Wire Suture Research Articles

Is the Abramson technique effective in pectus carinatum repair?

The minimally invasive pectus carinatum (PC) surgery described by Abramson has been performed in many centers. We have been using this technique since 2011. This article describes our experience with PC correction. Between 2011 and 2016, 32 patients at our institution underwent minimally invasive repair of a PC deformity. All patients presented with cosmetic complaints. The deformity involved the lower sternum (all had chondrogladiolar type PC), and three patients had asymmetrical deformities. All operations followed the principles defined by Abramson. Satisfactory esthetic results were achieved in our patients. The hospital stay averaged 5.3 days (range 4-7 days). The most common early complication was pneumothorax, and the most common late complication was wire suture breakage. The Abramson technique is an effective, minimally invasive procedure for PC with shorter operating and hospitalization times and low morbidity rates.

Larynx Trauma and Hyoid Bone Fracture after Bite Injury in Dog: Case Report

An 8-year-old male Jack Russell crossbreed dog was admitted to our hospital with dyspnea and shock following a dog-bite injury on the ventral neck. Radiographs revealed subcutaneous emphysema and bilateral thyrohyoid bone fractures. Intraoperatively, rupture of both sternohyoid muscles, both hyoepiglotticus muscles, both thyrohyoid muscles, and a partial cranial rupture of the superficial sphincter colli muscle were detected. Part of the epiglottis was detached from the thyroid cartilage. The patient’s severed muscles and torn epiglottis were reattached using a simple interrupted suture pattern. Hyoepiglotticus muscles could not be identified. The bilateral thyrohyoid bone fractures were repaired with intraosseous wire suture. A temporary tracheostomy tube and an esophageal feeding tube were placed postoperatively. The dog was discharged after 8 days, re-examined at 2 and 6 months and laryngeal and pharyngeal function were evaluated as normal. To the authors’ knowledge, this is the first report of a dog that presented with laryngeal trauma with hyoid bone fracture and acute dyspnea that underwent surgical treatment resulting in an acceptable outcome.

Os acromiale fixation: a biomechanical comparison of polyethylene suture versus stainless steel wire tension band

Symptomatic hardware is a commonly reported complication after surgical fixation of an unstable meso-type os acromiale. This study compared the biomechanical properties of a cannulated screw tension band construct using a metal wire tension band vs. a suture tension band, considering that the suture construct could allow for decreased hardware burden in the clinical setting. A meso-type os acromiale was created in 16 cadaveric shoulders. Two cannulated 4-mm screws were placed in each specimen. Tension band augmentation was accomplished with a 1-mm stainless steel wire (wire group) or a #5 braided polyethylene suture (suture group), with 8 specimens in each group. An inferiorly directed force was applied to the anterior acromion at 1 mm/s on a materials testing machine. Stiffness and ultimate failure load were recorded and analyzed. No significant difference (P = .22) was observed in the ultimate failure load between the wire (228 ± 85 N; range, 114-397 N) and the suture (275 ± 139 N; range, 112-530 N). No significant difference (P = .17) was observed in the stiffness between the wire (28 ± 12 N/mm; range, 18-53 N/mm) and the suture (38 ± 25 N/mm; range, 10-83 N/mm). Stainless steel wire and polyethylene suture have similar biomechanical strength in the cannulated screw tension band fixation of meso-type os acromiale at time zero.

Minimally invasive repair of pectus carinatum and how to deal with complications.

While less common than pectus excavatum, pectus carinatum is also a chest wall deformity affecting males in higher proportion than women. Patient requests for a solution of this disease occur especially during the growth spurt of puberty when this malformation becomes more obvious and difficult to conceal. Those people suffering from pectus carinatum are very likely subject to behavioral changes and negative personality impacts. By compressing the protruding anterior region of the chest wall we achieve correction of the chest contour and simultaneous lateral expansion of the depressed costochondral arches. This original technique and the procedure to apply it fit within the category of minimally invasive surgery. The compression system acts in a way similar to that of orthodontic braces. Two rectangular fixation plates are fixed to the compression strut with screws. The plates have threaded holes along a groove in the central portion, and two holes at both ends used to attach them to the ribs by means of steel wire suture. The compression strut has to be modified into a convex shape to adapt it to the particular characteristics of the patient's malformation. This molding is done using benders designed as part of the procedure.

Perspectives of the use of commissure in patients with oblique fractures of the lower jaw

There was carried out an analysis of the results of treatment of 34 patients with oblique fractures of the lower jaw by the method of commissure osteosynthesis that was elaborated by the authors.Aim: to increase the effectiveness of treatment of patients with oblique fractures of the lower jaw at the expense of optimization of commissure osteosynthesis.Methods: there was carried out examination and operative treatment of 34 patients with oblique fractures of lower jaw of the different localization. In the area of the lower jaw angle – 19 (55,88 %) patients, in the area of the lower jaw body – 12 (35,29 %) persons, the number of patients with fractures of the neck with dislocation of the head of lower jaw was 3 (8,83 %). All patients were the persons of male sex 32–55 years old. The operative treatment was consisted in commissure osteosynthesis according to the method elaborated by the authors.Results: there were not observed any complication in operated patients during postoperative period. There were not observed the secondary displacement of splinters or inflammatory complications. The consolidation of splinters was clinically observed on 21 day after operation. In remote terms (3 month after osteosynthesis) patients have no complaints the disorders of dental occlusion did not take place.Conclusions: An offered method of osteosynthesis with wire suture allows:1. Eliminate the horizontal displacement of splinters;2. Eliminate the shortening of the jaw arch and the deviation of occlusion with deformation of the patient’s face;3. Raise the stability of osteosynthesis.The remote results testify the high effectiveness of the method that allows recommend it for the wide use in clinical practice

Management of post-sternotomy mediastinitis in cardiac patients

Post-sternotomy mediastinitis is a severe complication of cardiac surgery and accompanied by high mortality and cost of treatment. To date, there are no large clinical trials defining treatment of these patients. In this study the authors offer early postoperative wound sanitation, use of vacuum drainage in all cases and surgical repair with local tissues. Sternal destruction is cured by osteosynthesis with wire sutures and perforated metal plates. Proposed algorithm showed low incidence of reccurent wound infection, mortality and duration of treatment.

Reduction in deep sternal wound infection with use of a peristernal cable-tie closure system: a retrospective case series.

BackgroundDeep sternal wound infections are a rare but serious complication after median sternotomy. We evaluated the incidence of deep sternal wound infection associated with two techniques for sternal closure.MethodsIn this retrospective case series, we recorded the method of sternal closure in consecutive patients undergoing a variety of cardiothoracic surgical procedures. Sternal closure in the historical control group was performed using trans-sternal, stainless-steel wire sutures; subsequent patients were closed using wire sutures in conjunction with a novel, peristernal cable-tie closure system to reinforce the corpus sterni. Perioperative care was standardized between groups. Demographics, risk factors, and postoperative outcomes were analyzed.ResultsBetween July 2010 and July 2014, 609 consecutive adult patients underwent sternal closure following open median sternotomy at a single hospital in Mobile, Alabama. Sternal closure was accomplished with wire sutures in the first 309 patients and with cable-tie reinforcement in the subsequent 300 patients. Baseline characteristics were comparable between groups, except that the cable-tie group exhibited greater preoperative comorbidity. Mean body mass index was comparable between groups (30.2 ± 6.6 kg/m2 wire suture versus 30.5 ± 7.7 cable-tie, p = 0.568). Deep sternal wound infection occurred in 2.6 % (8/309) patients in the wire-suture group, whereas no deep sternal wound infections were observed in the cable tie group (p = 0.008).ConclusionsThe peristernal cable-tie system was a simple and reliable method for sternal closure after open median sternotomy, and was associated with a reduced risk of deep sternal wound infection, even in an obese and comorbid population.

Nitinol clips sternal osteosynthesis after heart/great arteries surgery as a method for prevention of postoperative complications

The problem of sternal osteosynthesis after cardiac surgery is relevant because of a relatively high incidence of postoperative complications associated with inadequate sternal consolidation. The use of nitinol clips is one of the reliable and versatile methods of sternal osteosynthesis. Our research included 208 postoperative patients with different cardiac surgical pathologies. All interventions were carried out with cardiopulmonary bypass using median sternotomy. Patients were divided into 2 groups according to sternal fixation methods: group 1 (105 patients) - wire suture osteosynthesis, group 2 (103 patients) - nitinol clips closure. The short-term postoperative results were analyzed by using the major criteria for comparison. Radiographically confirmed varying degrees of sternal defects in the immediate postoperative period were observed in 15.2% of patients in group 1 and 3.8% of patients in group 2. In group 1 significant sternal defects requiring sternal refixation were observed in 4.8% of patients; in group 2 no such cases were identified. The mean blood loss in the drainages for 24 hours after surgery in group 1 was 351 65 ml; in group 2 - 192 43 ml. The total number of resternotomies for bleeding in group 1 was 6.7% of cases, with half of them being the patients with the source from the sternum in the site of wire sutures, while in group 2 4.9% patients underwent resternotomy, with no bleeding from the sites of clip fixation. Thus, the use of nitinol clips after longitudinal median sternotomy is a more reliable method of sternal osteosynthesis (as compared with the classical method), which enables us to minimize the risk of damage to the retrosternal structures, preserve sternal consolidation and reduce blood loss in the drainages in the early postoperative period.

Biomechanical evaluation of different surgical techniques for treating patellar tendon ruptures

The aim of this study was to biomechanically assess patellar tendon repair techniques with additional cable wire or polydioxanone suture (PDS) cord augmentation in comparison with a suture-anchor repair technique. Patellar tendon repair was performed in 60 specimens using a porcine bone model. Yield load, maximum load, stiffness and elongation of patellar tendon reconstructions with (1) cable wire augmentation, (2) PDS cord augmentation or (3) suture anchor repair were evaluated using a cyclic loading and load-to-failure test setup. In comparison with suture anchor repair, augmentation of the reconstruction with either cable wires or PDS cords provides significantly higher maximum loads (527 and 460N vs. 301N; p < 0.01 and p = 0,012, respectively) under load-to-failure testing and less elongation (8.81mm ± 1.55mm and 10.56mm ± 3.1mm vs. 18.38mm ± 7.51mm; p = 0.037 and p = 0.033, respectively) under cyclic loading conditions. Augmentation of a patellar tendon repair with either a cable wire or a PDS cord provides higher primary stability than suture anchor repair in patellar tendon ruptures. The study supports the use of additional augmentation of a tendon repair in the clinical setting in order to prevent loss of reduction and allow for early post-operative mobilisation.

A combination of the clip-with-line method and the tunnel technique during esophageal endoscopic submucosal dissection: a technical solution?

A 76-year-old woman was referred to our endoscopy unit for endoscopic submucosal dissection (ESD) of a 3-cm-diameter nodule exhibiting high grade dysplasia and complicating a large Barrett's esophagus. A classic tunnel was created beneath the lesion ([Fig. 1]) with a HybridKnife Type T (ERBE Electromedizin, Tübingen, Germany). After incision of the mucosa on both sides of the tumor, the scope was withdrawn. A Resolution Clip (Boston Scientific, Natick, Massachusetts, USA) was inserted into the operative channel of the endoscope and attached to a 250-cm line made of nonabsorbable suture wire (Peters Surgical, Paris, France) bent in a U-shape. The scope was reinserted with the line in parallel, and the clip with the attached line was placed at the proximal side of the tunnel ([Fig. 2] and [Fig. 3]). Constant countertraction, applied by grasping the external part of the linewith a plastic 11 g Kocher forceps (Nessicare dressing kit, LCH Medical Products, Paris, France), facilitated excellent exposure of the remaining submucosal layers ([Fig. 4] and [Fig. 5]) on both sides, greatly aiding dissection after tunneling ([Fig. 6], [Video 1]).

Fabrication of aligned fibrous tubular scaffolds reinforced by suture wire for tracheal regeneration

Fabrication of aligned fibrous tubular scaffolds reinforced by suture wire for tracheal regeneration

Braided tape suture provides superior bone pull-through strength than wire suture in greater tuberosity of the humerus

IntroductionThe purpose of this study is to compare the pull-through strength of transosseous braided tape suture with wire suture in proximal humeri bones (greater tuberosity). MethodsA biomechanical study on eight cadaveric human specimens where two transosseous sutures were randomly applied on each specimen (anterior and posterior). Force/displacement curves were obtained for each specimen and the maximum pull-through load was noted. ResultsThere is a significant difference in maximal pull-through strength favoring braided tape suture over wire suture. ConclusionsTransosseous braided tape suture provides almost twice the bone pull-through strength and is slightly correlated to volumetric bone mineral density.

Transosseous braided-tape and double-row fixations are better than tension band for avulsion-type greater tuberosity fractures

IntroductionThe optimal treatment for avulsion-type greater tuberosity fractures is yet to be determined. Three fixation methods are tested: tension band with #2 wire suture (TB), double-row suture bridge with anchors (DR), and simple transosseous fixation with braided tape (BT). Materials and methodsTwenty-four porcine proximal humeri were randomised into three groups: TB, DR and BT. A standardised greater tuberosity (GT) osteotomy was performed at 90° to the humeral diaphysis axis. A mechanical testing machine was used to simulate supraspinatus contraction. The force required to produce 3mm and 5mm displacement, as well as complete failure was measured with an axial load cell. Also, three cycles of shoulder flexion/extension with 25N of supraspinatus contraction were performed. Maximum GT fragment translation and rotation amplitude during one cycle were measured. ResultsDuring supraspinatus contraction, DR and BT groups (p<0.05) were superior to TB group for both displacements. The BT technique had the strongest maximal load to failure (BT=466N; DR=386N; TB=320N). For the flexion/extension, DR and BT groups had less displacement and rotation than TB group (anterio-posterior displacement: BT=2.0mm, DR=1.9mm, TB=5.8mm; anterio-posterior angular displacement: BT=1.4°, DR=1.0°, TB=4.8°). No significant difference was observed between DR and BT groups, except for the medio-lateral rotation favouring the DR group. ConclusionIn conclusion, BT and DR are good fixation methods to treat displaced avulsion-type greater tuberosity fractures. They have similar mechanical properties, and are stronger and more stable that the TB construct. Potential advantages of the BT over the DR may be a lower cost and easier surgery. Level of evidenceBasic science study (LEVEL II).

Percutaneous endoscopic gastrostomy with Funada-style gastropexy greatly reduces the risk of peristomal infection.

Background and aims: Peristomal wound infections are common complications of percutaneous endoscopic gastrostomy (PEG). The Funada-style gastropexy device has two parallel needles with a wire loop and suture thread, and was developed about 20 years ago in Japan. This kit has allowed us to perform dual gastropexy very easily; PEG with gastropexy has become a very popular technique in Japan. The present study aimed to compare the advantages and disadvantages of PEG with the gastropexy technique with the standard ‘pull' method.Methods: We retrospectively reviewed 182 consecutive, non-randomized patients undergoing PEG in our hospital, and a comparative analysis was made between the gastropexy (87 patients) and non-gastropexy (95 patients) groups.Results: The rates of patients having erythema (11.6% vs. 47.9%; P < 0.001), exudates (2.3% vs. 14.9%; P < 0.01) and infection (0% vs. 6.4%; P = 0.01) in the peristomal area were lower in the gastropexy than in the non-gastropexy group. The rate of minor bleeding from the peristomal area was higher in the gastropexy than in the non-gastropexy group (12.8% vs. 2.1%; P < 0.01), but no patient required a blood transfusion. Mean procedure time was longer in the gastropexy group than in the non-gastropexy group (31 vs. 24 min; P < 0.001). The 30-day mortality rates were 4.7% and 5.3% respectively, and these deaths were not related to the gastrostomy procedure.Conclusion: PEG with gastropexy markedly reduces peristomal inflammation. Although minor bleeding and a longer procedure time were disadvantages, there were no severe complications. The findings suggested that PEG with Funada-style gastropexy was a safe and feasible method for reducing early complications of PEG.

Potential of the use of an antioxidant compound to promote peripheral nerve regeneration after injury

The peripheral nervous system is a vital part of the body because it transfers information to coordinate all actions. Peripheral nerve injuries are detrimental to the proper function of this system and can cause loss of sense and movement. It is of utmost importance to research approaches to the treatment of peripheral nerve damage because such injuries can drastically change a person's life, and these traumatic injuries are a significant cause of physical disabilities that primarily affect the lives of young adults of working age. The aetiologies of traumatic peripheral nerve injury include penetrating injury, crush, traction, ischemia, and less common mechanisms, such as thermal-, electric shock-, radiation-, percussion-, and vibration-induced injuries (Robinson, 2004). Lacerations, for example, by glass, knives, fans, saw blades, auto metal, and long bone fractures, account for approximately 30% of serious nerve injuries. Another common injury mechanism is compression, which may involve mechanical deformation and ischemia. Manipulation of the nerve can generate a severe inflammatory reaction in the nerve, and these reactions have been likened to chemical burns with dense scarring accompanied by considerable pain (Bagheri et al., 2011).

Modified technique for anatomic acromioclavicular joint reconstruction

Introduction: Acromioclavicular (AC) joint reconstruction using a tendon graft with clavicular tunnels and with/without coracoid tunnels is a treatment of choice for injuries more severe than Grade III. We are reporting a modified technique of AC joint reconstruction using tendon graft and endobutton loop in nine patients at mean follow-up of 18 months. Materials and Methods: Nine patients with an average age of 36 years (25-55 years) underwent this procedure between October 2011 and June 2013 at this hospital for Grade III or more AC joint injury. In all the patients, the semitendinosus graft was used to recreate coracoclavicular and AC ligaments with the added fixation with fiberwire tied over an endobutton over the clavicle. Results : At the mean follow-up of 18 months the average American Shoulder and Elbow Surgeons score was 89.06 (Range 69.99-96.66) and constant score was 89.77 (Range 75-97). According to constant score four patients had excellent, four had good, and one had satisfactory post-operative function according to constant score. One patient had minimal (0.5 cm) loss of reduction and one had a superficial infection. Both this complication did not affect the final outcome. Conclusion: This technique is near anatomic with added advantage of protecting the repair with fiber wire suture and also reducing the risk of clavicular fracture with endobuttion placed on the superior surface of clavicle. It also avoids the risk of coracoid fracture.

Locking plate fixation provides superior fixation of humerus split type greater tuberosity fractures than tension bands and double row suture bridges

BackgroundThis paper aims to determine the strongest fixation method for split type greater tuberosity fractures of the proximal humerus by testing and comparing three fixation methods: a tension band with No. 2 wire suture, a double-row suture bridge with suture anchors, and a manually contoured calcaneal locking plate. MethodsEach method was tested on eight porcine humeri. A osteotomy of the greater tuberosity was performed 50° to the humeral shaft and then fixed according to one of three methods. The humeri were then placed in a testing apparatus and tension was applied along the supraspinatus tendon using a thermoelectric cooling clamp. The load required to produce 3mm and 5mm of displacement, as well as complete failure, was recorded using an axial load cell. FindingsThe average load required to produce 3mm and 5mm of displacement was 658N and 1112N for the locking plate, 199N and 247N for the double row, and 75N and 105N for the tension band. The difference between the three groups was significant (P<0.01). The average load to failure of the locking plate (810N) was significantly stronger than double row (456N) and tension band (279N) (P<0.05). The stiffness of the locking plate (404N/mm) was significantly greater than double row (71N/mm) and tension band (33N/mm) (P<0.01). InterpretationLocking plate fixation provides the strongest and stiffest biomechanical fixation for split type greater tuberosity fractures.

Patellar ligament rupture in the dog: repair methods and patient outcomes in 43 cases

The medical records of dogs receiving surgery for unilateral patellar ligament rupture between 1999 and 2012 at 12 multidisciplinary referral centres were reviewed. Forty-three cases were identified; 26 were traumatic...

Is steel wire closure of sternotomy better than polyester suture closure?

Median sternotomy is the preferred approach for open heart surgeries. The sternotomy incision is predominantly closed with either steel wire or polyester suture. The type of material used is primarily based on the surgeon's choice, and both materials achieve a good result. No prospective clinical study has been undertaken to evaluate differences in the incidence of wound infection and the degree of pain associated with both techniques. Our randomized controlled double-blind study included 200 adults undergoing single-valve replacement. The technique of surgery, apart from the material used for sternal closure, was the same in both groups. Postoperatively, patients were analyzed for wound infection and wound pain based on the ASEPSIS score and Numeric Pain Rating Score, respectively. The polyester suture group had a significantly higher mean ASEPSIS score, indicating a higher incidence of wound infection, and more late wound complications. The polyester suture group also had a significantly higher mean pain score. The steel wire group had significantly higher mediastinal drain output in the first 48 h after surgery. The use of polyester suture for sternal closure in adult patients results in increased wound infection, wound pain, and late wound complications, but lower mediastinal drain output.

Use of Wire Suture for the Management of Fractures in Calves

Various reduction and fixation techniques have been introduced for the treatment of different types of fractures. Therefore, this study was planned to evaluate two methods of fracture treatments in calves having complete fractures due to automobile accident. In addition, a retrospective study was done to observe the occurrence of fractures in calves. Calves presented with the history of automobile accident and clinical signs suggestive of fractures were subjected to detailed physical, orthopaedic and radiographic examination to confirm fractures. For treatment 20 fractures case were included, where 8 cases were treated with closed reduction with external fixation using bamboo splints and plaster of paris. Whereas, open reduction with internal fixation using stainless steel orthopaedic wires and modified thomas splints were used to treat 12 fractures in long bones of calves aged 8 days to 5 months.All calves treated with open reduction and internal fixation showed good weight bearing in the immediate post-operative period. The fixators applied to different bones were well-tolerated, and the animals could lie down, stand and walk freely with the fixator without any problems after 60 days. Post operative radiography confirmed that bone fragments were well maintained until healing occurred and radiograph showed negligible callus and a radioluscent line (less remarkeble radiolucent area) at 60 days. There was no periosteal reaction around the wire suture at the fracture site. So, wire suture provided good alignment and stabilization of fracture fragments, rapid union of fracture resulting in early functional usage of limb. In contrast, two calves cured among 8 calves treated with closed reduction and external fixation, this study resulted that prognosis was not favorable in calves The results of this study exemplify the successful use of wire sutures in the treatment of complete fractures of the long bones in calves.