enough to be manipulated and can be fixed to a vicryl suture thread allowing it to enter the knee and be fixed inside the meniscal lesion. The clot is wrapped inside the meniscal lesion with inside-out or outside-in suture technique. Results: We used this technique for multiple types of lesions, like bucket handle meniscal tear, horizontal meniscal cleavage, parrot beak tear, and even in lesions within white-white zone. The postoperative protocol is the same as standard inside-out meniscal repair. This technique has been used in the literature with promising results. Conclusion: The fibrin clot–augmented meniscal repair is a demanding but promising technique. We need further follow-up to confirm its effectiveness. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Motion sensor-based haptic master controller with finger band soft actuator for surgical robots

This paper presents a motion sensor-based haptic master controller capable of static and dynamic force presentation by the newly invented Finger Band Soft Actuator (FBSA). The master controller operates a surgical assist robot using the 6 degrees of freedom position and posture data tracked by an optical motion capture. The haptic force presentation can be realized by the pneumatic pressure of FBSA, which can be highly integrated into the controller mechanism to maintain precise manipulability. The FBSA can present a pressing force of 3.7 N for a small-sized finger and 5.1 N for a large-sized finger at an internal pressure of 60 kPa, and there is a monotonically increasing and decreasing relationship between the air pressure and the pressing force. The effectiveness of haptic force presentation by the FBSA was experimentally evaluated in the master-follower operation of a surgical assist robot. Ten subjects performed the task of pulling a suture thread and controlled the manipulation to achieve the directed tension. The experimental result shows that with the four levels of force presentation scheme by the FBSA, the error between suture tension and target operating force is significantly smaller than without force presentation.

Circumferential Cross-Stitch Suture for Longitudinal Lateral Meniscal Tear Around the Popliteal Tendon Hiatus Region

Lateral meniscal repair of the popliteal hiatus is technically demanding. The inside-out technique requires an additional incision and carries the risk of posterolateral soft tissue damage to the knee joint. In addition, the presence of the popliteal tendon limits the route of the suture thread. Within the current trend of the all-inside suture technique, meniscal suture-based all-inside repair demonstrates biomechanical advantages over anchor-based all-inside repair. We introduce a meniscal suture-based all-inside meniscal repair technique for longitudinal lateral meniscal tears.

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Repercussions of perineal repair using surgical glue or suture thread on postpartum outcomes: A controlled randomized clinical trial in São Paulo, Brazil.

The type of perineal repair can have significant long-term effects on various functions in a woman's postpartum life. The aim was to compare urinary incontinence (UI), women's satisfaction, pelvic floor muscle strength (PFMS), and sexual function according to the type of perineal repair (surgical glue or suture thread) during the first eight months after normal childbirth. A controlled randomized clinical trial of 133 primiparous women undergoing perineal repair during birth with surgical glue or sutures, evaluated during labor and monitored up to 8 months postpartum, from March 2017 to September 2018, in the city in São Paulo, Bazil. Descriptive and inferential analyses were carried out. A total of 133 women were included in the study, 111 (83.5%) were assessed between 10 to 20 days postpartum, 121 (91.0%) between 50 to 70 days, and 54 (40.6%) between 6 to 8 months. There were no significant differences for UI concerning the type of repair; however, there was a significant difference concerning the postpartum period (p=0.031), with a higher prevalence at two months. Most women reported satisfaction, with the highest levels reported two months after birth (p=0.019). For PFMS, the mean of the glue and suture groups were 32.4 cmH2O and 27.4 cmH2O, but not significant. Women in the glue group showed higher mean values in all sexual function domains but without significance. Surgical glue showed good aesthetic and functional results in the perineum at eight months postpartum.

Assessment of Mechanical Properties and Antimicrobial Effects of Hyaluronic Acid Coating on Absorbable Suture Material: An In-vitro Study

Introduction: The use of absorbable suture materials in surgical procedures is a critical aspect of wound closure and tissue repair. In recent years, there has been growing interest in exploring the potential benefits of incorporating Hyaluronic Acid (HA), a naturally occurring biopolymer, into these sutures. By shedding light on the interactions between HA and absorbable sutures, the present study seeks to provide valuable insights that could enhance the quality of surgical wound management. Aim: To assess the mechanical properties and antimicrobial effects of HA-coated and uncoated absorbable suture material. Materials and Methods: The in-vitro study was conducted at Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India in a year 2022. A total of 70 samples of HA-coated and uncoated Vicryl 4-0 suture material were tested for tensile strength using an Instron machine. An anti-bacterial effect against Pseudomonas aeruginosa and Streptococcus mutans was assessed using a Mueller Hinton agar (MHA) plate, and the zone of inhibition was measured. Additionally, both the uncoated and HA-coated Vicryl 4-0 suture materials were analysed under the Scanning Electron Microscope (SEM) to determine the surface characteristics. An independent t-test was used to compare the tensile strength of coated and uncoated suture materials. Results: The mean tensile strength of uncoated and HAcoated suture material was 6.47±0.23 MPa and 3.78±1.02 MPa, respectively. The difference between both groups was statistically significant (p<0.05). For Pseudomonas aeruginosa and Streptococcus mutans, the zone of inhibition was 8.0±0.5 mm in diameter and 9±0.5 mm in diameter, respectively, around coated Vicryl 4-0 suture material, whereas no zone of inhibition was observed for both Pseudomonas aeruginosa and Streptococcus mutans around uncoated suture material. SEM analysis showed superior surface characteristics of HA-coated suture thread when compared to uncoated suture thread. Conclusion: HA-coated suture material does not exhibit superior tensile strength when compared to the uncoated suture material. However, HA-coated suture material has potent antibacterial effects against Pseudomonas aeruginosa and Streptococcus mutans. Additionally, SEM analysis showed improved surface characteristics in favour of the coated suture material.

The choice of the most appropriate suture threads for pancreatic anastomoses on the basis their mechanical characteristics

The choice of the most appropriate suture threads for pancreatic anastomoses on the basis their mechanical characteristics

Facile roll-to-roll production of nanoporous fiber coatings for advanced wound care sutures.

Theranostic sutures are derived from innovative ideas to enhance wound healing results by adding wound diagnostics and therapeutics to typical sutures by functionalizing them with additional materials. Here, we present a new direct electrospinning method for the fast, continuous, inexpensive, and high-throughput production of versatile nanofibrous-coated suture threads, with precise control over various essential microstructural and physical characteristics. The thickness of the coating layer and the alignment of nanofibers with the thread's direction can be adjusted by the user by varying the spooling speed and the displacement between the spinneret needle and thread. To show the flexibility of our method for a range of different materials selected, gelatin, polycaprolactone, silk fibroin, and PEDOT:PSS (poly(3,4-ethylene dioxythiophene):poly(styrene sulfonate)) were the resultant nanofibers characterized by scanning electron microscopy (SEM) imaging and conductivity tests. In a series of in vitro and ex vivo tests (pig skin), sutures were successfully tested for their flexibility and mechanical properties when used as weaving and knotting sutures, and their biocompatibility with a keratinocyte cell line. For temperature-based drug-releasing tests, two fluorescent molecules as drug models with high and low molecular weight, namely fluorescein isothiocyanate-dextran (20 kDa) and rhodamine B (470 Da), were used, and their steady release with incremental increase of temperature to 37 °C over 120 min was seen, which is appropriate for bacterial treatment drugs. Given the advantages of the presented technique, it seems to have promising potential to be used in future medical applications for wound closure and bacterial infection treatment via a temperature-triggered drug release strategy.

Drug loading of bioresorbable suture threads by supercritical CO2 impregnation: a proof of concept for industrial scale-up

Supercritical CO2 (scCO2) impregnation emerged as a suitable technique to load thermosensitive drugs in polymeric devices thanks to mild process temperatures, the absence of toxic solvents and the easy removal of residual solvent through depressurization. This technique has been successfully tested at lab scale but few attempts to scale-up the process are reported. This work aims at filling this gap by performing a scCO2 impregnation at pilot scale of bioresorbable suture threads with ketoprofen. The process led to low drug loading values (0.2 – 0.8%) and to a very fast eluting rate, suggesting that they can be suitable when an immediate burst release is needed. Experiments were complemented by a multiscale mathematical modeling to better rationalize the outcomes. This work constitutes a proof of concept for a possible strategy to perform the scale-up of scCO2-assisted drug loading and highlighted some aspects to be addressed for future developments.

S-FIX: A sutured way of doing sutureless SFIOL surgeries beyond X-NIT!

The video describes a technique in scleral fixation intraocular lens (SFIOL) surgery that is very simple and easily reproducible by any novice surgeon. This technique may serve as a simple option for tucking the haptic of a multipiece IOL into the sclera without the need for the scleral flap, scleral pocket, forceps, glue, or flange. The two most crucial steps in scleral fixation intraocular lens (SFIOL) surgery are 1) the exteriorization of the haptic, and 2) the fixation of the exteriorized haptic. The first half of the video describes the steps of our previously published technique of extraocular needle-guided haptic insertion technique (X-NIT), which simplifies the exteriorization step by shifting the intraocular hand-shake maneuver to an extraocular site. The second half describes a novel suture-guided haptic fixation (S-FIX) device, which simplifies the fixation step. S-FIX has three components: 1) a 380-micron spatulated needle, 2) a 5-o nylon suture thread, and 3) a polyimide tube. There are four steps involved in S-FIX: 1) docking of the exteriorized haptic into the polyimide tube, 2) pushing the docked polyimide tube into the eye, 3) suture bite starting from the point of sclerotomy, and 4) pulling the suture thread. As the suture thread is being pulled, the haptic along with the polyimide tube comes out and the haptic gets fixed into the narrow suture track. The technique enhances the overall safety in SFIOL surgeries by avoiding haptic slips during exteriorization and fixation steps. Most anterior segment and novice surgeons do not perform SFIOL surgeries due to fear of fall of IOL. https://youtu.be/ZoJBiw2SNaU.

Drug-Eluting Sutures by Hot-Melt Extrusion: Current Trends and Future Potentials.

Surgical site infections (SSIs) may result from surgical procedures requiring a secondary administration of drugs at site or systemically in treating the infection. Drug-eluting sutures containing antimicrobial agents symbolise a latent strategy that precludes a secondary drug administration. It also offers the possibility of delivering a myriad of therapeutic agents to a localised wound site to effect analgesia, anti-inflammation, or the deployment of proteins useful for wound healing. Further, the use of biodegradable drug-eluting sutures eliminates the need for implanting foreign material into the wound, which needs to be removed after healing. In this review, we expound on recent trends in the manufacture of drug-eluting sutures with a focus on the hot-melt extrusion (HME) technique. HME provides a solvent-free, continuous one-step manufacturing conduit for drug-eluting sutures, hence, there is no drying step, which can be detrimental to the drug or suture threads and, thus, environmentally friendly. There is the possibility of combining the technology with additive manufacturing platforms to generate personalised drug-loaded implantable devices through prototyping and scalability. The review also highlights key material requirements for fabricating drug-eluting sutures by HME, as well as quality attributes. Finally, a preview of emerging drug-eluting sutures and advocacy for harmonisation of quality assurance by regulatory authorities that permits quality evaluation of novelty sutures is presented.

Complications Related To The Retention Of Impression Material In The Submucosa In Immediate Loading Dental Implants Rehabilitations - A Clinical Alert.

The increasing use of osseointegrated dental implants and modifications in surgical techniques has increased the number of unpredictable events during and after surgery. Complications are described as intercurrences in the course of the treatment and, when resolved, do not compromise the outcome. However, when unresolved, they lead to the failure of the rehabilitation. A new clinical complication that has arisen in cases of full arch immediate loading implants is the presence of impression material inside the tissues, that can cause dehiscence of the sutures, infection and severe postoperative pain. Therefore, a careful suture should be carried out using the correct suture thread and the correct positioning of the tip of the impression syringe so that the material is not inserted into the tissues. The aim of this short communication is to highlight the necessary care and alert colleagues to the signs and symptoms of this type of complication.

Способ фиксации капсулы хрусталика с внутрикапсульным кольцом в одной точке при децентрации ИОЛ в позднем послеоперационном периоде на фоне псевдоэксфолиативного синдрома

Purpose. To assess the clinical effectiveness of the method of fixing the lens capsule with an intracapsular ring at one point in IOL decentration in the late postoperative period against the background of pseudoexfoliative syndrome (PES). Methods. Patient A., 71 years old. He was admitted with a diagnosis of OD – pseudophakia, decentration of the IOL, PES; OS – artifakia, PES. In the anamnesis: 5 years ago, cataract phacoemulsification with intracapsular ring and IOL implantation in the right eye. Examination: visometry, perimetry, autorefractometry, pneumotonometry. In order to center the IOL at the OD, ab interno fixation of the lens capsule with the intracapsular ring was performed to the sclera at one point in the region of the ciliary sulcus using a suture needle with a double thread and a guide needle. The suture thread on the intracapsular ring was fixed with a «cow hitch». Results. On the 2nd day after surgery, visual acuity without correction was 0.7. On examination, the right eye is calm, the cornea is transparent, the anterior chamber is of medium depth, the moisture of the anterior chamber is transparent, the pupil is round 3 mm, centered, the IOL is in the correct position. Visual acuity did not change throughout the entire period of observation, intraocular pressure remained compensated for the entire period of observation of the patient. Conclusion. This example demonstrates the feasibility of using an intracapsular ring during phacoemulsification against the background of PES and the clinical effectiveness of the method of fixing the lens capsule with an intracapsular ring at one point in IOL decentration in the late postoperative period. Key words: intracapsular ring, pseudoexfoliative syndrome, «cow hitch»

Comparison of the Effects of Using Nylon Sutures versus Vicryl Sutures on Inflammation after Pterygium Surgery

Introduction: Until now, many surgical sutures have been used for pterygium surgery, but it has not yet been determined which suture thread is preferable for pterygium surgery. In this study, we compared the results of using two surgical sutures, Nylon and Vicryl.
 Methods: This study was conducted as a Randomized Clinical Trial (RCT) at Shahid Sadoughi Hospital. Seventy patients who were referred and met the criteria for pterygium surgery were assigned to two groups, A and B, each consisting of 35 individuals. Group A utilized the Nylon sutures while Group B utilized the Vicryl sutures. The examinations were performed in terms of study variables according to a questionnaire pre-determined by an ophthalmologist's assistant on the 1st day, 7th day, 4th, and 8th week after operation. The collected data were entered into STATA14 software and considering the qualitative nature of most dependent variables, the collected data were analyzed using Chi-square test.
 Results: According to all the obtained results, it could be concluded that a certain sutures could not be chosen especially better than other suture, because each one had its own advantages and disadvantages. But on a case-by-case basis, Vicryl suture could be recommended for patients who had come to the hospital from far away cities because it did not need to be pulled by the doctor and it created the feeling of the presence of a foreign body in the patient's eye, because it reduced the need to return to the hospital.
 Conclusion: In this study, we compared vicryl and nylon sutures in pterygium surgery, and for the first time among other similar studies, we investigated the rate of knot untying of the sutures, and came to the conclusion that each of the nylon sutures and Vicryl has its advantages and disadvantages, but due to the fact that in the Vicryl thread group, the presence of a body was felt less and it did not need to be pulled, we recommended it for the patients visiting from distant cities. It is suggested to compare vicryl and silk sutures in order to find the most suitable suture for pterygoid surgery.

Vascular Repair for Iatrogenic Injury during Microsurgical Procedures: Clinical Investigation and Review of 18 Cases at a Single Institution.

Intracranial vascular injury (VI) due to surgery is a critical complication that can lead to serious neurologic deficits. To our knowledge, only a few review articles on VI during an operation have been published so far. We retrospectively investigated the type, cause, and measurement of VI during surgery at our institution. Unexpected VI cases occurred in 18 of 2,228 craniotomy procedures, including 794 aneurysm clippings and 357 tumor resections. We investigated the causes and coping techniques of the VI cases, as well as their full details. There were six cases of aneurysm neck tear, one case of sylvian vein injury, and one case of superior trunk perforation during direct clipping. Regarding tumor resection procedures, nine cases of arterial injury and one case of cortical vein injury were extracted. Almost all VIs were caused by carelessness or basic manipulation mistakes. We repaired all these cases with simple placement of suture threads with or without pinch clips, flow alteration using bypass techniques, and in 16 cases no neurologic deficit or deterioration on imaging occurred; however, 3 patients were verified to have ischemic changes on postoperative imaging. Most VIs were directly caused by a simple error and carelessness of an operator or an assistant. Many of these injuries can be avoided if a basic set of rules are followed and remembered during the surgical procedure. However, the surgical procedure involves human work, and errors cannot be eradicated even upon maximum concentration levels. Neurosurgeons should be prepared for an eventual quick repair of an unexpected cerebral VI.

The choice of the most appropriate suture threads for pancreatic anastomoses on the basis of their mechanical characteristics

The choice of the most appropriate suture threads for pancreatic anastomoses on the basis of their mechanical characteristics

Double-Layered Hand-Sewn versus Stapled Intestinal Anastomosis in Patients Who Underwent Ileal Urinary Diversion in Radical Cystectomy: A Comparative and Cost Effective Study

Introduction: Intestinal anastomosis can be performed by hand suturing (single layer or double layer) or by a mechanical suturing machine. The aim of the study was to compare complications, operative time, and costs of the intestinal anastomosis techniques. Methods: A retrospective comparative study was conducted including patients who underwent radical cystectomy and uretero-ileo-cutaneostomy or vescica ileale Padovana orthotopic neobladder. Double-layered hand-sewn intestinal anastomosis (HS-IA) were performed using Vicryl stitches. Mechanical-stapled intestinal anastomosis (MS-IA) were performed with a mechanical stapler. Results: Data of 195 patients who underwent were collected. 100 (51.3%) patients underwent HS-IA and 95 (48.7%) patients underwent MS-IA. Considering the complications classified according to Clavien-Dindo, a statistical difference with higher incidence for grade one in the HS-IA both in the ileal conduit group and in the neobladder one than the MS-IA (15.8% and 8.7%, respectively, in HS-IA vs. 1.7% and none in MS-IA). There is not a significant difference in time to flatus and time to defecation. Difference is recorded in the ileal conduit groups for the length of stay (10 days, range 9–12 with HS-IA vs. 13 days range 12–16 days with MS-IA (p < 0.001). The cost of the suture thread used for a single operation was 0.40 euros, whereas the overall cost of a disposable mechanical stapler and one refill was 350.00 €. Conclusion: Both HS-IA and MS-IA are safe and effective for patients. The cost for the stapling device is 350 €, in contrast, the cost for Vicryl sutures is negligible.