Suture Thread Research Articles

Uniform straw-like cell architecture for three-dimensional cell-cell communication assay.

EB: embryoid body; 2D: two-dimension; 3D: three-dimension; PBS: phosphate buffered saline.

Optimization of the knot configuration for early accelerated rehabilitation after Achilles tendon rupture

Background Panda Rope Bridge Technique (PRBT) was an new minimally invasive technique consisted of two bridge anchors (proximal anchors at calcaneus and distal anchors at myotendinous junction) and strong ropes (threads of the suture anchors) stretched between them, which was suitable for early accelerated rehabilitation of Achilles tendon rupture. However, the optimal knot configuration with PRBT was unknow. The purpose of this study was identify minimum number of half hitches necessary to maintain knot security for PRBT.Methods Using an Instron device we tested the effect of different knot configuration in two kinds of suture threads (Ethibond™ #5 and Ultrabraid™ #2). According to the result of it, we put the optimal knot configuration into Part 1 with PRBT test model and Part 2 with modified PRBT test model, to evaluate whether the optimal knot configuration could complete the cyclic loading test simulated early rehabilitation.Findings In the first part of the study, the optimal knot configuration of Ethibond™ #5 suture thread was the combination of three half hitches and one double throw half knot, and the optimal knot configuration of Ultrabraid™ #2 suture thread was the combination of five half hitches and one double throw half knot. In the second part of the study, only Ultrabraid™ #2 suture thread with optimal knot configuration had finished all test in Part 1.Interpretation The Ultrabraid™ #2 suture thread with optimal knot configuration was suitable for PRBT with early accelerated rehabilitation after Achilles tendon repair.

Home Program for Acquisition and Maintenance of Microsurgical Skills During the Coronavirus Disease 2019 Outbreak

BackgroundDuring the current global crisis unleashed by the severe acute respiratory syndrome coronavirus 2 outbreak, surgical departments have considerably reduced the amount of elective surgeries. This decrease leads to less time in the surgical room to develop and improve the surgical skills of residents. In this study, we developed a training program to obtain and maintain microsurgical skills at home, using a smartphone camera and low-cost materials, affordable for everyone.MethodsUsing a smartphone camera as a magnification device, 6 participants performed 5 exercises (coloring grids, grouping colors, unraveling of a gauze, knots with suture threads, and tower of Hanoi), both with the dominant and with the nondominant hand, for 4 weeks. We compared performance at the beginning and at the end of the training process. Each participant filled out an anonymous survey.ResultsWhen we compared the performance at the beginning and at the end of the training process, we found significant improvements (P = 0.05) with the dominant as well as the nondominant hand in all the exercises. All participants were satisfied or very satisfied with the definition of the objectives of the training process, material availability, the exercises performed, the choice of the time to train, and general satisfaction with the training program.ConclusionsWe developed a microsurgical skills training program to be performed at home, which can be easily reproduced. It allows residents to improve manual coordination skills and is regarded as a feasible adjunct for ongoing training for surgical residents.

Histological Inflammation in Human Ureter either Healthy or Fitted with Double-Pigtail Stent or a Thin 0.3 F Suture Thread: A Preliminary Study.

Background Ureteral stent intolerance reduces patients' quality of life. It has been suggested that changes in the shape of stents could decrease discomfort. In previous studies, the innovative pigtail-suture stent (i.e., JFil® or MiniJFil®) with a thin 0.3 F suture thread significantly decreased stent-related symptoms. Fortuitously, a dilation of the ureter containing the sutures was discovered. In addition, no inflammation was seen on the ureter wall around the suture in endoscopy. In this preliminary study, we assessed ureteral inflammation in the human ureter when it was healthy or when fitted with a double-pigtail stent or a thread. Materials and Methods After consent and inclusion of patients in the protocol, fifteen segments of ureters were collected during cystectomy procedures for bladder tumors. Ureteral inflammation was assessed on the histological section stained with hematoxylin-eosin. Histological grading (cumulative range of 0 to 6) assessing inflammation was performed on the ureter section for mucosa inflammation and inflammation in the muscle layer. Results A marked ureteral inflammatory reaction was observed in all cases of ureters fitted with a double-pigtail stent with a mean inflammation score of 4.8 ± 0.4. The ureter fitted with the thin suture thread showed inflammation in only one case with a mean inflammation score of 1.8 ± 1.3 (p=0.001). Conclusion Although the study was limited by the small number of patients, it confirmed that the double-pigtail stent induced ureteral inflammation in all cases and the thin 0.3 F suture thread caused less ureteral inflammation than the double-pigtail stent. The concept of material reduction within the urinary tract seems necessary in order to decrease mucosal irritation. The JFil® or the MiniJFil® thread could meet this requirement.

The Role of Bacterial Colonization of the Suture Thread in Early Identification and Targeted Antibiotic Treatment of Surgical Site Infections: A Prospective Cohort Study.

Background: The aim of the present study is to investigate the role of the colonization of suture thread to identify patients at risk of developing a surgical site infection (SSI) after clean surgical procedures. Methods: Patients who underwent elective clean surgery procedures at the Surgery Unit of the AOU-University of Campania Luigi Vanvitelli in a 21-month period were prospectively enrolled. For each patient, a synthetic absorbable thread in Lactomer 9-1 was inserted into the surgical site at the end of surgery and microbiologically evaluated after 48 h. Antibiotic prophylaxis was chosen according to international guidelines. Results: A total of 238 patients were enrolled; 208 (87.4%) of them were subjected to clean procedures without the placement of prosthesis, and 30 (12.6%) with prosthesis. Of the 238 patients, 117 (49.2%) underwent an antimicrobial prophylaxis. Overall, 79 (33.2%) patients showed a bacterial colonization of the thread: among the 208 without the implantation of prosthesis, 19 (21.8%) of the 87 with antibiotic prophylaxis and in 58 (47.9%) of the 121 without it; among the 30 patients with the implantation of prosthesis, only two patients showed a colonized thread. The patients with antibiotic prophylaxis developed a colonization of the thread less frequently than those without it (17.9% vs. 47.9%, p < 0.001). SSI was observed in six (2.5%) patients, all of them showing a colonized thread (7.6% vs. 0%, p < 0.001). The bacteria identified in colonized threads were the same as those found in SSIs. Conclusions: Our study presents a new method that is able to precociously assess patients who have undergone clean procedures who may develop SSI, and identify the microorganism involved.

Effect of antiseptic gels in the microbiologic colonization of the suture threads after oral surgery

Three different bioadhesive gels were evaluated in a double-blind randomized clinical trial in which microbial growth in the suture thread was assessed following post-surgical application of the aforementioned gels. Also assessed in this trial were, the intensity of post-surgical pain as well as the degree of healing of the patients’ surgical wounds. A total of 21 patients (with 42 wisdom teeth) participated in this trial. Chlorhexidine gel, chlorhexidine-chitosan gel, and hyaluronic acid gel were evaluated, with a neutral water-based gel serving as the control agent. The aerobic and facultative anaerobic bacterial recovery on blood agar was lower in the placebo group than in the experimental groups. The most significant difference (p = 0.04) was observed in the chlorhexidine-chitosan group. in which the growth of Blood Agar and Mitis Salivarius Agar was significantly higher than in the placebo group. The intensity of post-surgical pain was very similar among all the groups. Significantly better healing rates were observed in the patients treated with chlorhexidine-chitosan gel when compared with those who used the placebo gel (p = 0.03), and in particular when compared with those patients who used hyaluronic acid gel (p = 0.01). Through our microbiological analyses, we were able to conclude that none of the bioadhesive gels tested resulted in beneficial reductions in the bacterial/fungal populations. However, the healing rates of patients who were treated with chlorhexidine-chitosan were better than those of the patients who used either the placebo gel or the hyaluronic acid gel.

Pain, healing and satisfaction of women after perineal repair with surgical glue and suture.

To compare the intensity of pain, the healing process and women's satisfaction with the repair of perineal trauma during vaginal delivery using surgical glue or suture. Cross-sectional study aligned with a clinical trial conducted at a maternity in Itapecerica da Serra, São Paulo. The sample consisted of women who were evaluated between 10 and 20 days after delivery. The outcomes were analyzed according to the distribution of women in the experimental group (EG: perineal repair with Glubran-2® surgical glue; n=55) and in the control group (CG: perineal repair with Vicryl® suture thread; n=55). 110 puerperal women were evaluated. There was no difference between EG and CG regarding sociodemographic and clinical-obstetric characteristics. The intensity of perineal pain, assessed by the visual numeric scale was lower among women in the EG compared to the CG (p<0.001). According to the REEDA scale, there was no significant difference in perineal healing (p=0.267) between EG and CG. The satisfaction of women with perineal repair, assessed using a five-point scale, was higher with the use of surgical glue (p=0.035). Surgical glue showed advantages in relation to perineal pain and greater satisfaction for women compared to the use of suture. The healing process was similar for both types of repair.

Using Hypodermic Needle as Suture Needle in Emergency.

Sometimes, suture thread detaches from needle while suturing. This leads to wastage of left over thread and we have to repeat whole process of suturing as the extra suture needles are not easily available. The present article highlights the use of hypodermic needle as suture needle in such emergencies.

In Reply to the Letter to the Editor Regarding “Place-and-Clip Method for Fixing the Suture Thread in Deep-Brain Vascular Lesions: A Technical Case Report”

In Reply to the Letter to the Editor Regarding “Place-and-Clip Method for Fixing the Suture Thread in Deep-Brain Vascular Lesions: A Technical Case Report”

Letter to the Editor Regarding “Place-and-Clip Method for Fixing the Suture Thread in Deep-Brain Vascular Lesions: A Technical Case Report”

Letter to the Editor Regarding “Place-and-Clip Method for Fixing the Suture Thread in Deep-Brain Vascular Lesions: A Technical Case Report”

A Learning Approach for Suture Thread Detection With Feature Enhancement and Segmentation for 3-D Shape Reconstruction

A vision-based system presents one of the most reliable methods for achieving an automated robot-assisted manipulation associated with surgical knot tying. However, some challenges in suture thread detection and automated suture thread grasping significantly hinder the realization of a fully automated surgical knot tying. In this article, we propose a novel algorithm that can be used for computing the 3-D coordinates of a suture thread in knot tying. After proper training with our data set, we built a deep-learning model for accurately locating the suture's tip. By applying a Hessian-based filter with multiscale parameters, the environmental noises can be eliminated while preserving the suture thread information. A multistencils fast marching method was then employed to segment the suture thread, and a precise stereomatching algorithm was implemented to compute the 3-D coordinates of this thread. Experiments associated with the precision of the deep-learning model, the robustness of the 2-D segmentation approach, and the overall accuracy of 3-D coordinate computation of the suture thread were conducted in various scenarios, and the results quantitatively validate the feasibility and reliability of the entire scheme for automated 3-D shape reconstruction.

A Perspective on Polylactic Acid-Based Polymers Use for Nanoparticles Synthesis and Applications.

Polylactic acid (PLA)—based polymers are ubiquitous in the biomedical field thanks to their combination of attractive peculiarities: biocompatibility (degradation products do not elicit critical responses and are easily metabolized by the body), hydrolytic degradation in situ, tailorable properties, and well-established processing technologies. This led to the development of several applications, such as bone fixation screws, bioresorbable suture threads, and stent coating, just to name a few. Nanomedicine could not be unconcerned by PLA-based materials as well, where their use for the synthesis of nanocarriers for the targeted delivery of hydrophobic drugs emerged as a new promising application. The purpose of the here presented review is two-fold: on one side, it aims at providing a broad overview of PLA-based materials and their properties, which allow them gaining a leading role in the biomedical field; on the other side, it offers a specific focus on their recent use in nanomedicine, highlighting opportunities and perspectives.

Diabetes mellitus and periodontitis: Inflammatory response in orthodontic tooth movement.

This study evaluated, in experimental model, the inflammatory alterations in gingival tissue and alveolar bone during the orthodontic tooth movement (OTM) in diabetes mellitus (D) and periodontitis (P). Forty male Wistar rats, 90days old and weighing 300g. The sample was divided into four groups (n=10). OTM: orthodontic movement (10days, 0.4N force); P+OTM: periodontitis (ligature-induced periodontitis, 3-0 silk suture thread) and orthodontic movement; D+OTM: diabetes (Alloxan-induced diabetes, 150mg/kg) and orthodontic movement; and D+P+OTM: diabetes, periodontitis and orthodontic movement. Tooth displacement was measured; fibroblast, inflammatory cells, osteoclast and blood vessels were quantified by histomorphometric analysis. Inflammatory markers, interleukin-6 (IL-6) and tumour necrosis factor (TNF-α) were quantified by ELISA(Enzyme-Linked Immunosorbent Assay) in gingival tissue. The fibroblastic growth factor (bFGF), transforming growth factor (TGF-β1) and the vascular endothelial growth factor (VEGF) were measured via Western blotting in the alveolar bone. The results were analysed by ANOVA and Tukey's test at a 5% significance level. The quantification of inflammatory cells and the expression of IL-6, TNF-α, TGF-β1 and bFGF were increased in diabetes and periodontitis. However, the number of fibroblasts and blood vessels and the percentage of birefringent collagen fibres were higher in healthy animals. There was greater tooth displacement in the OTM group. Diabetes Mellitus modifies the inflammatory response. The increased expression of inflammatory markers IL-6, TNF-α and TGF-β1 in diabetic animals impairs neovasculogenesis and tissue reorganization during orthodontic tooth movement, which may be aggravated by periodontitis.

Surgical Suture Thread Detection and 3-D Reconstruction Using a Model-Free Approach in a Calibrated Stereo Visual System

In robot-assisted surgery (RAS), three-dimensional (3-D) position estimation of a surgical suture thread is essential in automating the wound suturing procedure. Nevertheless, accurate suture thread’s segmentation and its 3-D coordinates reconstruction remain challenging because of its flexible property and lacking indistinctive feature points. In this paper, a novel model-free method is proposed to enable the 3-D computation of a suture thread through a calibrated stereo camera system. In this method, only the suture thread’s tip and grasping points need to be indicated on one image with mouse clicks, and their accurate image positions can be detected using computed contour information. Afterward, key points that represent the suture thread are generated on one image, while their matched points on the second camera frame are evaluated through an iterative algorithm for 3-D model reconstruction. Experiments using different backgrounds and environmental conditions were conducted to examine the accuracy and robustness of the 2-D segmentation. The suture threads were then formed in various 3-D shapes, and their respective 3-D models were reconstructed for comparison. The experimental results confirm the feasibility of our method in reducing human intervention in the detection of matched key points on an image pair, thereby guaranteeing an accurate 3-D coordinates computation of a suture thread.

AT1 receptor antagonism promotes bone loss attenuation in experimental periodontitis, blocks inflammatory mediators, and upregulates antioxidant enzymes and bone formation markers.

The initiation and progression of periodontitis might involve a local renin-angiotensin system in periodontal tissue. This study hypothesized that Losartan treatment could promote protection to rats submitted to experimental periodontitis (EP) by attenuating alveolar bone loss due to reduction in inflammatory cytokines, better reactive oxidant species regulation and maintenance of the balance between bone formation and resorption factors. One hundred and thirty rats were submitted to EP with a silk suture thread (4.0) placed around the lower right first molar for 1, 3, 7, and 14 consecutive days. The study comprised four groups: G1-control without EP; G2-animals with EP treated with water; G3-Losartan-treated animals (treatment started at the same day of EP induction), and G4-animals previously treated with Losartan for 30 days followed by induction of EP and continuity of treatment. G2 rats had greater bone loss volume, increased number, and thickness and decreased separation of trabeculae. On the other hand, G4 animals showed significant improvements in these parameters. Histological analysis revealed that EP favors inflammatory cell infiltration and junctional epithelium, cementum with alveolar bone crest destruction, but animals pretreated with Losartan (G4) did not show these features. Although the G3 animals did not demonstrate the improvements detected in G4, mRNA expression results were similar. In mandibular tissue, EP promoted mRNA increases for ACE, AT1 receptor, and inflammatory mediators as well as decreases for antioxidant enzymes. However, Losartan treatments attenuated these responses in addition to promoting an increase in bone formation markers and transcription factors. AT1 receptor modulates EP progression.

Biomechanical comparison study of two ultra-strong sutures in repair of Achilles tendon via panda rope bridge technique

To compare the biomechanical properties of two ultra-strong sutures and suturing methods in panda rope bridge technique (PRBT) application, and provide guidance for clinical selection of suture threads and suture methods. Forty Achilles tendons from bulls were randomly divided into 4 groups ( n=10) and transected at the 4 cm proximal to the tendon insertion. Groups A and B used Ethibond sutures (USP 5), the proximal end was fixed at the myotendious junction with Krackow sutures and the distal end was fixed through a calcaneus canal. Groups A and B had 4 and 8 threads through the stump plane, respectively. Groups C and D used Ultrabraid sutures (USP 2), the proximal end was fixed at the myotendious junction with Krackow sutures and the distal end was fixed in the calcaneus with two anchors. Groups C and D had 4 and 8 threads through the stump plane, respectively. The dynamic tensile forces of 20-100, 20-200, 20-300, and 20-400 N were tested respectively by using a dynamic tensile testing machine at 0.5 Hz for 250 cycles. After each stage of testing, the gap between stumps was measured with a caliper and the type of suture failure was recorded. After dynamic tensile forces of 20-100 N and 20-200 N, the gaps of the four groups arranged from small to large were groups D, B, C, and A. The differences between groups A and B and groups C and D were significant ( P<0.05). But after dynamic tensile forces of 20-300 N and 20-400 N, the gaps were more than 5 mm in all groups. The suture retention rates of the four groups after dynamic tensile forces of 20-100 N and 20-200 N were all 100%. The suture retention rates of groups A, B, C, and D were 0, 80%, 60%, and 100%, respectively after dynamic tensile forces of 20-300 N. The differences of suture retention rates between group A and groups B and D were significant ( P<0.05). There was no significant difference between groups B, C, and D ( P>0.05). After dynamic tensile forces of 20-400 N, the suture retention rates of groups A, B, C, and D were 0, 50%, 0, and 70%, respectively. There were significant differences between groups A and B and groups C and D ( P<0.05). Repairing Achilles tendon rupture via PRBT with 8 ultra-strong sutures through the stump plane can meet the mechanical requirements for walking by using ankle boots and heel pads in the early accelerated rehabilitation after operation.

Theoretical Investigation of Design Space for Multi Layer Drug Eluting Bioresorbable Suture Threads.

The work presented here is focused on the development of a comprehensive theoretical model for the description of drug release from a double - layer bioresorbable suture thread and the therapeutic efficacy of the active compounds delivered in the surrounding tissue. In particular, the system under investigation is composed of a core of slow-degrading polylactic- acid-co-ε-caprolactone (PLCL), where an antibiotic compound (Vancomycin) is loaded, surrounded by a shell of a fast-degrading polylactic-co-glycolic acid (PLGA) which contains an anesthetic drug (Lidocaine hydrochloride) for the post-surgical pain relief. This system is of potential interest for the combined effects provided by the different active molecules, but the different release and polymer degradation dynamics, as well as their mutual influence, do not allow an intuitive a priori evaluation of device behavior, which can be rationalized through mathematical modeling. The model takes into account the main involved phenomena (polymer degradation and diffusion of the drugs within the device and the tissue, where they are metabolized) and their synergic effects on the overall system behavior. Model results are discussed in order to quantify the impact of the main design parameters on device performances, thanks to the use of phase diagrams (which show drug effect in time and space) whose insights are summarized in order to determine a design space according to the specific needs.

Biodegradable suture threads as controlled drug delivery systems

ABSTRACTChitosan yarns, which could be used as surgical suture threads that potentiate the healing process by releasing N-acetyl-D-glucosamine (GlcNAc), were developed using the wet spinning method. Scanning electron microscopy and mechanical traction tests were performed, followed by biodegradation and in vitro release tests. Morphologically, the yarns were cylindrical and well defined. During tensile tests, a decrease in the mechanical properties of the wires was observed owing to the addition of GlcNAc; however, the mechanical properties remained consistent with the specifications of the US Pharmacopeia. It was also determined that GlcNAc accelerated the degradation process of chitosan. The release of GlcNAc occurred slowly during the first 14 days of the in vitro release tests, and more rapidly thereafter. Thus, this study indicated that the wet spinning technique was effective for obtaining chitosan suture threads, which could be promising controlled drug delivery systems.

Place-and-Clip Method for Fixing the Suture Thread in Deep-Brain Vascular Lesions: A Technical Case Report

Intracranial vascular injury incurred during surgery must be repaired as quickly as possible. The standard repair procedure is surgical suturing. However, the narrow and deep working space may obstruct creating a knot with the suture thread. Resection of an olfactory groove meningioma was performed in a 73-year-old woman via the right lateral supraorbital approach. Tumor retraction caused an injury to the pericallosal artery. After temporary clipping of the vessel, a 10-0 nylon thread was placed on the vascular lesion and the end of the thread was fixed with an aneurysm clip. Fixing the suture thread with an aneurysm clip can be a rescue technique in suturing procedures on deeply located vascular lesions.

Exploring platelet lysate hydrogel-coated suture threads as biofunctional composite living fibers for cell delivery in tissue repair

To engineer functional tissue substitutes, it is required a multi-component, multi-scale approach that combines both physical, chemical and biological cues. Fiber-based techniques have been explored in the field of tissue engineering to produce structures recapitulating tissue architecture and mechanical properties. In this work, we engineered biofunctional composite living fibers (CLF) as multi-compartment fibers with a mechanically competent core and a hydrogel layer. For this purpose, commercial silk suture threads were coated with a platelet lysate (PL) hydrogel by first embedding the threads in a thrombin solution and then incubating in PL. The fabrication set-up was optimized and the biological performance was studied by encapsulating human adipose-derived stem cells (hASCs). The developed coating process rendered CLF with a homogenous PL hydrogel layer covering suture threads. Encapsulated hASCs were viable up to 14 d in culture and were able to align at the surface of the core fiber and deposit collagen types I and III. In summary, the study shows that PL–hASCs hydrogel coated suture threads represent a simple multi-compartment and multifunctional system, with PL hydrogel offering biofunctionality to guide the biological activities of encapsulated cells in addition to the replication of tissue-level mechanical support provided by the suture threads.