Fascial closure of median laparotomies with a synthetic, resorbable suture material (polyglycolic acid)

In a prospective randomized study polyglycolic acid sutures (PGA) and polyester sutures for closure of median abdominal fascial incisions are compared. Occurrence of infection, incisional hernia, wound dehiscence and suture fistulas is evaluated. With regard to these complications no significant differences could be detected. PGA shows its advantage in less tissue reaction (avoiding fistulae).     

New synthetic resorbable suture material in animal experiments and in clinical testing

This new synthetic absorbable suture material has been tested in 90 animal experiments (Wistar rats) with regard to tissue reaction, absorption and breaking strength. The data obtained were compared with Polyglactin 910 (Vicryl), Catgut plain and polyester fibres. PDS-sutures produced only a minimal tissue reaction and were completely resorbed after 168 days. They retained 50% of its breaking strength until the 40th day after implantation.     

Running synthetic absorbable suture in abdominal wound closure

One hundred thirty-four consecutive, unselected, primary, linear abdominal surgical incisions were closed with running polyglactin suture. The only wound complication was a single infection. No wound dehiscence, incisional hernia, late wound pain or suture sinus occurred.     

Can resorbable suture material be used in surgery of the supra-aortic branches?

The experience with the use of monofilament absorbable suture (5/0 USP) in supraaortal vessels shows the same results related to neurological complication. The postoperative technical complications (bleeding, occlusion, restenosis) could be significantly reduced (p less than or equal to 0.05). Suture ruptures of aneurysms were not observed after resorbable vascular suture. The resorbable monofilament suture material is useful in high pressure vessel system.     

Sternal closure using semirigid fixation with thermoreactive clips

Sternomy represents the standard approach to the heart and great vessels in most cardiothoracic procedures. Closure of this incision is simple; however, healing complications such as dehiscence, osteomyelitis, mediastinitis, and superficial wound infection or fistula may occur. We describe an alternative technique for sternal closure using semirigid fixation with thermoreactive clips.     

Wavy line closure for revision of abdominal scars with suture marks in children

Although various methods are available to treat scars, it is difficult to manage those with suture marks that look like fish-bones, mainly because a large amount of tissue between the suture marks must be discarded with the scar. We report the wavy line closure for revision of abdominal scars with suture marks in three children who were operated on for congenital abdominal diseases. The entire scar, including all the suture marks, was excised using an incision consisting of a pair of smoothly waved lines. This incision makes it possible to reduce the tension on the wound by preserving the normal skin between the suture marks, which is followed by fine scars. The resulting wave-shaped scar is less noticeable and more resistant to postoperative contracture than a straight scar.     

New suture material for intestinal sutures in children]

In the experiments on puppies the authors studied the possibility for the use of ophthalmologic tendinous threads as a suture material for interintestinal anastomoses after intestinal resection. Ophthalmologic tendinous thread was used in a neonate with atresia of the small bowel. Six months' follow-up revealed a good result.     

Sternal closure with titanium plate fixation--a paradigm shift in preventing mediastinitis

Sternal instability predisposes to post-operative mediastinitis. Biomechanical studies have shown the superiority of rigid plate fixation over wire circlage in sternal healing. We studied rigid plate fixation for sternotomies in high-risk patients. High-risk patients were identified as those having three or more historically established risk factors for post-operative mediastinitis, such as COPD, re-operative surgery, renal failure, diabetes, steroid use, obesity, existing infection, and immunosuppression. Three hundred and twenty high-risk patients had prophylactic rigid plate fixation (Group S) between July 2000 and Jan 2005. The control group (Group C) comprised 215 patients with similar risk profiles that were not plated during 2000 and 2001. Average age, male-female ratio, risk factors and type of procedures were similar in both groups. Follow up ranged from 4 to 200 weeks. There were 12 peri-operative deaths (3.75%) in group S and 8.6% (18 patients) in group C. There were no instances of deep mediastinitis in group S. Group C had mediastinitis in 28 (13%, P<0.05), requiring high dose antibiotics and plastic surgical intervention. Sternal fixation with titanium plates is an effective way of ensuring sternal immobility thereby reducing the substrate for bony infections. Application of this technique in high-risk patients prevents mediastinitis.     

Sternal segment dislocation in children

Three cases of sternal segment dislocation in children are described. The primary mechanisms were direct blow in a 4-year-old boy, indirect forces in a 3-year-old boy, and osteomyelitis in a 10-year-old boy. The two former cases were dislocated at the junction of the manubrium with the sternal body, and the latter case was at the junction of the first and second sternal segments. The dislocated segments were gradually rotated for approximately 2 weeks and were finally stabilized after rotation. While in the dislocated state, the patients were observed conservatively, although all the dislocated segments were remodeled. Surgical treatment of sternal segment dislocation is not inevitable.     

Sternal closure with reabsorbable pin and cord in pediatric-less invasive cardiac surgery

In pediatric less invasive cardiac surgery, we recently closed a patient's sternum using reabsorbable radiolucent poly-(L-lactide) acid sternal pins together with multifilament polydioxanone cord after a lower partial median sternotomy. This combination completely prevents postoperative sternal deformity, and leaves no radiopaque material identifiable radiographically, which is a significant cosmetic benefit.     

Conventional running suture and continuous double loop closure: an experimental study of wound strength.

OBJECTIVE: To study the strength of laparotomy wounds closed by a continuous double loop technique or a conventional running suture, taking into account the ratio of suture length: wound length. DESIGN: Experimental study. ANIMALS: 60 Sprague-Dawley rats. INTERVENTIONS: Midline laparotomy incisions were closed with either a conventional running suture or a continuous double loop. Wounds were allocated to closure with a suture length: wound length ratio of 3, 4 and 7. MAIN OUTCOME MEASURES: Bursting pressure, bursting volume and the way the suture cut through the tissues. RESULTS: With a suture length: wound length ratio of 3 or 4 bursting pressure and bursting volume were lower with a continuous double loop closure. A conventional running suture and a continuous double loop produced similar bursting pressure and bursting volume only if closure was with a ratio of 7. CONCLUSIONS: Wound bursting strength is higher with a conventional running suture than with a continuous double loop closure when the effect of the suture length: wound length ratio is accounted for.     

Running closure of clean and contaminated abdominal wounds using a synthetic monofilament absorbable looped suture

(Received for publication on June 24, 1998; accepted on Jan. 7, 1999)